Paeds Flashcards
1
Q
What are red flags to be seen by neonatologist post birth in terms of vitals
A
CRT> 3 seconds
HR>160
HR< 100
RR> 60
Fever>38^C
2
Q
Until when is bow legs normal
A
3-4 years
3
Q
When refer bow legs to paediatric surgeons
A
Pain
Difficulty walking
Failure to thrive
Growth restriction
Intercondylar length over 6cm
4
Q
What investigations are done for a child under 3 months presenting with fever
A
In all children
- FBC
- CRP
- Blood cultures
- urine dip
Stool sample if diarrhoea
CXR if chest signs
If under 1 months do LP
If 1-3 months then do LP
5
Q
If under 3 months in A&E with fever who give parenteral antibiotics to
A
Under 1 month if fever
1-3 months if fever and unwell
Give ampicillin and cefotaxime
6
Q
AXR of meconium ileus
A
No air fluid levels
Distended bowel
7
Q
Bruises at different stages of healing
A
NAI
8
Q
Cause of pediculosis
A
Pediculus capitis
9
Q
Contraindications for steroids in meningitis
A
Under 3 months
Non-bacterial cause
WCC under 1000/mml3
Low protein
10
Q
Why are steroids given in meningitis
A
To prevent hearing loss
11
Q
What measure bilirubin in neonate with
A
If under 24 hours- serum level
Over 24 hours- transcutaenous
12
Q
What cause of nec fasc does chickenpox predispose to
A
Group A strep
13
Q
Immediate congenital diaphragmatic hernia management
A
Intubate and ventilate
NG tube
14
Q
What is used to assess chance of having septic arthritis
A
Kocher criteria
- WCC over 12
- fever over 38.5
- ESR over 30
- unable to weight bear
15
Q
White lump in babys mouth and otherwise asymptomatic
A
Epsteins pearl
16
Q
What are benign murmurs
A
Venous hum- Heard as a continuous blowing noise heard just below the clavicles
Still’s murmur- Low-pitched sound heard at the lower left sternal edge
17
Q
Differentiating branchial cyst and cystic hygroma
A
Branchial cyst- anterior triangle, anechoic on USS
Cystic hygroma- posterior triangle, transilluminates
18
Q
Signs on examination of aortic stenosis and what is management
A
ESM radiating to neck
Slow rising pulse
Thrill
Managment is a balloon valvulotomy
19
Q
Management of aortic coarctation
A
When PDA closes will get collapse so need to give prostaglandins
Balloon repair
20
Q
Systolic murmur head loudest in the back and low leg BP
A
Aortic coarctation
21
Q
Management of tet spells
A
A-E
Bring knees up
Propanolol, adrenaline, morphine and sodium bicarbonate
22
Q
Management of ASD vs VSD
A
Only when severe symptoms in ASD
Seccundum- catheter
Primum- surgical
Small VSD (<3mm) can be monitored with echos
Large VSD (>3mm) catopril, furosemide and calories with NG tube if needs be
23
Q
Murmurs in
- tricuspid atresia
- ASD
- TGA
- VSD
- aortic coarctation
A
Tricuspid atresia- ESM at LLSE
ASD- fixrd splitting of S2, can be ESM at ULSE
TGA- single loud S2 but can be no murmur
VSD- holosystolic murmur at LLSE which can radiate over praecordium
Aortic coarctation- systolic murmur loudest at the back
24
Q
PDA features on examination
A
Wide pulse pressure
Collapsing pulse
Machine like continuous murmur
25
Management of rheumatic fever
High dose aspirin
Steroids and pain relief
26
First line and gold standard for intussuception
USS
Gold standard- contrast enema
27
Management of meconeum ileus
Gastrograffin enema
Surgery if unsuccessful
28
Antibiotics for NEC
Vancomycin and cefotaxime
29
First line and gold standard for oesophageal atresia
NG tube with CXR
Gold standard- gastrogaffin swallow
30
Imaging for malrotation
AXR with barium contrast
31
What are the types of TOF
A- failure of proximal and distal to connect
B- proximal oesophagus connects to trachea
C- distal oesophagus connects to trachea
D- both proximal and distal connect
E- oesophagus normal but is fistula halfway up
32
What will show whirlpool on abdo USS of infant
Malrotation
33
Management of hirschprungs
Bowel irrigation with barium enema
Ano-rectal pull through definitive
34
Management of pityriasis versicolor
Ketoconazole shampoo
35
Management of pityriasis rosea
None unless itching when use emollients
36
When is USS needed during the infection
Recurrent UTI under 6 mths
Atypical
- abdo mass
- poor urinary flow
- sepsis
- raised creatinine
- non-ecoli
- does not respond in 48 hours
37
When is USS done 6 weeks post infection
Recurrent UTI older than 6 months
First UTI under 6 months
38
When do DMSA and MCUG 6 months later
Under 3 with atypical or recurrent UTI
Older than 3 with recurrent UTI
39
How deal with leukocyte positive and nitrites negative on urine dip in kids
Older than 3 do not give abx but take culture
Younger than 3, give abx and treat
40
How manage undescended testicles
Unilateral
- Patient should be referred from around 3 months seeing a urological surgeon by 6 months of age
- if bilateral reveiwed within 24 hours as needs urgent genetic or endocrine investigation
41
Management of constipation in a child
If any red features do not treat and refer for urgent review
- Symptoms of constipation appearing from birth or during the first few weeks of life — may indicate Hirschsprung's disease
- Delay in passing meconium for more than 48 hours after birth, in a full-term baby
- Abdominal distention with vomiting
- Family history of Hirschsprung's disease
- Ribbon stool pattern
- Leg weakness or motor delay
- Examination may reveal unexplained lower limb deformity or abnormal neuromuscular signs, including abnormal reflexes.
- Abnormal appearance of the anus
- Abnormalities in the lumbosacral and gluteal regions
If amber features, refer in 2 weeks and do treat
- signs of poor care
- failure to thrive or signs of other cause like sx suggesting hypothyroidism
42
When refer for umbilical hernias
3 years
43
How manage faecal disimpaction
Macrogol and review after 1 week
If after 2 weeks does not work use stimulant laxative like Senna
If does not work refer to specialist
If not tolerant of macrogol use senna and if the stools are hard add lactulose or docusate
44
How manage constipation
Macrogol (drug depends on age) If over 12 Mavicol, if under mavicol paediatric
If not tolerated use senna and add lactulose if not tolerated
If does not improve use Senna however if get diarrhoea reduce dose
45
Difference between red and brown coloured urine
Red- lower tract bleed
Brown- glomerular pathology as broken down into casts
46
Management of active UC
Mild to moderate
- topical aminosalicylates for 4 weeks
- if dont work use oral
- can use steroids too if ineffective (topical or oral)
Moderate to severe
- infliximab, adalimumab
47
Management of active crohns
Oral steroids
48
How to induce remission in UC
Oral aminosalicylate
49
How to induce remission in crohns
Azathioprine
50
Management of lactose intolerance
Refer to dietician
Encourage vit d and calcium intake
51
Mass in groin area with severe vomiting and tense abdomen
Incarcerated hernia
52
When refer for hydrocele
3 years
53
How is mesenteric adenitis investigated
USS
54
What investigation should be done on any child presenting with swelling or pain in testicle
USS to loko for cancer
55
PA versus lateral CXR finding in croup
PA- shows subglottic narrowing (steeple sign)
Lateral- acute epiglottis (thumb sign)
56
What is given for epiglottitis
Dexamethasone and cephalosporin
57
Antibiotics in pertussis
Offer antiobiotic if cough has lasted less than 21 days
- clarithomycin if less than 1 month
- clarithomycin or azithromycin if over 1 month
If contraindicated use co-trimoxazole (not licensed if under 6 weeks)
58
Pneumothorax guidelines
Breathless or over 2 cm= needle aspiration -> if fails chest drain
Any intervention needs followup in 2 weeks in OPD
Under 2cm= discharge and see in OPD in 2 weeks
59
How does bacterial tracheitis present
Croup like
Very high fever
Copious airway secretions
Caused by stpahylococcus aureus
60
What is bronchiolitis obliterans and what causes it
Repair of lung tissues is in overdrive leading to scar tissue formation
Adenovirus
61
Guidelines for asthma if over 5
1st: SABA or start on low dose ICS if ave asthma symptoms three times a week or more or are woken at night by asthma symptoms once weekly
2nd: If not already on ICS start this
3rd: Add LTRA
4th: Swap LTRA for LABA
5th: Change LABA and ICS for MART
6th: Increase dose to medium dose ICS
7th: Refer to specialist
62
Guiedlines for asthma under 5
1. SABA or go straight to ICS if symptoms over 3x a night
2. Paediatric moderate dose ICS for 8 weeks and monitor
- if no resolvement consider different diagnosis
- sx reoccurred within 4 weeks of stopping ICS restart low dose ICS as maintenance
- sx reoccurred beyond 4 weeks restart moderate dose ICS
3. SABA, low dose ICS, LTRA
4. Stop LTRA and refer to paediatric asthma specialist
63
How investigate asthma in all patients
Refer for spirometry
If unclear refer for FeNO
64
Management of acute asthma
Trial nebulised salbutamol
Ipatropium nebulised
If after 1 hour sats below 92 add mag sulph to nebuliser
Steroids- oral or IV depending on tolerance
Then if these unsuccessful consider
- IV salbutamol
- IV mag sulphate
- IV aminophylline
65
Doses of steroids in asthma attack
- oral
-IV
Under 2- 10mg
2-5- 20mg
Over 5- 30-40mg
IV= (4 mg/kg repeated four hourly
66
Management of WEST syndrome
Refer for tertiary centre assessment within 24 hours
Combination therapy with vigabatrin and prednisolone
67
Causes of each CP
Spastic
- hemiplegic= antenatal/genetic cause
- diplegic= PVL
- quadriplegic= HIE
Dyskinetic= HIE and kernicterus
68
Red flags for CP
Cant sit before 8mths
Cant walk before 18mths
Hand preferance before 1 year
Persistent toe walking
69
What happens in each of the focal seizures
Parietal- dyaesthesia
Frontal- motor symptoms unilaterally
Temporal- automatisms or strange smells
Occipital- positive or negative visual signs
70
EEG finding of absence seizures and lennox gastaut syndrome
Absence- Symmetrical 3hz wave and spike pattern
Lennox gastaut- slow spike
71
Management of plagiocephaly
Turn cot around
