Paediatrics Flashcards
You’re asked to see a 5-hour old baby on the post-natal ward. They were born by ventouse and have now developed a swelling over the side of their scalp which does not cross the suture lines. What is the most likely diagnosis?
Cephalohaematoma
What is craniosynostosis?
Premature fusion of the skull sutures
During the routine NIPE, a new mum asks you about a strange mark on her 16 hour old baby. There is a large dark blue macular lesion overlying the baby’s sacrum. What is the most likely diagnosis and what will you tell the mum?
This is a Mongolian blue spot. Although benign, it cant take a few years to start to fade. Most are resolved within 10 years.
You are completing a NIPE on a 10-hour old baby. The delivery was complicated by shoulder dystocia. The right arm is held in fixed flexion at the elbow and wrist. What is the likely diagnosis and what structure is injured?
Klumpke’s palsy - Caused by injury to the T1 and C8 roots of the brachial plexus
What are the risk factors associated with DDH?
Female, Firstborn, Family Hx, Breech presentation, oligiohydramnios, fetal neuromuscular disorders
What are thr risk factors associated with SUFE
Male sex, Obesity, Puberty, Afro-Carribean ethnicity, Delayed skeletal maturity, Hyopopituitarism
What clinical features are associated with SUFE?
Limp, hip - knee pain, pain on movement in all directions, shortened externally rotated leg
What are the radiological features associated with SUFE?
Steel sign (double density at metaphysis on AP), widening of ipsilateral growth plate, decreased epiphyseal height, Trethowan’s sign (Klein’s line does not intersect the upper femoral epiphysis)
What are the causes of VUR?
Primary (abnormal but normal anatomy i.e. large ureteric orifice) Secodary - posterior urethral valve, meatal stenosis, neuropathic bladder, dysfunctional bladder
What investigations are used in the diagnosis of VUR?
Micturating cystourethrogram (gold standard) DMSA scan (renal scarring) Ultasound (hydronephrosis)
What is the pathogenesis of ITP?
A viral infection leads to the development of platelet membrane glycoprotein specific antibodies leading to immune mediated destruction of platelets.
What investogations are indicated in the diagnosis of ITP?
FBC - thrombocytopaenia, coagulation studies (excludes DIC), Inflammatory markers (excludes infection) blood film (excludes haemolytic anaemia etc)
How does ITP present?
Petechial rash, purpura, unexplained bleeding
How should ITP be managed?
IVIG, steroids, IV anti-D
What are the potential complications of ITP?
Intracranial haemorrhage, Intraabdominal haemorrhage. Manage with high dose IVIG, steroids +/- splenectomy
What are the clinical features of Down syndrome?
Depressed nasal bridge, prominent epicanthic folds, upslanting palpebral fissues, low set ears, protruding tongue, widened sandal gap clinodactyly, single palmar crease, hypotonia, brushfield spots,
How is Down syndrome screened for and diagnosed?
Triple test - nuchal translucency, elevated beta-hCG, low PAPP-A
Quadruple test - AFP, beta-hCG, inhibin-A, oestriol
Diagnosis - FISH/karyotyping from amniocenesis or CVS
What are the four defects that make up tetrallogy of fallot?
Pulmonary stenosis, VSD, RVH and overriding aorta
What are the cyanotic congenital heart defects?
TOF, TGA, Pulmonary atresia, total anomolous pulmonary venous drainage, tricuspd atresia, truncus arteriosus, complete AVSD
What are the management otpions for a Tet-spell?
Position in knee to chest position - increases systemic vascular resistance, decreasing R->L shunt.
Medical management - High flow oxygen and oral mrphine, or IV morphine and beta blockers
What advice can be given to parents to reduce the risk of SUDI sudden unexpected death in infancy (aka SIDS sudden infant death syndrome)
Always put baby to sleep on their backs with their feet at the bottom of the bed, use child safety approved matresses, don’t co sleep with the baby, keep soft objects out of the rib other than one blanket not over the face, do not smoke, control the room temperature,, use a pacifier with a string attached
What are the red flags in a febrile child?
Age < 3m, non-blanching rash, bulging frontanelle, neck stiffness, status epilepticus, focal neurology, pale/mottled skin, unresponsive to social cues, unable to stay awake, weak/high pitched,/continuous cry, unresponsive, reduced skin turgour
What are the risk factors for neonatal sepsis?
Previous baby with invasive GBS infection, maternal GBS colonisation, PPROM, prematurity, intrapartum fever or suspected chorioamionitis, infection in the other twin/triplet etc, maternal sepsis
What are the causes of neonatal seizures?
infection, hypoglycaemia, hypocalcaemia, neonatal abstinence syndrome, HIE, intraventricular haemorrhage, cerebral malformation
