paeds Flashcards
Meckel’s Diverticulum
2 rule
gastric/ pancreatic mucosa which can bleed -painless
Technectium scan
resection if symptomatic otherwise leave
comp is intusussception
Littre’s hernia
vitello-intestinal ducton
Coarctation of the aorta
loudest between scapulae, loud brachial
may present with leg pain and dizziness if mild
angioplastic/ balloon stent
give prostaglandins while waiting for surgery
hypertension may be complication esp after surgery = give antihypertensives
VSD
the smaller the louder
<3mm - loud pan systolic, poor gain and feeding
spontaneously resolve, no risk of IE after closure
>3mm - may have HF, surgery at 3-6 months, softer pan systolic
echo is diagnostic
ASD - heart
foramen ovale fails to close
cardiac catheterisation at 3 years
ESM fixed splitting of S2
Haemangioma
Infantile and congenital
congenital: non-involuting or involuting (12-18 months) - may do embolisation if causing problems
laryngeal haemangioma –> ENT referral, ulcerated
medical photography and review in 3 months
preterm, IVF, bleeding in pregnancy
superficial, deep, mixed
USS/ MRI
PHACES and LUMBAR syndromes
Juvenile dermatomyositis
Heliotrope rash on eyelids and malar rash
raised ESR and creatinine kinase
Proximal weakness
Nappy rash
Irritant, candida, seborrhoeic
candida: superficial pustules, satellite spots, check oral
seborrhoeic: flaking, salmon pink patches, cradle cap
hgih absorbency, disposable, fragrance free nappy wipes
topical imidazole for candida, fluclox for bacterial, if eczema - hydrocortisone
Tinea
Kerion and hair loss (alopecia) immediate derm referral
topical terbinafine, moderate = + hydrocortisone, severe = oral
Skin scrapings and wood’s lamp
Hypothyroidism
Downs and Turners
Jaundice, constipation, lethargy, developmental delay, poor feeding, umbilical hernia, macroglossia
<2 = neuro, >2 = short stature (cretinism)
TFTs monitored
every few weeks until TSh stabilise, every month until puberty, then annually
Thyrotoxicosis
Grave’s, de Quervain’s, Hashimotos, post-partum
foetal high CTG and goitre on USS
neutropenia - warn about fever/ sore throat - come back
Neuroblastoma
neural crest tissue of adrenal glands
abdominal mass and distension
orbital ecchymoses
bone pain
biopsy, check BM fx (mets)
Epiglottitis
do not lie down
cefuroxime and dexamethosone after ENT, paeds, anaes support
rifampicin for household contacts
Epistaxis
10-15 mins bleed stop
cautery + Naseptin application
if not then nasal packing
Meconium aspiration
GA >42 weeks
if no GBS infection then observe
if signs of infection = IV gentamicin and ampicillin and O2 support if needed
Meconium ileus
gastrograffin enema
billous vomiting
biliary atresia and cf
Encopresis
soiling after age of potty training 4 years
psych stressors - school, travel, diet, malabsorption, medication changes, food intolerance
Vitamin D
phsophate loss - Fanconi’s
looser’s zones/ pseudofractures
formula feed
calcium carbonate and chole/ergocalciferol
Wilm’s
abdominal mass not crossing midline
painless haematuria
hypertension
flaws
CT abdo/ pelvis
resection, chemo, radio
GS: renal biopsy - small round blue cells
Beckwith Weidemann syndrome
Hernias
6 weeks = 2 days
6 months = 2 weeks
6 years = 2 months
if large/ symptomatic >1 = 2/3 surgery, if small = 4/5
process vagialis
if strangulated/ obstructed = emergency laparotomy with cephalosporin
VZV
head and trunk then spread
IV aciclovir in imunocompromised
bacterial infection (fluclox and aciclovir), NSAIDS = necrotising fasciitis, purpura fulminans (protein C and S inactivation), encephalitis = cerebellar signs, shingles
EBV
Paul Bunnel and Monospot
white exudate on tonsils
Roseola Infantum
Nagayama spots
febrile seizures
diarrhoea and cough
Measles
4 days before and after
prodrome of fever, malaise, conjunctivitis
otitis media, subacute sclerosing panencephalitis - 7 years after
encephaltis after couple weeks
notifiable - HPU
Mumps
Orchitis, encephalitis, sensorineural loss, amylase
9 days after swelling starts infective
salivary IgM, amylase
Rubella
spares limbs unlike measles
Forcheimer spots
thrombocytopenia and encephalitis
5 days after
Retinoblastoma
leukocoria
strabismus
visual problems
no biopsy
examination under anaesthetic
enucleation, chemo, laser therapy
secondary malignancy e.g. osteosarcoma
autosomal dominant
Otitis Media
haemophilus, strep, RSV
<2 + bilateral, <3 months, immunocompromised, perforation
can give delayed if has not improved in 3 days
breastfeeding is protective
passive smoking
cleft palate, down;s
ENT emergency if mastoiditis - CT
meningitis, brain abscess, facial nerve palsy, labyrintitis
if perfroation, amoxicillin oral for 5 days then review in 6 weeks
check speech and developmental milestones
Otitis media with effusion
if cleft palate or Down’s –> immediate ENT referral
speech and development, poor performance in school
two pure audiometry tests 3 months apart
non-surgical: hearing aids - active monitor for 3 months
surgical: grommets
