Peds Brief Flashcards
What is the management of neonatal jaundice with breast feeding < 6 times per day?
Increase frequency of breast feeding.
What is the treatment of breast milk jaundice in neonates with breast feeding > 8 times per day?
Temporary cessation of breast feeding for 2 days then resume breast feeding.
TTT Of breast feeding jaundice:
Neonatal jaundice with breast feeding>8 times/d:
TTT of breast milk jaundice:
TTT Of breast feeding jaundice: increase frequency of breast feeding.
Neonatal jaundice with breast feeding>8 times/d: breast milk jaundice.
TTT of breast milk jaundice: temporary cessation of breast feeding for 2ds then resume breast feeding.
Jaundice at 1st day:
Jaundice at 3rd day:
Direct Jaundice after 7th day:
Jaundice at 1st day: hemolytic disease of new born(DT Rh incompatability).
Jaundice at 3rd day: physiological jaundice.
Direct Jaundice after 7th day: biliary atresia.
1st step in management Of neonatal jaundice:
Bilirubin> 270 micromol/L :
Bilirubin> 340 micromol/L : ]
1st step in management Of neonatal jaundice: total& direct billirubin.
Bilirubin> 270 micromol/L : phototherapy.
Bilirubin> 340 micromol/L : exchange transfusion
Asymptomatic Indirect hyperbilirubinemia in healthy adult:
TTT of neonatal hypoglycemia…
Cyanosis with feeding which improve with crying… Dx:
Test of choice if choanal atresia suspected:
Inv. Of choice for Dx of choanal atresia:
Asymptomatic Indirect hyperbilirubinemia in healthy adult: gilbert $.
TTT of neonatal hypoglycemia… 1st line: IV glucose.. if failed: IM glucagon.
Cyanosis with feeding which improve with crying… Dx: choanal atresia.
Test of choice if choanal atresia suspected: catheter test.
Inv. Of choice for Dx of choanal atresia: CT scan with contrast.
Describe the presentation of neonatal jaundice on the 1st day.
Hemolytic disease of the newborn (due to Rh incompatibility).
What is the first step in the management of neonatal jaundice?
Check total and direct bilirubin levels.
What is the treatment for asymptomatic indirect hyperbilirubinemia in a healthy adult?
Gilbert syndrome.
What is the first-line treatment for neonatal hypoglycemia?
IV glucose; IM glucagon if IV glucose fails.
Describe the diagnosis of cyanosis with feeding that improves with crying.
Choanal atresia.
What is the test of choice if choanal atresia is suspected?
Catheter test.
What is the management approach for innocent murmurs in children?
Reassure, but refer to a pediatrician if necessary.
What is the most common cause of omphalitis?
Staphylococcus aureus.
What is the most common source of infection in omphalitis?
Umbilicus.
What is the most common cause of cleft lip and cleft palate?
Genetics.
Describe the management approach for fused labia in a neonate.
Leave it alone; if treatment is needed, use estrogen cream, but never pull them apart.
Treatment for labial fusion
The join usually separates naturally by the time your child reaches puberty. This happens slowly. There is no pain and your child will not notice it happening.
Treatment is not usually needed. If the labial fusion is causing significant problems (e.g. problems urinating), treatment options may include gentle massage or applying oestrogen cream. Surgery to pull apart the labia is a last resort, but it is not recommended as there is a high risk that the fusion will return.
Leaving labial fusion alone is the safest and most effective treatment.
There is no relationship between labial fusion and any other medical conditions. Labial fusion will not have any effect on your child’s future ability to have sexual intercourse or have babies.
What is the most common cause of clubfoot in newborns?
Postural factors, especially in primigravida women.
The cause is not known. For parents of a baby with clubfoot, the chance of their second child being born with the condition is one in 30.
https://www.rch.org.au › C…PDF
Clubfoot (talipes equinovarus) - The Royal Children’s Hospital
What is the diagnosis for a child with 3 days of fever followed by a maculopapular rash?
Roseola infantum.
What is the most important complication of measles?
Otitis media.
What is the most important vitamin to be given in measles?
Vitamin A.
Describe the presentation of a child with VURTI, Koplik spots on the buccal mucosa, and a maculopapular rash.
