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AKT > Paeds > Flashcards

Paeds Flashcards

1
Q

Meningitis B immunisation dates

A

2, 4, 12 months

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2
Q

Measles isolation time

A

4 days from onset of rash

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3
Q

Wilms Tumour Fx

A

abdominal mass
visible painless haematuria
typically 3-5 yo

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4
Q

Laryngomalacia Fx

A

noisy respiration (stridor) within 4-6 weeks
99% resolve spontaneously

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5
Q

Mild to moderate acute asthma Mx

A

Bronchodilator B agonist 1 puff every 30-60s up to 10 puffs
if no improvement, repeat and refer to hospital
steroid therapy given to all children with acute asthma

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6
Q

Steroid (PO Prednisolone) dosing for acute asthma

A

2-5yrs - 20mg OD
>5 - 30-40mg OD

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7
Q

Intussusception Fx

A

6-18months old
severe, crampy, progressive abdo pain
“red currant jelly” stool
“sausage shape” mass in abdomen

Ix/
USS - target-like mass

Mx/
Reduction via air insufflation

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8
Q

X-Linked recessive conditions

A

Beckers/ Duchenne muscular dystrophy
Colour blindness
Fabry’s disease
G6PD deficiency
Haemophilia A and B
Hunter’s disease
Lesch-Nyhan syndrome
Nephrogenic diabetes insipidus
Wiskott-Aldrich syndrome

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9
Q

UTI in under 3 months Mx

A

hospital admission

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10
Q

UTI in >3months

A

if Upper UTI - consider hospital. If not, for PO Abx eg cephalosporin or Co-Amox (7-10 days)

if Lower UTI - PO Abx eg Trimeth, Nitro (3 days)

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11
Q

Infantile Colic Fx

A

<3 months old
excessive crying, pulling up of legs - esp in evenings
self resolves

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12
Q

Pertusis (Whooping cough) Ix

A

Per Nasal swab

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13
Q

Pertussis/ Whooping cough diagnostic criteria (5)

A

> 14 days without clear cause
paroxysmal cough
inspiratory whoop
post-tussive (coughing fit) vomit
undiagnosed apnoea episodes in infants

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14
Q

Pertussis/ Whooping cough Mx

A

<6 months old = admitted
Notifiable disease

PO Clarithromycin (or azithro/ erythro)
Household contact - prophylactic Abx
School exclusion: 48 hours after starting Abx or 21 days from onset if no abx

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15
Q

Croup Fx

A

URTI - Parainfluenza virus
6 months to 3 years old
stridor
barking cough
fever
coryza

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16
Q

Croup Mx

A

Mild - Single dose PO Dexamethasone 0.15mg/kg (or Pred)
Mod/ Severe - Hospital
Emergency treatment - high flow O2 + Adrenaline Nebs

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17
Q

Risk factors for Sudden Infant death syndrome (5)

A

prone sleeping
parental smoking
bed sharing
hyperthermia (and head covering)
prematurity

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18
Q

Hand foot and mouth cause

A

Coxsackie A16
Enterovirus 71

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19
Q

Risk factors for developmental dysplasia of hip (6)

A

female
breech presentation
positive FHx
first born child
oligohydramnios
birth weight >5kg/ 11ibs

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20
Q

Chronic Asthma Mx age 5-16

A

1 - SABA
2 - SABA + ICS
3 - SABA + ICS + Leukotriene recep antagonist (LTRA)
4 - SABA + ICS + LABA
5 - SABA + MART (ICS+LABA)

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21
Q

GORD in infants on formula Mx

A

1st - reduce feeds to 150ml/kg/day + more frequent
2 - 2 week trial of feed thickeners
3 - Gaviscon (Alginate)
4 - PPI

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22
Q

Scarlet fever Fx

A

Group A Haem Strep (strep pyogenese)
fever, malaise, tonsillitis
strawberry tongue
rash - fine punctuate erythema sparing the mouth (circumoral palor)

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23
Q

Scarlet fever school exclusion

A

24hrs after commencing Abx

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24
Q

Erythema infectiosum/ Fifth disease/ slapped cheek syndrome
Cause
Fx

A

parvovirus B19
lethargy, headache, fever

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25
Q

Rubella Fx

A

Rash - pink maculopapular, initially on face spread to rest of body
Suboccipital or Postauricular LNs

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26
Q

BenPen Paeds doses for Meningococcal septicaemia (3)

