Paediatrics Flashcards
Organism that causes acute epiglottitis
Haemophilia influenza B
Features of acute epiglottitis
High temperature
Generally unwell, toxic child
Stridor
Drooling
X-ray sign of acute epiglottitis
Thumb sign
Management of acute epiglottitis
Intubate - call anaesthetist
Secure airways
Common organism that causes croup
Parainfluenza virus
Features of croup
Barking cough - worse at night
Stridor
Cold symptoms
Croup on X-ray
Steeple sign
severe croup
Features
Inspiratory stridor at rest
Sternal wall retractions
distress/agitation - sign of hypoxemia
Tachycardia
Management of croup
0.15 mg/kg of ORAL DEXA - regardless of severity
If not available give prednisolone
Severe cases = give oxygen (high flow) and nebulised adrenaline
Prognosis of croup
Natural resolution - complete recovery
Define enuresis
Involuntary discharge of urine - day or night or both
+ child >= 5 years old
+ with no congenital or acquired defects
Primary vs secondary enuresis
Primary - never achieved continence before
Secondary - dry for at least 6 months
Management of primary daytime enuresis over the age of 2
Refer to secondary care or enuresis clinic
Management of primary enuresis w/o daytime symptoms
- < 5 yrs
reassure
Management of primary enuresis w/o daytime symptoms
> 5 yrs
If < 2x/week = reassure
If > 2x/week =
-short term = desmopressin ( camp or child >7)
- long term = enuresis alarm + reward system
(Enuresis alarm first line for children <7)
** if 2 complete courses of treatment dont work = Refer to secondary care
Management of secondary enuresis
Refer to paediatrician
Common causes of secondary enuresis (4)
Emotional upset (?abuse)
UTI
DM
Constipation
How should the reward system work in enuresis management
Reward for agreed behaviour rather than dry nights
What happens in reflex nephropathy?
Urine goes back from bladder to ureters and kidneys - vesico-ureteric reflux
= dilated pelvicalyceal system -
=Repeated UTIs
= progressive renal failure
Cause of reflux nephropathy
Occurs mainly in children
Congenital abnormality at insertion of ureters into bladder
Diagnosis of reflux nephropathy
- Initial
- Gold standard
- For parenchymal damage
Initial = Renal US +urinalysis + C&S
Gold* = MCUG (micturating cystourethrogram)
Damage (cortical scars) - DMSA
Treatment of reflux nephropathy
1 - low dose antibiotics = Trimethoprim daily
If it fails or there’s parenchymal damage = Surgery (ureter reimplantation)
4 cm lateral neck mass not translucent
Dx?
Branchial cyst
5 cm translucent lateral neck mass
Dx?
Lymphangioma
Ddx for lateral neck mass
Lateral = along or near strenocleidomastoid
Branchial cyst
Lymphangioma
Differentiate by translucency
3cm midline lump
Painless , Mobile
Moves with tongue protrusion
Thyroglossal cyst
severe croup
Features
Inspiratory stridor at rest
Sternal wall retractions
distress/agitation - sign of hypoxemia
Tachycardia
Management of croup
0.15 mg/kg of ORAL DEXA - regardless of severity
If not available give prednisolone
Severe cases = give oxygen (high flow) and nebulised adrenaline
Prognosis of croup
Natural resolution - complete recovery
Define enuresis
Involuntary discharge of urine - day or night or both
+ child >= 5 years old
+ with no congenital or acquired defects
Primary vs secondary enuresis
Primary - never achieved continence before
Secondary - dry for at least 6 months
Management of primary daytime enuresis over the age of 2
Refer to secondary care or enuresis clinic
Management of primary enuresis w/o daytime symptoms
- < 5 yrs
reassure
Management of primary enuresis w/o daytime symptoms
> 5 yrs
If < 2x/week = reassure
If > 2x/week =
-short term = desmopressin ( camp or child >7)
- long term = enuresis alarm + reward system
(Enuresis alarm first line for children <7)
** if 2 complete courses of treatment dont work = Refer to secondary care
Management of secondary enuresis
Refer to paediatrician
Common causes of secondary enuresis (4)
Emotional upset (?abuse)
UTI
DM
Constipation
How should the reward system work in enuresis management
Reward for agreed behaviour rather than dry nights
What happens in reflex nephropathy?
