Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 5 conditions list > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Acute kidney injury
findings?
investigation?
management?

A

oliguria
hypotension

elevated creatinine

STOP AKI
- septic screen
- Toxic medications?
- Optimise volume status
- Prevent harm - relieve obstructions, treat complications e.g hyperkalemia

pre renal (mostly caused by hypovolemia)
- fluid resus
-Noradrenaline if severe hypotension

renal
- Glomerulonephritis, thrombotic microangiopathy, acute tubular injury
- furosemide if volume overloaded

post renal
- urology referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute epiglottis
diagnosis?
management?

A

respiratory distress, tripod positioning, DROOLING, high fever. Thumbprint sign on X-ray

Caused by H influenzae type B, rare due to vaccinations

do not examine throat due to risk of airway collapse.

Secure airway - intubation = 1st line
IV ceftriaxone
Oxygen

Rifampicin prophylaxis to close contacts!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Appendicitis

A

abdominal pain, nausea and vomiting, RLQ pain

Ultrasound in children

supportive treatment (nil by mouth IV fluids analgesia) + appendicectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Eczema management?

A

emollients - cetraben, diprobase

topical steroids if not sufficient -> start with weakest = topical hydrocortisone
moderate strength = betamethasone
strong = mometasone
(eumovate, dermovate)

if uncontrolled with steroids = topical tacrolimus

infected = flucloxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Biliary Atresia
diagnosis?
management?

A

neonatal jaundice
pale stools
elevated direct bilirubin

  1. no end stage liver disease = hepatoportoenterostomy (Kasai procedure!! - create pathway of bile flow directly from liver to small intestine). + antibiotics for 1 year

liver disease = liver transplant

  1. ursodeoxycholic acid to promote bile flow
  2. fat soluble vitamins for nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bronchiectasis (dilation of bronchi)
diagnosis?
management?

A

Chronic cough with sputum production, recurrent pulmonary infection
Finger clubbing
Intermittent hemoptysis
Wheeze

50% idiopathic

chest CT - signet ring sign
sweat chloride test
screen for antibody deficiency = IgM, IgA, IgG
Bronchoscopy

treat CF if cause
vaccinations for strep pneumo and seasonal influenza
antibiotics for exacerbations if NO CF diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

bronchiolitis
diagnosis?
management?

A

cough, wheezing, tachypnea, runny nose
LRTI in a child < 1 years old - suspect bronchiolitis!!!

RFs: chronic lung disease, CHD, preterm

supportive care, usually self limiting

admit to hospital if severe resp distress.
sats below 92% if < 6 weeks old
Sats less than 90% if 6 weeks or over
Or if apnoea occurs

pavalizumab prophylaxis in preterm infants - Monoclonal antibody to RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cellulitis
diagnosis?
management?

A

flucloxacillin
Cellulitis + VZV = flucloxacillin + amoxicillin

erysipelas presents similarly BUT is well demarcated and is treated with penicillin V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

coeliac disease
diagnosis?
management?

A

diarrhea, abdominal pain, anemia, dermatitis
igAtTG, endomysial antibody

gluten free diet
calcium and vitamin D tablets
iron only if deficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cystic fibrosis
diagnosis?
management?

A

failure to pass meconium
failure to thrive
recurrent infection/cough/sinusitis
genital abnormalities in males

sweat test, genetic test

meconium ileus = water-soluble contrast enema + oral osmotic agents

respiratory infection = oral antibiotic eg amoxicillin

GI disease = optimising nutrition. pancreatic replacement if necsssary, ursodeoxycholic acid for liver disease

flucloxacillin as prophylaxis for s.aureus pneumonia

lumacaftor/ivacaftor

Chronic infection with Pseudomonas and Bulkholderia in CF are associated with increased morbidity and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Intussuception
symptoms
diagnosis
management

A

abdominal pain
vomiting (abdominal obstruction - unopened bowels)
currant jelly red stool - late sign -blood may be seen rectal exam
RUQ mass may be palpable

abdominal ultrasound = 1st line - target like mass
AXR - can show obscured liver edge w paucity of air in RUQ, dilated proximal bowel loops

Ng tube and IV fluids may be needed
reduction using air or barium enema = 1st line - perforation risk
surgery if fails or signs of peritonitis
consider broad spectrum antibiotics - clindamycin and gentamicin

associated with HSP, lymphoma, CF, viral infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hirschprungs disease
symptoms
diagnosis
management
Complications?

A

failure to pass meconium
abdominal distention and vomiting may occur

AXR - dilated loops
rectal biopsy with barium enema = confirmatory

bowel irrigation + surgery

complications:
Hirschprungs enterocolitis = proximal colonic dilatation secondary to obstruction + bacterial overgrowth -> fever, abdominal distention, bloody diarrhea -> antibiotics, ng TUBE, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Acute gastroenteritis
organism diffferential if blood in stool?
HUS signs? treatment?

A

ecoli
salmonella - if chicken or egg ingestion

Thrombocytopenia - blood count
Microangiopathic haemolytic anaemia - jaundice
Acute renal failure - renal and electrolytes

AVOID antibiotics
IV isotonic crystalloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pyloric stenosis
symptoms?
investigation?
management?

A

projectile’ non bilious vomiting, typically 30 minutes after a feed
constipation and dehydration may also be present
a palpable mass may be present in RUQ

Blood gas - hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

ultrasound abdomen - target/dougnut sign

IV fluid resucitation = 1st line (including correction of potassium)
then Ramstedt pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hepatospleenomegaly differentials in child

A
  1. leukemia - high white cell count
  2. malaria
  3. thalassemia
  4. Gauchers
  5. EBV - low wcc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Parvovirus B19
symptoms
RF
investigation
complication in pregnancy?

