Paediatrics Flashcards
1
Q
Rinne test
A
AC>BC = Normal/SNHL
BC>AC= CHL
2
Q
Tanner stages
A
I:
- 0–15 years
- None
II:
- Commencement of puberty
-8–15
- Pubic hair first, along with breast budding
- Scrotal/Testicular growth, penis growth after a year
III:
- Increase in hair and pigmentation
3
Q
Development of pubic hair
A
Boys: 9 years
Girls: 8 years
4
Q
List of autosomal dominant diseases
A
D -dystrophy myotonia
O - osteogenisis imperfecta
M - Marfan’s
I - intermittent porphyria
N - Noonan’s
A - achondroplasia, familial adenomatous polyposis (FAP)
N - neurofibromatosis
T - Tuberous sclerosis
V- Von Willebrand
H - Huntington’s HNPCC
H - hereditary spherocytosis
H- familial hypocholesteraemia
R - retinoblastoma
5
Q
List of autosomal recessive diseases
A
A - albinism
B - thalassaemia
C - cystic fibrosis
D - deafness
E - emphysema
F - Friederich’s ataxia (trinucleotide test, repeat GAA)
G - Gaucher’s disease
H Hemochromatosis, homocystinuria
S - sickle cell
P - phenylketonuria
N - Wilson’s
X - xeroderma pigmentosa
6
Q
List of X-linked recessive diseases
A
D- diabetes insipidus
D - Duchenne’s
C - colour blindness
C - chronic granulomatous disease (membranous type)
F - Fabry’s disease (alpha- glucosidase deficiency)
F - fragile X syndrome (Martin Bell Syndrome)
2 blood - haemophilia. G6PD
2 syndrome Lesch Nylon syndrome, Wiskots Aldrich yndrome
7
Q
SIADH in children
A
- hyponatremia
- excessive amount of ADH from hypothalamus-pituitary
8
Q
SIADH in children symptoms
A
- nausea and vomiting
- headache
- problems with balance
- mental changes (confusion, memory problems)
- seizures or worst case, coma
9
Q
SIADH in children causes
A
- type 2 DM medication:
- antiepileptic
- antidepressant
- surgery under general anaesthesia
- brain disorders, injury, infections, stroke
- lung disease (pneumonia, tuberculosis, cancer, chronic infections)
- cancer of lung, small intestine, brain, leukaemia
10
Q
Addison’s disease in children
A
- hyponatraemia with hyperkalaemia
- 21-hydroxylase deficiency
- Dehydration, hypotension, and shock
11
Q
Lymphoblastic leukaemia in children
A
- Live-attenuated vaccines contraindicated (MMRV, rotavirus, yellow fever)
12
Q
Hyponatremia in children
A
Dehydration: hypernatremia
Cardiac: Pseudohyponatremia
Addisons:
- Low aldosterone
- Hyperkalaemia
- hypotension
13
Q
Hyponatraemic seizures in children
A
- increasing irritability
- increasing lethargy, - increasing tonic-clonic generalised
seizures - respond poorly to conventional anticonvulsants (phenytoin, phenobarbitone)
- address hyponatraemia by 3% NaCl solution
14
Q
Hypernatremia in children
A
- “doughy” skin
- Isotonic (normal) saline for an initial bolus
15
Q
Most common long-term complication of streptococcus pneumonia meningitis in children
A
Deafness 11%
Intellectual disability (mental retardation)-4%.
-Spasticity and/or paresis-4 %.
-Seizure disorder-4 %
16
Q
Weber’s test
A
Normal = lateralizes equally to both ears
CHL= lateralizes to abnormal ear
SNHL= lateralizes to the normal ear
17
Q
Acute Otitis media risk factors
A
- Age (6-18 months)
- Lack of breastfeeding
- Day care attendance
- Smoke exposure
18
Q
Pathogens that give arise to acute otitis media
A
- Streptococcus pneumoniae (most common)
- Nontypeable (?) Haemophilus influenzae
- Moraxella catarrhali
19
Q
Complications of Otitis media
A
Acute mastoiditis
20
Q
Acute mastoiditis pathogen
A
Streptococcus pneumoniae
21
Q
Acute mastoiditis initial treatment
A
sample from the ear discharge should be taken for culture DONE BY ENT
flucloxacillin + a third-generation cephalosporin
22
Q
Acute otitis media treatment
A
- Amoxicillin 1st choice (used for 1 week)
- 2nd line: amoxicillin-clavulanate
23
Q
Acute otitis media treatment px that’s allergic to penicillin
A
- clindamycin
- azithromycin
24
Q
Chronic suppurative otitis media treatment
A
Assess if tympanic membrane intact or perforated:
If intact: ciprofloxacin ear drops to treat on going infection
If perforated: initial treatment ear toilet with povidone-iodine solution, followed by
dry mopping with rolled toilet papers2 to 3 times a day using 20ml syringe with plastic tubing. In addition, ciprofloxacin ear drops
25
Untreated a tympanic membrane perforation secondary to chronic otitis media
- Marginal perforation with discharge
- Perforation that is surrounded by granulation tissue
- Continuously discharging central perforation
- Perforation associated with a cholesteatoma
26
Cholesteatoma risk factors
- history of recurrent acute otitis media
- chronic middle ear effusion
- tympanostomy tube placement
- history of cleft palate
27
Bilateral sensorineural deafness in children
Congenital sensorineural deafness.
28
Lymph nodes red flags
Weight loss
Sustained fever
Night sweats Generalized lymphadenopathy
Signs and symptoms of pancytopenia
Mass persisting> 6 weeks
Lymph node> 3 cm
Thyroid mass
Supraclavicular mass
Hard, irregular mass
Fixed mass
29
1 standard deviation above/below the 50th percentile
Weight: overweight/underweight
30
2 standard deviation above/below the 50th percentile
Weight: obese/severely underweight
31
Marfan's syndrome (MFS) features
- autosomal dominant connective tissue
disorder (FBN1)
- **affects height**
- **does not affect weight**
- aortic aneurysm
dissection, aortic regurgitation (Decrescendo high-pitched diastolic murmur at the left sternal edge)
- Myopia and ectopic ocular lens.
32
Marfan's syndrome (MFS) investigation
echocardiogram
33
Most common neurological cancers in children
34
Most common neurological symptoms in children with cancer
- Nausea
- Vomiting
35
Lymphadenopathy in children
viral upper respiratory tract infection
TB, Infectious
mononucleosis cytomegalovirus infection
Cat scratch disease
haematological and nonhematological malignancies, Kawasaki
disease.
36
Kawasaki disease features
- acute onset of fever more than 39C
-inadequate response to paracetamol
- sole, palm and tongue erythema
- desquamation of fingertips (vasculitis)
- tender mass in the right hypochondrium
- elevated CRP and ESR
37
Kawasaki disease in children complications
- vasculitis leading to coronary artery aneurysm 17-31% (second week and second month
of illness)
-
38
Kawasaki disease in children management
- aspirin and immunoglobulins
-Steroids must be avoided
39
< 6 months + > 7 days fever + systemic
inflammation but no other explanation for febrile illness
Atypical Kawasaki
40
Growing pains
Growing pains refers to pain in the lower
extremities of growing active children.
children between 2 and 12 years with the peak
incidence in preschool children.
mostly felt in the thighs, calves and
behind the knee.
intermittent and in mostly present in the afternoon and evening after activity during the day.
Pain may also wake up the child at night.
41
male adolescent athlete + pain below the knee + tenderness
Osgood-Schlatter disorder
42
Osgood-Schlatter disorder management
Gentle quadriceps stretching exercises
- self limiting up to 12 months
NOTE: Corticosteroids are absolutely contraindicated
43
Perthes
- avascular necrosis of the femoral head.
