PAEDS Flashcards

1
Q

What is familial short stature?

A

Child is short but normal, parents are short and normal, with normal bone age.

Child will become short adult.

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2
Q

What is constitutional delay of growth and puberty (CDGP)?

A

Mainly occurs in boys, with family history and delayed bone age.

Can give testosterone, and child will have later growth spurt.

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3
Q

What are some pathological causes of short stature?

A
  • Undernutrition
  • Chronic illness (IBD, asthma)
  • Iatrogenic (Steroids)
  • Psychological and social factors
  • Hormonal (hypothyroidism, growth hormone deficiency)
  • Syndromes (Turner’s, Prader-Willi)

Requires exclusion of organic disease.

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4
Q

What are the tests for growth hormone deficiency?

A
  • GH stimulation tests (Arginine test, Insulin tolerance test)
  • Low IGF-1
  • Delayed bone age

Can be due to pituitary causes or congenital hypothyroidism.

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5
Q

What are the features of congenital adrenal hyperplasia (CAH)?

A
  • Androgen secreting tumor
  • Precocious pseudopuberty
  • Elevated adrenal hormones

Includes abnormal sex hormone secretion.

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6
Q

What is jaundice?

A

Yellow discoloration of skin and tissues due to accumulation of bilirubin.

Most obvious in sclera, visible once total bilirubin > 40-50 umol/l.

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7
Q

What can cause pathological jaundice in newborns?

A
  • Haemolysis
  • Sepsis
  • ABO incompatibility
  • Rhesus disease

Jaundice < 24 hours old is always pathological.

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8
Q

What is kernicterus?

A

Severe untreated jaundice in newborns leading to permanent brain damage.

Caused by high levels of unconjugated bilirubin crossing the blood-brain barrier.

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9
Q

What are the early signs of kernicterus?

A
  • Poor feeding
  • Lethargy
  • Seizures
  • Encephalopathy

Late consequences may include severe choreoathetoid cerebral palsy and learning difficulties.

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10
Q

What is pyloric stenosis?

A

Condition characterized by non-bilious projectile vomiting in infants aged 2-12 weeks.

Palpation of ‘olive tumor’ and visible gastric peristalsis may be observed.

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11
Q

What are common features of gastroesophageal reflux (GORD)?

A
  • Effortless vomiting
  • Feeding problems
  • Regular chest infections

Very common and usually self-limiting.

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12
Q

What is the typical presentation of intestinal atresia?

A

Portion of the intestine is completely blocked or absent, preventing normal passage of foods and fluids.

Symptoms often present immediately after birth with bilious vomiting.

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13
Q

What is the significance of a double bubble sign on abdominal X-ray?

A

Indicates duodenal obstruction, commonly seen in intestinal atresia.

Dilation of stomach and proximal duodenum.

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14
Q

What is the treatment for congenital biliary atresia?

A

Kasai portoenterostomy, best performed before 60 days of life.

Aims to restore bile flow and prevent liver failure.

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15
Q

What defines precocious puberty?

A

Onset of secondary sexual characteristics before age 9 in boys or age 8 in girls.

MRI pituitary to exclude tumors in cases of central precocious puberty.

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16
Q

What is the Tanner method?

A

A system for staging puberty from 1 to 5, where 1 indicates no puberty and 2 indicates the start of puberty.

Used to assess sexual maturity.

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17
Q

What are the signs of diabetes in children?

A
  • Thinner
  • Tired
  • Thirsty
  • Toilet more

Presents with heavy nappies and blurred vision.

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18
Q

What is the purpose of the finger prick test in suspected DKA?

A

To measure blood glucose levels, > 11mmol/l indicates need for same-day review.

DKA can occur rapidly in children.

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19
Q

What are the common tests for assessing jaundice?

A
  • FBC and ferritin
  • U/E, LFT, Ca, CRP
  • Coeliac and IgA
  • IGF-1, TFT, prolactin, cortisol, gonadotrophins
  • Karyotype

Important to differentiate between conjugated and unconjugated bilirubin.

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20
Q

What is the primary test for diagnosing Gilbert’s disease?

A

Assay for deficiency of the enzyme UDP glucuronic.

Common and mild condition leading to unconjugated bilirubin.

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21
Q

What is the treatment for prolonged jaundice?

A

Phototherapy using visible light at 450nm wavelength to convert bilirubin to a water-soluble isomer.

Thresholds for treatment are guided by charts.

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22
Q

What are the consequences of untreated congenital hypothyroidism?

A

Will be short in stature and have abnormal proportions.

Screened for early treatment within the first two weeks of birth.

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23
Q

What are common symptoms of obesity in pediatric patients?

A
  • Poor growth
  • Learning difficulties
  • Loss of appetite control

May be associated with syndromes and endocrine conditions.

