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Child Health > Paeds common conditions > Flashcards

Paeds common conditions Flashcards

1
Q

signs respiratory distress in children?

A

tachypnoea
cyanosis and paleness
grunting, nasal flaring & intercostal recession
tachycardia, sweating, drowsiness

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2
Q

microbiology of common cold in kids?

A

rhinovirus

RSV

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3
Q

common cold presentation?

A

sneezing, runny ose, mild fever

associated sore throat, acute otitis media

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4
Q

common cold typically lasts how long?
treatment ?
complications?

A

10 days
nil - rest and fluids and analgesia

secondary bacterial infection, bronchitis

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5
Q

child with viral prodrome for a few days, develops intermittent, loud, harsh stridor (especially when upset) and has a barking cough + hoarseness - Dx?

A

Croup

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6
Q

what is croup?

causative organism??

A 
viral tracheolayrngobronchitis
(upper airway obstruction from inflammation)
Parainfluenza virus (parents are paranoid)
RSV??
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7
Q

typical age range when croup presents?

A

6 months-6 years

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8
Q

On examination in croup ??

A

apyrexial, no signs systemic upset, able to swallow oral secretions

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9
Q

indicator of moderate disease in croup?

indicators of severe disease?

A

stridor at rest with no agitation or lethargy

agitations/restlesness
sternal retractions
constant stridor
cyanosis
lethargy
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10
Q

Ix in croup?

A

Dx usually clinical

can do an AP neck x ray

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11
Q

finding on AP neck x ray in croup?

A

Steeple sign (narrow trachea)

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12
Q

management of croup for all?
if mild?
moderate?
severe?

A

Dexamethasone stat

supportive care at home

nebulized adrenaline

oxygen, nebulized adrenaline +/- intubation

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13
Q

sudden onset (no prodrome), drooling and unable to swallow, constant soft stridor and muffled voice in child aged 2-7, fever, signs systemic upset, resp distress, unable to lie down??

A

epiglottitis
(acute bacterial infection of the epiglottis)

kid unable to swallow

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14
Q

causative organism in epiglottis ?

A

HiB (H influenzae B)

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15
Q

Ix in epiglottis ?

typically shows what sign?

A

Lateral neck Xray

thumb print sign (enlarged epiglottis)

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16
Q

When should management be started in epiglottitis?

A

straight away, do not wait for x ray before starting treatment

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17
Q

Must not do what in epiglottitis?

A

examine throat or frighten child

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18
Q

treatment in epiglottits ?

A

hold oxygen mask close to child

call anaesthetist and ENT - critical paediatric airway (rigid layrngoscopy + intubation)

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19
Q

As well as supportive care in epiglottis could also maybe give what antibiotic?

A

IV ceftriaxone

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20
Q

acute LRTI typically seen in kids <1y/o - recent cold followed by cough, wheeze, intercostal recession, cyanosis and mild fever??

A

bronchiolitis

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21
Q

causative organism in bronchiolitis?

A

RSV (resp syncitial virus)

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22
Q

Ix in bronchiolitis and typical finding ?

Management ?

A

CXR
Hyperinflation with patchy changes

Supportive care

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23
Q

Presentation of pneumonia in child?

A

malaise and fever
respiratory distress
older children - pleural pain and crackles

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24
Q

Management of pneumonia in children:
If community acquired and non severe -
1) treatment if <1y/o?
2) treatment if >1y/o?

A

1) co amoxiclav
2) amoxicillin

(penicillin allergic = clarithromycin)

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25
Q

Children with community acquired pneumonia which is severe - treatment ??

A

co amoxiclav +/- clarithromycin (if suspected atypical)

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26
Q

hospital acquired pneumonia in a child - management (of any severity)?

A

co-amoxiclav

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27
Q

what does bordatella pertussis cause ?

A

whooping cough

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28
Q

how does whooping cough (bordatella pertussis) present ?

A

1-2 week Hx of cold symtpoms and nocturnal cough

Followed by 2-3 weeks of paroxysms of cough (coughing fits) followed by an inspiratory whoop

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29
Q

in whooping cough following fits of coughing and inspiratory whoop child can what?

A

vomit/ become cyanosed

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30
Q

Dx Ix in whooping cough?

A

culture of nasopharyngeal aspirate/swab

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31
Q

Treatment of whooping cough?

Can give what treatment if they have presented within 21 days of onset of symptoms?

A

supportive

clarithromycin

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32
Q

what should always be considered in DDx of child with stridor ?

