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Paeds Flashcards

ED, renal ✔, cardio ✔, resp ✔, immunology ✔, gi ✔, neonates ✔, infectious disease ✔ endo ✔

1
Q

What is the most common cause of bronchiolitis?

A

RSV

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2
Q

At what age is bronchiolitis most common?

A

Under 2 year olds, most commonly under 6 months

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3
Q

What is the pathogenesis of bronchiolitis, how long does it last and at what day does it peak?

A

Starts as a URTI, half recover and half develop LRT symptoms
Up to 2 weeks. Peaks ~day 4

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4
Q

What are the two main concerns in a pt with bronchiolitis?

A

Respiratory effort and saturations.
Tolerating feeds.

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5
Q

What is a classic presentation of appendicitis?

A

Localized severe RIF pain, may move to LIF (Rovsing’s sign).
Nausea +/- vomiting
Fever
Pain worsens when walking (abuts the iliopsoas muscle)
Percussion tenderness or rebound tenderness- suggests peritonitis and thus rupture of appendix

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6
Q

What are the differentials for appendicitis?

A

Mesenteric adenitis
Constipation/IBD/IBS
UTI/ pyelonephritis/ renal colic
Testicular torsion
Ovarian torsion/cyst rupture etc

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7
Q

What is the classic presentation of measles?

A

Fever, coryza, conjunctivitis
Rash: starts on face behind ears, spreads to rest of the body. Develops ~3days after fever.
Koplik spots: white spots on buccal mucosa, 2 days after fever

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8
Q

How long does measles last?
How long should you isolate?

A

7-10 symptomatic days
Should isolate for a further 4 days after resolution of symptoms

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9
Q

What are the complications of measles? How common are they? What is the most common complication?

A

30% develop complications

Encephalitis/meningitis
Hearing loss- otitis media most common complication
Vision loss
Pneumonia
Diarrhoea
Mortality

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10
Q

What is the murmur typically heard with VSD?

A

Pansystolic murmur
Heard at the left lower sternal border

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11
Q

What genetic conditions are VSDs most commonly associated with?

A

Down’s syndrome
Turner’s syndrome

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12
Q

Is a VSD acyanotic or cyanotic, L to R or R to L

A

L to R shunt
Acyanotic

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13
Q

What are the common complications of a L to R shunt?

A

R sided overload, R side HF, pulmonary hypertension.

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14
Q

What is Eisenmenger syndrome?

A

When a L to R shunt changes to R to L, as pulmonary HTN increases the right sided pressure, pushing blood to the left side of the heart. The patient will then become cyanotic.

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15
Q

What is an oral fluid challenge?

A

A way of giving unwell children fluids. They are given 1ml/kg every 10 minutes (or just do 5ml per 5 mins if unsure of weight), through an enteral syringe.
If this doesn’t improve the child’s health and hydration status, an NG may be needed.

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16
Q

What murmur is most likely heard in a patient with Turner’s syndrome?

A

Ejection systolic murmur:
Turner’s syndrome is associated with a bicuspid aortic valve which causes an ejection systolic murmur.

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17
Q

In a child with bronchiolitis, what features indicate immediate referral to hospital?

A

Apnoea
Severe resp distress(inter/sub costal recessions, grunting, RR>70)
Persistent O2 sats of less than 92% on air

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18
Q

What is the shaken baby syndrome triad?

A

Retinal haemorrhages
Subdural haematoma
Encephalopathy

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19
Q

What is the causative organism of epiglottitis?

A

HIB- Haemophilus influenzae B

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20
Q

What is pathognomonic for Kawasaki disease?

A

Fever >5 days

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21
Q

How is Kawasaki disease treated?

A

High dose aspirin

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22
Q

When can a patient with scarlet fever return to school?

A

24 hours after starting antibiotics

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23
Q

What are the features of tetralogy of fallot?

A

RV hypertrophy
Overriding aorta
VSD
RV outflow obstruction/pulmonary stenosis

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24
Q

What murmur will be caused by a patent ductus arteriosus?

A

Machinery murmur at the upper left sternal edge

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25
Q

What should be given immediately after birth if transposition of the great arteries is suspected, and why?

