Paeds Flashcards by Jessica Radford

Q

Which infants should routinely be referred for US for DDH?

A

Child hip problem in 1st-deg relative

Breech >= 36 wk

Multiple pregnancy

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Q

Barlow and Ortolani tests done when?

A

Newborn check
6-8 week check

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Q

Investigation of suspected DDH with US hips at age

A

<4.5 months old

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Q

Investigation of suspected DDH with Xray at age:

A

> 4.5 months old

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Q

Management of DDH with Pavlov harness at age:

A

<5 months old

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Q

Management of DDH with surgery at age:

A

> 5 months old

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Q

Neonatal blood spot screening (‘Guthrie’/’heel-prick’) is performed at..

A

Day 5-9 of life

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Q

Neonatal blood spot screens for..

A

Congenital hypothyroidism
Cystic fibrosis
Sickle cell disease
Phenylketonuria
Medium chain acyl-CoA dehydrogenase deficiency (MCADD)
Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
Homocystinuria (HCU)

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Q

Precocious puberty in females

A

Secondary sexual characteristics <8 yrs

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Q

Precocious puberty in males

A

Secondary sexual characteristics <9yrs

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Q

5-16y asthma - Newly-diagnosed with symptoms <3/week + no nocturnal waking

A

SABA reliever therapy alone
(salbutamol)

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Q

5-16y asthma - Newly-diagnosed with symptoms >=3/week +/- nocturnal waking

A

SABA + paediatric low-dose ICS
(<=200 mcg budesonide/equiv)

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Q

5-16y asthma -
Not controlled on:

SABA alone

A

SABA + paediatric low-dose ICS
(<=200 mcg budesonide/equiv)

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Q

5-16y asthma -
Not controlled on:

SABA + paediatric low dose ICS

A

SABA + paediatric low-dose ICS + LTRA

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Q

5-16y asthma -
Not controlled on:

SABA + paediatric low dose ICS + LTRA

A

Stop LTRA
SABA + paediatric low-dose ICS + LABA

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Q

5-16y asthma -
Not controlled on:

SABA + paediatric low-dose ICS + LABA

A

SABA + MART [paediatric low-dose ICS + LABA]

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Q

5-16y asthma -
Not controlled on:

SABA + MART [paediatric low-dose ICS + LABA]

A

SABA + MART [paediatric moderate-dose ICS + LABA]
or
SABA + paediatric moderate-dose ICS + LABA

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Q

5-16y asthma -
Not controlled on:

SABA + moderate-dose ICS + LABA
(fixed-dose or MART)

A

Paediatric high-dose ICS (MART/separate)
or
Theophylline/Expert advice

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Q

Refer for unilateral undescended testes - at what age?

A

3 months

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Q

Management of bilateral undescended testes

A

Same-day paediatrician review

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Q

Occurrence of undescended testis in newborn term male

A

2-3%

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Q

Croup - features prompting admission

A

Moderate/severe
<6m
Known upper airway abnormality
Uncertain diagnosis

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Q

Management of mild croup

A

Stat dose PO dexamethasone 150mcg/kg

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Q

Management of scarlet fever

A

PO Penicillin V QDS for 10/7

Notify PHE

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Management of Scarlet Fever (pen-allergic)

Azithromycin OD for 5/7

Management of impetigo

Fusidic acid 2% TDS 5 days

Presentation of Measles

Irritable febrile prodrome Conjunctivitis Koplik spots Rash behind ears > confluent

Classic presentation of Rubella

Maculopapular rash, from face -> whole body Postauricular + suboccipital LN

Classic presentation of Mumps

Fever Earache + pain on eating (unilateral -> bilateral)

Presentation of Erythema Infectiousum (Fifth-disease/Slapped-cheek/Parvovirus B19)

Fever Headache + lethargy Rash from cheeks -> upper arms.

Scarlet fever - features (Group A haemolytic strep toxins)

Fever Tonsillitis Strawberry tongue Sandpaper rash + Circumoral pallor

HFM disease presentation (Cocksackie A16 virus)

Vesicles in mouth + palms + soles Fever, sore throat

Bed-wetting is considered normal up to age.

