Paeds Flashcards
All live vaccines can be given at any time before and after each other except which?
Vaccination with yellow fever or varicella/zoster requires a 4 week minimum between giving MMR.
Normocytic normochromic anaemia + arthralgia + raised ESR + fine “salmon pink” rash
Dx and Rx
JIA
Rx: NSAIDs
Consider DMARD eg. methotrexate if severe
RF+ve associated with worse prognosis
NB. Rash distinguishes JIA from other causes
Definition of SGA births
Birth weight <10th centile for gestational age
50-70% physiological; 30-50% IUGR
Post-partum complications of SGA babies
Hypoglycaemia (low glycogen stores)
NEC (bowel hypoxia)
Polycythaemia + thrombocythaemia
Hypocalcaemia (delayed vD pathway development)
Maternal IUGR RFs
Substance abuse eg. smoking
Congenital infection
Maternal age >40
10 year old boy with marble like swellings in neck and armpit
Lymphoma
NON-Hodgkins most common
Usual px: painless lymphadenopathy
B symptoms if more severe
10 year old with visual impairment and brown patches on skin
Optic glioma as manifestation of NF1 (cafeaulait spots)
Most common paed malignancy
Px?
ALL 2-5yo
Rash, anaemia, infections, HSM, LNopathy
CF complications
DM
Recurrent chest infection
Infertility
NASAL POLYPS
(not CKD)
Initial Rx of acute apiglottitis
Neb adrenaline
Headache -> chest infection Sx
Dx and Rx
Mycoplasma pneumonia
PO Erythromycin
DiGeorge S features
CATCH22 Cardiac anomalies Abnormal facies Thymic hypoplasia Cleft palate Hypocalcaemia + hypoPTH c22 deletion
IE. poor immunity to infection
NB. also get cognitive/behavioural/psych problems
When can a child:
- copy a cross
- copy a circle
- copy a square
- copy a triangle
- 3 years
- 4 years
- 4.5 years
- 5 years
How old can tell their age?
3 years
How old can enjoy symbolic play?
18-24months
Laryngotracheobronchiolitis Rx
aka. Croup
Rx: oral dex
Age for febrile convulsions
6mo-3yo
HSP features and Rx
Colicky abdo pain + palpable pruritic rash + arthritis
+/- haematuria, proteinuria
Rx: NSAIDs, roids
Asian/AfroCarrib
dark blue lesion on back/buttocks
present from birth
Dx and prognosis
Mongolian blue spot/slate grey nevus
Slowly resolve over first few years
Itchy annular lesions with central clearing
Tinea
Ddx: annular psoriasis
Immunodeficiency presdispositions: NP defect? T-cell defect? B-cell defect? Leukocyte defect? Complement/MAC defect?
NP defect: recurrent abscess and fungals
T-cell defect: severe or atypical viral/fungal
B-cell defect: severe bacterial, but not Neisseria meningitidis
Leukocyte defect: poor wound healing, skin ulcers
Complement/MAC defect: Recurrent Meningococcal disease
EEG centrotemporal spikes
Benign rolandic epilepsy of childhood
most common cause of childhood seizures
Hearing loss, developmental delay, CT intracranial calcificaiton
Congenital CMV
Hearing loss and prog renal disease
Alport’s sydrome
Hearing loss and goitre
Pendred syndryome (~hypothyroid)
What gestation at risk of RDS due to surfactant deficiency
<34/40
haematuria + resp infections at same time
IgA(t same time) nephropathy
6 week old with jaundice, umbilical hernia, dry skin
Hypothyroidism
often non-uk residents
First day new born jaundice. negative Coombs. Heinz bodies present
G6PD deficiency
Middle East/SE Asian/Mediterranean
Complications of cleft palate
Feeding Speech Hearing Ear infections Jaw development eg. displaced teeth (no ocular association)
Features of salicylate poisoning and sources
N+V
lethargy
Dizzy + tinnitus
Severe: hyperventilation, deafness
Sources:
aspirin
wintergreen oil eg. tiger balm, deep heat
Clumsiness
Poor coordination
Headache worse in morning
intracranial tumour
What is Reye’s syndrome
Life-threatening complication of viral infection, associated with use of aspirin
Fever, hypoglycaemia, hepatomegaly, deranged LFTs
(no jaundice)
Imaging in UTI guidelines
<6mo + recurrent or atypical UTI = USS during infection
<6mo and typical UTI = 6 week USS
<3mo = refer to paeds urgently
Newborn ALS compressions:breath ratio
3:1
FTT
Unwilling to breastfeed
Became blue on bottle
Congenital cyanotic heart disease
Most common organism of pneumonia in >2yo
Strep pneumoniae
APGAR score description
0/1/2
Appearance: cyanotic/peripheral cyanosis/pink
Pulse: 0/100/140
Grimace: No response/weak cry/cry
Activity: Floppy/some flexion/well flexed and resisting extension
RR: Apneic/slow irregular/strong cry
Paeds ALS - how to assess circulation?
