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Paediatrics Flashcards

1
Q

Williams syndrome

A 
Short stature 
Learning difficulties 
Transient neonatal hypercalcaemia 
Supravalvular aortic stenosis
Friendly extrovert personality
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2
Q

Prader Willi syndrome

A

Hypotonia
Hypogonadism
Obesity

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2
Q

Noonans syndrome

A

Webbed neck
Short stature
Pulmonary stenosis
Pectus excavatum

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3
Q

Edwards syndrome (tri 18)

A

Rocker bottom feet
Micrognathia
Overlapping fingers
Low set ears

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4
Q

Patau syndrome (tri 13)

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly (pink finger slopes inwards)
Scalp lesions

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5
Q

Fragile x syndrome

A 
Leaning difficulties 
Macrocephaly
Long face
Large ears
Macro-orchidism
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6
Q

fragile x

A 
learning diff
big head
big ball
long face
large ears
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7
Q

pierre robin

A

small chin

cleft palate

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8
Q

infections and agents

A

Hand foot mouth – coxsackie a16

Croup – parainfluenza

Scarlet – strep pyogenes

Slapped face (5th, eryth infect) – parovirus b19

Whooping – bordatella pertussis - vaccine

Epiglottitis – HIb - vaccine

Bronchiolitis – RSV

Gastroenteritis - rotavirus

Glandular fever (IM) - EBV

Common cold - rhinovirus

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9
Q

otitis media

A

usually 2dry to RTI

80% self limiting

  • ipubrofen, paracetamol
  • but may give amoxicillin (delayed presc?)

20% get recurrent - glue ear
- effusion level, reduced hearing
- worry about learning delay
T: grommets

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10
Q

pharyngitis and tonsillitis

1/3 bacterial
2/3 viral

A

difficult to distinguish bact (eg Gr A strep) vs viral

centor scale >3 give Abx

  • exudate
  • lymphadenop
  • fever
  • no cough

headache and abdo pain also point ot bact

T: Pen V 500 qds
* avoid amoxicillin (if due to EBV casues macpap rash)

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11
Q

tonsillectomy indication

A

recurrent - missing school
quinsy (peritonsillar abscess)
obstructive sleep apnoea (1%)

often done with adenoidectomy and grommets

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12
Q

Laryngeal and trachael infections

A

include croup (parainfl) and epiglottits (HIb)

cause resp distress
- tugging, sub/intercostal recessions

Epi

  • onset over hours -> toxic (t>38.5)
  • minor cough, soft stridor
  • open mouth, drooling, not drinking

Croup

  • onset over days - starts w cold (urti), worse at night
  • barking cough
  • able to drink
  • harsh stridor
  • peak at 1-2yrs
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13
Q

Croup

A

Viral laryngotracheitis
PARAINFLUENZA

Barking cough
Stridor, hoarseness
Respiratory strain (recessions, tugging etc)

Onset over days
1 - 2 years peak incidence

(vs epiglottis: very unwell suddenly)

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14
Q

Croup treatment

A

Oral dexamethasone
Oral prednisolone

Nebulised steroids (budesonide)
Nebulised adrenaline (quick but temporary relief)
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15
Q

Epiglotitis

A

HIb (most now immunised)
V quick onset (hours)

Toxic/ acutely unwell
Sitting still, drooling

Stridor
Mild cough

Do not examine throat - total obstruction

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16
Q

Whooping cough

A

should be immunised

100 days
Bordetella pertussis

Catarrhal phase
Paroxysmal phase (3-6 weeks)
    - may vomit with coughing
    - may have periods with apnoea
    - epistaxis, telangectasia etc
Convalescent phase

Ix: pernasal swab

Tx: erythromycin

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17
Q

Whooping cough

A

type of bronchitis in children

should be immunised

100 days
Bordetella pertussis

Catarrhal phase
Paroxysmal phase (3-6 weeks)
    - may vomit with coughing
    - may have periods with apnoea
    - epistaxis, telangectasia etc
Convalescent phase

