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3a follow up > Paeds > Flashcards

Paeds Flashcards

1
Q

What kind of murmur does ASD have?

A

Ejection systolic
Left upper sternal edge
Fixed splitting of S2

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2
Q

What kind of murmur does VSD have?

A

Pan-systolic
Left lower sternal edge

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3
Q

What kind of murmur does PDA have?

A

Continuous machinery-like murmur

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4
Q

What kind of murmur does coarctation of the aorta have?

A

Mid-systolic murmur
Radiates to back
Radio-femoral delay

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5
Q

What kind of murmur does Pulmonary stenosis have?

A

Ejection systolic
Louder on inspiration

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6
Q

What kind of murmur does aortic stenosis have?

A

Ejection systolic
Louder on expiration

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7
Q

What kind of murmur does mitral regurgitation have?

A

Pansystolic murmur
High pitched blowing

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8
Q

What kind of murmur does tricuspid regurgitation have?

A

Pansystolic murmur
Louder on inspiration
High pitched blowing

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9
Q

What kind of murmur does aortic regurgitation have?

A

Early diastolic murmur
High pitched blowing

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10
Q

What kind of murmur does pulmonary regurgitation have?

A

Early diastolic murmur
High pitched blowing

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11
Q

Which murmurs are pansystolic?

A

VSD
Tricuspid regurgitation
Mitral regurgitation

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12
Q

Which murmurs are ejection systolic?

A

ASD
Pulmonary stenosis
Aortic stenosis

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13
Q

Which murmurs are early diastolic?

A

Pulmonary regurgitation
Aortic regurgitation

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14
Q

Pathophysiology of Hirschsprungs?

A

Absence of parasympathetic ganglion cells in the myenteric plexus

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15
Q

Red signs for paediatric traffic light system?

A

Colour - mottled/blue/ashen/pale
No response to social cues/does not wake when roused
Weak
Continuous high-pitched cry
Grunting/tachypnoea
<3months with temp >38
Non blanching rash
Seizures

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16
Q

Fluid bolus requirements? (Paeds)

A

10mg/kg 0.9% NaCl

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17
Q

Maintenance fluids? (Paeds)

A

100mg/kg for 10kg
50 mg/kg for 10kg
20mg/kg for the rest
0.9% NaCl + 5% glucose

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18
Q

Organism for hand foot mouth disease?

A

Coxsackie A16

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19
Q

Examples of live vaccines?

A

MMR, BCG, chicken pox, NASAL influenza, rotavirus

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19
Q

When is newborn blood spot test?

A

5 days

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20
Q

Conditions tested for on newborn blood spot?

A

CF, sickle cell disease, congenital hypothyroidism, phenylketonuria, maple syrup urine disease

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21
Q

Which vaccines are given at 8 weeks?

A

6-in-1, Rotavirus, Meningococcal B

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22
Q

Which vaccines are given at 12 weeks?

A

6-in-1, Rotavirus, Pneumococcal

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23
Q

Which vaccines given at 16 weeks?

A

6-in-1, Meningococcal B

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24
Q

Which vaccines given at 1 year?

A

2-in-1, MMR, Meningococcal B, Pneuomoccal

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25
Q

When is nasal flu vaccine given?

A

2-8 years

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26
Q

What vaccines given at 3 years 4 months?

A

4-in-1, MMR

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27
Q

When is HPV vaccine given?

A

13-14 years

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28
Q

Which vaccines given at 14 years?

A

3-in-1, Meningococcal ACWY

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29
Q

Which vaccines are in the 6-in-1?

A

Diptheria
Polio
Pertussis
Tetanus
Hepatitis B
HiB

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30
Q

Examples of inactivated vaccines?

A

Polio, flu

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31
Q

Treatment for meningitis in infants >3 months?

A

IV Ceftriaxone or Cefotaxime

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32
Q

Treatment for meningitis in <3 months?

A

IV Cefotaxime and Amoxicillin

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33
Q

By what age does infantile colic usually subside?

