questions Flashcards
common CVS defect in children with downs
AVSD
Roughly what are the asthma treatment guidelines in children under 5
- low dose ICS + SABA
review - add LTRA (montelukast)
roughly what are the asthma guidelines in children between 5-11
- ICS + SABA
- low dose MART -> ICS + LABA
- if cant tolerate the MART then consider adding a LTRA
never add a LTRA alone
what is done to evaluate asthma new treatment
reassess in 6 weeks
do a symptom diary
when does hand dominance develop and if its any earlier what does this suggest
2 years
if earlier can suggest cerebral palsy or spastic hemiplegia
what are the common features of epiglottis
- noisy breathing
- extreme pain
- cant eat
- drooling
-upright
-inspiratory stridor
what is usually treatment for epiglottis
endotracheal intubation
child on methylphenidate starts to develop side effects such as tics what can you start him on
Atomoxetine is a noradrenaline reuptake inhibitor. It is recommended for ADHD refractory to Methylphenidate or in those who it is not appropriate due to risk factors or development of side effects. Development of facial tics is an indication to change medications
what Is a sign of congestive heart failure in infants
hepatomegaly
as they are so small it is easy to palpate the edges of the liver
which murmer is often heard with turners and what is the cause
ejection systolic murmur
due to radio femoral delay from correction of the aorta
what should you do if a child has ingested a foreign object and there is no distress
watch and wait for it to pass
Foreign bodies ingested into the stomach or small intestine will not be visible on a chest X-ray.
what are the two main things you should measure if someone is started on a stimulant medication
height and weight and they should be monitored twice a year
which is more extreme conduct disorder or oppositional defiant disorder
Conduct disorder is characterised by repetitive and persistent antisocial behaviours, including physical aggression towards people and animals, and destruction of property, often leading to disciplinary problems at school or involvement with the law.
it is more severe than oppositional defiant
what abnormality is found with a patent ductus arteriosis
A collapsing pulse arises from the increased pressure gradients and a continuous murmur from turbulent flow across the ductus arteriosus.
machinery murmer
what is a blood test marker for bacterial sepsis
Procalcitonin
which is the correct dose of adrenaline in children between 6-12
300 micrograms 1:1000 IM adrenaline
how can you collect urine in children when its hard to collect
urine pad
intususception key features
- abdominal colicky pain - child draws up their legs
- vomiting
- blood stained mucus stool
- sausage shaped mass in right lilac fossa
- distended abdomen
- lethargy and pallor in between episodes
treat:
NG tube and fluids
air enema
what is a common sign on X-ray seen with intususseption
target sign
A 6 year old girl is brought to A&E by her mother with worsening chickenpox and a painful left leg. She has been recovering from chickenpox over the past week, with a vesicular rash that spread from her torso to her back and both legs. Over the past day, she has been suffering fevers, lethargy and the lesions on her left leg have become blistered with surrounding erythema.
She has a temperature of 39.2ºC. On examination, there is erythema over the left leg which is visibly swollen, extremely tender on palpation and there is evidence of crepitus when palpating surrounding tissues.
what does she have and what is the organism causing this
This child is presenting with features of necrotising fasciitis, a life-threatening soft tissue infection characterised by severe pain, erythema, swelling, and crepitus due to subcutaneous gas. S. pyogenes, a Group A Streptococcus, is a common cause, particularly following skin breaches such as the vesicles of chickenpox, which provide a portal of entry.
what is a common bacterial cause of mesenteric adenitis
Yersinia enterocolitica is the most common cause of mesenteric adenitis, often following a respiratory infection in adolescents.
what condition tends to precede mesenteric adenitis
upper resp tract infection
A 1-day-old infant presents with abdominal distension and bilious green vomiting. The infant has not passed stool. Abdomen examination shows distension with no palpable mass. A plain abdominal radiograph demonstrates dilated loops of bowel filled with meconium.
Meconium ileus is a condition in which the meconium becomes thick and sticky and obstructs the distal ileum, causing distension of the proximal bowel. It is most commonly associated with cystic fibrosis.
what does perthes disease show on X-ray
Diagnosed via hip X-ray showing sclerosis and fragmentation of the epiphysis
if a baby presents with GORD what should be trialed
alginate (gaviscon)
in breastfed babies, or reducing the volume of feeds and increasing their frequency in formula-fed babies, before trialling a thickener and later an alginate.
what crisis can paravirus B19 cause
aplastic anemia - body stops producing new red blood cells
if children present with global developmental delay what should you do as a first line investigation
genetic karyotyping
what is the most common complication of measles
pneumonia in 5-10% of measles cases.
