Paeds Flashcards
APGAR score
score: 2,1,0
Appearance - colour: pick, blue extremities, blue all over
Pulse: >100, <100, nil
Grimace (reflex irritability): cries/sneezes/coughs, grimace, nill
Activity - muscle tone: active, flexed, floppy
Resp effort: strong/cries, weak/irregular, nil
1, and 5 minutes of age. If low repeat at 10 mins
0-3 is very low score,
4-6 is moderate low
7-10 means the baby is in a good state
Asthma mx in children <5
- SABA
- SABA & Moderate dose ICS 8wks. Resolution & recurrence in 4 weeks-> low dose ICS. Resolution & recurrence after
4 weeks-> anther 8ks of mod dose ICS. No resolution-> alternate dx - SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)
- stop LTRA & refer
Asthma mx in children 5-17
- SABA
- SABA & low dose ICS
- SABA & low dose ICS & LTRA
- SABA + paediatric low-dose ICS + LABA
- SABA + MART (low-dose ICS)
- SABA + MART (mod-dose ICS) OR #4 w mod dose ICS
- SABA + MART (high-dose ICS) OR #4 w mod dose ICS OR ++ theophylline OR referral
autosomal dominant conditions
Autosomal recessive - usually ‘metabolic’ (except G6PD - x linked recessive)
autosomal dominant conditions being ‘structural’ (except ataxia telangiectasia and Friedreich’s ataxia- AR)
Achondroplasia
Acute intermittent porphyria
Adult polycystic disease
Antithrombin III deficiency
Ehlers-Danlos syndrome
Familial adenomatous polyposis
Hereditary haemorrhagic telangiectasia
Hereditary spherocytosis
Hereditary non-polyposis colorectal carcinoma
Huntington’s disease
Hyperlipidaemia type II
Hypokalaemic periodic paralysis
Malignant hyperthermia
Marfan’s syndromes
Myotonic dystrophy
Neurofibromatosis
Noonan syndrome
Osteogenesis imperfecta
Peutz-Jeghers syndrome
Retinoblastoma
Romano-Ward syndrome
tuberous sclerosis
Von Hippel-Lindau syndrome
Von Willebrand’s disease
autosomal recessive conditions
Cystic fibrosis
Albinism
Ataxic telangiectasia
Friedreich’s ataxia
Congenital adrenal hyperplasia
Cystinuria
Fanconi anaemia
Gilbert’s syndrome
Haemochromatosis
Wilson’s disease
Sickle cell anaemia
Chickenpox features & mx
infectivity = 4 days before rash, until 5 days after the rash first appeared
incubation period = 10-21 days
school exclusion: 5 days after the onset of the rash).
keep cool, trim nails
calamine lotion
to prevent secondary bacterial infection
- avoid NSAIs
Patau syndrome (trisomy 13)
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Edward’s syndrome (trisomy 18)
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
Fragile X
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
Noonan syndrome
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Pierre-Robin syndrome
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
Prader-Willi syndrome
Hypotonia
Hypogonadism
Obesity
William’s syndrome
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
Cri du chat syndrome (chromosome 5p deletion syndrome)
Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism
congenital Rubella
Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus)
Glaucoma
congenital Cytomegalovirus
Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly
congenital Toxoplasmosis
Cerebral calcification
Chorioretinitis
Hydrocephalus
Constipation in children mx
-1. polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)
2. add a stimulant laxative
do not use dietary interventions alone as first-line treatment although ensure the child is having adequate fluid and fibre intake
Infants not yet weaned (usually < 6 months)
- bottle-fed infants: give extra water in between feeds. Try gentle abdominal massage and bicycling the infant’s legs
- breast-fed infants: constipation is unusual and organic causes should be considered
Cow’s milk protein intolerance/allergy (CMPI/CMPA) mx
If formula fed
- extensive hydrolysed formula (eHF) milk
- amino acid-based formula (AAF)
if breathed
- continue breastfeeding
- eliminate cow’s milk protein from maternal diet & calcium supplements for mum
Initial management of suspected cyanotic congenital heart disease
supportive care until defensive surgical correction
- prostaglandin E1 e.g. alprostadil
developmental delay Referral points
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk unsupportedat 18 months
Fine motor skill problems
- hand preference before 12 months
Gastro-oesophageal reflux in children mx
advise regarding position during feeds - 30 degree head-up
trial of smaller and more frequent feeds
thickened formula OR alginate therapy e.g. Gaviscon.
