Paediatrics Flashcards by Anna Yaroslavtseva

Name 11 common paediatric genetic conditions?
type of abnormality?- chromosome
presenting features?

Cri du Chat syndrome- chromosome 5p deletion, cat-like cry, poor feeding/weight gain, learning difficulty, hypertelorism

Patau syndrome- caused by trisomy 13, cleft lip/ palate, microcephaly, polydactyl

Edwards syndrome- trisomy 18, low set ears, micrognathia, rocker bottom feet

Prader Willi syndrome- deletion in PATERNAL copy 15q-11-13, hypotonia, hypogonadism, obesity

William’s syndrome- chromosome 7 deletion, short stature, learning difficulties, extroverted, aortic stenosis

Fragile X syndrome- trinucleotide repeat of X-chromosome, macrocephaly, large ears, high arched palate, long thin face, macroorchidism (testes larger than normal for the age)

Noonan syndrome- autosomal dominant, webbed neck, short stature pulmonary stenosis, pectus excavatum (ribs grow inwards)

Turner’s syndrome- 45XO/ 45X (only have 1 X-chromosome, affects girls only), short stature, wide spaced nipples, primary amenorrhoea (NEVER experienced menstruation), shield test

Down’s syndrome- trisomy 21, single palmar crease, short neck, round face and flat nasal bridge, protruding tongue, brush-field eye spots

Klinefelter syndrome- 47XXY (males with an extra X-chromosome), increased oestrogen levels, gynaecomastia, tall/ slim, reduced muscle bulk, hypogonadism, > risk of oesteopersis/ breast cancer

DiGeorge syndrome- chromosome 22 deletion, tetralogy of Fallot, long face and small teeth, broad nose, cleft palate

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Common causes of limp in a child?

‘STOP LIMPING’

S- septic arthritis
T- toddler’s fracture
O- Osteomyelitis
P- perthes disease

L- limb length discrepency
I- inflammation (reactive arthritis, JIV)
M- malignancy
P- pyomyositis
I- iliopsoas abscess
N- neurological
G- gastrointestinal/ genitourinary

Trauma/ non-accidental injury
Slipped femoral epiphysis

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What are the 4 signs of tetralogy of Fallot?
VROP

v- ventricular septal defect
r- right ventricular hypertrophy
o- overriding aorta
p- pulmonary stenosis

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what is RSV?
causes?
pathophysiology?
transmission?

Respiratory syncytial virus

Most common cause of bronchiolitis (affects bronchioles LRTI)

-Infants <6 months at greatest risk in winter months
-Transmitted via respiratory droplets (cough, sneeze)
-Causes more than one cell to merge together – hence syncytial virus
-Infected cells eventually die leading to inflammation -> bronchiolitis -> increased mucus production -> oedema in bronchioles -> restricts airflow

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Symptoms of RSV?
RSV management?

Symptoms:
Mild: cough, fever, sore throat
Severe- wheezing, SOB, hypoxia

Management: mostly self-limiting and needs conservative treatment

Moderate/ severe- oxygen support

Vaccine now available

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Outline the childhood vaccine timeline

-Type of vaccine
-Age at which they get the vaccine
8 weeks
12 weeks
16 weeks
1 year
2+ years
3 years and 4 months

8 weeks: 6 in 1, MenB, Rotavirus
12 weeks: 6 in 1, Pneumococcal and Rotavirus
16 weeks: 6 in 1, MenB
1 year: Hib/ MenC, MMR, Pneumococcal, MenB
2 years: Flu (annual)
3 years and 4 months: MMR, 4 in 1 pre-school booster

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Causes of non-blanching rash in children (4)

Meningococcal septicaemia
Idiopathic thrombocytopenia (ITP)
HSP
Leukaemia

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Viral rashes in children (3) and the virus it is caused by?

Measles- rubeola
Mumps- paramyxovirus
Hand, foot and mouth disease- coxsackie virus

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Vesicular and pustular rashes (2) and organism caused by?

Varicella zoster (VZV)
Impetigo (S. aureus, group A strep)

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Name 5 infantile rashes

Nappy rash
Molluscum contangiosum
Erythema Toxicum
Candidiasis
Congenital dermal melanocytosis

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How does KAWASAKI disease present?
Signs and sx
Investigations
Complications
Management

High persistent fever >5 days
Widespread erythematous maculopapular rash
Skin peeling of hand/ feet
Swollen neck lymphs
Dry cracked lips
Red/ bumpy/ swollen tongue-> strawberry
Painful hands/ feet
Red eyes

Bloods: FBC, U+Es, CRP (anaemia, leucocytosis, thrombocytopenia)
Urinalysis
ECHO: Coronary artery aneurysm

Complications: coronary artery aneurysm, leaky valves, pericardial effusion

Management:
Admission
IVIG (immunoglobulins) -> reduce risk of coronary artery complications
Aspirin -> reduce thrombocytosis (contraindicated in <16s other than those with Kawasaki)
Prednisolone -> reduce vessel inflammation

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Investigations and management for Scarlett fever?

