Paeds Flashcards
1
Q
How do you manage croup?
A
Single dose dexamethasone
2
Q
How do you manage croup if severe?
A
Oxygen and nebulised adrenaline
3
Q
How do you manage asthma in those under 5?
A
- SABA
- Low does corticosteroids
- Leukotriene antagonist (Montelukast)
- Refer
4
Q
How do you manage asthma in those 5-12 years?
A
- SABA
- Low dose corticosteroids
- LABA (salmeterol)
- Increase corticosteroid & consider montelukast or theophylline
- High dose corticosteroid
5
Q
How do you manage asthma in those over 12 years?
A
- SABA
- Low dose corticosteroids
- LABA (salmeterol)
- Increase corticosteroid & consider montelukast or theophylline or LAMA (tiotropium)\
- High dose corticosteroid
6
Q
What are the indications of a life-threatening asthma attack?
A
Peak flow < 33% predicted, hypotension, exhaustion and poor respiratory effort, cyanosis, altered consciousness or silent chest
7
Q
What are the indications of a severe asthma attack?
A
Peak flow < 50% predicted, sats <92%, respiratory distress, unable to complete sentences in one breath,RR >40 in 1-5 yrs or >30 >5yrs, HR >140 in 1-5 yrs or > 125 in > 5 yrs.
8
Q
What are the steps in the acute management of a severe asthma attack?
A
- Nebulised salbutamol (&ipratropium bromide)
- Oral prednisone
- IV hydrocortisone
- IV magnesium sulphate
- IV salbutamol
- IV aminophylline
9
Q
What is the investigation of choice for intussusception?
A
Abdominal US
10
Q
What causes hand, foot and mouth?
A
Coxsackie A16
11
Q
What are the features of hand, foot and mouth?
A
Mild systemic upset (sore throat and fever), oral ulcers followed by vesicles on the palms and soles
12
Q
What are the signs of vitamin D deficiency in children?
A
Poor growth, delayed teeth, swollen wrists and frontal bossing
13
Q
What blood results are found in a child with rickets?
A
Low calcium, low phosphate, high ALP and high PTH
14
Q
What is the treatment for bacterial meningitis in babies < 3 months?
A
IV cefotaxime and IV amoxicillin
15
Q
What is the treatment for bacterial meningitis in children > 3 months?
A
IV cefotaxime (or ceftriaxone)
16
Q
What are the features of Patau syndrome? - trisomy 13
A
Microcephaly, small eyes, cleft lip/palate, polydactyly, scalp lesion
17
Q
What are the features of Edward’s syndrome? - trisomy 18
A
Micrognathia, Low-set ears, Rocker bottom feet, Overlapping of fingers
18
Q
What are the features of Fragile X syndrome?
A
Learning difficulties, Macrocephaly, Long face, Large ears, Macro-orchidism
19
Q
What are the features of Noonan syndrome?
A
Webbed neck, Pectus excavatum, Short stature, Pulmonary stenosis
20
Q
What are the features of William’s syndrome?
A
Short stature, Learning difficulties, elfin facies, Friendly, extrovert personality, Transient neonatal hypercalcemia, supravalvular aortic stenosis
21
Q
What congenital heart condition is associated with Down syndrome?
A
Atrioventricular septal defect
21
Q
What congenital heart conditions are most commonly associated with Down syndrome?
A
Endocardial cushion defect (AVSD)
Ventricular septal defect
22
Q
What are the features of Down syndrome?
A
Hypotonia, Brachycephaly, Short neck, Short stature, Flattened face and nose, Prominent epicanthic folds, Single palmar crease, learning disability
23
Q
What are the features on the combined test that indicate Down syndrome?
A
Nuchal translucency >6mm, increased beta-HCG and low PAPPA
24
What are the red high-risk signs in a sick child?
Mottled/ashen/blue skin, reduced skin turgor, grunting, tachypnoea >60, moderate recessions, non-blanching rash, bulging fontanelle, age <3 months & temp 38℃
25
What is a venous hum?