A

6 months

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34
Q

Features to be explored in monitoring asthma control?

A

Pattern of medication use (overuse)
Persistence of symptoms e.g. wheeze/nocturnal cough/reduced physical activity
Involvement of secondary care e.g. HDU/ICU admission

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35
Q

Appearance of meningococcal bacteria on microscope?

A

Gram negative diplococci

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36
Q

How long before notifiable disease reported?

A

Immediately

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37
Q

What is glandular fever also known as?

A

Infectious mononucleosis

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38
Q

Causative organism for glandular fever?

A

Epstein-Barr virus (HHV4)
Other causes - HHV6, CMV

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39
Q

Triad of symptoms in glandular fever?

A

Pyrexia, lymphadenopathy, sore throat

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40
Q

How long does glandular fever typically last?

A

2-4 weeks

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41
Q

Glandular fever diagnosis?

A

Heterophil antibody test (monospot test) in the 2nd week of illness

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42
Q

Management of glandular fever?

A

Supportive
Analgesia
Avoid contact sports for 4 weeks after - risk of splenic rupture

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43
Q

What is androgen insensitivity syndrome?

A

End-organ resistance to testosterone due to X-linked recessive condition

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44
Q

How does androgen insensitivity present?

A

Genetically male 46XY have female phenotype

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45
Q

Features of androgen insensitivity syndrome?

A

‘Primary amenorrhoea’
Little or no pubic/axillary hair
Undescended tests -> groin swellings

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46
Q

Diagnosis of androgen insensitivity syndrome?

A

Buccal smear/chromosomal analysis shows XY
After puberty - testosterone concentrations normal to elevated

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47
Q

Management of androgen insensitivity syndrome?

A

Counselling - raise as female
Bilateral orchidectomy
Oestrogen therapy

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48
Q

Causes of jaundice in the first 24 hours of birth?

A

Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency

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49
Q

Causes of jaundice 2-14 days old?

A

Common - usually physiological
More RBCs and less developed liver function
Breastfeeding jaundice

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50
Q

Causes of jaundice after 14 days?

A

Biliary atresia
Hypothyroidism
UTI
Breast milk jaundice
Prematurity
Congenital infections

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51
Q

What is in a prolonged jaundice screen?

A

Conjugated and unconjugated bilirubin
Coombs’ test
TFTs
FBC and blood film
Urine MCS
U&Es and LFTs

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52
Q

Which type of bilirubin causes kernicterus?

A

Unconjugated bilirubin

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53
Q

Which type of bilirubin is high in biliary atresia?

A

Conjugated

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54
Q

What is the APGAR score?

A

Assess health of newborn baby

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55
Q

When is APGAR score assessed?

A

1 and 5 minutes. Repeated at 10 minutes if low score <7

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56
Q

What is assessed in the APGAR score?

A

Appearance (colour)
Pulse
Grimace (reflex irritability)
Activity (tone)
Respiration (crying)

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57
Q

How long excluded from school with hand, foot, and mouth disease?

A

No need if feel well

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58
Q

Gross motor milestones?

A

2m - lifts head to 45 degrees
6m - pulls to sit/rolls
7-8m - sits up straight
9m - crawls
12m - walking

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59
Q

Gross motor milestones for walking, running jumping etc?

A

Walking - 12 months
Running - 16 months
Jumping - 18 months
Stairs (one at a time) - 2 years
Upstairs normally - 3 years
Downstairs normally - 4 years

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60
Q

Fine motor milestones?

A

6w - tracks objects/faces
3m - reaches for objects
6m - palmar graps
9m - pincer grip
12m - good pincer grip

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61
Q

Block building milestones?

A

12m - 2 blocks
18m - 4 blocks
2y - 8 blocks
3y - bridge

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62
Q

Drawing milestones?

A

18m - scribble
2y - straight lines
3y - circle
4y - square and cross
5y - triangle

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63
Q

Speech/hearing milestones?

A

3m - squeals
6m - babbling
9m - mama/dada
12m - 2-3 words
2y - combine 2 words
2.5y - vocab 200 words
3y - short sentences, who, what?
4y - why, when, how?

