Paediatrics 1 Flashcards
Top two common organisms causing infection of the newborn eye (ophthalmia neonatorum)
Chlamydia trachomatis
Neisseria gonorrhoea
short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis
=
Gene
RF
AD/AR
Achondroplasia
FGFR 3 gene
Advancing maternal age
AD
Acute epiglottitis is caused by which organism
Sx (4)
What is the tripod position?
Mx (3)
Haemophilus influenzae
Generally unwell
High temp
Stridor
Drooling
Sitting, leaning forward, neck extended - helps them breathe
Mx anaesthetics, oxygen, IV abx
XR may show what in acute epiglottitis?
Thumb sign
XR in croup can show what?
Steeple sign
Which leukemia is the most common affecting children?
Peak incidence age
ALL
2-5yo
Name five poor prognostic factors with children with ALL
Age <2 or >10
WCC >20 at time of diagnosis
Non-caucasian
Male
T or B cell surface markers
Name seven features of ALL
Anaemia
Neutropenia
Thrombocytopenia
Testicular swelling
Bone pain
Hepatosplenomegaly
Fever
What is HbH disease?
Type of anaemia
Number of alpha globulin alleles affected
Alpha thalassemia
3 alpha globulin alleles are affected leading to a
Hypochromic microcytic anaemia with splenomegaly
Life threatening asthma attack
Sats
PEF
Chest signs (2)
<92%
<33%
Silent chest
No respiratory effort
Severe asthma attack
Sats
PEF
Chest signs (2)
HR >5yo and 1-5yo
RR
<92%
33-50%
HR > 125 (>5yo), >140 (1-5yo)
RR >30 if >5yo >40 if 1-5yo
Too breathless to talk or feed
Accessory muscle use
Moderate asthma attack aged 2-5yo
Sats
Moderate asthma attack >5yo
sats
PEF
> 92%
> 92%
50% PEF
Mild - mod asthma Mx
How often
Max number of puffs
How many times to repeat before referring to hospital?
SABA with spacer
1 puff every 30-60 seconds
Max 10 puffs
Can repeat and then refer to hospital
Prednisolone 3-5 days
Pred dosing
2-5yo
>5yo
mg/kg
20mg OD
30-40mg OD
1-2mg/kg
5-16yo asthma mx (7)
- SABA
- SABA + paeds low dose ICS
- SABA + paeds low dose ICS + LTRA
- SABA + paeds low dise ICS + LABA
- SABA + MART (combined low dose ICS + LABA)
- SABA + MART (mod dose ICS)/ SABA + mod dose ICS + LABA
- SABA + MART (high dose ICS) / SABA + high dose ICS + LABA/ SABA + theophylline/ SABA + seeking advice from expert
Low
Mod
High dose ICS doses
200
200-400mcg
>400mcg
Mx asthma <5yo
(4)
- SABA
- SABA + 8 week trial of paeds mod ICS
Then stop and monitor sx
If sx didn’t resolve during 8 week trial then ?alternative diagnosis
If sx resolved and then reoccured within 4 weeks of stopping ICS rx then restart ICS at paediatric low dose ICS
If sx resolved and then reoccurred >4 weeks after stopping then repeat 8 week trial of paeds mod dose ICS
- SABA + paeds low dose ICS + LTRA
- Stop LTRA and refer
DSM-V definition of ADHD
(Three main symptoms)
How many features in children up to 16 and >=17yo
Common age range of diagnosis
Inattention
Hyperactivity
Impulsivity
Children up to 16yo have to have six features
17yo and over have to have five features
3-7yo
Non pharmacological Mx ADHD (2)
Drug therapy is offered to which age group
- 10 week watch and wait period to see if symptoms are persistent
- Refer to CAMHS or paeds with special interest in behavioural disorders
5 or more yo
Drug treatment in ADHD
1st line
2nd line
If you benefit from 2nd line but can’t tolerate SE
1st line methylphenidate (six week trial)
If inadequate reponse
2nd line lisdexamfetamine
3rd line dexamfetamine (if you benefit from lisdexam but can’t tolerate SE)
SE methylphenidate (3)
Monitoring (2)
AP
Nausea
Dyspepsia
Height and weight every 6 months
Baseline ECG
ADHD adults mx (2)
- Methyl or lisdexam
Autism
Features (3)
Impaired social communication
Repetitive behaviours
Intellectual/ language impairment
AD conditions
Disease is passed on to what percentage of children?
50%
AR conditions
Two heterozygote parents
What percentage will have the condition?
Will be a carrier?
Will be unaffected
25%
50%
25%
Age range for benign rolandic epilepsy?
What is it? (when and type of seizure) (2)
EEG shows
Seizures stop by
4-12yo
Seizures typically at night, partial +/- secondary generalisation
EEG shows centro-temperoral spikes
Seizures stop by adolescence
Bronchiolitis
Age range
Organism
Worse when?
<1yo (peak 1-9 months)
RSV
Worse in winter
Bronchiolitis Ix (1)
Mx (3)
Immunofluorescence of nasopharyngeal secretions
Humidified O2 if O2 <92%
NG feeding
Suction
What is Sever disease?
Calcaneal apophysitis
Overuse injury in sporty kids
What is the differences between cephalohaematoma and caput succedaneum
Cephalohaematome
Develops hours after birth
Parietal region
Takes months to resolve
Caput succedanaeum
Present at birth
Forms over vertex and crosses suture line
Resolves within days
Complication of cephalohaematoma
Jaundice
Chickenpox
Infectivity period
4 days prior to rash until 5 days after rash
Chickenpox features
Fever initially
Itchy rash on head and trunk and then spreads
Macular then papular then vesicular
Mx chickenpox (3)
What may increase risk of secondary bacterial infection?