A

slapped cheek rash
Sickle cell, HIV
Parvovirus serology
hydrops fetalis in pregnant woman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hemophilia A (x linked recessive)
symptoms
investigation
management
complications

A

excessive bruising, bleeding, hemarthrosis

aPTT time - prolonged. everything else is normal!

avoid NSAIDS
early management of trauma

chronic arthropathy, compartment syndrome, hematuria, hep B infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HSP (IgA vasculitis)
symptoms
RFs
diagnosis
management
complications

A

tetrad of rash, abdominal pain, arthritis/arthralgia, and glomerulonephritis.

History of Upper respiratory tract infection

FBC & clotting screen - normal, used to exclude other causes such as ITP and sepsis which can cause low platelet and abnormal coagulation)

renal function, and urine dipstick

most cases resolve in 4 weeks
joint pain/abdo pain = ibuprofen
nephritis/ proteinuria = oral corticosteroids, IV if moderate. IV cyclophosphamide if severe

Intussusception
Acute renal impairment
Arthritis/arthralgia, typically involving ankles and knees
Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute lymphoblastic leukemia
symptoms
diagnosis
management
complications and how to treat?

A
  1. hepatospleenomegaly
  2. high white cell count
    (more common than AML) BUT neutropenia (frequent infections),
    Thrombocytopenia (petechiae/ echymoses), anemia
    fever

FBC
Blood smear

  1. rehydration
  2. alluprinol - prevent tumour lysis s
  3. platelet transfusion
  4. bone marrow aspirate
  5. chemotherapy once definite diagnosis

tumour lysis syndrome -Potassium, phosphate, uric acid, LDH are all like to be high. -> renal failure risk

febrile neutropenia -> Piptazobactam and gentamicin prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Acute myeloid leukemia
symptoms
diagnosis
management
complications

A

Anemia, thrombocytopenia, neutropenia

Lymphadenopathy, hepatospleenomegaly

Blood smear - diagnostic, blasts and auer rods
- if no auer rods, immunophotyping to distinguish AML from ALL
- if aleukemic lukemia suspected = bone marrow aspirate

Chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Slipped upper femoral epiphyses
symptoms
RFs
diagnosis
management
complications

A

external rotation of leg
Restricted range of motion
hip pain, referred pain to knee or groin
Trendelenburgs gait

Obesity, endocrine disorders, puberty
most common cause of limp/hip symptom in children aged 12-14. Presents in adolescence
Perthes more common in 4-7 years

pelvic Xray - DIAGNOSTIC - widening of growth plate/ physis. klein line does not intersect femoral head (shows displacement)

internal pinning and fixation of epiphysis

avascular necrosis, limb length discrepancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DDH
symptoms
diagnosis
management
complications

A

Toe walking
abnormal positioning of leg,
Limb length discrepancy
Trendelenburgs gait
NO PAIN

+ ortolani (hip abduction) and barlow (hip adduction) test, trendelenburg

RFs:
- breech presentation
- family history
- female sex
- birth weight > 5 kg
- oligohydramnios
can be associated with Talipes

USS hips at 6 weeks for breech babies at or after 36 weeks gestation, or babies with family history

if the infant is > 4.5 months then x-ray is the first line investigation

<6months is observation, Pavlik harness
>6 months with dislocation = closed reduction, cast

DDH is hip abnormality seen in newborns and infants 0-4
Perthes/ transient synovitis = 4-10
SCFE = 10 -16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Developmental milestones
Gross motor

A

6 weeks - head control begins

6 months - no head lag, sitting

1 year - cruises, walks

18 months - walks well, runs

2 years - climbs stairs, kicks ball

36 months - stands on one leg

Exam May ask what developmental milestones group is affected, or what the developmental age of child is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Developmental milestones
Fine motor vision

A

6 weeks - fixes and follows

6 months - full hand grip

1 year - mature pincer, pointing

18 months - build tower of 3, hand preference, scribbles

2 years - build tower of 7, circular scribbles

36 months - draws circle, imitates bridge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Developmental milestones
language hearing

A

6 weeks - stills to sound

6 months - turn to sound, babble

1 year - first word, response to name

18 months - 6-12 words, follow simple instructions

2 years - 2 words sentence

36 months - speaks in sentences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Developmental milestones
social skill
self-care

A

6 weeks - smiles

6 months - laughs and squeals

1 year - waves, peekaboo, drinks from cup

18 months - spoon feeding, symbolic play

2 years - toilet training, remove garment

36 months - parallel play, interactive play, sharing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

whooping cough
symptoms
diagnosis
management

A

cattarrhal phase - viral infection symptoms
coughing - worse after feeds, associated with vomiting
INSPIRATORY whoop
APNEA periods in infants

Per nasal swab
Significant lymphocytosis w low or normal neutrophils - bloods

infants under 6 months with suspect pertussis should be admitted

+ an oral macrolide!! (e.g. clarithromycin, azithromycin or erythromycin)
Erythromycin prophylaxis to close contacts
School exclusion till 48 hours after starting antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

croup
symptoms
diagnosis
management
complications

A

bark like /seal like cough
Worse at night
clinical diagnosis
Clinical or steeple sign on CXR (viral laryngotracheobronchitis)
6 months to 6 years main occurrence. Peak at 2 years old!

Parainfluenza is a key cause

never perform throat examination due to risk of airway obstruction

Oral dexamethasone (0.15mg/kg)
*bacterial tracheitis is differential - same sounds, but high fever, thick airway secretions, more severe, usually caused by staph aureus. can cover w IV cefuroxime and Flucloxacillin

if severe = marked sternal wall retractions/resp distress/stridor = oxygen + nebulised adrenaline!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Congenital CMV signs?

