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Difficult Passmed- MLA > Paeds > Flashcards

Paeds Flashcards

1
Q

Organism likely responsible - pain out of proportion on clinical presentation, contact lens and recent freshwater swimming is classical of

A

acathoembic keratitis

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2
Q

Typically what organism is seen in contact lens wearers who have keratitis

A

Pseudomonas aeruginosia

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3
Q

Features of Retinoblastoma - is it familial, symptomatic, management

A
  • Autosomal dominant, around 10% cases are hereditary
  • Absence red reflex, replaced by white pupil, strabismus, visual problems
  • Mx - enucleation
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4
Q

GORD Mx in children and if they don’t respond to first line

A

1.Alginates (gaviscon) + thickened feeds
2. Don’t respond - trial PPI

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5
Q

What age would the av child be able to sit without support, crawl and walk unsupported

A

Sit with support = 6m
Sit without support = 6-8m
Crawls = 9m
12m = crusises, walks with one hand held
14-15m = walks unsupported

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6
Q

What are the rules regarding when to vaccine premature babies?

A

Premature = routine Vacc according to chronological age
Babies born prior to 28 weeks = first set of immune at hospital as risk apnoea

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7
Q

Ix for diagnosis of DMD

A

Genetic testing

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8
Q

What type of inheritance is Haemophilia A

A

X linked recessive - only in males

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9
Q

At what age:
- Respond to their own name
- Vocal 2-6 words
- Talk in short sentences (3-5 words)

A
  • Respond to their own name = 9-12m
  • Vocal 2-6 words = 12-18m
  • Talk in short sentences (3-5 words) = 2.5-3 years
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10
Q

Describe Meconeum ileus

A

Usually delayed passage meconium and abdominal distention
Most have CF
XR will not show fluid level as meconium is viscid
Infants who down respond to PR contrast and NG N-Actyl cysteine will need surgery to remove plugs

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11
Q

Shaken baby syndrome triad

A

Retinal haemorrhage, subdural haematoma, encephalopathy

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12
Q

What are the contraindications to Lumbar puncture

A
  • Focal neuro signs
  • papilloeema
  • Significant bulging fontanelle
  • DIC
  • Signs cerebral herniation
    Meningococcal septicaemia - do blood cultures + per instead
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13
Q

Mx of episodic vs multiple trigger viral wheeze

A

Symptomatic tx only
1. SABA or anticholinergic by space
2. Intermittent LRTA or inhaled corticosteroids or both

If multiple trigger wheeze - trial of either ICS or LRTA 4-8 weeks

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14
Q

Mitochondrial diseases - what mode inheritance

A

Maternal

So all children from affected mums ill inherit it.

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15
Q

Ix of choice fro stable children with suspected Meckels diverticulum

A

Technetium scan

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16
Q

Tx meningitis in children <3m VS >3M

A

<3m = IV amoxicillin and IV Cefotaxime to cover Listeria

> 3m = IV Cefotaxime (or ceftriaxone)

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17
Q

Features Films tumour

A

Abdo mass (most common), painless haematuria, flank pain, anorexia, fever etc.

It is a childhood malignancy in <5 usually

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18
Q

Which murmur/ defect:
Mid-sys C-D murmur, loudest at upper left sternal border

A

ASD

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19
Q

Which murmur/defect: Pan-sys, loudest at left lower sternal border

A

VSD

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20
Q

Continuous C-D machinery murmur.
What problems and Mx

A

PDA - Indomethicin/ibuprofen to close

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21
Q

Which CHD is associated with Turners syndrome and the Mx

A

Coarctation of aorta
Prostaglandins till surgery - alprostadil

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22
Q

what murmur = Ejection systolic, slow rising pulse and narrow pulse pressure

A

Aortic valve stenosis

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23
Q

What are the 3 cyanotic heart disease problems, the tx and age of presentation

A

Tet Fallot, Transpoistion great arteryes, Tricuspid atresia

In Cyanotic need Prostaglandin E1 - Alprostadil to maintain PDA till surgery

Cyanotic presenting first days of life = TGA
Presenting 1-2m age = TOF

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24
Q

Mx of the CHD that causes boot shaped heart on CXR

A

Tet dallot - PGs till surgery

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25
Q

Chronic asthma <5 mx

A

SABA
SABA + 8 week ICS trial
SABA + ICS + LRTA
Stop LRTA + specialist

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26
Q

Chronic asthma 5-16 mx

A

SABA
SABA + ICS
SABA + ICS + LRTA
SABA + ICS + LABA (salmeterol)
SABA + MART (inc ICS)
SABA + increase MART dose

