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Phase 3A Conditions > SAQ > Flashcards

SAQ Flashcards

1
Q

Croup:
Likely pathogen?
Management?

A

Parainfluenza virus
Single dose of IV dexamethasone

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2
Q

Whooping cough:
Likely pathogen?
Management?

A

Bordello pertussis
Azithromycin

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3
Q

VIW:
Likely pathogen?
Management?

A

RSV
Supportive

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4
Q

Bronchiolitis:
Likely pathogen?
Management?

A

RSV
Supportive

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5
Q

Red flags for hospital admission of children?

A

Cyanosis
Moderate/severe intercostal recessions
Apnoeas
Temp over 38 under 3 months, under 39 any age
Feeding below 50%
RR over 60
Clinical dehydration
Grunting

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6
Q

Epiglottitis:
Pathogen?
Treatment?

A

Heamophilius influenza B
SECURE AIRWAY
Ceftriaxone and dexamethasone.

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7
Q

Chest compression ratio for different ages?

A

Neonatal 3:1
Paediatric 15:2
Adult 30:2

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8
Q

What are the components of the APGAR scoring system?

A

Appearance (cyanosis)
Pulse
Grimace
Activity (muscle tone)
Respiration (RR and effort)

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9
Q

What pulse is checked in a child under 1 vs a child over 1?

A

Under 1: femoral
Over 1: carotid

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10
Q

Otitis media:
Pathogen?
Management?

A

Strep pneumonia
SYSTEMIC ILLNESS
NO IMPROVEMENT AFTER 3 DAYS
BILATERAL OTITIS MEDIA
HIGH FEVER
amoxicillin 5 days.

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11
Q

Sound:
ASD
VSD
Patent PDA
ToF

A

1 Left upper sternal edge ejection-systolic murmur

2 Left lower sternal border pan-systolic murmur

3 Machinery murmur in the left subclavicular region

4 Ejection systolic murmur left-upper sternal border (same as ASD)

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12
Q

Treatment for patent PDA?

A

Indomethacin

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13
Q

Medication for cyanotic heart defect prior to surgery?

A

Prostaglandin to preserve the PDA

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14
Q

Which heart defects are cyanotic?

A

ToF
Coarctation of the aorta
Transposition of the GA

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15
Q

GORD management?

A

Mix gaviscon into feed
PPI second line

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16
Q

Cows milk protein allergy management?

A

Hydrolysed formula
Mother avoid dairy and take a calcium supplement

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17
Q

What is the management for pyloric stenosis?

A

Pyloromyotomy

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18
Q

What are the two most common causes of gastroenteritis?

A

Noravirus and rotavirus

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19
Q

What is the first line investigation for suspected IBD?

A

Faecal calprotectin

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20
Q

What is the management for crohns (acute and chronic)?

A

Acute is steroids
Chronic is azathioprine

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21
Q

What is the management for UC (acute and chronic)?

A

Both it is mesalazine.

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22
Q

What is the first line investigation in suspected coeliac?

What confirms the diagnosis?

A

Total IgA and anti-TTG

Small bowel biopsy.

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23
Q

What is shown on rectal biopsy in Hirschsprungs disease?

A

The absence of parasympatethic ganglion cells in the rectum.

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24
Q

What is the investigation of choice for intussusseption?

A

Abdominal USS

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25
Q

What do urine dipstick results show with respect to a UTI?

A

Nitrites are best indicator - treat as UTI regardless

Leukocytes are also common - treat as UTI if ALSO clinical symptoms of UTI.

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26
Q

When should a child receive an abdo USS following a UTI? What are the timeframes?

A

If under 6 months within 6 weeks.
If under 6 months and recurrent during illness.
If recurrent within 6 weeks.
If atypical during illness.

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27
Q

What is an MCUG scan used for?

A

To check for vesico-ureteric reflux.

Use in under 6 months with recurrent or atypical UTI.

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28
Q

What is the management for eneuresis?

A

Conservative until 5 YO
Enuresis alarm over 5 years

Desmopressin for short term control

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29
Q

What is the nephrotic syndrome triad?

Most common cause of nephrotic syndrome in children?

A

Oedema
Low albumin
Proteinuria.

Most common is minimal change disease.

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30
Q

What is the treatment for minimal change disease?

A

Prednisolone
Can use diuretics for oedema.

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31
Q

What are the two causes of nephritic syndrome in children?

A

IgA nephropathy.
Post strep glomerulonephritis.

