Paeds other Flashcards
1
Q
What investigations are offered if Newborn hearing screen is abnormal?
A
Auditory brainstem response test
2
Q
Otitis media is infection of which part of the ear?
A
Middle ear
3
Q
What are the clinical features of otitis media?
A
Pain
Fever
Irritability
Anorexia
vomiting
4
Q
When should you admit a child under 3months with otitis media?
A
If their temperature is above 38C
5
Q
When should you admit children over 3 months with otitis media?
A
Complications of the disease such as:
Meningitis
Mastoiditis
Facial nerve palsy
6
Q
What is the management of otitis media?
A
Most children just require paracetamol/ibuprofen for pain and fever control.
Antibiotics if systemically unwell or doesn’t improve within 4 days
7
Q
What is glue ear?
A
Otitis media with an effusion
8
Q
What type of hearing loss does glue ear cause?
A
Conductive hearing loss
9
Q
What are the risk factors for glue ear?
A
Male sex
Siblings with glue ear
Winter and spring
Bottle feeding
Day care attendance
Parental smoking
10
Q
What age does glue ear usually present?
A
Peaks at 2 years
11
Q
What is the treatment for glue ear?
A
Grommet insertion to allow air to pass through into the middle ear
12
Q
What is a concomitant (comitant) squint?
A
Non paralytic
Full movement of extraocular muscles
The angle of deviation of the squint remains the same during eye movements
13
Q
What is an incomitiant squint?
A
Damage to the extraocular muscles or their nerves.
Diplopia
Paralysis of the extraocular muscles
14
Q
What is periorbital cellulitis?
A
Inflammation and infection of the tissue and skin surrounding the eye
15
Q
WHat is the cause of periorbital cellulitis?
A
Scratch or bite around the eye, letting bacteria in.
16
Q
Treatment of periorbital cellulitis?
A
Antibiotics as soon as possible
17
Q
How long does the fever last for it to be considered Kawasaki disease?
A
Over 5 days
18
Q
What is the acronym for remembering the other features of Kawasaki disease?
A
CREAM
19
Q
What does CREAM stand for?
A
Conjunctivitis
Rash
Erythema (hands and feet)/Edema
Adenopathy
Mucosal involvement (strawberry tongue)
20
Q
What is the treatment for Kawasaki disease?
A
IV immunoglobulins and high dose aspirin
21
Q
What is the typical onset of measles like?
A
Conjunctivitis followed by a rash 2-5 days later
22
Q
What are the symptoms of measles?
A
Fever above 40C
Coryzal symptoms
Koplik spots
23
Q
What are koplik spots?
A
Small grey discolourations of the mucosal membranes in the mouth. Appearing 1-3 days after measles infection begins
24
Q
What is the management of measles?
A
Supportive care
Antipyrexial treatment
Vit A in children under 2
25
What are the main complications of measles?
Otitis media
Pneumonia
26
What does the rash look like in chicken pox?
Pustule filled blisters
27
Which virus causes chicken pox?
Varicella virus
28
Management of chicken pox?
Conservative management
Reduce scratching
Oatmeal baths
29
Where does the rash caused by rubella typically start and then move to?
Starts on the face and moves down to the trunk, sparing the arms and legs
30
How does the rubella rash differ from the measles rash?
Rubella spares the limbs
Measles includes the limbs
31
Which 5 symptoms does rubella typically present with?
Fever
Coryza
Arthralgia
Rash
Lymphadenopathy
32
How long does it take symptoms of rubella to resolve?
7-10days
33
Which 4 complications can rubella infection cause in pregnancy?
In the first 20 weeks can cause:
Cataracts
Deafness
PDA
Brain damage
34
What is the management for rubella?
Supportive treatment
35
What type of bacteria cause diptheria?
Corynebacterium
36
What are corynebacterium?
Gram positive bacilli
37
Which part of the body does diphtheria affect?
Nose and throat
Sometimes skin
38
What are the 5 main symptoms of diphtheria?
Thick grey/white coating covering throat nose and tongue
High temp
Sore throat
Swollen glands
Difficulty breathing and swallowing
39
What is scalded skin syndrome?
A rare skin infection which looks like the child has been burned and their skin is peeling
40
What age children are at highest risk of SSSS?