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64
Q

Social milestones?

A

6w - smiling
6m - food/objects in mouth
9m - stranger fear
12m - waves bye-bye, drink cup w 2 hands
18m - play alone
2y - parallel play
3y - fork and spoon
4y - play with others

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65
Q

Which genetic defect is Down’s syndrome?

A

Trisomy 21

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66
Q

Which genetic defect is Edwards syndrome?

A

Trisomy 18

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67
Q

Which genetic defect is Patau syndrome?

A

Trisomy 13

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68
Q

Symptoms of Edwards syndrome?

A

Rocker bottom feet
Overlapping fingers
Microcephaly
Low set ears
VSD/ASD/ToF

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69
Q

Symptoms of Patau syndrome?

A

Polydactyly
Microcephaly
Cleft lip/palate
Scalp lesions

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70
Q

What is Noonan syndrome?

A

Autosomal dominant condition
‘Male Turners’

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71
Q

Symptoms of Noonan syndrome?

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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72
Q

What type on inheritance is Prader-Willi?

A

Imprinting

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73
Q

Symptoms of Prader-Willi?

A

Obesity
Hypotonia
Hypogonadism
Learning difficulties

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74
Q

What is Kleinfelter?

A

47XXY
Male with additional X chromosome

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75
Q

Symptoms of Kleinfelters?

A

Taller height
Wide hips, gynaecomastia
Small testicles/infertility

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76
Q

Management of Kleinfelter?

A

Testosterone injections
Breast reduction surgery

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77
Q

What is Turner’s syndrome?

A

45XO
Female with single X chromosome

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78
Q

Symptoms of Turner’s?

A

Short stature
Webbed neck
High arching palate
Broad chest, wide spaced nipples

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79
Q

Heart defects in turners?

A

Coarctation of the aorta
Bicuspid aortic valve

80
Q

Puberty in Turner’s?

A

Primary amenorrhoea

81
Q

What is Fragile X syndrome due to?

A

Mutation on the X chromosome- trinucleotide repeat

82
Q

Symptoms of Fragile X?

A

Long, narrow face
Large ears
Large testicles after puberty
Intellectual disability

83
Q

What is Kallman syndrome?

A

Delayed puberty due to hypogonadotrophic hypogonadism

84
Q

Symptoms of Kallman syndrome?

A

Male with anosmia
Delayed puberty
Hypogonadism/cryptorchidism
LH/FSH inappropriately low

85
Q

Pattern of inheritance for Kallman?

A

X-linked recessive

86
Q

Treatment for whooping cough?

A

Clarithromycin within 21 days of onset

87
Q

Treatment for scarlet fever?

A

PO Penicillin V for 10 days (phenoxymethylpenicillin)

88
Q

Exclusion criteria for scarlet fever?

A

24 hours after starting antibiotics

89
Q

Exclusion criteria for whooping cough?

A

2 days after starting antibiotics or 21 days from onset of cough

90
Q

Exclusion criteria for measles?

A

4 days from onset of rash

91
Q

Exclusion criteria for rubella?

A

5 days from onset of rash

92
Q

Exclusion criteria for mumps?

A

5 days from onset of swollen glands

93
Q

Exclusion criteria for chicken pox?

A

Until all lesions crusted over

94
Q

Exclusion criteria for impetigo?

A

Until lesions crusted over or 48 hours after antibiotics

95
Q

Organism causing slapped check?

A

Parvovirus B19

96
Q

Risk factors for DDH?

A

Oligohydramnios
Breech presentation
Female
Family history
Macrosomic history

97
Q

Dietary advice for cystic fibrosis?

A

High calorie, high fat diet w/ enzyme supplementation

98
Q

Electrolyte abnormalities in CAH?

A

Hyponatraemia, hyperkalaemia

99
Q

Inheritance pattern of CAH?

A

Autosomal recessive

100
Q

Most common cause of CAH?

A

21-hydroxylase enzyme deficiency

101
Q

Episodes in ToF with crying turning blue are called?

