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MSRA > Paeds > Flashcards

Paeds Flashcards

1
Q

Presentation of osgood schlatter disease?

A

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

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2
Q

Presentation of chondromalacia patellae? (also called patellar pain syndrome?

A

Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy

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3
Q

Immediate management of croup?

A

all children with mild, moderate, or severe croup should receive a single dose of oral dexamethasone (0.15 mg/kg body weight)

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4
Q

Different presentations of septic arthritis vs transient arthritis?

A

Septic arthritis severely restricted joint movement, high temp and complete inability to weight bear

Transient - low grade temp, can weight bear

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5
Q

Presentation of bronchiolitis?

A

coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory crackles (not always present)
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

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6
Q

Management of bronchiolitis?

A

Management is largely supportive
humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
suction is sometimes used for excessive upper airway secretions

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7
Q

Features of (male) fragile X?

A 
learning difficulties
large low set ears, long thin face, high arched palate
macroorchidism
hypotonia
autism is more common
mitral valve prolapse
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8
Q

When to worry about nocturnal enuresis?

A

5 years or older

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9
Q

Characteristics of innocent murmurs in children?

A 
soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
may vary with posture
localised with no radiation
no diastolic component
no thrill
no added sounds (e.g. clicks)
asymptomatic child
no other abnormality
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10
Q

Doses of IM benzylpenicillin for ?meningococcal sepsis?

A

< 1 year 300 mg
1 - 10 years 600 mg
> 10 years 1200 mg

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11
Q

What virus causes croup?

A

Parainfluenza virus

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12
Q

Pertussis treatment?

A

azithromycin or clarithromycin if the onset of cough is within the previous 21 days

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13
Q

What will indomethacin and prostaglandins do to a Patent ductus arteriosus?

A

Prostaglandins will keep open

Indomethacin will close

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14
Q

Fever referral to Paeds ED in under 3 months? ho0w high does the fever need to be?

A

A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness

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15
Q

features of tetralogy of fallot?

A

ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta

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16
Q

If you were to treat bed wetting what is used ?

A

Desmopressin if >7yrs

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17
Q

Methylphenidate side-effects?

A

abdominal pain, nausea and dyspepsia

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18
Q

When and what are the newborn checks?

A

Newborn

  • Clinical examination of newborn
  • Newborn Hearing Screening Programme e.g. oto-acoustic emissions test
  • Give mother Personal Child Health Record

First month
- Heel-prick test day 5-9 - hypothyroidism, PKU, metabolic diseases, cystic fibrosis, medium-chain acyl Co-A dehydrogenase deficiency (MCADD)

Midwife visit up to 4 weeks

Following months

  • Health visitor input
  • GP examination at 6-8 weeks
  • Routine immunisations

Pre school
- National orthoptist-led programme for pre-school vision screening to be introduced

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19
Q

Rule re inheritance of congenital conditions?

A

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

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20
Q

What is genetic anticipation? What disorders are affected?

A

Trinucleotide repeat disorders tend to have earlier onset in subsequent affected generations.

Huntington’s disease and Myotonic dystrophy

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21
Q

Presentation of measles?

A

Prodrome: irritable, conjunctivitis, fever

Koplik spots: white spots (‘grain of salt’) on buccal mucosa

Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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22
Q

Presentation of mumps?

A

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

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23
Q

Presentation of rubella?

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day

Lymphadenopathy: suboccipital and postauricular

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24
Q

Presentation of Erythema infectiosum?

A

Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

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25
Q

Presentation of scarlet fever?

A

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

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26
Q

Presentation of hand foot and mouth disease?

A

Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

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27
Q

What does parovirus case?

A

Erythema infectiosum

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28
Q

What does coxsackie virus cause?

A

Hand foot and mouth

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29
Q

Is head banging normal in children?

A

<3yrs yes if above - should have ASD assessment

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30
Q

Hand preference abnormal below what age?

A

Abnormal below 12 months

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31
Q

Patau syndrome presentation?

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

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32
Q

Edwards syndrome presentation?

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

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33
Q

Fragile X presentation?

A 
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
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34
Q

Noonan syndrome presentation?

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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35
Q

Pierre robin syndrome presentation?

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

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36
Q

Prader willi syndrome presentation?

A

Hypotonia
Hypogonadism
Obesity

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37
Q

Williams syndrome presentation?

A 
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
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38
Q

Cri du chat syndrome (chromosome 5p deletion syndrome) Presentation?

A

Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism

39
Q

Most common congenital heart disease for cyanotic and acynaotic (separately)?

A

Cyanotic: TGA most common at birth, Fallot’s most common overall

Acyanotic: VSD

40
Q

Most common presentations of wilms tumour?

A

abdo mass

41
Q

When do you get physiological jaundice?

A

Physiological jaundice develops 2-3 days post-delivery and should resolve by 14 days

Within the first 24 hours is always pathological

42
Q

Levels of bilirubin in physiological jaundice?

A

<100

43
Q

Features of kawasaki’s disease?

A

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel

44
Q

How to calculate down syndrome risk in increasing age?