A

Prostaglandin E1 will keep the ductus arteriosus patent, to allow a route of alternate blood flow, preventing cyanosis.

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26
Q

What will be found o/e of a SUFE?

A

Loss of internal rotation of the leg in flexion

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27
Q

Criteria for immediate request for CT head following head injury

A

Suspicion of non accidental injury
Dangerous mechanism of injury
LOC >5mins
Amnesia >5 mins
Drowsiness or GCS less than 14
3 or more episodes of vomiting
Seizure and no hx of epilepsy
Suspicion of skull injury
Tense fontanelle
Focal neurological deficit
In under 1 year old- bruise, swelling or laceration more than 5cm on head

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28
Q

What does the 4 in 1 booster provide immunity against?

A

Diphtheria, tetanus, whooping cough and polio

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29
Q

What immunizations are given at ages 3-4?

A

MMR plus 4 in 1 (DTaP+IPV)

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30
Q

At what age is the 6 in 1 vaccine given?

A

2-4 month olds

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31
Q

What is hypospadias and what other condition is it associated with?

A

A congenital defect caused by incomplete fusion of the urethral folds embryologically - urethral meatus can be found in other locations e.g. ventral aspect of the penis.
Also, 10% will have cryptorchidism

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32
Q

What can be given for PDA?

A

Indomethacin or ibuprofen (inhibits prostaglandin synthesis)

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33
Q

What is the causative organism of scarlet fever?

A

Group A haemolytic strep

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34
Q

What is the most common type of nephrotic syndrome in children?
What is the pathophysiology

A

Minimal change
Podocyte damage leads to fusion of podocytes and leakage of proteins

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35
Q

What are some of the causes of minimal change disease

A

May be idiopathic
Can be secondary to:
- FSGS
- Membranoproliferative glomerulonephritis
- HSP
- Diabetes
- Infection (e.g. HIV, hepatitis, malaria)

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36
Q

What are small molecular weight proteins and hyaline casts on urinalysis, indicative of?

A

Minimal change disease

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37
Q

Management of minimal change?

A

Prednisolone - high dose for 4 weeks and then weaned over 8 weeks
Low salt diet, diuretics, HAS

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38
Q

What are the complications of nephrotic syndrome?

A

Hypovolaemia (fluid is in the interstitial space)
Thrombosis (loss of clotting factors, and the liver responds to low albumin by producing pro thrombotic proteins)
Infection (loss of Ig through kidneys)
Acute or chronic renal failure
Relapse (80% in minimal change)

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39
Q

When do children get control of daytime urination, and night time urination?

A

Diurnal enuresis resolves by 2 years
Nocturnal enuresis resolves by 3-4 years.

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40
Q

What are some causes of primary nocturnal enuresis?

A

Overactive bladder
Fluid intake before bed
Psychological distress
Secondary causes (chronic constipation, UTI, learning disability or cerebral palsy)

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41
Q

What is the stepwise management of primary nocturnal enuresis?

A

Reassure parents if children under 5.
1) 2 week toileting diary to help establish underlying cause. Treat underlying cause.
2) Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet
3) Positive reinforcement.
4) Enuresis alarms
5) Pharmacological treatment

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42
Q

What is secondary nocturnal enuresis?

A

When a child begins wetting the bed when they have previously been dry for at least 6 months.

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43
Q

Causes of secondary nocturnal enuresis?

A

Think abuse/safeguarding- maltreatment is a cause
UTI
Constipation
Type 1 diabetes
New psychosocial problems (e.g. stress in family or school life)

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44
Q

What is the pathophysiology of haemolytic uraemic syndrome?

A

Follows gastroenteritis caused by ecoli 0157 or shigella:
- Microangiopathic haemolytic anaemia (thrombi partially obstruct the small blood vessels and churn the red blood cells as they pass through, causing them to rupture)
- AKI (thrombi in nephrons)
- Thrombocytopenia (due to formation of blood clots)

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45
Q

Presentation of HUS?

A

1 week post gastroenteritis (which pc with bloody diarrhoea)
-fever
-abdo pain
-lethargy
-pallor
-oliguria
-haematuria
-hypertension
-bruising
-jaundice
-confusion

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46
Q

How is HUS managed?