A

Hypercyantoic/Tet spells

102
Q

Symptoms of ToF?

A

Recurrent chest infections
Poor feeding
Breathlessness

103
Q

What is Duchenne muscular dystrophy?

A

Disorder in the dystrophin genes needed for normal muscle function

104
Q

Duchenne muscular dystrophy inheritance pattern?

A

X-linked recessive

105
Q

Investigations for Duchenne muscular dystrophy?

A

Muscle biopsy
Genetic testing
Serum CK
Muscle MRI

106
Q

Management of Duchenne muscular dystrophy?

A

Supportive - no cure
Medical - corticosteroids
Surgical - correct contractures
Physio
Exercise
Education
Counselling

107
Q

Surgical procedure for biliary atresia?

A

Kasai procedure/portoenterostomy

108
Q

Which cancers Noonan syndrome increased risk of?

A

Neuroblastoma (N=N)
Leukaemia

109
Q

Neuroblastoma symptoms?

A

Abdominal mass
Blueberry muffin rash
Raccoon eyes
Weight loss
Bone pain

110
Q

Management of UTI in <3months?

A

Refer to paeds

111
Q

Treatment for lower UTI in children and how long?

A

Nitrofurantoin or Trimethoprim for 3 days

112
Q

Causes of UTI in children other than E. Coli?

A

Proteus
Klebisella
Pseudomonas
Enterococcus

113
Q

Risk factors for UTI in children?

A

<1 year
Female sex
Sexual abuse
Immunosuppression
Poor hygiene
Anatomical abnormalities

114
Q

Typical toddler’s fracture?

A

Spiral fracture of the tibia

115
Q

How can unconjugated bilirubin be treated?

A

Phototherapy

116
Q

What is Caput succedaneum?

A

Oedema on presenting part of head

117
Q

Common cause of Caput succedaneum?

A

Ventouse delivery

118
Q

Features of Caput succedaneum?

A

Soft swelling
Crosses suture lines
Present at birth

(CS = CS = crosses sutures)

119
Q

What is cephalohaematoma?

A

Swelling on newborn head

120
Q

Possible complication of cephalophaematoma?

A

Jaundice

121
Q

Features of cephalohaematoma?

A

Develops hours after birth
Doesn’t cross suture lines
Up to 3 months to resolve

122
Q

By what age is it a red flag to not be walking?

A

18 months

123
Q

Triad of haemolytic uraemic syndrome?

A

AKI
Microangiopathic haemolytic anaemia
Thrombocytopenia

124
Q

What is Henoch-Schonlein purpura?

A

IgA mediated small vessel vasculitis

125
Q

Features of Henoch-Schonlein purpura?

A

Following infection
Purpuric rash - legs, arms, buttocks
Abdo pain
Poly arthritis
IgA nephropathy e.g. haematuria, renal failure

126
Q

What is Immune thrombocytopenia?

A

Immune mediated reduction in platelets

127
Q

Triad of Immune thrombocytopenia?

A

Bruising
Rash
Epistaxis/gingival bleeding

128
Q

Findings from Immune thrombocytopenia investigations?

A

Isolated thrombocytopenia

129
Q

Paediatric NICE amber flags?

A

Nasal flaring
Lung crackles on auscultation
Not responding normally to social cues
Reduced nappy wetting
Dry mucous membranes
Pallor reported by parent or carer

130
Q

Paediatric NICE red flags?

A

Moderate or severe chest wall recession
Does not wake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting

131
Q

Findings for Hirschsprung disease?

A

Rectal biopsy
X-ray: loops of dilated bowel + air/fluid

132
Q

Findings for intestinal malrotation?

A

X-ray: double bubble sign
Lack of stool in RLQ of colon

133
Q

Sausage shaped mass in RUQ is?

A

Intussusception

134
Q

Olive lump in upper abdomen is?

A

Pyloric stenosis

135
Q

Undescended testes increase the risk of which complications?

A

Testicular torsion
Testicular cancer
Infertility

136
Q

What type of murmur in ToF?

