Paediatrics 2 Flashcards by H JP

Whooping cough aka
Gram +ve or -ve

Features (4)
How long can symptoms last
What can be seen on bloods?

Pertussis - bordetella pertussis
Gram negative

2-3 days of coryzal symptoms
Coughing bouts, worse at night and may end in vomiting
Inspiratory whoop
Apnoea
Symptoms can last 10-14 weeks
Lymphocytosis marked

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Mx whooping cough
<6 months
When would you give abx?
Which abx?
Who else should be offered abx?
School exclusion

Admit
If onset of the cough is within the previous 21 days
Clarithro
Household contacts
48 hours after starting abx or 21 days from onset of sx if no abx

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Eye test at
Birth
6 weeks
3 months

Red reflex
Fix and follow to 90 degrees
Fix and follow to 180 degrees

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Eye test at
12 months
>3 years
>4 years

Pincer grip
Letter matching test
Snellen charts

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Diagnostic testing for vesicoureteric reflux
What investigation can be done to check for renal scarring?

Micturating cystourethrogram
DMSA to check for renal scarring (4-6 months post infection)

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How may VUR present? (3)

Hydronephrosis antenatally
Recurrent UTIs in childhood
Reflux nephropathy

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UTI mx
< 3 months
> 3 months with an upper UTI
> 3 months with a lower UTI

Refer to paeds
Consider admission OR PO cephalosporin/ coamox for 7-10 days
Local guidelines usually trimeth or nitro

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Investigation for children with UTIs
<6 months
>6 months

<6 months with first UTI should have an US within 6 weeks
>6 months first UTI which responds to treatment DOES NOT require imaging unless features of an atypical infection

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Complications of undescended testis (3)

Infertility
Torsion
Testicular cancer

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Mx undescended testis
Unilateral versus bilat
When to refer
When to operate

Unilateral
Refer from 3 months of age
Orchidopexy at 1yo

Bilateral - review within 24 hours

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When do umbilical hernias normally resolve by?
Associated with? (2)

Age 3
Afro-Caribbean
Down’s syndrome

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Turner’s syndrome features (4)
Chromosomal
What is the most common renal abnormality?
Gonadotrophin levels will be?

Webbed neck
Short stature
Wide spaced nipples
Primary amenorrhoea
45X0

Horseshoe kidney
Raised

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Perianal itching
Although 90% have no symptoms at all
=
Ix
Mx (2)

Threadworm
Enterobius vermicularis
Apply sellotape and send tape to check for eggs

Mebendazole if >6 months
+ all members of the household

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When does primary tooth eruption typically begin?
When does it usually end?

6 months
2.5yo

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Teething mx (2)

Chewable teething rings
Simple analgesia

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SIDS
Most common at what age?

Name five major RF

3 months

Prone
Parental smoking
Prematurity
Bed sharing
Hyperthermia

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Non major RF for SIDS (5)

Male
Multiple births
Social class IV and V
Maternal drug use
Winter

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Illness according to age
<6 months
6months-3yo
2-6yo

Bronchiolitis
Croup
Acute epiglottitis

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Slipped capital femoral epiphysis
Position of leg

Loss of internal rotation
Leg flexed
Displacement of femoral head postero-inferiorly

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What is plagiocephaly?
What is craniosynostosis?

Parallelogram shaped head
Premature fusion of the skull bones

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Erythematous rash with coarse yellow scales
Scalp, nappy area, face, limb flexures
=

Mx
Mild-mod
Severe

Usually resolves by what age?

