Paeds Flashcards
most likely location of foreign body in lungs
right middle lobe (widest, shortest, most vertical of bronchi)
Features of raised ICP
headache, morning vomiting, sun setting eyes, papilloedema, changes in vision
Dehydration assumptions
if sx of clinical dehydration but no red flag features = assume 5% dehydration
if red flag features present = assume 10% dehydration
osteogenesis imperfecta
autosomal recessive disorder of collagen synthesis. blue sclera, bowing of legs, hx of fractures
staphylococcal scalded skin syndrome
fever, irritability, widespread red rash with pus and crusting around eyes/nose/mouth
erythema toxicum
common skin rash that affects newborns, red base with small pustules
features of congenital hypothyroidism
jaundice, hypotonia, macroglossia, poor feeding, weight gain, sleepy
red flags in headache
recent trauma seizures altered consciousness speech disturbance weakness in legs/arms change in behaviour photophobia, neck stiffness, non blanching rash
Crohn’s mx
induce remission = steroids +/- azathioprine/methotrexate/biologics
maintain remission = azathioprine/methotrexate
explain IBD to patient
chronic inflammation in gut which can lead to pain, bloody diarrhoea, weight loss and problems with absorbing nutrients. it is a life-long condition and it tends to come and go in flare ups every so often but there is medication that can be given to prevent and treat flare-ups. MDT
T1DM Mx
daily insulin regimen = combination of long and short acting insulins
regular blood glucose monitoring
educate on how to administer subcut insulin, how to monitor blood glucose levels, how to recognise sx of hypoglycaemia
refer to dietician
Diabetes UK for resources, advice, helpline
DKA Mx
basic observations
full head to toe physical examination looking for clinical sx of dehydration + drowsiness
blood gases for pH, glucose, U&Es, ketones
urine dipstick for ketones + glucose
take A to E approach
if shocked –> fluid bolus
otherwise, calculate fluid requirements
correct fluid deficit over 48h
use 0.9% NaCl with 40mmol KCl / L
start IV insulin infusion of 0.1units/kg/hr after 1h of fluids
when glucose <14, add 5% dextrose to fluids
regular monitoring of glucose, fluid output, neurological status, U&Es, continuous ECG
what should you do to prevent cerebral oedema in DKA Mx
regular monitoring of neurological status
make sure that glucose drops by a maximum of 5mmol/hr
sx of cerebral oedema
headache, sx of raised ICP, irritability, reduced consciousness
cerebral oedema mx
hypertonic saline
restrict fluids
call seniors + discuss further care with critical care
measles complications
encephalitis
fever induced convulsions
subacute sclerosing panencephalitis (progressive brain damage, fatal)
mumps complications
encephalitis hearing loss pancreatitis infertility spontaneous miscarriage
rubella complications
encephalitis
congenital rubella syndrome
mdoerate/mild asthma exacerbation mx
admit if worsening sx despite inhaler, previous episode of life-threatening exacerbation.
high flow o2
salbutamol in metered dose inhaler with spacer, 1 puff every 30-60s + take 5 tidal breaths per puff
if needed, can give ipratropium bromide in combination
oral prednisolone 3-5d
asthma exacerbation discharge + F/U
discharge when don’t need salbutamol for 4h
F/U 48h after discharge to review compliance, inhaler technique, discuss stepping up
allergen avoidance/smoking/vaccinations
questions to ask in Down’s syndrome hx
feeding difficulties (macroglossia) dysmorphic facial features difficulties passing urine/bowels (hirschsprungs?) floppy? convulsions? difficulty breathing? pallor? (congenital heart disease) tests/scans during pregnancy delivery hx developmental milestones
down’s syndrome Ix
full physical examination to look for dysmorphic features
karyotyping for trisomy 21
echo for congenital heart defects
abdo USS for Hischsprung’s + biliary/duodenal atresia
migraine mx
simple analgesia
nasal sumatriptans
consider adding anti-emetics, e.g., metoclopramide
F/U in 1 month or come back if sx get worse
eczema mx
avoid triggers/irritants
emollients (use 500g/day, in all areas)
topical corticosteroids (potency depends on severity)
bandages
if severe, phototherapy, systemic therapy
neonatal jaundice ix
basic obs
full physical examination, including abdo exam looking for tenderness + masses
urine dip
admit for bloods - FBC, conjugated/unconjugated bilirubin, LFTs, TFTs, blood film, Coomb’s test
Croup mx
single dose oral dexamethasone
if this does not setting sx, can consider giving repeat dose
NSAIDs, high flow O2, fluids as needed
consider nebulised adrenaline if severe
explain croup to patient
infection of upper airways, including the voice box and windpipe (larynx + trachea). usually caused by a virus (often parainfluenza).
