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