Paeds Flashcards
Kid with spiral fracture. What do you do?
Admit and investigate for NAI
Kid with petechial rashes, low RBC and raised WBC with a limp and sick
ALL
On newborn check, inverted ankles and plantar flexed, what sign is this?
Talipes equinovarus (clubfoot)
Difficult balance, cannot build block of towers, hyperreflexia. What type of CP and where is lesion?
ataxic - cerebellum
Cannot examine ear directly, lump behind ear causing ear to stick out
Mastoiditis
Kid with 2cm mass (inframandibular) on left side, painful – blood film shows: toxic left shift with reactive neutrophilia.
Lymphadenitis
3 year old Kid with hypochromic microcytic anaemia and low ferritin. What could be the cause? Folate deficiency, Thalassaemia, Coeliac, fussy eater
Fussy eater
Girl with abdominal pain only when going to school, not weekends.
Functional abdominal pain
Cyanosis in 6 week old with clubbing and systolic stenosis heard at left sternal border
Tetralogy of fallot
How should you give influenza vaccine to kid who is allergic to eggs?
Hospital IM injection
Kid with bilateral calf hypertrophy - what investigations?
Measure creatine kinase - muscular dystrophy
Kid with pellet stools, and loose stool sometimes
Overflow diarrhoea secondary to constipation
Maintenance fluid to give to kid with diabetes mellitus - DKA and no DKA
In DKA: 0.9% saline, no DKA: 0.9% saline with 5% dextrose
Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected?
Pyramidal tracts
Child with mild croup symptoms comes to GP. RR of 65. What is your management?
Keep child calm and get them urgently to hospital
Premature baby with distended abdomen, vomiting, episode of blood in stool - diagnosis?
Necrotising enterocolitis
Voraciously hungry kid, hypotonia, feeding difficulties as a neonate, almond eyes
Prader-willi
Neonate, with reduced leg movements and fever
Osteomyelitis
Kid with rashes crusted over. He is scratching them and also has a fever and cool peripheries. What is the cause of his acute presentation?
Varicella zoster viraemia
Baby who just started solid foods and was being weaned has become constipated. What do you do?
Encourage more fluids
Fussy eater (kid), drinks a lot of cow’s milk, tired. What is the cause?
Iron deficiency anaemia
Muscle stiffness and tightness, difficulties with fine motor - what kind of cerebral palsy and location of lesion in the brain?
Spastic, damage to the motor cortex or pyramidal tracts
Involuntary, uncontrolled movements (athetosis), difficulty controlling posture and balance, facial grimacing or drooling - what kind of cerebral palsy and location of lesion in the brain?
Dyskinetic Cerebral Palsy, damage to the basal ganglia or thalamus
Problems with balance and coordination, unsteady movements, tremors or shakiness - what kind of cerebral palsy and location of lesion in the brain?
Ataxic Cerebral Palsy - Damage to the cerebellum
Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected?
spastic CP - Pyramidal tracts or motor cortex
Kid needs fluids, but you can’t get standard IV access. Where do you go?
Intraosseous
3 months old baby with signs of HF, systolic murmur that radiates over the praecordium
VSD
4 year old girl with a high fever that was followed by a rash. What is the most likely diagnosis?
Roseola infantum
Kid with a temp of 39, cap refill 6s, generally unwell and bulging fontanelles
Meningococcal septicaemia
Kid with URTI, generalised abdominal tenderness
Mesenteric adenitis
Mother with cold sores has been kissing her child who has a background of eczema
Eczema herpeticum
Nappy rash with satellite lesions - diagnosis and treatment?
Candida infection, clomitrazole
5 y/o presents with widespread non-blanching erythematous rash over her body, after 1 week of cough and coryzal symptoms. Teperature is 37.2, pulse 95bpm, BP 90/60, RR 22, and O2 sats are 98% on room air. Urinanalysis yields no abnormalities, but FBC shows elevated WCC and a platelet count of 7 x 10^9. What is the most likely diagnosis?
Immune thrombocytopenic purpura
Boy born at 40 weeks with male phenotype, but neither testicle can be palpated on examination. What is the most likely diagnosis?