septic arthritis tx
IV fluclox 2 weeks, switch to oral for another 2-4 weeks
Kocher criteria
used to differentiate between transient synovitis vs septic arthritis
takes into account whether they are non weight-bearing on affected side, temperature, WCC, ESR
childhood obesity mx
managed in primary care
diet - regular, healthier meals, smaller portions, eat together as a family
exercise - fun activities, at least 1hr moderate activity per day
less screen time
orlistat considered for >12yo
MDT approach!
obesity ix
general examination
height, weight, BMI
FBC, U&Es, TFTs, LFTs, IGF-1, OGTT
pyloric stenosis complications
dehydration
severe electrolyte imbalance
weight loss
questions to ask to differentiate between GORD and infantile spasms
associated with feeding?
vomiting after?
question to ask when suspecting west syndrome
whether they are reaching developmental milestones
development delay often seen in west syndrome
west syndrome ix
basic obs full neuro exam abdo exam bloods - FBC, U&Es, LFTs, glucose brain MRI EEG
west syndrome mx
corticosteroids
early diagnosis and tx associated with improved outcomes
assoc. with loss of skills, learning disabilities, continued epilepsy
F/U following discharge after
F/U 4-6 weeks after discharge with paediatrician to do head to toe screen
meningococcal septicaemia mx
basic obs full physical examination take an A to E approach initiate sepsis 6 protocol - insert 2 wide bore cannulae, take blood cultures/glucose/lactate, give high flow oxygen, IV fluids, IV abx ; refer for lumbar puncture alert seniors
Duchenne’s mx
basic obs full physical examination, look at calves look for waddling gait + Gower's sign creatine kinase genetic analysis or muscle biopsy
explain duchenne’s to patient
genetic disorder where there is progressive muscle damage and weakness. this will mean that will eventually lose ability to walk but can delay this a bit with physio, corticosteroids, protecting bone health w/ vit D + bisphosphonates. can use physical aids to help with walking, eventually wheelchair. OT to adapt home and school to help with mobility. eventually, the muscles in the heart and lung will be affected, at which point the condition becomes life-threatening. MDT! paeds/gp/cardio/resp/physio/OT/psych/counselling/school
Scabies tx
Permethrin
When do kids smile
6 weeks, refer by 8 weeks
which congenital infections most likely to affect fetus if contracted by mother in first trimester
Rubella (90% chance of developing congenital syndrome!)
