Paeds Flashcards
Pertussis aka & phases
Whooping cough
- Catarrhal phase- six urticaria for 1-2 wks
- Paroxysmal- increase cough severity last 2-8 wks
- Convalescent phase- cough subsides over wks to months
Management whooping cough and isolation
Pertussis
<6 months old- admit
Notifiablendisease
Po macrolide- clari/ azithro/ erythromycin if cough w/in 21 days
School 48hrs after commencing and/ 21d from onset of six if no abx
facial features of Down’s sy
trisomy 21
upslanting aplpebral fissure, epicanthic folds, Brushfield spots in iris, protruding tongue, small low set ears, round/flat face, flat occiput
which syndrome has single palmar crease
Down’s sy
Most common Cardiac complication of Down’s sy
Endocardial cusion defect- AV septal canaldefects
cardiac complications in Down’s sy
Desc ordern (most common-> least)
AV septal defect- most common
VSD
secundum ASD
(less toF, isoldated PDA)
GI complications in Down’s sy
Duodenal atresia
Hirschprung
Which disease produces Barking cough?
Name organism
Croup
PARAINFLUENZA VIRUS
Mx of Parainfluenza virus (Croup)
oral dexamethasone 0.15mg/kg ALL children regardless severity
Emergency mx of croup
O2
nebulised adrenaline
po dexamethasone 0.15mg/kg
Sx Pyloric Stenosis
presents 2nd - 4wks
projectile vomiting esp 30min after feed
palpabl abdo mass in upper abdomen
hypochloraemia, hypokalaemic alkalosis due to persistent vomiting
Necrotising Enterocolitis Sx +AXR
feeding intolerence abdominal distension, bloody stool
dilated bowel loops, bowe wll oedema
Pneumatosis intestinalis **
Common Premature infants
Hearing test newborn
Otoacoustic
Hearing test newborn& infants
Auditory brainstem response if otoacoustic emission test is normal
6-9 months hearing test
Distraction test
18months to 2.5 years mile stone
Recognition of familiar objects
> 2yrs hearing test
Performance testing , speech discrimination test
> 3yrs hearing test
Pure tone audiometry
Hypospadiasis mx
Corrective mx when around 12 months , x circumcisiom
Patau syndrome
Trisomy 13
Microcephalic small eyes
Cleft lip/pakate
Polydactyl
Scalp lesion
Holiprosencephaly- failure of brain to divide into lobes
Edward’s syndrome
Trisomy of chromosome 18
Micrognathus
Low set ears
Rocker bottom
Overlapping fingers
Noonan syndrome , name heart defect
Webbed neck, pectins excavating, short stature
Pulmonary stenosis
Prader willi syndrome
Hypotonia, obesity, hypogonadism
Williams syndrome
Elfin face: upturned noses long upper lip length, puffiness around eyes, learning difficulties transient hypercalcaemia, supravalvular aortic stenosis
Cri du chat syndrome
Chromosome 5p del
Characteristic cry due to larynx and neurological problems
Feeding difficulties leaning difficulties, hypertelorism
Fragile X syndrome
Trinulceotide repeat disorder CGG >200 repeats
Leaning difficulties, large low set eyes, long thin face, hypotonia, autism , mitral valve prolapse
Down’s syndrome
Trisomy chromosome 21
Fave: u0slanting palpebral fissures epicanthic folds, brush field spots: small grey.brown spots seen in peripheral iris, single palmar crease, hypotonia, congenital heart defects, duodenal atresia, hirschprung, hypothyroidism, Alzheimer’s disease
Cardiac problem in Down’s syndrome
Endocardial cushion defect: AV septa, canal defects
Then csf, secundum ASD, ToF, isolated PDA
Another name for group A haemolytic streptococcus
Streptococcus pyogenes
Which pathogen causes strawberry tongue
Strep pyogenes/ haemolytic group A streptococcus
5th disease aka
Erythema infectiosum, aka Parvo b19 virus
Meningitis B vaccine and meningitis ACWY vaccine
Meningitis C replaced by Meningitis AVWY for 13-18yrs
Meningitis b: 2, 4 months
13-18yrs: meningitis ACWY
Mmr vaccine scheduled doses
12-15months
3-4 years
