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3A GH > Paeds > Flashcards

Paeds Flashcards

1
Q

Hirschsprung’s disease define

A

Congenital absence of ganglia in a segment of colon

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2
Q

what’s in a septic screen?

A

bloods - WCC, CRP
blood cultures
LP
urine

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3
Q

why do you do an LP in a septic screen?

A

to exclude meningitis

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4
Q

how do you obtain a urine sample in a child?

A

clean catch
OR subrapubic aspirate
OR catheter

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5
Q

CSF shows ^WCC, ^protein, low glucose. Does this picture suggest a bacterial or viral infection?

A

bacterial

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6
Q

CSF shows WCC 50, normal protein and glucose. Does this picture suggest a bacterial or viral infection?

A

viral

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7
Q

gram negative diplococcus on LP culture

A

neisseria meningitidis

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8
Q

what causes the purpuric rash of meningococcal septicaemia

A

DIC

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9
Q

what does GP give in community for suspected meningitis?

A

IM benzylpenicillin

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10
Q

what supportive care may a child need in ITU following ^^fluids

A

O2

dialysis

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11
Q

prophylaxis for meningitis contacts

A

rifampicin or ciprofloxacin

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12
Q

contraindications/side effects of rifampicin

A

interacts with contraceptive pill
stains contact lenses
stains urine red

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13
Q

how is neisseria meningitidis passed on to contact

A

aerosolized

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14
Q

2 yr old
malaise, pallor, reduced appetite, febrile, rash
L thigh soreness, reluctant to weight bear
Differentials

A

systemic JIA [juvenile idiopathic arthritis]
septic arthritis
ALL

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15
Q

what aspect of examination is important in a child with JIA? and why

A

opthalmology

JIA associated uveitis

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16
Q

Tx for JIA

A 
NSAIDs
corticosteroid intra-articular injection
systemic steroids
methotrexate
TNF alpha inhib e.g. inflix
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17
Q

fever, red eyes/injected conjunctiva, sore mouth & throat, red cracked lips, strawberry tongue, maculopapular rash, cervical swelling, swollen red palms
Dx? differential?

A

Kawasaki disease

scarlet fever

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18
Q

management of kawasaki disease

A

IVIG

aspirin

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19
Q

complications of IVIG

A

anaphylaxis

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20
Q

complications of aspirin

A

bruising, nosebleed

reyes syndrome

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21
Q

reye’s syndrome

A

encephalopathy and liver failure following viral illness

^by aspirin

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22
Q

4 Sx of bowel obstruction

A

Vom
Pain
X opening bowels
Distension

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23
Q

Bilious vomiting - worry about?

A

MALROTATION

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24
Q

nephrotic syndrome - what do you see 1. Symptom, 2. in blood, 3. in urine

A
  1. oedema
  2. hypoalbuminaemia, hyperlipidaemia
  3. proteinuria
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25
Q

Mx steroid sensitive nephrotic syndrome

A 
prednisolone
pneumococcal vaccine
varicella titres
pen V
diuretics
Na/H2O moderation
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26
Q

renin, angiotensin, ACE, aldosterone do what

A

salt and water retention, ^BP

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27
Q

signs and Sx of glomerulonephritis (urine, blood, systemic)

A

proteinuria, haematuria, ^blood creat, HTN, oedema

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28
Q

oedematous child 10 days post nasopharyngeal infection. Dx? organism?

A

Acute post-streptococcal glomerulonephritis

group A beta haemolytic strep

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29
Q

Acute post-streptococcal glomerulonephritis Ix

A

urinalysis (haem,protein)
microscopy (RBC casts)
FBC (anaemia)
U+E (^creat, urea)

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30
Q

Treatment of paeds post-strep glomerulonephritis, and what about if there was encephalopathy/

A

Na+ restrict
diuretics
antihypertensives
penicillin

nitroprusside [enceph]

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31
Q

what is henoch schonlein purpura and what areas does it affect?

A

vasculitis. skin, joints, kidneys, gut

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32
Q

what causes HSP nephritis?

A

IgA deposition

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33
Q

Sx of lower tract UTI in paeds

A

dysuria, ^freq, haematuria, low abdo pain, incont

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34
Q

Sx upper tract UTI in paeds

A

loin/abdo pain, fever, malaise, vom

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35
Q

what do you expect on UTI dipstick

A

nitrites, WBC

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36
Q

UTI Mx in paeds

A

Abx, fluids, pain relief, image for underlying abnorm

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37
Q

what is Vesicoureteric reflux

A

retrograde reflux of urine from bladder into ureter/kidney

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38
Q

what is a dangerous side effect of giving a child too much IV fluids

A

cerebral oedema

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39
Q

what GCS is indication to intubate?

A

8

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40
Q

fluids for 5% dehydrated child

A

4ml/kg/hr for 1st 10kg
2ml/kg/hr for next 10kg
if dehydrated, add 50ml/kg/day

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41
Q

DKA initial management

A

IV fluids

insulin 1-2 hrs after fluid administration

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42
Q

neonate 10 days of age. Raised TSH. Diagnosis?

A

congenital hypothyroidism

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43
Q

most common cause of congen hypothyroidism in uk, consanguinous, and worldwide

A

uk - dysgenesis
consang - dyshormonogenesis
world - iodine def

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44
Q

what investigation could you perform to differentiate dysgenesis and dyshormonogenesis in congen hypothyroid

A

radioisotope US

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45
Q

consequence of congen hypothyroid that screening has helped prevent

A

cretinism [mental and physical retardation]

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46
Q

Tx for congen hypothyroidism

A

levothyroxine

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47
Q

congenital adrenal hyperplasia sign on physical exam

A

ambig gen

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48
Q

why is CO2 low in met acidosis?

A

hyperventilation to correct ^acid by breathing out CO2

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49
Q

blood gas - pH 7, CO2^

A

resp acidosis

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50
Q

what blood gas derangement do you see in congen adrenal hyperplasia and why?

