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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
Down's syndrome signs
Epicanthic fold, single palmar crease, flattened nose, abnormal outer ears, macroglossia, hypotonia
26
Down's syndrome associations
Duodenal atresia, congenital heart disease
27
Patau's syndrome mutation
Trisomy 13
28
Patau's syndrome signs
Polydactyly, cleft lip and palate, small eyes, scalp defects
29
Edwards syndrome mutation
Trimsomy 18
30
Edward's syndrome symptoms
Prominent occiput, small mouth and chin, short sternum, overlapping fingers, rocker bottom feat
31
Turner's syndrome mutation
45XO
32
Turner's syndrome symptoms
Short stature, webbed neck, widely spaced nipples, spoon-shaped nails, low set ears
33
Turner's syndrome treatment
Growth hormone therapy, oestrogen replacement (COCP)
34
Kawasaki's symptoms
fever, conjunctivitis, rash, adenopathy (cervical), strawberry tongue + cracked lips, hands/feet - erythema + desquamation
35
name the left to right shunts
atrial septal defects ventricular septal defects persistent ductus arteriosus
36
name the two types of atrial septal defects
secundum ASD - defect in the centre of the atrial septum | partial ASD - communication between bottom of atrial septum and the atrioventricular valves
37
Symptoms of ASD
None Recurrent chest infections/wheeze Arrhythmias
38
Signs of ASD
Ejection systolic murmur
39
Invesitgations for ASD
Chest radiography - cardiomegaly, enlarged pulmonary arteries, increased pulmonary vascular markings ECG - secundum ASD = RBBB, right axid deviation. Partial = superior QRS axis Echocardiography
40
Management for ASD
cardiac catheterisation for secundum ASD | surgical correction for partial ASD
41
symptoms of a small VSD
asymptomatic
42
physical signs of a small VSD
loud pansystolic murmur at lower left edge
43
investigations for small VSD
echocardiography
44
management for a small VSD
closes spontaneously
45
symptoms of a large VSD
heart failure with breathlessness and failure to thrive
46
signs of a large VSD
tachypnoea, tachycardia, enlarged liver from heart failure, soft pansystolic murmur
47
Investigations of a large VSD
chest radiograph ECG echocardiography
48
Management for a large VSD
Diuretics Captopril Surgery at 3-6 months
49
define persistent ductus arteriosus
connection between the pulmonary artery and the descending aorta which has failed to close (by 1 month)
50
clinical features of PDA
continuous murmur beneath left clavicle, collapsing or bounding pulse
51
investigations of PDA
chest radiograph
52
management of PDA
closure
53
what causes chicken pox
varicella zoster infection
54
how is chicken pox spread
respiratory droplets
55
how long does chicken pox last
up to 7 days
56
chicken pox symptoms
vesicular rash - 200-500 lesions on head and trunk, appear as papules, vesicles, causing scar formation
57
complications of chicken pox
encephalitis secondary bacterial infection - staphylococci, group A streptococcal Pneumonitis Disseminated infection in the immunocompromised
58
treatment of chicken pox
IV acyclovir in immunocompromised children oral valaciclovir in adolescents and adults Human varicella zoster immunoglobulin (VZIG) for high-risk immunosuppressed
59
how is shingles caused
reactivation of latent varicella-zoster virus
60
How is measles transmitted
a single stranded RNA Morbillivirus from the paramyxovirus family, transmitted via respiratory droplets
61
Presentation of measles
rash for 3 days fever for at least 1 day cough, coryza, conjunctivitis Koplik's spots
62
investigations for measles
salivary swab or serum sample for immunoglobulin M (IgM) | RNA detection in salivary swabs
63
management for measles
paracetamol or ibuprofen with plenty of fluids | vaccinations
64
Measles complications
Pneumonitis, secondary bacterial infection Encephalitis Diarrhoea, hepatitis Vitamin A deficiency
65
Measles prevention
Measles vaccine | Vitamin A
66
What is Kawasaki's disease
a systemic vasculitis, due to immune hyperreactivity
