Paediatrics Flashcards
When is jaundice pathological in the newborn?
When within 24hrs
What causes Perthe’s disease?
More common at 4-8 years
Due to avascular necrosis of the femoral head
What causes SUFE?
10-15 years - Displacement of the femoral head epiphysis postero-inferiorly
What is the most important treatment for prevention of neonatal respiratory distress syndrome?
Administer dexamethasone to the mother
How does intussuception present, and how do we investigate it?
An infant with inconsolable crying, drawing legs up to the abdomen associated with pallor, vomiting → ?intussusception
US
What is caput succadaenum?
Caput succedaneum is a swelling due to pressure of the presenting part on the cervix. It is present from birth with poor margins and crosses suture lines. It typically resolves in 1-2days and does not usually require treatment.
A 6-week-old baby boy presents to his GP with symptoms of regurgitation and vomiting after feeding. His mother also reports ongoing issues with diarrhoea. Formula fed. What should we advise?
If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance then a extensive hydrolysed formula should be tried
How does acute epiglottitis present?
When you attend you find the patient sat on his mothers knee leaning forward and drooling. There is audible stridor from the end of the bed.
What causes epiglottitis?
Haemophilus influenzae type B
How does measles present?
Measles is characterised by prodromal symptoms, Koplik spots. maculopapular rash starting behind the ears and conjunctivitis
What is Kocher’s criteria?
Kocher’s criteria is used to assess the probability of septic arthritis in children using 4 parameters:
Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr
How does Kawasaki’s disease presnet?
High fever lasting >5 days, red palms with desquamation and strawberry tongue are indicative of Kawasaki disease
Define precocious puberty
Precocious puberty is the development of secondary sexual characteristics before 8 years in girls and 9 years in boys
When is croup most commonly diagnosed?
Whereas the peak incidence of croup is 6 months -3 years, bronchiolitis is seen in 1-9 month olds
How do we treat croup?
Oral dex
At what age would the average child acquire the ability to sit without support?
6-8m
How does TTN and RDS differ?
TTN is caused by a delay in the clearance of lung fluid, which is naturally present in utero. It is more commonly seen in babies born via Caesarean section and presents with tachypnoea soon after delivery that settles within a few hours.
RDS presents with features of respiratory distress soon after delivery, which get progressively worse without treatment. It occurs due to surfactant deficiency and causes alveolar collapse after expiration. It is most commonly seen in premature and low birth weight babies.
How does necrotising enterocolitis present?
Early signs of necrotising enterocolitis: feeding intolerance, abdominal distension and bloody stools
What is the inheritance pattern in CF?
Autosomal recessive
What is pavalizumab?
Palivizumab is a monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease.
What is physiological neonatal vaginal discharge?
White vaginal discharge - This occurs as a result of maternal oestrogen crossing the placenta before birth, stimulating the baby’s vaginal mucosa to proliferate and secrete mucus. It usually resolves spontaneously within a few days to weeks after birth without any intervention.
A mother brings in her 6-year-old boy who complains of ‘an itchy bottom’ at night. He is otherwise systemically well, developing normally and denies any change in his bowel habit. An external examination of the anus is unremarkable.
Which one of the following is the most likely cause?
Threadworm
What causes scarlet fever?
Scarlet fever, also known as scarlatina, is primarily caused by group A beta-haemolytic streptococci (GABHS), specifically the bacterium Streptococcus pyogenes
How does scarlet fever present?
The disease mainly affects children and presents with a sore throat, fever, strawberry tongue and a fine sandpaper-like rash on the trunk.
Children under what age are not legally able to consent to sex?
Children under the age of 13 years are not able to consent to sexual intercourse and hence any sexual activity would be regarded as rape under the law. This is one situation under the GMC guidelines where you are compelled to break confidentiality
How does Edward’s syndrome (trisomy 18) present?
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers - Edward’s syndrome
How do we treat whooping cough?
Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days
What causes acute epiglottitis?
Acute epiglottitis is caused by Haemophilus influenzae type B
What are Koplik spots?
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Seen in measles
How does measles present?
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
How does mumps present?
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
How does rubella present?
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
How does scarlet fever present?
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
What causes scarlet fever?
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
What is hand, foot and mouth disease?
What organism causes it?
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
How does cephalohaematoma present?
A cephalohaematoma appears as a swelling due to bleeding between the periosteum and the skull. It is most commonly noted in the parietal region and is associated with instrumental deliveries. The swelling usually appears 2-3 days following delivery and does not cross suture lines. It gradually resolves over a number of weeks.
What is caput succadeneum?
