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Last minute > Paeds > Flashcards

Paeds Flashcards

1
Q

What are red flags to be seen by neonatologist post birth in terms of vitals

A

CRT> 3 seconds
HR>160
HR< 100
RR> 60
Fever>38^C

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2
Q

Until when is bow legs normal

A

3-4 years

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3
Q

When refer bow legs to paediatric surgeons

A

Pain
Difficulty walking
Failure to thrive
Growth restriction
Intercondylar length over 6cm

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4
Q

What investigations are done for a child under 3 months presenting with fever

A

In all children
- FBC
- CRP
- Blood cultures
- urine dip
Stool sample if diarrhoea
CXR if chest signs
If under 1 months do LP
If 1-3 months then do LP

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5
Q

If under 3 months in A&E with fever who give parenteral antibiotics to

A

Under 1 month if fever
1-3 months if fever and unwell
Give ampicillin and cefotaxime

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6
Q

AXR of meconium ileus

A

No air fluid levels
Distended bowel

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7
Q

Bruises at different stages of healing

A

NAI

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8
Q

Cause of pediculosis

A

Pediculus capitis

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9
Q

Contraindications for steroids in meningitis

A

Under 3 months
Non-bacterial cause
WCC under 1000/mml3
Low protein

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10
Q

Why are steroids given in meningitis

A

To prevent hearing loss

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11
Q

What measure bilirubin in neonate with

A

If under 24 hours- serum level
Over 24 hours- transcutaenous

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12
Q

What cause of nec fasc does chickenpox predispose to

A

Group A strep

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13
Q

Immediate congenital diaphragmatic hernia management

A

Intubate and ventilate
NG tube

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14
Q

What is used to assess chance of having septic arthritis

A

Kocher criteria
- WCC over 12
- fever over 38.5
- ESR over 30
- unable to weight bear

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15
Q

White lump in babys mouth and otherwise asymptomatic

A

Epsteins pearl

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16
Q

What are benign murmurs

A

Venous hum- Heard as a continuous blowing noise heard just below the clavicles
Still’s murmur- Low-pitched sound heard at the lower left sternal edge

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17
Q

Differentiating branchial cyst and cystic hygroma

A

Branchial cyst- anterior triangle, anechoic on USS
Cystic hygroma- posterior triangle, transilluminates

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18
Q

Signs on examination of aortic stenosis and what is management

A

ESM radiating to neck
Slow rising pulse
Thrill
Managment is a balloon valvulotomy

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19
Q

Management of aortic coarctation

A

When PDA closes will get collapse so need to give prostaglandins
Balloon repair

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20
Q

Systolic murmur head loudest in the back and low leg BP

A

Aortic coarctation

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21
Q

Management of tet spells

A

A-E
Bring knees up
Propanolol, adrenaline, morphine and sodium bicarbonate

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22
Q

Management of ASD vs VSD

A

Only when severe symptoms in ASD
Seccundum- catheter
Primum- surgical

Small VSD (<3mm) can be monitored with echos
Large VSD (>3mm) catopril, furosemide and calories with NG tube if needs be

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23
Q

Murmurs in
- tricuspid atresia
- ASD
- TGA
- VSD
- aortic coarctation

A

Tricuspid atresia- ESM at LLSE
ASD- fixrd splitting of S2, can be ESM at ULSE
TGA- single loud S2 but can be no murmur
VSD- holosystolic murmur at LLSE which can radiate over praecordium
Aortic coarctation- systolic murmur loudest at the back

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24
Q

PDA features on examination

A

Wide pulse pressure
Collapsing pulse
Machine like continuous murmur

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25
Q

Management of rheumatic fever

A

High dose aspirin
Steroids and pain relief

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26
Q

First line and gold standard for intussuception

A

USS
Gold standard- contrast enema

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27
Q

Management of meconeum ileus

A

Gastrograffin enema
Surgery if unsuccessful

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28
Q

Antibiotics for NEC

A

Vancomycin and cefotaxime

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29
Q

First line and gold standard for oesophageal atresia

A

NG tube with CXR
Gold standard- gastrogaffin swallow

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30
Q

Imaging for malrotation

A

AXR with barium contrast

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31
Q

What are the types of TOF

A

A- failure of proximal and distal to connect
B- proximal oesophagus connects to trachea
C- distal oesophagus connects to trachea
D- both proximal and distal connect
E- oesophagus normal but is fistula halfway up

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32
Q

What will show whirlpool on abdo USS of infant

A

Malrotation

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33
Q

Management of hirschprungs

A

Bowel irrigation with barium enema
Ano-rectal pull through definitive

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34
Q

Management of pityriasis versicolor

A

Ketoconazole shampoo

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35
Q

Management of pityriasis rosea

A

None unless itching when use emollients

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36
Q

When is USS needed during the infection

A

Recurrent UTI under 6 mths
Atypical
- abdo mass
- poor urinary flow
- sepsis
- raised creatinine
- non-ecoli
- does not respond in 48 hours

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37
Q

When is USS done 6 weeks post infection

A

Recurrent UTI older than 6 months
First UTI under 6 months

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38
Q

When do DMSA and MCUG 6 months later

A

Under 3 with atypical or recurrent UTI
Older than 3 with recurrent UTI

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39
Q

How deal with leukocyte positive and nitrites negative on urine dip in kids

A

Older than 3 do not give abx but take culture
Younger than 3, give abx and treat

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40
Q

How manage undescended testicles

A

Unilateral
- Patient should be referred from around 3 months seeing a urological surgeon by 6 months of age
- if bilateral reveiwed within 24 hours as needs urgent genetic or endocrine investigation

