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Paeds Flashcards

1
Q

what will you find in bacterial infected LP?

A

neutrophils, high opening pressure, high protein, low glucose

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2
Q

what will you find in viral infected LP?

A

lymphocytes, high opening pressure, normal glucose

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3
Q

name the most common bacterial commensal

A

N.meningitidis-even more common in smokers

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4
Q

what organisms are most likely to cause meningitis in different age groups?

A

Under 3m (neonates)-group b strep, listeria, e coli
3m-5y-h influenzae
5+-n meningitidis and strep pneumoniae

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5
Q

what would you give to the 14 year old sister of a young boy with meningitis?

A

ciprofloxacin

rifampicin is CI in pregnant and taking COCP

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6
Q

viral causes of meningitis?

A

HSV

enteroviruses

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7
Q

what are the symptoms of septic arthritis in a child?

A

acutely unwell
pseudoparesis
acutely tender erythematous joint
just limp or referred knee pain

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8
Q

management of child with suspected septic arthritis?

A 
septic screen
USS-effusion
XR-any trauma
aspiration and culture
antibiotics
initial short lived immobilisation
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9
Q

what presents in a similar way to septic arthritis?

A

transient synovitis it is more acute however and will resolve spontaneously. Pain is less severe, child is otherwise well

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10
Q

what is irritable hip?

A

acute transient synovitis

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11
Q

what do you see Nikolivsky’s sign with?

A

scalded skin syndrome, where the skin separates on touch

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12
Q

how might a child with hypoglycaemia present?

A 
abdo pain
irritability
dizzy
faint
hunger
seizure
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13
Q

what electrolyte disturbance may complicate hypoglycaemia and what are the signs of this?

A

hypokalaemia-shown by generalised muscle weakness

ST depression, t wave sagging

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14
Q

what are the dangers of infusing too quickly?

A

cerebral oedema-especially if salt and sugar are low

central pontine myelinolysis

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15
Q

what do steroids do to blood sugar levels?

A

increase them

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16
Q

how many compressions in a child?

A

5 breaths then 15 to 2, adrenaline every 3-5 mins

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17
Q

how is puberty triggered?

A

from 8yo-pulses of GnRH are started

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18
Q

what is the sequence of events in female puberty?

A

thelarche
adrenarce (hair growth, growth spurt, acne)
menarche

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19
Q

what is allopurinol used for in ALL?

A

tumour lysis syndrome prevention, high potassium, phosphate and lactic acidosis

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20
Q

acidotic symptoms

A 
N&V
stomach cramps
hyperventilation
chest pain/palpitations
weakness
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21
Q

alkalosis symptoms

A 
confusion
seizures
tetany
abnormal sensations
arrythmia
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22
Q

what are aplastic crises in sickle cell disease caused by?

A

parvovirus b19- treat with hydration and o2

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23
Q

give 2 enzymopathies which will lead to non spherocytic haemolytic anaemia

A

glucose 6 phosphate dehydrogenase deficiency

pyruvate kinase deficiency

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24
Q

what is a diagnostic feature of beta thalassaemia on HPLC?

A

high HbA2 (2 alpha, 2 delta)

