Paeds Flashcards
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
When is primary amenorrhoea?
15 y/o with secondary sex characteristics
13 y/o without secondary sex characteristics
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
Management of DDH?
Most unstable hips will spontaneously stabilise by 3-6 weeks of age
Pavlik haress in kids <5 months and still unstable
If older - surgery
2 y/o, dropping centiles, nasal polyps?
Consider CF
LH and Testosterone pattern in:
- Primary hypogonadism (Klinefelter’s)?
- Hypogonadotrophic hypogonadism (Kallman’s syndrome)
- Androgen insensitivity syndrome?
- Testosterone secreting tumour?
Primary hypogonadism (Klinefelter’s):
LH - high
Testosterone - low
Hypogonad Hypogonad (Kallman’s):
LH - low
Testosterone - low
Androgen insensitivity:
LH - high
Testosterone - normal/high
Testosterone secreting tumour:
LH - low
Testosterone - high
CI for breastfeeding?
HIV Drugs: - lithium - amiodarone - chemo (plus methotrexate and leflunomide) - antidepressants (not SSRI)
Gross motor milestones:
6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?
6 weeks - head control
3 months - no head lag on pulling up to sit
6 months - pushes onto arms when lying on stomach
9 months - sits without support, pulls to stand, holds onto furniture, may crawl
1 year - cruises furniture, walks with one hand held
18 months - runs, squats to pick up ball
2 years - stairs with 2 feet
3 years - stairs with 1 foot
4 years - hops, tip toes
5 - bike
Fine motor milestones:
6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?
6 weeks - follows torch with eyes
3 months - hand regards - hands held in midline
6 months - palmar grasp
9 months - index finger to point
1 year - pincer grip
18 months - tower of 3 bricks
2 years - scribbles, tower of 6-7 bricks
3 years - draw circles, tower of 9
4 years - simple picture of man
5 - triangle
Language milestones:
6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years?
6 weeks - stills to voice
3 months - starting to vocalise
6 months - babbles, screams when annoyed, mama/dada
9 months - localises to sound, babbles for self-amusement
1 year - responds to name
18 months - knows 5-20 words
2 years - simple instructions, 50+ words, combine 2 words
3 years - knows own name, asks who/what questions
4 years - stories, count to 20, asks when/where/how questions
Social milestones:
6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 4 years, 5 years?
6 weeks - social smile
3 months - reacts pleasurably to familiar sounds
6 months - friendly with strangers
9 months - distinguishes strangers, plays peek-a-boo
1 year - drinks from cup
18 months - feeds with spoon, mimics adults
2 years - puts on shoes, messy, symbolic play
3 years - vivid imagination, understands sharing
4 years - dresses & undresses
5 - ties shoe laces
Red flags of development?
- asymmetrical movement
- not reaching for objects by 6 months
- unable to sit unsupported by 12 months
- unable to walk by 18 months
- no speech by 10 months
- loss of skills
- concern over vision and hearing
- showing signs of handedness before 12 months - possible cerebral palsy
Infantile colic:
- age?
- what does it look like?
<3 months
Bouts of excessive crying and pulling-up of legs, often worse at evenings
Happens to 20% infants, cause unknown
Red flags for feverish child?
What should you do?
- pale/mottled/blue skin
- No response to social cues, appears ill
- weak, high-pitched cry
- Grunting
- tachypnoea >60, chest indrawing
- reduced skin turgor
- Age <3 months and >38 degrees
- Neck stiffness, non blanching rash, bulging frontanelle, neck stiffness, seizure
Refer urgently up to paeds
Don’t prescribe abx unless apparent source
Do kids need kept off school with hand foot and mouth?
Head lice?
No
No
Hearing tests in kids?
Newborn - otoacoustic emissions test
If abnormal - brainstem auditory response test
6-9 months - distraction test - health visitor
Before school - pure tone audiometry
Hypospadias management?
Corrective surgery at 12 months
Essential they are not circumcised prior as the foreskin may be used in repair
Vaccines given:
- at birth?
- 2 months?
- 3 months?
- 4 months?
- 12 months?
- 3-4 years?
- 12-13 years?
- 13-18 years?
- annually 2-8 years?
