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Paediatrics 👫👶🏼 > Week 2 part 2 > Flashcards

Week 2 part 2 Flashcards

1
Q

By what age should a child be referred for not sitting unsupported

A

9 months

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2
Q

What age should a child be referred for not walking unsupported

A

18 months

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3
Q

What age should a child be referred for no words by

A

2 years

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4
Q

What is regression

A

Loss of milestones

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5
Q

Red flag signs: positive

A

Loss of developmental skills

Concerns re hearing or vision

Floppiness

No speech by 18-24 months

Asymmetry of movement

Persistent toe walking

Head circumference >99th C or

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6
Q

Congenital abnormalities account for what percent of all births

A

3%

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7
Q

Birth asphyxia

A

Flat at birth

Metabolic acidosis in fetal, cord or early neonatal samples

Early onset moderate or severe encaphalopathy

Abnormal CTG, featal bradycardia or absense foetal HR

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8
Q

Outcome of birth asphyxia

A

Multisystem dysfunction within 72 hours of birth

Hypoxic ischaemic encephalopathy

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9
Q

Management of birth asphyxia

A

Seizures

Fluid balance, avoid cerebral oedema

Cardiac and resp support

Whole body cooling to 33-34C for 72 hours

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10
Q

How does the myconium affect the airway

A

MAS can affect the baby’s breathing in a number of ways, including chemical irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the inactivation of surfactant by the meconium (surfactant is a natural substance that helps the lungs expand properly).

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11
Q

Complications of Myconium asporation

A

PPHN

Airleak

Asphyxia - renal failure…

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12
Q

Management of myconium aspiration

A

Oxygen - need to overcome hypoxaemia

Respiratory support - may need ventilation

Surfactant therapy

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13
Q

Hormonal regulation of fetal growth

A

Insulin - produced by the fetus

IGF1 and 2 - correlates best with fetal weight

Epidermal growth factor

Leptin
Nerve growth factor
Vit D

GROWTH HORMONE - dont have receptror until later

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14
Q

Effects of babies born small

A 
Hyperglycaemia 
Hypoglycaemia 
Hypocalcaaemia
Hypothermia 
Polycythaemia
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15
Q

Consequences for growth if hypothyroid

A

Stop growing

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16
Q

Exogenous eczema classifications

A

Allergic contact dermatitis
Irritant contact dermatitis
Photosensitive eczema

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17
Q

Flares of childhood eczema

A

Infections/viral illness

Environment: central heating/cold air

Pets

Teething

Stress

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18
Q

Affect of turner’s on height

A

Short stature

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19
Q

Most common eczema in children

A

Atopic

Particularly alongside asthma and hayfever

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20
Q

Presentation of atopic eczema in infancy

A

Typically starts on face/neck

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21
Q

Presentation of atopic eczema in older children

A

Felxural pattern predominates (antecubital fossa, popliteal fossae, wrists, hands, ankles)

Facial eczema also possible/may recur

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22
Q

Atopic eczema is due to an abnormality in…

A

Filaggrin proteins

  • they bind keratin filametns together and play a role in producing a natural moisturising factor
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23
Q

Effect of loss of barrier function in atopic eczema

A

Loss of water

Irritants may penetrate (soap, detergent, solvents, dirt)

Allergens may penetrate

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24
Q

When should puberty occur

Girls

Boys

A

8-13

9-14

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25
Q

Causes of delayed puberty

A

Gonadal dysgenesis (turners)

Chronic disease - crohn’s asthma

Impaired HPG axis

Peripheral - testicular irradiation

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26
Q

Cause of central precocious puberty

A

Girls - activation of gonadal axis at pituitary level - usually idiopathic

Boys - brain tumour

Treatment GnRH agonist

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27
Q

Pathological causes of short stature

A

Undernutrition

Chronic illness (JCA, IBD, Coeliac)

Iatrogenic (steroids)

Psychological and social

Hormonal (GHD, hypothyroidism)

Syndromes (Turner, prader willi)

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28
Q

Congenital hypothyroidism causes

A

Athyreosis

Hypoplastic

Eptopic

Dyshormogenic

  • picked up at newborn screening
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29
Q

