Random Flashcards
1
Q
Strawberry tongue
Complications of this condition?
Management of this condition ?
A
Kawasaki Disease
- swollen erythrmatous tongue, conjunctival injection , high grade fever < 5 days ,
Conplications - Coronary Artery Aneurysm
Management - High dose aspirin, IVIG, Echo
2
Q
Steroid use in children with acute asthma exacerbation
A
All children should have steroids for 3-5 days
2-5 years old 20mg OD
> 5 years old 30-40 mg OD
3
Q
Biochemical abnormalities in Congenital Adrenal Hyperplasia
A
Raised:
Plasma 17 hydroxyprogesterone lebels
Plasma 21 deoxycortisol levels
Urinary adrenocorticosteroid metabolites
4
Q
Management of croup
A
Single dose oral dexamethasone (0.15/kg) to all children (pred if no dex)
- high flow oxygen and nebuliser adrenaline
5
Q
Common causes of loss of red eye reflex in children
A
Congenital cataract
Retinoblastoma
6
Q
First step of asthma management
A
Very low dose inhaled corticosteroid
2nd step - >5 years add a LABA and if 5< add a LRA
laBa for BIG kids
3rd Step-
>5 and good LABA response = increase LABA dose
>5 poor LABA response = stop LABA and increase steroid dose
4th step - increase steroid dose
5th step - PDI
7
Q
Prematurity is a major risk factor for what condition in a neonate
A
Neonatal respiratory distress syndrome
8
Q
C Section is the major risk factor for which neonatal condition
A
transient tachypnoea of the newborn
9
Q
Management of paediatric constipation
A
First line is osmotic laxative or if fecal impaction is present give polyethylene glycol 3350 and electrolytes
Second line give stimulant laxative
10
Q
Projectile non bile stained vomiting
A
Pyloric Stenosis
Dx: Test Feed or USS
Ranstedt Pyloromyotomy
11
Q
Central abdominal Pain
URTI
A
Mesenteric Adenitis
Conservative
12
Q
7 month old
Colicky Pain
Palpable mass
A
Intussusception
Tx: Reduction with air insufflation
13
Q
Recurrent abdominal Pain
Acute presentation with volvulus
A
Malrotation
Need surgery and ladds procedure if concern about future volvulus
14
Q
Abdominal distension and delayed passage of meconium
A
Hirschprung’s disease
Tx: Rectal washouts and then anorectal pullthrough
15
Q
Choking and vomiting spells following food consumption
A
Oesophageal atresia
16
Q
Delayed passage of meconium and abdominal distension
Rectal contrast studies can be therapeutic
A
meconium ileus
- Viscous stools
- often CF related
- NG N Acetyl cysteine
- Surgery
17
Q
Jaundice >14 days
Increased conjugated bilirubin
A
Biliary Atresia
Kasai Procedure
18
Q
Premature
Abdi distension and haematochezia
A
Necrotising Enterocolitis
- Pneumatosis Instestinalis And free air on AXR
TX - Gut rest, TPN
- Laporatomy if perforation
19
Q
Febrile under 3 month screen
A
FBC blood culture CRP Urine dip CXR - if respirstory signs Stool culture - if diarrhoea
20
Q
Temperature monitoring :
< 4 Weeks?
> 4 weeks?
A
< 4 weeks: Electronic thermometer in axilla
> 4 weeks: Electronic/ Chemical in axilla or infrared tympanic thermometer
21
Q
What HLA association with coeliac’s?
A
DQ2 + DQ8
22
Q
Organisms which may colonies CF patients
A
Staph aureus
pseudomonas aureg
burkholderia cepacia
aspergillus
23
Q
Systolic Murmur In pulmonary area
fixed splitting of second heart sound
A
Atrial Septal Defect
24
Q
Craniofacial haematoma developing after birth
Doesn’t cross suture line
A
Cephalhaematoma
- blood is intra- periosteal
25
Present at birth
Crosses suture lines
Resolves in days
Caput Succaedaneum
| - Blood crosses suture lines
26
Boggy swelling
| Crosses sutures
Supaponeurotic haemorrhage
| - can have hawmorrhagic shock
27
Birth trauma associated with ventouse device in delivery
Chignon
28
Perinephric abscess:
Do they typically have anterior or posterior extension?
Posterior
Unlikely to feel a mass on abdominal examination
29
First line anti epileptic in :
Generalized seizures
Partial seizures
General: Sodium Valproate
Partial: Carbamezapine
30
Which of the following anti epileptics interact with CYP450?