A

met acidosis

low aldosterone -> fluid loss, low Na, ^K

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51
Q

describe congen adrenal hyperplasia

A

disorder of the adrenal gland. deficiencies in enzymes required for the production of the steroid hormones [cortisol/aldosterone]

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52
Q

antenatal Tx for adrenal hyperplasia

A

dexamethasone

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53
Q

postnatal Tx of confirmed CAH

A

hydrocortisone, fludrocortisone, sodium chrloride

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54
Q

define wheeze

A

expiratory

whistling/polyphonic

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55
Q

causes of paediatric wheeze

A

Persistent infantile wheeze
Viral episodic wheeze
Asthma
CF, chronic lung, aspiration, tracheobronchomalacia

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56
Q

Tx acute asthma

A 
O2
salbutamol [neb]
ipatropium bromide[atrovent]
pred 1mg/kg
IV salb
aminophylline/MgSO4
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57
Q

causes of poor Tx response in paeds asthma

A 
Compliance
Bad disease
Choice of drugs/devices
Diagnosis
Environment
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58
Q

risks of long term inhaled corticosteroid use

A

Adrenal suppression
Growth slowing
Osteoporosis?

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59
Q

important environmental factors not to be missed in wheezy children

A

smoking, pets

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60
Q

how does viral wheeze differ from asthma

A

NO interval Sx
NO excess atopy
improve w/age
regular inhaled steroids don’t help

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61
Q

child with diff. breathing, neck extended, drooling. Dx?

A

epiglottitis

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62
Q

how is pneumonia diagnosed in a child over 3 years

A

history of cough +/- diff breathing <14 days

^RR

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63
Q

usual cause croup

A

para-influenza virus

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64
Q

barking seal-like cough. Diagnosis?

A

croup

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65
Q

Tx of croup

A

oral dexamethasone/pred > inhaled budesonide

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66
Q

common bacterial cause of pneumonia in children

A

Strep pneumoniae
S. aureus
Klebsiella pneumoniae

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67
Q

why is epiglottitis now rare

A

HiB vaccine

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68
Q

most common viral cause of pneumonia in children. 1 other

A

RSV

influenza

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69
Q

define hypochondroplasia

A

hereditary. Retarded growth of long bones

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70
Q

first sign of normal puberty in boys and girls

A

breast buds

testicular enlargement

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71
Q

what age is defined as early and delayed puberty in boys and girls

A

girls <8, >13

boys <9, >14

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72
Q

factors that affect birth weight

A 
Maternal size + weight
Parity
Gestational diabetes
Smoking
Paternal size
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73
Q

paeds: causes of short stature

A 
psychosocial
endocrine disease e.g. cushings
short parents
delayed puberty
low birth weight
chronic disease
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74
Q

what is stridor?

A

high pitched inspiratory sound

due to obstruction of larynx/large airways

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75
Q

how does wheeze differ from stridor?

A

wheeze is polyphonic/musical
wheeze expiratory
smaller airways
takes long time to breathe OUT

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76
Q

differential diagnosis from stridor

A 
viral croup
bacterial tracheitis
epiglottitis
foreign body
laryngomalacia
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77
Q

what should you NOT do in a child with stridor

A

upset/ attempt to examine throat -> complete obstruction

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78
Q

age range for croup

A

6months to 6 years

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79
Q

what is the pathophysiology of croup?

A

subglottic oedema, inflammation, exudate

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80
Q

causes of breathing difficulties in 6 month old

A

bronchiolitis
pneumonia
cardiac failure

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81
Q

main cause of bronchiolitis and other cause

A

Respiratory synctial virus

mycoplasma, paraflu, adenovirus

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82
Q

who is at ^risk of bronchiolitis

A

less than 6 months
chronic lung disease
congen heart dis
immunodef

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83
Q

investigations for bronchiolitis

A

nose swab RSV

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84
Q

Mx of bronchiolitis

A

O2
NGT
CPAP
intubate/ventilate

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85
Q

prevention of bronchiolitis

A

palivizumab monthly IM

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86
Q

how would you manage bronchiolitis-type illness differently if the child had CF?

A

give Abx [even if it might be viral]

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87
Q

what conditions are included in the newborn heel prick?

A 
CF
sickle cell
congen hypothyroidism
MSUD
PKU
MCADD
IVA
GA1
HCU
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88
Q

what is the mode of inheritance for CF

A

autosomal recessive

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89
Q

pathophys behind CF

A

mutation in CF gene on chromosome 7 that codes for CFTR protein Na/Cl channel = thick mucus

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90
Q

describe some body systems affected by CF and how

A

GI - meconium ileus, steatorrhoea
resp - like bronchiectasis, recurrent pneum
pancreas - exocrine insufficiency
poor growth/failure to thrive

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91
Q

mx of VSD

A

furosemide, 2nd line ACEi/ digoxin

surgical closure if large

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92
Q

where does PDA go to and from

A

aorta to pulm artery

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93
Q

describe the initial immediate paediatric life suport steps for an unresponsive child

A 
shout for help
open airway
5 rescue breaths
15 chest compressions
CPR 15:2
call resus team
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94
Q

in a choking child, who is now unconscious, what is your initial step

A

open the airway
check for foreign body
5 rescue breaths
CPR 15:2

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95
Q

in a choking child who is conscious, what is your initial management?

A

5 back blows
5 chest/abdo thrusts
check for foreign body

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96
Q

name some organic and non-organic causes of faltering growth

A

non-org - neglect, poor feeding technique, short stature

organic - CF, heart defect, Downs, UTI, CP, diarrhoea

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97
Q

Ix faltering growth

A 
FBC [anaemia]
urine dip [then culture to confirm UTI]
UandE
LFT
coeliac screen
TFT
glucose
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98
Q

normal amount of milk for child

A

150ml /kg /day

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99
Q

what parameters will be raised on a urine dip in UTI

A

nitrites, leucocytes

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100
Q

2 usual organisms for paeds UTI

A

E. coli

Klebsiella

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101
Q

treatment of paediatric UTI >3 months old

A

trimepthoprim

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102
Q

paeds UTI, done urine dip and culture. Potential further Ix and why?