4 -8 years of age
associated with hip pain and intermitent limp.
44
Perthes features
- **Normal Caucasian boy**
- 4 and 10 years, peak incidence at 5 to 7 years
- 15% bilateral
- widening of joint hip space
Hip pain result of **necrosis of the involved bone**
-pain may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh.
- The quadriceps muscles and adjacent thigh soft tissues may atrophy, and the hip may develop **adduction flexion contracture**
- **antalgic gait** with limited hip motion, or a Trendelenburg gate (abductor lurch).
- Pain may be present with passive range of motion and
limited hip movement, **especially internal rotation and abduction**
45
Perthes disease management
- **refer to surgeon**
Surgeon will make call on conservative or surgical
- conservative: brace
- surgical: osteotomy/femoral head fixation, hip replacement worst case
46
slipped capital femoral
epiphysis (SCFE)
- Overweight adolescent of 10 to15 years
- bilateral in 20%
- Limp and irritability of hip on movement
- Knee pain — referred from the affected hip
- On flexion of the hip, it rotates externally. Hip
is often in external rotation on walking.
- Most movements restricted, especially
internal rotation.
47
slipped capital femoral epiphysis (SCFE) management
- Cease weight-bearing and refer urgently.
- lf acute slip, gentle reduction via traction is
better than manipulation for prevention of
later avascular necrosis.
- Once reduced, perform pinning
48
Developmental dysplasia (DDH) of the hip features
- neonates from **breech delivery**
- Female 6xt more likely
- unilateral or bilateral (positive family hx)
- **Diminished abduction in flexion of the
affected hip**
- Apparent inequality of legs: affected
leg being shortened and externally rotated
- Asymmetrical skin creases of the groin and
thigh
- ‘clicking’ on hip movements
49
Developmental dysplasia (DDH) of the hip dx
Barlow test —‘telescoping’ movements in the long axis of the flexed and abducted thighs.
**Ortolani test** — flexed hips are abducted. thighs are the grasped between the thumbs in front and other fingers behind. The child’s knees are flexed and hip flexed to a right
angle. **positive sign makes audible and palpable ‘jerk’ or ‘clunk’ (not a click). **
- Ortolani and Barlow tests but is usually negative after two months
- **Ultrasound** is excellent especially up to **3-4 months**
50
Henoch-Schönlein purpura (HSP) in children
- Autumn, winter and spring months
- IgA mediated vaculitis
- anaphylactoid purpura
- arthralgia (not arthritis),
- non-thrombocytopenic purpura (the purpura is vascular due to leukocratic activity)
-typical symmetrical distribution over legs and buttock.
- **colicky abdominal pain** 2 to 4 weeks
- melena
- ankle swelling
- nephritis
51
Henoch-Schönlein purpura (HSP) in children Dx
-Clinical presentation + urinalysis for nephritis
52
Henoch-Schönlein purpura (HSP) in children complication
Intussusception (due to intestinal oedma and bleeding)
53
Transient synovitis
- 3-8 years
- URTI hx
- sudden onset unilateral hip or groin pain most common sx
- medial thigh or knee
pain 2nd common sx
Arthralgia and arthritis secondary to synovium inflammation
- no fever, or only a mild fever
54
Transient synovitis
- NSAIDs 48 hours
- bed rest
55
Features of Epiglottitis
– H. influenzae
**High fever**, sore throat,
dysphagia, odynophagia,
**drooling** due to inability to swallow the saliva because swallowing
is painful and difficult.
child miserable adopts a tripod position with a **hyperextended neck** to maintain the airway open. Muffled voice (hot potato voice)
Lungs are clear on auscultation initiallt later **expiratory stridor** (ominous sign.)
56
Epiglottitis treatment
- supplemental oxygen
- intubate
57
age of epiglottitis
more common between
ages 2 and 4 years;
58
Thumb sign in X-ray
Acute epiglottitis
- intubation at hospital
59
Foreign body
U/L wheeze
60
Asthma in children definitive dx
- 2 and 5 years
-Bilateral wheezing
- viral wheezing, pre-school wheeze, episodic viral wheeze and multiple
trigger wheeze
61
Infrequent Intermittent asthma in children
- less than one episode of asthma in 6
weeks and no symptoms in between the flare-ups
- inhaled short-acting beta2 agonist
(SABA)
62
Asthma short-acting beta2 agonist SABA
salbutamol
63
Asthma LABA
64
CXR in bronchiolitis
B/L perihilar infiltrates
65
Expiratory wheeze + RSV URTI + barking cough
Croup
66
Croup management
mild: no treatment
moderate/severe:
-**Dexamethasone 0.3 mg/kg orally (first-line);**
- Prednisolone 1mg/kg orally, or
- Budesonide 2mg by nebulizer
most severe with significant airway obstruction/fatigue: Adrenaline 1% (1:100, 10mg/ml) solution 0.05ml/kg/dose
67
Cervical masses in children
1. Congenital
2. Inflammatory/ infective
3. Neoplastic
68
Posterior triangle of the neck mass
**CCP**
- Cystic hygroma
- Cervical rib
- Pancoast tumour
- (Naso/oropharyngeal squamous cell carcinomas)
69
Cervical masses in neonatal period
- thyroglossal duct cyst (TDC)
- teratomas
- sternocleidomastoid tumours of infancy
- vascular or lymphatic malformations.
70
Complications of thyroglossal duct cyst (TDC)
- **Infection**
-Malignancy 1%
- Overgrowth and pressure of the underlying
structures.
- Rupture and fistula formation
71
Anterior triangle of the neck mass
**BCC**
- Branchial cyst
- Carotid body tumour
- Carotid aneurysm
72
Midline of the neck mass
**TTD **
- Thyroid nodule
- Thyroglossal cyst
- Dermoid cyst
73
Acute rheumatic fever high risk population (JONES)
Major criteria:
- Carditis
-Polyarthritis
-Chorea.
-Subcutaneous nodules.
-Erythema marginatum
- Polyarthritis or aseptic mono-arthritis or
polyarthralgia
Minor criteria
-Fever more than 38c
-Previous rheumatic fever
-Arthralgia
-Raised ESR/CRP more than 30
-ECG shows prolonged PR interval
74
Acute rheumatic fever treatment
- benzathine penicillin IM
-Roxithromycin if allergic to penicillin/NSAIDs
75
Treatment of Perthes disease
Conservative: Splinting
Surgery: osteotomy
76
Features of Acute rheumatic fever (ARF)/ erythema marginatum.
2 major and 2 minor criteria
- **history of sore throat 3 weeks**
-**migratory arthralgia/arthritis**
- Erythema marginatum - well demarcated bright red/pink macules rash
77
Initial ARF dx
2 major criteria OR one major and two minor criteria + Evidence of preceding GAS infection
78
recurrent attack of ARF dx
Two major criteria OR one major and two minor criteria OR three minor criteria + Evidence of preceding GAS infection
79
ARF dx
Cultures for GAS are the gold standard (Throat swab)
80
Most common cause of vaginal bleeding in children
vaginal foreign body
81
nonspecific vulvovaginitis
- caused by chemical
irritants such as bubble baths or by poor hygiene
- stop bubble baths and use only cotton underwear
82
vulvovaginitis management in children
no voiding difficulties: reassure
voiding difficulties: topical oestrogen or oestradiol cream applied twice daily
severe obstruction to urinary flow with retention or recurrent infections: Manual or surgical separation
83
Causes of vaginal bleeding in children
- Vaginal foreign body
- Severe vulvovaginitis
- Trauma (including straddle injury and sexual
abuse)
- Excoriation associated with threadworms
- Onset of first menstruation
- Haematuria
- Urethral prolapse
84
Enuresis management in children
- Spontaneous resolution <5 years (84%)
- Bed wetting alarms >5 years and conservative methods (fluid
intake, toileting, reward system) failed + wetting >2 per week
- nasal desmopressin alternative bed wetting alarm.
