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Big Reece's Little Specialties > Paeds > Flashcards

Paeds Flashcards

1
Q

Left to right shunts

A

Breathless
VSD
ASD
persistant arterial duct

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2
Q

Right to left shunts

A

Cyanotic/blue
Tetralogy of fallot
Transposition of great arteries

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3
Q

Outflow obstruction in a well child (symptomatic w/ murmur)

A

Pulmonary stenosis

Aortic stenosis

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4
Q

Outflow obstruction in a sick neonate

A

Coarcatation of the aorta

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5
Q

ASD key signs

A

Ejection systolic murmur, loudest at sternal edge
Fixed and widely split S2
Secundum - RBBB and R axis deviation
Partial AVSD - apical pan systolic murmur, Superior QRS )(-ve AVF)

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6
Q

ASD associations

A 
Foetal Alcohol syndrome
Noonan Syndrome (PTPN11 mutation)
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7
Q

ASD Rx

A

Secundum - catheterisation and occlusion device (close PFO)

pAVSD - Surgery

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8
Q

Small VSD signs and treatment

A 
Asymptomatic
Loud Pansystolic murmur
Quiet P2 
Normal ECG
Closes spontaneously
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9
Q

Large VSD signs and treatment

A 
Heart failure
Breathless (L to R shunt)
quiet/no pan systolic murmur
Loud P2
Biventricular hypertrophy on ECG
Pulm HTN - upright T wave, Eisenmenger syndrome
Needs surgery
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10
Q

VSD assocations

A

Foetal alcohol syndrome

Down’s

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11
Q

Persistant ductus arteriosus signs, management and associations

A

Associated w/ Rubella
Continuous murmur below the left clavicle
Collapsing/Bounding pulse
Usually asymptomatic unless large - then acts like large VSD
Close w/ coil/occlusion device

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12
Q

Tetralogy of fallot- 4 signs and the shunt

What is the murmur

A

Large VSD
Overiding aorta
Right Ventricular hypertrophy
Pulmonary stenosis

Right to left shunt - blue, cyanotic
ES murmur at left sternal edge
Hypercyanotic spells after sleep
Finger clubbing

Lets Voluntarily Open ouR ring pieces everyone! - Large VSD, Overriding aorta, right to left shunt, RVH, PS, ES murmur

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13
Q

Tetralogy of fallot assocations

A

Foetal alcohol syndrome, diGeorge’s

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14
Q

Tetralogyof fallot treartment

A

surgery at 6-9m

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15
Q

Transposition of great arteries treatment

A

Maintain PDA with prostaglandins
arterial switching surgery in first few days of life
Can do balloon atrial septostomy to save life

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16
Q

Transposition of great arteries signs

A

R to left shunt
Cyanosis
S2 loud and singular
often no murmur

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17
Q

when do you review an undisseneded testis & when should they have orchoplexy by

A

3m review

surgery before 6m

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18
Q

what are features of an innocent murmur

A 
Varies w/ posture
Soft blowing in the pulmonary area
Short buzzing in the aortic area
No diastolic component 
No radiation
No thrill
no added sounds
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19
Q

What is the Rx for Enuresis

A 
Star chart
Toilet training
reduce liquid and toilet before bed time
Enuresis alarm if <7
Desmopressin if needed short term or don't want alarm >7
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20
Q

When do all breech babies get to check for DDH and when

A

bilateral hip USS at 6 weeks

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21
Q

ALL features

A

Presents between 2 and 5

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae

And other features
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
fever is present in up to 50% of new cases (representing infection or constitutional symptom)
testicular swelling

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22
Q

Signs of rubella in child

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

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23
Q

Phimosis

A

Normal foreskin won’t retract from ~3 (don’t try and retract as a neonate, and half of one year olds wont retract)
This causes muzzling of the glans
Commonest cause is balantis xerotica obliteratans –> usually used to have a retractile foreskin
Circumsize

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24
Q

Hyposapdias

A

ventral urethral meatus - usually on distal shaft or glans penis
Ventral curation of the shaft, more apparent on erection
Hooded appearance of the foreskin

