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Paediatrics Flashcards

1
Q

What is the first line management for ADHD in children?

A

Methylphenidate

  • initially on 6 week trial basis
  • CNS stimulant
  • SE: abdominal pain, nausea, dyspepsia, stunted growth
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2
Q

What is Kawasaki’s disease?

A

A type of vasculitis predominantly seen in children.

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3
Q

What are the features of Kawasaki’s disease?

A 
High grade fever lasting >5 days 
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms of the ands and soles of feet
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4
Q

What is the diagnosis and management of Kawasaki’s disease?

A

Clinical diagnosis

Management:
High dose aspirin
IV immunoglobulin
Echo to screen for coronary artery aneurysm

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5
Q

What is scarlet fever?

A

A reaction to erythrogenic toxins produced by group a haemolytic streptococci.

Common in children aged 2-6 years with peak incidence at 4

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6
Q

What are the features of scarlet fever?

A 
Fever: typically lasts 24-48 hours
Malaise, headache, nausea/vomiting 
Sore throat
Strawberry tongue 
Rash: first on torso and spares palms and soles
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7
Q

What is the diagnosis of scarlet fever?

A

Throat swab taken but antibiotic started before results

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8
Q

What is the management of scarlet fever?

A

Oral penicillin V for 10 days (phenoxymethylpenicilin)
Or azithromycin if allergic
Can return to school 24 hours after starting antibiotics

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9
Q

What is croup?

A

An acute infective upper respiratory disease causing oedema in the larynx affecting children aged 6 months to 2 years.

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10
Q

What causes croup?

A

**Parainfluenza virus

Also: Influenza, adenovirus, RSV

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11
Q

describe the presentation of croup

A 
Increased work of breathing
“Barking” cough
Hoarse voice
Stridor
Low grade fever
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12
Q

What is the management of croup?

A

Oral dexamethosone- single dose of 150mcg/kg

Then: oxygen, nebulised budesonide, nebulised Adrenalin and incubation/ventilation

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13
Q

What is cystic fibrosis?

A

An autosomal recessive genetic condition affecting chromosome 7 —> mucus glands.

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14
Q

What is the initial presentation of cystic fibrosis?

A

Screened for at birth with newborn bloodspot test

Meconium ileus is often first sign. Presents with not passing meconium within 24 hours, abdominal distension and vomiting

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15
Q

What are the signs and symptoms of cystic fibrosis?

A 
Symptoms:
Chronic cough
Thick sputum production
Recurrent LRTI
Steatorrhea 
Abdominal pain/bloating

Signs:
Low birth weight
Nasal polyps
Finger clubbing
Crackles and wheezes on auscultation
Abdominal distension
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16
Q

Describe the diagnosis of cystic fibrosis

A

Newborn blood spot testing
Sweat test is gold standard - chloride concentration >60mmol/L
Genetic testing for CFTR gene - amniocentesis or chorionic villus sampling

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17
Q

What are the common microbial colonisers of cystic fibrosis

A

Staph aureus and pseudomonas

Staph aureus: people take prophylactic fluclox
Pseudomonas: troublesome to get rid of - treat with nebulised antibiotics such as tobramycin and oral cipro

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18
Q

What is the management of cystic fibrosis?

A 
Chest physio
Exercise
High calorie diet
CREON tablets help digestion
Prophylactic fluclox
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19
Q

What do you need to monitor in people with cystic fibrosis?

A

Diabetes
Osteoporosis
Vitamin d deficiency
Liver failure

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20
Q

Give an overview of measles

A

RNA paramyxovirus
Spread by droplets
Infective from prodrome until 4 days after rash starts
Incubation period of 10-14 days

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21
Q

What are the features of measles?

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots (before rash): white spots on buffalo mucosa
Rash: starts behind ears then to whole body
Diarrhoea occurs in 10% patients

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22
Q

What is the investigation and management of measles?

A

Investigations: IgM antibodies can be detected within a few days of rash onset

Management:
Mainly supportive
Admission may be required for immunosuppressive or pregnant patients

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23
Q

What are the complications of measles?

