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Dan's Copy > Paeds Peer Teaching 2 > Flashcards

Paeds Peer Teaching 2 Flashcards

1
Q

List the VACTERAL association.

A
  • Vertebral (scoliosis / hypoplasia)
  • Anal atresia (imperforate anus)
  • Cardiac (VSD / ASD / Tetralogy)
  • Trachea-Oesophageal fistula
  • Oesophageal atresia
  • Renal / radial aplasia
  • Limb defects (hypoplastic thumb, polydactyly, syndactyly)
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2
Q

List the ‘CHARGE’ associations.

A
  • Colomboma (pupil defect)
  • Heart defect
  • Choanal atresia (blockage of nasal passage)
  • Retardation of growth / development
  • Genital hypoplasia
  • Ear anomalies
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3
Q

Who’s involved in the MDT if a child has a cleft lip / palate?

A
  • Surgeon
  • Orthodontist
  • SALT
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4
Q

A child had a cleft lip / palate. When would repairs be carried out?

A

Lip repair: 3 months

Palate repair: 9 months

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5
Q

List 4 things which contribute to morbidity in a child with cleft lip / palate.

A
  • Poor feeding
  • Milk aspiration
  • Speech delay
  • Conductive hearing loss
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6
Q

What is ‘spina bifida’?

A

Failure of neural tube to close in first trimester.

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7
Q

What causes spina bifida?

A
  • Insufficient folic acid

- Drugs (valproate, carbamazepine)

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8
Q

What are the 3 grades of defect seen in spina bifida?

A
  • Occulta: hidden defect, hairy lower back, often asymptomatic
  • Meningocele: meninges protrude but not exposed, spinal cord intact
  • Myelomeningocele: open lesion, severe weakness and disability.
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9
Q

What is the pathophysiology of DDH?

A
  • Shallow acetabulum doesn’t cover femoral head -> dislocatable
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10
Q

Which 2 tests are used for DDH?

A
  • Barlow’s: dislocation

- Ortolani: relocation

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11
Q

Risk factors for DDH?

A
  • Breech presentation
  • Family History
  • Prematurity
  • Twins
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12
Q

Treatment for DDH?

A
  • Pavlik harness

- Surgical reduction

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13
Q

Late signs of undiagnosed DDH?

A
  • Unilateral limp
  • Leg dragging
  • Restricted movement
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14
Q

What are the 4 classes of developmental milestones?

A
  • Gross motor
  • Fine motor / vision
  • Speech / language
  • Social
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15
Q

A child of 6 weeks should be able to:

A
  • Stabilise head
  • Social smile
  • Eye tracks movement
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16
Q

A child of 6 months should be able to:

A
  • Sit unsupported

- Palmar grasp at 5 months

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17
Q

At what age should a child be walking?

A

9 - 18 months

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18
Q

Define cerebral palsy.

A

Permanent, non-progressive movement disorder due to a lesion of the developing brain.

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19
Q

What are the pre-natal risk factors for cerebral palsy?

A
  • Cerebral malformation
  • Infection (TORCH)
  • Metabolic
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20
Q

What are the perinatal risk factors for cerebral palsy?

A
  • Hypoxia
  • Intrapartum trauma
  • Prematurity complications
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21
Q

What are the post natal risk factors for cerebral palsy?

A
  • Head trauma
  • Stroke
  • Meningitis
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22
Q

How would a child with Cerebral palsy present?

A

Spasticity (70% = UMN signs)

  • rigidity
  • hypereflexia / tonic
  • Weakness
  • Delayed milestones
  • poor co-ordination
  • Persistent primitive reflexes
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23
Q

What are the 4 types of Cerebral Palsy?

A
  • Hemiplegic
  • Diplegia
  • Ataxia
  • Athetoid (dyskinetic)
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24
Q

List some problems associated with Cerebral Palsy.

A
  • Epilepsy
  • Audiovisual development
  • Respiratory problems
  • Poor growth
  • Intellectual disability
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25
Q

Risk factors for Cerebral palsy?

A
  • Preterm birth
  • Twins
  • Maternal infection
  • Difficult delivery
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26
Q

How is cerebral palsy diagnosed?

A 
Clinical diagnosis
- CT / MRI indicated if ?cause or ongoing conditions eg.: 
? hydrocephalus
? SDH
? AVM 
? Malignancy
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27
Q

Treatment for Cerebral palsy?

A
  • Early MDT involvement
  • Physio
  • Paediatrician
  • Orthopod
  • OT
  • Dietician
  • Community Liaison
28
Q

Vaccinations:

What should you do if child is feverish or younger than indicated?

A
  • Delay the vaccine
29
Q

What kind of vaccine should be given to the immunocompromised?

A
  • Live attenuated vaccine
30
Q

What is in the 6 in 1 vaccine, and when should it be given?

A

Given at 2 / 3 / 4 months

  • Diphtheria
  • Tetanus
  • Pertussis
  • Polio
  • HiB
  • Hep B
31
Q

What kind of vaccine is the MMR vaccine?

When should it be given?

A

Given at 1y and 3yrs+4m
- Live attenuated vaccine
- Maternal Ig protection for approx 1 year.
MMR should be given at 6 months if there is an outbreak.

32
Q

Describe Measles.

A
  • Maculopapular rash
  • Fever
  • URTI
  • > complicated encephalitis
33
Q

Describe Mumps.

A
  • Swollen parotids
  • Fever
  • Subfertility in men.
34
Q

Describe rubella.

A
  • Mild fever
  • Rash
    Maternal infection = fetal abnormalities.
35
Q

List some signs of moderate / severe dehydration.

