2paeds Flashcards
roseola cause
herpes 6
DDH RF
oligohydramnios - low level of fluid restricts movement and development of hip
newborn hearing test
automated otoacoustic emission test.
Asthma in children aged 5-11: first-management →
Asthma in children aged 5-11: first-management → twice-daily paediatric low-dose ICS + SABA as needed
when do you not do USS for DDH?
DDH in a child >4.5 months: x-ray is the first-line investigation
A 4-year-old boy is brought to the emergency surgery with a fever and a blotchy rash. His mother says the rash was initially just behind his ears but is now all over his body. On examination, you also noticed clusters of white lesions on the buccal mucosa. The child has not been vaccinated.
What complication is this child at risk of?
pneumonia from measles
A mother arrives at the paediatric emergency department with her 4-year-old boy. He has a fever and she has noticed raised nodes on his neck. She has given him paracetamol and ibuprofen but his temperature is not reducing. His lips have become extremely dry and cracked and his tongue red and slightly swollen. She has noticed that his feet are also red and puffy now, and he is developing a widespread fine rash. What is the most likely diagnosis?
High fever lasting >5 days, red palms with desquamation and strawberry tongue are indicative of Kawasaki disease
Hand, foot and mouth disease starts with general malaise and pyrexia, however skin lesions in the form of vesicles appear in the mouth.
pertussis treatment
Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days
A 4-hour-old baby boy, born at 36 weeks gestation, is observed to have hypotonia and poor sucking reflex during feeding in the maternity unit. The nursing staff is concerned and has requested an urgent review by the on-call doctor. Initial investigations reveal a blood glucose level of 2.3 mmol/L.
Admit to neonatal unit and give IV 10% dextrose is the correct answer, as the infant presents with symptoms of hypotonia and poor sucking reflex. Pre-term infants are particularly susceptible to neonatal hypoglycaemia.
increase breastfeeding and monitor glucose only if asymptomatic
neonatal sepsis most common presentation
grunting and RDS
female puberty
breasts –> axillary hair –> menarche
sandpaper rash and strawberry tongue
scarlett fever - seizures common
Perthes disease in young child
avascularisation of femoral head
Perthes’ disease presenting under the age of 6 years has a good prognosis requiring only observation
The most common heart lesion associated with Duchenne muscular dystrophy is
dilated cardiomyopathy
A baby born at 34 weeks to a healthy mother, is currently undergoing a check whilst on the ward. The baby appears healthy on general inspection and the mother reports no concerns so far. On examination, a large volume, collapsing pulse is noted, and a heaving apex beat, as well as a left subclavicular thrill. On auscultation of heart sounds, the doctor notes a continuous ‘machinery-like’ murmur.
The doctor arranges an urgent echocardiogram, which confirms her suspected diagnosis. No other abnormalities or defects are demonstrated on the echo.
If the findings persist after one week, what would be the most appropriate initial management?
give indomethacin
Preterm infants with haemodynamically significant patent ductus arteriosus 1 week after birth - give ibuprofen/indomethacin to promote duct closure
cause of cleft
maternal anti epileptic use in pregnancy
partial seizures at night - diagnosis and Ix result
benign rolandic epilepsy- EEG showing centrotemporal spikes
should you start CPR in a 4 year old boy with a pulse of 30bpm?
also start CPR in children who become bradycardic (heart rate < 60 min-1) with signs of inadequate perfusion despite adequate respiratory support’.
15:2 ratio
turners heart defects
bicuspid aorta more common that coarctation
turners murmur
crescendo-decrescendo murmur on the upper right sternal border which radiates to the carotids.
ejection systolic
investigation of choice for reflux nephropathy
Micturating cystography is the investigation of choice for reflux nephropathy
Term infant with clinical significant PDA →
transcatheter ΡDA closure (not ibuprofen/indomethacin)
bronchiolitis features
fine inspiratory crackles, rhinitis, feeding difficulties, expiratory wheeze, low grade fever
when to consider pneumonia in suspected bronchiolitis
Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.
