Paeds Flashcards
What does the placenta provide for the fetus in the blood?
Oxygen and nutrients
what is disposed of via the placenta (fetal->mother)
C02, lactate
what are the 3 fetal shunts?
Ductus Venosus
Ductus Arteriosus
Foramen Ovale
What 2 structures are connected by Ductus Venosus and what does it enable in fetal supply?
Umbilical vein - IVC
Enables blood to bypass the liver
What structures are connected by ductus arteriosus and what does this enable in fetal supply?
Pulmonary artery with aorta
Enables bypass of pulmonary circulation
what structures are connected by the foramen ovale and what does this enable in fetal supply?
R to L atria
Enables the bypass of the pulmonary circulation
What does the first breath lead to after birth re the foramen ovale?
expands the alveoli, decreases pulmonary vascular resistance>fall in pressure in RA > squash atrial septum - closure of Foramen Ovale.
What does the foramen ovale become after shutting
Fossa ovalis
After a few weeks
What causes the closure of the Ductus Arteriosus?
Increased blood oxygenation > drop in circulating prostaglandins > closure of DA -> ligamentum arteriosum
What causes the ductus venosus to stop functioning?
after birth, umbilical cord clamped - no flow in umbilical veins > structurally closes > ligamentum venosum
What are innocent murmurs?
What are they caused by?
Flow murmurs
Caused by fast blood flow through the heart during systole
What are the features of innocent murmurs (S)?
Soft Short Systolic symptomless situation dependent
Which features of a murmur would prompt referral to paeds cardio?
murmur louder than 2/6
diastolic murmur
louder on standing
failure to thrive, feeding difficulty, cyanosis, SOB
Investigating murmur in children:
CXR
ECG
Echocardiogram
What is split second heart sound?
Inspiration>chest wall/diaphragm pull lungs + heart open > negative intra-thoracic pressure > RA fills faster pulling blood from venous system > RV takes longer to empty > delay in closure of pulmonary valve - split sound
Atrial septal defect murmur?
mid-systolic crescendo-decrescendo at upper L sternal border
Fixed split second heart sound (insp and exp)
Patent Ductus Arteriosus murmur?
If significant - normal HS 1 + continuous crescendo-decrescendo machinery murmur - obscuring HS2
Tetralogy of Fallot murmur?
Pulmonary stenosis > ejection systolic murmur at pulmonary area
What is a Patent Ductus Arteriosus
DA fails to close after 2-3/52 life.
What causes PDA?
Genetic or maternal infection - rubella
Prematurity = RF
Presentation PDA
Mostly asymptomatic in children, especially if small PDA
Can present as heart failure in young adults
Pathophysiology PDA
L>R shunt (acyanotic)
Pulmonary HTN
RV hypertrophy
LV hypertrophy
When might a PDA be heard?
Newborn examination
How will PDA be picked up?
Murmur SOB difficulty feeding poor weight gain LRTIs
How is PDA Dx?
Echocardiogram
Mx PDA?
Monitored using echo <1yr
After 1yo, unlikely to spontaneously close
trans-catheter/surgical closure
In which part of the atrial septum lies the foramen ovale?
Septum secondum
What happens in an atrial septum defect?
Shunt - LA>RA (pressure gradient) -> right sided overeload, RH strain
RHF
Pulmonary HTN
Following an ASD what can pulmonary HTN eventually lead to?
Eisenmenger syndrome
What is Eisenmenger syndrome?
Pulmonary P > systemic P
Shunt reversal - R->L shunt
Cyanosis
Types of ASD
Ostium secondum
Patent Foramen Ovale
Oostium Prinum (->AVSD - cyanosis)
Complications of ASD
stroke due to VTE
atrial fibrilation / atrial flutter
Pulmonary HTN
Eisenmenger syndrome
How does ASD affect common DVT?
Commonly with DVT, embolises>travels to R side of heart and causes PE
With ASD - embolises>RA then LA then brain - stroke
How do ASDs commonly present
Antenatal scan / newborn examination
Presentation Atrial Septal Defect:
May be asymptomatic in childhood, present with dyspnoea/HF/stroke in adulthood
Symptoms Atrial Septal Defect childhood:
SOB difficulty feeding poor weight gain LRTIs acyanotic as L>R shunt
Mx of ASD
refer to paeds cardio
Asx -> watch and wait
Surgical closure - transvenous catheter closure
Open heart surgery
How to reduce the risk of cx of Atrial Septal Defects in adults
Anticoagulation - NOAC, aspirin, warfarin
which genetic conditions are VSDs commonly associated with ?
Down’s syndrome
Turner’s syndrome
What happens with VSD over time?
L>R shunting, right sided overload, RHF, Pulmonary hypertension
shunt reversal - Eisenmenger - cyanosis
How might VSD be picked up
Antenatal scan
newborn examination
may present in adulthood
VSD Symtpoms
poor feeding dyspnoea tachypnoea failure to thrive acyanotic as L>R shunt
VSD murmur?
Pan-systolic
systolic thrill on palpitation
causes of pan-systolic murmur?
Ventricular Septal Defect
Mitral regurgitation
Tricuspid regurgitation
Tx Ventricular Septal Defect?
Paeds cardio referral
Asx - w&w - spontaneous closure
Sx - transvenous catheter closure, open heart surgery
diuretics
What is there an increased risk of in Ventricular Septal Defect patients?
Infective endocarditis
Offer prophylactic Abx pre-surgery
When can Eisenmenger’s present?
1-2yo - large shunts
adulthood - small shunts
exacerbated by pregnancy
How does eisenmenger present?
Cyanosis
What does the cyanosis lead to in eisenmengers?
Bone marrow responds to low oxygen sats by producing more RBCs + Hb -> polycythaemia
What causes a plethoric complexion in eisenmenger’s?
Polycythaemia
Examination findings for eisenmenger’s?
RV heave
Loud HS2
Raised JVP
Peripheral oedema
Ex findings related to the chronic hypoxia of eisenmenger’s?
Cyanosis
Clubbing
Dyspnoea
Plethoric complexion
Mx Eisenmenger
Correct underlying abnormality
Once the pulmonary P>systemic P, not possible to medically reverse - Heart and Lung transplant
Supportive tx eisenmengers?
O2 Sildenafil - Pulm HTN Venesection - polycythaemia Anticoagulation - thrombosis prophylactic Abx - infective endocarditis
What is coarctation of aorta?
Congenital condition, narrowing of aortic arch around the ductus arteriosus
What underlying condition is coarctation of aorta commonly associated with ?
Turner’s syndrome
what is the effect on the arteries distal to the narrowing in coarctation of aorta?
reduced pressure to these arteries
Where will there be increased P in coarctation of aorta?
In the arteries proximal to the narrowing, commonly the heart and the first three branches
Presentation of coarctation of aorta?
weak femoral pulses
Ix Coarctation of aorta:
4 limb BP - high P in limbs supplied from arteries before the narrowing (arms), reduced P in limbs supplied from arteries after the narrowing
Systolic murmur
Coarctation signs in infancy
tachypnoea, increased wob poor feeding grey/floppy baby LV heave - (LV hypertrophy) underdeveloped L arm, legs acyanotic
Mx coarctation
most can live sx free until adulthood
severe cases - emergency surgery after birth
Sx - correct the narrowing, ligate the DA
While waiting for emergency surgery for coarctation correction, what tx can be given straight after birth?
Prostaglandin E - keeps DA open
How many leaflets make up the pulmonary valve normally?
3
In pulmonary valve stenosis, what happens?
leaflets form abnormally -> fusion/thickening -> narrow opening between RA and pulmonary artery
Pulmonary valve stenosis presentation:
mostly asx
murmur - newborn exam
fatigue on exertion, SOB, dizziness, fainting
Signs Pulmonary valve stenosis:
Ejection systolic murmur - pulmonary area
palpable thrill - pulmonary area
RV heave - RV hypertrophy
JVP up - giant a waves
Mx Pulmonary valve stenosis :
Paeds cardio
Asx - w&w
Sx - surgery - balloon valvuloplasty (via venous catheter)
Open heart surgery
Gold standard Ix Pulmonary valve stenosis:
Echocardiogram
pathologies coexisting in Tetralogy of Fallot:
VSD
Overriding Aorta
Pulmonary Valve stenosis
RV hypertrophy
What does overriding aorta mean:
Aortic valve enterance is displaced further to the right than normal, above the VSD
When RV contracts, greater proportion deoxygenated blood enters aorta
What symptom do overriding aorta and Pulmonary valve stenosis cause in ToF?
Cyanosis
Which way is the shunt in ToF?
R>L
causes cyanosis
degree depends on severity of Pulmonary valve stenosis
Risk factors for ToF
Rubella infection
maternal age>40
alcohol consumption in pregnancy
DM mother
Ix ToF
Echocardiogram
What shape is the heart in ToF on CXR?
Boot shaped - characteristic (due to RV thickening)
Presentation of ToF:
Antenatal checks
Newborn exam - ejection systolic murmur due to Pulmonary valve stenosis
HF<1yo
can present older
Signs and symptoms ToF:
Cyanosis Clubbing Poor feeding poor weight gain ejection systolic murmur Tet spells
What are Tet spells
During ToF, some infants have deep blue skin, nails, lips when agitated, increased CO2 causes this.
