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Week 2 paces cases > Paediatrics > Flashcards

Paediatrics Flashcards

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1
Q

Jaundice differentials in a baby

A

Depends on timing
<2days => ABO incompatability or rhesus incompatability
Sepsis

2 days - 2 weeks 
G6PD 
Hereditary spherocytosis
Sepsis
Breast milk jaundice

> 2weeks
Biliary atresia

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2
Q

Causes of failure to thrive

A

Increased energy requirement => chronic issue =>CF, hyperthyroidism

Malabsorption = coeliac

Poor intake/neglect
(ask about school and mental health) or issue with feeding e.g. cleft palate

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3
Q

Features of failure to thrive

A

Crossing growth centiles

Child persistently in the bottom 5th percentile

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4
Q

Investigation and management of failure to thrive

A

Ensure adequate nutrition
Ensure social support and support at school as well as financial support

Ix for any potential Dx = sweat test, anti-TTg, FBC (anaemia), TFTs (hyperthyroidism)

Organic cause in <5%!

Dietician

Regular appointments to check progress

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5
Q

Factors that determine good growth in a child

A 
Adequate intake 
Endocrine levels 
Co-morbidities 
Emotional health (supported child)
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6
Q

Until which age should you correct height/weight etc. for prematurity?

A

2 years old

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7
Q

Whats the cut off for concern for number of centiles crossed?

A

2

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8
Q

By what age should a baby have doubled their original weight?

A

Around 4 months

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9
Q

Average age of puberty in females

A

11

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10
Q

Order of puberty development in females

A

Breast budding
Pubic hair
Menarche

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11
Q

Cut offs for precocious puberty in males/females

A

<8 for females

<9 for males

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12
Q

Causes of precocious puberty

A

Central (most common), just normal puberty happening earlier
Peripheral = intracranial tumour, endocrine tumours e.g. McCune Albright syndrome

Congenital adrenal hyperplasia

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13
Q

Ix for precocious puberty

A

Brain MRI to rule out central tumour
USS of ovaries/testis to assess size + determine if gonadal tumour present
Endocrine levels

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14
Q

Mx of precocious puberty

A

Ix to rule out sinister causes

Give GnRH analogues to delay puberty and help with development and mental health

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15
Q

Causes of delayed puberty

A

Late bloomer (most common, check with hand bone xray)

High gonadotrophin secretion
Kallmans syndrome
Turner’s syndrome

Low gonadotrophin secretion
Pituitary tumour

Systemic issues such as CF or Crohn’s

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16
Q

Definition of delayed puberty in boys and girls

A

No pubertal development by the age of 14 in girls and 15 in boys

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17
Q

Most common cause of delayed puberty

A

Late bloomer

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18
Q

First line tests for delayed puberty

A

Hand xray for bone age

LH and FSH levels to rule out gonadotrophin issues

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19
Q

Symptoms of acute lymphoblastic leukamia (ALL)

A

Any children presenting in GP with bruising, enlarged lymph nodes and systemic illness should be referred for specialist assessment.

Lymphadenopathy is the most common sign in ALL.

Other symptoms which may be present include: hepatosplenomegaly, pallor or petechiae, fever, fatigue, dizziness, weakness, and epistaxis.

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20
Q

Congential disorder that increases the risk of ALL

A

Down’s syndrome

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21
Q

Diagnosis of ALL

A

Firstly do FBC and blood film
Bone marrow biopsy

Remember to screen for coagulopathy

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22
Q

Features of child with bone cancer

A 
FLAWS 
Limp or bone painn 
Ask about pain at NIGHT 
Ask if any signs of trauma 
Rule out NAI
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23
Q

Causes of short stature

A 
Familial 
Delayed puberty (this tends to catch up)
Nutritional 
Chronic illness 
Genetic (Turner's and Down's)
Thyroid issues 
GH deficiency 
Chronic steroid use (e.g. Crohn's or another chronic illness)
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24
Q

Ix for short stature

A

Growth charts (plot mid parental height)
Bloods for FBC, thyroid, CRP, U&E
Imaging of bones

