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Paediatrics from passmed > Random > Flashcards

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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

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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

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3
Q

Biochemical abnormalities in Congenital Adrenal Hyperplasia

A

Raised:

Plasma 17 hydroxyprogesterone lebels
Plasma 21 deoxycortisol levels
Urinary adrenocorticosteroid metabolites

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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
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5
Q

Common causes of loss of red eye reflex in children

A

Congenital cataract

Retinoblastoma

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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

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7
Q

Prematurity is a major risk factor for what condition in a neonate

A

Neonatal respiratory distress syndrome

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8
Q

C Section is the major risk factor for which neonatal condition

A

transient tachypnoea of the newborn

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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

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10
Q

Projectile non bile stained vomiting

A

Pyloric Stenosis

Dx: Test Feed or USS

Ranstedt Pyloromyotomy

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11
Q

Central abdominal Pain

URTI

A

Mesenteric Adenitis

Conservative

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12
Q

7 month old
Colicky Pain
Palpable mass

A

Intussusception

Tx: Reduction with air insufflation

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13
Q

Recurrent abdominal Pain

Acute presentation with volvulus

A

Malrotation

Need surgery and ladds procedure if concern about future volvulus

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14
Q

Abdominal distension and delayed passage of meconium

A

Hirschprung’s disease

Tx: Rectal washouts and then anorectal pullthrough

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15
Q

Choking and vomiting spells following food consumption

A

Oesophageal atresia

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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
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17
Q

Jaundice >14 days

Increased conjugated bilirubin

A

Biliary Atresia

Kasai Procedure

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18
Q

Premature

Abdi distension and haematochezia

A

Necrotising Enterocolitis

  • Pneumatosis Instestinalis And free air on AXR

TX - Gut rest, TPN
- Laporatomy if perforation

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19
Q

Febrile under 3 month screen

A 
FBC
blood culture
CRP
Urine dip 
CXR - if respirstory signs
Stool culture - if diarrhoea
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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

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21
Q

What HLA association with coeliac’s?

A

DQ2 + DQ8

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22
Q

Organisms which may colonies CF patients

A

Staph aureus
pseudomonas aureg
burkholderia cepacia
aspergillus

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23
Q

Systolic Murmur In pulmonary area

fixed splitting of second heart sound

A

Atrial Septal Defect

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24
Q

Craniofacial haematoma developing after birth

Doesn’t cross suture line

A

Cephalhaematoma

  • blood is intra- periosteal
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25
Q

Present at birth
Crosses suture lines
Resolves in days

A

Caput Succaedaneum

- Blood crosses suture lines

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26
Q

Boggy swelling

Crosses sutures

A

Supaponeurotic haemorrhage

- can have hawmorrhagic shock

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27
Q

Birth trauma associated with ventouse device in delivery

A

Chignon

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28
Q

Perinephric abscess:

Do they typically have anterior or posterior extension?

A

Posterior

Unlikely to feel a mass on abdominal examination

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29
Q

First line anti epileptic in :

Generalized seizures

Partial seizures

A

General: Sodium Valproate

Partial: Carbamezapine

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30
Q

Which of the following anti epileptics interact with CYP450?

Sodium Valproate
Carbamezapine
Lamotrigine
Phenytoin

A

Sodium Valproate - Inhibitor
Carbamezapine and Phenytoin - Inducers
Lamotrigine - no interaction

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31
Q

Dose of adrenaline in anaphylaxis:

<6 years
6-12 years
12< years

A

<6 years - 150 mcg
6-12 years - 300 mcg
12< - 500 mcg

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32
Q

BTS Asthma guidelines:

After Very Low dose ICS + SABA PRN.
Next Step in:

<5 years old
>5 years old

A

<5 years old : Leukotriene receptor agonist

>5 years old: LABA

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33
Q

Girls or boys more at risk from SIDS?

