Paediatrics Flashcards
Median age and Limit age for walking
Median age: 12 months
Limit age: 18 months
Child appears to be developing normally and hitting their milestones for the first year but then they lose their skills (regression). Which condition is this associated with?
Rett’s syndrome
How do you diagnose global developmental delay
Significant delay in 2 or more of
- Gross/fine motor
- Speech/language
- Cognition
- Social/personal
- ADL
What 3 things make up the autistic triad
Social interaction
Communication
Flexibility of thought/imagination
In which condition is grower’s manouvre seen in ?
Duchenes muscular dystrophy
MMR is live/inactivated vaccine
Live
Whooping cough vaccine is live/inactivated?
Inactivated
Diphtheria vaccine is live/inactivated?
inactivated
Which 2 vaccines cannot be given to anyone with an egg allergy ?
Flu
Yellow fever
5 in 1 childhood vaccine - what are the 5 things
Diphtheria Tetanus Polio Pertussis Haemophilus influenza B
What is normal pulse range for a child less than 11 months
110-160 bpm
What is normal pulse range for a child 12-24 months
100-150 bpm
What is normal pulse range for child 2-4y
90-140 bpm
What is normal pulse range for child 5-11y
80-130 bpm
What is normal pulse range for child over 12
70-110 bpm
What is normal resp rate for child less than 11 months
30-50
Paediatric BLS algorithm - what do you do initially if patient is unresponsive / not breathing / only occasional gasps
Danger
Responsiveness (unresponsive)
Shout for help (call resus team)
5 rescue breaths
If you give unresponsive child 5 rescue breaths and they do not respond, what do you do?
15 chest compressions -> 2 rescue breaths and so on
If during CPR, you attach a defibrillator to the patient and it shows shockable rhythm, what do you do?
Administer shock then resume CPR for 2 mins until rhythm is assessed again
What is the most common disease of the lower respiratory tract during the first year of life
Bronchiolitis
What is the likley diagnosis?
few day Hx corzyal symptoms, persistent cough with increased work of breathing, often affects a child’s ability to feed.
On examination: wheeze / crackles on auscultation
Bronchiolitis
You should routinely perform a chest X‑ray in children with bronchiolitis. True or false?
False
- often looks like a pneumonia
coryzal prodrome lasting 1 to 3 days, followed by:
persistent cough and
either tachypnoea or chest recession (or both) and
either wheeze or crackles on chest auscultation (or both)
What is likelly diagnosis
Bronchiolitis
How should bronchiolitis (in the hospital) be managed
O2 for patients with O2 sats less than 92%
Fluids - if patient is dehydrated
sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory), hoarse voice, and respiratory distress due to upper-airway obstruction. Symptoms are usually worse at night. There may be a fever.
What is likely diagnosis?
Can this be managed at home or in hospital?
Croup (severe, needs hospitlisation)
Bronchiolitis typically affects which age
Under 2
Croup typically affects which age
6 months -> 6 years
What treatment should child with croup receive
Oral dexamethasone (single dose)
Croup is viral or bacterial?
Upper or lower RTI?
Viral (typically parainfluenza virus types 1 or 3)
Upper RTI
first line antibiotic in child with CAP
amoxicillin, 5 days
if child has severe CAP what is first line treatment
Co-amoxiclav
Where should you routinely measure body temperature in children age 0-5
Axilla / ear
5 signs of dehydration in a child
Dry mucous membranes Reduced skin turgor Prolonged cap refill time Weak pulse Cold extremities
Tachypnoea, crackles in the chest, nasal flaring, chest indrawing, cyanosis, oxygen saturation of 95% or less when breathing air. What does this make you think or?
Pneumonia
If a child has suspected/proven infection and at least 2 of the following:
temp <36 or >38
inappropriate tachycardia
altered mental state (sleepy/irritable/floppy)
reduced peripheral perfusion / prolonged cap refill
What do you think is going on and how do you manage?
SEPSIS
initiate sepsis 6
Bacterial tonsillitis confirmed and high centor score. What antibiotic is used
Phenoxymethylpenicillin
Antibiotics are usually required to treat acute ottitis media. True or false?
