Paeds Flashcards
What symptoms are associated with HSP?
Purpuric rash, joint pain, abdo pain
What is the likely Hx in HSP?
Recent throat infection
What investigation is key in HSP follow up and what are you looking for?
Urine - proteinuria and haematuria
Where is the rash most commonly seen in HSP?
Legs and bum, arms face and trunk
Diagnosis of HSP?
Bloods - raised IgA, CRP, ESR, platelets
What distinguishes HSP from ITP/TTP?
Low platelet count
what are the cyanotic CHD?
- VSD
- ASD
- PDA
What are the symptoms of VSD?
Tachycardia, tachypnoea, panysystolic murmur at lower left sternal edge
What are the symptoms of ASD?
Asymptomatic!!! Ejection systolic murmur at left upper sternal edge
What are the symptoms of PDA?
Continuous blowing murmur below left clavicle
What time frame is a PDA pathological?
> 1 month
How do you treat a small VSD?
Leave it and it will spontaneously close but monitor
How do you treat a PDA?
NSAIDS to close it
What are the cyanotic CHD?
Tetralogy of Fallot and transposition of great arteries
What are the 4 features of ToF?
- Pulmonary stenosis
- Overriding aorta
- VSD
- Right ventricular hypertrophy
What are the symptoms of ToF?
Cyanosis, difficult breathing, squatting on exercise, clubbing of fingers and toes and systolic murmur
How is ToF treated?
Open heart surgery
Beta blockers
noradrenaline
What vessels are affected in transposition of great arteries?
SVC, IVC, Pulmonary artery, pulmonary veins, aorta
When is Transposition identified?
When the ductus arteriosis closes
How do you treat Transposition (2 things)
Induce a PDA with prostaglandins and arterial switch operation
What is the leading cause of acute epiglottis?
H. influenza B
What is a key fact in kids with acute epiglottis
Not up to date with vaccines!!!!
What are some symptoms of acute epiglottits
Sat upright, open mouth breathing, drooling, can’t speak or swallow, NO COUGH
What is the most important thing to do when you suspect acute epiglottis?
Call anaesthetist to intubate
What must you NOT do in acute epiglottis?
Examine throat
What symptoms are suggestive of croup?
Worse at night, barking cough, stridor, following short coryzal episode
What is the most common cause of croup?
Parainfluenza
What heart murmur would you get for pulmonary stenosis?
Ejection systolic at left upper sternal edge
What heart murmur would you get for aortic stenosis?
Ejection systolic at right upper sternal edge
What heart murmur would you get for coarctation of the aorta?
ejection systolic at left upper sternal edge
What symptoms might you get for coarctation of aorta?
Increasing with age, SoB, intermittent claudication, radio-radial/femoral delay
What are the 4 S’s of harmless murmurs?
- Soft
- Systolic
- aSymptomatic
- left Sternal edge
Investigations if you find a murmur?
ECHO (antenatal)
ECG
CXR
What direction does the blood flow in Acyanotic CHD?
Left to right
What direction does blood flow in cyanotic CHD?
Right to left
What syndrome do you get if you do not treat acyanotic heart defects?
Eisenmenger’s syndrome
What is the risk with Eisenmenger’s?
Reversal of L-R shunt so causes cyanosis
What is the other name for croup?
Laryngeotracheobronchitis
Where in the resp tract is the obstruction in croup?
Upper
Age range for croup?
6 months - 6 years (peak at 2y)
Tx for simple croup?
Dexamethasone (single dose - 0.15mg/kg)
OR
Nebulised budenoside
Tx for severe croup?
High flow oxygen
Nebulised adrenaline
Tx for acute epiglottis?
IV Cefuroxime
What is the other name for whooping cough?
Pertussis
What is the main cause of whooping cough
Bordatella pertussis
What are the symptoms of whooping cough?
Inspiritory whoop, worse at night, vomiting, cyanosis, nose bleeds, subconjunctival haemorrhages
How long does phases of whooping cough last?
Paroxysmal phase = 3-6 weeks
Cough = months (100 days_
Ix for whooping cough?
Nasal swab culture and PCR
Tx for whooping cough if <1 month old?
5 days of Azithromycin
Tx for whooping cough in >1 months old?
7 days of Azithromycin and Erythromycin
What is the main age range for bronchiolitis?
