Paeds Q Flashcards
Most common cause of meningitis in ages 3-6 months
Haemophilus influenza
Neisseria meningitidis
Strep pneumonia
Close contacts within 7 days of bacterial meningitis onset should be given which AB ?
Oral ciprofloxacin or rifampicin
Most common cause of meningitis in ages 0–3 months
E.coli
Listeria monocytogenes
Pre-hospital ABs for meningococcal disease
IM benzylpenicillin
Features in an infant of maternal alcohol abuse
Small eye openings
Growth retardation
Low set ears
Flat philtrum
Sunken nasal bridge
Short palpebral fissure
Think upper lip
Cardiac malformations
What congenital heart condition is Fragile X syndrome associated with ?
Mitral valve prolapse
What genetic mutation causes fragile X syndrome ?
Trinucleotide repeat
What are Fragile X features in males
Learning difficulties
Large, low set ears, long face, high arched platelet
Large testicles
Hypotonia
Autism
Mitral valve prolapse
How can fragile x be diagnosed ?
Antenatal chorionic villus sampling
What paediatric respiratory condition should one never examine the throat ?
Croup
What is the epidemiology of Croup ?
Peak incidence at 6 months
More common in autumn
What are the features of Croup ?
Stridor
Barking cough (worse at night)
Coryzal symptoms
What are the features of moderate croup ?
Frequent barking cough
Audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation in the child
Child = Alert
What are the features of severe croup ?
Frequent barking cough
Prominent inspiratory stridor
Marked sternal wall retractions
Significant distress and agitation or lethargy or restlessness (signs of hypoxaemia
Tachycardia indicates severe obstruction
What is the admission criteria for croup ?
Moderate or severe
<6 months of age
Known upper airway abnormalities e.g. laryngomalacia or Downs
Uncertainty on DD e.g. acute epiglottis, bacterial tracheitis, peritonissllar abscess and foreign body inhalation
X-ray sign associated with croup
Steeple sign - lateral view- subglottic narrowing
X-ray sign epiglottis
Thumb sign - lateral view of swollen epiglottis
Management of croup - mild/moderate
Single dose oral dexamethasone
Emergency treatment of croup
High flow oxygen
Nebulised adrenaline
What is the inheritance pattern of Haemophilia A
X-linked recessive
Thus all daughters will be carriers
And 50% chance of disease if male
What is synovitis ?
When the synovium of a joint becomes inflamed (swollen)
How does synovitis present ?
Limp/refusal to weigh bear
Groin or hip pain
Usually following a viral infection
(Low grade fever)
What is the typical age group of synovitis presentation ?
3-9 years
What is the MCC of ambiguous genitalia in newborns
Congenital adrenal hyperplasia
What are the typical features of reflex anoxic seizure ?
Child goes very pale
Falls to floor
Secondary anoxic seizure are common
Rapid recovery
When can a child with scarlet fever return to school ?
24 hours after commencing antibiotics
What is scarlet fever ?
A reaction to the erthrogenic toxins produced by group A haemolytic streptococci
What is the most common cause of scarlet fever ?
Group A strep e.g. streptococcus pyogenes
What is the peak incidence of scarlet fever ?
2-6 years
4 is peak incidence
How is scarlet fever spread ?
Respiratory route by respiratory droplets
How does scarlet fever usually present ?
Incubation period 2-4 days
Fever typically lasting 24-48 hours
Malaise, headache, nausea/vomiting
Sore throat
Strawberry tongue
Rash
What kind of rash will present with scarlet fever ?
Fine punctate erythema (pinhead) which generally appears first on the torso and spares the palms and soles
Often described as having a rough sandpaper like texture
Children will appear flushed with circumoral pallor
Desquamation occurs later in the course partially around the fingers and toes
How is scarlet fever diagnosed ?
Throat swab
But AB treatment should be commenced immediately
How is scarlet fever managed ?
Oral penicillin V for 10 days
Azithromycin if allergy
Notifiable disease
Potential complications of scarlet fever
Otitis media - most common complication
Rheumatic fever - typically 20 days after infection
Acute glomerulonephritis - typically occurs 10 days after infection
Invasive complications e.g. bacteremia, meningitis, necrotizing fasciitis (rare but can be life threatening)
At what age can a pt be treated as an adult and presumed to have capacity
16
What guidelines are used in patients requiring contraception who are under 16
Fraser Guidelines
What is the most common cause of stridor in infants ?