Sodium Valproate
Carbamezapine
Lamotrigine
Phenytoin
Sodium Valproate - Inhibitor
Carbamezapine and Phenytoin - Inducers
Lamotrigine - no interaction
31
Dose of adrenaline in anaphylaxis:
<6 years
6-12 years
12< years
<6 years - 150 mcg
6-12 years - 300 mcg
12< - 500 mcg
32
BTS Asthma guidelines:
After Very Low dose ICS + SABA PRN.
Next Step in:
<5 years old
>5 years old
<5 years old : Leukotriene receptor agonist
| >5 years old: LABA
33
Girls or boys more at risk from SIDS?
Boys
34
Most common fractures associated with NAI
Radial
Humeral
Femoral
NAI Management:
Ix: Skeletal Survey, CT Head, Urine Dipstick, LFTs,
Involve police and social services
35
What is the largest cause for cerebral palsy?
i) Antenatal factors
ii) intrapartum factors
ii) postnatal
It is thought antenatal causes are the reason for 80% of cerebral palsy
36
Four broad categories for cerebral palsy
Spastic
DyskinetiC
Ataxic
Mixed
37
in what type of nappy rash are flexural creases spared?
Irritant Dermatitis
```
Other nappy rashes:
Seborrhoeic Dermatitis
Candida Dermatitis (in flexures and characteristic satellites)
atopic eczema
psoriasis
```
38
Condition where ureters are laterally displaces and enter the bladder more perpendicularly than is normal
Vesicouereteric reflux
- diagnosed with micturating cystourethrogram and a DMSA scan to screen for renal scarring
1-5 staging system
- I: Reflex into the ureter only, no dilatation
- II; Reflux into the renal pelvis on micturition, no dilatation
- III: Mild/moderate dilatation of the ureter, renal pelvis and cal yes
- IV: Dilation of the renal pelvis and calyces with moderate urethral tortuosity
- V: Gross dilatation or the ureter, pelvis and calyces with ureteral tortuosity
39
Treatment of whooping cough?
Diagnosis?
Bordatella Pertussis: Gram Negative bacterium
History; cough worse at night and after feeding. Inspiratory whoop. Lymphocytosis
Diagnosis - Per nasal swap, PCR and serology becoming increasingly available to increase diagnosis time
Macrolide - although not shown to alter disease course. Give if onset of cough is within 21 days.
40
What findings should prompt hospital referral for bronchiolitis
(7)
```
Less than 50% of normal
food intake
Lethargy
Apnoea
RR >70
Signs of increased respiratory effort
cyanosis
O2 Sats <94%
Uncertain diagnosis
```
41
NRDS:
RFs
(5)
Prematuratity!
26-28 weeks : 50%
30-31 weeks : 25%
Male babies
Diabetic mothers
C Section
Second of premature twins
Ix: CXR - Ground glass appearance
42
Impetigo caused By MRSA:
Treatment?
Topical mupirocin (Bactroban)
USUALLY (non- MRSA)
Flucloxacillin
macrolide
43
Posterior displacement of tongue
Pierre Robin Syndrome
44
Link each of these cardiac defects which childhood syndrome:
Supravalvular Aortic Stenosis
Pulmonary Stenosis
SVAS - William's Syndrome
| Pulmonary Stenosis - Noonan's syndrome
45
Guthrie Test:
When performed?
What conditions? (9)
5-9 days postnatally
```
Congenital Hypotjyroidism
CF
Sickle cell
phenylketonuria
MCADD
maple syrup urine disease
isovaleric acidaemia
Glutamic aciduria type 1
homocysteinuria
```
46
Erythematous
Raised
Multilobed
Capillary Haemangioma
- Increase in size until 6-9 months and then regresses
- can present in the upper respiratory tract
Cavernous Haemangiomas are deep capillary hameangiomas
47
Features of an innocent murmur
```
Soft
Varies with posture
Localised with no radiation
Non Diastolic
No Thrill
No added sounds
Asymptomatic
```
48
Flat purple lesion
| present since birth
Port Wine stain capillary malformation
- Don't resolve spontaneously
49
What type of GN?