Supervised time in day on fornt
72
Management of benign intracranial hypertension
Repeated LPs
73
How do MS vs tuberous scleoris lesions appear
MS= demyelinating, hypointense, white matter lesions
Tuberous sclerosis= calcified, subependymal
74
Presentation of tuberous sclerosis
Ash leaf macules
Brain ependymomal
Lumps under nails
75
Management of juvenile myoclonic seizures
Sodium valproate
Lamotrigine second line
76
Investigating first time seizure
Bloods - metabolic causes
12 lead ECG
EEG within 72 hours
MRI if suspecct underlying structural cause
Refer to be seen in 2 weeks
77
Management of
- tonic clonic seizures
- focal seizures
- absence seizures
- myoclonic seizures
- atonic or tonic
Tonic clonic- Sodium valproate if male and girl under 10
Lamotrigine if over 10 and will have to be on long term therapy
Focal- Lamotrigine or levetiracetam
Absence- ethosuximide
Myoclonic- Sodium vaproate if male and girl under 10
Levetiracetam if girl over 10 who may need to continue long term
Atonic- Sodium vaproate if male and girl under 10
lamotrigine if girl over 10 who may need to continue long term
78
Status epilepticus
Over 5 minutes
Buccal midazolam, rectal diazepam or IV lorazepam
Wait 5 minutes
Give second dose of diazepam
If no response
- phenytoin
- levetiracetam
- sodium valproate
If no response try these again
If no response phenobarbital or general anaesthesia
79
What is scissor walking seen in
Diplegic CP
80
If febrile seizure repeats within 24 hours what type of febrile seizure is it
Complex
81
X-ray finding of perthes disease
Loss of joint space initially then loss of femoral head
82
Management of chondromalacia patellae
Physio
83
Difference in presentation of the spina bifidas
Occulta- can be incidental or through tethered chord syndrome
Meningocele- no abnormal neurology but sac can burst causing meningitis or hydrocepahlus
Myelomeningocele- severe abnormal neurology like bladder/bowel dysfunction, club foot or paresis
84
Up until when is pes planus normal and what is it
4-8
Flat feet
85
Pathophysiology and presentation of osteochondritis dissecans
Reduction in blood flow to patella which fragments off
Pain after exercise
Locking and catching of knee
Gives way easily
86
Management of osteomyelitis and septic arthritis abx wise
IV flucloxacillin (clindamycin if pen allergic)
Vancomycin if MRSA
87
Spinal muscle atrophy presentation
Difficulty to maintain head
Breathing difficulties
Weak cough and cry
Proximal muscle weakness
Hypotonia
Autosomal recesive
88
What is differnece between anencephaly and encephalocele
Anencephaly- failure of fusion of cranial neural tube which presents with with stillbirth
Enancephalocele- herniation of brain and meninges through midline skull defect
89
Difference in location and presentation of osteosarcoma vs ewings sarcoma
Ewings- feverish, middle of long bones
Osteosarcoma- Swelling around a joint, Painless most often, Reduced mobilityaround knee
90
Investigations for EBV
Over 12 in second week do blood film- see over 20% atypical (activated) lymphocytes
Under 12- if ill over a week do serology
91
Investigation for rubella
Oral fluid sample for NAAT
92
Management of mumps if very immunocompromised/HIV but no immunisation
MMR vaccine
93
When give aciclovir for varicella
Oral
- Under 1 month
- Over 14 if within 1 day of rash starting
IV
- immunocompromised
94
Teenager presents with cyanosis after being born abroad
Eisenmgenger
95
What can cause BCG scar to become inflammed
Kawasaki
96
What is used for sedation in children
Nitrous oxide or midazolam
97
When approaching an ill child what is initial approach
A-E
Initially either jaw thrust or head tilt and chin lift depending on if trauma
98
How can mesenteric adenitis present
Very unwell in a lot of pain
Diffuse lymph node enlargement
99
How long does WHO recommend breast feeding for
Up to and beyond 2 years
100
Management of tongue tie
1st line; refer for breastfeeding support
2nd line; if dropping weight centile then frenotomy
101
What does torn frenulum in mouth suggest
NAI from forced feeding
102
Dropping centiles with no evidence of systemic disease after age of 2
GH deficiency
103
How manage febrile convlusion if evidence of infection source like pneumonia
Want to admit and manage in hospital
104
Differentiating between osteomyelitis and septic arthritis on history
Osteomyelitis more insidious
105
What do if sexual abuse suspected
Refer to hospital for forensic examination
106
Indications for immediate head CT
- NAI suspected
- post traumatic seizure