A

hearing loss, low birth weight, petechial rash, microcephaly and seizures, periventricular calcifications

+/- blueberry muffin rash

urine or salivary PCR test

oral valganciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Congenital Toxoplasmosis signs?

A

chorioretinitis, hydrocephalus, intracranial calcifications

+/- blueberry muffin rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Congenital Rubella signs?

A

sensorineural deafness, eye abnormalities (e.g. retinopathy and cataracts) and congenital heart disease (especially pulmonary artery stenosis and patent ductus arteriosus).

+/- blueberry muffin rash

if infection as an infant: pink macules and papules at head, moves down, post-auricular lymphadenopathy. athralgia

supportive care

encephalitis, thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Congenital Herpes signs?

A

vesicular rash, very low birth weight, microcephaly, microphthalmia and preterm

encephalitis, herpetic lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Congenital varicella zoster signs?

A

hypertrophic scars, limb defects, ocular defects (such as cataracts and microphthalmia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

congenital syphilis

A

notched teeth, saddle nose, saber shins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Measles symptoms
diagnosis
management
complications

A

rash beginning at head then spreading
cough conjuctivitis, koplik spots, coryza

measles-specific IgM and IgG serology

supportive care - paracetamol/ibuprofen
consider vitamin A

otitis media is most common complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

HHV 6/ roseola symptoms

A

fever then rose coloured macules on body. siezures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Prevention of HIV transmission to baby?

A

babies born should recieve zidovudine for 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Epilepsy
management
complications/ side effects drugs

A

recurrent febrile siezures =rectal diazepam or buccal midazolam)

tonic clonic:
- sodium valproate 1st line
- lamotrigine if child bearing age

absence:
- ethusuximide
- sodium valproate

myoclonic:
- valproate

Focal:
- carbamezepine
- lamotrigine if child bearing age

treatment not given for childhood rolandic epilepdy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Epididymitis and orchitis
symptoms
diagnosis
management
complications

A

scrotal pain and swelling
unilateral
may be hot and erythematous
sexual health RF

gram stain urethral secretions
NAAT test urethral secretions

gonorrhea/chlamydia = ceftriaxone and doxycyline

enteric organisms = levofloxacin

M genitalium = moxifloxacin

idiopathic or viral eg mumps = supportive measures

tuberculous = tb meds

underlying vasculitis = rheumatologist referral

scrotal elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Neonatal Hypoglycemia
symptoms
diagnosis
management
complications

A

< 2.6 mmol/L
transient hypoglycemia in first hours after birth is normal - monitor blood glucose

RF for persisitent = preterm, gestational diabetes, inborn errors of metabolism

‘jitteriness’, irritable, tachypnoea
pallor

poor feeding/sucking, weak cry, drowsy, hypotonia, seizures

  • asymptomatic
    encourage normal feeding (breast or bottle)
    monitor blood glucose
  • symptomatic or very low blood glucose <1.5
    admit to the neonatal unit, intravenous infusion of 10% dextrose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

treatment for child with hypoglycemia?

A

mild/moderate = fast acting glucose by mouth + Carbs

severe = IV 10% glucose or IM glucagon/ concentrated oral glucose if not in hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Kawasaki disease
symptoms
diagnosis
management
complications

A

rash
conjuctival injection
enlarged cervical lymph nodes
strawberry tongue
desquamation of palms and soles (late sign)

Fever - at least 5 days, conjunctivitis can help differentiate from scarlet fever. Kawasaki uncommon in child > 8 years

Scarlet fever differential - will have runny nose, cough, sore throat

FBC - anemia, Thrombocytosis!! leukocytosis!!

  1. IVIG infusion = 1st line
    (inflixmab + corticosteroids if resistant to IVIG)
  2. high dose aspirin to reduce thrombosis risk for first 72 hours then low dose for 8 weeks

coronary artery aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Down syndrome
symptoms
diagnosis
management
complications

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Mumps

complications

A

swelling of parotid gland - clinical diagnosis

self limiting, rest, paracetamol
7 days away from school
seek help if meningitis or
epididymo-orchitis develops

deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Volvulus
symptoms
diagnosis
management

A

twisting of bowel causing obstruction
bilious vomiting
abdominal pain

upper GI contrast - done if vomiting, lights up, allows you to follow the orientation of the bowel the whole way through, shows abnormal positioning of vowel

CT abdomen with contrast -> done when theres no vomiting and low concern of malrotation

emergency surgery = Ladd procedure with open laparotomy

suppportive care: NG tube if obstruction, antibiotics, IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Perthes disease
symptoms
investigations
management
complications

A

caused by avascular necorosis of femoral epiphysis

hip pain can radiate to knee, worse during activities
limp
reduced range of movement in hip
more common in boys
trendelenburg sign may be present

plain x ray - femoral head collabse and fragmentation, subchondral fracture. widening of epiphyses = early sign

Conservative:
- NSAIDS, monitor if less than 5 years
cast/braces
- if over 7 years - surgical containment

osteoarthritis, premature fusion of growth plates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Idiopathic thrombocytopenic purpura

symptoms
diagnosis
management
complications

A

bruising
petechial or purpuric rash
bleeding is less common and typically presents as epistaxis or gingival bleeding
follows viral illness typically

full blood count - isolated thrombocytopenia
blood film

asymptomatic or minor bleeding: - self resolving 6-8 weeks
avoid activities that can cause trauma

severe bleeding/platelet count (e.g. < 10 * 109/L) =
- IVIG + corticosteroid + platelet transfusion

chronic/persistent disease =
mycophenolate/rituximab/
eltrombopag. splectomy 2nd line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Congenital diaphragmatic hernia