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41
Q

Management of constipation in a child

A

If any red features do not treat and refer for urgent review
- Symptoms of constipation appearing from birth or during the first few weeks of life — may indicate Hirschsprung’s disease
- Delay in passing meconium for more than 48 hours after birth, in a full-term baby
- Abdominal distention with vomiting
- Family history of Hirschsprung’s disease
- Ribbon stool pattern
- Leg weakness or motor delay
- Examination may reveal unexplained lower limb deformity or abnormal neuromuscular signs, including abnormal reflexes.
- Abnormal appearance of the anus
- Abnormalities in the lumbosacral and gluteal regions
If amber features, refer in 2 weeks and do treat
- signs of poor care
- failure to thrive or signs of other cause like sx suggesting hypothyroidism

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42
Q

When refer for umbilical hernias

A

3 years

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43
Q

How manage faecal disimpaction

A

Macrogol and review after 1 week
If after 2 weeks does not work use stimulant laxative like Senna
If does not work refer to specialist
If not tolerant of macrogol use senna and if the stools are hard add lactulose or docusate

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44
Q

How manage constipation

A

Macrogol (drug depends on age) If over 12 Mavicol, if under mavicol paediatric
If not tolerated use senna and add lactulose if not tolerated
If does not improve use Senna however if get diarrhoea reduce dose

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45
Q

Difference between red and brown coloured urine

A

Red- lower tract bleed
Brown- glomerular pathology as broken down into casts

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46
Q

Management of active UC

A

Mild to moderate
- topical aminosalicylates for 4 weeks
- if dont work use oral
- can use steroids too if ineffective (topical or oral)

Moderate to severe
- infliximab, adalimumab

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47
Q

Management of active crohns

A

Oral steroids

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48
Q

How to induce remission in UC

A

Oral aminosalicylate

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49
Q

How to induce remission in crohns

A

Azathioprine

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50
Q

Management of lactose intolerance

A

Refer to dietician
Encourage vit d and calcium intake

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51
Q

Mass in groin area with severe vomiting and tense abdomen

A

Incarcerated hernia

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52
Q

When refer for hydrocele

A

3 years

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53
Q

How is mesenteric adenitis investigated

A

USS

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54
Q

What investigation should be done on any child presenting with swelling or pain in testicle

A

USS to loko for cancer

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55
Q

PA versus lateral CXR finding in croup

A

PA- shows subglottic narrowing (steeple sign)
Lateral- acute epiglottis (thumb sign)

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56
Q

What is given for epiglottitis

A

Dexamethasone and cephalosporin

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57
Q

Antibiotics in pertussis

A

Offer antiobiotic if cough has lasted less than 21 days
- clarithomycin if less than 1 month
- clarithomycin or azithromycin if over 1 month
If contraindicated use co-trimoxazole (not licensed if under 6 weeks)

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58
Q

Pneumothorax guidelines

A

Breathless or over 2 cm= needle aspiration -> if fails chest drain
Any intervention needs followup in 2 weeks in OPD
Under 2cm= discharge and see in OPD in 2 weeks

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59
Q

How does bacterial tracheitis present

A

Croup like
Very high fever
Copious airway secretions

Caused by stpahylococcus aureus

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60
Q

What is bronchiolitis obliterans and what causes it

A

Repair of lung tissues is in overdrive leading to scar tissue formation
Adenovirus

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61
Q

Guidelines for asthma if over 5

A

1st: SABA or start on low dose ICS if ave asthma symptoms three times a week or more or are woken at night by asthma symptoms once weekly
2nd: If not already on ICS start this
3rd: Add LTRA
4th: Swap LTRA for LABA
5th: Change LABA and ICS for MART
6th: Increase dose to medium dose ICS
7th: Refer to specialist

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62
Q

Guiedlines for asthma under 5

A
  1. SABA or go straight to ICS if symptoms over 3x a night
  2. Paediatric moderate dose ICS for 8 weeks and monitor
    - if no resolvement consider different diagnosis
    - sx reoccurred within 4 weeks of stopping ICS restart low dose ICS as maintenance
    - sx reoccurred beyond 4 weeks restart moderate dose ICS
  3. SABA, low dose ICS, LTRA
  4. Stop LTRA and refer to paediatric asthma specialist
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63
Q

How investigate asthma in all patients

A

Refer for spirometry
If unclear refer for FeNO

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64
Q

Management of acute asthma

A

Trial nebulised salbutamol
Ipatropium nebulised
If after 1 hour sats below 92 add mag sulph to nebuliser
Steroids- oral or IV depending on tolerance
Then if these unsuccessful consider
- IV salbutamol
- IV mag sulphate
- IV aminophylline

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65
Q

Doses of steroids in asthma attack
- oral
-IV

A

Under 2- 10mg
2-5- 20mg
Over 5- 30-40mg

IV= (4 mg/kg repeated four hourly

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66
Q

Management of WEST syndrome

A

Refer for tertiary centre assessment within 24 hours
Combination therapy with vigabatrin and prednisolone