Caput succadeneum is commonly seen in newborns immediately after birth. It occurs due to generalised superficial scalp oedema, which crosses suture lines. It is associated with prolonged labour and will rapidly resolve over a couple of days.
C-aput S-uccadaneum -> C-rosses S-uture lines
What are Brushfield spots/
Brushfield spots are small grey or brown spots seen on the periphery of the iris. They are associated with Down syndrome.
What is the murmur heard in PDA?
Patent ductus arteriosus is associated with a continuous murmur whilst Pulmonary stenosis presents with a systolic murmur.
How do we maintain PDA in a neonate?
Maintenance of the ductus arteriosus with prostaglandins is the initial management for duct dependent congenital heart disease
Ensures a route of alternate blood flow. The parallel circulatory systems caused by TGA means that ductus arteriosus closure will result in profound cyanosis and circulatory failure. Prostaglandins maintain the patency of the ductus arteriosus through dilation of vascular smooth muscle
We may do this in TGA
What is the commonest cause of stridor in children?
Laryngomalacia
When is hand preference abnormal, and what should you do?
Hand preference before 12 months is abnormal - it could be an indicator of cerebral palsy. Urgent referral to paediatrician.
How do innocent murmurs sound?
They are Soft, Systolic, Short, Symptomless, Standing/Sitting (vary with position).
Child aged 5-16 years with asthma not controlled by a SABA + paediatric low-dose ICS + leukotriene receptor antagonist asthma management in children 5-16…
add a LABA (salmeterol) and stop the leukotriene receptor antagonist (montelukast)
How do we test for developmental dysplasia of the hip?
Barlow manoeuvre: attempted dislocation of a newborns femoral head
How does Turner’s syndrome present?
Short stature + primary amenorrhoea ?Turner’s syndrome
How does Patau syndrome present?
Trisomy 13
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
How does Edward’s syndrome present?
Trisomy 18
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
How does fragile X syndrome present?
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
When do we expect babies to smile by?
Referral points
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
What is the difference between amino acid based formula and extensively hydrolysed formula?
Amino acid-based formula is appropriate for infants with severe cow’s milk protein intolerance. This formula is less palatable, however, it is appropriate for those with severe intolerance as it is composed of free amino acids only.
What is the Ortolani manoeuvre
Ortolani manoeuvre: attempted relocation of a newborn’s femoral head after dislocation due to the Barlow manoeuvre
How do we manage severe croup?
NICE recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
nebulised adrenaline
When is nocturnal enuresis normal?
Under 5y.o.
How do we manage hypospadias?
Circumcision should not be performed for infants with hypospadias - the foreskin may be used in the corrective procedure. Procedure performed at 6 months
What is roseola infantum?
A coryzal illness with associated high fever that resolves and is followed 1-2 weeks later by an erythematous rash across the trunk and limbs is a classical history of roseola infantum. Associated with febrile seizures
What is gastoschisis?
Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord. Born with exposed bowel.
Management
vaginal delivery may be attempted
newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
What is seen in tetralogy of fallot?
TOF mnemonic is PROV- pulmonary stenosis, RVH, overriding aorta, vsd
How does congestive HF present in neonates?
Presentation of heart failure in neonates: poor feeding, shortness of breath, hepatomegaly
How do we treat scarlet fever?
Treated with oral penicillin V, and can go back to school after 24H tx
What is the first sign of puberty in girls?
boobs, pubes, grow, flow
How does umbilical granuloma present?
An umbilical granuloma is 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.
How do we treat umbilical granuloma?
It is treated by regular application of salt to the wound, if this does not help then the granuloma can be cauterised with silver nitrate.
What is an Epstein pearl? How is it treated?
small white cystic vesicle around 2mm in diameter situation on the hard palate close to the midline. They are common on the hard palate, but may also be seen on the gums where the parents may mistake it for an erupting tooth. No treatment is generally required as they tend to spontaneously resolve over the course of a few weeks.
What is seen on the CXR in transcient tachypnoea of the newborn?
. Increased respiratory rate and the chest x-ray findings of hyperinflation and fluid in the horizontal fissure are key findings in transient tachypnoea of the newborn. This patient should be managed with supportive care and supplemental oxygen if required. Symptoms usually resolve spontaneously within a couple of days.
What is the most common cause of childhood hypothyroidism in the United Kingdom?
The correct answer is Autoimmune thyroiditis. In the United Kingdom, the most common cause of childhood hypothyroidism is autoimmune thyroiditis, also known as Hashimoto’s thyroiditis. This condition occurs when the immune system mistakenly targets and damages the thyroid gland, leading to decreased production of thyroid hormones.
What is the Barlow manouevre?
Barlow manoeuvre: attempted dislocation of a newborns femoral head