Is a benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles
26
What are the features of measles?
Prodromal phase: Fever, conjunctivitis, irritable
Koplik spots
Rash - maculopapular rash starts behind ear then whole body
27
What is the most common complication of measles?
Otitis media
28
What are the features of chickenpox?
Fever initially
Itchy rash starting on head/trunk - initially maculopapular then vesicular
Mild systemic upset
29
What are the features of mumps?
Fever, malaise, muscular pain
Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral
30
What are the features of rubella?
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
31
What causes erythema infectiosum?
Parvovirus B19
32
What are the features of erythema infectiosum?
Also known as fifth disease or 'slapped-cheek syndrome'
Lethargy, fever, headache
'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
33
What are the features of scarlet fever?
Fever, malaise, tonsillitis
'Strawberry' tongue
Sandpaper rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
34
What causes scarlet fever?
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
35
How do you treat scarlet fever?
Phenoxymethylpenicillin (penicillin V) for 10 days
36
What causes roseola infantum?
Human Herpes virus 6 (also known as sixth disease)
37
What are the features of roseola infantum?
High-grade fever which resolves before onset of rash. Febrile seizures. Starts on the trunk before spreading to the limbs, maculopapular rash and not itchy.
38
What causes whooping cough?
Pertussis bordetella
39
How do you test for whooping cough?
Nasal swab for Pertussis bordetella
40
When should whooping cough be considered?
Acute cough >2 weeks and has one or more of the following features:
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
41
How should whooping cough be managed?
Notifiable disease
School exclusion: 48 hours after commencing antibiotics
Oral macrolide (e.g. clarithromycin or azithromycin)
Household contacts antibiotic prophylaxis
Infants < 6months admitted
42
What are the notifiable diseases?
Scarlet fever, Rubella, Measles
43
What are the features of Necrotising enterocolitis?
Vomiting, diarrhoea, feeding intolerance, abdominal distension, hematochezia and abdominal discolourartion
44
What investigations should be used for Necrotising enterocolitis and what will they show?
Abdominal x-ray - dilated bowel loops, bowel wall oedema, pneumatosis intestinalis, portal vein gas, pneumoperitoneum, Rigler sign (air in & out of bowel)
45
What are the four features that makeup Tetralogy of Fallot?
1. Ventricular septal defect
2. Right ventricular hypertrophy
3. Pulmonary stenosis
4. Overriding aorta
46
What is the clinical presentation of Tetralogy of Fallot?
Tet spells (cyanotic, tachypnoea, loss of consciousness in first month of life), ejection systolic murmur at left sternal edge, boot-shaped heart on x-ray, low birth weight and poor feeding
47
What are the clinical features of Transposition of the great arteries?
cyanosis, tachypnoea, loud single S2, prominent right ventricular impulse on palpation, 'egg-on-side' appearance on chest x-ray
48
What is Ebstein's anomaly?
Low insertion of the tricuspid valve resulting in a large atrium and small ventricle
49
What are the feature of coarctation of the aorta?
Radio-femoral delay
Mid systolic murmur, maximal over back
Heart failure
50
What are the features of Ebstein's anomaly?
Cyanosis, hepatomegaly, tricuspid regurgitation
Prominent 'a' wave in the distended jugular venous pulse
Pansystolic murmur, worse on inspiration
Right bundle branch block → widely split S1 and S2
51
What causes Ebstein's anomaly and what other heart condition is associated with Ebstein's?
Exposure to lithium in-utero
Patent foramen ovale (PFO) or atrial septal defect (ASD) and WPW
52
What murmur is associated with an atrial septal defect?
Ejection systolic murmur, fixed splitting of S2
53
What murmur is associated with a ventricular septal defect?
Pan-systolic murmur
54
How do you treat a patent ductus arteriosus?
Indomethacin or ibuprofen (inhibits prostaglandin synthesis)
55
What are the features associated with PDA?
Left subclavicular thrill, continuous 'machinery' murmur
Large volume, bounding, collapsing pulse
Wide pulse pressure and heaving apex beat
56
Why should aspirin not be given to children?