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67
Q

Causes of each CP

A

Spastic
- hemiplegic= antenatal/genetic cause
- diplegic= PVL
- quadriplegic= HIE
Dyskinetic= HIE and kernicterus

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68
Q

Red flags for CP

A

Cant sit before 8mths
Cant walk before 18mths
Hand preferance before 1 year
Persistent toe walking

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69
Q

What happens in each of the focal seizures

A

Parietal- dyaesthesia
Frontal- motor symptoms unilaterally
Temporal- automatisms or strange smells
Occipital- positive or negative visual signs

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70
Q

EEG finding of absence seizures and lennox gastaut syndrome

A

Absence- Symmetrical 3hz wave and spike pattern
Lennox gastaut- slow spike

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71
Q

Management of plagiocephaly

A

Turn cot around
Supervised time in day on fornt

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72
Q

Management of benign intracranial hypertension

A

Repeated LPs

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73
Q

How do MS vs tuberous scleoris lesions appear

A

MS= demyelinating, hypointense, white matter lesions
Tuberous sclerosis= calcified, subependymal

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74
Q

Presentation of tuberous sclerosis

A

Ash leaf macules
Brain ependymomal
Lumps under nails

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75
Q

Management of juvenile myoclonic seizures

A

Sodium valproate
Lamotrigine second line

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76
Q

Investigating first time seizure

A

Bloods - metabolic causes
12 lead ECG
EEG within 72 hours
MRI if suspecct underlying structural cause
Refer to be seen in 2 weeks

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77
Q

Management of
- tonic clonic seizures
- focal seizures
- absence seizures
- myoclonic seizures
- atonic or tonic

A

Tonic clonic- Sodium valproate if male and girl under 10
Lamotrigine if over 10 and will have to be on long term therapy
Focal- Lamotrigine or levetiracetam
Absence- ethosuximide
Myoclonic- Sodium vaproate if male and girl under 10
Levetiracetam if girl over 10 who may need to continue long term
Atonic- Sodium vaproate if male and girl under 10
lamotrigine if girl over 10 who may need to continue long term

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78
Q

Status epilepticus

A

Over 5 minutes
Buccal midazolam, rectal diazepam or IV lorazepam
Wait 5 minutes
Give second dose of diazepam
If no response
- phenytoin
- levetiracetam
- sodium valproate
If no response try these again
If no response phenobarbital or general anaesthesia

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79
Q

What is scissor walking seen in

A

Diplegic CP

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80
Q

If febrile seizure repeats within 24 hours what type of febrile seizure is it

A

Complex

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81
Q

X-ray finding of perthes disease

A

Loss of joint space initially then loss of femoral head

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82
Q

Management of chondromalacia patellae

A

Physio

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83
Q

Difference in presentation of the spina bifidas

A

Occulta- can be incidental or through tethered chord syndrome
Meningocele- no abnormal neurology but sac can burst causing meningitis or hydrocepahlus
Myelomeningocele- severe abnormal neurology like bladder/bowel dysfunction, club foot or paresis

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84
Q

Up until when is pes planus normal and what is it

A

4-8
Flat feet

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85
Q

Pathophysiology and presentation of osteochondritis dissecans

A

Reduction in blood flow to patella which fragments off

Pain after exercise
Locking and catching of knee
Gives way easily

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86
Q

Management of osteomyelitis and septic arthritis abx wise

A

IV flucloxacillin (clindamycin if pen allergic)
Vancomycin if MRSA

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87
Q

Spinal muscle atrophy presentation

A

Difficulty to maintain head
Breathing difficulties
Weak cough and cry
Proximal muscle weakness
Hypotonia

Autosomal recesive

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88
Q

What is differnece between anencephaly and encephalocele

A

Anencephaly- failure of fusion of cranial neural tube which presents with with stillbirth
Enancephalocele- herniation of brain and meninges through midline skull defect

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89
Q

Difference in location and presentation of osteosarcoma vs ewings sarcoma

A

Ewings- feverish, middle of long bones
Osteosarcoma- Swelling around a joint, Painless most often, Reduced mobilityaround knee

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90
Q

Investigations for EBV

A

Over 12 in second week do blood film- see over 20% atypical (activated) lymphocytes
Under 12- if ill over a week do serology

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91
Q

Investigation for rubella

A

Oral fluid sample for NAAT

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92
Q

Management of mumps if very immunocompromised/HIV but no immunisation

A

MMR vaccine

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93
Q

When give aciclovir for varicella

A

Oral
- Under 1 month
- Over 14 if within 1 day of rash starting
IV
- immunocompromised

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94
Q

Teenager presents with cyanosis after being born abroad

A

Eisenmgenger

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95
Q

What can cause BCG scar to become inflammed

A

Kawasaki

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96
Q

What is used for sedation in children

A

Nitrous oxide or midazolam

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97
Q

When approaching an ill child what is initial approach

A

A-E
Initially either jaw thrust or head tilt and chin lift depending on if trauma

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98
Q

How can mesenteric adenitis present

A

Very unwell in a lot of pain
Diffuse lymph node enlargement

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99
Q

How long does WHO recommend breast feeding for

A

Up to and beyond 2 years

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100
Q

Management of tongue tie

A

1st line; refer for breastfeeding support
2nd line; if dropping weight centile then frenotomy

