Paeds Flashcards
what are the 3 fetal shunts
ductus venosus
foramen ovale
ductus arteriosus
what does the ductus venosus connect
umbilical vein to inferior vena cava so blood can bypass the liver
what does the foramen ovale connect
right and left atrium so blood can bypass the right ventricle and pulmonary circulation
what does the ductus arteriosus connect
pulmonary artery with aorta so blood can bypass the pulmonary circulation
how does the foramen ovale shut
1st breath expands alveoli, decreases pulmonary vascular resistance, decreases right atrium pressure so left atrium pressure is high, squashing atrium septum - seals after few weeks to become the fossa ovalis
how does the ductus arteriosus close
increased blood oxygenation drops amount of circulating prostaglandins - becomes ligaments arteriosum
how does the ductus venosus close
immediately stops function because umbilical cord is clamped - becomes ligamentum venosum
what are innocent/flow murmur
common in children
fast blood flow through areas of the heart during systole
features of an innocent murmur
soft
short
systolic
symptomless
situation dependent - quieter when standing, appears when unwell etc
prompts for investigation of a murmur
louder than 2/6
diastolic
louder on standing
other symptoms e.g. failure to thrive
where would you hear mitral regurgitation murmur
5th intercostal space, midclavicular line
where would you hear a tricuspid regurgitation murmur
5th intercostal space, left sternal border
where would you hear a ventricular septal defect murmur
left lower sternal border
where would you hear an aortic stenosis murmur
2nd intercostal space, right sternal border
where would you hear a pulmonary stenosis murmur
2nd intercostal space, left sternal border
where do you hear a hypertrophic obstructive cardiomyopathy murmur
4th intercostal space on left sternal border
what type murmur do you hear in mitral reurgitation
pan systolic
what murmur do you hear in tricuspid regurgitation
pan systolic
what murmur do you hear in a ventricular septal defect
pan systolic
what murmur do you hear in aortic stenosis
ejection systolic
what murmur do you hear in pulmonary stenosis
ejection systolic
what murmur do you hear in hypertrophic obstructive cardiomyopathy
ejection systolic
what is a splitting second heart sound
pulmonary valve closes slightly later than aortic valve
what type of murmur do you hear in tetralogy of fallot
ejection systolic
where do you hear the murmur in tetralogy of fallot
2nd intercostal space, left sternal border
what can cause right to left shunt/cyanotic heart disease
tetralogy of fallot
transposition of the great arteries
truncus
tricuspid abnormalities
total anomalous pulmonary venous return
when does a PDA usually stop functioning and then close
stops functioning 1-3 days after birth
closes within 2-3 weeks
what causes/is a potential risk factor for PDA
rubella
prematurity
pathophysiology caused by a PDA
aorta pressure > pulmonary vessels
left to right shunt
pulmonary hypertension and right sided heart strain
right ventricular hypertrophy
eventually left ventricular hypertrophy
what type murmur do you get in PDA
on 1st heart sound but may continue into second
continuous crescendo-decrescendo machinery murmur
what are the 3 types of ASD
ostium secondum
patent foramen ovale
osmium primum
what is the most common ASD
ostium secondum
complication of ASD
stroke (when patient has a DVT)
atrial fibrillation/flutter
pulmonary hypertension
eisenmenger syndrome
type of murmur heard in ASD
mid-systolic, crescendo-decrescendo murmur, fixed split second heart sound
Where is murmur heard in ASD
upper left sternal border
what conditions are commonly associated with a VSD
Downs syndrome
turners syndrome
what skin changes will a patient have in Eisenmengers syndrome and why
become cyanotic due to right to left shunt
bone marrow responds to hypoxia - polycythemia
plethoric complexion
what is coarctation of the aorta
narrowing o the aortic arch usually around the ductus arteriosus
what condition is coarctation of the aorta associated with
turners
presentation of someone with coarctation of the aorta
weak femoral pulses
high blood pressure in some limbs, lower in others
murmur heard in coarctation of the aorta and where
systolic
below left clavicle and left scapula
management of coarctation of aorta
prostaglandin E immediately after birth to keep ductus arteriosus open until surgical repair
associations with pulmonary valve stenosis
tetralogy of fallot
William syndrome
Noonan syndrome
congenital rubella syndrome
what are the component of tetralogy of fallot
ventricular septal defect
overriding aorta
pulmonary stenosis
right ventricular hypertrophy
risk factors for tetralogy of fallot
maternal rubella infection
increased maternal age
diabetic mother
alcohol consumption in pregnancy
what is seen on chest X-ray in tetralogy of fallot
boot-shaped heart
what are tet spells
intermittent periods where right to left shunt causing a cyanotic episode
how will an older child stand in a tet spell
squat
what is Ebsteins anomaly
tricuspid valve set lower in right side of the heart
causing a bigger right atrium and small right ventricle
what is ebsteins anomaly associated with
right to left shunt in ASD
Wolf-Parkinson-White syndrome
lithium use
what would the heart sound like in Ebsteins anomaly
gallop rhythm (addition of 3rd and 4th heart sound)
what would the heart sound like in Ebsteins anomaly
gallop rhythm (addition of 3rd and 4th heart sound)
what is transposition of the great arteries
attachments of aorta and pulmonary trunk are swapped
what does immediate survival depend on in transposition of the great arteries
having a shunt e.g. PDA, ASD, VSD
management of transposition of great arteries
prostaglandin infusion to maintain ductus arteriosus
balloon septostomy in foramen ovale to creat large ASD
cardiopulmonary bypass is only definitive treatment
what is bronchiolitis usually caused by
RSV (respiratory syncytial virus)
in what age are you likely to see/consider bronchiolitis
most common under 6 months
consider in under 1 year
consider in ex-premature babies with chronic lung disease under 2
what is the pathophysiology behind bronchiolitis
smallest amount of inflammation and mucus in airway causes air to circulate back to alveoli
presentation of bronchiolitis
coryza symptoms
signs of respiratory distress
dyspnoea, tachypnoea, apnoeas
poor feeding
mild fever <39
what will you hear on auscultation of bronchiolotis
wheeze and crackles on auscultation
what are signs of respiratory distress
raised respiratory rate
use of accessory muscles
intercostal and subcostal recessions
nasal flaring
head bobbing
tracheal tugging
cyanosis
abnormal airway noises
what is the typical course of bronchiolitis infection
coryzal symptoms - half spontaneously get better
chest symptoms 1-2 days after
day 3/4 worst
lasts 7-10 days
recovered within 2-3 weeks
what does bronchiolitis make you more likely to have in childhood
viral induced wheeze
when would you admit someone with bronchiolitis
<3 months
pre-existing condition e.g. prematurity, downs, cf
50-75% less normal milk intake
clinical dehydration
resp rate >70
oxygen sats <92%
moderate to severe respiratory distress
apnoeas
parents not confident in ability to manage
what can be given to high risk babies to prevent from getting RSV
palivizumab
how is viral induced wheeze different to astha
present before 3
no atopic history
only occurs during viral infections
how would you classify moderate asthma
peak flow >50% predicted
normal speech
no features
how would you classify severe asthma
peak flow <50% predicted
saturations <92%
unable to complete sentences in one breath
signs of respiratory distress
resp rate > 40 in 1-5 years old, >30 in >5 years old
heart rate >140 in 1-5 years old, >125 in >5 years old
how would you classify life threatening asthma
peak flow < 33% predicted
saturations <92%
exhaustion and poor respiratory effort
hypotension
silent chest
cyanosis
altered consciousness/confusion
what is the step up order of acute asthma management
salbutamol inhalers
nebulisers with salbutamol/ipratoprium bromide
oral prednisolone (1mg/kg once a day for 3 days)
IV hydrocortisone
IV magnesium sulfate
IV salbutamol
IV aminophylline
what is the step-down of salbutamol
10 puffs 2 hourly
10 puffs 4 hourly
6 puffs 4 hourly
4 puffs 6 hourly
what is the medical management of chronic asthma in a patient under the age of 5
SABA
8 week trial moderate dose ICS
(if fine after stay on SABA
if recurs within 4 weeks, start on ICS
if recurs after 4 weeks repeat trial)
add LRTA
refer to specialist
what is the medical management of chronic asthma in a patient aged 5-12
SABA
low dose ICS
LRTA
medium dose ICS
stop LRTA, start LABA
MART
referral to specialist
what is the medical management of chronic asthma in a patient > 12 years old
(same as adult)
SABA
low dose ICS
LABA
medium dose ICS
oral leukotriene receptor antagonist/oral theophylline/inhaled LAMA (tiotropium)
high dose ICS
combine treatments from step 5, oral salbutamol?
