Flashcards in Paediatrics 2 Deck (137):
In kids, what 2 inhaled mediations are typically used together as preventers? Which one is started first?
Inhaled corticosteroids and inhaled LABA
Start with the corticosteroid
What can be used after LABA in preventing asthma attacks, particularly in younger kids?
Leukotriene antagonists (montelukast)
Or occasionally oral aminophylline
What is a nebuliser used for?
Acute attacks of e.g. Asthma, when oxygen is needed alongside inhaled medication
Management of acute asthma in kids?
Oxygen + everything possible short acting bronchodilator (consider neb) + oral pred
IV hydrocortisone (-> intensive care)
IV salbutamol and aminophylline
What medications are commonly used in pneumonia management in kids?
When does epiglottitis most commonly occur?
2-8 year olds
Most common causative organism of epiglottitis historically? What about now?
Now more common to be strep pneumoniae, GAS etc.
Presentation of epiglottitis?
Sore throat, odynophagia, drooling (can't swallow secretions)
Ant neck tenderness over hyoid
What features indicate severe epiglottitis?
Dysphagia and dysphonia
Gold standard diagnostic for epiglottitis?
Fibre optic laryngoscopy
Most common complication of epiglottitis?
Describe the use of PEFR in asthma investigations?
Do mornings and evenings (diurnal variation)
Observe day-day variation
And do in response to treatment (bronchodilator)
If you suspect epiglottitis what must you absolutely not do?
Stick a tongue depressor in
What factors of a gastroenteritis suggest a bacterial cause?
Severe abdo pain
What situations should increase index of suspicion for dehydration in kids with gastroenteritis?
Infants under 6m or low BW
Unable to take extra fluids
How is dehydration ideally investigated in kids?
Body weight change over course of illness; less than 5% is not clinically dehydrated, 5-10 % is clinical dehydration and >10% is shocked
Features which indicate dehydration in a child?
Look unwell, altered consciousness
Reduced urine output
Reduced skin turgor, dry mucus membranes
Sunken eyes and fontanelles
Features which indicate severe dehydration/shock in a child?
Features of dehydration + increased CRT, cold peripheries and mottled skin, weak pulses, hypotension, grossly sunken eyes
General principles of ORT in gastroenteritis in kids?
Avoid anti-diarrhoeals, Abx may be necessary if septic
If dehydrated and able to take oral fluids, ORT solution for maintenance and rehydration
If severe or unable to take oral, IVT rapid infusion followed by deficit and maintenance
What is impetigo?
Staph (occasionally strep) infection in skin causing honey-coloured crusting via vesicles/pustules/bullae rupture
RFs for impetigo?
Preexisting skin stuff e.g. Eczema
Can kids with impetigo go to school?
No - not until lesions are cleared and dry
Signs of orbital cellulitis?
Painful eye movement
Reduced visual acuity
Causes of petechial/purpural rash and fever in kids?
Meningococcal sepsis or other bacterial
HSP and other vasculitis
Entero-or other viruses
Viral causes of macropapular rashes + fever in kids?
HHV 6/7 (Roseola)
Slapped cheek (PVB19)
Bacterial causes of maculopapular rash + fever in kids?
Scarlet fever (GAS)
Erythema marginatum (rheumatic fever)
Salmonella typhi (typhoid rose spots)
Lyme disease (erythema migrans)
Non-infective causes of a maculopapular rash in kids?
3 viral causes of vesicular rash in kids?
Coxsackievirus - hand foot and mouth
Bacterial causes of vesicular rash in kids?
Boils and furuncles, carbuncles
Scalded skin, toxic epidermal necrolysis
Differentiating factors between nappy rash and thrush in kids?
Thrush may be present elsewhere e.g. Mouth, has satellite lesions, may have exudate and may appear in creases
What lesions are pathognomic of measles?
Koplich spots - White lesions in mouth
Symptoms of measles?
Coryzal, conjunctivitis, coughing
Diffuse MP rash and Koplich spots
'Hives' - itchy, blotchy skin (inflammation of superficial skin)
Central White papule (wheal) surrounded by erythematous flare
Can precede angioedema
What can HSV 1 and 2 cause in kids?
As well as cold sores, can cause gingivostomatitis
Describe progression of chicken pox?
Papules appear day 0
Typically start crusting after 5 or 6 days
May be fluctuant fever and coryza
Progression of lesions in chicken pox?
Macule -> papule -> vesicle -> pustule -> crust
Complications of chickenpox?
What infection does EBV most classically cause?
What virus is implicated in Burkitts lymphoma?
Common differential for measles and rubella?
Roseola infantum (HHV 6/7)
3Cs of measles? Other Sx?
Cough coryza conjunctivitis
MP rash and koplichs spots
Sx of mumps?
