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paediatrics > Pass Medicine Notes > Flashcards

Pass Medicine Notes Flashcards

1
Q

What are the signs of high risk factors in babies under 3 months with a fever?

A
  • Pale/mottled/ashen/blue.
  • No response to social cues.
  • Appears ill to a healthcare professional.
  • Does not wake or if roused does not stay awake.
  • Weak, high-pitched or continuous cry.
  • Grunting.
  • Tachypnoea: respiratory rate >60 breaths/minute.
  • Moderate or severe chest indrawing.

• Reduced skin turgor.

  • Age <3 months, temperature >=38°C
  • Non-blanching rash
  • Bulging fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal neurological signs
  • Focal seizures
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2
Q

Hirschprung’s disease is commonly associated with which syndrome?

A

Down’s syndrome.

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3
Q

How does Hirschprung’s present?

A

Neonatal period: failure or delay to pass meconium.

Older children: constipation, abdominal distension.

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4
Q

What is the Tetralogy of Fallot and why does it occur?

A 
TOF is a result of anterior malalignment of the aorticopulmonary septum. The four characteristic features are:
ventricular septal defect (VSD)
right ventricular hypertrophy
pulmonary stenosis
overriding aorta
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5
Q

Patients with epiglottitis may adopt what position?

A

Patients with acute epiglottis may adopt the ‘tripod’ position.

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6
Q

Epiglottitis is caused by what pathogen?

A

Haemophilus influenzae type b.

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7
Q

What are the signs of epiglottitis in children?

A

Abrupt onset and rapid progression (within hours) of dysphagia, drooling, and distress (‘the three D’s’) are hallmarks of epiglottitis in children, and patients frequently adopt the ‘tripod’ position to maximise airway opening. The ‘tripod position’ can also be seen in other respiratory conditions such as a retropharyngeal or peritonsillar abscess.

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8
Q

A 3-year-old male presents to the emergency department with his mother who is anxious about ‘his cold becoming worse’. She informs you that the cough he has had for 4 days has become louder and more frequent and he hasn’t eaten anything for the past 24 hours. On examination he is febrile (38.4ºC) and mildly agitated with overt coryzal symptoms. There is mild retraction of the skin around the sternal wall and a gentle, soft inspiratory high pitched noise heard between fits of coughing. What is the most appropriate management in this case?
- what’s the condition?

A

Croup - A single dose of oral dexamethasone (0.15 mg/kg) is to be taken immediately regardless of severity.

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9
Q

Croup is commonly caused by what?

A

Parainfluenza viruses

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10
Q

What are the features of croup?

A

stridor
barking cough (worse at night)
fever
coryzal symptoms

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11
Q

How does biliary atresia present?

A

Biliary atresia is a congenital disease where there is an absence of the biliary tree, causing in cirrhosis. This typically presents with persistent jaundice and hepatomegaly within the first few weeks of life.

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12
Q

How does duodenal atresia present?

A

Duodenal atresia is a congenital malformation that presents with signs of bowel obstruction such as a distended abdomen, bilious vomiting and absence of bowel movements. This is strongly associated with Down’s syndrome and can sometimes be detected during antenatal ultrasound screening.

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13
Q

How does inssusception present?

A

Intussusception occurs when a segment of bowel is pulled into itself. It presents, usually after the first three months of life, with a classic triad of intermittent abdominal pain, vomiting and a right upper quadrant mass. Children will often pull their legs up to their tummy in pain and there may be ‘red currant jelly’ stool. On ultrasound you may see the ‘target sign’.

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14
Q

How does transposition of the great arteries vs tetralogy of fallot present?

A

Cyanotic congenital heart disease presenting within the first days of life is TGA.
Cyanotic congenital heart disease presenting at 1-2 months of age is TOF.

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15
Q

What is it important to monitor in pyloric stenosis?

A

Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting.

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16
Q

Congenital talipes equinovarus aka

A

Club foot

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17
Q

What are the potential causes of neonatal hypotonia?

A

Hypotonia is associated with Prader-Willi, it is also associated with neonatal sepsis, spinal muscular atrophy, cerebral palsy and hypothyroidism.

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18
Q

What is Palivizumab used for?

A

Palivizumab is a monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease.

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19
Q

Who is at risk of developing RSV?

A

Those at risk of developing RSV include:

Premature infants
Infants with lung or heart abnormalities
Immunocompromised infants

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20
Q

What are the risk factors for neonatal sepsis?

A

Risk factors for neonatal sepsis include low birth weight (<2.5kg), prematurity, membrane rupture >18 hours, and current group B streptococcus infection.

21
Q

How does acute epiglottitis present?

A

This history is suggestive of acute epiglottitis (acute onset, relatively normal respiratory rate, forward lean and stridor), a potentially life-threatening condition that requires urgent assessment and treatment in secondary care. Hospital transfer should be by blue light ambulance.

22
Q

What is laryngomalacia?

A

Laryngomalacia is a very common, benign cause of noisy breathing in infants

23
Q

What are the features acute epiglottitis?

A

rapid onset
unwell, toxic child
stridor
drooling of saliva

24
Q

Scarlett fever is caused by what pathogen?

A

Scarlet fever is a reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes). It is more common in children aged 2 - 6 years with the peak incidence being at 4 years

25
Q

How does Scarlett fever present?

A 
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
'strawberry' tongue
rash
26
Q

What is Perthe’s disease?