Also can lead to LOC, seizures, death
Tet spell - what can children do to help and why?
squatting in older children/knees to chest in younger - increases systemic vascular resistance - encourage blood to pulmonary vessels
Tet spell mx
Involve senior paediatrician supplementary O2 BBs IV fluids Morphine Sodium bicarbonate - met acidosis phenylpherine infusion - systemic vascular resistance up
Mx ToF neonates
Prostaglandin E infusion - maintain DA
total surgical repair - OHS
What is ebstein’s anomaly?
Congenital heart defect where tricuspid valve set lower in R side of heard (towards apex) + incompetent > larger RA, smaller RV
This leads to poor flow from RA>RV>pulmonary vessels
Which shunt is Ebstein’s anomaly associated with?
R>L shunting across atria via an ASD
Leads to cyanosis
Which other syndrome is Ebstein’s anomaly associated?
Wolff-Parkinson-White
How does Ebstein’s anomaly commonly present
Like HF - oedema Gallop rhythm heard on auscultation, +HS3+HS4 Cyanosis SOB, tachypnoea poor feeding collapse/cardiac arrest
how would ebstein’s anomaly present with an ASD
cyanosis and symtomatic a few days after birth - when DA (which has been compensating) closes
Ebstein’s anomaly: Ix
ECG - arrhythmias, RA enlargement, RBBB, left axis deviation
CXR - cardiomegaly, RA enlargement
Echo- Dx, severity
Medical management of Ebstein’s anomaly
tx arrhythmias, HF
prophylactic Abx for infective endocarditis
Definitive sx mx to correct underlying abnormality
What is transposition of the great arteries?
attachments of aorta and pulmonary trunk to the heart are swapped (transposed)
RV>aorta
LV>pulmonary vessels
In transposition of great arteries, which side of heart does systemic circulation flow?
Right
In transposition of great arteries, which circulation flows through L side of heart?
Pulmonary
which conditions are associated with transposition of great arteries?
VSD
Coarctation
Pulmonary stenosis
When is transposition of great arteries a problem?
Immediately after birth - no connection between systemic and pulmonary circulation > cyanosed baby
loud S2 is audible and a prominent right ventricular impulse is palpable
On what does immediate survival depend in ToGA?
Shunt between systemic>pulmonary circulation via PDA, VSD, ASD
How is ToGA usually diagnosed?
Antenatal USS
If doesn’t present at birth, what sx ToGA
cyanosis RDS Tachycardia poor feeding poor weight gain sweating
Mx ToGA
VSD enables time to plan definitive tx
Prostaglandin infusion - maintain PDA
Balloon septostomy - catheter Foramen Ovale via umbilicus to create an ASD
Definitive - OHS - arterial switch + correct other heart defects
what are causes of constipation in children?
Idiopathic or functional
secondary causes constipation paeds?
Hirschprung's disease CF Hypothyroid disease SC lesions sex abuse intestinal obstruction anal stenosis cows milk intolerance
what is the effect of breastfeeding on stools passed?
Variable - can be as little as one stool/week passed in breast fed babies
constipation sx:
<3 stools/week hard stools - difficult to pass rabbit droppings straining and painful passage abdo pain loss of sensation of needing to go
What posture may be seen in constipation?
Relentive posturing - holding abdo posture
What causes overflow soiling?
Faecal impaction - loose smelly stools
Examination of constipated child:
palpable hard stools in abdomen
lifestyle factors leading to constipation?
habitually not opening the bowels low fibre diet dehydration sedentary lifestyle psychosocial (safeguarding)
red flags constipation:
not passing meconium neuro sx vomiting ribbon stool abnormal anus/lower back failure to thrive acute severe abdo pain/bloating
what causes failure to pass meconium?
Hirschprungs (associated with downs)
CF
Meconium - when should it be passed and how does it look?
Before 48 hours (ideally in first 24 hours)
green n gross
Meconium aspiration
green liquor
neonatal distress
neonatal pneumonia
Seen in late babies >42/40
management meconium aspiration
suction
?Abx for pneumonia
Ribbon stool seen in?
Anal stenosis
Cx constipation:
pain reduced sensation haemorrhoids overflow/soiling psychological impact
Mx constipation in child
exclude red flags
lifestyle factors/diet
Movicol - first line
disempaction regimen - high dose laxatives at first
psych - schedule visits, bowel diary, star charts
What is GOR?
Gastro-oesophageal reflux is where stomach contents reflux into oesophagus, throat and mouth via the lower oesophageal sphincter
What is important about babies and the lower oesophageal sphincter?
It is immature in babies up to 1yr
presentation GOR in children under 1:
chronic cough hoarse cry distressed/crying/unsettled after feeding reluctance to feed pneumonia poor weight gain
In children over 1 how may GOR present
Similar to adults - heartburn, acid regurgitation, retrosternal/epigastric pain, bloating, nocturnal cough
vomiting causes paeds:
over-feeding GOR pyloric stenosis (projectile) gastroenteritis appendicitis UTI/tonsilitis/meningitis Intestinal obstruction BN
red flags vomiting child:
Not keeping any food down projectile/forceful vomiting bile-stained/green haematemesis/melaena abdo distension reduced consciousness/bulging fontanelle/ neuro sx resp sx blood in stool sx infection rash apnoea
Mx GOR paeds
conservative - reassurance small meals burping regularly not overfeeding upright posture after feed
Medical mx GOR
gaviscon with feeds
thickened milk/formula
ranitidine Omeprazole
If needed further Ix with GOR, what would you do?
barium meal
endoscopy
Sx fundoplication if severe
Sandifer’s syndrome - what is this?
Brief episodes of abnormal movements associated with GOR in infants
Torticollis
Dystonia - back arching
What is torticollis?
Forceful contraction of neck muscles > twisting of neck
West syndrome - what is key feature?
Infantile spasms,
Interictal EEG - hypsarrhythmia
mental retardation
Mx Sandifer’s?
Sx improve as GOR improves
Refer to specialist
What is pyloric stenosis?
Hypertrophy>narrowing of pyloric sphincter - prevents food travelling stomach>duodenum
Where is the pyloric sphincter?
Ring of smooth muscle forms the canal between the stomach and duodenum
What is paathophysiology of pyloric stenosis?
after feeding>powerful peristalsis of stomach>due to stenosis food>oesophagus>mouth>projectile
when does pyloric stenosis present?
First few weeks of life
Hungry, thin baby
features pyloric stenosis
failure to thrive
projectile vomiting
Ex/Ix Pyloric stenosis
Large olive felt in upper abdomen - peristalsis
Hypochloric metabolic alkalosis
Dx and Mx pyloric stenosis
USS for dx- thickened and elongated pylorus
Sx tx - laparoscopic pyloromyotomy (Ramstedt’s)
Presentation gastroenteritis
D/V/N
from stomach to intestines
ddx gastroenteritis
IBD Lactose intollerance Coeliac CF Toddler's diarrhoea IBS Iatrogenic - Abx
common viral causes gastroenteritis
Rotavirus
Norovirus
Adenovirus
E. coli as cause of Gastroenteritis?
faecal contact
0157>shiga toxin> haemolytic uraemic syndrome (HUS)
No Abx!!!
Traveller’s diarrhoea cause? Cure?
Campylobacter jejeni
gram -ve
ingestion
Azithromycin/ciprofloxacin
If gatroenteritis with a history of swimming pools, drinking water contamination?
Shigella
Shiga toxin>HUS
Azithromycin/ciprofloxacin
raw eggs/poultry/food contamination leading to gastroenteritis?
Salmonella
Abx if severe - culture dependent
CF diet mx
High calorie, high fat, pancreatic enzyme supplement with each meal
what is a poor prognostic factor in congenital diaphragmatic hernia?
Presence of liver in thoracic cavity
Lung:head <1
is there a risk of recurrence of CDH?
yes - depending on severity
which side is CDH more common?
Left (85%)
risks of CDH in future? (cx)
Pulmonary HTN
future children with CDH
Limping child, acute onset, viral infections ass., mild fever, well child, boys age 2-12
Transient synovitis
Limping child, very unwell, high fever
holding leg flexed, abducted and externally rotated
pain! warm jt to palpate
septic arthritis/osteomyelitis
painless limp indicates
JIA
neonate girl with disparity in skin creases behind L/R hips
Developmental dysplasia of hip
What is Perthe’s disease?
Avascular necrosis of femoral head
4-8yo
obese child, 10-15 years, 2/52 hx stiff hip/knee pain - no trauma
Slipped Upper Femoral Epiphysis
ix - 2 view both hips XR
Epistaxis in children causes:
nose picking
foreign body
URTI
Allergic rhinitis
Above what age are nose bleeds considered less sinister?
2yo
high fever lasting >5 days, strawberry tongue, red palms with desquamation, conjunctive infection, lymphadenopathy is:
Kawasaki’s disease
What type of disease is Kawasaki
Vasculitis
clinical dx
Mx kawasaki?
Aspirin - high dose
IV IG
ECHO
Main cardiac cx Kawasaki?
Coronary artery aneurysm
Normal social smile response at how many weeks old for normal milestones?
6-8/52
if prem + weeks prem on
Normal milestone: laughs?
3/12
When do babies become shy and take everything to their mouth (normal milestone)?
