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Paeds Flashcards

1
Q

Whooping cough:

  • immunisation?
  • symptoms?
  • bloods?
  • complications?
  • Ix?
  • Rx?
A

2, 3, 4 months and 3-5 years

2-3 days coryza symptoms followed by:

  • inspiratory whoop (forced inhalation against a closed glottis - not always present)
  • infants may have spells of apnoea
  • persistent coughing

marked lymphocytosis

Can last 10-14 weeks
Coughing can lead to subconjunctival haemorrhage

Nasal swab for culture
However, PCR and serology more available now

Clarithromycin/Azithromycin if present within 21 days of cough onset

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2
Q

4 day old premature baby not passed meconium with abdominal distension and bilious vomiting:

  • What is it?
  • Cause?
  • More common in?
  • Ix?
  • Rx?
A

Hirshprung disease

Parasympathetic neuroblasts fail to migrate from neural crest to distal colon, uncoordinated peristalsis, functional obstruction

Classically PR exam leads to passing stool
Abdo XR can be done
Gold standard - rectal biopsy

Initially rectal washouts
Resection of affected bowel definitive

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3
Q

Kawasaki disease:

  • symptoms?
  • Ix?
  • Rx?
  • Complications?
A
  • high grade fever for 5 days, resistant to anti-pyrexial
  • conjunctival injection
  • strawberry tongue
  • cervical lymphadenopathy
  • red palms and soles which later peel

No Ix, clinical

High dose aspirin
IVIG

Coronary artery aneurysm - all patients get echo to screen for this

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4
Q

4 year old kid with non-tender palpable mass in LLQ?

A

Refer urgently <48 hrs to paediatrics for assessment of neuroblastoma/nephroblastoma

This applies to any kid with palpable abdominal mass or unexplained organomegaly

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5
Q

Neuroblastoma:

  • where do tumours arise?
  • Ix?
A

Neural crest of adrenal medulla (most common) or sympathetic nerves

Ix:

  • raised urinary VMA and HVA
  • Calcification on XR (potentially)
  • Biopsy
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6
Q

Who gets screened for DDH if no Ortolani/Barlow test?

A

USS at 6 weeks if breech >36 weeks, regardless of successful ECV

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7
Q

Definitive diagnosis of epiglottitis?

Management?

A

Direct visualisation by senior, airway trained staff (anaesthetics/ENT)

However, if there is concern e.g. of foreign body
- lateral view XR - thumb sign

(posterior view in croup will show subglottic narrowing - steeple sign)

Rx:
O2
Abx
Intubation may be necessary

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8
Q

Presentations of vesicoureteric reflux?

Ix?

A
  • Antenatal: hydronephrosis on USS
  • Recurrent childhood UTI
  • Reflux nephropathy - chronic pyelonephritis, renal scarring may cause renin release and hypertension

Diagnosing VUR: micturating cystourethrogram
Renal scarring: DMSA

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9
Q

Achondroplasia inheritance?

A

AD but 70% cases sporadic

Mutation of fibroblast growth factor 3 causing abnormal cartilage

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10
Q

Most common malignancy in kids?
Presentation?
Ix?
Prognosis?

A

ALL

  • Anaemia, neutropenia, thrombocytopaenia
    (tiredness, pallor, infections, easy bruising, petechiae)
  • Bone pain
  • Hepatosplenomegaly
  • Fever
  • Testicular swelling

Bloods - low everything
>20% blasts
Bone marrow >20% blasts

Most common type CD10

90% cure rate, chemo for 2-3 years

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11
Q

When is short child normal?

A

Familial - normal if within 2SD predicted

Slow growth during childhood without normal growth spurt, but after puberty will grow normally to reach normal adult height

Pathological:

  • Neglect
  • Endocrine: thyroid, GH
  • Malabsorption: Crohn’s, lactose intolerance, CF
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12
Q

When is puberty precocious and delayed?

How is puberty defined in boys and girls?

A

Precocious:

  • Girls <8
  • Boys <9

Delayed:

  • Girls >13
  • Boys >14

Boys: growth of testes >4ml

Girls, 3 stages:

  • thelarche - breast budding
  • adrenarche - body hair and odour
  • menarche - period
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13
Q

Usual cause of acute diarrhoea in children?

Causes of chronic?

A

Rotavirus - vomiting and fever for first 2 days as well
Rehydration

Chronic:

  • Cow’s milk intolerance
  • Toddler’s diarrhoea - vary in consistency, often contains undigested food
  • Coeliac disease
  • post-gastroenteritis lactose intolerance
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14
Q

Newborn is born be emergency C sec due to foetal distress, what are steps of neonatal resus?

A
  1. Dry baby
  2. Check HR, breath and tone
  3. If gasping/not breathing give 5 inflation breaths
  4. Reassess for increase in HR, if none then repeat
  5. If adequate inflations and HR still <60, start chest compressions
    3: 1 compressions:inflations
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15
Q

Paediatric BLS?

A

Check for pulses and breaths - use femoral/brachial pulses if <1 y/o

Give 5 rescue breaths

If on your own give 30:2 compressions

If help give 15:2 compressions

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16
Q

Causes of constipation in kids?

