Paeds key facts Flashcards
1
Q
What is the treatment ladder for chronic asthma? (age dependant)
A
Under 5:
- SABA
- Low-dose Steroid
- Add montelukast
- Refer to a specialist
5-16:
- SABA
- Low-dose steroid
- montelukast
- Stop LTRA and add LABA
- Swap to MART (low dose ICS)
- med ICS MART
- high ICS MART
- Refer to specialist
17+:
- SABA
- Low-dose steroid
- montelukast
- Stop OR CONTINUE LTRA and add LABA
- Swap to MART (low dose ICS)
- med ICS MART
- high ICS MART
- Refer to specialist
2
Q
What is the key criteria for moderate/severe/life-threatening asthma attack?
A
Moderate:
Pf>50% expected
Normal speech and no other features of note.
Severe:
PF<50%
Sats<92%
Cannot complete sentences in one breath.
Signs of respiratory distress.
High resp and/or HR
Life-threatening:
- PF <33% predicted
- Sats <92%
- Silent chest
- Poor respiratory effort
- Cyanosis
3
Q
What is the management ladder for an asthma attack/viral induced wheeze?
A
- SABA (nebulisor)
- O2 to maintain 94-98%
- Prednisolone for 3-5 days after attack
- Consider use of ipratropium bromide if there is no response to SABA
4
Q
What are the key signs of respiratory distress in a child? (8)
A
- Cyanosis
- Tracheal tugging
- Head bobbing
- Increased RR
- Intercostal and subcostal recessions.
- Use of accessory muscles.
- Nasal flarring
- Abnormal airway noises.
5
Q
What is the key diagnostic factor for pneumonia?
A
High fever (over 38.5) with coarse crackles
6
Q
What is the most common pathogen to cause pneumonia?
A
Strep. Pneumoniae
7
Q
What is a likely source of pneumonia in a pre-vaccinated infant?
A
Strep B
8
Q
What is the most common cause of viral pneumonia?
A
Respiratory syncytial virus (RSV)
9
Q
What is the first line treatment for bacterial pneumonia?
A
Amoxicillin
10
Q
What is the most pathogen that causes of Croup?
A
Parainfluenza virus
11
Q
What is the key symptom of croup?
A
Barking cough.
12
Q
What is the treatment for croup?
A
Single dose of dexamethasone
13
Q
What is the most common pathogen to cause whooping cough?
A
Bordello pertussis
14
Q
What is the test to confirm a whooping cough diagnosis?
A
Nasopharyngeal swab with PCR.
15
Q
What is the treatment for whooping cough?
A
Azithromycin within 3 weeks.
Supportive care
16
Q
Is whooping cough notifiable?
A
Yes - tell PH
17
Q
What is the minimum age chronic asthma can be diagnosed?
A
2 YO
18
Q
What type of hypersensitivity is allergic rhinitis?
A
IgE mediated type 1 hypersensitivity reaction.
19
Q
What is the most pathogen to cause VIW?
A
RSV
20
Q
What age is VIW most common in?
A
Under 3 YO
21
Q
What is the management for VIW?
A
SABA
o2 with target 94-98
NO STEROID (compared to asthma)
22
Q
What is the most common pathogen to cause bronchiolitis?
A
RSV
23
Q
What age is associated with bronchiolitis?
A
under 1 year - peak at 6 months
24
Q
What is the management for bronchiolitis?
A
Conservative unless red flags present.
25
What are the red flags for hospital admission for children with a respiratory condition?
Factors that indicate the need for urgent hospital admission include:
- Resp rate over 60
- Grunting
- Moderate/severe Subcostal/intercostal recessions
- Apnoeas
- Cyanosis.
- Reduced consciousness
- Clinical dehydration
- Temp 38 or higher in under 3 months, 39 or higher in all ages.
- Neck stiffness
- Non-blanching rash
26
What is the most common pathogen to cause epiglottitis?
Haemophilius influenza type B (HIB)
27
What is the treatment for epiglottitis?
Ceftriaxone and dexamethasone
28
What is the inheritance pattern for CF?
Which chromosome does it affect and which gene?
Autosomal recessive
Affects the CFTR gene on chromosome 7.
29
What is the most common sign of CF except for heelprick test?
Meconium ileus (no stool passed for first 24 hours, alongside abdominal distension and vomiting due to bowel obstruction)
30
What is the gold standard test for CF?
Sweat test
31
What is the order for paediatric life support?
- Call for help
- Open airway
- Look, listen and feel for breathing
- 5 rescue breaths
- Check pulse (femoral under 1, carotid over 1)
- Compressions at 100-120 BPM
- 15:2 rate to 1/3 depth.
- In an infant (under 1 year) use thumbs and encircling technique.
- In older children, use either heel of one hand or both hands interlocked as seen in adults.
32
What is the most common cause of stridor in babies?
Laryngomalacia
33
What is the most common cause of ENT infections (otitis media etc.)?
Strep pneumoniae
34
When are antibiotics given for otitis media? What is the first line and for how long?
Given if there is evidence of systemic illness.
Amoxicillin for 5 days.
35
What differentiates orbital cellulitis from periorbital cellulitis?
- Eye pain/reduced movement
- Bulging/swelling of the eye
- Visual disturbance
36
What is the finding on auscultation for a VSD?
Pansystolic murmur at the lower left sternal border.
37
Treatment for VSD?
- Small? Watch and wait
- Big? Surgical correction
38
Auscultation for ASD?
Ejection systolic murmur at the upper left sternal border.
39
What is the treatment for ASD?
Watch and wait if small.
Surgical correction if big.
40
What is the auscultation for a PDA?