- Goodpasture's
- ANCA positive vasculitis
Rapidly progressive glomerulonephritis
- ie crescenteric
Nephritic syndrome
50
Berger's Disease
| IGA nephropathy
Mesangioproliferative GN
- Nephritic Syndrome
51
Post Streptococcal GN
| Renal Disease in SLE
Diffuse proliferative glomerulonephritis
| - Mixed nephritic and nephrotic
52
cryoglobulinaemia, Hep C, Partial lipodystrophy
Membranoproliferative GN (mesangiocapillary)
53
Renal disease caused by:
Hodgkins
NSAID
minimal change disease:
nephrotic syndrome
54
Renal disease caused by:
infection
rheumatoid drugs
malignancy
membranous GN
- nephrotic syndrome
55
Renal disease caused by:
Heroin
HIV
Idiopathic
Focal Segmental Glomerulosclerosis
| - nephrotic syndrome
56
Which drugs should be excluded in breast feeding
| 7
```
Antibiotics- cipro, tetra, chloramphenicol, sulphonamides
Psychiatric- lithium, benzos
Aspirin
Carbimazole
Sulphonureas
Cytotoxic Drugs
Amiodarone
```
57
Absence Seizures:
Prognosis?
Management?
90-95% stop by the time adulthood
Management: Sodium Valproate and ethosuximide
58
How do you assess obesity in a child?
NICE Recommends uing the UK 1990 BMI charts
BMI : above 91st centile consider intervening
BMI : above 98th centile start looking for comorbodities
59
Childhood causes of obesity
```
GH Deficiency
Hypothyroidism
Down's Syndrom
Cushing's Syndrome
Prader-Willi Syndrome
```
60
Risk factors for developmental dysplasia of the hip (7)
```
Female
Breech
Family history
first child
oligohydramnios
BW>5kg
Congenital calcaneovalgus foot deformity
```
61
Path behind acne vulgaris?
What organism?
Obstruction of pilosebaceous follicle with keratin plugs. Comeodones,, inflammation and pustules.
80% of adolescents
and is more common in females beyond age of 25
Anaerobe- propinitobacterium acnes
62
Undescended Testes:
When to refer?
When to operate?
Refer: 6 months
Operate: 12 months
Orchidopexy
63
Features of anorexia
Most things low - LH, FSH, Hypokalaemia
Gs and Cs Raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
64
```
Neonate
Breathessness on exhaustion
Sweating
Poor Feeding
Chest Infections
```
HEART FAILURE
- Most commonly VSD
Cyanotic heart disease:
- TOF
- TGA
- Tricuspid atresia
65
Blocked or vastly reduced GnRH release from the hypothalamus
Kallmann's Syndrome
- delayed puberty
- history of undescended testes
- primary amennorhoea
- anosmia
- other congenital abnormalities
66
Feeding intolerance
Abdominal distension
Haematochezia
Necrotising Enteroclitis
AXR:
- dilated loops of bowel, bowel wall oedema, signs of bowel perforation
Antibiotic therapy
67
List features of cystic fibrosis:
presentation
later features
presentation:
meconium ileus
RTIs
steatorrhoea, FTT
Hepatic pathology
Later features:
```
short stature
DM
Delayed puberty
Rectal prolapse
nasal polyps
male infertility, female subfertility
```
68
Contraindications to MMR? (5)
Immunosuppression
Having had another live vaccine within 4 weeks
Neomycin Allergy
Avoid conception within a month after having vaccine
IG therapy within past 3 months - interferes with immune response to the vaccine
69
Loss of function of a TS gene on chromosome 13
Retinoblastoma
- most common ocular malignancy in children
- 10% cases are hereditary
- absence of red reflex is most common presentation
- Mx - enucleation or external beam radiation therapy
70
Coronary Artery Aneurysms are a complication of:
```
Croup
Parvovirus B19 infection
Measles Infection
Kawasaki Disease
Henlock Shonein Purpura
```
Kawasaki disease
- echo is an important investigation
Mx:
High dose aspirin
IVIG
Echocardiogram
71
Mx of Kawasaki disease:
| 3 things
High dose aspirin
IVIG
Echocardiogram
72
# Define precious puberty:
Boys
| Girls
Boys <9 years old
- rare and usually has organic cause
Girls <8 years old
- familial/idiopathic and is benign
Precocious puberty can be categorised into:
Gonadotrophin dependent causes - premature activation of HPGA
Gonadoptrophin independent - sex hormone excess
73
Features of migraines in children
Shorter Lasting
Bilateral
GI Disturbance
74
Commonest paediatric cause of nephrotic syndrome
Minimal change glomerulonephritis - T Cell cytoke mediated damage to GBM
```
Cause:
Idiopathic (80%)
Drugs: NSAIDs, rifampicin
Hodkin's, Thymoma
Infectious Mono
```
Mx: Steroids, Cyclophosphamide
- stop before adulthood
- 1/3 have one episode, 1/3 have infrequent replases, 1/3 have frequent relapses
Renal biopsy only really indicated if steroid response is poor
75
What constitutes a prolonged jaundice screen?
| When should it be instituted?
