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Fourth Yerar > PAEDS > Flashcards

PAEDS Flashcards

1
Q

What vomiting problem causes low Cl, K and metabolic acidosis

A

Pyloric stenosis- non-bile stained

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2
Q

Meningitis B immunization schedule

A

2, 4, 12 months

(8 weeks, 16 weeks, a year)

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3
Q

In 5-16 after SABA fails what do you add

A

LOW DOSE inhaled corticosteroids

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4
Q

Large right atrium and small right ventricle cause

A

Ebstein’s anomaly. Low insertion of the tricuspid valve (?lithium overdose, pan-systolic murmur)

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5
Q

Roseola infantum most common complication

A

Febrile convulsions (rapid rise in body temp due to viral illness)

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6
Q

Congenital CMV presentation

A

low birth weight, generalized Petechial rash, microcephaly, seizures, hepatosplenomegaly with jaundice

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7
Q

How can CF present in stool

A

Steatorrhoea due to fat malabsorption

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8
Q

Which Abx for whooping cough if onset <21 days ago

A

Azithromycin or clarithromycin (oral macrolide)

If after 21 days no Abx?

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9
Q

First line treatment for threadworm

A

Single dose mebendazole for whole household and lifestyle advice

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10
Q

‘Machinery-like murmur’, left-sided thrill diagnosis andMx

A

Patent ductus areriosus, give indomethacin in postnatal period

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11
Q

Scarlet fever presentation

A

Fever, throat ache, strawberry tongue, ‘sandpaper-like’ rash more intense in cubital fossa

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12
Q

PAEDS BLS algorithm start with B in under 1 (infant)

A

Look listen feel for breathing-> 5rescue breaths-> check brachial pulse-> 15:2 two-thumb encircling technique

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13
Q

What is given in transposition of the great arteries and why

A

Ductus arteriosus is a passage between the aorta and the PA during foetus. Mums placenta provides O2 and so it doesn’t need to use its lungs. It then closes when baby is born to prevent O2 an unO2 blood getting mixed up. Prostaglandins keep it open and so are given in transposition of the great arteries to keep it mixed until surgery

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14
Q

Absent heart sounds but tinkling in newborn diagnosis and Mx n

A

Congenital diaphragmatic hernia (tinkling is bowel sounds) Mx with NG tube insertion and/or intubate and ventilate before surgical repair

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15
Q

Which infection stops lung transplants

A

Burkholderia cepacia (gram negative, often resistant)

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16
Q

Most common associated feature with hypospadias

A

Cryptochidism (undescended testes)- 1 in 10

Most often in isolation though

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17
Q

Most common complications of VSD 2

A

Pulmonary hypertension

Endocarditis

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18
Q

What do you give to all children with an asthma attack for 5 days after

A

Oral pred (steroid)40mg

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19
Q

What Otho problem is common in obese 12 year old boys (abnormal gait)

A

Slipped upper femoral epiphysis

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20
Q

When born via breech what do you have to do 6 weeks postnatal

A

USS pelvis (paediatric hip USS) as increased risk of developmental dysplasia of the hips (DDH)

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21
Q

When delivered by ventouse delivery what is a common complication involving head appearance

A

Caput succadeaneum,-localised edema from prolonged application of suction cup (crosses suture lines)

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22
Q

How to remember childhood immunizations (3,4,6 in one)

A

6in1 before 6 months old
4in1 3-4years
3in1 >13 years

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23
Q

What is the causative organism of whooping cough

A

Bordatella pertussis

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24
Q

Which heart murmur can you hear with Turner’s syndrome

A

Ejection systolic murmur due to biscuspid aortic valves

Upper left sterns edg

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25
Q

What condition is red-currant jelly a late sign in

A

Intussusception. Treat with air insufflation

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26
Q

Which Paeds rash has fever before then rash after

A

Roseola

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27
Q

Sore throat sandpaper rash strawberry tongue

A

Scarlet fever

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28
Q

Cough conjunctivitis Coryza

A

Measles

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29
Q

Slapped cheek

A

Parvo

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30
Q

4 features of tetralogy of fallot

A

Ventricular septal defect
Right ventricular hypertrophy
Pulmonary stenosis
Overriding aorta

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31
Q

Which murmur is tetralogy of fallot

A

Ejection systolic (due to pulmonary stenosis)

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32
Q

Loose stools 4-5 weeks after gastroenteritis

A

Transient Lactose intolerance

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33
Q

Triad of shaken baby

A

Retinal haemorrhage
Subdural haematoma
Encephalopathy

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34
Q

Impetigo when can they go to school

A

Not until the lesions are crusted and healed OR 48 hours after commencing Abx treatment

