Paeds (things I forget) Flashcards
At what age does a child start to talk in short sentences?
2.5-3 years
At what age does a child have a vocabulary of 2-6 words?
12-18 months
At what age does a child start to respond to their own name?
9-12 months
At what age does a child start to ask ‘what’ and ‘who’ questions?
3 years
At what age does a child start to combine 2 words?
2 years
At what age does a child start to ask ‘why’, ‘when’ and ‘how’ questions?
4 years
At what age does a child start to sit without support (with a straight back)?
7-8 months
At what age does a child start to run?
16 months-2 years
At what age would you be concerned that a child still isn’t walking by?
18 months
At what age does a child start to ride a tricycle using pedals?
3 years
Describe the typical features of chicken pox
- Rash usually starts on trunk/face
- Widespread, erythematous, raised, vesicular blistering lesions
- Itch
Describe the typical features of Coxsackie’s
- Viral sx
- Mouth ulcers
- Blistering red spots/vesicles on hands/feet/mouth
- Itchy
What are the differences between Kawasaki’s disease and Scarlet fever?
Kawasaki - longer fever (>5 days); desquamation (skin peeling); conjunctivitis
Scarlet - sandpaper rash, tonsilitis
Describe the typical features of measles
- Fever
- Coryzal sx
- Conjunctivitis
- Koplik spots (blue/white spots in cheek)
- Rash starts behind ears and spreads
Describe the typical features of roseola infatum
High grade fever followed by rash –> febrile convulsions/seizures
What is an umbilical granuloma?
- Overgrowth of tissue which occurs during healing process of umbilicus
- Most common in first few weeks of life
- Small, red growth of tissue in centre of umbilicus
- Wet and leaks small amounts of clear/yellow fluid
- Treated by regular application of salt - if not then cauterised with silver nitrate
What is osteochondritis dissecans?
- Fragment of bone in knee joint becomes detached due to lack of blood supply
- Chronic knee pain typically after exercise
- Swelling and locking of joint
What is the most common cause of stridor in neonates?
Laryngomalacia
What does spastic cerebral palsy result from?
Damage to upper motor neurones in the periventricular white ball/pyramidal tracts
What does ataxic type cerebral palsy result from?
Damage to upper motor neurones in the cerebellum
What does dyskinetic cerebral palsy result from?
Damage to the basal ganglia and substantia nigra - athetoid movements and oromotor problems
What is seborrhoeic dermatitis?
- Common in infants - often presents within first few weeks of life
- Greasy/yellow rash with flaky scales
- Most common on scalp/face/ears/neck
- Treat with baby shampoo and baby oil
What is mesenteric adenitis?
- Inflamed mesenteric lymph nodes
- Often preceded by viral infection
- Abdominal pain
- Normal eating/drinking/bowel movements/no vomiting
- Self limiting
Describe the typical features of Edward’s syndrome (18)
- Small mouth/chin
- Flexed, overlapping fingers
- Rocker-bottom feet
Describe the typical features of Patau’s syndrome (13)
- Cleft lip/palate
- Scalp defects
- Small eyes/eye defects
- Polydactyly
Describe the typical features of Pierre-Robin syndrome
- Micrognathia (undersized jaw)
- Glossoptosis (posterior displacement of tongue)
- Cleft palate
Describe the typical features of Fragile X syndrome
- Trinucleotide repeat of FMR1 gene
- Intellectual disability
- Long narrow face
- Large ears
- Large testicles
- Associated with mitral valve prolapse
Describe the typical features of Noonan syndrome
Essentially male version of Turner’s syndrome
- Chromosome 12 (autosomal dominant)
- Short
- Broad forehead
- Webbed neck
- Low set ears
- Pulmonary stenosis
- Factor XI deficiency
Describe the typical features of Prader Willi syndrome
- Chromosome 15
- Imprinting pattern
- Obesity
- Dysmorphic features
What is Prader-Willi syndrome associated with?
- Neonatal hyptonia
- Neonatal sepsis
- Spinal muscular atrophy
- Hypothyroidism
What is Down’s syndrome associated with?