85
Gastroenteritis in children causes
- Norovirus 95% aus
- faecal--oral route
- Contaminated food and water (cold meats)
- 12 to 24/48 hour incubation period
- noninflammatory, nonbloody, non-mucoid
86
Norovirus Gastroenteritis in children dx
PCR stool
87
Gastroenteritis in children clinical features
Common:
- Nausea
- Vomiting
- Diarrhoea
- Abdominal cramps
Not common:
- Headache
- Low-grade fever
- Chills
- Muscle aches
- Malaise
88
Gastroenteritis in children management
Symptomatic
89
anal fissure features
- passage of hard stools
90
anal fissure management in children
- anusol cream (lignocaine)
- pain for anal fissure is under control, laxatives and fibre diet
91
Hirschsprung disease (HD)
- 15-20 % of newborn intestinal obstructions
- 80% in the first 6 weeks of life
- male > female
- congenital anomaly by absence of ganglia in a segment of colon and paralysis of this aganglionic segment
-starts at the anus and progresses up
the rectum towards the colon. (Delayed meconium passage)
- Failure to pass meconium in the first 24 hours but w/ gradual
onset of abdominal distension of days to weeks.
- Persistent and progressive constipation
-Vomiting late
92
Hirschsprung disease (HD) complication
enterocolitis
93
Hirschsprung disease (HD) Dx
Rectal suction biopsy – Gold standard
94
3 months
- hold the neck
- recognize mother’s face
95
Hirschsprung Disease (HD) Mx
- Laxatives (mild cases)
- Surgery
96
intestinal malrotation with volvulus
- 6 months
-bilious vomiting
- crampy abdominal pain
- abdominal distention
- bloody, mucoid stool
97
Hypertrophic Pyloric Stenosis features in children
- 2 and 6 weeks of age
- gastric outlet narrowing
- projectile vomiting a few minutes after feeding
- non bloody, non bilious vomiting
- delayed capillary refill > 2 seconds
98
Hypertrophic Pyloric Stenosis risk factors in children
-Formula feeding
-Male
-Caucasian background
-Firstborn
-Maternal smoking during pregnancy
-Positive family history
-Both erythromycin and azithromycin < 2weeks
99
Hypertrophic Pyloric Stenosis in children mananament
Initial: Fluid resuscitation
Best: Ramstedts Pyloromyotomy
100
Proteinuria in children
> 1+ protein on urine dipstick exam
- perform urinalysis for confirmation
101
Abnormal UA in children
- Asymptomatic microscopic hematuria
- Repeat UA after fever settles if no UTI (2 positive UA)
102
UTI in children
- Fever, nausea, vomiting
- abdominal pain
- Leukocytes and nitrites on urinalysis
103
UTI in children investigation
- suspect vesicoureteric reflux
- < 3 years (2-36 months) US of the kidney, ureter & bladder
- If US normal then voiding cystoureterogram (VCU)
104
UTI hospital admission indication
- Most of children less than 3 months.
- Children who are seriously unwell such as
those with toxic appearance or
dehydration.
- Oral antibiotics cannot be tolerated.
105
UTI in children Managment
1st line: trimethoprim
cephalexin
106
UTI in infants < 1 year
- 1st: US
- micturating cystourethrogram (MCU): rule out vesicoureteric reflux
107
tachycardia + sunken eyes + >3 sec capillary resuscitation
severe dehydration
108
severe dehydration management
10-20ml/kg boluses of 0.9% normal saline
109
Renal scarring in children
- Recurrent urinary tract infections (more than
2 times during childhood)
- Dimercaptosuccinic acid scintigraphy (DMSA) - Gold Standard
110
DMSA indications
- Clinical suspicion of renal injury
- Reduced renal function
- Suspicion of VUR
- Suspicion of obstructive uropathy on ultrasound in older toilet-trained children
111
post-streptococcal Glomerulonephritis (PSGN) in children symptoms
- hypertension 50-90%
- haematuria 30-50%
- oedema 60%
- Decreased complement (C3) levels
112
post-streptococcal Glomerulonephritis (PSGN) management
- Fluid restriction
- Loop diuretics/dialysis
- Steroids (caution, could be wrong)
113
Minimal Change Disease (MCD) in Children
- nephrotic syndrome
- <6 years
- Absence of hypertension
Absence of hematuria by Addis count
- Normal complement levels
- Normal renal function
114
Minimal Change Disease (MCD) in Children dx
**1. Nephrotic range proteinuria-urinary protein excretion greater than 50 mg/kg per
day.**
**2. Hypoalbuminemia-serum albumin
concentration less than 30 g/L.**
3. Edema.
4. Hyperlipidaemia
115
Nephrotic disease management
- Corticosteroid (Prednisolone)
116
Causes of obesity in children
- Hypothyroidism (check TSH)
- Excessive caloric intake
- Cushing's disease (ACTH, cortisol)
117
Autistic disorder features
- preoccupations with activities
- objects
- delayed speech language development
- Aggression and irritability
- poor communication with friends and avoiding eye contact
118
Characteristic features of autistic disorder
1. Onset during infancy and early childhood
2. Lack of socila interactions
least two of the following:
- No awareness of the feelings of others
- No or abnormal comfort seeking in
response to distress
- No imitation
- No social play
- cannot socialize, (no eye contact )
3- Impaired communication
least one of the following:
- No babbling, gesture, mime or spoken
language
No non-verbal
communication
- abnormal form of
speech
- inability to make conversation
-abnormal speech
4- Restricted or repetitive activities, interests and
imaginative development, shown in at least one of
the following:
- stereotyped body movements
- persistent preoccupations and
rituals with objects or activities
- gets troubled over changes in routine or
surroundings
- No imaginative and symbolic play
5- Behavioral problems:
- tantrums
- hyperactivity
- risk-taking activity
119
Autism treatment
Atypical antipsychotics (Risperidone)
120
Relationship between ADHD & ODD
In more than 50% of px with ADHD, ODD is also a part of the clinical picture
121
kidney scarring features in children
- one kidney smaller than the other
122
nutshell diagnosis of autistic disorder requires
the presence of core features by the
age of 3 years:
1. Impairment of social interaction
2. Impairment of communication
3. Restricted, repetitive and stereotyped patterns of activities, behavior and interest
123
kidney scarring investigation of choice in children
DMSA (gold standard)
- Clinical suspicion of renal injury
- Reduced renal function
- Suspicion of VUR
- Suspicion of obstructive uropathy on ultrasound in older toilet-trained children
124
6 weeks
- good head control
- head stabilises when sitting
- track objects
- startes at loud noise
- social smile
125
2 months
social smile 6 weeks
126
3 months
- hold the neck
- recognize mother’s face
127
4 months
- eye contact with people
- look for mother when she speaks
- happy or settled most of the time
-follow activities with eyes
128
6 months
- Sits without support
- Rolls from prone to supine vice versa
- palmar grasp
- hand to hand transfer
- turns head to loud noise
- understands bye bye and no
- puts object to mouth (stops at 1 year)
- shakes rattle
reaches for bottle/breast
- Ability to explore things by holding, looking at them and putting them in mouth
129
8 months
- sits without support
- repeats syllables 'mama/dada'
- enjoys peekaboo
130
9 months
- crawls
- stranger anxiety
131
12 months
- 'Cruises'
-thumb grasp
- imitates speech with meaning
- waves goodbye
132
14 months
- pulls string on toy
133
15 months
- neat pincer grasp
134
18 months
- walks without support
- can build 2 tower blocks
- say 3 words
- drinks from cup
135
2 years child expected to
- walking upstairs
- Scribbling
- points to body part
- knowing 2 pronouns
-Toilet trained
- self feeding by spoon/cup
136
2.5 years
- runs/jumps
- throws ball
- build 4 blocks
- 2 word sentences
137
3 years
- ride tricycle
- copes vertical line/ circle
- can use scissors
- 3-word sentences
138
4 years
- learns bicycle
-copies square
- first and last name
- dress with supervision
139
5 years
- hops on one foot
- draw a person with 3 parts triangles
- knows colours
- dress without supervision
140
Encoperesis
voluntary or involuntary passageof stools
- place
other than the toilet
- >1/month for 3months
- >4years
141
Social & emotional developmental milestones
142
Emotional development milestones
143
Types of encoperesis
primary- child has never been
continent
secondary- previously
continent.