Urine goes back from bladder to ureters and kidneys - vesico-ureteric reflux
= dilated pelvicalyceal system -
=Repeated UTIs
= progressive renal failure
Cause of reflux nephropathy
Occurs mainly in children
Congenital abnormality at insertion of ureters into bladder
Diagnosis of reflux nephropathy
- Initial
- Gold standard
- For parenchymal damage
Initial = Renal US +urinalysis + C&S
Gold* = MCUG (micturating cystourethrogram)
Damage (cortical scars) - DMSA
Treatment of reflux nephropathy
1 - low dose antibiotics = Trimethoprim daily
If it fails or there’s parenchymal damage = Surgery (ureter reimplantation)
4 cm lateral neck mass not translucent
Dx?
Branchial cyst
5 cm translucent lateral neck mass
Dx?
Lymphangioma
Ddx for lateral neck mass
Lateral = along or near strenocleidomastoid
Branchial cyst
Lymphangioma
Differentiate by translucency
3cm midline lump
Painless , Mobile
Moves with tongue protrusion
Thyroglossal cyst
Fluctuant lump, transilluminates in the neck ?
Cystic hygroma
Management of suspected non accidental injury
Relieve pain + treat underlying medical conditions
** Skeletal survey
Inform local safeguarding
Refer to social services
Features of HSP
PAAN
Non blanching purpura+- arthralgia, abdominal pain, nephropathy= hematuria, proteinuria
Purpura - on buttocks and lower limb
Precipitated by URTI
All bloods - normal except raised ESR,IgA,creatinine
Osteogenesis imperfecta
- inheritance pattern
- features
- treatment
Autosomal dominant
- collagen metabolism disorder - brittle bone disease
Blue sclera , dental abnormalities , brittle bones
Multiple/explained fractures
Hearing loss 2ry to otosclerosis
Bisphosphonate
Management of acute asthma exacerbation children
Oxygen
Salbutamol
Ipratropium bromide
Corticosteroids -Oral pred or IV Hydrocortisone
If still exacerbating consider
- salbutamol IV, IV aminophylline, IV MgSo4
Laryngomalacia
Congenital abnormality larynx
Presents @ 4 weeks of age - stridor
Watery diarrhoea + weight loss + abdominal pain Foul smelling flatulence, bloating Dx? First line investigation Another investigation
Treatment
Giardiasis
1- stool microscopy for ova and parasite
2- stool ELISA/PCR
Metronidazole and hygiene
Diarrhoea followed by RUQ pain
Amoeba
Breath holding spells vs reflex anoxic seizures
BHS - turns blue and stops breathing
Mainly 6mo-2yrs , rapid recovery
Reflex anoxic - child stops breathing and turns pale
Upward eye deviation + jerky movements
NO tongue biting
Management is the same for both - reassurance , put child in recovery position
Treat iron deficiency and ferritin if present
5 week old baby
Prolonged jaundice with pale stool dark urine liver enlargement and low weight for age
Dx?
Investigation
Biliary atresia
- direct conjugated bilirubin
= surgery
8 week baby +prolonged jaundice, yellow stool, pale rune, liver enlargement
Low weight, difficult feeding and vomiting
Dx?