otorrhoea is SE of myringotomy and grommets
Brain tumours
cranial nerve palsies, seizures, medulloblastoma, ependyoma - hydrocephalus, cranipharyngeoma, pituitary adenoma
CLIC sargent - cancer and leukaemia in children social worker
Benign IC hypertension -papilloedema but normal everything else, obesity - LP with manometry
MRI > CT
Infantile spasms
clusters
hypsarrhythmias
Torch screen, lactate, ammonia, hypoglycaemia
tuberous sclerosis, hypoxic brain injury
can cause developmental delay and development of epilepsy
poor prognosis
triad of infantile spasms, hypsarrhythmias and encephalopathy - regression/ plateau in development
triggered by feeding and noise
steroids and vigabatrin (can cause irreversible visual field defects)
Bone tumours
Ewing’s: onion skinning, t(11;22)
osteosarcoma: mets to lung, Rb gene
sarcoma specilaist team, limb sparing surgery +/- amuputation + chemo +radio
Nephrotic and nephritic
Antithrombin loss = procoagulant
strep titre even minimal associated
lipid profile
shifting dullness
steroids
neprhitic: can give prophylactic trimetoprim
reduce steroid dose after 4 weeks
JIA
like RA - swan neck deformity
NSAIDs, steroids, DMARDs
morning stiffness
uveitis
persistent joint swelling > 6 weeks
reactive arthritis
gonorrhoea, chlamydia, yersinia,
sterile pyuria
NSAIDs because after infection
fractures
greenstick - distal radial
normal: distal radial, elbow, clavicle, tibia
NAI: humerus, femoral, radial
femoral
· Neonates (0-28 days) – padded splints or Pavlik’s harness
· <18 months – Gallows traction
· 1-6 years – straight leg skin traction
>4 years – intramedullary nail (+ more support if >11y)
radial = k=wire
pain management: intranasal midazolam/ ketamine
Ottawa’s ankle and knee rule
spinal muscular atrophy
poor feeding
cant stand and NG tube in type 2
gastroschisis and omphacoele
omph: umbilical cord attached, chromosomal disorders, Beckwith-Wiedemenn syndrome
gastro: vaginal then theatre within 4 hours to correct
more gradual staged repair for omph
omphacoele assoc w/ syndromes
gastroschisis with smoking young age alcohol
congenital diaphragmatic hernia
due to incomplete diaphram formation
USS during preg
CXR - displaced mediastinum, loops of bowel in chest, collapsed left lung)
NG tube and suction then surgery to re-expand lungs and ventilatory support
Bochdhalek hernia in left lung
barrel shaped chest and scaphoid abdomen
Intussusception
Dance’s sign = RLQ
Peyer’s patches
think recurrent = Meckel’s diverticulum, polyps
sausage shaped mass in RUQ
teelscoping of proximal into distal
rectal air insufflation
Whooping cough
catarrhal –> spasmodic –> convalesecent
can last 10-14 weeks
worse at night and after feeds
Abx need to be given within 21 days
seizures, subconjunctival, pneumonia
admit if <6 months, severe breathing difficulty, seizures
<1 month = clarithro, >1 month = erythro
Neonatal resus
1) dry baby
2) asses HR and breathing
3) 5 inflation breaths if not breathing/ gasping
4) reassess if chest not moving 2 person airway control and repeat inflation breaths
5) if chest moving - ventilation 30 seconds
6) if HR < 60 - 3:1 chest compressions
7) check HR every 30 seconds
if still not IV access and give drugs
Duchenne’s and Becker’s
resp problems
mother reports child slipping through hands
Becker’s more milder form, wheelchair later, cardiaomyopathy, scapula winging and waddling gait (shoulder and pelvic girdle weakness)
lung function tests - decreased vital capacity
air stacking and insufflation
glucocorticoids may strengthen muscles over time
proximal to distal
geneitc testing is GS
Tetralogy of Fallot
overriding aorta, RVOTO - determinant of severity of cyanosis, RVH, VSD
tet spells
ejection systolic at lower left sternal border
Acutely: lie babies on their back and bend their knees. In hospital, oxygen should also be provided
otherwise: prostaglandin infusion, BT shunt and then 6 months surgery to correct RVOTO and close VSD
RDS
ground glass appearance
IV fluids, antibiotics, intratracheal surfactant
if looks well and comfortable = nasal cannulae
if >30 weeks/ looks well + acidosis = nCPAP
if <30 weeks/ looks unwell + acidosis = positive pressure ventilation
diabetic mothers
Cerebral palsy
causes: antepartum - TORCH, peripartum - HIE, preterm, postpartum - meningitis, PVL
hand preference before 1 year, tip toe walking (refer anyone with persistent)
MRI
clasp knife, tip toe in spastic
chorea, dystonia, athetosis - fanning of fingers in dyskinetic
hypotonia in ataxic
follow up with MDT for 2 years
red flags for other neuro conditions: progressive, MRI not keeping with CP, lost attained abilities/ skills
SCOPE disability charity
feeding difficulties
Sepsis
<30 mins - ST4 or above reg, <1 hr = consultant
Lp if <1 month unwell between 1 and 3 months, WCC count really low/ high between 1 and 3 (5 and 15)
procalcitonin good marker of bacterial sepsis
continuous monitoring and review
if. failed IV then IO
deep ear swab
IV fluid bolus if shock
sepsis 6 within 1 hour
