Paeds Flashcards
Meningitis B immunisation dates
2, 4, 12 months
Measles isolation time
4 days from onset of rash
Wilms Tumour Fx
abdominal mass
visible painless haematuria
typically 3-5 yo
Laryngomalacia Fx
noisy respiration (stridor) within 4-6 weeks
99% resolve spontaneously
Mild to moderate acute asthma Mx
Bronchodilator B agonist 1 puff every 30-60s up to 10 puffs
if no improvement, repeat and refer to hospital
steroid therapy given to all children with acute asthma
Steroid (PO Prednisolone) dosing for acute asthma
2-5yrs - 20mg OD
>5 - 30-40mg OD
Intussusception Fx
6-18months old
severe, crampy, progressive abdo pain
“red currant jelly” stool
“sausage shape” mass in abdomen
Ix/
USS - target-like mass
Mx/
Reduction via air insufflation
X-Linked recessive conditions
Beckers/ Duchenne muscular dystrophy
Colour blindness
Fabry’s disease
G6PD deficiency
Haemophilia A and B
Hunter’s disease
Lesch-Nyhan syndrome
Nephrogenic diabetes insipidus
Wiskott-Aldrich syndrome
UTI in under 3 months Mx
hospital admission
UTI in >3months
if Upper UTI - consider hospital. If not, for PO Abx eg cephalosporin or Co-Amox (7-10 days)
if Lower UTI - PO Abx eg Trimeth, Nitro (3 days)
Infantile Colic Fx
<3 months old
excessive crying, pulling up of legs - esp in evenings
self resolves
Pertusis (Whooping cough) Ix
Per Nasal swab
Pertussis/ Whooping cough diagnostic criteria (5)
> 14 days without clear cause
paroxysmal cough
inspiratory whoop
post-tussive (coughing fit) vomit
undiagnosed apnoea episodes in infants
Pertussis/ Whooping cough Mx
<6 months old = admitted
Notifiable disease
PO Clarithromycin (or azithro/ erythro)
Household contact - prophylactic Abx
School exclusion: 48 hours after starting Abx or 21 days from onset if no abx
Croup Fx
URTI - Parainfluenza virus
6 months to 3 years old
stridor
barking cough
fever
coryza
Croup Mx
Mild - Single dose PO Dexamethasone 0.15mg/kg (or Pred)
Mod/ Severe - Hospital
Emergency treatment - high flow O2 + Adrenaline Nebs
Risk factors for Sudden Infant death syndrome (5)
prone sleeping
parental smoking
bed sharing
hyperthermia (and head covering)
prematurity
Hand foot and mouth cause
Coxsackie A16
Enterovirus 71
Risk factors for developmental dysplasia of hip (6)
female
breech presentation
positive FHx
first born child
oligohydramnios
birth weight >5kg/ 11ibs
Chronic Asthma Mx age 5-16
1 - SABA
2 - SABA + ICS
3 - SABA + ICS + Leukotriene recep antagonist (LTRA)
4 - SABA + ICS + LABA
5 - SABA + MART (ICS+LABA)
GORD in infants on formula Mx
1st - reduce feeds to 150ml/kg/day + more frequent
2 - 2 week trial of feed thickeners
3 - Gaviscon (Alginate)
4 - PPI
Scarlet fever Fx
Group A Haem Strep (strep pyogenese)
fever, malaise, tonsillitis
strawberry tongue
rash - fine punctuate erythema sparing the mouth (circumoral palor)
Scarlet fever school exclusion
24hrs after commencing Abx
Erythema infectiosum/ Fifth disease/ slapped cheek syndrome
Cause
Fx
parvovirus B19
lethargy, headache, fever
Rubella Fx
Rash - pink maculopapular, initially on face spread to rest of body
Suboccipital or Postauricular LNs
BenPen Paeds doses for Meningococcal septicaemia (3)
<1 = 300mg
1-9 = 600mg
10-17 = 1200mg
6 in 1 vaccine are…
at 2,3,4 months
diptheria
tetanus
Pertusis
polio
Hib
Hep B
MMR Vaccine at what dates
12-13 months
3-4 years
Amber/ Immediate risk criteria in febrile child
Pallor/ pale
Decreased activity
Nasal flaring
RR >50 in 6-12 months
RR >40 in >12 months
HR > 160 <12months
HR > 150 12-24 months
HR >140 2-5 yrs
Poor feeding/ reduced urine output
Temp >39 in 3-6yo
Fever >5/7
swollen joint/ painful limp
