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Paediatrics Flashcards

1
Q

Which blood vessels does the PDA connect?

A

Pulmonary artery and descending aorta

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2
Q

What type of murmur do the following create:

  1. ASD
  2. VSD
  3. PDA
  4. Coarctation in aorta
A
  1. Midsystolic crescendo-decrescendo
  2. Loud pansystolic murmur
  3. Continuous machinery murmur
  4. Loud systolic murmur in left intraclavicular region
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3
Q

How can someone present with an ASD in later life?

A

Stroke - a clot from a DVT can bypass lungs

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4
Q

What are the 4 features of Tetralogy of Fallot?
What murmur does it present with?
What will you see on CXR?

A

Overiding aorta, VSD, pulmonary stenosis, RVH
Loud ejection systolic
Boot shaped heart

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5
Q

What cardiac arrhythmia is associated with Ebstein’s anomaly?

A

Wolff-Parkinson-White

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6
Q

What will you see on CXR with transposition of the great arteries?

A

Heart looks like an “egg on a string”

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7
Q

What is the medical management of heart failure in children? (4)
When should oxygen not be used?
What other management should you consider for a child presenting with heart failure and failure to thrive?

A

ACE-I (e.g. catopril), diuretics (e.g. furosemide), prostaglandins, inotropes (e.g. dobutamine)
Duct-dependent heart failure as can cause ducts to close
High calorie feeds

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8
Q

What is tested for on the newborn heel prick test?

A

Sickle cell, cystic fibrosis, congenital hypothyroidism, 5 metabolic disorders

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9
Q

What are you likely to see on neck x-ray with epiglottitis?

A

Thumbprinting

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10
Q

What are signs of respiratory distress? (8)

A 
Raised respiratory rate
Use of accessory muscles
Intercostal and subcostal recession
Nasal flaring
Tracheal tug
Head bobbing
Cyanosis
Abnormal airway sounds
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11
Q

What is the characteristic cough of croup?
What symptoms would suggest severe croup? (2)
When should croup usually resolve in mild cases?

A

Seal-like barking cough
Agitation, lethargy
48h

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12
Q

What are the signs and symptoms of anaphylaxis?

  1. A (3)
  2. B (4)
  3. C (3)
A

A - stridor, hoarseness, swelling in larynx
B - tachypnoea, wheeze, cyanosis, low O2%
C - hypotension, pale, clammy

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13
Q

What is the NICE criteria for diagnosing bronchiolitis? (4)

A

1 to 3 day history of coryzal symptoms with :
Persistent cough AND
Either tachypnoea or chest recession AND
Either wheeze or crackles on auscultation

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14
Q

How long does it take for bronchiolitis to resolve?

A

2-3 weeks

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15
Q

What can happen with severe coughing fits in whooping cough? (3)
How long does it take for whooping cough to resolve?
What should you do after managing child?

A

Vomiting, apnoea, LOC
8 weeks
Notify Public Health

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16
Q

Which tests can you use to diagnose cystic fibrosis? (2)

What is the general management of CF? (4)

A

Sweat test, genetic testing

MDT :) chest physiotherapy, bronchodilators, prophylactic antibiotics, high calorie diet

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17
Q

What can you assess to determine dehydration in a child? (9)

A 
Body weight - >4% is significant, >7% is severe
Skin turgor
Tears (present vs absent)
Urine output
Eyes (sunken vs not sunken)
Anterior fontanelle (sunken vs not sunken)
Mucuous membranes
Blood pressure
Heart rate
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18
Q

How do you cause a hyponatraemic dehydration?

A

Lose sodium and water at same rate with vomiting/diarrhoea

However, drink water to compensate without salts = hyponatraemic

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19
Q

How many stools and vomits put you at higher risk of dehydration in 24h?