Galactosemia
Causes of prolonged jaundice (6)
Biliary atresia Congenital hypothyroidism Breast milk jaundice Galactosemia UTI Congenital infections - CMV toxoplasmosis
Congenital hypothyroidism
Features
Treatment
Jaundice, constipation, cold mottled dry skin , floppy,
Oral levothyroxine
Features biliary atresia
Biliary atresia - obstructive jaundice
= pale urine, dark stool , FTT , hepatomegaly
4-8 YO starts walking late
Waddling gait
Raised CK
DMD
Initial test for DMD
CK
Then
Muscle biopsy - if + —> genetic testing
Mutated dystrophin in striated muscle
Double bubble seen in
Duodenal atresia
Volvulus and malrotation
Sudden onset green bilious vomiting in neonate \+ blood per rectum \+ double bubble sign on Xray. Dx? Treatment
Malrotation and volvulus
ABCDE , NG decompression
Refer to paediatrics surgery for laparotomy and resection
Projectile non bilious vomiting approx 30 mins after feed in 3-8 week neonate
Palpable almond sized mass
Pyloric stenosis
Dx of pyloric stenosis
Abdominal ultrasound - thickened pylorus
Imbalance in pyloric stenosis
Metabolic alkalosis
Urgent step in pyloric stenosis
Serum potassium K+
Treatment pyloric stenosis
Correct dehydration and electrolytes
NGT
Ramstedt pyloromyotomy
Infant (6-18 mo) + crying + paroxysmal abdominal colic pain
+ bloodstained stool = red currant jelly (late sign)
+- sausage shaped mass RUQ
Dx?
Intussusception
Finding on abdominal US for intussusception
Target sign / doughnut sign
Treatment of intussusception
Mechanical reduction
1st line - air enema insufflation
2nd - reduction by barium enema
If failed - surgical reduction (laparotomy)
Painless bleeding per rectum in a male child 2-3 YO Dx? Investigations: Initial , definitive
Meckels diverticulum
Initial - radioisotope scan
Definitive - laparotomy
Treatment of meckels diverticulum
Surgical resection
Meckels rule of 2
2-3 YO
Mainly male
2 inches long
2 feet from ileocecal valve
Measles
Features
Fever, irritability Rash - face/neck —> body Koplik spots on buccal mucosa URTI NO cervical lymphadenopathy
*measles = rubeola
Management of measles
Supportive
Notifiable disease
Reassurance
Features of rubella
Low grade fever
Rash - maculopapular (face —> body) ; fades by 3-5th day
lymphadenopathy - suboccipital postauricular
Froschheimer’s spots - soft palate
Measles vs Rubella
Measles:
No lymphadenopathy
Spots on BUCCAL mucosa
Rubella:
Lymphadenopathy
Spots on soft palate
Roseola
Features
Sudden high temp
Non itchy rash chest or legs —> body
Erythema infectiousum
Features
Organism
Slapped cheek appearance
Parvovirus B19
Hand foot and mouth disease
Organism
Features
Management
Coxsackie virus
Painful ulcers on tongue + grey blisters on hand and feet
Mgmt
= supportive + reassurance
Test for suspected UTI in infants and children >3 months
Urine dipstick
If nitrite + leukocyte - negative - no further management
If + = start ABx, and send urine sample for culture
NICE - clean catch urine sample
11 referrals
- developmental milestones assessment
- No smile by 8 weeks
- No eye contact by 3 months
- Can’t hold object by 5 months
- Can’t reach for objects by 6 months
- cant transfer objects between hands by 9 mo
- cant sit unsupported by 12 months
- Cant walk by 18 months
- No single meaningful words by 18 months
- Only dada and mama by 24 months
- 2-3 word sentences by 2.5 years
At any point of time if a parent is concerned about their speech
Refer for hearing test
Tower of 3 age
18 months
Tower of 6 age
2 years
Tower of 8 with four bricks
2.5 years
Draw a line age
2 years
Draw circle age
3 years
Draws cross @ age
3.5
