Paediatrics Flashcards
1
Q
Organism that causes acute epiglottitis
A
Haemophilia influenza B
2
Q
Features of acute epiglottitis
A
High temperature
Generally unwell, toxic child
Stridor
Drooling
3
Q
X-ray sign of acute epiglottitis
A
Thumb sign
4
Q
Management of acute epiglottitis
A
Intubate - call anaesthetist
Secure airways
5
Q
Common organism that causes croup
A
Parainfluenza virus
6
Q
Features of croup
A
Barking cough - worse at night
Stridor
Cold symptoms
7
Q
Croup on X-ray
A
Steeple sign
8
Q
severe croup
Features
A
Inspiratory stridor at rest
Sternal wall retractions
distress/agitation - sign of hypoxemia
Tachycardia
9
Q
Management of croup
A
0.15 mg/kg of ORAL DEXA - regardless of severity
If not available give prednisolone
Severe cases = give oxygen (high flow) and nebulised adrenaline
10
Q
Prognosis of croup
A
Natural resolution - complete recovery
11
Q
Define enuresis
A
Involuntary discharge of urine - day or night or both
+ child >= 5 years old
+ with no congenital or acquired defects
12
Q
Primary vs secondary enuresis
A
Primary - never achieved continence before
Secondary - dry for at least 6 months
13
Q
Management of primary daytime enuresis over the age of 2
A
Refer to secondary care or enuresis clinic
14
Q
Management of primary enuresis w/o daytime symptoms
- < 5 yrs
A
reassure
15
Q
Management of primary enuresis w/o daytime symptoms
> 5 yrs
A
If < 2x/week = reassure
If > 2x/week =
-short term = desmopressin ( camp or child >7)
- long term = enuresis alarm + reward system
(Enuresis alarm first line for children <7)
** if 2 complete courses of treatment dont work = Refer to secondary care
16
Q
Management of secondary enuresis
A
Refer to paediatrician
17
Q
Common causes of secondary enuresis (4)
A
Emotional upset (?abuse)
UTI
DM
Constipation
18
Q
How should the reward system work in enuresis management
A
Reward for agreed behaviour rather than dry nights
19
Q
What happens in reflex nephropathy?
A
Urine goes back from bladder to ureters and kidneys - vesico-ureteric reflux
= dilated pelvicalyceal system -
=Repeated UTIs
= progressive renal failure
20
Q
Cause of reflux nephropathy
A
Occurs mainly in children
Congenital abnormality at insertion of ureters into bladder
21
Q
Diagnosis of reflux nephropathy
- Initial
- Gold standard
- For parenchymal damage
A
Initial = Renal US +urinalysis + C&S
Gold* = MCUG (micturating cystourethrogram)
Damage (cortical scars) - DMSA
22
Q
Treatment of reflux nephropathy
A
1 - low dose antibiotics = Trimethoprim daily
If it fails or there’s parenchymal damage = Surgery (ureter reimplantation)
23
Q
4 cm lateral neck mass not translucent
Dx?
A
Branchial cyst
24
Q
5 cm translucent lateral neck mass
Dx?
A
Lymphangioma
25
Ddx for lateral neck mass
| Lateral = along or near strenocleidomastoid
Branchial cyst
Lymphangioma
Differentiate by translucency
26
3cm *midline* lump
Painless , Mobile
*Moves with tongue protrusion*
Thyroglossal cyst
27
severe croup
| Features
Inspiratory stridor at rest
Sternal wall retractions
distress/agitation - sign of hypoxemia
Tachycardia
28
Management of croup
0.15 mg/kg of ORAL DEXA - regardless of severity
If not available give prednisolone
Severe cases = give oxygen (high flow) and nebulised adrenaline
29
Prognosis of croup
Natural resolution - complete recovery
30
Define enuresis
Involuntary discharge of urine - day or night or both
+ child >= 5 years old
+ with no congenital or acquired defects
31
Primary vs secondary enuresis
Primary - never achieved continence before
| Secondary - dry for at least 6 months
32
Management of primary daytime enuresis over the age of 2
Refer to secondary care or enuresis clinic
33
Management of primary enuresis w/o daytime symptoms
| - < 5 yrs
reassure
34
Management of primary enuresis w/o daytime symptoms
| > 5 yrs
If < 2x/week = reassure
If > 2x/week =
-short term = desmopressin ( camp or child >7)
- long term = enuresis alarm + reward system
(Enuresis alarm first line for children <7)
** if 2 complete courses of treatment dont work = Refer to secondary care
35
Management of secondary enuresis
Refer to paediatrician
36
Common causes of secondary enuresis (4)
Emotional upset (?abuse)
UTI
DM
Constipation
37
How should the reward system work in enuresis management
Reward for agreed behaviour rather than dry nights
38
What happens in reflex nephropathy?