False
If an antibiotic is required to treat acute ottitis media, Which antibiotic is prescribed?
Amoxicillin
What is the bst indicator or UTI
+ve leukocyte esterase OR
+ve nitrites
+ve nitrites
For infants younger than 6 months with first-time UTI that responds well to treatment….do they require follow up investigation?
Yes, US within 6 weeks
For infants younger than 6 months with atypical UTI…d they require investigation? If so, what and when?
Yes
- acute US investigation
For infants older than 6 months with first-time UTI that responds well to treatment….do they require follow up investigation?
NO
Wheezing occurs during inspiration.expiration?
Expiration
What is the most common inhaler used in children?
pressurised meter dose inhaler (pMDI)
pressurised meter dose inhaler (pMDI) MUST be used with a spacer in children. True or false?
True
Name 2 examples of DPI (dry power inhaler)
Ellipta
Accuhaler
If you use an inhaler that contains steroids, what should you do afterward?
Rinse your mouth out with water
How do you instruct someone to use a pMDI
Open cap Shake inhaler breathe out fully ensure good seal of inhaler around mouth and breathe in slowly and deeply Count to 10 before breathing out
How do you instruct someone to use a DPI ?
Open cap
Hold inhaler horizontally
Load the device by pushing back the lever
breathe out fully
ensure good seal of inhaler around mouth and breathe in as hard and fast as possible
Count to 10 before breathing out
Spacer for pMDI for pre-school child
Yellow aerochamber with mask or volumatic with mask
Spacer for pMDI for school aged children
Blue aerochamber or volumatic without mask
What kind of inhaler is a symbicort and what drugs are in it
Combination of ICS + LABA
Budesonide + formoterol
What kind of inhaler is a seretide and what drugs are in it
Combination of ICS + LABA
Fluticasone + salmeterol
Management of severe croup
Oral dexamethasone
Nebulised adrenaline with oxygen
Which organism causes bacterial tracheitis ?
Staph aureus
Which organism causes acute epiglottitis?
Haemophilus influenzae type B
Acute onset
high fever in an ill, toxic-looking child
• an intensely painful throat that prevents the child
from speaking or swallowing; saliva drools down
the chin
• soft inspiratory stridor and rapidly increasing
respiratory difficulty over hours
• the child sitting immobile, upright, with an open
mouth to optimise the airway.
what does this make you think
Acute epiglottitis
What is the prophylaxis for whooping cough
Erythromycin
What is laryngomalacia
Recurrent or continuous stridor since birth
Fever, poor feeding, cough, lethargy, cyanosis
• Tachypnoea, nasal flaring, chest recession, wheeze
and end-inspiratory coarse crackles over the
affected area
• O2 saturation may be decreased
What does this most likely suggest?
Pneumonia
What are 2 risk factors for transient early wheezing
Maternal smoker
Prematurity
Resolves by age 5, associated with viral illnesses
Name 2 SABAs (relievers)
How long are they effective for?
Salbutamol
Terbutaline
Effective for 2-4 hrs
They are used PRN
Name 2 LABAs
How long are they effective for?
Salmeterol
Formoterol
Effective for 12 hrs
tracheal tug (looks like trachea is touching back of c-spine), sternal recession suggests
Upper airway obstruction
reduced air entry is often associated with? and what investigation should be carried out?
empyema
US
Management of acute mild asthma attack
10 puff salbutamol via spacer
oral prednisolone
Management of acute moderate asthma attack
10 puff salbutamol via spacer (re-assess every hour)
may need to go nebulised -> life threatening
Management of acute severe/life threatening asthma attack
Oxygen Salbutamol (nebuliser) IV hydrocortisone Ipatroprium bromide (nebs) IV magnesium sulphate Oral theophyline / IV aminophiline
Sat upright, hyperextended neck, looks really unwell, drooling
Epiglottitis
Management of severe croup
Oral dexamethasone
Nebulised adrenaline
Management of severe croup
Oral dexamethasone
Nebulised adrenaline
commonest cause of bloody diarrhoea and dehydration?
