Paeds Flashcards
How to treat neonatal hypoglycaemia if aymptomatic?
Encourage early feeding and monitor blood glucose
How to treat neonatal hypoglycaemia if symptomatic or severe hypoglycaemia (<2)?
Initiate IV infusion of 10% dextrose + admit to the neonatal unit
What are features of Necrotising enterocolitis?
Premature infant
Bloody stools
Abdominal distension
Not feeding well
Reduced bowel sounds
Vomiting
X-ray -> asymmetrical bowel loops and bowel wall oedema and Pneumatosis intestinalis (gas building up in the intestine and escaping under diaphragm)
One of the biggest killers of preterm infants
What are features of Persistent pulmonary hypertension of the newborn?
- failure to transition from fetal circulation to postnatal circulation
- severe hypoxia and cyanosis that does not improve with supplemental oxygen administration
What are features of pulmonary hypoplasia?
- underdevelopment of the lungs
- severe respiratory distress and poor oxygenation
What are features of Surfactant deficient lung disease?
severe respiratory distress
tachypnoea
nasal flaring
audible expiratory grunting
common in preterm infants born before 37 weeks gestation
What are features of transient tachypnoea of the newborn?
rapid breathing
grunting,
mild intercostal recession
Normal to midly reduced oxygen stats
Due to delayed clearance of fetal lung fluid after birth
risk factors include elective Caesarean section without labour and maternal diabetes
usually resolves within 24-48 hours with supportive care
What are red flags in children?
- Moderate or severe chest wall recession.
- Does not awake if roused.
- Reduce skin turgor.
- Mottled or blue appearance.
- Grunting
What are signs of biliary atresia in neonates?
Prolonged neonatal jaundice
hepatomegaly
splenomegaly
abnormal growth
cardiac murmurs if associated cardiac abnormalities are present
Conjugated bilirubin + Bile acids + aminotransferases are all abnomally high
What are signs of dyskinetic cerebral palsy?
athetoid movements (feeding difficulties, making lots of slow, writhing movements of his hands and feet) and oro-motor problems (drooling)
What are signs of intestinal malrotation?
Infant with bilious vomiting & obstruction
his legs up and crying
poor feeding
What are signs of neonatal spesis?
should be considered in infants with vague signs such as poor feeding, grunting, lethargy
What are signs of Perthes Disease?
- both hip pain or knee pain
- hip pain: develops progressively over a few weeks
limp - Can last months
- If < 6Y then wait and watch is >6Y then surgery
What are the symptoms of Kawasaki disease?
High fever lasting >5 days, red palms with desquamation and strawberry tongue
What is considered high risk of serious illness and that the baby should be assessed immediatly?
child aged < 3 months with a fever > 38ºC
What is first line treatment for threadworms?
Mebendazole
What is the cut off for neonatal hypoglycaemia?
< 2.6 mmol/L
What is the most common cause of congential stridor in neonatal children?
Laryngomalacia
What is the most common cause of stridor in 3-6 month year olds?
Bronchiolitis
What is treatment of wooping cough?
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
What radiological sign is seen in rickets?
Joint widening
When would you do a bone marrow biopsy for immune thrombocytopenia (ITP)?
For splenomegaly
What is mesenteric adenitis?
Mesenteric adenitis describes inflamed mesenteric lymph nodes. It is often preceeded by a viral infection. It is self limiting
What is a diagnostic test for Hischsprung’s disease?
Rectal biopsy
What are symptoms of Hischsprung’s disease?
- delayed passage of meconium
- bdominal distension
- bilious vomiting
At what age can patients accept treatment if tey have capacity?
- 16
- under 16 at times as well
At what age can patients refuse treatment if tey have capacity?
18
What are the symptoms of slipped capital femoral epiphysis (SCFE)?
- acute-onset right-sided groin pain
- inability to weight bear following potential trauma
- Obese patient between the ages 10-15
What would be seen on examination of a slipped capital femoral epiphysis (SCFE)?
Reduced internal rotation of the leg in flexion
What is the first line investigation for Developmental dysplasia of the hip (DDH)?
X-ray
What heart condition is associated with Turner’s syndrome?
bicuspid aortic valve (more common than coarctation of the aorta)
What is hand, foot and mouth disease called?
Coxsackie A16
What are symptoms of hand, foot and mouth disease?
mild systemic upset, oral ulcers followed by vesicles on the palms and soles
How much do you give in fluid resus for children/ young people?
bolus of 10 ml/kg over less than 10 minutes
What are signs of Tetralogy of Fallot:?
- Cyanosis or collapse in first month of life
- hypercyanotic spells.
- Ejection systolic murmur at left sternal edge
What is Tetralogy of Fallot:?
