Paediatrics Flashcards
When should lumbar puncture be delayed?
- Sepsis or rapidly spreading rash
- Respiratory/ cardiovascular compromise
- High risk of bleeding
- Sign of raised ICP
- papilloedema
- GCS <= 12
- uncontrolled seizures
- focal neurological deficits
Meningitis mx
< 3 months: cefotaxime + amoxicillin
3 months - 50 years: ceftriaxone ± Dexamethasone
> 50 years: ceftriaxone + amoxicillin
*notifiable disease
When to hold Dexa in meningitis?
- septic shock
- meningococcal septicaemia
- immunocompromised
- meningitis after surgery
**ideally should be given within 12 hours of starting abx
bacterial meningitis prophylaxis
contact within 7 days before rash onset - Oral ciprofloxacin or rifampicin
minimal change disease 1/3 rule
1/3 recovers
1/3 infrequent relapse
1/3 frequent relapse (stops before adulthood)
Intussusception
- 6-36 months. more in boys
- triggered by infection e.g. viral URTI, Rota, HSP
- non-bilious vomiting -> bilious vomiting
- intermittent abdo-pain (15 mins)
- inconsolable crying, drawing knees
- late: red currant jelly stool
- o/e RUQ sausage mass
Ix US
Mx air enema unless perforated and peritonitis
Richter hernia
strangulation without obstruction
Congenital inguinal hernia
Patent processus vaginalis
More common in premature babies, on the right side
Mx urgent surgical repair, risk of incarceration
Infantile umbilical hernia
More common in premature and afro-Caribbean
Spontaneous resolution by 4-5
Hodgkin lymphoma - what age?
Bimodal
20s and 60s
Hodgkin lymphoma subtypes
- Nodular sclerosing
- Mixed cellularity
- Lymphocyte predominant
- Lymphocyte depleted
Hodgkin lymphoma poor prognostic factors
B symptoms:
Night sweats
Fever > 38ºC
Weight loss >10% in 6 months
Testicular torsion presentation
- Severe scrotum pain, radiating to lower abdomen
- N+V
o/e: - testis is swollen, tender, and retracted upwards
- cremasteric reflex lost
- Prehn’s sign negative (elevation of testis doesn’t relieve pain)
Pyloric stenosis presentation and cause
2nd-4th weeks old
Projectile vomiting 30 mins after feeding
Palpable mass in upper abdomen
Hypertrophy of the circular muscles of pylorus
Testicular torsion mx
Urgent surgical exploration and fixation bilaterally
(Bell clapper deformity)
Pyloric stenosis risk factors
- Boys
- Family history
- First-borns
Pyloric stenosis Ix and Mx + complications
Abdominal US
Mx Ramstedt pyloromyotomy
Complications: Hypochloraemia, hypokalaemia and alkalosis
Acute epiglottitis
HiB, tripod and drooling
- Call seniors, do not examine
- Give O2, IV abx and steroids
- Endotracheal intubation may be necessary
Type 1 DM Ix
- Test for ketones (urine dip or blood)
- Random blood glucose
- C peptide (low in T1DM)
- autoantibodies
*c peptide and autoantibodies in atypical presentations
Features of DKA
- polyuria, polydipsia
- NV, abdominal pain
- Kussmaul respiration (deep hyperventilation)
- Acetone breath (fruity, pear breath)
Type 1 DM diagnostic criteria
Symptomatic: fasting glucose > 7mM or random glucose > 11.1mM (or after 75g OGTT)
Asymptomatic: above but on two occasions
DKA diagnostic criteria
all 3
1. Random blood glucose > 11mM/ or known diabetic
2. Blood ketones >= 3mM or urine ketone 2+
3. Bicarbonate < 15 or pH < 7.3
DKA mx
- Fluid replacement
- Insulin
- Potassium and cardiac monitoring
Fluid replacement in DKA
isotonic saline (0.9% saline)
1L over 1 hr
1L over 2 hrs
1L over 2 hrs
1L over 4 hrs
1L over 4 hrs
1L over 6 hrs
Insulin in DKA
0.1unit/kg/hr - rapid acting
If glucose < 14mM, add 10% dextrose at 125ml/hr
*may need long acting too
Potassium in DKA
K+ can drop while giving insulin
add 20mM KCl in 500ml
*may need cardiac monitoring
*normal potassium: 3.5-5.3
Down syndrome features
Down syndrome cardiac complications
- Endocardial cushion disease (atrioventricular septal canal defect)
- VSD
- Tetralogy of fallot
Down syndrome associated conditions
- Hypothyroidism
- Subfertility
- learning difficulty
- ALL
- atlantoaxial instability
- Alzheimer’s disease
- repeated resp infections + glue ear
- short stature
Kawasaki disease fx
crash and burn
- Conjunctivitis
- rash (maculopapular)
- lymphadenopathy
- strawberry tongue
- hand and feet desquamation
high fever
Kawasaki disease mx
high dose aspirin
IvIg
echocardiogram for coronary artery aneurysm
UTI under 3 months
urgent paediatrics review
When to do urinalysis in kids?
- Sx of UTI
- Unexplained fever >38º
- other infection not responding to treatment
upper UTI in >3 months
3 days abx
nitrofurantoin, cefalexin
*safety net that they’ll improve in 1-2 days if not seek help
US post-UTI
under 6 months - US after 6 weeks
over 6 months - US only if atypical or recurrent UTI
UTI prevention
- use the potty more often
- time potty sessions
- empty bladder completely
- drink water
- avoid constipation
- cotton underpants
- no soap or bubble bath
Paracetamol overdose within 1 hr mx
activated charcoal
Paracetamol overdose mx
IV acetylcysteine over 1 hr if
- plasma paracetamol concentration above treatment line
- staggered overdose
- 8-24 hrs after 150mg/kg overdose even if concentration unknown
- >24hrs with jaundice and sign of hepatotoxicity
Acetylcysteine side effects
Anaphylactoid reaction (non-IgE mast cell release)
mx: stop and restart at lower rate
Prognostic factors for paracetamol overdose
- prothrombin time
- arterial pH <7.3
- encephalopathy
- raised creatinine
Croup age group
6 months - 6 years
autumn
Croup virus
parainfluenza virus
Croup mx
all get single dose PO dexamethasone
emergency: O2 and nebulised adrenaline
admit if - under 3 months, or moderate/ severe croup
