Paeds Flashcards
Transient Tachypnoea of Newborn
Commonest cause of resp distress in newborn period, due to delayed fluid resorption in the lungs, settles in 1-2days
RF - C-section
Inv - CXR (hyperinflation, fluid in horizontal fissure)
-> support, oxygen
Speech and Hearing Milestones
3m - turns to sound
6m - double syllables (adah)
9m - mama, understands no
12m - knows own name
12-15m - 2-6 words (refer at 18m)
2yrs - combine 2 words
2.5yrs - 200 words
3yrs - short sentences, asks what and who, 1-10
4yrs - why, when, how
BLS
Compression: ventilation (30:2 for lay people, 15:2 if two rescuers)
- unresponsive? shout for help
- open airway, feel for breathing
- 5 rescue breaths
- Check circulation (infant use brachial/ femoral, children use femoral)
- 15:2 (compressions = 100-120/min, lower half of sternum in kids or two thumb encircling in infants)
Should be 1/3 of AP chest deep
Greenstick Fracture
Unilateral cortical breach only (not whole way through)
Bowing Fracture
Plastic deformity, without cortical disruption
Infantile colic
Common and benign, normally <3m, cause unknown
= excessive crying, pulling of legs, worse in evening
-> reassurance, gone by 6m, do not use simeticone/ lactase
Croup
URTI, infants and toddlers, parainfluenza
RF - 6m-3yrs, autumn
Inv - clinical, CXR (PA steeple subglottic narrowing, lateral thumb sign)
-> don’t examine throat, single dose PO dex, O2, neb adrenaline in emergency
Admit -
Moderate or severe
<3 months
Known upper airway abnormalities
Uncertain diagnosis (? epiglottitis, quinsy, foreign body)
Severity of Croup
Mild - occasional barking, no stridor, no or mild suprasternal/ IC recession, child is well
Moderate - frequent barking cough, easily heard stridor at rest, wall retraction at rest, no/ little distress, child can be placated
Severe - frequent cough, prominent inspiratory stridor, retraction, sig distress/ agitation/ lethargy/ restless, tachy
GORD
RF - preterm, neuro issues
= <8wks, vom and regurg post-feed, excessive crying while feeding
-> 30 degree head up during feed, sleep on back, small frequent feeds, thickened formula, alginate, PPI (distress, v growth), severe fundoplication
Umbilical Hernia
Most resolve by 3yrs
RF - black, Down’s
Whooping Cough (Pertussis)
Infectious disease, antenatal/ childhood vaccination (not lifelong protection)
Causes - gram-ve bacteria Bordetella pertussis
= 3 phases
1. Catarrhal: 1-2wks, like viral URTI
2. Paroxysmal: 2-8wks, cough gets worse, ^at night/ after feeding, post-cough vom, insp whoop (forced insp against closed glottis), apnoea
3. Convalescent - wks to mths to get better
Inv - nasal swab
-> notifiable, if <21d give PO -mycin, admit <6m, Ab prophylaxis to house
*School excl 48hrs after Abx or 21d from symptom onset
Comp - bronchiectasis, pneumonia, seizures
Cleft Lip and Palate
Most common orofacial congenital deformity, 1 in 1000
RF - polygenic inheritance, maternal anti-epileptic use
= issues with feeding/ speech, otitis media if palate
-> repair cleft lip week 1 to 3m, palate 6-12m
Congenital Diaphragmatic Hernia
Herniation of abdo viscera into chest cavity due to incomplete diaphragm formation, 1 in 2000, 50% mort
80% left-sided posterolateral (Bochdalek)
= pulmonary hypoplasia, resp distress after birth, concave chest, reduced breath sounds, heart sounds displaced medially
Achondroplasia
AD, mutation of fibroblast GFR3, abnormal cartilage
RF - 30% FHx, older parents