- GCS less than 14 on assessment, GCS less than 15 in under 1 YO
- focal neurology
- 2 hours after injury GCS less than 15
- suspected skull fracture
- tense fontanelle
- for children under 1 a bruise or laceration over 5 cm
107
Indications for CT within 1 hour or observe
If one of following then observe for 1 hour, if MORE than 1 have to do in less than 1 hour
- LOC over 5 mins
- high velocity impact (RTA, over 3m fall)
- 3 or more vomiting episodes
- amnesia over 5 mins
- abnormal drowsiness
If develop either abnormal drowsiness, vomits again or abnormal drowsiness with 1 of above RFX then do CT in less than 1 hour
108
What is a a child protection plan
Put in place to protect children at high risk of harm
109
Management of Cows milk allergy
1. Avoid trigger
- If formula fed use hypoallergenic formula
- If breast fed exclude from diet (takes2-3 weeks tho) and can give maternal calcium and vit D supplements
2. must regularly monitor growth
3. Reintroduce in 6-12 months using Milk Ladder
110
What is bucket handle fracture and what seen in
Fracture of the metaphyseal corner in tibia
Seen in NAI
111
What is long term complication of measles
Subacute sclerosing panencephalitis
112
What vaccine is given at birth
BcG sometimes
- born in areas of uk where high rate (40 in 1000)
- parent or grandparent born in country where (40 in 1000)
- live with or close contact of someone with infectious TB
113
What is in the 6 in 1
Diphteria
HBV
Tetanus
Polio
Pertussis
HIB
114
How is flu vaccine administered in children
Intranasal
115
Vaccinations done at 2,3 and 4 months
2 months
- 6 in 1
- oral rotavirus
- Men B
3 months
- 6 in 1
- PCV (pneumococcal)
- oral rotavirus
4 months
- 6 in 1
- Men B
116
What vaccinations are done at 1 year
MMR
Men B
PCV
Men C/HIB
117
What vaccinations are done at 3 years and 4 months
MMR
4 in 1
118
What in the 4 in 1
Diphteria
Tetanus
Whooping cough
Polio
119
When is the flu vaccine given to children
Every year in september 2-10
120
When is HPV vaccine given
12-13 years
121
What given at 14 years
MEN ACWY
3 in 1
- tetanus
- dipheteria
- polio
122
What prophylactic antibiotic is given in SCD
Penicillin V
123
How is G6PD diagnosed
Enzyme assay 2-3 months after crisis
124
What appears with red, ragged fibres on muscle biopsy
Mitochondrial disorder
125
How do mitochondrial disorders present
Myopathy- muscle cramps and weakness
126
Presentation of folate deficiency
Anaemia
Glossitis- smooth beefy red tongue
Angular stomatitis
127
When is exchange transfusion indicated for SCD crisis
Priapism
Stroke
Acute chest syndrome
128
What is found on electrophoresis of sickle cell anaemia
HbS and HbF
129
Management of sickle cell crises
Fluids
Oxygen
Analgesia
130
What are the types of biliary atresia
T1- common bile duct
T2- cystic dict
T3- fulla tresia where over 90%
131
What causes a bleed in sclera of eye- newborn
Subconjunctival haemorrhage
132
CXR of RDS vs CLD
RDS- groundglass with air bronchogram
CLD- Widespread opacification
Can be atelectasis, multicystic appearance, emphysema or pulmonary scarring
133
Abx in RDS
Benzylpenicillin and gentamicin
134
Management of ROP
Treated for up to 2 years
MDT approach
Photocogulation
135
CLD treatment
Manage oxygen therapy- wean off if necessarty or give what necessary
Caffeine citrate
Nitric oxide if pulmonary hypoplasia or pulmonary HTN
136
Management of cleft lip and palate
MDT- surgeons, ENT, orthodontist, SALT, feeding team
Orthodontic devices may be needed if feeding difficult
Speech and language therapy
Cleft lip repaired in first 3 months of life
Cleft palate between 6-12 months of life
137
Causes of pulmonary hypoplasia
Congenital diaphragmatic hernia- most common
Oligohydramnios
Tetralogy of fallot
Osteogenesis imperfecta
Diaphram agenesis
138
Management of chlamydia vs gonrrhoea opthalmia neonatorum
Chlamydia- Oral erythomycin
Gonorrhoea- single dose cefotaxime
139
Neonatal hypoglycaemia management
Less than 1.5
- admit to neonatal unit
- confirm with lab blood glucose assay
- IV 10% glucose 2ml/kg bolus
- followed by infusion of 3.6ml/kg/hr
- monitor regularly
Between 1.5 and 2.5
- feed immediately
- recheck glucose after 30 mins and if still low consider admitting and starting IV glucose
140
Cyanosis after birth with absent heart murmurs and signs of HF
PPHN
141
Causes of persistent pulmonary hypertension of the newborn
Idiopathic
OR
Secondary to neonatal pulmonary conditions
- meconium aspiration
- ttn
- congenital diaphragmatic hernia
- RDS
SSRI or NSAIDS
142
Abx for meconeum aspiration