A

Medical emergency
-Hospital admission
-Supportive management (e.g. IV fluids, blood transfusions, haemodialysis)
Condition is self limiting

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47
Q

What type of polycystic kidney disease presents in childhood(neonates)?
And what is it a mutation of?

A

Autosomal recessive polycystic kidney disease (ARPKD)
-Mutation in the polycystic kidney and hepatic disease 1 (PKHD1) gene on chromosome 6.

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48
Q

How does autosomal recessive polycystic kidney disease present?

A

In neonates:
cystic enlargement of renal collecting ducts
Oligohydramnios, pulmonary hypoplasia, Potter syndrome
Congenital liver fibrosis

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49
Q

What is multicystic dysplastic kidney?

A

One of the baby’s kidneys is made up of many cysts while the other kidney is normal
-usually the cystic kidney will atrophy and disappear before 5 years of age

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50
Q

What is the most common renal tumour in children, and in what specific age group?

A

Under 5 y/o
Wilms tumour

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51
Q

What are the 2 most common causes of nephritis in children?

A

Post streptococcal glomerulonephritis
IgA nephropathy

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52
Q

What is the pathophysiology of post strep glomerulonephritis?

A

1-3 weeks after β-haemolytic streptococcus infection (e.g. tonsillitis caused by Strep pyogenes):
-Immune complexes (antigens, antibodies and complement proteins) get stuck in the glomeruli of the kidney
-Causes inflammation
-Leads to deterioration in function and AKI

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53
Q

What are anti-streptolysin antibody titres? When is it useful?

A

Blood test to measure antibodies produced against group A strep bacteria. Indicates recent infection.

May be used if suspicious of recent infection, causing complications e.g. post strep glomerulonephritis

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54
Q

What is the pathophysiology of IgA nephropathy, and what is the other name for this condition?

A

Berger’s disease (related to HSP)
IgA deposits in the nephrons of the kidney causes inflammation

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55
Q

What will a biopsy show to support a diagnosis of Berger’s disease?

A

IgA deposits
Glomerular mesangial proliferation

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56
Q

How is IgA nephropathy managed?

A

Supportive treatment of renal failure
Immunosuppressant to slow progression of disease e.g. steroids, cyclophosphamide

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57
Q

What is the diagnosis?
3 to10 y/o F presents with:
Vaginal soreness, itching, erythema, discharge and dysuria.
Urinalysis- +ve for leukocytes only.
No improvement after treatment for UTI and thrush.

A

Vulvovaginitis

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58
Q

What can exacerbate vulvovaginitis?

A

Wet nappies
Chemicals or soaps
Tight clothing
Poor toilet hygiene
Constipation
Threadworms
Pressure on area e.g. horse riding
Chlorinated pools

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59
Q

What is the management for vulvovaginitis?

A

Symptoms usually resolve after puberty, as oestrogen helps to keep skin and mucosa healthy
Supportive management- advise to avoid exacerbating factors
Severe cases may require oestrogen cream

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60
Q

What are the risk factors for cryptorchidism?

A

FMH
Low birth weight
Small for gestational age
Prematurity
Maternal smoking during pregnancy

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61
Q

What is the name of the corrective surgery for cryptorchidism, and at what age should this be done?

A

Orchidopexy
6-12 months of age (they may descend on their own at 3-6 months)

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62
Q

What does cryptorchidism increase the risk of?

A

Testicular torsion
Infertility
Testicular cancer

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63
Q

What is a hydrocele?
And simple vs communicating

A

A collection of fluid within the tunica vaginalis that surrounds the testes
Simple- fluid is contained to the tunica vaginalis
Communicating- the processus vaginalis links the tunica vaginalis and the peritoneal cavity, allowing the fluid to travel between the hydrocele and the peritoneal cavity

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64
Q

What are the differentials for a hydrocele?
What is the key examination finding of a hydrocele?

A

Cryptorchidism
Hernia
Testicular torsion
Haematoma
Tumour

Transillumination with light

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65
Q

How is a hydrocele managed?

