Passmed - Paeds Flashcards
1
Q
Organism causing acute epiglottitis
A
Haemophilus influenzae type B
2
Q
Acute epiglottitis signs and symtoms
A
rapid onset high temperature, generally unwell stridor drooling of saliva 'tripod' position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
3
Q
Epiglottitis dx
A
Diagnosis is made by direct visualisation (only by senior/airway trained staff, see below).
X-rays may be done, particularly if there is concern about a foreign body:
a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’
in contrast, a posterior-anterior view in croup will show subglottic narrowing, commonly called the ‘steeple sign’
4
Q
Epiglottitis mx
A
immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)
endotracheal intubation may be necessary to protect the airway
if suspected do NOT examine the throat due to the risk of acute airway obstruction
the diagnosis is made by direct visualisation but this should only be done by senior staff who are able to intubate if necessary
oxygen
intravenous antibiotics
5
Q
Most common malignancy affecting children + peak incidence
A
Acute lymphoblastic leukaemia
Peak incidence - 2-5 years
6
Q
ALL symptoms and signs
A
Bone marrow failure
- anaemia: lethargy and pallor
- neutropaenia: frequent or severe infections
- thrombocytopenia: easy bruising, petechiae
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
7
Q
ALL poor prognostic factors
A
age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers non-Caucasian male sex
8
Q
Aetiology of alpha thalassaemia
A
Deficiency of alpha chains in Hb
2 separate alpha-globulin genes are located on each chromosome 16
9
Q
Clinical severity of alpha thalassaemia
A
If 1 or 2 alpha globulin alleles are affected - hypochromic microcytic blood film, normal Hb
If are 3 alpha globulin alleles are affected - hypochromic microcytic anaemia with splenomegaly
This is known as Hb H disease
If all 4 alpha globulin alleles are affected (i.e. homozygote) then death in utero (hydrops fetalis, Bart’s hydrops)
10
Q
Causes of ambiguous genitalia in children + basic physiology
A
Most common cause - CAH
Other causes
True hemaphroditism
maternal ingestion of androgens
initially gonads in fetus are undifferentiated on the Y chromosome there is a sex-determining gene (SRY gene) which causes differentiation of the gonad into a testis if absent (i.e. in a female) then the gonads differentiate to become ovaries
11
Q
Apgar score
A
https://litfl.com/wp-content/uploads/2019/03/APGAR-score-Table-3.png
0-3 very low score
4-6 moderate low
7-10 baby is in a good state
12
Q
Appendicitis in <4 presentation
A
Uncommon
Often presents with perforation
13
Q
Asthma attack in children
severe vs life-threatening
SpO2 PEF HR RR Behaviour
A
Severe SpO2 <92% PEF 33-50% best or predicted HR >125 (>5y), >140(1-5y) RR >30 (>5y), >40 (1-5y) Behaviour Too breathless to talk or feed Use of accessory neck muscles
SpO2 <92% PEF <33% best or predicted Behaviour Silent chest Poor respiratory effort Agitation Altered consciousness Cyanosis Increasing CO2
14
Q
Asthma attack in children mx
A
Emergency transfer to hospital if severe or life-threating
Children >5
mild to moderate acute asthma:
Bronchodilator therapy
Salbutamol via spacer (for a child < 3 years use a close-fitting mask)
give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat beta-2 agonist and refer to hospital
Steroid therapy
should be given to all children with an asthma exacerbation
treatment should be given for 3-5 days
15
Q
Usual prednisolone dose used ins steroid therapy for asthma attacks
A
BTS
2-5
20mg OD
> 5
30-40mg OD
cBNF -
1-2mg/kg OD
16
Q
Asthma mx in children >5
A
1) SABA
2) SABA + low dose ICS
3) SABA + low dose ICS + LTRA
4) SABA + low dose ICS + LABA
5) SABA + MART
6) SABA + moderate dose ICS MART OR moderate dose ICS + LABA
7) SABA and
- high dose ICS or
- Trial of additional drug e.g. theophylline
- Seek advice
ICS doses = paediatric doses
17
Q
Asthma mx in children <5
A
1) SABA
2) SABA + 8 week trial of moderate dose ICS
symptoms did not resolve - review dx
symptoms resolved then recurred within 4 weeks of stopping ICS - restart ICS at a paediatric low dose
symptoms resolved then recurred beyond 4 weeks of stopping ICS - repeat 8 week trial of paediatric moderate dose ICS
3) SABA + paediatric low dose ICS + LTRA
4) stop LTRA, refer to specialist
18
Q
When do you decide to put a child on maintenance + reliever therapy rather than just reliever?
