Paediatrics Flashcards
Acute epiglottitis
Common bacterium
Features (5)
Position
Onset
Other
H. influenza type B
Features
- Tripod position
- Rapid onset
- Stridor
- Drooling of saliva
- Temperature
Thumb sign seen in which condition?
Steeple sign - subglottic narrowing seen in which condition?
Dx for epiglottitis
Mx
Sign seen on xray epiglottitis
Sign seen on xray croup
Visualisation +/- xray
Mx intubation, oxygen, abx
A sporty teenager presents with knee pain after exercise associated with intermittent swelling and locking
Osteochondritis dissecans
a teenage girl presents with medial knee pain following activity. The knee has given way on occasion
Patellar subluxation
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Osgood-Schlatter disease
tibial apophysitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Patellar tendonitis
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
Chondromalacia patellae
most common malignancy affecting children
Peak age
ALL
2-5yo
- Thrombocytopenia - easy bruising
- Anaemia - lethargy, pallor
- Neutropenia - frequent infections
- Fever
- Splenomegaly/ hepatomegaly
Name the most likely condition
ALL
ALL poor prognostic factors (5) Age WCC number Surface markers Race Gender
age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers non-Caucasian male sex
Aortic stenosis in children are associated with which three conditions?
Mx (2)
William’s syndrome
Coarctation of the aorta
Turner’s syndrome
- Valve replacement
- If gradient across valve is > 60 mmHg then balloon valvotomy
What is the APGAR score?
Score 0,1,2 for each of the below
Pulse: absent, <100, >100
Resp effort: nil, weak irregular, strong/ crying
Colour: blue all over, extremities blue, pink
Tone: flaccid, limb flexion, active movement
Reflex irritability: nil, grimace, cries on stimulation
0-3 very low
4-6 moderate
7-10 good
ADHD
Mx (4)
Mx
- 10 week watch and wait period
- Refer to paeds or CAMHS
- Education and training programmes
- Drug therapy as last resort and only offered to those >5yo –> first line methylphenidate for 6 weeks
If in adequate response –> lisdexamfetamine
Monitoring methylphenidate + lisdexamfetamine
Baseline ECG
Height and weight every 6 months
What is benign rolandic epilepsy? Type of seizures EEG findings? When do the seizures stop? Are they aware?
Seizures occur mainly at night Partial seizures EEG shows centro-temporal spikes Seizures usually stop by adolescence Has awareness
Bronchiolitis
Organisim
Age group
Features
Dx
RSV
Most common in <1yo
- Dry cough
- Wheeze
- Feeding difficulties
Dx immunofluorescence of nasopharyngeal secretions may show RSV
Bronchiolitis
Rx
- Oxygen via headbox if <92%
- NG feeding
- Suction for secretions
Difference between Caput succedaneum and Cephalohaematoma
When does the swelling occur? Which crosses suture lines? How long to resolve? Where is the swelling? Cause?
Caput succedaneum
- swelling following prolonged/ traumatic delivery
- vertex and crosses suture lines
- days to resolve
- present at birth
Cephalohaematoma
- develops several hours post delivery
- usually secondary to bleeding
- parietal region, does not cross suture lines
- can develop jaundice
- can take three months to resolve
Normal RR in newborn
Normal HR in newborn
35-60
120-160
Where do threadworms come from?
Name the bacteria
Features
Mx
Enterobius vermicularis
Infestation occurs after swallowing eggs that are present in the environment.
perianal itching, particularly at night
Vulval itching
Mx
<6 months - hygiene measures only
>6 months - mebendazole
Causes of snoring (5)
- obesity
- nasal problems
- recurrent tonsillitis
- Down’s syndrome
- hypothyroidism
What is hypospadias?
Mx
Incorrect anatomy of urethral meatus, usually on ventral side of penis
Mx
Refer immediately
Surgery at 1yo
Nil circumcision
Features of CF
- short stature
- delayed puberty
- rectal prolapse (due to bulky stools)
- nasal polyps
- male infertility, female subfertility
CF associated conditions (4)
Genetics
Usually picked up at newborn screening programmes
- Mec ileus
- Recurrent chest infections
- Malabsorption/ FTT
- DM
AR CFTR gene chrm 7 delta F508
Congenital cyst found in the mouth
Common on hard palate
Epstein’s pearl
Hand foot mouth disease: Virus:
coxsackie A16
At what age is head banging a sign of autism?
