Paediatrics Flashcards
Meningitis management <3 months and >3 months
<3 months= IV amoxicillin and cefotamine
> 3 months= IV cefotaxime (ceftriaxone) +/- dexamethasone if LP shows:
- WCC high, bacteria, or purulent CFS
Shaken baby triad (3)
Subdural haemorrhage
Retinal haemorrhage
Encephalopathy
Pethers (ischaemia) investigations (1)
X-ray
shows widening join spaces
Pethers management (1) when to operate? (1)
what are they at risk of? (1)
<6 years= conservative
>6 years= surgical consideration
Risk of OA
Scarlet fever is spread via respiratory route by
- what bacteria? (1)
- what management? (1)
- Group A haemolytic streptococci (usually Streptococcus pyogenes)
- 10/7 penicillin
Scarlet fever:
- when return to school? (1)
within 24hr
IT IS NOTIFIABLE DISEASE
Scarlet fever:
complications? (4)
- otitis media: the most common complication
- rheumatic fever: typically occurs 20 days after infection
- acute glomerulonephritis: typically occurs 10 days after infection
- invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) rarer
Paediatric migrane:
management? (2)
- 1st line= ibuprofen
- 2nd line IF OVER 12 = triptans
Downs syndrome:
- most common cardiac abnormality? (1)
- haematological? (1)
- Atrioventricular septal defect
- ALL
Purulent discharge and conjunctival inflammation in <30 days old makes you think of… (1)
- management (1)
- responsible organisms (2)
ophthalmia neonatorum (conjunctivitis under 30 days)
–> REFER OPTHALOMOGY
Responsible organisms include
- Chlamydia trachomatis
- Neisseria gonorrhoeae
Hirschprung’s disease:
- management 1st line? (1)
- 2nd line? (1)
- associated with with congenital abnormality (1)
(aganglionic segment of bowel due to a developmental failure of the parasympathetic)
- 1st= rectal washouts/ bowel irrigation
- 2nd= surgery
- Downs syndrome
Roseola infantum:
- age (1)
- main features? (2)
- school exclusion? (1)
- organism? (1)
- 6 months - 2 years
- fever followed later by rash 1-2 weeks later, erythematous across limbs and trunk
- febrile seizures common
- no school exclusion
- human herpes virus 6 (HHV6)
Rubella:
- rash pattern? (1)
- other features (3)
starting on the face before spreading to the rest of the body
- mild fever, sore throat and lymphadenopathy.
Croup:
- moderate features (5)
- severe features (5)
MODERATE:
- Frequent barking cough
- Easily audible stridor at rest
- Suprasternal and sternal wall retraction at rest
- No or little distress or agitation
- The child can be placated and is interested in its surroundings
SEVERE:
- Frequent barking cough
- Prominent inspiratory (and occasionally, expiratory) stridor at rest
- Marked sternal wall retractions
- Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
- Tachycardia occurs with more severe obstructive symptoms and hypoxaemia
Measles:
- rash pattern? (1)
- other features? (4)
starts behind the ears and then spreads to the rest of the body.
4Ks:
It is associated with fever, conjunctivitis, coryzal symptoms and white koplik spots on the inside of the mouth.
Croup:
- management (1)
- age (1)
- when to admit? (1)
(stridor, fever, coryza, increased WOB)
- Single dose of oral dexamethasone (0.15 mg/kg) is to be taken immediately regardless of severity
- 6 months - 1 year
- admit if ANY moderate/ severe Sx
Croup:
investigations/ diagnosis? (2)
- clinical diagnosis
- XR chest sometimes –> STEEPLE sign anterior view, THUMB sign in lateral view
Bow legs:
<4 yrs management? (1)
- Bow legs in a child < 3 is a normal variant and usually resolves by the age of 4 years
Risk factors for surfactant lung disease (4)
male sex
diabetic mothers
Caesarean section
second born of premature twins
Caffeine in babies
can be used as a respiratory stimulant in newborn babies
Surfactant lung disease:
- CXR finding (1)
- management (4)
- ‘ground-glass’ appearance with an indistinct heart border
- corticosteroids to mum
- O2
- ventilation
- exogenous surfactant via ET tube
nocturnal enuresis:
- what age?
