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Paediatrics Flashcards

1
Q

Acute epiglottitis
Common bacterium

Features (5)
Position
Onset
Other

A

H. influenza type B

Features

  1. Tripod position
  2. Rapid onset
  3. Stridor
  4. Drooling of saliva
  5. Temperature
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2
Q

Thumb sign seen in which condition?
Steeple sign - subglottic narrowing seen in which condition?

Dx for epiglottitis
Mx

A

Sign seen on xray epiglottitis
Sign seen on xray croup

Visualisation +/- xray
Mx intubation, oxygen, abx

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3
Q

A sporty teenager presents with knee pain after exercise associated with intermittent swelling and locking

A

Osteochondritis dissecans

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4
Q

a teenage girl presents with medial knee pain following activity. The knee has given way on occasion

A

Patellar subluxation

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5
Q

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

A

Osgood-Schlatter disease

tibial apophysitis

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6
Q

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

A

Patellar tendonitis

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7
Q

Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy

A

Chondromalacia patellae

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8
Q

most common malignancy affecting children

Peak age

A

ALL

2-5yo

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9
Q
  1. Thrombocytopenia - easy bruising
  2. Anaemia - lethargy, pallor
  3. Neutropenia - frequent infections
  4. Fever
  5. Splenomegaly/ hepatomegaly

Name the most likely condition

A

ALL

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10
Q 
ALL poor prognostic factors (5)
Age
WCC number
Surface markers 
Race 
Gender
A 
age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex
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11
Q

Aortic stenosis in children are associated with which three conditions?

Mx (2)

A

William’s syndrome
Coarctation of the aorta
Turner’s syndrome

  1. Valve replacement
  2. If gradient across valve is > 60 mmHg then balloon valvotomy
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12
Q

What is the APGAR score?

A

Score 0,1,2 for each of the below

Pulse: absent, <100, >100
Resp effort: nil, weak irregular, strong/ crying
Colour: blue all over, extremities blue, pink
Tone: flaccid, limb flexion, active movement
Reflex irritability: nil, grimace, cries on stimulation

0-3 very low
4-6 moderate
7-10 good

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13
Q

ADHD

Mx (4)

A

Mx

  1. 10 week watch and wait period
  2. Refer to paeds or CAMHS
  3. Education and training programmes
  4. Drug therapy as last resort and only offered to those >5yo –> first line methylphenidate for 6 weeks

If in adequate response –> lisdexamfetamine

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14
Q

Monitoring methylphenidate + lisdexamfetamine

A

Baseline ECG

Height and weight every 6 months

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15
Q 
What is benign rolandic epilepsy?
Type of seizures
EEG findings?
When do the seizures stop?
Are they aware?
A 
Seizures occur mainly at night 
Partial seizures 
EEG shows centro-temporal spikes
Seizures usually stop by adolescence
Has awareness
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16
Q

Bronchiolitis
Organisim
Age group
Features

Dx

A

RSV
Most common in <1yo

  1. Dry cough
  2. Wheeze
  3. Feeding difficulties

Dx immunofluorescence of nasopharyngeal secretions may show RSV

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17
Q

Bronchiolitis

Rx

A
  1. Oxygen via headbox if <92%
  2. NG feeding
  3. Suction for secretions
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18
Q

Difference between Caput succedaneum and Cephalohaematoma

When does the swelling occur? 
Which crosses suture lines? 
How long to resolve? 
Where is the swelling?
Cause?
A

Caput succedaneum

  • swelling following prolonged/ traumatic delivery
  • vertex and crosses suture lines
  • days to resolve
  • present at birth

Cephalohaematoma

  • develops several hours post delivery
  • usually secondary to bleeding
  • parietal region, does not cross suture lines
  • can develop jaundice
  • can take three months to resolve
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19
Q

Normal RR in newborn

Normal HR in newborn

A

35-60

120-160

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20
Q

Where do threadworms come from?
Name the bacteria

Features

Mx

A

Enterobius vermicularis
Infestation occurs after swallowing eggs that are present in the environment.

perianal itching, particularly at night
Vulval itching

Mx
<6 months - hygiene measures only
>6 months - mebendazole

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21
Q

Causes of snoring (5)

A
  1. obesity
  2. nasal problems
  3. recurrent tonsillitis
  4. Down’s syndrome
  5. hypothyroidism
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22
Q

What is hypospadias?

