Misc Paeds Flashcards
6 indications for Abx therapy in URTI in children?
Centor 3 or more Kids under 2 with bilateral OM Otorrhoea and AOM Systemic unwellness Complications from disease Significant comorbidities
How long would you expect acute OM to last?
Around 4 days
How long would you expect acute pharyngotonsilar infection to last?
1 week
How long would expect a common cold to last?
1-1.5 weeks
How long would you expect rhinosinusitis to last?
2.5 weeks
How long would you expect a cough/bronchitis to last?
3 weeks
3 biochemical criteria supportive of DI?
HyperNa Low urine osmolality High plasma osmolality
What is the diagnostic investigation of choice for DI? How do you interpret it?
Water deprivation test - normally should increase urine osmolality (concentrate) In cranial DI, urine osmolality stays low and plasma stays high but giving ADH (desmopressin) resolves this In nephrogenic DI, urine osmolality stays low and plasma high despite giving desmopressin
6 causes of cranial DI?
Idiopathic Craniopharyngioma Head injury Pituitary surgery Histiocytosis X DIDMOAD
4 causes of nephrogenic DI?
Genetic - ADH or aquaporin 2 genes Metabolic - high Ca or low K Drugs - demeclocyline, lithium Tubulointerstitial disease
Abx management for human bite?
Co-amoxiclav
Abx management for campylobacter?
Clarithromycin
What is the most common cause of childhood nephrotic syndrome?
Minimal change nephropathy
What is the pathophysiology behind minimal change nephropathy and what does biopsy show?
GBM damage via T cell/cytokines Leads to polyanion and albumin loss Biopsy shows podocyte fusion
What are two examples of proteins which leak out in minimal change nephropathy?
Transferrin Albumin
Management of minimal change nephropathy in kids?
Steroids PO - 80% responsive, if not renal biopsy Next line is cyclophosphamide
Prognosis of minimal change nephropathy?
1/3 full recover, isolated episode 1/3 frequent exacerbations, burns out by adulthood 1/3 infrequent exacerbations
Steps for newborn resuscitation?
Dry baby, maintain temp and start clock Assess tone, breathing and pulse If no breathing, 5 rescue breaths with open airway and feel for pulse response If no rise in pulse, recheck breathing technique - if okay and HR absent or under 60, commence chest compressions ratio 3:1 and reassess every 30s
Do you need to exclude kids with hand foot and mouth disease from school?
No - manage conservatively
What type of cyst contains keratin plugs?
Epidermal cysts
What age is aspirin contraindicated below?
16
How might choanal atresia present?
Cyanosis episodes in newborn, worse during feeding
Treatment for scalded skin syndrome?
Flucloxacillin
What interventions are recommended for a child with BMI over 91st centile?
Tailored clinical intervention
What interventions are recommended for a child with BMI over 98th centile?
Tailored clinical intervention and assess for comorbidites/underlying cause
What is the most common cause of childhood obesity? 5 other organic causes?
Lifestyle factors Also growth hormone deficiency, hypothyroid, Cushing’s, Prader Willi and Downs syndrome
5 areas of complications of obesity in children?
MSK - SUFE, OA, Blount’s disease, pain CVD risk long term Neurological - benign intracranial hypertension OSA Psychological
What is Blount’s disease?
Severe, progressive bowing of the legs in kids related to obesity
Below what age is transcutaneous measurement of bilirubin inappropriate?
Less than 24 hours - do serum bilirubin with breakdown
Going from 3m - 4 years, outline the developmental process of speech language and hearing in kids?
3m - turns to sound, squeals 6m - double syllable noises 9m - mama/dada, understands ‘no’ 12m - knows and responds to own name 12-15m - knows 2-6 words, understands simple commands 2 years - combines 2 words, points to body parts 2.5 years - at least 200 word vocab 3 years - 3-5 word sentences, what and who questions, colours and counts to 10 4 years - why, where and how questions
When would you expect a child to be able to count to 10 and name colours?
3 years old
How long should kids with chickenpox be excluded from school for?
Until all vesicles are crusted over
From 3m-4yrs, outline the developmental process of gross motor skills in kids?
3m - little-no head lag, lies on tummy with good head control, will sit if held with curved back 6m - lies on back kicking and holding feet, pulls to sit and rolls from front to back. Sits with curved back on own 7-8m - sits without support 9m - pulls to stand, crawls 12m - cruises 13-15m - walks unsupported 18m - squats to pick up toys and crawls upstairs 2 years - runs, walks up/downstairs with rail 3 years - stairs without rail, rides tricycle 4 years - hops on 1 leg
When would you refer a child who can’t sit without support?
12m
When would you refer a child who can’t walk unsupported?
18m
When would you refer a child without a first word?
18m
What is the recommended diet for CF patients?