67
Epidemiology of Kawasaki's disease
more common in Japanese children, more common in boys
68
Clinical features of Kawasaki's disease
``` Fever (>5 days) Conjunctivitis Rash Cervical lymphadenopathy Strawberry tongue, crack lips Red and oedematous palms and soles ```
69
investigations for Kawasaki's disease
inflammatory markers - CRP, ESR, WCC, platelet count rises Urinalysis LFTs Echocardiography - shows dilatation and aneurysms
70
Management for Kawasaki's disease
``` Aspirin - reduce risk of thrombosis IV immunoglobulin (IVIg) - lower the risk of thrombosis ```
71
Complications of Kawasaki's disease
coronary artery aneurysms pericarditis myocarditis heart failure
72
how is Rubella spread
respiratory route, from known contact
73
Rubella symptoms
low-grade fever, maculopapular rash, prominent lymphadenopathy
74
Rubella complications
arthritis, encephalitis, thrombocytopenia, myocarditis
75
Causative organisms of bacterial meningitis
neonatal - 3 months = Group B streptococcus, e.coli 1 month - 6 years = neisseria meningitidis, strep pneumoniae >6 years = neisseria meningitides, strep pneumoniae
76
Meningitis symptoms
fever, headache, photophobia, neck stiffness, purpuric rash, brudzinski sign, kernig sign, irritability, lethargy
77
Meningitis investigations
Lumbar puncture for CSF: increased WBC, increased protein, decreased glucose FBC, U&Es, LFTs, throat swab, CT/MRI brain scan
78
Management for meningitis
Community = IM benzylpenicillin Prophylaxis = Rifampicin Hospital - IV Ceftriaxone
79
Cerebral complications of meningitis
hearing loss local vasculitis local cerebral infarction hydrocephalus
80
causes of viral meningitis
enteroviruses EBV Adenovirus mumps
81
diagnosis of viral meinigitis
``` culture or PCR of CSF: increased WBC, normal protein, normal glucose culture of stool urine nasopharyngeal aspirate throat swabs ```
82
define pyloric stenosis
narrowing of the pyloric canal which impairs gastric emptying
83
what age does pyloric stenosis present
between 2 and 7 weeks
84
symptoms of pyloric stenosis
projectile vomiting - non bile stained hunger, weight loss, dehydration peristalsis enlarged pylorus - palpable mass
85
investigations for pyloric stenosis
ultrasound abdomen | serum electrolytes
86
management of pyloric stenosis
correct fluid deficiency and electrolyte imbalance | Ramstedt's pyloromyotomy
87
complications of pyloric stenosis
electrolyte disturbance - hypokalaemic, hypochloraemic, metabolic alkalosis
88
define intussusception
invagination of proximal bowel into a distal segment - ileum moves into caecum via ileo-caecal valve
89
what age does intussusception | present?
3 months - 2 years
90
symptoms of intussusception
vomiting, abdominal pain, redcurrent jelly stools, sausage shaped RLQ abdo mass
91
investigations for intussusception
ultrasound scan - doughnut/Target sign | X-ray abdomen - distended small bowel, absence of gas in large bowel
92
management for intussusception
rectal air insufflation
93
Nephrotic syndrome symptoms
hypoalbuminaemia proteinuria oedema
94
causes of nephrotic syndrome
minimal change disease focal-segmental glomerulosclerosis post streptococcal nephritis
95
treatment for nephrotic syndrome
prednisolone diuretics, ACEi, NSAIDs cyclophoshamid +/- ciclosporin
96
What causes coryza?
Rhinovirus
97
What causes sore throat (pahryngitis)?
Adenoviruses | EBV
98
Define tonsilitis
A form of pharyngitis where there is intense inflammation of the tonsils, often with a purulent exudate
99
Causative organisms of tonsilitis?
EBV | Group A beta-haemolytic streptococci
100
Centor criteria for tonsilitis
Tonsillar exduate Tender anterior cervical lymphadenopathy Fever Absence of cough
101
Complications of tonsilitis
Quinsy Otitis media Sinusitis
102
Management for tonsilitis
Penicillin or erythromycin (if allergic to penicillin)
103
Define otitis media
infection/inflammation of the middle ear
104
Common age for otitis media?
6-12 months of age
105
Predisposing factors for otitis media?
