Paeds Flashcards
1
Q
What is a common condition that patients with measles get?
A
otitis media
2
Q
When should an undescended testis be referred?
A
3 months
3
Q
What are the common symptoms of Croup?
A
Barking cough - worse at night
Stridor
coryzal symptoms
fever
4
Q
What is the causative organism for croup?
A
Parainfluenza viruses
5
Q
What is the most common cause of stridor?
A
Laryngomalacia
6
Q
Where can a still’s murmur be heard?
A
left sternal edge
7
Q
Why should a child with downs syndrome be warned about taking part in physical activities?
A
They have atlanto-axial instability
8
Q
What is the management for meningitis?
A
> 3 months - IV cefotaxime
<3months - + IV amoxicillin
9
Q
What is the cause of perthe’s disease?
A
Avascular necrosis of femoral head
10
Q
What scores 2 points in the APGAR test?
A
pink all over
HR>100
cries on stimulation/sneezes
Flexion that resists extension
strong crying
11
Q
What is the most common presentation of neonatal sepsis?
A
Grunting or other signs of respiratory distress
12
Q
Describe the progression of chicken pox?
A
High temp - rash in face and torso - macular - vesicular
13
Q
What are some poor prognostic factors of ALL?
A
Male sex
non-caucasian
WBC > 20x10^9
Age <2 or >10
T or B cell surface markers
14
Q
What are the 4 characteristics of tetralogy of fallot?
A
VSD
RVH
Pulmonary stenosis, right ventricular outflow tract obstruction
Overriding aorta
15
Q
What is the management of ITP in a pt with petichae and purpura only?
A
No management - usually self limiting
16
Q
What is the name of the manovuere where a physician attempts to dislocate the femoral head?
A
Barlow manoeuvre for DDH
17
Q
What are the LH and FSH levels like in gonadotrophin dependant precocius puberty?
A
high
18
Q
What is the main characteristic of hypospadias?
A
Ventral urethral meatus
19
Q
What are the features of life-threatening asthma?
A
<92% o2 sats
silent chest
<33% PEF
poor resp effort
agitation
altered consciousness
cyanosis
20
Q
What is the management of an umbilical hernia in a newborn?
A
Watch and wait - they typically resolve between 12 months and 3 years
Tell pt to present again at 2 years
21
Q
Coryzal symptoms followed by bouts of coughing that can turn infants red and cause them to vomit it characteristic of which condition?
A
Pertussis - Whooping cough
22
Q
What is Osgood-Schlatter syndrome?
A
Type of osteochondrosis (self limiting developmental derangement of normal bone growth) - inflammation of tibial tuberosity
23
Q
What condition are these features characteristic of: bouts of excessive crying, pulling up of the legs and worse in the evening?
A
Infantile colic
24
Q
What does the shaken baby syndrome triad consist of?
A
retinal haemorrhages
Subdural haematoma
encephalopathy
25
What is the average age for a child being able to pull themselves up to standing?
8-10 months
26
What is the typical distribution of eczema in a 10 month year old?
Face and trunk
27
When and how long should steroids be given to children with an asthma attack?
Always
3-5 days
2-5 yrs 20mg OD
>5 40mg OD
28
What is the management for slipped capital femoral epiphysis?
Internal fixation
29
What sort of diet is recommended in CF?
High calorie and high fat
30
What is the chance of a father with haemophilia A passing it to his son when his mother has no FHx?
0% as it is an X-linked recessive condition
31
How long should a child with Hand, foot and mouth disease take off school?
It is not needed to take time off school if they are well
32
What is the most important investigation for suspected orbital cellulitis?
CT orbit
33
How does HSP present?
Purpura or petechiae, primarily located on the buttocks and lower limbs
Abdominal pain
Arthralgia or arthritis, predominantly in the knees and ankles
Renal involvement - Nephritis (hematuria and/or proteinuria)
Patients may present with a fever
Often, a history of a recent upper respiratory tract infection
34
What are risk factors for DDH
FHx
Female
Breech
Restricted intrauterine space
Postural deformity
35
How does Wilm's tumour (nephroblastoma) present? And what other conditions are associated with it?
