Paeds Flashcards
ITP Mx:
- Management is usually oral prednisolone (corticosteroid) however if platelet count is not less than 10 and there is no active bleeding, then NO management is required.
- usually self resolves in 6 months without any management
-advice to avoid activities that could result in trauma
-
Turner’s syndrome: associations ?
- is linked with Bicuspid Aortic Valve (ejection-systolic murmur)
Reflux Nephropathy(vesico-ureteric reflex): (in neonates)
- Gold standard investigation: Micturating Cystography
-Presents as: recurrent UTIs since very young age and raised creatinine
-Pathophys: ureters are placed laterally, entering bladder at more perpendicular angle
Noonan Syndrome:
young boy presenting with: short stature, webbed neck, pulmonary stenosis, ptosis: is a Autosomal Dominant Disorder, pectus excavatum (sunken chest) is likely.
risk factor for DDH:
- Oligohydramnios
- Female
- Breech presentation
-positive family history
Hand preference before 12 months of age is ABNORMAL: what to do?
- Refer urgently to paediatrician as could be a sign of cerebral palsy.
shaken baby syndrome:
Presents with triad of: retinal haemorrhage, encephalopathy, subdural haematoma
Indication of a Atypical UTI:
- Poor urine flow
-severely ill
-abdominal/bladder mass
-raised creatinine
-septicaemia
-failure to respond to treatment with suitable abx within 48 hours
Roseola Infantum rash:
Fever followed later by rash
- febrile seizures common
-is common in 6 months to 2 years
Retinoblastoma:
- loss of red reflex in neonates= detected at birth, strabismus, visual problems
- is autosomal dominant
ddx: congenital cataract but this would not present at Newborn check
Rota Virus vaccine (oral)- when given?
at 2 and 3 months
- is an oral, live attenuated vaccine
Indication for admission:
Audible stridor at rest
Perthe’s Disease: Mx- be careful with age of child:
- if child is LESS than 6 yrs-good prognosis, therefore reassurance and follow up only, if more than 6 years, then do splinting of the limb.
- Presents with hip pain, limping and reduced range of movement of hip
-pathophys: due to avascular necrosis of femoral head
-xray changes: early changes= widening of joint space
-diagnosis done by Xray
if child has limp+fever:
Refer for same day urgent assessment even if the diagnosis is Transient Synovitis as do not want to miss septic arthritis.
in neonates: which haemorrhage is common until 72 hours of birth?
- Intraventricular Haemorrhage
cardiac defect associated with Duchenne Muscular Dystrophy:
Dilated Cardiomyopathy
GI: malrotation classical presentation
associated with exomphalos(baby’s abdo wall does not fully develop in utero) and congenital diaphragmatic hernia
croup causative organism:
Parainfluenza virus
- presents in autumn months with barking cough and inspiratory stridor
Bronchiolitis causative organism:
- Respiratory Syncytial Virus
Escalation plan for children less than 3 months: (eg. for a suspected UTI):
admit SAME day to paeds ward for assesment
Meningitis management for children less than 3 months:
- IV Cefotaxime and IV amoxicillin, if more than 3 months, just Cefotaxime.
- Do not give steroids eg. dexamethasone in less than 3 months old.
Toddler’s diarrhoea:
- Benign condition that causes child no problems, happens due to fast transit through digestive system resulting in undigested food.
Mx: reassure and self-resolve
Asthma Mx: (look carefully at age of child, if less than 5 or more than 5)
- less than 5: Salbutamol, ICS, LABA
- More than 5- same as adult management: Salbutamol, ICS, Monteluklast (Leukotrine receptor antagonist)
Paeds life support resus:
1) if no signs of breathing: first give 5 rescue breaths.
2) check for signs of circulation
3) Chest compressions 15:2 ratio for children at a rate of 100-120/minute, otherwise 30:2
AVERAGE child walking age:
13-15 months but can often walk quicker than that.
Hand foot and mouth disease caused by:
Coxsackie A16 and enterovirus
- requires only symptomatic treatment.