A

Simple will resolve within 2 years with no complications. Only requires treatment if associated with other problems e.g. hernia.
Communicating can be treated with surgery to remove the processus vaginalis (the communication)

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66
Q

How do you manage a child under 3 months with a fever?

A

Immediate admission and IV abx (e.g. ceftriaxone)
Full septic screen- blood cultures, bloods, lactate
Consider lumbar puncture

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67
Q

When should you investigate children with UTI using USS?

A

Within 6 weeks if one or more of:
All children under 6 months
Recurrent UTI
Atypical UTI

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68
Q

What investigation is used to investigate for lasting damage after a UTI?

A

DMSA scan - dimercaptosuccinic acid scan

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69
Q

What is used to confirm a diagnosis of vesico-ureteric reflux?

A

Micturating cystourethrogram (MCUG)

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70
Q

What is the most important determining factor in determining the severity of TOF?

A

Degree of RV outflow obstruction/ pulmonary stenosis

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71
Q

What is the first line management of cows milk protein allergy?

A

Hydrolysed formula milk

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72
Q

Describe the rash seen in chickenpox and how it develops

A

Starts as raised red, itchy spots, primarily on the face or chest, before spreading to the rest of the body.
Progresses into small, fluid-filled blisters over a span of a few days.
Eventually crusts over and heals, typically leaving no scars unless the blisters have been scratched and infected.

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73
Q

When are people with chickenpox contagious?

A

Peak infectivity is 1-2 days before the rash appears, until 5 days after the rash first appeared, when all lesions have crusted over

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74
Q

What are the three core signs of ALL?

A

Neutropenia
Anaemia
Thrombocytopenia

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75
Q

What are the maternal risk factors for congenital cardiac disease of the newborn?

A

Infectious- e.g. rubella
Teratogenic drugs
Substance misuse
Poorly controlled type 1 or 2 DM (not gestational)

76
Q

What is the most common causative organism of impetigo?
What is the first and second line treatment of impetigo?

A

Staph aureus
1st line: Hydrogen peroxide 1%
2nd line: Fusidic acid

77
Q

What are the triad of symptoms for ADHD?

A

Inattention
Hyperactivity
Impulsivity

78
Q

What are reflex anoxic seizures, and at what age are they most common?

A

Breath-holding spells are paroxysmal, non-epileptic events
6 months- 6 years

79
Q

How is whooping cough diagnosed?

A

Bordetella pernasal swab - may take days/weeks for results
PCR and serology are increasingly used.

80
Q

What genes are associated with coeliac’s disease?

A

HLA DQ2
HLA DQ8

81
Q

What is the gold standard test for Coeliac’s disease, and what result would support the diagnosis?

A

Intestinal biopsy
- crypt hypertrophy
- villous atrophy

82
Q

What is involved in a coeliac screen?

A

(diet must contain gluten for testing)
anti TTG antibodies
anti endomysial antibodies

83
Q

What conditions are associated with coeliac disease?

A

T1DM
Thyroid disease
Autoimmune hepatitis
Primary biliary sclerosis
Primary sclerosing cholangitis
Down’s syndrome

84
Q

What are the complications of untreated coeliac disease?

A

Vitamin deficiencies
Anaemia
Osteoporosis
Ulcerative jejunitis
T cell lymphoma of the intestine
Non Hodgkin lymphoma
Small bowel adenocarcinoma

85
Q

What is the skin condition associated with coeliac disease?

A

Dermatitis herpetiformis

86
Q

What is redcurrant jelly stool a characteristic sign of?

A

Intussesception

87
Q

What age and gender does intussusception tend to occur?

A

6 months to 2 years
more common in boys

88
Q

What are the conditions associated with intussusception?

A

Concurrent viral illness
HSP
CF
Intestinal polyps
Meckel diverticulum

89
Q

What is a sausage shaped RUQ mass a characteristic sign of?

A

Intussusception

90
Q

How is intussusception managed?

A

Therapeutic enemas (air/water/contrast)
Surgical reduction

91
Q

What are the complications of intussusception?

A

Obstruction
Gangrenous bowel
Perforation

92
Q

A baby that is failing to thrive presents with projectile vomiting, o/e firm, round mass can be felt in the upper abdomen that feels like a large olive.
What is the diagnosis and blood gas likely to show?