A

> 5 stools

>2 vomits

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20
Q

What are the principles of management of gastroenteritis in children? (2)

How should you manage shock caused by gastroenteritis? (3)

A

Isolate child
Prevent dehydration e.g. ORS, continue to breastfeed

Fluid bolus (20ml/kg)
Then maintenance fluids
Monitor U&Es, glucose, weight daily
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21
Q

When does gastroenteritis tend to resolve?

A

Diarrhoea - 5-7 days, resolves completely in 2 weeks

Vomiting - 1-2 days, resolves completely by 3 days

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22
Q

What are the complications of gastroenteritis? (4)

A

Lactose intolerance
IBS
GBS
HUS

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23
Q

What are the complications of GORD in children? (4)

A

Failure to thrive
Oesophagitis
Recurrent pulmonary aspiration
Sandifer syndrome - severe arching of spine, dystonic neck posturing

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24
Q

What are the causes for urgent referrals for constipation in children? (7)

What are some medical causes of constipation that can initially be managed in primary care whilst referring? (3)

A 
Cystic fibrosis
Hirschprung's
Anal stenosis
Spina bifida
Cerebral palsy 
Intestinal obstruction
Sexual abuse

Coeliac disease
Cow’s milk protein allergy
Congenital hypothyroidism

25
Q

What examination is very important (!) when investigating constipation?

A

Lower limb neurological exam !

26
Q

What are the physical and psychological causes of emaciation in children?

A

Endocrine: T1DM, hypothyroidism, Addison’s
GI: coeliac, IBD, achalasia
Malignancy
JIA
Psychological: eating disorder, depression, OCD
Autism

27
Q

What electrolyte abnormalities would you expect to see in refeeding syndrome? (5)

A 
Hyponatraemia
Hypokalaemia
Hypomagnesaemia 
Hypophosphataemia 
Hypocalcaemia
28
Q

What are some of the features of refeeding sydrome? (4)

A

Rhabdomyolysis
Arrhythmias
Seizures
Sudden Death

29
Q

How do you manage refeeding syndrome? (5)

A 
Pabrinex
Refer to dietician
Slowly reintroduce food
Monitor fluid balance
Monitor electrolytes
30
Q

How do you treat intussuception?

A

Rectal air insufflation

31
Q

What features would suggest NAI? (7)

A

Delay in seeking help
Vague, inconsistent history
Injury not compatible with history/developmental age of child
Injuries of different ages
Multiple A&E attendances and to different sites
Pattern/artefact burns or injuries
Inappropriate affect from child or parent

32
Q

Which percentage of weight loss in the newborn would indicate a referral to paediatrics?
Weight loss can be normal in a newborn. By what week should they return to their birth weight?

A

> 10%

3 weeks

33
Q

What is the normal feed for a newborn?

A

150ml/kg/d if <1 month (every 4 hours)

100ml/kg/d if >1 month

34
Q

What drop in centiles on the growth chart would warrant a referral to paediatrics?

A

2 or more centiles OR anyone below 2nd centile

NB, if below 9th centile, then just 1 drop; if above 91st centile, then 3 or more

35
Q

What are important infective causes of fever to rule out according to NICE? (5)

A 
Meningitis
Pneumonia
UTI
Herpes simplex encephalitis
Kawasaki
36
Q

What are the most common causes of meningitis in:

  1. Under 3 months
  2. Over 3 months
A
  1. GBS, E. Coli, Listeria

2. Neisseria meningitidis, S pneumonia, Haemophilus influenzae (if not vaccinated)

37
Q

What are aseptic causes of meningitis?

Which cause should be considered in the immunocompromised?

A

Viral, fungal, TB, inflammatory, malignancy, sarcoidosis

Fungal

38
Q

What blood test is required to test for N meningitidis?

A

PCR

39
Q

Which antibiotic is most commonly used to treat meningitis?

