Paediatrics Flashcards
Management of viral induced wheeze
Episodic viral wheeze:
- 1st line = short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer
- 2nd line = intermittent leukotriene receptor antagonist (montelukast) or intermittent inhaled corticosteroids, or both
Multiple trigger wheeze
- trial of either inhaled corticosteroids or a leukotriene receptor antagonist (montelukast), typically for 4-8 weeks
Most common cause of bronchiolitis
RSV
Features of bronchiolitis
coryzal symptoms (including mild fever) precede:
- dry cough
- increasing breathlessness
- wheezing
- fine inspiratory crackles
- feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
When would you refer immediately (999), for bronchiolitis?
- apnoea (observed or reported)
- child looks seriously unwell to a healthcare professional
- severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
- central cyanosis
- persistent oxygen saturation of less than 92% when breathing air.
Ix for bronchiolitis
immunofluorescence of nasopharyngeal secretions
Management of bronchiolitis
Management is largely supportive:
1. humidified oxygen is given via a head box (if O2 sats < 92%)
- nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
- suction is sometimes used for excessive upper airway secretions
What is laryngomalacia?
Congenital abnormality of the larynx.
Infants typical present at 4 weeks of age with:
stridor
What is haemolytic uraemic syndrome?
Tirad of:
- acute kidney injury
- microangiopathic haemolytic anaemia
- thrombocytopenia
Ix for HUS
- full blood count: anaemia, thrombocytopaenia, fragmented blood film
- U&E: acute kidney injury
- stool culture
Management of HUS
- treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
- No Abx, despite the preceding diarrhoeal illness in many patients
- plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
- eculizumab (in adults)
What is cradle cap?
Early sign of seborrhoeic dermatitis
How does cradle cap present?
Erythematous rash with coarse yellow scales
Management of cradle cap
mild-moderate: baby shampoo and baby oils
severe: mild topical steroids e.g. 1% hydrocortisone
Usually resolves spontaneously by 8 months
What is urticaria?
local or generalised superficial swelling of the skin ( hives)
Features of urticaria
- pale, pink raised skin. Variously described as ‘hives’, ‘wheals’, ‘nettle rash’
- pruritic
Management of urticaria
1st line = non-sedating antihistamines
Severe or resistent = prednisolone
What is kawasaki disease?
type of vasculitis which is predominately seen in children
Features of kawasaki disease
- high-grade fever which lasts for > 5 days.
- Fever is characteristically resistant to antipyretics - conjunctival injection
- bright red, cracked lips
- strawberry tongue
- cervical lymphadenopathy
- red palms of the hands and the soles of the feet which later peel
Ix for kawasaki disease
clinical diagnosis
Management of kawasaki disease
- high-dose aspirin
- intravenous immunoglobulin
- echocardiogram is used as the initial screening test for coronary artery aneurysms
What is syndrome of inappropriate ADH secretion (SIADH) ?
hyponatraemia secondary to the dilutional effects of excessive water retention.
Management of SIADH
- correction must be done slowly
- fluid restriction
- demeclocycline: reduces the responsiveness of the collecting tubule cells to ADH
- ADH (vasopressin) receptor antagonists have been developed
Typical presentation of flat feet
All ages
Absent medial arch on standing
Typically resolves between the ages of 4-8 years
Bow legs
1st-2nd year
Typically resolves by the age of 4-5 years
Screening for developmental dysplasia of the hip
all infants are screened at both the newborn check and also the six-week baby check using the Barlow and Ortolani tests
Ix for DDH
USS confirms diagnosis
Management of DDH
- most unstable hips will spontaneously stabilise by 3-6 weeks of age
- Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
- older children may require surgery
What is Perthes?
Degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years
Due to avascular necrosis of the femoral head, specifically the femoral epiphysis
Features of perthes’
- hip pain: develops progressively over a few weeks
- limp
- stiffness and reduced range of hip movement
Diagnosis of perthes’
plain x-ray
- early changes include widening of joint space
- later changes include decreased femoral head size/flattening
Management of perthes’
- To keep the femoral head within the acetabulum: cast, braces
- If less than 6 years: observation
- Older: surgical management with moderate results
- Operate on severe deformities
