Paediatrics Flashcards
A 4 year old boy presents with his parents due to nocturnal enuresis. What is your management? (3)
Explain (age 4 around 30% children still wet the bed).
- Reassure likely to resolve
- Ensure lots of daily fluid, restrict intake before bed
- Avoid caffeine, especially before bed
What are 1st and 2nd line treatments for a 7 year old boy wetting the bed at night?
1) Alarm training (to condition to wake up, takes 3-5 months to work). Finish once 14 dry nights consecutive
2) Desmopressin (age >7)
When is chicken pox considered to be infective and what is classed as significant contact?
From 2 days before rash until 5days after/ lesions crust over
Face to face OR 15 mins in same room is significant
What are the hallmark features of croup? (4)
Stridor
Barking cough (worse at night)
Fever
Coryzal symptoms
What factors should prompt consideration of admission for a child with croup (4)
< 6 months Frequent barking cough Easily audiable stridor at rest Sternal wall retractions Lethargy Tachycardia
What is the treatment for Croup (3)
Single dose oral dextamethosone (regardless of severity)
If emergency:
- High flow O2
- Nebulised adrenaline
At what age should a child be able to control their head?
3 months
At what age should a child be able to sit?
7-8 months
refer at 12 months
At what age should a child be able to roll front to back?
6 months
At what age should a child voice bable?
7-8 months (refer at 10 months)
At what age should a child be able to crawl?
9 months
At what age should a child start to walk unsupported?
13-15 months (refer at 18 months)
At what age should a child speak 1-2 words?
12 months
At what age should a child be able to run or walk up stairs?
2 years
At what age should a child be dry in the day time?
2.5 years
What are the two signs associated with meningitis?
Kernigs (hip and knee at 90 degrees, extend knee - causes pain in back = meningitis or SAH)
Brudzinski’s (neck stiffness means when neck is flexed, hip and knees also flex)
How should meningitis be managed in those (a) under 3 months and (b) over three months? (3)
Bacterial until proven otherwise All given dexamethasone to reduce hearing complications (<3mths) (a) Cefotaxime and amoxicillin (b) Ceftriaxone Supportive management
What assessment should also children have following an episode of meningitis?
Hearing assessment at 4 weeks
Followed up in paeds clinic for neurological complications
Which bacterium carries the worst prognosis for meningitis?
Strep Pneumoniae
30% mortality
Which bacterium carries the best prognosis for meningitis?
Neisseria meningitdes
3.5-10% mortality
Which is more specific of leucocytes and nitrates on urine dip?
Nitrates
93% so if +ve for nitrates then always treat for UTI
If leucocytes are +ve on urine dip but nitrates are -ve, what is the appropriate management of suspected UTI?
Leucocytes are more sensitive but less specific
If clinical signs = treat
If no clinical signs = don’t treat
What characteristic features are associated with nephrotic syndrome?
Massive proteinuria, low albumin and oedema
A father attends the surgery with his seven-year-old son. His son is experiencing intermittent nose bleeds with minimal blood loss. They always self-terminate and he is not currently bleeding. He has no significant past medical history or family history of bleeding disorders. What is the most appropriate management?
There are no sinister features and the child is over the age of two, so the most appropriate first-line management would be to prescribe a short course of nasceptin (topical chlorhexidine and neomycin), and discourage the child from picking his nose. Further investigations or referral does not need to be undertaken at this stage.
What three features must be present for a diagnosis of autism to be made?
Global impairment of language/ communication
Impairment of social relationships
Ritualistic and compulsive phenomena
What is the most accurate way to measure the extent of childs obesity?
Age and gender adjusted BMI calculation
not just weight chart
When should action be taken regarding obesity in children (2)?
If BMI over 91st centile then consider intervention
If BMI over 98th centile investigate for co-morbidities
What age and what are the presenting features of cows milk protein allergy?