A

Perthes’ disease is a degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head, specifically the femoral epiphysis. Impaired blood supply to the femoral head causes bone infarction.

27
Q

Slipped upper femoral epiphysis

A

Slipped upper femoral epiphysis is the commonest adolescent hip disorder. It occurs most commonly in obese males. It may often present as knee pain which is usually referred from the ipsilateral hip. The knee itself is normal. The hip often limits internal rotation. The diagnosis is easily missed. X-rays will show displacement of the femoral epiphysis and the degree of its displacement may be calculated using the Southwick angle. Treatment is directed at preventing further slippage which may result in avascular necrosis of the femoral head.

28
Q

How does TGA present on examination?

A

Transposition of the great arteries presents with no murmur but typically a loud single S2 is audible and a prominent right ventricular impulse is palpable on examination.

29
Q

Read summary of Acute lymphoblastic leukaemia (ALL).

A

Acute lymphoblastic leukaemia (ALL) is the most common malignancy affecting children and accounts for 80% of childhood leukaemias. The peak incidence is at around 2-5 years of age and boys are affected slightly more commonly than girls

Features may be divided into those predictable by bone marrow failure:

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae

And other features
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
fever is present in up to 50% of new cases (representing infection or constitutional symptom)
testicular swelling

30
Q

You are called to the postnatal ward as part of the neonatal team to review an infant born 8 hours ago who has suddenly turned blue and has an increased work of breathing. There is no grunting and he is not tachypnoeic. There is no murmur on examination.

A chest x-ray has been done which shows obvious cardiomegaly but it has not yet been reported. The ward team have already tried giving oxygen but this has not improved the breathing.

What is the most appropriate initial management?

A

Maintenance of the ductus arteriosus with prostaglandins is the initial management for duct dependent congenital heart disease.

31
Q

Acute lymphoblastic leukaemia may present with haemorrhagic or thrombotic complications due to DIC.

A

Acute lymphoblastic leukaemia may present with haemorrhagic or thrombotic complications due to DIC.

32
Q

How does necrotising enterocolitis present in babies?

A

Necrotising enterocolitis is one of the leading causes of death among premature infants. Initial symptoms can include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.

33
Q

How does necrotising enterocolitis present on x-ray?

A

Abdominal x-rays are useful when diagnosing necrotising enterocolitis, as they can show:
dilated bowel loops (often asymmetrical in distribution)
bowel wall oedema
pneumatosis intestinalis (intramural gas)
portal venous gas
pneumoperitoneum resulting from perforation
air both inside and outside of the bowel wall (Rigler sign)
air outlining the falciform ligament (football sign)

34
Q

What age male and female is defined as precocious puberty?

A

Development of secondary sexual characteristics before 8 years in females and 9 years in males.

35
Q

A VSD is heard a what type of murmur?

A

Pansystolic murmur.

36
Q

What pulse abnormality is associated with pulsus paradoxus?

A

Patent ductus arteriosus - large volume, bounding, collapsing pulse.

37
Q

Addisons =

A

Adrenal insufficiency

38
Q

Names the syndrome:
A boy with learning difficulties is noted to be extremely friendly and extroverted. He has short for his age and has supravalvular aortic stenosis.

A

William’s syndrome

39
Q

Most common presentation of neonatal sepsis:

A

Grunting and other signs of respiratory distress are the most common presentation of neonatal sepsis.

40
Q

Treatment of biliary atresia:

A

Surgery

41
Q

What are the symptoms of SUFE?

A

Hip, groin, medial thigh or knee pain
Loss of internal rotation of the leg in flexion
Bilateral slip in 20% of cases

42
Q

Management of SUFE?

A

Internal fixation: typically a single cannulated screw placed in the center of the epiphysis

43
Q

Acute epiglottitis is cause by what organism?

A

Acute epiglottitis is caused by Haemophilus influenzae type B.

44
Q

A 17-year-old girl presents to her GP because she is concerned that she hasn’t started menstruating yet. She is otherwise well in herself.

On examination, she is of normal height and has had breast development, but very little pubic hair. On examination of the abdomen you can feel two masses in the groin. Her external genitalia appear normal.

What is the most likely diagnosis?

A

Androgen insensitivity syndrome - classic presentation is ‘primary amenorrhoea’.

This patient has androgen insensitivity, which means they are genetically XY but are phenotypically female due to reduced/absent testosterone receptors in target tissues. It is an X-linked disorder. The masses are due to undescended testes.

45
Q

How does CAH present?

A

Congenital adrenal hyperplasia causes precocious puberty, and early onset of pubic hair, due to excess androgen production. Females with the condition usually have ambiguous genitalia and virilisation, whereas males have normal genitalia at birth.

46
Q

Neonatal jaundice in newborns is pathological not physiological at what time period?

A

Jaundice in the first 24 hrs is always pathological.

47
Q

Causes of jaundice in the first 24hours of birth:

A 
Causes of jaundice in the first 24 hrs
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
48
Q

IVH (intraventricular haemorrhage) in premature infants, Subdural Haematoma in Shaken Baby Syndrome

A

IVH in premature infants, Subdural Haematoma in Shaken Baby Syndrome.

49
Q

A resp rate of what is red flag in the NICE traffic light system?

A

A respiratory rate of >60 per minute (at any age) is a red flag according to the NICE paediatric traffic light system.

paediatrics (3 decks)

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