Mx

A

Incorrect anatomy of urethral meatus, usually on ventral side of penis

Mx
Refer immediately
Surgery at 1yo
Nil circumcision

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23
Q

Features of CF

A
  1. short stature
  2. delayed puberty
  3. rectal prolapse (due to bulky stools)
  4. nasal polyps
  5. male infertility, female subfertility
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24
Q

CF associated conditions (4)

Genetics

A

Usually picked up at newborn screening programmes

  1. Mec ileus
  2. Recurrent chest infections
  3. Malabsorption/ FTT
  4. DM

AR CFTR gene chrm 7 delta F508

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25
Q

Congenital cyst found in the mouth

Common on hard palate

A

Epstein’s pearl

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26
Q

Hand foot mouth disease: Virus:

A

coxsackie A16

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27
Q

At what age is head banging a sign of autism?

A 
3yo = sign of autism 
2yo = normal
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28
Q

Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

A

Hand foot and mouth disease

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29
Q

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci - strep pyogenes
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

A

Scarlet fever

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30
Q

Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

A

Erythema infectiosum

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31
Q

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

A

Rubella

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32
Q

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

A

Mumps

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33
Q

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

A

Measles

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34
Q

Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild

A

Chickenpox

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35
Q

Abdominal mass
Painless haematuria
Flank pain
Anorexia/ fever =

A

Wilm’s tumour

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36
Q

Moderate
Severe asthma criteria
Life threatening

PEFR
Sats 
Clinical signs 
HR 
RR
A

Moderate, severe, life threatening
PEFR >50%, 33-50%, <33%
Sats >92%, <92%, <92%

Moderate - no clinical features of asthma

Severe: Too breathless to talk
Life threateningL silent chest

Severe: HR >120 >5yo, >140 1-5yo

SevereRR >30 >5yo, >40 1-5yo
Life threatening poor resp effort

Severe: Use of accessory neck muscles
Life threatening: agitation, altered consciousness, cyanosis

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37
Q

Acute asthma mx

A
  1. SABA via a spacer
    1 puff every 30-60 seconds up to a maximum of 10 puffs

If sx not controlled repeat and refer

  1. Steroids 3-5 days
    2-5yo 20mg OD
    >5yo 30-40mg
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38
Q

Asthma chronic mx >5yo

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + low dose ICS + LTRA
  4. SABA + low dose ICS + LABA (stop LTRA if not helpful)
  5. SABA + MART (low dose ICS)
  6. SABA + MART (mod ICS) OR SABA + mod ICS + LABA
  7. SABA + MART (high ICS) OR
    SABA + high ICS + LABA OR
    Step 6 + theophylline OR
    Refer
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39
Q

Asthma chronic mx <5yo

A
  1. SABA
  2. SABA + mod dose ICS 8 week trial
    After 8 week trial stop the ICS
    - if symptoms did not improve, consider alternative diagnosis
    - if symptoms had improved but reoccured within 4 weeks, start SABA and low dose ICS
    - if symptoms had improved but reoccured after 4 weeks, retrial 8 weeks mod dose ICS + SABA
  3. SABA + low dose ICS + LTRA
  4. Stop LTRA and refer
40
Q

SIDS protective factors (3)

A

breastfeeding
room sharing
the use of dummies

41
Q 
Features
rapid onset
unwell, toxic child
stridor
drooling of saliva
A

acute epiglottitis

42
Q 
Features are of sudden onset
coughing
choking
vomiting
stridor
A

Inhaled foreign body

43
Q

Congenital abnormality of the larynx.
Infants typical present at 4 weeks of age with:
stridor

A

Laryngomalacia

44
Q 
stridor
barking cough (worse at night)
fever
coryzal symptoms
6 months - 3 years
=?
A

Croup

45
Q

What is Plagiocephaly?

What is Craniosynostosis?