<3 months if formula Regurg and vomiting Diarrhoea Atopic eczema Colic symptoms (irritable and crying)
Can also cause wheeze and cough
How should suspected cows milk protein allergy be investigated?
Clinical (eliminate cows milk - switch to eHF milk)
Can also do skin prick test and/ or total IgE or specific (RAST) IgE for CMP
How should cows milk protein allergy be managed?
eHF milk is first line, if failed try amino-acid formula (AAF)
(if breast fed eliminate cows milk from maternal diet)
Use eHF when breastfeeding stops until 12 months of age
What should parents be advised regarding the prognosis of cows milk protein allergy?
Normally resolves by 1-2 years of age
What is roseola infantum, what age does it affect and what are the key features?
c- what is the causative organism
6months - 2 years
Viral infection - High fever which after a few days develops into a maculopapular rash
c- Human Herpes Virus 6
What investigations should be performed for all children presenting with a UTI?
Urine dip
Observations
If well = Do US in 6 weeks for VUR (Vesico-ureteral reflux)
If unwell = Do immediate US for VUR
(note VUS causes 30% of UTI’s in children)
When should a micturating cystogram be performed? (3)
After an atypical/ severe UTI
if abnormality on USS after UTI
If two (with upper symptoms) or three (lower only) UTI’s
How does heart failure in young babies tend to present?
Breathlessness worse on exertion (feeding)
Sweating
Poor feeding
Recurrent chest infections
What are the most common 4 acyanotic congenital heart conditions?
VSD (30%)
ASD
PDA
Coarctation
What are the three most common causes of cyanotic congenital heart conditions?
- Tetralogy of fallot (present 1-2 months) - Ejection systolic murmur
- Transposition of the great arteries
- Tricuspid atresia
What is neonatal respiratory distress syndrome and what are the main risk factors?
Lack of surfactant (also called surfactant deficient lung disease)
- RF’s = Prematurity, diabetic mothers, c-section
What features characterise transient tachypnoea of the newborn?
Tachypnoea shortly after birth, fully resolves within one day of life
What feature would suggest an aspiration pneumonia in a neonate with tachypnoea?
Meconium staining of the liquor
A neonate presents with tachypnoea, what are the main RF’s in the history that would suggest (a) NRDS (b) transient tachypnoea of newborn and (c) aspiration pneumonia
a- Prematurity (surfactant deficiency)
b - C-section
c- Meconium staining
A newborn male baby is found to have an undescended right testicle during the routine 6-8 week examination. It is neither palpable in the scrotum or inguinal canal. What is the most appropriate management?
Review at 3 months
(Occurs n 2-4% of infants, more common if pre-term. Review at 3 months, should see surgeon before 6 months, most surgeries performed at 1 yr)
What is the typical history of hand foot and mouth disease?
Mild illness followed by sore throat, fever and then ulcers and lesions in mouth, on hands and on feet. Usually scattered erythematous macules and papules
How should hand foot and mouth disease be managed?
Self-limiting (7-10days)
Hydration and analgesia
Reassure no link to disease in cattle
Very infective, keep off school until feel well (few days before to 5 days after syx start)
What is hirsprungs disease, the common symptoms, investigation and management?
Missing nerves = reduced bowel movements and constipation (can lead to enterocolitis). More common in boys and downs syndrome.
Syx: Normally won’t pass meconium in 48 hours, will have swollen belly and constipation. Investigation is X-ray then rectal biopsy. Treated with surgery.
What are your four main differentials for a child presenting with chronic diarrhoea and what symptoms may make each more likely?
Cows milk intolerance - most common (1-2 years)
Toddler diarrhoea - See undigested food and varied consistency of stools (1-5 years, diet to treat and child well)
Coeliac -
Post-gastroenteritis lactose intolerance
How common is umbilical hernia and what should parents be advised?
1 in 5 newborns
Usually resolves by 2 years
What can be used to distinguish between umbilical granuloma and omphalitis (umblicial cellulitis)?