Reye syndrome
57
What are the components of the APGAR score?
Pulse, respiratory effort, colour, muscle tone and reflex irritability.
58
If a newborn has an abnormal hearing screen, what should be done next?
Auditory brainstem response test
59
What is the most common cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency
60
What result does congenital adrenal hyperplasia have on hormone levels?
Low cortisol and aldosterone
High ACTH and high testosterone
61
How might congenital adrenal hyperplasia present?
Severe - Ambiguous genitalia, salt wasting (vomiting, dehydration and hypotension), hyponatraemia, hyperkalaemia and hypoglycaemia.
Mild - early puberty
62
What is Reye syndrome and what causes it?
Linked to aspirin use and is characterised by encephalopathy and liver damage
63
What are the two most common causes of nephritis in children?
IgA nephropathy and post-streptococcal glomerulonephritis
64
What are the differences between IgA nephropathy and post-streptococcal glomerulonephritis?
post-streptococcal nephritis associated with low complement levels
main symptom in post-streptococcal glomerulonephritis is proteinuria (although haematuria can occur)
there is typically an interval between URTI & onset of renal problems in post-streptococcal nephritis
65
What are the 4 features of Henoch-Schonlein purpura?
1. Purpura (palpable)
2. Arthritis/arthralgia (knees and ankles)
3. IgA nephritis (haematuria &/or proteinuria)
4. GI involvement (abdo pain)
66
What causes Henoch-Schonlein purpura?
Often triggered URTI (IgA vasculitis)
67
What is the cause of post-streptococcal glomerulonephritis?
Occurs 1 – 3 weeks post-β-haemolytic streptococcus infection eg. tonsillitis or impetigo
68
What are the features of post-streptococcal glomerulonephritis?
Haematuria, oligouria, cola coloured urine, peripheral or periorbital oedema
69
What are the features of intussusception?
Paroxysmal abdominal colic pain, the infant will draw their knees up & turn pale
Vomiting
Bloodstained stool - 'red-currant jelly' - is a late sign
Sausage-shaped mass in the right upper quadrant
70
What investigation should be done for intussusception and what may they show?
USS - target sign
71
What is the management of intussusception?
Pneumatic (air) reduction under fluoroscopic guidance
72
How do you treat biliary atresia?
Kasai procedure
73
What are the main types of cerebral palsy?
Spastic - damage UMN
Dyskinetic (Athetoid) - damage to basal ganglia
Ataxic - damage to cerebellum
74
What are infantile spasms and how may it present on EEG?
Generalised myoclonic jerks occur in clusters 10-100 usually when the child is waking. Poor prognosis.
Hypsarrhythmia
75
What are the features of Juvenile myoclonic epilepsy?
Onset in the teenage years F>M
Infrequent generalized seizures, often in morning//following sleep deprivation
Daytime absences
Sudden, shock-like myoclonic seizures (like jerks)
76
What are the features of Lennox-Gastaut syndrome?
onset 1-5 yrs
features: tonic-clonic seizures, atypical absences, falls, jerks
90% moderate-severe mental handicap
EEG: slow spike
77
What is Benign Rolandic epilepsy and how do they appear on EEG?
Focal seizures affecting the head and hand.
5 -12 yr olds, usually during sleep, treatment not required as usually outgrown.
Centrotemporal spikes on EEG
78
What changes are seen on microscopy in minimal change disease?
None except for in electron microscopy - effacement of podocyte foot processes
79
How do you treat minimal change disease?
Corticosteroids
80
What imaging should be used for suspected developmental dysplasia of the hip?
USS unless > 4.5 months then x-ray
81
What imaging should be used for suspected developmental dysplasia of the hip?
USS unless > 4.5 months then x-ray
82
What treatment should be used for developmental dysplasia of the hip?
Pavlik harness in children younger than 4-5 months
83
How does Duchenne muscular dystrophy present?
progressive proximal muscle weakness from 5 years
calf pseudohypertrophy
Gower's sign: child uses arms to stand up from a squatted position
30% of patients have intellectual impairment
84
What causes Duchenne muscular dystrophy?
