Paeds Flashcards
1
Q
Commonest cause of neck lump in children
A
Lymphadenopathy, history of local infection or general illness
2
Q
Lymphoma characteristics
A
Rubbery, painless lymphadenopathy. Associated night sweats and splenomegaly.
3
Q
Thyroid cyst appearance
A
Midline between isthmus and hyoid bone, moves upward on protrusn of the tongue. If infected can be painful
4
Q
What is a cystic hygroma
A
Congenital lymphatic lesion typically found in the neck
5
Q
Brachial cyst presentation
A
Oval, mobile cyst that develops between sternocleidomastoid muscle and the pharync.
6
Q
What is cervical rib
A
More common in adult females, cause of thoracic outlet syndrome
7
Q
Hodgkin lymphoma summary
A
Reed-Sternberg cell, painless lymphadenopathy (large), B symptoms often uncommon
8
Q
Diagnosis of Hodgkin lymphoma
A
Biopsy
9
Q
Management of Hodgkin lymphoma
A
Chemo +/- radiotherapy 80% cured
10
Q
Non-Hodgkin lymphoma summary
A
May affects B or T cells. Much more common and more common in elderly, may cause vena cava obstruction (facial flushing/swelling)
11
Q
What is Burkitt’s lymphoma
A
High-grade B-cell neoplasm, usually in African, malaria endemic areas. Tumour of facial bones
12
Q
What virus is associated with Burkitt’s lymphoma
A
EBV - found in almost all cases. Chronic malaria is thought to reduce resistance to this
13
Q
Peak incidence of ALL
A
2-5 years old, boys slightly more affected, 80% of childhood leukaemias
14
Q
Features of ALL
A
Anaemia (lethargy and pallor)
Neutropaenia (frequent infection)
Thrombocytopaenia (easy bruising, petechiae)
15
Q
Other features of ALL
A
Bone pain (secondary to bone marrow infiltration) Splenomegaly Hepatomegaly Fever Testicular swelling
16
Q
Investigations in ALL
A
Low Hb Thrombocytopenia Circulating leukaemic BLAST CELLS ON BLOOD SMEAR DIC LP CXR - mediastinal maas (T cell disease)
17
Q
How is ALL diagnosed
A
Bone marrow biopsy
18
Q
What is Wilms tumour
A
Renal tumour, usually present before 5 with large abdominal mass and haematuria.
19
Q
Quick retinoblastoma summary
A
Autosomal dominant, most within first 3 years of life, white pupillary reflex replacing red. May have squint
20
Q
Glucose-6-dehydrogenase deficiency
A
Neonatal jaundice, haemolysis causing fever, malaise, abdo pain and dark urine. Precipitated by infection, broad beans and drugs. X-linked recessive
21
Q
Hereditary spherocytosis summary
A
Sphere RBCs, commonly presents as neonatal jaundice, anaemia, splenomegaly, aplastic crisis (caused by parvovirus B19). Oral folic acid needed
22
Q
Most common causative organism for UTI in children
A
E.coli (80%), proteus, pseudomonas
23
Q
Predisposing factors for UTI
A
Infrequent voiding, hurried micturition, neuropathic bladder, vesicoureteric reflux, poor hygiene, STRUCTURAL ABNORMALITY
24
Q
Presentation of UTI in childhood
A
Infants - poor feeding, vomiting, irritability
Younger children - abdo pain, fever, dysuria
Older children - dysuria, frequency, haematuria
25
What features would suggest an upper UTI
Fever >38, loin pain/tenderness
26
Management of UTI in children
<3 months - referred immediately to paediatrician
Upper UTI admit to hospital (cephalosporin/co-amox for 7-10 days)
>3 months lower UTI - trimethoprim or nitrofuratonin
27
What is the triad of haemolytic uraemic syndrome
Acute kidney injury
Microangiopathic haemolytic anaemia
Thrombocytopenia
28
What is the commonest cause of haemolytic uraemic syndrome
E.coli (Shiga toxin producing type)
| Also: HIV, pneumococcal infection, SLE
29
Management of haemolytic uraemic syndrome
Fluids, blood transfusion/dialysis if needed.
