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3ayeeeee > Paeds Q > Flashcards

Paeds Q Flashcards

1
Q

Most common cause of meningitis in ages 3-6 months

A

Haemophilus influenza
Neisseria meningitidis
Strep pneumonia

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2
Q

Close contacts within 7 days of bacterial meningitis onset should be given which AB ?

A

Oral ciprofloxacin or rifampicin

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3
Q

Most common cause of meningitis in ages 0–3 months

A

E.coli
Listeria monocytogenes

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4
Q

Pre-hospital ABs for meningococcal disease

A

IM benzylpenicillin

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5
Q

Features in an infant of maternal alcohol abuse

A

Small eye openings
Growth retardation
Low set ears
Flat philtrum
Sunken nasal bridge
Short palpebral fissure
Think upper lip
Cardiac malformations

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6
Q

What congenital heart condition is Fragile X syndrome associated with ?

A

Mitral valve prolapse

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7
Q

What genetic mutation causes fragile X syndrome ?

A

Trinucleotide repeat

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8
Q

What are Fragile X features in males

A

Learning difficulties
Large, low set ears, long face, high arched platelet
Large testicles
Hypotonia
Autism
Mitral valve prolapse

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9
Q

How can fragile x be diagnosed ?

A

Antenatal chorionic villus sampling

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10
Q

What paediatric respiratory condition should one never examine the throat ?

A

Croup

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11
Q

What is the epidemiology of Croup ?

A

Peak incidence at 6 months
More common in autumn

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12
Q

What are the features of Croup ?

A

Stridor
Barking cough (worse at night)
Coryzal symptoms

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13
Q

What are the features of moderate croup ?

A

Frequent barking cough
Audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation in the child
Child = Alert

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14
Q

What are the features of severe croup ?

A

Frequent barking cough
Prominent inspiratory stridor
Marked sternal wall retractions
Significant distress and agitation or lethargy or restlessness (signs of hypoxaemia
Tachycardia indicates severe obstruction

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15
Q

What is the admission criteria for croup ?

A

Moderate or severe
<6 months of age
Known upper airway abnormalities e.g. laryngomalacia or Downs
Uncertainty on DD e.g. acute epiglottis, bacterial tracheitis, peritonissllar abscess and foreign body inhalation

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16
Q

X-ray sign associated with croup

A

Steeple sign - lateral view- subglottic narrowing

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17
Q

X-ray sign epiglottis

A

Thumb sign - lateral view of swollen epiglottis

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18
Q

Management of croup - mild/moderate

A

Single dose oral dexamethasone

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19
Q

Emergency treatment of croup

A

High flow oxygen
Nebulised adrenaline

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20
Q

What is the inheritance pattern of Haemophilia A

A

X-linked recessive
Thus all daughters will be carriers
And 50% chance of disease if male

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21
Q

What is synovitis ?

A

When the synovium of a joint becomes inflamed (swollen)

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22
Q

How does synovitis present ?

A

Limp/refusal to weigh bear
Groin or hip pain
Usually following a viral infection
(Low grade fever)

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23
Q

What is the typical age group of synovitis presentation ?

A

3-9 years

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24
Q

What is the MCC of ambiguous genitalia in newborns

A

Congenital adrenal hyperplasia

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25
Q

What are the typical features of reflex anoxic seizure ?

A

Child goes very pale
Falls to floor
Secondary anoxic seizure are common
Rapid recovery

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26
Q

When can a child with scarlet fever return to school ?

A

24 hours after commencing antibiotics

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27
Q

What is scarlet fever ?

A

A reaction to the erthrogenic toxins produced by group A haemolytic streptococci

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28
Q

What is the most common cause of scarlet fever ?

A

Group A strep e.g. streptococcus pyogenes

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29
Q

What is the peak incidence of scarlet fever ?

A

2-6 years
4 is peak incidence

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30
Q

How is scarlet fever spread ?

