Paediatrics Flashcards
What are 6 important differentials for acute abdominal pain in a child?
Torsion, intussusception, volvulus, perforated viscus, incarcerated hernia, DKA.
Risk of contamination of urine samples in kids? Abx for cystitis and pyelo in kids? When is U/S required?
25% risk for MSU + cleancatch. C: bactrim or trimethoprim 3 days, keflex 2nd line. Pyelo: 7-10 days, augmentin 3rd line. U/S if renal impairment, boys < 3mo or recurrent UTI.
How is vulvovaginitis manged in kids? 6 features.
Loose cotton underwear, maintain healthy weight, rinse after showering, avoid bubble bath/soaps/perfumes, use barrier cream like parrafin for symptoms, salt or vinegar bath.
What are 3 aspects of history to consider in a straddle injury? How are they usually managed?
Tetanus, risk of abuse, bowel/bladder function. If mild: salt water bath for comfort, topical anaesthetic or barrier cream, avoid strenuous activity for 24hr.
What are the features of PURPLE crying -age, duration, timing. What are 7 differentials for acute irritability?
6-8 weeks, crying 2-4 hours per day, worse in afternoon may draw up legs. Sepsis/UTI, raised ICP, hair tourniquet, intusussception, corneal injury, fracture, abuse/PND.
What are 5 features of nonpharm management/advice of purple crying? How much sleep does a 3mo need?
Pattern for feeding/sleeping, routine for bedtime, massage/rocking, give primary carer a break once per day, avoid excess stimulation. 3mo sleeps 15h per day, tired after 2hr being awake.
What are 10 differentials of behavioural problems in children?
ADHD, ASD, Anxiety/PTSD, developmental delay, learning disability, hearing/visual impairment, language disorder/speech delay, opposition defiant disorder/conduct disorder, abuse, foetal alcohol syndrome.
What are 6 risk factors for ADHD? What testing may be indicated?
Fhx, foster or out of home care, pre-term, prenatal alcohol/drug exposure, existing anxiety, epilepsy, ASD, conduct disorder. Test for visual/hearing impairment, anaemia, thyroid disease.
What is 1st line management of ADHD in kids? Some examples.
Psychosocial intervention - reward good behaviour, nonpunitive consequences. Written family rules, positive attention to good behaviour, ignore minor attention seeking, regular one on one time doing things they like, fixed routines, highlight important information, keep areas uncluttered, sit near front, have rest breaks.
What are signs and red flags of ASD?
Difficulty with shared attention, repetitive behaviours, not understanding indirect language/cues. RF: no babbling or pointing by 12mo, no sharing of interest in objects with others, no single words by 16mo or two word phrases by 24mo.
What is the definition of an undescended testicle? When is referral indicated? When is urgent review required?
Testis not descended by 3mo. No ultrasound required. Refer if unilateral for orchidopexy between 6-12mo (before 12mo risk infertility). If bilateral with genital abnormalities or can’t feel anywhere, then urgent referral.
What are the TEN4FACES rule for NAI? What 4 fractures are high risk for NAI? What tests are done for bruising?
Bruising to Torso, Ear, Neck in under 4yo. Bruising in 4-6mo. Injury to Frenulum, Angle of jaw, Cheek, Eyelid, Sclera at any age. Metaphyseal corner < 2yo, rib fractures (esp posterior), scapula, sternum. FBE, APTT, INR, fibrinogen.
How is expected growth calculated? What are 2 common causes of short stature? What are 5 pathological causes?
1/2 of (F + M +/-13). Constitutional delay of growth, familial short stature. Growth hormone deficiency, hypothyroidism, cushings syndrome, systemic disease, chromosomal abnormality.
What tests are indicated for poor growth? How is growth hormone assessed?
FBE, UEC, LFT, TFTs, ferritin, glucose, b12. Urine MCS (esp if < 1yo). Faecal MCS + fat globules, fatty acid crystals. Coeliac if gluten. ESR + faecal calprotectin if >1 yo. GH: IGF-1 level or stimulated GH level.
