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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
Chronic asthma <5 mx
SABA SABA + 8 week ICS trial SABA + ICS + LRTA Stop LRTA + specialist
26
Chronic asthma 5-16 mx
SABA SABA + ICS SABA + ICS + LRTA SABA + ICS + LABA (salmeterol) SABA + MART (inc ICS) SABA + increase MART dose
27
Chronic asthma 16+ mx
SABA SABA + ICS SABA + ICS + LABA
28
Acute asthma mx
Salbutamol space Neb salb/ipratropium bromide PO PRednisolone IV Hydrocortisone IV MgSO4 IV Salb IV Aminophylline
29
Short synacthen ↓cortisol, ↑ACTH - What type of adrenal insufficiency is this
Primary adrenal insufficiency Addison’s disease - autoimmune destruction of adrenals. Bronze hyperpigmentation
30
Short synacthen ↓ACTH ↓Cortisol What type of adrenal insufficiency is this
2 Adrenal Insufficiency Loss/damage to pituitary
31
↓BP, AMS, ↓Blood sugar, ↓Na, ↑K+ + abdo pain = diagnosis and management
Addisonian Crisis ↓BP, AMS, ↓Blood sugar, ↓Na, ↑K+ IV hydrocortisone
32
Ambiguous genitalia Hyperpigmentation M- early puberty, small testes F- facial hair condition and what happens to cortisol and aldosterone
CAH ↓ Cortisol ↓Aldosterone
33
Primary amenorrhoea, undescended testis causing groin swellings in females, breast development. Phenotype female but genotype male what condition is this
androgen insensitivity
34
Delayed pubertym hypogonadism, anosmia, sex hormones low, FH,FSH low/N (inappropriately) what condition is this
Kallman
35
Taller than av, lack secondary sexual characteristics, small firm testes, infertile, gynaecomas, elevated gonadotroohin levels. Chromosomal analysis what condition
kleinfelters
36
Most common nephrotic syndrome in children
Minimal change disease - hyaline casts
37
Mx Enuresis - nocturnal vs urge
1.Alarms Nocturnal - desmopressin Urge - oxybutynin
38
Projectile non-bilious Common 3-6weeks vomiting Olive shaped mass dx, ix, mx
Pyloric stenosis US Hypochloremic Hypokalamia met alkalosis Ramstedt pyloromyotomy
39
Central abdominal pain + URTIs Inflamed LNS dx
Mesenteric adenitis
40
6-9m Diarrhoea, vomiting, sausage shaped mass (RUQ), drawing legs up to abdo, pallor, red jelly stool (late sign) dx, ix, mx
Intussusception US Air insufflation
41
Ix, Mx intestinal malrotation
Upper GI contrast study + USS Laparotomy and if volvulus present or high risk then Ladds procedure
42
Delay in meconium Abdo distention/constipation in older children dx, ix, mx
Hirschprung's Rectal biopsy Rectal washout -> anorectal pull through surg
43
Choling + cyanotic spells after aspiration Ass with polyhydramnios dx
oesophageal atresia
44
Jaundice after 14 days, increased conjugated bilirubin Most likely dx and mx
Biliary atresia Kasai procedure
45
Usually in preterm Abdo distention + blood in stools dx, ix, mx
Necrotising enterocolitis XR - football sign (Riglers) TPN + gut rest
46
Undescended testis - management: Unilat vs bilat
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
Congenital defect - ant abdo wall defect lateral to umbilical cord. Name of condition and mx plan
Gastroschisis Congenital defect - ant abdo wall defect lateral to umbilical cord. Can attemp VD but surgery asap
48
Abdo contents protrude through ant abdo wall but covered in amniotic sac. dx, mx
Exomphalos (omphalocoele) Abdo contents protrude through ant abdo wall but covered in amniotic sac. C section planned.
