Paeds peer teaching Flashcards
1
Q
Croup symptoms
A
barking cough, stridor, runny nose/fever
NO DROOLING
2
Q
Croup age
A
6 months to 3 years
3
Q
what is croup
A
mucosal inflamation of upper airway
4
Q
croup causative organism
A
parainfluenza virus
5
Q
X-ray investigation for croup
A
steeple sign
6
Q
Mild/moderate croup treatment
A
oral dexamethasone 0.15mg/kg
7
Q
bronchiolitis symptoms and what age
A
widespread wheeze, 3 - 6 months, tachyonoea, elevated resp rate. accessory muscle use. NO FEVER
8
Q
Bronchiolitis cause organism
A
RSV
9
Q
acute epiglottitis symptoms
A
rapid onset, Drooling, stridor, tripod position, cant swallow. Unvaccinated/T1DM
10
Q
Acute epiglottitis causative organism
A
Haemophilus influsezae B
11
Q
X ray sign epiglotitis
A
thumb print sign
12
Q
Croup Treatment
A
high flow oxygen
Corticosteroids (dexamethasone)
nebulised adrenaline
13
Q
impetigo causative organism
A
staphylococcus aureus, group b strep pyrogens
14
Q
impetigo symptoms and age
A
golden yellow crusting, 2-6 years, red sores around mouth and nose, itchy
15
Q
mild impetigo treatment
A
topical antibiotics - fusidic acid 2% for 5 days
regular hand washing, no touching lesions
16
Q
Stephen Johnson syndrome symptoms
A
erythematous macules causing target like lesions,
Nikolsky’s sign (skin peels when rubbed)
lamotrigine use
blistering erosion on oral mucosa
burning eyes
17
Q
Stephen Johnson syndrome causative drug/organism
A
lamotrigine, carbamazepine, allopurinol, NSAID’s
mycoplasma pneumoniae
18
Q
what is Stephen Johnson treatment
A
stop offending drug, supportive
wound care similar to burns
topical steroids - maybe not effective
19
Q
What is Stephen Johnson syndrome
A
a rare immune mediated hypersensitivity reaction affecting the skin and mucus membranes
20
Q
what is the criteria for mild croup
A
no stridor at rest, mild work of breathing
21
Q
what is the criteria for moderate croup
A
stridor at rest
22
Q
what is the criteria for severe croup
A
significant stridor at rest, significant respiratory distress, pale, tired child
23
Q
severe croup treatment
A
nebulised adrenaline, oxygen, oral/IV dexamethasone 0.3mg/kg
24
Q
what is bronchiolitis
A
inflamation and mucous build up in the lower airways
25
When does bronchiolitis occur
before 1 (3-6 months most common)
26
Risk factors for severe bronchiolitis
chronic lung disease
congenital heart disease
prematurity
downs syndrome
cystic fibrosis
27
bronchiolitis investigation
x ray to rule out pneumonia
28
management of bronchiolitis
oxygen, CPAP, fluid support
29
Short term complications of bronchiolitis
dehydration, hyponatraemia, apnoea, respiratory failure
30
what is epiglottitis
life threatening inflamation of the epiglottis
31
risk factors for epiglottitis
Non-vaccinated, immunocompromised, diabetes
32
Epiglottitis investigation
only if airway stable
first line: laryngoscopy
second line: lateral neck xray
33
What type of condition is eczema classified as?
chronic atopic condition
34
what causes eczema
defects in the skin barrier, causing inflamation, which causes more defects in the skin barrier
35
How does exzema present
dry red itchy patches, on face, neck and flexor surfaces, history asthma/FH
36
What is the first line management for eczema
emollient cream - thin=E45, thick =50/50 hydromol
37
what is second line treatment for eczema (and medication names
topical steroids
Mild: Hydrocortisone
Moderate: Eumovate
Potent: Betnovate
Very potent: Dermovate
38
which medications make up the steroid ladder for eczema
Mild: Hydrocortisone
Moderate: Eumovate
Potent: Betnovate
Very potent: Dermovate
39
what should you consider when prescribing potent steroids
not near face or eyes
40
lifestyle advice for eczema maintenance
avoid hot water,
no scratching,
no harsh soaps/soap substitute.
