Paeds Flashcards
Presentation of osgood schlatter disease?
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Presentation of chondromalacia patellae? (also called patellar pain syndrome?
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
Immediate management of croup?
all children with mild, moderate, or severe croup should receive a single dose of oral dexamethasone (0.15 mg/kg body weight)
Different presentations of septic arthritis vs transient arthritis?
Septic arthritis severely restricted joint movement, high temp and complete inability to weight bear
Transient - low grade temp, can weight bear
Presentation of bronchiolitis?
coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory crackles (not always present)
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
Management of bronchiolitis?
Management is largely supportive
humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
suction is sometimes used for excessive upper airway secretions
Features of (male) fragile X?
learning difficulties large low set ears, long thin face, high arched palate macroorchidism hypotonia autism is more common mitral valve prolapse
When to worry about nocturnal enuresis?
5 years or older
Characteristics of innocent murmurs in children?
soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area may vary with posture localised with no radiation no diastolic component no thrill no added sounds (e.g. clicks) asymptomatic child no other abnormality
Doses of IM benzylpenicillin for ?meningococcal sepsis?
< 1 year 300 mg
1 - 10 years 600 mg
> 10 years 1200 mg
What virus causes croup?
Parainfluenza virus
Pertussis treatment?
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
What will indomethacin and prostaglandins do to a Patent ductus arteriosus?
Prostaglandins will keep open
Indomethacin will close
Fever referral to Paeds ED in under 3 months? ho0w high does the fever need to be?
A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness
features of tetralogy of fallot?
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
If you were to treat bed wetting what is used ?
Desmopressin if >7yrs
Methylphenidate side-effects?
abdominal pain, nausea and dyspepsia
When and what are the newborn checks?
Newborn
- Clinical examination of newborn
- Newborn Hearing Screening Programme e.g. oto-acoustic emissions test
- Give mother Personal Child Health Record
First month
- Heel-prick test day 5-9 - hypothyroidism, PKU, metabolic diseases, cystic fibrosis, medium-chain acyl Co-A dehydrogenase deficiency (MCADD)
Midwife visit up to 4 weeks
Following months
- Health visitor input
- GP examination at 6-8 weeks
- Routine immunisations
Pre school
- National orthoptist-led programme for pre-school vision screening to be introduced
Rule re inheritance of congenital conditions?
Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias
Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II
What is genetic anticipation? What disorders are affected?
Trinucleotide repeat disorders tend to have earlier onset in subsequent affected generations.
Huntington’s disease and Myotonic dystrophy
Presentation of measles?
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
Presentation of mumps?
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Presentation of rubella?
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Presentation of Erythema infectiosum?
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
Presentation of scarlet fever?
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Presentation of hand foot and mouth disease?
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
What does parovirus case?
Erythema infectiosum
What does coxsackie virus cause?
Hand foot and mouth
Is head banging normal in children?
<3yrs yes if above - should have ASD assessment
Hand preference abnormal below what age?
Abnormal below 12 months
Patau syndrome presentation?
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Edwards syndrome presentation?
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
Fragile X presentation?
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
Noonan syndrome presentation?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Pierre robin syndrome presentation?
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
Prader willi syndrome presentation?
Hypotonia
Hypogonadism
Obesity
Williams syndrome presentation?
Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis
Cri du chat syndrome (chromosome 5p deletion syndrome) Presentation?
Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism
Most common congenital heart disease for cyanotic and acynaotic (separately)?
Cyanotic: TGA most common at birth, Fallot’s most common overall
Acyanotic: VSD
Most common presentations of wilms tumour?
abdo mass
When do you get physiological jaundice?
Physiological jaundice develops 2-3 days post-delivery and should resolve by 14 days
Within the first 24 hours is always pathological
Levels of bilirubin in physiological jaundice?
<100
Features of kawasaki’s disease?
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel
How to calculate down syndrome risk in increasing age?
1/1,000 at 30 years then divide by 3 for every 5 years
When are women offered the pertussis vaccine in pregnancy?
