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4th year Paediatrics > Level 2 conditions > Flashcards

Level 2 conditions Flashcards

(72 cards)

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1
Q

Birth Asphyxia

A

Fetal hypoxia + increased co2 –> metabolic acidosis

Treatment:

  1. Endotracheal intubation
  2. Adrenaline
  3. Glucose/fluids if needed
  4. Phenytoin or diazepam if seizing
    • 72 hours Therapeutic cooling - 33.5 degrees
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2
Q 
Birthmarks
Salmon patch
port wine stain 
strawberry naevus / infantile haemangioma
Mongolian spots
pigmented naevua
sebaceous navus
A
  • Salmon patch = pink mark on face + fades over 2 yrs
  • port wine stain = purple lesion, associated with sturge-weber syndrome–> fits
  • strawberry naevus = soft, raised red capillary, regresses by school years
  • Mongolian spots = blue lesion over bum/legs
  • pigmented naevus = moles, eg cafe au lait >4 may indicate neurofibromatosis

sebaceous navus = raised warty naeus on scalp

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3
Q

Cephalohaematoma

A

Blood between skull and scalp
Doesnt cross suture line
Can cause jaundice

Ddx = caput succadenum - crosses sutures

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4
Q

Haemolytic disease

A

Rhesus + Abo incompatability
Check with direct Coombs

Management: Rhesus prophylaxis, anti D igG at 28 weeks

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5
Q

Prematurity

Complications

A

Baby born before 37 weeks
Most issues before 32 weeks

Complications

  • Resp Distress + recurrent apnoea
  • Patent DA
  • Anaemia
  • Nec Ent
  • Intraventricilar haemorrhage
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6
Q

Resp distress dyrnome

A

Surfactant deficiency
Preterm, Fhx, C-section,

CF: cyanosis, tachypneaic, accessory muscles, grunting

IVX: CXR, bilateral ground glass, decreased lung volume

Management: Betamethasone or DEX steroids IM if preterm is imminent
Delivery room resus
Administer Abx until pneumonia is excluded
02 therapy CPAP

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7
Q

Small baby IUGR

A

Symmetrical small head and body = intrinsic eg downs syndrome

asymmetrical big head small body = Extrinsic factors eg maternal malnutrition or placental insufficiency

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8
Q

Talpies

Treatment?

A

Subluxation of talonavicular joint

Management: USS detection

Treatment: Early orthopaedic referred
1. PONSETI - conservative manipulation, repeated plaster caste, achilles tenotomy, boots and bars

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9
Q

Chicken pox

A

Varicella Zoster
Itubation 11-21 days

Presentation: rash on head and trunk lasting 2 weeks
Cant go back to school till lesions crusted over

Tx: Acyclovir used in severe cases or those immunisuppresed + paracetemol to control fever

Complications = fluclox if get infectious

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10
Q

Conjunctivitis

Treat with?

A

Neonatal conjunctivitis usually starts 3rd day of life. If complicated

–> Treat with Neomycin

Can be gonoccocal or chlamydial

Childhood conjunctivitis = red eyes and dischargne
Viral, bacterial and allergic

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11
Q

Food allergy

A

igE antibodies
Most common = milk, eggs, peanuts

Presentation: Bloody diarrhoea, mucus + abdo pain
FTT, eczema, anaphylaxis

Ivx = igE, exclude coeliac

Management: IM adrenaline in anaphylaxis, most resolve by 2 years except peanut

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12
Q

Infectious mononucleosis

A

90% caused by EBV /CMV

Prodrome: 3-5 days, headache, low grade fever
Syx: exudative pharygitis, tender lumps, hepatosplenomegaly

Ivx: FBC, monospot test

Treatment: Supportive care for syx, avoid contact sport for 1 month

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13
Q

Kawasaki disease

1,2,3,4,5
1 = tongue strawberry
2 = eyes
3 = lymph nodes
4 = limbs (rash) palms and soles 
5 = days temp
A

Onset 6 months - 4 years
Self limiting vasculitis
Diagnosis = warm CREAM

5 day temp >38.5
Conjunctivitis bilateral
Rash
Erythema on palms and soles
Adenopathy
Mucus membranes involved = dry strawberry tongue 
RISK coronary artery aneurysms!!!!

