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Child Health > Passmed/Pastest > Flashcards

Passmed/Pastest Flashcards

1
Q

what are the features of an infant haemangioma

A

visible mass appearing shortly after birth, usually in head and neck area, usually raised and red but may be blue if involving deeper structures

surrounding skin will be blanched and telangeictasia may be seen

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2
Q

what is the treatment for infant haemangioma

A

if asymptomatic and child is <5/6 months - watch and wait they usually regress by this time

if symptomatic oral beta blockers is first line (propanolol)

topical beta blockers are used if oral arent tolerated

surgery is reserved for compression of vital structures or ones that fail to regress

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3
Q

what is the difference between caput succedaneum and cephalohaematoma

A

cephalohaematoma - DOES NOT CROSS SUTURE LINES, well circumscribed smooth fluctuant mass with no skin changes, often in occipito-parietal area

caput succedaneum - crosses midline and suture lines , diffuse swelling of the scalp

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4
Q

when can a child with a seizure be managed at home

A

if it lasted <15 mins, with complete recovery within an hour, with no focal features and the child is otherwise well and not requiring any drugs like antibiotics

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5
Q

what is the cause of toddlers diarrhoea

A

increased gut motility in a developing digestive system

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6
Q

what are the features of toddlers diarrhoea

A

chronic watery diarrhoea with undigested food in a child that is otherwise well and growing without an issue

usually resolves by 5 years old

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7
Q

what is the likely mechanism of a newborn with a haemorrhage born out of hospital

A

vitamin k deficiency - all newborns are deficient and if born in hospital they get a vit k injection

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8
Q

what are features of allergic rhinitis in children

A

paroxysmal nocturnal cough usually at night with occasional retching vomiting

may have noisy breathing/rattly chest

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9
Q

whats the most likely diagnosis of a child presenting with haematuria, periorbital oedema and oliguria following an URTI

A

acute glomerulonephritis

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10
Q

what are features of hyper-IgE syndrome

A 
recurrent respiratory infections (staph/Hib) 
coarsening of facial features 
chronic eczematoid eruptions
cold abscesses  
two sets of teeth at same time
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11
Q

what kind of inheritence is hyper-IgE syndrome

A

AD or Ar

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12
Q

what is a sign a child may have duschennes muscular dystrophy

A

gowers manouvre when getting up - walks on hands “climbing up on his legs”

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13
Q

if duschennes MD is suspected what blood test can be done before a biopsy

A

creatinine phosphokinase

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14
Q

what is the most common brain tumour in children

A

cerebellar astrocytoma

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15
Q

what is stills disease

A

systemic-onset juvenile arthritis

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16
Q

what are features of systemic-onset juvenile arthritis/stills disease

A

high spiking fever progressing throughout day, peaking at night and then settling down by morning to climb again.

salmon pink rash, malaise, arthralgia, weight loss, lymphadenopathy

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17
Q

how do you manage systemic-onset juvenile arthritis/stills disease

A

NSAIDS +/- steroids

methotrexate

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18
Q

what are the components of tetralogy of falot

A

right ventricular hypertrophy
ventricular septal defect
tricuspid atresia/right sided outflow obstruction
overriding aorta

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19
Q

when should a <5 year old with asthma be referred to a respiratory paediatrician

A

when using salbutamol inhaler >3 times a week and they are on SABA + low dose ICS + LTRA

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20
Q

what is suspected for a child with a musty odour or the skin and urine, hypopigmentation and eczema

A

phenylketonuria

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21
Q

what is tetralogy of falot’s cause

A

anterosuperior displacement of the infundibular septum

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22
Q

what are features of achondroplasia

A

short limbs and stature but with normal growth of head leading to ‘abnormally large head’ appearance

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23
Q

what mutation is responsible for achondroplasia

A

activation of the FGF3 receptor

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24
Q

what is edwards syndrome

A

trisomy 18

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25
Q

what are features of edwards syndrome

A

microcephaly, overlapping fingers, rocker bottom feet, congenital heart disease,breathing and feeding problems, severe learning difficulty

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26
Q

when is a pavlick harness contraindicated for DDH and what is the only alternative

A

in children over 6 months old or with irreducible deformity, surgery is the only option

