Paediatrics Flashcards
What are signs of platelet type bleeding?
Mucosal bleedingPetechiaeBruusingPersistent bleeding from skin cuts
What are signs of clotting factor bleeding?
BruisingDeep haematomas
What is the main cause of platelet type bleeding?
Any thrombocytopenia or platelet dysfunctionVWD
What is the main cause of clotting factor bleeding?
Haemophilia
Phases of treatment of chemotherapy
InductionConsolidationInterim maintainenceDelyaed intensificationMaintainance
What happens in the induction phase of chemotherapy?
4-6 weeks of triple therapy chemo
What happens in the maintenance phase of chemotherapy?
Weekly oral methotrexate and daily oral mercaptopurine for 2 years (girls) or 3 years (boys) with monthly pulses of Vinc and Dex, and three monthly intrathecals.
What is intrathecal chemotherapy?
Treatment in which anticancer drugs are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord.
Wht are the sanctuary sites in ALL?
CNS and testes
What neutrophil count and fever temperature for neutropenic sepsis?
0.5 X 10 to the power of 9/LFever: 38
What is the main cardiac complication which should be screened for in Kawasaki’s disease?
Coronary Artery Aneurysm
Treatment of Kawasaki
Intravenous immunoglobulins and high dose aspirin
First line for atopic eczema
Flucloxacillin
Mode of inheritence of Duchenne’s?
X linked recessive
Name the sign which is classically associated with Duchenne’s, and may be evident if the child was asked to rise to stand from sitting on the floor.
Gower’s sign
What is henoch schonlein purpura
Henoch-Schonlein purpura (also known as IgA vasculitis) is a disorder that causes the small blood vessels in your skin, joints, intestines and kidneys to become inflamed and bleed
What weeks are at term for giving birth?
37-42 weeks
What weeks are at pre-term for giving birth?
Less than 36 plus 6
What is LBW?
Less than 2.5kg
What is a normal birth weight?
3.5 to 4kg
What is a very LBW?
Less than 1.3kg
What is an extremely LBW?
Less than 1kg
How to help temperature in preterm babies?
Put in bagPut hat on
Why do you give preterms caffiene?
Caffeine may also improve better lung stretch and expansion, cardiac output and blood pressure in premature infants, which improves oxygen supply throughout the body and brain
How does intussusception present?
Colicky abdominal pain, together with a mass on clinical examination.The often cited red current jelly type stool is a rare but classical feature.
How do juvenile polyps present?
may occur as part of the familial polyposis coli syndromes. The lesions, which are hamartomas, are often cherry red if they protrude externally.
Common cause of bright red rectal bleeding in children?
The hard stool causes a tear of the ano-rectal mucosa with subsequent fissure. The pain from the fissure must be addressed promptly or the child will delay defecation and this fissure will worsen.
When does duodenal atresia commonly present?
Few hours after birth
Diagnosis of duodenal atresia?
AXR shows double bubble sign, contrast study may confirm
Age at presentation of malrotation with volvulus?
Usually 3-7 days after birth, volvulus with compromised circulation may result in peritoneal signs and haemodynamic instability
When does jejuneal/ileal atresia present?
Usually within 24 hours of birth
When does meconium ileus present?
Typically in first 24-48 hours of life with abdominal distension and bilious vomiting
What is an inguinal hernia due to?
patent process vaginalis
Inguinal hernia repair rule
Six/two rule< 6 weeks old = correct within 2 days< 6 months = correct within 2 weeks< 6 years = correct within 2 months
Features of malrotation?
most common in babies <30 days of age. It tends to present with bilious vomiting. The abdomen is typically soft and non-tender initially, but if not treated, it leads to strangulation of the gut. This is suggested in this scenario by the presence of a distended and firm abdomen, and the lack of stool.
Presentation of pyloric stenosis?
non-bilious and is typically projectile. Its peak age of onset is age 4-8 weeks. Weight loss and dehydration are very common at presentation.
