Paediatrics 3 Flashcards
What are the techniques that can be used to collect a urine sample from a baby?
Clean catch sample
Catheter specimen
Suprapubic catheter
List some causes of gross motor developmental delay:
Cerebral palsy
Duchene muscular dystrophy
Traumatic brain injury
Infections
- TORCH
At what age can a Diskus dry powder device for asthma be used?
> 8 years and above
If a cystic fibrosis patient presents with abdominal pain, what diagnosis should always be considered? and how is it diagnosed?
and how is it treated?
Distal Intestinal Obstruction Syndrome
- DIOS
Abdominal x-ray
+
Water- soluble contrast study
Stool softeners
What is the device used to deliver regular prophylactic antibiotics centrally to children and what group of patients maybe likely to have one?
Port-a-cath
(differs to a Hickman line as the tubes are underneath the skin)
Cystic fibrosis
What ages are children vaccinated against H. Influenza?
2,3,4 and 12
What things must you NOT do when presented with a child with likely epiglottitis?
Distress
Examine the throat
Cannulate (distressing)
What are the differentials for stridor:
Croup
Bacterial tracheitis
Foreign body
List some causes of stridor in children:
Epiglottitis
- very high temperature
- drooling
- very unwell looking
Croup
- barking cough
- coryzal symptoms
Laryngomalacia
- 4 weeks of age
Inhaled foreign body
What is the term when the skull sutures widen apart and why is it clinically significant?
Suture Diastasis
if this is present with a fracture it is suggestive of Non- Accidental injury
What is the treatment of hypoglycaemia in a child who is unconscious? - with dose
Glucagon - IM or IV
2ml/kg of 10% Dextrose
or
2.5ml/kg of 10% Dextrose in neonate
What are the congenital disorders causing hypothyroidism? and what is the signs and symptoms?
Thyroid dysgenesis
- poorly formed or non existent
Thyroid dyshormonogenesis
- enzyme defect
Maternal Hypothyroidism
- iodine deficiency causing cretinism
Symptoms:
- poor feeding
- lethargy
- hoarse cry
Signs:
- prolonged jaundice
- coarse faces
- hypotonia
- wide fontanelle
- bradycardia
- goitre
List some aetiologies to Vesico-Ureteric reflux and highlight the investigations and management:
Primary:
- abnormal ureteric orifice
- short submucosal tunnel
Secondary:
- Obstructive - posterior urethral valves
- Neuropathic bladder
- dysfunctional bladder
Investigations:
- MCUG
- DMSA (for scarring)
Management:
- prophylactic antibiotics
- Laxatives to prevent constipation
Surgical:
- STING operation - bulking
- Re-implantation of ureters
- Nephrectomy
What are the signs of a complex febrile seizure?
> 15 mintues
Focal neurology
> 2 seizures within 24 hours
What other disorders are associatted with austism?
ADHD
Tourettes
Depression
Fragile X syndrome
When is performing a LP contraindicated in suspected meningococcal disease?
In shock
- as they are unstable
Rash development
- DIC has begun so will have coagulopathy
Signs of raised ICP
*the rash if pathomenomic and the bacteria are not resistant to any forms of the antibiotics. therefore cultres and sensitivity from a LP add little value in the acute setting.
Further PCR of blood cultures can be obtained with 24 hours
What are the classic signs of infantile spasm (West Syndrome?)
and what is the treatment?
Flexion of head
Flexion of hips and legs
Extension of arms
- looks like a startled response
Prednisolone
What is the first line management for intussusception?
Catheter insertion with air inflation.
- done under fluoroscopic guidance
2nd line:
- urgent laparotomy with manual reduction
How can you distinguish oligoarticular JIA from Systemic JIA?
Systemic:
- more severe
- destructive
- swinging fever
- maculopapular rash
Oligo-articular affects larger joints and the patient is usually relatively well.
- <4 joints
- asymmetrical
- uveitis
In precocious puberty in boys, if the testes are small what does this highlight and name a typical condition?
Shows a peripheral cause. Most commonly adrenal hyperplasia as this will create a negative feedback to FSH and LH which means reduced enlargement of testes.
*note if it was a sex-cord stromal tumour you would expect one testes to be larger than the other
What is the main cause of a massive G.I bleed in children between 1-2 years old - often requiring a transfusion?
Merkel’s diverticulum
What is the pathogen of Roseola infantum and what is the most common complication?
Human herpes -6 disease - HHV-6
Febrile convulsions
If a child <3 months has a UTI, what should the management be?
Admitted to hospital.
