Paeds Flashcards
(167 cards)
1
Q
most likely location of foreign body in lungs
A
right middle lobe (widest, shortest, most vertical of bronchi)
2
Q
Features of raised ICP
A
headache, morning vomiting, sun setting eyes, papilloedema, changes in vision
3
Q
Dehydration assumptions
A
if sx of clinical dehydration but no red flag features = assume 5% dehydration
if red flag features present = assume 10% dehydration
4
Q
osteogenesis imperfecta
A
autosomal recessive disorder of collagen synthesis. blue sclera, bowing of legs, hx of fractures
5
Q
staphylococcal scalded skin syndrome
A
fever, irritability, widespread red rash with pus and crusting around eyes/nose/mouth
6
Q
erythema toxicum
A
common skin rash that affects newborns, red base with small pustules
7
Q
features of congenital hypothyroidism
A
jaundice, hypotonia, macroglossia, poor feeding, weight gain, sleepy
8
Q
red flags in headache
A
recent trauma seizures altered consciousness speech disturbance weakness in legs/arms change in behaviour photophobia, neck stiffness, non blanching rash
9
Q
Crohn’s mx
A
induce remission = steroids +/- azathioprine/methotrexate/biologics
maintain remission = azathioprine/methotrexate
10
Q
explain IBD to patient
A
chronic inflammation in gut which can lead to pain, bloody diarrhoea, weight loss and problems with absorbing nutrients. it is a life-long condition and it tends to come and go in flare ups every so often but there is medication that can be given to prevent and treat flare-ups. MDT
11
Q
T1DM Mx
A
daily insulin regimen = combination of long and short acting insulins
regular blood glucose monitoring
educate on how to administer subcut insulin, how to monitor blood glucose levels, how to recognise sx of hypoglycaemia
refer to dietician
Diabetes UK for resources, advice, helpline
12
Q
DKA Mx
A
basic observations
full head to toe physical examination looking for clinical sx of dehydration + drowsiness
blood gases for pH, glucose, U&Es, ketones
urine dipstick for ketones + glucose
take A to E approach
if shocked –> fluid bolus
otherwise, calculate fluid requirements
correct fluid deficit over 48h
use 0.9% NaCl with 40mmol KCl / L
start IV insulin infusion of 0.1units/kg/hr after 1h of fluids
when glucose <14, add 5% dextrose to fluids
regular monitoring of glucose, fluid output, neurological status, U&Es, continuous ECG
13
Q
what should you do to prevent cerebral oedema in DKA Mx
A
regular monitoring of neurological status
make sure that glucose drops by a maximum of 5mmol/hr
14
Q
sx of cerebral oedema
A
headache, sx of raised ICP, irritability, reduced consciousness
15
Q
cerebral oedema mx
A
hypertonic saline
restrict fluids
call seniors + discuss further care with critical care
16
Q
measles complications
A
encephalitis
fever induced convulsions
subacute sclerosing panencephalitis (progressive brain damage, fatal)
17
Q
mumps complications
A
encephalitis hearing loss pancreatitis infertility spontaneous miscarriage
18
Q
rubella complications
A
encephalitis
congenital rubella syndrome
19
Q
mdoerate/mild asthma exacerbation mx
A
admit if worsening sx despite inhaler, previous episode of life-threatening exacerbation.