A

Otitis media: most common
Pneumonia: most common cause of death
Encephalitis typically occurs 1-2 weeks following onset of illness
Febrile convulsions

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24
Q

What are the features of pyloric stenosis?

A

‘Projectile’ vomiting, typically 30 mins after feed
Constipation and dehydration
A palpable mass in the upper abdomen
Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

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25
What is the diagnosis and management of pyloric stenosis?
Diagnosis is mostly made by US Management is with Ramstedt pyloromyotomy
26
What is whooping cough?
Pertussis is an infectious disease caused by gram-negative bacterium bordetella pertussis.
27
When are you immunised against whooping cough?
2,3,4 months and 3-5 years.
28
What are the features of whooping cough?
Coughing bouts: usually worse at night and after feeds Inspiratory whoop Spells of apnoea Marked lymphocytosis
29
What are the diagnostic criteria for whooping cough
Suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause and has one or more of the following: Paroxysmal cough Inspiratory whoop Post-tussive vomiting
30
What is the diagnosis of whooping cough?
Per nasal swab culture for bordetella pertussis | PCR and serology
31
What is the management of whooping cough?
<6 months should be admitted Notifyable disease Oral macrolide (e.g. clarithromycin, etc) Household contacts offered antibiotic prophylaxis School exclusion: 48 hours after commencing antibiotics
32
What is autism spectrum disorder?
It is a neurodevelopmental condition characterised by qualitative impairment in social interaction and communication.
33
What are the clinical features of autism spectrum disorders?
1. Impaired social communication and interaction: - children play alone - failure of nonverbal cues - socially isolated 2. Repetitive behaviours, interests and activities: - inflexible adherence to nonfunctional routines 3. Intellectual or language impairment - Less than 10 words by age 2
34
What is the management of autism spectrum disorders
There is no cure but early idetification and treatment can help Early education and behavioural interventions Pharmacological interventions: - SSRIs, Antipsychotics drugs and methylphenidate for ADHD Family support and counselling.
35
Define intussusception
Describes the invagination of one portion of bowel into the lumen of the adjacent bowel, most commonly around the ileo-ceacal region Usually affects infants between 6-18 months. Boys>girls
36
What are the features of intussusception?
Paroxysmal abdominal colic pain during which infant draws knees up to chest, turn pale and vomit. Vomiting Bloodstained stool ‘red current jelly’ is a late sign Sausage-shaped mass in the right upper quadrant
37
What is the investigation for intussusception?
USS may show target-like mass
38
What is the management of intussusception?
Reduction by air insufflation under radiology control - first line If this fails, or child has signs of peritonitis = surgery
39
Define bronchiolitis
Condition characterised by acute bronchiolar inflammation. RSV is the pathogen in 75-80% cases. Most common cause of serious LRTI in <1yr olds
40
What are the features of bronchiolitis?
``` Coryzal symptoms Dry cough Increasing breathlessness Wheezing, fine inspiratory crackles Feeding difficulties associated with increasing dyspnoea ```
41
When should you immediately refer a child with bronchiolitis? (999)
``` Apnoea Looks seriously unwell Severe respiratory distress e.g. grunting, chest recession or RR >70bpm Central cyanosis O2 <92% ```
42
When should you consider referring a child with bronchiolitis to hospital?
RR >60 Inadequate oral fluid intake Clinical dehydration
43
What is the investigation for bronchiolitis?
Immunofluorescence of nasopharyngeal secretions may show RSV
44
What is the management of bronchiolitis?
Largely supportive: O2 NG feed Suction
45
What is muscular dystrophy?
It’s an umbrella term for genetic conditions that cause a gradual weakening and wasting of muscles. Most common is duchenne’s muscular dystrophy.
46
What is the gower’s sign?
It is the sign for duchennes muscular dystrophy - children use their hands to get up off the floor because they have proximal muscle weakness.
47
Give the aetiology of duchenne’s muscular dystrophy
Caused by a defective gene for dystrophin on the X-chromosome. It is an x-linked recessive condition so women who are carriers usually don’t have any symptoms.
48
What is the presentation of duchenne’s muscular dystrophy?