Fever, malaise, coryza
Parotitis - unilateral->bilateral
What blood result may be present in mumps? If associated with abdo pain what might be going on?
Can cause pancreatitis
What complication may arise from the parotitis associated with mumps? Other major complications?
Transient unilateral hearing loss
Orchitis (mumps orchitis)
Features of rubella?
Major importance in congenital infection
Otherwise mild illness associated with non-itchy MP rash (like measles)
Describe the rash in rubella?
Maculopapular (ddx for measles, Roseola)
Non-itchy in kids
What is transient tachypnoea of the newborn?
Presumed retained lung fluid which causes tachypnoea amongst other symptoms in the newborn lasting 1-2 days
Major RFs for transient tachypnoea of the newborn?
Slightly preterm infants delivered by CS
CXR findings for transient tachypnoea of newborn?
Prominent pulmonary vasculature
Fluid in fissures
What is neonatal respiratory distress syndrome?
Combo of lack of surfactant and structural lung immaturity in preterm infants
Leading to tachypnoea, tachycardia, increased respiratory effort etc.
CXR findings of NRDS?
Reduced chest volume, ground glass appearance, air bronchograms
Prevention and management of NRDS?
Prevention is maternal steroids before 34 weeks
Management is CPAP and other respiratory support
What is meconium aspiration syndrome?
Meconium passed into amniotic fluid in response to Fetal distress/hypoxia and then aspirated by fetus causing respiratory distress
RFs for NRDS?
Indications of meconium aspiration syndrome?
Yellow-green amniotic fluid
Low APGAR scores
Findings and CXR/ABG findings indicating meconium aspiration?
Crackles in chest
Hyperinflation, patchy atalectasis
In what babies is meconium aspiration more common?
Over 40 weeks
What is the likely cause of respiratory distress in a newborn at 41 weeks with yellow-green amniotic fluid?
2 likely differentials for tachycardia at preterm gestations?
What is meconium ileus?
Meconium sticky and creates obstruction in lower GI tract
What disease is meconium ileus suggestive of?
What is hypoxic ischaemic encephalopathy?
Evidence of asphyxia-related brain injury in neonates
2 common causes of hypoxic ischaemic encephalopathy?
Systemic hypoxaemia secondary to respiratory distress etc.
Reduced cerebral blood flow
Symptoms of severe hypoxic ischaemic encephalopathy?
Stupor/coma, loss of pupillary reflexes
Hypotonia and absent primitive reflexes
Symptoms of mild hypoxic ischaemic encephalopathy?
Transient hypertonia and brisk reflexes
Signs of moderate hypoxic ischaemic encephalopathy?
Hypotonia and diminished reflexes
Absent primitive reflexes
Apnoeas and mild seizures
Why is neonatal hypoglycaemia common?
Neonates have large glucose demand and poor glucose regulatory mechanisms
RFs for neonatal hypoglycaemia split into causes?
Decreased glucose - IUGR, prem, inborn errors of metabolism
Increased insulin - maternal DM
Increased requirements - hypothermia, sepsis, NRDS
Misc - hypothyroidism, polycythaemia, CNS stuff
What is hirschprungs disease?
Aganglionic bowel segments which therefore can't relax, meaning meconium cant be passed and leading to obstruction
When should meconium have been passed?
Most by 24 hours
Definitely by 48 hours
Gold standard investigation for hirschprungs?
Suction rectal biopsy
Other than failure to pass meconium, features suggestive of hirschprungs?
Greeny brown vomit
Obstruction - distension, flatus
Explosive bloody stools post PR
Management of hirschprungs?
Surgically resect the aganglionic segment, followed by reanastamosis
What chromosomal abnormality is linked to hirschprungs?
Aetiology of enlarged adenoids?
Recurrent or chronic infection e.g. EBV
Allergies and irritants
When are the adenoids largest? When have they significantly atrophied by?
Largest age 5ish, atrophy by age 7 and normally gone by teenage years
Symptoms of enlarged adenoids?
Recurrent sinusitis, OM, OME etc.
Difficulty nose breathing, instead mouth breathing
Snoring, sleep apnoea and noisy breathing
Investigation for suspected enlarged adenoids?
Flexible fibre optic nasopharyngoscopy
Management of enlarged adenoids?
Can try steroids and stuff, might end up whipping them out along with tonsils
What is used to screen for hearing abnormalities in the newborn?
EOAE (evoked otoacoustic emission)
How does visual acuity change in newborn? When is it like that of adults?
Starts off poor
Adult by about 3 years
Eye positional problem 'normal at birth'? When should this by gone by?
Squint - gone by 12 weeks
When does a palmar grasp arise?
When should lost body weight at birth be gone by?
When do motor problems manifest in kids?
Within first 18 months
When do speech and language problems manifest in kids?
