Paediatrics 2 Flashcards
Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress- what do you think?
Best initial management?
consider a diaphragmatic hernia (normally on the left side posterolateral Bochdalek hernia)
Intubation and ventilation
Pneumonia and what abx to give:
S .pneumoniae- most common
If no response add…
If suspect mycoplasma or chlamydia
Influezna assoc. pneumonia (decrease in secretions so increases liklihood of bac penumonia) -
S .pneumoniae- Amoxacillin (first-line)
Add… Macrolide eg. erythromycin or clarithromycin
MYCoplasma or chlamydia- Macrolide eg. erythroMYCin or clarithromycin
Influenza assoc. - give Co-amoxiclav
What antibody is passed on baby from mothers breast milk?
IgA- A first in the alphabet and first received when you’re a baby
Also in , tears, saliva and GI secretions.
Nocturnal enuresis
Full Management run through
- First look…
2 Advice…. (3) - (This is usually first-line)
- Med
- First look for underlying triggers eg. DM, UTI, Constipation
- fluid intake
- toileting patterns: encourage to empty bladder regularly during the day and before sleep
- lifting and waking
- Reward system
- Eneuresis alarm
- Med- Desmopressin, use for short-term control or if alarm not effective
What you see on ABG in pyloric stenosis?
Hypocholaremic, HyPOkalaemic, Metabolic alkalosis
Meckels Diverticulum
First-line imaging
If unremarkable second line imaging -
First-line: Abdo USS
If unremarkable second line: Tecnetium scan
what do you use these drugs for a how do you remeber them?
Ceftriaxone
Cefotaxime
Ceftriaxone- STI gonorrhoea. It is also CI in babies as worsens jaundice in neonates
CefotaxiME- MEningitis (+ amoxacillin if 3 months to cover Listeria)
Meningitis is TAXing!
What is the traid of shaken baby syndrome?
Age range
- Retinal haemorrhags
- Subdural haemorrhages
- Encephalopathy
0-5 yo
Transiet Tachypnoea of Newborn (TTN)
MOre common in?
STEM- presentations
Managment
C-sections
- Hyperinflated lungs CXR
- Tachypnoea
- Fluid in horizontal fissure CXR
Management
1. Supportive and monitor
2. If sup oxygen if required, usually settles in 1-2 days
Cerebal palsy management ladder for spasticity
- med
- med
- med
4.
- Oral diazepam
- Oral and intrathecal baclofen
- Botulinum toxin A
- Ortho surgery and selective dorsal rhizotomy
Fragile X features: 7
-learning difficulties
- Macrocephaly
-large low set ears, long thin face, high arched palate
-macro-orchidism (large testicles)
-hypotonia
-autism is more common
-mitral valve prolapse
Male puberty
First sign = + what age
Max height spurt at….
Female Puberty
First sign = + what age
Max height spurt at….
Some strange but Normal changes in puberty 3
Male puberty
First sign = Testicular vol (>4ml indicates puberty) occurs 10-15yo
Max height spurt at 14
Female Puberty
First sign = breast development + 9-13yo
Max height spurt at 12 before menarche 13
Some strange but Normal changes in puberty
1. gynaecomastia may develop in boys
2. asymmetrical breast growth may occur in girls
3. diffuse enlargement of the thyroid gland may be seen
Edwards features (4)
What trisomy?
Micrognathia- lower jaw is undersized
Low-set ears
Rocker bottom feet
Overlapping of fingers
Trisomy 18
What do these investigtions look for?
DMSA
MCUG (micturating cystourethrogram)
Renal USS
DMSA- SCARRING!
MCUG (micturating cystourethrogram)- Vesoureteric reflux
Renal USS- gross anatomical abnormality
PDA
Features (5)
Management
1. On its own-
2. If assoc with another congenital heart defect-
- Continues Machine like murmur
- Wide pulse pressure
- Left subclavian thrill
- Displaced apex beat
- large volume, bounding, collapsing pulse
Management
1. On its own- Indomethacin (NSAID) which inhibs prostoglandin therefore closes
2. If assoc with another congenital heart defect- Give prostoglandin E1 to prop it open and prevent cyanotic until after surgery
Bow legs in a child less thean 3yo, what should you do?
