Pediatrics Flashcards
Meckels diverticulum symptoms?
investigation?
management
complications?
GI bleed - most common cause in kids age 1-2
abdominal pain mimicking appendicitis
technetium scan
surgery
volvulus and intussuception risk
Management for newly delivered baby not breathing, cyanosed
HR >100 = 5 breaths of air via face mask
HR <60 = CPR
if thought meconium causing airway obstruction = suction
Jaundice in 1st 24 hours after birth (pathological jaundice) is due to?
- problems in red blood cells
- cross reaction with maternal blood (eg rhesus hemolytic disease) - more likely if 2nd pregnancy
Risk factors for UTI in children?
vesicoureteral reflux - dilated and tortuorus ureter, dilated calyxes. rather than UTI in child, can also present antenatally as hyrdonephrosis on ultrasound
CONTINUOUS mumur in child, best heard under left clavicle is most likely? management?
Patent ductus arteriosus
manage with indomethacin
(pulmonary stenosis instead has a systolic murmur and ASD has a fixed split S2)
management of fever >38 in a child <3 months
urgent admission to hospital
Child aged 5-16 years with asthma not controlled by a SABA + low-dose ICS. next step?
add a leukotriene receptor antagonist
ALL symptoms
Anemia, neutropenia! (Despite leukocytosis) and thrombocytopenia (Petechiae)
ITP can cause thrombocytopenia but not neutropenia or leukocytosis. ITP often follows viral illness.
Bed wetting treatment?
- Changes in routine, reward system = 1st line
- Alarm = 2nd line
- Desmopressin
child <5 years is normal, give reassurance and advcie
Top causes of meningitis in children
Neonates to 3 months = group b strep!!, listeria, E. coli
1 month to 6 years = neisseria, hemophilus influenza, strep pneumonia
ADHD 1st line management? Side effects?
Stunted growth due to decreased appetite
Cardiotoxic - ecg
Down syndrome complications?
features?
hypothyroidism, dementia, leukaemia, and seizures, atlanto-axial instability (always screen for in patients that play sports)
sandal gap between big and first toe
brushfield spots on iris
etc
Necrotising enterocolitis symptoms and findings?
managment
Bilious vomiting
Abdominal distention
Bloody stools
AXR = dilated bowel loops, intramural gas, portal venous gas
- common I premature neonates
- broad spectrum antibiotics
Croup
Diagnosis?
investigation?
Management?
clinical diagnosis
Clinical or steeple sign on CXR
never perform throat examination due to risk of airway obstruction
Oral dexamethasone (0.15mg/kg)
if severe = marked sternal wall retractions/resp distress = oxygen + nebulised adrenaline
Congenital rubella syndrome?
Cataracts
Sensorineural deafness
Congenital CMV
Sensorineural deafness
NO cataracts
Congenital toxoplasmosis
Cerebral calcification
Chorioretinitis
Hydrocephalus
Pyloric stenosis
symptoms?
investigation?
management?
‘projectile’ vomiting, typically 30 minutes after a feed
constipation and dehydration may also be present
a palpable mass may be present in the upper abdomen
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting ( elevated bicarbonate)
ultrasound abdomen - target/dougnut sign
pyloromyotomy
Whooping cough
symptoms
Investigations
Management
cattarrhal phase - viral infection symptoms
coughing - worse after feeds, associated with vomiting
INSPIRATORY whoop
Per nasal swab
infants under 6 months with suspect pertussis should be admitted
an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days
Neonatal hypoglycemia management?
< 2.6 mmol/L
- asymptomatic
encourage normal feeding (breast or bottle)
monitor blood glucose - symptomatic or very low blood glucose
admit to the neonatal unit, intravenous infusion of 10% dextrose
bronchiolitis
management
supportive measures only
Epiglottis
symptoms
investigations
management
stridor, drooling saliva, tripod positioning
if suspected do not examine throat due to risk of airway collapse.
direct visualisation by senior aiway trained staff = 1st line. CXR also useful - thumb and steeple sign
intubation if necessary, oxygen, antibiotics
DMD
symptoms
investigations
management
calf pseudohypertrophy
Gower sign
progressive proximal muscle weakness
genetic testing = 1st line
can also do proximal muscle biopsy
supportive management
management of undescended testes?
