Paediatric Flashcards by V Nr

Eczema herpeticum
Sx

Seen > in atopic/asthma
Monomorphic widespread VIRAL infection commonly herpes

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Nephrotic syndrome

Hypoalbuminemia
Hypercholesterolemia
Oedema

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General approach for hematuria

Dipstick»Urinalysis»urine culture»rft»asotcomplement»USG

All based on initial result, mngt differ according to the scenario

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Transient Tachypnea of Newborn

•Early onset, delayed fluid clearance from lung,lasts 4-6hrs
Features of resp distress, grunting, nasal flaring, ICR,SCR
•Improvement with O2 support

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TTN vs RDS

RDS worsen after 48-72hrs
Due to surfactant deficiency

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Bed wetting
Age

Daytime Continence acquired by 3 yrs old
Night time Continence by 6 yrs old

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SVT (narrow complex) with stable hemodynamic status
Age wise

<6mth: face immersion in cold water
>6 mth : icepack applied on the face
School aged: blow the thumb 10-15sec/ syringe after full inspiration ( child must look strained)
Valsalva fails: IV adenosine

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SVT in shock

Synchronised DC cardioversion

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Wide complex tachycardia
Aka SVT with aberrancy

IV amiodarone

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Acute mastoiditis

•Complication of acute otitis media
•post auricular swelling and redness
• initial step: culture swab
• commence abx : flucloxacillin + 3rd gen cephalosporin

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Next step after abx in acute mastoiditis

CT scan
Hearing assessment during convalescent period

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Cut-off for overweight and obesity
WHO

85th-96th centile
>97th centile

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Neck mass approach (if lymphadenopathy)

Watchful waiting 6 weeks if reactive lymph node
+ red flags need prompt action
If no red flags : FNAC

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Painful limbs , bilateral,> at night, but gait is normal and no tenderness elicited by movement

Growing pains

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Acute epiglottitis

Acute,sudden onset sore throat, dysphagia,drooling of saliva, tripod posture, expiratory stridor

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Acute epiglottitis airway mngt

Severe:Bag mask ventilation 100% O2
Endotracheal intubation (smaller tube)
If fail: surgical cricothyroidotomy
For child < 8 yrs: needle cricothyrotomy

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Lymphadenopathy
Anterior vs posterior ∆

Anterior: USG
Posterior: FNAC
Look into other associated factors as well

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Perthes disease

Idiopathic AVN femoral head
4-10 yrs old
Hip pain radiating to knee, painless limp
Limited IR & Abduction
Xray serial
Scottish Rite brace initial Rx
If fails—- osteotomy

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Acute rheumatic fever
∆
2 major / 1 major+ 2 minor
+
Presence of GAS
SPECS
FEP

Major: Polyarthritis, Erythema marginatum, Sydenham chorea, Subcutaneous nodule,Carditis
Minor: fever, ESR>30, PR interval prolonged

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Recurrent ARF criteria

2 major or 1 major + 2 minor or 3 minor
+
GAS infection

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Vulvovaginitis in child

FB (MCC) : blood with foul smelling
Threadworm: a/w itchiness
Sexual abuse

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Thyroglossal duct cyst
Most common complications

By order:
1. Infection
2. Malignancy

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Enuresis ( after age of 6)

Initial test: urinalysis and USG
Enuresis alarm
Vasopressin
TCA

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Most common AGE virus

Norovirus
Self limiting
PCR if needed but not necessary

Overweight centile child with normal height centile

TSH Prior to that, diet, parents obesity all taken into consideration

MCC of Acute mastoiditis and acute otitis media

Streptococcus pneumoniae

Language delay

> 24 months is a concern

1° encopresis Vs 2° encopresis

1°: never been continent 2° : previous continent MCC: constipation with overflow incontinence, attitude issues: conduct disorder/oppositional defiant disorder

Regression SX? Cause?

SX:Baby talk, thumb sucking, enuresis Cause? Sexual abuse, parental separation

Patient with arrested Tanner 2 stage

•Bone age determination 1st •Xray of Left Wrist and Left Hand done •Bone age can differentiate actual age vs Turner syndrome

MCC of pubertal delay

Constitutional delay

Anaphylactic reaction Adrenaline dose

O2 1st 0.2ml adrenaline 1:1000 deep IM

Vertigo in child

•Always suspect CNS tumor or epilepsy, needs specialist opinion •EEG or CT scan

Hypertrophic pyloric stenosis

•Non bilious vomiting, within 30 mins after feeding •2mth-6mth age •Epigastric mass •Hypochloraemic metabolic alkalosis

Marfan Syndrome Murmur findings?

AR : 3 different murmurs Decresendo murmur Austin Flint Functional systolic murmur

Marfan Syndrome Organs involved? Autosomal? Best ix?

Heart ❤️, skeleton 🦴, eyes 👀 Autosomal dominant Cardiac Echo

Wheezing in child Algorithm ? Rx:

Determine HX Sudden or insidious Unilateral or bilateral Family HX Rx: if sudden, suspect FB or aspiration.. admit and O2 therapy Insidious: neb salbutamol to see wheeze or early asthmatic or other causes

Neuroblastoma

Common in early age < 2 yrs old Extra cranial: non tender mass palpable

Wilms tumor

Median age: 3.5 yrs Large smooth mass does not ❌ cross midline, non tender Hematuria+ hypertension MCC

UPJ obstruction

√ Intermittent flank pain √ Nausea and vomiting √ Hydronephrosis+/- √ USG during painful episodes diagnostic if Urinalysis and culture are normal *Intermittent kinking causes pain due to obstruction

Duration of school exclusion for Measles

Patients with established measles should be excluded until 4 days after the onset of rash.

ITP

Diagnosis by exclusion NO specific test Mild , asymptomatic: rest Mild bleeding: steroid Mod : ivIg Severe: splenectomy

ITP platelet transfusion

If platelet<10,000

Painless rectal bleeding in child btw 2-8 yrs old

Juvenile colonic polyps

Retinoblastoma Ix ? Initial? Best?

Initial: USG: intraocular calcification Best : MRI

Croup SX + signs Rx

1-3 yrs ;Tachypnea,brassy cough, inspiratory or biphasic stridor Mild/Mod/Severe Mild: early r/v Mod: neb Budesonide or oral steroids Severe: neb Adrenaline+ steroids

Pertussis Phase? Ix? Rx?

1. Catarrhal/paroxysmal/convalescent Infectivity upto 21 days 2. Nasopharyngeal aspirate Serology igA

Contact of pertussis mngt

Vaccine within 21 days of contact

Question 42-50

Pertussis must do

Language delay MCC

Hearing impairment

Orofacial MCC

Genetic : sporadic/familial Others: Drugs Smoking Alcohol Folic acid Maternal DM and obese

Noonan Syndrome

Hypertelorism, amblyopia Downslanting lateral eye Ptosis Low set ear Webbed neck Heart

DDH

Barlow's: telescopic Otolani: palpable clunk/jerk Not 🚫 click

VUR Long term abx

Low dose 1/4 or 1/3 abx dosage continuous!!!

Transposition of Great Arteries

MCC cyanosis heart disease Classical cyanosis happens as the ductus arteriosus begins to shut after the 1st cry. No murmur Immediate surgery

Failure to thrive (FTT)

The most common cause of failure to thrive is inadequate caloric intake.

Asymptomatic microscopic hematuria with fever

• Repeat UA once fever settles • repeat urine analysis over next 2 weeks( 2 out of 3 + ) needs detail evaluation

SIADH in children causes