Paeds Flashcards
Whooping cough:
- immunisation?
- symptoms?
- bloods?
- complications?
- Ix?
- Rx?
2, 3, 4 months and 3-5 years
2-3 days coryza symptoms followed by:
- inspiratory whoop (forced inhalation against a closed glottis - not always present)
- infants may have spells of apnoea
- persistent coughing
marked lymphocytosis
Can last 10-14 weeks
Coughing can lead to subconjunctival haemorrhage
Nasal swab for culture
However, PCR and serology more available now
Clarithromycin/Azithromycin if present within 21 days of cough onset
4 day old premature baby not passed meconium with abdominal distension and bilious vomiting:
- What is it?
- Cause?
- More common in?
- Ix?
- Rx?
Hirshprung disease
Parasympathetic neuroblasts fail to migrate from neural crest to distal colon, uncoordinated peristalsis, functional obstruction
Classically PR exam leads to passing stool
Abdo XR can be done
Gold standard - rectal biopsy
Initially rectal washouts
Resection of affected bowel definitive
Kawasaki disease:
- symptoms?
- Ix?
- Rx?
- Complications?
- high grade fever for 5 days, resistant to anti-pyrexial
- conjunctival injection
- strawberry tongue
- cervical lymphadenopathy
- red palms and soles which later peel
No Ix, clinical
High dose aspirin
IVIG
Coronary artery aneurysm - all patients get echo to screen for this
4 year old kid with non-tender palpable mass in LLQ?
Refer urgently <48 hrs to paediatrics for assessment of neuroblastoma/nephroblastoma
This applies to any kid with palpable abdominal mass or unexplained organomegaly
Neuroblastoma:
- where do tumours arise?
- Ix?
Neural crest of adrenal medulla (most common) or sympathetic nerves
Ix:
- raised urinary VMA and HVA
- Calcification on XR (potentially)
- Biopsy
Who gets screened for DDH if no Ortolani/Barlow test?
USS at 6 weeks if breech >36 weeks, regardless of successful ECV
Definitive diagnosis of epiglottitis?
Management?
Direct visualisation by senior, airway trained staff (anaesthetics/ENT)
However, if there is concern e.g. of foreign body
- lateral view XR - thumb sign
(posterior view in croup will show subglottic narrowing - steeple sign)
Rx:
O2
Abx
Intubation may be necessary
Presentations of vesicoureteric reflux?
Ix?
- Antenatal: hydronephrosis on USS
- Recurrent childhood UTI
- Reflux nephropathy - chronic pyelonephritis, renal scarring may cause renin release and hypertension
Diagnosing VUR: micturating cystourethrogram
Renal scarring: DMSA
Achondroplasia inheritance?
AD but 70% cases sporadic
Mutation of fibroblast growth factor 3 causing abnormal cartilage
Most common malignancy in kids?
Presentation?
Ix?
Prognosis?
ALL
- Anaemia, neutropenia, thrombocytopaenia
(tiredness, pallor, infections, easy bruising, petechiae) - Bone pain
- Hepatosplenomegaly
- Fever
- Testicular swelling
Bloods - low everything
>20% blasts
Bone marrow >20% blasts
Most common type CD10
90% cure rate, chemo for 2-3 years
When is short child normal?
Familial - normal if within 2SD predicted
Slow growth during childhood without normal growth spurt, but after puberty will grow normally to reach normal adult height
Pathological:
- Neglect
- Endocrine: thyroid, GH
- Malabsorption: Crohn’s, lactose intolerance, CF
When is puberty precocious and delayed?
How is puberty defined in boys and girls?
Precocious:
- Girls <8
- Boys <9
Delayed:
- Girls >13
- Boys >14
Boys: growth of testes >4ml
Girls, 3 stages:
- thelarche - breast budding
- adrenarche - body hair and odour
- menarche - period
Usual cause of acute diarrhoea in children?
Causes of chronic?
Rotavirus - vomiting and fever for first 2 days as well
Rehydration
Chronic:
- Cow’s milk intolerance
- Toddler’s diarrhoea - vary in consistency, often contains undigested food
- Coeliac disease
- post-gastroenteritis lactose intolerance
Newborn is born be emergency C sec due to foetal distress, what are steps of neonatal resus?