X-linked recessive condition
85
What investigations can diagnose Duchenne muscular dystrophy?
Raised creatine kinase
Genetic testing to confirm the diagnosis
86
What are the features of transient synovitis?
Recent viral infection
Limp/refusal to weight bear
Groin or hip pain
Low-grade fever may be present
87
What is Perthes disease?
Idiopathic avascular necrosis of the bone.
Linked to repeated minor trauma to bone.
88
What are the features of Perthes disease?
Pain in the hip or groin
Gradual limp
Restricted hip movements & stiffness
Referred pain to the knee
89
What investigations should be done in suspected Perthes disease?
X-ray
If normal then MRI
90
How should you manage Perthes disease?
Conservative - rest, crutches, monitoring
If > 6 yrs → surgery
91
What is slipped capital upper epiphysis?
Femoral neck moves away from head
92
What are the features of slipped capital upper epiphysis?
Hip, groin, thigh or knee pain
Restricted range of hip movement (internal rotation and abduction)
Painful limp - worse on movement
Restricted movement in the hip
History of minor trauma or growth spurt
93
How do you diagnose slipped capital upper epiphysis?
X-ray in AP and lateral (typically frog-leg) view
94
How do you manage slipped capital upper epiphysis?
Internal fixation: typically a single cannulated screw placed in the centre of the epiphysis
95
What is Osgood-Schlatter disease?
Inflammation at the tibial tuberosity where the patella ligament inserts. Stress from running, jumping and other movements
96
What are the features of Osgood-Schlatter disease?
Visible or palpable hard & tender lump at the tibial tuberosity
Pain in the anterior aspect of the knee
Pain worse with physical activity, kneeling & on extension of knee
97
How do you manage Osgood-Schlatter disease?
Supportive - rest and NSAIDs
98
Which blood test should be done to investigate JIA?
Antinuclear antibody (ANCA) but may be negative
99
What are the features/differences between oligoarticular and polyarticular JIA?
Oligoarticular - < 5 joints, medium & large joints, asymmetrical
Polyarticular - ≥ 5 joins, symmetrical
100
What are the features of systemic onset juvenile idiopathic arthritis?
Pyrexia, Salmon-pink rash, Lymphadenopathy, Arthritis, Uveitis, Anorexia and weight loss
101
What vaccines should be given at 2 months?
'6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B
102
What vaccines should be given at 3 months?
'6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
PCV
103
What vaccines should be given at 4 months?
'6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Men B
104
What vaccines should be given at 12 months?
Hib/Men C
MMR
PCV
Men B
105
What vaccines should be given at 3-4 years?
'4-in-1 pre-school booster' (diphtheria, tetanus, whooping cough and polio)
MMR
106
How should intestinal malrotation be treated?
Ladd's procedure (includes division of Ladd bands and widening of the base of the mesentery)
107
What are the features of Osgood-Schlatter disease?
Visible or palpable hard & tender lump at the tibial tuberosity
Pain in the anterior aspect of the knee
Pain worse with physical activity, kneeling & on extension of knee
108
What is Hirschsprung’s disease?
A congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum. - absence peristalsis
109
What are the features of Hirschsprung's disease?
Delay in passing meconium (more than 24 hours)
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive
110
How do you treat Hirschsprung's disease?
Initially: rectal washouts/bowel irrigation
Definitive management: surgery Swenson procedure
111
How do you diagnose Hirschsprung's disease?
Abdominal x-ray
Rectal biopsy: gold standard for diagnosis
112
How do you treat Juvenile myoclonic epilepsy?
Sodium valproate
113
What is Ebstein's anomaly?
Congenital heart condition - tricuspid valve is set lower in R side of heart (towards the apex) → bigger R atrium & smaller R ventricle.
114
What are the features of Ebstein's anomaly?