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25
Who should manage children with endocrine issues?
Paediatric endocrinologist
26
How do you calculate predicted height for a boy/girl
Mum + Dad + 13 all divided by 2 for a boy - 13 for a girl
27
DDx or jaundice in a child
Pre-hepatic => haemolysis = G6PD, SCD, AIHA, HUS Hepatic => Gilbert's, hepatitis Post-hepatic => Gallstones
28
Neurological symptoms of jaundice indicate...
Kernicterus
29
Management of jaundice in a newborn
Try to rule out sinister causes of jaundice Plot on a bilirubin chart and use phototherapy or exchange transfusion if severe (very high levels)
30
Symptoms of croup
Viral URTI progressing to barking cough Hoarse cry Inspiratory stridor Respiratory distress in severe cases Symptoms get worse when the child is distressed Fever
31
Most common cause of croup
Parainfluenza virus | Causes tissue swelling and oedema, limiting airflow and causing stridor
32
Signs of respiratory distress
``` Nasal flaring Pursed lips Head bobbing Tracheal tug Intercostal recessions Subcostal recessions Use of abdominal muscles (belly breathing) Frightened look Sweating due to increased work Grunting ```
33
DDx for croup
Croup Bacterial tracheitis (similar but with purulent secretions) Epiglottitis Foreign body (for the stridor)
34
Mx of croup
Admit if <6mo or severe Give wafted O2 Single dose of dexamethasone Nebulised adrenaline
35
What is bronchiolitis?
LTRI infection of infants between 2-6 months old
36
What causes most cases of bronchiolitis?
RSV
37
RF for severe bronchiolitis
Prematurity | Chronic lung disease
38
Typical features of bronchiolitis
Coryzal symptoms (fever, snotty nose and cough) Then get LRTI Sx like dry cough and WHEEZE They go off their feeds Ex shows fine inspiratory crackles, widespread wheeze Fever
39
Dx of bronchiolitis
Nasopharyngeal aspirate for rapid RSV testing incase you want to isolate them
40
DDx for bronchiolitis
Viral wheeze Asthma Pneumonia
41
Mx of bronchiolitis
Usually self-limiting unless signs of severe disease = hydration, antipyrexial meds such as ibuprofen and paracetamol ``` Hospital admission if: Poor feeding (<50% normal), resp distress, low O2 sats, Hx of apnoea, resp rate >70 ``` Mx in hospital = oxygen and NG feeding
42
Definition of pneuomia
LRTI with radiological changes (this is how you differentiate from croup and bronchiolitis)
43
Common causes of pneumonia
S. pneumoniae, H influenzae, S aureus A typical = M pneumonia
44
Diagnoses to consider in an unwell, febrile child
Pneumonia UTI Meningitis
45
Features of pneumonia in infants
``` Cough Fever Preceded by URTI Sx Signs of respiratory distress SPUTUM ```
46
Mx of pneumonia in children
Antibiotics Anti-pyrexials Consider admission if signs of repsiratory distress or low O2 sats
47
Why dont we use aspirin in young children <16yo?
Reyes syndrome
48
Most common cause of epiglottitis
H influenzae
49
Symptoms of epiglottitis
``` Child stooped forward Drooling Dyspnoea Looks toxic High temperature ```
50
Mx of suspected epiglottis
Keep the child calm and give wafted O2 and nebulised adrenline Get the crash trolley Alert senior and anaesthetist as well as ENT Intubate the patient IV antibiotics IV steroids and IV maintenance fluids
51
Features of a viral wheeze
SYMPTOM FREE BETWEEN BOUTS Precipitated by viral infection e.g. coryzal Unpredictable, non-sterotyped response
52
Features of asthma
``` Precipitated by triggers May be wheezy in the interim Responds to B agonist History of atopy Night time cough ```
53
Symptoms of pertussis infection
``` Dry hacking cough Continuous cough Petichae on face Child looks unwell Afebrile ```
54
Mx of pertussis infection
Supportive :(
55
Features of a life threatening asthma infection
``` Hypotension Silent chest Unable to talk Confusion Coma Exhaustion PEFR <33% ```
56
Mx of asthma (chronic)
SILLI
57
Mx of asthma (acute)
``` O2 NEBS IV hydrocortisone or oral pred IV salbutamol (ITU) IV aminophylline ```
58
What is HSP?
IgA mediated vasculitis | Often triggered by preceding strep nfection
59
Features of Henoch-Scholein purpura
Palpable purpuric rash Arthralgia Abdominal pain Renal involvement (nephrotic syndrome)
60
Mx of HSP
Supportive and symptomatic treatemnt = simple analgesia Steroids for any renal involvement
61
Features of a Wilm's tumour
``` Abdominal mass Loss of appetite Weight loss Fever Blood in urine ```
62
