Paeds Flashcards
Rashes in kids
Rubella- starts behind the ear, spreads to face and neck then down to torso and then to the extremities. Non-confluent rash and maculopapular, resolves in 3-5 days.
Roseola- known as sixth disease due to HHV-6. High fever lasting 3-5 days followed by erythematous maculopapular rash that starts as temperature subsides. Rash is initially on trunk and spreads centrifugally to face and limbs. Associated with febrile seizures and is self-limiting- supportive care only.
Measles (rubeola)- rash starts on forehead and neck and spreads down to trunk and finally involves the limbs, over 3-4 days. Rash fades in order of appearance. Leaves behind a brownish discolouration sometimes accompanied by desquamation. Also presents with fever, coryzal sx. cough and conjunctivitis- Koplik’s spots are pathognomic of measles- erythematous, white spots on buccal mucosa.
Slapped cheek disease- caused by parvovirus B19, also known as erythema infectiosum. Prodromal sx of fever, headache, arthralgia, coryzal sx. lasting 2-3 days. Then 7-10 day period of no symptoms.
Then bright, red, slapped cheek rash appears on face with nasolabial folds usually spared- erythematous maculopapular rash on proximal extremities and trunk. Frequent recurrence of sx.
Hand, foot and mouth disease- caused by coxsackie A16. Features inc fever, sore throat, dysphagia and vesicles in oral cavity along with tender erythematous maculopapular eruptions across butt, arms and legs (mainly arms). Usually on dorsal aspect rather than palmar.
Scarlet fever- Group A strep (strep pyogenes). Fever, malaise, headache, sore throat, N&V, strawberry tongue, coarse/SANDPAPER textured rash. Oral pen V for ten days.
Chickenpox- caused by varicella zoster virus. Fever, itchy rash starting on head and neck and spreading towards trunk and extremities, systemic upset usually very mild. Rash initially macular then papular then vesicular. Supportive management- trim nails and calamine lotion. Complications include- pneumonia, encephalitis, disseminated haemorrhagic chickenpox.
What is Cows Milk protein allergy?
Allergy to cows milk protein can give IgE mediated (wheeze and rash) and non IgE mediated (eczema) sx.
Gold standard investigation is removal of cows milk from diet and then reintroduction- monitoring for symptoms.
Treatment is the same- removal of cows milk protein from diet whilst maintaining suitable alternatives within the diet.
What is Wilm’s nephroblastoma?
Commonest intra-abdominal tumour in childhood.
Most common feature is palpable intra-abdominal mass- other sx include HTN, fever due to tumour necrosis, haematuria and anaemia.
Cystic fibrosis- features, investigations and treatments
Features:
Respiratory- reduced mucociliary clearance leads to increased infection
Pancreatic insufficiency- reduced ion transport means enzymes can not get across
Biliary insufficiency- concentrated bile causes buildup and blockages
GI- low volume secretions cause increased viscosity.
Investigations-
Sweat testing confirms diagnosis (98% sensitive)
Molecular genetic testing for CFTR gene
Management-
Resp- mucus thinners, abx, airway clearance
GI- supplemental pancreatic enzymes,
What is whooping cough?
Caused by Bordetella pertussis, incidence has gone down due to vaccination.
Causes characteristic whoop noise during bouts of paroxysmal cough- cough can last for over 3 months.
Coughing bouts are usually worse at night.
First choice treatment is macrolide antibiotic such as clarithromycin.
Features of intussusception
Most common cause of intestinal obstruction in children
Red-currant jelly stool
Legs flexed and in the air
Cramping abdominal pain
Bile stained vomiting
Sausage shaped mass on palpation.
Ultrasound can reveal target sign.
Treatment is with barium enema.
What is croup?
Croup is a viral respiratory tract infection usually caused by the parainfluenza virus.
Features-
Fever, hoarseness, barking cough and stridor
CXR shows steeple sign- subglottic narrowing.
Tx- steroids and nebulised adrenaline
What is epiglottitis?
Caused by haemophilus influenzae B
Features- sore throat, odynophagia, muffled voice, drooling, fever and tripod sign (child leans forward to reduce upper airway obstruction).
Treatment- cephalosporins and steroids.
What is diphtheria?
Nasal discharge which is watery and becomes bloody and pus stained.
Pseudomembranous pharyngitis which gives fever, cervical lymphadenopathy and bull neck appearance.
Give antitoxin, IV benpen and oral penicillin V subsequently.
What is necrotising enterocolitis?
Life threatening illness mainly affecting preterm babies- occurs in 2nd to 3rd week of life
Features-
poor feeding, bile stained vomiting, blood stained stools, abdominal distension, tender abdomen to palpation.
Abdo XR to confirm diagnosis
Management- NBM, NG tube, IVF, IV abx, TPN.
What is bronchiolitis?
Bronchiolitis is caused by RSV.
Features-
Tachypnoea, wheeze, intercostal recessions, coryzal sx.
Diagnosed clinically. Usually just supportive care.
What is Port Wine Stain?
Vascular birthmark consisting of superficial and deep dilated capillaries.
Lesion can be improved by pulse dye laser.
What is Kawasaki’s disease? What is a complication that needs to be screened for in Kawasaki’s Disease?
Kawasaki’s disease is a vasculitis seen usually in children.
Features- CRASHBURN
Conjunctivitis (bilateral)
Rash
Strawberry tongue
Hands and soles red
Fever>5 days
Treat with high dose aspirin and IVIG
Coronary artery aneurysms with echo.
Features of common childhood syndromes
Patau Syndrome- trisomy 13
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Edwards Syndrome- trisomy 18
Micrognathia
Low set ears
Overlapping fingers
Rocker bottom feet
Noonan syndrome-
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Fragile X-
Learning Difficulties
Macrocephaly
Long face
Large Ears
Macro-orchidism
Prader-Willi Syndrome-
Hypotonia
Hypogonadism
Obesity
What are DDH risk factors and management?
Female (6x greater risk)
Breech presentation
Positive FHx
Oligohydramnios
Birth weight > 5kg
Firstborn
Ultrasound to confirm if clinically suspected
Pavlik harness in kids younger than 5 months, surgery in older kids.
