Paeds Flashcards
NICE Immediate referral criteria?
- apnoea (observed or reported)
- child looks seriously unwell to a healthcare professional
- severe respiratory distress
- a respiratory rate of over 70 breaths/minute
- central cyanosis
- persistent oxygen saturation of less than 92% when breathing air.
NICE consider referral criteria
- a respiratory rate of over 60 breaths/minute
- difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume, taking account of risk factors
- clinical dehydration.
Management of Perthes disease in <6?
Observation
What is the management of umbilical hernias?
- Usually self-resolve
- If large/symptomatic, repair at 2-3 years
- If small and asymptomatic, repair at 4-5 years
What is the management of meningitis in children < 3 months?
IV Cefotaxine plus IV Amoxicillin
progressive hip pain, limp and stiffness
Perthes disease
Brushfield spots in the iris are suggestive of which genetic condition?
Downs
painless rectal bleeding with no other acute abdominal signs?
Think Meckels Diverticulum
What should not be given to children <3 months with bacterial meningitis?
Corticosteroids
What should you do if there are no signs of breathing on initial assessment of a child?
Give 5 rescue breaths
Blue sclera is associated with what?
Osteogenesis imperfecta
What should be given to all children who have an asthma attack?
Oral prednisolone for 5 days
What criteria is used to assess the likelihood of septic arthritis in children?
- Inability to weight bear
- Fever > 38.5
- WCC > 12
- ESR > 40
Management of bow legs
If <3 - normal variant and usually resolves by 4 years old
If >3 - refer to paediatrics
Management of Children presenting with glue ear with a background of Down’s syndrome or cleft palate
Refer to ENT
When should a child be reviewed by a senior endocrinologist?
If ketonaemia and acidosis have not resolved within 24 hours of DKA
A lesion where causes finger abduction weakness
T1
What are risk factors for SUFE?
- Obesity
- Male
- Local trauma
- Hormone deficiencies: thyroid, GH
- Chemo/Radio
What are examination findings for SUFE?
Limp on walking, external rotation of limb, hip motion is limited (flexion, abduction and medial rotation)
What are signs of decompensated congenital heart disease?
Poor feeding, dyspnoea, tachycardia, weak pulse, cold peripheries, hepatomegaly, engorged neck veins, gallop rhythm
What is Eisenmenger’s syndrome?
When a left-to -right shunt leads to pulmonary hypertension and shunt reversal, therefore turning an acyanotic heart defect into a cyanotic heart defect.
What are risk factors for respiratory distress syndrome?
Maternal diabetes, Caesarean sections, second twins, males, hypothermia, perinatal asphyxia, FH,prematurity
Which cells in the lung produce surfactant?
T2 Pnemocytes
What will be seen on CXR for RDS?
Ground glass appearance
Simple febrile convulsion vs complex
Complex - Focal, >15 minutes, Repeat seizure within 24 hours
What is cerebral palsy?
A chronic disorder of movement and posture due to non progressive brain abnormalities occurring before the brain is fully developed
What are non-motor signs of cerebral palsy?
Delayed milestones, failure to thrive, epilepsy, urinary
incontinence, constipation, drooling, sleep disturbance,
contractures
What are signs of intussception on abdo x ray?
Right lower quadrant opacity, dilated gas-filled proximal bowel with absence of gas distally, multiple fluid levels, perforation
What are indications for surgery with intussception?
- Peritonitis
- Failed enema
- Perforation
- Prolonged history
Murmur for ASD vs VSD
ASD - ejection systolic
VSD - pansystolic at left sternal border
What is Turners chromosomal abnormality?
XO karotype
What is the most common cardiac defect with Turners syndrome?
Bicuspid aortic valve
Slow movements of hand and feet with difficulty holding objects + drooling in a child?
Dyskinetic CP
Paeds BLS
- 5 rescue breaths
- 15:2 (3:1 for newborn) chest compressions on lower half of sternum with depth of 1/3 of chest
- Use 2 thumb encircling technique for chest compression for infants
Where is the damage in dyskinetic cerebral palsy?
Basal ganglia and substantia nigra
Craniopharyngioma vs pituitary adenoma?
PA - bitemporal superior quadrantinopia
CP - bitemporal inferior quadrantinopia
What age do febrile convulsions normally stop?
5 years
Aplastic crisis vs sequestration crisis?
Aplastic - reduced reticulocytes
Sequestration - increased reticulocytes
What should not be given to patients with suspected meningococcal sepsis?
Dexamethasone
ALL can present with haemorrhage or thrombotic complications due to what?
DIC
How does TTP present?
FAT RN
Fever
Anaemia
Thrombocytopenia
Renal dysfunction
Neuro abnormalities
Cystic fibrosis associations?
- Short stature
- DM
- Delayed puberty
- Nasal polyps
- Rectal prolapse
- Male infertility
Swollen and retracted testicle
Testicular torsion
What is the investigation for sickle cell anaemia?
Haemoglobin electrophoresis
Which seizures appear in the morning after waking?
Myoclonic -> treat with sodium valproate/leviteracetam
Infant <3 with suspected UTI?
Refer to Paeds
What should be measured in patients with active HSP?
- Blood pressure and urinalysis
What is used for the longer term management of sickle cell anaemia?
Hydroxyurea -> increases levels of HbF
Signs of tetralogy of fallot on examination?
- Loud systolic murmur in pulmnary area
- Ejection systolic murmur
Sign of TOF on ECG?
Right axis deviation
What conditions are screened for in NIPE?
- Congenital cataracts
- Congenital HD
- Undescended testes
- DHH
- Newborn hearing
What are signs of DDH on X-ray?