A

Ejection systolic

137
Q

Causes of bilious vomiting?

A

Duodenal atresia
Malrotation/obstruction
Hirschsprung
NEC

138
Q

Complications of measles?

A

Pneumonia
Otitis Media
Encephalitis

139
Q

Which heart defect in Fragile X?

A

Mitral valve prolapse

140
Q

Which boney prominence affected in Osgood-Schlatter?

A

Tibial tuberosity

141
Q

Common complication of roseola infantum?

A

Febrile convulsions

142
Q

Antibiotic choice for mycoplasma?

A

Macrolide

143
Q

Which movement is lost in SUFE?

A

Internal rotation of the leg in flexion

144
Q

Features of maternal CMV?

A

Low birth weight
Purpuric rash
Microcephaly

145
Q

Features of maternal Rubella?

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease

146
Q

Features of maternal toxoplasmosis?

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

147
Q

Pyloric stenosis blood gas results?

A

Hypokalaemia
Hypochloraemia
ELEVATED bicarbonate

148
Q

What are nasal polyps a key feature of?

A

Cystic fibrosis

149
Q

Features of life threatening asthma?

A

PEFR <33%
O2 <92%
Silent chest/cyanosis/poor resp effort
Bradycardia, hypotension, dysrhythmia
Exhaustion, confusion or come

150
Q

Features of severe acute asthma?

A

PEFR 33-55%
Can’t complete sentences
RR >25/min
Pulse >110bpm

151
Q

What is the screening tool used for child development?

A

ASQ-3 (ages and stages questionnaire)

152
Q

Asthma management steps if <5 years?

A

SABA
SABA + LTRA/ICS (very low dose)
SABA + ICA + LTRA
Increase ICS to low dose

153
Q

Asthma management steps in 5+ years?

A

SABA
SABA + ICS (very low dose)
SABA + ICS + LABA/LTRA
Consider stopping LABA if no response

154
Q

Nephrotic syndrome triad?

A

Low albumin
High urine protein
Oedema

Due to permeability of the basement membrane in the glomerulus

155
Q

Causes of nephrotic syndrome and findings?

A

Minimal change disease

Hyaline casts in urine

156
Q

Nephritic syndrome triad?

A

Reduced kidney function
Haematuria
Proteinuria

Due to inflammation of nephrons in the kidney

157
Q

Causes of nephritic syndrome?

A

Post-streptococcal glomerulonephritis
IgA nephropathy

158
Q

Findings for post-strep glomerulonephritis?

A

Raised anti-streptolysin O titre in blood

159
Q

Findings for IgA nephropathy?

A

IgA deposits in renal biopsy

160
Q

Drug treatments for neonatal abstinence syndrome?

A

Cocaine - phenobarbitone IV
Heroin - oral morphine

161
Q

Heart rate for different ages?

A

<1 - 110-160
1-2 - 100-150
2-5 - 90-140
5-12 - 80-120
>12 - 60-100

162
Q

Respiratory rate for different ages?

A

<1 - 35-40
1-2 - 25-35
2-5 - 25-30
5-12 - 20-25
>12 - 15-20

163
Q

Red flags for development milestones?

A

Loss of milestones OR not able to:
Hold object at 5m
Sitting unsupported at 12m
Standing independently at 18m
No words at 18m
No interest in others at 18m
Walking independently at 2y
Not running at 2.5y

164
Q

First management step in managing ‘tet spells’?

A

Calm child and knees to chest position

165
Q

What is seen on an x-ray in bronchiolitis?

A

Hyperinflation

166
Q

Management of bronchiolitis as an inpatient?

A

Humidified oxygen
NG feeds

167
Q

Which steroids given PO and IV in acute asthma?

A

PO prednisolone
IV hydrocortisone

168
Q

Stepwise approach to acute asthma management?

A

1 - SABA inhalers
2 - Nebulised salbutamol/ipratropium
3 - PO predisolone
4 - IV hydrocortisone
5 - IV magnesium sulphate
6 - IV salbutamol
7 - IV aminophylline

169
Q

What are the ages of delayed/precocious puberty?