Rotavirus vaccine dates
2, 3 months
Cows milk protein allergy in bottle fed Mx
1st - extensive hydrolysed formula feed
2 - amino acid base formula
Cows milk protein allergy in breastfed Mx
Continue breastfeeding
eliminate cows milk from mother’s diet
Ca/ Vit D for Mum
Extensive Hydrolysed formula when weaning off breast milk for at least 6 months
measles complication
pneumonia
Ophthalmia neonatorum
Fx
Mx
bilateral conjunctivitis <30 days old
urgent ophthal/ paeds assessment
Cephalhaematoma Fx
Swelling on skull that does NOT cross the suture lines
from birth - takes months to resolve
Edwards syndrome (Trisomy 18) Fx
low set ears
rocker bottom feet
overlapping fingers
Jaundice in newborns (first presenting at..)
<24 hours
2-14 days
>14 days (prolonged)
<24 hours - always pathological - Rhesus incompatibility, ABO, hereditary spherocytosis
2-14 days - usually physiological
> 14 days - prolonged jaundice screen eg bilirubin, direct Coombes test, etc
- eg biliary atresia, hypothyroid, breast milk jaundice, galactosaemia
Red flags for constipation
from birth/ first few weeks
>48hrs passing of meconium - ?hirchsprung/ CF
multiple anal fissures
neurological signs in lower limbs
large naevus over sacral area - ?spina bifida
Contraindications to MMR vaccine (4)
severe immunosuppression
allergy to neomycin
received another live vaccine within 4 weeks
immunoglobulin therapy within past 3 months
Neonatal blood spot/ heel prick test dates
5th-9th day of life
Neonatal blood spot/ heel prick screens for (5)
sickle cell
cystic fibrosis
hypothyroid
phenylketonuria
MCADD
Milestones red flags
birth - 3 months
4-6 months
6-12 months
12-24 months
<3 months - persistent fisting, rolling
4-6 months - absent smile by 10 weeks, failure to reach for objects by 5 months, unable to support head
6-12 months - persistence of primitive reflexes by 6 months,
sit unsupported 9 months, no babbling, 12 months no attempt to crawl, 12 months unable to stand holding on
12-24months - hand dominance before 12 months ?hemiparesis. not walking unsupported by 18 months
Infantile spasms (West syndrome) Fx
present 4-8 months
more common in males
carry poor prognosis - associated with progression to epilepsy
characteristic “salaam” attacks - flexion of head, trunk arms followed by extension of arms
NSAID are used with caution in chickenpox because increase risk of…
Necrotising fasciitis
13-18 yo vaccine
Diptheria / Tetanus / polio
Men ACWY
Threadworm Mx
Mebendazole stat + hygiene advice
all household contact need to be treated despite symptoms
Acute epiglottitis cause
Haemophilus influenzae type B
Pneumococcal Conjugate vaccine (PCV) dates
3, 12 months
Meningitis C vaccine dates
12-13 months (1 year)
14 years
Meningitis B Vaccine dates
2, 4, 12 months
Nocturia Mx
<5yo - reassurance, diet, toileting behaviour
5+ - 1st Enuresis alarm
desmopressin for short term eg sleep overs
Acyanotic congenital heart disease
VSD (most common)
ASD
PDA
coarctation of aorta
aortic valve stenosis
scarlet fever Mx
10/7 PO Pen V (phenoxymethylpenicillin) OR Amox
5/7 PO Azithromycin (pen allergy)
Notify Public health within 3 days
Barlow manouvre (DDH)
attempts to dislocate articulated femoral head
fragile x fx (4)
learning difficulty
macrocephaly
large ears
macro orchidism
Impetigo Mx
Fusidic acid 2% TDS 5 days OR Hydrogen peroxide 1%
School exclusion until all lesions crusted over/ healed or 48 hours after starting Abx
Montelukast main side effect
nightmares
Episodic viral childhood wheeze Mx (only occurs during URTI, not in between)
1st - Salbutamol
2nd - LTRA or ICS or both
