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phase 3a > Paeds > Flashcards

Paeds Flashcards

1
Q

What is the most common resp infection in infants?

A

Bronchiolitis

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2
Q

Bronchiolitis Ax

A

RSV

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3
Q

Bronchiolitis presentation

A

coryzal symptoms dry cough and breathlessness

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4
Q

Bronchiolitis Signs

A

Tachypnoea, chest recession
wheeze or crackles (?VIW if just wheeze)

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5
Q

When do you admit for bronchiolitis?

A

Problems with feeding Low O2 Sats <92

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6
Q

Bronchiolitis Ix

A

clinical diagnosis

Viral throat swabs

?CXR (exclude pneumonia, show hyperinflation)

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7
Q

Bronchiolitis Tx

A

O2 ?fluids ?NG tube

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8
Q

Pneumonia Ax

A

50% idiopathic

newborns : Grp B Strep

<5: RSV, strep pneumoniae, h. influenzae

>5: mycoplasma, strep. chlamydia pneumoniae

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9
Q

Pneumonia presenation

A

‘unwell’ child

resp: cough, diff breathing

General: lethargy, poor feeding, fever

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10
Q

Pneumonia signs

A

Increased RR: Tachypnoea

end inspiratory crackles

decreased O2

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11
Q

Pneumonia Ix

A

CXR nasopharyngeal aspirate

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12
Q

Pneumonia Tx

A

Amoxicillan -> co-amoxiclav

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13
Q

At which ages is appendicitis most and least common

A

Most common 10-20 Least common <3

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14
Q

Appendicitis Presentation

A

Anorexia vomiting abdo pain, central and colicky -> RIF and aggravated by movement

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15
Q

Appendicitis Signs

A

flushed face fever + McBurneys

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16
Q

Appendicitis Ix

A

urine dipstix - WBC

US - thickened non-compressable appendix with increased blood flow

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17
Q

Appendicitis Tx

A

Appendicectomy

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18
Q

Tonsillitis Ax

A

Gp A Beta-haemolytic strep Epstein-Barr Virus

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19
Q

Tonsillitis Presentation

A

throat: Sore, diff swallowing -> LOA, no voice/hoarse

sick

lethargy

earache

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20
Q

Tonsillitis Signs

A

Red tonsils white/yellow coating on tonsils

swollen glands in neck or jaw

fever

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21
Q

Tonsillitis Tx

A
  • symptoms normally go in 3-4 days
  • paracetamol or ibuprofen lozenges, throat spray, antiseptic solutions
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22
Q

When would a tonsillectomy be considered?

A

-recurrent tonsillitis -Peritonsillar abcess (quinsy) -obstructive sleep apnoea

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23
Q

Glandular Fever Ax

A

EBV

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24
Q

Glandular Fever Presentation

A

Fever, fatigue malaise
Sore throat: englarged tonsils, exudative, raised cervical nodes
Petechia (red/purple spots) on soft palate
Maculopapular rash
Later: Jaundice, hepato/splenomegaly

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25
Q

Glandular Fever Ix

A

-monospot test: detects heterophile abs (could have early false -ve)

Test for EBV specific abs if -ve monospot after 6w but still symptomatic

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26
Q

Glandular Fever Tx

A

Avoid contact sport 3 weeks (splenic rupture)
Avoid alcohol
Paracetamol

IV fluids
steroids if tonsils v big

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27
Q

What is spina bifida?

A

Neural tube defect, vertebral arch of spinal column either incompletely formed or absent

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28
Q

How does spina bifida present?

A

often incidental finding on X-ray

-tethered cord damage causes most symptoms

  • bladder/bowel dysfunction
  • pain/weakness of lower limb

-80% have skin over defect with

  • hairy patch
  • fatty lump
  • hemangioma (red/purple spot made up of blood vessels)
  • dark spot or birth mark
  • skin tract or sinus
  • hypopigmented spot
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29
Q

how is spina bifida diagnosed

A

Prenatal: raised AFP, 18-21 wk scan
screening bloods

X-ray, CT

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30
Q

What is the treatment for spina bifida?