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27
Q

what virus causes bronchiolitis

A

respiratory syncytial virus (RSV)

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28
Q

what is the most common cause of cyanosis of a newborn

A

Transposition of the great arteries

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29
Q

how do you differentiate between hypoplastic left heart syndrome and TGA

A

HLHS has pulmonary oedema/respiratory distress whereas TGA does not, it presents with cyanosis and severe low oxygen saturation

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30
Q

when should you ultrasound a newborns hips for ?DDH if ortolanis and barlows test is normal, and when should the scan be done

A

if they have significant risk factors for DDH
(oligohydramnios , breech position)

4-6 weeks as opposed to 2 weeks for a positive ortolanis/barlows

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31
Q

when should a child have a CT head for ?intracranial haemorrhage post head trauma within 1 hour

A

any more than >1 of

  1. LOC >5 mins
  2. abnormal drowsiness
  3. 3+ episodes of vomiting
  4. dangerous mechanism/high speed impact
  5. retrograde/anterograde amnesia for >5 mins
  6. suspicion of NAI
  7. post traumatic seizure with no ddx of epilepsy
  8. GCS <15 , initially or 2 hours after
  9. tense fontanelle
  10. signs of basal skull fracture
  11. focal neurological defect
  12. any bruise/swelling/laceration on head if <1yo
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32
Q

when should a child be monitored for 4 hours post head injury

A

only one of

  1. LOC >5 mins
  2. abnormal drowsiness
  3. 3+ episodes of vomiting
  4. dangerous mechanism/high speed impact
  5. retrograde/anterograde amnesia for >5 mins
  6. suspicion of NAI
  7. post traumatic seizure with no ddx of epilepsy
  8. GCS <15 , initially or 2 hours after
  9. tense fontanelle
  10. signs of basal skull fracture
  11. focal neurological defect
  12. any bruise/swelling/laceration on head if <1yo
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33
Q

what are signs of a congenital toxoplasmosis infection

A

jaundice at birth, organomegaly and convulsions

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34
Q

what is the most common cause of an uncomplicated, raised unconjugated bilirubin in a newborn, presenting after the first 24 hours of life

A

breast milk jaundice

genetic testing should rule out gilberts

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35
Q

what % of omphalocele causes are genetic

A

15%

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36
Q

what is the presentation of roseola infantum

A

child aged 6-24 months with a 3-5 day history of a blanching rash, high (>40) fevers, lethargy, cervical lymphadenopathy and enlarged tonsils

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37
Q

how do you treat roseola infantum

A

it is self limiting so supportive

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38
Q

what causes roseola infantum

A

Human Herpes Virus 6

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39
Q

what is the most likely cause of a RIF pain with cervical lymphadenopathy and high fever, following a viral URTI

A

mesenteric adenitis

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40
Q

what does an egg on side appearance of the cardiac shadow on XR indicate

A

TGA

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41
Q

what is the definitive management of TGA

A

balloon atrial septostomy

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42
Q

whats the treatment of otitis media +/- effusion in children without abnormal architecture

A

amoxicillin 500mg TDS for 5 days

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43
Q

whats the treatment of otitis media +/- effusion in children with known abnormal facial architecture (T21, cleft palate)

A

specialist referral

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44
Q

whats the most sensitive test for detecting a viral gastroenteritis in a child

A

stool electron microscopy

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45
Q

what are the options for procedural sedation of a child

A

nitrous first line or:

midazolam - if the procedure is only expected to cause mild/moderate pain

Ketamine - if the procedure is expected to be more painful or if nitrous/midazolam not working

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46
Q

what is the medical management of conjugated hyperbilirubinaemia

A

ursodeoxycholic acid

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47
Q

what is the appropriate investigation if you suspect sickle cell anaemia

A

haemoglobin electrophoresis

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48
Q

what is the most likely cause of frontal bossing, FTT, splenomegaly and anaemia

A

beta-thalassaemia

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49
Q

what are the common symptoms of congenital hypothyroidism

A

most clinical features similar to adults

drowsiness and poor feeding with a large protruding tongue and flattened nasal bridge

50
Q

how is congenital hypothyroidism screened for

A

heel-prick test (guthrie test)

51
Q

what is the first-line investigation for a swelling post-delivery that crosses the suture lines in a neonate, and what are you worried about