1-9 months
What is the main cause of bronchiolitis?
RSV (respiratory syncytial virus)
What are some other causes of bronchiolitis?
Parainfluenza, human metapneumovirus
Symptoms of bronchiolitis?
Resp distress, coryzal, breathless, poor feeding
6 signs of resp distress?
Head bobbing, nasal flaring, subcostal recessions, intercostal recessions, tracheal tug, grunting
Ix for bronchiolitis?
Nasal swab and PCR
CXR for hyperinflation
Mx for bronchiolitis?
SUPPORTIVE!!!
humidified O2
NG feeds if cannot feed
Fluids
What is a preventative treatment for bronchiolitis, and when is it given?
Palivizumab.
IM once a month
Indications: CF, downs, immunocompromised, CHD
Define asthma
Chronic inflammatory disorder of the lower airways, secondary to hypersensitivity. It is reversible airway obstruction.
Classic triad of symptoms in asthma?
- Bronchospasm
- Mucosal swelling and inflammation
- increased mucus forming a plug
Features of asthma
Nocturnal dyspnoea, wheeze, cough, sputum, diurnal variation, low exercise tolerance, disturbed sleep
Diagnosis of asthma (3 kinds)
- FEV1:FVC = <70%
- Reversibility with bronchodilator of FEV +12%
- FeNO >35ppb
What cells are involved in asthma?
CD4 cells / eosinophils / IgE
What role does IgE have in asthma?
Binds to mast cells in mucosa, causing release of inflammatory mediators + histamine
What causes increased mucus in asthma?
Histamine
What Tx must be done for asthma in all ages?
Avoid triggers, check inhaler technique
What to add if SABA and low dose ICS don’t work in >5y?
Leukotriene receptor antagonists (e.g. Montelukast)
If SABA, ICS, LTRA don’t work in asthma >5y
LABA / Maintenance and reliever therapy
What to add if asthma not controlled by SABA in <5y?
8 week trial of moderate-dose ICS
Difference in measuring <5 and >5y asthma attack
If >5y must include PEF values
Severe asthma attack
- Sats <92%
- PEF <50%
- Unable to talk
- Tachycardic and pnoeic
- Use of accessory muscles
Life threatening asthma attack
- Sats <92%
- PEF <33%
- Silent chest
- Poor resp effort
- Decreasing consciousness
- Cyanosed
Mx of asthma attack
- ABCDE
- High flow O2
- Nebulised Salbutamol
- IV Hydrocortisone
- Ipratropium Bromide
- Mg Sulphate IV
CALL ICU!!!!!!!!!
Mx CF
High calcium and fat diet
Chest physio and draining
Pancreatic enzyme replacement therapy
Prophylactic Abx
Main pathogens in causing chest infection in CF
Pseudomonas aeriginosa
Staph aureus
What acid-base disturbance might you find in pyloric stenosis
HypoK, hypoCl, metabolic acidic alkalosis
Most common site for intussusception?
Ileum into caecum via oleo-caecal valve
What signs would you find in intusseption?
Child drawing knees up to chest and going pale.
Redcurrent jelly stool.
Sausage shaped mass in Right Lower Quadrant
What would an USS show if a pt had intussusception?
Doughnut / target sign
How to treat intussusception?
Rectal air insufflation
What can intestinal malrotation lead to?
Volvulus and infarction of the entire midgut
What age does intestinal malrotation present?
1-7 days
Signs and symptoms of intestinal malrotation
BILLIOUS VOMITING
Abdominal pain
Tenderness
What is the single diagnostic test for malrotation?
Upper GI contract study
What is the treatment for intestinal malrotation?
Ladd’s procedure - rotate bowel anticlockwise
What would you suspect in a premature baby that is fed with cow’s milk with GI symptoms?
Necrotising enterocolitis
Signs and symptoms of NEC
BILLIOUS VOMITING
Fresh blood in stool
Abdo pain and distension
Shock
What might and X-ray show if a baby has NEC?
Distended loops of bowel
Thick bowel wall
Football sign
Mx for NEC?
ABCDE
Stop oral feeds
Broad spectrum antibiotics (ampicillin, gentamicin, cefotaxime)
Surgery
What causes Hirschsprung’s?
