Paeds Flashcards
What to check at well child visit
vaccinations
growing ie head lenght wt
abuse/neglect
development milestones
Failure to thrive organic reasons
genetic ie CF
heart disease
pyloric stenosis
GORD
Developmental milestones gross motor
2mo
4mo
6mo
1yr
2yr
3yr
4yr
5yr
lift head
roll over
sit up
walk
steps
tricycle
hop
skip
Developmental milestones fine motor
3yr
4yr
5yr
circle
cross
triangle
Developmental milestones social
6 weeks
6mo
1yr
social smile
stranger anxiety
1 year separation anxiety
path of acute allergic reaction
IGE-mediated type 1 hypersen
trigger = cross linking of mast cells which degranulate = histamine release
anaphylaxis presentation n tx
urticaria (rash)
hypotension
wheeze
from trigger
remove cause
adrenaline IM 0.5ml 1:1000
fluids
chlorphenamine IV
steroids
Urticaria presentation n tx
wheal
whelt
erythema
No hypotension
check not anaphylaxis
Self limiting
non sedating anti hist ie loratidine,cetrizine
angioedema present n mx
swelling all over but esp airway
post acei
no rash no hypotension
secure airway
anti hist
steroids
if c1 esterase deficiency = give FFP
allergic rhinitis presentation n mx
shiners (runny eyes)
Salute sign (pushing nose up to wipe)
Pale boggy mucosa
nasal polyps
cobblestining bc post nasal drip
avoid trigger
intranasal steroids
Allergic conjuctiv present n mx
shiners runny eyes
conjunct injection
chemosis (swelling)
h2 antihisatmines
LTA
Food allergies cause n presentation n management
wheat soy milk eggs
Nuts shellfish (anaphylaxis)
N&V&D
and associated with atopic dermatitis
Clx dx but maybe foot trial to narrow down trigger
tx avoid trigger and carry epi pen if anaphylaxis
Tx for milk protein allergy
n cause
MC cause soy formula
tx cows milk
breatfeed
hydrolysed formula
What is BRUE
brief resolved unexplained event
<1yo + <1min duration of;
change in;
colour
tone
breathing
responsiveness
Low risk Brue criteria
Age
term baby> 60 days
pre term >32GA or >45Post conception
No hx to suggest any of causes
no physical findings
no cpr for episode
1st time episode
Things that might want to rule out w brue
gord
LRTI
seizure (eye move.jerk)
sepsis (fever)
heart disease (FTT &murmur)
abuse (mult injuries)
SIDS prevention
sleep on back (flattens occiput)
dont share bed
smoking cessation
vaccine CI egg allergy
yellow fever
Vaccines CI if immunocomp
Live attenuated ie
MMRV
influenza if live (intranasal) - (IM Flu is ok)
Mom hep B +ve (chronic or acute during preg)
baby mx?
Hep B vaccine course now
+ Hep B ig
DTaP vaccine schedule
5 doses
3x in 1st year, 1x 3-5, 1x 13-18
2mo,3mo,4mo
3-5yrs
13-18yrs
= full lifetime course
wound
pt had full tetanus course
last dose<10yrs
regardless of would severity
no vaccine
no tet immunoglob(Tig)
Pt full course of tetanus vaccines last dose >10 years
Tetanus prone wound (dirty) = Vaccine booster?
High risk would ie
compound frac, delayed surg intervention , large degree devitalised tissue = vaccine boost + Tig
unknown tetanus hx
vaccine booster
if high risk/tetanus prone would = also Tig
hiB vacciine for
epiglottisis
mmrv course and CI
12-15mo
3-4years
CI pregnanct women severe immunocomp ie transplant, AIDs, biologics
Tetanus presentation
how does Vaccine n Tig work
tx
dirty wound, lockjaw, spasms
lethal dose <immune response
TIG - block toxin
Vaccine (toxoid ie looks like tet)
Tx intubate, sedate , muscle relaxer, metronidazole
Diptheria presentation n mx
High fever, sob, dysphagia
grey pseudomembranious in oropharynx (do not touch)
secure airway, abx, antitoxin
Pertussis presentation 3 phases
Tx
vague catarrhal stage -infectious days of rinorhea, cough and low grade fever
Paraxysmal phase - coughiing spells interspersed with insp. whoop
Resolution phase
supportive ie secure airway if need
erythromcin Iv abx
Common cause of otitis externa
swimmers ear
pseudomonas
staph. aureus
seb dermatitis (fungal)
contact dermatitis (allergiccor irritatnt)
Otitus media causing bugs
presentation and Dx
Resp bugs - strep.pneum, h.influ, moraxella
painful ear - relief on tugging
Pneumatic insufflation ie air on eardrum = stiff
common cold causing pathogen
rhinovirus
choanal atresia
connection between mouth and nose
Unilat and bi(emergency)
Blue baby at rest (nose breather ie breastfeeding)
Pink when crying
catheter cant get through if complete atresia
erthyema infectiosum
virus
pt:
tx
complications
PARVOVIRUS 19
‘slapped cheek’
fever and rash
supportive
aplastic crisis in sickle cell thalasemia and sperocytosis
hydrops fetalis
time off school slapped cheek
infectious for 10 days before rash so once it comes no time off
roseola infantum virus
HHV 6
roseola infantum sx
tx and comps
High fever then rash AFter fever
Starts on trunk and spreads outwards
supportive tx
febrile seizures
measles prodrome
and spread
4 Cs
cough
corzya
conjunctivitus
Coplik spots (white small spots in mouth)
fever and rash
spreads from face (behind ears ) to whole body inc palms n soles
measles virus
paramyxovirus
later in life complication of measles
subacute sclerosing panencephalitis
rubella prodrome
and spread
generalised tender lymphadenopathy
fever and macular rash from face spread to trunk
itchy
measles infectious period
4 days before and after rash
rubela infecious spread
7 days before and after sx
varicella zoster sx
rash
difuse vesicles on erthyematous base
diff stages of healing
NO fever
starts on head back trunk then peripheries
varicella zoster (VZV) infectious period
2 days before and 5 days after sx start which is usually when lesions crust over
mumps
presentation
complication
pubertal males
parotiditis
orchiditis
infertility
hand foot and mouth disease
virus and presentation
coxsackie a16
vesicular rash on mouth (1st) then feet and hand
Kochers criteria
Septic arthritis in kids
sickle cell path
glutamate swapped for valine 6th space on chromosome 16
definitive ddx sickle cell
HB electrophoresis
sickle cell crisis mx
opiates
iv fluids
oxygen
abx if infection
blood transfusion
when to use exchange transfusion sickle cell
neuro
acute chest ie chest pain sob pul. oedema
sickle cell crisis prophylaxis
hydroxyurea
pneum vaccine every 5 yrs
check if pt in sickle crisis
change from their baseline
low hb
higher bili
higher retic count
pain
sickle cells on smear
what can happen with transfusion in sickle pt
iron overload = give deferoxamine
chronic consequences of sickle
too much haemolysis
= chronic anaemia -> kidney release epo -> bone marrow constantly stimulated to make more RBCs = inc retic count
= high levels of unconjugated bilirubin -> pigmented gallstones & jaundice (cholecyst)
organ autoinfarct ie spleen, avascular necrosis of hip, brain lungs etc
risk of osteomyelitis
MC cause osteomyelitis
staph aureus
pt osteomyelitis with salmonella organism
= pt has sickle cell
Aplastic crisis
sudden drop in hb post parvovirus
pancytopenia but mostly Hb
meconium ileus in cystic fibrosis presentation and findings
no bowel movement since birth
distended abdo
abdo XR - dilated bowel loops proximal to an impaction
rectal biopsy negative
cystic fibrosis fx
short stature
Diabetes
delayed puberty
rectal prolapse (bulky stools)
nasal polyps
male infert, female subfert
uni undescended testes at birth
bilateral
review at 3mths if persist - refer
review senior paeditrician in 24hrs
whooping cough tx
azithromycin/clarithromycin if cough within 21 days