Trident hands -
achondroplasia -
more achondroplasia features
short limbs (rhizomelia), lumbar lordosis and midface hypoplasia.
severe vs life threatening asthma
A baby born at 35 weeks gestations via normal vaginal delivery is found to be irritable 48 hours after birth and suffers a convulsion. There is no obvious head trauma or swellings. Which one of the following cranial injuries is most likely to have occurred?
intraventricular haemorrhage
congenital diaphrgamatic hernia
more common on left, can recur, can get pulmonary HTN, increased risk of sibling having it
whooping cough how long to exclude from school after abx
48 hours
The initial management in Hirschprung’s disease is
rectal washouts/bowel irrigation
paeds BLS rescue breaths
5
Females in the family all have the disease, and there is an abrupt stop when it is passed through male lineage ?
mitochondrial disease- will not be passed on to children from father
murmurs in VSD, aortic coarctation, PDA and pulmonary stenosis
when is neonatal blood spot screening performed
Between fifth and ninth day of life
boy with very swollen inflamed leg after chickenpox and high temp
Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis
strep pyogenes
maintain vs close congenital heart hole
maintain = prostaglandin E1
close = indomethacin (do like door like closing a door)
boy with temp, anaemia, neutropaenia and thrombocytopaenia
ALL - acute lymphoblastic leukaemia
Meningitis is a cause of fever and purpura, as seen in this patient. However, you would expect to see neutrophilia in bacterial meningitis, not neutropaenia; therefore, bacterial meningitis is unlikely here.
You are asked to review a term neonate on the postnatal wards. On examination of the palate, you notice a white-coloured nodule at the roof of the mouth. This is not interfering with feeding and baby is alert and active. What is the most likely diagnosis?
epsteins pearl
what can cause bronchiolitis to be more severe
congenial heart disease
You are called by the mother of a 18-month-old boy. He has been unwell with a suspected viral upper respiratory tract infection for the past few days. His mother reports that he has just had a seizure. Three months ago he had a confirmed febrile convulsion following a similar illness. You arrange to see the child that morning. Which one of the following factors should prompt referral to paediatrics?
child still being drowsy 2 hours post seizure
2 year old sudden onset bilateral limp next steps
Urgent assessment should be arranged for a child < 3 years presenting with an acute limp - urgent paeds referral
not just urgent x ray
All breech babies at or after 36 weeks gestation require
USS for DDH screening at 6 weeks regardless of mode of delivery
2 main findings in congenital rubella
Congenital rubella
sensorineural deafness
congenital cataracts
A 6-year-old boy is brought to surgery by his mother. For the past 2 months he has been complaining of pain in his shins and ankles at night-time. His symptoms are bilateral he is otherwise well. There is no family history of note. Clinical examination is unremarkable. What is the most likely diagnosis?
growing pains
GORD 1st line in bottle vs breast fed
bottle - thickened
breast - alginate
An 18 month old boy is brought to the emergency room by his parents. He was found in bed with a nappy filled with dark red blood. He is haemodynamically unstable and requires a blood transfusion. Prior to this episode he was well with no prior medical history. What is the most likely cause?
Meckels diverticulum is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.
NEC is typically seen in the first few weeks of life, whereas Meckel’s presents later
well child with diarrhoea and vomiting
Introduce oral rehydrating solution
Discourage the drinking of fruit juices and carbonated drinks, especially in those at increased risk of dehydration [NICE 2009].
You are asked to attend a preterm delivery. The neonate is born at 36 weeks gestation via emergency Caesarean section. The neonate has difficulty initiating breathing and requires resuscitation. They are dyspnoeic and tachypnoeic at a rate of 85 breaths/min. On auscultation of the chest, there is reduced breath sounds bilaterally. Heart sounds are displaced medially. The abdominal wall appears concave. What is the most likely diagnosis?
concave appearance = Congenital diaphragmatic hernia presents with scaphoid abdomen, due to herniation of the abdominal contents into the cleft
noonan
webbed neck, pulmonary stenosis, ptosis and short stature. pectus excavatum
A 6-year-old girl with cystic fibrosis attends for her routine clinic appointment. She was diagnosed with cystic fibrosis at 3 weeks of age following newborn screening. She has been well with no recent respiratory exacerbations. Her sputum culture has grown Pseudomonas aeruginosa for the first time. She is currently on pancreatic enzyme replacement therapy.
What is the most appropriate next step in management?
Commence nebulised colistin and oral ciprofloxacin
important to try and eradicate
red flag RR
A respiratory rate of >60 per minute (at any age) is a red flag according to the NICE paediatric traffic light system
temp over 38 only in children under 3 months
unwell child traffic light
