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Paediatrics Flashcards

1
Q

Ill neonate - consider…

3

A
  1. Sepsis (infection screen including LP)
  2. Hypoglycaemia
  3. Metabolic disturbances
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2
Q

Feeding difficulty causes in neonates

4

A
  1. Sepsis
  2. Prematurity
  3. Heart failure
  4. Congenital abnormalities (e.g. cleft palate)
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3
Q

Neonatal jaundice - when to admit…

2

A
  • Within 2 hours - jaundice occurs in first 24 hours of life
- Within 6 hours:
FIRST occurs after 7 days
Prolonged jaundice
Unwell
Gestational age <35/40
Pale stool and dark urine
Poor feeding
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4
Q

Physiological jaundice

=

A

Day 2 - 10 (increased BR load)

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5
Q

Breast-milk jaundice

=

A

Day 2 - several weeks

= prolongation of physiological jaundice in breastfed babies, baby well

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6
Q

Pathological jaundice

causes - many, eg of 4

A

Many causes, eg.

  • blood group incompatibility
  • sepsis
  • metabolic disorders
  • biliary atresia
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7
Q

Failure to thrive

=

A

= significant drop in expected rate of growth compared with other children of similar age/sex

—> use centile/growth charts to track
(Normal to lose 10% bodyweight in first few days of life)

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8
Q

Failure to thrive - prenatal causes

4

A
  1. Prematurity
  2. Maternal malnutrition
  3. IUGR
  4. Maternal smoking/alcohol
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9
Q

Failure to thrive - postnatal causes

5

A
  1. Feeding problems, e.g. cleft palate
  2. Reflux
  3. GI disorders, e.g. malabsorption
  4. Organ failure
  5. Neglect
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10
Q

Management of FTT

4

A
  1. Dietary input
  2. Social worker input
  3. Paediatric input
  4. Treat underlying cause
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11
Q

Numerical examples of paeds chromosomal abnormalities

3

A

DEP

  1. Down’s - trisomy 21
  2. Edwards - trisomy 18
  3. Patau’s - trisomy 13
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12
Q

Sex chromosome abnormalities

2

A
  1. Klinefelter’s - 47 XXY

2. Turner’s - 45 XO

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13
Q

Down’s syndrome

Features (5)

Associations (4)

A

Features:

  1. Smaller ears
  2. Flat nasal bridge
  3. Brushfield spots
  4. Epicanthic folds
  5. Wide space between 2nd/3rd toes

Associations:

  1. ALL
  2. Congenital heart disease
  3. Hirschprung’s
  4. Duodenal atresia
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14
Q

Signs of congenital heart abnormalities

4

A
  1. FTT
  2. Murmur
  3. Poor feeding
  4. Heart failure symptoms
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15
Q

Congenital abnormalities - broad headings

3

A
  1. Heart
  2. Gut
  3. Neurological
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16
Q

Congenital heart abnormalities -

Acyanotic v Cyanotic

(4) v (4)

A

Acyanotic:

  1. ASD
  2. VSD
  3. PDA
  4. Aortic coarctation

Cyanotic:

  1. Fallot’s tetralogy
  2. TGA (transposition of great arteries)
  3. Pulmonary stenosis
  4. Tricuspid atresia
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17
Q

Gut congenital abnormalities

3 + info

A
  1. Hirschprung’s = development failure of parasympathetic plexus —> constipation.
    Mx = surgical removal of affection section
  2. Pyloric stenosis - projectile vomiting approx 3-4 weeks; sometimes visible peristalsis.
    Mx = Ramstedt’s pyloromyotomy
  3. TOF = connection between trachea and oesophagus —> higher incidence of aspiration pneumonia.
    Mx = surgical correction
18
Q

Neuro congenital abnormalities

2

A
  1. Cerebral palsy

2. Spina bifida

19
Q

SPINA BIFIDA

Def
Types
Dx
Ix
Mx
A

= NTD - vertebral arch of spinal column absent or incomplete

Can be occulta (overlying skin intact, no protrusion of spinal cord) or cystica (open - visible cystic mass on back, e.g. meningocele)

Dx - prenatally: AFP, anomaly scan, amniocentesis

Ix - full spine examination & check for other abnormalities

Mx - can be treated surgically (in utero or post-natally) to prevent complications, e.g. meningitis

20
Q

CEREBRAL PALSY

Defn
Cause
Features
Mx

A

= group of conditions permanently affecting motor (movement) and coordination

Caused by damage to brain before, during or soon after birth

Features - include high or low muscle tone, delayed milestones, etc

Mx - MDT approach, e.g. physio, speech therapy, etc

21
Q

Talipes equinovarus (club foot)

A

Foot can’t be placed on ground

Conservative Mx - e.g. ponseti method of stretching/casting
Or surgical, e.g. if fixed deformity

22
Q

PERTHES

Defn
Demo
So
Mx

A

= avascular necrosis of femoral head epiphysis

M>F, age 5-10

May have limp, pain in knee/hip

Non-surgical, e.g. analgesia
VS surgical when persists

23
Q

SUFE

Defn
Demo
Sx
Mx

A

Epiphysis ‘slipped’ down and back

M>F, age 10-15

May have Iimp, pain in knee/hip/groin

Surgery as may lead to avascular necrosis of femoral head

24
Q

Irritable hip

A

Pain and limp eg following infection

Admit if other causes in doubt. Rest and analgesia

25
Q

JIA (Still’s disease)

