Paeds Flashcards
Breastmilk jaundice can last until? Rx?
Up to 12 weeks
Phototherapy if above the treatment line
2 types of criggler-naijarr
Type 1 - severe and will lead to bilirubin encephalopathy + brain damage
2 - less severe
Colicky abdo pain, constipation, vomiting, headache, drowsiness + papilloedema
Lead poisoning
-> GI symptoms and raised ICP
Severe vomiting and GI bleed, then CV compromise and drowsiness
Iron toxicity
2 week old suddenly drowsy with tense fontanelle. Raised PT on bloods? Why has this happened and who does it usually happen to?
Intracerebral haemorrhage due to vit K deficiency
-Lack of vit K in breast milk. Doesn’t occur in bottle-fed as fortified
Life-threatening asthma exacerbation pneumonic
CHEST
Cyanosis
Hypotension
Exhaustion
Silent chest OR spO2 <92%
Threatening peak flow <33%
BTS asthma steps
SABA (if infrequently needed) + Low dose ICS
-Add LABA
-Add LTRA (or increase ICS)
Most common hearing loss in children. When does it occur? Usual Rx?
Otitis media with effusion (glue ear)
Usually following acute otitis media
Monitor - usually resolves in 6-12 weeks (may then need referral)
Difference between Otitis media with effusion and Chronic suppurative otitis media ? Extra risk of?
Inflammation present in CSOM
-Risk of cholesteatoma
Bed wetting in kids ix? when management? When pharma
Urine culture/dip
-Also check for psych issues Eg school performance
Not until at least 6
Can use alarms/star charts
Could use intranasal desmopressin if off to friend’s house for sleepover etc
Cyanosed newborn with oligaemic lung fields
Pulmonary atresia
-Need to maintain open PDA
Tetralogy falot what are the bits
Overriding aorta
VSD
R ventricular outflow tract obstruction
-> RVH (Boot shaped heart)
Perthes disease in who? What is it and how does it present?
Boys 3-10
AVN of the femoral epiphysis
Gradual onset limp / pain (may be Knee pain as referred)
Who gets SUFE and what is it? Rx?
Teenage obese boys
Fracture through growth plate -> leg length discrepancy / limp / groin pain
Surgical Rx to prevent permanent deformity
6-9m most common cause of GI obstruction
Intussusception (red jelly poo)
Hypertropic pyloric stenosis presents at what age with what
3 weeks
Vomiting + olive mass in abdo
GI obstruction and ‘double bubble’ on XR in neonate
duodenal atresia
Meconium obstruction 1st line rx
Radiocontrast enema
Unconjugated hyperbilirubin in first 24hrs
Haemolytic disease - usually ABO incompatibility
Well newborn has progressive conjugated hyperbilirubin with pale stools and dark urine
Biliary atresia
Jaundiced at birth with microcephaly and abdo distention with organomegaly ? When else microcephaly
CMV infection
Microcephaly also in rubella / toxoplasmosis
5m irritability, cyanosis and episodes of LOC
CXR - right-sided aortic arch + oligaemic lung fields
Tetralogy of fallot
When is tachy really tachy in <5
> 140
Colicky Abdo pain in ‘paroxysms’ with sausage-shaped mass in RUQ
intussusception
- Especially <1yr
Teenage girl monthly pain has worsened this month. No constipation. preg negative. Palpable mass in lower abdo
Haematocolpus (retained blood during menstruation.
-Usually due to abnormality eg imperforate hymen
Viral illness and now crampy Abdo pain and tenderness on palpation
Mesenteric adenitis
[often mistaken for appendicitis]
9m spasmic abdo pain, vomiting and bloody stools
Intussusception
<1 wheeze, cough, fever, tachypnea =
Bronchiolitis
6y painless limp XR - flattened and fragmented femoral head
Perthes = AVN
[XR may be initially normal]
Infantile colic rx
Can keep upright after feeds
-Gaviscon / others not first line and no evidence base
Normal age range - heart rates
<1: 100-160
1-2: 100-150
2-5: 95-140
5-12: 80-120
>12: 60-100
Poisoning - GI symptoms and raised ICP / haemolysis
Lead
poisoning - tachycardia, hallucinations, breathing difficulty
tricyclics
poisoning - drowsy vomiting and jaundice
paracetamol
posioning - tinnitus, acidocis and hypoglycaemia
salicilates
Vomiting and GI bleed -> drowsy and CV collapse
Iron
Who needs the US of hips as a newborn for DDH and by when? Rx?