A

foreign body inhalation

child choking/coughing

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33
Q

Management of foreign body inhalation:

a) if child choking?
b) if child not choking?

A

a) back slaps or abdominal thrusts

b) removal via bronchoscopy under GA

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34
Q

Acute/life threatening asthma attack in children:

suspected pO2?

A

<92%

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35
Q

acuta asthma attack PEF will be what % of predicted?

A

33-50%

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36
Q

life threatening asthma attack PEF will be what % of predicted?

A

<33% predicted

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37
Q

severity of asthma attack:

a) cant complete sentences in one breath or too breathless to speak?
b) silent chest with cyanosis?

A

a) acute attack

b) life threatening attack

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38
Q

Poor respiratory effort, exhaustion, confusion and hypotension indicates what severity of asthma attack?

A

life threatening

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39
Q

HR and RR in acute asthma attack ??

A

Increased (tachycardic and tachypneoic)

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40
Q

management of acute asthma attack in children:

first line management ?

A

Bronchodilators + steroids

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41
Q

acute asthma attack can give salbutamol how often ? max dose of how many puffs?

A

salbutamol every 30-60 seconds up to max dose of 10 puffs

can also give neb salbutamol + ipratropium

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42
Q

acute asthma attack in child consider adding in what to each nebulizer if sp02 <92% ?

A

MgSO4

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43
Q

steroids given in acute asthma attack in kids ?

A

prednisolone (use early)

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44
Q

dose of prednisolone in acute asthma treatment in kids:

a) <2 y/o?
b) 2-5 y/o?

A

a) 10mg

b) 20mg

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45
Q

acute otitis media in a child usually self limiting but when should antibiotics be considered? (5)

1st line T?

A 
<2y/o
bilateral
marked otorrhea
marked symptoms
bulging tympanic membrane

amoxicillin (clarithromycin if allergic)

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46
Q

following group A strep throat/tonsillitis, child develops fever, lymphadenopathy and a strawberry tongue, and a red roughened macular rash on chest arms neck and legs (worst in skin folds) - Dx ?

A

scarlet fever

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47
Q

rash in scarlet fever described as ?

scarlet fever typically develops within how long after tonsillitis?

A

sandpaper rash

within 3 weeks

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48
Q

scarlet fever - advise re school?

possible complication?

A

stay off school until rash resolves

rheumatic fever

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49
Q

Key features of an innocent murmur ?? (4)

A

Patient asymptomatic
No radiation or thrill
Made worse with fever
Change with respiration/position (Decrease when sitting up, increase when lying down)

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50
Q

2 innocent murmurs ?

A

Systolic murmur (soft systolic murmur best heard in the 2nd - 4th intercostal spaces

Venous hum (continuous murmur best heard below clavicles) diasspears when child lies down and occurs due to turbulent flow in head and neck veins

51
Q

In child:
Loud pan systolic murmur best heard at lower left sternal edge but radiates throughout precordium. Associated thrills +/- symptoms of HF - disease ?

A

ventricular septal defect

52
Q

In child:

Soft ejection systolic murmur best heard at upper left sternal edge with fixed splitting of S2 ??

A

Atrial septal defect

53
Q

In child:

Ejection systolic murmur heard between shoulder blades. Associated weak femoral and radio-femoral delay??

A

coarctation of the aorta

54
Q

In child:

Continuous machine like murmur best heard below left clavicle ??

A

PDA (patent ductus arteriorsis)

55
Q

What does cyanosis + murmur indicate ??

A

Tetralogy of fallot

56
Q

what are the 4 defects in tetralogy of fallot?

A

Ventricular septal defect (VSD)
Pulmonary stenosis
Right ventricular hypertrophy
Over-riding aorta

57
Q

main cause of gastroenteritis in children?
presentation?

Ix? T?

A

rotavirus

fever with D & V & ab pain

Stool PCR
supportive, ensure hydration

58
Q

Inflammation of the mesenteric lymph nodes which can occur secondary to viral infection (gastroenteritis/URTI) ??

A

Mesenteric adenitis

59
Q

presentation of mesenteric adenitis?

A

fever
acute onset RIF pain (mimic appendicitis)
O/E: diffuse tenderness, cervical lymohadenopathy

60
Q

IX in mesenteric adenitis ?

Treatment ?

A

USS (enlarged mesenteric lymph nodes)

Supportive (self limiting)

61
Q

initial vague ab pain then localized to RIF, child cannot jump up and down (pain worse on movement ) ???