Multiple factor viral childhood wheeze Mx (occurs with URTIs, exercise, smoke, allergens)
LTRA or ICS for 4-8 weeks
Precocious puberty dates
Female - 8 years
Male - 9 years
Patau syndrome (trisomy 13)
Microcephaly
small eyes
Noonans syndrome Fx
Webbed neck
pectus excavatum
short stature
pulmonary stenosis
Prader Willi syndrome
Hypotonia
Hypogonadism
Obesity
Concerning developmental milestones for referral
- smile
- sit unsupported
- walk
- hand preference
- does not smile by 10 weeks
- can not sit unsupported by 12 months
- can not walk by 18 months
- hand preference before 12 months
Hearing testing in children
Newborn - Otoacoustic emission test - part of the Newborn Hearing Screening programme
Newborn + Infants - Auditory Brainstem Response test - performed if initial screening abnormal
6-9 months - Distraction test - by health visitor
18 month - 2.5 yrs - recognition of familiar objects - eg “where is teddy”
> 2.5yrs Speech discrimination - uses similar sounding objects
> 3 yrs Pure tone audiometry - performed at school
Head lice (pediculosis capitis) Mx
Malathion/ Wet combing/ Dimeticone/ isopropyl myristate and cyclomethicone
household contacts do not need to be treated unless affected
school exclusion not required
Constipation Mx
1st - Movicol (Macrogol/ polyethylene glycol 3350)
2nd - Senna (stimulant)
3rd - Lactulose (Osmotic)
GORD in infants breastfed Mx
1st - supportive - 30degrees head up, baby sleep on back, trial smaller more frequent feeds, switch the thickened formula
2nd - alginate (gaviscon) therapy - not used as same time as thickening agents
3rd - PPI ONLY if distressed feeding/ faltering growth/ difficulty feeding AND above have already been tried
Undescended testes Mx
Unilateral - refer at 3 months to urology
Bilateral - Urgent Paeds admission
X linked recessive
Turners (exception)
Haemophillia A
G6PD
Affected males can only have unaffected sons and carrier daughters.
Male child of a heterozygous female carrier = 50% chance of being AFFECTED
Female child of a heterozygous female carrier = 50% chance of being a CARRIER
Paeds BLS compression breath ratio
5 rescue breaths followed by 15 compressions to 2 breaths
In toeing Mx
<8yr old = reassurance
8+ and gait abnormality (eg tripping over) = orthopaedics
roseola infantum cause
human herpes virus 6
Methylphenidate (for ADHD) critical side effect
stunted growth - height and weight need to be measured every 6 months
Migraine in children Mx
PO Ibuprofen > paracetamol
Intranasal sumatriptan
Mitochondrial disease inheritance
inheritance is only via the maternal line
none of the children of an affected male will inherit the disease
all of the children of an affected female will inherit the disease
Rotavirus vaccine dates
oral, live attenuated vaccine
2, 3 months
if after 15 + 24 weeks then risk of intussusception
UTI <6 month olds
respond to Abx - USS within 6 weeks
atypical UTI - USS acutely, DMSA 4-6 months post infection, MCUG also
Vesicoureteric reflux Ix
Micturating Cystourethrogram - for diagnosis
DMSA - for renal defects eg scarring from reflux
Chickenpox Mx
Keep cool, trim nails, calamine lotion
School exclusion: until all lesions are dry and crusted over, usually 5 days after onset of rash
Chickenpox complications (4)
pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox
arthritis, nephritis and pancreatitis may very rarely be seen
Developmental milestones social behaviour
6 weeks - smiles (refer at 10 weeks)
3 months - Laughs
6 months - not shy
9 months - shy, takes everything to mouth
Knee problems in children
- Chondromalacia patellae
teenage girls
