paediatrics 👶🏻 Flashcards
classic tetrad for severely infected infants with congenital toxoplasmosis
hydrocephalus
chorioretinits
convulsions
cerebral calcifications
what causes toxoplasmosis
toxoplasma gondii
eating uncooked meat/exposure to cat faeces
What kind of history will a patient present with who has functional abdominal pain
Vague, persistent, central abdo pain
Acute,chronic or cyclic
Girls 8-12
Nausea and vomiting
Fx of functional disorders
What history would a patient with constipation present with
Vague abdo pain
Painful defecation
Poor diet and fluid intake
Obesity
Faecal incontinence
On clinical examination of a patient with constipation what would you find
Minimal-mild abdo tenderness
Stool in rectum
Abdo distension
Faecal mass palpable
Mx of constipation
Stool softening laxatives
Improving water, food and fibre intake
What history would a patient with gastroenteritis present with
Vague abdo pain with nausea and vomiting
Diarrhoea +/- mucus
Recent travel, contact with sick person or ingestion of suspicious food/drink
With gastroenteritis, if it last more than 10 days what does that suggest
Parasitic or non-infectious cause
On clinical examination of patient with gastroenteritis what would you see
Diffuse abdo pain
Abdo distension
Hyperactive bowel sounds
Signs of volume depletion
Low grade fever
What history would a patient with coeliac disease present with
Recurrent abdo pain, cramping or distension
Bloating and diarrhoea
Dermatitis herpetiformis
Family history of coeliac disease
On clinical examination of a patients with coeliac disease what would you see
Generalised abdo pain or bloating
Underweight or failing to thrive
What history would a patient with TB present with
Night fever
Sweating
Cough
Haemoptysis
Poor appetite
Weight loss
Recent travel abroad
Treatment for TB
isoniazid
Rifampicin
Ethambutol
Pyrazinamide
History of patient with scarlet fever
Under 10
Sore throat
Malaise
GI upset
Clinical examination of pt with scarlet fever will reveal ?
Strawberry tongue
Sandpaper-like generalised rash
Fever
Tender cervical lymphadenopathy
Dx scarlet fever
Rapid throat swab but abx should be started immediately
Mx scarlet fever
Oral phenoxymethylpenicillin 10 days
If PA azithromycin
Children can return to school 24 hours after commencing abx
CREAM
Conjunctivitis
Rash
Erthyema of hands and feet
Adenopathy (cervical)
Mucosal involvement (strawberry tongue, oral fissures)
high grade fevers for >5 days
kawasaki disease
Mx of Kawasaki disease
High dose aspirin - due to risk of Reye’s syndrome aspirin is usually contraindicated in children
IV immunoglobulin
Sx of staphylococcus toxic shock syndrome
High grade fever
Malaise
Erthymematous rash
Syncope
Hypotension
Progression of toxic shock syndrome
Initially non specific flu like symptoms possibly with nausea, vomiting and diarrhoea
Then rapid progression to high fever and eruption of widespread rash that covers >90% body surface
Ix toxic shock syndrome
CK elevated
Low platelets
Blood, throat or CSF culture: no growth of pathogen
Mx toxic shock syndrome
Antibiotics
Fluid resuscitation
Vasopressors
Surgical debridement
Signs and symptoms you would see with coeliac disease paediatric
Failure to grow/thrive
buttocks wasting
Foul smelling faeces
Conjunctival pallor
Abdominal distension
Presentation of measles
Fever >40
Coryzal sx
Conjunctivitis followed by a rash 2-5 days after onset of sx
Koplik spots
Lasts about 5 days
Other names for fifth disease
Parvovirus B19
Slapped cheek syndrome
Erythema infectiosum
Presentation of fifth disease
Prodrome of fever, Coryza and diarrhoea
Bright red rash on cheeks followed by lacy rash on extremities
What is roseola
Aka sixth disease
Common disease of infancy caused by human herpes virus 6
Complications of roseola
Febrile convulsions
Presentation of roseola
Febrile and lethargic for up to 5 days
Blanching, rose pink macular rash erupts and covers trunk typically
Can spread to face and limbs
Cervical lymphadenopathy
Mx of roseola
Supportive
What history would a patient with asthma present with
Family history
Wheezing triggered by change in Weather, Environmental tobacco smoke, exercise, emotion
Tachypnoea
Dry night time cough
What history would a patient with bronchiolitis present with
Under 1 year
Seasonal - common in winter
Passive tobacco exposure
Cough increased in severity over time
Features of bronchiolitis
Coryzal symptoms
cough
Increasing breathlessness
Wheezing
Feeding difficulties
In what cases is bronchiolitis more severe
Bronchopulmonary dysplasia e.g premature
Congenital heart disease
Cystic fibrosis
Causes of bronchiolitis
