Child Health Flashcards
SUFE
slipped upper femoral epiphysis
obese boy with hip (+/- knee) pain
S econdary school age (10-15)
rare
loss of internal rotation whilst in flexion
M - internal fixation
perthe’s
developmental dysplasia of hip
RF: breech delivery
I: x-ray, USS
live attenuated vaccines:
MMR
Rotavirus
BCG
Smallpox
inactive vaccines: polysaccharides
Hib
Meningococcal
Pneumococcal
vaccinations: 2 months
6 in 1
ORAL rotavirus
Men B
6 in 1 vaccinations
diptheria, tetanus, pertussis, polio , Haemophilus B, hepatitis B
vaccinations: 3 months
6 in 1
Oral rotavirus
PCV
vaccinations: 4 months
6 in 1
Men B
Men B
vaccinations: 12-13 months
Hib/Men C
MMR
PCV (pneumococcal conjugate)
Men B
vaccinations: 2-8 years
Flu vaccine (annual)
vaccinations: 3-4 years
4 in 1 preschool booster (DTaP w/ MMR)
vaccinations: 12-13 years
HPV vaccination
vaccinations: 13-18 years
3 in 1 teenage booster (Diptheria Tetanus and POLIO)
Men ACWY
vaccinations: pregnancy
When are they offered
Influenza
Pertussis (2012)
16-32 weeks gesation
stimulants for growth
infants (0-3) : nutrients and insulin
child (3-12) : GH and thyroxine
pubertal (12-18): sex steroids
obesity causes
growth hormone deficiency
hypothyroidism
down’s
cushing’s
Prader-Willi
normal weight loss in new borns
5-10% of body weight
normal deviation from line on child’s height graph
+/- 2 standard deviations
puberty - girls
breasts (thelarche): budding
body hair (adrenarche): pubic and auxiliary hair
menstruation (menarche)
puberty - boys
testicular growth (10-15 years)
testicular volume >4ml
body hair: pubic and auxiliary hair
menstruation (menarche)
growing pains
NEVER present at the start of the day
worse after a day of activity
no limp, limitations of physical activity
systemically well
normal physical examination
precocious puberty
adrenal hyperplasia: low FSH & LH
delayed puberty
androgen insensitivity: primary amenorrhoea and no pubic hair
kallmann’s syndrome: hypogonadotrophic hypogonadism
klinefter’s syndrome
most children achieve day and night urinary continence by
3-4 years-old
Thrush of breast tx. mum and baby:
Maternal: topical meconazole or oral fluconazole
Baby if < 4 months: oral nystatin
Baby if > 4 months: Miconazole gel
developmental red flags:
10 weeks: smile
12 months: sit unsupported
18 months: walking
other: asymmetry of movement, visual or auditory concerns, loss of skills
edward’s syndrome (trisomy 18)
microcephaly
micrognathia
overlapping of fingers
rocker bottom feet
down syndrome (trisomy 21)
hypothyroidism
T1DM
ALL
alzheimer’s
noonan syndrome
short stature
webbed neck
pectus excavatum
pulmonic murmurs: pulmonary stenosis
turner syndrome
short stature
primary amenorrhoea
bicuspid aortic valve
patau syndrome (trisomy 13)
cleft lip
extra fingers
microcephaly
cyclopia
Prader-Willi
inheritance: imprinting
high temperature
suggests bacterial rather than viral infection
pierre robin syndrome
posterior displacement of tongue (may result in airway obstruction)
cleft palate
micrognathia
fragile X
neurodevelopment delay
facies: elongated, protruding
macroorchidism
hypotonia
recurrent otitis media
williams syndrome
Friendly extroverted personality with learning difficulties and elf like face
supravalvular aortic stenosis
DiGeorge syndrome (22)
Abormal face
Cleft lip
HYPOCALCAEMIA
increased risk of schizophrenia
duchenne muscular dystrophy
A: X-linked recessive
I: genetic testing
croup
A - parainfluenza virus
E - autumn
P - stridor (intermittent, harsh), barking cough (worse at night)
I - clinical diagnosis
M - oral dexamethasone (0.15 mg/kg), nebulised adrenaline (emergency)
admission: audible stridor at rest
epiglottitis
A - haemophilus influenzae type B
P - no prodrome, drooling, unable to swallow, muffled voice, tripod position