A

Vast majority idiopathic

  • dehydration
  • low-fibre
  • meds e.g. opiates
  • anal fissure
  • hypothyroidism
  • Hirschprung disease
  • hypercalcaemia
  • learning disability
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17
Q

Management of constipation in kids?

A

Check for faecal impactation: severe constipation, overflow soiling (very loose or rabbit droppings, or very large stools that can block toilet), faecal mass palpable in abdo

If impaction present:

  • polyethylene glycol + electrolytes (Movicol)
  • add lactulose if no improvement in 2 weeks

Maintenance is same - Movicol 1st line, lactulose added if no response

Ensure dietary fibre and enough fluids but don’t use this as 1st line alone

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18
Q

Causes of jaundice <24 hours?
Prolonged?
Ix for prolonged?

A 
Early:
Rhesus disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency

Prolonged:

  • biliary atresia
  • hypothyroidism
  • galactosaemia
  • UTI
  • breast milk jaundice (actually caused by suboptimal intake)
  • infection (CMV, toxoplasma)

Ix:

  • Split bili - most important
  • direct coombs test
  • TFT
  • FBC and film
  • urine MC&S and reducing sugars
  • U&E and LFT
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19
Q

Management of Perthes?

A

Cast/braces may be used to keep femoral head in acetabulum

If <6y/o - observe, most resolve with time

> 6y/o - surgery

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20
Q

DDH management?

A

Most unstable hips will spontaneously stabilise by 3-6 weeks of age

Pavlik haress in kids <5 months and still unstable

If older - surgery

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21
Q

Kocher criteria for septic arthritis in kids?

A

Non-weight bearing
Fever >38.5
WCC >12
ESR >40

0 = pretty much 0 risk
1 = 3% chance
2 = 40% chance
3 = 93% chance
4 = 99% chance
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22
Q

Age and time of year for croup?

A

6 months-3 years
Autumn

Stridor
Barking cough worse at night
Fever, coryzal

Admit if:

  • <6 months
  • Co-existant airway e.g. laryngomalacia, Down’s Synd
  • uncertainty about diagnosis

Ix:

  • Usually clinical diagnosis
  • CXR: PA subglottic narrowing (steeple sign)

Management:
Everyone - single dose oral dexamethasone

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23
Q

Chicken pox incubation and infectivity?
Presentation?
Management?
Complications?

A

Incubation 10-21 days
Infective 4 days before rash appears until rash completely crusts over (usually about 5 days)

Fever initially, then itchy rash starting on head/trunk then spreading.
Initially macular then papular then vesicular

  • Calamine lotion
  • School exclusion until rashes heal
  • If immunocompromised/newborn then VZIG, aciclovir if it develops
  • Secondary bacterial infection - can be a small area of cellulitis to group A strep necrotising fasciitis (needing morphine etc)
  • pneumonia
  • encephalitis
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24
Q 
Cow's milk protein intolerance/allergy presentation?
Investigation?
Management if formula fed?
Management if breast fed?
Prognosis?
A

Appears around 3 months in formula fed infants (can be in breast-fed rarely if mum drinks milk)

  • regurg and vomiting
  • diarrhoea
  • urticaria/atopic eczema
  • ‘colic’ - irritability/crying
  • wheeze/chronic cough
  • rarely angioedema/anaphylaxis

Usually clinical, but if needed:

  • ski prick/patch
  • total IgE and specific IgE (RAST) for cow’s milk protein
  • -> both type I/type IV can occur

Formula fed:

  • Extensive hydrolysed formula if formula-fed
  • amino acid-based formula if severe/still reacting to eHF

Breast fed:

  • continue breastfeeding
  • eliminated cow’s milk from maternal diet and consider calcium supplements
  • eHF when stop breastfeeding until 12 months

Prognosis:

  • IgE - 55% tolerant by 5y/o
  • Type IV - almost all tolerant by 3y/o
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25
Q

Management of febrile convulsions?

Chance of epilepsy?

A

Any kid with first seizure admit to paeds

Risk of further = 1/3
If recurrences, teach parents to use rescue meds - buccal midazolam or rectal diazepam. Phone ambulance if >5 mins

Regular antipyretics = no benefit

2.5% chance of epilepsy in general public
Febrile convulsions alone raise this slightly

febrile convulsions + complex seizure + neurodevelopment disorder = 50% chance

Complex = 15-30 mins, focal, or repeat within 24 hours

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26
Q

2y/o, dropping centiles, nasal polyps?

A

Consider CF

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27
Q

Positive immunoreactive trypsinogen on heel prick test?
Next test?
Causes of false positive on this test?

A

CF

Sweat test showing raised Cl

False positive:

  • malnutrition
  • adrenal insufficiency
  • glycogen storage disease
  • nephrogenic diabetes insipidus
  • G6PD deficiency

False neg:
- Skin oedema due to hypoalbuminaemia due to pancreatic exocrine insufficiency

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28
Q

Management of congenital umbilical hernia?

A

Usually self-resolve

Elective repair if 2-3 y/o if large or if symptomatic

If asymptomatic/small wait until 4-5 y/o to perform elective repair

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29
Q

Classification of types of precocious puberty?

