MD3 Paeds Flashcards
Cafe au lait spots associated with which condition?
Neurofibromatosis
What is HSP?
Henoch-Schönlein purpura - the most common vasculitis in kids. Usually follows an URTI.
3x meds for Kawasaki Tx
Aspirin
IVIG
Steroids
How does pertussis commonly affect the eye in kids?
Subconjunctival hammorahge from coughing so hard
Mnemonic for Kawasaki:
CRASH n Burn
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet swollen
Burn = fever for over 5 days
What is the biggest worry with Kawasaki’s and how do we monitor for it?
Coronary artery aneurysm - clot risk - heart attack. Monitor via ECHO
Ix for haemolysis
LDH
Bilirubin
Reticulocytes
Coombs (DAT)
Blood film
Which nerve roots are impacted in claw hand/hyper extended wrist?
C8 and T1 - ulnar nerve impact
Unable to pince Piece of paper between thumb and pointer finger is sign of which nerve dysfunction?
Ulnar nerve
Surgery for pyloric stenosis?
Pyloromyotomy
Most common cause of bronchiolitis?
RSV
Which 3 body fluids are we always going to check in neonatal fever?
Urine (MCS), blood (cultures), CSF (LP)
3 key risks for neonatal sepsis?
GBS positive
Prolonged rupture of membranes
Sick mum at time of birth
Episodes of cyanosis is med school talk for which condition?
Tetralogy of fallot
Characteristics of Still’s murmur?
The S’s:
- soft
- Systolic
- symptomless
- sternal (no radiation)
- supine (loudest when you lie Still - way to remember).
What body part to measure pre-ductal and post-ductal sats in neonate? What is a possible cause if the readings are different?
Right arm for pre-ductal and either foot for post-ductal. If they’re different it suggests a patent PDA.
What is Ebstein’s anomaly?
Dysfunctional/absent tricuspid valve. Causes right atrium to be huge from all the blood not moving through/staying through. Essentially causes heart failure.
Technical cut off for hypoglycemia?
2.6
How long does allergy desensitisation take?
3-5 years
Which vaccine may cause intussiception?
Rotavirus
Croup mx?
MINIMAL HANDLING (they get pissed off).
- always one dose of oral dex
- nebulised adrenaline as needed
Best IV steroid for severe asthma?
IV methypred. Strong and quick, dex also used but lasts a long time.
Mnemonic for asthma treatment:
A POSSUM
aminophylline
Pred (steroids) (oral Pred or iv methypred)
Oxygen - prongs or mask
Saba - burst therapy
Sama - can also do burst therapy
Uhhdrenaline (IM last resort)
Mag Sulph
What is the name for the benign rash that often accompanies a viral infection?
Viral exanthem
Top 7 things to consider in acute paediatric limp?
Most common is transient synovitis
Infection (OM or SA)
DDH
SUFE
Perthe’s JIA
malignancy
JIA
Risks for DDH?
Things that cause less space/awkward position in uterus (+family history)
- oligohydramnios
- macrosomia
- breech birth
Age of SUFE vs Perthe’s?
Perthe’s: 4-8 years old
SUFE - older than 10 and fat
Which neuro disease has distal muscle weakness that spreads proximal?
Duschennes muscular dystrophy
Symmetrical purpura to legs in age 2-8 is likely to be?
HSP
HSP is usually due to what? And it may cause which complication?
Usually due to URTI and may cause intussiception
Which 3 conditions are tested for in triple barrier screening?
CF
Fragile X
Spinal muscular atrophy
Treatment for periorbital cellulitis?
Keflex 7-10 days
Is periorbital cellulitis bilateral or unilateral?
Usually unilateral, consider allergic rhinitis if bilateral.
How to differentiate periorbital cellulitis from orbital cellulitis?
Orbital cellulitis has all the features of peri-orbital (red, swollen, painful) PLUS 1. Proptosis 2. Ophthalmaplegia 3. Visual impairment.
Mx for orbital cellulitis?
Urgent ENT/ophthalmology referral. May need CT orbit and defs IV fluclox
List some red flags for headache history:
- sudden and severe
- early morning
- waking up due to headache
- triggered by abdominal pressure increase
- focal neuro signs
- weight loss
- head injury
Which medication can be used in acute migraine in kids over 8?
Chlorpromazine
What are the two risk assessment tools that are always the answer in exams for GP questions?