Urine goes back from bladder to ureters and kidneys - vesico-ureteric reflux
= dilated pelvicalyceal system -
=Repeated UTIs
= progressive renal failure
39
Cause of reflux nephropathy
Occurs mainly in children
| Congenital abnormality at insertion of ureters into bladder
40
Diagnosis of reflux nephropathy
- Initial
- Gold standard
- For parenchymal damage
Initial = Renal US +urinalysis + C&S
Gold* = MCUG (micturating cystourethrogram)
Damage (cortical scars) - DMSA
41
Treatment of reflux nephropathy
1 - low dose antibiotics = Trimethoprim daily
If it fails or there’s parenchymal damage = Surgery (ureter reimplantation)
42
4 cm *lateral neck mass not translucent*
| Dx?
Branchial cyst
43
5 cm translucent lateral neck mass
| Dx?
Lymphangioma
44
Ddx for lateral neck mass
| Lateral = along or near strenocleidomastoid
Branchial cyst
Lymphangioma
Differentiate by translucency
45
3cm *midline* lump
Painless , Mobile
*Moves with tongue protrusion*
Thyroglossal cyst
46
Fluctuant lump, transilluminates in the neck ?
Cystic hygroma
47
Management of suspected non accidental injury
Relieve pain + treat underlying medical conditions
** Skeletal survey
Inform local safeguarding
Refer to social services
48
Features of HSP
PAAN
Non blanching purpura+- arthralgia, abdominal pain, nephropathy= hematuria, proteinuria
Purpura - on buttocks and lower limb
Precipitated by URTI
All bloods - normal except raised ESR,IgA,creatinine
49
Osteogenesis imperfecta
- inheritance pattern
- features
- treatment
Autosomal dominant
- collagen metabolism disorder - brittle bone disease
Blue sclera , dental abnormalities , brittle bones
Multiple/explained fractures
Hearing loss 2ry to otosclerosis
Bisphosphonate
50
Management of acute asthma exacerbation children
Oxygen
Salbutamol
Ipratropium bromide
Corticosteroids -Oral pred or IV Hydrocortisone
If still exacerbating consider
- salbutamol IV, IV aminophylline, IV MgSo4
51
Laryngomalacia
Congenital abnormality larynx
| Presents @ 4 weeks of age - stridor
52
```
Watery diarrhoea + weight loss + abdominal pain
Foul smelling flatulence, bloating
Dx?
First line investigation
Another investigation
```
Treatment
Giardiasis
1- stool microscopy for ova and parasite
2- stool ELISA/PCR
Metronidazole and hygiene
53
Diarrhoea followed by RUQ pain
Amoeba
54
Breath holding spells vs reflex anoxic seizures
BHS - turns blue and stops breathing
Mainly 6mo-2yrs , rapid recovery
Reflex anoxic - child stops breathing and turns pale
Upward eye deviation + jerky movements
NO tongue biting
Management is the same for both - reassurance , put child in recovery position
Treat iron deficiency and ferritin if present
55
5 week old baby
Prolonged jaundice with pale stool dark urine liver enlargement and low weight for age
Dx?
Investigation
Biliary atresia
- direct conjugated bilirubin
= surgery
56
8 week baby +prolonged jaundice, yellow stool, pale rune, liver enlargement
Low weight, difficult feeding and vomiting
Dx?