Left subclavicular thrill and machinery murmur.
41
What is the treatment for PDA?
- Indomethacin
- Surgery if big
42
When are prostaglandins used in congenital heart defects?
Maintain the PDA. Used in:
- Coarctation of the aorta
- Transposition of the great arteries
- Tetralogy of Fallot
43
What is the key history of rheumatic fever?
Developed following tonsillitis, with associated joint pain and chorea (rapid, involuntary movements)
44
What is the treatment for rheumatic fever?
10 days of penicillin
High dose aspirin
Prophylactic antibiotics (penicillin) afterwards
45
What is the ECG for SVT?
Absence of P waves with a regular rhythm
46
What is the ECG for AF?
Absence of P waves with an irregularly irregular rhythm
47
What is the ECG for Atrial flutter?
Saw tooth pattern with 2:1 ratio of P:QRS with rapid rate.
Regular intervals.
48
What is the most common pathogenic cause of infective endocarditis?
Staph. aureus
49
What is the standard treatment for endocarditis?
Amoxicillin for 4 weeks.
50
What are the four features of tetralogy of fallot?
- Overriding aorta
- Pulmonary valve stenosis
- VSD
- RVH
51
Auscultation for tetrology of fallot?
Investigation for tetrology of fallot?
- ejection systolic murmur
- Echocardiogram
52
What is the treatment for tetrology of fallot?
- Prostaglandins to maintain PDA until surgery can be arranged.
53
What criteria is used to diagnose infective endocarditis?
What are the two major signs on this criteria?
Duke criteria:
- Two or more positive blood cultures
- Positive findings on the echocardiogram
54
When is GORD normal in paediatrics?
Below the age of 1
55
What is the management for GORD?
If under 1 with no red flags, conservative management:
- Small frequent meals
- Regular burping
- Keep baby upright whilst feeding
If more severe:
- Gaviscon mixed into feed
- PPI if unresolved
56
What is the treatment for Cow's protein allergy?
- Replace formula with special hydrolyzed formulas.
- Mother stop eating dairy (+ca supplements)
57
What is the key symptom of pyloric stenosis
Projectile vomiting
58
What is the investigation for pyloric stenosis?
Abdo USS
59
What is the management for pyloric stenosis?
Surgical - pyloromyotomy.
60
What is the diagnostic criteria for IBS?
At least one of:
- Pain or discomfort relived by opening bowels
- Bowel habit abnormalities
- Stool abnormalities
At least two of:
- Straining/incomplete emptying
- Bloating
- Worse after eating
- Passing mucus
61
What is the conservative management for IBS?
- Adequate fluid intake
- Regular small meals
- More/ less fibre = constipation/diarrhoea
- Limit caffeine
- Increase exercise
- Probiotics
62
What is the medical management of IBS?
iF conservative measures dont work:
- Loparemide for diarrhoea
- Laxatives for constipation
Consider CBT and SSRI if remains uncontrolled.
63
What are the two most common causes of gastroenteritis?
Noravirus and rotavirus
64
How is gastroenteritis managed?
- Ensure adequate fluid intake (fluid challenge)
- IV fluids if unable to keep fluids down
65
How long should a child with gastroenteritis be off school?
- 48 hours from resolution of symptoms.
66
How is constipation managed?
- Lifestyle changes (increase fluids, encourage regular bowel movements, increase fibre)
First line laxative is movicol
67
What is the key symptom for appendicitis?
Severe central abdo pain that moves to the right illiac fossa over time.
68
What scan is used to confirm a diagnosis of appendicitis?
CT abdo
69
What is the management for appendicitis?
Appendectomy urgently
70
What are some key differences between crohns and UC?
Crohns affects the entire GI tract, UC affects the colon and rectum only.
Crohns has skip lesions, UC doesnt
Crohn's has cobblestone mucosa appearance, whereas UC has crypt abscesses.
Crohn's is transmural but UC is just the colonic submucosa.
71
What is the first line investigation for suspected IBD?
Faecal calprotectin.
72
What is the gold standard investigation for IBD?
Endoscopy
73
What is the management for crohns disease (acute and chronic)?
Acute - steroids (prednisolone)
Chronic - Azathioprine, second line immunosuppressants (methotrexate and infliximab)
74
what is the management for UC (acute and chronic)?
Acute - Mesalazine (second line prednisolone)
Chronic - Mesalazine (second line azathioprine)
75
What gene is associated with coeliac disease?
HLA-DQ2
76
What is the investigation pathway for coeliac disease?
Check overall IgA levels to exclude IgA deficiency, and at the same time check for raised anti-TTG
If inconclusive, check for raised anti-EMA
If serology suggestive of coeliac, refer for endoscopic small bowel biopsy to confirm the diagnosis (GS).
77
What is the treatment for coeliac disesase?
Lifelong gluten free diet.
78
What is the gold standard diagnostic test for Hirschsprung's disease?
Rectal biopsy showing absence of ganglionic cells.
79
What are the key symptoms for intussusseption?
- Red jelly-like stools
- Sausage shape in RUQ
80
What is the diagnostic investigation for intussusseption?
Abdo USS
81
What is the treatment for intussusseption?
- Therapeutic enema (water or air)
- If this fails, surgical reduction.
82
What is the treatment for Meckel's diverticulum?
Resection of the part of the bowel containing the diverticulum.
83
What is the key complication of a UTI?
Acute pyelonephritis.
84
What is a common cause of fever with no other symptoms in young children?
UTI - always do a dipstick to rule this out.
85
What is the best investigation for suspected UTI?
- Urine dipstick with a clean catch.
86
What findings on a urine dipstick indicate a potential UTI?