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24
Q

What is the role of insulin in diabetes management?

A

Regulates blood glucose levels and may be necessary in cases of DKA.

DKA management often requires immediate insulin administration.

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25
Q

What are the signs of septic-optic dysplasia?

A

Mild face hypoplasia, excess subcutaneous fat, and delayed skeletal maturation.

Important features to consider in growth hormone deficiency.

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26
Q

What is the definition of hypertrophic cardiomyopathy?

A

A condition where the heart muscle becomes abnormally thick, potentially leading to heart failure.

Important to monitor in patients with congenital heart defects.

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27
Q

What are the characteristics of non-bilious vomiting?

A

Projectile vomiting, often seen in conditions like pyloric stenosis.

Differentiates from bilious vomiting, which indicates intestinal obstruction.

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28
Q

What is the main concern with bilious vomiting in newborns?

A

It signals potential intestinal obstruction and requires immediate evaluation.

Conditions like malrotation or volvulus can be life-threatening.

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29
Q

What is the management for gastroesophageal reflux disease (GERD)?

A
  • Dietary modifications
  • Positioning during sleep
  • Use of PPIs and antacids

Surgery is a last resort in severe cases.

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30
Q

What defines the peak height velocity in girls during puberty?

A

Occurs around age 12, with growth slowing down as breast development matures.

Menarche indicates nearing final height.

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31
Q

What is a life-threatening emergency that occurs due to ischemia and necrosis of the intestines?

A

Volvulus

Volvulus is often caused by Ladd’s bands, which are abnormal fibrous bands that obstruct the duodenum.

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32
Q

What are common symptoms of intestinal obstruction due to volvulus?

A
  • Bilious vomiting (Green)
  • Severe abdominal distension
  • Irritability and inconsolable crying
  • Bloody stools if ischaemia occurs
  • Signs of shock if ischemic
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33
Q

What imaging finding is known as the ‘double bubble sign’?

A

It indicates duodenal obstruction on an abdominal X-ray.

This sign is often seen in cases of volvulus.

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34
Q

What is considered the gold standard for diagnosing upper gastrointestinal obstruction?

A

Upper GI contrast study

This study can show a corkscrew appearance of twisted intestines.

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35
Q

What is the emergency procedure performed for volvulus?

A

Ladd’s procedure

This involves untwisting the volvulus, removing Ladd’s bands, widening the mesenteric base, and performing an appendectomy.

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36
Q

During fetal development, how do the intestines normally rotate?

A

270-degree counterclockwise rotation around the superior mesenteric artery (SMA).

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37
Q

What is malrotation in the context of intestinal development?

A

Incomplete rotation of the intestines, leading to abnormal positioning of the small and large intestines.

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38
Q

What condition involves part of the intestine telescoping into an adjacent segment?

A

Intussusception

This condition can lead to obstruction and potential ischemia.

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39
Q

What are common triggers for intussusception?

A
  • Rotavirus
  • Adenovirus
  • Meckel’s diverticulum
  • Henoch-Schönlein purpura
  • Cystic fibrosis
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40
Q

What is a classic symptom of intussusception in infants?

A

Intermittent, severe, crampy, progressive abdominal pain.

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41
Q

What is the characteristic stool appearance associated with intussusception?

A

Red currant jelly stools.

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42
Q

What imaging finding is typical for intussusception?

A

Target-like mass or doughnut appearance on ultrasound.

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43
Q

What is meconium ileus?

A

A functional obstruction due to lack of peristalsis, often associated with cystic fibrosis.

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44
Q

What is the main symptom of meconium ileus in newborns?

A

Failure to pass meconium within 24-48 hours.

45
Q

What does a contrast enema reveal in cases of meconium ileus?

A

Microcolon with meconium pellets.

46
Q

What condition is characterized by the absence of ganglion cells in the colon?

A

Hirschsprung’s disease.

47
Q

What is the gold standard for diagnosing Hirschsprung’s disease?

A

Rectal biopsy.

48
Q

What is Meckel’s diverticulum?

A

A true congenital diverticulum of the small intestine resulting from incomplete obliteration of the vitelline duct.

49
Q

What is the most common symptom of Meckel’s diverticulum?

A

Painless lower GI bleeding.

50
Q

What is the typical age of presentation for symptoms of Meckel’s diverticulum?

A

Before 2 years of age.

51
Q

What imaging technique is used to detect ectopic gastric mucosa in Meckel’s diverticulum?

A

Technetium-99m Pertechnetate Scan.

52
Q

What condition involves an allergy to milk proteins?

A

Cow’s milk protein allergy (CMPA).

53
Q

What are common symptoms of cow’s milk protein allergy?

A
  • Loose, watery stools
  • Abdominal pain and distension
  • Excessive flatulence
  • Vomiting or gastro-oesophageal reflux
54
Q

What is the main difference between lactose intolerance and cow’s milk protein allergy?

