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Year 5 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Developmental milestones for a 6 week old

A
  • Holds head briefly in ventral suspension
  • Some head lag
  • Primitive reflexes
  • Symmetrical limb movement
  • Holds fist closed
  • Turns to light
  • Fixes and follows through 90o, especially faces
  • Cries
  • Responds to mother’s voice
  • Startles to noises
  • Smiles
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2
Q

Developmental milestones for a 3-4 month old baby

A
  • No head lag
  • Raises chest (resting on elbows) when prone
  • More vigorous limb movement
  • Holds objects placed in hand
  • Reaches for objects
  • Fixes and follows through 180o
  • Cooing
  • Quietens to mother’s noises
  • Laughs
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3
Q

Developmental milestones for a 5-6 month old baby

A
  • Sits supported/unsupported with a curved back
  • Lifts chests on extended arms when prone
  • Rolls front to back and back to front
  • Brings objects to midline
  • Transfers objects between hands
  • Consciously releases objects
  • Starts mouthing objects
  • Early babbling
  • Happy screams
  • No stranger anxiety
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4
Q

Developmental milestones for a 8-9 month old baby

A
  • Sits unsupported with a straight back
  • May crawl/bum shuffle
  • Early pincer grip
  • Looks for fallen objects
  • Developed babbling - repetitive consonants
  • Says ‘mama’ and ‘dada’
  • Stanger anxiety
  • Plays peekaboo
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5
Q

Developmental milestones for a 10 month old baby

A
  • Pulls to stand
  • Cruising
  • Developed pincer grip
  • Understands no
  • Understands concept of bye bye
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6
Q

Developmental milestones for a 12 month old baby

A
  • Early walking - unsteady/broad based gait
  • Bangs objects together
  • Casts objects
  • Object permanence - looks for hidden toys
  • Points at things
  • Few individual words
  • Imitates sounds and speaks jargon with conversational intonation
  • Understands name and simple objects
  • Finger feeds
  • Holds spoon and attempts use
  • Waves bye bye/claps
  • Points to convey excitement or desire
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7
Q

Developmental milestones for a 15 month old baby

A
  • Confident walking
  • Builds towers of 2-3 bricks
  • Turns thick cardboard pages
  • Obeys simple commands
  • Can identify simple objects
  • Uses cup and spoon
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8
Q

Developmental milestones for an 18 month old baby

A
  • Squats to pick up objects
  • Runs
  • Builds towers of 4 blocks
  • To and fro scribble
  • Points to pictures in books
  • Turns pages in books a few at a time
  • 10-20 words including common objects
  • Common two word phrases
  • Points to body parts
  • Removes socks/shoes
  • Imitative play/domestic mimicry
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9
Q

Developmental milestones for a 2 year old baby

A
  • Jumping
  • Kicks ball
  • Climbs stairs two feet per stair/holding on
  • Circular scribble
  • Draws straight lines
  • Build towers of 6 blocks
  • 50+ words
  • Links words together to make 2-3 word sentences
  • Understands functions of objects and verbs
  • Obeys two-part commands
  • Feeds with fork and spoon
  • Starts toilet training
  • Temper tantrums
  • Plays alongside other children
  • Symbolic play
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10
Q

Developmental milestones for a 3 year old child

A
  • Rides a tricycle
  • Climbs stairs with one foot per step and goes down stairs with two feet per step
  • Copies a circle
  • Builds a tower of 9 blocks
  • Copies a bridge and a stair with 6 blocks
  • Knows several nursery rhymes
  • Complex 4-5 word sentences
  • State first and last name
  • ‘What’ and ‘who’ questions
  • Understands predisposition
  • Understands sizes
  • Washes hands
  • Plays with other children
  • Understands concept of sharing
  • Pretend play
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11
Q

Developmental milestones for a 4 year old

A
  • Hops
  • Walks up and down stairs like an adult
  • Copies a cross
  • Copies stairs with 10 blocks
  • Can tell descriptive account of events
  • Uses ‘why’, ‘when’ and ‘how’
  • Understands negatives and three part commands
  • Undresses but can not dress independently
  • Understands turn taking
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12
Q

Developmental milestones for a 5 year old

A
  • Skips
  • Catches ball
  • Copies a triangle/square
  • Tells a complex story using all tenses
  • Dresses independently, including zips and buttons
  • Can eat with a knife and fork
  • Chooses and names best friends
  • Imaginative play, role playing or making up stories
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13
Q

Developmental indications for referral at 6-8 weeks

A
  • Asymmetrical Moro reflex
  • Unable to fix and follow
  • Not smiling
  • Excessive head lag
  • No startle to sound
  • Absent red reflex
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14
Q

Developmental indications for referral at 12 weeks

A
  • Persistent squint
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15
Q

Developmental indications for referral at 8 months

A
  • Persistent primitive reflexes

- Not vocalising

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16
Q

Developmental indications for referral at 1 year

A
  • Hand preference

- Not responding to their own name

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17
Q

Developmental indications for referral at 18 months

A
  • Not walking
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18
Q

Developmental indications for referral at 2 years

A
  • No/few words
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19
Q

Developmental indications for referral at 3 years

A
  • Not speaking in sentences
  • Not interacting with other children
  • Not following simple commands
  • Unable to use the toilet
  • Unable to use a spoon
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20
Q

Routine assessment of a newborn

A
  • Top to toe examination
  • Red reflex
  • Feeding
  • Bladder and bowels opened
  • Weight
  • Head circumference
  • DDH screen
  • Heart sounds
  • Newborn hearing screen
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21
Q

Routine assessment at 7-14 days old

A
  • Reassessed to ensure adequate feeding
  • Any parental anxieties or maternal mental health concerns
  • Guthrie blood spot test
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22
Q

Routine assessment at 6 weeks old

A
  • Repeat newborn examination
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23
Q

Routine assessment at 8-12 months

A
  • Full developmental check

- Growth and feeding

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24
Q

Routine assessment at 2-2.5 years

A
  • Full developmental check

- Discussion of any social developmental concerns

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25
Q

Define global developmental delay

A

Developmental delay in 2 or more areas of development

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26
Q

Causes of developmental delay

A
  • Congenital neurological defects
  • Acquired neurological defects
  • Congenital infection
  • Acquired infection
  • NM disorders
  • Endocrine abnormalities
  • Genetic syndromes
  • PDD
  • Nutritional deficiencies
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27
Q

Investigations to consider in a child with developmental delay

A
  • FBC + haematinic: iron deficiency anaemia, B12, folate deficiency
  • U&Es: renal function, hyponatremia
  • Creatinine kinase: DMD
  • TFTs: hypothyroidism
  • LFTs: underlying metabolic disorder
  • Bone profile and vitamin D: vitamin D deficiency
  • Hearing test
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28
Q

Reassuring signs in a baby with a heart murmur

A
  • Pink with normal O2 sats
  • No respiratory distress
  • Quiet, intermittent, positional murmur
  • Good feeding
  • Normal BPs in each limb
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29
Q

Components of the APGAR score

A 
Appearance
Pulse
Grimace/reflex irritability
Activity/muscle tone
Respiratory effort
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30
Q

Conditions which are screened for in the Guthrie test

A
  • Neonatal hypothyroidism
  • CF
  • Sickle cell disease
  • PKU
  • Medium chain AcylCoA dehydrogenase deficiency
  • Homocystinuria
  • Maple syrup urine disease
  • Isolvaeric academia
  • Glutaric aciduria type 1
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31
Q

Risk factors for neonatal hypoglycaemia

A
  • Maternal diabetes
  • Maternal preeclampsia
  • Maternal beta blocker use
  • IUGR
  • SGA/LGA
  • Prematurity
  • Macrosomia
  • Foetal hypothermia
  • Foetal sepsis
  • Foetal hyperinsuliaemia
  • Foetal polycythaemia
  • Perinatal stress
  • HIE
  • BW syndrome
  • Nesidioblastosis
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32
Q

Symptoms of neonatal hypoglycaemia

A
  • Lethargy
  • Poor feeding/refusal to feed
  • Jitteriness
  • Seizures
  • Apnoea
  • Hypothermia
  • Irritability
  • Pallor
  • Weak/high pitched cry
  • Hypotonia
  • Coma
  • Rapid and irregular respirations
  • Hunger
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33
Q

Investigations for neonatal hypoglycaemia

A
  • Blood glucose
  • True blood glucose level
  • C-peptide
  • Lactate
  • Metabolic screen
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34
Q

Management of neonatal hypoglycaemia

A
  • Monitor blood sugars regularly in at risk neonates
  • Good feeding
  • Temperature maintenance
  • IV dextrose infusion if required
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35
Q

Main causative organisms in early onset neonatal sepsis

A
  • GBS

- E. Coli

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36
Q

Risk factors for early onset neonatal sepsis

A
  • Group B strep in a previous pregnancy
  • Maternal GBP, bacteriuria or infection in current pregnancy
  • Prolonged rupture of membranes
  • Preterm birth following spontaneous preterm labour
  • Foetal distress without adequate explanation
  • Intrapartum maternal fever
  • Suspected/confirmed chorioamnionitis
  • Suspected/confirmed maternal sepsis during labour or within 24 hours of birth
  • Suspected or confirmed infection in a baby in a multiple pregnancy
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37
Q

Signs/symptoms of neonatal sepsis

A
  • Temperature instability
  • Vomiting
  • Respiratory distress, apnoea, tachypnoea, increased respiratory support requirement
  • Brady/tachycardia
  • Pallor, cyanosis, mottling
  • Hypotension
  • Encephalopathy
  • Altered tone
  • Unexplained bruising, petechiae or excessive bleeding
  • Hypo/hyperglycaemia without reason
  • Lethargy/drowsiness
  • Local signs of infection
  • Seizures
  • Jaundice
  • Poor urine output
  • Poor tolerance of handling
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38
Q

Investigations to consider in neonatal sepsis

A
  • Blood gas
  • FBC
  • Inflammatory markers
  • Blood culture
  • Lumbar puncture
  • Urine culture
  • CXR
  • AXR
  • Nasopharyngeal aspirate
  • Stool culture
  • Skin swabs
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39
Q

Management of early onset neonatal sepsis

A

IV Ben Pen + Gent within 1 hour, for at least 36-48 hours

7-10 days for positive blood culture, 3 weeks for positive CSF culture

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40
Q

Causative organisms of late-onset neonatal sepsis

A
  • GBS
  • Staphylococcus
  • Colioforms
  • Pseudomonas
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41
Q

Risk factors for late onset sepsis

A
  • Prolonged hospitalisation
  • Presence of foreign bodies
  • Congenital malformations
  • Parenteral nutrition
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42
Q

Management of late-onset neonatal sepsis

A

IV Cefotaxime + Gent within 1 hour

7-10 days for positive blood culture, 3 weeks for positive CSF culture

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43
Q

Causes of jaundice within 24 hours of birth

A
  • Rhesus incompatibility
  • ABO incompatibility
  • G6PD deficiency
  • Hereditary spherocytosis
  • Infection
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44
Q

Causes of jaundice between 48 hours and 2 weeks post birth

A
  • Breast-feeding jaundice
  • Physiological jaundice
  • Polycythaemia
  • Resolving cephalohaematoma
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45
Q

Causes of prolonged jaundice after birth (2 weeks)

