Paediatrics Flashcards
What is the most common cause of neonatal infection?
Group B streptococcus = Strep. agalactiae
What are the commonest causes of neonatal jaundice to happen within 24 hours of birth?
- ABO incompatibility (more common, usually milder, DAT positivity, can occur in the first pregnancy)
- rhesus incompatibility (DAT positivity, can’t occur in the first pregnancy)
- G6PD
- sepsis
Early onset: can start in first 24h of life, but also on day 2 or 3
What are the commonest causes of neonatal jaundice to happen within 14 days after birth?
- biliary atresia (conjugated bili)
- breast milk jaundice (unconjugated bili)
Breat milk jaundice treatment: although stopping breastfeeding is the most rapid way to reduce bilirubin levels, in majority of infants, interrupting breast feeding is not necessary or advisable. The baby is usually well and the jaundice subsides by 6 weeks- 4 months
When should a child be referrel for delay in developmental milestones?
- unable to hold objects placed in hand by 5 months
- unable to reach for objects by 6 months
- not sitting by 12 months
- not walking, no speech by 18 months
- unable to put words together by 2 years
- unable to run by 2.5 years
What are the clinchers for cystic fibrosis?
Physiopathology: CFTR gene > abnormal chloride channels in the epithelial cells > abnormal fluid production > increased thickening of mucus > increases chances of pulmonary infections
Screening test: heel prick test
Diagnostic test: sweat test
Lungs and digestive system worsen over time.
Abdominal distention occurs from malabsorption.
Faltering growth if untreated.
Recurrent and persistent chest infections.
Management: chest physiotherapy to cleat the mucous, oxygen if low saturation, antibiotics in acute exacerbation or as prophylaxis in childhood, bronchodilators in patients with reversible component of airway obstruction
Common organisms
- childhood/ early teenage years: Staph aureus
- teenage years/ adult life: Pseudomonas
What is most common cause for eye discharge under 12 months?
Blocked nasolacrimal duct.
Treatment os massaging of the ducts and reassurance.
If a child has purulent discharge with either swelling of the eyelid or an injected conjunctiva, they must be seen in secondary care.
What are the directives for urological imaging in children?
BELOW 6 MONTHS OF AGE:
- USG always during acute infection (within 6 weeks) + MCUG if USG is abnormal
6 MONTHS TO 3 YEARS:
- no image if typical UTI
- USG if atypical UTI (perform during acute infection) or recurrent UTI (perform within 6 weeks)
- DMSA 4-6 months after infection if atypical or recurrent UTI; and consider MCUG for those
ABOVE 3 YEARS
- no image if typical UTI
- USG during infection if atypical UTI
- USG within 6 weeks if recurrent UTI + DMSA 4-6 months after recurrent infection
Remember:
- DMSA to look for renal scarring
- DMSA during an acute infection is always the wrong answer
- MCUG after 3 years old is always the wrong answer
For typical ITU above 3 years old, no scans are required. If patient remains asymptomatic after treatment, a repeat mid-stream urine culture is unnecessary.
Which congenital heart defect is mostly associated with Down syndrome?
Atrioventricular septal defect (systolic murmur)
What to suspect in a child with failure to thrive and iron deficit anaemia?
Poor nutritional intake or coeliac disease
How to calculate fluid ressuscitation?
For severe dehydration, correct with IV fluid (Hartmann’s)
IV bolus 10ml per kg
How to calculate fluid for maintenance?
Holliday-Segar formula:
first 10kg = 100 ml/kg/day
next 10kg = 50 ml/kg/day
remainder = 20 ml/kg/day
To calculate the rate (ml/hour), divide the total amount by 24kg.
In neonates, what are common causes of conductive hearing loss?
Conductive hearing loss: sound waves cannot pass from the outer ear to the inner ear, usually because of a blockage
Effusion from a middle ear infection can result in reduced transmission of sound to the inner ear.
In neonates, what are common causes of sensorineural hearing loss?
Sensorineural hearing loss: lesions in the cochlea or auditory nerve
Ototoxicity from aminoglycosides
Congenital infections such as congenital cytomegalovirus
What are clinchers for epiglottitis?
- rapid onset
- high temperature
- stridor
- drooling of saliva
- difficulty speaking
- muffling or chances in the voice
Summon the most experienced anaesthetist to intubate before obstruction occurs.
What are clinchers for pyloric stenosis?
- epigastric mass / olive-sized abdominal mass
- vomit after every feed
- constipation
Next step of action - serum potassium
Next most urgent investigation - serum potassium
Next step to help diagnose the condition - abdominal US
What mumur is characteristic of persistent ductur arteriosus?
Continuous “machinery” murmur, which is best heard at the left infraclavicular area or upper left sternal border
How to differentiate Von Willebrand disease, haemophilia and DIC?
VWD
- platelet-type bleeding (mucosal bleeding)
- aPTT prolongued
- bleeding time prolongued
Haemophilia
- factor type bleeding (deep bleeding into muscles and joints)
- aPTT is prolongued
DIC
- bleeding everywhere (venepuncture sites, GI tract, ear nose throat, skin: purpura)
- aPTT prolongued
- bleeding time prolongued
- PT prolongued
What are the features of Henoch-Schonlein purpura?
HSP
- purpuric rash
- abdominal pain
- arthralgia
One rare complication is intussusception, which can present as severe abdominal pain with rectal bleeding and fever.
When and how to treat primary enuresis?
Younger than 5y - reassurance
Older than 5y
- infrequent betwetting (less than 2x week) - reassurance
- if long-term treatment required - enuresis alarm (not suitable for patients with daytime symptoms) + bladder training + oxybuynin
- if short-term control required (eg: sleepovers) - desmopressin for 3 months (orally not intranasally)
Referral to secondary care or enuresis clinic if children above 24 months old + primary bedwetting + daytime symptoms
How does TCA overdose present in paediatrics? Which tests should be ordered for investigations and how should it be managed?
Presentation: child who takes unkown bottle of medication and later becomes lethargic
ECG: widened QRS, peaked T waves (indication of hyperkalaemia)
Investigations: urea, electrolytes, toxicology screen, ECG, ABG
Tt: sodium bicarbonate and correction of electrolytes
What are the clinical features and management of GORD?
CLINICAL FEATURES
- gagging or choking during feeds
- recurrent vomiting
- cries shortly after feeds
- faltering growth in severe cases
MANAGEMENT
- trial of thickeners (Carobel)
- alginates (Gaviscon)
- PPI (Omeprazole) for 4 weeks
How to differentiate GORD from cow’s milk allergy?
Milk allergy has additional clinical features, such as loose and frequent stools, perianal redness, blood or mucus in stool, pruritus, urticaria, angioedema
How to diagnose coeliac disease?
TTG IgA (tissue transglutaminase) positive
or EMA (IgA endomysial antibody) positive
plus IgA deficiency positive
if IgA deficiency is negative, request IgG instead
Also: alpha-gliadin antibodies positive
What is secondary enuresis, its causes and management?
Secondary enuresis happens when a child of any age, who has previously been dry for at least six months, is now wetting the bed consistently at night with or without daytime symptoms.
Causes could be emotional upset, UTI, constipation, or polyuria due to diabetes mellitus.
Management is referral to secondary care, for a paediatrician to further investigate.