Draw square @
4 years
Draw triangle at
5 years
Most common organism affecting chest in cystic fibrosis
Staph aureus
2. Pseudomonas
Inguinal hernia vs femoral hernia
Inguinal - above + medial to pubic tubercle
Femoral - below + lateral to pubic tubercle
Risk factors of inguinal hernia
Male Heavy lifting Old age Chronic cough Previous abdominal surgery
Treatment of hernia
< 10
>10
<10 - herniotomy
>10 - herniorrhaphy
Obstructive sleep apnoea in children
Next step
Investigation of choice
Refer to ENT surgeons
Polysomnography
Rett’s syndrome
Normal development until 2-3 Y
Regression afterwards - motor social language coordinations
Willis ekbom syndrome
Investigations
= restless leg syndrome
Check iron
- low - give supplements
- normal - give dopamine agonist
Diagnosis of Kawasaki
Fever + at least 4 of : Conjunctival injection Bright red cracked lips Strawberry tongue Painless cervical lymphadenopathy Red palms soles - later desquamation Polymorphous rash
Mnemonic RASH
Conjunctivitis, rash , adenopathy, strawberry tongue , hand foot erythema, burning high fever
Complications of Kawasaki
Coronary artery aneurysm
Management of Kawasaki
High dose aspirin
IVIG
Initial screening test for coronary artery aneurysms
In Kawasaki
Echo
Why should aspirin use be avoided in children
Reye’s syndrome
- encephalitis + liver damage
Commonest organism causing scarlet fever
Group A strept pyogenes
Features of scarlet fever
Fever Sore throat - clincher Rash - sand paper like rash = trunk —>body ; no palms or soles Strawberry tongue Cervical LNS Tonsils w/ palate exudates
Management of scarlet fever
When can children return to school
Oral penicillin V 10 days
If allergic - azithromycin
24 hrs after start of ABX
Notifiable disease
Complications of scarlet fever
otitis media - most common
Rheumatic fever - typically 20 days after infection
Diagnostic imaging for malrotation and volvulus
Abdominal XR - double bubble
Barium enema
Diagnostic imaging for pyloric stenosis
Abdominal US
Diagnostic imaging for intussusception
Abdominal US
- target sign
Peripartum exposure to varicella
Management
Peripartum = 7 days before or after delivery
Give VZIG + isolation
If 8 or more days - observation, advise mum to continue caring for baby
Infectivity of chicken pox
4 days before rash appears
5 days after
When should VZIG be given (3)
Immunocompromised w/ exposure
Pregnant w/ exposure + no VZ antibodies
Newborns with peripartum exposure
When shoul acyclovir be given in chicken pox (2)
Immunocompromised w/ chicken pox
Pregnant w/ CP
Management of febrile seizure
<5 mins - antipyretics
>5 mins - benzodiazepine - buccal midazolam
Type of hearing loss in otitis media
CHL
Aminoglycoside ototoxicity hearing loss
SNHL
Congenital infections cause what type of hearing loss
SNHL
CMV
When should you worry about fever post vaccine
> 1 week of fever
TCA overdose features
Immediate action , tx
Dilated pupil ,dry mouth , dry flushed skin , tachycardia
Drowsiness, Hypotension urine retention , wide QRS
ECG monitor
- wide QRS , broad complex tachy
IV NS 250ml + sodium bicarbonate 50 mmol IV slow infusion 8.4%
Investigate what delayed milestones
No smile 8 weeks No eye contact 3 months No holding objects 5 months No reaching for object 6 months No transferring objects 9 months Not sitting unsupported 12 months No walking 18 months No meaningful s words 18 months Only mama dada @ 24 months No 2-3 word sentences 30 month/2.5 yrs No running by 2.5 yrs
Advice for SIDS
Avoid - prone sleeping , parental smoking, parental sedative use at child bedtime , soft bedding
