Paediatrics Flashcards
Name the developmental milestone at 4-12 weeks
Holding head up when lying flat
Name the developmental milestone at 3-5 months
Reaches for objects and can hold them
Can lift head and chest
Name the developmental milestone at 6 and 8 months respectively
6m - can sit up with support
8m - can sit up unaided
Name three developmental milestones at 9-12 months
Drops objects and picks them up
Starts to crawl
Can pull themselves up in prep to stand
Name two major milestones happening at 12 months
Begin to stand
Says first word
Name 3 developmental milestones at 13-18 months
Starts to feed themselves
Begins to build with bricks
Starts to walk unaided
What developmental milestone happens at 24 months?
Walks up and down steps
Describe the Moro Reflex
Startled response to a change in sensory stimuli (i.e dropping the baby)
Should stop at 2-4m
Describe the Rooting Reflex
Baby automatically turns head to touch on cheek (assists in finding food)
Should stop at 3-4 months
Describe the Palmar Reflex
Hands grip anything placed in them
Should stop at 5-6 months
Describe the Asymmetrical Tonic Neck
When turning the head, the limbs on the same side extend while the opposite side bends
Describe Symmetrical Tonic Neck
When head is down, arms bend and legs extend
When head is back arms extend and legs bend
Describe the Spinal Galant Reflex
Hip rotation when back is touched on either side
At 6 week checks both Mother and Babies are checked, describe 5 features of the Mother’s Check
How stitches have healed Breasts Rubella Immunity Vaginal Discharge? Periods? Mental Health
What four things does the 6 week check of the baby aim to detect?
Congenital Heart Disease
Congenital Cataracts
Delevopmental Dysplasia of the Hip
Undescended Testes
Give three risk factors for DDH
Oligohydramnios
Family History
Breach Position
What is Barlow’s Test?
Identifies hips which are dislocatable
Keep ipsilateral hand on pelvis and greater trochanter, and with other hand FLEX and ADDUCT the hip, pushing posteriorly to see if hip ‘pops out’
What is Ortolani’s Test?
Identifies hips which are dislocated
Abduct the hip until it is flat on the bed, to see if you hear a ‘click’
What is the ‘Red Reflex’?
Should have a red reflection when shining an opthalmoscope into baby’s eye
If not indicates ocular pathology such as cataracts or other opacities
What body temperatures would cause concern in an infant (ie red and amber flag)?
> 38 degrees in 0-3m (RED)
>39 in 3-6m (AMBER)
Describe the infant classifications of ‘Tachycardia’
Greater than 160bpm in <1yr
Greater than 150 in 1-2yr
Greater than 140 in 2-4yr
Describe the infant classifications of ‘Tachypnoea’
RR>60 in 0-5m
RR>50 in 6-12m
RR>40 in older than 12m
Give 5 differentials for the ‘Common Cold’ in infants
Meningitis Herpes Simplex Encephalitis Pneumonia UTI Kawasaki
What is Whooping Cough?
A notifiable disease
A highly infectious respiratory infection caused by Bordatella Pertussis
Can still occur in vaccinated individuals
What is the incubation period and infectivity period of Whooping Cough?
Incubation Period is 7-20d
Non infectious after 3 weeks of symptoms onset
Describe the first stage presentation of Whooping Cough
Catarrhal
Mild Respiratory Infection
Describe the second stage presentation of Whooping Cough
Paroxysmal Coughing
After 1-2 weeks
Prolonged dry hacking cough followed by characteristic ‘whoop’ as they catch their breath
The cough can last 2-3 months even after infection has cleared
Describe two possible investigations for Whooping Cough
Nasopharyngeal Swab Culture Serology Testing (for Anti-Pertussis IgG)
Describe the management of Whooping Cough
Hospital Admission if under 6 months
Antibiotics don’t alter clinical course, only affect infectivity (therefore Clarythromycin only within first 3 weeks)
What is GORD in Children?
Non forceful regurgitation of milk and other gastric contents into the oesophagus (should be distinguished from vomiting - active)
Give four risk factors for GORD in Children
Premature Birth
FH
Obesity
Hiatus Hernia
Give four presentations of GORD
Heartburn
Recurrent regurgitation/vomiting
Feeding and Behavioural Problems
Failure to Thrive
What is laryngopharyngeal reflux?
Reflux into larynx, oropharynx and/or nasopharynx
How would you manage GORD in infants?
Reassure that it’s very common and generally doesn’t require any further investigation
If formula fed try smaller more frequent meals with thickened formula (Gaviscon, Carobel)
When should you investigate infantile GORD further?