A palpable abdominal mass that does not cross the midline, although it may be bilateral in up to 5% of cases.
Abdominal distension
Haematuria
Hypertension
Often asymptomatic unless the tumour grows sufficiently large to cause pain or disrupt other abdominal structures.
WAGR syndrome (Wilms' tumour, Aniridia, Genitourinary anomalies, and mental Retardation)
Beckwith-Wiedemann syndrome - Hemi hypertrophy of the body
Denys-Drash syndrome
36
What is the management of meningitis in children younger than 3 months old?
1. Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
2. Steroids
NICE advise against giving corticosteroids in children younger than 3 months
dexamethsone should be considered if the lumbar puncture reveals any of the following:
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
3. Fluids
treat any shock, e.g. with colloid
4. Cerebral monitoring
mechanical ventilation if respiratory impairment
5. Public health notification and antibiotic prophylaxis of contacts
ciprofloxacin is now preferred over rifampicin
37
Which Abx are cautioned in breastfeeding mothers?
ciprofloxacin (potential joint problems),
nitrofurantoin (G6PD deficiency),
teicoplanin,
clindamycin (antibiotic-associated colitis),
co-trimoxazole.
38
How does a Ewing sarcoma present in imaging and histology?
X-ray: lamellated (onion skinning) periosteal reaction
MRI: large mass with necrosis
Histology: small blue round cells with clear cytoplasms on H&E staining
39
How does an osteosarcoma present on a radiograph?
sunburst pattern and codman's triangle
40
How do you differentiate between TGA and Tetralogy of Fallot?
TGA: first 24hrs and loud S2
TOF: 1-2 months and ejection systolic murmur (pulmonary stenosis)
41
What congenital heart defects are associated with turner's syndrome?
bicuspid aortic valve (15%)
Co-arctation of the aorta
aortic dilatation and dissection are the most serious long term health problems
42
What cardiac defects are associated with Down's syndrome?
multiple cardiac problems may be present:
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)
43
What are some associated conditions and long term complications of Down's syndrome?
congenital heart defects (40-50%)
duodenal atresia
Hirschsprung's disease
subfertility: males are almost always infertile due to impaired spermatogenesis. Females are usually subfertile, and have an increased incidence of problems with pregnancy and labour
learning difficulties
short stature
repeated respiratory infections (+hearing impairment from glue ear)
AML>acute lymphoblastic leukaemia
hypothyroidism
Alzheimer's disease
atlantoaxial instability
44
What is a positive gower's sign and in which condition does it present?
Patient uses hands to climb up legs to stand up
Duchenne muscular dystrophy
45
What is the gold standard investigation for Duchenne muscular dystrophy?
Genetic testing
46
What is the difference in presentation between duchenne's and becker's?
Duchenne's presents in early childhood whereas becker's presents in later in childhood
47
What is the most likely mode of inheritance of Trisomy 21
Meiotic non-disjunction
48
How do you investigate and manage Eisenmenger syndrome?
Echo
Pulmonary function tests
Cardiac catheterisation - GOLD STANDRARD
Heart lung transplant
Palliative
49
How do you investigate and manage malrotation?
Upper GI contrast study - corkscrew appearance
Urgent laparotomy (ladd's procedure)
50
What is the dose of IM adrenaline given to children under the age of 12?
300ug
500ug for 12+ and adults
51
How does Edwards syndrome present?
Low set ears
Micrognathia
Omphalocele
Overlapping 4th and 5th fingers
Rocked bottom feet
Congenital heart defects
52
When should patients be given IV steroids in an acute asthma exacerbation?
All patients should receive steroids - ideally orally only IV if they can't tolerate oral steroids
53
What are causes of cerebral palsy
Antenatal: Congenital infection (CMV, toxoplasmosis, rubella) Cerebral malformation
Intrapartum: Asphyxia/Trauma
Postnatal: Meningitis, intraventricular haemorrhage, head trauma
54
How do you investigate and manage cerebral palsy?
MRI
MDT - speech and language therapy, physiotherapy, OT
Medical - Intrathecal baclofen, botox, anticonvulsants
Surgical - Orthopaedic surgery (MSK deformities or injuries) , gen surg
55
How do you manage GORD in young children?
