Paediatrics Flashcards
What are the four domains of development?
Gross motor
Fine motor
Speech, language & hearing
Social,Behavioural &
Emotional
When should a child be walking?
By 18 months
If not, check Creatine Kinase as they may have muscular dystrophy.
When does a child develop object permanence?
9 months
When should children start using single words/nouns e.g. mummy?
1 year
When should children start using two words/verbs?
2 years
When should children start smiling?
6 months
When should children have bowel control?
3 years
When should children have bladder control?
4 years
When does right and left handedness start to develop?
Around 2 years.
If there is dominance before this then its a concerning sign (MSK/neurological issue?)
When should children start to understand negatives?
3 years
When should children develop a fine pincer grip?
12 months
When should children be able to sit upright?
9 months
if later than a year its concerning
When should children be able to draw a vertical line?
2 years
When should children be able to draw shapes?
3 years
What is the difference between impairment, disability and handicap?
Impairment: Structural or functional problem e.g. neuropathy.
Disability: How they are limited compared to average person e.g. can’t walk.
Handicap: How this stops them doing certain tasks e.g. can’t work or play sport.
What tool is used to assess disability?
WHO-DAS
WHO Disability Assessment Schedule
Cognition -understanding, communication
Mobility - moving around
Self-care - hygiene/eating etc
Social - relationships, fun
Life-Activity - work/school
Participation - joining in with the community
What vaccines are included in the 6 in 1 vaccine?
Diphtheria Tetanus Pertussis Polio Hib Hep B
Give two examples of live vaccines
MMR Rotavirus Smallpox Chicken pox Yellow Fever
[MRS CY]
When is the MMR vaccination given?
1 year
3 years 4 months
Give an example of a toxoid vaccine
Diphtheria
Tetanus
Give an example of an inactive vaccine
Polio
Rabies
Flu
Hep A
Give an example of a sub-unit/conjugate vaccine
Hep B Pertussis HPV Meningoccocal Pneumococcal
What virus is responsible for causing Chicken Pox?
Varicella Zoster
Herpes 3
What is the order of the chicken pox rash?
Macules
Papules (raised pink)
Vesicles (fluid filled)
Crusts
When is a child with chicken pox no longer contagious?
When the lesions have all crusted over.
Give a complication of chicken pox
Encephalitis Myocarditis Transient arthritis Secondary bacterial infection Purpura fulminans (coagulopathy)
What is the treatment for chicken pox?
Paracetamol & Hydration
(Aciclovir only if severe e.g. encephalitis or if immunocompromised).
What is the pathogen responsible for epiglottitis?
Haemophilus influenzae Type B (HiB)
[G-ve coccobacillus]
Give two signs of epiglottitis
Drooling Sitting forwards Stridor Fever Tachypnoea
Which two specialty teams should you urgently involve if you suspect epiglottitis?
ENT and anaesthetics as you may need to intubate.
What investigations would you perform if you suspect Epiglottitis?
Lateral cervical spine X-ray (look for “thumb sign” = enlarged epiglottis).
Throat swab culture for HiB
Laryngoscope
FBC
What is the treatment for epiglottitis?
Oxygen
Ceftriaxone IV
IV Fluids
What is Stridor?
High pitched breathing sound made on inspiration
Give two symptoms of otitis externa
Otalgia
Itch
Discharge
Hearing loss
What is the treatment for ottitis externa?
Analgesia (paracetamol/ibuprofen)
Warm compress e.g. flannel
Typically self-limiting
Only use topical antibiotics/steroids if severe.
What organism typically is the cause of mastoiditis? What is the best treatment?
Streptococcus pneumonae
Co-amoxiclav IV (1st line)
May require surgery
What is the treatment for otitis media?
Analgesia (paracetamol/ibuprofen)
If systemically unwell then amoxicillin (clarithromycin if allergic to penicillin).
What is the cause of whooping cough?
Bordatella pertussis
G-ve coccobacilli
Give two signs/symptoms of whooping cough
Barking cough (seal like) Cyanosis (turns blue) Worse at night Fever Coughing fits
What is the treatment for whooping cough?
Macrolide antibiotic
erythromycin, clarithromycin, azithromycin etc
What is the most common cause of bronchiolitis?
Respiratory Scyncytial Virus (RSV)
What is bronchiolitis?
A lower respiratory tract infection common in children under 2 years
(1/3rd of kids get it)
What is the treatment for bronchiolitis?
Oxygen
Most resolve in 2-3 weeks.
Give two symptoms of bronchiolitis
Very snotty Fever Dry cough Wheeze Stops feeding
What is the cause of Hand Foot and Mouth disease?
Coxsackie A16 virus
Enterovirus
[Hand foot mouth cock guts]
Give two signs of Hand Foot and Mouth disease
Rash on palms/soles Vomiting Fever Off food Sore mouth/tongue
What is the treatment for Hand Foot and Mouth disease?