A

Boys

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34
Q

Most common fractures associated with NAI

A

Radial
Humeral
Femoral

NAI Management:

Ix: Skeletal Survey, CT Head, Urine Dipstick, LFTs,
Involve police and social services

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35
Q

What is the largest cause for cerebral palsy?

i) Antenatal factors
ii) intrapartum factors
ii) postnatal

A

It is thought antenatal causes are the reason for 80% of cerebral palsy

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36
Q

Four broad categories for cerebral palsy

A

Spastic
DyskinetiC
Ataxic
Mixed

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37
Q

in what type of nappy rash are flexural creases spared?

A

Irritant Dermatitis

Other nappy rashes:
Seborrhoeic Dermatitis
Candida Dermatitis (in flexures and characteristic satellites)
atopic eczema
psoriasis
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38
Q

Condition where ureters are laterally displaces and enter the bladder more perpendicularly than is normal

A

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
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39
Q

Treatment of whooping cough?

Diagnosis?

A

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.

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40
Q

What findings should prompt hospital referral for bronchiolitis

(7)

A 
Less than 50% of normal
food intake 
Lethargy
Apnoea
RR >70
Signs of increased respiratory effort
cyanosis
O2 Sats <94%
Uncertain diagnosis
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41
Q

NRDS:

RFs

(5)

A

Prematuratity!
26-28 weeks : 50%
30-31 weeks : 25%

Male babies
Diabetic mothers
C Section
Second of premature twins

Ix: CXR - Ground glass appearance

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42
Q

Impetigo caused By MRSA:

Treatment?

A

Topical mupirocin (Bactroban)

USUALLY (non- MRSA)

Flucloxacillin
macrolide

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43
Q

Posterior displacement of tongue

A

Pierre Robin Syndrome

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44
Q

Link each of these cardiac defects which childhood syndrome:

Supravalvular Aortic Stenosis
Pulmonary Stenosis

A

SVAS - William’s Syndrome

Pulmonary Stenosis - Noonan’s syndrome

45
Q

Guthrie Test:

When performed?
What conditions? (9)

A

5-9 days postnatally

Congenital Hypotjyroidism
CF
Sickle cell
phenylketonuria
MCADD
maple syrup urine disease
isovaleric acidaemia
Glutamic aciduria type 1
homocysteinuria
46
Q

Erythematous
Raised
Multilobed

A

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
Q

Features of an innocent murmur

A 
Soft
Varies with posture
Localised with no radiation 
Non Diastolic 
No Thrill
No added sounds
Asymptomatic
48
Q

Flat purple lesion

present since birth

A

Port Wine stain capillary malformation

  • Don’t resolve spontaneously
49
Q

What type of GN?

  • Goodpasture’s
  • ANCA positive vasculitis
A

Rapidly progressive glomerulonephritis
- ie crescenteric

Nephritic syndrome

50
Q

Berger’s Disease

IGA nephropathy

A

Mesangioproliferative GN

  • Nephritic Syndrome
51
Q

Post Streptococcal GN

Renal Disease in SLE

A

Diffuse proliferative glomerulonephritis

- Mixed nephritic and nephrotic

52
Q

cryoglobulinaemia, Hep C, Partial lipodystrophy

A

Membranoproliferative GN (mesangiocapillary)

53
Q

Renal disease caused by:

Hodgkins
NSAID

A

minimal change disease:

nephrotic syndrome

54
Q

Renal disease caused by:

infection
rheumatoid drugs
malignancy

A

membranous GN

  • nephrotic syndrome
55
Q

Renal disease caused by:

Heroin
HIV
Idiopathic

A

Focal Segmental Glomerulosclerosis

- nephrotic syndrome

56
Q

Which drugs should be excluded in breast feeding

7

A 
Antibiotics- cipro, tetra, chloramphenicol, sulphonamides
Psychiatric- lithium, benzos 
Aspirin
Carbimazole
Sulphonureas
Cytotoxic Drugs
Amiodarone
57
Q

Absence Seizures:

Prognosis?