9/12
Milestone: puts hand on cup to drink
6/12
milestone: drinks from cup + uses spoon
12-15/12 up to complete competencty age 2
milestone: spoon + fork
3yo
milestone: knife and fork
5yo
helps get self dressed/undressed
12-15/12
removes shoe/hat
18/12
puts on shoes/hat
2yo
dresses independently apart from buttons/laces
4yo
Plays peekaboo milestone:
9/12
waves byebye and plays patacake
12/12
plays happily alone
18/12
plays near/not with other children:
2yo
plays with other children:
4yo
Causes of neonatal hypotonia?
neonatal sepsis
Wednig-Hoffman (spinal muscular atrophy 1)
hypothyroid
Prader-Willi syndrome
Down’s syndrome
cerebral palsy (hypotonia may precede the development of spasticity)
maternal causes neonatal hypotonia?
benzos
maternal MG
Haemophilia A: what type of genetic disorder is this?
X-linked recessive
factor VIII deficiency compared to HaemB IX def
What is the transmission rate of X linked if:
male has the disease, female is not even a carrier
0% chance
No male-male transmission as males always give Y to their sons
What is intussusception?
invagination of one portion of bowel into the lumen of the adjacent bowel
Clinical features: intussuseption:
paroxysmal abdo colic pain during paroxysm infant knees up, pale Vomiting blood stool - redcurrent jelly sausage shaped mass RUQ
Ix: intussusception?
USS - target shaped mass
Mx intussusception:
reduction by air insufflation under radiological control
Sx if peritonism
(pneumatic reduction under fluoroscopic guidance)
asthma mx: step 2 difference in <5, >5?
moderate paeds dose ICS <5,
low paeds dose ICS >5
Asthma management >5 steps:
- SABA
- low dose ICS
- LTRA
- LABA -LTRA
- switch ICS/LABA for MART
- moderate dose ICS MART
- high dose ICS, theophylline, expert
Transient tachypnoea of newborn: what increases the risk ?
Delayed reabsoprtion of fluid in lungs
CS increases risk
Ix/Mx TTN?
Ix - CXR - hyperinflation of lungs horizontal fissure
Mx - supplemental O2, usually resolves after 1-2 days
what disease makes children more likely to snore?
Down’s syndrome - sleep apnoea
due to low muscle tone of upper airways due to large tongue/adenoids
causes of snoring in children:
obesity nasal problems - polyps, deviated septum, hypertrophic nasal turbinates recurrent tonsilitis Down's syndrome hypothyroidism
which congenital heart defect is linked to taking Lithium in pregnancy>
Ebstein’s anomaly
Hirschprung’s disease: Dx test
rectal biopsy - full thickness
absence of ganglion cells from mysenteric and submucosal plexuses
If parents do not give consent, but intelligent and able under 16 wants sx, which you deem in her best interests, what can you do and who’s guidelines do you reference?
Gillick competency
If stable - written consent will do
If urgent - verbal consent ok
Which disease commonly presents as primary amenorrhoea? WITH GROIN SWELLINGS
Androgen insensitivity
What is the genotype of Turner syndrome?
45, X0
Short stature, shield chest and webbing of the neck is a presentation of?
Turner syndrome
Kleinfelter syndrome karyotype?
47 XXY
what is another way of describing primary hypogonadism?
Kleinfelter
Kleinfelter sx:
taller than average lack secondary sex characteristics small, firm testes infertile, gynaecomastia (risk male br ca) elevated Gonadotrophin levels
Kallman’s syndrome sx:
delayed puberty hypogonadism, cryptorchidism anosmia sex hormone levels low LH/FSH levels v low/normal normal/tall height
why is there delayed puberty in Kallman’s syndrome?
hypogonadotrophic hypogonadism
How is Kallman’s inherited?
X-linked recessive
type of vaccine in rotavirus?
Oral live attenuated
if mycoplasma pneumonia suspected as childhood pneumonia cause - what Abx?
erythromycin
cerebral palsy definition?
disorder of movement and posture due to non-progressive lesion of the motor pathways in the developing brain
commonest cause of Cerebral Palsy?
antenatal (80%) - cerebral malformation, congential infection (rubella, toxoplasmosis, CMV)
name some intrapartum causes of CP?
birth asphyxia / trauma
postpartum causes CP?
Intraventricular haemorrhage
meningitis
head trauma
clinical manifestation of CP?
abnormal tone in early development
not meeting motor milestones
abnormal gait
feeding difficulty
CP associated non-motor symptoms?
learning difficulties (60%) epilepsy (30%) squints (30%) hearing impairments (20%)
classes/types of CP?
spastic (70%) - hemiplegia, diplegia, quadraplegia
dyskinetic
ataxic
mixed
Mx CP?
MDT
tx spasticity in CP?
oral diazepam oral/intrathecal baclofen botulinim toxin type A orthopaedic sx selective dorsal rhizotomy
should children be excluded from school for head lice until tx starts?
no
do not treat household contacts unless they have it
other names for head lice
pediculosis capitis
nits
Mx nits?
malathian, wet combing
dimeticone,
isopropyl myristate,
cyclomethicone
which rash is characterised by a 3-5day high fever followed by a maculopapular rash starting on CHEST and spreads to limbs
Roseola Infantum
Herpes Virus 6
when does roseola infantum rash occur?
as fever is disappearing
‘slapped cheek syndrome’ - rash starts on cheeks then spreads - which rash?
Parvovirus B19
Group A strep - skin features?
cellulitis
erysipelas
impetigo
which cause of rash commonly leads to Koplik’s spots?
Measles
What is a: skull deformity producing unilateral occipital flattening, which pushes the ipsilateral forehead ear forwards producing a ‘parrallelogram’ appearance
Plagiocephaly
Mx plagiocephaly?
reassurance
normally resolves between 3-5
epistaxis, bruising, increased PT time ->
Acute Lymphoblastic Leukaemia
which diseases may show lowered erythrocytes and platelets?
Aplastic anaemia
Myelodysplasia
what is the commonest malignancy affecting children?
ALL
80% all childhood leukaemia
features of ALL caused by bone marrow failure:
anaemia (lethargy, pallor)
neutropenia (frequent, severe infections)
thrombocytopaenia (frequent bruising, petechiae)
other features of ALL:
bone pain
hepatosplenomegaly
fever, night sweats, wt loss, fatigue
testicular swelling
types of ALL:
common ALL - CD10 present, pre-B phenotype
T-cell (20%)
B-cell (5%)
poor prognostic factors for ALL:
age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers non-Caucasian male sex
what does genetic anticipation mean?
hereditary diseases have younger onset in each successive generation
give two examples of diseases with genetic anticipation?
Huntington’s disease
Myotonic dystrophy
what causes genetic anticipation?
trinucleotide repeats
name some examples of trinucleotide repeats?
Fragile X HD myotonic dystrophy spinocerebellar ataxia spinobulbar muscular atrophy dentatorubral pallidoluysian atrophy
Mx: croup
PO Dexamethasone
Pred if not availalbe
emergency croup tx?
high flow O2
nebulised adrenaline
croup also known as:
laryngeotracheobronchitis
eneuresis definition?
involuntary discharge of urine by day/night/both
eneuresis Mx
look for underlying causes
reward good behavior
alarm <7
desmopressin 7<
if newborn hearing screening abnormal, which test do they go on to have and when?
Auditory brainstem response test as newborn/infant
how is hearing assessed as part of the newborn hearing screening assessment?
Otoacoustic emmision testing
slipped upper femoral epiphysis (SUFE) Mx;
Sx: internal fixation across the growth plate
what does the Pontesi method tx?
Clubfoot
WHat does a Pavlik harness treat?
Developmental dysplasia of the hip
Risk with SUFE?
avascular necrosis of femoral neck
4 week old child comes with red rash on her scalp + yellow flakes - dx?
seborrhoeic dematitis
Mx of seborrhoeic dermatitis
baby shampoo/oils if mild
if severe - topical steroids - hydrocortisone 1%
why do children with CF get foul smelling stools?
steatorrhoea caused by pancreatic insufficiency
if there are 2+ responders to a paediatric life support emergency, how many chest compressions:ventilations
15:2
If on own, how many chest compressions:ventilations in paeds
30:2
how many rescue breaths are given in resus?
5
what is major risk factor for TTN?
CS
What is major risk factor for apsiration pneumonia?
meconium staining of amniotic fluid
major risk factor for Neonatal Respiratory Distress Syndrome?
Prematurity
what is linked with NRDS?
surfactant deficiency lung disease
Hirschprung’s disease presentation:
bilious vomiting,
abdo distension
constipation
failure to pass meconium first 2 days
first sign of puberty in girls:
breast development 11.5years
male first sign puberty?
testicular growth 12 years
SpO2<92% PEF<33% predicted silent chest poor respiratory effort agitation altered consciousness cyanosis
Life threatening asthma
Severe asthma sx:
SpO2<92% PEF 33-50% too breathless to talk/feed HR>125 >5yo HR>140 <5yo RR>30/40 o5/u5 use accessory muscles
coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine end inspiratory crackles
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
Dx?
Bronchiolitis
RSV
tx - supportive
when is peak incidence bronchiolitis?