A

Lactose intolerance is due to reduced levels of the enzyme lactase, not an allergy.

55
Q

What is the typical age range for toddlers experiencing frequent loose stools due to immature gut motility?

A

6 months to 5 years.

56
Q

What are common symptoms of chronic constipation in children?

A
  • Poor appetite
  • Irritability
  • Abdominal pain or distension
  • Overflow diarrhoea
57
Q

What is the typical management for chronic constipation in children?

A
  • Dietary changes (increased fiber)
  • Osmotic laxatives (e.g., Movicol)
  • Stimulant laxatives (e.g., Senna)
58
Q

What are common bacterial causes of meningitis in neonates?

A
  • Group B streptococcus
  • Escherichia coli
  • Listeria
59
Q

What are the classic symptoms of meningitis in older children?

A
  • Fever
  • Headache
  • Photophobia
  • Neck stiffness
60
Q

What laboratory findings are indicative of bacterial meningitis?

A
  • Turbid or purulent CSF
  • High white cell count
  • Elevated protein
  • Low glucose
61
Q

What is the recommended initial treatment for suspected bacterial meningitis?

A

3rd generation cephalosporin antibiotics.

62
Q

What are the bacterial findings in meningitis?

A

Turbid or purulent, high opening pressure, high WCC (polymorphs), high protein, glucose < 50% of serum.

WCC refers to white cell count.

63
Q

What is the initial management for suspected sepsis in children?

A

ABCDE approach: Airway, Breathing, Circulation (20ml/kg fluid bolus, inotropes), DEFG (don’t forget glucose 2ml/kg 10% dextrose).

64
Q

Which antibiotics are recommended for meningitis?

A

3rd generation cephalosporin (e.g., cefotaxime/ceftriaxone), plus IV amoxicillin if < 1 month old to cover listeria.

65
Q

What complications are associated with pneumococcal meningitis?

A
  • Hydrocephalus
  • Neurodisability
  • Seizures
  • Hearing loss
  • Blindness
66
Q

Describe Streptococcus pneumoniae.

A

Gram positive lancet shaped diplococcus, facultative anaerobe, colonises nasopharynx in 11-93%.

67
Q

What is the transmission route for Neisseria meningitis?

A

Respiratory droplet transmission, often follows upper respiratory tract infection (URTI).

68
Q

What are the clinical features of sepsis?

A
  • Systemic inflammatory response
  • Suspected or proven infection
  • Severe = organ dysfunction
  • Shock = cardiovascular dysfunction
69
Q

Which organisms are common causes of sepsis in neonates < 1 month?

A
  • GBS
  • E. coli
  • Listeria
70
Q

What are the red flags for serious infection in children?

A
  • Pale/blue
  • No response to social cues
  • Weak, high pitched or continuous cry
  • Grunting
  • Tachypnoea (RR > 60)
  • Chest indrawing
  • Reduced skin turgor
  • Bulging fontanelle
  • Neck stiffness
  • Non-blanching rash
  • Focal seizures
71
Q

What are the risk factors for infection in children?

A
  • Prematurity < 37 weeks
  • Prolonged rupture of membranes (PROM)
  • Maternal GBS
  • Previous child with GBS
  • Maternal STI
  • SIRS > 2 criteria
72
Q

What is the significance of a weak femoral pulse in neonates?

A

It indicates possible coarctation of the aorta.

73
Q

What are the characteristics of innocent murmurs?

A
  • Soft
  • Short
  • Systolic
  • Symptomless
  • Situation dependent
  • Asymptomatic
  • Short duration
  • Rated 1-2 out of 6
  • No thrills
74
Q

What is the most common innocent murmur in children?

A

Still’s murmur.

75
Q

What are the symptoms of aortic stenosis?

A
  • Reduced exercise tolerance
  • Exertional chest pain
  • Syncope
76
Q

What is the treatment for patent ductus arteriosus (PDA)?

A
  • Echocardiogram
  • Fluid restriction
  • Diuretics
  • Prostaglandin inhibitors (IV ibuprofen, indomethacin)
  • Surgical ligation if symptomatic
77
Q

What are the four abnormalities in Tetralogy of Fallot?

A
  • Narrowing of RV outflow tract (pulmonary valve stenosis)
  • Large ventricular septal defect (VSD)
  • Overriding aorta
  • RV hypertrophy
78
Q

What is the management for transposition of the great arteries?

A
  • Prostaglandins E2 infusion to keep PDA open
  • Balloon septostomy
  • Switch procedure for correction
79
Q

What are the symptoms of testicular torsion?

A
  • Red scrotum
  • Asymmetry
  • Acute tenderness to touch
80
Q

What is the clinical significance of Klinefelter syndrome?

A

47XXY, associated with infertility and other developmental issues.