E. coli 0157 (HUS)
What will you see in a blood film of HUS?
red cell breakdown
Treatment of HUS
establish IV access
get bloods
urinalysis
IV fluids -> keep checking bloods
How would you describe billious vomiting?
what does it suggest?
dark green
suggests mechanical obstruction
7 year old female, central abdo pain for 2 days now radiating to right, abdo soft Preceding cold/viral infection neck lymphadenopathy Observations fine What is likely diagnosis?
Mesenteric adenitis
Domperidone - side effects (2)
Long QT
Brugada syndrome
Need ECG every 3 months
bilious vomiting, very hungry baby, every time they feed they vomit, big head little body
diagnosis?
Management?
diagnosis: Pyloric stenosis
Management: correct electrolytes -> surgery
bilious vomiting, very hungry baby, every time they feed they vomit, big head little body
diagnosis?
Management?
diagnosis: Pyloric stenosis
Management: correct electrolytes -> surgery
Heavy child (weight above 90th centile) , 9-11 year, mainly male, atraumatic limp, antalgic gait, leg length discrepancy. Suggest diagnosis? suggest investigation?
SUFE XR pelvis (AP and lateral)
Hot swollen joints, often more than one, cyclical temps, fluid filled joints, normal inflammatory markers. Child otherwise well. What is likely diagnosis?
juvenile idiopathic arthritis
Less than 5 more common in baby boy affects hip (more common) / knee preceded by viral illness Suggest diagnosis?
Transient synovitis
between 3-9 y/o
more common in boys
present with leg length discrepancies
Perthes disease
Kid with recent chicken pox / insect bite.
Vomiting, lethargy, fever, red hot swollen joint (knee).
very severe pain.
think about?
investigation?
Septic arthritis
Ix: joint aspiration
involve orthopaedics early
4 yo girl presents with “sore knee” lasts 2 days. Not getting better with calpol. Walking with a limp no Hx of trauma.
Obs: normal, afebrile
OE: slightly antalgic gait, no swollen or red joints
Transient synovitis
Infected rash give
Antibiotics
Non blanching rash differentials
Meningococcal HSP ITP Acute leukaemia HUS
Non blanching rash differentials
Meningococcal HSP ITP Acute leukaemia HUS
Rash in SVC distribution. does this make it more/less severe?
Less
- this rash is due to coughing / vomiting
Dry rash give
Emollients
5 week old girl. Unsettled for last week. crying after feeds, vomiting, initial weight loss, now following 50th centile.
Obs: normal, afebrile
OE: examines well, no rashes, soft fontanella, well hydrated.
What is likely diagnosis?
GORD
Tx: conservative
Allergy vs Intolerance
allergy - hypersensitivity reaction (involved immune system)
Intolerance - direct effect from the food (bloating/loose stools/sore stomach), no involvement of immune system
2 types of food allergy
Immediate hypersensitivity reaction (IgE mediated)
Delayed hypersensitivity reaction (type IV)
first line treatment of eczema
Steroid creams and emollients
Atopic individuals are more likely to have
Immediate hypersensitivity reaction (IgE mediated)
Delayed hypersensitivity reaction
Immediate
IgE mediated food allergy
Tingling in mouth
Swelling
Urticarial rash
Angioedema
Urticarial type rash with dot in the middle. What is likely
Erythema murtiforme
Investigating IgE mediated food allergy
Blood tests (IgE) Skin prick
When would you get an epipen?
Wheezy
Peanut allergy
Treatment of food allergy
Avoidance of trigger
Anti-histamine +/- steroids
Adrenaline
Immunotherapy - give you small doses of what you’re allergic to
Sore tummy, lose poos, blood in poo in children under 1
Cows milk protein allergy/intolerance
What do you do if you have a bottle fed baby with cows milk protein allergy/intolerance, step 1
Hydrolysed formula milk
What do you do if you have a bottle fed baby with cows milk protein allergy/intolerance if hydrolysed formula milk doesn’t work?
Amino acid based formula milk
If you have an exclusively breast feeding mother but the baby has cows milk protein allergy/intolerance. What do you do?
Make sure mum is dairy free and also soy free.
