Paeds short Flashcards
KEEP IT SHORT
Rubella - urgently notifiable (within 24 hours)
Prodrome: fever, coryza, rash and lymphadenopathy
Rash: face to trunk, limb-sparing
Dx: serology rubella-specific IgM antibodies
Mx: supportive, off school until 5 days after rash develops
If unvaccinated pregnant woman: congenital rubella syndrome: cataracts, PDA, deafness
Measles - urgently notifiable
Measles morbillivirus
Prodrome: fever >40, coryza, conjunctivitis, Koplik spots (grey spots in Mouth)
2-5 days after: rash behind ears spread to trunk and limbs
Dx: oral fluid sample for measles RNA and measles-specific IgM and IgG
Mx: supportive, off school until 4 days after rash development
Complications: AOM, pneumonia, blindness, subacute sclerosing panencephalitis
Bacterial tonsillitis
Strep pyogenes (group A strep)
Centor: fever (>38), exudate, cervical lymphadenopathy, no cough
score 3/4 = abx, 1st line is Phenoxymethylpenicillin (pen V), macrolide if allergy
Pyloric stenosis
Hypertrophy of the pyloric sphincter, leading to narrowing of pyloric canal
Key symptom: projectile vomiting post-feed
Key sign: hypokalaemic hypochloraemic metabolic alkalosis
Dx: abdominal ultrasound
Tx: IV fluids, pyloromyotomy
Status Epilepticus
Seizure > 5 mins or multiple seizures w/o regaining awareness
Mx: IV lorazepam/buccal midazolam/rectal diazepam, repeat after 10 mins if needed
Then IV Levetiracetam
Then anaesthetist or PICU
Nocturnal enuresis (bedwetting)
Primary: never been dry at night
Secondary: previously dry, now lost it (UTI, DMT1)
Dx: hx, examination, urine dip
Secondary - further Ix
Mx: avoid fluid intake before bed, regular toileting
2nd line: enuresis alarm
3rd: desmopressin (ADH analogue)
Cystic fibrosis
Autosomal recessive condition due to mutation in CFTR gene on chromosome 7
Impaired ion transport:
- Thick biliary/pancreatic/ lung secretions
- Lack of pancreatic lipase in GI, mucus excess + bacterial colonisation in lungs
Ix: newborn heel-prick, sweat test
Mx: chest physio, high-calorie diet, dornase alfa, Creon, salbutamol, prophylactic flucloxacillin
Newborns = meconium ileus
Osteosarcoma
- Malignant bone tumour, mainly affects children and adolescents.
- Clinical features: prolonged bone pain, bone swelling, decreased ROM.
- Dx: urgent X-ray within 48hrs (new bony growth - sunburnt look), CT, biopsy
- Mx: surgical resection, chemo +/= radio
Down Syndrome (Trisomy 21)
Clinical features: upward slant to eyes, single palmar crease, hypotonia, leaning difficulties, VSD/ASD
Ix: combined or quadruple test antenatally, chorionic villus sampling, amniocentesis
Mx: MDT: physio, OT, speech + language, educational support, mx of complications, regular check ups
Necrotising enterocolitis
Severe GI disease that mainly affects premature infants, intestinal ischaemia and infection
Clinical features: vomiting, bloody stools, abdo distension, acidosis
Dx: abdo x-ray shows dilated bowel loops, pneumatosis intestinalis, pneumoperitoneum
Mx: nil-by-mouth, broad-spectrum abx, Total Parenteral Nutrition , surgical resection
Acute lymphoblastic leukaemia
Uncontrolled proliferation of mutated lymphoid progenitor cells, replacing normal haematopoietic cells in the bone marrow
Clinical features: lymphadenopathy (most common), pallor, unexplained petechiae, fever, fatigue
Dx: immediate specialist referral if unexplained petechiae or hepatosplenomegaly, otherwise 48-hr FBC
Bone marrow biopsy: > 20% blast cells = diagnostic
Mx: chemo, bone marrow transplant
Neonatal jaundice
Causes: HDN, sepsis, physiological, breast milk, infection
Clinical features: yellowing of skin and eyes, poor feeding, lethargy, well if physiological or breast milk jaundice
Starts around 2 days, better by 14 days at term, 21 days if pre-term
Ix: serum bilirubin levels
Mx:
- Admit if <24 hrs or >7 days old, if unwell, <35 weeks gestational age