A

Respiratory route by respiratory droplets

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31
Q

How does scarlet fever usually present ?

A

Incubation period 2-4 days
Fever typically lasting 24-48 hours
Malaise, headache, nausea/vomiting
Sore throat
Strawberry tongue
Rash

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32
Q

What kind of rash will present with scarlet fever ?

A

Fine punctate erythema (pinhead) which generally appears first on the torso and spares the palms and soles
Often described as having a rough sandpaper like texture
Children will appear flushed with circumoral pallor
Desquamation occurs later in the course partially around the fingers and toes

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33
Q

How is scarlet fever diagnosed ?

A

Throat swab
But AB treatment should be commenced immediately

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34
Q

How is scarlet fever managed ?

A

Oral penicillin V for 10 days
Azithromycin if allergy
Notifiable disease

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35
Q

Potential complications of scarlet fever

A

Otitis media - most common complication
Rheumatic fever - typically 20 days after infection
Acute glomerulonephritis - typically occurs 10 days after infection
Invasive complications e.g. bacteremia, meningitis, necrotizing fasciitis (rare but can be life threatening)

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36
Q

At what age can a pt be treated as an adult and presumed to have capacity

A

16

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37
Q

What guidelines are used in patients requiring contraception who are under 16

A

Fraser Guidelines

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38
Q

What is the most common cause of stridor in infants ?

A

Laryngomalacia
Caused by a floppy epiglottis which folds into the airway on inspiration

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39
Q

When is surgery indicated in laryngomalacia

A

When there is poor feeding to the extent that failure to thrive occurs

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40
Q

Typical laryngomalacia presentation ?

A

4 weeks old
Poor feeding
Stridor

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41
Q

DD’s of Stridor in children

A

Croup
Acute epiglottis
Inhaled foreign body
Laryngomalacia

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42
Q

What is croup ?

A

A form of URSI caused by a combination n of laryngeal oedema and secretions
Primarily causes by parainfluenza viruses

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43
Q

What are the typical features of Croup ?

A

Barking (seal like) cough which is worse at night
Stridor
Fever
Coryzal symptoms

44
Q

What is the epidemiology of Croup ?

A

Peak incidence at 6 months - 3 years
More common in autumn

45
Q

What is the cause of acute epiglottis

A

Haemophilus influenzae type B

46
Q

What age is the peak incidence of acute epiglottis ?

A

2-6 years

47
Q

What are the features if acute epiglottis ?

A

Rapid onset
Unwell, toxic child
Stridor
Drooling saliva

48
Q

Where in the lungs is a foreign body most likely to end up ?

A

Right lower lobe

49
Q

What type of babies should be screened with US or X-ray (more than 4.5 months) of the hips ??

A

Breech babies
FHx of 1st degree relative with hip problems in early life
Multiple pregnancy

50
Q

RFs for development dysplasia of the hip

A

Female sex (x6)
Breech presentation
Positive family history
Firstborn children
Oligohydramnios
Brith weight >5kg
Congenital calcaneovalgus foot deformity

51
Q

Clinical examinations for developmental dysplasia of the hip

A

Barlow test
Ortolani test
Check for symmetry of leg length, level of knees when hips and knees are bilaterally flexed, restricted abduction of the hip in flexion

52
Q

What is Barlow’s test ?

A

Attempts to dislocate an articulated femoral head

53
Q

What is Ortolani’s test ?

A

Attempts to relocate a dislocated femoral head

54
Q

Management of developmental dysplasia of the hip ?

A

Most will spontaneously stabilise by weeks 3-6 of age
Pavlik harness in children younger than 4-5 months
Older children may need surgery

55
Q

A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a branching punctate rash sparing the face.

