Paediatrics 3 Flashcards by H JP

Abdominal pain
Rectal bleeding
Intestinal obstruction
=

Meckel’s diverticulum

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Meckel’s diverticulum Ix (1)
Mx

Meckle’s scan - 99m technetium pertechnetate
Mx surgery

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Mx meningitis
<3 months
>3 months

IV amoxi/amp + IV cefotaxime
IV cefotaxime/ceftriaxone

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Consider dexamethasone in meningitis if LP shows? (4)
What age group does not get steroids?

Children <3months do not get steroids
Consider dexamethasone if LP shows:
1. Frankly purulent CSF
2. WCC >1000
3. Raised WCC with protein >1
4. Bacteria on Gram stain

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If suspected meningococcal septicaemia treat with:
Dose
<1 year
1-10yo
>10yo

IM/ IV benpen
300mg
600mg
1200mg

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Mitochondrial diseases are passed on via mother or father?

What might you see on muscle biopsy?

Mother
Red, ragged fibres

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CI to MMR (3)
How long should pregnancy be avoided for post MMR?

Immunosuppression
Allergy to neomycin
Children who have received another live vaccine by injection within 4 weeks

4 weeks

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Painless limp =

Juvenile idiopathic arthritis

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Paeds BLS
Ratio lay versus non lay
How many rescue breaths?

30:2
If non lay x2 then 15:2
5 rescue breaths

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Rate for chest compressions
Depth
How does compressions differ for children and infant
What is the difference between a child and an infant (age)

100-120/min
depth: depress the lower half of the sternum by at least one-third of the anterior–posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child)

in children: compress the lower half of the sternum
in infants: use a two-thumb encircling technique for chest compression

<1, 1-puberty

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Mx SUFE (2)

Bed rest + non weight bearing
Percutaneous pinning of the hip

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Cherry red lesions surrounding the umbilicus
Bleed on contact
Seropurulent discharge
=
Mx

Umbilical granuloma
Mx chemical cautery + silver nitrate

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Umbilical discharge of small bowel content

Persistent vitello-intestinal duct
Surgery

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Urinary discharge from umbilicus

Persistent urachus

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Infection of the umbilicus

Common bacteria

Omphalitis
Staph Aur

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Paraumbilical hernia vs umbilical
Which is more likely to resolve spontaneously?

Umbilical (12months to 3 years to resolve)

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Left subclavicular thrill
Machinery murmur
Bounding, collapsing, large volume pule
Wide pulse pressure
Heaving apex beat

Patent ductus arteriosus

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PDA
Mx

Indomethacin OR ibuprofen

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PDA RF (3)

Premature
High altitude babies
Maternal rubella infection in the first trimester

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Gold standard diagnostic test for Hirschsprung’s disease
1st line Ix

Rectal biopsy
AXR

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Mx Hirschsprung’s disease (2)

Rectal washouts
Surgery

Neonatal sepsis mx

IV benpen + gent

When can abx be ceased in neonates?

At 48 hours if CRP <10

Define nephrotic syndrome triad

Proteinuria >1g/m2
Hypoalbuminaemia <25
Oedema

Peak incidence age for nephrotic syndrome Most commonly is

2-5yo Minimal change glomerulonephritis

Features of intussusception (6) Age Gender

Drawing knees up Turn pale Vomiting Red currant jelly Sausage shaped mass in RUQ Abdominal colic pain M>F 6-18months

Intussusception Ix (1) Mx (2)

USS - target like mass Reduction by air insufflation Surgery

Most common cause of hypothyroidism in children:

Autoimmune thyroiditis

Medial knee pain due to lateral subluxation of the patella Knee may give way

Patellar subluxation

Athletic teenage boy Chronic anterior knee pain Worse after running Tender below patella on examination

Patella tendonitis

Pain after exercise Intermittent swelling and locking

Osteochondritis dissecans

Sporty teenagers Pain, tenderness and swelling over tibial tubercle

Osgood Schlatter

Softening of cartilage of patella Teenage girls Anterior knee pain on walking and down stairs and rising from prolonged sitting

Chrondromalacia patellae

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics conjunctival injection bright red, cracked lips strawberry tongue cervical lymphadenopathy red palms of the hands and the soles of the feet which later peel

Kawasaki disease

Mx Kawasaki (2)

High dose aspirin IV immunoglobulin

When to intervene with obesity in children? When to assess for co-morbidities? Hint: centile

> 91st centile >98th centile

RF for obesity in children (3)

Asian children Female Taller children

Name five conditions that can cause obesity

Hypothyroidism GH deficiency Down's Cushing's Prader-Willi

Majority of children achieve day and night time continence by what age?

3/4yo

Define enuresis Difference between primary and secondary

Involuntary discharge of urine by day or night in a child 5 or more Primary - has never achieved Secondary - dry for at least six months

Mx enuresis (5) 1. Name three causes 2. & 3. General advice 4. 1st line therapy 5. Medication

1. Look for cause e.g constipation, UTI, DM 2. Fluid intake, toiletting patterns 3. Reward systems 4. Enuresis alarm 5. Desmopressin

Jaundice 24 hours 2-14 days >14 days

24 hours pathological Common and usually physiological Abnormal

Causes of jaundice in the first 24 hours (4)

Rhesus haemolytic disease ABO haemolytic disease Hereditary spherocytosis G6PD

Causes of prolonged jaundice (6)

Biliary atresia (raised conjugated bilirubin) Hypothyroidism Galactosaemia UTI Breast milk jaundice Prematurity

How to check what the correct cuff size is when measuring BP in children?

2/3 of upper arm

Fine, fair hair Marfanoid body habitus Leaning difficulties Severe myopia Increased risk of VTE Malar flush Livedo reticularis = Mx

Homocystinuria B6 pyridoxine supplements

What is Still's murmur?

Low pitched sound heart at the lower left sternal edge Innocent murmur

Characteristics of an innocent ejection murmur (5)

Soft blowing murmur in pulmonary area or aortic area Vary with posture Localised, no radiation Asymptomatic child No added sounds

Hearing tests: Newborn Infants 6-9 months

Otoacoustic emission test Auditory Brainstem Response test Distraction test

Hearing test 18 months- 2.5yo >2.5yo (2) >3yo

Recognition of familiar objects Performance testing + Speech discrimination testing Pure tone audiometry