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35
Q

What is the organism called in threadworms

A

Enterobius Vermicularis (vermin)

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36
Q

What is the first line treatment/ best treatment in under 7 for bed wetting

A

Enuresis alarm

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37
Q

When to refer to ortho in bow legs

A

4

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38
Q

Meningitis tx under 3 months

A

iv cefotaxime and amox

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39
Q

What are poor prognostic factors in ALL for age at diagnosis, sex, WCC at diagnosis and one other

A

Less than 2 or more than 10 at diagnosis
male sex
WCC more than 20
Having B or T cell surface markers

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40
Q

Pierre-Robin presentation

A

Robin me of my airway so small mandible , tongue retraction, cleft palate

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41
Q

Which condition rocker bottom feet

A

Edwards

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42
Q

Supravalvular aortic stenosis with learning difficulties

A

William’s

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43
Q

Turners presentation 2 main

A

Primary a,enorrhoea
Shirt stature

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44
Q

Most common organism for croup

A

Parainfluenza virus

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45
Q

Hirschsprungs presentation

A

pr bleeding
Pain like appendicitis
From birth

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46
Q

What do you give in patent ductus arteriosus

A

Indomethacin or ibuprofen

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47
Q

Prolonged jaundice, hepatomegaly, splenomegaly, abnormal growth from birth

A

Biliary atresia - surgery heptoportoenterostomy to allow bile drainage

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48
Q

Milestones in premature babies under 2

A

Add on the amount of time they were premature so 6 weeks milestone would be 12 weeks if 6 weeks early

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49
Q

What Abx for whooping cough

A

Azithromycin or clarithromycin

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50
Q

Acute limp in under 3 MX

A

Urgent referral for Paeds assessment to rule out septic arthritis or traumatic injury. Can even present asymptomatic but limp

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51
Q

Forward lean with strider

A

?Acute epiglottitis

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52
Q

Which cardiac abnormality is associated with bipolar disorder treatment in pregnancy

A

Ebstein’s anomaly

Lithium

Posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle causing regurg (systolic murmur) and stenosis (diastolic) of the TV

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53
Q

Why is bicarbonate elevated in pyloric stenosis

A

Loss of H+ ions in profuse vomiting so equilibrium shifts to the left to make it back up

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54
Q

Is ballotable mass in abdomen of a child a red flag

A

Yes for Wilm’s tumour. (median 3 yrs) . Abdo mass, painless haematuria, flank pain, anorexia, fever

Urgent referral

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55
Q

First line tx for DDH in under 6 months

A

Pavlik harness- holds hips in optimal position for joint and socket development to correct the dysplasia

Oat older maybe surgery

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56
Q

Which congenital condition presents with elfin facies

A

William’s syndrome (will Ferrell in elf)

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57
Q

Picks up objects with a preference for a hand under 12 months

A

Suggests neuro problems with the other limb- most likely cerebral palsy

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58
Q

First step in Mx for potential epiglottitis

A

Call anaesthetist to assess for intubation to protect the airway
Then give o2 and IV Abx

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59
Q

UTI Mx in under 3 months in GP

A

Immediate referral to Paeds

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60
Q

Difference in rash in scarlet and Kawasaki

A

Scarlet is sandpaper (erythematous, rough texture)
Kawasaki is widespread maculopapular

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61
Q

Diagnoses in cyanotic CHD in first days of life vs 1-2 months

A

Cyanotic congenital heart disease presenting within the first days of life is TGA.
Cyanotic congenital heart disease presenting at 1-2 months of age is TOF

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62
Q

Roseola infantum presentation

A

High fever lasting a few days

Then later followed by maculopapular rash, diarrhoea, cough, ?febrile convulsions

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63
Q

What age group are you concerned about pulling up of legs and why

A

3 months- 3 years as this is when you get intussuception- in under 3 months it’s probably just infantile colic

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64
Q

What might u give in recurrent febrile seizures

A

Oral midazolam or rectal diazepam (benzodiazepine rescue meds)

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65
Q

Immediate mx of croup

A

Stat dose dexamethazone 0.15mg/kg

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66
Q

Which surgical name for Mal rotation with volvulus

A

Ladd’s procedure

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67
Q

How does neonatal hypoglycaemia present

A

Irritable
Feeding poorly
Jittery And high RR on examination

Preterm birth is key risk factor as liver cant generate glucose

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68
Q

What is Barlow manoeuvre (ortho)