prolonged rupture of membranes
early onset: benzylpenicillina and gentamicin (GEL)
late: fluclox + gentamicin (staph epidermitis)
ceftriaxone for gram -ve cover if needed
seizures, resp distress > 4 hours
P U on AVPU
Gastroenteritis
CHESS + listeria = dysentery
rotavirus most common
* Complications → dehydration → shock (increased risk if…)
* <6m old
* >5 diarrhoeal stools in <24hrs
* >2 vomits in <24hrs
Cannot tolerate extra fluids or malnourished
can do oral rehydration solution
no antidiarrhoels
no sugary/ carbonated drinks
Antibiotic treatment for slamonella <6 months or immunocompromised
sepsis
extra intetsinal spread
c.diff
post-infectious IBS, HUS, transient lactose intolerance
- Children ≤ 5 years: Rehydration with ORS at 50mL/kg over 4 hours
Children > 5 years: Rehydration with 200mL ORS after each loose stool (in addition to normal fluid intake) in clinical dehydration not shock + maintenance
Infantile spasms
encephalopathy - regression of developmental skills, hypsarrythmia on EEG, salaam attacks = West’s syndrome
ammonia, lactate, glucose, torch screen, EEG does not exclude
tuberous sclerosis: ash leaf spots, angiofibroma on the nose,
steroids and vigabatrin
poor prognosis, development of learning disabilities and epilepsy
symmetrical
triggered by noise and feeding
in clusters
UTI
if <3 months admit and give IV co-amox
if >3 months and lower UTI = PO trimethoprim for 3 days F, 5 days M
if > 3 months and upper + vomtiing = IV co amox and admit
if upper and no vomiting = PO cefalexin
if recurrent consider long term prophylaxis before MCUG if no VUS then stop
if < 6 months and atypical = urgent USS and DMSA in 4-6 months + MCUG
if first presenation = USS within 6 weeks, can consider MCUG
if >6 months + < 3 years and atypical = urgent USS (if non-E.coli and responding well then within 6 weeks)
if recurrent: USS within 6 weeks and DMSA +/- MCUG (FHx pf VUR, poor urine flow, dilation on USS)
if >3 years: atypical = same as above but no need for MCUG
recurrent UTI = >= 2 upper, 1 upper and lower or >3 lower
atypical: very unwell, not E.coli, not responding to Abx for 48 hours
precocious puberty
<8 and <9
boobs, pubes, grow and flow
Tanner’s and Prader’s orchidometer (> 4ml)
flat, budding, rounded, mens within 2 years, more rounded and only nipple raised
gonadotrophin depended: tumour, hydrocephalus, meningitis
independent: McCune Albright (thyroid, cushings, acromegaly), CAH, gonadal tumours, leydig cell tumour
premature thelarche and adrenarche
refer to paeds endo
if atrophic testes = CAH
if bilateral enlarge: gonadrotrophin dependent
if unilateral: tumour
dependent: GnRH analogues and GH
but no tx if no underlying pathology
independent: ketoconazole
gold standard diagnosis: GnRH stimulation test
Down’s
ASVD
hypothyroidism
Hirschsprungs
Infertility
Glue ear
ALL
ASD
Alzheimer’s
annual thyroid, opthalmic and hearing checks up to 5 years then every 2 years
local DS clinic and parent support groups
Epicanthal folds in addition to upslanting palpebral fissures
meiotic non-dysjunction
Enuresis
primary: not ever had a dry period for longer than 6 months
secondary: after 6 month dry period
constipation, neuropathic bladder, reduced bladder sensation, detrusor instability, emotional upset, UTI, diabetes
> 5 years when should have sensation
if wetting on getting up and dry at night with girls = ectopic ureter
>7 = desmopressin first line
>5 = enuresis alarm
4 weeks follow up after alarm continue after better until 14 consecutive dry nights
if not responded to 2 courses of Tx = community paeds referral/ enuresis clinic/ secondary care
status epilepticus
convulsing more than 5 minutes without gaining consciousness
in community - buccal midazolam after 5 minutes if not recovered call ambulance
in patient: buccal midazolam/ rectal diazepam –> IV lorazepam x2 –> anaesthetic support and Iv phenytoin –> rapid sequence induction with sodium theopenthone
CAH
21 hydroxylase def –> 17a-OH progesterone build up
USS on internal genitalia in neonates
IV hydrocortisone, dextrose and fluids
lifelong is hydrocortisone but give fludro as well if salt losing
metabolic acidosis
monitor 17a-OH progesterone, androgens, skeletal growth, androgens
5a-reductase def = XY, feminisation, male organs
21 = XX, no male or female organs
androgen insensitivity = XY, female phenotype
17a = XY, feminisation, hypertensive
double dose if ill
enlarged penis small testes
Testicular torsion
undescended testes is a rf
if presented within 4-6 hours greater testicular viability
urine dip to rule out epididymo-orchitis
duplex USS - increased in orchitis and decreased in torsion
if surgery not available in 6 hours, then manual detortion
orchidoplexy but may need orchidectomy
bell clapper testis
pain relief and anti-emetics
Chronic asthma
Pectus excavatum and carinatum
Harrison’s sulci
FEV1/FVC <70 and 12% improvement with bronchodilator in >5
<5 = clinical diagnosis
FeNO >30 = inflammation
how much school missed
use spacer?
