Paediatrics Flashcards
At what week are surfactants produced in the lungs
17-26 weeks
so babies worn before this will require ventilation support
Name some difference on resp tract in child vs adult
Tongue: Childs is larger in proportion to mouth
Epiglottis: it is floppier, u-shaped in child and shorter in adults
Vocal cords: it is upwardly slanted in child whereas it is horizontal in adults
The larynx is more anterior and superior in child
less lung capcity in a child
Treatment for surfactant deficiency
CPAP + steroids +diuretics +RSV monoclonal antibody
What is laryngomalacia
congenital abnormality of the larynx cartilage causes supraglottic collapse during the inspiratory phase of respiration
How does laryngomalacia present
harsh cough
stridor
breathing/ feeding/ sleeping difficulties
What is meckel’s diverticulum
formation of a small pouch consisting of tissue found elsewhere in the body like pancreatic or gastric tissue
it is clinically indistinguishable from appendicitis
what are the rules of 2 in meckel’s diverticulum
Occurs in 2% of population
2cm long
2 feet from ileocaecal valve
Presents under 2 years of age
2 x more common in males
in meckels diverticulum if gastric cells are present then how would the patient present
bloody stools as the gastric cells will cause ulceration
what is volvulus
occurs when the bowel twists so the blood supply to that part of the bowel is cut off
life threatening
symptoms of volvulus
bilious vomiting
severe abdominal pain
irritability
poor feeding
diarrhoea
fever
examination findings on volvulus
distended abdomen
very tender
dehydrated
tachycardia
Investigation for volvulus
AXR
Bloods- FBC, CRP, U&E
Barium swallow- if child stable
Management for volvulus
Resuscitate- iv fluids, analgesia, abx
NG tube insertion to decompress the abdo distension
Emergency laparotomy for ;adds procedure +/- stoma formation
what are the 2 types of stomas and what do they contain
colostomy- contents more solid
ileostomy - contents more liquid
what is wilms tumour
unilateral renal tumour
2 common finding in wilms tumour
palpable abdo mass and abdominal distention
treatment for wilms tumour
chemo and surgical resection
what is neuroblastoma
a form of cancer that develops from specialised nerve cells (neuroblasts) left behind from a baby’s development in the womb
where does neuroblastoma most commonly originate from
adrenal or paraspinal sites
what does a neuroblastoma present with
abdominal distension or mass +anorexia
what in urine is suggestive of neuroblastoma
catecholamines
Treatment for neuroblastoma
chemotherapy, surgery and radiotherapy
what is rhabdomyosarcoma
soft tissue sarcoma in children , occurs around muscular structures
what syndrome is rhabdomyosarcoma associated with
Li-Fraumeni syndrome
what is gastroschisis
defect in the abdominal wall, gut exposed
what is omphalocele
failure of viscera to return into abdo cavity
How can a button battery indigestion present as
increased drooling
poor oral intake
distress when feeding
what is hypospadias
meatus on underside of penis
if hypospadias is noted earlier on then what must you avoid doing
do not circumcise, because foreskin used in repair
what age is a hypospadias usually repaired at
6-9 months
most common symptoms of an UTI in infants younger than 3 months
Fever
vomiting
lethargy
irritability
Treatment for UTI in children under 3 months
send urine sample for urgent microscopy and culture
refer to paeds specialist care for further investigation
also think safeguarding
Treatment for UTI in children over 3 months
if leukocyte or nitrate or both positive then start antibiotics and send for culture
what ages are neonate
new-born to 4 weeks of age
What is SCBU
Low dependency unit (Special care), if babies >32 weeks that only require some extra support before going home
What is NICU
neonatal intensive care- different levels
What is PICU
Babies aged 28 days and over (also if babies have previously been discharged home)
What week is term
40 weeks
preterm meaning
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed
extremely preterm (less than 28 weeks)
very preterm (28 to 32 weeks)
moderate to late preterm (32 to 37 weeks).
what is the leading cause of bacterial sepsis in neonates
group b strep infection
risk factors for group b strep infection in neonates
Previous sibling: GBS+ in pregnancy or GBS+ infection
Maternal colonization
Prolonged rupture of membranes (PROM) ≥ 18 hrs prior
to delivery
Intrapartum maternal fever
Pre-term
name of complication of neonatal jaundice
bilirubin encephalopathy = brain damage
what time range does physiological jaundice occur and when odes it peak
more than 24 hrs of life up to 2 weeks
levels peal around 3-5 days of life and start to resolve slowly over 2 weeks
Treatment for normal physiological jaundice
require reassurance
hydration and adequate feeding +stooling
Management for jaundice
plot on bilirubin threshold graph
ways to treat: exchange transfusion or phototherapy
what gender is muscular dystrophy more common in
male
what are the 3 main types of muscular dystrophy
duchenne (most common)
becker
limb-girdle dystrophies
ix for muscular dystrophy
serum CK
cardiac -ECG, echo
muscle biopsy and genetic testing
appearance of rash caused by neissereria meningitidis
non blanching purpuric or petechial rash
appearance of stevens - Johnson’s syndrome
widespread blisters/ bullae
over erythematous
/macular/haemorrhagic skin
symptoms of stevens-Johnson’s syndrome
fever
arthralgia
myalgia
conjunctivitis
pneumonitis
what is the cause of eczema herpeticum
type 1 HSV co-infection with active atopic eczema
appearance of molluscum contagiosum(viral)
flesh-coloured
dome shaped papules on skin
Management for molluscum contagiosum
self resolves after approximately 18 months
appearance of slapped cheek/parvovirus b19
malar rash with circumoral pallor
then a lace like rash on trunk and extremities follows
Management for parvovirus b19
supportive , self limiting
appearance of chickenpox
starts on head and trunk then spreads throughout the body
red macules-> papules ->pustules ->crusting
symptoms of chickenpox
headache
anorexia
URTI
fever
itching
Management for chickenpox
Antihistamines
paracetamol
acyclovir
VZIG for prophylaxis for contact at risk individual
appearance of roseola
after 3-5 days -fine maculopapular rash lasting 2 days
symptoms of roseola
high fever
runny nose
tiredness
appearance of rubella
maculopapular exanthem
pink and pinpoint starting on
face first then spreading
caudally to trunk and
extremities. Generalised over
24 hours
symptoms of rubella
Fever, arthritis, arthralgias.