A

US kidney for reflux/ hydronephrosis
DMSA scan for scarring
MCUG for reflux

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103
Q

5 yr old starts soiling herself at school, unaware she’s doing it, L iliac fossa mass. Diagnosis?

A

overflow secondary to constipation

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104
Q

name 5 causes of diarrhoea in children

A 
breast feeding
gastroenteritis
thyrotoxicosis
IBS
intesusception
crohns
coeliac
CF
food intolerance
overflow sec to constip
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105
Q

Mx of diarrhoea due to overflow secondary to constipation

A

movicol
diet
toilet behaviour

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106
Q

4 yr old, swelling of face ankles and scrotum. Proteinuria, no blood. Diagnosis?

A

nephrotic syndrome

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107
Q

causes of proteinuria in chldren

A

orthostatic proteinuria
nephrotic syndrome
glomerulonephritis

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108
Q

how do you distinguish nephrotic syndrome and glomerulonephritis on urinalysis

A

neph - protein

glom - protein and blood

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109
Q

diagnostic criteria for nephrotic syndrome

A

hypoalbuminaemia
proteinuria
peripheral oedema

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110
Q

Ix for neph syndrome

A

urine dip
U and E
BP
complement/ immunoglob levels

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111
Q

Mx of nephrotic syndrome

A 
pred
fluid and salt restrict
if v oedematous then diuretics
penicillin due to low imm
pneumococcal vaccine
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112
Q

signs of resp distress

A

Tachypnoea, subcostal recession, intercostal recession, nasal flaring, head bobbing, tracheal tug, cyanosis

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113
Q

4 domains of the developmental examination

A

Gross motor
Fine motor and vision
Speech and hearing
Social & emotional

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114
Q

where is erythropoetin released and in what instance

A

kidney due to low blood O2

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115
Q

what happens in erythroblastosis fetalis [ haemolytic disease of the newborn.]

A

Rh-ve mother previously sensitised to Rh+ve cells, Transplacental passage of antibodies, Haemolysis of fetal cells

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116
Q

erythroblastosis fetalis [ haemolytic disease of the newborn.] signs and symptoms

A

anaemia
splenomegaly, hepatomegaly
jaundice

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117
Q

erythroblastosis fetalis [ haemolytic disease of the newborn.] Tx

A

immunoglobulin

intrauterine transfusion

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118
Q

most common anaemia in children

A

iron def

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119
Q

causes of paeds iron def anaemia

A

LBW, excessive cows milk intake, GI bleed (e.g. hookworm)

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120
Q

iron deficiency anaemia in paeds
Sx
O/E
CXR

A

Sx: pallor, anorexia, fatigue
O/E: tachycardia, murmur, splenomegaly
CXR: cardiac dilatation

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121
Q

why do children with sickle cell disease need imms [ Pneumococcal, influenza, meningococcal}

A

asplenia

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122
Q

other than vaccination how might you treat children with sickle cell to prevent sepsis

A

prophylactic penicillin

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123
Q

complications of sickle cell disease

A 
anaemia
cardiomegaly
pain crises
stroke
acute chest syndrome
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124
Q

Tx for sickle cell

A

blood transfusion
stem cell transplant
hydroxycarbamide

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125
Q

what is G6PD deficiency? + how does it present

A

haemolysis

neonatal jaundice, anaemia

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126
Q

what induces G6PD

A

drugs, fava beans, fever, acidosis

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127
Q

Mx for von willebrands

A

desmopressin
vWF containing Factor 8 concentrate
avoid NSAIDs

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128
Q

most common childhood leukaemia

A

ALL

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129
Q

maintenance fluids. How much ml/kg/hr?

A

1st 10kg = 4ml
2nd 10kg = 2ml
rest, 10kg = 1ml

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130
Q

when calculating the fluid requirements of a child, if here are signs of shock what should you do first in terms of fluids? (+ vol and exceptions)

A

fluid bolus
20ml/kg
or 10ml/kg in DKA, neonates or trauma

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131
Q

in paediatrics, generally replace deficit over 24 hrs. When would you replace over 48hrs?

A

DKA

Hypernatraemic dehydration

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132
Q

give some examples of organisms that commonly cause tonsilitis

A

strep pyogenes [group A strep]
adenovirus
EBV

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133
Q

what organism causes epiglottitis

A

haemophilus influenza B

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134
Q

what organism causes whooping cough

A

pertussis

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135
Q

common organisms croup

A

parainfluenza

RSV

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136
Q

common organism causes of pneumonia in children

A

strep pyogenes [group A strep]
strep pneumoniae
staph
haemophilus influenzae

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137
Q

secondary infection with which bacteria can signif worsen varicella zoster

A

strep/staph

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138
Q

antibiotics for meningitis in <3 months

A

cefotaxime and amoxi [for listeria]

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139
Q

antibiotics for meningitis in >3 months

A

cefotaxime or ceftriaxone

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140
Q

drowsy child with full fontanelle and neck stiffness

A

meningitis

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141
Q

a child with tachypnoea and non-blanching red/purple rash

A

meningococcal septicaemia

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142
Q

treatment of priamry immune deficiency in children

A

Antibiotic /antiviral prophylaxis
Prompt treatment of infections
Replacement immunoglobulin
Bone marrow transplant

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143
Q

how do vaccines work?

