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Paeds Flashcards

1
Q

Transient Tachypnoea of Newborn

A

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

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2
Q

Speech and Hearing Milestones

A

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

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3
Q

BLS

A

Compression: ventilation (30:2 for lay people, 15:2 if two rescuers)

  1. unresponsive? shout for help
  2. open airway, feel for breathing
  3. 5 rescue breaths
  4. Check circulation (infant use brachial/ femoral, children use femoral)
  5. 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

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4
Q

Greenstick Fracture

A

Unilateral cortical breach only (not whole way through)

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5
Q

Bowing Fracture

A

Plastic deformity, without cortical disruption

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6
Q

Infantile colic

A

Common and benign, normally <3m, cause unknown

= excessive crying, pulling of legs, worse in evening

-> reassurance, gone by 6m, do not use simeticone/ lactase

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7
Q

Croup

A

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)

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8
Q

Severity of Croup

A

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

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9
Q

GORD

A

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

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10
Q

Umbilical Hernia

A

Most resolve by 3yrs

RF - black, Down’s

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11
Q

Whooping Cough (Pertussis)

A

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

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12
Q

Cleft Lip and Palate

A

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

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13
Q

Congenital Diaphragmatic Hernia

A

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

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14
Q

Achondroplasia

A

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

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15
Q

Epiglottitis

A

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

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16
Q

APGAR

A

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

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17
Q

Appendicitis

A

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

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18
Q

Acute Asthma: Severity

A

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

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19
Q

Acute Asthma: Management

A

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

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20
Q

Chronic Asthma management

A

5-16yrs similar to adults (but if LTRA not helping, stop it)
<5yrs;

  1. 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
  3. SABA + low ICS + LTRA
  4. stop LTRA and refer
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21
Q

ADHD

A

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)

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22
Q

Autism

A

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

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23
Q

Benign Rolandic Epilepsy

A

= 4-12yrs, seizures at night, ^partial (facial paresthesia, strange noises), may have 2nd generalisation

Inv - EEG (centrotemporal spikes)

-> excellent prog, seizures stop in teens

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24
Q

Biliary Atresia

A

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

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25
Q

Bronchiolitis

A

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

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26
Q

Caput Succadaneum vs Cephaloheamotoma

A

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

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27
Q

Cerebral Palsy

A

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

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28
Q

Chickenpox

A

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)

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29
Q

Measles

A

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)

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30
Q

Mumps

A

RNA paramyxovirus, droplet spread

= fever, muscle pain, parotitis (uni to bilateral)

-> notify

Comp - orchitis, unilateral HL, meningoencephalitis, panc

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31
Q

Rubella

A

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

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32
Q

Erythema infectiosum

A

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

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33
Q

Scarlet Fever

A

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)

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34
Q

Hand Foot and Mouth Disease

A

Coxsackie A16 and enterovirus 71, self-limiting

= sore throat, fever, oral ulcers, later palm/ feet vesicles

-> symptomatic, no school exclusion

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35
Q

Childhood syndromes

A

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

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36
Q

Types of CHD

A

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

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37
Q

Congenital Infections

A

CMV - low birth weight, purpura, SN deaf, small head

Rubella - SN deaf, cataracts, glaucoma, CHD (PDA)

Toxoplasmosis - cerebral calcification, chorioretinitis, hydrocephalus

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38
Q

Cows Milk Protein Intolerance/ Allergy

A

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

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39
Q

Neonatal Cyanosis

A

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

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40
Q

CF

A

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

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41
Q

DDH

A

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

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42
Q

Management of D and V

A

-> continue BF, encourage fluids (not fruit juice/ fizzy), if dehydrated give 50ml/kg low osmolarity ORS over 4hrs + maintenance ORS

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43
Q

Causes of Diarrhoea

A

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

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44
Q

Down’s Syndrome

A

= 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

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45
Q

Ebsteins Anomaly

A

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

46
Q

Febrile Convulsions

A

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

47
Q

Traffic Light Fever System

A

-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

48
Q

Abdo Wall Defects

A

Gastroschisis - lateral to umbilical cord, can attempt vaginal delivery, surgery asap

Exomphalos (omphalocele) - covered in amniotic sac, need c-section and staged repair

49
Q

Growing Pains

A

Not if;
Present in morning/ wake up at night
Limp
Limits activity
Systemically unwell
Milestone issues
Abnormal exam

50
Q

Key Facts about Growth

A

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

51
Q

Haemorrhagic Disease of the Newborn

A

Babies are born deficient in Vit K

RF - breastfed, maternal antiepileptics

-> all babies offered Vit K IM or PO

52
Q

Immediate CT head

A

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

53
Q

Head Lice

A

Pediculus capitis infestation.