Gallop rhythm - tricuspid regurgitation (pan-systolic murmur) and tricuspid stenosis (mid-diastolic murmur)
Cyanosis
HF eg. oedema, SOB, poor feeding
Enlarged R atrium present on imaging
115
What investigation is essential to screen for a potential complication of Kawasaki disease?
Echocardiogram to screen for coronary artery aneurysms are a complication
116
How may a congenital diaphragmatic hernia present?
Dyspnoea and tachypnoea at birth
Scaphoid abdomen, due to herniation of the abdominal contents into the cleft
117
What are the 5 components of the APGAR score?
Pulse, Respiratory effort, Colour, Muscle tone, Reflex irritability
118
What screening do breech babies need regardless of the mode of delivery?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks
119
How should a threadworm infection be treated?
A single dose of oral mebendazole for entire household and hygiene advice
120
What auditory screening test is done in newborns?
Otoacoustic emission test
If abnormal - Auditory Brainstem Response test
121
What auditory screening test is done in children starting school?
Pure tone audiometry
122
What is the first and second-line treatment for ADHD?
1st Methylphenidate
2nd Lisdexamfetamine
123
What are the features of fetal alcohol syndrome?
short palpebral fissure
thin vermillion border/hypoplastic upper lip
smooth/absent filtrum
learning difficulties
microcephaly
124
What antibiotics should be given for meningitis in children > 3 months?
Intravenous ceftriaxone
125
What antibiotics should be given if a diagnosis of meningitis is made in the community?
Intramuscular benzylpenicillin
126
What antibiotics should be used as prophylaxis for close contacts of patients with meningococcal meningitis?
Ciprofloxacin
127
What is Meckel's diverticulum?
Common congenital GI condition. Remnant of the omphalomesenteric duct & contains ectopic ileal, gastric or pancreatic mucosa.
128
How might Meckel's diverticulum present?
Abdominal pain mimicking appendicitis
Rectal bleeding - massive painless GI bleed
Intestinal obstruction
129
What investigation should be done in Meckel's diverticulum (if hemodynamically stable)?
Meckel's scan - 99m technetium pertechnetate, which has an affinity for gastric mucosa
130
What is the most common cause of epiglottitis?
In unvaccinated - Haemophilus influenza B
Vaccinated - Streptococcus group A
131
What are the features of epiglottitis?
Pyrexia, generally unwell, inspiratory stridor, drooling of saliva, tongue out, muffled voice, 'tripod' position, sore throat.
132
What features can be seen on an x-ray in epiglottitis?
Lateral view - thumb sign
Posterior-anterior view - steeple sign
133
What cardiac conditions are associated with Turner syndrome?
Bicuspid aortic valve and aortic coarctation.
134
What are the possible causes of prolonged neonatal jaundice (>14 days)?
Biliary atresia
Hypothyroidism
G6PD deficiency
UTI or prematurity
135
What are the possible causes of neonatal jaundice in the first 24hrs?
ALWAYS pathological
Haemolytic disease (rhesus or ABO)
Hereditary spherocytosis
136
Which metabolic abnormality would a patient with pyloric stenosis most likely present with?
Hypochloremic hypokalemic metabolic alkalosis
137
What are the features of Kawasaki disease?
High-grade fever lasts for > 5 days, Conjunctivitis, Bright red, cracked lips, strawberry tongue, cervical lymphadenopathy, red palms of the hands & the soles of the feet
138
How do you treat Kawasaki disease?
High dose aspirin and immunoglobulins
139
Should you prescribe antibiotics for otitis media?
Only prescribe if:
Symptoms > 4 days or not improving
Systemically unwell
Immunocompromise
< 2 years with bilateral otitis media
Otitis media with perforation and/or discharge
140
What antibiotics should you prescribe for otitis media?
5-7 day course of amoxicillin
141
What is glue ear?
Otitis media with an effusion, and hearing loss is usually the presenting feature.
142
How is glue ear treated?
Grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube.
143
Which bacteria commonly cause otitis media?
Strep pneumoniae and Haemophilus influenzae
144
What checks should be done for the use of Methylphenidate in ADHD?