Children under 5 at greatest risk
41
What type of bacteria causes SSSS?
Staph aureus
42
What is the appearance of SSSS on the skin?
Fluid filled blisters
Large sheets of the top layer of skin can peel away
43
How is SSSS diagnosed?
Skin biopsy
Culture
44
How is SSSS treated?
Antibiotics
45
Symptoms of TB?
Productive cough
Haemoptysis
Weight loss
Night sweats
46
Risk factors for TB?
Travel to Africa, south asia, south america, russia etc
47
Treatment of TB?
Isoniazid and rifampicin for 6 months
Pyrazinamide and ethambutol for 2 months
48
Which of the TB treatments can cause liver toxicity?
Rifampicin
Isoniazid
Pyrazinamide
49
Which of he TB treatments causes visual problems?
Ethambutol (remember E for eyes)
50
Which TB treatment might cause urine to go red/orange?
Rifampicin (R for red wee)
51
When does a baby qualify for the BCG vaccine?
If they come from a country/ have parents and grandparents from a country whose TB incidence if more than 40 per 100,000
52
How is polio transmitted?
Faecal oral route
53
What symptoms do patients with polio most commonly get?
URTI symptoms
Diarrhoea and vomiting
54
What is a rare complication of polio?
Paralysis, can affect the diaphragm meaning respiratory support is needed
55
What is coxsackie's disease?
Hand foot and mouth
56
What are the features of hand, foot and mouth?
Sore throat and fever
Oral ulcers
Vesicles on the palms and soles of feet
57
What is the management for hand foot and mouth?
Hydration and analgesia
Supportive treatment
Keep off school until feeling better
58
Which viruses are hand foot and mouth caused by?
Coxsackie A16 and enterovirus 71
59
Which bacteria is usually responsible for scarlet fever?
Strep pyogenes
60
How is scarlet fever spread?
Respiratory route by inhaling or ingesting droplets
61
How long is the incubation period of scarlet fever?
2-4 days
62
What are the characteristic symptoms of scarlet fever?
Fever
Malaise
Sore throat
Strawberry tongue
Rash
63
What are the characteristic signs about the rash in scarlet fever?
Pinhead spots
First appears on torso
Spares the palms and soles
64
What is the management of scarlet fever?
Penicilin for 10 days
Notifiable disease!
65
When can the child return to school if they have scarlet fever?
24 hours after starting antibiotics
66
What is TSS?
A severe systemic reaction to staphylococcal exotoxins
67
What are the symptoms of TSS?
Fever > 38.9C
Hypotension
Diffuse erythematous rash
De squamation of rash
Involvement of other organ systems
68
What is the management of TSS?
Removal of infected focus e.g. tampon
IV fluids
IV antibiotics
69
Which bacteria causes impetigo?
Staph or strep
70
Where do impetigo lesions tend to occur?
On the face
Flexures of the limbs
71
How is impetigo spread?
Direct contact with the infected scabs of a person.
72
What are the characteristic features of an impetigo lesion/
Golden crusted skin lesions typically around the mouth
73
How do you treat impetigo?
1% H202 cream for patients not systemically unwell
Topical antibiotic creams such as fusidic acid can also be used
74
How long should kids with impetigo be off school for?
Until lesions are crusted and healed
Or until 48 hours after Abx treatment
75
What are the symptoms of slapped cheek syndrome?
High temp
Runny nose and sore throat
Headache
Red rash on one or both cheeks
76
Management of slapped cheek syndrome?
Conservative management
Fluids, rest, paracetamol
Moisturiser if pruitis
77
Who does klinefelters syndrome affect?
Men
78
What is the pathophysiology of klinefelters?
XXY chromosomes. The characteristics typically do not develop until later on.
79
Name 5 features of Klinefelter's.
Taller than expected with long arms and legs
Broader hips
Poor muscle tone
Reduced facial and body hair
Small penis ad testicles
Gynaecomastia
Infertility
80
What is the treatment for klinefelters?
testosterone replacement therapy
81
Who does Turners syndrome affect?
Only girls
82
What is the pathophysiology of turners?
Only 1 X chromosome
83
Name 5 key features of turners?
