Paeds Percistence Flashcards
When should you US for DDH?
Breech at 36 weeks, born breech before 36 weeks, 1st degree relative with DDH, multiple pregnancy
What is Barlow and Ortolani test?
Barlow = attempts to dislocate femoral head Ortolani = attempts to relocated dislocated hip
What are the major RFs for SIDS?
Prone sleeping, bed sharing, head covering, parental smoking, hyperthermia and prematurity
What condtioin is commonly seen in those with VSD?
Endocarditis
What are the first signs of puberty, when do they occur?
Boys = testicular enlargement (10-15 years) Girls = breast developemtn (9-13 years)
Sx of William’s syndrome?
Short stature, LDs, extremley extroverted personality, transient neonatal hypercalcaemia, supravalvular aortic stenosis
Sx of Pierre-Robin syndrome?
Microganathia, posterior displacement of the tongue (may cause upper airway obstruction) and cleft palate
Sx of Cri du Chat Syndrome?
characteristic cry (due to larynx and neurological issues), feeding problems and poor weight gain, LDs, microcephaly, micrognathia and hypertelorism
How should you diagnose and treat UTIs in children?
Clean catch urine sample.
<3/12 = immediate peads refferal.
>3/12 and upper UTI = hospitalisation or 7-10 days cepholosporin or co-amoxiclav.
>3/12 and lower UTI = 3 days trimethoprim, nitrofurantoin, cephalosporin or amoxicillin (return if still unwell after 24-48 hours)
True or false, you should not give antidiarrhoeal medications to children under 3?
False, you should not give them to children under 5!
Consider oral rehydrating solutions or give IV fluids if shocked!
What is the cause of Head Lice? What is the best treatment?
Pediculosis Capitis.
Malathion and wet combing
What is the contraindication to lung transplant in CF patients?
Chronic Burkholderia Cepacia Infection
Which diseases are we concerned about spreading between CF patients?
Burkholderia Cepacia Infection and Pseudomonas Aerginosa
Which medications can you take for CF if you are homozygous for the delta F508 mutation?
Lumacaftor or Ivacaftor
What type of diet is reccomended in ADHD?
Normal balanced diet
True for False, individuals with Pethes disease have a higher risk of OCD?
False, they have a higher risk of ADHD and depression
Sx/Tx of Transient synovitis?
Sx occur within a few weeks of vrial infection (typically URTI).
Limp, refusal to weight bare, groin/hip pain, no systemic illness or fever.
Tx = simple analgesia, follow up in 48 hours and 1 week to ensure improvement
Sx/Tx of Septic Arthritis?
Rapid onset hot swollen and painful joint, refusal to weight bare, stiffness and reduced ROM, systemic illness (fever, lethargy or sepsis)
Tx = joint aspiration and empiricle IV Abx. Continue Abx treatment for 3-6 weeks
What heart condition is associated with DMD, when is it seen?
Dilated cardiomyopathy
Begins in adolesence and is rapidly progressive
What condition does Meckles Diverticulum often mimic?
Appendicitis
However there will also be massive painless rectal blood loss
What is the first line Ix for pyloric stenosis and what is seen on blood tests?
Abdo US
Hypochloraemic, hypokalaemic alkalosis
WHat is the treatment for pyloric stenosis?
Ramstedt pylorotomy
Which vaccinations should a child recieve at 8 weeks?
6-in-1, Rotavirus and Men B
What vaccinations should a child recieve at 12 weeks?
6-in-1, PCV and Rotavirus
Which vaccinations should a child recieve at 16 weeks?
6-in-1, Men B
Which vaccinations should a child recieve at 1 year?
HiB/Men C, MMR, PCV, Men B
At what age should a child recieve the flu vaccine?
Every year from 2-10 years
What vaccinations should a child recieve at 3 years and 4 months?
MMR, 4-in-1 pre-school booster
What vaccinations should a child recieve in their teenage years?
HPV, 3-in-1 teenage booster and MenACWY
What is in the 6-in-1 vaccine?
Diptheria, Hep B, HiB, Polio, Tettanus and Whooping Cough
What is in the 4-in-1 preschool booster?
Diptheria, Tetanus, Whooping Cough and Polio
What is in the 3-in-1 teenage booster?
