Paeds Key Points Bank Flashcards
Threadworms
Perianal itching at night
Mx
- single dose of mebendazole for whole family and hygeine advice
ASD
Fixed splitting of 2nd heart sound
VSD
Pansystolic murmur in lower left sternal edge
Coarctation of the aorta
Crescendo-decrescendo murmur in upper left sternal edge
PDA
Continuous machinery murmur in upper left sternal edge
Pulmonary stenosis
Ejection systolic murmur in upper left sternal edge
Venous hum (Innocent murmur)
Sounds like blowing through nose below both clavicles
Still’s murmur (Innocent murmur)
Low pitched heart sound at lower left sternal edge
Roseola infantum
HHV6
6 months - 2 years
High fever comes and then goes and then a maculopapular rash develops
Diarrhoea, cough
Associated with aseptic meningitis and hepatitis
Laryngomalacia
4 weeks old with stridor
Mx
- self resolves by 2 years old
- if failure to thrive or breathing problems then surgery
Commonest cause of headaches in children
Migraine without aura
Mx
- ibuprofen, sumitriptan nasal spray
- pizotifen and propranolol prophylaxis
Infantile spams (West syndrome)
4-8 month old boy
Flexion of head trunks and arms followed by extension of arms (salaam attack) and hypsarrythmia on EEG
Poor prognosis
Mx
- vigabatrin
CF + Hirschprung
Meconium ileus
Infantile colic
Inconsolable crying, drawing up knees, flatus
Crying starts and stops for no reason that lasts for >3 hrs a day for >3 days a week for >1 week
Congenital cataract
No red reflex at birth
Retinoblastoma
Red reflex present at birth but not at around 18 months
Seborrhoeic dermatitis
Scalp (cradle cap), nappy area, flexures
Mx
- mild - baby shampoo/oils
- severe - mild topical steroids (1% hydrocortisone)
Hand Foot and Mouth Disease
Coxsackie A16
Maculopapular rash in mouth, palms and soles, groin and buttocks
Sore throat and low-grade fever
Paediatric BLS
Patient not breathing –> 5 rescue breaths –> assess circulation –> not breathing + no pulse –> CPR at 15:2
Jaundice
<24 hours - always pathological - ABO/rhesus haemolytic disease, hereditary spherocytosis, G6POD deficiency
2-4 days - common - physiological
>14 days - biliary atresia (high conjugated bilirubin), hypothyroidism, galactosaemia, UTI, congenital infection, breast milk jaundice
Ix for >14 days - conjugated and unconjugated bilirubin, direct antiglobulin test, TFTs, FBC, blood film, urine for MC&S and reducing agents, U&Es and LFTs
Development dysplasia of hip
RFs - female, breech, firstborn, birth weight >5kg, family history
Measles
Prodrome - fever, conjunctivitis
Koplik spots (white spots on buccal mucosa)
Rash - starts behind ears then to whole body, discrete maculopapular rash becoming blotchy and confluent - initially blanching, becomes non-blanching later
Fever persists during the rash
Mumps
Fever, malaise, muscular pain
Parotitis - initially unilateral and becomes bilateral
Rubella
Pink maculopapular rash, initially on face spreads to whole body and usually fades by the 3-5 day
suboccipital and postauricular lymphadenopathy
Congenital rubella
Sensorineural deafness, congenital cataracts, PDA, glaucoma
Congenital toxoplasmosis
Cerebral calcification, chorioretinitis, hydrocephalus
Congenital CMV
Growth retardation, purpuric skin lesions
Nocturnal enuresis
Involuntary urination in a child aged 5 years or older, with no congenital or acquired defects of the nervous system or urinary tract
Mx
- look for underlying causes (constipation, diabetes mellitus, UTI if recent onset)
- advise on fluid intake, diet and toileting behaviour
- reward systems
- <7 - enuresis alarm
- >7 - desmopressin if needed in short term or alarm is not working
Pyloric stenosis
2-4 weeks old, M>F
Hypertrophy of the circular muscles of the pylorus
Projectile vomiting 30 minutes after feeding
May see a palpable mass in the upper abdomen or peristalsis in LUQ
Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
Diagnosis by USS
Mx
