Paeds Flashcards
laryngomalacia presents at
4 weeks
fever, rash starting on head/trunk before spreading, mac/pap –> vesicular
Chicken pox
Which children get varicella IGs
immune comp
peripartum exposure
Prodrome (irritable, conjunctivitis, fever)
Koplik spots in mouth
Rash starting behind ears (discrete mac pap rash that becomes confluent on whole body)
measles
what if child exposed to measles but not vaxxed
give vax within 72h (MMR)
mumps management
supportive
macpap rash on face spreads to whole body, fades 3-5 days
lymphadenopathy
rubella
erythema infectiosum (slapped cheek) pathogen
parvovirus B19
slapped cheek can cause what in adults
acute arthritis
Group A strep disease
scarlet fever
scarlet fever rx
oral pen v 10 days (azithro if allergy)
hand food and mouth pathogen
coxsackie A16 virus
what rash has a strawberry tongue and sandpaper rash
scarlet fever
Projectile non bilious vomiting at 4-6 weeks
pyloric stenosis
Blood gas result in pyloric stenosis
hyperchloraemic metabolic acidosis
how to diagnose pyloric stenosis
test feed
USS
Colicky pain, diarrhoea and vomiting, sausage shaped mass, red jelly stool 6-9 months
intussusception
intussusception rx
air insufflation
Scaphoid abdomen with bilious vomiting
malrotation (with volvulus)
Delayed meconium and abdo distension
Hirschsprung’s disease OR CF
Hirschsprung’s diagnosis?
Full thickness rectal biopsy
Hirschsprung’s Rx
rectal washouts
then anorectal pullthrough procedure
Choking and cyanotic spells following aspiration
May be associated with VACTERL
oesophageal atresia
biliary atresia rx
Kasai procedure
biliary atresia is an increase in which bili
conjugated
Premature baby with abdo distention and bloody stools
Free air on XR
necrotising enterocolitis
Necrotising enterocolitis rx
complete gut rest (TPN)
Laparotomy if perf.
Commonest cause of acute abdo in children
appendicitis
intususseption age range
6-9months
pyloric stenosis age range
4-6 weeks
appendicitis age range
> 5y
abdo pain following URTI/LRTI/gastroenteritis
mesenteric adenitis
Basis of asthma diagnosis
response to bronchodilator rx
Child over 5 asthma inhaler regime
SABA
+ICS
+LABA/LTRA
SABA + MART
Child under 5 inhaler regime
SABA
+ICS
+LTRA
(refer)
What is APGAR used for
the infant’s condition after birth
Many cafe au lait spots and axillary freckling indicates
neurofibromatosis
port wine stain localised to trigeminal area could be
Sturge-Weber syndrome (underlying meningeal haemangioma and IC calcification - associated with fits)
How to differentiate between reflex anoxic seizures and epilepsy
no post ictal drowsiness
RAS is post minor injury
Are reflex anoxic seizures dangerous?
No
Murmur that is systolic, musical, does not radiate, varies with position
Innocent
7 Ss of a reassuring murmur
Sensitive (moves with positional changes)
Short duration
Single (no click, gallop or extra HS)
Small (doesn’t radiate)
Sweet (not harsh)
Systolic (diastolic are typically bad)
Machinery murmur L subclavicular suggests
PDA
Harsh pan systolic murmur at lower left sternal edge with parasternal thrill
VSD
PResentation soon after birth with cyanosis/murmur
ToF
ToF XR finding
boot shaped heart
Treatment for PDA
prostaglandin inhin (ibuprofen)
shock and poor perfusion in first days of life with weak femoral pulses
Coarctation of the aorta (as the duct closes)
Severe cyanosis and acidosis after birth
Transposition of great arteries
Transposition of great arteries rx
Keep duct open with prostaglandin E2 and atrial septostomy to allow blood to mix until surgical switch
When is heel prick test done
5-9th day of life
When is jaundice pathological
first 24h and after 2 weeks
causes of jaundice in first 24h
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD
Partial seizures at night in children
Benign rolandic epilepsy
Referral points (3) for dev delay
No smiling at 10 weeks
Cannot sit unsupported at 12 months
Cannot walk at 18 months
CXR findings of transient tachypnoea of the newborn
hyperinflation, fluid in horizontal fissure
Teenage girl with anterior knee pain on stairs and getting out of a chair
Chondromalacia patellae
Sporty teen with pain, tenderness and swelling over tibial tubercle
osgood schlatter
Knee pain after exercise with intermittent swelling and locking in absence of trauma
osteochondritis dissecans
Medial knee pain and giving way
patellar subluxation
Chronic anterior knee pain in an athletic teenage boy that worsens after running, o/e tender below patella
patellar tendonitis
Soft, fluctuant swelling on head soon after birth that doesn’t cross suture lines of skull
Cephalohaematoma
Cephalohaematoma mx
generally just observe
Don’t aspirate
Soft, fluctuant swelling on head soon after birth that crosses suture lines of skull
Subgaleal haemorrhage
OR
Caput succedaneum if pitting
Rx for chlamydial opthalmia neonatorum
oral erythro or topical tetracycline
Rx for gonococcal opthalmia neonatorum
IV cephalosporin
How to differentiate between chlamydial, gonococcal and viral neonatal conjunctivitis
gonococcal more severe (lid swelling, copious discharge)
Viral may have subconj haemorrage and lymphadenopathy.
