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Pass Med > Paeds > Flashcards

Paeds Flashcards

1
Q

Infantile spasms

A

West syndrome
Childhood epilepsy presents in first 4-8 months
More common in males
Carry poor prognosis- serious underlying condition

Features
Salaam attaches; flex ion of head, trunk arms followed by extension of arms
Lasts 1-2 sec, may be repeated up in 50 timers
Progressive mental disability

Investigation
EEG- Hypsarrhythmia in 2/3
CT- diffuse/ localised brain disease

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2
Q

Congenital rubella

A 
Sensorineural deafness
Congenital cataracts 
Congenital heart disease- PDA
Growth retardation 
Hepatosplenomegaly 
Salt and pepper chorioretinitis 
CP
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3
Q

Toxoplasmosis

A 
Cerebral calcification 
Chorioretinits
Hydrocephalus 
Anemia
Hepatosplenomeg
Cerebral palsy
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4
Q

CMV

A 
Most common congenital infection
Growth retardation
Purpuric skin lesions
Sensorineural deafness
Encephalitis/seizures
Pneumonitis
HSmegaly
Anemia 
Jaundice
CP
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5
Q

Estropia
Exotropia
Hypertropia
Hypotropia

A

Eye moves to nose
Eye moves temporally
Eye moves upwards
Eye moves downwards

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6
Q

Squint

A

Strabismus - misalignment of the visual axes
Can be concomitant (common) and paralytic (rare)

Diagnosis
Corneal light reflection test
Cover test- cover eyes and watch movement

Mgmt;
Eye patches to prevent amblyopia
Referral to secondary care

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7
Q

Concomitant squint

A

Due to imbalance in extraocular muscles

Convergent is more common than divergent

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8
Q

Paralytic squint

A

Due to paralysis of extraocular muscles

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9
Q

Trinucleotide repeat disorders

A 
Associated with anticipation 
Fragile X CGG
Hungtintons CAG
Myotonic dystrophy CTG
Friedreichs ataxia GAA.
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10
Q

6 in 1

A 
Diphtheria 
H influenza B
Pertussis
Polio
Tetanus 
Hep B
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11
Q

Vaccines ages

A

2 4 6 12 13 months

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12
Q

Vaccines at 2 months

A

6 in 1
Men B
Rotavirus
PCV- PNEUMOCOCCAL

3 injections + oral drops
Fever common after men B- 2.5mls at injections, 4-6hrs up to 4 doses
Mild diarrhoea after rotavirus- extra milk, wash hands
Loose clothes- sorenes, redness, swelling at site

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13
Q

Vaccines at 4 months

A

6 in 1
Men B
Rota virus

2 injections and oral drops

Precautions

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14
Q

6month vaccines

A

6 in 1
PCV
Men C

3 injections

Soreness
Fever
Headaches and irritability

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15
Q

12 months vaccines

A

MMR
Men B

  • rash 6-10 days after MMR- mini measles, not contagious
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16
Q

13 months vaccines

A

Hib
Men C+ PCV

2 injections

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17
Q

Acute epiglottitis

A

Most common cause h INFLUENZA
Less common by strep pyogens, pneumonia

Features;
Rapid onset
High temp
Very unwell
Stridor 
Drooling saliva
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18
Q

Developmental dysplasia of the hip

A

Replacing old term- congenital dislocation of the hip,
Affects 1-3% newborns

RF;
Female x6 more likely
Breech
Family hx
Firstborn 
Oligohydramnios
Birth weight <5kg

More common in left hip, 20% are bilateral

Ortolani and Barlow method
US to confirm

Treat;
Most unstable will spontaneously stabilise by 3-6 weeks
Under 4months- pavlik harness
Older- surgery

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19
Q

Palau

A

Trisomy 13

Microcephalic 
Small eyes
Cleft lip/palate
Polydactyl
Scalp lesions
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20
Q

Edwards

A 
Trisomy 18 
Micrognathia
Low set ears
Rocker bottom feet
Overlapping fingers
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21
Q

