Paediatrics Flashcards
Criteria for admission with croup?
Any features of moderate or severe croup:
- Frequent barking cough
- Easily audible stridor
- Significant sternal wall retractions
- Agitated, lethargic
**<6 months of age
What are the clinical features of hand, foot and mouth disease?
- Usually affects <10 year olds
- Systemic sx: fever, cough, abdo pain
- Mouth ulcers followed by rash affecting hands, feet, face, buttocks
What are the features of measles?
- Initial prodrome: fever, conjunctivitis
- Koplik spots - white spots on buccal mucosa
- Rash, beginning behind the ears before spreading around whole body
What are the features of scarlet fever?
- Fever
- Malaise, headache, nausea/vomiting
- Strawberry tongue
- Rash: fine punctate erythema (sandpaper texture)
Management of scarlet fever…
Throat swab taken, followed by antibiotics without delay:
1st line = Pen V for 10 d
2nd line = Azithromycin
What are the x-ray findings of necrotising enterocolitis?
- Dilated bowel loops
- Bowel wall oedema
- Pneumoperitoneum resulting from perforation
- Air both inside and outside the bowel wall
What is the management of threadworms?
Mebendazole antifungal = 1st line –> given to all household members
What are the clinical features of Kawasaki disease?
- High grade fever (resistant to antipyretics)
- Conjuctival injection
- Bright, red cracked lips
- Strawberry tongue
- Red palms and soles - desquamation
What is the management of Kawasaki disease?
- High dose aspirin - risk of coronoary anuerysm
- IV Ig
- Echo rather than coronary angiography
What is the definition of precocious puberty?
Development of secondary sexual characteristics at under 9 in males and under 8 in females.
What is the management of childhood asthma?
1= SABA
2= SABA + low-dose ICS
3= SABA + low dose ICS + LTRA
4= SABA + low dose ICS + LABA
5 = SABA + maintenance and reliever therapy (MART)
With under 5s:
1= SABA
2 = SABA +low dose ICS
3= SABA + low dose ICS +LTRA
When is pneumonia suspected in bronchiolitis patients?
High grade fever (>39C)
What are the feartures of transient synovitis?
- Limp
- Groin/ hip pain
- Usually preceded by viral infection
Risk factors for development dysplasia of hips?
- Female gender
- Breech presentation
- Positive family history
- Large baby weight
What clinical tests are used to test for development dysplasia of hips?
Barlow = dislocation of hip
Ortalani = relocaton of hip
Immunisation schedule UK :
Birth = BCG if risk factors
2 months = 6 in 1 vaccine (diphtheria, polio, whooping cough, tetanus, Hib, Hep B), oral rotavirus, Men B
3 months = 6 in 1 vaccine (diphtheria, polio, whooping cough, tetanus, Hib, Hep B), oral rotavirus, PCV
4 months = 6 in 1 vaccine (diphtheria, polio, whooping cough, tetanus, Hib, Hep B), Men B
12-13 months = MMR, PCV, Men B, Hib/Men C
3-4 years = 4 in 1 vaccine (diphtheria, polio, whooping cough, tetanus), MMR
12-13 years = HPV for girls and boys
13-18 years = Men ACWY
What hearing test is carried out at birth?
Otoacoustic emission test - part of newborn hearing screening programme
Auditory brainstem repsonse test is carried out if otoacoustic emission test is abnormal
What hearing test is carried out at school entry?
Pure tone audiometry
What is the antibiotic treatment for meningitis?
<3 months = IV amoxicillin + IV cefotaxime
>3 months = IV cefotaxime or ceftriaxone
What antibitoic prophylaxis is used for meningitis?
Ciprofloxacin for all contacts
Why is vitamin K offered to all newborn babies?
Babies tend to be deficient of Vitamin K which can impact clotting factors therefore more at risk of haemorrhagic disease
What warrants immediate hospital referral for bronchiolitis?
- Apnoea
- Severe respiratory distress e.g. grunting, significant chest recessions, RR>70
- Central cyanosis
- Persistent SpO2 <92%
When should children be referred urgently for delay in developmental milestones?
- Not sitting upright at 12 months
- Not walking at 18 months
- Hand preference before 12 months
What neurological signs are seen in Down’s syndrome?
- Hyporeflexia
- Hypotonia
What is roseola infantum?
High fever followed by maculopapular rash across trunk and limbs
What is vesicoureteric reflux and how does it present?