IVX: bloods, ECG, echo

Treament: High dose, Immunoglobulins IVIg wihtin 10 days
+ Aspirin (only time allowed as can cause reyes syndrome = rapidly progressive encephalopathy)

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14
Q

Measles

A

Young children
Incubation 8-12 days

(5Cs)
- KOLPICK SPOTS - white spots
- Cough
- Conjunctivits 
- coryza 
\+ fever + rash starts on face + spreads

Treatment: Prevention with vaccine
Immunocompromised give Ribavarin

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15
Q

Perioribtal cellulitis

do CT scan to check its not gone into eye to check its not orbital

A

Infection of peri-orbital skin around eye
Agents: S.aureus, may occur secondary to paranasal/ dental abcess.

Features: Fever, unilateral erythema, tenderness + oedema of eyelid

IVX: if severe and eye movements limited then refer to optimal/ ent

Tx: Ceftriaxone if eye movement visible and if not metronidazole

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16
Q

Brain tumours

30% are?
mean age?

A

30% are medulloblastomas. Mean age is 9y.
2X as common in boys.
Most are Gliomas = astrocytoma’s or medulloblastomas which
have spinal mets at diagnosis

Commonly presents with raised ICP.
Mostly cerebellar signs. DANISH Acronym
•Dysdiachokinesia, Ataxia, Nystagmus, Intention Tremor, Scanning dysarthria, Heel-Shin test positive

Syx: Papilledema, altered LOC, headache, vomiting, behavioural change, bulging fontanelle, raised BP, low HR
May exhibit focal neurological signs depending on site of tumour.

Management

  • MRI with contrast. Persistent back pain in children should always warrant an MRI.
  • Never do an LP if suspected raised ICP. Can cause coning.

Treatment
Surgery, Radiotherapy and Chemotherapy

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17
Q

Haemophillia

a =8
b=9

A

Only MEN affected
X -linked autosomal recessive clotting disorder

Syx depend on severity of haemophillia e.g easy brusiing

IVX: increased APPT , clotting screen

Treatment: lifestyle = avoid contact sports forever
IV factor 8 or 9 as prophylaxis

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18
Q

Leukaemia - most common in children?

lymphoma- most common in adolesence?
most common in childhood?

A 
Acute Lymphoblastc Leukaemia (ALL=
always little people)
Most common childhood malignancy 
CF: weeks/days quick onset, malaise, anorexia, bone pain,  headaches
IVX: FBC = thrombocytopenia 
CXR identifies mediastinal masses 
Tx- chemo for 3 years

Lymphoma?
Adolesence = Hodgkins due to EBV risk = reed sternberg cells
Childhood = Non hodgkins due to Burkitts
Tx = chemo

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19
Q 
Sickle cell
Cause of crisis?
1. aplastic?
2. occlusion
3. haemolytic 
4. sequestration = sickling within organ

Management?
maintainance fluids?

A

Autosomal recessive HbSS = anaemia, HbSB = trait

  • Present with sudden pain in crisis
    1. aplastic due to infection eg PAROVIRS
    2. occlusion - thrombotic PAINFUL
    3. rare- hb drops
    4. sequesttrion pooling of blood in organ - abdo pain

ivx: blood film shows sickles cells

Management:

  1. Analgesia,
  2. 02
  3. keep warm + 38 degrees
  4. broad spec abx if temp
    • 150% normal mainatainance fluids

HbSS prophylaxis oral Pen V, folate supplements, vaccine and bone marrow transplant could cure

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20
Q

Inhialed foreign body

A

IVX: CXR with lateral views will show hyperinflation of infected side and mediastinal shift
Bronchoscopy to visualise object