Aus CVD risk calculator
AUSDRISK - for diabetes
What is the regular bowel screening regimen for those of regular risk?
Fecal occult blood test one every two years from age 45 - 75
List two risk factors that would heighten a person’s base risk for bowel cancer?
- first degree relative diagnosed under 50!
- Lynch syndrome in the family
What are the main 3 risk factors for CKD?
HTN, diabetes and advanced age.
Molluscum contagiosum is caused by a pathogen of the same name belonging to which family of pathogens?
Poxviruses
Strep A throat infection leading to systemic rash = ?
Scarlet fever
Which obs sign is a pre-terminal sign in kids?!
Hypotension
What is the most common spot for eczema in baby?
Face
What is the most common cause of injury bringing paediatric patients to hospital?
Falls
Fecal soiling is often due to which cause in paeds?
Overflow diarrhoea from constipation
Which signs following a fracture would indicate the need for urgent ortho review?
- pale limb
- neurovascular disruption
- severe swelling
Protracted bacterial bronchitis (resp infection for weeks straight) is best treated with which abx?
Augmentin
What is the pattern of growth for a haemangioma?
Not present at birth usually, grow within first months of life, tend to resolve by age 5.
Haemangioma’s in which locations should prompt referral?
Genitals, orbit, inside mouth.
What age should kids not have bruises and why?
Below 4-6 months kids should not have new bruises (may be some birth bruises). This is because they aren’t walking so shouldn’t be bumped into things. If they do have bruises suspect NAI.
Explain TEN4FACES.
below age 4: bruising should not be present on:
T - torso
E - ears
N - neck
Frenulum, angle of jaw, cheeks, eyelids, subconjunctivae.
Listeria is a risk in kids of what age?
Young kids like babies and infants only.
What are some indications for neuro imaging in paeds following head injury?
- focal neuro deficit
- seizures
- GCS below 8
- haemotypanum
What is the best pain scale in a 5 year old?
Wong Baker score
Best resus fluid in a neonate?
Always 0.9% saline always always Always.
Non-blanching rash in young child is sort of code for which condition?
Meningococcal rash
Which condition should be ruled out before a diagnosis of febrile convulsion is made?
Meningitis and encephalitis
Virtually all sick kids get which investigations in ED?
BSL, ketones and a urine
ABX for paed sepsis (not neonate)?
IV fluclox and ceftriaxone
Risks for perinatal sepsis?
- GBS positive
- prolonged rupture of membranes
- maternal fever/infection
Does a PDA cause acute deterioration? What kind of cardiac abnormality classically causes sudden decline within a week or so of life?
PDA alone shouldn’t cause acute decline.
Coarctation of the aorta causes sudden decline as the PDA closes and this ruins the backup plumbing, suddenly blood isn’t travelling systemically. Rapid decline.
Non-responsive to multiple boluses in a neonate means you should suspect which pathophysiology?
Cardiac cause of shock/hypotension
If suspect cardiac cause, what monitoring would you put on a neonate?
Pre and post ductal sats
4 limb BP
examine femorals
A difference in upper limb vs lower limb BP and impalpable femoral pulses suggest which diagnosis?
Coarctation of the aorta
Mx for coarctation of Aorta (surg and med)?
They should have initially been treated for sepsis before you even considered a cardiac cause.
Med - prostaglandin E1 (prostin)
Transfer to tertiary centre. Eg. PIPER.
Surg - fix issue x
Why might coarctation of the aorta present with a systolic murmur and hepatomegaly?
Murmur - classic in coarctation best heard over the back (nearest aorta thin point).
Hepatomegaly due to the heart failure aspect.
‘Salmon pink rash’ is a classic presentation in which paeds condition?
JIA
Which pose for a paeds pelvic x ray?
AP frog leg pose
If you look into a kid’s nose and see turbinate touching septum, it probably suggests?
Allergic rhinitis
Hallmark of a thyroglossal cyst?
Moves up and down when kid sticks tongue in and out
Infection that can cause a goitre?
Mumps
How old do you have to be to have the flu vax?
6 months. 2 doses for those under 9.
Red flag on growth chart?
dropping by 2 percentile lines
How much do neonates tend to feed?
150 ml/kg/day
When should solids be introduced?
4-6 months
2 most important acquired heart diseases in paeds?