Tetralogy of fallot (TOF) features
what determines degree of cyanosis and clinical severity
VSD
Right vent hypertrophy
right vent outflow obstruction - pulmonary stenosis
Overriding Aorta
severity of right ventricular outflow obstruction ie pul stenosis
Croup
cause
age group and
diagnosis/ xray
viral - parainfluenza
3mo-3yrs
dx = clx
Xray
PA= steeple sign
lateral = thumb sign
Steeple sign on xray
subglottic narrowing
Thumb sign on xray
swelling of epiglottis
Bacterial tracheitis
cause
presenttaion
mx
staph aureus MC post viral URTI bc mucosal damage and local immune changes
Stridor
high fever
purulent secretions
musosal necrsis and sloughing
Iv abx
Retropharyngeal abscess defining features
anterior chain unilateral lymph nodes
tender neck mass
peritonsillar abscess defining features
uvular deviation to unaffected side
foreign body airway obstruction (FBAO) extrathoracic
inspiratory stridor
foreign body airway obstruction intrathoracic
exp wheeze
FBAO xray findings
-ve coin sign AP
+coin sign lateral
= in trachea
bronchiolitis bug and presentation
RSV
<2 yo
coryzal sx precede
wheeze
SOB
cough
feeding difficulties
sx peak 3-4 days
cystic fibrosis pneumonia bug
and pancreas mx
pseudomonas
pancreatic enzyme supplements with meals
vitamins ADEK
NEC pt & sign
premature bby
xray = peumatosis intestinalis
intussusception age, ix, mx
3months- 3 years
USS = target sign
tx = air enema
surgery if peritonitis, perforation, or enema fail
meckels diverticulum presntation ddx and tx
vitelline duct remenant
painless GI bright red bleeding
ddx = technicium -99 scna
tx = resection
indicator of cerebral palsy
Not sitting by 8 months (corrected for gestational age)
Not walking by 18 months (corrected for gestational age)
Early asymmetry of hand function (hand preference) before 1 year (corrected for gestational age)
Persistent toe-walking
school exclusion rubella
5 days onset of rash
school exclusion scarlet fever
24hrs after startiing abx
school exclusion whooping cough
2 days after abx
or 21 days from sx starting if no abx
school exclusion measles
4 days from onset of rash
school exclusion chickepox
all lesions crutsed over
school exclusion mumps
5 days from onset of swollen glands
school exclusion gastroentritis
48hrs sx settles
school exclusion impetigo
until lesions crusted and healed
or started 48hrs since starting abx
recurrent febrile seizures management
Rectal diazepam
buccal midazolam
cystic fibrosis homoozygous for delta F508 mutation tx
lumacaftor/Ivacaftor (Orkambi)
threadworm organism
enterobius vermicularis
chronic management of CF
chest physio and postural drainage twice a day
high calorie diet including high fat intake
fever traffic light system red
colour - pale, mottled, ashen, blue
activity - appears ill to professional, no response social cues, doest wake when aroused, weak high pitches continuous cry
resp - grunting, RR>60, mod/sev chest indrawing
circ - reduced skin turgor
other = age <3 w temp>38
peads bls
5 rescue breaths
15 compressions (rate 100-120permin) : 2 breaths
depth of compressions = 1/3 of the chest
stills disease
systemic juvenile arthritis
subtle salmon pink rash
high swinging fevers
enlarged LN
weight loss
joint inflammation
splenomegaly
muscle pain
pleurtitis
pericarditis
raised inflam markers
stills disease complications
macrophage activation syndrome (MAS)
ie kid with DIC and low ESR
which JIA may have +ve ANA
oligoarticular JIA
RF -ve in JIA
chicken pox medication CI
NSAIDs increase risk of necrotising faciitis in pt w chicken pox
whooping cough tx
macrolide ie azithromycin
what age should stop having febrile seizures
usually lasts happens from 6mths to 5 years
klumpke paralyisis
damage to t1
due to traction
loss of intrinsic hand muscles (thmb adductions and finger abduction)
and sensory loss over medical epicondyle
bronchiolitis ix
nasopharyngeal asp
immunofloresence shows rsv
bronchiolitis refereal to hosp criteria
apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.
bronchiolitis mx in hosp
o2
nasal suction
ng feeing
bronchiolitis on chest xr
hyperinflation
croup sx
barking cough
hoarseness
stridor
croup causes
parainfluenza
rsv
measles
influenza a n b
croup differentials
acute epiglottitis,
bacterial tracheitis,
peritonsillar abscess
foreign body inhalation
croup who to admit
moderate or severe croup
< 3 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
uncertainty about diagnosis
(important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