A
  • Biliary atresia
  • Hypothyroidism
  • UTI
  • Neonatal hepatitis
  • Physiological/breast-feeding
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46
Q

Investigations to consider in a baby with jaundice

A
  • Bilirubin level - total + conjugated vs unconjugated
  • FBC and blood film
  • Coomb’s test
  • CRP
  • Blood culture
  • TFTs
  • LFTs
  • Urinalysis
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47
Q

Management options for neonatal jaundice

A
  • UV phototherapy
  • Exchange transfusion
  • Ig therapy
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48
Q

Main complication of unconjugated bilirubinaemia

A

Kernicterus

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49
Q

Causes of HIE

A
  • Antepartum haemorrhage
  • Cord prolapse
  • Cord obstruction
  • Shoulder distocia
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50
Q

Clinical features of HIE

A
  • Floppy baby
  • Little/no respiratory effort
  • Irritability
  • Hypertonia
  • Seizures
  • Multi-organ failure
  • Long-term neurodisability
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51
Q

Risk factors for intraventricular haemorrhage

A
  • LBW
  • Preterm birth
  • Severe RDS
  • Perinatal asphyxia
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52
Q

Diagnostic investigation for intraventricular haemorrhage

A

Cranial US

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53
Q

Causes of neonatal seizures

A
  • Infection
  • Hypoglycaemia
  • Intraventricular haemorrhage
  • Neonatal cerebrovascular events
  • Cerebral malformation
  • HIE
  • Withdrawal
  • Electrolyte imbalance
  • Head injury
  • NAI
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54
Q

Investigations in neonates with seizures

A
  • Cranial US

- Cerebral Function Analysing Monitor

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55
Q

Causes of congenital heart disease

A
  • Chromosomal disease
  • Intrauterine infection
  • Maternal disease
  • Drugs in pregnancy
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56
Q

4 abnormalities in Tetralogy of Fallot

A
  • Pulmonary stenosis
  • Overriding aorta
  • VSD
  • Right venticurlar hypertrophy
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57
Q

Name the congenital heart disease

  • Systolic murmur in the upper left sternal edge
  • Hyper-cyanotic spells
  • Heart failure or cardiogenic shock
  • Boot shaped heart on CXR
A

TOF

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58
Q

Management of an acutely unwell neonate with TOF

A
  • Prostaglandin infusion

- Urgent referral for cardiac surgery

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59
Q

Management of hypercyanotic spells in TOF

A
  • ‘Knees to chest’ position
  • High flow O2
  • IV morphine and beta blockers
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60
Q

Name the congenital heart disease

  • Most common cyanotic heart disease seen in neonates
  • Cyanosis
  • Circulatory compromise
  • ‘egg on side’ CXR
  • Normal ECG
A

Transposition of the great arteries

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61
Q

Management of transposition of the great arteries

A
  • PG infusion
  • Balloon atrial septostomy
  • Corrective surgery
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62
Q

Name the congenital heart disease

  • Mild/moderate cyanosis
  • Progresses to pulmonary congestion and heart failure
A

Truncus arteriosus

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63
Q

Name the congenital heart disease
- Cyanosis

  • ‘Snowman in a snowstorm’ CXR
A

Total anomalous pulmonary drainage

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64
Q

Management of TAPD

A
  • PG infusion

- Surgical correction

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65
Q

Name the congenital heart disease

  • Cyanosis soon after birth
  • Systolic murmur at lower left sternal edge OR continuous murmur below left clavicle
A

Tricuspid atresia

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66
Q

Management of tricuspid atresia

A

Surgical correction and Fontan circulation

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67
Q

Name the congenital heart disease

  • Down syndrome
  • Heart failure
  • cyanosis
  • ejection systolic murmur at ULSE + pansystolic murmur at apex
  • Loud, fixed splitting of S2
A

AVSD

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68
Q

Name the congenital heart disease

  • Down syndrome or foetal alcohol syndrome
  • Heart failure
  • Systolic murmur at LLSE
  • Pulmonary plethora on CXR
A

VSD

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69
Q

Name the congenital heart disease

  • Down syndrome
  • Heart failure
  • Soft systolic murmur in UPSE
  • Fixed splitting of S2
A

ASD

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70
Q

Name the congenital heart disease

  • Prematurity
  • Continuous machinery murmur heard midway below left clavicle
  • +/- early systolic murmur at ULSE
  • Bounding pulses
A

PDA

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71
Q

Management of PDA

A
  • Diuretics or fluid restriction
  • Paracetamol or indomethacin
  • Surgical ligation or percutaneous coil closure
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72
Q

Name the congenital heart disease

  • Rheumatic fever OR Turner syndrome OR William syndrome
  • Asymptomatic
  • Heart failure
  • Chest pain
  • Syncope
  • Harsh ejection systolic murmur over URSe
  • Slow rising pulse
  • Narrowed pulse pressure
  • Soft S2
A

Aortic stenosis

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73
Q

Name the congenital heart disease

  • Turner syndrome
  • Asymptomatic
  • Weak femoral pulses
  • Relative hypertension in upper limbs
  • CV collapse
  • Murmur heard radiating to back/between clavicles
A

Coarctation of the aorta

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74
Q

Name the congenital heart disease

  • Noonan syndrome OR William syndrome OR alagille syndrome
  • Asymptomatic
  • Cyanosis
  • Ejection systolic murmur at ULSE, radiates to back
  • Ejection click
A

Pulmonary stenosis

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75
Q

Name the murmur

  • Continuous hum below right clavicle
  • Decreases when patient is supine or pressure applied to neck
A

Venous hum

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76
Q

Name the murmur

  • Early soft systolic murmur in LLSE or URSE with musical quality
  • Increased when patient is supine
A

Still’s murmur

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77
Q

Name the murmur

- Ejection systolic murmur at ULSE, DOES NOT radiate to back

A

Pulmonary flow murmur

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78
Q

Key characteristics of an innocent murmur

A
  • Systolic
  • Soft
  • Small
  • Short
  • Single
  • Sweet
  • Sensitive
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79
Q

Common accidental injury sites

A
  • Head: parietal bone, occiput and forehead
  • Nose
  • Chin
  • Elbows
  • Palms of hands
  • Knees
  • Shins
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80
Q

Common NAI sites

A
  • Ears
  • eyes
  • Soft tissues of cheeks
  • Intra-oral injuries
  • ‘triangle of safety’
  • Forearms
  • Inner aspects of arms
  • Back and side of trunk
  • Chest and abdomen
  • Groin/genitals
  • Inner aspects of thighs
  • Soles of feet
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81
Q

Red flags for NAI

A
  • well demarcated bruises with specific implement patterns
  • Bruises not on bony prominences
  • bilateral injuries
  • bruises that can not be ages accurately
  • regular edges to burns
  • spiral, oblique or metaphyseal fractures
  • Inconsistent story describing injury
  • fractures in non-mobile children
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82
Q

Examples of neglect

A
  • Poor diet
  • Failure to meet health needs
  • Failure to achieve educational achievement
  • Poor hygiene
  • failure to protect from danger
  • Failure to provide protection from witnessing violence
  • Failure to provide emotional warmth
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83
Q

Examples of emotional abuse

A
  • Lack of emotional warmth/love
  • Constant criticism
  • Placing developmentally inappropriate expectations on children
  • Bullying
  • Witnessing or hearing or maltreatment
  • Exploitation/corruption
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84
Q

Risk factors for child abuse

A
  • Domestic violence
  • Parental mental health problems
  • Parental drug/alcohol abuse
  • Previous maltreatment of other children
  • Disability in the child
  • Known maltreatment of animals
  • Parents who have suffered sexual abuse
  • Vulnerable/unsupported parents
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85
Q

What should you do if you suspected a child is being abuse?

A

Admit to hospital for safety and report to safeguarding officer

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86
Q

Risk factors for T1DM

A
  • Family history
  • Viruses
  • early cow’s milk consumption
  • Other dietary factors
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87
Q

Clinical features of T1DM

A
  • Short history of symptoms
  • Polyuria/nocturia/enuresis
  • Thirst
  • Weight loss
  • Fatigue
  • Behavioural changes
  • Blurred vision
  • Polyphagia
  • recurrent infections
  • Abdo pain/nausea and vomiting
  • Respiratory distress
  • Hypovolemia/dehydration/shock
  • Coma
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88
Q

Diagnostic criteria for diabetes

A

Symptomatic +

  • Fasting glucose >7 OR
  • Random glucose >11.1
Asymptomatic 
\+ 2 fasting glucose >7 OR
\+ 2 random glucoses >11.1 OR
\+ 1 fasting glucose >7 + 1 random glucose >11.1
\+ OGTT 2 hour result 11.1 OR
\+ HbA1c >48
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89
Q

Investigations to consider in T1DM

A
  • FBC
  • U&Es
  • LFTs
  • Bone profile
  • HbA1c
  • Autoimmune disease screen
  • GAD antibodies
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90
Q

Sick day rules in diabetes

A
  • Keep taking insulin
  • Eat as you can manage
  • Check sugars more often
  • Check ketones
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91
Q

Triad of DKA

A

1) Ketonaemia
2) Hyperglycaemia
3) Acidosis

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92
Q

Symptoms of DKA

A
  • Dehydration
  • Nausea and vomiting
  • Kussmaul respirations
  • Pear drop breath
  • Abdominal pain
  • Fatigue
  • Reduced consciousness
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93
Q

Investigations in DKA

A
  • Blood glucose
  • Blood/urinary ketones
  • ABG
  • U&Es
  • FBC
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94
Q

Management of DKA

A

1) Assess fluid status
2) Fluid bolus (in severe DKA)
3) Maintenance fluids with K+
4) Insulin

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95
Q

Monitoring in DKA

A
  • Hourly assessment
  • Continuous ECG
  • Blood tests 2 hours after treatment then 4 hourly
  • Fluid balance
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96
Q

Complications of DKA

A
  • Cerebral oedema
  • Hypokalemia
  • Hyperkalemia
  • Aspiration pneumonia
  • Hypogylcaemia
  • VTE
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97
Q

Symptoms of hypoglycaemia

A
  • Anxiety
  • Tachycardia
  • Headache
  • Abdo pain
  • Ataxia
  • Weakness
  • Confusion
  • Personality changes
  • Seizures
  • Coma
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98
Q

Management of hypoglycaemia

A

Conscious:

1) 10-20g rapidly absorbed glucose PO
2) Recheck glucose in 15 mins
3) Repeat if necessary
4) Long-acting carb

Unconscious:

1) IM/SC glucagon
2) 2ml/kg 10% glucose

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99
Q

Influences of growth at different ages

A
  • 0-1: nutrition

- Pre-pubertal child: GH

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100
Q

Red flags for short stature in children

A
  • lower height centiles
  • large disparity between child’s height and mid-parental height
  • dysmorphic features
  • signs of chronic illness
  • increased weight:height ratio
  • Disproportionate upper:lower segment ratios
  • Rapid reduction in height velocity
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101
Q

Causes of short stature

A
  • Familial short stature
  • Constitutional delay or growth and puberty
  • Idiopathic
  • SGA
  • GH deficiency
  • Endocrine disease
  • SHOX gene mutations
  • Noonan syndrome
  • Russell-Silver syndrome
  • Prader-Willi syndrome
  • Skeletal dysplasia
  • Chronic illness
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102
Q

