Paediatrics Flashcards
Croup markers of severity (RCH) (5)
-Altered conscious state/behaviour
-Persistent stridor at rest
-Increased resp rate
-Accessory muscle use
-O2 sats (late sign)
Croup oral doses (mild-mod) (3)
Pred 1mg/kg (stat +/- 24 hrs later)
Oral dex 0.15mg/kg stat dose
Budesonide 2mg neb BD for 48 hours
Severe croup doses (2)
Nebulised adrenaline 1:1000 5ml (0.5m/kg, max. 5ml)
Dexa oral/IM/IV 0.6mg/kg, max 12mg
eTG- pred 2/mg kg also an option for severe
Causes of failure to thrive (crossing two centile lines on growth chart) (6)
Inadequate nutrition (most common)
Chronic illness (cardiac/resp/renal failure/infections/anaemia)
Reduced absorption:
-Pancreatic insufficiency (CF)
-Coeliac disease, CMPI
-Vomiting (GORD), diarrhoea
-Renal loss (diabetes)
Notes on scissor frenectomy for tongue tie?
questionable evidence
○ Complications - oral aversion, breast refusal, bleeding
○ If frenectomy performed, should be done in conjunction with ongoing fit and hold adjustments, MH support and lactation consultant support
Scarlet fever clinical features (5)
Prodrome (malaise/fever/sore throat/vomiting)
Blanching ‘boiled lobster’/sunburn rash - prominent in neck/axilla/cub foss/groin
Circumoral pallor
Sandpaper rash w/ desquamation
Strawberry tongue
Group A Strep
Kawasaki disease DDx (6)
-GAS infections (strep throat, Scarlet/rhuematic fever)
-EBV/adenovirus
-Systemic JIA
-Sepsis/Toxic Shock syndrome
-Stevens-Johnson syndrome
-Drug reaction
Optimal timeframe for surgical intervention of:
-Undescended testes
-Inguinal/femoral hernia
-Hydrocele
-Umbilical hernia
-Bow legs & knock knees
-Undescended testes - 6-12 months, not longer than >12 mths (USS not needed prior to referral)
-Inguinal/femoral hernia - ASAP (6:2 rule, e.g 6 weeks - 6 months –> surgery within 2 weeks)
-Hydrocele - Review at 12 mths - repair by 2 years
-Umbilical hernia - leave to age 4 - surgery after
-Bow legs & knock knees - BL normal up to 3 years, KK normal 3-8 years
Limping child DDx (many)
-Infections (SA/OM)
-NAI
-Bone malignancy
-Reactive arthritis
0-4 y.o
-Transient synovitis of hip
-Acute myositis
-Toddlers fracture
-DDH
5-10 y.o
-Transient, acute myositis, DDH
-Perthe’s disease
Adolescent
-Perthe’s
-SUFE
-Traction apophysitis (Osgood-Schalatter, calcaneal (severs)
OSA kids causes (6)
-Enlarged tonsils/adenoids
-Allergic rhinitis
-Obesity
-Muscle weakness
-Craniofacial abnormalities/cleft palate
-Down syndrome
OSA kids clinical features (5)
- Snoring - common, but don’t consider as normal
○ Unrefreshed sleep (wakes tired and grumpy)
○ 2ndary enuresis
○ Poor weight gain
○ Difficulties w/ behaviour/concentration
Cow’s milk protein allergy clin. features/history features (5)
-blood & mucous in stool
-diarrhoea/constipation
-poor weight gain
-eczema
-FHx of atopy
Red flag DDx for unsettled baby (6)
-sepsis
-hair tourniquet
-Corneal abrasion
-NAI
-Raised ICP
-Incarcerated inguinal hernia
- Conjugated (‘cholestatic’) jaundice = ?cause (1)
- Conjugated (‘cholestatic’) jaundice = always pathological –> refer paeds gastro
- Otherwise feeding well, well looking & prolonged jaundice - most likely physiological
DDH risk factors (4)
-female sex
-breech delivery
-intrauterine packaging deformities e.g. plagiocephaly, foot deformities or torticollis
-family history of DDH
USS (best until 4 mths age)
○ 4-6 months - either XR or USS
○ After 6 months - X-ray preferred
Constipation - organic causes (6)
-Cow’s milk protein allergy
-Coeliac disease
-Hypothyroidism
-Cystic Fibrosis
-Electrolyte abnormalities (hypercalcaemia, hyperkalaemia)
-Meds (e.g opioids, anticholinergics)
Constipation - management aspects & doses of laxatives (6)
- Fibre, fluid intake
- Regular exercise
- Refer OT/continence physio for toilet training if >4 y.o
- Disimpaction
○ PEG (Movicol) 1-1.5g/kg/day for 3-6 days
○ 2nd line - liquid parrafin (Parachoc) - Maintenance
○ PEG 0.75g/kg/day - aim for extra soft stools
○ May need up to 6 mths of Rx - Add stimulants (e.g Senna) if brief period of constipation whilst on maintenance Rx
Nasal obstruction causing mouth breathing DDx (5)
-Rhinitis (allergic/non-allergic)
-Inferior turbinate hypertrophy
-Deviated nasal septum
-Nasal polyposis
-Adenoid hypertrophy