IV ampicillin and gentamicin
143
Neonatal resus
1. Dry baby
2. Assess tone, resp rate, HR
3. If gasping or not breathing 5 INFLATION breaths
4. Reassess
5. If HR less than 60 bpm start chest compression and VENTILATION breaths at rate of 3:1
144
Management of choledochal cyst
Surgical excision with roux en y anastamosis to biliary duct
145
What is it when urine passes through the umbilicus
Urachus
146
Foetal alcohol syndrome
Learning difficulties
Microcephaly
Growth retardation
Cardiac malformations
Epicanthic folds
Sooth philtrum (area between nose and mouth)
Small palpebral fissue
147
What congenital infection will present with an asymptomatic mother
Toxoplasmosis
148
What is craniosyntiosis
When sutures of the brain fuse prematurely
149
What are the 2 types of craniosyntiosis
Sagittal (AP suture)- long flat head
Lamdoidal synostosis (posteriorly, goes laterally)- appears like plagiocephaly
150
What tends to cause sagittal craniosyntosis
Premature infants lying on their sides
151
What is difference between low and high anorectal anomalies
Low- at level of anus it has close in, may be a fistula to the surrounding skin
High- bowel has closed off higher up, associated with fistulas to bladder etc
152
Management of retractile testes
Reassurance and follow-up annually
153
Surgical management of undescended testes
If in inguinal canal- orchidopexy
If anywhere else- laparoscopy
154
Difference between early and late onset sepsis
Within 72 hours of birth is early
155
What determines what bilirubin measuring device used
Within 24 hours of life or born under 35 weeks- serum reading
After 24 hours- transcutaneous bilirubinometer
156
Potter sequence presentation
Pulmonary hypoplasia
Renal agenesis
Clubbed feet
Low set ears
Flattened nose
Downwards epicanthal folds
157
What is chorioretinitis
Posterior uveitis
158
Management of phototherapy in neonate
Aim for 50 under target
Once 50 micromoles below can stop then re measure in 12-18 hours
If this is 50 below then no further measurement required
If less than 50 below remeasure in 12 hours
159
How does mycoplasma pneumonia present
Insidious onset compared to normal pneumonia
160
Abx for AOM
1st line- amoxicillin
2nd line/penicillin intolerant- macrolide
If does not respond in 2-3 days use co-amox and in this scenario if penicillin allergic seek micro advice
161
What presents with choking on feeding, cyanosis on feeding and relieved by crying
Choanal atresia
162
What are the 2 types of squint and how manage
Concomitant- one eye diverges typically inwards
Paralytic- varies with gaze direction
Check red reflex
If over 3 months refer to opthalmologist
163
Management of otitis externa
If very mild- Hygiene measures
- avoid swimming for 10 days
- dont clean ears
If more severe
- topical neomycin or clotrimazole with or without topical corticosteroids
If immunocompromised or severe infection
- oral flucloxacillin
164
Investigation and management of cholesteatoma
Otoscopy then do diffusion weighted MRI
Mastoidectomy
165
Difference in when things need to be removed from ear
Within 6 hours
- glue
- battery
- corrosive
Same day
- insect
- food matter
Next available appointment
- cotton ear buds etc
166
How are things from ear removed
First try to remove self- is best chance
If not refer to ENT for removal with ENT microscope
If unsuccessful will need general anaesthetic as children can become very agitated
167
Management of sinusitis
Under 10 days just fluids etc
Over 10 days
If over 12 prescribe high dose nasal corticosteroids (mometasone)
Consider back up abx(pen V) to be used if symptoms do not improve within 10 days
If severe illness or comlpications prescribe oral coamoxiclav
168
Antibiotics for sinusitis
Phenoxymethicillin for 5 days
If allergic or intolerant clarithomycin but can use doxy if over 12
If no improvement use co-amoxiclav
169
Management of orbital cellulitis
Contrast CT scan of face
IV co-amoxiclav
170
When to treat tonsilitis/pharyngitis
Do fever pain or centor
If FPAIN over 4 or centor over 3
Consider antibiotics- phenoxymethicillin
Lower threshold if increased risk of rheumatic fever, immunosuppressed or compromised
171
What does fluctuant neck lump suggest
Abscess from lymphadenitis
172
Bacterial vs viral conjunctivitis management
Bacterial
- If severe chloramphenicol or fusidic acid drops
- If not that bad can give back-up
Viral
- Will resolve in 2 weeks
- Warm dress with saline for symptoms
- Send swabs if return to GP with symptoms
173
Viral conjunctivitis management
Will resolve in 2 weeks
