Paeds Flashcards
What age is the average child able to sit without support?
6-8 months
what age would a child acquire the ability to walk unsupported?
13-15 months
What are the characteristics of William’s syndrome?
- elfin facies
- friendly/social
- learning difficulties
- short stature
- transient neonatal hypercalcaemia
- supravalvular aortic stenosis
What is Perthes’ disease?
Avascular necrosis of the femoral head
What are the common presenting features of perthes’ disease?
- hip pain - progressive over a few weeks
- limp
- stiffness and reduce ROM
- More likely in boys
- Kids ages 4-8yrs
What X-Ray changes are seen in Perthes’ disease?
widening of joint spaces, decreased femoral head size
What is the management of Perthes’ disease?
- Cast and braces
- most resolve with conservative management <6yrs old
- if >6 can operate
What is the Kocher’s criteria?
Used to assess the probability of septic arthritis in children
- fever > 38.5
- non-weight bearing
- raised ESR
- raised WCC
What is the treatment of threadworm?
oral mebendazole (given to all family members)
What is the treatment of whooping cough?
oral macrolide - clarithro/erythro/azithromycin
school exclusion for 48hrs after Abx
How much adrenaline do you give to a 6-12 year old in anaphylaxis?
300 micrograms (0.3ml of 1 in 1000)
What is the management of bed wetting in children under 5?
Reassure
What is the first line management of children over 7 with persistent bed wetting?
enuresis alarm
What side effect of methylphenidate should be monitored?
Stunted growth
What is the management of croup?
single dose of oral dexamethasone
high flow oxygen and nebulised adrenaline
What ages do you use different chest compression techniques?
under 1 year - two thumbs circling
1 year to puberty - one hand on lower half of sternum
over puberty - two hands on upper part of sternum
What are the features of intussusception?
intermittent, severe, crampy, progressive abdo pain, usually seen between 6-18months. Infant draws up knees and turns pale, may have vomiting. Cries during episode not inbetween. Late sign - red-currant jelly stool
What investigation is used to diagnose intussusception and what do you see?
Ultrasound
Target-like mass
How do you calculate maintenance fluids for children?
100ml/24hrs for first 10kg
50ml/24hrs for next 10kg
20ml/24hrs for every kilo after
What is the most common complication of measles?
Otitis media - pneumonia is most common cause of death
What is the management of meningitis in children?
< 3 months IV cefotaxime + amoxicillin
> 3 months IV cefotaxime
What is a common non-bacterial cause of otitis externa?
Candida albicans
How can you differentiate Hirschsprung disease from cystic fibrosis?
Both cause meconium ileus. Hirschsprung’s will show lack of innervation on a rectal biopsy
What are the features of necrotising enterocolitis on X-Ray?
dilated asymmetrical bowel loops with intramural gas
How do you diagnose pyloric stenosis?
ultrasound
What are the features of pyloric stenosis?
Projectile vomiting (30 mins after feeding), constipation and dehydration, mass in upper abdomen. occurs in first few weeks of life
Which vaccines are oral, live attenuated?
Rotavirus, polio and typhoid
Which vaccines are inactivated toxin vaccines?
tetanus, diphtheria, pertussis
When is the rotavirus vaccine given?
2 and 3 months of age
What investigations should you do for cows milk protein allergy?
skin-prick testing, IgE and RAST for cows protein
What are the barlow and ortolani tests?
Barlow - break - dislocate hip
Ortolani - relocate hip
What investigation is done for developmental dysplasia of the hip?
ultrasound if a baby
>4.5 months - X Ray
What pathogen causes bronchiolitis?
RSV
What are the features of bronchiolitis?
Coryzal symptoms, dry cough, breathlessness, wheezing, fine inspiratory crackles, feeding difficulties, low fever
What is the management of bronchiolitis?
largely supportive, can give humidified oxygen, if sats less than 92%
Which vaccines are in the 6in1?
diphtheria, tetanus, whooping cough, polio, Haemophilus influenza B, hep B (dont take weird poo’s big boy)
When are the 6in1 vaccines given?
