Paediatrics Flashcards
Immunisations for 2 months, 3 months, 4 months, 1 year, 3-4 years, 12-13 years, 14 years?
2 months = 6-in-1, oral rotavirus, Men B
3 months = 6-in-1, oral rotavirus, PCV
4 months = 6-in-1, Men B
1 year = Hib/Men C, MMR, PCV, Men B
3-4 years = 4-in-1, MMR
12-13 years = HPV (6, 11, 16 & 18)
14 years = 3-in-1, men ACWY
When should premature babies be immunised?
No adjustment needed
→ if < 28 weeks vaccines should be given in hospital
What is included in the 6-in-1, 4-in-1 and 3-in-1 vaccines?
6-in-1 = diphtheria, tetanus, whooping cough, polio, Hib and hep B
4-in-1 = diphtheria, tetanus, whooping cough and polio
3-in-1 = diphtheria, tetanus and polio
Extra vaccination offered at birth if TB risk factors?
BCG
Features and management of measles?
Generally unwell e.g. fever
White (Koplik) spots in mouth
Rash that starts behind ears
Management = supportive
Features and management of mumps?
Generally unwell e.g. fever
Parotitis, orchitis, pancreatitis
Management = supportive
Features and management of rubella?
Generally unwell e.g. fever
Lymphadenopathy
Rash that starts on face
Management = supportive
School exclusion for children with measles vs mumps vs rubella?
Measles = 4 days from rash onset
Mumps = 5 days from swollen gland onset
Rubella = 5 days from rash onset
Hearing test done after birth vs before entering school?
Birth = otoacoustic emission test
→ brainstem response test is abnormal
Before school = pure tone audiometry
When is the heel-prick test carried out?
5-9 days after birth
Conditions the heel-prick test screens for?
Congenital hypothyroidism
Maple syrup urine disease
Cystic fibrosis
Sickle cell disease
Phenylketonuria
Homocytinuria
MCADD
Isovaleric acidaemia
Glutaric aciduria type 1
When should a child smile?
6 weeks
When should a child sit without support vs crawl vs walk unsupported?
Sit = 7-8 months
Crawl = 9 months
Walk = 13-15 months
When should a child hold things with palmar grasp vs have good pincer grip?
Palmar grasp = 6 months
Pincer grip = 12 months
Referral indications for child developmental delay?
Does not smile by 10 weeks
Cannot sit unsupported by 12 months
Cannot walk unsupported at 18 months
Hand preference before 12 months?
May indicate cerebral palsy
Milestone age correction for premature baby?
Normal age + number of weeks born early
Neonatal period?
0-28 days
APGAR score components and when is it assessed?
Appearance, Pulse, Grimace, Activity, Respiration
1, 5 and 10 minutes post-delivery
Normal HR and RR for children < 1?
HR = 100-160
RR = 30-40
Newborn resuscitation?
- Dry baby and maintain temperature
- Gasping or not breathing = 5 inflation breaths
- Reassess and repeat inflation breaths if needed
- No improvement = 30 seconds ventilation
- No improvement = 3:1 CPR
Most common cause of NRDS and main risk factor?
Transient tachypnoea of the newborn (TTN)
C-section delivery
Features, investigation and management of TTN?
Tachypnoea
Nasal flaring and grunting
Use of accessory muscles
Investigation = CXR (fluid in horizontal fissure)
Management = supportive
Features and management of meconium aspiration syndrome?
Meconium stained liquor
Green staining of infant
Post-term or difficult delivery
Respiratory distress
Management = supportive
Acute management of congenital heart disease?
Prostaglandin E1 e.g. alprostadil
Anatomical features of TOF and implication?
Ventricular septal defect
Right ventricular hypertrophy
Pulmonary stenosis
Overriding aorta
Implication = right-to-left shunt
What determines the severity of TOF?
Degree of pulmonary stenosis
Features and management of TOF?
Cyanotic “tet” spells
Apnoeic episodes
Tachypnoea
Failure to thrive
Ejection systolic murmur
Management = surgery, beta-blockers for tet spells
CXR feature of TOF?
“Boot-shaped” heart (due to RVH)
Anatomical feature of patent ductus arteriosus and implication?
Connection between pulmonary trunk and descending aorta
Implication = left-to-right shunt
Features and management of patent ductus arteriosus?
Continuous “machine-like” murmur
Left subclavicular thrill
Collapsing pulse
Wide pulse pressure
Management = NSAID e.g. indomethacin
Features of innocent murmur?
5 S’s:
→ soft
→ short
→ systolic
→ symptomless
→ situational (postural)
Management of neonatal hypoglycaemia?
Asymptomatic = encourage breast/bottle feed + monitor
Symptomatic or severe = IV dextrose 10%
Is jaundice normal in newborns?
Yes, between 2-14 days
< 24 hours or > 14 days = assess for pathology
Causes of jaundice in < 24 hours old?
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency
Causes of jaundice in > 14 days old?
Biliary atresia
Hypothyroidism
Infection
Prematurity
Breast milk jaundice
Features and management of biliary atresia?
Jaundice > 14 days old
Hepatosplenomegaly
High conjugated bilirubin
Management = kasai procedure, liver transplant
Features of neonatal GORD?
Milky vomit after feeds
Worse when laid flat
Cough, hoarse crying
Parental counselling on GORD?
- Due to immature LOS
- 90% improve by age 1
- Give small and frequent feeds
- Keep baby upright and burp regularly
- Other options = Gavison, thickened formulas, PPI trial
Features of cow’s milk protein intolerance and cow’s milk protein allergy?
Milky vomit after feeds
Diarrhoea, bloating, irritability
Urticaria, pruritis, rash (CMPA only!)
Parental counselling on CMPA/CMPI?
- Most grow out of it by 2-3 years
- Other CMPA options = hydrolysed formula or breast feeding with mum avoiding dairy
- Other CMPI options = hydrolysed formula or breast feeding
Parental counselling on breastfeeding?
- Recommended exclusively until 6 months
- Benefits = contains antibodies and nutrients required by baby, less likely to be overweight, reduced maternal breast and ovarian cancer risk
- Disadvantages = cracked/sore nipples, risk of mastitis and abscess
Features and management of neonatal sepsis?
Respiratory distress
Tachycardia
Jaundice, seizures
Group B strep infection
Management = IV benzypenicillin + IV gentamicin
Capput succedaneum vs cepahlohaematoma?
Capput succedaneum = present at birth, vertex, swelling crosses suture lines, resolves quickly
Cephalohaematoma = develops after birth, parietal, swelling does not cross suture lines, resolves slowly
Main risk factor and management of intraventricular haemorrhage?
Preterm birth
Management = supportive, shunt if hydrocephalus
Management of undescended testes?
Unilateral = consider referral around 3 months
Bilateral = paediatric review < 24 hours
Management of hypospadius?
Surgery around 12 months
Shaken baby syndrome features?
Triad of:
→ retinal haemorrhages
→ subdural haematoma
→ encephalopathy
Inheritance patterns that can only be passed down from maternal line?
X-linked recessive
Mitochondrial
Genetics and features of Down’s syndrome?
Trisomy 21
→ small, low-set ears
→ epicanthic folds
→ single palmar crease
→ learning difficulties
→ hypotonia
→ heart defect
→ duodenal atresia
→ hirchsprung’s disease
Most common congenital heart defect in Down’s syndrome?
Endocardial cushion defect
Ventricular septal defect
Complications of Down’s syndrome?
Glue ear
Recurrent infection
Hypothyroidism
Alzheimer’s disease
Genetics and features of Turner’s syndrome?
45 X or 45 XO
→ wide chest
→ webbed neck
→ primary amenorrhea
→ learning difficulties
→ heart defect
→ horseshoe kidney
Most common congenital heart heart defects in Turner’s syndrome?
Bicuspid aortic valve
Coarctation of the aorta
Male version of Turner’s syndrome?
Noonan syndrome
Genetics and features of Prader-Willi syndrome?
Deletion on chromosome 16
→ childhood obesity
→ hypotonia
→ hypogonadism
→ learning difficulties
Genetics and features of Fragile X syndrome?
Trinucleotide repeat (CGG)
→ large, low-set ears
→ long, thin face
→ high arched palate
→ macroorchidism
→ learning difficulties
Genetics and features of Klinefelter’s syndrome?
47 XXY
→ tall
→ delayed puberty
→ small, firm testes
→ gynaecomastia
Genetics and features of Kallman’s syndrome?
X-linked recessive
→ anosmia
→ delayed puberty
→ hypogonadism
→ cryptorchidism
Genetics and features of androgen insensitivity syndrome?
46 XY (male) with female phenotype
→ primary amenorrhea
→ undescended testes in groin
First sign of puberty in males vs females?
Males = testicular growth
Females = breast development
Definition of precocious puberty?
Secondary sexual characteristics in females < 8 years and males < 9 years
When should a child be urinary continent?
3 to 4 years old
Management of nocturnal enuresis?
1st line = lifestyle advice
2nd line = enuresis alarm
3rd line = desmopressin
N.B. desmopressin may also be used short-term e.g. for a sleepover
Management of UTI in children?
< 3 months = urgent paediatric referral
> 3 months upper UTI = admission + antibiotics
> 3 months lower UTI = antibiotics
Features and investigation for vesicoureteric reflux?
Hydronephrosis
Recurrent UTIs
Chronic pylonephritis
Investigation = micturating cystourethrogram
Red flag in dehydrated child?
Reduced skin turgor
Dehydration management in children?
Give 50ml/kg ORS over 4 hours + ORS maintenance
Features of infantile colic?
Irritability
Crying
Drawing up of knees
Management of constipation (< 3 stools a week) in children?
1st line = movicol paediatric plain
2nd line = add stimulant laxative
3rd line = stimulant + osmotic laxative
Feature, investigation and management of Hirschprung’s disease?
Feature = failure to pass meconium
Investigation = AXR, rectal biopsy (gold standard)
Management = bowel irrigation, surgery
Features, investigation and management of intussusception?
Features = bilious vomit, abdominal pain, drawing knees up and turning pale, bloody stool, sausage-shaped mass
Investigation = abdo USS
Management = air insufflation, surgery
Abdominal USS feature of intussusception?
Target sign
Most common cause of painless, massive GI bleed in young children?
Meckel’s diverticulum
Features, investigation and management of Meckel’s diverticulum?
Features = usually asymptomatic, abdominal pain mimicking appendicitis, melaena, obstruction
Investigation = 99m technetium scan
Management = surgery
Features, investigation and management of pyloric stenosis?
Features = non-bilous projectile vomit, dehydration, abdominal mass
Investigation = abdo USS
Management = ranstedt pyloromyotomy
Metabolic derangement associated with pyloric stenosis?
Hypochloraemic hypokalaemic metabolic alkalosis
Management of gastroschisis vs exomphalos?
Gastroschisis = urgent surgery
Exomphalos = staged repair, cover with sac until ready for surgery
Features of growing pains?
Not present when child wakes up
Intermittent symptoms
Systemically well
No limp or examination findings
Barlow and Ortolani test?
Barlow = trying to dislocate femoral head
Ortolani = trying to relocate femoral head
Babies who automatically need USS for DDH?
Breech presentation
FH of hip problems at birth
Multiple pregnancy
Investigations and management of DDH?
< 4.5 months = USS
> 4.5 months = X-ray
Management = Pavlik harness
Features and management of transient synovitis?
Mostly children aged 3-8
Limp/not weight bearing
Groin or hip pain
Should NOT have high fever
Management = supportive
Features and management of slipped capital femoral epiphysis?
Obese child
Hip, groin or knee pain
Loss of internal rotation in flexion
Management = internal fixation
Features and management of Perthe’s disease?
Progressive hip pain
Limp/not weight bearing
Reduced range of movement
Management = brace/cast + observation (< 6), surgical management (> 6)
Pathophysiology of cerebral palsy and causes?
Non-progressive lesion of the motor pathways in the developing brain
→ cerebral malformation
→ congenital infection e.g. rubella
→ IVH
→ hypoxia/asphyxiation
Most common meningitis organisms in neonates vs > 1 year?
Neonates = group B strep
> 1 year = neisseria meningitidis
Management of paediatric meningitis?
< 3 months = IV amoxicillin or ampicillin + IV cefotaxime
> 3 months = IV cefotaxime or ceftriaxone
Steroids can be used in children > 3 months
Child has clusters of movements like body scrunching or head bobs?
Infantile spasms
Child goes pale, falls to floor and recovers quickly after pain or intense emotion?
Reflex anoxic seizure
Child has exclusively nighttime seizures?
Benign rolandic epilpesy
Features and management of simple vs complex febrile seizure?
Simple = < 15 mins, generalised, no recurrence within 24 hours
Complex = 15-30 mins, focal, may recur within 24 hours
Management = supportive, BZD if needed
Parental counselling for febrile seizures?
- Affects children 6 months-5years
- 1 in 3 risk of recurrence
- Anti-pyretics do not reduce risk
- Call ambulance if lasts > 5 mins
- Small risk of developing epilepsy especially if complex seziures
Nerve roots affected in Erb’s vs Klumpke’s palsy and clinical sign?
Erb’s = C5, C6
→ waiter’s tip
Klumpke’s = C8, T1
→ claw hand
Management of a pulled elbow (radial head subluxation)?
Passive pronation with elbow flexed at 90°
Management of talipes equinovarus (club foot)?
Ponseti method (progressive casting)
Night-time braces until age 4
Paediatric resuscitation?
- Airway manoeuvres
- Give 5 rescue breaths
- Check femoral or brachial pulse
- Give 15:2 CPR
Features and management of Kawasaki disease?
Fever resistant to antipyretics
Conjunctival injection
Red, cracked lips
Strawberry tongue
Red palms/soles → desquamation
Management = high-dose aspirin + IV immunoglobulins
Complication of Kawasaki disease and screening test?
Coronary artery aneurysm
Echocardiogram
Management of threadworms?
Mebendazole and hygiene advice for all household members