- Phototherapy or exchange transfusion according to treatment threshold graph
Complication: kernicterus - brain damage due to excessive bilirulin
Nephrotic syndrome: minimal change disease
Peripheral/facial oedema, proteinuria, hypoalbuminemia
Dx: urine dipstick show 3+/4+ protein, urine protein: creatinine > 200mg/mmol , serum albumin < 25g/L, kidney biopsy
Mx: oral prednisolone
Immune thrombocytopenic purpura
Autoimmune disease characterised by reduced circulating platelets. Usually following a viral infection
Clinical features: easy bruising, petechiae, nosebleeds
Dx: FBC (thrombocytopenia), blood film, CRP
Mx: watch and wait as usually self-limiting
Impetigo
Staphylococcus aureus
Bullous: fluid-filled lesions > 1cm
Non-bullous: erythematous macule becoming pustules/vesicles
Dries into homey-coloured lesions
Mx:
- Hydrogen peroxide 1%
- Face: fusidic acid
- Abx e.g. flucloxacillin (or clarithromycin) if widespread or bullous
- Stay off school until 48 hours after tx started
Pertussis (whooping cough)
Bordetella pertussis - gram -ve coccobacillus
Clinical features: flu-like, coryza, fever for 1-2 weeks, then intense “whooping” cough fits, maybe vomit, faint or cyanosis after. Young infants: apnoea, no whoop
Dx: PCR + culture of nasopharyngeal swabs or secretions
Mx: < 21 days onset e.g. clarithromycin, admission if <6m or resp complications
Preorbital cellulitis
Infection and inflammation of the superficial tissue around the eyes
Clinical features: erythema, swelling, pain, fever, malaise
Mx: immediate empirical oral/IV abx based on severity e.g. flucloxacillin
Infectious mononucleosis (glandular fever)
Epstein Barr virus, transmitted via saliva
Clinical features: fever, sore throat, fatigue, hepato/splenomegaly
Dx: clinical, +ve heterophile antibody (Paul Bunnell) test
Mx: maculopapular rash if treated with amoxicillin otherwise supportive
Back to school once feeling better
Parvovirus B19 infection (slapped cheek syndrome/5th disease)
Prodrome: fever, coryza, and diarrhoea
Then reticular (lace-like) rash across body and bright red cheeks . Perioral and forehead-sparing
Dx: clinical
Mx: supportive, children can go back to school when rash appears as no longer infectious
Can cause hydrops fetalis (oedema) in foetus and aplastic crisis in sickle cell anaemia
Non-accidental injury
Clinical features: delayed presentation, inconsistent caregiver history, injuries/bruises at various healing stages, unwitnessed injury, subconjunctival/retinal haemorrhage
Dx: detailed hx, body map and skeletal survey
Mx: inform senior or safeguarding lead, admit for safeguarding while investigations, treat wounds, social service involvement
Juvenile idiopathic arthritis
Common paediatric chronic inflammatory joint condition
Persistent joint swelling > 6 weeks before 16yo without infection/other causes
Clinical features: salmon pink rash, fever > 5 days, malaise, joint pain
Dx: negative antinuclear ab and rheumatoid factor, raised CRP, ESR, platelets, serum ferritin
Mx: MDT: paeds, physio, OT, ophthalmologists, NSAIDS, intra-articular (if only affecting a few joints) or oral steroids (systemic disease) for flares e.g. methylprednisolone
Neonatal respiratory distress syndrome
Deficiency of surfactant in lungs = alveolar collapse
Preterm infants < 35weeks
Clinical features: respiratory distress: tachypnoea, nasal flaring, grunting and intercostal recession
Ix: X-ray: ground-glass appearance = oedema in alveoli
Mx: if preterm birth suspected, maternal corticosteroids to help foetal surfactant production
Neonate: Intratracheal artificial surfactant
Duchenne muscular dystrophy
Most common type of muscular dystrophy, X-linked recessive (boys)
Gene mutation in dystrophin gene on X chromosome, dystropin protein absent, important for muscle structure.
