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MSRA 2023 > Paeds > Flashcards

Paeds Flashcards

1
Q

Pertussis aka & phases

A

Whooping cough

  1. Catarrhal phase- six urticaria for 1-2 wks
  2. Paroxysmal- increase cough severity last 2-8 wks
  3. Convalescent phase- cough subsides over wks to months
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2
Q

Management whooping cough and isolation

A

Pertussis

<6 months old- admit
Notifiablendisease

Po macrolide- clari/ azithro/ erythromycin if cough w/in 21 days

School 48hrs after commencing and/ 21d from onset of six if no abx

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3
Q

facial features of Down’s sy

A

trisomy 21

upslanting aplpebral fissure, epicanthic folds, Brushfield spots in iris, protruding tongue, small low set ears, round/flat face, flat occiput

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4
Q

which syndrome has single palmar crease

A

Down’s sy

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5
Q

Most common Cardiac complication of Down’s sy

A

Endocardial cusion defect- AV septal canaldefects

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6
Q

cardiac complications in Down’s sy

A

Desc ordern (most common-> least)

AV septal defect- most common
VSD
secundum ASD

(less toF, isoldated PDA)

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7
Q

GI complications in Down’s sy

A

Duodenal atresia
Hirschprung

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8
Q

Which disease produces Barking cough?
Name organism

A

Croup
PARAINFLUENZA VIRUS

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9
Q

Mx of Parainfluenza virus (Croup)

A

oral dexamethasone 0.15mg/kg ALL children regardless severity

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10
Q

Emergency mx of croup

A

O2
nebulised adrenaline
po dexamethasone 0.15mg/kg

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11
Q

Sx Pyloric Stenosis

A

presents 2nd - 4wks

projectile vomiting esp 30min after feed
palpabl abdo mass in upper abdomen
hypochloraemia, hypokalaemic alkalosis due to persistent vomiting

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12
Q

Necrotising Enterocolitis Sx +AXR

A

feeding intolerence abdominal distension, bloody stool

dilated bowel loops, bowe wll oedema
Pneumatosis intestinalis **

Common Premature infants

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13
Q

Hearing test newborn

A

Otoacoustic

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14
Q

Hearing test newborn& infants

A

Auditory brainstem response if otoacoustic emission test is normal

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15
Q

6-9 months hearing test

A

Distraction test

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16
Q

18months to 2.5 years mile stone

A

Recognition of familiar objects

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17
Q

> 2yrs hearing test

A

Performance testing , speech discrimination test

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18
Q

> 3yrs hearing test

A

Pure tone audiometry

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19
Q

Hypospadiasis mx

A

Corrective mx when around 12 months , x circumcisiom

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20
Q

Patau syndrome

A

Trisomy 13
Microcephalic small eyes
Cleft lip/pakate
Polydactyl
Scalp lesion
Holiprosencephaly- failure of brain to divide into lobes

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21
Q

Edward’s syndrome

A

Trisomy of chromosome 18

Micrognathus
Low set ears
Rocker bottom
Overlapping fingers

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22
Q

Noonan syndrome , name heart defect

A

Webbed neck, pectins excavating, short stature
Pulmonary stenosis

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23
Q

Prader willi syndrome

A

Hypotonia, obesity, hypogonadism

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24
Q

Williams syndrome

A

Elfin face: upturned noses long upper lip length, puffiness around eyes, learning difficulties transient hypercalcaemia, supravalvular aortic stenosis

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25
Q

Cri du chat syndrome

A

Chromosome 5p del

Characteristic cry due to larynx and neurological problems
Feeding difficulties leaning difficulties, hypertelorism

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26
Q

Fragile X syndrome

A

Trinulceotide repeat disorder CGG >200 repeats

Leaning difficulties, large low set eyes, long thin face, hypotonia, autism , mitral valve prolapse

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27
Q

Down’s syndrome

A

Trisomy chromosome 21

Fave: u0slanting palpebral fissures epicanthic folds, brush field spots: small grey.brown spots seen in peripheral iris, single palmar crease, hypotonia, congenital heart defects, duodenal atresia, hirschprung, hypothyroidism, Alzheimer’s disease

