Paediatrics 1 Flashcards
Neonate NEWBORN BLS
5 steps
- Dry baby and maintain temperature
- Assess tone, respiratory rate, heart rate
- If gasping or not breathing give 5 inflation breaths*
- Reassess (chest movements)
- If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
*Inflation breaths are different from ventilation breaths. The aim is to sustain pressure to open the lungs.
8-year-old boy presented with:
- progressive gait disturbance and falls, unsteady gait and toe walking at the age of 4 years.
- Tremors in the hands were noted sometime prior to this visit.
- Gait was wide-based and unsteady
- pes cavus
- mild scoliosis
- absence of cardiac murmur.
diagnosis and genetic pattern?
Friedreich’s ataxia is autosomal recessive
Perthes disease- Avascular necrosis of head femoral head
More common in boys or girls?
Caterall Staging
Stage 1
Stage 2
Stage 3
Stage 4
5 times more common in boys
Caterall Staging
Stage 1 Clinical and histological features only
Stage 2 Sclerosis with or without cystic changes and preservation of the articular surface
Stage 3 Loss of structural integrity of the femoral head
Stage 4 Loss of acetabular integrity
Perthes Disease Management
1. Supportive:
2. < 6yo
3. Older
4.
- To keep the femoral head within the acetabulum: cast, braces
- If less than 6 years: observation
- Older: surgical management with moderate results
4 .Operate on severe deformities
ITP Management
Usually…
BUT
1
2
3
- usually, no treatment is required. Advice about preventing trauma for bleeding
BUT if platelets <10 * 109/L) or there is significant bleeding:
- oral/IV corticosteroid
- IV immunoglobulins
- platelet transfusions can be used in an emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by the circulating antibodies
Going back to school rules:
- Rubella
- Scarlet fever
- Hand foot and mouth
- Whooping cough
- Measles
- Chickenpox
- Mumps
- Infectious gastroenteritis
- Impetigo
- Rubella- 5 days from rash onset
- Scarlet fever- 24 hours from when abx started
- Hand foot and mouth- none
Whooping cough- 2 days after commencing abx (or 21 days from onset of symp if no abx)
- Measles- 4 days from rash onset
- Chickenpox- until all lesions have crusted over
- Mumps- 5 days from swollen glands
- Infectious gastroenteritis- 48 hours from when symptoms have settled
- Impetigo- Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
Fragile X syn.
genetic pattern
features 6
X-linked dominant
Features in males
- learning difficulties
- large low set ears, long thin face, high arched palate
- macroorchidism
- hypotonia
- autism is more common
- mitral valve prolapse
Is conjugated or unconjugated bilirubin elevated in biliary atresia?
Conjugated bilirubin is elevated in biliary atresia
Unconjugated -> conjugated in the liver
Before starting anti-TNF med, what investigation would you do and why?
CXR- to rule out latent TB which can be reactivated
Seborrhoeic dermatitis in children
aka
Site? (4)
Describe the rash basically
Management:
1.
2.
3. If severe/ persistent
aka- ‘Cradle cap’
site- scalp, nappy area, face, limb flexures
erythematous rash with coarse yellow scales
Management
1. Reassurance that it doesn’t affect the baby, usually resolves within a few weeks
2. Massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.
3. If severe/persistent a topical imidazole cream may be tried
Knee pain children and young adult STEMS
- Chondromalacia patellae -
- Osgood-Schlatter disease
(tibial apophysitis) - Osteochondritis dissecans
- Patellar subluxation
- Patellar tendonitis
Chondromalacia patellae - teenage girls, anterior knee pain on walking up + down stairs, rising from prolonged sitting
- Osgood-Schlatter- sporty teenagers, Pain, tenderness + swelling over the tibial tubercle, Pain on bending down
- Osteochondritis dissecans- Pain after exercise
Intermittent swelling and locking - Patellar subluxation- Medial knee pain due to lateral subluxation of the patella
Knee may give way - Patellar tendonitis- athletic teenage boys, Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Risk factors for noonatal hypoglycaemia
- preterm birth (< 37 weeks)
- maternal diabetes mellitus
- IUGR
- hypothermia
- neonatal sepsis
- inborn errors of metabolism
- nesidioblastosis
- Beckwith-Wiedemann syndrome
Managment of threadworm
Single dose of oral Mebendazole and for the entire household + hygeine advice
Down syndromes are at in crease of what with regards to contact sport STEM!
atlanto-axial instability- If participate in specific sports, they may carry an increased risk of neck dislocation (e.g. trampolining, gymnastics, boxing, diving, rugby and horse riding)
Pataus is what chromsome?