Shorter than average
No menstrual periods
Infertility due to underdeveloped ovaries
Broad chest and widely spaced nipples
Heart conditions
Kidney abnormalities
84
What is the treatment for Turners?
Supplemental oestrogen and progesterone from age 10 to bring on periods.
85
What is the prevalence of downs syndrome?
1 in 691 births
86
What is the genetic cause of down's?
Trisomy of chromosome 21
87
How can Down's be diagnosed prenatally?
Chorionic villus sampling or amniocentesis
88
What features are seen in down's syndrome in the neonatal period?
Hypotonia
Poor moro reflex
Slanted palpebral fissures
89
What are the facial features of Down's?
Slanted palpebral fissures
Flat facial profile
Extra skin on the back of neck
90
How is the development of children with Down's affected?
Delayed developmental milestones
Mild to moderate intellectual disability
91
What is the genetic issue of Edwards syndrome?
3 copies of chromosome 18
92
What percentage of children with Edwards syndrome live longer than 5 years?
10%
93
What are the features of Edwards syndrome?
Heart defects
Intellectual disability
Developmental delays
Contractures
Seizures
Microcephaly
Low set ears
Rocker bottom feet
94
Which heart defects are seen in Edwards syndrome?
VSD
ASD
PDa
95
What is the chromosomal abnormality in patau's syndrome?
Trisomy of chromosome 13
96
Name 3 characteristic features of pataus syndrome?
Cleft lip and palate
Abnormal small eye or only one eye
Problems with the development of nasal passages
97
When is screening offered for Down's, Edwards and Patau's?
Between 10 - 14 weeks gestation
98
Who is more severely affected by fragile X syndrome?
Males are more adversely affected than females
99
What are the characteristic facial features seen in Fragile X syndrome?
Long narrow face
Large ears
Prominent jaw and forehead
100
What are the other, non facial features of fragile X?
Flexible fingers
Flat feet
Macro orchidism
ASD or ADHD
101
What is the most common type of muscular dystrophy?
Duchennes
102
Who does Duchenne's most commonly affect?
Most commonly affects boys
103
At what age are most patients with Duchennes wheelchair bound by?
Age 12
104
What are the features of Duchennes?
Imbalance of lower limb strength
Contractures
Lumbar lordosis
Calf hypertrophy
Diminished muscle tone and deep tendon reflexes
105
Gower's sign is positive in which genetic condition?
Muscular dystrophy (Patient climbs up their body from sitting to standing due to an imbalance of strength)
106
When do signs of Angelman's syndrome begin to show?
6-12 months of age
107
What signs of Angelman's begin to show at 6-12 months of age?
Not being able to sit unsupported
Not being able to babble
108
What are the distinctive features of Angelman's?
Frequent laughter and smiling with little stimulus
Excitable and flapping hand
Restless
Short attention span
Trouble sleeping
109
Which chromosome does Prada-Willi affect?
Chromosome 15
110
What are the symptoms of Prada-Willi in childhood?
Excessive appetite and constant hunger
Restricted growth
Lack of sexual development
111
What are the consequences of Prada-Willi?
Obesity and T2DM
112
Features of Noonan syndrome?
Broad forehead
Ptosis
Wide set eyes
Short broad nose
Low set ears
Small jaw
Short stature
Heart defects at birth
113
What is the most common cardiac pathology associated with Duchennes?
Dilated cardiomyopathy
114
What hearing test is performed on school entry in the UK?
Pure tone audiometry
115
What type of genetic condition is haemophilia A?
X linked
116
What are the presenting features of eczema?
Itchy erythematous rash
Scratching
117
Description of mild eczema.
Areas of dry skin
Infrequent itching
May be some redness
118
Description of moderate eczema.
Areas of dry skin
Frequent itching
Redness
Excoriation of skin
119
Description of severe eczema.
Widespread dry skin
Incessant itching and redness
Bleeding, skin thickening, cracking
Alteration of pigment
120
Treatment of mild eczema?
Lots of emollients
Mild topical corticosteroids for areas of redness
121
Treatment of moderate eczema?
Lots of emollients
0.01% betamethasone for redness and inflammation
1% hydrocortisone on delicate areas
Non-sedating antihistamines for itch
122
Treatment of severe eczema?