Exclusion for mumps, whooping cough, diarrhoea and vomiting, measles, chicken pox
Mumps: 5days from onset of swollen gland
Whooping cough: 2 days after starting abx or 21 days from onset of sx if no abx
Diarrhoea and vomiting: sx have settled for 48 hours
Measles: 4 days from onset of rash
Chickenpox: all lesions crusted over
Developmental milestone: turn towards sound
3 months
When say mama and dada, understands no
9months
Responds to own name
12 months
2-6 words
12-15 months
Combine 2 words
2 years
Vocab 200 words
2.5- 3 years
Asks what and who questions
Talks in short sentences counts to 10
3 years
Why, when and how questions
4 years
Sits without support
7-8 months
Pulls to standing, crawls
9 months
Walks with one hand held
12 months
Squats to pick up toys
18 months
Runs, walks upstairs and downstairs holding on to rail
16 months - 2years
Tricycle
3 years
Hops on 1 leg
4 years
Skipped capital femoral epiphysis. Sx + mx
Rare hip condition esp obese boys
Hip groin, medial thigh/ knee pain
XR typically frog-leg
Mx: single cannulated screw placed in centre of epiphysis
Perthes disease mx and XR findings
Degen condition affecting hip joint
A vascular necrosis of femoral head
XR: widening of joint space, decreased femoral head size/ flattening
Mx: braces, cast older 6years: surgical mx
Kocher criteria
Septic arthritis:
>38.5 degree
High est
High wbc
Non-weight bearing joint
Point system
1 3%, 2- 40%, 3- 93%, 4- 99%
Developmental dysplasia of the hip dx
Routine Us: +fmhx, breech position, multiple preg.
Barlow & ortolani test:
- Barlow: dislocate adductor and downward pressure
- ortolans: relocate flex hip and turn 90 degree
Imagining: US <4.5 months otherwise CR
Developmental dysplasia of hip mx
Usually stabilise but can use Pavlov harness in children<4.5 months
Mx constipation in children 1st line
polyethylene glycol + electrolytes movicol paeds plain
Cyanotic congenital heart disease and which one is most common
Tetralogy of fallot MOST COMMON
Tricuspid atresia
Transposition of great arteries
Stenosis of pulmonary valve
Duct dependent heart disease
ToF
Ebsteins anomaly
Pulmonary atresia
Pulmonary stenosis
Acyanotic congenital heart disease , name and which one is the most common
VSD MOST COMMON
ASD
PDA
CoA
When do you have the anomaly scan to check heart
18-20 weeks
Tetralogy of Fallot, what is it and sx
VSD, RVH, RV outflow obstruction-> pulmonary stenosis, overriding aorta
Test spell: episodic hypercyanotic episodes due to near occlusion of RV outflow tract
Mx of transposition of great arteries
Needs ductus arteriosus to remain open with prostaglandins
XR findings of ToF and TgA
CXR ToF: boot shaped heart
CXR TGA: egg on side CxR
PDA sx esp heart murmur and mx
Acyanotic congenital heart disease
Continuous machinery murmur
Wide pulse pressure, left subclavian thrill
Mx: close PDA by inhibiting PG synthesis by giving ibuprofen or indomethacin
Bartters syndrome inheritance and what it is and electrolyte abnormalities
AR
Severe hypokalaemia due to defective chloride absorption at Na/K/2Cl co transporter in ascending loop of Henle
Hypokalaemia, normotension
Difference between paeds and adult asthma mx
Take out LtRa if not helped
- SABA
- LOW DOSE ICS + SABA
- LOW DOSE ICS, SABA, LTRA
- LOW DOSE ICS, SABA, LABA AND STOP LTRA
- SABA, MART
- SABA, MART MED DOSE ICS
- HIGH DOSE ICS, SABA, LABA
Acute exacerbation of asthma in children mx
Broncho dilator
Steroid
<2yrs 10mg OD
2-5 years 20mg OD
>5 years 30-40mg OD
To Upton 3days
Tapering not needed unless exceeds 14days
Turner’s syndrome, heart findings
One X chromosome or deletion of short arm of one of X chromosome
45 XO
Short stature, webbed neck, bicuspid aortic valve, CoA- ejection cre+dec systolic murmur.