A

induce antibody production specific to organism

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144
Q

Sx TB

A

fever, night sweats, wt loss, cough

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145
Q

what type of fluids for maintainence paeds

A

0.9% NaCl and 5% glucose

and KCl 10mmol

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146
Q

how much extra fluid do you prescribe when a child is 5% dehydrated and 10% dehydrated/shocked

A

5% - 50ml/kg/day

10% - 100ml/kg/day

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147
Q

what would a blood gas of a child with bronchiolitis show? [met/resp alk/acid]

A

resp acidosis

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148
Q

what would a blood gas of a child in septic shock show? [met/resp alk/acid]

A

metabolic acidosis

[^lactate due to poor perfusion]

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149
Q

what would a blood gas of a child in respiratory distress show? [met/resp alk/acid]

A

resp alkalosis

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150
Q

what would a blood gas of a child with projectile vomiting show? [met/resp alk/acid]

A

metabolic alkalosis

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151
Q

4 week old with projectile vomiting. Diagnosis?

A

pyloric stenosis

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152
Q

what age does a child have to be before you would diagnose asthma?

A

> 5

153
Q

what is the age limit for the diagnosis of bronchiolitis?

A

<1

154
Q

in acute asthma management, when would you give salbutamol nebulised/ in spacer?

A

if on O2 -nebulised

155
Q

ACUTE - if asthma not controlled on salb/steroids, what other options can you try?

A

aminophylline, IV salbutamol, magnesium

156
Q

what do you hear on auscultation of bronchiolitis chest

A

wheeze and crackles

157
Q

bronchiolitis symptoms

A

SOB
decreased feeding
coryza

158
Q

investigation for cohorting bronchiolitis patients

A

nasal pharyngeal aspirate

159
Q

most common cause of nephrotic syndrome

A

minimal change disease

160
Q

what Ix in nephrotic syndrome [paeds], because you’re gonna immunosuppress them with steroids

A

varicella titres

161
Q

criteria for kawasakis

A 
fever 5/7 and 4 out of:
mucosal
hand and feet desquam
eyes conjunc
adenopathy cervical
rash truncal
162
Q

differential for kawasaki

A

group A strep, measles

163
Q

There is no diagnostic Ix for kawasaki. But what investigation might you wish to perform with regards to a serious consequence of kawasakis?

A

echocardiogram [CAA]

164
Q

management of kawasakis

A

aspirin

IVIG

165
Q

neonatal jaundice <1 day old, differentials?

A

haeomolysis e.g. rhesus

sepsis

166
Q

main treatment of neonatal jaundice, and 1 other treatment for severe

A

phototherapy

exchange transfusion

167
Q

Ix for neonatal jaundice

A

FBC check haemoglob
direct coombs test
split bilirubin

168
Q

what type of bili is high in neonates with biliary atresia jaundice?

A

conjugated

169
Q

prolonged neonatal jaundice [not fading with 14 days / 21 days for prem] Causes?

A 
biliary atresia
breastfeeding
sepsis
CF
hypothyroidism
170
Q

severe adverse consequence of neonatal jaundice

A

kernicterus

171
Q

what is the age range for febrile fits

A

6 months to 6 yrs

172
Q

what increases risk of neonate having cranial bleed

A

prem

intubated and ventilated

173
Q

how do you investigate and diagnose neonatal intraventricular bleed

A

cranial US

174
Q

eye complication of prematurity

A

retinopathy of prem

175
Q

most common heart murmur in prem babies

A

PDA

176
Q

drug to help close PDA

A

ibuprofen/ indomethacin

177
Q

what causes resp distress sydrome in neonates

A

surfactant deficiency

178
Q

why starve prem enonates for 48 hrs?

A

reduce risk of nec ent

179
Q

neonate, distended abdomen and acidotic blood gas. X-ray shows distended loops of bowel and air in bowel wall. Diagnosis?

A

Nec ent

180
Q

management for nec ent

A

cefotaxime and vancomycin

surgery

181
Q

what is gowers sign on examination and what condition commonly seen in

A

shows proximal weakness, patient uses arms/hands to ‘walk up’ body
duchennes muscular dystrophy

182
Q

paeds - what conditions might give trendelenburg gait?

A

perthes disease
develpomental dysplasia of hip
slipped capital femoral epiphysis
CP [hemiplegic]

183
Q

what is perthes disease

A

reduced blood supply to head of femur -> necrosis

184
Q

paeds - causes of equinus gait

A 
idiopathic
CP
limb-length discrepancy
clubfoot
muscular dystrophy
185
Q

trendelenburgs tests the competence of which muscles?

A

hip abductors

186
Q

most common anatomical origin of limp in paeds?

A

hip

187
Q

differentials for limp in <4 yr old

A 
fracture
septic arthritis
osteomyelitis
JIA
foreign body in foot
188
Q

differentials for limp in 4-10 yr olds

A 
fracture
septic arthritis
osteomyelitis
JIA
foreign body in foot
Perthes
transient synovitis
189
Q

differentials for limp in >10 yr olds

A

fracture
septic arthritis
osteomyelitis
SCFE

190
Q

most common cause of limp in under 10s

A

transient synovitis

191
Q

Sx transient synovitis and which gender affected more

A 
limp
pain in thigh/knee
fever
reduced ROM
BOYS
192
Q

9-16 yr old, Hx of trauma, acute limp, knee pain, hip abducted and ext rotated

A

slipped capital femoral epiphysis

193
Q

Mx septic arthritis

A

aspirate/drain

Abx [fluclox]

194
Q

organisms in septic arthritis

A

STAPH
group B strep in infants
strep pnemoniae in <4
Neisseria gonorrhoeae in adolescents

195
Q

chronic limping child, age 4-8, unilateral pain and family history. Likely diagnosis?

A

perthes

196
Q

11 yr old boy, 5/12 L knee pain, antalgic gait, reduced int rotation

A

SCFE

197
Q

16 month old, waddles, no pain, reduced abduction

A

developmental dysplasia of hip?

198
Q 
6 yr old girl
right thigh pain
antalgic gait
recent cough
good ROM
temp 37.6
Diagnosis?
A

transient synovitis?

199
Q

4 yr old girl, swollen joints knee/ankle, stiffness reduced ROM, little pain. Diagnosis?

