Paediatrics Flashcards
2 most common types of atrial septal defect
- Ostrium secondum (septum secondum does not close)
2. Patent foramen ovale
Most common complication of atrial defect septal
Increased risk of stroke if patient has VTE (clots pass from right atrium into left atrium towards the brain)
A mid-systolic murmur alongside a split S2 heart sound may be a sign of
Atrial septal defect
Pulmonary hypertension secondary to septal defects is termed
Eisenmenger’s Syndrome
3 RF of atrial septal defect
- Down’s Syndrome
- Epstein’s abnormality
- Foetal alcohol syndrome
2 RF for ventricular septal defect
- Down’s Syndrome
2. Turner’s Syndrome
Mitral regurgitation and tricuspid regurgitation in someone with Down’s Syndrome may be a sign of
Ventricular septal defect
Coarctation of the aorta involves narrowing of the aortic arch at which point
Ductus arteriosus
Blood pressure differences in all limbs, alongside a left ventricular heave may be a sign of
Coarctation of the aorta
Coarctation of the aorta is most commonly associated with
Turner’s Syndrome
The ductus arteriosus should close at
2-3 weeks after birth
What shunt is seen in a patent ductus arteriosus?
Left-to-right
Widened pulse pressure and dyspnoea in a premature baby 1 month after birth may be a sign of
Patent ductus arteriosus
4 pathologies in Tetralogy of Fallot
- Ventricular septal defect
- Overriding aorta
- Pulmonary stenosis
- Right ventricular hypertrophy
Pathophysiology behind an overriding aorta
The aortic valve is shifted to the right causing it to receive deoxygenated blood
Tet spells can be defined as
Intermittent, life-threatening cyanotic episodes
CXR finding for Tetralogy of Fallot
Boot-shaped heart
Type of shunt in Tetralogy of Fallot
Right-to-left shunt
What maternal infection can cause congenital heart abnormalities such as Tetralogy of Fallot and patent ductus arteriosus
Rubella
What murmur is atrial septal defect associated with?
Mid systolic, fixed P2, crescendo-decrescendo
What 3 conditions is an ejection systolic murmur without a fixed P2, that radiates to the axilla/back on inspiration a sign of?
- PS
- Tetralogy of Fallot
- Coarctation of the aorta
A subclavian holosystolic murmur could be a sign of
Patent ductus arteriosus
A pan systolic murmur is
VSD
An ejection systolic murmur at the 4th ICS LSB could be a sign of
Hypertrophic obstructive cardiopathy
4 referral criteria for a child with a heart murmur
- Louder on standing
- Diastolic
- Louder than 2/6
- Associated symptoms
4 cyanotic heart disease conditions
ASD, VSD, PDA, transposition of the great arteries
Explain Eisenmenger’s syndrome
Right-to-left shunt defect arising when pulmonary pressure > systemic pressure, causing cyanosis.
Seen in worsened VSD, ASD, PDA.
What is the only cyanotic heart disease condition that causes cyanosis (if stable)?
Transposition of the great arteries
SVT is caused by
Additional electrical circuits between the atria-ventricles creating a short circuit, increasing heart rate
Palpitations and light-headedness in a child may be a sign of
SVT
WPW syndrome is marked by what ECG finding and where is the re-entry point?
Slurred Q wave, Bundle of Kent
3 management points for a child with SVT
Valsava manœuvre, carotid sinus massage, catheter ablation
Emergency management of persistent SVT
Cardioversion, IV-antiarrythmics (adenosine)
Most common respiratory tract infection in a 1 year old
Bronchiolitis
Most common respiratory tract infection in a 3 year old
Epiglottitis
Laryngomalacia is also described as
Noisy breathing
Assume an apnoea episode if what two things have occurred?
