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
2
Q
ABx for acute bacterial tonsillitis
A
Pen V or phenoxymethylpenicillin
pen allergic - clarithromycin
3
Q
Abx for otitis media
A
amoxicillin
pan allergic - clarithromycin
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)
5
Q
how should you investigate a child with a limp
A
bloods - cultures if ?septic arthritis
XR - AP, lateral AND frog leg
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%
7
Q
cause of septic arthritis in neonates
A
GBS
8
Q
most common first line ABX for septic arthritis
A
IV fluclox
9
Q
cause of septic arthritis in sickle cell patients
A
salmonella
10
Q
community Abx for meningitis
A
IM Benpen
11
Q
hospital abx for meningitis
A
<3m cephalosporin + amoxicillin + gentamicin
> 3m cephalosporin + gentamicin
12
Q
what kind of vasculitis is kawasaki
A
medium vessel
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
14
Q
Tx kawasaki
A
300mg aspirin + IV immunoglobins (+PPI cover)
15
Q
what does a ‘sandpaper rash’ indicate
A
scarlett fever
16
Q
what causes scarlett fever
A
GAS - strep pyogenes
17
Q
Tx for scarlett fever
A
10 days Pen V/amox
18
Q
advice around school for scarlett fever
A
avoid school for 2 weeks or for 24 hours after Abx
19
Q
main difference between scarlett fever and kawasaki in terms of clinical presentation
A
scarlett fever doesnt cause bilateral conjunctivitis
20
Q
what is a BRUE
A
brief unresolved unexplained event
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
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
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
24
Q
inheritence of neurofibromatosis type 1
A
Autosomal dominant
25
diagnostic criteria for NF1
```
1st degree relative with NF1
6+ cafe-au-lait patches (>5mm pre puberty, 15mm post-puberty)
>1 neurofibroma
axillary freckling
lisch nodule
optic gliomas
```
26
what are lisch nodules
brown/red/gold patches on the iris
27
associated pathologies with NF1
```
epilepsy
phaechromocytoma
pulmonary hypertension
renal artery stenosis and HTN
MEN syndromes
Malignant nerve sheath tumours
```
28
inheritence of tuberous sclerosis
autosomal dominant
29
cutaneous features of tuberous sclerosis
ash leaf papules
shagreen patches
angiofibromas
subungal fibroma
30
neurological features of tuberous sclerosis
infantile spasms
epilepsy
astrocytomas
31
screening blood test for duschennes muscular dystrophy
CK levels
32
if a child is born with T21 what should be investigated as a screening measure
ECHO
FBC
TFTs
hearing screen
33
how are turner syndome complications managed
growth hormone therapy
Sex hormone replacement
34
what position is the appendix in if they have a positive psoas sign
retrocaecal
35
what is dunphys sign in appendicitis
pain on coughing
36
what is a useful appendicitis screen
inability to walk without a limp/hop on one leg
37
difference between appendicitis and mesenteric adenitits
mesenteric adenitis has a higher fever, preceding viral infection, still has appetite and pyrexia is usually higher grade. also no WBC/CRP elevation
38
what is associated with causing ovarian torsion
ovarian cysts
39
heart sounds + murmur in ASD
fixed widely split 2nd heart sound
ejection systolic murmur at upper left sternal edge
40
Tx ASD
majority none
large/symptomatic/impairing function = device valve closure
41
murmur for VSD
pansystolic murmur at lower left sternal edge
42
what direction does blood flow in PDA
aorta to pulmonary artery
43
when is a patent duct considered pathologically patent
1 month
44
murmur for PDA
continuous murmur throught all stages + bounding pulse
45
symptoms of a PDA
heart failure symptoms
46
classical CXr findings of tetralogy of falot
boot-shaped small heart
decreased pulmonary vascular markings
47
when is Tetralogy of falot surgery done
around 6 months of age
48
classic CXR for TGA
'egg on side' appearance
narrow mediastinum
49
causes of myocarditis
coxsackie b or adenovirus
50
management innocent murmur
still investigate as per any murmur but communicate that its most likely benign
51