Measles.
What is the complication of parvovirus B19 infection in patients with sickle cell anemia or hereditary spherocytosis?
Aplastic anemia.
What is the complication of parvovirus B19 infection in pregnancy?
Hydrops fetalis in the fetus.
What is the characteristic presentation of scarlet fever?
Strawberry tongue, circumoral pallor, and sandpaper rash.
Describe the presentation of herpangina.
Ulceration on the posterior pharynx, uvula, and palate only.
What is the difference in presentation between herpangina and hand-foot-mouth disease?
Herpangina only involves ulceration on the posterior pharynx, uvula, and palate, while hand-foot-mouth disease also includes ulceration on the hands and feet.
What is the course of action for school exclusion in hand-foot-mouth disease?
Exclude the child from school until all lesions crust over.
What is the cause of herpangina and hand-foot-mouth diseases?
Coxsackie virus.
What is the treatment for mild to moderate croup?
Inhaled corticosteroids.
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
What is the treatment for severe croup?
Inhaled nebulized adrenaline.
Describe the presentation of a child with very high fever, expiratory stridor, and drooling of saliva.
Likely suffering from epiglottitis.
Describe the clinical presentation of Kawasaki disease.
Fever for 5 days and 4 of the following: Conjunctivitis, Rash, Erythema, Adenopathy, and Mucous Membrane involvement.
What is the most important investigation for Kawasaki disease?
Echocardiogram.
What is the most serious complication of Kawasaki disease?
Myocarditis and coronary aneurysm.
What is the first-line treatment for Kawasaki disease?
Intravenous immunoglobulin (IVIG).
Describe the most specific finding on otoscopy in otitis media.
Loss of mobility of the eardrum.
What is the drug of choice for otitis media according to current updates?
According to the current RACGP guidelines, the drug of choice for treating acute otitis media is amoxicillin. This antibiotic is preferred due to its effectiveness, safety profile, and low cost. For patients who are allergic to penicillin, alternatives such as cephalosporins, macrolides, or clindamycin may be used, depending on the nature of the allergy and local resistance patterns.
The guidelines emphasize a watchful waiting approach in cases where the diagnosis is uncertain or the condition is mild, reserving antibiotics for those with severe symptoms or who do not improve within 48-72 hours of initial observation.
For more detailed information, you can refer to the RACGP Otitis Media Guidelines oai_citation:1,RACGP - Otitis Media Guidelines oai_citation:2,Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines | BMJ Open.
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What is the first-line drug for chronic otitis media?
Ciprofloxacin drops.
Describe the post-exposure prophylaxis for varicella.
Vaccine for immune-competent individuals within 72 hours and Intravenous immunoglobulin (IVIG) for pregnant and immune-compromised individuals.
What is the treatment for phimosis?
Cortisone cream.
Describe paraphimosis.
Inflammation of the penis with the inability to retract the foreskin forward.
How is paraphimosis treated initially?
Urgent manual reduction; if failed, incision may be necessary.
Define balanitis in children.
Whitish discharge on the glans penis; treated with cortisone cream.
Do medical professionals recommend circumcision from a medical standpoint?
No, circumcision is not recommended.
What is hypospadias and why is circumcision avoided in such cases?
Urethral opening on the ventral surface of the penis; foreskin is needed for surgical correction.
Describe urethral stenosis in a child with a history of urinary catheterization.
Difficulty in initiating urination; diagnosis is confirmed by urethroscopy.
What is toddler diarrhea?
Diarrhea in a 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.
What is the most common cause of constipation in children?
Diet.
How long after weaning can constipation occur in children?
After weaning.
Define meconium ileus or Hirschsprung in a child presenting with constipation since birth.
Possible causes of constipation since birth.
What is the common presentation in functional constipation?
A full rectum with stool.
Describe the treatment for acute constipation.
Enema.
What is the most effective approach for bowel training in children?
Bowel training.
What is the most common cause of rectal prolapse in children?
Constipation.
What is the management for a healthy child with leg pain that may awaken them from sleep and normal investigations?
Reassurance.
How is infantile colic diagnosed and managed in a healthy child with normal investigations?