Analgesia
Supportive
What is the cause of slapped cheek syndrome and what is it also known as?
Parvovirus B19
“Fifth Disease”
What is the cause of Glandular Fever (aka infectious mononucleosis)?
Epstein Barr Virus [Herpes 4]
Give a complication of glandular fever
Guillain Barre Syndrome
Encephalitis
Hepatitis (+ jaundice)
True or false, people with glandular fever should not play sport for a month?
True , due to risk of organ rupture.
What is the cause of meningococcal septicaemia?
Neisseria Meningitidis
[G-ve]
NB: 10% of us have it in the back of our nasopharynx.
Give two investigations you would do if you suspect meningococcal septicaemia
Blood culture Lumbar puncture CT head FBC CRP
What is the treatment for meningococcal septicaemia?
IV Ceftriaxone
IV fluids
Dexamethasone (if >3months to reduce swelling).
What is the cause of mumps?
The mumps virus
A 17 year old patient presents with parotid swelling, fever and malaise. What do you suspect?
Mumps
Give two complications of mumps
Meningitis
Hearing loss
Orchitis (+infertility)
Pancreatitis
What is the treatment for mumps?
Supportive
gargle salt water
True or false, aspirin is the most common cause of Reye syndrome?
False.
Viral infection e.g. cold or chicken pox is the most common cause.
NB: Don’t give aspirin to under 16s
Give two signs of Reye syndrome
Vomiting Confusion Seizures Irritability Encephalopathy Deranged LFTs
NB: Around 30% die or have brain damage.
What is the most common cause of UTI?
E. coli
[G-ve aerobe]
Give one antibiotic you would consider for an lower UTI and an upper UTI
Lower:
- Nitrofurantoin
- Trimethoprim
Upper:
- Cefalexin
- Coamoxiclav
NB: Patients with penicillin allergies can still take cephalosporins safely.
If a UTI is resistant to penicillin or cephalosporin, what antibiotic can you use?
Meropenem
What is vesicoureteric reflux?
When urine flows retrograde from the bladder into the ureter.
It is common in paediatric UTI.
What three scans should be performed in patient’s under 6 months with UTI
Micturating Cystourethrogram (MCUG) - looks at urine flow.
Ultrasound
Dimercaptosuccinic acid scan (DMSA) - checks for scarring.
[MUD]
What is the most common cause of scarlet fever?
Group A Strep
[Strep Pyogenes]
Give two signs of scarlet fever
Sandpaper rash
Strawberry tongue
Fever
Lymphadenopathy
What is the treatment for scarlet fever?
Oral penicillin
[Cephalosporin if allergic]
How long should kids be off school with scarlet fever?
1-2 days post starting Abx.
What is the cause of measles?
Measles virus
Give two signs of measles
Rash starts on face and spreads to body.
Fever
Conjunctivitis
Koplik spots
What is the treatment for measles?
Supportive
Antipyretics/Analgesic
What is the cause of Impetigo?
Staph Aureus or Strep Pyogenes.
Give two signs of impetigo
Yellow crusty skin lesions
Pain
Itchy
What is the treatment of impetigo?
Topical antiseptic (1st line) e.g. Hydrogen peroxide 1% OR Topical antibiotic (2nd line) e.g. Fusidic acid 2% if antiseptic not appropriate.
Oral antibiotics if widespread bullous impetigo or patient is systemically unwell e.g. amoxicillin or cephalexin.
Which team must you involve if you suspect orbital cellulitis?
ENT review
[concern is brain abscess]
What is the treatment for orbital cellulitis?
Triple therapy:
Flucloxacillin
Metronidazole
Cefotaxime
[‘Fuck My Cellulitis’]
Give a common cause of orbital cellulitis
Staph aureus
Strep pneumoniae
[Often results from a sinus infection]
What is chemosis?
Swollen conjunctiva
What investigations would you perform for orbital cellulitis?
Blood cultures
FBC
CT/MRI
Name a common pathogen responsible for meningitis in neonates and in infants (post 3 months).
Neonates: [GEL]
- Group B strep
- E. coli
- Listeria
Infants:
- Haemophilus Influenzae
- Neisseria Meningitidis
- Strep Pneumoniae
What antibiotic would you use to treat meningitis in neonates vs infants?
Neonates: Cefotaxime + Amoxicillin (for Listeria)
Infants: Ceftriaxone
Which antibiotic is used as prophylaxis for meningitis? What else is given to patients at risk?
Ciprofloxacin
Rifampicin
Vaccinations:
Men B & ACYW
Hib
Pneumococcal
What is another name for laryngotrachealbronchitis?
Croup
What causes croup?