A
  • Tachycardia
  • > 2 Cap refill time
  • Weak pulses
  • Mottling
  • Cold
  • Cyanosis
  • Coma
  • Hypotension is a late finding and may occur after coma
36
Q

What fluid should you give STAT if moderate / severe dehydration?

A

10 - 20ml/kg of 0.9% Saline bolus

37
Q

What fluid should you give as maintenance fluid in kids?

A

0.9% saline + 5% dextrose + 10mmol KCl

38
Q

What are the total daily fluid requirements?

A

1st 10kg = 100ml/kg/day
2nd 10kg = 50 ml/kg/day
Remainder = 20ml/kg/day

39
Q

In a 27kg child, what amount of fluid should you give them for maintenance fluids?

A

1st 10kg = 100 x 10 = 1000
2nd 10kg = 50 x 10 = 500
3rd 7kg = 20 x 7 = 140
= 1640ml/day (68ml/hr)

40
Q

Neck swelling history.

A

Fever, duration and onset

  • Thyroid screen
  • Vaccination Hx
41
Q

How should you examine a kid’s neck swelling.

A

Infected - mobile + tender
Malignant - fixed and matted
Look in the mouth and throat - don’t poke anything down the throat if airway.

Common sites = lymph nodes (anterior chain), parotid, thyroid, mastoid.

42
Q

Investigations for a neck swelling?

A
  • FBC: raised WCC in infection, atypical lymphocytes if EBV
  • Throat culture if ?Group A Strep
  • Amylase if ?Mumps
  • TFTs if ?thyroid
43
Q

Describe Mastoiditis.

A
  • Medical emergency -> meningitis, sinus thrombosis
  • Ear pushed out / previous otitis media
  • IV ABx + mastoidectomy
44
Q

Describe Parotitis (Mumps)

A
  • Parotid swelling
  • Fever + malaise
  • Scrotal pain
  • Raised amylase
  • IgG / IgM antibodies
  • Fluids + analgesia
  • ?Subfertility
45
Q

Describe IgG and IgM levels in infection.

A

Recent infection: High IgG and high IgM

Previous infection or vaccination: High IgG + Normal IgM

No previous exposure: Normal IgG + Normal IgM

46
Q

How does ?Hodgkin’s Lymphoma present?

A
  • Firm, non-tender lymphadenopathy.
  • Fevers, night sweats, weight loss, fatigue
  • Hepatosplenomegaly
47
Q

What is Hodgkin’s lymphoma associated with?

A
  • Immunosuppression

- Previous EBV

48
Q

What investigations should you do if ?Hodgkin’s lymphoma?

A
  • Lymph node biopsy: Reed-Sternberg cells
  • FBC
  • Staging CT / MRI
49
Q

What treatment should you give for Hodgkin’s Lymphoma?

A
  • Radiotherapy
  • Chemotherapy
  • MAB (eg. Rituximab, a CD20 antagonist)
50
Q

A premature baby might have an intraventricular haemorrhage. What signs might they have?

A
  • Seizures

- Bulging fontanelle

51
Q

A premature baby has Retinopathy of Prematurity. Why?

A
  • Exposure to O2 is a cause
52
Q

A prem baby has Respiratory distress syndrome.
Why?
What would you seen on CXR?
What would you do?

A
  • Underdeveloped lungs
  • Ground glass XR
  • Give surfactant / O2 / CPAP
53
Q

Prem baby has NEC. What signs do they have?
Prevention of NEC?
Management?

A
  • Failure to thrive
  • Breast milk is preventative
  • Supportive Mx + surgery
54
Q

Prem baby has sepsis. What are you going to do?

A
  • Full workup including:
  • Bloods
  • Urine
  • CSF: ?Group B Strep / E. coli
  • Give Abx -> gentamicin / BenPen
55
Q

Kawasaki’s pneumonic?

A

CRASH and BURN (Fever > 5 days)

  • Conjunctivitis (bilateral and non-purulent)
  • Rash
  • Adenopathy (cervical and unilateral)
  • Strawberry tongue + cracked lips
  • Hands + feet: erythema + desquamation
56
Q

Treatment for Kawasaki’s?

A
  • Aspirin
  • IV Ig
  • ECHO + Cardio referral (risk of coronary artery aneurysm)
57
Q

Describe Perthe’s disease.

A
  • 4-8yo boys

- Avascular necrosis of the femoral head

58
Q

Describe SUFE.

A
  • Obese
  • Adolescent male
  • Groin pain
59
Q

Describe Septic Arthritis.

A
  • Red, hot, swollen, tender, mono arthritis, systemic upset

- Urgent Abx + aspirate + wash out + orthopod opinion

60
Q

Describe JIA

A
  • Persistent swelling
  • Can’t walk up stairs
  • Extra-articular involvement
61
Q

Describe Osgood-Schlatter disease.

A
  • Young, athletic teens

- Swelling below knee

62
Q

Describe Duchenne’s.

A
  • Proximal weakness
  • Boys
  • Gower’s sign
  • Respiratory involvement
63
Q

What might make you suspicious of NAI?

A
  • History incompatible with injury / unclear Hx
  • Delay in seeking medical attention
  • Multiple fractures, retinal haemorrhage, torn frenulum
  • Injury in a non-ambulatory / totally dependent child
64
Q

What fractures increase the index of suspicion for NAI?

A
  • Metaphysical corner fracture (shaking)
  • Rib fracture
  • Skull fracture
65
Q

What bruises increase the index of suspicion for NAI?

A
  • Ear
  • Cheeks
  • Buttocks
  • Forearms
  • Neck

Dan's Copy (19 decks)

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