A
Symptoms at presentation that clearly indicate the need for maintenance therapy (e.g. asthma-related symptoms >3x/week or causing waking at night)
Asthma uncontrolled with SABA alone
19
Q
When do you decide to trial a child <5 on a moderate dose paediatric ICS for asthma?
A
Symptoms at presentation that clearly indicate the need for maintenance therapy (e.g. asthma-related symptoms >3x/week or causing waking at night)
Asthma uncontrolled with SABA alone
20
Q
• Paediatric Doses for CS in asthma (budesonide or equivalent)
o Low dose
o Moderate dose –
o High dose
A
• Paediatric Doses (budesonide or equivalent)
o Low dose - <200 mcg
o Moderate dose – 200-400 mg
o High dose - >400 mcg
21
Q
ADHD features
A
Persistent symptoms
Developmental delay
<16 - 6 features have to be present
>= 17 - 5 features need to be present
Inattention
Does not follow through on instructions
Reluctant to engage in mentally-intense tasks
Finds it difficult to sustain tasks
Easily distracted
Finds it difficult to organise tasks or activities
Often forgetful in daily activities
Often loses things necessary for tasks or activities
Often does not seem to listen when spoken to directly
Hyperactivity/impulsivity
Unable to play quietly
Talks excessively
Does not wait their turn easily
Will spontaneously leave their seat when expected to sit
Is often ‘on the go’
Often interruptive or intrusive to others
Will answer prematurely, before a question has been finished
WIll run and climb in situations where it is not appropriate
22
Q
ADHD management in children
A
- 10 week watch + wait
- refer to 2ndary care
- education and training programmes for parents
- drug therapy >5, last resort
- Methylphenidate
(6 week trial) - 1st line - lisdexamfetamine - 2nd line
- dexamfetamine - if lisdexamfetamine is beneficial but side effects cannot be tolerated
23
Q
SE of medication used for ADHD
A
Methylphenidate - Abdominal pain, N, dyspepsia
weight + height should be monitored every 6 months
cardiotoxic
ECG before treatment
24
Q
ASD autism sympotms and signs
A
Social communication impairments and repetitive behaviours are present during early childhood (typically evident before 2–3 years of age),
Impaired social communication and interaction:
Children frequently play alone and maybe relatively uninterested in being with other children.
They may fail to regulate social interaction with nonverbal cues like eye gaze, facial expression, and gestures.
Fail to form and maintain appropriate relationships and become socially isolated.
Repetitive behaviours, interests, and activities:
Stereotyped and repetitive motor mannerisms, inflexible adherence to nonfunctional routines or rituals are often seen.
Children are noted to have particular ways of going about everyday activities.
ASD is often associated with intellectual impairment or language impairment.
Attention deficit hyperactivity disorder (35%) and epilepsy (18%) are also commonly seen in children with ASD.
ASD is also associated with a higher head circumference to the brain volume ratio.
25
AR vs AD inheritance - what conditions do they cause?
AR - metabolic
| AD - structural
26
AD conditions
```
Adult polycystic disease
Antithrombin III deficiency
Ehlers-Danlos syndrome
Familial adenomatous polyposis
Hereditary haemorrhagic telangiectasia
Hereditary spherocytosis
Hereditary non-polyposis colorectal carcinoma
Huntington's disease
Hyperlipidaemia type II
Hypokalaemic periodic paralysis
Malignant hyperthermia
Marfan's syndromes
Myotonic dystrophy
Neurofibromatosis
Noonan syndrome
Osteogenesis imperfecta
Peutz-Jeghers syndrome
Retinoblastoma
Romano-Ward syndrome
tuberous sclerosis
Von Hippel-Lindau syndrome
Von Willebrand's disease*
```
*type 3 von Willebrand's disease (most severe form) is inherited as an autosomal recessive trait. Around 80% of patients have type 1 disease
27
AR conditions
```
Congenital adrenal hyperplasia
Cystic fibrosis
Familial Mediterranean Fever
Haemochromatosis
Sickle cell anaemia
Thalassaemias
Wilson's disease
```
28
Beefy red well defined patches, especially in skin folds
Candida
29
Annular erythematous plaque that has advancing scaly edges and central clearing
Tinea corporis
| Fungal cutaneous infection that can affect an infant’s torso
30
Murmurs in the following heart defects
```
ASD
VSD
Coarctation of the aorta
PDA
PS
```
ASD ejection systolic murmur and fixed splitting of the second heart sound
VSD pansystolic murmur in lower left sternal border
Coarctation of the aorta Crescendo-decrescendo murmumr in thr upper L sternal border
PDA diastolic machinery murmur in the upper left stenrnal border
PS Ejection systolic in the upper left sternal border
31
What murmur does the ASD produce and why?