A

Scarlet fever

56
Q

A 3 year old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted

A

Rubella

57
Q

A four-year-old boy presents with fever, malaise and a ‘slapped-cheek’ appearance

A

Parvovirus B19

58
Q

DDs rash in children

A

Chicken pox
Measles
Mumps
Rubella
Erythema infectiosum
Scarlet fever
Hand, foot and mouth disease

59
Q

Features of chicken pox

A

Initial fever
Itchy rash starting on head/trunk before spreading
Initially macular then papular then vesicular
Systemic upset is usually mild

60
Q

Features of measles

A

Irritable prodrome, conjunctivitis and fever
Koplik spots: white spots (grain of salt) on buccal mucosa
Rash: starts behind the ears and then to the whole body, discrete maculopapular rash becoming blotchy and confluent

61
Q

Features of mumps

A

Fever, malaise and muscular pain
Parotitis (earache, pain on eating)
Unilateral initially but then becomes bilateral in 70%

62
Q

Features of rubella

A

Rash which is pink and maculopapular
Initially on the face before spreading to the whole body usually fading by day 3-5
Lymphadenopathy: suboccipital and postauricular

63
Q

Features of erythema infectiosum

A

Also known as fifth disease or slapped-cheek syndrome
Caused by parvovirus B19
Lethargy, fever, headache
Slapped cheek rash spreading to proximal arms and extensor surfaces

64
Q

Features of scarlet fever

A

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
Strawberry tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Sandpaper like texture

65
Q

Features of hand, foot and mouth disease

A

Caused by coxsackie a16 virus
Mild systemic upset:sore throat and fever
Vesicles in the mouth and on the palms and soles of the feet

66
Q

Features of chicken pox rash

A

Itchy, rash starting on the head/trunk before spreading
Initially macular then popular then vesicular

67
Q

Features of measles rash

A

Starts behind the ears and then spread to the whole body
Discrete maculopapular rash that becomes blotchy and confluent

68
Q

Features of mumps

A

Painful swellings in the side of the face under the ears (the parotid glands)
Start unilateral but 70% of cases become bi-lateral 70%

69
Q

Features of Rubella rash

A

Pink maculopapular initially on the face before spreading to the whole body usually fading after 3-5 days

70
Q

Features of erythema infectiosum rash

A

Starts on cheeks and gives slapped appearance before spreading to the proximal arms and extensor surfaces

71
Q

Features of scarlet fever rash

A

Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Sandpaper like texture

72
Q

Features of hand, foot and mouth rash

A

Vesicles in the mouth and on the palms and soles of the feet

73
Q

Neonatal causes of hypoglycaemia

A

Preterm birth (<37 weeks)
Maternal DM
IUGR - interuterine growth restriction
Hypothermia
Neonatal sepsis
Inborn errors of metabolism
Nesidioblastosis
Bechwith-Wiedemann syndrome

74
Q

Features of Neonatal hypoglycaemia

A

May be asymptomatic
Autonomic changes - jitteriness, irritable, tachypnoea, pallor
Neuroglucopenic - poor feeding/sucking, weak cry, drowsy, hypotonia, seizure
Other - apnoea, hypothermia

75
Q

Management of neonatal hyoglycaemia

A

Asymptomatic - encourage normal feeding (breast or bottle), monitor blood glucose
Symptomatic - admit to neonatal unit, IV infusion of 10% dextrose

76
Q

Medical intervention in Enuresis

A

Desmopressin - ADH analogue
Useful for short-term management or if enuresis alarm is not effective

77
Q

In a neonate how would transposition of the great arteries present ?

A

Turns blue and becomes tachypnoeic 5 mins after birth
On asultation nenonate has no murmur but a single loud S2
On palpation there is a prominent ventricular pulse

78
Q

What is the MC cyantoic heart defect and when does it present ?

A

Tetralogy of Fallot
Between 1 and 6 months

79
Q

How would Tetralogy of Fallot present on auscultation ?

A

It causes a loud ejection systolic murmur that is loudest at the left left sternal edge with radiation to the axillae

80
Q

What is tricuspid atresia ?

