Paeds Flashcards
When is meningococcal vaccine given?
2 months, 4 months and 12-13 months
What is the difference between cephalhaematoma, caput succadeneum and craniosynostosis
Cephalhaematoma:
* Doesnt cross suture lines.
* Appears a couple of days after instrumental delivery.
* Is due to bleeding between the periosteum and the skull.
Succadeneum
* Sewlling appears immediately after birth
* Generalised superficial scalp oedema, which crosses suture lines.
* Associated with prolonged labour.
Craniosynostosis:
* Premature closure of cranial sutures, causing deformity of the skull.
How to manage reflux in babies?
1) Nurse 30 degrees head up. Advise they should sleep on back, ensure not being overfed, trial smaller more frequent feeds.
2) If bottle fed add thickener
3) If not trial alginate (gaviscon)
4) IF unexplained feeding difficulty/distressed/faltering growth then trial PPI (used to be ranitidine but now withdrawn)
5) Metoclopramide but under specialist advice. If really bad they’ll consider Nissens fundoplication
Features of Williams syndrome
- Small upturned nose
- Long philtrum (upper lip length)
- Wide mouth
*Full lips
*Small chin
*Puffiness around the eyes.
**Associated with Aortic stenosis.
How to manage food allergy in children?
First establish whether IgE or non IgE mediated.
IgE mediated = Bad(E) - more likely to have more severe GI sx AND chest involvement so things like wheeze.
To manage IgE mediated they need skin prick testing.
Non IgE mediated - Eliminate the allergen for 2-6 weeks then slowly reintroduce with a ladder. E.g. if eggs then start with cooked eggs before scrambled.
Is transposition of the great arteries cyanotic or acyanotic?
How is this managed?
cyanotic.
Need to keep the ductus arteriosus open with prostaglandins.
Surgery = definitive
3 cyanotic congenital cardiac problems?
CT
Transposition of great vessels
Tetralogy of Fallot
Tricuspid atresia.
Tetralogy of fallot features?
What would you see on XR?
VSD
Pulmonary stenosis
RVH
Overriding aorta (should be over LV but actually its in the middle so gets blood from right heart too).
CXR will show a boot shaped heart
Usually presents age 1-2 months however can be as late as 6 months. Children get ‘tet spells’ - upset get cyanosed, inc RR and can LOC
Management is surgery usually in first year of life.
How to manage CMPA
1) If formula fed
2) If breastfeeding
Prognosis?
1) eHF extensive hydrolysed formula. If not working then amino acid based formula.
2)Eliminate cow’s milk protein from maternal diet. Consider prescribing calcium supplements to mum.
Use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
IgE mediated - 55% will be milk tolerant by 5.
Non-IgE mediated - most children will be milk tolerant by 3.
Challenge is often performed in the hospital setting as anaphylaxis can occur.
When would you refer a child to have vaccines at hospital and why?
Babies born under 28 weeks - risk of apnoea.
What is Edwards syndrome?
Trisomy 18
Get micrognathia, low-set ears, rocker bottom feet and overlapping of fingers - Edward’s syndrome
Management of Kawasakis
High-dose aspirin - usually can’t give this in children due to risk of
Reye’s syndrome but do for this.
IVIG
echo- ? coronary artery aneurysms
Kawasaki features
High-grade fever which lasts for > 5 days.
Conjunctivitis
Red palms of the hands and the soles of the feet which later peel
Eyes -conjunctival injection
Lymphadenopathy(cervical)
Mouth sore, strawberry tongue
How can you tell adrenal cause of precocious puberty from other causes?
Small testes if adrenal hyperplasia.
Pink Mac pap rash that starts on the face then spreads to body. Suboccipital and post auricular lymphadenopathy.
Rubella
Child presents with fever, malaise and tonsillitis associated with a ‘strawberry’ tongue and a fine punctate erythematous rash sparing the area around the mouth
Scarlet fever
What is Hirschsprung’s disease ?
rare but think of it if it takes a long time for child to pass meconium, or later in life if child is constipated.
Parasympathetic Auerbach and Meissner plexuses affected.
Ix: AXR, rectal biopsy is gold standard,
Slapped cheek proper name
erythema infectiosum
Virus that causes Hand foot and mouth?
Coxsackie A16
What does parainfluenza cause?
Croup
What does haemophilus influenzae cause?
acute epiglottitis
exacerbation of bronchiectasis
IECOPD
Child with fever, conjunctivitis, white spots on buccal mucosa, rash starting behind ears
Measles
Child with fever, fine punctate erythematous rash with ‘sandpaper’ texture, strawberry tongue
Scarlett fever
Puberty in females
Age??
First signs?
First sign is breast development at around 11.5 years of age (range = 9-13 years)
Height spurt reaches its maximum early in puberty (at 12) , before menarche
menarche at 13 (11-15)
there is an increase of only about 4% of height following menarche
Puberty in males
Age?
First signs?
First sign is testicular growth at around 12 years of age (range = 10-15 years)
testicular volume > 4 ml indicates onset of puberty
maximum height spurt at 14
How to diagnose vesicoureteric reflux in children
Micturating cystourethrogram
When would NICE say to image the urinary tract?
infants < 6 months who present with a first UTI which responds to treatment should have an ultrasound within 6 weeks.
children > 6 months who present with a first UTI which responds to treatment do not require imaging unless there are features suggestive of an atypical infection or recurrent infection
When should a DMSA scan be done?
Why?
4-6 months after an initial infection
To look for renal scarring
When would you do MCUG and why?
Identifies vesicoureteric reflux. Only recommended for infants younger than 6 months who present with atypical or recurrent infections
How to manage acute mild-mod asthma in children?
Bronchodilator therapy
give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)
give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat beta-2 agonist and refer to hospital
Steroids should be given to all children with an exacerbation and
treatment should be given for 3-5 days
Scarlet fever causative organism
Group a haemolytic strep