- is very contagious, typically spreads in nursery.
-children DO NOT need to be excluded from school.
Roseola(also known as 6th disease) causative organism:
- Caused by Human Herpes Virus 6(remember because also called 6th disease).
Intussusception Inv:
- Ultrasound= would show a target-like mass
Transposition of great arteries:
-Is a medical emergency, presents with cyanosis and loud S2 sound and systolic murmur heard on auscultation
- Mx: Prostaglandin to keep ductus arteriosus open.
NB: Indomethacin is used to close the duct (is a NSAID)
Pyloric Stenosis:
- presents with forceful projectile vomiting about 30 minutes after feeding.
- hypochloride hypokalaemia metabolic alkalosis
-diagnosis is made by Ultrasound
-Mx: Ramstedt Pyloromyotomy
Neonatal Hypoglycaemia (risk factor):
- born preterm(before 37 week)at 35 weeks gestation.
- Presentation: Jittery, irritable, poor feeding and tachypnoea(abnormally rapid breathing)
Contraindication for a Lumbar Puncture:
Meningococcal Septicaemia (purpura rash alongside meningitis infection)
- others: signs of raised ICP(papilloedema, bulging of fontanelle, DIC)
Meningitis prophylaxis:
Abx= Ciprofloxacin and public health notify about disease and contacts
Biliary Atresia:
- Jaundice presenting after first 2 weeks
- Dark urine and pale stools
-Appetite and growth disturbance
Mx: Surgical treatment is the only definitive treatment
Escalation pathway of a child presenting with limp+fever(even if diagnosis of Transient Synovitis is suspected)
refer for SAME day assessment as need to exclude septic arthritis
Necrotising Enterocolitis:
- presents often in premature neonates with: feeding intolerance, abdominals distension, bloody stools.
- Abdo xray: shows dilated bowel loops, often asymmetrical in distribution, pneumatosis intestinalis(gas)
Test for NEWBORNS with hearing problems:
Otoacoustic emission test
DDH(developmental dysplasia of hip) Mx:
- Less than 6 months old= 1st line) Pavlik harness
- if more than 6 months or 2nd line if Pavlik Harness has not worked= Spica cast in flexion and abduction
DDH Inv: (Age is relevant)
- Ultrasound
NB: - if more than 4.5 months= then xray=1st line
Kawasaki disease complication investigation:
Coronary artery aneurysm- Echocardiogram
Gonadotrophin INDEPENDENT precocious puberty:
FSH and LH levels are LOW
Gonadotrophin DEPENDENT precocious puberty(puberty starting before 8 years of age):
FSH and LH levels are HIGH
- more common in females
Threadworms pathogenic name:
Enterobius Vermicularis
Threadworms:
Mx: Mebendazole- is used 1st line for children
Sx: Perianal itching at night
Slipped capital femoral epiphysis:
- Loss of internal rotation of leg in flexion
- Obese 10 year old classical picture
Haemophilia A mode of inheritance:
- X linked recessive
Transient Tachypnoea of the newborn:
- Presents with Respiratory Distress.
- Condition is: rapid breathing, grunting, mild intercostal recession.
- Occurs due to delayed clearance of lung fluid.
- Usually presents within 24-48 hours after birth
CXR: shows hyperinflation of the lungs and fliud
Ddx: Persistent pulmonary hypertension of the newborn: occurs when there is a failure to transition from foetal circulation to postnatal circulation.
Nasal polyps, recurrent respiratory infections and weight loss are associated with which condition?
- Cystic Fibrosis
1st line for enuresis(bed wetting) management:
Enuresis alarm
Important ethics (paeds specific-under 16yrs):
A child can consent to but NOT refuse treatment, even if they are in full capacity, example:
If a patient has appendicitis, and wants to refuse treatment, even if they have full capacity, they cannot!