Clinical features: muscle wasting, weakness, difficulties with movement, hypertrophic calves
Gower’s sign: use hands to climb up the legs when rising from floor
Dx: creatinine kinase, then genetic testing
Mx: MDT, exercise, physio, wheelchairs, mobility aids, glucocorticoids, genetic counselling, surgery to correct scoliosis and contractures
Complications: contractures, scoliosis, global developmental delay, dilated cardiomyopathy, learning difficulties
Meningococcal infection - notifiable
Neisseria meningitidis
Clinical features: fever, lethargy, headache, rigors, vomiting, non-blanching purpuric rash, hypovolaemic shock
Dx: blood culture, CSF
Mx: DO NOT DELAY empirical IV abx, then treat based on sensitivities and local guidelines
<3 months = cefotaxime
> 3 months = ceftriaxone
Ciprofloxacin for close contacts
Type 1 diabetes mellitus
Destruction of insulin-producing beta-cells in the pancreas
Clinical features: polydipsia, polyuria, lethargy, weight loss
Dx:
- Oral glucose tolerance test > 11.1mmol/L
- Random BM > 11.0mmol/L
- Fasting BM > 7.0mmol/L
- HbA1c: >6.5% or 48 mmol/mol)
Mx:
Basal-bolus insulin regime - long-acting at night and short-acting before meals
Hypo: sugary snack if conscious, IV dextrose/IM glucagon if unconscious
Neonatal sepsis
Severe infection in infants < 90 days
Early onset within 72 hrs of life - Group B Strep (S. agalactiae)
Late-onset after 72 hrs - Staph. aureus
Clinical features: feeding difficulties, fever, respiratory distress, reduced GCS
Dx: FBC, CRP, blood cultures, LP for meningitis, CXR for meconium aspiration. Add urine sample if late onset
Mx: early onset = empirical IV benzylpenicillin and gentamicin, then based on culture results
Late onset = broad spectrum (IV flucloxacillin + gentamicin)
Febrile convulsions
Seizures that occur during febrile illness
Simple: tonic-clonic, <15 mins, does not occur again in same illness
Complex: focal, > 15 minutes, multiple seizures without recovery in between
Dx: bloods to identify infection, LP if meningitis suspected, EEG if recurrent
Mx: ensure safety, recovery position after, call ambulance if > 5 mins
Testicular torsion
Twisting of the testicle around the spermatic cord
Clinical features: sudden onset severe unilateral testicular pain, loss of cremaster reflex, persistent pain despite elevation (negative Prehn’s sign)
Dx: urgent surgical exploration and bilateral orchidopexy (fixation), whirlpool sign on testicular doppler
UTI
Infection of the urethra, bladder, ureters or/and kidneys
E.coli most common, Klebsiella, Proteus, Pseudomonas
Clinical features:
- Infant: fever, lethargy, vomiting, poor feeding, urinary frequency
- Older: fever, abdo pain, vomiting, dysuria, urinary frequency
Dx: urine dipstick (clean-catch sample), nitrites = UTI, nitrites + leukocytes = UTI, only leukocytes = not UTI unless clinical evidence
Tx: trimethoprim, nitrofurantoin, amoxicillin for 3 days, admit if if < 3m with fever and start IV abx (e.g. ceftriaxone)
Hernia
A protrusion of an internal organ through its surrounding wall, inguinal hernia protrude through the inguinal canal
If strangulated (stuck) and compromised blood supply: severe pain, vomiting, signs of bowel obstruction, non-reducibility, swelling and tenderness in affected area
Mx
Inguinal: surgical intervention - emergency herniotomy
Abdominal: surgical release of affected bowel
Wilm’s tumour (nephroblastoma)
Embryonic renal malignancy in children.