High calorie, high fat with pancreatic enzymes with every meal Vitamin supplementation
What is the recommended chest physio programme for CF patients?
At least BD chest physio and postural drainage Pretty much from diagnosis
How would you take a sample to test for pertussis?
Nasal swab
Give two examples of inactivated vaccines?
IM flu Rabies
Give 6 examples of fragment vaccines?
Diphtheria Pertussis HBV Meningitis Pneumonia HiB
What type of vaccine is tetanus?
Detoxified exotoxin
Outline the APGAR score criteria?
When is the APGAR score completed routinely? When else?
Normally 1 and 5 minutes of life
May be repeated at 10, 15, 20 if concerned/less than 7 after 5 mins
What are the 3 areas of results of APGAR scoring?
0-3 = very low
4-6 = moderately low
7-10 = good
What is the first sign of puberty in males? When does it occur?
Testicular enlargement - around 12 years old (10-15)
What testicular volume signifies the onset of puberty?
Over 4mls
When do boys’ height spurts occur?
Around 14 years
What is the first sign of puberty in females and when does this occur?
Breast development - around 11.5 years (9-13)
When do girls’ height spurts occur? What about menarche?
Age 12 - before menarche (Age 13)
What counts as precocious puberty in girls? What about boys?
Under 8 years in girls
Under 9 years in boys
What 3 normal variants of physical changes may occur in pubertal kids?
Gynaecomastia
Asymmetrical breast development
Diffuse thyroid enlargement
What precaution should be taken for babies born at less than 28 weeks when receiving first set of vaccines? Why?
Have them in hospital - due to risk of apnoea
What are the 4 things that can be used to assess in the area of fine motor/vision development in kids?
General development - eyesight, hand function
Bricks and towers
Drawing
Book pages
When is hand preference abnormal before?
18m - especially if shown before 12m
Outline general fine motor/vision development from 3-12m?
3m - reaches, briefly holds; fixes and follows 180d; alert to human faces
6m = palmar grasp, transfers at 7m; looks everywhere
9m = early pincer; points
12m = refined pincer; bangs toys together
Outline brick towers from 15m - 3 years?
15m = two bricks
18m = 3
2 years = 6
3 years = 9
Outline drawing development from 18m - 5yrs?
18m - scribbles in circle
2 years - copies vertical line
3 years - circle
4 years - cross
5 years - square and triangle
Outline how kids interact with book pages from 15m - 3 years?
15m - looks at book, pats pages
18m - turns pages several at a time
2yrs - turns pages one at a time
When should you refer a non-smiling child?
10 weeks
When should a child be using a knife and fork?
5 years
When should a child be using a spoon and fork?
3 years
What is the normal duration of oral steroids for acute asthma attacks? What is different about kids who are already on oral steroid maintenance?
3 days
If on maintenance, increase dose to 2mg/kg up to 60mg
What is the most common headache in kids?
Migraine
What are the 4 areas of social/emotional development to assess in kids?
Smiling and shyness
Drinking and eating
Dressing
Playing
What are the biochemical characteristics of congenital adrenal hyperplasia?
21 B hydroxylase deficiency causes increased plasma 17 hydroxyprog, 21 deoxycortisol and urinary adrenocortical metabolites
What system is used to assess hirsutism in kids?
Ferriman Gallwey scoring system - looks at different body areas
Most common cause of hirsutism?
PCOS
3 causes of hypertrichosis?
Porphyria cutanea tarda
Anorexia
Ciclosporin
What age group is roseola most commonly seen in?
6m-2yrs
What is enucleation and what is it most commonly done for in kids?
Taking out whole eye
Rb
When and how is the flu vaccine normally given? Contraindications?
Starting at 2-3 years then annually via nasal spray
Is live so immunodeficient kids need the IM one, other usual CIs incl egg allergy
Empirical management of non-red flag constipation in kids? What if this doesn’t work?
Advise good fluid and fibre intake
Movicol satchets first line
+/- stimulant after couple of weeks
Can use stimulant with lactulose if movicol no good
First line med for localised impetigo? Second line?
Topical fuscidic acid
Topical retapamulin
2 medication options for severe/extensive impetigo?
Oral fluclox, or oral erythromycin if pen allergic
4 features of hyponatraemic dehydration?
Jerky muscle twitches and movements
Increased muscle tone and reflexes
Convulsions
Drowsiness/coma
What valve disease is traditionally associated with William’s syndrome?
Supravalvular AS
What syndrome do these kids have? Features?
William’s syndrome
Cardiac - supravalvular AS
Small stature, reduced growth
Developmental delay and learning difficulties
‘Happy puppet’
Sensitive hearing
Renal abnormalities
Hypercalcaemia
What syndrome is this describing?
Turner syndrome
What syndrome does this baby have? Features?