How do these relate to treatment?
- Nitrites BEST INDICATOR - treat as UTI if found.
- Leukocytes ONLY TREAT AS UTI IF THERE IS OTHER EVIDENCE OF UTI
87
If dipstick contains nitrites and/or leukocytes, what is the next step in investigations?
- Send an MSU off for culture.
88
When should children receive an abdominal USS following a UTI?
- Under 6 months old WITHIN 6 WEEKS.
- Under 6 months AND recurrent UTI DURING ILLNESS.
- Recurrent UTI WITHIN 6 WEEKS.
- Atypical UTI (confirmed by microbiology) DURING ILLNESS
89
What is a MCUG scan used for? When is it used?
To check for vesico-uteric reflux.
Used in children under 6 months old with recurrent or atypical UTI.
90
What is the treatment for UTI?
Under 3 months - refer to paediatric specialist.
Everyone else gets trimethoprim or nitrofurantoin.
91
What is the treatment for acute pyelonephritis?
Cefalexin.
92
At what age does primary nocturnal enuresis become abnormal?
Over 5 years old.
93
What is the management for nocturnal enuresis?
Conservative first:
- Healthy diet
- Adequate daily fluid intake
- Avoid caffeine
- Bed pads
- Positive rewards system
For long term control use an enuresis alarm.
For short term control, desmopressin can be offered.
94
What is the classical triad for nephrotic syndrome?
- Protein in the urine
- Low albumin
- Oedema
95
What is the most common cause of nephrotic syndrome in children?
Minimal Change disease.
96
What is the treatment for nephrotic syndrome/minimal change disease?
Prednisolone
Can use diuretics for oedema.
97
What is the main difference between nephrotic syndrome and nephritis?
Nephrotic syndrome: Protein in the urine
Nephritic syndrome: Protein AND BLOOD in the urine.
98
What are the two most common causes of nephritis in children?
Post-streptococcal glomerulonephritis.
IgA nephropathy.
99
What is the treatment for post-streptococcal glomerulonephritis?
Usually supportive.
Need to control BP/oedema?
- Antihypertensives
- DiureticsSupportive with diuretics for oedema.
100
What is the treatment for IgA nephropathy?
Usually supportive.
Can use steroids to slow progression.
101
AKI after tonsillitis - what is the most likely cause?
Post-streptococcal glomerulonephritis.
102
When is hypospadias surgery carried out?
Approximately 12 months of age.
103
What are the three key symptoms of haemolytic uraemic syndrome?
- Microangiopathic haemolytic anaemia
- AKI
- Thrombocytopenia.
104
What is the management for haemolytic uraemic syndrome?
- Urgent blood transfusion (anaemia)
- Dialysis (AKI)
- Fluids
105
Where does eczema present for babies compared to young children and adults?
- Presents on the face in babies.
- In adults, more likely to present on the flexor surfaces (crease in elbows, back of knees)
106
What is the management for eczema?
- Emolients (E45)
For severe flares, may use hydrocortisone.
107
How does Stevens-Johnson syndrome present?
Fever, cough, sore throat, itchy skin + eyes.
Progresses to a red/purple rash that blisters and peels.
108
How is Stevens-Johnson syndrome treated?
Medical emergency. Admit to hospital.
Treat with steroids, immunoglobulins and immunosupressants.
109
What type of reaction mediates allergic rhinitis?
IgE type 1 mediated reaction.
110
What are some common triggers for allergic rhintis?
- Dust mites
- Pollen
- Pets
111
What is the treatment for allergic rhinitis?
- Avoid triggers
- Antihistamines (nasal and/or oral)
112
What is the treatment for hives (acute and chronic)?
Acute flares - oral steroids
Chronic - Fexofenadine
113
What is the key difference between anaphylaxis and a less threatening allergic reaction?
Loss of airway, breathing or circulation.
114
What is the management for anaphylaxis?
ABCDE
IM adrenaline is mainstay
Also use antihistamines and steroids.
ALL CHILDREN NEED ADMISSION AND MEASURE THE MAST CELL TRYPTASE WITHIN 6 HOURS.
Give an epipen for future reactions.
115
What is the key diagnostic symptoms for Kawasaki disease?
- Persistently high fever MORE THAN 5 DAYS
- Widespread erythematous maculopapular rash STARTS ON HANDS AND FEET.
- STRAWBERRY TONGUE
- Skin peeling on palms and soles of feet.
- Lymphadenopathy
- Conjunctivitis
116
What is the treatment for Kawasaki?
High dose aspirin
IV immunoglobulins
EchoCG to check for coronary aneurysm.
117
What are the key findings for measles?
- High fever (over 39)
- Starts on face/behind ears and spreads downwards.
- Koplik's spots (spots on the inside of the mouth).
118
What investigation is required for measles?
- IgM/IgG serology to confirm the diagnosis.
119
Is measles notifiable?
Yes - inform PH after serology confirmation.
120
What is the management for measles? How long school exclusion required?
Management is conservative.
Isolate at least 4 days after the rash has appeared.
121
Is Kawasaki contagious?
No
122
What is the key diagnostic criteria for VZV?
Starts with fever, then the rash develops
Vesicular generalised rash that is itchy.
123
What is the management for VZV? How long is school exclusion?
- Self-limiting.
- Can use aciclovir if over 14 and presents within 24 hours.
- Stops being contagious when all lesions have dried and crusted over.
124
What are the notifiable diseases in paediatric infectious diseases?
- Whooping cough
- MMR (measles, mumps and rubella)
- HIB (epiglottitis)
- Haemolytic Ureamic Syndrome
- Acute viral hepatitis (A, B and C)
- TB
- Scarlet Fever
- Bacterial meningitis
125
How does rubella present?