<5:
SABA –> SABA + moderate dose ICS (8 weeks trial) if recurred within 4 weeks of stopping = low dose if beyong 4 weeks of stopping = moderate –> SABA + LTRA + low dose ICS –> refer to specialist
>5:
SABA –> SABA + low dose ICS –> SABA + low dose ICS + LTRA(review in 4-8 weeks) –> SABA + low dose ICS + LABA –> SABA + MART (moderate dose ICS) –> specialist
if good asthma control can step down to lowest steroid dose
Acute Asthma
every 20-30 mins for an hour
if at home every 10-20 mins
consider quadrupling ICS dose for next 14 days if cant can give PO pred for 3-7 days
1-2-3-4 hourly, >94% sats, >75% PEFR then discharge
follow up within 2 days in hosp and week in GP
if on MgSO4 use ECG
Iv salb/ aminophylline
transfer to ICU
5 tidal breaths per puff
Atrovent
salb overdose = vomiting, shviering
paco2 rising = near fatal
Duodenal atresia
blind end to duodenum
Down’s
double bubble sign
duodenoduodenostomy
polyhydramnios
DDD - downs, double bubble, duodenodudeno
Hypospadias
three features: hooded prepuce, ventral meatus, curvature of shaft (chordee)
baso urethra not at tip of penis
important not to be circumscised before surgery at 12 months as need skin
Normal dehydration
Different to DKA
Bolus is same
shocked = 20ml/kg over 15 mins
non-shocked = 10ml/kg over 60 mins
but deficit is not according to pH but weight loss
no clinical dehydration = <5%
clinical = 5-10%
shock = >10%
1% = 200ml as deficit
maintenance is with 5% dextrose unlike DKA
4,2,1 calculation
first 10kg, next 10kg and rest = 4 x – + 2 x ___ + 1 x ___
oral rehydration solution in clinical dehydration (has glucose in it)
continue breastfeeding, avoid sugary drinks, advise fluid intake before and after
FOFSALT and SALTLOSS
signs of clinical undectable are baso nromal, in clinical dehydr - red urine output, lethargy, dry mucous membranes, shock = cold peipeheries and other symps
Perthes
4-8 year
short stature and hyperactivity (think ADHD)
Catterall staging - 1= no changes, 2 = cystic changes ona rticular surface, 3 = femoral head changes to integrity, 4 = acetabulum integrity
<6 = obs, pain relief, physio, splints
>6 = osteotomy
limb shortening
roll test = guaridng
MRI if persistent pain despite normal x-rays
should raise suspicion of this if > 4weeks
Persistent pulmonary hypertension
fluoxetine can cause
think HF so may need CXR, urgent echo
absent heart murmurs and signs of HF
O2 and inhaled inotropes, may need ventilation
Kwashiokor and marasmus
Kwashiokor - proteins
Marasmus - fat and proteins
think like nephrotic so oedema, muscle wasting
in marasmus get more weight loss, dry wrinkled skin
Impetigo
Staph aureus/ strep
warm weather, scratching
incubation period 4-10 days
non bullous, local = hydrogen peroxide cream then topical fusidic acid
non bullous, wide spread - topical fusidic/ oral fluclox
widespread bullous = oral fluclox
school exclusion until healed and crusted over or 48 hours after starting Abx
what is considered as DKA being resolved
bicarbonate >15
ketones <0.6
pH > 7.3
Delayed puberty
13 not starting breast devlopment, 15 for periods
infection, trauma, chemo, intracranial tumours, hypothryoidism, testicular torsion
>=75th = drop by 3
25-75th = drop by 2
<25th = drop by 1
wrist x-ray = constitutional delay
prolactin TSH
orchidometer <=4ml
charting of parents
IM test for 3-6 months, 6 weekly
transdermal oestrogen for 3-6 months
monitor for overdevelopment of breasts and early fusion of epiphyses then give progesterone once established
Kleinfelters
sparse axillary and pubic hair
47XXY
tall stature
gynaecomastia
small firm testes
Kallman’s
X-linked recessive
failure of GnRH neurones to migrate to hypothalamus
anosmia
hypogonadotrophic hypogonadism
Tonsilitis
tonsillectomy: 7 in 1, 5 in 2 , 3 in 3
sandpaper rash, amox rash, change in voice
ibuprofen, difflam, fluids
centor: fever, anterior cervical lymph, absence of cough, lymph exudate (3/4)
feverpain: FASTI (inflamed tonsils, symptoms within 3 days) - 4,5 , 2,3 = consider
admit: difficulty breahing, dehydration, quinsy, systemically ill
lemierre’s syndrome: septic emboli and internal jugular vein inflam - high dose benzylpen + debridement
Laryngomalacia
supraepiglottic collapse - baso voice box
FTT, poor feeding
GOR symps
onset within 2 weeks of birth (2-6 weeks)
worse lying down
coughing
Ix: flexible laryngoscopy
usually resolves within 18-24 months
thicked feeds for GOR
if failure to grow and rlly impacting then epiglottic supraglottoplasty
hypotonia, Down’s
normal cry as vocal cords not affected
mesenteric adenitis
diagnosis of exclusion - mainly appendicitis on clinical suspicion
may have to do USS and bloods
always inc in PACES differentialsI
ITP
avoid activities, contact sport which result in trauma
<20 = IVIG, steroids, anti-RhD
if life-threatening haemorrhage then transfusion
1-2 weeks after vaccine/ infection
reoslve in 6-8 weeks
Threadworms
Enterobius Vermicularis
<6 months - 6 weeks hygiene
cut nails, no scrtahcing, change linen, handwashing
mebendazole and 2 weeks measures
Epilepsy
lamotrigine not for myoclonic
ethosuximide for absence
MDT
ECG
benign rolandic epilepsy - during sleep and hypersalivation - younger children
juvenile myoclonic epilepsy - waking up - older children
progressive - deteriorates overtime
school
weight gain in valproate
rash in carb and lam
carb and lam for focal
status epilepticus
- Roll on side (if safe to do so) + high-flow oxygen + check glucose
- First line treatment if seizure not resolved within 5 minutes: IV lorazepam or buccal midazolam or rectal diazepam
- If seizure is continuing after 10 minutes: IV lorazepam
- If seizure continues for another 10 minutes: IV lorazepam; call for senior support, including anaesthesia if not already done so
- IV Phenytoin (IV phenobarbitone if patient normally takes phenytoin)
Rapid sequence induction with sodium thiopentone
comp: behvaioural problems, memory loss, hypoxic brain injury
scoliosis
Adam’s forward test
minimal pain
X-rays, Cobb;s angle > 10
if severe then brace
CF
low faecal elastase for pancreatic insufficiency
DM in older children
gastrograffin eneme for meconium ileus
at each appointment: SpO2, obs, clinical exam, sputum sample, spirometry
prophylactic Abx = fluclox
flare up: co-amox for 14 days
RhDnase = mucolytic
guthrie and immunoreactive trypsinogen
Cystic Fibrosis Trust
Downs
upslanting palpebral fissures
epicanthal folds
hearing, thyroid levels, visual tests
annually until 5 years then 2 yearly
local DS clinic
hypotonic floppy baby
biliary atresia
hepatosplenomegaly
T1: common bile duct, T2: cystic duct, T3: full atresia
GS: technetium TIBIDA scan
Confirmation: cholangiogram
USS can be part of 1st line = triangular cord sign
FUP
bronchiolitis
Fine bi-basal end-inspiratory crackles
CPAP if resp failure
12-18 months
croup
acute epiglottis as ddx, no ENT
bacterial tracheitis
alternative is IM dex and nebulised budenoside
moderate if stridor and recessions at rest
seevre if cyanosis, tachy, baso sepsis symps
if severe, neb adrenaline first line as cant swallow dex
appendicitis
anorexia
guarding
mcBurney’s point
if retrocoecal no guarding
VBG
DDH
at 36 if breech, USS regardless at 6 weeks, also FHx for scan
first, female, oligohydramnios
>6months - surgeyr
avascular necrosis
galeazzi sign
barlows: adduct and upwards
SUFE
loss of internal rotation on flexion
Tredelenburg gait
anterolateral and frog leg views
unsatble: suregry
stable: internal screw fixation, contralateral hip fixation
non weight bearing and rest before surgery
widened gowth plate
short displaced ephyphyses postero inferiroly
septic arthritis
abducted, flexed, pseudopralysis
aspirate until dry
Kocher - WCC, CRP, fever, non weight bearing
2 weeks IV 4 weeks oral Abx
fluclox
cephalosporins in young
cefotaxime - neonates ceftriaxone – <6
x-ray only after 2-3 weeks
osteomyelitis
24 to 72 hrs IV antibiotics
then 6 weeks oral Abx
Affected limbs should be immobilised
Surgical debridement may be necessary if there is dead bone or a biofilm
Surgical drainage if the child does not respond within the first 24 to 48 hours to the AB treatment
X-ray changes may only be seen later - subperiosteal new born formation, Brodie abscess
flucloxacillin/ penicillin or flucloxacillin/fusidic acid
paeds ortho
HSP
follow up weekly then monthly for BP and urine dip to check nephritis
IV corticosteroids if renal involevemtn
oral steroids if scrotal swelling/ oedema
NSAIDs for joint point
usually no need Mx, resolves in 4 weeks
Tetralogy of fallot
acute lie back and bend knees
BT shunt and prostaglandin and then 6 months later to close VSD and correct aorta
ejection systolic as pulmonary stenosis
SCD
Family origins questionnaire
Guthrie test
penicillin V
sickle solubility does not differentiate between trait and disease so GS is haemoglobin electrophoresis
hip xray to check avascular necrosis
folic acid supplementation for growth
osteomyelitis
3-9 months
Thalassaemia
osteopaenia due to iron overload
desferrioxamine
A4 - Barts, hydrops fetalis, oedematous at birth, massive placenta
A3 = anaemia; rest no anaemia
flat cranium
Hair on end appearance
Chr 11, Chr 16 (B, A respectively)
Leukaemia
lymphadenopathy
leukaemia cutis
induction –> consolidation –> intensification –> maintenance
high fluids and allopurinol, crossmatch plts, plt transfusion, specialist centre, BM aspirate, transplant
Infant colic
GOR conservative Mx
white noise
cry-sis website
support
no infacol
reoslve by 6 months
if persistent then GOR/ milk protein allergy
hydrolysed/ alginate 2 week trial
* paroxysmal, inconsolable crying or screaming,
* often accompanied by drawing up the knees
passage of excessive flatus takes place several times a day
osgood schlatter
anterior knee pain
reduce some activity such as jumping and running
will get better after growth spurt
eczema
finger amount, 30 mins of emollient before steroid
itchywheezysneezy
pacth test for contact
<2 week referral if severe and not responded in 1 week/ faield bacterial tx
phototherapy if rlly severe
brestfeeding can delay presentation
sedating anti-histamines for 7-14 days if severe and distubred sleep
if severe itching 1 month trial of non-sedating
non urgent referral if recurrent, contact dermatitis, causing social probs, unclear diagnosis
Eisenmenger’s
comp of LtoR shunts - PDA, VSD