Presentation of necrotising enterocolitis?
presents in neonates with abdominal pain, swelling, diarrhoea with bloody stool, green/yellow vomit, lethargy, refusal to eat, and lack of weight gain
What is the first line for threadworms?
Mebendazole
Murmur heard in turner’s sometimes?
Ejection systolic murmur due to bicuspid aortic valve
Risk factors for neonatal sepsis?
Mother who has had a previous baby with GBS infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancyPremature (<37 weeks): approximately 85% of neonatal sepsis cases are in premature neonatesLow birth weight (<2.5kg): approximately 80% are low birth weightEvidence of maternal chorioamnionitis
What are Koplik spots
white spots (‘grain of salt’) on the buccal mucosa
Features of acute epiglottitis?
rapid onsethigh temperature, generally unwellstridordrooling of saliva’tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
SUFE management?
internal fixation: typically a single cannulated screw placed in the centre of the epiphysis
Is perthes more common in boys or girls?
Boys
What is Ebstein anomaly?
tricuspid valve is in the wrong position and the valve’s flaps (leaflets) are malformed.
Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress should make you consider what?
A diaphragmatic hernia
Chest compression speed in BLS?
100-120/min
Neonatal hypoglycaemia level in the first 24 hours of life?
< 2.6 mmol/L
Management of symptomatic or very low blood glucose in child?
admit to the neonatal unitintravenous infusion of 10% dextrose
Key features of Patau syndrome?
Microcephalic, small eyesCleft lip/palatePolydactylyScalp lesions
Key features of Edward’s syndrome?
MicrognathiaLow-set earsRocker bottom feetOverlapping of fingers
Key features of fragile X?
Learning difficultiesMacrocephalyLong faceLarge earsMacro-orchidism
Features of Noonan syndrome?
Webbed neckPectus excavatumShort staturePulmonary stenosis
Features of Pierre-Robin syndrome?
MicrognathiaPosterior displacement of the tongue (may result in upper airway obstruction)Cleft palate
Features of Prader-Willi syndrome
HypotoniaHypogonadismObesity
Features of William’s syndrome?
Short statureLearning difficultiesFriendly, extrovert personalityTransient neonatal hypercalcaemiaSupravalvular aortic stenosis
Features of Cri du Chat syndrome?
Characteristic cry (hence the name) due to larynx and neurological problemsFeeding difficulties and poor weight gainLearning difficultiesMicrocephaly and micrognathismHypertelorism
What is Hirschsprung’s disease?
aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses.
How long with Scarlet fever stay off school?
24 hours after commencing abx
PDA with no cyanosis what to use?
Idomethacin
PDA with cyanosis what to use?
Prostaglandins
When is hand preference a concern?
If it is before 12 months
Causes of snoring in children?
obesitynasal problems: polyps, deviated septum, hypertrophic nasal turbinatesrecurrent tonsillitisDown’s syndromehypothyroidism
Cyanotic congenital heart diseases?
tetralogy of Fallottransposition of the great arteries (TGA)tricuspid atresia
Features of roseola infantum?
high fever: lasting a few days, followed later by amaculopapular rashNagayama spots: papular enanthem on the uvula and soft palatefebrile convulsions occur in around 10-15%diarrhoea and cough are also commonly seen
Features of kawasaki disease?
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyreticsconjunctival injectionbright red, cracked lipsstrawberry tonguecervical lymphadenopathyred palms of the hands and the soles of the feet which later peel
William’S mneumonic
ShortStruggles in schoolSmileySupravalvular aortic stenosis
Secnd line after just SABA in paedaitric asthma?
Add ICS
Organism causing threadworms?
Enterobius vermicularis
Features in ASD?
shortness of breath, lethargy, poor appetite and growth and increased susceptibility to respiratory infections
Features in VSD?
Pansystolic murmur in lower left sternal border
Features of coarctation of the aorota?
Crescendo-decrescendo murmur in the upper left sternal border
Findings of a PDA?
