Paeds Flashcards
Organism likely responsible - pain out of proportion on clinical presentation, contact lens and recent freshwater swimming is classical of
acathoembic keratitis
Typically what organism is seen in contact lens wearers who have keratitis
Pseudomonas aeruginosia
Features of Retinoblastoma - is it familial, symptomatic, management
- Autosomal dominant, around 10% cases are hereditary
- Absence red reflex, replaced by white pupil, strabismus, visual problems
- Mx - enucleation
GORD Mx in children and if they don’t respond to first line
1.Alginates (gaviscon) + thickened feeds
2. Don’t respond - trial PPI
What age would the av child be able to sit without support, crawl and walk unsupported
Sit with support = 6m
Sit without support = 6-8m
Crawls = 9m
12m = crusises, walks with one hand held
14-15m = walks unsupported
What are the rules regarding when to vaccine premature babies?
Premature = routine Vacc according to chronological age
Babies born prior to 28 weeks = first set of immune at hospital as risk apnoea
Ix for diagnosis of DMD
Genetic testing
What type of inheritance is Haemophilia A
X linked recessive - only in males
At what age:
- Respond to their own name
- Vocal 2-6 words
- Talk in short sentences (3-5 words)
- Respond to their own name = 9-12m
- Vocal 2-6 words = 12-18m
- Talk in short sentences (3-5 words) = 2.5-3 years
Describe Meconeum ileus
Usually delayed passage meconium and abdominal distention
Most have CF
XR will not show fluid level as meconium is viscid
Infants who down respond to PR contrast and NG N-Actyl cysteine will need surgery to remove plugs
Shaken baby syndrome triad
Retinal haemorrhage, subdural haematoma, encephalopathy
What are the contraindications to Lumbar puncture
- Focal neuro signs
- papilloeema
- Significant bulging fontanelle
- DIC
- Signs cerebral herniation
Meningococcal septicaemia - do blood cultures + per instead
Mx of episodic vs multiple trigger viral wheeze
Symptomatic tx only
1. SABA or anticholinergic by space
2. Intermittent LRTA or inhaled corticosteroids or both
If multiple trigger wheeze - trial of either ICS or LRTA 4-8 weeks
Mitochondrial diseases - what mode inheritance
Maternal
So all children from affected mums ill inherit it.
Ix of choice fro stable children with suspected Meckels diverticulum
Technetium scan
Tx meningitis in children <3m VS >3M
<3m = IV amoxicillin and IV Cefotaxime to cover Listeria
> 3m = IV Cefotaxime (or ceftriaxone)
Features Films tumour
Abdo mass (most common), painless haematuria, flank pain, anorexia, fever etc.
It is a childhood malignancy in <5 usually
Which murmur/ defect:
Mid-sys C-D murmur, loudest at upper left sternal border
ASD
Which murmur/defect: Pan-sys, loudest at left lower sternal border
VSD
Continuous C-D machinery murmur.
What problems and Mx
PDA - Indomethicin/ibuprofen to close
Which CHD is associated with Turners syndrome and the Mx
Coarctation of aorta
Prostaglandins till surgery - alprostadil
what murmur = Ejection systolic, slow rising pulse and narrow pulse pressure
Aortic valve stenosis
What are the 3 cyanotic heart disease problems, the tx and age of presentation
Tet Fallot, Transpoistion great arteryes, Tricuspid atresia
In Cyanotic need Prostaglandin E1 - Alprostadil to maintain PDA till surgery
Cyanotic presenting first days of life = TGA
Presenting 1-2m age = TOF
Mx of the CHD that causes boot shaped heart on CXR
Tet dallot - PGs till surgery
Chronic asthma <5 mx
SABA
SABA + 8 week ICS trial
SABA + ICS + LRTA
Stop LRTA + specialist
Chronic asthma 5-16 mx
SABA
SABA + ICS
SABA + ICS + LRTA
SABA + ICS + LABA (salmeterol)
SABA + MART (inc ICS)
SABA + increase MART dose
Chronic asthma 16+ mx
SABA
SABA + ICS
SABA + ICS + LABA
Acute asthma mx
Salbutamol space
Neb salb/ipratropium bromide
PO PRednisolone
IV Hydrocortisone
IV MgSO4
IV Salb
IV Aminophylline
Short synacthen
↓cortisol, ↑ACTH
- What type of adrenal insufficiency is this
Primary adrenal insufficiency
Addison’s disease - autoimmune destruction of adrenals. Bronze hyperpigmentation
Short synacthen
↓ACTH ↓Cortisol
What type of adrenal insufficiency is this
2 Adrenal Insufficiency
Loss/damage to pituitary
↓BP, AMS, ↓Blood sugar, ↓Na, ↑K+ + abdo pain = diagnosis and management
Addisonian Crisis
↓BP, AMS, ↓Blood sugar, ↓Na, ↑K+
IV hydrocortisone
Ambiguous genitalia
Hyperpigmentation
M- early puberty, small testes
F- facial hair
condition and what happens to cortisol and aldosterone
CAH
↓ Cortisol ↓Aldosterone
Primary amenorrhoea, undescended testis causing groin swellings in females, breast development.
