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ICM/FCM > Paediatrics (Geeky Medics) > Flashcards

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
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2
Q

What is the management of colic?

A

Parental reassurance

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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
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4
Q

What age does intussusception present?

A

6 months - 2 years

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5
Q

Is intussusception associated with concurrent viral illness?

A

Yes

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6
Q

What is the initial investigation to diagnose intussusception?

A

Ultrasound

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7
Q

When is surgical resection required to manage intussusception?

A

If the bowel becomes gangrenous

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8
Q

How is intussusception managed?

A

Therapeutic enemas

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9
Q

What is volvulus?

A

Twisted bowel - bowel twists around itself and the mesentery it is attached too

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10
Q

How does volvulus present?

V = vomiting

A
  • Green bilious vomiting
  • Abdominal distention
  • Abdominal pain
  • Absolute constipation and no wind
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11
Q

What does sigmoid volvulus look like on an abdominal x-ray?

A

Coffee bean shape

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12
Q

What is the gold standard to diagnose volvulus?

A

Contrast CT scan

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13
Q

How is a sigmoid volvulus managed?

think of scopy

A

endoscopic decompression

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14
Q

List some symptoms of problematic GORD in babies

A
  • chronic cough
  • distress after feeding
  • reluctance to feed
  • poor weight gain
  • pneumonia (aspiration)
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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
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16
Q

How can GORD in babies be medically managed?

similar to adults

A
  • Gaviscon

- Omeprazole

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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
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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

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19
Q

What is the most common bacteria to cause otitis media in children?

A

Strep pneumoniae

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20
Q

What does the TM look like in otitis media?

3 marks

A
  • Bulging
  • Red
  • Inflamed
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21
Q

What does severe otitis media in children do to the TM?

A

Pressure can cause the TM to rupture and leak discharge

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22
Q

What is the management of most cases of otitis media?

A
  • Resolves within 3 days / week without antibiotics

- Simple analgesia

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23
Q

In what cases would you consider prescribing antibiotics for otitis media?

A
  • co-morbidities
  • unwell / immunocompromised
  • bilateral in child <2
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24
Q

What is the first line abx for otitis media?

A

Amoxicillin 5 days

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25
Q

What is glue ear and how does it differ to normal otitis media?

A

Otitis media with effusion where the middle ear becomes full of fluid, causing loss of hearing

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26
Q

What are the findings of glue ear when looking down an otoscope?

A
  • Dull TM
  • air bubbles
  • visible fluid level
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27
Q

How long does it normally take glue ear to resolve by itself without treatment?

A

3 months

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28
Q

What management may children with co-morbidities require with glue ear?

A

Grommets

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29
Q

Name 2 risk factors that can increase the risk of getting otitis externa?

A
  • “Swimmers ear”

- Trauma (ear plugs)

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30
Q

What can pre-dispose a patient to having otitis externa?

A

Recent fungal/bacterial infection needing the use of antibiotics as the abx kills the good bacteria

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31
Q

What two bacteria cause otitis externa?

A
  • Pseudomonas aeruginosa

- Staph aureus

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32
Q

Why is p.aeruginosa difficult to treat in children with cystic fibrosis?

A

It colonizes the lungs and is naturally resistant to many antibiotics

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33
Q

What can moderate otitis externa be managed with?

A

Otomize ear spray - topical antibiotic and steriod

includes Neomycin, dexamethasone and acetic acid

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34
Q

What is cholesteatoma?

A

Abnormal collection of squamous cells in the middle ear

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35
Q

How does cholesteatoma present? (2 marks)

A
  • Prolonged foul discharge over weeks from affected ear

- Unilateral conductive hearing loss

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36
Q

What type of imaging is useful to determine the diagnosis of cholesteatoma?

A

CT Head

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37
Q

How is cholesteatoma managed?

A

Surgical removal

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38
Q

What is rheumatic fever?

A

Auto-immune condition when the body starts to attack the cells in the tissue after a streptococcal infection

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39
Q

What organs does rheumatic fever affect? (4)

A
  • Heart
  • Joints
  • Skin
  • Nervous system
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40
Q

How long after a strep infection (tonsillitis) does rheumatic fever start?

A

2-4 weeks later

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41
Q

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)

A 
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

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42
Q

How can rheumatic fever affect the heart?

A
  • Tachy/Brady
  • Murmurs
  • Pericardial rub
  • Heart failure
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43
Q

How does rheumatic fever cause changes to the tongue?