3-6month
what causes orofacial clefts during pregnancy?
maternal anti-epileptics use
What tests are used to diagnose developmental dysplasia of hip in early childhood?
Barlow and Ortalani test
what is breech delivery a risk factor for in terms of gait abnormalities?
DDH
what type of pulse is associated with PDA?
collapsing
large volume, bounding
Left subclavicular thrill continuous machinery murmur large vol, bounding collapsing pulse wide pulse pressure having an apex beat present acyanotic ALL features of?
features of PDA
Mx PDA - medical?
Indomethacin - prostaglandin inhibitor closes the hole in most cases
surgical repair if failss
commonest cause of croup?
Parainfluenza virus
chest compressions for children of all ages should be at what rate?
100-120bpm
which murmur will change on variation of posture?
Benign ejection systolic murmur
which murmur is heard at lower Left sternal edge?
Still’s murmur
low-pitched
which murmur is heard as a continuous blowing out sound just below the clavicles?
Venous hums - turbulent flow in great veins returning blood to heart
risk factors for SIDS?
prone sleeping parental smoking bed sharing hyperthermia / head covering prematurity
jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma
hypernatraemic dehydration
Learning difficulties - ASD Macrocephaly Long face Large low set ears Macro-orchidism
Syndrome?
Fragile X
Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions Syndrome??
Patau syndrome
Which chromosome is Patau syndrome and what is the cause?
trisomy 13
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
Edward syndrome
Trisomy 18
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Noonan syndrome
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
Pierre - Robbins
Or Treacher- Collins
Differentiating between Pierre-Robin and Treacher-Collines
TC is AD so FHx positive
Hypotonia
Hypogonadism
Obesity
Prader-Willi
Ch15
What causes the problem in Prader-Willi?
loss of the paternal locus from Ch15
get most of their Ch15 from mother
What causes problem in Angelmann?
Loss of maternal locus from ch15
get most of their ch15 from dad
Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis elfin faces Syndrome?
William’s syndrome
Characteristic cry due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism
Cri du chat syndrome
genetic cause of cri du chat ?
ch5 p deletion
Micrognathism?
undersiezed jaw
small chin
hypertelorism
increased distance between two organs, typically refers to eyes
what is gastrochisis?
intestinal loops protruding through a hole in the abdomen to the left of the umbilicus.
Omphalocele?
intestinal loops protruding through a hole in the abdomen - through the umbilicus.
what is gastrochisis associated with ?
low socioeconomic
mat age<20, smoking, alcohol use
what is first line type of laxative in childhood constipation?
osmotic laxative
when is stimulant laxative used in constipation mx?
2nd line
commonest cause of hypothyroidism in UK?
autoimmune thyroiditis
3yo boy, 6/12 hx of chronic diarrhoea- 5-7 loose stools/day. contain ‘carrots, peas and sweet corn’ and generally undigested food.
growing well, stable on the 75th percentile on the growth chart for weight, height and head circumference. Otherwise well
Toddler’s diarrhoea
stools containing carrots and peas ->
Toddler’s diarrhoea
commonest cause diarrhoea in developed world
Cows milk intolerance
moderate vs severe croup differentiation?
severe: expiratory stridor marked sternal wall retractions severe agitation tachycardia cyanosis <1yo
Mx croup regardless of severity:
PO dexamethasone
if severe croup, what also can be mx:
nebulised o2, pred
On examination you note multiple vesicles over both palms and around the mouth. She is also pyrexial.
Disease?
Hand foot and mouth disease
What type of disease is hand foot and mouth?
Self-limiting viral illness
Mx hand foot and mouth?
Requires symptomatic treatment only
when might someone get Stevens-Johnson syndrome?
severe drug sensitivity reaction?
chickenpox school exlusion criteria - until when?
should be excluded until all lesions have crusted over (usually about 5 days)
mx chickenpox in children:
calamine cream
ADHD meds started in children: what needs monitoring?
height and weight 6/12
what is first line ADHD drug in children?
Methylphenidate
what are all ADHD drugs toxic?
cardiotoxic
baseline ECG
differentiate between epilepsy and reflex anoxic seizure?
rapid recovery RAS
why might neonate be jaundiced benign?
higher number of RBCs
shorter RBC lifespan
slower liver conjugation
why can unconjugated bilirubin pass the blood brain barrier?
lipid-soluble
what causes kernicterus?
deposition and accumulation of unconjugated bilirubin in the brain (BG)
how does kernicterus manifest?
hearing loss
irreversible brain damage, cerebral palsy
death
risk factors for abnormal bilirubin levels in neonatets?
- RBC breakdown
- acidosis
if a newborn develops jaundice in first 24 hours of life or has abnormally high unconjugated bilirubin levels, what should you do to mx?
Sepsis screen
blood group incompatibility
(both these increase RBC breakdown)
causes of jaundice linked to the liver’s ability to cocnjugate bilirubin?
G6PD deficiency
hypoxic liver injury
dehydration from poor feeding
intestinal pathologies/obstructions
Tx for hyperbilibrubinaemia?
Phototherapy - light to conjugate the free bilirubin and increase it’s secretion
if severe hyperbilirubinaemia, how do you treat?
exchange transfusion
episodic viral wheeze mx:
- symptomatic only
- SABA
- LTRA / PO ICS / both
up to what time period after a febrile convulsion is normal for a child to be drowsy?
1 hour
beyond this is not simple febrile convulsion
when do febrile convulsions normally occur?
early on in viral infection
how long do seizures last in febrile convulsion normally?
usually brief <5 mins
how would seizures in febrile convulsions typically be described>
Tonic clonic
which condition should you never do an airway examination if suspect:
Croup
can cause airway to obstruct
breastfed first 2/52 life before switched to formula. 6/52 hx regurgitation, vomiting, diarrhoea and eczema
cows milk protein intolerance
IX test for cows milk protein intolerance?
skin prick/patch testing
total IgE and specific IgE (RAST) for cow’s milk protein
in children with IgE-mediated CMPI - when will most children be tolerant?
55% by 5 years will be milk tolerant
In children with non-IgE-mediated CMPI - when will most children be tolerant?
3 years old
if want to perform a milk challenge in CMPI, where do you do this? why?
in hospital - risk of anaphylaxis
what should mothers who are breastfeeding child with CMPI do?
avoid dairy
what must you do as part of mx for whooping cough?
Notify Public Health England
household prophylaxis
Tx whooping cough?
if onset cough <21/7
PO macrolide
eg clarithromycin, azithromycin or erythromycin
complications of pertussis:
subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures
jittery and hypotonic baby may suggest?
neonatal hypoglycaemia
what is a maternal risk factor for neonatal hypoglycaemia?
Maternal labetolol for pre-eclampsia
neonatal hypoglycaemia causes?
maternal diabetes mellitus prematurity IUGR hypothermia neonatal sepsis inborn errors of metabolism nesidioblastosis Beckwith-Wiedemann syndrome
attempts to dislocate an articulated femoral head describes which neonatal examination?
Barlow test for DDH
DDH risk factors:
female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity
attempts to relocate a dislocated femoral head describes which neonatal exam?
Ortaloni test DDH
Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress should make you consider?
Diaphragmatic hernia
initial mx of diaphragmatic hernia in RDS resus?
intubate and ventilate
NG to keep air out of bowel
karyotype: Turner’s syndrome?
Is it an inherited condition?
X0, 45X
not inherited, random monosomy
short stature shield chest, widely spaced nipples webbed neck bicuspid aortic valve (15%), coarctation of the aorta (5-10%) primary amenorrhoea cystic hygroma (often diagnosed prenatally) high-arched palate short fourth metacarpal multiple pigmented naevi lymphoedema in neonates (especially feet) gonadotrophin levels will be elevated hypothyroidism horseshoe kidney
Turner’s syndrome
<16yo understands the professional’s advice
<16yo cannot be persuaded to inform their parents or allow the professional to contact them
<16yo likely to begin, or continue having, sexual intercourse with or without contraceptive treatment
unless they receives contraceptive treatment, their physical or mental health, or both, is likely to suffer
the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
Fraser guidelines
precocious puberty is the onset of 2nd sex charas before what ages in m and f?
9m
8f
commonest occular malignancy of childhood?
retinoblastoma
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems
retinoblastoma
mx retinoblastoma:
enucleation (removal of eye) - not only option
external beam radiation/chemo/photocoagulation
prognosis : retinoblastoma:
excellent, 90% live to adulthood
puffy swelling that usually occurs over the presenting part and crosses suture lines
Caput succedaneum
Caput succedaneum tx:
no tx
manage conservatively - resolves within days
Premature baby Intolerant to feeds Generally unwell Tender abdomen Absent bowel sounds Distended abdomen Blood in stools Peritonitis and shock
Necrotising enterocolitis
AXR:
dilated bowel loops (asymmetrical)
bowel wall oedema
pneumatosis intestinalis (intramural gas)
portal venous gas
pneumoperitoneum (from perforation)
air inside and outside of the bowel wall (Rigler sign)
air outlining the falciform ligament (football sign)
necrotising enterocolitis
when is MenB vaccines given?
2,4,12 months
what often preceeds ITP?
viral illness
schistocytes are often seen on blood smears?
Thrombotic Thrombocytopaenia Purpura
how many episodes vomiting before CT in children following a head injury?