Granuloma - Cheery red, wet, leaks fluid (clear/ yellow). First few weeks of life
Omphalitis - Superficial cellulitis a few days after birth
What is the treatment for an umbilical granuloma?
Salt application progressing to silver nitrate cauterisation
What is the treatment for omphalitis? What is it?
Infection of umbilical cord stump
Topical and systemic antibiotics
What is the most common causative organism in acute epiglottitis?
Haemophilus influenzae B
What are the most common causative organisms of meningitis in babies < 3months?
GEL
Group B strep
E. coli
Listeria monocytogenes.
What age does SUFE tend to present? What are the presenting symptoms?
Age 10-15
Presents with a limp, risk factors include obesity, rapid growth
What age does Perthe’s disease tend to present? What are the presenting symptoms?
Age 4-10
Hip pain developing over weeks with limp
(Do x-ray)
What dietary management should be recommended for patients with ADHD?
Keep diet and behaviour chart - only make changes based on food shown to worsen behaviour
Name 4 features of ADHD?
Extreme restlessness
Poor concentration
Uncontrolled activity
Impulsiveness
A GP suspects a young boy has ADHD, name the management steps (3)
Refer to specialist
2- Methylphenidate (ritalin)
- Needs growth monitoring every 6 months, along with BP and pulse
3- Add atomoxetine
What is the first line management for whooping cough?
Azithromycin or Clarithromycin if onset in last 21 days
- Exclude from school for 5 days from onset tx
Name 3 features of whooping cough
Coughing bouts - worse at night/ after feeding Inspiratory whoop Central cyanosis Anoxia leading to syncope or seizures Lymphocytosis
How do you diagnose whooping cough?
Nasal swab for Bordetella pertussis (can take weeks to come back so provisional
A 14-year-old boy presents to the emergency department with a headache. On further questioning, he complains that the lights are hurting his eyes and on examination, the doctor notices a rash on his chest. He has a respiratory rate of 22/min, a heart rate of 140/min and a blood pressure of 80/60 mmHg. Which test should not be ordered in this patient?
Lumbar puncture
Spreading or extensive purpura, signs of shock, signs of raised ICP or clotting abnormalities are all CI to doing an LP in suspected meningitis
Jason a 14-year-old boy with Down’s syndrome who presents to the GP with tiredness. Which conditions are associated with Down’s syndrome which could cause fatigue? (2)
Hypothyroid
T1DM
What is a Gastroschisis, how does it present?
Gastroschisis refers to a congenital defect lateral to the umbilicas (similar to omphalocele but in latter the defect is in the umbilicus itself)
NB: Gastroschisis is associated with deprivation risks
Name 3 features of fetal alcohol syndrome?
Small head
Flattened philtrum (groove between nose and lip)
Thin upper lip
What percentage of children are affected by cows milk protein allergy?
6%
What are IgE mediated and non-IgE mediated reactions?
IgE mediated = Immediate hypersensitivity reaction
Non-IgE mediated = Delayed reaction
How should you correct developmental milestones for premature babies?
Use corrected age (Chronological age - number of weeks prem).
i.e - a one year old born 3 months prem has a corrected age of 9 months
What is the most common cause of convulsion within 48 hours of birth in pre-term infants?
Intraventricular Haemorrhage from trauma in birth
USS to diagnose
What is the most common cause of convulsion within 48 hours of birth in term infants who had a forceps delivery?
Subdural haemorrhage
A 5-year-old child presents to the emergency department complaining of right iliac fossa pain. On examination there is no rebound tenderness or guarding. Urine dipstick and routine bloods come back as normal. The mother reports she had a viral infection a few days ago. What’s the most likely diagnosis.
Mesenteric adenitis is inflamed lymph nodes within the mesentery. It can cause similar symptoms to appendicitis and can be difficult to distinguish between the two. It often follows a recent viral infection and needs no treatment
What age does Merkels diverticulitis usually present?
