Paeds (ENT, Derm, MSK, Rheum) Flashcards
Tonsillitis Cause + Sx
S. Pyogenes =>
Fever Sore throat Diff swallowing/talking Drooling SOB
Tonsillitis Scoring
CENTOR Criteria
Abence of Cough
Tender, Cerv LN’s
White Exudate on Tonsils
Temp > 38
Tonsillitis Mx
Analgesia, Rest, Fluids
Delay ABx (Likely Viral)
If Bact confirmed: (CENTOR > 3): PO Phenoxybenzylpenicillin V (10 days)
Tonsillectomy Indications
Recurrent Tonsillitis (> 7/yr in 1yr, > 5/yr in 2yrs, > 3/yr in 3yrs)
Recurrent Tonsillar episodes
Enlarged Tonsils => Diff breathing/swallowing/sleeping (snoring)
Scarlet Fever Cause + Sx
(Group A, beta-Haem S. Pyogenes):
Fever
Sore Throat (Tonsillitis)
Bright Red, Itchy rash over Face + Body (1wk) (+/- Strawberry Tongue)
Scarlet Fever Mx
Rest, Fluids, Analgesia
Abx: Penicillin (Can return to school 24hrs after starting Abx)
Anti-Histamine
Hearing loss (< 3yo) Ix:
SN
CN
Mixed
(Chlidren < 3yo): Audiometry
Basic Resp to Sound (w/ results plotted on Audiogram)
SN loss:
Reduced AC + BC (=> AC > BC)
CN loss:
Reduced AC w/ Normal BC (=> BC > AC)
Mixed:
Reduced AC + BC w/ difference btw AC + BC > 15dB (AC > BC)
Cleft Lip/Palate Mx
Cleft Lip:
Surg at 3mo
Cleft Palate:
Surg at 6-12mo
Viral Examthemas: Chickenpox Measles Scarlet Fever Rubella Slapped Cheek D
Chickenpox (VZV):
Red, Painful, Itchy Vesicles
Measles:
Flat, Red, widespread (w/ Koplik spots - White, Inside of mouth)
Scarlet Fever (S. Pyogenes): Flushed cheeks, Strawberry tongue, Red, Rough vesicles (Sandpaper)
Rubella:
Mild, Erythematous rash
Slapped Cheek D (Parvovirus B19):
Diffuse, Bright red rash on cheeks,
Raised, Reticular (net-like), Itchy rash
Roseola Infantum Patho + Sx
Human Herpes V 6/7 =>
Sudden, High-fever (+/- Febrile Convulsions)
Mild, Erythematous, Non-Itchy rash
Hand, Foot + Mouth D Sx + Warning
Red Blistering spots on Hands/Feet
Small, painful mouth Ulcers
Avoid close-contacts (Highly Contagious)
Impetigo Patho + Sx
Highly contagious Superficial Bact Inf
=> Bullous: Large, Flaccid Bullae/Blisters => Burst leaving Crusty, Golden Patches (Systemic Sx)
=> Non-Bullous (No Systemic Sx)
Impetigo Mx
Self-isolate (Until lesions healed)
Non-bullous:
Antiseptic cream, Top Fusidic Acid
PO Flucloxacillin
Bullous:
PO/IV Flucloxacillin
Pityriasis Rosea Features
Herald patch (Circle/Oval) => Red, Itchy rash (Christmas tree distribution)
Scabies Sx + Mx
Sx:
Extreme Itching (esp at night)
Burrows along palm/soles
Close contact
Mx:
Permethrin cream
PO Ivermectin
Salter-Harris #’s Classification
- Straight Across
- Above
- Below
- Through Everything
- Crush
Limp Referral Criteria - 9
Child < 3yo Duration > 6 months Child > 9yo w/ restricted/painful Hip Unable to weight-bear Severe Pain/Agitation Neurovascular compromise Red Flags (Fever, Fatigue, Weight loss, Night Sweats, Inflamm or Persistent Pain) Suspicion of Abuse Deformity
DDH Patho + Sx
Abnormal development of Fetal (Hip) bones in Preg => Instability (+/- Subluxation/Dislocation)
Asymmetry (Hips, Leg length, Knee Height, Skin folds, Movements), Restricted Hip Abduct, Clicking (No USS needed), Clunking (USS needed) (+) Ortolani: Ant dislocation (+) Barlow: Post dislocation
DDH Ix + Mx
USS,
(If > 6mo: X-ray)
Mx:
Pavlik Harness 6-8wks (Holds Fem head in Acetabulum w/ Hips Flex + Abd)
If > 6mo or Harness failed: Surg w/ Hip spica cast
Transient Synovitis Patho + Sx
(3-10yo)
Temp Inflamm of synovium of Hip (Recent viral URTI) =>
Limp,
Groin/Hip Pain,
Refusal to weight-bear,
Mild low-grade Fever
Transient Synovitis Ix + Mx
Joint Asp (Excl SA, If purulent: Tx as Sepsis)
