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
Management of febrile convulsions? | Chance of epilepsy?
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
26
2y/o, dropping centiles, nasal polyps?
Consider CF
27
Positive immunoreactive trypsinogen on heel prick test? Next test? Causes of false positive on this test?
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
28
Management of congenital umbilical hernia?
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
29
Classification of types of precocious puberty?
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
30
LH and Testosterone pattern in: - Primary hypogonadism (Klinefelter's)? - Hypogonadotrophic hypogonadism (Kallman's syndrome) - Androgen insensitivity syndrome? - Testosterone secreting tumour?
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
31
Klinefelter's karyotype? | Features?
47 XXY Primary hypogonadism - tall - lack of secondary sex characteristics - small, firm testes - infertile - gynaecomastia (increased oestrogen:testosterone) - elevated gonadotrophin levels
32
Kallman's inheritance? | Features?
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
33
Androgen insensitivity genetics? Features? Management?
``` 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 ```
34
Define primary amenorrhoea? | Causes of primary amenorrhoea?
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
35
Initial Ix of primary amenorrhoea? | Management?
- 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
36
Contraindications for breast feeding?
``` HIV Drugs: - lithium - amiodarone - chemo (plus methotrexate and leflunomide) - antidepressants (not SSRI) ```
37
Gross motor milestones: | 6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?
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
38
Fine motor milestones: | 6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?
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
39
Language milestones: | 6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years?
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
40
Social milestones: | 6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?
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
41
What is specific and global delay? Deviation? Regression?
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
42
Red flags of development?
- 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
43
Ddx of stridor in a kid?
- 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
44
Indications for CT head in kids after injury?
- 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
45
Initial fluid bolus in a dehydrated kid e.g. sepsis?
20ml/kg
46
When should you do a school culture for kids with D&V? | Management of kids with D&V if they are not dehydrated?
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
47
Hypernatraemic dehydration?
- jittery - increased muscle tone - hyperreflexia - convulsions - drowsy/coma
48
Features of growing pains?
- usually at night after lots of exercise - never present in morning - no limp - no limit on activity - systemically well, normal milestones
49
Gastroschisis birth and management? Exomphalos? What is exomphalos assoc w?
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
50
Caput succedaneum? Cephalhaematoma? Neonatal intracranial haemorrhages?
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
51
Causes of hypertension in kids?
``` Renal parenchymal disease Renal vascular disease Coarctation of aorta Phaeochromocytom Congenital adrenal hyperplasia Essential/primary hypertension ```
52
Infantile spasms pattern of movement?
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
Infantile colic: - age? - what does it look like?
<3 months Bouts of excessive crying and pulling-up of legs, often worse at evenings Happens to 20% infants, cause unknown
54
Dermoid cysts: - common locations? - defining features? Desmoid cyst?
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
Amber flags for feverish child? | What should you do?
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
Red flags for feverish child? | What should you do?
- 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
Features of had foot and mouth? Cause? Management? School exclusion?
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
Head lice: - spread? - symptoms/incubation? - Diagnosis? - management? - school exclusion?
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
Hearing tests in children?
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
Management of hypospadias?
Corrective surgery at 12 months Essential they are not circumcised prior as the foreskin may be used in repair
61
Most common cause of hypothyroidism in kids?
Also autoimmune Others include: - Post total-body irradiation (e.g. for ALL) - Iodine deficiency (in developing world)
62
Central causes of hypotonia at birth? | Other causes?
Down Syndrome Prader-willi Hypothyroidism Cerebral palsy (hypotonia before hypertonia) Others: - infection - hypoxia - encephalopathy - spina bifida, spinal muscular atrophy, GBS, MG, myotonic dystrophy
63
ITP in kids: - antibodies against? - features?
GP IIb/IIIa complex More acute than in adults Following infection or vaccination usually self limiting over 1-2 weeks
64
Contraindication to vaccines? When should it be delayed? Live vaccines? Specific for diphtheria/tetanus/polio vaccine?
- 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
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?
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
What's in the 6 in 1 vaccine? | What's in the 4 in 1 pre-school booster?
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
Type of fluid for maintenance in young people/kids?
0.9% saline (+ glucose if needed) | as opposed to more dilute for adults
68
T1DM risks what in foetus?
Spina bifida | Cardiac malformation
69
Do frequent doctors appts point towards child abuse? Torn frenulum? 3 commonest fractures in NAI of kids of any age?
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
5 significant RF for sudden infant death syndrome?
- sleeping prone - sleeping in same bed as baby - parental smoking - room too hot or head covered - prematurity
71
General management points of CF?
- 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
Premature babies vaccines and developmental milestones?
Normal chronological age, don't delay
73
If parent brings in kid to have MMR vaccine a few years late? What book has all the info about vaccines?
Give 2 doses 3 months apart Green book
74
Reflex anoxic seizure?
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
``` Mongolian blue spots? Milia? Stork mark/salmon patch? Port wine stain? Strawberry haemangioma? Spitz naevi? ```
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
Nappy rash? | Management?
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
seborrhoeic dermatitis in newborns - how does it usually present? in infants? Management?
Cradle cap - itchy, yellow (maybe erythematous) scale on scalp Infants - flexures - axillae, neck creases, groin with NO skin fold sparing Rx: emollients +/- steroids
78
Roseola cause? Presentation? How to differentiate from Rubella?
HHV-6 High fever followed by discrete pink macular rash once fever subsides High fever, lack of sub occipital lymph nodes
79
Parvovirus B19 presentation in a child? if in pregnancy what to do? Complications of it? School exclusion?
- 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
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What is erythema toxicum?