A

1/1,000 at 30 years then divide by 3 for every 5 years

45
Q

When are women offered the pertussis vaccine in pregnancy?

A

16-32 weeks

46
Q

What does the heel spot test test for?

A 
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
47
Q

If a baby didn’t have the heel spot test then what test would you use for CF?

A

Sweat test

48
Q

Risks of undescended testes?

A

increased risk of infertility, torsion and testicular cancer

49
Q

Management of undescended testes

A

Unilateral undescended testis
NICE CKS now recommend referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
Orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation

50
Q

What is the most common cardiac abnormality associated with downs?

A

AVSD

51
Q

How would a PDA present ?

A 
left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
52
Q

In terms of brisk stacking what ages should you be able to do what?

A

15 months Tower of 2
18 months Tower of 3
2 years Tower of 6
3 years Tower of 9

53
Q

What age should a baby have a palmar grasp?

A

5-6 months

54
Q

What age do you correct hypospadius?

A

12 months

55
Q

What babies are at risk of Vit K deficiency?

A

Breast-fed babies are particularly at risk as breast milk is a poor source of vitamin K. Maternal use of antiepileptics also increases the risk

56
Q

R/F for surfactant lung disease? (RDS)

A

male sex
diabetic mothers
Caesarean section
second born of premature twins

57
Q

What drug for threadworm?

A

mebendazole

Treat whole household

58
Q

When should kids be able to sit without support?

A

7-8 months

59
Q

What is Kallman’s syndrome?

A

Kallman’s syndrome is a cause of delayed puberty secondary to hypogonadotrophic hypogonadism

60
Q

Inheritance pattern of haemophilia A?

A

X linked recessive

61
Q

What are the common causative organisms of meningitis in newborns (or recently born)?

A

Group b strep - usually acquired from mother

62
Q

What is trisomy 18?

A

Edwards (rocker bottom feet)

63
Q

What is trisomy 21?

A

Downs

64
Q

What is trisomy 13?

A

Patau

65
Q

Xray finding in Transient tachypnoea of the newborn?

A

hyperinflation and fluid in the horizontal fissure

66
Q

How does Osteochondritis dissecans present>

A

Pain after running intermittent swelling and locking

67
Q

How does Patellar subluxation present?

A

Medial knee pain due to lateral subluxation of the patella

Knee may give way

68
Q

How does patellar tendonitis present?

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

69
Q

Difference in exomphalos and gastroschisis?

A

Exomphalos - the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.

Gastroschisis - a congenital defect in the anterior abdominal wall just lateral to the umbilical cord.

gastroschisis tends to be a stand alone bowel condition, exomphalos is associated with cardiac and kidney diseases

70
Q

Advice for fluids in enuresis?

A

Do not restrict fluids. The child should have about eight drinks a day, spaced out throughout the day, the last one about 1 hour before bed.

71
Q

Carrier rate for CF gene in UK?

A

carrier rate is 1 in 25

72
Q

First sign of puberty in boys and girls?

A

Boys:
first sign is testicular growth at around 12 years of age (range = 10-15 years)
testicular volume > 4 ml indicates onset of puberty

Girls:
first sign is breast development at around 11.5 years of age (range = 9-13 years)

73
Q

Normal changes in puberty (that may seem pathological?)

A

gynaecomastia may develop in boys
asymmetrical breast growth may occur in girls
diffuse enlargement of the thyroid gland may be seen

74
Q

What do APGAR scores represent?

A

A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state

75
Q

Comression to breaths ratio in PLS?

A

15:2

76
Q

Management of kawasaki disease?

A
  1. high-dose aspirin
  2. intravenous immunoglobulin
  3. echocardiogram is used as the initial screening test for coronary artery aneurysms
77
Q

When do umbilical hernias resolve?

A

By 3, refer after this

78
Q

At what age do the majority of children achieve day and night time urinary continence?

A

3-4

79
Q

RF for DDH?

A 
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
80
Q

When should a child be able to hop on one foot?

A

4 years

81
Q

When should a child be able to squat to pick up a ball

A

18 months

82
Q

When should a child be able to pull to stand?

A

9 months

83
Q

How long off school for mumps?

A

excluded from school for 5 days from the onset of swollen glands

84
Q

Inheritance pattern of CF?

A

x linked recessive

85
Q

Most common cause of hypothyroidism in children?

A

autoimmune thyroiditis.

86
Q

Example of a mild steroid?

A

Hydrocortisone 1%

87
Q

What is in dermovate, is it potent or mild?

A

Clobetasone and it is potent

88
Q

Most common cause of primary headaches in children?

A

Migraine

89
Q

First line treatment for paediatric migraines?

A

Ibuprofen

90
Q

How would CCF present in Neonates?

A

poor feeding, shortness of breath, hepatomegaly

91
Q

What organism causes acute epiglottitis?

A

Haemophilus influenzae

92
Q

Common referral ages for different issues in development?

A

doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months

93
Q

What is the triad of haemolytic uraemic syndrome?

A

acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

94
Q

What is the most common cause of HUS in children?

A

E.coli - enterotoxins

MSRA (22 decks)

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