use emollients
41
what disease causes golden yellow crusts around the mouth
impetigo
42
widespread impetigo infection treatment
oral flucloxacillin
clarithromycin if allergic
43
impetigo lifestyle advice
short nails
no close contact with others for 48 hours
wash infected areas gently with soap and water
44
Stephen Johnson syndrome what affects prognosis
extent of skin involvment
older age = worse
45
Stephen Johnson syndrome complications
Sepsis, pneumonia, dehydration, long term blindness
46
What is ADHD
Persistent patterns of inattention, hyperactivity and impulsivity that interfere with functioning
47
what is inattention in ADHD
Easily distracted/forgetful
difficulty following instructions
difficulty planning tasks
often daydreaming/off task
48
what is hyperactivity in ADHD
fidgets or squirms
can't sit still
talks excessively
49
what is impulsivity in ADHD
interrupts others
inability to queue/wait turn
engages in risky behaviours
50
what behavour assessments are used for ADHD
Conners' rating scale, SNAP rating scale
51
what is the diagnostic criteria for ADHD
6 months of symptoms
two or more settings
symptoms before age 12
52
what is management for ADHD
Behavoural therapy (first line)
stimulants - methylphenidate/
non stimulants - atomoxetine
53
what is ASD
A neurodevelopmental disorder characterised by difficulties in social communication, restricted interests, repetitive behaviour and sensory sensitivities
54
what social communication difficulties occur in autism
delayed speach development
difficulty engaging in conversation
struggles to respond to social cues
lack of eye contact
difficulty showing empathy
55
what is an example of restricted interests/behaviours in autism
repetitive movements
fixation on specific activities or objects
strong preference for routines
56
Paediatric red flags
mottled skin, appears ill to health care professional, grunting, signs of increased work of breathing/accessory muscles, Non-blanching rash, bulging fontanel
57
what is a Macule
flat non palpable lesion
58
what is a papule
elevated palpable lesions
59
what are vesicles
fluid filled blisters (chicken pox)
60
2 weeks ago upper respiratory infection
kolpik spots in mouth - white spots
unvaccinated
measles
61
Measles causative organism
RNA paramyxovirus
62
measles management
supportive - notifiable disease
63
Measles complications
otitis media, pneumonia, encephalitis
64
rough (sandpaper) rash in flexor creases, strawberry tongue, swolen glands
scarlet fever
65
scarlet fever cause
strep pyrogens
66
Scarlet fever treatment
10 days penicillin
67
non-vaccinated
low grade fever then after resolved
face downwards rash
red spots on soft palate (palatal petechiae)
swelling lymph nodes behind ears - suboccipital/postauricular
rubella
68
rubella cause
toga virus
69
congenital rubella complications
teratogenic, cause deafness, congenital cateracts, heart defects, cerebral palsy
70
why no MMR vaccine for pregnant mum
live vaccine - risky
71
bright red rash on face, 2 days later spotty Rash on trunk/arms/legs
slapped cheek
72
slapped cheek cause
parvovirus B19
73
slapped cheek+sickle cell =
sickle cell crisis
74
1 year old
high fever then
trunk-peripheral rash
red spots on uveal and soft pallate
roseola infantum
75
roseola infantum complication
febrile seizure more likely
76
petechiae on back - purple/red
small patch on arm
Abuse/Non-accidental injury
77
Kawasaki diease symptoms
Crash and Burn
conjunctivitis, rash, adenopathy, strawberry tongue, hands (palmar erythema, swelling)
Burn = fever
cracked lips
japanese/afrocarribean
78
kawasaki disease investigation/treatment
echocardiogram - aortic aneurism
give high dose aspirin - reduces risk
IV immunoglobulins
79
what is Reyes syndrome
swelling of the liver and brain, associated with aspirin use
80
shock definition
inadequate circulation to meet tissue demands causing end organ damage
81
septic shock definition
an infection in your body causes extremely low blood pressure and organ failure due to sepsis
82
early signs of shock