pulm pressure and resistance increases causes RtoL shunt - cyanosis
diabetes
DAFNE
hypoglycaemia alarm with continuous monitoring
if not CGM then 5 times a day cap reading
lipohypertrophy
regular review of complications for 12 and over annually
HbA1c at least 4x a year
pump only short acting insulin
inject long acting everyday
short - actrapid (lispro), long = insulitard (determir)
type 2: HHS - fluids and oral metformin
>320 osomlality
obesity
> 95% obese
85-94 = overweight
limit screen time to <2 hours
orlistat only considered if >12 and >40 BMI or >35 BMI plus complications
coeliac disease
osteoporosis
6-12 month review - growth, adherence
macrocytic
coeliac uk
Conjunctivitis
viral: watery discharge, painless, conjunctival follicles, saline solution to clean, contagious, adenovirus
bacterial: yellow discharge, painful, chloramphenicol
allergic: mucoid, grittiness, same time every year, antihistamines and clean, conjunctival papillae
opthalmia neonatrum: eye swelling and think mucopurulent discharge - chalmydia (2 weeks PO erythromycin) and gonorrhoea
avoid sharing towels
corneal involvement = photophobia
Strabismus
paralytic (nerve palsy) and non-paralytic (refractive error)
retinoblastoma
eyeglasses -> eye patch –> eye drops –> eye muscle surgery
Bone tumours
Ewings
onion skilling
t(11;22)
osteosarcoma
metastases to lung
Rb gene so retinoblastoma
for both
Specialist sarcoma team
limb sparing surgery +/- amputation, chemo, radio
hirschsprung
can do barium enema as initial but if systemically unwell can cause perf
hisrchsprung enterocolitis - c-diff infection
rectal washouts prior to surgery (bowel irrigation) then anorectal pull through
NEC
LBW and preterm
Abdo x-ray - pneumonitis intestinalis, pneumoperitoneum, bowel wall oedema, gas cysts
bowel rest and total parenteral nutrition
bell staging
I = 3 day Abx (suspected)
IIa = mild - 7-10 days
IIb = modeerate = 10-14
IIIa = paracentesis, ventilation
IIIb = perforation - ileostomy
kawasaki
IVIG within 10 days
give high dose asprin for 1-3 days after fever or max 24 days
then low dose until echo review (repeat) at 6-8 weeks
if coronary aneurysm in severe may need long term warfarin and 6 monthly follow up - ECG and echo
short stature
malabsorption, CF
<2.5 for age and sex or > 2 SDs away from mid parental height
otitis externa
chronic and acute
fungal more chronic
necrotising otitis externa = ENT emergency
dont swim for 7-10 days
no soap inside ears
keep dry
azetic acid over the counter
may consider neomycin
oral if immunosuppressed
ear irrigation if ear wax
constipation
hypothyroidism and hypercalcaemia
senna is stimulant
rare in breastfeeding so organic cause
give fluids, diluted juices in infants in weaned
more water between feeds in formula fed
abdo massage and bicycling legs
IBD
chrons and colitis uk
induction and maintenance
flare ups, life long
coexisiting depression
PUCAI >65 = severe
10-64 = moderate
stress can be trigger
chronic condition
severe fulminating in UC = IV steroids, stool frequency >8 a day, tachy
loss of goblet cells and lymphocytosis in UC
on azathioprine - · Must not have live vaccines
Must have pneumococcal and influenza vaccines
in children may go for protein modular diet and enteral nutrition (NG) > steroids as growth
topical aminosalicylate for 4 weeks then switch to oral
amino used for remission as well, steroids just first line
hypoglycaemia
<1.5 = admit and 10% dextrose
if due to hyperinsulinism = give glucagon infusion
if persistent refer to endo
Jaundice
<50umol - repeat in 24 hrs if no rf’s, in 18 hours if rf’s
check bilirubin every 4-6 hours until stable, once stable every 6-12 hrs
keep in 12-18 hours after stopping (when >50umol below threshold) for rebound
encephalopathy - opisthotonus, arching, high pitched cry, hypertonic; >8.5umol per hour, >350umol at over 37 weeks gestation = exchange transfusion
encourage frequent breast feeding during photo
>450 = plasma exchnage
DAT
>250=phototherapy
CLD of prematurity
can give dex if >= 8 days old
CXR - widespread opacification
VBG - acidosis, hypercapnea, hypoxia
Turner’s
bicuspid aortic valve - ejection systolic
lymphoedema of hands and feet in neonates
cystic hygroma
spoon shaped nails
multiple pigmented naevi
NAI
delayed presentation
CAIT, MASH
child in need, child protection plan
enuresis
fundoscopy
child protection register
Cardiac failure
poor feeding, poor weight gain, hepatomegaly
enhance nutrition
prostaglandin infusion in cyanotic
Rheumatic fever
Jone’s
high dose aspirin, amoxicillin, may need steroids if not resolved imemdiately
prophlayxis of benzathine penicillin for 10 years after last episode or 21 years of age
mitral stenosis
Congenital Heart Disease
5A’s and 4C’s (3T’s and pulmonary stenosis)
uncontrolled diabetes (not gest), syndromes, alcohol, drugs e.g. lithium, sodium valproate, infections
AVSD in Down’s also cyanotic
Baso cyanotic is prostaglandin + BT
Left to right = NSAIDs + cardiac catheterisatio
Tricuspid atresia
Left evntricle only efficicnet
right ventricle small
BT shunt then can connect SVC/IVC to pilmonary artery
ESM
Transposition of great arteries
