PEADS PASSMED Flashcards
Hand foot and mouth
-Mild systemic upset(fever, sore throat), ulcers, spots on hands and feet
-Cocksackie A16/ enterovirus 71
-Contagious
-Self limiting (hydration and analgesia)
-School exclusion not needed unless child feels unwell
Features of cystic fibrosis in neonatal period
-Meconium ileum (bowel obstruction that occurs when meconium is thicker and sticker than normal creating a blockage), prolonged jaundice (less common)
-The thicker stool is secondary to meconium
Mesenteric adenitis vs appendicitis ??
-Inflamed lymph nodes within mesentery
-Mesenteric adenitis usually no rebound tenderness or guarding and followed by viral infection
Paediatric BLS - INFANTS
-Brachial or femoral pulse
-15:2
-100-120/min
-Two thumb encircling technique for chest compression
What is Turners syndrome?
-Chromosomal disorder (FEMALES)
-Caused by presence of one X chromosome( 45, X) or deletion of short arm on X chromosome (45,XO)
Features of Turner’s syndrome
-Short stature
-Shielded chest, widely spaced nipples
-Webbed neck
-Primary amenorrhoea (never start period)
-Cystic hygroma (prenatally)
-High arched palate
-Short fourth metacarpal
-Multiple pigmented nave
-Lymphoedema in neonates (especially feet)
-Gonadotrophin levels INCREASED
-Hypothyrodisim in common
-Horseshoe kidney - common renal abnormality
Turners syndrome and heart
-Bicuspid aortic valve (15%) - Ejection systolic murmur
-Increased risk of aortic dilatation and dissection
-Regualr monitoring needed
What is a bicuspid aortic valve?
Aortic valve only has two leaflets instead of three - congenital defects
- It is associated with dilatation of ascending aorta
-Can cause aortic stenosis or aortic regurgitation
-In heads -valvuloplasty
Febrile convulsions
-Occur 6 months - 5 years
-Occur early in viral infection due to rapid rise in temperature
-Can be categorised into SIMPLE (<15 minutes, generalised, no recurrence in 24 hours, complete recovery in hour), COMPLEX (15-30 minutes, Focal seizure, repeat seizure), FEBRILE STATUS EPILEPTICUS (>30 minutes)
When to admit to peads for febrile seizure?
-1st seizure
-Any features of complex siezure
Ongoing management of febrile seizure
-Parents call ambulance if lasts >5 minutes
-NOTE: antipyretics have not been shown to reduce chance of febrile seizure occurring
What can be given if recurrent febrile convulsions?
-Benzodiazepine rescue medication - rectal diazepam or buccal midazolam
-NOTE: SPECIALIST
Future risk of febrile convulsions
-1 in 3
-Varies depending on (age of onset <18 months , fever <39, shorter duration before seizure , family history of febrile convulsionns)
-If no risk factors only a 2.5% risk of developing epilepsy
-If family history of epilepsy, complex febrile seizures or background of neurodevelopment disorder - then more likely (50% if all three)
When should testes descend?
3 months - prompt referral if not descended by this age
Why is it important to management undescended testes?
-Increase risk of testicular cancer and infertility
-Torsion can occur
-Should be repaired at 6-18 months
Management of unilateral undescended testis
-Referal from 3 months with baby seeing surgeon before 6 months
Management of bilateral undescended testes
-Reviewed by senior paediatrician within 24 hours
-Urgent endocrine or genetic investigation
Tetrology of fallout features
-Cyanosis or collapse in first month life
-Ejection systolic murmur - due to pulmonary stenosis
What is tetralogy of fallout?
-Most common cause of congenital heart disease
-Presents 1-2 months
-Is a result of anterior malalignment of aorticopulmonary septum
What are the four characteristics of TOF?
-Ventricular septal defect (VSD)
-Right ventricular hypertrophy
-Right ventricular outflow tract obstruction - the severity of right ventricular outflow tract obstruction determines the degree of cyanosis and clinic severity
-Overriding aorta
Management of TOF
-Surgical repair
-Cyanotic episodes may be helped by beta blockers
Intestinal malrotation with volvulus
-USS whirlpool sign (midgut volvulus)
-Vomiting (green in colour from bile)
-Ladd’s procedure
Congenital diaphragmatic hernia
-Herniation of abdominal viscera into chest cavity due to incomplete formation of the diaphragm - can result in respiratory distress syndrome
-only 50% of newborns survive
-CXR bowel loops in chest cavity
What does 6-1 vaccine include?
Diphtheria, tetanus, whopping cough, polio, Hib, hepB
When is 6 in 1 vaccine given?
8, 12 , 16 weeks
Growing pains
-Normal examination
-Normally bilateral pain in legs occurring at night
Most common fractures associated with child abuse
-Humeral
-Radial
-Femoral
Umbiliac hernia
-Usually self resolve - if large and symptomatic expletive repair 2-3 years
-If small and asymptomatic perform elective repair 4-5 years
Neonatal death
death in first 28 days of life
Prognosis of CDH
1) liver position - lover in thoracic cavity poor prognosis
2) lung to head ratio
Medical management of croup
Dexamethasone 0.15mg/kg
When to admit with croup?
-If moderate ( frequent barking cough, easily audible stridor at rest, suprasternal and sternal wall retraction at rest)
-If severe (frequent barking cough, inspiratory stridor at rest, distress, restlessness, tachycardia)
What is bronchiolitis
-Acute bronchiolar inflammation
-Caused by RSV
What are the features of bronchiolitis?
-Coryzal symptoms
-De cough
-Increase breathlessness
-Wheezing, fine inspiratory crackles
-Feeding difficulties associated with increasing dyspneoa -REASON TO ADMIT
When to consider admission to hospital bronchiolitis?
-RR >60
-Clinical dehydration
difficulty breastfeeding or inadequate oral intake
Management of bronchiolitis?
Supportive
Phimosis management - non-retractible foreskin and/or ballooning during micturition in child under two
Expectant management - should resolve
NOTE: if over two and recurrent balamoposthisis or UTI then treatment can be considered
Causative agent of roseola infantum
Herpes virus 6
Benign Rolandic epilepsy
Seizures that occur at night
Child otherwise normal
Age for social smile
6 to 8 weeks
Risk factors for developmental dysplasia of the hip
-Female x6 risk
-Breech presentation
what is Barlow and ortolan test used for?
Developmental hip dysplasia
Barlow - attempt to dislocate articulated femoral head
Ortolani - attempts to recloate