Paediatrics 2 Flashcards
Whooping cough aka
Gram +ve or -ve
Features (4)
How long can symptoms last
What can be seen on bloods?
Pertussis - bordetella pertussis
Gram negative
2-3 days of coryzal symptoms
Coughing bouts, worse at night and may end in vomiting
Inspiratory whoop
Apnoea
Symptoms can last 10-14 weeks
Lymphocytosis marked
Mx whooping cough
<6 months
When would you give abx?
Which abx?
Who else should be offered abx?
School exclusion
Admit
If onset of the cough is within the previous 21 days
Clarithro
Household contacts
48 hours after starting abx or 21 days from onset of sx if no abx
Eye test at
Birth
6 weeks
3 months
Red reflex
Fix and follow to 90 degrees
Fix and follow to 180 degrees
Eye test at
12 months
>3 years
>4 years
Pincer grip
Letter matching test
Snellen charts
Diagnostic testing for vesicoureteric reflux
What investigation can be done to check for renal scarring?
Micturating cystourethrogram
DMSA to check for renal scarring (4-6 months post infection)
How may VUR present? (3)
Hydronephrosis antenatally
Recurrent UTIs in childhood
Reflux nephropathy
UTI mx
< 3 months
> 3 months with an upper UTI
> 3 months with a lower UTI
Refer to paeds
Consider admission OR PO cephalosporin/ coamox for 7-10 days
Local guidelines usually trimeth or nitro
Investigation for children with UTIs
<6 months
>6 months
<6 months with first UTI should have an US within 6 weeks
>6 months first UTI which responds to treatment DOES NOT require imaging unless features of an atypical infection
Complications of undescended testis (3)
Infertility
Torsion
Testicular cancer
Mx undescended testis
Unilateral versus bilat
When to refer
When to operate
Unilateral
Refer from 3 months of age
Orchidopexy at 1yo
Bilateral - review within 24 hours
When do umbilical hernias normally resolve by?
Associated with? (2)
Age 3
Afro-Caribbean
Down’s syndrome
Turner’s syndrome features (4)
Chromosomal
What is the most common renal abnormality?
Gonadotrophin levels will be?
Webbed neck
Short stature
Wide spaced nipples
Primary amenorrhoea
45X0
Horseshoe kidney
Raised
Perianal itching
Although 90% have no symptoms at all
=
Ix
Mx (2)
Threadworm
Enterobius vermicularis
Apply sellotape and send tape to check for eggs
Mebendazole if >6 months
+ all members of the household
When does primary tooth eruption typically begin?
When does it usually end?
6 months
2.5yo
Teething mx (2)
Chewable teething rings
Simple analgesia
SIDS
Most common at what age?
Name five major RF
3 months
Prone
Parental smoking
Prematurity
Bed sharing
Hyperthermia
Non major RF for SIDS (5)
Male
Multiple births
Social class IV and V
Maternal drug use
Winter
Illness according to age
<6 months
6months-3yo
2-6yo
Bronchiolitis
Croup
Acute epiglottitis
Slipped capital femoral epiphysis
Position of leg
Loss of internal rotation
Leg flexed
Displacement of femoral head postero-inferiorly
What is plagiocephaly?
What is craniosynostosis?
Parallelogram shaped head
Premature fusion of the skull bones
Erythematous rash with coarse yellow scales
Scalp, nappy area, face, limb flexures
=
Mx
Mild-mod
Severe
Usually resolves by what age?
Seborrhoeic dermatitis
Mild-mod baby shampoo and oils
Severe mild topical hydrocortisone
8 months
School exclusion
Rubella
5 days from onset of rash
School exclusion
Scarlet fever
24 hours after started abx
School exclusion
Whooping cough
48 hours post commencing abx
OR
21/7 from onset of symptoms
School exclusion
Measles
4 days from onset of rash
School exclusion
Chickenpox
Lesions have crusted over
School exclusion
Mumps
5/7 fron onset of swollen glands
School exclusion
D&V
48 hours post sx have settled
School exclusion
Impetigo
48 hours post commencing abx
OR
Until lesions are crusted and healed
School exclusion
Scabies
Influenza
Until treated
Until recovered
Scarlet fever is caused by which organism?
