paeds Flashcards
common cause of cough in infants
viral
structural airway
tracheo-oesophageal fistula
vascular rings
common cause of cough in toddlers
viral
FB
viral induced wheeze
common cause of cough in older kids
viral
asthma (if wheeze or dyspnoea)
chronic rhinitis
common cause cough adolescents
viral
asthma (wheeze and/or dyspnoea)
psychogenic
paediatric cough red flags
sudden onset without prodrome ?FB
associated with feeds
poor growth
loss of muscle bulk and subcut fat
abnormal cardiac exam
clubbing
differential air entry
causes of cough for >4weeks
Normal if well
pertussis (paroxysmal)
asthma
FB
sinusitis
supperative lung disease
pertissus greatest risk to
kids under 6 months
infectious period of pertusis
just prior to cough developing and for next 21 days if untreated
history of pertusis
cough and coryza 1 week (catarrhal)
cough in spells (paroxysmal)
convalescent stage (months)
pertussis incubation period
days 4-21
pertussis investigations
aboratory confirmation is not necessary for diagnosis, but may be helpful for infection control
A nasopharyngeal aspirate/swab for PCR is the investigation of choice. The test is usually negative after 21 days, or 5-7 days after effective antibiotic therapy has been commenced
Pertussis serology (IgA) may be detectable 2 weeks after the onset of the illness but rarely affects clinical management
pertussis treatment considered if?
Consider antibiotics if:
Diagnosed in catarrhal or early paroxysmal phase (may reduce severity)
Cough for less than 14 days (may reduce spread; reduces school exclusion period)
Admitted to hospital
Complications (pneumonia, cyanosis, apnoea)
Pertussis antibiotics:
Neonates:
Azithromycin 10 mg/kg oral daily for 5 days
Children who cannot swallow tablets:
Clarithromycin liquid 7.5 mg/kg/dose (max 500 mg) oral BD for 7 days
Children who can swallow tablets:
Azithromycin (for children = 6 months old): 10 mg/kg (max 500 mg) oral on day 1, then 5 mg/kg (max 250 mg) daily for 4 days
If macrolides are contraindicated:
Trimethoprim-sulphamethoxazole (8-40 mg per mL)
0.5 mL/kg (max 20 mL) BD for 7 days
infection control with pertussis
Exclude from school and presence of others outside the home (especially infants and young children) until received 5 days of therapy, or coughing for more than 21 days
will pertussis infection preclude vaccination
no, infected kids still need to complete schedule
is prophylaxis indicated in pertussis close contacts?
yes, if:
- contact with case while infections
AND
- first contact within 14 days (or 21 if under 6m)
AND
- age <6m OR
- incomplete vaccination
- member of house <6m
- attend childcare in same room as infants
criteria for adult pertussis prophylaxis
Expectant parents in last month of pregnancy OR
Health care worker in maternity hospital or newborn nursery OR
Childcare worker in close contact with infants <6 months OR
Household member aged <6 months
definition protracted bacterial bronchitis
wet cough daily for >4 weeks
no other alt cause
responds to ABX
common demographic for protracted bacterial bronchitis
ATSI kids
diagnosis of protracted bacterial bronchitis
sputum MCS if able to expectoate (age >7 yrs)
likely + haemophilus influenzae
most common cause of limping in kids
transient synovitis
acute myositis
minor trauma
severe localised joint pain and fever =
septic arthritis
red flags in the limping child
- duration >7days
- severe localised pain
- change to urine or bowels
-complete inability to weight bear - nocturnal pain symptoms
- constitutional symptoms
- generalised wasting
- fever
- petichae/purpura (HSP/malig/haem)
common differentials of limping a 0-4 years of age
transient hip synovitis
acure myositis
toddlers fracture
developmental hip dysplasia
differentials of limping in kids 5-10
transient hip synovitis
acute myostitis
developemtal dysplasia of the hip
-PERTHES
caused of limping in kids >10 years
- stress fractures and sprains
- traction apophysitis (osgood schlatters - tibial tuberosity)
- SUFE (slipped upper femoral epiphysis)
risk factors for developmental dysplasia of the hip
Risk factors for DDH
* Breech
* Positive family history
* Girls > boys
* Neuromuscular or joint problem (e.g. spina bifi da,
talipes)
recent viral illness, limp, pain on hip abduction and rotation?
transient synovitis (irritable hip)
risk factors for slipped femoral epiphysis
late childhood/early adolescence
hip or knee pain
90th centile in weight
can be bilateral
hip shortened and ext rotated
reduced movements esp internal rotation
XR findings with Perthes disease
increased density of femoral head epiphysis and widened medial joint space (avascular necrosis)
infant presents with 4 days of fever which settled then developed a rash.
Likey diagnosis and pathogen
Roseola infantum
Human herpes virus 6
vomiting, bloody diarrhoea, acute renal impairment
Haemolytic uraemic sundrome caused by Shiga toxin producing E Coli
how is Shiga producing E Coli spread?
eating raw or undercooked beef mince
eating uncooked fermented meat products (for example mettwurst and salami)
eating vegetables, salads and fruit juices contaminated with animal faeces
contact with farm animals
swallowing contaminated water.
11 year old child, very active in sports, presents with bilateral heel pain
- Dx
- Patho
- Tx
Severs disease
Injury to achiles tendon insertion to calcaneal bones
Calf stretches, reduce activity, ice, heel gel pads in shoes, time
young active boy, knee pain distal patella, worse on activity, limp afterwards, better with rest
Sinding-Larsen-Johansson syndrome - inflammation at insertion of patella tendon to patella
features of ITP
petichial rash in a
1. well child
2. isolated thrombocytopenia
3. normal FBE
features HSP
small bruise like spots on buttocks, legs, elbows
causes arthritis and abdo pain
Most common in children aged 2–10 years
* Vasculitic process
* Involves the following four organ systems:
* Skin – pathognomonic purpuric rash
* Joints
* Gut
* Kidneys.
cough, coryza, conjunctivitis, koplik spots
measles prodrome before rash develops