- Erythematous macular rash. Starts on face then spreads to the rest of the body.
- Mild fever
- Joint pain
- Sore throat
126
What is the management for Rubella?
- Inform PH.
- Conservative - self-limiting.
127
What is the key presentation for scalded skin syndrome?
- Skin infection that has a similar appearance to a burn or scald.
128
What is the treatment for scalded skin syndrome?
- Oral abx and fluids.
129
What are the key presenting factors of TB?
Immigration from a country with a high rate of TB.
- Cough/haemoptysis
- Night sweats.
130
What virus causes hand foot and mouth disease?
Cocksackie A virus.
131
How does hand foot and mouth disease present?
- Typical upper resp symptoms.
- Small mouth ulcers and blistering red spots MAINLY ON THE HANDS FEET AND AROUND THE MOUTH.
132
How long off school with hand foot and mouth?
Until the child is feeling better.
133
What is the management for hand foot and mouth?
No management - conservative.
134
What is the most common cause of roseola infantum?
HHV-6 (or 7)
135
What is the key diagnostic presentation for roseola infantum?
- Develops 1-2 weeks after an infection.
- High fever lasting 3-5 days that then disappears.
- Rash appears after fever for around 1-2 days. Rash is mild erythematous macular rash over the whole body and IS NOT ITCHY.
136
Does a child need keeping off school with roseola infantum?
No if they are well enough to attend.
137
What is the main complication of roseola infantum?
Febrile convulsions due to high fever.
138
What pathogen causes slapped cheek syndrome/fifth disease?
Parovirus B19
139
What is the rash for slapped cheek syndrome/fifth disease?
A red rash on one or both cheeks, followed by a red spotty rash on the chest back arms and legs.
140
What is the treatment for slapped cheek/fifth disease?
Supportive
141
How long off school with slapped cheek syndrome/fifth disease?
- No time off needed. No longer infectious if the rash has already appeared.
142
What pathogen is associated with scarlet fever?
Group A strep (usually tonsillitis).
143
What are the key features of scarlet fever?
- Rough sandpaper rash that starts on the trunk and spreads outwards.
- Can also cause a strawberry tongue and cervical lymphadenopathy.
144
What is the treatment for scarlet fever?
- Phenoxymethylpenicillin (penicillin V) for 10 days.
145
Is Scarlet fever notifiable?
Yes - tell PH
146
How long should a child with scarlet fever be kept off school?
For 24 hours after starting antibiotics.
147
What is the alternative name for hand foot and mouth disease?
Cocksackie's disease
148
What age should a child be able to sit without support (average and limit age)?
Average 6-8 months
Cutoff is 9 months
149
What age should a child be able to crawl?
9 months
150
What age should a child be able to walk (average and cutoff age)?
Average is 12 months.
Cutoff is 18 months.
151
What age should a child be able to run and jump?
2.5 years.
152
What age should a child be able to transfer toys between hands (average and cutoff)?
average is 7 months
Cutoff is 9 months.
153
What age should a child develop a pincer grip (average and cutoff)?
10 months average
limit 12 months
154
What age should a child have a vocabulary of 2-3 words?
12 months
155
What age should a child be able to make simple phrases with 2-3 words?
20-24 months
156
What age should a child be able to point to parts of their body?
18 months.
157
What ages should a child smile in response (average and cutoff age)?
average 6 weeks
Cutoff 8 weeks.
158
What age should a child play with others?
2.5-3 years.
159
What ages can a febrile convulsion occur between?
6 months and 5 years.
160
What are some key differentials for a febrile convulsion?
- Epilepsy
- meningitis
- Brain tumour
- Syncope
- Trauma
161
When should a child be admitted to hospital with a febrile convulsion?
- First febrile seizure
- Febrile seizure under 18 months
- Potential complex febrile seizure
162
What makes a febrile seizure complex?
- Partial or focal seizure
- Last more than 15 mins
- Occur more than once during the same illness.
163
What is a simple febrile convulsion?
- Generalised tonic-clonic seizure
- Less than 15 mins
- Occurs only once during a single febrile illness.
164
How does chance of developing epilepsy relate to febrile convulsions?
Increases risk, even more with a complex febrile convulsion.
165
What is the management for a febrile convulsion?
Paracetamol and ibuprofen for temperature
Treat the underlying infection.
166
What are some key symptoms of ADHD?
- Very short attention span
- Quickly swapping between activities
- Constantly moving/fidgeting
- Impulsive behaviour
- Disruptive/rule breaking
167
What is the first line medication for ADHD?
What is a key complication to monitor for with this medication?
- Methylphenidate
- Monitor for reduced growth.
168
What is meningococcal septicaemia?
Meningococcus bacteria in the bloodstream.
This is what causes the non-blanching petechial rash.
169
What are the two most common causes of bacterial meningitis in children and adults?
What is the most common cause of meningitis in neonates?
- Neiserria meningitidis
- Strep pneumoniae
Neonates - Strep B
170
What are the 3 most common causes of viral meningitis?
- Enterovirus (most common)
- Herpes simplex virus
- Varicella Zoster virus
171
What are the two key tests for meningitis?
Kernig's test - Lie flat and flex knee. Slowly straighten knee and look for discomfort.
Brudzinski's test: Lie flat and lift patients head towards their chest, observing for involuntary flexion of the hips and knees.
172
What are the key symptoms of meningitis?
- Neck stiffness
- Vomiting
- Photophobia
- Altered consciousness
- Seizures
- Petechial non-blanching rash.
173
How will meningitis present in a neonate?