Fragile x

A 
Learning difficulties
Macrocephaly
Long face
Large ears
Macro orchidism
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22
Q

Noonan syndrome

A

Webbed neck
Peru’s excavating
Short stature
Pulmonary stenosis

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23
Q

Pierre robin syndrome

A

Micrognathia
Posterior displacement of the tongue
Cleft palate

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24
Q

Prader willi

A

Hyptonia
Hypogonadism
Obesity

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25
Q

William syndrome

A

Short stature
Learning diffficulties
Friendly
Supraventrcular neonatal stenosis

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26
Q

Necrotising entercolitis

A

One of leading cases of death among premature infants.
Initally symptoms can include feeding intolerance, abdo dissension and bloody stools.
Progress to perforation and peritonitis

Abdo x-ray can show
Dilated bowel loops
Bowel wall oedema
Intramural gas
Portal venous gas
Rigler sign- air in and outside bowel wall
Football sign - air outlining falciform ligament

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27
Q

Chondromalacia patellae

A

Softening of the cartilage of the patella
Common in teenage girls
Usually anterior pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physio

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28
Q

Osgood- schlatter disease

A

Seen in sporty teens

Pain, Tenderness and swelling over tibial tubercule

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29
Q

Osteochondritis dissecans

A

Bone underneath the cartilage of a joint dies due to lack of blood flow

Pain after exercise
Intermittent swelling and locking

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30
Q

Patellar subluxation

A

Medical knee pain due to lateral subluxation of the patella

Knee may give way

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31
Q

Patellar tendinitis

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on exam

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32
Q

Capput succedaneum

A

Involves a fluid colllection with poorly defined margins caused by the pressure of the presenting part of the scalp against the dilating cervix during deleviery

Bleeding below scalp above the periosteum

Present at birth
Resolves in days- no treatment
Cross the suture lines

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33
Q

Cephalohaematoma

A

Develops several hours after birth
Most common in partial region, doesn’t cross sutures
No treatment
Months of resolve

Sub periosteal

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34
Q

Kawasaki disease

A

Type of vasculitis predominately seen in children
Can be associated with serious complications- including coronary artery aneurysms

Fts;
High grade fever- lasts over 5 days - resistant to anti pyretics
Conjunctival infection
Bright red cracked lips
Strawberry tongue
Cervical lymphadenopathy red palms and soles

ClINICAL DIAGNSOIS

High dose aspirin
IV immunoglobulin
Echo

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35
Q

Croup

A

URTI in infants and toddlers
Strider- laryngeal oedema and secretions
Usually causes by parainfluenza virus

Usually 6months- 3years
More common in autumn

Features
Strider barking cough
Fever
Coryzal

Admit if morderate to severe croup

Treat with a single dose oral dexamethaosine to all

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36
Q

Hand foot and mouth disease

A

Self limiting condition affecting children
Caused by coxsackie a16 or enterovirus
Very contagious and typically occurs in outbreaks

Clinical features
Mild systemic upset- sore throat and fever
Oral ulcers
Vesicles on palms and soles

Hydration and analgesia
If unwell should be kept off school until they feel better

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37
Q

X linked recessive

A

Only males are affected

Affected males can only have unaffected sons and carrier daughters

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38
Q

Vesicoureteric reflux

A

Abnormal backflow of urine from the bladder into the ureter and kidney
Common enough abnormality - predisposes you UTI
Important to investigate for VUR in children following a UTI

Ureters are displaced laterally, entering the bladder in a more perpendicular fashion

Diagnosis following a micturating cystourethrogram
DMSA scan to look for renal scarring

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39
Q

Asthma management

A

First line is now an inhaled corticosteroid low dose even prior to formal diagnosis being made.

