Paediatrics Flashcards
What is intussusception?
Telescoping of the terminal ileum into the proximal large bowel – leads to bowel obstruction – can lead to bowel necrosis of not treated
What are the classic symptoms of intussusception?
- Colicky abdo pain and distension
- Red current jelly stools (due to blood + mucous)
- RUQ “sausage shaped” mass
- Flexing of knees to chest to relieve pain
In what age child does Intusssception most commonly occur?
In infants (<12 months) - peak age is 9 month d
What is the treatment for intussusception?
Barium enema
What is the treatment for pinworm infection?
Mebenazole single oral dose
All family/close contacts need to be treated together
What is the transmission of pinworm infection?
faecal oral - someone scratches their butt - eggs in the fingernails get transferred to other surfaces including toys, bedding etc.
Can last on surfaces for a few weeks.
What is the treatment for erythema toxicum neonatorum?
No treatment required. It is benign and self limiting
What microorganism causes bronchiolitis?
RSV virus
What is the most common cause of croup?
Parainfluenza virus
What medication do you use for bronchiolitis prophylaxis in at risk infants/children?
Palivizumab (monoclonal antibody)
What are the main symptoms of Diphtheria?
- fever
- runny nose
- sore throat
- pseudomembranous pharyngitis - thick grey membrane at the pharynx
- severe cervical lymphadenopathy - - - bull neck appearance
What is the most common cause of Epiglottitis?
Haemophilus influenzae type B
How is Diphtheria transmitted?
- most commonly through respiratory droplets (coughs and sneezes)
- can be cutaneous - contact with the particles through open wounds
What is the cause of Roseola infantum?
Human herpes virus 6
What are the classic symptoms of Roseola infantum/6th disease?
Very high fever for 3 days - fever settles THEN you get a rash - usually spares the face
Rose pink macular, non itchy rash - sometimes surrounded by a fine halo
Fever is usually 39-40 and can present as febrile seizure
What is the cause of hand foot and mouth disease?
coxsackievirus type A
What are the key symptoms of hand foot and mouth disease?
- fever
- sore throat
- Rash all over the body including hands and feet that becomes vesicular
- mouth ulcers
Caused by Coxsackie virus
What is erythema infectiosum?
also known as 5th disease
It is infection by human parvovirus B19
What are the symptoms of 5th disease? (Parvovirus)
- mild illness
- fever, sore throat, runny nose for a couple days. symptoms settle THEN the rash appears
- red rash on the cheek
- “Lacey” red rash on arms, legs, trunk
What are classical features of measles?
measles is also known as RUBEOLA
- fever
- 3 Cs - cough, coryza, conjuctivitis
- Koplick’s spots - white spots on buccal mucosa (inside of cheek)
- On the 3rd day, the koplick’s spots disappear and the rash appears - starting behind the ears/head
What illness does Rotavirus cause
It causes diarrhoea illness in infants and children. Babies are vaccinated against it at 8 weeks and 12 weeks. It is a live attenuated vaccine.
What is the cause of glandular fever
a.k.a infectious mononucleosis
Epstein Barr Virus (EBV)
Developmental milestones: Can transfer objects from hand to hand
3-6 months
Developmental milestones: smiling
6 weeks
Developmental milestones: kick a ball
2 years old
Developmental milestones: tower of three
18 months
Developmental milestones: waves bye bye
12 months
Developmental milestone: riding a tricycle
3 years old
Developmental milestone: tower of 6
2 years old
Developmental milestone: tower of 9
3 years
Developmental milestone: hops one one leg
4 years old
Developmental milestone: Can roll from their tummy to their back
4 months
What is meconium ileus?
Meconium Ileus: Presents as failure to pass meconium and almost pathognomonic of cystic fibrosis. Abnormal GI secretions cause thickened meconium that can obstruct the lumen of the small bowel
What is Hirschsprung disease?
- Lack of ganglion cells in the rectum
- leads to bowel obstruction
- presents as failure to pass meconium in the first 48 hours of life
- abdo distension, vomiting
How is Hirschsprung disease diagnosed?
Rectal biopsy
What are the important features of growth hormone deficiency in a child?
- child shorter than their peers
- they grow slowly but proportionally (limbs/chest and abdomen)
- face looks younger than their age
- Chubby/abdominal fat
What are the key features of constitutional growth delay?
- normal size at birth
- late puberty
- growth period is prolonged
- Normal adult height
What are the key features of juvenile arthritis?
- Symmetrical inflammatory arthritis
- if systemic: salmon pink rash
What is haemorrhage disease of the newborn?