high flow o2
salbutamol in metered dose inhaler with spacer, 1 puff every 30-60s + take 5 tidal breaths per puff
if needed, can give ipratropium bromide in combination
oral prednisolone 3-5d
20
Q
asthma exacerbation discharge + F/U
A
discharge when don’t need salbutamol for 4h
F/U 48h after discharge to review compliance, inhaler technique, discuss stepping up
allergen avoidance/smoking/vaccinations
21
Q
questions to ask in Down’s syndrome hx
A
feeding difficulties (macroglossia) dysmorphic facial features difficulties passing urine/bowels (hirschsprungs?) floppy? convulsions? difficulty breathing? pallor? (congenital heart disease) tests/scans during pregnancy delivery hx developmental milestones
22
Q
down’s syndrome Ix
A
full physical examination to look for dysmorphic features
karyotyping for trisomy 21
echo for congenital heart defects
abdo USS for Hischsprung’s + biliary/duodenal atresia
23
Q
migraine mx
A
simple analgesia
nasal sumatriptans
consider adding anti-emetics, e.g., metoclopramide
F/U in 1 month or come back if sx get worse
24
Q
eczema mx
A
avoid triggers/irritants
emollients (use 500g/day, in all areas)
topical corticosteroids (potency depends on severity)
bandages
if severe, phototherapy, systemic therapy
25
neonatal jaundice ix
basic obs
full physical examination, including abdo exam looking for tenderness + masses
urine dip
admit for bloods - FBC, conjugated/unconjugated bilirubin, LFTs, TFTs, blood film, Coomb's test
26
Croup mx
single dose oral dexamethasone
if this does not setting sx, can consider giving repeat dose
NSAIDs, high flow O2, fluids as needed
consider nebulised adrenaline if severe
27
explain croup to patient
infection of upper airways, including the voice box and windpipe (larynx + trachea). usually caused by a virus (often parainfluenza).
28
septic arthritis tx
IV fluclox 2 weeks, switch to oral for another 2-4 weeks
29
Kocher criteria
used to differentiate between transient synovitis vs septic arthritis
takes into account whether they are non weight-bearing on affected side, temperature, WCC, ESR
30
childhood obesity mx
managed in primary care
diet - regular, healthier meals, smaller portions, eat together as a family
exercise - fun activities, at least 1hr moderate activity per day
less screen time
orlistat considered for >12yo
MDT approach!
31
obesity ix
general examination
height, weight, BMI
FBC, U&Es, TFTs, LFTs, IGF-1, OGTT
32
pyloric stenosis complications
dehydration
severe electrolyte imbalance
weight loss
33
questions to ask to differentiate between GORD and infantile spasms
associated with feeding?
| vomiting after?
34
question to ask when suspecting west syndrome
whether they are reaching developmental milestones
| development delay often seen in west syndrome
35
west syndrome ix
```
basic obs
full neuro exam
abdo exam
bloods - FBC, U&Es, LFTs, glucose
brain MRI
EEG
```
36
west syndrome mx
corticosteroids
early diagnosis and tx associated with improved outcomes
assoc. with loss of skills, learning disabilities, continued epilepsy
37
F/U following discharge after
F/U 4-6 weeks after discharge with paediatrician to do head to toe screen
38
meningococcal septicaemia mx
```
basic obs
full physical examination
take an A to E approach
initiate sepsis 6 protocol - insert 2 wide bore cannulae, take blood cultures/glucose/lactate, give high flow oxygen, IV fluids, IV abx ;
refer for lumbar puncture
alert seniors
```
39
Duchenne's mx
```
basic obs
full physical examination, look at calves
look for waddling gait + Gower's sign
creatine kinase
genetic analysis or muscle biopsy
```
40
explain duchenne's to patient
genetic disorder where there is progressive muscle damage and weakness. this will mean that will eventually lose ability to walk but can delay this a bit with physio, corticosteroids, protecting bone health w/ vit D + bisphosphonates. can use physical aids to help with walking, eventually wheelchair. OT to adapt home and school to help with mobility. eventually, the muscles in the heart and lung will be affected, at which point the condition becomes life-threatening. MDT! paeds/gp/cardio/resp/physio/OT/psych/counselling/school
41
Scabies tx
Permethrin
42
When do kids smile
6 weeks, refer by 8 weeks
43
which congenital infections most likely to affect fetus if contracted by mother in first trimester
Rubella (90% chance of developing congenital syndrome!)
