Paediatrics Flashcards
itchy rash over face, golden crust, fever
Mx
Impetigo
Hydrogen peroxide 1% cream, fusidic acid cream
rough maculopapular rash on face, periorbital sparing, red tongue
scarlet fever
Mx of scarlet fever
phenoxymethylpenicillin
red rash all over body, white Koplik spots inside buccal cavity
Measles
red rash on both cheeks, fever
Parvovirus B19
drooling, soft inspiratory stridor, unwell child
cause:
acute epiglottis
cause: haemophilus influenza B
widespread polymorphic rash across her torso, and she has oedematous feet. Examination of the mouth shows widespread mucosal erythema and a strawberry tongue.
Kawasaki disease
criteria to treat tonsillitis
CENTOR: no cough, has fever, has cervical lymphadenopathy, has exudate
give phenoxymethylpenicillin for 5 days
measles Px
conjunctivitis
raised red rash
high fever
white koplik spots in oral mucosa
hand foot and mouth MX
supportive
croup cause
parainfluenza
fever >5 days
conjunctivitis
swollen neck glands
red tongue
rash
Kawasaki
Kawasaki Mx
IV Ig + aspirin
echo to assess cardiac effect
ADHD not responding to conservative measures. Med:
methylophenidate
similar symptoms to SUFE but child under 10
perthes disease
failure to pass meconium
distended abdomen
explosive diarrhoea after removing finger during rectal examination
what is it, Ix, Mx
hirshsprungs disease
Ix: rectal suction biopsy
Mx: remove unhealthy bowel
machine whirring murmur
patent ductus arteriosus
use of prostaglandin E in ASD/VSD
allows the ductus to remain patent
blood will continue to flow into the heart
immediate/premature Mx of PDA
indomethacin (NSAID) to inhibit prostaglandin and therefore keep the ductus closed
Eisenmenger syndrome
the left -> right shunt reverses to become right -> left.
This happens when the pulmonary pressure > systemic pressure
coarctation of the aorta
narrowing of the aorta
systolic murmur loudest in the back. radio-femoral delay
wide neck, low set ears
coarctation of the aorta in a pt with turners syndrome
teratology of fallot
- right ventricular hypertrophy
- pulmonary stenosis
- overriding aorta
- ventricular septal defect
boot shaped heart on CXR
ToF
transposition of the great arteries
the aorta and pulmonary arteries are switched in position. creates two parallel circuits. incompatible with life in theory but there are many shunts which allow blood to still flow
feverish child, trouble swallowing, drooling, sitting forward (tripod position)
epiglottitis
cause of epiglottitis
haemophilia influenza B (there is a vaccine)
Dx and Mx of epiglottitis
lateral x ray of the neck = thumbprint sign
secure airway (may need intubation), IV antibiotics, dexamethson
what to prescribe in constipated child first line
movicol disimpaction regimen, then senna/lactulose etc
biliary atresia
congenital issue where the final part of the bile duct is not formed
bile cannot leave the gallbladder
raised conjugated bilirubin
jaundice!
born preterm, bloody stool, abdominal distension, bilious vomiting
Mx
necrotising enterocolitis
broad spectrum ABs and parenteral feeding
intussuception
the bowel telescopes into itself
sausage shaped mass, red currant stool, intermittent abdominal pain
Ix and Mx for intussuception
contrast enema, reduction for Mx
hirschsprungs disease
dysfunctional myenteric plexus; lack of parasympathetic ganglionic cells
no peristalsis, so faeces gets backed up, constipation
abdominal pain, doesn’t pass meconium, explosive excretion after digital rectal exam
intestinal obstruction Px
abdominal distention, bilious vomiting, failure to pass stool or wind
dilated loops of bowel proximal to the obstruction
abnormal bowel sounds (tinkling, then absent later in the obstruction)
olive shaped mass
pyloric stenosis
Mx for pyloric stenosis
pylomyotomy
Px of pyloric stenosis
olive shaped mass, projectile vomiting
Px of appendicitis
pain in central abdo that then travels to RIF
Rovsings sign: palpated on LIF, pain on RIF
x ray of duodenal atresia
double bubble
x ray of jejunal atresia
triple bubble
joint pain, fever, salmon-pink rash
Juvenile idiopathic arthritis / stills disease
how to differentiate roseola infantum vs slapped cheek
roseola infantum has a higher fever
lethargy, slurred speech, hepatomegaly, fever after taking aspirin
what has happened>
reyes syndrome
liver failure and subsequent encephalopathy
Presentation of phenylketonuria
Hypopigmentation
Musty odour
Eczema
Microcephaly
Two conditions which cause abdominal contents to protrude from the foetus’ abdomen and how to diffferentiate
Gastroschisis vs omphalocele
Omphalocele has organs covered in the peritoneum
Baby immediately vomiting uncurdled milk when breastfeeding
Tracheo oesophageal fistula
Milk is uncurdled as it hasn’t reached the stomach
Signs of clinical dehydration in children
Dry mucus membranes
Sunken eyes
Irritability
Normal crt
Signs of clinical shock in children
Mottled pale skin
Altered consciousness
Low bp
Prolonged cap refill time
Legg calve perthes disease
Comprised blood flow to the femoral head
Usually presents age 4 to 9 with limp and pain upon walking, better when sitting
Self limiting
how many inhaler puffs is equal to 1 nebule
6 (childs dose)
what is burst therapy in asthma attack Mx
100mcgs of salbutamol 10 puffs with spacer
every 20 mins for 1 hour
bilateral palpable flank masses
renal cysts, hepatic fibrosis
autosomal recessive pckd
potter syndrome
pulmonary hypoplasia
oligohydramnios
due to ARPKD / bilateral renal agenesis
appearance of a kid with potters sydnrome
low set ears
beaked nose
limb deformities
bilateral renal agenesis
both kidneys fail to develop
can cause potters sydnrome
Px of haemolytic uraemic syndrome
bloody diarrhoea
vomiting
hypertensive
pallor
seizures
haemorrhage disease of newborn is caused by..