Kawasaki’s and rheumatic heart disease
Features of Still’s murmur:
- sick (often URTI)
- systolic
- symptomless
- sternal border (lower left), no radiation.
- soft (like a song)
Loudest on lying on back.
Common acyanotic congenital heart diseases?
VSD - most common
ASD
PDA
Coarctation of aorta
Symptoms of moderate/severe VSD?
Heart failure symptoms + failure to thrive/lethargy. Edema collects in liver (hepatomegaly) in kids not periphery.
Murmur heard in VSD?
Pansystolic - same as mitral regurg because it’s the same mechanism - blood leaving ventricle through hole in walls.
ASD murmur type?
Mid-systolic due to pulm valve (increased pressure right side of heart)
‘Episodes of cyanosis’ are associated with which congenital heart disease. What is a finding on CXR?
Tetralogy of Fallot
Boot shaped heart on CXR
4 features of TOF?
- pulm stenosis
- VSD
- overriding aorta
- right ventricular hypertrophy
Key ix in any child with language delay?
Audiology
Delayed passage of meconium is often associated with which neonatal condition?
Hirchsprungs
What is encopresis?
Fecal incontinence/soiling.
Often due to constipation in kids.
ix for developmental syndromes?
Microarray
What is Gower’s sign and what disease does it screen for?
Trouble standing from a sitting position on the floor - typically using arms to get up.
test for Duschennes muscular dystrophy.
Carrier screen diseases?
CF, Fragile X, spinal muscular atrophy.
Mx of otitis media complicated by another factor such as implant, past meningitis, only good ear etc.
treat early, refer.
‘Bulging ear’
ear raised off head
redness/swelling behind ear
Are all signs of?
Mastoiditis.
Tx for insect in ear?
Drown it - saline or lignocaine.
Key differentiating feature for orbital cellulitis vs peri-orbital and mx for the former?
VISUAL CHANGES.
URGENT ENT referral
Artery at risk of being cut in a ceasarean if cut is above arcuate line?
Inferior epigastric
Pharm Mx for seizure (febrile or epileptic) lasting over 5minutes?
Midazolam
Child pulling at their ear is a sign of?
Ear infection
Most accurate way to take temp in neonate? Typical way?
Most accurate = rectal but most common is axillary in neonate.
Pathogen for hand foot and mouth?
Coxsackie
Fever for over 5 days in a child is med school talk for?
Kawasaki’s
Meningitis rash description?
Non-blanching purpuric rash
Cause of scarlet fever?
Group A strep
White spouts in mouth (Koplik spots) and a descending rash are features of?
Measles
Key VBG findings for pyloric stenosis?
Hypokalemia, hypochloremic, metabolic alkalosis.
Surg mx for pyloric stenosis?
Pyloromyotomy - after electrolytes have been resolved.
Most important molecule to correct in pyloric stenosis before surg?
Bicarb - risk due to metabolic alkalosis
Male under 3 months with UTI needs what Ix?
Renal USS
Nail pitting and dactylitis are common findings in which paediatric rheum condition?
psoriasis.
What phase of breathing does stridor typically occur in?
inspiration
ix for laryngomalacia?
flexible endoscopy
Mx bronchiolitis?
supportive. Monitor for hypoxia and dehydration.
Bronchiolitis typical agent?
RSV
Croup typical agent?
parainfluenza
Barking cough?
croup
Which genetic disease famously has delayed passage of meconium?
cystic fibrosis
Risk of protracted bacterial bronchitis in kids and best Tx?
Risk is bronchiectasis due to chronic lung disease.
tx = 4weeks of augmentin.
ix to confirm cystic fibrosis?
Sweat test
Usual amount of mass gain per week in neonates?
150g a week.
How to calculate corrected age?
For babies born before 37 weeks, subtract their birth gestation from 40 weeks. Then subtract that number from current age. Up until age 2.
Which intervention does not take corrected age into consideration?
immunisations - done chronologically.
Blood + mucus in neonate stool may suggest?
cow’s milk protein allergy
rare complication of rotavirus vaccine?
intussiception
Imaging for inhaled foreign body?
CXR with inspiratory and expiratory films.
Explain 4,2,1 rule.
For fluid maintenance in paeds.
4ml per kg per hour for first 10kg, then 2ml per kg per hour for the next 10 kg then 1ml per kg for every kg thereafter.
