Pediatrics Flashcards
Neonatal hypoglycemia management?
asymptomatic
encourage normal feeding (breast or bottle)
monitor blood glucose
symptomatic or very low blood glucose blood glucose of <1mmol/L
admit
intravenous infusion of 10% dextrose
differentiate between
caput succedaneum
and cephalohematoma
caput succadenum -> present at birth, forms over the vertex and crosses suture lines, resolves within days. fluid collection
cephalohematoma -> develops several hours after birth, most common in parietal region, does not cross suture lines, takes months to resolve. blood collection
A newborn infant is noted to have a posterior displacement of the tongue and a cleft palate. What is the most likely diagnosis?
Pierre-Robin Syndrome -> micrognathia (undersized jaw), glossoptosis (posterior displacement of the tongue) and cleft palate
Differentiate between acute epiglottitis and croup
Acute epiglottitis = tripod positioning, drooling!!. Stridor. Caused by Hib -> now seen more commonly in adults due to vaccination program. Diagnosis by direct visualization by senior staff. call anesthetist for intubation! Do not examine throat. Thumb print sign on x ray. IV antibiotics
Croup - stridor!! , SOB. Viral prodrome!! - Parainfluenza virus. Most common cause. Steeple sign on X-ray/supglottiv narrowing. Croup = barking Cough that may sound like a seal. managed with oral dex. SINGLE dose
Symptoms seen
Cyanosis/ tet spells
collapse in first month of life, Ejection systolic murmur
symptoms of noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
A 2-week-old infant with a small chin, posterior displacement of the tongue and cleft palate has what syndrome?
pierre robin syndrome
Management for ophthalmia neonatorum (infection of newborn eye)
Same day ophthalmology referral
What happens in necrotising enterocolitis?
management?
bowel of premature infants becomes ischaemic and infected.
dilated asymmetrical bowel loops AND pneumatosis intestinalis (intramural gas).!!
abdominal distension. bloody stools may be present
total gut rest and TPN, babies with perforations (eg free fluid in in abdomen) will require laparotomy
If a man has a mitochondrial disease, which family member is most likely to be affected?
Brother or sister - maternal inheritance
what is infantile colic?
benign condition characterised by irritability and excessive crying
tends to be worse in the evenings or at night. starts around 6-8 weeks old and most resolve by 6 months
First sign of puberty in boys?
Increase in testicular volume
What is transient tachypnoea of the newborn?
Diagnostic findings?
risk factor!!
Management?
commonest cause of respiratory distress in the newborn period.. rapid breathing, grunting, and mild intercostal recession. caused by delayed resorption of fluid in the lungs
Chest x-ray - hyperinflation of the lungs and fluid in the horizontal fissure.
c section!!
Observation/supportive care. O2 may be needed
Whooping cough symptoms?
Management?
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
Macrolide antibiotics- clarithromycin, azithromycin
school exclusion until 2 days after starting antibiotics
Important contraindication to lung transplant in CF?
chronic infection with Burkholderia cepacia
A normal pCO2 in an acute asthma attack indicates?
Life threatening attack - respiratory exhaustion - not blowing off co2
distinguish between pathological and physiological jaundice and prolonged jaundice
name causes of each
pathological = in first 24 hours. rhesus disease&hemolytic jaundice, blood group incompatibility. hypothyroidism. Coombs test important
tretaments - phototherapy, iV immunoglobulin, exchange transfusion
physiological = days 2-14 eg less developed liver, more rbcs, breast milk
prolonged = beyond 14 days. biliary atresia, hypothyroidism, galactosemia, UTI, breast milk
in a patient that present with acute asthma attack which improves with o2 and salbutamol, what else must be prescribed?
oral prednisolone, 40mg for 3-5 days
hemophilia A has what mode of inheritance?
x linked recessive
explain the law around medical consent by children under the age of 16 in UK
patients less than 16 years old may consent to treatment if they are deemed to be competent (an example is the Fraser guidelines, previously termed Gillick competence), but cannot refuse treatment which may be deemed in their best interest
non bullous impetigo treatment?
hydrogen peroxide cream 1%. exclusuion from school till lesions are crusted and healed
how do you differentiate between infantile spasms (siezures) and infantile colic?
what investigation is needed?
In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the ‘spasms’
eeg - rule out hypsarrhythmia commonly seen in West syndrome
in a viral induced wheeze, if SABA is not effective, next step in management?
ICS or monteleukast
febrile siezures typically stop at what age?
medication for recurrent febrile siezures?