- Dry baby
- Check HR, breath and tone
- If gasping/not breathing give 5 inflation breaths
- Reassess for increase in HR, if none then repeat
- If adequate inflations and HR still <60, start chest compressions
3: 1 compressions:inflations
Paediatric BLS?
Check for pulses and breaths - use femoral/brachial pulses if <1 y/o
Give 5 rescue breaths
If on your own give 30:2 compressions
If help give 15:2 compressions
Causes of constipation in kids?
Vast majority idiopathic
- dehydration
- low-fibre
- meds e.g. opiates
- anal fissure
- hypothyroidism
- Hirschprung disease
- hypercalcaemia
- learning disability
Management of constipation in kids?
Check for faecal impactation: severe constipation, overflow soiling (very loose or rabbit droppings, or very large stools that can block toilet), faecal mass palpable in abdo
If impaction present:
- polyethylene glycol + electrolytes (Movicol)
- add lactulose if no improvement in 2 weeks
Maintenance is same - Movicol 1st line, lactulose added if no response
Ensure dietary fibre and enough fluids but don’t use this as 1st line alone
Causes of jaundice <24 hours?
Prolonged?
Ix for prolonged?
Early: Rhesus disease ABO haemolytic disease Hereditary spherocytosis G6PD deficiency
Prolonged:
- biliary atresia
- hypothyroidism
- galactosaemia
- UTI
- breast milk jaundice (actually caused by suboptimal intake)
- infection (CMV, toxoplasma)
Ix:
- Split bili - most important
- direct coombs test
- TFT
- FBC and film
- urine MC&S and reducing sugars
- U&E and LFT
Management of Perthes?
Cast/braces may be used to keep femoral head in acetabulum
If <6y/o - observe, most resolve with time
> 6y/o - surgery
DDH management?
Most unstable hips will spontaneously stabilise by 3-6 weeks of age
Pavlik haress in kids <5 months and still unstable
If older - surgery
Kocher criteria for septic arthritis in kids?
Non-weight bearing
Fever >38.5
WCC >12
ESR >40
0 = pretty much 0 risk 1 = 3% chance 2 = 40% chance 3 = 93% chance 4 = 99% chance
Age and time of year for croup?
6 months-3 years
Autumn
Stridor
Barking cough worse at night
Fever, coryzal
Admit if:
- <6 months
- Co-existant airway e.g. laryngomalacia, Down’s Synd
- uncertainty about diagnosis
Ix:
- Usually clinical diagnosis
- CXR: PA subglottic narrowing (steeple sign)
Management:
Everyone - single dose oral dexamethasone
Chicken pox incubation and infectivity?
Presentation?
Management?
Complications?
Incubation 10-21 days
Infective 4 days before rash appears until rash completely crusts over (usually about 5 days)
Fever initially, then itchy rash starting on head/trunk then spreading.
Initially macular then papular then vesicular
- Calamine lotion
- School exclusion until rashes heal
- If immunocompromised/newborn then VZIG, aciclovir if it develops
- Secondary bacterial infection - can be a small area of cellulitis to group A strep necrotising fasciitis (needing morphine etc)
- pneumonia
- encephalitis
Cow's milk protein intolerance/allergy presentation? Investigation? Management if formula fed? Management if breast fed? Prognosis?
Appears around 3 months in formula fed infants (can be in breast-fed rarely if mum drinks milk)
- regurg and vomiting
- diarrhoea
- urticaria/atopic eczema
- ‘colic’ - irritability/crying
- wheeze/chronic cough
- rarely angioedema/anaphylaxis
Usually clinical, but if needed:
- ski prick/patch
- total IgE and specific IgE (RAST) for cow’s milk protein
- -> both type I/type IV can occur
Formula fed:
- Extensive hydrolysed formula if formula-fed
- amino acid-based formula if severe/still reacting to eHF
Breast fed:
- continue breastfeeding
- eliminated cow’s milk from maternal diet and consider calcium supplements
- eHF when stop breastfeeding until 12 months
Prognosis:
- IgE - 55% tolerant by 5y/o
- Type IV - almost all tolerant by 3y/o