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Child Health > Passmedicine > Flashcards

Passmedicine Flashcards

1
Q

First sign of puberty in boys and when does it occur?

A

Testicular growth around 12 years

range =10-15 years

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2
Q

What testicular volume indicates that puberty has begun?

A

Testicular volume >4ml

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3
Q

When do boys have their maximum growth spurt?

A

Maximum growth spurt age 14

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4
Q

First sign of puberty in girls and when does it occur?

A

Breast development around age 11.5 (range = 9-13)

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5
Q

Maximum height spurt in girls?

A

Maximum growth spurt at 12 (before menarche)

Only about 4% of growth after menarche

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6
Q

When does menarche begin in girls?

A

Age 13 (range 11-15)

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7
Q

Which viruses cause hand, foot and mouth disease?

A

Coxsackie A16

Enterovirus 71

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8
Q

Clinical features of hand, foot and mouth disease?

And management

A

Mild systemic upset - sore throat, fever
Oral ulcers
Followed later by vesicles on the palms and soles of the feet

Management:

  • general advice about hydration and analgeis
  • reassurance no link to cattle disease (comes from a different virus)
  • advise child to stay off school until symptom free - ask parent what school policy is on when child can return after illness

Your child is most contagious in the first 7 days. But the virus can stay in her body for days or weeks after symptoms go away and it could spread through her spit or poop. The best way to prevent that is to wash hands thoroughly. That applies to you, too, after you change a diaper or wipe a runny nose.

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9
Q

What is the rate you should perform chest compressions at for a child?

A

100-120 compressions per minute
Compressions should depress the sternum by at least a third of the depth of the chest
Those trained in paediatric CPR should use a ratio of 15:2 (not trained people just use adult 30:2)

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10
Q

First line investigation for DDH

A

Ultrasound scan is first line, except if the child is over 4.5 months as by then the femoral head will have ossified and x-ray will be better to visualise the joint

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11
Q

Risk factors for DDH

A
  • female sex
  • first born child
  • premature
  • breech presentation
  • oligohydramnios
  • positive family history
  • baby >5kg
  • congenitcal calcaneovalgus foot deformity
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12
Q

Which hip is DDH more common in?

A

Slightly more common in left hip

Around 20% of cases occur bilaterally

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13
Q

Treatment of DDH

A
  • most unstable hips will spontaneously stabilise within 3-6 weeks of age
  • Pavlik harness in children younger than 4-5 months
  • older children may require surgery
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14
Q

Pneumonic for the causes of meningitis in a child <3 months

A

GEL

Group B strep
E. coli
Listeria

Group B strep and e. coli can colonise the maternal reproductive tract and during birth, the baby can acquire these pathogens and become unwell

Listeria meningitis can occur if a women eats food contaminated with listeria while pregnant, as the infection can be transmitted from mother to foetus

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15
Q

Pneumonic for causes of meningitis in children aged 1 month to 6 years

A

NHS
Neisseria meningitides
Haemophilus influenza
Strep pneumonia

(after age 6, haemophilus influenza is not a significant cause of meningitis)

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16
Q

When should you intervene/assess for comorbidities in obese children?

A

Consider a tailored clinical intervention if BMI at 91st centile or above

Consider assessing for comorbidities if 98th centile or above

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17
Q

Causes of obesity in children

A
  • growth hormone deficiency
  • hypothyroidism
  • Down’s syndrom
  • Cushing’s syndrome
  • Prader willi syndrome
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18
Q

Why is it bad to be a morbidly fat kid

A

-orthopaedic problems: slipped upper femoral epiphyses, Blount’s disease (a development abnormality of the tibia resulting in bowing of the legs), musculoskeletal pains

Psychological consequences: poor self-esteem, bullying

Sleep apnoea

Benin intracranial hypertension

Long term consequences: increased incidence of type 2 diabetes mellitus, hypertension and ischaemic heart disease

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19
Q

This rash typically starts with a high grade fever, which usually resolves before the onset of the rash

A

Roseola infantum

  • usually starts on trunk and spreads to limbs
  • maculopapular rash and not itchy
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20
Q

Mouth sign of measles

A

Koplik spots

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21
Q

Where does measles rash usually begin?

A

Usually begins on the face and spreads to other parts of the body

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22
Q

What causes erythema multiforme macules in children?

A

Erythema multiforme is a hypersensitivity reaction to herpes 7 virus

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23
Q

Which virus is responsible for hand, foot and mouth disease?

