Paediatrics

Front 1

What is the clinical feature most effected by the age of a child

What could influence this clinical feature?

Back 1

Respiratory rate

Highest in neonates, gradually becomes slower approaching pre-adolescent/adolescent age.

RR influenced by
- Pulmonary/airwat infection
- Non-respiratory causes of inflammation (fever, anxiety, acidosis, pain, heart failure, CNS disease, Drugs, ammonia toxin)

Front 2

What is the condition that affects the family of an infant or child who has suffered what the parents believe is a 'close call' with death and thereafter perceived as vulnerable to serious injury or accidents?

Back 2

Vunerable Child syndrome

Front 3

During examination of an 8 m.o child, the difficulty of optimal chest auscultaion is primarily due to?

Back 3

Stanger Anxiety

Crying makes the chest physical examination almost impossible. Best conducted on the asleep, calm, nursing or feeding infant.

Front 4

Assesment of the childs state of well being by observation mostly relies on the childs?

Back 4

Interaction with parents

Important as this is the childs "normal" environment and is free from additional factors such as stranger anxiety.

Front 5

Based on the orientation to child development, when would you tell parents the highest risk of poisoning in children is present?

Back 5

2 years old

Self poisoning in toddlers occurs once they become ambulatory and are able to walk and climb.

Plants, berries and liquids also present a risk at this age

Front 6

What is the difference between injury control and accident prevention?

Back 6

Injuries have definable risks, are not random, and are both predictable and preventable. The term "accident" should no longer be used.

Front 7

between which periods of life do males have a higher injury rate than females?

Back 7

After the 1st/2nd years of life through to the 7th decade

Front 8

The proper age at which a child may cross a busy street alone after careful instruction is?

Back 8

10-12 yrs old

Below this age, children are unable to understand the risk and judge factors such as car speed

Front 9

A child is in respiratory distress with stridor and cyanosis with a presumptive diagnosis of viral croup. What should you not do?

Back 9

Transport immediately in the parents car to the nearest emergency department.

No acutely ill child should be transported by parents no matter how short the distance or how long the delay for emergency services to arrive

Front 10

Emergencies involving parents are stressful for the child, parents and emergency staff. What is useful in decreasing stress?

Back 10

- Parents presence at resuscitation
- Seperating child from other frightening sights and sounds
- Communicating clearly

Front 11

What are the causes of Pulseless Electrical Activity (PEA)

Back 11

Agents that work directly on the heart or interfere with cardiac output may produce PEA
- Toxins
- PE
- Pericardial Tamponade
- Pneumothorax

Front 12

What is the drug of choice for shock refractory VF?

Back 12

Amiodarone is the drug of choice for shock-resistant VT/VF
Lidocaine is second best

Front 13

What is the normal systolic blood pressure formula for ages 1-10?

Back 13

70 + (2 x age)

Front 14

What is the one best test to determine if shock is present?

Back 14

A mixed Venous O2 Saturation Measurement
(+ possibly lactate levels)

Mixed venous saturation reflects tissue oxygen extraction, which reflects oxygen delivery and oxygen consumption. If tissue oxygen consumption is greater than oxygen delivery, the mixed venous saturation declines

Front 15

The drug pair that both stimulates the heart and relaxes the vasculature is?

Back 15

Dopamine and dobutamine

Dopamine acts on dopaminergic and beta-adrenergic receptors of the heart

Dobutamine acts on beta-receptors of the heart and the peripheral arteries.

Front 16

A 5-yr-old boy presents with petechiae, fresh bruises, low-grade
fever, dizziness, and lethargy. You admit him to the hospital and start an IV infusion.
The most appropriate next step in management would be?

Back 16

Administration of Normal Saline

The dizziness and lethargy suggest poor central nervous system perfusion and hypotension. Intravenous fluid
(crystalloid) resuscitation is urgently needed and should be
given as soon as possible. It may need to be repeated often. In addition, intravenous antibiotics must be given rapidly, because early therapy of meningococcal sepsis with antibiotics has proven to reduce mortality. Steroids may be needed later if adrenal insufficiency is demonstrated in a patient unresponsive to fluid boluses and inotropic agents.