No blanket higher than infants shoulder
No heavy wrapping of baby or head covering
Place baby with feet at foot of cot
Avoid bed sharing
Imbalance in severe asthma
Respiratory acidosis
Common organism causing bronchiolitis
RSV
Features of bronchiolitis
Coryzal + dry cough
Wheezing + fine inspirations crackles
Feeding difficulty
Most common cause of serious LRTI in <1YO
Peak incidence of bronchiolitis
3-6 months
LN >/= 2 cm
Steps to be taken
FBC and blood film
US
Causes of lymphadenopathy children
ALL, lymphoma
CMV, EBV, Kawasaki, TB
Pathological jaundice causes
Jaundice in 1st 24 hrs
- Rh or ABO incompatibility
- hereditary spherocytosis
- G6PD
Prolonged jaundice screening
Conjugated and unconjugated bilirubin
Coombs test
TFTs
FBC , blood film , U&E, LFTs
Child w/ UTI still feverish after start of ABx for 2 days
Next step
Urgent US or MCUG
If they respond well to ABx - US w/in 6 weeks
Preterm baby + continuous machinery murmur
PDA
Cyanosis baby with ejection systolic murmur
Tetralogy of Fallot
Ejection systolic murmur = pulmonary stenosis
Tetralogy of Fallot
A
Progressive severe cyanosis + poor feeding
Pan systolic murmur on LSB
Tricuspid atresia
Acyanotic pan systolic murmur
VSD
Cyanotic heart diseases
Truncus arteriosus TGA Tricuspid atresia TOF Total anomalous pulmonary venous return
Acyanotic CHD
ASD VSD PDA CoA
PDA common in
Preterm babies
May close spontaneously
Diagnosis of PDA
Echo
Treatment PDA
Indomethacin
- inhibits prostaglandin synthesis
When to refer for hearing test
Any parental concern Doctor concern Temporal bone fracture Bacterial meningitis Severe unconjugated hyperbilirubinemia Delayed speech and language milestones
Hearing test in <6 mo
Otoacoustic emissions or
Audiological brainstem response
6-18 mo hearing test
Distraction testing
2-4 years hearing test
Speech discrimination pr
Conditioned response audiometry
> 5 years hearing test
Pure tone audio gram
Treatment of croup
Dexa - oral
If severe - o2+ neb adrenaline
Treatment bronchiolitis
Supportive care
Sudden high fever + rash on chest or below
No rash on head/neck
Roseola
Child > 2 YO + bed wetting + daytime symptoms
Refer 2ry care or enuresis clinic
Investigation of cushings
- best initial test
- localise lesion
Initial - overnight dexa suppression 1mg
Localise - high dose dexa suppression 8mg
Interpreting dexa suppression test
Low dose:
Cortisol is low = normal
High/normal cortisol = cushings
High:
Low cortisol - Cushing disease —> pituitary MRI
High/normal cortisol + low ACTH - adrenal cushings —> adrenal CT
“” + high ACTH - ectopic ACTH —> CT chest abdomen
Cushings
Syndrome vs disease
Both = increased cortisol
Syndrome - adrenal adenomas, ACTH prod e.g lung ca- small cell lung ca steroid meds
Disease - pituitary tumour - raised ACTH —> adrenal hyperplasia
IV fluids for children that cant tolerate orally
Initial bolus - NS
Maintenance - NS + 5% dextrose
NS + kcl if associated hypokalemia
Di George syndrome
CATCH 22 Cleft palate Abnormal face Thymic aplasia Cardiac - TOF Hypocalcemia, hypoparathyroidism 22 - chromosomal abnormality on C22
Hypchloraemic Hypokalemic alkalosis
Pyloric stenosis
What is the risk in Ehler danlos syndrome
Subarachnoid hemorrhage
Deletion of some genes on chromosome 15
Prader willi
Most common congenital heart defect in Down’s syndrome
AVSD
Management of 2ry enuresis
Refer to paeds
Common cause of 2ry enuresis
Emotional upset
UTI , DM, constipation
Wilson’s disease
- inheritance pattern
- presentation
Autosomal recessive
Cu deposition liver
Hepatosplenomegaly , deranged LFT , Cirrhosis
CNS - Ataxia, dysarthria, dystonia