A

JIA

200
Q

5 yr old boy, toe walking, no pain, ^lumbar lordosis. Diagnosis?

A

muscular dystrophy

201
Q

paeds most common type of leukaemia

A

ALL

202
Q

paeds - brain tumours presenation

A

early morning headache
vomiting
ataxia
personality change

203
Q

paeds - hodgkins lymphoma presentation

A

lump in neck, otherwise well

204
Q

most common malignancy in children

A

leukaemia

205
Q

children at ^ risk of developing malignancy

A

downs [ALL, AML]
neurofibromatosis 1 [astrocytoma, sarcoma]
immunosuppressed [lymphoma]

206
Q

paeds leukaemia presentation

A

fever, freq infections, pale, tired, bone/ joint pain, anaemia, lymphadenopathy, bruising

207
Q

abnormal red reflex in the eye [paeds] diagnosis?

A

retinoblastoma

208
Q

Ix for ALL

A 
FBC
blood film
CXR [mediastinal mass]
bone marrow aspirate
LP
209
Q

paeds ALL Mx

A

chemo

stem cell transplant

210
Q

when to scan in paediatric headache

A 
papilloedema
decreased acuity/vision loss
other neuro signs
early morning
ass. w/vom
decelerated growth
under 3
neurofibromatosis 1
211
Q

child with abdominal mass, proptosis

A

orbital involvement from metastatic neuroblastoma

212
Q

late effects of paeds malignncy Tx

A 
growth/ development
intellectual
cardiac toxicity
renal toxicity
fertility
psychological
213
Q

paediatric condition of congenital fragile bones

A

osteogenesis imperfecta

214
Q

plastic bones in paeds mean they get what types of fracture

A

greenstick [partial]

215
Q

paeds - strawberry neavus self limiting, but worrying in which areas?

A

eye

airway

216
Q

what is turners syndrome and what consequences?

A

part or whole of 1 X chromosome missing

infertility, short stature, lymphoedema at birth, coarcttio of aorta

217
Q

more than 5 cafe au lait spots =

A

neurofibromatosis

218
Q

cough, coryza, conjunctivitis, Koplik spots. Followed by red rash

A

measles

219
Q

‘slapped cheek’ rash

A

parvovirus

220
Q

hand foot and mouth is causes by what virus

A

coxsackie

221
Q

impetigo is caused by?

A

staph aureus or strep pyogenes

222
Q

scalded skin syndrome is caused by

A

staph aureus toxin

223
Q

sx of HSP

A

rash
joint pain
abdo pain

224
Q

erisypelas is caused by

A

Group A beta haemolytic streptococci (Streptococcus pyogenes).

225
Q

what bacteria causes scarlet fever and can lead to glomerulonephritis

A

streptococcus

226
Q

when is fetal surfactant produced during gestation

A

32 weeks

227
Q

27 weeker born, difficulty breathing, on O2. Causes/differentials?

A

surfactant
sepsis
congen heart disease

228
Q

what type of bacteria does ben pen cover

A

gram +ve cocci

229
Q

what type of bacteria does gent cover

A

gram -ve bacilli

230
Q

what Abx would you prescribe in a prem neonate in resp distress following prolonged ROM

A

ben pen and gent

231
Q

how do you begin feeds in a prem?

A

IV dextrose bolus 2-4ml

gut priming with breast milk

232
Q

prem in resp distress, capillary blood glucose drops to 2.2mmol/L. Reasons?

A

haven’t fed it
hypothermia -» use energy [glucose]
sepsis

233
Q

how do you monitor whether you are giving a prem neonate adequate feeds?

A

monitor albumin and glucose, input/ output, growth chart

234
Q

prem baby in resp distress deteriorates suddenly, goes pale, low BP. Wjhat might have happened?

A

intraventricular haemorrhage

235
Q

Prem baby with IVH. Name specific problems that may arise from damage sustained to eyes, hearing, lungs and brain.

A

retinopathy of prem
sensorineural and conductive loss
chronic lung
CP

236
Q

how do you assess level of jaundice clinically?

A

direct coombs test
transcutaneous bili
serum split bili

237
Q

what Ix would you perform in a jaundiced neonate within 24 hrs of birth?

A

FBC, blood film, blood groups, coombs test

238
Q

causes of hyperbilirubinaemia after 24 hrs of life in neonate

A

^bili production due to shorter RBC lifespan
dec conjugation due to hepatic immaturity
dec gut flora -> dec elimination of bile pigment
breastfeeding

239
Q

consequence of neonatal jaundice due to biliary atresia

A

liver failure&raquo_space; death

240
Q

clinical signs of KERNICTERUS

A

lethargy, poor feeding, hypertonicity, Opisthotonus [arching], shrill cry

241
Q

2 yr old brought to A and E with inconsolable crying, R leg not moving. FH of fractures and ‘getting shorter’. Diagnosis?

A

osteogenesis imperfecta

242
Q

what eye feature is seen in osteogenesis imperfecta

A

blue sclera

243
Q

Ix for osteogenesis imperfecta

A

bone profile bloods
xray
DEXA

244
Q

OSTEOGEN IMPERFECTA MODE OF INHERITANCE

A

type 1 - AUTO DOM
type 2 - recess
type 3 - recessive

245
Q

meningitis organisms in < 3months

A

e coli [major cause in neonates]
group B strep [via vaginal delivery]
listeria [presents soon after birth, imm comp]

neiss men [any age]
strep pneum [any]
haemophilus infl [<4]

246
Q

meningitis organisms age 1-6 yrs

A

Neisseria meningitides
strep pneumonia
haemophilus influenza

247
Q

meningitis organisms in > 6 yr old

A

neiss men

strep pneum

248
Q

what is the moro reflex

A

drop baby a few inches from one hand to other. Arms abduct, hands open, then arms adduct.

249
Q

significance of retaining primitive reflexes

A

lack of frontal lobe development e.g. CP

250
Q

at what age does a child develop a hand preference?