- ventricular septal defect (VSD)
- pulmonary stenosis
- right ventricular hypertrophy
- overriding aorta
What are signs of CF in new borns?
meconium ileus - bowel obstruction that occurs in newborns as a result of increased mucus production
- X-ray will show - dilated bowel loops
- Have delayd passing of meconium
What parts of the brain are effected in dyskinetic cerebral palsy?
Basal ganglia and the substantia nigra
What is a sign of admission in croup?
Stridor
What is a inoccent murmur?
Physiological or functional murmurs, are heart sounds produced when the blood flows rapidly through the heart and vessels.
Can’t be a diastolic murmur
What are signs of an innocent murmur?
- Short buzzing murmur in the aortic area
- Soft-blowing murmur in the pulmonary area
- Varies with posture
- Continuous blowing noise heard just below the clavicles
What is enterobius vermicularis?
Threadworms
What is a complication of chicken pox that causes severe pain, erythema, blistering, and disproportionate tenderness over the skin?
Necrotising fasciitis
What scan has to be done in Kawasaki disease?
- Echocardiogram
- Coronary artery aneurysms is a complication of Kawasaki
What is a complication of measles?
Pneumonia
What are signs of Perthes disease?
- avascular necrosis of the femoral head
- progressive hip pain, limp and stiffness
- 4- 8Y
- Mainly unilateral
- hip pain: develops progressively over a few weeks
What are signs of slipped upper femoral epiphysis?
- 10- 15 Y
- overweight or tall thin adolescents
- gait disturbance
- loss of internal rotation of the leg in flexion
- mainly unilateral
- hip, groin, medial thigh or knee pain
- X-ray -> frog leg
what is the triad for autism?
- communication impairment
- impairment of social relationships
- ritualistic behaviour
What are signs of early shock (compensated)?
- Normal BP
- Tachycardia
- Tachypnoea
- Plae or mottles extremities
- Reduced urine output
What are signs of late shock (decompensated)?
- Hypotension
- bradycardia
- acidotic (Kussmaul breathing)
- Blue extremities
- Absent urine output
When do you treat bronchiolitis with admission and oxygen therapy?
Apnoea (observed or reported)
Persistent oxygen saturation of <92% in air
Inadequate oral fluid intake (<50% of normal fluid intake)
Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
What are the electrolytes of non-bilious vomiting with pyloric stenosis?
Hypochloremic hypokalemic metabolic alkalosis
When does a child say mama and dada
9-10 months
What is the normal resp and heart rate of infants?
- resp rate between 30-60
- heart rate is 100-160
What is Alprostadil ?
prostaglandin E1
What are symptoms of hirschprung’s disease?
neonatal period e.g. failure or delay to pass meconium
older children: constipation, abdominal distension
Where is a brachial cyst located?
Usually located anterior to the sternocleidomastoid near the angle of the mandible
When is the oral rotavirus vaccine given?
2 + 3 months
When is the Men B vaccine given?
2,4 and 12-13 months
When should an APGAR score be done?
1,5 min of age
What bacteria is causes scarlet fever?
Group A haemolytic streptococci
What genetic condition commonly leads to inherited neurodevelopmental delay?
Fragile X syndrome
When a baby is suspected to have mild-moderate cows milk protein intolerance, what should be done?
Extensive hydrolysed formula should be used
What is a bisferiens pulse?
2 strong systolic peaks separated by a mid systolic dip
What conditions have a bisferiens pulse?
Aortic regurgitation and hypertrophic cardiomyopathy
What are features of PDA?
- continuous machinery murmur
- heaving apex beat
- wide pulse pressure
- left subclavicular thrill
How to confirm pertussis?
Pre nasal swab
How to treat croup?
Sing,e dose of oral dexamethasone
What organism causes bronchiolitis?
RSV - respiratory syncytial virus
What is given to all children with asthma exacerbations?
Oral prednisolone for 3-5 days
What dietary advice is given for CF?
High calorie and high fat with pancreatic enzyme supplementation for every meal
Is their exclusion from school for roseola?
No
Is their exclusion from school for whooping cough?
2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics
What is treatement of threadworms?
Prescribe a single dose of mebendazole for the household and give hygiene advice
What is treatment of perthe’s disease?
If less than 6 years: observation
Older: surgical management with moderate results
What is treatment of whooping cough?
Oral azithromycin (or clarithromycin) which are macrolids
What are signs of congential diaphragmatic hernia?
- respiratory distress at birth
- absent heart sounds
- tinkling sounds (bowel sounds) in resp exam on auscultation
When is neonatal jaundice pathalogical?
< 24h or > 14 days
What are the signs of biliary atresia?
Jaundice
Hepatomegaly with splenomegaly
Abnormal growth
Cardiac murmurs if associated cardiac abnormalities present
What is first line treatment of biliary atresia?
Surgery