A

Coxsackie A6 virus

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24
Q

Which virus causes roseola infantum

A

Herpes virus 6

herpes 7 causes erythema multiforme

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25
Q

Features of roseola infantum

A

High grade fever for several days, when fever resolves you suddenly get massive maculopapular rash

Febrile convulsions in 10-15%
Diarrhoea and cough are commonly seen

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26
Q

Delayed passage of meconium (>2 days)
Bilious vomiting
Abdominal distension

A

Hirschprungs disease (do rectal biopsy to confirm)

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27
Q

A 4-year-old boy was discharged from the hospital six weeks ago after an episode of viral gastroenteritis. He now has 4-5 loose stools each day which has been present for the past four weeks

A

Post-gastroenteritis lactose intolerance

remove lactose from diet and then gradually reintroduce to solve the problem

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28
Q

Which virus causes Roseola infantum?

A

Human herpes virus 6 (HHV6)

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29
Q

What is MART therapy

A

MART is a form of combined ICS and LABA treatment (its a single inhaler with both your steroid and LABA in it and its used for maintenance and for relief)

(beclametasone and formoterol)

MART is only available in combinations where the LABA has a fast acting component (e.g. formoterol)

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30
Q

What constitutes paediatric low/medium/high dose steroids?

A

Paediatric low dose = <200 micrograms (budesonide or equivalent)

Paediatric moderate dose = 200-400 micrograms (budesonide or equivalent)

> 400 micrograms = paediatric high dose (budesonide or equivalent)

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31
Q

Difference between episodic and multiple trigger wheeze, and treatment for them?

A

Episodic viral wheeze = child only wheezes when has an upper respiratory tract infection and is symptom free between episodes

Multiple trigger wheeze = as well as viral URTIs, other factors appear to trigger the wheeze, such as exercise, allergens and cigarette smoke

Treatment for episodic = give SABA or anticholinergic via a spacer (if this doesn’t work then give oral leukotriene receptor antagonist or inhaled corticosteroid)

If multiple trigger then start with inhaled SABA or a leuoktriene receptor antagonist, typically for 4-8 weeks

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32
Q

Most common cause of hypothyroidism in children in the UK

A

Autoimmune thyroiditis

(iodine deficiency is the most common cause in the developing world)

Other causes: post total-body irradiation (e.g. in a child previously treated for acute lymphoblastic leukaemia)

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33
Q

Child less than 3 months old with a temperature >38 degrees

A

ADMIT TO HOSPITAL

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34
Q

What is a bisferiens pulse and when might you see it?

A

It is a biphasic pulse (so it occurs in a cardiac cycle with two peaks -a small one followed by a broad and strong one)

It is a sign of problems with the aortic valve, including aortic stenosis and aortic regurgitation etc

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35
Q

What kind of babies are most likely to get patent ductus arteriosus?

A

Premature babies

Babies born at higher altitude or maternal infection in the first trimester

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36
Q

Treatment for patent ductus arteriosus

A

Indomethacin closes the connection in the majority of cases

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37
Q

Cardiac examination features of patent ductus arteriosus?

A 
Left subclavicular thrill
Continuous machinery murmur
Large volume, bounding, collapsing pulse
Wide pulse pressure
Heaving apex beat
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38
Q

Most common cause of hypothyroidism in children in the UK

A

Autoimmune thyroiditis

(iodine deficiency is the most common cause in the developing world)

Other causes: post total-body irradiation (e.g. in a child previously treated for acute lymphoblastic leukaemia)

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39
Q

How does giardiasis present?

A

Watery stools, nausea and fever

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40
Q

What conditions might you see a strawberry tongue in?

A

Kawasaki disease and scarlet fever

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41
Q

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

A

Osgood schlatters

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42
Q

Treatment for chondromalacia patellae?

A

Physiotherapy

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43
Q

Describe chondromalacia patellae and who it is most likely to affect?

A
  • Most likely to occur in teenage girls
  • Due to softening of the patellar cartilage
  • Typically anterior knee pain when walking up and down stairs/rising from prolonged sitting
  • Usually responds to physiotherapy
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44
Q

Osteochondritis dissecans

A
  • Caused by cracks in the cartilage
  • pain after exercise
  • Intermittent swelling and LOCKING
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45
Q

Medial knee pain

May give way

A

Patellar subluxation (caused by lateral subluxation of the patella)

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46
Q

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

A

Patellar tendonitis

47
Q

People with increased risk of umbilical herniation

A
  • Down’s syndrome
  • Afro-carribean
  • Mucopolysaccarhide storage disease
48
Q

When should you share information about children and sexual activity?