144
Cognitive development milestones
145
Staphylococcal scalded skin syndrome
known as Ritter disease
commonly in children less than 5 years of age
fever,
irritability, erythema,tender skin
Circumoral
erythema
crusting of the eyes, mouth, and nose
blisters on the skin
Postive Nikolsky sign- Peeling of the epidermis in
response to mild shearing forces
146
With constipation and overflow
Incontinence:
<3/week bowel movements
-stool partially emptied remaining
- stool leak out, often during the child's daily
activities.
- if constipation resolves encoperesis resoleves
147
Language development milestones
148
Encoperesis with No constipation overflow Incontinence:
there's no constipation, and the child’s faeces have normal consistency. Unlike in cases associated with constipation and overflow, soiling of this type is intermittent. Feces may be emitted in
a prominent location (e.g., as an act of defiance) or
may be an unintentional consequence of anal selfstimulation (e.g., a variety of masturbation).
Encopresis without constipation and overflow
incontinence is less common than the first type of
encopresis, and is often associated with
oppositional defiant disorder and conduct disorder.
It has been estimated that 3% of children with
psychiatric issues may have encopresis.
149
Oppositional Defiant Disorder (ODD) in Children
- 10-12 years
150
Oppositional Defiant Disorder (ODD) in Children Treatment
1st line: Antipsychotics (risperidone)
2nd line: mood stabilisers (sodium valproate) SSRIs
151
‘hand, foot
and mouth (HFM) disease’
- Self-limiting
- Coxsackie A virus. - Erythematous macular rash,
progressing to gray
vesicles
vesicles seen in buccal mucosa,
gums and tongue.
- doesn't involve the buttocks and the genitalia
- no scarring.
School Exclusion: until lesions dried up
152
Parvovirus B19
- Fifth disease (erythema infectiosum)
- **Low haemoglobin** patients with
haemolytic conditions (such as sickle-cell anaemia) thus develop a transient aplastic
crisis
- poorly functioning bone marrow (for a week or more)
153
Conductive disorder
- 12-18
154
Features of partial seizures
- no loss of consciousness
- no pos ictus
155
vertigo in children
- CNS tumours (medulloblastoma)
- temporal lobe epilepsy
156
cyanosed baby + No murmur at birth
Transposition of great vessels
157
Absent seizures ion children
- loss of consciousness
-pos ictus
- 30-60s duration
158
Febrile seizures/ convulsions
Simple:
- duration of less than 15 minutes
- do not occur more than once in 24 hours
Complex seizures:
- MAY last for longer than 15 minutes
- recur in
the course of 24 hours
159
Febrile seizures/ convulsions management
If seizure is of short duration and doesn't reoccur = reassurance
if the following situations:
1. A child with a pattern of prolonged seizures (usually longer than ten mins.) which
have previously responded to intravenous or rectal diazepam.
2. A child with clusters of repeated seizures in whom oral treatment is inappropriate.
3. A child with severe epilepsy who is remote from emergency services.
=
Rectal diazepam
160
Neurocysticercosis (NCC)
- raw meat consumption
- Tapeworm Taenia solium
- MRI single focal white matter lesions
- Blood test serology
- Albendazole
161
162
Temporal lobe seizures in children
163
Features of infantile spasms
- 3-7 months
sudden bending of the trunk and flexion of upper limbs
- Corticosteroids (prednisolone) 1st line for 8 to 10 week. Vigabatrin
- Clonazepam for acute presentation?
164
Tics in children
- also known as habit spasms
- individually recognisable, intermittent movements
- aware in the urge to perform the movement
- blinking,
- facial grimacing,
- shoulder shrugging,
- head jerking
165
Unknown seizures
- resistant to
treatment with
intravenous calcium
- **test Serum magnesium level**
166
BPPV child
- variant of migraine
preceeds - migraine in future
167
cyanosed baby + murmur at birth
Tetrology of fallot
168
Roseola infantum
exanthem subitum/sixth disease/three-day
fever
169
Roseola infantum features
3 to 5 days of high
fever may exceed) 40°C.
fever resolves abruptly
rash develops
170
cyanosed baby + No murmur at 2-7 days of life
Hypoplastic left heart
171
Features of diarrhoea
- opposite of vomiting
172
Roseola infantum causes
human herpes virus 7 (HHV-7),
enteroviruses (coxackievirus A and B, echovirus),
adenovirus, and parainfluenza virus type 1.
173
Austin-Flint murmur
mid-diastolic
rumbling murmur best heard over the apex.
In Severe Aortic Regurgitation
In MFS
174
MFS treatment
1st -beta blockers
2nd- verapamil, ACEinhibitors
175
Drugs closing ductus arteriosus
NSAIDS
176
most
common cause of failure to breastfeed?
Reduced frequency of
breastfeeding.
177
ureteropelvic junction (UPJ)
obstruction features
- most common cause
of paediatric hydronephrosis
- periodic abdominal pain with vomiting
- exacerbation on UPJ can also lead to pelvic distention, flank pain or even tenderness
178
Drug keeping the ductus arteriosus open or patent
PGE2
179
COUGH
acute (<3 weeks),
subacute (3-8 weeks)
chronic or persistent (>8
weeks).
180
ureteropelvic junction (UPJ)
obstruction diagnosis
US during painful episode
181
Idiopathic (immune) thrombocytopenic purpura (ITP)
- preceding viral infection
- s frequently < 20,000/μL
- other lab tests normal
-
182
Idiopathic (immune) thrombocytopenic purpura (ITP) in children management
- If not bleeding: monitoring/observation
- If bleeding: IVIG and corticosteroids (prednisone)
183
Isolated thrombocytopenia features
- following an URTI
- acute (~90%) or chronic (~10%)
- no pallor, lymphadenopathy
or hepatosplenomegaly.
- if platelets > 20 x 109/L: bed rest
- if platelets < 20 x 109/L: oral steroids (prednisolone)
184
Colon polyp
- benign hamartomas
- ages 2 and 8 years, peak at 3 to 4 years
- mostly painless
rectal bleeding
palpable polyp
on rectal examination >60%
185
anal fissure
- most common cause of painful rectal bleeding in children
- associated with constipation
- bright blood on the
surface of stool, on the nappy or toilet paper
186
retinoblastoma
- most common intraocular tumor in children
- Leukocoria (white cornea or Cat’s eye)
-strabismus
- initial: US (intraocular calcification)
- best dilated indirect
ophthalmoscopic examination under anesthesia
187
Chronic cough cause in children
asthma
188
separation anxiety in child features
- Want to stay at home with parents
- Get upset about going to school
aches or headaches, or do
not feel well without a physical cause -Do not have any serious behavior problems
- Do not try to hide their wish regarding not going to school from their parents
- Are more likely to be the youngest memberof a family
189
acute or subacute cause of cough
Post viral cough
190
diagnosis and staging of the VUR.