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25
Q

what does a neuroblastoma affect and what are the features

A

Affects the neural crest tissue (in the adrenal medulla) and the sympathetic chain
Usually have an abdominal mass
Get’s met features - LN, bone pain, bone marrow suppression etc

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26
Q

what is a wilms tumour and what does it affect

A

From embryonal renal tissue
Usually presents before 5, rarely seen after 10
Usually a large abdominal mass in an otherwise well child, can have haematuria

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27
Q

Congenital adrenal hyperplasia features (21a hydroxylase)

A

Insufficient cortisol and aldosterone –> Raised ACTH
Can have salt loosing crisis - 1w to 3w of age, usually males, with vomiting, weight loss, hypotonia and circulatory collapse

Increased production of testosterone:
Virilisation of external genitalia in females - clitoral hypertrophy, variable fusion of the labour
In males can have enlarged penis and pigmented scrotum but usually only seen after diagnosis
Muscular build, adult body odour, pubic hair, acne - precocious pubarche

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28
Q

Rx of congenital adrenal hyperplasia

A 
Lifelong glucorticoids (hydrocortisone) to suppress ACTH --> additional with illness or surgery 
FLudorcortisone if there is salt loss
Monitor growth, skeletal maturity, plasma adrongens, 17a progesterone
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29
Q

what diet can be used in chrons

A

Whole protein modular feeds (polymeric diet) for 6-8 weeks

Use steroids and immunosuppression if this fails to cause remission

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30
Q

facial features of Down’s

A 
round face
flat nose
Epicanthic folds
Brushfield spots in iris 
Small mouth
Protruding tongue
small ear
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31
Q

Other features of down’s (not facial) in baby

A 
Single palmar crease
wide sandal gap
Incurving and short 5th finger
VSD
ASVD
hypotonia 
duodenal artesia 
Hirschsprung disease
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32
Q

premature pubarche age

A

8 in girls

9 in boys

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33
Q

Delayed puberty age

A

14 in girls

15 in boys

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34
Q

Causes of short stature

A 
Familial (check mid parental height)
Constitutional - variation of normal growth (will end up growing normal, just delayed)
Turner's syndrome 
Noonan Syndrome 
Russel-Sliver syndrome
Coeliac
Crohn;s
CKD
Psychosocial deprivation
Hypothyroidism
Growth hormone deficiency 
Cushing syndrome
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35
Q

Causes of premature puberty

A 
Females:
Gonadotrophin independent - (Low FSH and LH) - Excess androgens from congenital adrenal hyperplasia or adrenal tumour (virilisation of genitalia before breast development) or ovarian tumour 
Gonadotrophin dependent (high FSH and LH) - Pituitary adenoma, hypothyroidism, , Neuro issues e.g hydrocephalus, post-irritadation,  tumours (craniophayngioma, neurofibromatosis)

Males:
gonadotrophin dependent (bilateral testicular enlargement) Intracranial tumour or rarely ßHCG secreting liver tumour
Gonadotrophin independent (small testicles) - Congenital adrenal hyperplasia or adrenal tumour
Check for testicular tumour

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36
Q

Signs of Turners syndrome and abnormality

A 
45X
wide spaced nipple, 
low posterior hair line, 
ovary dygenesis, 
short, 
neck webbing, 
spoon shaped nails, 
pigmented moles, 
coarctation of the aorta, 
bicuspid aortic valve 
wide carrying angle, 
recurrent otitis media
hypothyroidism 
lymphedema of the hands and feet in the neonate
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37
Q

Noonan Syndrome features

A

PTNP11 mutation
-characteristic faces - wide set eyes, ptosis, proptosis, large head, high hairline, broad forehead, low set backwards rotated ears
occasional mild learning difficulties
short webbed neck with trident hair line,
pectus excavatum,
short stature,
Pulmonary stenosis and ASD

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38
Q

how long do you have to wait after a live vaccine to give the MMR

A

4 weeks

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39
Q

Diarrhoea, with undigested food and no other systemic symptoms, what is the diagnosis