Definitive diagnosis for coeliac
jejunal biopsy - shows subtotal villous atrophy, intraepithelial lymphocytes and crypt hyperplasia
Toddler’s diarrhoea can only be diagnosed if
the child is thriving
‘Ribbon stools’ indicates?
Hirschprungs
Treatment for mild impetigo
fuscidic acid cream
Treatment for more severe/bullous impetigo
PO fluclox/erythro
Most common cause of ambiguous genitalia
Congenital adrenal hyperplasia
90% congenital adrenal hyperplasia have what deficiency
21-hydroxylase
What would the general chemical/hormonal cause of small testes be
An adrenal cause
Cafe au lait spots, precocious puberty suggests
McCune Albright syndrome
Age of precocious puberty
<8 girls, <9 boys
Age of delayed puberty
13+ in girls
14+ in boys
Delayed puberty with no sense of smell
Kallman’s
Delayed puberty and tall
What are the chromosones
Klinefelter 47XXY
Short, webbed neck, shield chest, primary amenorrhoea, short fourth metacarpals, high arched palate
Turner’s Syndrome 45X
Most common metabolic disease
phenylketonuria
Thumb print sign on lateral neck XR
Epiglottitis
Main pathogen viral gastroenteritis
rotavirus
Management of GORD
Feed little and often
Thickener
Gaviscon
PPI/ranitidine
Wide set eyes, hooded eyelids, tubular nose, broad nose tip. small mouth
Di George syndrome
Cocktail party speech, blue eyes, sunken nasal bridge, small teeth (elfin)
William’s syndrome
Ptosis, wide set eyes, webbed neck, sternal deformity, deeply grooved philtrum
Noonans
Long philtrum, monobrow, thin lips, low ears
Cornelia De Lange syndrome
White forelock, bright blue eyes, deafness
Waardenberg
large testicles,
Learning difficulty
Dev delay
High forehead,
hyperextendible joints
Fragile X
Central hypotonia that improves with age
Excessive appetite and weight gain
Sleep apnoea
Global dev delay
Prader-Willi
Prader Willi chromosome
15
Micrognathia, microcephaly, rocker bottom feet, overlapping fingers
Trisomy-18 (Edwards)
polydactyly
Scalp lesions
Midline facial defect
Neural tube defects
Microcephaly,
Rocker bottom feet
Trisomy 13- Pataus
Kawasaki disease rx
Igs and aspirin
Complication of kawasaki
coronary artery aneurysm
Inguinal hernia in children rx
elective surgery unless strangulated
Unconjugated hyperbilirubinaemia causes
haemolysis
sickle cell
spherocytosis
Premature (immature liver enzymes)
Infection
Bruising
Hypothyroid
Breast milk jaundice
Conjugated hyperbilirubinaemia causes
Hepatitis
CF
Cirrhosis
Biliary atresia
Complication of unconj bili being high
kernicterus (acute encephalopathy) can cause athetoid cerebral palsy and deafness
Hip pain following illness, refusal to wt bear but ok at rest. otherwise well, toddler
Transient synovitis
Painful swelling and restricted movement of large and small joints
Systemically ok, some mild anaemia
Morning stiffness
RF -ve, ANA +
Poly articular juvenile idiopathic arthritis
3yo girl with elbow (or knee or ankle) swelling and pain. Otherwise well. RF -ve, ANA +.