incompatible with life but usually co-existent with VSD, ASD etc. so short term relief
egg on string appearance
loud s2 no heart murmur
porstaglandin, balloon atrial septoplasty
Eisenmengers
R to L shunt from untreated L to R
pulmonary walls thicken and pulomary resistance
at 10-15 get cyanosis at R to L, death by RHF at 40-50yrs
early tx of L to R shunt
Timeframe of cyanotic heart disease
TA within 10 minutes
few hours TOGA
1-3 weeks - AVSD - Down’s (HF Tx and surgery at 3 months)
ToF any age
Eisenmenger’s 10-15 years
Ebstein’s anomaly
think similar to tricuspid atresia
but pulmonary regurg, pansystolic murmur
assoc with patent FO/ VSD
PDA
machine whirring murmur
heaving apex beat
wide pulse pressure
bounding collapsing pulse
indomethacin given postnatal
cardiac catheterisation
Innocent murmur
soft, systolic, single, sensitive to changes in position, small, short
still’s murmur, venous hum
exacerbated by febrile illness, should resolve after so review in few weeks if still present then may need echo
Acne
COCP - not in males
hepatic impairment so LFT monitoring with isotretinoin
use topicals for at least 2 months
azelaic acid
pustules
referral if scarring and nodules and pitting, severe psych impact, not responding to meds
molluscum
takes 6-9 months to resolve upto a year
if >2 years can do cryotherapy
migraine
topiramate
trigeminal neurones, vaso dilation, plasma protein, pulsations
glasses
nasal triptans
foreign body ENT
magic kiss, crocodile forceps, hook
facial pain
septal perforation
black discharge, fever = necrosis
stimulants
crash
risky behaviour
cocaine: nasal necrosis, arrhythmias, cardiac review with GP, dopamine reuptake inhibitor
ecstasy: bruxism, agitation relieved by dancing, serotonin release, death by dehydration and hyperthermia
crash (from 3 hours) and withdrawal phase (1-10 weeks) in cocaine
opiates
needle exchange programmes, blood borne pathogen screen
hep C
IE, sepsis, DVT, blood borne infections
substitution programme: low dose methadone/ high dose meth/ bupronephrine
need to be on maintenance before detox - 12w as outpatient, 4w as inpatient
always check malnutrition - bloods
inform about low tolerance and withdrawal symps
anti diarrhoeals, antieemetics
cannabis
irregular use does not cause major probs
anxiety, euphoria
PO is slower onset than smoking - peak at 30 mins
sinusitis
acute resolves in 12 weeks
recurrent 4 episodes a year
chronic > 12 weeks
<10 days - saline rinse, nasal decongestant
>10 days -14 days of nasal corticosteorids like mometasone if >12
not improved after 7 days then phenoxymelthypenicillin
undescended testes
unilateral - referral at 3 months age, urological surgery by 6 motnhs - orchidopexy
bilateral - 24hr urgent endocirne/ genetic investigation
gesttaional diabetes, alcohol use, preterm
head swelling
cranial USS in capput beacuse of subgaleal haemorrhage - encephalopathy
cranial USS also done in hydrocephalus
cows milk
extensive hydrolysed formula then amino acid
use at least 6 months and until1 year
review every 6-12 months
milk ladder
takes 2-3 weeks to have affect when remove milk from mum diet
monitor growth with paeds dietician
lead poisoning
givival blue lines
show up as hyperdense bands on bones - dtsal ulna and proximal femur
meconium aspiration
observe
antibiotics if features of infection IV ampicillin and gentamicin
if thick then suction
meconium ileus
gastrograffin enema
biliary atresia and CF
retinopathy of prem
vascular polifer –> retnial detach –> fibrosis –> blindness
laser photocoagulation
learning diabilities
<70 = severe need specialist schools
WISCV or FSIQ scores
dyslexia - reading age disproportionate to IQ, reading level >2 years behind
dyspraxia
dysgraphia
all MDT, IT support
disability is more cant do own things, difficulty may just be with learning
meningitis
ciprofloxacin for household contacts
coxsackie virus B
HPU
focal neuro signs in CI
coag profile
encephalitis
IV acyclovir for 3 weeks
subacute panenecephaltiis
SE of acyclovir: GI disturbance, photosensitive rash, fatigue
raised ICP
hypertonic saline and elevate bed
neuro team referral
haemorrhage
tuberculosis
admit
3 gastric washings on cobsecutive mornings as kids swallow saliva
test contacts
notifiable
<2 and in contant give isoniazid if IGA and tuberculin -ve after 6 weeks, stop, give BCG if not already given
key worker checks adherence
specialist TB service
pyridoxine
dex for meningitis
>=5mm
dex for meningitis TB
HUS
diarrhoea may become bloody
anuria/ oliguria
dont give antibiotics as can cause release of verotoxins
recent farm visits
myotonic dystrophy
CTG repeat
sustained muscle contraction
smaller < larger
hypotonia
feeding difficulties
resp difficulties
cataracts in mild
cardiac probs .e.g. arrythmias in classic
EMG - diver boomer appearance
lack of facial expression
sma
1 is worst
no anti-gravity power
need ng tube
2 - ng tube, cant independently stand
3- can stand, need wheelchair
laryngitis
common causes of pharyngitis
diphtheria
adeno, enteroviruses
strep a
peripheral nerve palsies
radial: wrist drop
ulnar: claw hand
brachial: erb’s, waiter’s tip
axillary: regimental path
peritoneal: foot drop