A

<1 = 300mg
1-9 = 600mg
10-17 = 1200mg

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27
Q

6 in 1 vaccine are…
at 2,3,4 months

A

diptheria
tetanus
Pertusis
polio
Hib
Hep B

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28
Q

MMR Vaccine at what dates

A

12-13 months
3-4 years

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29
Q

Amber/ Immediate risk criteria in febrile child

A

Pallor/ pale
Decreased activity

Nasal flaring
RR >50 in 6-12 months
RR >40 in >12 months

HR > 160 <12months
HR > 150 12-24 months
HR >140 2-5 yrs
Poor feeding/ reduced urine output

Temp >39 in 3-6yo
Fever >5/7
swollen joint/ painful limp

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30
Q

Rotavirus vaccine dates

A

2, 3 months

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31
Q

Cows milk protein allergy in bottle fed Mx

A

1st - extensive hydrolysed formula feed
2 - amino acid base formula

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32
Q

Cows milk protein allergy in breastfed Mx

A

Continue breastfeeding
eliminate cows milk from mother’s diet
Ca/ Vit D for Mum
Extensive Hydrolysed formula when weaning off breast milk for at least 6 months

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33
Q

measles complication

A

pneumonia

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34
Q

Ophthalmia neonatorum
Fx
Mx

A

bilateral conjunctivitis <30 days old
urgent ophthal/ paeds assessment

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35
Q

Cephalhaematoma Fx

A

Swelling on skull that does NOT cross the suture lines
from birth - takes months to resolve

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36
Q

Edwards syndrome (Trisomy 18) Fx

A

low set ears
rocker bottom feet
overlapping fingers

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37
Q

Jaundice in newborns (first presenting at..)
<24 hours
2-14 days
>14 days (prolonged)

A

<24 hours - always pathological - Rhesus incompatibility, ABO, hereditary spherocytosis

2-14 days - usually physiological

> 14 days - prolonged jaundice screen eg bilirubin, direct Coombes test, etc
- eg biliary atresia, hypothyroid, breast milk jaundice, galactosaemia

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38
Q

Red flags for constipation

A

from birth/ first few weeks
>48hrs passing of meconium - ?hirchsprung/ CF
multiple anal fissures
neurological signs in lower limbs
large naevus over sacral area - ?spina bifida

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39
Q

Contraindications to MMR vaccine (4)

A

severe immunosuppression
allergy to neomycin
received another live vaccine within 4 weeks
immunoglobulin therapy within past 3 months

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40
Q

Neonatal blood spot/ heel prick test dates

A

5th-9th day of life

41
Q

Neonatal blood spot/ heel prick screens for (5)

A

sickle cell
cystic fibrosis
hypothyroid
phenylketonuria
MCADD

42
Q

Milestones red flags
birth - 3 months
4-6 months
6-12 months
12-24 months

A

<3 months - persistent fisting, rolling
4-6 months - absent smile by 10 weeks, failure to reach for objects by 5 months, unable to support head

6-12 months - persistence of primitive reflexes by 6 months,
sit unsupported 9 months, no babbling, 12 months no attempt to crawl, 12 months unable to stand holding on

12-24months - hand dominance before 12 months ?hemiparesis. not walking unsupported by 18 months

43
Q

Infantile spasms (West syndrome) Fx

A

present 4-8 months
more common in males
carry poor prognosis - associated with progression to epilepsy
characteristic “salaam” attacks - flexion of head, trunk arms followed by extension of arms

44
Q

NSAID are used with caution in chickenpox because increase risk of…

A

Necrotising fasciitis

45
Q

13-18 yo vaccine

A

Diptheria / Tetanus / polio
Men ACWY

46
Q

Threadworm Mx

A

Mebendazole stat + hygiene advice
all household contact need to be treated despite symptoms

47
Q

Acute epiglottitis cause

A

Haemophilus influenzae type B

48
Q

Pneumococcal Conjugate vaccine (PCV) dates

A

3, 12 months

49
Q

Meningitis C vaccine dates

A

12-13 months (1 year)
14 years

50
Q

Meningitis B Vaccine dates

A

2, 4, 12 months

51
Q

Nocturia Mx

A

<5yo - reassurance, diet, toileting behaviour
5+ - 1st Enuresis alarm
desmopressin for short term eg sleep overs

52
Q

Acyanotic congenital heart disease

A

VSD (most common)
ASD
PDA
coarctation of aorta
aortic valve stenosis

53
Q

scarlet fever Mx

A

10/7 PO Pen V (phenoxymethylpenicillin) OR Amox
5/7 PO Azithromycin (pen allergy)
Notify Public health within 3 days

