Peds 2 Flashcards
What is the management of breast milk jaundice?
Temporary cessation of breast feeding for 2 days then resume breast feeding.
Describe the first step in the management of neonatal jaundice.
Check total and direct bilirubin levels.
How is neonatal hypoglycemia initially treated?
With IV glucose.
Define the term ‘choanal atresia’.
A condition where there is a blockage of the back of the nasal passage.
What is the test of choice if choanal atresia is suspected?
Catheter test.
Describe the management of innocent murmur.
Reassure, but refer to a pediatrician if necessary.
Management:
- Regular Monitoring: Monitor during routine check-ups.
- Parental Reassurance: Reassure parents about the benign nature of the murmur.
| Criteria | Details |
|————–|————-|
| Loud or Harsh Murmur | Grade ≥3/6, harsh, or long-lasting. |
| Diastolic or Continuous Murmur | Murmurs that occur during diastole or are continuous. |
| Unaffected by Position | Murmurs that do not change with position. |
| Radiating Murmurs | Radiate to the neck or back. |
| Associated Symptoms | Presence of shortness of breath, chest pain, fatigue, syncope. |
| Abnormal Signs | Clubbing, cyanosis, ejection clicks, added heart sounds, tachycardia, hypertension. |
| Family History | Family history of congenital heart disease or sudden cardiac death. |
| Syndromic Features | Other congenital anomalies present. |
Referral:
- Refer to a pediatric cardiologist for further evaluation and management if any of the above suspicious or pathological characteristics are present.
- RACGP Guidelines: Cardiac Murmurs in Children
- American Family Physician: Evaluation and Management of Heart Murmurs in Children
Criteria | Details |
|————–|————-|
| Soft and Low-Pitched | Typically Grade 1-2/6. |
| Systolic Murmurs | Occur during systole. |
| Position Dependent | Murmurs often change or disappear when the child is upright. |
| Localized | Heard best at the left lower sternal border or apex. |
| No Associated Symptoms | No shortness of breath, chest pain, fatigue, cyanosis. |
| No Abnormal Signs | Absence of clubbing, cyanosis, clicks, added sounds, tachycardia, hypertension. |
What is the most important complication of measles?
Otitis media.
How is bronchiolitis diagnosed in a child under 2 years old?
By the presence of wheezes.
What is the course of action in mild to moderate croup?
Inhaled cortisone
mild: no treatment
moderate/severe:
-Dexamethasone 0.3 mg/kg orally (first-line);
- Prednisolone 1mg/kg orally, or
- Budesonide 2mg by nebulizer
most severe with significant airway obstruction/fatigue: Adrenaline 1% (1:100, 10mg/ml) solution 0.05ml/kg/dose
How is severe croup treated?
With inhaled nebulized adrenaline.
mild: no treatment
moderate/severe:
-Dexamethasone 0.3 mg/kg orally (first-line);
- Prednisolone 1mg/kg orally, or
- Budesonide 2mg by nebulizer
most severe with significant airway obstruction/fatigue: Adrenaline 1% (1:100, 10mg/ml) solution 0.05ml/kg/dose
Describe the clinical presentation of a child with epiglottitis.
Symptoms include fever, sore throat, difficulty swallowing, and a characteristic with the neck extended and the chin pointing upwards.
What is the causative organism of epiglottitis?
Haemophilus influenzae.
What is the recommended treatment for epiglottitis?
Hospital admission and intubation.
Define Kawasaki disease.
A condition characterized by prolonged fever and a specific set of clinical criteria including conjunctivitis, rash, erythema, adenopathy, and mucous membrane involvement.
How is Kawasaki disease diagnosed?
Fever for 5 days or more plus 4 of the following criteria (CREAM): Conjunctivitis, Rash, Erythema, Adenopathy, and Mucous membrane involvement.
Describe the most important investigation in Kawasaki disease.
Echocardiogram (echo) to assess for cardiac complications.
What are the most serious complications of Kawasaki disease?
Myocarditis and coronary aneurysm.
Do you know the first-line treatment for Kawasaki disease?
Intravenous immunoglobulin (IVIG) is the first line, followed by aspirin as the second line.
Describe the presentation of a child with otitis media.
A child with fever, crying, and pulling on their ear.
What is the most common causative organism of otitis media?
Streptococcus pneumoniae.
How is otitis media treated according to current updates?
Initially with paracetamol, then amoxicillin if no response, and amoxicillin-clavulanate if still no response.
Define mastoiditis.
Inflammation of the mastoid bone typically presenting with swelling behind the ear.
What is the recommended imaging modality for diagnosing mastoiditis?
CT scan.