Any breech presentation after 36 weeks
-can screen with Barlow / Ortolani
US within 6 weeks
Palvik harness
Pyloric stenosis acid base typical? Rx?
HypoK, HypoCl metabolic alkalosis
Ramsted’s pyloromyotomy
Rockerbottom feet? Which genetic?
Edwards
Triosmy 18
Key blood test duchennes? Diagnosis?
CK
MPLA
[genetic testing if above not conclusive]
Key new drug for duchennes ? What does it do? In who?
Ataluren - restores the synthesis of dystrophin
Children >5 who can still walk
When refer straight to paeds with a child with fever?
if under 3m and fever needs referral
Croup bug? Rx?
Parainfluenza
0.15mg/kg oral dex
-Second line budenoside nebuliser
+/- neb adrenaline
Child complains episode of tingling LIPS/mouth.
May get twitching of face / drooling / disturbed speech?
Benign rolandic epilepsy
Maternal age for chance of downs 1:100
40
20= 1:1500
30= 1:800
35 = 1:270
Double bubble on xr? linked to?
Duodenal atresia
Downs
Baby / maternal risk factors for SIDS
Prone sleeping, winter, respiratory Sx
Young, high parity, smoking
22q11 deletion called?
DiGeorge
[absent thymus, hypoCa/PTH]
Severe exacerbation asthma
PO2?
RR?
PEFR?
HR?
PO2 <92%
RR >30
PEFR 33-50%
HR >125
Sickle cell
Abdo pain, hyperSpleen, anaemic with raised reticulocyte and jaundice =
Assoc with?
Differentiate to aplastic crisis on bloods?
Splenic sequestration crisis
[infarcts in spleen]
Parovirus b19
Aplastic crisis = low reticulocytes
Abdo pain and obstruction in sickle cell
Girdle mesenteric syndrome
Turner-like syndrome
Noonan
Most common cardiac defect in fragile X
MR
Small tongue which is pushed back and micrognathia
Pierre-robin
When oral rehydration solution in kid with normal obs and exam who has D&V?
Vomit >2x in 24hrs
Diarrhoea >5x in 24hrs
Age <1year
What mediates cows milk protein allergy?
IgE
[Remeber this can occur in breast fed if mum drinking cows milk]
Which vaccines MUST be given 4 weeks apart
Yellow fever +
MMR/Varicella
Insidious onset of limping child with sore hip? What is it?
Perthes disease
Avascualr necrosis of femoral head
Kid with sore jount with Fine rash with raised ESR and normocyctc normochromic anaemia ? Rx?
Juvenile idiopathic arthritis
[Rash often salmon pink]
Nsaids -> dmards
3 year old painless limp with asymmetric hip creases
Developmental dysplasia of the hip
Kid with swellings in neck and armpits that are not painful
NHL
(It’s more common than hodgkins)
Flat light brown skin patches and visual issues?
Neurofibromatosis
- optic glioma causes visual issues
Most common Haem malignancy in kids
ALL
[There’s Loads]
Kid with stridor working hard 1st line rx
Nebulised adrenaline
6m with wheeze and crackles, subcostal ressession and been snuffly for couple days =? 1st line rx
Bronchiolitis
O2
[No evidence for salbutamol]
Kid with headache -> cough and now patchy intisicial unilateral pneumonia rx?
Clary
[Headache -> pneumonia is leigonella ]
Kids absence epilepsy 1st line? 2nd?
Ethosuxamide
Valproate
Cardiac abnormalities and immune issues + hypocalcaemia ?
Di George syndrome
Hypoparathyroidism -> hypoCa
Sort stature, overly friendly with cardiac abnormalities and a little bit slow
William syndrome
When is peak age for febrile convulsions? Usual cause? Risk of epilepsy?
18 months
Viral infections.
2% risk epilepsy
Croup name? UsuL cause?
