Paeds Flashcards
How does infantum roseola present?
High fever, mild pharyngitis and lymphadenopathy. Temp returns to normal after 3-4 days, accompanied by appearance of rose-pink macular non-pruritic rash
How does congenital hypothyroidism present?
‘Good baby’ - sleep most of time, rarely cry!
Lethargic, poor feeding, constipation, symmetrically poor weight gain.
Coarse facial features with macroglossoa
Hypotonia, large fontanelles
Umbilical hernia
6 year old short for his height, increased subcutaneous fat around trunk, immature facial features, prominent forehead. Dx?
Growth hormone deficiency
4 y/o with recent upper respiratory infection now presents with abdo pain, pain in knees and ankles, and non blanching purpuric rash over backs of legs and buttocks
-Dx and what is it?
-most appropriate first line ivx?
Henoch-Schönlein Purpura (HSP) - IgA vasculitis. Present with purpuric rash, abdominal pain, arthritis/arthralgia and glomerulonephritis
-Urine dipstick to look for blood and protein
2nd step in asthma Mx for children still having symptoms after salbutamol
-for children under 5?
-children over 5?
Under 5 - LRTA ie montelukast
Over 5 - very low dose ICS
Usual age of smiling?
When to refer?
6 weeks
Refer at 10 weeks
When can sit without support?
when to refer?
7-8 months
Refer at 12 months
When should be able to walk unsupported and know 2-6 words?
When to refer for both?
13-15 months
Refer at 18 months
Most common cause of failure to thrive?
Non-organic causes ie social problems!
Classic electrolyte and acid-base balance of pyloric stenosis?
Hypochloraemic, hypokalaemic metabolic alkalosis
Ivx for pyloric stenosis?
Treatment?
-ultrasound
-correct fluid/electrolyte then Ramstedt’s or laparoscopic pyloromyotomy
Testing for Coeliac disease?
-patient must have eaten gluten-containing foods for at least 2 meals a day over last 6 weeks
-serological tests: IgA tissue transglutaminase antibody (tTGA) and IgA endomysial antibody (EMA)
-if positive, will need intestinal biopsy (and stay on gluten diet until after this)
Difference between Gillick competence and Fraser guidelines?
Gillick competence - determining a child’s capacity to consent
Fraser guidelines as specific to decide if a child can consent to contraceptive or sexual health advice and treatment (‘Fraser is sexy!’)
First line treatment for UTI in kids?
Trimethoprim
Day old neonate - bilious vomiting, scaphoid abdomen. USS shows double bubble sign. Dx?
Duodenal Atresia
How is Cystic fibrosis inherited and which chromosome does it affect?
-Autosomal recessive
-chromosome 7
Other names for erythema infectiosum? What is it caused by?
Fifth disease
Slapped cheek disease! (High 5 to face!)
Human parvovirus B19
When does respiratory distress syndrome normally start?
Within 4 hours of birth!
Treatment for Scarlett fever?
Penicillin
When does intussusception occur?
Which gender more common in?
5-10 months
More common in males
Symptoms of Insussusception?
Physical examination?
Ultrasound shows?
Vomiting (may be bile stained)
Pulling up legs to chest
Red currant jelly stool
Sausage-shaped mass felt in abdomen
Ultrasound: doughnut/target sign
Treatment for insussusception?
BARIUM ENEMA!
Both a method of imaging and treatment!
Risk factors for neonatal jaundice ?
Low birthweight (prem/small for dates)
Diabetic mother
Male infants
East Asian ethnicity
High altitude populations
Is physiological jaundice unconjugated or conjugated?
UNCONJUGATED
(Conjugated bilirubinaemia is ALWAYS pathological - biliary obstruction needs to be ruled out immediately!)
Causes for early jaundice (within first 24 hours):
Note: jaundice within 24 hours is PATHOLOGICAL AND NEEDS TO BE CONSIDERED HAEMOLYTIC IN NATURE UNTIL PROVEN OTHERWISE!
-Haemolytic disease (rhesus, ABO incapability, spherocytosis)
-Infection (congenital ie rubella, syphillis or postnatal infection)
-Increased haemolysis secondary to haematoma
-Maternal autoimmune haemolytic anaemia ie SLE
-Enzyme deficiency ie Gilbert’s syndrome
What is roseola infantum caused by?
Human herpesvirus (HHV-6)
How does Roseola infantum classically present?
- 3-5 days of high fever
- Fever resolves, but then gets pink/red macules and papules - start on neck/trunk and spread to extremities
Note- commonly associated with febrile seizures (up to 15%!)
How does Measles classically present?
What is the incubation period?
-Fever, maculopapular rash (starts on head/neck then spreads), cough, Coryza, conjunctivitis
-whiteish spots on erythematous buccal mucosa - KOPLIK’S SPOTS
Incubation period is 10 days
How does chickenpox present?
What is the incubation period?
-fever, malaise, generalised pruritic, vesicular rash
-incubation period is 14 days
Is Measles notifiable?
