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Paeds Flashcards

1
Q

Which vaccines are live vaccines?

A

1.MMR
2.rotavirus
3.BCG(Baccile Calmette Guerin), 4.Varicella,
5.influenza(nasal)

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2
Q

Causes of periorbital swelling

A
  1. Hypervolemic: Cardiac failure, nephritic syndromes, Acute renal failure
  2. Hypovolemic: Chronic Liver Disease/Cirrhosis, Nephrotic syndrome, malnutrition( Third spacing),
  3. Capillary leak (Infection, Inflammatory eg anaphylaxis)
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3
Q

Tetrad of Acute Glomerulonephritis(AGN)

A

Edema, hypertension, gross hematuria, azotemia

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4
Q

Causes of glomerulonephritis

A

Primary: IgA nephropaties eg FSGS
Secondary(HIV MAD)
-Hereditary: Alport’s
-Infections: Post streptococcal–Vascular: HUS

-Metabolic
-Autoimmune: SLE, RA
-Drugs: Aminoglycosides, nsaids

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5
Q

first line treatment for AGN in children

A

IV furosemide high dose

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6
Q

Mx of idiopathic nephrotic syndrome in chilhood( ISKDC regimen)

A

Prednisolone 60mg/m2/day x 4-6weeks then taper to 30mg/m2/alternate day

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7
Q

Diagnostic definition of Nephrotic syndrome

A

Proteinuria
>3.5g/1.73m2/day or UPCR >=0.2g/mmol

Hypoalbuminemia: <25g/L
Hyperlipidemia: Increased TGs, LDL
Edema

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7
Q

Cx of nephrotic syndrome

A
  1. Infections due to loss of immunoglobulins: Pneumococcus, UTI, Peritonitis
  2. Hypercoagulable state: Loss of anti thrombin 3
  3. Hypovolemia and shock
  4. Growth impariment
    Hyperlipidemia: CHD, atherosclerosis
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8
Q

Mx of acute nephrotic syndrome

A

IV 20% albumin infusion over 4/24 then IV furosemide 0.5-1 mg/kg

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9
Q

Common paeds emergencies

A

Shock
Respi distress
Seizures
Hyperemesis
Head injury
Other injurys
Poisoning

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10
Q

Common causes of upper airway obstruction

A

Foreign body aspiration
Croup
HIB epiglottitis
Retropharyngeal abscess?

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11
Q

Scores for assessing alertness in paeds

A

Modified GCS,AVPU

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12
Q

Common metabolic or electrolyte disturbances causing seizures

A

Hyper/hypoNa
Hypogly
HypoCa
HypoMg

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13
Q

Simple vs complex febrile seizure

A

Generalised vs focal
<15 vs >15 minutes
Does not vs recurrence within 24hr
No deficits vs deficits

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14
Q

Signs of meningitis

A

AMS, lethargy and irritability
Signs of meningeal irritation
-Nuchal rigidity
-Kernig:pain on knee extension
-brudzinski,:passive neck flexion cause involuntary leg flexion

These signs not accurate for 18months and younger

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15
Q

IDEAL methods of collecting urine for culture

A

Transurethral catheterization
Suprapubic aspiration

By left:urine bag,clean catch, voiding stimulation

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16
Q

Medications for NNP

A

IV Ampicillin and gentamicin

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17
Q

What does coke coloured urine suggest

A

Glomerular cause of hematuria

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18
Q

Christmas tree bladder appearance on MCU suggests?

A

Severe long standing neurogenic bladder or chronic bladder outlet obstruction

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19
Q

Signs of glomerular causes of hematuria on microscopy

A

Red cell casts, dysmorphic RBCs
(Make sure to rule out false positives if urine sample not fresh)

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20
Q

Causes of urinary calculi in children

A

Dietary: high salt intake, keto diet
Fluid intake poor
Structural abnormalities of kidney,ureters
Tubulopathy
GI malabsorption eg crohns
Medication

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21
Q

Requirements for diagnosis of UTI in children

A

1.Positive urine culture, usually 1 pathogen(GOLD standard)`

  1. Pyuria and Bacteriuria on microscopy
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22
Q

how to dy/dx Upper UTI from lower UTI

A

Sx: Fever, loin pain

Invx
1) Raised TW/CRP
Signs of renal involvements
1) Raised creatinine
2) Edema on US
3) Photopenic area on DMSA scan

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23
Q

Treatment options for UTI

A

Neonates: IV gentamicin+ ampicillin to cover listeria and enterococcus

Uncomplicated
-PO augmentin or IV gentamicin

Complicated/atypical
-IV ceftriaxone

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24
Q

How does dimercapto succinic acid scan(DMSA) work?