Ix: pernasal swab

Tx: erythromycin

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18
Q

Bronchitis in kids

A

mostly viral
cough, fever, wheeze and crackles
duration 2 weeks
abx no benefit

whooping cough is rare bacterial bronchitis
- pertussis - should be immunised

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19
Q

Bronchiolitis

A

Infancy (1-9 months)
RSV - infectious

Causing respiratory distress

  • sharp, dry cough
  • wheeze crackles
  • SOB tachy
  • cyanosis/pallor
  • hr

Tx: paracetamol and review
admit if resp distres/unwell
supportive humidified oxygen if needed

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20
Q

Asthma

A

Cough wheeze dyspnoea
Worse at night
Trigger
- cold air exercise dust smoke virus

Exacerbations?
Missed school?

Other atopy?
FH?

Respond to bronchodilator
- in young infancy hard to differentiate from viral wheeze (neither respond well to bronchodilator)

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21
Q

Asthma couselling

A

MESE

Medication
-relievers and preventers

Environment
- avoid passive smoking

Self monitoring PEFR

Educate
- inhaler technique

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22
Q

Asthma medication

A

1 - saba
2 - add inhaled steroid (200-400 mcg/day)
3 - increase steroid to 400
- laba (can combine)
(- for young children use leukotriene antag)
4 - increase steroid to 800
- consider oral course for exacerbations

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23
Q

Cystic Fibrosis

A

Autosomal recessive CFTR protein on chrom 7
1 in 25 carriers in Caucasian, 1 in 2500 live births

Viscosity of exocrine secretions

  • respiratory
  • pancreatic
  • salty sweat

diabetes
infertility

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24
Q

cystic fibrosis presentation

A 
Failure to thrive
Recurrent chest infections 
- persistent cough, sputum, wheeze
Malabsorption, steatorrhoea
15% meconium ileus in neonate (obstruction)

Can get diabetes
Can get bronchiectasis
Can get clubbing
Male infertility

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25
Q

Managements CF

A

Physiotherapy
Mucolytics
Enzyme replacement (CREON)
Prophylactic Abx every 3 months

Parental support
- risk that future sibling has CF (1 in 4)

Mean survival 32 years

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26
Q

Allergy

A

usually refer to type 1 hypersensitivity
Abnormal immune reaction to harmless stimuli

Range of types if reaction

  • severe (angio-oedema, bronchospasm)
  • milder (rash, GI Sx, coryzal Sx)

May grow it of it (not if nuts, seafood)

Talk about

  • avoidance
  • antihistamines
  • epipen
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27
Q

Hand foot mouth disease

A

Coxsackie a16

Sore throat, fever

Vesicles in mouth hand feet

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28
Q

Hand foot and mouth disease

A

febrile illness
pupulovesicular rash - hands feet buttock
vesicles on mouth

coxsackie a16

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29
Q

Scarlet fever

A

Strep pyogenes

Fine red rash on trunk and spreading

Fever
Sore throat
Headache
Strawberry tongue

T: penicillin v
exclusion from school for few days
good hygiene

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30
Q

Fifth disease
Slapped cheek
Erythema infectiousum

A

Parvoviruses b19

Lethargy fever head ache

Slapped cheek rash

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31
Q

Chicken pox

A

Varicella zoster

Fever

Itchy spreading rash

Macule > papule > vesicle

Paracetamol (calpol) and ibuprofen

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32
Q

Measles

A

Prodrome

  • irritable
  • conjunctivitis
  • fever
  • koplick spots

Rash

  • ear/face&raquo_space;> body
  • discrete macpap&raquo_space;> confluent, blotchy

Tx
Rest, eat and drink, isolation, treat superimposed infection, analgesia

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33
Q

measles complication

A

encephalitis
pneumonia

rarely 5-10yrs later - subacute sclerosing panencephalitis

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34
Q

Mumps

A

Fever malaise

Muscle pain

Parotitis (initially unilateral but 70% get bilateral)