Front 17

What is the normal alveolar-arterial (A-a) gradient?

Back 17

<10mmHg

Usually normal for children aged 1 month and older. Any deviation suggests V/Q mismatch, intrapulmonary shunt, cardiac left to right shunt, or rarely an alveolar diffusion defect

Front 18

A child presents to you with respiratory distress. What is the most appropriate immediate response?

Back 18

Position child in a comfortable position, reassess the airway, provide oxygen and other supportive measures.

A mask may frighten some children, nasal cannulas are usually well tolerated.

Front 19

Patients with severe forms of reactive airways disease (e.g. asthma) who require mechanical ventilation may benefit from what initial ventilator parameters?

Back 19

Low rates
prolonged inspiratory/expiratory times
low tidal volumes (<6ml/kg)

Front 20

What is the most important manouvre in preserving renal function in septic shock?

Back 20

Rapid restoration of the circulating volume

Front 21

What is an early morning headache a warning sign for?

Back 21

raised intracranial pressure

Front 22

What is the best investigation for blunt abdominal trauma in a paediatric patient?

Back 22

Abdominal CT with IV Contrast

Most useful for solid organs (liver, spleen, kidneys) but will also demonstrate panceatic injury, haemorrhage (free fluid), and intestinal injury

Front 23

What age do teenagers reach adult hematologic parameters?

Back 23

Girls: 12
Boys: 14

Front 24

What causes galactorrhoea in a teenage girl? (6)

Back 24

1. Drug-induced (OCP, amphetamines, cocaine, marajuana, opiates, methyldopa)

2. Pregnancy-associated (post abortion or miscarriage, may continue up to 3 months)

3. Malignancy (pituitary --> very high levels of prolactin, hypothalamic craniopharyngioma)

4. Hypothyroidism

5. Chronic Renal Disease

6. Chest wall (nipple manipulation, surgery, herpes zoster)

Front 25

Most common cause of pelvic pain in adolescents without a history of pelvic inflammatory disease?

Back 25

Endometriosis

Front 26

Techniques to increase compliance in adolescents

Back 26

Simplify regimen
Discuss potential side effects
Education
Enlist co-operation
Work together with parents (without giving them complete control)
Make the patient responsible
Use praise liberally
Avoid confrontation

Front 27

HEADSS

Back 27

Home
Education
Activities
Drugs
Sex
Suicide

Front 28

4 criteria required for the diagnosis of anorexia nervosa?

Back 28

1. Internal fear of becoming obese despite weight loss

2. Distortion of body image

3. Refusal to maintain normal BMI

4. Amenorrhoea in postmenarchal females

Front 29

What are some hormonal features seen in anorexia nervosa?

Back 29

Amenorrhoea
Symptoms of hypothyroidism (levels of T4 normal but T3 low)

Loss of diurnal variation of cortisol

Diminished plasma catecholamines

flattened glucose tolerance curve

Front 30

Psychologic profile of a typical person with anorexia nervosa

Back 30

Distorted body image
Poor self-esteem
Depression
Over-achiever perfectionist
Strong-willed
Uncommunicative behaviour
Distrustful
Irritablility
Obsessive thoughts of food/dieting

Front 31

What causes sudden death in a person with anorexia?

Back 31

Depressed cardiovascular functions due to effects on myocardium. Bradycardia, decreased QRS amplitudes, non-specific ST changes often without underlying electrolyte changes

Increased risk of arrhythmias if electrolytes are distorted (specifically K+ from vomitting and diarrhoea)

Front 32

How is bulimia diagnosed?

Back 32

History

High-caloric overeating and subsequent forced vomiting or other purging methods (laxatives, diuretics) often done in periods of psychological stress

Front 33

What is the difference between Primary and secondary Amenorrhoea

Back 33

Primary: no onset of menses by
- 16 or
- Within 3 years of onset of secondary sex characteristics or
- Within 1 year of onset of breast/pubic hair developement

Secondary
No menses for 3 months after previous establishment of regular menstrual periods

Front 34

What are some causes of primary amenorrhoea? (2 categories)

Back 34

Amenorrhoea without secondary sex characteristics
- Turner, 17a-hydroxylase deficiency
- Congenital absence of uterus
- Diminished gonadotrophins

Amenorrhoea with secondary sex characteristics
- Dysfunction of GnRH (stress, excess exercise, weight loss, PCOS, hypothyroidism)
- abnormal pituitary glands
- Ovarian dysfunction
- Abnormalities in genital tract
- Pregnancy

Front 35

What are some Complications of Bulimia?