What is the exclusion from school?
YES
5 days from onset of rash
What causes Scarlet fever?
Caused by the exotoxins produced by Strep Pyogenes (Group A Strep!)
How does Scarlet fever present?
-Few days of fever and sore throat
-Then, rash (coarse, like sandpaper) that starts on chest/torso then spreads to limbs. Skin sometime peels (desquamation)
-tongue: strawberry tongue
Management and school exclusion for Scarlet fever?
Penicillin for 10 days (Azithromycin if pen-allergic)
Child can return to school 24 HOURS after abx started
How does Rubella present?
-Prodrome of fever and coryzal symptoms
-Then PINK rash, starts on face and behind ears, spreads to trunk then extremeties
What type of virus causes Rubella?
Is it notifiable?
school exclusion?
Togavirus
Yes, NOTIFIABLE
6 days from onset of rash
How does erythema infectiosum present?
School exclusion?
Prodrome: fever & malaise
Characteristic ‘slapped cheek’ facial rash that spares perioral and periorbital regions (rash disappears after 2w but may come and go for up to a month when hot/exercising!)
No school exclusion! (Once child well)
Most common causes of hand foot and mouth disease?
School exclusion?
Coxsackie & enterovirus
No recommended school exclusion (once child is well)
What type of virus causes Mumps?
School exclusion?
Paramyxovirus
5 days from onset of swollen glands
When do Milia usually resolve?
By 1 month
Name for common rash (yellowish pustules and papules with red wheal) that present normally in first week of life?
Erythema toxicum neonatorum
Treatment for erythema toxicum neonatorum?
None, reassure (self-limiting)
Risk factors for respiratory distress syndrome?
Premature delivery
Male
C sections
Hypothermia
Maternal diabetes
Multiple pregnancy
Family history
Perinatal asphyxia
How is respiratory distress syndrome treated?
Surfactant replacement therapy is given via endotracheal tube
Main extra intestinal manifestations of Coeliac disease?
-Dermatitis herpetiformis (blistering skin rash on elbows/knees/buttocks)
-Iron deficiency anaemia
-Short stature & delayed puberty
-Arthritis and arthralgia
-Osteopenia & osteoporosis
When can a child normally sit?
When to refer
7-8 months
REFER AT 12 MONTHS
How does epiglottitis present?
Cause?
Sore throat, muffled voice, drooling, fever, anterior neck tenderness, oynophagia (pain swallowing), cervical lymphadenopathy
Hib!
Is neck xray done in epiglottitis, what may it show?
Thumbprint sign (inflammed glottis)
If CXR done for Croup, what may it show?
Steeple sign (subglottic narrowing)
14 y/o asylum seeker, purulent blood-stained nasal discharge, fever, inflamed pharynx with greyish membrane, enlarged lymph nodes - Dx?
Diptheria! (Dipped in grey!)
-nasal discharge that becomes purulent and blood stained
-‘bull neck’ - enlarged cervical lymph nodes
What is Extracorporeal membrane oxygenation (ECMO) used for?
Severe heart/lung dysfunction ie PRIMARY PULMONARY HYPERTENSION or RESPIRATORY DISTRESS SYNDROME
What is a port-wine stain?
Named after colour! Reddish/purple
Vascular birthmark PRESENT AT BIRTH
What is a Stork bite?
Telangiectatic naevus
Pink, FLAT, irregularly shaped mark on back of neck/forehead/eyelid/top lip
Skin is not thickened, feels the same as rest of body
Definitions of ‘atypical’ UTIs in children?
-seriously ill/septicaemia
-poor urine flow
-abdominal/bladder mass
-raised creatinine
-failure to respond to abx in 48 hours
-NON-E COLI ORGANISMS!
Treatment for <3 months with suspected UTI?
URGENT REFERRAL
Management for >3 y/o with:
Upper UTI
Lower UTI?
Upper - most need urgent referral!
-7-10 days co-Amox or cefalexin
Lower - 3 days of either
-Trimethoprim, nitrofurantoin, amoxicillin or cefalexin
Commonest epilepsy syndrome in childhood?
-Benign Rolandic epilepsy (prev called partial seizures)
-Usually 7-10 years
-More common in boys
-Often at night, involve one side of face, causing gurgling/grunting/dribbling
-generally outgrown by puberty!
3 month old with severe eczema and D&V. Most likely Dx?
Cow’s Milk Protein Allergy
NOTE in most young kids, CMPA rather than lactose intolerance which is IgE-mediated!
What to do if suspected CMPA?
Likely CMPA?
Suspected - try a ‘comfort’ milk ie Aptamil where some of protein is hydrolysed so it is less allergenic
Likely - prescribe EHF (extensively hydrolysed feeds) and refer
Features of INNOCENT heart murmur
-soft
-position dependent
-otherwise healthy
-occurs during systole or both (MURMURS DURING DIASTOLE ARE ALWAYS PATHOLOGICAL)
-no palpable thrill
-physiological splitting of S2
8 y/o with recurrent nosebleeds and bleeding gums over past week. Multiple bruises, no organomegaly. Low platelets, normal clotting. Dx and what is it?