81
Q

What are the signs of rickets in children?

A
  • Bowlegs
  • Harrison’s sulci
  • Bone pain
  • Stunted growth
  • Fragility
82
Q

What is the definition of sepsis?

A

A systemic inflammatory response plus suspected or proven infection.

83
Q

What are the typical findings in a child with coarctation of the aorta?

A
  • Increased blood pressure proximal to narrowing
  • Weak/absent femoral pulse
  • Harsh systolic murmur
84
Q

What is the treatment for cryptorchidism?

A

Orchidopexy to prevent complications like infertility and malignancy.

85
Q

What are the typical features of Staphylococcus aureus infection?

A
  • Gram positive cocci
  • Produces exotoxins
  • Colonises skin and mucosa
  • Associated with MRSA
86
Q

What is the significance of non-blanching rash in children?

A

It may indicate serious bacterial infection.

87
Q

What is orchidopexy?

A

A surgical procedure to correct undescended testicles

Typically performed in children to prevent complications such as infertility or malignancy risk.

88
Q

What is the risk of malignancy associated with orchidopexy?

A

<1%

This indicates a very low risk of developing cancer post-surgery.

89
Q

What is a possible complication of a non-retractable foreskin?

A

Recurrent balanitis

This condition may occur due to difficulty in cleaning the area.

90
Q

What is Balanitis Xerotica obliterans?

A

A condition characterized by a non-retractile foreskin and scarring

It can lead to difficulties in urination.

91
Q

What are the signs of testicular torsion?

A
  • Red scrotum
  • Asymmetry
  • Acutely tender to touch

These symptoms require immediate medical attention.

92
Q

What is the ‘Twist score’ related to?

A

A scoring system to assess the likelihood of testicular torsion

It helps guide urgent surgical intervention.

93
Q

What is a common indicator of torsion appendix testis?

A

A red scrotum with no asymmetry and a blue/black spot

This condition typically presents with tenderness but is less urgent than testicular torsion.

94
Q

What is hypospadias?

A

A condition where the meatus of the urethra is located on the ventral aspect of the penis

Severity can vary; anterior is most common, posterior is most severe.

95
Q

What are the risk factors for migraines?

A
  • Family history
  • Bright light/noise
  • Fatigue/stress

These factors can trigger or aggravate migraine attacks.

96
Q

What are the symptoms of a migraine?

A
  • Abdominal pain
  • Nausea and vomiting
  • Hemicranial pain
  • Photophobia
  • Phonophobia

Symptoms can vary and may include focal neurological symptoms.

97
Q

What are the preventative treatments for migraines?

A
  • Pizotifen
  • Propranolol
  • Amitriptyline
  • Topiramate
  • Valproate

These medications require consistent use for effectiveness.

98
Q

What characterizes tension headaches?

A

Diffuse, symmetrical, bandlike distribution with no localizing features

They are often chronic but can have symptom-free periods.

99
Q

What is the most common cause of acute asymptomatic seizures in childhood?

A

Febrile convulsions

Typically occur in children aged 3 months to 5 years with fever.

100
Q

What defines epilepsy?

A

Recurrent, unprovoked epileptic seizures

Seizures result from abnormal excessive discharge from cortical neurons.

101
Q

What is the role of EEG in seizure diagnosis?

A

Useful for distinguishing the type of seizure

However, EEG results should not be interpreted in isolation.

102
Q

What are the signs of hydrocephalus?

A
  • Large head circumference
  • Bulging fontanelles
  • Symptoms of increased intracranial pressure

It indicates an abnormal accumulation of cerebrospinal fluid in the brain.

103
Q

What is Duchenne muscular dystrophy?

A

A genetic myopathy characterized by progressive proximal muscle weakness

It is linked to mutations in the dystrophin gene.

104
Q

What is the developmental milestone for a baby at 6 months?

A
  • Rolls over from back to front
  • Sits up steadily without support
  • Transfers toys from one hand to another

These are key gross motor skills expected at this age.

105
Q

What vaccinations are given at 2 months?

A
  • Diphtheria
  • Tetanus
  • Pertussis
  • Polio
  • Haemophilus influenzae Type B
  • Hepatitis B
  • Pneumococcal disease (13 serotypes)
  • Rotavirus
  • Meningococcal group B

These vaccinations are crucial for infant health.

106
Q

What is enuresis?

A

Bedwetting

It can be classified as primary (always wet) or secondary.

107
Q

What is nephroblastoma?

A

The most common cause of abdominal mass in children, associated with Wilms’ tumor

Symptoms include lethargy, weight loss, and abdominal pain.

108
Q

What are the signs of an inhaled foreign body?

A
  • Sudden shortness of breath
  • Focal chest findings
  • Non-productive cough

Immediate intervention may be required, especially for high-risk objects.