Often found incidentally as abdominal mass
Clinical features: asymptomatic, abdominal pain, haematuria, lethargy, fever, hypertension, weight loss
Dx: abdo ultrasound, CT staging, biopsy for confirmation
Mx: surgical excision and removal of affected kidney (nephrectomy)
Paediatric basic life support
If infant or child unresponsive
- Open airway
- If not breathing normally, 5 rescue breaths with bag-mask ventilation
- If no signs of life, 15 chest compressions (100 - 200 compressions/ min, lower half of sternum) then 2 rescue breaths
- Repeat compressions and breaths in 15:2 ratio
Moderate asthma exacerbation
- Peak flow > 50% predicted
- Tachypnoea but <40 if 1 - 5 yo and <30 if >5 yo
- Tachycardia but < 140 if 1 - 5 yo and < 125 if >5 yo
- SpO2 > 92%
- Speaks in full sentences
Severe asthma exacerbation
- Peak flow 33 - 50% of predicted
- Respiratory distress: accessory muscles
- Can’t speak in full sentences
- Tachypnoea >40 if 1-5 yo and >30 if >5yo
- Tachycardia >140 if 1-5 yo, >125 if >5yo
- SpO2 < 92%
Life-threatening asthma
33, 92, CHEST
- Peak flow <33% predicted
- SpO2 <92%
- Cyanosis + confusion/altered consciousness
- Hypotension
- Exhaustion
- Silent chest/poor respiratory effort
- Tachycardia
Mx of asthma exacerbation in children
Stepwise
- O2 between 94 to 98%
- Inhaled salbutamol
- Nebulised salbutamol
- Nebulised ipratropium
- Senior for consideration of IV magnesium sulphate, IV salbutamol or aminophylline
All patients given oral steroids (e.g. prednisolone) or IV hydrocortisone if not tolerated
Asthma
Chronic inflammatory airway condition leading to reversible airway obstruction. The smooth muscles of airways are hypersensitive and respond and constrict in response to stimuli, causing airflow obstruction.
Clinical features of asthma
Dry cough, wheeze, SOB, tight chest
O/E: widespread expiratory wheeze, hyperinflated chest, respiratory distress during exacerbation
Things that point towards asthma in a hx
- Diurnal pattern - worse in morning and night
- Interval symptoms - symptoms between exacerbations
- Personal or family hx of atopy
- Non-viral triggers e.g. dust, cold air, exercise
Dx asthma
- Under 5: hx and examination and treat based on findings
Over 5:
- First line (quesmed): spirometry and bronchodilator reversibility, FEV1 improvement of 12% or more = dx asthma
- If inconclusive = fractional exhaled nitric oxide (FeNO). > 35 ppb = positive
- Offer PERF variability monitoring at the same time as FeNO. PERF variability > 20% + FeNO = dx asthma
- If only PERF variability OR FeNO positive, trial bronchodilator to help confirm or refute dx
Mx asthma in under 5 year olds
- low-dose ICS as maintenance therapy for 8 to 12 weeks with SABA
- Check inhaler techique and adherence
- Check environmental source e.g. mould, smoking
- Refer to asthma specalist
NICE guidelines
Mx asthma 5 - 11 years olds
- Salbutamol inhaler + low-dose ICS as maintenance therapy
MART route
- MART with low-dose ICS and LABA (formoterol)
- Moderate-dose MART
Conventional pathway
- LTRA added to the low-dose ICS and SABA, if unable to manage the MART - assess after 8 - 12 weeks
- MART with low-dose ICS with LABA +/- LTRA
- Secondary care referral for e.g. high-dose ICS
Mx asthma for 12 years old and over
Same as adults
- low-dose corticosteroids/formoterol combination inhaler (used as needed AIR therapy)
- low-dose MART (low-dose ICS and LABA)
- moderate-dose MART
- check FeNo, if raised, refer to specialist
- if FeNO not raised, LTRA or LAMA trial for 8 to 12 weeks
- If not effective, try the other one
- Refer to specialist
Complete asthma control in a patient
- No daytime symptoms
- No night-time waking
- No limitations on activities including exercise
- Normal lung function
- Minimal side effects from medication
Intussusception
Invagination/telescoping of proximal segment of bowel into distal segment - commonly ileum into caecum
Clinical features: severe colicky pain, vomiting, redcurrant jelly stool (blood-stained mucus, late), sausage-shaped abdominal mass
Ix: abdominal ultrasound: target/donut sign
Mx: air/contrast enema, surgical reduction if ineffective
Bronchiolitis
1 - 12 months, inflammation of bronchioles.