A

Attempting to dislocate an articulated femoral head (adduction with downward pressure)

Tests for instability in DDH

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69
Q

Which surgical problem is associated with congenital diaphragmatic hernia and/ or exomphalos

A

Malrotation

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70
Q

At what age are we concerned by bow legs

A

Age 4 or 5

Below this is a normal variant in children

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71
Q

How does necrotising enterocolitis present

A

Feeding intolerance
Abdo distension
Bloody stools

Then progresses to Abdo discolouration, perforation, peritonitis

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72
Q

What is ITP

A

Immune thrombocytopenia purpura

Type 2 hypersensitivity reaction (immune mediated) leading to a reduction in the platelet count

(Body attacking own platelets)

May follow infection/ vaccination and more acute in kids

Usually doesn’t require treatment as it resolves in 6 months either way, but if the platelet count is under 10 you may give oral/ IV corticosteroid

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73
Q

What is the difference between exomphalos and gastroschisis and how does Mx differ

A

Exomphalos is bowel protruding out of Abdo wall but it is has a peritoneal covering around it -> staged closure starting asap with completion at 6-12 months (to prevent respiratory complications

Grastroschisis is bowel protruding out of Abdo wall but with no peritoneum around it -> immediate urgent correction

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74
Q

Which genetic condition is associated with supravalvular aortic stenosis

A

William’s syndrome

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75
Q

Which neonatal condition causing jaundice would have high conjugated bilirubin and which would have high unconjugated bilirubin

A

Biliary atresia has high conjugated as its already been conjugated in the liver

Gilbert’s has high unconjugated as lack of enzyme that mediates conjugation

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76
Q

What are the 8 S’s of an innocent murmur

A

Soft
Systolic
Short
S1 and S2 normal
Symptomless
Special tests normal
Standing/ sitting (postural variation)
Sternal depression

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77
Q

How does bronchiolitis present

A

Coryzal prodrome

Mild fever
Persistent cough
Wheeze

red flag is grunting, no nappy wetting, cyanosis, exhaustion, other signs of RDS

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78
Q

How does whooping cough present

A

Catarrhal phase like a viral URTI lasting 1-2 weeks

Paroxysmal phase of cough increasing in severity, worse at night and after feeding, and can cause vomit/ central cyanosis. Whoop sometimes present. Subsides over weeks/ months

Give oral azithromycin if presented within 3 weeks of symptomatic onset

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79
Q

How to treat whooping cough

A

Oral azithromycin

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80
Q

Which vaccine is given in 16-32 weeks pregnant women to protect newborns

A

Pertussis (whooping cough)

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81
Q

Child between 4 and 12 presenting with partial seizures at night, otherwise normal

A

Benign Rolandic epilepsy

Will usually stop by adolescence

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82
Q

Adolescent presenting with infrequent generalised myoclonus seizures in the morning/following sleep deprivation

A

Juvenile myoclonic epilepsy

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83
Q

Definitive Mx for SUFE

A

Internal fixation across the growth plate (surgical management)

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84
Q

First line drug for ADHD in kids and side effects

A

Methylphenidate

Can cause Abdo pain, nausea, dyspepsia- can cause stunted growth and weight loss

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85
Q

What is ratio for compressions and ventilations is a newborn

A

3:1

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86
Q

Which heart lesion is most commonly associate with duchenne’s muscular dystrophy

A

Dilated cardiomyopathy

DMD presents with progressive proximal muscle weakness from 5 years, calf pseudohypertrophy, Gower’s sign

Typical prognosis 25-30 years

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87
Q

Most common heart problem with fragile X

A

Mitral valve prolapse

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88
Q

Mx of perthes in under 6 vs over 6

A

Under 6 observe

Over 6 surgical mx.

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89
Q

How do u get a definitive diagnosis for hirschsprungs

A

Rectal biopsy for absence of ganglionic cells

90
Q

What extra vaccine would be offered to kids with relatives born in South Asia

A

Bcg for tuberculosis

91
Q

What age do febrile convulsions typically stop

A

5

92
Q

Which type of seizure shows hypaarrythmia on EEG and prognosis

A

West’s syndrome (infantile spasms)
Poor prognosis

93
Q

What age is puberty precocious in women?

A

8

94
Q

What heart condition is the most serious long term health complications of turners

A

Aortic dilatation and dissection

Most common is biscupsid aortic valve and coarctation of the aorta

95
Q

How does mitochondrial inheritance work?