3
Criteria for immediate request for CT scan of the head (children):
- LOC>5min witnessed
- Amnesia> 5 min
- Abnormal drowsiness
- Three + episodes of vomiting
- Clinical suspicion NAI
- Post-traumatic seizure, no Hx epilepsy
- GCS <14, or < 1 year GCS< 15
- Suspicion of open/depressed skull injury/tense fontanelle
- Any sign of basal skull fracture (haemotympanum, panda’ eyes, CSF leak from the ear or nose, Battle’s sign)
- Focal neurological deficit
- <1 year, presence of bruise, swelling/laceration of >5 cm on the head
- Dangerous mechanism of injury (high-speed RTA either as pedestrian, cyclist or vehicle occupant, fall from a height >3 m, high-speed injury from a projectile or an object)
systemic onset JIA also known as?
Still’s disease
still’s disease/JIA has characteristic rash?
Salmon-pink rash
JIA dx criteria (age and time course):
<16yo, >6wks
features of systemic JIA:
pyrexia salmon-pink rash lymphadenopathy arthritis uveitis anorexia and weight loss
Ix: JIA
ANA may be positive, especially in oligoarticular JIA (<4jts)
rheumatoid factor is usually negative
if a baby is born >36 wks with breech presentation, what follow up imaging does it need and for what?
USS 6 weeks, for DDH
itchy bottom but no other sx: what is wrong?
Threadworm infection
management of threadworm infection:
hygiene measures and single dose of mebendazole for all family
Dx: threadworms
sellotape attatched to perianal area to catch eggs and send for microscopy
what are trident hand deformity indicative of?
Achondroplasia
short limbs (rhizomelia), lumbar lordosis and midface hypoplasia
macrocephaly with frontal bossing
- which congential abnormality?
achondroplasia
sandle-gap in which syndrome?
downs
Achondroplasia inheritance?
AD
mutuation of FGFR3 gene causes?
achondroplasia
microcephaly causes?
normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis
what age says ‘mama’ ‘dada’
9-10/12
double syllable word milestone?
6/12
when will child know and respond to own name?
12/12
repeated flexion of head/arms/trunk followed by extension of arms repeated 50x is classical chracteristics of?
Infantile spasms
what is West syndrome?
Infantile spasms - salaam attacks
type of epilepsy
when is west syndrome commonly seen?
4-8/12
EEG: West syndrome
Hypsarrhythmia
West syndrome: mx and px
- vigabratin
ACTH also used
poor prognosis
Perthe’s disease in u6yo mx:
observations
Perthe’s disease in over 6 mx
surgical repair
hip pain: develops progressively over a few weeks
limp
stiffness and reduced range of hip movement
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
DX?
Perthe’s disease
Perthe’s disease cx?
osteoarthritis
premature fusion of the growth plates
What is the most important treatment for prevention of neonatal respiratory distress syndrome?
Administer Dexamethasone to mother
MMR how long wait between vaccines?
3 months to maximise uptake, if >10yo 1 month enough
If DDH suspected, what ix:
USS
A child aged < 3 months with a fever > 38ºC - initial mx step?
Refer for paeds assessment same day
Small testes in precocious puberty indicate :
adrenal cause
eg. adrenal hyperplasia
unilateral testes growth in precocious puberty indicate
gonadal tumour
bilateral enlargement testes in precocious puberty indicates:
gonadotropin release from IC lesion
advanced development in all areas and would be associated with a history of sexual aggression during childhood ??
testotoxicosis
talks in short sentences:
2.5-3yrs
vocab of 2-6 words:
12-18 months
Mx: Hirschprungs (definitive)
bowel ressection
eczema: first line tx:
topical emolients
what comes after topical emolients in step-wise mx of eczema?
topical steroids
If premature baby: wht is the timetable on vaccines?
give as normal, do not correct for gestational age
walks unsupported: age?
13-15/12
small umbilical hernia mx:
in under 1s, normall resove by 12/12 so watch and wait
what sx should parents be told about during watch and wait for umbilical hernia to seek medical attention if they see?
vomiting, pain and being unable to push the hernia in
newborn resus chest compression:ventilation ratio
3:1
if bronchiolitis sx but really high temp >39 - what should you consider?
pneumonia
short palpebral fissure thin vermillion border/hypoplastic upper lip smooth/absent filtrum learning difficulties microcephaly growth retardation epicanthic folds cardiac malformations
Fetal Alcohol syndrome
ask what and who questions?
3 years
Ask when and how questions?
4 years
combine 2 words: milestones
2 years
small cystic structure which has obviously been recently infected. On removal of the scab, there is hair visible within the lesion, what type of cyst?
Dermoid
where do dermoid cysts occur>
at sites of embryonic fusion
which cells do dermoid cysts contain?
multiple cell types - includes hair
Hirschprung’s disease AXR findings:
dilated loops of bowel with fluid levels. The anus appears normally located.
premature infant (30-week gestation) presents with distended and tense abdomen. She is passing blood and mucus per rectum, and she is also manifesting signs of sepsis.
Necrotising enterocolitis
newborn baby boy presents with gross abdominal distension. He is diagnosed with cystic fibrosis and his abdominal x ray shows distended coils of small bowel, but no fluid levels.
Meconium ileus
Lower UTI tx paeds
3/7 course Abx per local policy
what would clean catch sample show for a child with a suspected UTI?
positive for leukocytes and nitrates
Upper UTI tx paeds?
10/7 course Co-amoxiclav
what is commonest cause of cardiac arrest in paeds?
respiratory - hypoxia
causative organisms of meningitis in neonates-3months old?
GBS
E.Coli
Listeria
causative organisms of meningitis in 1/12-6yo ?
neisseria meningitidis
strep pneumo
haemophilus influenzae
causative organisms meningitis over 6yo?
neisseria meningitidis
strep pneumo
Bow legs in a child < 3 mx?
reassurance, likely to resolve in <4yos
what would blood gas of child with ?pyloric stenosis classically show?
elevated bicarbinate, hypochloraemia, hypokalaemia
causative organism acute epiglottitis?
Hib - thumb sign
2/12 old gradually worsening noisy breathing, worse on eating. lower centile for weight and poor food intake:
Laryngomalacia
never present at the start of the day after the child has woken
no limp
no limitation of physical activity
systemically well
normal physical examination
motor milestones normal
symptoms are often intermittent and worse after a day of vigorous activity
growing pains
rare cx of chickenpox?
pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox
arthritis, witis and pancreatitis may very rarely be seen
Vesicoureteric reflux: Ix:
micturating cystourethrogram - to dx
DMSA to look for renal scarring
in newborn exam, white-coloured nodule at the roof of the mouth. Dx:
epstein’s pearl
what is an epstein’s pearl?
congential cyst found in the mouth - no tx needed
when does heel prick test of newborns occur?
day 5
what does heel prick test test for?
CF,
congenital hypothyroidism,
sickle cell disease,
other metabolic diseases - phenylketonuria
for CF, what does the heel-prick test look for?
raised IRT (immunoreactive trypsinogen)
if heelprick shows raised IRT, what test should next be done?
sweat test to confirm for CF
>60
commonest cx of roseola infantum?
febrile convulsions
what can epstein’s pearls be mistaken for?
neonatal teeth
cx of undescended testes?
infertility
torsion
testicular cancer
psychological
mx undescended testes?
review at 3/12 old and refer to paediatric surgeon
orchidopexy
when will average child sit without support
6-8/12
nappy rash: in iritant dermatitis, where is characteristically spared?
creases/flexors
Typically an erythematous rash which involve the flexures and has characteristic satellite lesions
candida dermatitis
commonest cause nappy rash?
irritant dermatitis
mx nappy rash:
disposable nappies are preferable to towel nappies
expose napkin area to air when possible
apply barrier cream (e.g. Zinc and castor oil)
mild steroid cream (e.g. 1% hydrocortisone) in severe cases
mx nappy rash if ?candida dermatitis
topical imidazole,
no barrier cream
commonest cause of ambiguous genetalia in newborns?
congenital adrenal hyperplasia
which gender is phenotype in androgen insensitivity syndrome?
female
what underlying condition, dx in childhood could cause DM in teenager?
CF
when is first dose MMR given in UK
12-13/12
when is the second dose MMR given UK?
3-4 years
pre-school booster
Autosomal recessive conditions are generally affecting?
metabolic
Autosomal dominant conditions are generally?
structural
The abdominal film demonstrates a large soft tissue opacity (‘sausage-shaped’) in the left upper quadrant.
intussusception
Perthe’s disease more common boys/girls?
boys x5
1 month old baby girl presents with bile stained vomiting. She has an exomphalos and a congenital diaphragmatic hernia - ?
malrotation
risk of 40yo mother giving birth to a Down syndrome baby?
1/100
risk of 45yo giving birth to a down syndrome baby>
1/50
measles - immediate aftermath cx?
otoitis media pneumonia encephalitis febrile convulsion ketaroconjunctivitis diarrhoea appendicitis myocarditis
what cx might be seen 5-10 years after a measles infection?
subacute sclerosing panencephalitis
commonest presenting feature of a Wilm’s tumour?
abdominal mass
RUQ when lying down
smooth, non-tender
abdominal mass (most common presenting feature) painless haematuria no lymphadenopathy flank pain other features: anorexia, fever unilateral in 95% of cases
Wilm’s tumour
where does Wilm’s tumour most commonly metastasise to ?
lung (20%)
Mx : wilm’s tumour
nephrectomy
Chemo/RT
prognosis : Wilm’s tumour
good, 80% cure rate
what causes RDS in neonate with CDH?
pulmonary hypoplasia and hypertension
when should APGAR scores be tested for (eg. after CS for macrosomia)?