Management: A-E
Effective cough –> encourage to cough
Ineffective + conscious = 5 back blows + 5 thrusts
Ineffective + unconscious = open airway, 5 rescue breaths –> CPR 15:2 in child, 3:1 neonate

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21
Q

Middle ear infection = otitis media

Examinaiton

treatment

A

Very common under 8 years old
Recurrent episodes can cause Glue ear = secretaory otitis media
Presentation:
Infants = high gever, irritability, head rolling, ear rubbing
older children = ear ache, deafness + discharge

Examination: Mild inflammation of tympanic membrane and dialated vessels on handle of malleus
Absent light reflex –> buldging TM and evenrually perforation and discharge.

Treatment: Calpol + allow to burst
If child systemically unwell = antibiotics - oral amoxicillin + paraceteol
if TM performates, can use topical abx eg ciprofloxacin

Surgery : gromet insertion for 1 year

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22
Q

Appendicitis

Ivx:

Management

A

Presentation: Pain aggrevated by movement, mild fever, centra abdo pain localised to Mcburneys RIF
Guarding, irritable, change in bowel habit

Ivx: Urinalysis abnormal in 1/3, bloods raised WCC + cRP,
USS 90% accurate in diagnosing

Management: Nil by mouth, A-E, Antibiotics, antiemeteics, analgesia, surgical review, appendicetomy

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23
Q

Coaelic disease

A

Intolerance to Gliadin
RF: Introduction of cereals before 4 months inc risk

Presentation: 8-24 months when starting solids, FTT, abdo distension, irritability, buttock wasting, pale floating stools

Ivx: If Serum tissue Transglutamase iGA (TTG), then small bowel endoscopy ans jejunal biopsy
Shows crypt hyperplasia and villous atrophy

Management: diet of excluding gluten
Risk of GI lymphoma if gluten ingested

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24
Q

Feeding problems
Should weigh?
Kwashikor vs Marsamus

A

Should weight 2X (age+4) e.g 2 X (5yrs+4) = 18 kg
Kwashikor = normal energy but inadequate protein so swollen abdomen
Marsimus = inadequate energy and protein

