PEDS Flashcards
triad of the shaken baby syndrome
Retinal haemorrhages, subdural haematoma and encephalopathy
Characteristics of an innocent ejection murmur include:
DIASTOLIC IS DANGER
hand foot and mouth
virus?
presentation?
coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
scarlet fever presentation?
caused by?
tx?
‘coarse red rash’ and ‘strawberry tongue’.
10 days of phenoxymethylpenicillin PEN V or azithromycin if there is a suspected allergy to penicillin.
erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes)
Kawasaki disease
presentation?
tx?
lasts longer then scarlet fever (scarlet is 2-4 days)
FEVER LASTING >5DAYS
erythematous polymorphous rash,
strawberry tongue,
cervical lymphadenopathy,
bilateral conjunctivitis, oedema, erythema, and skin peeling of the hands and feet.
ASPIRIN
Parvovirus B19 aka eythema infectiosum
erythematous facial rash appearing on one or both cheeks (resembling a ‘slapped cheek’) in children.
Rubella
rash?
non-confluent, maculopapular rash that on face
Lymphadenopathy: suboccipital and postauricular
THINK RUBY EARS
spreads to the face and neck, and then to the trunk and extremities.
preterm baby:
reduced breath sounds bilaterally.
Heart sounds are displaced medially.
The abdominal wall appears concave.
What is the most likely diagnosis?
Congenital diaphragmatic hernia presents with scaphoid abdomen, due to herniation of the abdominal contents into the cleft
Cradle cap
name?
tx?
Seborrhoeic dermatitis
mild-moderate: baby shampoo and baby oils
severe: mild topical steroids e.g. 1% hydrocortisone
recurrent urinary tract infections
renal ultrasound that showed dilatation of the ureters.
test is most appropriate to grade the severity?
Micturating cystography is the investigation of choice for reflux nephropathy
Dimercaptosuccinic acid (DMSA) scan?
assessing renal parenchymal defects which may result from vesicoureteral reflux (VUR)
croup
presentation?
tx?
emergency tx?
stridor
barking cough (worse at night)
fever
coryzal symptoms
Parainfluenza
tx- dexamethasone
emergency tx- oxygen and nebs adrenaline
7 year old, alot taller, developed pubic hair, large penis but small testes?
ADRENAL HYPERPLASIA
Small testes in precocious puberty indicate an adrenal cause of the symptoms
Slipped upper femoral epiphysis (SUFE)
age?
presentation?
ix?
mx?
10-15
obese boys
groin/knee/thigh pain
when are new babies risk of vitamin K deficiency
Breastfed babies are at risk of vitamin K deficiency
risk factor for sudden infant death syndrome (SIDS)?
when and what type food to reintroduce milk protein in children with cows milk protein allergy.
The milk ladder can be used after 6 months of age to reintroduce milk protein in children with cows milk protein allergy.
MALTED MILK BISCUITS
IM benzylpenicillin dose for suspected meningococcal septicaemia in the community?
under 1
1 to 10 years
more then 10
cardiac ultrasound showed the foetal aorta and pulmonary trunk lying in parallel with an absence of crossing, confirming the suspected diagnosis.
dx? what tx to give?
transposition of the great arteries.
Prostaglandin E1 is given intravenously to neonates with transposition of the great arteries (TGA) to maintain the ductus arteriosus,
hand foot and mouth
virus?
presentation?
coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
Measles
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Gastroschisis vs exomphalos
exomphalos: kidney issues
10-month-old
days ago he developed a fever
following this he developed a rash
blanching, rose pink macules present on his trunk.
Roseola infantum - fever followed later by rash
common 6 months - 2 years
fever followed later by rash
febrile seizures common
What is the role of caffeine in neonates?
Caffiene can be used as a respiratory stimulant in newborn babies
10-month male infant
over using his right hand in preference to the left.
mx?
Hand preference before 12 months is abnormal - it could be an indicator of cerebral palsy
cephalohaematoma
presentation?
swelling due to bleeding between the periosteum and the skull.
most commonly noted in the parietal region and is associated with instrumental deliveries.
usually appears 2-3 days following delivery and does not cross suture lines. It gradually resolves over a number of weeks.
