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Quesmed phase 3a > paeds > Flashcards

paeds Flashcards

1
Q

most common childhood malignancy

A

acute lymphocytic leukaemia

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2
Q

key presentations of ALL

A
  • lymphadenopathy = MC sx
  • hepatosplenomegaly
  • anaemia (fatigue and pallor),
  • thrombocytopenia (bruising and epistaxis)
  • neutropenia (recurrent infections and fever).
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3
Q

conditions associated with Down’s syndrome

A
  • four-fold increased risk of developing ALL
  • duodenal atresia
  • recurrent otitis media
  • hypothyroidism
  • Visual problems e.g. cataracts, squint + myopia
  • Hearing loss – eustachian tube abnormalities
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4
Q

core features of autism

A
  • narrow interests
  • language deficits
  • repetitive behaviors
  • repetitive hand movements
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5
Q

fraser guidelines key components

A
  1. patient should understand the clinician’s advice,
  2. they cannot be persuaded to discuss the situation with their parents,
  3. are likely to continue having intercourse without treatment,
  4. are likely to suffer (mentally or physically) without treatment,
  5. that it is in the patient’s best interests to provide the prescription.
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6
Q

Patients on methylphenidate should have what monitoring?

A
  • height and weight because it can affect appetites –> slowed growth
  • apetite
  • BP
  • pulse
  • symptoms
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7
Q

ADHD Mx

A
  • 1st line = conservative Mx with behavioural therapy, CBT, social training. Extra support at school. Sleep support with sleep hygiene methods and failing that melatonin
  • 2nd line = medical mx only for kids >5yrs. methylphenidate is 1st line.
    lisdex or dexamphetamine are 2nd line options if methyl doesn’t work and is trialled for 6 weeks
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8
Q

scarlet fever causative organism

A

Group A streptococcus - commonly strep pyogenes

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9
Q

Over the last 48 hours he has developed a sore throat, headache and fever. In the last 24 hours he has developed a coarse, erythematous rash over his face and torso and his mother reports that his tongue appears bright red

A

scarlet fever

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10
Q

what is the most common congenital cardiac defect

A

VSD
accounts for about 30-60% of all congenital heart defects

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11
Q

key features of

A

preceding history of URTI

classic triad of

  1. abdominal pain
  2. arthralgia
  3. purpura on the extensor surfaces

AND renal involvement as IgA immune complexes can deposit in the kidneys and cause haematuria and proteinuria.

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12
Q

what is HSP

A

a small vessel vasculitis - MC vasculitis in kids

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13
Q

cause of Down’s syndrome

A

Meiotic non-disjunction
an error during meiosis which leads to a gamete with 2 copies of chromosome 21 being produced. linked to maternal age

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14
Q

what concentration of adrenaline is used in anaphylaxis

A

1: 1000

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15
Q

paediatric doses of adrenaline

A

Immediate administration of adrenaline (1:1000, IM):

  • Child > 12 years: 500 micrograms IM (0.5 mL)
  • Child 6-12 years: 300 micrograms IM (0.3 mL)
  • Child 6 months - 6 years: 150 micrograms IM (0.15 mL)
  • Child < 6 months: 100-150 micrograms IM (0.1-0.15 mL)
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16
Q

describe the common presentation of a strangulated hernia

A

There is often a history of preceding intermittent pain which resolves.
The hernia is able to reduce in the past but has become strangulated now –> worsening pain that doesn’t resolve

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17
Q

what is the honeymoon period in T1DM

A

immediately after a diagnosis of T1DM the pancreas may still produce some insulin. therefore insulin requirements may be low.
these pts need close monitoring as their insulin requirements may suddenly increase as the remaining beta cells are destroyed
they are at high risk of DKA if this happens

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18
Q

Mx of a hypo in an unconscious pt

A
  1. 2ml/kg IV 10% dextrose - preferred treatment if in hospital
  2. IM glucagon - preferred for outside of hospital
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19
Q

what is the first step in resuscitation of an unresponsive paediatric patient
+ why

