Paeds things you forget Flashcards
What is most common kidney stone in kids?
Phosphate stone - due to proteus UTI alkalinising urine.
What is fever in kids?
>
- This is red flag if <3m. >39 is fever if >3m.
Red flag infection signs in kids
o Fever >38C if <3m or >39C if 3-6m.
o Colour – pale, mottled, cyanosed.
o Level of consciousness reduced / neck stiffness / bulging fontanelle / status epilepticus / focal neurological signs/seizures
o Significant respiratory distress
o Bile-stained vomiting
o Severe dehydration or shock
Non-specific infection/meningitis abx given to neonates
<3m - cefotaxime. Add ampicillin if <1m to cover Listeria
>3m - ceftriaxone (contraindicated in <3m as displaces bilirubin from binding sites)
Aciclovir if encephalitis considered.
Most common cause of meningitis at different ages:
Neonate to 3m - BEL (Group B strep, E.coli, Listeria)
1m to 6yrs - NHS (N.meningitides, S.pneumoniae, Hib)
>6yrs - N.meningitides, S.pneumoniae
Meningitis prophylaxis
Ciprofloxacin, or Rifampicin
Name a group A and a group B strep
Group A - S.pyogenes
Group B - S.agalactiae
Way to remember, the letter’s dont match
Mumps Px, Ix, Cx
Px - Parotitis, fever, malaise.
Ix - Plasma amylase (may be raised due to pancreatic involvement)
Cx - Orchitis
5C’s of measles
Also 2 Tx’s
Cranky (malaise), cough, coryza, conjunctivitis, coplik spots
Also a rash spreading from behind the ears (maculopapular, effects whole body)
Generally supportive care, if severe:
Ribavirin, Vitamin A supplements
Facts about Kawasaki:
a) What size vessel?
b) What happens to platelets?
c) Ages effected?
d) Diagnostic criteria?
e) Tx (hospital admission? 2 drugs? What if aneurysm?)
a) Medium vessel vasculitis
b) thrombocytosis leading to thrombosis
c) 6m to 4yrs, peaks at age 1.
d) Fever >5 days + 4/5 of Conjunctivitis, Rash, cervical
lymphAdenopathy, Strawberry tongue, swollen/red/peeling Hands
e) Yes admit to ITU. IVIg 10 days, High dose Aspirin 6wks, Warfarin)
Treatment of Chicken Pox? Inc. school exclusion and pregnant mums.
Paracetamol + Diphenhydramine (skin emollient) or antihistamine (NSAIDs contraindicated)
If severe and >2, aciclovir.
Generally excluded for 5 days after onset of rash, or all lesions crusted over.
Pregnant women exposed are tested for immunity (look for varicella antibodies); Ig recommended within 10 days if non-immune, and aciclovir if infection occurs.
School exclusion for the following: Chicken pox, Diarrhoea/vomiting, Mumps, Measles and Rubella, whooping cough
Which xanthems require no school exclusion?
Chicken pox - until lesions have crusted (5 days)
Diarrhoea/vomiting - 2 things so can only come back to school 2 days symptoms free
Mumps has 5 letters, so 5 days after symptoms onset. Same for Rubella (measles 4 days though)
Whooping cough - whoop whoop 2 days since starting abx.
Scarlet fever - 1 day since starting abx.
No exclusion - Slapped cheek (B19), Roseola, EBV, head lice, threatworms and Hand foot and mouth (cox)
Antenatal infection. Features of CMV, VZV, Toxoplasmosis and Rubella infection in pregnancy
Congenital CMV - hearing loss, thrombocytopenia (petechial rash), microcephaly. No Tx, serology to diagnose.
VZV - hypertrophic scars (not petechial rash), limb defects (hypoplasia), ocular defects. Non-immune mum exposed then 10days Ig, aciclovir if infection occurs, similar for baby.
Rubella - triad of sensorineural deafness, ocular defects, CHD (PDA, pulmonary artery stenosis). No Tx.
Toxoplasmosis - cerebral calcification, chorioretinitis, hydrocephalus (mental handicap, convulsions, spasticity, visual impairment). Tx with Spiramycin. If vertical transmission Pyrimethamine + folinic acid.
Loss of internal or external rotation in SCFE?
