Paeds Flashcards
At what age should a child fix and follow?
Fix & follow at 4-6 weeks
At what age should a child have head control?
Head control at 10-12 weeks
At what age should a child be able to sit unsupported?
Sitting at 6 months
At what age should a child be able to use a pincer grip or finger feed?
Pincer grip and finger feed at 9-10 months
At what age should a child be able to pull to stand/cruise?
Pull to stand/cruise at 11 months
What are the 4 fields of development?
1) Gross Motor
2) Fine motor and vision
3) Language and hearing
4) Social and play
4 year old boy, who has developed muscle weakness which now means he is unable to walk. He has been slow to reach his developmental milestones and has mild cognitive impairment. He has scoliosis. He has a positive Gower’s sign.
a) What disease is the dx?
b) What type of inheritance is it?
c) What blood test would you expect to be very high?
4 year old boy, who has developed muscle weakness which now means he is unable to walk. He has been slow to reach his developmental milestones and has mild cognitive impairment. He has scoliosis. He has a positive Gower’s sign.
a) Duchennes muscular dystrophy
b) X linked recessive
c) Creatine kinase would begin in the 1000’s/10,000
What are the primitive reflexes and when do they go?
Primitive reflexes: Stepping 6wks Palmer/plantar grasp 3m Moro's 4ms Fencing - asymmetric tonic neck reflex 6m Sucking and rooting 6m Parachute 9m
What are the two tests for the hips in a new born examination?
Barlows - aDDucts hip with posterior force to promote disslocation (knees in pushing into bed)
Ortolani’s - aBDucts hip with anterior force to reduce the hip joint (knees out and pushing forwards from behind)
What are the main things not to forget in a new born examination?
Eyes (red reflex - cataracts?)
Heart
Hips (developmental dysplasia of the hips - barrows and ortolani’s)
Anus - is there a hole?
If developmental dysplasia of the hip is suspected in a 5 wk old, what Ix would you order?
USS - proximal femoral epiphysis hasn’t ossified yet so US provides enough information
What are the complications if hip dysplasia is not treated?
Limp, hip pain and OA when older
A 3 wk old, ex prem - born at 28wks presents with blood PR and brining up bile/blood in his NG tube. O/E he has abdo distension and has abdomen is has a shiny red appearance.
a) Dx
b) Appearance on AXR?
A 2 wk old, ex prem - born at 28wks presents with blood PR and brining up bile/blood in his NG tube. O/E he has abdo distension and has abdomen is has a shiny red appearance.
a) Necrotising enterocolitis - damage to gut wall, causing inflammation and oedema - air enters the gut wall with risk of perforation
b) Appearance on AXR? air in wall of intestine and portal hepatic gas, dilated loops and thickened bowel wall
Who is at risk of getting NEC (necrotising enterocolitis)
Risks of NEC?
Born at <32 weeks
Babies that are unwell or were unwell/poor growth in the womb
Not being breast fed
Give examples of congenital infections
Rubella (hearing impairment and cataracts)
CMV (neurodevelopment)
Toxoplasmosis (undercooked meats and cat poo - retinopathy, cerebral calcification, hydrocephalus and LT neurological disabilities)
Syphilis (rash on soles and palms - give penicillin to infants)
Varicella Zoster
A mum received morphine during delivery - what medication do you give and why?
Naloxone to prevent respiratory distress
Until what age do you account for prematurity on Growth Charts?
<18m
What abs do you test for with coeliac’s?
Tissue tranglutaminase
Anti endomysial
What are the risks of non-compliance to a gluten free diet in a patient with coeliac’s disease?
Cancer 3.5x GI cancer 8x Small bowel lymphoma 25x Male infertility osteopenia
What is the fluid calculation to correct for dehydration?
% dehydration X 10 X wt in kg
How do you calculate maintenance fluids?
What fluid do you use for maintenance?
100 mls/kg/day = 1st 10
50 mls/kg/day = 2nd 10 (11-20 kg)
20 mls/kg/day = everything after
0.45% saline and 5% dextrose
What are the causes of hypothyroidism:
a) world wide
b) UK
What are the causes of hypothyroidism:
a) world wide = iodine deficiency
b) UK= maldescent of the thyroid and athyroisis (linguine mass/unilobular small gland O/E
When and how is newborn screening done?
5-6 days post birth
Blotting sheet - heel prick test
What is screened for on the new born screening test?
1) Sickle cell disease
2) CF
3) Congenital hypothyroidism
4) PKU Phenylketonuria
5) MCADD
6) Maple syrup urine disease
7) Isovaleria acidaemia
8) Glutaria aciduria
9) Homocystinuria
What is the most common cause of a UTI in infants?
UTI - E.Coli
An infant has a UTI due to E.coli - what treatment would you start them on?
E.Coli - IV cefuroxime
What pathogens can cause osteomyelitis?
Staph aureus
Steptococcus
H. Influenzae
A 7yr old girl presents to A&E feeling lethargic, she is not alert but responds to voice. O/E you notice a purple rash on her skin. You suspect meningitis - what abx would you give?
IV cefotaxime
What abx would you give for CAP?
a) mild
b) moderate
What abx would you give for CAP?
a) mild = PO amoxicillin
b) moderate = IV benzylpenicillin
What type of organisms does penicillin cover?