Tetanus, Diptheria and Polio
What is the commonest GI malformation? What are the symptoms?
Oesophageal atreasia with distal tracheooesophageal fistula
Inutero = polyhydramnios
After birth = blowing bubbles, salivation and drooling, cyanotic episodes on feeding and respiratory distress/aspiration
How do you diagnose the commonest GI malformation
Pass an NG tube and x-ray, the NG tube will be seen coiled in the oesophagus
What is Gastroschisis?
A paraumbilical defect where the bowel is loose and herniated to the right side of the body.
It is seen on antenatal scans and causes raised AFT
What is an Omphalocele?
A ventral defect in the umbilical ring with herniation of the abdominal contents covered by peritoneum.
It is seen on antenatal scans and causes raised AFT
What are small and large omphalocele’s associated with?
Small (i.e. no liver, just bowel) = beckwith – Wiedemann syndrome
Large = pulmonary hypoplasia
These babies are at high risk of hypothermia
Sx of a congenital diaphragmatic hernia?
Newborn respiratory distress, displaced apex beat, bowel sounds in the hemithorax and a scaphoid abdomen
What is seen on x-ray in duodenal atresia and malrotation + volvulous?
Duodenal atresia = double bubble sign
Malrotation + volvulous = coffee bean sign
How can you differentiate meconium ileus and hirschprung’s?
CF will be picked up on heel prick testing.
In Meconium ileus after therapeutic enema stools will pass normally, this is not seen in Hirschprungs.
In hirschprungs there will also be contracted distal segment and dilated proximal segment on AXR
How long do undescended testes generally take to resolve? When should you investigate further?
Generally resolve by 6 months - 1 year - consider refferal if not resolved by 6 months.
If there are bilateral undescended testes investigate further for the cause (low testosterone) or do orchixoplexy if undescended after 1 year
Which type of inguinal hernia is seen most commonly in paeds?
Indirect! (goes through the deep then superficial inguinal ring)
Direct hernias can occur in premature babies as their inguinal wall is weak
How can inguinal hernias be differentiated?
Indirect = bulge is lateral to the pubic tubercle and inferior epigastric vessels
Direct = medial to the inferior epigastric vessels.
Both are more prominent on cying.
Ring occlusion test can differentiate between the two (if hernia still occurs it is direct)
Sx of incarceration?
tender lump, irritable baby and vomiting
Tx of inguinal hernias?
All require surgery due to the risk of incarceration. Incarceration = immediate surgery <6 weeks = operate within 2 days <6 months = operate within 2 weeks <6 years = operate within 2 months
Sx of hypospadius?
Meatus on the ventral surface of the penis, hooded foreskin, spraying on urination.
What if the meatus is on the dorsal surface of the penis?
Epispadias
What should you do if there is undescended testes and hypospadius?
Look for a cause of low testosterone.
If parents want surgical repair they must NOT circumsice their child
Sx of testicular torsion?
Testicle diplaced higher and more horizontal (Bell clapper deformity), acutley swollen and tender testicle, vomiting.
How can you differentiate between testicular torsion and epidiymitis?
Prehn’s sign.
Lift the testicle - if this relieves pain (positive test) then it is epididymitis. If not it is testicular torsion
How quickly should you surgicallyy repair testicular torsion?
within 6 hours
Sx of intussusception?
Recent viral infection (typically URTI).
Colicky abdo pain where the legs are drawn up to the chest, sausage shaped mass in the abdomen, vomiting and red current jelly stools (this is a late sign and indicates ischaemia!)
Ix and Tx intussusception?
USS = target/doughnut sign AXR = dilated proximal bowel loops Tx = rectal air insufflation (only if there are no signs of peritonism), surgical correction if this fails or if there are signs of ischaemia
Which metabolic abnormality is seen in pyloric stenosis?
Hypochloraemic Hypokalaemic Metabolic Alkalosis
Ix and Mx of pyloric stenosis?
Test feed = feel for an olive sized mass in the RUQ. USS = thickened pylorus
Mx = Ramstedt pylorotomy
True or false platelets mirror disease activity in NEC?
TRUE
Low platelets is a worse prognosis
Mx of NEC?
NBM, give cefotaxime and vancomycin.
Do laparotomy if rapid distension and/or signs of perforation
What are some major RFs for NEC?