Behaviour — personality changes , declining school performance
Dx of Wilson’s
Initial - LFT + serum CU (very low <0.1)
Treatment Wilson’s
Lifelong penicillinamine
If acute liver failure - liver transplant
Alpha anti-trypsin deficiency
Presentation
Haemoptysis + cough + jaundice
Hemoptysis + hematuria
Goodpastures
Hematuria after bloody diarrhoea
HUS
Hematuria + SNHL
Alport syndrome = x linked
Macrophages with periodic acid-schiff granules
Whipples disease
+ve anti glial in antibodies
Coeliac disease
Peak incidence of nephrotic syndrome
2-5 years old
Minimal change 80%
Features of minimal change disease
Nephrotic syndrome Normal tension Selective proteinuria - only albumin and transferrin leak through Renal biopsy - definitive test = fusion of podocytes
Raised PTT + bleeding time
VWD
Raised PT PTT bleeding time
DIC
Normal PT
10-14 s
Normal PTT
35-45 s
Bleeding time
3-9 minutes
Treatment hemophilia A
Desmopressin
If major bleeding - recombinant factor 8
Treatment hemophilia B
Recombinant factor 9
What should NOT be given in treatment of hemophilia
NSAIDs
IM injections
Treatment congenital hypothyroidism
Oral levothyroxine until 2 years old
ECG - delta waves + wide QRS
Wolff Parkinson white syndrome
Bilateral ground glass appearance on neonate xray
RDS
RDS vs meconium aspiration
RDS - preterm <32 weeks
MA - post term >42 weeks
Increased risk of meconium aspiration in:
Hx of mat HTN Preeclampsia Chorioamnionitis Smoking Substance abuse
1st line in VUR management
ABx - low dose trimethoprim daily
If fails or parenchymal damage
= surgery
Dx of VUR
Imaging
Initial , gold std , parenchymal damage
Initial - Renal US + urinanalysis
Gold = MCUG
DMSA - cortical scars
Salt wasting in infant male
CAH
ITP treatment
IV immunoglobulins
Treatment HUS
IV fluids +- transfusion +- dialysis
If very severe - plasma exchange
NEVER gibe ABx
Echogenic bowel on pre-natal US
Cystic fibrosis
Necrotising enterocolitis
- main RF
- features
Prematurity
Increased risk when empirical ABx given to infants beyond 5 days
Vomiting - feeding intolerance, hypoactive, distended abdomen , bloody stools
Distended loops + air in bowel on XR
Dx?
Pneumatosis intestinalis Necrotising enterocolitis (NEC)
Treatment NEC
TPN + total gut rest
If perforated = laparotomy
Stop feeds + IV fluids + abdominal films +start systemic ABx
VACTERL
Vertebral anal cardiac trachesophageal, renal, limb defects
GORD presentation in children
< 1 yo Non projectile vomiting after feeds Gags, chokes after feeds Crying, difficult to feed FTT - severe GORD
Treatment of GORD paediatrics
Assess breastfeeding, increased frequency and decreased amount
Gaviscon - try this 1st
Then PPI H2
APGAR
Appearance
0 - blue/pale 1- acrocyanosis (blue extremities pink body) 2- pink all over
Pulse
0-absent 1- <100 2- >100
Grimace
0- no response 1- grimace on aggressive stimulation/suction 2- cry cough sneeze on stimulation
Activity
0- floppy 1- some limb flexion 2- active
Respiration
0- absent 1- weak irregular gasping 2- strong robust cry
0-3 = very low score
4-6 moderate low
7-10 = good state
Breast milk jaundice
Features
Management
Starts in 2nd week of life
Increased Unconjugated bilirubin
Infants are well
Advise mother to continue breastfeeding - disappears in 6 weeks
p-ANCA +ve + intermittent bloody diarrhoea + weight loss + abdominal pain
Ulcerative colitis
P anca - specific in Churg Strauss but can be + in UC
Innocent Murmur
Children 3-8 YO
Due to turbulent blood flow at the outflow tract of the heart
More evident in fever and in supine position
Benign/ physiologic
Cow milk allergy