Diastolic machinery murmur in the upper left sternal border
Pulmonary stenosis murmur?
Ejection systolic murmur in the upper left sternal border
Newborn chest compression and ventilation rate?
03:01
M S O memeory aid in childhood constipation
1st line : Movicol (specific type of osmotic laxative use in pediatric)2nd line : Stimulant (Senna)3rd line : Osmotic (lactulose)
Investigation of choice for intussusception?
ultrasound is now the investigation of choice and may show a target-like mass
Scarlet fever treatment>
Oral pencillin V for 10 days
Management of exomphalos (omphalocele)
a staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressureif this occurs the sacs is allowed to granulate and epithelialise over the coming weeks/monthsthis forms a ‘shell’as the infant grows a point will be reached when the sac contents can fit within the abdominal cavity. At this point the shell will be removed and the abdomen closed
When should unilateral undescended testis be referrred?
considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
Mumur in tetralogy of fallot?
Ejection systolic murmur due to pulmonary stenosis
Management of pyloric stenosis?
Ramstedt pyloromyotomy
Management. ofHirschprungs
initially: rectal washouts/bowel irrigationdefinitive management: surgery to affected segment of the colon
Side effect of methylphenidate (ADHD medication)
Stunted growth
How long should febrile convulsion last for you to call an ambulance?
5 minutes
Bronchodilator therapy in mild to moderate acute asthma attack?
Bronchodilator therapygive a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)give 1 puff every 30-60 seconds up to a maximum of 10 puffsif symptoms are not controlled repeat beta-2 agonist and refer to hospital
Management of mild to moderate acute asthma attack with steroids?
should be given to all children with an asthma exacerbationtreatment should be given for 3-5 days
Emergency treatment of croup?
high-flow oxygennebulised adrenaline
1 defective alpha gene
Silent carrier
3 defective alpha gennes
HbHExcess beta chainsCauses hypoxia
4 alpha gens deleted?
Hb Bart’s hydropsfetalisSevere hypoxia
Features of benign rolandic epilepsy?
seizures characteristically occur at nightseizures are typically partial (e.g. paraesthesia affecting the face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements)the child is otherwise normal
EEG characteristic in benign rolandic epilespy?
Controtemporal spikes
Autosomal recessive conditions are often thought to be what?
Metabolicsome ‘metabolic’ conditions such as Hunter’s and G6PD are X-linked recessive whilst others such as hyperlipidaemia type II and hypokalaemic periodic paralysis are autosomal dominan
autosomal dominant conditions are thought to be what?
Structural some ‘structural’ conditions such as ataxia telangiectasia and Friedreich’s ataxia are autosomal recessive
Phases in Whooping cough?
Catarrhal phaseParoxysmal phaseConvalescent phase
What is the catarrhal phase in whooping cough?
symptoms are similar to a viral upper respiratory tract infectionlasts around 1-2 weeks
Features in the paroysmal phase of whooping cough?
the cough increases in severitycoughing bouts are usually worse at night and after feeding, may be ended by vomiting & associated central cyanosisinspiratory whoop: not always present (caused by forced inspiration against a closed glottis)infants may have spells of apnoeapersistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizureslasts between 2-8 weeks
Features in the convalescnet phase of whooping cough?
the cough subsides over weeks to months
Cuaes of chronic diarrohea
most common cause in the developed world is cows’ milk intolerancetoddler diarrhoea: stools vary in consistency, often contain undigested foodcoeliac diseasepost-gastroenteritis lactose intolerance
What ineritance pattern is haemophilia A
X linked recessive
Treatment lines for childhood asthma?
1- SABA2- SABA and ICS3- SABA, ICS and LTRA4- SABA, ICS and LABA5- SABA and switch ICS/LABA for a maintaincence and reliver therapy MART that includes a paeidatric low dose ICS6- SABA and paediatric moderate ICS MART or consider changing back to a fixed dose of. amoderate dose ICS and a seperate LABA7- SABA and one of the following options: increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MARTa trial of an additional drug (for example theophylline)seeking advice from a healthcare professional with expertise in asthma
Precocious puberty age in males and females?