Should be instituted after 14 days of life if still jaundiced. Being jaundiced between 2-14 days is common.
Screen:
Bilirubin - Raised conjugated = biliary atresia
DAT - HA
TFTs - Hypothyroidism
FBC and blood film - infections
Urine :MC&s, reducing sugars (galactosaemia)
Us&Es and LFTs
76
Most common presenting feature in Wilm's Tumour?
Abdominal Mass
Other features:
- painless haematuria
- flank pain
- fever
- unilateral
- lung mets are common
- associated with: beckwith-wiedemann syndrome, WAGR syndrome
77
Maintenance fluid for children
100 ml / kg for first 10 kg
50 ml / kg for second 10 kg
20 ml / kg for subsequent kgs
78
Which hearing test is performed at school entry?
Pure tone audiometry
Hearing Tests and relevant ages:
Newborn - Otoacoustic emission
Newborn/Infant - Auditory Brainstem Response Test
6-9 months - Distraction Test
18 months- 30 months - Recognition of familiar objects
>2.5 years - performance testing
>2.5 years - speech discrimination tests (similar sounding objects)
>3 years - pure tone audiometry (school entry)
79
Mucocutaneous lesions and iron deficiency anaemia are seen in which two conditions?
Peutz Jeger Syndrome - Pigmented intestinal polyps
Hereditary Haemorrhagic Telangiectasia
80
Cutaneous manifestations of Tuberous Sclerosis
Leaf Spots - depigmented patches
Shagreen Patches - roughened lumbar spine
Adenoma Sebaceum - butterfly distribution over nose
Subungual (below nail) fibromata
Cafe au Lait spots
Structural abnormalities in retina, heart, gliomas. polycystic kidneys, lung cysts
81
Opioid + SSRI:
Risk of?
Serotonin Syndrome
82
Sx associated with:
persistent urachus?
persistent vitello-intestinal duct?
Persistent Urachus - bladder discharge (urine) from the umbilicus
Persistent VI Duct - This is on the spectrum of meckel's diverticulum (just persistence of proximal part of the duct). Umbilical discharge of small bowel content.
83
Salmon pink rash
non weight bearing
intermittent fevers
Still's Disease! - the rash and the fevers point to systemic features
Still's disease is basically JIA with extra-articular features
84
Which antidepressant would you initiate in a teenager or child? (after appropriate psychological therapies of course)
Fluoxetine
85
RFs for Developmental Dysplasia of the hip
```
Female
Breech
FH
First child
Oligohydramnios
BW > 5kg
Calcaneovalgus foot deformity
```
86
You notice a baby has a calcaneovalgus foot deformity.
What other developmental abnormalities should you look for?
Developmental Dysplasia of the hip
Calcaneovalgus foot deformity (kind of extreme dorsiflexion)
87
When should you initiate LABA in the asthma management of children 5> ?
You don't
LABA is not licensed in this age group
88
RFs for SIDS
Follow up for cot death?
```
Prematurity
Male Gender
Hyperthermia
Social Class IV and V
Parental smoking
Prone sleeping babies
Multiple births
Bottle feeding
Maternal drug use
Winter months (incidence increases)
```
FU: Work up for sepsis and inborn errors if metabolism
89
Rheumatoid Factor presence in juvenile idiopathic arthritis?
No
JIA is the most common cause of arthritis in <16 year olds
90
Diagnosis of rheumatic fever?
| three categories
Evidence of recent streptococcal infection (strep pyogenes is the organism thought to initiate the immune reaction)
AND
Either 2 major criteria or 1 major and 2 minor criteria
Major Criteria:
- Sydenhams Coreoa
- erythema marginatum
- polyarthritis
- carditis
- subcutaenous nodules
Minor criteria
- arthralgia
- prolonged PR interval
- raised inflammatory markers (ESR and CRP)
- pyrexia
91
Your child comes home from school with a letter saying there has been a measles case in the school. You remember you elected to not get the MMR vaccination and are overcome with panic.
What do you do?
You get the MMR vaccine administered to the child within 72 hours.
92
Symptoms of epistaxis and bruising in a child?
Think about leukaemia!
93
Most common cardiac defect seen in trisomy 21?