Investigations in children with short stature

A
  • FBC
  • U&Es
  • LFTs
  • Vit D
  • TFTs
  • TTG
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103
Q

Red flags for tall stature in children

A
  • Recent growth acceleration
  • Large disparities in child’s height and mid-parental height
  • Dysmorphic features
  • Chronic illness
  • Disproportionate upper: lower segment ratios
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104
Q

Causes of tall stature in children

A
  • Precocious puberty
  • Sex hormone deficiency
  • Excess adrenal androgens
  • GH excess
  • Hyperthyroidism
  • Klinefelter syndrome
  • Marfan syndrome
  • Homocystinuria
  • Soto syndrome
  • BW syndrome
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105
Q

Define precocious puberty

A

Onset of puberty before 8 in girls and 9 in boys

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106
Q

Risk factors for precocious puberty

A
  • Female

- Elevated BMI

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107
Q

Causes of precocious puberty

A
  • Idiopathic
  • Pituitary tumours
  • CAH
  • Adrenal/ovarian/testicular tumours
  • Cushing’s
  • Hyperthyroidism
  • McCune-Albright syndrome
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108
Q

Investigations in precocious puberty

A
  • Baseline and stimulated LH/FSH, oestrogen and testosterone
  • Adrenal androgens
  • TFTs
  • Imaging
  • Bone age X-ray
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109
Q

Define delayed puberty

A

Absence of any signs of puberty by age 13.5 in girls and 14 in boys

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110
Q

Causes of delayed puberty

A
  • Constitutional delay
  • Hypogonadotrophic hypogonadism e.g. Kallmann, pituitary tumour, systemic disease
  • Hypergonadotrophic hypogonadism e.g. Turner, Klinefelter, gonadal trauma
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111
Q

Investigations for delayed puberty

A
  • Baseline bloods
  • Wrist x-ray
  • Baseline and stimulated FSH, LH, oestrogen, testosterone
  • Karyotype
  • Imaging
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112
Q

Symptoms of GORD

A
  • Persistent/recurrent regurgitation
  • Feeding difficulties/food refusal or crying after feeds
  • Arching of neck/back
  • Respiratory symptoms
  • Sore throat/hoarseness
  • Apnoeic episodes
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113
Q

Management of GORD in infants

A

1) Lifestyle changes

2) Medication
- Breast-fed babies: 1-2 weeks of antacid
- Formulae fed: thickened feeds
- Older children: 4 week trial ranitidine/omeprazole

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114
Q

Risk factors for pyloric stenosis

A
  • Males
  • Firstborns
  • Strong FH
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115
Q

Symptoms of pyloric stenossi

A

Onset between 3-4 weeks old

  • Non-bilious projectile vomiting
  • Secondary haematemesis
  • Lethargy
  • Weight loss/failure to thrive
  • Constipation
  • Thin but hungry infant
  • Dehydration
  • Visible gastric peristalsis
  • Palpable tumour (olive shaped mass) - DIAGNOSTIC
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116
Q

Investigations in pyloric stenosis

A
  • ABG: hypochloremic hypoklaemic alkalosis
  • U&Es
  • Abdominal US: pyloric thickness >4mm, pyloric muscle length >18mm, failure of fluid passage pass pylorus despite vigorous gastric peristalsis
  • Contrast studies: string sign
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117
Q

Management of pyloric stenosis

A
  • NG tube insertion and suction
  • Stopping of oral feeds
  • IV fluid bolus and maintenance fluids/replacement fluids
  • Ramsted’s pyloromyotomy
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118
Q

Causes of intussusception

A
  • Meckel Diverticulum
  • Peutz-Jegher polyps
  • Small bowel lymphoma
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119
Q

Clinical features of intusussception

A

Symptoms between 2 months and 2 years old, usually <1

  • Sudden colicky abdominal pain every 10-20 mins
  • Pallor
  • Bilious vomiting
  • Redcurrant jelly stool
  • Weak/lethargic
  • Dehydration
  • Tachycardia
  • Sausage-shaped mass in RUQ
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120
Q

Investigations for intusussception

A
  • Routine bloods
  • ABDO US: target sign
  • Abdo xray
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121
Q

Management of intusussception

A
  • Appropriate fluid resus
  • Broad spectrum IV antibiotics
  • PNEUMATIC REDUCTION ENEMA
  • Urgent laparotomy: failed air enema, highly distended abdomen, peritonism
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122
Q

Complications of intusussception

A
  • Ischaemia and necrosis
  • Haemorrhage
  • Perforation
  • Infection
  • Recurrent
  • Death
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123
Q

Clinical features of mesenteric adenitis

A

Presents in <15s

  • acute abdo pain
  • fever
  • malaise
  • anorexia
  • nausea
  • diarrhoea
  • headache
  • pharyngitis
  • cervical lymphadenopathy
  • may have preceding URTI
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124
Q

Management of mesenteric adenitis

A
  • Reassurance

- Hydration

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125
Q

Clinical features of infantile colic

A

Presents in first few weeks of life

  • Excessive/inconsolable crying
  • crying worse in late afternoon/evening
  • drawing knees up to chest
  • arching of back
  • systemically well child
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126
Q

Diagnostic criteria for infantile colic

A

Child whose crying lasts >3 hours per day on >3 days per week and has persisted >3 weeks in absence of other causes

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127
Q

Management of colic

A
  • Reassurance
  • Soothing techniques
  • Exclusion of cow’s milk
  • Simethicone drops
  • Lactose drops
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128
Q

Clinical features of Meckel diverticulum

A
  • Asymptomatic
  • Rectal bleeding
  • Ulceration
  • Intussusception
  • Volvulus
  • Diverticulitis
  • Umbilical abnormalities
  • Neoplasm
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129
Q

Investigation for Meckel diverticulum

A
  • Meckel scan
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130
Q

Management of Meckel diverticulum

A

Surgical excision of diverticulum and adjacent ileal segment

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131
Q

Clinical features of constipation

A
  • Infrequent bowel movement
  • Excessive foul-smelling flatulence
  • Irregular stool texture
  • Passing occasional large stools or frequent small pellets
  • Not wanting to go to the toilet
  • Overflow diarrhoea
  • Abdominal pain and bloating
  • poor appetite
  • Fatigue
  • Irritability
  • Occasional blood in stools
  • Encopresis
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132
Q

Differentials for childhood constipation

A
  • Hirschsprung’s disease
  • Bowel obstruction
  • Spinal cord compression
  • Imperforate anus
  • Hypothyroidism
  • Coeliac
  • Electrolyte abnormalities
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133
Q

Management options for childhood constipation

A

1) Lifestyle changes
2) Disimpaction therapy with oral Macrogol +/- Senna
3) Maintenance therapy e.g oral macrogol

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134
Q

Clinical features of Toddler’s diarrhoea

A
  • Child aged between 6 months and 5 years
  • Diarrhoea lasting over a number of weeks followed by a period of normal stools
  • Stools containing undigested foods
  • Mild abdo pain
  • Systemically well child
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135
Q

Red flags in childhood diarrhoea

A
  • Blood or mucus in stool
  • Faltering growth
  • Fever
  • Severe abdo pain
  • Vomiting
  • Incontinence
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136
Q

Management of Toddler’s diarrhoea

A
  • Limit fruit juice and carbonated drinks
  • Avoid excessive fluid intake
  • Increase fat content of diet
  • Optimise dietary fibre
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137
Q

Clinical features of NEC

A
  • Abdominal symptoms in a previously stable premature baby upon starting feeds e.g. stops tolerating feeds, abdominal distention, abdo pain, bloody stools
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138
Q

Investigation of choice for NEC

A

Abdo X-ray:

  • Small bowel dilatation
  • Pneumatosis intestinalis (DIAGNOSTIC)
  • Fixed dilated loop of bowl
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139
Q

Management of NEC

A
  • NBM
  • Commence IV fluids and TPN
  • Insert large bore NG tube on free drainage
  • IV broad spectrum antibiotics
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140
Q

Main cause of morbidity in CDH

A

Lung hypoplasia

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141
Q

Clinical features of CDH

A
  • RDS in first few mins of life
  • Mediastinal shift
  • Scaphoid abdomen
  • Bowel sounds on chest auscultation
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142
Q

Investigations for CDH

A
  • Normally diagnosed on antenatal US
  • CXR
  • US
  • GI contrast study
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143
Q

Risk factors for gastrochisis

A
  • Young maternal age
  • Maternal smoking
  • Maternal substance abuse
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144
Q

Management of gastrochisis

A
  • Venous access
  • NG tube drainage
  • Broad spectrum antibiotics
  • Fluids as necessary
  • TPN
  • Primary closure or preformed silo
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145
Q

Management of exomphalos

A

Minor: can be operated on shortly after birth

Major: opening covered with dressings, surgical closure at a later date

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146
Q

Causes of meconium ileus

A
  • CF
  • Ano-rectal malformation
  • Hirschsprung’s disease
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147
Q

Classic presentation of meconium ileus

A
  • Baby does not pass meconium in 48 hours after birth
  • Abdominal distention
  • Vomiting
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148
Q

Investigations of meconium ileus

A
  • Abdo X-ray
  • Gastrografin enema
  • CF investigation
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149
Q

Management of meconium ileus

A
  • air enema
  • rectal washouts
  • laparotomy
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150
Q

Differentials for bilious vomiting

A
  • Malrotation
  • Duodenal/intestinal atresia
  • HD
  • Anorectal malformation
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151
Q

Investigations for malrotation

A
  • US

- URGENT UPPER GI CONTRAST STUDY (diagnostic): corkscrew sign

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152
Q

Risk factors for Hirschsprung’s disease

A
  • Male
  • FH
  • Down syndrome
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153
Q

Clinical features of Hirschsprung’s disease

A
  • Failure to pass meconium
  • Progressive abdo distention
  • Bilious vomiting
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154
Q

Gold standard investigation for Hirschsprung’s disease

A

Rectal biopsy

  • Anorectal manometry
  • Plain abdo Xray
  • Lower GI contrast studies
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155
Q

Management of Hirschsprung’s disease

A
  • Anorectal washouts
  • Stoma formation
  • Surgical correction
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156
Q

Complications of Hirschsprung’s disease

A
  • Enterocolitis
  • Faceal soiling
  • Chronic constipation
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157
Q

Clinical features of biliary atresia

A
  • Term babies with normal birth weight
  • Jaundice soon after birth, which worsens
  • Dark urine and pale stool
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158
Q

Investigations for biliary atresia

A
  • Serum bilirubin - total and conjugated
  • US scan
  • Hepatobiliary iminodiacetic acid
  • Liver biopsy (definitive)
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159
Q

Management of biliary atresia

A
  • Surgical correction (Kasai procedure)
  • Antibiotics
  • Vitamin A, D, E, K supplementation
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160
Q

Red flags in URTIs in children

A
  • Multiple episodes/continuous symptoms
  • Faltering growth
  • Focal signs
  • Other infections
  • Unusual organisms
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161
Q

Clinical features of tonsillitis

A
  • Sore throat
  • Dysphagia
  • Tender lymph nodes
  • Ear pain
  • Fever
  • Halitosis
  • Lethargy
  • Malaise
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162
Q

Causes of croup

A
  • Parainfluenza
  • Adenovirus
  • RSV
  • Measles
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163
Q

Clinical features of croup

A
  • More common in winter
  • Child age 6 months to 3 years
  • 1-3 days of coryza
  • Mild fever
  • Breathlessness
  • Baking cough, worse at night
  • Inspiratory stridor
  • Signs of respiratory distress
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164
Q

Management of coup

A
  • Reassurance
  • Analgesia
  • Oral steroids
    • Nebulised adrenaline (if stridor at rest)
    • oxygen (if stridor at rest with agitation or lethargy)
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165
Q

Risk factors for bronchiolitis

A
  • Age <3
  • Season
  • Premature birth
  • Bronchopulmonary dysplasia
  • Low muscle tone
  • passive smoke exposure
  • Impaired airway clearance and function
  • Congenital heart disease
  • Down syndrome
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166
Q

Cause of bronchiolitis

A

RSV

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167
Q

Clinical features of bronchiolitis

A
  • Preceding URTI symptoms
  • Dry episodic cough
  • Tachypnoea
  • Signs of increased work of breathing
  • Hyperinflation
  • Crackles
  • Wheeze
  • Reduced air entry
  • Poor feeding
  • Apnoea
  • Afebrile/low grade fever
  • Systemically well child
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168
Q

Management of bronchiolitis

A
  • Minimal handling
  • Nasal suction
  • Oxygen/ventilation
  • IV fluids/tube feeding
  • Respiratory support
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169
Q

Clinical features of asthma

A
  • Wheeze
  • Cough
  • Chest tightness
  • Difficulty breathing
  • Diurnal and seasonal variation
  • Multiple triggers
  • Associated atopy
  • Responds to appropriate treatment
  • Tachypnoea
  • Increased work of breathing
  • Decreased O2 sats
  • Reduced air entry
  • Hyperinflation
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170
Q

Chronic asthma management in an under 5

A

1) SABA
2) Very low dose ICS OR LTRA
3) Add LTRA
4) Consider increasing ICS dose
5) Refer to specialist care

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171
Q

Chronic asthma management in >5s

A

1) SABA
2) ICS
3) LABA OR LTRA
4) increase steroid or add LABA or LTRA
5) Refer to specialist care

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172
Q

Features of a severe asthma attack

A
  • Sats <92%
  • PEF 33-50%
  • Too breathless to talk in sentences/eat
  • Accessory muscle use
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173
Q

Features of a life-threatening asthma attack

A
  • Sats <92%
  • PEF <33%
  • Poor respiratory effort
  • Altered consciousness
  • Hypotension
  • Tachycardia
  • Exhaustion
  • Cyanosis
  • Silent chest
  • Confusion
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174
Q

Management of an acute asthma attack

A

1) Inhaled/nebulised salbutamol
2) Oral prednisolone OR IV hydrocortisone
3) Admit to hospital and reassess after 20 minutes
4) add nebulised ipratropium bromide if required (can be repeated back to back 3 times)
5) IV salbutamol, Mag sulphate or aminophylline

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175
Q

Features of salbutamol toxicity

A
  • Metabolic acidosis
  • Rising lactate
  • Hypokalemia
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176
Q

Clinical features of CF

A
  • Failure to pass meconium
  • Meconium ileus/ bowel obstruction
  • Thick viscous meconium
  • Prolonged neonatal jaundice
  • Failure to thrive
  • Large appetite
  • Wet cough
  • Recurrent URTIs
  • Chronic sinusitis
  • Nasal obstruction/nasal polyps
  • Genital abnormalities in males
  • Steatorrhoea
  • Rectal prolapse
  • Diabetes
  • Cirrhosis and portal hypertension
  • Finger clubbing
  • GORD
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177
Q

Management of CF

A
  • Prophylactic oral/nebulised antibiotics
  • Prophylactic oral antifungals
  • Nebulised hypertonic saline
  • Chest physio
  • Nebulised DNAse
  • Bronchodilators
  • Pancreatic enzyme supplements
  • Micronutrients
  • High calorie diet
  • H2RA or PPI
  • Insulin
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178
Q

Long term monitoring required in CF patients

A
  • Serial CXR
  • Abdominal US
  • Bone scan
  • Glucose tolerance test
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179
Q

Long term complications of CF

A
  • CF-related diabetes
  • CF-related liver disease
  • Infertility
180
Q

Cause of pertussis

A

Bordetella pertussis

181
Q

Clinical features of pertussis

A
  • Catarrhal phase
  • Fever
  • Paroxysmal whooping cough leading to vomiting or apnoea
182
Q

Investigations of pertussis

A
  • Postnasal swab in first few weeks of illness

- FBC

183
Q

Management of pertussis

A
  • Reassurance
  • Admit if: <6 months, oxygen requirement
  • Erythromycin to reduce infectiveness if presenting within 21 days of symptom onset
  • Report to PUBLIC HEALTH
  • Keep away from others for 5 days after starting antibiotics or 21 days after start of cough
184
Q

Complications of pertussis

A
  • Subconjuctival haemorrhage
  • Rib fractures
  • Pneumothorax
  • Hernia
  • Fainting
  • Intraventricular haemorrhage/hypoxic brain injury
185
Q

Guidance to prevent SUDI

A
  • Always put babies to sleep on their backs with their feet at the bottom of the cot
  • Use a hard or safety-approved surface
  • Do not co-sleep
  • Keep soft objects out of the baby’s bed
  • Do not smoke
  • Do not allow the room to get too hot or cold
  • Do not use a dummy with a string or cord attached
  • Seek medical attention if baby becomes unwell
186
Q

Clinical features of a brain tumour

A
  • Headache
  • Vomiting
  • Visual signs/symptoms
  • Motor signs/symptoms
  • Behavioural change
  • Drowsiness
  • Seizures
  • Bulging fontanelles
187
Q

Investigation for a child with a suspected brain tumour

A

URGENT CT/MRI brain

188
Q

Clinical features of a neuroblastoma

A
  • Most common in children <5
  • Pallor
  • Weight loss
  • Malaise
  • Abdo mass
  • Bone pain, limp
  • Lymphadenopathy
  • Spinal cord compression
  • Bone marrow compression
  • Diarrhoea
  • Hypertension
189
Q

Clinical features of a Wilms tumour

A
  • Most common in children <4
  • Palpable abdo mass
  • Haematuria
  • Hypertension
190
Q

Clinical features of bone tumours

A
  • Common in teenagers and young adults
  • Pain
  • Swelling
  • Pathological fractures
191
Q

Clinical features of rhabdomyosarcoma

A
  • More common in children <10
  • Palpable abdo mass
  • Pain
  • Urinary obstruction
  • Nasal obstruction
192
Q

Risk factors for inguinal hernia

A
  • Prematurity

- Male sex

193
Q

Clinical features of an inguinal hernia

A
  • Reducible lump
  • Intermittent lump
  • Discomfort/heaviness
  • Strangulation: erythematous overlying skin, nausea, vomiting, severe pain and tachycardia
194
Q

Management of an inguinal hernia

A
  • Babies <6 months: hernia repair within 2 weeks of presentation
  • Older children: elective surgery, unless hernia is irreducible (SURGICAL EMERGENCY)
195
Q

Complications of inguinal hernia

A
  • Strangulation
  • Infection
  • Bleeding
  • Testicular atrophy
  • Damage to spermatic cord structures
196
Q

Conditions associated with undescended testes

A
  • Prader-Willi syndrome
  • Kallmann syndrome
  • CAH
  • Exomphalos
  • Gastroschisis
197
Q

Management of undescended testes

A

Palpable
- Elective inguinal orchidopexy at 3 months (3-6 months apart in bilateral cases)

Impalpable
- Laparoscopy and movement or removal of the testes depending on location

198
Q

Complications of undescended testes

A
  • Infertility
  • Malignancy
  • Cosmetic/psychological complications
199
Q

Management of symptomatic phimosis

A
  • Topical corticosteroid cream for 4 weeks with gentle retraction
  • Foreskin preserving surgery or circumcision
200
Q

Complications of circumcision

A
  • Bleeding
  • Inclusion cysts
  • Damage to glans and urethra
  • Infection
201
Q

Risk factors for hypospadias

A
  • Children with vertebral abnormalities, anorectal malformation, cardiac defects, tracheo-oesphageal fistulas
  • FH
202
Q

3 features of hypospadias

A
  • Chordee
  • Hooded foreskin
  • Abnormal site of anterior meatus
203
Q

Management of hypospadias

A

Surgical correction

204
Q

Causes of PUJ obstruction

A
  • Urethral stricture
  • Abnormal ureteric folds
  • Crossing vessels compressing the ureter
205
Q

Investigations in PUJ/VUJ obstruction

A
  • Antenatal/postnatal US
  • Repeat postnatal US at 6 days and 6 weeks
  • MCUG
  • MAG3 renography
  • Serial US scans
206
Q

Management of PUJ obstruction

A
  • Prophylactic trimethoprim

- Pyeloplasty

207
Q

Complications of pyeloplasty

A
  • Anastomotic leak
  • Narrowing at side of anastomosis
  • Continued deterioration of renal function
208
Q

Management of VUJ obstruction

A
  • Ureter reimplantation OR stenting for 6 months
209
Q

Gold standard investigation for VUR

A

MCUG

210
Q

Management of VUR

A

Medical

  • prophylactic antibiotics
  • laxatives
  • anticholinergics and bladder training

Surgery:

  • Circumcision
  • STING procedure
  • Reimplantation of ureters
  • Nephrectomy
211
Q

Indications for surgical management in VUR

A
  • Patient develops breakthrough infections
  • Deterioration in renal function
  • New renal scars
  • Failure of medical treatment
  • Bilateral grade IV/V disease
212
Q

Most common cause of renal failure in children

A

Posterior urethral valves

213
Q

Clinical features of PUV

A
  • Distended bladder
  • Hydronephrosis
  • Difficulty in passing urine
  • UTIs
  • Renal failure
214
Q

Investigations in PUV

A
  • US scan within 24-48 hours of life

- MCUG (gold standard)

215
Q

Management of PUV

A
  • Immediate bladder drainage
  • Empirical prophylactic antibiotics
  • Stabilisation of kidney function
  • Valve ablation or vesicostomy
216
Q

Complications of PUV

A
  • Renal failure
  • Dysfunctional abnormal bladder
  • Infertility
217
Q

Clinical features of anaphylaxis

A
  • Stridor/wheeze
  • Abdo cramps
  • Nausea and vomiting
  • Diarrhoea
  • Hypotension
  • Tachycardia
  • Shock
  • Urticaria/angioedema
218
Q

Management of anaphylaxis

A

Acute:

  • Resus using ABCDE
  • Remove allergen if possible
  • Adrenaline IM
  • Chlorpheniramine
  • Hydrocortisone

Long term:

  • Allergen avoidance
  • Skin prick testing and immunoassay testing
  • Epipen prescription
  • Allergen-specific immunotherapy
219
Q

Clinical features of cow’s milk protein allergy

A
  • Onset between 2-8 weeks old
  • Systemically well child
  • Blood tinged stool
  • Change in stool frequency
  • Skin changes
220
Q

Management of cow’s milk protein allergy

A
  • Elimination of cow’s milk in maternal diet OR
  • Protein hydrolysate formula milk
  • Re-introduction of cows milk protein at 9 months
221
Q