A

Gonadotrophin dependent (true)

  • premature activation of hypothalamic-pituitary-gonadal axis
  • FSH and LH raised

Gonadotrophin independent (false)

  • excess sex hormone
  • FSH and LH low

Males:

  • Rare, usually false
  • bilateral testes enlargement = true
  • unilateral testicle enlargement = tumour
  • small testes (normal for age) = adrenal cause (BAH or tumour)

Female:

  • usually idiopathic/familial, follows normal sequence
  • If false, due to rare things like McCune Albright Syndrome
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30
Q

LH and Testosterone pattern in:

  • Primary hypogonadism (Klinefelter’s)?
  • Hypogonadotrophic hypogonadism (Kallman’s syndrome)
  • Androgen insensitivity syndrome?
  • Testosterone secreting tumour?
A

Primary hypogonadism (Klinefelter’s):
LH - high
Testosterone - low

Hypogonad Hypogonad (Kallman’s):
LH - low
Testosterone - low

Androgen insensitivity:
LH - high
Testosterone - normal/high

Testosterone secreting tumour:
LH - low
Testosterone - high

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31
Q

Klinefelter’s karyotype?

Features?

A

47 XXY
Primary hypogonadism

  • tall
  • lack of secondary sex characteristics
  • small, firm testes
  • infertile
  • gynaecomastia (increased oestrogen:testosterone)
  • elevated gonadotrophin levels
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32
Q

Kallman’s inheritance?

Features?

A

X-linked recessive

Delayed puberty
Hypogonadotrophic hypogonadism
Failure to GnRH neurones to migrate to hypothalamus

ANOSMIA and delayed puberty

  • delayed puberty
  • hypogonadism
  • cryptorchidism
  • anosmia
  • sex hormones low, LH/FSH low
  • tall

Also cleft lip/palate

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33
Q

Androgen insensitivity genetics?
Features?
Management?

A 
X-linked recessive
Male genome (46XY) with female phenotype

Primary amenorrhoea
undescended testes - groin swelling
breast development may occur due to testosterone being converted to estradiol

Ix: chromosomal analysis

Counselling - raise as female
Bilateral orchidectomy (testicular cancer - seminoma?)
Oestrogen therapy
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34
Q

Define primary amenorrhoea?

Causes of primary amenorrhoea?

A

No period by 15 y/o but with normal development of breasts and pubic hair
OR
No puberty at all by 13 (girls only obvz)

  • Gonadal dysgenesis (e.g. - Turner’s Syndrome 45X) - most common
  • Androgen insensitivity (testicular feminisation)
  • Congenital malformations of genital tract
  • Functional hypothalamic amenorrhoea (e.g. anorexia)
  • Congenital adrenal hyperplasia
  • Imperforate hymen
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35
Q

Initial Ix of primary amenorrhoea?

Management?

A
  • bHCG
  • FBC, U&E, coeliac, TFT
  • Gonadotrophin
  • -> low = hypothalamic cause
  • -> raised = ovarian cause (e.g. Turner’s)
  • PRL
  • androgen levels
  • oestradiol
  • Treat underlying cause
  • If Turner’s likely need HRT to prevent osteoporosis
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36
Q

Contraindications for breast feeding?

A 
HIV
Drugs:
- lithium
- amiodarone
- chemo (plus methotrexate and leflunomide)
- antidepressants (not SSRI)
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37
Q

Gross motor milestones:

6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?

A

6 weeks - head control

3 months - no head lag on pulling up to sit

6 months - pushes onto arms when lying on stomach

9 months - sits without support, pulls to stand, holds onto furniture, may crawl

1 year - cruises furniture, walks with one hand held

18 months - runs, squats to pick up ball

2 years - stairs with 2 feet

3 years - stairs with 1 foot

4 years - hops, tip toes

5 - bike

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38
Q

Fine motor milestones:

6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?

A

6 weeks - follows torch with eyes

3 months - hand regards - hands held in midline

6 months - palmar grasp

9 months - index finger to point

1 year - pincer grip

18 months - tower of 3 bricks

2 years - scribbles, tower of 6-7 bricks

3 years - draw circles, tower of 9

4 years - simple picture of man

5 - triangle

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39
Q

Language milestones:

6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years?

A

6 weeks - stills to voice

3 months - starting to vocalise

6 months - babbles, screams when annoyed, mama/dada

9 months - localises to sound, babbles for self-amusement

1 year - responds to name

18 months - knows 5-20 words

2 years - simple instructions, 50+ words, combine 2 words

3 years - knows own name, asks who/what questions

4 years - stories, count to 20, asks when/where/how questions

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40
Q

Social milestones:

6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?

A

6 weeks - social smile

3 months - reacts pleasurably to familiar sounds

6 months - friendly with strangers

9 months - distinguishes strangers, plays peek-a-boo

1 year - drinks from cup

18 months - feeds with spoon, mimics adults

2 years - puts on shoes, messy, symbolic play

3 years - vivid imagination, understands sharing

4 years - dresses & undresses

5 - ties shoe laces

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41
Q

What is specific and global delay?
Deviation?
Regression?

A

specific - delay on 1 of 4

global - significant delay in 2 or more of 4

deviation - not delay but not normal -> autism

regression - loss of previously attained skills -> rest syndrome, metabolic stuff

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42
Q

Red flags of development?