A

Strawberry tongue

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44
Q

What bacteria typically causes rheumatic fever?

A

Group A beta haemolytic streptococcal (strep pyogenes)

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45
Q

What investigation can you do to help determine the causative bacteria in rheumatic fever?

A

Throat swab

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46
Q

What investigation can you do to determine a recent strep infection when diagnosing rheumatic fever?

A

ASO (antistrep antibodies) titres

  • repeat after 2 weeks to confirm negative test
  • Assess if levels going up or down
47
Q

Name 3 risk factors for developing rheumatic fever?

A

Young age
Female
Geographical location (Africa, south america)

48
Q

What is the antibiotic management of rheumatic fever?

A

phenoxymethylpenicillin (penicillin V) for 10 days

49
Q

What medication can a patient with rheumatic fever take to help treat joint pain?

50
Q

What medication can patients with rheumatic fever take to help treat carditis? (2)

A

Aspirin

Steroids

51
Q

What is another name for downs syndrome?

A

Trisomy 21

52
Q

How does downs syndrome present? (dysmorphic features) 4 marks

A
  • Flat face and nose
  • Epicanthic folds
  • Upward sloping palpebral fissures
  • Hypotonia
53
Q

Name 4 complications associated with downs syndrome?

A
  • Learning disability
  • Hypothyroidism
  • Cardiac defects (VSD)
  • Visual problems
54
Q

What are the three classic features of Turner Syndrome?

A
  • Short stature
  • Webbed neck
  • Widely spaced nipples
55
Q

What age is Turner’s syndrome associated with?

56
Q

What type of genetic condition is cystic fibrosis?

A

Autosomal recessive

57
Q

What are the three consequences of the cystic fibrosis mutation?

A

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
Q

What is the diagnostic test for cystic fibrosis?

A

Sweat test

59
Q

Name 4 symptoms of cystic fibrosis

A

1) Chronic cough with thick sputum
2) Loose greasy stools
3) May taste salty
4) Failure to thrive

60
Q

What are the two options of treatment in a clinical setting if a patient’s febrile convulsion has continued for 5 minutes?

A

Rectal diazepam

Buccal midazolam

61
Q

How is RSV transmitted between children? (2)

A

Droplets

Touching surfaces

62
Q

How does mucus plugging in bronchiolitis cause atelectasis?

A

Mucus plug traps air –> air diffuses into bloodstream –> causes airways to collapse

63
Q

Name 3 risk factors that pre-dispose a child to developing bronchiolitis?

A

1) Not breastfed
2) Born premature
3) Neuromuscular disorders –> unable to clear airways easily

64
Q

What are the 8 signs of respiratory distress in an unwell child?

A
  • Raised RR
  • Use of accessory muscles
  • Intercostal/subcostal recessions
  • Tracheal tug
  • Nasal flaring
  • Head bobbing
  • Cyanosis
  • Abnormal airway noises
65
Q

Describe wheezing and when is it heard?

A

W = Whistling

Heard during expiration

66
Q

Describe grunting and when you hear it?

A

Glottis is still partially closed

Heard on expiration

67
Q

Describe stridor and when do you hear it?

A

High pitched noise caused by obstruction of the upper airway

Heard on inspiration

68
Q

If a child has had bronchiolitis as an infant, what are they more likely to have in childhood?

A

Viral induced wheeze

69
Q

What RR would warrant a hospital admission for a child presenting with bronchiolitis?

A

RR above 70

70
Q

What supportive management can parents take for their child presenting with bronchiolitis?

A

Adequate water intake

Saline nasal drops/suctioning

71
Q

What is Palivizumab and when is it given and why?

A

Monoclonal antibody that targets the RSV to provide prevention against bronchiolitis

Given in monthly injections as the levels decrease over time

72
Q

What are the four abnormalities of tetralogy of fallot? (heart probles)

A

1) Ventricular septal defect
2) Overriding aorta
3) Pulmonary stenosis
4) Right ventricular hypertrophy

73
Q

What is the most common cause of cyanosis in babies less than 24 hours old?

A

Transposition of the great arteries

74
Q

What is transposition of the great arteries?

A

When the position of the aorta and pulmonary artery have swapped, disrupting the cycle of deoxygenated and oxygenated blood

75
Q

What is the initial management of transposition of great arteries and what does it do?

A

Prostaglandin E1 –> helps to keep the ductus arteriosus open to mix the blood

76
Q

What virus causes chicken pox?

