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Phase 3A > Paeds > Flashcards

Paeds Flashcards

1
Q

Main causative organism in Croup

A

Parainfluenza virus

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2
Q

Symptoms for Croup

A

Barking cough, stridor, breathlessness, poor feeding, fever, worse at night

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3
Q

Treatment for croup

A

Single dose oral dexamethasone

Severe - nebulised adrenaline

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4
Q

Causative organism in Epiglottis

A

Haemophilis influenza B

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5
Q

Symptoms for epiglottis

A

Unable to swallow, drooling, soft inspiratory stridor, no cough

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6
Q

Treatment for epiglottis

A

IV cefuroxime

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7
Q

Causative organism for whooping cough (pertussis)

A

Bordetella Pertussis

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8
Q

Symptoms for whooping cough

A

Inspiratory whoop, worse at night, vomiting, cyanosis, epistaxis

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9
Q

Investigations for whooping cough

A

Per nasal swab culture

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10
Q

Treatment for whooping cough

A

<1 month = Azithromycin 5 days

>1 month = Azithromycin/Erythromycin 7 days

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11
Q

Causative organism for Bronchiolitis

A

RSV

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12
Q

Symptoms for bronchiolitis

A

coryzal, breathlessness, poor feeding

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13
Q

Signs for bronchiolitis

A

fine end inspiratory crackles, high pitched wheeze, cyanosis

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14
Q

Investigations for bronchiolitis

A

PCR analysis of nasal secretions

CXR - hyperinflation

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15
Q

Treatment for bronchiolitis

A

Supportive, oxygen, feeds, fluids

Palivizumab - monoclonal antibody

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16
Q

Symptoms of asthma

A

intermittent dyspnoea, wheeze, cough, sputum, diurnal variation, exercise tolerance, disturbed sleep

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17
Q

Cystic fibrosis genetics?

A

autosomal recessive
defect in CFTR on chromosome 7 (f508)
1 in 25 carriers

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18
Q

Cystic fibrosis investigations

A

Guthrie heel prick screening test - immunoreactive trypsinogen
faecal elastase
sweat test
gene abnormalities

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19
Q

Cystic fibrosis management

A

chest physiotherapy

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20
Q

Causative organisms in Meningitis

A

Neiserria meningitis
Haemophilis influenza
Streptococcus pneumoniae
E.coli

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21
Q

Meningitis symptoms

A

Fever, stiff neck, seizure, non-purpuric rash

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22
Q

Meningitis investigations

A

Septic screen, cultures + LP

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23
Q

Meningitis treatment

A

Community - IM Benzylpenicillin
Hospital - IV Ceftriaxone
Prophylaxis - Rifampicin

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24
Q

Down’s syndrome mutation

A

Trisomy 21

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25
Q

Down’s syndrome signs

A

Epicanthic fold, single palmar crease, flattened nose, abnormal outer ears, macroglossia, hypotonia

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26
Q

Down’s syndrome associations

A

Duodenal atresia, congenital heart disease

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27
Q

Patau’s syndrome mutation

A

Trisomy 13

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28
Q

Patau’s syndrome signs

A

Polydactyly, cleft lip and palate, small eyes, scalp defects

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29
Q

Edwards syndrome mutation

A

Trimsomy 18

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30
Q

Edward’s syndrome symptoms

A

Prominent occiput, small mouth and chin, short sternum, overlapping fingers, rocker bottom feat

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31
Q

Turner’s syndrome mutation

A

45XO

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32
Q

Turner’s syndrome symptoms

A

Short stature, webbed neck, widely spaced nipples, spoon-shaped nails, low set ears

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33
Q

Turner’s syndrome treatment

A

Growth hormone therapy, oestrogen replacement (COCP)

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34
Q

Kawasaki’s symptoms

A

fever, conjunctivitis, rash, adenopathy (cervical), strawberry tongue + cracked lips, hands/feet - erythema + desquamation

