Paeds Flashcards
1
Q
Scarlett fever sx
A
Sore throat, fever, headache, bright red tongue and a coarse, red rash
fine punctate erythema (‘pinhead’)
2
Q
Organism causing Scarlett and age group
A
Group A haemolytic streptococci (usually Streptococcus pyogenes). It is more common in children aged 2 - 6 years with the peak incidence being at 4 years.
3
Q
Mx of Scarlett
A
oral penicillin V for 10 days
patients who have a penicillin allergy should be given azithromycin
children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease
4
Q
Kawasaki disease
A
fever typically lasts 5 days or longer.
It also presents with an erythematous polymorphous rash, strawberry tongue,
cervical lymphadenopathy, bilateral conjunctivitis, oedema, erythema, and skin peeling of the hands and feet.
5
Q
Parvovirus B19 sx
A
erythematous facial rash appearing on one or both cheeks (resembling a ‘slapped cheek’)
An erythematous maculopapular rash on the trunk, back, and limbs may develop a few days after the facial rash.
6
Q
Transient tachypnoea of the newborn sx and mx
A
Common after C sections
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
Management
observation, supportive care
supplementary oxygen may be required to maintain oxygen saturations
Transient tachypnoea of the newborn usually settles within 1-2 days
7
Q
Vaccines in premature babies
A
Babies who were born prematurely should receive their routine vaccinations according to chronological age
Babies who were born prior to 28 weeks gestation should receive their first set of immunisations at hospital due to risk of apnoea.
8
Q
Tetrology of Fallot
A
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
9
Q
BLS peads
A
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 (see above)
10
Q
Ix for intusseption
A
US
11
Q
Conditions with genetic anticipation
A
Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
12
Q
Average child able to sit and walk and when should you refer
A
SIt 7-8 average
Refer 12m
Walk 13-15
Refer 18m
13
Q
Movement lost most in SUFE
A
Internal rotation
14
Q
Complications of measles
A
Immediate- pneumonia
5-10 yrs Subacute sclerosing panencephalitis
15
Q
Whooping cough tx
A
Oral azithromycin (macrolide)
is indicated if the onset of the cough is within the previous 21
household contacts should be offered antibiotic prophylaxis
school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
16
Q
Diagnostic criteria for whooping cough
A
Acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
17
Q
Blue peripheries with cyanosis. The rest of the examination is normal. Oxygen saturations are 97% pre and post ductally. Good tone
A
Acrocyanosis
18
Q
Mx of left subclavicular thrill, continuous ‘machinery’ murmur
A
indomethacin or ibuprofen
19
Q
Measles features
A
prodromal phase
irritable
conjunctivitis
fever
Koplik spots
typically develop before the rash
white spots (‘grain of salt’) on the buccal mucosa
rash
starts behind ears then to the whole body
discrete maculopapular rash becoming blotchy & confluent
desquamation that typically spares the palms and soles may occur after a week
diarrhoea occurs in around 10% of patients
20
Q
Most common cause of childhood hypothyroidism in UK
A
AI thyroiditis
21
Q
Edward’s syndrome
A
RockEr Bottom Feet
Low set ears
Overlapping fingers
22
Q
Fragile X
A
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
23
Q
Noonan syndrome
A
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
24
Q
Features of Roseola infantum
A
high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
School exclusion is not needed.
25
Hand, foot and mouth disease
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
26
Scarlet fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
'Strawberry' tongue
Rash - fine punctate erythema sparing the area around the mouth
27
Erythema infectiosum
slapped-cheek syndrome'
Caused by parvovirus B19
Lethargy, fever, headache
'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
28
RF for bruising after birth
Breastfed babies are at risk of vitamin K deficiency
29
AR vs AD conditions
Autosomal recessive conditions are 'metabolic'
exceptions: inherited ataxias
Autosomal dominant conditions are 'structural'
exceptions: Gilbert's, hyperlipidaemia type II
30
White discharge in newborn girl PV
Most newborn girls have some mucoid white vaginal discharge which usually disappears by 3 months of age
31
Caffeine in neonate
Caffiene can be used as a respiratory stimulant in newborn babies
Wean off ventilator
32
Giving MMR
3 months between doses to maximise the response rate.
A period of 1 month is considered adequate if the child is greater than 10 years of age.
In an urgent situation (e.g. an outbreak at the child's school) then a shorter period of 1 month can be used in younger children.
