Paeds Flashcards

Question

Infantile spasms, or West syndrome, mx

Answer 1

EEG shows hypsarrhythmia in two-thirds of infants CT demonstrates diffuse or localised brain disease Management poor prognosis vigabatrin is now considered first-line therapy ACTH is also used

Answer 2

if a child not immunized against measles comes into contact with measles then MMR should be given w/in 72hrs (vaccine-induced measles antibody develops more rapidly than that following natural infection)

Answer 3

1. Antibiotics < 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime > 3 months: IV cefotaxime (or ceftriaxone) 2. dexamethsone if older than 3mo & lumbar puncture reveals: - frankly purulent CSF - CSF white blood cell count greater than 1000/microlitre - raised CSF white blood cell count with protein concentration greater than 1 g/litre - bacteria on Gram stain

Answer 4

Intravenous benzylpenicillin with gentamicin

Answer 5

open airway look, listen, feel for breathing give 5 rescue breaths check for signs of circulation infants use brachial or femoral pulse, children use femoral pulse 15 chest compressions: 2 rescue breaths ( lay rescuers 30:2) in children: compress the lower half of the sternum - one-third of the anterior–posterior dimension in infants: use a two-thumb encircling technique for chest compression

Answer 6

1. Dry baby and maintain temperature 2. Assess tone, respiratory rate, heart rate 3. If gasping or not breathing give 5 inflation breaths 4. Reassess (chest movements) 5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1

Answer 7

Management To keep the femoral head within the acetabulum: cast, braces If less than 6 years: observation Older: surgical management with moderate results Operate on severe deformities

Answer 8

S .pneumoniae is the most likely causative agent of a bacterial pneumonia in children Amoxicillin is first-line for all children with pneumonia Macrolides may be added if there is no response to first line therapy Macrolides should be used if mycoplasma or chlamydia is suspected In pneumonia associated with influenza, co-amoxiclav is recommended

Answer 9

'development of secondary sexual characteristics before 8 years in females and 9 years in males'

Answer 10

Scarlet fever: typically lasts 24 to 48 hours malaise, headache, nausea/vomiting sore throat 'strawberry' tongue rash fine punctate erythema ('pinhead') which generally appears first on the torso and spares the palms and soles children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures it is often described as having a rough 'sandpaper' texture desquamination occurs later in the course of the illness, particularly around the fingers and toes Kawasaki 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

Answer 11

oral penicillin V 10 days pen allergy- azithromycin children can return to school 24 hours after commencing antibiotics scarlet fever is a notifiable disease

Answer 12

Scarlet fever- 24hrs after abx Whooping cough- 2 days after abx Measles- 4 days after rash onset Rubella- 5 days after rash onset Chikenpox- allcrusted over lesions Mumps - 5 days after swollen gland onset D&V- settled for 48hrs Impetigo- crusted lesions or 2 days after abx start Scabies - until treated Influenza- until recovered

Answer 13

fever >38.5 degrees C non-weight bearing raised ESR raised WCC

Answer 14

retinal haemorrhages, subdural haematoma, and encephalopathy.

Answer 15

loss of internal rotation of the leg in flexion & hip-knee pain obese children and boys 10-15 years ix- AP and lateral (typically frog-leg) views are diagnostic mx - internal fixation: typically a single cannulated screw placed in the centre of the epiphysis

Answer 16

infants less than 3 months old should be referred immediately to a paediatrician hildren aged more than 3 months old with an upper UTI should be considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs

Answer 17

micturating cystourethrogram a DMSA scan may also be performed to look for renal scarring

Answer 18

infants under 6 months with suspect pertussis should be admitted notifiable disease an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated within 21 days household contacts should be offered antibiotic prophylaxis school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics ) Prophylaxis - Women who are between 16-32 weeks pregnant will be offered the vaccine & infants

Answer 19

Duchenne muscular dystrophy G6PD deficiency Haemophilia A,B