Ejection systolic murmur with fixed splitting of the second heart sound
about the systolic nature of the murmur it is to ejection systolic murmur = increased flow through the pulmonary valve due to the left to right shunt, the fixed delay being caused by an increased loading pressure of the right ventricle delaying closure of the valve
32
Paramteres that need monitoring when the child is on mthylphenidate for ADHD
Methylphenidate, a stimulant, may suppress appetite and cause growth impairment in children
```
It is advised to monitor
growth (weight + height)
blood pressure
pulse
on a regular basis.
```
33
Neonatal resuscitation When do you start CPR on a newborn?
When HR <60 bpm
34
Neonatal resuscitation when do you suction their airways?
When there is thick maeconium causing obstruction as it can cause reflex bradycardia in babies
If the infant becomes bradycardic, positive pressure ventilation to aerate the lungs is indicated despite the prsesence of meconium
35
Neonatal resuscitation
```
DAM I ReCussitAte (RCA)
Dry
Access (APGAR)
Meconium in mouth (suck if presence)
Inflation breath 5 (via mask)
ReAssess (APGAR)
Compression (if HR<60)
Adrenaline
```
36
Nephritic syndrome
1-2 days post infection
1-2 w post infection
1-2 days post infection igA nephropathy
| 1-2 w post infection post strep glomerulonephritis
37
Which one of the following is the most common cause of nephrotic syndrome in children?
Minimal change disease
| Majority of cases are idiopathic + respond well to steroids
38
Why would NSAIDs like ibuprofen not be recommended in anchild with chickenpox?
NSAIDs can increase the risk of necrotising fasciitis in patients with chicken pox
A common complication is secondary bacterial infection of the lesions
NSAIDs may increase this risk
whilst this commonly may manifest as a single infected lesion/small area of cellulitis, in a small number of patients invasive group A streptococcal soft tissue infections may occur resulting in necrotizing fasciitis
39
Kawasaki disease main signs and symptoms
'CRASH + Burn'
```
Conjunctivitis
Rash
Adenopathy (lymph)
Strawberry tongue... the classic
Hand swelling with desquamation
```
Burn - fever >5 days
40
Vaccinations in
premature babies
Babies <28
When should they be given?
Babies who were born prematurely should receive their routine vaccinations according to chronological age; there should be no correcting for gestational age. Babies who were born prior to 28 weeks gestation should receive their first set of immunisations at hospital due to risk of apnoea.
41
How do you calculate the correct Timing of milestones for a baby born prematurely?
Developmental milstones - Expected Age + (40 - gestational age at birth)
[Example for social smile: Usually expected at 6 weeks for a normal child. But would be expected by 14 weeks for a child born at 32 weeks. 6 + (40-32) = 14]
42
Roseola infantum infection characteristics
caused by human herpes virus 6
Roseola infantum is a common viral illness that causes a characteristic 3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever. The fever is typically rapid onset and can often predispose to febrile convulsions. The rash typically starts on the trunk and limbs (this is different to chickenpox which is typically a central rash). HHV6 is neurotropic (attacks the nervous system) and thus a rare complication is encephalitis and febrile fits (after cessation of the fever).
Mneumonic
6 looks like a rose
HHV 6 - 6th disease
3 days fever + 3 days rash (in total, that's 6 days)
43
Commonest complication of measles
Otitis media
44
High AFP
| Low AFP
High AFP -
Fetal Neural tube defects (meningocele, myelomeningocele and anencephaly)
Fetal Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy
```
Low AFP
Edwards syndrome
DS
maternal DM
Maternal obesity
```
45
What is another name for pg e1
Alprostadil
46
Duchenne muscular dystrophy typical presentation
Proximal weakness (On examination, he places his hands on his knees and then his thighs to stand up from lying down on his front)
Muscle calf hyperteophy
Delayed walking
47
Duchenne muscular dystrophy diagnostic ix
Genetic testing
48
ASD vs VSD murmur
ASD's have a fixed split S2 sound due to the increased venous return overloading the right ventricle during inspiration and delaying closure of the pulmonary valve. VSD are associated with a pansystolic murmur.
