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Child Health > Paeds in a day > Flashcards

Paeds in a day Flashcards

1
Q

difference between EBV tonsillitis and acute bacterial

A

both have exudate but EBV has a much more diffuse spread of it, bacterial tends to be spottier and sparser

EBV also has posterior cervical lymph nodes

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2
Q

ABx for acute bacterial tonsillitis

A

Pen V or phenoxymethylpenicillin

pen allergic - clarithromycin

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3
Q

Abx for otitis media

A

amoxicillin

pan allergic - clarithromycin

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4
Q

red flag features for a child with a limp

A 
suspected NAI 
>2 weeks 
signs of cancer - (pallor, Back pain, Night sweats, Lymphadenopathy, hepatosplenomegaly)
multiple joints
leg length discrepancy 
abnormal neurology 
current fever 
>8 and localised pain (XRAY)
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5
Q

how should you investigate a child with a limp

A

bloods - cultures if ?septic arthritis

XR - AP, lateral AND frog leg

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6
Q

kochers criteria for septic arthritis

A

non-weight beating
ESR >40/CRP >20
WCC >12
Temp >38.5

1/4 = 3%
2/4 = 40%
3/4 = 93%
4/4 = 99%
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7
Q

cause of septic arthritis in neonates

A

GBS

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8
Q

most common first line ABX for septic arthritis

A

IV fluclox

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9
Q

cause of septic arthritis in sickle cell patients

A

salmonella

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10
Q

community Abx for meningitis

A

IM Benpen

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11
Q

hospital abx for meningitis

A

<3m cephalosporin + amoxicillin + gentamicin

> 3m cephalosporin + gentamicin

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12
Q

what kind of vasculitis is kawasaki

A

medium vessel

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13
Q

diagnostic criteria for kawasaki

A 
>5 days of fever + 4/5 of:
bilateral non-suppurative conjunctivitis
oral changes
peripheral extremity changes
rash
cervical lymphadenopathy
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14
Q

Tx kawasaki

A

300mg aspirin + IV immunoglobins (+PPI cover)

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15
Q

what does a ‘sandpaper rash’ indicate

A

scarlett fever

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16
Q

what causes scarlett fever

A

GAS - strep pyogenes

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17
Q

Tx for scarlett fever

A

10 days Pen V/amox

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18
Q

advice around school for scarlett fever

A

avoid school for 2 weeks or for 24 hours after Abx

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19
Q

main difference between scarlett fever and kawasaki in terms of clinical presentation

A

scarlett fever doesnt cause bilateral conjunctivitis

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20
Q

what is a BRUE

A

brief unresolved unexplained event

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21
Q

criteria for BRUE diagnosis

A

brief and now resolved episode >1 of

cyanosis
decreased/irregular/absent breathing
hyper/hypotonia
altered consciousness

diagnosis of occlusion

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22
Q

features of low risk vs high risk BRUE

A 
high risk
<2 months
prematurity
Phx/cluster BRUEs
CPR given
developmental delay 
FHx BRUE/SIDs
abnormal examination findings
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23
Q

parental advice for BRUE

A

dont shake baby awake

no association between SIDS and BRUE

breastfeed if possible

don’t smoke, co-sleep, allow extremities of temperatures

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24
Q

inheritence of neurofibromatosis type 1

A

Autosomal dominant

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25
Q

diagnostic criteria for NF1

A 
1st degree relative with NF1
6+ cafe-au-lait patches (>5mm pre puberty, 15mm post-puberty)
>1 neurofibroma
axillary freckling
lisch nodule 
optic gliomas
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26
Q

what are lisch nodules

A

brown/red/gold patches on the iris

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27
Q

associated pathologies with NF1

A 
epilepsy
phaechromocytoma
pulmonary hypertension 
renal artery stenosis and HTN
MEN syndromes
Malignant nerve sheath tumours
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28
Q

inheritence of tuberous sclerosis

A

autosomal dominant

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29
Q

cutaneous features of tuberous sclerosis

A

ash leaf papules
shagreen patches
angiofibromas
subungal fibroma

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30
Q

neurological features of tuberous sclerosis

A

infantile spasms
epilepsy
astrocytomas

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31
Q

screening blood test for duschennes muscular dystrophy

A

CK levels

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32
Q

if a child is born with T21 what should be investigated as a screening measure

A

ECHO
FBC
TFTs
hearing screen

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33
Q

how are turner syndome complications managed

A

growth hormone therapy

Sex hormone replacement

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34
Q

what position is the appendix in if they have a positive psoas sign

A

retrocaecal

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35
Q

what is dunphys sign in appendicitis

A

pain on coughing

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36
Q

what is a useful appendicitis screen

A

inability to walk without a limp/hop on one leg

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37
Q

difference between appendicitis and mesenteric adenitits

A

mesenteric adenitis has a higher fever, preceding viral infection, still has appetite and pyrexia is usually higher grade. also no WBC/CRP elevation