A

cranial ultrasound to check for subgleal haemorrhage

52
Q

what is the main concern with subgleal haemorrhage

A

neonatal seizures, shock, death

53
Q

what are features of galactoseaemia

A

jaundice, hepatomegaly, elevated liver enzymes,

presence of reducing substances in the urine

54
Q

what kind of small bowel obstruction is common in kids with cystic fibrosis

A

meconium ileus

55
Q

what is erbs palsy

A

C5/6 injury usually due to shoulder dystocia

56
Q

what are the signs of erbs palsy

A

reduced moros reflex on that side with reduced tone

57
Q

what congenital infection causes jaundice, microcephaly, thrombocytopenia and periventricular calcification

A

TORCH infections - the most common of which is CMV

58
Q

what is the classic triad of congenital toxoplasmosis infection

A

hydrocephalus, chorioretinitis and tram like calcifications on CT

59
Q

what are some classic features of congenital syphilis infection

A

hutchinsons teeth - wide spaced notched small teeth
frontal bossing of the skull
saddle nose deformity
anterior bowing of shins (shaber shins)
cluttons joints - symmetrical knee swelling

60
Q

what does a congenital parovirus infection cause

A

hydrops fetalis (cmv also causes but parovirus should be excluded)

61
Q

what is hydrops fetalis

A

accumulation of fluid in more than one compartment in the foetus - scalp/pericardium/peritoneal cavity/subcutaneous tissue

62
Q

First line treatment for threadworm

A

oral mebendazole

63
Q

what is the most common cause of neonatal sepsis in the UK

A

Group B strep infection

64
Q

what are features of coxsackie infection

A

hand foot and mouth disease

oral ulcers
fever
red spots on hands and feet

65
Q

what drug is used to induce duct closure in children with PDA

A

indomethacin

66
Q

what are the empirical antibiotics for ?meningococcal septicaemia in <3 months and >3 months and why is it different

A

<3 months: IV cefotaxime + IV amoxicillin

3 months: IV cefotaxime

IV amoxicillin covers for listeria

67
Q

what is a typical presentation + examination findings for a patient with transposition of the great arteries

A

baby is cyanosed very shortly after birth

no murmur but loud S2 and prominent right ventricular pulse

68
Q

when should you administer steroids to a patient with ?meningococcal septicaemia

A

<3 months = dont

> 3 months + findings suggestive of infection on CSF = give IV dexamethasone

69
Q

why is IV dexamethasone given in meningococcal septicaemia

A

prevents neurological sequalae

70
Q

what are the biochemical abnormalities shown in gilberts syndrome on an LFT

A

normal liver enzymes but raised unconjugated bilirubin

71
Q

what is indicated for children at high risk of hypoxic brain injury after labour

A

therapeutic cooling

72
Q

what liver malformation is caused by congenital CMV infection

A

biliary atresia

73
Q

what vaccinations are given at birth

A

BCG if there has been Tb in the family for the past 6 months

74
Q

what vaccinations are given at 2 months

A

6 in 1 (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)

Men B

Oral Rotavirus

75
Q

what vaccinations are given at 3 months

A

6 in 1 (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)

Oral rotavirus

PCV

76
Q

what vaccinations are given at 4 months

A

6 in 1 (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)

Men B

77
Q

what vaccinations are given at 12-13 months

A

Hib/Men C

MMR

PCV

Men B

78
Q

what vaccines are offered at 2-8 years

A

annual flu vaccine

79
Q

what vaccine should be given at 3-4 years

A

(‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)

MMR

80
Q

what vaccination is given at 12-13 years old

A

HPV - boys and girls now

81
Q

what vaccinations are given at 13-18 years old

A

‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)

Men ACWY

82
Q

what is the most common complication of intracerebral bleeding

A

hydrocephalus

83
Q

what should be the primary consideration of a neonate presenting with raised conjugated bilirubin

A

biliary atresia

84
Q

what are features of a life threatening asthma attack in children

A 
SpO2 <92% 
PEF <33% 
Silent chest
Poor respiratory effort
Drowsiness 
Agitation
Cyanosis
85
Q

What are features of a severe asthma attack in children

A

SpO2 < 92%

PEF 33-50%

Too breathless to talk or feed

Heart rate
>125 (>5 years)
>140 (1-5 years)

