paeds Flashcards
jaundice
first 24 hours pathological
1 day- 2 weeks normal
over 2 weeks conjugated- bilirubin test
unconjugated could be breast milk jaundice
treat unconjugated treat w phototherapy not UV
biliary atresia
bilious vomiting
pale stool and dark urine
check for sepsis
coombs test
US
liver biopsy definitive
treat w kasai surgery
kernicterus
bilirubin in brain
seizures
encephalopathy
poor feeding
lethargy
ckd
eGFR >90
polyuria
hyponatremia
hypokalaemia
congenital anomolies
glomerulonephitis
turners
downs
prune belly
gold standard sphygonometre
pertussis
whooping
vomit
catarhall phase- coryza and then 3-6 weeks coughing fits
bordetella pertussis
macrolides- clarithomycin, azithromycin, doxy
celft lip
pataus associated
congenital abnormalities
retracted jaw
alocholic mom, obese, lack of folic acid
surgery and lip taping
undescended testis
leave for a year
infertility risk
orchidopexy surgery to pull it down
3 types- true, retractile, ascending ectopic testes not on track
US
sepsis treated
under 18 yrs- ceftriaxone
under 28 days- IV benzpen and gen
listeria - amoxiccilin
meningitis and sepsis causes orgn under 1 month
Group B strep
E coli
Listeria
GEL
meningitis and sepsis causes after 1 month
SHN
strep pneumonai
haem inf type B
neisseria
meningitis treatment
IM BEN PEN
ceftiaxonr in hospital
meningitis presentation
bridinskis sign - reflexive flexion of the knees and hips following passive neck flexion
fever
rash non blanching
bacterial - increased protein decreased glucose
viral- increased protein low glucose high lymphocytes
patau
trisomy 13
cleft lip
-combined test 10-14 weeks
-high beta HCG
-low pepperoni PAPP-A
-high nucle translucency
less big gap than downs
small head, extra fingers and toes polydactyly, small chin
learning support and meds for whatever
parvovirus B 19
slapped cheek
death to babies
children fine
perthes
increased joint space
avascular necrosis
Observation and Conservative Management if <7 years: Hip movement and Analgesia
Restrict painful activities
Consider osteotomy in older children >7 years or <7 years with severe disease
stiff hip and decreased movement
crescent shaped femoral head
can predispose u to ostoarthritis
Herring Grade (Lateral Pillar Classification)
Head-at-risk signs (Stulberg)
The nearer the femoral head is to round, the better the prognosis (Stulberg)
waldenstrom stages
duodenal atresia
down syndrome
polyhydramnios causes
bilious vomiting
duodenalstotomy
double bubble sign
down syndrome
AVSD and VSD mostly
one palmar crease
trisomy 21
lower IQ smaller ears
duodenal atresia
hypotonia, hyperflexibility
hypothyroidism
early alzheimers
combined test at 10-14
if not then quadruple test at 16-20 weeks
diagnostic is amniocentesis (11-13 weeks)
patent ductus arterois
aorta and pulmonary
machine like crescendo decrescendo
echo
observation- closes within year 1
fluid restriction
indomethacin and ibuprofen
surgical ligation
neuroblastoma
under 5 years
cancer on adrenal cell
catecholamines on urine
small round blue cells on biopsy
urgently refer within 48 hours and surgery
bronchiolitis
under 1 years
no fever mild fever
supportive
Nasopharyngeal aspirate with PCR
RSV
Cough with crackles +/- wheeze
normally resolves within 2 weeks
henoch schlonlein
abdo pain
arthritis
palpable purpura
renal failure
biopsy shows IgA deposits
bloods
urinalysis
AVSD
systolic murmur
down syndrome
found 2-3 weeks
Signs of cardiac failure (poor feeding, faltering growth, breathlessness, vomiting, pulmonary oedema crackles)
ecg
ECHO gold standard
Manage cardiac failure with diuretics (e.g. Furosemide)
Surgical repair
orofacial granulomatosis
swollen lips
if diarrohea then check foecal calprotectin to check for crohns
tumour lysis electrolyte imbalance s
hyperkalaemia
hyperuricaemia
hyperphosphataemia
hypocalcaemia
Uand E
ECG
give fluids and allopurinol
never give potassium
scalded skin
conjuctivis
nikolsky- skin peels away
supportive
iv ceftriaxone
TGA
birth a smurf
rigth to left
prostaglandins to keep PDA open
until 2-3 day then do surgery
ech0
tracheitis
croup tht gets worse
Airway control and stabilization with valve mask or intubation if required
Pain and Fever
Pus laden trachea
Croup (Stridor, Hoarse voice, Barking cough)
May be productive or unproductive cough
Staph/Strep Infection
Mild-Moderate: Oral Antibiotics (e.g. Co-amoxiclav/Augmentin)
Severe: IV antibiotics (e.g. Ceftriaxone, Clindamycin)
asthma
under 5- ICS then SABA then LTRA then add ICS.
