Paediatrics Flashcards
Mnemonic for gluten foods?
BROWS: barley rye oats wheat and spelt (type of wheat).
HEADSS mnemonic
Home and environment Education and employment Activities Drugs Sexuality Suicide/ depression
Podophyllotoxin
Podophyllotoxin, also known as podofilox, is a medical cream that is used to treat genital warts and molluscum contagiosum. It is not recommended in HPV infections without external warts. It can be applied either by a healthcare provider or the person themselves.
aflatoxin
Bladder cancer
New differentials for paeds headache
Stress
Eye Strain
Dental Carries
Tumours: Medulloblastoma and infratentorial medulloblastomas.
How do paeds headaches present?
Irritability and changes in feeding, toileting/ nappies, behaviour, etc.
Paracetamol dosing in children? What is it in adults?
15mg/kg 4 hourly with a maximum of 100mg/kg/day OR 1g in a day according to Jess.
1g 4-6 hourly is max normal dose paracetamol for adults
How do we manage a simple headache in kids? What about migraine? What about meningitis if it’s under 2 months of age.
If it’s simple, give them paracetamol dude.
If they are a kid under 12, give them ibuprofen. If they are a kid over twelve, aspirin and sumitriptan can be added (INTRANASAL)
Cefotaxime and benzylpenicilin.
Questions to ask on a puberty history?
Age at takeoff (i.e. onset of growth acceleration)
- Age at peak height velocity + peak height velocity
- Duration of puberty
- Contribution of the pubertal growth spurt to final adult
height
HISTORY:
- Presence of absence of acne, body odour, oiliness of skin,
erections and nocturnal emissions in boys, PV discharge or
bleeding in girls
- Increase or decrease in growth rate
- Family history unexplained early death in male sibling (may
suggest CAH), PP in male relatives (suggests familial limited PP)
- Family history of pubertal onset
- Activities (e.g. ballet dancers and gymnasts tend to have delayed
puberty)
- Diet
Investigations for a precocious puberty?
Investigations: - Bloods: o FSH, LH, testosterone, estrogen o GnRH stimulation test o DHEA, DHEAS, hCG o TFTs o Tumour markes (alpha-fetoprotein, Bhcg)
- Imaging: o XR wrist + hand (bone age) o USS abdo (if adrenal tumour suspected + in girls) o Testicular USS o CT head o MRI brain + pituitary
What is Ramsay hunt?
Post herpes zoster infection, we get a facial nerve palsy and hearing loss in that ear.
DDX for precocious puberty?
It’s iether GnRH dpeendent or independent, and we test this by looking at the LH and FSH which will be elevated.
Idiopathic, hypothal hamartoma (also look for seizures, adipsia, diabetes inspidius, obesity or cachexia) and literally ANY intracranial pathology. Prolonged hypothyroid is also in this category.
Peirpheral (GnRH independent) includes CAH, Adrenal/ testicular neoplasm, exposure to exogenous testosterone.
Investigations for a delayed puberty?
Investigations: - FSH, LH, testosterone, oestrogen, serum prolactin, other pituitary hormones - FBC, ESR - Urea, creatinine, serum proteins - TFTs - Karyotype - Bone age - ?urine MCS (metabolic abnormalities assoc w/ assoc conditions) - ?MRI
DDX for dleayed puberty?
If there are normal or low serum gonadotrophins, the problem is central:
Constitutional delay. Usually familial.
Chronic illness/ poor nutrition.
Kallman’s/ hyperprolactin.
Elevated serum gonadotrophins:
- Primary gonadal failure (tunrner’s klinefelter’s Noonan’s)
ANorchia
Gonadal destruction secondary to trauma etc.
Child has a learning disability: how do you work this up?
History:
- Standard history and physical exam – include history from
parents/ caregivers regarding onset and source of symptoms and
family history of similar patterns
o Demographic data
o Birth, developmental and medical history
o Family and social history
- Hearing and vision assessment
- School history
- Consider contributing causes, e.g. anxiety, family dysfunction,
auditory processing problems
- Consider co-morbidities, e.g. ADHD, other behavioural disorders,
language disorders, developmental disorders, intellectual
disability
- Copies of any previous assessments (mental health, language,
cognitive, audiology)
DDX for a learning disability? Thus, ask around this.