A

Pyloric stenosis
Hypochloric hypokalaemic metabolic alkalosis

93
Q

What are the causes of paediatric intestinal obstruction?

A

Meconium ileus
Hirschsprung’s disease
Oesophageal atresia
Duodenal atresia
Intussusception
Imperforate anus
Malrotation of the intestines with a volvulus
Strangulated hernia

94
Q

What are the red flags in a paediatric pt with constipation?

A

Not passing meconium within 48 hours of birth
Neurological signs or symptoms
Vomiting
Ribbon stool (anal stenosis)
Abnormal anus
Abnormal lower back or buttocks
Failure to thrive
Acute severe abdo pain and bloating

95
Q

What and where is Meckels Diverticulum?

A

Malformation of the distal ileum

96
Q

What are the complications of Meckel’s diverticulum?

A

Inflammation - diverticulitis
Rupture
Volvulus
Intussusception

97
Q

What is mesenteric adenitis and what causes it?

A

Inflamed abdominal lymph nodes
Infection such as tonsillitis or URTI

98
Q

What is an appendix mass?

A

When the omentum surround and sticks to the inflamed appendix, forming a palpable mass in the RIF

99
Q

What are the differences between gastroschisis and omphalocele?

A

G- defect in the anterior abdo wall just lateral to the umbilical cord. There is no amniotic sac covering the intestines
O- defect in the umbilicus. The intestines are covered by an amniotic sac formed by amniotic membrane and peritoneum

100
Q

What is the management of gastroschisis?

A

May be delivered by vaginal delivery or c/s
Newborns to go to theatre within 4 hours of birth

101
Q

What conditions are associated with an omphalocele?

A

Beckwith-Wiedemann syndrome (can cause omphalocele and wilms tumour etc)
Down’s syndrome
cardiac and kidney malformations

102
Q

How is an omphalocele managed?

A

C/s delivery to reduce the risk of sac rupture
Staged repair - due to lack of space and high intra abdo pressure

103
Q

What is ‘cradle cap’ and how is it managed

A

Seborrhoeic dermatitis, which may develop in the first few weeks of life
Topical emollient
Resolves spontaneously around 8 months of age often

104
Q

What is Kocher’s criteria used for, and what are the four criteria?

A

To evaluate the likelihood of septic arthritis in paediatric patients
Inability to weight bear
Fever >38.5
WCC >12
ESR >40

105
Q

What is Ebstein’s abnormality and what causes it?

A

The posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle- causes tricuspid regurg and stenosis
Use of lithium in pregnancy

106
Q

What is the first line management for threadworm?

A

Mebendazole

107
Q

What are the three phases of whooping cough?

A

Catarrhal phase- URTI symptoms for around a week.
Paroxysmal phase- paroxysmal cough, coughing fits increasing in intensity, worse after feeding and at night, may end in vomiting/cyanosis/apnoea. Lasts 2-8 weeks.
Convalescent phase- cough subsides

108
Q

What is the diagnostic criteria for whooping cough?

A

Suspect if acute cough for 2 or more weeks, without obvious cause. Plus, one or more of:
Paroxysmal cough
Inspiratory whoop
Post-tussive vomiting
Undiagnosed apnoeic attacks in young infants

109
Q

What are the possible complications of whooping cough

A

Subconjunctival haemorrhage
Pneumonia
Bronchiectasis
Seizures

110
Q

Who is offered the bordetella pertussis vaccine and when?

A

Children- 2,3,4 months and 5 yrs
Pregnant women- 16-32/40

111
Q

What is a sign of epiglottitis on xray?

A

Lateral x-ray of the neck:
Thumb/thumbprint sign (soft tissue shadow pressed into the trachea)

112
Q

How is epiglottitis managed?

A

Do NOT examine the pt.
Alert senior paediatrician and anaesthetist
1- ensure airway is secure
2- IV abx ceftriaxone and steroids e.g. dex

113
Q

What is the main complication of epiglottitis to be aware of?

A

Epiglottic abscess

114
Q

What is laryngomalacia? Pathophysiology?

