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Passmed revision > Paeds > Flashcards

Paeds Flashcards

1
Q

Unexplained lump/swelling

Bone pain

A

Osteosarcoma

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2
Q

Joint pain
Locking
Swelling

A

Osteochondritis dissecans - cracks in articular cartilage + underlying subchondral bone

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3
Q

Batter’s syndrome - cause?
Effect on BP?
Effect on U+Es?

A

Na/K/Cl transporter is defective

Normotension
Hypokalemia

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4
Q

Congenital heart defect where tricuspid valve leaflets are attached to R ventricle?

Associations?

A

Ebstein’s anomaly

  • tricuspid regurg
  • WPW
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5
Q

Cause of scarlet fever

A

Grp A haemolytic streptococci

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6
Q

Mx of Perthe’s disease? depends on age?

A

<6yo: observation + keep femoral head in cast, braces

>6yo: surgical management with limited benefit

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7
Q

Slipped capital femoral epiphysis - how does the femoral head displace?

How is movement limited?
Where is the pain?

A

Femoral head is displaced posteroinferiorly

  • Loss of internal rotation when leg is flexed
  • Pain in hip, groin, medial thigh, knee pain
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8
Q

Kocher criteria for septic arthritis

A

Raised ESR
Can’t weight bear
Fever

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9
Q

Continuous hum heard below both clavicles

  • what is it called? what is the cause?
A

Venous hum

Due to turbulent flow from great veins

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10
Q

Benign murmur heard on lower left sternal border

A

Still’s murmur

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11
Q

Benign murmur heard on upper left sternal border

A

Pulmonary flow murmur

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12
Q

Salmon pink rash + pain and stiffness in knees

  • Dx? potential other clinical features?
A

Systemic onset JIA

lymphadenopathy
Uveitis
Anorexia
Pyrexia

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13
Q

Roseola infantum vs chicken pox

A

Chicken pox is itchy

Roseola = high grade fever which subsides before non=itchy rash appears

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14
Q

Severe hip pain + inability to weight bear. USS shows effusion in joint capsule
No fever, no haemodynamic changes

A

Transient synovitis

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15
Q

Tx of threadworm

A

Give one dose of mebendazole to whole household

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16
Q

Best first line investigation for suspected intussusception?

A

USS

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17
Q

Red currant jelly stool

A

Intussusception

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18
Q

Colicky abdo pain
Draws up knees
Vomiting
Palpable abdominal mass

A

Intusussception

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19
Q

Management of Intusussception

A

Air insufflation with radiological guidance

If peritonitis or air insufflation fails –> surgery

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20
Q

Normal apgar score?

A

> =7

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21
Q

what factors determine the apgar score?

A 
HR
Resp effort
reflex response
colour
Muscle tone
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22
Q

Management of child with mild cow’s milk protein intolerance

A

Extensive hydrolysed formula milk

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23
Q

Management of severe cow’s milk protein alergy

A

Amino acid based formulas milk

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24
Q

difference between cow’s milk protein intolerance and allergy?

A 
intolerance = delayed reaction (non-IgE mediated)
allergy = immediate reaction (IgE mediated)
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25
Q

Kawasaki disease - 6 features

A 
Fever >5 days
Conjunctivitis
Strawberry tongue
Cracked red lips
Skin peeling from hands and feet
Cervical lymphadenopathy
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26
Q

Management of Kawasaki’s disease

A

High dose aspirin

IVIG

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27
Q

3 treatments for treating spasticity in CP?

A

Botulinum toxin type A
Baclofen
Diazepam

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28
Q

at what age would you refer a child if the cannot:

  • sit without support?
  • walk without support?
A

sit w/o support = 12 months

walk without support = 18 months

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29
Q

Neonatal CPR - what is the protocol?

A

If not breathing = 5 ventilation breaths

If HR doesn’t improve: 3:1 chest compressions:ventilation breaths

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30
Q

When is the meningitis B vaccination given

A

2, 4 and 12 months

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31
Q

Which vaccinations are routinely given to teenagers?

A

3 in 1 teenage booster (DTP)

Meningitis ACWy

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32
Q
  • Rash like sandpaper on the body
  • Fever
  • Flushed cheeks
  • Cervical lymphadenopathy
  • White coating on the tongue
A

Scarlet fever

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33
Q

Dx and Mx of scarlet fever?