A
  • 5 rescue breaths prior to commencing chest compressions
  • because paediatric pts are more likely to suffer respiratory arrest than cardiac arrest.
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20
Q

Bordetella pertussis microscopic morphology

A

Gram-negative coccobacillus

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21
Q

The most common type of heart block in children is…

A

complete heart block [third-degree heart block]

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22
Q

pathophysiology of third degree heart block

A
  • In complete heart block, the electrical impulse never gets past the A-V node.
  • thus the atria and ventricles contract independent of each other
  • The only reason a person can survive is that another, weaker natural pacemaker takes over in the ventricles.
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23
Q

presentation of third degree heart block

A
  • loss of consciousness.
  • cyanotic spells
  • pre-syncope [feeling faint]
  • syncope [fainting]
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24
Q

MC complication of measles
+ other complications

A
  • MC = otitis media
  • others: pneumonia, acute encephalitis, hearing or vision loss.
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25
Q

double bubble on xray

A

duodenal atresia

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26
Q

duodenal atresia clinical presentations

A
  • Antenatally, with association of polyhydramnios due to inadequate ingestion of amniotic fluid by the foetus
  • Postnatally, with a distended abdomen and vomiting.
    • The vomit may be bilious or non-bilious, the nature of which depends on the site of atresia.
    • The vomiting typically onsets within hours to days of life.
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27
Q

Mx of duodenal atresia

A

Early surgical intervention is required, involving a duodenoduodenostomy

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28
Q

define duodenal atresia

A

congenital condition where the duodenum is blind-ending so is not patent and results in obstructive symptoms

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29
Q

define neonatal jaundice

A

yellowing of a newborn’ skin and eyes due to build up of bilirubin

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30
Q

causes of neonatal jaundice

A

<24 hours

  • Haemolytic disorders (Rhesus incompatibility, ABO incompatibility, G6PD deficiency, spherocytosis)
  • Congenital infections (TORCH screen indicated)
  • Sepsis

24hrs - 14 days

  • Physiological jaundice
  • Breast milk jaundice
  • Dehydration
  • Infection, including sepsis

> 14 days [21 if preterm]

  • Hypothyroidism
  • Biliary obstruction (including biliary atresia)
  • Neonatal hepatitis
  • physiological, breastmilk, infection.
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31
Q

physiological neonatal jaundice

A

Is common and caused by
- Relative polycythaemia in newborns
- Shorter red blood cell lifespan compared to adults
- Less efficient hepatic bilirubin metabolism in the first few days of life

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32
Q

Sx of neonatal jaundice

A
  • yellowing of skin and eyes
  • poor feeding
  • lethargy
  • kernicterus in severe untreated cases
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33
Q

what is kernicterus

Sx?

A
  • a complication of untreated neonatal jaundice
  • excess bilirubin damages the basal ganglia within the brain

Sx:

  • irritability
  • vomiting
  • hypotonia FOLLOWED BY hypertonia
34
Q

yellowing of skin and eyes + pale stool + dark urine =

A

biliary atresia

35
Q

Ix for neonatal jaundice

A
  • transcutaneous bilirubin levels
  • serum bilirubin if TC levels are raised
    plot levels of a nomograph
  • FBC, LFT,
  • USS of liver to investigate for hepatitis and biliary atresia
36
Q

A thrill and grade 4/6 systolic murmur radiating to the left axilla and back, with no variation on respiration or posture, suggests…

A

a significant ventricular septal defect.