BEFORE 5 (so 3-4 years)
rewards –> enuresis alarm –> desmopressin
Differential of: non-blanching petechial rash but NO fever (2)
ITP (recent cold)
AKA Immune (or idiopathic) thrombocytopenic purpura (ITP) is an immune-mediated reduction
HUS triad (3)
microangiopathic haemolytic uraemia
acute kidney injury
thrombocytopenia
Meningitis organisms
- <3 months
- 1month - 6 years
- >6 years
Neonatal to 3 months
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes
1 month to 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
Greater than 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Vitamin K in babies: who is deficient?
breastfed
Raised FSH/LH in primary amenorrhoea
Turners syndrome (gonadal dysgenesis)
WOULD PRESENT EARLY
Raised FSH, LH and low oestradiol with secondary amenorrhaea
premature ovarian failure
(cessation of menses for 1 year before the age of 40)
intrauterine adhesions following dilation and curettage
+ secondary amenorrhoea
Asherman’s syndrome
Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone
androgen insensitivity syndrome
development of male secondary sexual characteristics in females (such as deep voice and hirsutism)
Congenital adrenal hyperplasia (CAH)
impaired cortisol synthesis leading to surplus progesterone which is converted to extra testosterone to reduce the levels of progesterone. Unlike AIS, the body is still responsive to testosterone, therefore, this would mean that this patient would have hirsutism and excess male-pattern hair growth, including axillary and pubic hair, which is not seen here. A diagnosis of CAH would also not explain the bilateral lower pelvic swellings, which are likely to be undescended testes.
medication to reduce size of uterine fibroids
GnRH agonist e.g. leuprolide
COCP and surgery
don’t have 4-6 weeks prior to major surgery
best HRT for VTE risk
transdermal
Strawberry cervix
- cause
- management
Trichomonas vaginalis
Oral metronidazole
bacterial vaginosis
oral metronidazole
gonorrhoea management
IM ceftriaxonec
cottage cheese discharge
cause?
management?
thrust/ vaginal candidasis/ Candida albicans
medication:
oral fluconazole 150 mg as a single dose first-line
clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated
vulval erythema, fissuring, satellite lesions may be seen
thrush / candida
recurrent thrush treatment?
4+ episodes / year = recurrent
confirm with swab
induction: oral fluconazole every 3 days for 3 doses
Most common benign ovarian tumour in women under the age of 25 years
Dermoid cyst (teratoma)
The most common cause of ovarian enlargement in women of a reproductive age
Follicular cyst
Most common type of ovarian pathology associated with Meigs’ syndrome
fibroma
commonest type of ovarian cyst
Follicular cysts
If ruptures may cause pseudomyxoma peritonei
Mucinous cystadenoma
The most common type of epithelial cell tumour
Serous cystadenoma
May contain skin appendages, hair and teeth
Dermoid cyst (teratoma)
most common ovarian cancer
serous carcinoma
chocolate cyst
endometriotic cyst
scarlet fever rash (Streptococcus pyogenes): what type of rash? (1)
where? (1)
rough rash
diffuse rash involving cheeks, neck and torso
spares hands
sore throat 2 days before
scarlet fever treatment (Streptococcus pyogenes)
oral penicillin V for 10/7
An 18-month-old boy presents to the GP with his mother, who is concerned about a new rash. His mother reports that the rash came on suddenly 1 day ago. His mother recalls he had a cold with a high fever two weeks ago, but this appears to have settled now. Otherwise he is normally fit and well.
On examination, there is an erythematous rash across the child’s trunk and limbs. The rash does not appear itchy and blanches with pressure.
Roseola infantum
Small testes in precocious puberty indicate what cause?
ADRENAL cause
whooping cough vaccine (pertussus) in pregnancy
Women who are between 16-32 weeks pregnant are offered the pertussis vaccine
12yo + joint pain + salmon pink rash
Systemic onset juvenile idiopathic arthritis (AKA Still’s disease) has a characteristic salmon-pink rash
features of juvenile idiopathic arthritis
Features of systemic onset JIA include
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
how to keep ductus arterioles open
Prostaglandin E1
Threadworms symptoms (2)
- perianal itching, particularly at night
- girls may have vulval symptoms
Threadworms treatment (2)
- Mebendazole single dose
- TREAT WHOLE HOUSEHOLD
Diagnosis may be made by the applying Sellotape to the perianal area and sending it to the laboratory for microscopy to see the eggs. However, most patients are treated empirically and this approach is supported in the CKS guidelines.