Respiratory syncytial virus
Clinical features: preceding coryza 1 - 3 days, cough, fever (<39), tachypnoea, chest recessions, wheeze/crackles
Mx: usually supportive (adequate fluids, nutrition, calpol if fever), hospital admission if RR >60, <50% oral intake, SpO2 < 92%, cyanosis, apnoea, respiratory distress (grunting, recession, tracheal tugging) - O2 therapy if <90% and NG tube if not tolerating oral
Prevention: palivizumab injection (mAb)
Kawasaki’s disease
> 5 days fever, sore throatand CREAMPie
- C - conjunctivitis
- R - rash (erythematous, maculopapular)
- oE - oEdema/erythema,
- A - adenopathy
- M - mucosal inflammation (strawberry tongue, cracked lips),
- Peeling of skin of palms and feet (desquamation)
Ix: ECG, echo
Mx: IV immunoglobin + high-dose aspirin, regular echocardiogram for risk of coronary artery aneurysms
Croup
6m - 2yrs, URTI causing laryngeal oedema
Parainfluenza virus
Clinical features: prodromal coryza, seal-bark cough, inspiratory stridor, respiratory distress (intercostal, subcostal, sternal recessions, grunting, nasal flaring)
Ix: clinical, SpO2
Mx: 0.15mg/kg oral dexamethasone + supportive, consider hospital if:
- Respiratory distress, high fever, RR>60, cyanosis, lethargy/agitation, reduced fluid intake and wet nappies, < 3 months, chronic disease e.g. heart, CF
Acute epiglottitis
Inflammation of the epiglottis, 1 - 6 years old
Haemophilus influenzae type B (HiB) - if not up to date with immunisation
Clinical feature - acute onset, high fever “toxic-looking” child - drooling, struggling to breathe, can’t speak, minimal cough, inspiratory stridor, tripoding!
Mx:
- DON’T EXAMINE THE THROAT + AIRWAY AS IT CAN MAKE OSTRUCTION WORSE!
- Call senior paediatrician, ENT and anaesthetist to secure airway, e.g. endotracheal intubation, IV abx, e.g. cefuroxime.
Developmental dysplasia of hip
The femoral head and acetabulum do not articulate correctly.
RFx: Female, firstborn, breech, FHx
Clinical features: limited hip abduction, asymmetrical thigh skinfolds
Ix: Barlow’s (posterior dislocation) and Ortolani’s (relocation on hip abduction), if positive refer for hip USS
Mx: mild = observation. More severe = Pavlik harness for 6 - 12 weeks or surgical correction
ADHD
Triad of hyperactivity, impulsivity and inattention
Dx: CAMHS psychiatrist via history + examination, behavioural observations, teacher/parent reports/rating scales, neuropsychological testing
Mx:
Behaviour: CBT, psychoeducation, extra support at school
Medical: methylphenidate if > 5yo, monitor weight, height, BP, HR as can impact growth
Ventricular septal defect
Congenital cardiac defect where there is a hole in the ventricular sputum
Clinical features:
- Asymptomatic if small
- Larger VSD: Exertional SOB, fatigue, failure to thrive, difficulties with feeding
- Undetected: heart failure or Eisenmenger’s syndrome
- pan systolic murmur at lower left sternal border
Ix: ECG (LVH), CXR (cardiomegaly), echo to confirm Dx and grading
Mx: most will self-resolve, larger VSD = diuretics + ACEi for HF, high-energy feeds for growth, surgical closure
ASD (atrial septal defect)
Acyanotic heart disease as left to right shunt
Symptoms
- None (commonly)
- Poor feeding, failure to thrive
- Recurrent chest infections/wheeze
- Arrhythmias (40+)
Signs
- Hepatomegaly
- Oedema
- Ejection systolic murmur particularly at the upper left sternal edge
Diabetic ketoacidosis
Complication of T1DM: hyperglycaemia, ketonaemia and metabolic acidosis
Clinical features: N+V, dehydration, abdominal pain, hyperventilation, altered mental status
Ix: blood glucose (>11.1mmol/L), arterial blood gas (pH < 7.3), blood ketone levels (> 3mmol/L)
Mx:
- Senior paediatricians
- ABCDE