0.9% saline with 5% dextrose.
2/3 if CNS or Resp insult.
Most common cause of gastro in paeds in melbourne?
norovirus
Paracetamol dose in kids?
15mg/kg QID
Abx for sepsis age 0-2 months then after 2 months?
0-2 months - benpen and cefotaxime.
2 months on - fluclox and ceftriaxone
What to suspect if ‘effortless’ tachypnea?
ACIDOSIS
sepsis or DKA
Max bolus amount in neonates?
40ml/kg
3x pharm tx for hayfever?
- Anti-histamine
- Nasal spray eg. mometasone
- Inhaled steroid eg. fluticasone
MOA adrenaline?
Adrenergic agonist.
alpha - vasoconstriction
b2 - bronchodilation
Which atypical pain medication can be used as a sole procedural agent and does not cause risk to air way patency?
ketamine
Permanently shocked looking baby with ‘sun-setting eyes’ is a classic sign of?
4th ventricle hydrocephalus
Lump in jugular is a worry for which disease?
Hodgkins lymphoma mets to lymph node
Triggers for hypoglycemia in teens with T1Dm?
alcohol. meal skipping. exercise.
H. pylori Tx:
PPI, clarithromycin, amoxicillin
Mx for wrist buckle fracture?
Splint for 3 weeks then review. Usually don’t need ortho review.
Air enema is a tx for?
Intussicpetion
Protracted breastfeeding is associated with which vitamin/mineral deficiency?
iron
Risk of circumfrential burn and the mx?
Risk that it will restrict thorax expansion (impact breathing).
Mx - escharotomy
Best Mx of community burn?
20 mins of cool water within 3 hrs of burn the best treatment. NO ICE.
Surgical mx of deep burns?
Skin graft
Signs on exam of a deep burn?
No sensation in the area. Poor cap refill. white colour.
Babies not sitting backwards (as recommended) in car who experience an MVA are more at risk of what traumatic injury?
Upper cervical fractures/injuries
If femoral fracture found in a child after a trauma like a MVA, which imaging should be performed?
CT chest - enough force to snap femur likely snapped something else and need to check no haemo/pneumothorax
Best ix if ‘seat belt’ sign after MVA?
CT
Chart to describe pain level in young kids?
Wong Baker chart
Spiral fracture in a non-walking child is indicative of?
NAI
Scabies tx
permethrin cream neck down whole family
Triad of HSP
rash + abdo pain + arthralgia
Derangement in which vital sign are indicative of pre-terminal state in kids?
hypotension
After what age is bed-wetting an issue?
Age 7
In babies, eczema is most common in what area?
face
Evidence of neurovascular compromise in fracture?
Pale, swollen, poor nerve function.
Abx for protracted bacterial bronchitis?
4 weeks augmentin
Options for reporting NAI?
- mandatory reporting - call child services (DFFH)
- orange door if kid just need some extra support
Non-resposnive to fluid bolus in hypotensive/poor sats child?
suspect cardiac.
Exam findings in coarctation of aorta?
Absent femoral pulses
marked BP difference in upper and lower limbs
systolic murmur best heard in back
mottled skin
Pharm mx for coarctation?
prostin
Ix for coarctation?
ECHO, ECG, CXR
Endocrinology cause for neonatal shock?
CAH - very dehydrated
Ix for global developmental delay?
microarray, CK (rule out muscular dysrophies), fragile X PCR, TFTs.
A worrying panadol dose that needs NAC is?
200mg/kg or more
Reversal agent for benzoes?
Flumazenil
Minimum age to dx asthma?
5 years old
All 4 developmental domains being down is indicative of?
A syndrome eg. trisomy
Which food should be avoided in infants under a year?
Honey
Separating GOR from GORD.
GORD has failure to thrive, blood in vomit due to gastritis, noisy breathing due to acid.
Pharm mx for infant GORD?
Omeprazole
Breathlessness during feed is a buzz word for which set of conditons?
Congenital cardiac disease
Most important ddx for stridor is ?
anaphylaxis
‘intramural gas’ and ‘wall thickening’ on AXR are terms used for?
NEC
Findings of VSD on examination?
- vitals - tachypnea, tachycardia.
- observation - mottled but acyanotic
- growth - impacted
- auscultation - pan-systolic cardiac murmur
- hepatomegaly
