General Paediatrics Flashcards
what is the alternative name for croup?
laryngotracheobronchitis
what is are some differentials for croup that you must rule out?
epiglottis or foriegn body because can cause obstruction
describe the signs and symptoms of croup?
barking cough
inspiratory stridor
signs of hypoxia (if obstruction present)
signs of increased WOB (subcostal recession etc)
coryzal prodrome
symptoms worse at night
what is the cause of croup?
viral infection- parainfluenza
what should you exclude or consider in a child with a prolonged fever?
kawasaki disease
what is the diagnostic criteria for kawasaki disease?
Fever for 5 days or more, plus
4 out of 5 of:
- polymorphous rash
- bilateral (non purulent) conjunctival injection-=mucous
- membrane changes, e.g. reddened or dry cracked lips, strawberry tongue, diffuse redness of oral or pharyngeal mucosa
- peripheral changes, e.g. erythema of the palms or soles, oedema of the hands or feet, and in convalescence desquamation
- cervical lymphadenopathy (> 15 mm diameter, usually unilateral, single, non purulent and painful)
what are some important causes of fever in a child that you have to exclude?
meningitis/encephalitis meningococcal sepsis osteomyelitis septic arthritis UTI
what are some important causes of prolonged fever in a child to exclude?
kawasaki
malignancy
autoimmune
HSP
what can cause projectile vomiting in a child?
pyloric stenosis
what defines ‘failure to thrive’ in a child?
If a child falls across two major centiles= failure to thrive
if the baby’s weight is less than the 3rd centile= failure to thrive (not as sensitive)
what is the general cause of febrile convulsions in a child?
viral infections
what age group do febrile convulsions generally occur?
from 6months to 6yrs of age
what are some symptoms of a febrile child which may think they are very unwell?
bulging fontanelles non blanching rash reduced conscious state focal neurological signs status epilepticus neck stiffness bile stained vomiting mottled skin tachycardia/tachypnoea/severe increased WOB
what is the first thing you need to ask yourself if a neonate/infant presents with vomiting and fever?
Bilious or non bilious?- is the vomit green?
what are some causes of bilious vomiting in an infant? you’re in GP land. what would you do?
obstruction (mal-rotation, volvulus, duodenal atresia, necrotising enterocolitis)
- refer for surgical admission + fluid resuscitation in hospital
what are some causes of non-bilious vomiting in an infant?
intussuception 5mths-3yrs old, pyloric stenosis 3-6 weeks post birth, infection/sepsis)
Or metabolic causes (e.g. adrenal insufficiency) + CNS causes
what are the measurements we need to take for a child’s growth chart?
height weight head circumference (until 2 years old)
what are signs of respiratory distress in a child?
intercostal recession and subcostal recession + tracheal tug + nasal flare + head bobbing + grunting + paradoxical abdominal movements
what are the 2 bacterial/viral causes of tonsilitis we have to exclude in a child
Strep throat (bacterial) EBV (viral)
what are some consequences of strep throat
Post strep glomerulitiis Rheumatic fever tonsil abscess acute OM cervical adenitus acute bacterial sinusitus
what are some acquired causes for stridor?
croup epiglottitis bacterial tracheitis retropharyngeal abscess quinsy dipthethria foreign body
what are some congenital causes for stridor?
subglottic stenosis
vocal cord palsy
laryngomalacia
what is the age usually seen for inhaled foreign body?
6months to 4yrs
what are some examination findings for inhaled foreign body in a child?
tracheal deviation reduced air entry localised wheeze fever? stridor
describe bronchiolitis
acute viral infection of the Lower respiratory tract
what age group do we see bronchiolitis?
common under 1yr old but can present up to 2yrs
what are some examination findings for bronchiolitis?
subcostal recession hyperinflated chest fine inspiratory crackles wheeze mild fever tachypnoea
how do we treat bronchiolitiis?
supportive management only
how might we assess the severity of asthma in a child?
night symptoms?
increased frequency of exacerbations
no. of hospitalisations
how often are they using their puffer?
what is the BMI definition of overweight for a child aged between 2-18yrs?
For children 2 – 18 years or age, overweight is defined as BMI above the 85th centile on BMI chart
what is the BMI definition of obese for a child aged between 2-18yrs?
Obese is defined as BMI >95th centile on CDC BMI chart or above the 97th centile on WHO BMI chart
how might we assess whether a child less than 2 yrs old is overweight?
For children under 2 years, overweight is defined as above the 97th percentile on WHO growth charts and gaining weight rapidly.
describe pyloric stenosis
Hypertrophic Pyloric Stenosis (HPS) is due to progressive thickening of the circular muscle of the pylorus. This leads to gastric outlet narrowing.