5 years
benzodiazepine
3-year-old boy. last 12 hours bilious vomiting on multiple occasions. assed one stool which contained small amounts of blood.
what is the likely diagnosis?
investigation?
management?
intusscueption
USS = first line = target sign
reduction by air insufflation
during paroxysm the infant will characteristically draw their knees up and turn pale
how can you distinguish between intussuception and necrotising enterocolitis?
diagnostic test in NE?
both have abdominal distension, bilious vomiting and bloody stool
NE more commonly encountered in premature infants! than young children like intussuception
Abdominal x-ray
a distended abdomen and bilious vomiting in a 2-week child is highly suggestive of?
diagnosis?
intestinal malrotation and volvulus. the obstruction here causes bilious vomiting
upper GI contrast study and USS
name red flag symptoms in pediatric traffic light system
respiratory rate >60 breaths/minute
reduced skin tugor
moderate intercostal recession
age <3 months!!
temp >38 !!
weak, high pitched or continous cry
scarlet fever symptoms?
management?
rash ->. spares palms and soles. ROUGH or sandpaper like texture, sore throat, strawberry tongue may be present
oral penicillin 5 for 10 days
meningitis treatment in children< 3 months
IV amoxicillin in addition to cefotaxime to cover for Listeria
> 3 months is IV cefotaxime or ceftriaxone. note ceftriaxone contraindicated in children <3 months
APGAR scoring
Activity
Pulse
Grimace
Appearance
Respiration
For each thing it’s 0-2 points max
A 4-year-old boy is noted to have macrocephaly and learning difficulties. What is the most likely diagnosis?
Fragile X syndrome. also large ears, macro-orchidism
why is oligohydramnios a risk factor for DDH?
it restricts foetal movement and thus normal development of the hip joint.
symptoms of SCFE?
hip, groin, medial thigh or knee pain. inability to weight bear
loss of internal rotation of the leg in flexion
may present following acute trauma or chronically
commonly in obese boys.
in neonates with hypoxic injury, what is done to reduce the chances of HIE?
therapeutic cooling
poor prognostic factors for ALL?
male sex
presenting <2 years or >10 years; having B or T cell surface markers; and having a WCC > 20 * 10^9/l at diagnosis.
ALL symptoms?
anaemia, neutropaenia (infections eg cough) and thrombocytopaenia
Others: splenomegaly, hepatomegaly, bone pain
*note high number of white cells produced so high wcc!! -> but they do not function properly
Perthes disease presentation?
(idiopathic avascular necrosis of the femoral head)
management?
pain and a limp, reduced tange of hip movements movements.
observation. only surgery if fracture or joint collapse
transient synovitis presentation?
1-2 weeks after an upper respiratory tract infection or gastrointestinal infection.
what type of pulse is seen in a patent ductus arteriosus?
collapsing pulse
classify the types of cerebral palsy and structures damaged in each
spastic (70%)
subtypes include hemiplegia, diplegia or quadriplegia
increased tone resulting from damage to upper motor neurons!!!
dyskinetic
caused by damage to the basal ganglia and the substantia nigra!!!
athetoid movements and oro-motor problems (drooling)
ataxic
caused by damage to the cerebellum!! with typical cerebellar signs. struggle with fine motor skills! eg building a tower
mixed
when is the first dose of MMR vaccine given?
at 12-13 months
what is an umbilical granuloma?
overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.
what features make penumonia more likely than bronchiolitis?
high fever (over 39°C) and/or
persistently focal crackles.
name 3 oral live attenuated vaccines
polio
rotavirus
typhoid
in the first ___ minutes of life suboptimal SP02 readings can be expected from a healthy neonate
10 minutes
features seen in achondroplasia?
trident hand deformity (short, stubby fingers with separation between the middle and ring fingers), short limbs (rhizomelia), lumbar lordosis and midface hypoplasia.
A 16-year-old female presents with chronic left knee pain. The pain is typically felt after jogging. There is also intermittent swelling and locking of the same joint. What is the most likely diagnosis?
osteochondritis dissecans
Osgood-Schlatter disease rarely causes pain at rest. with activity pain is localised at tibial tuberosity. swelling can occur
VSD increases risk of what condition?
endocarditis
what medical condition is associated with fragile x syndrome?
mitral valve prolapse
which complication of ALL can lead to recurrent nosebleeds and easy bruising?
DIC
hirschprungs disease management?
initially: rectal washouts/bowel irrigation
definitive management: surgery
risk factors for neonatal RDS?