referral to specialist
oral steroids at low dose under guidance
presentation of pneumonia
cough - typically wet or productive
high fever > 38.5
tachypnoea/tachycardia
increased work of breathing
lethargy
delirium
chest signs of pneumonia
bronchial breast sounds
focal coarse crackles
dullness to percuss
bacterial causes of pneumonia
streptococcus pneumonia
group A strep
group B strep
staph aureus
haemophilus influenza
mycoplasma pneumonia
viral causes of pneumonia
RSV
parainfluenza
influenza
treatment for bacterial pneumonia
amoxicillin
+ macrolide to cover atypical (mono therapy if penicillin allergy)
when would you commonly see croup
6 months - 2 years
most common cause of croup
parainfluenza
presentation of croup
increased work of breathing
barking cough
hoarse voice
stridor
low grade fever
management of croup
single dose of 150mcg/kg dexamethasone (can be repeated if required after 12 hours)
if no response = oxygen, nebulised budesonide, nebulised adrenalin, intubation/ventilation
most common cause of epiglottitis
haemophilus influenza type B
presentation of epiglottitis
sore throat and stridor
drooling
tripod position
high fever
difficulty or painful swallowing
muffled voice
what would you see on investigation for epiglottitis
thumb/thumbprint sign on lateral X-ray of the neck
management of epiglottitis
prep for intubation/tracheostomy
ceftriaxone
dexamethasone
complication of epiglottitis
epiglottic abscess
what causes laryngomalacia
aryepiglottic folds are shortened pulling on epiglottis
what shape is seen in laryngomalacia
omega shape
presentation of laryngomalacia
~ 6 months
inspiratory stridor
more prominent when feeding, upset, lying on back or URTI
what causes whooping cough
bordetella pertussis
presentation of whooping cough
mild coryzal symptoms
paroxysmal cough starts after a week
loud inspiratory whoop
may get apnoeas
how do you diagnose whooping cough
nasopharyngeal swap with PCR testing/bacterial culture
if had cough > 2 weeks - anti-pertussis toxin immunoglobulin G
management of whooping cough
notifiable disease
macrolide antibiotics (clarithromycin <1 month, azithromycin or clarithromycin >1 month, erythromycin in pregnant women), co-trimoxazole as alternative
prophylactic antibiotics to close contacts
resolves within 8 weeks, long lasting cough
complication of whooping cough
bronchiectasis
prevention of chronic lung disease of prematurity/bronchopulmonary dysplasia
corticosteroids in mothers showing signs of prematurity
CPAP at birth
caffeine to stimulate respiratory effort
don’t over oxygenate
what causes cystic fibrosis
autosomal recessive condition = gene mutation of cystic fibrosis transmembrane conductance regulatory gene on chromosome 7 (delta-F508) with codes for chloride cellular channels
what are the key consequences in cystic fibrosis
- thick pancreatic and biliary secretions blocking ducts resulting in lack of digestive enzymes e..g pancreatic lipase
- low volume thick airway secretions reducing airway clearance = bacterial colonisation and susceptibility to airway infection
- congenital bilateral absence of the vas deferens
how would cystic fibrosis present
often picked up on newborn blood spot test
Meconium ileus - not passing meconium within 24 hours leading to distention and vomiting
can present later in childhood with recurrent LRTI, failure to thrive or pancreatitis
symptoms of cystic fibrosis
chronic cough
thick sputum production
recurrent respiratory tract infections
steatorrhoea
salty sweat
poor height/weight gain
signs of cystic fibrosis
low weight/height
nasal polyps
finger clubbing
crackles/wheeze on auscultation
abdominal distention
gold standard diagnostic test for cystic fibrosis
sweat test
pilocarpine applied to skin, electrolodes either side, sweat absorbed
diagnosis if chlorine >60
common microbial colonisers in cystic fibrosis and what measures are taken
staph aureus - long term prophylactic flucloxacillin
pseudomonas - long term nebulised antibiotics e.g. tobramycin, oral ciprofloxacin
causes of clubbing in children
hereditary
cyanotic heart disease
IE
CF
TB
IBD
liver cirrhosis
what type of inheritance pattern if primary ciliary ddyskinesia/Kartagner’s syndrome
autosomal recessive
what is primary ciliary dyskinesia/Kartagner’s syndrome
affects motile cilia of cells in body, notably in respiratory = build up of mucus = more likely for infection, affects cilia in Fallopian tubes = reduced or absent fertility
what is Kartagner’s triad
paranasal sinusitis
bronchiectasis
situs inversus (internal organs on other side of body)
how do you diagnose primary ciliary dyskinesia/Kartagners syndrome
sample of ciliated epithelium of upper airway via nasal brushing or bronchoscopy to examine action of the cilia
what are abdominal migraines
central abdominal pain > 1 hour
associated nausea/pallor/headache/photophobia/aura
usually develop traditional migraines when older
how do you treat acute attack of abdominal migraine
low stimulus environment
paracetamol
ibuprofen
sumatriptan
preventative medications of abdominal migraine
pizotifen
propanolol
cyproheptadine
flunarizine (CCB)
what are signs of problematic reflux
chronic cough
hoarse cry
distress after feeding
reluctance to feed
pneumonia
poor weight gain
> 1 year old - heartburn, pain, bloating, nocturnal cough
what is Sandifer’s syndrome
brief episodes of normal movements
torticollis = forceful contraction of neck muscles causing twisting of neck
dystonia = abnormal muscle contractions causing twisting movement, arching of back or unusual postures
what is pyloric stenosis
hypertrophy of the ring of smooth muscle connecting stomach and duodenum causing food to be ejected into oesophagus when stomach peristalsis
presentation of pyloric stenosis
first few weeks of life
hungry, thin and pale baby failing to thrive
projectile vomiting
olive size feeling in abdomen
what would a blood gas show in pyloric stenosis
hypochlorite metabolic alkalosis
how do you diagnose pyloric stenosis
abdominal ultrasound
how do you treat pyloric stenosis
laparoscopic pyloromyotomy - Ramstedt’s operation
what is gastritis
inflammation of stomach presenting with nausea and vomtiing
what is enteritis
inflammation of the intestines presenting with diarrhoea
what is gastroenteritis
inflammation of the stomach all the way to the intestines presenting with nausea, vomiting and diarrhoea
what is the most common cause of gastroenteritis
viral - rotavirus, norovirus
what is the main concern in gastroenteritis
dehydration
how are you likely to get e.coli gastroenteritis
contact with infected faeces, unwashed salads or contaminated water
how are you likely to get campylobacter jejuni