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101
Q

What does torn frenulum in mouth suggest

A

NAI from forced feeding

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102
Q

Dropping centiles with no evidence of systemic disease after age of 2

A

GH deficiency

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103
Q

How manage febrile convlusion if evidence of infection source like pneumonia

A

Want to admit and manage in hospital

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104
Q

Differentiating between osteomyelitis and septic arthritis on history

A

Osteomyelitis more insidious

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105
Q

What do if sexual abuse suspected

A

Refer to hospital for forensic examination

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106
Q

Indications for immediate head CT

A
  • NAI suspected
  • post traumatic seizure
  • GCS less than 14 on assessment, GCS less than 15 in under 1 YO
  • focal neurology
  • 2 hours after injury GCS less than 15
  • suspected skull fracture
  • tense fontanelle
  • for children under 1 a bruise or laceration over 5 cm
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107
Q

Indications for CT within 1 hour or observe

A

If one of following then observe for 1 hour, if MORE than 1 have to do in less than 1 hour
- LOC over 5 mins
- high velocity impact (RTA, over 3m fall)
- 3 or more vomiting episodes
- amnesia over 5 mins
- abnormal drowsiness

If develop either abnormal drowsiness, vomits again or abnormal drowsiness with 1 of above RFX then do CT in less than 1 hour

108
Q

What is a a child protection plan

A

Put in place to protect children at high risk of harm

109
Q

Management of Cows milk allergy

A
  1. Avoid trigger
    - If formula fed use hypoallergenic formula
    - If breast fed exclude from diet (takes2-3 weeks tho) and can give maternal calcium and vit D supplements
  2. must regularly monitor growth
  3. Reintroduce in 6-12 months using Milk Ladder
110
Q

What is bucket handle fracture and what seen in

A

Fracture of the metaphyseal corner in tibia
Seen in NAI

111
Q

What is long term complication of measles

A

Subacute sclerosing panencephalitis

112
Q

What vaccine is given at birth

A

BcG sometimes
- born in areas of uk where high rate (40 in 1000)
- parent or grandparent born in country where (40 in 1000)
- live with or close contact of someone with infectious TB

113
Q

What is in the 6 in 1

A

Diphteria
HBV
Tetanus
Polio
Pertussis
HIB

114
Q

How is flu vaccine administered in children

A

Intranasal

115
Q

Vaccinations done at 2,3 and 4 months

A

2 months
- 6 in 1
- oral rotavirus
- Men B

3 months
- 6 in 1
- PCV (pneumococcal)
- oral rotavirus

4 months
- 6 in 1
- Men B

116
Q

What vaccinations are done at 1 year

A

MMR
Men B
PCV
Men C/HIB

117
Q

What vaccinations are done at 3 years and 4 months

A

MMR
4 in 1

118
Q

What in the 4 in 1

A

Diphteria
Tetanus
Whooping cough
Polio

119
Q

When is the flu vaccine given to children

A

Every year in september 2-10

120
Q

When is HPV vaccine given

A

12-13 years

121
Q

What given at 14 years

A

MEN ACWY
3 in 1
- tetanus
- dipheteria
- polio

122
Q

What prophylactic antibiotic is given in SCD

A

Penicillin V

123
Q

How is G6PD diagnosed

A

Enzyme assay 2-3 months after crisis

124
Q

What appears with red, ragged fibres on muscle biopsy

A

Mitochondrial disorder

125
Q

How do mitochondrial disorders present

A

Myopathy- muscle cramps and weakness

126
Q

Presentation of folate deficiency

A

Anaemia
Glossitis- smooth beefy red tongue
Angular stomatitis

127
Q

When is exchange transfusion indicated for SCD crisis

A

Priapism
Stroke
Acute chest syndrome

128
Q

What is found on electrophoresis of sickle cell anaemia

A

HbS and HbF

129
Q

Management of sickle cell crises

A

Fluids
Oxygen
Analgesia

130
Q

What are the types of biliary atresia

A

T1- common bile duct
T2- cystic dict
T3- fulla tresia where over 90%

131
Q

What causes a bleed in sclera of eye- newborn

A

Subconjunctival haemorrhage

132
Q

CXR of RDS vs CLD

A

RDS- groundglass with air bronchogram
CLD- Widespread opacification
Can be atelectasis, multicystic appearance, emphysema or pulmonary scarring

133
Q

Abx in RDS

A

Benzylpenicillin and gentamicin

134
Q

Management of ROP

A

Treated for up to 2 years
MDT approach
Photocogulation

135
Q

CLD treatment

A

Manage oxygen therapy- wean off if necessarty or give what necessary
Caffeine citrate
Nitric oxide if pulmonary hypoplasia or pulmonary HTN

136
Q

Management of cleft lip and palate

A

MDT- surgeons, ENT, orthodontist, SALT, feeding team
Orthodontic devices may be needed if feeding difficult
Speech and language therapy
Cleft lip repaired in first 3 months of life
Cleft palate between 6-12 months of life

137
Q

Causes of pulmonary hypoplasia

A

Congenital diaphragmatic hernia- most common
Oligohydramnios
Tetralogy of fallot
Osteogenesis imperfecta
Diaphram agenesis

138
Q

Management of chlamydia vs gonrrhoea opthalmia neonatorum

A

Chlamydia- Oral erythomycin
Gonorrhoea- single dose cefotaxime

139
Q

Neonatal hypoglycaemia management

A

Less than 1.5
- admit to neonatal unit
- confirm with lab blood glucose assay
- IV 10% glucose 2ml/kg bolus
- followed by infusion of 3.6ml/kg/hr
- monitor regularly
Between 1.5 and 2.5
- feed immediately
- recheck glucose after 30 mins and if still low consider admitting and starting IV glucose