= short Limbs (rhizomelia), short fingers (brachydactyly), large head with frontal bossing, narrow foramen magnum, midface hypoplasia (flat nasal bridge), trident hands, lumbar lordosis
Epiglottitis
Rare serious infection, Hib, now more common in adults due to vacc
= rapid onset, fever, generally unwell, stridor, drooling, tripod position
Inv - DO NOT EXAMINE, direct visualisation (senior only), XR (thumb/ steeple sign)
-> ET intubation, oxygen, IV Abx
APGAR
Appearance - pink (2), blue extremities (1), blue all over (0)
Pulse - >100, <100, none
Grimace - cries on stimulation, grimace, none
Activity - active movement, limb flexion, flaccid
Resp - strong/ crying, weak/ irregular, none
Done at 1 and 5mins, repeat at 10 if low
= 0-3 very low, 4-6 moderate, 7-10 good
Appendicitis
RF - 10-20yrs, <4yrs unlikely but present ^perf
= periumbilical pain, radiates to RIF, low fever, minimal vomiting, anorexia, can’t hop on R leg, worse coughing, Rovsing’s
*younger or retrocaecal (psoas) may present atypically
Inv - ^inflam, neut-predominant leucocytosis, US in F, CT
-> lap appendicectomy, prophylactic Abx, lavage if perf
Acute Asthma: Severity
Severe = PEF 33-50%, can’t talk, accessory neck muscles, HR >140 if 1-5yrs or >125 over 5, RR >40 1-5yrs or >30 over 5
Life threatening = O2 <92%, PEF <33%, silent chest, v BP, cyanosis, poor resp effort, exhaustion, confusion
Acute Asthma: Management
BD via spacer (close-fitting mask <3yrs), 1 puff every 30/60secs (up to 10), repeat, refer to hosp
Steroids 3-5days to all with exac;
2-5yrs - 20mg OD
>5yrs - 30-40mg OD
Chronic Asthma management
5-16yrs similar to adults (but if LTRA not helping, stop it)
<5yrs;
- SABA
- 8 week trial of mod ICS - no resolution then review diagnosis, symptoms recur <4 weeks then restart at low dose, if recur >4wks then repeat the trial
- SABA + low ICS + LTRA
- stop LTRA and refer
ADHD
Persistent symptoms of inattention, hyperactivity and impulsivity
RF - 3-7yrs, boys, maybe genetic
= six features 0-16yrs, five in 17yrs+
-> 10 week watch and wait, refer to paeds behavioural CAMHS if not resolved, parental education, drugs last (>5 only) e.g., methylphenidate, lisdexamfetamine
Methylphenidate: monitor weight and height 6mthly, baseline ECG (cardiotoxic)
Autism
Impaired social interaction and communication, stereotyped behaviour/ interests
RF - boys, ADHD and epilepsy
= usually presents before 2-3yrs, any level of intellectual disability (50% impaired), big head circumference: brain vol
-> applied behavioral analysis, preschool program, TEACCH, Denver model, JASPER, family counselling
Benign Rolandic Epilepsy
= 4-12yrs, seizures at night, ^partial (facial paresthesia, strange noises), may have 2nd generalisation
Inv - EEG (centrotemporal spikes)
-> excellent prog, seizures stop in teens
Biliary Atresia
Obliteration or discontinuity in the biliary system
RF - F>M
= neonatal cholestasis in first weeks of life, jaundice, dark urine, pale stools, appetite and growth issues, hepatomegaly
Inv - ^cBR, LFTs, US, excl. ATAT/ CF
-> surgery
Bronchiolitis
Inflammation and infection of the bronchioles, RSV
RF - <1yrs (peaks 3-6m), winter, ^severity if prem/ CHD/ CF
= coryzal, dry cough, SOB, wheeze, fine insp crackles, feeding issues
Immediate ambulance if apnoea, looks unwell to HCP, severe resp distress (grunting, marked recession or RR over 70), central cyanosis or O2 <92%
Consider hospital if RR >60, difficult BF/ oral intake, clinical dehydration
Inv - nasopharyngeal IF