A

You should usually share information about sexual activity in children under 13, who are considered in law to be unable to consent (GMC)

49
Q

Who gets x-linked recessive disorders and what is the one exception?

A

Males get X-linked recessive disorders as they only have 1 X chromosome
The exception is Turner’s syndrome where the female only has 1 X chromosome

50
Q

Which clotting factor is missing in haemophilia A?

A

Clotting factor VII

eight = Aight

51
Q

Which clotting factor is missing in haemophilia B?

A

Clotting factor IX

52
Q

Inheritance pattern of haemophilia?

A

X-linked recessive

53
Q

Risk factors for surfactant deficient lung disease

A
  • preterm babies
  • male sex
  • being the second born of premature twins
  • caesarean section
  • diabetic mothers
54
Q

Chest x-ray findings of surfactant deficient lung disease

A

Ground glass appearance and indistinct heart border

55
Q

How should you investigate renal scarring in a child?

A

Radionucleotide scan with dimercaptosuccinic acid (DMSA)

56
Q

Investigation for vesicoureteric reflux and for renal scarring

A

Investigate VUR using micturating cystourethrogram

Investigate scarring with radionucleotide scan with DMSA

57
Q

When is the heel prick test performed?

A

Between days 5 and 9

58
Q

Treatment of croup

A

Regardless of severity give single dose of oral dexamethasone at 0.15mg/kg (NICE)

Give oxygen if saturations are <92%

(emergency treatment =high flow oxygen and nebulised adrenaline)

(prednisolone is fine if dexamethasone isn’t available)

59
Q

Which viruses are responsible for croup?

A

Parainfluenza viruses are responsible for the majority of cases

60
Q

Chest x-ray shows a “boot shaped heart”

A

Tetralogy of fallot

61
Q

Central causes of hypotonia in a child/neonate

A

Down’s syndrome
Prader-willi syndrome
Hypothyroidism
Cerebral palsy (hypotonia may precede the development of spasticity)

62
Q

Management of a child <3years with acute limp

A

All children <3 with an acute limp should be urgently assessed in secondary care:

  • they are at a higher risk of septic arthritis
  • high risk of child maltreatment
63
Q

Acute onset
Usually accompanies viral infections, but the child is well or has mild fever
More common in boys aged 2-12 (average age 5-6)

A

Transient synovitis

quite rare in really young children- average age of onset 5-6

64
Q

How does juvenile idiopathic arthritis present

A

Presents with a limp - may be painless (although could be painful in acute phase)

65
Q

What is perthes disease and which age group is it more common in?

A

Avascular necrosis of the femoral head, more common in 4-8 years old

66
Q

Causes of prolonger jaundice in neonates?

A 
Biliary atresia
Hypothyroidism
Galactosaemia
Urinary tract infection
Breast milk jaundice
Congenital infection (e.g. CMV, toxoplasmosis)
67
Q

Tests you’d want to do if a baby still has jaundice after 2 weeks

A 
Conjugated and unconjugated bilirubin (this is the most important test as raised conjugated bilirubin could indicate biliary atresia, which requires urgent surgical intervention)
Direct antiglobulin test (Coombs' test)
TFTs
FBC and blood film
Urine for MC&amp;S and reducing sugars
U&amp;Es and LFTs
68
Q

What do you need to assess and record in febrile children?

A

Temperature
Heart rate
Respiratory rate
Capillary refill time

69
Q

Child under 3 months with temperature >38C what do you do?

A

High risk illness - refer to paediatrics

70
Q

What is the best practice for giving neonatal vitamin K?

A

Once off IM injection (given shortly after birth)

-Better than giving orally as means parents won’t forget it and babies won’t vomit it up

71
Q

Why do you need to give babies vitamin K shortly after birth?

A

They are relatively deficient and you want to prevent against haemorrhagic disease of the newborn (if babies don’t have enough vitamin K then they might not be able to produce enough clotting factors)

72
Q

Non-bilious vomiting

A

Pyloric stenosis

73
Q

Is pyloric stenosis more common in males or females?

A

Pyloric stenosis more common in males

74
Q

How does pyloric stenosis present

A

Projectile NON-bilious vomiting at 4-6 weeks of life

75
Q

How do you diagnose pyloric stenosis?

