High Yield Paediatrics (2/2) Flashcards
You are asked by a midwife to see a baby 18 hours post-delivery as he is concerned about yellow skin discolouration. The baby was born vaginally at 39 weeks with no complications. There was no relevant antenatal history. Mum is keen to breast feed and baby has successfully fed multiple times.
What is the most appropriate next action to take?
Switch to bottle feeding and reassure that she will return to a normal colour within 2 weeks
Arrange an exchange transfusion
Monitor serum bilirubin
Monitor bilirubin using transcutaneous bilirubinometer
Investigate using direct coombs test
monitor serum bilirubin
neonatal jaundice
high bilirubin, that in serious cases can cause brain damage (Kernicterus)
Types
- Physiological: breakdown of excess foetal RBC -> self resolving rise in bilirubin beteen 2- 7 days
- Patholigcal: jaundice within first 24 hours
causes of pathological jaundice (<24h)
- Rhesus haemolytic disease: -ve mum and +ve baby leads to IgG destruction of RBC after second exposure
o Prevent sensitisation with Anti-D therapy - ABO incompatibility: As above, less severe. Mum is typically group O
- Neonatal sepsis
- RBC pathology (e.g. G6PD deficiency or hereditary spherocytosis)
- Extravascular cause ventricular haemorrhage or haematoma from birth trauma
causes of prolonged jaudice (>14 days)
- Biliary atresia: Blocked bile ducts leads to raised conjugated bilirubin
- Breast milk jaundice
- Other endocrine or metabolic causes e.g. (Hypothyroidism)
Physiological jaundice
- 2-14 days is common (up to 40%).
- More red blood cells, more fragile red blood cells and less developed liver function
- Increased production (rbc breakdown, gilberts), decreased clearance (especially prem).
A father brings in his 5-year-old daughter into the GP. The father is upset because the girl has multiple bruises on her limbs, despite no reported history of trauma. PMH: 2 chest infections in the past month
O/E: She is otherwise well in herself and has no signs of any lacerations, broken bones or head trauma. Temp. 37.3 oC
What is the most appropriate first step in management?
Contact reception staff discretely to contact social services team
Tell the father that you will have to contact social services as a precautionary matter and then ask reception to call them
IM benzylpenicillin
Take a full blood count
Immediate PO tranexamic acid
take a full blood count
- Recurrent chest infections – neutropaenia – frequent or severe infections.
- Fever common on first presentation due to infections
- Bruising caused by thrombocytopaenia.
- “Could this be ALL?!”
acute lymphoblastic leukemia
Background
- Malignant proliferation of blast cells
- Most common childhood cancer, typically 2-10
Presentation
- Anaemia
- Bleeding/bruising/petechiae
- Infection
+
- Bone pain
- Fever/constitutional symptoms
- Short Hx
Signs:
- Splenomegaly & Hepatomegaly
- May have a lymphoid mass
preventing tumour lysis syndrome in leukemia and lymphoma
give allopurinal
AML
commonest leukemia in adukts
* Auer rods
* Risk of DIC
* RFx: Polycythaemia rubra vera, down’s syndrome
AML
commonest leukemia in adukts
* Auer rods
* Risk of DIC
* RFx: Polycythaemia rubra vera, down’s syndrome
medical causes of bruising
ALL
Von Willebrand disease
Immune thrombocytopaenia
Liver disease
Von Willebrand Disease
– autosomal dominant.
- Platelet disorder – epistaxis, menorrhagia.
- Take APTT & PT
ITP – Immune thrombocytopaenia
Immune reaction reducing platelet count. Typically follows an infection or vaccination. Bruising or petechial rash. Investigate for anything more severe. Usually, self resolving.
child abuse
Types - Physical – Sexual – Emotional - Neglect
Red flags
– child not yet mobile (less likely to bruise themselves when active) – Unexplainable fractures
– Repeat attendance to A&E
– Delayed presentation
– Child overtly frightened/ withdrawn
– Body location.
What to do:
- Always alert your seniors of your concerns.
- Report is purely factual account, don’t include hunches/ feelings.
- Skeletal survey.
- Safeguarding lead informed and inform parents that you are doing this.
Child at higher risk if disabled
A father brings in his 2-year-old into GP. He is rubbing both his ears a lot and crying at night more than usual. This has been going on for 2 days. The child had a tonsil infection last week but is otherwise well.
On examination, the ear is hot and red. Temperature 37.2℃. Tympanic membrane in tact.
What is the most appropriate first step in management?
Discharge with oral amoxicillin 5 days
Discharge with oral flucoxicillin 5 days
Discharge home with information leaflet on the disease
Refer to ENT specialist
Discharge with 5 days amoxicillin and steroid cream
Discharge home with information leaflet on the disease (otitis media is usually self resolving)
When to give antibiotics in otitis media:
- > 4 days or not resolving
- Bilateral and <2 years old
- Immunocompromise
- Perforation of ear drum and/or otorrhea (discharge)
- Externa (swimming history)
A 4-year-old boy is accompanied by his mother to the emergency department with a 48-hour history of right ear pain. His mother reports that his right ear started to leak white fluid earlier this morning. He has no significant past medical history.On examination, the external ear did not appear erythematous, however, otorrhoea was present with white purulent discharge.
Observations:
Heart rate: 130 beats/minute.
Blood pressure: 120/60mmHg.
Respiratory rate: 24 breaths/minute.
Temperature: 38.2ºC.
Otoscopy revealed a red tympanic membrane with a perforation.
What is the most appropriate initial management of this patient?
Admit to paeds ward for observation
Usually self resolving so send home
Discharge with 5 day prescription of oral amox
Discharge with 7 day prescription of oral flucox
Refer to ENT specialist
Discharge with 5 day prescription of oral amox
A 5-day old boy is on the ward and you have been asked by the nurse to see him and his parents due to persistent green vomiting. He was born at 36 weeks and it was an uncomplicated delivery. Bowels have reduced in opening frequency today. Mother reports the child is sleepier and doesn’t like it when you rub his tummy. On examination he is tachycardic and has a distended tender abdomen. What is the most likely diagnosis?
Cow’s milk protein allergy
Hirschsprung’s disease
Pyloric stenosis
Midgut volvulus
Intussception
midgut volvulus
bilious vomiting = red flag and have to rule out midgut volvulus first. 1st week
summary of paed abdopain
duodenal atresia
Within hours
- Downs syndrome
- DOuble bubble on XR
Hirshsprungs
Within hours
Meconium ileus. Developmental failure to produce Auerbach and Meissner plexuses (parasympathetic) = peristalsis + obstruction.
tracheo- oesophageal fistula
Within hours
Connection between eosophagus and trachea.
Cough, cyanosis, resp distress.
Can be later
intestinal malrotation
within days
XR
can progress to volvulus
midgut volvulus
within days
Rotation of gut cutting off blood supply = ischaemia and emergency