A

tinkling bowel sounds on chest auscultation
respiratory distress

1st line = intubate and ventilate
THEN - surgical repair of diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Bacterial meningitis
symptoms
diagnosis
management

A

<3 Months = IV ampicillin/amoxicillin + cefotaxime

> 3 months = IV ceftriaxone

presenting in primary care = IM/IV benzylpenicillin

recent foreign travel - add vancomycin

dexamethasone my play a role but AVOID in menigococcal septicemia and children under 3 months

review of child by pediatrician in 4-6 weeks, hearing assessment

contacts give ciprofloxacin

50
Q

Osteosarcoma

A

pain in long bones - arms/ legs near growth areas (metaphysis), including around the knees.
- systemic symptoms: weight loss or fever and

wide surgical resection and reconstruction

51
Q

Duchenne MD

A

delayed motor milestones
ambulatory difficulties
calf hypertrophy
gowers sign

genetic testing - 1st line
elevated CK

DMD = corticosteroid + physiotherapy + exercise

spinal muscular atrophy = psychosocial and neuropalliative care

52
Q

Sickle cell disease
symptoms
diagnosis
management
complications

A

persistent pain in skeleton, chest or abdomen
dactylitis
bone pain
jaundice may occur

electrophoresis
blood smear
fbc and reticulocyte count

prophylaxis: immunisation against encapsulated organisms, daily oral penicillin and folic acid

Acute crisis:
- oral and IV analgesia

acute chest syndrome, priaprasm or stroke:
- exchange tranfusion

chronic problems:
- consider hydroxycarbamide in children
- spleenectomy
- bone marrow transplant

53
Q

Testicular torsion

A

testicular pain/swelling/erythema
high riding testicle
absent cremasteric reflex
no pain relief upon elevation of scrotum

orchiectomy/orchidopexy
fixation of contralateral testes

54
Q

Retinoblastoma
symptoms
diagnosis
management
complications

A

leukocoria - white pupillary reflex
fundoscopy

Gross vitreous seeding (tumour cells floating within vitreous cavity)
- enucleation 1st line
- adjuvant chemo if infiltration of iris, ciliary body, sclera, optic nerve

minimal or no seeding:
systemic chemotherapy
+ cryotherapy or laser ablation = tumour > 2 disc diameters in size
laser ablation only = tumour <2 disc diameters

55
Q

Reactive Arthritis
symptoms
diagnosis
management
complications

A

arthritis
conjuctivitis or iritis
preceeding chlamydia or GI infections

clinical diagnosis

NSAIDS - 1st line

persistent = sulfasalzine (DMARD)

56
Q

eczema herpeticum treatment

eczema staph infection treatment?

A

IV aciclovir
IV flucloxacillin

57
Q

Asthma

A

Dry cough, wheeze, SOB
Typical triggers
Personal/family history of atopy
Wheeze on auscultation

step 1 = SABA
step 2 = Low dose inhaled steroids via MDI and aerochamber
step 3 =

*any sudden deterioration in a patient with a lung condition, eg marked respiratory distress, hypoxia and HTN, think Tension pneumothorax!

If the wheeze only related to cough or colds -> it might be a viral induced wheeze instead

Severe asthma - can’t complete sentences in one breath, too exhausted to talk, use of accessory muscles. Give SABA + prednisolone or hydrocortisone. Consider ipatropium bromide

Life threatening - hypotension, cyanosis, silent chest, poor respiratory effort, confusion Give SABA + prednisolone or hydrocortisone + ipatropium bromide

58
Q

conjuctivitis

A

viral - self limiting, clean with saline, wash hands to prevent spread

bacterial - usually self limiting but can treat with azithromycin/erythromycin

gonorrhea - IV ceftriaxone
chlamydia - oral arithromycin or doxy
^ both cause purulent discharge

allergic - artificial tears, antihistamine

59
Q

dehydration

A

> or = 5% weight loss
10 = Shock

treatment = ORS 75mL/kg every 4 hours

IV fluids only indicated for Shock, deterioration, or persistent vomiting

60
Q

Allergic Rhinitis

A

Sneezing
Nasal pruritus, discharge, congestion
Eye redness/itching

Mild/intermittent
= allergen avoidance + intranasal non sedating antihistamine

Persistent/ moderate - severe
Allergen avoidance + intranasal antihistamine + intranasal corticosteroid (beclometasone, budesonide, fluticasone)

Ineffective therapy still:
sublingual or subcutaneous immunotherapy

61
Q

Cows protein milk allergy

A
62
Q

Food allergy

A

exclusion of offending foods
mild reaction = non-sedating antihistamines

severe w cardio/laryngeal or bronchial involvement = IM adrenaline (epipen) + salbutamol if bronchospasm occurs

  • provide epipens
  • food challenge after 6-12 months symptom free
63
Q

Anaphylaxis
symptoms
management

A

breathing difficulty - SOB, wheeze, stridor
airway swelling
Hypotension
urticaria
tachycardia

ABCDE assesment - if unresponsive and in cardiorepiratory arrest :
- start CPR

if not:
remove trigger
lie patient flat
IM adrenaline 1:1000, asses response after 5 min and repeat in intervals until adequate response

high flow oxygen
IV fluids

give antihistamine after initial resus:
(IV chlorphenamine 10mg + IV hydrocortisone 200mg??)

referral to allergy clinic
future management - epipen

64
Q

Urticaria
management

A

1st line = trigger avoidance

severe =
- certirizine OR other non-sedating antihistamine eg fexofenadine, loratidine
- prednisolone

If occurs with angioedema that involves airway=
- adrenaline injection 1st line
- IV dypenhydramine

