Paediatrics Flashcards
Nocturnal Enuresis PE 0170
P enuresis
P enuresis with daytime symptomes
S enuresis (search cause) - Refer to Pediatrician
1) Primary enuresis = NIGHT bedwetting only! -
<5 years: reassure -
> 5 years and bedwetting less than twice/week= reassure
- *NB if mother wants a short term ttt (child going to sleepover at his friend’s house for ex) = desmopressin
- If long term ttt= Alarm then reward
1) Primary enuresis with daytime symptoms
a child thats bedwet at day time REGARDLESS of age
Referred to an ENURESIS clinic or SECONDARY care.
DAY TIME: 1. bladder retraining 2. oxybutynin 3. oral/SL desmopressin
NIGHT TIME: 1. enuresis alarm 2. reward system
2)Secondary Enuresis: - A child that has been dry for at least 6 months and now consistently bedwet at night -
1) EMOTIONAL UPSET ( child abuse)
2) 2ry to infection and diabetes.
**Urine/ Glucose test
Culture for infection —>
if -ve= refer to pediatrician!
Bronchiolitis or Pneumonia in UK 4 week old with bilateral basal crepitation and T 38.4 and Tachypnoea ?
T>39, FOCAL crackles- PNEUMONIA
otherwise the most common in this age group is BRONCHIOLITIS
babies and children under 2 years of age and
most commonly in the first year of life, peaking between 3 and 6 months.
- Bronchiolitis is more commonly seen in healthy children born at term whereas pneumonia is more common in children with some underlying disease, preterm birth or a history of preceding viral infection.
- Pneumonia will usually present with more than 39 while bronchiolitis has fever less than 39.
- Pneumonia commonly has focal findings on auscultation while bronchiolitis will have more widespread findings.
Diarrhoea Differentials
travel + wt loss(in chronic case)+ watery D. + long duration + abd distention = giardia travel
Tx - rehydration plus metronidazole
watery D. + short duration + abd. crump = E. coli
bloody diarrhea = campylobacter jujeni / Salmonella and Shigella
bloody diarrhea after long term Antibiotics = clostridium difficile ( pseudomembarenous colitis)
bloody diarrhea: Campylobacter Jejuni
Traveler’s Diarrhea: E.Coli
Diarrhea in paeds: Viral (Rota Virus)
Diarrhea(GIT Infection) + weakness+ Areflexia : Guillian-Barre Syndrom
Diarrhea followed by RUQ pain: Amoeba Watery
Diarrhea after camping or long travels in Europe: Giardia Diarrhea
D after long-term antibiotics: Clostridium Difficle
Diarrhea after eating raw eggs or chicken: Salmonella
Diarrhea just hour after a meal: Staph Toxin
Diarrhea in bed ridden pt (e.g handicapped) + stony hard stools : Fecal impaction
Cough ddx
Epiglotitis….
Stridor + drooling of saliva n fever … (thumb sign L.Xray)
CALL anasthetist / Intubation of ET tube and Antibiotics
Bronchiolitis…. (Most common in children UK >pneumonia )
Cough fever +sob+ expiratory wheeze + bilat basal crep
humidified oxygen
Croup…
Barking cough+stridor…. (steeple sign)
oral dexamethasone
Pertussis.
Episodic severe cough+ fever n cyanosis….
Clarithromycin or Azithromycin
Scarlet fever
Sore throat/cough,fever n RASH …
.Antibiotics
Child fall while playing / with Subconjunctival Hemorrhage / You are FY2 DR/ X ray head or CT
X ray for confirmation and CT for diagnosis (as you are FY2 dr you can request Xray)
subconjuntival hemorrhage is the bleeding within the eye,
whereas racoon eyes/panda eyes/ periorbital ecchymosis is the accumulation of blood (that seeps down from the skull fracture) within the periorbital soft tissue.
so CT needed in case of racoon eyes and not for subconjuntival hemorrhage.