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35
Q

Rubella

A

Pink macpap rash
Face&raquo_space; body

Lymphadenopathy
- sub occipital and post auricular

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36
Q

rubella vs measles

A

both macpap rash face -> body

rubella - lymphadenopathy (suboccip)

measles - koplick, conjunctivitis, ear ache

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37
Q

Cerebral palsy - what is it

A

Disorder of movement
Permanent non- progressive lesion in developing brain
Can get other neurological/learning difficulties

Manifestation may change as child develops, even though lesion doesn’t progress

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38
Q

Presentation of cerebral palsy

A

Neonatal FFFF

  • fits
  • floppy
  • feeding
  • funny mood (irritable)

Within 1st year ART

  • Asymmetry
  • persistent primitive Reflexes
  • Tone abnormalities (spasticity)

Delayed and abnormal motor development

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39
Q

Causes of cerebral palsy

A

80% antenatal

  • infection
  • hypoxia/vascular occlusion

10% hypoxic/ischaemic birth injury
- more likely in preterm

10% post-natal cerebral injury

  • infection
  • severe hypoglycaemia
  • kernicterus
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40
Q

Types of cerebral palsy

A
  • 70% spastic
    UMN lesion
    hemi (one side), di (legs), quadri (4 limbs) …plegia
  • 10% dyskinetic (contract/relax in opposing muscle groups - uncoordinated, involuntary, jerky movements)
    basal ganglia
    distonia (proximal, trunk), athetoid (distal, finger fanning)
  • 10% ataxic
    cerebellum
    hypotonic, uncoordinated, poor balance
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41
Q

cerebral palsy management

A

CT or MRI - brain lesion

Multidisciplinary input - Child Development Services

  • SALT
  • nutrition
  • physiotherapy
  • occupational therapists (equipment)
  • educational needs

Respite support, financial support

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42
Q

Fits faints funny turns

A

Breath holding - following crying
- go limp

Reflex anoxic spell - following injury/illness
- white/collapse

Myoclonic epilepsy
- shock-like jerks

Syncope/vasovagal
- go hot

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43
Q

Febrile convulsions

A

3% kids under 5
Strong familial link

Seen early in viral illness
As temperature spikes

2/3 will be a one off
1/3 go on to have more febrile convulsion

Increase risk of epilepsy (6% vs 1.4%) but not causative
But complex seizures could indicate tendency to epilepsy - prolonged, focal, repeated

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44
Q

Epilepsy

A

Tendency to have recurrent seizures
1 in 200 children

Mainly idiopathic (80%)
- secondary to cerebral injury, neurocutaneous conditions
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45
Q

seizure types

A

generalized - tonic clonic, absence
- treat sod val or lamot

partial - focal neurology

  • commonly temporal lobe
  • may be comlex (altered conscious) or simple
  • often aura, lip smacking, imp conscious
  • -> must do MRI ?brain tumour
  • carbamez
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46
Q

juvenile myoclonic epilepsy

A

three features

  • myoclonus
  • generalised tonic clonic
  • absence

t: boy: sodium val; girls: lamotrigine

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47
Q

status epilepticus

A

ABC

pre hospital rescue - buccal medaz or rectal diaz

in hosp 
iv lorazepam
- phenytoin
-- anaethetics
identify casue - temp, glucose
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48
Q

migraine in kids

A

most common headache in kids

lasting > 4hrs
pulsatile, severe, unilat
aggravated by phys activity
aura
nausea, vom, photo/phono-phobia

family hist

T:
acute
- ibuprofen +\- triptan (nasal or oral)
- antiemetic
- rest in dark quiet room

General: avoid triggers (regular food, sleep, avoid caffeine, choc, cheese, ocp)

Prevention if 4 per month
- propranolol (ci:asthma)
- or topiramate (! in females - fetus and contracep)
prevent - pizotifen or propranolol

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49
Q

Cardiac defects

A

Often multiple defects
Often other congenital malformation

Acyanotic (ASD / VSD/PDA) are most common

Cyanotic - TOF, AVSD, transposition

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50
Q

Acyanotic Cardiac Defects

M
resus, support (diuretic)
iv prostaglandin for coarctation
nsaid for pda
conservative -> surgery or catherterisation
A