A

Toddler’s diarrhoea

They have faster transit of food through the GIT

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40
Q

Risk factors for developmental dysplasia of the hip

A 
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
41
Q

Does caput seccudeum cross the suture lines

A

Yes

superficial scalp oedema associated w/ prolonged labour

42
Q

Does Cephalohaematoma cross the suture lines

A

No

bleeding between the periosteum and skull, most common parietaly

43
Q

what increases risk of cleft lip/palate
How is it inherited
How do you treat it and when

A 
maternal anti-epileptic use 
polygenic inheritance
repair cleft lip at 3m 
Repair cleft palate at 6-12m 
N.b cleft palate can making feeding more difficult and can increase the risk of acute otitis media (avoid an adenectomy as it will exacerbate feeding problems and nasal quality of speech)
44
Q

what is covered in peritoneum, an Omphalocele or gastroschisis
how do you manage both?

A

An omphalocele
An omphalocele is a defect with umbilicus
Manage omphalocele with gradual repair, starting immediately and completed over 6-12m to prevent respiratory complications

Gastroschsis is a defect lateral to the umbilicus
Cover a gastroschsis with clingfilm to prevent dehydration and protein loss, pass an NG tube and surgical repair straight away

45
Q

was is the Pierre robin sequence

A

Micoganthia (small jaw)
& posterior displacement of the tongue
+ Midline cleft of soft palate
Can cause obstruction, cyanotic episodes, feeding difficulties

46
Q

what is ebsteins anomaly and what is the main risk factor

A 
"atrialisation" of the right heart
Tricuspid valve moved downward w/ tricuspid regard (early systolic murmur) 
right ventricular conduction defects
can get Wolf_parkinson_white syndrome
use of lithium during pregnancy
47
Q

Rx for UTI in kids

A

infants less than 3 months old should be referred immediately to a paediatrician

children aged more than 3 months old with an upper UTI should be considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days

children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours

48
Q

Rx for Necrotising Enterocolitis

A

Treatment is with total gut rest and TPN, babies with perforations will require laparotomy

49
Q

Signs and Rx of Intrusussception

A

Telescoping bowel
Proximal to or at the level of, ileocaecal valve
6-9 months of age
paroxysmal, severe, Colicky pain,
diarrhoea
bilious or non bilous vomiting (depends on location), sausage-shaped mass,
red jelly stool.
Treatment: reduction with air insufflation- 3 attempts due to risk of perforation –> then go for surgical reduction

50
Q

Signs of hypernatraemia dehydration

A 
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
51
Q

What are signs of PDA and how do you close it

A 
left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat

Close with indomethacin/NSAIDS

52
Q

what is Congenital dermal melanocytosis

A

commonly called Mongolian blue spot.
These are purplish-blue flat macules on the lower back, buttocks and lower limbs.
They are usually found in darker skinned babies, including those of African and Asian descent, though can be found in Caucasian babies.

53
Q

Threadworm Signs and Rx

A

Threadworm infestation is asymptomatic in around 90% of cases, possible features include:
perianal itching, particularly at night
girls may have vulval symptoms

CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists

54
Q

treating Kawasaki disease

A

High dose aspirin
IVIG
echocardiogram to look for coronary artery aneyrysms

55
Q

Rx for small, recurrent, epistaxis with no sister features

A

short course of topical chlorhexidine and neomycin, and discourage the child from picking his nose

56
Q

what is a common complications of viral gastroenteritis

A

Transient lactose intolerance, presenting with diarrhoea

57
Q

Features of West Syndrome

A

infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents in the first 4 to 8 months of life and is more common in male infants. They are often associated with a serious underlying condition and carry a poor prognosis

Features
characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap

Investigation
the EEG shows hypsarrhythmia in two-thirds of infants
CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)

Management
poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used

58
Q

what do you use to treat mycoplasma pneumonia

A

A macrolide

59
Q

Features of juvenile idiopathic arthritis

A 
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
60
Q

Achondroplasia Features

A

Achondroplasia is an autosomal dominant disorder associated with short stature. It is caused by a mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene. This results in abnormal cartilage giving rise to:
short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis

61
Q

when is the Guthrie test performed

A

between 5 and 9 days

62
Q

treatment for spastic CP

A

treatments for spasticity include oral diazepam,
oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy

anticonvulsants, analgesia as required

63
Q

Necrotsing enterocolitis signs (and X-ray signs) and Rx

A 
Often preterm neonates
Feed intolerance
Vomiting (may be bile stained)
Distended abdomen 
Stool with fresh blood
Shock

Thickening of the bowel wall with intramural gas
Distended loops of bowel
gas in the portal tract

NBM, Total parenteral nutirtion
Broad spec ABx
Surgery for perforation

64
Q

Jaundice causes <24 hours

A

Haemolytic stuff - Rh, ABO G6PD, spherocytosis, pyruvate kinase deficiency
Sespsi

65
Q

Jaundice cause at 24hr to 2 weeks

A

Physiological )and breast milk jaundice -=-> dehydration can excaerbate
infection or haemolysis
Bruising
polycythema
Crigler-Najjar - rare, glucrunoyl transferase is missing - high unconjugated bilirubin

66
Q

Persistant jaundice >2weeks

A 
Unconjugated:
Pyloric stenosis 
Infection - UTI
Hypothyroidism
Haemolytic anaemia

Conjuagated (>25)
Bile duct obstruction
Hepatitis

67
Q

Rx for neonatal jaundice

A

Plot on serial bilirubin chart
Phototherapy (450nm blue light) - can cause macular rash and bronzing of the skin
Exchange transfusion

68
Q

what is the risk of high unconjugated bilirubin

A

Kernictus –> encephalopathy

69
Q

Meconium aspiration pathophysiology and signs

A

Meconium results in obstruction + is an irritant (chemical pneumonitis) + predisposes to infection
Passed in response to hypoxia

Tachypnoea (>60), laboured breathing (recessions) nasal flaring, expiratory grunting, cyanosis
Lungs are overinflated w/ areas of consolidation and colapse

#Rx = mechanically ventialte
No evidence sucking out meconium does anything
70
Q

what SSRI is most commonly associated with persistent pulmonary hypertension

A

Sertraline

71
Q

Oesophgeal artesia signs

Rx

A

Assoc with polyhyrdramnios
Absent stomach bubble on antental USS

Persistant salivation and drooling from the mouth
Cough and choke on feeds
Aspiration of saliva, milk, acid
Most will have VACTREL malformations

Pass a wide calliber NG tube
Continuous suction
Surgical correction

72
Q

What conditions can Staph cayse

A

Impertigo - honey crusted skin
Boils
Perioribital cellulitis
Staph scalded skin syndrome - exfoliative toxin causes seperation of the epidermis –> fever, malaise, pruluent crusting around eyes/nose/mouth and then Nikolsky sign positive, erythema tenderness of the skin

73
Q

Measles signs

A 
Fever
cough 
runny nose
marked malaise
Koplik spots (white spots on tongue)
Keratoconjuctivits
Coryza
Maculopapular red rash, spreading downwards from behind ears --> becomes blotych and confluent, then can desquamate

complications - pneumonia, enecphalitis (1 in 5000),
subacute sclerosising panenecphalitis (1 in 100,000)- 7 years after measles infection - loss of neurological function, progressing to dementia and death

74
Q

Signs of mumps

A

fever
Maliase
Parotitis (one side, but then bilateral over the next few days) –> ear ache, pain on eating and dinking
infective for 7 days afterr parototis
unilateal transient hearing loss
Plasma amylase raised
Can cause orchitis - but infertility is unusual

75
Q

signs of rubella

A

mild/lowgrade fever prodrome
Rash - initially on face then spreading centrfugially to whole body
Postauricular and suboccipital LN

76
Q

signs of scarlet fever

A

Strep throat/pahrynigits (exudative and enlarged tonsils, Cervical LN, sore throat)
White strawberry tongue, which desquamates leaving red strawberry tongue
SANDPAPER red rash, appears first on trumk, small papulles resembling goosebumps - palms and soles left univlved
rash more pronounced in skin creases
flsuehd face
Pastia’s Lines which are petechiae arranged in a linear pattern
desqumates about a week later leaving a sunburnt appearance

77
Q

red current jelly stool

A

Intussusception

78
Q

sausage shaped mass

A

Intussuception

79
Q

what are the signs of intussuception

A

Paroxysmal, severe, collicaly pain - draws up legs, become pale
May refuse feeds
Vomit - might be bile stained depending on site
Sausage shaped mass palpable
Recurrant jelly stool - blood and mucus
Abdominal distension and shock

80
Q

What are the AXR signs of intussuception

A

Distended small bowel

Absence of gas distally

81
Q

What is the Rx for intussuception

A

rectal air insuffliation by a radiologisr

Surgery

82
Q

GORD signs

A

Regurgiation and vomiting
faltering growth from severe vomiting
Osophagitis - haematemesis, iron deficency anaemia
recurrent pulmonary aspiration - pneumonia, wheeze, cough,
Dystonic neck posturing - Sandifer syndrome

83
Q

GOR

A 
regurg and vomiting
Put on weight though and otherwise well
Normally resolves by 12m as lower sphincter matures
Give reassurance
Add feed thickner - Carobel
Smaller and more frequent feeds
84
Q

Signs of pyloric stenosis

A

Projectile vomiting after feeds
Hunger until dehydrated
weight loss
hypocholareamc metabolic alkalosis with low Na and K
Gastric peristalisis seen moving as a wave from left to right after a feed
olive mass in RUQ

Rx - pylomyotomy

85
Q

Condition that can be asymptomstic or present with severe rectal bleeding (which is neither malaenia nor bright red)

A

Meckel’s diverticulum

86
Q

Non-projectile bilious vomiting and Dx

A

Malrotation/Volvus

need urgent laprotomy

87
Q

Causes of SI obstruction in the neonate

A

Artesia of the duodenum - double bubble sign on xray with absence of air distally (will probably have down’s)
Meconium Ileus - CF
Meconium plug
Malrotation w/ volvus

88
Q

Signs of SI obstruction in the neonate

A

Persistant vomiting - bile stained if below ampulla of vater
Mecnium passage delayed or absent with no transition to normal stool
Abdo distension
High lesions present soon after birth
Distal lesions may not present for days

89
Q 
Boy with moderate-severe learning difficulties
Macrocephaly
Macroorchadism
Long face
Large everted ears
Broad forehead
A

Fragile X

90
Q

Signs of fragile X

A 
Mod-severe learning difficulties
Macrocephaly
Macroorchidism
Long face
Large everted ears
prominent mandible
braod forehead
mitral valve prolapse
joint laxity
scoliosis 
autism 
hyperactivity
91
Q 
low birthweight
prominent occupit
small mouth and chin
flexed overlapping finger
rocker bottom feet
cardiac and renal malformations
A

Edwards (t18)

92
Q

Edwards syndrome

A 
T18
low birthweight
prominent occupit
small mouth and chin
flexed overlapping finger
rocker bottom feet
cardiac and renal malformations
93
Q 
Structural defect of brain
scalp defect
small eyes and other eye defect
cleft lip and palate
polydactyl
Cardiac and renal malformations
A

Patau (t13)

94
Q

Signs of Patau syndrome

A 
Structural defect of brain
scalp defect
small eyes and other eye defect
cleft lip and palate
polydactyl
Cardiac and renal malformations
95
Q

what is eisenmenger syndrome

A

in left to right shunt (high pulm blood flow) that ins’t treated
Pulmonary arteries become thick walled and resistance to flow increases
Then at age 10-15, shunt reverses and the teenager becomes cyanotic
This is porgressive and they die in their 4th of 5th decade

96
Q

when is phimosis normal until

A

2 years

97
Q

what condition is associated with pathological phimosis and how do you treat it?

A

Blanatis Xerotica Obliterans
presents with erythema, oedema and generation of purulent material from distal phimotic foreskin
Circumcisionn

98
Q

JIA symptoms

A 
Features of systemic onset JIA include
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss

Big Reece's Little Specialties (4 decks)

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