Kawasaki disease
5+ DAYS OF FEVER
AND
4/5 of:
- Bilateral conjunctivitis
- Cervical lymphadenopathy
- Polymorphic rash
- Cracked lips/strawberry tongue
- Oedema/desquamation of the hands/feet
Kawasaki management
high dose aspirin
(and intravenous immunoglobulin)
Kawasaki disease is one of the few indications for the use of aspirin in children. Due to the risk of Reye’s syndrome aspirin is normally contraindicated in children
kawasaki investigations
Echo
kawasaki complications
coronary artery aneurysm
Turner’s syndrome is associated with a what murmur
ejection systolic (bicuspid aortic valve)
transient tachypnoea of the newborn CXR finding
hyperinflation and fluid in the horizontal fissure
Cephalohaematoma vs caput succadaneum
CEPHALOHAEMATOMA= Several hours after birth, doesn’t cross suture lines, can take months to resolve, parietal
CAPUT SUCCEDANEUM= presenta t brith, crosses lines, resolves within days
commonest cause of stridor in neonate
Laryngomalacia
Congenital abnormality of the larynx.
Infants typical present at 4 weeks of age
(croup is 6 months - 3 years)
Whooping cough treatment
azithromycin or clarithromycin if the onset of cough is within the previous 21 day
Labial adhesions treatment? (1)
when to give? (1)
oestrogen cream
oney give if recurrent UTIs
It is usually seen in girls between the ages of 3 months and 3 years and can generally be treated conservatively. Spontaneous resolution tends to occur around puberty. It should be noted that the condition is different from an imperforate hymen.
mumps school excusion
5 days from onset of swollen glands
An infant with inconsolable crying, drawing legs up to the abdomen associated with pallor, vomiting →
intussusception
oftening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Chondromalacia patellae
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Osgood-Schlatter disease
(tibial apophysitis)
Pain after exercise
Intermittent swelling and locking
Osteochondritis dissecans
Medial knee pain due to lateral subluxation of the patella
Knee may give way
Patellar subluxation
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Patellar tendonitis
neonatal blood spot screening (5-7 days of life)
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
Barlows test
Attempts to dislocate an articulated femoral head.
Developmental dysplasia of the hip diagnosis
US
however, if the infant is > 4.5 months then x-ray is the first line investigation
Developmental dysplasia of the hip management
most unstable hips will spontaneously stabilise by 3-6 weeks of age
Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
older children may require surgery
cradle cap (seborrhoeic dermatitis) treatment
baby shampoo and baby oil
most common cause hypothyroidism in kids
AUTOIMMUNE
other causes: post total-body irradiation (e.g. in a child previous treated for acute lymphoblastic leukaemia)
iodine deficiency (the most common cause in the developing world)
acyanotic heart disease types in kids
ventricular septal defects (VSD) - most common, accounts for 30%
atrial septal defect (ASD)
patent ductus arteriosus (PDA)
coarctation of the aorta
aortic valve stenosis
ALL OTHERS ARE CYANOTIC (e.g. tetraology of Fallot, TGA, tricuspid atresia)
snoring in kids
obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism
roseola infantum most common complication
febrile convulsion
congenital abnrmalities: Noonan
Noonan = no neck./ webbed neck
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
congenital abnrmalities: patau
polydactyly (can count to 13 on their hands - chromosome 13)
congenital abnrmalities: prada willy
prada-willy = hypogonadism
congenital abnormalities: Edwards
Edward syndrome = Prince Edward has a royal chin - micrognathia, microcephaly, overlapping digits
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
congenital abnormalities; fragile X
xtra large
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
williams syndrome
prince William v friendly
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
continuous murmur
patent ductus arteriosus
Acrocyanosis
a completely normal finding in newborn babies within the first 24-48 hours of life. It is characterised by peripheral cyanosis (bluish discolouration of the hands and feet) with normal central perfusion and normal oxygen saturations. This physiological phenomenon occurs due to peripheral vasoconstriction and the normal transition from fetal to newborn circulation. The presence of good tone, normal oxygen saturations both pre and post-ductally, and absence of other concerning features supports this diagnosis.