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35
Q

name the left to right shunts

A

atrial septal defects
ventricular septal defects
persistent ductus arteriosus

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36
Q

name the two types of atrial septal defects

A

secundum ASD - defect in the centre of the atrial septum

partial ASD - communication between bottom of atrial septum and the atrioventricular valves

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37
Q

Symptoms of ASD

A

None
Recurrent chest infections/wheeze
Arrhythmias

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38
Q

Signs of ASD

A

Ejection systolic murmur

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39
Q

Invesitgations for ASD

A

Chest radiography - cardiomegaly, enlarged pulmonary arteries, increased pulmonary vascular markings
ECG - secundum ASD = RBBB, right axid deviation. Partial = superior QRS axis
Echocardiography

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40
Q

Management for ASD

A

cardiac catheterisation for secundum ASD

surgical correction for partial ASD

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41
Q

symptoms of a small VSD

A

asymptomatic

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42
Q

physical signs of a small VSD

A

loud pansystolic murmur at lower left edge

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43
Q

investigations for small VSD

A

echocardiography

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44
Q

management for a small VSD

A

closes spontaneously

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45
Q

symptoms of a large VSD

A

heart failure with breathlessness and failure to thrive

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46
Q

signs of a large VSD

A

tachypnoea, tachycardia, enlarged liver from heart failure, soft pansystolic murmur

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47
Q

Investigations of a large VSD

A

chest radiograph
ECG
echocardiography

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48
Q

Management for a large VSD

A

Diuretics
Captopril
Surgery at 3-6 months

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49
Q

define persistent ductus arteriosus

A

connection between the pulmonary artery and the descending aorta which has failed to close (by 1 month)

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50
Q

clinical features of PDA

A

continuous murmur beneath left clavicle, collapsing or bounding pulse

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51
Q

investigations of PDA

A

chest radiograph

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52
Q

management of PDA

A

closure

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53
Q

what causes chicken pox

A

varicella zoster infection

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54
Q

how is chicken pox spread

A

respiratory droplets

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55
Q

how long does chicken pox last

A

up to 7 days

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56
Q

chicken pox symptoms

A

vesicular rash - 200-500 lesions on head and trunk, appear as papules, vesicles, causing scar formation

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57
Q

complications of chicken pox

A

encephalitis
secondary bacterial infection - staphylococci, group A streptococcal
Pneumonitis
Disseminated infection in the immunocompromised

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58
Q

treatment of chicken pox

A

IV acyclovir in immunocompromised children
oral valaciclovir in adolescents and adults
Human varicella zoster immunoglobulin (VZIG) for high-risk immunosuppressed

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59
Q

how is shingles caused

A

reactivation of latent varicella-zoster virus

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60
Q

How is measles transmitted

A

a single stranded RNA Morbillivirus from the paramyxovirus family, transmitted via respiratory droplets

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61
Q

Presentation of measles

A

rash for 3 days
fever for at least 1 day
cough, coryza, conjunctivitis
Koplik’s spots

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62
Q

investigations for measles

A

salivary swab or serum sample for immunoglobulin M (IgM)

RNA detection in salivary swabs

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63
Q

management for measles

A

paracetamol or ibuprofen with plenty of fluids

vaccinations

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64
Q

Measles complications

A

Pneumonitis, secondary bacterial infection
Encephalitis
Diarrhoea, hepatitis
Vitamin A deficiency

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65
Q

Measles prevention

A

Measles vaccine

Vitamin A

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66
Q

What is Kawasaki’s disease

A

a systemic vasculitis, due to immune hyperreactivity

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67
Q

Epidemiology of Kawasaki’s disease

A

more common in Japanese children, more common in boys

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68
Q

Clinical features of Kawasaki’s disease

A 
Fever (>5 days)
Conjunctivitis
Rash
Cervical lymphadenopathy
Strawberry tongue, crack lips
Red and oedematous palms and soles
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69
Q

investigations for Kawasaki’s disease

A

inflammatory markers - CRP, ESR, WCC, platelet count rises
Urinalysis
LFTs
Echocardiography - shows dilatation and aneurysms