16-32 weeks
What does the heel spot test test for?
congenital hypothyroidism cystic fibrosis sickle cell disease phenylketonuria medium chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria (pyridoxine unresponsive) (HCU)
If a baby didn’t have the heel spot test then what test would you use for CF?
Sweat test
Risks of undescended testes?
increased risk of infertility, torsion and testicular cancer
Management of undescended testes
Unilateral undescended testis
NICE CKS now recommend referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
Orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
What is the most common cardiac abnormality associated with downs?
AVSD
How would a PDA present ?
left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat
In terms of brisk stacking what ages should you be able to do what?
15 months Tower of 2
18 months Tower of 3
2 years Tower of 6
3 years Tower of 9
What age should a baby have a palmar grasp?
5-6 months
What age do you correct hypospadius?
12 months
What babies are at risk of Vit K deficiency?
Breast-fed babies are particularly at risk as breast milk is a poor source of vitamin K. Maternal use of antiepileptics also increases the risk
R/F for surfactant lung disease? (RDS)
male sex
diabetic mothers
Caesarean section
second born of premature twins
What drug for threadworm?
mebendazole
Treat whole household
When should kids be able to sit without support?
7-8 months
What is Kallman’s syndrome?
Kallman’s syndrome is a cause of delayed puberty secondary to hypogonadotrophic hypogonadism
Inheritance pattern of haemophilia A?
X linked recessive
What are the common causative organisms of meningitis in newborns (or recently born)?
Group b strep - usually acquired from mother
What is trisomy 18?
Edwards (rocker bottom feet)
What is trisomy 21?
Downs
What is trisomy 13?
Patau
Xray finding in Transient tachypnoea of the newborn?
hyperinflation and fluid in the horizontal fissure
How does Osteochondritis dissecans present>
Pain after running intermittent swelling and locking
How does Patellar subluxation present?
Medial knee pain due to lateral subluxation of the patella
Knee may give way
How does patellar tendonitis present?
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Difference in exomphalos and gastroschisis?
Exomphalos - the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.
Gastroschisis - a congenital defect in the anterior abdominal wall just lateral to the umbilical cord.
gastroschisis tends to be a stand alone bowel condition, exomphalos is associated with cardiac and kidney diseases
Advice for fluids in enuresis?
Do not restrict fluids. The child should have about eight drinks a day, spaced out throughout the day, the last one about 1 hour before bed.
Carrier rate for CF gene in UK?
carrier rate is 1 in 25
First sign of puberty in boys and girls?
Boys:
first sign is testicular growth at around 12 years of age (range = 10-15 years)
testicular volume > 4 ml indicates onset of puberty
Girls:
first sign is breast development at around 11.5 years of age (range = 9-13 years)
Normal changes in puberty (that may seem pathological?)
gynaecomastia may develop in boys
asymmetrical breast growth may occur in girls
diffuse enlargement of the thyroid gland may be seen
What do APGAR scores represent?
A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state
Comression to breaths ratio in PLS?
15:2
Management of kawasaki disease?
- high-dose aspirin
- intravenous immunoglobulin
- echocardiogram is used as the initial screening test for coronary artery aneurysms
When do umbilical hernias resolve?
By 3, refer after this
At what age do the majority of children achieve day and night time urinary continence?
3-4
RF for DDH?
female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity
When should a child be able to hop on one foot?
4 years
When should a child be able to squat to pick up a ball
18 months
When should a child be able to pull to stand?
9 months
How long off school for mumps?
excluded from school for 5 days from the onset of swollen glands
Inheritance pattern of CF?
x linked recessive
Most common cause of hypothyroidism in children?
autoimmune thyroiditis.
Example of a mild steroid?
Hydrocortisone 1%
What is in dermovate, is it potent or mild?
Clobetasone and it is potent
Most common cause of primary headaches in children?
Migraine
First line treatment for paediatric migraines?
Ibuprofen
How would CCF present in Neonates?
poor feeding, shortness of breath, hepatomegaly
What organism causes acute epiglottitis?
Haemophilus influenzae
Common referral ages for different issues in development?
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
What is the triad of haemolytic uraemic syndrome?
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
What is the most common cause of HUS in children?
E.coli - enterotoxins