A

parallelogram shaped head

premature fusion of skull bones

46
Q

What is the Kocher criteria?

What is it used for?

A

Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip.

Non weight bearing
Temp >38.5
ESR >40
WCC >12

More than 1 criteria 40% chance of septic arthritis

47
Q

Mx unilateral undescended testes

Mx bilateral

A

Refer at 3 months
To be seen by 6 months
Surgery at 1yo - orchidopexy

Reviewed by a senior paediatrician within 24hours

48
Q

Complications of undescended testes (3)

A

infertility
torsion
testicular cancer

49
Q

Name x5 cyanotic heart disease in children

A
  1. ToF (presents at 1-2 months)
  2. Transposition (presents at birth)
  3. Tricuspid atresia
50
Q

Name x5 acyanotic heart disease in children

A
  1. VSD
  2. PDA
  3. ASD
  4. Coarctation
  5. Aortic valve stenosis
51
Q

SIDS major RF (5)
SIDS other RF (5)
Usually what age

A 
sleeping prone 
parental smoking 
prematurity 
bed sharing
hyperthermia
male sex
multiple births
social classes IV and V
maternal drug use
incidence increases in winter

1st year of life, commonly at 3 months

52
Q

RF for Surfactant deficient lung disease (5)

CXR findings

A
  1. prematurity
  2. male sex
  3. diabetic mothers
  4. Caesarean section
  5. second born of premature twins

ground-glass’ appearance with an indistinct heart border

53
Q

Hirschsprung’s disease
Initial ix
Gold standard Ix
Mx

A

AXR
Rectal biopsy

initially: rectal washouts/bowel irrigation
definitive management: surgery to affected segment of the colon

54
Q

Umbilical hernia in children mx

Which race is more common
Common in which condition?

A

Usually resolves by age 3yo

Afro-Caribbean infants
Down’s syndrome

55
Q

acute hip pain associated with a viral infection
2-10yo
commonest cause of hip pain in children

A

transient synovitis

mx self limiting

56
Q

When is the heel prick test done?

Diseases checked for? (9)

A

5-9 days of life

congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
57
Q

Most common nephrotic syndrome?

Mx

A

Minimal change

High dose steroids

58
Q 
fine, fair hair
learning difficulties, seizures
downwards (inferonasal) dislocation of lens
increased risk of VTE
malar flush, livedo reticularis
Mx
A

Homocystinuria

vitamin B6 (pyridoxine) supplements.

59
Q

What is cradle cap?
What age?
When does it resolve?

Mx

A

First few weeks of life
Erythematous rash with coarse yellow scales on scalp
Seborrhoeic dermatitis
Usually resolves spontaneously by 8 months

mild-moderate: baby shampoo and baby oils
severe: mild topical steroids e.g. 1% hydrocortisone

60
Q

What is used to maintain a patent ductus arteriosus?

A

PGE1

61
Q

What is the nitrogen washout test?

A

To differentiate cardiac from non-cardiac causes of cyanosis.

Give 100% O2 for 10 minutes
Take an ABG
If pO2 <15kPa = cyanotic congenital heart disease

62
Q

What is Acrocyanosis?

How long will it last?

A

Normal peripheral cyanosis around mouth and extremities.
Occurs immediately after birth
Can persist for 24 to 48 hours

63
Q 
Development milestones
When to refer:
Not smiling by?
Cannot sit unsupported by?
Cannot walk by?
A

doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months

64
Q

Chickenpox infectivity period

Features (4)

A

4 days prior to the rash, 5 days after the rash, or until lesions have crusted over

  1. fever initially
  2. itchy, rash starting on head/trunk before spreading.
  3. Initially macular then papular then vesicular
  4. systemic upset is usually mild
65
Q

Chickenpox
Name of virus
Mx (1)

A

Varicella zoster

  1. Calamine
66
Q

Child development

When is hand preference abnormal?

