PAEDIATRICS 3 Flashcards
How might an older child present with DDH?
Trendelenberg gait and leg length discrepancy
How is duchennes diagnosed?
Raised CK
Genetic testing is the diagnostic tool of choice now rather than muscle biopsy
School exclusion for rubella?
5 days from the onset of the rash
School exclusion for measles?
4 days from the onset of the rash
School exclusion for mumps ?
5 days from the onset of swollen glands
Investigations to diagnose infantile spasms?
EEG will shows hypsarrhythmia
CT or MRI as 70% with have abnormalities e.g. tuberous sclerosis which is the most common cause
What is the likely cyanotic congenital heart disease that presents in the first days of life? What about in the first 1-2 months of life?
Days - Transpoistion of the great arteries
Months - tetralogy of fallot
What is enuresis?
Involuntary discharge of urine by day/night/both in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract
Possible underlying causes of enuresis in children?
Constipation
Diabetes mellitus
UTI if recent onset
Location of cystic hygroma and branchial cyst?
Cystic hygroma is usually behind the sternocleidomastoid muscle
Banchial cyst is usually anterior to this
Outline scoring system for APGAR?
Appearance- pink (2), extremities blue (1), blue all over (0)
Pulse >100 (2), <100 (1), absent (0)
Grimace - cries in stimulation/coughs/sneezes (2), grimaces (1), nil (0)
Activity - active movement (2), limb flexion (1), flaccid (0)
Resp effort - strong crying (2), weak irregular crying (1), nil (0)
0-3 low
4-6 moderate lo1
7-10 good
What does it mean if there is raised immunoreactive trypsinogen on heel prick testing?
It can indicate cystic fibrosis so a sweat test is indicated
How much more likely are children with Down’s syndrome to get leukaemia?
> 30x more likely to get ALL
100x more likely to get AML
Features of congenital rubella syndrome?
Sensorineural deafness
Congenital cataracts
Congenital heart disease
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Salt and pepper chorioretinitis
Microphthalmia
CP
Features of congenital CMV?
Growth retardation
Blueberry muffin skin lesions - pinpoint petechiae
Microcephaly
Sensorineural deafness
Encephalitis/seizures
Hepatosplenomegaly
Features of congenital toxoplasmosis syndrome?
Neuro - cerebral calcification, hydrocephalus, chorioretinitis
Ophthalmic - retinopathy & cataracts
Features of foetal varicella syndrome?
Skin scarring
Microphthalmia (small eyes)
Limb hypoplasia
Microcephaly
LD
What does variable expressivity mean in genetics?
Expressivity is the degree to which a genotype is expressed as a phenotype within an individual
Variable expressivity is when individuals with a shared genotype exhibit varying phenotypes
From what age can a transcutaneous bilirubinometer be used in babies to measure the bilirubin level?
From 24 hours old
When is puberty considered delayed?
In boys when there are no signs of testicular development by age 14
In girls when there is no sign of breast development by 13 or no periods by age 15
When is it considered early menarche?
When it starts before the age of 12
What are orofacial clefts (e.g. cleft lip) associated with?
Maternal AED use in pregnancy
Rubella in pregnancy
Smoking in pregnancy
Benzo use in pregnancy
Trisomies
Prognosis of umbilical hernias>
Usually resolve spontaneously by age 3
What are the 2 most common causes of pulmonary hypoplasia?
Olighydramnios
Congenital diaphragmatic hernia
Features of severe croup?
Frequent barking cough
Prominent inspiratory strider at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy and restlessness (hypoxia)
Tachycardia
Features of moderate croup?
Frequent barking cough
Easily audible strider at rest
Suprasternal and sternal wall retraction at rest
No or little distress/agitation
Child can be placated and is interested in its surroundings
Which children with suspected croup should be admitted?
If mod-severe
<3 months old
If they have known upper airway abnormalities e.g. laryngomalacia
If uncertain about diagnosis and need to rule out things like epiglottitis, FB inhalation, bacterial tracheitis
When can a child ask what and who questions?
At 3
When does a child ask why, when and how questions?
At 4
When can a child draw a circle?
3
When can a child draw a line?
2
When can a child draw a square and triangle?
5
When can a child draw a cross?
4
LP findings indicative of bacterial rather than viral infection?
Turbid fluid
Elevated opening pressure
Raised WBC - predominantly neutrophils
Increased protein
Reduced glucose
Radiological features of rickets?
Fraying - in distinct margins at the metaphysis
Widening of joints esp in the wrist
Management of a child <3 with a limp?
Admit
Heart sounds in transposition of the great arteries?
No murmur
Single loud S2
What can increase the risk of a secondary bacterial infection after chicken pox?
Use of NSAIDs
Prognosis of perthes in a child under 6?
Very good - just need observation!
What are Epstein pearls?
Congenital cysts found on the hard palate usually in the midline
What are Bohn’s nodules?
White masses found in the inner labial aspect of the maxillary alveolar ridges
Biggest risk factor for NRDS?
Prematurity
XR findings in NRDS?
Diffuse ground glass appearance with low lung volumes and a bell-shaped thorax
What is omphalitis?
Umbilical cellulitis that occurs in the first few days of life
What is an umbilical granuloma?
A red growth of tissue on the umbilcus which appears wet and will leak clear/yellow fluid
Presents in the first few weeks of life
What % of children with roseola infantum will get febrile convulsions?
10-15%
What causes roseola infantum?
HHV 6
What typically causes loss of internal rotation whilst the hip is flexed in a child?
SUFE
When can a child return to school with scarlet fever?
24 hours after staring the antibiotics
Investigation of choice for vesicoureteric reflux?
Micturiting cystourethrogram
Criteria for immediate request for CT head in children?
Loss of consciousness >5 mins
Amnesia >5 mins
Abnormal drowsiness
3 or more discrete episodes of vomiting
?NAI
Post-traumatic seizure (but with no Hx of epilepsy)
GCS <14 (or if a baby under 1 then GCS <15)
Suspicion of open or depressed skull injury or tense fontanelle
Basal skull fracture signs
Focal neurological deficit
If under 1 - presence of bruise, swelling, laceration >5cm on head
Dangerous mechanism of injury