Keep cool
Calamine lotion
School exclusion
NSAIDs
Heel prick test tests for which four conditions
- Hypothyroidism
- PKU
- CF
- MCADD
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
=
Measles
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
=
Mumps
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
=
Rubella
Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
=
Erythema infectiosum
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
=
Hand, foot and mouth disease
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
=
Scarlet fever
Codeine use in children rule
Breastfeeding yes or no
> 12yo for pain that is not controlled by paracetamol or ibuprofen
No
Name five acyanotic congenital heart coditions
VSD (most common)
ASD
PDA
Coarctation
Aortic valve stenosis
Name three cyanotic congenital heart conditions
ToF (presents 1-2months old) most common
Transposition of the great arteries (presents at birth)
Tricuspid atresia
Red flags for constipation in children (7)
From birth
Passage of meconium >48 hours
Ribbon stools
Faltering growth (amber)
Weakness in legs
Locomotor delay
Distension
Mx constipation
- Movicol
- add Senna (stimulant)
- Substitute stimulant for osmotic e.g lactulose
Cow’s milk protein intolerance
Age of onset
Features (5)
Present usually in the first 3 months of life
Regurgitation
Vomiting
Diarrhoea
Urticaria
Colic symptoms
Cow’s milk protein intolerance
Ix (3)
Skin prick
Patch testing
RAST IgE for cow’s milk protein
Cow’s milk protein intolerance Mx
Formula fed (2)
Breastfed (3)
- Extensive hydrolysed formula
- Amino acid based formula
- Continue breastfeeding
- Eliminate cow’s milk protein from maternal diet
- eHF milk when breastfeeding stops until 12 months of age
Croup
Age range
Organism
Season
6 months - 3 years
Parainfluenza
Autumn
Croup features (4)
Stridor
Barking cough - worse at night
Fever
Coryzal sx
Who should be admitted with croup? (4)
Moderate or severe
<6 months
Known upper airway abnormalities
Uncertainty about diagnosis
Mx croup (2)
Emergency treatment (2)
Single dose dexamethasone 0.15mg/kg
OR
Prednisolone
Oxygen
Nebs adrenaline
CF
AD/AR
Common organisms that colonise (2)
AR
Staph Aur
Pseudomonas aeruginosa
Name four presenting features of CF
Recurrent chest infections
Meconium ileus
Steatorrhoea/ FTT
Liver disease
Name six non presenting features of CF
Short stature
Rectal prolapse
Nasal polyps
DM
Delayed puberty
Infertility/ subfertility
CF mx (6)
Pharmaclogical therapy (2)
- BD chest physio + postural drainage
- High calorie diet with high fat intake
- Minimise contact with other CF patients
- Vitamin supplementation
- Pancreatic enzyme supplements
- Lung transplant
Lumacaftor/lvacaftor
Referral for developmental delay
Not smiling by
No sitting by
Cannot walk by
10 weeks
12 months
18 months
Hand preference before what age is abnormal?
Could indicate?
12 months
Cerebral palsy
Name seven risk factors for developmental dysplasia of the hip
- First born
- Oligohydramnios
- Positive FH
- Female
- Breech presentation
- Congenital foot deformity
- Birth weight >5kg
Developmental dysplasia of the hip
Most common in which hip?
Who requires screening with an US? (3)
Left
1st degree FH, breech presentation K36 and above, multip
What test is done at the six week check to check for developmental dysplasia of the hip?
Barlow - dislocate
Ortolani - relocate
Ix of choice for DDH
Unless what age, in which case which scan?
US
Unless >4.5months - XR
Most common cause of gastroenteritis in children (organism)
Rotavirus
Gastroenteritis
Diarrhoea usually lasts for ? and stops within ?
Vomiting usually lasts for ? and stops within ?
5-7 days 2 weeks
1-2 days 3 days
Who is a stool culture done on in gastroenteritis? (3)
Suspected septicaemia
Immunocompromised
Blood/mucous in stool
High LH, low testosterone =
Klinefelters
Primary hypogonadism
XXY
Low LH and low testosterone
Hypogonadotrophic hypogonadism
Kallman’s
High LH normal/ high testosterone
Androgen insensitivity syndrome
Low LH and high testosterone
Testosterone secreting tumour
often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels
=
Klinefelter’s
XXY
‘delayed puberty’
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal
patients are typically of normal or above average height
=
Inherited?
Kallman’s
X linked recessive
‘primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol
=
Mx (3)
Androgen insensitvity syndrome
46XY
Raise child female
Orchidectomy (increased risk of testicular cancer with undescended testes)
Oestrogen therapy
Congenital abnormality of the layrnx
Infants typical present at 4 weeks of age with:
stridor
=
Laryngomalacia
Which vaccination should be deferred in children with an evolving or unstable neurological condition
DTP
precocious puberty
cafe-au-lait spots
polyostotic fibrous dysplasia
short stature
=
McCune-Albright syndrome
X linked recessive inheritance affects which gender?
Males sons are
Males daughters are
Each male child of a heterozygous female carrier has what chance of being affected
Each female child of a heterozygous female carrier has what chance of being carrier
Males only
Males sons are unaffected
Males daughters are carriers
Each male child of a heterozygous female carrier has a 50% chance of being affected
Each female child of a heterozygous female carrier has a 50% chance of being a carier
Wilm’s tumour
Age
Features (3)
Mx
Under age of 5
Abdominal mass
Painless haematuria
Flank pain
Paediatric review within 48 hours