A
  • asymmetrical movement
  • not reaching for objects by 6 months
  • unable to sit unsupported by 12 months
  • unable to walk by 18 months
  • no speech by 10 months
  • loss of skills
  • concern over vision and hearing
  • showing signs of handedness before 12 months - possible cerebral palsy
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43
Q

Ddx of stridor in a kid?

A
  • foreign body
  • anaphylaxis
  • croup
  • epiglottitis
  • laryngomalacia (soft, floppy trachea, worse on crying, lying, eating, resolves by around 2 y/o)

foreign body:

  • if choking, back slaps/abdo thrusts
  • if not, remove via bronchoscopy under GA
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44
Q

Indications for CT head in kids after injury?

A
  • LOC >5 mins
  • amnesia lasting >5 mins
  • drowsy
  • 3+ vomits
  • suspicion of NAI
  • seizure
  • GCS <14
  • bony depression/bulging fontanelle
  • sign of skull # (haemotympanym, panda eyes, CSF in ear/nose, Battle sign)
  • focal neurological deficit
  • If <1, presence of bruise/swelling >5cm
  • dangerous mechanism of injury
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45
Q

Initial fluid bolus in a dehydrated kid e.g. sepsis?

A

20ml/kg

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46
Q

When should you do a school culture for kids with D&V?

Management of kids with D&V if they are not dehydrated?

A

Culture if:

  • septic
  • blood/mucus in stool
  • immunocompromised

Consider culture if:

  • recently abroad
  • not improved by 7 days
  • uncertain about diagnosis

Management if NOT dehydrated:

  • continue feeds
  • encourage fluid intake
  • discourage fruit juices/fizzy juice

If dehydration suspected:

  • give 50ml/kg oral rehydration solution over 4 hours, plus ORS as maintenance as small amounts
  • continue breastfeeding
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47
Q

Hypernatraemic dehydration?

A
  • jittery
  • increased muscle tone
  • hyperreflexia
  • convulsions
  • drowsy/coma
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48
Q

Features of growing pains?

A
  • usually at night after lots of exercise
  • never present in morning
  • no limp
  • no limit on activity
  • systemically well, normal milestones
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49
Q

Gastroschisis birth and management?
Exomphalos?
What is exomphalos assoc w?

A

Gastroschisis - defect in anterior abdo wall just next to cord

  • vaginal delivery may be attempted
  • theatre asap (<4 hours after birth)

Exomphalis - abdo contents protrude through wall but covered in amniotic sac formed by amniotic membrane and peritoneum

  • C-section at 37 weeks
  • staged repair
  • if repair too difficult, leave sac to ‘granulate/epithelialise’ and repair when older

assoc w Down syndrome, cardiac and kidney malformations

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50
Q

Caput succedaneum?
Cephalhaematoma?
Neonatal intracranial haemorrhages?

A

Caput - pressure in scalp causing swelling/bruising, reduces over a few days

Cephal - SVD/ventouse/forceps - tense swelling limited to frontanelle - weeks-months

Intracranial - epidural never happens. Subdural may occur rarely with forceps. SAH more common than that and can cause irritability/convulsions in first 2 days. Intraventricular commonest and occur if premature, also cause irritability and convulsions and hypotonia. USS scan

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51
Q

Causes of hypertension in kids?

A 
Renal parenchymal disease
Renal vascular disease
Coarctation of aorta
Phaeochromocytom
Congenital adrenal hyperplasia
Essential/primary hypertension
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52
Q

Infantile spasms pattern of movement?

A

Flexion of head, trunk and arms followed by extension of arms - this lasts 1-2 seconds and they repeat it 50 times

West syndrome - EEG hypsarrhythmia, poor prognosis

53
Q

Infantile colic:

  • age?
  • what does it look like?
A

<3 months

Bouts of excessive crying and pulling-up of legs, often worse at evenings

Happens to 20% infants, cause unknown

54
Q

Dermoid cysts:
- common locations?
- defining features?
Desmoid cyst?

A

Locations:

  • Midline neck
  • external angle of eye
  • posterior pinna of ear

Features: all 3 germ cell origins, include things like hair follicles etc. (aka teratomas)

Desmoid - large infiltrative masses usually around abdo, chest wall, back and thigh. Arise from the muscle. Most common in FAP.

55
Q

Amber flags for feverish child?

What should you do?

A

Amber:

  • Pallor seen by parent/carer but resolving/intermittent
  • No smile, decreased activity, not responding to normal social cues
  • Nasal flaring
  • Resp rate 50 (6-12 months) or 40 (>12 months)
  • sats <95%
  • crackles
  • Age 3-6 months and fever >39
  • tachycardia >160 (<12 months), >150 (1-2 years), >140 (2-5 years)
  • CRT 3secs
  • dry mucous membranes

Send home with strict safety netting or refer to paeds specialist for further assessment

56
Q

Red flags for feverish child?

What should you do?

A
  • pale/mottled/blue skin
  • No response to social cues, appears ill
  • weak, high-pitched cry
  • Grunting
  • tachypnoea >60, chest indrawing
  • reduced skin turgor
  • Age <3 months and >38 degrees
  • Neck stiffness, non blanching rash, bulging frontanelle, neck stiffness, seizure

Refer urgently up to paeds
Don’t prescribe abx unless apparent source

57
Q

Features of had foot and mouth?
Cause?
Management?
School exclusion?