Describe the treatment of chronic otitis media.
Management includes aural toilet and the use of ciprofloxacin ear drops.
What is the most important post-exposure prophylaxis for varicella?
Vaccine for immune-competent individuals within 72 hours and intravenous immunoglobulin (IVIG) for pregnant and immune-compromised individuals.
Describe the school exclusion criteria for varicella.
Exclude until the blisters have dried or at least 5 days after the rash appears.
What is the most common complication of mumps in children?
Encephalitis.
What is the most common complication of mumps in adults?
Orchitis.
Describe the cause of abnormal semen analysis in a patient with a history of mumps and sulfasalazine use.
Sulfasalazine, not mumps, is the cause of abnormal semen analysis in this case.
What is the likely diagnosis in a patient with a long-standing history of dry cough, especially at night?
Bronchial asthma.
Describe the presentation of a patient with long-standing dry cough and fever.
Pertussis (whooping cough) should be suspected.
What is the initial investigation of choice in the first 3 weeks of pertussis presentation?
PCR of a nasopharyngeal swab.
What is the preferred prevention method for pertussis?
Vaccination.
Describe the management of a child with limping.
Initial step is usually an x-ray, except in clear cases of transient synovitis where ultrasound is preferred.
What is the diagnosis in a child with a history of camping and malabsorption?
Giardiasis, treated with metronidazole.
Describe the clinical presentation of a newborn with esophageal atresia.
Frothy saliva and regurgitation of milk.
What is the first step in managing esophageal atresia?
Passage of a wide-bore catheter followed by an x-ray.
What is the treatment for esophageal atresia?
Surgical intervention.
Define phimosis.
Inflammation of the penis leading to the inability to retract the foreskin.
What is the treatment for phimosis?
Cortisone cream.
No investigation is required. However, a trial of topical corticosteroid (eg 0.1% betnovate) may be effective, thus avoiding the need for referral. We advise twice-daily application to the narrow (phimotic) segment together with gentle retraction for four weeks.
https://www.racgp.org.au › …PDF
Paediatric surgery for the busy GP – Getting the referral right - RACGP
Describe paraphimosis.
Inflammation of the penis with the inability to retract the foreskin forward.
How is paraphimosis treated?
Urgent manual reduction; if failed, incision may be necessary.
Define balanitis in children.
Whitish discharge on the glans penis; treated with cortisone cream.
What is the medical recommendation regarding circumcision from a medical perspective?
It is not recommended.
Describe hypospadias.
Urethral opening on the ventral surface of the penis; circumcision is avoided as the foreskin may be used in surgery.
What is the next step if hypospadias is diagnosed?
Avoid circumcision as the foreskin may be needed for surgery.
Do children with urethral stenosis have difficulty initiating micturition?
Yes, along with a history of urinary catheterization.
What is the preferred diagnostic investigation for urethral stenosis?
Urethroscopy.
How is urethral stenosis treated?
Initially with repeated dilation; if unsuccessful, surgery may be required.
Describe toddler diarrhea.
Diarrhea in a completely healthy child under 5 years old with normal investigations.
What are the potential consequences of excessive fruit juice consumption in children?
Tooth caries, obesity, and diarrhea.
Define constipation in pediatric patients.
Most commonly related to diet.
How long after weaning can constipation occur?
It can occur after weaning.
Do infants with constipation since birth likely have meconium ileus or Hirschsprung disease?
Yes.
Describe the presentation in functional constipation.
A full rectum with stool.
What is the most common cause of anal fissure in infancy?
Constipation.
How is acute constipation treated?
With an enema.
What is the most effective treatment for constipation?
Bowel training.
What is the most common cause of rectal prolapse in children?
Constipation.
Describe the presentation of rectal prolapse in children.
Rectal prolapse, recurrent chest infections, and failure to thrive may be present.
What is the most important question to ask a child with rectal prolapse?
About their bowel habits.
Do children with lactose intolerance typically experience abdominal cramping and diarrhea after consuming lactation or dairy products?
Yes.
What is the preferred investigation for lactase intolerance?
Hydrogen breath test.
How is lactase intolerance treated?
With a lactose-free diet, including lactose-free formula for infants (e.g., soy-based formula).
What is the most common cause of epistaxis in children?
Hot weather.
Describe growing pains in healthy children.
Leg pain that may awaken the patient from sleep; all investigations are normal.
What is the diagnosis and management of a healthy child crying and pulling their leg to their abdomen with normal investigations?
Diagnosis: Infantile colic; Management: Reassurance and diet modification.
Do breath-holding spells typically present with crying followed by cyanosis and then convulsions?
Yes.