A

In the zygote mitochondria is only present from the ovum not the spermicide so a mitochondrial disease can only be passed form mum to baby

96
Q

How does the management of meningitis in under 3 months vs over 

A

Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)

97
Q

How do you treat scarlet fever (not too unwell )

A

Oral penicillin V for 10 days 

98
Q

What age do we refer for undecscended testes

A

3 months to be seen at 6 surgery at 12

99
Q

What is mesenteric adenitis

A

Inflamed lymph nodes in the mesentery

Causes similar symptoms,s to appendicitis’s

Follows recent viral infection

Requires no treatment

100
Q

Until what age would you urgently refer all kids with acute limp

A

3 years

Risk of septic arthritis

Above that likely transient Synoptics

101
Q

How does rickets present

A

Aching bones and joints
Bow legs, kyphoscolosis,
widening of wrist joints

102
Q

First line inv for DDH in different ages

A

Less than 4-5 months = USS (most co,mon)
More than = XR

103
Q

Hepatosplenomegaly with signs of anaemia I’m under 6

A

ALL

104
Q

How do you treat cystic fibrosis

A

Regular physiotherapy and drainage
high calorie diet
supplements
in those who are homozygous for the gene mutation give lumacaftor/ivacftor (orkambi)

105
Q

What events in pregnancy cause orofacial clefts? 

A

Smoking, antiepileptics, benzodiazepines, rubella 

106
Q

What do you give to prevent RSV in kids who are at increased risk of severe disease

A

Palivizumab

Monoclonal antibody

107
Q

Which condition will present with primary amenorrhoea and testicles in the groin

A

Androgen insensitivity syndrome

Resistance to testosterone so genotypically male (46XY) but female phenotype

Breast development can still occur due to conversion of testosterone to oestradiol

108
Q

Gold standard diagnosis of hirschprungs

A

Rectal biopsy - shows lack of ganglionic nerve cells

109
Q

How do u measure bilirubin in less than and more than 24 hour year old kids

A

Under= serum bilirubin within 2 hoirs

Over= transcutaneous bilirubinometer

110
Q

How do u investigate ITP

A

Clinical exam

FBC shows isolated thrombocytopenia

BONE MARROW EXAM OMLY REQUIRED IF ATYPICAL FEATURES E.G. splenomegaly, lymphadenopathy

111
Q

How do u treat ITP

A

Normally you don’t and it resolved in 6 months

Can give steroid* immunoglobulin if v low platelet count

112
Q

What is ITP

A

Immune mediated reduction in platelets

Petechial rash in otherwise well child

May often be triggered by precedin* viral illness

Presents with bruising, petechial/ purpuric rash, ?epistaxis

113
Q

Which gender is perthes more common in

A

Boys

114
Q

When do you refer for surgery in umbilical hernia

A

5 years unresolved

115
Q

What are the two possible underlying causes of muconeum lieu’s (not passing Meconium due to obstruction )

A

Hischsprung or CF

116
Q

Complications of undescended testes

A

Infertility
Torsion
Cancer

117
Q

What is maternal labetalol a Rf for

A

Neonatal hypoglycaemia

118
Q

Salmon pink rash with joint pain

A

Juvenile idiopathic arthritis

119
Q

How to treat biliary atresia

A

Early surgical intervention

(Kasai procedure - heptoportoenterostomy)

120
Q

How does meckles diverticulum present?

A

 painful massive rectal bleed (bright red)

Cam have constipation, n and v, Abdo pain 

Most common cause of massive big bleed in under 2s

121
Q

Lice household contact tx

A

Nothing unless also have lice

If so treat with insecticide (malathion)

122
Q

School exclusion for lice

A

None

123
Q

Which type of seizures happen at night (partial seizures)

A

Benign Rolandic epilepsy

124
Q

Why do you not give ibrupofen in chicken pox

A

Increases risk of necrotising facitis

125
Q

Q27
What is the first sign of puberty in boys?

A

increase in testicular volume.