CXR findings?
prematurity
maternal diabetes -> insulin inhibits surfactant production
c section
ground-glass’ appearance with an indistinct heart border
developmental milestones times
name some complications of measles
Otitis Media for Measles. not externa
pneumonia
encephalitis
conjuctivitis
myocarditis
a benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles is?
venous hum
a 14 year old girl has hemophilia, what other condition does she likely have?
turners syndrome
hemophilia is x linked recessive so is expected to only occur in males
most common cause of cardiac arrest in children?
hypoxia -> may be choking incident
what are the most common causes of cyanotic heart disease?
tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia
4 year old with bedwetting management?
Children under the age of 5 years who have nocturnal enuresis can be managed with reassurance and advice
18 month old girl with acute limp and coryzal symptoms. management?
urgent specialist assesment as <3 years with acute limp
transient synovitis uncommon in age group,. septic arthritis more common
what are risk factors for RSV and thus warrant administration of Pavalizumab?
Premature infants
Infants with lung or heart abnormalities
Immunocompromised infants
JIA symptoms?
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
intestinal malrotation is associated with which medical conditions?
exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia
differentiate findings in ITP, HSP and meningtis
ITP - non blanching rash, no fever, viral prodrome
HSP -> non blanching rash, athralgia, abdominal pain
Meningitis -> non blanching rash, fever, other signs of being unwell
ASD auscultation findings
ejection systolic murmur, fixed split S2
Partial siezures at night, marked by -> hemifacial paraesthesias, oropharyngeal manifestations (e.g. strange noises) and hypersalivation is characteristic of?
benign rolandic epilepsy
Umbilical hernia management?
Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic peform elective repair at 4-5 years of age.
Causes of microcephaly?
normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis
Patient with suspected transient synovitis eg viral infection before symptoms. But temp is 38. Management ?
Urgent referral due to presence of fever! Must rule out septic arthritis
In pediatric BLS, how many rescue breaths given intially? Why?
5
Main cause of arrest in kids is hypoxia.
Changes in the peripheries such as oedema or peeling.
Bilateral nonpurulent conjunctivitis
Polymorphic rash.
Cervical lymphadenopathy.
Investigation to screen for complications?
Echo
What test is contraindicated in meningococcal septicemia?
Lumbar puncture.
Sepsis - bp, heart rate etc
children with an unexplained enlarged abdominal mass in children - possible Wilm’s tumour - arrange paediatric review with 48 hours
Hand foot and mouth disease management
Symptomatic treatment only
Signs differentiating between early (compensated) shock and late (decompensated) shock*:
early shock
- normal bp
Tachycardia
- tachypnea
Pale and mottled
Urine output reduced
late shock
hypotension
bradycardiaacidotic (Kussmaul)
blue extremities
urine output absent
in infants with vague signs such as poor feeding, grunting, lethargy
What should be considered
Risk factors?
Neonatal sepsis- resp distress also most common symptom
Premature
Birth weight less than 2.5kg
GBS
Chorioamnionitis
AD conditions list them
Achondroplasia
Cough and wheeze in <1 year old, in a background of viral illness is most likely?
when is this condition severe?
Bronchiolitis
O2 if sats less than 92
Stridor not present!!
severe if for example signs of reps distress eg grunting!!, marked chest recession
What is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?
Diagnosis?k
Meckels diverticulum
Technetium scan
14 year old after holiday abroad light brown macules and confluent patches affecting most of his back and chest. management?
Ketoconazole. Patient has pytiriasis versicolor
What is the corrected age for developmental milestones in a premature baby?
Normal age to meet developmental milestone + number of weeks born premature. Normal birth is at 40 weeks .
A 4-year-old boy was discharged from the hospital six weeks ago after an episode of viral gastroenteritis. He now has 4-5 loose stools each day which has been present for the past four weeks. Cause ?
Lactose intolerance - complication of viral gastroenteritis
2 year old a small smooth cyst is identified which is located above the hyoid bone. On ultrasound the lesion appears to be a heterogenous and multiloculated mass. most likely cause?
Dermoid cyst
Passage of meconium after x is a red flag
48 hours
when should dexamethasone be considered for patients with meningitis?
Over 3 months old!!
And any of
frankly purulent CSF
CSF white blood cell count greater than 1000/microlitre
raised CSF white blood cell count with protein concentration greater than 1 g/litre
bacteria on Gram stain
what is cradle cap (seborrhoeic dermatitis)?
management?
yellow scales on the scalp but can also affect the face, ears and neck in newborns
baby shampoo and oil
when can children with scarlet fever return to school?
24 hours after commencing antibiotics
coeliac disease presentation?
failure to thrive
diarrhoea
abdominal distension/pain
older children may present with anaemia
in infants, what is the typical distribution of atopic eczema?
