Paeds Flashcards by Katherine Wostenholme

What is the most common cause of cardiac arrest in children?

Respiratory causes e.g. Hypoxia

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How would you investigate SCFE?

AP and lateral Xray (frog leg) of BOTH hips

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How would you manage SCFE?

Internal fixation by surgical pinning

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Describe asthma control in 5-16 yrs

SABA 
SABA + low dose ICS
SABA + Low dose ICS + LTRA
SABA + Low dose ICS + LABA (-LTRA)
SABA + Moderate dose ICS MART 
Referral

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Describe asthma control in 5 or less

SABA
SABA and 8 wk trial of ICS
If symptoms resolve then reoccur after 4 weeks off steroids - commence again
If symptoms do not resolve, consider alternative diagnosis
SABA + ICS + LTRA
Refer

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What are the 3 features of shaken baby syndrome?

Subdural haemotoma
Retinal haemorrhage
Encephalopathy

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Give 5 features of PDA

Left subclavicular thrill 
Apex beat heave 
Large volume, bounding, collapsing pulse
Wide Pulse pressure 
Machinary continuous murmur

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Give an example of a duct dependant disease

How would you treat this?

Transposition of the great arteries

Give prostaglandin E1 to maintain PDA for surgery

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What is the most common sign of neonatal sepsis?

Respiratory distress

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Describe the initial management of diaphragmatic hernia

Insert NG tube to keep air out of gut

If cyanosed - intubation and ventilation

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What does a ‘beefy red’ well defined patch suggest

Candidal dermatitis

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What age range is perthes disease seen in?

4-8

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Is perthes disease more common in girls or boys?

5 x more common in boys

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Describe what is seen on downs syndrome screening if postive

Low AFP
Low oestriol
High HCG 
Low PAPPA
Thickened nucheal translucency

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How do you treat mycoplasma pneumonia

Erythromycin

ANY OTHER is amoxicillin

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Why are children with Downs syndrome prone to snoring?

Due to the hypotonia and large tongue and adenoids

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Describe the antibiotic therapy for children with suspected meningitis

less than 3 months
over 3 months

< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime

> 3 months: IV cefotaxime (or ceftriaxone)

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How does transposition of the great arteries present on auscultation?

No murmur
Loud single S2
Prominent ventricular pulse

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What is laryngomalacia?

A very common benign cause of noisy breathing in infants

It is congenital softening of the cartilage of the larynx, causing collapse during inspiration

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What is the most common cause of proteinuria in children?

Transient proteinuria

precipitants include infection, pregnancy and heavy exercise

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Describe how Henoch-Schonlein Purpura presents?

Tetrad of:
Rash
Abdominal pain
Arthralgia
Glomerulonephritis

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What do abnormally high levels of conjugated bilirubin suggest?

Biliary atresia

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How does biliary atresia present?

Prolonged neonatal jaundice
Raised conjugated bilirubin
Hepatomegaly
Splenomegaly palpable by 3-4 weeks

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What is the cause of mono (glandular fever)?

EBV

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How does EBV infection present?

Lymphodema Pharyngitis Hepato/splenomegaly

What happens when you treat EBV incorrectly with antibiotics?

A widespread scarring rash appears

What is EBV associated with?

Lymphoproloferative disorders e.g. Burkitt's Lymphoma

Describe the presentation of measles

High fever Widespread macropapular rash which begins in the face Flu-like symptoms Conjunctivitis Koplik's spots (white spots in the mouth)

What causes scarlet fever?

Group A streptococcus infection

Describe the presentation of scarlet fever

``` Begins as pharyngitis Strawberry tongue Lymphadenopathy High fever Sandpaper rash after 1-2 days ```

Describe the presentation of rubella

Low grade fever Lymphadenopathy Joint pain Rash that begins on the face and spreads to trunk and limbs

Calculate maintenance fluids formula.

First 10kg = 100ml/kg Second 10kg = 50ml/kg After= 20ml/kg

Calculate replacement deficit fluids formula

%deficit x weight (kg) x 10

What is the most important investigation in orbital cellulitis

CT orbit

Describe the features of congenital rubella syndrome

Eye defects (loss of red reflex) Congenital heart disease (PDA) Senorineural deafness Purpuric 'blueberry muffin' skin rash is also common

What is Prehn's test?

Test to see if there is relief of pain on elevation of the testicles. It indicates a diagnosis of acute epididymitis

What does mesenteric adenitis present with?

Non specific abdominal pain GUARDING IS RARE No change in appetite Follows an URTI

How does neonatal herpes simplex virus present?

Vesicular lesions on the eye, oral mucosa Encephalitis Sepsis

What is hand foot and mouth disease caused by?

Coxsackie A16 virus

What is slapped cheek syndrome caused by?

Parvovirus B19

What is first line in depression in under 18s?

Fluoxetine

Describe the presentation of Prader-Willi

``` Obesity Hyperphagia (binge eating) Short stature Hypotonia as a child Hypogonadism Learning difficulties ```

What are the characteristic features of Fragile X?

Long thin face | Large low set ears

Describe how Turner's syndrome presents

Primary amenorrhoea Wide webbed neck Wide spaced nipples No 2y sexual characteristics

Describe a classical finding in Kallmann syndrome

Ansomia (lack of sense of smell) Failure to start puberty More common in males

What is the diagnostic investigation for oesophageal atresia?