Why soy free? Has increased plant oestrogens in soya milk
Children of any age can get pMDI / DPI ?
pMDI
Overview of management of acute severe stridor
Identify underlying cause
- eg croup, epiglottitis, foreign body, anaphylaxis
Combined nebulisers
- oxygen
- steroid (dexamethasone)
- adrenaline
Which hormone is responsible for the let down reflex in breast feeding?
Oxytocin
Children on cow’s milk should receive full fat milk / semi skimmed milk?
Full fat milk - up until the age of 5
What is the protein in a cows milk based formula?
Lactose
Solid foods are recommended to be introduced after X months?
6 months
How many wet nappies should a baby have in 24 hours?
At least 3
What is the significance of a fever lasting for 5 or more days?
think about Kawasaki disease
When administering adrenaline in anaphylaxis, what position should the patient be in?
lie down with legs up
In an adult / child over 12, what dose of adrenaline should be given for anaphylaxis?
500mcg (5ml 1 in 1000)
In a child 6-12 years, what dose of adrenaline should be given for anaphylaxis?
300mcg (3ml 1 in 1000)
In a child under 6, what dose of adrenaline should be given for anaphylaxis?
150mcg (0.15ml 1 in 1000)
Which 3 drugs are important in anaphylaxis
Adrenaline
Hydrocortisone
Chlorphenamine (anti-histamine)
‘projectile’ vomiting, typically 30 minutes after a feed
constipation and dehydration may also be present
a palpable mass may be present in the upper abdomen
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
most common in 2nd-4th week of life.
What is the suggested diagnosis here?
Pyloric stenosis
What is the definitive investigation in allergy testing?
Eat the food - be exposed to the allergen
if you’re going to do allergy testing (skin prick / bloods for IgE levels) when should you NOT do them?
Within 4-6 weeks of an allergic reaction
- wait until after this time
Before doing skin prick test, how long does child need to be off anti-histamine?
3 days
Children under X age don’t get soy milk?
Children under 6 months
Which antihistamine is used in anaphylaxis
Chlorphenamine
Treatment of acute allergic reaction (not anaphylaxis) what is first line
Chlorphenamine
Where is IM adrenaline injected into
Anterolateral aspect of thigh
Latent TB treatment
3 months of isoniazid
Which medication may be used for an infant with GORD
Gaviscon
5 year old girl referred with failure to gain weight and possible weight loss.
Daily abdominal pain and bloating
Loose stools x 4 daily.
What is the likely diagnosis?
and what initial investigations should you do?
Coeliac disease or crohns
TTG
Anti-endomesial antibodies (EMA)
What is the gold standard investigation for diagnosis of coeliac disease
Endoscopy with duodenal biopsy
Explosive passing of stool after PR exam suggests which diagnosis
Hirschsprung’s disease
12 year old boy referred from general paediatric clinic with abdominal pain and weight loss.
Treated for irritable bowel syndrome for 2 years.
Now loosing weight and passing blood PR.
Stool cultures normal.
What is likely diagnosis?
Ulcerative colitis
Projectile vomiting in first few weeks of life and hunger after vomiting makes you think
Pyloric stenosis
Children with gord are usually
- gaining weight normally
- failing to thrive
Gaining weight normally
Pyloric stenosis is more common in boys/girls?
Boys (4:1)
Management of pyloric stenosis
correct any fluid and electrolyte disturbance with intravenous fluids
then pyloromyotomy
Abdominal pain accompanied with viral infection with lymphadenopathy. What is likely diagnosis?
Mesenteric adenitis
What is the commonest cause of intestinal obstruction in infants after the neonatal period
Intusucception
1 year old with paroxysmal, colicky pain
with pallor, abdominal mass, redcurrant jelly
stool, draws legs up. what is likely diagnosis?
Intusucception
When in a childs life does malrotation usually present?
First 3 days of life
What is the most common bacterial cause of gastroenteritis
Campylobacter
Mesalazine is used in crohns / UC ?