Around 18m to 3yrs
When do social and communication problems manifest in kids?
Up to what age can brain injury potentially cause cerebral palsy in kids?
When are temper tantrums normal in kids?
When should kids have grown out of temper tantrums?
Around 5-6 years
1-2-3 approach to temper tantrums?
Ask child to stop and tell them what you want to do
Warn them what will happen if they don't stop
Describe autistic spectrum disorders?
Pervasive developmental disorders which are lifelong
3 categories of ASD required symptoms?
Difficulty with social interaction
Difficulty with behaviours, interest and activities
What 3 other disorders are common with ASDs?
When does ADHD usually manifest in kids?
3 criteria of ADHD?
Management approaches to ADHD?
Behavioural, social support
Meds e.g. Methylphenidate (Ritalin)
Side effects of Ritalin (methylphenidate)?
Insomnia (give melatonin)
What personality disorder are kids with conduct disorder at 50% risk of growing into as an adult?
5 common causes of false positives for CF sweat test?
False negative for CF sweat test?
2 breathing techniques for CF in kids? 1 for older kids?
Percussion and postural drainage
Forced expiration techniques
Symptoms of cardiac failure in kids?
SOB, trouble feeding, sweating, recurrent chest infections
Signs of cardiac failure in kids?
FTT, tachycardia, tachypnoea, cyanosis, heart murmurs, cardiomegaly, cool peripheries, hepatosplenomegaly
3 Hs of serious causes of constipation in kids?
Management of childhood IBD?
Elevated diet (amino acids)
Avoid steroids long term
When and in whom does pyloric stenosis present?
6-8 week males
Electrolyte disturbances in pyloric stenosis?
Dehydration and hyponatraemia
Hypochloraemic, hypokalaemic metabolic alkalosis
What features of history in kids make cows milk intolerance more likely than GORD?
What tests are used in kids for cows milk protein intolerance?
RAST tests (Ab to food proteins)
Jejunal biopsy - eosinophils in lam prop
When and in whom does intussusception present?
5-12 month males
What is nocturnal enuresis?
Nighttime bed wetting
What must you exclude to make transient synovitis diagnosis in acutely limping kids?
What is West Syndrome? When does it peak?
Infantile spasms - clusters of head nodding, arm jerks every 3-30 seconds
Peaks around 5m
Meds first line for absence seizures?
What is the presumed mechanism of stillbirth?
What test is used for haemolytic disorders in little kids?
3 reasons for physiological jaundice?
Increased bilirubin production from neonatal blood cell breakdown
Decreased bilirubin excretion due to liver immaturity
Immature gut flora
What is SIDS?
Unexplained death in infants less than 1 year old, peak 1-4m
3 preventative measures for SIDS?
Don't sleep prone - sleep supine
Don't smoke around kid
5 things that might make you think of NAI in kids?
Odd, incongruent or inconsistent history
Unusual mode of injury or presenting features
Presenting late to different doctor having missed routine appts
Non-parental adult presents with kid
Where are bruises common in toddlers?
Forehead, shins (learning to walk)
When are bruises in kids unusual?
Weird places e.g. Back, face, buttocks
Patterns e.g. Hand grip marks, specific objects, slap marks
If they are in immobile babies
Causes of NAI head injuries in kids?
Shaking - causes apnoea, hypoxic ischaemic damage
Subdurals or haemorrhages
What fractures are almost always due to NAI in kids?
Rib fractures, particularly posterior
Things that are suggestive of accidental burn rather than NAI burn?
Asymmetrical, flexure sparing, splash marks etc.
3 phases of whooping cough?
Catarrhal (1-2 weeks URTI)
Paroxysmal (cough typically around 1m, whoops)
Convalescent (chronic cough for 2 weeks)
Early Sx of tetanus?
Trismus (jaw locking) - muscle spasms in jaw
Worsening spasms in all muscle groups
What type of vaccine is the DTaP?
What does polio cause?
Headache, myalgia, generally unwell
And acute onset flaccid paralysis and areflexia in one limb (LMNL)
What does neonatal GH deficiency cause?
Followed by FTT after 6-12 months
When should a kid be able to say their 1st and 2nd names?
When should a kid be counting to 10 and beyond?
Clinical features of hypothyroidism/cretinism?
Hypotonia, coarse facial features/big tongue, hoarse cry, dry skin, hypothermia, prolonged jaundice, umbilical hernia, short stature, developmental delay/learning difficulties, constipation
Delayed ant font closure
What characterises Kwashiorkor?
Severe protein deficiency (too many carbs) leading to chronic diarrhoea and abdominal distension, oedema, tight skin/funny coloured hair, irritability and anorexia
What characterises Marasmus?
Total calorie malnutrition leading to emaciated appearance with no abdominal dysfunction