Paediatrics (Geeky Medics) Flashcards
1
Q
How does infantile colic present in a child?
A
- Inconsolable crying (high-pitched)
- Facial redness
- Knees drawing up to chest
- Passing wind
2
Q
What is the management of colic?
A
Parental reassurance
3
Q
How does intussusception present in a child?
A
- Preceding viral illness
- reoccurrence of colicky abdominal pain
- associated crying
- bilious vomiting
- red currant jelly stools
- palpable sausage shaped mass in right upper quadrant
- irritable
4
Q
What age does intussusception present?
A
6 months - 2 years
5
Q
Is intussusception associated with concurrent viral illness?
A
Yes
6
Q
What is the initial investigation to diagnose intussusception?
A
Ultrasound
7
Q
When is surgical resection required to manage intussusception?
A
If the bowel becomes gangrenous
8
Q
How is intussusception managed?
A
Therapeutic enemas
9
Q
What is volvulus?
A
Twisted bowel - bowel twists around itself and the mesentery it is attached too
10
Q
How does volvulus present?
V = vomiting
A
- Green bilious vomiting
- Abdominal distention
- Abdominal pain
- Absolute constipation and no wind
11
Q
What does sigmoid volvulus look like on an abdominal x-ray?
A
Coffee bean shape
12
Q
What is the gold standard to diagnose volvulus?
A
Contrast CT scan
13
Q
How is a sigmoid volvulus managed?
think of scopy
A
endoscopic decompression
14
Q
List some symptoms of problematic GORD in babies
A
- chronic cough
- distress after feeding
- reluctance to feed
- poor weight gain
- pneumonia (aspiration)
15
Q
How can a parent simply manage GORD in a baby?
A
- Small frequent meals
- No over feeding
- Burping regularly
- keep baby upright after feeding
16
Q
How can GORD in babies be medically managed?
similar to adults
A
- Gaviscon
- Omeprazole
17
Q
How does acute otitis media present in young children?
A
- Tugging of ear / behaviour change
- Fever / coryzal symptoms
- Crying / irritable
- sleeping poorly
- discharge if TM perforated
18
Q
What normally precedes otitis media in children and why?
A
viral URTI due to the bacteria travelling from the throat, through the eustachian tube to the ear
19
Q
What is the most common bacteria to cause otitis media in children?
A
Strep pneumoniae
20
Q
What does the TM look like in otitis media?
3 marks
A
- Bulging
- Red
- Inflamed
21
Q
What does severe otitis media in children do to the TM?
A
Pressure can cause the TM to rupture and leak discharge
22
Q
What is the management of most cases of otitis media?
A
- Resolves within 3 days / week without antibiotics
- Simple analgesia
23
Q
In what cases would you consider prescribing antibiotics for otitis media?
A
- co-morbidities
- unwell / immunocompromised
- bilateral in child <2
24
Q
What is the first line abx for otitis media?
A
Amoxicillin 5 days
25
What is glue ear and how does it differ to normal otitis media?
Otitis media with effusion where the middle ear becomes full of fluid, causing loss of hearing
26
What are the findings of glue ear when looking down an otoscope?
- Dull TM
- air bubbles
- visible fluid level
27
How long does it normally take glue ear to resolve by itself without treatment?
3 months
28
What management may children with co-morbidities require with glue ear?
Grommets
29
Name 2 risk factors that can increase the risk of getting otitis externa?
- "Swimmers ear"
| - Trauma (ear plugs)
30
What can pre-dispose a patient to having otitis externa?
Recent fungal/bacterial infection needing the use of antibiotics as the abx kills the good bacteria
31
What two bacteria cause otitis externa?
- Pseudomonas aeruginosa
| - Staph aureus
32
Why is p.aeruginosa difficult to treat in children with cystic fibrosis?
It colonizes the lungs and is naturally resistant to many antibiotics
33
What can moderate otitis externa be managed with?
Otomize ear spray - topical antibiotic and steriod
| includes Neomycin, dexamethasone and acetic acid
34
What is cholesteatoma?
Abnormal collection of squamous cells in the middle ear
35
How does cholesteatoma present? (2 marks)
- Prolonged foul discharge over weeks from affected ear
| - Unilateral conductive hearing loss
36
What type of imaging is useful to determine the diagnosis of cholesteatoma?
CT Head
37
How is cholesteatoma managed?
Surgical removal
38
What is rheumatic fever?