NG Tube (with radio-opaque end) and chest Xray

What should you do if you hear a small murmur on a NIPE exam?

Review in 24hrs (as long as they are well) as the fetal circulation undergoes significant changes within the first few hours of life If still present after 24hrs - refer for echo

What is Ebstein's anomaly?

Usually seen when lithium has been used in pregnancy. A congenital heart defect characterised by a large right atrium, small right ventricle and tricuspid incompetence

What is the treatment for Whooping cough?

Azithromycin or calrithromycin if onset has been in the last 21 days They must stay off school for 48 hours after commencing antibiotics OR 21 days from onset of symptoms if no antibiotics

What is the top cause of painless massive GI bleed requiring transfusion between 1-2?

Meckels Diverticulum

What is the advice on school exclusion for chickenpox?

Should be excluded until all lesions have crusted over

What heart defect is associated with Turner's syndrome?

Aortic coarctation

What should you do in asymptomatic neonatal hypoglycaemia?

Encourage normal feeding (whatever is preferred) and monitor blood glucose

What should you do in symptomatic/ very low neonatal hypoglycaemia?

Admit to neontal unit and give IV 10% Dextrose

What is acute epiglottis caused by?

Haemophilus influenza type B

What Is the first sign of puberty in boys?

Increase in testicular volume >4ml

You see a 3yo child who is bow legged - what is the most appropriate action?

It is normal in less than 3 years. It usually resolves by 4 years

What should be offered to all breech babies at or after 36 weeks gestation at 6 weeks?

Pelvic USS for DDH regardless of mode of delivery

What does persistent non bilious vomiting and peristalsis seen in the LUQ suggest?

Pyloric stenosis

What is the advice on school exclusion for scarlet fever?

A child with scarlet fever can return to school 24 hours after commencing antibiotics

How does congenital hypothyroidism present?

``` Macroglossia (large tongue) Hypotonia Umbilical hernia Reduced feeding Constipation ```

How is Meckel's diverticulum diagnosed?

Technetium scan

What is the cause of acute bilirubin encephalopathy?

Toxic buildup of unconjugated bilirubin

What is the definitive management of biliary atresia?

Hepatoportoenterostomy (Kasai procedure)

When does breast milk jaundice occur?

1 day-2 weeks after birth. It is caused by increased bilirubin reuptake in the gut

What are inguinal hernias caused by?

Failure of the processus vaginalis to obliterate

What is the karyotype in Turner's syndrome?

Describe the features of Klinefelter's syndrome

``` Phenotypically male Testicular atrophy Gynaecomastia Female distribution of hair (Due to INCREASED oestrogen production) ```

What is the karyotype in Klinefelter's syndrome?

XXY

What is the in the treatment of Turner's syndrome? (endo)

GH therapy

What is raised n physiological jaundice?

Unconjugated bilirubin

What is the definitive diagnosis for Duchenne's muscular dystrophy?

Muscle biopsy

What is the treatment for measles?

Supportive care

What is the chance of a child having another febrile seizure after having 1?

30-40%

What is a potential side effect of ingesting too much cow's milk?

Iron deficiency

What is the 1st line treatment of tonsillitis?

Penecillin QDS 5-10 days

What is a cardiac side effect of salbutamol?

Tachycardia

What is the incubation period for chickenpox?

21 days

What is impetigo caused by?

Staph. Aureus

What are the 1st line antibiotics for Nectrotising enterocolitis?

Clindamycin and Cefotaxime

Where does eczema affect in infants?

Face and trunk

What should you do in an infant less than 3 months with suspected UTI?

Refer immediately to paeds

What is the most common cause of headache in children?

Migraine

When does the moro reflex usually disappear?

4 Months

When is the neonatal blood spot screening test typically performed in the UK?

Between the 5th-9th day of life

At what ratio should chest compressions:rescue breaths be given in paediatric resus?

15:2

What type of vaccine is the rotavirus vaccine?

Oral, live attenuated vaccine

What is the most common cause of hip/knee pain in the 10-14 age group?

Transient synovitis

What is the most appropriate diet advice in cystic fibrosis?

High calorie and high fat diet with pancreatic enzyme supplementation for every meal

What should you do with babies that are jaundiced within 24hrs of birth?

Measure and record the serum bilirubin urgently (within 2 hrs) - it is likely to be pathological rather than physiological

How is vitamin K administered after birth?

One off IM injection

What is exomphalos (omphalocele)?

Abdominal contents protruding through the anterior abdominal wall but covered by the amniotic membrane and peritoneum

What is the management of exomphalos (omphalocele)?

1. c-section to reduce risk of sac rupture | 2. Staged repair over weeks-months

What is gastroschisis?

A congenital defect in the anterior abdominal wall lateral to the umbilical cord.

What is the management of gastroschisis?

1. Vaginal delivery may be attempted | 2. Newborns should go to theatre asap (within 4 hrs)

Describe APTT and PT in haemophilia

prolonged APTT and normal PT

What are the most common fractures associated with child abuse?

Radial Humeral Femoral

How do you treat eczema herpeticum?

Life threatening - admit for IV aciclovir

What is carp mouth associated with?

Russel-Silver