altered mental state
tachypnoea
tachycardia
prolonged cap refill time
decreased urine output
83
late signs of shock
loss of skin turger
prolonged central refill time
hypotension
hypothermia
decreased oxygen sats
84
meningitis viral and bacterial cause
viral: HSV 1
bacterial cause in under 3 months = group B strep
over 3 months = meningococcus
85
Meningitis pathophysiology
virus/bacteria colonised nasopharyngeal airway and invades blood stream. from there it crosses the meninges and is in the brain. the hosts immune system causes oedema/raised ICP whilst fighting the infection
86
meningitis symptoms
purpuric rash, fever, headache, neck stiffness, photophobia, seizures, papilloedema/bulging fontanel
87
Meningitis signs
KErnig' s sign - Knee extension is painful
BrudziNsKi's sign - neck flexion leads to knee flexion
88
when to avoid LP in children
raised ICP (headache more painful lying down, vomiting)
Rash present - blood culture will give same info
89
meningitis treatment in all settings
IM benpen GP
IV cefotaxime (if under 3 moths also amoxicillin for listeria)
Dexamethasone only if no septicaemia (just meningitis)
notify public health england
90
meningitis prophylaxis
ciprofloxacin
young children rifampicin
91
innocent murmur
soft/blowing murmur
systolic
asymptomatic
change between lying/sitting (disappear lying)
left sternal edge
92
foetal circulation
ductus venosus - oxygenated blood to heart. foramen ovale bypasses lungs and shunts from right to left atrium. ductus arteriosus connects pulmonary artery to aorta.
First breath decreases pulmonary resistance because oyxgen is a pulmonary dilator. this means left atrium pressure is greater than right atrium pressure which causes foramen ovale to close
93
causes of tetralogy of fallot (genetic and IU)
downs syndrome, di georges syndrome, FAS
94
what makes up tetralogy of fallot
VSD
pulmonary stenosis
right ventricle hypertrophy
overriding aorta
95
symptoms of tetralogy of fallot
tet spells
squating todler
heart failure before 1
96
which feature of tetralogy of fallot controls severity
pulmonary stenosis
97
tetralogy of fallot murmur
harsh systolic ejection murmur over pulmonic/left sternal area with systolic thrill
98
what is Transposition of great arteries
aorta is connected to right ventricle and pulmonary artery is connected to left ventricle, creating two separate circulations and resulting in only deoxygenated blood being pumped around the body
99
transposition of great arteries risk factors
maternal diabetes
100
VSD genetic association
Edwards (trisomy 18), turners (45x0) downs
101
appendicitis symptoms
central to Right illiac fossa abdo pain, , nausea/vomiting, anorexia, mild pyrexia
102
appendicitis treatment
appendectomy
103
appendicitis examination signs
guarding, rebound tenderness, percussion tenderness,
rosvings sign - LIF palpatation causes RIF pain
psoas sign - right hip extension = pain
obturator sign - right hip internal rotation
104
investigations appendicitis
USS - free fluid
raised inflamatory markers
105
GORD - symptoms
milky vomiting after feeds, knees to chest, arching back, crying/irritable
106
GORD cause in first 6 months of life
still developing oesophageal sphyncter
107
management GORD
conservative - keep upright, spontaneous resolve, check not too much feed
medical - Gaviscon 2 weeks, add feed thickener, omeprazole/ranitidine if no improvement
surgical - laparoscopic fundoplication
108
pyloric stenosis symptoms
non-milky projectile vomiting after feed, olive size mass in left epigastrium
109
pyloric stenosis investigation
USS - hypertrophic sphincter
110
management pyloric stenosis
pyloromyotomy
111
Pyloric stenosis ABG results
hypokalaemia, hypochoraemic metabolic acidosis
112
hirshprungs disease what is it
aganglionic distal colon (caused by failure of the parasympathetic plexus
113
hirschprungs disease symptoms
no passage of meconium in 48 hours, distended abdomon, forceful passage after DRE
114
Hirschprungs diagnosis
First line DRE - explosive passage following