140
Q

Cyanosis after birth with absent heart murmurs and signs of HF

A

PPHN

141
Q

Causes of persistent pulmonary hypertension of the newborn

A

Idiopathic
OR
Secondary to neonatal pulmonary conditions
- meconium aspiration
- ttn
- congenital diaphragmatic hernia
- RDS
SSRI or NSAIDS

142
Q

Abx for meconeum aspiration

A

IV ampicillin and gentamicin

143
Q

Neonatal resus

A
  1. Dry baby
  2. Assess tone, resp rate, HR
  3. If gasping or not breathing 5 INFLATION breaths
  4. Reassess
  5. If HR less than 60 bpm start chest compression and VENTILATION breaths at rate of 3:1
144
Q

Management of choledochal cyst

A

Surgical excision with roux en y anastamosis to biliary duct

145
Q

What is it when urine passes through the umbilicus

A

Urachus

146
Q

Foetal alcohol syndrome

A

Learning difficulties
Microcephaly
Growth retardation
Cardiac malformations
Epicanthic folds
Sooth philtrum (area between nose and mouth)
Small palpebral fissue

147
Q

What congenital infection will present with an asymptomatic mother

A

Toxoplasmosis

148
Q

What is craniosyntiosis

A

When sutures of the brain fuse prematurely

149
Q

What are the 2 types of craniosyntiosis

A

Sagittal (AP suture)- long flat head
Lamdoidal synostosis (posteriorly, goes laterally)- appears like plagiocephaly

150
Q

What tends to cause sagittal craniosyntosis

A

Premature infants lying on their sides

151
Q

What is difference between low and high anorectal anomalies

A

Low- at level of anus it has close in, may be a fistula to the surrounding skin
High- bowel has closed off higher up, associated with fistulas to bladder etc

152
Q

Management of retractile testes

A

Reassurance and follow-up annually

153
Q

Surgical management of undescended testes

A

If in inguinal canal- orchidopexy
If anywhere else- laparoscopy

154
Q

Difference between early and late onset sepsis

A

Within 72 hours of birth is early

155
Q

What determines what bilirubin measuring device used

A

Within 24 hours of life or born under 35 weeks- serum reading
After 24 hours- transcutaneous bilirubinometer

156
Q

Potter sequence presentation

A

Pulmonary hypoplasia
Renal agenesis
Clubbed feet
Low set ears
Flattened nose
Downwards epicanthal folds

157
Q

What is chorioretinitis

A

Posterior uveitis

158
Q

Management of phototherapy in neonate

A

Aim for 50 under target
Once 50 micromoles below can stop then re measure in 12-18 hours
If this is 50 below then no further measurement required
If less than 50 below remeasure in 12 hours

159
Q

How does mycoplasma pneumonia present

A

Insidious onset compared to normal pneumonia

160
Q

Abx for AOM

A

1st line- amoxicillin
2nd line/penicillin intolerant- macrolide
If does not respond in 2-3 days use co-amox and in this scenario if penicillin allergic seek micro advice

161
Q

What presents with choking on feeding, cyanosis on feeding and relieved by crying

A

Choanal atresia

162
Q

What are the 2 types of squint and how manage

A

Concomitant- one eye diverges typically inwards
Paralytic- varies with gaze direction
Check red reflex
If over 3 months refer to opthalmologist

163
Q

Management of otitis externa

A

If very mild- Hygiene measures
- avoid swimming for 10 days
- dont clean ears
If more severe
- topical neomycin or clotrimazole with or without topical corticosteroids
If immunocompromised or severe infection
- oral flucloxacillin

164
Q

Investigation and management of cholesteatoma

A

Otoscopy then do diffusion weighted MRI
Mastoidectomy

165
Q

Difference in when things need to be removed from ear

A

Within 6 hours
- glue
- battery
- corrosive
Same day
- insect
- food matter
Next available appointment
- cotton ear buds etc

166
Q

How are things from ear removed

A

First try to remove self- is best chance
If not refer to ENT for removal with ENT microscope
If unsuccessful will need general anaesthetic as children can become very agitated

167
Q

Management of sinusitis

A

Under 10 days just fluids etc
Over 10 days
If over 12 prescribe high dose nasal corticosteroids (mometasone)
Consider back up abx(pen V) to be used if symptoms do not improve within 10 days
If severe illness or comlpications prescribe oral coamoxiclav

168
Q

Antibiotics for sinusitis

A

Phenoxymethicillin for 5 days
If allergic or intolerant clarithomycin but can use doxy if over 12
If no improvement use co-amoxiclav

169
Q

Management of orbital cellulitis

A

Contrast CT scan of face
IV co-amoxiclav

170
Q

When to treat tonsilitis/pharyngitis

A

Do fever pain or centor
If FPAIN over 4 or centor over 3
Consider antibiotics- phenoxymethicillin
Lower threshold if increased risk of rheumatic fever, immunosuppressed or compromised