Age 5

Short-term management of bed-wetting in >7yr old (eg school trip)

Desmopression Limit fluid 1hr pre - 8hr post

Incidence of cleft lip/palate

1 / 1000

Cleft lip usually repaired when

1 week - 3 months

Cleft palate usually repaired when

6 months - 1 year

Presentation of missed DDH in an older child

Trendelenberg gait + leg length discrepancy

1st-line management of CMPA Formula-fed Mild/moderate

eHF (extensive hydrolysed formula)

Management of CMPA Formula-fed Severe/2nd-line

AAF (amino acid-based formula)

1st-line management of CMPA- breast-fed

Maternal cows milk elimination Calcium + vit D supplement eHF milk after weaning

Pertussis vaccine in pregnancy

All offered 16-32 wks

Management of pertussis >6 months old

Macrolide (if within 21 days onset) Prophylactic antibiotics for household Notify PHE

Complications of pertussis

Apnoea Pneumonia, Bronchiectasis Seizures Subconjunctival haemorrhage, petechiae

Incidence of DDH

1 - 3% (20% of which are bilateral)

Features of congenital Rubella

Sensorineural deafness Congenital cataracts

Pyloric stenosis age of presentation

2wk - 6wk (rarely up to 4 months)

Definitive management of pyloric stenosis

Pyloromyotomy (Ramstedt or laparoscopic)

Presentation of pyloric stenosis

Projectile vomits 30min after feed Upper abdominal mass Constipation, dehydration, alkalosis

Chance of Down's syndrome child - at maternal age 35

1 in 270

Chance of Down's syndrome child - at maternal age 20

1 in 1,500

Chance of Down's syndrome child - at maternal age 30

1 in 800

Chance of Down's syndrome child - at maternal age 40

1 in 100

Chance of Down's syndrome child - at maternal age 50

>=1 in 50

Investigation used to diagnose vesicoureteric reflux (VUR)

Micturating cystourethrogram

Investigation to look for renal scarring secondary to VUR

Radionuclide scan using dimercaptosuccinic acid (DMSA)

Complications of measles

Otitis media Pneumonia Encephalitis (1-2 weeks later) Subacute sclerosing panencephalitis (5 - 10 yr later) Keratoconjunctivitis Myocarditis

Management of measles contacts

Offer MMR within 72hr, if not already vaccinated

6-8 week check looks for:

Undescended testes DDH Congenital heart disease Congenital cataract

Diagnosis of whooping cough

Cough >14 days, and 1 of: Paroxysmal cough Inspiratory whoop Post-tussive vomiting Apnoea attacks

Hip abnormality found at 6 week check - management

Refer specialist + US <10wks

Roseola infantum - presentation

High fever, rash follows later

Features of Patau syndrome (trisomy 13)

Cleft lip/palate Polydactyly Scalp lesions

Features of Noonan syndrome

Webbed neck Pulmonary stenosis Pectus excavatum

Features of Fragile X

Macrocephaly Macro-orchidism Learning difficulty

Features of Pierre-Robin syndrome

Micrognathia Posterior tongue displacement Cleft palate

Features of Prader-Willi syndrome

Obesity Hypotonia Hypogonadism

Features of Edward's syndrome (trisomy 18)

Rocker-bottom feet Overlapping fingers Low-set ears

Features of William's syndrome

Friendly and extroverted Transient neonatal hypercalcaemia Supravalvular aortic stenosis

Cri du chat syndrome (chromosome 5p deletion)

Characteristic cry Feeding difficulty Hypertelorism

Suspected meningococcal septicaemia in the community - immediate antibiotic management if < 1 year old

IM benzylpenicillin 300mg

Suspected meningococcal septicaemia in the community - immediate antibiotic management if 1 - 10 years old

IM benzylpenicillin 600mg

Suspected meningococcal septicaemia in the community - immediate antibiotic management if > 10 years old

IM benzylpenicillin 1200mg

Limping child - indications for urgent assessment (admission)

< 3 years old > 9 years + painful/restricted ROM Unable to weight-bear Fever / B symptoms Severe pain / Night-awakening Neurovascular compromise Safeguarding concern

Develepment - hand dominance before what age is a red flag (for cerebral palsy)

18 months

Unexplained abdominal mass in a child - management

Urgent paediatric review within 48hr (possible Wilm's tumour)

Household contacts of threadworms

Stat Mebendazole - all family members on same day

Which household members should not be treated for threadworms

Pregnant, breastfeeding, < 2 years old

Features of Kawasaki disease

High fever > 5 days Conjunctival injection Cervical LN Red cracked lips, strawberry tongue Red palms/sole > peel

Management of Kawasaki disease

High-dose aspirin IVIG ECHO for coronary aneurysm

Antibiotic treatment of whooping cough in community (onset < 21 days) - < 1 month old

Clarithromycin

Antibiotic treatment of whooping cough in community (onset < 21 days) - >= 1 month old