CMV
Parvovirus B19
blueberry muffin appearance rash in newborn
CMV or rubella
severe croup mx
nebulised corticosteroids (if too unwell to take oral)
consider nebulised adrenaline
bleep anaesthetist
SUFE Ix vs Perthe’s Ix
SUFE = AP & lateral frog leg views Perthe's = xray
sudden severe gastrointestinal haemorrhage of dark blood in baby
Meckel’s diverticulum
benign condition where the head becomes moulded into a slightly abnormal shape
plagiocephaly
blocked nose, runny eyes, nasal voice, allergic reaction due to dust mites
perennial rhinitis
neonatal conjunctivitis <5d after birth
gonorrhoea
neonatal conjunctivitis 5-14d after birth
chlamydia
why is bronchiolitis mx different for <1yo
supportive mx in all cases
but do not give salbutamol to <1yo as they do not have the receptors for it to be effective yet
retinoblastoma
most common ocular malignancy in children
tends to be diagnosed at 18 m/o on average
autosomal dominant
absence of red reflex, strabismus, visual problems
excellent prognosis
mx = external beam radiation / chemo/ photocoagulation, enucleation
epilepsy definition
2 or more seizures with no identifiable cause
advice for parents about baby weight loss after birth
normal to lose 10% body weight after birth but they should regain by 2 weeks
nephrotic syndrome mx
60mg/m2/day of prednisolone for 4-6 weeks, then reduce the dose to 40mg/m2/day and give it on alternate days for 4-6 weeks
then reduce dose gradually
duodenal astresia mx
duodenodudenostomy
scaphoid abdomen –> dx?
congenital diaphragmatic hernia
indications of life-threatening asthma
silent chest cyanosis PEFR <33% normal pCO2 exhaustion/poor respiratory effort altered level of consciousness
why should you avoid NSAIDs in chickenpox
increased risk of necrotising fasciitis
achondroplasia
autosomal dominant
inhibition of chondrocyte proliferation due to defect in fibroblast growth factor 3 receptor
short stature + short limbs
spares head
neonatal resus
dry baby
assess RR/HR/tone
if not breathing, 5 inflation breaths
reassess
if chest not moving, another 5 inflation breaths
if chest moving but HR<60, ventilation for 30s
if HR still < 60, start chest compressions with ventilation breaths 3:1
reassess every 30s
if still HR<60, gain venous access + consider drugs
nebulised salbutamol doses for < 5yo + > 5yo
<5yo = 2.5mg >5yo = 5mg
why can intussusception happen after a recent illness
recent viral illness –> inflammation of Peyer’s patches –> lead point for intussusception
why can minimal change disease lead to recurrent infections + thrombosis
loss or protein in urine includes loss of antibodies –> recurrent infections
loss of antithrombin –> thrombosis
spina bifida occulta
1 or more vertebrae have not formed properly –> skin lesion –> tuft of hair, dimpling, birth mark
tethered spinal cord syndrome
complication of spina bifida occulta –> spinal cord is attached to spinal canal –> limits movement of spinal cord –> weakness, bowel/urinary sx
meningocele
meninges bulge out in between vertebrae –> no sx but can lead to increased risk of hydrocephalus / meningitis
myelomeningocele
most severe form of spina bifida
spinal cord herniates out in between vertebrae –> severe neuro complications –> clubfoot, bowel/urinary sx, weakness in legs
cephalohaematoma vs caput succedaneum
cephalohaematoma = collection of blood between skull and periosteum
caput succedaneum = collection of blood outside periosteum
skull periosteum scalp
Becker’s muscular dystrophy
better than Duchenne’s
presents later in life
normal life expectancy
constipation mx
if impacted –> disimpaction regime of escalating dose of movicol over 2 weeks