Galactosemia
57
Causes of prolonged jaundice (6)
```
Biliary atresia
Congenital hypothyroidism
Breast milk jaundice
Galactosemia
UTI
Congenital infections - CMV toxoplasmosis
```
58
Congenital hypothyroidism
Features
Treatment
Jaundice, constipation, cold mottled dry skin , floppy,
| Oral levothyroxine
59
Features biliary atresia
Biliary atresia - obstructive jaundice
| = pale urine, dark stool , FTT , hepatomegaly
60
4-8 YO starts walking late
Waddling gait
Raised CK
DMD
61
Initial test for DMD
CK
Then
Muscle biopsy - if + —> genetic testing
Mutated dystrophin in striated muscle
62
Double bubble seen in
Duodenal atresia
| Volvulus and malrotation
63
```
Sudden onset green bilious vomiting in neonate
+ blood per rectum
+ double bubble sign on Xray.
Dx?
Treatment
```
Malrotation and volvulus
ABCDE , NG decompression
Refer to paediatrics surgery for laparotomy and resection
64
Projectile non bilious vomiting approx 30 mins after feed in 3-8 week neonate
Palpable almond sized mass
Pyloric stenosis
65
Dx of pyloric stenosis
Abdominal ultrasound - thickened pylorus
66
Imbalance in pyloric stenosis
Metabolic alkalosis
67
Urgent step in pyloric stenosis
Serum potassium K+
68
Treatment pyloric stenosis
Correct dehydration and electrolytes
NGT
Ramstedt pyloromyotomy
69
Infant (6-18 mo) + crying + paroxysmal abdominal colic pain
+ bloodstained stool = red currant jelly (late sign)
+- sausage shaped mass RUQ
Dx?
Intussusception
70
Finding on abdominal US for intussusception
Target sign / doughnut sign
71
Treatment of intussusception
Mechanical reduction
1st line - air enema insufflation
2nd - reduction by barium enema
If failed - surgical reduction (laparotomy)
72
```
Painless bleeding per rectum in a male child
2-3 YO
Dx?
Investigations:
Initial , definitive
```
Meckels diverticulum
Initial - radioisotope scan
Definitive - laparotomy
73
Treatment of meckels diverticulum
Surgical resection
74
Meckels rule of 2
2-3 YO
Mainly male
2 inches long
2 feet from ileocecal valve
75
Measles
| Features
```
Fever, irritability
Rash - face/neck —> body
Koplik spots on buccal mucosa
URTI
NO cervical lymphadenopathy
```
*measles = rubeola
76
Management of measles
Supportive
Notifiable disease
Reassurance
77
Features of rubella
Low grade fever
Rash - maculopapular (face —> body) ; fades by 3-5th day
lymphadenopathy - suboccipital postauricular
Froschheimer’s spots - soft palate
78
Measles vs Rubella
Measles:
No lymphadenopathy
Spots on BUCCAL mucosa
Rubella:
Lymphadenopathy
Spots on soft palate
79
Roseola
| Features
Sudden high temp
| Non itchy rash chest or legs —> body
80
Erythema infectiousum
Features
Organism
Slapped cheek appearance
| Parvovirus B19
81
Hand foot and mouth disease
Organism
Features
Management
Coxsackie virus
Painful ulcers on tongue + grey blisters on hand and feet
Mgmt
= supportive + reassurance
82
Test for suspected UTI in infants and children >3 months
Urine dipstick
If nitrite + leukocyte - negative - no further management
If + = start ABx, and send urine sample for culture
NICE - clean catch urine sample
83
11 referrals
| - developmental milestones assessment
1. No smile by 8 weeks
2. No eye contact by 3 months
3. Can’t hold object by 5 months
4. Can’t reach for objects by 6 months
5. cant transfer objects between hands by 9 mo
6. cant sit unsupported by 12 months
7. Cant walk by 18 months
8. No single meaningful words by 18 months
9. Only dada and mama by 24 months
10. 2-3 word sentences by 2.5 years
84
At any point of time if a parent is concerned about their speech
Refer for hearing test
85
Tower of 3 age
18 months
86
Tower of 6 age
2 years
87
Tower of 8 with four bricks
2.5 years
88
Draw a line age
2 years
89
Draw circle age
3 years
90
Draws cross @ age
3.5
91
Draw square @
4 years