-> humidified oxygen, NG feed, airway suction, Palivizumab to high risk babies
Caput Succadaneum vs Cephaloheamotoma
CS - oedema of the presenting part of the head
= crosses suture lines, resolves in days
CH - bleeding between periosteum and skull (^parietal)
= limited to suture lines, <3 months to heal, jaundice
Cerebral Palsy
Non-progressive lesion of motor pathways in the developing brain
Causes - 80% antenatal (malformation, infection), intrapartum (asphyxia, trauma), postnatal (IV haemorrhage, meningitis, trauma)
Link - learning difficulty, epilepsy, squints, hearing impairment
Spastic: ^tone due to UMN damage, -plegia
Dyskinetic: BG/ SN damage, oro-motor issues or athetoid movements
Ataxic: cerebellar issues
= abnormal tone, delayed motor milestones, abnormal gait, feeding difficulties
Chickenpox
Primary infection with varicella zoster, resp spread, can be caught from someone with shingles
= initial fever, itchy rash on head/ trunk, macular then papular then vesicular
-> school excl until lesions crusted over (≈5 days after rash onset)
Comp - 2nd bacterial (^risk with NSAIDs, group A strep, nec fas)
Measles
RNA paramyxovirus, aerosol spread
= Irritable/ fever/ conjunctivitis prodrome, Koplik spots, rash behind ears to whole body, discrete MP to blotchy confluent, desquamation >1wk, 10% diarrhoea
-> notifiable disease, jab <72hrs if haven’t had it
Comp - OM, pneumonia (^death), encephalitis (1-2wks after), subacute sclerosing panencephalitis (5-10yrs after)
Mumps
RNA paramyxovirus, droplet spread
= fever, muscle pain, parotitis (uni to bilateral)
-> notify
Comp - orchitis, unilateral HL, meningoencephalitis, panc
Rubella
Togavirus, winter and spring
= low fever prodrome, pink MP rash for 3-5days, face to body, suboccipital and postauricular nodes
Comp - arthritis, v PLT, encephalitis, myocarditis, risk of congenital rubella syndrome if contracted during preg
Erythema infectiosum
Fifth disease/ slapped cheek, Parovirus B19, resp spread
= mild fever, rose-red rash on cheeks, may spread (rarely palms and soles), may recur in heat for months
Inv - check maternal IgM and IgG (risk <20wk preg, hydrops fetalis)
-> no school exclusion
Scarlet Fever
Reaction to toxins produced by group A strep (pyogenes), resp droplet spread
= 2-6yrs, <48hr fever, strawberry tongue, pinhead rash, torso (spares palms and soles), circumoral pallor, rough sandpaper texture, desquamation
-> notify, oral pen V for 10d (or azithro), return to school 24hrs after starting Abx
Comp - OM, GN (10d), rheumatic fever (20d)
Hand Foot and Mouth Disease
Coxsackie A16 and enterovirus 71, self-limiting
= sore throat, fever, oral ulcers, later palm/ feet vesicles
-> symptomatic, no school exclusion
Childhood syndromes
Patau (tri 13) - small eyes, cleft, extra fingers
Edwards (tri 18) - small jaw, low ears, overlapping fingers, rocker bottom feet
Fragile X (TNR) - LD, big head, long face, big balls, mitral prolapse
Noonan (12) - webbed neck, excavatum, short, PS
Pierre robin - small jaw, posterior tongue, cleft palate
Prader-Willi (15q) - low tone, small balls, obesity
William’s - short, LD, friendly, neonatal ^Ca, AS
Cri du Chat (5p) - larynx and neuro problems, LD, small head and jaw, wide eyes
Types of CHD
Acyanotic
VSD (Down, Edward, Patau = pansystolic)
ASD
PDA
Coarctation (Turner’s = narrowing at the DA)
AV stenosis
Cyanotic
ToF (1-2m to show)
TGA (most common to present at birth)
Tricuspid atresia
Congenital Infections