Clinical diagnosis with throat swab for culture

Phenoxymethylpenicillin (10 days)
Regular Fluids
Chlorphenamine -> itchiness

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Symptoms of ITP?
How is ITP diagnosed?
Management of ITP?

Easy bruising
Rash
Bleeding from the gums or nose
Blood in urine / stools
Heavy menstrual flow in post-menarche females

Investigations:
Full blood count will show low platelets (thrombocytopenia) + blood films
Clotting screen

Management:
Children usually improve without treatment
Intervention not usually required unless very low platelet count or excessive bleeding
Avoid aspirin and NSAIDS and IM injections
Discuss with haematology

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What is HSP?
Symptoms?
Investigations?
Managaement?

A small blood vessel vasculitis is characterised by the deposition of IgA immune complexes causing inflammation.

Symptoms:
Abdominal pain
May result in blood in the stool
Arthralgia affecting the knees and ankles
Proteinuria / haematuria due to vasculitis in the kidneys
Hypertension

Investigations:
Urinalysis to monitor kidney function
BP monitoring
Mainly diagnosed clinically

Management:
No specific treatment – analgesia for joint pain
Steroids may be needed for severe symptoms

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What is Meningococcal Septicaemia?
Symptoms?
Investigations?
Management?
Complications?

Blood infection of the bacteria Neisseria Meningitidis bacteria

SIGNS & SYMPTOMS:
Fever
Respiratory distress
Reduced level of consciousness
High-pitched cry
If meningococcal disease (MenSep + Meningitis): May present with signs of meningism (photophobia, neck stiffness, headache)
Non-blanching petechial rash. If the dots are larger they are called purpura.
Any part of the body may be affected but it commonly affects the trunk and limbs

Investigations:
Bloods- FBC, U+Es, LFT, CRP
Blood cultures
Urinalysis + cultures
LP unless contraindicated

Management:
Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
Steroids not recommended
Fluids- to treat shock
Cerebral monitoring

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List 5 contraindications for an LP in Meningitis in children ?

For patients with meningococcal septicaemia a lumbar puncture is contraindicated - blood cultures and PCR for meningococcus should be obtained.

Contraindication to lumbar puncture (any signs of raised ICP)

-focal neurological signs
-papilloedema
-significant bulging of the fontanelle
-disseminated intravascular coagulation
-signs of cerebral herniation

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Symptoms of Leukaemia?
Investigations?
Management?
Complications?

SIGNS & SYMPTOMS:
Increased susceptibility to infection
Easy bruising
Bleeding
Non-blanching rash
Joint pain – bone invasion

DIAGNOSIS:
Full blood count showing pancytopenia
Blood film
Bone marrow biopsy

COMPLICATIONS:
Neutropenic sepsis
Anaemia – shortness of breath, fatigue
Can be fatal

MANAGEMENT:
Consult with haemoncology for management (chemotherapy, stem cell transplant)

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Management for impetigo?

Fusidic acid cream

-7 days under 12 years
-5-10 days for 12-17 years

School exclusion
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

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What is erythema toxicum?

Rash that only affects new-borns and presents in the first few days of birth.
Sometimes referred to as baby acne.

SIGNS AND SYMPTOMS
-Can be on a baby’s face, arms, legs and torso.
Looks like small, filled spots and often gets mistaken for being filled with pus, but there is no infection.

No management required and goes away within a week/ weeks

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What is CONGENITAL DERMAL MELANOCYTOSIS (MONGOLION BLUE SPOT)?

-Flat blue/blue-grey birthmark that can appear at birth but also in the first few weeks after birth.

-Very common in children of Asian, middle Eastern, Mediterranean or African background.
Very rare in children of white European background but can happen.

-Melanocytes produce melanin (makes skin pigment) which is also responsible for hair and eye colour. These cells remain in the dermis at birth but continue to produce melanin which appears as a blue/blue-grey colour through the skin.

Diagnosis:
Exclude safeguarding concerns

Management:
No managament
Can last until 10 years old or later into adulthood

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Management for nappy rash?
Complications of nappy rashes?

MANAGEMENT:
Antifungal creams or ointments which can be obtained over the counter, typically Clotrimazole 10% (Canesten) 2-3 times a day.

COMPLICATIONS:
-Can develop into oral thrush and Nystatin is given.
-Pain is quite a common complication.
-A secondary bacterial infection can happen in some babies and needs to be treated accordingly

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What is eczema herpeticum?
Symptoms?
Investigations?
Management?
Complications?