Physiological delay in descent
22 m/o child had cough and coryza for 2 days, and is now struggling with breathing. She has subcostal and intercostal recessions and widespread wheeze. Her temperature is 37.3, HR 125, RR 45, O2 sats 98% on room air. What is the most appropriate next step in her management?
a. 0.5L/min supplemental oxygen
b. 2 puffs beclomethasone inhaler
c. 10 puffs salbutamol inhaler
d. Intravenous aminophylline
e. Oral prednisolone
10 puffs salbutamol inhaler
2 y/o girl with loud barking cough and stridor is finding it increasingly difficult to breathe. Temperature 38.3, HR 190bpm, RR 53, O2 sats 92% on room air. Which is the most appropriate immediate treatment?
a. Intravenous salbutamol
b. Intubation and ventilation
c. Nebulised adrenaline
d. Nebulised salbutamol
e. Oral dexamethasone
Nebulised adrenaline - emergency croup management
A 3 y/o boy has pruritis ani which is worse at night. He has no abdominal pain and bowel movements are normal. He is growing well and his development is normal. What si the most appropriate course of action?
a. Chlorpheniramine solution
b. Hydrocortisone
c. Macrogol sachet
d. Mebendazole solution
e. Miconazole cream
Mebendazole - it’s threadworm
3 week old baby referred for prolonged jaundice, dark wet nappies, and pale stools. There are no developmental concerns and he is currently breastfed. Birth weight was 3.45kg and he currently weighs 3.2kg, Temperature is 37.1, HR 140, RR 45, O2 sats 98% on room air. Investigations:
Hb 110 (normal)
WCC 6 (normal)
Platelets 430 (slightly high)
Bilirubin 175 (high)
Conjugated bilirubin 100 (high)
ALP 160 (normal)
ALT 35 (normal)
Albumin 25 (lower end of normal)
Sodium 137 (normal
Potassium 4 (normal)
What is the most appropriate next step in management?
a. Feeding advice
b. Inpatient ultrasound
c. I.V. antibiotics
d. Outpatient ultrasound
e. Phototherapy
Inpatient ultrasound
A 5 year old boy seen in GP with a rash across buttocks on a background of 4 days of cough, coryza, and mild fever, but he is otherwise generally well. Temperature 37.4, HR 105, capillary refill <1s, RR 25, O2 sats 99% on room air. What is the most likely diagnosis?
Henoch-Schonlein purpura (its 2-3 days after illness, whereas ITP is 1-2 weeks after)
A 2 y/o in GP has worsening painful rash behind the knee for 5 days. He has eczema managed with E45 cream. Temperature 37.2, HR 130, RR 30, O2 sats 98%. What is the most appropriate management?
a. Immediate referral to Paediatric A&E
b. Give oral Aciclovir for 1 week
c. Give oral Flucloxacillin for 1 week
d. Give topical dermovate
e. Give topical fusidic acid
AnE referral (eczema herpeticum)
Lymphadenitis tx
Watch and wait
16 hour old baby is jaundiced, has yellow stools, is sleepy, and is not feeding. The mother was positive for Group B Streptococcus in her previous pregnancy. What is the most likely diagnosis?
GBS sepsis
A baby is born with 45XO karyotype. What is the most likely cardiac abnormality associated with this syndrome?
Bicuspid aortic valve, followed by coarctation of aorta
2 y/o girl has a fever of 39.7 and a painful, swollen right eye with preserved eye movements (periorbital cellulitis). What is the most appropriate first-line treatment?
Co-amoxiclav, oral - fluclox if not near eye
Mother with SLE has a baby who is born with a slow heartbeat. What is the most likely diagnosis?
Congenital heart block
2 month old boy attends GP with fever, rash, and coryza. He is taking 70% of his normal feeds and is producing a normal number of wet nappies. There is a non-blanching petechial rash on his left arm. Temperature 38.9, HR 148, RR 43, and O2 sats 98% on room air. What is the most appropriate pharmacological management to give in the GP surgery?
IM benzylpenicillin - community meningococcal sepsis tx
2 week old boy in GP has bilateral red eyes with purulent discharge since birth. What is the most likely causative organism?
chlamydia trachomatis - bilateral purulent eyes
Newborn baby, rash on face and body. Full term.