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27
Q

Chronic asthma 16+ mx

A

SABA
SABA + ICS
SABA + ICS + LABA

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28
Q

Acute asthma mx

A

Salbutamol space
Neb salb/ipratropium bromide
PO PRednisolone
IV Hydrocortisone
IV MgSO4
IV Salb
IV Aminophylline

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29
Q

Short synacthen
↓cortisol, ↑ACTH

  • What type of adrenal insufficiency is this
A

Primary adrenal insufficiency
Addison’s disease - autoimmune destruction of adrenals. Bronze hyperpigmentation

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30
Q

Short synacthen
↓ACTH ↓Cortisol

What type of adrenal insufficiency is this

A

2 Adrenal Insufficiency
Loss/damage to pituitary

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31
Q

↓BP, AMS, ↓Blood sugar, ↓Na, ↑K+ + abdo pain = diagnosis and management

A

Addisonian Crisis
↓BP, AMS, ↓Blood sugar, ↓Na, ↑K+
IV hydrocortisone

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32
Q

Ambiguous genitalia
Hyperpigmentation
M- early puberty, small testes
F- facial hair

condition and what happens to cortisol and aldosterone

A

CAH
↓ Cortisol ↓Aldosterone

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33
Q

Primary amenorrhoea, undescended testis causing groin swellings in females, breast development.
Phenotype female but genotype male

what condition is this

A

androgen insensitivity

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34
Q

Delayed pubertym hypogonadism, anosmia, sex hormones low, FH,FSH low/N (inappropriately)
what condition is this

A

Kallman

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35
Q

Taller than av, lack secondary sexual characteristics, small firm testes, infertile, gynaecomas, elevated gonadotroohin levels. Chromosomal analysis

what condition

A

kleinfelters

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36
Q

Most common nephrotic syndrome in children

A

Minimal change disease - hyaline casts

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37
Q

Mx Enuresis - nocturnal vs urge

A

1.Alarms
Nocturnal - desmopressin
Urge - oxybutynin

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38
Q

Projectile non-bilious
Common 3-6weeks
vomiting
Olive shaped mass

dx, ix, mx

A

Pyloric stenosis
US
Hypochloremic Hypokalamia met alkalosis
Ramstedt pyloromyotomy

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39
Q

Central abdominal pain + URTIs
Inflamed LNS

dx

A

Mesenteric adenitis

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40
Q

6-9m
Diarrhoea, vomiting, sausage shaped mass (RUQ), drawing legs up to abdo, pallor, red jelly stool (late sign)

dx, ix, mx

A

Intussusception
US
Air insufflation

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41
Q

Ix, Mx intestinal malrotation

A

Upper GI contrast study + USS
Laparotomy and if volvulus present or high risk then Ladds procedure

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42
Q

Delay in meconium
Abdo distention/constipation in older children

dx, ix, mx

A

Hirschprung’s
Rectal biopsy
Rectal washout -> anorectal pull through surg

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43
Q

Choling + cyanotic spells after aspiration
Ass with polyhydramnios

dx

A

oesophageal atresia

44
Q

Jaundice after 14 days, increased conjugated bilirubin

Most likely dx and mx

A

Biliary atresia
Kasai procedure

45
Q

Usually in preterm
Abdo distention + blood in stools

dx, ix, mx

A

Necrotising enterocolitis
XR - football sign (Riglers)
TPN + gut rest

46
Q

Undescended testis - management:
Unilat vs bilat

A

Unilateral UD testicle - review at 3m - if perists then refer. If orchidopexy then most at 1years old.
Bilateral then review by senior paediatrician in 24hrs as may need urgent endocrine or genetic Ix

47
Q

Congenital defect - ant abdo wall defect lateral to umbilical cord.

Name of condition and mx plan

A

Gastroschisis
Congenital defect - ant abdo wall defect lateral to umbilical cord. Can attemp VD but surgery asap

48
Q

Abdo contents protrude through ant abdo wall but covered in amniotic sac.

dx, mx

A

Exomphalos (omphalocoele)
Abdo contents protrude through ant abdo wall but covered in amniotic sac. C section planned.