33
Age for transient synovitis
3-8
34
Chondromalacia patellae vs Osgood-Schlatter disease vs Osteochondritis dissecans
CP
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
OSD
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
OD
Pain after exercise
Intermittent swelling and locking
35
Mx of croup
single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Emergency treatment
high-flow oxygen
nebulised adrenaline
36
When to admit croup
moderate or severe croup
< 3 months of age
known upper airway abnormalities
37
Gastroschisis vs exomphalos
Gastroschisis
anterior abdominal wall just lateral to the umbilical cord.
Can have vaginal delivery
newborns should go to theatre as soon as possible after delivery
Exomphalos
abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac
caesarean section is indicated to reduce the risk of sac rupture
a staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure
38
Mx of Hirschprungs
initially: rectal washouts/bowel irrigation
definitive management: surgery to affected segment of the colon
39
Pathophysiology of Hirschprungs
parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon → developmental failure of the parasympathetic Auerbach and Meissner plexuses → uncoordinated peristalsis → functional obstruction
40
RF of DDH
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
41
Perthes presentation
Presents with progressive hip pain, limp and stiffness
42
Mx of Perthes
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
43
Most common causer of stridor in neonates
Laryngomalacia
44
First signs of puberty in boys and girls
Males
first sign is testicular growth at around 12 years of age (range = 10-15 years)
Females
first sign is breast development at around 11.5 years of age (range = 9-13 years)
45
Steroid mx in asthma
Use a dose of 10 mg prednisolone for children under 2 years of age, 20 mg for children aged 2-5 years and 30-40 mg for children >5 years.
46
Severity of asthma Children greater than 5 years of age
Moderate
SpO2 > 92%
PEF > 50% best or predicted
Severe
PEF 33-50% best or predicted
Can't complete sentences in one breath or too breathless to talk or feed
Heart rate > 125/min
Respiratory rate > 30/min
Life
PEF < 33% best or predicted
Silent chest
Poor respiratory effort
Altered consciousness
Cyanosis
47
Upslanting palpebral fissures, prominent epicanthic folds, low-set ears and flat face neuro exam
Hypotonia
48
RF for SIDS
prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity
49
When to admit for fever in child
Any child less than 3 months old with a temperature > 38ºC
50
Hypospadias tx
Corrective surgery at around 12 months of age is required and children should not be circumcised.
51
RF of surfactant deficient lung disease
premature infants
male sex
diabetic mothers
Caesarean section
second born of premature twins
52
Jaundice in the newborn period
Jaundice<24 hours is always pathological.
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
Jaundice in the neonate from 2-14 days is common
Jaundice >14 days
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
prematurity
53
Ix for , cracked lips, a bright red tongue, a widespread erythematous maculopapular rash and peeling of the skin on the hands and feet. She has bilateral conjunctivitis.
Echo - Kawasaki disease
54
Mx of PDA
indomethacin or ibuprofen
55
Duct dependent cardiac lesions mx
A patent ductus arteriosis can be kept open with prostaglandins
Duct dependent cardiac lesions include: tetralogy of fallot, ebstein's anomaly, pulmonary atresia and pulmonary stenosis.
56
Patient not started menstruating. On examination, you note her short stature and webbed neck.
What would you expect to hear on auscultation of her heart
ESM
Turner- Bicuspid valve
57
Innocent murmur criteria
Soft, Systolic, Short, Symptomless, Standing/Sitting (vary with position)
58
Mx of migraine
ibuprofen
triptans may be used in children >= 12 years but follow-up is required
59
Precocious puberty definition
development of secondary sexual characteristics before 8 years in females and 9 years in males
60
Ix for DDH
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
61
Time off school for mumps
If a child has mumps they need to be excluded from school for 5 days from the onset of swollen glands
62
Congenital heart disease in neonates
poor feeding, shortness of breath, hepatomegaly
63
Neonate resus guidelines
Birth: Dry the baby, start the clock
Within 30 seconds: Assess tone, breathing and heart rate.
Within 60 seconds: If gasping or not breathing - open the airway and give 5 inflation breaths
You then reassess for an increase in the heart rate. If there is no increase in the heart rate you ensure the inflation breaths you are giving are adequate by checking chest movement.
If the chest is not moving you assume the inflation breaths are inadequate and recheck head position, consider 2-person airway control and other manoeuvers and repeat inflation breaths then look for a response.
When the chest is moving: If heart rate is not detectable or slow (< 60 min-1) - start chest compressions with 3 compressions to each breath.