Inability to internally rotate on flexion of the hip (so there is obligatory external rotation)
In in (inability to internally rotate)
What do you add after SABA and ICS in >/< 5’ for asthma
If >5 you add salmeterol a LABA ( the S of salmeterol looks like a 5 indicating it can be used >5.
If <5 you add montelukast.
Nevermind, it is LTRA for both.
Which kids with pneumonia / bronchiolitis do you admit to hospital?
SASI
* Severe resp distress (grunting, RR >70, marked recessions
* Apnoeas
* Saturations <90% (<92% if <6months)
* Inadequate fluid intake (50-75% of usual)
Levels of asthma attack severity
Moderate - can talk, PEFR >50%, O2 >92%
Severe - cannot talk, PEFR 30-50%, O2 <92%, use of accessory muscles
Life-threatening - silent chest, cyanosis, reduced LOC, exhaustion, normal PCO2
What is first, second line Tx for faecal impaction?
First line - macrogol (osmotic) laxative + electrolytes (Movicol paediatric plan would be polythene glycol and electrolytes)
Second line - Stimulant laxative can be added (e.g. Senna)
If movicol doesnt work, a different osmotic laxative can be used, e.g. lactulose.
NB diet on its own wont treat foetal impaction but is first line for chronic constipation. Bulk laxatives are of value.
What is sandifer syndrome
Unusual movements of head/back associated with reflux. Usually resolves by 2yrs of age.
Management of ITP in kids?
The majority resolve spontaneously over 6-8wks and require no Mx, however safety net. Avoid contact sports.
Only start prednisolone if platelet count is raised. Splenectomy if life threatening.
Tx of AOM? When are abx indicated?
Generally, watch and wait as AOM spontaneously reoslves in 80% of 4 days. Indications for immediate abx = <2, bilateral AOM, systemically unwell.
If abx indicated - first line = 5 day course of amoxicillin, Clarithromycin is 2nd line abx if allergic.
Refer to ENT if >6 episodes in 12m or effusion for >3m bilaterally or >6m unilaterally.
Describe 4 benign skin lesions that may be found on NIPE
Epstein pearls - small white pearls along the midline of the palate.
Milia - white pimples on nose and cheeks
Mongolian blue spots - blue/black macular discoloration looks like bruise. Fade over first few years.
Erythema toxicum - neonatal urticaria 2-3days . White pinpoint papules w/ eosinophils.
What is naveus flammeus?
Port wine stain - present from birth, usually grows with infant. Due to vascular malformation of capillaries. May be associated with Sturge-Weber syndrome.
What is carvernous haemangioma?
Strawberry naevus - not usually present at birth (differentiates from naveus flammeus), but appears in first month. More common in preterm. No Tx but topical propranolol may speed regression.
What are cafe au lait patches related to?
Neurofibromatosis if 5+
Describe irritant dermatitis (nappy rash) Px and Mx
Cx
Irritant effect of urine on skin, worse if mixed with faeces.
Erythematous, scalded appearance. Flexures are spared.
Mild - protective emollient. More severe - topical steroids.
Cx - candida infection may complicate nappy rashes - erythematous, involves flexures and satellite lesions. Tx with topical antifungal.
Describe infantile seborrheic dermatitis Px, Mx
First 3 months of life, starts on scalp as thick, yellow layer (cradle cap). May extend to flexures and napkin area. NOT itchy like eczema.
Mild - emollients. Severe - ointment w/ sulphur/salicylic acid. Mild topical steroid.
Describe atopic eczema in kids Px, Mx
First year of life (uncommon in first 2m like infantile seborrheic dermatitis). Itchy rash predominantly face and trunk (older has flexor/friction surfaces).
Can get eczema herpeticum.
Mx - avoid irritants (soap) and mittens.
Emollients.
Topical corticosteroids need to be used with care. Avoid face.
>2 - immunomodulators cream.
Skin prick testing for cow’s milk protein allergy.
Describe stephen johnson and TEN
Steven johnson is <10% skin involved. If >30% then toxic epidermal necrolysis (TEN).
It is a severe type 4 skin reaction - skin can peel off.
Admit to burn unit/hospital. IVIg, abx, antihistamines.
Cx - dehydration, sepsis.
Some neonatal DS features
Hypotonia
Poor moro reflex
upslanted palpebral fissures
Single palmar crease
Bushfield spots in iris
Low set ears
Global developmental delay
Edward’s what is JEF18?