Back 35

- Electrolyte abnormalities
- Eosophageal reflux
- Cardiomyopathy from use of Ipecac
- CNS changes of perceptions of satiety
- Enamel erosion, salivary gland enlargement

Front 36

What is the PCOS triad?

Back 36

- amenorrhoea/oligomenorrhoea
- hirsutism
- obesity

Front 37

What are the normal values of the menstrual cycle?

Back 37

Most cycles last no longer than 8 days
No more or less frequent than every 21-40 days
Not associated by > 80ml blood loss (ask for clotting for a more reliable guage)

Front 38

When do boys develope the ability to reproduce?

Back 38

Spermache: 13.3 years

Front 39

What are the 4 types of substances used by teens?

Back 39

1. Experimental
2. Recreational
3. Problematic
4. Addictive

Front 40

What is the antidote for opiod toxicity?

Back 40

Naloxone

Front 41

What are the symptoms of Nicotine withdrawal?

Back 41

onset within 2 hours of last use
Peaks at 24 hours
Persist for weeks

Symptoms
- strong desire for nicotine
- irritability
- frustration/anger/depression
- difficulty concentrating
- increased appetite
- Headache
- GI disturbances

Front 42

What are some signs of Nicotine withdrawal?

Back 42

- Decreased Heart rate
- weight gain
- decreased catecholamine levels
- decreased metabolic rate
- Alteration of REM pattern

Front 43

How common is gynecomastia in teenage boys?

Back 43

75% aged 12-14.5 have some breast development

Front 44

Why does gynecomastia occur in teenage boys so commonly?

Back 44

Early in puberty, oestrogen production increases relatively faster than testosterone. In obese boys, aromatase (found in higher concentrations in adipose tissue) converts testosterone to oestrogen

Front 45

What drugs are associated with gynecomastia? CHEST

Back 45

Ca-channel blockers
Hormonal medications (OCP, steroids)
Experimental drugs (marijuana, heroin)
pSychoactive drugs (TCA, diazepam)
Testosterone antagonists (spiranolactone)

Front 46

What is the most common solid cancer in older adolescent males?

Back 46

Testicular cancer

Front 47

Which side do varicoceles more commonly occur?

Back 47

Left

Left spermatic vein drains to the left renal vein, right spermatic vein drains to IVC. Hemodynamics favour higher left-sided pressures predisposing the left side

Front 48

What are the risks for infants of teenage mothers?

Back 48

- low birth weight
- premature or small for gestational age
- infant mortality 2-3 times higher
-

Front 49

How soon after conception will a urine pregnancy test be positive?

Back 49

hCG can be detected in the urine 1-3 weeks post conception

Front 50

What is the mechanism of the Oral contraceptive pill?

Back 50

1. Interference with hypothalamic GnRH (suppresses FSH/LH)

2. Increased Cervical mucus thickness and reduced volume

3. Atrophy of endometrium and decreased glycogen content (reduced chance of implantation)

Front 51

What are the contraindications of OCP use? (6)

Back 51

1. History of thromboembolic disease
2. Abnormal LFT's
3. Oestrogen dependant neoplasia
4. Breast cancer
5. Undiagnosed vaginal/uterine bleed
6. Pregnancy

Front 52

After OCP's are discontinued, how long is amenorrhoea likely to persist?

Back 52

Few months after discontinuation. If > 6 months, secondary causes should be sought.

Front 53

What is the risk to the fetus if the mother begins taking OCP's?

Back 53

Masculinization of female infants and higher bilirubin levels of the newborn.

Front 54

What oral treatments are effective for emergency postcoital contraception?

Back 54

Ethinyl Oestrodiol/norgestrel

Most effective when given 72hours of intercourse