travellers diarrhoea
raw/uncooked poultry, untreated water, unpasteurised milk
incubation period of campylobacter jejuni and when should it resolve by
incubation = 2-5 days
resolve after 3-6 days
what do you give if a person has e.coli gastroenteritis
no antibiotics - increased risk of HUS which is increased in e.coli due to shiga toxin
what would you give if a person had severe campylobacter jejuni
azithromycin or ciprofloxacin
how are you likely to get shigella gastroenteritis
faeces contaminating drinking water, swimming pools and food
what is the incubation period for shigella gastroenteritis and when would it usually resolve by
incubation = 1-2 days
resolve within 1 week
how are you likely to get salmonella gastroenteritis
raw eggs, poultry or food contaminated with infected faeces of small animals
what type of bacteria is bacillus cereus
gram positive rod
how are you likely to get bacillus cereus
inadequately cooked food/food not immediately refrigerated after cooking e.g. fried rice
how are you likely to get yersinia entercolitica gastroenteritis
raw or undercooked pork
antibodies associated with coeliac disease
anti-TTG and anti-EMA
genetic associations with coeliac disease
HLA-DQ2
HLA-DQ8
how would diagnose coeliac disease
stay on gluten containing diet
endoscopy and intestinal biopsy showing crypt hypertrophy and villous atrophy
how would you characterise signs of Crohns
NESTS
no blood or mucus
entire GI tract
skip lesions on endoscopy
terminal ileum most affected/transmural inflammation
smoking is a risk factor
how would you characterise signs of ulcerative colitis
CLOSEUP
continuous inflammation
limited to colon and rectum
only superficial mucosa affected
smoking is protective
excrete blood and mucus
use aminosalicylates
primary sclerosis cholangitis association
medication to induce remission in crohns
steroids = 1st line (oral pred/IV hydrocortisone)
immunosuppressants - azathioprine/methotrexate/infliximab
medication to maintain remission in crohns
1st line = azathioprine/mercaptopurine
alternatives = methotrexate/infiximab
medication to induce remission in ulcerative colitis
1st line = aminosalicylate (mesalazine)
2nd line = corticosteroids
severe = 1st line - IV corticosteroids, 2nd line = IV ciclosporin
medication to maintain remission in ulcerative colitis
aminoosalicylate
azathioprine
mercaptopurine
surgical management of ulcerative colitis
panproctocolectomy - permanent ileostomy or ileoanal anastomosis (J pouch)
what is biliary atresia
section of bile duct narrowed or absent so in cholestasis bile not transported from liver to bowel so excretion of conjugated of bilirubin is prevented
what is the presentation of biliary atresia
presents shortly after birth
jaundice (suspect in >14 days in term babies, >21 days in premature)
management of biliary atresia
Kasai portoenterostomy (attach section of small intestine to opening of liver)
presentation of intestinal obstruction
persistant vomiting - may be bilious
abdominal pain/distention
failure to pass stools/wind
abnormal bowel sounds (high pitched/tinkling in early obstruction, absent later)
what would you expect to see on an abdominal xray in intestinal obstruction
dilated loops of bowels proximal to obstruction
collapsed loops of bowel distal to obstruction
absence of air in the rectum
what is the pathophysiology behind Hirschsprung’s Disease
absence of parasympathetic ganglion cells in distal bowel/rectum
what is it called if the entire colon is affected in Hirschsprung’s disease
total colonic aganglionosis
associations with Hirschsprung’s disease
family history
downs syndrome
neurofibromatosis
Waardenburg syndroom (pale blue eyes, hearing loss, patches of white skin and hair)
multiple endocrine neoplasia type II
presentation of Hirschsprung’s disease
delay in passing meconium
chronic constipation since birth
abdominal pain and distention
vomiting
poor weight gain/failure to thrive
what is Hirschsprung-Associated Enterocolitis
inflammation and obstruction occurring in neonates with Hirschsprungs
presentation of HAEC
2-4 weeks after birth
fever
abdominal distention
bloody diarrhoea
sepsis
complication of HAEC
toxic megacolon and perforation
diagnostic test for HAEC
rectal biopsy showing absence of ganglionic cells
what is intususception
where the bowel invaginate/teloscopes into itself which thickens size of bowel and narrows lumen
when would you likely see intussusception
infants aged 6 months - 2 years
more common in boys
associations with intussusception
concurrent viral illness
Henoch-Schonlein purpura
cystic fibrosis
intestinal polyps
mocked diveritculum
presentation of intussusception
redcurrant jelly stool
mass in RUQ = sausage shaped
severe, colicky abdominal pain
pale, lethargic, unwell
vomiting
intestinal obstruction
peak incidence of appendicitis
10-20 years
signs/symptoms of appendicitis
abdominal pain (starts centrally, moves to RIF)
tenderness in McBurney’s point
loss of appetite
nausea/vomiting
Rovsing’s sign
guarding
what is Rovsings sign
palpation of LIF causes pain in RIF
what 2 signs of appendicitis indicates it is more likely peritonitis
rebound tenderness
percussion tenderness
what may trigger type 1 diabetes
coxsackie B virus and enterovirus
3 characteristic symptoms of a patient presenting with type 1 diabetes
polyuria
polydipsia
weight loss
treatment for severe hypoglycaemia
IV dextrose and IM glucagon
long term macrovascular complications in type 1 diabetes
coronary artery disease
peripheral ischaemia
stroke
hypertension
long term microvascular complications in type 1 diabetes
peripheral neuropathy
retinopathy
glomerulosclerosis
what is adrenal insufficiency
adrenal glands not producing enough steroid hormones e.g. cortisol and aldosterone
what is primary adrenal insufficiency
Addisons - adrenal glands been damaged (autoimmune)
what is secondary adrenal insufficiency
inadequate ACTH
damage to pituitary gland - hypoplasia, surgery, infection, loss of blood flow, radiotherapy
what is tertiary adrenal insufficiency
inadequate CRH release by hypothalamus
can be causes by long term oral steroids (>3 weeks)
features of adrenal insufficiency in babies
lethargy
vomiting
poor feeding
hypoglycaemia
jaundice
failure to thrive
features of adrenal insufficiency in older children
nausea or vomiting
poor weight gain/weight loss
reduced appetite
abdominal pain
muscle weakness or cramps
developmental delay/poor academic performance
bronze hyperpigmentation to skin
why do you get bronze hyperpigmentation to the skin in adrenal insufficiency
ACTH stimulates melanocytes
blood results seen in addisons
low cortisol
low aldosterone