vitamin k deficiency
unilateral wheeze, no signs of infection
foreign body inhalation
murmur in ASD
ejection systolic murmur heard in the pulmonary region
fixed split s2 (pulmonary valve closes later than the aortic valve)
murmur in VSD
systolic murmur at the pulmonary region
diastolic murmur at heart apex
most significant risk factor for developmental dysplasia of the hip
breech position in 3rd trimester
tests for DDH
barlow and ortolani
what type of heart sound is heart in ASD?
and why
fixed split second heart sound.
ASD = left to right shunt causes an increased pressure in the Right Atrium. This means the pulmonary valve closes later than the aortic valve. “fixed” means that it happens irrespective of inspiration and expiration.
most common cerebellar neoplasm in childhood
astrocytoma
blood gas reading on pyloric stenosis
hypochloraemic hypokalaemia metabolic alkalosis
murmur and heart sounds heard in VSD
holosystolic murmur
loud s2
maternal diabetes is assoc with what congenital heart abnormality
VSD
maternal rubella is assoc with what congenital heart abnormailty
PDA
turners syndrome karyotype and association
45XO
coarctation of the aorta
what abnormalities are seen in ToF
pathophis
- VSD
- RV hypertrophy
- pulmonic stenosis
- overriding aorta
deoxygenated blood cannot leave the pulmonary artery due to stenosis
shunts through the VSD instead
cyanotic
murmur heard in ToF
ejection systolic in left upper sternal border
short term and long term Mx of TGA
short term: prostaglandin e2 to maintain PDA. balloon atrial septostomy
Long term: arterial switch opereation
cyanotic heart disease presenting in the first week of life
transposition of the great arteries
cyanotic heart anomaly presenting after the first week of life
ToF
4 examples of acyanotic heart disease
VSD
ASD
PDA
CoA
signs of unwell child (A/B,C,D)
A/B: increased work of breathing, tachypnea, poor air entry
C: blue, long cap refill time, cool peripheries, tachycardia
D: AVPU, irritability
cephalohaematoma
what is it, px, associations, Mx
subperiosteal haemorrhage
caused by birth trauma
assoc with prolonged 2nd stage of labour, instrumental delivery,
does not cross suture lines
well-circumscribed fluctuant mass, parietal bone
appears in first week of life, disappears by few months
caput succedaneum
px, mx
diffuse swelling of the scalp that is above the periosteum, so it crosses suture lines
resolves within first few days of life
subgaleal haemorrhage
associations Px Mx
assoc with instrumental delivery
rupture of emissary veins, leading to bleeding between the periosteum and the gala aponeurosis.
fluctuant mass, overlying bruising
crosses over suture lines
Mx: monitor for haemorrhagic shock
Moro reflex
Arms flayed out
Then pulled back in tight to chest
Crying
Asymmetrical Moro reflex shows
Brachial plexus / isolated nerve injury
Waiters tip deformity …
Erbs palsy
son had a runny nose and sore throat for the past few days but then developed bright red rashes on both cheeks. He now has a raised itchy rash on his chest that looks lace-like in appearance
Parvovirus b19
Mx of bordetella pertussis
Azithromycin
congenital adrenal hyperplasia pathophis
defect in hydroxylase 21 gene
hydroxylase 21 is required to convert progesterone into aldosterone and cortisol
so it can’t happen in CAH]
however hydroxylase 21 isn’t required to convert progesterone into testosterone.
so all free progesterone is converted to testosterone
Px of Congenital adrenal hyperplasia in females
tall, virilised genitals, large clitoris, absent periods
Px of congenital adrenal hyperplasia in males
tall, large penis, small testicles, deep voice
general Px of CAH and why
poor feeding, vomtiing, diarrhoea, bronzed skin
due to the production of ACTH (due to lack or cortisol and aldosterone)
Ix findings in CAH
unequivocally elevated serum conc of 17-hydroxyprogesterone
pathophis of phenylketonuria
defect in phenylalanine hydroxylase gene
buildup of phenylalaine
inheritance pattern of phenylketonuria
autosomal recessive
prevention of migraines when propranolol is contraindicated
topiramate
at what age is enuresis alarm offered for bed wetting
over 7 years
small jaw, low-set ears, rocker-bottom feet and overlapping fingers.
what is the syndrome and what is the chromosomal abnormality
edwards
trisomy 18
webbed neck, pectus excavatum, short stature and pulmonary stenosis.
noonans syndrome
microcephaly, small eyes, cleft lip/palate, polydactyly and scalp lesions.
syndrome + chromosomal abnormality
patau
trisomy 13
features of turners syndrome but in a boy
noonans syndrome
hearing screening for newborns (2 tests)
- otoacoustic emission test
if failed: - impedance audiometry
3 examples of oral live attenuated vaccine
rotavirus
polio
typhoid
intestinal malrotation is more likely to affect where? + Mx?
small bowel
Ladd’s procedure
Williams syndrome
Px, what chromosome
elfin facies, strabismus, broad forehead, short stature
very friendly, learning difficulties
micro deletion on chromosome 7
what is in the 6 in 1 vaccine
diptheria
tetanus
polio
pertussis
Haemophilus influenza B
Hep B