Can lead to a rubella
panencephalitis.(after a week)
appearance of measles
Maculopapular rash lasts 6-8
days
symptoms of measles
Fever, coryza, cough, non-
purulent conjunctivitis, Koplik
spots
cause of impetigo
Staphylococcal aureus or
streptococcal skin infection
appearance of impetigo
Erythematous macules (may
progress to be
vesicular/bullous) on face,
neck or hands
symptoms of impetigo
The rash presents as oozing
or crusted blisters which can
be present anywhere on the
body but are usually found
around the mouth and nose
Management for impetigo
Topical (fusidic acid,
mupirocin) or systemic
(flucloxacillin or clarithromycin)
cause of scarlet fever
group a strep
appearance of scarlet fever
The rash has a rough
(sandpaper-like) texture, and
is usually worse in the skin
folds (Pastia’s lines)
symptoms of scarlet fever
Fever, sore throat, general
fatigue/headache/nausea. 24-
48 hours later, a rash appears
on the abdomen and spreads
to the neck and extremities
appearance of tinea capitis (head),
tinea corporis (body)
fungal
Pruritic, circular, erythematous
scaly patch spreading
centrifugally. Central clearing
is seen
Management for tinea capitis (head),
tinea corporis (body)
Daily application of topical
antifungals for 3 weeks.
Systemic therapy indicated in
patients with failed topical
therapy (terbinafine,
fluconazole or itraconazole).
diff between pityriasis alba and versicolor
alba (eczema) vs
versicolor (fungal)
appearance of pityriasis alba and versicolor
Small, scaly patches of skin
became hypopigmented (or
sometimes hyperpgimented).
Often the smaller patches join
together over time
treatment for pityriasis alba and versicolor
The treatment is with topic
antifungal cream or shampoo
(e.g. ketoconazole) if practical
– usually for up to two weeks.
Or if this fails, oral antifungals
(ketoconazole or fluconazole)
can be considered. The colour
can take a few months to
return to normal.
appearance of nappy rash
An erythematous macular,
papular rash located around
the nappy area that can
spread to the lower abdomen
or upper thighs
physiological response of poor pulmonary drainage in LVF
pulmonary oedema causes RR to increase, SOB and recession
physiological response of low systemic output in LVF
SNS activation and adrenaline causes tachycardia, vasoconstriction, pallor and long CRT and sweatiness
3 physiological response of RVF
peripheral oedema
Hepatomegaly
Ascites
examples of acyanotic heart disease
L side problem
-L to R shunt
- L ventricle outflow obstruction
- pulmonary stenosis- don’t cause much problem other than murmurs
examples of L-R shunts
( ventricular septal defect, PDA, ASD,AVSD)
examples of left ventricle outflow obstruction
AS
Coarctation of aorta
PS
causes of cyanotic heart disease
R sided obstruction
Right to left shunt
3 cyanotic heart disease
TOF - tetralogy of fallots
TGA - transposition of the great arteries
PA - pulmonary atresia
4 characteristic of fallots tetralogy
pulmonary stenosis
overriding aorta
VSD
Right ventricular hypertrophy
what type of murmur is heard in tetralogy of fallot
Aortic regurge- diastolic decrescendo murmur
what is transposition of the great arteries
the Pulmonary artery and aorta switches place meaning RV pumps blood into the aorta and LV pumps blood into the Pulmonary artery
if the heart in a featus is duct dependant what must you avoid when it comes to treatment and why
Oxygen as the duct will close if excess oxygen is present
6 differences between an innocent and significant murmur
INNCOENT :
1.soft
2.no radiation
3.Praecordial only
4.systolic and short
5.varies with posture
6.well
SIGNIFICANT:
1.harsh
2.radiates
3.audible elsewhere
4.not!
5.doesnt
6.other signs (failure, blue)
how does varicella spread
respiratory route
incubation period for varicella
12-14 days
description of varicella rash
macular-papular- vesicular
dew drop on a
rose petalrose petal”” (vesicle surrounded by halo(vesicle surrounded by halo
erythema) - initially clear then cloudy 2-3 D.erythema) - initially clear then cloudy 2-3 D.
Superficial lesions. Superficial lesions