If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance then…
switch to extensive hydrolysed formula
Patau syndrome chromosome
13
chrondromalacia patellae vs osteochonditis dissecans
Osteochondritits dissecans = LOCKING
This condition is characterised by a fragment of bone in the knee joint that becomes detached due to a lack of blood supply. The fragment and its overlying cartilage can then move around inside the joint, causing symptoms such as pain, swelling, and locking - all symptoms described by this patient. It’s most common in adolescents and young adults, particularly those who are active or participate in sports.
Chondromalacia patellae is an incorrect option. While it does present with knee pain that worsens with activity, it typically involves a grinding sensation or clicking sound within the knee joint and is often associated with quadriceps muscle weakness. Additionally, chondromalacia patellae doesn’t usually cause intermittent swelling or locking of the joint.
umbilical granuloma: how to treat? (1)
an overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.
- REGULAR SALT ON WOUND
if this does not help then the granuloma can be cauterised with silver nitrate.
Which one of the following is the most common cause of nephrotic syndrome in children?
minimal change disease
Minimal change glomerulonephritis nearly always presents as nephrotic syndrome, accounting for 80% of cases in children and 25% in adults. The majority of cases are idiopathic and respond well to steroids
nephrotic syndrome features (3)
Nephrotic syndrome is classically defined as a triad of
proteinuria (> 1 g/m^2 per 24 hours)
hypoalbuminaemia (< 25 g/l)
oedema
At what age would the average child acquire the ability to crawl?
9 months
cows milk protein intolerance
Multi-system involvement
7 months would suggest the new introduction of top up feeds which correlates with the symptoms
Faltering growth along with the multi-system involvement would suggest cows’ milk protein intolerance
newborn resuscitation steps
- DRY BABY
- assess HR and RR
- 5 inflation breaths
hypospadias
Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants. There appears to be a significant genetic element, with further male children having a risk of around 5-15%.
It is usually identified on the newborn baby check. If missed, parents may notice an abnormal urine stream.
Hypospadias is characterised by
a ventral urethral meatus
a hooded prepuce
chordee (ventral curvature of the penis) in more severe forms
the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.
hypospadias management
Hypospadias most commonly occurs as an isolated disorder. However, associated conditions include cryptorchidism (present in 10%) and inguinal hernia.
Management
refer for corrective surgery to be done ~12 months of age
it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
in boys with very distal disease, no treatment may be needed.
Maternal mortality includes…
any death in pregnancy and labour as well as up to six weeks post partum
Paediatric BLS
give 5 rescue breaths if there are no signs of breathing on initial assessment
Autosomal recessive conditions are
‘metabolic’ - exceptions: inherited ataxias
Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II
von willebrand disease: what’s important to note in FH
DOMINANT inheritance–> must have family history
hemorrhagic disease of newbown is also called..
vitamin K deficiency
(–> deficiency of 1972)
–> treatment = IM vitamin K after birth
multiple erythematous macular lesions omn forehead, eyes, and upper lip that blanch with pressure
Stork mark/ salmon patch
another word for port wine stain
naevus flammeus
what age can:
roll from front-to-back, transfer objects to midline, laugh, turn to voice
4 months
Erythema toxic neonatorum
(ALA toxic erythema of the newborn)
looks like excema of newborn
harmless red rash that appears on newborn skin.
can have pustules/ diffuse blotchy erythema
benign
resolves after 7-14 days
8 year old, recurrent nosebleeds, bleeding gums, bruises, low platelets, no organomegaly
idiopathic thrombocytopenia purpura (ITP)
autoimmune destruction of platelets
Acute = <6 months
refer to specialist
may treat conservatively or with things like red
Atpical UTI in children
seriously ill
poor urine flow
abdominal or bladder mass
raised Cr
sepsis
NON-E COLI organism
fail to respond to Abx
–> Increased complication risk e.g. renal scaring or septicaemia
HIGH risk features
no response to cues
weak, high-pitched crying
grunting
RR >60
decreased skin turgor
bulging dontonel
pale/mottled
What age to urgently refer all UTIs
<3 months
(>3 months if upper UTI)
pyloric stenosis: acidosis or alkalosis? (1)
management (1)
hypochloraemic, hypokalaemia metabolic alkalosis
pyloromyotomy
early jaundice is always..
