Paediatrics Flashcards
Transient Synovitis Management
Afebrile and symptoms for less than 72 hours = Analgesia and rest
Febrile = urgent assessment
What are salmon patches?
Vascular flat patches on the eyelids and neck that usually fade
At 3 months what would you expect of a child in terms of speech and development?
Turns to sounds and quietens to their name.
At 6 months what would you expect of a child in terms of speech and development?
Double syllable sounds
At 9 months what would you expect of a child in terms of speech and development?
Mamma Dadda
Understands No
At 12 months what would you expect of a child in terms of speech and development?
Responds to their name
At 12-15 months what would you expect of a child in terms of speech and development?
2-6 words
simple commands
At 2 years what would you expect of a child in terms of speech and development?
Combine two words
Points to body parts
At 2.5 years what would you expect of a child in terms of speech and development?
200 word vocabulary
At 3 years what would you expect of a child in terms of speech and development?
Short Sentences
Colours
Counts to ten
At 4 years what would you expect of a child in terms of speech and development?
Asks Why Who When
What is the Antibiotic of choice in Whooping cough
Azithromycin or Clarithromycin
Signs of Whooping cough
Inspiratory Whoop
Vomiting or Cyanotic spells after coughing
Coughing worse after eating
Subconjuctival Haemorrhage
Who is the Whooping cough vaccine offered to?
Pregnant women from 16 weeks
Young children
Gross Motor Milestones - At 3 months what would be expected?
No or little headlag
If held sitting lumbar lordosis
Gross Motor Milestones - At 6 months what would be expected?
Pulls to sitting
Rolls from front to back
Held sitting back is straight
Gross Motor Milestones - At 7-8 months what would be expected?
Sits without support
At what age would you refer a child who cant sit without support?
12 months
Gross Motor Milestones - At 9 months what would be expected?
Pulls to standing
Crawls
Gross Motor Milestones - At 12 months what would be expected?
Cruises
Gross Motor Milestones - At 13-15 months what would be expected?
Walks unsupported
At what age would you refer a child who cant walk unaided?
18 months
Gross Motor Milestones - At 18 months what would be expected?
Squats to pick things up
Gross Motor Milestones - At 2 years what would be expected?
Runs
Uses stair railing on stairs
Gross Motor Milestones - At 3 years what would be expected?
Using tricycle with pedals
Uses stairs unaided
Gross Motor Milestones - At 4 years what would be expected?
Hops on one leg
Is bottom shuffling a normal variant?
Yes
How is Necrotising Enterocolitis managed?
IV antibiotics + fluids
Bowel Rest and TPN
If rupture - Laparotomy
When is a six week USS of the hips required?
developmental dysplasia
Breach Presentation at 36 weeks
Breach Presentation at delivery
Twins
First degree relative with developmental dysplasia
What are the investigations in Hirschprungs Disease?
Abdominal Xray
Rectal Biopsy - Gold Standard
What is the management of Hirschprungs Disease?
Bowel Irrigation -> Surgical Anorectal Pull through is curative
Causes of Neonatal Hypotonia
Sepsis
Hypothyroidism
Prader Willi
Spinal Muscle Atrophy Type 1
What are some causes of Neonatal Hypotonia?
Sepsis
Hypothyroidism
Prader-Willi
Spinal Muscular Atrophy Type 1
High Fever followed by a maculopapular rash between 6 months and two years old?
Roseola Infantum - Herpes Virus 6
What is screened for in the heel prick test ?
Cystic fibrosis (CF) Congenital hypothyroidism (CHT) Phenylketonuria (PKU) Classical galactosaemia (C Gal) Glutaric aciduria type 1 (GA1) MCADD (medium-chain acyl-CoA dehydrogenase deficiency) Homocystinuria (HCU) Maple syrup urine disease (MSUD)
If a heel prick comes back positive for elevated immunoreactive trypsinogen what should be undertaken next?
Sweat Test for CF
When is the heel prick test done?