1, 5, 10 mins
APGAR score refers to ?
Appearance (colour) Pulse (heart rate) Grimace (reflex irritability) Activity (muscle tone) Respiratory effort
exomphalos?
protruding bowel
plan C-S 37/40 (within a membrane) - staged repair
optimal tx of protruding bowel?
staged closure immediately with completion at 6-12/12
why is there a gradual repair in exophalos?
to prevent respiratory cx
mx gastrochitis?
urgent correction (sx)
Osgood-Schlatter disease.
This condition occurs as a result of inflammation at which bony prominence?
Tibial tuberosity
commonest cardiac cx of Turner syndrome?
bicuspid aortic valve
this is commoner than coarctation of aorta
roseola school exclusion?
0 days
d/v school exclusion?
48 hours from symptoms ending
whooping cough school exclusion?
2 days after starting Abx or 3 weeks if no Abx given
scarlet fever school exclusion?
24 hours post Abx given
school exclusion - measles and rubella?
4 days from onset of rash
type of rash in hand foot and mouth disease?
25 mm scattered erythematous macules and papules, often with a central greyish vesicle.
which vaccine should be offered to babies with family history of TB or from high risk region/country with TB (defined as >40 cases/100000) as defined by WHO?
BCG vaccine for TB
which condition are nasal polyps associated with?
CF
peak incidence ALL?
2-5yo
RDS in prematurity - Cx?
retinopathy of prematurity
renal failure
what screening is part of the core Child Health Promotion Program as outlined in the Children’s National Service Framework?
newborn clinical exam,
newborn hearig test
5-day heel prick test
GP exam 6-8/52
can 14yo refuse tx?
no
what prodrome of raised temperature before the rash begins on the torso and face
chickenpox
when and how is vit K given to newborn?
soon after birth, PO/IM injection as a one off
hereditary sensorineural deafness children?
Usher syndrome, Pendred syndrome, Jervell-Lange-Nielson syndrome, Wardenburg syndrome
average child crawls:
6/12
average age: good pincer grip?
12 months
If no changes on ?Perthe’s disease - which is second line Ix?
MRI
Turner syndrome: murmur commonest?
ejection systolic heard loudest over aortic valve
when is Men C vaccine given?
12-15monthss
when is pneumococcal conjugate vaccine given?
3, 12 months
PCV
what vaccines are given at 2/12:
6-1 (dip, tetanus, pertussis, polio, Hib, Hep B)
PO rotavirus
PCV
MenB
cysts are usually multiloculated and heterogeneous. Most are located above the hyoid
Dermoid cyst
which neck masses are soft and transilluminate. Most are located in the posterior triangle?
cystic hygroma
which cysts are usually located laterally and derived from the second branchial cleft. Unless infection has occurred they will usually have an anechoic appearance on ultrasound?
brachial cysts
commonest cause of stridor in neonates?
laryngomalacia
what is a common complication of viral gastroenteritis?
lactose intolerance
haemorrhage mostly affects pre-term infants and can be diagnosed by ultrasound examinations.?
also causes seizures?
Intraventricular haemorrhage
what type of haemorrhage can follow the use of forcepts?
subdural
haemorrhages are common and may cause irritability and even convulsions over the first 2 days of life.?
subarachnoid
scaphoid abdomen
CDH
‘atrialisation’ of the right ventricle
ebstein’s anomaly
scarlet fever: causative organism?
group A haemolytic strep
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
'strawberry' tongue
rash - fine punctate erythema ('pinhead') which generally appears first on the torso and spares the palms and soles. Children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures. It is often described as having a rough 'sandpaper' texture. Desquamination occurs later in the course of the illness, particularly around the fingers and toesscarlet fever
if suspected NAI and mother is staying on the ward, what do you do?
listen to her concerns and share with her your concerns
Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of
shaken baby syndrome
left sided haematoma over the parietal bone. It does not extend beyond the margins of the parietal bone and is soft to touch
cephalhaematoma
what may develop as a cx of cephalhaematoma?
jaundice
mx: necrotising enterocolitis
broad spec Abx
cefotaxime, vancomycin
The initial management in Hirschprung’s disease
rectal washouts/bowel irrigation
blue-purple birthmark, often confused for bruising, that may be seen in children with darker skin tones
Mongolian blue spot
other name for mongolian blue spot?
congenital dermal melanocytosis
commonest cause of nephrotic syndrome in children?
minimal change glomerulonephritis (80%)
mx minimal change glomerulonephritis?
steroids
Nephrotic syndrome is classically defined as a triad of
:
proteinuria >1g/m2/24hrs hypoalbuminaemia <25g oedema frothy urine also hyperlipidaemia likely
to suggest septic arthritis, WCC and ESR would be:
WCC>12
ESR>40
what test is contraindicated in meningococcal septecaemia?
LP
name two examples of diseases caused by genetic imprinting?
Prader-Willi
Angelmann
umbilical hernia mx:
usually self resolve by 1, but if large or symptomatic, perform elective age 2/3
if small and aysmptomatic elective reapir 4/5 yo
regurgitation and vomiting diarrhoea urticaria, atopic eczema 'colic' symptoms: irritability, crying wheeze, chronic cough rarely angioedema and anaphylaxis may occur Dx?
cows milk protein allergy
10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?
within 2 hours take bilirubin serum level
what causes jaundice in first 24 hours?
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
how is jaundice described within 2-14 days?
physiological
what is prolonged causes of jaundice (>14 days old)
biliary atresia hypothyroidism galactosaemia urinary tract infection breast milk jaundice congenital infections e.g. CMV, toxoplasmosis
not showing signs of breathing at one minute. Heart rate is >100bpm, but he is floppy and cyanosed. What is the most appropriate next step in management?
5 rescue breaths via facemask
child < 3 years presenting with an acute limp: mx
urgent hospital assessment
when is Men ACWY given?
13-18 years
do antipyretics prevent further convulsions?
no
in which gender only do x-linked recessive diseases manifest?
males
what is important to remember about transmission in X-linked recessive diseases?
cannot be male-male (as father passes his Y-ch to son)
which diseases follow a maternal pattern?
mitochondrial - if male - no chance of passing it on
what type of disease is leber’s optic atrophy?
mitochondiral
In an infant, the appropriate places to check for a pulse are the
brachial and femoral arteries
G6PD deficiency - type of inheritance?
x-linked recessive
when a child with LD lacks capacity to consent, and treatment is in her best interest - how many parents need to consent?
1
first step in newborn resus for RDS as a fetus?
dry the baby
maintain temp and start the clock
why can bruising at birth lead to raised bilirubin?
haemolysis
when is jaundice always pathological?
in first 24 hours of life
in england, what rights to parents have regarding their children’s treatment:
can overule to consent to treatment in patient’s best wishes, cannot demand or refuse treatment
which heart defect is associated with fragile X?
mitral valve prolapse
Fragile X cx:
mitral valve prolapse, pes planus, autism, ADHD memory problems speech disorders
which lung disease is associated with Kartagener’s syndrome?
bronchiectasis
what can G6PD deficiency do to gallstones?
pigmented
where does measles rash start?
behind ears
11/12m ED - rash started 2 days ago, initially behind the ears but spread.
Pre-rash coryzal sx.
Irritable, has white spots in his mouth and his eyes appear inflamed.
measles
Koplik spots
10yom R knee pain. Past three months and lasts for several hours at a time. Antalgic gait and has apparent right leg shortening. What is the most likely diagnosis?
Perthes disease
Cyanosis or collapse in first month of life, hypercyanotic spells. Ejection systolic murmur at left sternal edge
ToF
early onset puberty in male where LH and FSH low:
gonadotrophin independent
eg. adrenal hyperplasia
parents should call ambulance if febrile convulsion lasts?
> 5mins
2/52 slow to establish on feeds. Past 7 hours he has been vomiting and the vomit is largely bile stained. On examination, he has a soft, scaphoid abdomen.
intestinal malroatation
scaphoid abdomen and bilious vomiting is highly suggestive of
intestinal malrotation and volvulus
1-day old emergency CS for RDS. Decreased air entry on L and displaced apex beat. scaphoid abdomen
CDH
Displaced apex beat and decreased air entry are suggestive of
CDH
before what age is hand preference abnormal?
12/12
what does early hand dominance suggest?
CP
what time period has to elapse before a child has another live vaccine after having one?
4 weeks
CI to MMR:
severe immunosuppression
allergy to neomycin
received another live vaccine by injection within 4 weeks
pregnancy should be avoided for at least 1 month following vaccination
immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)
if ?child abuse - what is likely RFs?
frequent A/E attenders - see different doc each time late presentation after injury hx child abuse in family torn frenulum poor weight gain
scarlet fever tx:
PO Penecillen 10/7
azithromycin
What is the most appropriate way to confirm a diagnosis of pertussis
Per nasal swab
Cyanotic congenital heart disease presenting within the first days of life is
TGA
Cyanotic congenital heart disease presenting at 1-2 months of age is
TOF
At what age do the majority of children achieve day and night time urinary continence?
