Paeds Flashcards
(138 cards)
1
Q
What is the most common resp infection in infants?
A
Bronchiolitis
2
Q
Bronchiolitis Ax
A
RSV
3
Q
Bronchiolitis presentation
A
coryzal symptoms dry cough and breathlessness
4
Q
Bronchiolitis Signs
A
Tachypnoea, chest recession
wheeze or crackles (?VIW if just wheeze)
5
Q
When do you admit for bronchiolitis?
A
Problems with feeding Low O2 Sats <92
6
Q
Bronchiolitis Ix
A
clinical diagnosis
Viral throat swabs
?CXR (exclude pneumonia, show hyperinflation)
7
Q
Bronchiolitis Tx
A
O2 ?fluids ?NG tube
8
Q
Pneumonia Ax
A
50% idiopathic
newborns : Grp B Strep
<5: RSV, strep pneumoniae, h. influenzae
>5: mycoplasma, strep. chlamydia pneumoniae
9
Q
Pneumonia presenation
A
‘unwell’ child
resp: cough, diff breathing
General: lethargy, poor feeding, fever
10
Q
Pneumonia signs
A
Increased RR: Tachypnoea
end inspiratory crackles
decreased O2
11
Q
Pneumonia Ix
A
CXR nasopharyngeal aspirate
12
Q
Pneumonia Tx
A
Amoxicillan -> co-amoxiclav
13
Q
At which ages is appendicitis most and least common
A
Most common 10-20 Least common <3
14
Q
Appendicitis Presentation
A
Anorexia vomiting abdo pain, central and colicky -> RIF and aggravated by movement
15
Q
Appendicitis Signs
A
flushed face fever + McBurneys
16
Q
Appendicitis Ix
A
urine dipstix - WBC
US - thickened non-compressable appendix with increased blood flow
17
Q
Appendicitis Tx
A
Appendicectomy
18
Q
Tonsillitis Ax
A
Gp A Beta-haemolytic strep Epstein-Barr Virus
19
Q
Tonsillitis Presentation
A
throat: Sore, diff swallowing -> LOA, no voice/hoarse
sick
lethargy
earache
20
Q
Tonsillitis Signs
A
Red tonsils white/yellow coating on tonsils
swollen glands in neck or jaw
fever
21
Q
Tonsillitis Tx
A
- symptoms normally go in 3-4 days
- paracetamol or ibuprofen lozenges, throat spray, antiseptic solutions
22
Q
When would a tonsillectomy be considered?
A
-recurrent tonsillitis -Peritonsillar abcess (quinsy) -obstructive sleep apnoea
23
Q
Glandular Fever Ax
A
EBV
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
25
Glandular Fever Ix
-monospot test: detects heterophile abs (could have early false -ve)
Test for EBV specific abs if -ve monospot after 6w but still symptomatic
26
Glandular Fever Tx
Avoid contact sport 3 weeks (splenic rupture)
Avoid alcohol
Paracetamol
IV fluids
steroids if tonsils v big
27
What is spina bifida?
Neural tube defect, vertebral arch of spinal column either incompletely formed or absent
28
How does spina bifida present?
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
29
how is spina bifida diagnosed
Prenatal: raised AFP, 18-21 wk scan
screening bloods
X-ray, CT
30
What is the treatment for spina bifida?
Fetal surgery \<26wks
postnatal surgery to correct in first days of life
31
Common causes of limp in children \< 4 years old
* fracture
* osteomyelitis
* NAI
* septic arthritis
* DDH
32
Common causes of limp in child 4-10 years old
* fracture
* osteomyelitis
* septic arthritis
* perthes
* transient synovitis
33
common causes of limp in child over 10 years old
* fracture
* osteomyelitis
* septic arthritis
* perths
* chondromalacia
* SCFE
34
Which regions are most responsible for limp in children?
1. hip
2. leg
3. knee
4. thigh and foot
35
Which non MSK areas do you need to examine in the limping child and why?
1. abdomen
* intra abdominal pathology can be cause
2. testes
* testicular torsion can be cause
36
How would you diagnose trauma as the cause of a limp?