Birth: BCG if at risk
2 months: 6 in 1, oral rotavirus, MenB
3 months: 6 in 1, oral rotavirus, pneumococcal
4 months: 6 in 1, Men B
12 months: HiB/MenC, MMR, pneumococcal, MenB
3-4 years: 4 in 1 booster, MMR
12-13 years: HPV
13-18 years: 3 in 1 teenage booster, MenACWY
Annually 2-8 years: flu
What’s in the 6 in 1 vaccine?
What’s in the 4 in 1 pre-school booster?
tetanus, diphtheria, polio, whooping cough, HepB, H influenza B
(given at 2, 3, 4 months)
4 in 1: tetanus, diphtheria, polio, whooping cough
3 in 1 teenage: tetanus, diphtheria, polio
Type of fluid for maintenance in young people/kids?
0.9% saline (+ glucose if needed)
as opposed to more dilute for adults
Reflex anoxic seizure?
Kids 6 months - 3 years old
In response to painful/emotional stimuli:
- goes pale
- falls to floor
- may start starts shaking (anoxic seizure)
- rapid recovery
Neurally mediated by vagus nerve
Mongolian blue spots? Milia? Stork mark/salmon patch? Port wine stain? Strawberry haemangioma? Spitz naevi?
Mong B: Slate grey congenital melanocytosis usually over buttocks/back, start regressing after 1y/o
Milia: Small, benign, keratin filled cysts on face, occur at any age but common in newborns
Stork/Salmon: blotchy pink vascular birthmarks found on forehead, eyelids or nape of neck, usually disappear over a couple of months but may persist. 50% prevalence in newborns
Port wine: deep red/purple, vascular birth marks that tend to be unilateral. Unlike others, they remain and tend to darken and raise over time. Rx cosmetic camouflage/laser therapy
Strawberry: erythematous, multilobed haemangioma that grows until 6-9 months then regresses, usually gone by 10y/o. Common on face, neck, scalp. If blocking visual field/bleeding then propranolol.
Spitz: pink/red naevus which grow rapidly to about 1cm in kids on face or legs, usually excised to be safe
Nappy rash?
Management?
Irritant contact dermatitis, spares skin folds
- Keep skin clean and dry - change nappies regularly
- Leave undressed if possible
- topical steroids if bad
- barrier creams with every nappy once healed (zinc/castor oil)
seborrhoeic dermatitis in newborns - how does it usually present?
in infants?
Management?
Cradle cap - itchy, yellow (maybe erythematous) scale on scalp
Infants - flexures - axillae, neck creases, groin with NO skin fold sparing
Rx: emollients +/- steroids
Roseola cause?
Presentation?
How to differentiate from Rubella?
HHV-6
High fever followed by discrete pink macular rash once fever subsides
High fever, lack of sub occipital lymph nodes
What is erythema toxicum?
Harmless rash seen in babies aged 2-5 days old
Pustules with surrounding erythema, can become widespread and confluent
Self limiting, no Rx
Monitoring if giving a kid methylphenidate (1st line) or lisdex (2nd line) for ADHD?
Both need ECG monitoring
Methylphenidate needs height and weight monitoring, can stunt growth
Early onset and late onset sepsis and causes of each?
Risk factors?
EOS <72hrs - GBS (75%), E Coli
LOS 7-28 days - environmental - staph epi, listeria, klebsiella, pseudomonas
RF: mother with previous GBS infection or colonisation screened, PPROM, intraparum infection
Low birth weight, prematurity, maternal chorioamnionitis
If prolonged jaundice, what should be screened for?
G6PD deficiency
Galactosaemia
Hypothyroidism
a1-antitrypsin deficiency
ABG of pyloric stenosis?
ABG of diarrhoea?
hypokalaemic, hypochloraemic metabolic alkalosis
Metabolic acidosis
4 features of TOF??
TOF - overriding aorta, pulmonary stenosis, VSD, RVH
-> boot shaped cardiomegaly, ejection systolic murmur, tet spells
B blockers for tet spells
glucose level for neonatal hypoglycaemia?
Management if asymptomatic?
If symptomatic?
<2.6
If asymptomatic - encourage breastfeeding and monitor regularly
If symptomatic (jittery, pale, tachypnoeic, irritable, weak cry, hypotonia) - admit to neonatal unit for 10% dextrose infusion
