Paediatrics Flashcards
1
Q
When do you give the BCG vaccine in the UK?
A
At birth if someone in the family has been exposed in the last 6 months
2
Q
At which ages is the 6-in-1 vaccine given?
A
2, 3 and 4 months
3
Q
What is the 6-in-1 vaccine?
A
Diphtheria Tetanus Whooping Cough Polio Haemophilus influenzae B (Hib) Hepatitis B
4
Q
At which ages is the oral rotavirus given?
A
2 and 3 months
5
Q
At which ages is the Men B vaccine given?
A
2, 4 and 12 months
6
Q
At which ages is the PCV (Pneumococcal) vaccine given?
A
3 and 12 months
7
Q
At which ages is the MMR given?
A
12 months and 3-4 years
8
Q
At which age is the HPV vaccine given?
A
12-13 years (both males and females)
9
Q
At which age is the 4-in-1 given?
A
3-4 years
10
Q
What is in the 4-in-1 vaccine?
A
Diphtheria
Tetanus
Whooping Cough
Polio
11
Q
What is in the 3-in-1 vaccine?
A
Diphtheria
Tetanus
Polio
12
Q
When is the 3-in-1 vaccine given?
A
13-18 years
13
Q
When is the Men ACWY vaccine given?
A
13-18 years (usually before starting university)
14
Q
When is the influenza vaccine given?
A
2-8 years
15
Q
When is the Hib/MenC joint vaccine given?
A
12 months
16
Q
Which vaccines do you receive at 3 months?
A
6-in-1, Oral Rotavirus, PCV
17
Q
Which vaccines do you receive at 4 months?
A
6-in-1, Men B
18
Q
Which vaccines do you receive at 12 months?
A
Men B, PCV, MMR, Hib/Men C
19
Q
Which vaccines do you receive at 2 months?
A
6-in-1, Oral Rotavirus, Men B
20
Q
At which age should solid foods be introduced?
A
6 months
21
Q
What are the screening tests available for allergies?
A
blood tests and skin pricks
22
Q
What is the diagnostic test for food allergy?
A
Food challenge is the gold-standard
23
Q
What is the 4 step management for food allergy?
A
1 - avoid allergen
2 - anti-histamines (± steroid)
3 - adrenaline
4 - immunotherapy
24
Q
Management of CMPA (Cow’s Milk Protein Allergy) - usually occurs in first year of life
A
Give hydrolysed or amino acid based formula
Reintroduce after 1 year
25
Buzzword: barking/harsh cough
Croup
26
Buzzword: drooling
Epiglottitis
27
What causes croup?
Parainfluenza virus
28
What causes bronchiolitis?
RSV
29
Management of croup
Everyone should receive a single dose dexamethasone
30
What is the commonest cause of intrinsic AKI in Scotland?
HUS (E.coli O157)
31
Diagnosing Appendicitis
Clinical
32
Management of transient synovitis
Watch and wait - self-limiting
33
Diagnosis of SUFE
XR Pelvis (AP and Lateral)
34
Diagnosis of Perthes
XR Pelvis AP
35
What is usually the first clinical sign of cystic fibrosis?
Meconium ileus
36
What genetic condition is nasal polyps associated with?
Cystic fibrosis
37
Diagnosis of CF
Sweat test (positive is high chloride >60mEq/L)
38
Medication of choice for CF delta F508 variant
Lamacaftor/Ivacaftor (Orkambi)
39
Purple inhaler
Seretide - contains fluticasone (twice as potent as beclamethasone)
40
Brown inhaler
Clenil Modulite - equivalent to Beclomethasone
41
Diabetic targets - BG/Hypos/HBA1c
BG 4-7 mmol
Hypos ≤2 mild /week
HBA1c ≤48 mmol/mol in year 1 of diagnosis and ≤56 mmol/mol thereafter
42
Management of hyperketonaemia in T1DM
0.6-1.5 give insulin
| >1.5 emergency
43
Management of severe hypos in the community
Call ambulance, administer glucagon injection
44
Antenatal steroids reduce the risk of .... (4)
RDS
Sepsis
IVH
NEC
45
Antenatal magnesium sulfate reduces the risk of ...
