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GP FELLOWSHIP RNZGP > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Inguinal hernia surgery timing

A

<6 weeks : Within 2 DAYS

6 weeks- 6 months: within 2 WEEKS

> 6 months; within 2 MONTHS

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2
Q

Roseola Infantum

A
  • Starts on trunk then to neck and extremities

-Maculopapular

  • HHV6-7
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3
Q

Laterothoracic exanthem

A

Unilateral axila or groin- spreads centrifugally then bilatreal

Resolves within 5 weeks

EBV, parvovirus, adenovirus

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4
Q

Erythema infectiosum

A

SLAPPED cheek
Parvovirus b19

Stage 1: cheeks
Stage 2: lace like limbs

Note: pregnant woman who’ve been exposed: Have immune status checked and refer to O&G

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5
Q

Gianotiii-Crosti Syndrome

A

Self limiting
Multiple viruses

EXTENSOR surfaces: Vesiculopapular rash NON pruritic

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6
Q

Measels rash

A

Koplik’s spots

Red macules and papules cephalocaudal spread

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7
Q

Rubella rash

A

Pink maculopapular face then to trunk and extremities over 24 hours

Erythematous papules on palate (Forchheimer spots)

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8
Q

Paediatric dose of Augmentin

A

22.5/3.2 mg/kg

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9
Q

First line testing for bruising in children

Second line testing for bruising in children

A

APTT
PT/INR
Fibrinogen
FBC

VWD screen
Blood group
Factor VIII & IX
Ca
LFT
EUC, creatinine

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10
Q

Signs of adequate milk supply

A
  • Weight gain 150-200g /wk (first 3 months)
  • 5-8 nappies/24hrs
  • Passing soft stool once daily
  • Waking spontaneously for feeds
  • Settling between feeds
  • Alert and content when awake
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11
Q

Poor growth /slow weight gain investigations

A
  • Urine MCS
  • FBC, EUC, LFT
  • TSH
  • Glucose
  • Coeliac serology
  • B12
  • Stool fat globules, fatty acid crystals
    >12m :ESR & Fetal calprotectin
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12
Q

Hypoxia levels to indicate severe respiratory condition (paediatrics)

A

<90%

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13
Q

Signs of severe respiratory condition (paediatrics)

A
  • Irritability/lethargy
  • Marked increased accessory muscle use
  • Marked increased RR
  • 02 sats <90% or cyanosis
  • Tachycardia (significantly increased)
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14
Q

CAP antibiotics dosing for children

A

Amoxicillin 25mg/kg up to 1g 8 hourly for 3 days

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15
Q

Rheumatic Fever (1st line 2 agents) PLUS allergy to penicillin 2 options

A

Benzathine benzylpenicillin 1.2million units

Phenoxymethylpenicillin 500mg BD for 10 days

Delayed nonsevere hypersensitivity
Cefalexin 25mg/kg BD 10 days

Immediate or delayed severe allergy
Azithromycin 500mg Daily 5 days

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16
Q

Rheumatic Fever Hypersensitivity to penicillins

A

Delayed Non-severe hypersensitivity
Cefalexin 25mg/kg BD 10 days

Immediate or Delayed severe allergy
Azithromycin 500mg Daily 5 days

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17
Q

Rheumatic fever treatment of arthralgia or arthritis

A

Naproxen
5-10mg/kg up to 500mg BD

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18
Q

Impetigo non endemic setting - dose of oral abx

A

Flucloxacillin 12.5mg/kg 6 hourly 7 days

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19
Q

Examination findings for OSA

A
  • Boggy inferior turbinates
  • Nasal mucous inflammation
  • Tonsillary hypertrophy
  • OME
  • Adenoid facies
  • Retrognathia
  • obesity
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20
Q

Protracted Bacterial Bronchitis treatment

A

2-6 weeks of Augmentin 22.5, 3.2mg/kg

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21
Q

Dose of Macrogol 3350 for disimpaction (child)

Then maintenance dose

A

1-1.5g/kg/day for 3-6 days

0.75g/kg/day

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22
Q

Upper limit of normal for gynaecomastia in adolescent (measurement of enlargement)

A

4cm

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23
Q

Red flags for gynaecomastia

A
  • > 4cm
  • Pre-pubertal
  • Rapid progression
  • Persistent for >1yr or after 17
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24
Q

Febrile seizure dose

A

Midazolam 0.2-0.3mg/kg (up to 10mg) buccally or intranasal

  • repeat 10 mins later if still seizing
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25
Q

Severe nappy rash differentials

A
  • Staph scalded skin syndrome
  • Streptococcal perineal dermatitis
  • Bullous impetigo
  • Kawasakis disease (if fever)
  • Candida albicans infection
  • Infantile seborrheic dermatitis
  • Steven Johnsons syndrome
26
Q

Kawasaki findings

A

Fever 5 or more days
with 4 of the following
- Bilateral non exudative conjunctivitis
- Polymorphous rash
- mucositis
- Cervical lymphadenopathy
- extremity changes (palmar erythema, oedema and desquamation)

** also a desquamating nappy rash can be present in initial phase

27
Q

12 month vaccines

A

MMR
Prevenar
Meningococcal ACWY

Optional
Flu
Bexsero (meningococcal b)

28
Q

Crying baby history questions to establish cause (long list)

A
  • Sudden onset of crying (red flag)
  • Known triggers (eg feeding)
  • Bilious or projectile vomiting
  • Changes to feeding
  • Changes to formula
  • Poor weight gain
  • Blood or mucous in stool
  • Watery/frothy diarrhoea
  • New onset rash
  • Bruise or deformity
  • Change in alertness
  • Maternal coping
  • red eye, not opening eye
29
Q