9 in males and 8 in females
What is osteochondritis dissecans?
Pain after exerciseIntermittent swelling and locking
When are the three doses of meningitis B vaccine given?
2 months4 months12-13 months
Features of Wilms tumour?
abdominal mass (most common presenting feature)painless haematuriaflank painother features: anorexia, feverunilateral in 95% of casesmetastases are found in 20% of patients (most commonly lung)
X ray findings in necrotising enterocolitis?
dilated bowel loops (often asymmetrical in distribution)bowel wall oedemapneumatosis intestinalis (intramural gas)portal venous gaspneumoperitoneum resulting from perforationair both inside and outside of the bowel wall (Rigler sign)air outlining the falciform ligament (football sign)
Fragile X - taking the X and making XL:
XL testes (macroorchidism)XL face (long thin face)X eXtra relaxed - hypotoniaL - Learning difficulties
Hypospadias is characterised by what?
a ventral urethral meatusa hooded prepucechordee (ventral curvature of the penis) in more severe formsthe urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.
What is the cause of jaundice in first 24 hours?
Pathological
Management of acute limp in under 3 year olds?
Urgent admission
Diagnostic test for hirschprung’s?
Rectal biopsy
Most common cause of ambigiousn genitalia in newborns?
Congenital adrenal hyperplasia
Recurrent febrile convulsions management?
Benzoiazepine
What does spastic cerebral palsy result from?
Damage to upper motor neurons in the periventricular white matter
Most likely organism to cause croup?
Parainfluenza virus
Most common cause of stridor in a neonate?
Laryngomalacia
What is gastroschisis?
congenital defect in the anterior abdominal wall just lateral to the umbilical cord.
First line for ADHD in children?
Methylphenidate
When is the oral rotavirus given?
2 and 3 months old
Cause of small testes?
Adrenal cause
What is barlow test?
Barlow test: attempts to dislocate an articulated femoral head
Features of Infantile spasms?
characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the armsthis lasts only 1-2 seconds but may be repeated up to 50 timesprogressive mental handicap
Diseases that dont require school exclusion?
ConjunctivitisFifth disease (slapped cheek)RoseolaInfectious mononucleosisHead liceThreadwormsHand, foot and mouth
The most specific indicators of a life-threatening asthma attack are:
CyanosisPoor respiratory effortPeak expiratory flow rate < 33%Silent chestAltered level of consciousness
Management of UTI if less than 3 months?
Immediate referral to paediatrics
TOF is a result of anterior malalignment of the aorticopulmonary septum. The four characteristic features are:
ventricular septal defect (VSD)right ventricular hypertrophyright ventricular outflow tract obstruction, pulmonary stenosisoverriding aorta
What are the episodic cyanotic features seen in tetralogy of fallot infants?
episodic hypercyanotic ‘tet’ spells due to near occlusion of the right ventricular outflow tract
What is androgen insensitivty syndrome?
X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype. Complete androgen insensitivity syndrome is the new term for testicular feminisation syndrome
Features of androgen insensitivty synbdrome?
‘primary amenorrhoea’undescended testes causing groin swellingsbreast development may occur as a result of conversion of testosterone to oestradiol
Chickenpox is a risk factor for what tissue incfection?
invasive group A streptococcal soft tissue infections including necrotizing fasciitis
What is insussusception?
e invagination of one portion of the bowel into the lumen of the adjacent bowel, most commonly around the ileo-caecal region.
Investigations for vesicoureteric reflux?
VUR is normally diagnosed following a micturating cystourethrograma DMSA scan may also be performed to look for renal scarring
Freatures of gastro-oesophageal reflu in children?
typically develops before 8 weeksvomiting/regurgitationmilky vomits after feedsmay occur after being laid flatexcessive crying, especially while feeding
Triad for shaken baby syndrome?
