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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
Causes of delayed puberty
Gonadal dysgenesis (turners) Chronic disease - crohn's asthma Impaired HPG axis Peripheral - testicular irradiation
26
Cause of central precocious puberty
Girls - activation of gonadal axis at pituitary level - usually idiopathic Boys - brain tumour Treatment GnRH agonist
27
Pathological causes of short stature
Undernutrition Chronic illness (JCA, IBD, Coeliac) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyroidism) Syndromes (Turner, prader willi)
28
Congenital hypothyroidism causes
Athyreosis Hypoplastic Eptopic Dyshormogenic - picked up at newborn screening
29
Thyroid deficiency will cause
Lack of height gain Pubertal delay Poor school performance
30
Why might a child be obese
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
31
Symptoms of diabetic ketoacidosis
Nausea and vomiting Abdo pain - sometimes thought to be appendicitis Sweet smelling, ketotic breath Drowsiness Rapid, deep "signing" respiration Coma
32
How would you test a child for diabetes
Finger prick capillary glucose test If result >11 mmol/l They have diabetes Call for review same day
33
Most important pubertal stages in a girl
Breast budding - tanner stage B2
34
What is the most important pubertal stage in a boy
Testicular enlargement | Tanner stage G2 - T
35
Red flag symptoms for childhood cancer
Unexplained petichiae, hepatosplenomegaly Repeat attendance for the same problem but no clear diagnosis Rest pain, back pain and unexplained lump
36
Most common cancers in childhood
Leukaemia CNS tumours Lymphomas Neuroblastomas
37
Principles of management of childhood cancer
Parental support MDT Play therapy Venous access Long term therapy
38
What is tumour lysis syndrome
Metabolic derangement by tumour cells that can appear in response to chemo, anaesthesia and infection
39
Why does tumour lysis syndrome cause renal failure
Urate load and calcium phosphate deposition in renal tubules High potassium is primary problem --> high urate --> high potassium --> poor glomerular filtration --> low calcium
40
Treatment of tumour lysis syndrome
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
Febrile neutropenia definition
Neutrophils 38
42
Symptoms of spinal cord compression
Weakness - ambulatory, non ambulatory, paraplegia Spine tenderness (children never get back pain!) Sphincter disturbance Sensory disturbance
43
Management of spinal cord compression in child (tumour)
MRI Dexamethasone - 1mg/kg Chemo or radio (try avoid)
44
Where does seborrheoic dermatitis occur
Mainly scalp and face often in babies under 3 months
45
How would you treat seborrheoic dermatitis
Emollients Antifungal creams Antifungal shampoos Mild top steroids
46
Discoid eczema is characterised by
Scattered annular/circular patches of itchy eczema - often seen as a pattern of atopic eczema
47
Where does pomphylx eczema most commonly occur
Hand and foot eczema Vescicles
48
Which skin condition occurs in association with venous insufficiency
Varicose eczema
49
Treatment of varicose eczema
Emollients Topical steroids Compression stockings (take care to ensure arterial blood supply maintained)
50
How is best to test for allergic eczema
Patch testing or skin prick or blood test for food allergen
51
What causes irritant eczema
Repeated contact Water and soaps Touching irritant foods; citrus, tomatoes, chemical irritants
52
Symptoms of food allergy
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
How would you assess if a child has an allergy
Blood tests for specific IgE antibodies Skin prick tests
54
Treatment of eczema
Lotions creams or ointments Topical steroids Topical immunosupression - calcineurin inhibitors UVB light therapy (could increase skin cancer risk over time) Immunosupressive medication
55
Range of topical steroids and their potency
Mild - hydrocortisone Moderate - eumovate Potent - betnovate Very potent - dermovate
56
What presents as pustules and honey-coloured crusted erosions
Impetigo
57
Causative organism for impetigo
Staph aureus
58
Treatment of impetigo
Topical antibacterial - fucidin Oral antibiotic - flucloxacillin
59
How long does molluscum contagiosum take to clear
Up to 24 months
60
What is molluscum contagiosum
Common benign self limiting infection Molluscipox virus Pearly papules
61
Treatment of molluscum contagiosum
Potassium hydroxide - wake up the immune system!
62
Treatment of viral warts
Cryotherapy - freeze Topical paints - salicylic acid
63
Non-dermatological symptoms of viral exanthems
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
Virus responsible for chicken pox
Varicella zoster
65
Reactivation of the varicella zoster virus causes...
Shingles
66
What must you warn parents of those with chicken pox
Contagious 1-2 days before rash appears and lesions have crusted - need to avoid in pregnant women
67
Presentation of parvovirus
Slapped cheek - lace like network rash - erythematous rash cheeks -
68
Rare complications of parvovirus
Aplastic crisis in haemolytic disorders - virus attacks red cells in bone marrow
69
How might parvovirus affect pregnant women
Spontaneous abortion Intrauterine death Hydrops fetalis
70
What time of year is hand foot and mouth most comon
Epidemics late summer or autumn months
71
Causative organism in hand foot and mouth
Enterovirus - usually coxsackie
72
Presentation of hand foot and mouth
Blisters on hands, feet and in the mouth and viral symptoms
73
Causes of erythema nodosum
Infections - strep, upper RTI Inflammatory bowel disease Sarcoidosis Drugs - OCP, sulphonamides, penicillin Mycobacterial infection
74
What test would you do for someone with lip swelling and fissuring and oral mucosal lesions
Suspect crohn's and do lip biopsy
75
Presentation of erythema nodosum
Painful erythematous sub cut nodules Over skins Slow resolution - like bruise
76
Which skin condition is associated with coeliac disease
Dermatitis herpetiformis | - itchy blisters on scalp, shoulder, buttock, elbows and knees that can appear in clusters
77
Bilateral undescended testes may indicate...
Hypogonadotrophic hypogonadism
78
Rate of cleft lip and/or palate
1 in 700
79
Talipes
Medial (varus) or lateral (valgus) deviation of the foot that cannot be mamnipulated into the normal position
80
How would you differentiate between a coccygeal bit and a dermal sinus tract
Coccygeal pits aren't associated with any lumps, hairy patches or haemangioma - they need no investigation
81
What do dermal sinus tracts indictate
They require neurological evaluation (including MRI) They are associated with spinal fluid drainage, intradural dermoid or epidermoid cysts, and spinal cord tethering
82
Forms of congenital brachial palsy
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
Cataracts at birth
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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