UC
Which types of medications may be used in constipation
Stool softener (laxitive) Stimulant laxative (senna)
Which is worst
- right to left cardiac shunt
- left to right cardiac shunt
Right to left cardiac shunt
Transposition of the great arteries and tetralogy of fallot are both
- R to L shunt
- L to R shunt
R to L shunt
In the foetus, the RIGHT/LEFT atrium has higher pressure?
Right atrium
When a baby takes its first breaths, volume in the right atrium increases/decreases and the volume in the left atrium increases/decreases
R atrium - decreases
L atrium - increases
Name 3 L to R shunts
ASD
VSD
Persistent ductus arteriosus
ASD murmur type
- systolic / diastolic
- ejection / pan / holi
Ejection systolic
VSD murmur type and heart sound
Pan systolic murmur
Quiet second heart sound
continuous murmur beneath the left clavicle
collapsing or bounding pulse
patent ductus arteriosus
Cyanosis within the first week of life think either (2)
Tetrallogy of fallot
Transposition of the great vessels
• A large VSD
• Overriding of the aorta with respect to the
ventricular septum
• Subpulmonary stenosis causing right ventricular
outflow tract obstruction
• Right ventricular hypertrophy as a result.
Tetralogy of fallot
Seritide is twice as potent as clenile modulate inhaler. True or false?
True
An 11 year old is very stable and needs to step down their asthma treatment. They are currently taking Seretide 125 Evohaler 2 puffs twice daily. What is the safest step down option?
Seretide 125 Evohaler 1 puff twice daily
Clenil Modulite 100mcg 1 puff twice daily
Seretide 50 Evohaler 2 puffs twice daily
No change
Seretide 50 Evohaler 2 puffs twice daily
- Seretide is a combination inhaler of Fluticasone and Salmeterol. This steps down from 1000mcg/day to 400 mcg/day by using the lower strength inhaler, but crucially, this doesn’t change the daily Salmeterol dose. Patients may be more likely to manage as the “2 puffs twice a day” instructions are also the same. If patients need to move in smaller steps, you can exchange individual puffs of Seretide 125 with Seretide 50 to bring the dose in a series of smaller steps, but that’s more fiddly and needs the family to have clear instructions!
Which medication can be used to help keep cardiac duct open?
Prostaglandin
What may a single palmar crease be a sign of?
Downs syndrome
For how long should gestational correction be continued for premature infants born at 32-36 weeks gestation?
1 year
For how long should gestational correction be continued for premature infants born at 28-32 weeks gestation?
2 years
Common organism causing sepsis in neonate ?
Group B strep
- usually after recovering from RDS
- early signs: lethargy and gastric residuals
- Bloody stool, temperature instability, apnoea and bradycardia
What does this suggest?
Necrotising enterocolitis (NEC)
If you stroke both carotids at the same time, what can happen?
Make someone faint
- baroreceptor reflexes firing
In the womb, where do you get oxygen from?
PLacneta
Where is the foramen ovale
Right atrium to transfer blood from RA –> LA
What medication is used for strawberry haemangioma to help them shrink
propranolol
Rash on baby, comes up a couple of days after birth, completely benign, baby is otherwise well, what is it?
Erythema toxicum
Papsule with punctum in the middle makes you think
Molluscum contagiosum
What causes molluscum contagiosum
Pox virus
Coryza symptoms, swollen red cheeks, what is the syndrome and what virus causes it?
Slapped cheek syndrome
Virus: parovirus
Slapped cheek syndrome affects
- platelets
- red blood cells
- white blood cells
Red blood cells
Scarlet fever treatment
IV penicillin
- since it is group A strep
White strawberry tongue, peeling of fingers of toes, erythematous, rough rash, perioral palor. What is likely diagnosis?
Scarlet fever
Yellow gold crusted lesion on face - what is it? and what organism?
Impetigo
Staph aureus
Child presents with around 10 loose stools per day, otherwise well and thriving. What is likely diagnosis?
Toddler’s diarrhoea
- likely grow out of it
3 month old boy referred to outpatient clinic with persistent vomiting.
Growing well on centile chart.
Bottle feeding
What is likely going on?
GORD
In children, you can diagnose coeliac disease on blood tests alone (ie you don’t have to do endoscopy). True or false?