Ix for Wilms tumour
Abdominal USS Urine dip Abdominal CT
63
Mx of Wilm's tumour
Surgery on kidneys (very sucessful)
64
Features of IgA nephropathy
``` Sore throat (centor => strep) Few days later -> blood in urine ```
65
Management of IgA nephropathy
ACEi | Supportive
66
Management of post-streptococcal glomerulonephritis
Treat the infection (Abx) | Otherwise supportive unless high BP in which case give ACEi
67
Additional questions to ask in paeds Hx
``` DFIBS Development Feeding Immunisations Birth School and social worker ```
68
Red flags of bedwetting
Headache | They were fine and now bad again
69
Bad causes of bed wetting
Abuse SOL UTI
70
Stepwise Mx of bedwetting
``` Ix Star chart Reduce caffeine and other drinks before bed Enuresis alarm Desmopressin ```
71
Features of SUFE
Limping child Obese Externally rotated leg Frog's leg xray shows disruption of Klein's line
72
Management of SUFE
Bilateral screwing
73
Features of Perthes disease in children
Painful knee/hip Limp X-ray shows avascular necrosis
74
Management of Perthes
<6yo and/or <50% damage = conservative (analgesia and physiotherapy) >6yo and/or >50% necrosis -> operative
75
Red flags of joint pain in children
Fever Weight loss Night pain!
76
Features of transient synovitis
Illness 4-6w ago (usually viral) Now cant see, pee or climb a tree Multiple joints painful
77
Management of transient synovitis
Supportive with analgesia
78
Features of measles infection
Rash that starts on the face and spreads to the rest of the body Koplik spots
79
Features of Scarlet fever infection
``` S Scarlet fever Strep Sore throat Strawberry tongue ```
80
Features of rubella infection
Rubella = fruit juice | Pink rash on the back and torso
81
Features of parvovirus infection
Red cheeks thats warm to touch | Systemically unwell
82
Features of hand foot and mouth infection
Vesicles in mouth, on hands and sole of feet
83
Features of roseola infection
RoseOla | Fever then as it subsides a rash appears thats maculopapular
84
Features of Kawasaki's disease
``` Strawberry tongue Refratory, >5day fever Peeling palms and soles Irritable child Lymphadenopathy Rash is never vesicular ```
85
Ix in Kawasakis disease
Bloods (infective picture) ECG Echocardiogram for coronary artery aneurysm
86
Mx of Kawasaki
High dose aspirin (watch out for Reyes) | IVIG
87
What is Reyes syndrome
Acute encephalopathy and fatty degeneration of the liver | Seen with aspirin Mx in children
88
Features of chickenpox
Caused by VZV Viral prodrome (mild fever, headache, malaise) Pruritic rash thats very itchy, they crust over
89
Features of meningitis
``` Headache Photophobia Neck stiffness Feel very unwell Non-blanching rash ```
90
Complications of chickenpox
Encephalitis Meningitis Bacterial infection e.g. impetigo
91
Risks of chickenpox
Pregnant women Neonates Immunocompromised
92
Ix and Mx for measles
Salivary swab is required to Dx | Mx = supportive
93
Complication of port wine stain on head
Sturge Weber syndrome
94
What is cerebral palsy?
Permanent issue with motor or positional function
95
Causes of cerebral palsy
``` Usually prenatal (ischaemic event) Shoulder dystocia or traumatic birth Seizures Kernicterus Meningitis/encephalitis ```
96
Symptoms of cerebral palsy depend on...
Where the lesion is Cortex -> UMN Lower than cerebellum -> LMN Delayed development Stiff muscles or floppy Persistence of primitive reflexes
97
Types of cerebral palsy
Spastic (most common) damage in the brain leads to say a hemiplegia Dyskinetic = issues with basal ganglia causing poor coordination, hypotonia etc
98
Managment of cerebral palsy
``` MDT Physio Pain management School support Nutrition Spasticity medication ```
99
Features of idiopathic thrombocytopaenic purpura
Viral illness followed by sudden onset of purpura and petichiae in a child Epistaxis Low platelet count Diagnosis of exclusion Must rule out HUS, TTP, DIC, NAI!
100
Mx of ITP
Usually supportive | Can use oral steroids or IVIG if severe bleeding
101
Features of pyloric stenosis
Projectile vomiting Olive shaped mass Still wanting to feed
102
Mx of pyloric stenosis
Dx = abdominal USS ABG shows hypochloaraemic, hypokalaemic metabolic acidosis Supportive until Ramstedt pyloromyotmy
103
Features of DKA
``` Abominal pain Vomiting Diabetes background or features (weight loss, increased urination) Hyperkalaemia Ketonuria High ketones in blood High glucose ```
104
