Paeds Flashcards
Ddx of acute limp
Infection - osteomyelitis, septic arthritis, hand-foot-mouth-dx
Inflammation - reactive arthritis, transient synovitis after coryza, paths dx, osgood-schlatter dx
Trauma - contusion and fractures
Malignancy - leukaemia (bruising with low Hb and platelets), neuroblastoma, bone tumours e.g. sarcoma/osteosarcoma
Mechanical - toddler fracture and SUFE
Ddx of chronic limp
Metabolic - VitD/Ca deficient
Congenital - DDH, talipes
neuromsk - Muscular dystrophy, cerebral palsy
Rheum - chronic SCFE, JIA, lyme dx, RA
CI to LP
Focal seizure (do CT head instead)
Raised ICP - bulging fontanelle, papilloedema, Cushing triad of HTN, relative bradycardia, irregular breathing)
Spina bifida/sacral dimple
Bleeding disorder
Why NPA in children with broncholitis since there is no treatment?
You don’t want to put two children with different viruses together
To prevent viral spread
Investigations is child suspicious of NAI (3)
CT head
Skeletal survey of all long bones
Retinal haemorrhage
Keep in hospital and voice concern to senior
Causative organisms for meningitis in children by age groups
<3/12
- GBS
- E.coli
- Listeria
3/12-6y
- Neisseria meningitidis
- Strep pneumo
- Haemophilus influenza B
> 6y
- Neisseria meningitides
- Streptococcus pneumoniae
No more Hib because of vaccination
Consider uncommon organisms if failure to response to rx or clinical cause unusual
- mycoplasma (also target shaped lesions, erythema multiform)
- Borrelia burgdorferi
- Fungal infections
Mx for meningitis
Antibiotics
- IV ceftriazone +/- ampicillin for listeria cover
- If recent travel or recent abx exposure, add vancomycin
- If HSV suspected, add acyclovir
Fluids
Correct electrolytes
Dexamethasone to reduce brain swelling and risk of long term complications but NOT IN <3/12
For household contacts,
- give rifampicin to eradicate nanopharyngeal carriage for H. influenza and meningococcal infections
Recurrent meningitis
test for complement def
long term complications of meningitis
Hearing loss - offer audiology assessment after recovery
Local vasculitis
Local cerebral infarction
Subdural effusion - confirm by CT and may require prolonged antibiotics
Hydrocephalus - shunt
Cerebral abscess - CT and drain + abx
HSV encephalitis tx
IV acicylovir for 21 days
Newborn baby with coarse facies, large fontanelle and hypotonia
Congenital hypothyroidism
7 day male with 1 day history of poor feeding and vomiting. uneventful pregnancy, full term, good BW. Blood glucose of 2 mol, low sodium, high potassium. What investigation is likely to confirm diagnosis?
- Abdo USS
- ACTH levels
- Karyotype
- 17 hydroxyprogesterone
- chloride levels
- 17 hydroxyprogesterone
This child is having an Addisonian crisis. 17OHprogesterone is the test for adrenal crisis.
Child with constitutional puberty delay. What test can confirm this diagnosis?
Bone age - which will show delayed skeletal maturity
Toddler accidentally spilt mom’s hot tea over hands. No social/safeguarding concern, legit mom’s accidental mistake. What to do next?
- Discharge
- Admit and take bloods
- Admit and give IV fluids
- Call the duty social worker to express concerns
- Discuss case with regional burns centre
- Discuss case with regional burns centre
Burns involving face, hands or perineum all NEED to be discussed with regional burns centre and they would likely want to review the child
22-month cruising not talking yet at your GP. What to do next?
- Refer to general hospital paeds
- Refer to community developmental paeds
- Take bloods e.g. CK
- Reassure normal
- Review in 4 weeks at the GP
2.Refer to community developmental paeds
Developmental issues all goes to community developmental paeds, not hospital gen paeds
List the top 3 most common types of cancers in children
- 32% Leukaemias (80% ALL)
- Brain and spinal tumours e.g. astrocytomas, medulloblastomas
- Lymphomas (Hodgkin’s non-Hodgkin, Burkitt’s)
NB. All ?children cancer e.g. above 3 + neuroblastoma, sarcomas, Wilms tumour and bone tumours need to be referred under 48hours wait rule not the usual 2ww in adults (Except retinoblastoma which is 2ww)
Indicators for poor prognosis in ALL in children (5)
- Presenting <1 or >10 y.o
- High tumour load
- t(4,11)/hypodiploidy
- poor initial response to first chemo
- MRD+ve/CSF+ve
Management of ALL in children
- Stabilise with RBC transfusion, platelets and abx
- 1st chemo to induce remission
- Consider HLA-matched sibling BMT during remission if option exists
- 2nd intensive chemo +/- CNS therapy using intrathecal methotrexate
- Maintenance chemo for 3 years with PCP prophylaxis (co-triamoxazole)
- If relapse, repeat chemo +/- radiotherapy/BMT
What is ABVD chemotherapy regimen, what is it used to treat? and what is the cure rates with this therapy?
ABVD = doxorubicin, bleomycin, vinblastine, decarbazine
Used in Hodgkin’s lymphoma
Cure rate of 80%
How does Hodgkin’s lymphoma present in children?
Painless lymphadenopathy (worse on alcohol)
FLAWS uncommon. Unlike ALL where FLAWS predominant
Investigations for Hodgkin’s lymphoma
Lymph node biopsy - reed sternberg (owl eyes) cells
BM biopsy
Imaging (PET scan of all lymph nodes)
What is CHOP chemotherapy regimen and what is it used to treat?
CHOP = cyclophosphamide, doxorubicin, vincristine, prednisolone
This is used in non-hodgkin lymphoma
> 80% survival