- unilateral = review at 3 months if still undescended
- bilateral = review by senior pediatrician within 24 hours
enterobious vermicularis/pinworm management?
metronidazole
Benign rolandic epilepsy vs Juvenile myoclonic epilepsy
BRE - focal siezure in children - one side of face, drooling, one limb involvement. may become generalised. occur before or after sleeping
JME - myoclonic jerks of LIMBS, typically on background of daytime absences. can become generalised
Children below 0.4th centile for height management?
review by pediatrician
child < 3 years presenting with an acute limp management?
refer urgent pediatric assessment
neonatal sepsis symptoms?
top causes?
investigations?
management
Respiratory distress!!!: Apnea, tachypnea, nasal flaring, grunting, subcostal recessions.
Tachycardia
Jaundice
Seizures: if cause of sepsis is meningitis
Abdominal distention
- GBS, ecoli. higher risk in low birth weight + pre term
- blood cultures, LP
- IV benzylpenicillin with gentamicin
GORD symptoms?
typically develops before 8 weeks
vomiting/regurgitation
milky vomits after feeds
may occur after being laid flat
excessive crying, especially while feeding
Hirschsprungs management?
- bowel irrigation = 1st
- followed by surgery
Wilms tumour presentation?
abdominal mass
PAINLESS hematuria
no pain on palpation - contrast Polycystic kidney disease and renal cyst with pain
Kawasaki disease symptoms?
management?
high-grade fever which lasts for > 5 days.
conjunctival injection
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel
aspirin
IV immunoglobins
ECHO - must rule out coronary artery aneurysm
Describe the APGAR score and interpret it.
(it should be taken at 1 and 5 minutes after birth)
Appearance
- pink = 2
- body pink, extremities blue = 1
- blue all over = 0
Pulse (heart rate)
- >100 = 2
- <100 = 1
- absent = 0
Grimace (reflex irritability)
- cries on stimulation/sneezes/coughs = 2
- Grimace = 1
- nil = 0
Activity (muscle tone)
- Active movement = 2
- limb flexion = 1
- flaccid = 0
Respiratory effort
- strong, crying = 2
- weak, irregular = 1
- Nil = 0
0 -3 = very low
4 -6 = moderate low
7-10 = good state
Intussusception
symptoms?
investigation?
management?
abdominal pain
vomiting
currant jelly red stool
abdominal ultrasound - target like mass
reduction by air insufflation under radiological control,
Key risk factor for Developmental dysplasia of hip?
DDH when missed can present as?
breech presentation
USS hips at 6 weeks for breech babies at or after 36 weeks gestation
Trendelenberg gait
limb length discrepancy
(no pain compared to other differentials)
diagnosis = Ultrasound
if the infant is > 4.5 months then x-ray is the first line investigation
Neonatal Hypoglycemia
risk factors?
symptoms
management?
preterm birth (< 37 weeks)
maternal diabetes mellitus
neonatal sepsis
inborn errors of metabolism
jitteriness, pallor, poor feeding, weak cry, drowsy, siezures
asymptomatic
encourage normal feeding (breast or bottle)
monitor blood glucose
symptomatic or very low blood glucose
admit to the neonatal unit
intravenous infusion of 10% dextrose
Slipped upper femoral epiphesis
symptoms
investigation
management
complications
hip, groin, medial thigh or knee pain
loss of internal rotation of the leg in flexion
rf: obese children and boys
pelvic xray
internal fixation
avascular necrosis, limb length discrepancy
Osteosarcoma
symptoms
- pain in long bones - arms/ legs near growth areas (metaphysis), including around the knees.
- worsening pain over time, more severe at night or with rest
- systemic symptoms: weight loss or fever and
xray
biopsy = onfirmatory
Rubella symptoms?
investigations?
management?
Cystic fibrosis management
- high calorie high fat diet
- pancreatic enzyme supplementation
- modulators
Management when concerned about hypoxic brain injury?
Therapeutic cooling
