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Paediatrics > Random Passmed Flashcards > Flashcards

Random Passmed Flashcards

1
Q

Infantile Colic

A
  • Characterized by bouts of crying and pulling-up of legs (20% of infants).
    Improves 3-4 months of age and resolves by 6 months.
  • Worse in evenings/nights.
  • Commences around 6-8 weeks.
  • Consult specialist if symptoms persisting over 5 months, parents unable to cope, symptoms worsening.
  • If symptoms improving at 3-4 months, reassure and offer follow-up appointment in 1 month.
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2
Q

Gastroesophageal Reflux Disease (GORD)

A
  • Differs from infantile colic.
  • Symptoms include hoarse cry, chronic cough, feeding difficulties.
  • Pyloric stenosis presents at 2-6 weeks of age.
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3
Q

Hypospadias

A
  • Circumcision avoided as foreskin is used in corrective surgical procedure.
  • Surgery typically done at 12 months
  • Cyptorchidism in approx 10%
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4
Q

Neonatal Hypoglycemia
- Define
- In-utero risk factors
- Management
- When to stop hypoglycaemia protocol

A
  • Defined as blood glucose <2.6 mmol/L.
  • Common in the first 24 hours, usually not pathological.
  • Maternal labetalol use during pregnancy increases the risk.
  • Management: asymptomatic - normal feeding, monitor blood glucose; symptomatic - admit to neonatal unit, IV 10% dextrose.
  • Maternal diabetes increases the risk due to fetal insulin release.
  • Babies on hypoglycemia protocol - stopped when at least 3 blood glucose values >2.5 mmol/L.
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5
Q

Orofacial Clefts

A
  • Associated with maternal smoking, benzodiazepine use, antiepileptics, rubella (maternal), trisomy 18, 13, 15 (fetal).
  • Cleft lip repaired from 1st week of life to 3 months.
  • Cleft palate repaired between 6-12 months.
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6
Q

Neonatal Respiratory Distress Syndrome

A
  • Associated with maternal diabetes (insulin inhibits surfactant production).
  • Ground glass appearance on x-ray, indistinct heart border.
  • Treatment: maternal corticosteroids, O2, assisted ventilation, exogenous surfactant via endotracheal tube.
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7
Q

Chromosomal Abnormalities
- Pierre-Robin
- Patau
- Edwards
- Williams

A
  • Pierre-Robin: palate (cleft), posterior tongue displacement, small chin.
  • Patau (Trisomy 13): polydactyl, microcephaly, low-set ears, cleft palate.
  • Edwards (Trisomy 18): widely spaced eyes, rocker bottom feet, overlapping fingers, ptosis, low set ears, short stature.
  • Williams: sparkly personality, elvish features, CVD (supravalvular aortic stenosis), hypercalcemia, intellectual disability.
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8
Q

Hypoxic Ischemic Encephalopathy

A
  • Therapeutic cooling (33-35 degrees for 72 hours) within 6 hours of birth/hypoxia-inducing event.
  • Slows metabolic rate, allows more recovery time from hypoxic insult
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9
Q

Cause of slap cheek?
Cause and mx of scarlet fever?
Eczema presentation?

A
  • Slap cheek caused by Parvovirus (5th disease).
  • Presents with a slap cheek appearance.
  • Scarlet fever: group A strep, punctate erythema on torso first, spares palms and soles.
  • Oral penicillin V for 10 days; azithromycin if allergic.

Eczema: <2 extensor surfaces and face, >2 flexure surfaces and creases of the face and neck.