Left-to-right shunts

  • ASD/VSD/PDA
  • present with heart failure
  • pan systolic murmur

HEART FAILURE

  • feeding probs
  • infections
  • sweaty
  • fail to thrive

Might get chronically raised pulmonary HTN – Eisenmenger’s

Obstructive defects

  • severe coarctation
  • stenosis
  • present with shock/collapse (duct dependant systemic circulation)
  • GIVE PROSTAGLANDIN
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51
Q

Cyanotic Cardiac Defects

A

Cyanotic

  • tetralogy
  • AVSD
  • transposition

Duct dependant pulmonary circulation
Present in first week BLUE BABY
- as duct closes
- give prostaglandin iv

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52
Q

Meningitis

A

Most commonly viral - self limiting

Bacterial v serious

  • newborns: Group B Strep
  • otherwise: neisseria menigitidis (menigococcus), strep pneumonia
  • mainly affects young people
  • up to 10% die
  • 10% long term probs (deafness, seizures, brain injury - affecting particular limb)
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53
Q

Meningitis

A

Most commonly viral - self limiting

Bacterial v serious

  • mainly affects young people
  • up to 10% die
  • 10% long term probs (deafness, seizures, brain injury - affecting particular limb)
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54
Q

meningitis presentation

A

fever,leth, poor feed, irritable
vom, HEADACHE

septicaemia: shock, PURPURIC RASH

!! drowsy, loc, seizure, hypotonia, photophobia

!!! bulging fontanelle, stiff neck, opisthotonis

  • brudinski’s - lift head - legs raised
  • kernig’s - hip flexed, extending knee painful
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55
Q

Meningococcal septicaemia

A

Flu illness and fever

Purpurin rash

Must give IM penicillin pre hospitalisation

Progresses to shock coma death

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56
Q

meningitis mgmt

A

septic screen - blood, uti, cxr, csf
start acyclovir until known
- raised wcc and crp points to bacterial

CSF
!! dont do lumbar puncture if signs of raised ICP
- coma, raised bp, papilloedema, focal neurology
- coagulopathy

in GP
- stat benzylpenicillin (IV or IM)

in hospital

  • IV ceftriaxone
  • plus dexamethasone (>3m)
  • plus ampicillin if <3m (vs listeria)
57
Q

CSF in meningitis

A

Leukocytes +

Bacterial

  • turbid
  • polymorph
  • high protein (1-5g/l) low glucose (<40% serum)

Viral

  • clear
  • less electrolyte change
  • -> self limiting supportive

Mx of bacterial

  • immediately start abx
  • dexamethasone if over 3 months
  • prophylaxis for contacts
58
Q

Recurrent abdo pain

A

Majority are IDIOPATHIC

GI

  • upper GIT
  • inflammation
  • infection
  • malabsorption
  • constip

UTI

Gynaecological

  • dysmenorrhea
  • PID
59
Q

Idiopathic recurrent abdo pain

A

Comparable to recurrent tension headaches/growing pains

Reassurance
No cause identifiable
Safety net - what to look out for
Monitor - keep a diary
Liase with school - attendance
- minimise interference with daily life
Address stresses at home/school
60
Q

Acute abdomen

A

Appendix
- anorexia, still, fever, vom

Intersusseption

  • intermittent screaming and pallor
  • under 2 years

Mesenteric adenitis
- node enlargement 2ary to viral infection

DKA?
UTI?

61
Q

Vomiting in young baby

A

Over feeding

Reflux

PS

Bowel obstruction
- rare but must ask about bile stained vom?

Whooping cough

62
Q

Pyloric stenosis

A

4-6 weeks
Boys
Projectile vom post feed

Hungry
Dehydrated
Olive mass in epigastrum

Low chloride/potassium/sodium
Alkalosis

T: resus w fluid and correct electrolytes
Ramstedts procedure

63
Q

Vomiting in older child

A

Gastroenteritis

Systemic infection

  • UTI
  • otitis media
  • mening

Migraine

64
Q

Organic abdo pain HISTORY

A

F.A.N.E.W

Fever
Appetite
Night
Energy
Weight

Other bowel/urinary/gynae symptoms

65
Q

UTI in kids

A

General symptoms of fever, irritability, vomiting

Maybe frequency, dysuria, bedwetting

Pain? Systemic illness? Constipation?