```
ASD = A Split Double
VSD = Very Systolic = Pansystolic
```
49
Difference bn CLL and ALL
Typically CLL is asymptomatic and diagnosed by lymphocytosis whereas ALL is symptomatic yet has pancytopaenia and excessive blast cells which appear on a blood film but not a WCC
50
Presentation of
Ebstein's anomaly
Ventricular septal defects
Tetralogy of fallot
Mitral valve prolapse
Ebstein's anomaly
- caused by the use of lithium in pregnancy
- occurs when the posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle
- tricuspid regurgitation (pan-systolic murmur) and tricuspid stenosis (mid-diastolic murmur)
- enlargement of the right atrium
- right-sided HF
- accessory conduction pathways
Ventricular septal defects
- Pan-systolic but not diastolic murmur
Tetralogy of fallot typically
- presents at 1-2 months of age rather than in the days after birth
Mitral valve prolapse
- Mid systolic click followed by a late systolic murmur but has no diastolic element
51
Medication to be avoided in chickenpox
Ibuprofen should be avoided in chicken pox as there is an associated risk between use of NSAIDs and the development of necrotising fasciitis.
52
Describe the roseola rash
Roseola presents with blanching, pink papules which start on the trunk and spread to arms and legs and only develop after cessation of the fever.
53
DDH RF
- Feet first
- Female
- Fluid (oligohydramnios)
- Fatty (>5kgs)
- First born with Family history
- Foot deformity (calcaneovalgus deformity)
54
VSD complications
Endocarditis
Pulmonary hypertension
Aneurysms of the ventricular septum
55
Commonest cause of ambiguous genitalia in newborns
CAH
56
Septic arthritis presentation
A child with septic arthritis of the hip would typically have a swollen, warm hip joint with severe pain with passive movement
The hip often rests in a flexed, abducted and externally rotated position
The child often has a high temperature, looks unwell and may have other deranged observations such as tachycardia
57
Transposition of the great arteries presentation
No murmur
Loud single S2
Prominent right ventricular impulse palpable on examination
58
Findings in cyanotic heart deftects
Cyanotic
TGA: loud S2 and prominent RV impulse
ToF: ejection systolic murmur (due to pulmonary stenosis)
Tricuspid: ejection systolic and prominent apical impulse
59
Findings in a cyanotic heart defects
Acyanotic
VSD: pan systolic associated with chromosomal abnormalities e.g. Down's
ASD: more common in adults, ejection systolic and fixed splitting S2
PDA: 'machinery' murmur associated with prematurity/rubella
CoA: radio-femoral delay, apical click and mid systolic
60
What do you need to consider before giving indometacon/ibuprofen to close a PDA in a newborn?
echo to rule out whether he has a duct dependent defect that needs to keep the DA open
61
Findings in transient tachypnoea of the newboRn TTN + RF
increased respiratory rate in an otherwise well neonate born at term
presence of fluid in the horizontal fissure
```
RF
CS
LBW
macrosomia
maternal asthma
maternal DM
```
62
most common heart lesion associated with Duchenne muscular dystrophy
dilated cardiomyopathy
63
Subaponeurotic haemorrhage or subgaleal haemorrhage
is a rare condition seen in newborns caused by rupturing of the emissary veins that connect the dural sinuses and the scalp veins. This leads to blood accumulating in the aponeurosis of the scalp and periosteum. These can occur secondary to ventouse delivery and are an important differential to caput succedaneum. They are not confined by cranial sutures either but run deep to the galeal aponeurosis and are bloody rather than serosanguinous or oedematous fluid in nature.
64
When can the MMR vaccine be given if children have not been immunised according to the schedule?