Causes for learning difficulties: - Genetic syndromes: o Sotos o Tuberous sclerosis o Neurofibromatosis - Metabolic conditions: o Hypothyroidism o Diabetes - Common: o Dyslexia o ADHD o Down’s syndrome o Fragile X syndrome o qTuberous sclerosis o ASD o FAS o Absence epilepsy
Hx and exmaination for behavioural problesm?
History:
- full paediatric history
- ABC:
o Antecedent = what were the events preceding the
behavior?
o Behaviour = what is the behavior exactly?
o Consequence = what did the parents do to resolve the
situation?
- Clarify where the behaviours occurs behavior occurring acorss
two or more settings (home, educational and/or social setting)
are more likely to be indicative of an underlying mental health
problem
o Behavior occurring in one setting only may reflect an
issue specific to that setting
- Nutrition
- Sleep patterns
- Family functioning
- Ask about parent mental health, parenting practices
- Family risk factors – unemployment, drug and alcohol misuse,
financial stress
- Social support
- Family history of developmental/behavioural problems
Examination:
- Observe the child’s behavior
o But be aware that some kids behave well when they
know they are being observed
o Also observe parent-child interaction
- Dysmorphic features
- Full physical examination
- Consider brief developmental assessment
General management of behavioural problems?
- Establish clear goals: what do they want to improve? What is your capacity to do this?
- Set a positive example, and incentivise the kid with some rewards
- Set up consistency, between parents, at school and at other houses
- Set clear boundaries and expectations.
What are the specific behavioural problems for kids throughout different age groups and how are they managed?
Specific behavioural problems:
TANTRUMS + OPPOSITIONAL BEHAVIOUR IN TODDLER (1-3 yo):
- Can occur at any time, but commonly during meals and sleep time
- Management of tantrums:
o Stay calm, walk away and ignore behavior until
tantrum stops
o Praise child when appropriate behavior begins again
o Behavior will initially escalate, but quickly decline
- Management of aggressive behavior:
o Remain calm and don’t raise voice, ask child to stop and
redirect them to another activity
o If they do stop, praise them
o If they don’t stop ‘quiet time’ in same room
o If still don’t stop or leave quiet time go to time out in
another room
ANGER AND AGGRESSION IN PRESCHOOLERS (3-5yo):
Low priority behavior (e.g. whinging) can be dealt with by:
- ignoring the behavior
- distracting the child
- logical consequences for the child’s action, e.g. if draw on wall
with pen, take pen away from them for a few minutes but make
sure to give pen back so child can practice using it properly on
paper
High priority behaviour, such as behavior with associated safety
concerns (e.g. kicking, punching, absconding):
- time out
HYPERACTIVITIY OR INATTENTION IN SCHOOL AGED CHILDREN (5-
11yo):
Management needs to be implemented both at home and school.
School:
- In school, first priority is to exclude co-morbid learning
difficulties
o Test hearing + vision
o If required, special education and cognitive assessment
can be organized through school
- Classroom strategies:
o Sitting the child up front, next to quiet student
o Having frequent breaks
o Rewarding for staying on tasks
- Parents should liase with teacher for a management plan
- Fidget toys
Home:
- Withdrawal of privileges (e.g. no TV for 1 hour)
Social Hx for a fever? Remember I’m just going to write a huge list of differentials from the systems i covered last year and go through a review. Just remember otitis media, HIV, UTI and neoplasma, also osteomyelitis.
Travel history and sick contacts
Causes of chronic fever in kids?
Occult abscess Atypical pneumonia Hepatitis UTI Osteomyelitis HIV Infectious mononucleosis Tuberculosis Infective endocarditis Collagen vascular disease Neoplastic disease Factitious fever
What is the traffic light screening system for fever?
Looks at the risk of the deterioration by doing a full systems review etc. Looks at colour, activity, respiratory, hydration, and other.
How do we manage septic shock in a bebe?
Fluclox and gent if normal csf
If unknown csf do fluclox and cefotaxime
change once sensitivites come back. If culture negative treat for 48 hours or stop if clinically improving
UTI antibiotic in a kid?
Trimethoprim and not sulfa