* trauma history
* X-ray
* anteroposterior and lateral views
37
Where would toddlers fracture generally be and how would it present? How would you treat?
* spiral tibial
* pre-school age
* unwitnessed fall
* local tenderness over tibial shaft
* Tx- immobolise
38
What is the most common cause of acute hip pain in children 3-10
transient synovitis
39
Who does transient synovitis most commonly affect and how does it present?
* boys
* acute onset (sometimes post resp infection)
* unilateral
* no pain at rest
* passive movements only painful at extreme ranges
* may refuse to walk
40
What investigations would be performed if transient synovitis was suspected, what would they show?
* FBC - normal or high
* ESR - normal or high
* X-Ray - can be normal
* USS - effusion
41
How would you treat transient synovitis?
* rest and physio
* NSAIDs can reduced duration of symptoms
* usually resolves 2/52
42
How does a septic arthritis history present?
* \<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
43
What would be in the findings from an examination of a joint affect by septic arthritis?
* red, warm, tender, decreased ROM
44
What investigations would be performed if septic arthritis was suspected, what would they show?
* **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
45
How would you treat septic arthritis?
* 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
46
What is Kocher Criteria
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%
47
What is Perthes disease?
Avascular necrosis of femoral head
48
What increases the risk of Perthes
* male
* low birth weight
* short stature
* low socio-economic class
* passive smoking
49
How does Perthes present?
* insidious
* unilateral limp and pain (hip or knee)
* no trauma
50
What would be the +ve finding on an examination of someone with Perthes?
* limited ROM
* roll test - pt supine, internally and externally rotate joint to invoke guarding or spasm (especially internally)
51
What investigations would be performed if Perthes disease was suspected, what would they show?
X-ray
* increased density of femoral head
* sclerosis
* fragmentation
* eventual flattening of proximal femoral head
bone scan and MRI (helpful in diagnosis)
52
How is Perthes managed?
* 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
53
What is SCFE?
Slipped capital femoral epiphysis
results in displacement of epiphysis of femoral head - needs prompt Tx to prevent avascular necrosis
54
Risk factors for SCFE
* tall and thin
* short and obese
* metabolic endocrine abnormalities
* family Hx
* usually occurs at puberty
55
SCFE presentation
* 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
56
What would be the positive findings in an examination of a patient with SCFE disease?
* decreased abduction and internal rotation of hip
* hip flexion often causes external rotation
* may be leg shortening
57
What investigations would be performed if SCFE was suspected, what would they show?
* XR
* widening and irregularity of plate of femoral epiphysis
* displacement of epiphyseal plate medial and superior
58
What is the treatment for SCFE?
Pinning of hip
59
Risk factors of DDH
* female
* breech
* c-section
* pre-mature
* 1st child
* family hx
60
When is neonatal screening repeated and what do you look for with DDH?
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
What is the Tx for DDH?
* conservative - splint or harness
* surgery
62
What is a wheeze?
whistling sounds heard on expiration due to resp tree narrowing
63
What are the common diagnosis for recurrent wheeze?
1. persistent infantile wheeze
2. viral episodic wheeze
3. asthma (multiple trigger wheeze)
64
Probably cause of wheeze age \<3
Transient early wheeze
* small airways
* maternal smoking
* early virus
* pre-term
65
Probable cause of wheeze 3-6
viral episodic wheeze
* airway hyperactivity
* RSV/LRI
66
Probable cause of wheeze \>6
IgE associated asthma
* airway hyperactivity
* atopy
67
Summarise viral episodic wheeze
* no interval symptoms
* no XS of atopy
* improves with age
Tx
* bronchodilators
* oral steriods
* No benefit from inhaled steriods
68
Acute asthma summary
* 02 (if needed)
* B-agonist
* prednisolone (or IV Hydrocortisone)
* IV salbutamol bolus
* amniophylline/MgS04/Salbutamol infusion
69
Examples of preventer inhalors
inhaled steriods - brown
* beclomethasone
* budesonide
* fluticasone
70
Examples of reliever inhalers
Blue - B2 agonists
* salbutamol
* torbutaline
ipratropium bromide
71
Examples of add on asthma therapy
LABA
* Salmeterol
* formoterol
leukotriene receptor antagonists
* monteleukast
* theophyllines
* omalizumab (anti IgE)
* protexo (high IgE)
72
Describe Stepwise approach to asthma mx in ages 5-12
1. Inhaled SABA
2. + 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
Common reasons for unresponsiveness to Tx in asthma
* adherence
* rule of 3rds, adequate, partial, none
* diagnosis
* environment
* choice of drugs/devices
* bad disease
74
Side effects of ICS
* might cause brief slowing of growth but doesnt affect final adult height
* probably doesnt affect bones
* can suppress adrenals
75
What are the adrenal layers and what do they produce?