Also known as “Vit K deficiency bleeding
- babies have relatively low vitamin K in first few days after birth
- they do not have enough Vitamin K stores and also gut sterility
- Vit K is produced by gut bacteria
- typically occurs in breast fed babies (as formula is fortified with Vitamin K) in the first few days of life
- Can present as bleeding from mucous membranes, from the umbilical stump or cause intracerebral haemorrhage
- NICE guidelines recommend all newborn babies have a prophylactic dose of Vitamin K
What is the function of Vitamin K?
Vitamin K is a fat soluble vitamin synthesised by gut bacteria - it is required for the production of clotting factor II, VII, IX and X in the liver
What is Reye’s syndrome?
A rare complication that can develop if children take aspirin during a viral illness - mitochondrial dysfunction
- acute non-inflammatory encephalopathy with fatty liver failure
What is necrotising enterocolitis?
- life threatening illness.
- Intestinal inflammation –> bacterial invasion of the bowel wall –>bowel necrosis and perforation
- Occurs in premature formula fed infants in the 2nd or 3rd week of life
What are the key features of pyloric stenosis?
- Presents around the fourth week of life
- projectile, postprandial, NON-BILLOUS vomiting associated with a voracious appetite.
- A right upper quadrant abdominal mass (palpable olive) may also be felt
- Hypochloraemic hypokalaemia metabolic acidosis
What are the important symptoms of duodenal atresia?
- bilious vomiting in the first days of life, presents much earlier than pyloric stenosis.
- AXR - double-bubble sign, two air-filled spaces representing the stomach and duodenum
- Associated with Down syndrome and can cause polyhydraminos by impairing GI absorption of of amniotic fluid swallowed by the fetus distal to the intestinal obstruction. Instead the amniotic fluid is refluxed back into the amniotic space.
What is the most common cause of failure to thrive?
Poor nutrition/not enough calories due to psycho-social issues of the parents/family
How can you distinguish physiological jaundice vs non-physiological jaundice in the neonate?
Physiological - onset is 24-48 hours AFTER birth
Non-physiological - immediately after birth
Jaundice in the first 24 hours is ALWAYS pathological
What are the causes of physiological jaundice in the neonate?
- Fetal Hb has a shorter life-span that adult Hb - so is broken down at a much quicker rate than the immature liver can cope with - this leads to bilirubin accumulation
- Breast milk jaundice - presents typically within first week of life.
What is haemolytic disease of the newborn?
- sensitized Rh-negative mother gives birth to an Rh-positive fetus.
- unconjugated hyperbilirubinaemia
- direct Coombs test positive
X ray of the child shows “thumbprint sign” what condition is this pathognomonic for?
Epiglottitis
Developmental milestone: can jump on two feet
2 years old
What is a stork mark/bite
- common birthmark
- pink, flat, patches which can occur on forehead, eyelids, back of neck
- blanching
- temporary
- caused by dilated capillaries under the skin.
- also called “salmon patch”
- medical term is nevus simplex
What is a port wine stain?
- birthmark
- present at birth
- lasts a lifetime
- capillary malformation
- reddish purple macular lesion
What is nappy rash?
- prolonged contact with urine and faeces —> contact dermatitis —> colonisation with Candida albicans
What is the treatment for nappy rash?
Topical antifungal
What is the first line treatment for impetigo?
Topical hydrogen peroxide 1% cream
What is toddler diarrhoea?
Toddler diarrhoea is a common condition in children between 6 months and 5 years of age, characterised by chronic, non-bloody, watery diarrhoea with no signs of malabsorption or growth failure. It typically occurs during the daytime and is associated with the intake of large amounts of fruit juice, high-fibre foods, and other carbohydrates. It is usually self-limiting and resolves by the age of 5 years.
What is cow’s milk protein allergy and what are the clinical features?
allergy to casein and whey proteins in cow’s milk
Onset: 1-6 months s
Sx
- diarrhoea
- vomiting
- urticaria
- anaphylaxis
Mx
- milk-free diet
- hydrolysed milk formula which is hypoallergenic
Soy milk not recommended for <6months old. also 50% of those with this allergy will develop soy protein allergy.
Goat milk not recommended due to cross-reactivity with cow milk - may also cause allergic reaction
What is the clinical presentation of scarlet fever?
- fever
- sore throat
- cervical lymphadenopathy
- classic “sandpaper” rush over trunk and limbs - SPARING AROUND THE MOUTH
- face looks flushed
- strawberry tongue
Presentation of Kawasaki disease?
- high grade fever lasting > 5 days
- bilateral conjunctivitis
- cervical lymphadenopathy
- swollen hands and feet
- rash appears on 3rd-5th day - then goes onto desquamate/peel
- strawberry tongue
(both scarlet fever + Kawasaki give strawberry tongue)
