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Medicine Finals > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Describe a heart murmur.

A

Loudness (1-6).
Presence of a thrill ensures murmur is at least a grade 4 or above.
Timing (systolic, diastolic, continuous).
Duration (ejection, mid or pansystolic).
Site - where loudest.
Radiation.

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2
Q

Features of an innocent murmur.

A 
Asymptomatic.
No thrills or heaves.
Soft systolic murmur.
varies with position.
Localised to one area.
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3
Q

Cyanotic congenital heart lesions.

A

Tetralogy of Fallot.
Transposition of the great arteries.
Tricuspid atresia.
Pulmonary atresia.

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4
Q

5 causes of cyanosis.

A
  1. Respiratory disease.
  2. Cardiac.
  3. During a seizure.
  4. Stress: infection, hypoglycaemia, adrenal crises.
  5. CNS depression: drugs, trauma, asphyxia.
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5
Q

Common causes of cardiac failure.

A
  1. Cardiac:
    - neonatal: PDA, hypoplastic left heart syndrome, coarctation of the aorta, cardiomyopathy, critical aortic stenosis.
    - infant: VSD, AVSD, cardiomyopathy.
    - child: cardiomyopathy, failing complex congenital heart disease.
  2. Stress: fever, hypoxia, infection, acidosis.
  3. Anaemia.
  4. Fluid overload.
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6
Q

Types of cardiac abnormalities associated with Down’s Syndrome.

A

AVSD, VSD, ASD, Tetralogy of Fallot.

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7
Q

Types of cardiac abnormalities associated with Turner’s syndrome.

A

Aortic stenosis, coarctation of the aorta, bicuspid aortic valve.

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8
Q

Atrial Septal Defect.

A

Secundum defect, in the centre of the atrial septum.
Primum defect (partial AVSD_ at the crux of the heart.
Usually asymptomatic in childhood.
Incidental murmur.
Later in life may present with breathlessness and arrhythmias.
Treatment - transcatheter device closure (secundum only) or surgical repair (secundum and primum).
Good long term outlook.

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9
Q

Ventricular Septal Defect.

A

2/1000 births.
Membranous or muscular part of the septum - small, medium or large.
Small - usually asymptomatic and ~80% close spontaneously.
Large/haemodynamically significant VSDs repaired in 1st 6 months of life.
Large - effects are left ventricular overload and increased pulmonary blood flow causing cardiac failure.
Heart failure - medical management with diuretics, ACE inhibitors, maximising nutrition (often with NG feeds).
Earlier surgery if failure to thrive.

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10
Q

Patent Ductus Arteriosus.

A

Associated with prematurity and maternal rubella.
Continuous murmur under left clavicle.
Complications include heart failure and failure to thrive.
Treatment in preterm infants - NSAIDs and surgical ligation if medical management fails.
Older children - occlusion by cardiac catheterisation.

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11
Q

Coarctation of the Aorta.

A

Neonates - collapse, cardiac failure, weak/absent femoral pulses.
Older children/adults - hypertensive, absent femoral pulses or radio-femoral delay.
CXR - cardiomegaly, rib notching.
Treatment - surgery in infants, balloon dilatation/stenting more common in adults.

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12
Q

Transposition of the Great Arteries.

A

Most common cyanotic condition.
2 separate circulations - mixing occurs at atrial level and arterial duct.
Effortless tachypnoea and acidotic when duct closes.
May not have a murmur.
CXR - ‘egg on side’.
Prostaglandin to open arterial duct.
May need urgent balloon arterial septostomy (BAS) to increase mixing at atrial level.
Definitive surgery - arterial switch (good long-term outcome).

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13
Q

What conditions make up Tetralogy of Fallot?

A
  1. Ventricular septal defect.
  2. Right ventricular outflow obstruction (RVOTO).
  3. Aortic override of VSD.
  4. Right ventricular hypertrophy.
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14
Q

Tetralogy of Fallot.

A

Can be pink if minimal RVOT obstruction (progressively cyanosed due to fixed obstruction).
Hypercyanotic spells due to dynamic RVOT obstruction.
Polycythaemia (haematocrit of 55-80%) is characteristic.
CXR - boot shaped heart with an upturned apex.
Associated with Di George Syndrome (22q 11 microdeletion),

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15
Q

Define cerebral palsy.

A

A dynamic/changing disorder of posture and movement caused by a non-progressive lesion to the developing brain.

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16
Q

Comorbidities of cerebral palsy.