- initial bolus fluid of 10ml/kg of 0.9 NaCl over 15 mins
- Rehydrate over 24 hours and avoid fluid bolus to reduce risk of cerebral oedema
- Give fixed-rate insulin infusion + IV dextrose once glucose below 14mmol/L
- Treat underlying cause e.g. sepsis
Coeliac disease
Autoimmune disease where the immune system reacts to gluten and attacks the small bowel
Clinical features: abdominal pain, steatorrhoea, fatigue, failure to thrive, dermatitis herpetiformis
Dx: anti-tissue transglutaminase (TTG) IgA antibodies + total IgA levels, anti-TTG IgG if IgA deficiency, IgA anti-endomysial antibodies (EMA)
Gold standard is OGD (oesphagogastroduodenoscopy) and duodenal/jejunal biopsy - villous atrophy and crypt hyperplasia
Mx: life-long gluten free diet
Hirschsprung’s disease
Congenital condition, absence of parasympathetic ganglion cells from the colon (ranges from small area to entire colon) and rectum
Clinical features: delay in passing meconium, chronic constipation since birth, abdominal pain and distention, vomiting, failure to thrive
Dx: abdominal x-ray, rectal biopsy to confirm dx
Mx: surgical removal of affected section of the bowel.
Acute otitis media
Acute inflammation of the middle ear - viral or bacterial
Clinical features: fever, malaise, pain in affected ear, preceding viral URTI
Dx: clinical with otoscopy
Mx:
Most cases: supportive and analgesia
Abx = amoxicillin or clarithromycin
Consider admission if:
- < 3 months + fever > 38
- 3 - 6 months + fever > 39
- Severe
Consider immediate abx if:
- systemically unwell
- High risk of complications
- Bilateral and under 2yo
Delayed abx
- For use after 3 days if no improvement
Patent ductus arteriosus
Ductus arteriosus remains open > 1 month after birth
Clinical features: asymptomatic, feeding difficulties, failure to thrive, or signs of heart failure, characteristic “machine-whirring” continuous murmur at upper left sternal border
Mx: only if symptomatic
- NSAIDs inhibits prostaglandin synthesis = closes PDA or paracetamol
- Surgical ligation rarely
Sickle cell disease
A genetic disorder causing dysmorphic shape of RBCs - autosomal recessive and affects the beta-chain of haemoglobin - HbS
Afro-Caribbean, Hispanic or Mediterranean
Symptoms from complications
- Vaso-occlusive crises - severe pain from tissue ischaemia
- Anaemia due to increased RBC haemolysis
Mx: acute: IV opiates, oxygen therapy, IV fluids, top-up transfusions, abx if infection
Long-term: hydroxyurea increase HbF, regular transfusions, folic acid, iron chelation, prophylactic penicillin, regular influenza and pneumococcal vaccines
Cerebral palsy
Group of non-progressive permanent movement disorders due to damage to CNS area involved in motor control
Clinical features: depends on site and extent of lesion, delays in reaching milestones, spasticity, increased deep tendon reflexes, increased muscle tone
Dx: brain MRI to assess damage
Mx:
- Physio, occupational therapy, speech and language therapy
- Baclofen for muscle spasms and Botox for contractures
- Surgical for MSK deformities or releasing tendons
Chickenpox (varicella zoster virus)
Intubation period up to 21 days
Fever, fatigue, loss of appetite
- Distinctive rash: starts as raised red, itchy spots on face or chest, spread to rest of body
- Then small, fluid-filled vesicles over next few days
- Within 5 days, lesions crust over and heal
Mx: measures to prevent spread and infection e.g. keep fingernails short, long-sleeve shirts, oatmeal baths and calamine lotion, paracetamol
School exclusion 1 - 2 days before rash development - most infectious
Scarlet fever - notifiable urgently
- Cause: group A streptococcal infection (Streptococcus pyogenes)
- Most common in children 5–12 years.