Age
Group A haemolytic strep (strep pyogenes)
2-6yo
Features of scarlet fever (6)
Describe the rash and location
Fever 24-48 hours
Malaise, headache, N&V
Strawberry tongue
Sore throat
Fine punctate erythema (pinhead) first on the torso sparing the palms and soles
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash
fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
flushed appearance
‘sandpaper’ texture
Scarlet fever
Scarlet fever
Mx (2)
PO penicillin V 10/7
Azithro if pen allergic
Scarlet fever complications (2)
Otitis media
Glomerulonephritis (10 days after infection)
Rotavirus
Type of vaccine
How many doses and when?
PO vaccine, live attenuated
x2 doses at 2 and 3 months
Roseola infantum is also known as
Caused by
Age range
School
Sixth disease
HHV 6
6 months to 2 years
No exclusion needed
High fever for a few days
Then a maculopapular rash
Nagayama spots on uvula and soft palate
Febrile convulsions
Roseola infantum
Average age of retinoblastoma
AD/AR
Features (3)
18 months
AD
Absence of red reflex
Replaced by a white pupil
Strabismus (squint)
Projectile vomiting, typically 30 mins after a feed
Constipation and dehydration
Palpable mass in upper abdomen
=
What age group?
Ix
Mx
Pyloric stenosis
Second to fourth weeks of life
US
Ramstedt pyloromyotomy
First sign of puberty in males and females:
Testicular growth
Breast development
Definition of precocious puberty
Development of secondary sexual characteristics before
Age 8 in females
Age 9 in males
Classification of precocious puberty:
Gonadotrophin dependent
(due to premature activation of hypotha-pit-gonad axis)
Raised FSH, LH
Gonadotrophin independent
(due to excess sex hormones)
FSH & LH low
Classification of wheeze
Episodic: only with an URTI
Multiple trigger wheeze: many triggers
Mx episodic wheeze (2)
- SABA or SAMA via a spacer
- Intermittent LTRA or INH steroids
Mx multiple trigger wheeze (2)
INH steroids or LTRA 4-8 weeks
Phimosis mx
Expectant
Unless over 2yo with recurrent balanoposthitis or UTI where treatment can be considered
AR
Fair hair, blue eyes
Learning difficulties
Musty odour to urine and sweat
Seizures
Developmental delay
Phenylketonuria
Mx Perthe’s disease (3)
Cast/ braces
If <6yo: observe
Older: surgical
Risk of Down’s with increasing maternal age
Age to risk 20-45
20 1500
30 800
35 270
40 100
45 50
Eczema in children
Typically presents before what age
Infants affected location
Younger children
Older children
<2yo
Infants: face and trunk
Young: extensor surfaces
Older children flexor surfaces
Mx eczema children (4)
- Emollients
- Topical steroid (emollient first and wait 30 mins)
- Wet wrapping
- PO ciclosporin
When to refer a child with epistaxis?
Under the age of 2yo
Epstein’s pearl mx
Location
Spontaneously resolve over the course of a few weeks
Common on hard palate but can also be on the gum
Age for febrile seizures
6 months to 5 years
When to admit a child with seizures to paeds?
First seizure OR
Features of complex seizure
Features of a complex febrile seizure (3)
Length of time
Type of seizure
Number within 24 hours
15 mins - 30 mins
Partial
>1 in 24 hours
RF for developing epilepsy following febrile seizures (3)
Complex seizure
BG neurodevelopmental disorder
FH of epilepsy
Tachypnoea
Age 6-12 months
>12 months
> 50
40
Tachycardia
<12 months
12-24 months
2-5yo
> 160
150
140
If history is suggestive of an IgE mediated allergy what investigation can be offered?
If hx suggestive of non-IgE mediated allergy what can be offered?