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28
Q

Cardiac problem in Down’s syndrome

A

Endocardial cushion defect: AV septa, canal defects

Then csf, secundum ASD, ToF, isolated PDA

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29
Q

Another name for group A haemolytic streptococcus

A

Streptococcus pyogenes

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30
Q

Which pathogen causes strawberry tongue

A

Strep pyogenes/ haemolytic group A streptococcus

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31
Q

5th disease aka

A

Erythema infectiosum, aka Parvo b19 virus

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32
Q

Meningitis B vaccine and meningitis ACWY vaccine

A

Meningitis C replaced by Meningitis AVWY for 13-18yrs

Meningitis b: 2, 4 months
13-18yrs: meningitis ACWY

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33
Q

Mmr vaccine scheduled doses

A

12-15months
3-4 years

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34
Q

Exclusion for mumps, whooping cough, diarrhoea and vomiting, measles, chicken pox

A

Mumps: 5days from onset of swollen gland
Whooping cough: 2 days after starting abx or 21 days from onset of sx if no abx
Diarrhoea and vomiting: sx have settled for 48 hours
Measles: 4 days from onset of rash

Chickenpox: all lesions crusted over

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35
Q

Developmental milestone: turn towards sound

A

3 months

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36
Q

When say mama and dada, understands no

A

9months

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37
Q

Responds to own name

A

12 months

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38
Q

2-6 words

A

12-15 months

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39
Q

Combine 2 words

A

2 years

40
Q

Vocab 200 words

A

2.5- 3 years

41
Q

Asks what and who questions
Talks in short sentences counts to 10

A

3 years

42
Q

Why, when and how questions

A

4 years

43
Q

Sits without support

A

7-8 months

44
Q

Pulls to standing, crawls

A

9 months

45
Q

Walks with one hand held

A

12 months

46
Q

Squats to pick up toys

A

18 months

47
Q

Runs, walks upstairs and downstairs holding on to rail

A

16 months - 2years

48
Q

Tricycle

A

3 years

49
Q

Hops on 1 leg

A

4 years

50
Q

Skipped capital femoral epiphysis. Sx + mx

A

Rare hip condition esp obese boys

Hip groin, medial thigh/ knee pain

XR typically frog-leg

Mx: single cannulated screw placed in centre of epiphysis

51
Q

Perthes disease mx and XR findings

A

Degen condition affecting hip joint
A vascular necrosis of femoral head

XR: widening of joint space, decreased femoral head size/ flattening

Mx: braces, cast older 6years: surgical mx

52
Q

Kocher criteria

A

Septic arthritis:
>38.5 degree
High est
High wbc
Non-weight bearing joint

Point system
1 3%, 2- 40%, 3- 93%, 4- 99%

53
Q

Developmental dysplasia of the hip dx

A

Routine Us: +fmhx, breech position, multiple preg.

Barlow & ortolani test:
- Barlow: dislocate adductor and downward pressure
- ortolans: relocate flex hip and turn 90 degree

Imagining: US <4.5 months otherwise CR

54
Q

Developmental dysplasia of hip mx

A

Usually stabilise but can use Pavlov harness in children<4.5 months

55
Q

Mx constipation in children 1st line

A

polyethylene glycol + electrolytes movicol paeds plain

56
Q

Cyanotic congenital heart disease and which one is most common

A

Tetralogy of fallot MOST COMMON
Tricuspid atresia
Transposition of great arteries
Stenosis of pulmonary valve

57
Q

Duct dependent heart disease

A

ToF
Ebsteins anomaly
Pulmonary atresia
Pulmonary stenosis

58
Q

Acyanotic congenital heart disease , name and which one is the most common

A

VSD MOST COMMON
ASD
PDA
CoA

59
Q

When do you have the anomaly scan to check heart

A

18-20 weeks

60
Q

Tetralogy of Fallot, what is it and sx

A

VSD, RVH, RV outflow obstruction-> pulmonary stenosis, overriding aorta

Test spell: episodic hypercyanotic episodes due to near occlusion of RV outflow tract

61
Q

Mx of transposition of great arteries

A

Needs ductus arteriosus to remain open with prostaglandins

62
Q

XR findings of ToF and TgA

A

CXR ToF: boot shaped heart

CXR TGA: egg on side CxR

63
Q

PDA sx esp heart murmur and mx

A

Acyanotic congenital heart disease

Continuous machinery murmur
Wide pulse pressure, left subclavian thrill

Mx: close PDA by inhibiting PG synthesis by giving ibuprofen or indomethacin

64
Q

Bartters syndrome inheritance and what it is and electrolyte abnormalities

A

AR

Severe hypokalaemia due to defective chloride absorption at Na/K/2Cl co transporter in ascending loop of Henle

