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Phase 3a > Paeds > Flashcards

Paeds Flashcards

1
Q

What is the most common pathogen to cause Bronchiolitis?

A

RSV

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2
Q

What is the most common pathogen to cause Croup?

A

Parainfluenza virus

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3
Q

What are the symptoms of Bronchiolitis?

A

Common cold symptoms, dry cough

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4
Q

What are the signs in Bronchiolitis?

A

Tachypnoea, Tachycardia, Subcostal & Intercostal recessions, Hyperinflation, Fine end-inspiratory crackles, High pitch wheeze

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5
Q

What is the management for Bronchiolitis?

A

Fluids, Paracetamol, Supportive e.g. humidified oxygen, CPAP

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6
Q

What is the other name for Croup?

A

laryngotracheobronchitis

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7
Q

What are the symptoms of Croup?

A

Common cold symptoms, cough, fever, malaise, hoarseness, typically worse at night

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8
Q

What are the signs of Croup?

A

Barking cough, chest recessions

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9
Q

What is the management of mild Croup?

A

Paracetamol, Ibuprofen, one-off dose of dexamethasone

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10
Q

What is the management for moderate Croup?

A

Paracetamol, Ibuprofen, oral dexamethasone, prednisolone or nebuliser steroids

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11
Q

What is the management of severe Croup?

A

Addition of nebulised adrenaline (1mg/ml)

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12
Q

A child presents with stridor, what condition is it important to rule out other than Croup?

A

Epiglottitis

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13
Q

What is the pathogen that causes Epiglottitis?

A

Haemophilus influenzae B

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14
Q

How would you differentiate Epiglottits from Croup?

A

1) No prodrome
2) More acute onset (hours not days)
3) No barking cough
4) Can’t drink
5) Drooling
6) Soft breathing sounds

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15
Q

What are the causative pathogens of pneumonia in neonates?

A

1) Group B Strep
2) E.coli
3) Klebsiella

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16
Q

What is the causative pathogen of pneumonia in older children?

A

1) Strep pneumoniae

2) Mycoplasma pneumoniae

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17
Q

What are the symptoms of pneumonia?

A

Shortness of breath, cough, pleuritic chest pain

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18
Q

What are the signs of pneumonia?

A

Fever, dull percussion, crackles, bronchial breathing, signs of respiratory distress (chest recessions)

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19
Q

Is a cough in pneumonia likely to be productive or non-productive in children?

A

Non-productive (may be in older children)

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20
Q

How is pneumonia diagnosed in children if mild?

A

Clinically

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21
Q

What investigations could be done for pneumonia if the symptoms are severe?

A

Nasopharyngeal aspirate, Blood culture, chest x-ray

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22
Q

What is the antibiotic for pneumonia in a child?

A

Amoxicillin

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23
Q

List some possible causes for constipation in a child

A

1) Normal/physiological
2) Hypothyroidism
3) Coeliac
4) Hirschsprung’s disease
5) Spina bifida
6) Anorectal abnormality
7) Crohn’s disease

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24
Q

What are the symptoms of constipation?

A

Pain when passing stools, straining on passing stools, hard stools

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25
Q

Do children typically appear well or unwell when constipated?

A

Well

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26
Q

What are the clinical features of long-standing constipation?

A

Over-distended rectum, loss of sensation in the anus, involuntary soiling

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27
Q

What is the reason for involuntary soiling in children with long-standing constipation?

A

Loss of sensation of needing to go to the toilet as well as liquid faeces from the small intestine leaking around the hard compacted faeces

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28
Q

What is the red flag related to constipation for Hirschsprung’s disease?

A

Failure to pass meconium

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29
Q

What is the red flag related to constipation for hypothyroid and coeliac disease?

A

Faltering growth

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30
Q

What may you be concerned about in a child with a distended abdomen and constipation?

A

Hirschsprung’s disease, GI immobility or obstruction

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31
Q

What would you be concern about if a child with constipation and perianal fistula, accesses or fissures?

A

Crohn’s disease

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32
Q

What is used to treat constipation in children?

A

Movicol

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33
Q

What two causative pathogens may be responsible for a UTI in children?

A

E.coli or Klebsiella

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34
Q

What are the clinical features of a UTI in infants?

A

Fever, vomiting, lethargy, poor feeding/faltering growth, offensive urine, febrile seizures

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35
Q

What are the clinical features in a child (non-infant)?

A

Same as infant (Fever, vomiting, lethargy, poor feeding/faltering growth, offensive urine, febrile seizures) plus dysuria, frequency, abdominal pain, recurrent enuresis

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36
Q

What is enuresis?

A

involuntary urination - particularly at night

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37
Q

What is used to diagnose a UTI?

A

Urine dipstick (Urinalysis)

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38
Q

What is the first-line treatment for a UTI in children?

A

Trimethoprim (first-line)

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39
Q

For how long do you treat a lower UTI?

A

3 days

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40
Q

For how long do you treat a upper UTI?

A

7 days

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41
Q

What further investigations can you do for a child who gets UTIs?

