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Paeds 5 Flashcards

1
Q

What are some poor prognostic factors for ALL?

A 
<1 years, >10 years old 
WCC >50
T cell markers 
Non - Caucasian 
Male
BCR ABL
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2
Q

What classical features are found on examination of a child with coeliac disease? and list some other differentials for the disease:

A

Distended abdomen

Pale

Wasting of the gluteal muscles

Dermatitis herpetiformis
- this isn’t always found

Differentials:

  • IBD
  • IBS
  • Cystic fibrosis
  • Bacterial over growth
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3
Q

Outline some general causes of failure to thrive:

A

Increased metabolic demand:

  • congenital heart disease
  • recurrent infection
  • malignancy
  • hyperthyroidism

Inadequate absorption:

  • coeliac disease
  • cystic fibrosis
  • pancreatic insufficiency

Poor intake:

  • reflux
  • cleft palate
  • neurological defects

Environmental:

  • poor access
  • poor economics
  • maternal depression
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4
Q

List some causes of non-biological causes of failure to thrive:

A

Low socioeconomic status
- unable to afford good food

Inadequate intake
- insufficient food offered

Maternal depression
- poor feeding

Neglect

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5
Q

In a child with coeliac disease what food groups can they not eat from? and is coeliac disease for life?

A

Wheat

Rye

Barley

if diagnosis is before <2 years old a trial of gluten can be done in childhood with jejunum biopsies taken to check for changes.
some children may recover.

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6
Q

What are the major causes of conjugated bilirubin?

A

TORCH infections

Biliary atresia

Neonatal hepatitis

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7
Q

List the three main causes of non-pathological or life threatening causes unconjugated bilirubin in the neonate:

A

Breast milk

Hypothyroidism

Polycythemia

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8
Q

In a child with jaundice how often should bilirubin levels be taken?

A

2-4 hours with careful monitoring

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9
Q

What are the signs of kernicterus?

A

Opisthotonus - arching of the back

Sleepiness

Hypotonia

Poor feeding

Poor munro response

High pitched cry

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10
Q

What are some mild signs of dehydration in a child and what are some severe signs?

A

Mild:

  • sunken eyes
  • sunken fontaelle
  • reduced skin turgor

severe:
- dry nappies
- weak pulse
- reduced BP

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11
Q

Which babies are at risk of severe bronchiolitis?

A 
Preterms 
Low birth weight 
Chronic lung disease 
Congenital heart disease 
Immuno-deficiency

*Palivizumab can be given to these kids as prophylaxis

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12
Q

What are the types of Undescended testes and what is the investigations and management?

A

Two major types:

  • palpable and non palpable (Cryptorchidism)
  • Retractile and non-retractile

Investigations:
Palplable is clinical
Non-palpable: laparoscopy

Management:
Palpalble: Inguinal orchiopexy (done at 3 months)
- and beta - hCG
Non-palpable: laparoscopic surgery

**bilateral non-palpable testes requires genetic workout

Complications:

  • fertility
  • Seminomas’
  • Cosmetic
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13
Q

Which babies get an US of the hips to check for DDH and when is this done?

A

Anyone with 1st degree relative

Breech presentation

Multiple pregnancy

Barlow/ Ortolani findings

Outpatients in 2 weeks if clunk identified
Outpatients within 6 weeks if risk factor identified

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14
Q

What signs suggest over feeding rather than an underlying condition?

A

> 200ml/kg/ day

Over fed babies will have normal growth and look healthy. Will usually only have vomiting as a the symptom

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15
Q

What are the causes of GORD in a child?

A

Immature muscular

Neurological illness
- cerebral palsy

Liquid only
- Recumbent positioning

Positioning

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16
Q

What is a syndrome that can be seen in neonates with GORD which involves the neurological system?

A

Sandifer syndrome

  • Torticollis
  • Opisthotonus
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17
Q

What are some risk factors to colic? and what is the diagnostic criteria?

A

< 5 months

Exposure to cigarette smoke

Formula fed

Diagnosis:

  • > 3 hours per episode
  • > 3 days a week
  • > 3 weeks
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18
Q

What are the red flags for constipation?