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70
Q

Management for Kawasaki’s disease

A 
Aspirin - reduce risk of thrombosis
IV immunoglobulin (IVIg) - lower the risk of thrombosis
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71
Q

Complications of Kawasaki’s disease

A

coronary artery aneurysms
pericarditis
myocarditis
heart failure

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72
Q

how is Rubella spread

A

respiratory route, from known contact

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73
Q

Rubella symptoms

A

low-grade fever, maculopapular rash, prominent lymphadenopathy

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74
Q

Rubella complications

A

arthritis, encephalitis, thrombocytopenia, myocarditis

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75
Q

Causative organisms of bacterial meningitis

A

neonatal - 3 months = Group B streptococcus, e.coli
1 month - 6 years = neisseria meningitidis, strep pneumoniae
>6 years = neisseria meningitides, strep pneumoniae

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76
Q

Meningitis symptoms

A

fever, headache, photophobia, neck stiffness, purpuric rash, brudzinski sign, kernig sign, irritability, lethargy

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77
Q

Meningitis investigations

A

Lumbar puncture for CSF: increased WBC, increased protein, decreased glucose
FBC, U&Es, LFTs, throat swab, CT/MRI brain scan

78
Q

Management for meningitis

A

Community = IM benzylpenicillin
Prophylaxis = Rifampicin
Hospital - IV Ceftriaxone

79
Q

Cerebral complications of meningitis

A

hearing loss
local vasculitis
local cerebral infarction
hydrocephalus

80
Q

causes of viral meningitis

A

enteroviruses
EBV
Adenovirus
mumps

81
Q

diagnosis of viral meinigitis

A 
culture or PCR of CSF: increased WBC, normal protein, normal glucose
culture of stool
urine
nasopharyngeal aspirate
throat swabs
82
Q

define pyloric stenosis

A

narrowing of the pyloric canal which impairs gastric emptying

83
Q

what age does pyloric stenosis present

A

between 2 and 7 weeks

84
Q

symptoms of pyloric stenosis

A

projectile vomiting - non bile stained
hunger, weight loss, dehydration
peristalsis
enlarged pylorus - palpable mass

85
Q

investigations for pyloric stenosis

A

ultrasound abdomen

serum electrolytes

86
Q

management of pyloric stenosis

A

correct fluid deficiency and electrolyte imbalance

Ramstedt’s pyloromyotomy

87
Q

complications of pyloric stenosis

A

electrolyte disturbance - hypokalaemic, hypochloraemic, metabolic alkalosis

88
Q

define intussusception

A

invagination of proximal bowel into a distal segment - ileum moves into caecum via ileo-caecal valve

89
Q

what age does intussusception

present?

A

3 months - 2 years

90
Q

symptoms of intussusception

A

vomiting, abdominal pain, redcurrent jelly stools, sausage shaped RLQ abdo mass

91
Q

investigations for intussusception

A

ultrasound scan - doughnut/Target sign

X-ray abdomen - distended small bowel, absence of gas in large bowel

92
Q

management for intussusception

A

rectal air insufflation

93
Q

Nephrotic syndrome symptoms

A

hypoalbuminaemia
proteinuria
oedema

94
Q

causes of nephrotic syndrome

A

minimal change disease
focal-segmental glomerulosclerosis
post streptococcal nephritis

95
Q

treatment for nephrotic syndrome

A

prednisolone
diuretics, ACEi, NSAIDs
cyclophoshamid +/- ciclosporin

96
Q

What causes coryza?

A

Rhinovirus

97
Q

What causes sore throat (pahryngitis)?

A

Adenoviruses

EBV

98
Q

Define tonsilitis

A

A form of pharyngitis where there is intense inflammation of the tonsils, often with a purulent exudate

99
Q

Causative organisms of tonsilitis?