Thyroid deficiency will cause

A

Lack of height gain

Pubertal delay

Poor school performance

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30
Q

Why might a child be obese

A

Simple obesity

Drugs - insulin, steroids, antithyroid, sodium valproate

Syndrome - prader-willi, down’s syndrome

Hypothalamic-pituitary pathology (pituitary tumour)

Endocrinopathy - hypothyroid, growth hormone deficiency, androgen xs, insulinoma

Diabetes

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31
Q

Symptoms of diabetic ketoacidosis

A

Nausea and vomiting

Abdo pain - sometimes thought to be appendicitis

Sweet smelling, ketotic breath

Drowsiness

Rapid, deep “signing” respiration

Coma

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32
Q

How would you test a child for diabetes

A

Finger prick capillary glucose test

If result >11 mmol/l

They have diabetes

Call for review same day

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33
Q

Most important pubertal stages in a girl

A

Breast budding - tanner stage B2

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34
Q

What is the most important pubertal stage in a boy

A

Testicular enlargement

Tanner stage G2 - T

35
Q

Red flag symptoms for childhood cancer

A

Unexplained petichiae, hepatosplenomegaly

Repeat attendance for the same problem but no clear diagnosis

Rest pain, back pain and unexplained lump

36
Q

Most common cancers in childhood

A

Leukaemia

CNS tumours

Lymphomas

Neuroblastomas

37
Q

Principles of management of childhood cancer

A

Parental support

MDT

Play therapy

Venous access

Long term therapy

38
Q

What is tumour lysis syndrome

A

Metabolic derangement by tumour cells that can appear in response to chemo, anaesthesia and infection

39
Q

Why does tumour lysis syndrome cause renal failure

A

Urate load and calcium phosphate deposition in renal tubules

High potassium is primary problem –> high urate –> high potassium –> poor glomerular filtration –> low calcium

40
Q

Treatment of tumour lysis syndrome

A

Avoidance!
ECG monitoring to give clues to arrythmia

Hyperhydrate/diuresis

NEVER GIVE POTASSIUM

Treat hyperkalaemia with calcium resonium, salbutamol and insulin

Give allopurinol or rasburicase to tackle high uric acid

41
Q

Febrile neutropenia definition

A

Neutrophils 38

42
Q

Symptoms of spinal cord compression

A

Weakness - ambulatory, non ambulatory, paraplegia

Spine tenderness (children never get back pain!)

Sphincter disturbance

Sensory disturbance

43
Q

Management of spinal cord compression in child (tumour)

A

MRI

Dexamethasone - 1mg/kg

Chemo or radio (try avoid)

44
Q

Where does seborrheoic dermatitis occur

A

Mainly scalp and face often in babies under 3 months

45
Q

How would you treat seborrheoic dermatitis

A

Emollients

Antifungal creams

Antifungal shampoos

Mild top steroids

46
Q

Discoid eczema is characterised by

A

Scattered annular/circular patches of itchy eczema

  • often seen as a pattern of atopic eczema
47
Q

Where does pomphylx eczema most commonly occur

A

Hand and foot eczema

Vescicles

48
Q

Which skin condition occurs in association with venous insufficiency

A

Varicose eczema

49
Q

Treatment of varicose eczema

A

Emollients

Topical steroids

Compression stockings (take care to ensure arterial blood supply maintained)

50
Q

How is best to test for allergic eczema

A

Patch testing or skin prick or blood test for food allergen

51
Q

What causes irritant eczema

A

Repeated contact

Water and soaps

Touching irritant foods; citrus, tomatoes, chemical irritants

52
Q

Symptoms of food allergy

A

Immediate reactions - lip swelling, facial redness/itching, anaphlactoid symptoms)

Late reactions - worsening eczema 24/48 hours after ingestion - encourage food diaries

GI problems
Failure to thrive
Severe eczema unresponsive to treatment
Severe generalised itching when skin appears clear

53
Q

How would you assess if a child has an allergy

A

Blood tests for specific IgE antibodies

Skin prick tests

54
Q

Treatment of eczema

A

Lotions creams or ointments

Topical steroids

Topical immunosupression - calcineurin inhibitors

UVB light therapy (could increase skin cancer risk over time)