Mx:
Analgesia + f/up w/in 48hrs,
Self-resolve w/in 1wk),
(If < 3yo: Admit, If > 3yo: Safetynet
Perthes D Patho + Sx
(5-10yo): AVN of Fem Head => Deformity +/- Early OA:
Slow Onset Hip Pain (+/- Referred Pain to Groin/Knee)
w/ no Hx of Trauma
Limp, Restricted movement
Perthes D Ix
X-ray (AVN of Fem head +/- Normal bone),
CRP/ESR (Excl SA, JIA),
Technetium Bone scan
Perthes D Mx
Maintain healthy position (Bed rest, Traction, Crutches) PT (Reduce stress on Bone/Joint, maintain ROM) Reg Xrays (Assess healing) (If Severe/Non-healing/Older: Surg)
SUFE Eped, Patho, Sx
(Obese Male Adolescents undergoing growth spurt):
Fem head displaced from growth plate (Minor trauma) =>
Disproportionate Pain (+/- Limp) Restricted movement of Hip + Knee
O/E:
Hip held in Ext Rotat (Restricted Int Rotat)
SUFE Ix + Mx
X-ray (SUFE),
CRP/ESR (Excl SA/JIA)
Mx:
Surg (Reduce + Fixate Fem head)
Osteosarcoma Patho + Sx
(10-20yo, Cancer of Long Bones):
Persistent Bone Pain (esp at night => Waking)
Bone swelling (Palpable mass)
Reduced ROM
Osteosarcoma Ix
Persistent Bone Pain/Swelling =>
Urgent X-ray w/in 48hrs:
Poorly-defined lesions
Fluffy appearance (Cortical destruction)
Sunburst (Periosteal React: Irritation of Periosteum)
(Raised ALP)
Osteosarcoma Mx
(If X-ray (+): Urgent referral w/in 48hrs)
Surg resection (+/- Limb Amputation)
+/- Adj ChemoTx
Osteopenia vs
Osteomalacia vs
Osteoporosis
Osteopenia: Reduced Bone mass (Radiolucent on Xray)
Osteomalacia: Reduced Bone minerals w/ normal matrix
Osteoporosis: Reduced Bone matrix w/ (normal) minerals (=> Reduced Bone Mass)
(Minerals can only bind to matrix that is there)
Osgood-schlatters D Eped + Patho
(Adolescent males playing Sports):
Repeated stress + tension of patella tendon at tibial tuberosity whilst growing =>
Multiple small Avulsion #’s
Growth + Inflamm of Tibial tuberosity => Hard, painful Lump
Osgood-schlatters D Sx
Gradual Hx of (Visible/Palpable) Hard, Tender lump at Tibial tuberosity
Ant Knee Pain (Exacerbated by Activity, Kneeling, Ext of Knee)
Osgood-schlatters D Mx
Rest, Ice, Cool Compression, Elevation
NSAIDs,
(Stretching + PT),
If Full Avulsion #: Surg
JIA Criteria
Auto-Immune Inflamm in Joints > 6wks
< 16yo
All other causes Excl (SA)
HSP Patho + Sx
Henoch-Schönlein Purpura: (IgA Vasculitis triggered by URTI/Gastroenteritis) =>
Palpable purpura (Buttocks/LL -> Trunk + Arms) Diffuse Abdo Pain (GI Haem, Infarct, Intussusception) Arthritis/Arthralgia (Knee/Ankle) IgA deposits (=> Haematuria/Proteinuria +/- Nephrotic Synd)
Kawasaki D Patho + Sx
(Med V Vasculitis in Boys < 5yo)
Persistant High Fever > 5 days,
Rash,
Lymphadenopathy
Widespread Erythroderma (w/ peeling on soles of feet/hands)
(+/- Strawberry Tongue, Bilat conjunctivitis, Arthralgia)
Kawasaki D Ix
FBC (Anaemia, Raised WBC’s/Plt’s), Raised CRP/ESR, LFTs (Raised ALT/AST, Low Alb), Urinalysis (Raised WBC’s w/out Inf), Echo (Coronary A Aneurysm)
Kawasaki D Mx
High-dose Aspirin (Reduce risk of VTE),
IVIg (Reduce risk of Coronary A Aneurysm),
Reg Echo monitoring
Rheumatic Fever Patho + Sx
(Type 2 Hypersensitivity React 2-4wks Post-strep Tonsillitis) =>
Fever SOB Rash (Pink rings on torso) Chorea Migratory Arthritis (affects Large Joints) Firm, Painless Nodules over Ext Surfaces Carditis (+/- Mitral Valve D)
Rheumatic Fever Ix + Scoring
ASO titres Jones Criteria (2 Maj, 1 Maj + 2 Min)
Rheumatic Fever Mx + Monitoring
NSAIDs,
Aspirin + Steroids (Tx Carditis),
Prophylactic Abx (Prevent recurrence)
Monitor for:
(Rheum Fever),
Valvular HD (Mitral Stenosis), Chronic HF
