Paediatrics Flashcards
What are the two causes of strawberry tongue?
1) Scarlet fever
2) Kawasaki disease
What is scarlet fever?
Skin rash reaction to toxins produced by Group B haemolytic strep (e.g Strep Pyogenes)
Sandpaper rash
What timeframe neonatal jaundice always pathological?
In the first 24hrs
(can be normal day 2 - day 14)
(and likely pathological if prolonged after 14 days)
Which scalp swelling crosses suture lines?
Caput succadenum
(scalp oedema due to pressure during delivery)
White cysts in mouth?
Epstein Pearls
Causes of congenital aortic stenosis?
1) Turner’s syndrome in girls
2) Aortic Coarctation
3) Edward’s syndrome (wide lips, low ears, saddle nose)
What age does intussusception occur?
0.5 years to 1.5 years
How do you manage an umbilical hernia in 1 year old?
If no complications, advise no action needed and that usually resolves by age 3. If it doesn’t, can later assess for surgery.
Can children under 18 refuse life saving treatment?
No, given in best interests
What to do if under 13 reports they are having sex with person 13 or over?
This is statutory rape, so inform authorities
Can child under 16 consent to treatment? incl COCP
Yes, if they have capacity according to Fraser Guidelines.
Encourage to avoid sex, educate them on safe sex, encourage them to tell parents, but if you think they will have sex anyway and not providing COCP will harm them, you can prescribe it
Red umbilical lesion leaking discharge, in a baby a few weeks old.
How do you treat it?
Umbilical granuloma
Apply salt
Young child, gets fever. Following fever develops macular skin rash on trunk?
Roseola infantum
(FEVER THEN RASH)
16 year old with one spot of rash (herald patch) followed by oval scaly plaques in chirstmas tree distribution
Pityriasis rosacea
What’s the difference between Roseola Infantum and Pityriasis Rosacea?
RI - infants
HHV6/7 primary infection
Fever then rash
PR - adolescents/adult
HHV6/7 reactivation
Herald patch then rash follows Langer’s lines
When are MMR doses given?
1 year and 3-4 years
Minimum time interval between live vaccine doses?
4 weeks
Ataxia, loss of proprioception + Cardiomyopathy?
Friedrich’s ataxia
What is inheritance pattern of Friedrich’s ataxia?
Autosomal recessive
Features of Tetralogy of Fallot?
Overriding aorta
Pulmonary stenosis
Right Ventricular Hypertrophy
VSD
How does Tetralogy of Fallot present?
Cyanotic episodes called ‘Tet spells’
Triggered when infant upset, feverish or in pain
Systolic murmur due to pulmonary stenosis
What does CXR show in Tetralogy of Fallot?
Boot shaped heart
Which cyanotic heart disease is most common at birth and which is most common overall?
Birth - TGA
Overall - TOF
What age does TOF present?
Few weeks
What is Transient Tachypnoea of the newborn? What is a risk factor for it?
What may CXR show?
Increased RR occurring at birth, can last for couple days
Caused by fluid not cleared from lungs
Risk factor - C-section
CXR - fluid in horizontal fissure
When does newborn exam in GP occur and what do you look for?
6-8 weeks
DDH
Undescended testis
Heart sounds
Growth
Which manoeuvres test for DDH? What is the 1st line Ix? What is the Mx?
Barlow - dislocate
Ortelani - relocate
Ix - USS Hip
Mx - Pavlik harness
Symptoms of pyloric stenosis?
Age of onset?
Electrolyte abnormalities?
Projectile vomiting shortly after feeds
6 weeks
low Cl, low K, alkalosis
Features of ‘innocent’ murmur?
Systolic
Soft
Short
Sitting/Standing
Symptomless
Joint pain following recent viral infection? Mx?
Transient synovitis
Mx - supportive
What causes Hand, Foot and Mouth Disease and how do you treat?
Coksackie virus
Therefore, supportive management only
What are exclusively breastfed babies going to be deficient in, that requires a top up at birth?
Vitamin K!
All newborn babies offered Vit K
In premature babies at risk of RSV, what can be given as prophylaxis?
Pavilizimumab (monoclonal antibody to prevent RSV)
Protrusion of bowel at para-umbilically at birth - 2 types, what are they, how to differentiate and how are they managed?
Gastroschiasis (visible exposed bowel), therefore take to theatre same day
Exomphalocele (protruding bowel but covered in amniotic sac), therefore let it form a shell and surgically correct at later date
Most common cause of stridor in baby? (i.e. may present as noisy breathing during feeds)
Laryngomalacia
i.e. floppy epiglottis which folds into airway during feeding
malacia = soft
Organisms which cause meningitis >3 months?
NHS
Organisms which cause meningitis <3 months
GBS
Listeria
tall, small balls, lack of secondary sexual characteristics, low testosterone, high LH
Kleinfelter’s (XXY)
primary hypogonadism (i.e. problem in testis)
delayed puberty and lack of smell
Kallmann’s
Hypogonadotropic hypogonadism
Genotypically male but phenotypically female (small breasts, amenorrhoea)
Androgen insensitivity syndrome
(testosterone normal/high, LH high)
raise as female
How do you manage reflux in breastfed baby?