- Poor feeding
- Hypotonia
- Lethargy
- Hypothermia
- BULGING FONTANELLE
174
Bacterial meningitis vs viral meningitis:
Appearance?
Protein?
Glucose?
WCC?
Culture?
Bacterial:
Appearance - cloudy
Protein - High
Glucose - Low
WCC - High (neutrophils)
Culture - Postive
Viral:
Appearance - Clear
Protein - Normal (or mildly raised)
Glucose - Normal
WCC - High (lymphocytes)
Culture - Negative
175
How is suspected bacterial meningitis managed in a GP setting?
If there are signs of meningitis AND a non-blanching petechial rash, ggive a stat dose of benzypenicillin and arrange hospital transfer.
176
What initial investigations are done when meningitis suspected? (help establish bacterial or viral)
- Blood culture
- LP.
(meningococcal PCR)
(Viral PCR)
177
How is suspected bacterial meningitis managed in a hospital setting?
What steps are taken after bacterial meningitis has been confirmed?
What is the prophylactic management for close contacts?
Antibiotics:
- Cefotaxime + amoxicillin if under 3 months.
- Cefotaxime only over 3 months.
After bacterial meningitis confirmed by LP/culture:
- Give dexamethasone daily for 4 days in children over 4 YO.
- Tell PH
Prophylaxis for people with close contact for the previous 7 days. Give a single dose of ciprofloxacin within 24 hours of diagnosis.
178
What is the management for confirmed viral meningitis?
Usually only supportive.
Can use aciclovir if HSV or VZV are confirmed on viral PCR.
179
What are the main complications after meningitis?
- Cerebral palsy
- Seizures
- Hearing loss
180
What is the first and second line treatment for tonic-clonic seizures?
1st - Sodium valproate.
2nd - Lamotrigine/carbamazepine
For women, no valproate.
181
What is the first and second line treatment for focal seizures?
Reverse of tonic clonic:
1st - Lamotrigine/carbamazepine
2nd - Valproate
182
Where does a focal seizure start? How does a focal seizure present?
Starts in one lobe of the brain:
Frontal - motor symtpoms (eye movements, neck movements, posturing)
Occipital - visual disturbance (floaters)
Parietal - parasthesia (pins and needles)
Temporal - deja vu, GI symptoms, automatisms (lip smacking etc)
183
What is the management for absence seizures?
Sodium valproate or ethosuximide.
184
What is the treatment for atonic seizures?
1st - valproate
2nd - lamotrigine
185
What is the treatment for myoclonic seizures?
1st - valproate
2nd - lamotrigine, levetiracetam or topiramate.
186
What are the first line treatments for infantile spasms?
- Prednisolone
- Vigabatrin
187
When are investigations started in children who have had a seizure?
After they have had two simple seizures (tonic-clonic) or one more complex seizure.
188
What are the investigations used in suspected epilepsy?
- EEG
- MRI brain
- ECG (exclude cardiac problems)
- Electrolytes (exclude abnormalities)
- Glucose (exclude hypoglycaemia/diabetes)
- Blood cultures, urine cultures, LP (exclude infective causes)
- Lying/standing BP to check for syncope.
189
What general advice should be given to parents of a child with epilepsy?
- Showers not baths
- Cautious about swimming without close supervision
- Cautious with heights/traffic
Managing a seizure:
- Place on floor in a safe position.
- Something soft under head
- Remove obstacles
- Call an ambulance if lasts more than 5 mins.
190
What is status epilepticus?
- Seizure that lasts more than 5 mins.
- 2 or more seizures without regaining consciousness in the interim.
191
What is the management pathway for status epilepticus in hospital?
ABCDE:
- Secure airway
- Give O2
- Assess the breathing/cardiac function
- CHECK BLOOD GLUCOSE
- IV access
- IV lorazepam. Repeat after 10 mins if seizure continues.
- After two doses of lorazepam, phenytoin.
192
What are the alternative medications to IV lorazepam if treating status epilepticus in the community?
Buccal midazolam
Rectal diazepam.
193
What are the key features of autism?
Social interaction:
- Lack of eye contact
- Delay in smiling
- Avoidance of physical contact.
- Difficultly reading non-verbal cues and establishing friendships
Communication:
- Delay of language progression
- Difficulty with imaginative play
- Repetitive language/phrases
Behaviour:
- Deep interests in patterns/objects/numbers
- Repetitve movements
- Fixed routines
- Extremely restricted food preferences
194
What are the three eating disorders and what is the difference between them?
Anorexia nervosa - Patient feels overweight despite evidence of normal/reduced BW.
Bulimia nervosa - Binge eating followed by purging. May be a normal body weight.
Binge eating disorder - Person has episodes where they excessively overeat. Will usually have a high BMI.
195
What is the mainstay of treatment for eating disorders?
CBT
196
In severe cases of anorexia nervosa, what is the management?
- Admission for refeeding and observation for refeeding syndrome
197
What are the key things to remember during an admission for refeeding?
Slow reintroduction of food (limits risk of refeeding)
Monitor magnesium, potassium, phosphate and glucose.
Fluid balance monitoring
ECG monitoring
Supplementation with B and thiamine
198
How will blood tests change on someone with refeeding syndrome?
- Low magnesium
- Low potassium
- Low phosphate
- Fluid overload
199
What is the management and timeframe for bilateral undescended testes?
- If undescended by 6-8 weeks, urgent referral to paediatrics to be seen within 2 weeks.
200
How is unilateral undescended testicle managed?
- Review at 6-8 weeks
- Review at 4-5 months.
If still undescended, refer to urology to be seen at 6 months to consider surgery between 6 and 12 months.
201
What are the symptoms of hypothyroidism?