Face and trunk.
what is the most likely cause of worsening neurological function in a premature infant born at 34 weeks gestation.
IVH. may occur spontaneously
gold standard test for vesico-ureteral reflux
gold standard test to look for renal scarring = a complication of vesico-ureteral reflux?
Micturating cystourethrogram. This is an imaging test that involves filling the bladder with a contrast material and then taking x-rays while the patient urinates to visualise any reflux
Radionuclide scan using dimercaptosuccinic acid (DMSA).
learn immunisation schedule
patau syndrome affects chromosome?
13
which syndrome in children is associated with supravalvular aortic stenosis?
Williams Syndrome
retinal hemorrhage, encephalopathy and what is seen in shaken baby syndrome?
subdural hematoma
treatment for pneumonia in children?
Amoxicillin is first-line for all children with pneumonia
Macrolides should be used if mycoplasma or chlamydia is suspected
one reason for an urgent ct scan after head trauma is at least x episodes of vomiting
when is the menB vaccine given, when is the HPV vaccine given
what vaccines are given at 3-4 years?
what is Pauciarticular JIA?
what is systemic onset JIA?
JIA where 4 or less joints are affected
JIA with regular and intermittent fevers
primary ovarian failure can be seen in girls with what condition?
Turners Syndrome
Cyanotic congenital heart disease presenting within the first days of life is?
Cyanotic congenital heart disease presenting at 1-2 months of age is?
TGA
TOF
hand preference before ___ months is abnormal and could be an indicator of ___
12 months
cerebral palsy
what is growing pains?
pain in legs of child with no obvious cause
Features of growing pains
never present at the start of the day after the child has woken
no limp
no limitation of physical activity
systemically well
normal physical examination
motor milestones normal
symptoms are often intermittent and worse after a day of vigorous activity
exomphalos vs gastroschisis management?
Exomphalos should have a gradual repair to prevent respiratory complications. Gastroschisis requires urgent correction as no membrane covering
Rubella symptoms
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
At what age would the average child start to play alongside, but not interacting with, other children?
2 years
parallel play = 4 years
treatment for patients with CF that have an infection with Pseudomonas aeruginosa
oral ciprofloxacin
whihc rescue medication can be prescribed for recurrent febrile siezures?
(rectal diazepam or buccal midazolam)
features of hypernatremic dehydration?
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
GORD treatment in infants
1st line = alginate/gaviscon if breastfed, feed thickener if bottle fed
unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
distressed behaviour
faltering growth
first line treatment for constipation in kids?
macrogols (e.g. Movicol) is first-line
if insuffeicient add a stimulant laxative -> senna
unborn child with exomphalos management?
c section at 37 weeks
DDH 1st line investigation?
ultrasound is generally used to confirm the diagnosis if clinically suspected
however, if the infant is > 4.5 months then x-ray is the first line investigation
name a vaccine that is offered to pregnant women
pertussis
at what age would the average child acquire a good pincer grip?
12 months
perthes can present with short stature and pain specifically on internal rotation, not limited internal rotation seen in SUFE. if x rays are normal when perthes is suspected -> mri hip
when is hypospadias surgery performed?
at 12 months old
name a genetic syndrome associated with autism
fragile x
perthes disease management?
observation
compression ventilation ratio in newborns?
3 to 1
Kawasaki management?
high dose aspirin and a single dose of IVIG
when would a bone marrow biopsy be indicated for ITP
if atypical findings present eg splenomegaly, bone pain, and diffuse lymphadenopathy. high wcc, which may suggest an underlying myeloproliferative malignancy.
why should you avoid NSAIDs in chickenpox?
increased risk of necrotising fascitis
what maternal drug increases risk of orofacial clefts?
antiepileptics
necrotising enterocolitis pathogenesis?
symptoms?
managment?
complications
invasion of gas producing bacteria in gut wall of premature or VLBW infants -> necrosis
feeding intolerance (bilious emesis), tender distended abdomen, GI bleeding (hematemesis, hematochezia), pneumatosis intestinalis (air in bowel wall)
bowel rest
- discontinuation of feeds
- gastric decompression, parenteral nutrition
- blood cultures and antibiotics!!!
septic shock
bowel perforation -> free intraperitoneal air -> laparotomy required!!
describe some signs and complications of Downs syndrome
respiratory and ear infections -> hearing loss risk and hearing tests required
OSA, epilepsy
expressive language delay
hirschprungs, duodenal atresia
typical face/body signs
what are the components of the capacity act?