A

Appendicitis

62
Q

Non blanching purpuric rash on buttocks and extensor surfaces with abdominal pain, flitting arthritis +/- glomerulonephritis (haematuria) ??

A

HSP (henoch schonlein pupura)

ab pain usually accompanies but may precede rash

63
Q

what is HSP??

Dx??

A

Its an IgA, ANCA -ve small vessel vasculitis

Skin or renal biopsy

64
Q

child with regurgitation, chronic hiccups, refusal to feed and failure to thrive? (in older children - layrngitis and in adolescents - heartburn/acid brash??

A

GORD

65
Q

Ix of GORD?

A

endoscopy and oesophageal pH

BUT Dx usually clinical

66
Q

management of GORD in child?

A

avoid over feeding, sit upright longer after feeds, nursing in prone position
Antacids
Ranitidine
Most cases resolve by 6-9 months

67
Q

projectile vomiting after feeding, milky and no bile, baby not keen to feed and few stool movements?

A

pyloric stenosis

68
Q

pyloric stenosis - O/E what?

A

Olive shaped mass in RUQ

visible peristalisis

69
Q

Ix pyloric stenosis?

A

USS but Dx usually clinical

70
Q

Treatment of pyloric stenosis ?

A

Ramstedts pyloral myotomy

71
Q

What can children with pyloric stenosis have on their blood result/blood gas?

A

hyperchloraemic hypokalaemic alkalosis

72
Q

Intermittent vomiting, milky/yellow, red jelly stool and O/E sausage shaped ab mass??
typical age of presentation = 6 months

A

Intussecpetion

73
Q

whats intususseption?

most commonly occurs where?

A

bowel telescopes in on itself causing obstruction

terminal ileum

74
Q

Ix in intusucception?

A

USS (see a target lesion)

75
Q

management of intusucception?

A 
conservative = air enema reduction
surgical = if conservative fails
76
Q

green bilious vomit in child 1 hour - 1 year of age ??

A

malrotation with volvulus until proven otherwise

surgical emergenecy

77
Q

suspected malrotation with volvulus?

a) 1st line Ix?
b) Dx Ix?

management ?

A

a) AXR
B) upper GI contrast series (D-J flexure) + US

Immediate referral to surgery

78
Q

child aged <5, watery diarrhoea 4-10 times a day with visible lumps of food, otherwise well and no deviation in growth?

A

Toddler diarrhoea

nil treatment - reassure and restrict high sugar drinks

79
Q

child vomiting due to over feeding will typically be ?
normal amount baby should receive a day?
normal intake for child should be ?

A

above expected centile for weight

150mls/kg/day

80
Q

cows milk intolernace presentation?
Ix?
management ?

A

chronic diarrhoea

trial of milk free diet

continue milk free diet with challenge tests every 6 months until intolerance has resolved

81
Q

chronic diarrhoea in child - if growth normal unlikely to be what?
If everything normal and no visible food - 1st line is to ?

A

malabsorptive of IBD

trial of cows milk free diet

82
Q

constipation in child: red flags?

A

failure to pass meconium within 48 hours
abnormal appearance of the anus
constipation from birth
faltering growth

83
Q

functional constipation in child - how many poos a week?

other features?

A

<3 defecations per week
large stools block toilet
rabit droppings
may have weekly overflow incontinence

childhood constipation main cause of enuresis

84
Q

risk factors for childhhood constipation?

A

low fibre, obesity, low fluids

85
Q

management of childs constipation

A 
increase fluids and fibre
stool softeners (movicol/lactulose)
86
Q

In older child constipation and abdominal distension, in younger child may present with failure to pass meconium by 48 hours ??

A

Hirschprungs disease

87
Q

O/E in hirschprungs disease?

Dx Ix?

A

explosive passage of stoll following PR exam

Full thickness rectal biopsy

88
Q

UTI in children:
presentation in neonate?
in toddler ?
older kids ?

A

sepsis, poor feeding, irritabilty, more wet nappies

feverish, generally unwell, vomiting, vulvitis in girls

dysuria, incontinence, ab pain/aymptomatic, vulvitis in girls

89
Q

associations in UTI in children ?

A

vesicoureteric reflux
renal tract abnormalities
renal scarring due to chronic infections and reflux

90
Q

for all children who are non sepcifically unwell or have symptoms of UTI do what Ix?