Voiding cystoureterogram
191
Bordetella pertussis (whooping cough) hospital admission
- **Infants less than 6 months of age**
- Any child with complications (i.e. apnoea,
cyanosis, pneumonia, encephalopathy, pneumothorax)
192
Bordetella pertussis (whooping cough) school exclusion
3 weeks start of symptoms
2 weeks start of **cough**
<5 days of antibiotics
193
Bordetella pertussis (whooping cough) investigation
Children: Nasopharyngeal aspiration
Adults: nasopharyngeal swab
194
Lobar Pneumonia in children
- streptococcus pneumoniae
- high fever
- **chest auscultation
deceitfully normal**
-high fever
- pallor
-respiratory distress
195
expiratory stridor
196
Lobular (atypical) Pneumonia in children
- fever is not often that high.
- insidious onset
- prodromal
state
197
inspiratory
stridor
suggests obstruction above the glottis.
198
Pneumonia in children investigation
initial step: chest X-ray (to see consolidation)
199
Choanal atresia features
- failure of canalization of the bucconasal membrane.
CHARGE SYNDROME
- coloboma
- heart defect,
- atresia choanae
- retarded growth
- genital abnormality
- ear abnormality
200
Choanal atresia dx
pass nasogastric tube (also managment)
no use in giving oxygen
201
Choanal atresia management
Mild hypoxemia: nasogastric tube
Severe hypoxemia: intubation and ventilation
202
CHARGE SYNDROME
-bilateral choanal atresia
coloboma
- heart defect,
- atresia choanae
- retarded growth
- genital abnormality
- ear abnormality
203
Laurence-Moon-Biedl syndrome
- autosomal
recessive
-Obesity
- mental retardation
- hypogonadism
- retinitis
pigmentosa with night blindness
- polydactyly
204
Fröhlich syndrome
- adiposogenital dystrophy
- obesity associated with a hypothalamic tumour
205
Noonan's (Male Turner’s) syndrome features
- Affects males
- An autosomal disorder involving **mutation in chromosome 11**
- **Pulmonary valve stenosis**
- **Webbed neck**
- Abnormalities in cardiac conduction and rhythm
- flat nasal bridge
- single palmar crease
- protruding tongue
- eyes that are apart more than usual
- low set ears
206
Turner Syndrome features
- Affects females
-Madelung deformity
- short stature,
- webbed neck
- low-set ears
- low hairline at the back of the neck
- epicanthal folds
207
Turner Syndrome complications
- aortic coarctation
- Complete atrioventricular septal defect (CAVSD) – 37 percent
- Ventricular septal defect (VSD) – 31 percent
- ASD – 15 percent
- Partial atrioventricular septal defect (PAVSD) – 6 percent
- Tetralogy of Fallot (TOF) – 5 percent
- PDA – 4 percent
208
prominent ulnar head and apparent volar subluxation of the wrist on the forearm
Madelung deformity
209
vesicoureteral reflux (VUR)
Grade I: Reflux into the nondilated ureter
2. Grade II — Reflux into the ureter and renal calyces without dilation
3. Grade III — Reflux with mild to moderate dilation
and minimal blunting of the fornices
4. Grade IV — Reflux with moderate ureteral
tortuosity and dilation of pelvis and calyces
5. Grade V — Reflux with gross dilation of ureter,
pelvis and calyces, loss of papillary impressions,
and ureteral tortuosity **NEED SURGERY**
210
vesicoureteral reflux (VUR) management
management depends on grading:
Grade I-IV: **continuous antibiotics**
Grade V: **Surgery**
211
Tetralogy of Fallot (TOF)
4 defects
- blood going from left to right ( acyanotic)
- all have VSD (systolic murmur)
- pulmonary stenosis
- right ventricle hypertrophy
- overriding aorta
212
Patent ductus arteriosus. (PDA)
-acyanotic
- pansystolic machinery murmur (harsh) at the left sternal border
- wide pulse pressure.
- Definite treatment surgical closure
213
Ventricular septal defect (VSD)
- holosystolic murmur at left sternal border
- acyanotic
214
Atrial Septal Defect (ASD)
- acyanotic
- mid-systolic murmur at the pulmonary area, a split-second heart sound and a loud P2
2 main types:
- Ostium Primum: most dangerous type, can lead to pulmonary hypertension and heart failure, Prophylactic antibiotics recommended
- Ostium Secundum: most common type, e hole is higher in the septum, not serious, symptoms uncommon in infancy
215
Transposition of the great arteries (TGA)
- central cyanotic after 10-12 hours
Aorta and pulmonary arteries are reversed
- no murmur as there is no hole
- **prescribe PG e1**
- definite treatment: surgery to correct the transposition
216
Innocent murmur
7S
-soft
- systolic
- short duration
- sounds (S1 &S2)
- symptomless
- Special tests normal (X-ray, ECG)
- Standing/Sitting changes (not fixed) (increased when supine)
217
Pathological murmurs
Family hx of sudden cardiac death or
congenital heart disease
- in utero exposure to certain medications (lithium) or
alcohol
- Maternal diabetes mellitus
- History of rheumatic fever
- History of Kawasaki disease
- Grade 3/6 or higher murmurs
- Harsh quality
- Abnormal S2
- The presence of a systolic click
- Increased intensity with decreased venous
return (e.g., when the patient stands)
- The patient has any symptoms that could be
related to a cardiac condition (e.g. shortness
of breath, chest pain, poor feeding, etc.)
218
murmurs that increase in
intensity when the venous return to the heart is
decreased:
1. hypertrophic obstructive
cardiomyopathy (HOCM)
2. mitral valve prolapse
3. venous hum (low-pitched continuous
murmurs produced by blood returning from
the great veins to the heart)
219
most common
allergens that can cause allergy and asthma
dust mites 90%
sheepskin 2nd most common
220
Duodenal atresia features
- Neonate w/ vomiting (after first feeds)
- Down syndrome 5%
distal obstruction to the papilla of Vater 80%
-bilious vomiting
- M > F
-X-ray: 'double-bubble’
- drooling
- abdominal distension (very late symptom)
221
Down syndrome in children
- short stature
- microcephaly
- centrally placed hair whorl
- small ears
- redundant skin on the nape of the neck
- flat nasal bridge
- Cardiac lesions 30% to 50% (endocardial cushion defect, VSD, tetralogy of Fallot (all 30%)
- Duodenal atresia
222
Edwards syndrome in children
- Mortality is 50% in the first week and 90% in the first year
- low-set ears,
- a prominent
occiput,
- a short sternum,
- a closed hand with overlapping fingers,
- cardiac defects,
rocker-bottom (rounded) feet,
- cleft lip and/or palate
223
Müllerian agenesis
- Female gonads do not secrete Müllerian-inhibiting factor (MIF)
- Male testes secrete MIF
- empty scrotum
- testes are impalpable in inguinal canal
224
Oxygen saturation in children
- >93%
- RR 50
225
Bronchiolitis
- acute LRTI <12 months (2 weeks to 9 months)
- respiratory syncytial virus (RSV)
- irritating cough and rhinorrhoea
- distressed wheezing breathing
- Hyper-inflated chest (barrel-shaped)
- Use of accessory muscles and subcostal
recession
- fine inspiratory crackles
- supportive with oxygen and hydration
- bilateral perihilar congestion on X-ray (not necessary)
226
Bronchiolitis management
100% oxygen via nasal prongs.