30
Which cranial nerve is most likely to be affected by raised ICP
Abducens VI because it has a very long intracranial course
31
Red flag symptoms for headache
Growth failure, new onset squint, worse in mornings, torticollis, ataxia, papilloedema, abnormal gait
32
Prophylactic treatment for migraine
sodium channel blockers (valproate), propranolol
33
What is a generalised epileptic attack
Arrises from both hemispheres
34
Investigations for epilepsy
ECG is recommended in all as don't want to miss long-QT syndrome. EEG if epilepsy suspected
35
What is West syndrome
Infantile spasms - flexion of head and trunk followed by extension of the arms often on waking
36
Side effects of valproate
Weight gain, hair loss, teratogenic
37
Side effects of carbamazepine
Rash, hyponatraemia, ataxia
38
Side effects of lamotrigine
Rash, insomnia, ataxia
39
What diet can be used in epilepsy
Ketogenic (high fat, low carb)
40
Types of muscular dystrophies
Duchenne, Becker, congenital
41
Features of Duchenne muscular dystrophy
X-linked recessive, deletion of dystrophin gene. Present with waddling gait at around 5 years. Corticosteroids help, CPAP overnight.
42
What is Becker muscular dystrophy
Same gene as Duchenne, a less severe form and presents later
43
Brain haemorrhage in children
Most common extradural from injury - lucid interval where seem okay.
Subdural indicates shaken baby syndrome
SAH very rare
44
Conditions tested for in newborn screening
Cystic fibrosis, sickle cell disease, congenital hypothyroidism, phenylketonuria, galactosaemia, homocytinuria
45
5 Signs of kernicterus
Irritability, poor feeding, seizures, coma, opisthotonus (muscle spasm)
46
Diseases associated with Down's syndrome
Atrioventricular septal defect, duodenal atresia, Hirschprung's disease, hypothyroidism, coeliac disease, apnoea, leukaemia, Alzheimer's
47
What chromosome abnormality is Edwards syndrome
Trisomy 18
48
What chromosome abnormality is Patau syndrome
Trisomy 13
49
What chromosome abnormality is Turner's syndrome
45 X
50
3 signs of Turner's syndrome on foetal ultrasound
Foetal oedema of neck hands and feet
Cystic hygroma
Structural heart/kidney defects
51
What chromosome abnormality is fragile X
X-linked recessive - trinucleotide repeat
52
What blood test result would indicate Duchenne's muscular dystrophy
Raised creatinine kinase
53
Duchenne's muscular dystrophy mode of inheritance
X-linked recessive
54
Features of congenital adrenal hyperplasia
Low mineralocorticoids - vomiting, dehydration, weight loss. Loow cortisol - hypoglycaemia, clitoral hypertrophy, penis enlargement
55
What is the risk of treating hyponatraemia quickly
Cerebral oedema causing damage to myelin sheath in brainstem (pons). Can cause paralysis, dysphagia and dysarthria
56
X-ray finding for tetralogy of Fallot
Boot-shaped heart, right sided aortic arch
57
4 causes of heart failure in the neonate
Severe coarctation of the aorta
Critical aortic valve stenosis
Hypoplastic left heart syndrome
Interruption of the aortic arch
58
3 causes of heart failure in infant
(due to L-R shunt)
VSD
ASD
Patent ductus arteriosus
59
3 causes of heart failure in older child
Eisenmenger syndrome
Rheumatic heart disease
Cardiomyopathy
60
3 factors which contribute to airway narrowing in asthma
Bronchial muscle contraction
Mucosal inflammation
Increased mucous production
61
Severe asthma attack features
Inability to complete sentences
Pulse >140
RR >40 (>5yrs)
Peak flow 35-50% predicted
62
Features of life threatening asthma attack
```
Silent chest
LOC/exhaustion
Cyanosis
Peak flow <33% predicted
Poor respiratory effort
Normal or raised PaCO2
```
63
Features of ADHD
```
INATTENTION
HYPERACTIVITY
IMPULSIVENESS
impaired concentration
distractibility
difficulty taking turns
fidgety
```
64
Treatment for ADHD
CBT, methylphenidate (stimulant medicine - increase dopamine)
65
Side effects of methylphenidate
Dry mouth
Loss of appetite
Insomnia
66
Erythema multiforme and causes
Rash with target lesions
| Penicillin, NSAIDs, phenytoin, HSV!
