Paeds Flashcards
What is the most common cause of cardiac arrest in children?
Respiratory causes e.g. Hypoxia
How would you investigate SCFE?
AP and lateral Xray (frog leg) of BOTH hips
How would you manage SCFE?
Internal fixation by surgical pinning
Describe asthma control in 5-16 yrs
SABA SABA + low dose ICS SABA + Low dose ICS + LTRA SABA + Low dose ICS + LABA (-LTRA) SABA + Moderate dose ICS MART Referral
Describe asthma control in 5 or less
SABA
SABA and 8 wk trial of ICS
If symptoms resolve then reoccur after 4 weeks off steroids - commence again
If symptoms do not resolve, consider alternative diagnosis
SABA + ICS + LTRA
Refer
What are the 3 features of shaken baby syndrome?
Subdural haemotoma
Retinal haemorrhage
Encephalopathy
Give 5 features of PDA
Left subclavicular thrill Apex beat heave Large volume, bounding, collapsing pulse Wide Pulse pressure Machinary continuous murmur
Give an example of a duct dependant disease
How would you treat this?
Transposition of the great arteries
Give prostaglandin E1 to maintain PDA for surgery
What is the most common sign of neonatal sepsis?
Respiratory distress
Describe the initial management of diaphragmatic hernia
Insert NG tube to keep air out of gut
If cyanosed - intubation and ventilation
What does a ‘beefy red’ well defined patch suggest
Candidal dermatitis
What age range is perthes disease seen in?
4-8
Is perthes disease more common in girls or boys?
5 x more common in boys
Describe what is seen on downs syndrome screening if postive
Low AFP Low oestriol High HCG Low PAPPA Thickened nucheal translucency
How do you treat mycoplasma pneumonia
Erythromycin
ANY OTHER is amoxicillin
Why are children with Downs syndrome prone to snoring?
Due to the hypotonia and large tongue and adenoids
Describe the antibiotic therapy for children with suspected meningitis
- less than 3 months
- over 3 months
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
How does transposition of the great arteries present on auscultation?
No murmur
Loud single S2
Prominent ventricular pulse
What is laryngomalacia?
A very common benign cause of noisy breathing in infants
It is congenital softening of the cartilage of the larynx, causing collapse during inspiration
What is the most common cause of proteinuria in children?
Transient proteinuria
precipitants include infection, pregnancy and heavy exercise
Describe how Henoch-Schonlein Purpura presents?
Tetrad of: Rash Abdominal pain Arthralgia Glomerulonephritis
What do abnormally high levels of conjugated bilirubin suggest?
Biliary atresia
How does biliary atresia present?
Prolonged neonatal jaundice
Raised conjugated bilirubin
Hepatomegaly
Splenomegaly palpable by 3-4 weeks
What is the cause of mono (glandular fever)?
EBV
How does EBV infection present?
Lymphodema
Pharyngitis
Hepato/splenomegaly
What happens when you treat EBV incorrectly with antibiotics?
A widespread scarring rash appears
What is EBV associated with?
Lymphoproloferative disorders e.g. Burkitt’s Lymphoma
Describe the presentation of measles
High fever
Widespread macropapular rash which begins in the face
Flu-like symptoms
Conjunctivitis
Koplik’s spots (white spots in the mouth)
What causes scarlet fever?
Group A streptococcus infection
Describe the presentation of scarlet fever
Begins as pharyngitis Strawberry tongue Lymphadenopathy High fever Sandpaper rash after 1-2 days
Describe the presentation of rubella
Low grade fever
Lymphadenopathy
Joint pain
Rash that begins on the face and spreads to trunk and limbs
Calculate maintenance fluids formula.
First 10kg = 100ml/kg
Second 10kg = 50ml/kg
After= 20ml/kg
Calculate replacement deficit fluids formula
%deficit x weight (kg) x 10
What is the most important investigation in orbital cellulitis
CT orbit
Describe the features of congenital rubella syndrome
Eye defects (loss of red reflex)
Congenital heart disease (PDA)
Senorineural deafness
Purpuric ‘blueberry muffin’ skin rash is also common
What is Prehn’s test?
Test to see if there is relief of pain on elevation of the testicles. It indicates a diagnosis of acute epididymitis
What does mesenteric adenitis present with?
Non specific abdominal pain
GUARDING IS RARE
No change in appetite
Follows an URTI
How does neonatal herpes simplex virus present?
Vesicular lesions on the eye, oral mucosa
Encephalitis
Sepsis
What is hand foot and mouth disease caused by?
Coxsackie A16 virus
What is slapped cheek syndrome caused by?
Parvovirus B19
What is first line in depression in under 18s?
Fluoxetine
Describe the presentation of Prader-Willi
Obesity Hyperphagia (binge eating) Short stature Hypotonia as a child Hypogonadism Learning difficulties
What are the characteristic features of Fragile X?
Long thin face
Large low set ears
Describe how Turner’s syndrome presents
Primary amenorrhoea
Wide webbed neck
Wide spaced nipples
No 2y sexual characteristics
Describe a classical finding in Kallmann syndrome
Ansomia (lack of sense of smell)
Failure to start puberty
More common in males
What is the diagnostic investigation for oesophageal atresia?
