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.
What does convulsion followed by cyanosis suggest in children?
Epilepsy.
Define encopresis.
Involuntary passage of stool in children over 4 years old.
How is encopresis treated?
Initially with toilet training; if unsuccessful, diet modification; if still unsuccessful, laxatives may be needed.
Define enuresis.
Involuntary passage of urine in children over 5 years old.
What is the most common cause of enuresis?
Psychological factors, but a urine culture must be done first.
What is the most common organic cause of enuresis?
Urinary tract infection (UTI).
What is the most important investigation to be done in enuresis?
Urine culture.
How should a patient with enuresis who plans to go camping be managed?
With desmopressin.
What is the best long-term treatment for enuresis?
Alarm clock.
What is the preferred investigation for hydrocephalus?
CT scan (MRI > CT > US).
Describe transient synovitis.
Limping after a viral upper respiratory tract infection or with the onset of a URI.
What is the most common cause of limping in children?
Transient synovitis.
What is the preferred investigation for transient synovitis?
Ultrasound.
How is transient synovitis treated?
With analgesics and joint traction.
What is the first investigation of choice for a limping child?
X-ray.
What is the first investigation of choice for a child limping after a viral upper respiratory tract infection?
Ultrasound.
How much fluid does a child need daily?
150 ml/kg.
Describe GERD in infants with excessive vomiting and good general condition.
Gastroesophageal reflux disease (GERD).
Describe the diagnosis for an infant presenting with excessive vomiting and bad general condition as CHPS.
CHPS is the diagnosis.
What is the best investigation for GERD?
24-hour pH monitoring.
What is the best advice to give to a mother with an infant suffering from GERD?
Maintain an upright position after feeding.
What is the most important question to ask a mother who loses consciousness at her daughter’s wedding with normal physical exam and tests?
History of separation anxiety with the child.
Define separation anxiety in children.
It is not a normal part of development and requires psychological treatment.
What is the most common cause of painless bleeding in children under 2 years old?
Meckel’s diverticulum.
What is the treatment for Meckel’s diverticulum?
Surgery.
How should allergic rhinitis be treated?
Intranasal cortisone at night.
Describe the condition where chronic cough and rhinorrhea improve with antihistamines.
Post-nasal drip.
What are the symptoms of anaphylaxis after a bee sting or peanut ingestion?
Hives, hypotension, wheezy chest, and possibly lip and tongue swelling.
What is the most common cause of anaphylaxis?
Food, followed by bee stings and drugs.
What is the treatment of choice for anaphylaxis?
IM epinephrine at the thigh.
What is the recommended dose of epinephrine for different age groups during anaphylaxis?
Adults >12 years: 0.5mg IM, Children 6-12 years: 0.3mg IM, Children <6 years: 0.15mg IM.
What should a patient with recurrent anaphylaxis carry?
An epinephrine pen.
What is the likely cause of sudden onset respiratory distress and localized wheezes in children?
Foreign body inhalation.
Describe the diagnosis for a male child with recurrent chest and gastrointestinal infections, decreased immunoglobulins, and lymphoid tissue.
X-linked agammaglobulinemia.
What is the treatment for X-linked agammaglobulinemia?
IVIG.
What condition presents with recurrent infections, suppurative lymphadenitis, and gingival abscesses?
Chronic granulomatous disease (CGD).
What is the most affected cell type in CGD?
Neutrophils.
What is the most common organism causing infections in CGD?
Staphylococcus aureus.
Which enzyme is affected in CGD?
NADPH oxidase.
What is the specific test used to diagnose CGD?
Nitroblue tetrazolium test.
What is the first step in managing head injury in children?
Follow a flow chart.
What is the recommended action for a child with head trauma and a skull fracture who develops convulsions, recurrent vomiting, or altered mental status?
CT scan is necessary.
What should be done for a child with head trauma, no loss of consciousness, and only one episode of vomiting?
Reassure the parents.
What is the management for a child with head trauma, persistent headache, and two episodes of vomiting?
Observe for 4 hours.
What is the immediate intervention if the Glasgow Coma Scale is less than 8 in a child with head trauma?
Immediate intubation.
Explain the inheritance pattern of autosomal recessive diseases.
Both chromosomes are required for the individual to be affected.
Explain the inheritance pattern of autosomal dominant diseases.
Only one chromosome is needed for the individual to be affected.
How should child growth be assessed?
Always follow the growth chart.
What is the most affected parameter by acute malnutrition?
Weight.
What follows periods of arrested growth in children?
Catch-up growth.
What is the best clinical indicator for overweight and underweight in children?
BMI growth chart.
What is the most common cause of obesity?
Overfeeding.
Describe the most common cause of Failure to Thrive (FTT).
Psychological factors.
What is the common presentation of FTT when accompanied by constipation?
FTT with constipation only.