37
Q
  • MC cause of nephrotic syndrome in kids
  • what is seen on histology of renal biopsy
A
  • Minimal change disease is the most common cause of nephrotic syndrome in children
  • characterised by minimal or no histological changes on biopsy.
38
Q

appearance of the heart if ToF

A

boot shaped heart

39
Q

causative organism of roseola infantum

A

human herpes virus 6

40
Q

main complication of roseola infantum

A

febrile convulsions caused by spikes in temperature

41
Q

NEC key presenting features

A
  • premature infant
  • abdominal distention
  • bilious vomiting
  • bloody stool
  • feed intolerance
  • absent bowel sounds
  • Signs of systemic compromise, including an acidosis on a blood gas and respiratory distress
42
Q

NEC gold standard Ix + results

A

Xray

  • Rigler’s sign: both sides of the bowel are visible due to gas in the peritoneal cavity
  • Dilated bowel loops
  • Distended bowel
  • Thickened bowel wall
43
Q

kawasaki Mx

A

Aspirin and intravenous Immunoglobulin (IVIG)

44
Q

scarlet fever Mx

A

10 day course of phenoxymethylpenicillin

45
Q

when do kids typically start walking unassisted

A

Most toddlers start walking unaided between 13 and 15 months of age.

46
Q

when should a kid not starting to walk unaided by trigger a referral

A

If a toddler has not started walking by 18 months, a referral to paediatrics should be made to see if there are any underlying health issues

47
Q

what should a baby be able to do at 6 months

A

roll over and may be able to sit up

48
Q

what should a baby be able to do at 9 months

A

pull up to stand
crawl independently

49
Q

risk factors for SUFE
which is MC

A
  • obesity is MC
  • endocrine disorders: hypothyroidism, growth hormone deficiency, hypopituitarism and renal failure osteodystrophy
50
Q

when should a child with croup be sent to hospital

A
  • Stridor and/or signs of resp. distress e.g. sternal recession at rest
  • Hypoxia / cyanosis
  • High fever
  • Respiratory rate > 60
  • Lethargy or agitation
  • Fluid intake < 75% of normal or no wet nappies for 12 hours
  • Aged under 3 months
  • Chronic conditions such as immunodeficiency, chronic lung disease or neuromuscular disorders
51
Q

asthma diagnostic investigations

A
  1. spirometry with bronchodilator reversibility
  2. FeNO testing. In children with uncertain asthma diagnosis despite normal spirometry results, measuring fractional exhaled nitric oxide can provide additional diagnostic value.
  3. Peak flow variability monitoring should also be offered at the same time as FeNO testing
52
Q

Kawasaki disease clinical features and Dx criteria

A

Diagnosis is made based on a high-grade fever for 5 days + 4/5 CREAM features:

  1. Conjunctivitis (bilateral, non-exudative)
  2. Rash (any non-bullous rash[polymorphous])
  3. Edema/Erythema of hands and feet – can peel later.
  4. Adenopathy (cervical, commonly unilateral and non-tender)
  5. Mucosal involvement (strawberry tongue, oral fissures, red cracked lips etc)
53
Q

main complication of kawasaki

A

Coronary artery aneurysms or dilation:arises in up to a quarter of affected children

54
Q

causes of bilious vomiting

A
  • intestinal malrotation and volvulus
  • intussusception [not always, dependent on location]
  • Hirschprung’s disease
55
Q

ENT manifestations of Downs

A
  • small nose with a flat nasal bridge,
  • small and low set ears,
  • hearing issues and ear infections,
  • hypothyroidism
56
Q

coeliac disease skin manifestation

A

dermatitis herpetiformis
papulovesicular rash which is commonly found on the buttocks, legs, arms or abdomen

57
Q

What is the CENTOR criteria used for and what are its components

A

used to indicate the likelihood of a sore throat being caused by bacteria:

  • Fever over 38ºC
  • Tonsillar exudates
  • Absenceof cough
  • Tenderanterior cervical lymph nodes (lymphadenopathy)
58
Q

when should antibiotics be given for tonsillitis

A

when the CENTOR score in ≥3

59
Q

What is an alternative to CENTOR criteria and what are the components

A

FeverPAIN - must score 4 or 5

  • Feverduring previous 24hours
  • P–Purulence (pus on tonsils)
  • A–Attended within 3days of the onset of symptoms
  • I–Inflamed tonsils (severely inflamed)
  • N–No cough or coryza
60
Q

sore throat / tonsillitis management

A
  • Conservative mx if viral or bacterial unlikely with paracetamol and ibuprofen + adequate fluid intake.
    • MUST safety net. Come back if no improvement within 3 days OR if fever rises above 38.3
  • ABX if centor score ≥3 or feverPAIN ≥4.
    • 1st line – phenoxymethylpenicillin for 10 days OR clarithromycin 10 days in pen allergic pts.
    • Also consider abx in immunocompromised pts, pts with a hx of rheumatic fever and those with significant comorbidities as they are at a greater risk of serious infection.
61
Q

what classes as a complex febrile convulsion

A
  • duration >15 mins
  • more than 1 episode within 24 hours
  • child does not fully recover within 1 hour
62
Q

what is the most specific sign for meningococcal disease

A

non-blanching rash

63
Q

lumbar puncture contraindications

A
  • Raised ICP
  • ## extensive purpuric rash over the puncture site
64
Q

language development expectations of a 3 yr old

A

A child at the age of three should have a growing vocabulary and be able to use simple sentences, as well as recognise and name at least one colour.

65
Q

long term risks of untreated coeliac disease

A
  • lymphomas (such as EATL - enteropathy associated T-cell lymphoma)
  • small bowel adenocarcinomas
66
Q

what are the trisomy syndromes

A
  • 21 = Down’s
  • 18 = Edwards
  • 13 = Patau
67
Q

congenital anomalies of Pataus

A

microcephaly, cleft lip and palate, polydactyly, and cardiac defects

68
Q

key features of JIA

A

Sx lasting ≥6 weeks

  • joint pain and/ or swelling,
  • morning stiffness
  • limited RoM
  • lymphadenopathy,
  • uveitis,
  • pyrexia,
  • anorexia
  • weight loss
69
Q

Fraser guidelines are specifically for girls <16 seeking contraception
T/F

A

FALSE
it applies to <16 yr olds seeking treatment specifically for sexual health.
therefore also applies to boys.

70
Q

Fraser guideline vs Gillick competence

A

The Fraser guidelines may be confused with Gillick competency. Gillick competency can be applied in the wider context of medical treatment of under 16s, whereas the Fraser guidelines are specific to sexual health.

71
Q

how do you differentiate between septic arthritis and transient synovitis

A

high grade fever in septic arthritis
kocher criteria used to differentiate

72
Q

what is the kocher criteria and what are its components

A

The Fraser guidelines may be confused with Gillick competency. Gillick competency can be applied in the wider context of medical treatment of under 16s, whereas the Fraser guidelines are specific to sexual health.

73
Q

key features of inflammatory arthritis

A

Key features of inflammatory arthritis = joint pain + swelling + stiffness.

74
Q

what is still’s disease

A

systemic JIA

75
Q

key features of systemic JIA

A
  • subtle salmon pink rash,
  • high swinging fevers,
  • joint pain,
  • enlarged lymph nodes,
  • weight loss,
  • muscle pain,
  • pleuritis + pericarditis
76
Q

combined test =

A
  • 1st line testing for downs
  • done between 11-14 weeks
  • involves USS and maternal bloods
    • scan loks for nuchal translucency thicker than 6mm = ↑ risk
    • bloods:
      • B-hCG: raised = ↑ risk
      • pregnancy associated plasma protein A low = ↑ risk.
77
Q

triple test

A
  • done between 14 and 20 weeks
  • maternal bloods only:
    • B-hCG: raised = ↑ risk
    • Alpha fetoprotein low = ↑ risk
    • serum oestriol low = ↑ risk
78
Q

quadruple test

A

same as triple test but includes inhibin A: raised = ↑ risk

79
Q

Mx of neonatal jaundice

A

1st line = Phototherapy. usually sufficient.
Exchange transfusions: removing blood from the neonate and replacing it with donor blood. used in severe cases

80
Q
A

Quesmed phase 3a (6 decks)

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