3yo = sign of autism 2yo = normal
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
Hand foot and mouth disease
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci - strep pyogenes
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Scarlet fever
Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Erythema infectiosum
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Rubella
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Mumps
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Measles
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
Chickenpox
Abdominal mass
Painless haematuria
Flank pain
Anorexia/ fever =
Wilm’s tumour
Moderate
Severe asthma criteria
Life threatening
PEFR Sats Clinical signs HR RR
Moderate, severe, life threatening
PEFR >50%, 33-50%, <33%
Sats >92%, <92%, <92%
Moderate - no clinical features of asthma
Severe: Too breathless to talk
Life threateningL silent chest
Severe: HR >120 >5yo, >140 1-5yo
SevereRR >30 >5yo, >40 1-5yo
Life threatening poor resp effort
Severe: Use of accessory neck muscles
Life threatening: agitation, altered consciousness, cyanosis
Acute asthma mx
- SABA via a spacer
1 puff every 30-60 seconds up to a maximum of 10 puffs
If sx not controlled repeat and refer
- Steroids 3-5 days
2-5yo 20mg OD
>5yo 30-40mg
Asthma chronic mx >5yo
- SABA
- SABA + low dose ICS
- SABA + low dose ICS + LTRA
- SABA + low dose ICS + LABA (stop LTRA if not helpful)
- SABA + MART (low dose ICS)
- SABA + MART (mod ICS) OR SABA + mod ICS + LABA
- SABA + MART (high ICS) OR
SABA + high ICS + LABA OR
Step 6 + theophylline OR
Refer
Asthma chronic mx <5yo
- SABA
- SABA + mod dose ICS 8 week trial
After 8 week trial stop the ICS
- if symptoms did not improve, consider alternative diagnosis
- if symptoms had improved but reoccured within 4 weeks, start SABA and low dose ICS
- if symptoms had improved but reoccured after 4 weeks, retrial 8 weeks mod dose ICS + SABA - SABA + low dose ICS + LTRA
- Stop LTRA and refer
SIDS protective factors (3)
breastfeeding
room sharing
the use of dummies
Features rapid onset unwell, toxic child stridor drooling of saliva
acute epiglottitis
Features are of sudden onset coughing choking vomiting stridor
Inhaled foreign body
Congenital abnormality of the larynx.
Infants typical present at 4 weeks of age with:
stridor
Laryngomalacia
stridor barking cough (worse at night) fever coryzal symptoms 6 months - 3 years =?
Croup
What is Plagiocephaly?
What is Craniosynostosis?
parallelogram shaped head
premature fusion of skull bones
What is the Kocher criteria?
What is it used for?
Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip.
Non weight bearing
Temp >38.5
ESR >40
WCC >12
More than 1 criteria 40% chance of septic arthritis
Mx unilateral undescended testes
Mx bilateral
Refer at 3 months
To be seen by 6 months
Surgery at 1yo - orchidopexy
Reviewed by a senior paediatrician within 24hours
Complications of undescended testes (3)
infertility
torsion
testicular cancer
Name x5 cyanotic heart disease in children
- ToF (presents at 1-2 months)
- Transposition (presents at birth)
- Tricuspid atresia
Name x5 acyanotic heart disease in children
- VSD
- PDA
- ASD
- Coarctation
- Aortic valve stenosis
SIDS major RF (5)
SIDS other RF (5)
Usually what age
sleeping prone parental smoking prematurity bed sharing hyperthermia
male sex multiple births social classes IV and V maternal drug use incidence increases in winter
1st year of life, commonly at 3 months
RF for Surfactant deficient lung disease (5)
CXR findings
- prematurity
- male sex
- diabetic mothers
- Caesarean section
- second born of premature twins
ground-glass’ appearance with an indistinct heart border
Hirschsprung’s disease
Initial ix
Gold standard Ix
Mx
AXR
Rectal biopsy
initially: rectal washouts/bowel irrigation
definitive management: surgery to affected segment of the colon
Umbilical hernia in children mx
Which race is more common
Common in which condition?
Usually resolves by age 3yo
Afro-Caribbean infants
Down’s syndrome
acute hip pain associated with a viral infection
2-10yo
commonest cause of hip pain in children
transient synovitis
mx self limiting
When is the heel prick test done?
Diseases checked for? (9)
5-9 days of life
congenital hypothyroidism cystic fibrosis sickle cell disease phenylketonuria medium chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD)
Most common nephrotic syndrome?
Mx
Minimal change
High dose steroids
fine, fair hair learning difficulties, seizures downwards (inferonasal) dislocation of lens increased risk of VTE malar flush, livedo reticularis Mx
Homocystinuria
vitamin B6 (pyridoxine) supplements.