Floppiness or cyanosis
Referral criteria for respiratory tract infections (5 points)
- Child is seriously unwell
- Severe respiratory distress
- Central cyanosis
- Persistent oxygen saturations < 92%
- Observed/reported sleep apnoea
Considerations for referral in respiratory tract infections
- RR > 60 breaths/min
- Poor feeding/inadequate oral intake (50-75%)
- Clinical dehydration
- Risk factors such as < 3 months, immunodeficiency, comorbidities
- Carer’s ability to care affected/long distance to hospital
Croup is a URTI caused by
Virus - parainfluenza, influenza, RSV, diphtheria (can also cause epiglottitis)
Croup CXR finding
Steeple sign
RSV is what type of virus
Pneumoviridae
Whooping cough is a gram -ve URTI caused by what bacteria?
Bordetella pertussis
What is the catarrhal phase in whooping cough?
7-10 days incubation period where URTI symptoms begin to develop. Patient is contagious.
How long is a patient contagious for with whooping cough?
Onset of symptoms - 48 hours after 1st dose of Abx. If Abx does not work, 21 days.
What is the paroxysmal phase of whooping cough?
Severe coughing fits (paroxysms) with inspiratory whooping 1 week after URTI symptoms develop
Apnoea, cyanosis, post-jussive vomiting and a cough could indicate
Whooping cough
What Abx for whooping cough?
Macrolide
Most common cause of bronchiolitis and what time of year does it arise?
RSV - Sept-April (winter)
When should a parent/carer seek medical help for a child with a RTI? (6 points)
- Increased RR and effort
- Apnoea
- Cyanosis
- Reduced fluid intake (50-75%), signs of dehydration (dry mouth, reduced urine)
- Persistent worsening of fever
- Less responsive child (unable to wake, cannot stay awake)
3 ways to differentiate viral-induced wheeze from asthma?
- Appears only when child has a viral illness
- Family history of viral-induced wheeze
- No history of atopy
Condition that causes chronic stridor on inhalation, that sounds like whistling?
Laryngomalacia
Laryngomalacia is a partial airway obstruction caused by what folds?
Aryepiglottic folds becoming shortened - forces epiglottis into an omega shape - causing the supraglottic larynx to flop
What wheeze should be investigated further?
Focal wheeze
5 signs/symptoms of pneumonia in a child
- High fever > 39 degrees
- Cyanosis
- Raised RR > 60 pm < 5 months, > 50 pm 6-12 months, > 40 pm 12 months +
- Focal wheeze
- Oxygen sats < 95%
Results suggestive of asthma (4 points)
- Spirometry ratio < 70%
- +ve > 12% BDR
- Peak flow > 20% variability
- FeNO > 35 ppb in children
Asthma management in < 5 years
- SABA inhaler
- ICS or LTRA
- Offer the other option
- Referral
Asthma management in a child aged 5-12 years
- SABA
- ICS
- LABA (salmeterol) if there is a good response
- Increase ICS dose +/- LTRA or oral theophylline
- Increase ICS to high dose
- Referral
What age do undescended testicles tend to drop?
3-6 months
What type of hydrocele is congenital?
Communicating - drains peritoneal fluid into the tunica vaginalis membrane.
Complication of hydroceles
Inguinal hernia
Neonates with a bell clapper deformity are at risk of
Testicular torsion
The meatus forms in what weeks of pregnancy
9-12 weeks
Chordee refers to
Penile head that curves downwards
Biggest RF for hypospadias
FH
Hypospadias may be a sign of
Intersex
Proteus mirabilis is seen in boys with
Uncomplicated cystitis
How many children with UTI have a urological abnormality?
50%
Who is most at risk of UTI in first year of life?
Uncircumcised boys
A child with an unexplained fever > 38 degrees and loin pain should have a
Urine sample sent off for microscopy and culture
A 2 year old child with a LUTI should have a
Dipstick and urine sample sent off
When should you treat for UTI?
