Paeds 2 Flashcards
Infant reflexes. When from - until and what are they? Moro Grasp Rooting Stepping
Moro Head extension causes abduction followed by adduction of the arms
Present from birth to around 3-4 months of age
Grasp Flexion of fingers when object placed in palm
Present from birth to around 4-5 months of age
Rooting Assists in breastfeeding
Present from birth to around 4 months of age
Stepping Also known as walking reflex
Present from birth to around 2 months of age
Perthes Features? Diagnosis? Complications? Mx?
Features
hip pain: develops progressively over a few weeks
limp
stiffness and reduced range of hip movement
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
Diagnosis
plain x-ray
technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist
Complications
osteoarthritis
premature fusion of the growth plates
Management
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
Whilst examining a 3 day old baby born at 36 weeks gestation, you notice a very prominent murmur during systole and diastole, loudest over the left sternal edge. A chest X-Ray shows massive cardiomegaly, particularly prominent in the right atrium. From the notes you see that the mother of the child has bipolar disorder, but is otherwise healthy and has had no congenital heart problems. There is no relevant family history besides a paternal cousin who developed cardiomyopathy in their late teens. Given the history what is the most likely underlying diagnosis?
Cause?
Ebsteins anomaly
Lithium in pregnancy -> Tricuspid leaflets displaced anteriorly + Enlarged RA
Auscultation of mitral valve prolapse
Mid systolic click followed by late systolic murmur
What can be given in replacement for penicillin if allergy? Treatment of strep
Azithromycin
A 3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted
Diagnosis?
Rubella
A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face
Diagnosis?
Scarlett fever
When should a child be talking in short sentences? Eg 3-5 words
3 years
Mx of seborrhoeic dermatitis? What is is also called?
Cradle cap
Mild/moderate - baby shampoo and baby oils
Severe - mild topical steroids - Eg 1% hydrocortisone
[usually spontaneous resolution at 8 months]
Features of testicular torsion
Testicular pain with associated nausea and vomiting
Swelling of testis
Absent cremaster reflex
Elevation of testicle -> worsening pain
Characteristic features of toxoplasmosis congenital infection
Cerebral calcification
Chorioretinitis
Hydrocephalus
Characteristic features of CMV congenital infection
Growth retardation
Purpurin skin lesions
Turners cardiac malformation and murmur?
bicuspid aortic valve, aortic valve stenosis and/or aortic coarctation
Systolic loudest over aortic region
4 central causes of floppy children
Down’s syndrome
Prader-Willi syndrome
hypothyroidism
cerebral palsy (hypotonia may precede the development of spasticity)
Steroids following an exacerbation of asthma
Oral steroids for 3 days
Signs of a Moderate? severe asthma attack?
Life threatening?
Moderate
SpO2 > 92%
No clinical features of severe asthma
Severe SpO2 < 92% Too breathless to talk or feed Heart rate > 140/min Respiratory rate > 40/min Use of accessory neck muscles
Life-threatening SpO2 <92% Silent chest Poor respiratory effort Agitation Altered consciousness Cyanosis
What should you measure in all children with asthma exacerbation >5? Levels ?
PEF
Severe = 33-50%
Life threatening = <33%
Mitochondrial inheritance ?
Maternal
Features of Nappy rash
The most common cause, due to irritant effect of urinary ammonia and faeces. Creases are characteristically spared
Typically an erythematous rash which involve the flexures and has characteristic satellite lesions
Erythematous rash with flakes. May be coexistent scalp rash
A less common cause characterised by an erythematous scaly rash also present elsewhere on the skin
Other areas of the skin will also be affected
Irritant dermatitis Candidiasis dermatitis Seborrheoic dermatitis Psoriasis Atopic eczema
Mx of nappy rash
disposable nappies are preferable to towel nappies
expose napkin area to air when possible
apply barrier cream (e.g. Zinc and castor oil)
mild steroid cream (e.g. 1% hydrocortisone) in severe cases
Most common cause of stridor in children? Features?
Laryngomalacia
Congenital abnormality of larynx
Usually presents at 4 weeks with stridor
[Laryngomalacia is the most common cause of stridor in infants. It occurs due to a floppy epiglottis which folds into the airway on inspiration. This is normally a self-limiting condition, but if the stridor becomes severe with signs of respiratory distress, or if there is failure to thrive (due to poor feeding), then surgery is recommended to improve the airway.]
Ix in all infants with fever? What do all febrile children get?
Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present
Temp
HR
RR
Cap refil
Non motor problems with Cerebral palsy
learning difficulties (60%) epilepsy (30%) squints (30%) hearing impairment (20%)
Autosomal dominant
Develop colonic cancer and endometrial cancer at young age
80% of affected individuals will get colonic and/ or endometrial cancer
High risk individuals may be identified using the Amsterdam criteria
Lynch syndrome
Hearing test in newborns?
Automated otoacoustic emissions
Coeliac genes?
When do features normally occur? What are they?
Diagnosis?
HLA-DQ2, HLA-DQ8
With the introduction of cereals (gluten) Failure to thrive Diarrhoea Abdo distension Anaemia in older children
IgA TTG antibodies
Jejunal biopsy - subtotal villus atrophy
Diet in CF
High calorie high fat
Pancreatic enzyme supplementation with eachmeal