Lots of emollients
0.1% betamethasone for redness and inflammation
0.01% betamethasone on delicate areas
Non-sedating antihistamines for itch
123
When do you refer to derm for severe eczema?
If treatment has been trialled for 1 week and shows no benefit
124
What is Stephen Johnson syndrome?
Severe systemic reaction involving the skin usually caused by drugs
125
What are the clinical features of Stephen Johnson syndrome?
Maculopapular rash
Mucosal involvement
Fever
Arthralgia
126
Name 4 causes of Stephen Johnson syndrome?
Penicillin
Sulphonamides
Lamotrigine
NSAIDs
127
Which 4 drugs commonly cause urticaria?
Aspirin
Penicillins
NSAIDs
Opiates
128
Between what ages do febrile seizures typically occur in children?
6 months and 5 years
129
What are the features of a febrile convulsion?
Last less than 5 mins
Occur early on in viral infection
Most commonly tonic clonic
130
What is the management following a first febrile seizure?
Admission to paediatrics
131
What is the risk of another febrile convulsion after a first one occuring?
1 in 3
132
What are the risk factors for another febrile seizure occuring?
Age of onset under 18 months
Fever < 39C
Shorter duration of fever before seizure
133
When should patients be advised to call an ambulance in a febrile seizure?
If it lasts longer than 5 mins
134
Which vaccines are in the 6 in 1 vaccine?
Diphtheria
Tetanus
Polio
Whooping cough
Hep B
HIB
135
Which vaccines are in the 4 in 1 vaccine?
Diphtheria
Tetanus
Polio
Whooping cough
136
Which vaccines are in the 3 in 1 vaccine?
Diphtheria
Tetanus
Polio
137
Which vaccines do babies get at 8 weeks?
6 in 1
Oral rota virus
Men B
138
Which vaccines do babies get at 12 weeks?
6 in 1
Oral rotavirus
Pneumococcal
139
Which vaccines do babies get at 16 weeks?
6 in 1
Men B
140
Which vaccines do infants get at 1 year?
MMR
HiB/Men C
Men B
Pneumococcal
141
Which vaccines are included in the preschool booster at 3-4 years?
4 in 1
MMR
142
What is DKA?
A complication of pre-existing T1Dm or the first presentation
143
What is the pathophysiology of DKA?
Uncontrolled lipolysis, resulting in an excess of free fatty acids which are converted into ketone bodies.
144
What are the clinical symptoms of DKA?
Abdo pain
Polyuria, polydipsia, dehydration
Acetone smelling breath
Kussmaul respiration (deep hyperventilation)
145
What are the criteria for the BM, pH, bicarb and ketones for a diagnosis of DKA to be made?
Glucose > 11mmol/l
pH < 7.3
Bicarb < 15mmol/l
Ketones > 3mmol or 2+ on dipstick
146
What are the principles of management of DKA?
Fluids but not too quickly
IV infusion of insulin
Correct electrolytes
147
What electrolyte disturbances are commonly seen in DKA?
Seum K high but total body potassium is low (this then falls with insulin so needs to be corrected)
Low bicarb
High ketones
148
Which fluids should you give in the first hour management of DKA?
Isotonic saline (0.9% NaCl)
149
What fluids should you give after the first hour in management of DKA?
0.9% saline with potassium chloride
150
When should dextrose be given in DKA?
When blood glucose is less than 15mmol/l
151
At what rate should insulin be given in DKA?
0.1 unit/kg/hour
152
Name 4 complications of chicken pox?
Pneumonia
Encephalitis (with cerebellar involvement)
DIC
Arthritis
153
Name 8 drugs which can cause Stephen Johnson syndrome?
Penicillin
Sulphonamides
Carbamazepine
Phenytoin
Lamotrigine
NSAIDS
Allopurinol
COCP
154
A Wilm's tumour is found in which part of the body?
Kidney (nephroblastoma)
155
At what age does a Wilm's tumour typically present?
Children under 5 with a median of 3 years
156
What are the most common symptoms of a Wilm's tumour?
Abdo mass
Painless haematuria
Flank pain
Anorexia/Fever
157
Where is the most common place for metastes to be found in a Wilms tumour?
Lung
158
When should a child be reffered for suspected wilms tumour?