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25
what should you consider in an anaemic child who is not responding to treatment?
alpha thalassaemia trait-no treatment
26
what is vWF?
the carrier protein for VIII and it sticks platelets to damaged endothelial wall
27
what is the underlying pathology of haemolytic disease of the newborn?
isoimmune-rhesus disease, need to prevent or give transfusions
28
how is haemophilia transmitted?
x linked
29
what could cause thrombocytopenia in children?
ITP, SLE, HUS (shigella), DIC, scurvy; impaired production from Fanconi, aplastic anaemia
30
what are kocher's criteria?
fever>38.5 ESR>40 in first hour WCC>12 unable to weight bear
31
when is internal rotation painful?
in septic arthritis, kept abducted, externally rotated and flexed and in Perthe's internal rotation will lead to guarding or spasm
32
what are the risk factors for developmental dysplasia of the hip?
female, breech, oligohydramnios, C section, first child, club foot and other deformaties
33
what are the most common viruses in bronchiolitis?
respiratory syncitial virus in most, but also influenza, papa and adneno, rhino
34
what does smoking in pregnancy increase risk of?
asthma, IUGR, prematurity, miscarriage, SIDS, cleft lip
35
febrile, toxic infant, irritable with nappy changing with restricted joint range-what is the diagnosis and how is the hip likely to be arranged?
septic arthritis | abducted, externally rotated and flexed
36
sudden limp in otherwise well child
transient synovitis-child feels well but can also have fever, irritablility. they'll have no pain at rest
37
fever, erythematous rash, red eyes, irrritability, oral mucositis, erythema of hands and feet
Kawasaki disease
38
loss of ROM, pain, stiffness and restriction
not so much swelling so JIA, in systemic will also have fever and serositis
39
points of a baby check?
``` heart-listen eyes-red reflex: retinoblastoma or cataracts hips-O+B testicles-descended, check female (check anus head circumference and fontanelles cleft feel tummy check back stretch legs-talipes equinovarus) ```
40
what are the symptoms of Steven's Johnson?
cough, fever, conjunctivitis, rash on skin, burning sensation
41
what drugs can cause Steven's Johnson?
allopurinol, carbemazepine, CMV
42
what will be raised in Kawasaki disease?
ESR, CRP, WCC, neutrophils, plts
43
what organ infiltration can occur in ALL other than hepatosplenomegaly?
CNS>headaches and seizures | testicular enlargement
44
what kind of lymphoma is more common in children?
non Hodgkins
45
commonest kind of brain tumour in children?
astrocytoma
46
what finding will you get when investigating a child with neuroblastoma
increased catecholamines
47
what happens in Langerhan's cell histiocytosis?
bone lesions>fracture | DI
48
what is Reye's syndrome?
asso with aspirin and URTI | non inflammatory encephalopathy and fatty degeneration of the liver. Only supportive management
49
what is Cushing's triad?
bradycardia, systolic hypertension and irregular tachypnoea
50
what does a child with homocysteinuria need?
B6 supplements
51
in what disease can you not make dopamine or catecholamines
phenylketonuria because can't make tyrosine
52
what does mineralcorticoid do?
retains bicarb and sodium and flushes out potassium
53
what is the peak height velocity?
girls-stage 3 breast development | boys-12-14mL
54
most likely meningitis bugs in neonates?
E coli L. monocytogenes GBS
55
most likely meningitis bugs in 1m-6y?
NHS
56
most likely meningitis bugs 6+
N and S
57
what facial defects do you get with Down's syndrome?
flattened nose macroglossia shortened neck epicanthic folds
58
what are the 3 types of cerebral palsy?
athetoid spastic ataxic
59
what long term problems are associated with Down's syndrome
learning difficulties congenital heart disease early Alzheimer's
60
what is achondroplasia?
AD bone disorder- disproportionately small limbs, frontal bossing, large skull may also have hydrocephalus
61
what is Marfan's?
``` AD disorder of connective tissue tall long thin digits hyperextensible joints high arched palate myopia asso chest deformity and scoliosis, incompetent aortic root with valvular incompetence, mitral prolapse and regurgitation and aortic aneurysms echo monitoring is needed ```
62