A

Fever, systemic upset
Oral ulcers
Followed by vesicles on foot/hand

Coxsackie A16 or enterovirus 71

Rx: analgesia and hydration
No link to cattle
Children do not need kept off school (obvz if they are too ill to go in then keep them off)

58
Q

Head lice:

  • spread?
  • symptoms/incubation?
  • Diagnosis?
  • management?
  • school exclusion?
A

Head to head contact - cannot jump/fly/swim

Itchy head when infected, remaining itchy for 7-10 days

Ix: wet fine tooth comb to expose roots - nits are the empty white shells

Rx; only if evidence of live lice. Malathion, dimeticone etc.
Household contacts do not need treatment

No need to exclude from school

59
Q

Hearing tests in children?

A

Otoacoustic emission test - newborn

Auditory brainstem response testing - if otoacoustic abnormal - newborn

Distraction test - 6-9 months - performed by health visitor and requires 2 trained staff

1.5-2.5 years - recognition of familiar objects “what one’s a teddy bear?”

> 2.5-3 years - Speech discrimination test
Pure tone audiometry (done at school entry in most of UK)

60
Q

Management of hypospadias?

A

Corrective surgery at 12 months

Essential they are not circumcised prior as the foreskin may be used in repair

61
Q

Most common cause of hypothyroidism in kids?

A

Also autoimmune

Others include:

  • Post total-body irradiation (e.g. for ALL)
  • Iodine deficiency (in developing world)
62
Q

Central causes of hypotonia at birth?

Other causes?

A

Down Syndrome
Prader-willi
Hypothyroidism
Cerebral palsy (hypotonia before hypertonia)

Others:

  • infection
  • hypoxia
  • encephalopathy
  • spina bifida, spinal muscular atrophy, GBS, MG, myotonic dystrophy
63
Q

ITP in kids:

  • antibodies against?
  • features?
A

GP IIb/IIIa complex

More acute than in adults
Following infection or vaccination
usually self limiting over 1-2 weeks

64
Q

Contraindication to vaccines?
When should it be delayed?
Live vaccines?
Specific for diphtheria/tetanus/polio vaccine?

A
  • previous anaphylaxis to same vaccine or components (e.g. egg protein for yellow fever/flu)

Delayed:
- current febrile illness

CI live vaccine:

  • pregnancy
  • immunosuppression

DTP vaccine:
- defer in kids with evolving/unstable neurological condition

65
Q

Vaccines given:

  • at birth?
  • 2 months?
  • 3 months?
  • 4 months?
  • 12 months?
  • 3-4 years?
  • 12-13 years?
  • 13-18 years?
  • annually 2-8 years?
A

Birth: BCG if at risk

2 months: 6 in 1, oral rotavirus, MenB

3 months: 6 in 1, oral rotavirus, pneumococcal

4 months: 6 in 1, Men B

12 months: HiB/MenC, MMR, pneumococcal, MenB

3-4 years: 4 in 1 booster, MMR

12-13 years: HPV

13-18 years: 3 in 1 teenage booster, MenACWY

Annually 2-8 years: flu

66
Q

What’s in the 6 in 1 vaccine?

What’s in the 4 in 1 pre-school booster?

A

tetanus, diphtheria, polio, whooping cough, HepB, H influenza B
(given at 2, 3, 4 months)

4 in 1: tetanus, diphtheria, polio, whooping cough

3 in 1 teenage: tetanus, diphtheria, polio

67
Q

Type of fluid for maintenance in young people/kids?

A

0.9% saline (+ glucose if needed)

as opposed to more dilute for adults

68
Q

T1DM risks what in foetus?

A

Spina bifida

Cardiac malformation

69
Q

Do frequent doctors appts point towards child abuse?
Torn frenulum?
3 commonest fractures in NAI of kids of any age?

A

A&E yes, GP no

A&E suggests want to see different doc each time to avoid suspicion

Suggests forcing bottle in baby’s mouth

Fracs:

  • humerus
  • radius
  • femur
70
Q

5 significant RF for sudden infant death syndrome?

A
  • sleeping prone
  • sleeping in same bed as baby
  • parental smoking
  • room too hot or head covered
  • prematurity
71
Q

General management points of CF?

A
  • Regular chest physio, at least twice daily
  • high calorie, high fat diet with pancreatic enzyme supplements every meal
  • Vitamin supplements
  • Minimise contact with other CF patients to prevent Burkholderia/Pseudomonas infection
  • Lung transplantation - contra-indicated in chronic Burkholderia infection
72
Q

Premature babies vaccines and developmental milestones?

A

Normal chronological age, don’t delay

73
Q

If parent brings in kid to have MMR vaccine a few years late?
What book has all the info about vaccines?

A

Give 2 doses 3 months apart

Green book

74
Q

Reflex anoxic seizure?

