Paediatrics Flashcards
What is the first line management for ADHD in children?
Methylphenidate
- initially on 6 week trial basis
- CNS stimulant
- SE: abdominal pain, nausea, dyspepsia, stunted growth
What is Kawasaki’s disease?
A type of vasculitis predominantly seen in children.
What are the features of Kawasaki’s disease?
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
What is the diagnosis and management of Kawasaki’s disease?
Clinical diagnosis
Management:
High dose aspirin
IV immunoglobulin
Echo to screen for coronary artery aneurysm
What is scarlet fever?
A reaction to erythrogenic toxins produced by group a haemolytic streptococci.
Common in children aged 2-6 years with peak incidence at 4
What are the features of scarlet fever?
Fever: typically lasts 24-48 hours Malaise, headache, nausea/vomiting Sore throat Strawberry tongue Rash: first on torso and spares palms and soles
What is the diagnosis of scarlet fever?
Throat swab taken but antibiotic started before results
What is the management of scarlet fever?
Oral penicillin V for 10 days (phenoxymethylpenicilin)
Or azithromycin if allergic
Can return to school 24 hours after starting antibiotics
What is croup?
An acute infective upper respiratory disease causing oedema in the larynx affecting children aged 6 months to 2 years.
What causes croup?
**Parainfluenza virus
Also: Influenza, adenovirus, RSV
describe the presentation of croup
Increased work of breathing “Barking” cough Hoarse voice Stridor Low grade fever
What is the management of croup?
Oral dexamethosone- single dose of 150mcg/kg
Then: oxygen, nebulised budesonide, nebulised Adrenalin and incubation/ventilation
What is cystic fibrosis?
An autosomal recessive genetic condition affecting chromosome 7 —> mucus glands.
What is the initial presentation of cystic fibrosis?
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
What are the signs and symptoms of cystic fibrosis?
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
Describe the diagnosis of cystic fibrosis
Newborn blood spot testing
Sweat test is gold standard - chloride concentration >60mmol/L
Genetic testing for CFTR gene - amniocentesis or chorionic villus sampling
What are the common microbial colonisers of cystic fibrosis
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
What is the management of cystic fibrosis?
Chest physio Exercise High calorie diet CREON tablets help digestion Prophylactic fluclox
What do you need to monitor in people with cystic fibrosis?
Diabetes
Osteoporosis
Vitamin d deficiency
Liver failure
Give an overview of measles
RNA paramyxovirus
Spread by droplets
Infective from prodrome until 4 days after rash starts
Incubation period of 10-14 days
What are the features of measles?
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
What is the investigation and management of measles?
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
What are the complications of measles?
Otitis media: most common
Pneumonia: most common cause of death
Encephalitis typically occurs 1-2 weeks following onset of illness
Febrile convulsions
What are the features of pyloric stenosis?
‘Projectile’ vomiting, typically 30 mins after feed
Constipation and dehydration
A palpable mass in the upper abdomen
Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
What is the diagnosis and management of pyloric stenosis?
Diagnosis is mostly made by US
Management is with Ramstedt pyloromyotomy
What is whooping cough?
Pertussis is an infectious disease caused by gram-negative bacterium bordetella pertussis.
When are you immunised against whooping cough?
2,3,4 months and 3-5 years.
What are the features of whooping cough?
Coughing bouts: usually worse at night and after feeds
Inspiratory whoop
Spells of apnoea
Marked lymphocytosis
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
What is the diagnosis of whooping cough?
Per nasal swab culture for bordetella pertussis
PCR and serology
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
What is autism spectrum disorder?
It is a neurodevelopmental condition characterised by qualitative impairment in social interaction and communication.
What are the clinical features of autism spectrum disorders?
- Impaired social communication and interaction:
- children play alone
- failure of nonverbal cues
- socially isolated - Repetitive behaviours, interests and activities:
- inflexible adherence to nonfunctional routines - Intellectual or language impairment
- Less than 10 words by age 2
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.
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
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
What is the investigation for intussusception?
USS may show target-like mass
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
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
What are the features of bronchiolitis?
Coryzal symptoms Dry cough Increasing breathlessness Wheezing, fine inspiratory crackles Feeding difficulties associated with increasing dyspnoea
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%
When should you consider referring a child with bronchiolitis to hospital?
RR >60
Inadequate oral fluid intake
Clinical dehydration
What is the investigation for bronchiolitis?
Immunofluorescence of nasopharyngeal secretions may show RSV
What is the management of bronchiolitis?
Largely supportive:
O2
NG feed
Suction
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.
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.
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.
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
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
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
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
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
What is Fragile X syndrome?
Caused by a mutation in the FMR1 gene on the X chromosome.
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
What is the management of fragile X syndrome?
Supportive
What are simple febrile convulsions?
Generalised, tonic clonic seizures that last less than 15 minutes and only occur once during an illness.
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.
What is the management of febrile convulsions?
Identify and manage the underlying source of infection and control the fever with analgesia.
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
What are the classic features of henoch-schonlein purpura?
Purpura
Joint pain
Abdominal pain
Renal involvement
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
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
What is the management of henoch-schonlein purpura?
Supportive
Steroids is debatable
Monitor with urine dipstick and BP
What’s the difference between omphalocele and gastroschisis?
Omphalocele: herniated organs are covered by peritoneal sac
Gastroschisis: herniated organs not covered by peritoneum
Which heart condition is associated with Marfan’s?
Aortic root dilation –> aortic regurgitation
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
Which conditions are hirschprung’s disease associated with?
Down’s syndrome
Neurofibromatosis
Waardenburg syndrome
MEN II
Can occur by itself as well
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
What is the initial and diagnostic investigations of Hirsschprung’s disease?
Abdominal xray = initial Rectal biopsy (full thickness) = diagnostic
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
What is the management of congenital hernias?
Inguinal: repair ASAP
Umbilical: conservative management
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
When should parents call an ambulance with regards to febrile seizures?
If seizure does not stop after 5 minutes
What is a child protection plan?
Devised for children at risk of significant harm