The features of life-threatening asthma
33,92 CHEST. Any one of the following:
PEF <33%
SO2 <92% or PO2 <8
Cyanosis
Hypotension
Exhaustion, altered consciousness
Silent chest
Tachyarrhythmias
what is the treatment for pyloric stenosis
Laparoscopic pyloromyotomy
to do before: Often infants will have low potassium and low sodium from vomiting and dehydration. This must be corrected. There may be hypochloraemic alkalosis. Definitive treatment is surgical, with division of the hypertrophied pylorus
when should you start immunisations in a preterm baby
Preterm infants, regardless of their gestational age at birth, should begin vaccinations according to the routine immunisation schedule at their chronological age, unless contraindicated.
if a meningococcal infection is suspected in children what are the immediate options for treatment
you want to try and get antibiotics in them as soon as possible
if they dont have IV access you can give them IM benzylpenicillin
how long is measles often infective
usually 4 days after the onset of the rash
patients with sickle cell are at a higher risk of becoming infection from which species
salmonella
in tetrology of fallot which defect will suggest worse cyanosis
the pulmonary stenosis
if there is more stenosis then less blood is reaching the lungs to be oxygenated and hence the worse the cyanosis will be
treatment for widespread non bullous impetigo
- topical fusidic acid 2% for 5 days
what is the cut off age for a child to be sent straight to ANE for a urinary tract infection
if less than three months of age then they should be given IV antibiotics most likely VUR
in children with minimal change disease what is the treatment escalation plan
- offer oral high dose steroids
- stop the steroids and offer ciclosporin an immunosuppressant
what can maternal pre eclampsia lead to and why
meconium aspiration syndrome - it often leads to placental insufficiency, which results in fetal hypoxia (low oxygen levels), causing the fetus to pass meconium in the womb,
what does meconium aspiration syndrome show on X-ray
Bilateral patchy infiltrates
when should babies be offered Vit K
IM vit K on the first day of life
FeNO of which level is diagnostic of asthma
35
in whooping cough which antibiotic reduces the period of infectivity
clarithromycin
what is the most common complication of sickle cell in children
vaso - occlusive crisis
in bronchiolitis when do you offer oxygen therapy
when their oxygen stats are only below 90% and child must be over 6 weeks
they may be in slight respiratory distress but that’s fine this doesn’t mean they need oxygen
if a child is found to have misalignment in their eyes what should be the first step
referral to ophthalmologist
in croup if there is sign of airway compromise what should you give
nebulised adrenaline over IV adrenaline
what is a common history of strangulated hernia
vomiting and is complaining of abdominal pain. The abdominal pain has come intermittently in the past but is now acutely worsening. He does not complain of pain on passing urine.
generalised tenderness that is worse on palpation in the inguinal region. On palpation, there is a mass in the right inguinal region.
what is the pattern of measles
- fever cough and runny nose
- rash starts at the forehead and then proceeds to continue downwards
3.kolpilok spots on the buccal mucosa
what is the appropriate investigation for muscular dystropy
genetic testing - deletions of the dystrophin gene.
in primary care CK levels may be looked at
when should the moros reflex disappear
by 6 months
if a young boy presents with abdominal pain with no history of trauma what should your first consideration be
testicular tortion
children with coeliacs disease are at an increased risk of what malignancy
MALT
lymphomas
what is the best test to determine Reyes syndrome
live biopsy showing hepatocyte microvesicular steatosis
how long should children with impetigo be kept off school
48 hours or until lesions are all crusted over
what is the cause of early onset sepsis in neonates vs late onset
early onset - Streptococcus agalactiae
late onest - Staphylococcus aureus
if a child is suspecting a delay in their fine motor skills what is the issue and what test could have been done to prevent it
issues with fine motor skills means issue with vision this should have been detected during their newborn screening exam of the eyes looking for coingentinal cataracts and retinoblastoma
what is the most common heart defect in turners
bicuspid aortic valve, which may lead to aortic stenosis or regurgitation.
haematuria, hypertension, fever and an abdominal mass are key features of a
nephroblastoma
acute lymphoblastic leukaemia is commonly seen in which condition
downs syndrome
causes of bilious vomiting
malrotation, duodenal atresia and meconium ileus.