A

Dx: throat swab BUT start Abx before results arrive
Tx: Oral penicillin V for 10 days
- Return to school 24 hours after Abx started
- Notifiable disease

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34
Q

Most common complication of scarlet fever

A

Otitis media

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35
Q

2 year old boy with a 1 day history of limp + pain - next step?

A

Urgent hospital assessment du not higher risk of septic arthritis in <3 yo

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36
Q

Clinical Fx of bronchiolitis

A 
<1yo
Coryza precedes: 
- Dry cough, SOB
- Fine inspiratory crackles
- Wheeze
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37
Q

Immediate referral for bronchiolitis is indicated by…?

A
  • Apnea
  • Looks v unwell
  • Severe respiratory distress (RR>70)
  • Central cyanosis
  • Sats <92%
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38
Q

What Fx in the history would lead you to a diagnosis of constipation in a child?

A
  • <3 stools/week
  • Overflow soiling
  • ‘Rabbit droppings’
  • Blocking the toilet
  • Pain on passing stool
  • Anal fissure
  • Bleeding with stools
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39
Q

Causes of constipation

A 
Dehydration/lowfibre diet
Opiates
Anal fissure
HYPOthyroid
Hirschsprung's
hypercalcemia
Learning disability
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40
Q

Red flags in constipation

A
  • Constipation since birth
  • ‘Ribbon’ stools
  • Abdominal distension
  • Social care - child mistreatment
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41
Q

Management of constipation

A

Start with escalating dose regimen of Movicol

  • Use stimulant laxative if not responding, then use lactulose
  • continue mediation until regular bowel habit is established, then reduce dose

-Improve fluid intake, increase fibre

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42
Q

Dx of malrotation?

A

upper GI contrast study + USS

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43
Q

Main RF for necrotising enterocolitis

A

Prematurity

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44
Q

mx for necrotising enterocolitis

A

total gut rest + TPN

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45
Q

at what age can a child consent to sex?

A

13

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46
Q

Elevation of the testicle = increased pain?

Elevation of the testicle = relieves pain?

A

Increased pain = torsion

Relieves pain = epididymitis

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47
Q

Stepwise mx of bed wetting

A
  1. look for other causes (UTI, DM, constipation)
  2. Fluid intake - reduce
  3. Reward chart - reward peeing before bed
  4. Enuresis alarm vs desmopressin - depends on child
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48
Q

3 heart defects in Turners

A
  • Bicuspid aortic valve
  • Aortic root dilation
  • Coarctation of the aorta
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49
Q

6 in 1 vaccine - how many times and when is it given?

What does it protect against?

A 
Diphtheria
Tetanus
Pertussis
Polio
Hib
Hep B

Given 3 times, at 2, 3, 4 months

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50
Q

When is MMR vaccine given?

A

12 months

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51
Q

What is included in the 4 in 1 booster? when is it given?

A

Diphtheria
Tetanus
polio
Pertussis

Pre school - 3-4 years old

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52
Q

When is Men B vaccine given?

A

2 months
4 months
12 months

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53
Q

2 prognostic factors for congenital diaphragmatic hernia

A 
Liver position (if raised, this is poor)
Chest to head ratio (>1 is good)
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54
Q

Mx of Kawasaki’s

A

High dose aspirin
IVIG
Echo - to look for coronary artery aneurysm

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55
Q

Cervical LNopathy
Swollen red tongue
Gunk in eyes
Fever for a week

A

Kawasaki’s

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56
Q

Intraventircular haemorrhage - RF? complications? When does it present? Mx?

A

RF - PREMature babies
Complications - hydrocephalus (as clot occludes CSF flow)
Presents in first 3 days
Mx - supportive

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57
Q

Abdominal migraines consist of what features in order to diagnose?

A

Abdominal pain + 2 of the following:
Nausea, vomiting, pallor, anorexia

with normal examination

58
Q

Vaccines given at 2 months?

A
  • 6 in 1 (diphtheria, tetanus, polio, pertussis, Hib, Hep B)
  • PCV (pneumococcal conjugate)
  • Men B
  • Oral rotavirus vaccine
59
Q

In a boy with precocious puberty, what particular thing do you want to examine?

60
Q

How does examination of the testes help with finding the cause of precocious puberty

A

Bilateral enlargement –> central cause (FSH/LH from intracranial lesion)

Unilateral enlargement –> gonadal tumour

No enlargement –> ADRENAL CAUSE (congenital adrenal hyperplasia)

61
Q

Causative organism in croup?

A

parainfluenza

62
Q

What is given as prevention of bronchiolitis? To whom?