Retinal haemorrhages, subdural haematoma, and encephalopathy
Management of episodic viral wheeze?
treatment is symptomatic onlyfirst-line is treatment with short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacernext step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or boththere is now thought to be little role for oral prednisolone in children who do not require hospital treatment
Features of childhood sexual abuse can include:
pregnancysexually transmitted infections, recurrent UTIssexually precocious behaviouranal fissure, bruisingreflex anal dilatationenuresis and encopresisbehavioural problems, self-harmrecurrent symptoms e.g. headaches, abdominal pain
Cause of scarlet fever?
Group A haemolytic streptococci
causative agent of roseola infantum?
Huamn herpes virus 6
Other possible consequences of roseola infantum infection
aseptic meningitishepatitis
Management of meningitis in less than. 3months old?
IV amoxicillin (or ampicillin) + IV cefotaxime
Features of achondroplasia?
short limbs (rhizomelia) with shortened fingers (brachydactyly)large head with frontal bossing and narrow foramen magnummidface hypoplasia with a flattened nasal bridge’trident’ handslumbar lordosis
Management of whooping ciugh?
infants under 6 months with suspect pertussis should be admittedin the UK pertussis is a notifiable diseasean oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spreadhousehold contacts should be offered antibiotic prophylaxisantibiotic therapy has not been shown to alter the course of the illnessschool exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
Clinical features of hand, foot and mouth?
mild systemic upset: sore throat, feveroral ulcersfollowed later by vesicles on the palms and soles of the feet
Features of ALL in children?
anaemia: lethargy and pallorneutropaenia: frequent or severe infectionsthrombocytopenia: easy bruising, petechiaebone pain (secondary to bone marrow infiltration)splenomegalyhepatomegalyfever is present in up to 50% of new cases (representing infection or constitutional symptom)testicular swelling
APGAR criteria?
PulseRespiratory effortColourMuscle toneReflex irritability
VACCINE at 13-18 years?
‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)Men ACWY
What is Meckel;’s diverticulum?
congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa.
Presentation of Meckel’s diverticulum?
abdominal pain mimicking appendicitisrectal bleeding: Meckel’s diverticulum is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 yearsintestinal obstruction: secondary to an omphalomesenteric band (most commonly), volvulus and intussusception
What is considered a very low blood glucose?
Less than 1 mmol/L
How long to stay off school after rubella is diagnosed?
5 days from onset of rash
How long to stay off school with hand, foot and mouth?
No exclusion
CKS suggest admitting any child with moderate or severe croup. Other features which should prompt admission include:
- < 6 months of age* known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)* uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
What are salaam attacks? What is this seen in?
flexion of the head, trunk and arms followed by extension of the armsInfantile spasms or also known as west syndrome
Symptoms of haemolytic uraemia syndrome?
microangiopathic haemolytic uraemia, acute kidney injury and thrombocytopenia
Features of ITP?
- bruising* petechial or purpuric rash* bleeding is less common and typically presents as epistaxis or gingival bleeding* May follow an infection or vaccination
What is mesenteric adenitis?
inflamed lymph nodes within the mesentery.
What is pauciarticular JIA?
- joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows* limp* ANA may be positive in JIA - associated with anterior uveitis* Less than 4 joints affected
What kind of vaccine is rotavirus?
LAV
Why does a venous hum occur?
Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles
What are the masses felt in androgen insensitivity syndrome?
Undescended testis
Management of perthes if less than 6?
Observation
What are venous hums?
Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles
What is a Stills mumur?
Low-pitched sound heard at the lower left sternal edge
Characteristics of an innocent ejection murmur include:
soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic areamay vary with posturelocalised with no radiationno diastolic componentno thrillno added sounds (e.g. clicks)asymptomatic childno other abnormality
Features suggestive of hypernatraemic dehydration:
jittery movementsincreased muscle tonehyperreflexiaconvulsionsdrowsiness or coma
Management of paediatric intestinal malrotation with volvulus?