3-4yo
if find abdo mass in GP OE, what is appropriate mx?
refer to local paeds department
6/52. term. has difficulty feeding due to increased wob. As the on-call doctor, you are called to review this baby. You witness the baby feeding and note she is pink and well perfused but sweating with an increased respiratory rate. On examination, you hear a soft pan-systolic murmur at the lower left sternal border.
What is the most likely underlying pathology? (general)
heart failure
neonate needing resus team input:
RR>60 grunting HR< 100 / >160 CRT> 3 seconds 38°C or above, or 37.5°C on 2 occasions 30 minutes apart sats below 95% presence of central cyanosis
do people with CMP allergy normally resolve?
55% IgE mediated resolve by 5yo
what needs monitoring every 6/12 in ADHD pts on methylphenydate?
height and weight
electrolyte abnormality seen in pyloric stenosis?
hypochloremic hypokalaemic metabolic alkalosis
APGAR score for newborns: 2 points for:
HR>100 Resp effort - strong, crying Colour- pink muscle tone - active movement reflex irritability - cries on stim/sneezes/cough
APGAR score: 1 point
HR<100 Resp effort - weak, irregular colour - body pink, extremities blue muscle tone - limb flexion reflex irritability - grimace
APGAR refers to:
Appearance Pulse rate Grimace? Activity Reflex irritability
what condition is Down’s syndrome commonly associated with ?
hypothyroidism
lesser risk of hyper
risk of T1DM
2-yom - not growing at the same rate as the other children.
Foul-smelling diarrhoea about 4-5 times a week, abdo pain.
Bloated abdomen and wasted buttocks. He has dropped 2 centile lines and now falls on the 10th centile.
Dx?
coeliac
coeliac Ix:
IgA TTG Abs
which vaccines at 12/12?
Hib/Men C + MMR + PCV + Men B
when is croup presentation more common (season)?
autumn months
UTI mx: infant <3/12
refer immediately to paediatrician
UTI: infant >3/12 mx:
admission to hospital
which pathogen commonly causes hand foot and mouth disease?
coxsackie a16
enterovirus 71
mild systemic upset: sore throat, fever
oral ulcers
followed later by vesicles on the palms and soles of the feet
hand foot and mouth
in phimosis, what should be avoided in younger children?
forcible retraction of the foreskin
in children <2, mx phimosis?
reassure and review in 6/12
in children this young this is normal and will commonly resolve on own
when does moro reflex typically disappear?
4/12
when does grasp reflex disappear?
5/12
when does rooting reflex (helps during breastfeeding) disappear?
4/12
when does stepping/walking reflex disappear?
2/12
why may people with Turner’s syndrome get X-linked recessive disorders?
only have 1 X Ch
what is Palivizumab and why is it sometimes given to prem babies?
Monoclonal Ab used to prevent RSV (bronchiolitis)
15yom knee pain
relieved by rest and made worse by kneeling and sports activities?
Osgood-schlatter
diagnostic Ix for NEC?
AXR
pathognomonic pneumatosis intestinalis (gas in gut wall)
healthy infant - 1 week old
what ranges should RR and HR be
RR: 30-60
HR: 100-160
which childhood infection has a prodrome characterised by fever, irritability and conjunctivitis?
measles
commonest cause of headache in children?
migraine
if 9/52 infant otitis media infection and temp >38 - mx
admit for paeds assessment
risk factors: red light for feverish child
- Pale/mottled/ashen/blue
- No response to social cues
- Appears ill to a healthcare professional
- Does not wake or if roused does not stay awake
- Weak, high-pitched or continuous cry
- Grunting
- Tachypnoea: respiratory rate >60 breaths/minute
- Moderate or severe chest indrawing
- Reduced skin turgor
- Age <3 months, temperature • >=38°C
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
if amber lights in feverish child: Mx:
safety net
distribution of eczema rash in 10/12 old:
face and trunk
homocystinuria: inheritance?
recessive
how to mx transient hypoglycaemia in hours after birth?
observe and encourage early feeding
which ix in <3/12 with fever :
Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present
what needs to be screened for in children with Downs who play sports?
atlanto-axial instability > neck dislocation
The oral rotavirus vaccine is given:
2+3 months
4M -ED. Limping for the past 48 hours and pain in his right leg. He is normally fit and well, although has recently recovered from URTI. His BMI ‘healthy’ range and there is no history of trauma. dx?
transient synovitis
undescended testicle - how long wait before referral?
6/12
if medical mx of NEC but deteriorates - sx mx?
laparotomy
Mx: meningitis in <3/12:-
IV amoxicillin and IV cetotaxime (not ceftriaxone in this age)
(covers for listeria)
Mx:meningitis >3/12:-
IV Cefotaxime
enlarging neck swelling that has been present for the past year. On examination you note a smooth midline lesion which is round and located just below the hyoid bone. It measures 2.5 cm x 2 cm and rises on protrusion of the tongue.
Thyroglossal cyst
ocated in the anterior triangle, and are usually in the midline and below the hyoid. Typically, the cyst rises on protrusion of the tongue as well as on swallowing.
thyroglossal
maternal steroid use in pregnancy increases the risk of:
DDH
belly button is always wet and leaks out yellow fluid. On examination, you note a small, red growth of tissue in the centre of the umbilicus, covered with clear mucus.
Dx?
umbilical granuloma
umbilical granuloma mx:
occurs in 1/5 babies resolves by 2yo
If constipation - chronic, tried movicol, next step?
add senna
X-linked recessive condition: mother is carrier, chances of passing it on?
50%
risk factors for surfactant deficiency lung disease?
male sex
diabetic mothers
Caesarean section
second born of premature twins
alpha-thalassaemia
deficiency in alpha chains of Hb
how many alpha globulin genes are located on the chromosome coding for them and which Ch is this?
Ch16
2 genes on each ch16
a-thalassaemia: If 1 or 2 alpha globulin alleles are affected then
hypochromic and microcytic, but the Hb level would be typically normal. ‘trait’
a-thalassaemia: if 3alpha globulin alleles are affected
hypochromic microcytic anaemia with splenomegaly. This is known as Hb H disease. jaundice
a-thalassaemia: if 4 alpha globulin alleles are affected:
(i.e. homozygote) then death in utero (hydrops fetalis, Bart’s hydrops)
ADHD: dietary advice?
normal balanced diet
unless food diary shows relationship
16-m - groin pain 3hrs. n+vomited x3. He recently had unprotected vaginal sex. Tenderness and swelling of the scrotum and left testicle, with absence of the cremaster reflex on the left side. Elevation of the affected testicle causes increased pain.
testicular torsion
phren’s sign postitive??
epididymitis - elevation of the testicle relieves the pain
newborn baby check shows jaundice - next appropriate step?
blood film
autism: epidemiology - sex and onset age?
males 75%
<3 yo
autism triad:
global impairment of language and communication
impairment of social relationships
ritualistic and compulsive phenomena
most children have reduced IQ
associated conditions of Autism:
fragile X
Rett’s syndrome
what needs measuring in jaundiced child urgently?
serum bilirubin level
how to measure obesity in children?
BMI percentile adjusted for age and gender
when can child use the palmar grasp?
5-6/12
when can child draw circle?
3yo
when can child stack tower of blocks 3-4 high?
18/12
6/12 from Bangladesh. 1/52 coryzal symptoms. Not been feeding well for the past two days and started to vomit today. Coughing bouts so severe he turns red. No inspiratory or expiratory noises are noted. Clinical examination reveals an apyrexial child with a clear chest. What is the most likely diagnosis?
Pertussis
hand foot mouth school exclusion?
no need
13yof. Her systolic blood pressure is <100mmHg, and her respiratory rate is raised. She has a suspected source of this infection (respiratory tract). pyrexial - 39. With these vital signs, ->
?sepsis
The most common fractures associated with child abuse are:
- Radial
- Humeral
- Femoral
5-year-old child presents to the emergency department complaining of right iliac fossa pain. On examination there is no rebound tenderness or guarding. Urine dipstick and routine bloods come back as normal. The mother reports that her daughter had a viral infection a few days ago.
mesenteric adenitis
what is mesenteric adenitis and how mx?
inflamed lymph nodes within the mesentery. Similar sx to appendicitis. It often follows a recent viral infection and needs no treatment
average child runs at what age?
16-24/12
average child rides a tricycle:
3 years
features of atypical UTI:
Seriously ill Poor urine flow Abdominal or bladder mass Raised creatinine Septicaemia Failure to respond to abx by 48 hours Infection with non-E. coli organisms.
4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face
scarlet fever
3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted
rubella
death is defined as babies dying between 0-28 days of birth?
neonatal death
Puerperal death
maternal death within the puerperal period <6/52
Perinatal death
deaths that are a result of obstetric events, the term encompasses stillbirths and deaths within the first week of life
An 8-M -> ED severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa.
Which of the above is most concerning?
normal pCo2 in an acute asthma attack is life-threatening
Life threatening asthma sx:
Cyanosis Poor respiratory effort Peak expiratory flow rate < 33% Silent chest Altered level of consciousness
Pain after exercise
Intermittent swelling and locking
Osteochondritis dissecans
transient synovitis mx:
analgesia and rest - it is self-limiting
cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?