What is cradle cap?
What age?
When does it resolve?
Mx
First few weeks of life
Erythematous rash with coarse yellow scales on scalp
Seborrhoeic dermatitis
Usually resolves spontaneously by 8 months
mild-moderate: baby shampoo and baby oils
severe: mild topical steroids e.g. 1% hydrocortisone
What is used to maintain a patent ductus arteriosus?
PGE1
What is the nitrogen washout test?
To differentiate cardiac from non-cardiac causes of cyanosis.
Give 100% O2 for 10 minutes
Take an ABG
If pO2 <15kPa = cyanotic congenital heart disease
What is Acrocyanosis?
How long will it last?
Normal peripheral cyanosis around mouth and extremities.
Occurs immediately after birth
Can persist for 24 to 48 hours
Development milestones When to refer: Not smiling by? Cannot sit unsupported by? Cannot walk by?
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
Chickenpox infectivity period
Features (4)
4 days prior to the rash, 5 days after the rash, or until lesions have crusted over
- fever initially
- itchy, rash starting on head/trunk before spreading.
- Initially macular then papular then vesicular
- systemic upset is usually mild
Chickenpox
Name of virus
Mx (1)
Varicella zoster
- Calamine
Child development
When is hand preference abnormal?
Before 12 months
Constipation mx (2)
- Movicol Paediatric Plain using an escalating dose regimen
2. If not effective after 2 weeks add a stimulant laxative e.g lactulose
Cow’s milk protein intolerance (CMPI)
Presentation
Features (5)
Within first 3 months of life in formula fed babies
- regurgitation
- diarrhoea
- urticaria, atopic eczema
- ‘colic’ symptoms: irritability, crying
- vomiting
Cow’s milk protein intolerance (CMPI)
Mx (2)
If breastfeeding? Mx
Mild-moderate sx
1. extensive hydrolysed formula (eHF) milk
Severe sx
2. amino acid-based formula (AAF)
If breastfeeding
Continue breastfeeding
Eliminate cow’s milk protein from mum’s diet
Calcium supplements
Usually resolves in children by age 3-5
Croup
Caused by?
Age
Parainfluenza
6 months - 3years
Croup
When to admit? (4)
Mx (2)
Acute (2)
- <6 months
- Upper airway abnormalities
- Moderate or severe croup
- Uncertain diagnosis
Mx
Single dose dexamethasone to all children regardless of severity
OR
Pred
Acute
High flow oxygen
Nebulised adrenaline
RF development dysplasia of the hip (6)
- female sex: 6 times greater risk
- breech presentation
- positive family history
- firstborn children
- oligohydramnios
- birth weight > 5 kg
Who gets screening for development dysplasia of the hip?
(3)
Dx investigation
Mx (3)
USS
- 1st degree relative with hip problems early in life
- Breech from K36
- Multiple pregnancy
Barlow (dislocate) and Ortolani (relocate)
All babies newborn and at 6 week check
USS unless >4.5months - xray
Mx most will resolve by 3-6 weeks of age
Otherwise Pavlik harness if <4 months
Otherwise surgery
Most common cause of acute diarrhoea in children?
Chronic diarrhoea
Rotavirus
Cows milk protein intolerance
Eczema
Locations commonly affected?
Age of onset
Age it normally resolves
Mx
Face and trunk, younger children is extensor surfaces
Older children flexor surfaces, creases of face and neck
Normally onset <6months, resolves by age 5
Mx
- simple emolients
- topical steroids
What age to refer kids with epistaxis?
Age <2yo
Pneumonia
Most common organism
Mx
Mx myoplasma or chlamydia
Mx pneumonia associated with influenza
Strep pneum
Amoxicillin
Macrolides should be used if mycoplasma or chlamydia is suspected
In pneumonia associated with influenza, co-amoxiclav is recommended
‘projectile’ vomiting, typically 30 minutes after a feed
constipation
dehydration
palpable mass may be present in the upper abdomen
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
=
age of onset
dx
mx
pyloric stenosis
second to fourth weeks of life
USS
Surgery: Ramstedt pyloromyotomy
School exclusion No exclusion (7)
Conjunctivitis Slapped cheek/ fifth disease Roseola Infectious mononucleosis Head lice Threadworms Hand, foot and mouth
School exclusion Scarlet fever Whooping cough Measles Rubella Chickenpox + impetigo Mumps Scabies+ influenza
Days 24 hours after starting abx 2 days after starting abx 4 days of onset of rash 5 days of onset of rash all lesions crusted over 5 days of onset of swollen glands Until recovered
Measles
Infective period
Features (3) including location of rash
Ix
Mx
What to do if has not taken MMR but has been exposed to measles?