True
- if ttG >10 times the upper limit of normal
- if classical symptoms present
What is the target blood sugar level for a diabetic before meals?
4-7
What si the target blood sugar level for a diabetic 2 hours after meals?
5-9
Lantis (glargine) is long acting or short acting
Long acting
Outline the management of DKA
Oxygen if required
IV access
- IV fluids (first)
- IV insulin
Polyuria Polydypsia Tiredness Tummy pain Weight loss
Diabetes
decreased/increased skin tugor is a sign of dehydration
Decreased
There is a risk of what with DKA?
Cerebral oedema
Converting IV to sub cut
- 05 units / kilo
- half their weight
- half again for lantis
- and thirds for novorapid
Surfactant deficiency CXR findings
Small volume lungs
diffuse granular opacification
bubbly lungs
pneumothorax
TTN definition
Slow clearing of pulmonary fluid
onset within 24 hours of birth
Normal or hyperinflated lungs
interstitial lines
fluid in the fissures
air space oppacification
TTN
Distress during delivery
over inflated lungs (air trapping)
air leaks
Meconium aspiration
patchy opacities
over infaltion
atelectasis
what do you suspect
Pneumonia
endotracheal tube goes into right main bronchus. what can happen to the left lung?
L lung can collapse
- since it is unventilated
children under 6 months - UTI imaging required ?
US
If abnormal
- VCUG and renogram
What does DMSA scan look at
Renal function
done 4-6 months post complicated UTI to assess relative renal function and scarring
Buldging fontanelles suggests
Raised ICP
Spiral long bone fractures in a child suggests
NAI
Posterior or lateral rib fractures. What does this suggest?
NAI
Fracture
- broken on one side but bowing on the other (ie other side intact) . What is this called?
greenstick fracture
Which classification system is used to classify growth plate injuries
Salter harris classification
- 1-5
2 is most common
Fixed split S2 - which heart defect
ASD
- think A split double (splitting of 2nd heart sound)
Which type of murmur do you get in VSD?
holosystolic murmur
Which medications would you give in coarctation of the aorta to keep the ductus arteriosus open?
prostaglandin E
Which medications would you give in patent ductus arteriosus to promote duct closure?
Indomethacin
Ibuprofen
transposition of the great arteries can be diagnosed on antenatal US. True or false?
True
What is the most common cyanotic heart defect in paeds
tetralogy of fallot
Loud harsh ejection systolic murmur in which heart defect
Tetralogy of fallot
Is tetrallogy of fallot cyanotic?
Yes
Spots -> fluid filled blisters (vesicles -> crust over. On skin. what is this?
Chickenpox
How is chickenpox spread?
Droplets (coughs, sneezes)
Blue mark on bum
mongolian blue spot
If someone has talipes….what should you to?
Try and straighten it out to see if it is fixed or not
If talipes does’t straighten out, what should you do?
Refer to orthopaedics for splinting
Lumps on babys head differential
Caput
Cephalohaematoma
How do you tell the difference between caput and cephalohaematoma?
Cephalohaematoma doesn’t cross the suture lines
Physiological jaundice (3 causes)
Breast feeding
foetal haemoglobin
2 potentially pathological causes of jaundice
Prolonged - over 14 days
Immediately after birth - in first 24 hours
PDA is a shunt from right/left -> right/left
Left -> Right
Extreme preterm
Very preterm
Moderate-late preterm
ranges
Extreme preterm: before 28 weeks
Very preterm: 28-32 weeks
Moderate-late preterm: 32-36 weeks
Preterm baby doesn’t get formula milk. True or false?
True
- breast milk
- donor expressed breast milk
What is RDS commonly due to
Lack of surfactant
Structural immaturity of lung tissue
Who is most likely to get TTN
Babies delivered by C section
Over reaction to mistakes
Thumb sucking when older
Self mutilation
Sudden speech disorders
What kind of abuse does this suggest?