- AVSD (most common)
- VSD
- Tetralogy of fallot
- Hypothyroidism
- ALL
- Alzheimer’s
Describe the typical features of Turner syndrome
- Short
- Webbed neck
- Broad chest
- Late/incomplete puberty/infertility
- ESM
- Associated with bicuspid aortic valve/coarctation of aorta/aortic stenosis
What is the management for Turner syndrome?
- Human growth hormone replacement e.g. somatotropin
- Oestrogen replacement therapy
Describe the typical features of Williams syndrome
- Bubbly, trusting personality
- Learning difficulty
- Elfin facies
- Associated with supravalvular aortic stenosis/pulmonary stenosis
What are the main complications of measles?
Otitis media and pneumonia
What should you not give when treating chickenpox?
NSAIDs e.g. ibuprofen - increase risk of necrotising fasciitis (e.g. group A strep infections)
Why is aspirin not commonly given to children and what is the exception?
Risk of Reye’s syndrome - Kawasaki’s disease
What murmur is heard in tetralogy of fallot?
Ejection systolic murmur in pulmonary area
What murmur is heard in PDA?
- Continuous machinery murmur
- Loudest at left sternal edge
- Left subclavicular thrill
- Collapsing pulse
- Wide pulse pressure
What murmur is heard in pulmonary stenosis?
- Ejective systolic murmur
- Loudest at left upper sternal edge
What is heard in TGA?
Loud S2 sound
What murmur is heard in coarctation of aorta?
- Crescendo decrescendo murmur
- Loudest at left upper sternal edge
What murmur is heard in VSD?
- Pansystolic murmur
- Loudest at left lower sternal edge
What murmur is heard in ASD?
- Ejection systolic murmur
- Fixed wide split S2
How can innocent murmurs be identified?
- Precipitated by febrile illness
- Soft
- Systolic
- Changes with posture
- No additional sounds
- Localised to an area (doesn’t radiate)
When is the 6-in-1 vaccine given?
2/3/4 months
When is the rotavirus vaccine given?
2/3 months
When is the MenB vaccine given?
2/4 months and 1 year
When is the pneumococcal vaccine given?
3 months and 1 year
When is the HiB/Men C vaccine given?
1 year
When is the MMR vaccine given?
1 year and 3 years 4 months
When is the HPV vaccine given?
12-13 years
When is the MenACWY vaccine given?
18 years
What is the management for croup?
Single dose of oral dexamethasone (o.15mg/kg)
- Nebulised adrenalien + oxygen
What is the management for whooping cough?
Macrolide abx - azithromycin/clarithromycin
What is the typical presentation for roseola infantum?
- 1 year old
- 2-3 day history of malaise/reduced eating/cough
- High grade fever that is worse in evenings
- Maculopapular rash
What is the typical presentation for parvovirus-19?
- Biphasic
- School aged child
- Many are asx or non-specific viral sx (low grade fever/headache)
- Rose-red rash on cheeks that spreads to body (lace-like) - no longer infectious once rash appears
What is the typical presentation for rubella?
- Unvaccinated
- Rash starts on face then spreads to rest of body (pink)
- Forchheimer spots (spots on soft palate)
What are the clinical features of congenital rubella?
- Sensorineural deafness
- Congenital cataracts
- Purpuric skin lesions
- Hepatosplenomegaly
What is the typical presentation for measles?
- Unvaccinated
- Maculopapular rash that starts behind ears then spreads to rest of body (dark red/brown) and becomes confluent
- Koplik spots (white spots on buccal mucosa)
- Conjunctivitis
What is the typical presentation for Kawasaki’s disease?
- Phasic
- Fever >5 days
- Strawberry tongue
- Desquamation of palms/soles
- Conjunctivitis
- Cracked lips
- GI symptoms
What is the typical presentation for scarlet fever?
- Fever
- Strawberry tongue
- Sandpaper rash
What is the pattern of inheritance for Duchenne muscular dystrophy?
X linked recessive
What condition is duchenne muscular dystrophy associated with?
Dilated cardiomyopathy
Why should you not give ceftriaxone to infants <3 months?
Displaces bilirubin –> kernicterus (unconjugated bilirubin crosses blood brain barrier)
Give cefotaxime instead
What diet can be used in children with epilepsy that is hard to control and is generally unresponsive to antiepileptic medications?