- Fever, sore throat, headache 1 - 2 days before rash
- Classic ‘sandpaper-like’ maculopapular rash that starts on chest or abdomen and spreads, with flushed cheeks and perioral sparing.
- White-coated, sore or swollen tongue or strawberry tongue
- Associated with lymphadenopathy
- Only bacterial cause of childhood exanthema
- Mx
10 days antibiotics (phenoxymethylpenicillin or erythromycin), infectious until after 1st abx dose
Complications: glomerulonephritis, rheumatic fever, invasive group A strep
Roseola infantum/sixth disease
Human herpes virus 6
Initial high fever > 40, up to 5 days
Then blanching, rose-pink macular rash over trunk but can spread to face and limbs
Rhinorrhoea, sore throat and lymphadenopathy
Mx: paracetamol or ibuprofen, hydration and nutrition
Once fever resolves, child can go back to school
Gastro-oesophageal reflux (GOR)
Immaturity of the lower oesophageal sphincter, allowing stomach content to flow back into the oesophagus
Vomiting post-feeds (usually milky), poor feeding, poor weight gain
Mx: small frequent feeds, burping regularly, not overfeeding, gaviscon, thickened milk/special anti-reflux formula, PPI if ineffective
Depression
- Mood changes: anhedonia, sadness
- Cognitive changes: excess guilt
- Physical: excessive sleep, lack of sleep, fatigue
Dx: psychiatric, medical history and examination e.g. Patient Health Questionnaire for Adolescents (PHQ-A)
Mx: refer to CAMHS if active suicide ideation, moderate to severe
- CBT
- Family and school support
- fluoxetine
Anaphylaxis
Acute, life-threatening allergic reaction characterised by wheezing (difficulties breathing), inspiratory stridor, hypotension, angioedema
Mx:
- ABCDE
Adrenaline (1:1000) IM
- < 6months: 100 - 150 micrograms
- 6m - 6y: 150 micrograms
- 6 - 12y: 300 micrograms
- > 12y: 500 micrograms
Post-crisis, observe for 6 - 12 hours in case of bi-phasic reaction
Tetralogy of Fallot
Pulmonary stenosis, right ventricular hypertrophy, VSD and overriding aorta
- detected at 20-week anomaly scan
- Cyanosis
- Poor feeding and growth
- Tet spells (reversal of shunt to R to L)
Dx: SpO2, echo to confirm, CXR might show boot-shaped heart
Mx: corrective surgery at 3 - 6 months
Tet spells: place infant on back and flex knees, O2 in hospital, propranolol
Meconium aspiration
Meconium = first faeces passed by newborns, thick and dark green in colour.
“Meconium-stained liquor” is when meconium is passed just before delivery into the amniotic fluid
Can cause meconium aspiration if foetus inhales this = respiratory distress
CXR = aspiration pneumonitis (patchy infiltrates)
Mx: O2 therapy, antibiotics
Lymphoma
Type of cancer affecting lymphocytes in the lymphatic system = lymphadenopathy
- Hodgkin’s (specific disease) - 20 - 25yo and 80yo. HIV, EBV, autoimmune conditions
- Non-Hodgkin’s (common in childhood- all other types)
Most common features = unexplained lymphadenopathy in neck, axilla or inguinal region
B symptoms: weight loss, fever, night sweats less common
Classic exam trope = lymph node pain in HL after alcohol
Ix: lymph node biopsy = Reed-Sternberg cells (owl face cells)
CT, MRI, PET scan for staging
Stages: Lugano classification:
- Stage 1: confined to one node or group
- Stage 2: multiple nodes on one side of diaphragm
- Stage 3: nodes on both sides of diaphragm
- Stage 4: widespread involvement
Mx: HL = chemo and radiotherapy
NHL: watch and wait, chemo, mAb (e.g. rituximab), radiotherapy, stem cell transplant