A

> 48 hours of meconium

Distention of abdomen

Neurological disorders
- locomotor failure

Ribbon stools

Excessive vomiting

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19
Q

What are the two type of Cow’s milk protein intolerance seen in children and how do they present?

A

Two types:

  • IgE mediated (type I hypersensitivity)
  • Non- IgE mediated (type IV hypersensitivity)

IgE:

  • 2-4 hour onset
  • Urticarial rash
  • pruritus’
  • Angioedema **this can potentially be fatal and helps distinguish it from non-IgE
  • colic
  • D&V
  • Respiratory wheeze
  • rhinosinusitis symptoms

Non- IgE:

  • 48- 2 week onset
  • eczema rash
  • pruritus’
  • Colic
  • Bloody diarrhoea
  • Respiratory wheeze

Treatment:

  • hydrolysed formula
  • if being breast fed ask mother to not drink cow’s milk
20
Q

What is Baclofen and when is it used?

A

Baclofen is a muscle relaxant.

used in cerebral palsy to help relax tight muscles.

21
Q

Regarding injection sites for DM, should they be rotated around on and why?

A

Yes

- avoids complications such as lipohypertrophy and lipodystrophy

22
Q

What is the effective of growth hormone on blood glucose levels?

A

Increases blood glucose level
- supresses insulin

*this is why you can do a glucose suppression test in acromegaly

23
Q

Give account for relative hyperglycaemia seen in the morning of teenagers:

A

Increased sex and GH hormones increases cortisol and release of sugars.
- dawn phenonium

24
Q

Any girl who is primary amenorrhoeic, should they have karyotyping carried out?

A

Yes they should

- to rule out turners syndrome

25
Q

What is tested for to confirm a diagnosis of congenital adrenal hyperplasia?

A

17 hydroxyprogesterone
- it accumulates due to lack of 21 hydroxylase

other tests:

  • ACTH
  • renin
  • cortisol

*serum steroid is diagnostic as well

26
Q

What is the typical management of ITP and should you give steroids?

A

Observation and advice.

  • usually self resolves following 6-8 weeks
  • if child injuries head they should come to A&E due to risk of bleed

Steroids are not recommended until the diagnosis is absolutely certain due to risk of it being leukaemia

27
Q

What viruses are associated with type I diabetes, and what other conditions should you screen for at diagnosis?

A

Enteroviruses
Mumps
CMV

Other diseases to screen for at diagnosis:

  • coeliac disease
  • Thyroid disease
28
Q

What advice would you give to a child who is newly diabetic?

A

Technique of injections

Sick day rules

  • increase monitoring
  • up insulin if needed

Hypo recognition and management

Importance of moving injection sites

29
Q

When should insulin be started in a child with DKA? and what monitoring are you going to do of a child with DKA?

A

Start insulin 1 hour after initiating fluid therapy

Monitoring during treatment:

  • Blood glucose level
  • BP
  • HR
  • GCS
  • ECG (for hypokalamia)
30
Q

Can prematurity be associated with delay in milestones?

A

Yes

31
Q

What is the only absolute indication for circumcision?
and
What is an absolute contraindication for circumcision?

A

Balanitis Xerotica Obliterans

Hypospadius
- often foreskin is used to repair the defect

32
Q

If a child is dehydrated how much fluid should they receive?

A

You should aim to correct the dehydration in 48 hours.

This is achieved by:
- If 5% dehydrated: Add 50mls/kg on top of maintenance fluid over 48 hours

  • if 10% dehydrated: Add 100mls/kg on top of maintenance fluid over 48 hours
33
Q

Whats the pathology, risk factors and management of retinopathy of prematurity?

A

Excessive oxygen shuts off vascular endothelial growth factor in the retina creating relative hypoxia
- this leads to excessive blood vessel formation damaging retina.