A

EBV

Group A beta-haemolytic streptococci

100
Q

Centor criteria for tonsilitis

A

Tonsillar exduate
Tender anterior cervical lymphadenopathy
Fever
Absence of cough

101
Q

Complications of tonsilitis

A

Quinsy
Otitis media
Sinusitis

102
Q

Management for tonsilitis

A

Penicillin or erythromycin (if allergic to penicillin)

103
Q

Define otitis media

A

infection/inflammation of the middle ear

104
Q

Common age for otitis media?

A

6-12 months of age

105
Q

Predisposing factors for otitis media?

A 
Older sibling
Males
Parental smoking
Immune deficiency
Asthma
Dummy
Bottle feeding
Down's syndrome
106
Q

Complications of otitis media

A

Mastoiditis

Meningitis

107
Q

Common pathogens of otitis media

A

Strep pneumoniae
H influenzae
Moraxella catarrhalis

108
Q

Management for otitis media

A

Paracetamol or ibuprofen

109
Q

Asthma risk factors

A 
Family history
Bottle fed
Atopy
Male
Pollution
Lung disease
110
Q

Asthma triggers

A 
Pollen
House dust mites
Feathers
Fur
Exercise
Smoke
Chemicals
Viruses
Cold air
111
Q

Symptoms and signs of asthma

A

Wheeze
Coughing
Dyspnoea
Symptoms are worse at night and early morning

112
Q

Treatment for asthma ages 5-16

A
  1. SABA - Salbutamol
  2. SABA + ICS - Beclamethasone
  3. SABA + ICS + LRTA - Montelukast
  4. SABA + ICS + LABA - Salmeterol (remove LRTA here)
113
Q

Treatment for asthma under 5 years old

A

SABA

8 week ICS

114
Q

Signs and symptoms of cystic fibrosis

A

Breathlessness, bronchiectasis, recurrent infections, steatorrhoea, malnutrition, failure to thrive, males almost always infertile (failure of vas deferens and epididymis)

115
Q

Complications of cystic fibrosis

A 
Haemoptysis
Pneumonia
Pneumothorax
Diabetes
Cirrhosis
Male infertility
116
Q

name the right to left shunts (cyanosis)

A

Tetraology of Fallot’s

Transposition of great arteries

117
Q

Four clinical features of Tetralogy of Fallot’s

A

Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

118
Q

Signs and symptoms of Fallot’s tetralogy

A

Cyanotic
Breathlessness
Pallor
Irritability

119
Q

Investigations of Fallot’s tetraology

A

Chest radiograph - small heart, boot shaped apex

Harsh ejection systolic mumur

120
Q

Management for Fallot’s tetralogy

A

Close VSD, relieve right ventricular outflow tract obstruction

121
Q

Define necrotising enterocolitis

A

Bacterial invasion of ischaemic bowel wall

122
Q

Symptoms of necrotising enterocolitis

A

Bile-stained vomiting
Distended abdomen
Fresh blood in stool
Infant rapidly becomes shocked

123
Q

Findings on abdominal x-ray for necrotising enterocolitis

A

Distended loops of bowel
Thickening of the bowel wall with intramural gas
Rigler and Football sign

124
Q

Complications of necrotising enterocolitis

A

Bowel perforation

Malabsorption if extensive ischaemia

125
Q

Management for necrotising enterocolitis

A

Stop oral feeding
Broad spectrum antibiotics
Surgery for any bowel perforation

126
Q

What is the main complication of jaundice?

A

Kernicterus

127
Q

Define Kernicterus

A

Encephalopathy resulting from the deposition of unconjugated bilirubin in the basal ganglia and the brainstem nuclei

128
Q

Symptoms of kernicterus

A

Lethargy, poor feeding, irritability, increased muscle tone, seizures, coma

129
Q

Causes of jaundice

A

<24 hours of age: Congenital infection - CMV, syphilis, rubella, herpes. Rhesus incompatibility.
Jaundice 24 hours - 2 weeks: Physiological jaundice, breast milk jaundice, infection e.g. UTI. Bruising, polycythaemia
Jaundice >2 weeks: Bile duct obstruction, neonatal hepatitis, infection, pyloric stenosis, hypothyroidism

