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Peads Flashcards

1
Q

3 most common ways a child with JIA will present

A

Swelling
Stiffness (morning)
Loss of ROM

Deformity
Pain
Warmth colour change

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2
Q

5 differentials for JIA

A 
Septic arthritis
Reactive arthritis
No accidental injury
Malignancy
Transient synovitis
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3
Q

5 illnesses under the umbrella of JIA

A 
Polyarticular JIA
Oliarticular JIA
Ethesitis related arthritis
Psoriatic arthritis
Systemic arthritis
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4
Q

What joints are commonly affected in oligoarthritic JIA

A

Lower limb joints (knees , ankles)

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5
Q

What joints are commonly affected in polyarticular JIA

A

Small joints (hands and feet)

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6
Q

What joints are commonly affected in ethesitis related arthritis

A

Feet- plantar fasciitis

Sacroiliac

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7
Q

What adult rheumatological disease is analogous to ethesitis related arthritis

A

Ankalysing spondylitis

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8
Q

Three signs of psoriatic arthritis

A

Nail pitting
Dactylitis
Painful joints
Psoriatic plaques

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9
Q

What disease of the eye is common in JIA

A

Chronic anterior uveitis

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10
Q

Which paediatric malignancy has the strongest genetic predisposition

A

Retinoblastoma

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11
Q

Delayed puberty is most common in which gender and what is the likely cause

A

Makes

Constitutional delay in growth and puberty

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12
Q

What are the two types of precocious puberty?

A

Gonadotropin dependent

Gonadotropin independent

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13
Q

What condition may several cafe au lait spots indicate

A

Neurofibromatosis

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14
Q

What is the commonest cause of pneumonia

A

Influenza

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15
Q

What pathogen is most commonly responsible for viral exacerbations of asthma

A

Rhinovirus

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16
Q

Two differentials for acute stridor

A

Acute epiglotitis

Croup

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17
Q

Two causal organisms of croup

A

Parainfluenza virus

RSV

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18
Q

Treatment of croup

A

Oral dexamethasone

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19
Q

Seal barking cough is characteristic of what illness?

A

Croup

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20
Q

Stridor
Fever
Cold peripheries
Drawling

What could this be

A

Acute epiglottis

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21
Q

What two conditions does meningococcus commonly cause

A

Meningitis

Septicaemia

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22
Q

What three conditions does H. Influenza B (HiB) commonly cause

A

Epiglottitis
Meningitis
Pneumonia

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23
Q

What three factors should make you consider pneumonia in a child under 3YOA

A

Fever >38.5
Recession
RR>50

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24
Q

X-ray findings for pneumonia

A

Fluffy consolidations

Bronchograms

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25
Q

What two organisms commonly cause paediatric pneumonia

A

Pneumococcus

HiB

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26
Q

If the pneumonia doesn’t respond to amoxicillin what should you consider and what medication would you change to

A

Causal organisms of mycoplasma pneumoniae

Clarythromycin

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27
Q

Differentials for cough caused by pneumococcus

A

Fatigue & poor sleep - bronchitis

High resp rate - pneumonia

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28
Q

Tx for rhesus incompatibility

A

IV IG

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29
Q

Tx for neonatal jaundice

A

Phototherapy

Exchange transfusion

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30
Q

What might the diagnosis be for a neonate that is hypertensive but who’s lower limbs are poorly perfused

A

Coarctation of the aorta

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31
Q

What needs to be closely monitored in coarctation of the aorta ?

A

Urine output (representative of renal perfusion)

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32
Q

What age would you see gastroenteritis in?

A

<5s (around 2)

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33
Q

What is the most common pathogen responsible for gastroenteritis ?

A

Rotavirus

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34
Q

How much wt loss would you expect in shock

A

10%

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35
Q

What signs might you see in hypernatremic dehydration

A 
Fidgety 
Hypertonia 
Hyperreflexia 
Transient hypoglycaemia 
Depressed fontanelle
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36
Q

What is a complication of hyponatremic dehydration

A

Seizures

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37
Q

What happens to brain volume in hypernatremic dehydration

A

Decrease in brain volume

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38
Q

What bloods should you take when giving IV fluids

A

Glucose
Plasma electrolytes
Urea
Cr

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39
Q

Treatment of clinical dehydration (before shock)

A

Oral rehydration solution
Replace fluid deficit
Maintenance fluids

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40
Q

Treatment of shock from dehydration

A 
Fluid bolus (can be repeated)
Correct deficit over 24hours
Maintenance fluids
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41
Q

Signs of clinical dehydration progressing to shock

A

TachyC
TachyP
Altered responsiveness

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42
Q

A 4 year old child is on salbutamol and beclamethasone and asthma is not controlled what is the next step in asthma tx

A

LTRA I.e. montelukast

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43
Q

A 9 year old is on salbutamol and budesonide and needs the next stage up in asthma tx , what is this

A

+LABA inc salmeterol, formeterol

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44
Q

A 12 year old is on a SABA, ICS and a LABA what is the 4th stage in escalating asthma tx

A

Increase ICS

If on max dose add oral steroid

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45
Q

Oral steroids in asthma treatment requires careful monitoring of what?