NG Tube (with radio-opaque end) and chest Xray
What should you do if you hear a small murmur on a NIPE exam?
Review in 24hrs (as long as they are well) as the fetal circulation undergoes significant changes within the first few hours of life
If still present after 24hrs - refer for echo
What is Ebstein’s anomaly?
Usually seen when lithium has been used in pregnancy. A congenital heart defect characterised by a large right atrium, small right ventricle and tricuspid incompetence
What is the treatment for Whooping cough?
Azithromycin or calrithromycin if onset has been in the last 21 days
They must stay off school for 48 hours after commencing antibiotics OR 21 days from onset of symptoms if no antibiotics
What is the top cause of painless massive GI bleed requiring transfusion between 1-2?
Meckels Diverticulum
What is the advice on school exclusion for chickenpox?
Should be excluded until all lesions have crusted over
What heart defect is associated with Turner’s syndrome?
Aortic coarctation
What should you do in asymptomatic neonatal hypoglycaemia?
Encourage normal feeding (whatever is preferred) and monitor blood glucose
What should you do in symptomatic/ very low neonatal hypoglycaemia?
Admit to neontal unit and give IV 10% Dextrose
What is acute epiglottis caused by?
Haemophilus influenza type B
What Is the first sign of puberty in boys?
Increase in testicular volume >4ml
You see a 3yo child who is bow legged - what is the most appropriate action?
It is normal in less than 3 years. It usually resolves by 4 years
What should be offered to all breech babies at or after 36 weeks gestation at 6 weeks?
Pelvic USS for DDH regardless of mode of delivery
What does persistent non bilious vomiting and peristalsis seen in the LUQ suggest?
Pyloric stenosis
What is the advice on school exclusion for scarlet fever?
A child with scarlet fever can return to school 24 hours after commencing antibiotics
How does congenital hypothyroidism present?
Macroglossia (large tongue) Hypotonia Umbilical hernia Reduced feeding Constipation
How is Meckel’s diverticulum diagnosed?
Technetium scan
What is the cause of acute bilirubin encephalopathy?
Toxic buildup of unconjugated bilirubin
What is the definitive management of biliary atresia?
Hepatoportoenterostomy (Kasai procedure)
When does breast milk jaundice occur?
1 day-2 weeks after birth. It is caused by increased bilirubin reuptake in the gut
What are inguinal hernias caused by?
Failure of the processus vaginalis to obliterate
What is the karyotype in Turner’s syndrome?
XO
Describe the features of Klinefelter’s syndrome
Phenotypically male Testicular atrophy Gynaecomastia Female distribution of hair (Due to INCREASED oestrogen production)
What is the karyotype in Klinefelter’s syndrome?
XXY
What is the in the treatment of Turner’s syndrome? (endo)
GH therapy
What is raised n physiological jaundice?
Unconjugated bilirubin
What is the definitive diagnosis for Duchenne’s muscular dystrophy?
Muscle biopsy
What is the treatment for measles?
Supportive care
What is the chance of a child having another febrile seizure after having 1?
30-40%
What is a potential side effect of ingesting too much cow’s milk?
Iron deficiency
What is the 1st line treatment of tonsillitis?
Penecillin QDS 5-10 days
What is a cardiac side effect of salbutamol?
Tachycardia
What is the incubation period for chickenpox?
21 days
What is impetigo caused by?
Staph. Aureus
What are the 1st line antibiotics for Nectrotising enterocolitis?
Clindamycin and Cefotaxime
Where does eczema affect in infants?
Face and trunk
What should you do in an infant less than 3 months with suspected UTI?
Refer immediately to paeds
What is the most common cause of headache in children?
Migraine
When does the moro reflex usually disappear?
4 Months
When is the neonatal blood spot screening test typically performed in the UK?
Between the 5th-9th day of life
At what ratio should chest compressions:rescue breaths be given in paediatric resus?
15:2
What type of vaccine is the rotavirus vaccine?
Oral, live attenuated vaccine
What is the most common cause of hip/knee pain in the 10-14 age group?
Transient synovitis
What is the most appropriate diet advice in cystic fibrosis?
High calorie and high fat diet with pancreatic enzyme supplementation for every meal
What should you do with babies that are jaundiced within 24hrs of birth?
Measure and record the serum bilirubin urgently (within 2 hrs) - it is likely to be pathological rather than physiological
How is vitamin K administered after birth?
One off IM injection
What is exomphalos (omphalocele)?
Abdominal contents protruding through the anterior abdominal wall but covered by the amniotic membrane and peritoneum
What is the management of exomphalos (omphalocele)?
- c-section to reduce risk of sac rupture
2. Staged repair over weeks-months
What is gastroschisis?
A congenital defect in the anterior abdominal wall lateral to the umbilical cord.
What is the management of gastroschisis?
- Vaginal delivery may be attempted
2. Newborns should go to theatre asap (within 4 hrs)
Describe APTT and PT in haemophilia
prolonged APTT and normal PT
What are the most common fractures associated with child abuse?
Radial
Humeral
Femoral
How do you treat eczema herpeticum?
Life threatening - admit for IV aciclovir
What is carp mouth associated with?
Russel-Silver