Ladd’s procedure (includes division of Ladd bands and widening of the base of the mesentery)
What age should phimphosis be corrected?
If over 2 years old
What is therapeutic cooling?
Deliberate lowering of a patient’s body temperature. The intention of this is to cool the brain, and subsequently prevent brain damageEffocacy has only been proven in neonates
Mneumonic fror DDH
NAME?
Whay happens if significant outflow obstruction to RV?
If there is significant stenosis, deoxygenated blood entering the right ventricle can only travel into the arterial circulation via the overriding aorta (i.e. it cannot travel into the pulmonary circulation like normal due to the stenosis of the pulmonary valve). This will lead to an increased amount of deoxygenated blood in the arteries, causing a bluish-tinge to the skin (i.e. cyanosis). If the degree of pulmonary stenosis is less, deoxygenated blood entering the right ventricle can travel into the pulmonary circulation and not into the aorta, thus allowing oxygenation and less severe cyanosis
What is done if otoacoustic emission test is abnormal?
Auditory brainstem response test
Complications of chickenpox?
NSAIDs may increase this riskwhilst this commonly may manifest as a single infected lesion/small area of cellulitis, in a small number of patients invasive group A streptococcal soft tissue infections may occur resulting in necrotizing fasciitispneumoniaencephalitis (cerebellar involvement may be seen)disseminated haemorrhagic chickenpoxarthritis, nephritis and pancreatitis may very rarely be seen
Features of growing pains?
never present at the start of the day after the child has wokenno limpno limitation of physical activitysystemically wellnormal physical examinationmotor milestones normalsymptoms are often intermittent and worse after a day of vigorous activity
CF features?
neonatal period (around 20%): meconium ileus, less commonly prolonged jaundicerecurrent chest infections (40%)malabsorption (30%): steatorrhoea, failure to thriveother features (10%): liver disease
2 months vaccine?
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)Oral rotavirus vaccineMen B
3 month vaccines?
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)Oral rotavirus vaccinePCV
4 months vaccines?
‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)Men B
12-13 months vaccines?
Hib/Men CMMRPCVMen B
2-8 years vaccine?
Flu vaccine (annual)
3-4 year vaccine?
‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)MMR
12-13 vaccine?
HPV vaccination
Features of tetrlogy of fallot?
ventricular septal defect (VSD)right ventricular hypertrophyright ventricular outflow tract obstruction, pulmonary stenosisoverriding aorta
What age do you get a good pincer grip?
12 months
Features oif measles?
prodromal phase irritableconjunctivitisfeverKoplik spotstypically develop before the rashwhite spots (‘grain of salt’) on the buccal mucosarashstarts behind ears then to the whole bodydiscrete maculopapular rash becoming blotchy & confluentdesquamation that typically spares the palms and soles may occur after a weekdiarrhoea occurs in around 10% of patients
What minutes after birth assess apgar?
1 and 5
Peak incidence of croup?
Autumn
What us biliary atresia?
paediatric condition involving either obliteration or discontinuity within the extrahepatic biliary system, which results in an obstruction in the flow of bile. This results in a neonatal presentation of cholestasis in the first few weeks of life. The pathogenesis of biliary atresia is unclear, however, infectious agents, congenital malformations and retained toxins within the bile are all contributing factors.
What is palivizumab?
Monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease.
Inheritance pattern of Prader Willi
example of genetic imprinting where the phenotype depends on whether the deletion occurs on a gene inherited from the mother or father:Prader-Willi syndrome if gene deleted from fatherAngelman syndrome if gene deleted from mother
Heart defect associatedd ith duchennes?
Dilated cardiomyopathy
Meningitis causes in neonatal to 3 months?
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranesE. coli and other Gram -ve organismsListeria monocytogenes
What is Immune (or idiopathic) thrombocytopenic purpura
immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex. It is an example of a type II hypersensitivity reaction.