Seborrhoeic dermatitis

Mild-mod baby shampoo and oils
Severe mild topical hydrocortisone

8 months

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School exclusion
Rubella

5 days from onset of rash

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School exclusion
Scarlet fever

24 hours after started abx

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School exclusion
Whooping cough

48 hours post commencing abx
OR
21/7 from onset of symptoms

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School exclusion Measles

4 days from onset of rash

School exclusion Chickenpox

Lesions have crusted over

School exclusion Mumps

5/7 fron onset of swollen glands

School exclusion D&V

48 hours post sx have settled

School exclusion Impetigo

48 hours post commencing abx OR Until lesions are crusted and healed

School exclusion Scabies Influenza

Until treated Until recovered

Scarlet fever is caused by which organism? Age

Group A haemolytic strep (strep pyogenes) 2-6yo

Features of scarlet fever (6) Describe the rash and location

Fever 24-48 hours Malaise, headache, N&V Strawberry tongue Sore throat Fine punctate erythema (pinhead) first on the torso sparing the palms and soles

fever: typically lasts 24 to 48 hours malaise, headache, nausea/vomiting sore throat 'strawberry' tongue rash fine punctate erythema ('pinhead') which generally appears first on the torso and spares the palms and soles flushed appearance 'sandpaper' texture

Scarlet fever

Scarlet fever Mx (2)

PO penicillin V 10/7 Azithro if pen allergic

Scarlet fever complications (2)

Otitis media Glomerulonephritis (10 days after infection)

Rotavirus Type of vaccine How many doses and when?

PO vaccine, live attenuated x2 doses at 2 and 3 months

Roseola infantum is also known as Caused by Age range School

Sixth disease HHV 6 6 months to 2 years No exclusion needed

High fever for a few days Then a maculopapular rash Nagayama spots on uvula and soft palate Febrile convulsions

Roseola infantum

Average age of retinoblastoma AD/AR Features (3)

18 months AD Absence of red reflex Replaced by a white pupil Strabismus (squint)

Projectile vomiting, typically 30 mins after a feed Constipation and dehydration Palpable mass in upper abdomen = What age group? Ix Mx

Pyloric stenosis Second to fourth weeks of life US Ramstedt pyloromyotomy

First sign of puberty in males and females:

Testicular growth Breast development

Definition of precocious puberty

Development of secondary sexual characteristics before Age 8 in females Age 9 in males

Classification of precocious puberty:

Gonadotrophin dependent (due to premature activation of hypotha-pit-gonad axis) Raised FSH, LH Gonadotrophin independent (due to excess sex hormones) FSH & LH low

Classification of wheeze

Episodic: only with an URTI Multiple trigger wheeze: many triggers

Mx episodic wheeze (2)

1. SABA or SAMA via a spacer 2. Intermittent LTRA or INH steroids

Mx multiple trigger wheeze (2)

INH steroids or LTRA 4-8 weeks

Phimosis mx

Expectant Unless over 2yo with recurrent balanoposthitis or UTI where treatment can be considered

AR Fair hair, blue eyes Learning difficulties Musty odour to urine and sweat Seizures Developmental delay

Phenylketonuria

Mx Perthe's disease (3)

Cast/ braces If <6yo: observe Older: surgical

Risk of Down's with increasing maternal age Age to risk 20-45

20 1500 30 800 35 270 40 100 45 50

Eczema in children Typically presents before what age Infants affected location Younger children Older children

<2yo Infants: face and trunk Young: extensor surfaces Older children flexor surfaces

Mx eczema children (4)

1. Emollients 2. Topical steroid (emollient first and wait 30 mins) 3. Wet wrapping 4. PO ciclosporin

When to refer a child with epistaxis?

Under the age of 2yo

Epstein's pearl mx Location

Spontaneously resolve over the course of a few weeks Common on hard palate but can also be on the gum

Age for febrile seizures

6 months to 5 years

When to admit a child with seizures to paeds?

First seizure OR Features of complex seizure

Features of a complex febrile seizure (3) Length of time Type of seizure Number within 24 hours

15 mins - 30 mins Partial >1 in 24 hours

RF for developing epilepsy following febrile seizures (3)

Complex seizure BG neurodevelopmental disorder FH of epilepsy

Tachypnoea Age 6-12 months >12 months

>50 >40

Tachycardia <12 months 12-24 months 2-5yo

>160 >150 >140

If history is suggestive of an IgE mediated allergy what investigation can be offered? If hx suggestive of non-IgE mediated allergy what can be offered?