2 years
Presents same as appendicitis
What age does intussueption normally present?
Before 9 months
How does Intussusception usually present?
Pain and crying
Pulling knees to chest in pain
Recurrent jelly stool (blood and diarrhoea)
Lethargy
A 4 month old baby girl is admitted to the Emergency Department after her mother noted that she stopped breathing. The baby was fit and well earlier. Unfortunately, advanced life support failed to resuscitate the baby. Her temperature on admission was 36.8ºC. The child was previously fit and healthy and up-to-date with vaccinations. On post-mortem, retinal haemorrhages were noted in the baby’s eyes bilaterally. What would explain the likely primary mechanism that have lead to the baby’s death?
Shaken baby syndrome
Classical triad: Retinal haemorrhages, subduralhaematoma, encephalopathy
Typical children 0-5
Intentional shaking
At what ages is croup most commonly seen?
6 months to 3 years
You are asked to review a 1-hour-old neonate on the delivery suite. They were born via elective Caesarean section. Maternal antenatal history is significant for gestational diabetes. A heel prick test shows the baby’s blood glucose is 2.2 mmol/L. What is the next step in management?
Observe and encourage early feeding
Transient hypoglycemia following birth is common
What ages in bronchiolitis most common in?
Under 18months (peak at 3-6 months as maternal IgG provides some protection) Almost all children have it before age two
How does bronchiolitis present? (3)
Cough (increasing in severity over days - dry wet or croupy)
Wheeze
Fluctuating findings
Fever
Bubble and squeak when listing to lungs
Often preceeded by rhrinitis or a cold
Lasts around 9 days (find out where they are in the picture)
What pathogen causes bronchiolitis?
Respiratory syncytial virus (80%)
Name three management steps for bronchiolitis? When do you admit?
Supportive (fluids etc)
Admit only when persistent hypoxia or tachypnoea or can’t feed
NG tube if can’t feed
Oxygen if sats <92%
Only give steroids if suspected asthma
You are asked to see a baby on the post-natal ward 10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?
Measure serum bilirubin immediately
Jaundice in first 24 hours is always abnormal
What test is used to diagnose glandular fever?
Heterophil antibody test (monospot test)
- FBC and monospot test used in 2nd week of illness to diagnose glandular fever
Name three management steps for glandular fever?
Rest, fluids, avoid alcohol
Simple analgesia
Avoid contact sports for 8 weeks (risk of splenic rupture)
What causes glandular fever and how long do symptoms typically take to resolve?
Caused by EBV
Typically 2-4 weeks to resolve but fatigue may persist
What is the classic glandular fever triad of symptoms?
Sore throat
Lymphadenopathy
Pyrexia
+ malaise, splenomegaly (50%)
What antibiotic should be avoided if glandular fever is suspected?
Amoxicillin/ ampicillin
99% of patients who take the above will develop a rash if concurrent infectious mononucleosis
A four-year-old child with poorly controlled asthma attends GP surgery with his mother due to increasing frequency of his asthma exacerbations. He is already on salbutamol inhaler as required and beclometasone inhaler 200mcg/day. He uses these devices with a spacer and has good technique. What is the next best step in his management?
Add leukotriene receptor antagonist
Children < 5 years whose asthma symptoms are not controlled on a SABA + ICS - add a LTRA (over 5 managed same as adults)
Next after this is refer to specialist
How should a patient with cystic fibrosis be counselled regarding diet? (3)
High calorie and high fat
Enzyme supplements with every meal
Name 4 differentials for a poorly feeding baby at 3 weeks?
Infection (bronchiolitis) Sepsis (or other severe infection) Congenital heart disease (VSD, tetrology of fallot) DKA Inborn errors of metabolism
What is the definition of neutropenic sepsis?
Temperature > 38.5 (or 2x readings of <38)
Neutrophils <0.5
Name 3 features of Kawasaki disease?