Laryngotracheobronchitis
Parainfouenza virus
Usual cause of acute epiglotitis
Haemophylis Influenza
<6m and has UTI what Ix is required
If responds to abx in <48 hrs -> US within 6 weeks
If doesnt respond
DSMA / MCUG
7-9years old migrane rx
Ibuprofen 200mg
Known heartfailure and develops hearing loss due to which drug
Furosemide
Pyelonephritis in kids orally rx?
Cefalexen 500mg BD 7 days
Abx for sinusitis which causes oesophagitis
Droxycycline
Tonsillitis given abx and now thrombocytopenia
Penicillin V
Which type of infection in:
Neutrophil defects->
T cell defects->
B cell defects ->
Leukocyte defects ->
Complement defects ->
Neutrophil defects-> Abscesses + fungal
T cell defects-> viral and fungal
B cell defects -> Severe bacterial but not menigococcal
Leukocyte defects -> Delayed wound healing + ulcers
Complement defects -> recurrent meningococcal
Kid walking and jerking in night unable to talk =? seen on eeg?
benign rolandic epilepsy
[usually resolves by teens]
EEG -> centrotemopral spikes
10 keeps falling and cant run anymore with pes cavus
charot marie tooth
Mum had multiple miscarriages and now baby has jaundice at 4 weeks with failure to thrive
Resus haemolytic disease
[Likely exposed to Rh in prev pregnancies]
18 month with poor head growth and intracranial calcification on CT
Congenital CMV
sensoryneural hearing loss and goitre =
Pentad syndrome - SN loss and Hypothyroidism
1w old develops rash with pin point papules on erythematous base ?
erythema toxicum
What sign for DDH
Ortolanis sign - abducting a flexed hip and knee to check for dislocation
Barlow - backward pressure on hip to subluxation
Galeazzi sign - one leg shorter than other at 3 months
Most common primary bone tumour
Osteosarcoma
Baby with absent red reflex and white pupil
Retinoblastoma
Eye deviating out is called? When present all the time called?
What if patient has a squint that deviates out on cover/uncover test?
eye deviating out is called ‘exo-‘
When present all the time called ‘-tropia’
Exophoria
girl <3 hits puberty ?
Hamartoma (usually hypothalamus)
Infant with central cyanosis who keeps squating
tetralogy of fallot
kartanger syndrome features
dextrocardia
sinusitis and bronchiectasis due to impaired ciliary function
2yo with slow-rising pulse and ejection systolic murmur rx?
Balloon angioplasty (for AS)
Surgical valve replacement if fails
Infant hearing test use
otoacoustic emissions
Reyes syndrome usual presentation in infants
Post viral illness
[especially following aspirin use]
Impaired liver function WITHOUT jaundice
Infants - Respiratory symptoms, hypoglycaemia and hepatomegaly
Atypical uti eg pseudomonas plan in kids?
Antibiotics and US during acute illness
When US in paeds UTI
<6 months - US in 6 weeks
>6 months and recurrent infections
Atypical UTI - US during admission
Neonatal ALS basics
Assess HR every 30 seconds
-If no pulse
CPR 3:1 per breaths
Most common pneumonia in kids
Strep pneumo
Start of PALS
5 rescue breaths
15:2 CPR
psoriasis rx in kids
<6 - topical steroids
>6 - vid d analogue eg calcipotriol
kid with abnormal facial movements that start at finger tip and move to face + and a funny taste in the mouth but retais consciousness? rx?
Partial sezuire / peti mal / jacksonian
Lamotrigine / carbamazepine
[valproate second line]
Kid seizing with no IV access
Buccal midazolam
[IV loraz if access]
All babies born to HIV positive mothers should have HIV antibody test when? [Even if multiple negative HIV viral DNA tests perinatally]
18 months
What is anterograde amnesia
Unable to create new memories following injury
19 purulent urethral discharge and urethritis? rx?
Gonnorea
Azithro
When immunosuppression in polycythaemia
Organomegally
Weight loss / night sweats
thrombocytosis
Kid with unilateral proptosis progressing over weeks
rhabdomyosarcoma
kid with diabetes + optic atrophy
wolfram syndrome
Cows milk protein allergy - what type of milk can they have?
Breast
extensively hydrolyzed [milk proteins broken down]