Caput succadeneum
newborns immediately after birth
occurs due to generalised superficial scalp oedema, which crosses suture lines
It is associated with prolonged labour and will rapidly resolve over a couple of days.
Hypospadias surgery?
Corrective surgery at around 12 months of age is required
children should not be circumcised
tuberous sclerosis inherited in…?
AD
NEW BORN BABY VIA C-section
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
dx?
transient tachypnoea of the newborn (TTN) is the commonest cause of respiratory distress in the newborn period.
caused by delayed resorption of fluid in the lungs
Palivizumab for? what is it?
monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease.
Those at risk of developing RSV include
Premature infants
Infants with lung or heart abnormalities
Immunocompromised infants
IgE-mediated allergy vs non-IgE-mediated allergy
Chondromalacia patellae
Osgood-Schlatter disease
(tibial apophysitis)
Osteochondritis dissecans
Patellar subluxation
Patellar tendonitis
when to refer fever seen in gp- peds
pertussis vaccine pregnancy?
What is the time frame that defines maternal mortality?
Maternal mortality includes any death in pregnancy and labour as well as up to six weeks post partum
first-line for nocturnal enuresis if general advice has not helped
when to use meds, what med?
enuresis alarm
desmopressin
particularly if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family
Congenital heart disease: types
acyanotic vs cyanotic
cyanotic- think 3 T’s!!
4-month-old baby girl
Four weeks ago you started a trial of alginate therapy (Gaviscon) for frequent regurgitation associated with distress.
now now reports she appears to be refusing feeds.
what next?
Tetralogy of Fallot: features?
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
bronchiolitis is seen in (age)?
1 to 9 months old
in stems look at the age! if this then supportive mx
Friedreich’s ataxia inheritance pattern?
AR
pneumonia …..abx…?.. is first line for all children who are not allergic to penicillin
amoxicillin
Macrolides may be added if there is no response to first line therapy
Turner’s syndrome is associated with an …murmur??
EJECTION SYSTOLIC MURMUR
Meningitis in children
0 TO 3MONTHS?
1 MONTH TO 6 YEARS?
GREATER THEN 6 YEARS?
Acute epiglottitis is caused by ?
Features?
Haemophilus influenzae type B
rapid onset
high temperature, generally unwell
stridor
drooling of saliva
‘tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
most common cause of primary headache in children
migraine
Measles complication
pneumonia and otitis media
most common congenital cardiac abnormality in Down’s syndrome
Atrioventricular septal defects
new born baby check
babys peripheries are blue with cyanosis.
dx?
Acrocyanosis (peripheral cyanosis around the mouth and extremities) is common in neonates
new born baby check
babys peripheries are blue with cyanosis.
dx?
Acrocyanosis (peripheral cyanosis around the mouth and extremities) is common in neonates
Crawls age?
8 to 10 months
9-year-old daughter
mum concerned because she noticed that for the last 2 months, her daughter has been showing signs of breast development.
what to do?
reassure
Precocious puberty is the development of secondary sexual characteristics before 8 years in girls and 9 years in boys
ear condition common in down syndrome?
otitis media
when and how to screen for (developmental dysplasia of the hips) DHH?
risk factors
the baby requires ultrasound
breech baby
risk factors:
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
unobstructed umbilical hernia in 1yo. mx?
reassure
Umbilical hernias in newborns typically self-resolve by 3 years of age
formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance … what to do next?
a extensive hydrolysed formula should be tried
When is the neonatal blood spot screening test typically performed in the United Kingdom
5th and 9th day of life
heel prick test
Persistent vitello-intestinal duct
umbilical discharge that discharges small bowel content.
carrier rate of cystic fibrosis in the UK?
1/25
11-year-old Nigerian girl
complaining of a sore throat, pain on swallowing and this morning, her father has noticed swellings on both sides of her lower face and upper neck.
can she go to shcool?