Advise about wiping and wet nappies

66
Q

UTI in kids

A

under 3 months - refer

upper uti - 7-10 days broad spec + refer

simple uti - 3days trimethoprim

in teenager

  • ask about sti
  • advise voiding after sex
67
Q

First line treatment constipation

A

Movicol paediatric plain
dietary and fluid advice
Lactulose if not tolerated

68
Q

Enuresis

A

Delay in sphincter control and nighttime bladder awareness
Familial and emotional aspect
- but mostly happy and normal just taking a bit longer

Nocturnal common

  • 10% 5y
  • 5% 10y
  • 1% 15y

Fluid and toilet routine
Not afraid of getting out of bed in night
Not punish - praise dryness, help change sheets
Alarms desmopressin

69
Q

Primary enuresis

A

Delay in normal sphincter control - quite common

Rule out illness

Fluid intake and toilet routine 
No impediments to bathroom at night
Star chart
Alarm
Desmopressin (not lasting cure)

Could have neurological component
- test reflexes, anal tone, sensation

70
Q

Secondary enuresis

A

UTI?
Diabetes?
Constipation?

  • do urine sample
71
Q

methyphenidate - also known as..

A

ritilin

72
Q

Soiling

A

Mostly due to retention - pain, anxiety

softener (docusate, lactulose)
stimulant (senna)
retraining

73
Q

gastroenteritis in children

A

Rotavirus

74
Q

Chronic diarrhoea

A

Non-pathological

  • otherwise thriving
  • ‘toddler diarrhoea’

Malabsorption (failure to thrive)

  • CF (diag: sweat test)
  • coeliac (anti TTG)
  • lactose intolerance (follows acute gastroenteritis) soya milk until Sx resolve

Inflammatory

  • cows milk protein intolerance (bloody)
  • IBD

Infection
- giardia

75
Q

Coeliac

A

Gluten intolerance
- found in wheat and rye

Usually before age of 2
Present w irritability, anorexia, vomiting, diarrhoea 
Pale, foul smelling stools
Abdo distension, wasting, pallor
May get clubbing

Ix

  • fe deficiency anaemia
  • may be mixed w macrocytic
  • steatorrhoea
  • anti TTG antibodies
  • jejunal biopsy
76
Q

infantile colic

A

common under 3m

worse in evening

77
Q

Cows milk protein intolerance

A
  • non IgE
    Bloody diarrhoea
    Vomiting/abdo pain

IgE
Urticaria
Bronchospasm, angioedema

Substitute soy milk

Resolve within 1-2 years

78
Q

intersusception

A

episodes of screaming

  • pale, vom
  • drawing knees up
  • red current jellys stool
  • sausage mass in abdo

T: fluid
insufflation (pump air) –> surgery

79
Q

Nephrotic syndrome

A

Minimal change glomerulonephritis

Proteinuria
Oedema
Recent viral illness

T: restrict fluid and salt intake

  • prednisolone
    • will cause immunosupression - avoid vaccines and chickenpox
80
Q

Jaundice

A

in newborn - bad
think haemolysis
- rhesus/abo incompat
- g6pd or spherocytosis

otherwise often physiological or breast milk related
(breast milk affects conjugation)
- continue, ensure good fluid intake
- consider phototherapy

if there is conjugated bilirubinaemia - this suggests hepatobiliary problem - ? biliary atresia, neonatal hepatitis

81
Q

wilms nephroblastoma

A

common malig in kids

balotable mass, distension, pain/haematuria

82
Q

Diabetes couselling

A

DISH

Diet

  • carb counting how effects insulin req
  • regular meals - don’t skip
  • high fibre, complex carbs, low fat
  • exercise

Insulin regimes
- injections or pump

Self monitor- glucose

  • between 4-6
  • 4 tests per day

Hypos - look out
- hungry sweaty faint irritable

83
Q

DKA presentation

A

General background

  • polyuria, polydipsia, weightloss
  • infections
  • enuresis

Acute

  • vomit abdo pain
  • kussmaul breathing
  • dehydration!
  • drowsy confused
85
Q