54
Q

Barlow manouvre (DDH)

A

attempts to dislocate articulated femoral head

55
Q

fragile x fx (4)

A

learning difficulty
macrocephaly
large ears
macro orchidism

56
Q

Impetigo Mx

A

Fusidic acid 2% TDS 5 days OR Hydrogen peroxide 1%
School exclusion until all lesions crusted over/ healed or 48 hours after starting Abx

57
Q

Montelukast main side effect

A

nightmares

58
Q

Episodic viral childhood wheeze Mx (only occurs during URTI, not in between)

A

1st - Salbutamol
2nd - LTRA or ICS or both

59
Q

Multiple factor viral childhood wheeze Mx (occurs with URTIs, exercise, smoke, allergens)

A

LTRA or ICS for 4-8 weeks

60
Q

Precocious puberty dates

A

Female - 8 years
Male - 9 years

61
Q

Patau syndrome (trisomy 13)

A

Microcephaly
small eyes

62
Q

Noonans syndrome Fx

A

Webbed neck
pectus excavatum
short stature
pulmonary stenosis

63
Q

Prader Willi syndrome

A

Hypotonia
Hypogonadism
Obesity

64
Q

Concerning developmental milestones for referral
- smile
- sit unsupported
- walk
- hand preference

A
  • does not smile by 10 weeks
  • can not sit unsupported by 12 months
  • can not walk by 18 months
  • hand preference before 12 months
65
Q

Hearing testing in children

A

Newborn - Otoacoustic emission test - part of the Newborn Hearing Screening programme

Newborn + Infants - Auditory Brainstem Response test - performed if initial screening abnormal

6-9 months - Distraction test - by health visitor

18 month - 2.5 yrs - recognition of familiar objects - eg “where is teddy”

> 2.5yrs Speech discrimination - uses similar sounding objects

> 3 yrs Pure tone audiometry - performed at school

66
Q

Head lice (pediculosis capitis) Mx

A

Malathion/ Wet combing/ Dimeticone/ isopropyl myristate and cyclomethicone
household contacts do not need to be treated unless affected
school exclusion not required

67
Q

Constipation Mx

A

1st - Movicol (Macrogol/ polyethylene glycol 3350)
2nd - Senna (stimulant)
3rd - Lactulose (Osmotic)

68
Q

GORD in infants breastfed Mx

A

1st - supportive - 30degrees head up, baby sleep on back, trial smaller more frequent feeds, switch the thickened formula
2nd - alginate (gaviscon) therapy - not used as same time as thickening agents
3rd - PPI ONLY if distressed feeding/ faltering growth/ difficulty feeding AND above have already been tried

69
Q

Undescended testes Mx

A

Unilateral - refer at 3 months to urology
Bilateral - Urgent Paeds admission

70
Q

X linked recessive

A

Turners (exception)
Haemophillia A
G6PD

Affected males can only have unaffected sons and carrier daughters.

Male child of a heterozygous female carrier = 50% chance of being AFFECTED
Female child of a heterozygous female carrier = 50% chance of being a CARRIER

71
Q

Paeds BLS compression breath ratio

A

5 rescue breaths followed by 15 compressions to 2 breaths

72
Q

In toeing Mx

A

<8yr old = reassurance
8+ and gait abnormality (eg tripping over) = orthopaedics

73
Q

roseola infantum cause

A

human herpes virus 6

74
Q

Methylphenidate (for ADHD) critical side effect

A

stunted growth - height and weight need to be measured every 6 months

75
Q

Migraine in children Mx

A

PO Ibuprofen > paracetamol
Intranasal sumatriptan

76
Q

Mitochondrial disease inheritance

A

inheritance is only via the maternal line

none of the children of an affected male will inherit the disease

all of the children of an affected female will inherit the disease

77
Q

Rotavirus vaccine dates

A

oral, live attenuated vaccine
2, 3 months
if after 15 + 24 weeks then risk of intussusception

78
Q

UTI <6 month olds

A

respond to Abx - USS within 6 weeks
atypical UTI - USS acutely, DMSA 4-6 months post infection, MCUG also

79
Q

Vesicoureteric reflux Ix

A

Micturating Cystourethrogram - for diagnosis

DMSA - for renal defects eg scarring from reflux

80
Q

Chickenpox Mx

A

Keep cool, trim nails, calamine lotion

School exclusion: until all lesions are dry and crusted over, usually 5 days after onset of rash

