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Year 3 GP > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Name the developmental milestone at 4-12 weeks

A

Holding head up when lying flat

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2
Q

Name the developmental milestone at 3-5 months

A

Reaches for objects and can hold them

Can lift head and chest

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3
Q

Name the developmental milestone at 6 and 8 months respectively

A

6m - can sit up with support

8m - can sit up unaided

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4
Q

Name three developmental milestones at 9-12 months

A

Drops objects and picks them up
Starts to crawl
Can pull themselves up in prep to stand

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5
Q

Name two major milestones happening at 12 months

A

Begin to stand

Says first word

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6
Q

Name 3 developmental milestones at 13-18 months

A

Starts to feed themselves
Begins to build with bricks
Starts to walk unaided

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7
Q

What developmental milestone happens at 24 months?

A

Walks up and down steps

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8
Q

Describe the Moro Reflex

A

Startled response to a change in sensory stimuli (i.e dropping the baby)
Should stop at 2-4m

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9
Q

Describe the Rooting Reflex

A

Baby automatically turns head to touch on cheek (assists in finding food)
Should stop at 3-4 months

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10
Q

Describe the Palmar Reflex

A

Hands grip anything placed in them

Should stop at 5-6 months

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11
Q

Describe the Asymmetrical Tonic Neck

A

When turning the head, the limbs on the same side extend while the opposite side bends

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12
Q

Describe Symmetrical Tonic Neck

A

When head is down, arms bend and legs extend

When head is back arms extend and legs bend

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13
Q

Describe the Spinal Galant Reflex

A

Hip rotation when back is touched on either side

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14
Q

At 6 week checks both Mother and Babies are checked, describe 5 features of the Mother’s Check

A 
How stitches have healed
Breasts
Rubella Immunity
Vaginal Discharge? Periods?
Mental Health
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15
Q

What four things does the 6 week check of the baby aim to detect?

A

Congenital Heart Disease
Congenital Cataracts
Delevopmental Dysplasia of the Hip
Undescended Testes

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16
Q

Give three risk factors for DDH

A

Oligohydramnios
Family History
Breach Position

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17
Q

What is Barlow’s Test?

A

Identifies hips which are dislocatable
Keep ipsilateral hand on pelvis and greater trochanter, and with other hand FLEX and ADDUCT the hip, pushing posteriorly to see if hip ‘pops out’

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18
Q

What is Ortolani’s Test?

A

Identifies hips which are dislocated

Abduct the hip until it is flat on the bed, to see if you hear a ‘click’

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19
Q

What is the ‘Red Reflex’?

A

Should have a red reflection when shining an opthalmoscope into baby’s eye
If not indicates ocular pathology such as cataracts or other opacities

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20
Q

What body temperatures would cause concern in an infant (ie red and amber flag)?

A

> 38 degrees in 0-3m (RED)

>39 in 3-6m (AMBER)

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21
Q

Describe the infant classifications of ‘Tachycardia’

A

Greater than 160bpm in <1yr
Greater than 150 in 1-2yr
Greater than 140 in 2-4yr

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22
Q

Describe the infant classifications of ‘Tachypnoea’

A

RR>60 in 0-5m
RR>50 in 6-12m
RR>40 in older than 12m

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23
Q

Give 5 differentials for the ‘Common Cold’ in infants

A 
Meningitis
Herpes Simplex Encephalitis
Pneumonia
UTI 
Kawasaki
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24
Q

What is Whooping Cough?

A

A notifiable disease
A highly infectious respiratory infection caused by Bordatella Pertussis
Can still occur in vaccinated individuals

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25
Q

What is the incubation period and infectivity period of Whooping Cough?