Risk factors for lactose intolerance

A
  • Increasing age
  • East Asian ethnicity
  • Gastroenteritis
  • Coeliac disease
  • IBD
222
Q

Clinical features of lactose intolerance

A
  • Diarrhoea
  • Abdo pain
  • Flatulence
  • Bloating/distention
223
Q

Investigations for lactose intolerance

A
  • Food diary
  • Low faecal pH
  • Reducing substances in the stool
224
Q

Management for lactose intolerance

A
  • Lactose restriction
  • Vitamin D and calcium supplements
  • Lactase enzyme replacement
225
Q

Routine vaccines given at 2 months

A
  • 6 in 1
  • Men B
  • Rotavirus
226
Q

Vaccines in the 6 in 1

A
  • Diptheria
  • Tetanus
  • Polio
  • Pertussis
  • HiB
  • Hep B
227
Q

Routine vaccines given at 3 months

A
  • 6 in 1
  • Pneumococcal
  • Rotavirus
228
Q

Routine vaccines given at 4 months

A

6 in 1

- Men B

229
Q

Routine vaccines given at 1 year

A
  • HiB/Men C
  • Pneumococcal
  • MMR
  • Men B
230
Q

Routine vaccines given at 2-7 years

A
  • Influenza annually
231
Q

Routine vaccines given at 3 years 4 months

A
  • DTPP

- MMR

232
Q

Routine vaccines given at 12-13 years

A
  • HPV
233
Q

Routine vaccines given at 14 years

A
  • DTP

- Men ACWY

234
Q

Side effects of vaccinations

A
  • localised side effects e.g swelling, redness, discomfort
  • Fever
  • Malaise and rash
  • Anaphylaxis (rare)
235
Q

CI to vaccinations

A
  • Acute febrile illness or moderate/severe illness
  • Immunosuppression (live vaccines)
  • Previous anaphylactic reaction
  • Pregnancy (live vaccines)
236
Q

‘Amber’ features of severity in an unwell child

A
  • Pallor
  • Abnormal response to social cues
  • No smiles
  • Wakes with prolonged stimulation
  • Reduced activity
  • Nasal flaring
  • Tachypnoea (>50 in <12 months, >40 in >12 months)
  • O2 sats <95%
  • Chest crackles
  • Tachycardia (>160 in <1s, >150 in 1-2, >140 in >2s)
  • Cap refill >3s
  • Dry mucous membranes
  • Poor feeding
  • Reduced urine output
  • Age 3-6 months
  • Temp >39
  • Fever for >5 days
  • Rigors
  • Swelling of a limb/joint
  • Non-weight bearing limb/not using a limb
237
Q

‘Red’ features of severity in an unwell child

A
  • Pale/mottled/ashen/blue
  • Unresponsive to social cues
  • Appears ill
  • Asleep or does not stay awake
  • Weak/high-pitched/continuous cry
  • Unresponsive
  • Grunting
  • Tachypnoea (>60)
  • Moderate/severe chest recession
  • Sats <92%
  • Reduced skin turgor
  • Deteriorating BP
  • Age <3 months
  • Non-blanching rash
  • Bulging fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal neurological signs
238
Q

Septic screen in <3 months old

A
  • Bloods
  • Urine MC&S
  • CXR
  • LP
239
Q

How long should children with pertussis stay off school?

A

48 hours from commencing antibiotics
OR
21 days from onset of illness if not antibiotic treatment

240
Q

Complications of pertussis

A
  • Pneumonia
  • Seizures
  • Encephalopathy
  • Vomiting
  • Conjunctival haemorrhage
  • Facial oedema
241
Q

Clinical features of chickenpox

A
  • Discrete erythematous maculopapular rash with some vesicles and crusting
  • Itch
  • Systemic symptoms but fairly well
242
Q

Diagnosis of chickenpox

A

Usually clinical, can be backed up with PCR or serology

243
Q

Management of chickenpox

A

Symptomatic

Acyclovir if treatment indicated

244
Q

How long should children with chickenpox stay off school?

A

Until all vesicles have crusted over

245
Q

Cause of Hand foot and mouth disease

A

Coxsackie virus

246
Q

Clinical features of hand foot and mouth disease

A
  • Discrete erythematous papules around mouth/tongue and palms and soles
  • Associated GI symptoms
  • Systemically well
247
Q

How long should children with hand foot and mouth stay off school?

A

They don’t need to stay off school as long as they feel well

248
Q

Management of hand foot and mouth disease

A

None

249
Q

Cause of impetigo

A

Staph Aureus

250
Q

Clinical features of impetigo

A
  • Most common in 2-5 years old
  • Itchy, flaky, raised crusted golden lesions and surrounding erythema
  • Systemically well
251
Q

Management of impetigo

A
  • Mild: topical antiseptic wipes, Topical fusidic acid

- Extensive or not responding to treatment: Oral flucloxacillin

252
Q

How long should children with impetigo stay off school?

A

Until all lesions are crusted and healed
OR
48 hours after commencing antibiotics

253
Q

Clinical features of measles

A
  • Prodromal fever, coryzal symptoms, cough, conjunctivitis, Koplik spots, malaise
  • Widespread erythematous maculopapular ‘lacy’ rash starting on face and spreading distally
  • cervical lymphadenopathy
  • Systemically unwell
254
Q

Diagnosis of measles

A

Throat swab

255
Q

Management of measles

A
  • supportive
  • IgG to immunocompromised patients
  • Vaccinate contacts
256
Q

How long should children with measles stay off school?

A

4 days from the onset of the rash

257
Q

Complications of measles

A
  • Otitis media
  • Pneumonia
  • Encephalitis/meningitis
  • Seizures
  • Late onset subacute sclerosing panencephalitis
258
Q

Cause of scarlet fever

A

Strep infection

259
Q

Risk factors for scarlet fever

A
  • Chickenpox
  • Recent childbirth
  • Alcoholism
  • Immunosuppression
260
Q

Clinical features of scarlet fever

A
  • Confluent erythematous macular sandpaper rash with perioral sparing
  • Strawberry tongue
  • Associated cough, sore throat, otalgia, sinusitis
  • Systemically unwell
261
Q

Management of scarlet fever

A

10 days penicllin/amoxicillin

262
Q

How long should children with scarlet fever stay off school?

A

24 hours after commencing antibiotic treatment

263
Q

Complications of scarlet fever

A
  • Rheumatic fever
  • Sepsis
  • Pneumonia
  • Endocarditis/pericarditis
  • Arthritis
  • Osteomyelitis
  • Nec fasc
264
Q

Cause of slapped cheek disease

A

Parvovirus B19

265
Q

Clinical features of slapped cheek disease

A
  • Prodromal URTI
  • Bright red rash on both cheeks
  • May be followed by an itchy widespread papular rash
  • Systemically unwell
266
Q

How long should children with slapped cheek stay off school?

A

They don’t need to stay off school

267
Q

Clinical features of eczema herpeticum

A
  • Redding and painful scaly lesions with sparing of the skin creases and the eyes
  • Punched out lesions
  • Systemically unwell
268
Q

Management of eczema herpeticum

A
  • IV Acyclovir
  • URGENT derm referral
  • opthamology referal if there is eye involvement
269
Q

Inheritance method of achondroplasia

A

Autosomal dominant

270
Q

Clinical features of achondroplasia

A
  • Short limbs
  • Thoracolumbar kyphosis
  • Disproportionately short stature
  • Megalencephaly with prominent forehead
  • Midfacial hypoplasia
271
Q

Inheritance method of Marfan syndrome

A

Autosomal dominant

272
Q

Clinical features of Marfan syndrome

A
  • Heart defects
  • Ophthalmological defects
  • Spontaneous pneumothorax
  • Tall/thin stature
  • Long limbs
  • Spinal scoliosis
  • Recurrent hernias
273
Q

Inheritance method of CF

A

Autosomal recessive

274
Q

Inheritance method of sickle cell anaemia

A

Autosomal recessive

275
Q

Inheritance method of haemophilia

A

X-linked recessive

276
Q

Inheritance method of DMD and BMD

A

X-linked recessive

277
Q

Inheritance method of red- green colour-blindness

A

X-linked recessive

278
Q

Inheritance method of Prader-Willi syndrome

A

Paternal allele silencing on chromosome 15

279
Q

Clinical features of Prader-Willi syndrome

A
  • Learning difficulties
  • Short stature
  • Severe hypotonia and poor feeding in neonates
  • Hyperphagia and obesity
  • Hypogonadism
280
Q

Inheritance method of Angelman syndrome

A

Maternal allele silencing on chromosome 15

281
Q

Clinical features of Angelman syndrome

A
  • Unusually happy disposition with inappropriate laughing/clapping
  • Characteristic facial appearance
  • Severe learning difficulties and developmental delay
  • Seizures
  • Ataxia
282
Q

Inheritance method of Beckwith-Wiedemann syndrome

A

Silencing of maternal alleles on chromosome 11

283
Q

Clinical features of Beckwith-Wiedemann syndrome

A
  • Neonatal macrosomia
  • Hemi-hypertrophy
  • Neonatal hypoglycaemia
  • Macroglossia
  • External ear abnormalities
  • Exomphalos
  • Increased childhood cancer risk, especially Wilms tumour
284
Q

Inheritance method of Fragile X syndrome

A

Increasing CGG repeat in FMR1 gene on X chromosome

285
Q

Clinical features of Fragile X syndrome

A
  • Learning difficulties
  • Prominent ears and jaw
  • Stereotypical hand movements
  • Seizures
  • Hyperactivity
  • Macro-orchidism
286
Q

Clinical features of Down syndrome

A
  • Low birth weight
  • Hypotonia
  • Upslanting palpebral fissures and epicanthic folds
  • Brachycephaly
  • Low set ears
  • Depressed nasal bridge
  • Large protruding tongue
  • Singular palmar creases
  • Clinodactyly
  • Brushfield spots
  • Sandal gap
287
Q

Neonatal screening required in Down syndrome

A
  • Echo
  • FBC or spun PCV
  • TFTs
  • Hearing screen at 8 months old
  • Vision screens throughout childhood
288
Q

Complications of Down syndrome

A
  • OSA
  • Cardiac abnormalities
  • Respiratory tract infections e.g. otitis media
  • Structural GI abnormalities e.g. duodenal atresia, Hirschsprung’s disease
  • Susceptibility to infection
  • T1DM
  • Coeliac disease
  • Seizures
  • Early onset Alzheimers
  • Increased frequency of leukaemia
  • Hypothyroidism
  • Short stature and atlanto-axial instability
  • Cataracts and visual impairment
  • Developmental delay/learning difficulties
  • Poor feeding
  • Psychological disorders
289
Q

Edward syndrome

A

Trisomy 18

290
Q

Clinical features of Edward syndrome

A
  • Dysmorphic facies: small jaw, low set ears, prominent occiput
  • Flexed, overlapping fingers
  • Clenched fists
  • Rocker bottom feet
  • Hammer toes
  • Growth restriction
  • Cardiovascular malformation
  • GI malformation
  • Renal defects
  • Neurological defects
  • Developmental delay
291
Q

Patau syndrome

A

Trisomy 13

292
Q

Clinical features of Patau syndrome

A
  • LBW
  • Cardiac malformations
  • Facial defects: microcephaly, scalp defects, ear abnormalities, cleft lip/palate, nasal malformation
  • Nervous system defects
  • GI malformation
  • GUI malformation
  • Limb abnormalities: rocker bottom feet
293
Q