If it becomes projectile
If it becomes haematemesis/blood stained
What is Croup?
Inflammation of upper respiratory tract usually as a result of viral infection, affecting primarily 6 months to 3 years
What is Spasmodic Croup?
If recurrent bouts then aetiology is more likely allergic than infective
How would Croup present?
Typical URTI then a barking cough/hoarse voice starts
May have Stridor
Severity assessed with Westley CLinical Scoring System
How would you manage Croup?
Keep the child as calm as possible Paracetamol/Ibuprofen Inpatient O2 Therapy Oral Dexamethasone/Nebulised Budesonide Nebulised Epinephrine
Name three features that decrease the probability of a child having Asthma
Symptoms only occurring in conjunction with a cold
Isolated cough without wheeze/breathing difficulties
Productive cough
Spirometry can be used from the age of 5, if it was negative what other investigations could you consider?
Atopic Status (Skin tests, IgE) Bronchial Hyperresponsiveness (exercised induced? Metacholine induced?)
Describe the four step (up) management for Asthmatic Children under 5
1) SABA PRN
2) Beclometasone Diproprionate
3) If over 3 - Leukotriene Antagonist (Montelukast)
4) Refer to Paediatrician
Describe the five step (up) management for Asthmatic Children aged 5-12
1) SABA PRN
2) Betamethasone Diproprionate
3a) LABA
3b) Increase Steroid dose to 400mcg or add Leukotriene Antagonist
4) Increase Steroid dose to 800mcg
5) Oral Steroids
Name the most common brand name of a SABA inhaler
Ventolin
Name two brand names of steroid inhalers
QVAR (Beclometasone)
Pulmicort (Budesonide)
What is contained in Fostair inhalers?
Formeterol and Beclometasone
What is contained in Symbicort inhalers?
Formeterol and Budesonide
Conjunctivitis in children is normally bacterial in origin, how would it present?
Generally absence of itch
Purulent discharge
Discomfort
Mild Photophobia
Give 3 risk factors for Conjunctivitis in Children
Nasolacrimal duct obstruction
Concomitant Otitis Media and Pharyngitis
Exposure to affected individual
What is Opthalmia Neonatorum?
Any conjunctivtis in the first 28 days of life
Caused by either Silver Nitrate eye drops (originally used as prophylaxis against conjunctivitis) or infection by maternal genital tract
How would you manage Conjunctivitis in children?
Self limiting
Gonorrhoea - IM Ceftriaxone
Chlamydia - Tetracylcline ointment and systemic doxycycline
Name three common pathogens of Acute Otitis Media
Haemophilus Influenza
Streptococcus Pneumoniae
Streptococcus Pyogenes
State four symptoms of Acute Otitis Media
Pain (tugging at ear)
Malaise
Irritability
Fever
How would Acute Otitis Media present on an auroscope?
Red/Cloudy tympanic membrane, likely bulging
What might be a sign of ear perforation of Children with Acute Otitis Media?
Relieves pain in the child
Scream/Distressed may suddenly stop
Green Pus out of ear
When should you admit patients with Acute Otitis Media?
Children under 3 months with a temp greater than 38 (RED FLAG) Suspected complications (meningitis, mastoiditis, facial nerve paralysis)
When should you offer Abx for Acute Otitis Media? What should you give?
Systemically unwell
At risk of complications
Symptoms not improving after four days
Children less than 2y/o with bilateral infection
5 Day Amoxicillin
Give 4 causes of constipation in Children
Anorectal Malformation
Cow’s Milk Allergy
CF
Hischsprungs Disease
How would you manage Constipation in a child
Disimpaction - Osmotic Laxative (Movicol Paediatric) and then if no improvement after two weeks a Stimulant Laxative (Bisacodyl)
Maintenance - increased fluids and fibre, bowel charts
Why should you avoid prolonged use of Stimulant laxatives?
Can cause atonic colon and hypokalaemia
What is the infectivity period of Chickenpox?
2d prior to lesions appearing to after they scab over (around 5d later)
Who is at risk of SERIOUS complications of Chickenpox?
Immunocompromised
Pregnancy (for mother and foetus)
Name four features of Chickenpox
Pyrexia
Headache
Malaise
Lesions
Describe the lesions of Chickenpox
Papule to Vesicle to Pustule to Crust
How would you manage Chickenpox?