- severe bronchiolitis and requires rehydration
using intravenous fluids or nasogastric tube.
227
bronchiolitis high risk of airway compromise
- Infants younger than 3 months of age
- Preterm or low birth weight infants.
– Infants with chronic lung disease.
– Infants with congenital acyanotic heart disease.
228
Pulmonary hypoplasia
- Oligohydramnios
- Kidney US (bilateral renal agenesis)
229
Laryngomalacia in children
- congenital softening of the tissues of the larynx
- **noisy breathing ** worsens when agitated, feeding, crying or sleeping
on back
- High pitched sound
- symptoms present at
birth, can become more obvious within the first
few weeks
- outgrow by 18 to 20 months
230
most common cause of failure to thrive
inadequate caloric intake
231
Tonsillitis management
- Perform throat swab+ start antibiotics
- If swab+ve = continue antibiotics
- if swab-ve = discontinue antibiotics
232
tonsillectomy in children
- Hemorrhage common complication, also life thereatening
- bleeding may occur in the early post-operative
period or may be as delayed as 5 to 10 days
- bleeding secondary to tonsillar fossae infection
233
post-tonsillectomy haemorrhage management
- Resuscitation - 2 large bore cannula with
bloods
- Reservation of cross-matched packed red
cells
- IV antibiotics: with 1.2g Benzyl Penicillin, 6-hourly + 500mg of metronidazole, 12-hourly
- NSAIDs
- Hydrogen peroxide gargle - 20mls of
hydrogen peroxide diluted with water in a
ratio of 1:6.
234
Retropharyngeal abscess
- inflamed prevertebral soft tissue
- inability to extend the neck
- lateral neck film demonstrates a widened prevertebral soft tissue strip
- typically not present with airway compromise and hypoxia
235
What Vitamin is given to babies after birth?
- Vitamin K IM injection to avoid intercranial haemorrhage
236
Aboriginal Australians are deficient in what vitamin
Vitamin D
237
umbilical granuloma
- most common umbilical mass
- overgrowth of tissue during the healing process
- soft pink or red lump
- leaks small amounts of clear or yellow fluid
- presence of non-purulent discharge
238
umbilical granuloma management
topical silver nitrate
- cauterisation may need to be repeated at 3-day intervals if drainage persists
239
Most common organism causing ophthalmia neonatorum
Chlamydia trachomatis
- notifiable disease
240
ophthalmia neonatorum treatment
oral erythromycin and sulfacetamide eye drops
241
Neisseria gonorrhoea infection in a child
Vaginal non-bloody pus-like discharge 95%
242
Bacterial conjunctivitis in children
- gonorrhoea: fast and aggressive (3 and 7 days after birth)
- chlamydia: slow and less aggressive (end of 1st week - 1 month after birth)
243
Bacterial conjunctivitis in children school exclusion
- Excluded until discharge has resolved
244
congenital adrenal
hyperplasia (CAH)
- 21-hydroxylase deficiency
-
245
congenital adrenal
hyperplasia (CAH) dx
Palpable gonads:
-Pelvic ultrasound
-Testosterone and dihydrotestosterone (DHT) ratio.
-LH and FSH.
-ACTH stimulation test.
-hCG stimulation test
No palpable gonads:
- markedly elevated 17-hydroxyprogesterone 90%
-Serum electrolytes.
-Plasma renin activity
246
Hereditary angioedema
- recurrent angioedema without pruritis in:
- upper respiratory tract
- gastrointestinal tract
- subcutaneous tissues
- autosomal dominant reduced C-1 esterase
inhibitor levels (HAE type I) or poorly functional (HAE type II)
247
Meningitis in children features
- < 1 month old
- fever
- poor feeding
- jaundice
- bulging fontanelle
- seizures
- nuchal rigidity
- irritability/lethargy
- Usually GBS
248
Meningitis management in children
CSF analysis/Lumbar puncture FIRST:
- turbidity
- low glucose (less than 1.7 mmol/L)
- elevated proteins
- elevated white cells (20 to 30 cells/microL)
- Gram stain may be negative 60%
> 7 days **E. Coli most
common**
IF signs of ICP (seizure, papilledema) then CT head
249
Immediate management of acute meningitis in chidren
-Airway, Breathing, Circulation, Disability, Exposure (Primary Survey).
-Obtain immediate intravenous access (an intraosseous needle may be required).
-Administer intravenous dexamethasone (0.15 mg/kg).
-Intravenous ceftriaxone (100 mg/kg).
-Take blood cultures.
250
Aortic coarctation in children
- 90% of blood is shunted across ductus arteriosus (well tolerated)
- low cardiac output and shock once the ductus arteriosus closes
251
Aortic coarctation symptoms in children
- hypotension,
- cyanosis,
- respiratory distress,
- **shock with normal or weak upper extremity pulses **
- **absent femoral pulses**
- Metabolic acidosis is seen as compensation to respiratory alkalosis
- prostaglandin E1 infusion to maintain a patent ductus
arteriosus and surgical repair
252
incidence of congenital heart disease in children
1 child: 2% to 6%
2 children: 20% to 30%
253
indications for preventer therapy in asthama
symptoms at night
>1 canister beta 2 aginists every 3mon
using beta 2 agonists >2days /week
asthma attacks >2/month
infrquent asthma attacks but severe
spirometry with reversible airflow obstruction
254
most common congenital heart disease in infants?
Ventricular Septal Defect (VSD) 1 in 100 Australian infants
255
Hepatoblastoma
-<5 years
- mass in right upper quadrant
- abdominal distension
- right-sided abdominal pain
- familial adenomatous polyposis high risk
- lost appetite and weight
- vomiting and jaundice (very rare)
256
infant < 2 years + low-grade fever + abdominal distension + loss of appetite + limb pain + abdominal mass that crosses the midline
Neuroblastoma
- originates from adrenal glands
257
3-4 years of age + kidney claw sign + abdominal mass does not cross midline
nephroblastoma (Wilm's tumour)
258
most common cause of sinus bradycardia in
neonates
secondary to Respiratory failure and hypoxia
259
Most common allergy in children
Food allergy 80%
260
most common cause of short stature in children
Constitutional delay of growth and puberty
- lack of breast development-thelarche in girls above 13 years
- testicular volume less than 4ml by the age of 14 years
261
Growth investigations to consider prior to referral
- FBC
- urea & electrolytes
- ESR
- Coeliac serology
NOTE: GH is pulsatile therefore not diagnostic
262
bacterial balanitis ( bacterial infection of the
foreskin) treatment
- topical antibiotics mupirocin
- mild inflammation without pus or other signs of cellulitis = topical
steroids
263
best method of anaesthesia for neonatal circumcision
Dorsal penile nerve block
264
most common cause of jaundice in a neonate
within 24 hours after birth?
Haemolysis due to ABO incompatibility
- always pathological
265
most common cause of hyponatremia in children
- diarrhoea
266
hyponatremia in children
-Gastrointestinal fluid losses.
-Administration of hypotonic fluids.
-Severe infections-meningitis, encephalitis, pneumonia, bronchiolitis, sepsis etc can lead to SIADH
267
persistent hyponatremia in children
– Congenital Adrenal Hyperplasia.
– Addison’s Disease.
– Psychogenic polydipsia.