anterior knee pain on walking up and down stairs/ up from sitting - Osgood-Schlatter disease
sporty teenagers
Pain, tenderness and swelling over the tibial tubercle - Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking - Patellar subluxation
Medial knee pain due to lateral subluxation of the patella
Knee may give way - Patellar tendonitis
athletic boys
Chronic anterior knee pain that worsens after running
Tender below the patella
Threadworm Fx
AKA Enterobius vermicularis
Child, perianal itch
Rubella school exclusion
5 days post onset of rash
Fine motor developmental milestones
3 month
6 month
9 month
12 month
18 month
2 yr
3 yr
4 yr
3 month - reaches for object
6 month - palmar grasp, pass object one hand to another
9 month - points
12 month - Pincer grip
18 month - Tower block 3 , draw scribble
2 year - Tower block 6 , draw line
3 year - Tower block 9 , draw circle
4 year - draw cross
Gross motor developmental milestones
6 months
7-8 months
9 month
12 month
13-15 month
18 month
2 yr
3 yr
4 yr
6 month - Rolls front to back, pull to sit
7-8 - sit without support (refer at 12 month)
9 month - pull to stand, crawl
12 month - cruise
13-15m - walk unsupported (refer at 18 month)
18m - squat to pick up toy
2yr - run, walk stairs with rail
3yr - tricycle, walk stairs without rail
4yr - hops
Williams syndrome Fx
learning difficulties, extremely friendly, extroverted
Short stature
Supravalvular aortic stenosis
Whooping cough school exclusion cirteria
48 hours after Abx or
21 days from symptom onset
Noonam syndrome Fx
webbed neck
short stature
pulmonary stenosis
pectus excavatum
ptosis
autosomal dominant
From birth till about 2 years of age, genu varum (bow legs) is a normal variant. Referral should be considered if genu varum is asymmetrical or persists beyond 3 years of age and vitamin D deficiency is an important differential if the genu varum is severe. Genu Valgus (knock knees) is a normal variant between 3- 6 years of age and again vitamin D deficiency should be considered if the valgus is severe or persists. Flat feet is a normal variant until age 3. Most flat feet resolve by age 8 years as the foot arch starts to develop from around 3 years of age. Arches should appear when asking the infant to stand on their tip toes, and the foot should also be flexible and painless. Painful rigid flat feet should always be referred and may suggest tarsal coalition.
From birth till about 2 years of age, genu varum (bow legs) is a normal variant. Referral should be considered if genu varum is asymmetrical or persists beyond 3 years of age and vitamin D deficiency is an important differential if the genu varum is severe. Genu Valgus (knock knees) is a normal variant between 3- 6 years of age and again vitamin D deficiency should be considered if the valgus is severe or persists. Flat feet is a normal variant until age 3. Most flat feet resolve by age 8 years as the foot arch starts to develop from around 3 years of age. Arches should appear when asking the infant to stand on their tip toes, and the foot should also be flexible and painless. Painful rigid flat feet should always be referred and may suggest tarsal coalition.
Food allergy diagnostic test
oral food challenge
UTI <6 months old Mx
Treat as normal with Abx
Requires renal USS
(if >6months then no need for USS)
Acute otitis media Mx
1st - Amox (Clari if pen allergy)
2nd - Co Amox (if no improvement after 3 days)
Tourette’s Mx
Haloperidol
Bile stained vomit in <1yo
Red flag - urgent refer - ?obstruction/ volvulus
ADHD Mx
1st - Methylphenidate
2nd - Lisdexamfetamine
3rd - atomoxetine