Immunosupressive medication

55
Q

Range of topical steroids and their potency

A

Mild - hydrocortisone

Moderate - eumovate

Potent - betnovate

Very potent - dermovate

56
Q

What presents as pustules and honey-coloured crusted erosions

A

Impetigo

57
Q

Causative organism for impetigo

A

Staph aureus

58
Q

Treatment of impetigo

A

Topical antibacterial
- fucidin

Oral antibiotic
- flucloxacillin

59
Q

How long does molluscum contagiosum take to clear

A

Up to 24 months

60
Q

What is molluscum contagiosum

A

Common benign self limiting infection

Molluscipox virus

Pearly papules

61
Q

Treatment of molluscum contagiosum

A

Potassium hydroxide

  • wake up the immune system!
62
Q

Treatment of viral warts

A

Cryotherapy - freeze

Topical paints - salicylic acid

63
Q

Non-dermatological symptoms of viral exanthems

A

Associated viral illness
Fever, malaise, headache

Caused by reaction to a toxin produced by the organism, damage to the skin by the organism or an immune response

64
Q

Virus responsible for chicken pox

A

Varicella zoster

65
Q

Reactivation of the varicella zoster virus causes…

A

Shingles

66
Q

What must you warn parents of those with chicken pox

A

Contagious 1-2 days before rash appears and lesions have crusted

  • need to avoid in pregnant women
67
Q

Presentation of parvovirus

A

Slapped cheek

  • lace like network rash
  • erythematous rash cheeks

-

68
Q

Rare complications of parvovirus

A

Aplastic crisis in haemolytic disorders - virus attacks red cells in bone marrow

69
Q

How might parvovirus affect pregnant women

A

Spontaneous abortion

Intrauterine death

Hydrops fetalis

70
Q

What time of year is hand foot and mouth most comon

A

Epidemics late summer or autumn months

71
Q

Causative organism in hand foot and mouth

A

Enterovirus - usually coxsackie

72
Q

Presentation of hand foot and mouth

A

Blisters on hands, feet and in the mouth and viral symptoms

73
Q

Causes of erythema nodosum

A

Infections - strep, upper RTI

Inflammatory bowel disease

Sarcoidosis

Drugs - OCP, sulphonamides, penicillin

Mycobacterial infection

74
Q

What test would you do for someone with lip swelling and fissuring and oral mucosal lesions

A

Suspect crohn’s and do lip biopsy

75
Q

Presentation of erythema nodosum

A

Painful erythematous sub cut nodules

Over skins

Slow resolution - like bruise

76
Q

Which skin condition is associated with coeliac disease

A

Dermatitis herpetiformis

- itchy blisters on scalp, shoulder, buttock, elbows and knees that can appear in clusters

77
Q

Bilateral undescended testes may indicate…

A

Hypogonadotrophic hypogonadism

78
Q

Rate of cleft lip and/or palate

A

1 in 700

79
Q

Talipes

A

Medial (varus) or lateral (valgus) deviation of the foot that cannot be mamnipulated into the normal position

80
Q

How would you differentiate between a coccygeal bit and a dermal sinus tract

A

Coccygeal pits aren’t associated with any lumps, hairy patches or haemangioma - they need no investigation

81
Q

What do dermal sinus tracts indictate

A

They require neurological evaluation (including MRI)

They are associated with spinal fluid drainage, intradural dermoid or epidermoid cysts, and spinal cord tethering

82
Q

Forms of congenital brachial palsy

A

Paralysis of shoulder and biceps –> waiter’s tip (C5-6)

Paralysis of shoulder biceps and forearm extensors (C5-7) –> as above although elbow may be slightly flexed

Complete paralysis of limb (C5-T1) –> flail limb with claw hand - may have horner’s on the affected side

83
Q

Cataracts at birth

A

If red reflex cannot be seen

  • need urgent referral to opthalmologist

Best removed surgically within the first 2 weeks of life

Paediatrics 👫👶🏼 (8 decks)

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