Skin prick test or IgE antibodies
Eliminate allergen for 2-6 weeks and then reintroduce
What is Freiberg disease?
Seen in which group of people?
Usual location
Features (3)
Mx (3)
How long can recovery take?
Metatarsal avascular necrosis
Tall, athletic females
2nd metatarsal
Pain, swelling, stiffness
Activity limitation, analgesia, casts/boots
1 year
Age of onset of GORD
Mx (5)
<8 weeks
- 30 degree head up
- Sleep on back
- Smaller and more frequent feeds
- Thickened formula trial
- Gaviscon
When can a PPI be used in GORD? (3)
If any one of the following:
1. unexplained feeding difficulties
2. distressed behaviour
3. faltering growth
Mx head lice (3)
If living lice are found:
1. Malathion
2. Wet combing
3. Dimeticone
How to diagnose a migraine without aura?
A >= 5 attacks fulfilling the below criteria:
B Lasts 4-72hours
C At least x2 of:
1. Frontal/ temporal
2. Pulsating
3. Mod-severe intensity
4. Aggravated by physical activity
D At least one of:
1. N&V
2. Photophobia/ phonophobia
Mx migraine (2)
SE of 2nd line management
- Ibuprofen
- > 12yo can offer triptans (nasal spray sumatriptan only)
SE: tingling, heat, heaviness, pressure
How to diagnose a tension type headache
A at least 10 previous headache episodes
B 30 mins -7 days
C at least x2 of:
1. Pressing/ tightening
2. Mild - moderate intensity
3. Bilateral
4. No aggravation by physical activity
D Both of the following:
1. No nausea/vomtiing
2. No photophobia
What age does infantile colic occur?
Worse at what time of day?
Characteristic features (2)
3 months old
Evening
Bouts of excessive crying, pulling up of legs
When do infantile spasms occur? (age)
4-8 months
When do infantile spasms occur? (age)
What does an EEG show?
Mx (2)
4-8 months
Hypsarrhythmia
Vigabatrin + ACTH
characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap
Infantile spasms
Mx laryngomalacia (1)
When does it normally resolve by?
What can you do for symptomatic relief?
Resolve spontaneously by 18-24 months
Symptomatic relief by hyperextending neck
Surgical intervention rare
Inspiratory stridor : high-pitched and crowing. This is usually intermittent, occurring in the supine position e.g. when the child lies on its back, when feeding or when agitated
Symptoms increase in severity during the first 8 months but tend to resolve by 18-24 months
Respiratory distress, failure to thrive and cyanosis are rare
=
Laryngomalacia
problems with micturition including pooling in the vagina
on examination thin semitranslucent adhesions covering the vaginal opening between the labia minora are seen, which sometimes cover the vaginal opening completely
=
Mx (3)
Labial adhesions
Conservative
If associated with repeat UTIs then topical oestrogen
Surgery
Typically an erythematous rash which involve the flexures and has characteristic satellite lesions
Mx
Candida dermatitis
Mx topical imidazole (do not use barrier cream)
The most common cause, due to irritant effect of urinary ammonia and faeces
Creases are characteristically spared
=
Irritant dermatitis
Erythematous rash with flakes. May be coexistent scalp rash
Seborrhoeic dermatitis
Mx nappy rash
- Disposable nappies
- Expose area to air
- Apply barrier cream
- Mild steroid cream
Measles features (7)
Irritable
Conjunctivitis
Fever
Koplik spots (white spots on buccal mucosa)
Rash starting behind the ears then maculopapular rash
Becomes blotchy and confluent
Sparing of palms and soles
Complications measles (4)
Otitis media
Pneumonia
Encephalitis
Febrile convulsions
Mx of contacts of measles
If not immunised then should be offered MMR within 72 hours
Age of onset
GORD
Infantile colic
Pyloric stenosis
Febrile seizures
Infantile spasms
GORD <8 weeks
Infantile colic 3 months
Pyloric 2-4 weeks of life
Febrile seizures 6 months - 5yo
Infantile spasms 4-8 months