Diagnosis: infantile colic; Management: reassurance and diet modification.
Describe breath-holding spells in children.
Crying followed by cyanosis and then convulsion.
What is the diagnosis when a child has a convulsion followed by cyanosis?
Epilepsy.
Define encopresis in a child over 4 years old.
Involuntary passage of stool.
What is the initial treatment for encopresis?
Toilet training; if failed, diet modification; if failed, laxatives.
What is enuresis in children over 5 years old?
Involuntary passage of urine.
What is the most common cause of enuresis in children?
Psychological, but urine culture must be done first.
What is the most common organic cause of enuresis in children?
Urinary tract infection (UTI).
What is the most important investigation to be done in a child with enuresis?
Urine culture.
What is the best management for a child with enuresis going camping soon?
Desmopressin.
What is the best long-term treatment for enuresis?
Alarm clock.
What is the imaging modality of choice for hydrocephalus?
CT scan (MRI > CT > US).
Describe transient synovitis in a child presenting with limping after a viral infection.
Limping after a viral infection; also known as transient synovitis.
What is the most common cause of limping in children?
Transient synovitis.
What is the initial investigation of choice for transient tenosynovitis?
Ultrasound.
What is the treatment for transient tenosynovitis?
Analgesics and joint traction.
What is the first investigation of choice for a limping child?
X-ray.
What is the recommended fluid intake for children daily?
150mg/kg.
Describe gastroesophageal reflux disease (GERD) in infants presenting with excessive vomiting and good general condition.
Diagnosis: GERD in infants with excessive vomiting and good general condition.
Describe the diagnosis for an infant presenting with excessive vomiting and bad general condition.
CHPS
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 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 and its significance.
Not a normal part of development, requires psychological treatment
What is the most common cause of painless bleeding in children under 2 years old?
Meckel’s diverticulum
How is Meckel’s diverticulum treated?
Surgery
What is the treatment of choice for allergic rhinitis?
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, lip and tongue swelling
What is the most common cause of anaphylaxis?
Food, followed by bee stings and drugs
How is anaphylaxis treated?
IM epinephrine at the thigh
What is the recommended dose of epinephrine for different age groups during anaphylaxis?
Adults >12 years: 0.5mg IM, Child 6-12 years: 0.3mg IM, Child <6 years: 0.15mg IM
What should a patient with recurrent anaphylaxis carry?
Epinephrine pen
What is the likely cause of sudden onset respiratory distress and localized wheezes in children?
Foreign body inhalation
Describe the most serious cause of localized wheezes in adults.
Tumor
What is the diagnosis for a male child with recurrent chest and gastrointestinal infections, decreased immunoglobulins, and lymphoid tissue?
X-linked agammaglobulinemia
How is X-linked agammaglobulinemia treated?
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 showing 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 head trauma patient?
Intubation
Explain the inheritance pattern in autosomal recessive diseases.
Both chromosomes are required for the individual to be affected
Explain the inheritance pattern in autosomal dominant diseases.
Only one chromosome is needed for the individual to be affected
How should child growth be assessed?
Follow the growth chart
What does it indicate if a child’s growth is between the 5th and 85th percentile on the growth chart?
Normal growth
What does it indicate if a child’s growth is between the 85th and 95th percentile on the growth chart?
Overweight
What does it indicate if a child’s growth is above the 95th percentile on the growth chart?
Obese
What does it indicate if a child’s growth is below the 5th percentile on the growth chart?
Underweight
What is the most affected parameter by acute malnutrition?
Weight
Describe the period of growth that follows periods of arrested growth.
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
What is the most common cause of Failure to Thrive (FTT)?
Psychological factors
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).
Define the defect seen in both BPD and abdominal width in IUGR.
Symmetrical IUGR (MCC: chromosomal abnormalities, congenital infection).
How should a child with a fish bone in the larynx be treated?
Laryngoscopy.
What is the most important thing to check in an immigrant infant from Sudan?
Ca & vit. D (high risk of rickets).
Describe the treatment of foreign body aspiration in the nose.
Removal under anesthesia.
What is the risk of high flow O2 to premature infants?