Prolonged neonatal jaundice
Poor feeding
Consitpation
Increased sleep
Reduced activity
Slow growth and development
202
What is the treatment for hypothyroidism?
Levothyroxine
203
What are the blood findings for a patient with congenital adrenal hyperplasia?
Low aldosterone
Low cortisol
High testosterone
204
What are the findings for males and females with mild cases of congenital adrenal hyperplasia?
Usually found in puberty:
Both sexes:
- Tall for age
- Deep voice
- Early puberty
Males will have small testicles and large penises
Females will have facial hair and primary amenorrhea
205
What is the management for congenital adrenal hyperplasia?
- Cortisol replacement
- Aldosterone replacement.
- Females may require corrective surgery with ambiguous genitalia.
206
What is the most common finding for a female with severe congenital adrenal hyperplasia?
Ambiguous genitalia with an enlarged clitorus.
207
What are the two key findings for androgen insensitivity syndrome?
- Bilateral inguinal hernias (Containing testes)
- Primary amenorrhea
208
What is the key findings on blood tests for androgen insensitivity syndrome?
- High LH:FSH ratio (at least 2:1)
- Raised testosterone
- Raised oestrogen
209
What is the treatment for androgen insensitivity syndrome?
Bilateral orchidectomy
Oestrogen therapy
210
What type of anaemia is caused by iron deficiency?
Microcytic anaemia
211
How is iron deficiency anaemia treated in children?
Improve diet
Ferrous sulfate.
Blood transfusion is rarely needed.
212
What is thalassaemia?
A genetic deficit in the alpha/beta protein chains that make up Hb.
213
What inheritance pattern does thalassaemia have?
Autosomal recessive.
214
What are the signs/symptoms of thalassaemia?
Microcytic anaemia
Fatigue
Pallor
Splenomegaly
Pronounced forehead/cheekbones (due to bone marrow expansion)
215
What investigations are used in suspected thalasaemia?
FBC (microcytic anaemia)
Haemoglobin electrophoresis (shows globin abnormalities)
DNA testing to look for genetic abnormality
216
What is the key complication of thalassaemia?
How can this be prevented?
Iron overload.
This is why serum ferritin levels are monitored regularly.
217
What is the potential curative treatment for thalassaemia?
Bone marrow transplant
218
What are the three levels of B-thalassaemia? How do these look genetically?
Thalassaemia minor - one abnormal and one normal gene.
Thalassaemia intermedia - Two defective genes, or one defective gene and one deletion gene.
Thalassaemia major - Two deleted genes.
219
What inheritance pattern does haemophilia have?
X-linked recessive.
220
What is the key symptom of haemophilia?
Excessive bleeding in response to trauma
Spontaneous bleeding with no trauma.
221
How is haemophilia diagnosed?
Bleeding scores
Coagulation factor assays
Genetic testing
222
What is the management for haemophilia?
Give an infusion of the affected clotting factors (VIII or IX)
223
What is the difference between haemophilia A and B?
A affects clotting factor VIII
B affects clotting factor IX.
224
What is the difference between idiopathic thrombocytopenia purpura and immune thrombocytopenia purpura?
They are the same thing!!
225
What are the key diagnostic factors for ITP?
What often proceeds ITP?
Bleeding (gums and nose)
Bruising
Petechial or purpuric non-blanching rash.
Often there is a recent viral illness.
226
What type of reaction causes ITP?
Hypersensitivity type II
227
What investigation should be done for ITP and what will the findings be?
FBC - isolated thrombocytopenia
OTHERWISE THINK ALL
228
What is the medical management for ITP?
Usually no treatment required and will resolve after 3 months.
If severe anaemia:
- Prednisolone
- IV immunoglobulins
-Blood Transfusion (if required)
229
What advice should be given about ITP?
- Avoid contact sports
- Avoid IM injections
- Avoid NSAIDs and aspirin
230
What is the most common leukaemia in children?
ALL - Acute lymphoblastic leukaemia.
231
What is the key finding on an FBC for leukaemia?
- Anaemia
- Leukocytosis
- Throbocytopenia
232
What common genetic conditions increase the risk of leukaemia?
- Down's syndrome
- Noonan syndrome
233
What are the key symptoms of leukaemia?
- Failure to thrive
- Weight loss
- Night sweats
- Petechiae and abnormal bruising (thrombocytopenia)
- Lymphadenopathy
- Bone and joint pain
- Hepato and splenomegaly
- Unexplained fever
234
What are the key investigations for suspected leukaemia?
- FBC (low platelets, RBC and WCC)
- Blood film (blast cells present)
- Bone marrow biopsy
- Lymph node biopsy
235
What is the mainstay of management for leukaemia?
Chemotherapy.
236
What is the second most common type of leukaemia in children?
AML - Acute myeloid leukaemia.
237
What is the cure rate for leukaemia?
ALL - about 80%
Less positive for AML
238
How is maintenance fluid calculated?
- First 10kg 100ml per kg
- Next 10kg 50ml per KG
- Rest 20ml per KG
Gives daily fluid maintenance in ml/day
239
What are the three key features of Turner syndrome?
- Short stature
- Webbed neck
- Widely spaced nipples
240
What heart defect is Turner Syndrome associated with?
Bicuspid Aortic valve (most common)
Coarctation of the aorta (next most common)
241
What treatments can be offered for Turner Syndrome?
- Growth hormone therapy for short stature
- Oestrogen and progesterone
- Fertility treatment
242
What type of inheritance is Turner syndrome?
Not usually inherited - instead caused by the loss of one "X" chromosome in a female.
243
What genetic abnormality causes Down's syndrome?