65
Q

Lactose intolerance management

A

avoid dairy products
calcium and vitamin D supplementation

66
Q

Mesenteric adenitis
Symptoms
Investigations
Management

A

enlarged mesenteric lymph nodes caused by viral infection)

Abdominal pain, tenderness, fever
Nausea or vomiting
Typically due to viral infection - sore throat, cold prodrome

Clinical diagnosis

Self limiting, pain killers if needed

67
Q

Hemangioma
Diagnosis
Management

A

Doppler ultrasound -> distinguish infantile haemangioma from vascular malformations (e.g., venous malformations, arteriovenous malformations, lymphatic malformations)

Asymptomatic = reassurance

Functional impairment/cosmetic disfigurement
= propanolol (or corticosteroids)
Consider surgical excision

68
Q

Subarachnoid hemorrhage
Causes
Diagnosis
Management

A

Rupture of saccular aneurysm- main
AVMs

Non contrast CT head

GCS 8 or lower = cardiopulmonary support
Consider nimodipine
Endovascular coiling, surgical clipping = definitive

69
Q

Subdural hemorrhage
Management

A

Consider NAI due to shaking
Small = conservative
GCS<9 with large hematoma or midline shift = surgical

Antiepileptics

70
Q

Peptic ulcer disease and gastritis

A

abdominal pain - often related to eating and nocturnal

endoscopy - if bleeding
h pylori breath test or stool test

bleeding ulcer:
- endoscopy +/- blood transfusion
- PPI
- Surgery or ablation

non bleeding, H pylori negative:
- PPI, treat underlying cause

non bleeding, H pylori +ve
- PPI + clarithromycin + amoxicillin (triple therapy)

treat children with PPI, if it doesnt work, do an endoscopy, if it is normal = Functional dyspepsia diagnosis

71
Q

Periorbital and orbital cellulitis

A

Redness and swelling of eye
Decreased vision, proptosis

Periorbital - superficial injury eg insect bite

Orbital - usually due to underlying bacterial sinusitis

CT sinus and orbit with contrast

WBC count

IV antibiotics eg cefotaxime
Hospital admission

72
Q

Cerebral Palsy
Risk Factors
Symptoms
Diagnosis
What anatomical structure is most likely affected?
Management

when would you be worried about a neurological disorder instead?

A

antenatal: maternal illnesses (e.g., chorioamnionitis, TORCH infections,

perinatal: prematurity, birth asphyxia (due to placental abruption, rupture of the uterus, prolonged/obstructed labour, instrumental delivery), brain malformation, neonatal sepsis, neonatal siezures

postnatal: meningitis, head trauma prior to 3 years

others: metabolic/genetic disorders,thyroid disease, iodine deficiency, thrombotic disorders) severe hyperbilirubinaemia, periventricular haemorrhage, respiratory distress, teratogen exposure

abnormal motor development - spasticity (80%), dystonia, chorea, ataxia, athetosis, hypotonia

delayed motor milestones:
- not sitting by 8 months
- not walking by 18 months
- hand preference before 1 year
- late head control, rolling and crawling

toe walking/knee hyperextension

delay in speech and cognition may occur

MRI Brain -periventricular leukomalacia, congenital malformation, stroke or haemorrhage, cystic lesions

Affects motor cortex!!!

occupational therapy, physiotherapy and speech therapy
for children at risk, follow up programme with MDT up till 2 years

symptomatic medicines:
stiffness - baclofen
sleeping - melatonin
constipation - laxatives
drooling - anticholinergic

  • absence of risk factors
  • family history of neurological disorders
  • loss of already attained cognitive and developmental abilities
  • different MRI findings
  • focal neurological signs
73
Q

Juvenile idiopathic arthritis
Symptoms
Diagnosis
Management

A

Swelling, warmth, painful limited movement
Tenderness may occur
Arthritis in 1 or more joints for at least 6 weeks before age 16

Clinical diagnosis
ESR CRP ANA RF may be elevated

Polyarticular/ 5 or more joints:
= methotrexate

Specialist rheumatologist management

4 or less
=intraarticular corticosteroids eg triamcinolone or methyl prednisolone

NSAIDS for sacroilitis and enthesitis

74
Q

Pneumothorax
Symptoms
Diagnosis
Management

A

pleuritic chest pain
dyspnea
ipsilateral reduced breath sounds

CXR - absent lung markings

small = observation + 02 for 1-2 hours

needle decompression - if child at risk of respiratory failure

chest drain - for all tension pneumothoraces or ventilated or preterm infants that deteriorate

75
Q

Malaria
Symptoms
Diagnosis
Management

A

Headache
Myalgia
Arthralgia
Fever
Diarrhoea
Jaundice and siezures may occur
Non specific symptoms in children <5

history of travel to endemic area/inadequate prophylaxis

FBC - thrombocytopenia, anemia
Blood smear - parasites
Rapid diagnostic test

p falciparum:
- oral artemisinin combination
- if severe parental artesunate for 24 hours then artemisinin combination

non falciparum
- artemisinin combination

notifiable

76
Q

Hypoxic Ischemic Encephalopathy

A
77
Q

Obstructive sleep apnea

A

breathing through an open mouth
snoring, gasping, choking while asleep
HTN

Polysomnography = diagnostic

Adenotonsillectomy = 1st line
CPAP = 2nd line

Treatment of precipitating conditions: reflux, obesity

78
Q

Hyperthyroidism
symptoms
diagnosis
management
complications

A

heat intolerance, weight loss, palpitations, tremor

Graves disease most common cause in child - orbitopathy, pretibial myxedema, TSH receptor antibodies
- thyroid nodules and thyroiditis may also cause
- neonatal graves disease - transplacental passage of maternal TSIs

elevated T4.T3, Suppressed TSH

Carbimazole or propylthiouracil = 1st line. risk of neutropenia - medical attention if fever or sore throat

radioiodine or surgery = 2nd line

can use beta blockers for symptomatic relief - anxiety, tremor, tachycardia

thyroid storm -> high temp, changes in mental status

78
Q

Peripheral nerve palsies

A

Erbs palsy - lateral traction on neck during delivery
klumpke pasly = upward force on arm during delivery
winged scapula

physiotherapy, occupational therapy

79
Q

Raised intracranial pressure

A

infant: increased head size, tight fontanelle
other: morning headache, headache waking from sleep, vomiting, visual disturbance, fluctuating conciousness, siezure, ataxia or other motor disturbance