Conservative - sit up straight, smaller feeds, burp regularly, assess breastfeeding technique, thicken formula feeds with alginate (gaviscon)
Medical - 4 week trial of ranitidine (H2 antagonist) or omeprazole (PPI)
Surgical - nissen fundoplication
56
What causes dyskinetic cerebral palsy and how does it present?
Damage to basal ganglia and substantia nigra
Athetoid movements and oro motor problems
57
What are indications of a CT scan within 1 hour in a patient <16
NAI
Basal skull fracture - panda and/or battle sign
GCS score <14 at time of injury or <15 if under 1 years old
GCS score <15 at 2hrs after injury
focal neurological defecit
With head injury - more than 1 risk factor:
3 or more discrete episodes of vomiting
LOC > 5 mins (witnessed)
Dangerous mechanism of injury
Current bleeding or clotting disorder
Only 1 - monitor for minimum 4 hrs - if GCS drops <15 than CT within 1 hr
58
What is the first line serological blood test for coeliac disease?
Anti TTG IgA antibody and IgA levels
59
How does atrial septal defect present on auscultation?
Ejection systolic murmur (upper left sternal border)
Fixed split second heart sound
60
How does prader-willi syndrome present?
progressive obesity,
hyperphagia,
short stature
learning difficulties
on a background of hypotonia
which would have caused difficulty breastfeeding as an infant
61
What are possible causes of fine motor and vision delays that can be picked up in the NIPE exam
Cataracts and retinoblastoma - red light reflex
62
What heart defect presents as a loud, harsh pansystolic murmur at the left lower sternal edge on auscultation
Ventricular septal defect
63
What is transient proteinuria?
common, benign and tends to recede as the precipitant is removed.
Precipitants include seizures, strong infections, pregnancy and heavy exercise.
It is likely if the urine dip were to be repeated in 24 hours, the protein would either be undetectable or at trace levels
64
What are the constituents of the CENTOR criteria and what score requires treatment?
Tonsillar exudate
Fever >38
Tender anterior cervical lymphadenopathy
Absent cough
Score of 3 or more:
500mg Penicillin V PO QDS 5-10 days
Penicillin allergy - Clarithromycin/Erythromycin 250-500mg PO BD for 5 days
65
How does autoimmune encephalitis present?
Confusion
seizures
movement disorders
emotional lability
psychosis
cognitive impairment
reduced conscious level
66
How do you investigate a suspected rubella infection?
Serology
rubella specific IgM or rise in rubella specific IgG
67
What causes a primary hydrocele?
Incomplete obliteration of the processus vaginalis
68
Why is it important to do an urine dipstick in Henon Schonlein Purpura?
To determine if there's any kidney impairment (dipstick +ve haematuria)
69
How do you investigate and manage haemolytic disease of the newborn
Ix:
DAT
USS to detect foetal oedema
LFTs - complications
Mx:
Severe anaemia - intrauterine transfusions
Early delivery if severe
Postnatal - photoherapy or exchange transfusion to manage high billirubin
Immunoglobulins
Follow up for developmental issues
70
What is the gold standard diagnostic test for coeliac disease?
oesophagogastroduodenoscopy (OGD) with duodenal/jejunal biopsy
71
What is a branchial cyst and how does it present?
embryological remnant resulting from the development of the branchial arches, which form parts of the head and neck
It is typically observed as a painless cystic mass located anterior to the sternocleidomastoid muscle just below the ear, becoming more apparent in late childhood.
72
What is Retinopathy of prematurity?
Abnormal and uncontrolled development of blood vessels in the retina in premature infants as a result of free radical damage from high oxygen levels
73
How does hydrocephalus present?
Enlarged head circumference
Bulging anterior fontanelle
Sunsetting eyes - impaired upward gaze due to raised ICP
Distension of scalp veins
74
How do you manage measles?
Supportive Mx
Vaccination is crucial
75
What is the first line management for impetigo in a systemically well patient?
Hydrogen peroxide 1% cream - 2-3x a day for 5 days
76
How do you Ix and Mx Hirschprung's disease?