Features? (4)
13
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Diet advice for children with ADHD
Normal balanced
If its a young teen with hip pain, how can you differenciate between Perthes and SUFE? (2)
SUFE-
Age 10-15yo
key examination finding being the loss of internal rotation of the leg in flexion.
Perthes
3-10yo
NO LIMIT IN MOVEMENT
Congenital heart defect
Cyanotic presenting in the first days of life =
Cyanotic presenting in the first 1-2 months =
Days = Transposition of great vessels
Months = TOF
What vaccines do you recive between the ages of 12-13 and then 13-18yo?
12-13yo = HPV vaccination
13-18 years = ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
When should you routinely assess APGAR score?
1 and 5 minutes of age
Whooping cough going back to school rules?
Also what abx is used?
48 hours following commencement of antibiotics (or 21 days from onset of symp if no abx)
clarithromycin
Briefly explain the pathology and what you’d see on a hormonal panel in these conditions causing delayed puberty in females?
Turners-
Consitutional delay of puberty
Congenital adrenal hyperplasia
Functional hypothalamic amenorrhoea
Premature ovarian insufficiency
Turners- Due to ‘streak’ ovaries- Ovaries dont produce oestrogen but increase in LH and FSH. Also low anti-mullarian hormone (low reserve)
Consitutional delay of puberty- Normal hormonal panel, LH and FSH will not be elvated in pre-pubertal girls
Congenital adrenal hyperplasia-
Functional hypothalamic amenorrhoea- usually a result of stress, eating disorder or intense exercise resulting in depression of GnRH. Might expect to see a low BMI, which causes a low level of LH and FSH to be released into the bloodstream
Premature ovarian insufficiency- ovaries entering a menopausal state early, usually before a patient’s 40s. The oestrogen level decreases resulting in a high LH and FSH level
What is hypospadias and what condition is assoc. with it?
3 management points for hypospadias
hypospadias- congenital abnormality of the penis. Urethra comes out on the ventral side.
Assoc. with Cryptorchidism (undestended testes) 1/10 with hypospadias have cryptorchidism therefore examine groin.
Management:
- Make sure they pass urine in first 24 hours
- Don’t get circumcised because foreskin can be used in surgery
- Surgery at 12 months
Major risk factors for SIDS ( sudden infant death syndrome) are: (5)
- prone sleeping
- parental smoking
- bed sharing
- hyperthermia and head covering
- prematurity
What is alpha thalassaemia?
What chromo?
There are two seperate alpha-globulin genes located on each chromosome….
Severity depends on the number of alpha globulin alleles affected:
1 or 2 alpha globulin alleles affected =
If are 3 alpha globulin alleles are affected =
If all 4 alpha globulin alleles are affected (i.e. homozygote) =
- Due to a deficiency of alpha chains in haemoglobin
chromosome 16
1 or 2 alpha globulin alleles affected = hypochromic and microcytic, but Hb levels would be typically normal
3 = hypochromic microcytic anaemia with splenomegaly. This is known as Hb H disease
All 4 = death in utero (hydrops fetalis, Bart’s hydrops)
Kochers criteria for septic arthritis
- Non-weight bearing - 1 point
- Fever >38.5ºC - 1 point
- WCC >12 * 109/L - 1 point
- ESR >40mm/hr
5.
Receiving the MMR as a child later in life. When do you give second dose?
Max response =
Max response = 3 months between doses to maximise the response rate
1 month is considered adequate if the child is > 10 years of age.