A

Pavilizumab - against RSV!

Given to high risk children - PREM, immunocompromised, heart/lung abnormalities

63
Q

How does scarlet fever differ from Kawasaki’s

A

Kawasaki’s - any old rash

Scarlet fever - sandpaper like rash

64
Q

How does Downs’ –> snoring?

A

Low muscle tone in upper airways
Large adenoids + tongue
Obesity

65
Q

3 causes of nappy rash?

A

Irritant dermatitis = due to ammonia and faeces

Candida dermatitis = involves flexures + satellite lesions

Seborrheic dermatitis = flakes + scalp rash

66
Q

General management for nappy rash

A

Disposable nappies (not towel nappies)

Expose area to air when possible

Use barrier cream (if severe, use mild steroid)

67
Q

Sx of whooping cough OTHER than inspiratory whoop?

A

Coughing bouts: so bad it ends with vomiting + central cyanosis

  • -> subconjunc haemorrhages + anoxia –> seizures + syncope
  • Last 10-14 weeks
68
Q

School exclusion for pertussis?

A

2 days after starting Abx (or 21 days form onset of Sx if no abx)

69
Q

Abx treatment for pertussis?

A

Oral macrolide

70
Q

Typical metabolic abnormality in pyloric stenosis?

A

Hypochloremic hypokalemic metabolic alkalosis

71
Q

A mother brings her son in to surgery as she suspects he has a squint. She thinks his right eye is ‘turned inwards’. You perform a cover test to gather further information. Which one of the following findings would be consistent with a right esotropia?

A

On covering the L eye, the R eye moves laterally to take up fixation

72
Q

1st line Management of cows milk protein intolerante/allergy

A

If formula fed:
1. Extensive hydrolysed formula milk

If breast fed: eliminate cow’s milk protein from maternal diet
Use eHF milk when breastfeeding stops

73
Q

Rocker bottom feet is seen in which 2 syndromes?

A

Edwards

Patau

74
Q

Facial features of Fragile X?

A

Long face
Large ears
High palate

75
Q

which vaccines are given at 2 months

A

6 in 1
MenB
PCV

76
Q

Complications of roseola infantum?

A

Febrile convulsions
Aseptic meningitis
Hepatitis

77
Q

3 causes of cyanotic congenital heart disease

A

Tetralogy of Fallot
Tricuspid atresia
Transposition of Great Arteries

78
Q

Triad of shaken baby syndrome

A

Retinal haemorrhages
Encephalopathy
Subdural haematoma

79
Q

Exclusion advice for HHV 6(roseola infantum)

80
Q

Exclusion advice for scarlet fever

A

24 hours after commencing Abx

81
Q

Exclusion advice for impetigo

A

until lesions have crusted over

82
Q

Exclusion advice for mumps

A

until 5 days afte ronset of swollen glands

83
Q

Does oligo or polyhydramnios predispose to DDH?

84
Q

Surgical management of pyloric stenosis?

A

Ramstedt pyloromyotomy

85
Q

2 month old with H. influenza meningitis

Name 2 drugs that should be given

A

Ceftriaxone + dex

86
Q

Prophylaxis to close contacts of a child with meningitis?

87
Q

Anal itching + unremarkable examination?

A

Threadworm

88
Q

HHV6 causes … aka…

A

Roseola infantum aka sixth disease

89
Q

Features of Sixth disease - name 5

A 
Maculopapular rash
Diarrhoea
Cough
High fever
Febrile convulsions
90
Q

Medical mx for nocturnal enuresis?

A

desmopressin

91
Q

Eczema distribution:
in infants?
young children?
Older children?

A

Infants: face + trunk
Young child: extensor surfaces
Older child: Flexors

92
Q

Pathognomic x-ray sign for NEC?

A

Intramural bowel gas

93
Q

average age at which a child should drink from a cup without spilling anything?

94
Q

Management of mild cradle cap?

A
  • Baby shampoo + baby oil + emollients
95
Q

how long is the ABx course for a 5 year old girl with lower UTI?

A
  • 3 days of oral abx
96
Q

Medication for whooping cough?

A
  • macrolides (azithromycin/erythromycin)

Isolate the child for 2 days after starting abx.

97
Q

SIDS - RFs?

A

Lying prone
Smoking
PREM

98
Q

Which head lump which develops few hours after birth does NOT cross sutures

A

Cephalohaematoma

99
Q

Growing pains - when do they tend to coccur

A

at night, and NEVER on waking

100
Q

Baby born breech. Ortolani and Barlows sign are normal. next Mx?

