Paeds Flashcards
Milestone: mature pincer grip
9-12 months
Milestone: walking
18mo (red flag age)
Which food comes with a risk of infant botulism and therefore should be avoided before 12months?
Honey
Milestone: hop
4yr
Symptoms of lactose intolerance
Loose stools which can be foamy or watery
Painful poos - burn due to acidity
Abdominal bloating
Gurgling stomach
Characteristics and genetics of Kleinfelters
47XXY
Tall stature Sparse facial/body hair Gynaecomastia Infertility Learning difficulties Small testicles (due to hypogonadism)
Vaccines at 8 weeks
6 in 1: DTaP, polio, HiB, hepatitis B
Meningitis B
Pneumococcal conjugate (PCV)
Rotavirus (oral)
Vaccines at 12 weeks
6 in 1: DTaP, polio, HiB, hepatitis B
Rotavirus (oral)
Vaccines at 16 weeks
6 in 1: DTaP, polio, HiB, hepatitis B
Pneumococcal (PCV)
Meningitis B
Vaccines at 1 yr
HiB and MenC
Pneumococcal (PCV)
MMR
Meningitis B booster
Vaccines at 3yr 4mo
DTaP + polio
MMR
Vaccines at 14yr
Diphtheria, tetanus and polio
MenACWY
Vaccines offered to 65yr
Influenza - inactivated
Pneumococcal polysaccharide vaccine (PPV)
Vaccines offered at 70yo
Shingles
Two types of pneumococcal vaccine and when they are given
Pneumococcal conjugate vaccine (PCV) - 8wk, 16wk, 1yr
Pneumococcal polysaccharide vaccine (PPV) - 65yr
Contents of 6-in-1 vaccine and when it is given
DTaP - diphtheria, tetanus and pertussis
Polio
Hepatitis B
HiB
given at 8wk, 12wk, 16wk
When is temperature concerning in children?
> 38 degrees in <3mo
3-6mo and >39 degrees
Temperature for more than 5 days
Temperature under 36 degrees and checked 3 times
Age range most affected by croup?
6mo-6yr
Acute Epiglottitis age range
1-6yr
FeverPAIN score components and interpretation
Fever - in past 24h Purulent Tonsils Attend within 3 days Inflamed tonsils No cough/coryza
1 for each
0-1 = no abx
2-3 = consider delayed prescription
4-5 = consider ab
3 drugs used in anaphylaxis
Adrenaline
Chlorphenamine
Hydrocortisone
2 tests for DDH
Barlow’s test = flex hip and knee, push posteriorly to dislocate
Ortolani test = attempt to reduce the dislocation
Newborn exam: describe findings that may be present when examining the genitalia
Female = clitoromegaly in congenital adrenal hyperplasia
Male - epispadia = defect on dorsal surface, hypospadia = defect on the ventral surface
Undescended testes
Craniofacial abnormalities in Down’s Syndrome
Round face Epicanthic folds Flat nasal bridge Flat occiput and third fontanelle Upslanted palpebral fissures Small ears Brushfield spots in the iris Protruding tongue
Non-craniofacial abnormalities in Down’s Syndrome
Short neck Single palmar creases Incurved and short 5th finger Sandal gap between 1st and 2nd toe Congenital heart defects Duodenal atresia
Most common pathogens in neonatal sepsis
<5 days = maternal floria e.g. E.coli, GBS
>5 days = above plus S. aureus
Define early and late neonatal sepsis
Early - 0-7 days
Late - 7-28 days
Management of neonatal sepsis
<5 days = benzypenicillin (covers GBS), gentamicin (covers E. coli)
> 5 days = as above but plus flucloxacillin for s aureus
Stages of HIE
Stage 1 / Mild –> irritability, hyperventilation, overstimulated, hypertonic
Stage 2 / Moderate –> movement abnormalities, hypotonia, seizures
Stage 3 / Severe –> no spontaneous movements, fluctuating hypo/hypertonia, seizures, multi-organ failure
Management of HIE
Resuscitation
Anticonvulsant
Cooling - to reduce brain damage, especially for moderate-severe HIE
Which babies are at risk of intraventricular haemorrhage?
Preterm babies, especially <30 weeks
How does intraventricular haemorrhage lead to hydrocephalus?
Bleeding into ventricles Ventriculomegaly Blood products block the arachnoid granulations Build up of fluid Hydrocephalus
Aetiology of ARDS
Surfactant deficiency as this is not made until 34 weeks gestation, so significantly preterm babies are affected
Leads to alveolar collapse and prevents gas exchange
Diagnosis of ARDS
Clinical signs
Ground glass CXR
Management of ARDS
Respiratory support e.g. CPAP
Surfactant therapy
Maternal steroids before delivery - prevention
Which babies are affected by transient tachypnoea of the newborn
- C sectioned babies
- Fast delivery
This is due to reduced stress hormones during the delivery which are needed to help the baby clear its lungs
Diagnosis of TTN
Tachypnoea - >60breaths/min
CXR - lung hyperinflation, fluid in horizontal fissure of R lung
When should TTN resolve by?
Within 3 days
Clinical features of necrotising enterocolitis
- Intolerance to feeding
- Vomiting bile
- Bloody stools
- Shiny distended abdomen
- Shock
Maintenance fluid in children
100ml/kg for first 10kg
50ml/kg for next 10kg
20ml/kg for every kg after
0.9% saline with 5% glucose +/- 20mmol/L KCl
Deficit/replacement fluid calculation in children
Weight x % dehydration x 10
Fluid bolus calculation in children
20ml/kg - sepsis/shock
10ml/kg trauma /DKA
Genetic pattern and pathophysiology of Duchennes muscular dystrophy
X-linked recessive (so mainly affects men) mutation of dystrophin gene which forms part of muscle cell cytoskeleton, leading to myofibre necrosis (hence raised CK)
Symptoms and signs of Duchennes muscular dystrophy
Waddling gait Slow running Delayed walking Pseudohypertrophy if calves Learning difficulties
Growers sign - difficulty getting up from floor, children roll prone and walk up their legs
Diagnosis of Duchennes
- CK raised - should be done on every boy not walking by 18 months
- genetic testing
Heelprick test is for…
- Sickle cell disease
- Cystic fibrosis
- Congenital hypothyroidism
Then 6 inherited metabolic disorders
- Phenylketonuria
- MCADD
- Maple syrup urine disease
- Isovaleric acidaemia (IVA)
- Glutaric Aciduria type 1 (GA1)
- Homocysteinuria