Complication of Atopic Eczema caused by a specific infection. -Caused by the Herpes Simplex Virus (HSV) signs appear 5-12 days after infection

SIGNS AND SYMPTOMS
Unwell, swollen lymph nodes, temperatures, weeping blisters and sores.
May present septic.

Investigations:
Viral culture
Abs staining
PCR
Blood smear
Bacterial swabs MC&S

MANAGEMENT
-Classed as a dermatological emergency prompt management is needed.
-Aciclovir IV every 8 hours for 14 days or orally 5 times a day for 5 days.
Swabs
Ophthalmology review if it is near their eyes.

Complications:
Contagious
Avoid pregnant and immunocompromised people
Cellulitis
Impetigo

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What is Perthes disease?
Causes
Symptoms
Investigations
Management
Complications

Avascular necrosis of the femoral head
>boys 5-10 years old

Causes: genetics, vascular anomalies, trauma

Symptoms:
-hip pain: develops -progressively over a few weeks
-limp
-stiffness and reduced range of hip movement
-x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening

Investigations:
x-ray
technetium bone scan or MRI if normal x-ray and symptoms persist

Complications:
osteoarthritis
premature fusion of the growth plates

Management:
Rest
Cast/ braces
Surgery

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Causes of seizures? 7

Epilepsy
Febrile convulsions
Stoke/ ICH
SOL
Autoimmune- cerebral vasculitis
Trauma/ head injury/ NAI
Toxins- meds, drugs, overdose
Metabolic- hypoglycaemia, DKA, electrolyte abnormalities

Hepatic encephalopathy
Wernickes and Korsakoffs encephalopathy

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Investigations for seizures? Bedside Bloods Imaging Specialist tests

Bedside: Observations. Blood glucose. Urinalysis for urosepsis. ECG to rule out underlying cardiac cause Toxicology screen Bloods: FBC. CRP. UEs. LFTs. Blood Cultures. VBG (inc. Lactate). Bone Profile. Coagulation – required for LP if indicated. Imaging: MRI head. CT head if urgent MRI not available. Special Tests: Lumbar Puncture if indicated. EEG. Genomic sequencing

Common causes of headaches in children?

Migraines SOL- malignancy, abscess, cysts, vascular malformations Tension headaches II-HNT Medication overuse headaches

Seizure management algorithm?

-Start timer -1st dose of benzo (IV, PR or buccal depending on access) -after 5-mins: 2nd dose of benzo -after 5mins: levetiracetam -if ongoing -> phenytoin or RSI

Asthma management 'O SHIT ME'

O- oxygen S- Salbutamol H- hydrocortisone/ prednisolone I- ipratropium T- Theophylline M- magnesium sulphate E- escalation (ventilation/ intubation)

Features of a mild-moderate asthma attack?

Features worsening dyspnoea, wheeze and cough that is not responding to salbutamol -PEFR 50-75% best or predicted -Speech normal -RR < 25 / min -Pulse < 110 bpm

Features of a severe asthma attack?

-PEFR 33 - 50% best or predicted -Can't complete sentences -RR > 25/min -Pulse > 110 bpm

Features of a life-threatening asthma attack?

-PEFR < 33% best or predicted -Oxygen sats < 92% -Silent chest, cyanosis or feeble respiratory effort -Bradycardia, dysrhythmia or hypotension -Exhaustion, confusion or coma A normal pCO2 in an acute asthma attack indicates exhaustion and should, therefore, be classified as life-threatening.

Acute anaphylaxis management? Features? ABC

ABCDE- if no ABC problems, patient is not having anaphylaxis 1 in 1,000 IM adrenaline Features: A- swelling of throat/ tongue, stridor, hoarse voice B- Wheezing, dyspnoea C- hypotension, tachycardia widespread rash. itching

Management for SUFE?

Internal fixation surgery

What complication does a breech presentation increase the risk of?

Developmental dysplasia of the hip (DDH)

Management for neonatal hypoglycaemia

Asymptomatic: Encourage normal feeds and monitor BMs Symptomatic: Neonatal unit admission 10% IV dextrose

Management for nocturnal enuresis?

Identify triggers- constipation, DM, UTI General advice Reward system- star charts 1. Enuresis alarm: first-line 2. Desmopressin: short-term control

Heart defect associated with Duchenne?

Dilated cardiomyopathy

What is the acid status in a baby with pyloric stenosis?

Hypochloremic hypokalemic metabolic alkalosis

Machinery like murmur?

Patent ductus arteriosus at the upper left sternal edge

Ejection systolic murmur?

Pulmonary stenosis at the upper left sternal edge

Systolic murmur?

Coarctation of the aorta in the left infraclavicular area under the left scapula

Cyanotic murmur?

Tetralogy of Fallot- hyper-cyanotic episode after 1 month of birth

Cause of threadworms- organism?