Emotional abuse
If you recognise potential child abuse at work, normal office hours, who do you report to
Senior colleague
Child protection team
Which types of injuries/bruising makes you concerned about child abuse
Bruising on a child who can’t mobilise yet
Bruising at ears
Bruising at upper arm / outer thigh
Fractures suggesting NAI
Fractures of different ages
Spiral femoral fracture
C spine fracture (shaking)
Surfactant is pig extract. True or false?
True
Why is vitamin K given at birth
To prevent bleeding disorders
Pre-term neonate
bilious vomiting, bloody stool, abdo distention
What is this likely to be
NEC
Risk factors for NEC
Preterm
Formula feeding
IUGR
When prescribing an inhaler, what should you remember
include strength and types of inhaler
Prescribe in number of puffs
Dextrocardia + bronchiectasis + chronic sinusitis suggests
Kartagener syndrome
First time AF, lasted longer than 48 hours. Patient doing ok.
How do you manage?
Do you want to cardiovert and if so either
- pharmacological
- elecrical
Bisoprolol and anticoagulation for 3 weeks
Then electrical cardioversion
Red patchy rash in first week of life. What is it and how do you treat?
Erythema toxicum
Self limiting
Measles and rubella have which type of rash
Maculopapular
Which type of rash is seen in chicken pox
Vesicular
Purpura and petichiae are associated with which infection
Meningitis
Target lesions are associated with which rash
Steven Johnson syndrome
In HSP, the child will be well / unwell
Well
The rash between HSP and which other condition looks similar?
Meningitis
Why do babies with respiratory distress grunt
trying to increase alveolar pressure
Chest x-ray of respiratory distress syndrome will show
Ground glass opacification
What is RDS caused by
Relative surfactant deficiency
How is production of surfactant stimulated
By steroids
How to manage a tension pneumothorax
Needle decompression
Chest drain
Babies at risk of RSV, what do you give them?
Pavalizumab - this is IgG to RSV
Term baby, especially delivered by c-section, what respiratory problem do you risk?
TTN
- lungs filled with amniotic fluid
What gestation do babies learn to suck?
32 weeks gestation
Treatment of neonatal acne?
Nothing
First line oral acne for teenager?
Tetracycline
Why should you never give a baby tetracycline?
affects bones / teeth in babies
Jaundice that appears before 24 hours old, what are you worried about ?
Haemolytic disease
- ABO
- rhesus disease
All pregnant mkthers get antiD. True or false?
True
Prolonged jaundice - what are you worrying about
Biliary atresia
Pale stools and dark urine - is this conjugated / unconjugated jaundice?
Conjugated
Day 6 we get gurthrie teat
Screened for thyroid function
Why treat jaundice with light therapy
if your level is too high, can cross the BBB, can cause cererbal palsy - kernicterous
How does light therapy work for babies with high unconjugated jaundice
change bilirubin from fat soluble to water soluble isomer
Erbs palsy involves which nerves?
C5, C6
Klumpke’s palsy involves which nerves?
C8, T1
AXR - air/gas in the gut wall. What does this make you think?
NEC
4-6 week age group Distention of stomach Baby vomits towards end of / just after feed PROJECTILE vomit What is the likely diagnosis
Pyloric stenosis
Colicky pain, young child, mass may be felt in abdomen.
What is the likely diagnosis?
Insusception
True bilous vomiting suggests
Intestinal obstruction
What are the 4 features of tetralogy of fallot?
Right ventricular hypertrophy
Pulmonary stenosis
Ventricular septal defect
Overriding aorta
Rash: Small, pearly papules with central umbilication
molluscum contagiosum
What is the treatment of molluscum contagiosum
Self limiting
Failure to pass meconium in first 24-48 hours after birth, vomiting and abdominal distension makes you think?
Hirshprung’s disease
What investigation is needed for the definitive diagnosis of Hirshprung’s disease?
Suction assisted full thickness rectal biopsies
Most common site of aspiration
- right main bronchus
- left main bronchus
Right main bronchus
Acute glomerulonephritis often follows a sore throat / URTI. True or false?
True
Which age group is most common for intussception
9-12 months
Convulsing child in hospital. Episode has been lasting over 5 mins and you have vascular access. What do you give?