A 
Epilepsy.
Learning disability.
Behavioural problems.
Feeding problems/GORD.
Osteoporosis.
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17
Q

Define myelomeningocele.

A

Outpouching of the spinal cord and its coverings through a defect in posterior elements of vertebral arches.

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18
Q

Define an epileptic seizure.

A

A transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.

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19
Q

Definition of epilepsy.

A
  1. At least 2 unprovoked seizures occurring more than 24 hours apart.
  2. 1 unprovoked seizure and a probability of further seizures similar to the general recurrence risk after 2 unprovoked seizures (75%).
  3. At least 2 seizures in a setting of reflex epilepsy. +
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20
Q

Causes of amblyopia.

A

Amblyopia = poor vision in a structurally normal eye.

  1. Reduced view through eye (e.g. ptosis, cataract).
  2. Unequal focus (e.g. anisometropia).
  3. Misalignment of eyes (e.g. squint).
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21
Q

Causes of leukocoria.

A

Cataract.
Retinoblastoma.
Many others - retinal detachment, toxoplasmosis, uveitis etc.

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22
Q

Describe Gower’s sign.

A

When a child uses their hands to splint their legs to help them rise from sitting.

  • function of weakness.
  • classically in DMD.
  • but may occur in any condition with muscle weakness.
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23
Q

Top 3 bacterial causes of septic arthritis.

A

Staph aureus.
Strep pneumoniae.
Haemophilus influenzae.

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24
Q

Features of septic arthritis.

A 
Systemically unwell (fever, headache, may have another focus of infection).
The joint is - very painful, hot, red, swollen, held immobile (pseudoparalysis).
25
Q

What diagnostic criteria make septic arthritis very likely?

A

Pyrexia >38.5 within the last week.
Inability to weight bear through the limb.
Raised ESR >40mm/h.
WBC > 12.

26
Q

Management of septic arthritis.

A 
A-E assessment and resuscitation if unwell.
Urgent aspiration (under GA) with immediate microscopy and gram stain, culture and sensitivity.
Blood cultures (minimum of 2). 
High dose IV abx.
27
Q

What is rheumatic fever caused by?

A

Streptococcal infection.

28
Q

Features of rheumatic fever.

A

Carditis.
Arthritis.
Neurological features (Sydenham’s chorea).
Rash (erythema marginatum).

29
Q

Define JIA.

A

A group of conditions all including childhood onset of chronic inflammatory arthritis of unknown aetiology.

30
Q

What conditions are associated with JIA?

A

SLE.
Dermatomyositis.
Scleroderma (particularly localised).
Vasculitis.

31
Q

What 2 vasculitis conditions are more common in children than adults?

A

Henoch Schonlein Purpura.

Kawasaki disease.

32
Q

Which malignancies in childhood cause an MSK presentation?

A

Leukaemia (AML, ALL).
Neuroblastoma.
Primary bone tumours (e.g. Ewing’s sarcoma, osteosarcoma).

33
Q

Top 5 causes of thrombocytopenia/platelet function abnormalities.

A
  1. Malignancy (leukaemia/lymphoma).
  2. Bone marrow failure.
  3. Inherited platelet conditions.
  4. Microangiopathic haemolytic anaemia.
  5. ITP.
34
Q

Top 5 features suggestive of malignancy in lymphadenopathy.

A
  1. Site - supraclavicular, epitrochlear nodes.
  2. Associated systemic symptoms.
  3. Hepatosplenomegaly.
  4. Other palpable masses.
  5. Signs of bone marrow infiltration (i.e. anaemia, bruising, petechiae).
35
Q

Top 5 malignant causes of lymphadenopathy.

A
  1. Acute leukaemia (ALL, AML).
  2. Lymphoma.
  3. Hodgkin’s lymphoma.
  4. Neuroblastoma.
  5. Rhabdomyosarcoma.
36
Q

Top 5 infectious causes of lymphadenopathy.

A
  1. Bacterial lymphadenitis (e.g. staph, strep).
  2. Viral infection (viral URTI’s, EBV, CMV, adeno, VZV, HIV, roseola, rubella).
  3. Cat scratch test (Bartonella henselae).
  4. TB.
  5. Atypical mycobacterium.
37
Q

Top 5 autoimmune causes of lymphadenopathy.

A
  1. Kawasaki’s disease.
  2. JIA.
  3. SLE.
  4. Sarcoidosis.
  5. Drug reactions.
38
Q

What vaccine should those with a confirmed anaphylactic reaction to egg not have?