Preterm babies

A

Development will seem delayed

Measure from expected date

85
Q

Longer term complications of prematurity

A

Hearing and vision
- retinopathy

Brain injury

  • CP
  • epilepsy
  • leaning difficulties

Chronic lung disease if needed lots of ventilators support

86
Q

Prematurity counselling

A

Longer stay in hosp w special care
Considerable variety - slight delay -> disbaled
- partly depends on how early
- 28 weeks - considerable morbid/mortal, months in hosp
- 34-37 excellent (probs - hypo, bili, warmth)

S.F.W.R.I.H. B.H/V.L

Small
Feeding probs - close attention
Warmth - thermoregulation

Respiratory

  • steroid PRE DELIVERY (or surfactant to baby)
  • ventilatory support

Infection - prophylactic abx

  • respiratory
  • NEC

Hypo’s

  • hyglycaemia, calcaemia, hyperbilirubin
  • can damage brain

Long term: H/V.B.L

  • hearing vision
  • brain - epilepsy, ld, cp
  • lungs
87
Q

Premature baby - what to ask in history

A 
Mums age and health
Pregnancy
- smoke or drink
- infections
- abnormalities on scan
- diabetes
- HTN
88
Q

Apgar score

A

0 - 2
2 normal, 0 none

hr >100
resp effort - crying
muscle flexion
respond to irrritation
colour

max 10 = normal
< 7 morbidity

89
Q

Birth reflexes

A

Moro
Grasp
Rooting
Stepping

90
Q

diabetes in pregnancy risk to newborn

A

macrosomia - trauma, asphyx
hypoglycaemia post delivery
polycythaemia

91
Q

pregnancy TORCH screen

A

Toxoplasmosis (learning diff, epilepsy, eyes)
- uncooked meat, fish, cat feac

Other (hiv, measles)

Rubella (neonatal deaf, catar, heart def)

CMV (cerebral palsy, deafness)

Herpes (ocular, neurological)
- non immune mum exposed to varic zoster
test for antibodies —> give VZIg, treat w acyclovir

92
Q

common neonatal infection

A

group b strep

from mums vag
- can give abx in delivery (preterm, prom, fever)

93
Q

retinoblastoma

A

present around 18m - no red reflex, strabismus
10% hered

nb cataracts also cause no red relfex but should be detected earlier

94
Q

PKU

A

prob w phenylalanine breakdown
mental retard and seizures
fair hair, blue eyes, eczema

guthrie test at birth (for phe)

phenylpyruvate in urine

95
Q

Neonatal sound checks

A

Evoked otoacoustic emission
- test cochlea

Auditory brainstem response audiometry
- EEG shows brains response to sound

96
Q

Reflux in infants

A

Can cause fail to thrive
Crying after feeds
Vomiting
Worse lying down

To help:
Thicken foods
Feed upright

Can give antacids or cimetidine

97
Q

Areas of development

A

Gross motor
Fine motor and vision
Hearing, speech and language
Social, emotional and behavioural

98
Q

Key features in history of developmental delay

A

Problems in pregnancy

  • smoking, drinking
  • infection
  • abnormalities on scan

Delivery

  • antepartum haemorrhage
  • prolonged PROM
  • prematurity
  • traumatic birth

Neonate

  • feeding
  • infection
  • kernicterus

FH - when did parents walk, specific inherited conditions in the family eg muscular dystrophy
Other developmental milestones

99
Q

Delayed development causes

A

Familial, constitutional
Pregnancy: drinking, smoking
Neonate: congenital infection

Mental handicap
- slow to learn

Cerebral palsy - hypertonic
Syndromes - hypotonic

Deprivation, abuse

Specific deficit
- deafness, blindness

100
Q

Gross motor

A

Newborn

  • flexed limbs
  • symmetrical
  • head lag
2 months - head raise
4 months - head control
8months - sitting
9 months - crawl
10 months - pull up, stand support