I: clinical diagnosis, neck xray (thumb printing)
M: airway, oxygen, IV antibiotics (ceftriaxone)
bronchiolitis
A - respiratory syncytial virus (RSV)
E - < 24 months
P - coryzal symptoms, increased work of breathing, fine inspiratory crackles
M - supportive
more severe in CHD
community acquired pneumonia
< 12 months: co-amoxiclav
> 12 months: amoxicillin
pertussis (whooping cough)
A - Bordatella Pertussis
P -
1. coryzal symproms
2. paroxysms of cough / fits
I - nasal swab
M - macrolide (clarithromycin, azithromycin)
household contacts: ABx prophylaxis
absence: 48 hrs from commencing ABx
notifiable disease
scarlet fever
A: GABHS and tonsilitis
P: fever, strawberry tongue, lymphadenopathy, sandpaper rash
M: oral penicillin V (10 days)
absence: 24 hours after starting ABx
notifiable disease
C: otitis media
asthma
- SABA
- low dose ICS
- LTRA
- IV salbutamol
- aminophyline
exacerbation:
- beta therapy (b2 agonist)
- steroid therapy for 3-5 days
(<2 yrs 10 mg, >2: 20 mg)
viral induced wheeze
> 1 y/o
wheeze
M - SABA, oral montelukast/ inhaled corticosteroid
acute otitis media
antibiotics: amoxicillin
- <2 yrs
- bilateral
- marked otorrhoea
- bulging tympanic membrane
Features of innocent cardiac murmur in childhood:
soft
systolic
situational
asymptomatic
venous hum
continuous murmur
heard best below the clavicles due to turbulent flow in the head and neck veins
disappears when child lies down
murmur causes
1 - 2 days: transposition of great arteries, tricuspid atresia
1 - 2 months: tetralogy of fallot
murmur - VSD
PANsystolic
thrills
symptoms of heart failure
inc risk of endocarditis
murmur - coarctation of aorta
ejection systolic
murmur - atrial septal defect
soft ejection systolic murmur
patent ductus arteriosus
continuous machine-like murmur best heard below left clavicle
M: indomethacin, ibuprofen to promote duct closure
cyanotic congenital heart diseases
- Tetralogy of fallot
- Transposition of great vessels (TGA)
- Tricuspid atresia
- Total anomalous pulmonary venous return
- Truncus arteriosus
M: prostaglandin E1
ebstein’s anomaly
pyloric stenosis
hypertrophic pylorus
E - 2-6 weeks
P - projectile non-billious vomiting, palpable mass, hypochloraemic, hypokalaemic metabolic alkalosis
I - USS
M - ramstedt pyloromyotomy
malrotation
P - billious vomiting, abdominal distension, obstruction
biliary atresia
E: >2 weeks
P - billious vomiting, prolonged jaundice, hepatomegaly, splenomegaly
M: surgical (kasai procedure)
necrotising enterocolitis
E - premature infants, newborn infants
P - vomiting, abdominal distension, red currant jelly stools
I: AXR (gas cysts)
intussussception
E: older infants (6-18 months)
P: colicky abdominal pain, bilious vomiting, red currant jelly stool (late sign)
I: USS
chronic diarrhoea
I:
bloods: anti-TTG
sweat test
stool culture
growth charts
M:
allergy trial: cows milk-free
constipation red flags
failure to pass meconium w/in 48 hours
abnormal appearance of anus
constipation from birth
faltering growth
laxative ladder
- movicol
- stimulant laxative
- bisacody
- Senna
- glycerol - osmotic laxative
- polyethylene glycol
- lactulose
hirschprung’s
explosive passage of stool following PR exam:
delayed passage of meconium
P: vomiting, abdominal distension
I: rectal biopsy
UTI
< 3 months
> 3 months
I: USS renal tract
M:
lower
- <3 months: IV amoxicillin, gentamicin
- >3 months: trimpethoprim/nitrofurantoin (3 days)
upper: IV amoxicillin, gentamicin
congenital infections
toxoplasmosis: cerebral calcification, chorioretinitis, hydrocephalus
rubella
cytomegalovirus
rash causes
measles
roseola
rubella
measles
A: RNA Paramyxovirus
P:
prodrome: cough, fever nasal discharge
koplick spots - white spots on red background that develop on the buccal mucosa
maculopapular rash - starts on face, neck, behind ears