67
Name 2 complications of eczema
```
Cellulitis (gram positive cocci) - treat with flucloxacillin
Eczema Herpeticum (herpes simplex) - acyclovir
```
68
Complications of chicken pox
Secondary bacterial infection - toxic shock syndrome
Encephalitis/cerebellitis
DIC
Purpura fulminans
69
What are Fraser guidelines used for
To give contraception to under 16s
70
Conditions of Fraser guidelines
```
Understands professionals advice
Cannot be persuaded to inform their parents
Likely to continue without contraception
Physical or mental health will suffer
In best interests
```
71
What is Gillick Competence
Child <16 must be able to understand advice given
72
3 causative organisms of meningitis <3
Group B strep
E.coli
Listeria
73
4 features of an innocent murmur
aSymptomatic
Soft blowing
Systolic murmur
Left Sternal edge
74
3 symptoms of toxic shock syndrome
Fever >39
Hypotension
Diffuse erythematous macular rash
75
Treatment of toxic shock syndrome
Ceftriaxone, Intravenous immunoglobulin
76
Causes of sensorineural hearing loss
Congenital rubella, HIE, meningitis
77
5 causes of stridor
```
Croup
Epiglottitis
Laryngomalacia
Bacterial tracheitis
Foreign body
```
78
What is the triad of Henoch-Schonlein Purpura
Purpura (buttocks/extensor surfaces)
Arthritis
Abdominal pain
79
What is the first sign of puberty
Breast development
| Testicular enlargement
80
Signs of ASD on asucultation
Ejection systolic murmur at the left sternal edge.
| Splitting of the second heart sound
81
What murmur is heard in VSD
Pansystolic murmur at lower left sternal edge
| reverse correlation to noise volume
82
Signs of PDA
Continuous machinery murmur
| Increased pulse pressure, collapsing pulse
83
Features of growing pains
```
Never present at start of day
No limp
No limitation of movement
Systemically well
Normal examination
Worse after a day of vigorous activity
```
84
What can cause erythrocytosis
smoking, alcohol or polycythaemia vera
85
Cause of neutrophilia
cancer or result of chemotherapy, viral infection such as hepB/C or HIV, medications (antipsychotics, carbimazole) or autoimmune disorders
86
What liver enzyme may be raised in osteomalacia, rickets, vit D deficiency or primary bone tumours
raised ALP
87
Infectious mononucleosis need to knows
a maculopapular rash develops in 99% who take amoxicillin whilst they have infectious mononucleosis (note amox not treatment for mono)
88
What electrolyte imbalance does congenital adrenal hyperplasia cause
Hyponatraemia (low aldosterone), hyperkalaemia, metabolic acidosis
89
What areas are protected from chemotheraputic agenst
CNS and testes
90
What is penacillamine and what is it used for
Copper chelating agent, used in Wilson's disease
91
What therapy can be given to those with sickle cell disease
Hydroxycarbamide - prevents vaso-occlusive complications
blood transfusions
prophylactic penicillin - as have splenectomy
bone marrow transplant - curative but risky
92
Which clotting factor deficiency is haemophilia A
VIII
93
What clotting factor deficiency is haemophilia B
IX
94
What is the final product of the coagulation cascade
fibrin
95
Symptoms of septic arthritis
Single swollen joint, severe pain, pyrexia, no tolerate passive movement, cannot weight bear
96
What scan can be used to show effectiveness of lymphoma treatment
PET scan - uses a radioactive tracer to show areas of high uptake (cancer)
97
age group of Perthes disease
5-10 years
98
Causes of limp in children 1-3 years
missed DDH, septic arthritis, transient synovitis, leukaemia
99
Causes of limp in children 11-16
slipper upper femoral epiphysis (obesity RF), reactive arthritis and sports injuries
100
What does a double bubble sign on abdominal x-ray indicate
duodenal atresia
101