Day 5
Hand Foot and Mouth - Causative organism
Coxsackie or less likely Enterovirus
Hand Foot and Mouth - Symptoms
Mild systemic upset
Oral Ulcers
Vesicles on palms or soles
Hand Foot and Mouth - Management
Symptomatic only
No school exclusion
Williams Syndrome
Chromosome 7 Elfish Features Happy Disposition Short Stature Aortic Stenosis
Williams Syndrome Diagnosis
FISH Studies
Criteria for admitting a child with Bronchiolitis.
Apnoea Respiratory Distress RR >70 Central Cyanosis <92% oxgen
What is the first line management of neonatal hypoxic ischaemic brain injury?
Therapeutic cooling
Presentation of Measles
High fever >40 degrees
Kopliks spots - grey spots on the mucosa of the mouth
Conjunctivitis then later a rash - usually 2-5 days after
Management of measles
Supportive
Vitamin A in all children below 2 years old
exclude 4 days from onset of rash
What are common complications of Measles?
Acute otitis media
Bronchopneumonia
Encephalitis
A neonate has rapidly deteriorated after delivery. It is noted that the amniotic fluid was brown stained. What is the likely culprit?
Meconium aspiration is likely to cause a Pneumothorax.
What is the first line management of neonatal sepsis?
IV Benzylpenicillin
Commonest organisms in Neonatal Sepsis
Group B Streptococci
E.Coli
Maintenance Fluids in paediatrics.
100ml/kg/day for first 10kg
50ml/kg/day for second 10kg
20ml/kg/day for every kg over 20.
Scarlet Fever - presentation
fever myalgia strawberry tongue sand paper rash tonsilitis
Scarlet Fever - cause
Group A strep
Strep. Pyogenes
Scarlet Fever - complications
Otitis Media
Rheumatic Fever
Glomerulonephritis
Scarlet Fever management
Oral Penicillin or azithromycin if pen allergic - 10 days
Return to school for 24 hours of Antibiotics
Describe a ceaphalohaematoma
Bruising
Doesn’t cross suture lines
Describe a Caput Succedaneum
Localised oedema due to vents cup use
Crosses suture lines
resolves in 3-6 weeks
Kawasaki Presentation
High fever resistant to antipyrexics Conjunctival Injection Bright red cracked lips Cervical Lymphadenopathy Strawberry tongue Desquamation of palms and soles
Kawasaki - Management
Clinical diagnosis requiring 4 symptoms
High dose aspirin
IV immunoglobulin in severe cases
Echocardiogram of coronary arteries
What is a major complication associated with Kawasaki disease?
Coronary Artery Aneurysm
Microcephally Small eyes Cleft lip Polydactyly Scalp Lesions Dead within months
Pataus
Trisomy 13
Micrognathia - small jaw
Low set ears
Rocker bottom feet
Overlapping fingers
Edwards
Trisomy 18
Learning difficulties Macrocephaly Long face Large ears Macro orchidism
Fragile X syndrome
Webbed neck
Pectus excavatum
Short
Pulmonary Stenosis
Noonan syndrome
Webbed neck is usually what?
Turners - females
Noonan syndrome - both genders
Micrognathia - small jaw
Posterior displaced tongue
Cleft palate
Pierre - Robin
Hypotonia
Hypogonadism
Obesity
Prader Willi syndrome
Hypertelorism - increased distance between eyes Microcephaly Small jaw Learning difficulties Larynx issues abnormal crying
Cri Du Chat
present from birth
Dark red
Port wine stain
Asthmatic guideline under 5 years old
SABA
SABA + Moderate Dose ICS for 8 weeks - reassess if helped good if not rethink
SABA + Low dose ICS
SABA + ICS + Leukotriene Receptor Antagonist
Refer
Asthmatic guidelines over 5 years old
SABA ICS + SABA ICS + Leukotriene Receptor Antagonist + SABA ICS + LABA + SABA ICS/LABA combined + SABA
Short, friendly disposition, aortic stenosis
William syndrome
What are the five causes of rashes in children?
Roseola Infantum Measles Parvovirus Scarlet fever Rubella
Mild fever with a sore throat and lymphadenopathy
Rash starts on the face but spreads to the rest of the body
Rubella
Erythematous rash starts behind the ear and spreads.
Measles
Precocious Puberty
<8 in girls
<9 in boys
Neonatal Resus
Dry and warm Assess APGAR Poor resperitory effort or none at all -> 5 ventilation breath Reassess HR <60 -> 5:1 compression to inspiration
When would you admit a child for bronchiolitis ?
Apnoea
Persistent O2 sats <92
<50% oral intake
Persistent severe reparatory distress
When would you refer a newborn to the neonatal ward?
RR >60 Respiratory Distress bpm -<100 or >160 Capillary refill >3 seconds >38 degress or 37.5 on two separate occasions O2 sats <95 Central cyanosis
Stridor
Barking cough
Fever
Croup
Croup causative organism and management
Parainfluenza
Oral Steroids
Nebulised Adrenaline and O2 if acutely unwell
In a child with difficult to control epilepsy. What diet can be trialled?
Ketogenic
Neonate born via C section present with respiratory distress.
Chest Xray shows fluid in horizontal fissure and hyper expanded lungs
Transient Tachyopnoea of the New born
Supportive treatment only
Oxygen may be required in poor saturations (humidified)
A child presents with a new onset purpuric rash. What is your management?
regardless of symptoms they should be immediately referred (same day) to rule out Menigococcal infection or ALL.
Inverted and plantar flexed foot that cant be passively corrected.
Club foot - manage with serial casting - ponseti method
Sudden onset bilious vomiting abdominal pain tachyopnoae and tachycardia in previously well child. Normal abdominal exam except tenderness
Intestinal malrotation - usually duodenum is obstructed
Upper GI contrast study and USS used
Ladds procedure is management
Signs of a shaken baby
Retinal haemorrhage, encephalopathy, subdural haematoma
Describe the management of a unilateral undescended testicle.
Should have descended by 3 months ->referral to be seen by surgeon by 6 months -> surgery by 6-18 months
Describe the management of bilateral undescended testicles.
Immediate 24hr referral to paediatrics for endocrine and genetic studies.
Jaundice developing after 2 weeks alongside a history of reduced appetite pale stools dark urine and growth disturbance.
Biliary atresia - Increased conjugated bilirubin
Surgery is curative
Antibiotics and bile acid enhancers may be beneficial post op
Children below 0.4 decile for height
Refer to paediatrics
Children below 2 decile of height
Seen by GP
When is bed wetting normal up to?
5 years is the cut off point prior to this you simply offer advice on diet and lifestyle factors.
What is the management of enuresis?
Look for a cause - UTI constipation Diabetes Mellitus
Rewards system - star chart etc
Enuresis alarms
Desmopressin - good for short term control i.e going for a sleep over
Inguinal hernia repair
<1 year - urgent surgical referral
>1 year - routine surgical referral
School exclusion in roseola infantum
non required
What is the cut of for weight lost in the first week of life?
10% weight loss
Any more and a midwife review of feeding is required
At what age are Varus knees normal up until?
Should resolve by 4 years
Neonatal Hypoglycaemia
Asymptomatic - Encourage good breast feeding and reassess
Symptomatic or very low - transfer to neonate ward + IV 10% dextrose
What is the investigation of choice is suspected developmental dysplasia affecting a child over 4.5 months?
X ray
Erythematous rash with yellow scale affecting scalp, face, nappy area and or limb flexural lines.
Seborrhoic Dermatitis
Mild - Moderate - baby shampoo and oil
Severe - Mild topical steroid
Resolves by 8 months
Signs of Down syndrome
Brushfeild spots in iris Upslanting palpebral fissures Epicathic folds Flat occiput Singla palmar crease Sandle gap Hypotonic Duodenal atresia Hirschprungs Cardiac defects
List some cardiac anomalies related to Down syndrome.
Commonest is endocardial cushioning defect VSD ASD Tetralogy of fallot Isolated PDA
Long term effects of Down syndrome
Sub fertility Short stature Recurrent respiratory tract infections + glue ear Acute lymphoblastic leukaemia Hypothyroid Alzhiemers Atlantoaxial instability
Commonest cause of ambiguous genitalia in newborn
Congenital adrenal hyperplasia
Inverted and Plantar flexed foot
Club foot
Ponseti method - serial casting from soon after birth
Linked to Cerebral Palsy, spina bifida, trisomy 18
Billous vomiting on the first day is likely to be?
Intestial Atresia - look for double bubble sign on x ray
Surgery is required
Double Bubble = Duodenal
Tripple bubble = jejunal
Causes of a cleft lip
Inherited
Maternal anti-epileptics
Management of a cleft lip
Orthodontic devices - help feeding
Speech therapy
Surgery - lip is repaired before the palate
Neonatal sepsis develops within 48 hrs of delivery
Strep B
Vaginal canal commensals
Neonatal sepsis develops after 48 hours of delivery
Hospital acquired
Staph Epidermidis
Staph aureus
Normal development and no other symptoms
Flat occiput + protruding forehead on opposite site
< 3 years
Plagiocephally
Due to sleeping on back
Resolves by 3-5 years - Reassure until then
Strawberry Naevi
Only treat if obstructing field of view, ulcerated, bleeding
Topical propanolol is now first line
Management in a diaphragmatic hernia
Immediate intubation
gentle inotropes and fluids
Age child smiles
6 weeks
Age a child who doesn’t smile should be referred by?
10 weeks
Age a child should laugh by
3 months
Age child is not shy at
6 months
Age child becomes shy
9 months
At what age is the child competent with a spoon and doesn’t spill their cup.
2 yers
Age child plays peekaboo
9 months
Age child waves bye bye
12 months
Age child plays alone
18 months
Age child plays alongside but not with other children
2 years
Age child plays with other children
4 years
Management of a child <3 with an acute limp
Urgent assessment as septic arthritis is more common in this age group
Hearing tests in children
Newborn = Otoacoustic emissions test
Infant or abnormal Otoacoustic emission test = Auditory Brainstem Test
6-9 months = distraction test
School entry = Pure tone audiometry
Child with croup and stridor at rest - managment
Immediate paediatric admission
Commonest cause of a massive painless GI bleed in 1-2 year olds?
Meckels diverticulum
Basic paediatric referral timeline
Doesn’t smile at 10 weeks
Doesn’t sit unsupported at 12 months
Doesn’t walk at 18 months
Small red growth within centre of umbilicus, producing clear or yellow fluid
Within few months of birth
Systemically well
Umbilical Granuloma - overgrowth from healing
Regular application of salt -> silver nitrate
When might you consider pneumonia rather than bronchiolitis?
Focal crackles
Persistent high fever
What are some RED flag symptoms in paediatrics?
Moderate to severe intercostal recession Doesn't wake if roused Reduced skin turgor Mottled or blue skin Grunting
Describe a mild croup
Occasional barking cough
No stridor at rest
No/mild intercostal recession
Well looking child
Describe a moderate croup
Frequent barking cough
Stridor
Recession at rest
No distress
Describe a severe croup
Prominent inspiratory stridor at rest
Marked recession
Distressed agitated lethargic
Tachycardia
Croup admission
<6 months
Mod/severe croup
Uncertain diagnosis - epiglottitis supraglottitis
Bruising in a non mobile infant
All should be referred to paediatrics
Circulatory collapse around day 2
Heart failure
Reduced femoral pulses
Systolic murmur heard under left clavicle and over the back
Coarctation of the aorta
What can be used in severe Tet spells
Phenylephrine
Epiglottitis managment
Call for help Senior ENT, Anaesthetic and alert PICU Don't alarm or examine throat of child Secure airway Culture and examine once secured Cefuroxamine
Diagnostic of mumps
Salivary IgA
Constipation in children - management
Movical Paediatric plan is first line -> + stimulant (Senna) -> swap movicol for lactulose
Management of GORD in a infant
Gaviscons + thickened foods trial for 1-2 weeks
PPI if feeding issues, distressed, faltering growth
-trial for 4 weeks
A pearly mass on the midline of the posterior hard palate of a newborn.