Auto-immune condition when the body starts to attack the cells in the tissue after a streptococcal infection
39
What organs does rheumatic fever affect? (4)
- Heart
- Joints
- Skin
- Nervous system
40
How long after a strep infection (tonsillitis) does rheumatic fever start?
2-4 weeks later
41
Mrs JONES had FEAR that she had rheumatic fever
How is a diagnosis of rheumatic fever made alongside evidence of a recent strep infection?
JONES (major) FEAR (minor)
```
J - Joint arthritis (migratory)
O - Organ inflammation
N - Nodules
E - Erythema marginatum rash
S - sydenham chorea (uncontrolled rapid limb movements)
```
F - Fever
E - ECG changes (prolonged PR interval)
A - Arthralgia without arthritis
R - raised inflammatory markers
42
How can rheumatic fever affect the heart?
- Tachy/Brady
- Murmurs
- Pericardial rub
- Heart failure
43
How does rheumatic fever cause changes to the tongue?
Strawberry tongue
44
What bacteria typically causes rheumatic fever?
Group A beta haemolytic streptococcal (strep pyogenes)
45
What investigation can you do to help determine the causative bacteria in rheumatic fever?
Throat swab
46
What investigation can you do to determine a recent strep infection when diagnosing rheumatic fever?
ASO (antistrep antibodies) titres
- repeat after 2 weeks to confirm negative test
- Assess if levels going up or down
47
Name 3 risk factors for developing rheumatic fever?
Young age
Female
Geographical location (Africa, south america)
48
What is the antibiotic management of rheumatic fever?
phenoxymethylpenicillin (penicillin V) for 10 days
49
What medication can a patient with rheumatic fever take to help treat joint pain?
NSAIDs
50
What medication can patients with rheumatic fever take to help treat carditis? (2)
Aspirin
| Steroids
51
What is another name for downs syndrome?
Trisomy 21
52
How does downs syndrome present? (dysmorphic features) 4 marks
- Flat face and nose
- Epicanthic folds
- Upward sloping palpebral fissures
- Hypotonia
53
Name 4 complications associated with downs syndrome?
- Learning disability
- Hypothyroidism
- Cardiac defects (VSD)
- Visual problems
54
What are the three classic features of Turner Syndrome?
- Short stature
- Webbed neck
- Widely spaced nipples
55
What age is Turner's syndrome associated with?
Teenagers
56
What type of genetic condition is cystic fibrosis?
Autosomal recessive
57
What are the three consequences of the cystic fibrosis mutation?
1) Thick pancreatic and biliary secretions --> lack of digestive enzymes
2) Low volume thick airway secretions --> bacterial colonisation --> URTI
3) Congenital bilateral absence of vas deferens --> male infertility
58
What is the diagnostic test for cystic fibrosis?
Sweat test
59
Name 4 symptoms of cystic fibrosis
1) Chronic cough with thick sputum
2) Loose greasy stools
3) May taste salty
4) Failure to thrive
60
What are the two options of treatment in a clinical setting if a patient's febrile convulsion has continued for 5 minutes?
Rectal diazepam
Buccal midazolam
61
How is RSV transmitted between children? (2)
Droplets
| Touching surfaces
62
How does mucus plugging in bronchiolitis cause atelectasis?
Mucus plug traps air --> air diffuses into bloodstream --> causes airways to collapse
63
Name 3 risk factors that pre-dispose a child to developing bronchiolitis?
1) Not breastfed
2) Born premature
3) Neuromuscular disorders --> unable to clear airways easily
64
What are the 8 signs of respiratory distress in an unwell child?
- Raised RR
- Use of accessory muscles
- Intercostal/subcostal recessions
- Tracheal tug
- Nasal flaring
- Head bobbing
- Cyanosis
- Abnormal airway noises
65
Describe wheezing and when is it heard?
W = Whistling
Heard during expiration
66
Describe grunting and when you hear it?
Glottis is still partially closed
Heard on expiration
67
Describe stridor and when do you hear it?
High pitched noise caused by obstruction of the upper airway
Heard on inspiration
68
If a child has had bronchiolitis as an infant, what are they more likely to have in childhood?
Viral induced wheeze
69
What RR would warrant a hospital admission for a child presenting with bronchiolitis?
RR above 70
70
What supportive management can parents take for their child presenting with bronchiolitis?
Adequate water intake
Saline nasal drops/suctioning
71
What is Palivizumab and when is it given and why?
Monoclonal antibody that targets the RSV to provide prevention against bronchiolitis
Given in monthly injections as the levels decrease over time
72
What are the four abnormalities of tetralogy of fallot? (heart probles)
1) Ventricular septal defect
2) Overriding aorta
3) Pulmonary stenosis
4) Right ventricular hypertrophy
73
What is the most common cause of cyanosis in babies less than 24 hours old?