Turner syndrome

A

XO

294
Q

Clinical features of Turner syndrome

A
  • Lymphoedema of hands and feet after birth
  • Short stature
  • Broad/webbed neck with low hairline
  • Shield-shaped chest with widely spaced nipples
  • Wide carrying angles of the arms
  • Hypoplastic nails
  • High arched palate
  • Cystic hygroma
  • Structural renal abnormalities
  • Coarctation of the aorta
  • Non-immune foetal hydrops
295
Q

Investigations for a child with ?Turner syndrome

A
  • Karyotype testing
  • LH/FSH levels: usually high in <4, low in 4-10 the high in >10s
  • TFTs
  • U&Es
  • Fasting blood glucose and HbA1c
  • Renal US
  • Echo/Cardiac MRI
  • Hearing assessment
296
Q

Management of Turner syndrome

A
  • GH supplementation
  • Transdermal oestrogen replacement therapy
  • Vitamin D and calcium supplementation
  • Avoidance of obesity
  • Egg donation and IVF
297
Q

Complications associated with Turner syndrome

A
  • Coarctation of the aorta
  • Hypoplastic left heart syndrome
  • Aortic aneurysm and aortic dissection
  • Streak ovaries and primary ovarian failure
  • Infertility
  • Myopia
  • Otitis media
  • Renal structural abnormalities
  • Hypothyroidism
  • Increased risk of T1DM, osteoporosis, coeliac disease, IBD
298
Q

Definition of a febrile covulsion

A

A fit that occurs in a child with a temperature >38 and the absence of CNS infection, metabolic imbalance or a neurological condition

299
Q

Clinical features of a febrile convulsion

A
  • Children 6 months to 6 years
  • Only occurs with a temp >38
  • Can be simple, complex or status, but usually simple
  • Usually last <5 mins
  • Associated with rapid and full neurological recovery
300
Q

Management of febrile seizures

A
  • Assess for cause of fever
  • Temperature control with paracetamol
  • Patient education - risk of recurrence, seek medical help if seizures last <5 minutes and call an ambulance if they last >5 mins
  • PR diazepam if seizure lasts >5 mins
301
Q

Indications for admission in a febrile seizure

A
  • First febrile seizure
  • Seizure lasting >15 mins
  • Focal seizure
  • Seizure recurring within same febrile illness within 24 hours
  • Incomplete recovery after 1 hour
  • Child <18 months
  • parental anxiety
  • Suspected serious cause of infection
  • No apparent focus of infection
302
Q

Investigations in an afebrile seizure

A
  • Full set of obs
  • FBC
  • U&Es
  • Calcium
  • Magnesium
  • Vitamin D
  • Metabolic work up
  • Blood glucose
  • Anti-epileptic medication levels
  • ECG
  • EEG
  • CT/MRI head
  • LP
303
Q

Indications for hospital admission in an afebrile seizure

A
  • Age <1
  • GCS <15 1 hour after seizure
  • Signs of raised ICP
  • Generally unwell
  • Meningism
  • Signs of respiratory aspiration
  • High parental anxiety
  • Complex seizures
304
Q

Define epilepsy

A

> 2 unprovoked seizures at least 1 day apart which are thought to arise from abnormal electrical activity in the brain

305
Q

Causes of epilepsy

A
  • Idiopathic
  • Genetic
  • Structural
  • Metabolic brain disorders
  • Immune disease
  • Infection
306
Q

Investigations to help support a diagnosis of epilepsy

A
  • Home video recording
  • EEG
  • MRI
  • Genetic tests
307
Q

Define status epilepticus

A

Seizure or repeated seizures lasting >30 mins without regaining of consciousness

308
Q

Causative organisms of meningitis in those <3 months

A
  • GBS
  • E coli
  • Listeria
309
Q

Causative organisms in meningitis in those 3 months to 16 years

A
  • Strep pneumoniae
  • N. meningitides
  • HiB
310
Q

Antibiotics for meningitis in <3 months old

A
  • Cefotaxime + amoxicillin
311
Q

Antibiotics for meningitis in >3 months old

A
  • Ceftriaxone

- Corticosteroids

312
Q

Risk factors for cerebral abscess

A
  • Local infection
  • Head injury/skull fracture
  • Systemic infection
  • Congenital heart disease
  • Intracranial shunts
313
Q

Clinical features of a cerebral abscess

A
  • Systemic upset
  • Fever
  • Vomiting
  • Headache
  • Drowsiness
  • Seizures
  • Bulging fontanelles
  • High-pitched cry
  • Neck stiffness
  • Abnormal movements/tone
  • Changes in personality/speech
314
Q

Risk factors for CP

A
  • Male sex
  • Antenatal infection
  • Multiple pregnancy
  • Low/high birth weight
315
Q

Causes of CP

A
  • Antenatal infection
  • Antenatal radiation exposure
  • Intraventricular haemorrhage
  • Periventricular leukomalacia
  • Congenital malformations
  • Hypoxic ischaemic injury during delivery
  • Postnatal hyperbilirubinaemia
  • Neonatal hypoglycaemia
  • Neonatal cerebral infarcts
  • Meconium aspiration syndrome
  • Hydrocephalus
  • Head injury
  • CNS infection
316
Q

Clinical features of CP

A
  • Motor difficulties
  • Hearing and visual problems
  • Feeding difficulties/faltering growth
  • Aspiration pneumonia
  • Dental caries
  • Behavioural difficulties
  • Communication difficulties
  • Bladder/bowel dysfunction
  • Skeletal deformities
  • Intellectual impairment
  • Seizures
317
Q

3 main subtypes of CP

A

1) Spastic
2) Extrapyramidal
3) Ataxic

318
Q

Clinical features of hemiplegic spastic CP

A

Arms and legs on one side affected:

  • flexed pronated arms with clenched fist
  • hand preference before 12 months
  • difficulty in hand manipulation
  • circumduction gait
  • Toe-hell gait
  • delayed walking
  • Sparing of the face
  • Spasticity greatest in anti-gravity muscles
319
Q

Clinical features of diplegic spastic CP

A

Lower limbs affected:

  • Commando crawl
  • Scissoring of lower legs
  • Severely delayed walking
  • Toe heel gait with feet help in Equinovarus position
  • Underdeveloped legs
320
Q

Clinical features of quadriplegic spastic CP

A

Features of hemiplegic and diplegic CP in all 4 limbs

  • Increased tone
  • Decreased spontaneous movement
  • Swallowing difficulties
  • Weak such
  • seizure disorders
  • Significant intellectual impairment
  • Associated developmental abnormalities
321
Q

Clinical features of extrapyramidal CP

A
  • Poor head control
  • Hypotonia in infancy and dyskinetic movement as they develop
  • Speech and feeding problems
322
Q

Clinical features of ataxic CP

A
  • Hypotonia
  • Intention tremor
  • Poor coordination
  • Broad-based unsteady gait
  • Delayed motor development
323
Q

Indications for CT/MRI in a child with a headache

A
  • Focal neurological signs
  • Signs of raised ICP
  • Headaches worse on lying down
  • Confusion
  • Altered consciousness
  • Change in personality
  • Abnormal gait
  • Growth failure
  • Diplopia
  • Facial nerve palsy
  • Visual field defects
  • Seizures
  • Atypical auras
  • Thunderclap headaches
  • Known existing secondary cause
324
Q

Indications for CT head in a child with head injury

A

ONE of:

  • GCS <14 if >1 or <15 if <1 on ED arrival
  • GCS <15 more than 2 hours post injury
  • Post-trauma seizure with no history of epilepsy
  • Suspected NAI
  • Suspected open or depressed skull fracture
  • Tense fontanelle
  • Signs of basal skull fractures: panda eyes, Battle’s signs, Haemotympanum, CSF leakage
  • Child <1 with bruise, swelling or laceration on head measuring >5cm
  • Focal neurological deficit

OR TWO of:

  • Witnessed loss of consciousness
  • Three discrete episodes of vomiting
  • Abnormal drowsiness
  • Amnesia >5 mins
  • Dangerous mechanism of injury
325
Q

Indications for spinal CT in a child with a head injury

A
  • Plain Xray would be technically difficult/inadequate
  • Strong clinical suspicion of injury despite normal x-ray
  • GCS <13 on initial assessment
  • Focal peripheral neurological signs
  • Definitive diagnosis of C-spine injury is needed urgently
  • Patient is having other body areas scanned
  • Patient has been intubated
326
Q

Management of a child with a minor head injury

A

Discharge home with appropriate red flag advice

327
Q

Management of a child with possible signs of an intracranial bleed but no indications for CT head

A

Admit and observe for at least 4 hours (12-24 hours for skull fractures)

328
Q

Causes of raised ICP

A
  • Traumatic brain injury
  • Hydrocephalus
  • Brain tumour
  • Infection
  • Metabolic upset
  • Idiopathic intracranial hypertension
329
Q

Clinical features of raised ICP

A
  • Headache
  • Vomiting
  • Visual signs and symptoms
  • Motor signs and symptoms
  • Growth and developmental abnormalities
  • Behavioural changes
  • Diabetes insipidus
  • Seizures
  • Altered consciousness
  • Papilloedema
  • Sunset sign
  • Retinal haemorrhage
  • Pupillary abnormalities
  • Cushing’s sin: bradycardia, hypertension, fluctuating consciousness and irregular respiration
330
Q

Management of raised ICP

A
  • Elevation of bed head to 30o
  • Maintain airway
  • Maintain adequate ventilation and circulation
  • Antipyretics
  • Analgesia, sedation +/- neuromuscular blockage
  • Seizure prophylaxis
  • Hyperosmolar therapy: 3% NaCl bolus
  • Fluids restriction
  • Surgical decompression
331
Q

Clinical features of DMD/BMD

A

DMD onsets in early childhood, BMD onsets around age 10.