A

A condition where the supraglottic larynx is structured in a way that causes partial airway obstruction.
-The two aryepiglottic folds are shortened, pulling the epiglottis over the tracheal opening
-The tissue surrounding the supraglottic larynx is softer and has less tone in laryngomalacia, meaning it can flop across the airway

115
Q

At what age does laryngomalacia occur? How does it present?

A

In infants, incidence peaking at 6 months.
With stridor on inhalation. Can cause problems feeding. Rarely causes repiratory distress.

116
Q

How is laryngomalacia managed?

A

Often self resolves as the larynx matures and grows, better able to support itself. Usually, no intervention is needed.
In more severe cases:
Tracheostomy may be necessary, to bypass the larynx
Surgery is an option to alter the tissue structure

117
Q

What is another name for primary ciliary dyskinesia?

A

Kartagner’s syndrome

118
Q

What is the inheritance pattern of Kartagner’s syndrome

A

Autosomal recessive

119
Q

What is the pathophysiology of primary ciliary dyskinesia?

A

Inherited condition, leading to:
Dysfunction of the motile cilia around the body, including the respiratory tract.
Causes a buildup of mucus and bacteria in the lungs and bronchioles.
Also affects the cilia in fallopian tubes and the flagella of sperm.

120
Q

What population is primary ciliary dyskinesia most common in?

A

Populations where there is consanguinity

121
Q

What is Kartagner’s triad?

A

Paranasal sinusitis
Bronchiectasis
Situs Inversus

3 key features of PCD, but not all patients will have all three.

122
Q

How does primary ciliary dyskinesia present?

A

Similarly to CF:
Frequent and chronic LRTI
Poor growth
Bronchiectasis

123
Q

How is primary ciliary dyskinesia diagnosed?
What other investigations may be done?

A

Key diagnostic investigation:
Sample the ciliated epithelium and examine action of the cilia - obtained through nasal brushing or bronchoscopy
Also:
CXR for situs invertus
Semen analysis for male infertility

124
Q

How is primary ciliary dyskinesia managed?

A

Similar to CF and bronchiectasis:
Daily chest physiotherapy
High calorie diet
Abx

125
Q

What is the most common cause of croup?

A

Parainfluenza

126
Q

What age is affected by croup?

A

6 months to 2 years

127
Q

What is croup?

A

URTI causing oedema in the larynx

128
Q

How is croup managed?

A

Oral dexamethasone - usually single dose
Also supportive treatment and infection prevention measures

129
Q

What is the stepwise management of asthma in under 5s?

A

1- SABA
2- Add ICS or LTRA
3- Add the other option from step 2
4- Specialist referral

130
Q

What is the stepwise management of asthma in 5-12 year olds?

A

1- SABA
2- Add ICS
3- Add LABA
4- Increase ICS. Consider adding: oral LTRA or theophylline
5- Further increase ICS to highest dose
6- Specialist referral

131
Q

What is the stepwise management of asthma in over 12 years?

A

Same as adults:
1- SABA
2- Add ICS
3- Add LABA
4- Increase ICS. Consider: LRTA, theophylline or LAMA
5- Increase ICS. Consider additional step 4 treatments
6- Specialist referral (may start oral steroids etc)

132
Q

How is acute viral wheeze managed?

A

Same as acute asthma:
O2, nebs (salbutamol and ipratropium bromide), prednisolone, IV (hydrocortisone, magnesium sulphate, salbutamol, aminophylline)

133
Q

How is a sweat test performed and why?

A

Gold standard for diagnosis of CF
Pilocarpine in added to a patch on the leg or arm. Electrodes are placed on either side of the patch and a small current is used. This causes the skin to sweat.
This is then sent to the lab to test for chloride concentration. Diagnostic amount is >60mmol/l

134
Q

What else are pts with CF screened for? And what else can they develop?

A

DM
Osteoporosis
Vit D deficiency
Liver failure

Not screened but can develop:
Pancreatic insufficiency
Males are infertile due to lack of vas deferens

135
Q

What are the two main colonisers to remember in CF?

A

Staph aureus- prophylactic flucloxacillin is given
Pseudomonas- difficult to get rid off and increasingly abx resistant, particularly bad prognosis

136
Q

What are the symptoms of CF?