A

Assess kidney function by comparing the 2 kidneys uptake/filtering ratio

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25
Q

Mx of vesicoureteric reflux(VUR)

A

Prophylactic Abx in VUR garde 3-5 until 2 years after last febrile UTI

Surgical if above fails
1. Deflux injection(STING)
2. Ureteric reimplantation

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26
Q

Infant caloric and fluid requirements

A

Caloric: 120-150ml/kg/day

Fluid: 100ml/kg/day

Infant formulas give about 0.67 cal/ml

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27
Q

Management of gastro esophageal reflux(GER)

A

Sit up child after feeds
Spread out the intake of feeds
PPIs if there is Sx of GERD

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28
Q

Definition of shock

A

Life threatening circulatory disorder resulting in reduced end organ perfusion and eventually damage

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29
Q

Impt things to ask for pediatrix hx

A

Activity level: irritability, lethargy,drowsiness

Nocturnal symptoms: Presence would be a red flag

Input output: Oral intake, bowel and urinary movements(eg diapers changed)

Developmental, antenatal and immunisation Hx

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30
Q

What does bloody mucoid stools suggest

A

Bacterial GE rather than a viral GE

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31
Q

Mx of functional constipation

A

Dietary changes: more fibre and fruits
Behavioral/toilet training
Laxatives eg lactulose
Lignocaine/analgesics if there are fissures

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32
Q

Causes of diarrhea

A

Secretory:
Osmotic: Malabsoption, a/w food intake(lactose intolerance,celiac)
Inflammatory:

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33
Q

Which vaccine is a/w intussusception in infants

A

Rotavirus

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34
Q

Causes of urinary frequency

A

1.Polyuria: Diabetes
2.External genitalia irritation: vulvitis and balanitis
3.Bladder-Bowel dysfunction
4.Bladder
- Irritative: UTI, urinary calculi, hyperCa, OAB, Cystitis
- Obstrutive, Neurogenic bladder, Posterior urethral valve, Ureterocele

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35
Q

It is impt to ask voiding habits in children with UTI, what are they

A
  1. Toilet training difficultues
  2. Urinary incontincnce
  3. Voiding habits: FUN DISH
  4. Weak urinary steam/dribbling
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36
Q

Signs of spina bifida

A
  1. Neurologic sings: Hyporeflexia, Hypotonia, weakness, loss of anal wink, perianal anesthesia, palpable neurogenic bladder
  2. Pouch, sacral dimple,lipoma or tuft of hair on examination
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37
Q

Signs of missed UTI in infants

A

Fever that is NOT a/w URTI, rash, recent vaccination and resolves with Abx

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38
Q

How to assess bladder function

A
  1. Frequency-volume charting
  2. Bladder US
  3. Uroflow
  4. Urodynamics
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39
Q

Mx of neurogenic bladder

A
  1. Clean intermittent catherization
  2. Surgical: Bladder augmentation or Mitrofanoff procedure
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40
Q

Causes of red urine

A
  1. Hematuria
  2. Myoglobinuria
  3. Bilirubinuria and hemoglobinuria
  4. Drugs eg rifampicin, warfarin
  5. Food pigments: Beetroot, blackberry
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41
Q

dy/dx non glomerular and glomerular hematuria

A

Painful vs painless
LUTS sx vs nil
Red/pink vs coke coloured urine
Non uniform vs uniform stream colour