A

Before 12 months

67
Q

Constipation mx (2)

A
  1. Movicol Paediatric Plain using an escalating dose regimen

2. If not effective after 2 weeks add a stimulant laxative e.g lactulose

68
Q

Cow’s milk protein intolerance (CMPI)
Presentation

Features (5)

A

Within first 3 months of life in formula fed babies

  1. regurgitation
  2. diarrhoea
  3. urticaria, atopic eczema
  4. ‘colic’ symptoms: irritability, crying
  5. vomiting
69
Q

Cow’s milk protein intolerance (CMPI)
Mx (2)
If breastfeeding? Mx

A

Mild-moderate sx
1. extensive hydrolysed formula (eHF) milk
Severe sx
2. amino acid-based formula (AAF)

If breastfeeding
Continue breastfeeding
Eliminate cow’s milk protein from mum’s diet
Calcium supplements

Usually resolves in children by age 3-5

70
Q

Croup
Caused by?
Age

A

Parainfluenza

6 months - 3years

71
Q

Croup

When to admit? (4)

Mx (2)
Acute (2)

A
  1. <6 months
  2. Upper airway abnormalities
  3. Moderate or severe croup
  4. Uncertain diagnosis

Mx
Single dose dexamethasone to all children regardless of severity
OR
Pred

Acute
High flow oxygen
Nebulised adrenaline

72
Q

RF development dysplasia of the hip (6)

A
  1. female sex: 6 times greater risk
  2. breech presentation
  3. positive family history
  4. firstborn children
  5. oligohydramnios
  6. birth weight > 5 kg
73
Q

Who gets screening for development dysplasia of the hip?
(3)

Dx investigation

Mx (3)

A

USS

  1. 1st degree relative with hip problems early in life
  2. Breech from K36
  3. Multiple pregnancy

Barlow (dislocate) and Ortolani (relocate)
All babies newborn and at 6 week check

USS unless >4.5months - xray

Mx most will resolve by 3-6 weeks of age
Otherwise Pavlik harness if <4 months
Otherwise surgery

74
Q

Most common cause of acute diarrhoea in children?

Chronic diarrhoea

A

Rotavirus

Cows milk protein intolerance

75
Q

Eczema
Locations commonly affected?
Age of onset
Age it normally resolves

Mx

A

Face and trunk, younger children is extensor surfaces
Older children flexor surfaces, creases of face and neck
Normally onset <6months, resolves by age 5

Mx

  1. simple emolients
  2. topical steroids
76
Q

What age to refer kids with epistaxis?

A

Age <2yo

77
Q

Pneumonia
Most common organism
Mx

Mx myoplasma or chlamydia
Mx pneumonia associated with influenza

A

Strep pneum
Amoxicillin

Macrolides should be used if mycoplasma or chlamydia is suspected
In pneumonia associated with influenza, co-amoxiclav is recommended

78
Q

‘projectile’ vomiting, typically 30 minutes after a feed
constipation
dehydration
palpable mass may be present in the upper abdomen
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
=

age of onset
dx
mx

A

pyloric stenosis
second to fourth weeks of life
USS
Surgery: Ramstedt pyloromyotomy

79
Q 
School exclusion 
No exclusion (7)
A 
Conjunctivitis
Slapped cheek/ fifth disease 
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth
80
Q 
School exclusion 
Scarlet fever 
Whooping cough 
Measles
Rubella 
Chickenpox + impetigo 
Mumps
Scabies+ influenza
A 
Days 
24 hours after starting abx 
2 days after starting abx
4 days of onset of rash 
5 days of onset of rash 
all lesions crusted over 
5 days of onset of swollen glands 
Until recovered
81
Q

Measles
Infective period

Features (3) including location of rash
Ix
Mx
What to do if has not taken MMR but has been exposed to measles?

A

infective from prodrome until 4 days after rash starts

  1. Prodrome - irritable, conjunctivitis, fever
  2. Koplik spots - white spots on buccal mucosa before rash
  3. rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

Ix IgM antibodies
Mx supportive

Give MMR within 72 hours

82
Q

Measles

Top two complications

A
  1. Otitis media

2. Pneumonia

83
Q

Whooping cough AKA
Bacterium
Gram +ve/-ve

Features (5)
How long can symptoms last for?