Warm dress with saline for symptoms
Send swabs if return to GP with symptoms
174
When suspect herpetic conjunctivtis
It causes a blepharoconjunctivitis typically
Ulcers on periocular skin
Refer to opthal
175
What is in fever pain
F- fever in last 24 hours
A- absence of cough
P- prurulent discharge
S- symptoms over 3 days
S- severe inflammation
176
Management of different F-Pain scores
Under 2 do nothing
2-3- delayed antibiotics
4 or more- give abx
177
What used for seborrheic dermatitis in infant
For both scalp and nappy rash
- wash in emollient and then use clotrimazole if does not work
178
What is used if cellulitis around the eyes and nose
Co-amoxiclav
179
What used if cellulitis on top of chicken pox
Flucloxacillin and amoxicillin
Pen allergic- Ciprofloxacin and metronidazole/clarithomycin
180
Management of infantile haemangioma if cosmetic disfugurement or near to nose, eyes or mouth
If small then topical timolol
If large then oral propanolol
181
Treatment of irritant dermatitis nappy rash
If mild erythema +asymptomatic- OTC barrier protection
If inflamed and bothersome- 1% hydrocortisone and OTC barrier protection
182
Candida nappy rash tx
No barrier protection
Use imidazole cream
183
Organisms and tx for scabies, head lice and threadworms
Scabies
- sarcopetes scabiei
- permethrin
Head lice
- pediculus capitis
- dimeticone lotion
Threadworms
- enterobius vermicularis
- <6mths= hygiene measures, >6mths= membendazole
184
Tinea corporis and cruris tx
Mild- clotrimazole/terbinafine cream
Severe- oral terbinafine
185
How is HSP managed
NSAID or paracetamol and bed rest
Typically will resolve in a few weeks
Oral pred if GI bleeding, severe abdo pain or scrotal involvement
IV if nephrotic range proteinuria or declining renal function
186
How is HSP managed
NSAID or paracetamol and bed rest
Typically will resolve in a few weeks
Oral pred if GI bleeding, severe abdo pain or scrotal involvement
IV if nephrotic range proteinuria or declining renal function
187
How does each nappy rash appear and its features
Irritant dermatitis- creases spared
Candida- erythematous rash which i- nvolves the flexures and has satellite lesions
Seborrheic dermatitis- has flakes and concomitant scalp rash
Psoriasis- scaly erythematous rash
188
Complications of chicken pox
Immunosuppressed- leads to severe streptococcal and staphylococcal infection affecting the joints and bones
Glomerulonephritis
Myocarditis
Pneumonitis
Bacterial superinfection
189
Management of bacterial superinfection in chicken pox
Admit to hospital
IV flucloxacillin and aciclovir
190
Management if labial fusion
If no major symptoms can reassure and review
If significant symptoms topical oestrogen for 4-6 weeks
Surgical management if thick and severe or trapped urine causing terminal dribbling and vulval inflammation
191
Management of tinea captits in children
Exclude kerion
Take hair and scalp sample for culture
Commence oral terbinafine or griseofulvin
When culture comes back change antifungal accordingly
192
Management of branchial cyst
Antibiotics if infected
Surgical excision is needed
193
Impetigo management
Localised and not unwell
Hydrogen peroxide 1% cream
If unsuitable
- fusidic acid 2%
- mupirocin 2%
Widespread and not unwell
Offer oral or topical
Topical
1st fusidic acid 2%
2nd mupirocin 2%
Oral
Flucloxacillin
Clarithomycin if aged 1month-11 years erythomycin if 11-17
Bullous or unwell
1st fluclox
2nd Clarithomycin if aged 1month-11 years erythomycin if 11-17
194
First line for acne
Mild/moderate
Combination of topical adapalene and benzol peroxide
Combination of topical tretinoin and clindamycin
Benzoyl peroxide and clindamycin
Moderate/severe
Combination of topical adapalene and benzol peroxide
Combination of topical tretinoin and clindamycin
Benzoyl peroxide and clindamycin
ALSO
Topical azelaic acid and oral doxycycline and lymecycline
ALL GIVEN FOR 12 weeks
195
If have cellulitis on top of chicken pox- what is most likely cause
Strep pyogenes
196
Most common neck lump in kids
Lymphadenitis
197
What are congenital warts
It is possible to be born with congenital viral warts on the anus or genitals transmitted from the mother to baby during birth
198
Difference in presentation of scarlet fever vs guttate psoriasis
Scarlet fever- within 24 hours of sore throat
Guttate psoriasis- a few days later with scaly papules
199
Management of alopecia areata
If evidence of hair regrowing then can use watchful waiting
If no hair regrowth or severe distress then very potent corticosteroids- betamethasone valerate 0.1%