92
Draw triangle at
5 years
93
Most common organism affecting chest in cystic fibrosis
Staph aureus
| 2. Pseudomonas
94
Inguinal hernia vs femoral hernia
Inguinal - above + medial to pubic tubercle
| Femoral - below + lateral to pubic tubercle
95
Risk factors of inguinal hernia
```
Male
Heavy lifting
Old age
Chronic cough
Previous abdominal surgery
```
96
Treatment of hernia
< 10
>10
<10 - herniotomy
| >10 - herniorrhaphy
97
Obstructive sleep apnoea in children
Next step
Investigation of choice
Refer to ENT surgeons
Polysomnography
98
Rett’s syndrome
Normal development until 2-3 Y
| Regression afterwards - motor social language coordinations
99
Willis ekbom syndrome
| Investigations
= restless leg syndrome
Check iron
- low - give supplements
- normal - give dopamine agonist
100
Diagnosis of Kawasaki
```
Fever + at least 4 of :
Conjunctival injection
Bright red cracked lips
Strawberry tongue
Painless cervical lymphadenopathy
Red palms soles - later desquamation
Polymorphous rash
```
Mnemonic RASH
Conjunctivitis, rash , adenopathy, strawberry tongue , hand foot erythema, burning high fever
101
Complications of Kawasaki
Coronary artery aneurysm
102
Management of Kawasaki
High dose aspirin
| IVIG
103
Initial screening test for coronary artery aneurysms
| In Kawasaki
Echo
104
Why should aspirin use be avoided in children
Reye’s syndrome
| - encephalitis + liver damage
105
Commonest organism causing scarlet fever
Group A strept pyogenes
106
Features of scarlet fever
```
Fever
Sore throat - clincher
Rash - sand paper like rash
= trunk —>body ; no palms or soles
Strawberry tongue
Cervical LNS
Tonsils w/ palate exudates
```
107
Management of scarlet fever
| When can children return to school
Oral penicillin V 10 days
If allergic - azithromycin
24 hrs after start of ABX
Notifiable disease
108
Complications of scarlet fever
otitis media - most common
| Rheumatic fever - typically 20 days after infection
109
Diagnostic imaging for malrotation and volvulus
Abdominal XR - double bubble
| Barium enema
110
Diagnostic imaging for pyloric stenosis
Abdominal US
111
Diagnostic imaging for intussusception
Abdominal US
| - target sign
112
Peripartum exposure to varicella
| Management
Peripartum = 7 days before or after delivery
Give VZIG + isolation
If 8 or more days - observation, advise mum to continue caring for baby
113
Infectivity of chicken pox
4 days before rash appears
| 5 days after
114
When should VZIG be given (3)
Immunocompromised w/ exposure
Pregnant w/ exposure + no VZ antibodies
Newborns with peripartum exposure
115
When shoul acyclovir be given in chicken pox (2)
Immunocompromised w/ chicken pox
| Pregnant w/ CP
116
Management of febrile seizure
<5 mins - antipyretics
| >5 mins - benzodiazepine - buccal midazolam
117
Type of hearing loss in otitis media
CHL
118
Aminoglycoside ototoxicity hearing loss
SNHL
119
Congenital infections cause what type of hearing loss
SNHL
| CMV
120
When should you worry about fever post vaccine
>1 week of fever
121
TCA overdose features
| Immediate action , tx
Dilated pupil ,dry mouth , dry flushed skin , tachycardia
Drowsiness, Hypotension urine retention , wide QRS
ECG monitor
- wide QRS , broad complex tachy
IV NS 250ml + sodium bicarbonate 50 mmol IV slow infusion 8.4%
122
Investigate what delayed milestones
```
No smile 8 weeks
No eye contact 3 months
No holding objects 5 months
No reaching for object 6 months
No transferring objects 9 months
Not sitting unsupported 12 months
No walking 18 months
No meaningful s words 18 months
Only mama dada @ 24 months
No 2-3 word sentences 30 month/2.5 yrs
No running by 2.5 yrs
```
123
Advice for SIDS
Avoid - prone sleeping , parental smoking, parental sedative use at child bedtime , soft bedding
No blanket higher than infants shoulder