Advise minimising scratching and avoiding pregnant women/neonates etc
Symptom management with Paracetamol and Antihistamines for Pruritus
Only give Acyclovir if at risk of complications
Describe 3 complications of Chickenpox
Secondary bacterial infection
Viral Pneumonia
Encephalitis
Name the early and late complications of VZV in pregnancy
Early - Congenital Varicella Syndrome (IUGR)
Late - Premature Delivery
Define Measles
A notifiable disease caused by RNA Morbillivirus
One of the most infectious diseases (airborne transmission via respiratory droplets)
What is the infective period of Measles?
Four days before the rash appears until four days after
How does Measles present?
Prodrome - fever/cough/conjunctivitis/Kopliks spots on buccal mucosa (red spots with bluish white centre)
Rash - first seen in head anc neck before spreading to trunk and limbs (lasts 3-4 days before fading to give brownish discolouration)
How is Measles diagnosed?
Lab test for specific IgM for Measles within 6 weeks of onset
How would you manage Measles?
Self limiting
Paracetamol/Ibuprofen
Stay at home
Give 3 complications of Measles
Bronchopneumonia
Giant Cell Pneumonitis
Acute Demyelinating Encephalitis
Describe 5 features of Head lice management
Can still attend school No need to wash clothing/bedding Mechanical - wet combing Physical Insecticides - Hedrin (block o2 supply) Chemical Insecticides
Describe the pathophysiology of Viral Warts
Caused by various strains of HPV
Infection of keratinocytes causes hyperkeratinisation and epidermal thickening
Transmitted by direct contact
Describe three subtypes of viral warts
Common - papules and nodules usually on hands
Plantar Wart - Verucca
Periungal Wart - Warts around the nails, more common in nail biters
How would you manage viral warts?
Generally don’t
If immunocompromised/symptomatic then use topical salicyclic acid or cryotherapy
Describe the pathophysiology of Threadworms
Female threadworms lay their eggs around the childs perineurium and produce an irritant mucous which causes intense pruritus
How might Threadworms present?
Nocturnal pruritus
Prepubertal vaginal discharge/UTI/nocturnal enuresis
What investigations would you do if you suspected Threadworms?
Simple report of appearance of ‘moving cotton’
ALWAYS suspect the possibility of sexual abuse
How would you manage Threadworms?
Good hygiene for 6 weeks (tight udnerwear at night/shower every morning/change and wash undwear and bedding daily)
Mebendazole (single dose) if over two (only kills adult worms) FOR WHOLE FAMILY
What is Scarlet Fever?
Exotoxin mediated disease arising from Strep Pyogenes (normally from tonsillar/pharyngeal infection
Spread by respiratory droplets
How does Scarlet Fever present?
Onset of illness is usually sudden with fever/headache/sore throat
Rash follows 24-48hrs after
Describe the Scarletiniform Rash
First affects neck/trunk/scapula
Coarse texture
Circumoral Pallor
Tongue - white strawberry
How would you manage Scarlet Fever?
Penicillin/Azithromycin for 10 days
Rest and Fluids
Paracetamol/Ibuprofen
What is the difference between GORD and GOR in Children?
GORD is where there is evidence of Oesophagitis (crying, arching back)
What is the Colic Rule of 3?
Crying more than 3 hours a day, more than 3 days a week, for more than three weeks
Generally occurs from 2 weeks to four months
Still Thriving
How would Cows Milk Protein Allergy present?
Any of the 8 core GI symptoms
In terms of timing in children’s symptoms, what is a red flag?
Nocturnal symptoms are rare in children, so should be treated as a red flag
Describe the pathophysiology of DDH
Misalignment of femoral head and acetabulum , causing them to grow out of proportion to each other
Ligaments and labrum hypertrophy to fill the space
Results in unstable hip joint
How might a patient with DDH present?
May have no symptoms and be an incidental finding on the 6w baby check
Uneven leg length
Painless Limping
Waddling gait
How is DDH managed?
<6 months - Povliks harness, keeping the femoral head in the acetabulum via flex ion and abduction
> 6 months - reduction under anaesthesia
What is Perthes Disease?
Childhood disease where blood supply to the femoral head is reduced resulting in avascular necrosis
How would a patient with Perthe’s disease present?
Limp and Hip Pain (often referred to knee, worsened with activity, or with internal rotation/abduction
Associated Muscle Disuse Atrophy
How would you investigate suspected Perthes Disease?
X-ray - flattening/misshapen femoral head
MRI
How would you manage Perthes Disease?
Generally self resolving, so just conservative management including physio
If very fractured may require surgery
What is Gillick’s Competence?
The idea that some children will be capable/competent enough to consent to their own medical management decisions despite being under the age of 16