Potentially cardiotoxic - perform a baseline ECG
Weight and height should be monitored every 6 months
145
How should lower UTIs in children be managed?
< 3 months old = referred immediately to a paediatrician
> 3 months old with a lower UTI = 3 days either trimethoprim (first line) or nitrofurantoin
146
How should upper UTIs in children be managed?
< 3 months old = referred immediately to a paediatrician
> 3 months with upper UTI = consider admission & Cefalexin
147
What imaging should babies < 6 months have following a UTI?
Atypical or recurrent infections = DMSA & Micturating cystourethrogram
If just normal UTI = US within 6 weeks
148
What antibiotic should be used for pneumonia in children?
Amoxicillin
149
When should Erythromycin be used in paediatric pneumonia?
If mycoplasma or chlamydia is suspected
150
What causes androgen insensitivity syndrome?
X-linked recessive condition, defect in androgen receptor results in end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype.
151
What are the hormone levels in androgen insensitivity syndrome?
Testosterone, oestrogen and LH levels are elevated
152
What is Kallman's syndrome?
Delayed puberty secondary to hypogonadotrophic hypogonadism, due to failure of GnRH-secreting neurons to migrate to the hypothalamus
153
What are the features of Kallman's syndrome?
'delayed puberty'
hypogonadism, cryptorchidism
anosmia
sex hormones & LH/FSH levels are low
154
How do you manage constipation?
1. Polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)
2. Stimulant laxative (Senna)
3. Osmotic laxative (lactulose)
155
How should exomphalos and gastroschisis be repaired?
Exomphalos should have a gradual repair to prevent respiratory complications. Gastroschisis requires urgent correction
156
What are red flags in gross motor skill development?
Not sitting unsupported @ 12 months
Not walking @ 18 months
Hand preference before 18 months
157
What are the 4 main causes of inspiratory stridor in children?
Croup
Inhaled foreign body
Acute epiglottis
Laryngomalacia (baby's larynx is soft & floppy
158
What is tested for in the Guthrie test or 'heel-prick test'?
Congenital hypothyroidism
Cystic fibrosis
Sickle cell disease
Metabolic conditions such as maple syrup urine disease, MCADD and phenylketonuria
159
What are the two most common congenital heart defects associated with Turner's syndrome?
Bicuspid aortic valve
Coarctation of the aorta
160
What vaccine is available against bronchiolitis and who is it available for?
Palivizumab
All childen < 24 months immunocompromised
161
What antibiotics should be given in suspected neonatal sepsis?
Benzylpenicillin + Gentamicin
162
What would a blood gas in congenital adrenal hyperplasia salt crisis show?
Hyponatraemia Hyperkalaemia
Metabolic acidosis
163
What is the classic triad of haemolytic uraemic syndrome?
Haemolytic anaemia
Acute kidney injury
Low platelet count (thrombocytopenia)
164
What causes haemolytic uraemic syndrome?
Shiga toxin produced by e.coli or shigella
165
What are the features of Wilm's tumour?
abdominal mass (most common presenting feature)
painless haematuria
flank pain
anorexia, fever
hypertension
166
What is Infectious mononucleosis?
Epstein Barr virus (EBV). It is commonly known as the “kissing disease”, “glandular fever” or “mono”
167
What advice should be given to patients with Infectious mononucleosis?
Avoid alcohol & contact sport (splenic rupture)
168
What tests should be done in suspected coeliac?
Tissue transglutaminase (TTG) antibodies (IgA) are first-choice
Endomyseal antibody (IgA)
Check IgA deficiency if negative
169
How do you diagnose mononucleosis?
heterophil antibody test (Monospot test)
170
How do you treat impetigo?
Hydrogen peroxide (topical)
171
How do you treat scabies?
Permethrin
172
What fluid bolus should be given to children in shock?
20ml/kg bolus is administered in shock, however in DKA and HF give 10ml/kg
173
How can faecal impaction be managed?
1. Macrogol and electrolytes (Movicol Paediatric Plain)
2. Stimulant laxative e.g. senna