if good response, continue movicol in lower dose maintenance regime
if inadequate response, add stimulant laxative, eg senna
if still inadequate, use alternative stimulant laxative or substitute movicol with lactulose (osmotic laxative)
conservative measures - including more fibre and fluid in diet, establishing toileting routine so sitting on toilet after meal times, star chart
acute otitis media mx
reassure, analgesia, should resolve within 3-7d
consider abx if bilateral AOM in <2yo, comorbidities, no improvement after 3d; 5-7d amoxicillin
if has not improved after 2 courses of abx, refer to ENT
spastic cerebral palsy lesion location
motor cortex
spastic cerebral palsy features
increased tone (stiffness, less flexibility, poor balance) types: hemiplegic, diplegic, quadriplegic
dyskinetic cerebral palsy lesion location
basal ganglia
dyskinetic cerebral palsy features
loss of coordination of movement –> abnormal/involuntary movements –> chorea, athetosis, dystonia
ataxic cerebral palsy lesion location
cerebellum
neuroblastoma
malignancy that develops from immature nerve cells of sympathetic nervous system, often forms on adrenals. sx - abdominal mass, hepatomegaly, cutaenous lesions, skeletal pain
androgen insensitivity syndrome
genotypically male but phenotypically male
end organ resistance to testosterone
sx = groin swellings (undescended testes), primary amennorhea, delayed puberty
reactive arthritis presentation
anterior uveitis, arthritis, urethritis
nappy rash (skin fold sparing) mx
high absorbency nappies
fragrance free wipes
barrier cream (zinc + castor oil)
if irritated, consider 7d course of topical hydrocortisone
nappy rash that does not spare skin folds/beef red rash/satellite lesions mx
topical imidazole
tuberous sclerosis
autosomal dominant
leaf shaped skin hypopigmentation rash
benign tumours in many organs, eg retinal hamartoma, rhabdomyoma, angiomyolipoma, infantile spasms
febrile seizure mx in community
if seizure does not resolve after 5 mins, give buccal midazolam. If after 5 mins, still does not resolve, call ambulance
GORD when breastfeeding mx
breastfeeding assessment position upright after feeds 1) alginate therapy 2) ranitidine/PPI if all fails, consider enteral feeding + Nissen fundoplication
GORD when bottlefed mx
review feeding hx encourage smaller, more frequent feeds position upright after feeds 1) thickened feeds 2) alginate therapy 3) ranitidine/PPI if all fails, consider enteral feeding + Nissen fundoplication
precocious puberty - examination of testicles
if unilateral enlargement –> testicular tumour
if bilateral enlargement –> gonadotrophic dependent cause, eg elevated FSH/LH due to irradiation, brain injury, hydrocephalus, hypothyroidism etc
if atrophy –> consider ectopic cause –> adrenal tumours, CAH, mccune albright
Meckel’s diverticulum can be identified via what ix
technetium 99 scan
hydatid torsion presentation
torsion of embryological remnant in upper pole of testicle
presents similarly to testicular torsion with swelling, redness, pain but also blue dot on upper pole + positive cremasteric reflex + less acute hx
epididymitis presentation
presents similarly to testicular torsion with redness, swelling, pain but with positive cremasteric reflex + dysuria / discharge
doppler USS can rule out torsion
premature thelarche mx
reassure + review in 4-6 months
headlice mx
1) wetcombing 2) malathion / dimeticone
what is otitis media effusion
collection of fluid in middle ear without inflammation, sometimes follows acute otitis media.
otitis media effusion mx
often self-resolves so watchful waiting for 6-12 weeks with two hearing tests (tympanometry + pure tone audiometry).