+ nitrites +/- + leukocytes
3 referral criteria in paediatric UTI cases
- Seriously unwell
- Baby < 3 months (send urine sample off)
- Pyelonephritis
2 first-line Abx for UUTI
Cefalexin or co-amoxiclav
2 first-line Abx for LUTI
Trimethoprim or nitrofurantoin (if eGFR > 45 ml/min)
3 ultrasound criteria for children with UTI
- < 6 months and first UTI
- < 6 months and recurrent UTI
- > 6 months and recurrent UTI (6 weeks)
VUR causes
Retrograde flow of urine to kidney
Posterior urethral valve causes
Retrograde flow to bladder in newborn boys
HUS triad
- AKI
- Microangiopathic haemolytic anaemia
- Thrombocytopenia
HUS tends to be caused by
Bloody gastroenteritis - STEC E. Coli 0.157
Nappy rash tends to be caused by what dermatitis?
Irritant contact dermatitis
What can worsen nappy rash? (3 things)
Bottle feeding, cloth nappies, antibiotics
What should be avoided in nappy rash?
Poor quality/cloth nappies, powders, perfumed soaps
Examples of 2 barrier creams for nappy rash
Zinc and castor oil ointment or white soft paraffin ointment (sudocrem)
Cradle cap is also known as
Seborrheic dermatitis
Cradle cap is often colonised by what?
Malassezia yeast
Management of cradle cap
- Brush scalp with a light covering of vegetable or olive oil
- This will loosen scales
- Gently wash it off with shampoo
- Soak thick scales with white petroleum jelly
- Topical anti-fungals
Urticaria can be treated with what
Antihistamines - fexofenadine
Bull’s-eye target lesions that are symmetrical in nature may be a sign of
Erythema multiform
5 causes of erythema multiform
- Infection: HSV, mycoplasma pneumonia, hepatitis B, EBV
- Aminopenicillins
- Anticonvulsants
- Lidocaine
- Vaccines
Stevens-Johnson Syndrome affects how much of the body area and what is it characterised by?
10%
- Acute onset of rash
- Erosions and ulcerations of mucosa
- Nikolsky’s sign - epidermal layer sloughs off
5 causes of Stevens-Johnson Syndrome
- Trimethoprim
- Sulfamethoxaole
- Penicillins
- NSAIDs
- Infection
Cellulitis is caused by
S. pyogenes and S. aureus
1st line antibiotics for Class I cellulitis
Flucloxacillin or clarithromycin
Bullous impetigo is caused by
S. aureus
Non-bullous impetigo is caused by
S. aureus +/- S. pyogenes
Strep impetigo can cause
Glomerulonephritis
Honey-coloured red sores may be a sign of
Non-bullous impetigo
How long is a child contagious for with impetigo?
48 hours after initial treatment
1st and 2nd line treatment for non-bullous impetigo
1st: Hydrogen peroxide 1%
2nd: Topical flucloxacillin and fusidic acid 2%
Management of bullies impetigo
Oral flucloxacillin
3 referral criteria for impetigo
- Recurrent
- Bullous - in babies particularly
- Immunocompromised/very unwell
Lice is caused by the
Pediculus humans capititis
The white spots in hair are
Lice eggs
When should a parent treat their child for lice?
Wet comb on days 1, 5, 9, 13 and 17 using medicated lotions and sprays
Scabies is caused by
Parasitic itch mite sarcoptes scabiei
Itching that worsens at night, with a red papule rash could be
Scabies
Management of scabies
- Treat all household members and close friends/family
- Wash all bedding, clothes and towels at 60 degrees or quarantine for 72 hours
- Topical insecticide (permethrin)
- Treat itch with topical hydrocortisone and antihistamines
Coeliac’s Disease attacks where in the GI tract and what 2 histopathological findings does it cause?
Jejunum
Villous atrophy and crypt hypertrophy
Newly-diagnosed T1DM should be tested for what condition due to what common gene
Coeliac Disease - HLA-DQ2 gene
Itchy blisters on the abdomen of a child, coupled with mouth ulcers and failure to thrive are signs of
Coeliac Disease
Rare gastrointestinal cause of cerebellar ataxia in children
Coeliac Disease
What should be excluded for when testing for Coeliac Disease?