what is the incubation period for chicken pox
up to 21 days
when to do an US vs a MCUG
MCUG usually up to 6 months
if a baby presents with a UTI first line is an US
if the US comes back as abnormal or they don’t respond to antibiotics in 48 hours consider a MCUG
children with sickle cell should receive which extra vaccine
they should receive all the usual vaccines and on top meningococcal conjugate vaccine meningococcal serogroups A, C, W, and Y,
if there is positive findings for developmental hip dysplasia in the newborn examination check what is the nextstep
hip US when the baby is between 4-6 weeks old
slipped femoral epiphysis often presents with which limitation and what often causes it
limitation of internal rotation due to pain. treatment with growth hormone
what is the treatment of duodenal atresia
Duodenoduodenostomy
reduced feeding, bile-stained vomiting, abdominal distension, and passage of ‘redcurrant jelly’ stool (with blood-stained mucus). The pain is often intermittent and is severe during attacks. A classic ‘target’ sign on abdominal ultrasound is seen as concentric echogenic and hypogenic bands, demonstrating the invagination of a bowel segment into an adjacent one.
intususseption
treatment of scarlet fever
10 day course of phenoxymethylpenicllin
how does measles present
- fevers above 40
- coryza symptoms
- rash start at forehead behind the ears
- conjunctivitis 2-5 days after the onset of symptoms
which symptoms would make you think to refer a child to haematology
bruising, enlarged lymph nodes and systemic illness should be referred for specialist assessment to investigate for acute lymphocytic leukaemia.
what is the criteria for complex febrile seizure
2 seizures in less than 24 hours as part of the same febrile illness.
which organism causes meningococcal septicaemia
neisseria meningitidis
which gram stain in nesisseria meningitidis
gram-negative intracellular diplococcus.
Waterhouse-Friderichsen syndrome
massive adrenal haemorrhage and septic shock, the presentation is known as Waterhouse-Friderichsen syndrome
in neisseria meningitidis
treatment for meningococcal infection and treatment to prevent spread
benzylpenicillin as a dose in GP
in hospital cerftriaxone for 7-10 days IV
and to prevent spread ciprofloxacin
hypotonia, macroglossia, an umbilical hernia, reduced feeding and constipation
symptoms of congenital hypothyroidism
for a child on methylphenidate what is something you must regularly measure With them
height every 6 months
how to calculate maintenance fluid in children eg child is 32 kg
100 ml/kg/day for the first 10 kg of bodyweight
50 ml/kg/day for the second 10 kg of bodyweight
Remaining bodyweight at 20 ml/kg/day
Therefore, this patient requires (100 x 10 kg) + (50 x 10 kg) + (20 x 12kg) = 1740 ml/day of maintenance fluids.
which presentation causes developmental hip dysplasia to be more common
breech
what are some features of Prader willi syndrome
This is the correct answer. This girl with progressive obesity, hyperphagia, short stature and learning difficulties on a background of hypotonia which would have caused difficulty breastfeeding as an infant, most likely has a diagnosis of Prader-Willi syndrome. Parents of children with Prader-Willi syndrome often report that their child will eat anything and everything and will be consistently hungry
treatment for bacterial otitis media
5-7 day course of amoxicillin
what is the most common cause for acute onset of diarrhoea and vomiting in children
norovirus
when should you stop phototherapy
Stop phototherapy and recheck bilirubin levels in 12-18 hours time. If bilirubin remains >50 micromoles/L below treatment threshold at this time, no further monitoring is needed
if a newborn presents with a squint what is the next appropriate step
Refer if still present at 8 weeks
This is the recommendation for a squint in a newborn. Many children have a squint in the first few weeks of life as the muscles are still weak. However, most babies grow out of it quickly. A squint persisting beyond 8 weeks is suspicious and treatment and investigations need to start as soon as possible to ensure the child does not develop amblyopia
what is a key diagnostic feature of ALL
more than 20% blast cells in the bone marrow
Which of the following features would point more towards a diagnosis of Henoch–Schönlein purpura (HSP) than immune thrombocytopenia purpura (ITP)?
Proteinuria
Renal impairment is not a recognised feature of ITP, so proteinuria and haematuria would point more towards a diagnosis of HSP. This is because around 40–50% of patients with HSP can develop renal disease, varying from mild haematuria or proteinuria to severe renal failure.