A

Urinalysis

91
Q

managment of UTI in children:
if lower UTI-
a) age <3 months?
b) age >3 months?

A

a) IV amoxicillin and gentamicin

b) Trimethoprim or nitrofurantoin (3 days)

92
Q

treatment of upper UTI in kids ??

A

IV amox and gent

93
Q

To assess the renal tract in children what Ix?

A

USS

94
Q

When should an USS scan be done in children with UTI?

A

ALL children <3 months
(During infection if atypical, up to 6 weeks after otherwise)

ALL children >6 months who suffer from RECURRENT infections

95
Q

RNA paramyxovirus spread via droplets ?

A

Measles

96
Q

presentation of measles?

A

prodromal cough fever and nasal discharge (4/7)
koplicks spots: white spots on red background on buccal mucosa
maculopapular rash: develops after about 4 days, starts on face neck and behind ears and rapidly spreads to cover whole body

97
Q

Ix for measles?

A

Measles specific IgM - Elisa

98
Q

managment for measles?

A

notify public health

supportive care

99
Q

fever malaise, bilateral parotid swelling, orchitis in boys, may have aspectic meningitis/pancreatitis ass??

A

Mumps

100
Q

causative orgnanism in mumps?

A

RNA paramyxovirus

101
Q

Ix for mumps?

Treatment ?

A

salivary IgM for mumps (throat swab)

Isolation and supportive care

102
Q

what is german measles ? causative virus?

A

Rubella (RNA rubella virus)

103
Q

presentation of rubella (german measles)??

A

pink discrete maculopapular rash - starts on face then rapidly spreads to whole body
sub occipital lymphadenopathy

104
Q

Ix of german measles ?

Treatment ?

A

Rubella IgM

Supportive care

105
Q

Rubella during pregnancy ass with what risks to child ?

Screened for when?
Management in pregnancy?

A

congenital heart disease
deafness
reduced IQ

Booking

Immunoglobulin

106
Q

atopic dermatitis rash typically appears where in infants?

A

face and extensor surfaces, flexures spared

107
Q

confluent erythema around nappy area, skin folds spared ?

A

nappy rash

108
Q

non itchy yellow scale on scalp of newborn/flexural rash in axillae, neck creases groin (no skin fold sparing) in infant ??

A

seborrhoeic

109
Q

High fever (+/- febrile convulsions), discrete macular rash on trunk (no sub occipital lymphadenoathy) Dx??

A

Roseola

110
Q

cause of roseola?

A

roseola virus (type of herpes virus)

111
Q

management of roseola?

A

anti-pyretics and hydration

112
Q

bilateral macular erythema on face (slapped cheek), maculopapular rash with lacy erythema on trunkl, fever and polyarthritis - Dx?

A

erythema infectiousum (slapped cheek)

risk of fetal death if pregnant mother catches it

113
Q

causative orgnaism in erythema infectiousum?

A

parovirus B19

114
Q

harmless rash seen in babys 2-5 days old - pustules with surrounding erythema and can become widespread?

A

erythema toxicum

self limiting

115
Q

m/c cause of meningitis in children?

A

viral

116
Q

m/c cause of bacterial meningitis in neonates?

A

listeria, group B strep

117
Q

m/c cause of bacterial meningitis in children?

A

h influenzae, meningococcal, pneumococcal

meningitis should be considered in all acutely ill children

118
Q

what is kernigs sign?

A

resistance to knee extension when hip is flexed

119
Q

Ix for meningitis (urine, bloods, Lumbar puncture)

a) lumbar puncture showing neurophils, high protein and low glucose - Dx?
b) lumbar puncture showing lymphocytes, normal protein and normal glucose - Dx?

A

a) bacterial

b) viral

120
Q

management of suspected bacterial meningitis in general practice ??

A

IM Benzylpenicillin

121
Q

Management of bacterial meningitis in secondary care:

1) if <3 months old??
2) if >3 months old??

A

1) cefotaxime + amoxicillin
2) cefotaxime 1 dose
daily doses of ceftriaxone +/- dexamethasone

122
Q

most common cause of infective encephalitis ?

others?

A

herpes simplex virus

mumps, varicella zoster, parovirus B19

123
Q

how presentation of encephalitis differs from meningitis?

A

viral prodrome

odd behaviour more prominent

124
Q

Ix (as per meningitis)

What is seen on MRI in HSV encephalitis ??

A

bilateral temporal lobe focus

Child Health (3 decks)

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