CMV - low birth weight, purpura, SN deaf, small head
Rubella - SN deaf, cataracts, glaucoma, CHD (PDA)
Toxoplasmosis - cerebral calcification, chorioretinitis, hydrocephalus
Cows Milk Protein Intolerance/ Allergy
3-6% of children, immediate IgE allergy and delayed intolerance seen, tolerate by 5 or 3yrs
= <3m, formula-fed, regurg, vom, diarrhoea, urticaria, atopic eczema, colic, wheeze, chronic cough, rarely anaphylaxis
Inv - clinical, skin prick/ patch, total and specific IgE (RAST)
-> refer if FTT
Formula fed - extensive hydrolyzed formula, amino acid-based
Breastfed - continue BF but eliminate cows milk from mums diet, use EHF for 6m when stop BF
Neonatal Cyanosis
Very common <24hrs
Inv - nitrogen washout test (non/cardiac cause, Pa02 <15 after 10mins 100% o2 is CHD)
Acrocyanosis: cyanosis around mouth and extremities, immediately after birth for <48hrs
CF
AR, defect in CFTR, ^viscosity of secretions
= meconium ileus, jaundice, recurrent chest infections, steatorrhea, FTT, liver disease, short, DM, delayed puberty, rectal prolapse, nasal polyps, male infertility
Inv - high sweat chloride (>60)
-> BD chest physio, high calorie/fat, avoid other CF patients, vitamin sup, pancreatic enzyme sup, transplant, Lumacaftor for homo delta F508
Comp - colonisation by staph aureus, pseudomonas, burkholderia, aspergillus
DDH
Structural abnormality of the hip, higher chance of subluxation and dislocation, ^left
RF - 6F:M, breech, FHx, 1st child, oligohydramnios, bw >5kg
Inv - screened for at 6-8 week check (Barlow to dislocate posteriorly, Ortolani to relocate), US if 1st degree FHx/ breech 36wk+/ twins, XR >4.5mths
-> Pavlik harness, may need surgery >5m
Management of D and V
-> continue BF, encourage fluids (not fruit juice/ fizzy), if dehydrated give 50ml/kg low osmolarity ORS over 4hrs + maintenance ORS
Causes of Diarrhoea
Gastroenteritis - rotavirus most common (fever, d+v), risk of dehydration and lactose intolerance
Also, cows milk intolerance (most common cause in developed world), toddler diarrhoea, coeliac
Down’s Syndrome
= upslanting palpebral fissures, epicanthic folds, small low ears, Brushfield spots in iris, protruding tongue, flat occiput, single palmar crease, low tone, short, recurrent resp infections
Comp
- bowel: duodenal atresia, Hirschprung’s
- cardiac: endocardial cushion defect (AV septal canal), VSD, secundum ASD, Fallot, PDA
- others incl. subfertility, glue ear, ALL, hypothyroid, atlantoaxial instability, Alzheimers
Ebsteins Anomaly
Low insertion of the tricuspid valve, larger atrium and smaller ventricle
Cause - lithium exposure in-utero
Link - patent foramen ovale, ASD, WPW
= cyanosis, hepatomegaly, TR (pansystolic, worse on insp), widely split S1 and s2, prominent a wave, RBBB
Febrile Convulsions
Seizures provoked by fever, 3% of 6m- 5yr olds
Simple = <15m (usually 2-3m), generalised, recover <1hr
Complex = 15-30m, focal, repeat <24hrs
Febrile SE = >30mins
-> admit if first, >5mins or complex, antipyretics do not reduce chance, PR diazepam or buccal midazolam if recur
Comp - 1/3 have another, epilepsy risk is 2.5%, 50% risk if complex + FHx epilepsy + neurodevelopmental disorder
Traffic Light Fever System
-Green
Normal
-Amber (safety net or refer)
Pallor
Not normal response to cues, no smile, v activity, hard to wake
Nasal flaring, crackles, O2 <95%, RR >50 (6-12m)/ >40 (>1y)
HR >160 (<1yr)/ 150 (<2yr)/ >140 (2-5yrs), CR > 3secs, dry membranes, poor feeding, v urine output