Next step is laba if over 5 and leukotriene receptor antagonists if under

Saba prn if using more than 3 times per week - not controlled

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40
Q

Bronchiolitis

A

Characterised by acute bronchiolar inflammation
Rsv is cause in 75-80% of cases
Peak age of incidence is 3-6 months
Higher incidence in winter

Features 
Coryzal symptoms 
Dry cough 
Increasing breathlessness
Wheezing 
Feeding difficulties

Hospital if
Resp rage over 60,dehydration

Humified oxygen
Suction
Ng feeding

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41
Q

Roseloa Infantum

A

Caused by HHV6 common in infancy

High fever 
Then 
Maculopapular rash- not itchy 
Febrile convulsion in 10-15%
Diarrhoea and cough

Complications
Hepatitis
Aspectic meningitis

42
Q

Hirschsprung disease

A

Caused by an aganglionic segment of bowel due to failure of development of the Meisser plexus

Rare 1/5000
Important in differential of constipation

Presentations
Neonatal Period- failure or delay to pass meconium
Older; constipation
Abdo dissension

3 times more common in males
Down syndrome

43
Q

Constipation

A

Usually under 6 months 3 per day

After 3 once per day

44
Q

Causes of constipation

A 
Dehydration
Low fiber 
Meds like opiates
Anal fissure 
Over enthusiastic potty training 
Hypothyroidism 
Hypercalcaemia
Hirschsprung’s disease 
Learning disabilities
45
Q

Red flags constipation

A 
Reported from birth or first few weeks 
Ribbon stools
Faltering growth
Locomotive delay 
Abdo distenion
46
Q

Nocturnal enuresis

A

Most children achieve nocturnal and day continence by 3 or 4

Enuresis is defined as the involuntary discharge of urine by day or night or both in children over 5 in the absence of congenital or acquired defecting in CNS or urinary tract

Can be primary- never achieved continence
Secondary have been dry for at least 6 months before

Enuresis alarm first line under 7
Desmopressin if over 7

47
Q

Thread worms

A

Treat with mebendazole if over 6 months . Single treatment

Anthelmintic and hygiene for all the family

48
Q

Pyloric stenosis

A

Typically presents in 2nd to 4th week of life with vomiting
Caused by hypertrophy of the circular muscles of the pylorus

4 in 1000
4 times more common in males
10-15 % have a positive family history
First borns are more commonly affected

Features 
Projectile vomiting 30mins after feed
Constipation and dehydration
Palpable mass in upper abdo
Hypochloraemic hypokalaemic snd alkalosis

Mgmt with ramstedt pylormyotomy

49
Q

CF management

A

Regular - at least twice weekly chest physio and postural drainage
High calorie, high fat diet
Vitamin supplementation
Pancreatic enzyme at every meal

50
Q

PYLORIC STENOSIS

A

Males > females
5-10% have a family history
Projectile non bile vomit at 4-6 weeks
Test feed and US needed

Tx w/ ramstedt pyloromyotomy

51
Q

Acute appendicitis

A

Uncommon in under 3

If present- usually will present in atypical manner

52
Q

Mesenteric amenities

A

Central abdo pain and URTI

Conservative management

53
Q

Intussception

A 
Telescoping bowel 
Proximal or at the level of the ileocaecal valve
6-9 months 
Colicky pain, diarrhoea and vomiting
Sausage shaped mass
Red jelly stool

Treat; reduction with air insufflation

54
Q

Malrotation

A 
High calcium at the midline
Exomphalos
Congenital diaphragmatic hernia 
Need upper GI contrast study
Treatment is by laparotomy
55
Q

Oesophageal atresia

A

May present with chocking and cyanoitc spells

56
Q

Hilary atresia

A

Jaundice >14days
Increased conjugated bilirubin
Urgent Masai procedure

57
Q

Intraventricular haemorrhage

A

Most commonly associated with spastic diplegic cerebral palsy due to anatomical proximity of the corticospinal tracts

58
Q

Cerebral palsy

A

Disorder of movement and posture due to a non progressive lesion of the motor pathways in the developing brain
2/1000 births

Abnormal tone early infancy
Delayed motor milestones
Abnormal gait
Feeding difficulties