Parainfluenza
Influenza
{Bacteria also]
Give two signs of croup
Stridor Barking cough Hoarse voice Worse at night Otherwise well
What sign might you expect to see on CXR of a patient with croup?
“Steeple sign”
[pinched trachea]
What is the treatment for croup?
Dexamethasone
Nebulised adrenaline (if severe)
Supportive
What causes Henoch-Schonlein Purpura?
IgA vasculitis
[Abnormal immune response]
Cause: unknown
Often follows viral infection.
What is the treatment for Henoch-Schonlein Purpura?
Analgesia
Corticosteroids
Give a cause of Haemolytic Uremic Syndrome (HUS)
E. coli [EHEC] 0157:H7
Shigella
Salmonella
What is the treatment for HUS?
Plasmapheresis
Transfusion
Supportive
Dialysis
What is the cause of Rubella?
Rubella virus
Give two signs of Fragile X syndrome
Large ears Large testicles Autistic features Long face Intellectual impairment
What is the cause of Prader Willi Syndrome? What is the difference between Prader Willi and Angelman?
Loss of function mutation of genes on Chromosome 15
Prader Willi = paternal mutation
Angelman = maternal mutation
Give two signs of Prader Willi Syndrome
Intellectual impairment Obesity Infertile Hypogonadism Downward mouth Almond shaped eyes Narrow temple distance
True or false, Rhett syndrome is mostly inherited?
False.
95% is de novo i.e. a germ line mutation
Give two signs of Rhett syndrome
Repetitive movements (hand wringing)
Intellectual impairment
Seizures
Small head
What is the karyotype for Turner’s syndrome?
45 XO
[Female missing an X]
Give two signs of Turner’s syndrome
Webbed neck Short stature Low set ears Low hairline Infertile (mostly)
What is the karyotype of Kleinfelter’s syndrome?
47XXY
[Male with extra X]
Give two signs of Kleinfelter’s syndrome
Tall Normal intellect Low libido Gynaecomastia Small genitalia Infertile
What is strabismus?
Misalignment of the axis of the eyes when focussed on an object
[Aka a squint]
What is the most common cause of refractive error in children?
Strabismus [Squint]
2% will have a transient squint in first 3 months.
What are the 4 types of manifest squints and latent squints?
Manifest - always present. Esotropia - inward Exotropia - outward Hypertropia - upward Hypotropia - downward
Latent - present only when eye is covered. Esophoria - flicks outwards Exophoria - flicks inwards Hyperphoria - flicks down Hypophoria - flicks up
In strabismus surgery what is the difference between recession and resection?
Recession = weakens the muscle
Resection = strengthens the muscle
For how long and how young must you be to suffer from Juvenile Idiopathic Arthritis?
> 6 weeks
Under 16 years of age
How many joints are affected in oligoarticular and polyarticular arthritis?
Oligoarticular = 4 or fewer Polyarticular = 5+
An obese 12 year old comes in with a limp, which common fracture do you suspect?
Slipped Capital Femoral Epiphysis [SCFE]
Sciffy from too much skippy peanut butter!
Give a risk factor for hip dysplasia in an infant
Genetic
Breech birth
Swaddling
What are the 2 clinical examinations done to investigate hip dysplasia in newborns?
Barlow = aDduct + push inferiorly to dislocate.
[‘Barlow is an Addict’]
Ortalani = aBduct to relocate.
[B comes before O]
What is hip dysplasia?
Where the head of the femur is misaligned with the acetabulum.
This can progress to subluxation where the head of the femur is partially out or full luxation (dislocation).
Which hip joint condition is most common in 4-8 year olds?
Perthe’s Disease
[Osteochondritis]
Loss of blood supply to the femoral head resulting in avascular necrosis and loss of bone mass.
Give two causes of faltering growth in an infant
INTAKE:
- Cleft palate
- Vomiting
- Malnutrition
- Neglect
ABSORPTION:
- Coeliacs
- CMPA
ENERGY USE:
- Cancer
- Heart disease
What is a PEG tube?
Percutaneous Endoscopic Gastronomy
Tube inserted into the stomach via the abdominal wall. Indicated if there is a danger of aspiration or for gastric decompression.
In cow’s milk protein allergy (CMPA) how do you differentiate between IgE mediated and non-IgE mediated?
IgE mediated = reaction is within 2hrs.
Non-IgE mediated = 2-72 hrs.
What is the advice for CMPA?
Avoid cow’s milk for 12-18 months then start trying to reintroduce it.
True or false, cow or goat milk is fine for babies under 1 year old?
False. It does not contain a full nutrition profile.
Can drink whole milk from 1-2 years on.
What is the test for lactose intolerance?
Hydrogen breath test
Nil by mouth for 12 hrs, then baseline taken. Lactose solution given and breath rechecked every 15 minutes for 4 hours.