130
Q

Investigations for jaundice

A

Transcutaneous bilirubin meter

131
Q

Management for jaundice

A

Phototherapy

Exchange transfusion

132
Q

Define juvenile idiopathic arthritis

A

Chronic inflammatory joint disease in children and adolescents. Persistent joint swelling (of >6 weeks duration) presenting before 16 years of age

133
Q

Name the subtypes of JIA

A 
Oligoarthritis - persistent
Oligoarthritis - extended
Polyarthritis RF negative
Polyarthritis RF positive
Systemic arthritis
Psoariatic arthritis
Enthesitis-related arthritis
134
Q

How many joints does polyarthritis affect?

A

More than 4 joints

135
Q

How many joints does oligoarthritis aeffect?

A

Up to and including 4 joints

136
Q

Features of JIA

A 
Gelling (stiffness after periods of rest)
Morning joint stiffness and pain
Intermittent limp
Loss of ROM
Warmth
Joint swelling
137
Q

Complications of JIA

A 
Chronic anterior uveitis
Flexion contractures of the joints
Growth failure
Osteoporosis
Amyloidosis
138
Q

Management of JIA

A 
NSAIDs
Joint injections - for oligoarthritis
Methotrexate - polyarthritis
Systemic corticosteroids
Cytokine modulators
139
Q

Define osteomyelitis

A

Infection of the metaphysis of long bones

140
Q

The most common sites for osteomyelitis?

A

Distal femur

Proximal tibia

141
Q

Most common causative organisms for osteomyelitis?

A

Staphylococcus Aureus
Streptococcus
Haemophilus influenzae

142
Q

Symptoms of osteomyelitis

A

Severe pain
Immobile limb (pseudoparesis)
Fever
Swelling and tenderness over the infected site

143
Q

Complications of osteomyelitis

A

Septic arthritis

144
Q

Investigations of osteomyelitis

A

Blood cultures - raised WBC
X-rays - soft tissue swelling
Ultrasond
MRI

145
Q

Treatment for osteomyelitis

A

IV Cefuroxime

Surgical drainage

146
Q

Define septic arthritis

A

Infection of the joint space leading to bone destruction

147
Q

Most common age for septic arthritis

A

Children <2 years old

148
Q

Causes of septic arthritis

A

Haematogenous spread
Puncture wound
Infected skin lesion - e.g. chicken pox
Spread from osteomyelitis

149
Q

Causative organisms of septic arthritis

A

Staphylococcus aureus
H. influenzae before Hib vaccine
Immunodeficiency
Sickle cell

150
Q

Presentation of septic arthritis

A 
Erythematous warm, acutely tender joint
Reduced ROM
Pseudoparesis, pseudoparalysis
Joint effusion
Limp
151
Q

Investigations for septic arthritis

A 
Aspiration of joint space under ultrasound
Blood cultures
Increased WCC and acute-phase reactants
Ultrasound of deep joints
X-rays to exclude trauma
152
Q

Management of septic arthritis

A

Prolonged course of IV abx

Wash out/surgical drainage

153
Q

Define devlopmental dysplasia of the hip

A

Spectrum of disorders ranging from dysplasia to subluxation through to frank dislocation of the hip

154
Q

Risk factors for developmental dysplasia of the hip

A 
Female sex
Breech presentation
Positive FH
Firstborn children
Oligohydramnios
155
Q

Presentation of developmental dysplasia of the hip

A

A limp or abnormal gait
Asymmetrical skinfolds around the hip
Limited abduction of the hip or shortening of the affected leg
Limb length discrepancy

156
Q

Investigations of developmental dysplasia of the hip

A

Dynamic ultraound

157
Q

Treatment for developmental dysplasia of the hip

A 
Most unstable hips spontaneously stabilise by 3-6 weeks of age
Pavlik harness (flexion-abduction orthosis)
158
Q

What is the most common cause of hip pain in paediatric population?

A

Transient synovitis

159
Q

Causes of transient synovitis?