high ACTH
high renin
blood results seen in seocndary adrenal insufficiency
low cortisol
low ACTH
normal aldosterone
normal renin
diagnostic test for adrenal insufficiency
short synacthen test
management of adrenal insufficiency
hydrocortisone
fludocortisone
what would be the presentation of Addisonian crisis/adrenal crisis
reduced consciousness
hypotension
hypoglycaemia, hyponatraemia and hyperkalaemia
what is congenital adrenal hyperplasia
deficiency of 21-hydroxylase enzyme which converts progesterone into aldosterone and cortisol so instead gets converted into testosterone
what is the inheritance pattern of congenital adrenal hyperplasia
autosomal recessive
presentation of severe congenital adrenal hyperplasia
hyponatraemia, hyperkalaemia, hypoglycaemia
in females - virilised/ambiguous genitalia, enlarged clitoris
presentation of females in mild congenital adrenal hyperplasia
tall for their age
facial hair
absent periods
deep voice
early puberty
hyperpigmentation
presentation of males in mild congenital adrenal hyperplasia
tall for their age
deep voice
large penis
small testicles
early puberty
2 causes of growth hormone deficiency
congenital - genetic mutation in GH1 or GHRHR, or empty sella syndrome
acquired - infection, trauma, surgery
what is empty sella syndrome
pituitary gland underdeveloped or damaged
presentation of growth hormone deficiency
micropenis
hypoglycaemia
severe jaundice
poor growth 2/3
short stature
slow development of movement and strength
delayed puberty
investigation to diagnose growth hormone deficiency
growth hormone stimulation test
- measure response to medications that should stimulate release of growth hormone e.g. glucagon, insulin, arginine and clonidine
treatment given in growth hormone deficiency
daily subcutaneous growth hormone - somatropin
what is it called when the thyroid is underdeveloped
dysgenesis
what is it called when the thyroid is fully developed but it doesn’t produce enough hormone
dyshormongenesis
how is congenital hypothyroidism diagnosed
newborn blood spot screening test
presentation of congenital hypothyroidism
prolonged neonatal jaundice
poor feeding
constipation
increased sleeping
reduced activity
slow growth and development
associations with acquired hypothyroidism/hashimotos
antithyroid peroxidase antibodies (anti-TPO)
antithyroglobulin autoantibodies
presentation of acquired hypothyroidism
fatigue/low energy
poor growth
poor weight gain
poor school performance
constipation
dry skin and hair loss
management of hypothyroidism
levothyroxine
when do you do USS’s in UTIs
< 6 months with 1st UTI - do USS within 6 weeks or during if atypical
recurrent - USS within 6 weeks
atypical - USS during
when do you test dimercaptosuccinic acid (DMSA) in UTI
4-6 months after to asses for damage
when do you do vesico-uteric reflux test in UTIs
recurrent/atypical in <6 months
what is vulvovaginitis
inflammation and irritation of the vulva and vagina
when would you often see vulvovaginitis
girls aged 3-10
what can vulvovaginitis be exacerbated by
wet nappies
use of chemicals/soaps
tight clothing
poor hygiene
constipation
threadworms
pressure
highly chlorinated pools
what is the classic triad of nephrotic syndrome
proteinuria
hypoalbuminaemia
oedema
2 main types of nephritic syndrome
post-streptococcal glomerulonephritis
IgA nephorpathy
signs seen in nephritic syndome
haematuria
proteinuria (less than nephrotic)
triad of Haemolytic Uraemia Syndrome
haemolytic anaemia
acute kidney injury
thrombocytopenia
what is enuresis
involuntary urination
what age is nocturnal enuresis typically controlled by
3-4 years
what age is diurnal enuresis typically controlled by
2 years
management of enuresis
desmopression taken at bedtime
oxybutynin
imipramine
inheritance pattern of polycystic kidney disease seen in children
autosomal recessive
pathophysiology of polycystic kidney disease
mutation of PKHD1 on chromosome 6
- codes for fibrocysin/polyductin protein complex
- responsible for creation of tubules and maintenance of healthy epithelial tissue in kidneys, liver and pancreas
features of polycystic kidney disease
cystic enlargement of renal collecting ducts
oligohydramnios, pulmonary hypoplasia and Potters syndrome
what is Potter syndrome
lack of amniotic fluid causing underdeveloped ear cartilage, low set ears, flat nasal bridge and skeletal abnormalities
what is multicystic dysplastic kidney
one kidney made up of many cysts, other normal
cystic one will atrophy and disappear before age of 5
what is Wilms tumour
tumour in kidney affecting children typically under 5
what is a posterior urethral valve
tissue at proximal end of urethra causing obstruction of urine output
what would be seen on an abdominal ultrasound in posterior urethral valve
enlarged, thickened bladder
bilateral hydronephrosis
what is cryptochidism
undescended testes
complications of undescended testes
testicular torsion
infertility
testicular cancer
risk factors for undescended testes
family history
low birth weight
small for gestational age
prematurity
maternal smoking during pregnancy
management of undescended testes
most will descend in 3-6 months
urologist if not by 6 months
orchidopexy between 6-12 months
what is hypospadias
where the urethral meatus is abnormally displaced to the ventral side of the penis towards to scrotum
what is epispadias
where the meatus is displaced to dorsal side
what is a hydrocele
collection of fluid in the tunica vaginalis that surrounds the testes
what happens in a simple hydrocele
common in newborn males
fluid will get reabsorbed over time
what happens in a communicating hydrocele
tunica vaginalis is connected with the peritoneal cavity via the processes vaginalis
hydrocele can fluctuate in size
what would be seen on examination of a hydrocele
soft, smooth, non-tender swelling around one of the testes
transilluminate
what are the 5 components of the APGAR score
appearance
pulse
grimace
activity
respiration
what is the scoring criteria for appearance in APGAR score
0 - blue/pale centrally
1 - blue extremities
2 - pink
what is the scoring criteria for pulse in the APGAR score
0 = absent
1= <100
2 = >100
what is the scoring criteria for grimace in the APGAR score
0 = no response
1 = little response
2 = good response
what is the scoring criteria for activity in the APGAR score
0 = floppy
1 = flexed arms and legs
2 = active
what is the scoring criteria for respiration in the APGAR score
0 = absent
1 = slow/irregular
2 = strong/crying
positives of delayed umbilical cord clamping
improved haemoglobin, iron stores and blood pressure
reduction in intraventricular haemorrhage and necrotising enterocolitis