The Green Book recommends allowing 3 months between doses to maximise the response rate
A period of 1 month is considered adequate if the child is greater than 10 years of age
In an urgent situation (e.g. an outbreak at the child's school) then a shorter period of 1 month can be used in younger children
You give MMR not immunoglobulin to the child if they are unvaccinated and come into contact with measles
65
Congenital diaphragmatic hernia symptoms and signs
Scaphoid abdomen, due to herniation of the abdominal contents into the cleft
dyspnoea and tachypnoea at birth
reduced breath sounds
Heart sounds are displaced medially
The auscultation findings are due to pulmonary hypoplasia and compression of the lung due to the presence of abdominal contents in the thoracic cavity.
Prompt treatment and respiratory support are required.
66
Paediatric BLS resuscitation in infants
5 rescue breaths
in infants use a two-thumb encircling technique for chest compression
15:2
67
Which parameter should be monitored in children on methylphenidate for ADHD?
Growth
this happens because methylphenidate suppresses appetite (leading to side effect of poor appetite), which can then go on to cause stunted growth. That's why growth is monitored through-out treatment, and drug holidays are suggested on weekends/school holidays!
68
Infantile spasms vs infantile colic
In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the 'spasms'
Infantile spasms
6-month-old baby crying, which stops abruptly and the child draws his chin into his chest, throws his arms out. The child then relaxes and starts crying again, and over the course of the minute long video this is repeated around 10 times.
The mother also reports that the child has been referred to the community paediatric clinic due to slight delay in reaching developmental milestones.
69
2 day old presenting with meningitis - which is the most likely causative organism?
GBS
70
Commonest cause of meningitis in
Neonatal to 3 months
1 month to 6 years
Greater than 6 years
Neonatal to 3 months
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes
1 month to 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
```
Greater than 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
```
71
Child presenting with symptoms of spastic cerebral palsy- where is the lesion
vs ataxic cerebral palsy
Upper motor neurons in the periventricular white matter
This child has spastic diplegia, a form of cerebral palsy most commonly secondary to periventricular leukomalacia, a condition occurring more frequently in premature infants. Necrosis of the white matter in the fragile area surrounding the lateral ventricles causes upper motor neuron lesions resulting in the spasticity seen in this patient's lower limbs.
To note, spastic type cerebral palsy is caused by damage to the pyramidal tracts hence may be referred to as pyramidal cerebral palsy.
Lesions to the UPPER motor neurons in the cerebellum would result in ataxic type cerebral palsy. As with spastic cerebral palsy, there is generally motor delay but it would also present with HYPOTONIA (as opposed to hypertonia), varying signs of ataxia (e.g. dysarthria, dysdiadochokinesia, sometimes nystagmus, etc.), impaired balance and coordination, intention tremors, and a wide-based gait (in walking patients).
72
RF for NRDS, TTN, aspiration pneumonia
Prematurity is the major risk factor for NRDS.
Caesarean section is the major risk factor for tachypnoea of the newborn (TTN).
Meconium staining is the major risk factor for aspiration pneumonia.
73
NRDS vs TTN
. Prematurity is the major risk factor for NRDS. Caesarean section is the major risk factor for tachypnoea of the newborn (TTN).
NRDS
Respiratory distress shortly after birth which usually worsens over the next few days
CXR - diffuse ground glass lungs with low volumes and a bell-shaped thorax
TTN
Tachypnoea shortly after birth and often fully resolves within the first day of life.
CXR - heart failure type pattern (e.g. interstitial oedema and pleural effusions)
but key distinguishing features from congenital heart disease are a normal heart size and rapid resolution of the failure type pattern within days.
74
A 6-year-old boy attends the emergency department with acute shortness of breath. His parents report that he has had a cold for a few days but today has been struggling more with his breathing. He has had several prior admissions for wheeze and has had exertional breathlessness and nighttime cough for the past year.
His observations show a respiratory rate of 30/min, heart rate 130/min, saturations 94% and temperature of 37.4ºC. He has intercostal and subcostal recession and a global expiratory wheeze but responds well to salbutamol.
What acute medication/medications should he be prescribed on discharge?
salbutamol inhaler + 3 days prednisolone PO are the correct acute medications to prescribe on discharge. For all children suffering an acute exacerbation of asthma 3-5 days of oral prednisolone should be given. It is important to ensure that all patients have an adequate supply of their salbutamol inhaler with advice on when and how to use it.