126
Q

When is the MMR vaccine given

A

12 months

3 yrs 4 months

127
Q

Investigations for coeliac

A

Anti-TTG antibiody test

Mildly elevated could do scope and biopsy

128
Q

What chronic condition is nasal polyps associated with

A

Cystic fibrosis

129
Q

How does eczema present in infants

A

Rash on face and extensor surfaces as opposed to classical flexor distribution

130
Q

Does a single episode of vomiting following a head injury indicate a CT

A

Apparently not

Needs to be 3

131
Q

What is meckels diverticulum

A

Small outpouching of intestine in the lower portion of the SI

Can still produce acid so causes ulceration and bleeding

Rule of 2s:
- 2% of pop
- 2 feet from ileocaecal valve
- 2 inches long
- usually presents under the age of 2

Most common cause of painless massive GI bleed requiring a transfusion in kids

132
Q

What is the rule of 2s GI

A

For Meckels diverticulum

2% of pop
2 feet from ileocaecal valve
2 inches long
Usually presents <2

133
Q

How do you investigate meckels diverticulum in a stable and severe case

A

Stable= Meckel’s scan= 99m technetium pertechnetate (has an affinity for gastric mucosa)

Severe= mesenteric arteriography

134
Q

Which investigation looks for renal scarring in vesicoureteric reflux?

A

DMSA

Taken up by healthy renal tubular cells and not scarred ones

135
Q

Which organism is the most likely cause of skin complications from chicken pox e.g. necrotising fasciitis

A

B-Haemolytic Group A Strep e.g. strep throat

136
Q

What kind of laxative is first line in constipation

A

Osmotic to soften the stool

E.g. movicol

137
Q

What do you give in severe croup after oral steroids

A

Oxygen and nebulised adrenaline

Causes vasoconstriction in upper airway, reducing airway edema which is the main problem in croup

Salbutamol has no effect on this, used in severe bronchiolitis/ asthma

138
Q

Until what age is 39 degrees a red flag

A

3 months

139
Q

When is RR of over 60 a reg flag

A

At any age

140
Q

6 year old girl
Foot pain after walking
Writing slow, needs rests after prolonged
Pain in legs at night after lots of activity during the day
Otherwise very well

A

Hypermobility

141
Q

Which rash is most intense on cubital fossa

A

Scarlet fever

142
Q

Rf for DDH

A

girls
firstborn children
families where there have been childhood hip problems (parents, brothers or sisters)
babies born in the breech position (feet or bottom downwards) after 28 weeks of pregnancy

143
Q

Abx choice in mycoplasma pneumoniae causing pneumonia in kids

A

Azithromycin

144
Q

Abx in simple pneumonia not caused by mycoplasma pneumoniae or associated with influenza

A

, amoxicillin

145
Q

Abx choice in kids with pneumonia associated with influenza

A

Coamoxiclav

146
Q

Abx choice in kids with suspected meningitis

A

Benzylpenicillin

147
Q

Roseola infantum causative organism

A

Roseola infantum is caused by human herpes virus 6

148
Q

Kocher’s criteria for diagnosing septic arthritis

A

Kocher’s criteria is used to assess the probability of septic arthritis in children using 4 parameters:
Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr

149
Q

What can a child do at 2 months

A

2 months:

lift head 45 degrees (when laying on face), turns to sound, follows objects past midline, social smile

Parents Little Baby: looks up to sound, smiles because he sees both his parents, one on either side of midline

150
Q

What can a child do at 4 months

A

4 months: lift head 90 degrees/raise up to chest, roll over, find midline, reach for objects, puts objects in mouth, coos (these are vowel sounds), and laughs

Fat Happy Baby: baby is rolling and laughing and cooing because he just discovered midline and is reaching for cake that he will cram into his mouth

151
Q

What can a child do at 6 months

A

6 months: sit up with no head lag, raking grasp, transfer objects between hands, babbles (consonants), recognizes familiar faces

Street-Corner Baby: sitting up on sidewalk, transferring a rake from hand to hand while babbling at people he thinks he recognizes

152
Q

What can a child do at 9 months

A

9 months: Crawl, pull to stand, point, specific babbling (mama, dada), stranger anxiety

Watch Dog Baby: crawls to window, pulls to stand to see out, points at stranger in yard and says mama to get attention of parents.

153
Q

What can a child do at 12 months

A

12 months: Walk, pincer grasp, 1 word, patacake, bye bye, peekaboo

Playful Zombie Baby: walking at you, snapping pincers, repeating one word over and over (brrraaaaains), and just wants to play patacake and peekaboo before waving bye bye.

154
Q

What can a child do at 15 months

A

15 months: walks well, imitates, controlled release of blocks (can stack 2)

Little Sister Baby: wants to be just like big sister, walks confidently to the blocks and imitates making a 2 block tower

155
Q

What can a child do at 18 months

A

18 months: Throw, scribble, 4 block tower, 1 step command, uses spoon/cup, points to parts of body

Sir Charming Baby: needs to get note to Rapunzel so scribbles note on paper to throw into high 4 block tower, catapult has cup on end, shoves note in with spoon, and throws note at tower, hitting Rapunzel in the face

156
Q

What can a child do at 2 years

A

2 years: Run, stairs (1 foot at a time), 20-50 words, 2 step command, parallel play

Bad Twins: mom gives two commands to twin boys to run to the stairs, then walk up the 25 stairs. Each walks up the 25 stairs not helping the other.