Primary amennorhoea, short 4th metacarpal, lymphoedema in neonates especially feet
ITP which hypersensitivity and mx
Type II hypersensitivity
Mx:
1. Usually no tax needed, 80% resolves
2. If very low pot count- will need po;if corticosteroid or ivIg
3. Emergency platelet transfusion
Measles pathogen , sx, complications
Paramyxovirus
Infective from prodrome until 4 days after rash starts
Sx: flulike sx, Koplik spots, rash behind ears the. Whole body- maculopapular rash
Otitis media- most common
Pneumonia- most common cause of death, encephalitis 1-2 weeks onset of illness, subacute sclerosis encephalitis, keratoconjunctivitis
Roseola infantum aka, pathogen, sx
6th disease
HHV 6
High fever followed by maculopapular rash trunk + ling
Nagayama spots: popular exanthem on uvula and soft palate
Febrile convulsion
Scarlet fever aka, sx, infection route, mx, isolation
Group A haemolytic streptococci- strep pyogenes.
Resp route
Fever: typically 24-48hours, rash fine punctuate erythema first on torso and spare palms and soles, rough sandpaper texture. Strawberry tongue.
Mx: penicillin V 10 days if allergic azithromycin. Can return to school after 24 hours starting abx
Complications of scarlet fever
Rheumatic fever: 20 days
Acute glomerulonephritis- 10days after infection
Kawasaki dx and mx
Vasulitis predominantly seen in children
Dx: >5days of high fever resistant to antipyretics + CREAM 4/5
C: conjunctivitis
R: rash polymorphous non vesicular
E: oedema or erythema of hands and feet
A: adenopathy- enlarge cervical lymphadenopathy
M: mucosal involvement- erythema or fissure or crusting, strawberry tongue
Mx: high dose aspirin, ivIg , echo look for coronary artery aneurysm
Pathogen causes acute epiglottis
Haemophilia influenza type B
Sx of acute epiglottis and investigations esp XR
Rapid onset, strider, increased temperature, drooling of saliva, tripod position
Direct visualisation by senior/ airway trained staff
XR: concerned about foreign body- lateral view: thumb signs welling of epiglottis, subglottic narrowing steeple sign
Croup which pathogen, sx, XR findings, mx
Parainfluenza virus
Sx: strider, barking cough worse at night, fever.
CXR: subglottic narrowing - steeple sign
Mx: single dose po dexamethasonr 0.15mg/kg all children regardless of severity, prednisolone alternative if dexamethasone not available
Ermegency: high flow O2, nebulised adrenaline- vasoconstriction in upper airway mucosa, decreases airway oedema & improves airflow
Bronchiolitis causes, mx, prevention
Bronchiolitis 75-80% RSV most common cause of serious LRTI in <1year, peak in winter
Mx: supportive, O2 , NFT if not taking fluid or feed, suction excessive upper respiratory secretion
Meningitis mx in children and prophylaxis
<3months: iv amoxicillin /ampicillin + iv cefotaxim
>3months: > iv cefotaxime / ceftriaxon
Steroids: dexamethasone considered if LP- frank purple not csf, CSF WBC with protein >1g/L, bacteria on gram stain
Abx prophylaxis: ciproflox > rifampicin
Meningococcal septicaemia in community mx
Benzylpenicillin
<1 yr 300mg
1-10years 600mg
> 1200mg
Inheritance of cystic fibrosis and Ix
AR
Defect in cystic fibrosis transmembrane conductance regulator gene (CFTR) cAMP regulated Chloride channel on chromosome 7
Ix: on day 6 using dried blood spot on Guthrie card
Sweat test
APGAR SCORE
Score at 1 and 5min, if low repeat at 10min
A; appearance, blue, cyanotic at extremities, pink.