A

Growth

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46
Q

How do you manage a moderate acute exacerbation of asthma?

A

Up to 10puffs of Salbutamol

+ oral pred 3-7days

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47
Q

How do you manage a severe acute exacerbation of asthma ?

A

Puff or neb salbutamol
Oral/IV pred
Inhaled ipratropium

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48
Q

How do you treat a life threatening asthma attack

A

Neb salbutamol
IV pred
Neb ipratropium
+/- IV Sal/Mg

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49
Q

In a life threatening asthma exacerbation they have not responded to salbutamol, ipratropium or pred what do you do next?

A 
Contact PICU
CXR
Confirm it’s asthma
Blood gases
Consider ventilation
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50
Q

What will VEW respond to

A

Bronchodilators such as ipratropium bromide (won’t respond to sabas)

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51
Q

2 differentials for CMPA

A

Toddlers diarrhoea

Gastroenteritis

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52
Q

How might a neonate with hyperthyroidism present?

A 
Irritable
TachyC
Wt loss
Diarrhoea
Exophthalmos
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53
Q

How do you treat hyperthyroidism in an infant?

A

Carbamazepine

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54
Q

What congenital infections might a foetus acquire?

A 
CMV 
Rubella
Syphilis 
B19
Toxoplasmosis
Varicella zoster
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55
Q

What is the treatment for a neonate with syphilis

A

Penicillin

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56
Q

What is the treatment for an infant with CMV

A

Gancyclovir

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57
Q

What is the treatment for maternal varicella zoster near delivery

A

Acyclovir + zoster Ig

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58
Q

What impact might rubella have on the foetus

A

Cataracts
Deafness
Congenital heart defect

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59
Q

What effect might cmv have on the neonate

A

Hepatosplenomegally
Sensorineural hearing loss
Cerebral palsy
Epilepsy

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60
Q

What effect might toxoplasmosis have on a neonate

A

Retinopathy
Cerebral calcification
Hydrocephalus

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61
Q

What is the test for coeliac disease

A

Upper GI endoscopy + biopsy

TGA-IGA

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62
Q

Treatment of giardia and c diff

A

Metronizadole

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63
Q

Endocrine causes of faltering growth

A

Low GH
Low IGF-1
Hyperthyroidism

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64
Q

Treatment of turners causing faltering growth

A

GRowth hormones

+ oestrogens

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65
Q

Symptoms of chrones

A

Abdo pain
Diarrhoea
Wt loss

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66
Q

Symptoms of UC

A

Bloody stool
Abdo pain
Urgency

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67
Q

Areas affected in chrones and UC

A

Chrones - all over , mainly terminal ileum

UC- rectum

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68
Q

Depth of pathology in :
Chrones
UC

A

Chrones - transmural

UC- sun mucosal / mucosal

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69
Q

Treatment for chrones

A

Infliximab

Steroids - pred, bude, hydrocort

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70
Q

Investigations to order in faltering growth

A 
TGA-IGA - coeliac 
TSH - hyperT
Nutritional bloods
FBC- anaemia / infection
ESR/CRP - chrones 
U&amp;E -CKD
Kariotype - congenital 
X-ray- skeletal maturation / skeletal dysplasia
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71
Q

What factors indicate RSD

A

Cyanotic
Laboured breathing
TachyP+ bradyC

72
Q

Signs of laboured breathing

A

Nostril flaring
Recession
Grunting

73
Q

Complications of IVH

A

Hydrocephalus

Cerebral palsy- bilateral peri ventricular leukomakacia (cystic lesions) = 90% spastic diplegia

74
Q

Treatment of RDS

A

Surfactant therapy
Raised ambient O2
(Ventilation)

75
Q

Complication of ventilation for RDS

A

Pneumothorax in 10%

76
Q

Signs of pneumothorax

A

Hyperinflation of one lung

Reduced breath sounds in one lung

77
Q

What is meant by an episode in neonatal medicine

A

BradyC and desaturation that don’t correct in 30s

78
Q

Causes of neonatal episodes

A 
Immature resp center -can stimulate into breathing 
Anaemia 
HypoG
HF
Seizures
Electrolyte disturbances 
Infections
79
Q

Signs that a neonate has NEC

A

Bloating (see on X-ray)
Off feeds
Vomiting +/- bile
Blood stained stool

80
Q

Management of NEC

A

Benpen + gent
Parenteral nutrition
CV support

Surgery - comp short bowel syndrome
+/- ventilation

81
Q

Neonatal triad of hypo

A

Hypoglycaemia
Hypoxia
Hypothermia

82
Q

What conditions (7) are premature babies at risk of :

