Pediatrics Flashcards
Neonatal hypoglycemia management?
asymptomatic
encourage normal feeding (breast or bottle)
monitor blood glucose
symptomatic or very low blood glucose blood glucose of <1mmol/L
admit
intravenous infusion of 10% dextrose
differentiate between
caput succedaneum
and cephalohematoma
caput succadenum -> present at birth, forms over the vertex and crosses suture lines, resolves within days. fluid collection
cephalohematoma -> develops several hours after birth, most common in parietal region, does not cross suture lines, takes months to resolve. blood collection
A newborn infant is noted to have a posterior displacement of the tongue and a cleft palate. What is the most likely diagnosis?
Pierre-Robin Syndrome -> micrognathia (undersized jaw), glossoptosis (posterior displacement of the tongue) and cleft palate
Differentiate between acute epiglottitis and croup
Acute epiglottitis = tripod positioning, drooling!!. Stridor. Caused by Hib -> now seen more commonly in adults due to vaccination program. Diagnosis by direct visualization by senior staff. call anesthetist for intubation! Do not examine throat. Thumb print sign on x ray. IV antibiotics
Croup - stridor!! , SOB. Viral prodrome!! - Parainfluenza virus. Most common cause. Steeple sign on X-ray/supglottiv narrowing. Croup = barking Cough that may sound like a seal. managed with oral dex. SINGLE dose
Symptoms seen
Cyanosis/ tet spells
collapse in first month of life, Ejection systolic murmur
symptoms of noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
A 2-week-old infant with a small chin, posterior displacement of the tongue and cleft palate has what syndrome?
pierre robin syndrome
Management for ophthalmia neonatorum (infection of newborn eye)
Same day ophthalmology referral
What happens in necrotising enterocolitis?
management?
bowel of premature infants becomes ischaemic and infected.
dilated asymmetrical bowel loops AND pneumatosis intestinalis (intramural gas).!!
abdominal distension. bloody stools may be present
total gut rest and TPN, babies with perforations (eg free fluid in in abdomen) will require laparotomy
If a man has a mitochondrial disease, which family member is most likely to be affected?
Brother or sister - maternal inheritance
what is infantile colic?
benign condition characterised by irritability and excessive crying
tends to be worse in the evenings or at night. starts around 6-8 weeks old and most resolve by 6 months
First sign of puberty in boys?
Increase in testicular volume
What is transient tachypnoea of the newborn?
Diagnostic findings?
risk factor!!
Management?
commonest cause of respiratory distress in the newborn period.. rapid breathing, grunting, and mild intercostal recession. caused by delayed resorption of fluid in the lungs
Chest x-ray - hyperinflation of the lungs and fluid in the horizontal fissure.
c section!!
Observation/supportive care. O2 may be needed
Whooping cough symptoms?
Management?
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
Macrolide antibiotics- clarithromycin, azithromycin
school exclusion until 2 days after starting antibiotics
Important contraindication to lung transplant in CF?
chronic infection with Burkholderia cepacia
A normal pCO2 in an acute asthma attack indicates?
Life threatening attack - respiratory exhaustion - not blowing off co2
distinguish between pathological and physiological jaundice and prolonged jaundice
name causes of each
pathological = in first 24 hours. rhesus disease&hemolytic jaundice, blood group incompatibility. hypothyroidism. Coombs test important
tretaments - phototherapy, iV immunoglobulin, exchange transfusion
physiological = days 2-14 eg less developed liver, more rbcs, breast milk
prolonged = beyond 14 days. biliary atresia, hypothyroidism, galactosemia, UTI, breast milk
in a patient that present with acute asthma attack which improves with o2 and salbutamol, what else must be prescribed?
oral prednisolone, 40mg for 3-5 days
hemophilia A has what mode of inheritance?
x linked recessive
explain the law around medical consent by children under the age of 16 in UK
patients less than 16 years old may consent to treatment if they are deemed to be competent (an example is the Fraser guidelines, previously termed Gillick competence), but cannot refuse treatment which may be deemed in their best interest
non bullous impetigo treatment?
hydrogen peroxide cream 1%. exclusuion from school till lesions are crusted and healed
how do you differentiate between infantile spasms (siezures) and infantile colic?
what investigation is needed?
In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the ‘spasms’
eeg - rule out hypsarrhythmia commonly seen in West syndrome
in a viral induced wheeze, if SABA is not effective, next step in management?
