Paediatrics Flashcards
By what age should the testes be descended?
by 3 months - if they are noted to not be descended at 8 week baby check, then advise to bring back to be re-examined at 3 months
what should be done if the testes are still not descended at 3 months?
refer to paediatric surgeons - to be seen before 6 months of age
what are the red flag features for sarcoma?
persistent fevers
pain - usually in one specific area, nocturnal and at rest
persistent localised swelling
what vaccination could be given at birth?
BCG - if comes from high risk country for TB
what vaccinations are given at 2 months?
“6 in 1” - diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B
Oral rotavirus vaccine
Men B
what vaccinations are given at 3 months of age?
“6 in 1” - diphtheria, tetanus, whooping cough, polio, Hib and hep B
Oral rotavirus
pneumonoccocal
what vaccinations are given at 4 months of age?
“6 in 1” - diphtheria, tetanus, whooping cough, polio, Hib, hep B
Men B
what vaccinations are given at 12 months?
Hib/Men C vaccine (1st)
MMR (1st)
pneumococcal (2nd)
Men b (3nd dose)
what vaccination is given at 3-4 years?
“4 in 1” preschool booster - diphtheria, tetanus, whooping cough, polio
MMR
what is vaccination is given at 12-13 years?
HPV vaccine
what vaccination is given between 13-18 years?
3 in 1 teenage booster - tetanus, diphteria, polio
ACWY
what is the expected symptom duration of croup?
2 days
what is the expected symptom duration of sore throat?
2-7 days
what is the expected symptom duration of earache?
7-8 days
what is the expected symptom duration of common cold in children?
15 days
what is the expected symptom duration of bronchiolitis?
21 days
what is the expected symptom duration of nonspecific URTI?
16 days
what is the expected symptom duration of acute cough in children?
25 days
what infection causes fever, malaise, tonsillitis, strawberry tongue and then a fine sandpaper erythematous rash which starts on the trunk then spreads to extremities and around the mouth?
scarlet fever
what is scarlet fever?
toxin mediated infection caused by group A strep
what age does scarlet fever commonly affect?
2-10 years
what are the symptoms of scarlet fever?
prodromal phase of fever, nausea, vomiting, sore throat, headache 1-2 days before rash
then develops characteristic sandpaper type of rash which starts on the trunk and spreads to the arms and legs
desquamination of hands and feet in later stages
strawberry tongue
circumolar pallor
what is the management of scarlet fever?
pen V for 10 days
azithro/clari if pen allergic
supportive care
what are some possible complications of scarlet fever?
rheumatic fever
post-strep glomerulonephritis
is scarlet fever a notifiable disease?
yes
how long should a child stay off school with scarlet fever?
at least 24 hours after starting abx
what causes a sore throat, fever and then the development of vesicles on the mouth, palms and soles of feet?
hand foot and mouth (coxackie A16 virus)
what are symptoms of hand food and mouth disease?
viral illness - low grade fever, sore throat, malaise, poor appetite
followed by development of vesicles on the hands, mouth and feet - are non-itchy and non-blanching
what is the treatment of hand foot and mouth disease?
supportive treatment - resolves in 7-10 days
how long should children stay off school for with hand foot and mouth?
until feeling well - no exclusion applies
what infection causes a slapped cheek appearance?
erythema infectiosum - parvovirus b19
what causes slapped cheek?
parvovirus b19
what are the symptoms of erythema infectiosum/slapped cheek?
prodrome - 1 week before rash - low grade fever, malaise, headache, coryzal symptoms
phase 2: rash - slapped cheek on cheeks + lacy reticular rash on trunks and limbs - lasts for 1-3 weeks
phase 3: arthropathy - symmetrical polarthritis
management of slapped cheek/erythema infectiosum?
supportive care
what are some potential complications of slapped cheek/parvovirus?
aplastic crisis in sickle cell anaemia
hydrops fetalis - can cross placenta and cause heart failure - pregnant women need referring for serological testing
prolonged arthritis
is school exclusion required in erythema infectiosum / parvovirus b19?
no
what causes a pink maculopapular rash on the face, which spreads to the whole body?
rubella
what causes rubella?
rubella virus
what are the symptoms of rubella?
fever, malaise, coryzal symptoms
rash - pink maculopapular rash that starts on the face and spreads to the trunk/limbs within 24 hours and fades in 3 days
lymphadenopathy
forchemier spots - petechiae on soft palate
what is the management of rubella?
notifiable disease
supportive
what are complications of rubella?
congenital rubella syndrome - triad of senosorineural deafness, cataracts, heart defects
encephalitis
thrombocytopenia
what is the school exclusion recommendations for rubella?