A 
RDS 
IVH 
Cerebral palsy 
PDA 
HIE
Retinopathy of prematurity 
Bronchopulmonary dysplasia
83
Q

What is retinopathy of prematurity

A

At the vascularising junction, risk of retinal detachment and blindness

84
Q

What factor increases the risk of retinopathy of prematurity

A

High O2 concs

85
Q

What is bronchopulmonary dysplasia

A

Requiring O2 after 36w

86
Q

What would a CXR show in bronchopulmonary dysplasia

A

Areas of opacification + cystic changes

87
Q

Complication of Bronchopulmonary dysplasia

A

Resp failure with infection ie. broncholitis

88
Q

Which direction does the o2 sats curve shift for foetal hb?

A

To the left

89
Q

Why does the pressure in the left atria increase at birth

A

Pulmonary resistance drops

More blood flow through lungs

90
Q

Why is transient TachyP of the newborn more common in Csections

A

No squeezing of fluid out of lungs

No catecholamines which stim resorb of alveolar fluid

91
Q

When and where would you hear a PDA

A

In a baby with RDS
Under L clavicle
Systolic cont into diastole

92
Q

Differential for PDA

A

Venous humm

93
Q

Name two innocent murmurs

A

Stills murmur

Venous humm

94
Q

Characteristics of an innocent murmur

A 
5Ss
Soft
Systolic
Assymptomatic
Positional 
Left eternal edge 
No thrills
Less than grade 3
95
Q

What is the most common presentation of a congenital heart defect?

A

Poor feeding

96
Q

Explain how essenmengers syndrome can happen in a L to R shunt

A

Blood flows from a high pressure system to a low pressure system causing pulmonary hypertension

97
Q

4 categories of congenital heart defect

A 
Breathless 
Blue
Breathless &amp; blue
Assymp + murmur
Sick + murmur
98
Q

What could be the causes of an assymptomatic neonate w/ murmur

A

Pulmonary stenosis

Aortic stenosis

99
Q

Name 3 ICS

A

Budesonide
Beclamethasone
Fluticasone

100
Q

Side effects of ICS (3)

A

Adrenal suppression
Osteoporosis
Growth suppression

101
Q

Most common viral cause of bronchiolitis

102
Q

Most common bacterial cause of pneumonia

A

Strep pneumoniae

103
Q

Most common viral causes of pneumonia

A

RSV

Influenza (HiB)

104
Q

Treatment for pneumonia caused by influenza

105
Q

Treatment for comm aq’ pneumonia

A

Amox + macrolide (claryth) if not responding to amox

106
Q

What time of year is croup most common

A

Spring / autumn

107
Q

What age is the peak incidence of croup

108
Q

What is the treatment for croup

A

Dexamethasone 150mcg/kg

109
Q

List some early features which may be suggestive of cerebral palsy

A 
Delayed milestones 
Abnormal gate 
Hand preference before 12yoa
Small head
Feeding difficulties 
Abnormal tone
110
Q

Name two other neuro features you would expect to see in spastic CP

A

Hyper reflexia

Extensor plantar response

111
Q

What is the most common pathogen to cause croup

A

Parainfluenza

112
Q

Tripod stance + drewling+ fever and flushed

What do you need to rule out

A

Epiglottis

113
Q

Stridor + very unwell child =?

A

Epiglottis

114
Q

What disease/ illness is the precursor to bronchiectasis

A

Persistent bacterial bronchitis

115
Q

What pathogens can cause PBB (persistent bacterial bronchitis)

A
  • strep pneumonia/pneumococcus
  • h.influenza
  • moraxella catarrrhalis
116
Q

What is the treatment for persistent bacterial bronchitis

A

Physio

Coamox

117
Q

In an under 3yo what three factors would make you consider pneumonia

A

Fever >38.5
RR>60
Recession

118
Q

Complications of pneumonia

A

Pleural effusions
Empyemas
Abscesses

119
Q

Chronic causes of cough

A 
CF
Asthma
PBB
Foreign body
TB
GORD
120
Q

In CF what does the CFTR protein code for

A

AMP dependent chloride channel

121
Q

CF is a autosomal recessive disorder. What chromosome is effected?

A

Chromosome 7

122
Q

Why in CF do you get steatrrhoea

A

Effects the pancreases - enzyme deficiencies

123
Q

Differentials for wet cough with purulent sputum

A

Bronchiectasis

CF

124
Q

How might a baby with CF present

A

Meconium ileus

125
Q

Tx for CF

A

Ivacaftor

Lumicaftor

126
Q

What are the respiratory findings in CF

A

Hyperinflation due to air trapping
Coarse insp creps
Exp wheeze

127
Q

Investigation for CF

A

Sweat test- high conc of chloride

128
Q

What is characteristic of CF stool

A

Pale, greasy, low feacal elastase

129
Q

What prophylactic abx would you give in CF

130
Q

Loose stool+ faltering growth+recurrent chest Infections

What are you suspicious of?