Most cases = respiratory syncytial virus RSV
What is a common complication seen in bronchiolitis caused by RSV
Hyponatraemia
What history would a typical patient with croup present with
Male
Between 6 months and 6 years
Seal like barking cough worse at night
Stridor
Incidence in autumn/winter
Mild fever
Mx of croup
Dexamethasone
Supportive
Adrenaline nebuliser in emergency
What causes croup
Upper airway infection
Vast majority of cases caused by parainfluenza virus
Other viruses include adenovirus, RSV and influenza
What history would a typical patient with acute epiglottis present with
Hib unvaccinated
2-6 years of age
Drooling
High fever, generally unwell looking child
Patient finds it easier to breathe if leaning forward and extending neck
Stridor
Mx of epiglottis
Immediate senior involvement
DO NOT EXAMINE THROAT
Secure airway
Oxygen
Clinical features of intussusectpion
6-18 months
Severe colicky abdo pain (draws you legs and turns pale)
Vomiting
Sausage shaped mass in RUQ
Red-currant jelly stool
Abdo distension
Mx of intussusception
Rectal air insufflation
What would you see on an abdo x ray for intussusception
Target sign +/- free abdo air
Clinical features of meckels diverticulum
Asymptomatic OR parent Vitelli-intestinal duct
OR painless rectal bleeding OR abdo pain, intussusception, obstruction
Describe the tripod position and what is this indicative of
Upright leaning forward with extended neck and open mouth
Acute epiglottis
Mx of acute epiglottitis
Call senior to intubate and secure airway
Then o2 and IV abx
Describe wheeze
Monophonic or polyphonic musical sound louder on expiration due to narrowing in lower airway
Describe Stridor
Single note occurs in inspiration due to upper airway obstruction
Clinical features of neonatal sepsis
Resp distress
Tachycardia
Apnoea
Change in mental status
Jaundice
Seizures
Poor feeding
Abdominal distension
Vomiting
In order of prevalence
Describe neonatal resuscitation if baby is not breathing
5 inflation breaths
If no improvement - optimise airway and repeat 5 breaths
Once airway is established check pulse If HR <60 ventilate 30 seconds
If still<60 chest compressions
Presenting features of necrotising enterocolitis
<3 weeks old
Bike streaked vomit
Absent bowel sounds
Abdo distension
Bloody stools
Risk factors for necrotising enterocolitis
Premature birth
Dx of necrotising entercolitis
Abdo x ray
What would you see on an abdo x ray of a necrotising enterocolitis patient
Dilated bowel loops
Pneumotosis intestinalis
Portal venous gas
Pneumoperitoneum
Mx of necrotising enterocolitis
Drip and suck (IV fluids and antibiotics, nil by mouth so NG tube aswell)
Surgical resection of necrotic bowel
Presenting features of acute epiglottis
High fever
Toxic appearance
Inspiratory Stridor
Drooling
Absence of cough
CXR for acute epiglottis would show ?
Thumb sign
Triggers for DKA
Infection
Non compliance
Inappropriate dose alteration
First presentation of T1DM
Myocardial infarction
For paediatric patients coming in when would a CT head in 1 house be indicated
GCS <=13 (14 if <1yo)
Post traumatic seizure
Basal skull fracture
(And more)
Red flags in a feverish child that you should urgently refer for paediatric assessment
Pale, mottled,ashen or blue skin
No response to social cues
Appears ill to a healthcare professional
Does not wake or if roused does not stay awake
Weak high pitched or continuous cry
Grunting
Reduced skin turgor
Bulging Fontanelle, neck stiffness, non-blanching rash
Age<3 months with temp >=38
Status epilepticus, focal seizures, focal neurological deficits
features of foetal alcohol syndrome
functional or structural nervous system abnormalities
growth impairment
specific facial abnormalities e.g. short palpebral fissures, smooth philtrum and thin upper lip
what is an important and common side effect of methylphenidate
appetite suppression and subsequent growth suppression
inheritance pattern of duchennes muscular dystrophy
x linked recessive inherited genetic defect that reduces the expression of dystrophin
presentation of duchennes muscular dystrophy
muscle wasting and weakness in early childhood
children may have bulky-appearing muscles as degenerated muscle is replaced by fat
parents may notice that the child “slips through their hands” when they pick them up
causes of jaundice in the first 24 hours
always pathological
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- glucose-6-phosphodehydrogenase deficiency
jaundice in the neonate from 2-14 days ?? what causes this
this is common and usually physiological
more commonly seen in breastfed babies
jaundice after 14 days of life in a newborn, what do you do?