Following conservative advice (smaller, more frequent feeds at 30 degrees, continue to sleep on back)
2 week - Gaviscon
if fails - 4 week PPI
if able to have formula, try thickener first, but do not give gaviscon simultaneously
Regarding measles, what’s the most common complication, most common cause of death and any other complications?
Most common - otitis media
Most common cause of death - pneumonia
Other
- keratoconjunctivitis
- encephalitis
- subacute sclerosis pan encephalitis (years later, poor prognosis)
In children with asthma, should you give steroids?
YES
All asthma exacerbations in children - give steroids
Sandpaper like rash, sore throat, fever, strawberry tongue?
Scarlet fever
(caused by Group A strep)
Give phenocymethylpenicillin
Exclude from school for 48hrs from Abx
Do you need to exclude from school for hand, foot and mouth disease?
NO
(cocksakie A virus)
Do you need to exclude from school for Rubella?
YES
5 days from rash onset
Notifiable disease
When is heel prick test done and what is tested?
Day 5-9 of life
Sickle cell
CF
Congenital hypothyroidism
Phenylketonuria
MCAAD
and more
Which organism causes scarlet fever?
Group A beta haemolytic STREP
(i.e. streptococcus progenes)
Hand preference before what age is abnormal?
12 months
Why is UTI, especially recurrent UTI concern in children?
reflux nephropathy
Need to exclude vesicoureteric reflux essentially, as can lead to kidney scarring
Investigation for VSU?
Micturating cystoureterogram
(radiopaque dye injected into
Investigation to assess if there is renal scarring?
DMSA scan
IV injection of radioactive dye, and then scan. maps kidneys
Which diseases are X-linked recessive?
Haemophilia A and B
Duchenne Muscular Dystrophy
Which transmission is not possible in X-linked recessive diseases?
male to male not possible
male to daughter only as carrier
assuming unaffected mother
i.e. father cannot pass on active disease to children
father cannot pass any gene onto son
father can only at most make daughter carrier
Criteria to diagnose septic arthritis?
Kocher criteria /4
temp >38.5
WCC>12
Unable to weight bear
ESR>40
When can rotavirus vaccine be given to child?
2 months, 3 months
cannot be given after 15 weeks
Management of SUFE?
urgent surgery
How do you determine cause of precocious puberty in boys?
Based on size of balls
big balls - central cause
one big ball - testicular cause
small balls - adrenal cause
What hearing screening tests are done for all children?
newborn - echo test
start of school - pure tone audiogram
What are the knee problems in teenagers/older adults
Locking knee - osteochondritis dissecans
Tibial tuberosity tender - osgood schlatter disease
Pain on bending knee - chondromalacia patellae
Knee giving way - patellar subluxation
Triad for nephrotic syndrome?
Proteinuria, low albumin, oedema
Most common cause of nephrotic syndrome and its Treatment?
Minimal change disease
Oral prednisone
Which age groups do Bronchiolitis and Croup affect?
ALPHABETICAL ORDER
B, C
Bronchiolitis 3-6 months
Croup 6 months - 3 years
Causes of upper airway obstruction (Stridor) in kids?
Acute epiglottitis
Croup
Peritonisillar abscess
Inhaled foreign body
Laryngomalacia (Most common cause of stridor)
How does the distribution of eczema differ in infants?
Located om extensors rather than flexures!!
How do you treat eczema in child?
Hydromol
Dermol
Hydrocortisone
When do you screen for DDH with USS?
Breech
Family history of DDH
Multiparty (Saba must have been screened)
How do you manage a non-IgE mediated allergy?
given no risk of anaphylaxis in theory, can reintroduce slowly
Primary amenorrhoea, short, no breasts?
turner’s
Ddx is PCOS, but breasts normal, not necessarily short and may be primary or secondary amenorrhoea
Is all cyanosis harmful?
Only if its central
Peripheral cyanosis and at mouth is normal in neonates - called acrocyanosis.
If central, 100% oxygen test - if pO2 still low (<15), suggests cyanotic heart disease
Fever >5 days in a chid, what should you suspect?
Kawasaki’s
Which 2 conditions cause strawberry tongue? Difference between them
Scarlett fever
Kawasaki’s
Sandpaper course rash, face sparing
vs
Hand desquamation
Which congenital syndrome associated with pectus excavatum?
Noonan’s
How many initial rescue breaths in Paeds ALS?
5 rescue breaths
then 15:2
What is the management of DDH?
Pavlik Harness
If this fails, surgery
What should be given to all children who have an asthma exacerbation?
Oral prednisolone 2mg/kg for 3 days
(max 40mg)
When is whooping cough vaccine given to pregnant women?
Whooping cough vaccine is given to pregnant women between 16-32 weeks, because neonates are particularly susceptible to it.
NB// babies then receive it at 2,3,4 and 3-5 years