Harmless rash seen in babies aged 2-5 days old Pustules with surrounding erythema, can become widespread and confluent Self limiting, no Rx
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Causes of meningitis <3 months? 3 months-6 years? >6 years?
Listeria, GBS Neisseria, Strep pneumo, HiB Strep pneumo, neisseria
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Initial management of meningitis? | Contacts?
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)
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Definition of reduced consciousness in a kid? | When to intubate?
GCS 14 or less P or U on AVPU If GCS <9, unresponsive or signs of raised ICP
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Fluid challenge if hypotensive in a kid?
20ml/kg fluid chalenge | 10ml/kg isotonic saline if assoc with raised ICP
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If BM<3 in kid?
2ml/kg 10% dextrose
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Urgent CT in kid with reduced consciousness? | Signs of raised ICP?
GCS <8 Raised ICP Focal neurology ICP: bulging fontanelle, bradycardia (+/- hypertension), abnormal pupils, abnormal posturing, abnormal breathing pattern
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When to do LP in kid with reduced consciousness?
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
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Causes of raised ICP? | Management?
SOL, cerebral oedema, intracranial haemorrhage Management: - GCS <9 - tilt head to 20-30 deg - fluid restriction +/- mannitol - PICU - urgent imaging
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Differential of flaccid paralysis of a kid?
GBS | Acute spinal cord lesion: SOL, demyelination, transverse myelitis
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How to measure temperature in a kid?
<4 weeks - electronic axillary thermometer 4 weeks - 5 years - electronic axillary or infrared in axilla
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Onset ADHD? Diagnosis? Management? Monitoring?
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
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Autism - apart from rigid thought, difficult relationship establishment, delay/poor communication (and odd speech) what else is there? Diagnosis? Management?
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
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Presentation of McArdle's disease?
Stiffness and myalgia during exercise then typical second wind Myoglobinuria after exercise
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``` What is term? Normal birth weight? Perinatal mortality? Neonatal mortality? Postnatal mortality? Infant mortality? ```
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
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Normal values or HR, RR and systolic BP at: - <1? - 1-5? - 5-12?
<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
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When is guthrie heel prick taken? | What does it test for?
5 days CF Sickle cell Congenital hypothyroidism 5 inherited metabolic conditions including PKU, homocystinuria and maple syrup
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Postnatal baby check? | What does it include?
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
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What can hypothermia cause in newborn?
increased work of breathing, hypoxia, hypoglycaemia
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``` When is surfactant produced? Presentation of ARDS? O2 and CXR? Management? Complications? ```
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
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Apnoea of prematurity?
Gaps of breathing >20 seconds as breathing centres in brain not fully developed May require ventilation
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Early onset and late onset sepsis and causes of each? | Risk factors?
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
Presentation of neonatal sepsis?
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
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Ix for neonatal sepsis? | Empirical abx?
``` 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)
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TTN?
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
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Meconium aspiration syndrome?
More common in post-terms Meconium stained liquor Foetal distress - hypoxia, increased work of breathing Suction and supportive care
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Causes of heart failure in newborn?
Infections: TORCH Chromosomal abnormalities Rhesus haemolytic disease TORCH: Toxoplasma, others, Rubella, CMV, HSV
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Presentation of heart failure
Hypoxia, pul oed, sacral ankle and periorbital oedema, hepatosplenomegaly Supportive care (prostaglandins if needed to keep PDA)
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PPHN? Features? Management?
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
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Causes of neonatal seizures?
``` Infection Kernicterus Hypoglycaemia Hypocalcaemia Drug withdrawal Peri/intra-ventricular haemorrhage Hypoxic ischaemic encephalopathy - most common ``` Subtle: Posturing, sucking, lip smacking, nystagmus Phenobarbital
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If prolonged jaundice, what should be screened for?
G6PD deficiency Galactosaemia Hypothyroidism a1-antitrypsin deficiency
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Presentation of kernicterus? Management? Long term sequelae?
Jaundice, poor feeding, shrill cry, hypertonicity Exchange transfusion Deafness, reduced IQ
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Foetal circulation?
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
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Causes of microcephaly? (5)
- normal variation/familial - foetal alcohol syndrome - congenital infection - perinatal brain injury (hypoxic ischaemic encephalopathy) - Patau syndrome
114
What conditions are assoc w down syndrome? (8)
``` Hypothyridism ALL Alzheimer's AVSD Duodenal atresia Hirschprung's Atlantoaxial instability T1DM ```
115
Undescended testes in newborn incidence? Management if unilateral and bilateral? Complications?
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
Inheritance of Huntington's?
AD
117
Are VSD repaired? | What complications are they at risk of?
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
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?
- 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
Atrial septal defect: - why systolic murmur and fixed splitting S2? - Presentation?
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
ABG of pyloric stenosis? | ABG of diarrhoea?
hypokalaemic, hypochloraemic metabolic alkalosis Metabolic acidosis
121
Cyanotic heart defects?
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
Acyanotic heart heart defects?
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
VSD: - assoc? - post-natal presentations if not picked up in 20-week scan? - Management? - Complications?
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
Management of tet spells?
B blockers
125
Causes of pulmonary hypoplasia?
Oligohydramnios | Congenital diaphragmatic hernia
126
Congenital diaphragmatic hernia presentation?
Often picked up in antenatal scans Resp distress soon after birth due to pulmonary hypertension and hypoplasia
127
Risk factors for cleft lip/palate?
Maternal anti epileptic use | Inheritance (polygenic)
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glucose level for neonatal hypoglycaemia? Management if asymptomatic? If symptomatic?
<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