A

18 months

251
Q

define cerebral palsy

A

chronic disorder of posture and movement

due to non progressive lesions sustained <2yrs

252
Q

what are the TORCH infections

A 
Toxoplasmosis
Other (syphilis, varicella-zoster, parvovirus B19)
Rubella
CMV
Herpes

causes of congenital abnorm/ neonatal mortality/morbidity

253
Q

causes of cerebral palsy antenatally, perinatally and postnatally

A

antenatal: APH, TORCH, alcohol, rhesus
perinatal: trauma, fetal distress, hyperbilirubinaemia
postnatal: IVH, hypoxia, meningitis

254
Q

signs and symptoms of cerebral palsy

A

motor: delayed milestones, weakness, paralysis

epilepsy

speech/ language

learning disability

EVOLVING

255
Q

WHY DO CP signs/Sx change over time

A

when child doesnt reach expected milestones, probelms are picked up

256
Q

list the 4 types of cerebral palsy from most to least common and the area of the lesion

A

spastic (pyramidal)
dyskinetic (basal ganglia)
ataxic (cerebellar)
(mixed)

257
Q

kernicterus causes which type of CP?

A

dyskinetic

258
Q

which limb is affected more by spastic hemiplegic CP and how might this present in home life

A

arm > leg

early hand prefernce

259
Q

which limbs are more affected in diplegic spastic CP

A

legs>arms

260
Q

most severe form of CP and consequences

A

spastic quadriplegia

swallowing difficulties, seizures, aspiration pneumoina, reduced IQ

261
Q

symptoms of dyskinetic/athetoid CP

A

hyper/hypotonia
poor movement flow/chorea
hearing probs
dysarthria (weak muscles)

262
Q

Investigations in suspected CP

A

TORCH screen

MRI

263
Q

Mx of CP

A

treat complications e.g. epilepsy

botox for spasticity

264
Q

differentials of child daydreaming

A 
absence seizure
visual problems
hearing problems
ADHD
behavioural
sleep deprivation
265
Q

how can you investigate for absence seizure

A

hyperventilation [blowing windmill] induces absence
video record
EEG

266
Q

describe an absence seizure

A

approx 10s pause
stops mid sentence, then carries on where left off
patient unaware
eyes may roll up

267
Q

first line Tx for paeds absence seizures and 2 side effects

A

ethosuximide

D and V, rash

268
Q

absence seizures age 6, tonic clonic age 12, clumsy in the morning. Diagnosis?

A

juvenile myoclonic epilepsy

269
Q

1st and 2nd line Tx for juvenile myoclonic epilepsy

A

sodium valproate

lamotrigine

270
Q

prognosis of juvenile myoclonic epilepsy

A

8/10 need antiepileptics for life

well controlled by meds

271
Q

at what age would you be concerned about a child squint

A

> 3 months, must be seen by 6 months

272
Q

using a cover test, what type of squint would correct when other eye covered

A

non-paralytic

273
Q

what are exo and esotropia in paeds squint

A

exotropia - divergent, one eye turned out

esotropia - convergent, one eye turned in

274
Q

investigation in paralytic squint

A

CT or MRI

275
Q

name the 6 muscles for eye movement

A 
superior rectus
inferior rectus
medial rectus
lateral rectus
superior oblique
inferior oblique
276
Q

causes of squint in paeds

A 
attempt to overcome vision problem e.g. short sightedness
measles
CP
retinoblastoma
Downs
277
Q

Mx of squint

A

glasses, patch
botox
surgery

278
Q

consequences of not treating squint

A

persistent blurred /double vision
a lazy eye
low self-esteem

279
Q

developmental milestones: at what age would you expect a child to:-

smile

sit with support

sit without support

A

smile - 6 weeks

with support - 4-6 months

without - 6-9 months

280
Q

developmental milestones: at what age would you expect a child to:-

reach out for objects

pincer grasp

waves goodbye

drinks from cup what age

A

reach out for objects: 4-6 months

pincer grasp: 7-12 months

waves goodbye 7-12 months

drinks from cup 12-15 months

281
Q

developmental milestones: at what age would you expect a child to:-

turns head to name

speaks single words

speaks 6 words

A

turns head to name 6-9 months

speaks single words 12-15 months

speaks 6 words 18 months

282
Q

developmental milestones: at what age would you expect a child to:-

crawl

walks with hand held

walks indep

A

crawl 6-9 months

walks with hand held 7-12 months

walks indep 18 months

283
Q

developmental milestones: at what age would you expect a child to:-

builds with blocks

stacks 5-6 blocks

uses a spoon what age

A

builds with blocks 18 months

stacks 5-6 blocks 18 months - 2 yrs

uses a spoon what age 18 months - 2 yrs

284
Q

what is an Oral Glucose Tolerance test

A

2 hr measurement after ingestion of glucose load

285
Q

cerebral consequence of DKA management

A

cerebral oedema

286
Q

DKA management

A 
Fluid
Insulin
Monitor glucose hourly
Monitor electrolytes: K+ /ketones (2 hourly)
Fluid balance
Hourly neuro obs
287
Q

DM hypo Sx

A 
Nausea
Confusion
Shakey
Sweaty
pallor
Palpitations
Dizzy
Headache
Visual problems
Hearing loss
Slurred speech
LOC
Convulsions
288
Q

define cows milk allergy.

associated with?