Temp 39+ (3-6m), fever 5days+, rigors
-Red
Pale, mottled, blue
No response to cue, ill to HCP, doesn’t wake, weak/ high pitched cry
Grunting, RR > 60, chest indrawing
Reduced skin turgor
Temp 38+ (<3m), signs of meningitis
Abdo Wall Defects
Gastroschisis - lateral to umbilical cord, can attempt vaginal delivery, surgery asap
Exomphalos (omphalocele) - covered in amniotic sac, need c-section and staged repair
Growing Pains
Not if;
Present in morning/ wake up at night
Limp
Limits activity
Systemically unwell
Milestone issues
Abnormal exam
Key Facts about Growth
Infancy (0-2yrs) - nutrition and Insulin drive
Childhood (3-11yrs) - GH and thyroxine
Puberty (12-18yrs) - GH, sex steroid
GP if <2nd centile for height, paeds if <0.4 centile
Haemorrhagic Disease of the Newborn
Babies are born deficient in Vit K
RF - breastfed, maternal antiepileptics
-> all babies offered Vit K IM or PO
Immediate CT head
LOC or amnesia >5min
Drowsy
Vomit 3+ times
Suspect NAI
Seizure
GCS <14 (<15 if under 1yr)
Suspect open or basal fracture
Focal neuro issues
Under 1 and >5cm bruise, swelling or cut
Dangerous mechanism
Head Lice
Pediculus capitis infestation.
Inv - fine toothed comb
-> only treat if living lice e.g., wet combing, malathion
Hearing Tests
Newborn - all get otoacoustic emission test, if abnormal then auditory brainstem response test
6-9m - distraction test, health visitor (need two staff)
18m-2.5yrs - recognition of familiar objects
> 2.5 - speech discrimination test, similar-sounding objects
> 3 - pure tone audiometry, at school entry
Hirschprung’s
Aganglionic segment of bowel, developmental failure of Auerbachs plexus
RF - M, Down’s
= delayed meconium, constipation, distension
Inv - AXR, rectal biopsy best
-> rectal washouts and irrigation, surgery
Hypospadias
Link - cryptorchidism, inguinal hernia
= ventral urethral meatus, hooded prepuce, chordee (ventral curvature)
-> refer, surgery at 1yr, no circumcision
Immunisation
Contra - previous anaphylactic reaction to a component, (live) IS or pregnant
Delay if intercurrent/ febrile illness
Vaccination Schedule
Birth/ 4wks/ 1yr - Hep B, BCG (4wk only)
2 months - 6 in 1 (Hib, Hep B, pertussis, diptheria tetanus and polio) + Men B + oral rotavirus
3 months - 6 in 1 + rota + pneum
4 Months - 6 in 1 + Men B
12-13 months - Hib/ Men C + MMR + pneum + Men B
2-15yrs - flu
3yr 4m - 4 in 1 (DTP, pertussis) + MMR
12-13yrs - HPV
14yrs - 3 in 1 (DTP) + Men ACWY
Innocent Murmurs
Ejection - turbulent flow at the outflow tract of the heart
Venous hums - turbulent flow in the great veins, cont blowing below clavicles
Stills - low pitch, lower left sternal border
= may vary with posture, local, don’t radiate, not diastolic, no added sounds or thrills, no symptoms
Intraventricular Haemorrhage
RF - prem (spont, <72hrs after birth)
= hydrocephalus (blood may clot and block CSF flow)
Intussusception
Section of bowel invaginates into another, mostly in ileo-caecal region
= 6-18mths, boys, red currant jelly stool, intermittent crampy abdo pain, draw knees up, vomit, sausage in RUQ
Inv - US (target)
-> air insufflation, surgery if fails or peritonitis
Juvenile Idiopathic Arthritis
Arthritis <16yrs that lasts >6wks
Pauciarticular (60%)
= 4 or less joints, knees/ ankles/ elbows, pain, swelling
Systemic onset (Still’s Disease)
= fever, salmon pink rash, arthritis, uveitis, lymph
Inv - RF neg, may be ANA+
Kawasaki Disease
Medium-sized vessel vasculitis, kids
