Paeds Flashcards
Are hypospadias and cryptorchidism linked?
Yes, approximately 10% of neonates with hypospadias have cryptorchidism, may also have inguinal hernias
What is the standard hearing test done in new-borns? What happens if they fail this test?
Otoacoustic emission test
If they fail this - auditory brainstem response test
Sx of biliary atresia? How do you manage it?
Seen in the first few weeks of life
Jaundice occurring or persisting after the first 14 days of life (due to increased conjugated bilirubin), hepato-splenomegaly, appetite disturbance and abnormal growth
Mx = surgery (Kasai Procedure)
Sx and Mx of intestinal malrotation and volvulous?
Green vomit, no stools passed (obstruction).
Mx = Ladd’s procedure
Mx of nocturnal enuresis?
Decrease fluid intake, and teach toilet patterns
Enuresis alarm
If patient is >8 and requires rapid management consider use of desmopressin
What is Epstein’s pearl
A congenital cyst found in the roof of the mouth
Conservative Mx only
What is mesenteric adenitis? How does it present?
Inflamed mesenteric lymph nodes leading to abdo pain after a viral illness
What is seen on AXR in Hirschsprung’s disease?
What is the initial and definitive management?
Dilated loops of bowel with a fluid level
Initial = Rectal washout and bowel irrigation
Definitive = surgery
When should you suspect ToF? What are the 4 abnormalities?
Suspect if there are intermittent cyanotic episodes accompanied by tachypnoea and examination shows a harsh ejection systolic murmur.
VSD
R ventricular hypertrophy
R ventricular outflow obstruction (pulmonary stenosis)
Overriding aorta
Which type of murmur is seen in Turner’s syndrome?
Ejection systolic (due to bicuspid aortic valve)
What is the causative organism of hand foot and mouth? Is school exclusion required?
Coxsackie A16. NO!
What should you do with a 2 year old presenting with symptoms highly suggestive of transient synovitis?
Refer to paeds for urgent assessment.
All limping children under 3 require this!
What is phimosis? When is it considered normal?
Non-retractile foreskin, may cause ballooning of the foreskin on urination
It is normal in those under 2 years
Which milestones should you refer a child to paediatrics if they are missed?
Refer if the child is not:
Smiling by 10/52
Sitting unsupported by 12 months
Walking by 18 months
If the child is showing hand preference before 12 months
Sx and causative organism of Roseola Infantum? Is school exclusion required?
High fever followed by a maculopapular rash (painless and affecting mainly the trunk), Nagayama spots of the soft palate. May cause diarrhoea, cough or febrile convulsions
Caused by HHV6. School exclusion is not required
Sx and Ix in DMD? What is the pattern of inheritance?
Sx = Proximal muscle weakness, calf pseudohypertrophy, gowers positive (uses arms to stand from a squatted position)
Ix = Genetic testing
X-linked recessive
Name the risk factors for surfactant deficient lung disease?
Prematurity, male, DM in mother, C-section birth
What is seen on CXR in surfactant deficient lung disease? How can we manage?
Respiratory distress syndrome with ground-glass appearance on CXR. There will be an indistinct heart border
Mx = maternal corticosteroid’s if premature delivery, assisted ventilation and exogenous surfactant via ET tube
Mx of chicken pox?
Calamine lotion and paracetamol, avoid NSAIDs due to risk of developing necrotising fasciitis. School exclusion until all lesions have crusted over
What is the compression:ventilation ratio in newborns?
3:1
What are the features which indicate a life threatening asthma attack?
SpO2 <92%
PEFR <33% best/predicted
Altered consciousness
Silent chest
Agitation
Cyanosis
Poor resp effort
What is Gastroschisis?
A defect in the anterior abdominal wall lateral to the umbilical cord where the bowel is found lose on the outside of the body.
Can be delivered vaginally - should go to theatre ASAP after birth
What is Exomphalos/Omphalocele?
Abdo contents protrude through the anterior abdominal wall but are covered in amniotic sac
Must be delivered by C-section, is repaired in stages
What should you give to immunocompromised people at risk of VZV infection?
VZIG
Mx of scarlet fever?
10 days phenoxymethylpenicillin or azithromycin if pen allergic
School exclusion until 24 hours after starting Abx
What is the most common complication of measles? What is the most common cause of death?
Otitis media is the most common complication
Pneumonia is the most common cause of death
Ix of SUFE and Perthe’s disease?
SUFE = X-ray hip
Perthe’s = X-ray hip first line, if normal X-ray but symptoms persist perform MRI
What is the triad of shaken baby syndrome?