CMV
Parvovirus B19
44
blueberry muffin appearance rash in newborn
CMV or rubella
45
severe croup mx
nebulised corticosteroids (if too unwell to take oral)
consider nebulised adrenaline
bleep anaesthetist
46
SUFE Ix vs Perthe's Ix
```
SUFE = AP & lateral frog leg views
Perthe's = xray
```
47
sudden severe gastrointestinal haemorrhage of dark blood in baby
Meckel's diverticulum
48
benign condition where the head becomes moulded into a slightly abnormal shape
plagiocephaly
49
blocked nose, runny eyes, nasal voice, allergic reaction due to dust mites
perennial rhinitis
50
neonatal conjunctivitis <5d after birth
gonorrhoea
51
neonatal conjunctivitis 5-14d after birth
chlamydia
52
why is bronchiolitis mx different for <1yo
supportive mx in all cases
| but do not give salbutamol to <1yo as they do not have the receptors for it to be effective yet
53
retinoblastoma
most common ocular malignancy in children
tends to be diagnosed at 18 m/o on average
autosomal dominant
absence of red reflex, strabismus, visual problems
excellent prognosis
mx = external beam radiation / chemo/ photocoagulation, enucleation
54
epilepsy definition
2 or more seizures with no identifiable cause
55
advice for parents about baby weight loss after birth
normal to lose 10% body weight after birth but they should regain by 2 weeks
56
nephrotic syndrome mx
60mg/m2/day of prednisolone for 4-6 weeks, then reduce the dose to 40mg/m2/day and give it on alternate days for 4-6 weeks
then reduce dose gradually
57
duodenal astresia mx
duodenodudenostomy
58
scaphoid abdomen --> dx?
congenital diaphragmatic hernia
59
indications of life-threatening asthma
```
silent chest
cyanosis
PEFR <33%
normal pCO2
exhaustion/poor respiratory effort
altered level of consciousness
```
60
why should you avoid NSAIDs in chickenpox
increased risk of necrotising fasciitis
61
achondroplasia
autosomal dominant
inhibition of chondrocyte proliferation due to defect in fibroblast growth factor 3 receptor
short stature + short limbs
spares head
62
neonatal resus
dry baby
assess RR/HR/tone
if not breathing, 5 inflation breaths
reassess
if chest not moving, another 5 inflation breaths
if chest moving but HR<60, ventilation for 30s
if HR still < 60, start chest compressions with ventilation breaths 3:1
reassess every 30s
if still HR<60, gain venous access + consider drugs
63
nebulised salbutamol doses for < 5yo + > 5yo
```
<5yo = 2.5mg
>5yo = 5mg
```
64
why can intussusception happen after a recent illness
recent viral illness --> inflammation of Peyer's patches --> lead point for intussusception
65
why can minimal change disease lead to recurrent infections + thrombosis
loss or protein in urine includes loss of antibodies --> recurrent infections
loss of antithrombin --> thrombosis
66
spina bifida occulta
1 or more vertebrae have not formed properly --> skin lesion --> tuft of hair, dimpling, birth mark
67
tethered spinal cord syndrome
complication of spina bifida occulta --> spinal cord is attached to spinal canal --> limits movement of spinal cord --> weakness, bowel/urinary sx
68
meningocele
meninges bulge out in between vertebrae --> no sx but can lead to increased risk of hydrocephalus / meningitis
69
myelomeningocele
most severe form of spina bifida
spinal cord herniates out in between vertebrae --> severe neuro complications --> clubfoot, bowel/urinary sx, weakness in legs
70
cephalohaematoma vs caput succedaneum
cephalohaematoma = collection of blood between skull and periosteum
caput succedaneum = collection of blood outside periosteum
skull periosteum scalp
71
Becker's muscular dystrophy
better than Duchenne's
presents later in life
normal life expectancy
72
constipation mx
if impacted --> disimpaction regime of escalating dose of movicol over 2 weeks
