Paediatrics 3 Flashcards
Abdominal pain
Rectal bleeding
Intestinal obstruction
=
Meckel’s diverticulum
Meckel’s diverticulum Ix (1)
Mx
Meckle’s scan - 99m technetium pertechnetate
Mx surgery
Mx meningitis
<3 months
>3 months
IV amoxi/amp + IV cefotaxime
IV cefotaxime/ceftriaxone
Consider dexamethasone in meningitis if LP shows? (4)
What age group does not get steroids?
Children <3months do not get steroids
Consider dexamethasone if LP shows:
1. Frankly purulent CSF
2. WCC >1000
3. Raised WCC with protein >1
4. Bacteria on Gram stain
If suspected meningococcal septicaemia treat with:
Dose
<1 year
1-10yo
>10yo
IM/ IV benpen
300mg
600mg
1200mg
Mitochondrial diseases are passed on via mother or father?
What might you see on muscle biopsy?
Mother
Red, ragged fibres
CI to MMR (3)
How long should pregnancy be avoided for post MMR?
Immunosuppression
Allergy to neomycin
Children who have received another live vaccine by injection within 4 weeks
4 weeks
Painless limp =
Juvenile idiopathic arthritis
Paeds BLS
Ratio lay versus non lay
How many rescue breaths?
30:2
If non lay x2 then 15:2
5 rescue breaths
Rate for chest compressions
Depth
How does compressions differ for children and infant
What is the difference between a child and an infant (age)
100-120/min
depth: depress the lower half of the sternum by at least one-third of the anterior–posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child)
in children: compress the lower half of the sternum
in infants: use a two-thumb encircling technique for chest compression
<1, 1-puberty
Mx SUFE (2)
Bed rest + non weight bearing
Percutaneous pinning of the hip
Cherry red lesions surrounding the umbilicus
Bleed on contact
Seropurulent discharge
=
Mx
Umbilical granuloma
Mx chemical cautery + silver nitrate
Umbilical discharge of small bowel content
Mx
Persistent vitello-intestinal duct
Surgery
Urinary discharge from umbilicus
Persistent urachus
Infection of the umbilicus
Common bacteria
Omphalitis
Staph Aur
Paraumbilical hernia vs umbilical
Which is more likely to resolve spontaneously?
Umbilical (12months to 3 years to resolve)
Left subclavicular thrill
Machinery murmur
Bounding, collapsing, large volume pule
Wide pulse pressure
Heaving apex beat
Patent ductus arteriosus
PDA
Mx
Indomethacin OR ibuprofen
PDA RF (3)
Premature
High altitude babies
Maternal rubella infection in the first trimester
Gold standard diagnostic test for Hirschsprung’s disease
1st line Ix
Rectal biopsy
AXR
Mx Hirschsprung’s disease (2)
Rectal washouts
Surgery
Neonatal sepsis mx
IV benpen + gent
When can abx be ceased in neonates?
At 48 hours if CRP <10
Define nephrotic syndrome triad
Proteinuria >1g/m2
Hypoalbuminaemia <25
Oedema
Peak incidence age for nephrotic syndrome
Most commonly is
2-5yo
Minimal change glomerulonephritis
Features of intussusception (6)
Age
Gender
Drawing knees up
Turn pale
Vomiting
Red currant jelly
Sausage shaped mass in RUQ
Abdominal colic pain
M>F
6-18months
Intussusception
Ix (1)
Mx (2)
USS - target like mass
Reduction by air insufflation
Surgery
Most common cause of hypothyroidism in children:
Autoimmune thyroiditis
Medial knee pain due to lateral subluxation of the patella
Knee may give way
Patellar subluxation
Athletic teenage boy
Chronic anterior knee pain
Worse after running
Tender below patella on examination
Patella tendonitis
Pain after exercise
Intermittent swelling and locking
Osteochondritis dissecans
Sporty teenagers
Pain, tenderness and swelling over tibial tubercle
Osgood Schlatter
Softening of cartilage of patella
Teenage girls
Anterior knee pain on walking and down stairs and rising from prolonged sitting
Chrondromalacia patellae
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel
Kawasaki disease
Mx Kawasaki (2)
High dose aspirin
IV immunoglobulin
When to intervene with obesity in children?
When to assess for co-morbidities?
Hint: centile
> 91st centile
98th centile
RF for obesity in children (3)
Asian children
Female
Taller children
Name five conditions that can cause obesity
Hypothyroidism
GH deficiency
Down’s
Cushing’s
Prader-Willi
Majority of children achieve day and night time continence by what age?
3/4yo
Define enuresis
Difference between primary and secondary
Involuntary discharge of urine by day or night in a child 5 or more
Primary - has never achieved
Secondary - dry for at least six months
Mx enuresis (5)
1. Name three causes
2. & 3. General advice
4. 1st line therapy
5. Medication
- Look for cause e.g constipation, UTI, DM
- Fluid intake, toiletting patterns
- Reward systems
- Enuresis alarm
- Desmopressin
Jaundice
24 hours
2-14 days
>14 days
24 hours pathological
Common and usually physiological
Abnormal
Causes of jaundice in the first 24 hours (4)
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD
Causes of prolonged jaundice (6)
Biliary atresia (raised conjugated bilirubin)
Hypothyroidism
Galactosaemia
UTI
Breast milk jaundice
Prematurity
How to check what the correct cuff size is when measuring BP in children?
2/3 of upper arm
Fine, fair hair
Marfanoid body habitus
Leaning difficulties
Severe myopia
Increased risk of VTE
Malar flush
Livedo reticularis
=
Mx
Homocystinuria
B6 pyridoxine supplements
What is Still’s murmur?
Low pitched sound heart at the lower left sternal edge
Innocent murmur
Characteristics of an innocent ejection murmur (5)
Soft blowing murmur in pulmonary area or aortic area
Vary with posture
Localised, no radiation
Asymptomatic child
No added sounds
Hearing tests:
Newborn
Infants
6-9 months
Otoacoustic emission test
Auditory Brainstem Response test
Distraction test
Hearing test
18 months- 2.5yo
>2.5yo (2)
>3yo
Recognition of familiar objects
Performance testing + Speech discrimination testing
Pure tone audiometry