- acute
- delayed
Acute - igE mediated
So assess cow milk protein allergy - skin prick test / blood test
Delayed -
Non igE mediated
Change to hypoallergenic formula
Commonest cause of early-onset neonatal infection
Streptococcus agalactiae (GBS)
Investigation of pyloric stenosis
Abdominal ultrasound
Recommended dose for children above 1 YO
VIT D
400 IU = 10 mcg per DAY
Bimodal age presentation Hodgkin’s lymphoma
<25 YO or >55 YO
Organism causing HFMD
Coxsackie A16 and enterovirus 71
Infantile spasm / west syndrome
Features
1st 4-8 months of life
M>F
Flexion of head trunks and arms —> extension of arms
Progressive mental handicap
Investigation west syndrome
EEG - hypsarrythmia
CT - diffuse/localised brain disease e.g tuberous sclerosis
Management of infantile spasms
1- vigabatrin
ACTH
Poor prognosis
Imaging in child with UTI
<6mo
- responds to treatment
- atypical/recurrent UTI
- responds to Tx = UD in 6 weeks Atypical or recurrent = US in acute infection DMSA 4-6 mo after infection MCUG
Imaging in child with UTI
>6mo - <3yrs
- responds to treatment
- atypical/recurrent UTI
RTT - nothing
Atypical - US now , DMSA after 4-6 months
Recurrent - US in 6 weeks, DMA “^”
Imaging in child with UTI
>3 yrs
- responds to treatment
- atypical/recurrent UTI
RTT - no imaging
Atypical - only US now
Recurrent - US in 6 weeks, DMSA 4-6 months
Diagnostic criteria - whooping cough
Acute cough <14 days w/o apparent cause + 1 or more :
- paroxysmal cough
- Inspiration whoop
- Post tussive vomiting , central cyanosis
- undiagnosed apnoea can attacks - young infants
Dx of whooping cough
Nasal swab culture of bordetella pertussis
Management whooping cough
< 6 months old - admit , notifiable disease
Oral macrolides - clarithromycin , azithromycin, erythromycin if onset of cough is within the last 21 days
Prophylaxis for household contacts
School - 48 hrs after starting ABx or 21 days from onset if no ABx given
Complications of whooping cough
Subconjuctival hemorrhage
Pneumonia
Bronchiectasis
Seizures
When is pertussis vaccine offered to pregnant women
20-32 weeks
Influenza + DPT vaccine
Umbilical granuloma management
Signs of infection - fusiliers acid
No signs - table salt 1st line , silver nitrate 2nd line
Subclassifications of osteomyelitis
Haematogenous
= bacteriuria - monomicrobial - children commonly
Most common = vertebral osteomyelitis
Non haematogenous
Spread from soft tissue to bone - poly microbial - adults -
RF- diabetic foot/pressure sores, PAD
Staph aureus except SCA = salmonella
Investigations osteomyelitis
MRI
Management osteomyelitis
Flucloxacillin 6 weeks
Clindamycin - penicillin allergic
IV fluid resuscitation - paeds
Mod - severe dehydration = IV NS bolus over <10 mins
- term neonate = 10-20 ml/kg
- children + young people = 20 ml per kg
- small vol of fluid in underlying cardiac and renal problems
When does lymphadenopathy require urgent referral (paeds)
Firm and non tender
Hard
Progressively enlarging
>2cm
2 types of flat head syndrome
Plagiocephaly - flattened on 1 side (asymmetrical)
Brachycephaly - back of head becomes flattened
Dysgraphia
Deficiency in the ability to write
What team do you refer a child with writing difficulty
Educational psychologist
Management of ITP
Prednisolone
IV immunoglobulins
Admit to paediatric ward
Platelet transfusion if life threatening bleed
Management ophthalmia neonatorum
Reassure or
Refer 2ry care if purulent discharge + swelling of lid or injected conjunctiva
Chlamydia - erythromycin orally
Gonorrhoea - ceftriaxone IV
Important cause of seizure in afebrile child
Hypoglycemia