a prolonged jaundice screen is performed
causes of prolonged jaundice (>14 days) in a newborn
biliary atresia
hypothyroidism
galactosaemia
UTI
breast milk jaundice
prematurity
congenital infections
what is staphylococcal scalded syndrome and how does it present
severe desquamating rash that affects infants
presentation: systemically ill child presents with superficial fluid-filled blisters with acute-onset erythroderma with a positive Nikolsky sign, oral mucosa is usually unaffected
Nikolsky sign
slight pressure on skin causes peeling of superficial epidermis
positive is SSSS, TEN and pemphigus vulgaris
mx SSSS
IV abx and supportive treatment
what enterovirus causes hand-foot-and-mouth disease
typically Coxsackie A
presentation of henoch-schonlein purpura
purpuric rash classically over lower limbs
abdo pain
arthralgia
what is ALL
acute lymphoblastic leukaemia
most common paediatric cancer
clinic presentation of ALL
pallor
unexplained bruising
persistent fatigue
hepatosplenomegaly
lymphadenopathy
increased susceptibility to infection so they might be having a huge reaction to a simple infection
most common in children 2-5 years
mx ALL
treatment included chemotherapy and stem cell transplantation
investigations for measles
3-14 days after onset of sx - measles specific IgG and IgM serolgy
1-3 days - PCR
most common complication associated with measles
acute otitis media
presentation of rubella
nonspecific sx
coryzal sx
arthralgia
rash that spreads from face to reset of body sparing limbs
lymphadenopathy
what are the characteristic features of congenital rubella infection
cataracts
deafness
patent ductus arteriosus - machine-like murmur
brain damage
purpuric skin rash aka “blueberry muffin” rash
presentation of mumps
high fever and multiple organ involvement
most common - parotitis
2nd most common - orchitis - swelling of the testicles
other rare presentations include
deafness
aseptic meningitis
encephalitis
investigating mumps
saliva specific IgM
how is impetigo presented
pruritic rash on the face usually with golden crusting
usually presents in infants and school age children
management of impetigo
topical fusidic acid is the first line
oral flucloxacillin can be used if still persists
when infected with impetigo when can children return to school
48 hours after abx therapy or after the lesions have crusted over
1st and 2nd line mx tonic clonic seizures
1st - sodium valporate
2nd - lamotrigine/carbamezapine
1st and 2nd line mx focal seizures
1st - carbamezapine/lamotrigine
2nd - sodium valporate
what are atonic seizures
brief lapses in muscle tone
known as drop attacks
what is status epilepticus
medical emergency
defined as when a seizure lasts longer than 5 minutes or they have 2 or more seizures without regaining consciousness in interim
mx of status epilepticus
A-E
IV lorazepam twice
then final step is IV phenytoin or IV phenobarbital
what are febrile convulsions
type of seizure that occurs in children with high fevers
not caused by epilepsy or any underlying neurological condition
appears in 6 months - 5 years old
management of febrile convulsions
Identify and treat the underlying cause of high fever
control fever with simple analgesia
what is west syndrome aka infantile spasms
rare disorder that occurs in infants aged around 6 months
characterised by a cluster of full-body spasms
poor prognosis
management of west syndrome
prednisolone and vigabatrin
EEG findings for West syndrome
hyps arrhythmia
what are benign rolandic seizures?
occurs in 3-10-year-olds and almost exclusively in sleep
generalised tonic clinic seizures in their sleep
excellent prognosis - most outgrown by puberty
EEG findings - centrotemporal spikes
what is a Wilm’s tumour
embryological tumour from developing kidney
most common abdomen tumour in children especially under 5
presentation of Wilm’s tumour
abdominal mass that does not cross the midline
abdominal distension
haematuria
diagnosis of Wilms tumour
initial ix: USS
diagnostic : biopsy