Dose of midazolam for seizures
1) IM/IV
2) buccal/IN

A

1) 0.1mg/kg up to 10mg

2) 0.3mg/kg up to 10mg

30
Q

Complications of EBV

A
  • Splenic rupture
  • Prolonged fatigue
  • Derranged LFTs
  • DIC
  • Meningitis
  • Myocarditis
  • Pancreatitis
  • Pneumonia
31
Q

Straddle injuries management

A
  • Salt water baths
  • Topical anaesthetic cream or barrier cream
  • reduced strenuous activity 24 hrs
  • Simple analgesia
32
Q

Differentials for ADHD and Behavioural issues

A
  • ODD
  • PTSD
  • ASD
  • GDD
  • FASD
  • Early-life trauma (disrupted attachment)
  • Anxiety
  • Child abuse
  • Hearing or visual impairment
  • OSA
  • Iron deficiency
  • Thyroid disease
33
Q

Bowed leg intercondylar distance cut off for referral

A

> 6cm

34
Q

Bowed leg cut off for age (when no longer normal)

A

Beyond 3 years

35
Q

Dark urine and pale stools (jaundice) type of hyperbilirubinaemia

A

Conjugated

36
Q

Conjugated hyperbilirubinaemia (dark urine, pale stools) what to do

A

URGENT referral

37
Q

Vaccinations for ATSI (special)

A
  • BCG (NT, QLD, North SA)
  • Hep A (NT, SA, QLD, WA) (2 doses before 5, first in 2nd year of life)
  • HEP b- ALL AGES CAN GET THIS
  • Bexsero
  • 13vPCV (NT, SA, QLD, WA) & adults >50
  • Influenza >6m
  • 23vPPPV (4yrs old & again in 5 yrs) & >50 12 months post 13 and then agin in 5 yrs
38
Q

Vaccine hesitancy strategies

A
  • Inform about no jab no pay
  • Explain herd immunity
  • Non - judgemental approach
  • Find out about barriers
  • Explain limitations to childcare attendance
  • explain how it prevents serious infections
39
Q

Recent infection (eg impetigo) then now with facial oedema….

What are you worried about?

A

Post streptococcal Glomerular nephritis

40
Q

Post strep glomerulonephritis triad

A
  • Discoloured urine (haematuria)
  • Oliguria
  • Oedema
41
Q

Premature babies and vaccinations:
- Gestational (corrected) or chronological age?

A

Chronological

42
Q

Most common causes of short stature

A

1) Constitutional delay of growth and puberty
2) Familial short stature

43
Q

Diagnosis (physical signs) of constitutional delay in growth and puberty

A

GIRL:
Lack of breast development (tanner stage 2) >13

BOY
Testicular Volume <4mL by age 14

44
Q

Poor Growth Investigations

A

Simple bloods
CMP
Coeliac
TSH
IGF
Karyotype
Bone age Xray

45
Q

Fever temperature cut off for vaccine safety

A

Can be given if <38.5

46
Q

Signs of mild dehydration (trick)

A

Most have none

47
Q

Measels triad of early symptoms (hint: three cs)

A

Cough
Coryza
Conjunctivitis

48
Q

FLU vax inital dose for children >6months but <9 years

A

Dose PLUS BOOSTER in 4 weeks

49
Q

What am I ?
When do I peak (age)

A

Erythema toxicum neonatorum

2 days to 2 weeks

50
Q

What age can you add LABA in kids

A

Over 6 years

51
Q

Treatment time course for aspirin in Kawasakis

A

6 weeks

52
Q

Mongolian spot duration expected

A

Up to 4 years old

53
Q

Bronchiolitis signs of severity

A
  • O2 (<92 moderate, <90 severe)
  • APNOEAS
  • Feeding difficulty
  • Accerssory muscle use: moderate or marked
  • RR
  • Irritable
54
Q

Best antihistamine for children

A

Certirizine (can use from 6 months)

55
Q

Normal time frame for passage of meconium

A

48 hours

56
Q

Henoch Schonlein Purpura Follow up protocol

A

Urinalysis and BP
- weekly 1st month
- Forthnightly from weeks 5-12
- Then review at 6 months and 12 months

57
Q

Vaccine-Proximate febrile seizure- time frame

A
  • 5-14 days following live
  • Within 48hours post innactivated’

NOTE: However, vaccine proximate status epilepticus should be referred to a pediatrician due to association with Dravet syndrome.

58
Q

Risk factors for ADHD

A
  • Concurrent ASD, Anxiety, ODD, Learning disorder
  • Low birth weight
  • Pre-term birth
  • In care
  • Family history
59
Q

What is included on the neonatal screening test (Guthrie test)

A
  • Phenylketonuira (PKU)
  • Congenital hypothyroidism (CHT)
  • Cystic Fiborisis
  • Galactoseamia
  • Rare disorders of metabolism
60
Q

Causes of conjugated hyperbilirubinaemia (>10% fraction of total bili)

A
  • Biliary atresia
  • choledochal cyst
  • Alpha1 anti-trypsin
  • Neonatal hepatitis
  • Bile plug
61
Q

Chronic (wet) cough in a small child differentials?

A
  • CF
  • Protracted bacterial bronchitis
  • Primary ciliary dyskinesia
  • Alpha1 Anti-tripsin
  • Recurrent aspiration
  • Bronchiectasis
  • ## Primary immunodeficiency

GP FELLOWSHIP RNZGP (20 decks)

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