IgA Deficiency
3 autoantibodies often seen in Coeliac Disease?
Anti-TTG
Anit-EMA
Anti-DGP
Meconium ileus is a sign of
CF
Hirschsprung’s Disease causes no peristalsis in the distal bowel/rectum - obstruction due to absence of what
Myenteric plexus parasympathetic ganglion nerve cells
Congenital diverticular disease that commonly causes intussusception
Meckel’s
5 conditions that predispose someone to intussusception
- Concurrent viral illness
- Henoch-Schonlein purpura
- CF
- Meckel’s
- Polyps
5 RF of abdominal pain in children
- Persistent/bilious vomiting
- Severe/chronic diarrhoea
- Unexplained fever
- Rectal bleeding
- Weight loss/failure to thrive
5 causes of medical abdominal pain in children
- Constipation
- UTI
- Coeliac Disease
- IBD
- Mesenteric Adenitis
Define mesenteric adenitis
Abdominal lymphadenopathy following URTI/tonsillitis or during gastroenteritis.
Abdominal migraines often lead to headache migraines. What signs/symptoms are seen?
- Central abdo pain > 1 hour
2. Associated N&V, headache, aura
Management of non-organic, functional abdominal pain
- Maintain a healthy lifestyle
- Minimise stress
- Do not focus/ask about pain
- Avoid NSAIDs
- School counsellor/child psychologist
A RUQ sausage-shaped mass might indicate
Intussusception
Projective vomiting and an olive-shaped mass in the upper abdomen could indicate
Pyloric stenosis
What becomes narrowed in pyloric stenosis?
The pyloric sphincter
Investigation for pyloric stenosis
Abdo US
Ramstedt’s operation is performed to correct
Pyloric stenosis
Gastroenteritis is most commonly caused by
Viruses
E. coli 0157 causes
HUS - avoid antibiotics.
Bloody diarrhoea may be caused by what 2 bacteria
E. coli 0157 and Yersinia enterocolitica
Right-sided abdominal pain and a fever could be what 2 conditions
- Appendicitis
2. Mesenteric adenitis - secondary to gastroenteritis (yersinia enterocolitica)
Antibiotics are used to treat gastroenteritis when
There is a high risk of complications
5 signs/symptoms of constipation
- < 3 stools/week
- Hard stools
- Rabbit dropping stools
- Overflow soiling
- Retentive posturing
RF in childhood constipation
- Abnormal anus
- Ribbon shaped stools (stenosis)
- Neurological signs
- No meconium in first 48 hours
- Vomiting
Laxative of choice for idiopathic paediatric constipation
Movicol - Macrogol (osmotic laxative)
High doses of laxatives are given to children who are
Faecally impacted
Encopresis is
Faecal incontinence.
3 complications of gastroenteritis in a child
- E.coli 0157 - HUS
- Lactose intolerance
- GBS
Another is reactive arthritis
What immunoglobulin mediates cow’s milk allergy?
IgE
GI symptoms after consuming cow’s milk is a sign of
Cow’s milk protein intolerance (allergy is also allergic symptoms)
Mothers breastfeeding babies with a cow milk protein allergy should
Avoid dairy and slowly introduce milk
Lactose intolerance can arise following
Gastroenteritis
Oesophagitis in children is most commonly caused by
Allergies/atopy - eosinophilic oesophagus
Haematemesis and melena in a child with a tummy bug may be a sign of
Mallory-weiss tear secondary to severe vomiting
The most common cause of childhood jaundice
Viral hepatitis A/B
Jaundice that presents in a baby late in the first week of life and peaks in week 2-3
Breast milk jaundice (unconjugated bilirubin)
5 causes of neonatal jaundice
- Prematurity
- Rh incompatibility (RBC haemolysis)
- Biliary atresia
- Breast milk
- Congenital hypothyroidism
Complication of hyperbilirubinaemia in a neonate
Kernicterus - bilirubin induced encephalopathy
What can be used to measure bilirubin levels in a premature baby?