Hypokalaemia, normotension

65
Q

Difference between paeds and adult asthma mx

A

Take out LtRa if not helped

  1. SABA
  2. LOW DOSE ICS + SABA
  3. LOW DOSE ICS, SABA, LTRA
  4. LOW DOSE ICS, SABA, LABA AND STOP LTRA
  5. SABA, MART
  6. SABA, MART MED DOSE ICS
  7. HIGH DOSE ICS, SABA, LABA
66
Q

Acute exacerbation of asthma in children mx

A

Broncho dilator
Steroid

<2yrs 10mg OD
2-5 years 20mg OD
>5 years 30-40mg OD

To Upton 3days
Tapering not needed unless exceeds 14days

67
Q

Turner’s syndrome, heart findings

A

One X chromosome or deletion of short arm of one of X chromosome
45 XO

Short stature, webbed neck, bicuspid aortic valve, CoA- ejection cre+dec systolic murmur.

Primary amennorhoea, short 4th metacarpal, lymphoedema in neonates especially feet

68
Q

ITP which hypersensitivity and mx

A

Type II hypersensitivity

Mx:
1. Usually no tax needed, 80% resolves
2. If very low pot count- will need po;if corticosteroid or ivIg
3. Emergency platelet transfusion

69
Q

Measles pathogen , sx, complications

A

Paramyxovirus

Infective from prodrome until 4 days after rash starts

Sx: flulike sx, Koplik spots, rash behind ears the. Whole body- maculopapular rash

Otitis media- most common
Pneumonia- most common cause of death, encephalitis 1-2 weeks onset of illness, subacute sclerosis encephalitis, keratoconjunctivitis

70
Q

Roseola infantum aka, pathogen, sx

A

6th disease
HHV 6

High fever followed by maculopapular rash trunk + ling
Nagayama spots: popular exanthem on uvula and soft palate
Febrile convulsion

71
Q

Scarlet fever aka, sx, infection route, mx, isolation

A

Group A haemolytic streptococci- strep pyogenes.

Resp route

Fever: typically 24-48hours, rash fine punctuate erythema first on torso and spare palms and soles, rough sandpaper texture. Strawberry tongue.

Mx: penicillin V 10 days if allergic azithromycin. Can return to school after 24 hours starting abx

72
Q

Complications of scarlet fever

A

Rheumatic fever: 20 days
Acute glomerulonephritis- 10days after infection

73
Q

Kawasaki dx and mx

A

Vasulitis predominantly seen in children

Dx: >5days of high fever resistant to antipyretics + CREAM 4/5

C: conjunctivitis
R: rash polymorphous non vesicular
E: oedema or erythema of hands and feet
A: adenopathy- enlarge cervical lymphadenopathy
M: mucosal involvement- erythema or fissure or crusting, strawberry tongue

Mx: high dose aspirin, ivIg , echo look for coronary artery aneurysm

74
Q

Pathogen causes acute epiglottis

A

Haemophilia influenza type B

75
Q

Sx of acute epiglottis and investigations esp XR

A

Rapid onset, strider, increased temperature, drooling of saliva, tripod position

Direct visualisation by senior/ airway trained staff
XR: concerned about foreign body- lateral view: thumb signs welling of epiglottis, subglottic narrowing steeple sign

76
Q

Croup which pathogen, sx, XR findings, mx

A

Parainfluenza virus

Sx: strider, barking cough worse at night, fever.

CXR: subglottic narrowing - steeple sign

Mx: single dose po dexamethasonr 0.15mg/kg all children regardless of severity, prednisolone alternative if dexamethasone not available

Ermegency: high flow O2, nebulised adrenaline- vasoconstriction in upper airway mucosa, decreases airway oedema & improves airflow

77
Q

Bronchiolitis causes, mx, prevention

A

Bronchiolitis 75-80% RSV most common cause of serious LRTI in <1year, peak in winter

Mx: supportive, O2 , NFT if not taking fluid or feed, suction excessive upper respiratory secretion

78
Q

Meningitis mx in children and prophylaxis

A

<3months: iv amoxicillin /ampicillin + iv cefotaxim
>3months: > iv cefotaxime / ceftriaxon
Steroids: dexamethasone considered if LP- frank purple not csf, CSF WBC with protein >1g/L, bacteria on gram stain

Abx prophylaxis: ciproflox > rifampicin

79
Q

Meningococcal septicaemia in community mx

A

Benzylpenicillin

<1 yr 300mg
1-10years 600mg
> 1200mg

80
Q

Inheritance of cystic fibrosis and Ix

A

AR
Defect in cystic fibrosis transmembrane conductance regulator gene (CFTR) cAMP regulated Chloride channel on chromosome 7

Ix: on day 6 using dried blood spot on Guthrie card
Sweat test

81
Q

APGAR SCORE

A

Score at 1 and 5min, if low repeat at 10min

A; appearance, blue, cyanotic at extremities, pink.