Absence of ganglionic cells from myenteric plexus of large bowel
What actually happens to the bowel in Hirschsprung’s?
Narrowing, contracted segment
What is the identifying factor for Hirschsprung’s?
Failure to pass meconium within 48 hours
What disorder is associated with Hirschsprung’s?
Down’s
Clinical features of Hirschsprung’s?
- Abdo distension
2. Late bile stained vomit
What happens if you do a PR exam in Hirschsprung’s?
You feel a narrow segment and then when you withdraw, there is a flow of liquid stool
What is the diagnostic test for Hirschsprung’s?
Suction rectal biopsy
Most common cause of nephrotic syndrome?
Minimal change disease
Triad of features in nephrotic syndrome?
- Hypoalbuminaemia
- Proteinuria
- Oedema (peripheral, scrotal/vulval, periorbital, ascites)
Tx for the MOST nephrotic disease
Prednisolone (60mg/m2/day)
Tx if steroid-resistant nephrotic disease
Diuretics Salt restriction ACEi NSAIDs Cyclophosphamid + ciclosporin
3 main features of haemolytic uraemic syndrome
- Acute renal failure
- Thrombocytopenia
- Microangiopathic haemolytic anaemia
What classically precedes HUS?
Bloody diarrhoea caused by E. coli
Tx for HUS
Supportive
Plasma exchange if severe thrombocytopenia and anaemia
Complications of HUS
HTN, chronic renal failure
3 main features of Henoch-Schonlein Purpura
- Sandpaper like raised purpura
- Arthritis in knees and ankles
- Abdo pain
What classically precedes HSP
URTI caused by Strep pyogenes
What are the features of an infantile spasm?
Head nodding, arm jerking
What is the diagnostic test for infantile spasms
EEG shwoing hypsarrhythmia
How to you define status epilepticus
> 30min tonic-clonic seizure (but treat after 5 min)
How to treat status epilepticus
Buccal midazolam
IV lorazepam
IV phenytoin
What MUST you give in the community if you suspect meningitis
IM benzylpenicillin
What causes meningitis in neonates
Group B Strep
E. coli
Listeria
What causes meningitis in infants? (1m - 6y)
N. meningitidis
Strep. pneumonia
H. influenza
What causes meningitis in older kids?
N. meningitidis
Strep. pneumonia
What do you screen for at 11-13 weeks?
Down’s syndrome, Patau’s syndrome, Edward’s syndrome
At 11-13w, what do you measure?
- hCG
- PAPP-A
- USS nuchal translucency
What defects might you pick up on the 20w scan?
Neural tube
Major heart defects
Renal agenesis
Skeletal/CNS
What is the name of the heel-prick, blood spot test?
Guthrie’s
What age is Guthrie’s done?
5-8 days
What 6 things does Guthrie’s test for?
Cystic fibrosis Congenital hypothyroid Phenylketonuria Medium-chain-acetly-coA-dehydrogenase-deficiency Maple syrup urine Sickle cell
What is the only antenatal test for chromosomal and inherited disorders?
Chorionic villous sampling - placental biopsy of fetal cells
Signs for Patau’s syndrome (13)?
Polydactyly, cleft palate, heart defects, global developmental delay
Edward’s syndrome signs (18)?
Cleft palate, heart defects, global delay, kidney malformation
What type of people get Turner’s syndrome?
Females (because deletion of X)
Symptoms of Turner’s syndrome?
Short, wide spaced nips, webbed neck, micrognathia, amenorrhoea, delayed puberty, infertile, coarctation of aorta
Tx for Turner’s
growth hormone and oestrogen replacement via COCP
What maternal things might cause spina bifida?
Insufficient folic acid Antiepileptic drugs (valproate, carbamazepine)
What are the two manoeuvres used in testing for hip dysplasia?
Barlow’s - dislocation
Ortolini’s - relocation
Risk factors for hip dysplasia
Breech
Family Hx
Prematurity
Twins
At why age would you be concerned about palmar grasp?
5 months
At what age would you be concerned if the child couldn’t yet walk?
18 months
What would you expect a 6 week old baby be able to do?
social smile, eye tracks movements, head stabilisation
What are the 4 categories for development?