Ketogenic diet - high fat, low carbohydrate, controlled protein diet
What are the clinical features of benign rolandic epilepsy?
Partial seizures at night
What are the clinical features and investigations for West’s syndrome?
- Infantile spasms that appear to look like colic
- Abnormal EEG/MRI/CT (definite pathology)
What would the heel prick test show in someone with CF?
Raised immunoreactive trypsinogen (IRT)
What are the clinical features of congenital CMV infection?
- Hearing loss
- Low birth weight
- Petechial rash
- Microcephaly
- Seizures
What are the distinguishing clinical features of necrotising enterocolitis, what will the investigation show and what is the management?
- Bilious vomiting
- Blood in stool
- AXR = dilated bowel loops, thickened bowel walls, gas in bowel wall and free gas in peritoneal cavity (if perforation)
- NBM
- IV fluids
- TPN
- Abx
- Worsens - laparotomy
What are the distinguishing clinical features of intussusception, what will the investigations show and what is the first-line management?
- Bilious vomiting
- Redcurrant jelly stools
- Sausage-shaped mass in RUQ
- Abdominal USS = target sign
- Rectal air insufflation (air enema)
What are distinguishing features of duodenal atesia, what will the investigation show and what is the first-line management?
- Associated with Down’s syndrome
- Presents few hours after birth
- AXR = double bubble sign
- Duodenostomy
What are the distinguishing clinical features of Hirschsprung’s and what will the investigation show?
- Meconium ileus
- Palpable mass in lower abdomen
- Empty rectal vault
- Rectal biopsy = absence of parasympathetic ganglion cells in the myenteric plexus
What is Hirschsprung’s associated with?
- Down’s syndrome
- Waardenburg syndrome
- Multiple endocrine neoplasia T2
What are the distinguishing clinical features of pyloric stenosis and what will the investigations show?
- Projectile vomiting
- Abdominal USS - thickened pylorus
- Blood gas analysis - hypochloraemic, hypokalemic metabolic alkalosis
What are the distinguishing clinical features of biliary atresia, what will the investigations show and what is the first-line management?
- Jaundice
- Hepatosplenomegaly
- High conjugated bilirubin
- Surgery - Kasai portoenterostomy
What is line of management options for ADHD?
- Watch and wait for 10 weeks
- Refer to secondary care
- Medication (patients >5) = methylphenidate –> lisdexamfetamine –> dexamfetamine
What is the management for viral induced wheeze?
Same as asthma - first line is inhaled salbutamol
What are the causes and clinical features of impetigo and what is the management?
- Staph. aureus or group A strep (strep pyogenes)
- Golden crust lesions typically starting on the face
- FIRST LINE = topical hydrogen peroxide cream
- Topical fusidic acid
- IF BULLOUS = systemic abx e.g. flucloxacillin/erythromycin
Damage to which nerves causes Erb’s palsy?
C5-C6
What is the most common cause of meningitis in neonates amd children?
Neonates = group B streptococcus
Children = neisseria meningitidis
What is the management for meningitis?
Community = IM benzylpencillin
Hospital = IV cefotaxime/ceftriaxone
Prophylaxis = oral ciprofloxacin/rifampicin
What are the clinical features of congenital syphilis?
- Generalised lymphadenopathy
- Hepatosplenomegaly
- Rash
- Skeletal malformations
What are the complications of chlamydia infection in pregnancy?
Increased risk of:
- Chorioamnionitis
- Preterm rupture of membranes
- Neonatal conjunctivitis
- Neonatal pneumonia
What imbalances are seen in congenital adrenal hyperplasia?
- Hyponatraemia
- Hyperkalaemia
- Metabolic acidosis
What are the clinical features and investigations for haemolytic uraemic syndrome?
- Diarrhoea that turns bloody
- Triad = AKI, thrombocytopenia and normocytic anaemia
- Blood film - schistocytes and helmet cells
What is the typical presentation of IgA nephropathy?
Haematuria following URTI
What are the causes of infectious mononucleosis (glandular fever)?
- Most common = EBV (HHV-4)
- CMV/HHV-6
What are the clinical features of infectious mononucleosis?