12-15 months - walking development
18 squat to pick up toy
2 - run

101
Q

Fine motor

A

2 months - follow object
4 months - reach out

6-8 months - grasp, transfer
10 months - mature pincer

18 months +
- drawing, building

102
Q

Cognitive develment

A

Pre-operational
- centre of world, magical events, personifies objects

Operational (school age)
- practical, ordered

Formal operational (adolescence)
- reasoning, abstract thought
103
Q

Down’s syndrome

A

1 in 800 births
Trisomy 21
Assoc with increased maternal age

104
Q

Downs diagnosis

A

Pre-natal diagnosis

  • choice to have screening (nuchal translucency 11-14 and blood test 16)
  • gives risk score (w age)
  • amniocentesis can confirm (1% miscarriage)

Postnatal

  • clinical suspicion
  • blood test: karyotype

If confirmed

  • screen for congenital heart defects
  • hearing and visual tests
105
Q

Downs neonatal symptoms

A

Hypotonia

Facies

  • flat nose
  • small eyes/ears (lowset)
  • space between eyes
  • epicanthic folds
  • tongue

Single palmar crease
Wide spaced first toe

106
Q

Further problems in Down’s

A

Congenital heart defects
- AVSD
Learning difficulties
Hearing and visual impairments

duodenal atresia (double bubble) - bilious vom
Epilepsy 
Hypothyroid
Coeliac
Alzheimers
Leukaemia

Life expectancy: 50’s

107
Q

Downs management

A

Multi-disciplinary input

  • speech and language
  • learning support
  • health - heart, vision, hearing

Support groups

108
Q

hirschprungs

A

abnormal innervation of rectum

cant relax –> obstruction
fail to pass meconium ileus, distension and vom

complicated by colitis

assoc w Down’s

T: fluid, ng tube –> surgery

109
Q

Downs risk

A

Age 30 approximate chance 1/1000

Divide by 3 for every 5 years older

110
Q

Puberty

A

Tanner stages based on testicals/breasts and hair

First signs
B: testicals enlarge (10-14)
G: breasts devel (9-13)

Growth spurt
- early for girls late for boys

Menarche late for girls
- delayed if not by 16

Secondary chacs

  • body shape
  • acne
  • odour
  • mood
111
Q

Problems with precocious puberty

A

Small final height

Psychological

112
Q

Investigate premature puberty

A

Before 8 in girl

Before 9 in boy

Precocious puberty means whole thing not just thelarche/pubarche (generally self limiting)

Organic causes (as opposed to constitutional)

  • will have dissonance
  • virilisation
  • rapid

Central - Gn dependant (large testes)
Pseudo - sex steroids from tumour/ hyperplasia (small or one large testicle)

end up with short stature

113
Q

Delayed puberty

A

Normal by
G: 13
B: 14

Concerned if still not within one year

Majority constitutional - reassure
Girls: Turners

Low Gn’s (hypothalamic dysfunction)

  • chronic disease
  • stress

Gn’s high

  • chromosomal (Turners)
  • gonadal damage from surgery/chemo/trauma
114
Q

rashes in kids

A

macpap - rubella, measles

purpuric - meningeal, henoch schonlein, thrombocytopenia

vesicular - chickenpox, herpes, hfm

pustular - impetigo (golden crust)

115
Q

Acne management

A

Reassure - common, treatable
ADDRESS PSYCHOLOGICAL ISSUES

Mild

  • benzoyl peroxide - wash or cream
  • good for papulopustular - anti-inflammatory
    • SE: skin irritation
  • topical clindamycin

Moderate

  • oral antibiotics - tetracycline, lymecyclin, eryth
  • cocp for girls (esp diannete)
  • adapelene gel - topical retinoid - anticomodonal
    • light sensitive