A

Fetal surgery <26wks
postnatal surgery to correct in first days of life

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31
Q

Common causes of limp in children < 4 years old

A
  • fracture
  • osteomyelitis
  • NAI
  • septic arthritis
  • DDH
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32
Q

Common causes of limp in child 4-10 years old

A
  • fracture
  • osteomyelitis
  • septic arthritis
  • perthes
  • transient synovitis
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33
Q

common causes of limp in child over 10 years old

A
  • fracture
  • osteomyelitis
  • septic arthritis
  • perths
  • chondromalacia
  • SCFE
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34
Q

Which regions are most responsible for limp in children?

A
  1. hip
  2. leg
  3. knee
  4. thigh and foot
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35
Q

Which non MSK areas do you need to examine in the limping child and why?

A
  1. abdomen
    • intra abdominal pathology can be cause
  2. testes
    • testicular torsion can be cause
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36
Q

How would you diagnose trauma as the cause of a limp?

A
  • trauma history
  • X-ray
    • anteroposterior and lateral views
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37
Q

Where would toddlers fracture generally be and how would it present? How would you treat?

A
  • spiral tibial
  • pre-school age
  • unwitnessed fall
  • local tenderness over tibial shaft
  • Tx- immobolise
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38
Q

What is the most common cause of acute hip pain in children 3-10

A

transient synovitis

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39
Q

Who does transient synovitis most commonly affect and how does it present?

A
  • boys
  • acute onset (sometimes post resp infection)
  • unilateral
  • no pain at rest
  • passive movements only painful at extreme ranges
  • may refuse to walk
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40
Q

What investigations would be performed if transient synovitis was suspected, what would they show?

A
  • FBC - normal or high
  • ESR - normal or high
  • X-Ray - can be normal
  • USS - effusion
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41
Q

How would you treat transient synovitis?

A
  • rest and physio
  • NSAIDs can reduced duration of symptoms
  • usually resolves 2/52
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42
Q

How does a septic arthritis history present?

A
  • <2 years old acutely unwell
  • can be after puncture wound or infected skin lesion (chicken pox)
  • pain present at rest
  • movement painful and resisted
  • hip pain referred to knee
  • one joint affected, mainly large joints
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43
Q

What would be in the findings from an examination of a joint affect by septic arthritis?

A
  • red, warm, tender, decreased ROM
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44
Q

What investigations would be performed if septic arthritis was suspected, what would they show?

A
  • aspiration of joint space under US for organisms and culture
  • WCC and CRP - increased
  • culture - +ve
  • USS - effusion
  • X-ray
    • bony changes not evident for 14-21 days
    • 28 days 90% show abnormalities
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45
Q

How would you treat septic arthritis?

A
  • Abx (initally IV) Fluclox
  • if deep joint or no resolution then wash out or surgical drainage
  • Initially immobilise but mobilisation must follow to prevent permanent deformity
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46
Q

What is Kocher Criteria

A

Probability of septic arthritis

  • Non weight bearing 1/4=3%
  • Temp > 38.5 2/4= 40%
  • ESR > 40 mm/hr 3/4 = 93%
  • WBC >12,000 4/4 = 99%
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47
Q

What is Perthes disease?

A

Avascular necrosis of femoral head

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48
Q

What increases the risk of Perthes

A
  • male
  • low birth weight
  • short stature
  • low socio-economic class
  • passive smoking
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49
Q

How does Perthes present?

A
  • insidious
  • unilateral limp and pain (hip or knee)
  • no trauma
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50
Q

What would be the +ve finding on an examination of someone with Perthes?

A
  • limited ROM
  • roll test - pt supine, internally and externally rotate joint to invoke guarding or spasm (especially internally)
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51
Q

What investigations would be performed if Perthes disease was suspected, what would they show?