negative of delayed cord clamping
increase in neonatal jaundice
when should the newborn blood spot test be done
day 5 (8 at latest)
what does the newborn blood spot test screen for
sickle cell disease
cystic fibrosis
phenylketonuria
congenital hypothyroidism
medium chain acyl-coA dehydrogenase deficiency
maple syrup urine disease
isovaleric acidaemia
glutamic acuduria type 1
homocystin
what is Barlows test
baby on back, hips adducted and flexed at 90 degrees and knees bent to 90 degrees
apply gentle downwards pressure on knees through femur to see if femoral head will dislocate posteriorly
what is Ortolani test
baby on back with hip and knees flexed
gentle pressure to abduct hips and apply pressure behind legs to see if hips will dislocate anteriorly
what is Moro reflex
when rapidly tipped backward the arms and legs will extend
what is rooting reflex
tickling the cheek will cause the baby to turn towards the stimulus
what is caput succedaneum
fluid collecting on scalp outside of periosteum
pressure to area of scalp during traumatic, prolonged or instrumental delivery
what is a cephalohaemaotma
collection of blood between the skull and periosteum
lump does not cross suture line
resolves in few months
risk of anemia and jaundice
what is Erbs palsy
injury to C5/C6 nerves in brachial plexus during birth
what is seen in the arm in Erbs palsy
waiter tip appearance
weakness of should abduction, external rotation, arm flexion and finger extension
most communist cause of neonatal sepsis
group b streptococcus
when would you initiate antibiotics in neonatal sepsis
2 or more clinical features or 1 red flag
red flags for neonatal sepsis
confirmed or suspected sepsis in mother
signs of shock
seizures
term baby needing mechanical ventilation
respiratory distress > 4 hours after birth
presumed sepsis in another baby in a multiple pregnancy
what is given in neonatal sepsis
benzylpenicillin and gentamycin
what causes hypoxic-ischaemic encephalopathy
maternal shock
intrapartum haemorrhage
prolapsed cord
nuchal cord
presentation of mild grade HIE
poor feeding, irritable, hyper-alert
resolves within 24 hours
normal prognosis
presentation of moderate grade HIE
poor feeding, lethargic, hypotonic, seizures
can take weeks to resolve
~ half develop cerebral palsy
presentation of severe grade HIE
reduced consciousness, apnoeas, flaccid and reduced/absent reflexes
50% mortality
~90% develop cerebral palsy
what can help treat HIE
therapeutic hypothermia
what is kernicterus
brain damage due to high bilirubin levels
what is seen on a chest X-ray in respiratory distress syndrome
ground glass appearance
risk factors for necrotising entercolitis
low birth weight/premature
formula feeds
respiratory distress and assisted ventilation
sepsis
PDA
presentation of nectrosiing entercolitis
intolerance to feeds
vomiting - green bile
generally unwel
distended, tender abdomen
absent bowel sounds
blood in stools
what would be seen on an abdominal X-ray for diagnosis of necrotising entercolitis
dilated loops of bowel
bowel wall oedema
pneumatosis intestinalis
pneumoperitoneum
gas in portal veins
when would signs and symptoms present in neonatal abstinence syndrome
3-72 hours for opiates, diazepam, SSRIs and alcohol
24 hours - 21 days for methadone and other benzos
CNS symptoms of neonatal abstinence syndrome
irritability
increased tone
high pitched cry
not settling
tremors
seizures
vasomotor and respiratory symptoms of neonatal abstience syndrome
yawning
sweating
unstable temperature
tachypnoea
metabolic and gastrointestinal symptoms of neonatal abstinence syndrome
poor feeding
regurgitation or vomiting
hypoglycaemia
loose stools with small nappy area
what do you give for opiate withdrawal in neonatal abstinence syndrome
oral morphine sulfate
what do you give for non-opiate withdrawal in neontaal abstinence syndrome
oral phenobarbitone
symptoms of fetal alcohol syndrome
microcephaly
thin upper lip
smooth flat philtrum
short palpebral fissure
learning and behavioural disabilities
features of congenital rubella syndrome
congenital cataracts
congenital heart disease
learning disability
hearing loss
risk factors for sudden infant deaths syndrome
prematurity
low birth weight
smoking during pregnancy
male baby
normal course of puberty in girls
development of breast buds, then pubic hair
start periods around2 years after the start of puberty
normal course of puberty in boys
enlargement of testicles, then penis
gradual darkening of the scrotum
development of pubic hair
deepening of the voice
what causes hypergonadotrophic hypogonadism
previous damage to gonads
congenital absence of testes or ovaries
Klinefelters syndrome
turners syndrome
genetics in Klinefelters syndrome
male has additional X chromosome
47 XXY
features of Klinefelter syndrome
taller height
wider hips
gynaecomastia
weaker muscles
small testicles
reduced libido
shyness
subtle learning difficulties
genetics of turners syndrome
female has single X chromosome
features of turners syndrome
short stature
webbed neck
widely spaced nipples
high arching palate
ptosis
cubitus valgus - abnormal feature of elbow
underdeveloped ovaries
late or incomplete puberty
inheritance of Noonan syndrome
autosomal dominant
features of Noonan syndrome
short stature
broad forehead
ptosis
hypertelorism - wide space between eyes
prominent nasolabial folds
inheritance of Marfan syndrome
autosomal dominant
features of Marfan syndrome
tall stature
long neck, limbs, fingers
hyper mobility
pectus carinatum or excavatum
inheritance / genetic of fragile x syndrome
x linked (males always affected, females can vary)
mutation in FMR1
features of fragile x syndrome
delay in speech and language development
long narrow face
large ears and testicles
hypermobility
ADHD, autism
seizures
genetics behind Prader-Willi syndrome
loss of functional gene on proximal arm of chromosome 15 inherited from father
features of Prader-Willi syndrome
constant insatiable hunger
hypotonia
hypogonadism
mild-moderate learning disability
fair, soft skin prone to bruising
almond shaped eyes
genetics behind Angelman syndrome
loss of function of the uBE3A gene, deletion on chromosome 15
key features of angelman syndrome
unusual fascination with water
happy demeanour
widely spaced teeth
genetics behind William Syndrome
deletion of material on one copy of chromosome 7
key features of William syndrome
very sociable
starburst eyes
wide mouth with big smile
associated conditions with William syndrome
supravalvular aortic stenosis
hypercalcaemia
what is cerebral palsy
non-progressive, permanent neurological problems resulting from damage to the brain around the time of birth