75
HSP vs ITP
```
HSP:
usually post-bacterial infection (URTi)
palpable purpuric rash
polyarthralgia
+/- haematuria, abdo pain
Normal/raised plt count
```
ITP:
usually post-viral infection
flat (non-palpable) petechial rash
Isolated low platelets
76
Hypernatremia vs hyponatraemia
```
Full OF SALT
Flushing
Oedema
Fever
Seizures
Agitation
Low urine output
Thirst
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
```
```
SALT LOSS
Stupor
Anorexia (+ N&V)
Limp tone
Tendon reflexes reduced
Lethargy
Orthostatic hypotension
Seizures
Stomach cramps
```
77
common cause of invasive skin infections following chickenpox
group A streptococcal infections
e.g. streptococcus pyogenes
78
What is Sandifer syndrome?
o Sandifer syndrome is a condition in which an infant has dystonia and back-arching which is associated with gastro-oesophageal reflux (GORD). It can be confused as being a seizure
79
CXR in RDS vs TTN vs meconium aspiration
Respiratory distress syndrome - A chest x-ray of RDS typically shows reduced lung volumes and diffuse granular opacities, hypoxia
Transient tachypnoea of the newborn - hyperinflation and the presence of fluid in the horizontal fissure, no hypoxia
Meconium aspiration patchy atelectasis or consolidation, would present with hypoxia
80
What does the heel prick test test for?
They are tested for cystic fibrosis (CF), congenital hypothyroidism, sickle cell disease, and a number of other metabolic diseases.
81
Why does PDA lead to LVH?
PDA is a L-to-R shunt
Blood flows from the aorta to the pulmonary artery
Increased blood flow to the lungs
Pulmonary HTN
Increased return to the left side of the heart --> left ventricular volume overload
82
WCC + ESR suggesting septic arthritis
WCC > 12
| ESR > 40
83
Hirschsprung's RF
```
RF's point towards Hirschspung, remember
Male
Down's
Chr 10 deletion
MEN2a
```
84
What is bilious vomiting a sign of?
Bilious vomiting is a sign of obstruction.
Meconium Ileus in CF is caused by the viscous meconium obstructing the the small intestines, usually at the ileum. Therefore feeds and secretions (such as bile) build up, cause abdominal distension, and are forced back the other way=> producing bile containing, green vomit (bilious vomiting).
N.B: Obstruction proximal to the opening of the bile duct won't cause this e.g pyloric stenosis.
85
An 8-year-old boy presents to the emergency department severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa.
Which of the above is most concerning?
A normal pCO2 is indicative of reduced respiratory effort in asthma as is, therefore, a life-threatening sign. Normal pCO2 is 4.8-6 kPa.
86
How do you decide on the schedule of vaccination for premature babies
All premature babies should still have immunisations at regular time (no adjustment required), however if <28 weeks at birth, should be given in hospital due to higher risk of apnoea. If a baby develops apnoea, bradycardia, or desaturation after the first immunisation, the second immunisation should also be given in hospital with similar monitoring.
87
When can children
```
Scribble
Draw a line
Circle square
Cross
Triangle
```
Can scribble at age 1
Can draw a line (has 2 ends) at age 2
Can draw a circle (*3*60 degrees) at age 3
Can draw a square or a cross (4 sides/points) at age 4
Can draw a triangle at age 5 (I always just remember this one because it's annoying that it isn't age 3)
88
Auditory tests
Pure tone audiometry
Auditory brainstem response test
Otoscoustic emission test
Pure tone audiometry
- is a hearing test that assesses air conduction by placing headphones in the person's ears and asking them to signal when they hear the beep. It is performed on school entry to assess a child's hearing before they start school. If this is abnormal, they will be referred for further tests.
Auditory brainstem response test is performed when neonatal otoacoustic emission test is abnormal. It involves using electrodes to detect responses to auditory stimuli.
Otoscoustic emission test the test of choice for the newborn hearing screen. An earpiece is placed in the neonate's ear and clicks are played. The sounds that come back are then detected and this assesses whether the cochlear is functioning normally.
89
Where is the lesion in spastic cerbral palsy?
Frontal lobe is incorrect. The frontal lobe is the part of the brain that controls motor function. The motor cortex at the back of the frontal lobe is the site of damage in spastic cerebral palsy. This is the most common type of cerebral palsy and is characterised by hypertonia.