define failure to thrive
significant interruption of growth compared to other children of a similar age, sex and height, crossing 2 centiles on a growth chart
63
what do stridor and wheeze indicate?
stridor-upper airway obstruction | wheeze-decreased diameter in the lower airways from secretions
64
key features of measles
maculopapular behind ears and on face then trunk and extremeties koplick spots
65
what do koplick spots look like?
buccal mucosa, opposite second molar, red spots with white or blue speck in the middle
66
causes of non blanching rash
thrombocytopenia bacteraemia enteroviruses and influenza HSP
67
what do you need to investigate in someone with HSP?
BP U&Es for dehydration and renal function urinalysis
68
how do you manage impetigo?
fusidic acid topically, if don't respond then oral fluclox
69
what bacteria commonly case impetigo
strep pyogenes | staph aureus
70
what are the common causes of encephalitis in children?
delayed swelling following response to an antigen eg respiratory viruses and enteroviruses direct invasion of the brain by a neurotoxic virus like HSV-usually treated with IV aciclovir because of this
71
what are the 3 features of toxic shock syndrome caused by S. aureus?
fever>39 hypotension diffuse erythematous macular rash
72
where might periorbital infection spread from and to?
from otitis media or dental abscess | to orbit and then on to meningies
73
what kind of rash do you get with rheumatic fever
erythema marginatum
74
how long does chickenpox last for?
7 days
75
what can enteroviruses cause in children?
encephalitis hand foot and mouth meningitis myocarditis
76
why does a barking cough occur in croup?
immobilisation of the vocal cords
77
what is included in airway remodelling
more goblet cells | more muscle mass in wall of airways
78
onset of abscence seizures
4-12
79
what is the most common cause of respiratory distress in term infants?
transient tachypnoea of newborn- more common if CS, usually settles after a day and infection needs to be ruled out
80
what kind of cells produce surfactant?
type II pneumocytes
81
what is given as the prophylxis of pertussis?
macrolides | erythromycin for preggers
82
when is viral episodic wheeze most common
4-6 yo
83
what is osgood schlatter's
osteochondritis of the patellar tendon
84
how do you improve meal refusal?
``` don't force feed more regular meals more suitable meals smaller portions less distractions less snacking ```
85
what are the features of anorexia nervosa?
``` self induced weight loss to 85% of original weight or becoming under 17.5 distorted body image fear of gaining weight endocrine disorder delay in puberty ```
86
what are the features of bulimia
persistent preoccupation with eating and irresistible craving for food counteracting with purging or starving dread of gaining weight
87
physical features of anorexia
``` cold peripheries bradycardia amenorrhoea lanugo hair ankle oedema ```
88
how is Bell's palsy treated
10 d pred
89
what is the most common kind of strasbismus?
non paralytic-concomitant-imabalance in extraocular muscles
90
what is strasbismus asso with
LDS, Down's, CP, Edward's
91
complication of strasibsmus
amblyopia
92
what is marfans a defect in?
fibrillin 1
93
connective tissue disorder syndrome presentations
aortic aneurysm pneumothroax lens dislocation/strasbismus hypermobility/arthalgia
94
autosomal recessive disoders?
``` congenital adrenal hyperplasia CF Freidriech's ataxia galactosemia phenylketonuria sickle cell tay sachs disease thalassaemia ```
95
X linked disorders?
duchenne and beckers fragile x glucose 6 phosphate dehydrogenase deficiency haemophilia A and B
96
what are the symptoms of Fanconi anaemia/
``` failure to thrive polydipsia polyuria anaemia metabolic acidosis rickets ```
97
what are the symptoms of rickets
``` bow legged failure to thrive pain in bones dental deformities muscle cramps fractures ```
98
IBD features in children
failure to thrive delayed puberty arthalgia adult sx: abdo pain, weight loss, fever, lethargy
99
how often should a child be defecating?
4 per day as infant, falls to 2 per day by 1 year, after falls to about 1 a day
100
features of toddler diarrhoea
``` don't trouble the child bits in no malabsorption usually resolve by past 5 must increase fibre and reduce fruit juice ```