A

immunological reaction to milk proteins

atopy

289
Q

what is Giardiasis and how do you treat

A

protozoa
causes villous atrophy, diarrhoea with cysts
METRONIDAZOLE

290
Q

pathophysiology of coeliac

A

^ T and B lymphocyte response to gluten -> villous atrophy

291
Q

what is Dermatitis Herpetiformis

A

gluten sensitivity Rash- erythematous/pruritus

with or without villous atrophy

292
Q

non-GI manifestations of coeliac

A

osteoporosis
dermatitis herpetiformis
dental enamel defects

293
Q

Ix for coeliac

A

endoscopy and biopsy for histo
IgA, Tissue transglutaminase antibodies, endomysial antibodies, IgG
Sx response to gluten exclusion

294
Q

how do you manage the pancreatic insufficiency in CF children

A

Pancreatic Enzyme Replacement Therapy (PERT)

295
Q

paeds crohns and UC Mx

A 
Steroids
Immunosupressives
Azothioprine
Methotrexate
Infliximab (anti-TNFa)
296
Q

non-GI maifestations of IBD

A

arthritis
osteoporosis
erythema nodosum
episcleritis

297
Q

acute scrotum, main important differential and others

A 
TESTICULAR TORSION!
hydatiform torsion (blue dot on transilumination)
epidydimo orchitis
trauma
acute hydrocoele
idiopathic scrotal oedema
298
Q

2 peaks in age of testicular torsion presentation

A

neonatal

puberty

299
Q

symptoms of testicular torsion

A

sudden onset v severe pain
tender on palpation
can vomit
late signs: red/swollen

300
Q

how long do you have to save the testicle in testicular torsion?

A

6 hours

301
Q

balantis xerotica obliterans (BXO)

A

phimosis (unable to retract foreskin) and urethral stenosis. Decreased urinary and sexual function

302
Q

define hypospadius. And why is it important to palpate testes?

A

opening of the urethra is on the underside of the penis

in case it’s ambiguous genitalia (congenital adrenal hyperplasia)

303
Q

why do you gove CAH child sodium?

A

adrenals make too little aldosterone, salt and water loss

304
Q

casues of groin swelling paeds

A

indirect inguinal hernia
hydrocoele
lymph nodes

305
Q

neck lymph nodes in children - when worrying?

A

posterior triangle [behind SCM ]
>2 weeks
>2cm/ enlarging
inflamed

306
Q

what is pyloric stenosis?

A

hypertrophy of sphincter muscle

307
Q

causes of conductive hearing loss

A

otitis media with effusion
Ear wax
perforated eardrum
abnormality of the outer ear

308
Q

1 yr old, fell and banged head
Pale, stiff, unresponsive, jerking of all 4 limbs.
Few seconds and then she came round.
Diagnosis

A

reflex anoxic seizure

309
Q

4 month old. Episodes of suddenly bending arms and neck and bring legs to chest. Last a few seconds. Seems to cry out in pain. Diagnosis?

A

west Syndrome (Infantile spasms)

310
Q

define west syndrome

A

epilepsy syndrome composed of the triad of infantile spasms, EEG hypsarrhythmia, and developmenta delay

311
Q

3 months old with sudden jerks of the arm whilst asleep, does not wake. Diagnosis?

A

benign myoclonic jerks

312
Q

2 year old - flushed and unsettled, with 2 min episode of rigidity and shaking, drowsy afterwards. Diagnosis

A

febrile convulsion

313
Q

failure to thrive: Inadequate calorie intake - Organic causes

A

Impaired suck/ swallow:

Oro- motor dysfunction/neuro disorder e.g. CP/ Cleft palate

314
Q

failure to thrive: Inadequate calorie intake – Non-Organic/ enviromental causes

A

poor feeding technique
poor meternal-fetal relationship
neglect

315
Q

failure to thrive - Inadequate calorie absorption causes

A

coeliac, giardia, lactose intolerance, cows milk protein allergy, pancreatic disease, short bowel syndrome

316
Q

failure to thrive - Excessive calorie loss causes

A

vomiting (GORD/pyloric sten)

317
Q

failure to thrive - Excessive calorie requirements causes

A

chronic illness (resp/GI/immune def)
Thyrotoxicosis
Malignancy
Abnormal movement disorder

318
Q

earliest you should wean from breastmilk to solid food

A

6 months

319
Q

define ADHD, 3 core problems, age criteria, when and where

A

ATTENTION DEFICIT HYPERACTIVITY DISORDER
1. inattention 2. hyperactivity 3. impulsivity

  • persistent and impact on daily functions
  • Present before 12 years
  • Developmentally inappropriate
  • 2 or more settings
320
Q

organic causes that predispose to ADHD

A

prem
neurofibromatosis
fetal alcohol/smoking

321
Q

Mx of ADHD

A

advice on positive parenting, booklets, behavioural techniques
parental education programmes
older - CBT

METHYLPHENIDATE

322
Q

3 aspects of autistic spectrum disorder

A

communication difficulty
social interaction difficulty
X imagination/rigidity of thought

323
Q

define preterm

A

<37 weeks

324
Q

how do you treat apnoeas and bradycardia in neonates

A

caffiene

325
Q

what is transferred from mother to baby in the last 3 months gestation that prevents neonatal sepsis

A

IgG

326
Q

complications of otitis media

A

mastoiditis
tympanic membrane perforation
extradural/subdural/cerebral abscess
meningitis

327
Q

management of recurrent otitis media

A

Analgesia
Repeat antibiotic courses
Antibiotic prophylaxis
Grommet insertion

328
Q

predisposing factors for glue ear (otitis media with effusion)

A

parental smoking
breast feeding
male
anatomical e.g. cleft palate

329
Q

indication for tonsilectomy

A

recurrent tonsilitis > 7 times / year

sleep disordered breathing/obstructive sleep apnoea

330
Q

define Developmental Delay

A

Development along the normal route

Child takes longer than norm to reach each milestone

331
Q

define Developmental Disorder

A

Development does not follow normal patterns.

May make developmental progress but disordered

332
Q

define Developmental Arrest/Regression

A

Normal development first

Then failure/slow to gain new skills/ loss of skills

333
Q

how long do children maintain Palmar and Plantar grasp primitive reflex

A

0–3 months

334
Q

define neglect

A

A standard of care that does not meet the needs of the child

335
Q

UTI in neonates/ infants, acutely ill, suspected pyelonephritis or vomiting. Treatment?