- Ramstedt pyloromyomotomy
ADHD
Characterised by extreme restlessness, poor concentration, uncontrolled activity and impulsiveness
M>F
Mx
- refer to CAMHS
- food diary to look for link between food and behaviour
- methylphenidate - monitor growth, psych symptoms and BP every 6 months
Umbilical hernia
Common, no treatment required
Usually resolve by 3 years
Associated to Down’s syndrome
Early onset neonatal sepsis (<48 hours)
GBS - bacteraemia, joint infections, meningitis –> benzylpenicillin
E. coli - menigitis, UTI –> gentamycin
Listeria –> ampicillin
Late onset neonatal sepsis (>48 hours)
Apnoea, poor feeding, respiratory distress, convulsions
GBS, e. coli, listeria, staph aureus, enterococci, citrobacter koseri, candida
Mx
- flucloxacillin + vancomycin –> piperacillin/tazobactam + vancomycin
- community acquired - cefotaxime + amoxicillin + gentamycin
Marfan’s syndrome
Autosomal dominant
Tall, pectus excavatum, scoliosis, repeat pneumothoraces
Down’s syndrome
Trisomy 21
Upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small ears, single palmar crease, hypotonia, congenital cardiaac abnormalities (tetralogy of fallot), duodenal atresia, Hirschsprung’s disease
Turner syndrome
45, XO
Short, shield chest, widely spaced nipples, webbed neck, bicuspid aortic valve, coarctation of the aorta, primary amenorrhoea, cycstic hygroma, high arched palate, multiple pigmented naevi
Increased risk of autoimmune disease
Associated with haemophilia
Erythema infectiosum
Parvovirus B19
Slapped cheek rash spreading to proximal arms and extensor surfaces
Lethargy, fever, headache, coryza
Scarlet fever
Group A Streptococcus
Strawberry tongue, fever, malaise, tonsilitis
Rough sandpaper rash (fine punctate erythema) sparing the face
Chickenpox
Initially fever
Itchy papular rash starting on head/trunk before spreading and becoming vesicular –> pustular –> crust over
Mild systemic upset
Respiratory distress syndrome
RFs - male, diabetic mother, C-section, second of premature twins, delivery at <34 wks
CXR - ground glass appearance + indistinct heart border
Mx - oxygen, assistend ventilation, exogenous surfactant via endotracheal tube
Prophylaxis - maternal steroids (betamethasone) if in labour <34 wks
Patau syndrome
Trisomy 13
Microcephaly, cleft palate, polydactyly, scalp lesions
Edward’s syndrome
Trisomy 18
Micrognathia, low set ears, rocker bottom feet, overlapping fingers
Fragile X syndrome
M>F, associated with MVP and autism
Macrocephaly, long face, large ears, learning difficulties
Noonan syndrome
Webbed neck, pectus excavatum, short, pulmonary stenosis
Pierre-Robin sequence
Micrognathia, cleft palate, posterior displacement of tongue
Prader-Willi syndrome
Hypotonia, hypogonadism, obesity
William’s syndrome
Deletion on Chr 7
Short, learning difficulties, friendly, transient neonatal hypercalcaemia, supravalvular aortic stenosis
Toddler’s diarrhoea
Undigested food in stool
Caput succedaneum
Present at birth - due to prolonged/difficult deliveries
Forms over vertex and crosses suture lines
Resolves in days - managed conservatively
Cephalohaematoma
Develops a few hours after birth - due to prolonged/difficult delivery
Commonly in parietal region and does not cross suture lines
Resolves in months - managed conservatively
Febrile convulsion
6 months - 5 years
Occur early in a viral infection
Generalised tonic-clonic seizures lasting <5 minutes with complete recovery within an hour
Is a risk factor for epilepsy
Mx
- first seizure or any complex features –> paediatrics
- giving paracetamol is good but it does not affect the chances of a febrile convulsion
Epilepsy risk factors
Family history, having complex febrile seizures, a background of neurodevelopmental disorder
Omphalocele
AKA exomphalos
Intestines and liver extend out of the body in a sac through the umbilicus
Gastroschisis
Intestines extend out of the body through a hole next to the umbilicus
No sac