What is average weight gain in first year of life? What are some other differentials for slow weight gain?(Physical, social, systemic disease)
150-200g per week 3mo, 100-150g per week 3-6mo. 70-90g 6-12mo. Breast feeding difficulty, cleft palate, restricted diet, parental mental illness/disability, food insecurity, family violence, behavioural disorders, chronic liver disease, pancreatic insufficiency (CF), congenital heart disease.
Management of acute airway obstruction in kids? 6 differentials.
Avoid distress/handling, allow child to sit in comfortable position, urgent ambulance, can give oxygen +/- nebulised adrenaline. DDx: epiglottitis, quinsy, tracheitis, burn/trauma, severe croup, anaphylaxis.
5 features of severe pneumonia in kids? Abx with allergies?
Respiratory distress, hypoxia < 90% or cyanosis, marked tachycardia, altered mental state, empyema. Amoxicillin TDS 3-5d, cefuroxime if allergic. Azithromycin or clarithromycin if severe allergy.
Doxy if >8yo, no liquid form.
Who gets bronchiolitis? Symptoms, timing and 5 features of management.
< 12mo, cough/fever/crackles/wheeze. Peak day 2-3, resolves 7-10d. Saline nose drops to clear nose when feeding, supeficial suction before feeding, frequent small feeds, minimise handling/allow rest, review in 48hr.
What are the 8 findings to look for severe bronchiolitis? How is it managed?
WOB, RR, Oxygen < 92%, hydration status, cap refill, apnoeic episodes, irritable/drowsy, unable to feed. Oxygen via NP or high flow canula if < 90%, NG hydration if < 50% hydration.
Who gets croup? Symptoms, timing, 5 features of moderate > severe croup.
From 6mo to 6yo. Coryza, fever, barking cough, stridor. Cough usually better in 3 days. Behaviour (agitation, drowsy), intermittent to persistent stridor at rest, resp rate, chest wall retraction, hypoxia is a late sign.
How is mild and severe croup managed?
1mg/kg pred (max 50) as single or 2d course, can add inhaled budesonide. No steam. If severe: nebulised adrenaline 5mL of 1:1000 + pred or dex 0.6mg/kg (max 12mg). Minimise handling, sit in comfortable position.
Epiglottitis - cause, presentation, mx features.
Usually HiB. Rapid fever, drooling, muffled voice, neck hyperextension. No cough. Sniffing and tripod positions. Keep child calm, NBM, don’t examine airway, urgent transport to hospital, supplemental oxygen considered.
DDx (milder conditions) for OSA, causes of nasal obstruction and OSA in kids.
Obstructive hyperventilation. N: rhinitis, deviated septum, adenoid hypertrophy, nasal polyposis. OSA: tonsillar and adenoid size majority, obesity, long term allergy, neuromuscular - eg. downs syndrome low tone.
What are the 6 symptoms of OSA in kids?
Snoring 3+ nights per week, restless sleep w increased WOB, pauses in breathing/gasping, mouth breathing, night sweats, daytime sleepiness/morning headache/poor function.
What are some history and exam features to look for in paediatric OSA? Ix, Mx
Nasal trauma, allergic rhinitis, atopic history, dental/speech issues (crowding); long narrow face, receding chin, pale boggy inferior turbinates, deviated septum, large tonsils. Polysomnography best, overnight O2 screen. Surgery if bad, consider IN steroids.
What is the natural history of pertussis? How do you diagnose it?
Coryza w cough for 1 week then paroxysms of coughing after w inspiratory whoop and post tussive vomiting. Well between spasms, no fever. Nasopharyngeal PCR in 1st 3-4 weeks, serology positive after 2 weeks, cultures rarely helpful.
How/when is pertussis treated? Public health measures? Prophylaxis?
Azith (or clarith) for 5 days, bactrim 2nd line, use within 3 weeks of symptoms. Contagious for 3 weeks or 5d after abx. Notifiable. Exclude from school 14d from exposure OR 5d abx or 21d of symptoms untreated. Vax contacts if not vaxed
When is pertussis prophylactically treated?
If close contact to case that is infectious (< 5d abx or 21d cough) + contact within last 2 weeks. Treat if < 6mo or childcare/house member < 6mo or last mo of pregnancy OR child without 3 doses.