PATHOLOGICAL
haemolytic disease
infection
haemolytic
maternal autoimmune haemolytic anemia
enzyme deficiecies
Risk factors for neonatal jaundice
COMMON
low birthweight
breastfed
male
east asian
high altitudes
maternal diabetes
when is MMR given
1 year
3 year 4 months
14 M greyish membrane to phaynx, 38.5oC, trouble swallowing, no vaccines
diphtheria
“thumbprint sign”
epiglottitis
“steeple sign”
Croup
slapped cheek
scarlet fever
OR
erythema infectiosum/ “Fifth disease”/ slapped cheek - parvovirus B19
palpable symmetrical purpuric rash, GI Sx, join pains, renal involvement
HSP
Henoch-Schonlein Purpura
IgA mediated autoimmune hypersensitivity vasculitis of childhood
age to kick a ball
2 years
age to smile
0-3 months
when to refer if cannot walk
18 motnhs
when to refer if cannot sit without support
12 months
when to refer if doesn’t know 2-6 words
18 months
when to refer if cannot smile
10 weeks
respiratory distress in neonates features
grunting
subcostal/ sternal recession
tracheal tug
flaring of nasal alae
bronchiolitis most common cause
RSV
commonest epilepsy in childhood
bening rolandic epilepsy
TORCH
Toxoplasma gondii
Other agents (Treponema palladium, varicella zoster virus, parvovirus B19, Zika)
Rubella
Cytomegalovirus
Herpes simplex virus
IUGR vs macrocosmic babies complications
Macrosome= more complications at or after birth (obstructed labour, hypoglycaemia)
IUGR= higher longer term cardiovascular problems (HTN/ coronary heart disease/ T2DM). IUGR babies are stressed due to increased cortisol –> lung maturation and less RDS
what failure to thrive is clinically significant
> 2 standard deviations
Commenest cause in UK= non organic causes e.g. social problems
nappy rash
Candida albicans
topical imidazole cream (clotrimazole/ miconazole)
can consider steroids if discomfort
abdominal mass in kids –>
consider films tumor
management RSV (bronchiolitis)
oxygen and hydration
innocent murmur
soft
sitting (goes away on positioning)
silent
splitting of S2
no palpable thrill
systolic
33 week premature baby
delivered 4 hr ago
tachypnoeic and grunting
respiratory distress syndrome
when to use ECMO in kids
primary pulmonary hypertension or respiratory distress syndrome (think REPLACING the lungs)
duodenal atresia
scaphoid abdomen
double bubble sign on US
CPR ratio in children
15:2
calculation to estimate weight in child
(age+4) *2
complications mumps
infertility
pancreatitis
whooping cough pregnant women
erythromycin (azithromycin/ clarithromycin in other s if onset within 21 days)
rockerbottem feet- which congenital abnormality
EDWARDS
autosomal dominant vs recessive
Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias
Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II
oligohyhdraminos or polyhydraminos- which is a risk factor for breech
OLIGO
Abdominal x-rays are useful when diagnosing necrotising enterocolitis
dilated bowel loops (often asymmetrical in distribution)
bowel wall oedema
pneumatosis intestinalis (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)
cause of prolonged jaundice
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
jaundice is more common in breastfed babies
mechanism is not fully understood but thought to be due to high concentrations of beta-glucuronidase → increase in intestinal absorption of unconjugated bilirubin
prematurity
due to immature liver function
increased risk of kernicterus
congenital infections e.g. CMV, toxoplasmosis
when is meningitis B vaccine given
2, 3 and 12-13 months
when to give macrocodes for child pneumonia
if chlamydia or mycoplasma suspected
(if influenza suspected then give co-amoxiclav)
benign Rolandic epilepsy
partial seizures at night
anticipation - what does it mean
EARLIER age of onset in successive generations
Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
spinocerebellar ataxia
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy
UMBILICAL vs inguinal hernia in kids
UMBILICAL = resolve by 2-3 years
inguinal= treat
umbilical hernias associated with
Associations
Afro-Caribbean infants
Down’s syndrome
mucopolysaccharide storage diseases
supravalvular aortic stenosis. The syndromic features include the small upturned nose, long philtrum (upper lip length), wide mouth, full lips, small chin, and puffiness around the eyes
williams syndrome
all breech babies require…
US at 6 weeks for DDH
complications chicken pox
pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox
arthritis, nephritis and pancreatitis may very rarely be seen
Gastroschisis
Whereas gastroschisis tends to be a stand alone bowel condition, exomphalos is associated with cardiac and kidney diseases
Management
vaginal delivery may be attempted
newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
Exomphalos (omphalocoele)
In exomphalos (also known as an omphalocoele) the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.