101
Q

best imaging for visualising Perthe’s

102
Q

Time course of symptoms in Perthes

A

few weeks of progressive hip pain, limp and Reduced ROM

103
Q

Mx of <6yo with Perthes

A

Cast, braces, active monitoring

104
Q

Ix in suspected Perthes

A

X-ray

if X-ray normal but symptoms persist –> MRI

105
Q

Intestinal loops protruding through the umbilicus in a neonate

A

Omphalocele

106
Q

Intestinal loops protruding through a hole lateral to umbilicus in a neonate

A

gastroschisis

107
Q

When does moro reflex typically disappear

A

3-4 months

108
Q

Name 4 reflexes in babies

A

Moro
Rooting
Grasp
Stepping

109
Q

Mx of intraventricular haemorrhage

A

Supportive

- if hydrocephalus/high ICP –> think of a shunt

110
Q

wtf is akathisia

A

severe restlessness

111
Q

Screening test for depression

112
Q

Common SEs of TCAs (imipramine)

A

antimuscarinic SEs: dry mouth, blurry vision, constipation

113
Q

Inhaled steroid used for asthma control?

A

budesonide

114
Q

eg of low dose ICS

A

<200mcg budesonide

115
Q

eg of moderate dose ICS

A

200-400mcg budesonide

116
Q

Male version of turners

  • chest appearance?
  • cardio probs?
A

Noonan

  • pectus excavatum
  • pulmonary stenosis
117
Q

Facial appearance in Patau

A

microcephaly + small eyes

118
Q
  • Micrognathia (small jaw)
  • Posterior displacement of the tongue
  • Cleft palate
A

Pierre Robin

119
Q

3 features of Pierre RObin

A
  • Small jaw (micrognathia)
  • Posterior displacement of tongue
  • Cleft palate
120
Q

knee pain when walking up and down stairs and rising from prolonged sitting

A

Chondromalacia patellae = inflammation of cartilage of patella

121
Q

Oshgood Schlatter disease - classical presentation

A

sporty teens

swelling and pain on tibial tubercle

122
Q

Mx of chondromalacia patellae

A

RICE + anti-inflam + physio

123
Q

mx of osgood schlatter

A

Rest
Ice
Elevation
Stretch thigh and hamstrings

124
Q

Mx of child with itchy bottom and no other sx

A

treat empirically for threadworm ewww

Hygiene + single dose mebendazole for whole household

125
Q

Mx of toddlers diarrhoea

A

Increase fat and fibre

avoid juice + squash + carbonated drink

126
Q

Mx of gastroenteritis with clinical signs of dehydration

A

ORS for 50ml/kg in 4 hours

Avoid other fluids + solid foods

127
Q

Mx of gastroenteritis with shock, after initial fluid bolus

A

maintenance + replacement with 0.9% saline + 5% dextrose

  • monitor U+Es, glucose, Cr
  • Avoid solid foods
128
Q

When is guthrie test performed

129
Q

Avg age for sipping from a cup and eating with spoon

130
Q

Hirschsprungs - best initial tx?

Definitive Tx?

A

Initial: bowel irrigation
Definite: anorectal pull through

131
Q

mx of whooping cough

A
  • Azithromycin if within first 21 days of onset

- Notify PHE

132
Q

neonatal hypoglycaemia in the first few days - how to Mx?

A
  • Encourage regular feeding
  • require dextrose if:
  • <2mM
  • cannot feed
  • jittery/other Sx
133
Q

When is menB vaccine given

A

2, 4, and 12 months

134
Q

Child with ADHD on methylphenidate: what needs to be monitored?

A

Growth
Psychiatric assessment
BP (risk of HTN)

135
Q

Markers of severe croup

A

Hypoxemia –> restlessness/agitation/lethargy

136
Q

Child birth - what are the first things you do

A

Dry the baby, remove wet towels + start the clock

137
Q

PDA is a connection between…?

  • murmur?
A

Pulmonary artery + descending aorta

Continuous machinery murmur +

138
Q

PDA pulse

A

Large volume + bounding + collapsing pulse

139
Q

how many chest compressions/minute for children of all ages?

140
Q

Contraindications to MMR vaccine

A

Allergy to neomycin
Had a diff live vaccine in the past 4 weeks
Had IVIG therapy in the past 3 weeks
Severe immunosuppression

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