They will also require an ultrasound
plsu potentially further workup depending on atypical, recurrent etc
*IV amox + Gent
Why is hand preference <18 months a bad thing?
Suggestive of Spastic hemiplagia
What are the major types of Cerebral palsy?
Spastic cerebral palsy
- hemiplegia (one side)
- diplegia (legs)
- quadraplegia
Extrapyramidal
- Dystonic movements
- chorea movements
- Athetoid movements
Ataxic cerebral palsy
- cerebellar damage
List some key referral points in the developmental history:
No smile - 10 weeks
Unable Sit unsupported - 12 month s
no walking - 18 months
Preferred dominance before 18 months
What is the most important cause of conjugated bilirubin to rule out in a baby with jaundice?
Biliary atresia
What is the definition of prolonged jaundice in a neonate?
Term baby:
- >14 days
Pre-term baby:
- >21 days
What are differentials for respiratory distress in a neonate?
Transient tachypnoea of newborn
Respiratory distress syndrome
Meconium aspiration
Pneumothorax
Respiratory infection
What are the associated gastrointestinal defects with Down’s syndrome?
Increased risk of:
- Hirschsprung’s disease
- duodenal atresia
- imperforate anus
- oesophageal reflux
- Coeliac disease
What are some of the symptoms of Rubella syndrome?
Cataracts Microphthalmos - abnormal eye formation Sensorineural hearing loss Thrombocytopenic purpura/ Blue berry muffin rash Heart defects: PDA most common
List some teratogenic drugs and their effects:
Phenytoin:
- cleft lip
- cardiac defects
- craniofacial abnormalities (foetal hydantoin syndrome)
Sodium Valproate
- neural tube defects
Lithium
- Ebstein’s anomaly
Warfarin
- frontal bossing
- cardiac defects
Tetracycline
- discoloration of teeth
What features of short stature suggest a pathological origin:
Discrepancy between weight and height
Movement away from mid-parental height
Slow velocity of height
What are the definitions of faltering growth:
A drop deceleration of >2 centiles in weight
Extremely low BMI
Slow height growth or weight for length
Weight less than 5th percentile more than 2 occasions
When is the Guthrie heel prick test done, what 5 core conditions are tested for and what are some caveats to performing the test?
Completed at 5 days old.
PKU Congenital hyporthyroidism (cretinism) Cystic fibrosis sickle cell diseases MCADD Maple Syrup Urine Disease
Infants must have been on milk feeds for at least 48 hours and not had a blood transfusion in the last 72 hours.
What is the term used to describe a flattened one side of the head due to the position of the child?
Positional plagiocephaly
What sign is seen bilaterally on both sides of the costal margin across he diaphragm in chronic asthma and in osteomalacia?
Harrison’s sulcus
Diaphragm tension pulls the bones in causing a groove. this may be from normal tension with soft bones as seen in osteomalacia or in abnormal tension as seen in chronic lung disease
Give some differentials for an acute and chronic cough:
Acute:
- URTI
- Croup
- Bronchiolitis
- Acute exacerbation of asthma/ Viral wheeze
- Pertussis
- Inhaled foreign body
Chronic:
- Asthma
- Infection
- GORD
- Chronic illness (CF, Kartagener)
What is the most common cause of pneumonia in 5-15 year olds?
Mycoplasma pneumoniae
What age must a child be to use a dry powder device?
> 8 years old
High light the key management of cystic fibrosis:
Daily chest physiotherapy
Prophylaxis antibiotics
- may require portacath
Creon supplements
Fat soluble vitamins
High calorie diet
What are the two main screening methods for CF?
Immunoreactive trypsinogen
- done on spot test
Sweat test, genetic testing
*done if failure to thrive and failure of first pass meconium
List 5 causes of cyanosis in a child:
Respiratory disease
Cardiac
During a seizure
Stress
- infection, hypoglycaemia
CNS depression
- drugs
- trauma
List some differentials for hepatosplenomegaly:
Infection
- malaria
- parasitic infection
Congestive cardiovascular disease
Extramedullary hematopoiesis
- thalassemia
Malignancy
- leukemia
What are the top causes for haematemesis?
Swallowed blood
- from cracked nipples
- epistaxis
Repeated vomit
Ulceration/ hiatus hernia
Bleeding disorders
Oesphageal varices `
List 5 medical causes of acute abdomen in a child:
Gastroenteritis
Henock sholien
Constipation
DKA
Acute nephritis
List 5 surgical causes of acute abdomen in a child:
Acute appendicitis
Intussusception
Volvulus
Strangled inguinal hernia
Torsion of testes
What are the risk factors for iron deficiency anaemia in children and what can be given alongside the supplements to aid absorption:
Preterm
Low birth weight
Multiple births
Excessive cow’s milk
Vitamin C increases absorption
What are the poor prognostic indicators for leukemia?