200
Boggy and pustular raised area where is hair loss
Kerion
201
Gold standard for CMPA
Double blind oral food challenge
202
Differentials for small circular rashes
Discoid eczema
Tinea- not very itchy and localised
203
Neonatal features of Downs
Upslanting palpebral features
Smal low set ears
Round flat face
Flat occiput
Hypotonia
Brushfield spots in iris
Single palmar crease
Duodenal atresia
Hirschprung disease
204
Complications of edwards
Gastro
- Omphalocele
- Eosophageal atresia
- Hepatoblastoma
Renal
- wilms tumour
- horseshoe
Cardiac
- septal
- PDA
205
Examination of edwards findings
Prominent occiput
Cleft lip and palate
Low set ears
Rockerbottom feet
Overlapping fingers
Microcephaly
Micrognathia (small jaw)
206
Whats in pierrer robin sequence
Micrognathia
Posterior displacement of tongue which can cause airway obstruction (glossoptosis)
Cleft palate
207
Fragile X presentation
Intellectual disability
Delayed speech
Delayed motor development
Autism
ADHD
Seizure disorders
Premature ovarian failure
208
Examination features of fragile X
Long narrow face
Prominent jaw
Large ears
Large testes post puberty
Macrocephaly
209
Examination of patau
Scalp lesions from failure of skin to develop
Micropthalmia
One eye in middle of face
No nose
Polydactyly
Rockerbottom feet
210
Problems of pataus
GI-omphaloce
Renal- PCKD
Cardio- VSD, PDA, dextrocardia
Neuro- myelingocele, developmental delay
211
Examination findings of noonans
Webbed neck
Trident hairline
Pectus excavatum
Short
Widespaced nipples
212
Defect in noonan syndrome
Autosomal dominant
Protein kinase mutation Chr 12
213
Complications of noonans
Pulmonary valve stenosis
Factor Xi deficiency
Ptosis
214
Presentation of prader-willi and angelmans
Hypotonia
Hyperphagia
Almond shaped eyes
Hypogonadism
Epicanthal folds
Flat nasal bridge and upturned nose
Learning disability
215
Difference between prader-willi and angelman syndrome
Both have deletion of 15q (long arm)
Paternal deletion= prader willi
Maternal deletion= angelman
Get myoclonic seizures in angelmans
216
Genetic inheritance of prader wili
Imprinting
217
Cardiac complication of fragile X
Mitral valve prolapse
218
Klinefelters features
Infertility
Hypogonadism
Gynaecomastia
Tall
47 XXY
219
Defining obesity in children
If under 12 use weight centiles
- overweight above 91st centile
- obese above 98th centile
- severe above 99.6 centile
If over 12 use BMI
- overweight above 25
- obese above 30
220
Inheritance of fragile X
X linked autosomal dominant
221
What are categories of DKA
Mild- pH 7.2-7.29
Moderate- pH 7.1-7.19 or bicarb less than 10
Severe- pH under 7.1 or bicarb less than 5
222
How to treat cerebral oedema from DKA
Mannitol
223
Gonadotrophin dependant causes of precocious puberty
Idiopathic/familial
CNS abnormalities
- hydrocephalus
- infection
- post irradiation
- surgery
- tumours
Hypothyroidism
224
Gonadotrophin independent causes of precocious puberty
Adrenal
- tumours
- congenital hyperplasia
McUne Albright Syndrome
Tumours producing sex hormones
Exogenous tumours
225
What would suggest tumour producing sex hormones as cause of precocious puberty
Virilisation
Lots of pubic hair in isolation
226
What is tumours cause precocious puberty in girls vs boys
Girls- granulosa
Boys- leydig
227
When should late puberty be investigated in a boy
Past 14- expect it 9-14
228
What can present with premature thelarche between 6- 24 months
Premature thelarche provided no accompaniement of growth spurt or pubic hair development
229
How is gonadotrophin dependant precocious puberty treated
Treat cause
Gonadotrophin agonists with GH as GNRH stunts bone growth
230
Causes of delayed puberty
Constitutional delay
Low gonadotrophin
- systemic disease/exercise/stress causing function hypogonadotrophins
- panhypoituitarism
- intracranial pathology
- hypothyroidism
- kallmann
High gonadotrophin
- klinefelters
- turner
- acquired gonadal failure
231
Management of congenital adrenal hyperplasia
IV hydrocortisone
IV dextrose
232
Investigating CAH in children
17 hydroxyprogesterone
In neonate have to do USS as 17 OHprogesterone confounded for by mother
233
Management of constitutional delay of puberty
1st line- reassure and observe
2nd- IM testosterone every 6 weeks for 6 months if male
transdermal oestrogen
234
Management of primary gonadal failure causing delayed puberty
Boys- testosterone injection
Girls- oestrogen replacement
235
How is gonadotrophin independant precocious puberty treated
Ketoconazole
236
How treat precocious puberty from CAH