Trisomy 18
undersized Jaw (micrognathia)
Edward’s
Feet - rocker bottom feet (also can get this in patau’s)
Edward’s and patau’s are similar. What sets them apart?
Polydactyly in patau’s
Angelman’s inheritance?
Imprinting of paternal copy.
Kids are happy and excitable with severe disability.
Fragile X inheritance and Px
X-linked dominant transmission. Expansion of CGG triplet repeat on X-chromosome.
Big long head and big balls but floppy and autistic.
Features of turner’s
Short stature, wide nipples, webbed neck, bicuspid aortic valve/coarctation of aorta, primary amenorrhoea, hypothyroidism.
Describe Pierre-robin syndrome
Micrognathia, Posterior displacement of tongue, Cleft palate.
Small boy with a robin in his mouth
Describe inguinal hernia in kids
Usually indirect through inguinal canal. In premature babies with weak/friable, direct.
Px with lump in groin, can be strangulated = obstruction, pain, vomiting.
Tx - surgery.
Hydrocele / Varicocele
Differentiation from inguinal hernia and Mx
Can get above it.
Usually resolve spontaneously. Surgery considered if persists beyond 2yrs.
Undescended testes Mx, Cx
Present in 5%, more common in premature.
If bilateral undescended testes, karyotype must be established and should be reviewed by senior within 24hrs.
Imagining not helpful.
If 1 not descended, watch and wait for 3m.
Orchidopexy is usually performed at/before 1yr as spontaneous descent unlikely thereafter.
Torsion, reduced fertility, malignancy.
Describe foreskin retraction, rash ballooning
Not retractile before 3yr, then gradually becomes it.
Can become red as part of napkin rash - leave alone unless extensive/purulent discharge.
Ballooning rarely causes any trouble.
When do you worry about phimosis?
Puberty. It is normal up to 3yrs.
BXO (balanitis xerotica obliterans) causes progressive scarring and doesnt invert - worry about this.
<12 - reassurances and hygiene. Steroids if BXO. No surgery.
>12 - try topical corticosteroid. If doesnt work then surgery.
Paraphimosis - ring of narrower skin, requires emergency reduction surgery.
Hypospadias location, associations, Mx
80% on distal shaft of ventral penis. Hooded appearance. Hooded foreskin – ventral deficiency. It does join at the front.
Caudi – penis is bent forward instead of being straight.
Ventral meatus – wee comes out of the bottom side of the penis. It is usually distal.
Associated with cryptorchidism.
Surgery is not mandatory but if needed 2-3yrs of like (after 3months). It is important NOT circumcised.
Determinant of growth hormones
After birth
Childhood
Puberty
Thyroid hormone
GH producing IGF-1. Vit D also needed.
Testosterone/oestradiol
What is occipital plagiocephaly?
Babies on back sleeping can mould the head. It improves as more mobile. No Tx.
How can puberty be investigated?
Bone age measurement w/ x-ray of wrist.
Pelvic US looking at uterine size
Precocious puberty ages, types, Ix
8 in females, 9 in males.
Gonadotrophin dependent (true/central) from premature activation of hypothalamus. Puberty is consant.
Gonadotrophin independent (false, pseudo) from excess sex steroids outside of pituitary gland. Puberty is dissonant.
Differentiate w/ LHRH test. Give GnRH and see if LH/FSH rises. If not then pseudo.
Is PP more worrying in males or females?
In females PP usually just premature onset of normal puberty.
Gonadotrophin independent (CAH, adrenal tumours - virilisation, pubic hair before breast development).
Males PP usually pathological (gonadotrophin dependent due to tumour). MRI.
Late puberty: ages, types and causes in those types.
Cx. Which gender more worrying?
14 in females, 15 in males.
Constitutional delay - most common.
Hypogonadotrophic hypogonadism - Kallmann’s, tumours, systemic disease (CF, AN, CD, excessive exercise).
Hypergonadotrophic hypogonadism - Klinefelter, Turner, gonadal damage (chemo, radio, surgery, trauma).
Psychological, reproduction defects, reduced bone mass.