- Three copies of chromosome 21 (trisomy 21)
244
What are the key clinical features of Down's syndrome?
- Hypotonia
- Brachycephaly (small head and flat back)
- Short stature
- Short neck
- Single palmar crease
- Epicanthic folds
245
What are the common complications of Down's syndrome?
- Recurrent otitis media
- Deafness
- Strabismus/squint
- Hypothyroidism
- Cardiac defects (VSD/ASD/PDA/ToF)
- Leukaemia
- Dementia
246
What is the best choice test for Down's syndrome screening?
The combined test - is both gold standard and first line.
Combines both foetal and maternal tests.
Results are:
- Nuchal translucency >6mm
- beta-HCG high
- PAPPA low
247
What results will be seen on a triple screening test in Down's syndrome?
beta-HCG will be high
AFP will be low
Serum oestriol will be low
248
At what risk level does a mother receive antenatal testing for down syndrome following screening?
If there is a greater than 1 in 150 risk.
249
What is the antenatal testing procedure for Down's Syndrome?
Chorionic villus sampling (done earlier in pregnancy before 15 weeks)
Amniocentesis (done later in pregnancy)
250
What routine follow-up investigations are recommended for children with Down's syndrome?
- Regular thyroid checks
- EchoCG
- Audiometry
- Regular eye checks.
251
What is the other name for Edward's syndrome?
Trisomy 18
252
After positive screening, what tests are done to confirm a diagnosis of Edward's syndrome?
Chorionic villus sampling or amniocentesis.
253
What are the key characteristics of Edward's syndrome?
- Decreased muscle tone (hypotonia)
- Low set ears
- Overlapping fingers
- Rockerbottom feet
-Cardiac abnormalities
254
What genetic abnormality causes William's syndrome?
Deletion of genetic material on chromosome 7.
255
What are the key characteristics of William's syndrome?
- Broad forehead
- Flattened nasal bridge
- Long philtrum (long face)
- Very sociable personality
- Starburst eyes.
- Big smile.
256
What are the two key conditions associated with William's syndrome?
Supravalvular aortic stenosis.
Hypercalcaemia.
257
What is the most common type of muscular dystrophy in children?
Duchennes Muscular Dystrophy.
258
What is the inheritance pattern for Duchenne's muscular dystrophy?
X linked recessive
259
What sign is associated with Duchenne's muscular dystrophy?
Gower's sign - using their hands on their legs to help them stand up.
260
What is the overarching symptom for all types of muscular dystrophy?
Progressive muscle weakening and muscle wasting.
261
What causes rickets?
Deficiency in Vitamin D or calcium.
262
What key bone deformities can occur in rickets?
Bowing of the legs
Knock knees (inwards curve of the legs)
263
What key investigations are used in suspected rickets?
Serum vitamin D is first thing.
Then Xray of the long bones (lower limbs)
264
What usually proceeds an episode of transient synovitis?
An upper viral respiratory tract infection.
265
What is the key differentiating factor between transient synovitis and septic arthritis?
TS no temperature, whereas SA will have a fever.
266
When does a child with suspected transient synovitis need referring to A and E?
If they develop a fever or become systemically unwell.
267
What is the management for transient synovitis?
What safety netting advice should be given?
Simple analgesia to treat discomfort.
NEED TO SEND TO A&E IF SYSTEMICALLY UNWELL/HAVE A FEVER FOR ?SEPTIC ARTHRITIS
268
What is the most common causative organism of septic arthritis?
Staph Aureus
269
What are the key symptoms of septic arthritis?
Hot swollen joint
Unable to weight bear
SYSTEMIC SYMPTOMS - FEVER, LETHARGY, SEPSIS
270
What is the management for septic arthritis?
Admit to hospital
Joint aspiration and sent for culture
Empirical IV Abx to until sensitivities are known for 3-6 weeks. Then adjust accordingly.
271
What is osteomyelitis vs septic arthritis?
Osteomyelitis - Infection of the bone and bone marrow.
Septic arthritis - Infection of the joint
272
What is the most common pathogen to cause osteomyelitis?
Staph Aureus.
273
What is the initial investigation for osteomyelitis?
What is the GS investigation?
Initial is XR
Gold standard is MRI
274
What is the treatment for osteomyelitis?
Abx prolonged
275
What are they key diagnostics for perthes disease?
SLOW ONSET:
- Pain in hip/groin
- Limp
- Restriction of movement
NO HISTORY OF TRAUMA
276
What is the initial investigation for perthes disease? What are the findings on this?
XR - widening of the joint space
Inflammatory markers to exclude other causes
277
What is the management of perthes disease?
Bed rest
Traction
Crutches
Analgesia
Physio
Regular XR to assess healing.
278
What is the most common aeitology of Slipped upper femoral epiphysis?
8 - 15 year old overweight boy.
279
What are the key diagnostic symptoms/history of SUFE?
- Minor trauma not in proportion to the pain.
- Painful limp
- Restricted movement (ESPECIALLY RESTRICTED INTERNAL ROTATION)
280
What is the investigation for SUFE?
XR BOTH hips.
281
What is the definitive management for SUFE?
Surgery
282
What are the major risk factors for developmental dysplasia of the hip?
First degree FH
Breech presentation
Multiple pregnancy
283
What are the two special tests used in newborn screening to detect developmental dysplasia of the hip?
Ortolani test - See if the hip can be dislocated anteriorly
Barlow test - See if the femoral head will dislocate posteriorly
284
If a child is suspected to have DDH, what is the investigation?
When else is this needed regardless of examination findings?
USS of hips.
Also needed if the baby was breach.
285
What is the management of DDH?