1. Glomerulosa = Mineralcorticoids (aldosterone)
2. Fasciculata = Glucocorticoids (cortisol)
3. Reticularis = Sex Hormones (dihydrotestosterone)
(Go Find Rex, Made Good Sex)
76
What are the two ventral body wall defects?
1. exomphalos
2. gastroschisis
77
What is exomphalos?
abdo contents protruding through umbilical ring covered with transparent sac (amniotic membrane and peritoneum)
78
What is gastroschisis?
bowel protruding through defect in anterior abdo wall adjacent to umbilicus, _no_ covering sac
79
risks of developing ventral body wall defects
conditions related to placental insufficiency
* maternal illness and infection
* drugs
* smoking
* alcohol
80
How do ventral body wall defects present?
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
Ix for ventral body wall defects
* increased MSAFP (maternal serum alpha-fetoprotein)
* karyotyping
* imaging
* amniocentesis
82
Exomphalos Mx
* IV fluid
* surgery +/- silo
* if sac intact not much pre-op care needed
* if sac ruptured same tx as gastroschisis
83
Gastroschisis Mx
* 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
ADHD features
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
ADHD management
mild 1st - parent training/education -\> methylphenidate -\>lisdexamfetamine
severe 1st - methylphenidate -\> lisdexamfetamine
Methylphenidate SE= decreased appetite dont take on weekends
86
Symptoms of ASD
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
non medical ASD management
early intensive behavioural intervention (increases IQ, enhances motor, social and living skills
±speech therapy
±special schooling
- parent training
- benefits
88
What is MART
Maintenance and reliever therapy
ICS and LABA in one inhaler take daily and for sx relief
(symbicort, fostair)
89
What ICS doses are considered low/mod/high
low: \<200
mod: 200-400
high: \>400
90
SABA example, use, MoA and SE
salbutemol
reliever
relax airway SM
SE: tremor
91
ICS example, use, and SE
beclometasone
preventer
SE: oral candidiasis, stunted growth
92
LABA example and use
salmeterol
preventers
93
LTRA exmaple and use
Leukotriene receptor antagonist
Monteleukast
oral preventers
94
Asthma spirometry results
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
Choice of Abx for tonsillitis
Phenoxymethypenicillin
| (clarithromycin or erythromycin)
96
Facial features of a baby with Downs
Wide spaced eyes
oblique palpebral fissues
Epicanthal folds
short broad nose
deeply grooved philtrum
protruding tongue
small chin and short neck
97
Body features of baby with Downs
low set oval ears
excess nuchal skin
swollen oedematous dorsum of hands and feet
single palmer crease
98
What are later medical problems and child with Downs might encounter?
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
None physical neonatal features of Downs
* Hyperflexibilty
* muscular hypotonia
* transient myelosyplasia of newborn
100
What is the genetics of Patau?
Trisomy 13
101
How does Patau present?
**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
Pataus prognosis?
Mean survival 2.5 days
50% live past 1 week
5-10% 1 year survival
103
Pataus diagnosis?
10-14 wks: combined test (hCG PAPP-A)
11-14 weeks: CVS
\>15w: aminocentesis
18-21w: physical conditions scan
104
Genetics of Edwards
Trisomy 18
105
US findings in Trisomy 18
Growth restriction
Polyhydraminos
overlapping fingers
Congential heart defects
strawberry haped cranium
106
Neonatal features of trisomy 18
Low birth weight
Low set ears
small jaw
cleft lip and palate
overlapping fingers
rocker bottom feet
107
Prognosis of Edwards
8% 1 year survival
108
Prevention of spina bifida?