Gram +ve: Grp A Strep, Grp B Streph, most pneumococcus, some staph aureus
What does co-amoxiclav cover?
Same as amoxicillin ( Grp A step, pneumococcus, listeria)
Staph Aureus, haemophilis
UTI - E.coli/enterococcus
What would you prescribe in a HSV & VZV infection
Aciclovir
What pathogens can cause bronchiolitis?
RSV
Para influenza virus
Influenza A/B
Rhino Virus
Give 2 examples of live attenuated vaccines
Live attenuated vaccines:
MMR
BCG
What is done in a full septic screen?
1) Bloods = Cultures, FBC, U&Es, ESR & CRP, Gas (whats growing, how badly infected, reactive proteins)
2) Urine = MC&S + Dipstick (infection?)
3) CXR
4) LP
Maggie is about to give birth, but like 1/5 women she has group B strep. What is she given at delivery to protect the baby?
Group B strep carrying mothers are giving penicillin at delivery
What is purpura and petechiae?
Purpura = blood that is extravascular, it has leaked into the skin and mucus membranes Petechiae = small <3mm Ecchymoses = larger legions >5mm
Give differential diagnoses for fever - excluding infections.
Non-infective causes of fever: Reactive arthritis (post infection) Connective tissue problems - SLE, JIA Kawasaki disease Rheumatic fever IBD Neoplasms Drug related
A 6yr old complains of a sore R hip for the past few days. The hip is swollen and warm.
Give differential Dx.
A 6yr old complains of a sore R hip. The hip is swollen and warm - acute articular inflammation.
Transient synovitis
Septic arthritis
Osteomyelitis
What is perthes disease?
Perches disease is vascular necrosis to the head of the femur - they may have pain in the hip/knee, limp and have stiffness.
60% recover without treatment but others may need physio, crutches, plasters or surgery
What prophylaxis do you give for close contacts with meningitis?
Ciprofloxacin or rifampicin
If pregnant give ceftriaxone
What are the criteria for a close contact with meningitis?
Close contacts, 7 days prior to disease:
Adults and children that have lived in household
Or attended childcare group >4 hrs
A 3 yr girl has a 2 month hx of malaise, pallor, reduced appetite, febrile episodes and is complaining of pain in her L thigh and is not unable to weight bare.
If this is JIA what blood results would you expect?
JIA
Normal bloods except a very high ESR
What commonly causes Impetigo?
Staph Aureus
What normally causes Scarlet fever?
Group A Strep
What are the causes of CP?
Antenatal - Genetic, infection (CMV), haemorrhagic
Peri natal - Infection, hypoxia (birth asphyxia or placental factors)
Post natal - Infection (meningitis, encephalitis, abscess), prematurity, anoxia, trauma, symptomatic hypoglycaemia, hydrocephalus, hyperbilirubinaemia
Define CP
Cerebral palsy
= abnormality in movement or posture causing activity limitation attributed to a static brain lesion in a developing brain
What are the types of CP?
Spastic
Dyskinetic
Ataxic
What is meningococcal septicaemia caused by and what abx do you give?
Nisseria meningitidis
Cefotaxime and ampicillin
What do you give close contact prophalaxisis of meningococcal septicaemia?
Rifampicin or ciprofloxacin
How does Kawasaki disease present?
WARM >5 day fever
Cervical lymph node
Rash: on palms and soles - then peeling skin
Erythema/maculopapular
Adenopathy - cervical lymph nore
Mucous membranes - lips cracked and starwberry tongue
A 4yr old boy presents with fever and a sore throat. O/E you notice he has a very red tongue and rash on his body.
His bloods have raised WBC.
What is the cause?
How do you treat?
Scarlet fever
Caused by: group A haemolytic step
Rx: PO penicillin
You suspect a child has sepsis.
What Ix do you request?
FBC, cultures, CRP, gases, glucose and lactate
You have a 2 day old neonate with sepsis.
What abx would you give and what are you trying to cover?
Ampicillin + cefotaxime OR (benpen + genatmycin)
Cover BGS and -ve bacilli
What are the cerebral complications of meningitis?
Hearing loss
Local vasculitis - may lead to cranial nerve palsies
Local cerebral infarction - lead to focal/multifocal seizures
Hydrocephalus
Cerebral abscess
Give viral causes of meningitis
EBV, adenovirus, Mumps
What are the two signs that you see in meningitis?
Brudzinski - on back, bending their neck while bringing their knees up to elicit neck stiffness (bringing both together)
Kernig - on back, one hip flexed and extending the knee is painful/more resistant (kicking out leg)
What are the treatment options for a child with constipation?
1 = stool softener with Movicol (polyethylene glycol) 2 = stimulant laxative with Senna 3 = osmotic laxative with lactulose
What do you see on histology for Crohns?
Blunted vili, branching crypts and metaplasia
What do you see on histology for Coeliacs?
Vilious atrophy, crypt hyperplasia and inflammatory infiltrate
What do you see on histology for UC?
Inflamed walls and ulceration
Crypt damage - architectural distortion, abscesses and crypt loss
What causes croup?
How do you treat croup?
Usually - Parainfluenza virus
PO Prednisolone or IV dexamethasone + adrenaline (if severe)
What is in the 6-1 vaccine
Tetanus, diphtheria, polio, HiB, Bordetella pertussis, hep B