– Obstructive uropathy
268
Chronological age and bone age
-should be equal
- difference <2 years = normal (reassure)
- difference > 2 years = constitutional delay
269
Guillain-Barré syndrome in children
- Campylobacter infection
- 10 days after a nonspecific viral illness
- acute polyneuropathy
- progressive, mostly symmetric muscle weakness (days or weeks) beginning in the lower
extremities and progressing toward the trunk
- absent or depressed deep
tendon reflexes
270
Guillain-Barré syndrome dx in children
- spinal fluid protein measurement (elevated protein 2x normal)
- glucose and cell counts are normal
271
Guillain-Barré syndrome management in children
- observation (24-48 hours)
- intravenous immunoglobulin,
steroids, or plasmapheresis (respiratory failure)
272
Charcot-Marie-Tooth disease in children
- peroneal and intrinsic foot muscle atrophy (strange feet)
- extending to the intrinsic hand muscles and proximal leg
273
Fragile X syndrome in children
- inherited disorder
- Fragile X Mental Retardation 1 (FMR1) gene expansion
- associated primary ovarian
insufficiency & tremor ataxia syndrome
- All males with the full mutation
- Relative macrocephaly
- Strabismus
*Pale blue irises
*Midface hypoplasia with sunken eyes
*Arched palate
*Mitral valve prolapse (seemingly benign)
*Joint hyperlaxity (particularly of the thumbs, fingers, and wrists)
*Hypotonia
*Doughy skin over the dorsum of hands
*Flexible flat feet
274
Tay Sachs disease in children features
- 2 to 6 months
- **Retinal cherry red spots 90%**
- progressive weakness and loss of motor skills
- with hypotonia
- hyperreflexia
- retinal ganglion cells become distended with glycolipid
275
Tay Sachs disease in children investigation
Fundoscopy: retinal cherry red spots in 90%
276
Tay Sachs disease in children blood test
Hexosaminidase A & B enzyme
277
Mumps meningitis in children
- **occurs in the post-pubertal male 25%, usually unilateral**
- Paramyxovirus isolated from CSF,
saliva and nasopharynx
- fever,
- lethargy,
- **bilateral parotid swelling**
- parasternal oedema
278
Mumps meningitis in children complications
- Aseptic meningitis
- testes causing orchitis, usually unilateral,
279
Tetanus vaccinations in children
- 3 vaccinations at 2,4 and 6 months
- 1st booster at 4 years
- 2nd booster between 12-17 years
280
Clean laceration tetanus
- no immunoglobulins required
- check to see vaccination status and vaccinated in indicated
281
Dirty laceration tetanus
- immunoglobulins required
282
DTPa minimum dose
duration
4 weeks
- booster doses 10 years and 20 years after primary course
283
Oral polio vaccine (OPV) in children
Preterm babies should not get vaccinated until after leaving hospital (might spread the live vaccine virus to other babies in the hospital)
- inactivated polio vaccine can be used instead
284
Hydrocele in children
- scrotal swelling
- A bluish discoloration of the skin if the hydrocele is large.
- Fluctuation in the size of the swelling (mainly in infants).
- The area of the hydrocoele is clearly defined.
- Hydroceles are not painful but may cause discomfort if they are large.
285
Hydrocele in children investigation
positive transillumination test
286
Hydrocele in children management
- wait until 18 months (resolve spontaneously)
- surgery if not resolved after 18 months
287
cystic fibrosis in children
- autosomal recessive
- 1:3700
- Sweat chloride test
- DNA testing (CFTR) diagnostic 72%
288
Kernicterus in children
pathogenic sign of bilirubin staining of the brain stem nuclei and
cerebellum
– Athetoid cerebral palsy with or without seizures.
– Developmental delay.
– Hearing deficit.
– Oculomotor disturbances including paralysis of upward gaze.
– Dental dysplasia.
– Intellectual impairment.
289
Vitamin A deficiency
night blindness
drying of the conjunctivas and sclera
dry skin
Poor growth and impaired cognition
290
Duchenne's muscular dystrophy in children
- X-linked recessive trait
- after
- deficiency of dystrophin
beginning to walk features become more evident
- Pseudohypertrophy limited to the calf muscle
- hip girdle weakness at 2 years
- Gower sign (use of the hands to “climb up” the legs in order to assume the upright position) at 3-5 years
- use of a wheelchair after 12 years
- mental impairment and cardiomyopathy
- Death respiratory failure, heart failure, pneumonia, or aspiration
291
Klumpke paralysis
- C7, C8 & T1 injury
- affects elbow
- hand palsy
292
Acute disseminated encephalomyelitis (ADEM)
autoimmune-demyelinating
<10 years of age
preceeding URTI
high-dose corticosteroids to treat
293
Neonatal hypoglycaemia features
- Mid-line defects (Congenital pituitary deficiency)
- Hepatomegaly (glycogen storage diseases and fatty acid oxidation
disorders)
- Micro penis (congenital gonadotropin deficiency, possible pituitary, cortisol deficiency)
abnormalities
- Macrosomia (maternal history of
gestational diabetes)
294
Hypoglycaemia IV infusion
2ml/kg of 10% dextrose IV
295
benign haemangioma
- strawberry naevus
- around 1 to 4 weeks of age, then get bigger, for a few months
- stop growing between 6-12 months
- **gradually disappear over the next few years**
- if naevus at eyes, nose, ears or trachea then laser therapy
- If anywhere else, then observation
296
ABO hemolytic disease in this infant
positive direct Coombs test
297
Brain tumours in children
- account for 25% -
30% of all paediatric malignancies
- 1 to 10 years infratentorial (posterior fossa)
- After 10 years of age, supratentorial tumour's (eg, diffuse astrocytoma)
298
infratentorial tumours in children
cerebellar and brainstem tumours (medulloblastoma, cerebellar astrocytoma)
- ICP
- nausea
- vomiting,
- ataxia,
- vertigo,
- papilloedema
- Cranial nerve VI to X palsies
299
Phenylketonuria,
- autosomal recessive
- absence of an enzyme that metabolizes
phenylalanine to tyrosine
mental retardation
- Treatment consists of a diet that maintains phenylalanine at levels low enough to
prevent brain damage but adequate to support normal physical and mental
development.
300
supratentorial tumours in children
301
Seborrheic dermatitis in children
- Erythema toxicum 50% of term newborns
- commonly greasy, scaly, and erythematous rash
- face, neck, axilla, and diaper area
302
Mongolian spot in children
- a bluish-grey lesion over
buttocks, lower back, and occasionally extremities extensor surfaces
- blacks, Asians, and Latin Americans
- tend to disappear by
1 to 2 years
303
Biotinidase
autosomal
recessive trait
dermatitis, alopecia, ataxia,
hypotonia, seizures, developmental delay, deafness, immunodeficiency, and
metabolic acidosis
Treatment is lifelong administration of free biotin.
304
Sickle cell anaemia in children
- pneumonia,
- pulmonary thromboemboli
- sepsis
NOTE: with sickle-cell anaemia, these can be rapidly progressive and quickly fatal
- require hospitalisation
305
causes of iron deficiency anaemia in
children
– Excessive intake of cow’s milk.
– Prematurity.
– Low birth weight.
– Coeliac disease.
– Lead poisoning.