A

By test feed or USS

76
Q

Treatment for pyloric stenosis?

A

Ramstedt pyloromyotomy (open or laparoscopic)

77
Q

Central abdominal pain and URTI?

A

Mesenteric adenitis

78
Q

Mesenteric adenitis management?

A

Conservative management

79
Q

Where does intussusception usually occur?

A

Proximal to or at the level of, the ileocaecal valve

80
Q

When does intussusception usually occur?

A

6-9 months of pain

81
Q

How does intussusception present?

A

Presents with colicky pain, diarrhoea, vomiting, SAUSAGE SHAPED MASS AND RED JELLY STOOL

82
Q

Treatment for intussusception?

A

Air insufflation

83
Q

High caecum at the midline

Feature in exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia

A

Malrotation

84
Q

How do you diagnose malrotation?

A

Upper GI contrast study and USS

85
Q

Treatment for malrotation

A

Laparotomy

86
Q

Majority of patients with meconium ileus have which disease?

A

Cystic fibrosis

87
Q

Associated with tracheo-oesophageal fistula and polyhydraminos

A

Oesophageal atresia

88
Q

Treatment for meconium ileus

A

PR contrast studies may dislodge meconium plugs.

Infants who do not respond to PR contrast and NG N-acetyl cysteine will require surgery to remove the plugs

89
Q

Treatment for Hirschprung’s disease?

A

Treatment is with rectal washouts initially, thereafter an anorectal pull through procedure

90
Q

May present with choking and cyanotic spells following aspiration?

A

Oesophageal atresia

91
Q

VACTERL associations

A

Oesophageal atresia

92
Q

What does VACTERL stand for?

A 
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-esophageal fistula
Renal anomalies
Limb abnormalities
93
Q

Treatment for biliary atresia?

A

Urgent kasai procedure

94
Q

Jaundice >14 days

Increased conjugated bilirubin

A

Biliary atresia

95
Q

How does biliary atresia present?

A

Jaundice >14 days

Increased conjugated bilirubin

96
Q

Main risk factor for necrotising enterocolitis?

A

Prematurity

97
Q

Abdominal distension and passage of bloody stools

A

Necrotising enterocolitis

98
Q

How does necrotising enterocolitis present?

A

Distended abdomen and passage of bloody stools

99
Q

Treatment for necrotising enterocolitis?

A

Total gut rest and TPN (babies with perforations will require laparotomy)

100
Q

Treatment for threadworms

A

Single dose mebendazole for child and all the members of the household

101
Q

Biggest risk factor for TTN?

A

Caesarian section (because the fluid in the lungs doesn’t get squeezed out after birth)

102
Q

Drug treatment for whooping cough

A

Azithromycin or clarithromycin

103
Q

Which bacteria causes whooping cough?

A

Bordatella pertussis

104
Q

Does whooping cough immunisation work?

A

No, neither infection nor immunisation results in lifelong protection

105
Q

How does whooping cough present?

And blood findings

A

2-3 days of coryza then cough
Cough usually worse at night and after feeding
May end by vomiting and associated with central cyanosis
Inspiratory whoop - not always present (caused by forced inspiration against a closed glottis)
Persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope and seizures

Marked lymphocytosis

Symptoms may last 10-14 weeks and tend to be more severe in infants

106
Q

How to diagnose whooping cough

A

Nasal swab culture for bordatella pertussis

107
Q

Whooping cough complications

A

Subconjunctival haemorrhage
Pneumonia
Bronchiectasis
Seizures

108
Q

What is an umbilical granuloma?

A

An umbilical granuloma is an overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.

109
Q

How do you treat umbilical granuloma?

A

Treat with regular application of salt to the wound

If this does not help then cauterise with silver nitrate

110
Q

What is gastroschisis?

A

Gastroschisis is a congenital condition which is characterised by a defect in the anterior abdominal wall through which the abdominal contents protrude.

111
Q

What is omphalitis?

A

Omphalitis or umbilical cellulitis is a bacterial infection of the umbilical stump which presents as a superficial cellulitis, usually a few days after birth.

112
Q

First line treatment for nocturnal enuresis for children <7?

A

Enuresis alarm

113
Q

First line treatment for nocturnal enuresis for children >7?

A

Desmopressin

114
Q

How does patellar tendonitis present?

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

Child Health (24 decks)

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