Scarlett Fever (2-8 yr / Fever / rash / sore throat / )
Caused by ( GAStrep or Streptococcal Pyrogens ) not Stap.A
(S)carlet fever: 7S; - Streptococcus pyogen - Sore throat with pale exudate - Strawberry tongue - Sandpaper RASH on the (TRUNK) - Spare sole and palm rash - around Six yr age (2-8 yr) -
Rx: Penici[S]lline V
Best consideration for Vesico-Ureteric reflux PE 4050
Ab Prophylaxis should be considered prior to Considering surgery (low reflux )
UV reflex does not cause renal scaring
UTI causes renal scarring and damages the most at early weeks of age
only surgical correction in two cases»»
1) breakthrough UTI infection despite prophylactic antibiotics
2) persistent high grade VUR (4 or 5 ) with renal scaring
Surgery correction is generally reserved for Hight grade reflux
Umbilical Granuloma
Umbilical granuloma -
a red bump on baby’s navel after the cord falls off & dried -
it’s usually harmless unless infected
1st line : Table Salt (Simple & effective)
salt draws water out of the wet granuloma resulting in necrosis and shrink
2nd Line : Silver Nitrate (no improvement with Na 1 wk )
If pus seen + fever etc - Apply Fusidic Acid
Lymphangioma (cystic hygroma) / Brachial cyst / Thyroglossal cyst
Lymphangioma : antero-Lateral to sternocleidomastoid muscle, Light translucence positive , Lymph present (soft and compressible), Age < 2 years(90%) Rule of L's.
Branchial cyst: Antero-medial to sternocleidomastoid muscle, Hemorrhagic fluid present , Non-compressible, Non-translucent , Age=Early adulthood.
Non accidental injury Ddx
admit > analgesia > treat urgent medical condition > registered protection officer> social services
Non blenching Bursing Ddx HS purpura Haemophilia ITP Leukemia
Fracture Ddx
Osteogenesis imperfecta - BLUE SCLERA , dental abn , brittle bones (Auto Dominant )
UTI in child Spiceman collection (clean catch / catheter / suprapubic aspiration)
1) Dip stick analysis of urine (+Nitrate and ±Leukocytes )
2) Urine Microscopy
3) Urine Culture
Malrotation and Volvulus- (neonate ) volve= rotate (twist in the intesting surrounding the mesentry )
(child - midgut / surgery need / adult - caecum and sigmoid / rerotate with colonoscope)
Sudden billious vomiting +
blood per rectum +
double bubble in X ray
Hirschsprung-----or congenital/toxic megacolon... (No peristalsis / nerve plexus or ganglion in colon (esp descending ) doesn't develop / resulting continuous contraction and constipation ) may lead to sigmoid volvulus abdominal distension + failure to pass meconium + repeated vomiting
Cystic Fibrosis----- meconium ileus+ ( most children with thick meconium in ileus have cystic fibrosis) failure to thrive + Bilious vomiting Echogenic USG on perinatal USG
Duodenal Atresia- vomiting large amt bilious or non bilious, (right after birth / pass stool 2 times/ then no bowel movement ) abdominal distension , no passage stool, jaundice + double bubble sign
Necrotising Enterocolitis--- (most common GI infection in premature babies) premature or low weight bith+ bloody stools+ abdominal distension+ bilious vomiting.
Vitamin D take or not take
Babies having 500ml or > Formula Milk / DO NOT NEED VITAMIN D
All adults including babies need to take Vit D 400IU / 10mcg per day (also Caucasians )
Fever with Rash (Measles / Scarlet Fever / Rubella / Erythema Infectiosum) PE 0330
Measles(Rubeola) -
macules and patches / on face / neck and shoulders /
Koplik spots /
no cervical lymphadenopathy
Scarlet Fever -
sorethroat / strawberry tongue / sandpaper rash /
tender cervical lymphadenopathy
Rubella(German Measles) -
Pink macules and papules /
on forehead then to face/ trunk / extremities on 1st day/
Fades on face on first day and the rest of the body by third day
Cervical lymphadenopathy
Erythema infectiosum (Parvovirus B19)- Slapped Cheek appearence
Measles / Scarlet fever / Rubella
Measles - Koplic spots on Buccal mucosa / No cerval Lnodes
Rubella - Forshheimer spots on Soft palate / Cervial Lnodes
Scarlet fever - Sorethroat /
Neonatal Jaundice(24 hr or 2 to 14 days) / Prolong Jaundice (>14 days )
Pathological within the first 24 hours
Start form 2-14 common (40%) and PATHOLOGICAL
Seen in Breast Fed Babies
A child with 2cm lymph node and growing in size over 6 wk/ Immobile and non tender
No fever , wt loss , tiredness , signs of infection / Most app investigation
CP / USG / Infection screen
Full blood count and Blood Film for leukemia and lymphoma
Hodgkin lymphomas in 75 % of cases have no B symptoms (loss of wt, night sweat and fever)….they will present with enlarged cervical LN and be asymptomatic otherwise
ALL is the most common leukemia in peads.
