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PM Finals > Paeds > Flashcards

Paeds Flashcards

1
Q

APGAR score

A

score: 2,1,0
Appearance - colour: pick, blue extremities, blue all over
Pulse: >100, <100, nil
Grimace (reflex irritability): cries/sneezes/coughs, grimace, nill
Activity - muscle tone: active, flexed, floppy
Resp effort: strong/cries, weak/irregular, nil

1, and 5 minutes of age. If low repeat at 10 mins

0-3 is very low score,
4-6 is moderate low
7-10 means the baby is in a good state

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2
Q

Asthma mx in children <5

A
  1. SABA
  2. SABA & Moderate dose ICS 8wks. Resolution & recurrence in 4 weeks-> low dose ICS. Resolution & recurrence after
    4 weeks-> anther 8ks of mod dose ICS. No resolution-> alternate dx
  3. SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
  4. stop LTRA & refer
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3
Q

Asthma mx in children 5-17

A
  1. SABA
  2. SABA & low dose ICS
  3. SABA & low dose ICS & LTRA
  4. SABA + paediatric low-dose ICS + LABA
  5. SABA + MART (low-dose ICS)
  6. SABA + MART (mod-dose ICS) OR #4 w mod dose ICS
  7. SABA + MART (high-dose ICS) OR #4 w mod dose ICS OR ++ theophylline OR referral
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4
Q

autosomal dominant conditions

A

Autosomal recessive - usually ‘metabolic’ (except G6PD - x linked recessive)

autosomal dominant conditions being ‘structural’ (except ataxia telangiectasia and Friedreich’s ataxia- AR)

Achondroplasia
Acute intermittent porphyria
Adult polycystic disease
Antithrombin III deficiency
Ehlers-Danlos syndrome
Familial adenomatous polyposis
Hereditary haemorrhagic telangiectasia
Hereditary spherocytosis
Hereditary non-polyposis colorectal carcinoma
Huntington’s disease
Hyperlipidaemia type II
Hypokalaemic periodic paralysis
Malignant hyperthermia
Marfan’s syndromes
Myotonic dystrophy
Neurofibromatosis
Noonan syndrome
Osteogenesis imperfecta
Peutz-Jeghers syndrome
Retinoblastoma
Romano-Ward syndrome
tuberous sclerosis
Von Hippel-Lindau syndrome
Von Willebrand’s disease

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5
Q

autosomal recessive conditions

A

Cystic fibrosis
Albinism
Ataxic telangiectasia
Friedreich’s ataxia
Congenital adrenal hyperplasia
Cystinuria
Fanconi anaemia
Gilbert’s syndrome
Haemochromatosis
Wilson’s disease
Sickle cell anaemia

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6
Q

Chickenpox features & mx

A

infectivity = 4 days before rash, until 5 days after the rash first appeared
incubation period = 10-21 days

school exclusion: 5 days after the onset of the rash).
keep cool, trim nails
calamine lotion

to prevent secondary bacterial infection
- avoid NSAIs

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7
Q

Patau syndrome (trisomy 13)

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

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8
Q

Edward’s syndrome (trisomy 18)

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

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9
Q

Fragile X

A

Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism

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10
Q

Noonan syndrome

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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11
Q

Pierre-Robin syndrome

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

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12
Q

Prader-Willi syndrome

A

Hypotonia
Hypogonadism
Obesity

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13
Q

William’s syndrome

A

Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

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14
Q

Cri du chat syndrome (chromosome 5p deletion syndrome)

A

Characteristic cry (hence the name) due to larynx and neurological problems

Feeding difficulties and poor weight gain

Learning difficulties

Microcephaly and micrognathism

Hypertelorism

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15
Q

congenital Rubella

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus)
Glaucoma

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16
Q

congenital Cytomegalovirus

A

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly

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17
Q

congenital Toxoplasmosis

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

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18
Q

Constipation in children mx

A

-1. polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)
2. add a stimulant laxative

do not use dietary interventions alone as first-line treatment although ensure the child is having adequate fluid and fibre intake

Infants not yet weaned (usually < 6 months)
- bottle-fed infants: give extra water in between feeds. Try gentle abdominal massage and bicycling the infant’s legs
- breast-fed infants: constipation is unusual and organic causes should be considered

19
Q

Cow’s milk protein intolerance/allergy (CMPI/CMPA) mx

A

If formula fed
- extensive hydrolysed formula (eHF) milk
- amino acid-based formula (AAF)

if breathed
- continue breastfeeding
- eliminate cow’s milk protein from maternal diet & calcium supplements for mum

20
Q

Initial management of suspected cyanotic congenital heart disease

A

supportive care until defensive surgical correction
- prostaglandin E1 e.g. alprostadil

21
Q

developmental delay Referral points

A

doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk unsupportedat 18 months

Fine motor skill problems
- hand preference before 12 months

22
Q

Gastro-oesophageal reflux in children mx

A

advise regarding position during feeds - 30 degree head-up

trial of smaller and more frequent feeds

thickened formula OR alginate therapy e.g. Gaviscon.