antenatal causes of cerebral palsy
maternal infections
trauma during pregnancy
perinatal causes of cerebral palsy
birth asphyxia
preterm birth
post natal causes of cerebral palsy
meningitis
severe neonatal jaundice
head injury
4 types of cerebral palsy
spastic
dyskinetic
ataxic
mixed
what happens in spastic cerebral palsy
hypertonia and reduced function due to damage to UPN ( can be monoplegia, hemiplegia, diplegia and quadriplegia)
what happens in dyskinetic cerebral palsy
hyper and hypo Tonia, athetoid movements and oro-motor problems
damage to basal ganglia
what happens in ataxic cerebral palsy
problems with coordinated movement due to damage to cerebellum
what is a concomitant squint
differences in control of extra ocular muscles
what is a paralytic squint
paralysis in one or more of extra ocular muscles
what is esotropia
inward positioned squint
what is exotropia
outward positioned squint
most common cause of hydrocephalus
aqeductal stenosis
presentation of hydrocephalus
increased occipito-frontal circumference
bulging anterior fontanelle
poor feeding and vomiting
poor tone
sleepiness
treatment for hydrocephalus
ventriculoperitoneal shunt
what is craniosynostosis
where the skulls sutures close permanently leading to raised ICP
inheritance of Duchennes muscular dystrophy
x linked recessive
what is Gower’s sign
specific technique to stand up from lying down with proximal muscle weakness
hands and knees, push hips upwards and backwards, shift weight backwards, bring hands to knees, walk hands up body
inheritance of spinal muscle atrophy
autosomal recessive
what does spinal muscle atrophy affect
lower motor neurons
1st line for depression in children
fluoxetine
2nd line for depression in children
sertraline or citalopram
1st line for anxiety in children
sertraline
medications for ADHD
central nervous system stimulants
methylphenidate, dexamfetamine, atomoxetine
what is Russell’s sign
calluses on the knuckles, seen in bulimia
what electrolyte results would you see in referring syndrome
hypomagnesaemia
hypokalaemia
hypophopsphataemia
what is copropraxia
type of complex tic
obscene gestures
what is coprolalia
type of complex tic
obscene words
when would physiologic anaemia of infancy present
6-9 weeks
when would physiologic anaemia of infancy present
6-9 weeks
inheritance/genetics of sickle cell disease
autosomal recessive
abnormal gene for beta-globin on chromosome 11
general management of sickle cell disease
penicillin as antibiotic prophylaxis
hydroxycarbamide (stimulates fetal haemoglobin production)
what happens in a vaso-occulsive sickle cell crisis
cells clog capillaries and cause distal ischaemia
dehydration and raised haematocrit
what happens in a splenic sequestration sickle cell crisis
cells block blood flow within spleen
what happens in an aplastic sickle cell crisis
temporary loss of creation of new blood cells
triggered by parvovirus B19
inheritance of thalassaemia
autosomal recessive
chromosome affected in alpha thalassaemia
16
chromosome affected in beta thalassaemia
11
inheritance of hereditary spherocytosis
autosomal dominant
inheritance of G6PD deficiency
x linked recessive
what can G6PD deficiency be triggered by
fava beans
what is the presentation of G6PD deficiency
neonatal jaundice
Heinz bodies seen on blood film
how do you confirm diagnosis of anaphylaxis
measure serum mast cell tryptase within 6 hours of event
what is Digeorge syndrome
CATCH 22
congenital heart disease
abnormal facial appearance
thymus gland incompletely developed
cleft palate
hypoparathyroidism
22nd chromosome affected
inactivated vaccinations
polio
flu
hep a
rabies
subunit and conjugate vaccinations
pneumococcus
meningococcus
hep b
pertussis
hib
hpv
shingles
live attenuated vaccinations
MMR
BCG
chickenpox
nasal influenza
rotavirus
what vaccinations are given at 8 weeks
6 in 1
meningococcal type B
rota virus
what vaccinations are given at 12 weeks
6 in 1
pneumococcal
rotavirus
what vaccinations are given at 16 weeks
6 in 1
meningococcal type B
what vaccinations are given at 1 year
2 in 1
pneumococcal
MMR
meningococcal type B
what vaccination is given yearly between years 2 and 8
influenza nasal vaccine
what vaccinations are given at 3 years 4 months
4 in 1
MMR
what vaccination is given aged 12-13
HPV (2 doses 6-24 months apart)
what vaccinations are given aged 14 years
3 in 1
meningococcal groups A, C, W, Y
what vaccinations are in the 6 in 1
diptheria
tetanus
pertussis
polio
Hib
hep B
what vaccinations are in the 2 in 1
hib
meningococcal type c
what vaccinations are in the 4 in 1
diphtheria
tetanus
pertussis
polio
what vaccinations are in the 3 in 1
diptheria
tetanus
polio
most common cause of meningitis in > 3 months
neisseria meningitidis
most common cause of meningitis in neonates
group b strep
treating meningitis in < 3 months
cefotaxime plus amoxicillin
treating meningitis in > 3 months
ceftriaxone
what is added to meningitis treatment if risk of penicillin resistant pneumococcal infection
vancomycin
most common cause of encephalitis
HSV (type 1 in children, 2 in neonates)
contraindications for LP
GCS <9
Haemodynamically unstable
active seizures or post ictal
treatment for encephalitis
acyclovir
treatment for encephalitis if caused by CMV
ganiclovir
testing for infectious mononucleosis/glandular fever
heterophiles antibodies (takes 6 weeks to be produced)
monospot test - react to RBCs from horses
Paul-Bunnel- from sheep
incubation period of mumps
14-25 days
what HIV level indicates having a normal vaginal delivery is best
<50
what HIV level indicates the need to consider a c-section
5-400
what HIV indicates the need for a C-section
> 400
what is given in c-section if the viral load of HIV is unknown/>10000
IV zidovudine
what does HBsAg mean in Hep B
active infection
what does HBeAg mean in Hep B
marker of viral replication, implies high infectivity
what does HBcAB mean in Hep B
past or current infection
what does HBsAb mean in Hep B
implies vaccination or past/current infection
what does HBV DNA mean in Hep B
direct count of viral load
most common cause of tonsilitis
group A strep (pyogenes)
treatment for tonsilitis
phenoxymethylpenicillin, clarithromycin if true penicillin allergy
centor criteria for tonsilitis
fever >38
tonsillar exudates
absence of cough
tender anterior cervical lymph nodes
feverPain score for tonsilitis
fever
purulence
attended within 3 days
inflammed tonsils
no cough or coryza
what is trismus
unable to open mouth
what type of voice do you get in a quinsy/peritonsillar abscess
hot potato voice
indications for tonsillectomy
7 or more in 1 year
5 per year in 2 year
3 per year in 3 years
recurrent abscesses > 2 episodes