Glomerular:red cell casts, dysmorphic RBCs, significant proteinuria

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42
Q

Non glomerular causes of hematuria

A

Isolated
1. UTI
2. Urethritis
3. Adenovirus

Recurrent
1. Urolithiasis
2. Nutcracker kidney
3. Exercise induced
4. Tumor
5.Cyst

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43
Q

Haematuria red flags

A
  1. Recurrent and persitent
  2. Nephrotic and nephritic syndrome
  3. Renal impairment
    4, Renal calculi
  4. Proteinuria
  5. Extrarenal manifesttaions
  6. FHx
  7. Low serum C3
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44
Q

What should be done for all children with UTIs

A

Neurological examination of LL and anal sphincter,US KUB

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45
Q

What does CAKUT stand for

A

Congenital abnormalities of Kidney,Urinary Tract

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46
Q

When do anterior and posterior fontanelles close

A

Posterior: within 2 months
Anterior:by 7-18 months

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47
Q

Surgical options for biliary atresia

A

Kasai procedure

Definitive: Liver transplant

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48
Q

ABCDE of Decomensated chronic liver disease

A

Albumin Low(leuconychia)
Bilirubin high(icterus)
Coagulopathy(ecchymoses)
Distended abdomen(Ascites)
Encephalopathy(asterixis,AMS)

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49
Q

ABCDE of portal hypertension

A

Ascites
Bleeding(hematemesis,UBGIT)
Caput medusae
Diminished liver function
Enlarged spleen

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50
Q

Signs of chronic liver disease

A

Loss of axillary hair,gynaecomastia,spider nevae, clubbing, testicular atrophy, palmar erythema

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51
Q

What are gilberts and criggler najar syndromes

A

Causes of indirect hyperbilirubinemia in newborns

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52
Q

What kind of inheritance pattern is least indicative with family history

A

Autosomal recessive

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53
Q

What is a BT shunt and what is its function

A

A blalock taussig shunt that connects the subclavian artery to the pulmonary artery,acting as a PDA.

Used palliatively for tetralogy of fallot

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54
Q

What is the tetralogy of fallot

A

Pulmonary stenosis
Right ventricular hypertrophy
Ventricular septal defect
Overriding aorta

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55
Q

Complications of gastroenteritis

A
  1. Hypovolemia and shock
  2. Electrolyte imbalances(Na,K)
  3. Metabolic acidosis
  4. Acute kidney injury(AKI)
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56
Q

Diagnostic criteria of Kawasaki Disease(KD) acronym

A

CREAM

Conjunctivitis(Bilateral)
Rashes(Erythematous polymorphous)
Edema(of extremities)
Adenopathy
Mucosal changes(erythema,cracking,inflamed)

AND fever of 5+ days
Major criteria: 4/5

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57
Q

What does BCGitis suggest

A

Kawasaki disease due to BCG reactivation

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58
Q

Differentiating factors between simple and complex febrile fits

A

Duration: 15 mins
Age group 6 months to 5 years
Semiology: GTC vs focal
Post ictal: recovered vs deficit
Frequency: more or less than 1 in 24hrs

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59
Q

Dysmorphic vs isomorphic red blood cells in urine

A

Glomerular vs urological cause of hematuria

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60
Q

How to differentiate asthma and viral bronchitis/bronchiolitis( NOT CFM ACCURATE INFO)

A

Bronchodilator response,Interval Sx, personal and family Hx of atopy

61
Q

Common bugs causing lobar pneumonia in children

A

Group B strep, Listeria Monocytogenes, Moraxella catarrhalis, Mycoplasma pneumoniae

62
Q

How long does it take for fever to downtrend after starting antibiotics

63
Q

Signs of respiratory distress

A

Tachypnea, oxygen desaturation

Nasal flaring and grunting in infants

Use of accessory muscles of respiration: Intercostal, subcostal and supraclavicular retractions

64
Q

Features of DiGeorge Syndrome mnemonic

A

CATCH 22

Cardiac Abnormalities (TOF, ASD, VSD)

Anomalous face( Winged hypoplastic nose bridge)

Thymus aplasia/hypoplasia

Cleft Palate

Hypoparathyroidism

22q11 deletion

65
Q

Sx of parvovirus B19 infection

A

Fever
Cory a
Nausea
Diarrhea
Erythematous malar rash with relative circumoral pallor