- 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
How do you manage Kawasaki disease? (3)
High-dose aspirin
Intravenous immunoglobulin
Echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms
*Kawasaki is one of the few indications for aspirin use in children (normally avoided due to risk of Reyes syndrome)
Which one of the following is the most common cause of nephrotic syndrome in children?
Minimal change disease
A 4-year-old boy is brought to the clinic by his mother who has noticed a small lesion at the external angle of his eye. On examination there is a small cystic structure which has obviously been recently infected. On removal of the scab, there is hair visible within the lesion. What is the most likely diagnosis?
Dermoid cysts occur at sites of embryonic fusion and may contain multiple cell types. They occur most often in children.
What sort of murmur does a PDA present with?
Continuous murmur head loudest under left clavicle - machinery murmur
- Large volume bounding or collapsing pulse, heaving apex beat and continuous
A child presents with a continuous, blowing murmur just below the clavicles, what is the diagnosis?
Venous hum
Innocent murmur
A child presents with a low pitched murmur, loudest at the L sternal edge, what is the diagnosis?
Stills murmur
Innocent murmur
A child presents with a harsh pansystolic murmur, what is the most likely defect?
VSD
Or mitral/ tricuspid regurgitation if described as ‘blowing’
A child presents with a continuous, machine like murmur, what is the most likely diagnosis?
PDA
A child presents with a late systolic murmur, what are the two top differentials?
Coarctation of the aorta
Mitral prolapse
A child presents with and ejection systolic murmur, what are the 3 most common differentials?
Aortic stenosis
ASD
Tetrology of fallot
Name 5 causes of clubbing in a child
CF Congenital heart disease Coeliac Crohns/ UC Cancer
What is the first line antibiotic for children with pneumonia?
Amoxicillin
(Erythromycin if mycoplasma suspected
A 7-year-old boy presents to the GP as he does not seem to be developing in the same way as his classmates. He is now a lot taller than most of his friends and he has started to develop hair around his genitalia and armpits. On examination, his penis is also large for his age however his testes remain prepubertal, with a size of 2.4cm.
What is the most likely cause of this boy’s precocious puberty?
Adrenal hyperplasia
What pathogen causes scarlet fever?
Group A Streptococci
At what age delay should premature babies be given their routine vaccinations?
None
Start as normal (from 8 weeks after birth no matter how prem)
What advice should be given to parents regarding fever after vaccination?
Fevers are common and if under 39 degrees (fever in kids is approx over 37.5degrees) then give upto 3 doses of liquid paracetamol (4hours apart). If concerning features take to A+E
How long does redness and a bump at the site of an immunisation usually last?
2-3 days
Name 5 differentials for hip pain in kids?
Transient synovitis < Following viral infection (2-12yrs) - diagnosis of exclusion
Perthes disease < Boys, progressive over weeks (4-8yrs)
SUFE < Obese (10-16yrs)
Juvenile idiopathic arthritis < Swelling, ANA may be +ve
Septic arthritis < Systemically unwell, severe RROM, any age
DDH should be picked up on newborn exam (more common in F)
How does transient synovitis present? (2)
Age 2-10
Acute hip pain, associated with viral infection
(most common cause of hip pain in kids)
How is intussucception managed?
Air insufflation under radiological control
Blowing air in
How does pylori stenosis usually present? (3)
Projectile vomit around 30 mins following feed
Constipation and dehydration
Possible palpable mass in upper abdomen
(4x more common in boys)
How is pyloric stenosis managed?
Ramstedt pyloromyotomy
Cutting muscle under GA
How is chickenpox managed?
Supportive
(Keep nails trimmed, calamine lotion)
- Keep away from immunocompromised
- Infective til 5 days after rash and until crusting/ no new lesions
What is the definition of cerebral palsy?
Non-progressive, permenant disorder causing functional difficultly with movement and posture, formed in utero or before 2-3 years of age
What are the main causes of CP?