A

X-ray

  • increased density of femoral head
  • sclerosis
  • fragmentation
  • eventual flattening of proximal femoral head

bone scan and MRI (helpful in diagnosis)

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52
Q

How is Perthes managed?

A
  • if <50% femoral head affected
    • bed rest and traction (use of pulling force)
  • More severe/late presentation
    • femoral head needs to be covered by acetabulum then hip kept abducted by plaster or by performing femoral or pelvic osteotomy
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53
Q

What is SCFE?

A

Slipped capital femoral epiphysis

results in displacement of epiphysis of femoral head - needs prompt Tx to prevent avascular necrosis

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54
Q

Risk factors for SCFE

A
  • tall and thin
  • short and obese
  • metabolic endocrine abnormalities
  • family Hx
  • usually occurs at puberty
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55
Q

SCFE presentation

A
  • acute onset after minor trauma or insidious onset
  • hip, thigh (maybe referred knee pain)
  • painful to weight bear
  • several week Hx of vague groin or thigh discomfort
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56
Q

What would be the positive findings in an examination of a patient with SCFE disease?

A
  • decreased abduction and internal rotation of hip
  • hip flexion often causes external rotation
  • may be leg shortening
57
Q

What investigations would be performed if SCFE was suspected, what would they show?

A
  • XR
    • widening and irregularity of plate of femoral epiphysis
    • displacement of epiphyseal plate medial and superior
58
Q

What is the treatment for SCFE?

A

Pinning of hip

59
Q

Risk factors of DDH

A
  • female
  • breech
  • c-section
  • pre-mature
  • 1st child
  • family hx
60
Q

When is neonatal screening repeated and what do you look for with DDH?

A

8/52

  • Barlow, can hip be dislocated
  • Ortolani, can hip be relocated back into acetabulum on abduction?
  • asymmetrical skin creases in thigh or buttock
  • USS if suspected DDH
61
Q

What is the Tx for DDH?

A
  • conservative - splint or harness
  • surgery
62
Q

What is a wheeze?

A

whistling sounds heard on expiration due to resp tree narrowing

63
Q

What are the common diagnosis for recurrent wheeze?

A
  1. persistent infantile wheeze
  2. viral episodic wheeze
  3. asthma (multiple trigger wheeze)
64
Q

Probably cause of wheeze age <3

A

Transient early wheeze

  • small airways
  • maternal smoking
  • early virus
  • pre-term
65
Q

Probable cause of wheeze 3-6

A

viral episodic wheeze

  • airway hyperactivity
  • RSV/LRI
66
Q

Probable cause of wheeze >6

A

IgE associated asthma

  • airway hyperactivity
  • atopy
67
Q

Summarise viral episodic wheeze

A
  • no interval symptoms
  • no XS of atopy
  • improves with age

Tx

  • bronchodilators
  • oral steriods
  • No benefit from inhaled steriods
68
Q

Acute asthma summary

A
  • 02 (if needed)
  • B-agonist
  • prednisolone (or IV Hydrocortisone)
  • IV salbutamol bolus
  • amniophylline/MgS04/Salbutamol infusion
69
Q

Examples of preventer inhalors

A

inhaled steriods - brown

  • beclomethasone
  • budesonide
  • fluticasone
70
Q

Examples of reliever inhalers

A

Blue - B2 agonists

  • salbutamol
  • torbutaline

ipratropium bromide

71
Q

Examples of add on asthma therapy

A

LABA

  • Salmeterol
  • formoterol

leukotriene receptor antagonists

  • monteleukast
  • theophyllines
  • omalizumab (anti IgE)
  • protexo (high IgE)
72
Q