Abnormal backflow of urine from bladder into the ureter –> causing dilatation and more prone to infections
Usually presents as recurrent UTIs in childhood –> can lead to reflux nephropathy (chronic pyelonephritis secondary to VUR)
What is the pattern of eczema in children?
Young children = eczema affects the extensor surfaces
Older children = eczema affects the flexor surfaces
What are the main risk factors of sudden infant death syndrome?
- Putting the baby to sleep prone
- Parental smoking
- Prematurity
- Sleeping in the same bed as parents
What are the features of ITP in children?
- Bruising
- Petechial rash with no fever present- often after viral illness
- Bloods show isolated thrombocytopaenia
What are the fearures of henoch-schonlein purpura?
- Petechial, non-blanching rash of legs and buttcoks
- Joint pain
- Abdominal pain
- Haematuria
What is the management of gastro-oesophageal reflux in children?
Conservative = advice about head 30 deg head up during feeding
= Trial of thickened formula for formula feeds
= Ensure not being overfed
Medical = Trial of alginate therapy (gaviscon) after feeds
= PPI used if there is distressed behaviour, faltering growth, unexplained feeding difficulties
What are the two forms of precocious puberty?
Gonadotrophin dependent:
Premature activation of HPA axis
FSH an LH raised
Gonadotrophin independent:
Due to excess sex hormones
FSH and LH low
What is the Kocher criteria for septic arthritis?
- Fever >38.5 C
- Non-weight bearing
- Raised ESR
- Raised WCC
What is the management of whooping cough?
< 6 months –> admission
Antibiotics –> Azithromycin or Erythromycin
What are the key features of necrotising enterocolitis?
- Feeding intolerance
- Abdominal distension
- Bloody stools
How does Perthe’s disease present?
- Progressive pain and stiffness in hip
- Resulting in limping
- Typically occurs in children aged 4-8
What is the management of paediatric headache?
Ibuprofen = first line
Nasal sumatriptan if older than 12 years old
What are the triad of features in shaken baby syndrome?
- Retinal haemorrhages
- Encephalopathy
- Subdural haematoma
What is the management of nocturnal enuresis
1st line = Night time enuresis alarm
2nd line = Desmopressin (can be used for short term relief)
What is the management of constipation in children?
- Movicol
- Lactulose
What is the most common cardiac complication seen in Down’s syndrome?
Ventricular septal defect
What is the main differentiating feature of croup and bronchiolitis?
Croup = barking cough and inspiratory stridor
Bronchiolitis = wheeze and tachypnoea
What is first line drug for ADHD in children?
Methylphenidate
What are some key features of Turner’s syndrome?
- Webbed neck
- Short stature
- Bicuspid aortic valve
- Primary amenorrhoea
What is acrocyanosis?
Peripheral cyanosis that is seen in healthy newborn infants - occurs immediately from birth but will resolve within 24-48 hours
What is the first sign of puberty in a girl?
Breast development at 11.5 years (between 9-13)
What is the first sign of puberty in boys?
Testicular growth at around 12 years
How does congenital diaphragmatic hernia present?
- Dyspnoea
- Tachypnoea
** Due to lungs being compressed from abdominal contents in thoracic cavity
How do you differentiate between caput succedeneum and cephalohaematoma?
caput succedeneum = swelling that occurs immediately after birth, crosses suture lines
cephalohaematoma = swelling that appears 2-3 days after birth, usually in parietal region, does not cross suture lines
What is the BLS algorithm in children?
- Unresponsive —> shout for help
- Look, listen, feel for breath
- 5 rescue breaths
- Check for brachial/ femora pulse
- Start compressions: ventilations 15:2 ratio (if two trained staff, otherwise 30:2)
What are some key risk factors for developing RDS?
- Premature birth
- Male sex
- Diabetic mother
- C section
What is the management of RDS?
Oxygen
Assisted ventilation
Exogenous surfactant
What are the different time periods of neonatal jaundice?
Jaundice in first 24 hours after birth –> pathological
Jaundice from 2-14 days –> physiological
Jaundice after 14 days –> prolonged
Features of intussusception…
- intermittent, severe crampy abdominal pain
- Inconsolable crying
- Drawing knees up when in pain
- Bloodstained stool –> “red currant jelly”
Features of lead poisoning…
- Colicky abdominal pain
- Anaemia
- Encephalopathy –> raised ICP
