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