Pauci articular JIA
Complication of pauci articular JIA
chronic iridocyclitis
What is the other type of JIA
Still’s disease (systemic)
JIA management
NSAIDs
Corticosteroids/immunesuppresants in severe
PT/OT
What types of white cells are seen in CSF in bacterial vs viral meningitis
polymorphs in bac
lymphocytes in viral
What does fibrin web indicate in CSF
TB
What is waterhouse friderichsen syndrome
Complication of meningococcal meningitis
coagulopathy –> haemorrhagic necrosis of the adrenals.
-DIC
-Acute adrenal failure
-Resp failure
genetics of duchennes
x linked recessive
What blood result would you find in duchennes
raised CK
Difference between duchennes and beckers
Beckers is rarer
Milder, later age and better prognosis
Also X linked recessive
What is anencephaly
type of spina bifida - cranial part of neural tube doesn’t develop, infant dies soon after birth
What is myelomeningocele
type of spina bifida -
open lesion
SC covered by meninges
Severe weakness of lower limbs
bladder and anal denervation
Hydrocephalus
What is meningocele
type of spina bifida -
SC intact but sac of meninges exposed- risk rupture and meningitis
What is spina bifida occulta
type of spina bifida - vertebral bodies fail to fuse properly. Will have a sign on their lower back eg tuft of hair, pit, naevus.
What investigation is indicated in spina bifida occulta
spinal USS
What do cold agglutins in serum indicate
Mycoplasma pneumoniae (will get haemolytic anaemia)
CXR sign in respiratory distress syndrome of preterm infants
Ground glass appearance, air bronchograms
Mx resp distress syndrom
surfactant replacement via ETT
Way to avoid resp distress syndrom
maternal steroids 48h prior to delivery
‘honey comb lung’ and hyper expanded on cxr in pre term infant
bronchopulmonary dysplasia
HSP needs what follow up
renal
commonest cause of thrombocytopenia in children
ITP
ITP antibody
IgG
ITP normally follows what
viral infection
ITP mx
treatment not normally required, 6-8 week disease course
Ensure to differentiate from leukaemia/aplastic anaemia
If bleeding- pred PO but needs BM examination before this as could mask diagnosis of leukaemia.
IV anti D
IV IG
Avoid contact sports while plts low
Most common cause of AKI in children
HUS
HUS mx
generally supportive
Commonest type of childhood leukaemia
ALL
pancytopenia in child could be
Aplastic anaemia
Aplastic anaemia mx
immune suppressant
Stem cell transplant
what age does squint need referral
> 5-6months
commonest type of thalassaemia
beta
does thalassaemia trait need treatment
no
beta thalassaemia features
Frontal bossing
Dental abnormalities
Severe haemolytic anaemia
Hepatosplenomegaly (increased production to compensate for no HbA being produced)
Beta thalassaemia mx
regular blood transfusions
80% nephrotic syndrome is due to
minimal change glomerulopephritis
Bilateral undescended testes could indicate
hypopituitarism
cryptorchidism mx
orchidopexy before 2 yrs
Double bubble sign on AXR
duodenal atresia
OR
volvulus
Both will have distended stomach and duodenumd
Eczema herpeticum mx
aciclovir systemic and urgent derm rv
umbilical hernia mx
usually self resolve by 3yrs
order of puberty in girls
boobs, pubes, grow, flow
Turners is associated with what heart issue
bicuspid valve
How long off school for mumps
5 days from the onset of swollen glands
Congenital rubella syndrome symptoms
sensorineural deafness, eye abnormalities and congenital heart disease
labial adhesions and recurrent utis
oestrogen cream
What category of babies require USS for DDH (regardless of ortolani etc)
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
Bow legs in a child < 3 is..?
a normal variant and usually resolves by the age of 4 years
Concave abdo at birth and dyspnoeic and tachypnoeic
congenital diaphragmatic hernia
Risk factors for SIDS
prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity
William’s syndrome murmur
aortic stenosis