Neurodevelopmental problems
46
Risk factors for RDS
- M>F
- Maternal diabetes
- Maternal hypertension
- IUGR <29 weeks
- Sepsis
- Hypothermia
- C-section
- Second twin
47
Neonatology. What is Vitamin K given for?
Prevent haemorrhagic disease of the newborn
48
Why is caffeine given to preterm babies?
Prevent apnoeic episodes
49
What is the current guidance regarding multivitamin?
Given till age 5
50
Features of NEC
Bloody stool, bilious vomiting and large distended abdomen
51
Diagnosis of NEC
Abdominal X-ray
52
Management of NEC
TPN and antibiotics
| Surgery if severe
53
At which gestation does suckling reflex develop?
35 weeks - preterm before this age must get NG tube
54
At what times post-delivery are APGAR measures recorded?
1 minute
5 minutes
10 minutes
55
What is first/second/third line management of status epilepticus?
1 - Benzodiazepines e.g. IV lorazepam, buccal midazolam or rectal diazepam
2 - Phenobarbitol/Phenytoin
3 - General Anaesthesia
56
First line for focal seizures
Carbamazepine
57
First line for generalised seizures
Sodium valproate
58
Neonatal hearing tests
1 - Automatic Oto-Acoustic Emission (AOAE)
... for further investigation proceed to...
2 - Automated Auditory Brainstem Response (AABR)
59
Which factors require Vit K?
F2/7/9/10
60
When is Vitamin K given in the newborn?
IM at birth or PO on days 1, 7 (and 28 if breastfed)
61
A subperiosteal haematoma that does not cross suture lines and is associated with prolonged labour or instrumental delivery
Cephalohaematoma
62
What is the difference between Caput and Cephalohaematoma?
Caput can cross suture lines
63
Neonatology. What is the risk of high levels of bilirubin?
Kernicterus - bilirubin-induced encephalopathy
64
Management for neonatal hyperbilirubinaemia
Mild - self-limiting
Moderate - phototherapy
Severe - immunoglobulin or an exchange transfusion
65
Define prolonged neonatal jaundice
beyond 14 days in term infants or 21 days in preterm infants
66
What is the most common cause of prolonged neonatal jaundice?
Breast milk
67
Clinical features of biliary atresia
conjugated bilirubin, jaundice, pale stools, dark urine
68
Clinical features of physiological Jaundice
arises after 24 hours and resolves before 14 days in term infants (21 days in preterm infants)
69
Most common cause of neonatal sepsis?
Group B Streptococcus
70
Screening and diagnosis for Down syndrome
Screening:
- USS at 11-14 weeks -> Nuchal Translucency
- Serum biochemistry -> BhCG and PAPP-A
Diagnosis
- Chorionic Villous Sampling/Amniocentesis/NIPT
71
When is the fetal anomaly scan?
18-21 weeks
72
Which blood test screens are mothers offered?
Hep B, HIV, Syphilis and susceptibility to Rubella
| Rhesus negative mothers to receive Anti-D
73
Management of Nephrotic Syndrome
Oral steroids - prednisolone (if no response in 4-6 weeks proceed to biopsy)
Oedema managed with 20% human albumin and furosemide
74
First line for paediatric constipation
Osmotic laxative e.g. Movicol
| Nutrition advice
75
What conditions is strawberry tongue seen in?
Kawasaki Disease and Scarlet Fever
76
Age-range for Perthes
4-10 years
77
VSD murmur
Pansystolic
78
ASD murmur
Fixed split S2 sound due to the increased venous return overloading the right ventricle during inspiration and delaying closure of the pulmonary valve
79
Management of Perthes
Under 6 with no sign of femoral head structural damage - observation with serial X-rays as there is a good chance of recovery
Surgical management is rarely indicated in uncomplicated cases in children under 6 unless there is the presence of fracture or joint collapse
80
At which time of year and in which age group is the peak incidence of bronchiolitis?
Winter in 3-6 month infants
81
Which genetic condition is associated with neonatal hypotonia?