Ix
Abdo X-ray
GOLD STANDARD - Rectal suction biopsy
Mx
Bowel irrigation/washouts
Surgery - endorectal pull through
77
How does minimal change disease present?
Oedema, including facial swelling and puffiness around the eyes
Frothy urine, caused by excessive protein in the urine (proteinuria)
Fatigue
Weight gain due to fluid retention
78
What is acute chest syndrome?
A type of sickle cell crises:
vaso-occlusion within the pulmonary microvasculature → infarction in the lung parenchyma
dyspnoea, chest pain, pulmonary infiltrates on chest x-ray, low pO2
management:
pain relief
respiratory support e.g. oxygen therapy
antibiotics: infection may precipitate acute chest syndrome and the clinical findings (respiratory symptoms with pulmonary infiltrates) can be difficult to distinguish from pneumonia
transfusion: improves oxygenation
the most common cause of death after childhood
79
What is the inheritance pattern of DMD?
X-linked Recessive
80
When should a GP do an ENT referral for tonsiliits?
More than 7 in 1 year
More than 5 per 2 years
More than 3 per 3 years
no explanation for recurrent symptoms
81
What is the difference between Exomphalos (omphalocele) and Gastroschisis?
Omphlaocele is when the potruding bowel is covered by the amniotic sac
In gastroschisis the bowel is not covered by a perotineal membrane leading to an increased risk of fluid and protein loss
82
What dose of PO oral dexamethasone is given as management for croup?
0.15mg/kg
83
Alongside oral dex what else can be given in the management of severe croup?
Nebulised adrenaline
High flow O2
Second dose of oral dex after 12 hours - if mild stridor present but generally well
84
When is an otoacoustic emission test done? And what test is done if the result is abnormal?
first 4-5 wks of life
Auditory brain response test
85
What level of LD is an IQ score of 45 associated with?
Moderate
86
How does osteogenesis imperfecta present?
presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common
87
What is the first line management for seasonal affective disorder?
CBT
88
How is necrotising enterocolitis investigated?
Diagnosis of NEC primarily involves abdominal X-rays, which may reveal:
Dilated bowel loops
Pneumatosis intestinalis (gas within the bowel wall)
Portal venous gas
Pneumoperitoneum
The severity of NEC is staged using Bell's classification, which utilises a combination of clinical signs and radiological findings.
89
How do you manage ballooning during micturation in a child less than 2 years old?
Watch and wait
(if they are older than 2 and have recurrent balanitis or UTIs than treatment can be considered)
90
How does mesenteric adenitis present?
Mesenteric adenitis is a condition in which the abdominal lymph nodes become inflamed, causing non-specific abdominal pain.
The pain is less severe than in acute appendicitis, may or may not localise to the right iliac fossa and resolves within 24-48 hours.
Mesenteric adenitis is often preceded by an upper respiratory tract infection (URTI), with cervical lymphadenopathy. The condition usually resolves spontaneously; parents should be reassured that it is self-limiting
91
What is the gold standard investigation and management for hirschprung's disease
GOLD STANDARD: rectal biposy
other: Abdo X-ray
Mx: Bowel irrigation/rectal washouts
Definitive: Anorectal pull through (surgery)
92
What are the most common causes of neonatal bacterial conjunctivitis?
Neisseria gonnorhea - 24hrs - 5days
Chlamydia trochomitis - 5 days - 2wks
The first-line treatment is oral erythromycin for 14 days. Before receiving the culture results, topical chloramphenicol eye ointment may be applied to the eyes if there is evidence of inflammation or purulent discharge
93
What is the first line management of tonic-clonic or myoclonic seizures?
Sodium valproate
94
What is the management for talipes equinovarus?
Ponseti method - gentle manipulation of the feet followed by casting and bracing
95
What is the abx management for meconium aspiration?
IV gentamicin and ampicillin
96
How many days off school should a child with mumps take?
5 days following onset of parotitis
97
What are poor prognostic markers of ALL?
age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex
98
What is erythema toxicum?
benign rash in newborns which consists of verythematous macules (flat red patches) papules (small bumps) and pustules. The eruption waxes and wanes over several days and rarely for more than a day.