Epsteins Pearl - no treatment is needed as its a benign cyst
Measles prodrome
Cough Coryza Conjunctivitis
If someone is suspected of having delayed puberty what test can they undergo?
X-ray hands and wrist - bone age will be delayed
Neonatal phototherapy
Check their bilirubin after 4-6 hours - if 50 below threshold then stop
Recheck bilirubin 12-18 hours after this - if still 50 below they require no more monitoring
- if within 50 of the threshold recheck in 12 hours and consider restarting
Jaundice within 24 hours
Rhesus
ABO incompatibility
G6PD
Hereditary Spherocytosis
What tests should be done in a case of neonatal jaundice occurring within 24 hours
Coombs
Osmotic fragility
Blood film
Causes of jaundice over 14 days.
Hypothyroidism Biliary Atresia UTI Breast milk jaundice Premature Infection
What tests should be done in a case of neonatal jaundice occurring over 14 days?
FBC Unconjugated and conjugated bilirubin Coombs TFT Blood film Urine U+Es LFT
What is used to asses renal function in <18?
Creatinine
eGFR isn’t licensed for children
Management of a UTI
<3 months = immediate admission
>3 months upper UTI = consider admission or 7-10 days of antibiotics
>3 months lower UTI = 3 days antibiotic
How long should a newborn stay in hospital if they have a risk factor for developing sepsis?
24 hour for observations
What other condition is strongly linked to hypospadias?
Cryptochordism
Paediatric Red Flags - Colour
Pale
Mottled
Blue
Paediatric Red Flags - Activity
No responce to social cues
Very difficult to rouse and if aroused falls back to sleep
Weak high pitched continuous cry
Paediatric Red Flags - Respiratory
Grunting
Tachypnoea >60
Mod/severe chest indrawing
Paediatric Red Flags - other
Looks ill to a healthcare professional Reduced skin turgor <3 months >38 degrees Non blanching rash Bulging fontanelles Neck stiffness Status epilepticus Focal neurological signs
Paediatric amber flags - Colour
Pallor reported by carer
Paediatric amber flags - activity
No smile
Prolonged stimulation required to wake them
Paediatric amber flags - Respiratory
Nasal flaring
<95% oxygen
Crackles
RR >50
Paediatric amber flags - Circulation
Dry
Cap Refil - >3
Poor feeding
Reduced urine output
Paediatric amber flags - other
> 39 degrees 3-6 months
Fevere for over 5 days
Swelling
Non weight bearing leg
What age do children reach for objects
3 months
What age do children show a palmar grip and pass objects between hands?
6 months
What age do children point with a finger and use an early pincer grip?
9 months
What age do children show a good pincer grip?
12 months
How many bricks in a tower by 15 months?
2
How many bricks in a tower by 18 months?
3
How many bricks in a tower by 2 years?
6
How many bricks in a tower by 3 years?
9
Hand dominance before 12 months.
Always pathological - strong indicator for cerebral palsy
Respiratory Distress
Distended abdomen
Chocking / problems swallowing
Overflow salivation
oesophageal atresia
Polyhydramnious during pregnancy is an indicator swell.
Investigation and management in oesophageal atresia
NG tube is passed down as far as it can go. Chest x-ray is taken which will show the level of the atresia due to radiopaque NG tube.
Management is surgery
Management of a squint before 8 weeks old.
Squints are not abnormal before 8 weeks observe and refer if persist over 8 weeks
Congenital heart block - cause and management
Maternal SLE with Anti Ro and LA
Pacemaker is required
All children under three months with a fever require.
Blood, Urine and CSF culture