= high fever for >5days (resistant to antipyretics), conjunctival injection, red cracked lips, strawberry tongue, cervical nodes, peeling palms/ soles
Inv - ECHO (coronary artery aneurysm)
-> high dose aspirin, IV Ig
Meckels
Remnant of the omphalomesenteric duct, occurs in 2%, 2 feet from IC valve, 2 inches long
= asymptomatic, mimics appendicitis, PR bleed (massive painless, 1-2yrs), obstruction
Inv - if stable do a Meckel’s scan (99m Technetium pertechnetate)
-> remove if narrow neck or symptomatic
Meconium Aspiration Syndrome
Resp distress caused by meconium in the trachea, ^post term
Mitochondrial Disease
Small amount of DNA found in mitochondria
Inherited only from the maternal line, all kids from affected mum will inherit, none from affected father
Inv - muscle biopsy (red ragged fibres)
Nappy Rash
Irritant dermatitis - most common, spares creases
Candida - red rash with flexures and satellite lesions
Seborrheic - flaky red rash, may also have on scalp
Others incl. psoriasis, atopic eczema
-> barrier cream and maybe mild steroid cream if bad, top imidazole for candida
Necrotising Enterocolitis
One of leading causes of death in premature infants
= feeding issues, distension, blood stools, perf and peritonitis
Inv - AXR (football sign - air around falciform lig, rigler - air in and out bowel wall, pneumoperitoneum, pneumatosis intestinalis - intramural gas, dilated bowel loops, oedema)
Neonatal Blood spot
Done at days 5-9
Congenital hypothyroid
CF
Sickle cell
PKU
MCADD
MSUD
IVA
GA1
HCU
Neonatal Hypoglycaemia
Transient low sugar in the first few hours is common, persistent if underlying issue
Causes - prem, maternal DM, IUGR, hypothermia, neonatal sepsis, Beckwith-Wiedemann
= no symptoms or jittery, irritable, ^HR, poor feeding, weak cry, drowsy, low tone, apnea, hypothermia
-> feed if asymp, admit and IV 10% dextrose symp/ severe
Neonatal Sepsis
Severe infection in the blood in the first 28 days of life, early (<72hrs) vs late (7-28d)
Causes - group B strep, staph epidermidis, pseudomonas
RF - GBS in mum (^black) or prev baby with it, prem, low birth weight
= resp distress (grunting, flaring, accessory muscles), ^HR, apnoea, jaundice, seizures, v feeding
-> IV ben pen + gent 10 days, can stop after 2 days if CRP<10 and -ve cultures (start and now)
Nocturnal Enuresis
Pathological >5yrs
Causes - constipation, UTI, DM
-> advice (fluids, schedule, reward systems), enuresis alarm 1st line, desmopressin (short term control or alarm not worked)
Normal Lower Limb Variants
Flat feet - all ages, goes by 4-8yrs
In toeing - present in 1st year
Out toeing - all ages, goes by 2yrs
Bow legs - presents <2yrs. goes by 4-5yrs
Knock knees - presents 3-4yrs, goes on own
Vital Signs
HR and RR
<1 - 110-160 and 30-40
1-2 - 100-150 and 25-35
2-5 - 90 - 140 and 25 - 30
5-12 - 80-120 and 20-25
PDA
Connection between pulmonary trunk and descending aorta
RF - prem, rubella, high altitude
There is a left to right shunt = RVH and pulmonary HTN.
= left sub clavicular thrill, continuous machinery murmur, large vol, collapsing and bounding pulse, wide pulse pressure, heaving apex
-> indomethacin or ibuprofen (inhibits prostaglandins to close it)
Perthes Disease
Idiopathic AVN of femoral head, remodeling and new blood vessels but can lead to soft deformed head
RF - 5M:F
= 4-8yrs, hip pain, limp, stiffness, reduced ROM, 10% bilateral
Inv - XR (wide joint space, later v head size/flattening)
-> observe <6yrs, surgery
Comp - OA, premature growth plate fusion.