  • Delayed walking
  • Frequent falls
  • Developmental delay
  • Waddling gait/Trendelenburg gait
  • Muscle hypertrophy, particularly in the calves
  • Gower’s sign
  • Kyphoscoliosis
  • Cardiomyopathy
  • Respiratory failure
  • GORD
  • Intellectual impairment
  • Seizures
332
Q

Investigations in DMD/BMD

A
  • Creatinine kinase: elevated
  • Dystrophin gene mutation testing
  • Muscle biopsy
333
Q

Management of DMD/BMD

A
  • Optimisation of nutrition
  • Prompt management of infection
  • Close cardiac monitoring
  • Respiratory support
  • Physio/OT
  • Calcium, Vit D, Bisphosphonate therapy
  • Corticosteroids
  • Surgical procedures
334
Q

Clinical features of myotonic dystrophy

A

Autosomal dominant

  • Hypotonia
  • Facial muscle weakness
  • Breathing, feeding problems
  • Dysarthria
  • Arrhythmias, cardiomyopathy
  • Hypothyroidism
  • Adrenal insufficiency
  • Immunological deficiency
  • Cataracts
  • Intellectual impairment
335
Q

Diagnosis of myotonic dystrohy

A

Genetic testing

336
Q

Risk factors for neural tube defects

A
  • Previous child with a neural tube defect
  • Poor maternal nutrition
  • Lack of folic acid intake during pregnancy
337
Q

Types of neural tube defects

A
  • Spina bifida
  • Meningocele: protrusion of the meninges through the skull and vertebrae
  • Myelomeningocele: protrusion of the meninges and spinal cord through the vertebrae
  • Encephalocele: protrusion of brain and meninges through a midline skull defect
338
Q

Clinical features of spina bifida

A
  • Skin lesions in sacral region

- Associated neurological dysfunction

339
Q

Clinical features of meningocele

A
  • Hydrocephalus
  • Midline fluctuant mass in back covered by skin
  • Bladder and bowel dysfunction
340
Q

Clinical features of myelomeningocele

A
  • Bladder/bowel incontinence
  • CSF leak
  • Muscle weakness/paralysis
  • Hydrocephalus
  • Sensory loss
  • Cranial nerve palsies
  • Scoliosis
341
Q

Management of neural tube defects

A

Surgical correction (+/- CSF shunt)

342
Q

Complications of encephalocele

A
  • Cerebral abnormalities
  • Hydrocephalus
  • Visual defects
  • Microcephaly
  • Cognitive loss
  • Seizures
343
Q

Define microcephaly

A

Head circumference which is more than 3 SDs below the mean for age and sex

344
Q

Causes of microcephaly

A
  • Isolated microcephaly
  • Down syndrome
  • Edward syndrome
  • Congenital infection
  • Foetal alcohol syndrome
  • Ischaemic/hemorrhagic stroke
345
Q

Causes of hydrocephalus

A
  • Infection
  • Haemorrhage
  • Tumour
  • Trauma
  • Choroid plexus papilloma
346
Q

Clinical features of hydrocephalus

A
  • Bulging fontanelle
  • Broadening forehead
  • Enlarging head circumference
  • Sunsetting of pupils
  • Irritability, lethargy or drowsiness
  • Muscle spasticity with brisk reflexes
  • Dilated scalp veins
  • Headache
  • Signs of raised ICP
  • Confusion
  • Blurred vision
  • Urinary/faecal incontinence
347
Q

Diagnosis of hydrocephalus

A

Cranial US

MRI - GOLD STANDARD

348
Q

Management of hydrocephalus

A
  • Acetazolamide + Furosemide

- VP shunt

349
Q

Clinical features of transient synovitis

A
  • Children aged 2-12
  • Sudden onset limp with hip/knee pain
  • Absence of rest pain
  • Decreased range of motion, especially internal rotation
  • Limb held in position of greatest comfort (typically flexed, abducted and slightly externally rotated)
  • Preceding/accompanying URTI
  • Systemically well child
350
Q

Management of transient synovitis

A
  • Rest and simple analgesia

- Should resolve within 2 weeks

351
Q

Clinical features of reactive arthritis

A
  • Preceding GI infection or STI 2-4 weeks before joint symptoms
  • Acute fever, malaise and fatigue
  • Mono or polyarthritis affecting knees, ankles, hands and feet
  • Sacroileitis
  • Heel pain
  • Plantar fasciitis
  • Urethritis
  • Conjunctivitis
  • Keratoderma blennorrhagia
  • Circinate balanitis
  • Macules and pustules
352
Q

Investigations for reactive arthritis

A
  • Inflammatory markers
  • FBC
  • HLA-B27
  • Microbiology
  • Joint aspiration
  • Plain X-ray
353
Q

Management of reactive arthritis

A
  • Rest
  • Joint immobilisation
  • Physio
  • NSAIDs
  • Intra-articular steroids or systemic steroids
  • Antibiotics
354
Q

Prognosis for reactive arthritis

A
  • 1/3 develop recurrent/chronic disease
  • 1/3 have functional limitation due to destructive arthritis
  • 1/3 recover
355
Q

Define JIA

A

Joint inflammation presenting before 16 years old and persisting for at leas 6 weeks in the absence of infection or other defined cause

356
Q

Treatment of JIA

A
  • Physio
  • NSAIDs
  • Intra-articular injection
  • Oral steroids and DMARDs
357
Q

Complications of JIA

A
  • Growth failure
  • Anterior uveitis
  • Amyloidosis
  • Osteoporosis
358
Q

Clinical features of osteogenesis imperfecta

A
  • Osteopenia
  • Bone fragility and fractures
  • Ligament laxity
  • Blue sclera
  • Hypermobile joints
  • Hearing loss
  • Multiple Wormian bones in skull
  • Short stature
  • Dental problems
359
Q

Investigations in osteogenesis imperfecta

A
  • Antenatal US
  • Play Xray
  • Bone densitometry
  • Genetic testing
360
Q

Management of osteogenesis imperfecta

A
  • Physio
  • Rehab and prompt splinting of fractures
  • Bisphosphonates
  • Surgery
361
Q

Risk factors for nephrotic syndrome

A
  • Asian
  • Male
  • Previous infection
  • Medications e.g. NSAIDs
  • SLE
  • Diabetes
  • HIV
  • FH
  • Previous nephrotic syndrome
362
Q

Causes of nephrotic syndromr

A
  • Minimal change disease
  • FSGS
  • Membranous nephropathy
  • Membranoproliferative GN
363
Q

Clinical features of nephrotic syndrome

A
  • Children aged 2-6
  • Proteinuria
  • Hypoalbuminaemia
  • Oedema e.g. peri-orbital
  • Discomfort related to swelling or skin breakdown
  • Weight gain
  • Abdo distention
  • Fatigue
  • Foamy urine
  • Increased infections
  • Poor growth and development
364
Q

Investigations in nephrotic syndrome

A
  • Serum albumin
  • Urine dipstick
  • Early morning protein/albumin: creatinine ratio
  • 24 hour urinary protein
  • Lipid profile
  • Renal function
  • Urinary sodium
  • TFTs
  • FBC
365
Q

Management of nephrotic syndrome

A

High dose corticosteroids for 4 weeks

  • BP monitoring
  • Dietary sodium restriction
  • Prophylactic penicillin
  • Fluid management
  • Vaccination
  • Immunomodulatory agents
366
Q

Complications of nephrotic syndrome

A
  • Infection
  • Intravascular hypovolemia
  • Hypercoaguability
367
Q

Bacterial causes of UTI

A
  • E. coli
  • Proteus
  • Klebsiella
  • Enterococcus
  • Staph
368
Q

Risk factors for UTI

A
  • Sex: male <6 months, then female
  • Constipation
  • VUR
  • Congenital abnormalities of the urinary tract
  • Previous UTIs
  • Encopresis
  • Nephrolithiasis
  • Uncircumcised boys
369
Q

Clinical features of a UTI in children

A
  • Changes in urine appearance and smell
  • Increased urinary frequency, urinary incontinence
  • Dysuria
  • Abdo pain
  • Fevers/rigors
  • Nausea and vomiting
  • Poor growth
  • Poor feeding
  • Irritability
  • Sleepiness
  • Jaundice
  • Difficulty breathing
370
Q

Features of an atypical UTI

A
  • Serious illness
  • Poor urine flow
  • Abdo or bladder mass
  • Spinal lesion
  • Renal dysfunction
  • Sepsis
  • Failure to respond to suitable antibiotics in 48 hours
  • Infection with non-E.coli organisms
371
Q

Define recurrent UTIs

A
  • 2+ episodes of UTI with pyelonephritis OR
  • 1 episode of UTI with pyelonephritis + 1 episode with cystitis OR
  • 3+ episodes of UTI with cystitis
372
Q

Investigations in UTI

A
  • Urine culture: clean catch, MSU, catheter, urine bag
  • Urine dipstick
  • FBC
  • BP & U&Es
373
Q

Further investigations for UTI (e.g. recurrence)

A
  • Renal US
  • MCUG
  • DMSA
374
Q

Indications for IV antibiotics in UTI

A
  • Children <3 months
  • Acutely unwell children
  • Persistent vomiting
375
Q

Complications of UTI

A
  • Sepsis
  • Renal abscess
  • Pyelonephritis
  • AKI/CKD
  • Hypertension
  • Hydronephrosis
376
Q

Risk factors for recurrent UTIs

A
  • Children <6 months
  • Female
  • Underlying renal tract abnormalities
  • Uncorrected predisposing factors
  • Renal abscess
  • Hydronephrosis
377
Q

Causes of enuresis

A
  • Physiological
  • Bladder instability
  • Bladder neck muscle weakness
  • Neurogenic bladder
  • Anatomical abnormalities
  • Urinary concentration defects e.g. T1DM, diabetes insipidus, renal disorders
  • UTIs
  • Constipation
  • Emotional upset
  • Developmental delay
  • Maltreatment
  • Primary neurological deficit
378
Q

Investigations in enuresis

A
  • Diary of fluid intake, toileting and bedwetting
  • Urine C&S
  • Bladder US
  • Spinal MRI
  • Urodynamic studies
379
Q

Management of enuresis

A
  • Lifestyle advice
  • Reward system
  • Bell-pad alarms
  • Desmopressin
  • Tricyclics/anticholinergics
380
Q

Clinical features of HSP

A
  • Children age 3-10
  • More common in males
  • Non-blanching purpuric rash over buttocks and extensor surfaces of limbs
  • Arthralgia, especially in knees and ankles
  • Abdo pain
381
Q

Investigations in HSP

A
  • BP
  • Urine dipstick
  • U&Es
  • Albumin
382
Q

Management of HSP

A
  • Monitor in primary care until resolution
  • Simple analgesia (AVOID NSAIDs)
  • Long term follow up with repeat U&Es
383
Q

Indications for referral to nephrology in HSP

A
  • Nephrotic range proteinuria
  • Renal dysfunction
  • Hypertension
  • Macroscopic haematuria
384
Q

Complications of HSP

A
  • GN
  • GI involvement
  • CNS involvement
  • Orchitis
  • Pulmonary vasculitis
385
Q

Treatment of eczema with secondary bacterial infection

A

Mild: antiseptic washes, topical antibacterial cream

Widespread: oral antibiotics, topical corticosteroid

386
Q

Management of infantile seborrheic dermatitis

A
  • Reassurance
  • Emollients
  • Frequent shampooing
  • Removal of scales with gentle brushing
387
Q

Management of headlice

A

Topical pediculicides e.g. Permethrin, phenothrin or malathion

388
Q

Risk factors for DDH

A
  • Female
  • FH
  • First born
  • Breech presentation at delivery
  • Maternal oligohydramnios
  • Associated neuromuscular disorders
389
Q

Clinical features of DDH

A
  • Neonates and infants
  • Asymmetry of the skin folds around the hip
  • Painless limp
  • Limited abduction
  • Child walking on toes on affected side
  • Leg length discrepancy
390
Q

Investigations for DDH

A
  • US in neonates

- Plain Xray in older children

391
Q

Management of DDH in a newborn

A
  • Double nappies

- Harness

392
Q

Management of DDH in a child 6 months-6 years

A
  • Gradual closer reduction

- Formal open reduction if this fails

393
Q

Management of DDH in a child over 6

A

Open reduction

394
Q

Complications of DDH

A
  • OA
  • Subluxation of the hip
  • Spinal changes
395
Q

Risk factors perthes disease

A
  • Male
  • Caucasian
  • Age: 4-8
  • FH
  • LBW
  • Low SES
  • Delayed skeletal ages
396
Q

Clinical features of Perthes disease

A
  • Limp following physical exertion in the absence of trauma
  • Groin pain
  • Antalgic gait
  • Trendelenburg sign
  • Limited range of movement
  • Muscle wasting
  • Leg length discrepancies
397
Q