Late puberty is more worrying in girls, as boys just less sensitive to hormones (karyotype girls)
Describe gender effected, Ax, Px, Mx of:
- Klinefelter
- Turner’s
- Kallmann’s
Kallmann (hypo hypo) - M>F. Lack of GnRH hormones. Px at with late puberty and anosmia. Ix w/ LHRH test. Requires lifelong testosterone or oestrogen (+progesterone). Risk of osteoporosis
Klinefelter’s (hyper hypo) - Male w/ extra X chromosome. There is tall stature (SHOX -height gene on X chromosome). Small testes, infertility, lack of puberty. Can be gynaecomastia. Karyotype. Requires testosterone replacement.
Turner’s is girls with delayed puberty, short stature, webbed neck. Karyotyping. Give oestrogen and maybe GH.
Where is main site of haemopoiesis in foetus?
Liver
Describe O2 sats and Hb levels at in utero/at birth.
Also, WBC and plt counts
O2 is around 70% at birth hence Hb is high. These start to normalise over the weeks.
WBC is high but plts in normal adult ranges.
Preterm will have low stores of iron, folic acid and B12.
How can you distinguish red cell aplasia (congenital, TEC, B19) from other forms of anaemia?
Low reticulocytes (can be raised in IDA etc.)
Describe HS inheritance, Px and Mx
Autosomal dominant
Haemolysis - anaemia, hepatosplenomegaly, jaundice, dark wee, gallstones. Aplastic crisis if B19 infection (slapped cheek).
Diagnosed on blood film.
Oral folic acid. If severe then splenectomy (>7yrs old as sepsis risk).
Describe G6PD inheritance, Px and Mx
X-linked recessive
Haemolysis - anaemia, hepatosplenomegaly, jaundice, dark wee, gallstones triggered by fava beans and certain abx/drugs.
Bite cells on blood film, measure G6PD.
Avoid triggers, transfusions rarely.
Px and Mx of sickle cell anaemia
Anaemia w/ jaundice from haemolysis
Infection susceptibility (hyposplenism)
Vaso-occlusive crisis (cold, dehydration, exercise, hypoxia) - hand-foot syndrome (dactylitis), acute chest syndrome, AVN of femoral head.
Priapism
Requires immunisations, folic acid (anaemia). Hydroxycarbamide (increase HbF production) and BM transplant.
Acute crisis - analgesia, hydration, abx, O2.
Inheritance and Mx of haemophilia
X-linked recessive
Acute - tranexamic acid, recombinant factors (8 for a, 9 for b)
Chronic
- Avoid IM injections, aspirin and NSAIDs.
- Prophylactic f8 if severe
- Desmopressin (DDAVP) for mild A
Biliary atresia
- Aetiology/pathophysiology
- Px
- Ix
- Tx
Fibro-obliterative obstruction of extrahepatic and intrahepatic ducts. Aetiology unknown. Chronic liver failure and death within 2yrs if not treated.
Obstructive jaundice picture. Faltering growth. Hepatosplenomegaly (portal HTN).
Raised CB, abnormal LFTs. US. Diagnosis confirmed by cholangiogram. Diagnosis before 6-8wks preferable.
Kasai hepato-porto enterostomy. Nutrition/fat soluble vitamin supplements. Ursodeoxycholic acid.
Wilm’s tumour aetiology, Px, Ix, Mx
tumour of pluripotent embryonic renal precursor cells. Usually age 2-5.
Unilateral, large, painless, abdominal/flank mass. Haematuria in 10-25%. Anaemia in 25% (haemorrhagic, IDA). Can have varicocele.
Abdo US first line, Surgical resection diagnostic.
Nephrectomy, chemo/radio.
Neuroblastoma aetiology, Px, Ix, Mx
Neural crest tissue in adrenal medulla/SNS.
Most have abdo mass but can be anywhere along sympathetic chain. Usually <5yrs. Symptoms of mets.
Urinary catecholamine levels 1st line. Confirmation w/ biopsy.
Surgery.
Rhabdomyosarcoma aetiology, Px, Ix, Mx
Sarcoma - malignant connective tissue, Rhabdomyo - striated muscle. <18. Primitive mesenchymal tissue.
Head and neck most common sites (proptosis, nasal obstruction), can involve bladder.
Biopsy.
Tx depends on age/site - surgery, chemo/radio.
Most common brain tumour, Px, Ix, Tx
Astrocytoma (40%) Medulloblastoma (20%)
Recurrent vomiting, ataxia, behaviour change, siezures, eye problems (double vision), developmental delay, macrocephaly.
MRI scan, LP may be CI.
Surgery relieving hydrocephalus.
Which type of lymphoma more common in kids?