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10
Q

Respiratory - Cystic Fibrosis

A
  • Infection with Burkholderia cepacia is a contraindication for lung transplants.
  • Lumacaftor/Ivacaftor (Orkambi) used for those homozygous for delta F508 mutation
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11
Q

Ortho
- Definitive mx SUFE
- Growing pain sx
- Age for Osgood-Schlatter

A
  • Definitive management SUFE: in situ fixation with cannulated screw
  • Growing pain symptoms shouldn’t be present in the morning, often intermittent and worse after vigorous activity.
  • Osgood-Schlatter: knee pain at 10-15 years old
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12
Q

ENT - Retinoblastoma

A
  • Most common pediatric ocular cancer.
  • Autosomal dominant.
  • Absence of red reflex most common presenting symptom.
  • Strabismus is common; treatment includes external beam radiation therapy, chemotherapy, photocoagulation, enucleation.
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13
Q

Cardio - Innocent Murmur

A
  • Soft, systolic, short, symptomless.
  • Standing/sitting (may vary with position).
  • Epstein’s Anomaly: atrialization of the right ventricle, low insertion of the tricuspid valve, large right atrium, small right ventricle
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14
Q

When is the APGAR score assessed?

A

At 1 and 5 minutes of age

Pulse, resp effort, colour, muscle tone and reflex irritability

Higher score = good health (0-3 very low, 4-6 moderately low, 7-10 good health)

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15
Q

What are the next steps if the APGAR score is <5 at 5 minutes?

A

Repeat at 10, 15 and 30 minutes and umbilical cord blood gas sampling considered

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16
Q

What is Kocher’s criteria for septic arthritis?

A
  • Inability to weight bear (1 pt)
  • Fever >38 (1 pt)
  • WBC >12 x10^9/L (1 pt)
  • ESR >40mm/hr (1 pt)
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17
Q

What is the next step in treatment for constipation if Movicol is insufficient?

A

Add Senna (stimulant laxative)

Movicol = osmotic laxative

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18
Q

What is the management of umbilical hernias?

A
  • Usually self resolve
  • If large (>1.5cm)/ symptomatic perform elective repair at 2-3 years
  • If small and unsymptomatic perform eletive repair at 4-5 years
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19
Q

What is the management for an umbilical hernia that incarcerates during the observation period?

A

Manually reduce and surgically repair within 24 hours

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20
Q

How and where should chest compressions be performed in paediatric BLS?

A

Lower 1/2 of the sternum using the heel of the hand

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21
Q

What is the rate of chest compressions in paediatric BLS?

A

100-120 bpm (1/3 sternal depression)

15:2

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22
Q

Where is the damage located in dyskinetic cerebral palsy?

A

Basal ganglia and substantia nigra

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23
Q

What are the classical symptoms of dyskinetic cerebral palsy?

A
  • Athetoid movements
  • Oro-motor problems
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24
Q

What do lesions in the amygdala produce?

A

Kluver-Bucy syndrome

  • Hypersexuality
  • Hyperorality (preoccupation with oral sensations and behaviours)
  • Hyperphagia (excessive eating)
  • Visual agnosia (impaired visual recognition)
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25
Q

What is the presentation of cow’s milk protein intolerance?

A

Presentation days-weeks after CMP ingestion

  • Diarrhea
  • Emesis
  • Colic
  • Rectal bleeding

Rapid onset
- Urticaria
- Wheezing
- Itching
- Angioedems
- Coughing/ sob

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26
Q

What is the presentation of congenital hypothyroidism?

A
  • Hypotonia
  • Macroglossia
  • Umbilical hernia
  • Reduced feeding
  • Constipation
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27
Q

What is the heel prick test used to screen for?

A

5-8 days of life
- Phenylketonuria
- Hypothyroidism
- Cystic fibrosis
- Congenital adrenal hyperplasia

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28
Q

What is the mechanism of jaundice in pyloric stenosis?

A

Decreased hepatic glucuronosyltransferase activity

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29
Q

What is the inflammation pattern in Croup?

A

Laryngotracheobronchitis

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30
Q

What are the guidelines for children who are admitted to hospital with suicide attempt?

A

Admission and urgent CAMHS assessment before discharge

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31
Q

When is treatment for enuresis initiated?

A

Once the child has turned 5

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32
Q

When should toxic shock syndrome be suspected in a child?

A

When there’s an unwell child with an unhealed burn

Treatment involves intensive care department with paeds consultant and plastic surgeon input

Resus with cryoprecipitate may be necessary

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33
Q

What is erythema infectiosum?