Skin prick test or IgE antibodies Eliminate allergen for 2-6 weeks and then reintroduce

What is Freiberg disease? Seen in which group of people? Usual location Features (3) Mx (3) How long can recovery take?

Metatarsal avascular necrosis Tall, athletic females 2nd metatarsal Pain, swelling, stiffness Activity limitation, analgesia, casts/boots 1 year

Age of onset of GORD Mx (5)

<8 weeks 1. 30 degree head up 2. Sleep on back 3. Smaller and more frequent feeds 4. Thickened formula trial 5. Gaviscon

When can a PPI be used in GORD? (3)

If any one of the following: 1. unexplained feeding difficulties 2. distressed behaviour 3. faltering growth

Mx head lice (3)

If living lice are found: 1. Malathion 2. Wet combing 3. Dimeticone

How to diagnose a migraine without aura?

A >= 5 attacks fulfilling the below criteria: B Lasts 4-72hours C At least x2 of: 1. Frontal/ temporal 2. Pulsating 3. Mod-severe intensity 4. Aggravated by physical activity D At least one of: 1. N&V 2. Photophobia/ phonophobia

Mx migraine (2) SE of 2nd line management

1. Ibuprofen 2. >12yo can offer triptans (nasal spray sumatriptan only) SE: tingling, heat, heaviness, pressure

How to diagnose a tension type headache

A at least 10 previous headache episodes B 30 mins -7 days C at least x2 of: 1. Pressing/ tightening 2. Mild - moderate intensity 3. Bilateral 4. No aggravation by physical activity D Both of the following: 1. No nausea/vomtiing 2. No photophobia

What age does infantile colic occur? Worse at what time of day? Characteristic features (2)

3 months old Evening Bouts of excessive crying, pulling up of legs

When do infantile spasms occur? (age)

4-8 months

When do infantile spasms occur? (age) What does an EEG show? Mx (2)

4-8 months Hypsarrhythmia Vigabatrin + ACTH

characteristic 'salaam' attacks: flexion of the head, trunk and arms followed by extension of the arms this lasts only 1-2 seconds but may be repeated up to 50 times progressive mental handicap

Infantile spasms

Mx laryngomalacia (1) When does it normally resolve by? What can you do for symptomatic relief?

Resolve spontaneously by 18-24 months Symptomatic relief by hyperextending neck Surgical intervention rare

Inspiratory stridor : high-pitched and crowing. This is usually intermittent, occurring in the supine position e.g. when the child lies on its back, when feeding or when agitated Symptoms increase in severity during the first 8 months but tend to resolve by 18-24 months Respiratory distress, failure to thrive and cyanosis are rare =

Laryngomalacia

problems with micturition including pooling in the vagina on examination thin semitranslucent adhesions covering the vaginal opening between the labia minora are seen, which sometimes cover the vaginal opening completely = Mx (3)

Labial adhesions Conservative If associated with repeat UTIs then topical oestrogen Surgery

Typically an erythematous rash which involve the flexures and has characteristic satellite lesions = Mx

Candida dermatitis Mx topical imidazole (do not use barrier cream)

The most common cause, due to irritant effect of urinary ammonia and faeces Creases are characteristically spared =

Irritant dermatitis

Erythematous rash with flakes. May be coexistent scalp rash =

Seborrhoeic dermatitis

Mx nappy rash

1. Disposable nappies 2. Expose area to air 3. Apply barrier cream 4. Mild steroid cream

Measles features (7)

Irritable Conjunctivitis Fever Koplik spots (white spots on buccal mucosa) Rash starting behind the ears then maculopapular rash Becomes blotchy and confluent Sparing of palms and soles

Complications measles (4)

Otitis media Pneumonia Encephalitis Febrile convulsions

Mx of contacts of measles

If not immunised then should be offered MMR within 72 hours

Age of onset GORD Infantile colic Pyloric stenosis Febrile seizures Infantile spasms

GORD <8 weeks Infantile colic 3 months Pyloric 2-4 weeks of life Febrile seizures 6 months - 5yo Infantile spasms 4-8 months