64
Apgar score
Pulse
Absent
<100
>100
Resp
None
Weak irregular
Strong crying
Colour
Blue
Blue extremities
Red
Tone
Flaccid
Limb flexion
Active
Irritability
Nil
Grimace
Cries on stimulation
Assessed at 1, and 5 minutes of age. If the score is low then it is again repeated at 10 minutes.
A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state
65
Milk ladder
The milk ladder can be used after 6 months of age
Start with biscuits
Then muffin->pancake_> cheese->yoghurt->milk
66
Androgen insensitivity syndrome
End-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype
'primary amenorrhoea'
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol
67
Kallman syndrome
delayed puberty secondary to hypogonadotrophic hypogonadism
failure of GnRH-secreting neurons to migrate to the hypothalamus.
'delayed puberty'
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
Low LH low test
68
Klinefelter's syndrome
karyotype 47, XXY
often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated LH low test
69
Factors which suggest faecal impaction include:
symptoms of severe constipation
overflow soiling
faecal mass palpable in the abdomen (digital rectal examination should only be carried out by a specialist)
70
Mx of constipation
If not impacted-
Polyethylene glycol 3350 + electrolytes as the first-line treatment.
Add a stimulant laxative
If impacted
Polyethylene glycol 3350 + electrolytes
Add a stimulant laxative if no disimpaction after 2 weeks
Substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose
71
Development milestones in language
2 months - co
4 months - haha
6 months- babble
9 months - mommy dadda
12 months - 1+ word
2 years- combine 2 words
72
Development milestones in gross motor
2 months - head up
4 months - roll over
6 months- sits
9 months - crawl
12 months - walk
2 years- run
3 years- tricycle
73
Development milestones in social
2 months - twinkle (smile)
4 months - Focus on sound
6 months- Stranger anxiety
9 months - Name (respond)
12 months - Told command
74
Croup vs bonchiolitis age
croup is 6 months -3 years, bronchiolitis is seen in 1-9 month olds
75
Mx of jaundice in <24 hrs
Measure bilirubin
76
foul-smelling diarrhoea,abdominal pain, bloated abdomen and wasted buttocks dx
Coeliac disease
Measure TTG IGA abx
jejunal biopsy showing subtotal villous atrophy
77
Mx of enuresis
Children under the age of 5 years who have nocturnal enuresis can be managed with reassurance and advice
Desmopressin may be considered if initial strategies are not successful and if the child is over 7 years old.
enuresis alarm
generally first-line for children
78
Cow's milk intolerance sx and ix
typically presents in the first 3 months of life in formula-fed infants
regurgitation and vomiting
diarrhoea
urticaria, atopic eczema
'colic' symptoms: irritability, crying
wheeze, chronic cough
skin prick/patch testing
total IgE
79
Mx of Cow's milk protein intolerance
If severe- refer to pads
If bottle- extensive hydrolysed formula (eHF)
amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF
Management if breastfed
continue breastfeeding
eliminate cow's milk protein from maternal diet.
80
Rotavirus vaccine
it is an oral, live attenuated vaccine
2 doses are required, the first at 2 months, the second at 3 months
Cannot be give after 15w
81
Presentation of cyanosis of TOF vs TGA
TGA- within 24 hrs
TOF- 1-2 months
82
Omphalitis vs Umbilical granuloma vs Persistent urachus vs Persistent vitello-intestinal duct
Omphalitis
infection of the umbilicus
Umbilical granuloma
cherry red lesions surrounding the umbilicus
Persistent urachus
urinary discharge from the umbilicus
Persistent vitello-intestinal duct
umbilical discharge that discharges small bowel content
83
Viruses causes croup
parainfluenza, adenovirus, and respiratory syncytial virus (RSV
84
Mx of viral wheeze
children requires supportive management only
85
Neonatal blood spot screening
5-9 days of life
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
86
Benign rolandic epilepsy
seizures characteristically occur at night
seizures are typically partial (e.g. paraesthesia affecting the face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements)
the child is otherwise normal
The prognosis is excellent, with seizures stopping by adolescence
87
Heart condition in Downs
AVSD
88
Shaken baby syndrome
Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of the shaken baby syndrome
89
William's syndrome
Small upturned nose
long philtrum (upper lip length)
wide mouth
Small chin
Puffiness around the eyes.
aortic stenosis
90
Cephalohaematoma
It typically develops several hours after delivery and is due to bleeding between the periosteum and skull. The most common site affected is the parietal region
Jaundice may develop as a complication.
A cephalohaematoma up to 3 months to resolve.
91
Caput succadeneum
immediately after birth.