No heavy wrapping of baby or head covering
Place baby with feet at foot of cot
Avoid bed sharing
124
Imbalance in severe asthma
Respiratory acidosis
125
Common organism causing bronchiolitis
RSV
126
Features of bronchiolitis
Coryzal + dry cough
Wheezing + fine inspirations crackles
Feeding difficulty
Most common cause of serious LRTI in <1YO
127
Peak incidence of bronchiolitis
3-6 months
128
LN >/= 2 cm
| Steps to be taken
FBC and blood film
| US
129
Causes of lymphadenopathy children
ALL, lymphoma
| CMV, EBV, Kawasaki, TB
130
Pathological jaundice causes
Jaundice in 1st 24 hrs
- Rh or ABO incompatibility
- hereditary spherocytosis
- G6PD
131
Prolonged jaundice screening
Conjugated and unconjugated bilirubin
Coombs test
TFTs
FBC , blood film , U&E, LFTs
132
Child w/ UTI still feverish after start of ABx for 2 days
| Next step
Urgent US or MCUG
If they respond well to ABx - US w/in 6 weeks
133
Preterm baby + continuous machinery murmur
PDA
134
Cyanosis baby with ejection systolic murmur
Tetralogy of Fallot
| Ejection systolic murmur = pulmonary stenosis
135
Tetralogy of Fallot
A
136
Progressive severe cyanosis + poor feeding
| Pan systolic murmur on LSB
Tricuspid atresia
137
Acyanotic pan systolic murmur
VSD
138
Cyanotic heart diseases
```
Truncus arteriosus
TGA
Tricuspid atresia
TOF
Total anomalous pulmonary venous return
```
139
Acyanotic CHD
ASD VSD PDA CoA
140
PDA common in
Preterm babies
| May close spontaneously
141
Diagnosis of PDA
Echo
142
Treatment PDA
Indomethacin
| - inhibits prostaglandin synthesis
143
When to refer for hearing test
```
Any parental concern
Doctor concern
Temporal bone fracture
Bacterial meningitis
Severe unconjugated hyperbilirubinemia
Delayed speech and language milestones
```
144
Hearing test in <6 mo
Otoacoustic emissions or
| Audiological brainstem response
145
6-18 mo hearing test
Distraction testing
146
2-4 years hearing test
Speech discrimination pr
| Conditioned response audiometry
147
>5 years hearing test
Pure tone audio gram
148
Treatment of croup
Dexa - oral
If severe - o2+ neb adrenaline
149
Treatment bronchiolitis
Supportive care
150
Sudden high fever + rash on chest or below
| No rash on head/neck
Roseola
151
Child > 2 YO + bed wetting + daytime symptoms
Refer 2ry care or enuresis clinic
152
Investigation of cushings
- best initial test
- localise lesion
Initial - overnight dexa suppression 1mg
| Localise - high dose dexa suppression 8mg
153
Interpreting dexa suppression test
Low dose:
Cortisol is low = normal
High/normal cortisol = cushings
High:
Low cortisol - Cushing disease —> pituitary MRI
High/normal cortisol + low ACTH - adrenal cushings —> adrenal CT
“” + high ACTH - ectopic ACTH —> CT chest abdomen
154
Cushings
| Syndrome vs disease
Both = increased cortisol
Syndrome - adrenal adenomas, ACTH prod e.g lung ca- small cell lung ca steroid meds
Disease - pituitary tumour - raised ACTH —> adrenal hyperplasia
155
IV fluids for children that cant tolerate orally
Initial bolus - NS
Maintenance - NS + 5% dextrose
NS + kcl if associated hypokalemia
156
Di George syndrome
```
CATCH 22
Cleft palate
Abnormal face
Thymic aplasia
Cardiac - TOF
Hypocalcemia, hypoparathyroidism
22 - chromosomal abnormality on C22
```
157
Hypchloraemic Hypokalemic alkalosis
Pyloric stenosis
158
What is the risk in Ehler danlos syndrome
Subarachnoid hemorrhage
159
Deletion of some genes on chromosome 15
Prader willi
160
Most common congenital heart defect in Down’s syndrome
AVSD
161
Management of 2ry enuresis
Refer to paeds
162
Common cause of 2ry enuresis
Emotional upset
| UTI , DM, constipation
163
Wilson’s disease
- inheritance pattern
- presentation
Autosomal recessive
Cu deposition liver
Hepatosplenomegaly , deranged LFT , Cirrhosis