4 days after onset of rash
what causes prodromal viral phase, followed by parotitis?
mumps
what causes mumps?
mumps virus
what are the symptoms of mumps?
prodromal viral phase 1-2 days
painful bilateral parotid gland swelling
tenderness at mandibular angle
difficulty chewing /swallowing
orchitis
pancreatitis
aseptic meningitis
encephalitis
management of mumps?
supportive - resolves in 7-10 days
what are some complications of mumps?
orchitis - subfertility
meningitis
pancreatitis
encephalitis
hearing loss - rare but permanent
school exclusion advice for mumps?
stay off school for 5 days after swelling strted
how is mumps spread?
respiratory droplets and saliva
what causes kolpik spots, and blochy maculopapular rash that starts behind the ears and spreads to the rest of the body?
measles
what causes measles?
causes by measles virus
how does measles spread?
highly contagious - through water droplets
what is the incubation period for measles?
10-12 days prior to symptoms
what are the symptoms of measles?
high fever, coryza, cough, conjunctivits
kolpik spots - white spots on buccal mucosa
maculopapular rash - starts behind the ears and at the hairline then spreads downwards, initially blanching then becomes non-blanching
what are common complications of measles?
acute encephalitis - happens in 1 in 1000 cases but when does happen 1 in 4 die
SSPE - encephalitis, occurs years later, fatal
pneumonia
diarrhoea
miscarriage, preterm birth, stillbirth
management of measles?
supportive
how long should children be kept off of school with measles?
4 days before and 4 days after rash
what causes whooping cough?
bordatella pertussis
what are the symptoms of whooping cough?
prodromal viral phase - 1-2 weeks
then whooping cough - worse at night, and after feeding
infants may have apnoeic spells
lasts for 2- 8 weeks
what is the diagnostic criteria for whooping cough?
acute cough for more than 14 days with no apparent cause and has paroxysmal cough + inspiratory whoops, post-tussive vomiting or apnoeic attacks
how do you diagnose whooping cough?
nasal swab for brodatella pertussis
management of whooping cough?
infants under 6 months - admission
oral macrolide usually clari/azithro/erythro - if inset of cough within 21 days
household contacts should be offered abx prophylaxis
what is the school exclusion advise for whooping cough?
48 hours after commencing abx
what are some complications of whooping cough?
subconjunctival haemorrhage
penumonia
bronchiectasis
seizures
what causes croup?
parainfluenza virus - accounts for majority of cases
what is the age typically affected by croup?
6 months - 3 years
what are the symptoms of croup?
barking, seal like cough
stridor
worse at night
fever, coryzal
who should be admitted with croup?
moderate/severe croup
< 3 months of age
known upper air way abnormalities - downs syndrome, laryngomalacia
uncertain diagnosis
what constitutes as mild croup?
occasional barking cough
no audible stridor at rest
no or mild intercostal recession
child is otherwise well in self and happy
management of croup?
single dose of 0.15mg/kg to all children regardless of severity
pred is alternative if dex not available
what is the emergency treatment of croup?
high dose O2
neb adrenaline
what causes acute epiglottitis?
haeomphilus influenza type B
symptoms of acute epiglottitis?
rapid onset
drooling
stridor
tripod position - leaning forwards, neck in seated position
management?
NO exam of throat
immediate anaesthetics support
needs O2 usually intubated
IV abx
what is seen on XRAY for acute eppiglotits?
thumb sign
steeple sign
what age is bronchiolitis most common?
< 1 year old
what causes bronchiolitis?
RSV virus in 75-80% of cases
symptoms of bronchiolitis?
coryzal symptoms
dry cough
increased breathlessness
wheezing/fine insp crackles
feeding difficulties
what is the criteria for immediate admission of child with suspected bronchiolitis?
apneoa reported or observed
child looks seriously unwell
severe resp distress- grunting, chest recession, RR > 70
central cyanosis
SpO2 < 92%
what is the crtieria for “considering” hospital referral for bronchiolitis?
RR > 60
< 50% oral intake
clinical dehydration
what is the school advice re chickenpox?
until all lesions crusted over - usually 5 days after onset of rash
who should receive VZIG for chickenpox?
immuncompromised patients
new borns with exposure in perinatal period
what is the incubation period of chicken pox?
10-14 days
at what age does flat fleet resolve?
by 4-8 years
parental reassurance
what age does intoeing resolve?
by 8-10 years old
what age does out toeing reoslve?
usually by 2 years - if persistent , refer
what age does bow legs resolve?
4-5 years
what age does knock knees resolve?
spontaneously
what hearing test is used for newborns?
aautomated otoacoustic emission test p small soft tipped earpiece is placed in the baby’s ear which sends a clicking sound to the cochela. The presence of a soft echo indicates normal cochlea
what test is done if the audiologist finds the automatated otoacoustic emission test to be inconclusive?
auditory brainstem response test
when is pure tone audiometry done?
done at school age
when should you refer a baby that cannot sit without support?
aged 12 months
at what age should you refer a baby that cannot walk unsupported?