if a mother is taking amiodarone can she breast feed
no
how should children with HSP be followed up
regular urine dip for 12 months to check for haematuria and proteinuria
if neonate is has a high risk factor for high bilirubin (breast fed) and has symptoms of high bilirubin and you check their bilirubin levels and they are below threshold what do you do
if bilirubin levels are within 50 units of criteria they should be rechecked within 18 hours and be kept in hospital
In an adolescent, localised pain of several months duration with no traumatic event or associated injury and an associated mass on examination is highly suggestive of which bone abnormality
osteosarcoma
what can a hydrocele that hasn’t resolved in 1-2 years be a risk factor of
indirect inguinal hernia as the processus vaginalis fails to close
what type of hypersensitivity reaction is asthma
type 1
which antibiotics need to be given immediately in epiglottis
Intravenous cefuroxime
in slapped cheek syndrome when are they no longer infectious
once the rash appears on face and torso
what is equivalent to the two week wait in peads
48 hour scan/review
what is the tetrad of symptoms in HSP
joint pain, abdominal pain, rash, and kidney impairment.
child has autoimmune hypothyroidism what is she at risk of
other autoimmune conditions
such as vitiligo
type 1 diabetes, rheumatoid arthritis
juvenile idiopathic arthritis is commonly associated with which condition
anterior uveitis
if a child has a milk allergy what can they be given
hydrolysed formula casein-based peptide
most common cause of croup
parainfluenza
Which of the following routinely tested for substances is raised in physiological jaundice?
During physiological neonatal jaundice, raised levels of unconjugated bilirubin occur for two main reasons. Firstly, the presence of foetal erythrocytes (red blood cells) in the neonate which are present in a higher volume and have a higher turnover than adult erythrocytes, thus creating higher levels of bilirubin on breakdown.
Secondly, the immature liver of newborn infants is not able to metabolise unconjugated bilirubin into conjugated bilirubin for excretion into the gastrointestinal tract as quickly. Therefore, it is relatively common for neonates to experience temporarily raised levels of unconjugated bilirubin, known as physiological jaundice
babies that drink cows milk before the age of one are at risk of which deficiency
iron
If a child presents with asthma what are some testing that can be done apart from diagnostic testing.
allergy testing - this is a big part of asthma
food allergy
allergy to materials
what allergies may a child under 1 present with if they have asthma later on in life
cows milk allergy - presenting with GI symptoms along with eczema
when should you give someone some IV mg sulphate in an asthma attack
within 1 hour
what birth delivery makes children more prone to asthma
C section
what are some questions that should be asked in a history of asthma
- how often does it affect day to day
- does it affect going into school
- does it affect activities in school
- how many times do you need to take your inhaler
what are some hypersensitivity reactions
Asthma
Atopic eczema
Allergic rhinitis
Hayfever
Food allergies
Animal allergies
which IG is associated with allergy
IGE
after someone has had an anaphylactic reaction what can be done to confirm it
at 6 hours measure mast cell tryptase
what can a severe exacerbation of asthma lead to
pneumothorax, so if despite treatment its not improving then can consider a chest x ray to rule out pneumothorax
cows milk intolerance vs cows milk allergy
intolerance -> can drink cows milk and still flourish but will have GI symtoms
allergy -> will have GI features AND allergic signs so mum will have to go dairy free or have hydrolysed formula feeds
when do children usually grow out of cows milk allergy
3 yrs
blood tests and screening for children with recurrent infections
Full blood count: low neutrophils suggest a phagocytic disorder and low lymphocytes suggest a T cell disorder
Immunoglobulins: abnormalities suggest a B cell disorders
Complement proteins: abnormalities suggest a complement disorder
Antibody responses to vaccines, specifically pneumococcal and haemophilus vaccines
HIV test if clinically relevant
Chest xray for scarring from previous chest infections
Sweat test for cystic fibrosis
CT chest for bronchiectasis
what is the difference between viral and bacterial gastroenteritis
bacterial often presents with blood and mucus in stool and will have systemic signs of a high fever
will have high WCC, neutrophil, CRP
in which gastroenteritis would you do a blood culture in
bacterial
what are some differentials for pyloric stenosis
- GORD
- cows milk intolerance or allergy
how much weight does a neonate usually lose
10% over first 10 days
what are some of the key investigations for pyloric stenosis
- US
- palpate and can feel an olive shaped mass and feel an empty stomach
- venous blood gas
In an infant what is the fluid you usually give
0.45% Nacl, 10% dextrose and 10 mmil in 500ml of kcl
septic arthritis is it worth doing a joint aspirate