  1. trauma
  2. brain tumour
  3. Hydrocephalus - chiari malformation? spina bifida? arachnoid cysts? - treated with shunt
  4. meningitis
80
Q

Nephrotic Syndrome
list different causes in child

Minimal change disease
symptoms
investigations
management
complications

A
  1. minimal change disease - often idiopathic or triggered by infection, immunization, drugs eg NSAIDs. may be secondary to lymphoma. MCD = MAIN cause in child
  2. FSGS - may be secondary to sickle cell, HIV, or congenital malformations (single kidney, kidney removal)
  3. membranous nephropathy

MCD symptoms:
facial/generalised edema
no HTN or hematuria
recent viral illness

urine protein/creatine ratio
24 hour urine protein

management:
oral prednisolone = 1st line
+ fluid restriction + low salt diet
advanced MCD = albumin and furosemide

81
Q

Nephritic syndrome/glomerulonephritis
symptoms
management

symptoms
investigations
management
complications

A

hematuria, proteinuria, fatigue

mild=
treat underlying cause eg. phenoxymethylpenicillin for post-strep GN

moderate =
ACE inhibitor or ARB
treat underlying cause

Severe =
prednisolone and immunosuppresant eg Rituximab (give prophylactic trimethoprim for immunosuppression)

RPGN - treatment depends on subtype but may involve prednisolone and cyclophosphamide. give prophylactic trimethoprim

82
Q

Hodgkins Lymphoma
symptoms
diagnosis
management
complications

A

Painless cervical and or supraclavicular lymphadenopathy

B symptoms may occur - fevers, nights sweats, weight loss

PET/CT - shows extent of disease

Lymph node biopsy - diagnostic = reed stern berg cells

FBC - low Hb and platelets; WBC count may be high or low

ABVD combination chemo - adriamycin, bleomycin, vinblastine, dacarbazine
+ 2 cycles ABVD + radiotherapy if favourable
+ 4 cycles of ABVD + medium radiation if unfavourable
Refractory or relapse disease = chemo + ASCT. Brentoximab vedotin if ASCT fails. Nivolumab, Pembrolizumab as last line

83
Q

Diabetic Ketoacidosis
symptoms
diagnosis
management
complications

A

nausea, vomiting, abdomina pain, hyperventilation, acetone smell on breath

typically in Type 1 diabetes - history of weight loss, polydipsia, polyuria

venous blood gas - metabolic acidosis
blood ketones - elevated
blood glucose - elevated

oral fluids and SC insulin if alert child

not alert = IV fluids and IV insulin
fluids = 0.9% saline, add on 5% glucose after glucose drops below 14mmol/l

all fluids administered to children must contain 40mmol/L potassium chloride unless child has renal failure

IV insulin should commence 1-2 hours after starting fluids

monitor with ECG for hypokalemia

complications:
1. cerebral oedema - from replacing fluids too quickly causing hyponatremia - watch for neurological symptoms: headache, deacreased HR, increased BP, agitation - treat with mannitol or hypertonic sodium chloride

  1. hypokalemia - consider stoping insulin
84
Q

Diabetes mellitus type 1
symptoms
management

A

polyuria, polydipsia
random glucose> 11.1
fasting glucose>7
elevated HBA1C

absence of ketoacidosis, presence of obesity, acanthosis nigricans, +ve family history, suspect type 2 -> confirmed with negative autoantibody tests

therapy options;
1.multiple daily injection basal bolus
2. continuous subcutaneous insulin infusion
3. 1,2, or 3 insulin injections per day

type 2 = metformin and lifetsyle modifications

85
Q

Cardiac Arrest
management

A

5 rescue breaths
15 chest compressions, 2 rescue breaths

shockable rhythms:
- CPR +defibrillator
- + adrenaline

86
Q

Brain tumours

A

Pilocytic astrocytoma = most common in child, usually in cerebellum

Medullobalstoma = most common malignant brain tumour in child. hydrocephalus risk

ependymoma

craniopharyngioma - bitemporal hemianopia

Pinealoma

surgery-> treat hydrocephalus, tissue diagnosis and resection. radiotherapy and chemo depending on tumour

87
Q

Downs syndrome
complications

A

hypothyroidism, dementia, leukaemia, and seizures, atlanto-axial instability (always screen for in patients that play sports)

sandal gap between big and first toe
brushfield spots on iris
etc

88
Q

HPV infection

A

respiratory papillomatis -> infection of true vocal cords

warts - sertypes 1,2,6,11

89
Q

Pneumonia
symptoms
diagnosis
investigations
management

A

Fever, breathing difficulty, increased RD
Abdominal pain

decreased breath sounds, dullness to percussion, wheeze, consolidation on X-ray

chest xray - consolidation
pulse oximeter

hospital admission if:
02 <92%
grunting, marked chest recession, RR>60/min
cyanosis
child looks seriously unwell, does not wake or stay awake
temp >38 in child <3 months