38
Q

what is associated with causing ovarian torsion

A

ovarian cysts

39
Q

heart sounds + murmur in ASD

A

fixed widely split 2nd heart sound

ejection systolic murmur at upper left sternal edge

40
Q

Tx ASD

A

majority none

large/symptomatic/impairing function = device valve closure

41
Q

murmur for VSD

A

pansystolic murmur at lower left sternal edge

42
Q

what direction does blood flow in PDA

A

aorta to pulmonary artery

43
Q

when is a patent duct considered pathologically patent

A

1 month

44
Q

murmur for PDA

A

continuous murmur throught all stages + bounding pulse

45
Q

symptoms of a PDA

A

heart failure symptoms

46
Q

classical CXr findings of tetralogy of falot

A

boot-shaped small heart

decreased pulmonary vascular markings

47
Q

when is Tetralogy of falot surgery done

A

around 6 months of age

48
Q

classic CXR for TGA

A

‘egg on side’ appearance

narrow mediastinum

49
Q

causes of myocarditis

A

coxsackie b or adenovirus

50
Q

management innocent murmur

A

still investigate as per any murmur but communicate that its most likely benign

51
Q

what are the scanning principles for UTI in children

A

never scan if there is a response within 2 days of treatment

atypical UTI = USS during infection

recurrent UTI = USS within 6 weeks + DMSA 4-6 months following acute infection

52
Q

signs of a paeds UTI

A

can be anything

jaundice
vomiting
irritability
FTT
fever
poor feeding
53
Q

what counts as early neonatal sepsis

A

<72 hours

54
Q

most common organisms for neonatal sepsis

A

GBS
Ecoli
listeria/Hib/Strep

55
Q

what signs may indicate neonatal sepsis

A

low temp

tachycardic

56
Q

what counts as prolonged jaundice

A

> 3 weeks post birth

57
Q

what causes prolonged neonatal jaundice

A

unconjugated - physiological/breath milk, hypothyroid, infection, haemolytic, pyloric stenosis

conjugated - bile duct obstruction, neonatal hepatitis

58
Q

what causes jaundice in the period of 24hrs to 3 weeks

A 
physiological
breast milk 
infection - UTI
haemolysis
polycythaemia
crigler-najjar 
poor feeding/dehydration
59
Q

what is kernicterus

A

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

60
Q

which bilirubin is lipid-soluble

A

unconjugated (indirect)

61
Q

Tx for ITP

A

no bleeding - home, monitor FBC, avoid contact sports

Bleeding - consider immunoglobins, steroids +/- platelets

62
Q

what should you consdier before diagnosing ITP

A

other causes for low platelets (DIC/Sepsis/leukaemia etc)

63
Q

whats more common haemophilia A or b

A

A

64
Q

how is haemophilia stratified

A

% of factor levels

5-40% - mild
1-5% moderate
<1% severe

65
Q

Tx haemophilia bleed

A

recombinant factor concentrate

severe subtype gets prophylactic factor infusions from ages 2-3

66
Q

definition of faltering growth

A

fall across 1+ centiles if Birthweight <9th centile

fall across 2+ centiles if BW 9-91 centile

fall across 3+ centiles if BW >91st centile

any child <3rd centile

67
Q

advantages of breastmilk

A 
provides immunity
reduces risk of SIDs
increased intelligence
decreased risk of obesity
protects against allergies
protects against asthma
optimal nutrition
68
Q

contraindications for breastfeeding

A

mother has HSV1 on breasts

galactosaemia

69
Q

can you breastfeed with HIV

A

yes

70
Q

when should you get a stool culture in gastroenteritis

A

blood/mucous in stool
immunocompromised
recent travel
>7 days/diagnostic uncertaintl

71
Q

when should you take U+Es in gastroenteritis

A

IV fluids needed

concerned about hypernatraemia

72
Q

gastroenteritis management

A

no dehydration - encourage little and often
mild - ORS oral
moderate/not tolerating oral - NG ORS
severe/not tolerating NG - IV Fluids

73
Q

features of UC that are specific for it

A

pus in stool
fatigue
rectal pain
failure to defacate

74
Q

features of Crohns that are specific for it

A

nausea
vomiting
mouth sores
swelling eyes

75
Q

what should be screened for when T1DM is diagnosed in a child

A

Coeliacs disease

76
Q

most common paediatric cancer

A

ALL

77
Q

survival rate in ALL

A

90-95%

78
Q

prognostic factors for ALL (high risk parts)

A

Age (<1ye, >10yr)
WCC (>50)
Genetic mutation (philadelphia chromosome)
diseease state on presentation (CNS/testicular involvement)
spread of response to induction (failure to enter remission following induction)

79
Q

where are the majority of neuroblastomas in children

A

in the abdomen - e.g. adrenal tumours

80
Q

prognosis for neuroblastomas

A

poor - most present >1 yr old with advanced disease

81
Q

prognosis for nephrolastoma

A

good, >85% cure rate

82
Q

Tx nephroblastoma

A

chemo
delayed nephectomy
radiotherapy for advanced disease

83
Q

peak age of onset for ALL

A

2-5 years

84
Q

causes for hypoglycaemia in children

A 
idiopathic ketoic hypoglycaemia
inadequate intake
hyperinsulinaemia
endocrine deficienceies (GH deficiency, hypothyroidism) 
fatty acid metabolism defects
glycogen storage disorders
gluconeogenesis/glycogenlysis defects
organic acidaemias
85
Q

most common cause for hypoglycaemic in children

A

idiopathic ketoic hypoglycaemia

86
Q

tx hypoglycaemia

A

oral route if possible - dextrose tablets/fruit juice

unconcious/unsafe swallow/oral not working - 2ml/Kg IV bolus 10% dextrose (2.5 in neonateS) followed by 10% dextrose infusion to prevent rebound hypoglycaemia

87
Q

what counts as delayed puberty

A

absence of puberty by 13 (girls) or 14 (boys)

88
Q

what initial investigations are useful for delayed puberty

A 
karotyping 
TFT
LFT
FBC
U+E
Sex Hormones 
BMI/exercise
89
Q

in boys, if constitutional delay of growth/puberty is suspected what is the management

A

course of testosterone to ‘kickstart’ puberty

90
Q

definition of precocious puberty

A

onset of puberty before 8yrs (girls) or 9yrs (boys)

91
Q

signs of puberty beginning in girls/boys

A

breast budding in girls (not pubic hair development), and testicular enlargement >3mls in boys

Child Health (3 decks)

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