What is the first step in the management of meconium-stained amniotic fluid?
CTG & scalp pH monitoring
Describe the management of neonatal gynecomastia.
Observe (never squeeze).
How should a child with an insect in the ear be treated as the first step?
Kill it by oil, then removal with forceps or ear toilet.
Define the term ‘symmetrical IUGR’ and its most common causes.
Defect in both BPD and abdominal width; MCC: chromosomal abnormalities, congenital infection.
What is the recommended treatment for a child with a fish bone in the larynx?
Laryngoscopy.
Describe the management of short stature, delayed puberty, and precocious puberty.
First step: x-ray to detect bone age (BA). If CA > BA: reassure, if BA > CA: concerning.
How should a child with a battery ingested and located in the esophagus be managed?
Remove it by endoscope.
What is the most important aspect to check in an immigrant infant from Sudan?
Calcium and vitamin D levels (high risk of rickets).
Define ‘asymmetrical IUGR’ and its most common causes.
Defect in abdominal width but normal BPD; MCC: placental problems like preeclampsia.
How should a child with a bloody vaginal discharge and suspected foreign body in the vagina be treated?
Removal under general anesthesia.
Describe the management of foreign body aspiration in infants.
First step: x-ray; TTT: removal under anesthesia.
What is the management approach for a child with decreased breast milk production?
Increase frequency of breastfeeding.
Describe the management of a Mongolian spot in a neonate.
Reassure the parents.
What is the most common complication in an infant of a diabetic mother?
Hypoglycemia.
Define congenital torticollis.
Firm painless swelling at birth with later head tilt to one side.
How would you manage a cystic hygroma in a neonate?
Remove by surgery.
What is the recommended treatment for hemangioma if it does not spontaneously disappear by 7-8 years of age?
Cortisone is the first-line treatment.
Describe the presentation of a neonate with neonatal abstinence syndrome.
High pitched cry, sweating, tremor, vomiting, diarrhea, and possibly convulsions.
What is the initial management for a neonate with neonatal abstinence syndrome?
Opioids.
How would you diagnose imperforate anus in a newborn?
X-ray with the patient upside down.
Define the management of duodenal atresia in a neonate.
Surgery.
What is the recommended treatment for neonatal respiratory distress syndrome (RDS)?
Surfactant.
What is the antidote for paracetamol toxicity?
IV N-acetyl cysteine
Describe the symptoms of aspirin toxicity.
Vomiting, tinnitus, hyperventilation
What are the metabolic changes in aspirin toxicity related to respiration?
Respiratory alkalosis due to hyperventilation
What is the first step in treating organophosphate compound (OPC) poisoning?
Remove patient’s clothes
What are the symptoms of carbon monoxide poisoning in a person working in a garage after a BBQ party?
Headache, irritability, lethargy, cherry red skin color
What is the treatment for carbon monoxide poisoning?
High flow oxygen
What are the symptoms of OPC poisoning in a farmer?
Lacrimation, salivation, urination, defecation, rhinorrhea, bronchorrhea, wheezy chest, decreased BP and pulse rate, pinpoint pupils
What is the antidote for OPC poisoning?
Oximes
What is the treatment for iron poisoning?
Deferoxamine
What is the first step in managing a child who ingested white pills and developed arrhythmia?
Perform an ECG
What is the genetic inheritance pattern of hemophilia?
X-linked
What is the preferred type of milk for individuals with lactose intolerance?
Soy-based milk
What is the most common cause of delayed milestones in children?
Prematurity
What should be considered in a child with delayed milestones and a history of prolonged jaundice or ICU stay?
Neurological problem
What is the first step in managing dehydration in a child?
Attempt oral feeding; if unsuccessful, administer IV fluids
When is direct hyperbilirubinemia diagnosed?
When direct bilirubin is more than 20% of the total bilirubin
What condition should be suspected in a child with prolonged jaundice, constipation, hypotonia, and mental retardation?
Congenital hypothyroidism
What is the treatment for a child with a sting bite and limited swelling or rash only?
Oral antihistamine (oral promethazine)
What is the treatment for a child with a sting bite presenting with rash, wheezy chest, hypotension, or vomiting?
IM adrenaline
What is the most important investigation for a drowsy child in the morning?
Blood sugar measurement
What is the normal age for a 9-year-old girl to start menstruation?
Normal puberty
What is the term for a 2-year-old girl starting menstruation?
Precocious puberty
What is the term for breast enlargement in a 2-year-old girl without other signs of puberty?
Thelarche
What is the likely condition in a baby with rapidly increasing head size?
Hydrocephalus
Describe the characteristics of a tall boy with infertility, gynecomastia, and mental retardation.
Klinefelter syndrome
What is the initial investigation for infertility in a boy suspected of having Klinefelter syndrome?
Testosterone level measurement