Edwards
Prominent occiput, low set ears, small mouth/jaw
Small head
Clenched fists w/ overlapping fingers
Flexed big toe and prominent heels
What is this syndrome?
Patau
Management of nephrogenic DI?
Thiazide diuretic to increase Na excretion and lower serum osmolality
What is the ratio of chest compressions to breaths in neonatal resus?
3:1
Most common cause of diarrhoea in kids in UK?
Rotavirus
What causes head lice? Diagnosis and treatment?
Pediculosis capitis
Diagnose with fine tooth combing of wet or dry hair
Don’t exclude from school - treat if live lice with malathion shampoo, wet combing
Symptoms of threadworm infection? Management?
Perianal itching worse at night, +/- vulval Sx
Management is hygiene advice for whole household + antihelminth - mebendazole for over 6m olds, single dose for whole house
What happens if a kid missed MMR? When can they have it?
Can have a single dose and then repeat in 3m
Or repeat in 1m if over 10 years old or a current outbreak
What is the first carpal bone to ossify in kids?
Capitate
Which forearm bone head ossifies first in kids?
Radial
Management of kids with sickle cell?
Admit anyone in ?crisis or with a fever, because fever could be serious infection due to hyposplenism
Fluid and analgesia, and keep relatively cool
What type of hypersensitivity reaction is responsible for scabies? What happens?
Delayed type 4 hypersensitivity reaction, causing pruritis and linear tracks between fingers/web spaces
2 treatment options for scabies? Who do you treat?
Malathion or permethrin first line
Treat whole household and close physical contacts, note that itch may last 4-6 weeks
What does this patient have? What is the cause/association and what treatment is required?
Norwegian/crusted scabies, often seen in HIV
Needs ivermectin and isolation
What is toddler’s diarrhoea? Management?
Benign condition in young kids age 1-5, causing smelly paler stools with undigested food often lots of times in day
But otherwise well and gaining weight, normal dev.
Management is largely conservative, targetting the 4 Fs (keep Fat in diet, good Fluid, not too much Fruit juice, try altering Fibre)
What GI problem can occur transiently post-gastroenteritis?
Lactose intolerance
What is the most common cause of persistent diarrhoea in kids, especially those past breastfeeding?
Cows milk protein intolerance
What are the 5 options for hearing testing in kids and at what age is each appropriate?
Newborn - AOAE +/- AABE if abnormal
6-9m - distraction testing
18m-2.5 years - familiar object recognition (tests speech too)
Over 2.5 years - performance testing, speech discrimination, PTA
What are the two major divisions of bedwetting?
Primary (never been dry)
Secondary (prev been dry for at least 6m)
What is nocturnal enuresis defined as?
Involuntary nighttime wetting in a child of 5 years or more in absence of neuro/urinary defects
Ix and management of nocturnal enuresis? Stepwise approach depending on age?
Look for contributing factors e.g. constipation, DM, recurrent UTI
Initially fluid intake, diet and toileting advice
Reward systems e.g. star chart for toileting before bed
Then if under 7 try enuresis alarms
If over 7 or not worked try desmopressin
What type of murmur does ASD cause?
Pulmonary stenosis-like (over same area, systolic) causing fixed splitting of S2 (on insp/exp)
Murmur in kid that is systolic over pulmonary area, with fixed S2 splitting. Diagnosis?
ASD
What type of CP is associated with IVH? Why?
Spastic diplegic, because of close anatomical relation of corticospinal tracts
Describe the rash associated with seborrheic dermatitis in kids? Management? When does it resolve?
Yellow flakes on red rash on face, scalp, nappy area, flexures
Initially baby shampoo/oils, more severe try topical steroids
Resolves by 8m
What diet may be of use in IBS?
FODMAP diet
Explain the pathophysiology of G6PD deficiency? How is it inherited?
Reduced G6PD leads to reduced glutathione leads to increased red cell susceptibility to oxidative stress and intravascular haemolysis in response to certain stressors
XL recessive inheritance
How is hereditary spherocytosis inherited and what does it cause?
AD in Europeans, causes extravascular haemolysis
8 things which may trigger haemolysis in G6PD?
Quinine based drugs - antimalarials, cipro
Sulfa-based - sulfasalazine, sulfonamides, sulfonylureas
Nitrofurantoin
Infection
Broad fava beans
What are these? When do they settle by?
Plagiocephaly (parallelogram head)
Brachycephaly (short head)
Settle by age 3-5 usually
What are the 3 most common causes of nappy rash and how can you differentiate them?
Irritant dermatitis spares creases; usually due to urinary ammonia and faeces
Seborrhoeic dermatitis
Candida - white discharge involving flexures, can have satellite lesions
General management of nappy rash?