The condition usually presents between 2 and 6 weeks of age.
projectile, non-bilious vomiting
hypochloremic hypokalemic metabolic alkalosis can be associated
what are the main features of ADHD?
hyperactivity
impulsivity
inattention/easy distractibility
describe a general fluid replacement order for a dehydrated child in hospital?
give boluses of 10-20mls/kg every hr- normal saline
for a child with moderate dehydration due to vomiting, how might you fluid resuscitate them (think route)?
NGT tube even if the child is vomiting
for fluid maintenance, what types of fluid can we use in children?
plasma lyte
normal saline with glucose (NaCL 0.9 or 0.45% + 5% dextrose)
consider if K+ is required
what are some signs of severe dehydration in a child?
Very delayed CRT > 3 secs, mottled skin
Other signs of shock (tachycardia, irritable or reduced conscious level, hypotension)
Deep, acidotic breathing
Decreased tissue turgor
what are the Kocher’s criteria for differentiating septic arthritis and transient synovitis in a child?
- Inability to weightbear
- high fever
- high ESR in first hour >40
- high WCC >12
4/4 criteria would be a strong indicator of septic arthritis
what are some ddx for a child with an acute limp?
septic arthritis osteomyelitis Perthe's- AVN of capital femoral epiphysis slipped upper femoral epiphysis bony malignancy
how might we differentiate between septic arthritis and osteomyelitis in a child?
osteomyelitis- subacute onset, pain on movement, swelling/fever/erythema may be late onset, tenderness/localised pain
septic arthritis- acute onset, more likely to present with a high fever, pain on movement and at rest, loss of movement/range of motion
what are the ddx for asthma in a young child?
tracheomalacia viral respiratory infection inhaled foriegn body cystic fibrosis reflux
what are some complications of pertussis?
rib fracture subconjunctival haemorrhage pneumonia Otitis Media (most common) fainting post cough respiratory muscle fatigue--> apnoea encephalopathy and seizure
what are some classical features of pertussis?
inspiratory whoop
uncontrollable violent coughing associated with vomiting
prodrome of mild respiratory illness
what are some signs/symptoms of intussuception in a baby?
red current jelly stools, bloody diarrhoea vomiting +++ nonbilious--> bilious colicky abdo pain abdominal mass- sausage shape pallor and lethargy signs of hypovolemic shock
tell me about transient synovitis of hip?
Commonest reason for a limp in the pre-school age group.
Usually occurs in 3-8 year olds
History of recent viral URTI (1-2 weeks)
Child usually able to walk but with pain
Child otherwise afebrile and well
Mild-moderate decrease in range of hip movement - especially internal rotation.
Severe limitation of hip movement suggests septic arthritis.
Transient synovitis is a diagnosis of exclusion.
tell me about perthes disease?
Avascular necrosis of the capital femoral epiphysis. Age range 2-12 years (majority 4-8yrs) 20% bilateral Present with pain and limp Restricted hip motion on examination
tell me about slipped upper femoral epiphysis?
Late childhood/early adolescence.
Weight often > 90th centile.
Presents with pain in hip or knee and associated limp.
The hip appears externally rotated and shortened.
There is decreased hip movement - especially internal rotation.
May be bilateral.
what is the most common cause of constipation in kids?
functional constipation
how might we manage functional constipation in kids?
Position – footstool to ensure knees are higher than hips. Lean forward and put elbows on knees.
Toilet sits –5 minutes three times a day, preferably after meals. Praise child for sitting on toilet, keep toileting a positive experience.
A healthy diet and adequate fluid intake is important for children’s general health and wellbeing.
Excessive cow milk intake may exacerbate constipation in some children.
oral laxatives like movicol can be used
how might we manage nappy rash in infants?
Use disposable nappies.
Increase the frequency of nappy changing and cleansing the skin.
Application of a barrier cream at every change. Effective barrier creams include zinc paste, white soft paraffin and vaseline.
Letting the child spend as long as possible without a nappy on, lying on a soft absorbent sheet that is changed as soon as it is wet. Sunlight plays a role.
If there is associated candidal infection, leading to erythema in the folds and satellite pustules then topical anti-candidal therapy (an imidazole or nystatin) should be applied. This therapy is often combined with 1% hydrocortisone to reduce the associated inflammation.
what level of BP is ABNORMAL for children?
if BP is majorly low; this is not normal as it can mean that the child has lost up to 30% of their blood volume.
Other than this, BP is not a reliable measure in children.
define a neonate
baby less than 28 days corrected
at what ages do infants nose breathe?
4-6months exclusively through the nose
what are the 3 top causes of lumps in children?
congenital
inflammatory
cancer
what are some causes of apnoea?
whooping cough obstruction OSA acidosis anaemia patent ductus arteriosus
croup (may require intensive care in this case)
what is the most common respiratory pathogen causing infection in kids?