Describe Stepwise approach to asthma mx in ages 5-12

A
  1. Inhaled SABA
    • inhaled steriod (200-400mcg/day)
  3. +inhaled LABA and assess control
    • if good continue LABA
    • if middle continue LABA but increase ICS (400)
    • if no response stop LABA, increase ICS (400), trial therapies
  4. increase ICS (800)
  5. maintiain ICS, + daily oral steriod tablet
73
Q

Common reasons for unresponsiveness to Tx in asthma

A
  • adherence
    • rule of 3rds, adequate, partial, none
  • diagnosis
  • environment
  • choice of drugs/devices
  • bad disease
74
Q

Side effects of ICS

A
  • might cause brief slowing of growth but doesnt affect final adult height
  • probably doesnt affect bones
  • can suppress adrenals
75
Q

What are the adrenal layers and what do they produce?

A
  1. Glomerulosa = Mineralcorticoids (aldosterone)
  2. Fasciculata = Glucocorticoids (cortisol)
  3. Reticularis = Sex Hormones (dihydrotestosterone)

(Go Find Rex, Made Good Sex)

76
Q

What are the two ventral body wall defects?

A
  1. exomphalos
  2. gastroschisis
77
Q

What is exomphalos?

A

abdo contents protruding through umbilical ring covered with transparent sac (amniotic membrane and peritoneum)

78
Q

What is gastroschisis?

A

bowel protruding through defect in anterior abdo wall adjacent to umbilicus, no covering sac

79
Q

risks of developing ventral body wall defects

A

conditions related to placental insufficiency

  • maternal illness and infection
  • drugs
  • smoking
  • alcohol
80
Q

How do ventral body wall defects present?

A

increased alpha-fetoprotein and abnormal USS 2nd trimester

exomphalos

  • 4-12cm abdo wall defect
  • central epigastric hypogastric

gastroschisis

  • opening >5cm
  • R of umbilical cord
81
Q

Ix for ventral body wall defects

A
  • increased MSAFP (maternal serum alpha-fetoprotein)
  • karyotyping
  • imaging
  • amniocentesis
82
Q

Exomphalos Mx

A
  • IV fluid
  • surgery +/- silo
  • if sac intact not much pre-op care needed
  • if sac ruptured same tx as gastroschisis
83
Q

Gastroschisis Mx

A
  • plastic closure (gradual decomp of abdo contents from silo into abdo)
  • primary closure
  • wrap body in clingfilm to minimise fluid and heat loss
  • NG tube
  • gastric function should return over several weeks, reassess if not successful 6/52
84
Q

ADHD features

A

1) attention deficit (unable to listen, sustain attention in play, follow instruction, remember simple tasks)
2) hyperactivity (squirming, fidgiting, talks incessantly, restlessness)
3) impulsivity (blurts out answers, interupts)

85
Q

ADHD management

A

mild 1st - parent training/education -> methylphenidate ->lisdexamfetamine

severe 1st - methylphenidate -> lisdexamfetamine

Methylphenidate SE= decreased appetite dont take on weekends

86
Q

Symptoms of ASD

A

A) Communication difficulites

  • lack of desire
  • literal communication

B) Social difficultlies

  • lack of desire
  • lack of motivation to please others
  • affect when they want to be

C) imagination impaired

  • repetative behaviour
  • no creative play

A) impaired social interaction

  • unaware of existence/feelings of others - bad at making friends
  • abnormal repsonse to being hurt
  • impaired imitation
  • repeated play

B) impaired imagination

  • little babbling
  • no fantasy/pretend

C) poor range of activity/interests

  • stereotyped movements
  • reoccupation with parts of objects
  • marked distress over change
  • routines
87
Q

non medical ASD management

A

early intensive behavioural intervention (increases IQ, enhances motor, social and living skills

±speech therapy

±special schooling

  • parent training
  • benefits
88
Q

What is MART

A

Maintenance and reliever therapy

ICS and LABA in one inhaler take daily and for sx relief

(symbicort, fostair)