CNS - Ataxia, dysarthria, dystonia
Behaviour — personality changes , declining school performance
164
Dx of Wilson’s
Initial - LFT + serum CU (very low <0.1)
165
Treatment Wilson’s
Lifelong penicillinamine
| If acute liver failure - liver transplant
166
Alpha anti-trypsin deficiency
| Presentation
Haemoptysis + cough + jaundice
167
Hemoptysis + hematuria
Goodpastures
168
Hematuria after bloody diarrhoea
HUS
169
Hematuria + SNHL
Alport syndrome = x linked
170
Macrophages with periodic acid-schiff granules
Whipples disease
171
+ve anti glial in antibodies
Coeliac disease
172
Peak incidence of nephrotic syndrome
2-5 years old
| Minimal change 80%
173
Features of minimal change disease
```
Nephrotic syndrome
Normal tension
Selective proteinuria - only albumin and transferrin leak through
Renal biopsy - definitive test
= fusion of podocytes
```
174
Raised PTT + bleeding time
VWD
175
Raised PT PTT bleeding time
DIC
176
Normal PT
10-14 s
177
Normal PTT
35-45 s
178
Bleeding time
3-9 minutes
179
Treatment hemophilia A
Desmopressin
| If major bleeding - recombinant factor 8
180
Treatment hemophilia B
Recombinant factor 9
181
What should NOT be given in treatment of hemophilia
NSAIDs
| IM injections
182
Treatment congenital hypothyroidism
Oral levothyroxine until 2 years old
183
ECG - delta waves + wide QRS
Wolff Parkinson white syndrome
184
Bilateral ground glass appearance on neonate xray
RDS
185
RDS vs meconium aspiration
RDS - preterm <32 weeks
| MA - post term >42 weeks
186
Increased risk of meconium aspiration in:
```
Hx of mat HTN
Preeclampsia
Chorioamnionitis
Smoking
Substance abuse
```
187
1st line in VUR management
ABx - low dose trimethoprim daily
If fails or parenchymal damage
= surgery
188
Dx of VUR
Imaging
Initial , gold std , parenchymal damage
Initial - Renal US + urinanalysis
Gold = MCUG
DMSA - cortical scars
189
Salt wasting in infant male
CAH
190
ITP treatment
IV immunoglobulins
191
Treatment HUS
IV fluids +- transfusion +- dialysis
If very severe - plasma exchange
NEVER gibe ABx
192
Echogenic bowel on pre-natal US
Cystic fibrosis
193
Necrotising enterocolitis
- main RF
- features
Prematurity
Increased risk when empirical ABx given to infants beyond 5 days
Vomiting - feeding intolerance, hypoactive, distended abdomen , bloody stools
194
Distended loops + air in bowel on XR
| Dx?
```
Pneumatosis intestinalis
Necrotising enterocolitis (NEC)
```
195
Treatment NEC
TPN + total gut rest
If perforated = laparotomy
Stop feeds + IV fluids + abdominal films +start systemic ABx
196
VACTERL
Vertebral anal cardiac trachesophageal, renal, limb defects
197
GORD presentation in children
```
< 1 yo
Non projectile vomiting after feeds
Gags, chokes after feeds
Crying, difficult to feed
FTT - severe GORD
```
198
Treatment of GORD paediatrics
Assess breastfeeding, increased frequency and decreased amount
Gaviscon - try this 1st
Then PPI H2
199
APGAR
*Appearance*
0 - blue/pale 1- acrocyanosis (blue extremities pink body) 2- pink all over
*Pulse*
0-absent 1- <100 2- >100
*Grimace*
0- no response 1- grimace on aggressive stimulation/suction 2- cry cough sneeze on stimulation
*Activity*
0- floppy 1- some limb flexion 2- active
*Respiration*
0- absent 1- weak irregular gasping 2- strong robust cry
0-3 = very low score
4-6 moderate low
7-10 = good state
200
Breast milk jaundice
Features
Management
Starts in 2nd week of life
Increased Unconjugated bilirubin
Infants are well
Advise mother to continue breastfeeding - disappears in 6 weeks
201
p-ANCA +ve + intermittent bloody diarrhoea + weight loss + abdominal pain
Ulcerative colitis
P anca - specific in Churg Strauss but can be + in UC
202
Innocent Murmur
Children 3-8 YO
Due to turbulent blood flow at the outflow tract of the heart
More evident in fever and in supine position