proton pump inhibitor (PPI) as last resort

23
Q

Gastroschisis & exomphalos mx

A

Gastroscisis
vaginal delivery may be attempted
newborns should go to theatre asap

Exomphalos (omphalocoele)
caesarean section is indicated to reduce the risk of sac rupture
staged repair

24
Q

Immune (or idiopathic) thrombocytopenic purpura mx in children

A

bone marrow examinations is only required if there are atypical features

mx
usually, no treatment is required
advice to avoid activities that may result in trauma (e.g. team sports)
if the platelet count is very low (e.g. < 10 * 109/L) or there is significant bleeding. Options include:
oral/IV corticosteroid
IV immunoglobulins
platelet transfusions can be used in an emergency (e.g. active bleeding)

25
Q

Infantile spasms, or West syndrome, mx

A

EEG shows hypsarrhythmia in two-thirds of infants
CT demonstrates diffuse or localised brain disease

Management
poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used

26
Q

Measles mx

A

if a child not immunized against measles comes into contact with measles then MMR should be given w/in 72hrs

(vaccine-induced measles antibody develops more rapidly than that following natural infection)

27
Q

Meningitis in children mx

A
  1. Antibiotics
    < 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
    > 3 months: IV cefotaxime (or ceftriaxone)
  2. dexamethsone if older than 3mo & lumbar puncture reveals:
    - frankly purulent CSF
    - CSF white blood cell count greater than 1000/microlitre
    - raised CSF white blood cell count with protein concentration greater than 1 g/litre
    - bacteria on Gram stain
28
Q

Neonatal sepsis mx

A

Intravenous benzylpenicillin with gentamicin

29
Q

Paediatric basic life support

A

open airway

look, listen, feel for breathing
give 5 rescue breaths

check for signs of circulation
infants use brachial or femoral pulse, children use femoral pulse

15 chest compressions: 2 rescue breaths ( lay rescuers 30:2)
in children: compress the lower half of the sternum - one-third of the anterior–posterior dimension
in infants: use a two-thumb encircling technique for chest compression

30
Q

Newborn resuscitation

A
  1. Dry baby and maintain temperature
  2. Assess tone, respiratory rate, heart rate
  3. If gasping or not breathing give 5 inflation breaths
  4. Reassess (chest movements)
  5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
31
Q

Perthes disease mx

A

Management
To keep the femoral head within the acetabulum: cast, braces
If less than 6 years: observation
Older: surgical management with moderate results
Operate on severe deformities

32
Q

Pneumonia in children mx

A

S .pneumoniae is the most likely causative agent of a bacterial pneumonia in children

Amoxicillin is first-line for all children with pneumonia
Macrolides may be added if there is no response to first line therapy
Macrolides should be used if mycoplasma or chlamydia is suspected
In pneumonia associated with influenza, co-amoxiclav is recommended

33
Q

Precocious puberty
def

A

‘development of secondary sexual characteristics before 8 years in females and 9 years in males’

34
Q

Kawasaki vs scarlet

A

Scarlet
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash
fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
it is often described as having a rough ‘sandpaper’ texture
desquamination occurs later in the course of the illness, particularly around the fingers and toes

Kawasaki
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel

35
Q

Scarlet fever mx

A

oral penicillin V 10 days
pen allergy- azithromycin

children can return to school 24 hours after commencing antibiotics

scarlet fever is a notifiable disease

36
Q

school exclusion for infection

A

Scarlet fever- 24hrs after abx
Whooping cough- 2 days after abx
Measles- 4 days after rash onset
Rubella- 5 days after rash onset
Chikenpox- allcrusted over lesions
Mumps - 5 days after swollen gland onset
D&V- settled for 48hrs
Impetigo- crusted lesions or 2 days after abx start
Scabies - until treated
Influenza- until recovered

37
Q

Kocher criteria for the diagnosis of septic arthritis:

A

fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC

38
Q

Shaken baby syndrome
triad

A

retinal haemorrhages, subdural haematoma, and encephalopathy.

39
Q

Slipped capital femoral epiphysis px, ix&mx

A

loss of internal rotation of the leg in flexion & hip-knee pain
obese children and boys
10-15 years

ix- AP and lateral (typically frog-leg) views are diagnostic

mx - internal fixation: typically a single cannulated screw placed in the centre of the epiphysis

40
Q

UTI in children ,x

A

infants less than 3 months old should be referred immediately to a paediatrician

hildren aged more than 3 months old with an upper UTI should be considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days

children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours

antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs

41
Q

Vesicoureteric reflux ix

A

micturating cystourethrogram

a DMSA scan may also be performed to look for renal scarring

42
Q

whopping cough mx

A

infants under 6 months with suspect pertussis should be admitted

notifiable disease

an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated
within 21 days

household contacts should be offered antibiotic prophylaxis

school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

Prophylaxis - Women who are between 16-32 weeks pregnant will be offered the vaccine & infants

43
Q

X-linked recessive conditions

A

Duchenne muscular dystrophy
G6PD deficiency
Haemophilia A,B

PM Finals (21 decks)

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