A

A cyanotic heart defect which causes an ejection systolic murmur which is loudest at the left upper sternal edge and a prominent apical impulse

81
Q

What is transposition of the great arteries ?

A

Cyanotic congenital heart disease
Caused by the failure of the aorticopulmonary septum to spiral during septation
The aorta leaves the right ventricle
The pulmonary trunk leaves the left ventricle

82
Q

Which condition is a risk factor for transposition of the great arteries ?

A

Mothers with diabetes are at increased risk

83
Q

Clinical features of transposition of the great arteries

A

Cyanosis
Tachypnoea
Loud single S2
Prominent right ventricular impulse
‘Egg-on-side’ appearance on chest x-ray

84
Q

Management of TGA

A

Maintenance of ductus arteriosus with prostaglandins
Surgical correction is definite treatment

85
Q

How do the majority of atrial septal defects present ?

A

Asymptomatic (they don’t)

86
Q

How would a symptomatic child with an ASD present ?

A

SOB
Lethargy, poor appetite and growth and increased susceptibility to RI
On examination you would typically hear an ejection systolic murmur and fixed splitting of the second heart sound

87
Q

On auscultation what would you expect from a VSD

A

Pansytolic murmur in the lower left sternal border

88
Q

On auscultation what would you expect from a coarctation of the aorta

A

Crescendo-descrescendo murmur in the upper left sternal border

89
Q

On auscultation what would you expect from a coarctation of the aorta

A

Crescendo-descrescendo murmur in the upper left sternal border

90
Q

On auscultation what would you expect from a PDA

A

Diastolic machinery murmur in the upper left sternal border

91
Q

On auscultation what would you expect from a PS

A

Crescendo-decrescendo ejection murmur.

92
Q

What would a Pansytolic murmur in the lower left sternal border indicate

A

VSD

93
Q

What would a ejection systolic murmur and fixed splitting of the second heart sound indicate

A

ASD

94
Q

What would a Crescendo-decrescendo murmur in the upper left sternal border indicate

A

Coarctation of the aorta

95
Q

What would a Diastolic machinery murmur in the upper left sternal border indicate ?

A

PDA

96
Q

What would an ejection crescendo-decrescendo murmur indicate ?

A

Pulmonary stenosis

97
Q

What is the most common congenital heart disease type in children ?

A

VSD - 30%
(ASD in adults)

98
Q

Most common causes of cyanotic disease in children

A

Tetralogy of Fallot (more common but presents at 1-2 months)
Transposition of the greater arteries (more common noticed at birth)
Tricuspid atresia

99
Q

Management of umbilical hernia

A

1cm and easily reducible then wait to see if self resolve or elective repair at ages 4-5
If large or symptomatic then perform elective repair ages 2-3

100
Q

Management for Slipped capital femoral epiphysis

A

Orthopaedic in situ fixation with cannulated screw

101
Q

Typical presentation for slipped capital femoral epiphysis

A

10-15years
More common in obese children and boys

102
Q

What is slipped capital femoral epiphysis

A

Displacement of the femoral head epiphysis postero-inferiroly
May present acutely following trauma or more commonly with chronic persistent symptoms

103
Q

Features of slipped capital femoral epiphysis

A

Hip, groin, medial thigh or knee pain
Loss of internal rotation in the leg in flexion
Bilateral slip in 20% of cases
X-ray AP and lateral (frog view) is diagnostic

104
Q

What determines the degree of cyanosis and clinical severity in tetralogy of fallot ?

A

The severity of the right ventricular outflow tract obstruction i.e. level of pulmonary stenosis

105
Q

What are the 3 defects of tetralogy of fallot ?

A

VSD
Right ventricular hypertrophy
Pulmonary stenosis
Overiding aorta

106
Q

Features of TOF

A

Cyanosis
Tet spells - typically occur when the infant is upset, in pain or has a fever
Right to left shunt
Ejection systolic murmur due to pulmonary stenosis
Chest Xray - boot shaped heart

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