Management of DKA
Fluids until systolic >90 1L over 1 hour 1U insulin / kg / hr Once glucose <14, add dextrose Monitor potassium and correct accordingly Keep monitoring ECG for tented T waves or arrythmia Look out for hypercoagubility
105
Features of T1DM
``` Excess urination Weight loss Dizzy spells Sweet breath Hx of atopy ```
106
Mx of T1DM
Insulin Capillary glucose measurements Regular monitoring and screening with opthal and urine creatinine
107
Features of coeliac disease
``` Weight loss Chronic diarrhoea Dermatitis herpetiformis Failure to thrive Abdominal pain Fatigue Buttocks wasting Angular stomatitis and ulcers (iron deficiency) ```
108
Coeliac disease biopsy features
Villous atrophy and crypt hyperplasia
109
Common anaemia alongside coeliac
Microcytic because of poor iron absorption
110
Auto-antibody in coeliac
Anti-TTG
111
Definitive diagnosis of coeliac disease
Jejunal biopsy
112
DDx for coeliac disease
IBS IBD Pancreatic issues (CF) Lactose intolerance
113
Coeliac disease Mx
Gluten free diet Screening for MALT Iron supplements if needed Dietician involvement
114
Features of neglect/abuse
``` Posterior rib fracture Spiral fractures Retinal haemorrhages Failure to thrive Wetting and soiling Self harm Dishevelled appearance Story not lining up ```
115
Who do you inform if any suspicion of neglect or abuse?
Senior immediately
116
Features of otitis media
Child tugging at ear Fever Distracted and not feeding well Bulging tympanic membrane
117
When should you perform your ENT assessment?
At the end of the examination (can cause distress)
118
Managment of URTI (coryzal, bit of a cough and fever)
Steam inhalation Calpol Lemsip if older
119
Management of otitis media
Analgesia
120
Management of otitis media with effusion
Topical chlorphenamine and oral analgesia
121
Management of ear wax blocked ears
Olive oil drops
122
Features and diagnosis of Hirschsprungs
Delayed passage of meconium | Rectal biopsy shows decreased ganglion cells
123
Features of Down's syndrome during birth and 1st few days
Hypotonia | Poor feeding
124
How can a diagnosis of Down's syndrome be made?
Amniocentesis during pregnancy | Karyotype testing
125
Clinical features of Down's syndrome
Flat nasal bridge Single palmar crease Sandal gap between toes Learning difficulties
126
Conditions you are more likely to develop in Down's syndrome
Leukaemia Cardiac defects Hypothyroidism Alzheimers
127
Most common cardiac defect in Down's
Atrioventricular septal defect
128
Core features of autism
``` Poor social skills Impaired language (e.g. speech delay) Repetitive behaviours (hand flapping, tip-toe gait) ```
129
Features of Asperger's
Retain IQ and language levels
130
Ix for autism
HEARING ASSESSMENT Heel prick looking for metabolic issues such as phenylketonuria Remember that this could just be a normal child, wide variety of personalities
131
Management of autism
MDT BIOPSYCHOSOCIAL Educational support at school SALT Support groups Behaviour analysis Medical = anti-psychotics if the child has repetitive tendency to injury themselves
132
Associated issues with autism
``` Mood disorders Seizures Learning difficulties Anxiety OCD ADHD Hyperactivity Sleep deficits ```
133
Causes of PUO (fever >3w)
Infection (Kawasaki) Malignancy (leukaemia) Rheumatic disease (JIA) Inflammatory (IBD)
134
Causes of neonatal sepsis
E.coli Group B strep Listeria
135
Features of intussception
``` Child crying and off food Bringing knees up to chest Red current jelly stool Colicky pain Vomiting (billous early) Sausage shaped mass in upper abdomen ```
136
Ix of intussception
Abdo USS shows target sign | Contrast enema = gold standard
137
Mx of intussception
NBM IV fluid Air sufflation Analgesia
138
DDx rectal bleeding in child
``` Meckels IBD Cows milk protein intolerance (younger child) Abuse Coagulopathy Anal fissure ```
139
What is epilepsy?
The enduring predisposition for generating unprovoked seizures
140
Dx of epilepsy
>2 unprovoked seizures | >24hr apart
141
What are infantile spasms
West syndrome Poor prognosis, associated with tuberous sclerosis Have Salaam attacks (can be mistaken for colic)
142
DDx for seizure in infants
``` Epilepsy Breath holding spell (injury/upset, hold breath, go blue, collapse, recover quickly) Vasovagal attack Febrile convulsion Encephalitis ```

Week 2 paces cases (3 decks)

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