Respiratory rate
>30 breaths/min (>5 years)
>40 (1-5 years)

Use of accessory neck muscles

86
Q

what is the advice regarding exclusion from school with a child with chicken pox

A

until all lesions have crusted over they should be excluded from school

87
Q

what causes hypertonia in neonates

A

cerebral palsy - but its important to note that hypotonia may precede

88
Q

does cystic fibrosis cause hypotonia in children

A

no

89
Q

what is patau syndrome and what are some of the features

A

Trisomy 13

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

90
Q

what is edwards syndrome and what are some of the features

A

Trisomy 18

Micrognathia - small lower jaw
Low-set ears
Rocker bottom feet
Overlapping of fingers

91
Q

What are some features of fragile X syndrome

A 
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
92
Q

what are some features of noonans syndrome

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

93
Q

what are some features of pierre-robin syndrome

A

Micrognathia - small jaw
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

94
Q

what are some features of prader-willi syndrome

A

hypotonia
obesity
hypogonadism

95
Q

what are some features of williams syndrome

A 
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
96
Q

what are some features of crit du chat syndrome

A

Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism (abnormal distance between two body parts)

97
Q

what syndrome should be considered if a child has microcephaly

A

edwards or patau

98
Q

what syndrome causes rocker bottom feet

A

edwards syndrome

99
Q

what syndrome tends to cause macrocephaly

A

fragile X

100
Q

if a patient with a previous viral gastroenteritis presents with chronic loose stools what is the most likely diagnosis

A

transient lactose intolerance

101
Q

how do you manage a transient lactose intolerance following a viral gastroenteritis

A

exclusion of lactose from the diet with gradual reintroduction`

102
Q

what are features of cystic hygroma

A

soft posterior neck swelling that transilluminates

103
Q

what are features of a dermoid cyst

A

small mass, usually above the hyoid bone

on ultrasound there will be a heterogenous multiloculated mass

104
Q

what are features of a branchial cyst

A

smooth mass in anterior triangle (usually near mandible)

on ultrasound it is fluid filled an anechoic

105
Q

what are common features of measles

A

initial prodrome of cough, coryza and koplik spots (white spots on the buccal mucosa) presents before the emerging rash, which starts behind the ears and spreads down the body between day 3 and 5

106
Q

what is the most common complication of measles

A

otitis media

107
Q

what is the most common cause of death from measles

A

pneumonia

108
Q

what is the management of a slipped upper capital epiphysis

A

internal fixation along the growth plate

109
Q

what murmur indicates an aortic coarctation

A

Crescendo-decrescendo murmur in the upper left sternal border

110
Q

what murmur indicates a patent ductus arteriosus

A

Diastolic machinery murmur in the upper left sternal border

111
Q

what murmur indicates pulmonary stenosis

A

Ejection systolic murmur in the upper left sternal border

112
Q

what murmur indicates an atrioseptal defect

A

a ejection systolic murmur and fixed splitting of the second heart sound.

113
Q

what are the antibiotic reccomendations for ?pneumonia in children

A

Amoxicillin is first-line for all children with pneumonia

Macrolides (erythromycin) may be added if there is no response to first line therapy

Macrolides should be used if mycoplasma or chlamydia is suspected

In pneumonia associated with influenza, co-amoxiclav is recommended

114
Q

At what age do the majority of children achieve day and night time urinary continence

A

3-4 years

115
Q

what is the treatment for spasticity in cerebral palsy

A

oral diazepam

oral and intrathecal baclofen
botulinum toxin type A
orthopaedic surgery and selective dorsal rhizotomy
anticonvulsants
analgesia as required
116
Q

what type of inheritence is haemophilila

A

X linked recessive

117
Q

treatment for kawasakis

A

aspirin and IV immunoglobins

118
Q

what are some complications of mumps infection

A

orchitis

pancreatitis

infertility

119
Q

what heart abnormality is fragile x syndrome associated with

A

mitral valve prolapse

120
Q

what are the risk factors for SIDS

A 
prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity
121
Q

for how long should a child be excluded from school for with whooping cough

A

48 hours from commencement of antibiotics

Child Health (3 decks)

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