157
Q

Whaf can a child do at 3 years

A

3 years: Jump, Tricycle, dresses self (shirt, pants, shoes), full name, you, me, I

James Bond Baby: springs into action . . . jumps into 3-piece suit, stands in front of mirror and says full name, jumps on tricycle. You.Me. I, is his pickup line.

158
Q

What can a child do at 4 years

A

4 years: Stairs (alternating feet), hop, undresses, 1 foot (4 seconds), 4 word phrases (complete sentences), cooperative play

Bedtime Story Baby: really wants story time, so runs up stairs, hops on one foot to undress, so she and mom can read a story together. A Wrinkle in Time.

159
Q

What can a child do at 5 years

A

5 years: Skip, Tie shoes, Difference between reality/fantasy

Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas

160
Q

Hand foot and mouth disease school exclusion

A

None if they feel well

161
Q

What contraception is given to trans FTM not undergone surgery but on testosterone having sex with male partner

A

Copper coil as no hormones to interfere with testosterone therapy

162
Q

What is the most dangerous form of delivery in terms of neonatal bleeding

A

Prolonged ventouse delivery

High pressure exerted by vacuum

163
Q

Which congenital heart condition is associated with a continuous murmur

A

Patent ductus arteriosus

Loudest under left clavicle

164
Q

Which genetic condition is associated with hirschprungs

A

Downs

165
Q

What do you add to a child under 5 with SABA and ICS that needs more

A

Leukotrine receptor agonist e,g, montelukast

I’m 5-16 add LABA instead

166
Q

When do you refer if a child can’t sit without support

A

12 months

Should be 7-8 months

167
Q

When do you refer if a child can’t walk unsupported

A

18 months

13-15 is normal

168
Q

Atrial septal defect describe murmur

A

Ejection systolic murmur (pulmonary region)

Fixed splitting of the second heart sound

169
Q

Classic triad of Sx for Henoch-Schönlein purpura

A

Purpuric rash
Abdo cramping
Haematuria

Can give achey joints

170
Q

What do all breech babies need at 6 weeks

A

USS of hip

171
Q

What vaccine do you offer to kids with parents born in South Asia

A

BCG vaccine for TB

172
Q

What movement. Can’t you do in SUFE

A

Passively
loss of internal rotation of the leg in flexion

173
Q

5 core Sx of Kawasakis

A

Conjunctival infection (bilateral, no discharge)
Rash (never vesicular or bulbous, is generalized)
Adenopathy (usually cervical)
Strawberry tongue
Hands and feet changes

174
Q

What is the definitive surgical Mx for pyloric stenosis

A

Ramstedt pyloromyotomy

Dividing he pyloric muscle to increase the diameter of the gastric outlet

175
Q

Which disease causes hand foot and mouth

A

Coxsackie A16

Manage symptomatically - hydration and analgesia. No exclusion

176
Q

What is the most common presenting feature of wilms tumor

A

Abdo mass

Unexplained avoid mass in kids approx 3 refer urgently

Rare kidney cancer

177
Q

triad of nephrotic syndrome

A

Low serum albumin
High urine protein content (>3+ protein on urine dipstick)
Oedema

178
Q

investigations when suspecting nephrotic syndrome

A

urine dip for proteins (high)

serum albumin (low)

179
Q

cause of nephrotic syndrome

A

90% minimal change disease

can be secondary to another kidney problem or e.g. HSP

180
Q

what kind of murmur in TOF

A

harsh ejection-systolic murmur

due to the pulmonary stenosis

181
Q

What does CSF show for viral and bacterial meningitis

A

Will look turbid in bacterial
Pressure will be high in bacterial
Protein will be high in bacterial (maybe both)
Glucose will be low in bacterial
WBC is high in both (mostly neutrophils in bacterial, lymphocytes in viral)

TLDR everything high for bacterial apart from glucose

182
Q

How to work out paediatric maintainance fluids

A

0-10 kg= 100mls/kg
10-20kg= 50mls/kg
>20kg= 20mls/kg

This is for a day so would have to divide by 24 to give the hourly rate

So a child weighing 21kg would need 1520mls in a day so hourly rate of 63.3mls/hr
Prescribe 500 mls Hartmanns / NaCl with 5% dextrose

183
Q

How to work out paediatric resuscitation fluids

A

0.9% sodium chloride with no additives via intravenous (IV) in a standard bolus of 10 mL/kg over <10 minutes.

