Paeds Flashcards
Scarlett fever sx
Sore throat, fever, headache, bright red tongue and a coarse, red rash
fine punctate erythema (‘pinhead’)
Organism causing Scarlett and age group
Group A haemolytic streptococci (usually Streptococcus pyogenes). It is more common in children aged 2 - 6 years with the peak incidence being at 4 years.
Mx of Scarlett
oral penicillin V for 10 days
patients who have a penicillin allergy should be given azithromycin
children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease
Kawasaki disease
fever typically lasts 5 days or longer.
It also presents with an erythematous polymorphous rash, strawberry tongue,
cervical lymphadenopathy, bilateral conjunctivitis, oedema, erythema, and skin peeling of the hands and feet.
Parvovirus B19 sx
erythematous facial rash appearing on one or both cheeks (resembling a ‘slapped cheek’)
An erythematous maculopapular rash on the trunk, back, and limbs may develop a few days after the facial rash.
Transient tachypnoea of the newborn sx and mx
Common after C sections
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
Management
observation, supportive care
supplementary oxygen may be required to maintain oxygen saturations
Transient tachypnoea of the newborn usually settles within 1-2 days
Vaccines in premature babies
Babies who were born prematurely should receive their routine vaccinations according to chronological age
Babies who were born prior to 28 weeks gestation should receive their first set of immunisations at hospital due to risk of apnoea.
Tetrology of Fallot
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
BLS peads
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 (see above)
Ix for intusseption
US
Conditions with genetic anticipation
Fragile X (CGG)
Huntington’s (CAG)
myotonic dystrophy (CTG)
Friedreich’s ataxia* (GAA)
Average child able to sit and walk and when should you refer
SIt 7-8 average
Refer 12m
Walk 13-15
Refer 18m
Movement lost most in SUFE
Internal rotation
Complications of measles
Immediate- pneumonia
5-10 yrs Subacute sclerosing panencephalitis
Whooping cough tx
Oral azithromycin (macrolide)
is indicated if the onset of the cough is within the previous 21
household contacts should be offered antibiotic prophylaxis
school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
Diagnostic criteria for whooping cough
Acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
Blue peripheries with cyanosis. The rest of the examination is normal. Oxygen saturations are 97% pre and post ductally. Good tone
Acrocyanosis
Mx of left subclavicular thrill, continuous ‘machinery’ murmur
indomethacin or ibuprofen
Measles features
prodromal phase
irritable
conjunctivitis
fever
Koplik spots
typically develop before the rash
white spots (‘grain of salt’) on the buccal mucosa
rash
starts behind ears then to the whole body
discrete maculopapular rash becoming blotchy & confluent
desquamation that typically spares the palms and soles may occur after a week
diarrhoea occurs in around 10% of patients
Most common cause of childhood hypothyroidism in UK
AI thyroiditis
Edward’s syndrome
RockEr Bottom Feet
Low set ears
Overlapping fingers
Fragile X
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
Noonan syndrome
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Features of Roseola infantum
high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
School exclusion is not needed.
Hand, foot and mouth disease
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
Scarlet fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth
Erythema infectiosum
slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
RF for bruising after birth
Breastfed babies are at risk of vitamin K deficiency
AR vs AD conditions
Autosomal recessive conditions are ‘metabolic’
exceptions: inherited ataxias
Autosomal dominant conditions are ‘structural’
exceptions: Gilbert’s, hyperlipidaemia type II
White discharge in newborn girl PV
Most newborn girls have some mucoid white vaginal discharge which usually disappears by 3 months of age
Caffeine in neonate
Caffiene can be used as a respiratory stimulant in newborn babies
Wean off ventilator
Giving MMR
3 months between doses to maximise the response rate.
A period of 1 month is considered adequate if the child is greater than 10 years of age.
In an urgent situation (e.g. an outbreak at the child’s school) then a shorter period of 1 month can be used in younger children.
Age for transient synovitis
3-8
Chondromalacia patellae vs Osgood-Schlatter disease vs Osteochondritis dissecans
CP
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
OSD
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
OD
Pain after exercise
Intermittent swelling and locking
Mx of croup
single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Emergency treatment
high-flow oxygen
nebulised adrenaline
When to admit croup
moderate or severe croup
< 3 months of age
known upper airway abnormalities
Gastroschisis vs exomphalos
Gastroschisis
anterior abdominal wall just lateral to the umbilical cord.
Can have vaginal delivery
newborns should go to theatre as soon as possible after delivery
Exomphalos
abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac
caesarean section is indicated to reduce the risk of sac rupture
a staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure
Mx of Hirschprungs
initially: rectal washouts/bowel irrigation
definitive management: surgery to affected segment of the colon
Pathophysiology of Hirschprungs
parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon → developmental failure of the parasympathetic Auerbach and Meissner plexuses → uncoordinated peristalsis → functional obstruction
RF of DDH
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
Perthes presentation
Presents with progressive hip pain, limp and stiffness
Mx of Perthes
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
Most common causer of stridor in neonates
Laryngomalacia
First signs of puberty in boys and girls
Males
first sign is testicular growth at around 12 years of age (range = 10-15 years)
Females
first sign is breast development at around 11.5 years of age (range = 9-13 years)
Steroid mx in asthma
Use a dose of 10 mg prednisolone for children under 2 years of age, 20 mg for children aged 2-5 years and 30-40 mg for children >5 years.
Severity of asthma Children greater than 5 years of age
Moderate
SpO2 > 92%
PEF > 50% best or predicted
Severe
PEF 33-50% best or predicted
Can’t complete sentences in one breath or too breathless to talk or feed
Heart rate > 125/min
Respiratory rate > 30/min
Life
PEF < 33% best or predicted
Silent chest
Poor respiratory effort
Altered consciousness
Cyanosis
Upslanting palpebral fissures, prominent epicanthic folds, low-set ears and flat face neuro exam
Hypotonia
RF for SIDS
prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity