Paediatrics Flashcards
Inguinal hernia surgery timing
<6 weeks : Within 2 DAYS
6 weeks- 6 months: within 2 WEEKS
> 6 months; within 2 MONTHS
Roseola Infantum
- Starts on trunk then to neck and extremities
-Maculopapular
- HHV6-7
Laterothoracic exanthem
Unilateral axila or groin- spreads centrifugally then bilatreal
Resolves within 5 weeks
EBV, parvovirus, adenovirus
Erythema infectiosum
SLAPPED cheek
Parvovirus b19
Stage 1: cheeks
Stage 2: lace like limbs
Note: pregnant woman who’ve been exposed: Have immune status checked and refer to O&G
Gianotiii-Crosti Syndrome
Self limiting
Multiple viruses
EXTENSOR surfaces: Vesiculopapular rash NON pruritic
Measels rash
Koplik’s spots
Red macules and papules cephalocaudal spread
Rubella rash
Pink maculopapular face then to trunk and extremities over 24 hours
Erythematous papules on palate (Forchheimer spots)
Paediatric dose of Augmentin
22.5/3.2 mg/kg
First line testing for bruising in children
Second line testing for bruising in children
APTT
PT/INR
Fibrinogen
FBC
VWD screen
Blood group
Factor VIII & IX
Ca
LFT
EUC, creatinine
Signs of adequate milk supply
- Weight gain 150-200g /wk (first 3 months)
- 5-8 nappies/24hrs
- Passing soft stool once daily
- Waking spontaneously for feeds
- Settling between feeds
- Alert and content when awake
Poor growth /slow weight gain investigations
- Urine MCS
- FBC, EUC, LFT
- TSH
- Glucose
- Coeliac serology
- B12
- Stool fat globules, fatty acid crystals
>12m :ESR & Fetal calprotectin
Hypoxia levels to indicate severe respiratory condition (paediatrics)
<90%
Signs of severe respiratory condition (paediatrics)
- Irritability/lethargy
- Marked increased accessory muscle use
- Marked increased RR
- 02 sats <90% or cyanosis
- Tachycardia (significantly increased)
CAP antibiotics dosing for children
Amoxicillin 25mg/kg up to 1g 8 hourly for 3 days
Rheumatic Fever (1st line 2 agents) PLUS allergy to penicillin 2 options
Benzathine benzylpenicillin 1.2million units
Phenoxymethylpenicillin 500mg BD for 10 days
Delayed nonsevere hypersensitivity
Cefalexin 25mg/kg BD 10 days
Immediate or delayed severe allergy
Azithromycin 500mg Daily 5 days
Rheumatic Fever Hypersensitivity to penicillins
Delayed Non-severe hypersensitivity
Cefalexin 25mg/kg BD 10 days
Immediate or Delayed severe allergy
Azithromycin 500mg Daily 5 days
Rheumatic fever treatment of arthralgia or arthritis
Naproxen
5-10mg/kg up to 500mg BD
Impetigo non endemic setting - dose of oral abx
Flucloxacillin 12.5mg/kg 6 hourly 7 days
Examination findings for OSA
- Boggy inferior turbinates
- Nasal mucous inflammation
- Tonsillary hypertrophy
- OME
- Adenoid facies
- Retrognathia
- obesity
Protracted Bacterial Bronchitis treatment
2-6 weeks of Augmentin 22.5, 3.2mg/kg
Dose of Macrogol 3350 for disimpaction (child)
Then maintenance dose
1-1.5g/kg/day for 3-6 days
0.75g/kg/day
Upper limit of normal for gynaecomastia in adolescent (measurement of enlargement)
4cm
Red flags for gynaecomastia
- > 4cm
- Pre-pubertal
- Rapid progression
- Persistent for >1yr or after 17
Febrile seizure dose
Midazolam 0.2-0.3mg/kg (up to 10mg) buccally or intranasal
- repeat 10 mins later if still seizing
Severe nappy rash differentials
- Staph scalded skin syndrome
- Streptococcal perineal dermatitis
- Bullous impetigo
- Kawasakis disease (if fever)
- Candida albicans infection
- Infantile seborrheic dermatitis
- Steven Johnsons syndrome
Kawasaki findings
Fever 5 or more days
with 4 of the following
- Bilateral non exudative conjunctivitis
- Polymorphous rash
- mucositis
- Cervical lymphadenopathy
- extremity changes (palmar erythema, oedema and desquamation)
** also a desquamating nappy rash can be present in initial phase
12 month vaccines
MMR
Prevenar
Meningococcal ACWY
Optional
Flu
Bexsero (meningococcal b)
Crying baby history questions to establish cause (long list)
- Sudden onset of crying (red flag)
- Known triggers (eg feeding)
- Bilious or projectile vomiting
- Changes to feeding
- Changes to formula
- Poor weight gain
- Blood or mucous in stool
- Watery/frothy diarrhoea
- New onset rash