What defects can lead to Eisenmenger syndrome
ASD
VSD
PDA
102
Physiology of Eisenmenger's
High pressure in pulmonary artery due to left to right shunt causes changes in pulmonary microvasculature leading to pulmonary hypertension and subsequent reversal of the shunt
103
Features of Eisenmenger's
```
Original murmur disappear
cyanosis
clubbing
right ventricular failure
(lack of oxygen causes polycythemia)
Polycythaemia leads to haemoptysis and embolism
```
104
What is the treatment for Eisenmenger's
heart-lung transplantation
105
What should be given first for moderate DKA
IV fluids (0.9 saline) and 1 hour later SC insulin at 0.1units/kg/hr (over 48 hours)
106
What blood results would you see in DKA
```
Hyperglycaemia
acidosis
ketonaemia
mildly raised creatinine
low bicarbonate
```
107
What is the progression of a chickenpox rash
papules>vesicles>papules>crusts
108
Features of Turner's syndrome
```
hypothyroidism
congenital heart defects
coarctation of the aorta
bicuspid aortic valve
webbed neck
short stature
widely spaced nipples
```
109
JIA summary
Most common chronic inflammatory joint disease in children.
Defined as persistent joint swelling >6 weeks duration before the age of 16.
95% have disease separate from RA
110
Complications of JIA
```
Chronic anterior uveitis
Flexion contractures of the joints
growth failure
anaemia
osteoporosis
amyloidosis
```
111
Presentation of JIA
Most are oligoarthritis affecting 1-4 joints (mostly knee, ankle or wrist) associated with uveitis.
Other presentations are enthesitis, psoratic, systemic
112
Systemic JIA presentation
```
(around 9% of JIA)
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia
```
113
Management of JIA
```
NSAID/analgesic
steroid joint injection
methotrexate
systemic corticosteroids
TNF-alpha/inteleukin
```
114
Common causes of Stephen-Johnson syndrome
```
penicillin
phenytoin
lamotrigine
allopurinol
sulphonamides
carbamazepine
NSAIDs
OCP
mumps
flu
HSV
EBV
```
115
Symptoms of Steven-johnson syndrome
Maculopapular rash with target lesions being characteristic
Mucosal incolvement
fever
arthralgia
116
Lennox-Gastaut summary
extension of infantile spasms
1-5yrs
abscences, falls jerks
90% moderate-severe mental handicap
117
Typical juvenile myoclonic apilepsy
infrequent generalized seizures often in morning
daytime absence seizure
sudden myoclonic seizure
118
Characteristic features of fragile-X
```
learning difficulties
global developmental delay
large head
long face
large ears
prominent mandible
mitral valve prolapse
poor muscle tone
```
119
Features of Kallmann syndrome
```
delayed puberty
small penis
small testes
no body hair
reduced sense of smell
poor balance
learning difficulties
```
120
What is Klinefelter syndrome
delayed puberty
lack of secondary sexual characteristics
tall stature
learning difficulties
121
rash of dermatitis herpetiformis
itchy bullous rash affecting extensor surfaces
122
What does cholesterol correlate with
inversely with albumin
123
Complications of nephrotic syndrome
```
frequent relapses
hypercholesterolaemia
hypovolaemia
infection
thrombosis
```
124
what is the most common cause of nephrotic syndrome in children
minimal change disease
125
distribution of rash in henoch-scholen purpura
symmetrically distributed over buttocks and extensor surfaces of arms, legs and ankle
126
symptoms of henoch-schonlen purpura
```
rash
joint pain
abdominal pain
glomerulonephritis
fever
```
127
what is alginate therapy
feed thickeners/gaviscon
128
what does ottitis media look like on otoscope
red, bulging and tender tympanic membrane
129
what does ottitis media with effusion look like on otoscope
grey tympanic membrane, loss of cone of light reflex and a visible fluid level behind the membrane.