Transcutaneous bilirubinometer
4 reasons to suspect kernicterus
- Clinical features of kernicterus
- Serum bilirubin > 340 mm/l
- Rising bilirubin > 8.5 mm/l/hour
- Prematurity or illness
What type of hypersensitivity reaction is anaphylaxis and what immunoglobulin stimulates the mast cells to release histamine?
Type I
IgE
3 drugs given in anaphylaxis
- IM adrenaline
- Antihistamines (chlorphenamine or cetirizine)
- Steroids - IV hydrocortisone
Most common virus and most common bacteria that causes tonsillitis
Rhinovirus
Group A beta HS - Strep. pyogenes
Centor criteria and score for bacterial tonsillitis
> 3 = 40-60% chance of bacterial tonsillitis
- Fever > 38 degrees
- Exudate
- No cough
- Tender anterior cervical lymphadenopathy
Abdominal pain, vomiting and a headache in a child may be a sign of
Tonsilitis
Pharyngitis that presents in the winter/spring tends to be
Bacterial (GABHS)
Bacterial pharyngitis may cause
Scarlet fever
Enterovirus pharyngitis may cause
Hand, foot and mouth
Rhinorrhoea, nasal congestion and cough are present in what type of pharyngitis?
Viral
Complication of tonsillitis and management
Quinsy
Urgent ENT referral - incision and IV antibiotics
Abx advice for a mother worried about their infant with otitis media ( points)
- Most cases resolve without antibiotics
- Back-up Abx: If symptoms do not improve in 3 days or worsen/or child becomes systemically unwell
- Antibiotics tend to only benefit those who are very unwell, high risk of complications, children < 2 with bilateral infection
A 2 month old baby presents with a fever > 38 degrees and is pulling at their ear. What is your management?
Admit to hospital
1st line Abx for AOM
Amoxicillin or clarithromycin
3 antibiotic options for a child with AOM
- No Abx
- Delayed Abx
- Immediate Abx
Diagnosis and management for a child with recurrent AOM and hearing loss
Chronic OM with effusion/glue ear.
Audiology referral, most cases resolve in 3 months
Lifestyle change for a child with COM/recurrent AOM
Parents stop smoking
What type of sinusitis has symptoms that peak and resolve within 10 days?
Viral
Purulent nasal discharge, facial pain and headache are signs of what type of sinusitis?
Bacterial
Chronic sinusitis is associated with
Allergic rhinitis
Asthma
CF
ABG finding of pyloric stenosis
Metabolic alkalosis: Low K, low Na
Most common leukaemia in children
ALL
2nd most common leukaemia in children
AML
Cause of ALL in children
t(21;21) chromosomal translocation
What type of leukaemia peaks in under 2s?
AML
What type of leukaemia peaks in 2-3 year olds?
ALL
What does an abdominal x-ray in pregnancy predispose an unborn child to?
Leukaemia
What childhood leukaemia has a better survival rate?
ALL
NICE recommends immediate admission for children with what 2 signs that could suggest leukaemia
Unexplained petechiae and hepatomegaly
If a child presents with non-specific signs suggestive of leukaemia, what should be performed within 48 hours?
FBC + blood film
Describe physiologic anaemia of infancy
Reduction in Hb around 6-9 weeks of life due to high oxygen exposure in birth suppressing EPO production and thus RBC production
5 causes of anaemia in infants
- Physiological anaemia
- Prematurity
- Twin-twin transfusion
- Blood loss (i.e. lots of blood tests)
- Haemolysis: ABO, RH, G6PD
Helminth infection in the developing world is associated with
Chronic iron deficiency anaemia
SCA is caused by a defect in the beta-globin gene of what chromosome
11
Vaso-occlusive crises are hallmarked by what
Severe bone pain
Acute chest syndrome in SCA is due to
Lung capillary blockage
RBCs blocking splenic blood flow in SCA is known as
Sequestration crisis
Parvovirus B19 infection is associated with
Aplastic crisis
A 7 year old child presents to A&E with a non-blanching rash and recurrent nosebleeds. They have no meningeal features, but the mother reports that the child had a viral infection 2 weeks prior. What is the diagnosis?
