Paeds 3 Flashcards
When is the risk of congenital rubella syndrome highest?
If contracted in first 3 months of pregnancy (earlier = more severe defects).
If contracted >20 weeks gestation –> NO additional risk.
Incubation period of rubella?
14-21 days
What are 3 key cardiac abnormalities that may be seen in congenital rubella syndrome?
1) PDA
2) Pulmonary stenosis
3) VSD
Management of varicella of the newborn?
VZIG +/- aciclovir
What is foetal varicella syndrome caused by?
reactivation of the virus in utero as herpes zoster.
this reactivation ONLY occurs when the foetus is infected with varicella <20 weeks gestation.
What is the most common virus transmitted to the fetus during pregnancy?
Cytomegalovirus
What are 6 key maternal infections that can have foetal complications?
1) Rubella
2) VZV
3) Herpes (HSV)
4) Cytomegalovirus
5) Toxoplasmosis
6) Zika
How can congenital rubella affect hearing?
Sensorineural hearing loss
How can congenital rubella affect eyesight?
Congenital cataracts & retinopathy
What is the biggest risk factor for varicella of the newborn?
Maternal infection occurs <4 weeks from birth (50% risk)
Management of maternal CMV infection in an immunocompetent woman?
No treatment
What are the 3 most commonly noted clinical features in congenital CMV?
1) jaundice
2) petechiae
3) hepatosplenomegaly
When is the risk of congenital toxoplasmosis higher in pregnancy?
The risk is higher LATER in pregnancy
How can foetal CMV be diagnosed prenatally?
Amniocentesis & PCR testing of amniotic sample
Must be carried out AFTER 21 weeks gestation, as functioning foetal kidneys are required for the virus to be excreted into the amniotic fluid.
Infections that can be passed to baby in pregnancy –> TORCH
What are they?
T - toxoplasmosis
O - others (syphillis, hep B, zika)
R - rubella
C - CMV
H - herpes simplex
When is sudden infant death syndrome (SIDS) most common?
At 3 months of age
Surgical mx of paediatric intestinal malrotation with volvulus?
Ladd’s procedure - includes division of Ladd bands and widening of the base of the mesentery.
Location of atopic eczema in infants?
Usually involves the face and flexural surfaces of the body (as opposed to its classical flexural distribution).
What is the only definitive treatment for biliary atresia?
Surgical intervention
Mx of SUFE?
Surgery –> internal fixation across the growth plate
What is used to screen newborns for hearing problems?
Automated otoacoustic emission test.
This involves putting a small soft-tipped earpiece in the outer part of a baby’s ear which sends clicking sounds down the ear. The presence of a soft echo indicates a healthy cochlea.
What further test can be done if the otoacoustic emission test is abnormal?
Auditory brainstem response test
Is oligo or polyhydramnios a risk factor for DDH?
Oligohydramnios –> as it restricts foetal movement and thus normal development of the hip joint.
What is the mx of any child presenting with a limp/hip pain + a fever?
Refer for same day hospital assessment (even if a diagnosis of transient synovitis is suspected) –> to rule out septic arthritis.
Precocious puberty in males is uncommon and usually has an organic cause.
What can be used to help determine the location of the pathology?
Testes size
In precocious puberty in boys, where is the location of the pathology with:
a) bilateral enlargement of testes
b) unilateral enlargement of testes
c) small testes
a) gonadotrophin release from intracranial lesion
b) gonadal tumour
c) adrenal cause (tumour or adrenal hyperplasia)
Why are children with Down’s syndrome prone to snoring & sleep apnoea?
This is due to the low muscle tone in the upper airways and large tongue/adenoids.
There is also an increased risk of obesity which in people with Down’s syndrome which is another predisposing factor to snoring.
Peak age of incidence of bronchiolitis?
3m - 6m
Rate of chest compressions in paeds BLS?
100-120
What organis causes slapped cheek syndrome (erythema infectiosum)?
Parvovirus B19
What age does transient synovitis typically affect?
3-8y
What investigations should be performed in infants <3m with a fever?
1) FBC
2) Blood culture
3) CRP
4) Urine testing (for UTI)
5) CXR (only if resp signs)
6) Stool culture (if diarrhoea)
What is the causative agent of roseola infantum?
HHV-6
All breech babies at or after 36 weeks gestation require what screeing after birth?
US screening for DDH 6 weeks after birth (regardless of mode of delivery)
In paeds BLS, what are the 2 appropriate places to check for a pulse?
1) femoral
2) brachial
What neonatal glucose level indicates the need for 10% dextrose infusion?
<1 mmol/L (whether symptomatic or not)
Mx of ALL cases of neonatal hypoglycaemia that are symptomatic?
IV 10% dextrose infusion
Which condition causes joint pain and swelling and a salmon pink rash?
Juvenile idiopathic arthritis
What orgaism causes threadworms?
Eterobius vermicularis
What are some features of growing pains?
- never present at the start of the day after the child has woken
- no limp
- no limitation of physical activity
- systemically well
- normal physical examination
- motor milestones normal
- symptoms are often intermittent and worse after a day of vigorous activity
At what age does infatile colic usually resolve?
6m
How log after startig Abx can a child with scarlet fever return to school?
24h
What is the 1st line preventative medication to remember for abdominal migraine?
Pizotifen (serotonin agonist)
At what age is encopresis considered pathological?
≥4
At what age is enuresis considered pathological?
≥5
At what age does reflux in babies typically resolve?
1 y/o
What is a test feed done with in pyloric stenosis?
Dextrose water:
- if mass palpable on examination, no further investigations needed
- if not palpable –> US
What are the requirements for diagnosing pyloric stenosis on an abdo US?
(3)
1) Pyloric thickness >4mm
2) Pyloric length >18mm
3) An obstruction preventing the passage of fluid beyond the pylorus, despite gastric peristalsis.
What increases the risk of haemolytic uraemic syndrome?
Abx
Which part of the small intestine is most affected in Coeliac disease?
Jejunum
What is the gold standard for diagnosis of coeliac?
Duodenal biopsy
How long must patients be eating gluten for before testing for coeliac?
At least 6 weeks
What 2 genes are associated with coeliac?
1) HLA-DQ2 (90%)
2) HLA-DQ8
Give some complications of coeliac disease
1) Dermatitis herpetiformis
2) Osteoporosis
3) Infertility
4) Malignancy
5) Anaemia (iron, B12, folate)
6) Failure to thrive
7) Peripheral neuropathy
What feature can indicate intestinal atresia during pregnancy?
Polyhydramnios
How is a definitive diagnosis of pyloric stenosis made?
US –> thickened pylorus
What is the fluid requirement for 24 hours in children?
1st 10kg –> 100ml/kg/day
2nd 10kg –> 50ml/kg/day
Subsequent kg –> 20ml/kg/day
What condition is duodenal atresia associated with?
Down’s syndrome
Are air fluid levels seen on AXR in malrotation w/ volvulus?
Yes
What condition is annular pancreas associated with?
Down’s syndrome