Pulse: absent, <100, >100
Grimace: floppy, minimal response, prompt response
Activity: absent, flexed arms, active
Resp: absent, slow and irregular, vigorous cry
Caput succedaneum vs ceohalohaematoma
Caput succedaneum: oedema of scalp present at birth, typically crosses suture line, resolves within days
Cephalohaematoma: bleeding btw periosteum and skull, presents several hours after birth. Most commonly parietal region doesn’t cross suture lines, may take months to resolve
Shaken baby syndrome triad
Retinal haemorrhages, sudural haematology, encephalopathy
UTI in children common pathogen and Ix
Most common E. Coli
Ix:
If < 6nibths, uti responds to to- US in 6 weeks. > 6months and responds to tx, nil imaging unless atypical sx present
MSU, static radioisotope DMSA- identifies renal scarring after 4-6 months UTI. MCUG identifies vesicoureteric reflux only recommended for infant <6months who represents with atypical or recurrent UTI.
Gastroschisis vs omphalocele/ exomphalos
Gastroschisis congenital defect in anterior wall just lateral to umbilical hernia high risk of fluid and heat loss. Immediate surgery
Exomphalos/ omphalocele: abdominal contents protrudes through anterior abdominal wall but covered in amniotic sac formed by amniotic sac and peritoneum. C section reduces risk of rupture. Staged repair
Definition of precocious puberty.
Classification and its lab findings
Development of secondary sexual characteristics before
Boys 9 years and girls 8 years.
- Gonadotropin dependent: central/ true, high FsH/LH
- Gonadotropin independent: pseudo/false. Excessive sex hormones, low FSH/LH
Vesicoureteric reflux Ix
Antenatal period: hydronephrosis on Us
Micturating cystourethrogram: 15-20min injecting dye into bladder via catheter and taking XR whilst child passes urine
DMSA check renal scarring
Hearing test in children
OADRePSP
Otoacoustic emission test- new born
Auditory brain stem response test- newborn and infants
Distraction test- 6 to 9months
Recognition of familiar objects 18-2.5years
Performance testing > 2.5
Speech discrimination >2.5 years
Pure tone audiometry > 3years
Benign Rolandic epilepsy sx, IX Mx
Childhood epilepsy that occurs at night.
Typically partial but secondary generalisation may occur.
EEG: centrotemporal spikes can be seen
Mx: usually stops in adolescence
Mx of eczema and also severe eczema in children
Simple emollient if not effective, hydrocortisone 1% ointment applied BD
Severe: po cyclosporine
Pyloric stenosis: when does it present, lab findings, Ix and Mx
2nd- 4 weeks of life with projectile vomiting, palpable abdominal mass in upper abdomen.
Lab: hypochloremia, hypokalaemic alkalosis due to persistent vomiting.
Ix: US
Mx: pyloromyotomy
When do you do heel prick test and what do you screen for
5-9 days of life
Screen: congenital hypothyroidism, CF, sickle cell, ohenylketonuria, medium chain Scylla-CoA DH deficiency, maple syrup urine disease, isovakeric acidaemiam glutamic acid urea type 1, homocystinuria.
Retinoblastoma genetics, sx and mx
AD
Absent red reflex replaced by white pupil, strabismus
Mx: enucleation
Threadworms pathogen, sx, mx
Enterobius vermicularis aka pinworms
Sx: 90% ass, perinatal itching especially at night
Dx: sellotape test- lab microscopy to see eggs
Mx:mebendazole 1st line children >6mibths, single dose unless infection persists
Triad of nephrotic syndrome, most common cause
Proteinuria >1g/m2 per 24 hours
Hypoalbuminaemia <25g/L
Oedema
Minimal change disease
How to differentiate between cardiac and non cardiac causes of cyanosis in neonatal period
Nitrogen washout test,
100% O2 for 10min then do ABG. If pO2 is <15kPa likely cyanotic congenital heart disease present