enlarged tonsils causing difficulty breathing
most common cause of otitis media
strep pneumoniae
management of otitis media
amoxillin for 5 days
what is glue ear
otitis media with effusion
what would you see on glue ear
dull tympanic membrane with air bubbles
management of glue ear
grommets
congenital causes of hearing loss
maternal rubella or CMV
genetic deafness
associated syndrome e.g Down syndrome
perinatal causes of hearing loss
hypoxia during or after birth
prematurity
causes of hearing loss after birth
jaundice
meningitis/encephaltiis
otitis media/glue ear
chemotherapy
where do nosebleeds originate from
Kiesselbach’s plexus/Littles area
how do you treat tongue tie
frenotomy
what is a cystic hygroma and where would you see it
cyst filled with lymphatic fluid typically located in posterior triangle of neck on left hand side
what causes of thyroglossal cyst
thyroglossal duct persists
key differential of a thyroglossal cysts
ectopic thyroid tissue
how would you tell it is a thyroglossal cyst
moves with movement of tongue
what is a branchial cyst
round, soft, cystic swelling between angle of the jaw and sternocleidomastoid in anterior triangle
common causes of hip pain aged 0-4
septic arthritis
developmental dysplasia of the hip
transient synovitis
common causes of hip pain aged 5-10
septic arthritis
transient synovitis
perthes disease
common causes of hip pain aged 10-16
septic arthritis
slipped upper femoral epiphysis
JIA
types of growth plate fractures
SALTR
straight across
above
below
through
crush
what is the most common cause of septic arthritis
staphylococcus aureus
(neisseria gonnorhoea in sexually active teenagers)
most common cause of hip pain aged 3-10
transient synovitis following recent viral URTI
what is Perthes disease
disruption of blood flow to the femoral head causing avascular necorisis
who’s most commonly affected by Perthes disease
boys 5-8
what causes Perthes disease
minor trauma - slipped upper femoral epiphysis
how do you manage Perthes disease
keep hip in external rotation
most common cause of osteomyelitis
staphylococcus aureus
gold standard investigation for osteomyelitis
MRI
what would you see on an X-ray in osteosarcoma
fluffy appearance
sunburst appearance
what are the 2 types of talipes
equinovarus
calcaneolvalgus
what would you get in equinovarus talipes
plantar flexion an supination
what would you get in calcaneolvalgus talipes
dorsiflexion and pronation
how do you treat talipes
Ponseti method
best investigation for developmental dysplasia of the hip
ultrasound
what is the management of developmental dysplasia of the hip
Pavlik harness < 6 months
what is achondroplasia
disproportionate short stature
what is the inheritance pattern of achondroplasia
autosomal dominant
what is the genetic abnormality in achondroplasia
FGFR3 on chromosome 4
what is Osgood-Schlatters disease
inflammation at the tibial tuberosity where the patella ligament inserts
what is osteogenesis imperfecta
brittle bones prone to fracture due to malformation of collagen
presentation of osteogenesis imperfecta
hyper mobility
blue/grey sclera
when would you diagnose JIA
> 6 weeks in <16 year old
what are the 5 types of JIA
systemic JIA/Stills disease
polyarticular
oligoarticular
enthesitis
juvenile psoriatic arthritis
characteristic sign of systemic JIA/stills disease
subtle salmon pink rash
complication of Systemic JIA/Stills
macrophage activation syndrome
low ESR, acutely unwell, DIC
what is polyarticular JIA
5 or more joints
what is oligoarticular JIA
4 or less joints
girls < 6
what is enthesitis related arthritis
males > 6
HLA-B27
scoring system for Ehlers Danlos Syndrome
beighton score - one score for each side of the body
palms flat on floor with straight legs
elbows hyperextend
knees hyperextend
thumb can bend to touch forearm
little finger hyperextends > 90 degrees
what is POTS
postural othrostatic tachycardia syndrome
result of autonomic dysfunction
what is Henoch-Schonlein purpura
Upper airway infection or gastroenteritis triggers an IgA vasculitis
classic 4 features of HSP
purpura
joint pain
abdominal pain
renal involvement (–> nephrotic syndrome)
what is Kawasaki disease
systemic medium sized vessel vasculitis
who does Kawasaki disease more commonly affect
< 5 years
more common in Asian children
more common in boys
presentation of Kawasaki disease
persistant high fever > 5 days
widespread erythematous maculopapular rash and desquamation
strawberry tongue
cracked lips
bilateral conjunctivitis
cervical lymphadenopathy
complication of Kawasaki disease
coronary artery aneurysms
management of Kawasaki disease
high dose aspirin
IvIgG
what causes rheumatic fever
group a beta-haemolytic strep - pyogenes (from tonsilitis)
investigation for rheumatic fever
ASO antibody
diagnosis criteria for rheumatic fever
Jones criteria ‘‘JONES-FEAR”
Major criteria for rheumatic fever
JONES
joint arthritis
organ inflammation
nodules
erythema marginatum rash
sydenham chorea
minor criteria for rheumatic fever
FEAR
fever
ECG changes - prolonged PR - without carditis
Arthralgia without arthritis
raised inflammatory markers
steroid ladder for eczema
hydrocortisone
clobetasone
betamethasone
clobetasol
common bacterial infection cause in eczema and treatment
staphylococcus aureus
flucloxacillin
most common type of psoriasis in children
guttate
small raised papules over trunk and limbs
triggered by strep infection, stress or medications
what is Auspitz sign
small points of bleeding when plaques are scraped off in psoriasis
what is Koebner phenomenon
development of psoriatic lesions to area of skin affected by trauma
management of psoriasis
topical steroids
calcipotriol
dithranol
phototherapy with narrow band ultraviolet b light
what is a macule
flat marks
what is a papule
small lumps
what is a pustule
small lumps with yellow pus
what are comedomes
skin coloured papule representing blocked pulosebaceous units
what are black heads
comedones with black pigmentation in centre
what are ice pick scars
indentations in skin remaining after acne lesions heal
what are hypertrophic scars
small lumps in the skin remaining after acne lesions heal
what are rolling scars
irregular wave-like irregularities of the skin that remain after acne lesions heal
management of acne
topical benzoyl peroxide
topical retinoids
topical antibiotics
oral antibiotics
oral contraceptive pill
what are the 6 red rashes for viral exanthemas
measles
scarlet fever
rubella
dukes disease
parvovirus b19
roseola infantum
what causes scarlet fever
group A strep infection
characteristic signs for scarlet fever
strawberry tongue
sandpaper skin
red-pink blotchy macular rash