RSV
what are some signs of pathological paediatric murmurs?
all diastolic murmurs
pansystolic murmurs
murmurs associated with failure to thrive or cardiac failure
murmurs with a palpable thrill
in which states can a child’s murmur become accentuated?
can become accentuated in anaemia or fever (high output states)
what is vesicoureteral reflux. What might it cause?
abnormal retrograde flow of urine back up to kidneys due to impaired valve-like mechanism at the vesicoureteral junction
predisposes UTIs and hydronephrosis
define colic?
uncontrolled crying for >3hrs per day for 3 or more days of a week in an otherwise well healthy infant
what are the differentials for colic?
GORD/reflux
cow’s milk allergy
malabsorption
when might we consider cow’s milk allergy as a cause for prolonged crying in an infant and what can we try?
when a crying baby (crying for prolonged periods of time) is vomiting, having diarrhoea or has feeding difficulties, and history of atopy/eczema consider cow’s milk allergy.
can try a cow’s milk free diet either by choosing cow’s milk free infant formula or asking the mother to avoid cow’s milk in her diet
what is the triad of symptoms for henoch schloens purpura?
purpuric rash on the extensor surfaces of limbs (mainly lower) and buttocks, joint pain/swelling and abdominal pain.
how much formula does an infant require per day?
150mls/kg a day
how often do infants require breastfeeding?
every 3-4 hourly or demand breastfeeding
what are the typical characteristics of an innocent murmur in a child?
ejection systolic murmur soft blowing sound left sternal edge symptom free child no radiation
what are some differential diagnoses of congenital stridor?
laryngomalacia laryngeal cyst/web laryngeal stenosis GORD subglottic stenosis
A young child becomes profoundly cyanotic when agitated. What is your diagnosis and what is this called?
Hypercyanotic or tet episodes due to complete right ventricular outflow obstruction, usually related to
Untreated TOF
What are your ddx for an older child with liver derangement?
Hepatitis Paracetamol overdose Autoimmune cause Wilsons NASH Other drug reactions
In what newborn period is jaundice abnormal?
In the first 24 hrs post birth
at what position should the baby be to accurately palpate the anterior fontanelle?
at 45 degrees
how might we assess skin turgor in a child?
pinching the abdomen lightly
what on history might give us a sense of cardiovascular function in an infant and why?
history of feeds
Feeding is the most metabolically demanding activity that occurs in infants, and so can be used as a form of exercise tolerance
what is the technical term for bedwetting?
nocturnal enuresis
what is the difference between primary and secondary enuresis?
primary= continously be wet for at least 6 months
secondary- was dry for a period of time (6months) but relapsed
what are some causes of secondary enuresis to consider?
UTI neurogenic bladder Diabetes epilepsy sexual abuse
what does monosymptomatic nocturnal enuresis?
bedwetting without urinary incontinence during the day
when do we start treating nocturnal enuresis?
usually at 7 yrs and above
what is faecal incontinence usually associated with in children?
constipation
what are the medical causes of haematuria in children?
hypercalciuria thin basement membrane disease alport syndrome GN-IgA HSP coagulopathy/bleeding disorder
If a child with haematuria complains of pain, what do we think?
think surgical cause
such as calculi, tumour, stricture, trauma
if you have a child with microscopic haematuria what must you exclude?
illness in a child can cause microscopic haematuria. Wait until the child is well before checking the urine again
what are the complications of nephrotic syndrome in children?
infection, thrombosis, dehydration (because intravascular fluid leak out to extravascular spaces), effusions
if a child presents with nephrotic syndrome, what is our first line of action?
give steroids.
If the child responds to steroids= minimal change disease
If it doesn’t respond by 4 weeks, refer for a renal biopsy
what is the most sensitive test for post streptococcal glomerulonephritis? what can it also indicate?
low C3, C4
low C3 and C4 can also indicate lupus/SLE or membrano-glomerulonephritis
how do we treat post streptococcal glomerulonephritis?
frusemide to manage fluid overload + fluid restriction
what is a long term complication of HSP?
nephritis, which looks like IgA nephropathy
what are the main causes of CKD in the age group from 0-4?
posterior urethral valve
renal hypoplasia/dysplasia –> obstructive uropathy
a child lying in ED with abdo pain is drawing their legs up. what sort abdo pain may they have?
colicky abdo pain
how might we assess peritonism in a child with abdo pain?
Ask the child to suck their belly in as much as they can and then puff their tummy out to the level of your hand.
Ask the child to cough.
They may walk slowly with a hunched over posture
what are the two main causes of idiopathic nephrotic syndrome in children? which is more likely to progress to chronic kidney disease?
minimal change disease- usually steroid responsive and good prognosis
focal segmental glomerulosclerosis- Not immunosuppressive responsive and 60% progress to CJD
what is the clinical presentation of a child with IgA nephropathy?
episodes of macroscopic haematuria +/- abdominal flank pain often concurrent with viral infections
why are children with nephrotic syndrome at risk of thrombosis?
loss of anti-thrombin 3 in the urine
an ultrasound at 6 weeks confirms that a baby has dysplasia of the hips. what is your next line of action?
refer to orthopaedics