to do this you have to take them into surgery under GA and then take aspirate and clean out so often just clinical
common causes staph aureus and strep pyogenes
what is the fluclox regime in septic arthritis
- first two weeks in hospital IV
- last four weeks oral
compare a bag of fluids given to children vs adults
500ml of fluid in children
1L of fluid in adults
on a paediatrics prescription what do you always need to write on it
childs AGE
what is tumour lysis syndrome
when a person starts chemo, the rapid breakdown of the tumour can cause a lifethreatning response
it can cause raised serum potassium
describe the rash in HSP
- palpable
- symmetrical
- maculopapular
over buttocks and extensor surfaces
when does perthes disease usually present
young boys, key is if there is not history of trauma
some key features of bacterial pneumonia
- high fever
- localised pain
- abdominal pain
- age over 2
- absence of wheeze and rhinorrhoea
if a child presents with difficulty breathing due ti an inhaled foreign body what is the immediate management
rigid bronchoscopy
what is the genetic predisposition for ALL
t(12:21)
in ALL what are some of the immediate treatment options
- offer steroids if there is a mass in the mediastinum
- offer fluid rescus if acutely unwell do to high viscosity of the blood from the High WCC
if a baby has malrotation what scan can be done to confirm diagnosis
Upper gastrointestinal contrast study
what is the initial management for NEC
give some IV antibiotics
and parenteral nutrition
which vaccine is offered to all asthmatic patients
influenza
if children are on systemic corticosteroids and repeated doses then they can be given the pneumococcal vaccine
what is a big differential for slapped cheek that is important to consider
NAI
measles incubation period till appearance of temp
till appearance of rash
temp - 10 days
rash - 10 + 4 days
how much monitoring does a child need with HSP
3 months
if you struggle to collect blood from a child in sepsis what are the two tests you must prioritise collecting
blood sugar
blood culture
others would be venous blood gas, FBC, U+E, LFT, CRP …
meningococcal pcr
differentials for croup
bacterial tracheitis
foreign body
croup
when do children grow out of laryngomalacia
after 1 yr
EEG in absence epilepsy
3hz spike and wave
infantile spasm EEG
hypsarrhytmia
Previously well; mild URTI 1 week ago.
Rash appeared on front and back last night.
Rash more extensive this morning.
Noticed a blood blister on tongue.
No nose bleeds; no joint swelling.
Surprisingly well despite rash.
ITP secondary to glandular fever
protein losing enteropathy
what age group need an US for a UTI
if they are under 6 months then they need an US within 6 weeks, if they then have recurrent UTIs or they dont respond to antibiotics then need to consider a MCUG
what can the results of a urine dipstick be for proof of a UTI
leukocyte + nitrate +
leukocyte + nitrate -
leukocyte - nitrate +
risk factors for severe asthma
Previous near-fatal asthma e.g. previous ventilation or respiratory acidosis.
* Previous admissions for asthma, especially in the last year.
* Requiring three or more classes of asthma medication.
* Heavy use of SABA.
* Repeated attendances at ED for asthma care, especially in the past year.
* Brittle asthma.
features of GLOMERULAR heamaturia
Rusty or Coca-Cola colour
Usually painless
Oliguria and hypertension may be present
Urine microscopy:
* Small and dysmorphic RBC
* Red cell casts
* Spikes/blebs on RBC
* Loss of RBC circumferential halo
features of non glomerular heamaturia
Red or cranberry colour
Usually painful, but also painless
Urine microscopy:
* Monomorphic RBC
* No casts
* No spikes
* RBC circumferential halo present
in CKD what are some features seen in kids
- high urea leads to;
- increased bleeding
- learning impairment
low epo
- anemia
- growth restriction
CVS impairment
- hypertension
name some neurodevelopment disorders
- they affect the way the brain develops and can affect a persons learning and behaviour
- ADHD
- autism
- CP
- conduct disorders
what is the rule of two when it comes to investigating lymphadenopathy
> 2 LN palpable for >2 weeks
2cm in size / vary in size
2 or more regions affected
Unilateral supra-clavicular lymph nodes. - Palpable lymph nodes in this location
always need investigation as they may associated with malignancy
variable sizes suggest TB
key features of septic arthritis and some key investigations
- acute
- temperature
- inability to weight bear
- CRP, blood culture, US and Xray AP and lateral of the hip
US - JOINT EFFUSION in sepsis
Xray - baseline
if there is raised ICP and you need further investigation which is the next step
CT head, as you can then see if you are able to do a lunar puncture, doing a lumbar puncture before can lead to a brain herniation
what sign is seen in hirchsprungs disease
squirt sign, DRE leads to explosive poo
what Is the most common feature of turners syndrome
short stature
what lymphoma is associated with coeliacs disease
EATL lymphoma
why can some babies have small bruising with biliary atresia
due to low vitamin K from malabsorption of the fat soluble vitamins such as ADEK