Which antibiotic is required for:

  • GBS
  • Listeria
A

Ceftriaxone

  • Cefotaxime
  • Amoxicillin
40
Q

When should dexamethasone not be used in the treatment of meningitis? (2)

A

If over 12h since starting antibiotics

Meningococcal septicaemia

41
Q

What increases the risk of developing bacterial meningitis (environmental and medical)?

A

Overcrowded day care
Low family income

Maternal infection during birth
Basal skull fracture
Periorbital or orbital cellulitis, sinusitis, septic arthritis
Asplenism

42
Q

What are the complications of meningitis?

  1. Acute (6)
  2. Long term (5)
A

Seizures, raised ICP, metabolic disturbance, coagulopathy, anaemia, coma, death

Hearing impairment, neurological impairment, epilepsy, learning or developmental difficulties, psychosocial problems

43
Q

What is the long-term management after recovery from meningitis? (2)

A

Refer to paediatrician for follow up

Hearing assessment at 4 weeks

44
Q

What can cause a prolonged fever in children? (2)

A

Lyme disease

Kawasaki disease

45
Q

What are the important differentials for an acutely unwell neonate? (4)

A

Sepsis
Meningitis
Inborn errors of metabolism
NAI

46
Q

What investigations should you order for an acutely unwell neonate?

  1. Bloods
  2. Imaging
  3. Microscopy
A
  1. FBC, U&Es, LFTs, CRP, lactate, blood gas, blood cultures, ammonia, bicarbonate, glucose, coagulation
  2. CT head or cranial USS, CXR
  3. LP, urine dip and culture
47
Q

What should you calculate if a neonate presents with metabolic acidosis?

A

Anion gap

48
Q

What are the differentials for a non-blanching rash in a child?

  1. Will cause child to be unwell
  2. Child will be generally well
A
  1. Meningicoccal septicaemia, Leukaemia, DIC, HUS, measles

2. ITP, HSP, aplastic anaemia

49
Q

What is are the investigations and follow-up for a child presenting with HSP?

A

U&Es, eGFR, urine analysis, PCR, blood pressure

BP and urine for one year checking for renal involvement

50
Q

When should children generally recover from ITP?
When should you refer?
What management options are there for ITP? (3)

A

6 weeks - can take up to 3 to 6 months to fully revoer
6 months - examine bone marrow for inherited disorders
Tranexamic acid for bleeding, steroids, immunoglobulins

51
Q

What are features of the following types or UTI:

  1. Atypical (6)
  2. Recurrent (3)
A
  1. Poor urine flow, septic, non- E coli, raised creatinine, abdominal mass, failure to respond to antibiotics in 48h
  2. 2 or more upper UTI, 1 of both upper and lower UTI, 3 lower UTIs
52
Q

When should the following scans be used to investigate UTI in children?

  1. Renal USS
  2. MCUG
  3. DMSA
A
  1. <6 months, atypical UTI
  2. <6 months with recurrent or atypical UTI
  3. All those with recurrent UTI, <3 years with atypical
53
Q

At what age should interventions be trialled in children with enuresis?
What are these interventions? (2)

A

Over 5 years

Enuresis alarm, desmopressin

54
Q

What specific signs are found in someone with Duchenne muscular dystrophy? (2)
What blood test will be raised in Duchenne muscular dystrophy?

A

Gower’s sign, pseudohypertrophy of calves

Creatinine kinase

55
Q

Which conditions are ASD associated with? (3)

A

Fragile X
Tuberous sclerosis
Williams syndrome

56
Q

What are some causes of delayed walking?

A

Neurological: cerebral palsy, spina bidifia, central cause
Neuromuscular i.e. Duchenne’s
Environmental: bottom shuffler, psychosocial deprivation
Developmental dysplasia of hip
Metabolic conditions
Hypothyroidism

57
Q

When should the insulin be started in DKA in children?

A

1-2 hours after starting IV fluids

58
Q

What are the complications of DKA in children?

A

Cerebral oedema
Hypokalaemia
VTE

Finals (23 decks)

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