Reduced alpha and beta angles
Reduced bony coverage of femoral epiphysis
What are complications of DDH?
- Premature joint degeneration
- Arthritis
- Chronic lower back pain
- Delay in walking
- Avascular necrosis
Treatment for muscle spams in CP?
- Diazepam
- Baclofen
- Botox
Vomiting vs Reflux
Vomiting - forceful and active, Reflux - sphincter incompetence
Which organism causes hand, foot mouth/slapped cheek/roseola?
Coxsackie - HFM
Slapped Cheek - Parvovirus
Roseola - HH6
steeple sign
Croup
What is Eisenmenger’s syndrome?
Reversal of left-right shunt to a right-left shunt due to pulmonary HTN
ADHD has reduced function of where?
Frontal lobe
What is the most common small vessel vasculitis in children?
Henoch-Schonlein Purpura
Meningitis + septic shock + massive adrenal haemorrhage?
Waterhouse-Friderichsen syndrome
Rash organisms
Roseola - HH6
Slapped Cheek - Parvovirus
Hand, foot mouth - Coxsackie virus
Chickenpox - Varicella
small round blue cells on histology
Think Wilms tumour
What are the S of innocent murmurs?
- Soft
- Systolic
- Sensitive
- Short
- Symptomless
What is the treatment for epiglottitis?
- Intubation
- IV Cefuroxime
What can be given to promote closure of the duct and what to keep the duct open?
Keep open - Prostaglandins
Promote closure - Ibuprofen/Indomethacin
How long should patients be kept in for observation after anaphylactic reaction?
6 hours
Components of Fraser guidelines
the patient cannot be persuaded to inform their parents or carers
the patient understands the advice or treatment
the patient’s physical and/or mental health will suffer if they do not receive the treatment/advice
the treatment/advice is in the patient’s best interest
the patient is likely to continue having sex with or without treatment
Whooping cough is a risk factor for?
Bronchiectasis
Which chromosome is Downs, Edwards, Patau?
Patau - 13
Edward - 18
Down - 21
sensorineural deafness and a desquamating rash in a neonate?
Think congenital syphilis
Rickets can present as what?
Widening of the joints
Hearing tests in children
Newborn - otoacoustic emission test
If abnormal - auditory brainstem response test
3 years - Pure tone audiometry
What is not a red flag referral criteria?
Nasal flaring
grey spots on his buccal mucosa
Koplik spots -> measles
Signs of Turners?
- Short stature
- Lymphoedema
- Spoon shaped nails
- Webbed neck
- CHD
- Delayed puberty
- Wide spaced nipples
What is intusseception?
Telescoping of a segment of proximal bowel into a distal one
What is the management of intussusception?
- Rectal air insufflation/air enema if stable
- If unstable: laparoscopic reduction
What is DDH?
Where the femoral head and acetabulum do not articulate correctly
What are Barlow and Ortolani tests?
Barlow - attempt to dislocate the femoral head
Ortolani - attempt to relocate the dislocated femoral head
Investigations for DDH?
If <4.5 months: US
If >4.5 months: X-ray
When would you use correction for gestational age when assessing for milestones?
Until 2 years
Features of Patau?
- Microcephaly
- Clef lip and palate
- Polydactyly
Features of Edwards?
- Micrognathia
- Low set ears
- Rocker-bottom feet
- Overlapping fingers
What is the management of minimal change disease?
- Prednisolone
- Immunosuppressives such as ciclosporin
- Fluid restrict and low salt
Diffuse ‘lace-like’ rash develops across the body
Slapped cheek syndrome
What is a big maternal risk factor for transposition of the great arteries?
Diabetes
Triad of ADHD
- Impulsivity
- Inattention
- Hyperactivity
What must be performed before starting someone on methylphenidate?
ECG -> can be cardiotoxic
What are signs of foetal alcohol syndrome?
- Microcephaly
- Short palpebral fissures
- Absent philtrum
- Reduced IQ
- Cardiac abnormalities
What causes a tet spell?
Reversal of the shunt across the VSD leading to a right to left shunt and exacerbated cyanosis
Indications for tonsillectomy
seven or more episodes in a single year, five or more episodes/year in two years, or three or more episodes/year in three years
Crampy abdo pain with sore throat and some lymphadenopathy?
Think mesenteric adenitis
First line therapy for anorexia in kids?
Family therapy
How long can maternal antibodies protect foetus?
Upto 6 months
Dehydration, vomiting, hyponatraemia and hyperkalaemia shortly after birth?
Think Congenital adrenal hyperplasia
Grunting, cyanosis with barrel chest and scaphoid abdomen?
Think congenital diaphragmatic hernia -> tinkling bowels sounds
Yawning in a newborn baby that was previously well is a sign of what?
Opioid withdrawal
sunburst appearance on x ray?
Osteosarcoma
Gram negative coccobacillus?
Bordetella pertussis -> whooping cough
Inheritance of DMD?
X-linked recessive
recurrent otitis media in a girl?
Think Turners
Cataracts, deafness, hepatosplenomegaly, heart mumur + rash?
Think congenital rubella
Murmurs
ASD - Ejection systolic
VSD - pan systolic at lower left sternal edge
Pulmonary stenosis - Ejection systolic
Tricuspid regurg - pan systolic at lower left sternal edge
Management of hydrocephalus?
VP shunt insertion
What causes Kernicterus?
Toxic build up of unconjugated bilirubin
What are the live vaccines?
MMR
Influenza
BCG
Oral polio
Oral rota
Typhoid
Yellow fever