rectal biopsy gold standard
115
hirschprungs management
rectal wash out then aganglionic bowel resection
116
what is intussusception
telescoping of bowel
117
intussussception symptoms
colicy abdo pain, goes pale and draws in legs
118
intussussception sigsn
sausage shaped mass, red currant jelly stools
119
intusussception Investigation
ultrasound - target sign
120
intususception management
air enema - inflation of bowel
121
what are the 2 types of cows milk protein allergy
immediate IgE or delayed non-IgE
122
cows milk protein symptoms
regurgitation, vomiting, diarrhoea, atopic eczema, chronic cough, wheeze
123
cows milk protein allergy management
if formula fed: hydrolysed formula
if breast fed: maternal cows milk elimination and baby Ca supliments
124
what is Colic
excessive crying don't know cause - diagnosis of exclusion
125
diagnositic crieria for colic
under 5 months
recurrent prolonged crying with no underlying cause
126
biliary atresia symptoms
jaundice over 14 days
127
biliary atressia investigation
raised conjugated bilirubin
128
biliary atresia management
kasai procedure
129
febrile convulsions criteria
jerky movement and fever without CNS infection
130
pateu's what chromosome
trisomy 13
131
pateus features
dysmorphic features, cleft lip, rocker bottom feet, small eyes
132
pateu's complications
abdominal wall dysfunction (exomphalos)/kidney cysts
133
edwards chromosome abdnomality
trisomy 18
134
edwards features
rocker bottom feet (more common than in pateu's)
dysmorphic features and learning disability
135
downs syndrome chromosome
trisomy 21
136
downs syndrome features
hypotonia, brechycephaly (small head with flat back), flatterned face and nose, single palmar crease, short neck/stature
137
downs syndrome comlications
learning disability, recurrent otitis media
138
Turners syndrome chromosome abnormality
45xo
139
turners syndrome features
short stature
webbed neck
high arching palate
widely spaced nipples
140
turners syndrome complication
coarctation of aorta
141
what is leukaemia
excessive production of single type of abnormal white blood cell in bone
142
investigation for diagnosis of leukaemia
FBC - anaemia, leukopenia, thrombocytopenia
blood film - blast cells
bone marrow biopsy
lymph node biopsy
143
treatment for leukaemia
caemotherapy, radiotherapy, bone marrow transplant
144
leukaemia symptoms
night sweats, fever, weight loss
abnormal bruising/petechiae/bleeding
fatigue, fever, failure to thrive
lymphadenopathy
145
wilms tumour what kind of tumour
kidney
146
wilms tumour sympoms
abdo pain, haematuria, night sweats fever weight loss, hypertension
147
wilms tumour investiagations
USS abdo
then
CT/MRI for staging
biopsy is dignostic
148
wilms tumour managment
surgical excision of tumour and nephrectomy
adjuvant chemo/radiotherapy
149
osteosarcoma symptoms
bone pain worse at night, palpable swelling/mass that restricts movement
150
osteosarcoma investgation
urgent (within 48 hour) x ray - sunburst appearance - poorly defined and fluffy
blood test - raised alkaline phosphatase
151
osteosarcoma management
surgical resection (often with limb amputation)
adjuvant chemotherapy
152
APGAR
153
cerebral palsy cause
TORCH infections, placental insufficency
Birth asphixia, maternal hypotention, hypoxic, ischaemic encephalopathy
154
non-motor cerebral palsy
learning disability
eplilepsy
dysphagia
scoliosis
deafness
155
location of lesion for spastic cerebral palsy
upper motor neurone
156
location of lesion for dyskinetic cerebral palsy
basal ganglia/substantia nigra (think parkinsons)
157
treatment for spasticity in cerebral palsy
botox - botulinium toxin type A
baclofen - oral/into CSF (intrathecal)
oral diazapam
158
patent ductus arteiosus murmur
machinery like
159
patent ductus arteriosis treatment
indomethacin
160
Scarlet fever complications
rheumatic fever, otitis media
161
rosella infantum causative organism
Human Herpes Virus 6
162
rosella infantum age of effected kids
6-36 months/ under 2 years more likely
163
Kawasaki's disease age of affected kids