- Gross motor
- Fine motor and vision
- Speech and language
- Social
Presentation of cerebral palsy
Spasticity Rigidity Hypereflexia Weakness Delayed milestones Poor coordination Peristent primitive reflexes
Key 3 features of hemiplegic cerebral palsy?
- More likely arm than leg spasticity.
- Tiptoe.
- Dystonic posture
Key features of diplegic cerebral palsy?
- more likely leg than arm
2. knock-knees
Main cause of cerebral palsy
cerebral malformation
prenatal causes of cerebral palsy
- cerebral malformation
2. TORCH infection
perinatal causes of cerebral palsy
- hypoxia
- trauma
- premature
postnatal causes of cerebral palsy
- head trauma
- stroke
- meningitis
What is the 6 in 1 vaccine?
Diptheria Tetanus Pertussis Polio Haemophilus influenza B Hepatitis B
At what ages are the 6-in-1 vaccine given?
2, 3, and 4 months
At what ages are the MMR vaccines given?
1 year and 3y+4m
At what ages is the PCV vaccine given? (pneumococcal virus)
2, 4 and 12 months
At what age is the Rotavirus vaccine given?
2 and 3 months
At what age is the Men B vaccine given?
2, 3 and 12 months
What is given as a 4 in 1 vaccine (pre-school booster)?
- Diptheria
- Tetanus
- Pertussis
- Inactivated Polio
What is given as a 3-in-1 booster vaccine at 14 years?
- Diptheria
- Tetanus
- Inactiated Polio
What vaccine is given pre-uni?
Meningitis ACWY
What fluids do you give in dehydration?
10-20ml/kg bolus of 0.9% saline
How do you calculate the rate for maintenance fluids?
total daily requirement / 24
What fluids do you use for maintenance?
- Saline 0.9%
- Dextrose 5%
- KCl 10mmol
What are the fluid requirements for first 10kg?
100 ml/kg/day
What are the fluid requirements for the 2nd 10kg?
50ml/kg/day
What extra do you give a child if they are >20kg?
20ml/kg/day
What would you expect to be raised in a blood test for mumps that is ~diagnostic?
Amylase
What are 5 complications of prematurity?
- Intraventricular haemorrhage
- Retinopathy of prematurity
- Respiratory distress syndrome
- NEC
- Sepsis
Key 6 features of Kawasaki’s?
- Conjunctivitis - bilateral
- Rash
- Adenopathy (cervical/unilateral)
- Strawberry tongue and cracked lips
- Hand and foot erythema and desquamation
- Fever >5 days
Tx for Kawasaki
Aspirin
IV Ig
What must you not forget to do in follow up of Kawasaki’s?
ECHO AND CARDIO REFERRAL!!!
What can aspirin cause in kids?
Reye’s syndrome - coronary artery aneurysms
What would you diagnose if you saw a child who had long term joint swelling and couldn’t walk upstairs (they may also have rash etc.)?
JIA!!!
What would you diagnose if an 8 year old boy came to you with hip pain, and on X-ray you saw necrosis of the femoral head?
Perthe’s disease
What would you diagnose if you saw a baby with retinal haemorrhages, who had also had multiple fractures in the past?
Nothing - suspect non-accidental injury
What would metaphysical corner fractures indicate?
NAI
What might you see if you were to examine the ear of a child with otitis media?
Red, bulging tympanic membrane
What are the main causes of otitis media
viral - RSV, rhinovirus
back - pneumococcus, h.influeza
Complication of otitis media?
Otitis media with effusion (glue ear) which can cause hearing loss
If a child is abnormally tall, what syndrome might they have?
Kleinfelter’s
Marfan’s
GH secreting adenoma
What makes up a septic screen?
- Urine sample
- Bloods - FBC, cultures
- Lumbar puncture
What to do first in a very sick, febrile baby?
Septic screen IV antibiotics (cefotaxime, ceftriaxone OR ampicillin if <1m)
Red flags for sepsis?
- Fever >38 (if <3m)
- Fever >39 (3-6m)
- Pale, mottled or cyanosed
- Low GCS
- Bulging fontanelles
- Seizures
- Respiratory distress
- Bile-stained vomit
What is there a lack of in osteogenesis imperfect?
Type 1 collagen
Symptoms of osteogenesis imperfect?
Blue sclera Easy fractures Short Loose joints Hearing problems Aortic dissection
What is the hormone/thing issue in CAH?