101
what is the treatment for nephrotic syndrome?
60mg/m2 for 4 weeks then 40mg/m2 for 4 weeks on alternate days.
102
how is HSP treated?
it is self limiting so supportive, may need NSAIDs for joint pain and immunosuppression for kidney involvement-the nephritis is usually steroid resistant
103
what are the diabetic parameters?
``` fasting-over 7 post prandial (OGTT)-over 11 ```
104
how do you manage DKA in children?
10ml/kg boluses insulin monitor electrolytes, neuro obs, glucose, K+, ketones
105
what is the level of hypoglycaemia in children?
under 2.5mmol/L though may get symptoms below 4mmol
106
causes of vomiting in children?
``` overfeeding GORD pyloric stenosis gastroenteritis URTI intestinal obstruction ```
107
what are the signs of pyloric stenosis?
projectile vomiting, visible peristalsis, visible mass on test feed
108
how do you diagnose pyloric stenosis?
USS
109
what are the long term complications of coeliac disease
``` osteopenia overall cancers GI cancers lymphoma subfertility autoimmune and thyroid disease ```
110
how might IBD present in children?
``` fever weight loss apthous ulcers diarrhoea erythema nodosum arthalgia failed growth or delayed puberty ```
111
in what age is bronchiolitis most common in?
2-6 month olds
112
how to diagnose bronchiolitis
PCR of nasopharangeal aspirate
113
how can you prevent bronchiolitis?
IM pavilizumab monthly
114
what could non compliance with pancreatic enzymes lead to?
distal obstructive intestinal syndrome, big mucus poo in distal colon, presents with gradual obstructive symptoms, treat with enemata, therapeutic colonoscopy or surgically
115
how is infant respiratory distress syndrome going to present?
resp distress soon after birth: cyanosis, tachypnoea, recessions, grunting, flaring
116
which disease in young babies will give the ground glass appearance on XR?
infant respiratory distress syndrome
117
what congenital heart disease could cause cyanosis and breathlessness?
AVSD-it is associated with Down's syndrome
118
ASD murmur
ej systolic LUSE and split second heart sound
119
VSD murmur
pansystolic LLSE, transmitted to upper sternal edge
120
PDA murmur
machinery murmur in pulmonary area, LLSE
121
how are small VSDs managed?
good dental hygeine to prevent IE
122
how do you manage TOF spells?
settle put legs on chest propranolol BT shunt
123
TOF murmur
ej systolic upper left sternal edge
124
what disorders is Down's associated with?
AVSD, VSD, PDA, TOF
125
what is the most common site of intussusception?
ileocaecal
126
what are the symptoms of intussusception
``` abdo distension vomiting, may be bile stained redcurrant jelly stools mass-RIF refusing feeds ```
127
how is intussusception
rectal air insufflation but if peritonitis signs then needs surgical reduction
128
how is hirschprungs diagnosed?
suction rectal biopsy
129
what is meckels diverticulum?
remanant of vitello intestinal duct
130
vomiting in children-what could mimic gastroenteritis?
GI: pyloric stenosis, intussusception, acute appendicitis, Hirschsprung's systemic infection: meningitis or septicaemia local infection: resp, UTI, hep A, otitis media renal: HUS metabolic: DKA
131
how do you confirm post infection lactase deficiency
clinitest result is positive, shows sugars in the stool
132
what are the symptoms of gastroenteritis?
sudden change to loose watery diarrhoea
133
what children are at particular risk of dehydration in gastroenteritis?
``` under 6m premature over 6 stools in past 24 hours vomited 3+ times in last 24 hours already have malnutrition ```
134
what might happen if rehydration solutions are not given to a dehydrated child-just water?
fluid will move into intracellular compartments, will lead to convulsions (increased brain volume) and lower extracellular volume will lead to more extreme shock
135
define prematurity
up to 36+6
136
at what age do you start developing alveoli?
after 24 weeks
137
what do maternal steroids do?
activate type 2 pneumocytes
138
how could toxoplasmosis manifest in a neonate?
``` jaundice miscarriage fetal abnormalites hydrocephalus microcephaly chorioretinitis epilepsy anaemia ```
139
what infections can cause opthalmia neonatorum?
gonorrhoea chlamydia strep pneumoniae staph aureus
140
when are infections screened for?
