Paeds Flashcards
What is the most common pathogen to cause Bronchiolitis?
RSV
What is the most common pathogen to cause Croup?
Parainfluenza virus
What are the symptoms of Bronchiolitis?
Common cold symptoms, dry cough
What are the signs in Bronchiolitis?
Tachypnoea, Tachycardia, Subcostal & Intercostal recessions, Hyperinflation, Fine end-inspiratory crackles, High pitch wheeze
What is the management for Bronchiolitis?
Fluids, Paracetamol, Supportive e.g. humidified oxygen, CPAP
What is the other name for Croup?
laryngotracheobronchitis
What are the symptoms of Croup?
Common cold symptoms, cough, fever, malaise, hoarseness, typically worse at night
What are the signs of Croup?
Barking cough, chest recessions
What is the management of mild Croup?
Paracetamol, Ibuprofen, one-off dose of dexamethasone
What is the management for moderate Croup?
Paracetamol, Ibuprofen, oral dexamethasone, prednisolone or nebuliser steroids
What is the management of severe Croup?
Addition of nebulised adrenaline (1mg/ml)
A child presents with stridor, what condition is it important to rule out other than Croup?
Epiglottitis
What is the pathogen that causes Epiglottitis?
Haemophilus influenzae B
How would you differentiate Epiglottits from Croup?
1) No prodrome
2) More acute onset (hours not days)
3) No barking cough
4) Can’t drink
5) Drooling
6) Soft breathing sounds
What are the causative pathogens of pneumonia in neonates?
1) Group B Strep
2) E.coli
3) Klebsiella
What is the causative pathogen of pneumonia in older children?
1) Strep pneumoniae
2) Mycoplasma pneumoniae
What are the symptoms of pneumonia?
Shortness of breath, cough, pleuritic chest pain
What are the signs of pneumonia?
Fever, dull percussion, crackles, bronchial breathing, signs of respiratory distress (chest recessions)
Is a cough in pneumonia likely to be productive or non-productive in children?
Non-productive (may be in older children)
How is pneumonia diagnosed in children if mild?
Clinically
What investigations could be done for pneumonia if the symptoms are severe?
Nasopharyngeal aspirate, Blood culture, chest x-ray
What is the antibiotic for pneumonia in a child?
Amoxicillin
List some possible causes for constipation in a child
1) Normal/physiological
2) Hypothyroidism
3) Coeliac
4) Hirschsprung’s disease
5) Spina bifida
6) Anorectal abnormality
7) Crohn’s disease
What are the symptoms of constipation?
Pain when passing stools, straining on passing stools, hard stools
Do children typically appear well or unwell when constipated?
Well
What are the clinical features of long-standing constipation?
Over-distended rectum, loss of sensation in the anus, involuntary soiling
What is the reason for involuntary soiling in children with long-standing constipation?
Loss of sensation of needing to go to the toilet as well as liquid faeces from the small intestine leaking around the hard compacted faeces
What is the red flag related to constipation for Hirschsprung’s disease?
Failure to pass meconium
What is the red flag related to constipation for hypothyroid and coeliac disease?
Faltering growth
What may you be concerned about in a child with a distended abdomen and constipation?
Hirschsprung’s disease, GI immobility or obstruction
What would you be concern about if a child with constipation and perianal fistula, accesses or fissures?
Crohn’s disease
What is used to treat constipation in children?
Movicol
What two causative pathogens may be responsible for a UTI in children?
E.coli or Klebsiella
What are the clinical features of a UTI in infants?
Fever, vomiting, lethargy, poor feeding/faltering growth, offensive urine, febrile seizures
What are the clinical features in a child (non-infant)?
Same as infant (Fever, vomiting, lethargy, poor feeding/faltering growth, offensive urine, febrile seizures) plus dysuria, frequency, abdominal pain, recurrent enuresis
What is enuresis?
involuntary urination - particularly at night
What is used to diagnose a UTI?
Urine dipstick (Urinalysis)
What is the first-line treatment for a UTI in children?
Trimethoprim (first-line)
For how long do you treat a lower UTI?
3 days
For how long do you treat a upper UTI?
7 days
What further investigations can you do for a child who gets UTIs?
Ultrasound of kidneys, ureters and bladder; MCUG - reflux into kidneys; DMSA - renal scarring; MAG3 - structure and blockage of kidneys
What is Pyelonephritis and what complications can It lead to?
Bacterial infection of the renal parenchyma which can lead to renal scarring, hypertension and chronic kidney disease
What is the pathophysiology of asthma?