Transposition of the great arteries
74
What is transposition of the great arteries?
When the position of the aorta and pulmonary artery have swapped, disrupting the cycle of deoxygenated and oxygenated blood
75
What is the initial management of transposition of great arteries and what does it do?
Prostaglandin E1 --> helps to keep the ductus arteriosus open to mix the blood
76
What virus causes chicken pox?
Varicella zoster virus
77
How does a child with chickenpox present?
Fever
Itching
Loss of appetite sometimes
78
What is the criteria for a child with chickenpox in regards to school exclusion?
Should be excluded until all lesions have crusted over (5 days after rash)
79
What is the conservative management of chickenpox? (2)
Anti-histamines
| Calamine lotion
80
What should immunocompromised patients, neonates or patients exposed to the VZV in their first 20 weeks of pregnancy receive?
Varicella zoster immunoglobulin (VZIG)
81
What is the technique to provide BLS in children from 1 to puberty?
1 hand compressing lower half of sternum
5 rescue breaths
82
What is the technique for BLS of children under 1?
Two thumb circling technique
83
What is the most appropriate/initial management of acute epiglottits?
Endotracheal intubation by calling on-call anaesthetist
84
What bacteria causes acute epiglottitis?
Influenzae B
85
What is transient synovitis?
Transient irritation and inflammation of the hip joint
86
What is transient synovitis often associated with?
Recent viral URTI
87
What age does transient synovitis typically present?
3-10 years
88
How does a child present with transient synovitis? (4 marks)
- Limp
- Cannot weight bear
- Groin/hip pain
- Mild fever/ no fever
89
How is transient synovitis typically managed and when should they be followed up?
Simple analgesia
48 hours - 1 week
90
How long does it take for symptoms to fully resolve in patients with transient synovitis?
1-2 weeks
91
What is septic arthritis/osteomyelitis?
Infection of the joint/joint replacement
92
How does a patient present with septic arthritis/osteomyelitis?
- Rapid onset of hot, red and swollen joint
- Stiffness with reduced ROM
- Fever, lethargy
93
What causative organism should you think of when it comes to septic arthritis presenting in a young patient who is sexually active?
N.gonorrhoea
94
What is the gold standard investigation for septic arthritis?
Joint aspiration
95
What is the management of septic arthritis?
IV abx - Flucloxacillin & Ridampicin
96
What is juvenile idiopathic arthritis?
Autoimmune condition causing inflammation in the joints
97
How long does a patient need to have symptoms for it to be diagnosed as juvenile idiopathic arthritis?
More than 6 weeks
98
What is the management of JIA? (including referral)
- Referral to paeds rheumatology
- NSAIDs
- Steroids
- DMARDS
99
What is developmental dysplasia of the hip?
Structural abnormality in the hips caused by abnormal development of the fetal bones
100
How soon can developmental dysplasia of the hip be picked up?
Newborn examinations
101
How does a child present with developmental dysplasia of the hip? (3)
- Abnormal gait
- reduced range of movement
- Hip asymmetry
102
What is the gold standard investigation for developmental dysplasia of the hip?
US Hips
103
What is the management of developmental dysplasia of the hip in a patient less than 6 months?
Pavlik harness
104
What is the management of developmental dysplasia of the hip in a patient more than 6 months?
Surgery
105
What is perthes disease?
Disruption of blood flow to the femoral head causing avascular necrosis
106
What age is perthes disease more common in?
4-8
107
What is the complication of revascularisation of the femoral head in perthes disease?
Makes a soft and deformed femoral head that can lead to osteoarthritis
108
How does a patient with perthes disease present?
Slow onset
- Pain in hip/groin
- Limp
- Restricted hip movement
- ?pain referred to knee
109
What is the initial investigation for perthes disease that can be normal?
X-ray
110
What is Slipped upper femoral epiphysis?
Femoral head is displaced "slips" along the growth plate
111
What age and type of child is Slipped upper femoral epiphysis more commonly seen in?
10-15
| Adolescent obese male undergoing growth spurt
112
How does Slipped upper femoral epiphysis differ to perthes disease?
Can be triggered by minor trauma whereas perthes disease cannot
113
What examination findings would you see in a patient presenting with Slipped upper femoral epiphysis?
Prefer to stay in external rotation
restricted internal rotation
114
What is the initial investigation of Slipped upper femoral epiphysis?
X ray