49
Toddler diarrhoea
tools vary consistency, often contain undigested food
50
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)
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
Mx umbilical hernia
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
Epilepsy meds - what to give in general vs focal and absence and common S.E
SV (teratogenic) except… Focal - carbamazepine (agranulocytosis)/ Lamotrigine (SJS) Absence - Ethosuximide (Night terrors/rashes)
53
short limbs, large head, trident hand,s, lumbar lordosis dx, inheritance pattern
Achondroplasia Autosomal dominant - mutation n FGFR-3 = short limbs, large head, trident hand,s, lumbar lordosis
54
1st line Mx depression in children
FLuoxetine
55
1st line mx GAD in children
Sertraline
56
First line mx OCD+ bulimia in children
SSRI
57
Lack interest/ desire in relationships type personality
Schizoid
58
Unusual thoughts/beliefs Type personality disorder
Schizotypal
59
Microcephalic, Polydactyly, small eyes, cleft palate, scalp lesions
Pataus T13
60
Micrognathia, rocker bottom feet, low set ears, overlapping fingers
Edwards T18
61
Learning disabilities, macrocephaly, long face, large ears (protrudina, macro-orchidism. Most common ND delay cause
Fragile X
62
Webbed neck, Pectus excavatum. Short stature, pulmonary stenosis
Noonan
63
Microganthia, posterior displacement of the tongue (upp airway obstruction) + cleft palate
Pierre robin
64
Hypotonia, Hypogonadism, obesity
Prader willi
65
Short, LDs, elfin faces, friendly/extrovert personality, transient neonatal ↑Ca, supraclavicular aortic stensois
Williams
66
Deletion C5p. Cat cry, feeding problems, poor weight gain, LDs, microcephaly
cri du chat
67
Loss UBE3A (mum). Fascination with water, happy, widely spaced teeth
angelman
68
Webbed neck, short widely spaced nipples, as with CHD (coarctation of aorta). Primary amenorrhoea
Turners 45 XO F
69
↓tone, prominent epicanthic folds, single palpable crease Screen for atlanto-axial instability if participate in sports (_^risk neck dislocation)
Downs syn
70
↓LH/FSH, ↓test/oest - delay puberty + anosmia
kallman
71
When to do surgery for hypospadias
Cna be ass with cryptorchidism and inguian hernia Mx - refer to specialist and surgery usually at 12m. Do not cirucmcise before surgery.
72
Cataracts, LDs, heart defect, hearing loss which congenital infection
Rubella
73
FGR, Limb hypoplasia, chorioretinitis, scars which congenital infection
VSV
74
FGR, Microcephaly, HL LD, Seizures, vision loss which congenital infection
CMV
75
intracranial calcification, hydrocephalus, chorioretinitis which congenital infection
Toxoplasmosis
76
Microcephaly, FGR, ventriculomegaly, cerebellar atrophy which congenital infection
zika
77
Perthes mx
surgery if <6 observe 7 year old body - XR
78
SUFE - classic age and mx
12 boy obese - XR Often loss internal rotation of leg Surgery
79
↑ ALP,Nocturnal pain sunburst XR <48hrs
osteosarcoma
80
Mx DDH
Pavlik harness
81
Mx clubfoot (Talipes)
Ponseti method
82
Strawberry tongue, Cervical LNs, conjunctivitis, desquamation hands/sole of feet, fever 5+days dx, ix, mx
kawasaki ECHO to screen for coronary artery aneurysms Aspirin + IV IgG
83
Petechia no fever Dx
ITP
84
Koplik spots, rash starts behind ear Dx and exclusion rules
Measles Isolate 4d from resolution symp
85
↑ LNs (cervical), can have joint pain Dx and exclusion rules
Rubella isolate 5 d from res symptoms
86
Scarlet fever isolation rules
24 h after Abx
87
Whooping cough Tx and isolation rules
2d after Abx (PO azizthromycin) or 21d from onset. Nasal swab confirms
88
Mumps isolation rules
5d from onset swollen glands
89
Impetigo isolation rules
lesions crusted over or 48hrs after Abx
90
rash, caused by HHV 6-7, 1-2 weeks after with high fever dx
roseola infant
91
Meningitis tx for <3m vs >3m
<3m = IV Amox + iV Cefotaxime >3m = IV cefotaxime (or ceftriaxone) +/- dex
92
Pneumonia Mx in children and if mycoplasma or ass with influenza how does this change
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
Peri-anal itching (mostly night), girls may have vulval symp dx and mx
Threadworm Peri-anal itching (mostly night), girls may have vulval symp) Single dose mebendazole (>6m) for whole household and hygiene advice
94
Resus fluids in children
10 ml/kg stat 0.9% NaCl
95
Maintainance fluids for children
0.9% NaCl + 5% dextrose 100 ml/kg for first 10kg 50 ml/kg for second 10kg 20 ml/kg remaining kg
96
Replacement fluids for children
% 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
newborn resuscitation steps
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
APGAR score calculating
99
Cephalohaematoma vs caput succedaneum
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
Red flags in development of children
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
Neonatal hypoglycaemia - def, symptoms and mx
<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
Softening cartilage, common in teen girls Ant knee pain on walking up and down stairs + rising from prolonged sitting diagnosis and mx
Chondromalacia patellae Usually responds to physio
103
Sporty teens Pain, tenderness, swelling over tibial tubercle dx
Osgood-Schlatter
104
Pain after exercise Intermittent swelling and locking of knee diagnosis
Osteochondritis dissecans
105
Athletic teen boys Chronic ant knee pain that worsens after running Tender below patella on exam dx
Patellar tendonitis
106
Which hearing tests at: newborn, 6-9m, 18m-2.5 years, 2.5years and >3
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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