AML is more of acute sympt. Like Gum bleeding.
- If lymph nodes after infection (reactive lymphadenopathy) -> reassure
- If >2cm or progressively enlarging Firm/ nontender/ hard
With fever/ weight loss/ night sweats Refer urgently.
1st test is FBC: if normal then ALL unlikely,
perform Excision biopsy to rule out lymphoma If FBC abnormal then do peripheral smear to look for blast cells.
Woff- Parkinson-White Syndrome
Wolf = DOg delta waves
breathless and palpitation following exercise followed by rapid recovery
inv - ecg,24 hours ecg holter
ecg- delta P wave, Pre-exitation pattern,
short PR, prolong QRS
rx- catheter ablation medication- flecainide, propafenon
AV-node pathway blockers:–
1) b-blockers, 2)ca-blockers(verapamil,diltiazem), 3)adenosine.
Accessory pathway(AP) (Kenth pathway in WPW$) blockers:-
1) Procainamide, propafenone,flecainide
2) amiodarone &sotalol
Respiratory Distress Syndrome in Infants
More common in < 32 weeks gestation
CXR - Ground Glass appearance
Premature infants / CS deli / Maternal DM / MAS
Tx - Endotracheal Surfactant Replacement
Intermittent PPventilation
MAS (Meconium Aspiration Syndrome )
More common in Gestation > 42 weeks / Maternal HT / Oligohydramnios
Meconium - stained Amniotic Fluid
Cxr - aspiration pneumonitis
Tx - Airway SUCTION
O2 / Fluid and electrolyte Balance
UTI not responding to antibiotics after C and sensitivity
DMSA (done only in small babies and 4-6 weeks after UTI resolve and clear)
MCUG(can be done during UTI for recurrent and atypical UTI)
If child responds to treatment to UTI within 48 hours,
Ultrasound is arranged in 6 weeks .
If child doesn’t respond well within 48h,
then MCUG to detect VUR.
IF VUR presents then DMSA in 4-6 months to assess renal scarring.
6-month baby DMSA to search for renal scarring
6-3 years consider DMSA in atypical and recurrent UTI
>3 year not DMSA
Mituration Cystourethrogram - 6-3yr old child UTI no improvement 48 hr after Antibiotics
in atypical and recurrent UTI
Neonatal Jaundice ddx
Prolonge jaundice: >14 days Unconjugated>Child is well> Breast Milk Jaundice
Unconjugated>started at day 1> child well> Gilbert
> failure to thrive>HepatoSpleenoMegaly > Galactosemia
Conjugated>No fever>Biliary atresia/Torch
Conjuagated> protruded tongue> Hypothyroidism
Pyloric Stenosis Vs GERD
PS- non bilious vomiting AFTER BIRTH
Constant Hunger and Weight LOSS
GERD - recurrent vomiting and cries shortly after FEEDS
REFUSAL of feed / growing well and normal weight
- Rx Gaviscon (antacid with coating and last 24hr)
Necrotizing Enterocolitis (CL0080) (Intestinal Barrier Dysfunction ↓ IgA) Premature Birth(weak Blood supply) and Formula Feeding(weak immunity)
The smaller and earlier the baby, the higher the risk for NEC.