Retinal haemorrhages, encephalopathy and subdural haematoma
Which type of stridor is seen in croup?
Inspiratory
Which Abx should be used in meningitis?
If <3 months, cefotaxime and amoxicillin (or ampicillin)
If > 3 months, ceftriaxone and consider dexamethasone
Which symptoms seen in a feverish child score a red on the traffic light system?
Pale/mottles/ashen/blue skin
Reduced skin turgor
Bulging fontanelles
No response to social cues
Doesn’t wake or if roused doesn’t stay awake
<3 months with a fever of >=38
RR >60, grunting or mod/severe chest indrawing
Appears ill to a healthcare professional
Weak/high pitched/continuous cry
Sx of neurological disease e.g. meningitis/seizures
Describe immune thrombocytopenia?
Follows infection or vaccination
Sx = bruising, bleeding and petechial/purpuric rash
Ix = isolated thrombocytopenia, if atypical features do a bone marrow exam to exclude malignancy
Mx = no treatment required unless platelets <10 or significant bleeding (then give steroids, IVIG or platelet transfusion)
What is the commonest childhood leukaemia? How does it present?
ALL
Presents with anaemia, neutropenia and thrombocytopenia. There will be an increased WCC due to leukocytosis
What should you do if a non-mobile infant presents with bruising?
Refer for same day paeds assessment
Describe intussuseption?
Inconsolable crying with intermittent severe abdo pain where a child draws their knees up and turns pale. Bilious vomiting and red currant jelly stools are seen along with a sausage shaped mass in the RUQ
Ix = target sign on abdo USS
Mx = rectal air insufflation
Describe pyloric stenosis?
Projectile vomiting 30 mins after eating with constipation and dehydration. There will be a mass on palpation of the upper abdomen
Ix = USS and hypochloraemia hypokalaemia metabolic alkalosis
Mx = Ramstedt pyloromyotomy
Sx of late shock?
Hypotension, bradycardia, acidosis with Kussmaul breathing, blue skin and absent urine output
Sx of hypernatraemic dehydration?
Jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness and coma
Sx of Rickets?
Forehead bossing, bowing of the legs or knock knees, waddling gait, bone pain, widening of the joints (e.g. the wrists) and kyphoscoliosis.
Low vitamin D, low calcium and high Alk phosphate
What will hormone be like in Turner’s syndrome?
Low oestrogen, high LH and FSH, low anti-Mullerian hormone (as the ovaries are insufficient)
Describe Fragile X syndrome?
X-linked dominant
Sx = learning difficulties (the most common X-linked cause), ASD, mitral valve prolapse, hypotonia, macroorchidism, low set ears, long thin face and high arched palate
Describe Gilbert’s syndrome?
Autosomal recessive
Episodic jaundice after episodes of fasting, exercise or illness
Raised unconjugated bilirubin but no liver function test derangement.
No treatment required
Sx, Ix and Mx of transposition of the great arteries?
Cyanosis and tachypnoea shortly after birth
OE: loud single S2 heart sound, with no murmur and a prominent right ventricular impulse is palpable.
CXR = egg on side appearance
Mx = maintain ductus arteriosus with prostaglandin E1 until surgery
Mx of thread worms?
Single dose oral mebendazole to all household contacts
What should you consider to be the cause of prolonged cough without an apparent cause (>14 days), may be URTI symptoms associated with post-tussive vomiting? How do you treat?
Pertussis (whooping cough) caused by Bordetella pertussis.
Mx = macrolide ABx e.g. azithromycin
Sx of Congenital Adrenal Hyperplasia?
If severe = hyponatraemia, hyperkalaemia and hypoglycaemia shortly after birth. Females will have virilised (ambiguous) genitalia with an enlarged clitoris
If mild = tall for their age, early onset puberty. Males will small testicles with a large penis and deep voice, Females will have no periods, facial hair and a deep voice.
Hyperpigmentation is often seen
Mx Congenital Adrenal Hyperplasia?
Cortisol replacement with hydrocortisone and Aldosterone replacement with fludrocortisone.
Females with ambiguous genitalia require corrective surgery
What are the key features in Kallmann syndrome? What is its mode of inheritance and karyotype
X-linked recessive, 46XY
Hypogonadotropic hypogonadism and an impaired sense of smell.
At birth there may be undescended testicles or a small penis, later there may be lack of puberty
Describe Transient Tachypnoea of the Newborn?
The commonest cause of respiratory distress in newborns, it is often associated with C-section delivery.
CXR = hyperinflated lungs and fluid in the horizontal fissure
Mx = supportive care and oxygen if necessary
What are the distinguishing features of Pierre-Robin syndrome?