Enterobius vermicularis

What is included in the APGAR score? (5)

Pulse Respiratory effort Colour Muscle tone Reflex irritability

Infection where after periods of coughing child stops breathing and turns cyanotic

Pertussis aka Whooping cough Present with apnoea and cyanosis

What causes Croup?

Parainfluenza virus

Management for Croup?

Single dose oral dexamethasone or prednisolone if not dex not available

What virus causes 'slapped cheek'?

Parvovirus B19

What causes Roseola?

HHV-6

What causes hand, foot and mouth disease?

Coxsackie A16 virus

Name of colic seizure?

Infantile spams or West Syndrome

Type of murmur in Turner’s syndrome?

Ejection systolic murmur

Causative agent of scarlet fever?

Group A strep

What is necrotising enterocolitis? Symptoms?

Necrotising enterocolitis is one of the leading causes of death among premature infants. Symptoms: feeding intolerance abdominal distension and bloody stools abdominal discolouration perforation and peritonitis. Investigations; Abdominal x-rays as they can show: -dilated bowel loops (often asymmetrical in distribution) -bowel wall oedema -(intramural gas) -portal venous gas -pneumoperitoneum resulting from perforation -air both inside and outside of the bowel wall (Rigler sign) -air outlining the falciform ligament (football sign)

What is Hirschsprung’s disease?

Hirschsprung's disease is a birth defect in which nerves are missing from parts of the intestine. The most prominent symptom is constipation investigations

What should be monitored for a child on methyphenidate? ADHA drug

Growth charts This is due to its appetite suppressing effect which may lead to inadequate calorie intake and subsequently slow down growth. Therefore, it's crucial to monitor the child's height and weight regularly during the course of treatment.

What MSK triad is this? Hip pain, limp and recent infective illness Can also have fever

Transient synovitis Management: rest and analgesia

What MSK triad is this? Hip pain, limited range of movement and refusal to weight bear

Perthes disease

What MSK triad is this? Triggered by minor trauma, hip pain disproportionate to the severity of trauma and limited range of movement

Slipped upper femoral epiphysis

Risk factor for hip dysplasia?

Breech presentation

What is Meckel's diverticulum? Symptoms? Investigations? Management?

Meckel's diverticulum is a slight bulge in the small intestine present at birth Symptoms: Abdominal pain- can mimic appendicitis Rectal bleeding - common cause of painless rectal bleeding requiring a transfusion Intestinal obstruction Investigations: Meckel's scan Mesenteric arteriography Management: Surgery

What investigations should you perform in child <3 months with a fever? Bedside Bloods Imaging

Full blood count Blood culture C-reactive protein Urine testing for urinary tract infection Chest radiograph only if respiratory signs are present Stool culture, if diarrhoea is present

What medication can be prescribed as a rescue remedy for recurrent febrile seizures?

rectal diazepam or buccal midazolam

Common cause of jaundice in first few weeks of life?

Biliary atresia typically presents in the first few weeks of life with jaundice Signs: Jaundice Hepatomegaly with splenomegaly Abnormal growth Cardiac murmurs if associated cardiac abnormalities present Dark urine and pale stools Appetite and growth disturbance

Cause of 'fever followed later by rash?'

Roseola infantum

Management for Whooping cough?

Clarithromycin, azithromycin or erythromycin

Symptoms of Whooping cough?

14 day or more of: Paroxysmal cough Inspiratory whoop Post-tussive vomiting Undiagnosed apnoeic attacks in young infants

Paeds BLS algorithm?

5 rescue breaths 15:2 chest compressions

Name of surgical management for pyloric stenosis?

Pyloromyotomy

What is laryngomalacia?

Laryngomalacia is the most common cause of stridor in infants. It occurs due to a floppy epiglottis which folds into the airway on inspiration. This is normally a self-limiting condition, but if the stridor becomes severe with signs of respiratory distress, or if there is failure to thrive (due to poor feeding), then surgery is recommended to improve the airway. Causes noisy breathing during feeding

Management for DKA? Complication following fluid resus?

1. Fluid replacement (isotonic saline) 2. IV Insulin 3. Potassium replacement/ electrolyte correction 4. Long-acting insulin continued and short-acting insulin stopped Cerebral oedema

Diagnostic criteria for DKA?

-glucose > 11 mmol/l or known diabetes mellitus -pH < 7.3 - bicarbonate < 15 mmol/l -ketones > 3 mmol/l or urine ketones ++ on dipstick

DKA resolution criteria?

DKA resolution is defined as: -pH >7.3 and -blood ketones < 0.6 mmol/L and -bicarbonate > 15.0mmol/L

Common cause of neonatal sepsis?

Group B strep (GBS)

Management for undescended testes in a new-born?

Unilateral undescended testicle - review at 3 months - if persistent refer