under 4 years
164
types of acyanotic heart disease
with shunt
ASD
VSD
patent ductus arteriosus
without shunt
coarctation of aorta/aortic stenosis
165
types of cyanotic heart disease
with shunt
tetralogy of fallot
transposition of great artery
without shunt
pulmonary stenosis
pulmonary atresia
hypoplastic heart
166
what heart defects with downs syndrome
AVSD
167
which heart defects with turners syndrome (45x0)
coarctation of aorta
168
what heart defect with Pateu's syndrome (trisomy 13)
patent ductus arteriosus
169
what heart defect with edwards syndrome (trisomy 18)
ventricular septal defect
170
tetralogy of fallot investigation
chest x ray - boot shaped heart
171
tetralogy of fallot treatment
neonates - prostoglading infusion for keep ductus arteriosus patent
surgical repair
beta blockers
172
transposition of great arteries presentation
on day two when ductus arteriosus closes - cyanosis
173
transposition of great arteries investigation
chest x ray - egg on a string
174
transposition of great arteries management
prostaglandin infusion then surgery
175
when is transposition of great arteries compatible with life
with PDA, VSD or ASD
176
Ventricular septal defect presentation
sweating, fatigue, poor weight gain
177
ventricular septal defect murmur
pansystolic lower left sternal edge
178
VSD investigation
echocardiogram/chest xray
179
VSD management
most close spontaneously by 10 years
if significant, consider furosimide +ace inhibitor, then surgery
180
atrial septal defect murmur
split double murmur and ejection systolic murmur
181
atrial septal defect risk factors
maternal rubella
maternal diabetes
lupus
182
atrial septal defect symptoms
asymptomatic OR chest pain and excersice intolerance
183
atrial septal defect management
surgery to close form 3-5 years
184
atrial septal defect investigation
echocardiogram
185
what is pyloric stenosis and what age does it occur
hypertrophy of pyloric sphyncter
6-8 weeks
186
pyloric stenosis blood results
hypokalaemia, hypochoraemic metabolic acidosis
187
Intussusception risk factors
Meckel's diverticulum, polyps, viral infection, lymphoma
188
what is Meckel's diverticulum
Embryological remnant. Incomplete obliteration of
the vitelline duct
189
Meckel's diverticulum symptoms
asymptomatic / with rectal
bleeding, obstruction (redcurrant stools etc
-intussusception),
190
Meckel's diverticulum management
Surgical- small bowel resection or simple
diverticulectomy
191
what to ask about in colic (that it is not colic and is a problem)
detailed history, antenatal and birth history, family history and coping strategies
192
red flags in colic (that it isn't colic)
infection, fever, faltering growth
193
At what age can febrile seizures occur
6 months to 5 years
194
what is a simple febrile seizure
generalised seizure - less than 15 minutes, recovery within an hour and only 1 per febrile illness
195
what is a complex febrile seizure
may be focal, last more than 15 minutes, more than one per febrile illness
196
risk factors for febrile seizures
high fever, viral infection, family history
MMr vaccine (1/3000)
197
management for simple febrile seizures
admit and observe, safety netting (no objects in mouth, recovery position when over, stay with child, video seizure)
198
management of complex febrile seizures
diazepam if prolonged
199
do febrile seizures increase risk of epilepsy
NO
200
at what age does acute lymphoblastic leukaemia occur
2-3 years
201
at what age does acute myeloblastic leukaemia occur
under 2 years
202
leukaemia risk factors
xray exposure in utero
trisomy 21 (ALL)
203
Investigations after diagnosis of leukaemia
chest x-ray - mediastinal mass
lumber puncture - CNS involvment
bone marrow biopsy
204
factors affecting the change of recovery from leukaemia
better =
age 1-10
WCC over 50 at presentation
Female
no CNS involvement
205
side effects of leukaemia treatment
avascular necrosis
peripheral neuropathy
infertility
anxiety
206
which bone is commonly affected with osteosarcoma
femur (most common)
tibia
humerous