Present around 3-5 years with weakness in muscles around pelvis. Weakness is progressive and eventually all muscles will be affected and they will become wheelchair bound by the time they’re teenagers. Life expectancy of 25-35 with good control of cardiac and respiratory complications
49
What is the management of duchenne’s muscular dystrophy?
Oral steroids have been shown to slow progression of muscle weakness by as much as two years. Creatine supplementation can give slight improvement in muscle strength Generally no treatment
50
What is myotonic dystrophy?
Genetic disorder that usually presents in adulthood Progressive muscle weakness Prolonged muscle contractions. (Unable to release grip after handshake) Cataracts Cardiac arrhythmias
51
What are the features of Down syndrome?
``` Hypotonia Brachycephaly Short neck Short stature Flattened face and nose Prominant epicanthic folds Upward sloping palpable fissures Single palmer crease ```
52
What are the complications of down syndrome?
``` Learning disability Recurrent otitis media Deafness Visual problems Hypothyroidism Cardiac defects (ASD, VSD, PDA, TOF) Atlantoaxial instability Leukaemia Dementia ```
53
What is Fragile X syndrome?
Caused by a mutation in the FMR1 gene on the X chromosome.
54
What are the features of fragile X syndrome?
Usually presents with delay in speech and language development. Others are: ``` Intellectual disability Long, narrow face Large ears Large testicles Hypermobile joints ADHD Autism Seizures ```
55
What is the management of fragile X syndrome?
Supportive
56
What are simple febrile convulsions?
Generalised, tonic clonic seizures that last less than 15 minutes and only occur once during an illness.
57
What are complex febrile convulsions?
When they consist of partial or focal seizures, last more than 15 minutes or occur multiple times during the same illness.
58
What is the management of febrile convulsions?
Identify and manage the underlying source of infection and control the fever with analgesia.
59
What is henoch-schonlein purpura?
It is an IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children. Inflammation occurs in the affected organs due to IgA deposits in the blood vessels. Usually affects: skin, kidneys and GI tract
60
What are the classic features of henoch-schonlein purpura?
Purpura Joint pain Abdominal pain Renal involvement
61
What is the investigations in henoch-schonlein purpura?
Most important to exclude other pathology such as meningitis. ``` Investigations: FBC and blood film Renal profile Serum albumin CRP Blood cultures Urine dipstick Urine protein:creatinine ratio BP ```
62
What is the diangnosis of henoch-schonlein purpura?
Patient has palpable purpura and at least one of: - diffuse abdo pain - arthritis or arthralgia - IgA deposits on histology - proteinuria or haematuria
63
What is the management of henoch-schonlein purpura?
Supportive Steroids is debatable Monitor with urine dipstick and BP
64
What's the difference between omphalocele and gastroschisis?
Omphalocele: herniated organs are covered by peritoneal sac Gastroschisis: herniated organs not covered by peritoneum
65
Which heart condition is associated with Marfan's?
Aortic root dilation --> aortic regurgitation
66
What is hirschprung's disease?
Congenital condition where nerve cells of myenteric plexus are absent in the distal bowel and rectum. Absence of parasympathetic ganglion cells
67
Which conditions are hirschprung's disease associated with?
Down's syndrome Neurofibromatosis Waardenburg syndrome MEN II Can occur by itself as well
68
What is the presentation of Hirschprung's disease?
``` Delay in passing meconium Chronic constipation since birth Abdominal pain and distention Vomiting Poor weight gain and failure to thrive ```
69
What is the initial and diagnostic investigations of Hirsschprung's disease?
``` Abdominal xray = initial Rectal biopsy (full thickness) = diagnostic ```
70
What is the management of Hirschprung's disease?
Hirschprung's associated enterocolitis will need fluid resuscitation and management of the intestinal obstruction with abs. Definitive = surgical removal of the aganglionic section of bowel
71
What is the management of congenital hernias?
Inguinal: repair ASAP Umbilical: conservative management
72
What is the presentation of coarctation of the aorta?
acute circulatory collapse at 2 days of age when the duct closes heart failure & absent femoral pulses Systolic murmur heard under the left clavicle and over the back
73
When should parents call an ambulance with regards to febrile seizures?
If seizure does not stop after 5 minutes
74
What is a child protection plan?
Devised for children at risk of significant harm

Finals (20 decks)

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