Antenatal (prem, low birth weight, infections)
Perinatal (birth asphyxia, complicated delivery)
Post-natal (NAI, trauma, meningitis)
Name 4 features of cerebral palsy?
UMN spasticity (85%)
Delayed walking
Circumductive or scissor gait
Cognitive impairement (25%)
How does shaken baby syndrome commonly present?
Irritable/ poor feeding Increased head circumference, low GCS, seizures Full fontanelle Anaemia Retinal haemorrhage
What 5 things must you consider if NAI is suspected in an OSCE?
SMACK S- Safety of child M- Medical problems A- Ask a senior C- Contact social care K- Keep clear notes
What are the causes of jaundice in a newborn, split by the 3 main time periods?
First 24 hours = Haemolytic disease (rhesus, ABO) or herediatary spherocytosis, infection
Day 2-14 = Normal physiological jaundice (bilirubin <95th percentile)
After D14 = Biliary atresia, hypothyroidism, breast milk jaundice, infections (TORCH congenital or UTI)
What is a Coombs test? What are the two types and what do they check for?
Antiglobulin test
- For haemolytic anaemia (Direct)
- For antibodies against foreign cells (Indirect - use in transfusion and pregnancy)
What investigations are part of a prolonged jaundice screen for babies with jaundice past 14 days? (5)
- Conjugated and unconjugated bilirubin (if raised conjugated could indicate biliary atresia < urgent surgical intervention)
- Coomb’s test (direct)
- TFTs
- FBC and blood film
- Urine culture
When resuscitating children how much maintenance fluid should be given?
First 10kg = 100ml/kg
Second 10kg = 50ml/kg
After = 20ml/kg
What is the classical presentation of HSP?
Rash (pupuric) on legs and buttocks
- Classically after URTI
- Abdo pain and joint pain possible
- Renal involvement in 40%
How should you investigate HSP?
FBC (rule out ITP, leukaemia etc)
Urinalysis (for renal involvement)
Autoantibodies
NB: Must be referred to paeds
What treatment is given for HSP?
None, usually resolves in a few weeks
- Not infectious so can go to school
- Renal function at D7, 14 and 1,3,6,12 months
- Steroids only if renal disease
How does a febrile seizure classically present?
Age 3 months to 5 years (definition), most common under 3
- Caused by fever
- Will have normal post-ictal examination
(Ask about FHx as common)
What investigations should be done for a febrile seizure?
Clinical diagnosis
- If unknown screen for source of infection
Needs to be admitted for first seizure
Name 4 features of meningitis in a small child which would stimulate initiation of treatment following a convulsion?
- Drowsy before seizure OR Glasgow Coma Scale (GCS) <15 at one hour after seizure.
- Neck stiffness.
- Petechial (non-blanching) rash.
- Bulging fontanelle.
What advice should a parent be given regarding febrile seizures?
Self-limiting, only a very small increased epilepsy risk however feb seizures can reoccur
If comfortable then don’t have to bring in again unless seizure >5mins (or rash, confusion, dehydration)
What treatment should be given to children with fever at risk of febrile seizures?
Paracetamol and ibuprofen
> Note in hospital diazepam would be first line for status epilepticus in feb seizure
Name 3 common features of Down’s syndrome?
Low muscle tone Flattened facial profile Small head and ears Upward slanting eyes Short neck Single palmar crease
Cognitive impairment
Name 3 associations of Down’s syndrome
Congenital heart defects (50%) Visual problems (>50%) - cataracts Hearing loss (75%)
> Greatly inceased risk leukaemia
In what condition do you see a ‘hot potato’ voice?
Quinsy
peritonsillar abscess
What are the key features of Duchenne Muscular Dystrophy?
Proximal Muscle Weakness
> Often limited life to age 40
X-Linked so affects boys
What is patau’s syndrome, name 3 features?