over 5- ICS then SABA then add ICS then add LABA
PEFR- 50-75 mod- non rebreath O2, ipatropium bromide,
severe 33- 50
life threat- <33
near fatal PaCO2 increasing
angelman
widely spaced teeth
water lovers
happy
loss of function of UBE3A
15q11-13 deletion
scarlet fevr
strawberry tongue
sandpaper rash
alert
inflamed tonsilitis
phenoxymethylpencillin V
inguinal hernia
under 1 referral urgent
over 1 elective surgery
superolateral to pubic tubercle
can form hydrocele
uti
DMSA isotope scan for underlying dysplasia
vesicoureteric reflux and recurrent uti MCUG scan
lower UTI oral antibs dor 3 days
upper- Iv for 7-10 days or systemically unwell but oral if well
status epilepticus
IV benzos
if cant get access then
buccal medazolam
after that then try phenytoin
diarrhoea
secretory diarrhoea - toxin production. large. >6
osmotic- movement of water eg cows milk protein. allergy. fasting stops this but doesnt for secretory pH <5.5
ASD
upper left sternal edge
ejection systolic
left to right shunt
can lead to eisenmengers
Amplatzer/occlusion device insertion and transvenous cardiac catheter closure
Patch closure with open heart surgery
cerberal palsy
GMFCS
prematurity is most common
TORCH causes
head problems
toxoplasmosis infection for preg
baby gets-
intracranial caclification
hydrocephalis
chorioretinitis
wilms tumour
kidney
blue cell tumour
abdominal mass pain haematuria uti anaemia hypertension
US
ct or MRI
biopsy not recommended
urgent referral within 48 hours
nephrectomy often resolves hypertension
molluscum contagiosum
pearly papules with dimple in middle
self limiting
potassium hydroxide if concerned
tracheomalacia
recurrent croup
so u can give antibiotics if bad
CXR for tracheomalacia and laryngomalacia
cows milk protein allergy
first step trial of hydrolysed feed- neutramigen or aptamil pepT 1
biscuit things
when to induce labour
pH 7.21–7.24 OR lactate 4.2–4.8 mmol/L = BORDERLINE.
Repeat FBS within 30 min or consider delivery
pH ≤7.2 OR lactate ≥4.9 = ABNORMAL.
Immediate delivery indicated
prader willi
insatiable
chromosome 15
no leptin
hep b in pregnancy
tenofovir in 3rd trimester
babies dox within 24 hrs deluvery
hiv in preg
<50 vag birth
50- 399 - consider c section
> 400 same
ectopic
methotrexate
dont get preg for another 3 months
give anti D
induction of labour
membrane sweep. over 41 weeks
if bishops <8 offer vaginal prostaglandins
cook balloon
amniotomy head must be engaged. >7 is favourable
jia
pauci
type 1 positive ana. uveitis
2 HLAB27 ankylosing spondylitis
3 psoriatic arthritis
poli
1 RF pos- systemic
2 RF neg-
Systemic Onset Juvenile Idiopathic Arthritis (JIA) start early and disappear after 2-5 years. stills - salmon rash, fluctuating temperature
ANTEPARTUM HAEMORRHAGE
after 24 weeks
Spotting: streaks of blood on underwear
Minor haemorrhage: less than 50ml blood loss
Major haemorrhage: 50 – 1000ml blood loss
Massive haemorrhage: more than 1000 ml blood loss or signs of shock
what for preterm
tocolysis
IM betamethasone- for lungs
IM magnesium sulphate - for the heart
amenorrhea
primary
secondary - absence of menses for ≥ 3 months in a previously menstruating woman
hand foot and mouth
Coxsackie B
self limiting and emollients
gestational diabetes
induce labour at 38 weeks
folic acid 5g not 400mg
gest hypertension
mild 140-149
mod 150-159
severe over 160
labetalol
nifepidine if astham
HELLP is complication
PPH
Primary Postpartum Haemorrhage (PPH) is blood loss of >500ml within 24 hours of delivery
Severe Primary Postpartum Haemorrhage (PPH) is blood loss of >2000ml within 24 hours of delivery
Secondary Postpartum Haemorrhage (PPH) is blood loss >500ml from 24hrs postpartum to 6 weeks
PCOS
Oligoamenorrhoea or amenorrhoea
Hyperandrogenism (Clinical – Hirsutism and Acne or Biochemical – raised testosterone >2.5nmol/L)
Polycystic ovaries (≥12 follicles)
screen for diabetes
lifestyle
Combined hormonal contraception (to regulate menstruation)
Spironolactone (may reduce acne and hirsutism)
Eflornithine cream (given for hirsutism)
mirena coil
clomifene if want to be preg
treatment placenta praevia
If bleeding
- Corticosteroids before 34 weeks if bleeding
- Planned C-section between 34-36 weeks if bleeding
- Emergency C-section may be required withpremature labourorantenatal bleeding
sufe treatment
Treatment of Stable Slipped Upper Femoral Epiphysis (SUFE)
Stable slips (i.e. able to bear weight)
External in-situ pinning
Treatment of Unstable Slipped Upper Femoral Epiphysis (SUFE)
Severe unstable slips (i.e. unable to bear weight)
Open reduction and internal pinning (high AVN risk)
endometrial cancer
transvag
pipelle biopsy gold stand
oesophageal atresia
cant pass NG tube]
choking
cant eat
frothing
cgastric bubble
surgical repair