A

IV cefuroxime

336
Q

characteristic features of trisomy 21

A 
Learning/ developmental delay
Hypotonia
Short Stature
Congenital Heart Disease (AVSD, TOF) 
Duodenal Atresia
Upward Sloping Palpebral Fissures
Epicanthic Folds
Brachycephaly
Single Palmar Crease
337
Q

what is disability living allowance

A

benefit which helps with the extra costs involved in looking after a child with disability

338
Q

causes of osteoporosis in children

A 
osteogensis imperfecta
idiopathic
endocrine
drug induced (steroids)
malabsorption
immobile
339
Q

symptoms/ complications of osteogenesis imperfecta

A 
fractures
deformity
pain
impaired mobility
poor growth
Deafness
hernias
valvular prolapse
340
Q

medical treatment for osteogenesis imperfecta

A

bisphosphonatres (pamidronate)

341
Q

how does vitamin D affect bones

A

strengthens. makes calcium available by increasing absorption from the gut. regulates calcium an phosphate levels

342
Q

what can low maternal vitamin D cause in the newborn

A

bowed legs/ rickets

343
Q

systemic onset JIA symptoms

A 
arthritis
fever
rash
lymphadenopathy
hepatosplenomegaly
344
Q

define marophage activation syndrome

A

potentially fatal abnormal proliferation of macrophages, cytokines, T lymphocytes, NK cells. Cytopaenia and coagulopathy. Complication of rheumatic disease

345
Q

what can trigger macrophage activation syndrome?

A

infection

346
Q

which rheumatological diseases can be complicated by macrophage activation syndrome

A

SOJIA
SLE
kawasakis

347
Q

macrophage activation syndrome Sx

A

fever
hepatosplenomegaly
purpuric rash

348
Q

macrophage activation syndrome Tx

A

NSAIDs

steroid

349
Q

foramen ovale connects…

A

right atrium to left atrium

350
Q

ductus arteriosus connects..

A

pulm artery to aorta

351
Q

features heard on ausculation in ASD

A

ejection systolic over pulm area

fixed split S2

352
Q

ASD symptoms

A

asymptomatic when young, older - palpitations

353
Q

how might a baby present with a PDA, and what might you find on examination

A

symptoms: poor feeding, failure to thrive, tachypnoea, hepatomegaly, oedema
signs: Thrill, continuous murmur

354
Q

murmur of PDA

A

continuous ‘machine-like’

355
Q

murmur of VSD

A

pansystolic

356
Q

name the 5 cyanotic congenital heart condition

A 
tetralogy of fallot
transposition of great vessels
tricuspid atresia
Total anomalous pulmonary venous return
pulm HTN secondary to lung disease
357
Q

how would you differentiate a cyanotic child with lung/heart disease?

A

give O2 -> lung disease will improve

358
Q

systolic murmur, weak femoral pulses, BP discrepancy between arms and legs. Which congenital heart defect?

A

coarctation of the aorta

359
Q

Ejection systolic murmur in aortic area, Thrill palpable in suprasternal region and carotid area. defect?

A

aortic stenosis

360
Q

4 aspects of tetrallogy of fallot

A

pulm artery stenosis
right ventricular hypertrophy
overriding aorta
ventricular septal defect

361
Q

which heart defects have diastolic murmurs

A

aortic/pulm regurg

mitral/tricusp stenosis

362
Q

factors that increase risk of neural tube defect

A

Folic acid
Maternal diabetes
affected individual in the family

363
Q

symptoms of Prader- Willi Syndrome

A 
obesity
small genitalia
learning difficulties
neonatal hypotonia
poor feeding infant
364
Q

genetic cause of Prader- Willi Syndrome

A

Caused by a deletion in paternal chromosome 15 or maternal uniparental disomy

365
Q

symptoms of Angelmans Syndrome

A 
laughing, clapping
learning difficulties
microcephaly
seizures
ataxia and broad based gait
366
Q

genetic cause of Angelmans Syndrome

A

paternal uniparental disomy chromosome 15 or maternal chromosome 15 deletion

367
Q

what is amblyopia

A

“lazy eye”
Defective visual acuity which persists after
correction of the refractive error and removal of
any pathology

368
Q

define hyper and hypotropia

A

eye with squint deviates upwards/downwards

369
Q

define latent strabismus

A

eyes straight when both eyes are open.

Deviation of the visual axes can be elicited when each eye is covered

370
Q

casues of Pseudostrabismus

A 
Epicanthus
Narrow or wide interpupillary distance
Facial asymmetry
Unilateral ptosis
Deep set or prominent eyes
371
Q

management of amblyopia

A

glasses
patch good eye
surgery
botulinum toxin injection

372
Q 
on a pedigree chart, how are the following drawn:
male
female
someone with the disease
carrier
unborn child of unknown gender
deceased
A

male - square

female - circle

someone with disease - coloured in

carrier - half coloured in [dot for x-linked]

unborn child of unknown gender - diamond

deceased - diagonally crossed out

373
Q

causes of lobar colapse in the lung

A

blocked airway e.g. mucous plg/ foreign body

pneumothorax

mediastinal mass

374
Q

causes of unilateral/ bilateral pleural effusion

A

unilateral suggests infection

bilateral suggests fluid overload e.g. HF, nephrotic

375
Q

how would temperature help you differentiate bronchiolitis from pneumonia

A

bronch - low grade fever

consider pneumonia if temp >39 or focal crackles

376
Q

how do you calculate rate on an ECG?

A

5 big squares = 1 second

count 30 squares and X10

377
Q

what is meckel’s diverticulum

A

bulge in small intestine caused by congenital remnant

378
Q

management of TGA and TOF

A

prostaglandins to keep shunt open til surgery at 6 months

379
Q

management of pyloric stenosis

A

nil by mouth
fluids
correct electrolytes
Pyloromyotomy

3A GH (8 decks)

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