A

Kids 6 months - 3 years old

In response to painful/emotional stimuli:

  • goes pale
  • falls to floor
  • may start starts shaking (anoxic seizure)
  • rapid recovery

Neurally mediated by vagus nerve

75
Q 
Mongolian blue spots?
Milia?
Stork mark/salmon patch?
Port wine stain?
Strawberry haemangioma?
Spitz naevi?
A

Mong B: Slate grey congenital melanocytosis usually over buttocks/back, start regressing after 1y/o

Milia: Small, benign, keratin filled cysts on face, occur at any age but common in newborns

Stork/Salmon: blotchy pink vascular birthmarks found on forehead, eyelids or nape of neck, usually disappear over a couple of months but may persist. 50% prevalence in newborns

Port wine: deep red/purple, vascular birth marks that tend to be unilateral. Unlike others, they remain and tend to darken and raise over time. Rx cosmetic camouflage/laser therapy

Strawberry: erythematous, multilobed haemangioma that grows until 6-9 months then regresses, usually gone by 10y/o. Common on face, neck, scalp. If blocking visual field/bleeding then propranolol.

Spitz: pink/red naevus which grow rapidly to about 1cm in kids on face or legs, usually excised to be safe

76
Q

Nappy rash?

Management?

A

Irritant contact dermatitis, spares skin folds

  • Keep skin clean and dry - change nappies regularly
  • Leave undressed if possible
  • topical steroids if bad
  • barrier creams with every nappy once healed (zinc/castor oil)
77
Q

seborrhoeic dermatitis in newborns - how does it usually present?
in infants?
Management?

A

Cradle cap - itchy, yellow (maybe erythematous) scale on scalp

Infants - flexures - axillae, neck creases, groin with NO skin fold sparing

Rx: emollients +/- steroids

78
Q

Roseola cause?
Presentation?
How to differentiate from Rubella?

A

HHV-6

High fever followed by discrete pink macular rash once fever subsides

High fever, lack of sub occipital lymph nodes

79
Q

Parvovirus B19 presentation in a child?
if in pregnancy what to do?
Complications of it?
School exclusion?

A
  • Mild feverish illness, may not even be noticeable
  • slapped cheeks, followed by lacy maculopapular rash all over body
  • Can get polyarthritis

If mother catches in pregnancy <20 weeks she’ll need to get IgM and IgG antibodies checked as can result in foetal death (polyarthritis and severe anaemia more common in adults)

Comps:

  • pancytopenia if immunosuppressed
  • aplastic crisis in sickle cell (suppresses erythropoiesis for 1 week so aplastic crisis if chronic haemolysis)

No need as child is no longer infectious once rash appears

80
Q

What is erythema toxicum?

A

Harmless rash seen in babies aged 2-5 days old

Pustules with surrounding erythema, can become widespread and confluent

Self limiting, no Rx

81
Q

Causes of meningitis <3 months?
3 months-6 years?
>6 years?

A

Listeria, GBS

Neisseria, Strep pneumo, HiB

Strep pneumo, neisseria

82
Q

Initial management of meningitis?

Contacts?

A

IM BenPen if primary care

<3 months, >60 years or immunocompromised: amoxicillin + cefotaxime

Otherwise:
Dexamethasone + Cefotaxime
(hold dex if septic shock)

Single dose oral Cipro for close contacts in <7 days for meningococcal, plus booster vaccine once serotypes available (generally not needed for pneumococcal)

83
Q

Definition of reduced consciousness in a kid?

When to intubate?

A

GCS 14 or less
P or U on AVPU

If GCS <9, unresponsive or signs of raised ICP

84
Q

Fluid challenge if hypotensive in a kid?

A

20ml/kg fluid chalenge

10ml/kg isotonic saline if assoc with raised ICP

85
Q

If BM<3 in kid?

A

2ml/kg 10% dextrose

86
Q

Urgent CT in kid with reduced consciousness?

Signs of raised ICP?

A

GCS <8
Raised ICP
Focal neurology

ICP: bulging fontanelle, bradycardia (+/- hypertension), abnormal pupils, abnormal posturing, abnormal breathing pattern

87
Q

When to do LP in kid with reduced consciousness?

A

CNS infection suspected or febrile illness of unknown origin

CI:

  • Raised ICP
  • GCS <8 or deteriorating
  • Focal neurology
  • Clinical evidence of circulatory/septic shock

-> only carry out if CT says it is safe to do so

88
Q

Causes of raised ICP?

Management?

A

SOL, cerebral oedema, intracranial haemorrhage

Management:

  • GCS <9
  • tilt head to 20-30 deg
  • fluid restriction +/- mannitol
  • PICU
  • urgent imaging
89
Q

Differential of flaccid paralysis of a kid?

A

GBS

Acute spinal cord lesion: SOL, demyelination, transverse myelitis

90
Q

How to measure temperature in a kid?

A

<4 weeks - electronic axillary thermometer

4 weeks - 5 years - electronic axillary or infrared in axilla

91
Q

Onset ADHD?
Diagnosis?
Management?
Monitoring?

A

More common in boys aged 5-9, triad:
hyperactivity, impulsivity, inattention

Diagnosis:

  • present for at least 6 months
  • Observation at school and home using tools

Non-pharm management:

  • parental training, social skills training
  • sit at front of class
  • melatonin for sleep cycle, diet change

Pharm (last line):

  1. methylphenidate - 6 week trial
  2. lisdexamfetamine if no response

Both need ECG monitoring
Methylphenidate needs height and weight monitoring, can stunt growth

92
Q

Autism - apart from rigid thought, difficult relationship establishment, delay/poor communication (and odd speech) what else is there?
Diagnosis?
Management?