Micrognatia, cleft palate and posterior displacement of the tongue (leads to breathing difficulties)
Without any family history
What are the distinguishing features of William’s syndrome?
Learning difficulties, short stature, very friendly and extroverted, transient neonatal hypercalcaemia and supravalvular aortic stenosis
What are the distinguishing features of Noonan syndrome?
Webbed neck, pectus excavatum, short stature and pulmonary stenosis
What are the distinguishing features of congenital cytomegalovirus?
Hearing loss, low birth weight, petechial rash, microcephaly and seizures
Below what HR should you start CPR?
If a HR <60/min with signs of inadequate perfusion despite adequate respiratory support
Below what centile should children be referred for a non-urgent paediatric out patient review?
<0.4th centile
What does small testes in the context of precocious puberty imply?
An adrenal cause
How can we differentiate the causes of cyanotic congenital heart disease?
If it occurs in the 1st few days of life = transposition of the great arteries
If it occurs in the 1st month or 2 of life = tetralogy of fallot
In BLS where should you check the pulse?
In infants check brachial/femoral, in children check femoral
How should you manage children under 5 with diarrhoea (due to gastroenteritis)?
Offer oral rehydration solution and discourage fizzy drinks/fruit juice.
Do not offer anti-diarrhoeal medications
True or false, you can give either cefotaxime or ceftriaxone to all children with ?meningitis?
FALSE
Ceftriaxone is contraindicated in babies under 3 months
True or false, scarlet fever is a notifiable disease?
True!
How should you manage undescended testes?
If it is unilateral review in 3 months and refer if the problem persists - aim to operate around 1 year
If it is bilateral urgent paeds review is needed within 24 hrs
Which 2 bacteria are associated with increased morbidity and mortality in CF?
Pseudomonas and Bulkholeria
How should you manage premature babies when it comes to vaccination?
Offer them the vaccines according to their chronological age (NOT gestational age)
Those born before 28 weeks should receive their 1st set of vaccines in hospital due to risk of apnoea
Describe Infantile Spasms (West Syndrome)?
Presents in the 1st 4-8 months of life (mainly in males). Characteristic Salaam Attacks (flexion of the head, neck and trunk followed by extension of the arms) - attacks last 1-2 seconds but there may be many
There is progressive mental handicap and a poor prognosis
Mx = Vigabatrin
Which gender is a poor prognostic factor in ALL?
Being a male
Sx of Cows Milk Protein Allergy?
Regurgitation/vomiting, diarrhoea, ectopic eczema/urticaria, colic symptoms and chronic wheeze/cough
Mx of CMPA?
If formula fed: 1st line = switch to extensive hydrolysed formula, 2nd line = amino acid based formula
If breast fed: continue breastfeeding and eliminate cows milk from the maternal diet
What should you do if a baby presents with jaundice within the 1st 24 hours of life?
Measure serum bilirubin within 2 hours!
Is Perthe’s disease more common in boys or girls? What will early XR show?
More common in boys
Early X-ray will show widening of the joint space
Advice to give to parents in nocturnal enuresis?
Regular toileting throughout the day, avoid caffeine and excess fluid intake before bed
Sx of Kawasaki disease?
Fever for >5 days which is resistant to anti-pyretic drugs
Conjunctival injection
Bright red, cracked lips and a strawberry tongue
Cervical lymphadenopathy
Red palms and soles which may peel
Mx of Kawasaki disease?
High dose aspirin, IVIG and echo to screen for carotid aneurysms
What is the pathway for childhood asthma management?
SABA -> SABA + ICS -> SABA + ICS + LTRA -> SABA + ICS + LABA
Sx and Mx of Patent Ductus Arteriosus?
Difficulties feeding and weight loss, continuous machinery murmur, large bounding collapsing pulse, wide pulse pressure, Left sub clavicular thrill and a heaving apex beat
Mx = indomethacin and ibuprofen
How does mitochondrial disease affect the sex’s differently?
Inheritance is only via the maternal line, 0% of children from an effected male will inherit the disease, 100% of children from an effected female will inherit the disease
When should you suspect pneumonia over broncitis?
Fever >39 degrees
Persistent focal crackles in the lungs
What should you do with a patient presenting with constipation and a ballotable abdominal mass?
Urgent paeds refferal
How is achondroplasia inherited?
AD
Patients are always heterozygous as homozygous individuals are incompatible with life
What is Plagiocephaly?
Occipital flattening which pushes the ipsilateral forehead and ear forward. Skull is like a parrolelogram
No management is required - it is caused by children lying on their backs
What is Craniosynostosis?