So 10ml/kg over 10 mins of 0.9% sodium chloride

184
Q

How to calculate how much fluid to give to a child who is dehydrated

A

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

Given as a bolus

So a 12kg child with 5% dehydration= 600mls

Replace over a certain amount of time so give with maintainance fluids

So their maintainance fluid requirement is 1100mls over 24 hours

Plus 600= 1700mls /24= 71mls /hour

185
Q

How to interpret urine dip for UTI

A

leukocytes +ve and nitrites +ve= treat as UTI

Leukocytes +ve and nitrites -ve= send microscopy and culture and treat as UTI if <3

Leukocytes -ve and nitrites +ve= treat as UTI

Both negative= consider other diagnoses

186
Q

Croup management

A

Oral steroids first e.g. oral dexamethasone

Then oxygen

Then nebulised budesonide ?

Then nebulised adrenaline

Then intubation and ventilation

187
Q

Croup management

A

Oral steroids first e.g. oral dexamethasone

Then oxygen

Then nebulised budesonide ?

Then nebulised adrenaline

Then intubation and ventilation

188
Q

Bronchiolitis management

A

Supportive

Ensure adequate intake

Clear nasal secretions using suctioning and nasal drops

Supplementary O2

189
Q

Bronchiolitis management

A

Supportive

Ensure adequate intake

Clear nasal secretions using suctioning and nasal drops

Supplementary O2

190
Q

What is cystic fibrosis

A

Autosomal recessive disease

Mutation of gene that codes for chloride channels

Causing thick secretions causing duct blockage for digestive enzymes and reduced airway clearance

Can also cause bilateral absence of the vas deferens in boys meaning there is no way for sperm to get from tests to ejaculate

191
Q

How to diagnose cystic fibrosis

A

3 ways:

Blood spot testing (heel prick) which picks up most cases

Sweat test- bit of skin made to sweat and then sent to the lab for chloride concentration- CF=> 60mmol/L

192
Q

Two key colonizers of patients with cystic fibrosis

A

Staph aureus and pseudomonas aeruginosa

CF patients take long term prophylactic fluclox to prevent staph aureus infection but pseudomonas is hard to treat

These are common organisms that live in airways of CF patients due to reduced airway clearance

193
Q

How to treat impetigo

A

Hydrogen peroxide cream / fusidic acid if they are well

It is a bacterial infection highly infectious

Can give oral fluclox if a bit more unwell

194
Q

How does perthes present on X-ray

A

Initially would show increased density of the femoral head

Then the femoral head would have an irregular edge

You should specifically request a ‘frog leg’ hip X-ray view

X-ray is first line investigation

195
Q

How long are patients with chicken-pox infectious for

A

Up to 3 days before lesions appear and until the last lesion dries up

196
Q

How long is the incubation period for chicken pox

A

Up to 3 weeks

197
Q

How to differentiate between peri-orbital and orbital cellulitis

A

Periorbital is better. Presents with swelling in front of the septum (eyelid vibes). Treat with oral Abx but refer if any suspicion of OC

Orbital is bad and sight-threatening. Presents with pain on movement, reduced vision, color blindness, proptosis. Managed with IV Abx +/- surgical drainage of pus. MDT for sure

Periorbital usually caused by some injury, orbital usually caused by spread of infection from e.g. the sinuses

198
Q

Triad of haemlytic uremic syndrome

A

Microangiopathic haemolytic anaemia (normocytic)-> pallor, confusion
Acute kidney injury -> hypertension
Thrombocytopenia (low platelets) -> bruising

Also can present with abdominal pain

199
Q

What is the cause of of haemolytic uraemic syndrome

A

E.coli / Shigella causes gastroenteritis

Which then causes the destruction of red blood cells due to a pathology in the small blood vessels where tiny thrombi partially obstruct the small blood vessels and churn up the RBCs as they pass through causing rupture

200
Q

Management of haemolytic uraemic syndrome

A

Medical emergency -> admit

Supportive management-> fluids, blood transfusion, haemodialysis

Stool culture for causative organism

It is self-limiting and patients will recover

201
Q

Criteria for septic arthritis

A

fever >38.5C, non-weight bearing, ESR > 40, WCC > 12

202
Q

Fetal alcohol syndrome presentation n

A

features of foetal alcohol syndrome: microcephaly, short palpebral fissures, hypoplastic upper lip, absent philtrum, reduced IQ, and cardiac abnormalities