Risk factors:

  • preterm <32 weeks
  • oxygenation
  • low birth weight

Management:

  • 90-95% oxygen
  • Laser therapy
34
Q

Outline some of the differences in ABCDE management of a child:

A

Airway:

  • <6 months obligated nasal breathers
  • Larger heads - more prone to flopping forward
  • larger tongue
  • horseshoe epiglottis

*head bobbing in children is accessory muscle use

Breathing:

Circulation

  • higher HR due to reduced stroke volume
  • Higher circulating volume per Kg but overall lower so minimal blood loss may be a lot to a child
  • urine output <1ml/kg
  • *IO access is often needed over IV

Disability:

  • AVPU
  • Posture (hypotonic?)
  • Fontanelle
  • Glucose

*glucose bolus 2ml/kg of dextrose followed by infusion

Exposure:

  • bruising
  • skin rashes
35
Q

Prior to given fluids what things should you check in a paediatric patient?

A

Clinical condition

Weight

Input/ output

BP

Bloods which have recently being done

36
Q

In which settings are the fluid boluses and maintenance fluids different and what are they?

A

DKA, Major Haemorrhage , trauma

10ml/kg bolus

0-10kg = 2ml/kg/ hour 
10-40kg = 1ml/kg/ hour 
>40kg = fixed volume of 40ml/kg/ hour
37
Q

Which of the manoeuvres for DDH do what?

A

Barlow’s
- dislocates

Ortalini
- reconnects

38
Q

List some causes of a neonate presenting with shock:

A

Sepsis - No.1

Congenital cardiac disease

Metabolic
- hypoglycaemia

Surgical

  • malrotation
  • NEC
39
Q

Outline your management of a child with croup:

A

Mild (no symptoms at rest)

  • Dexamethasone 0.15mg/ kg
  • discharge home

Moderate (symptoms at rest)

  • Dexamethasone 0.15mg/ kg
  • admit for observations

Severe: (high RR, severe stridor, distressed)

  • Oxygen
  • Nebulised adrenaline 5ml 1:1000
  • Dexamethasone IV
  • PICU support
40
Q

What are the types of spina-bifida and what are some complications and what are some treatment of the more severe forms?

A

Spina -bifida occult
Meningocele
Myelomeningocele

Complications:

  • Hydronephrosis (atonic bladder)
  • hydrocephaly (Arnold Chari formation)
  • Constipation/ incontinence
  • Spinal tethering
  • Shunt blocking *presents with change in behaviour
  • ADHD
  • seizures

Investigations:

  • Anomaly scan 20 weeks
  • Alpha-fetal protein levels (high)
  • MRI of head and spine (Arnold Charlie malformation)
  • US of abdomen (usually for meningocele initially)

Management:

  • Surgical closure
  • Physiotherapy
  • Intermittent catherization and
  • Orthopaedics
  • Seizure medication
41
Q

What is called when there is neural tube defect causing protrusion of the brain and meninges in the skull?

A

Encephalocele

42
Q

What are some of the clinical signs and complications of Duchene muscular dystrophy? investigations and management:

A

X-linked

Signs:

  • Trendelenburg gait
  • Pseudohypertrophy of the calve muscles
  • Gower’s sign
  • Kyphoscoliosis

Comorbidities:

  • Cardiomyopathy
  • Respiratory distress
  • GORD
  • intellectual impairment

Investigation:

  • Creatine kinase level
  • Dystrophin (can be done by biopsy)

Management:

  • Nutrition
  • ACE + Beta blockers
  • Respiratory support (BiPAP, tracheostomy)
  • Surgery (lengthen tendons)
  • Corticosteroids
43
Q

What are the differences in DMD and BMD?

A

DMD:

  • out of frame deletion
  • More common
  • more severe
  • Early onset ~ 3 years
  • Life expectancy ~20 years old

BMD:

  • in frame deletion
  • less common
  • less severe
  • Around 10 years old
  • 40 years old life expectancy
44
Q

In suspected congenital heart disease what immediate tests do you want?

A

Echocardiogram
ECG
CXR

45
Q

What are some differentials on auscultation of a wheezy chest?

A

Asthma
Viral induced wheezed
Bronchiolitis
Bronchiectasis (CF)

46
Q

List some causes of collapse with poor respiratory effort in a 6 week old baby:

A

Sepsis

Congential cardiac disease

NAI

Post seizures

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