Investigations for Perthe’s disease

A
  • FBC and inflammatory markers
  • Plain AP and lateral X-rays
  • MRI
  • Radioisotope scanning
398
Q

Features of Perthe’s disease on X-ray

A
  • Collapse/flattening of the femoral head
  • Sclerosis from reduced resorption and relative osteopenia of the rest of the bone
  • Widening of the joint space
  • Subchondral fractures, partial collapse and femoral head fragmentation
  • Coxa magna
  • Subluxation
399
Q

Management of Perthes disease

A

Mild/moderate:

  • No weight bearing
  • NSAIDs
  • Regular physio

Severe disease, patient over 6, failure of conservative management, immobilisation required:

  • Varus osteotomy of femur
  • Innominate osteotomy of pelvis
400
Q

Complications of Perthe’s disease

A
  • Joint stiffness
  • Leg length discrepancy
  • Coza magna
  • Osteoarthritis
  • Premature fusion of growth plates
  • Hinged abduction
401
Q

Poor prognostic indicators for Perthe’s disease

A
  • Female
  • Onset after age 6
  • > 50% femoral head involvement
  • Lateral displacement of femoral head
  • Subluxation
402
Q

Risk factors for SUFE

A
  • Male
  • Obesity
  • Pubertal growth spurt
  • Caribbean ethnicity
  • Delayed skeletal maturity
  • Endocrine disorders
403
Q

Clinical features of SUFE

A
  • Child aged 10-15
  • Referred ipsilateral knee pain
  • Limping
  • Hip, thigh or knee pain
  • Pain on movement in all directions
  • Reduced range of motion, progressive loss of abduction and internal rotation
  • Shortened and externally rotated leg
404
Q

Investigations in SUFE

A
  • Plain AP and frog leg lateral X-rays

- MRI

405
Q

Radiological features of SUFE

A
  • Steel sign
  • Widening of ipsilateral growth plate
  • Decreased epiphysis height
  • Klein’s line
406
Q

Management of SUFE

A

Mild/moderate:

  • Analgesia
  • No weight bearing
  • Cannulated screw insertion under X-ray guidance

Severe:

  • Analgesia
  • No weight bearing
  • Corrective osteotomy and pinning

Prophylactic fixation of the other hip

407
Q

Complications of SUFE

A
  • Avascular necrosis
  • Coxa vera
  • Secondary OA
  • Contralateral SUFE
  • Chondrolysis
408
Q

Risk factors for septic arthritis

A
  • Prematurity
  • Penetrating injury
  • Diabetes mellitus
  • Joint surgery
  • Hip or knee prosthesis
  • Skin infection
  • Immunocompromise
  • Sickle cell disease
409
Q

Clinical features of septic arthritis

A
  • Acute pain and swelling of a joint
  • Overlying joint erythema
  • Severely restricted joint movement
  • Joint effusion
  • Posture changes
  • Systemically unwell
410
Q

Investigations in septic arthritis

A
  • FBC
  • Inflammatory markers
  • Blood cultures
  • US scan
  • X-ray
  • Joint aspiration
411
Q

Management of septic arthritis

A
  • Splint joint
  • IV antibiotics
  • URGENT surgical drainage and irrigation
412
Q

Complications of septic arthritis

A
  • Joint stiffness
  • Septic dislocation
  • Osteonecrosis
  • Shortening of the limb
  • Secondary OA
413
Q

Risk factors for osteomyeltitis

A
  • Penetrating injury
  • Diabetes
  • Skin infection
  • Immunocompromise
  • Sickle cell disease
  • Chronic steroid use
414
Q

Clinical features of osteomyelitis

A
  • Markedly painful, immobile limb
  • Febrile illness
  • Preceding URTI, skin lesion or injury
  • Warm, swollen, erythematous skin
  • Toxaemia
415
Q

Investigations in osteomyelitis

A
  • FBC
  • Inflammatory markers
  • Blood cultures
  • Plain X-rays
  • MRI
  • Bone biopsy
416
Q

Management of osteomyelitiss

A
  • Analgesia
  • Splint limb
  • URGENT IV antibiotics
  • Surgical exploration and drainage if no improvement in 36 hours
417
Q

Complications of osteomyelitis

A
  • Bone abscess
  • Bacteraemia
  • Chronic osteomyelitis
  • Altered bone growth
  • Pathological fracture
  • Septic arthritis
418
Q

Causes of conductive hearing loss

A
  • Down syndrome
  • Craniofacial abnormalities
  • Otitis media with effusion
  • Wax deposition
419
Q

Causes of sensorineural hearing loss

A
  • Genetic syndromes e.g. Alport
  • Prenatal infection
  • Birth trauma/birth hypoxia
  • Meningitis
  • Ototoxic drugs e.g. Gentamicin, Cisplatin
420
Q

Clinical features of acute otitis media

A
  • Common in children aged 6 months to 2 years
  • Otalgia
  • Pyrexia
  • Systemically unwell
  • Blood/fluid discharge from ear
  • Red bulging tympanic membrane/perforation
421
Q

Management of otitis media

A

Analgesia unless antibiotics indicated (amoxicillin)

422
Q

Indications for antibiotics in acute otitis media

A
  • Bilateral
  • Systemically unwell
  • Neonates/very young children
  • Persistent non-resolving infection
423
Q

Complications of acute otitis media

A
  • Tympanic membrane perforation
  • Chronic otitis media with effusion
  • Labyrinthitis
  • Mastoiditis
  • Intracranial complications
424
Q

Clinical features of qunisy

A
  • Trismus
  • Hot potato voice
  • Drooling
  • Odynophagia
  • Lethargy
  • Systemically unwell
  • Pyrexia
  • Affected tonsil, uvula and soft palate pushed towards centre of mouth
425
Q

Clinical features of epiglottitis

A
  • Children 3-5 years
  • Rapidly progressive symptoms with no coryzal prodrome
  • High fever
  • Drooling
  • Dysphagia
  • Significant distress
  • Stridor
  • Laboured breathing
  • Muffled/quiet voice
426
Q

Management of epiglottitis

A
  • DO NOT EXAMINE
  • Intubate
  • Broad spectrum IV antibiotics e.g. ceftriaxone
  • Nebulised steroids or adrenaline
427
Q

Advantages of breastfeeding

A
  • Provides infants with right amount of nutrients for health growth and development
  • Easily absorbed by infants
  • Not complicated by infections
  • Contains antibodies
  • Numerous longterm health benefits
  • Stimulates release of oxytocin
  • Facilitates postpartum weight loss
  • Contraceptive effect
  • Lowers risk of ovarian and breast cancer and osteoporosis in mothers
  • Saves time and money
  • Bonding opportunity
428
Q

Contraindications to breastfeeding

A
  • Active TB in mother
  • Mother with breast cancer undergoing chemotherapy
  • Syphilitic or herpetic lesions on breast or nipple
  • Infant inborn errors of metabolism causing intolerance
  • HIV positive mother
  • Mothers using illicit drugs
  • Mothers who develop VZV 5 days prior to or 2 days post delivery
429
Q

Define faltering growth/failure to thrive

A

Significant interruption in the expected rate of growth compared with other children of the same gender and age

430
Q

Causes of faltering growth

A
  • Anatomical abnormalities
  • Prolonged exclusive breastfeeding
  • Intestinal obstruction
  • Malabsorptive diseases
  • Recurrent infections
  • Congenital heart disease
  • Chronic pulmonary disease
  • Endocrine disease
  • Teratogenic exposure in utero
  • IUGR, prematurity or LBW
  • Genetic syndromes or inborn errors of metabolism
  • Anaemia
  • Poverty
  • Inappropriate diet
  • Coercive feeding
  • Distractions at mealtimes
  • Social isolation
  • Life stressors
  • Poor parenting skills
  • Neglect
  • Parental mental health issues
431
Q

Risk factors for childhood obesity

A
  • Prematurity
  • LGA
  • Poor maternal weight in pregnancy
  • Gestational diabetes
  • Preeclampsia
  • Ethnicity
  • Low SES
  • Endocrine disorders
  • Genetic syndromes
432
Q

Clinical features of vitamin B1/thiamine deficiency

A
  • Beriberi: symmetrical peripheral neuropathy, cardiomegaly, heart failure, peripheral oedema
433
Q

Clinical features of vitamin B2/riboflavin deficiency

A
  • Glossitis
  • Chellitis
  • Oedema of mucous membranes
  • Seborrheic dermatitis
434
Q

Clinical features of vitamin B3/niacin deficiency

A
  • Dementia
  • Dermatitis
  • Diarrhoea
435
Q

Clinical features of vitamin B5/pantothenic acid deficiency

A
  • Parasthesia in the extremities
436
Q

Clinical features of vitamin B6/pyridoxine deficiency

A
  • Glossitis
  • Chellitis
  • Depression
  • Irritability
  • Seizures
  • Confusion
437
Q

Clinical features of vitamin B7/biotin deficiency

A
  • Hair loss
  • Dry, scaly skin
  • Chellitis
  • Glossitis
  • Seborrheic dermatitis
438
Q

Clinical features of vitamin B9/folate deficiency

A
  • Neural tube defects

- Macrocytic anaemia

439
Q

Clinical features of vitamin B12 deficiency

A
  • Megaloblastic anaemia
  • Amnesia
  • Irritability
  • Subacute combined degeneration of the spinal cord
440
Q

Clinical features of vitamin C deficiency

A
  • Scurvy
  • Easy bruising
  • Bleeding gums
  • Follicular hyperkeratosis
  • Parafollicular haemorrhage
  • Impaired wound healing
  • Weakness
  • Arthralgia
  • Neuropathy
441
Q

Clinical features of vitamin E deficiency

A
  • Neurological deficits

- Haemolytic anaemia

442
Q

Clinical features of vitamin K deficiency

A
  • Easy bleeding/bruising
443
Q

Clinical features of vitamin A deficiency

A
  • Xerophthalmia
  • Dryness, fragility and clouding of the cornea
  • Bilot’s spots
  • Corneal keratomalacia
  • Corneal ulceration and scarring
  • Night blindness, severe visual impairment and complete blindness
  • Dry, scaly skin
  • Dry hair
  • Broken finger nails
  • Impaired immunity
444
Q

Risk factors for vitamin D deficiency

A
  • Dark skin
  • High latitudes
  • Winter
  • Excessive use of sunblock and protective clothing
  • Staying indoors
  • Being exclusively breastfed beyond 3-6 months
  • Inadequate maternal consumption
  • Maternal vitamin D deficiency during pregnancy
  • Premature birth
  • Medications
  • Impaired intestinal absorption
  • Liver/kidney disease
445
Q

Clinical features of vitamin D deficiency

A
  • Asymptomatic
  • Seizures
  • Cardiomyopathy
  • Poor growth
  • Delayed walking
  • Tooth decay/enamel hypoplasia
  • Bone pain
  • Osteomalacia
446
Q

Investigations in vitamin D deficiency

A
  • 25hydroxy vitamin D
  • Alk phos: increased
  • PTH: increased
  • 1,25-dihydroxyvitamin D: raised or lowered
447
Q

Vitamin D supplementation recommendation in UK

A

Recommended for all children between 6 months and 5 years old

Year 5 (9 decks)

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