Children with an unexplained enlarged abdo mass
159
Which is the most common childhood leukaemia?
ALL
160
What are the 3 features you will see on blood tests of leukaemia?
Anaemia
Neutropoenia
Thrombocytopenia
161
What age is the peak incidence of ALL?
2-5 years
162
What are the characteristic features of NAI?
Children under 2
Delayed presentation with injury
Changing narratives
Injury doesn't match with story
163
What are the triad of symptoms for shaken baby syndrome?
Retinal haemorrhage
Subdural haemorrhage
Hypoxaemic encephalopathy (brain swelling)
164
What is hypoxic ischaemic encephalopathy?
Brain damage resulting from antenatal or perinatal hypoxia
165
What is the pathophysiology of HIE?
Lack of Oxygen in the foetal circulation results in poor blood supply of oxygen to the brain
This causes irreversible brain damage from both primary neuronal death and secondary reperfusion injury.
166
Name 3 causes of HIE.
Placental abruption
Cord compression
Prolonged respiratory arrest after delivery
167
How do you diagnose HIE?
EEG and MRI
168
Which condition is HIE associate with?
Cerebral palsy
169
In children and infant life support how many rescue breaths should be given before starting chest compressions?
5 initial rescue breaths.
170
What is the ratio of compressions to breaths in children life support?
15:2
171
In children what compression technique should be used?
Compress lower half of the sternum
172
In infants what compression technique should be used?
2 thumbs encircling the chest
173
Why does neonatal respiratory distress happen?
Babies lungs not having produced enough surfactant
174
When does NRDS affect babies not born prematurely?
Mother has diabetes
Baby is underweight
Babies' lungs haven't developed correctly
175
What are the symptoms of NRDS?
Blue coloured lips, fingers and toes
Rapid shallow breathing
Flaring nostrils
Grunting noise
176
Management of NRDS?
Steroid injection before mum gives birth
Oxygen for baby, either nasal cannula or ventilation depending on severity
177
What is meconium aspiration syndrome?
Where the meconium has passed into the amniotic fluid and then made its way into the lungs
This leads to blockage and inflammation of the airways.
178
What is bronchopulmonary dysplasia?
Affects babies who have been born prematurely with breathing problems and need long-term breathing support and oxygen.
179
When is bronchopulmonary dysplasia typically diagnosed?
At 14-30 days old. If the baby is still needing oxygen or their condition is worsening.
180
What is Kallman syndrome?
Hypogonadotropic hypogonadism (delayed puberty)
As well as loss of sense of smell
181
What is the appearance of CSF in bacterial meningitis?
Cloudy
182
What are the characteristic findings of CSF in bacterial meningitis?
Low Glucose
High protein
High polymorphs
183
How do you manage a 4 years old with bed wetting?
Reassurance and advice until 5 years
After 5 years use bedtime monitoring
184
Hypotonia, macroglossia, an umbilical hernia and poor feeding are characteristic symptoms of what in a neonate?
Congenital hypothyroidism.
185
You suspect a 14 year old boy has an osteosarcoma as there is a swelling in his shoulder, what is the most appropriate next step?
Urgent x-ray within 48 hours
186
How much is a fluid bolus in children?
10mls/kg over less than 10 mins
187
What type of fluid is used in a fluid bolus?
0.9% normal saline
188
Name 2 signs of meningism.
Kernig's and brudzinski
189
What is kernigs sign?
Inability to straighten the leg when hip is flexed at 90 degrees
190
What is brudzinski's sign?
Forced flexion of the neck illicit reflex flexion of the hips
191
Which antibiotics for bacterial meningitis in under 3 months?
Cefotaxime plus amoxicillin for listeria cover
192
Which antibiotics in children over 3 months?
Cefotaxime
193
Which investigations in children with suspected meningitis?
Blood cultures
FBC, CRP, U&E, LFT
Coagulation
Blood gas
Urine culture
Viral throat swab
Lumbar puncture
194
What are contraindications for LP?
Raised ICP: Fluctuating consciousness, bradycardia, HTN, abnormal posture, eye signs
Coagulation abnormalities: platelet count lower than 100
Local superficial infection at LP site
Shock
Extensive or spreading purpura
195
What are the causative organisms of meningitis under 3 months?