171
Q

What does fluctuant neck lump suggest

A

Abscess from lymphadenitis

172
Q

Bacterial vs viral conjunctivitis management

A

Bacterial
- If severe chloramphenicol or fusidic acid drops
- If not that bad can give back-up
Viral
- Will resolve in 2 weeks
- Warm dress with saline for symptoms
- Send swabs if return to GP with symptoms

173
Q

Viral conjunctivitis management

A

Will resolve in 2 weeks
Warm dress with saline for symptoms
Send swabs if return to GP with symptoms

174
Q

When suspect herpetic conjunctivtis

A

It causes a blepharoconjunctivitis typically
Ulcers on periocular skin
Refer to opthal

175
Q

What is in fever pain

A

F- fever in last 24 hours
A- absence of cough
P- prurulent discharge
S- symptoms over 3 days
S- severe inflammation

176
Q

Management of different F-Pain scores

A

Under 2 do nothing
2-3- delayed antibiotics
4 or more- give abx

177
Q

What used for seborrheic dermatitis in infant

A

For both scalp and nappy rash
- wash in emollient and then use clotrimazole if does not work

178
Q

What is used if cellulitis around the eyes and nose

A

Co-amoxiclav

179
Q

What used if cellulitis on top of chicken pox

A

Flucloxacillin and amoxicillin
Pen allergic- Ciprofloxacin and metronidazole/clarithomycin

180
Q

Management of infantile haemangioma if cosmetic disfugurement or near to nose, eyes or mouth

A

If small then topical timolol
If large then oral propanolol

181
Q

Treatment of irritant dermatitis nappy rash

A

If mild erythema +asymptomatic- OTC barrier protection
If inflamed and bothersome- 1% hydrocortisone and OTC barrier protection

182
Q

Candida nappy rash tx

A

No barrier protection
Use imidazole cream

183
Q

Organisms and tx for scabies, head lice and threadworms

A

Scabies
- sarcopetes scabiei
- permethrin
Head lice
- pediculus capitis
- dimeticone lotion
Threadworms
- enterobius vermicularis
- <6mths= hygiene measures, >6mths= membendazole

184
Q

Tinea corporis and cruris tx

A

Mild- clotrimazole/terbinafine cream
Severe- oral terbinafine

185
Q

How is HSP managed

A

NSAID or paracetamol and bed rest
Typically will resolve in a few weeks
Oral pred if GI bleeding, severe abdo pain or scrotal involvement
IV if nephrotic range proteinuria or declining renal function

186
Q

How is HSP managed

A

NSAID or paracetamol and bed rest
Typically will resolve in a few weeks
Oral pred if GI bleeding, severe abdo pain or scrotal involvement
IV if nephrotic range proteinuria or declining renal function

187
Q

How does each nappy rash appear and its features

A

Irritant dermatitis- creases spared
Candida- erythematous rash which i- nvolves the flexures and has satellite lesions
Seborrheic dermatitis- has flakes and concomitant scalp rash
Psoriasis- scaly erythematous rash

188
Q

Complications of chicken pox

A

Immunosuppressed- leads to severe streptococcal and staphylococcal infection affecting the joints and bones
Glomerulonephritis
Myocarditis
Pneumonitis
Bacterial superinfection

189
Q

Management of bacterial superinfection in chicken pox

A

Admit to hospital
IV flucloxacillin and aciclovir

190
Q

Management if labial fusion

A

If no major symptoms can reassure and review
If significant symptoms topical oestrogen for 4-6 weeks
Surgical management if thick and severe or trapped urine causing terminal dribbling and vulval inflammation

191
Q

Management of tinea captits in children

A

Exclude kerion
Take hair and scalp sample for culture
Commence oral terbinafine or griseofulvin
When culture comes back change antifungal accordingly

192
Q

Management of branchial cyst

A

Antibiotics if infected
Surgical excision is needed

193
Q

Impetigo management

A

Localised and not unwell

Hydrogen peroxide 1% cream
If unsuitable
- fusidic acid 2%
- mupirocin 2%

Widespread and not unwell

Offer oral or topical
Topical
1st fusidic acid 2%
2nd mupirocin 2%
Oral
Flucloxacillin
Clarithomycin if aged 1month-11 years erythomycin if 11-17

Bullous or unwell

1st fluclox
2nd Clarithomycin if aged 1month-11 years erythomycin if 11-17

194
Q

First line for acne

A

Mild/moderate
Combination of topical adapalene and benzol peroxide
Combination of topical tretinoin and clindamycin
Benzoyl peroxide and clindamycin

Moderate/severe
Combination of topical adapalene and benzol peroxide
Combination of topical tretinoin and clindamycin
Benzoyl peroxide and clindamycin
ALSO
Topical azelaic acid and oral doxycycline and lymecycline

ALL GIVEN FOR 12 weeks

195
Q

If have cellulitis on top of chicken pox- what is most likely cause

A

Strep pyogenes

196
Q

Most common neck lump in kids

A

Lymphadenitis

197
Q

What are congenital warts

A

It is possible to be born with congenital viral warts on the anus or genitals transmitted from the mother to baby during birth

198
Q

Difference in presentation of scarlet fever vs guttate psoriasis

A

Scarlet fever- within 24 hours of sore throat
Guttate psoriasis- a few days later with scaly papules

199
Q

Management of alopecia areata

A

If evidence of hair regrowing then can use watchful waiting
If no hair regrowth or severe distress then very potent corticosteroids- betamethasone valerate 0.1%