Hypoxia and RDS.
Indomethacin for PDA can also cause the mesenteric arteries to constrict leading to ischaemia
What is Sandifer Syndrome?
Dystonic neck posturing seen with GORD
Mx of GORD?
Minor = reassurance and thickening agents (carobel)
Severe = PPI (omeprazole)
Very severe = (unresponsive to treatment and >1 year) Nissen fundoplication
How long should you treat consitpation for?
6 months
When should you suspect pneumonia over bronchiolitits?
If there is a high fever and localised signs suggesting consolidation
Do a CXR to exclude the diagnosis
Which children are considered high risk in bronchiolitits? What should they be given to prevent the disaese?
Congenital heart defects, BronchoPulmonary Dysplasia, CF, immunocompromise and prematurity
Give RSV monoclonal antibody (IM plaivizumab)
What causes mumps, how does it present?
RNA paramyxovirus - Mumps virus
Coryzal Sx followed by parotid swelling, ear ache and trismus (spasm of the muscles of mastication when chewing)
What causes measles, how does it present?
RNA paramyxovirus - morbillivirus
Cough, Cranky, Coryza and Conjunctivitis. Maculopapular rash with cephalocaudal progression (appears first behind the ears). Koplick spots in mouth
What causes rubella, how does it present?
RNA paramyxovirus - rubivirus
Coryzal prodrome, pink maculopapular rash, sub occipital or posterior auricular lymphadenopathy.
Arthralgia
How long should children with measles, mumps or rubella be excluded from school?
Measles = 4 days after rash appears Mumps = 5 days from swelling of the glands Rubella = 5 days after rash appears
What are the risks with pregnant women exposed to rubella?
<13 weeks = transmission to foetus is 80% so TOP can be offered
>16 weeks = 25% transmission risk but unlikely to cause defects
What is the triad of congenital rubella?
Sensorineural deafness, cardiac abnormalities and eye abnormalities (e.g. cataracts)
What are the complications of Parovirus B19?
Pure red cell aplasia = sickle cell disease, thalassaemia or Hereditary Spherocytosis
Transient aplastic crisis = HIV or organ transplant patients
Hydrops fetalis = >70% transmission to the foetus is >16 weeks, may requre inutero blood transfusion
What are the componenets of the fever pain score? What does the score mean?
Fever Purulent tonsils Attended rapidly (<3 days) severly Inflammed tonsils No cough or coryza
2-3 = 30-40% chance of strep - delayed prescription 4-5 = 60% chance of strep - prescribe
Tx for bacterial tonsilitis?
Phenoxymethypenicillin (pen V) for 7-10 days
Clarithromycin if penicillin allergic
What is Scarlet Fever?
A complication of group A haemolytic strep infection.
Rash appears 12-48 hours after onset of sore throat, feels like sandpaper. There will be strawberry tongue and circumolar pallor. Treat like tonsillits
Mx of chicken pox?
Supportive
If signs of infection (staph. A) = flucloxacillin
If immunocompromised = acyclovir
If pregnant = VZIG or acyclovir
Mx of impetigeo?
Topical hydrogen peroxide or topical fusidic acid. If severe or widespread oral flucloxacillin.
Exclude from school for 48 hours after abx treatment or until crusted over
What is the most common cause of acute otitis externa and otitis media?
Externa = Pseudomonas or Staph aureus bacterial infection Media = mostly viral
Mx of otitis externa?
Mild = topical ABx (e.g. amnioglycoside) and steroid drops (e.g. Sofradex)
What are the indications for Abx in otitis media?
> 4 days of symptoms, bilateral AOM in a child <2, discharge (this indicates perforation), immunocompromised pt.
What is glue ear? How can you treat it?
Otitis media with effusion.
Treat with otovent or if >3 months consider ENT refferal for gromits
What are the differences between transient synovitis and septic arthritis?
TS = follows viral infection, SA = follows staph. aureus infection (look for scratches or infected chicken pox) TS = will move the limb if persuaded, SA = will refuse to move the limb no matter what TS = pain is mostly on movement and improves throughout the day, SA = severe constantly
True or false any child under 2 with hip pain should be reffered to A&E?
False, any child under 3!
What is erythem toxicum neonatorum?
White pinpoint papules filled with eosinophils which appear around day 2-3 and last for 24 hours
What is strawberry naevus?