You would also expect hearing loss
130
What are some serious complications of ottitis media
acute mastoiditis
| intracranial abscess
131
what is the feverpain score used for
to assess whether pharyngitis is due to a bacterial infection and hence whether it needs antibiotics
132
fever pain scoring
Everything 1 point, max 5
1. fever in past 24 hours
2. absence of cough or coryza
3. symptom onset <3 days
4. purulent tonsils
5. severe tonsil inflammation
133
at what score on feverpain would you consider delayed antibiotics
2-3
134
at what score on the feverpain would you give antibiotics
4-5
135
what is naevus flammeus
port wine stain - congenital and on face
136
treatment of faecal impaction
disimpaction regimen:
| osmotic laxative
137
ITP need to knows
it is typically benign and resolves spontaneously after 6-8 weeks
NSAIDs should be avoided
contact sports should be avoided
138
ITP presentation
petechiae following a viral illness
| low platelets
139
when would you prescribe antibiotics for otitis media
under 2 years with bilateral infection
140
antibiotic of choice for otitis media
amoxicillin
141
what is the name of the surgical treatment for Hirschprungs
Swenson procedure
142
which syndrome has microganthia (small lower jaw)
Edward's syndrome
143
which syndrome has polydactyly
Patau's
144
which syndrome has pectus excavatum
Noonans
145
whichh syndrome has macrocephaly
fragile x
146
what is second line to methylphenidate for ADHD
lisdexamfetamine
147
what is given for viral induced wheeze
salbutamol via a spacer
| steroids are not helpful in viral induced wheeze!
148
common signs/symptoms of nec
```
abdominal distension
vomiting
visible intestine loops
rectal bleeding
lethargy
feeding intolerance
```
149
how is nec diagnosed
abdominal xray show
dilated bowel loops
bowel wall oedema
gas within wall of intestine.
150
what heart defect is William's syndrome associated with
supravalvular aortic stenosis (not cyanotic)
151
what can be used for acute asthma attack
nebulised salbutamol/ipratropium, high flow o2, corticosteroids.
Second line for severe attacks would be IV treatments
152
treatment for impetigo
if small a short course of hydrogen peroxide may be used. Otherwise topical antibiotics (fusic acid) or oral flucloxacillin may be used
153
what is cryptorchidism
undescended testes:
1 retractile (can be pulled into scrotum)
2 palpable
3 impalpable (may be in inguinal canal, abdominally or absent)
154
when to refer for undescended testes
bilateral - 6-8 weeks (to be seen within 2 weeks)
| unilateral - refer at 4-5 months
155
when should orchidopexy be performed
around 12 months
156
what is the treatment of choice for intussusception
rectal air insufflation
157
when would antibiotics be required for gastroenteritis
if suspicious of sepsis, immunocompromised or spread of infection
158
eczema treatments
1st line emolients
non-sedating antihistamine (cetirizine) with severe itching
topical corticosteroids if persistent
159
what is the commonest presentation of a varicocele
asymptomatic!
| may have a dull ache
160
what does a red swollen warm testicle indicate
epididymitis or orchiditis
| BUT CONSIDER TORSION
161
what does severe sharp pain in scrotum indicate
torsion but suspect with any abdo pain
162
some causes of jaundice <2 weeks
polycythemia
infection
physiological
rhesus incompatibility
163
how to correct acidosis due to DKA in children
fluids, DO NOT use sodium bicarbonate (but this can be used in adults)
164
side effects of topical corticosteroids
acne
striae
telangiectasia
thinning of skin
165
definition of JIA
a child presenting with joint swelling of >6 weeks duration in the absence of infection or any other defined cause
more common in girls
166
secondary care for JIA
refer to ophthalmology as at risk of anterior uveitis which can lead to blindness!
167
what type of seiures are febrile convulsions
tonic clonic
168
slapped cheek syndrome cause
parvovirus B19
169
treatment for croup not responsing to dexamethasone
oxygen + nebulised adrenaline
170
histology in coeliac disease
intraepithelial lymphocytes
normal thickness mucosa
villous atrophy
crypt hyperplasia
171
what disease has a cobblestone appearance
Crohn's disease
172
does toddlers diarrhoea cause faltering growth
no
173
does vomiting cause faltering growth
can do