Laryngomalacia
Caused by a floppy epiglottis which folds into the airway on inspiration
When is surgery indicated in laryngomalacia
When there is poor feeding to the extent that failure to thrive occurs
Typical laryngomalacia presentation ?
4 weeks old
Poor feeding
Stridor
DD’s of Stridor in children
Croup
Acute epiglottis
Inhaled foreign body
Laryngomalacia
What is croup ?
A form of URSI caused by a combination n of laryngeal oedema and secretions
Primarily causes by parainfluenza viruses
What are the typical features of Croup ?
Barking (seal like) cough which is worse at night
Stridor
Fever
Coryzal symptoms
What is the epidemiology of Croup ?
Peak incidence at 6 months - 3 years
More common in autumn
What is the cause of acute epiglottis
Haemophilus influenzae type B
What age is the peak incidence of acute epiglottis ?
2-6 years
What are the features if acute epiglottis ?
Rapid onset
Unwell, toxic child
Stridor
Drooling saliva
Where in the lungs is a foreign body most likely to end up ?
Right lower lobe
What type of babies should be screened with US or X-ray (more than 4.5 months) of the hips ??
Breech babies
FHx of 1st degree relative with hip problems in early life
Multiple pregnancy
RFs for development dysplasia of the hip
Female sex (x6)
Breech presentation
Positive family history
Firstborn children
Oligohydramnios
Brith weight >5kg
Congenital calcaneovalgus foot deformity
Clinical examinations for developmental dysplasia of the hip
Barlow test
Ortolani test
Check for symmetry of leg length, level of knees when hips and knees are bilaterally flexed, restricted abduction of the hip in flexion
What is Barlow’s test ?
Attempts to dislocate an articulated femoral head
What is Ortolani’s test ?
Attempts to relocate a dislocated femoral head
Management of developmental dysplasia of the hip ?
Most will spontaneously stabilise by weeks 3-6 of age
Pavlik harness in children younger than 4-5 months
Older children may need surgery
A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a branching punctate rash sparing the face.
Scarlet fever
A 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
A four-year-old boy presents with fever, malaise and a ‘slapped-cheek’ appearance
Parvovirus B19
DDs rash in children
Chicken pox
Measles
Mumps
Rubella
Erythema infectiosum
Scarlet fever
Hand, foot and mouth disease
Features of chicken pox
Initial fever
Itchy rash starting on head/trunk before spreading
Initially macular then papular then vesicular
Systemic upset is usually mild
Features of measles
Irritable prodrome, conjunctivitis and fever
Koplik spots: white spots (grain of salt) on buccal mucosa
Rash: starts behind the ears and then to the whole body, discrete maculopapular rash becoming blotchy and confluent
Features of mumps
Fever, malaise and muscular pain
Parotitis (earache, pain on eating)
Unilateral initially but then becomes bilateral in 70%
Features of rubella
Rash which is pink and maculopapular
Initially on the face before spreading to the whole body usually fading by day 3-5
Lymphadenopathy: suboccipital and postauricular
Features of erythema infectiosum
Also known as fifth disease or slapped-cheek syndrome
Caused by parvovirus B19
Lethargy, fever, headache
Slapped cheek rash spreading to proximal arms and extensor surfaces
Features of scarlet fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
Strawberry tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Sandpaper like texture
Features of hand, foot and mouth disease
Caused by coxsackie a16 virus
Mild systemic upset:sore throat and fever
Vesicles in the mouth and on the palms and soles of the feet
Features of chicken pox rash
Itchy, rash starting on the head/trunk before spreading
Initially macular then popular then vesicular
Features of measles rash
Starts behind the ears and then spread to the whole body
Discrete maculopapular rash that becomes blotchy and confluent
Features of mumps
Painful swellings in the side of the face under the ears (the parotid glands)
Start unilateral but 70% of cases become bi-lateral 70%
Features of Rubella rash
Pink maculopapular initially on the face before spreading to the whole body usually fading after 3-5 days
Features of erythema infectiosum rash
Starts on cheeks and gives slapped appearance before spreading to the proximal arms and extensor surfaces
Features of scarlet fever rash
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Sandpaper like texture
Features of hand, foot and mouth rash
Vesicles in the mouth and on the palms and soles of the feet
Neonatal causes of hypoglycaemia
Preterm birth (<37 weeks)
Maternal DM
IUGR - interuterine growth restriction
Hypothermia
Neonatal sepsis
Inborn errors of metabolism
Nesidioblastosis
Bechwith-Wiedemann syndrome
Features of Neonatal hypoglycaemia
May be asymptomatic
Autonomic changes - jitteriness, irritable, tachypnoea, pallor
Neuroglucopenic - poor feeding/sucking, weak cry, drowsy, hypotonia, seizure
Other - apnoea, hypothermia
Management of neonatal hyoglycaemia
Asymptomatic - encourage normal feeding (breast or bottle), monitor blood glucose
Symptomatic - admit to neonatal unit, IV infusion of 10% dextrose
Medical intervention in Enuresis
Desmopressin - ADH analogue
Useful for short-term management or if enuresis alarm is not effective
In a neonate how would transposition of the great arteries present ?