60% learning difficulties
30% epilepsy
30% squints
20% hearing impairment

59
Q

Causes of CP

A

Antenatal 80%- maternal torch infections
Intrapartum 10% birth asphyxia/trauma
Postnatal 10% intraventricular haemorrhage, meningitis, head trauma

60
Q

Classification of CP

A

Spastic 70%- hwmiplegia, diplegia, quadriplegia
Dyskinesia
Ataxia
Mixed

61
Q

Growing pains

A 
Benign idiopathic nocturnal limb pains of childhood
Common boys and girls 
3-12
Never present at the start of the day 
No limp
No limitation of physical activity
Systemically well
Normal exam
Motor milestones normal
Symptoms are often intermittent and worse after a day of vigorous activity
62
Q

Meningitis in children

A

Neonatal to 3 months
Group b STREP
E. coli
Listeria

1month- 6years
N. Meningit
Strep pneumonia’s
H influenza

Over 6
- h influenza

63
Q

Neonatal resus

A

Dry baby- start the clock
30s - assess tone breathing heart rate
60s gasping or not breathing 5 rescue breaths
Reassess

64
Q

APGAR score

A 
Activity
Pulse
Grimace
Appearance
Resp
65
Q

Activity apgar

A

0 ABSENT
1 FLEXED ARMS/LEGS
2 ACTIVE

66
Q

Pulse

A

0 absent
1 below 100
2 over 100
1

67
Q

Grimace

A

0 floppy
1 minimal response to stimu;action
2 prompt response

68
Q

Appearance

A

0 blue/ palse
1Pink body, blue extremities
2 pink

69
Q

Resp

A

0 absent
1 slow and irregular
2 vigorous cry

70
Q

APGAR results

A

0-3 very low
4-6 mod low
7-10 good state

71
Q

Fetal alcohol syndrome

A

Baby may show symptoms of withdrawal at birth- irritable. Hypotonic, tremors

Features
Short palpebral fissure
Thin vermillion border
Smooth/ absent Philtrum
Learning Disabilities
Microcephaly
Growth retardation
72
Q

Odds of baby with DS

20, 40 45

A

20 1 IN 1500
40 I IN 100
45 1 IN 50 or greater

73
Q

Causes of Down syndrome

A

Non dysfunction 94%
Robertsonian translocation 5%
Mosaic is 1%

74
Q

Causes of neonatal hypoglycemia

A 
Maternal DM
Prematurity
IUGR
Hypothermia 
Neonatal septic
Inborn errors of metabolism

Labetolol use in mum

75
Q

Pertussis

A

Gram neg

2-3 days of coryza then
Coughing bouts- worse at night and after feeds
Inspiratory whoop
Marked lymphocytosis

Nasal swab to diagnose
PCR and serology

Tx with macros due

76
Q

Li Fraumeni syndrome

A

A dominant
Mutations in p53
Sarcomas and leukaemias

77
Q

BRCA 1 & 2

A

Carried on chromosome 17-1 and 13-2
60% increased risk of breast cancer
55% increased risk ovarian cancer 1 and 23% with 2

78
Q

Lynch syndrome

A

A dominant
Colonic cancer and endometrial cancer at young age
80& of affected individuals will get colonic and or endometrial cancer

79
Q

Gardeners syndrime

A 
A dominant 
Multiple colonic polyps
Skull Oreo a thyroid cancer epidermoid cysts
Dermoid tumors
Variant of FAP 
APC Gene on chrom 5
80
Q

Respiratory distress syndrome

A

Caused by insufficient surfactant production and immaturity of the lungs

50% born at 26-28 weeks
25% 30-31 weeks

Other risk factors
Male 
Diabetic mothers
C section
Second born of premature twins

Cf; tachypnoea, intercostal recession, expiratory grunting, cyanosis

CXR ground glasss appearance

81
Q

Kawasaki disease

A

Type of vasculitis - usually seen in kids, uncommon
Features- high grade fever> 5days, resistant to anti pyretics
Conjucntival infection
Bright red, cracked lips
Strawberry tongue
Cervical LN
Red palms and soles