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32
Q

What is the management for post-streptococcal glomerulonephritis?

A

Usually supportive.

Need to control BP/oedema?
- Antihypertensives
- Diuretics

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33
Q

What is the management for IgA nephropathy?

A

Usually supportive.

Can use steroids to slow progression.

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34
Q

What is the anaphylaxis dosage?

A

IM adrenaline:
500 micrograms for over 12
300 micrograms 5-12
150 micrograms under 5

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35
Q

Kawasaki’s disease:
Key symptoms (2)?
Treatment?
Key investigation?

A

Strawberry tongue
Skin peeling on palms and soles.

High dose aspirin
IV immunoglobulins

EchoCG

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36
Q

Measles:
Key symptoms?
Management?

A

Unvaccinated.
High fever.
Koplik spots on the buccal mucosa.
Rash that starts on face/behind ears.

Conservative
Isolate for 4 days after rash appears.

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37
Q

Notifiable paediatric diseases?

A

Whooping cough
Measles
MMR
HIB
Haemolytic uraemic syndrome
Acute viral hepatitis
TB
Scarlet fever
Bacterial meningitis

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38
Q

Scalded skin syndrome:
Presentation?
Treatment?

A

Skin infection with the appearance of a burn.

Oral Abx and fluids.

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39
Q

Hand foot and mouth disease:
Key symptoms?
Management?
Pathogen?

A

Small ulcers on hands feet and around the mouth.
Conservative
Cocksackie A virus.

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40
Q

Roseola infantum:
Key symptoms?
Management?
Pathogen?

A

Fever that settles, then a macular erythematous macular rash over the whole body.
Conservative.
HHV-6

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41
Q

Scarlett Fever:
Key symptoms?
Management?
Pathogen?

A

Rough sandpaper rash.
Strawberry tongue.
Penicillin V for 10 days.
24 hours off school after starting abx.
Associated with strep A.

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41
Q

Slapped cheek syndrome:
Key symptoms?
Management?
Pathogen?

A

Red rash primarily focused on the cheeks.
Conservative management.
Parovirus B19

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42
Q

What is the cutoff age for a child being able to walk?

A

18 months.

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43
Q

What is the cutoff age for a child being able to sit unsupported?

A

9 months.

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44
Q

What is the cutoff for responsive smile?

A

8 weeks.

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45
Q

What age does febrile convulsion typically occur in?

A

6 months to 5 years.

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46
Q

What makes a febrile convulsion complex?

A

Over 15 mins long.

Focal seizure (rather than tonic clonic)

More than one seizure repeating within 24 hours or within the same febrile illness.

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47
Q

When does a febrile seizure require admission to paediatrics?

A

First seizure presentation.
Less than 18 months old.
Complex febrile seizure suspected.

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48
Q

ADHD:
First line medication?
What needs monitoring?

A

First line is methylphenidate.

Monitor growth.

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49
Q

Meningitis. Most common causes in:
Under 3 months
3 months to 60
Over 60

A

<3 months = strep B
3 months/60 YO = Nesseria meningitidis
Over 60 YO = Strep pneumoniae

50
Q

What are the most common viral causes of meningitis?

A

VZV
HSV
Enterovirus.

51
Q

What is the management in primary care for suspected meningitis?

A

IM benzylpenicillin with immediate transfer.

52
Q

What is the management for suspected bacterial meningitis in secondary care?

A

LP with viral PCR and blood cultures.

IV antibiotics:
Under 3 months or over 60 give cefotaxime and amoxicillin, if between give just cefotaxime.

Consider dexamethasone if likely to be strep pneumonia.

53
Q

Why is amoxicillin added for under 3 months old and over 60?

A

To cover for listeria monocytogenes.

54
Q

What is the management of close contacts after a confirmed case of bacterial meningitis?

A

All close contacts for the past 7 days need a single dose of ciprofloxacin.

55
Q

What is the treatment for viral meningitis?

A

Aciclovir.

56
Q

CSF for viral vs bacterial meningitis?

A

Viral:
Clear
Normal glucose
Normal/slightly raised protein
Lymphocytes
Culture is negative

Bacterial:
Cloudy
Glucose is low
Protein high
Neutrophils
Culture positive

57
Q

What are the two special tests for meningitis?

A

Kernig’s test - flex hip and knee and then extend leg at the knee. Look for pain.

Brudzinski’s test - flex chin into chest and look for involuntary flexion at the hip and knee.