IV Lorazepam
Convulsing child in hospital. Episode has been lasting over 5 mins and you DO NOT have vascular access. What do you give?
Buccal midazolam / rectal diazepam
Convulsing child in hospital. Episode has been lasting over 10 mins and you have vascular access. At 5 mins you gave lorazepam IV. What do you do at 10 mins?
Give IV lorazepam
3 triggers for reflex anoxic seizures
Pain
Fear
Anxiety
When should a child be able to sit unsupported?
6 months
When should child be able to walk?
12 months
When should child be able to transfer objects between hands?
6 months
When should child be able to develop pincer grip?
9 months
What age to draw a circle?
Age 3
Can’t run by X months is classified as delayed?
24
Hand dominance prior to X months is a red flag?
18 months
Primitive reflexes are usually lost by X months?
12 months
Describe the rooting reflex
Stroke a baby’s cheek causes baby to turn and open mouth
At 12 months of age, a child has persistence of primitive reflexes. Does this indicate:
- normal finding for this age
- UMN lesion
- LMN lesion
UMN lesion
HSP rash is blanching or non-blanching?
Non-blanching
HSP commonly involves which organ?
Kidneys
If someone is in status epilepticus, begin to intervene after X mins
5
Tried lorazepam for status epilepticus but not controlling seizure, what can you use?
phenytoin
How must you give phenytoin
Slowly over an infusion
Which age do febrile convulsions usually stop?
By age 6
18 month old male, not walking. What will you check?
CK levels for ?Duchenes muscular dystrophy
Sensory issues
Repetitive behaviour
Deficits in social communication and interaction
ASD
Cerebral palsy
- UMN lesion
- LMN lesion
UMN lesion
Prominent forehead Long, thin face High arch palate Dental overcrowding Pectus excuvatum Delayed gross motor milestones Dysmorphic features present
Fragile X
Main complication of chicken pox
Encephalitis
When will the anterior fontanelle have disappeared (roughly)?
Around 18 months
newborn with abdominal contents protruding through anterior abdominal wall but are covered in an amniotic sac. what is this likely to be?
Exopthalmos
What is the key investigation in pyloric stenosis?
US
What are the 2 treatments used in kawasaki disease
Aspirin
single dose IVIg
3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever - what does this suggest?
HHV6
roseola infantum
Coarctation of the aorta and PDA have SYSTOLIC murmurs. True or false?
False
SUFE
- painless / painful limp
- age group
Painful limp
Teenagers
Perthes disease
- painless / painful limp
- age group
Painless limp
Longer history (weeks / months)
Children 4-8y
Commonest brain tumour in young children
Medulloblastoma
Child 4 years old with PDA. What is the management?
Early operative closure is recommended in any patient where the defect has persisted beyond 6 months of age.
Which of the following is a child with recurrent upper urinary tract infections most likely to show?
Horseshoe kidney Neurogenic bladder Renal and ureteric calculi Vesicoureteric reflux
Vesicoureteric reflux
What is the likely diagnosis here:
A 5-year-old boy is referred to a paediatrician after his parents notice frank haematuria. On examination an abdominal mass is palpable. An intravenous urogram shows dilation of the pelvicalyceal system.
Wilms tumour
A 2-year-old child presents to the Emergency department with fever, left loin pain and offensive smelling urine.
He is pyrexial at 38.5°C. A clean catch urine is positive for blood, protein and nitrites.
What is most appropriate initial antibiotic therapy?
Co-amoxiclav
Name 3 causes of prolonged jaundice in the neonate
Biliary atresia
Hypothyroidism
G6PD deficiency
What does direct coombs test check for
Haemolysis
What is kernicterus
How does it present
A type of brain damage caused by excessive bilirubin levels
less responsive, floppy, drowsy baby with poor feeding. The damage to the nervous system is permeant, causing cerebral palsy, learning disability and deafness
CXR in RDS
Ground glass appearance
What is th investigation of choice for NEC
Abdominal XRay
Immediate management of NEC
nil by mouth with IV fluids, total parenteral nutrition (TPN) and antibiotics to stabilise them. A nasogastric tube can be inserted to drain fluid and gas from the stomach and intestines.