49
Q

Toddler diarrhoea

A

tools vary consistency, often contain undigested food

50
Q

Typically first 3m life in formula fed infants
Regurg, vom, diarrhea, urticaria, colic symp, wheeze, rarely angioedema/anaphylaxis

dx, mx (severe vs mild to mod)

A

If severe - paediatrician (failure to thrive)
In formula fed - extensive hydrolysed formula if mild-mod.
Severe - amino acid based formula
Continue breast feeding and eliminate cows milk protein from maternal diet.
IgE mediated - most will be ok by 5, in non-IgE most fine by 3

51
Q

Mx umbilical hernia

A

Usually self resolve, but if large or symptomatic perform elective repair at 2-3 years of age.
If small and asymptomatic then elective repair 4-5 years

52
Q

Epilepsy meds - what to give in general vs focal and absence and common S.E

A

SV (teratogenic) except…
Focal - carbamazepine (agranulocytosis)/ Lamotrigine (SJS)
Absence - Ethosuximide (Night terrors/rashes)

53
Q

short limbs, large head, trident hand,s, lumbar lordosis

dx, inheritance pattern

A

Achondroplasia
Autosomal dominant - mutation n FGFR-3 = short limbs, large head, trident hand,s, lumbar lordosis

54
Q

1st line Mx depression in children

A

FLuoxetine

55
Q

1st line mx GAD in children

A

Sertraline

56
Q

First line mx OCD+ bulimia in children

A

SSRI

57
Q

Lack interest/ desire in relationships

type personality

A

Schizoid

58
Q

Unusual thoughts/beliefs

Type personality disorder

A

Schizotypal

59
Q

Microcephalic, Polydactyly, small eyes, cleft palate, scalp lesions

A

Pataus T13

60
Q

Micrognathia, rocker bottom feet, low set ears, overlapping fingers

A

Edwards T18

61
Q

Learning disabilities, macrocephaly, long face, large ears (protrudina, macro-orchidism. Most common ND delay cause

A

Fragile X

62
Q

Webbed neck, Pectus excavatum. Short stature, pulmonary stenosis

A

Noonan

63
Q

Microganthia, posterior displacement of the tongue (upp airway obstruction) + cleft palate

A

Pierre robin

64
Q

Hypotonia, Hypogonadism, obesity

A

Prader willi

65
Q

Short, LDs, elfin faces, friendly/extrovert personality, transient neonatal ↑Ca, supraclavicular aortic stensois

A

Williams

66
Q

Deletion C5p. Cat cry, feeding problems, poor weight gain, LDs, microcephaly

A

cri du chat

67
Q

Loss UBE3A (mum). Fascination with water, happy, widely spaced teeth

A

angelman

68
Q

Webbed neck, short widely spaced nipples, as with CHD (coarctation of aorta). Primary amenorrhoea

A

Turners 45 XO F

69
Q

↓tone, prominent epicanthic folds, single palpable crease
Screen for atlanto-axial instability if participate in sports (_^risk neck dislocation)

A

Downs syn

70
Q

↓LH/FSH, ↓test/oest - delay puberty + anosmia

A

kallman

71
Q

When to do surgery for hypospadias

A

Cna be ass with cryptorchidism and inguian hernia
Mx - refer to specialist and surgery usually at 12m. Do not cirucmcise before surgery.

72
Q

Cataracts, LDs, heart defect, hearing loss

which congenital infection

A

Rubella

73
Q

FGR, Limb hypoplasia, chorioretinitis, scars

which congenital infection

A

VSV

74
Q

FGR, Microcephaly, HL LD, Seizures, vision loss

which congenital infection

A

CMV

75
Q

intracranial calcification, hydrocephalus, chorioretinitis
which congenital infection

A

Toxoplasmosis

76
Q

Microcephaly, FGR, ventriculomegaly, cerebellar atrophy

which congenital infection

A

zika

77
Q

Perthes mx

A

surgery
if <6 observe

7 year old body - XR

78
Q

SUFE - classic age and mx

A

12 boy obese - XR
Often loss internal rotation of leg
Surgery

79
Q

↑ ALP,Nocturnal pain
sunburst XR <48hrs

A

osteosarcoma

80
Q

Mx DDH

A

Pavlik harness

81
Q

Mx clubfoot (Talipes)