Amoxicillin = 1st line

if hospital admission not needed:
amoxicillin or clarithromycin if allergic

co-amoxiclav for high severity pneumonia, add clarithromycin if atypical organisms suspected

90
Q

Crohns disease
symptoms
diagnosis
investigations
management
complications

A

abdominal pain - may be RLQ
diarrhea - may be bloody
weight loss
extraintestinal manifestations

colonoscopy with biopsy

inducing remission : corticosteroid monotherapy for first presentation or first exacerbation in 12 months

maintaining remission :
azothioprine or methotrexate

patient on immunosppresants should not have live vaccines

educate about features of flares - eg weight loss

malabsorption, colon cancer

91
Q

Ulcerative Colitis
symptoms
diagnosis
investigations
management

A

diarrhea
abdominal pain
blood in stool
extraintestinal manifestations

colonoscopy

mild = 5ASA topical or oral
moderate = oral prednisolone
severe = surgery

92
Q

DIC
symptoms
diagnosis
investigations
management

A

widespread clotting factor consumption

petechiae, echhymosis, oozing, hematuria

signs of systemic collapse my be seen - oliguria, hypotension, tahcycardia

RFs; tumours, Hematological malignancies, trauma, burn, sepsis/infection

increased PT and PTT
decreased platelets, increased BT
decreased fibrinogen

treat underlying cause
+ platelets and coagulation factors if high risk of bleeding

93
Q

Cushings Syndrome
symptoms
diagnosis
management
complications

A

growth retardation in children
weight gain
abdominal striae
hypertension
hyperglycemia and insulin resistance
ammennorhea

step 1
- increased 24 hour urinary cortisol or late night salivary cortisol
- OR failure to suppress dexamethasone
= cushings syndrome. now distinguish cause in step 2

step 2 measure ACTH

low
= adrenal tumour - adrenal ct - resection
= exogenous glucocorticoids

high:
- do CRH stimulation test (inferior petrosal sinsus sampling)
- Increased ACTH and cortisol = cushings disease (pituitary dependent) - do MRI pituitary - transphenoidal surgery
- no increase in ACTH and cortisol = ectopic ACTH secretion - CT chest, abdomen and pelvis - surgical resection

94
Q

Hepatitis

A

hep A = supportive for pain, itch, rash, vaccinate close contacts

hep B =
supportive
+ antivirals eg entecavir

hep C =
only treat if > 3 years
antivrals
treatment faliure - combine antivirals or add oral ribavirin

95
Q

patent ductus arteriosus
symptoms
diagnosis
management
complications

A

Patent ductus arteriosus:
- continous machine like murmur - left infraclavicular region and left sternal border
- left to right shunt can cause RVH
- late cyanosis in lower extremities NOT whole body
widened pulse pressure

echo = diagnostic

  • manage with indomethacin
  • surgical ligation or percutaneous catheter device closure may be used if other methods unsuccessful
96
Q

Pulmonary stenosis
symptoms
diagnosis
management
complications

A

Systolic murmur ejection murmur over left sternal border
mild = observation

echo with doppler

moderate to severe = percutaneous balloon valvuloplasty

97
Q

Atrial septal defect
symptoms
diagnosis
management
complications

A

wide fixed SPLIT S2
ejection systolic murmur in upper left sternal edge

small = observation
large =
transcatheter closure - Ostium secundum ASD
open heart surgery - Ostium primum ASD

98
Q

Ventricular septal defect
symptoms
diagnosis
management
complications

A

holosystolic murmur in tricuspid area
shortness of breath

small:
observation = 1st line, for closure
prophylactic amoxicillin to prevent endocarditis

Large VSD -> corrective closure, pre operative furosemide to control HF symptoms

99
Q

Tetralogy of Fallot
symptoms
diagnosis
management
complications

A

whole body cyanosis - most common cause
hypercyanosis - tet spells
systolic ejection murmur

  1. systolic ejection murmur which improves on squatting -> pulmonary stenosis
  2. RVH -> boot shaped heart on xray. tet spells when crying or exercise due to worsening of RV outflow tract obstruction
  3. Overriding aorta
  4. VSD

echo = definitive

severe or worsening cyanosis:
prostaglandin E1 (alprostadil) - maintain patency of ductus arteriosus
shunt between subclavian and pulmonary artery
surgery/closure of VSD = definitive

100
Q

Transposition of great arteries
symptoms
diagnosis
management
complications

A

= separation of aortic and pulmonary circulations
whole body cyanosis

PGE1
heparin bolus then balloon atrial septostomy
atrial switch procedure in 1st 2 weeks

101
Q

Tricuspid atresia
symptoms
diagnosis
management
complications

A

absence of tricuspid valve and hypoplastic RV. requires ASD and VSD for viability
whole body cyanosis

PGE1 - maintain PDA
surgery with the first stage being
shunt between subclavian and pulmonary arteries

102
Q

Coarctation of aorta
symptoms
diagnosis
management
complications

A

HTN in upper extremities
weak/delayed pulse in lower extremities (BP Difference) - eg femoral pulse

notched appearance of intercostal arteries on CXR
associated with bicuspid aortic valve and Turner Syndrome
murmur may be heard at back
claudication with walking may occur

98% in distal left subclavian artery
most common presentation is at 48 hours once PDA closes

PGE1 - alprostadil - maintain PDA = 1st line
surgery -> arch reconstruction

103
Q

cyanosis in newborn causes

A

Cardiac
-5Ts are main causes:
- Transposition of great arteries
- tetralogy of fallot
- tricuspid atresia
- truncus arteriosus
- total anomalous pulmonary venous return

pulmonary
- examples include RDS, pneumonia, congenital diaphragmatic hernia , pulmonary edema

