Paeds Flashcards by Hamish Reed-Embleton

Breastmilk jaundice can last until? Rx?

Up to 12 weeks
Phototherapy if above the treatment line

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2 types of criggler-naijarr

Type 1 - severe and will lead to bilirubin encephalopathy + brain damage
2 - less severe

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Colicky abdo pain, constipation, vomiting, headache, drowsiness + papilloedema

Lead poisoning
-> GI symptoms and raised ICP

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Severe vomiting and GI bleed, then CV compromise and drowsiness

Iron toxicity

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2 week old suddenly drowsy with tense fontanelle. Raised PT on bloods? Why has this happened and who does it usually happen to?

Intracerebral haemorrhage due to vit K deficiency
-Lack of vit K in breast milk. Doesn’t occur in bottle-fed as fortified

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Life-threatening asthma exacerbation pneumonic

CHEST
Cyanosis
Hypotension
Exhaustion
Silent chest OR spO2 <92%
Threatening peak flow <33%

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BTS asthma steps

SABA (if infrequently needed) + Low dose ICS
-Add LABA
-Add LTRA (or increase ICS)

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Most common hearing loss in children. When does it occur? Usual Rx?

Otitis media with effusion (glue ear)
Usually following acute otitis media
Monitor - usually resolves in 6-12 weeks (may then need referral)

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Difference between Otitis media with effusion and Chronic suppurative otitis media ? Extra risk of?

Inflammation present in CSOM
-Risk of cholesteatoma

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Bed wetting in kids ix? when management? When pharma

Urine culture/dip
-Also check for psych issues Eg school performance

Not until at least 6
Can use alarms/star charts

Could use intranasal desmopressin if off to friend’s house for sleepover etc

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Cyanosed newborn with oligaemic lung fields

Pulmonary atresia
-Need to maintain open PDA

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Tetralogy falot what are the bits

Overriding aorta
VSD
R ventricular outflow tract obstruction
-> RVH (Boot shaped heart)

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Perthes disease in who? What is it and how does it present?

Boys 3-10
AVN of the femoral epiphysis
Gradual onset limp / pain (may be Knee pain as referred)

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Who gets SUFE and what is it? Rx?

Teenage obese boys
Fracture through growth plate -> leg length discrepancy / limp / groin pain
Surgical Rx to prevent permanent deformity

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6-9m most common cause of GI obstruction

Intussusception (red jelly poo)

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Hypertropic pyloric stenosis presents at what age with what

3 weeks
Vomiting + olive mass in abdo

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GI obstruction and ‘double bubble’ on XR in neonate

duodenal atresia

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Meconium obstruction 1st line rx

Radiocontrast enema

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Unconjugated hyperbilirubin in first 24hrs

Haemolytic disease - usually ABO incompatibility

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Well newborn has progressive conjugated hyperbilirubin with pale stools and dark urine

Biliary atresia

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Jaundiced at birth with microcephaly and abdo distention with organomegaly ? When else microcephaly

CMV infection
Microcephaly also in rubella / toxoplasmosis

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5m irritability, cyanosis and episodes of LOC
CXR - right-sided aortic arch + oligaemic lung fields

Tetralogy of fallot

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When is tachy really tachy in <5

> 140

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Colicky Abdo pain in ‘paroxysms’ with sausage-shaped mass in RUQ

intussusception
- Especially <1yr

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Teenage girl monthly pain has worsened this month. No constipation. preg negative. Palpable mass in lower abdo

Haematocolpus (retained blood during menstruation. -Usually due to abnormality eg imperforate hymen

Viral illness and now crampy Abdo pain and tenderness on palpation

Mesenteric adenitis [often mistaken for appendicitis]

9m spasmic abdo pain, vomiting and bloody stools

Intussusception

<1 wheeze, cough, fever, tachypnea =

Bronchiolitis

6y painless limp XR - flattened and fragmented femoral head

Perthes = AVN [XR may be initially normal]

Infantile colic rx

Can keep upright after feeds -Gaviscon / others not first line and no evidence base

Normal age range - heart rates

<1: 100-160 1-2: 100-150 2-5: 95-140 5-12: 80-120 >12: 60-100

Poisoning - GI symptoms and raised ICP / haemolysis

Lead

poisoning - tachycardia, hallucinations, breathing difficulty

tricyclics

poisoning - drowsy vomiting and jaundice

paracetamol

posioning - tinnitus, acidocis and hypoglycaemia

salicilates

Vomiting and GI bleed -> drowsy and CV collapse

Iron

Who needs the US of hips as a newborn for DDH and by when? Rx?

Any breech presentation after 36 weeks -can screen with Barlow / Ortolani US within 6 weeks Palvik harness

Pyloric stenosis acid base typical? Rx?

HypoK, HypoCl metabolic alkalosis Ramsted's pyloromyotomy

Rockerbottom feet? Which genetic?

Edwards Triosmy 18

Key blood test duchennes? Diagnosis?

CK MPLA [genetic testing if above not conclusive]

Key new drug for duchennes ? What does it do? In who?

Ataluren - restores the synthesis of dystrophin Children >5 who can still walk

When refer straight to paeds with a child with fever?

if under 3m and fever needs referral

Croup bug? Rx?

Parainfluenza 0.15mg/kg oral dex -Second line budenoside nebuliser +/- neb adrenaline

Child complains episode of tingling LIPS/mouth. May get twitching of face / drooling / disturbed speech?

Benign rolandic epilepsy

Maternal age for chance of downs 1:100

40 20= 1:1500 30= 1:800 35 = 1:270

Double bubble on xr? linked to?

Duodenal atresia Downs

Baby / maternal risk factors for SIDS

Prone sleeping, winter, respiratory Sx Young, high parity, smoking

22q11 deletion called?

DiGeorge [absent thymus, hypoCa/PTH]

Severe exacerbation asthma PO2? RR? PEFR? HR?

PO2 <92% RR >30 PEFR 33-50% HR >125

Sickle cell Abdo pain, hyperSpleen, anaemic with raised reticulocyte and jaundice = Assoc with? Differentiate to aplastic crisis on bloods?

Splenic sequestration crisis [infarcts in spleen] Parovirus b19 Aplastic crisis = low reticulocytes

Abdo pain and obstruction in sickle cell

Girdle mesenteric syndrome

Turner-like syndrome

Noonan

Most common cardiac defect in fragile X

Small tongue which is pushed back and micrognathia

Pierre-robin

When oral rehydration solution in kid with normal obs and exam who has D&V?

Vomit >2x in 24hrs Diarrhoea >5x in 24hrs Age <1year

What mediates cows milk protein allergy?

IgE [Remeber this can occur in breast fed if mum drinking cows milk]

Which vaccines MUST be given 4 weeks apart

Yellow fever + MMR/Varicella

Insidious onset of limping child with sore hip? What is it?

Perthes disease Avascualr necrosis of femoral head

Kid with sore jount with Fine rash with raised ESR and normocyctc normochromic anaemia ? Rx?

Juvenile idiopathic arthritis [Rash often salmon pink] Nsaids -> dmards

3 year old painless limp with asymmetric hip creases

Developmental dysplasia of the hip

Kid with swellings in neck and armpits that are not painful

NHL (It's more common than hodgkins)

Flat light brown skin patches and visual issues?

Neurofibromatosis - optic glioma causes visual issues

Most common Haem malignancy in kids

ALL [There's Loads]

Kid with stridor working hard 1st line rx

Nebulised adrenaline

6m with wheeze and crackles, subcostal ressession and been snuffly for couple days =? 1st line rx

Bronchiolitis O2 [No evidence for salbutamol]

Kid with headache -> cough and now patchy intisicial unilateral pneumonia rx?

Clary [Headache -> pneumonia is leigonella ]

Kids absence epilepsy 1st line? 2nd?

Ethosuxamide Valproate

Cardiac abnormalities and immune issues + hypocalcaemia ?

Di George syndrome Hypoparathyroidism -> hypoCa

Sort stature, overly friendly with cardiac abnormalities and a little bit slow

William syndrome

When is peak age for febrile convulsions? Usual cause? Risk of epilepsy?

18 months Viral infections. 2% risk epilepsy

Croup name? UsuL cause?

Laryngotracheobronchitis Parainfouenza virus

Usual cause of acute epiglotitis

Haemophylis Influenza

<6m and has UTI what Ix is required

If responds to abx in <48 hrs -> US within 6 weeks If doesnt respond DSMA / MCUG

7-9years old migrane rx

Ibuprofen 200mg

Known heartfailure and develops hearing loss due to which drug

Furosemide

Pyelonephritis in kids orally rx?

Cefalexen 500mg BD 7 days

Abx for sinusitis which causes oesophagitis

Droxycycline

Tonsillitis given abx and now thrombocytopenia

Penicillin V

Which type of infection in: Neutrophil defects-> T cell defects-> B cell defects -> Leukocyte defects -> Complement defects ->

Neutrophil defects-> Abscesses + fungal T cell defects-> viral and fungal B cell defects -> Severe bacterial but not menigococcal Leukocyte defects -> Delayed wound healing + ulcers Complement defects -> recurrent meningococcal

Kid walking and jerking in night unable to talk =? seen on eeg?

benign rolandic epilepsy [usually resolves by teens] EEG -> centrotemopral spikes

10 keeps falling and cant run anymore with pes cavus

charot marie tooth

Mum had multiple miscarriages and now baby has jaundice at 4 weeks with failure to thrive

Resus haemolytic disease [Likely exposed to Rh in prev pregnancies]

18 month with poor head growth and intracranial calcification on CT

Congenital CMV

sensoryneural hearing loss and goitre =

Pentad syndrome - SN loss and Hypothyroidism

1w old develops rash with pin point papules on erythematous base ?

erythema toxicum

What sign for DDH

Ortolanis sign - abducting a flexed hip and knee to check for dislocation Barlow - backward pressure on hip to subluxation Galeazzi sign - one leg shorter than other at 3 months

Most common primary bone tumour

Osteosarcoma

Baby with absent red reflex and white pupil

Retinoblastoma

Eye deviating out is called? When present all the time called? What if patient has a squint that deviates out on cover/uncover test?

eye deviating out is called 'exo-' When present all the time called '-tropia' Exophoria

girl <3 hits puberty ?

Hamartoma (usually hypothalamus)

Infant with central cyanosis who keeps squating

tetralogy of fallot

kartanger syndrome features

dextrocardia sinusitis and bronchiectasis due to impaired ciliary function

2yo with slow-rising pulse and ejection systolic murmur rx?

Balloon angioplasty (for AS) Surgical valve replacement if fails

Infant hearing test use

otoacoustic emissions

Reyes syndrome usual presentation in infants

Post viral illness [especially following aspirin use] Impaired liver function WITHOUT jaundice Infants - Respiratory symptoms, hypoglycaemia and hepatomegaly

Atypical uti eg pseudomonas plan in kids?

Antibiotics and US during acute illness

When US in paeds UTI

<6 months - US in 6 weeks >6 months and recurrent infections Atypical UTI - US during admission

Neonatal ALS basics

Assess HR every 30 seconds -If no pulse CPR 3:1 per breaths

Most common pneumonia in kids

Strep pneumo

Start of PALS

5 rescue breaths 15:2 CPR

psoriasis rx in kids

<6 - topical steroids >6 - vid d analogue eg calcipotriol

kid with abnormal facial movements that start at finger tip and move to face + and a funny taste in the mouth but retais consciousness? rx?

Partial sezuire / peti mal / jacksonian Lamotrigine / carbamazepine [valproate second line]

Kid seizing with no IV access

Buccal midazolam [IV loraz if access]

All babies born to HIV positive mothers should have HIV antibody test when? [Even if multiple negative HIV viral DNA tests perinatally]

18 months

What is anterograde amnesia

Unable to create new memories following injury

19 purulent urethral discharge and urethritis? rx?

Gonnorea Azithro

When immunosuppression in polycythaemia

Organomegally Weight loss / night sweats thrombocytosis

Kid with unilateral proptosis progressing over weeks

rhabdomyosarcoma

kid with diabetes + optic atrophy

wolfram syndrome

Cows milk protein allergy - what type of milk can they have?

Breast extensively hydrolyzed [milk proteins broken down]

Paeds Flashcards

(113 cards)