A

Ponseti method

82
Q

Strawberry tongue, Cervical LNs, conjunctivitis, desquamation hands/sole of feet, fever 5+days

dx, ix, mx

A

kawasaki

ECHO to screen for coronary artery aneurysms
Aspirin + IV IgG

83
Q

Petechia no fever

Dx

A

ITP

84
Q

Koplik spots, rash starts behind ear

Dx and exclusion rules

A

Measles
Isolate 4d from resolution symp

85
Q

↑ LNs (cervical), can have joint pain

Dx and exclusion rules

A

Rubella
isolate 5 d from res symptoms

86
Q

Scarlet fever isolation rules

A

24 h after Abx

87
Q

Whooping cough Tx and isolation rules

A

2d after Abx (PO azizthromycin) or 21d from onset. Nasal swab confirms

88
Q

Mumps isolation rules

A

5d from onset swollen glands

89
Q

Impetigo isolation rules

A

lesions crusted over or 48hrs after Abx

90
Q

rash, caused by HHV 6-7, 1-2 weeks after with high fever

dx

A

roseola infant

91
Q

Meningitis tx for <3m vs >3m

A

<3m = IV Amox + iV Cefotaxime
>3m = IV cefotaxime (or ceftriaxone) +/- dex

92
Q

Pneumonia Mx in children and if mycoplasma or ass with influenza how does this change

A

Amox
Macrolides added if no response
Mycoplasma pneumonia (target lesions) or chlaymdia suspected then macrolides (erythromycin) is first line
If associated with influenza (staph aureus) then co-amox is first line.

93
Q

Peri-anal itching (mostly night), girls may have vulval symp

dx and mx

A

Threadworm
Peri-anal itching (mostly night), girls may have vulval symp)
Single dose mebendazole (>6m) for whole household and hygiene advice

94
Q

Resus fluids in children

A

10 ml/kg stat 0.9% NaCl

95
Q

Maintainance fluids for children

A

0.9% NaCl + 5% dextrose
100 ml/kg for first 10kg
50 ml/kg for second 10kg
20 ml/kg remaining kg

96
Q

Replacement fluids for children

A

% dehydration X Weight X 10
5% = dry membranes, thirsty ↓UO, normal obs
10% = mild tachy, sunken eyes, NBP
15% = Marked tacy, ↓ BP, DCRT, Mottled

97
Q

newborn resuscitation steps

A

Dry + maintain temp
Assess tone, RR, HR
If gasping or not breathing - 5 inflation breaths
Reassess
If HR not improving and <60 then start Compressions and ventrilaiton breaths at 3:1

98
Q

APGAR score calculating

A
99
Q

Cephalohaematoma vs caput succedaneum

A

Cephalohematoma
Does NOT cross suture lines
Typically develops several hours after birth
Mostly parietal region
Up to 3m to resolve

Caput succedaneum
Crosses suture lines - mostly over vertex
Present at birth
Resolves within days

100
Q

Red flags in development of children

A

refer:
Doesn’t smile 10w
Cant sit unsupported at 12m
Cant walk 18m

Fine motor - hand pref before 12 (CP)
Gross motor - mostly DMD, CP etcSpeech and language - always check hearing.

101
Q

Neonatal hypoglycaemia - def, symptoms and mx

A

<2.6 mmol/L
Transient in first few hours after birth is common
Jittery, irritable, poor feeding, drowsy, hypotonia…
Asymp = Encourage normal feeding, monitor
Symptoms/very low = admit to unit, IV infusion 10% dextrose

102
Q

Softening cartilage, common in teen girls
Ant knee pain on walking up and down stairs + rising from prolonged sitting

diagnosis and mx

A

Chondromalacia patellae
Usually responds to physio

103
Q

Sporty teens
Pain, tenderness, swelling over tibial tubercle

dx

A

Osgood-Schlatter

104
Q

Pain after exercise
Intermittent swelling and locking

of knee

diagnosis

A

Osteochondritis dissecans

105
Q

Athletic teen boys
Chronic ant knee pain that worsens after running
Tender below patella on exam

dx

A

Patellar tendonitis

106
Q

Which hearing tests at: newborn, 6-9m, 18m-2.5 years, 2.5years and >3

A

Newborn - otoacoustic emission test (screening). If abnormal then Newborn & infants - auditory brainstem response test
6-9m - distraction test
18m-2.5 years - recognition familiar objects
>2.5 - performance testing/ speech discrimination tests
>3 - pure tone audiometry

Difficult Passmed- MLA (26 decks)

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