Phenotype female but genotype male
what condition is this
androgen insensitivity
Delayed pubertym hypogonadism, anosmia, sex hormones low, FH,FSH low/N (inappropriately)
what condition is this
Kallman
Taller than av, lack secondary sexual characteristics, small firm testes, infertile, gynaecomas, elevated gonadotroohin levels. Chromosomal analysis
what condition
kleinfelters
Most common nephrotic syndrome in children
Minimal change disease - hyaline casts
Mx Enuresis - nocturnal vs urge
1.Alarms
Nocturnal - desmopressin
Urge - oxybutynin
Projectile non-bilious
Common 3-6weeks
vomiting
Olive shaped mass
dx, ix, mx
Pyloric stenosis
US
Hypochloremic Hypokalamia met alkalosis
Ramstedt pyloromyotomy
Central abdominal pain + URTIs
Inflamed LNS
dx
Mesenteric adenitis
6-9m
Diarrhoea, vomiting, sausage shaped mass (RUQ), drawing legs up to abdo, pallor, red jelly stool (late sign)
dx, ix, mx
Intussusception
US
Air insufflation
Ix, Mx intestinal malrotation
Upper GI contrast study + USS
Laparotomy and if volvulus present or high risk then Ladds procedure
Delay in meconium
Abdo distention/constipation in older children
dx, ix, mx
Hirschprung’s
Rectal biopsy
Rectal washout -> anorectal pull through surg
Choling + cyanotic spells after aspiration
Ass with polyhydramnios
dx
oesophageal atresia
Jaundice after 14 days, increased conjugated bilirubin
Most likely dx and mx
Biliary atresia
Kasai procedure
Usually in preterm
Abdo distention + blood in stools
dx, ix, mx
Necrotising enterocolitis
XR - football sign (Riglers)
TPN + gut rest
Undescended testis - management:
Unilat vs bilat
Unilateral UD testicle - review at 3m - if perists then refer. If orchidopexy then most at 1years old.
Bilateral then review by senior paediatrician in 24hrs as may need urgent endocrine or genetic Ix
Congenital defect - ant abdo wall defect lateral to umbilical cord.
Name of condition and mx plan
Gastroschisis
Congenital defect - ant abdo wall defect lateral to umbilical cord. Can attemp VD but surgery asap
Abdo contents protrude through ant abdo wall but covered in amniotic sac.
dx, mx
Exomphalos (omphalocoele)
Abdo contents protrude through ant abdo wall but covered in amniotic sac. C section planned.
Toddler diarrhoea
tools vary consistency, often contain undigested food
Typically first 3m life in formula fed infants
Regurg, vom, diarrhea, urticaria, colic symp, wheeze, rarely angioedema/anaphylaxis
dx, mx (severe vs mild to mod)
If severe - paediatrician (failure to thrive)
In formula fed - extensive hydrolysed formula if mild-mod.
Severe - amino acid based formula
Continue breast feeding and eliminate cows milk protein from maternal diet.
IgE mediated - most will be ok by 5, in non-IgE most fine by 3
Mx umbilical hernia
Usually self resolve, but if large or symptomatic perform elective repair at 2-3 years of age.
If small and asymptomatic then elective repair 4-5 years
Epilepsy meds - what to give in general vs focal and absence and common S.E
SV (teratogenic) except…
Focal - carbamazepine (agranulocytosis)/ Lamotrigine (SJS)
Absence - Ethosuximide (Night terrors/rashes)
short limbs, large head, trident hand,s, lumbar lordosis
dx, inheritance pattern
Achondroplasia
Autosomal dominant - mutation n FGFR-3 = short limbs, large head, trident hand,s, lumbar lordosis
1st line Mx depression in children
FLuoxetine
1st line mx GAD in children
Sertraline
First line mx OCD+ bulimia in children
SSRI
Lack interest/ desire in relationships
type personality
Schizoid
Unusual thoughts/beliefs
Type personality disorder
Schizotypal
Microcephalic, Polydactyly, small eyes, cleft palate, scalp lesions
Pataus T13
Micrognathia, rocker bottom feet, low set ears, overlapping fingers
Edwards T18
Learning disabilities, macrocephaly, long face, large ears (protrudina, macro-orchidism. Most common ND delay cause
Fragile X
Webbed neck, Pectus excavatum. Short stature, pulmonary stenosis
Noonan
Microganthia, posterior displacement of the tongue (upp airway obstruction) + cleft palate
Pierre robin
Hypotonia, Hypogonadism, obesity
Prader willi
Short, LDs, elfin faces, friendly/extrovert personality, transient neonatal ↑Ca, supraclavicular aortic stensois
Williams
Deletion C5p. Cat cry, feeding problems, poor weight gain, LDs, microcephaly
cri du chat
Loss UBE3A (mum). Fascination with water, happy, widely spaced teeth
angelman
Webbed neck, short widely spaced nipples, as with CHD (coarctation of aorta). Primary amenorrhoea
Turners 45 XO F
↓tone, prominent epicanthic folds, single palpable crease
Screen for atlanto-axial instability if participate in sports (_^risk neck dislocation)
Downs syn
↓LH/FSH, ↓test/oest - delay puberty + anosmia
kallman
When to do surgery for hypospadias
Cna be ass with cryptorchidism and inguian hernia
Mx - refer to specialist and surgery usually at 12m. Do not cirucmcise before surgery.