if good response, continue movicol in lower dose maintenance regime
if inadequate response, add stimulant laxative, eg senna
if still inadequate, use alternative stimulant laxative or substitute movicol with lactulose (osmotic laxative)
conservative measures - including more fibre and fluid in diet, establishing toileting routine so sitting on toilet after meal times, star chart
73
acute otitis media mx
reassure, analgesia, should resolve within 3-7d
consider abx if bilateral AOM in <2yo, comorbidities, no improvement after 3d; 5-7d amoxicillin
if has not improved after 2 courses of abx, refer to ENT
74
spastic cerebral palsy lesion location
motor cortex
75
spastic cerebral palsy features
```
increased tone (stiffness, less flexibility, poor balance)
types: hemiplegic, diplegic, quadriplegic
```
76
dyskinetic cerebral palsy lesion location
basal ganglia
77
dyskinetic cerebral palsy features
loss of coordination of movement --> abnormal/involuntary movements --> chorea, athetosis, dystonia
78
ataxic cerebral palsy lesion location
cerebellum
79
neuroblastoma
malignancy that develops from immature nerve cells of sympathetic nervous system, often forms on adrenals. sx - abdominal mass, hepatomegaly, cutaenous lesions, skeletal pain
80
androgen insensitivity syndrome
genotypically male but phenotypically male
end organ resistance to testosterone
sx = groin swellings (undescended testes), primary amennorhea, delayed puberty
81
reactive arthritis presentation
anterior uveitis, arthritis, urethritis
82
nappy rash (skin fold sparing) mx
high absorbency nappies
fragrance free wipes
barrier cream (zinc + castor oil)
if irritated, consider 7d course of topical hydrocortisone
83
nappy rash that does not spare skin folds/beef red rash/satellite lesions mx
topical imidazole
84
tuberous sclerosis
autosomal dominant
leaf shaped skin hypopigmentation rash
benign tumours in many organs, eg retinal hamartoma, rhabdomyoma, angiomyolipoma, infantile spasms
85
febrile seizure mx in community
if seizure does not resolve after 5 mins, give buccal midazolam. If after 5 mins, still does not resolve, call ambulance
86
GORD when breastfeeding mx
```
breastfeeding assessment
position upright after feeds
1) alginate therapy
2) ranitidine/PPI
if all fails, consider enteral feeding + Nissen fundoplication
```
87
GORD when bottlefed mx
```
review feeding hx
encourage smaller, more frequent feeds
position upright after feeds
1) thickened feeds
2) alginate therapy
3) ranitidine/PPI
if all fails, consider enteral feeding + Nissen fundoplication
```
88
precocious puberty - examination of testicles
if unilateral enlargement --> testicular tumour
if bilateral enlargement --> gonadotrophic dependent cause, eg elevated FSH/LH due to irradiation, brain injury, hydrocephalus, hypothyroidism etc
if atrophy --> consider ectopic cause --> adrenal tumours, CAH, mccune albright
89
Meckel's diverticulum can be identified via what ix
technetium 99 scan
90
hydatid torsion presentation
torsion of embryological remnant in upper pole of testicle
presents similarly to testicular torsion with swelling, redness, pain but also blue dot on upper pole + positive cremasteric reflex + less acute hx
91
epididymitis presentation
presents similarly to testicular torsion with redness, swelling, pain but with positive cremasteric reflex + dysuria / discharge
doppler USS can rule out torsion
92
premature thelarche mx
reassure + review in 4-6 months
93
headlice mx
1) wetcombing 2) malathion / dimeticone
94
what is otitis media effusion
collection of fluid in middle ear without inflammation, sometimes follows acute otitis media.
95
otitis media effusion mx
often self-resolves so watchful waiting for 6-12 weeks with two hearing tests (tympanometry + pure tone audiometry).