131
Q

What could be the causes of a sick neonate with murmur

A

Coarctation of aorta

Left hypoplastic heart syndrome

132
Q

When is an innocent murmur more likely to be heard and why

A

When the child is ill due to increased CO

133
Q

4 features of TOF

A

Overriding aorta
VSD
Pulmonary stenosis
R ventricular hypertrophy

134
Q

Treatment of TOGV

A

IV PG to increase mixing until surgical repair

135
Q

Treatment of coarctation of the aorta

A

Balloon angioplasty

136
Q

What sign is seen on X-ray with coarctation of the aorta

137
Q

What syndrome do you classically see coarctation of the aorta in

138
Q

Treatment of VSD

139
Q

What congenital heart defect is most commonly seen in downs

140
Q

What injection is given at birth

A

Vit K to prevent haemorrhagic disease of the newborn

141
Q

What test is done for coeliac

142
Q

3 signs of neurofibromatosis

A

Cutaneous neurofibromas
High bp
Cafe au lait patches

143
Q

Inheritance pattern of neurofibromatosis

144
Q

What is the insulin dose calculation in DKA

A

0.05units per kg

145
Q

What is the calculation for fluid deficit ?

A

Wt x %dehydration x 10

Correct over 48hours

146
Q

What is the risk of giving fluids too quickly

A

Cerebral oedema

147
Q

What fluid should you give in DKA

A

Initially 0.9NaCl +K Cl

Once glucose <14mmol add 5% glucose

148
Q

What is the biochemical triad in DKA

A

Acidosis
HyperKetoneamia
Hyperglycaemia

149
Q

What is the treatment for HIE

A

Therapeutic cooling

150
Q

What is the threshold for glucose in DKA

151
Q

What is the definition of chronic lung disease (BPD)

A

O2 requirement after 36w

152
Q

What is the pH threshold for DKA

153
Q

What is the threshold for blood ketones in DKA

154
Q

How long should you wait after fluids to give insulin

155
Q

When do you give a fluid bolus

A

In DKA

Or in shock

156
Q

When do you not subtract the fluid bolus from the total fluid requirement ?

A

Anyone in shock

157
Q

How many mls fluid bolus do you give

1) DKA shock

A

20mls/kg

Up to 40mls

158
Q

How many mls fluid bolus do you give

1) no DKA+ shock

A

20mls/kg

Up to 40mls/kg

159
Q

How many mls fluid bolus do you give

1) no DKA +no shock

160
Q

How many mls fluid bolus do you give

1) DKA + no shock

161
Q

What are the 3 sections of fluid you need to address

A

Bolus
Deficit
Maintanence

162
Q

How do you calculate maintenance fluids

A

1st 10kg- 100mls/kg/day
2nd 10kg- 50mls/kg/day
Remainder -20mls /kg/day

163
Q

What is the feed calculation for a baby over 5days old

A

150ml/kg/day

164
Q

How much maintenance fluid would a child weighing 20kg need

A

10x100
10x50
-1500ml/day

165
Q

What are the signs of DKA

A

Dehydration
Kussmal breathing
Pear drop breath

166
Q

What are the symptoms of DKA

A

TTTCPUVA

Tired
Tachyponea
Thirsty
Confusion
Passing out
Urinating
Abdo pain
Vommiting
167
Q

Causes of faltering growth

A
  • Congenital abnormalities
  • Endocrine -GH /IGF deficiency/ hyperthyroidism
  • Social
  • small birth weigh/ preterm
  • GI causes
  • iatrogenic - steroids
  • systemic illness - CHD/ CF/ CKD
168
Q

What is the most common gear defect

169
Q

How would a child with a L to R cardiac shunt present

A

Breathless

Feeding problems

170
Q

What is a complication of a L to R cardiac shunt

A

Esseinmengers syndrome

171
Q

What 4 features does TOF have

A

VSD
Over riding aorta
Pulmonary stenosis
R V hyperteophy

172
Q

What murder presents with a machinery like murmur under the L clavicle

173
Q

What CHD is most common on Down’s syndrome

174
Q

What sign will you see with coarctation of the aorta on X-ray

175
Q

What HLA type is associated with coeliac disease

A

DQ2 and DQ8

176
Q

What antibodies are associated with coeliac disease

A

anti-tissue transglutaminase (tTG)

endomysial antibodies (EMA)

deamidated gliadin peptide (DGP) antibodies.

Phase 3a (7 decks)

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