Reassure, normal variant and usually resolves by the age of 4 years
CF
What is a indicator of increased mortality+ morbid? (2)
What is the important Contra-indication for lung transplant?
Increase mortality- chronic infection with Burkholderia cepacia or Pseudomonas
CI- chronic infection with Burkholderia cepacia
Croup: what features suggest you should admit?
1
2
3
- If mod or severe
- If known UTR Abnormlity- laryngomalacia, Down’s
- uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
What pulse abnormality assoc with PDA?
large volume, bounding, collapsing pulse
What genetic pattern is haemophilia?
X-linked recessive- there is no male-to-male transmission.
Midline cyst
1.thyroglossal cyst
-move with tongue protrusion, often below hyoid bone level
US : hypoechoic
2. dermoid cyst
-not move with tongue protrusion, move with underlying skin, often suprahyoid
US: hyperechoic, heterogenous
3. Ranula
-sublingual gland so can be seen from floor of mouth
Lateral cyst
1.Bronchial cyst
-anterior triangle at junction of carotid artery
-US : anechoic
2.lymphangioma (aka cystic hygroma)
-posterior triangle, big size and fluid filled
-US:hypoechoic
Most common cause of childhood hypothyroidism in the United Kingdom?
Autoimmune thyroiditis.
Infantile spasms
aka
More common in male or female?
when does it present?
Should you be concerned?
Features
- STEM
- lasts?
-
West syndrome
first 4 to 8 months of life
Male
Yes, associated with a serious underlying condition
Features
1. characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms
2. lasts only 1-2 seconds but may be repeated up to 50 times
3. progressive mental handicap
Infantile spasms
aka
What does EEG show?
Brain CT shows tuberous sclerosis
Management
first line-
… is also used
Prognosis is poor
EEG- hypsarrhythmia in two-thirds of infants
vigabatrin is now considered first-line therapy
ACTH is also used
Pertussis diagnostic criteria
admit if…
Management of pertussis/ whooping cough?
med-
also give…
School exclusion rule?
What age are you offered the vaccine?
acute cough that has lasted for 14 days or more w/o another apparent cause, and one or more from:
1. Paroxysmal cough.
2. Inspiratory whoop.
3. Post-tussive vomiting.
4. Undiagnosed apnoeic attacks in young infants.
admit if…under 6 months with suspect pertussis
Med: oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread
- Give household abx prophylaxis
school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
Trick questions- Given to mum. Women who are between 16-32 weeks pregnant will be offered
Edwards syn features 4
What chromosome?
- small jaw
- low-set ears
- rocker-bottom feet
- overlapping fingers.
trisomy 18
Fragile X features (5)
- large testicles
- mild-moderate learning difficulty
- a long and narrow face
- large ears
- flexible fingers
Pataus syn
chromo?
Features 5
Trisomy 13
- cleft lip/palate
- microcephaly
- small eyes
- polydactyly
- scalp lesion
When a child lacks capacity who gives the consent?
when a child lacks capacity, consent from one parent is sufficient to administer treatment as long as it is in the best interests of the child.
Also try involve child in the decision making process
Type of brain haemorrhage in preg:
- Pre-term baby-
- Following forceps-
- common and cause irritability-
- Pre-term baby- Intraventricular haemorrhage
- Following forceps- Subdural
- Common- Subarachnoid haemorrhage
Developmental dysplasia of hip
more common in males or females?
RFs (7)
- Older children
Females 6:1
RF
1. Female sex
2. breech presentation
3. positive family history
4. firstborn children
5. oligohydramnios
6. birth weight > 5 kg
7. congenital calcaneovalgus foot deformity
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