200
Q

Boggy and pustular raised area where is hair loss

A

Kerion

201
Q

Gold standard for CMPA

A

Double blind oral food challenge

202
Q

Differentials for small circular rashes

A

Discoid eczema
Tinea- not very itchy and localised

203
Q

Neonatal features of Downs

A

Upslanting palpebral features
Smal low set ears
Round flat face
Flat occiput
Hypotonia
Brushfield spots in iris
Single palmar crease
Duodenal atresia
Hirschprung disease

204
Q

Complications of edwards

A

Gastro
- Omphalocele
- Eosophageal atresia
- Hepatoblastoma
Renal
- wilms tumour
- horseshoe
Cardiac
- septal
- PDA

205
Q

Examination of edwards findings

A

Prominent occiput
Cleft lip and palate
Low set ears
Rockerbottom feet
Overlapping fingers
Microcephaly
Micrognathia (small jaw)

206
Q

Whats in pierrer robin sequence

A

Micrognathia
Posterior displacement of tongue which can cause airway obstruction (glossoptosis)
Cleft palate

207
Q

Fragile X presentation

A

Intellectual disability
Delayed speech
Delayed motor development
Autism
ADHD
Seizure disorders
Premature ovarian failure

208
Q

Examination features of fragile X

A

Long narrow face
Prominent jaw
Large ears
Large testes post puberty
Macrocephaly

209
Q

Examination of patau

A

Scalp lesions from failure of skin to develop
Micropthalmia
One eye in middle of face
No nose
Polydactyly
Rockerbottom feet

210
Q

Problems of pataus

A

GI-omphaloce
Renal- PCKD
Cardio- VSD, PDA, dextrocardia
Neuro- myelingocele, developmental delay

211
Q

Examination findings of noonans

A

Webbed neck
Trident hairline
Pectus excavatum
Short
Widespaced nipples

212
Q

Defect in noonan syndrome

A

Autosomal dominant
Protein kinase mutation Chr 12

213
Q

Complications of noonans

A

Pulmonary valve stenosis
Factor Xi deficiency
Ptosis

214
Q

Presentation of prader-willi and angelmans

A

Hypotonia
Hyperphagia
Almond shaped eyes
Hypogonadism
Epicanthal folds
Flat nasal bridge and upturned nose
Learning disability

215
Q

Difference between prader-willi and angelman syndrome

A

Both have deletion of 15q (long arm)
Paternal deletion= prader willi
Maternal deletion= angelman
Get myoclonic seizures in angelmans

216
Q

Genetic inheritance of prader wili

A

Imprinting

217
Q

Cardiac complication of fragile X

A

Mitral valve prolapse

218
Q

Klinefelters features

A

Infertility
Hypogonadism
Gynaecomastia
Tall
47 XXY

219
Q

Defining obesity in children

A

If under 12 use weight centiles
- overweight above 91st centile
- obese above 98th centile
- severe above 99.6 centile
If over 12 use BMI
- overweight above 25
- obese above 30

220
Q

Inheritance of fragile X

A

X linked autosomal dominant

221
Q

What are categories of DKA

A

Mild- pH 7.2-7.29
Moderate- pH 7.1-7.19 or bicarb less than 10
Severe- pH under 7.1 or bicarb less than 5

222
Q

How to treat cerebral oedema from DKA

A

Mannitol

223
Q

Gonadotrophin dependant causes of precocious puberty

A

Idiopathic/familial
CNS abnormalities
- hydrocephalus
- infection
- post irradiation
- surgery
- tumours
Hypothyroidism

224
Q

Gonadotrophin independent causes of precocious puberty

A

Adrenal
- tumours
- congenital hyperplasia
McUne Albright Syndrome
Tumours producing sex hormones
Exogenous tumours

225
Q

What would suggest tumour producing sex hormones as cause of precocious puberty

A

Virilisation
Lots of pubic hair in isolation

226
Q

What is tumours cause precocious puberty in girls vs boys

A

Girls- granulosa
Boys- leydig

227
Q

When should late puberty be investigated in a boy

A

Past 14- expect it 9-14

228
Q

What can present with premature thelarche between 6- 24 months

A

Premature thelarche provided no accompaniement of growth spurt or pubic hair development

229
Q

How is gonadotrophin dependant precocious puberty treated

A

Treat cause
Gonadotrophin agonists with GH as GNRH stunts bone growth

230
Q

Causes of delayed puberty

A

Constitutional delay
Low gonadotrophin
- systemic disease/exercise/stress causing function hypogonadotrophins
- panhypoituitarism
- intracranial pathology
- hypothyroidism
- kallmann
High gonadotrophin
- klinefelters
- turner
- acquired gonadal failure

231
Q

Management of congenital adrenal hyperplasia

A

IV hydrocortisone
IV dextrose

232
Q

Investigating CAH in children

A

17 hydroxyprogesterone
In neonate have to do USS as 17 OHprogesterone confounded for by mother

233
Q

Management of constitutional delay of puberty

A

1st line- reassure and observe
2nd- IM testosterone every 6 weeks for 6 months if male
transdermal oestrogen