ITP
Hereditary spherocytosis is what type of condition and seen in what ethnic background?
Autosomal dominant
Northern Europeans
3 paediatric presentations/signs/symptoms in children with undiagnosed T1DM
- DKA (most common)
- Secondary enuresis
- Recurrent infections (UTI, skin, fungal)
DKA in children can cause
Cerebral oedema
Triad of signs of DKA
- Ketoacidosis - marked by raised blood ketones and raised bicarbonate
- Dehydration - marked by polydipsia and polyuria
- Potassium imbalance - hypokalaemia symptoms but hyperkalaemia in blood serum
Management of DKA
Slow IV fluid resus with potassium and fixed rate insulin infusion
Management of DKA cerebral oedema
Slow IV fluids, IV mannitol and IV hypertonic saline
Congenital hypothyroidism is picked up in the
Newborn blood spot screening test
Prolonged jaundice, poor feeding and constipation in a neonate could indicate
Congenital hypothyroidism
Autoimmune hypothyroidism is also known as
Hashimoto’s
What 2 conditions is autoimmune hypothyroidism associated with
Coeliac and T1DM
Hashimoto’s disease is marked by what 3 blood findings
Raised TSH + low T4
Anti-TPO antibodies
Anti-thyroglobulin antibodies
Nausea and vomiting commonly causes what electrolyte imbalance
Hyponatraemia
Gastroenteritis in children causes what electrolyte imbalance
Hypernatraemia
Lethargy, thirst and confusion are signs of
Hypernatraemia
Chronic diarrhoea causes what type of electrolyte imbalance?
Hypokalaemia
ABG finding in someone with vomiting
Metabolic alkalosis - hypokalaemia, hyponatraemia
ABG finding in someone with diarrhoea
Metabolic acidosis - hyperkalaemia
Small volumes of dark urine and hyponatramia indicates
SIADH
Meningitis can cause reduced vasopressin/ADH. What can this cause?
DI - inability to concentrate urine due to reduced vasopressin or reduced sensitivity to vasopressin
Meningitis can cause continuous ADH release in spite of serum osmolarity.
SIADH - small volumes of dark urine and hyponatraemia.
SIADH treatment
Tolvaptan
Pain management for children (2 points)
- Paracetamol or ibuprofen
2. Morphine
Valgus feet are commonly seen in
Flat foot
Knock knees is associated with
Genetics, vitamin C/D/calcium deficiency
Bow legs is associated with
Achondroplasia, Rickets, Blount’s disease and reduced space in the womb
Osgood-Sclatter disease is caused by
Small avulsion/tear fractures at the proximal tibial epiphyseal plate/tibial tuberosity
Gradual pain and swelling below the knee that is relieved at rest in an active adolescent is a sign of
Osgood-Sclatter Disease
Complication of Osgood-Sclatter Disease
Avulsion tear
2 tests for developmental dysplasia of the hip
Ortolani and Barlow
Nursemaids elbow refers to
Partial elbow dislocation (pulled elbow), common in toddlers
Talipes is also known as
Clubfoot
Slipped upper femoral can be defined as
Instability of the proximal femoral growth plate
Open bone fractures are associated with
Osteomyelitis
Recent viral URTI and a limp in a afebrile child under 10 could suggest
Transient synovitis/irritable hip
Fever and limp in a child may be
Septic joint
Avascular necrosis of the femoral head in a 8 year old boy may be
Perthes Disease