Management?

A

90-95% stop by the time adulthood

Management: Sodium Valproate and ethosuximide

58
Q

How do you assess obesity in a child?

A

NICE Recommends uing the UK 1990 BMI charts

BMI : above 91st centile consider intervening
BMI : above 98th centile start looking for comorbodities

59
Q

Childhood causes of obesity

A 
GH Deficiency 
Hypothyroidism
Down's Syndrom
Cushing's Syndrome
Prader-Willi Syndrome
60
Q

Risk factors for developmental dysplasia of the hip (7)

A 
Female
Breech
Family history
first child
oligohydramnios
BW>5kg
Congenital calcaneovalgus foot deformity
61
Q

Path behind acne vulgaris?

What organism?

A

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
Q

Undescended Testes:

When to refer?

When to operate?

A

Refer: 6 months
Operate: 12 months

Orchidopexy

63
Q

Features of anorexia

A

Most things low - LH, FSH, Hypokalaemia

Gs and Cs Raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

64
Q 
Neonate
Breathessness on exhaustion
Sweating 
Poor Feeding
Chest Infections
A

HEART FAILURE
- Most commonly VSD

Cyanotic heart disease:

  • TOF
  • TGA
  • Tricuspid atresia
65
Q

Blocked or vastly reduced GnRH release from the hypothalamus

A

Kallmann’s Syndrome

  • delayed puberty
  • history of undescended testes
  • primary amennorhoea
  • anosmia
  • other congenital abnormalities
66
Q

Feeding intolerance
Abdominal distension
Haematochezia

A

Necrotising Enteroclitis

AXR:
- dilated loops of bowel, bowel wall oedema, signs of bowel perforation

Antibiotic therapy

67
Q

List features of cystic fibrosis:

presentation

later features

A

presentation:

meconium ileus
RTIs
steatorrhoea, FTT
Hepatic pathology

Later features:

short stature
DM
Delayed puberty
Rectal prolapse
nasal polyps
male infertility, female subfertility
68
Q

Contraindications to MMR? (5)

A

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
Q

Loss of function of a TS gene on chromosome 13

A

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
Q

Coronary Artery Aneurysms are a complication of:

Croup
Parvovirus B19 infection
Measles Infection
Kawasaki Disease
Henlock Shonein Purpura
A

Kawasaki disease

  • echo is an important investigation

Mx:
High dose aspirin
IVIG
Echocardiogram

71
Q

Mx of Kawasaki disease:

3 things

A

High dose aspirin
IVIG
Echocardiogram

72
Q

Define precious puberty:

Boys

Girls

A

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
Q

Features of migraines in children

A

Shorter Lasting
Bilateral
GI Disturbance

74
Q

Commonest paediatric cause of nephrotic syndrome

A

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
Q

What constitutes a prolonged jaundice screen?

When should it be instituted?

A

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
Q

Most common presenting feature in Wilm’s Tumour?

A

Abdominal Mass

Other features:

  • painless haematuria
  • flank pain
  • fever
  • unilateral
  • lung mets are common
  • associated with: beckwith-wiedemann syndrome, WAGR syndrome
77
Q

Maintenance fluid for children

A

100 ml / kg for first 10 kg
50 ml / kg for second 10 kg
20 ml / kg for subsequent kgs

78
Q

Which hearing test is performed at school entry?

A

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
Q

Mucocutaneous lesions and iron deficiency anaemia are seen in which two conditions?

A

Peutz Jeger Syndrome - Pigmented intestinal polyps

Hereditary Haemorrhagic Telangiectasia

80
Q

Cutaneous manifestations of Tuberous Sclerosis

A

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
Q

Opioid + SSRI:

Risk of?

A

Serotonin Syndrome

82
Q

Sx associated with:

persistent urachus?
persistent vitello-intestinal duct?