``` Older sibling Males Parental smoking Immune deficiency Asthma Dummy Bottle feeding Down's syndrome ```
106
Complications of otitis media
Mastoiditis | Meningitis
107
Common pathogens of otitis media
Strep pneumoniae H influenzae Moraxella catarrhalis
108
Management for otitis media
Paracetamol or ibuprofen
109
Asthma risk factors
``` Family history Bottle fed Atopy Male Pollution Lung disease ```
110
Asthma triggers
``` Pollen House dust mites Feathers Fur Exercise Smoke Chemicals Viruses Cold air ```
111
Symptoms and signs of asthma
Wheeze Coughing Dyspnoea Symptoms are worse at night and early morning
112
Treatment for asthma ages 5-16
1. SABA - Salbutamol 2. SABA + ICS - Beclamethasone 3. SABA + ICS + LRTA - Montelukast 4. SABA + ICS + LABA - Salmeterol (remove LRTA here)
113
Treatment for asthma under 5 years old
SABA | 8 week ICS
114
Signs and symptoms of cystic fibrosis
Breathlessness, bronchiectasis, recurrent infections, steatorrhoea, malnutrition, failure to thrive, males almost always infertile (failure of vas deferens and epididymis)
115
Complications of cystic fibrosis
``` Haemoptysis Pneumonia Pneumothorax Diabetes Cirrhosis Male infertility ```
116
name the right to left shunts (cyanosis)
Tetraology of Fallot's | Transposition of great arteries
117
Four clinical features of Tetralogy of Fallot's
Large VSD Overriding aorta Pulmonary stenosis Right ventricular hypertrophy
118
Signs and symptoms of Fallot's tetralogy
Cyanotic Breathlessness Pallor Irritability
119
Investigations of Fallot's tetraology
Chest radiograph - small heart, boot shaped apex | Harsh ejection systolic mumur
120
Management for Fallot's tetralogy
Close VSD, relieve right ventricular outflow tract obstruction
121
Define necrotising enterocolitis
Bacterial invasion of ischaemic bowel wall
122
Symptoms of necrotising enterocolitis
Bile-stained vomiting Distended abdomen Fresh blood in stool Infant rapidly becomes shocked
123
Findings on abdominal x-ray for necrotising enterocolitis
Distended loops of bowel Thickening of the bowel wall with intramural gas Rigler and Football sign
124
Complications of necrotising enterocolitis
Bowel perforation | Malabsorption if extensive ischaemia
125
Management for necrotising enterocolitis
Stop oral feeding Broad spectrum antibiotics Surgery for any bowel perforation
126
What is the main complication of jaundice?
Kernicterus
127
Define Kernicterus
Encephalopathy resulting from the deposition of unconjugated bilirubin in the basal ganglia and the brainstem nuclei
128
Symptoms of kernicterus
Lethargy, poor feeding, irritability, increased muscle tone, seizures, coma
129
Causes of jaundice
<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
Investigations for jaundice
Transcutaneous bilirubin meter
131
Management for jaundice
Phototherapy | Exchange transfusion
132
Define juvenile idiopathic arthritis
Chronic inflammatory joint disease in children and adolescents. Persistent joint swelling (of >6 weeks duration) presenting before 16 years of age
133
Name the subtypes of JIA
``` Oligoarthritis - persistent Oligoarthritis - extended Polyarthritis RF negative Polyarthritis RF positive Systemic arthritis Psoariatic arthritis Enthesitis-related arthritis ```
134
How many joints does polyarthritis affect?
More than 4 joints
135
How many joints does oligoarthritis aeffect?
Up to and including 4 joints
136
Features of JIA
``` Gelling (stiffness after periods of rest) Morning joint stiffness and pain Intermittent limp Loss of ROM Warmth Joint swelling ```
137
Complications of JIA
``` Chronic anterior uveitis Flexion contractures of the joints Growth failure Osteoporosis Amyloidosis ```
138
Management of JIA
``` NSAIDs Joint injections - for oligoarthritis Methotrexate - polyarthritis Systemic corticosteroids Cytokine modulators ```
139
Define osteomyelitis
Infection of the metaphysis of long bones
140
The most common sites for osteomyelitis?
Distal femur | Proximal tibia
141
Most common causative organisms for osteomyelitis?