A

Yellow fever vaccine.

39
Q

Live vaccines are contraindicated in which groups of people?

A

Immunosuppressed/immunocompromised:

  1. Severe primary immunodeficiency.
  2. Malignant disease with chemo/radiotherapy in the last 6 months?
  3. Solid organ transplant, on immunosuppressive medicine.
  4. Bone marrow transplant, until at least 12 months after finishing all immunosuppressive treatment, or later if developed graft-vs-host disease.
  5. High dose systemic steroids.
  6. On immunosuppressive drugs.
  7. HIV positive individuals shouldn’t receive BCG, but should be given MMR unless severe immunosuppression. Discuss yellow fever with specialists.
40
Q

What are the leading causes of bacterial meningitis?

A 
Neisseria meningitidis. 
Streptococcus pneumoniae (group B).
41
Q

Clinical features of bacterial meningitis in children?

A 
Fever
Headache
Nausea
Vomiting
Neck stiffness
Photophobia
Lethargy
Decreased conscious level
Seizures
Positive Kerning and Brudzinski tests
42
Q

Clinical features of bacterial meningitis in infants?

A 
Unexplained fever.
Lethargy.
High-pitched or irritable cry that cannot be soothed by parents. 
Poor feeding
Apnoeic or cyanotic attacks
Posturing
Seizures
Bulging fontanelle
43
Q

Signs of raised ICP.

A 
GCS <9 or a drop of 3 or more.
Relative bradycardia and hypertension.
Focal neurological signs.
Abnormal posture/posturing.
Unequal, dilated or poorly responsive pupils.
Papilloedema. 
Abnormal doll's eye movements.
44
Q

Presentation of meningococcal bacteraemia?

A

Fever
Petechial/purpuric rash
Relatively well child.
Rapidly deteriorating clinical condition, preceding to severe sepsis and septic shock.

45
Q

Features of septic shock?

A 
Difficulty breathing
Tachycardia
Hypotension
Cool extremities
Leg pain
Cap refill time >2 secs
Decreased conscious level
Moribund
46
Q

Describe tumour lysis syndrome?

A

Caused by breakdown of malignant cells.
Hyperuricaemia, hyperkalaemia, hypophosphataemia and hypocalcaemia
can result in AKI, seizures, cardiac arrhythmias and death (if unrecognised and untreated)
Most likely to occur during induction chemotherapy

47
Q

Early effects of chemo?

A 
Marrow suppression
Temporary hair loss
Nausea and vomiting
Hearing loss
Renal impairment
48
Q

Late effects of chemo?

A

Cardiac toxicity
Infertility
Risk of secondary malignancies

49
Q

Top 5 causes of a vomiting baby?

A
  1. Overfeeding
  2. Possetting
  3. GORD
  4. Pyloric stenosis
  5. Obstruction
50
Q

Top 5 causes of bilious vomiting in a baby?

A
  1. Malrotation
  2. NEC
  3. Atresia
  4. Hirschsprung’s disease
  5. Meconium disease
51
Q

Define NEC

A

An acute inflammatory disease occurring in the intestines of premature infants, and can lead to necrosis of the bowel.

52
Q

Top 5 features of NEC?

A
  1. Abdominal distension
  2. Blood in stool
  3. Feeding intolerance
  4. Vomiting (often bilious)
  5. Pyrexia
53
Q

Top 5 differential diagnosis of abdominal pain in children?

A
  1. Acute appendicitis
  2. Mesenteric appendicitis
  3. Constipation
  4. Gastroenteritis
  5. UTI
54
Q

Define intussusception.

A

The full thickness invagination of the proximal bowel to distal intestine.

55
Q

What conditions predispose children to intussusception?

A

HSP
Lymphoma
Cystic fibrosis

56
Q

Define hernia.

A

A protrusion of a viscus or part of a viscus into a cavity where it should not lie.

57
Q

Top 5 differential diagnosis of testicular pain in boys.

A
  1. Testicular torsion
  2. Torsion of the appendage
  3. Epidydimo-orchitis
  4. Hydrocoele
  5. Idiopathic scrotal oedema
58
Q

Define delayed puberty.

A

The absence of pubertal development by age 14 un girls and aged 15 in boys.

59
Q

Top 5 risk factors for substance misuse?

A 
Conduct disorder
Poor parenting
Early experience of substance abuse
Peer group pressure
Poor social environment

Medicine Finals (8 decks)

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