18 months
and what age can a baby squat to pick up a toy?
18 months
what age can babies crawl?
9 months
what age can babies roll front to back?
6 months
at what age can children hop?
4 years
what age can children walk up stairs without holding on to rail?
3 years
at what age does pyloric stenosis typically present?
2-6 weeks
symptoms of pyloric stenosis?
projectile vomiting
constipation
dehydration
failure to thrive
falling off weight chart
palpable mass in upper abdomen
what is pyloric stenosis caused by?
hypertrophy of the circular muscles in the pylorus
how do you diagnose threadworms?
usually clinical but can use sellotape test
what is the management of threadworms
mebenazole oral one off dose
treat all household members
what is caput succedaneum?
fluid collection with poorly defined margins caused by the pressure of the presenting part of the scalp against the dilating cervix (tourniquet effect of the cervix) during delivery. For the purpose of exams, this swelling would cross suture lines. The swelling is also present at birth and typically over the vertex.
what is cephalhaematoma and how can you tell?
does not cross suture lines
haemorrhoage between the skull and periosteum - limited to bone lines
can present 2-3 days after birth
at what age to children develop hand dominance?
18 months - if shows hand dominance prior to this - is a RED FLAG for cerebral palsy
what is osgood schlatter disease?
most common in sporty teenagers
due to tibial apophysitis
symptoms of osgood schlatter disease?
pain tenderness and swelling over the tibial tubercle
worse with exercise, relieved with rest
what is chondromalacia patallae?
softening of the cartilage of the patella
who is chrondromalacia patellae more common in?
teenage girls
what are the symptoms of chondromalacia pattella?
anterior knee pain on walking up and down the stairs, and rising from prolonged sitting
management of chondromalacia patallae?
physio
symptoms of osteochondritis dissecans?
pain after excersise
intermittent swelling and locking
what is osteochondritis dissecans?
Subchondral bone (beneath cartilage) loses blood supply → necrosis → cartilage weakens → fragment detaches
The loose fragment may remain partially attached or become a free-floating “joint mouse”, leading to locking and mechanical symptoms
what is infectious mononucleosis?
infection with EBV
what are the symptoms of infectious mononucleosis?
typically fever, sore throat, lymphadenopathy
how is infectious mononucleosis spread?
droplet - kissing disease
what is the incubation period of infectious mononucleosis?
4-6 weeks
management of infectious mononucleosis?
supportive
avoid penicillins - causes rash
avoid contact sports for 3-4 weeks due to risk of splenic injury
symptoms of fragile X?
fragile masculinity - big head and big balls to overcompensate, bit stupid
macrocephaly, long face, long ears, macro-orchidism, learning difficulties
symptoms of prader willi?
fat, floppy and small balls
obestiy, learning disability, hypogonadism, hypotonia
symptoms of pierre - robin syndrome?
pierre- french waiter - thin face/jaw, speaks in funny accent
micrognathia (thin face/jaw), posterior tongue displacement, cleft palate
williams syndrome?
small, playful boy who is foolish but has a big heart
short stature, friendly/extrovert, learning difficulties, supravalvular stenosis
symptoms of noonan syndrome?
No neck N
webbed neck, narrow pulomonary vessels , pectus excavatum
pataus syndrome?
pin head passau
cleft palate, polydactyl, microcephaly
cri cu chat syndrome symptoms?
french translation = cat , cats head
microcephaly, migrognathia and small larynx
when should you refer a child who has not started smiling?
10 weeks
what is the algorithm of paediatric basic life support?
unresponsive?
shout for help
open airway
look listen feel
give 5 rescue breaths
check for ciruculation
then 15 compression to 2 rescue breaths
what is the ongoing management of a child < 6 months with UTI?
abx acutely
refer for renal USS (6 weeks after infection) + DMSA (4-6 months)
which is first line abx for pyelonephritis in a child?
cefalexin
what is the genetic abnormality in turners syndrome?
45 XO
why is it not safe to give rotavirus vaccine after 15 weeks?
risk of intersussception
treatment of cradle cap?
reassurance that it doesn’t affect the baby and usually resolves within a few weeks
massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.
if severe/persistent a topical imidazole cream may be tried
what hip condition typically occurs in overweight male children?