Defn
Ix
Mx

A

Chronic arthritis in <16yo, similar features to adults

Raised inflammatory markers, HLA-B27 may be positive

Mx - physio, med (e.g. aspirin, methotrexate), surgery, urgent ophthalmology review for uveitis

26
Q

Pulled elbow

A

Usually under 5’s

Dislocation of radial head

Needs manual reduction

27
Q

ADHD

Defn
Mx

A

Triad of

  1. Inattention
  2. Hyperactivity
  3. Impulsiveness

At least more than 1 situation, impairing function, usually under age 7

Rx - methylphenidate (Ritalin)

28
Q

AUTISM

Dx
Mx

A

3 essential diagnostic features

  1. Social impairment (no interest, eye contact, few friends)
  2. Abnormal behaviour (lack of imagination, stereotyped play)
  3. Communication impairment (speech, non-verbal)

If high suspicion needs referral, e.g. autism team/CAMHS

29
Q

ENURESIS

Types (3)
Considerations
Physical causes? (6)
Mx (5)
Referral (4)
A

Types:

  1. Primary enuresis with day symptoms
  2. Primary enuresis without day symptoms
  3. Secondary enuresis (after being dry 6 months)

Consider - fluid intake, volume of urine, access to toilet, home & school issues.
Normal up to age 5, common up to age 10.

Physical cause?

  1. Overactive bladder
  2. Diabetes
  3. UTI
  4. Chronic constipation
  5. Neuro disorders
  6. Child maltreatment

Mx: (depending on stage and type)
1. Reassured if appropriate
2. Potty by bed for access, encourage pre-sleep urination
3. Rewards system e.g. star charts
4. Enuresis alarm (£50-100)
5. Desmopressin (can be short term or long term use) - usually age 7 and above, oral or sublingual
—>mimics ADH (so reduces urine production). HypoNa can happen therefore fluid restrict with only sips from 1 hour before taking to 8 hours after taking.
No evidence of adverse effects if taken long term

Referral more likely (e.g. enuresis clinic) if:

  1. Daytime wetting
  2. Secondary enuresis
  3. Recurrent UTIs
  4. Physical cause
30
Q

MEASLES

Org
Sx (2)
Mx
Notify?

A

Rubeola virus

  1. Erythematous maculopapular rash
  2. Koplik spots

Supportive treatment

Notify - Y

31
Q

MUMPS

Org
Sx
Mx
Notify?

A

Mumps virus

  1. Parotitis
  2. Epididymio-orchitis/oophoritis

Supportive treatment

Notify - Y

32
Q

RUBELLA (German measles)

Org
Sx
Mx
Notify?

A

Rubivirus

  1. Rash starts behind ears
  2. Arthritis/arthralgia

Supportive treatment

Notify - Y

33
Q

SCARLET FEVER

Org
Sx
Mx
Notify?

A

Streptococcus pyogenes

  1. Strawberry tongue
  2. Sandpaper rough rash

Penicillin V qds 10/7

Notify - Y

34
Q

SLAPPED CHEEK SYNDROME

Org
Sx
Mx
Notify?

A

Parvovirus B19

Erythematous facial rash

Supportive treatment

Notify - N

35
Q

CHICKENPOX

Org
Sx
Mx
Notify?

A

Varicella zoster

Macules, papules, clear vesicles, pustules

Supportive treatment

Notify - N

36
Q

HAND, FOOT & MOUTH DISEASE

Org
Sx
Mx
Notify?

A

Coxsackie A16

  1. Ulcers in mouth
  2. Macules/papules on hands/feet

Supportive treatment

Notify - N

37
Q

WHOOPING COUGH

Org
Sx
Mx
Notify?

A

Bordetella Pertussis

  1. Coughing fits
  2. Whooping
  3. Vomiting

—> Clarithromycin if <1mo
—> Azithromycin/clarithromycin if >1mo (non-pregnant)

Notify - Y

38
Q

ANAPHYLAXIS

Mx

A

Adults & >12:
0.5mg (0.5ml of 1 in 1000) adrenaline IM

> 12 (small):
0.3mg (0.3ml of 1 in 1000)

6-12y:
0.3mg (0m3ml of 1 in 1000)

Up to 6y:
0.15mg (0.15ml of 1 in 1000)

39
Q

MENINGITIS

Mx

A

Adults & >10:
1.2g Benzylpenicillin IM/IV

1-9y:
600mg

<1y:
300mg

40
Q

CHILD MALTREATMENT

4 types & when to suspect

A 
1. PHYSICAL
Bruising/lacerations/thermal injury/fracture when not mobile,
Bruising on non-bony areas,
Bruising in clusters,
Lacerations on areas usually covered,
Human bite mark,
Delayed presentation
  1. EMOTIONAL
    Persistent punishing (e.g. for bedwetting)
    Persistent rejection/scapegoating
    Persistent inappropriate threats/discipline
  2. SEXUAL
    Genital/anal/perianal injury without explanation
    STI/pregnancy in <13
    Sexualised behaviour in pre-pubertal child
  3. NEGLECT
    Failure to seek appropriate medical care
    Persistently smelly/dirty
41
Q

Child safeguarding measures

4

A
  1. Child protection register
    (Confidential details of children who are at risk of abuse/neglect)
  2. Child protection plan
    (Assesses likelihood of harm/Goals to reduce risk/Assigns responsibility and actions/Outline ongoing monitoring)
  3. Local safeguarding children boards
    (In every local authority - responsible for multi-agency co-ordination and monitoring)
  4. Serious case reviews
    (Undertaken where abuse or neglect has taken place/suspected and where death or serious harm has taken place)

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