In an urgent situation (e.g. an outbreak at the child’s school) then a shorter period of 1 month can be used in younger children.
If you have a VSD what are you at an increase of getting later in life?
endocarditis
Management steps for cows milk protein allergy
If formula fed
1. First-line =
2.
If breast fed
1.
2.
3. When breast feeding stops-
If formula fed
1. extensive hydrolysed formula (eHF) milk is the first-line with mod symp
2. Amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF
10% of infants are also intolerant to soya milk
If breast fed
1. continue breastfeeding
2. eliminate cow’s milk protein from maternal diet. Can have calcium supplements for mum
3. When breast feeding stops- eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
ADHD med methylphenidate side effect 5 but 1 main 1
stunted growth
insomnia, weight loss, anxiety, nausea and pain.
What is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.
Meckels diverticulum
results from the failure of the vitelline duct to obliterate during the fifth week of fetal development
Mitochondrial diseases are inherited following 3 principles:
- Affected males cannot pass it onto their children
- Affected females will pass it onto all of their children
- All individuals who inherit the affected mitochondria, will have the disease
Complete androgen insensitivity- - classic presentation (STEM 2)
what is it?
- primary amenorrhoea
- You get bilateral inguinal hernias which are actually undescended testes
- Small breast bud development and spare public hair due to aromatase androgens
phenotypically female genitalia in a genetic male, caused by failure of androgen masculinisation of genitalia in-utero
Route and how many times do you give Vit K to a neonate?
why is it given?
Who is at risk of this? (2)
Once- off dose IM injection
can also be given orally but IM is preferred if compliance is an issue with parents
Why? Given to prevent hemorrhagic disease
- breast fed babaies
- mums on anti-epileptics
What exam findings would you ding with neonate Congenital diaphragmatic hernia (2 and 1 STEM)
- dyspnoea and tachypnoea at birth
STEM - classical concave abdominal appearance - Reduced breath sound bilaterally
Genetic inheritance pattern of Sickle cell?
Autosomal recessive
DDH
Indication for 2 week hip USS
Indication for 6 week USS
2 weeks- abnormal birth check with ortolini and barlow
6 weeks
- Breech at birth
- Breech at 36 weeks
- 1st degree relatives with Hx of Hip problems
- Twin/Multiple pregnancy
Management of thread worm
a rogue fact which is very frustrating…
One off Mebendazole for patient and all family members + hygeine
Cannot be given to < 6 months!)
Febrile convulsions
Simple criteria (4)
Complex criteria (3)
Febrile status
Simple criteria (4)
- < 15 minutes
- generalised
- don’t reoccur in 24 hours
- complete recovery within 1 hour
Complex criteria (3)
- 15- 30 mins
- focal seizure
- may repeat within 24hrs/ same illness
Febrile status
- > 30 mins
Orofacial cleft lip causes
what maternal drugs in preg? (2)
Maternal factor in preg -
Infection in preg
syndromic disorders (3)
what maternal drugs in preg? - Benzos
- Anti-epileptics (phenytoin)
Maternal factor in preg
- smoking
Infection in preg
- rubella
syndromic disorders
- **18- edwards
- 13 pataus
- 15 - Prader-Willi syndrome?
Genetic pattern of inheritance Haemophilia A?
X-linked recessive
Therefore only mother to son passing
Features which may be present in a sexually abused child (8)
- pregnancy
- sexually transmitted infections, recurrent UTIs
- sexually precocious behaviour
- anal fissure, bruising
- reflex anal dilatation
- enuresis and encopresis
-behavioural problems, self-harm - recurrent symptoms e.g. headaches, abdominal pain
undescended unilateral testicle
what surgery is done?
Bilateral undescedended testes management?
Reassure and Referral if at 3 months of age hasn’t descended
child should be referred to a paediatric surgeon and seen before 6 months of age
Orchidopexy- this should occur at around 1yo
BILATERAL- Review by senior paed within 24 hours as the child may need urgent endocrine or genetic investigation