Associations
Beckwith-Wiedemann syndrome
Down’s syndrome
cardiac and kidney malformations
high pitched cry, temperature greater than 38C in an infant under 3-month-old
red flags –> admit
children BLS: ratio and rate of chest compressions
15:2
chest compressions should be 100-120/min
contraindication to pneumococcal vaccine
curent febrile illness
Vesicoureteric reflux (VUR) investigation of choice
Micturating cystography
hand, foot and mouth disease is caused by..
Coxsackievirus or Enterovirus.
most common congenital heart abnormalities; cyanotic and acyanotic
- cyanotic: TGA most common at birth, Fallot’s most common overall
- acyanotic: VSD most common cause
(peripheral cyanosis around the mouth and extremities) is common in neonates
Acrocyanosis
may last 24-48hr
bronchiolitis vs CAP in children
if you think BRONCHIOLITIs then NO ABC
Bartter’s syndrome
inherited cause (usually autosomal recessive) of severe hypokalaemia due to defective chloride absorption at the Na+ K+ 2Cl- cotransporter in the ascending loop of Henle. It should be noted that it is associated with normotension (unlike other endocrine causes of hypokalaemia such as Conn’s, Cushing’s and Liddle’s syndrome which are associated with hypertension)
age for early secondary sexual characteristics
before 8 years in girls and 9 years in boys
downs syndrome: hypo or hypertonia
hypotonia
when to refer undescended testes
referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
if bilateral–> URGENT referral
lymphocytosis and neutropenia following treatment for suspected recurrent tonsillitis
EBV
Cryoprecipitate contains
factor VIII, fibrinogen, von Willebrand factor and factor XIII
which cancer causes massive splenomegaly
CML
(crazy massive splenomegaly)
other causes:
myelofibrosis
chronic myeloid leukaemia
visceral leishmaniasis (kala-azar)
malaria
Gaucher’s syndrome
hypospenism blood film (1)
what condition is hyposplenism common in? (1)
COELIAC DISEASE
target cells
Howell-Jolly bodies
Pappenheimer bodies
sideritic granules
acanthocytes
haemoarthrosis in young boy is most likely…
Haemophilia
(note vWF also associated with Factor VIII and does not really cause haemoarthrosis)
increased risk of VTE in these underlying conditions…
malignancy
thrombophilia: e.g. Activated protein C resistance, protein C and S deficiency
heart failure
antiphospholipid syndrome
Behcet’s
polycythaemia
nephrotic syndrome
sickle cell disease
paroxysmal nocturnal haemoglobinuria
hyperviscosity syndrome
homocystinuria
e.g. elderly person with symptoms of anaemia e.g. fatigue (the most common presenting symptom)
massive splenomegaly
hypermetabolic symptoms: weight loss, night sweats etc
myelofibrosis
Laboratory findings
anaemia
high WBC and platelet count early in the disease
‘tear-drop’ poikilocytes on blood film
unobtainable bone marrow biopsy - ‘dry tap’ therefore trephine biopsy needed
high urate and LDH (reflect increased cell turnover)
isolated thrombocytopenia in a well patient
ITP
drugs that cause ITP
Valproic acid
Methotrexate
Carboplatin
Interferon
Isotretinoin
PanobinostatSmall testes in precocious puberty
H2 blockers and proton-pump inhibitors
Small testes in precocious puberty
adrenal cause
stridor is on
inspiration
Pyloric stenosis classically acid / alkali
hypochloraemic, hypokalaemic alkalosis
crawling age
9 months
meningitis - which Cef Abx?
cefTRIazone
pregnnacy - when can they have BCG vaccine
16-32 weeks
Pethers management
<6 years= observe
>6 years= surgicalh
head injury in shaken baby syndrome
SUBDURAL
neonatal blood spot test
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