what are the scanning principles for UTI in children
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
signs of a paeds UTI
can be anything
```
jaundice
vomiting
irritability
FTT
fever
poor feeding
```
53
what counts as early neonatal sepsis
<72 hours
54
most common organisms for neonatal sepsis
GBS
Ecoli
listeria/Hib/Strep
55
what signs may indicate neonatal sepsis
low temp
| tachycardic
56
what counts as prolonged jaundice
>3 weeks post birth
57
what causes prolonged neonatal jaundice
unconjugated - physiological/breath milk, hypothyroid, infection, haemolytic, pyloric stenosis
conjugated - bile duct obstruction, neonatal hepatitis
58
what causes jaundice in the period of 24hrs to 3 weeks
```
physiological
breast milk
infection - UTI
haemolysis
polycythaemia
crigler-najjar
poor feeding/dehydration
```
59
what is kernicterus
encephalopathy from the deposition of unconjugated bilirubin in basal ganglia and brainstem nuclei
60
which bilirubin is lipid-soluble
unconjugated (indirect)
61
Tx for ITP
no bleeding - home, monitor FBC, avoid contact sports
Bleeding - consider immunoglobins, steroids +/- platelets
62
what should you consdier before diagnosing ITP
other causes for low platelets (DIC/Sepsis/leukaemia etc)
63
whats more common haemophilia A or b
A
64
how is haemophilia stratified
% of factor levels
5-40% - mild
1-5% moderate
<1% severe
65
Tx haemophilia bleed
recombinant factor concentrate
severe subtype gets prophylactic factor infusions from ages 2-3
66
definition of faltering growth
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
advantages of breastmilk
```
provides immunity
reduces risk of SIDs
increased intelligence
decreased risk of obesity
protects against allergies
protects against asthma
optimal nutrition
```
68
contraindications for breastfeeding
mother has HSV1 on breasts
| galactosaemia
69
can you breastfeed with HIV
yes
70
when should you get a stool culture in gastroenteritis
blood/mucous in stool
immunocompromised
recent travel
>7 days/diagnostic uncertaintl
71
when should you take U+Es in gastroenteritis
IV fluids needed
| concerned about hypernatraemia
72
gastroenteritis management
no dehydration - encourage little and often
mild - ORS oral
moderate/not tolerating oral - NG ORS
severe/not tolerating NG - IV Fluids
73
features of UC that are specific for it
pus in stool
fatigue
rectal pain
failure to defacate
74
features of Crohns that are specific for it
nausea
vomiting
mouth sores
swelling eyes
75
what should be screened for when T1DM is diagnosed in a child
Coeliacs disease
76
most common paediatric cancer
ALL
77
survival rate in ALL
90-95%
78
prognostic factors for ALL (high risk parts)
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
where are the majority of neuroblastomas in children
in the abdomen - e.g. adrenal tumours
80
prognosis for neuroblastomas
poor - most present >1 yr old with advanced disease
81
prognosis for nephrolastoma
good, >85% cure rate
82
Tx nephroblastoma
chemo
delayed nephectomy
radiotherapy for advanced disease
83
peak age of onset for ALL
2-5 years
84
causes for hypoglycaemia in children
```
idiopathic ketoic hypoglycaemia
inadequate intake
hyperinsulinaemia
endocrine deficienceies (GH deficiency, hypothyroidism)
fatty acid metabolism defects
glycogen storage disorders
gluconeogenesis/glycogenlysis defects
organic acidaemias
```
85
most common cause for hypoglycaemic in children
idiopathic ketoic hypoglycaemia
86
tx hypoglycaemia
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
what counts as delayed puberty
absence of puberty by 13 (girls) or 14 (boys)
88
what initial investigations are useful for delayed puberty
```
karotyping
TFT
LFT
FBC
U+E
Sex Hormones
BMI/exercise
```
89
in boys, if constitutional delay of growth/puberty is suspected what is the management
course of testosterone to 'kickstart' puberty
90
definition of precocious puberty
onset of puberty before 8yrs (girls) or 9yrs (boys)
91
signs of puberty beginning in girls/boys
breast budding in girls (not pubic hair development), and testicular enlargement >3mls in boys