if no improvement, refer to ENT for surgical intervention or hearing aids
96
choking mx
encourage cough
5x back blows
5x abdominal thrusts
remove foreign body via flexible bronchoscopy
97
choking mx
```
encourage cough
5x back blows
5x abdominal thrusts
repeat maneouvres as necessary
remove foreign body via flexible bronchoscopy
```
98
Craniosynostosis
when cranial sutures fuse prematurely --> brain/head forms abnormally so need surgery
99
omphalitis - what is it + mx
infection of umbilical stump --> redness, pus
| need blood cultures + IV abx asap as can deseminate quickly in blood + cause sepsis
100
mastoiditis sx + complications
infection of the mastoid bone which is the bone which drains the middle ear, may follow persistent ear infection
sx - large bump behind ear, hearing loss, pain, headache
101
mastoiditis mx
abx
| surgery may be needed (myringotomy or mastoidectomy)
102
pyloric stenosis mx
IV fluids
nil by mouth
consult surgeons
Ramstedt's pyloromyotomy
103
Voraciously hungry kid, hypotonia, almond shaped eyes, initial problems feeding
prader willi
104
Unilateral nasal bleeding + crust
foreign body
105
VSD murmur
pansystolic murmur on lower left sternal edge
106
medulloblastoma
aggressive paeds brain tumour
small blue cells
sx - raised ICP (morning vomiting), cerebellar dysfunction (ataxia, squinting, abrnoaml eye movements)
107
indication for CT head in paeds head injury
```
vomiting 3 or more times
loss of consciousness/amnesia >5mins
abnormal drowsiness
focal neurological deficit
basal skull fracture
suspecting NAI
dangerous mechanism of injury
```
108
benign rolandic epilepsy
most common form of childhood epilepsy, most people outgrow by puberty
twitching/numbness/tingling of face/tongue, often at night, may be drooling / slurring of speech / excessive salivation
high amplitude spike in left centrotemporal region
109
what is given to sickle cell patients to reduce frequency of crises + increase HbF
hydroxycarbamide
110
causes of cerebral palsy
prenatal causes - placental dysfunction, congenital infection, cerebral malformations
delivery causes - hypoxic injury
infant causes - meningitis, encephalitis
111
murmur in rubella
patent ductus arteriosis
112
murmur in fragile X
mitral valve prolapse
113
phimosis sx + mx
= non retractile foreskin, may present with irritation, tenderness, dysuria, recurrent UTIs
reassure that is normal in under 2yo + should resolve between 2-6yo + keep reviewing
do not forcibly retract
then depending on severity (concerning sx include scarring, not retracting at all), can give steroids, circumcision
114
Wilm's tumour / nephroblastoma presentation, ix, mx
2nd most common childhood malignancy
sx: abdominal mass + painless haematuria, less commonly anaemia + abdo pain
ix: USS to look for mass, CT to confirm dx, CXR to check for lung mets, DO NOT DO BIOPSY
mx: nephrectomy, chemo + radiotherapy if gets worse
115
HUS mx
```
admit
consult haematology + nephrology
IV fluids
Monitor fluid balance, urine output, BP
50% will need dialysis during acute phase
renal transplant if irreversible damage
avoid abx, NSAIDs, opioids
```
Long-term F/U as there may be persistent proteinuria + progression to HTN + CKD
116
bilateral undescended testes mx
urgent referral to senior paediatrician for endo + genetic review
117
unilateral undescended testes mx
reassure
review at 6 week check
review at 3 months
if still not descended, refer to paediatric surgeon to complete orchidopexy before 12 months
118
calculating fluid deficit from weight loss
weight loss x 1L
119
fluid deficit based on pH in DKA
7.2-7.3 = 5%
7.1-7.2 = 7%
<7.1 = 10%
120
how to administer fluid bolus
fluid bolus = 10 x body weight
if non shocked, subtract fluid bolus from total fluid deficit
if shocked, you do not need to subtract, just give both bolus + fluid deficit
121
criteria to admit after febrile seizure
```
first presentation
< 18 m/o
was taking abx as it could be masking meningitis
residual focal neurological deficit
uncertain cause
```
122
Chignon
transient swelling particular to babies delivered using a Ventouse
123
infantile polycystic kidney disease
autosomal recessive
poor prognosis
bilaterally enlarge kidneys which compress on lungs causing difficulty breathing, HTN, CKD, hepatic fibrosis
hx of oligohydramnios
124
A vibratory bassoon-like murmur heard at the left sternal border in the supine position
Still's murmur
125
A continuous sound in the supraclavicular fossa (more so on the right) increased in deep inspiration
venous hum
126
Bronchopulmonary dysplasia
persistent oxygen requirement at 36 weeks post-menstrual age
| in premature babie
127
3 spike wave per second pattern bilaterally on EEG
absence seizure
128
umbilical hernia
very common in babies + infants
most likely will self resolve
not treated until 3-4y/o
safetynet for sx of incarceration (vomiting, abdo pain, hernia inflamed, non-reducible, stops passing stool)
129
dietary advice for cystic fibrosis patients
Eat a high calorie, high fat diet with enzyme supplements for each meal
130
post-streptococcal glomerulonephritis - good ix
low C3 levels
131
juvenile idiopathic arthritis
persistent joint swelling for >6weeks with no other indentifiable cause.