It occurs due to generalised superficial scalp oedema
crosses suture lines.
It is associated with prolonged labour and will rapidly resolve over a couple of days.
92
Normal lower limb variants in children
Bow legs-
Bow legs in a child < 3 is a normal variant and usually resolves by the age of 4 years
Knock knees
Typically resolves spontaneously
Flat feet
Typically resolves between the ages of 4-8 years
93
ITP vs HSP vs HUS
ITP
child presenting with petechiae and no fever and is usually preceded by a viral illness.
HSP
HSP are typically a non-blanching rash affecting the legs and buttocks, arthralgia and abdominal pain.
HUS
HUS is associated with a triad of microangiopathic haemolytic uraemia, acute kidney injury and thrombocytopenia. The symptoms are typically bloody diarrhoea, abdominal pain, fever and vomiting, and the history usually includes exposure to farm animals
94
IM benzylpenicillin for suspected meningococcal septicaemia in the community
< 1 year 300 mg
1 - 10 years 600 mg
> 10 years 1200 mg
95
+Ve ortolani or Barlow test
Urgent referral
96
Commonest cause of nephrotic syndrome in children
Minimal change
97
What is Palivizumab and when is it used
Monoclonal AB to protect against RSV
Those at risk of developing RSV include
Premature infants
Infants with lung or heart abnormalities
Immunocompromised infants
98
Causes of precocious puberty in males
Testes
bilateral enlargement = gonadotrophin release from intracranial lesion
unilateral enlargement = gonadal tumour
small testes = adrenal cause (tumour or adrenal hyperplasia)
99
Pertussius vaccine in pregnancy
Women who are between 16-32 weeks pregnant are offered the pertussis vaccine
100
When would you consider alternative diagnosis to bronchiolitis
Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.
101
Infection in neonate eye mx
referred for same-day ophthalmology/paediatric assessment.
102
erythematous rash in the nappy area with flexural sparing
Irritant dermatitis
103
Stills disease
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
ANA may be positive, especially in oligoarticular JIA
104
Meningitis in children: organisms
Neonatal to 3 months
Group B Streptococcus: usually acquired from the mother at birth.
E. coli and other Gram -ve organisms
Listeria monocytogenes
1 month to 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
Greater than 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
105
Vesicoureteric reflux ix
Micturating cystography
106
Meningitis in children < 3 months tx
IV amoxicillin in addition to cefotaxime to cover for Listeria
> 3 months: IV cefotaxime (or ceftriaxone)
107
Mx of GORD
advise regarding position during feeds - 30 degree head-up
infants should sleep on their backs
ensure infant is not being overfed
and consider a trial of smaller and more frequent feeds
a trial of thickened formula- only if bottle-fed
a trial of alginate therapy e.g. Gaviscon.
108
Rubella
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
109
Mx of labial adhesions
Labial adhesions: if recurrent urinary tract infections, oestrogen cream may be tried
110
seborrhoeic dermatitis mx
Baby shampoo and oil
111
Hearing tests
Newborn Otoacoustic emission test
Auditory Brainstem Response test May be done if otoacoustic emission test is abnormal
> 3 years Pure tone audiometry Done at school entry in most areas of the UK
112
Chest compressions for infants vs children
Both 100-120
113
No Exclusion from school
Slapped cheek
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth
114
Exclusion from school
24 hours after commencing antibiotics
Scarlet fever
2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
Whooping cough
4 days from onset of rash Measles
5 days from onset of rash Rubella
All lesions crusted over Chickenpox
5 days from onset of swollen glands Mumps
Until symptoms have settled for 48 hours
Diarrhoea & vomiting
Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
Impetigo
Until treated Scabies
Until recovered Influenza
115
Contraindications to MMR
severe immunosuppression
allergy to neomycin
children who have received another live vaccine by injection within 4 weeks
pregnancy should be avoided for at least 1 month following vaccination
immunoglobulin therapy within the past 3 months
116
Small white cystic vesicle around 2mm in diameter situation on the hard palate close to the midline mx
Epstein Pearl
No treatment is generally required as they tend to spontaneously resolve over the course of a few weeks
117
Child with a limp/hip pain has a fever mx
Should be referred for same-day assessment, even if a diagnosis of transient synovitis is suspected
118
Undescended teste risks associated
Undescended testicles are associated with an increased risk of infertility, torsion and testicular cancer
119
Mx of threadworms
Household contacts of patients with threadworms should be treated even if they have no symptoms
Single dose mebendazole
120
When is Men B vaccine given
2, 4, and 12 months of age
121