99
How do you manage ITP?
usually, no treatment is required
ITP resolves in around 80% of children with 6 months, with or without treatment
advice to avoid activities that may result in trauma (e.g. team sports)
other options may be indicated 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) but are only a temporary measure as they are soon destroyed by the circulating antibodies
100
How does breath holding attack present?
Angry child
collapses
regains conciousness very soon
101
How can you differentiate breath holding attack from reflex anoxic seizure?
reflex anoxic seizure is usually precipitated by trauma or injury and is more commonly associated with jerking
102
What is androgen insensitivity syndrome?
X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype.
'primary amenorrhoea'
little or no axillary and pubic hair
undescended testes causing groin swellings
breast development may occur as a result of the conversion of testosterone to oestradiol
103
How would you treat a 14yo inpatient rejecting treatment for anorexia?
Section 5(2) MHA
104
How does coarctation present in an infant?
Heart failure
Radio-femoral delay
or absent femoral pulse
105
How do you manage molluscum contagiousum in a child?
Reassure
106
How do you manage pnuemonia 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
107
How do you investigate an inhaled foreign body?
X-ray
108
How do you treat threadworms?
mebendazole
109
What is the most likely cause of blood stained nasal discharge with crusting?
Inhaled foreign body
110
How does DDH present?
Neonatal screening (Barlow and Ortolani +ve)
Limp or abnormal gait, delayed crawling/walking, toe-walking
Asymmetrical skin folds
Limb-length discrepancy (Galeazzi sign – baby on back, legs together and knees flexed – look at leg length)
111
What is the first line management for ADHD?
Watch and wait 10 weeks
ADHD focused group parent training programme
112
What is the management for conduct disorder?
Parent training programme
113
Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give?
second dose of oral dex
114
Is aspirin contraindicated in breastfeeding?
Yes - Reye's syndrome
115
How does achondroplasia present?
This leads to short stature with shortened limbs (rhizomelia) and a lumbar lordosis. Fingers will also be shortened (brachydactyly) and there is a separation between the middle and ring fingers (trident hand). In addition, patients have a flattenednasal bridge, frontal bossing and hypoplasia of the upper jaw, cheekbones and eye sockets.
116
What is torticollis?
Torticollis or “wry neck” can be congenital (and take up to 8 weeks to benoticeable) or acquired (e.g. from trauma or infection). In most cases, infant torticollis is caused by a sternocleidomastoid tumour and is congenital, muscular torticollis. This would mean that the baby’s range of motion in their neck is limited and they will struggle to turn their head in one direction. This may manifest subtly, such as them only managing to feed successfully from one breast. On examination, you may feel a mobile, non-tender nodule in the body of the sternocleidomastoid muscle. This is rarely firm or tender. The child may tilt their head in one direction with their chin tilted to the other side. The important detail is that this is asymmetrical not just ‘forwards’
117
What are complications of mumps?
Orchitis
Pancreatitis
meningits /encephalitis
118
What condition is talipes associated with?
Spina bifida
119
What two main signs are seen in patients with Testicular torsion?
absent cremestaric reflex
negative prehn's sign - pain is not relieved when testicles are elevated - positive in epidydimits
120
A 2 year old boy has acute onset of cough and drooling, with inspiratory upper airway noises. His vaccinations are up to date. His examination and obs are otherwise normal. What is the most likely diagnosis?
Inhaled foreign body
121
How does benign intercranial hypertension present?
Non-pulsatile, bilateral headaches, typically worse in the morning or after bending forwards. Some patients may also experience morning vomiting.
Visual disturbances, such as transient visual darkening or loss, likely due to optic nerve ischaemia.
Bilateral papilloedema seen on fundoscopy, indicating increased intracranial pressure.
122
How do you manage an anal fissure?
osmotic laxative
123
The mother of a 3 year old boy in General Practice has noticed that her son’s foreskin is ballooning on urination. The foreskin is non-retractile. There is no redness or discomfort. What is the most likely diagnosis?
Phimosis
124
A 5 month old boy in General Practice is found to have developmental delay and recurrent spasms. An EEG has shown hypsarrhythmia. What is the most likely diagnosis?
West syndrome
125