Hydrocortisone
GNRH agonist
237
What is unilateral gynaecomastia in puberty
Normal part of process
238
Presentation of marfans
High arched palate
Chest wall deformity
Lens dislocation
Arm span > height
Joint hypermobility
Tall
Mitral valve prolapse
Aortic arch abnormalities
Myopia- short sighted
239
Recurrent AOM in a short female
Turners
240
What are spoon shaped nails seen in
Turners due to lymphoedema
241
Clinical features of GH deficiency
Normal growth until 6-12 months
Drastically reduced bone age
Associated with neonatal hypoglycaemia, doll like face( round face with short chin and nose) and jaundice
242
How should height centiles be assessed with regards to referrals
Under 2nd centile= seen by GP
Under 0.4th centile= seen by paediatrician in outpatient setting
243
When refer for sitting unsupported
12 mths
244
Gross motor milestones
6wks- control head
6 mths- sit unsupported
1 year- stand
15mths- walk
2 years- run
3- rides tricycle
4- hops on 1 leg
245
Fine motor skills milestones
6wks- follows object
6mths- palmar grasp and transfers between hand
12 months- pincer grip
246
Building bricks milestones
15 mths- 2 blocks
18 mths- 3 blocks
2 years- 6 blocks
3 years- 9 blocks
247
When can draw line, circle and triangle
2 years- line
3 years- circle
5 years- triangle
248
Speech and language milestones
6wks- stills or startles to noise
6 months- turns head to sounds, can babble
12 months- knows and responds to name
15 mths- 2-6 words
2 years- combine 2 words
3 years- sentences
249
when refer for not having 2-6 words
18 months
250
Social milestones
6 wks- smiles
6 mths- puts hand to bottle when feeding
12 mths- waves
18 mths- plays alone
2 years- can play near others and use spoon
3 years- uses spoon and fork
4 years- plays with others
251
In DKA what is first thing assess and what determines
If in shock?
Yes
- 100% oxygen
- 10ml/kg 0.9% fluid bolus
- repeat until circulation restored (if do 4x then consider ionotropes)
No
- 10ml/kg 0.9% fluid over 30 mins
252
Once patient has received bolus how manage DKA
Calculate fluid requirements with 40mmol/L potassium depending on K level
Start insulin 0.05-0.1 units/kg/hour 1-2 hours after bolus
Observe with hourly blood glucose and ketones
253
How manage cerebral oedema in DKA
20% mannitol or 2.7% NaCl
254
Fluid resuscitation for children
10ml/Kg over less than 10 minutes
255
Calculating fluid maintenance for children
First 10kg- 100ml/kg/day
Next 10kg- 50ml/kg/day
Any Kg over 20kg- 20ml/kg/day
256
Red flags for clinical dehydration
Alterred consciousness
- irritable
- lethargic
Sunken eyes
Tachycardia
Tachypnoea
Reduced skin turgor
257
Red falgs for shock
Weak peripheral pulses
Cold extremities
Prolonged CRT
Pale or mottled skin
Hypotension- sign of decompensated shock
258
Management of clinical dehydration
Use ORS 50ml/kg over 4 hours with maintenance fluids
If vomiting and cant keep down use NG tube
259
How to calculated % dehydration if no weights
Clincal dehydration- 5%
Shock- 10%
260
How to calculate fluid deficit
Fluid deficit (mL) = % dehydration x weight (kg) x 10
261
Anaphylaxis guidelines
Remove trigger
Lie flat
IM adrenaline
A-C
Repeat adrenaline if no response after 5 mins with IV bolus
262
Doses of adrenaline
>12= 500mcg
6-12= 300mcg
6 months-5 =150 mcg
<6 months= 100-150mcg
263
Management of GORD in child breastfeeding
1. Breastfeeding assessment and advice
2. 1-2 week trial of alginate therapy- if symptoms improve after 2 weeks continue the therapy. Stop at regular intervals to see if symptoms have improved
If have not then medical treatment
264
Mangement of GORD in formula fed
1. Reduce volume of milk if excessive (150ml a day per kg)
2. Offer 1-2 weeks of smaller more frequent unless they already are small and frequent
3. 1-2 weeks of feed thickeners
4. Alginate therapy
5. Medical management
265
Medical management of GORD
4 week suspension of omeprazole
If doesnt work refer for possible endoscopy and potential metoclopramide treatment
266
When should arrange a specialist assessment by paediatrician GORD
Uncertain diagnosis
Growth issues
Unexplained distress in those with communication difficulty
Not responding to treatment
Avoiding food
Unexplained IDA
No improvement in GORD after a year
Sandifers syndrome suspected
Recurrent aspiration pneumonia
Upper airway erosion
Dental erosion in child with neurodisability
Recurrent otitis media (more than 3 episodes in 6 months)
267
Who give abx in AOM
- ottorrhoea
- perforation
- under 1 month
- systemically unwell
- bilateral under 2
- lasts 4 days