234
Q

Management of primary gonadal failure causing delayed puberty

A

Boys- testosterone injection
Girls- oestrogen replacement

235
Q

How is gonadotrophin independant precocious puberty treated

A

Ketoconazole

236
Q

How treat precocious puberty from CAH

A

Hydrocortisone
GNRH agonist

237
Q

What is unilateral gynaecomastia in puberty

A

Normal part of process

238
Q

Presentation of marfans

A

High arched palate
Chest wall deformity
Lens dislocation
Arm span > height
Joint hypermobility
Tall
Mitral valve prolapse
Aortic arch abnormalities
Myopia- short sighted

239
Q

Recurrent AOM in a short female

A

Turners

240
Q

What are spoon shaped nails seen in

A

Turners due to lymphoedema

241
Q

Clinical features of GH deficiency

A

Normal growth until 6-12 months
Drastically reduced bone age
Associated with neonatal hypoglycaemia, doll like face( round face with short chin and nose) and jaundice

242
Q

How should height centiles be assessed with regards to referrals

A

Under 2nd centile= seen by GP
Under 0.4th centile= seen by paediatrician in outpatient setting

243
Q

When refer for sitting unsupported

A

12 mths

244
Q

Gross motor milestones

A

6wks- control head
6 mths- sit unsupported
1 year- stand
15mths- walk
2 years- run
3- rides tricycle
4- hops on 1 leg

245
Q

Fine motor skills milestones

A

6wks- follows object
6mths- palmar grasp and transfers between hand
12 months- pincer grip

246
Q

Building bricks milestones

A

15 mths- 2 blocks
18 mths- 3 blocks
2 years- 6 blocks
3 years- 9 blocks

247
Q

When can draw line, circle and triangle

A

2 years- line
3 years- circle
5 years- triangle

248
Q

Speech and language milestones

A

6wks- stills or startles to noise
6 months- turns head to sounds, can babble
12 months- knows and responds to name
15 mths- 2-6 words
2 years- combine 2 words
3 years- sentences

249
Q

when refer for not having 2-6 words

A

18 months

250
Q

Social milestones

A

6 wks- smiles
6 mths- puts hand to bottle when feeding
12 mths- waves
18 mths- plays alone
2 years- can play near others and use spoon
3 years- uses spoon and fork
4 years- plays with others

251
Q

In DKA what is first thing assess and what determines

A

If in shock?
Yes
- 100% oxygen
- 10ml/kg 0.9% fluid bolus
- repeat until circulation restored (if do 4x then consider ionotropes)
No
- 10ml/kg 0.9% fluid over 30 mins

252
Q

Once patient has received bolus how manage DKA

A

Calculate fluid requirements with 40mmol/L potassium depending on K level
Start insulin 0.05-0.1 units/kg/hour 1-2 hours after bolus
Observe with hourly blood glucose and ketones

253
Q

How manage cerebral oedema in DKA

A

20% mannitol or 2.7% NaCl

254
Q

Fluid resuscitation for children

A

10ml/Kg over less than 10 minutes

255
Q

Calculating fluid maintenance for children

A

First 10kg- 100ml/kg/day
Next 10kg- 50ml/kg/day
Any Kg over 20kg- 20ml/kg/day

256
Q

Red flags for clinical dehydration

A

Alterred consciousness
- irritable
- lethargic
Sunken eyes
Tachycardia
Tachypnoea
Reduced skin turgor

257
Q

Red falgs for shock

A

Weak peripheral pulses
Cold extremities
Prolonged CRT
Pale or mottled skin
Hypotension- sign of decompensated shock

258
Q

Management of clinical dehydration

A

Use ORS 50ml/kg over 4 hours with maintenance fluids
If vomiting and cant keep down use NG tube

259
Q

How to calculated % dehydration if no weights

A

Clincal dehydration- 5%
Shock- 10%

260
Q

How to calculate fluid deficit

A

Fluid deficit (mL) = % dehydration x weight (kg) x 10

261
Q

Anaphylaxis guidelines

A

Remove trigger
Lie flat
IM adrenaline
A-C
Repeat adrenaline if no response after 5 mins with IV bolus

262
Q

Doses of adrenaline

A

> 12= 500mcg
6-12= 300mcg
6 months-5 =150 mcg
<6 months= 100-150mcg

263
Q

Management of GORD in child breastfeeding

A
  1. Breastfeeding assessment and advice
  2. 1-2 week trial of alginate therapy- if symptoms improve after 2 weeks continue the therapy. Stop at regular intervals to see if symptoms have improved
    If have not then medical treatment
264
Q

Mangement of GORD in formula fed

A
  1. Reduce volume of milk if excessive (150ml a day per kg)
  2. Offer 1-2 weeks of smaller more frequent unless they already are small and frequent
  3. 1-2 weeks of feed thickeners
  4. Alginate therapy
  5. Medical management
265
Q

Medical management of GORD

A

4 week suspension of omeprazole
If doesnt work refer for possible endoscopy and potential metoclopramide treatment

266
Q

When should arrange a specialist assessment by paediatrician GORD

A

Uncertain diagnosis
Growth issues
Unexplained distress in those with communication difficulty
Not responding to treatment
Avoiding food
Unexplained IDA
No improvement in GORD after a year
Sandifers syndrome suspected
Recurrent aspiration pneumonia
Upper airway erosion
Dental erosion in child with neurodisability
Recurrent otitis media (more than 3 episodes in 6 months)

267
Q

Who give abx in AOM

A
  • ottorrhoea
  • perforation
  • under 1 month
  • systemically unwell
  • bilateral under 2
  • lasts 4 days

Last minute (11 decks)

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