NHL in childhood.
HL is more in adolescence.
Describe bone tumours (osteosarcoma >Ewing sarcoma) Px, Ix, mx
Uncommon before puberty. Male predominance. Limbs most common site.
Persistent localised bone pain on waking. Otherwise well.
Plain X-ray -> MRI.
Chemo/surgery.
When should primitive reflexes disappear?
Abnormal if retained past first year of life.
What is the order we broadly develop the 4 fields of development?
Gross motor - during first year of life.
Vision/fine motor - from 1yr onwards.
Hearing, speech, language - from 18m of age
Social, emotional, behavioural - from 2.5yrs
Describe hearing tests and when they are done
OAE - newborn screening. Simple, quick but misses auditory neuropathy. High false positive rate in first 24hrs.
ABR - if OAE abnormal. Lower rate of false positives, but baby needs to be asleep.
Distraction testing 7-9m, done if missed newborn screening. You turn towards sounds.
Visual reinforcement 10-18m (up to 3yrs). Turn towards toys.
Pure tone audiometry - from 4yrs. Done at entry to most schools in UK.
Define impairment, disability, disadvantage
- Impairment – loss or abnormality of physiological function or anatomical structure
- Disability – any restriction or lack of ability due to the impairment
- Disadvantage –results from disability, and limits or prevents fulfilment of a normal role. It is situationally specific, e.g. a child with a learning disability may be a good skier.
Describe aetiology of CP
80% antenatal - CVH, ischaemia, maldevelopment, chorioamnionitis, TORCH infections, teratogens
10% perinatal - HIE, asphyxia
10% postanal - meningitis, head trauma, hyperbilirubinaemia
Describe general and subtypes Px of CP
Motor dysfunction - abnormal posture/tone (clasp knife) with delayed motor milestones. feeding difficulty, gait abnormality, asymmetric hand function <12m. Primitive reflexes persist.
Spastic (90%) - UMN lesion. Can be
- Hemiplegia - unilateral, often vascular cause.
- Quadriplegia - bilateral, severe, trunk involved, opisthotonos, seizures.
- Diplegia - 4 limbs effected but legs much worse. Associated w/ preterm and periventricular leukomalacia.
Dyskinetic (6%) - BG/SN damage. Uncontrolled involuntary movements (chorea, athetosis) and DROOLING. HIE most common cause, then hyperbilirubinaemia (kernicterus)
Ataxic (4%) - cerebellum damage. Symmetrical, genetic cause.
CP Ix & Mx
MRI on everyone.
For hypertonia - Botox injection, baclofen, deep brain stimulation.
General - PT, OT, SALT, sleep support etc.
Define ADHD diagnostic criteria
Functional impairment in >/2 domains (e.g. school and home).
3 core behaviours are:
- Hyperactivity - fidgety, talkative, noisy, cant remain seated.
- Inattention - easily distracted, not listening, forgetful, organisational problems
- Impulsivity - blurts out answers, interrupts, cant wait turns.
Need 6/9 inattentive symptoms and 6/9 hyperactivity/impulsivity.
Describe Mx of ADHD
1st line school stuff, rules etc.
If >5, hyperactivity responds symptomatically to medication.
- Stimulants - methylphenidate or dexamphetamine
- Non-stimulants - atomoxetine (3rd line).
All 3 are cardiotoxic so ECG before starting Tx.
Must monitor growth on methylphenidate.
Amphetamines work by boosting noradrenaline and dopamine in prefontal cortex by inhibiting presynaptic dopamine transporters.
Describe refractive errors (which is more common) and Mx
Hypermetropia (long sight) - most common refractive error in young children. Convex lens
Myopia (short sight) - most common refractive error if born preterm. Concave lens.
Describe squint/strabismus
- Manifest
- Latent
Ix, Mx, Cx
Misalignment of visual axes of eyes. Main RF are FHx, prematurity.
Manifest always appears not aligned. When you cover normal eye, abnormal one corrects itself. All muscles/nerves working just born not lined up. Suffix -TROPIA (esotropia inward)
- Causes - usually refractive error (hypermetropia associated w/ esotropia).
- can be seen on cover/uncover test and corneal reflections.
Latent - eyes appear aligned, only deviates when covered. Suffix -PHORIA (esophoria). Many of the population have this a little bit.
- can ONLY be detect on the alternate test.