not enough blood and oxygen reach your baby’s immature intestinal tissues
Dx
Bell staging (Radiological Signs )
Stage 1 - ileus / dilatation
Stage 2 - pneumatosis intestinalis (air in intestine) / Portal Venous Gas (Met Acidosis)
Stage 3 - pneumoperitoneum (Met Acidosis )
Tx
Stopping enteral feedings,
performing nasogastric decompression, and
broad-spectrum antibiotics - Pen /. Genta / Metro
Pneumoperitoneum - Surgery
painless rectal bleed in Meckel’s Divertaculum
painful bleed in Intussusception and Volvulus
intramural air in Necrotizing enterocolitis
non bilious projectile vomiting in Pyloric stenosis
Galactosaemia
Galactosaemia
term infant gets an E. coli sepsis and when a neonate develops cataracts. It should also be considered with neonatal jaundice and haemorrhage.
Inability to metabolize galactose( a sugar in milk)
Accumulation In brain
Eye –Cataract
Kidney —Kidney damage
Liver… Liver damage..
No conjugation.. Unconjugated bilirubinememia..
Stool yellow and no change in urine
Hypothyroidism
impairs bilirubin conjugation, slows gut motility and impairs feeding leading to hyperbilirubinemia.
Dehydration Mild -decrease urine output 5% -plus dry mucus membrane 10% -plus sunken fontanelle >10% -plus shock (CRT>3sec, rapid thready pulse, ↓ Skin turgor, tachycardia & tachypnea (60,50,40rule), cold peripheries )
Rx -
if only just dehydrated & can tolerate oral feeds > ORS
if in shock -> Give IV bolus dose of 0.9% NS @ rate of
100ml/kg for first 10kg
50ml/kg for next 10kg
20ml/kg for anything after 20kg total
For maintenance –> 0.9%NS + 5% Dextrose
PM 5000 7 day baby initial birth weight 3.5kg now 3.3kg / What to do next
Reassure / Continue Child Care
5-10% wieght loss in first days after delivery… Is normal
14 days to gain weight more than birth weight.
Rash in Children and When to return to School PE 0230
Cannot Return to School (S.I.C.K Miss Ruby )
Scarlet Fever
away form school until 24 hr after staring Abiotics
Impetigo
away form school until 48 hr after starting Ab or Lesions are Crusted or Healed
Chicken pox
Until VESICLES have Crusted or Healed
5 days after onset of rash
keep away form pregnant women also
Measles / Rubella
4 days after onset of rash
Can return to School (Her simple Molly Rosey is Partying )
Rosella
Parvo virus B19 or Slapped Cheek or the fifth disease or Erythema infentiosum (once rash has developed / self limiting / symptomatic tx)
Molluscum contagiosum
Herpes Simplex (cold sores )
Chicken pox–fluid filled blisters (centripetal distribution)
Rubella :white spots on soft palate plus Swollen lymph nodes
Measles: koblic spots on buccal mucosa
Roseola: sudden onset fever plus chest rash
Parvo: slap shaped distribution sparing nasolabial folds
Nephrotic Syndrome
7 year old kid with 2 day leg odema / no other problems
2-3 months of Corticosteroids reduced Sodium intake and
if SEVERE - – Fluid restriction and use of Furosemide.
Steroid dependent Nephrotic – IV Cyclophosphamide
PROteinuria >3g per 24 hr , HYPOalbuminemia < 30g per liter: NephROtic syndrome
proteinuria <3 , hematuria : NephRItic syndrome
Cow Milk Allergy
If CMA is suspected and reaction is Acute - IgE mediated
If CMA is suspected and reaction is Delayed - (Reflux , Loose Stool , Growth ↓) - Non IgE mediated
IgE Mediated cow’s milk protein allergy–
Acute —–skin prick/blood test [for acute, condition —
INVASIVE INVESTIGATION is ACCEPTED
NON IgE Mediated —
Not acute presentation —–so stopping cow’s milk and
substituting with hypoallergenic
{HYDROLYSED FORMULA } FOR 2 WEEKS CAN BE TRIED ,
IF NO IMPROVEMENT—-Amino acid formuls can be tried