66
Q

What kind of poisoning does medicate oil cause

A

Salicylate poisoning

67
Q

CT vs MRI brain for pt with seizures and signs of increased ICP, N/V and headache

A

CT brain, can be arranged faster to intervene within window

68
Q

What is low OFC a risk factor for

A

Impaired brain growth and risk for epilepsy

69
Q

Signs of spontaneous bacterial peritonitis(SBP)

A

Fever
Distended and tender abdomen
Risk of ascites

70
Q

Typical presentation of Meckels diverticulum

A

Painless bleeding in stools

71
Q

Which of doxycycline and cephalosporins have cross sensitivity with penicillins

A

Cephalosporins have cross sensitivity, macro lines do not

72
Q

Bulging Fontanelles and up going plantars in a neonate are

A

Physiological

73
Q

Possible reasons for difficult to treat asthma

A

Poor complaince
Wrong inhaler technique
Poor Mx of comorbids eg allergic rhinitis, passive smoking

74
Q

Cutoff for underweight BMI in SG

75
Q

Functional vs organic causes

76
Q

Toddlers diarrhea

77
Q

Malaria

78
Q

Mentzer index

79
Q

Most appropriate method of inhaler administration for a 3 year old

A

Small volume chamber with face mask

80
Q

Marian’s syndrome

81
Q

high risk infants for neonatal jaundice

A

Jaundice on first 24hrs of life
G6PD deficiency or other hemolytic conditions
ABO incompatibility
Rh incompatibility
Weight loss of >=10% on breastfeeding
Rapidly increasing serum bilirubin
Prematurity around 35-36 weeks
IUGR
Family Hx of severe NNJ

82
Q

Gold standard for UTI diagnosis

A

Urine culture after urine dipstick

83
Q

Why do neurocutaneous syndromes occur

A

Because skin and nervous systems are derived from ectoderm

84
Q

Name neurocutaneous syndromes and which are a/w seizures

A

A/w seizures:
Neurofibromatosis
Sturge Weber
Tuberous Sclerosis

Von Hippel Lindau
Ataxia Telegiectasia

85
Q

Different types of Anemias and the etiology

A

Hypochromic normocytic:
1)Iron deficiency
2)Thalassemia
2)Chronic disease and inflammation

Normochromic Normocytic
-Blood loss
-Hemolysis
- Chronic Disease

Macrocytic
-Folate deficiency
-Vit B12 deficiency

86
Q

Secondary causes of seizures

A

Meningitis
Thromboembolic events
Intracranial bleed or mass
Hypoglycemia
HypoCa
Hypo or Hyper Na
Viral associated encephalopathy
Neurocutaneous syndromes(Sturge Weber, Neurofibromatosis, Tuberous Sclerosis)

87
Q

Common pathogens causing meningitis

A

Infants: BEL

B Group Strep, E Coli, Listeria

Older children

NHS

Neisseria Meningitiditis
HIB
Strep pneumonia

88
Q

Criteria for Juvenile Idiopathic Arthritis

A

Unknown etiology of arthritis
Begins before 16th bday
Persists for >6weeks

89
Q

Joints that are difficult to evaluate with PE and best evaluated with imaging

A

Hip
Spine
Sacroiliac joint

90
Q

Signs of chronicity in joint exam

A

Muscle wasting
Contractures/Fixed Flexion Deformities
Limb Length Discrepancies

91
Q

Methods of treating JIA/inflammatory arthritis

A

NSAIDs
Oral Steroids
cDMARDs eg methotrexate
bDMARDs eg infliximab

92
Q

Most appropriate first test if suspecting IgA Vasculitis(Henoch Schonlein Purpura)

A

Urine dipstick to check for urine involvement

Blood tests are only to check for suspected complications

93
Q

IgA Vasculitis/HSP dx criteria

A

Purpural/Petechial rash(NON BLANCHABLE)

PLUS 1 OF

1) Abdi pain
2) Acute arthritis or arthralgia
3) Renal involvement(hematuria or proteinuria)
4) Biopsy showing predominant IgA deposits

94
Q

IGAV/HSP Mx

A

Mostly supportive

NSAIDs if joint involvement

Prednisolone if abdo pain is severe and intussusception excluded

Steroids and immunomodulation if renal involvement severe

95
Q

Types of heart findings on CXR

A

Boot shaped heart: Tetralogy of Fallot

Water bottle/Globular shaped heart: Pericardial effusion/cardiac tamponade

96
Q

1997 SLE criteria dance

A

Butterfly rash :hands on face
Discoid rash: hands making disc on face
Photosensitivity: Flashing hands
Ulcers: hands pointing to mouth
Flex biceps: Arthritis
Hands on sternum: Serositis
Hands on back:Renal disease
Hands on head: Neurological disease

3 fingers for 3 blood tests
1.FBC
2. ANA, anti dsDNA
3. Complement

97
Q

Mx of Kawasaki Disease

A

IVIG(mainstay) if within window of 10 days(from start if fever)
Aspirin

98
Q

What to rule out in Febrile child with joint pain/NWB

A

Septic Arthritis, do a joint aspirate before IV Abx

99
Q

% direct bilirubin of total bilirubin to be considered obstructive jaundice

100
Q

How Biliary Atresia is dx

A

Intraoperative cholangiogram(GOLD STANDARD)

Supportive: US HBS and LFT

101
Q

Causes of UBGIT in child with biliary atresia

A

Esophageal variceal bleeding or portal hypertensive gastropathy

102
Q

Most common type of cancer in paediatric age group

A

Haematological malignancies: Leukemia and Lymphoma

103
Q

Why are haematological malignancies the most common in paediatric age group

A

Because during adolescene the immune system is still developing

104
Q

Allergic March

A

Eczema in early childhood

Followed by asthma

Allergic conjunctivitis latest to set it

105
Q

Conjunctivitis with limbic sparing suggests?

A

Kawasaki disease

106
Q

Key non invasive investigation in assessment of constitutional/stature abnormalities

A

X Ray of left hand

Difference of more or less than 2 years from actual age suggests abnormal development

107
Q

Cutoff for obesity dx

A

Locally 97% internationally 95%

108
Q

Mainstay of early T2DM treatment

A

Diet modification
Behavioural changes eg exercise
Metformin

109
Q

What is Todd’s paralysis

A

Post ictal neurological deficits

110
Q

Most common causes hyperthyroidism and hypothyroidism

A

Hyper is Graves
Hypo is Hashimotos

111
Q

Most common causes of hyperthyroidism and hypothyroidism

A

Hyper is Graves
Hypo is Hashimotos
Euthyroid is physiological

112
Q

Usual appearance of short stature or growth delay due to endocrinopathy

A

Short and fat

113
Q

Endocrinopathies that cause short stature

A

Hypothyroidism, Cushings syndrome and HGH deficiency

114
Q

Criteria to differentiate septic arthritis and transient synovitis

A

Kocher criteria

115
Q

4 Terrible Ts of cyanotic heart disease with tachypnea

A

TGA
TPAVR
Truncus Arteriosus
Tricuspid Atresia

116
Q

Vaccinations that are mandatory in Singapore

A

Measles and Diphtheria

117
Q

Signs of salicylate poisoning

A

Tinnitus
Respiratory alkalosis
Metabolic acidosis
Hypoglycemia
Thrombocytopenia

118
Q

Signs of salicylate poisoning

A

Tinnitus N/V Lethargy Tachypnea
Respi alkalosis
Metabolic acidosis
Hypoglycemia
Thrombocytopenia

Moderate to severe toxicity will have more serious signs and sx

119
Q

3 Cs of measles

A

Cough, Coryza and conjunctivitis

120
Q

Invx for HSP/IgA Vasculitis

A

Renal panel looking for signs of renal involvement eg Nephrotic/Nephritic syndrome

Chest/Abdo XR
Ultrasound

121
Q

Mx of IgA Vasculitis

A

Supportive
NSAIDs IF Renal involvement ruled out
Corticosteroids if Intussusception or renal involvement

122
Q

How to calculate estimated systolic BP in children

A

70+ 2(Age)

Applicable up to age of 10, where 90mmHg is used

123
Q

Estimate of MAP in children

A

50+ (Age x 2)

124
Q

Principle for determining hypo and hypertension depending on age

A

20% deviation from estimated BP

125
Q

What does VACTERL stand for

A

Vertebral, Anal, Cardiac Abnormalities, Tracheo Esophageal fistula, Renal and Limb abnormalities

126
Q

Dysmorphic signs of T21

A

Hypertelorism
Palpebral fissures?
Low set ears
Flat nose bridge
Macroglossia and small mouth

Cleft palate

127
Q

Scoring for power in Neuro PE

A

0+: No mvmt
1+: Trace mvmt
2+: No mvmt against gravity
3+: Resists gravity
4+: Reduced power
5+: Normal power

128
Q

Scoring for reflexes in Neuro PE

A

0: Areflexic
1+: Hyporeflexic
2+: Normal
3+ Hyperreflexic w/o clonus
4+: Hyperreflexic with clonus

129
Q

Scoring for reflexes in Neuro PE

A

0: Areflexic
1+: Hyporeflexic
2+: Normal
3+ Hyperreflexic w/o clonus
4+: Hyperreflexic with clonus

130
Q

What is Still disease

A

Systemic JIA

131
Q

Still disease/ Systemic JIA criteria

A
  1. Arthritis of 1+ joint
  2. Fever for >2 weeks with 3 consecutive days of spike
  3. 1+ extra articular manifestation
132
Q

Extra articular manifestations of Still disease( Systemic JIA)

A
  1. Hepatosplenomegaly
  2. Lymphadenopathy
  3. Serositis( Peritonitis, Pleuritis, Pericarditis)
  4. Transient, migratory, macular salmon pink rash
133
Q

options for prophylactic abx in children with UTI

A

amoxicillin or cephalexin

134
Q

Common Cx of HFMD

A
  1. Dehydration and poor intake bc of ulcers
  2. Pneumonia
  3. Meningoencephalitis
135
Q

Is Hb drop in 6 week year infant often physiological or pathological

A

Most often physiological but tro pathological causes

136
Q

Components of full septic workup

A

Bloods
-BLOOD CULTURE
-FBC
-RP
-CRP/ESR

Procedures
-Lumbar puncture
-Catheterisation for Urine culture

Radio
-CXR+-

137
Q

Age grp which commonly sees febrile seizures and intussusception

A

6 months to 6 years

138
Q

How to administer PR diazepam

A

1.Squeeze out required amount
2. Spread cheeks,place nozzle
3. Administer
4. Close cheeks before removing nozzle

139
Q

Comorbids of tics/tourettes

A

ADHD and OCD

140
Q

Classical distribution of IgA Vasculitis palpable purpura

A

Extensor surfaces

141
Q

Red flags for febrile seizure return advice

A
  1. Seizure >5min
  2. No return to baseline
  3. Another seizure withib 24hrs
142
Q

When do febrile seizures usually present

A

Within 24-48hrs of seizure starting

143
Q

Risk factors for AMI in paeds

A
  1. Cocaine abuse
  2. Kawasaki
  3. Congenital Anomalous coronary artery
144
Q

Causes of pericarditis in children

A
  1. Viral eg coxsackie
  2. Autoimmune eg SLE
  3. Iatrogenic eg vaccines
  4. Post operative
145
Q

Acceptable height velocity

A

4.25cm/year

146
Q

Why kawasaki disease patients are not given live vaccines for 11 months

A

IVIG makes live vaccines ineffective

147
Q

Acronym for congenital Cytomegalovirus

A

MR DICS

Microcephaly
Retardation
Deafness
Intracranial periventricular calcifications
Seizures

148
Q

Why does thalassemia only have symptom onset around 6 months and not birth

A

Transition from fetal hemoglobin HbF to normal Hb alpha

149
Q

Indication for kidney biopsy for Paeds

A

> 10 y.o and steroid resistant nephrotic syndrome

M4 Stuff (11 decks)

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