A

Ultrasound of kidneys, ureters and bladder; MCUG - reflux into kidneys; DMSA - renal scarring; MAG3 - structure and blockage of kidneys

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42
Q

What is Pyelonephritis and what complications can It lead to?

A

Bacterial infection of the renal parenchyma which can lead to renal scarring, hypertension and chronic kidney disease

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43
Q

What is the pathophysiology of asthma?

A

Bronchial inflammation leading to bronchial hyper-responsiveness and airway narrowing

44
Q

How is asthma diagnosed in children over 5?

A

Spirometry - bronchodilator reversibility demonstrated

45
Q

What percentage improvement of what value demonstrates bronchiodilator reversibility?

A

12% improvement in FEV1

46
Q

In a child what is the first step in treating asthma?

A

SABA e.g. salbutamol

47
Q

In a child who is already taking a SABA what is the next step to control symptoms in asthma?

A

Add inhaled corticosteroids e.g. beclomethasone

48
Q

In a child >5 who is already taking a SABA and inhaled corticosteroids, what is the next step in treating symptoms in asthma?

A

Long-acting corticosteroids e.g. salmeterol

49
Q

In a child <5 years old who is on a SABA and inhaled corticosteroids what is the next step in treating symptoms of asthma?

A

Increase corticosteroids

50
Q

In a child >5 years old who is on a SABA, inhaled corticosteroids and a LABA what is the next step in treating symptoms of asthma?

A

Increase inhaled corticosteroids

51
Q

In a child <5 years old who is on a SABA and increased dose of inhaled corticosteroids what is the next step in treating symptoms of asthma?

A

Refer to paediatrician

52
Q

In a child who is on a SABA, increased inhaled corticosteroids, LABA what is the next step in treating symptoms of asthma?

A

Introduce oral steroids (done by a specialist)

53
Q

What is the management of a moderate acute exacerbation of asthma in a child?

A

SABA (2 puffs every 2 minutes up to 10 puffs), oral prednisolone (1 to 2mg per kg, up to 40mg)

54
Q

What is the management for a severe acute exacerbation of asthma in a child?

A

SABA (10 puffs or nebulised), oral prednisolone or IV hydrocortisone, consider inhaled ipratropium or IV salbutamol, aminophyline or magnesium

55
Q

What is the cause of Henoch-Schönlein Purpura (HSP)?

A

Unknown exact cause - often follows respiratory tract infection

56
Q

What are the clinical features of HSP?

A

Fever, rash (buttocks, extensor surfaces, typically not trunk), joint pain Itypically knees or ankles), colicky abdominal pain, renal involvement (hameturia or proteinuria)

57
Q

What investigations are done if HSP is suspected?

A

Urinalysis - check for renal involvement

58
Q

What is the management of HSP?

A

HSP is self-limiting, renal follow-up needed to check renal function

59
Q

What is the most likely diagnosis of the following: low-grade fever, headache, malaise followed by progressive swelling of one or both parotid glands?

A

Mumps

60
Q

What is the most likely diagnosis: Fever, cough, coryza, conjunctivitis, generalised maculopapular rash starting several days after fever that starts behind the ears then spreads

A

Measles

61
Q

What is the most likely diagnosis: Rash that appears on the face then spreads to the trunk and limbs with low-grade fever, sub occipital and posterior cervical lymphadenopathy, joint pains and conjunctivitis

A

Rubella (German Measles)

62
Q

What is the most likely diagnosis: Flu-like symptoms, cervical lymphadenopathy, sandpaper-like rash on chest and abdomen with a strawberry tongue

A

Scarlet fever

63
Q

What is the most likely diagnosis: polymorphous rash, cervical lymphadenopathy, strawberry tongue and cracked lips, Bilateral conjunctival injection with a fever

A

Kawasaki disease

64
Q

What is the cause of Scarlet fever?

A

Group A Strep

65
Q

What is the cause of Kawasaki disease?

A

Unknown - mix of genetic and environmental factors

66
Q

What is the management of Kawasaki disease?

A

High-dose Aspirin, Iv immunoglobulins

67
Q

What is the potential complication with the use of Aspirin in children?

A

Reye’s syndrome - damage to mitochondria can lead to brain and liver damage

68
Q

What complications can occur from Kawasaki disease?

A

Inflammation of blood vessels leading to thrombosis, aneurysm formation and aneurysm rupture

69
Q

What is the criteria for diagnosis of Kawasaki?

A

Fever lasting at least 5 days with four of the following: Bilateral conjunctival injection, change in mucous membranes, change in extremities, polymorphous rash, cervical lymphadenopathy

70
Q

What is the treatment for mumps?

A

Supportive

71
Q

What is the treatment for measles?

A

Supportive

72
Q

What is the treatment for rubella?

A

Supportive

73
Q

What complications can occur with mumps?

A

Painful testicular swelling, ovarian inflammation, acute pancreatitis, inflammation of the brain, hearing loss

74
Q

What complications can occur with measles?

A

Diarrhoea, pneumonia, bronchitis, otitis media, brain inflammation, corneal ulceration

75
Q

What problems can be seen in Congenital Rubella Syndrome?