Bronchial inflammation leading to bronchial hyper-responsiveness and airway narrowing
How is asthma diagnosed in children over 5?
Spirometry - bronchodilator reversibility demonstrated
What percentage improvement of what value demonstrates bronchiodilator reversibility?
12% improvement in FEV1
In a child what is the first step in treating asthma?
SABA e.g. salbutamol
In a child who is already taking a SABA what is the next step to control symptoms in asthma?
Add inhaled corticosteroids e.g. beclomethasone
In a child >5 who is already taking a SABA and inhaled corticosteroids, what is the next step in treating symptoms in asthma?
Long-acting corticosteroids e.g. salmeterol
In a child <5 years old who is on a SABA and inhaled corticosteroids what is the next step in treating symptoms of asthma?
Increase corticosteroids
In a child >5 years old who is on a SABA, inhaled corticosteroids and a LABA what is the next step in treating symptoms of asthma?
Increase inhaled corticosteroids
In a child <5 years old who is on a SABA and increased dose of inhaled corticosteroids what is the next step in treating symptoms of asthma?
Refer to paediatrician
In a child who is on a SABA, increased inhaled corticosteroids, LABA what is the next step in treating symptoms of asthma?
Introduce oral steroids (done by a specialist)
What is the management of a moderate acute exacerbation of asthma in a child?
SABA (2 puffs every 2 minutes up to 10 puffs), oral prednisolone (1 to 2mg per kg, up to 40mg)
What is the management for a severe acute exacerbation of asthma in a child?
SABA (10 puffs or nebulised), oral prednisolone or IV hydrocortisone, consider inhaled ipratropium or IV salbutamol, aminophyline or magnesium
What is the cause of Henoch-Schönlein Purpura (HSP)?
Unknown exact cause - often follows respiratory tract infection
What are the clinical features of HSP?
Fever, rash (buttocks, extensor surfaces, typically not trunk), joint pain Itypically knees or ankles), colicky abdominal pain, renal involvement (hameturia or proteinuria)
What investigations are done if HSP is suspected?
Urinalysis - check for renal involvement
What is the management of HSP?
HSP is self-limiting, renal follow-up needed to check renal function
What is the most likely diagnosis of the following: low-grade fever, headache, malaise followed by progressive swelling of one or both parotid glands?
Mumps
What is the most likely diagnosis: Fever, cough, coryza, conjunctivitis, generalised maculopapular rash starting several days after fever that starts behind the ears then spreads
Measles
What is the most likely diagnosis: Rash that appears on the face then spreads to the trunk and limbs with low-grade fever, sub occipital and posterior cervical lymphadenopathy, joint pains and conjunctivitis
Rubella (German Measles)
What is the most likely diagnosis: Flu-like symptoms, cervical lymphadenopathy, sandpaper-like rash on chest and abdomen with a strawberry tongue
Scarlet fever
What is the most likely diagnosis: polymorphous rash, cervical lymphadenopathy, strawberry tongue and cracked lips, Bilateral conjunctival injection with a fever
Kawasaki disease
What is the cause of Scarlet fever?
Group A Strep
What is the cause of Kawasaki disease?
Unknown - mix of genetic and environmental factors
What is the management of Kawasaki disease?
High-dose Aspirin, Iv immunoglobulins
What is the potential complication with the use of Aspirin in children?
Reye’s syndrome - damage to mitochondria can lead to brain and liver damage
What complications can occur from Kawasaki disease?
Inflammation of blood vessels leading to thrombosis, aneurysm formation and aneurysm rupture
What is the criteria for diagnosis of Kawasaki?
Fever lasting at least 5 days with four of the following: Bilateral conjunctival injection, change in mucous membranes, change in extremities, polymorphous rash, cervical lymphadenopathy
What is the treatment for mumps?
Supportive
What is the treatment for measles?
Supportive
What is the treatment for rubella?
Supportive
What complications can occur with mumps?
Painful testicular swelling, ovarian inflammation, acute pancreatitis, inflammation of the brain, hearing loss
What complications can occur with measles?
Diarrhoea, pneumonia, bronchitis, otitis media, brain inflammation, corneal ulceration
What problems can be seen in Congenital Rubella Syndrome?
Cardiac abnormalities (PDA is most common), cerebral, ophthalmic and auditory defects, prematurity with low birth weight, neonatal thrombocytopenia, anaemia and hepatitis
What infections are part of the TORCH syndrome/Complex?