Staphylococcus Aureus Streptococcus Haemophilus influenzae
142
Symptoms of osteomyelitis
Severe pain Immobile limb (pseudoparesis) Fever Swelling and tenderness over the infected site
143
Complications of osteomyelitis
Septic arthritis
144
Investigations of osteomyelitis
Blood cultures - raised WBC X-rays - soft tissue swelling Ultrasond MRI
145
Treatment for osteomyelitis
IV Cefuroxime | Surgical drainage
146
Define septic arthritis
Infection of the joint space leading to bone destruction
147
Most common age for septic arthritis
Children <2 years old
148
Causes of septic arthritis
Haematogenous spread Puncture wound Infected skin lesion - e.g. chicken pox Spread from osteomyelitis
149
Causative organisms of septic arthritis
Staphylococcus aureus H. influenzae before Hib vaccine Immunodeficiency Sickle cell
150
Presentation of septic arthritis
``` Erythematous warm, acutely tender joint Reduced ROM Pseudoparesis, pseudoparalysis Joint effusion Limp ```
151
Investigations for septic arthritis
``` Aspiration of joint space under ultrasound Blood cultures Increased WCC and acute-phase reactants Ultrasound of deep joints X-rays to exclude trauma ```
152
Management of septic arthritis
Prolonged course of IV abx | Wash out/surgical drainage
153
Define devlopmental dysplasia of the hip
Spectrum of disorders ranging from dysplasia to subluxation through to frank dislocation of the hip
154
Risk factors for developmental dysplasia of the hip
``` Female sex Breech presentation Positive FH Firstborn children Oligohydramnios ```
155
Presentation of developmental dysplasia of the hip
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
Investigations of developmental dysplasia of the hip
Dynamic ultraound
157
Treatment for developmental dysplasia of the hip
``` Most unstable hips spontaneously stabilise by 3-6 weeks of age Pavlik harness (flexion-abduction orthosis) ```
158
What is the most common cause of hip pain in paediatric population?
Transient synovitis
159
Causes of transient synovitis?
Viral infection
160
Signs on examination of transient synovitis
Restriction of hip internal rotation
161
Define Perthes disease
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
Presentation of perthes disease
onset of a limp | hip or knee pain
163
Physical examination findings for perthes disease
Limited abduction and internal rotation of the hip
164
Complications of perthes disease
Osteoarthritis | Premature fusion of growth plates
165
Associations for perthes disease
Short stature | Hyperactivity
166
Investigations for perthes disease
X-rays of both hips Bone scan MRI scan
167
Treatment for perthes disease
Bed rest Casting and bracing Surgery for low prognosis
168
Define slipped capital femoral epiphysis
Results in displacement of the epiphysis of the femoral head postero-inferiorly requiring prompt treatment in order to prevent avascular necrosis
169
Average age of slipped capital femoral epiphysis
13.4 boys 12.2 girls ASSOCIATED WITH PUBERTY
170
Presentation of slipped capital femoral epiphysis
Limp | Hip pain
171
Examination findings for slipped capital femoral epiphysis
Restricted abduction and internal rotation of the hip
172
Management for slipped capital femoral epiphysis
Percutaneous pinning in situ
173
Define osteogenesis imperfecta
Group of disorders of collagen metabolism causing bone fragility, with bowing and frequent fractures
174
How many types of osteogenesis are there?
4
175
What is the most common form of osteogenesis
Type 1 Autosomal dominant Fractures Associations - blue sclerae, hearing loss
176
Investigations for osteogenesis
Prenatal diagnosis by USS X-rays Bone densitometry Genetic testing
177
Treatment of osteogenesis
Physiotherapy Rehabilitation Bracing Bisphosphonates - Alendronate, zoledronate, pamidronate = reduce fracture frequency
178
Cause of Fragile X syndrome
FMR1 gene, CGG repeat on chromosome 27 | Trinucleotide repeat disorder
179
Clinical features of fragile X syndrome
Learning difficulties, delayed speech + language, delayed motor milestones, hyperactivity, anxiety, austim Long, narrow face, large ears, prominent jaw, big testes
180
Investigations for Fragile X syndrome
Molecular genetic testing of FMR1 gene
181
Management for Fragile X syndrome
Minocycline
182
Define Angelman's syndrome
Genetic imprinting, behavioural features include happy demeanour, easily provoked laughter, short attention span, mouthing of objects, affinity for water
183
Cause of Angelman's syndrome
Maternal deletion on chromosome 15 | OPPOSITE OF PRADER-WILLI
184
Clinical features of Angelman's syndrome
``` 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
Investigations for Angelman's syndrome
Chromosomal analysis | FISH
186
Treatment for Angelman's
``` Speech therapy Physiotherapy Parental training Education Anticonvulsants for epilepsy ```
187
Define GORD
Involuntary passage of gastric contents into the oesophagus
188
Symptoms of GORD
Recurrent regurgitation | Vomiting
189
Complications of GORD
``` Failure to thrive Oesophagitis Anaemia Pneumonia Apnoea ```
190
Investigations for GORD
Diagnosed clinically | Endoscopy with oesophageal biopsies
191
Management for GORD
Upright positioning Thickening agents in feeds H2 receptor antagonists - Ranitidine PPIs - Omeprazole

Phase 3A (10 decks)

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