M:
notifiable
absence - 5 days from onset of rash (same as mumps & rubella)
C: pneumonia
rubella
P:
maculopapular rash - pink; face -> whole body
lymphadenopathy: sub-occipital and post auricular
M:
absence - 5 days from onset of rash (same as mumps & measles)
eczema
P
infants: face and trunk
children: extensor surfaces
M: topical emollients
roseola infantum
A: Human herpes 6 (HHV-6)
P: high fever
maculopapular rash
nagayama spots: uvula and soft palate papules
M:
no absence required
erythema infectiosum
aka slapped cheek or fifths disease
ITP
P: post-infective, mucosal bleeding, well child
henoch schonlein
I: Skin or RENAL biopsy
kawasaki
large to medium cell vasculitis
P
fever > 5 days
red palms of hands
dry, cracked lips and strawberry tongue
bacterial conjunctivitis
widespread polymorphous rash
I: echocardiography
M: high dose aspirin
Impetigo school exclusion:
until lesions have crusted over or 48 hours after commencing antibiotic therapy
Scabies school exclusion:
Until treated
Influenza school exclusion:
Till recovered
Chicken pox school exclusion:
Till all lesions have crusted over
Diarrhoea and vomiting school exclusions
Until symptoms have settled for 48 hours
hand foot and mouth
A: coxsackie
M:
absence not required if child feels well
febrile convulsions
simple: generalised tonic clonic seizure that lasts < 5 minutes
complex:
focal onset
lasts longer than 10 minutes
recurrent seizures in one febrile illness
M: midazolam (rectal or buccal)
Complete recovery of consciousness w/in one hour
Below what age is red flag for febrile convulsions and why?
< 2 years
as children this age often show the classic signs and symptoms of meningitis
Hepatic metabolism in children ->
Greater than in adults due to comparative size of liver thus require higher doses of anti-epileptics and theophylline. - doses should not exceed adult dose.
temperature measurements
< 4 weeks: electronic thermometer in axilla
4 weeks - 5 years: electronic thermometer in axilla or infrared thermometer in axilla
meningococcal meningitis
M: IM Benzyl penicillin
bacterial meningitis
M:
< 3 months: IV cefotaxime + Amoxicillin
> 3 months: IV cefotaxime
neonatal sepsis
infants: respiratory distresss, poor feeding, grunting, lethargy
Autism spectrum disorder: what are the 4 domains of impairment
Social interactions
Thoughts and behaviours
Communication
Sensory hypersensitivity
Cow’s milk allergy tx.
1st line is extensively-hydrolysed formula feed.
hypospadias
M: corrective surgery before the age of 12 MONTHS - 1 year
Undescended testes
M:
3 months: referral
6 months: seen by surgeon
orchidopexy to treat
shaken baby
P: retinal haemorrhages, dubdural haemorrhage, encephalopathy
Skin lesions as DDx. for NAI
Mongolian blue spot - birth mark
wilm’s tumour
nephroblastoma
P: abdominal mass, painless haematuria, flank pain
Second hearing test for newborns/infants if otoacoustic test is abnormal
Auditory brainstem response test
genetic anticipation disorders
fragile X
huntington’s
myotonic dystrophy
spinocerebellar ataxia
meningitis organisms
< 3 months
GBS
e.coli
listeria
3 months - 6 years
strep pneumoniae
n. meningitidis
h. influenzae
> 6 years
strep pneumoniae
modes of inheritance
mitochondrial: maternal
x linked (recessive, dominant)
neonatal hypoglycaemia
asymptomatic: encourage normal feeding
symptomatic: admit to neonatal unit & give 10% IV dextrose
IV 10% dextrose
CXR features in TTN
Hyperinflation and fluid in the horizontal fissure
Age to consent
Age to refuse treatment
16
18
rate of chest compressions all children:
100-120 compressions/minute
ciclosporin adverse effects
Nephrotoxicity Hepatotoxicity Fluid retention Hypertension Hyperkalaemia
Everything UP: fluid, BP, K+, Hair, Gums, Glucose)
AGPAR score