proton pump inhibitor (PPI) as last resort
Gastroschisis & exomphalos mx
Gastroscisis
vaginal delivery may be attempted
newborns should go to theatre asap
Exomphalos (omphalocoele)
caesarean section is indicated to reduce the risk of sac rupture
staged repair
Immune (or idiopathic) thrombocytopenic purpura mx in children
bone marrow examinations is only required if there are atypical features
mx
usually, no treatment is required
advice to avoid activities that may result in trauma (e.g. team sports)
if the platelet count is very low (e.g. < 10 * 109/L) or there is significant bleeding. Options include:
oral/IV corticosteroid
IV immunoglobulins
platelet transfusions can be used in an emergency (e.g. active bleeding)
Infantile spasms, or West syndrome, mx
EEG shows hypsarrhythmia in two-thirds of infants
CT demonstrates diffuse or localised brain disease
Management
poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used
Measles mx
if a child not immunized against measles comes into contact with measles then MMR should be given w/in 72hrs
(vaccine-induced measles antibody develops more rapidly than that following natural infection)
Meningitis in children mx
- Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone) - dexamethsone if older than 3mo & lumbar puncture reveals:
- frankly purulent CSF
- CSF white blood cell count greater than 1000/microlitre
- raised CSF white blood cell count with protein concentration greater than 1 g/litre
- bacteria on Gram stain
Neonatal sepsis mx
Intravenous benzylpenicillin with gentamicin
Paediatric basic life support
open airway
look, listen, feel for breathing
give 5 rescue breaths
check for signs of circulation
infants use brachial or femoral pulse, children use femoral pulse
15 chest compressions: 2 rescue breaths ( lay rescuers 30:2)
in children: compress the lower half of the sternum - one-third of the anterior–posterior dimension
in infants: use a two-thumb encircling technique for chest compression
Newborn resuscitation
- Dry baby and maintain temperature
- Assess tone, respiratory rate, heart rate
- If gasping or not breathing give 5 inflation breaths
- Reassess (chest movements)
- If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
Perthes disease mx
Management
To keep the femoral head within the acetabulum: cast, braces
If less than 6 years: observation
Older: surgical management with moderate results
Operate on severe deformities
Pneumonia in children mx
S .pneumoniae is the most likely causative agent of a bacterial pneumonia in children
Amoxicillin is first-line for all children with pneumonia
Macrolides may be added if there is no response to first line therapy
Macrolides should be used if mycoplasma or chlamydia is suspected
In pneumonia associated with influenza, co-amoxiclav is recommended
Precocious puberty
def
‘development of secondary sexual characteristics before 8 years in females and 9 years in males’
Kawasaki vs scarlet
Scarlet
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
‘strawberry’ tongue
rash
fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
it is often described as having a rough ‘sandpaper’ texture
desquamination occurs later in the course of the illness, particularly around the fingers and toes
Kawasaki
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel
Scarlet fever mx
oral penicillin V 10 days
pen allergy- azithromycin
children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease
school exclusion for infection
Scarlet fever- 24hrs after abx
Whooping cough- 2 days after abx
Measles- 4 days after rash onset
Rubella- 5 days after rash onset
Chikenpox- allcrusted over lesions
Mumps - 5 days after swollen gland onset
D&V- settled for 48hrs
Impetigo- crusted lesions or 2 days after abx start
Scabies - until treated
Influenza- until recovered
Kocher criteria for the diagnosis of septic arthritis:
fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC
Shaken baby syndrome
triad
retinal haemorrhages, subdural haematoma, and encephalopathy.
Slipped capital femoral epiphysis px, ix&mx
loss of internal rotation of the leg in flexion & hip-knee pain
obese children and boys
10-15 years
ix- AP and lateral (typically frog-leg) views are diagnostic
mx - internal fixation: typically a single cannulated screw placed in the centre of the epiphysis
UTI in children ,x
infants less than 3 months old should be referred immediately to a paediatrician
hildren aged more than 3 months old with an upper UTI should be considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days
children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours
antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs
Vesicoureteric reflux ix
micturating cystourethrogram
a DMSA scan may also be performed to look for renal scarring
whopping cough mx
infants under 6 months with suspect pertussis should be admitted
notifiable disease
an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated
within 21 days
household contacts should be offered antibiotic prophylaxis
school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
Prophylaxis - Women who are between 16-32 weeks pregnant will be offered the vaccine & infants
X-linked recessive conditions
Duchenne muscular dystrophy
G6PD deficiency
Haemophilia A,B