Severe

  • oral retinoids - isotretinoin
    • use at night
    • ! teratogenic - must prove -ve preg, use condoms
    • SE: light sensitivity, erythema, scaliness
116
Q

craddle cap

A

seborrheic dermatitis

tend to self resolve

  • consider baby shampoo /oil
  • weak topical steroid if severe
117
Q

roseola infanatum

A

6m - 2yrs

fever follow few days later by pink macpap rash

HHV6 (6th disease)
exanthem subitum

118
Q

steroid ladder

A

hydrocortison
eumovate
betnovate
dermnovate

119
Q

Scabies

A

Sarcoptes scabie mite

V itchy all over due to type 4 hypersensitivity reaction to eggs

T: permethrin all over repeat after 7 days
Wash sheets
Treat contacts

Itch may persist for 4-6 weeks (reassure)

120
Q

Head lice

A

Pediculus capitits

Diag by fine combing hair

T: malathion, wet combing etc

121
Q

ITP

A

Petechiae and bruising

No fever

T: none> steroids> platelet transfusion

122
Q

Henoch-Scholein Purpura

A

Systemic vasculitis(small vessel)

No fever

Purpuric rash
- buttocks thighs legs

Joint pain
Abdo pain
Kidney impair

T: supportive

123
Q

Vaccines general info

A

All inactive apart from MMR (modified live vaccines)

Mild side effect possible with all

  • sore at site
  • drowsy

Mild fever, malaise, illness possible with MMR

Rare: anaphylaxis

Do not give if immune compromised
Do not give if child has acute illness

124
Q

knee problems in young

A

chondromalacia patellae
- bad up and down STAIRS

osteochondritis dissecans
- pain after exercise, LOCKING, SWELLING

O-S

  • tibial tuberosity pain, tender, swollen
  • sport

patella tendonitis
- chronic, tender, worse after running

125
Q

squints

A

concomitant - common, due to refractive error

paralytic - rapid, rare, - think space occ lesion

detect w cover test
refer
patch

126
Q

developmental dysplasia of hip

A 
females more (x6)
breech, big baby, oligohydram
fh, first baby, foot deform

20% bilat

may see asymmetry in young infant hip creases
barlow ortolani
us

self resolve or orthotic or surgery

127
Q

perthes disease

A

cause of limp
4-8years
avascular necrosis of hip

128
Q

juvenile idiopathic arthritis

A

painless limp

129
Q

slipped femoral upper epiphysis

A

cause of limp

10-15 years

130
Q

jabs

5in1= diptheria, tentanus, polio,
pertussis,
hib

A

2m: 5in1 + pneum
3m: 5in1 + men c
4m: 5in1 + men c + pneum

1y: mmr + hib + men c
preschool: mmr + 4in1 (not hib)

teens: girls: hpv
all: 3in1 + men c

131
Q

Other possible vaccinations

A

TB if contact suspected (Pakistan)

Hep B if close contact/mum is positive

132
Q

live vaccines

A

bcg, cholera, mmr, intranasal flu

all others are attenuated

133
Q

why have mmr vaccine

A

serious illnesses:

  • Measles- can be fatal - affect brain, lungs
  • Mumps- can cause infertility in boys, deafness
  • Rubella- if pregnant mother develops can damage her unborn child’s heart, brain, hearing, sight

Herd immunity - stop diseases from being able to spread

134
Q

Side effects of mmr vaccine

A

Uses live attenuated viruses

Mild fever and rash 7-10 days after injection (measles)
Swollen sore joints (rubella)
Lymph glands (mumps)

No effects are infectious or serious

135
Q

HPV vaccine

A

Gardasil
- vs HPV 6 & 11 (warts), 16 & 18 (cancer)

Previously Cervarix
- only vs cancer

Still need cervical screening
- vaccine does not prevent all cases of cervical cancer/ strains of HPV

Very safe very effective

136
Q

paediatric life support

A 
shout help
A - open airway
B - look listen feel
- not breathing - 5 RESCUE BREATHS
C - no pulse?
- 15:2 chest compressions
137
Q

2 - 5 parameters

A

rr 25- 30

hr 90 - 140

138
Q

5 - 12 parameters

A

rr 20 - 25

hr 80 - 120

139
Q

0 - 2 parameters

A

0-1
hr 110 - 160
rr 30 - 40

1-2
hr 100 - 150
rr 25 -35

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