If a child has mumps they need to be excluded from school for 5 days from the onset of swollen glands
most common congenital defect after birth?
TGA
cyanotic: TGA (transposition of the great arteries) most common at birth, Fallot’s most common overall
acyanotic: VSD most common cause
…?….. a complication of Kawasaki disease
how can this be screened?
Coronary artery aneurysms are a complication of Kawasaki disease and this should be screened for with an echocardiogram
…?….. a complication of Kawasaki disease
how can this be screened?
Coronary artery aneurysms are a complication of Kawasaki disease and this should be screened for with an echocardiogram
7-year-old girl
itching around her vulva and anus
threadworm
Prescribe a single dose of mebendazole for the household and give hygiene advice
Haemophilia A is an X-linked recessive disease.
how can it be passed?
all female offspring of affected men will be carriers. There is then a 50% chance of these females passing the gene on.
fragile x?
earning difficulties, macrocephaly, large ears and macro-orchidism
Whooping cough (pertussis) tx?
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
3-week old male baby
PREMATURE
Refusing feed
noticed that he passed some bloody stools.
WHAT IS IT?
DX?
Early signs of necrotising enterocolitis: feeding intolerance, abdominal distension and bloody stools
Abdominal x-ray
keep PDA open?
prostagladins
first-line treatment for paediatric migraine?
Ibuprofen is the first-line treatment for paediatric migraine
Patau syndrome
13
microcephaly, small eyes, low-set ears, cleft lip and polydactyly
William’s syndrome?
aortic stenosis- loud systolic murmur
small upturned nose, long philtrum, a small chin and puffy eyes.
Barlow vs ortolani?
Barlow manoeuvre is an attempted dislocation of a newborns femoral head. After performing this the Ortolani manoeuvre is used to attempt to relocate a dislocated femoral head.
you smell of BO
meconium aspiration syndrome.
findings? presentation?
during delivery thick meconium-stained amniotic fluid.
Chest X-ray shows patchy infiltrations and atelectasis.
Surfactant deficient lung disease on chest x ray baby?
ground glass opacities
3-year-old daughter
discomfort every time she is passing urine
semitranslucent adhesions completely covering the vaginal opening between the labia minora
dx?
tx?
Labial adhesions: prescribe trimethaprim for UTI
if recurrent urinary tract infections, oestrogen cream may be tried
Noonan syndrome
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
common cause of cyanotic congenital heart disease typically presenting at around 1-2 months
TOF
Pyloric stenosis typically presentATION AGE?
2-6 weeks
vomiting
child
partial seizures at night
name?
Benign rolandic epilepsy
Paediatric BLS:?
5 rescue breaths if there are no signs of breathing on initial assessment
18 year-old
moves to University.
Which of the following vaccinations should he receive if he has not had it previously?
Meningitis ACWY
What is the most important treatment for prevention of neonatal respiratory distress syndrome?
Administer dexamethasone to the mother
loss of the red-reflex
Retinoblastoma
Constipation in children:
macrogols (e.g. Movicol) is first-line
Meningitis in children: investigation and management
Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
contraindications for MMR vaccine
vaccination of yellow fever in last week
pregant
immunocompromised
anaplylaxisi to the vaccine, neomycin, gelatin
classic rash and description in juvenile idiopathic arthritis JIA
salmon pink rash!!
DDH age
what electrolyte inbalance for IUGR?
hypoglcemia, necrotising entercolitis, polycythemia, thrombocytopenia
which is more common
Non hogkins or hodgkins
NON-HOGKINS
eye condition linked to NF1?
optic glioma
child murmur that may be suspicious give example
pansystolic murmur
drooling- epiglititis
tx?
caused by haemophilus B
nebulised adrenaline, iv cefotaxime
bronchiolitis virus
RSV
CAP in child- starts off with a headache most likely by mycoplasma pneumonia
tx
oral clarthithromycin
second line tx for absense seizure
SODIUM VALPORATE
INDICATION TO REMOVE TONSILS
DiGeorge features
short
immune issues
official name for croup