Management of ITP?
usually, no treatment is requiredITP resolves in around 80% of children with 6 months, with or without treatmentadvice to avoid activities that may result in trauma (e.g. team sports)other options may be indicated if the platelet count is very low (e.g. < 10 * 109/L) or there is significant bleeding. Options include:oral/IV corticosteroidIV immunoglobulinsplatelet transfusions can be used in an emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by the circulating antibodies
Complications of undescended testis?
infertilitytorsiontesticular cancerpsychological
Steroid use in bacterial meningitis?
NICE advise against giving corticosteroids in children younger than 3 monthsdexamethsone should be considered if the lumbar puncture reveals any of the following:frankly purulent CSFCSF white blood cell count greater than 1000/microlitreraised CSF white blood cell count with protein concentration greater than 1 g/litrebacteria on Gram stain
Gross motor at 9 months?
Pulls to standingCrawls
Gross motor at 18 months?
Squats to pick up a toy
Gross motor at 4 years?
Hops on one leg
When is a neonatal death classed up until?
28 days
Motor memory aid for children
3 6 9 12 Head shoulders knees and toes3 months head control6 months - sitting (supported)9 - crawling12 - walking
Causes of neonatal hypotonia include:
neonatal sepsisWerdnig-Hoffman disease (spinal muscular atrophy type 1)hypothyroidismPrader-Willi
Diagnosis of pyrloci stenosis?
Ultrasound
Kocher criteria
Non-weight bearing - 1 pointFever >38.5ºC - 1 pointWCC >12 * 109/L - 1 pointESR >40mm/hr
MaNgwmwnr of trasient tachyponea of the newborn?
observation, supportive caresupplementary oxygen may be required to maintain oxygen saturations
Clinical features of transposition of the grreat arteries?
cyanosistachypnoealoud single S2prominent right ventricular impulse’egg-on-side’ appearance on chest x-ray
What should tinkling sounds in the heart make you consider?
The bowel in the thorax is responsible for the bowel sounds heard. The physical presence of bowel in thorax displaces the heart, and thus the heart sounds are heard louder on the right hand side.
Bronchioloitis symptoms that require referral
apnoea (observed or reported)child looks seriously unwell to a healthcare professionalsevere respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minutecentral cyanosispersistent oxygen saturation of less than 92% when breathing ai
When should ou passs your first poo by?
48 hours :)
Most common cause of childhood cardiac arrest?
Respiratory
Red flag respiratory rate in paeds?
More than 60 BPM
Most common congenital infection in the UK?
Cytomegalovirus
Complications of measles?
otitis media: the most common complicationpneumonia: the most common cause of deathencephalitis: typically occurs 1-2 weeks following the onset of the illness)subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illnessfebrile convulsionskeratoconjunctivitis, corneal ulcerationdiarrhoeaincreased incidence of appendicitismyocarditis
Circulation and hydration red flag symptom?
Reduced skin turgour
mANAGEMENT OF BRONCHITOLOGITIS?
humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%nasogastric feeding may be needed if children cannot take enough fluid/feed by mouthsuction is sometimes used for excessive upper airway secretions
Can return to school 24hours after abx?
Scarlet fever
Can return to school 2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )?
Whooping cough
4 days from onset of rash return to school condition?
Measles
All lesions crusted over condition that means can return to schoool?
Chickenpox
5 days from onset of swollen glands can return to school condition?
Mumps
Until lesions are crusted and healed, or 48 hoursafter commencing antibiotic treatment can return to school condition?
Impetigo
Management of chickenpox?
keep cool, trim nailscalamine lotionschool exclusion: NICE Clinical Knowledge Summaries state the following: Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash).immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG). If chickenpox develops then IV aciclovir should be considered
Gold standard investigation for hirschprungs?
Rectal biopsy
mycoplasma or chlamydia is suspected in a chest infection. What is the first line?
Macrolides
What should you not do if a patient presents with stridor?