A

Sensory hypersentitivity, doesn’t like taste/texture of foods or objects on skin

Asperger’s - social abnormality but no cognition or language

Diagnosis:

  • 6 months
  • semi-structured interviews/assessments

Management:

  • social skills training
  • SALT
  • school interventions
93
Q

Presentation of McArdle’s disease?

A

Stiffness and myalgia during exercise then typical second wind
Myoglobinuria after exercise

94
Q 
What is term?
Normal birth weight?
Perinatal mortality?
Neonatal mortality?
Postnatal mortality?
Infant mortality?
A

Term = 37 - 41+3

Weight = 2.5-4kg

Perinatal mortality = 24 weeks - 1 week post partum

Neonatal = <28 days

Postnatal = 28 days - 1 year

Infant = birth - 1 year

95
Q

Normal values or HR, RR and systolic BP at:

  • <1?
  • 1-5?
  • 5-12?
A

<1:
HR 110-160
RR 30-40
Sys BP 70-90

1-5:
HR 95-140
RR 25-30
Sys BP 80-100

5-12:
HR 80-120
RR 20-25
Sys BP 90-110

After same as adult

96
Q

When is guthrie heel prick taken?

What does it test for?

A

5 days

CF
Sickle cell
Congenital hypothyroidism
5 inherited metabolic conditions including PKU, homocystinuria and maple syrup

97
Q

Postnatal baby check?

What does it include?

A

Done by GP at 6-8 weeks
Preterms done at 6 weeks after expected delivery

Includes:

  • red reflex and squint
  • CVS, resp, abdo
  • genitalia
  • barlow and ortolani
  • head control when sitting and social smile
98
Q

What can hypothermia cause in newborn?

A

increased work of breathing, hypoxia, hypoglycaemia

99
Q 
When is surfactant produced?
Presentation of ARDS?
O2 and CXR?
Management?
Complications?
A

Production starts 24-28 weeks, usually enough to breathe normally by 34 weeks

Tachypnoea, grunting, nasal flaring, intercostal recession
Usually onset <4 hours after birth
Symptoms do not resolve in <24 hours unline TTN

O2 low
CXR ground glass

Surfactant and non-invasive/invasive ventilation

BPD: barotrauma and oxygen toxicity causing nectotising bronchitis and hyperinflation, difficulty weaning off ventilatory and long-term morbidity

100
Q

Apnoea of prematurity?

A

Gaps of breathing >20 seconds as breathing centres in brain not fully developed

May require ventilation

101
Q

Early onset and late onset sepsis and causes of each?

Risk factors?

A

EOS <72hrs - GBS (75%), E Coli

LOS 7-28 days - environmental - staph epi, listeria, klebsiella, pseudomonas

RF: mother with previous GBS infection or colonisation screened, PPROM, intraparum infection
Low birth weight, prematurity, maternal chorioamnionitis

102
Q

Presentation of neonatal sepsis?

A

Subacute onset

Resp distress - grunting (85%), nasal flaring, accessories etc
Tachycardia
Apnoea (40%)
Jaundice
Seizures
poor/reduced feeding
Abdo distension
Vomiting

Temp:

  • term infants likely to be febrile
  • pre-term likely to be cold
103
Q

Ix for neonatal sepsis?

Empirical abx?

A 
Blood culture (90% sensitive)
FBC
CRP
Blood gases (met acid)
Urine MC&S
LP (usually part of any septic screen <28 days)

Benzylpenicillin + gentamicin

(fluid, electrolyte, temperature, oxygen, glucose and prevention/management of acidosis paramount)

104
Q

TTN?

A

Failure to adequately clear fluid from lungs following delivery - common in Csec

RR >60
Otherwise completely well, no increased work of breathing

Monitor, should resolve in 24 hours

105
Q

Meconium aspiration syndrome?

A

More common in post-terms

Meconium stained liquor
Foetal distress - hypoxia, increased work of breathing

Suction and supportive care

106
Q

Causes of heart failure in newborn?

A

Infections: TORCH
Chromosomal abnormalities
Rhesus haemolytic disease

TORCH:
Toxoplasma, others, Rubella, CMV, HSV

107
Q

Presentation of heart failure

A

Hypoxia, pul oed, sacral ankle and periorbital oedema, hepatosplenomegaly

Supportive care (prostaglandins if needed to keep PDA)

108
Q

PPHN?
Features?
Management?

A

Failure to pulmonary pressure to drop, causing right to left shunt and hypoxia

Features:

  • resp distress
  • cyanosis
  • loud S2

Supportive care and inotropes whilst baby adapts

109
Q

Causes of neonatal seizures?

A 
Infection
Kernicterus
Hypoglycaemia
Hypocalcaemia
Drug withdrawal
Peri/intra-ventricular haemorrhage
Hypoxic ischaemic encephalopathy - most common

Subtle:
Posturing, sucking, lip smacking, nystagmus

Phenobarbital

110
Q

If prolonged jaundice, what should be screened for?

