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Medicine - Finals > Paediatrics > Flashcards

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

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2
Q

At which ages is the 6-in-1 vaccine given?

A

2, 3 and 4 months

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3
Q

What is the 6-in-1 vaccine?

A 
Diphtheria 
Tetanus
Whooping Cough 
Polio
Haemophilus influenzae B (Hib)
Hepatitis B
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4
Q

At which ages is the oral rotavirus given?

A

2 and 3 months

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5
Q

At which ages is the Men B vaccine given?

A

2, 4 and 12 months

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6
Q

At which ages is the PCV (Pneumococcal) vaccine given?

A

3 and 12 months

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7
Q

At which ages is the MMR given?

A

12 months and 3-4 years

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8
Q

At which age is the HPV vaccine given?

A

12-13 years (both males and females)

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9
Q

At which age is the 4-in-1 given?

A

3-4 years

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10
Q

What is in the 4-in-1 vaccine?

A

Diphtheria
Tetanus
Whooping Cough
Polio

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11
Q

What is in the 3-in-1 vaccine?

A

Diphtheria
Tetanus
Polio

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12
Q

When is the 3-in-1 vaccine given?

A

13-18 years

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13
Q

When is the Men ACWY vaccine given?

A

13-18 years (usually before starting university)

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14
Q

When is the influenza vaccine given?

A

2-8 years

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15
Q

When is the Hib/MenC joint vaccine given?

A

12 months

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16
Q

Which vaccines do you receive at 3 months?

A

6-in-1, Oral Rotavirus, PCV

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17
Q

Which vaccines do you receive at 4 months?

A

6-in-1, Men B

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18
Q

Which vaccines do you receive at 12 months?

A

Men B, PCV, MMR, Hib/Men C

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19
Q

Which vaccines do you receive at 2 months?

A

6-in-1, Oral Rotavirus, Men B

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20
Q

At which age should solid foods be introduced?

A

6 months

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21
Q

What are the screening tests available for allergies?

A

blood tests and skin pricks

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22
Q

What is the diagnostic test for food allergy?

A

Food challenge is the gold-standard

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23
Q

What is the 4 step management for food allergy?

A

1 - avoid allergen
2 - anti-histamines (± steroid)
3 - adrenaline
4 - immunotherapy

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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

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25
Q

Buzzword: barking/harsh cough

A

Croup

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26
Q

Buzzword: drooling

A

Epiglottitis

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27
Q

What causes croup?

A

Parainfluenza virus

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28
Q

What causes bronchiolitis?

A

RSV

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29
Q

Management of croup

A

Everyone should receive a single dose dexamethasone

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30
Q

What is the commonest cause of intrinsic AKI in Scotland?

A

HUS (E.coli O157)

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31
Q

Diagnosing Appendicitis

A

Clinical

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32
Q

Management of transient synovitis

A

Watch and wait - self-limiting

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33
Q

Diagnosis of SUFE

A

XR Pelvis (AP and Lateral)

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34
Q

Diagnosis of Perthes

A

XR Pelvis AP

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35
Q

What is usually the first clinical sign of cystic fibrosis?

A

Meconium ileus

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36
Q

What genetic condition is nasal polyps associated with?

A

Cystic fibrosis

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37
Q

Diagnosis of CF

A

Sweat test (positive is high chloride >60mEq/L)

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38
Q

Medication of choice for CF delta F508 variant

A

Lamacaftor/Ivacaftor (Orkambi)

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39
Q

Purple inhaler

A

Seretide - contains fluticasone (twice as potent as beclamethasone)

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40
Q

Brown inhaler

A

Clenil Modulite - equivalent to Beclomethasone

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41
Q

Diabetic targets - BG/Hypos/HBA1c

A

BG 4-7 mmol
Hypos ≤2 mild /week
HBA1c ≤48 mmol/mol in year 1 of diagnosis and ≤56 mmol/mol thereafter

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42
Q

Management of hyperketonaemia in T1DM

A

0.6-1.5 give insulin

>1.5 emergency

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43
Q

Management of severe hypos in the community

A

Call ambulance, administer glucagon injection

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44
Q

Antenatal steroids reduce the risk of …. (4)

A

RDS
Sepsis
IVH
NEC

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45
Q

Antenatal magnesium sulfate reduces the risk of …

A

Neurodevelopmental problems

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46
Q

Risk factors for RDS

A
  • M>F
  • Maternal diabetes
  • Maternal hypertension
  • IUGR <29 weeks
  • Sepsis
  • Hypothermia
  • C-section
  • Second twin
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47
Q

Neonatology. What is Vitamin K given for?

A

Prevent haemorrhagic disease of the newborn

48
Q

Why is caffeine given to preterm babies?

A

Prevent apnoeic episodes

49
Q

What is the current guidance regarding multivitamin?

A

Given till age 5

50
Q

Features of NEC

A

Bloody stool, bilious vomiting and large distended abdomen

51
Q

Diagnosis of NEC

A

Abdominal X-ray

52
Q

Management of NEC

A

TPN and antibiotics

Surgery if severe

53
Q

At which gestation does suckling reflex develop?

A

35 weeks - preterm before this age must get NG tube

54
Q

At what times post-delivery are APGAR measures recorded?

A

1 minute
5 minutes
10 minutes

55
Q

What is first/second/third line management of status epilepticus?

A

1 - Benzodiazepines e.g. IV lorazepam, buccal midazolam or rectal diazepam
2 - Phenobarbitol/Phenytoin
3 - General Anaesthesia

56
Q

First line for focal seizures

A

Carbamazepine

57
Q

First line for generalised seizures

A

Sodium valproate

58
Q

Neonatal hearing tests

A

1 - Automatic Oto-Acoustic Emission (AOAE)
… for further investigation proceed to…
2 - Automated Auditory Brainstem Response (AABR)

59
Q

Which factors require Vit K?

A

F2/7/9/10

60
Q

When is Vitamin K given in the newborn?

A

IM at birth or PO on days 1, 7 (and 28 if breastfed)

61
Q

A subperiosteal haematoma that does not cross suture lines and is associated with prolonged labour or instrumental delivery

A

Cephalohaematoma

62
Q

What is the difference between Caput and Cephalohaematoma?

A

Caput can cross suture lines

63
Q

Neonatology. What is the risk of high levels of bilirubin?

A

Kernicterus - bilirubin-induced encephalopathy

64
Q

Management for neonatal hyperbilirubinaemia

A

Mild - self-limiting
Moderate - phototherapy
Severe - immunoglobulin or an exchange transfusion

65
Q

Define prolonged neonatal jaundice

A

beyond 14 days in term infants or 21 days in preterm infants

66
Q

What is the most common cause of prolonged neonatal jaundice?

A

Breast milk

67
Q

Clinical features of biliary atresia

A

conjugated bilirubin, jaundice, pale stools, dark urine

68
Q

Clinical features of physiological Jaundice

A

arises after 24 hours and resolves before 14 days in term infants (21 days in preterm infants)

69
Q

Most common cause of neonatal sepsis?

A

Group B Streptococcus

70
Q

Screening and diagnosis for Down syndrome

A

Screening:
- USS at 11-14 weeks -> Nuchal Translucency
- Serum biochemistry -> BhCG and PAPP-A
Diagnosis
- Chorionic Villous Sampling/Amniocentesis/NIPT

71
Q

When is the fetal anomaly scan?

A

18-21 weeks

72
Q

Which blood test screens are mothers offered?

A

Hep B, HIV, Syphilis and susceptibility to Rubella

Rhesus negative mothers to receive Anti-D

73
Q

Management of Nephrotic Syndrome

A

Oral steroids - prednisolone (if no response in 4-6 weeks proceed to biopsy)
Oedema managed with 20% human albumin and furosemide

74
Q

First line for paediatric constipation

A

Osmotic laxative e.g. Movicol

Nutrition advice

75
Q

What conditions is strawberry tongue seen in?

A

Kawasaki Disease and Scarlet Fever

76
Q

Age-range for Perthes

A

4-10 years

77
Q

VSD murmur

A

Pansystolic

78
Q

ASD murmur

A

Fixed split S2 sound due to the increased venous return overloading the right ventricle during inspiration and delaying closure of the pulmonary valve

79
Q

Management of Perthes

A

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
Q

At which time of year and in which age group is the peak incidence of bronchiolitis?

A

Winter in 3-6 month infants

81
Q

Which genetic condition is associated with neonatal hypotonia?

A

Prader-Willi

82
Q

What is the peak incidence of acute lymphoblastic leukaemia ?

A

2-5 years

83
Q

Developmental milestones: Pincer grip

A

12 months (early pincer grip at 9 months)

84
Q

Developmental milestones: Points with finger

A

9 months

85
Q

Developmental milestones: Reaches for object

A

3 months

86
Q

Developmental milestones: Palmar grasp

A

6 months

87
Q

Developmental milestones: Tower of 2/3/6/9 blocks

A

15 months/18 months/2 years/3 years

88
Q

Developmental milestones: Little or no head lag on being pulled up to sit

A

3 months

89
Q

Developmental milestones: Crawls

A

8-10 months

90
Q

Developmental milestones: Pulls to standing

A

9 months

91
Q

Risk of using Lithium in pregnancy

A

Ebstein’s anomaly

92
Q

Clinical features of meconium ileus

A

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
Q

Developmental milestones: Hops on one leg

A

3-4 years

94
Q

Treatment of whooping cough?

A

Oral azithromycin or clarithromycin if onset in previous 21 days

95
Q

Live vaccines (6)

A 
BCG 
Yellow fever
Oral polio
Intranasal influenza
Varicella
Measles, mumps and rubella (MMR)
96
Q

Contraindication of live vaccine

A

Immunodeficient e.g. HIV, Azathiprine

97
Q

Inactivated vaccines (3)

A

rabies
hepatitis A
influenza (intramuscular)

98
Q

Which vaccines do individuals with chronic hep C qualify for?

A

annual influenza vaccine and the pneumococcal vaccine

99
Q

Which genetic condition is associated with autism?

A

Fragile X

100
Q

Inherited syndrome. Dextrocardia + Bronchiectasis

A

Kartagener’s syndrome

101
Q

Henoch-Schonlein purpura. Features

A

abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs

102
Q

What is Eisenmenger’s syndrome?

A

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
Q

Risk factors of Sudden Infant Death Syndrome

A

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
Q

Which cause of neonatal bilious vomiting is associated with Down’s Syndrome?

A

Duodenal atresia

105
Q

AXR shows double bubble sign

A

Duodenal atresia

106
Q

Age at presentation of duodenal atresia

A

few hours after birth

107
Q

Treatment of duodenal atresia

A

Duodenoduodenostomy

108
Q

Age at presentation of Malrotation with volvulus

A

3-7 days

109
Q

Treatment of Malrotation with volvulus

A

Ladd’s procedure

110
Q

Measles: Features

A

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
Q

Mumps: Features

A

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

112
Q

Rubella: Features

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

113
Q

Management of Impetigo

A

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
Q

Which conditions do not require school exclusion?

A 
Conjunctivitis
Fifth disease (slapped cheek)
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth
115
Q

School exclusion with Measles, Mumps and Rubella

A

Measles - 4 days from onset of rash
Mumps - 5 days from onset of swollen glands
Rubella - 5 days from onset of rash

116
Q

Murmur: ASD

A

ejection systolic murmur, fixed splitting of S2

Medicine - Finals (21 decks)

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