Cataracts, LDs, heart defect, hearing loss
which congenital infection
Rubella
FGR, Limb hypoplasia, chorioretinitis, scars
which congenital infection
VSV
FGR, Microcephaly, HL LD, Seizures, vision loss
which congenital infection
CMV
intracranial calcification, hydrocephalus, chorioretinitis
which congenital infection
Toxoplasmosis
Microcephaly, FGR, ventriculomegaly, cerebellar atrophy
which congenital infection
zika
Perthes mx
surgery
if <6 observe
7 year old body - XR
SUFE - classic age and mx
12 boy obese - XR
Often loss internal rotation of leg
Surgery
↑ ALP,Nocturnal pain
sunburst XR <48hrs
osteosarcoma
Mx DDH
Pavlik harness
Mx clubfoot (Talipes)
Ponseti method
Strawberry tongue, Cervical LNs, conjunctivitis, desquamation hands/sole of feet, fever 5+days
dx, ix, mx
kawasaki
ECHO to screen for coronary artery aneurysms
Aspirin + IV IgG
Petechia no fever
Dx
ITP
Koplik spots, rash starts behind ear
Dx and exclusion rules
Measles
Isolate 4d from resolution symp
↑ LNs (cervical), can have joint pain
Dx and exclusion rules
Rubella
isolate 5 d from res symptoms
Scarlet fever isolation rules
24 h after Abx
Whooping cough Tx and isolation rules
2d after Abx (PO azizthromycin) or 21d from onset. Nasal swab confirms
Mumps isolation rules
5d from onset swollen glands
Impetigo isolation rules
lesions crusted over or 48hrs after Abx
rash, caused by HHV 6-7, 1-2 weeks after with high fever
dx
roseola infant
Meningitis tx for <3m vs >3m
<3m = IV Amox + iV Cefotaxime
>3m = IV cefotaxime (or ceftriaxone) +/- dex
Pneumonia Mx in children and if mycoplasma or ass with influenza how does this change
Amox
Macrolides added if no response
Mycoplasma pneumonia (target lesions) or chlaymdia suspected then macrolides (erythromycin) is first line
If associated with influenza (staph aureus) then co-amox is first line.
Peri-anal itching (mostly night), girls may have vulval symp
dx and mx
Threadworm
Peri-anal itching (mostly night), girls may have vulval symp)
Single dose mebendazole (>6m) for whole household and hygiene advice
Resus fluids in children
10 ml/kg stat 0.9% NaCl
Maintainance fluids for children
0.9% NaCl + 5% dextrose
100 ml/kg for first 10kg
50 ml/kg for second 10kg
20 ml/kg remaining kg
Replacement fluids for children
% dehydration X Weight X 10
5% = dry membranes, thirsty ↓UO, normal obs
10% = mild tachy, sunken eyes, NBP
15% = Marked tacy, ↓ BP, DCRT, Mottled
newborn resuscitation steps
Dry + maintain temp
Assess tone, RR, HR
If gasping or not breathing - 5 inflation breaths
Reassess
If HR not improving and <60 then start Compressions and ventrilaiton breaths at 3:1
APGAR score calculating
Cephalohaematoma vs caput succedaneum
Cephalohematoma
Does NOT cross suture lines
Typically develops several hours after birth
Mostly parietal region
Up to 3m to resolve
Caput succedaneum
Crosses suture lines - mostly over vertex
Present at birth
Resolves within days
Red flags in development of children
refer:
Doesn’t smile 10w
Cant sit unsupported at 12m
Cant walk 18m
Fine motor - hand pref before 12 (CP)
Gross motor - mostly DMD, CP etcSpeech and language - always check hearing.
Neonatal hypoglycaemia - def, symptoms and mx
<2.6 mmol/L
Transient in first few hours after birth is common
Jittery, irritable, poor feeding, drowsy, hypotonia…
Asymp = Encourage normal feeding, monitor
Symptoms/very low = admit to unit, IV infusion 10% dextrose
Softening cartilage, common in teen girls
Ant knee pain on walking up and down stairs + rising from prolonged sitting
diagnosis and mx
Chondromalacia patellae
Usually responds to physio
Sporty teens
Pain, tenderness, swelling over tibial tubercle
dx
Osgood-Schlatter
Pain after exercise
Intermittent swelling and locking
of knee
diagnosis
Osteochondritis dissecans
Athletic teen boys
Chronic ant knee pain that worsens after running
Tender below patella on exam
dx
Patellar tendonitis
Which hearing tests at: newborn, 6-9m, 18m-2.5 years, 2.5years and >3
Newborn - otoacoustic emission test (screening). If abnormal then Newborn & infants - auditory brainstem response test
6-9m - distraction test
18m-2.5 years - recognition familiar objects
>2.5 - performance testing/ speech discrimination tests
>3 - pure tone audiometry