A

Thick sputum production and chronic cough
Recurrent LRTI
Steatorrhea
Abdo pain and bloating
Failure to thrive- weight and height

137
Q

What is the very first symptom of CF that may present?

A

Meconium ileus

138
Q

What is the inheritance pattern of congenital adrenal hyperplasia?

A

Autosomal recessive

139
Q

What is the pathophysiology of CAH?

A

There is a deficiency of 21 hydroxylase enzyme, which is responsible for the conversion of progesterone into aldosterone and cortisol. The excessive progesterone is converted into testosterone instead.
This results in low aldosterone, low cortisol and high testosterone.

140
Q

How does CAH present in severe cases?

A

Females present at birth with ambiguous genitalia due to high testosterone levels.
Can cause hyponatraemia, hyperkalaemia, hypoglycaemia.
Causes:
Poor feeding
Vomiting
Dehydration
Arrhythmias

141
Q

How does CAH present in mild cases?

A

During childhood or after puberty, tend to relate to high androgen levels:
Female- tall, facial hair, oligo/amenorrhoea, deep voice, early puberty
Male- tall, deep voice, large penis, small testicles, early puberty
Both- hyperpigmentation due to anterior pituitary production of ACTH and thus melanocyte simulating hormone

142
Q

How is CAH managed?

A

By specialist paediatric endocrinologists:
Cortisol replacement with hydrocortisone
Aldosterone replacement with fludrocortisone
Ambiguous genitalia may require corrective surgery

143
Q

What abx should be given to children <3 months, with meningitis, and why?

A

Cefotaxime- covers strep pneumoniae and N. meningitidis
Amoxicillin- to cover listeria monocytogenes

144
Q

What are the features o/e of PDA?

A

Left subclavicular thrill
Machinery murmur
Large volume bounding collapsing pulse
Wide pulse pressure
Heaving apex beat

145
Q

How is PDA managed?

A

Indomethacin is given to the neonate

146
Q

When does infantile colic improve and resolve?

A

Improves at 3-4 months, resolves at 6 months

147
Q

How does the presentation of IgA nephropathy and post strep glomerulonephritis differ?

A

Both present following URTI, with a nephritic picture e.g. haematuria
- IgA n. presents 1-3 days later
- post strep presents 7-14 days later

148
Q

What are the risk factors for neonatal sepsis?

A

Vaginal GBS colonisation
GBS sepsis in a previous baby
Maternal sepsis, chorioamnionitis or fever > 38ºC
Prematurity (less than 37 weeks)
PROM
PPROM

149
Q

What are the first line abx for neonatal sepsis?

A

Benzylpenicillin with gentamicin

150
Q

What are the common causative organisms of neonatal sepsis?

A

GBS (esp if w/in 72 hrs of birth, infection is most likey from mother)
E.coli
Listeria
Klebsiella
Staph aureus

151
Q

When are neonates treated for presumed sepsis?

A

If one rf or clinical feature, monitor for 12 hrs
If 2 or more rf or clinical features, start abx
If one red flag, start abx

152
Q

What is the complication of neonatal jaundice?

A

Kernicterus
Unconjugated bilirubin can cross the BBB

153
Q

What are the clinical features of Turner’s syndrome?

A

Short
Webbed neck
High arching palate
Downward sloping eyes with ptosis
Broad chest with wide spaced nipples
Cubitus valgus
Late or lack of puberty
Infertility

154
Q

What is one key feature o/e that should make you consider mumps dx?

A

Parotid gland swelling

155
Q

When can kids return to school with mumps?

A

5 days from onset

156
Q

When can kids return to school with rubella?

A

5 days from onset

157
Q

What viral exanthems don’t require school exclusion?

A

Hand foot and mouth disease
Slapped cheek

158
Q

When can kids return to school with chicken pox?

A

When all lesions have crusted over ~5 days after onset

159
Q

What are the complications of slapped cheek?

A

Complications of parvovirus B19:
Aplastic anaemia
Encephalitis/meningitis
Pregnancy comp inc. fetal death

160
Q

What causes roseola infantum?