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25
Inguinal hernia more common in? how to investigate?
8 times more common in boys Mainly indirect and caused by patent processes vaginalus More common on R side due to later sescent Symptoms are rare = intermittent swelling in groin, occurs when crying, may be visible on cough IVX: Transilluminaiton to exclude hydrocele Management: Surgical Herniotomy asap to avoid incarceration
26
Intussusception | Key signs?
1. Target sign on USS + small bowel obst on AXR 2. Red current jelly stool 3 3. Bile stained vomit 4. Drawing up of legs Management: 1. Resusscitation of IV fluids 2. Abx + analgesia 3. NG if vomiting 4. Air enema (radiologically guided air inflation within 12 hrs) - if doesnt work, surgiclal resection of gangrene bowel
27
Jaundice Pre hepatic Hepatic Post hepatic
Pre hepatic -> unconjugated e.g. haemolysis such as spherocytosis Hepatic --> Hepatocyte damage eg. hepatitis = mixed conj and unconj sp Dark urine, normal stools Post hepatic = conjugated Obstruction of biliary drainage e.g. biliary atresia, cholecystitis Dark urine, pale stoos + yellow skin and eyes
28
Mesenteric adenitis
Inflammation of lymph nodes in abdominal mesentry Mimics acute appendicits - result of recurrent VIRAL Presentaiton: central diffuse abdo pain (+ URTI) Fever, malaise, usually resolves within 48 yrs Pain less severe than appendix Ivx: Observation- syx should improve Large mesentaeric nodes seen at laporoscopy and normal appendix so no action needed
29
Pyloric stenosis RF Syx treatment? name of surgery?
-Progressive hypertrophy of pyloric muscle --> gastric outlet obstruction 4 X more common in boys RF: Fhx, first born Presentation between 2 + 7 weeks of age - Vomiting non billous that increases in freq and intensity = PROJECTILE - Hunger after vomiting and dehydration + weight loss Olive shaped mass - palpable in R hypo Ivx: test feeed and see peristalsis in abdo, USS to confirm Blood gas for metabolic acidosis Management: IV fluid restricton, NBM, empty stomach with NG tube - DRIP AND SUCK 48 hrs to correct electrolyte imbalance Treatment: surgery = Ramstedts Pyloromyotomy
30
Torsion of testicle most common age? Presentation:
MUST BE EXCLUDED in any child with scrotal pain Most common 12 years old RF: undescened testies Presentaiton: Sudden onset severe pain, N+V, absent cremesteric reflex Management: Must be relieved in 6-12 hrs to preserve via surgical exploration CONTRALATERAL testies fixed also to prevent
31
Undescended testies investiations? Treatment- palpable vs non palpable
Cryptochordism - more common in premature babies Spontaneous descent may occurs in 1st 6 months of life Exam: carried out in warm room attempt to bring testies down by sweeing massage in inguinal canal If palpable = Can be treated with an Orchiopexy via inguinal incision Impalpable = Laparoscopy to determine management as risk of malignant degeneration if in abdo
32
Disorders of sexual development - Klinefelters - kallmans - Androgen insensitivity syndrome
Klinefelters = 47XXY = feminisation of male - taller than avergae, lack of secondary sexual charactersiics, infertile, gynaecomastic, small testies kallmans = lack of smell with delayed puberty in BOY Androgen insensitivity syndrome aka testicular feminisaiton = 46 XY - Female phenotype with primary amenorrhoea, undescended testies but breast develop due to testosterone --> oestrogen
33
Ambiguous genitaelia Most common is Congenital adrenal hyperplasia CF male + female Treatment
CAH autosomal recessive disorder 90% cases caused by 21-hydroxxylase enzyme deficiency Causes salt loss, hyperplasia of adnreal gland = Acute adrenal crisis Females: Genitaelia look male - clitoral hyperplasia Males: Enlarged penis, scrotum pigmented, bilateral. non-palpable undescended testies IVx: Check Na, K, Glucose, pelvic US Management: Medical + surgical emergency Avoid immediate declaration of sex Counselling for parents + STEROIDS FOR LIFE = Glucocorticoid + mineralocorticoids
34
Precocious puberty | ages?
``` Less than 8 in girls and 9 in boys Central PP (true) = Gonadotrophin dependent e.g. intracrainal tumours. Puberty occurs due to early activation of hypothalamic gonadal axis ``` Peripheral PP = Gonadotrophin independent - e.g ovarian/testicular tumours - excess Sex steroidds CF: premature puberty Ivx: family history of puberty + evidence of growth acceleration?m