ITP (idiopathic thrombocytopaenic purpura)
-acute, transient disorder, affecting older kids 2-4 y/o, usually occurs after infection or immunisation
Management of ITP?
Usually just advice and support, and repeat FBC in 10 days
5 days baby present with bleeding gums and from umbilical wound, otherwise well. Likely Dx?
Hemorrhagic disease of newborn (or vitamin K deficiency bleeding!)
Quick way to estimate weight of child?
(Age + 4) x2
Blood spot tests which 9 things?
‘Come Cuddle/Hug My Magnificent PIGS’
Congenital hypothyroidism
Cystic Fibrosis
Homocystinuria
MCADD
Maple syrup urine disease
Phenyl ketonuria
Isovalaeric acidaemia
Glutaric acidaemia type 1
Sickle cell disease
When is blood spot test done?
Day 5-8
Which children get Necrotising enterocolitis and when?
Premature/underweight neonates
Usually 2nd to 3rd week of life
Risk factors for NEC?
-Maternal illicit drug use/HIV/chorioamnionitis
-Prematurity/low weight
-Congenital abnormalities
-Low flow/perfusion states ie placental abruption leading to neonatal shock
-Feeding type - preterm formula
Symptoms of NEC
Poor feeding, vomiting (may be bile stained) lethargy, abdo tenderness/distention
Blood/mucous in stools
How to confirm NEC and what would it show?
Abdo xray
Pathognomic findings:
-PNEUMATOSIS INTESTINALIS (gas in wall of intestine)
-PORTAL VENOUS GAS
Earlier signs:
Dilated, gas filled loops of bowel
Extraluminal (free) air
Management of NEC?
NBM
Nasogastric tube for decompression
IVF/TPN and IV abx
Surgery if necrosis suspected
Intubation/ventilation for apnoea
Features of EDWARDS syndrome
Ears - low set, malformed
Development issues with thumbs/hands
Weird palate - cleft
Absent radius
Rocker bottom feet
Don’t mess with me (clenched fist)
Small head and jaw (microcephaly, micrognathia)
Which trisomy is;
-Edward’s
-Patau
Edwards = 18
Patau = 13
Karyotype for Turner’s syndrome?
Girls/boys affected?
Classical features?
45XO - 1 X chromosome missing/partially missing! X chromosome ‘turned’ into O
Only GIRLS
Short stature (because missing chromosome!)
Gonadal dysgenesis - primary and secondary amenorrhea
Lymphoedema
Klinefelter’s syndrome chromosome abnormality?
Affects boys or girls?
Features?
Extra X chromosome (47XXY)
BOYS ONLY
Tall (because extra chromosome!)
Long arms and legs
Gymaecomastia
Central obesity
Small firm testicles
Which are the TORCH infections that are passed from mother to child during pregnancy/birth?
Toxoplasma gondii
Others (VZV, Parvovirus B19, Zika)
Rubella
CMV
HSV
Bloody mucousy stools in children - how to determine NEC vs intussusception?
NEC: 2nd to 3rd week of life in generally PREMATURE babies
Intussusception: infants 3-12 months, drawing up legs
Infant with instestinal obstruction within hours of birth, ‘soap bubble’ on abdomen xray. Dx?
Tx?
Meconium ileus!
Therapeutic enemas
If fails - surgery
Hirschprung’s disease
-associated with which condition?
-what is it?
-when does it usually present?
-presentation
-investigations?
-mx?
-Down’s syndrome
-partial/complete colonic obstruction associated with absence of ganglion cells
-from newborn up to 1 year of life
-NOT PASSING MECONIUM for 48 hours, abdo distension, vomiting
-RECTAL BIOPSY
-surgery
Usual age of presentation for pyloric stenosis?
Examination finding ?
Typically 3-6 week
Olive shaped mass in R upper abdomen
What is HARTNUP disease?
Symptoms?
Abnormality of renal/intestinal transport involving amino acids
-red, scaly, photosensitive rash
-neurological abnormalities- ataxia, unsteady gait, dysarthria, tremors, spasticity
How is fragile X inherited?
X linked DOMINANT (not so fragile!)
-commonest inherited cause of learning disability!
How is fragile X inherited?
X linked DOMINANT
-commonest inherited cause of learning disability!
First line treatment for absence seizures?
Ethosuximide
Or valproate
Or Lamotrigine
Where and when does a dermoid cyst present?
Young children
Lumps on lateral eyebrow ‘D for devil horns!!’
Forceps delivery - Several hours after birth, swelling that doesn’t cross suture lines, can take months to resolve. Dx? Where is the bleed?
CEPHALOHAEMATOMA
Between periosteum and skull
Forceps - swelling present from birth, crosses suture lines, resolves within days
Caput succedaneum