- Retinopathy of prematurity. 2. Lung dysplasia.
How should a child with an insect in the ear be managed?
Kill it by oil, then removal with forceps or ear toilet.
What is the first step in assessing fetal IUG?
US.
Do children with egg allergy have a contraindication to the MMR vaccine?
No, egg allergy is NOT a contraindication to MMR vaccine.
Describe the management of short stature, delayed puberty, and precocious puberty.
X-ray to detect bone age (BA). If CA > BA: reassure, if BA > CA: concerning.
What is the first step in meconium-stained cases?
Mask ventilation.
How should a child with a battery ingested in the esophagus be managed?
Remove it by endoscope.
Define the defect seen in abdominal width but normal BPD in IUGR.
Asymmetrical IUGR (MCC: placental problems like preeclampsia).
What is the management of decreased breast milk in infants?
Increased 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 at the neck side in a neonate?
Remove by surgery.
What is the recommended treatment for neonatal abstinence syndrome?
Opioids.
Describe the presentation of a neonate with imperforate anus.
No passing of stool since birth and no anal opening.
What is the first-line treatment for a hemangioma if it does not spontaneously disappear by 7-8 years of age?
Cortisone.
How would you diagnose duodenal atresia in a neonate?
Abdominal x-ray showing a double bubble sign.
Define the management of a neonate with a port wine stain.
Brain CT to exclude Sturge-Weber syndrome.
What is the treatment for duodenal atresia in a neonate?
Surgery.
How would you manage a neonate with a facial nerve palsy due to forceps delivery?
Reassure the parents.
Describe the antidote for paracetamol toxicity.
IV N-acetyl cysteine.
What are the symptoms of aspirin toxicity?
Vomiting, tinnitus, hyperventilation.
What are the metabolic changes seen in aspirin toxicity?
Respiratory alkalosis followed by metabolic alkalosis.
What is the treatment for carbon monoxide poisoning?
High flow oxygen.
What are the symptoms of organophosphate compound poisoning?
Lacrimation, salivation, urination, defecation, rhinorrhea, bronchorrhea, decreased BP and pulse rate, and possibly pinpoint pupils.
What is the first step in treating organophosphate compound poisoning?
Remove the patient’s clothes.
What is the antidote for organophosphate compound poisoning?
Oximes.
What is the treatment for iron poisoning?
Deferoxamine.
What is the initial step when a child ingests white pills and develops arrhythmia?
Perform an ECG, then administer sodium bicarbonate if ECG changes are present.
Describe the genetics of hemophilia.
X-linked inheritance.
What is the preferred type of milk for individuals with lactose intolerance?
Soy-based milk.
What is the most common cause of delayed milestones?
Prematurity.
What should be considered in a child with delayed milestones and a history of prolonged jaundice or ICU stay?
Neurological problems.
What is the first step in managing dehydration in a child?
Attempt oral feeding; if unsuccessful, switch to IV feeding.
When is direct hyperbilirubinemia diagnosed?
When direct bilirubin is more than 20% of the total bilirubin.
What condition should be suspected in a newborn with direct hyperbilirubinemia after the first week of life?
Biliary atresia.
List symptoms suggestive of congenital hypothyroidism.
Prolonged jaundice, constipation, hypotonia, enlarged tongue, umbilical or inguinal hernia, mental retardation.
What is the recommended treatment for a child with rash only or limited swelling after a sting bite?
Oral antihistamine (oral promethazine).
What is the management for a child with rash, wheezy chest, hypotension, or vomiting after a sting bite?
IM adrenaline.
What is the most important investigation for a drowsy child in the morning?
Blood sugar test.
What is the significance of a 9-year-old girl starting menstruation?
Normal puberty.
What does precocious puberty refer to in a 2-year-old child?
Early onset of menstruation.
What is the term for breast enlargement in a 2-year-old child?
Thelarche.
Describe the presentation of a baby with rapidly increasing head size.
Likely hydrocephalus.
Describe the characteristics of Klinefelter syndrome.
Tall stature, infertility, gynecomastia, and mental retardation.
What is the initial investigation for infertility in a boy suspected of having Klinefelter syndrome?
Testosterone level measurement.