A red lesion which grows rapidly in the first 5-8 weeks and then regresses after 6-9 months. Treat with topical propanolol to speed regression
What is congenital dermal melanocytosis?
AKA mongolian blue spots. Appear at birth or shortly after and are usually found on the base of the spine or buttocks. Will resolve spontaneously but may be mistaken for bruising
What is a strok bite?
AKA salmon patch
Present at birh and seen on the nape of the neck , on the face or around the eye lids. It is a pink flat rash and will balch completely and darken with activity.
What is a port wine stain?
AKA Naevus Flammeus
Present at birth, they will darken as the child ages and grow with the child (they are permanent). They are smooth and flat but may thicken in adult life
What is a Caput Succedaneum?
Boggy superficial scap swelling that crosses the suture lines and occurs due to pressure against the cervix during birth or ventouse delivery
Can cause jaundice
What is a cephalohaematoma?
Subperiosteal haemorrhage which is stuck tightly to the skull and does not cross the suture lines.
Can cause jaundice
What are the causes of jaundice in the 1st 24 hours of life?
ABO incompatibility (mum is O and baby is A/B) - most common cause
Rhesus haemolytic disease
TORCH infections
G6PD deficiency or Hereditary Spherocytosis
What are the TORCH infections?
Toxoplasmosis, Other (syphilis, parovirus, varicella zoster), Rubella, CMV, Herpes/Hepatitis
What is the lifespan of foetal and adult haemoglobin?
Foetal = 70 days Adult = 120 days
What are the causes of jaundice after 2 weeks (prolonged jaundice)?
Breast milk jaundice, congenital hypothyroidism, CF and biliary atresia (most important to exclude)
What is Kernicterus?
Acute Bilirubin Encephalopathy. Due to unconjugated bilirubin depositis in the basal ganglia after albumin binding capacity is exceeded.
Sx and complications of Kernicterus?
Sx = seizures, hypertonia and opisthotonus Complications = Cerebal Palsy, LDs, Sensorineural deafness
How do you treat meningitis?
<3 months = cefotaxime and amoxicillin
>3 months = cefotaxime and oral dexamethasone (4 times daily for 4 days if LP is suggestive of bacterial meningitis)
What are the contraindications for LP in meningitis?
Focal neurological signs, papilloedema, bulging of the fontanelle, DIC, cerebral herniation signs, meningococal spticaemia
Where should you check for the pulses in BSL in an infant and a child?
Infant = femoral and brachial Child = femoral
Sx of retinoblastoma? How is it inherited?
AD
Absent red reflex (replaced by white pupil), strabismus and visual problems
How can you manage retinoblastoma?
Enucleation, radiotherapy, chemotherapy or photocogulation.
>90% survive to adult hood
Sx and Mx of umbilical granuloma?
Red growth of tissue appearing in the centre of the umbillicus in the first few weeks of life. Usually wet and leaks clear/yellow fluid
Mx = put salt on it or failing this silver nitrate
What is omphalitis?
Staph. Aureus infection of the umbilical cord. Presents a few days after birth and there is risk of the infection spreadin systemically.
Mx = topical and systemic antibiotics
What is persistent urachus?
Urinary discharge from the umbillicus as the urachus is attached to the bladder
What is persistent vitello-intestinal duct?
Discharge of small bowel contents in the umbillicus, seen with meckles diverticulum
Sx of achondroplasia? How is it inherited?
AD or sporadic gene mutation
Rhizomelia, Brachydactyly, mid face hypoplasia with flattened nasal bridge, trident hands and lumbar lordosis
Sx of roseola infantum?
High fever followed by maculopapular rash, febrile convulsions, diarrhoea, cough and nagayama spots (on the uvula and soft palate)
What causes roseola infantum? How long is school exclusion and what are the key 2 complications?
Human herpes virus 6 (HHV6)
School exclusion not needed
Aseptic meningitits and hepititis
What is the use for Palivizumab?
Prevents RSV in high risk children (immunocompromised, premature infants and infants with heart/lung abnormalities).
Where does measles and chicken pox rashes start?
Measles = face
Chicken pox = head/trunk
What is the commonest child hood squint? WHat causes it?
Convergent squint, caused by hypermetropia (long sightedness)