Trisomy 13
Cleft palate
Polydactyly
Cardiac and eye defects
(tend to die by age 3)
What is Epsteins anomaly?
Caused by use of lithium in pregnancy (tricuspid valve leaflets displaced – results in tricuspid regurgitation and stenosis) giving both a pan systolic and diastolic murmur.
What are the most common viral and bacterial causes of gastroenteritis in kids?
Viral (much more common) = Rotavirus
Bacterial (relatively rare) = Campylobactor
How much adrenaline is given in anaphylaxis?
1 in 1000
- 15ml if <6years
- 3ml if 6-12yrs
- 5ml if <12 years
When giving a fluid bolus to children how much is given?
Fluid bolus in kids = 20ml/kg
DKA and trauma are exceptions where you give less (10ml/kg)
What medications are given in acute childhood asthma? (key acronym)
OSHIT Oxygen Salbutamol Hydrocortisone Ipratropium Theophylline
How does CPR in kids differ to adults?
<8yrs - Head in neutral position
Start with rescue breaths not compressions
Compression ratio 15:2 (start if HR <60)
Name 5 causes of developmental delay?
Muscular - Cerebral palsy, DMD
Metabolic - Fetal alcohol syndrome, inborn errors of metabolism
Chromosomal- Down’s, patau (t13, edwards t18)
Name 5 signs of respiratory distress in children?
Nasal flaring Abdominal breathing Tracheal tug Intercostal recession Head bobbing
What is the difference between stridor and grunting?
Stridor = Upper airway obstruction (inspiratory) Grunting = Expiring against partially closed glottis (exhaling)
How long does bronchiolitis tend to last?
9 days
Find out where in the course they are (if at start and worsening more likely to admit)
What factors predispose a child with bronchiolitis to be severe? (3)
Parental smoking
Prem kids
Other lung diseases
When is a heel prick test done and what does it test for?
At 5 days old
For CF, hypothyroid, sickle cell, inherited metabolic (PKU/ MCADD)
Any condition in paeds should be managed with an MDT approach, name 6 professionals in a paeds MDT?
Medical Nursing (think community or school) Physio Dietitian Education Psycho-social
What is 1st investigation when suspecting DDH in a newborn?
How is it managed?
USS
(if over 6months then X-ray)
Manage:
1) Conservative (watch and wait)
2) Pelvic harness
3) Surgery
What are barlow and ortolani’s test?
Barlow = Posterior (trying to dislocate) (Barlow = back) Ortolani = Try to put back in (relocate)
(Only do up to 6 months)
How do you investigate suspected perthes or SUFE?
Bilateral hip x-rays
FBC and CRP to r/o septic arthritis
TFT’s as that’s an RF for SUFE
How do you investigate and diagnosis transient synovitis?
R/o others (SA, perthe’s, SUFE etc.)
- Diagnosis of exclusion
- Supportive management (activity restricting, analgesia)
What are the Kocher criteria for septic arthritis?
Refusal of weight bearing
Raised CRP/ ESR
Raised WCC
Fever
(All 4= 99% septic arthritis, none = 0.2% chance)
> Joint aspiration (WCC and culture)
> Also do blood cultures
What is the acronym to remember salter Harris fractures?
SALTR (relative to epiphesysial (growth) plate) Slipped - T1 Above - T2 (75%) Lower T3 Through - T4 Ruined T5
What investigations are done to assess jaudice?
Transcutaneous bilirubinometer (screening) Serum bilirubin - Gold standard, plotted on a bhutani normogram
FBC, Coombs test (ABO/Rh incompatibility)
What is the main concern with jaundice in a newborn?
Kernicterus
Lethary, poor feeding, high pitched cry, neuro signs
(Deposition of unconjugated bilirubin in basal ganglia = possibly irreversiable neuro damage/ death)
What are the TORCH infections?
Toxoplasmosis Other (syphillis, varicella, parvovirus B19) Rubella Cytomegalovirus Herpes