ICS or monteleukast
febrile siezures typically stop at what age?
medication for recurrent febrile siezures?
5 years
benzodiazepine
3-year-old boy. last 12 hours bilious vomiting on multiple occasions. assed one stool which contained small amounts of blood.
what is the likely diagnosis?
investigation?
management?
intusscueption
USS = first line = target sign
reduction by air insufflation
during paroxysm the infant will characteristically draw their knees up and turn pale
how can you distinguish between intussuception and necrotising enterocolitis?
diagnostic test in NE?
both have abdominal distension, bilious vomiting and bloody stool
NE more commonly encountered in premature infants! than young children like intussuception
Abdominal x-ray
a distended abdomen and bilious vomiting in a 2-week child is highly suggestive of?
diagnosis?
intestinal malrotation and volvulus. the obstruction here causes bilious vomiting
upper GI contrast study and USS
name red flag symptoms in pediatric traffic light system
respiratory rate >60 breaths/minute
reduced skin tugor
moderate intercostal recession
age <3 months!!
temp >38 !!
weak, high pitched or continous cry
scarlet fever symptoms?
management?
rash ->. spares palms and soles. ROUGH or sandpaper like texture, sore throat, strawberry tongue may be present
oral penicillin 5 for 10 days
meningitis treatment in children< 3 months
IV amoxicillin in addition to cefotaxime to cover for Listeria
> 3 months is IV cefotaxime or ceftriaxone. note ceftriaxone contraindicated in children <3 months
APGAR scoring
A 4-year-old boy is noted to have macrocephaly and learning difficulties. What is the most likely diagnosis?
Fragile X syndrome. also large ears, macro-orchidism
why is oligohydramnios a risk factor for DDH?
it restricts foetal movement and thus normal development of the hip joint.
symptoms of SCFE?
hip, groin, medial thigh or knee pain. inability to weight bear
loss of internal rotation of the leg in flexion
may present following acute trauma or chronically
commonly in obese boys.
in neonates with hypoxic injury, what is done to reduce the chances of HIE?
therapeutic cooling
poor prognostic factors for ALL?
male sex
presenting <2 years or >10 years; having B or T cell surface markers; and having a WCC > 20 * 10^9/l at diagnosis.
ALL symptoms?
anaemia, neutropaenia (infections eg cough) and thrombocytopaenia
Others: splenomegaly, hepatomegaly, bone pain
*note high number of white cells produced so high wcc!! -> but they do not function properly
Perthes disease presentation?
(idiopathic avascular necrosis of the femoral head)
management?
pain and a limp, reduced tange of hip movements movements.
observation. only surgery if fracture or joint collapse
transient synovitis presentation?
1-2 weeks after an upper respiratory tract infection or gastrointestinal infection.
what type of pulse is seen in a patent ductus arteriosus?
collapsing pulse
classify the types of cerebral palsy and structures damaged in each
spastic (70%)
subtypes include hemiplegia, diplegia or quadriplegia
increased tone resulting from damage to upper motor neurons!!!
dyskinetic
caused by damage to the basal ganglia and the substantia nigra!!!
athetoid movements and oro-motor problems (drooling)
ataxic
caused by damage to the cerebellum!! with typical cerebellar signs. struggle with fine motor skills! eg building a tower
mixed
when is the first dose of MMR vaccine given?
at 12-13 months
what is an umbilical granuloma?
overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.
what features make penumonia more likely than bronchiolitis?
high fever (over 39°C) and/or
persistently focal crackles.
name 3 oral live attenuated vaccines
polio
rotavirus
typhoid
in the first ___ minutes of life suboptimal SP02 readings can be expected from a healthy neonate
10 minutes
features seen in achondroplasia?
trident hand deformity (short, stubby fingers with separation between the middle and ring fingers), short limbs (rhizomelia), lumbar lordosis and midface hypoplasia.
A 16-year-old female presents with chronic left knee pain. The pain is typically felt after jogging. There is also intermittent swelling and locking of the same joint. What is the most likely diagnosis?
osteochondritis dissecans
Osgood-Schlatter disease rarely causes pain at rest. with activity pain is localised at tibial tuberosity. swelling can occur
VSD increases risk of what condition?
endocarditis
what medical condition is associated with fragile x syndrome?
mitral valve prolapse