Mgmt
High dose aspirin
IV immunoglobulin

Complications; coronary artery aneurysm

82
Q

Retinoblastoma

A

Most common ocular malignancy in kids. Diagnosis usually 18months

Absence of red eye reflex
Strabismus
Visual problems

Treat;
Radiation, chemo
Enucleation

Prognosis is excellent

83
Q

Vitals

1 2, 2-5, 5-12, 12>

A

<1 HR 110-160 RR 30-40
1-2 HR 100-150 RR 25-35
2-5 HR 90-140 RR 25-30
5-12 HR 80-120 RR 20-25

84
Q

Moro

A

Gone at 3-4 months

85
Q

Grasp

A

4-5 months gone

86
Q

Rooting

A

Gone at 4 months

87
Q

Stepping

A

Gone at 2 months

88
Q

Autism

A 
75% are male
Usually develops before 3
Need all 3 of 
Global impairment of language and communication
Impairment of Social relationships 
Ritualistic and compulsive behaviour

Associated with retts and fragile x

89
Q

Perthes disease

A

Degenerative condition affecting the hip joints of children
Usually between 4-8
Avascular necrosis of the femoral head and infarction
5x tomes more common in boys

Fts;
Hip pain- develops over weeks
Limp
Stiffness and reduced range of movement 
X-ray changes- joint widening, decreased femoral head size

Complications
OA
Premature fusion of the growth plates

Mgmt
Cast and braces, to keep femoral head on acetabulum
Observe if under 6

90
Q

Epstein’s anomaly

A

Caused by lithium use in pregnancy
Displacement of the posterior leaflets of the tricuspid valve
Causes TR and TS + enlargement of the right atrium

91
Q

Acyanotic heart disease

A 
VSD- most common
ASD
PDA
Coarch
AS
92
Q

Cyanotic heart disease

A

TOF
TGA
Tricuspid atresia

93
Q

Chickenpox

A

High infectious
Spread via resp
Infectivity- 4 days before rash and 5 days after rash has appeared- usually they say to keep them out until all lesions have crusted over

Features
Fever initally
Itchy rash starting on head/trunk before spreading
Macular, papular then vesicles 
Systemic upset is mild

Keep cool, trim nails
Calamine lotion

Rare complications
Pneumonia
Encephalitis

94
Q

SIDS

A

Commonest cause of death under 1 year, peaks at 3 months

RF; 
Prematurity
Parental smoking 
Hyperthermia 
Putting baby to sleep prone
Male 
Bottle feeding 
Social classes
Winter
95
Q

Minimal change disease

A

75% of nephrotic syndrome cases in kids
Most idiopathic

Features
Nephrotic syndrome
Normotension
Renal biopsy- fusion of polo types

Manage
80% steroid responsive
Cyclophosphamide if resistant

Relapse is common

96
Q

Scarlet fever

A

Group a strep
More common in 2-6 year old- peak at 4

Incubation period of 2-4 days 
Fever
Malaise
Tonsillitis 
Strawberry tongue 
Rash- pinhead, first on torso, spares the face- can be flushed, sandpaper texture 
Desquaimation around fingers and toes 
Mgmt;
Oral penicillin V
Notifiable disease
Return to school 24hrs after antibiotics

Complications
Otitis media
RF
Acute glomerulonephritis

97
Q

Scaphoid abdomen and bilious vomiting

A

Interstitial malrotation

98
Q

Displaced apex beat and decreased air entry

A

Diaphragmatic hernia

99
Q

Coeliac disease in children

A

Children normally present before 3 following the introduction of cereals into diet

100
Q

Obesity in children

A

Common cause; lifestyle factors

Causes; 
Growth hormone deficiency
Hypothyroidism 
DS
Chyshings
Prayer- Willi
Consequences;
Orthopedic problems 
Psychological- poor self esteem
Sleep apnea
Benign intercrainial hypertension 
Increased dm2, HYPERTENSION, ischaemia heart disease

Pass Med (8 decks)

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