A

HHV-6

161
Q

What is the pattern of illness in roseola?

A

High fever (up to 40 degrees) 1-2 weeks after an infection
Fever lasts for 3-5 days and suddenly disappears
Rash appears after fever settles
May also be coryzal symptoms, sore throat and swollen lymph nodes during illness.

162
Q

What is the complication of roseola?

A

Febrile convulsions

163
Q

What is the triad of congenital rubella syndrome?

A

Deafness
Blindness
Congenital heart disease

164
Q

What are the 3 causes of limp in 0-5 y/os?

A

DHH
Septic arthritis
Transient synovitis

165
Q

What are the 3 causes of limp in 5-10 y/os?

A

Septic arthritis
Transient synovitis
Perthes disease

166
Q

What are the 4 causes of limp in 10-15 y/os?

A

Septic arthritis
Juvenile idiopathic arthritis
SUFE
Osgood Schlatter

167
Q

What is osgood schlatters disease?

A

Inflammation at the tibial tuberosity where the patella ligament inserts
There are multiple small avulsion # where the patella ligament pulls away tiny pieces of the tibial tuberosity

168
Q

How does Osgood Schlatter present?

A

Visible or palpable hard and tender lump at the tibial tuberosity
Pain in the anterior aspect of the knee
The pain is exacerbated by physical activity, kneeling and on extension of the knee

169
Q

What is the management of Osgood Schlatter’s disease?

A

Supportive:
Reduce activity
Ice
NSAIDs
Stretching and physio once symptoms have settled

170
Q

What is a complication of Osgood Schlatter’s disease?

A

A full avulsion #, where the tibial tuberosity is separated from the rest of the tibia

171
Q

What are the different types of cerebral palsy, and where in the brain/CNS is affected?

A

Spastic- UMN
Dyskinetic- Basal ganglia and substantia nigra
Ataxic- Cerebellum

172
Q

What are the triad of symptoms present in autism?

A

Impaired social interaction
Impaired communication
Stereotyped behaviours

173
Q

What are the three causes of pan systolic murmur?

A

VSD
Mitral regurgitation
Tricuspid regurgitation

174
Q

What are the possible complications of an atrial septal defect?

A

Stroke in the context of VTE
AF
Pulmonary HTN and right sided HF
Eisenmenger syndrome

175
Q

What heart defects can be caused by congenital rubella?

A

PDA
Atrial or ventricular septal defects
Pulmonary stenosis

176
Q

What is the pathophysiology of Hirschsprung’s disease?

A

Absence of parasympathetic ganglion cells in the distal bowel and rectum

177
Q

What conditions are associated with Hirschsprung’s?

A

Downs
Neurofibromatosis
MEN II

178
Q

What test is done to confirm a diagnosis of Hirschsprung’s?

A

Rectal biopsy

179
Q

What is the physiology of reflux in babies?

A

Immature LOS

180
Q

What are the signs of problematic reflux in an infant?

A

Chronic cough
Hoarse cry
Distress after feeding
Reluctance to feed
Pneumonia
Poor weight gain

181
Q

How should problematic reflux be managed?

A

Advise on keeping head up during and after feeds
Check not overfed, and try smaller more frequent meals
Trial thickened formula
Gaviscon mixed with deeds
PPI

182
Q

Recall childhood immunisation schedule

A

https://geekymedics.com/immunizations/

183
Q

What are the indications for tonsillectomy?

A

Episodes of tonsillitis:
7 in a year
5 per year for 2 years
3 per year for 3 years
Recurrent tonsillar abscess
Enlarged tonsils causing problems with breathing, swallowing or snoring

184
Q

What is the management of a post tonsillectomy bleed?

A

Involve ENT reg early
IV access and FBC, clotting, G+S
Analgesia
Sit up and spit blood instead of swallowing
NBM
IV fluids
Definitive:
-Re operate
-Hydrogen peroxide gargle
-Adrenaline soaked swab applied

185
Q

What is the characteristic rash in scarlet fever?

A

Sandpaper rash, starting on trunk and spreading

186
Q

How is Scarlet fever managed?

A

Penicillin V for 10 days
(phenoxymethylpenicillin)

Finals (8 decks)

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