104
Q

congenital cyanotic heart disease

A
105
Q

gastroesophageal reflux

A
106
Q

constipation

A
107
Q

hypothyoidism

A
108
Q

osteomyelitis

A

fever, tenderness/pain, reluctance to weight bear, swelling and erythema may occur

  • X-ray - May show signs or May be normal
  • take a blood culture, THEN give IV antibiotics
  • analgesia
  • if child deteriorates -> urgent surgical drainage/debridement
109
Q

Explain and classify causes of neonatal jaundice

give examples for causes of early jaundice and prolonged jaundice

A

High bilirubin in first 24 hours of life is always pathological. common causes of early jaundice:
1. hemolytic disease of newborn - ABO, rhesus!!
2. hemolytic anemia - G6PD
3. Gilberts, Rotor, Crigler-Naijar syndrome etc
3. Sepsis!!!/congenital TORCH infections
4. difficult deliveries -> hematoma formation

if in days 2, 3 jaundice develops or bilirubin is raised but doesnt reach a certain threshold, in otherwise normal baby you put it down as physiological such as decreased UGT/ impaired liver ability to excrete bilirubin, shorter life span of neonatal rbcs. may have to give phototherapy

however, if after 14 days (21 in preterm), bilirubin is still slighlty elevated/child is still jaundiced, or after 2 days it shoots up quickly, need to rule out causes of prolonged jaundice

prolonged jaundice causes:
1. biliary atresia = most feared, rule out
2. breast milk jaundice = most common
3. hepatitis
4. congenital hypothyroidism

110
Q

neonatal jaundice history taking points

A

Gestational age <38 weeks
Previous sibling with neonatal jaundice requiring phototherapy
Mother’s intention to breastfeed exclusively
Visible jaundice in the first 24 hours of life
Other important areas to cover in the history include:9

Family history: a history of inherited diseases (e.g. G6PD deficiency or liver disease) or previous sibling with jaundice (suggests a higher chance of haemolytic disease of the newborn)
Pregnancy history: congenital infections, diabetes (increases the risk of jaundice), maternal drugs (e.g. sulfonamides interfere with bilirubin-albumin binding), maternal blood group and any known antibodies
Labour and delivery history: birth trauma (e.g. bruising or cephalohaematoma)
Feeding history: breastfeeding or formula feeding, intake (poor intake causes delayed or infrequent stooling which increases enterohepatic circulation of bilirubin), vomiting (may be a sign of sepsis or galactosaemia)

111
Q

investigations for neonatal jaundice?

management?

A

measure bilirubin -> TCB, serum bilirubin

tests specific to suspected cause
liver ultrasound, fbc, blood film, G6PD Levels, blood urine and CSF if signs of infection

phototherapy, if bilirubin level is really high, exchange transfusion

112
Q

causes of Respiratory distress in newborn?

A

TTN (transient tachypnea of newborn) - most common
RDS - premature babies, mothers with diabetes
chronic lung disease of prematurity
congenital pneumonia - eg GBS, mum has chorioaminionitis
meconium aspiration

113
Q

What forms part of prolonged jaundice screen?

A
  • Conjugated bilirubin
  • LFTs
  • FBC - rule out a missed hemolytic anemia
  • Look at stools - May be pale
  • Thyroid function
114
Q

Explain breast milk jaundice
How is it Managed?

How does breast feeding failure jaundice differ?

A

Breast milk jaundice
Typically caused by:
* Factors in a mother’s milk that help a baby absorb bilirubin from the intestine
* Factors that keep certain proteins in the baby’s liver from breaking down bilirubin

Breastfeeding can continue as normal
Use bilirubin to guide management

Breast feeding failure jaundice (baby does not get enough breast milk)

115
Q

common causes of neonatal aneamia?

A

Hemolytic disease of newborn

G6PD deficiency - has breastfeeding mother taken relevant drugs or eaten fava beans?. other congenital hemolytic anemias

maternal parvovirus infection - passed across placenta?

fetomaternal hemorrhage

116
Q

Celiac disease
Symptoms
Investigations
Management

A

Celiac Disease
- Abdominal pain, bloating, diarrhoea/constipation

  • test for anti TTG antibodies which attack coeliac disease
  • Small bowel endoscopy and Biopsy!! = Gold standard to confirm diagnosis = villous atrophy, intra-epithelial lymphocytes
  • Damage to intestine, difficulty absorbing - iron and B12 deficiency. FBC important

Gluten free diet

117
Q

Fluids maintenance option for 2 year old boy with diarrhoea and vomiting, decreased food and fluid intake, 3% dehydrated and blood glucose of 6 mmol/L?

A

0.9% sodium chloride + 5% glucose
OR
Plasmalyte + 5% glucose

Glucose is important as can’t eat, and you need to try and avoid Ketoacidosis

118
Q

Child with 4 weeks smelly discharge from left nostril, sometimes tinged with blood. More recently she has had a persistent sneeze. Most likely diagnosis?

A

Foreign body!! - clue is blood tinged

Nasal polyp - asymptomatic in Children
Rhinitis and sinusitis = bilateral

119
Q

Scarlet fever
Symptoms
RFs
Diagnosis
Management

A

Sore throat, fever, rash
Strawberry tongue
cervical lymphadenopathy

Group A strep

Clinical diagnosis

Phenoxymethylpenicillin!!!

120
Q

7 year old girl acute asthma. 95% sats, mild increased work of breathing.

Management?

A

Inhaled salbutamol multidose via spacer

You would only give nebulised salbutamol if you need to deliver oxygen at the same time

Year 5 conditions list (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions