Paeds Flashcards
(150 cards)
1
Q
Which vaccines are live vaccines?
A
1.MMR
2.rotavirus
3.BCG(Baccile Calmette Guerin), 4.Varicella,
5.influenza(nasal)
2
Q
Causes of periorbital swelling
A
- Hypervolemic: Cardiac failure, nephritic syndromes, Acute renal failure
- Hypovolemic: Chronic Liver Disease/Cirrhosis, Nephrotic syndrome, malnutrition( Third spacing),
- Capillary leak (Infection, Inflammatory eg anaphylaxis)
3
Q
Tetrad of Acute Glomerulonephritis(AGN)
A
Edema, hypertension, gross hematuria, azotemia
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
5
Q
first line treatment for AGN in children
A
IV furosemide high dose
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
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
7
Q
Cx of nephrotic syndrome
A
- Infections due to loss of immunoglobulins: Pneumococcus, UTI, Peritonitis
- Hypercoagulable state: Loss of anti thrombin 3
- Hypovolemia and shock
- Growth impariment
Hyperlipidemia: CHD, atherosclerosis
8
Q
Mx of acute nephrotic syndrome
A
IV 20% albumin infusion over 4/24 then IV furosemide 0.5-1 mg/kg
9
Q
Common paeds emergencies
A
Shock
Respi distress
Seizures
Hyperemesis
Head injury
Other injurys
Poisoning
10
Q
Common causes of upper airway obstruction
A
Foreign body aspiration
Croup
HIB epiglottitis
Retropharyngeal abscess?
11
Q
Scores for assessing alertness in paeds
A
Modified GCS,AVPU
12
Q
Common metabolic or electrolyte disturbances causing seizures
A
Hyper/hypoNa
Hypogly
HypoCa
HypoMg
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
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
15
Q
IDEAL methods of collecting urine for culture
A
Transurethral catheterization
Suprapubic aspiration
By left:urine bag,clean catch, voiding stimulation
16
Q
Medications for NNP
A
IV Ampicillin and gentamicin
17
Q
What does coke coloured urine suggest
A
Glomerular cause of hematuria
18
Q
Christmas tree bladder appearance on MCU suggests?
A
Severe long standing neurogenic bladder or chronic bladder outlet obstruction
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)
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
21
Q
Requirements for diagnosis of UTI in children
A
1.Positive urine culture, usually 1 pathogen(GOLD standard)`
- Pyuria and Bacteriuria on microscopy
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
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
24
How does dimercapto succinic acid scan(DMSA) work?
Assess kidney function by comparing the 2 kidneys uptake/filtering ratio
25
Mx of vesicoureteric reflux(VUR)
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
26
Infant caloric and fluid requirements
Caloric: 120-150ml/kg/day
Fluid: 100ml/kg/day
Infant formulas give about 0.67 cal/ml
27
Management of gastro esophageal reflux(GER)
Sit up child after feeds
Spread out the intake of feeds
PPIs if there is Sx of GERD
28
Definition of shock
Life threatening circulatory disorder resulting in reduced end organ perfusion and eventually damage
29
Impt things to ask for pediatrix hx
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
30
What does bloody mucoid stools suggest
Bacterial GE rather than a viral GE
31
Mx of functional constipation
Dietary changes: more fibre and fruits
Behavioral/toilet training
Laxatives eg lactulose
Lignocaine/analgesics if there are fissures
32
Causes of diarrhea
Secretory:
Osmotic: Malabsoption, a/w food intake(lactose intolerance,celiac)
Inflammatory:
33
Which vaccine is a/w intussusception in infants
Rotavirus
34
Causes of urinary frequency
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
35
It is impt to ask voiding habits in children with UTI, what are they
1. Toilet training difficultues
2. Urinary incontincnce
3. Voiding habits: FUN DISH
4. Weak urinary steam/dribbling
36
Signs of spina bifida
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
37
Signs of missed UTI in infants
Fever that is NOT a/w URTI, rash, recent vaccination and resolves with Abx
38
How to assess bladder function
1. Frequency-volume charting
2. Bladder US
3. Uroflow
4. Urodynamics
39
Mx of neurogenic bladder
1. Clean intermittent catherization
2. Surgical: Bladder augmentation or Mitrofanoff procedure
40
Causes of red urine
1. Hematuria
2. Myoglobinuria
3. Bilirubinuria and hemoglobinuria
4. Drugs eg rifampicin, warfarin
5. Food pigments: Beetroot, blackberry
41
dy/dx non glomerular and glomerular hematuria
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
42
Non glomerular causes of hematuria
Isolated
1. UTI
2. Urethritis
3. Adenovirus
Recurrent
1. Urolithiasis
2. Nutcracker kidney
3. Exercise induced
4. Tumor
5.Cyst
43
Haematuria red flags
1. Recurrent and persitent
2. Nephrotic and nephritic syndrome
3. Renal impairment
4, Renal calculi
5. Proteinuria
6. Extrarenal manifesttaions
7. FHx
8. Low serum C3
44
What should be done for all children with UTIs
Neurological examination of LL and anal sphincter,US KUB
45
What does CAKUT stand for
Congenital abnormalities of Kidney,Urinary Tract
46
When do anterior and posterior fontanelles close
Posterior: within 2 months
Anterior:by 7-18 months
47
Surgical options for biliary atresia
Kasai procedure
Definitive: Liver transplant
48
ABCDE of Decomensated chronic liver disease
Albumin Low(leuconychia)
Bilirubin high(icterus)
Coagulopathy(ecchymoses)
Distended abdomen(Ascites)
Encephalopathy(asterixis,AMS)
49
ABCDE of portal hypertension
Ascites
Bleeding(hematemesis,UBGIT)
Caput medusae
Diminished liver function
Enlarged spleen
50
Signs of chronic liver disease
Loss of axillary hair,gynaecomastia,spider nevae, clubbing, testicular atrophy, palmar erythema
51
What are gilberts and criggler najar syndromes
Causes of indirect hyperbilirubinemia in newborns
52
What kind of inheritance pattern is least indicative with family history
Autosomal recessive
53
What is a BT shunt and what is its function
A blalock taussig shunt that connects the subclavian artery to the pulmonary artery,acting as a PDA.
Used palliatively for tetralogy of fallot
54
What is the tetralogy of fallot
Pulmonary stenosis
Right ventricular hypertrophy
Ventricular septal defect
Overriding aorta
55
Complications of gastroenteritis
1. Hypovolemia and shock
2. Electrolyte imbalances(Na,K)
3. Metabolic acidosis
4. Acute kidney injury(AKI)
56
Diagnostic criteria of Kawasaki Disease(KD) acronym
CREAM
Conjunctivitis(Bilateral)
Rashes(Erythematous polymorphous)
Edema(of extremities)
Adenopathy
Mucosal changes(erythema,cracking,inflamed)
AND fever of 5+ days
Major criteria: 4/5
57
What does BCGitis suggest
Kawasaki disease due to BCG reactivation
58
Differentiating factors between simple and complex febrile fits
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
59
Dysmorphic vs isomorphic red blood cells in urine
Glomerular vs urological cause of hematuria
60
How to differentiate asthma and viral bronchitis/bronchiolitis( NOT CFM ACCURATE INFO)
Bronchodilator response,Interval Sx, personal and family Hx of atopy
61
Common bugs causing lobar pneumonia in children
Group B strep, Listeria Monocytogenes, Moraxella catarrhalis, Mycoplasma pneumoniae
62
How long does it take for fever to downtrend after starting antibiotics
48-72hrs
63
Signs of respiratory distress
Tachypnea, oxygen desaturation
Nasal flaring and grunting in infants
Use of accessory muscles of respiration: Intercostal, subcostal and supraclavicular retractions
64
Features of DiGeorge Syndrome mnemonic
CATCH 22
Cardiac Abnormalities (TOF, ASD, VSD)
Anomalous face( Winged hypoplastic nose bridge)
Thymus aplasia/hypoplasia
Cleft Palate
Hypoparathyroidism
22q11 deletion
65
Sx of parvovirus B19 infection
Fever
Cory a
Nausea
Diarrhea
Erythematous malar rash with relative circumoral pallor
66
What kind of poisoning does medicate oil cause
Salicylate poisoning
67
CT vs MRI brain for pt with seizures and signs of increased ICP, N/V and headache
CT brain, can be arranged faster to intervene within window
68
What is low OFC a risk factor for
Impaired brain growth and risk for epilepsy
69
Signs of spontaneous bacterial peritonitis(SBP)
Fever
Distended and tender abdomen
Risk of ascites
70
Typical presentation of Meckels diverticulum
Painless bleeding in stools
71
Which of doxycycline and cephalosporins have cross sensitivity with penicillins
Cephalosporins have cross sensitivity, macro lines do not
72
Bulging Fontanelles and up going plantars in a neonate are
Physiological
73
Possible reasons for difficult to treat asthma
Poor complaince
Wrong inhaler technique
Poor Mx of comorbids eg allergic rhinitis, passive smoking
74
Cutoff for underweight BMI in SG
18.5
75
Functional vs organic causes
76
Toddlers diarrhea
77
Malaria
78
Mentzer index
79
Most appropriate method of inhaler administration for a 3 year old
Small volume chamber with face mask
80
Marian’s syndrome
81
high risk infants for neonatal jaundice
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
Gold standard for UTI diagnosis
Urine culture after urine dipstick
83
Why do neurocutaneous syndromes occur
Because skin and nervous systems are derived from ectoderm
84
Name neurocutaneous syndromes and which are a/w seizures
A/w seizures:
Neurofibromatosis
Sturge Weber
Tuberous Sclerosis
Von Hippel Lindau
Ataxia Telegiectasia
85
Different types of Anemias and the etiology
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
Secondary causes of seizures
Meningitis
Thromboembolic events
Intracranial bleed or mass
Hypoglycemia
HypoCa
Hypo or Hyper Na
Viral associated encephalopathy
Neurocutaneous syndromes(Sturge Weber, Neurofibromatosis, Tuberous Sclerosis)
87
Common pathogens causing meningitis
Infants: BEL
B Group Strep, E Coli, Listeria
Older children
NHS
Neisseria Meningitiditis
HIB
Strep pneumonia
88
Criteria for Juvenile Idiopathic Arthritis
Unknown etiology of arthritis
Begins before 16th bday
Persists for >6weeks
89
Joints that are difficult to evaluate with PE and best evaluated with imaging
Hip
Spine
Sacroiliac joint
90
Signs of chronicity in joint exam
Muscle wasting
Contractures/Fixed Flexion Deformities
Limb Length Discrepancies
91
Methods of treating JIA/inflammatory arthritis
NSAIDs
Oral Steroids
cDMARDs eg methotrexate
bDMARDs eg infliximab
92
Most appropriate first test if suspecting IgA Vasculitis(Henoch Schonlein Purpura)
Urine dipstick to check for urine involvement
Blood tests are only to check for suspected complications
93
IgA Vasculitis/HSP dx criteria
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
IGAV/HSP Mx
Mostly supportive
NSAIDs if joint involvement
Prednisolone if abdo pain is severe and intussusception excluded
Steroids and immunomodulation if renal involvement severe
95
Types of heart findings on CXR
Boot shaped heart: Tetralogy of Fallot
Water bottle/Globular shaped heart: Pericardial effusion/cardiac tamponade
96
1997 SLE criteria dance
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
Mx of Kawasaki Disease
IVIG(mainstay) if within window of 10 days(from start if fever)
Aspirin
98
What to rule out in Febrile child with joint pain/NWB
Septic Arthritis, do a joint aspirate before IV Abx
99
% direct bilirubin of total bilirubin to be considered obstructive jaundice
Above 20%
100
How Biliary Atresia is dx
Intraoperative cholangiogram(GOLD STANDARD)
Supportive: US HBS and LFT
101
Causes of UBGIT in child with biliary atresia
Esophageal variceal bleeding or portal hypertensive gastropathy
102
Most common type of cancer in paediatric age group
Haematological malignancies: Leukemia and Lymphoma
103
Why are haematological malignancies the most common in paediatric age group
Because during adolescene the immune system is still developing
104
Allergic March
Eczema in early childhood
Followed by asthma
Allergic conjunctivitis latest to set it
105
Conjunctivitis with limbic sparing suggests?
Kawasaki disease
106
Key non invasive investigation in assessment of constitutional/stature abnormalities
X Ray of left hand
Difference of more or less than 2 years from actual age suggests abnormal development
107
Cutoff for obesity dx
Locally 97% internationally 95%
108
Mainstay of early T2DM treatment
Diet modification
Behavioural changes eg exercise
Metformin
109
What is Todd's paralysis
Post ictal neurological deficits
110
Most common causes hyperthyroidism and hypothyroidism
Hyper is Graves
Hypo is Hashimotos
111
Most common causes of hyperthyroidism and hypothyroidism
Hyper is Graves
Hypo is Hashimotos
Euthyroid is physiological
112
Usual appearance of short stature or growth delay due to endocrinopathy
Short and fat
113
Endocrinopathies that cause short stature
Hypothyroidism, Cushings syndrome and HGH deficiency
114
Criteria to differentiate septic arthritis and transient synovitis
Kocher criteria
115
4 Terrible Ts of cyanotic heart disease with tachypnea
TGA
TPAVR
Truncus Arteriosus
Tricuspid Atresia
116
Vaccinations that are mandatory in Singapore
Measles and Diphtheria
117
Signs of salicylate poisoning
Tinnitus
Respiratory alkalosis
Metabolic acidosis
Hypoglycemia
Thrombocytopenia
118
Signs of salicylate poisoning
Tinnitus N/V Lethargy Tachypnea
Respi alkalosis
Metabolic acidosis
Hypoglycemia
Thrombocytopenia
Moderate to severe toxicity will have more serious signs and sx
119
3 Cs of measles
Cough, Coryza and conjunctivitis
120
Invx for HSP/IgA Vasculitis
Renal panel looking for signs of renal involvement eg Nephrotic/Nephritic syndrome
Chest/Abdo XR
Ultrasound
121
Mx of IgA Vasculitis
Supportive
NSAIDs IF Renal involvement ruled out
Corticosteroids if Intussusception or renal involvement
122
How to calculate estimated systolic BP in children
70+ 2(Age)
Applicable up to age of 10, where 90mmHg is used
123
Estimate of MAP in children
50+ (Age x 2)
124
Principle for determining hypo and hypertension depending on age
20% deviation from estimated BP
125
What does VACTERL stand for
Vertebral, Anal, Cardiac Abnormalities, Tracheo Esophageal fistula, Renal and Limb abnormalities
126
Dysmorphic signs of T21
Hypertelorism
Palpebral fissures?
Low set ears
Flat nose bridge
Macroglossia and small mouth
Cleft palate
127
Scoring for power in Neuro PE
0+: No mvmt
1+: Trace mvmt
2+: No mvmt against gravity
3+: Resists gravity
4+: Reduced power
5+: Normal power
128
Scoring for reflexes in Neuro PE
0: Areflexic
1+: Hyporeflexic
2+: Normal
3+ Hyperreflexic w/o clonus
4+: Hyperreflexic with clonus
129
Scoring for reflexes in Neuro PE
0: Areflexic
1+: Hyporeflexic
2+: Normal
3+ Hyperreflexic w/o clonus
4+: Hyperreflexic with clonus
130
What is Still disease
Systemic JIA
131
Still disease/ Systemic JIA criteria
1. Arthritis of 1+ joint
2. Fever for >2 weeks with 3 consecutive days of spike
3. 1+ extra articular manifestation
132
Extra articular manifestations of Still disease( Systemic JIA)
1. Hepatosplenomegaly
2. Lymphadenopathy
3. Serositis( Peritonitis, Pleuritis, Pericarditis)
4. Transient, migratory, macular salmon pink rash
133
options for prophylactic abx in children with UTI
amoxicillin or cephalexin
134
Common Cx of HFMD
1. Dehydration and poor intake bc of ulcers
2. Pneumonia
3. Meningoencephalitis
135
Is Hb drop in 6 week year infant often physiological or pathological
Most often physiological but tro pathological causes
136
Components of full septic workup
Bloods
-BLOOD CULTURE
-FBC
-RP
-CRP/ESR
Procedures
-Lumbar puncture
-Catheterisation for Urine culture
Radio
-CXR+-
137
Age grp which commonly sees febrile seizures and intussusception
6 months to 6 years
138
How to administer PR diazepam
1.Squeeze out required amount
2. Spread cheeks,place nozzle
3. Administer
4. Close cheeks before removing nozzle
139
Comorbids of tics/tourettes
ADHD and OCD
140
Classical distribution of IgA Vasculitis palpable purpura
Extensor surfaces
141
Red flags for febrile seizure return advice
1. Seizure >5min
2. No return to baseline
3. Another seizure withib 24hrs
142
When do febrile seizures usually present
Within 24-48hrs of seizure starting
143
Risk factors for AMI in paeds
1. Cocaine abuse
2. Kawasaki
3. Congenital Anomalous coronary artery
144
Causes of pericarditis in children
1. Viral eg coxsackie
2. Autoimmune eg SLE
3. Iatrogenic eg vaccines
4. Post operative
145
Acceptable height velocity
4.25cm/year
146
Why kawasaki disease patients are not given live vaccines for 11 months
IVIG makes live vaccines ineffective
147
Acronym for congenital Cytomegalovirus
MR DICS
Microcephaly
Retardation
Deafness
Intracranial periventricular calcifications
Seizures
148
Why does thalassemia only have symptom onset around 6 months and not birth
Transition from fetal hemoglobin HbF to normal Hb alpha
149
Indication for kidney biopsy for Paeds
>10 y.o and steroid resistant nephrotic syndrome