haemorrhage
> =2 = vomiting 3x, abnormal drowsiness, dangerous injury, LOC >5 mins (if 1 = 4 hours observation)
=1 = NAI, GCS <15, focal neuro symps, seizures, skull fracture signs
IVH –> CP; germinal matrix, 2) no enlarged 3) enlarged ventricles 4) around ventricles
periventricular leukomalacia = CP
trans fontanelle USS
ventriculo-peritoneal shunt, antixonvulsants, fluids
neural tube defects
anencephaly - failure to fully form brain and crnaium = stillbirth
meningocoela - normal neuro as only meninges protruding out
myelomeningocoela = spinal cord and meninges
spina bifida: tethered spinal cord syndrome comp, back pain worse after exercise
transient synovitis
NSAIDS and supportive
review in 48 hours and 1 week
if trauma same day x-ray
foreign body aspiration
encourage coughing then 5 backblows
drooling
may need bronchoscopy if in bronchus/ trachea
Magill forceps
Pneumonia
amox 7-14 days
can add erythro if mycoplasma/ chlamydia
48 hours not improving = pleural collection
RSV
4-6 weeks repeat cxr if atelactasis or lobar collapse
vaccinations
if mild egg = GP
if anaphylaxis = hosp
yellow fever no for egg allergy
MMR can be given no egg
no rotavirus for intussusception
influenza only contrandicated if admitted to PICU previously
tics vs tourettes
tourettes have sounds
arrhtyhmias
sinus arrhythmia varies with respiration
wolfparkinson white - tachycardia, delat wave, short pr interval, broad QRS
bundle of kent - bypass AV node, accessory athway, pre-excitation syndrome
ebsterin’s anomaly assoicated
vagal manouvres - ice in face, iv adenosine, eelctrocardioversion
androgen insensitvity
breats developement
no axillary hair or periods
bilateral orchidectomy as inc risk of testicular cancer
reyes
fatty infiltration of liver, pancreas and kdienys
hypoglycaemia
encephalopathy
diarrhoea and vomiting
supportive tx
anaphylaxis
mast cell tryptase
500, 300, 150, 100
12, 6-12, 6-6, <6
adrenaline always first line
vasovagal syncope
lie flat to avoid fainting
ECG within 2 days
rule out anaemia
DKA mx
give IV fluids w/ 20mmol of KCl per 500ml saline
IV insulin 0.1 after 1-2 hours
once glucose <14 = dextrose5%
monitor ECG for hypoK, switch to 0.05 insulin
every 1 hour monitor ketones .etc., 30 mins if severe
stop IV insulin after ketones <1 and switch to SC
GOR
4 week trial PPI
resolve by 1 year
fundoplication
pyloric stenosis
2-8 weeks
pyloromyotomy
bronchiolitis prophylaxis
palivizumab
phimosis
<2 = resolve
>2 = frequent UTIs = circumscision/ topical steroids
non retractable foreskin
painful erections, recurrent UTI, weak stream, swelling, redness and tenderness
assoc w/ BXO
Haemophilia
circumscision, umbilical cord clamping, heel prick, vit K
goosebump forehead
parvovirus
erythema infectiosum
lace like rash
cystic fibrosis
burkholderia and pseudomonas
high protein and calorie
immunoreactive trypsinogen
fatty liver
faecal elastase is low
gastrograffin enema for meconium ileus
pneumococcas and influenza
flucloxacillin
if flare 14 days co-amox
CFTR, chromosome 7
at what age does moro/ startle reflex disappear
6 months
Which of these is the correct rate of insulin infusion in Diabetic Ketoacidosis management?
0.05-0.1
Cupping, splaying, bowing’ are radiological findings in which condition
rickets
Lumacaftor is a novel drug used to treat Cystic Fibrosis. What is it’s mechanism of action?
Prevents misfolding and increases protein trafficking
A 7 year old child with Down Syndrome presents to A&E with bilious vomiting and some abdominal distension.
volvulus
An atypical UTI in children usually requires further investigations. Which of these options are listed in the NICE guidelines as a feature?
inc creatinine
sids
police coroner
lullaby trust
chromosomal abnormalities
MMM - mitral valve prolapse in fragile x
aortici in williams and hypercalcaemia
pulmonary in noonnan
cri du chat - cry + feeding difficutleis
tanner stage for males
Prepubertal, testicular volume <1.5ml
Penis grows in length only, testicular volume 1.5-6ml
Penis grows further in length and circumference, testicular volume 6-12ml
Development of glans penis, darkening of scrotal skin, testicular volume 12-20ml
Adult genitalia, testicular volume >20ml
both sexes tanner
Pre-pubertal: no pubic hair
Some downy hair at the base of the penis in males or over the labia majora in females
Coarser, thicker and curlier hair that spreads laterally to cover more of the pubis
Adult hair, not spreading to the thighs
Adult hair, spread to the medial thighs
so either B something P something or G.P
what vitamin is deficient in breastmilk
vitamin k
what can you see with breastfeeding jaundice
multiple bruises due to vit k deficiency
asymtomatic and thrill (4/6 intensity)
VSD
personality changes
autoimmune encephalitis
caused by demyelination
what diagnostic test for CMV antenatal
amniocentesis
(would screen and see hyperechogenic bowel in anomaly scan)
osteogenesis imperfecta
blue sclera
difficulty hearing
fractures
nai referral
police if need to be removed from premises immediately
forensic exam if sexual assault
social services otherwise
which phase is PMS
luteal
frenotomy
under GA > 3 months
no need GA < 3months