Meckel’s diverticulum
describe Meckel’s diverticulum:
congenital diverticulum of the small intestine
remnant of the omphalomesenteric duct
contains ectopic ileal, gastric or pancreatic mucosa
mx: meckel’s diverticulum:
sx
Patients with cystic fibrosis should follow which lifestyle related rule??
minimize contact with eachother to decrease the risk of cross-infection
usually presents in childhood, e.g. Failure to thrive polyuria, polydipsia hypokalaemia normotension weakness
Barrter’s syndrome
AR
acute exacerbation of asthma: tx:
oral pred 3-5/7
Idiopathic thrombocytopenic purpura may be preceded by
a self-limiting viral infection (eg glandular fever)
addisons?
primary adrenal insufficiency
hypocortisolism
children below which centile for height should be referred to a paediatrician?
0.4th
most likely causative agent of a bacterial pneumonia in children
streptococcus pneumoniae
vocabulary of between 20-50 words and will be able to join 2 words with meaning. age?
24/12
4 week old formula fed infant to the short stay paediatric ward. They are concerned because he has persistent non-bilious vomiting and is becoming increasingly lethargic. Despite this, his appetite is substantial. On examination, he appears pale and you can see visible peristalsis in the left upper quadrant. What is the most likely diagnosis?
pyloric stenosis
14-month-old girl present to their GP. They have noticed that in some photos there is no ‘red eye’ on the left hand side. When you examine the girl you notice an esotropic strabismus and a loss of the red-reflex in the left eye. There is a family history of a grandparent having an enucleation as a child. What is the most likely diagnosis?
retinoblastoma
Retinoblastoma features:
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems
Mx: retinoblastoma:
enucleation
external beam RT
chemo
photocoagulation
average child hops on one leg?
3-4yrs
average child pulls to standing?
8-10/12
squats to pick up ball average age?
18/12
episodes of cyanosis are usually worst during feeding. Improvement may be seen when the baby cries
choanal atresia
choanal atresia:
Posterior nasal airway occluded by soft tissue or bone.
Associated with other congenital malformations e.g. coloboma
Babies with unilateral disease may go unnoticed.
Babies with bilateral disease will present early in life as they are obligate nose breathers.
Treatment is with fenestration procedures designed to restore patency.
what can cause bronchiolitis to be more severe?
underlying congenital heart condition (VSD)
what is worth being aware of re sats in first 10 mins of life?
often innacurate
DDH in a child >4.5 months: first line ix:
XRay
definition of short stature?
standing below the 2nd centile height for age
2 endocrine conditions that cause short stature?
hypothyroid
cushings
2 risk factors for prematurity?
Multiple pregnancy, pre-eclampsia, cervical insufficiency, uterine growth insufficiency, low socioeconomic status, APH
what criteria for child with special educational needs? (2)
physical disability preventing them from accessing education facilities
significant congnition difficulty in learning compared to majority of children their age
first trimester test for downs syndrome?
combined test
a 6-year-old child with a vesicular skin lesion underneath his nose with a honey coloured crust. During the consultation, the child rubs it and a lesion ruptures and fluid exudates. Dx and causative organism?
Impetigo
saureus/srep pyogenes
impetigo school exclusion?
until 48 hours after abx started or until the lesions have crusted over - incredibly infectious
impetigo abx?
topical fusidic acid is first-line
topical retapamulin is used second-line if fusidic acid has been ineffective or is not tolerated
if impetigo extensive disease, which abx?
flucloxacillin
HIV related organism pneumonia ?
pneumocystis jiroveci
how will bacterial meningitis show in CSF?
turbid
neutrophils
protein +++
glucose low —
viral CSF analysis?
clear
lymphocytes
normal or raised protein
normal or low glucose
causes of meningitis in newborns:
listeria monocytogenes,
Ecoli
GBS
causes of meningitis older children:
neisseria meningitdis
Hib
Strep pneumo
causes meningitis adults:
neisseria meningitidis
strep pneumo
listeria monocytogenes
if suspect bacterial meningitis in community: immediate mx?
IM benpen
which antibiotic prophylaxis for household contacts of bacterial meningitis patients?
Rifampicin
Ciprofloxacin
JIA mx:
NSAIDs MTX, sulfasalazine - DMARDS Atalidimab, Retuximab Steroids (cx) Joint injections
commonest cause of septic arthritis:
saureus
gonorrhoea (if sexually active)
Maculopapular rash ddx:
measles, rubella, scarlet fever, kawasaki
petechial rash ddx (non-blanching):
meningococcal
Henoch-schurlein purpura
thrombocytopaenia
pustular (hemispherical lesions, purulent fluid) ddx:
impetigo
scalded skin
what is a potential cause of aspirin in children ??
Reye’s syndrome
rash + vom ->
or blood in stool + vom ->
think CMPI
DKA sx:
abdo pain vomiting loss GCS polyuria hypokalaemia
Stridor: URTI?
yes
Wheeze: LRTI/URTI?
LRTI
risk factors for bronchiolitis?
prematurity
congenital heart defect
smoke, bottle fed, high exposure to other children in nursery
CF bacteria infections:
saureus
pseudomonas auriginosa
aspergillus
CF sx:
meconium ilius fail to thrive recurrent infections steatorrhoea neonatal jaundice bronchiectasis rectal prolapse
UTI in children causes:
ecoli
proteus
pseudomonas
UTI (lower) >3/12: mx:
trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
causes of proteinuria in children:
nephrotic syndrome
DM1
infetions
4 areas of development:
gross motor
fine motor and vision
speech language and hearing
social and play
when and how do you image to assess CP lesion?
MRI age 2
which abx would you give all premature babies in neonatal unit and what are you concerned about?
Benzylpenecillin - GBS -> neonatal sepsis
hypoglycaemic premature baby tx:
dextrose 10% + fluids
parenteral nutrition
how to assess jaundice in newborn?
SBR score
biliary atresia? when will it present and what type of bilirubin and what mx?
> 14 days - jaundice, appetite, growth disturbance
conjugated bilirubin
Kasai procedure
if Rh + baby born to a Rh - mother: blood is taken from the cord to sample for:
FBC
Blood group
Direct coomb’s test:
- looking for Rh Ags on RBCs
if blue sclera and many fractures in childhood ->???
osteogenesis imperfecta
wha is inheritance of OG imperfecta?
AD
what is childhood version of osteomalacia?
Ricket’s - vit D def
initial mx of the congenital heart condition hypoplastic left heart syndrome?
Alprostadil
2/7 hx fever, sore joints
migrants
post-viral illness
pain, swelling moves jt-jt radnomly
Rheumatic fever
Group A strep
what does anal fibroids and recurrent utis suggest in child?
child sex abuse
NF1: inheritance?
autosomal dominant
cafe-au-lait patches? 6+?
NF1
Tubular sclerosis inheritance?
autosomal dominant
ash leaf and shagreen patches in which condition?
tubular sclerosis
duchenne muscular dystrophy inheritance?
x-lined recessive
But female carriers can be symptomatic if lyonisation
test CK
(associated with dilated cardiomyopathy)
single palmar crease upslanting eyes flat nasal bridge large saddle gap. dx?
downs
abdo pain, purpuric (non-blanching rash), clinically well. rash on leg and buttocks. some arthralgia. dx?
HSP
thalassaemia iheritance:
recessive
complication of bacterial otitis media?
mastoiditis
rules for tonsilectomy?
> 7 /yr
5 /2yr
3 subsequent 3 yr
paeds acute asthma mx:
O SHImT o2 salbutamol Hydrocortisone / pred Ipratropium nebs Mg So4 Tube - intubate - anaes
inguinal hernia in 4/12M - mx?
surgical reduction <2/52
< 6 weeks old = correct within 2 days
< 6 months = correct within 2 weeks
< 6 years = correct within 2 months
A 1-day-old neonate is noticed to have non-projectile bilious vomiting. They were born at 39 weeks to a 47-year-old mother. At the 11-week scan the nuchal thickness was 4mm. What is the most likely underlying diagnosis?
bilious vomiting on day 1 = duodenal atresia
trisomy 21
AXR: double bubble sign
A male infant is born by spontaneous vaginal delivery at 39 weeks gestation. He is well after the birth, established on bottle feeding and discharged home. His parents are concerned because he subsequently becomes unwell and vomits a large quantity of bile stained vomit approximately 2 days after discharge home. Looks ill and his abdomen is soft and non distended. dx?
intestinal malrotation
A 2-year-old has a history of rectal bleeding. The parents notice that post defecation, a cherry red lesion is present at the anal verge. dx?
juvenile polyps
Start IV fluid resuscitation in children or young people with a bolus of?
20ml/kg <10mins
how to reduce the chances of severe brain damage in neonates with hypoxic injury?
therapeutic coolin 33-35 degrees
what is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis?
chickenpox
should be considered in infants with vague signs such as poor feeding, grunting, lethargy?
neonatal sepsis
most common presentation of neonatal sepsis?
grunting and other respiratory distress sx
children under 5 years old with diarrhoea and vomiting caused by gastroenteritis??
ors - never anti-diarrhoeals -> hus
steroids in <3/12 -
NO