before 16 weeks
141
what infections are screened for in a mother?
HIV syphilis hep B UTIs
142
management of pregnant woman with hep B?
IVIg of hep B | vaccinate infant at birth
143
how is GBS in a pregnant woman treated?
intrapartum IV benzylpenicillin or ampicillin
144
how should MRSA sepsis be treated in an infant?
IV vancomycin and gentamicin
145
what are the neonatal features of Rubella?
part of TORCH so: prematurity, IUGR, haemolytic anaemia, jaundice, deafness, learning difficulty, microcephaly, congenital heart disease, failure to thrive, anaemia, thrombocytopenia
146
how do you test a mother for rubella?
IgM in saliva
147
what is the most commonly vertically transmitted infection?
CMV
148
how is CMV treated in infants?
IV ganciclovir
149
how can neonatal jaundice be treated?
either phototherapy or if more extreme then exchange transfusion
150
how do you calculate corrected age of a preterm infant?
their age+how many weeks they're premature by
151
when is maternal IgG transferred?
in the last 3 months of pregnancy
152
how is otitis media treated?
conservatively, antibiotics sometimes given but eustachian tube autoinflation can be used complication includes glue ear then mastoiditis
153
what will cause the low grade fever of appendicitis to increase?
peritonitis, sepsis, gangrene
154
what should be used with recurrent venous access and so a risk of thrombophlebitis?
central line
155
what defines acute diarrhoea?
under 14 days
156
causes of acute diarrhoea in children?
viral: rotavirus, adenovirus bacterial: salmonella, e coli parasites: giardia, entaoemoeba histiolytics
157
what are the 6 features of colitis
``` crampy abdo pain diarrhoea urgency tenesmus nocturnal soiling blood/mucus in stool ```
158
causes of chronic diarrhoea
intolerances: coeliac, CMPA, lactose CMV or adenovirus and parasites graft versus host disease
159
diarrhoea investigations
stool ova, cysts and parasites, mc and s coeliac screen calprotectin for ibd
160
what are the crohns lesions of the mouth?
orofacial granulomatosis
161
when does perforation occur in UC
only with toxic megacolon (also by C diff and CMV)
162
2 aims of treatment of IBD
induce (steroids) and maintain remission (5 aminosalicylates then biologics)
163
what is sulfasalazine
a 5 aminosalicylate-SEs include headache, SJS, hepatitis
164
what is gliadin taken up by in coeliac disease?
dendritic cells the presented on HLA DQ2
165
what are the histological findings on a biopsy of coeliac disease?
crypt hypertrophy villous atrophy intraepithelial lymphocytosis infiltration of lamina propria
166
what are the risk factors for DDH
female first child other abnormalities breech
167
what is the treatment of talipes equinovarus?
ponseti casting TA release boots bar
168
what gene defect is present in achondroplasia?
FGFR3
169
where are type 2 salter harris fractures?
through metaphysis and grwoth plate
170
how many microorganisms are needed for a diagnosis of UTI?
10X5 organisms per mL
171
when can dimercatosuccinic acid scinitgraphy show?
scarring in the kidneys, but only 3 months after infection
172
when is otitis media most common?
6-12 months
173
what are the features of turners?
``` lymphodema of hands and feet spoon shaped nails short stature coarctation of aorta delayed pbery infertility hypothyroidism recurrent otitis media ```
174
what are the organic causes of nocturnal enuresis?
UTI fecal retention polyuria (DM and CKD)
175
how should DDH be managed?
USS then refer to orthopaedics
176
what is deficient in CAH?
21 hydroxylase
177
what are the symptoms of a salt losing crisis?
vomiting weight loss floppy and unwell
178
when should testes have descended by?
2 years
179
how do you calculate expected height?
ave height +7 for boys -7 for girls
180
how many coughs and colds does a normal child have per year?
8
181
how do choleducal cysts usually present?
in children under 10 with jaundice, upper abdo mass and abdo pain may also give asc cholangitis and pancreatitis
182
give the name of a gene involved in coeliac disease
HLA DQ2.5 or 8
183
what is the triad of problems involved in West syndrome?
``` infantile spasms (1/2s that cause distress) developmental delay hypsarrythmia ```
184
what kind of infection causes perhilar patchiness?
mycoplasma pneumoniae