Catterall staging:
1 - clinical and histology only
2 - sclerosis, articular surface preserved
3 - loss of femoral head structure
4 - loss of acetabular integrity
Phimosis
-> observe <2yrs, treat >2 if recurrent infection or UTI
Pneumonia in kids
S. Pneumoniae most common bacteria
-> amoxicillin, + macrolide if no response (1st if mycoplasma/ chlamydia), co-amoxiclav for influenza
Pre-school Wheeze
Episodic - only wheeze when viral URTI
-> SABA, +LTRA or ICS
Multiple trigger - other triggers as well, ^risk of asthma
-> 4-8wk trial of ICS or LTRA
Tell parents to stop smoking
Early Puberty
Before 8 in girls or 9 in boys, ^F
Gonadotrophin dependent
- FSH and LH raised, premature activation of HPG axis
Gonadotrophin independent
- FSH and LH low, due to excess sex hormones
Testes
= Bilaterally large (intracranial lesion), unilateral large (gonadal tumour) or small (adrenal cause)
Pyloric Stenosis
Hypertrophy of the circular muscles of the pylorus
RF - 4M:F, FHx, 1st born
= 2-4wks, projectile vomiting 30 min after feed, constipation, dehydration
Inv - low chloride and potassium alkalosis, US
-> Ramstedt pyloromyotomy
Reflex Anoxic Seizures
Syncopal episode in response to pain or emotion
Cause - neurally-mediated transient asystole in children with very sensitive vagal cardiac reflexes
= startled, LOC/ fall to floor, may twitch, 30secs, rapid recovery, breath hold + cyanotic when upset more common
-> no treatment, most outgrow by 4-5yrs, no ^risk of epilepsy
Retinoblastoma
AD, most common ocular cancer in children, LOF chr 13, 10% hereditary
= 1.5 years, no red reflex (white), vision issues, strabismus
-> enucleation, chemo, radio, photocoagulation
90% survive to be adults
Roseola Infantum
Human herpes virus 6
= 6m-2yrs, high fever followed by MP rash, nagayma spots (papular enanthem on uvula and soft palate)
-> can go to school
Comp - febrile convulsion, aseptic meningitis, hepatitis
School Exclusions
24hrs of Abx - scarlet fever
48hrs of Abx - whooping cough
48hrs of Abx/ crusted over - impetigo
4 days of rash - measles
5 days of rash - rubella
5 days of swollen glands - mumps
48hours no symptoms - d+v
Until recovered - scabies, influenza
Shaken Baby syndrome
Retinal bleeds, subdural and encephalopathy
SUFE
Displaced head inferiorly along growth plate
RF - 10-15yrs, obese boys
= hip/ groin pain, loss of internal rotation in flexion
Inv - XR (AP and lateral)
-> internal fixation
Laryngomalacia
Part of the larynx is structured in a way that allows partial airway obstruction
= 4 weeks old, stridor
Surfactant deficient lung disease
Resp distress in prem infants
Inv - CXR (ground glass, hard to see heart border)
-> maternal steroids, surfactant
Tetralogy of Fallot
Most common cyanotic CHD
VSD
RVH
RV outflow obstruction (pulm stenosis)
Overriding aorta
= cyanosis at 1-2mths, tet spells (worse upset or in pain), R to L shunt, ejection systolic murmur (VSD does not cause murmur), right-sided aortic arch
Inv - CXR (boot shaped heart)
Threadworms
Enterobius vermicularis
= no symptoms or perianal itching, vulval symptoms
-> one dose mebendazole, treat all in household
Transient Synovitis
Transient inflammation of the synovial membrane
= 3-8yrs, hip pain after viral URTI, limp, low grade fever
-> self limiting (1-2 weeks), monitor if 3-9yrs and no fever, urgent specialist assessment if fever and limp/ joint pain
Transposition of the Great Vessels
Failure of the aorticopulmonary septum to spiral during septation
RF - maternal DM
= cyanosis, SOB, loud s2, prom RV impulse
Inv - CXR (egg on its side)
-> PGE1 to maintain DA then surgery
Undescended testes
RF - preterm