132
signs of systemic JIA
```
salmon pink rash
fever
malaise
lymphadneopathy
hepatosplenomegaly
neutrophilia
thrombocytosis
```
133
Choking or cyanosis during feeds + hx of polyhydramnios
tracheoesophageal fistula
134
growing pains
```
age 3-12yo
symmetrical joint pain in lower limbs that comes on only at night
no limp
exercise is not impeded
normal examination
```
135
central abdominal pain, nausea and vomiting episodes
abdominal migraines
136
how to tell colic apart from intussescpetion
colic = severe episodes occur then self resolve,
| paroxysmal inconsolable crying and drawing of the legs up towards the abdomen, which is accompanied by passing wind
137
neonatal hypoglycaemia asymptomatic mx
encourage feeding
| monitor blood glucose
138
neonatal hypoglycaemia mx when symptomatic or very low glucose
admit to neonatal unit
| IV infusion dextrose
139
Measles isolation advice
4 days off school after onset of rash
140
Rubella isolation advice
5 days off school after onset of rash
141
Parvovirus isolation advice
Isolation not needed after onset of rash as no longer contagious
142
Timeline of chicken pox rash
Macular to papular to vesicular to crusting over
143
Scarlet fever tx
Penicillin V (phenoxymethylpenicillin)
144
Isolation for 48h after starting abx?
Whooping cough
145
Isolation for 24h after starting abx?
Scarlet fever
146
Pertussis tx
Oral macrolide within 21 days of sx onset
147
Prophylaxis for household contacts in meningitis
Rifampicin / ciprofloxacin
148
Chronic asthma Mx under 5yo
1) SABA
2) 8 week trial of SABA + moderate dose ICS. If after trial, sx come back within a month, then child must have asthma so start them on SABA + low dose ICS. If sx return >1month after stopping trial, then do another trial
3) SABA + ICS+ LTRA
4) stop LTRA + refer to paeds asthma specialist
149
A teenage girl presents with medial knee pain following activity. The knee has given way on occasion is a stereotypical history of:
patellar subluxation
150
At what age would the average child acquire the ability to use double syllables e.g. 'adah','erleh'?
6 months
151
At what age would the average child acquire the ability to turns towards sound?
3 months
152
At what age would the average child acquire the ability to knows and responds to own name?
12 months
153
What is the mode of inheritance of osteogenesis imperfecta?
autosomal dominant
154
A sporty teenager presents with knee pain after exercise associated with intermittent swelling and locking is a stereotypical history of:
osteochondritis dissecans
155
autosomal recessive disorders to remember in paeds
sickle cell anaemia
Gilbert's syndrome
haemachromatosis
cystic fibrosis
156
paediatric neck masses
```
lymphadenitis
dermoid cyst (suprahyoid, midline)
thyroglossal cyst (below hyoid, midline)
branchial cyst (anterior triangle, angle of mandible)
lymphatic malformations (posterior triangle)
```
157
3. 5 y/o presents with widespread non-blanching erythematous rash over her body, after 1 week of cough and coryzal symptoms. Teperature is 37.2, pulse 95bpm, BP 90/60, RR 22, and O2 sats are 98% on room air. Urinanalysis yields no abnormalities, but FBC shows elevated WCC and a platelet count of 7 x 10^9. What is the most likely diagnosis?
ITP
158
periorbital/orbital cellulitis choice of abx
oral co-amoxiclav
159
SUFE mx
surgical internal fixation
160
<6m/o with typical UTI
6 week USS
| no other age group needs further ix for typical UTI
161
any age group with atypical UTI
immediate USS
162
atypical UTI 6 months old - 3 years old
immediate USS
DMSA
MCUG if DMSA is abnormal
163
recurrent UTI 6 months old - 3 years old
6 week USS
DMSA
MCUG if DMSA is abnormal
164
atypical UTI in over 3yo
immediate USS
165
recurrent UTI in over 3yo
6 week USS
166
<6m/o with atypical or recurrent UTI
6 week USS
DMSA
MSUG
167
when is an assessment by a paediatrician needed for GORD
```
red flag sx
faltering growth
feeding aversion
unexplained distress
unresponsive to medical mx
```