90
Hepatitis B in pregnancy mx of neonate
For babies who are born to mothers who are hepatitis B surface antigen positive, or are known to be high risk of hepatitis B
- should receive the first dose of hepatitis B vaccine soon after birth
and those born to mother's who are surface antigen positive
- should also receive 0.5 millilitres of hepatitis B immunoglobulin within 12 hours of birth
- a second dose of hepatitis B vaccine at 1-2 months and at 6 months
91
Inactivated toxin vaccines
| oral live attenuated vaccines
Inactivated toxin vaccines - injections
- tetanus
- diphtheria
- pertussis
oral live attenuated vaccines
- rotavirus
- polio
- typhoid
92
Cyanotic congenital heart disease presenting within the first days of life is
Cyanotic congenital heart disease presenting at 1-2 months of age is
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
93
Late systolic murmur
Aortic coarctation
| Mitral valve prolapse
94
Condition associated with hypospadias
1 in 10 children with hypospadias will also have cryptorchidism (undescended testes). Therefore, it is always important to examine the groin and scrotum in children with hypospadias as done in the above scenario. It is also important to ensure they have passed urine in the first 24 hours of life.
95
Stages of puberty in boys
Grapes (testicles), drapes (hair), grow, blow (ejaculation)
96
Acceptable stats for a neonate at
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According to newborn life support, acceptable sats are:
2 min
3 min
4min
5min
10min
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According to newborn life support, acceptable sats are:
60% at 2 min
70% at 3 min
80% at 4min
85% at 5min
90% by 10min
```
97
Remember the 8 S's of innocent murmurs:
Remember the 8 S's of innocent murmurs:
- Soft
- Systolic
- Short
- Sounds (S1 & S2) normal
- Symptomless
- Special tests normal (X-ray, EKG)
- Standing/ Sitting (vary with position)
- Sternal depression
98
The most common complication of measles is
otitis media because the respiratory virus can easily spread to the ear canals
99
Lactose intolerance vs cow milk allergy
Lactose intolerance is related to the absence of lactase in the GI, resulting in gastrointestinal symptoms - namely pain, bloating, flatulence and diarrhoea..
Cows milk intolerance/allergy is an allergic response (if true allergy) , which is IgE mediated. It results in the reflux and regurgitant symptoms in addition to abdominal pain, diarhroea etc.
The question should have cow milk allergy as intolerance implies an enzymatic deficiency such as lactose intolerance. Therefore, the eczema which is an example of atopy doesn't make sense with intolerance. It should be cow milk allergy
100
NEC mx
Remember for NEC, one of the presentation is blood in stools.
That means a STAIN (that's how we manage it)
S - Surgical emergency
T - TPN
A - Antibiotics
I - IV fluids
N - Nil by mouth
101
milestons
6 months all the S's: Sits up, Switch object from hand to hand/palmar grip, Shmooze (aka babble), Stranger danger (scared of new people)
9 months all the P's: Pull to stand (or crawl), Pincer grip, Papa (says papa/dada/mama), Playing Pica boo
12 months all the T's: Two-legs (walking), Two words (can say up to 2 words), Two of us (seperation anxiety wants to always be with mom), Two hands (drinks from cup with 2 hands)
102
The most common fractures associated with child abuse are:
Common fractures in paediatrics not associated with NAI are:
The most common fractures associated with child abuse are:
- Radial
- Humeral
- Femoral
Common fractures in paediatrics not associated with NAI are:
- Distal radial
- Elbow
- Clavicular
- Tibial
103
Lactose intolerance vs cows milk protein
Lactose-free formula would be appropriate if the child was considered to be lactose intolerant. The features pointing towards cow's milk protein intolerance are the rash and runny nose. Infants with lactose intolerance will usually have GI symptoms only.
104
DDH RF
Fat (macrosomia), Female, First Born, Foot-first (Breech), Family history (First-degree) and Fluid low (oligohydramnios)
105
ALL poor prognostic factors
It is male sex that is the poor prognostic factor here. Being Caucasian is not a poor prognostic factor.
Other poor prognostic factors are: presenting <2 years or >10 years; having B or T cell surface markers; and having a WCC > 20 * 10^9/l at diagnosis.
106
Perches disease mx in <6
Serial x-rays, observation and physiotherapy are the mainstay of treatment in cases under the age of 6 years where there is no significant collapse of the femoral head or gross structural abnormalities.
107
Perches disease mx in <6
Serial x-rays, observation and physiotherapy are the mainstay of treatment in cases under the age of 6 years where there is no significant collapse of the femoral head or gross structural abnormalities.