89
Q

What ICS doses are considered low/mod/high

A

low: <200
mod: 200-400
high: >400

90
Q

SABA example, use, MoA and SE

A

salbutemol

reliever

relax airway SM

SE: tremor

91
Q

ICS example, use, and SE

A

beclometasone

preventer

SE: oral candidiasis, stunted growth

92
Q

LABA example and use

A

salmeterol

preventers

93
Q

LTRA exmaple and use

A

Leukotriene receptor antagonist

Monteleukast

oral preventers

94
Q

Asthma spirometry results

A

FEV1 (vol exhaled at end of 1st second of forced expiration): significantly reduced

FVC (vol exhaled after a maximla expiration following full inspiration): normal

FEV1/FVC < 70%

95
Q

Choice of Abx for tonsillitis

A

Phenoxymethypenicillin

(clarithromycin or erythromycin)

96
Q

Facial features of a baby with Downs

A

Wide spaced eyes
oblique palpebral fissues
Epicanthal folds
short broad nose
deeply grooved philtrum
protruding tongue
small chin and short neck

97
Q

Body features of baby with Downs

A

low set oval ears
excess nuchal skin
swollen oedematous dorsum of hands and feet
single palmer crease

98
Q

What are later medical problems and child with Downs might encounter?

A

cardio: VSD, PDA
ENT: hearing loss, otitis media
Opth: cataracts, strabismus
GI: Coeliac, Duodenal atresia
Endo: hypothyroid
Neuro: learning diffs, behavioural issues, Dementia
Haem: AML, ALL

99
Q

None physical neonatal features of Downs

A
  • Hyperflexibilty
  • muscular hypotonia
  • transient myelosyplasia of newborn
100
Q

What is the genetics of Patau?

A

Trisomy 13

101
Q

How does Patau present?

A

PERC

  • *P**olydactyl
  • *E**ye defects and small eyes
  • *R**enal malformations
  • *C**left lip and palate/cardiac malformations
  • *S**tructural brain defects/scalp defects
102
Q

Pataus prognosis?

A

Mean survival 2.5 days

50% live past 1 week
5-10% 1 year survival

103
Q

Pataus diagnosis?

A

10-14 wks: combined test (hCG PAPP-A)
11-14 weeks: CVS
>15w: aminocentesis
18-21w: physical conditions scan

104
Q

Genetics of Edwards

A

Trisomy 18

105
Q

US findings in Trisomy 18

A

Growth restriction
Polyhydraminos
overlapping fingers
Congential heart defects
strawberry haped cranium

106
Q

Neonatal features of trisomy 18

A

Low birth weight
Low set ears
small jaw
cleft lip and palate
overlapping fingers
rocker bottom feet

107
Q

Prognosis of Edwards

A

8% 1 year survival

108
Q

Prevention of spina bifida?

A

Folic acid

  • prevents occurance and reduces severity if occurs
  • prenatal diagnosis and surgery
109
Q

Criteria for ADHD diagnosis?

A
  1. present before 12 years old
  2. developmentally inappropriate
  3. 2 settings
  4. edivdence of impairment on social, academic or occupational
110
Q

Croup AX

A

Parainfluenza virus

111
Q

croup presentation

A

prodrome: coryzal, fever

barking cough, harsh stridor when distressed

*dont examine throat*

112
Q

How do you manage a patient with croup?

A

mild: home
Severe: PO dexa, pred, neb steroids or adrenaline

intubate if severe

113
Q

Acute epiglottitis Ax

A

Hib

114
Q

Presentation of acute epiglottitis

A

child sitting upright, mouth open, drooling
high fever
stridor soft

sudden onset

115
Q

How do you manage acute epiglottitis?