Prader-Willi
82
What is the peak incidence of acute lymphoblastic leukaemia ?
2-5 years
83
Developmental milestones: Pincer grip
12 months (early pincer grip at 9 months)
84
Developmental milestones: Points with finger
9 months
85
Developmental milestones: Reaches for object
3 months
86
Developmental milestones: Palmar grasp
6 months
87
Developmental milestones: Tower of 2/3/6/9 blocks
15 months/18 months/2 years/3 years
88
Developmental milestones: Little or no head lag on being pulled up to sit
3 months
89
Developmental milestones: Crawls
8-10 months
90
Developmental milestones: Pulls to standing
9 months
91
Risk of using Lithium in pregnancy
Ebstein's anomaly
92
Clinical features of meconium ileus
This typically presents with the neonate not passing meconium with a distended abdomen. Vomiting may be bilious, which is in contrast to pyloric stenosis which does not contain bile. There is also no mass suggestive of intussusception or pyloric stenosis.
93
Developmental milestones: Hops on one leg
3-4 years
94
Treatment of whooping cough?
Oral azithromycin or clarithromycin if onset in previous 21 days
95
Live vaccines (6)
```
BCG
Yellow fever
Oral polio
Intranasal influenza
Varicella
Measles, mumps and rubella (MMR)
```
96
Contraindication of live vaccine
Immunodeficient e.g. HIV, Azathiprine
97
Inactivated vaccines (3)
rabies
hepatitis A
influenza (intramuscular)
98
Which vaccines do individuals with chronic hep C qualify for?
annual influenza vaccine and the pneumococcal vaccine
99
Which genetic condition is associated with autism?
Fragile X
100
Inherited syndrome. Dextrocardia + Bronchiectasis
Kartagener's syndrome
101
Henoch-Schonlein purpura. Features
abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs
102
What is Eisenmenger's syndrome?
Eisenmenger's syndrome secondary to an uncorrected ventricular septal defect (VSD).
Right ventricular hypertrophy is likely to occur as the left to right shunt through the VSD exposes the right ventricle to the high pressures from the left ventricle and this promotes remodelling of the right ventricle. The Right ventricle hypertrophies until its pressures overcome that of the left ventricle and thus the shunt is reversed (right to left) resulting in cyanosis.
103
Risk factors of Sudden Infant Death Syndrome
Major risk factors
- putting the baby to sleep prone: the relative risk or odds ratio varies from 3.5 - 9.3. If not accustomed to prone sleeping (i.e. the baby usually sleeps on their back) the odds ratio increases to 8.7-45.4
- parental smoking: studies suggest this increases the risk up to 5 fold
- prematurity: 4-fold increased risk
- bed sharing: odds ratio 5.1
- hyperthermia (e.g. over-wrapping) or head covering (e.g. blanket accidentally moves)
Other risk factors
- male sex
- multiple births
- social classes IV and V
- maternal drug use
- incidence increases in winter
104
Which cause of neonatal bilious vomiting is associated with Down's Syndrome?
Duodenal atresia
105
AXR shows double bubble sign
Duodenal atresia
106
Age at presentation of duodenal atresia
few hours after birth
107
Treatment of duodenal atresia
Duodenoduodenostomy
108
Age at presentation of Malrotation with volvulus
3-7 days
109
Treatment of Malrotation with volvulus
Ladd's procedure
110
Measles: Features
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots ('grain of salt') on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
111
Mumps: Features
Fever, malaise, muscular pain
| Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
112
Rubella: Features
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
113
Management of Impetigo
1 - Hydrogenperoxide 1% cream
2 - Fusidic Acid (if resistance suspected then topical mupirocin)
3 - Oral Flucloxacillin (or first-line in extensive disease) or Erythromycin if allergic
114
Which conditions do not require school exclusion?
```
Conjunctivitis
Fifth disease (slapped cheek)
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth
```
115
School exclusion with Measles, Mumps and Rubella
Measles - 4 days from onset of rash
Mumps - 5 days from onset of swollen glands
Rubella - 5 days from onset of rash
116
Murmur: ASD
ejection systolic murmur, fixed splitting of S2