203
Q

Duchennes muscula dystrophy which form of inheritance

A

X-linked recessive

204
Q

barking cough,

A

Croup

205
Q

How to diagnose gestational diabetes

A

either fasting glucose is 5.6mmol/L or above, or two-hour glucose is 7.8mmol/L or above. Manage with lifestyle changes THEN metformin

Give insulin if if the fasting blood glucose is 7.0mmol/L or above, or if the fasting blood glucose is between 6.0 and 6.9 mmol/L and there is evidence of macrosomia or polyhydramnios

206
Q

When can you do PCI after an MI

A

12 hours after symptoms onset

Recommended that its done <2 hours after medical attention as that’s how long it would take for fibrinolytics to work

207
Q

human herpes virus 6 which disease

A

Roseola infantum

208
Q

When are Abx indicated for otitis media

A

tympanic membrane is perforated
under 3-months old,
under 2 years and the infection is bilateral
4 or more day duration of symptoms

209
Q

Which blood test is raised in biliary atresia

A

Conjugated bilirubin

210
Q

New born baby exam

A

You would want a maternal history and baby history, and weigh the baby

General obs for pallor, jaundice, cyanosis

Tone: (hypotonia in Down’s syndrome-> reduced feeding)

Head: size (measure circumference) and shape (e.g. Caput succadedenum), fontanelle. Face for appearance, asymmetry, trauma, nose, eyes. OPTHALMOSCOPE for fundal reflex, ears. Mouth for cleft palate

Neck: webbed neck (Turner’s), neck lumps)

Upper limbs: symmetry, inspect fingers and palms(2 palmer creases), palpate brachial pulse

Chest: observe for IWoB (40-60 normal), chest expansion, listen to lungs and heart

Abdomen: observe for distension, umbilicus, inguinal hernia. Palpate organs

Genitalia: look for urethral meatus, penis size, palpate for testicles, discharge

Lower limbs: symmetry, oedema, tone and movement, femoral pulses, barlows and ortolanis test (back and out)

Back: inspect spine, anus for patency

Reflexes: palmar grasp, sucking, rooting, stepping , Moro

Skin: top to toe for bruises/ lacerations

211
Q

PGALS screening quetions

A

Do you have any pain/ stiffness in muscles, joints or back?

Do you have any difficulty getting yourself dressed without any help?

Do you have any problems going up or down the stairs?

212
Q

Inspection part of pGALS

A

General:
- body habitus
- scars
- muscle wasting
- psoriasis

Objects:
- walking aids
- prescriptions/ meds

Anterior:
- leg length discrepancy
- joint swelling/ erythema
- muscle bulk/ wasting
- elbow extension (5-15)
- valgus and varus (knees are away in varus)

Lateral:
- lordosis, kyphosis
- knee joint extension (hypermobility)
- foot arch

Posterior:
- scoliosis
- iliac crest alignment (leg length discrepancy)
- popliteal swelling
- shoulder alignment

213
Q

What is Trendelenburg gait

A

Defective hip abductor mechanism

Hip dips down to the side that is not weight bearing

214
Q

What is the cause of waddling gait

A

Usually a myopathy e.g. muscular dystrophy

215
Q

Arm movements in pGALS

A

Hands behind head and poin elbows out (abduction and external rotation, elbow flexion)

Hands held out in front with palms facing down (shoulder flexion, elbow extension, small joint extension). Inspect dorsal hand and nails

Palms up (supination)

Make a fist (flexion of small hand joints)

Precision grip

Praying position

Reach up to the sky with arms straight (extension and abduction)

Look up and down

Then squeeze their MCPJs

216
Q

Reflexes in a newborn baby exam

A

Palmar
Sucking
Rooting
Stepping
Moro

217
Q

SUFE Mx

A

Internal fixation across the growth plate is definitive

218
Q

Double bubble sign Abdo X-ray

A

Duodenal atresia

Ass with Down syndrome

219
Q

Stridor from birth

A

Laryngomalacia

220
Q

Which vaccine do you not give in a child with HIV

A

MMR

?cos its live

221
Q

Continuous machinery murmur over the upper left sternal edge.

A

PDA

222
Q

3 ECG changes in hypokalaemia

A

T-wave inversion
U-waves
Long QT interval -> increased risk of tornadoes des points

Fourth Yerar (5 decks)

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