Inv - fine toothed comb

-> only treat if living lice e.g., wet combing, malathion

54
Q

Hearing Tests

A

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

55
Q

Hirschprung’s

A

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

56
Q

Hypospadias

A

Link - cryptorchidism, inguinal hernia

= ventral urethral meatus, hooded prepuce, chordee (ventral curvature)

-> refer, surgery at 1yr, no circumcision

57
Q

Immunisation

A

Contra - previous anaphylactic reaction to a component, (live) IS or pregnant

Delay if intercurrent/ febrile illness

58
Q

Vaccination Schedule

A

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

59
Q

Innocent Murmurs

A

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

60
Q

Intraventricular Haemorrhage

A

RF - prem (spont, <72hrs after birth)

= hydrocephalus (blood may clot and block CSF flow)

61
Q

Intussusception

A

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

62
Q

Juvenile Idiopathic Arthritis

A

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+

63
Q

Kawasaki Disease

A

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

64
Q

Meckels

A

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

65
Q

Meconium Aspiration Syndrome

A

Resp distress caused by meconium in the trachea, ^post term

66
Q

Mitochondrial Disease

A

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)

67
Q

Nappy Rash

A

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

68
Q

Necrotising Enterocolitis

A

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)

69
Q

Neonatal Blood spot

A

Done at days 5-9

Congenital hypothyroid
CF
Sickle cell
PKU
MCADD
MSUD
IVA
GA1
HCU

70
Q

Neonatal Hypoglycaemia

A

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

71
Q

Neonatal Sepsis

A

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)

72
Q

Nocturnal Enuresis

A

Pathological >5yrs

Causes - constipation, UTI, DM

-> advice (fluids, schedule, reward systems), enuresis alarm 1st line, desmopressin (short term control or alarm not worked)

73
Q

Normal Lower Limb Variants

A

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

74
Q

Vital Signs

A

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

75
Q

PDA

A

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)

76
Q

Perthes Disease

A

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

77
Q

Phimosis

A

-> observe <2yrs, treat >2 if recurrent infection or UTI

78
Q

Pneumonia in kids

A

S. Pneumoniae most common bacteria

-> amoxicillin, + macrolide if no response (1st if mycoplasma/ chlamydia), co-amoxiclav for influenza

79
Q

Pre-school Wheeze

A

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

80
Q

Early Puberty

A

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)

81
Q

Pyloric Stenosis

A

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

82
Q

Reflex Anoxic Seizures

A

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

83
Q

Retinoblastoma

A

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

84
Q

Roseola Infantum

A

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

85
Q

School Exclusions

A

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

86
Q

Shaken Baby syndrome

A

Retinal bleeds, subdural and encephalopathy

87
Q

SUFE

A

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

88
Q

Laryngomalacia

A

Part of the larynx is structured in a way that allows partial airway obstruction

= 4 weeks old, stridor

89
Q

Surfactant deficient lung disease

A

Resp distress in prem infants

Inv - CXR (ground glass, hard to see heart border)

-> maternal steroids, surfactant

90
Q

Tetralogy of Fallot

A

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)

91
Q

Threadworms

A

Enterobius vermicularis

= no symptoms or perianal itching, vulval symptoms

-> one dose mebendazole, treat all in household

92
Q

Transient Synovitis

A

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

93
Q

Transposition of the Great Vessels

A

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

94
Q

Undescended testes

A

RF - preterm

-> refer >3 months (seen <6m), orchidopexy at 1yr, review by paeds <24hrs if bilateral (25%)

Comp - torsion, infertility, cancer, mental issues

95
Q

UTI

A

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

96
Q

Wilms tumour

A

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

97
Q

Retinopathy of Prematurity

A

Visual impairment due to over oxygenation, retinal neovascularisation, ^babies born <32wks

= loss of red reflex

98
Q

Therapeutic cooling

A

Use - neonates with HIE to prevent further brain damage

99
Q

3 Fetal Shunts

A

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

100
Q

Fetal Circulation

A

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

101
Q

ASD

A

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

102
Q

Signs of Resp distress

A

Raised RR
Accessory muscles - SCM, abdo, intercostal
Recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis

103
Q

Constipation

A

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

104
Q

Red Flags for Constipation

A

Starting from birth, delayed meconium, ribbon stools, leg weakness, distension, FTT

105
Q

Hydropcephalus

A

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

106
Q

VP Shunt

A

Shunt to allow drainage of CSF into the peritoneal cavity

Comp - infection, blocked, bleeding, outgrow them

107
Q

Prem Baby: Milestones

A

Corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks

108
Q

Septic Arthritis: Criteria

A

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

109
Q

Newborn Eye Infection

A

Suspected ophthalmia neonatorum should be referred for same-day ophth/paeds assessment

110
Q

Rickets

A

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

ALS (22 decks)

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