A

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
Q

Salmon pink rash
non weight bearing
intermittent fevers

A

Still’s Disease! - the rash and the fevers point to systemic features

Still’s disease is basically JIA with extra-articular features

84
Q

Which antidepressant would you initiate in a teenager or child? (after appropriate psychological therapies of course)

A

Fluoxetine

85
Q

RFs for Developmental Dysplasia of the hip

A 
Female
Breech
FH
First child
Oligohydramnios
BW > 5kg
Calcaneovalgus foot deformity
86
Q

You notice a baby has a calcaneovalgus foot deformity.

What other developmental abnormalities should you look for?

A

Developmental Dysplasia of the hip

Calcaneovalgus foot deformity (kind of extreme dorsiflexion)

87
Q

When should you initiate LABA in the asthma management of children 5> ?

A

You don’t

LABA is not licensed in this age group

88
Q

RFs for SIDS

Follow up for cot death?

A 
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
Q

Rheumatoid Factor presence in juvenile idiopathic arthritis?

A

No

JIA is the most common cause of arthritis in <16 year olds

90
Q

Diagnosis of rheumatic fever?

three categories

A

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
Q

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?

A

You get the MMR vaccine administered to the child within 72 hours.

92
Q

Symptoms of epistaxis and bruising in a child?

A

Think about leukaemia!

93
Q

Most common cardiac defect seen in trisomy 21?

A 
Endocardial Cushion Defects (40%)
Then:
VSD (30%)
Secundum ASD (10%)
TOF (5%)
PFA (isolated) (5%)
94
Q

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

A

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
Q

Contraindications to LP? (6)

A 
Dilated Pupils
Abnormal Dolls Eye movements
GCS <9 
Papilloedema
Focal Neurology
Relatie Bradycardia and hypertension
96
Q

Causes of congenital cyanotic heart disease (3 Ts)

A

Transposition of Great arteries
Tricuspid atresia
Tetralogy of fallot

97
Q

Features of the following epileptic syndromes:

Rolandic
West's Syndrome 
Rett Syndrome
Angelman Syndrome
Dravet Syndrome
Lennox-Gastaus Syndrome
A

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
Q

Management of Cow Milk Protein Allergy?

A

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
Q

Squint classification

Toward the nose
Temporally
Superiorly
inferiorly

A

Nose - esotropia
Temporally - exotropia
Superiorly- hypertropia
inferiorly- Hypotropia

100
Q

What is the causative agent for threadworm

A

Enterobius Vermicularis

  • sellotape test
  • mebendazole and hygeine measures for entire family
101
Q

keratin plugs

A

Epidermoid cyst

102
Q

Posterior nasal airway occlusion by soft tissue or bone:

diagnosis?

Symptomology

A

Choanal atresia

Episodes of cyanosis worse during feeding but worse during crying episodes or when oropharyngeal airway is used

103
Q

Antibodies against Glycoprotein IIb/IIIa or Ib-V-IX complex

A

ITP

  • Follows Viral URTI
  • 1-2 weeks
  • Can lead to evan’s syndrome (where there is a concurrent AIHA)
104
Q

Ebstein’s Anomaly:

What is it

What is the cause

A

Anterior displacement of the posterior leaflets of tricuspid valves

  • tricuspid regurgitation (pan systolic)
  • Tricuspic stenosis (mid diastolic)
105
Q

Bilirubin measurement in babies:

<24 hours
>24 hours

A

< 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
Q

ADHD drugs?

Counselling for drug therapy?

A

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
Q

MAB against RSV?

A

Palivizumab

108
Q

Management of scarlet fever

Complications (3)

A

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
Q

Chickenpox school exclusion?

A

Wait until all lesions crusted over.

management: Calamine lotion,

Newborn / Immunocompromised: VZIG in immunocompromised for prophylaxis, IV aciclovir to treat

Paediatrics from passmed (5 decks)

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