SUFE
what is slipped upper femoral epiphysis?
rare hip condition - where the femoral head displaces postero-inferiorly
exact aetiology is unclear - thought to be due to growth/hormonal factors
what are the symptoms of SUFE?
hip pain or knee pain exacerbated by movement
limping or altered gait
limited internal rotation of the hip
leg length discrepancy
how is SUFE diagnosed?
refer for XR - shows ice cream cone appearance
what is the management of SUFE?
surgical intervention - to prevent further slippage and complications
what are some complications of SUFE?
avascular necrosis of the femoral head
persistent deformity
what is chondromalacia patallae?
softening and deterioration of the cartilage of the underside of the patella usually due to overuse
what causes chondromalacia patellae?
Overuse – common in runners, cyclists, and athletes with repetitive knee bending.
Muscle weakness/imbalance – particularly weak quadriceps or tight hamstrings can cause the patella to track abnormally.
Poor biomechanics – flat feet, knock knees, or high-arched feet can lead to improper knee movement.
Previous trauma – a history of knee injuries can predispose to chondromalacia.
what are the symptoms of chondromalacia patellae?
dull aching anterior knee pain worse with movement
crepitus
mild swelling occasionally
management of chondromalacia patellae?
physiotherapy
rest , ICE
what should be monitored in children taking methyphenidate for ADHD?
growth - stimulant, reduces appetite, need to ensure growth remains stable, check every 6 months
what are examples of cyanotic heart disease?
tetralogy of fallot
transposition of the great arteries
tricuspid atresia
what are examples of acyanotic heart disease?
VSD
ASD
PDA
coarctation of aorta
aortic valve stenosis
what are the features of tetralogy of fallot?
Very Pale And Really Tired
V - ventricular septal defect
P - pulmonary stenosis
A - aorta overriding
R - right ventricular hypertrophy
T - tetralogy of fallot
what condition is VSD associated with?
downs syndrome
what are the symptoms of VSD?
mild - asymptomatic
moderate - FTT, poor feeding, SOB
severe - FTT, poor feeding, SOB, sweaty, pale, unwell
what are the signs of VSD?
thrill
pansystolic murmur at LLSB
loud S2
what is the most common acyanotic heart defect?
VSD
what is the second most common acyanotic heart defect?
ASD
what are the symptoms of ASD?
typically asymptomatic
can haev recurrent chest infections
what are the clinical findings of ASD?
ejection systolic murmur at ULSB
splitting of the 2nd sound
what is the most common heart defect associated with preterm neonates?
PDA
what are the symptoms of PDA?
small - asymptomatic
moderate - CHF, FTT
large - CHF, FTT, poor feeding, recurrent chest infections
what murmur is associated with PDA?
continuous machinery murmur
what heart defect is associated with turners syndrome?
coarctation of the aorta
what are the symptoms of coarctation of the aorta?
symptoms present 3-5 days after birth when the duct closes
absent femoral pulses
cold extremities
SOB
murmur heard between scapula
management of suspected reflux in baby who is breast feeding?
trial of gaviscon
management of suspected reflux in a baby who is bottle fed?
reduce feeds to 150ml/kg/24 hours
feed thickener trial for 1/2 weeks
alginate for 1/2 weeks
PPI for 4 weeks
refer for endoscopy if no improvement
what type of scan is used to diagnose vesicoureteric reflux?
micturating cystogram
what is vesicouretric reflux?
abnormal back flow of urine from the bladder into the ureter and kidney - urters are displaced laterally so they enter the bladder in a more perpendicular fashion, which causes backflow
how does vesicuourteric reflux present?
can be picked up antenatally - hydronephrosis on US
can also present as recurrent UTI
how much emollient should be used per week in a child with eczema?
250-500 grams per week
what are the rules around applying steroids and emollients together?
emollient first
wait 30 mins
then steroid
what is the age definition of precocious puberty?
development of sexual characteristics before 8 years in females and before 9 years in males
what causes roseola infantum?
HHV6
what age does roseola infantum typically affect?
6 months to 2 years
what are the features of infantum roseola?
high fever for few days then -
maculopapular rash
papular enanthem on the uvula and soft palate
febrile convulsions common - 10-15%
diarrhoea and cough commonly occur
what are the school exclusion rules with roseola infantum?
school exclusion not needed
what is a common SE of monteleukast?
nightmares
what is the dose of IM ben pen given in meningitis to < 1 year old?
300mg
what is the dose of IM ben pen given in meningitis 1-10 year old?
600mg
what is the genetic variation in Turners syndrome?
presence of only one sex chromosome
45 XO
what are the symptoms of turners syndrome?
if very short + primary amenorrhoea = think turners
short stature
webbed neck
wide space nipples
high arched palate
multiple pigmented naevi
what are the causes of physiological jaundice inthe first 24 hours?
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
what are some causes for prolonged jaundice (usually > 14 days) ?
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
prematurity
congenital infections - CMV, toxoplasmosis
