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MEDICINE FINALS > PAEDS > Flashcards

PAEDS Flashcards

1
Q

What are the milestones in a rapid development screen?

A

Smiling - 6 weeks
Sounds (turns to) - 6 months
Sitting - 9 months
Standing - 12 months
Words - 18 months
Talk - 50 words by 2.5 y, 3 word sentence by 3 y
Friends - pre-school

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2
Q

What are 3 primitive reflexes and when would their presence suggest cerebral palsy?

A

Moro reflex
- sudden extension of head leads to symmetrical extension and abduction followed by adduction of arms

Palmar grasp
- flexion of fingers when object placed in palm

Rooting
- head turns to stimulus when touched near mouth

Persists past 3-6 months

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3
Q

What stage of development would you expect a baby of 6 wks to be at?

A

GM - lift head off flat surface
FM/V - follow an object horizontally
HSL - startled by loud noises
SEB - smile

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4
Q

What stage of development would you expect a child of 3 months to be at?

A

GM - lift head and chest off flat surface
FM/V - follow object horizontally
HSL - turn to sounds, vocalising
SEB - recognise mother

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5
Q

What stage of development would you expect a child of 6 months to be at?

A

GM - sit supported, roll over
- absence of primitive reflexes
FMV - reach out, transfer object between hands
HSL - laugh, scream, babble
should be vocalising
SEB - expresses likes/dislikes, starting to wean at 6m

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6
Q

What stage of development would you expect a child of 9 months to be at?

A

GM - crawling/bum-shuffling
- pull to stand at 10 m
should sit unsupported
FMV - should be able to transfer between hands
HSL - responds to name, says mama, dada
SEB - clap, wave, play peek-a-boo

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7
Q

What stage of development would you expect a child of 1 year to be at?

A

GM - stand unsupported, pull upright, unsteady gait
FMV - scribble with crayon, mature pincer grip
should have pincer grip
HSL - use a few words
SEB - stranger anxiety
- drink from cup using 2 hands

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8
Q

What stage of development would you expect a child of 18 months to be at?

A

GM - walk backwards, walk upstairs with one hand held
- pick up object, recover
should be walking independently
FMV - build a tower of 3-4 bricks
- turn book pages
HSL - point to eyes, nose, mouth
- should be able to say at least 6 words with meaning

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9
Q

What are the red flags for gross motor development?

A
  • Poor head control or floppiness at 6 months
  • Unable to sit unsupported at 9 months
  • Not weight bearing through legs at 12 months
  • Not walking at 18 months
  • Not running at 2 years, or persistent toe walking
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10
Q

What are red flags for speech development?

A
  • No double syllable babble at 1 year
  • <6 words or persistent drooling at 18 months
  • No 2 – 3 word sentences by 2.5 years
  • Speech remains unintelligible to strangers by 4 years
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11
Q

What are the key features of autism?

A
  • impaired social communication and interaction
  • repetitive behaviours, interests and activities
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12
Q

What is the criteria for diagnosing attention deficit hyperactivity disorder?

A

6 features of inattention, hyperactivity and/or impulsivity + evidence of developmental delay

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13
Q

How is ADHD managed?

A
  1. 10 week watch-and-wait period before referring to secondary care
  2. education and training programmes
  3. 6 week trial of methylphenidate
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14
Q

What do you need to be careful of when prescribing methylphenidate?

A
  • monitor height and weight every 6 months
  • perform a baseline ECG as it is potentially cardiotoxic
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15
Q

How would you manage a child who has stopped breathing?

A
  1. shout for help
  2. open airway
  3. look, listen, feel for breathing
  4. FIVE RESCUE BREATHS
  5. check femoral pulse
  6. 15:2 chest compression + rescue breath
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16
Q

What is the management for Patent ductus arteriosus?

A

PDA with no cyanosis - Indomethacin
PDA with cyanosis - prostaglandins

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17
Q

What is the management for asthma in children aged 5-16?

A
  1. SABA
  2. SABA + low dose ICS (budesonide)
  3. SABA + low dose ICS + LTRA (Montelukast)
  4. SABA + low dose ICS + LABA (salmeterol)
  5. SABA + MART
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18
Q

When would intussusception typically present?

A

boys aged 3m - 18 months

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19
Q

How does intussusception present?

A
  • colic pain
  • pallor
  • vomiting
  • draws knees up to chest
  • red currant jelly in stools
  • sausage shaped mass in RUQ
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20
Q

How would you investigate a child with suspected intussusception and what would it show?

A

US abdomen - target shaped/donut mass

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21
Q

How is intussusception treated?

A

rectal air insufflation

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22
Q

When would malrotation typically present?

A

first 1-3 days of life (but can be any age)

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23
Q

How does malrotation present?

A
  • bilious vomiting (if volvulous)
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24
Q

What are risk factors for developing malrotation?

A
  • Exomphalos
  • Congenital diaphragmatic hernia
  • Intrinsic duodenal atresia
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25
Q

How is malrotation investigated and treated?

A

Ix = upper GI contrast study and USS

Mx = laparotomy (Ladd’s procedure)

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26
Q

Who typically gets pyloric stenosis?

A

boys, 2-8 weeks, family history!!

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27
Q

How would pyloric stenosis present?

A

projectile, non-bile stained vomiting

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28
Q

How do you investigate someone with possible pyloric stenosis?

A

Test feed = olive in RUQ and USS

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29
Q

How is pyloric stenosis treated?