A

Viral infection

160
Q

Signs on examination of transient synovitis

A

Restriction of hip internal rotation

161
Q

Define Perthes disease

A

An avascular necrosis of the capital femoral epiphysis of the femoral head due to interruption of the blood supply, followed by revascularisation and reossification

162
Q

Presentation of perthes disease

A

onset of a limp

hip or knee pain

163
Q

Physical examination findings for perthes disease

A

Limited abduction and internal rotation of the hip

164
Q

Complications of perthes disease

A

Osteoarthritis

Premature fusion of growth plates

165
Q

Associations for perthes disease

A

Short stature

Hyperactivity

166
Q

Investigations for perthes disease

A

X-rays of both hips
Bone scan
MRI scan

167
Q

Treatment for perthes disease

A

Bed rest
Casting and bracing
Surgery for low prognosis

168
Q

Define slipped capital femoral epiphysis

A

Results in displacement of the epiphysis of the femoral head postero-inferiorly requiring prompt treatment in order to prevent avascular necrosis

169
Q

Average age of slipped capital femoral epiphysis

A

13.4 boys
12.2 girls
ASSOCIATED WITH PUBERTY

170
Q

Presentation of slipped capital femoral epiphysis

A

Limp

Hip pain

171
Q

Examination findings for slipped capital femoral epiphysis

A

Restricted abduction and internal rotation of the hip

172
Q

Management for slipped capital femoral epiphysis

A

Percutaneous pinning in situ

173
Q

Define osteogenesis imperfecta

A

Group of disorders of collagen metabolism causing bone fragility, with bowing and frequent fractures

174
Q

How many types of osteogenesis are there?

A

4

175
Q

What is the most common form of osteogenesis

A

Type 1
Autosomal dominant
Fractures
Associations - blue sclerae, hearing loss

176
Q

Investigations for osteogenesis

A

Prenatal diagnosis by USS
X-rays
Bone densitometry
Genetic testing

177
Q

Treatment of osteogenesis

A

Physiotherapy
Rehabilitation
Bracing
Bisphosphonates - Alendronate, zoledronate, pamidronate = reduce fracture frequency

178
Q

Cause of Fragile X syndrome

A

FMR1 gene, CGG repeat on chromosome 27

Trinucleotide repeat disorder

179
Q

Clinical features of fragile X syndrome

A

Learning difficulties, delayed speech + language, delayed motor milestones, hyperactivity, anxiety, austim
Long, narrow face, large ears, prominent jaw, big testes

180
Q

Investigations for Fragile X syndrome

A

Molecular genetic testing of FMR1 gene

181
Q

Management for Fragile X syndrome

A

Minocycline

182
Q

Define Angelman’s syndrome

A

Genetic imprinting, behavioural features include happy demeanour, easily provoked laughter, short attention span, mouthing of objects, affinity for water

183
Q

Cause of Angelman’s syndrome

A

Maternal deletion on chromosome 15

OPPOSITE OF PRADER-WILLI

184
Q

Clinical features of Angelman’s syndrome

A 
Developmental delay
Gross motor milestones are delayed
Speech impairment
Combination of laughter and smiling - happy demeanour, laughter to most stimuli
Short attention span
Seizures
Ataxia
Broad based gait
Fascination with water
185
Q

Investigations for Angelman’s syndrome

A

Chromosomal analysis

FISH

186
Q

Treatment for Angelman’s

A 
Speech therapy
Physiotherapy
Parental training
Education
Anticonvulsants for epilepsy
187
Q

Define GORD

A

Involuntary passage of gastric contents into the oesophagus

188
Q

Symptoms of GORD

A

Recurrent regurgitation

Vomiting

189
Q

Complications of GORD

A 
Failure to thrive
Oesophagitis
Anaemia
Pneumonia
Apnoea
190
Q

Investigations for GORD

A

Diagnosed clinically

Endoscopy with oesophageal biopsies

191
Q

Management for GORD

A

Upright positioning
Thickening agents in feeds
H2 receptor antagonists - Ranitidine
PPIs - Omeprazole

Phase 3A (10 decks)

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