Toxoplasmosis, CMV, Herpes simplex (plu syphilis, paravirus and varicella zoster)
What are the symptoms that occur with TORCH Syndrome/Complex?
Hepatosplenomegaly, fever, lethargy, difficulty feeding, anaemia, petechiae, Purpura, jaundice, chorioretinitis (inflammation of the chorioid and retina)
What is Juvenile Idiopathic Arthritis?
Persistent joint swelling, starting before the age of 16 that lasts for 6 weeks or more
In addition to joint swelling, joint pain, loss of movement and limp what other symptoms are there in JIA?
Systemic symptoms e.g. Generalised cervical lymphadenopathy, fever, malaise, pallor, reduced appetite
What is the management of JIA?
NSAIDs, analgesia corticosteroid joint injections, methotrexate, systemic corticosteroids, cytokine modulators e.g. anti-TNF
What is the carrier rate for cystic fibrosis?
1 in 25
What is the most common mutation in Cystic Fibrosis?
F508
How might someone with CF present as a Neonate?
Meconium ileus
How might someone with CF present as an infant?
Prolonged jaundice, faltering growth, recurrent chest infections, malabsorption, steatorrhoea
How might someone with CF present as a young child?
Bronchiectasis, nasal polyps, rectal prolapsed, sinusitis
How might someone with CF present as an older child or adolescent?
Diabetes mellitus, liver cirrhosis, portal hypertension, distal intestinal obstruction, pneumothorax, haemoptysis, sterility in males
What examination findings may you find in someone with CF?
Productive cough, hyperinflation of the chest, coarse inspiratory crackles, exploratory wheeze, finger clubbing
How is Cystic Fibrosis diagnosed?
High-risk babies identified through heel-prick test, confirmation is through sweat test and genetic testing
What is the other name for the heel-prick test?
Guthrie test
What is involved in the management of Cystic Fibrosis?
Physiotherpy, regular hypertonic saline nebuliser, nutritional monitoring, high calorie diet (150% of normal calorie intake), fat-soluble vitamins, treatment of complications and lung-transplant at end-stage
What is tested in the heel-prick/Guthrie test of a newborn?
1) Cystic fibrosis
2) Sickle cell disease
3) Congenital hypothyroidism
Inherited Metabolic Diseases:
4) Phenylketonuria (PKU)
5) Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
6) Maple syrup urine disease (MSUD)
7) Isovaleric acidaemia (IVA)
8) Glutaric aciduria type 1 (GA1)
9) Homocystinuria (HCU)
What is the most common cause of Congenital Hypothyroidism in the UK?
Dygenesis - the thyroid gland is not in the right position and does not function properly
What is the most common cause of Congenital Hypothyroidism worldwide?
Iodine deficiency
What are the features of Congenital Hypothyroidism?
Faltering growth, feeding difficulties, prolonged jaundice, constipation, large tongue, hoarse cry, goitre, delayed development, umbilical hernia
How is congenital hypothyroidism diagnosed and what would be seen on the blood tests?
Newborn screening (Guthrie test) - bloods would show high TSH level
What is the management of congenital hypothyroidism?
Levothyroxine
What is the potential complication that can occur with a child born with iodine deficiency?
Cretinism - severely stunted physical and mental development with learning difficulties, clumsiness, short stature and large tongue
What is the cause of congenital adrenal hyperplasia?
Autosomal recessive disorder (relating to adrenal steroid biosynthesis)
What are the physical signs of Congenital Adrenal Hyperplasia in females?
Virillisation of the external genirtalia (clitoral hypertrophy and fusion of the labia) - genital ambiguity
What are the physical signs for Congenital Adrenal Hyperplasia in males?
Enlarged penis with pigmented scrotum
When is Congenital Adrenal Hyperplasia typically diagnosed in females?
At birth due to genital ambiguity
When is Congenital Adrenal Hyperplasia typically diagnosed in males - why is it different to females?
When they present with salt-losing crisis or additional symptoms - due to less obvious genital changes it is often missed in males at birth
What are the symptoms of a salt-losing crisis due to Congenital Adrenal Hyperplasia?
Vomiting, weight loss, hypotonia, circulatory collapse (low sodium, high potassium with metabolic acidosis and hypoglycaemia)
What is the treatment for Congenital Adrenal Hyperplasia?
Life-long hydrocortisone and fludrocortisone if a salt-loser
What treatment is given for a salt-losing crisis?
IV sodium chloride, IV glucose, IV hydrocortisone