SUFE (slipped capital femoral epiphysis) definitive mx:
Refer to Orthopaedics= for in-situ fixation with a cannulated screw
Presentation: obese boy with groin/thigh/knee pain
Investigation(diagnostic)= AP(Antero=posterior; beams pass from front to back) view and lateral view(typically frog leg views)
Roseola Infantum:
- Caused by Human herpes virus 6
- Presentation:first fever, then followed by rash(painless, non-pruritic)
Mx: No treatment is required and long term complications are rare.
Infantile spasms is also known as?
West Syndrome:
- is a childhood epilepsy syndrome
-‘salaam’ attacks
Investigation: EEG(electroencephalogram) shows hypsarrhythmia in 2/3rds of infants
- has a poor prognosis
-Vigabatrin is now considered 1st line
Female Puberty signs in order:
- 1st) Breast development at 11.5 years
-2nd) Height spurt reaches max at 12 years before menarche
-3rd) Menarche at 13
Asthma management for less than 5 years:
1st) Salbutamol
2nd) Beclometasone (low dose steroid)
3) Leukotriene receptor antagonist
Mx: for febrile convulsions in children that last longer than 5 minutes?
- Call ambulance immediately
DDH investigations:
- Ultrasound is generally used to confirm
-If infant is more than 4.5 months, then x-ray is 1st line investigation.
Jaundice in newborn period:
Within the first 24 hours is pathological jaundice
- needs paeds assessment
-causes of jaundice in first 24 hours: rhesus haemolytic disease, ABO haemolytic disease, hereditary spherocytosis.
- From day 2-14: physiological jaundice= Breastfed babies
-After 14 days= means prolonged jaundice: causes- biliary atresia, hypothyroidism, galactosaemia
Pyloric Stenosis Management:
Ramstedt Pyloromyotomy (surgical management)
- Diagnosis is made by ultrasound
-Presents as: Projectile vomiting, typically 30 minutes after feed, hypochloraemic hypokalaemic acidosis due to persistent vomiting.
Cerebral Palsy Presentation:
- Affects the Basal Ganglia and Substantia Niagra
- Presents: slow, twisting, repetitive movements of the arms that can be noticed and is accompanied by rapid involuntary movements.
Bronchiolitis management:
admit to hospital; but for supportive treatment.
Bow legs in children less than 3 is normal:
Normally resolves by the age of 4 years, reassure parent.
Notifiable infectious disease in children:
- Scarlet Fever : need to notify Public Health England.
Mitochondrial DNA inheritance pattern:
-Is only passed down to children through mother, so if father has condition, not necessary that mother has it too.
-None of male’s children will inherit disease (0%)
- All of female’s children will inherit the disease (100%)
Cystic Fibrosis inheritance pattern:
Autosomal Recessive
Head lice (Pediculus Capitis): household contacts treatment?
Household contacts DO NOT need treating unless they too have head lice, no need for prophylactic management.
Mx: Malathion, fine-tooth combing of wet/dry hair.
- School exclusion is not advised.
Difference between Reflex Anoxic Seizures and Epilepsy:
- Reflex Anoxic seizure= has a faster recovery after seizure unlike epilepsy(post-ictal effect)
- there is no significant treatment and has a good prognosis.
Congenital Rubella Presentation:
- Sensorineural deafness
- Congenital cataracts
Red flag for children:
- Resp rate of more than 60, manage: by immediately admitting to hospital
- then give antibiotics.
- be careful in feverish children who are less than 3 years of age.
Consider neonatal sepsis when presenting with vague symptoms like:
-Poor feeding, grunting, lethargy
Primary Amenorrhoea cause? (first period has not come yet)
- Complete Androgen Insensitivity
Causes of secondary amenorrhoea:
- PCOS (typically in patients with a high BMI)
- Pregnancy
- Prolactinoma
Ethics for Jehovah’s witness and child refusing treatment (blood transfusion)
In an emergency, you can provide treatment that is immediately necessary to save life or prevent deterioration in health without consent or, in exceptional circumstances, against the wishes of a person with parental responsibilitym