infective from prodrome until 4 days after rash starts
- Prodrome - irritable, conjunctivitis, fever
- Koplik spots - white spots on buccal mucosa before rash
- rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Ix IgM antibodies
Mx supportive
Give MMR within 72 hours
Measles
Top two complications
- Otitis media
2. Pneumonia
Whooping cough AKA
Bacterium
Gram +ve/-ve
Features (5)
How long can symptoms last for?
Pertussis
Bordetella pertussis
Gram negative
Features
- 2-3 days of coryzal sx .. then
- Coughing bouts, worse at night
- Vomiting +/- cyanosis
- Inspiratory whoop
- Apnoea
10-14 weeks
Whooping cough
When to admit?
Mx (2)
School exclusion
Complications (4)
<6 months
Mx
1. Macrolide if cough within 21 days of onset of cough
2. Household contacts should be offered abx
48 hours of onset of abx
- Subconjunctival haemorrhage
- Pneumonia
- Bronchiectasis
- Seizures
UTI in children
When to do an USS?
Other Ix (3)
< 6 months + first UTI which responds to treatment USS within 6 weeks
> 6 months with atypical infection or recurrent infection
Ix
- MSU - for culture
- DMSA 4-6 months post infection - to check for scarring
- MCUG if <6 months and atypical/ recurrent infection - to identify vesicoureteric reflux
What is the most common cause of cyanotic congenital heart disease?
Age of presentation?
Features (4)
CXR finding
ECG finding
What medication can be given for cyanotic episodes?
ToF
1-2 months
- VSD
- right ventricular hypertrophy
- pulmonary stenosis
- overriding aorta
CXR: ‘boot-shaped’ heart
ECG right ventricular hypertrophy
BBs
Scarlet fever caused by?
Features (6)
Group A haemolytic strep
Strep pyogenes
- ‘strawberry’ tongue
- . sand paper rash obvious in flexures
- rash: fine punctate erythema (‘pinhead’) on the torso and spares the palms and soles
Scarlet fever
Dx
Mx (2)
School exclusion
Complications
- Throat swab
Mx treat before results
- Penicillin V for 10 days
- Azithro if pen allergic
24 hours after commencing antibiotics
Complications
- Otitis media
- Glomerulonephritis
- RhF
Roseola infantum AKA
Caused by?
Sixth disease
HHV6
high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
=
Roseola infantum
Name the condition
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems
AD/AR
Chrm
Age of diagnosis
Mx
Retinoblastoma
AD
Chrm 13
18 months
Mx
Enucleation/ RT/ chemo/ photocoagulation
Food allergy Mx
If the history is suggestive of an IgE-mediated allergy what would you offer?
If the history is suggestive of an non-IgE-mediated allergy how would you manage the patient?
offer a skin prick test or blood tests for specific IgE antibodies to the suspected foods
eliminate the suspected allergen for 2-6 weeks, then reintroduce.
Gastroschisis
Mx (1)
MOD
Exomphalos
MOD
Associated with which three conditions?
Mx
Can have vaginal delivery
Theatre straight away
CS Beckwith-Wiedemann syndrome Down's syndrome cardiac and kidney malformations Mx can have surgery later as infant may need to grow a little so it can fit back in
Vaccinations At birth 2 months 3 months 4 months 12-13 months 2-8yo 3-4yo 12-13yo 13-18yo
At birth: BCG
2 months: ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), PO rotavirus, Men B
3 months: ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), PO rotavirus, PCV
4 months: ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B), Men B
12-13 months Hib/Men C, MMR, PCV, Men B
2-8 years Flu vaccine (annual)
3-4 years ‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio), MMR
12-13 years HPV vaccination
13-18 years ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio), Men ACWY
Low-pitched sound heard at the lower left sternal edge =
Still’s murmur - normal
paroxysmal abdominal colic pain
during paroxysm the infant will characteristically draw their knees up and turn pale
vomiting
bloodstained stool - ‘red-currant jelly’ - is a late sign
sausage-shaped mass in the right upper quadrant
= which condition?
Age
Gender
Ix + finding
Mx
Intussusception
6-18months M>F
USS - target-like mass
Mx reduction by air insufflation under radiological control