Examine their throat
MMR in children not at normal vaccine schedule. How long between vaccine intervals?
3 months1 month if urgent like school outbreak
All breech babies require what at 6 weeks after birth?
US of the hip
Red signs in children?
- Moderate or severe chest wall recession* Does not wake if roused* Reduced skin turgor* Mottled or blue appearance* Grunting
A 5-day-old baby has her heel prick test done, and it comes back that she has a raised level of immunoreactive trypsinogen (IRT). What is the most appropriate next test for this baby?
On day 5 of life, newborns have the heel prick test. They are tested for cystic fibrosis (CF), congenital hypothyroidism, sickle cell disease, and a number of other metabolic diseases. For CF, the levels of IRT are tested, and if they are raised that can indicate CF. The baby should then undergo the sweat test, and if this is raised, this confirms a diagnosis of CF.
You are asked to see a baby on the post-natal ward 10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?
Measure serum bilirubin within 2 hours as high risk for severe hupefbilirubinawmia
Features of slipped capital femoral epiphysis?
- hip, groin, medial thigh or knee pain* loss of internal rotation of the leg in flexion* bilateral slip in 20% of cases
Treatment of intususspeption?
Pneumatic reduction under fluoroscopic guidance
Management of necrotising enterocolitis?
Treatment is with total gut rest and TPN, babies with perforations will require laparotomy
Investigation for meckels diverticulum?
- the child is haemodynamically stable with less severe or intermittent bleeding then a ‘Meckel’s scan’ should be considered * uses 99m technetium pertechnetate, which has an affinity for gastric mucosa* mesenteric arteriography may also be used in more severe cases e.g. transfusion is required
What is caput succedaneum?
- the child is haemodynamically stable with less severe or intermittent bleeding then a ‘Meckel’s scan’ should be considered * uses 99m technetium pertechnetate, which has an affinity for gastric mucosa* mesenteric arteriography may also be used in more severe cases e.g. transfusion is required
Management of biliary atresia?
- Surgical intervention is the only definitive treatment for biliary atresia: Intervention may include dissection of the abnormalities into distinct ducts and anastomosis creation* Medical intervention includes antibiotic coverage and bile acid enhancers following surgery
Limping child pathway summary
- Fever and limping - bloods to r/o septic arthritis2. Trauma and limping - XR to r/o #3. No fever, not unwell, no trauma and limping - reassure, analgesia advise and GP follow-up if not improving with good safetynet
Features of systemic onset JIA include
pyrexia* salmon-pink rash* lymphadenopathy* arthritis* uveitis* anorexia and weight loss
Management of hirshprungs?
- initially: rectal washouts/bowel irrigation* definitive management: surgery to affected segment of the colon
What is irritant dermatitis
irritant effect of urinary ammonia and faecesCreases are characteristically spare
What is a patent ductus arteriosus?
connection between the pulmonary trunk and descending aorta
Treatment for cerebral palsy?
include oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy
Features of rickets?
- aching bones and joints* lower limb abnormalities: * in toddlers genu varum (bow legs) * in older children - genu valgum (knock knees)* ‘rickety rosary’ - swelling at the costochondral junction* kyphoscoliosis* craniotabes - soft skull bones in early life* Harrison’s sulcus
Management of asthma attack in children?
Salbutamol and steroids
Second line for perthes?
MRI
When is a heel prick done?
5-9 days of life
Purloin stenosis investigation?
Abdominal US
Antibiotics given in meningitis if more than 3 months?
- IV cefotaxime (or ceftriaxone)
When is the men B vaccine given?
2, 4 and 12-13 months.
When is first MMR vaccine given?
12-13 months old
What is an umbilical granuloma?
overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid. It is treated by regular application of salt to the wound, if this does not help then the granuloma can be cauterised with silver nitrate.
Management of surfactant deficient lung disease?
- prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation* oxygen* assisted ventilation* exogenous surfactant given via endotracheal tube