Erythema toxicum
A 15 year old boy has 3 weeks of cough, weight loss, night sweats and fever. He moved to the UK from India 3 years ago. His chest x-ray is show in the image (can’t find exact image but showed some left upper zone shadowing I think). Which investigation is regarded as the gold standard for diagnosis for his underlying condition?
Sputum culture
A term infant born to a diabetic mother is 4 hours old on the postnatal ward and is noted to be jittery. The capillary blood gas result is as follows: pH 7.37 (7.35 - 7.45), PCO2 5.5 kPa (4.6 -
6.4), PO2 4.9 kPa (8 - 12), glucose 2.4 mmol/L (3 - 6), lactate 2.0 mmol/L (1 - 2). Which is the most appropriate treatment for the baby in this scenario?
IV Dextrose
A 2 year old boy has acute onset of cough and drooling, with inspiratory upper airway noises. His vaccinations are up to date. His examination is otherwise normal. His temperature is 36.8C, pulse 120 bpm, blood pressure 100/60 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 98% breathing air. Which is the most likely diagnosis?
Croup
A 14 year old girl attends Paediatric Outpatients with ongoing headaches. These are associated with nausea and vomiting and she is missing school. They are occurring once per month and at any time of day. The headaches eventually settle after lying down in a dark room. She has tried NSAIDs, which do not help. Neurological examination is normal. Which is the most appropriate treatment?
a. Aspirin once daily
b. Metoclopramide when required
c. Nasal sumatriptan when required
d. Pizotifen when required
e. Propanolol once daily
Nasal sumatriptan
A 12 year old girl in GP complains of ongoing headaches for the last 4 months. The headaches are severe and throbbing in nature and often associated with nausea and vomiting. The headaches are worse in the morning. Her father has noticed he is more tired than usual and has been more irritable. Her weight is 62 kg. Which is the most likely diagnosis?
a. Benign intracranial hypertension b. Insomnia
c. Low mood
d. Migraine
e. Tension headaches
Migraine - throbbing, nausea and vomiting
A 7 year old boy in General Practice has a sore throat, fever and pain on swallowing for 1 day. His temperature is 38.5C, pulse rate 110 bpm, respiratory rate 24 breaths per minute, and oxygen saturation 99% breathing air. He has bilateral tonsillar enlargement with exudate and bilateral cervical lymphadenopathy. He is talking in full sentences without using accessory muscles. Which is the most appropriate management?
a. Admit to hospital
b. Continue supportive measures
c. Prescribe amoxicillin
d. Prescribe phenoxymethylpenicillin
e. Review in 48 hours
Prescribe phenoxymethylpenicillin - GP setting, sore throat, abx to give is pen V
Neonate had just one episode of billous vomiting. What should be done?
Paeds assessment / admit - obstruction until proven otherwise
Mum brings 2yo to GP 6 hrs after rolling off sofa onto carpeted floor while playing, happy playing now, interacting normally, no cuts bruising or bleeding, ENT exam normal, best management?
Same day paeds assessment
Child with bloody diarrhoea, puffy eyes, puffy face, low hb, hi BR, reticulocytes elevated, lo plt. Urine dip; blood 3+, leukocytes 2+, protein 1+, nitrites neg. What the dx?
HUS
Mum with 2 or 3 yo girl in GP/paeds A&E. Caught her attempting to eat chocolates from a box 30 mins ago, not sure if she ate one, took them away and she started screaming, stopped breathing, turned blue and fell to ground and started jerking arms and legs (unclear description), stopped shortly after. Currently child is running around waiting area and looks fine. Whats the most appropriate mx?
Reassure and safety net - breath holding spell
Pneumonia management in kids?
Oral amox 5 days (or clarithromycin/ cefaclor)
Single best bedside investigation for seizure in children?
Blood glucose
Treatment for haemolytic disease of the newborn?
Phototherapy, second line exchange transfusions
Scoring system for barking cough and stridor?
Westley croup score
Epiglottitis management
anaesthesia, intubation, IV ceftriaxone
Turner vs Kallman LH FSH
Turner = High
Kallman = Low
Paeds UTI abx - upper/lower uti
Upper - Cefelaxin (or co-amoxiclav)
Lower - Nitrofurantoin (or trimethoprim)
Red flag - fever under what age?
3 months