A

Incubation Period is 7-20d

Non infectious after 3 weeks of symptoms onset

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26
Q

Describe the first stage presentation of Whooping Cough

A

Catarrhal

Mild Respiratory Infection

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27
Q

Describe the second stage presentation of Whooping Cough

A

Paroxysmal Coughing
After 1-2 weeks
Prolonged dry hacking cough followed by characteristic ‘whoop’ as they catch their breath
The cough can last 2-3 months even after infection has cleared

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28
Q

Describe two possible investigations for Whooping Cough

A 
Nasopharyngeal Swab Culture
Serology Testing (for Anti-Pertussis IgG)
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29
Q

Describe the management of Whooping Cough

A

Hospital Admission if under 6 months

Antibiotics don’t alter clinical course, only affect infectivity (therefore Clarythromycin only within first 3 weeks)

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30
Q

What is GORD in Children?

A

Non forceful regurgitation of milk and other gastric contents into the oesophagus (should be distinguished from vomiting - active)

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31
Q

Give four risk factors for GORD in Children

A

Premature Birth
FH
Obesity
Hiatus Hernia

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32
Q

Give four presentations of GORD

A

Heartburn
Recurrent regurgitation/vomiting
Feeding and Behavioural Problems
Failure to Thrive

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33
Q

What is laryngopharyngeal reflux?

A

Reflux into larynx, oropharynx and/or nasopharynx

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34
Q

How would you manage GORD in infants?

A

Reassure that it’s very common and generally doesn’t require any further investigation
If formula fed try smaller more frequent meals with thickened formula (Gaviscon, Carobel)

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35
Q

When should you investigate infantile GORD further?

A

If it becomes projectile

If it becomes haematemesis/blood stained

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36
Q

What is Croup?

A

Inflammation of upper respiratory tract usually as a result of viral infection, affecting primarily 6 months to 3 years

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37
Q

What is Spasmodic Croup?

A

If recurrent bouts then aetiology is more likely allergic than infective

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38
Q

How would Croup present?

A

Typical URTI then a barking cough/hoarse voice starts
May have Stridor
Severity assessed with Westley CLinical Scoring System

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39
Q

How would you manage Croup?

A 
Keep the child as calm as possible
Paracetamol/Ibuprofen
Inpatient O2 Therapy
Oral Dexamethasone/Nebulised Budesonide
Nebulised Epinephrine
40
Q

Name three features that decrease the probability of a child having Asthma

A

Symptoms only occurring in conjunction with a cold
Isolated cough without wheeze/breathing difficulties
Productive cough

41
Q

Spirometry can be used from the age of 5, if it was negative what other investigations could you consider?

A 
Atopic Status (Skin tests, IgE)
Bronchial Hyperresponsiveness (exercised induced? Metacholine induced?)
42
Q

Describe the four step (up) management for Asthmatic Children under 5

A

1) SABA PRN
2) Beclometasone Diproprionate
3) If over 3 - Leukotriene Antagonist (Montelukast)
4) Refer to Paediatrician

43
Q

Describe the five step (up) management for Asthmatic Children aged 5-12

A

1) SABA PRN
2) Betamethasone Diproprionate
3a) LABA
3b) Increase Steroid dose to 400mcg or add Leukotriene Antagonist
4) Increase Steroid dose to 800mcg
5) Oral Steroids

44
Q

Name the most common brand name of a SABA inhaler

A

Ventolin

45
Q

Name two brand names of steroid inhalers

A

QVAR (Beclometasone)

Pulmicort (Budesonide)

46
Q

What is contained in Fostair inhalers?

A

Formeterol and Beclometasone

47
Q

What is contained in Symbicort inhalers?

A

Formeterol and Budesonide

48
Q

Conjunctivitis in children is normally bacterial in origin, how would it present?

A

Generally absence of itch
Purulent discharge
Discomfort
Mild Photophobia

49
Q

Give 3 risk factors for Conjunctivitis in Children

A

Nasolacrimal duct obstruction
Concomitant Otitis Media and Pharyngitis
Exposure to affected individual

50
Q

What is Opthalmia Neonatorum?