A

IV cefuroxime
intensive care, intubate

116
Q

Bacterial tracheitis Ax

A

staph aureus

117
Q

Bacterial tracheitis presentation

A

hours onset

older child

No prodrome

continuous stridors

118
Q

Features of Kawasaki disease

A

5 day fever

  • Mucuous membrane involvement: strawberry tongue, dry lips
  • Hands and feet: odema and desquamation
  • Eyes: bilat conjunctivitis
  • Adenopathy: cervival lymphadenopathy
  • Rash: truncal
  • Temp
119
Q

How do you manage Kawasaki?

A

IVIG in 10 days

aspirin

if persistent: immunosuppresion (infliximab, steroids, ciclosporin)

120
Q

What is the most serious complication of kawasaki?

A

Coronary aneurysm
6 week echo follow up to detect

121
Q

What is JIA?

A

joint inflam presenting in kids under 16 and persisting at least 6 weeks with other causes excluded

122
Q

What are the subsets of JIA?

A
  1. oligoarticular JIA (<5)
  2. polyarticular JIA RF -Ve (>5)
  3. polyarticular JIA RF +ve
  4. Systemic onset JIA (+fever)
  5. Juvenile psoriatic arth
  6. enthesitits related arth
  7. undiff arthritis
123
Q

Management of JIA

A

NSAIDS
Steroids: injection, systemic

methotrexate: subcut
surgery: joint replacement

124
Q

Which JIA subtype has increased risk of uveitis?

A

oligoarticular

125
Q

Whats the pathology of cystic fibrosis?

A

Autosomal recessive condition

airway: impaired ciliary function
intestine: meconium ileus
pancreas: ducts blocked by thick secretions (enzyme insufficients and malabsorption)

126
Q

How does cystic fibrosis get diagnosed

A

antenatal: CMV, amnio
Perinatal: scenning, jaundice, haemorrhagic disease of newborn
infancy: resp infections, FTT, diarrhoea
older: resp infections, bronchiectasis, male infert

127
Q

Cystic fibrosis signs

A

finger clubbing

cough, crackles, wheeze

obstructive FEV1 pattern

128
Q

Cystic fibrosis investigations

A
  • sweat test
  • genetic testing
  • sinus x-ray or CT scan: opacification
129
Q

Cystic fibrosis management

A

mucus clearance techniques
neb dornase alpha: reduces sputum viscosity
pancreatic enzymes
high calorie intake

130
Q

How do you test pancreatic function in cystic fibrosis patient?

A

low stool elastae

131
Q

what is cerebral palsy

A

Movement disorder resulting from a non-progressive lesion of motor pathways

132
Q

Later appearing symptoms of cerebral palsy

A

depend on where lesion is, symptoms appear gradually as child does not develop as expected

  • learning difficulties
  • epilepsy
  • squint
  • visual/hearing/speech and language impairment
    *
133
Q

Cerebral palsy causes

A

80% antenatal - gene deletions, infection, vascular occlusion

10% hypoxic ischaemic birth injury

10% post natal - trauma, meningitis, encephalitis

134
Q

Early signs of cerebral palsy

A
  • floppy baby
  • feeding difficulties
  • delayed motor milestones
  • persistence of primitive symptoms
  • asym hand movement (preference of hand <12m)
135
Q

Patterns of sypmtoms in Cerebral palsy

A
  1. spastic - 70% - lesion in pyramidal or corticospinal tract
  2. dystonic - 10% - lesion in basal ganglia
  3. ataxic - 10% cerebellum
  4. mixed - 10%
136
Q

Presentation of spastic cerebral palsy

A

UMN signs

  • hemiplegic - unilat asymmetrical arm> leg
  • quadriplegic - all limbs arm>leg
  • diplegic - all limbs legs>arms
137
Q

Cerebral palsy management

A

No cure

physiotherapy

splinting of affected contracted joints

botox injections - relax muscle in hyperonia, particularily for gait

SALT

138
Q

Causes of spina bifida

A

genetic, Downs, edwards, pataus
mum: alcohol, valproate, carbamazepine, db, not taking folic acid

phase 3a (9 decks)

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