185
when should testes have descended?
9m
186
what is the change seen in minimal change nephropathy?
fused podocytes
187
how is bronch dx?
nasopharangeal aspirate
188
CF chest infections
S aureus P aeruginosae H influenzae
189
what does Guthrie's test measure for CF?
immunoreactive trypsinogen
190
features of Potter's
limb deformities-severe talipes epicanthic folds beaked nose pulmonary hypoplasia leading to resp distress
191
when does SIDS most commonly occur?
2-4months
192
RFs for SIDS
``` boys preterm low birthweight multiple birth poor parents single mum mum high parity maternal smoking ```
193
what's the difference down the microscope between N meningitidis and S pneumoniae?
N meningitidis=gram NEGATIVE diplococci | S pneumoniae=gram POSITIVE diplococci
194
causes of neonatal jaundice?
alpha 1 antitrypsin deficiency | biliary atresia
195
common causes of nephrotic syndrome in children?
minimal change nephropathy focal segmental glomerulosclerosis post strep nephritis
196
what is the triad of nephrotic syndrome?
hypoalbuminaemia proteinuria oedema
197
what kidney condition do you need to check lipids in?
nephrotic syndrome
198
how do you manage steroid resistant nephrotic syndrome?
diuretics, salt restriction, ACEi, NSAIDs, ciclos[orin
199
what infection is the prodrome to HSP?
strep pyogenes
200
at what ages do febrile convulsions occur?
6m-3yr
201
what is measured in the quadruple test?
AFP, oestrodiol, hCG, inhibin A
202
congenital anomaly screen at 20 weeks, what do you look for
neural tube defects major heart defects renal agenesis skeletal abnormalities
203
when does the newborn exam need to be done?
within 72 hours then 6-8 week baby check
204
what is done in school screening?
vision, growth, obesity at 4 and 11
205
parts of baby check you missed!
femoral pulses height, weight, head circumference anus
206
how do you treat phenylketonuria?
avoid seafood and eggs | low protein
207
how do you treat medium chain acyl coA dehydrogenase deficiency
avoid fasting | give glucose and carb supplements
208
what are the different things found in CVS and amniocentesis?
CVS: chromosome disorders and inherited disorders | amniocentesis-chromosome disorders and ssex
209
general management priciples of Downs
echo at birth regular hearing, visual and dental appointments thyroid and coeliac screening educational
210
what is the pavolik harness used for?
DDH, also use surgical reduction-ponseti is talipes
211
specific pathophysiology behind athetoid CP?
BG lesion due to bilirubin encephalopathy or HIE gives ESPEs and fluctuation between hypo and hypertonia
212
what are the risk factors for CP
traumatic birth twins perterm maternal infection
213
number of compressions in children
5breaths | 15 compresssions then 15:2
214
what are the benefits and drawbacks to breastfeeding?
benefits: better bonding mother: reduced breast cancer risk baby: optimal nutrition, reduced NEC, GI infection DM, obesity
215
what causes diptheria?
Corynebacterium diptheriae
216
what causes erythema multiforme (target lesions)
mycoplasma pneumoniae HSV amoxicillin mostly viral infection though
217
what investigations should be done if you suspect a neruoblastoma?
24hr VMA and HVA
218
which leukaemias can imaninib be used in?
ALL and CML
219
what infections are associated with ALL?
Pneumocystic jirovecii pneumonia diseminated fungal coag -ve staph of central venous catheter
220
what are the side effects of chemotherapy
``` infection anorexia alopecia gut mucosal damage N&V ```
221
what are the 5 stages of chemotherapy?
induction, consolidation, interim maintainence, delayed intensification, maintainence
222
most common UTI of childhood?
E coli | klebsiella pneumoniae
223
what determines if a child with pneumonia gets IV?
in resp distress or pleural effusion or under 3
224
what infections are common in CF?
psudomonas and staph aureus
225
how is children's hearing tested?
evoked otoacoustic emission at birth then move on to automated auditory brainstem response if they have poor result
226
what kind of brain tumours occur in children?
astrocytoma and glioblastoma
227
complications of nephrotic syndrome
hypercholesterolaemia hypovolaemia thrombosis infection

3a (11 decks)

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