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Pediatrics Flashcards

1
Q

6 wks check

A
  1. to evaluate feeding pattern
  2. to measure growth and weight
  3. to detect abnormalities not noted in neonatal period
  4. to assess early development
  5. to ensure infant-maternal bonding
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2
Q

Signs of Innosent murmur

A

4 S’s:

‘InnoSent’ murmur = Soft, Systolic, aSymptomatic, left Sternal edge.

aSymptomatic patient
Soft blowing murmur (grades 1-3)
Systolic murmur only, not diastolic
left Sternal edge.

No associated hrt disease!

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3
Q

7 Stages of Childhood

A
  1. Newborn, neonate = first month of life
  2. Infant = 1 month to 1 year
  3. Toddler = 1 year to 3 years
  4. Preschool child = 3-5 years
  5. Schoolchild = 5-18 years
  6. Child = 0-18 years
  7. Adolescent = early (10-14); late (15-18)
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4
Q

Causes of childhood wheeze

A

Transient early wheezing
Atopic asthma (IgE-mediated)
Non-atopic asthma
Recurrent aspiration of feeds
Inhaled foreign body
Cystic fibrosis
Recurrent anaphylaxis in a child with food allergies
Congenital abnormality of lung, airway or heart
Idiopathic.

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5
Q

Assessment of Asthma Severity

A

Moderate
O2 sats > 92%
Peak flow > 50% predicted
No clinical severe features of severe asthma

Severe
Too breathless to talk or feed
Use of accessory neck muscles
O2 sats < 92%
Resp > 50/min (age 2-5), > 30 (age > 5)
Peak flow < 50% predicted or best value

Life threatening
Silent chest
Poor respiratory effort
Altered consciousness
Cyanosis
O2 sats < 92%
Peak flow < 33% predicted or best value

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6
Q

Diseases associated with DS

A

Celiac Disease & Lymphoma

Leukemia (56% higher rate than normal)

Atlanto-axial subluxation

Hirschsprung’s disease

DIabetes

Early onset dementia

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7
Q

Causes of Nappy Rash

A

ACES

Ammonia
Candidia
Eczema
Seborrhea

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8
Q

DDx Croup

A

croup
bacterial tracheitis
epiglottitis
• foreign body aspiration
• subglotic stenosis: congenital or iatrogenic
• laryngomalacia/tracheomalacia: collapse of epiglottis cartilage on inspiration
Anaphlaxis

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9
Q

DDx to FFT

A
  • Inability to feed: cleft palate, congenital, functional (cerebral palsy)
  • Inability to retain food: GORD
  • Malaborption: celiac disease or cystic fibrosis
  • Ongoing Illness
  • Metabolic problems: CAH, hypothyroidism
  • Social: neglect
  • Nutrition: poor diet
  • Down’s or other congenital syndromes sm
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10
Q

How do you diagnose migraines in children

A

A >= 5 attacks fulfilling features B to D
B Headache attack lasting 4-72 hours
C Headache has at least two of the following four features:
bilateral or unilateral (frontal/temporal) location
pulsating quality
moderate to severe intensity
aggravated by routine physical activity
D At least one of the following accompanies headache:
nausea and/or vomiting
photophobia and phonophobia (may be inferred from behaviour)

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11
Q

Management of migraines in children

A

Acute management
ibuprofen is thought to be more effective than paracetamol for paediatric migraine
the use of triptans in children should only be initiated by a specialist
sumatriptan nasal spay (licensed) is the only triptan that has proven efficacy but it is poorly tolerated by young people who don’t like the taste in the back of the throat
orodispersible zolmitriptan (unlicensed) is widely used in children aged 8-years and older
side-effects of triptans include tingling, heat and heaviness/pressure sensations

Prophylaxis: the evidence base is limited and no clear consensus guidelines exist
the GOSH website states: ‘in practice, pizotifen and propranolol should be used as first line preventatives in children.