Folic acid
- prevents occurance and reduces severity if occurs
- prenatal diagnosis and surgery
109
Criteria for ADHD diagnosis?
1. present before 12 years old
2. developmentally inappropriate
3. 2 settings
4. edivdence of impairment on social, academic or occupational
110
Croup AX
Parainfluenza virus
111
croup presentation
prodrome: coryzal, fever
barking cough, harsh stridor when distressed
\*dont examine throat\*
112
How do you manage a patient with croup?
mild: home
Severe: PO dexa, pred, neb steroids or adrenaline
intubate if severe
113
Acute epiglottitis Ax
Hib
114
Presentation of acute epiglottitis
child sitting upright, mouth open, drooling
high fever
stridor soft
sudden onset
115
How do you manage acute epiglottitis?
IV cefuroxime
intensive care, intubate
116
Bacterial tracheitis Ax
staph aureus
117
Bacterial tracheitis presentation
hours onset
older child
No prodrome
continuous stridors
118
Features of Kawasaki disease
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
How do you manage Kawasaki?
IVIG in 10 days
aspirin
if persistent: immunosuppresion (infliximab, steroids, ciclosporin)
120
What is the most serious complication of kawasaki?
Coronary aneurysm
6 week echo follow up to detect
121
What is JIA?
joint inflam presenting in kids under 16 and persisting at least 6 weeks with other causes excluded
122
What are the subsets of JIA?
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
Management of JIA
NSAIDS
Steroids: injection, systemic
_methotrexate_: subcut
surgery: joint replacement
124
Which JIA subtype has increased risk of uveitis?
oligoarticular
125
Whats the pathology of cystic fibrosis?
Autosomal recessive condition
airway: impaired ciliary function
intestine: meconium ileus
pancreas: ducts blocked by thick secretions (enzyme insufficients and malabsorption)
126
How does cystic fibrosis get diagnosed
antenatal: CMV, amnio
Perinatal: scenning, jaundice, haemorrhagic disease of newborn
infancy: resp infections, FTT, diarrhoea
older: resp infections, bronchiectasis, male infert
127
Cystic fibrosis signs
finger clubbing
cough, crackles, wheeze
obstructive FEV1 pattern
128
Cystic fibrosis investigations
* sweat test
* genetic testing
* sinus x-ray or CT scan: opacification
129
Cystic fibrosis management
mucus clearance techniques
neb dornase alpha: reduces sputum viscosity
pancreatic enzymes
high calorie intake
130
How do you test pancreatic function in cystic fibrosis patient?
low stool elastae
131
what is cerebral palsy
Movement disorder resulting from a non-progressive lesion of motor pathways
132
Later appearing symptoms of cerebral palsy
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
Cerebral palsy causes
80% antenatal - gene deletions, infection, vascular occlusion
10% hypoxic ischaemic birth injury
10% post natal - trauma, meningitis, encephalitis
134
Early signs of cerebral palsy
* floppy baby
* feeding difficulties
* delayed motor milestones
* persistence of primitive symptoms
* asym hand movement (preference of hand \<12m)
135
Patterns of sypmtoms in Cerebral palsy
1. spastic - 70% - lesion in pyramidal or corticospinal tract
2. dystonic - 10% - lesion in basal ganglia
3. ataxic - 10% cerebellum
4. mixed - 10%
136
Presentation of spastic cerebral palsy
**UMN signs**
* hemiplegic - unilat asymmetrical arm\> leg
* quadriplegic - all limbs arm\>leg
* diplegic - all limbs legs\>arms
137
Cerebral palsy management
No cure
physiotherapy
splinting of affected contracted joints
botox injections - relax muscle in hyperonia, particularily for gait
SALT
138
Causes of spina bifida
genetic, Downs, edwards, pataus
mum: alcohol, valproate, carbamazepine, db, not taking folic acid