Benign/ physiologic
203
Cow milk allergy
- acute
- delayed
Acute - igE mediated
So assess cow milk protein allergy - skin prick test / blood test
Delayed -
Non igE mediated
Change to hypoallergenic formula
204
Commonest cause of early-onset neonatal infection
Streptococcus agalactiae (GBS)
205
Investigation of pyloric stenosis
Abdominal ultrasound
206
Recommended dose for children above 1 YO
| VIT D
400 IU = 10 mcg per DAY
207
Bimodal age presentation Hodgkin’s lymphoma
<25 YO or >55 YO
208
Organism causing HFMD
Coxsackie A16 and enterovirus 71
209
Infantile spasm / west syndrome
| Features
1st 4-8 months of life
M>F
Flexion of head trunks and arms —> extension of arms
Progressive mental handicap
210
Investigation west syndrome
EEG - hypsarrythmia
| CT - diffuse/localised brain disease e.g tuberous sclerosis
211
Management of infantile spasms
1- vigabatrin
ACTH
Poor prognosis
212
Imaging in child with UTI
<6mo
- responds to treatment
- atypical/recurrent UTI
```
- responds to Tx = UD in 6 weeks
Atypical or recurrent
= US in acute infection
DMSA 4-6 mo after infection
MCUG
```
213
Imaging in child with UTI
>6mo - <3yrs
- responds to treatment
- atypical/recurrent UTI
RTT - nothing
Atypical - US now , DMSA after 4-6 months
Recurrent - US in 6 weeks, DMA “^”
214
Imaging in child with UTI
>3 yrs
- responds to treatment
- atypical/recurrent UTI
RTT - no imaging
Atypical - only US now
Recurrent - US in 6 weeks, DMSA 4-6 months
215
Diagnostic criteria - whooping cough
Acute cough <14 days w/o apparent cause + 1 or more :
- paroxysmal cough
- Inspiration whoop
- Post tussive vomiting , central cyanosis
- undiagnosed apnoea can attacks - young infants
216
Dx of whooping cough
Nasal swab culture of bordetella pertussis
217
Management whooping cough
< 6 months old - admit , notifiable disease
Oral macrolides - clarithromycin , azithromycin, erythromycin if onset of cough is within the last 21 days
Prophylaxis for household contacts
School - 48 hrs after starting ABx or 21 days from onset if no ABx given
218
Complications of whooping cough
Subconjuctival hemorrhage
Pneumonia
Bronchiectasis
Seizures
219
When is pertussis vaccine offered to pregnant women
20-32 weeks
| Influenza + DPT vaccine
220
Umbilical granuloma management
Signs of infection - fusiliers acid
| No signs - table salt 1st line , silver nitrate 2nd line
221
Subclassifications of osteomyelitis
Haematogenous
= bacteriuria - monomicrobial - children commonly
Most common = vertebral osteomyelitis
Non haematogenous
Spread from soft tissue to bone - poly microbial - adults -
RF- diabetic foot/pressure sores, PAD
Staph aureus except SCA = salmonella
222
Investigations osteomyelitis
MRI
223
Management osteomyelitis
Flucloxacillin 6 weeks
| Clindamycin - penicillin allergic
224
IV fluid resuscitation - paeds
Mod - severe dehydration = IV NS bolus over <10 mins
- term neonate = 10-20 ml/kg
- children + young people = 20 ml per kg
* small vol of fluid in underlying cardiac and renal problems
225
When does lymphadenopathy require urgent referral (paeds)
Firm and non tender
Hard
Progressively enlarging
>2cm
226
2 types of flat head syndrome
Plagiocephaly - flattened on 1 side (asymmetrical)
| Brachycephaly - back of head becomes flattened
227
Dysgraphia
Deficiency in the ability to write
228
What team do you refer a child with writing difficulty
Educational psychologist
229
Management of ITP
Prednisolone
IV immunoglobulins
Admit to paediatric ward
Platelet transfusion if life threatening bleed
230
Management ophthalmia neonatorum
Reassure or
Refer 2ry care if purulent discharge + swelling of lid or injected conjunctiva
Chlamydia - erythromycin orally
Gonorrhoea - ceftriaxone IV
231
Important cause of seizure in afebrile child
Hypoglycemia