35
Hypothyroidism - Congenital - Acquired IVx Treatment
Congenital = lack at birth and causes learning difficulty Detected at screening in Guthrie test which shows high TSH and low T4. Acquired: F>M, hashitmotos, dry skin, cold intolerance Thyroid imaging and TFT Management: Levothyroxine 10-15mg / kg a day
36
Obesity Drug Tx if severe
under 12 BMI > 98th centile, over 12 years = BMI over 30 Presentation: Fat and short = hypothyroid/ cushing Fat + tall = feeding too much Tx: Increase exercise, monitor diet Orlistat if severe obesity
37
Breath holding attack | Age group
Common aged 6 months to 18 months Child upset, stops breathing and turns pale/grey- transient LOC. rapid full recovery DDx = Reflex Anoxic seizure - Sudden pain, deathly grey, syncope, stiff, convulsions. Child wakes up drowsy Management: stay calm and lie on side
38
Epilepsy
``` Tonic = increased tone Clonic = contractions ``` Treatment: 1. Acute = rectal diazepam or Buccal midazolam 2. Sodium Valproate (not when female teenager) 3. Carbamazepine for focal
39
Head injury
``` A-E Immediate CT scan if LOC < 5mins, suspicion of nonaccedental > 3 episodes of vomting amnesia > 5 mins and abnoral drowsiness ``` Tx: secure C spine, decompress, control ICP
40
Hydrocephalus Management
Obstruction of CSF flow CF: large head, buldging fontanelle, fixed downward gaze Ivx: measure head circumference, cranial USS Management: Venticular peritoneal shunt 1st line
41
Migraine Treatment
10% with aura Presentation: pulsating pain, N+V, photophobia, headache on awakening Treatment: 1. Simple analgesia 2. Triptan 3. Domperidone = antiemetic 4. Prophylaxis with B blocker + Pizotifen (antihistamine)
42
Plagiocephaly
Flat head syndrome
43
Tics Tourettes tx?
Twitch like movement 1 in 10 children - presents at 6 years Worse when inactive and dissapears when concentrating Management: ignore the tic, Tourettes - motor and vocal tics Management: Clonidine and Risperidone
44
HAemolytic uraemic syndrome -HUS TRaid? Treatment?
``` Triad 1. Acute renal failure 2. Haemolytic anaemia 3. Thrombocytopenia Most common cause AKI in children ``` CF: Ecoli common cause- Fever, vomiting, weakness + Bloody diarrhoea, liver jaundice Ivx: bloods, anaemia, thrombocytopenia, stool and urine culture Management: report to local authority 1. dialysis and ECULIZUMAB
45
Nephrotic syndrome commonest cause in kids? How to treat this?
- Proteinuria + low albumin and oedema No.1 Cause in kids = minimal change disease CF: oedema, periorbital when waking up Management: hospitlise!!! 1. Fluid restriction and low salt diet 2. PREDNISOLONE 6 weeks 3. Diuretics 4. Penicillin during relapses "mininmal change disease= dont see much change at the start of disease"
46
Impetigo
Golden honey comb crust Due to staph aureus Highly contagious + complicates eczema ivx- skin swab for sensitivity Management: EXCLUSION FROM SCHOOL Avoid itching Topical Fluclox if bullous Non bullous - fusidic acid topic
47
Nappy rash and thrush
Flexures spared!! - Most commonly irritant dermatitis Can cause 2 bacterial or candidial Thrush =. Bright red rash clearly demarcated Satellite lesions beyond border tx: NYASTATIN cream and oral if needed Management: Barrier cream, frequent changing of nappy Severe = leave off nappy for a few days and steroid cream
48
Stevens Johnsons Cf Management
SEVERE erythema multiforme Affects skin, genitals, eyes and mucous membranes CF: prodrome of fever, cough, sore throat Abrupt rash --> widespread blisters and arthralgia Management: ICU or burns unit Hydration and emolient ointment Systemic corticostroids Identify cause (eg penicillin)
49
Developmental dysplasia of hip
Congential dislocation as acetabulum is shallow and doesnt cover hip CF: hip instability, subluxation F>M, must resolve by 9 weeks of birth Found at baby checks Barlow - dislocate and otolani re-locates 6 weeks- 4 months hip USS 4 months + x-ray Management: PAVLICK harness, if doesnt work surgery
50
Irritable hip / reactive arthritis = reiters cant see, pee, climb a tree
Autoimmunue attack on hoiny after GI or GU infection Cause: Chlamydia, Shigella, group A strep rheumatic fever CF: 1-4 weeks after infection develop joint swelling Ivx: raised ESR and CRP, XR normal Management: NSAIDS naproxen Steroids rheumatic fever = penicillnin