A

No secondary sexual characteristics
Girls = 8/13
Boys = 9/14

170
Q

Tanner staging in girls?

A

I - no pubic hair/breast dev
II - light/thin hair + breast buds
III - course/curly + elevate beyond areola
IV - adult-like hair not reaching thigh + areolar mound projects
V - hair to medial thigh + areolar mounds reduce, adult breast form

171
Q

Tanner staging in boys?

A

I - testicular volume <3ml
II - changes in texture to scrotal skin (red and wrinkled), thin/straight hair
III - increase size of penis and testicles (skin darker, more wrinkled) coarse/curly hair
IV - further enlargement with development of glans penis (length and width), adult-like hair not reaching thigh
V - adult size and shape, hair to medial thigh

172
Q

What is given until oedema is resolved in nephrotic syndrome?

A

Penicillin V

173
Q

Testicular volume by tanner staging?

A

I - up to 3mL
II - 4-5mL
III - 6-10mL
IV - 11-16mL
V - 17-25mL

174
Q

What is Ramsay Hunt syndrome?

A

Reactivation of the VZV in ganglion of the seventh cranial nerve

175
Q

Symptoms of Ramsay Hunt?

A

Auricular pain
Facial nerve palsy
Vesicular rash around the ear
Vertigo/tinnitus

176
Q

Dexamethasone dose for croup?

A

0.15mg/kg

177
Q

First line management for ADHD in children?

A

10 week ‘watch and wait’ period to see if symptoms change or resolve

178
Q

Common cause of haemolytic uraemic syndrome?

A

Shiga toxins from e coli or shigella

179
Q

What is microangiopathic haemolytic anaemia?

A

Haemolysis due to pathology in the small vessels (microangiopathy).
Thrombi obstruct the vessels > churn RBCs as they pass through > causing rupture

180
Q

Henoch-Schonlein purpura symptoms?

A

PAPAH
Purpura - buttocks
Abdominal pain
Poly arthritis
Haematuria

181
Q

Organism causing Scarlett fever?

A

Strep. pyogenes

182
Q

Impetigo causative organism?

A

Staph aureus (sometimes strep. pyogenes)

183
Q

Impetigo treatment?

A

Hydrogen peroxide/fusidic acid
Flucloxacillin if extensive

184
Q

Presentation of measles?

A

Rash from behind ears > body
Koplik spots

185
Q

Mumps presentation?

A

Parotitis
Earache
Pain on eating

186
Q

Complications of mumps?

A

Orchitis
Hearing loss (usually transient)

187
Q

Rubella presentation?

A

Maculopapular rash from face > body

188
Q

Most common cause of encephalitis in children?

A

HSV-1

189
Q

Complications of slapped cheek?

A

Aplastic crisis in sickle cell anaemia
Pregnant women = hydrops fetalis

190
Q

Exclusion criteria for hand, foot and mouth disease?

A

Non required - when child feels well

191
Q

Causes of meningitis in <3 months?

A

Group B strep
Listeria
E. coli

192
Q

Causes of meningitis >3 months?

A

Neisseria meningitidis
Strep pneumoniae
Haemophilus influenza B

193
Q

Bacterial meningitis LP findings?

A

Cloudy
Low glucose
High white cells - neutrophils
High opening pressure
High protein

194
Q

Viral meningitis LP findings?

A

Clear
Normal glucose
High white cells - lymphocytes
Normal opening pressure
Slightly high protein

195
Q

Causative organism in roseola infantum?

A

Human herpes virus 6

196
Q

Symptoms of roseola infantum?

A

High fever preceding:
Maculopapular rash
Febrile convulsions in 10-15%
Diarrhoea
Cough
Nagayama spots: papular enanthem on the uvula and soft palate

197
Q

What is the shaken baby syndrome triad?

A

Retinal haemorrhages
Subdural haematoma
Encephalopathy

3a follow up (7 decks)

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