A

Pertussis
Bordetella pertussis
Gram negative

Features

  1. 2-3 days of coryzal sx .. then
  2. Coughing bouts, worse at night
  3. Vomiting +/- cyanosis
  4. Inspiratory whoop
  5. Apnoea

10-14 weeks

84
Q

Whooping cough
When to admit?
Mx (2)
School exclusion

Complications (4)

A

<6 months

Mx
1. Macrolide if cough within 21 days of onset of cough
2. Household contacts should be offered abx
48 hours of onset of abx

  1. Subconjunctival haemorrhage
  2. Pneumonia
  3. Bronchiectasis
  4. Seizures
85
Q

UTI in children
When to do an USS?

Other Ix (3)

A

< 6 months + first UTI which responds to treatment USS within 6 weeks

> 6 months with atypical infection or recurrent infection

Ix

  1. MSU - for culture
  2. DMSA 4-6 months post infection - to check for scarring
  3. MCUG if <6 months and atypical/ recurrent infection - to identify vesicoureteric reflux
86
Q

What is the most common cause of cyanotic congenital heart disease?
Age of presentation?
Features (4)

CXR finding
ECG finding

What medication can be given for cyanotic episodes?

A

ToF
1-2 months

  1. VSD
  2. right ventricular hypertrophy
  3. pulmonary stenosis
  4. overriding aorta

CXR: ‘boot-shaped’ heart
ECG right ventricular hypertrophy

BBs

87
Q

Scarlet fever caused by?

Features (6)

A

Group A haemolytic strep
Strep pyogenes

  1. ‘strawberry’ tongue
  2. . sand paper rash obvious in flexures
  3. rash: fine punctate erythema (‘pinhead’) on the torso and spares the palms and soles
88
Q

Scarlet fever
Dx
Mx (2)

School exclusion

Complications

A
  1. Throat swab

Mx treat before results

  1. Penicillin V for 10 days
  2. Azithro if pen allergic

24 hours after commencing antibiotics

Complications

  1. Otitis media
  2. Glomerulonephritis
  3. RhF
89
Q

Roseola infantum AKA

Caused by?

A

Sixth disease

HHV6

90
Q

high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
=

A

Roseola infantum

91
Q

Name the condition
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems

AD/AR
Chrm
Age of diagnosis

Mx

A

Retinoblastoma
AD
Chrm 13
18 months

Mx
Enucleation/ RT/ chemo/ photocoagulation

92
Q

Food allergy Mx
If the history is suggestive of an IgE-mediated allergy what would you offer?

If the history is suggestive of an non-IgE-mediated allergy how would you manage the patient?

A

offer a skin prick test or blood tests for specific IgE antibodies to the suspected foods

eliminate the suspected allergen for 2-6 weeks, then reintroduce.

93
Q

Gastroschisis
Mx (1)
MOD

Exomphalos
MOD
Associated with which three conditions?
Mx

A

Can have vaginal delivery
Theatre straight away

CS 
Beckwith-Wiedemann syndrome
Down's syndrome
cardiac and kidney malformations
Mx can have surgery later as infant may need to grow a little so it can fit back in
94
Q 
Vaccinations 
At birth
2 months 
3 months
4 months 
12-13 months 
2-8yo
3-4yo
12-13yo 
13-18yo
A

At birth: BCG
2 months: ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), PO rotavirus, Men B
3 months: ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), PO rotavirus, PCV
4 months: ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), Men B
12-13 months Hib/Men C, MMR, PCV, Men B
2-8 years Flu vaccine (annual)
3-4 years ‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio), MMR
12-13 years HPV vaccination
13-18 years ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio), Men ACWY

95
Q

Low-pitched sound heard at the lower left sternal edge =

A

Still’s murmur - normal

96
Q

paroxysmal abdominal colic pain
during paroxysm the infant will characteristically draw their knees up and turn pale
vomiting
bloodstained stool - ‘red-currant jelly’ - is a late sign
sausage-shaped mass in the right upper quadrant
= which condition?
Age
Gender
Ix + finding

Mx

A

Intussusception
6-18months M>F
USS - target-like mass

Mx reduction by air insufflation under radiological control

MSRA (22 decks)

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