how do you treat scarlet fever
phenoxymethylpenicilin
characteristic sign of parvovirus b19
slapped cheek syndrome
what causes roseola infantum
HHV-6
key sign in erythema multiforme
target lesions
what causes hand foot and mouth disease
coxsackie A virus
what causes pityriasis rosea
HHV 6/7
characteristic sign in pityriasis rosea
herald patch
what is the fungus called that causes ringworm
trichophyton
where the types of ringworm affect - tines capitis
scalp
where the types of ringworm affect - tinea pedis
affects feet
where the types of ringworm affect - tinea cruris
groin
where the types of ringworm affect - tines corporis
body
what is onchomycosis
fungal nail infection caused by ringworm
classic location of scabies
between finger webs
what is panniculitis
inflammation of the subcutaneous fat on shins seen in erythema nodosum
what causes impetigo
staphylococcus auerus
appearance of impetigo rash
golden crust appearance
what is Nikolsky sign
in bullous impetigo - staphylococcus scaled skin syndorome - gentle rubbing of skin causes it to peel away
appropriate test to confirm pyloric stenosis diagnosis
test feed
managing cows milk protein intolerance for formula fed baby
trial of extensively hydrolysed formula
investigation of choice for intussuception
abdominal ultrasound
what would you see on abdominal ultrasound in intussusception
bull’s eye sign
what does bowel sounds in a respiratory exam indicate
diaphragmatic hernia
what do you need to monitor in methylpredinate
growth every 6 months
when would you likely see benign rolandic epilepsy
aged 4-12
what is benign rolandic epilepsy
seizures commonly occurring at night
partial seizure - can progress to secondary generalised
child is well
what would an ECG show in benign rolandic epilepsy
centro-temporal spikes
what is the genetic abnormality in Patau syndrome
trisomy 13
key features of Patau syndrome
polydactyly
cleft palate and lips
microcephaly
how do you differentiate between infantile spasms and spasms due to colic
will be distressed between between spasms in infantile spasms, in colic will be distressed during spasm
investigation in infantile spasm
ECG - hyperarrythmias seen in West syndrome
what would you hear in venous hums and where
continuous blowing murmur heard under clavicles
what would you hear in stills murmur and where
low pitched sound heard at lower left sternal border
most common complication of measles
otitis media
complication of fragile X syndrome
mitral valve prolapse
what is chondromalacia patellae
softening of the cartilage of the patella
what group would you likely see chondromalacia patellae
teenage girls
characteristic sign of chondromalacia patellae
anterior knee pain walking up and down stairs and when rising from sitting
what is characteristic of osteochondritis dissecans
swelling and locking
what are newborns offered if their hearing exam is abnormal
auditory brainstem response test
how do you treat mycoplasma pneumoniae
erythromycin
what is given to promote ductus arteriosus closure
ibuprofen or indomethacin
cause of painless massive GI bleed in 1-2 years
Meckel diverticulum
management of necrotising enterocolitis
laparotomy
management for intussecption
pneumatic reduction under fluoroscopic guidance
why don’t you give NSAIDs in chicken pox
increases risk of necrotising fasciitis
most common cardiac pathology associated with Duchennes
dilated cardiomyopathy
common complication of roseola infantum
febrile convulsions
management for intestinal malrotation
Ladd’s procedure
investigation of choice for stable Meckel diverticulum
technetium scan
what would a chest X-ray show in transient tachypnoea of a newborn
hyperinflation of lungs and fluid in the horizontal fissures
what happens when taking amoxicillin for glandular fever
maculopapular pruritic rash develops
when can a child with scarlet fever return to school
24 hours after starting antibiotics
when can a child with measles return to school
4 days after onset of rash
when can a child with whooping cough return to school
48 hours after starting antibiotics
when can a child with rubella return to school
5 days after onset of rash
where should the pulse be checked in infant bLS
brachial and femoral
triad of shaken baby syndrome
retinal haemorrhages
subdural haematoma
brain swelling
adrenaline dose for anaphylaxis
< 6 = 50
6-12 = 300
12+ = 500
what is a naevus flammeus
port wine stain
present from birth and grows with the child
what are the contraindications for waiting to prescribe antibiotics for acute otitis media
AOM in hearing ear
cochlear implant
bilateral AOM <2 years old
ruptured tympanic membrane
what is the name of the surgical procedure used to treat hirschsprung’s
Swenson
what is the name of the surgical procedure used to treat Meckel divetituclum if symptomatic
wedge excision
what is the most commonest cause of a convergent squint
hypermetropia
when would you roughly count someone as having severe DKA/10% dehydration
ph < 7.1
most common cause of death in measles
pneumonia
what can you give if mild bleeding in ITP
tranexamic acid
what do you give a child <3 months for a UTI
cefuroxime
what do you give an unwell child >3 months for pyelonephritis
cefuroxime
what do you give a well child > 3 months for pyelonephritis
cefalexin or co-amox
what do you give an unwell child >3 months for UTI
cefuroxime
what do you give a well child >3 months for UTI
trimethoprim
fluids given to a 0-1 day old
50-60ml/kg
fluids given to a 2 day old
70-80ml/kg
fluids given to a 3 day old
80-100ml/kg
fluids given to a 4 day old
100-120ml/kg
fluids given to a 5-28 day old
120-150ml/kg
Second line medication for ADHD
lisdexamfetamine
common ECG finding at a paediatric cardiac arrest
asystole
most common dysarthrythmia in paeds
supra ventricular tachycardia
common cause of late onset neonatal sepsis
staph aureus
what differentiates IgA nephropathy from post-strep glomerulonpehritis
IgA few days after infection, post-strep is few weeks
what is Prehns sign
in testicular torsion, elevation doesn’t relieve pain
triad for ADHD
inattention
hyperactivity
impulsivity
when is a macrolide no longer indicated for whooping cough
when child has had cough >21 days
difference between periorbital and orbital cellulitis
orbital is a life threatening event
pain on movement, vision changes and proptosis
when would you give 40mmol/L KCL until in dka
until glucose levels are <14
medication for infantile spasms
prednisolone
vigabatrin
inheritance of Kallmans
autosomal recessive
what is raised in CAH
17a-hydroxyprogesterone
poor prognostic factors in ALL
being male
<2 or >10
WBC >20x10^9 on diagnosis
T or B cell surface markers
non-Caucasian