2,3,4 months
Which vaccines are given at 12-13 months?
HiB/Men C
MMR
pneumococcal
Men B
Which vaccines are given in the pre-school booster?
4in1 (diptheria, tetanus, whooping cough, polio) MMR
What are the Red flag signs in paeds?
chest wall recession, does not wake if roused, reduced skin turgor, mottled/blue, grunting. RR>60
Turner’s syndrome is associated with which murmur?
Ejection systolic (due to bicuspid aortic valve)
When do kids typically start crawling?
9 months
What are the features of infantile colic?
Seen in a child < 3months. crying episodes, bringing legs up, often worse in the evenings. No management - just reassure
Which pathogen causes threadworm?
Enterobius Vermicularis
What is the first line treatment of threadworm?
Mebendazole
What are the features of roseola infantum?
HHV6. High fever for a few days, followed by maculopapular rose rash. Nayagama spots (on uvula and soft palate). May have cough/diarrhoea
What is the management of hand foot and mouth disease?
Caused by virus (coxsackie A16), supportive treatment
What type of murmur is present in tetralogy of fallot?
Ejection systolic
What are the key features of edwards and pataus?
Pataus = 13 = 13 fingers
Edwards = Eighteen = 18 when at rocker bottom
What are the features of necrotising enterocolitis?
Difficulty feeding, abdominal distension, blood in stools, vomiting in premature infants
What are the X-Ray signs of necrotising enterocolitis?
Dilated bowel loops, intra-mural gas, gas everywhere really
How can you remember the features of Pierre-Robin syndrome?
Robin me of my airways
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
Which medication is used to keep the ductus arteriosus patent?
Alprostadil (prostaglandin)
Which medication is used to close the ductus arteriosus?
Indomethacin (prostaglandin inhibitor), NSAIDS
What is the management of ITP?
conservative, avoid contact sports.
Can give steroids/IgG if count less than 10
(in adults, you give steroids)
How does ITP typically present?
Bleeding/bruising/petechial rash following infection. No systemic symptoms
What is the management of Croup?
Single dose of oral dexamethasone regardless of severity
Why shouldn’t you give ibuprofen to kids with chickenpox?
Increases the risk of secondary bacterial infections and necrotising fasciitis
What is Ebstein’s anomaly?
A heart defect caused by lithium use in pregnancy, tricuspid regurg and stenosis due to dodgy leaflets
How do you differentiate perthes disease and SUFE?
perthes - slow onset of hip pain and limp (4-8 yr olds, more common in boys)
SUFE - usually following minor trauma in an obese child (10-13 yr olds)
What is the treatment of head lice?
malathion, wet combing, dimeticone
What are the features of Meckel’s diverticulum?
2% of population, 2 ft from ileocaecal valve, 2 inches long.
abdo pain mimicking appendicitis, rectal bleeding (can be massive in 1-2 yr olds), intestinal obstruction
How do you diagnose Meckel’s diverticulum?
if stable: 99m technetium pertechnetate
if not: mesenteric arteriography
What are the features of innocent murmurs in children?
Soft, systolic, short, symptomless, sitting/standing variation, sounds normal: S1, S2.
Which organism is a threadworm?
enterobius vermicularis
How do you work out corrected age for milestones?
age + weeks born from 40 weeks
What are the features of rubella?
Three C’s - cough, coryza, conjunctivitis
What is the management of kawasaki disease?
Iv IgG and High dose aspirin
What is the first line management of threadworm?
Mebendazole
What are the features of biliary atresia?
Presents in first few weeks of life with obstructive jaundice > 2 weeks and hepatomegaly. Treat with surgery.
What causes roseola infantum?
HHV6. Fever followed by rash, in infants. Nayagama spots on uvula and soft palate
At what age must you urgently refer children with a limp?
Under 3 years old
and any children with a limp and a fever
What causes slapped cheek?
Parvovirus B19
What are the features of measles?
CCK - cough, conjunctivitis and Koplik spots