GBS
E.coli
Listeria
Strep pneumonia
196
What are the causative organisms of meningitis over 3 months?
Neisseria meningitidis
HIB
Strep pneumonia
197
What is the chemoprophylaxis for meningitis?
Ciprofloxacin
198
What is the treatment for meningitis if suspected in the community?
IM Benxylpenicillin
199
What 3 investigations would you do if you suspect DKA?
Check glucose, ketones and pH (blood gas)
200
What are the criteria for a diagnosis of DKA?
Acidosis less than 7.3 or bicarb less than 15
Blood ketones greater than 3
Hyperglycaemia
201
What is the management of DKA?
IV fluids first then IV insulin
202
List 3 complications of DKA therapy.
Cerebral oedema
Hypokalaemia
Hypoglycaemia
203
If the patient is not shocked do you subtract the fluid bolus later?
Yes!
204
How would you treat cerebral oedema?
Hypertonic saline
Mannitol
205
What is the consequence of untreated kawasaki's?
Coronory artery aneurysms
206
What is the treatment of kawasaki's?
IV immunoglobulins
High dose aspirin
207
What is the commonest cause of complications with measles?
Pneumonia
208
What symptoms may you see in congenital rubella syndrome?
Deafness, eye abnormalities and cardiac defects
209
Which virus causes slapped cheek syndrome?
Parvovirus B19
210
What are the typical symptoms of ITP?
Sudden appearance of petechial rash
Spontaneous bleeding or bruising in an otherwise well child.
211
What would you avoid in newly diagnosed ITP?
NSAIDS
Contact sports
IM injections
Careful with head injuries
212
What is the treatment for mild bleeding in ITP?
Tranexamic acid
213
Which drug is given for prophylaxis of bronchiolitis?
Palivizumab
214
Antibiotics in UTI in children?
Usually cefuroxime
215
What imaging is required if the baby responds well to UTI treatment?
6 weeks post infection renal tract USS
216
What do you see on USS in intussuception?
Target sign
217
Which other condition is associated with Hirschsprungs?
Down's syndrome
218
What is the surgical intervention for pyloric stenosis?
Ramstedt pyloromyotomy
219
What do you treat the household with in scabies?
Permethrin
220
Where is the most common site for scabies lesions?
Webs between fingers
221
What is necrotising enterocolitis?
Due to growth of bacteria in the gut lining, causing erosion of the wall, reduced oxygen and blood flow then necrosis of tissue.
222
When does NEC commonly occur?
Within a few days into the neonates life
223
What are the key clinical features of NEC?
Abdo distension
Intolerance to feeds
Metabolic acidosis
Green bilious vomitting
Dark bloody stools
Absent bowel sounds
224
What does NEC look like on abdo x-ray?
Dilated loop of bowel
Thickened bowel wall
gas in the bowel
225
What is the management of NEC?
Nil by mouth
IV fluids
Antibiotics
Nasogastric decompression
Surgery
226
What is the management of GBS in a neonate?
Benzyl penicillin
Gentamicin
Cefotaxime
227
What symptoms of inattention are seen in ADHD?
Easily distracted
Difficulty sustaining tasks
Often loses things
Forgetful
Doesn't seem to listen when spoken to
228
What are the hyperactivity symptoms of ADHD?
Unable to play quietly
Talks excessively
Doesn't wait their turn
Spontaneously leaves seat
On the go
Interruptive or intrusive
229
What is the first line medical management of ADHD?
Methylphenidate
230
If inadequate response to methylphenidate in ADHD what is the next line treatment?
Dexamphetamine
231
What are the most common causes of iron deficiency anaemia?
Low dietary intake
Menorrhagia
Bleeding disorder
IBD
Growth spurt
Hookworms
232
What is the typical presentation of iron deficiency anaemia?
Fatigue
Lethargy
Dyspnoea
Palpitations
Headache
Pallor
Tachycardia
233
What does a blood film show in iron deficiency anaemia?
Hypochromic microcytic RBC's
234
What is vesicoureteral reflux?
Abnormal backflow of urine from the blader into the ureter and kidneys.
235
What investigations would be done for vesicoureteral reflux?
Diagnosis following a micturating cystourethrogram