A

Cardiac abnormalities (PDA is most common), cerebral, ophthalmic and auditory defects, prematurity with low birth weight, neonatal thrombocytopenia, anaemia and hepatitis

76
Q

What infections are part of the TORCH syndrome/Complex?

A

Toxoplasmosis, CMV, Herpes simplex (plu syphilis, paravirus and varicella zoster)

77
Q

What are the symptoms that occur with TORCH Syndrome/Complex?

A

Hepatosplenomegaly, fever, lethargy, difficulty feeding, anaemia, petechiae, Purpura, jaundice, chorioretinitis (inflammation of the chorioid and retina)

78
Q

What is Juvenile Idiopathic Arthritis?

A

Persistent joint swelling, starting before the age of 16 that lasts for 6 weeks or more

79
Q

In addition to joint swelling, joint pain, loss of movement and limp what other symptoms are there in JIA?

A

Systemic symptoms e.g. Generalised cervical lymphadenopathy, fever, malaise, pallor, reduced appetite

80
Q

What is the management of JIA?

A

NSAIDs, analgesia corticosteroid joint injections, methotrexate, systemic corticosteroids, cytokine modulators e.g. anti-TNF

81
Q

What is the carrier rate for cystic fibrosis?

A

1 in 25

82
Q

What is the most common mutation in Cystic Fibrosis?

A

F508

83
Q

How might someone with CF present as a Neonate?

A

Meconium ileus

84
Q

How might someone with CF present as an infant?

A

Prolonged jaundice, faltering growth, recurrent chest infections, malabsorption, steatorrhoea

85
Q

How might someone with CF present as a young child?

A

Bronchiectasis, nasal polyps, rectal prolapsed, sinusitis

86
Q

How might someone with CF present as an older child or adolescent?

A

Diabetes mellitus, liver cirrhosis, portal hypertension, distal intestinal obstruction, pneumothorax, haemoptysis, sterility in males

87
Q

What examination findings may you find in someone with CF?

A

Productive cough, hyperinflation of the chest, coarse inspiratory crackles, exploratory wheeze, finger clubbing

88
Q

How is Cystic Fibrosis diagnosed?

A

High-risk babies identified through heel-prick test, confirmation is through sweat test and genetic testing

89
Q

What is the other name for the heel-prick test?

A

Guthrie test

90
Q

What is involved in the management of Cystic Fibrosis?

A

Physiotherpy, regular hypertonic saline nebuliser, nutritional monitoring, high calorie diet (150% of normal calorie intake), fat-soluble vitamins, treatment of complications and lung-transplant at end-stage

91
Q

What is tested in the heel-prick/Guthrie test of a newborn?

A

1) Cystic fibrosis
2) Sickle cell disease
3) Congenital hypothyroidism

Inherited Metabolic Diseases:

4) Phenylketonuria (PKU)
5) Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
6) Maple syrup urine disease (MSUD)
7) Isovaleric acidaemia (IVA)
8) Glutaric aciduria type 1 (GA1)
9) Homocystinuria (HCU)

92
Q

What is the most common cause of Congenital Hypothyroidism in the UK?

A

Dygenesis - the thyroid gland is not in the right position and does not function properly

93
Q

What is the most common cause of Congenital Hypothyroidism worldwide?

A

Iodine deficiency

94
Q

What are the features of Congenital Hypothyroidism?

A

Faltering growth, feeding difficulties, prolonged jaundice, constipation, large tongue, hoarse cry, goitre, delayed development, umbilical hernia

95
Q

How is congenital hypothyroidism diagnosed and what would be seen on the blood tests?

A

Newborn screening (Guthrie test) - bloods would show high TSH level

96
Q

What is the management of congenital hypothyroidism?

A

Levothyroxine

97
Q

What is the potential complication that can occur with a child born with iodine deficiency?

A

Cretinism - severely stunted physical and mental development with learning difficulties, clumsiness, short stature and large tongue

98
Q

What is the cause of congenital adrenal hyperplasia?

A

Autosomal recessive disorder (relating to adrenal steroid biosynthesis)

99
Q

What are the physical signs of Congenital Adrenal Hyperplasia in females?

A

Virillisation of the external genirtalia (clitoral hypertrophy and fusion of the labia) - genital ambiguity

100
Q

What are the physical signs for Congenital Adrenal Hyperplasia in males?

A

Enlarged penis with pigmented scrotum

101
Q

When is Congenital Adrenal Hyperplasia typically diagnosed in females?

A

At birth due to genital ambiguity

102
Q

When is Congenital Adrenal Hyperplasia typically diagnosed in males - why is it different to females?

A

When they present with salt-losing crisis or additional symptoms - due to less obvious genital changes it is often missed in males at birth

103
Q

What are the symptoms of a salt-losing crisis due to Congenital Adrenal Hyperplasia?

A

Vomiting, weight loss, hypotonia, circulatory collapse (low sodium, high potassium with metabolic acidosis and hypoglycaemia)

104
Q

What is the treatment for Congenital Adrenal Hyperplasia?

A

Life-long hydrocortisone and fludrocortisone if a salt-loser

105
Q

What treatment is given for a salt-losing crisis?

A

IV sodium chloride, IV glucose, IV hydrocortisone

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