Paediatrics Flashcards
What is the common age group that DDH presents and what the signs / clinical tests to screen for it?
0-3 years: Developmental dysplasia of the hip (DDH) = congenital dysplasia of the acetabulum and partial dislocation of the femoral head from the acetabulum. Predominantly effects females.
All newborns should be screened for DDH within the first 24-72 hours after birth.
First assess for risk factors: breach presentation at or after 36 weeks even if successful ECV, family history in 1st degree relative, fixed foot deformity (if a twin/triplet pregnancy and any of the babies have a risk factor they should all get USS)
Then Look, Feel, Move assessment
LOOK: look for asymetrical groin creases or leg length discrepancy
FEEL: Flex both hips and knees and assess for knees being at unequal lengths (postive galeazzi sign)
MOVE: 1) Gentle abduction test: with hips and knees flexed and with thumbs on inner thighs and forefingers over greater trochanters and gently abduct both hips at the same time. Assess for assymetrical or restricted hip abduction.
2) Barlow’s test: gentle push posteriorly with the hips and knees flexed in a neutral abd/adduction position. Assess for if hip slips posteriorly.
3) Ortolani test: abduct the hips in a flexed position and feel for the greater trochanter popping back anteriorly from a posteriorly displaced position.
Need USS within 2-4 weeks if positive examination finding (asymmetrical leg lengths / groin creases, asymmetrical /restricted abduction, positive Barlow’s or Ortolani’s).
Need USS within 4-6 weeks if no positive examination findings but risk factors (breach at or after 36 weeks, first degree relative, fixed foot deformity).
Can only really USS until 4-6 months. Then use X rays as the femoral head starts to ossify.
Early Mx = Pavlik harness (main risk is avascular necrosis of the femoral head). If conservative Mx fails or late presentation (>6-18 months) = surgical reduction.
Differential diagnoses in the limping child at different ages?
At any age:
- INFECTION: septic arthritis (can affect any joint but most commonly lower limb, FEVER +/- raised inflam markers, refusal to weightbear), osteomyelitis (pain on palpation over the bone)
- TRANSIENT SYNOVITIS: non infective inflammation of the joint synovium, sometimes a preceding history of viral illness but not always. Features that suggest septic arthritis rather than TS: 1) Fever 2) Raised ESR 3) Raised WCC 4) Refusal to weight-bear on affected site.
TRANSIENT SYNOVITIS IS VERY RARE IN CHILDREN UNDER 3.
- Fracture / soft tissue trauma
- Child abuse
0-3:
- Missed DDH
- Toddler’s fracture (undisplaced tibial shaft fracture commonly after unwitnessed fall)
3-10:
- Perthes disease (idiopathic avascular necrosis of the femoral head, higher risk in males, tend to present with several month onset of groin/thigh/knee pain especially after physical activity, limp + stiff joint. Mx over 50% self resolve within a couple of years, advise to avoid physical activity / contact sport during acute phase, some may need physio / crutches and arthrogram to assess if surgery needed for more severe cases.)
10-19:
- Slipped capital femoral epiphysis (SCFE): displacement of the femoral epiphysis from the metaphysis. presents with insidious hip/knee pain, antalgic gait, limited internal rotation, externally rotated + shortened affected limb. Risk factors = male, overweight, prev radiotherapy, hormonal issues (eg hypothyroidism, growth hormone deficiency). Mx: insitu screw fixation (if very unstable / severe might need to do an open reduction).
What are the major risk factors for Sudden Infant Death Syndrome
1) Sleeping on their front / prone
2) Parental smoking
3) Co-sleeping
4) Hyperthermia and head covering
5) Prematurity
When should vaccinations be given to premature infants ?
According to chronological age (Ie number of months from their delivery) NOT adjusted for gestational age.
They are at especial risk of infection so don’t want to delay until they are gestationally 2 months.
How should you manage nocturnal enuresis (bed wetting) in children <5
Reassurance, advice on reducing fluids in the evening, and toileting hygiene. Nocturnal enuresis in children <5 can be managed with reassurance
What are risk factors for surfactant deficient lung disease in neonates?
- the earlier the gestation the higher the risk
- male gender
- diabetic mothers
- c-section
- being the 2nd born of premature twins
What are the 4 defects of tetralogy of fallot?