if no improvement, refer to ENT for surgical intervention or hearing aids
choking mx
encourage cough
5x back blows
5x abdominal thrusts
remove foreign body via flexible bronchoscopy
choking mx
encourage cough 5x back blows 5x abdominal thrusts repeat maneouvres as necessary remove foreign body via flexible bronchoscopy
Craniosynostosis
when cranial sutures fuse prematurely –> brain/head forms abnormally so need surgery
omphalitis - what is it + mx
infection of umbilical stump –> redness, pus
need blood cultures + IV abx asap as can deseminate quickly in blood + cause sepsis
mastoiditis sx + complications
infection of the mastoid bone which is the bone which drains the middle ear, may follow persistent ear infection
sx - large bump behind ear, hearing loss, pain, headache
mastoiditis mx
abx
surgery may be needed (myringotomy or mastoidectomy)
pyloric stenosis mx
IV fluids
nil by mouth
consult surgeons
Ramstedt’s pyloromyotomy
Voraciously hungry kid, hypotonia, almond shaped eyes, initial problems feeding
prader willi
Unilateral nasal bleeding + crust
foreign body
VSD murmur
pansystolic murmur on lower left sternal edge
medulloblastoma
aggressive paeds brain tumour
small blue cells
sx - raised ICP (morning vomiting), cerebellar dysfunction (ataxia, squinting, abrnoaml eye movements)
indication for CT head in paeds head injury
vomiting 3 or more times loss of consciousness/amnesia >5mins abnormal drowsiness focal neurological deficit basal skull fracture suspecting NAI dangerous mechanism of injury
benign rolandic epilepsy
most common form of childhood epilepsy, most people outgrow by puberty
twitching/numbness/tingling of face/tongue, often at night, may be drooling / slurring of speech / excessive salivation
high amplitude spike in left centrotemporal region
what is given to sickle cell patients to reduce frequency of crises + increase HbF
hydroxycarbamide
causes of cerebral palsy
prenatal causes - placental dysfunction, congenital infection, cerebral malformations
delivery causes - hypoxic injury
infant causes - meningitis, encephalitis
murmur in rubella
patent ductus arteriosis
murmur in fragile X
mitral valve prolapse
phimosis sx + mx
= non retractile foreskin, may present with irritation, tenderness, dysuria, recurrent UTIs
reassure that is normal in under 2yo + should resolve between 2-6yo + keep reviewing
do not forcibly retract
then depending on severity (concerning sx include scarring, not retracting at all), can give steroids, circumcision
Wilm’s tumour / nephroblastoma presentation, ix, mx
2nd most common childhood malignancy
sx: abdominal mass + painless haematuria, less commonly anaemia + abdo pain
ix: USS to look for mass, CT to confirm dx, CXR to check for lung mets, DO NOT DO BIOPSY
mx: nephrectomy, chemo + radiotherapy if gets worse
HUS mx
admit consult haematology + nephrology IV fluids Monitor fluid balance, urine output, BP 50% will need dialysis during acute phase renal transplant if irreversible damage avoid abx, NSAIDs, opioids
Long-term F/U as there may be persistent proteinuria + progression to HTN + CKD
bilateral undescended testes mx
urgent referral to senior paediatrician for endo + genetic review
unilateral undescended testes mx
reassure
review at 6 week check
review at 3 months
if still not descended, refer to paediatric surgeon to complete orchidopexy before 12 months
calculating fluid deficit from weight loss
weight loss x 1L
fluid deficit based on pH in DKA
7.2-7.3 = 5%
7.1-7.2 = 7%
<7.1 = 10%
how to administer fluid bolus
fluid bolus = 10 x body weight
if non shocked, subtract fluid bolus from total fluid deficit
if shocked, you do not need to subtract, just give both bolus + fluid deficit
criteria to admit after febrile seizure
first presentation < 18 m/o was taking abx as it could be masking meningitis residual focal neurological deficit uncertain cause
Chignon
transient swelling particular to babies delivered using a Ventouse
infantile polycystic kidney disease
autosomal recessive
poor prognosis
bilaterally enlarge kidneys which compress on lungs causing difficulty breathing, HTN, CKD, hepatic fibrosis
hx of oligohydramnios
A vibratory bassoon-like murmur heard at the left sternal border in the supine position
Still’s murmur
A continuous sound in the supraclavicular fossa (more so on the right) increased in deep inspiration
venous hum
Bronchopulmonary dysplasia
persistent oxygen requirement at 36 weeks post-menstrual age
in premature babie
3 spike wave per second pattern bilaterally on EEG
absence seizure
umbilical hernia
very common in babies + infants
most likely will self resolve
not treated until 3-4y/o
safetynet for sx of incarceration (vomiting, abdo pain, hernia inflamed, non-reducible, stops passing stool)
dietary advice for cystic fibrosis patients
Eat a high calorie, high fat diet with enzyme supplements for each meal
post-streptococcal glomerulonephritis - good ix
low C3 levels
juvenile idiopathic arthritis
persistent joint swelling for >6weeks with no other indentifiable cause.