51
Juvenille idiopathic arthritis
Under 16 years old- unkknow cause of autoimmune arthritis Oligoarticular > 6 joints, poly 6+ or systemic Cause: Synovium is targeted organ for inflammation CF: swelling, joint pain, morning stiffness IVx: rheumatoid factor, ANA+, ESR, cRP, imaging Management: steroid joint injections, NSAIDs, methotrexate
52
Limping child
RED FLAG = nocturnal pain, redness, swelling, stiffness, weight loss pGals + urgent referral if <3 years or red flags
53
Rickets / vit d deficiency
Cause: low sun exposure, low dietary intake, CKD, medications eg antiepileptics CF: bowing of legs, delayed tooth eruption, progressive knock knees, skull softening, delayed walking Ivx: ALP, phosphate, vit D and ca, u+es Management: oral high dose vit D and Ca, safe sun exposure, diet
54
Autistic spectrum disorder
1. impaired social interaction 2. Global impairment of speech and language 3. Imposition of routines with ritualistic behaviour Ivx: Refer to autism team + multidisciplinary support
55
Blindness
Visual acuity <3/60 in one eye of child <16
56
Deafness
Conductive e,g otitis media Sensorineural eg genetic inherited, preterm, antenatal infection ivx: otoscope and refer
57
``` Developmental delay Sit with support - singles words - walks well - 2 word sentences 6 blocks, 9 blocks ```
red flags - Sit with support 6 months old - singles words 1 years - walks well 18 months - 2 word sentences 2 years 6 blocks 2 years 9 blocks 3 years
58
Anxiety
Syx: hyperarousal, heightened sense of danger, irritable Management: CBT, SSRI and self help
59
ADHD Treatment? Drugs? How often to monitor and why
Impulsivity, Inattention and Hyperactivity Treatment: Behavioural and family counselling - positive reinforcement Educational intervention - involve school Drugs: METHYPHENIDATE = RITALIN - monitor weight and height every 6 months SE: decreased appetite, poor sleep, tics
60
Necrotising Enterocolitis
Common in pre-term and first week, formula fed babies Presentation: Abdo distension, poor temp control, bloody stool, shock Ivx: AXR, CRP, stool culture Treatment; breast milk, If high risk give antenatal corticosteroids + abx prophylaxis --> Nill by mouth, laporotomy resection
61
Henoch Schoelen purpura triad
Arthritis, colicky abdo pain + purpuric rash in boys
62
Delayed puberty 1. Constitutional 2. Hypothalamaic Hypogonadism 3. Hypogonadotrophic Hypogonadism
Absence of puberty develpment by 14 for females and 15 for males 1. Constitutional = family history of delay 2. Hypothalamaic Hypogonadism = low FSH and LH due to chronic ilness eg chrons, malnutrition 3. HypERgonadotrophic Hypogonadism = e.g Klienfelters, turners = high FSH and LH ivx: LH, FSH, serum testosterone and estradiol, TFT Tx: Tesosterone for male to induce sexual development and oestradiol in females
63
Phenyketonuria CF:
Autosomal recessive - Phelyalanine cant be converted to tyrosine present 6- 12 month sold CF: Fair hair, blue eyes and eczema + --> Seizures Musty odour Ivx: Guthrie test + urinalysis. HIGH KETONES in urine Management: dietary change to low phenylalanien + high tyrosine and protein food monitor blood plasma phenylalaine regularly
64
Slapped cheek | dangerous for?
PArovirus Erythema infectiosum Dangerous aplastic crisis in Sickle cell
65
patent ductus arteriosus sound like? | Treat?
Continuous 'machinery' murmur | Treat = indomethacin or ibupofen = anti prostaglandin
66
Croup memory aid
"para" troup | Parainfluenze
67
bronchiolits memory aid
RSV=B
68
7 S of innocent murmer
``` Soft Systolic Short S1+2 normal Standing and sitting variation symtomless Special tests normal ```
69
Dowsn syndrome complicatons - cardiac? others?
``` Cardiac = endocardial cushion defect + VSD - Subfertility - ALL - Alzheimers - HIRSHSPRUNGS - Repeated resp infections ```
70
time frame difference for Henoch-Schonlein purpura, and Post infectious glomerulonephritis?
HSP vasculiis = days after due to igA nephritis | Post infectious = several weeks after infection
71
The first-line antibiotics for necrotising enterocolitis.
clindamycin and cefotaxime
72
age for perthes disease?
under 8 - (i went to perth when i was 8)

4th year Paediatrics (3 decks)

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