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12
Q

Causes of snoring in children

A

obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism

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13
Q

Risk of Down Syndrome

A

risk at 30 years = 1/1000
35 years = 1/350
40 years = 1/100
45 years = 1/30

One way of remembering this is by starting at 1/1,000 at 30 years and then dividing the denominator by 3 (i.e. 3 times more common) for every extra 5 years of age

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14
Q

Recurrence of downs syndrome in mom < 35

A

1: 100

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15
Q

DDx Organic Causes Constipation

A

endocrine: hypothyroidism, DM, hypercalcemia
• neurologic: spina bifida
• anatomic: bowel obstruction, anus (imperforate, atresia, stenosis)
• drugs: lead, chemotherapy, opioids

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16
Q

DDx Infertility and Workup

A
17
Q

Vomiting in the Newborn Period

A

Tracheoesophageal Fistula (TEF)

Pyloric Stenosis

Duodenal Atresia

Malrotation of the Intestine

18
Q

Diseases associated with Down Syndrome

A

Celiac disease/lymphoma
ALL (1% of DS)
Atlantoaxial dislocation
Hirschsprungs disease (2%)
Diabetes
Early Onset Dementia

19
Q

Vomiting AFTER the newborn period

A

Infectious and Inflammatory
• GI causes: gastroenteritis, peritonitis, appendicitis, hepatitis, ulcers, pancreatitis, cholecystitis
• non-GI causes: urinary tract infection (UTI), pyelonephritis, nephrolithiasis, otitis media,
labyrinthitis, meningitis, pneumonia

Anatomic:
GI tract obstruction: intussusception, volvulus, foreign body (e.g. bezoar)

GORD

Central Nervous System
increased intracranial pressure (ICP) (e.g. hydrocephalus, neoplasm)
• drugs/toxins
• migraine, cyclic vomiting

Other
• metabolic/endocrine: DKA, inborn errors of metabolism, liver failure
• poisons/drugs: lead, digoxin, erythromycin, theophylline
• psychogenic: rumination syndrome, anorexia/bulimia
• food allergy
• overfeeding
• pregnancy

20
Q

When do the following conditions classically present:

1) Pyloric stenosis
2) Infantile Colic
3) Febrile Seizures
4) Infantile Spasms
5) Intussuception
6) SIDS

A

1) 2-8 weeks
2) 10 days - 3 months
3) 6 months-6 years
4) 4-8 months
5) 3months-3 years
6) < 12 months age (95% by 6 months)

21
Q

Triad for Intussusception

A

Classic Triad (only occurs in 15% of patients at presentation): vomiting, abdo pain, passage of blood per rectum

22
Q

How would you describe SIDS to mother and what recommendations would you give her?

A

*Leading cause of death under 12 months of age

  • peak incidence 2-4 months
  • put in supine position, no smoking in house, avoiding overheating, place feet near end of bed, dont overcrowd the cot, dont sleep with infant
  • pacifiers appear to be protective
  • 3-5 time increase chance if sibling died of SIDS
23
Q

Infections:

Infectious Mononucleosis

Pertussis

Varicella (chicken pox)

Roseola

Measles

Mumps

Rubella

Erythema Infectiosum

A

Mono (EBV):

incubation:1-2 months

Kissing disease, 2-3 day prodrome of malaise/anorexia before fever, tonsillar exudate, lymphadenopathy, hepatosplenomegaly, pharingitis, any “itis” (hepatitis, arthritis, nephritis, myocarditis), chronic fatigue*

resolves over 2-3 weeks

*Do not give amoxicillin/ampicillin or you get a rash!!