Turns blue and becomes tachypnoeic 5 mins after birth
On asultation nenonate has no murmur but a single loud S2
On palpation there is a prominent ventricular pulse
What is the MC cyantoic heart defect and when does it present ?
Tetralogy of Fallot
Between 1 and 6 months
How would Tetralogy of Fallot present on auscultation ?
It causes a loud ejection systolic murmur that is loudest at the left left sternal edge with radiation to the axillae
What is tricuspid atresia ?
A cyanotic heart defect which causes an ejection systolic murmur which is loudest at the left upper sternal edge and a prominent apical impulse
What is transposition of the great arteries ?
Cyanotic congenital heart disease
Caused by the failure of the aorticopulmonary septum to spiral during septation
The aorta leaves the right ventricle
The pulmonary trunk leaves the left ventricle
Which condition is a risk factor for transposition of the great arteries ?
Mothers with diabetes are at increased risk
Clinical features of transposition of the great arteries
Cyanosis
Tachypnoea
Loud single S2
Prominent right ventricular impulse
‘Egg-on-side’ appearance on chest x-ray
Management of TGA
Maintenance of ductus arteriosus with prostaglandins
Surgical correction is definite treatment
How do the majority of atrial septal defects present ?
Asymptomatic (they don’t)
How would a symptomatic child with an ASD present ?
SOB
Lethargy, poor appetite and growth and increased susceptibility to RI
On examination you would typically hear an ejection systolic murmur and fixed splitting of the second heart sound
On auscultation what would you expect from a VSD
Pansytolic murmur in the lower left sternal border
On auscultation what would you expect from a coarctation of the aorta
Crescendo-descrescendo murmur in the upper left sternal border
On auscultation what would you expect from a coarctation of the aorta
Crescendo-descrescendo murmur in the upper left sternal border
On auscultation what would you expect from a PDA
Diastolic machinery murmur in the upper left sternal border
On auscultation what would you expect from a PS
Crescendo-decrescendo ejection murmur.
What would a Pansytolic murmur in the lower left sternal border indicate
VSD
What would a ejection systolic murmur and fixed splitting of the second heart sound indicate
ASD
What would a Crescendo-decrescendo murmur in the upper left sternal border indicate
Coarctation of the aorta
What would a Diastolic machinery murmur in the upper left sternal border indicate ?
PDA
What would an ejection crescendo-decrescendo murmur indicate ?
Pulmonary stenosis
What is the most common congenital heart disease type in children ?
VSD - 30%
(ASD in adults)
Most common causes of cyanotic disease in children
Tetralogy of Fallot (more common but presents at 1-2 months)
Transposition of the greater arteries (more common noticed at birth)
Tricuspid atresia
Management of umbilical hernia
1cm and easily reducible then wait to see if self resolve or elective repair at ages 4-5
If large or symptomatic then perform elective repair ages 2-3
Management for Slipped capital femoral epiphysis
Orthopaedic in situ fixation with cannulated screw
Typical presentation for slipped capital femoral epiphysis
10-15years
More common in obese children and boys
What is slipped capital femoral epiphysis
Displacement of the femoral head epiphysis postero-inferiroly
May present acutely following trauma or more commonly with chronic persistent symptoms
Features of slipped capital femoral epiphysis
Hip, groin, medial thigh or knee pain
Loss of internal rotation in the leg in flexion
Bilateral slip in 20% of cases
X-ray AP and lateral (frog view) is diagnostic
What determines the degree of cyanosis and clinical severity in tetralogy of fallot ?
The severity of the right ventricular outflow tract obstruction i.e. level of pulmonary stenosis
What are the 3 defects of tetralogy of fallot ?
VSD
Right ventricular hypertrophy
Pulmonary stenosis
Overiding aorta
Features of TOF
Cyanosis
Tet spells - typically occur when the infant is upset, in pain or has a fever
Right to left shunt
Ejection systolic murmur due to pulmonary stenosis
Chest Xray - boot shaped heart