- Bruise or deformity
- Change in alertness
- Maternal coping
- red eye, not opening eye
Dose of midazolam for seizures
1) IM/IV
2) buccal/IN
1) 0.1mg/kg up to 10mg
2) 0.3mg/kg up to 10mg
Complications of EBV
- Splenic rupture
- Prolonged fatigue
- Derranged LFTs
- DIC
- Meningitis
- Myocarditis
- Pancreatitis
- Pneumonia
Straddle injuries management
- Salt water baths
- Topical anaesthetic cream or barrier cream
- reduced strenuous activity 24 hrs
- Simple analgesia
Differentials for ADHD and Behavioural issues
- ODD
- PTSD
- ASD
- GDD
- FASD
- Early-life trauma (disrupted attachment)
- Anxiety
- Child abuse
- Hearing or visual impairment
- OSA
- Iron deficiency
- Thyroid disease
Bowed leg intercondylar distance cut off for referral
> 6cm
Bowed leg cut off for age (when no longer normal)
Beyond 3 years
Dark urine and pale stools (jaundice) type of hyperbilirubinaemia
Conjugated
Conjugated hyperbilirubinaemia (dark urine, pale stools) what to do
URGENT referral
Vaccinations for ATSI (special)
- BCG (NT, QLD, North SA)
- Hep A (NT, SA, QLD, WA) (2 doses before 5, first in 2nd year of life)
- HEP b- ALL AGES CAN GET THIS
- Bexsero
- 13vPCV (NT, SA, QLD, WA) & adults >50
- Influenza >6m
- 23vPPPV (4yrs old & again in 5 yrs) & >50 12 months post 13 and then agin in 5 yrs
Vaccine hesitancy strategies
- Inform about no jab no pay
- Explain herd immunity
- Non - judgemental approach
- Find out about barriers
- Explain limitations to childcare attendance
- explain how it prevents serious infections
Recent infection (eg impetigo) then now with facial oedema….
What are you worried about?
Post streptococcal Glomerular nephritis
Post strep glomerulonephritis triad
- Discoloured urine (haematuria)
- Oliguria
- Oedema
Premature babies and vaccinations:
- Gestational (corrected) or chronological age?
Chronological
Most common causes of short stature
1) Constitutional delay of growth and puberty
2) Familial short stature
Diagnosis (physical signs) of constitutional delay in growth and puberty
GIRL:
Lack of breast development (tanner stage 2) >13
BOY
Testicular Volume <4mL by age 14
Poor Growth Investigations
Simple bloods
CMP
Coeliac
TSH
IGF
Karyotype
Bone age Xray
Fever temperature cut off for vaccine safety
Can be given if <38.5
Signs of mild dehydration (trick)
Most have none
Measels triad of early symptoms (hint: three cs)
Cough
Coryza
Conjunctivitis
FLU vax inital dose for children >6months but <9 years
Dose PLUS BOOSTER in 4 weeks
What am I ?
When do I peak (age)
Erythema toxicum neonatorum
2 days to 2 weeks
What age can you add LABA in kids
Over 6 years
Treatment time course for aspirin in Kawasakis
6 weeks
Mongolian spot duration expected
Up to 4 years old
Bronchiolitis signs of severity
- O2 (<92 moderate, <90 severe)
- APNOEAS
- Feeding difficulty
- Accerssory muscle use: moderate or marked
- RR
- Irritable
Best antihistamine for children
Certirizine (can use from 6 months)
Normal time frame for passage of meconium
48 hours
Henoch Schonlein Purpura Follow up protocol
Urinalysis and BP
- weekly 1st month
- Forthnightly from weeks 5-12
- Then review at 6 months and 12 months
Vaccine-Proximate febrile seizure- time frame
- 5-14 days following live
- Within 48hours post innactivated’
NOTE: However, vaccine proximate status epilepticus should be referred to a pediatrician due to association with Dravet syndrome.
Risk factors for ADHD
- Concurrent ASD, Anxiety, ODD, Learning disorder
- Low birth weight
- Pre-term birth
- In care
- Family history
What is included on the neonatal screening test (Guthrie test)
- Phenylketonuira (PKU)
- Congenital hypothyroidism (CHT)
- Cystic Fiborisis
- Galactoseamia
- Rare disorders of metabolism
Causes of conjugated hyperbilirubinaemia (>10% fraction of total bili)
- Biliary atresia
- choledochal cyst
- Alpha1 anti-trypsin
- Neonatal hepatitis
- Bile plug
Chronic (wet) cough in a small child differentials?
- CF
- Protracted bacterial bronchitis
- Primary ciliary dyskinesia
- Alpha1 Anti-tripsin
- Recurrent aspiration
- Bronchiectasis
- ## Primary immunodeficiency