Azithromycin or clarithromycin

Antibiotic treatment of whooping cough in community (onset < 21 days) - pregnant woman

Erythromycin

Which conditions are Autosomal Recessive

Metabolic conditions Inherited ataxias

Which conditions are Autosomal Dominant

Structural conditions (+ Gilberts, hyperlipidaemia II)

Features of Freiberg's disease

Mid-foot pain, swelling + stiffness Adolescents

Pathology of Freibergs disease

Infarction > flattening of metatarsal head

Management of Freiberg's disease

Activity limitation + analgesia Orthotics Surgery (rare)

Epistaxis under 2 years old

Fast-track referral to exclude haematological disorder

Hearing test done as newborn

Otoacoustic emission test If abnormal > Auditory brainstem response test

Hearing test done at 6 - 9 months

Distraction test, by health visitor

Hearing test done at 18 months - 2.5 years

Recognition of familiar objects

Hearing test done at 2-3 years

Performance testing Speech discrimination tests

Hearing test done at school entry

Pure tone audiometry

1st-line management of infantile spasm (non-tuberous sclerosis)

Vigabatrin or steroid (prednisolone or tetracosactide)

EEG in Infantile spasm

Hypsarrhythmia

Age of presentation - intussusception

6 - 18 months

Features of intussusception

Paroxysmal colic, knees up, pale Vomiting Red-currant jelly stool Sausage-shaped mass RUQ (25%)

EEG findings with Benign Rolandic Epilepsy

Centro-temporal spikes

Features of Benign Rolandic Epilepsy seizures

At night Partial seizure Child otherwise normal

What age should child be competent with a spoon, and not spil with a cup

2 - 2.5 years

Developmental milestone - copies square and triangle

5 years

Developmental milestone - circular scribble

18 months

Developmental milestone - copies vertical line

2 years

Developmental milestone - copies circle

3 years

Developmental milestone - copies cross

4 years

Developmental milestone - says mama and dada

9 months

Developmental milestone - Knows and reponds to own name

9 - 12 months

Developmental milestone - knows 2-6 words

12 - 15 months (Refer at 18 months)

Developmental milestone - vocabulary of 200 words

2.5 years

Developmental milestone - talks in short sentences

2.5 - 3 years

Management of bruising in a non-mobile infant

Refer for same day paediatric assessment

Developmental milestone - tower of 2 bricks

15 months

Developmental milestone - tower of 3 bricks

18 months

Developmental milestone - tower of 6 bricks

2 years

Developmental milestone - tower of 9 bricks

3 years

Genu valgum (knock knees) usually resolve by

8 years

Genu varum (bow legs) usually resolve by

4 - 5 years

<6m had UTI which responded to treatment - follow-up?

US within 6 weeks

Child >6m First UTI responded to treatment - follow-up

No imaging required (unless suggested atypical infection)

Features suggestive of an atypical urine infection

Seriously ill Poor urine flow Abdominal/bladder mass Raised creatinine Not responding to 48hr of antibiotics Non-E.colli organism found

Infant with GORD - 2nd line after alginate

omeprazole suspension 4wk trial

Management of mild/moderate cradle cap

Baby shampoo + baby oils

Management of severe cradle cap (seborrhoeic dermatitis)

mild topical steroid (1% hydrocortisone)

Presentation of calcaneal apophysitis (Sever disease)

Bilateral heel pain in sporty child Heel squeeze tenderness

Features of Barter syndrome

Normotensive hypokalaemia Failure to thrive

Visible haematuria in a child

Paediatric review within 48hr (rule out Wilm's tumour)

WADR syndrome

Wilm's tumour Aniridia Genitourinary malformation Retardation

General risk of a further febrile convulsion

1 in 3

Management of suspected UTI in <3 month old

Immediate paediatrician review

Management of lower UTI in >3 months old

3 days oral antibiotics (according to local guidelines) Re-review if still unwell 24-48hr

Migraine - 1st line acute management

Ibuprofen

What is the average age that puberty starts in boys

12 years

Send urine MCS before antibiotics if:

<3y Pregnant Pyelonephritis/complicated UTI Recurrent UTI Leucocyte/nitrite +ve only

Management of pertussis in <6 month old

Admit Prophylactic antibiotics for household Notify PHE

1st line management infantile spasm - tuberous sclerosis

Vigabatrin

2nd line management infantile spasm - tuberous sclerosis

Steroid (prednisolone or tetracosactide)

Vitamin K given to

All babies (3rd dose if breast-fed)