58
Q

What are the signs of meningitis in a neonate?

A

BULGING FONTANELLE
Hypotonia
Lethargy
Reduced feeding

59
Q

What is the treatment for tonic clonic seizures?

A

Lamotrigine/leviteracitam

60
Q

What is the first line for focal seizures?

A

Lamotrigine/levetiracetam

61
Q

What is the first line for absence seizures?

A

Ethosuximide

62
Q

What is the first line for myoclonic seizures?

A

Levetiracetam

63
Q

What is the first line for atonic/tonic seizures?

A

Lamotrigine

64
Q

What is juvenile myoclonic epilepsey?

A

Sudden, brief muscle contractions usually just after waking.

65
Q

What is the alternative name for infantile spasms?

A

West syndrome.

Poor prognosis.

66
Q

What is the criteria for starting investigations for epilepsey?

A

Any more than one simple tonic-clonic seizure.

67
Q

What are the two key investigations for epilepsy?

A

EEG and MRI brain.

68
Q

How is status epilepticus managed in hospital?

A

ABCDE:

Airway secure
Give O2
Assess breathing/cardiac function.
CHECK BLOOD GLUCOSE
IV access
IV lorazepam with a second dose after 5-10 mins if no response.
IV phenytoin if still seizing.

69
Q

What is status epilepticus?

A

Seizure lasting over 5 mins
OR
Multiple seizures without recovery between.

70
Q

What are the three types of eating disorder?

A

Anorexia nervosa - Low BMI, pt feels overweight despite evidence to the contrary.

Bulimia nervosa - Normal BMI. Patient has episodes of binge eating followed by purging.

Binge eating disorder - high BMI. Patient has episodes where they overeat.

71
Q

What are the key things to monitor during refeeding?

A

Magnesium, potassium, phosphate and glucose.
ECG

72
Q

What are the blood results for refeeding syndrome?

A

Low potassium
Low phosphate
Low magnesium
Fluid overload.

73
Q

How is bilateral undescended testes managed?

A

Urgent referral to paediatrics if still undescended by 6-8 weeks.

74
Q

How is unilateral undescended testes managed?

A

Watch and wait for the first 6 months.

Refer for surgery if still undescended.

75
Q

When should retractile testes normalise?

A

During puberty.

76
Q

What are the signs of congenital hypothyroidism?

A

Prolonged jaundice neonatally.
Poor feeding
Constipation.
Reduced activity.
Slow growth and development.

77
Q

What is tested for on the newborn blood spot test?

A

Congenital hypothyroidism.
CF.
Sickle cell disease.
Metabolic conditions.

78
Q

What are the findings for congenital adrenal hyperplasia?

How does a male or female present?

A

Low aldosterone
Low cortisol
High testosterone.

Both:
Tall for age
Deep voice
Earrly puberty

Males:
Small testicles and large penis.

Females:
Facial hair
Primary amenorrhoea.

79
Q

What are the key findings for androgen insensitivity syndrome?

A

LH:FSH ratio of at least 2:1
Raised testosterone
Raised oestrogen.

80
Q

What is the treatment for androgen insensitivity syndrome?

A

Bilateral orchidectomy.
Oestrogen therapy.

81
Q

What type of anaemia does iron deficiency cause?

A

Microcytic anaemia.

82
Q

What type of anaemia does thalassaemia cause?

A

Microcytic.

83
Q

What is screened for early in pregnancy (before 10 weeks)?

A

Sickle cell
Thalassaemia.

84
Q

What is screened for later in pregnancy (around 14 weeks?

A

Edwards syndrome
Downs Syndrome
Patau’s syndrome

85
Q

ITP:
What is a key component of the history?
Key component of the examination?
FBC findings?

A

Recent viral illness.

Non-blanching petechial rash.

Isolated thrombocytopenia.

86
Q

What is the management for ITP?

A

No treatment. Can use steroids if severe.

87
Q

What is the most common paediatric leukaemia?

A

ALL

88
Q

What are the blood test results for AML?

A

Thrombocytopenia
Leukopenia
Anaemia

89
Q

What conditions are more likely for a person with Down’s Syndrome (5)?

A

Alzheimer’s disease
ALL
Hypothydroidism
Hearing impairments
Ventriculoseptal defects.

90
Q

What are the key features of Turner Syndrome?

A

Wide spaced nipples
Webbed neck
Short stature.

91
Q

What is the genetic term for turner syndrome?