- Sore throat
- Pyrexia
- Lymphadenopathy
- Maculopapular, pruritic rash in patients who take ampicillin/amoxicillin
What is the inheritance pattern of Kallmann’s syndrome and what are some distinguishing clinical features?
- Usually x-linked recessive
- Delayed puberty and anosmia
Describe CSF in bacterial meningitis vs viral meningitis/encephalitis
Bacterial = turbid appearance/raised polymorphs/raised protein/low glucose
Viral = clear appearance/raised lymphocytes/normal or raised protein/normal or low glucose
What is the management for JIA?
- NSAIDs
- Oligoarticular JIA = steroids (oral/IM/intra-articular)
- DMARDs e.g. methotrexate/sulfasalazine
- Anti-TNFa e.g. infliximab
What are the risk factors for developmental dysplasia of the hip?
- Female
- Breech presentation
- Fhx
- First-born
- Oligohydramnios
What is the management for developmental dysplasia of the hip and what are some complications if not treated?
- <6 months = pavlik harness
- Surgical intervention for reduction and stabilisation
- Gait abnormalities
- Hip pain
- Osteoarthritis
What is the management for slipped capital femoral epiphysis?
Refer to orthopaedics for in situ fixation with cannulated screw
What is the most common causes of neonatal sepsis?
Early-onset (<72 hours) = group B strep (strep agalactiae)
Late-onset (>72 hours) = staph aureus
What is the sepsis 6?
Give 3, take 3
Give:
- O2
- Abx
- Fluids
Take:
- Blood cultures
- Lactate
- Urine output
How do you differentiate between orbital cellulitis and periorbital cellulitis?
Orbital cellulitis is more severe and may present with:
- Reduced visual acuity
- Proptosis
- Ophthalmoplegia/pain with eye movement
- Managed with IV abx
What are some complications of sickle cell disease?
- Osteomyelitis (due to salmonella)
- Sickle cell crises e.g. vaso-occlusive crisis, acute chest syndrome, aplastic crisis and sequestration crisis
What malignancy is coeliac disease associated with?
- Enteropathy associated T-cell lymphoma
- Small bowel adenocarcinoma
What is the management for testicular torsion?
Urgent surgical exploration and bilateral orchidopexy
Where does hypospadias commonly affect and what is the management?
- Distal ventral surface of penis
- Corrective surgery at 12 months (PATIENT SHOULD NOT BE CIRCUMCISED)
What is Henoch-Schonlein purpura, what are the clinical features, investigations and management?
- Small vessel vasculitis
- Precipitated by viral URTI
- Purpura (over legs and bottom), abdominal pain and joint pain
- Raised ESR/CRP
- Raised IgA
- Symptomatic treatment (NSAIDs)
What is acute lymphoblastic leukaemia associated with?
t(12:21) translocation genetic abnormality - associated with better prognosis
What are the features of apgar?
- Muscle tone
- Reflex irritability
- Colour
- Respiratory effort
- Pulse
What are the ratios for neonatal and paediatric resuscitation?
- 5 inflation breaths
- Neonatal = 3:1
Paediatric = 15:2
What are red flag signs in children?
- Pale/mottle/ashen blue
- No response to social cues
- Does not wake/stay awake
- Weak
- High pitced/continuous cry
- Grunting
- RR > 60
- Age <3 months with temp >38
- Reduced skin turgor
- Non blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
What is the difference between gastroschisis and omphalocoele?
Gastroschisis - protrusion of abdominal contents through anterior abdominal wall lateral to the umbilical cord, NOT covered
Omphalocoele - protrusion of abdominal contents through anterior abdominal wall through umbilicus, covered by amniotic sac
Where does atopic eczema commonly present?
Infants = face and trunk
Young children = extensor surfaces
Children = flexor surfaces
What is an organic cause of precocious puberty in females?
McCune Albright syndrome (rare)
What tests are done to screen for DDH?
Barlow = attempts to dislocated articulated femoral head
Ortolani = attempts to relocated dislocated femoral head
What will an x-ray show in a patient with Perthes disease?
- Widening of joint space
- Decreased femoral head size
Technetium bone scan or MRI if normal plain x-ray but symptoms persist