81
Q

Chickenpox complications (4)

A

pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox
arthritis, nephritis and pancreatitis may very rarely be seen

82
Q

Developmental milestones social behaviour

A

6 weeks - smiles (refer at 10 weeks)

3 months - Laughs

6 months - not shy

9 months - shy, takes everything to mouth

83
Q

Knee problems in children

A
  • Chondromalacia patellae
    teenage girls
    anterior knee pain on walking up and down stairs/ up from sitting
  • Osgood-Schlatter disease
    sporty teenagers
    Pain, tenderness and swelling over the tibial tubercle
  • Osteochondritis dissecans
    Pain after exercise
    Intermittent swelling and locking
  • Patellar subluxation
    Medial knee pain due to lateral subluxation of the patella
    Knee may give way
  • Patellar tendonitis
    athletic boys
    Chronic anterior knee pain that worsens after running
    Tender below the patella
84
Q

Threadworm Fx

A

AKA Enterobius vermicularis

Child, perianal itch

85
Q

Rubella school exclusion

A

5 days post onset of rash

86
Q

Fine motor developmental milestones
3 month
6 month
9 month
12 month
18 month
2 yr
3 yr
4 yr

A

3 month - reaches for object

6 month - palmar grasp, pass object one hand to another

9 month - points

12 month - Pincer grip

18 month - Tower block 3 , draw scribble

2 year - Tower block 6 , draw line

3 year - Tower block 9 , draw circle

4 year - draw cross

87
Q

Gross motor developmental milestones

6 months
7-8 months
9 month
12 month
13-15 month
18 month
2 yr
3 yr
4 yr

A

6 month - Rolls front to back, pull to sit

7-8 - sit without support (refer at 12 month)

9 month - pull to stand, crawl

12 month - cruise

13-15m - walk unsupported (refer at 18 month)

18m - squat to pick up toy

2yr - run, walk stairs with rail

3yr - tricycle, walk stairs without rail

4yr - hops

88
Q

Williams syndrome Fx

A

learning difficulties, extremely friendly, extroverted
Short stature
Supravalvular aortic stenosis

89
Q

Whooping cough school exclusion cirteria

A

48 hours after Abx or
21 days from symptom onset

90
Q

Noonam syndrome Fx

A

webbed neck
short stature
pulmonary stenosis
pectus excavatum
ptosis

autosomal dominant

91
Q

From birth till about 2 years of age, genu varum (bow legs) is a normal variant. Referral should be considered if genu varum is asymmetrical or persists beyond 3 years of age and vitamin D deficiency is an important differential if the genu varum is severe. Genu Valgus (knock knees) is a normal variant between 3- 6 years of age and again vitamin D deficiency should be considered if the valgus is severe or persists. Flat feet is a normal variant until age 3. Most flat feet resolve by age 8 years as the foot arch starts to develop from around 3 years of age. Arches should appear when asking the infant to stand on their tip toes, and the foot should also be flexible and painless. Painful rigid flat feet should always be referred and may suggest tarsal coalition.

A

From birth till about 2 years of age, genu varum (bow legs) is a normal variant. Referral should be considered if genu varum is asymmetrical or persists beyond 3 years of age and vitamin D deficiency is an important differential if the genu varum is severe. Genu Valgus (knock knees) is a normal variant between 3- 6 years of age and again vitamin D deficiency should be considered if the valgus is severe or persists. Flat feet is a normal variant until age 3. Most flat feet resolve by age 8 years as the foot arch starts to develop from around 3 years of age. Arches should appear when asking the infant to stand on their tip toes, and the foot should also be flexible and painless. Painful rigid flat feet should always be referred and may suggest tarsal coalition.

92
Q

Food allergy diagnostic test

A

oral food challenge

93
Q

UTI <6 months old Mx

A

Treat as normal with Abx
Requires renal USS

(if >6months then no need for USS)

94
Q

Acute otitis media Mx

A

1st - Amox (Clari if pen allergy)
2nd - Co Amox (if no improvement after 3 days)

95
Q

Tourette’s Mx

A

Haloperidol

96
Q

Bile stained vomit in <1yo

A

Red flag - urgent refer - ?obstruction/ volvulus

97
Q

ADHD Mx

A

1st - Methylphenidate
2nd - Lisdexamfetamine
3rd - atomoxetine

98
Q
A

AKT (21 decks)

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