A

5th disease aka slapped cheek
Parvovirus B19

Mild prodromal period lasting 1-3 days and incubation period of 1 week

Slapped cheek appearance fades after 2-4 days and is followed by macular rash on the extremities (mainly extensor surfaces)

No exclusion from school required

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34
Q

What are the risks with a pregnant person becoming infected with parvovirus B19?

A

Infection in the first trimester is associated with 19% fetal death

But risks at all stages of pregnancy

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35
Q

Which patients does necrotising enterocolitis most commonly affect?

A

Formula-fed preterm infants, most commonly in the first few weeks of life

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36
Q

Which areas of the bowel are most commonly affected in necrotising enterocolitis?

A

Terminal ileum and ascending colon

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37
Q

What is the presentation of necrotising enterocolitis?

A

Bloody stool
Vomiting
Abdominal distention
Purpuric rash
Lethary
Cardiovascular collapse
Apnoea

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38
Q

What is the most likely cause of unilateral wheeze in a child <3?

A

Inhaled foreign object

(Child should be systemically well)

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39
Q

Where do inhaled foreign objects tend to lodge?

A

At the bifurcation of the right main bronchus, as it is more vertical

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40
Q

Why is polyhydramnios associated with tracheoesophageal fistula?

A

Because the amniotic fluid isn’t passed into the GI tract (due to the fistula)

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41
Q

What is the presentation of a tracheoesophageal fistula?

A

Immediate vomiting of uncurdles milk, mother with polyhydramnios

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42
Q

Which children is PDA more likely to occur in?

A

Children with hyaline membrane disease and in those with a concurrent cyanotic congenital heart condition

The initial stimulus for physiological closure of the ductus arteriosis is high blood oxygen tension

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43
Q

What is the first step for managing a febrile, neutropaenic child?

A

IV abx (tazocin)

Neutropaenic sepsis

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44
Q

What is the double bubble sign on abdominal x-ray?

A

Duodenal atresia

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45
Q

What is biliary atresia?

A

Blind-ended biliary tree (associated with trisomy 21) suffer from indigestion due to bile sludging and impaired fat absorption
+ jaundice from bile retention

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46
Q

What should point to mesenteric adenitis in children with right iliac fossa pain?

A

History of viral URTI and enlarged neck nodes and high temperature

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47
Q

What kind of fever does appendicitis tend to present with?

A

Low grade fever

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48
Q

Are patients who have had a VSD closed at high risk of developing infective endocarditis?

A

No, once the defect has been surgically repaired they’re not considered high risk

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49
Q

What is the management of necrotising enterocolitis?

A

Stop enteral feeding and medications
- TPN if feeds stopped >24 hours
- Confirmed NEC stop feeds for 7 days

NG tube
- Drain fluid and gas from the gut
- Monitor hourly gastric aspirates

Broad spectrum IV abx
- Eg. cefotaxime and vancomycin

IV fluids
- Cardiovascular support (inotropes if they need)

Surgery

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50
Q

When is surgery indicated in necrotising enterocolitis?

A
  • Perforation
  • Failure to respond to medical tx
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51
Q

What surgery is performed in necrotising enterocolitis?

A

Laparotomy with resection of necrosed bowel with either a primary anastomosis or defunctioning stoma

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52
Q

What is the managment for asymptomatic neonatal hypoglycaemia?

A
  • Confirm hypoglycaemia with blood glucose assay
  • Support breast-feeding techniques
  • Offer additional feed if willing (breast milk substitute or IV glucose)
  • Buccal glucose gel may be used in conjunction with a feeding plan
  • Neonatal doctor informed
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53
Q

How often should blood glucose be monitored when feeding interventions are introduced for neonatal hypoglycaemia?

A

Remeasure in 1 hour to ensure there’s a response

54
Q

What is the management for neonatal hypoglycaemia if pre-feed glucose is <2mmol/L or symptomatic?

A

Immediate glucose IV infusion
- Initial bolus of 2ml/kg 10%
- Infusion of 3.5mL/kg/hr 10%
- Aim for 3-4mmol/L

If glucose <1mmol/L buccal glucose gel is used as an interim whilst arranging IV infusion

55
Q

What is the management for neonatal hypoglycaemia secondary to hyperinsulinism?