A

45XO

92
Q

What heart defect is associated with Turner’s syndrome?

A

Bicuspid aortic valve (most common).
Coarctation of the aorta.

93
Q

What is the genetic term for down syndrome?

A

Trisomy 21

94
Q

What are the clinical features of Down’s syndrome?

A

Hypotonia
Brachycephaly (small head)
Short stature
Short neck
Single palmar creases
Epicanthic folds

95
Q

What does the combined test screen for?

A

Down’s syndrome
Edwards Syndrome
Patau’s syndrome.

96
Q

What are the findings on a combined test suggestive of:
Down Syndrome?
Edwards Syndrome?
Patau’s syndrome?

A

Nucheal translucency over 6mm
- beta HCG high
- PAPPA low

For Patau and Edwards, same but with lower bHCG

97
Q

What is the step after a positive combined test?

A

Non-invasive prenatal screening test:
Amniocentesis
OR
chorionic villous sampling

98
Q

What is the genetic termonology for Edward’s syndrome?

A

Trisomy 18.

99
Q

What are the key characteristics of Edwards syndrome?

A

Rockerbottom feet.
Low set ears.
Overlapping fingers.

100
Q

What are the key characteristics of Patau syndrome?

A

Microcephaly
Cleft lip/palate
Polydactyly

101
Q

What are the characteristics of fragile X?

A

Macrocephaly
Long face
Large ears

102
Q

What is an easy way to remember the symptoms of Noonan syndrome?

A

Male version of Turner syndrome.
Webbed neck
Short stature
Pectus excavatum.

103
Q

What are the characteristics of William’s syndrome?

A

Short stature
Learning difficulties
Friendy, extroverted personality.

104
Q

What is the genetic pattern for cystic fibrosis?
First symptom?
Gold standard test?

A

Autosomal recessive

Meconium illeus

Sweat test

105
Q

What is the most common form of muscular dystrophy in children?
What is the key sign?

A

Duchenne’s muscular dystrophy

Gower’s sign - using hands on legs to stand from seating due to weakness.

106
Q

What are the symptoms of septic arthritis?

A

Systemic symptoms - fever, lethargy, vomiting etc.

107
Q

How should septic arthritis be managed?

A

Admission to hospital.
Joint aspiration and culture.
Empirical IV Abx then adjust accordingly to sensitivities.

108
Q

What is the pathophysiology of perthes disease?

A

Avascular necrosis of the femoral head.

109
Q

What are the XR findings for perthes disease?

A

Widening of the joint space.

110
Q

What age for an actue limp requires urgent referral?

A

Under 3 years old.

111
Q

What is the management for developmental dysplasia of the hip?

A

USS of both hips.

Pavlik harness under 6 months.
Over 6 months surgical correction.

112
Q

HSP:
Symptoms?
Management?

A

Purpura on buttocks/lower limbs.
Abdo pain
Joint pain

Manage with NSAIDs
Can use steroids if unresolving.

113
Q

What criteria is used to assess the likelihood of septic arthritis in children?

A

Kocher criteria.

114
Q

When is anti-D prophylacis given to the mother?

A

Miscarriage over 12 weeks.
Abdominal trauma during pregnancy.
At birth if the baby is rhesus +ve.

115
Q

What is the treatment for jaundice of a baby?

A

Phototherapy.

116
Q

When does newborn respiratory distress syndrome typically occur?

A

Under 32 weeks gestation.

117
Q

What is the XR appearance of respiratory distress syndrome?

A

Ground glass appearance.

118
Q

What is the management of newborn resp distress syndrome?
Long term complications?

A

Artificial surfactant.
Assisted ventilation.

Chronic lung disease
Retinopathy of prematurity

119
Q

Meconium aspiration syndrome:
Key features (XR etc.)
Management

A

Meconium stained liquor
XR:
- Hyperinflation
- Patchy opacification
- Consolidation

Oxygen
Assisted ventilation
Abx in case of infection.

120
Q

What is the treatment for hypoxic ischaemic encephalopathy?

A

Therapeutic hypothermia.

121
Q

Transient tachypnoea of the newborn:
Pathophysiology?
XR findings?
Management?

A

Delayed resorption of fluid after birth. Most common after C-sections.

Chest XR findings:
- Hyperinflated lungs
- Fluid level.

Management:
- Oxygen
- Assisted ventilation.

122
Q
A

Phase 3A Conditions (13 decks)

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