A

Varicella zoster virus

77
Q

How does a child with chickenpox present?

A

Fever
Itching
Loss of appetite sometimes

78
Q

What is the criteria for a child with chickenpox in regards to school exclusion?

A

Should be excluded until all lesions have crusted over (5 days after rash)

79
Q

What is the conservative management of chickenpox? (2)

A

Anti-histamines

Calamine lotion

80
Q

What should immunocompromised patients, neonates or patients exposed to the VZV in their first 20 weeks of pregnancy receive?

A

Varicella zoster immunoglobulin (VZIG)

81
Q

What is the technique to provide BLS in children from 1 to puberty?

A

1 hand compressing lower half of sternum

5 rescue breaths

82
Q

What is the technique for BLS of children under 1?

A

Two thumb circling technique

83
Q

What is the most appropriate/initial management of acute epiglottits?

A

Endotracheal intubation by calling on-call anaesthetist

84
Q

What bacteria causes acute epiglottitis?

A

Influenzae B

85
Q

What is transient synovitis?

A

Transient irritation and inflammation of the hip joint

86
Q

What is transient synovitis often associated with?

A

Recent viral URTI

87
Q

What age does transient synovitis typically present?

A

3-10 years

88
Q

How does a child present with transient synovitis? (4 marks)

A
  • Limp
  • Cannot weight bear
  • Groin/hip pain
  • Mild fever/ no fever
89
Q

How is transient synovitis typically managed and when should they be followed up?

A

Simple analgesia

48 hours - 1 week

90
Q

How long does it take for symptoms to fully resolve in patients with transient synovitis?

91
Q

What is septic arthritis/osteomyelitis?

A

Infection of the joint/joint replacement

92
Q

How does a patient present with septic arthritis/osteomyelitis?

A
  • Rapid onset of hot, red and swollen joint
  • Stiffness with reduced ROM
  • Fever, lethargy
93
Q

What causative organism should you think of when it comes to septic arthritis presenting in a young patient who is sexually active?

A

N.gonorrhoea

94
Q

What is the gold standard investigation for septic arthritis?

A

Joint aspiration

95
Q

What is the management of septic arthritis?

A

IV abx - Flucloxacillin & Ridampicin

96
Q

What is juvenile idiopathic arthritis?

A

Autoimmune condition causing inflammation in the joints

97
Q

How long does a patient need to have symptoms for it to be diagnosed as juvenile idiopathic arthritis?

A

More than 6 weeks

98
Q

What is the management of JIA? (including referral)

A
  • Referral to paeds rheumatology
  • NSAIDs
  • Steroids
  • DMARDS
99
Q

What is developmental dysplasia of the hip?

A

Structural abnormality in the hips caused by abnormal development of the fetal bones

100
Q

How soon can developmental dysplasia of the hip be picked up?

A

Newborn examinations

101
Q

How does a child present with developmental dysplasia of the hip? (3)

A
  • Abnormal gait
  • reduced range of movement
  • Hip asymmetry
102
Q

What is the gold standard investigation for developmental dysplasia of the hip?

103
Q

What is the management of developmental dysplasia of the hip in a patient less than 6 months?

A

Pavlik harness

104
Q

What is the management of developmental dysplasia of the hip in a patient more than 6 months?

105
Q

What is perthes disease?

A

Disruption of blood flow to the femoral head causing avascular necrosis

106
Q

What age is perthes disease more common in?

107
Q

What is the complication of revascularisation of the femoral head in perthes disease?

A

Makes a soft and deformed femoral head that can lead to osteoarthritis

108
Q

How does a patient with perthes disease present?

A

Slow onset

  • Pain in hip/groin
  • Limp
  • Restricted hip movement
  • ?pain referred to knee
109
Q

What is the initial investigation for perthes disease that can be normal?

110
Q

What is Slipped upper femoral epiphysis?

A

Femoral head is displaced “slips” along the growth plate

111
Q

What age and type of child is Slipped upper femoral epiphysis more commonly seen in?

A

10-15

Adolescent obese male undergoing growth spurt

112
Q

How does Slipped upper femoral epiphysis differ to perthes disease?

A

Can be triggered by minor trauma whereas perthes disease cannot

113
Q

What examination findings would you see in a patient presenting with Slipped upper femoral epiphysis?

A

Prefer to stay in external rotation

restricted internal rotation

114
Q

What is the initial investigation of Slipped upper femoral epiphysis?

ICM/FCM (16 decks)

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