Paediatrics Flashcards
What does scaphoid abdomen in a newborn suggest?
Congenital diaphragmatic hernia
Also presents with dyspnoea and tachypnoea at birth due to hypoplasia of the lungs
What would be the more accurate way to describe ‘growing pains’ in a child?
Benign, idiopathic, nocturnal limb pains of childhood
- No concerning features (benign)
- Idiopathic
- Never present at the start of the day, often wake child up from sleep
- Worse after a day of exercise
- No limp or functional limitation
Triad of shaken baby syndrome
- Retinal haemorrhages
- Subdural haematoma (bridging veins ruptured)
- Encephalopathy
Management of umbilical hernias?
Usually self-resolve
If large/symptomatic ⇒ elective repair at 2-3yrs
If small/asymptomatic ⇒ elective repair at 4-5yrs
Differentiating between infantile spasms and infantile colic?
Infantile spasms = child will become distressed BETWEEN spasms (i.e. child crying, then draws chin into chest and throws arms out and stops crying, then repeats) ⇒ EEG for West’s syndrome
Infantile colic = child will become distressed DURING spasms
Rapid onset fever + stridor + drooling ⇒ ?
Acute epiglottitis
Other features:
- very uncomfortable, scared child
- tripodding
Compare neonatal respiratory distress syndrome (NRDS) and transient tachypnoea of the newborn (TTN) with respect to the following:
- biggest risk factor
- prognosis over a few days
- CXR features
NRDS = prematurity (NRDS = surfactant deficient lung disease, SDLD, so affects premature babies whose mothers don't have steroids antenatally) TTN = C-section
NRDS = worsens over the first few days of life TTN = resolves quickly
NRDS = ground glass lungs, low volume, bell-shaped thorax TTN = heart failure pattern (ABCDE)
Triad of symptoms in nephrotic disease
- Proteinura
- Hypoalbuminaemia
- Oedema
80% of paediatric cases are caused by minimal change disease, and 90% respond well to high-dose steroids
Invasive skin infection following chicken pox. Most likely causative organism?
S.pyogenes (GAS)
2nd most likely is S.aureus
Signs of a life-threatening attack in a child?
- Sats <92%
- PEF <33%
- Silent chest
- Poor respiratory effort (tiring child)
- Agitation
- Altered consciousness
- Cyanosis
Hypospadias referral?
Within 12m of life
How would cystic fibrosis present in a heel prick test?
Positive immunoreactive trypsinogen
What are the four features in tetralogy of Fallot?
- Right ventricular hypertrophy
- Overriding aorta
- Pulmonary stenosis
- Ventricular septal defect
Describe the asthma pathway for children aged 5-16
- SABA
- SABA + ICS
- SABA + ICS + LTRA
- SABA + ICS + LABA (replace the LTRA)
- SABA + low-dose* MART
- SABA + moderate-dose* MART
- SABA + high-dose* MART/ICS OR + theophylline
*the dose in MART refers to the dose of ICS within the MART (i.e. low-dose MART = low-dose ICS)
MART = combined ICS + LABA
Describe asthma pathway for children <5yrs
- SABA
- SABA + moderate-dose ICS (for 8w, then stop and reassess)
2a. If sx did not resolve during trial period ⇒ not asthma
2b. If sx resolved, but reoccured within 4w of stopping ⇒ continue ICS at low-dose
2c. If sx resolved, but reoccured after 4w of stopping ⇒ repeat step 2 (8 week trial) - SABA + ICS + LTRA
- Stop LTRA + refer to specialist
Treatment for bacterial meningitis in a <3month old?
IV cefotaxime + IV amoxicillin
Amoxicillin to cover Listeria infection
>3months is just IV cefotaxime (or ceftriaxone)
Characteristic features of congenital rubella?
- Sensorineural deafness
- Congenital cataracts
- CHD (e.g. PDA)
- Glaucoma
Characteristic features of congenital toxoplasmosis?
- Cerebral calcification
- Chorioretinitis
- Hydrocephalus
Characteristic features of congenital cytomegalovirus?
- LBW
- Purpuric skin lesions
- Sensorineural deafness
- Microcephaly
Causative organism for scarlet fever?
Group A strep (e.g. S.pyogenes)
Criteria for consideration of hospital admission in a child with bronchiolitis
- RR >60, or respiratory distress
- 25-50% reduction in usual oral intake
- Clinical dehydration
- Apnoea (observed or reported)
Cyanotic heart defects + their memory aids
- Truncus arteriosus (1 vessel)
- Transposition of the great arteries (2 vessels swapped)
- Tricuspid atresia (3 valves)
- Tetralogy of Fallot (4 defects)
Management of TGA
- Prostaglandin E1 to maintain ductus arteriosus
2. Surgical correction
Indication for admission in croup
Stridor at rest
Memory aid for differentiating between ASD and VSD murmurs
ASD = A Split Double = fixed split S2 VSD = Very Systolic = pan
ASD split S2 is due to ↑ venous return overloading the RV during inspiration ⇒ delaying closure of pulmonary valve
Causes of neonatal hypotonia
- Neonatal sepsis
- Werdnig-Hoffman disease (spinal muscular atrophy T1)
- Hypothyroidism
- Prader-Willi
Differentiating between necrotising enterocolitis and intussusception
NEC = newborn, bilious vomiting and bloody diarrhoea Intussusception = 5-12m, bloody diarrhoea
Treatment for necrotising enterocolitis?
IV cefotaxime + vancomycin