Age <1 year, >10 years Male T cell linage WCC >50 Failure to respond to chemotherapy
What are the features of malignancy in lymphadenopathy?
Supraclavicular, epitrochlear nodes
Systemic symptoms
Hepatosplenomegaly
Signs of marrow infiltration
What are the top causes of malignant lymphadenopathy in children?
ALL, AML
Lymphoma
Hodgkin’s disease
Neuroblastoma
Rhabdomyosarcoma
List some differentials for abdominal masses which are malignant:
Neuroblastoma Wilm's tumour Hepatoblastoma Lymphoma Germ cell tumours
Highlight some of the signs and symptoms seen in neonates who have meningitis:
High pitched crying
Uncontrollable crying
Poor feeding
Cyanotic episodes
Seizures
Budging fontanelle
What things should be analysed for in CSF of a child with suspected meningitis?
WCC
Protein
Organism cultures/ staining
PCR for pneumococcus/ meningococcus/ HSV/ VZV and enterovirus
What is the treatment for bacterial meningitis?
<6 weeks:
- IV Cefotaxime
- Amoxicillin
- Gentamicin
> 3 months
+ dexamethasone
*only add if no petechial or purpuric rashes
What is the management for sepsis in a child (not listing sepsis 6):
High flow oxygen
IV fluid - 20mls/kg 0.9% saline
IV cefotaxime
Correction of metabolic derangements
What are the most common causes of oedema in children?
Heart failure
Nephrotic syndrome
Liver failure
Malnutrition
What are the risk factors for nephrotic syndrome and what are some investigations into it and how is it treated?
Male Asian Previous infection Previous nephrotic syndrome Family history
Investigations
- FBC
- U&Es
- LFTs
- complement studies
- Infection (varicella, Streptolysin O antigen)
- Urine - PCR
- Biopsy (if indicated)
Treatment:
- High dose prednisolone
- 20% albumin + furosemide
- Pneumococcal vaccine
- Penicillin prophylaxis
- salt/ fluid restriction
During an asthma attack or severe croup what blood pressure sign may be seen and why?
Pulsus paradoxical
- more than a >10mmHg drop in the systolic blood pressure during inspiration than expiration.
probably due to less blood being able to enter the lung, bulging the right atrium compressing the left atrium reduces preload.
What are the drugs used in an acute asthma attack in children?
Oxygen Salbutamol Hydrocortisone Ipratropium Theophylline
“O-SHIT”
What are the degrees of dehydration in a child, and what is the volume of replacement?
mild 5% body weight (50ml/kg):
- lethargic
- loss of skin turgor
- dry mouth
- fontanelle slack
moderate 10% (100ml/kg):
- tachycardia
- tachypnoea
- fontanelle sunken
- eyes sunken
- mottle skin
Severe 15% (>150ml/kg)
- shock
- hypotension
Replacement:
- body weight loss
- maintenance (150ml/kg infants, 100ml/kg children)
- fluid loses
*fluid is replaced over 48 hours. so is added onto the chart
What are the drugs used in infantile spasm disorders?
ACTH
or
Corticosteroids
What is the complication that can occur with diffuse neonatal haemangiomatosis and segemental haemangiomas?
High output cardiac failure
What is the amount of neonatal need for fluid?
150ml/kg/day
After day 5
What constitutes the HEAD assessment for adolescents?
Home life
Education
Activities
Drinking
Driving
Drugs
Sex
Smoking
Suicide
What is the order of puberty in males and females?
Females:
- Breast development
- Pubic hair
- Rapid growth
- Menarche
Males:
- Testicular enlargement
- Pubic hair growth
- Height spurt
What drug can be used in delayed puberty in males?
Oxandrolone
or in older males intramuscular testosterone injections
What factors can be implemented to help with transitioning from paediatric services to adult?
inform early
Run specific teenage clinics
INvolve the GP
Encouragement self help
Highlight the management of a febrile seizure and list some differentials:
If:
less than 5mins and well and present then:
- antipyretics
If >5mins or not well
- Buccal midazolam
or
- PR diazepam
- education o parents and risk of recurrence. *to seek medical advice if it occurs >5mins.
differentials:
- Meningoencephalitis
- Epilepsy