A

G6PD deficiency
Galactosaemia
Hypothyroidism
a1-antitrypsin deficiency

111
Q

Presentation of kernicterus?
Management?
Long term sequelae?

A

Jaundice, poor feeding, shrill cry, hypertonicity

Exchange transfusion

Deafness, reduced IQ

112
Q

Foetal circulation?

A

Umbilical arteries from internal iliac arteries to placenta

Umbilical vein enters at umbilicus and diverts to liver

Skips liver via ductus venosus

Foramen ovale - R to left shunt allowing oxygenated blood into L heart

Ductus arteriosus - from pulmonary trunk to descending aorta

113
Q

Causes of microcephaly? (5)

A
  • normal variation/familial
  • foetal alcohol syndrome
  • congenital infection
  • perinatal brain injury (hypoxic ischaemic encephalopathy)
  • Patau syndrome
114
Q

What conditions are assoc w down syndrome? (8)

A 
Hypothyridism
ALL
Alzheimer's
AVSD
Duodenal atresia
Hirschprung's
Atlantoaxial instability
T1DM
115
Q

Undescended testes in newborn incidence?
Management if unilateral and bilateral?
Complications?

A

Occurs in 2-3%, 25% bilateral

Unilateral:
Wait until 3 months of age, if not descended then refer. Ideally see urology surgeon before 6 months of age and orchidopexy before 1 year

Bilateral:
Urgent pads appt within 24 hours for endocrine and/or genetic Ix

Comps:

  • testicular cancer
  • torsion
  • infertility
116
Q

Inheritance of Huntington’s?

117
Q

Are VSD repaired?

What complications are they at risk of?

A

If large defect causing haemodynamic instability yes, otherwise no

Endocarditis
Pulmonary hypertension
Ventricular septum aneurysm

(endocarditis - turbulent blood flow across defect damages endothelium, exposing vWF, allowing platelets to stick and bacteria to adhere if any is present in blood at time transiently and asymptomatically)

118
Q

How to tell if a child is in shock rather than just dehydrated?
How to tell if it is compensated (early) shock?
Decompensated (late) shock?

A
  • cold peripheries
  • CRT >2 secs
  • lethargic/altered responsiveness

Normotension

Will be tachycardic, tachypnoeic, have reduced urine output, reduced skin turgor etc - hypotension is ominous and indicates decompensated shock, which is ominous

Late:
hypotension, bradycardia, Kussmaul (acidotic) breathing, blue extremities, absent urine output

119
Q

Atrial septal defect:

  • why systolic murmur and fixed splitting S2?
  • Presentation?
A

Increased flow into RA and RV means increased flow than expected through pulmonary valve causing murmur and splitting of heart sounds

Usually asymptomatic
If severe, may have SOB, causing lethargy, poor appetite, poor growth and increased susceptibility to resp infections

120
Q

ABG of pyloric stenosis?

ABG of diarrhoea?

A

hypokalaemic, hypochloraemic metabolic alkalosis

Metabolic acidosis

121
Q

Cyanotic heart defects?

A

Transposition of great vessels - aorta arises from R ventricle, egg shaped cardiomegaly

TOF - overriding aorta, pulmonary stenosis, VSD, RVH
-> boot shaped cardiomegaly, ejection systolic murmur, tet spells

Tricuspid atresia
Pulmonary atresia
Severe ebstein’s anomaly

122
Q

Acyanotic heart heart defects?

A

VSD - most common
ASD - systolic murmur, fixed splitting of S2
Aortic stenosis

Coarctation - Assoc w turner’s syndrome, diminished lower limb pulses, radio-femoral delay, CXR rib notching

PDA - continuous machine ike murmur
Indomethacin

123
Q

VSD:

  • assoc?
  • post-natal presentations if not picked up in 20-week scan?
  • Management?
  • Complications?
A

the 3 trisomies, congenital infections - most common heart defect, 50% resolve naturally

Pres:

  • failure to thrive
  • HF - tachycardia, tachypnoea, hepatomegaly, pallor
  • pan systolic murmur (louder in smaller defects)

Management:

  • small usually close on own and asymptomatic
  • mod-large usually result in signs of HF in first few months
  • Nutritional support, symptomatic (diuretics etc), surgical closure

Comps:

  • aortic regurg
  • endocarditis
  • pulmonary hypertension
  • Right heart failure
  • Eisenmenger: prolonged pul HTN, causing left to right shunt, therefore cyanosis and clubbing - indication for heart and lung transplant
124
Q

Management of tet spells?

A

B blockers

125
Q

Causes of pulmonary hypoplasia?

A

Oligohydramnios

Congenital diaphragmatic hernia

126
Q

Congenital diaphragmatic hernia presentation?

A

Often picked up in antenatal scans

Resp distress soon after birth due to pulmonary hypertension and hypoplasia

127
Q

Risk factors for cleft lip/palate?

A

Maternal anti epileptic use

Inheritance (polygenic)

128
Q

glucose level for neonatal hypoglycaemia?
Management if asymptomatic?
If symptomatic?

A

<2.6

If asymptomatic - encourage breastfeeding and monitor regularly

If symptomatic (jittery, pale, tachypnoeic, irritable, weak cry, hypotonia) - admit to neonatal unit for 10% dextrose infusion

Finals Revision (29 decks)

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