Disposable nappies
Barrier cream
Mild steroid cream
When is antbiotic treatment indicated for whooping cough and what depending on age?
If cough started within last 21 days
Clarithromycin if under 1m
Azith/clarith if over 1m
Erythromycin if pregnant
When specifically is the Guthrie test done?
Day 5-9 of life
Describe the natural history of strawberry naevi?
Often not present at birth but may develop rapidly in first month
Increase in size to around 6-9m before regressing by 10 years
What antenatal procedure is a RF for strawberry naevus?
CVS
4 complications of strawberry naevus? Management of these?
Bleeding
Ulceration
Visual field blocking
Occuring in windpipe - airway obstruction
B blockers if required
What are the anaphylaxis adrenaline doses in kids?
Under 6 years - 150mcg
6-12 years - 300mcg
Over 12 adult - 500mcg
What is a Still’s murmur?
A low pitched murmur heard under the LSE in kids, benign/innocent
What kind of murmur in kids is always abnormal?
Diastolic
What can’t a mother with galactossaemia do?
Breastfeed
What percentage of kids with CP have hearing problems?
20%
What is the classical triad of congenital rubella syndrome?
SN deafness
Eye problems - retinopathy, cataract, microphthalmia
Congenital heart disease - pulm art stenosis, PDA
What disease is associated strongly with molloscum contagiosum now?
HIV - AIDS defining
What does a jittery, hypotonic baby whose mum was taking labetalol suggest?
Hypoglycaemia
When is persistent fisting abnormal? What broadly might it indicate?
Past 3m - hypertonia
When is head lag definitely abnormal? What may it indicate?
4m - hypotonia
What are 3 early (first year of life) gross motor signs that may indicate hypotonia?
Head lag past 4m
Not sitting propped up by 6m
Not sitting unsupported by 10m
Before when is hand dominance abnormal? Give 3 differentials?
18m
E.g. hemiplegia, CNS problem or brachial plexus problem
Define cerebral palsy?
A non-progressive insult to the immature brain causing persistent disorder of movement/posture occuring at less than 2year of age
5 general gross motor signs of CP?
Abnormal gait/posture
Delay in reaching milestones
Hypertonic extremities/earlier hypotonia
Persistent primitive reflexes
Early hand dominance
3 MSK complications of CP?
Scoliosis
Contractures
Hip/foot and other joint pathology
How does spastic CP present and change over time? What are the 3 types?
Initially hypotonic floppy baby then spastic
Hemiplegic (stroke), diplegic (HIE/PVL prems) and quadriplegic (often global delay and seizures)
What is the role of USS for premature babies’ heads?
For babies under 32 weeks scan at 7/14d for IVH
What is the main role of surgery in CP? Give 4 examples?
Orthopaedic complications
E.g. scoliosis repair, tendon lengthening, osteotomy and selective posterior/dorsal rhizotomy
What is the most common cardiac defect associated with Downs syndrome?
AVSD
4 MSK complications of Down syndrome?
Scoliosis
Perthe’s disease
DDH
Foot problems
What are 2 autoimmune problems associated with Downs syndrome that should be screened for? When?
Coeliac
Thyroid (usually hypo)
Screen around 10 years of age
5 things to screen for in Downs syndrome?
Ophth - cataracts/squint
Hearing - audiology
Cardiac - AVSD and other abnormalities
Autoimmune pathology (TFT/coeliac)
Hip USS at birth
Conservative medical approach to CF management?
Conservative - Early MDT involvement, chest physio BD, nutrition support with high calorie diet, immunisations, education and support for fam
Medical - Early treatment with abx esp to cover Hib/staph, bronchodilators, mucolytics
Complications of CF split into birth/infancy, childhood and adolescence/adulthood?
Infancy - neonatal jaundice, meconium ileus, faltering growth
Childhood - growth problems, recurrent LRTI, nasal polyps, rectal prolapse
Adolescence/adulthood - bronchiectasis, 2 diabetes,infertility, pneumothorax
Give 5 causes of acute limping child that can prevent at any age?
Ca
Septic arthitis
Osteomyelitis
JIA
Abuse
What criteria can be useful in distinguishing septic arthritis from transient synovitis? Briefly outline it?
Kocher criteria - 4 things, 3 or 4 = septic arthritis
Non weight bearing on affected side
ESR over 40
Fever over 38.5
White cells over 12000
What is the fluid bolus amount in paeds DKA? Why?
10ml/kg - cerebral oedema risk
What is the general fluid bolus resus for paeds?
20ml/kg
How to correct dehydration in kids?
If clinically shocked, add 100ml/kg on to normal maintenance over 24 hours
If not clinically shocked but dehydrated, add 50ml/kg over 24 hours
Between what years is the nasal flu spray given generally?
2-7
What is the risk of recurrent febrile convulsion after a first one?
30%