Premature fusion of the skull bones
How does fragile X affect head size?
It causes macrocephaly
Mx of children under 5 with nocturnal enuresis?
Reassurance and advice
What dietary advice should you give to CF patients?
High calorie, high fat diet with pancreatic enzyme supplementation after every meal
What are you at higher risk of in undescended testes?
Increased risk of infertility, torsion and testicular cancer
How do you do chest compressions in children and infants?
In children = 1 hand compressing the lower half of the sternum
In infants = 2 thumb encircling technique
How are LH/FSH and testosterone affected in androgen insensitivity syndrome?
Raised LH and FSH with normal to raised testosterone
What medical issues are seen more commonly in patients with Down’s syndrome?
ALL, Alzheimer’s, Hypothyroidism, Atlantoaxial instability, Short stature, Infertility, Learning difficulties and frequent respiratory tract infections
What should you do if there is raised Immunoreactive Trypsinogen (IRT) on heel prick test?
Do a sweat test ?CF
If raised this confirms the diagnosis
What causes Prader-Willi Syndrome?
Imprinting, the patient receives no copy of the paternal gene
What is being described by a multiloculated heterogenous mass above the hyoid bone?
A thyroglossal cyst
Which heart condition is seen in DMD?
Dilated Cardiomyopathy
What are the possible causes of jaundice in the 1st 24 hours of life?
It is ALWAYS pathological
Caused by ABO or rhesus haemolytic disease, hereditary spherocytosis or G6PD deficiency
Describe Osgood-Schlatter disease?
Gradual onset knee pain worse on kneeling or activity and relieved by rest. Pain is over the tibial tubercle and is seen in sporty teens
When are the combination vaccines given?
6-in-1 in those under <6 months
4-in-1 in those aged 3-4 years
3-in-1 on those ages >13 years
How can you distinguish between cephalohematoma and caput succedaneum?
Cephalohaematoma does not cross the suture lines
Caput Succedaneum does
What are Barlow and Ortolani test?
Used to screen for DDH
Barlow = attempts to dislocated the femoral head from the socket
Ortolani = attempts to relocate the femoral head into the socket
Sx of retinoblastoma? What is the pattern of inheritance?
Sx = loss of red reflex (most common), strabismus and visual problems
Autosomal dominant
1st signs of puberty?
Breast development in girls and testicular swelling in boys
What is the school exclusion in whooping cough?
2 days after starting antibiotics or 21 days after symptom onset
School exclusion in measles? What are the key symptoms?
4 days from onset of rash
Sx = rash begins on the head and spreads to the trunk then the limbs, koplik spots are seen in the mouth
School exclusion in rubella? What are the key symptoms?
5 days from onset of rash
Sx = rash starts on the head/neck and spreads to the feet. It is exacerbated by heat
What is seen in toddler’s diarrhoea?
Diarrhoea containing undigested food. There are no other symptoms
Sx of congenital rubella?
Sensorineural deafness, PDA and congenital cateracts
What should you do if there is ITP and splenomegaly?
BM aspirate
True or false, most children with IgE mediated CMPA will be milk tolerant by 3 years old?
TRUE
What should you always consider in any child with a delayed presentation?
Non-accidental injury
Which age group is pyloric stenosis most commonly seen?
3-6 weeks.
Babies will be keen to feed between vomiting episodes
What is seen in the 6-in-1 vaccine?
Diphtheria, Pertussis, Polio, Tetanus, HiB and Hep B
When do we give the MMR vaccine?
12 months and 3-4 years
What is Ebstein’s anomoly?
A large atrium with small ventricles and a low insertion of the tricuspid valve and tricuspid incompetence
True or false, transient lactose intolerance is common following gastroenteritis?
TRUE
Sx of Patau’s syndrome? Which chromosome is affected?
Sx = microcephaly, small eyes, low-set ears, cleft palate and polydactyly
Chromosome 13 is affected
When is bow legs considered a normal variant until?
Considered a normal variant until 3 years old. Should resolve by 4 years
Major risk factors for sudden infant death syndrome?
Prone sleeping, parental smoking, bed sharing, hyperthermia/head covering and prematurity
What is benign rolandic epilepsy
Partial seizures which may develop secondary to generalised seizures before or after bed time seen in children under 12
What is seen in males with CAH who have precocious puberty?
Normal for age testes with low LH and FSH but high testosterone (as there is a non-androgen cause of high testosterone)
What should you do as part of a sepsis screen in a child under 3 months with a fever?
FBC, Blood culture, CRP, Urine testing, CXR (if resp symptoms), stool culture (if diarrhoea)