A
  • Glucagon infusion
  • Diazoxide + chlorthiazide
  • Somatostatin analogue
56
Q

What is the management for neonatal hypoglycaemia if first-line feeding ineffective?

A

10% IV glucose infusion with levels re-tested within 15 minutes

57
Q

What is the management for neonatal respiratory distress syndrome?

A

A-E resus

Resp support
- Intubation and ventilation (severe RDS)
- Endotracheal surfactant
- CPAP (keeps lungs inflated)
- Supplementary O2 (aim between 91-95%)

Fluids

IV abx
- Broad spectrum combination eg. benzylpenicillin and gentamycin

CXR
- ASAP unless there’s only mild respiratory distress where this can be delayed

58
Q

What is the initial step in management if meningococcal meningitis is suspected (LP has been done)?

A

3rd generation cephalosporins (eg. cefotaxime, ceftriaxone) should be administered as quickly as possible after lumbar puncture

59
Q

What is the managment of meningitis if LP can’t be performed within 30 mins of hospital admission?

A

Empirical treatment

60
Q

When would a head CT be done before lumbar puncture in meningitis?

A

If there are clinical signs of raised ICP, not routinely performed

61
Q

When is jaundice in a newborn considered pathological?

A

When it presents before 24 hours, or after 24 hours and persists for >2 weeks

62
Q

What embryological abnormality causes tetrology of fallot?

A

Anterosuperior displacement of the infundibular septum

63
Q

What is the mechanism of transposition of the great arteries?

A

Failure of the aorticopulmonary septum to spiral

64
Q

When is it abnormal for a child to have a hand preference?

A

Before 12 months old

65
Q

By what age should a child be able to walk?

A

18 months

66
Q

When is it abnormal for a child to not be able to stand on one leg?

A

By 4 years old

67
Q

When is it abnormal for a baby not to be able to set unsupported?

A

By 8 months old

68
Q

What are the methods for securing the airway with acute epiglottitis?

A

Call ENT surgeon/ senior anaesthetist to secure airway
- Endotracheal intubation
- Nasotracheal intubation
- Tracheostomy

69
Q

What are the cyanotic heart conditions?

A

Presenting in the first week of life (relies of the ductus arteriosus being patient and become apparent once it closes):
- Total pulmonary atresia
- Tricuspid atresia
- TGA
- Tricuspid regurgitation and Ebstein’s anomany with right to left shunt via ASD

After the first week of life:
- TOF
- Total anomalous pulmonary venous drainage

70
Q

How can a congenital 5-alpha reductase deficiency present?

A

5-alpha reductase converts testosterone to DHT

Feminisation of the external genitalia, usually phenotypically female until puberty

Early detection allows for gender assignment with dihydrotestosterone treatment

Later detection may lead to female gender assignment with hormone therapy and preventive orchidectomy

71
Q

What is the first line management for infantile haemangiomas in children aged 5 weeks - 5 months?

A

Oral propranolol

Only if the haemangioma causes troublesome symptoms eg. becomes large, ulcerated or impairs functions such as vision, hearing or breathing

72
Q

What is the growth pattern of benign haemangiomas?

A
  • Grow rapidly in the first 3 months
  • Peak around the 5th month
  • Then regress

Usually appear at 4-6 weeks of life

73
Q

What is the management of asymptomatic haemangiomas?

A

Monitoring only:
- Medical photography and reassessment in 3 months

74
Q

How does congenital hypothyroidism cause neonatal jaundice?

A

Reduced bilirubin conjugation, gut motility and feeding

75
Q

What are the serum bilirubin levels for neonatal jaundice?

A

> 85micromoles/L

76
Q

How many words should children be speaking by 2 years?

A

50 or more

77
Q

What is the most common cerebellar neoplasm of childhood?

A

Astrocytoma

78
Q

What is the management of acute otitis media with tympanic membrane perforation?

A

5 day course of oral amoxicillin and a review to ensure healing (can be done in primary care) in 6 weeks

79
Q

When does autosomal recessive polycystic kidney disease present?