A

Any conjunctivtis in the first 28 days of life
Caused by either Silver Nitrate eye drops (originally used as prophylaxis against conjunctivitis) or infection by maternal genital tract

51
Q

How would you manage Conjunctivitis in children?

A

Self limiting
Gonorrhoea - IM Ceftriaxone
Chlamydia - Tetracylcline ointment and systemic doxycycline

52
Q

Name three common pathogens of Acute Otitis Media

A

Haemophilus Influenza
Streptococcus Pneumoniae
Streptococcus Pyogenes

53
Q

State four symptoms of Acute Otitis Media

A

Pain (tugging at ear)
Malaise
Irritability
Fever

54
Q

How would Acute Otitis Media present on an auroscope?

A

Red/Cloudy tympanic membrane, likely bulging

55
Q

What might be a sign of ear perforation of Children with Acute Otitis Media?

A

Relieves pain in the child
Scream/Distressed may suddenly stop
Green Pus out of ear

56
Q

When should you admit patients with Acute Otitis Media?

A 
Children under 3 months with a temp greater than 38 (RED FLAG)
Suspected complications (meningitis, mastoiditis, facial nerve paralysis)
57
Q

When should you offer Abx for Acute Otitis Media? What should you give?

A

Systemically unwell
At risk of complications
Symptoms not improving after four days
Children less than 2y/o with bilateral infection

5 Day Amoxicillin

58
Q

Give 4 causes of constipation in Children

A

Anorectal Malformation
Cow’s Milk Allergy
CF
Hischsprungs Disease

59
Q

How would you manage Constipation in a child

A

Disimpaction - Osmotic Laxative (Movicol Paediatric) and then if no improvement after two weeks a Stimulant Laxative (Bisacodyl)
Maintenance - increased fluids and fibre, bowel charts

60
Q

Why should you avoid prolonged use of Stimulant laxatives?

A

Can cause atonic colon and hypokalaemia

61
Q

What is the infectivity period of Chickenpox?

A

2d prior to lesions appearing to after they scab over (around 5d later)

62
Q

Who is at risk of SERIOUS complications of Chickenpox?

A

Immunocompromised

Pregnancy (for mother and foetus)

63
Q

Name four features of Chickenpox

A

Pyrexia
Headache
Malaise
Lesions

64
Q

Describe the lesions of Chickenpox

A

Papule to Vesicle to Pustule to Crust

65
Q

How would you manage Chickenpox?

A

Advise minimising scratching and avoiding pregnant women/neonates etc
Symptom management with Paracetamol and Antihistamines for Pruritus
Only give Acyclovir if at risk of complications

66
Q

Describe 3 complications of Chickenpox

A

Secondary bacterial infection
Viral Pneumonia
Encephalitis

67
Q

Name the early and late complications of VZV in pregnancy

A

Early - Congenital Varicella Syndrome (IUGR)

Late - Premature Delivery

68
Q

Define Measles

A

A notifiable disease caused by RNA Morbillivirus

One of the most infectious diseases (airborne transmission via respiratory droplets)

69
Q

What is the infective period of Measles?

A

Four days before the rash appears until four days after

70
Q

How does Measles present?

A

Prodrome - fever/cough/conjunctivitis/Kopliks spots on buccal mucosa (red spots with bluish white centre)

Rash - first seen in head anc neck before spreading to trunk and limbs (lasts 3-4 days before fading to give brownish discolouration)

71
Q

How is Measles diagnosed?

A

Lab test for specific IgM for Measles within 6 weeks of onset

72
Q

How would you manage Measles?