- Pavlik harness under 6 months
- Over 6 months surgery.
286
What is the diagnostic criteria for juvenile idiopathic arthritis?
Arthritis without any other cause, lasting for more than 6 weeks in a patient under 16 years old.
287
What are the key features of JIA?
Joint pain
Swelling
Stiffness
288
What is used to manage JIA?
NSAIDs
Steroids
DMARD
TNF-inhibitors (infliximab)
289
What is the triad of key symptoms for Henoch-Schonlein purpura (HSP)?
purpura on buttocks/lower limbs
joint pain
Abdominal pain
290
What is the management for Henoch-Schonlein purpura?
usually self resolves so just NSAIDS
Steroids can be used if severe.
291
What blood types of the mother and baby can result in haemolytic disease of the newborn occuring?
If the mother is rhesus D negative, and the baby is rhesus D positive in a SECOND pregnancy.
(first is usually OK as previous sensitisation has not yet occurred).
292
What are some key sensitising events in haemolytic disease of the newborn?
Abdominal trauma.
Miscarriage.
Termination of pregnancy.
Amniocentesis/villous sampling.
PV bleeding.
Mixing of blood during birth.
293
In what circumstances is Anti-D given as prophylaxis for haemolytic disease of the newborn?
Miscarriage after 12 weeks.
Abdominal trauma during pregnancy.
At birth if the baby tests positive for rhesus.
294
When (timeframe) does jaundice occur due to haemolytic disease of the newborn?
In the first day of life.
295
What key investigations should be carried out for a newborn with jaundice?
FBC
Coombs' test - ABO and rhesus status
LFTs
Cultures (if sepsis suspected)
296
What is the treatment for jaundice in a baby?
Treatment of underlying infection.
Phototherapy.
297
What gestational age does respiratory distress syndrome normally occur in?
Under 32 weeks.
298
How does newborn respiratory distress syndrome appear on XR?
Ground-glass appearance.
299
How is risk of newborn respiratory distress syndrome decreased in mothers with preterm labour?
Dexamethasone antenatally.
300
What is the management for a baby born with newborn respiratory distress syndrome?
Endotracheal surfactant
CPAP
Oxygen to maintain 91-95%
301
What are the two key long-term complications of newborn respiratory distress?
Chronic lung disease (CLD)
Retinopathy of prematurity (due to reduced oxygen leading to poor development of eye vasculature)
302
What age puts a baby at risk of meconium aspiration syndrome?
Late gestational age
303
What are the key clinical features of meconium aspiration syndrome?
Meconium stained liquor
Respiratory distress shortly after birth.
Typical XR findings (hyperinflation, patchy opacification, consolidation)
Increased O2 requirement.
304
What are the typical XR findings for meconium aspiration?
Hyperinflation
Patchy opacification
Consolidation.
305
What is the key investigation for meconium aspiration?
What are the other key investigations?
Chest XR
Cap gas
CRP
Blood cultures
306
What is the management is given for meconium aspiration syndrome?
Supportive:
- Oxygen
- CPAP if needed
- Start antibiotics in case of infective cause.
307
How does a baby with hypoxic-ischaemic encephalopathy present?
Hypoxic event in the perinatal or intrapartum period (maternal shock, intrapartum haemorrhage, prolapsed cord)
Acidosis
Poor APGAR score.
308
What is the management for hypoxic ischaemic encephalopathy?
Therapeutic hypothermia. Cool the baby to between 33 and 34 degrees.
309
What dates does physiological jaundice usually occur between? When should it resolve by?
After 24 hours and should be resolved by 2 weeks in full term babies, in 3 weeks for premature babies.
310
What is the most important cause of jaundice before 24 hours?
Neonatal sepsis
311
What is the most important management for a baby with jaundice?
Phototherapy.
312
What is the target dose for babies that are neonatally hypoglycaemic? How does this relate to management?
More than 2mmol/L. Encourage breastfeeding and admit to postnatal ward.
If under 1mmol/L or showing signs of hypoglycaemia, give glucose IV infusion at 10%. Give a initial loading dose if severe.
313
If a woman is found to be strep B positive, what is the management?
- Prophylactic antibiotics during labour (penicillin)
314
What is the most important complication of necrotising enterocolitis?
Bowel perforation.
315
How does necrotising enterocolitis present?
- Intolerance to feeds
- Bilious vomiting
- Abdominal distension
- Absent bowel sounds
- Blood in stool.
316
What is the key investigation for necrotising enterocolitis?
Abdo XR
- Gas in the bowel wall/abdominal cavity.
- Dilated bowel loops.
317
What is the management for necrotising enterocolitis?
- IV fluids
- Total parenteral nutrition
- Abx
Surgery to resect the dead bowel tissue.
318
What is the key risk factor for necrotising enterocolitis?
Prematurity.
319
What key investigation is needed for suspected HSP?
Urine dipstick/urinalysis to check kidney function.
320
What are the known risk factors for congenital heart disease (5)?
Poorly controlled type 1/type 2 diabetes
Rubella during pregnancy
Teratogenic drugs
Substance misuse (e.g. alcohol)
Family history
321
What are the key characteristics of Potter's syndrome?
Clubbed feet
Low set ears
Loose skin
Small lung fields/respiratory distress.
322
What is the pathophysiology of Transient tachypnoea of the newborn?
TTN - pulmonary oedema caused by delayed reabsorption of foetal alveolar fluid.
323
What is the biggest risk factor for transient tachypnoea of the newborn?
C-section as normal vaginal delivery helps to clear the fluid out.
324
What is the cutoff for precocious puberty for males vs females?
Male - Before 9 YO
Female - Before 8 YO