Complications: aseptic meningitis, encephalitis, guillian-barre, splenic rupture

Diagnose: monospot test, CBC + differentials looking for atypical lymphocytes

Treat: supportive (rule out strep throat), no sports for 6-8 weeks

Pertussis (bordetella Pertussis):

Whooping cough, incubation 6-20 days, infective 1 week before paroxysms to 3 weeks after, greatest incidence in children <1 and adolescents

Catarrhal phase: 1-2 weeks, mild cough and coryza (most contagious)

Paroxysmal phase: 2-4 weeks, intense cough, may vomit, pressure can result in subconjunctival hemorrhage, rectal prolapse, hernias

Diagnosis:

PCR of nasopharyngeal swab/aspirate, often clinical by paroxysms of cough in afebrile child

complications: otitis media, encephalopathy, seizures, resp: atelectasis, subq emphysema

Tx: Erythromycin, isolate until 5 days of tx, helps with infectivity but not course of illness*, erythromycin for all household contacts

Varicella:

Incubation 10-21 days, infective 1-2 days before rash until all vesicles are crusted

maternal infection in first/early second trimester risk of congenital varicella syndrome (low birth weight, CNS abnormalities, digit/limb abnormalities, eye defects)

complications: 2-HAP-E

2ndary bacterial infections, hepatitis, ataxia, pneumonia, encephalitis

Tx: supportive, acyclovir if severe, immunocompromised, neonates

Roseola (HH6 virus):

incubation:5-15 days

High fever (>39.5), URTI symptoms, pharynx, tonsils and tympanic membrane erythematous, cervical lymphadenopathy, fever ceases before rash (non-pruritic macules that coalesce and disappear in 1-2 days)

Tx: supportive

Complications: febrile seizures, encephalitis

Measles:

incubation: 10-14 days, infectivity: 4 days pre-rash, spread airborne

Prodrome: 3 C’s (cough, coryza, conjuctivitis), Koplik spots, maculopapular rash spreads over face and then descends over body over 3 days

Diagnose clinical and serology measles IgM

tx: Supportive and symptomatic
complications: 2ndary bacterial infections, encephalitis

Mumps (paramyxovirus):

Incubation: 12-25 days, infectivity: 7 days before parotitis and 7 days after, spread by droplets

diagnose by urine and saliva for viral serology

fever, headache, parotitis (bilateral, pushes earlobes up and out), myalgia, malaise

tx: supportive
complications: orchitis, infertility, pancreatitis, GN

Rubella:

incubation: 14-21 days, infective 7 days pre-rash and 5 days post-rash

diagnose by serology for rubella IgM

nonspecific URT symptoms, then maculopapular rash on face then spreads over entire body, pruritic, disappears by 4th day

symptomatic tx, prognosis excellent

Complications: arthritis/arthralgia, encephalitis

Erythema Infectiosum (5th disease, slap-cheek):

Parvovirus B19, incubation 4-14 das, infective prior to onset of rash, first 7-10 days is flu-like illness, day 10-17 is when rash appears on cheek, may be pruritis, fades in days to weeks

tx: supportive
complications: arthritis, infection during pregnancy can lead to fetal hydrops**, aplastic crisis

24
Q

DDx Purpuric Rash

A

Disorders of Homeostasis

1) Thrombocytopenia: ITP, TTP, HUS, DIC
2) Disorders of coagulation: von willibrand disease, hemophilia, liver disease

**Disorders of Vascular Integreity **

Trauma, Infection (N. gonorrhea), HSP, Vitamin C deficicency

25
Q

Pattern of eczema in:

Infants

Younger Children

Older Children

A
  • in infants the face and trunk are often affected
  • in younger children eczema often occurs on the extensor surfaces
  • in older children a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck
26
Q

Secondary Causes of Constipation

A

dehydration
low-fibre diet
medications: e.g. Opiates
anal fissure
over-enthusiastic potty training
hypothyroidism
Hirschsprung’s disease
hypercalcaemia
learning disabilities

27
Q

Causes of Microcephaly

A
28
Q

Causes of Macrocephaly

A

Familial macrocephaly
Raised intracranial pressure
Hydrocephalus - progressive or arrested
Chronic subdural haematoma
Cerebral tumour

UL Flashcards (8 decks)

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