A

In the neonatal period, causing death perinatally and almost always within the first year of life

80
Q

Common signs of NAI?

A
  • Bite marks
  • Torn frenulum (forced bottle feeding)
  • Ligature marks
  • Burns
  • Scolds
81
Q

Severe otitis externa management?

A

Topical acetic acid spray and oral antibiotics

If ear canal is swollen, wick placement to maximise topical ear drop solution

Abx treat deeper tissue infection (indicated by cervical lymphadenopathy), rarely used in umcomplicated otitis externa

82
Q

Abx regimen for severe otitis externa?

A

7 day course of flucloxacillin

83
Q

When are chest compressions started in a neonate?

A

After a total of 10 inhalation breaths and 30s of effective ventilation breaths

84
Q

Which neonatal GI condition is more common in turner’s syndrome?

A

Pyloric stenosis

85
Q

Signs of Erb’s palsy?

A
  • Reduced Moro’s reflex
  • Reduced tone
  • Waiter’s position

Associated with shoulder distocia, usually unilateral

86
Q

Management of Erb’s palsy?

A

Physiotherapy (self-resolving)

87
Q

Medical management for conjucated hyperbilirubinaemia in neonate?

A

Ursodeoxycholic acid

88
Q

What is the biochemical cause of achondroplasia?

A

Activation of fibroblast growth factor 3 (FGF3) receptor

Affects proliferation of chondrocytes

89
Q

Indications for CT scan within one hour?

A

More than one of:

  • LOC more than 5 minutes
  • Abnormal drowsiness
  • 3 or more episodes of vomiting
  • Dangerous mechanism of injury
  • Amnesia lasting more than 5 minutes

If they only have one feature:
- Observation for a minimum of 4 hours

90
Q

When should surgery for gastroschisis be performed?

A

Within a few hours

91
Q

What is otitis media with effusion referred to ENT?

A

If the patient has Down Syndrome or cleft palate

92
Q

What is the initial treatment for pyloric stenosis?

A
  1. Correction of metabolic derrangements
  2. Surgery
93
Q

What is a child in need plan?

A

A voluntary plan devised for children in need of:
- Extra support for health
- Extra support for safety
- Extra support for developmental issues

94
Q

When is Becker muscular dystrophy typically diagnosed?

A

5-25 years

Prognosis: mid 40s

95
Q

What is the management for a child <2 years old with ballooning of the foreskin?

A

Don’t routinely require referral for circumcision

96
Q

What is the management for balanitis caused by:

  • Non-specific dermatitis
  • Irritant/ allergic dermatitis
  • Candida
A

Non-specific
- Topical hydrocortisone 1% (until sx settle or 14 days)
- Imidazole cream (sx settle or 14 days)

Irritant/ allergic
- Avoid triggers
- Topical hydrocortisone
- Emoliants + soap substitute

Candida
- Imidazole cream
- Topical hydrocortisone if inflammation causing discomfort

97
Q

Management for severe balanitis infection?

A

Oral phenoxymethylpenicillin 10 days

(oral clarithromycin for true penicillin allergy 7 days)

98
Q

When is an urgent surgical referral for phimosis required?

A

The child is unable to pass urine

99
Q

What is the management for paraphimosis?

A

Urgent urological emergency

Manual reduction:
- Firm compression bandage over oedematous area
- Leave 10-15 mins
- Remove bandage and attempt to reduce
- Repeat bandage for 15 mins and re-attempt

Surgical reduction

100
Q

What is the gold standard investigation for cerebral palsy?

A

MRI head

Features include: periventricular leukomalacia

101
Q

What is paediatric inflammatory multisystem syndrome?

A

A systemic inflammatory response associated with COVID-19

102
Q

How is the length of aganglionic bowel determined in Hirschprungs?

A
  • Anorectal manometry or
  • Barium studies
103
Q

What is the management of Hirschprungs?

A
  1. Bowel irrigation
  2. Anorectal pull-through

Initial colostomy followed by anstamosis of normally innervated bowel to anus

104
Q

What is the surgical procedure for malrotation?