1) Pulmonary stenosis
2) Right ventricular hypertrophy
3) Ventricular septal defect
4) Over-riding aorta
Cyanotic, presents at birth, boot-shaped heart
What are the 5x types of CYANOTIC congenital heart defect?
1) Tetralogy of Fallot
2) Transposition of the great arteries
3) Tricuspid Atresia
4) Truncus arteriosus
5) Total anomalous pulmonary venous return
What are absolute contraindications to the MMR vaccine?
For all live attenuated vaccines: immunosuppression, prev anaphylactic reaction to MMR vaccine, prev anaphylactic reaction to gelatin or neomycin, pregnancy, yellow fever vaccination within the past 4 wks
(need at least a 4 week window between yellow fever and MMR or varicella vaccination
What doses of IM adrenaline should be given in anaphylaxis in the child
<6 = 150 micrograms of 1:1000
6-12 = 300 micrograms
>12 + adults = 500 micrograms
What are the sequalae associated with being SGA /IUGR?
Hypoglycaemia Polycythaemia Thrombocytopenia Necrotising enterocollitis hypocalcaemia
What are the 1st line drug treatments for ADHD?
1st line = Methylphenidate (ritalin)
2nd line = Dexamfetamine
What is the typical presentation of lymphoma in children?
NON-PAINFUL LYMPHOMA initially may be without other prodrome, can later develop B symptoms of fever, weight loss and nightsweats
Non-hodgkins = much more common than hodgkins
What is the typical presentation of acute lymphoblastic leukaemia (ALL)
Relatively sudden onset across several weeks
Overgrowth of immature lymphocytes in the bone marrow, liver, spleen and lymph nodes = anaemia, thrombocytopenia (bruising, petechia, nose bleeds), neutropenia (recurrent infections, hrpatosplenomegaly, lymphadenopathy
What are the associated conditions / sequelaea of cystic fibrosis?
- Pancreatitis -> diabetes
- Liver cirrhosis
- Nasal polyps
- Reduced fertility (absence of vas deferens in males, reduced fertility in females)
What drug is first line for absence seizures in children?
Sodium valproate
What is the classical presentation of Di-George syndrome?
CATCH-22
C - conotruncal cardiac defects (TETRALOGY OF FALLOT + truncus arteriosus)
A - abnormal faces (long face)
T - thymic hypoplasia (hypoparathyroidism + hypocalcaemia)
C - cleft palate
H - Hypocalcaemia
22 - due to deletion of part of chromosome 22
ALSO HAVE HIGHER RATES OF SCHIZOPHRENIA
What is the peak incidence of febrile seizures?
18 months
When is a febrile seizure considered complex?
- > if it lasts >15 mins
- > if there is recurrence within 24 hrs
- > if the seizure is focal at onset or at any time during the convulsion
What is the subsequent risk of epilepsy in a child presenting with a febrile seizure?
2%
seizures that occurred with a lower fever is associated with a higher chance of recurrence
What is functional abdominal syndrome?
periumbilical abdominal pain that occurs in otherwise well children around school-age
What is the typical presentation of cri de chat syndrome?
= chromosome 5p deletion (Five for Feline)
= cat-like cry, small jaw, small head (microcephaly), hypertelerism (eyes spaced far apart), learning difficulties
What is the typical presentation of Patau syndrome?
= trisomy 13
= poor survival, only 1 in 10 live longer than 5 years
= microcephaly, polydactyl (extra fingers/ toes), undescended testes, may have cyclopia (one eye, may have 1x cerebral hemisphere which isn’t survivable)
13 for unlucky -> don’t live very long
What is the typical presentation of Edward syndrome?
= trisomy 18
8dward syndrome
= neural tube defects, small jaw, prominent occiput, overlapping fingers, chroroid plexus cysts
Eighten for Edward
What is the typical presentation of Pierre-Robin syndrome?
= SOX-9 mutation
= cleft palate + posterior tongue displacement + small jaw
Pierre Robin = all about the face
What is the typical presentation of Prader-willi syndrome?
= deletion in paternal copy of 15q-11-15 (genetic imprinting)
= obesity + behavioural difficulty + HYPOgonadism + hypotonia