Check brachial or femoral (not carotid) pulse for TEN seconds
Most common cause of NEWBORN intestinal obstruction
Hirschsprungs disease
3 days old, unable to feed, vomiting bile, “scaphoid abdomen”
Duodenal atresia - requires radiology to Dx
3 days old. Abdo mass, distension, passing meconium regularly, now blood PR
Dx, usual age, late signs
Intussusception
6-18mo but can present earlier
Bleeding per rectum: suggests mucosal necrosis “redcurrant jelly”
Sudden infant death:
- Major RFs:
- Other RFs:
Major RFs:
- Parental smoking
- Bed sharing
- Sleeping prone
- hyperthermia
- prematurity
Other RFs:
- winter
- multiple birth
- male
- maternal drug use
- social class IV or V
Commonest cause of death in 1st year
SIDS ~3months
NB. Screen all siblings for sepsis or inborn errors of metabolism
DDH RFs, Ix, Rx
RFs:
- FH
- Female
- First born
- Breech
- Oligohydramnios
- Birth weight <5kg
Ix: urgent hip USS
Rx:
- Usually spontaneously resolve in 3-6 weeks
- Pavlik harness if <5mo
- Consider surgery if older
Labial adhesions:
- age of presentation
- Rx
3mo-3yo
Rx:
- usually spontaneously regress around puberty
- if multi UTI, trial TOP Oes cream
- if fails, consider surgical
Nocturnal enuresis:
- age of presentation
- Rx
Should achieve incontinence at 3-4yo ie. abnormal if 5+
Rx:
- Look for possible cause eg. constipation, UTI, DM
- Advise on diet and toileting behaviour (do not restrict fluids)
- Trial reward system eg. star chart
- If fails:
• <7yo = enuresis alarm
• >7yo = trial of oral desmopressin (esp. if need short term control)
Who is offered HPV Vaccine (Gardasil) and when?
All boys and girls aged 12-13yo
2 doses
Kawasaki features + Rx
Fever >5 days Conjunctivitis Red, cracked lips Strawberry tongue Cervical LNopathy Red, peeling hands and soles
Rx: high dose aspirin, IVIg, Echo (to r/v coronary aneurysms)
Paediatric marks features
Strawberry naevus/capillary haemangioma:
o Small red patch develops in first month and increasing in size until around 9 months
o Rx: first line = propranolol
Mongolian blue spots: blue spots on buttocks and lower back, resolve by 1yo
Port wine stains: purplish/red macule with irregular contours – do not resolve ie. Cosmetics or laser therapy
Stork mark/salmon patch: vascular birthmark, self resolves
Carrier rate in CF
1/25
Perthe’s disease:
- age of presentation
- Rx
~4-8 yo
Rx:
- Keep femoral head in acetabulum ie. Cast, braces
- <6yo = conservative, unless severe deformity
- > 6yo = surgical
Paediatric BLS:
Start with 5 rescue breaths ->
Check for circulation ->
15:2 compressions
AR inheritance rule of thumb
Metabolic EXCEPT ataxias too
AD inheritance
Structural EXCEPT Gilbert’s, hyperlipidaemia type II
Responds to own name
9-12mo
Most common cardiac congenital abnormality in Downs Syndrome
AVSD
Presentation of HF in neonates
poor feeding/FTT
hepatomegaly
SOB
Paeds Px of hereditary spherocytosis
Jaundice, gall stones
Hepatomegaly
Splenomegaly
Aplastic crisis
Vitamin supplementation in paeds, what ages? what replace?
Vit A, C, D from 6mo-5yo
Headbanging. When concern? What may it suggest?
Normal up to 2yo
>3yo ?autism
Which metabolic disease does neonatal blood spot not test for?
galactosaemia
First line pharm Rx for paeds constipation
Movicol
Indication for admission for NG feed
Child feeding <50%
Scarlet fever features
o Fever
o Sore throat
o Strawberry tongue
o Rash: punctate/pinhead erythema on torso, spares palms and soles
Bowed legs in child should resolve when?
by 4yo
Risk of Downs Syndrome in pregancy depends on mother of age, how?
1/1000 at mother 30yo, divide by 3 for every 5 years
<3mo + >38 deg ?action
same day paeds assessment (do not Px Abx w/o source)
Coxsackie A16 ftrs
~hand, foot, mouth disease + mild systemic upset
Parvovirus B19
~Erythema infectiosum aka 5th disease aka slapped cheek syndrome
+ fever
Rubella ftrs
pink maculopapular rash on face then spreads + LNopathy
Child with squint ?action
Refer all children with squints to Ophthal
o UNLESS <3mo old
“mama/dada”
9-10/12
Overlapping bones and positional head moulding in newborn ?Action
Normal in newborn but document clearly for GP
Non-IgE mediated cows milk protein allergy ?Rx
initiate milk ladder with malted milk biscuits first
When should not have head lag?
~3mo
When crawl
8-10mo
Roseola infantum Px
Fever -> settles -> rash
Jaundice in first 24h DDx
Always pathological
- ABO/Rh haemolysis
- G6PD
- Hereditary spherocytosis
Jaundice in first 2-14/7 DDx
Common and physiological
- investigate if persists
Prolonged jaundice DDx
o Biliary atresia o Hypothyroid o Galactosemia o UTI o Breast milk o Congenital infection
Sit without support, when able? when refer if not able?
7-8mo
12mo
Noonan syndrome ftrs
o Pulmonary stenosis o Pectus excavatum o Ptosis o Short o Webbed neck
Pierre-Robin ftrs
o Cleft palate
o Posterior displacement of tongue
o Micrognathia
Recurrent sticky eye in neonates Dx and Rx
Congenital tear duct obstruction
Self resolves by 1yo ie. reassure
Tuberous sclerosis features
adenoma sebaceum
epilepsy
FGM and police
Refer all to police if <18yo
- does not apply for over 18s
