Conjugated ('cholestatic') jaundice = ?cause (1)

Conjugated ('cholestatic') jaundice = always pathological --> refer paeds gastro Otherwise feeding well, well looking & prolonged jaundice - most likely physiological

Paediatrics Flashcards by Viet Nguyen

Croup markers of severity (RCH) (5)

-Altered conscious state/behaviour
-Persistent stridor at rest
-Increased resp rate
-Accessory muscle use
-O2 sats (late sign)

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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

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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

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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)

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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

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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

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Kawasaki disease DDx (6)

-GAS infections (strep throat, Scarlet/rhuematic fever)
-EBV/adenovirus
-Systemic JIA
-Sepsis/Toxic Shock syndrome
-Stevens-Johnson syndrome
-Drug reaction

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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

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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)

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OSA kids causes (6)

-Enlarged tonsils/adenoids
-Allergic rhinitis
-Obesity
-Muscle weakness
-Craniofacial abnormalities/cleft palate
-Down syndrome

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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

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Cow’s milk protein allergy clin. features/history features (5)

-blood & mucous in stool
-diarrhoea/constipation
-poor weight gain
-eczema
-FHx of atopy

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Red flag DDx for unsettled baby (6)

-sepsis
-hair tourniquet
-Corneal abrasion
-NAI
-Raised ICP
-Incarcerated inguinal hernia

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Conjugated (‘cholestatic’) jaundice = ?cause (1)

Conjugated (‘cholestatic’) jaundice = always pathological –> refer paeds gastro
- Otherwise feeding well, well looking & prolonged jaundice - most likely physiological

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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

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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 ## Footnote * If only dermatological symptoms (urticaria) + no features of severe reaction - not anaphylaxis Vasovagal 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 ## Footnote 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 ## Footnote 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 ## Footnote 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) ## Footnote 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