A

Ramstedt pyloromyotomy

30
Q

What biochemical picture would you get with pyloric stenosis?

A

low Na, K and Cl

31
Q

What reassuring things could you say to parent of child with GORD?

A
  • v common
  • usually begins before 8 weeks
  • becomes less frequent over time (normally resolved by 1yr)
32
Q

What is the initial treatment for a child with GORD?

A
  • small meals
  • sit upright
  • burp
33
Q

What is the pharmacological treatment for GORD?

A
  1. feed thickener e.g. alginate therapy
  2. trial of PPI e.g. ranitidine
  3. refer to paediatrician
34
Q

What are red flags for GORD?

A
  • bile
  • blood
  • projectile
  • faltering growth
35
Q

What is Hirschsprung’s disease?

A

Absence of ganglion cells in myenteric/submucosal plexus

36
Q

How would Hirschsprung’s disease present?

A

Delayed passage of meconium
Abdo distension
Vomiting

37
Q

How is Hirschsprung’s disease diagnosed?

A

Suction rectal biopsy

38
Q

How is Hirschsprung’s disease treated?

A

Initially rectal washouts then anorectal pull through procedure

39
Q

How would necrotising enterocolitis present?

A

abdo distension
bloody stools

40
Q

What are risk factors for developing necrotising enterocolitis?

A

Prematurity !
antibiotics >5 days

41
Q

How is necrotising enterocolitis treated?

A

total gut rest
TPN
- laparotomy if perforated

42
Q

How would you investigate for necrotising enterocolitis and what would you find?

A

X-ray
- pneumatosis intestinalis and evidence of free air

43
Q

How does coeliac disease present in infants? (4)

A
  • diarrhoea
  • faltering growth
  • muscle wasting
  • abdo distension
44
Q

How is coeliac disease diagnosed?

A
  1. IGA TTG (if low THEN anti endomyseal antibodies)
  2. endoscopic intestinal biopsy
45
Q

What would you find on biopsy of someone with coeliac?

A
  • villous atrophy
  • crypt hyperplasia
  • lamina propria infiltration with lymphocytes
46
Q

What is the most likely causative organism of meningitis in neonates?

A

Group B Strep

47
Q

What is the most likely causative organism of meningitis in children?

A

N meningitidis
Strep pneumoniae

48
Q

What would you see on LP sample of bacterial meningitis?

A

cloudy
- raised protein
- raised neutrophils
- low glucose

49
Q

What would you see on LP sample of viral meningitis?

A

clear
- normal/raised protein
- raised LYMPHocytes
- normal glucose

50
Q

Give 4 contraindications to LP in suspected meningitis?

A
  • focal neurological signs
  • papilloedema
  • significant bulging of the fontanelle
  • signs of meningococcal septicaemia
51
Q

What is the treatment for bacterial meningitis?

A

GP = IM benzyl penicillin

<3m = cefotaxime + amox
>3m = ceftriaxone

+ dexamethasone if >3m and super infected

52
Q

When would you do an LP on a child?

A

<3m with fever
<1yr and unexplained fever

53
Q

What are the signs of meningococcal septicaemia?

A

same as meningitis + NON-BLANCHING RASH

54
Q

What is the prophylaxis for meningitis and who should get it?

A
  • people who have had close contact within the 7 days before onset
  • oral ciprofloxacin
55
Q

How would scarlet fever present?

A

high fever+sore throat -> strawberry tongue -> rough SANDPAPER rash on cheeks, chest and tummy

56
Q

Which organism is responsible for scarlet fever and how is it treated?

A

Group A strep = penicillin

57
Q

How does measles present?

A

cough/coryza/cranky/conjuncitvitis/kopliC spots
THEN
maculopapular rash from head to toe

58
Q

What is a common complication of measles?

A

otitis media

59
Q

How is measles treated?

A

supportive -> should resolve in 7-10 days

60
Q

How does rubella present?

A

1- coryzal prodrome
2 - pink maculopapular rash
3 - LYMPADENOPATHY + ARTHRALGIA

61
Q

How does parvovirus/slapped cheek disease present?

A

1 - coryzal prodrome/fever
2 - malar rash/ gloves and stocking

62
Q

When does parvovirus stop being infectious?

A

When the rash disappears

63
Q

Which organism is mostly responsible for bacterial tonsillitis?

A

Group A beta haemolytic strep
( Strep pyogenes)

64
Q

When would you prescribe AbX for tonsillitis?

A

If they score 2-3 (delayed prescription)
If they score 4/5 (immediate prescription)

65
Q

Which organism most commonly causes bronchiolitis?

A

RSV (Respiratory syncytial virus)

66
Q

Which age group are most commonly affected by bronchiolitis?

A

<1

67
Q

How is bronchiolitis managed?

A

Admit if:
- <3 months
- prem
- downs syndrome
- CF
- <75% milk intake
- RR >70
- O2 <92

Tx = NG/nasal suction/ O2

68
Q

What causes croup?

A

Parainfluenza virus

69
Q

Which age group are most affected by croup?

A

6m - 2 years

70
Q

What symptoms would a child with croup get?

A
  • increased WOB
  • barking cough
  • STRIDOR
  • low grade fever
71
Q

How is croup treated?

A

ORAL DEXAMETHASONE
- or high flow O2 + nebulised adrenaline if difficulty breathing

72
Q

What is the causative organism in epiglottitis?

A

Haemophilus influenzae type b

MEDICINE FINALS (19 decks)

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