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