A

Ladd’s procedure

105
Q

What is the RBC lifespan in neonates?

A

70 days

106
Q

When is a serum bilirubin preferred over transcutaneous bilirubin in neonates?

A
  • Serum: when jaundice has developed within 24 hours or neonate born <35/40
  • Transcutaneous: >24 hours, >35/40

If transcutaneous >250, serum is indicated

107
Q

What is opthalmia neonatorum?

A

Inflammation of the conjunctiva occurring within 28 days of life (umbrella term)

Often benign, with most cases clearing with saline irrigation

108
Q

What are the main causes of neonatal conjunctivitis?

A
  • Chlamydia trachomatis (5 days - 2 weeks pp)
  • Neisseria gonorrhoea (24hrs - 5 days)

When bacterial infection is suspected, same-day referral to opthalmologist

109
Q

What is the first line treatment for chlamydia neonatal conjunctivitis?

A

Oral erythromycin 14 days

Before culture results, topical chloramphenicol eye ointment

110
Q

What is the first line treatment for gonoccocal neonatal conjunctivitis?

A

Single IV cefotaxime

(disseminated gonoccocal disease = IV cefotaxime x3 per day)

111
Q

Where is the inflammation in epiglottitis?

A

Supraglottis and surrounding tissues

112
Q

What is the organism responsible for most causes of epiglottitis in the UK?

A

Strep pyogenes

(Haemophilus influenzae historically most common cause, now reduced due to vaccination)

113
Q

What is the management of acute epiglottitis?

A
  • A-E (NO AIRWAY EXAMINATION)
  • Blood cultures
  • IV ceftriaxone 7-10 days
114
Q

What are the investigations for children presenting to secondary care with seizures?

A
  • ECG (undetected long QT syndrome)
  • Brain imaging (exclude SOL)
  • Metabolic panel
115
Q

What can lamotrigine exacerbate?

A

Myoclonic seizures

116
Q

What can exacerbate absence seizures?

A
  • Carbamazepine
  • Oxcarbazepine
117
Q

What is the first line treatment for absence seizures?

A
  • Ethosuximide
  • Sodium valproate
118
Q

What is the management of focal seizures?

A
  • Carbamazepine
  • Lamotragine
119
Q

What is the genetic mutation for Wilm’s tumour?

A

Deletion of the wilm’s tumour suppressor gene (WT-1) on chromosome 11

120
Q

What is WAGR syndrome?

A
  • Wilm’s tumour
  • Aniridia
  • GU abnormalities
  • Mental retardation
121
Q

What is the most appropriate investigation modality for wilm’s tumour?

A

Abdominal USS with Doppler studies

(echogeneic. heterogenous mass arising from kidney)

122
Q

What is the most common cause of hospital admissions in children <1?

A

Bronchiolitis

123
Q

What is bronchopulmonary dysplasia?

A

Lung damage secondary to mechanical ventilation in neonates

124
Q

What are the nail changes sometimes associated with alopecia?

A

Onycholysis and pitting

125
Q

What is trichotillomania?

A

Compulsive hair pulling

126
Q

When should suspected alopecia be referred to a dermatologist?

A
  • Diagnosis uncertain
  • Patient is a child
  • Disease is extensive (>50%)
  • Initial treatment fails
127
Q

What is the management of general hair loss in a child?

A
  • <50% watchful waiting
  • Topical corticosteroids 3 month course (patient is distressed)
128
Q

What does a raised fecal calprotectin suggest?

A

Intestinal inflammation

129
Q

Why is there left axis deviation in tricuspid atresia?

A

Due to development of a small non-functional right ventricle

130
Q

What is osteochondritis dissecans?

A

Disrupted blood supply to the cartilage within the knee joint

Symptoms include:
- Pain
- Swelling
- Locking of the joint following exercise

131
Q

What is chondromalacia patellae?

A

Cartilage of the patella softening, resulting in anterior knee pain

Common in teenage girls

Pain worse:
- Climbing stairs
- Standing from sitting

132
Q

When does GORD tend to resolve?

A

By 12 months

Paediatrics (16 decks)

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