A

Self limiting
Paracetamol/Ibuprofen
Stay at home

73
Q

Give 3 complications of Measles

A

Bronchopneumonia
Giant Cell Pneumonitis
Acute Demyelinating Encephalitis

74
Q

Describe 5 features of Head lice management

A 
Can still attend school
No need to wash clothing/bedding
Mechanical - wet combing
Physical Insecticides - Hedrin (block o2 supply)
Chemical Insecticides
75
Q

Describe the pathophysiology of Viral Warts

A

Caused by various strains of HPV
Infection of keratinocytes causes hyperkeratinisation and epidermal thickening

Transmitted by direct contact

76
Q

Describe three subtypes of viral warts

A

Common - papules and nodules usually on hands
Plantar Wart - Verucca
Periungal Wart - Warts around the nails, more common in nail biters

77
Q

How would you manage viral warts?

A

Generally don’t

If immunocompromised/symptomatic then use topical salicyclic acid or cryotherapy

78
Q

Describe the pathophysiology of Threadworms

A

Female threadworms lay their eggs around the childs perineurium and produce an irritant mucous which causes intense pruritus

79
Q

How might Threadworms present?

A

Nocturnal pruritus

Prepubertal vaginal discharge/UTI/nocturnal enuresis

80
Q

What investigations would you do if you suspected Threadworms?

A

Simple report of appearance of ‘moving cotton’

ALWAYS suspect the possibility of sexual abuse

81
Q

How would you manage Threadworms?

A

Good hygiene for 6 weeks (tight udnerwear at night/shower every morning/change and wash undwear and bedding daily)
Mebendazole (single dose) if over two (only kills adult worms) FOR WHOLE FAMILY

82
Q

What is Scarlet Fever?

A

Exotoxin mediated disease arising from Strep Pyogenes (normally from tonsillar/pharyngeal infection
Spread by respiratory droplets

83
Q

How does Scarlet Fever present?

A

Onset of illness is usually sudden with fever/headache/sore throat
Rash follows 24-48hrs after

84
Q

Describe the Scarletiniform Rash

A

First affects neck/trunk/scapula
Coarse texture
Circumoral Pallor
Tongue - white strawberry

85
Q

How would you manage Scarlet Fever?

A

Penicillin/Azithromycin for 10 days
Rest and Fluids
Paracetamol/Ibuprofen

86
Q

What is the difference between GORD and GOR in Children?

A

GORD is where there is evidence of Oesophagitis (crying, arching back)

87
Q

What is the Colic Rule of 3?

A

Crying more than 3 hours a day, more than 3 days a week, for more than three weeks
Generally occurs from 2 weeks to four months
Still Thriving

88
Q

How would Cows Milk Protein Allergy present?

A

Any of the 8 core GI symptoms

89
Q

In terms of timing in children’s symptoms, what is a red flag?

A

Nocturnal symptoms are rare in children, so should be treated as a red flag

90
Q

Describe the pathophysiology of DDH

A

Misalignment of femoral head and acetabulum , causing them to grow out of proportion to each other

Ligaments and labrum hypertrophy to fill the space

Results in unstable hip joint

91
Q

How might a patient with DDH present?

A

May have no symptoms and be an incidental finding on the 6w baby check

Uneven leg length

Painless Limping

Waddling gait

92
Q

How is DDH managed?

A

<6 months - Povliks harness, keeping the femoral head in the acetabulum via flex ion and abduction

> 6 months - reduction under anaesthesia

93
Q

What is Perthes Disease?

A

Childhood disease where blood supply to the femoral head is reduced resulting in avascular necrosis

94
Q

How would a patient with Perthe’s disease present?

A

Limp and Hip Pain (often referred to knee, worsened with activity, or with internal rotation/abduction
Associated Muscle Disuse Atrophy

95
Q

How would you investigate suspected Perthes Disease?

A

X-ray - flattening/misshapen femoral head

MRI

96
Q

How would you manage Perthes Disease?

A

Generally self resolving, so just conservative management including physio

If very fractured may require surgery

97
Q

What is Gillick’s Competence?

A

The idea that some children will be capable/competent enough to consent to their own medical management decisions despite being under the age of 16

Year 3 GP (6 decks)

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