```
Endocardial Cushion Defects (40%)
Then:
VSD (30%)
Secundum ASD (10%)
TOF (5%)
PFA (isolated) (5%)
```
94
You diagnose a 2 year old with episodic viral wheeze:
Which two out of these four therapies would you consider (maybe not initially)?
SABA
Inhaled Corticosteroid
Oral Steroid
LABA
SABA and Inhaled Corticosteroid
- you might also consider montelukast
The child will only wheeze with a concurrent URTI.
A second category of patients have multiple trigger wheeze ---> have triggers other than URTIs
95
Contraindications to LP? (6)
```
Dilated Pupils
Abnormal Dolls Eye movements
GCS <9
Papilloedema
Focal Neurology
Relatie Bradycardia and hypertension
```
96
Causes of congenital cyanotic heart disease (3 Ts)
Transposition of Great arteries
Tricuspid atresia
Tetralogy of fallot
97
Features of the following epileptic syndromes:
```
Rolandic
West's Syndrome
Rett Syndrome
Angelman Syndrome
Dravet Syndrome
Lennox-Gastaus Syndrome
```
Rolandic:
- Involve face mouth and speech
- Occur during sleep or just before walkin
- Age 6-8
West's
- hypyssarthymia on EEG, infantile spasms, developmental regression
Rett
- neurodevelopmental effecting girls
- start to regress before 1 years of age
- slowed growth, seizures, hand movements
Angelman
- diagnosed 3-7 years old
- laughter, flappy hand movements, seizures, delay and sleep disturbance
Dravet
- Gradual increase in frequency of seizures.
- Usually have an initial seizure which lasts >5 minutes requiring treatment and associated with a fever
- subsequent fevers don't need to be associated with a fever
Lennox- Gastaut Syndrome
- 2nd- 6th years of life
- frequent seizures of different types, mental retardation, psychological problems.
- very resistant to anti-epileptic medication
98
Management of Cow Milk Protein Allergy?
Most resolve before the age of 5
Categorised into formula fed and breast fed
Formula Fed:
- 1st Line - extensively hydrolysed formula (eHF)
- 2nd line - amino acid based formula
Breast Fed:
- Mum to stop having cow's milk
- eHF when breast feeding stops until 12 months of age at least for 5 months
99
Squint classification
Toward the nose
Temporally
Superiorly
inferiorly
Nose - esotropia
Temporally - exotropia
Superiorly- hypertropia
inferiorly- Hypotropia
100
What is the causative agent for threadworm
Enterobius Vermicularis
- sellotape test
- mebendazole and hygeine measures for entire family
101
keratin plugs
Epidermoid cyst
102
Posterior nasal airway occlusion by soft tissue or bone:
diagnosis?
Symptomology
Choanal atresia
Episodes of cyanosis worse during feeding but worse during crying episodes or when oropharyngeal airway is used
103
Antibodies against Glycoprotein IIb/IIIa or Ib-V-IX complex
ITP
- Follows Viral URTI
- 1-2 weeks
- Can lead to evan's syndrome (where there is a concurrent AIHA)
104
Ebstein's Anomaly:
What is it
What is the cause
Anterior displacement of the posterior leaflets of tricuspid valves
- tricuspid regurgitation (pan systolic)
- Tricuspic stenosis (mid diastolic)
105
Bilirubin measurement in babies:
<24 hours
>24 hours
< 24 hours:
- always pathological
- bilirubin should be measured within 2 hours of suspected jaundice
- phototherapy or exchange transfusion if severe
- Causes: rhesus haemolytic disease, ABO haemolytic disease, hereditary spherocytosis, G6PDD
>24 hours can start to use transcutaneous bilirubin measurement
106
ADHD drugs?
Counselling for drug therapy?
methylphenidate - Norepinephrine-Dopamine reuptake inhibitor
atomexitine - Norepinephrine Reuptake Inhibitor
Counselling:
SEs: Abdo pain, nausea, dyspepsia. 6 monthly growth monitoring, psychiatric monitoring and BP/HR measurements.
107
MAB against RSV?
Palivizumab
108
Management of scarlet fever
Complications (3)
Scarlet fever is an immunological reaction to strep pyogones
- Oral Pen V or Azithromycin
Notifiable disease.
Complications:
i) Otitis Media
ii) Rheumatic Fever
iii) Acute glomerulonephritis
109
Chickenpox school exclusion?
Wait until all lesions crusted over.
management: Calamine lotion,
Newborn / Immunocompromised: VZIG in immunocompromised for prophylaxis, IV aciclovir to treat
