Paediatrics Passmed Flashcards
Key points to consider in sexual abuse
Adults do not often believe child’s allegations
Higher incidence in children with special needs
30% father
15% unrelated man
10% brother
Features of sexual abuse
Pregnancy STIs, recurrent UTIs Sexually precocious behaviour Anal fissures, bruising Reflex anal dilatation enuresis and encopresis Behavioural problems e.g. self-harm Recurrent symptoms e.g. headache, abdo pain
Complications of Kawasaki disease
Coronary artery aneurysm
Features of Kawasaki disease
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 soles of the feet which later peel
Diagnosis of Kawasaki disease
Clinical diagnosis as there is no specific diagnostic test
Management of Kawasaki disease
High-dose aspirin (Kawasaki disease is one of the few indications for the use of aspirin in children because of Reyes syndrome)
IVIG
Echo to screen for coronary artery aneurysms
Acute scrotal disorders in children, and when they are most common?
Torsion- most common around puberty
Irreducible inguina hernia- <2 years old
Epididymitis - rare in prepubescent children
Is pyloric stenosis more common in M or F?
Incidence of 4/1000 live births
4 times more common in males
10-15% of infants have a positive family history
First-borns are more commonly affected
Features of pyloric stenosis
Projectile vomiting, typically 30 minutes after a feed
Constipation and dehydration may also be present
A palpable mass may be present in the upper abdomen
Hypochloremic, hypokalaemic alkalosis due to persistent vomiting
Diagnosis and management of pyloric stenosis?
Ultrasound
Management with Ramstedt pyloromyotomy
Fraser guidelines are used to assess if a patient <16 is competent to consent to treatment: what are these guidelines?
the young person understands the professional’s advice
the young person cannot be persuaded to inform their parents or allow the professional to contact them on their behalf the young person is likely to begin, or continue having, sexual intercourse with or without contraceptive treatment unless the young person receives contraceptive treatment, their physical or mental health, or both, is likely to suffer the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent
Risk factors for Surfactant deficient lung disease
Prematurity (risk decreases with gestation) Male Diabetic mother C-section Second born of premature twins
Clinical features of surfactant deficient lung disease
tachypnoea
Intercostal recession
Expiratory grunting
Cyanosis
CXR characteristically shows ground-glass appearance with an indistinct heart border
Management of surfactant deficient lung disease
Prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
Oxygen
Assisted ventilation
Exogenous surfactant given via endotracheal tube
Risk factors for developmental dysplasia of the hip
Female sex (6 times greater risk) Breech presentation Positive family history Firstborn children Oligohydramnios Birth weight >5kg Congenital calcaneovalgus foot deformity
DDH is slightly more common in left hip; 20% bilateral
Who is offered screening for developmental dysplasia of the hip?
All infants are screened at both the newborn check and also the six-week baby check using the Barlow and Ortolani tests
Require a routine ultrasound examination if:
First-degree family history of hip problems in early life
Breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
Multiple pregnancy
Clinical examination of developmental dysplasia of the hip
Barlow test: attempts to dislocate an articulated femoral head
Ortolani tests: attempts to relocate a dislocated femoral head
Symmetry of leg length
Level of knees when hips and knees are bilaterally felxed
Restricted abduction of the hip in flexion
US used to confirm diagnosis if clinically suspected
Management of DDH
most unstable hips will spontaneously stabilise by 3-6 weeks of age
Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months older children may require surgery
What percentage of childhood leukaemias are accounted for by ALL?
Around 80%
Peak incidence arat 2-5 years of age and boys are slightly more commonly affected than girls
Clinical features of ALL
Features may be divided into those predictable by bone marrow failure:
(Anaemia: lethargy and pallor
Neutropenia: Frequent or severe infections
Thrombocytopenia: easy bruising, petechiae)
And other features:
(Bone pain secondary to bone marrow infiltration
Hepatosplenomegaly
Fever in up to 50% cases (representing infection or constitutional symptoms)
Testicular swelling)
Types of ALL
Common ALL, CD10 present, pre-B phenotype (75%)
T-cell ALL (20%)
B-cell ALL (5%)
Poor prognostic factors for ALL
Age <2 years or >10 years WBC> 20x10^9/1 at diagnosis T or B cell surface markers Non-Caucasian Male sex
What mutation is responsible for achondroplasia?
Autosomal dominant disroder associated with short stature, caused by a mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene. This results in abnormal cartilage, which gives rise to clinical features
Clinical features of achondroplasia
Short limbs (rhizomelia) with shortened fingers (brachydactyly)
Large head with frontal bossing and narrow foramen magnum
Midface hypoplasia with a flattened nasal bridge
Trident hands
Lumbar lordosis
Risk factors for achondroplasia
Mostly sporadic mutations
Main risk factor is advancing parental age at the time of conception
Treatment for achondroplasia
No specific therapy, though some individuals benefit from limb lengthening procedures (usually involve application of Ilizarov frames and targeted bone fractures)
Who are most commonly affected by intussusception?
Usually affects infants between 6-18 months old
Boys are affected twice as often as girls
Features of intussusception
Paroxysmal abdominal colic pain- during paroxysm the infant wil characteristically draw their knees up and turn pale
Vomiting
Bloodstained (redcurrant jelly) stool is a late sign
Sausage-shaped mass in the RUQ
Investigation and management of intussususception
US is now investigation of choice and may show a target-like mass
Majority of children can be treated with reduction by air insufflation under radiological control, which is now widely used first-line compared to traditional barium enema
If this fails, or the child has signs of peritonitis, surgery is performed
Criteria for severe asthma attack in children
SpO2 <92%
PEF 33-50% best or predicted
Too breathless to talk or feed
Heart rate >125 (>5years) or >140 (1-5 years)
Respiratory rate >30/minute (>5 years) or >40 (1-5 years)
use of accessory neck muscles
Criteria for life-threatening asthma attack in children
SpO2 <92% PEF <33% best or predicted Silent chest Poor respiratory effort Agitation Altered consciousness Cyanosis
What are the commonest causes of epistaxis in children?
Nose picking (most common cause)
Foreign body
URTI
Allergic rhinitis
What are the constituent elements of the Apgar score?
Pulse Respiratory rate Muscle tone Colour Reflex irritability
What is the main feature of choanal atresia?
Posterior nasal airway occluded by soft tissue or bone
Associated with other congenital malformations e.g. coloboma
How do babies with choanal atresia present?
Babies with unilateral disease may go unnoticed
Babies with bilateral disease will present early in life as they are obligate nose breathers
How to treat choanal atresia?
Feenstration procedures designed to restore patency
NICE recommendations for diagnosing obesity in children?
NICE recommend considering tailored clinical intervention if BMI at 91st centile or above, and consider assessing for comorbidities if BMI at 98th centile or above
Risk factors for obesity in children
Asian children are four times more likely to be obese than white children
Female
Taller children
Causes of obesity in children
Growth hormone deficiency Hypothyroidism Down's Cushing's Prader-Willi
Consequences of obesity in children
Orthopaedic problems: slipped upper femoral epiphyses, Blount’s disease (a development abnormality of the tibia resulting in bowing of the legs), musculoskeletal pains
Psychological consequences: poor self-esteem, bullying
Sleep apnoea
Benign intracranial hypertension
Long-term consequences: increased incidence of type 2 diabetes mellitus, hypertension and IHD
Which organisms cause meningitis in neonates-3 months?
Group B strep: usually acquired from the mother at birth; more common in low birth weight babies and following prolonged rupture of the membranes
E.coli and other Gram -ve organisms
Listeria monocytogenes
Which organisms cause meningitis in 1 month-6 year olds?
Neisseria meningitidis
Strep pneumonia
Haemophilus infleunzae
Which organisms cause meningitis in children greater than 6 years?
Neisseria meningitidis
Strep pneumoniae
What type of organism is the measles virus?
RNA paramyxovirus
How is measles spread?
Droplets
Infective from prodrome until 4 days after rash starts
Incudbation period = 10-14 days
Clinical features of measles infection
Prodrome: irritable, conjunctivitis, fever
Koplik spots (before rash): white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind the ears and then to whole body, discrete maculopapular rash becoming blotchy and confluent
Investigations for measles infection
IgM antibodies can be detected within a few days of rash onset
Management of measles infection
Mainly supportive
Admission may be considered in immunosuppressed or pregnant patients
Notifiable disease –> inform public health
If a child not immunised against measles comes into contact with measles then MMR should be offered (vaccine-induced measles antibody develops more rapidly following natural infection)- this should be given within 72 hours