306
inguinal hernia ‘6-2’ rule
birth to 6 weeks, surgery is recommended within 2 days, 6 weeks to 6 months-surgery within 2 weeks and over 6 months surgery within 2 months
307
Diaphragmatic hernia in children
- Mortality 50%
- transmittal of abdominal contents across a
congenital or traumatic defect in the diaphragm
- profound respiratory distress
- birth at a tertiary-level
centre
- scaphoid abdomen
- bowel sounds in the chest
308
Diaphragmatic hernia in children management
- high-frequency oscillatory ventilation
- extracorporeal membrane oxygenation (ECMO)
309
Holt-Oram syndrome
hypoplastic radii, thumb abnormalities, and cardiac anomalies.
pectoralis major muscle is missing
310
Opioid intoxication in children
maternal analgesic narcotic drug (meperidine)
- depression of the newborn via crossing of the placenta
- administration
of naloxone, 0.1 mg/kg, IM, IV, or endotracheal
311
Rickets in children
- failure of bone mineralization
- Vitamin D deficiency
- a flattened occiput
- prominent forehead
-significant dental caries,
- bumpy ribs
- bowed extremities
312
maternal infection with mumps or rubella virus
may produce aqueductal stenosis hydrocephalus
313
Vitamin C deficiency
- irritability
- low-grade fever
- swelling
- tachypnoea
- and poor appetite
- impaired wound healing
- diffuse tenderness, worse in legs
314
Coombs test
Direct = autoimmune haemolytic anaemia
Indirect = antibodies in blood to see if there's reaction to blood transfusion
315
Pseudohematuria
beets, blackberries, and rhubarb
chloroquine
metronidazole
phenytoin
rifampinsulfasalazine
316
Galactosemia in children
- galactose-l-phosphate uridyl transferase enzyme deficiency
- serious damage to liver, brain, and eyes after being fed lactose milk
-
317
Galactosemia in children symptoms
-lethargy,
vomiting and diarrhoe,
-hypotonia,
-hepatomegaly
- jaundice (liver failure)
-failure to thrive
- cataracts
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Galactosemia in children treatment
- elimination
of lactose-containing milk from the diet
- exclusion of foods that contain casein, dry milk solids, whey, or curds
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Prader willi syndrome
- hypotonia, hypogonadism
- hyperphagia after the newborn period - hypomentia
- obesity
- deletion of a
portion of chromosome 15
- Feeding difficulties and failure to thrive in 1st year
- defect in the satiety center in the hypothalamus.
- Stringent caloric
restriction is the only known treatment
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Night terrors
- 5 and 7 years
- awaken suddenly, appear frightened and unaware of surroundings
- cannot recall the
event in the morning
- Sleepwalking is common
- reassurance
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Pseudohypoparathyroidism
(low serum calcium and high serum phosphorus
levels
- high
levels of endogenous parathyroid hormone
short,round-faced, and mildly retarded.
- Metacarpals and metatarsals are shortened
- subcutaneous and basal ganglia -
- calcifications
- cataracts can be present.
- Treatment: large doses of vitamin D and reduction of the
phosphate load.
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Abetalipoproteinemia in children
- Microsomal triglyceride transfer protein (MTP) gene mutation
- impaired VLDL formation
- decreased
vitamin E delivery to PNS/CNS
-
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Duchenne dystroph
- Pseudohypertrophy routinely is limited to the calf muscles
- lordotic posture as weakness evolves in the hip girdle
musculature
- waddling gait
-
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normal infants show the following
- Coarse, tremulous movements accompanied by ankle
clonus
- harlequin color change (a
transient, longitudinal division of a body into red and pale halves)
softness of
parietal bones at the vertex (craniotabes)
a liver that is palpable down to 2 cm
below the costal margin
325
adolescent + fever >38.5C + ↑WBC, ESR, CRP + Acute painful, tender and warm joint + limited movement + refusal to bear weight
Septic arthritis
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septic arthritis in children
- S aureus
- joint aspiration
327
septic arthritis management
- Joint drainage & debridement
- IV antibiotics
- orthopaedic surgeon referral
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Indication for urgent referral in children
- Green vomiting: gangrene of
the bowel
329
Autosomal dominant
Most are affected: males and femailes
330
congenital motor neuron disease in newborn/infant
Werdnig-Hoffmann disease
hypotonia, and muscle atrophy
Anterior horn cell
disease
331
Autosomal recessive
A few are affected: males and females
332
congenital motor neuron disease in older children
Kugelberg-Welander disease
Anterior horn cell
disease
hypotonia, and muscle atrophy
333
X- linked recessive
A few are affected: only males
334
Wiskott-Aldrich syndrome
- X-linked recessive
- Thrombocytopenia
- Eczema
- Increased susceptibility to infection
- bloody diarrhea and easy bruising
- impaired humoral
immunity
- low serum IgM and a normal or slightly low IgG
- low T cells and lymphocyte
- Few live past their teens, frequently succumbing to malignancy caused by
EBV infection.
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Adenosine deaminase (ADA)
deficiency
- Type of severe combined immunodeficiency (SCID)
- Lymphopenia from birth
- Platelets are not affected
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Toxic shock syndrome (TSS) in children
- S aureus
- “menstrual” TSS (associated with
intravaginal devices like tampons, diaphragms, and contraceptive sponges)
- “nonmenstrual” TSS associated with pneumonia
- skin infection
- bacteremia
- osteomyelitis
337
Toxic shock syndrome (TSS) in children treatment
Antibiotics against S aureus (penicillin)
338
Epstein-Barr virus (EBV) in children
PE:
- diffuse adenopathy
- tonsillar enlargement
- enlarged spleen
- small haemorrhages on the soft palate
- periorbital swelling
Blood:
- predominance of atypical lymphocytes with at least 10%
- heterophil antibodies present (may not be present in young
children)
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Epstein-Barr virus (EBV) in children management
- Self-limiting symptomatic management
- avoid contact sports to protect spleen
340
VATER/VACTERL
V- vertebral defect,
A- anal atresia,
C- cardiac defects,
TE- tracheoesophageal fistula
-R renal/radial defect
L- limb defects
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Undescended testes
descend into the scrotum during the
first two weeks of life
- the descent is unlikely to take place after the age of 1year
- 20 percent of premature males
- Orchidopexy is best performed by 12-18 month
- 5-10 times greater risk of developing a malignancy
342
Hx of travel to South Asia + fever + dry cough + dull frontal headache + gastroenteritis
Salmonella Typhi
343
Salmonella Typhi treatment
- South/South East Asia: azithromycin 1 g (child: 20 mg/kg up to 1 g)
Not India: ciprofloxacin 500 mg
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Early onset neonatal sepsis risk factors
– Maternal group B streptococcus colonization in current pregnancy.
– A previous baby with GBS infection.
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Late onset neonatal sepsis risk factors
– Artificial ventilation with an endotracheal tube.
– Extreme prematurity.
– Total parenteral nutrition.
- Central catheter
346
Coeliac disease assessment
gluten challenge for 4-6 weeks and then should have coeliac serology performed
347
Diabetic ketoacidosis in a young patient
- type 1 diabetes mellitus
- autoimmune (diseases celiac, autoimmune thyroiditis)
348
HPV contraindications
- egg and yeast allergy
349
strawberry like red mass on cheek
infantile haemangioma
350
infantile haemangioma management
reassure
-Gradual regress in size
351
< 8 girl + tall + pubic hair & breast development Tanner stage 3 + inappropriate sexual behaviour
Precocious puberty
352
Precocious puberty investigation
- serum FSH & LH estradiol
- MRI
- Bone age
353
dry eyes and mouth + low urine output + dilated pupils + decreased bowel sounds/constipation + sinus tachycardia + QRS interval
prolongation
anticholinergic toxicity (TCA)
354
anticholinergic toxicity (TCA) managment
Sodium bicarbonate Sodium bicarbonat
355
Eye Discharge
1st day - chemical irritation
6 days - Gonorrhoea
14 days- Chlamydia
356
IgA deficiency
increased frequency
* bronchitis,
* chronic diarrhoea,
* conjunctivitis
* otitis media in children
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Babies are at increased risk of contracting meningitis or septicaemia
(a)they are low birth weight.
(b)premature.
(c)born after prolonged labour.
(d)premature rupture of membrane.
Streptococcus B Group
358