Low cortisol
Low aldosterone
CAH symptoms in a male?
Enlarged penis Small testes Deep voice Early puberty Arrhythmias Vomiting Dehydration Hypoglycaemia Hyponatraemia
CAH symptoms in a female?
Virilised genitalia (ambiguous) Dehydration Vomiting Absent or abnormal periods Deep voice Facial hair Hypoglycaemia Hyponatraemia
Which department input do you need for CAH?
Endocrinology and Urology
What is the treatment for CAH?
IV fluids and electrolyte
Cortisol and aldosterone replacement (lifelong)
Hormone replacement and genital surgery if female
What do you need to be aware of if CAH child becomes unwell/stressed?
Extra cortisol needed
What is the most common leukaemia in children?
Acute Lymphoblastic Leukaemia
What is there a lack on in muscular dystrophy?
Dystrophin - links actin to cytoskeleton and regulated Ca2+
What would a raised creatinine phosphokinase suggest?
Muscular dystrophy
When might you consider Duschenne’s MD?
A boy, around 12-18 months when they start walking
How is DMD inherited?
X-linked
Symptoms of DMD?
Progressive muscle wasting Poor balance Scoliosis Progressive walking inability Waddling gait Resp problems Muscle spasms
Medical Tx for DMD?
Low dose pred - to maintain muscle tone.
Quinine for myotonia
At what point is jaundice in a neonate normal?
2-14 days
What are the causes of jaundice in <24h
Rhesus haemolytic disease
ABO incompatibility disease
G-6-PD deficiency
Spherocytosis
What are the causes of jaundice >14 days?
- Biliary atresia!!!
- Breast milk jaundice
- Congenital hypothyroid
- Pyloric stenosis
- TORCH infections
What is involved in a jaundice screen?
- Conjugated and unconjugated bilirubin
- Coombs test
- TFT
- FBC
- Blood film
- Urine
- UandE
- LFT
What complication can you get if you do not treat jaundice?
Kernicterus
What type of bilirubin causes kernicterus?
Unconjugated
Symptoms of kernicterus
- Poor feeding
- Hypotonia
- Fatigue and lethargy
Why does prolonged unconjugated jaundice cause kernicterus?
Unconjugated bilirubin can cross the BBB and accumulate in the grey mater
Main 2 pathogens causing Scarlet Fever?
- Strep pyogenes
2. Group A beta-haemolytic Strep
What symptoms are you likely to get in early stages of scarlet fever?
Vomiting, fever, headache, sore throat, abdo pain
What symptoms does scarlet fever progress to?
Rash (starting on neck and spreading to limbs and torso)
Strawberry tongue
Enlarged tonsils
Tx for scarlet fever?
Pencillin 10 days
Isolation, fluids and rest
Complications of scarlet fever?
Rheumatic fever
Post-strep glomerulonephritis
Complications of mumps?
Male infertility, meningitis, deafness, pancreatitis
Tx for whooping cough?
Azithromycin
Where does the measles rash begin/spread?
Begins behind ears and spreads to forehead and neck, then trunk and limbs
What are Koplik spots?
White clusters inside buccal mucosa, seen in mumps
What does a positive Coombs test indicate?
ABO incompatibility haemolytic disease
What happens in ABO?
Maternal IgG passes through placenta to baby and attaches to fetal RBC, causing haemolysis
What blood group causes symptomatic ABO?
O
Tx for ABO?
Phototherapy
IV Ig
Exchange transfusion
What status do mum and dad have to be to have Rh+ baby?
Mum -
Dad +
What happens in Rhesus haemolytic disease?
Fetal blood enters maternal circulation. maternal IgG made against RhD antigen. This IgG passes through placenta and destroys fetal
How do you prevent Rh disease?
IM anti-Rh antibodies
What needs to change about delivery if Rh?
Early delivery at 36 weeks, and IV transfusion
Is a Rh disease more likely to happen in baby 1 or baby 4?
Baby 4
Why are there no neurological side effects of biliary atresia?
Liver can still conjugate bilirubin
Tx for biliary atresia?
Kasai procedure - salvage liver and restore bile flow
Liver transplant
Does progesterone increase or decrease risk of prematurity?
Decrease
What do breech babies born >=36weeks need to screen for DDH?
USS at 6 weeks