-> refer >3 months (seen <6m), orchidopexy at 1yr, review by paeds <24hrs if bilateral (25%)
Comp - torsion, infertility, cancer, mental issues
UTI
Causes - e.coli, proteus, pseudomonas
RF - infrequent voiding, rushed, constipation, neuropathic bladder, poor hygiene, vesicoureteric reflux (ureters more lateral so harsher angle)
Inv - clean catch is best, micturating cystourethrogram (VUR), DMSA (renal scarring)
-> refer <3m, consider admission if >3m and upper UTI (Abx 7-10d), 3d Abx for lower UTI
Wilms tumour
Nephroblastoma, 80% cure rate
RF - Beckman-Wiedemann syndrome
= <5yrs, abdo mass, painless blood, flank pain, most unilateral, mets (lung)
-> unexplained abdo mass needs paeds review <48hrs, chemo and nephrectomy
Retinopathy of Prematurity
Visual impairment due to over oxygenation, retinal neovascularisation, ^babies born <32wks
= loss of red reflex
Therapeutic cooling
Use - neonates with HIE to prevent further brain damage
3 Fetal Shunts
These allow fetal circulation to bypass the lungs while they are developing
Ductus venosus - umbilical vein to IVC, bypasses liver
Foramen ovale - RA and LA, bypasses RV and pulm circulation
Ductus arteriosus - pulmonary artery and aorta
Fetal Circulation
When the baby takes its first breath the alveoli expand which decreases pulmonary vascular resistance. RA pressure falls below that of the LA = FO closes
When the blood gets oxygenated after birth prostaglandins drop = DA closes
Once the umbilical cord is clamped there is not blood passing through umbilical veins = Ductus venosus stops functioning
ASD
Most likely CHD to be found in adulthood, 50% mort at 50yrs
There are three types of ASD
1 Ostium secundum 70% (RBBB with RAD)
3 Ostium primum (RBBB with LAD, long PR)
= midsystolic murmur, fixed split s2 (RV has more blood to pump so pulmonary valve closes later)
Comp - stroke
Eisenmenger syndrome: left to right shunt as pressure in the LA > RA, pulmonary pressure eventually > systemic pressure, reverses shunt so right to left, cyanosis
Signs of Resp distress
Raised RR
Accessory muscles - SCM, abdo, intercostal
Recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Constipation
Causes - idiopathic, dehydrated, low fibre, meds, CF, anal fissure, Hirschprung, ^Ca, LD, psychosocial, desensitisation
-> Movicol paeds plan (polyethylene glycol + electrolytes, escalating dose), add stimulant laxative at 2wks
Red Flags for Constipation
Starting from birth, delayed meconium, ribbon stools, leg weakness, distension, FTT
Hydropcephalus
CSF build up in brain and spinal cord, made in choroid plexus of each ventricle, archnoid granulation absorbs CSF into venous circulation
Causes - aqueductal stenosis (narrow connection between 3rd and 4th), arachnoid cysts, arnold-chiari
= skull expands as bones don’t fuse until 2, poor feeding, vomiting, decreased activity
VP Shunt
Shunt to allow drainage of CSF into the peritoneal cavity
Comp - infection, blocked, bleeding, outgrow them
Prem Baby: Milestones
Corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks
Septic Arthritis: Criteria
Kocher’s criteria
Inability to bear weight - 1 point
Fever >38.5ºC - 1 point
WCC >12 x10^9/L - 1 point
ESR > 40mm/hr - 1 point
Newborn Eye Infection
Suspected ophthalmia neonatorum should be referred for same-day ophth/paeds assessment
Rickets
RF - v Ca diet, prolonged BF, unsupplemented cow’s milk formula, lack of sunlight
= aching bones and joints, bow legs in toddlers, knock knees in older kids, rickety rosary (swelling at costochondral junction), wide wrists, kyphoscoliosis, craniotabes (soft skull bones), Harrison’s sulcus
Inv - v vit D, v Ca, ^ ALP
-> PO vitamin D