Causes of short stature (8)
-Constitutional delay
-Familiar short stature
-Turner syndrome
-Acquired growth hormone deficiency (intracranial pathology/trauma)
-Hypothyroidism, Cushing’s
-Chronic disease - IBD/coeliac/CKD
-Lifestyle - Poor nutrition/extreme physical activity
-Meds - steroids/stimulants
Tall stature causes (6)
-Familial tall stature
-Precocious puberty
-Congenital adrenal hyperplasia
-Hyperthyroidism
-Klinefelter
-Marfan’s
Paeds UTI - when to USS KUB (3)
-Atypical organisms (staph, pseudomonas)
-UTI <3 y.o
-Recurrent UTIs
Paeds UTI Abx choices (6)
1- Trimethoprim 4mg/kg BD
1- Bactrim (4+20mg/kg BD)
2- Cephaflexin 12.5mg/kg QID
3- Augmentin
4- norfloxacin
5- Nitrofurantoin
Ix for ADHD/developmental disorder (4)
Hearing/vision test
FBE
iron studies
TFT
Language delay Rx steps (2)
-Hearing test
-Speech path referral
Most catch up to peers w/ Rx from speech path
?Which vaccine (reaction)
Reaction typically 5-12 days after vaccine
Fever, systemic symptoms (malaise/rash)
Not hypersensitivity
Okay for 2nd dose - a/e’s actually much less w/ 18mth dose
MMR
Anaphylaxis after immunisation - f/u management step
-Refer to allergy specialist for skin prick testing
- If only dermatological symptoms (urticaria) + no features of severe reaction - not anaphylaxisVasovagal syncope post-imms - monitoring, well hydrated prior, sit or lying during administration
Inguinal hernia DDx (5)
- Hydrocele - often w/ viral illness, irreducible
- Varicocele - ‘bag of worms’
- Inguinal lymphadenopathy
- Idiopathic scrotal oedema
-Abscess, tumour
99% = indirect
Burns depth assessment (examination features) (4)
Burns dressings - superficial - mid-dermal (2)
Dressings - dermal - full thickness (2)
-Skin colour
-Cap refill
-Sensation
-Presence of blistering
Foam/hydrocolloid
Parrafin gauze/silver
DDx red eye in children (9)
-Kawasaki’s disease
-Corneal foreign body
-Corneal abrasion
-Herpes simplex dendritic ulcer
-Scleritis/episcleritis
-Glaucoma
-Measles
-Orbital cellulitis
-Trachoma
Red flags for Spinal Muscular Atrophy (6)
○ Hypotonia
○ Poor head control
○ Frog-leg posture
○ Tongue fasciculations
○ Hyporeflexia
○ Otherwise bright and alert
Autosomal recessive - 25% recurrence risk, can offer genetic carrier screening
Clavicle fracture management (1), follow-up (1)
*usually just broad-arm sling immobilisation 2-3 weeks
○ Kids under <11 do not require GP or XR follow-up
Most heal and recover quickly, excellent outcomes,
Humeral shaft fracture management (1), follow-up (1)
- Excellent remodelling, collar and cuff or hanging U slab
- Fracture clinic in 1 week
Supracondylar fractures Ix (2), Management (2)
Need AP and lateral XR views
* Type 1 Gartland (undisplaced) - above elbow backslab at 90 deg flexion for 3 weeks
○ Follow-up GP 3 weeks, no Xray required
* Type 2 & 3 (angulated or displaced) –> refer Ortho
Pulled elbow clin. features (6)
- Holds elbow in extension, forearm in pronation - doesn’t use affected limb
○ Distressed only on elbow movement
○ No swelling, bruising or deformity
○ Maybe no tenderness on palpation
○ Resistance and pain w/ supination of foerarm- 50% no hx. of “pull”
Wrist metaphyseal fractures (FOOSH) Rx:
-Buckle injury
-Complete & undisplaed
-Complete & displaced
- Buckle injury - below-elbow backslab/removable splint for 3 weeks, no GP or fracture clinic f/u
- Complete & undisplaced - below-elbow cast 6 weeks, fracture clinic in 1/52
- Complete & displaced - closed reduction, 6 week immob, fracture clinic
Salter Harris I-IV management steps
- Salter Harris Type 1 & Type 2 - rarely impacts growth disturbance, below-elbow backslab 4 weeks +/- closed reduction, fracture clinic 5 days
Type 3 & 4 - refer Ortho for ORIF
SUFE - key clinical finding (1)
-Ix (2)
-Rx (2)
- Obligatory external rotation of leg with hip flexion
- AP and frog leg lateral pelvic XRs
- Rx - non-weight bearing, admit Ortho - surgical Rx
DDx chronic diarrhoea (4)
-IBD
-IBS
-coeliac
-chronic infection (Giardia)
Ix - FBE, UEC/LFT, CRP, iron studies, coeliac serology
Vaccine cold chain breach management (4)
○ Secure the vaccines
○ Isolate affected ones in appropriate fridge
○ Label affected ones
-Review monitoring log to assess length of time exposed to inappropriate temps