signs of systemic JIA
salmon pink rash fever malaise lymphadneopathy hepatosplenomegaly neutrophilia thrombocytosis
Choking or cyanosis during feeds + hx of polyhydramnios
tracheoesophageal fistula
growing pains
age 3-12yo symmetrical joint pain in lower limbs that comes on only at night no limp exercise is not impeded normal examination
central abdominal pain, nausea and vomiting episodes
abdominal migraines
how to tell colic apart from intussescpetion
colic = severe episodes occur then self resolve,
paroxysmal inconsolable crying and drawing of the legs up towards the abdomen, which is accompanied by passing wind
neonatal hypoglycaemia asymptomatic mx
encourage feeding
monitor blood glucose
neonatal hypoglycaemia mx when symptomatic or very low glucose
admit to neonatal unit
IV infusion dextrose
Measles isolation advice
4 days off school after onset of rash
Rubella isolation advice
5 days off school after onset of rash
Parvovirus isolation advice
Isolation not needed after onset of rash as no longer contagious
Timeline of chicken pox rash
Macular to papular to vesicular to crusting over
Scarlet fever tx
Penicillin V (phenoxymethylpenicillin)
Isolation for 48h after starting abx?
Whooping cough
Isolation for 24h after starting abx?
Scarlet fever
Pertussis tx
Oral macrolide within 21 days of sx onset
Prophylaxis for household contacts in meningitis
Rifampicin / ciprofloxacin
Chronic asthma Mx under 5yo
1) SABA
2) 8 week trial of SABA + moderate dose ICS. If after trial, sx come back within a month, then child must have asthma so start them on SABA + low dose ICS. If sx return >1month after stopping trial, then do another trial
3) SABA + ICS+ LTRA
4) stop LTRA + refer to paeds asthma specialist
A teenage girl presents with medial knee pain following activity. The knee has given way on occasion is a stereotypical history of:
patellar subluxation
At what age would the average child acquire the ability to use double syllables e.g. ‘adah’,’erleh’?
6 months
At what age would the average child acquire the ability to turns towards sound?
3 months
At what age would the average child acquire the ability to knows and responds to own name?
12 months
What is the mode of inheritance of osteogenesis imperfecta?
autosomal dominant
A sporty teenager presents with knee pain after exercise associated with intermittent swelling and locking is a stereotypical history of:
osteochondritis dissecans
autosomal recessive disorders to remember in paeds
sickle cell anaemia
Gilbert’s syndrome
haemachromatosis
cystic fibrosis
paediatric neck masses
lymphadenitis dermoid cyst (suprahyoid, midline) thyroglossal cyst (below hyoid, midline) branchial cyst (anterior triangle, angle of mandible) lymphatic malformations (posterior triangle)
- 5 y/o presents with widespread non-blanching erythematous rash over her body, after 1 week of cough and coryzal symptoms. Teperature is 37.2, pulse 95bpm, BP 90/60, RR 22, and O2 sats are 98% on room air. Urinanalysis yields no abnormalities, but FBC shows elevated WCC and a platelet count of 7 x 10^9. What is the most likely diagnosis?
ITP
periorbital/orbital cellulitis choice of abx
oral co-amoxiclav
SUFE mx
surgical internal fixation
<6m/o with typical UTI
6 week USS
no other age group needs further ix for typical UTI
any age group with atypical UTI
immediate USS
atypical UTI 6 months old - 3 years old
immediate USS
DMSA
MCUG if DMSA is abnormal
recurrent UTI 6 months old - 3 years old
6 week USS
DMSA
MCUG if DMSA is abnormal
atypical UTI in over 3yo
immediate USS
recurrent UTI in over 3yo
6 week USS
<6m/o with atypical or recurrent UTI
6 week USS
DMSA
MSUG
when is an assessment by a paediatrician needed for GORD
red flag sx faltering growth feeding aversion unexplained distress unresponsive to medical mx