Pulse: absent, <100, >100

Grimace: floppy, minimal response, prompt response

Activity: absent, flexed arms, active

Resp: absent, slow and irregular, vigorous cry

82
Q

Caput succedaneum vs ceohalohaematoma

A

Caput succedaneum: oedema of scalp present at birth, typically crosses suture line, resolves within days

Cephalohaematoma: bleeding btw periosteum and skull, presents several hours after birth. Most commonly parietal region doesn’t cross suture lines, may take months to resolve

83
Q

Shaken baby syndrome triad

A

Retinal haemorrhages, sudural haematology, encephalopathy

84
Q

UTI in children common pathogen and Ix

A

Most common E. Coli

Ix:
If < 6nibths, uti responds to to- US in 6 weeks. > 6months and responds to tx, nil imaging unless atypical sx present

MSU, static radioisotope DMSA- identifies renal scarring after 4-6 months UTI. MCUG identifies vesicoureteric reflux only recommended for infant <6months who represents with atypical or recurrent UTI.

85
Q

Gastroschisis vs omphalocele/ exomphalos

A

Gastroschisis congenital defect in anterior wall just lateral to umbilical hernia high risk of fluid and heat loss. Immediate surgery

Exomphalos/ omphalocele: abdominal contents protrudes through anterior abdominal wall but covered in amniotic sac formed by amniotic sac and peritoneum. C section reduces risk of rupture. Staged repair

86
Q

Definition of precocious puberty.
Classification and its lab findings

A

Development of secondary sexual characteristics before
Boys 9 years and girls 8 years.

  1. Gonadotropin dependent: central/ true, high FsH/LH
  2. Gonadotropin independent: pseudo/false. Excessive sex hormones, low FSH/LH
87
Q

Vesicoureteric reflux Ix

A

Antenatal period: hydronephrosis on Us
Micturating cystourethrogram: 15-20min injecting dye into bladder via catheter and taking XR whilst child passes urine
DMSA check renal scarring

88
Q

Hearing test in children

A

OADRePSP
Otoacoustic emission test- new born
Auditory brain stem response test- newborn and infants
Distraction test- 6 to 9months
Recognition of familiar objects 18-2.5years
Performance testing > 2.5
Speech discrimination >2.5 years
Pure tone audiometry > 3years

89
Q

Benign Rolandic epilepsy sx, IX Mx

A

Childhood epilepsy that occurs at night.
Typically partial but secondary generalisation may occur.

EEG: centrotemporal spikes can be seen

Mx: usually stops in adolescence

90
Q

Mx of eczema and also severe eczema in children

A

Simple emollient if not effective, hydrocortisone 1% ointment applied BD

Severe: po cyclosporine

91
Q

Pyloric stenosis: when does it present, lab findings, Ix and Mx

A

2nd- 4 weeks of life with projectile vomiting, palpable abdominal mass in upper abdomen.

Lab: hypochloremia, hypokalaemic alkalosis due to persistent vomiting.

Ix: US

Mx: pyloromyotomy

92
Q

When do you do heel prick test and what do you screen for

A

5-9 days of life

Screen: congenital hypothyroidism, CF, sickle cell, ohenylketonuria, medium chain Scylla-CoA DH deficiency, maple syrup urine disease, isovakeric acidaemiam glutamic acid urea type 1, homocystinuria.

93
Q

Retinoblastoma genetics, sx and mx

A

AD

Absent red reflex replaced by white pupil, strabismus

Mx: enucleation

94
Q

Threadworms pathogen, sx, mx

A

Enterobius vermicularis aka pinworms

Sx: 90% ass, perinatal itching especially at night

Dx: sellotape test- lab microscopy to see eggs

Mx:mebendazole 1st line children >6mibths, single dose unless infection persists

95
Q

Triad of nephrotic syndrome, most common cause

A

Proteinuria >1g/m2 per 24 hours
Hypoalbuminaemia <25g/L
Oedema

Minimal change disease

96
Q

How to differentiate between cardiac and non cardiac causes of cyanosis in neonatal period

A

Nitrogen washout test,
100% O2 for 10min then do ABG. If pO2 is <15kPa likely cyanotic congenital heart disease present

MSRA 2023 (22 decks)

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