Paediatrics Flashcards

Question

Cystic hygroma

Answer 1

A cystic hygroma is a common lymphatic malformation and usually present within the first two years of life as a smooth and painless mass that transilluminates. It is located within the posterior triangle and can rapidly increase due to a respiratory tract infection.

Answer 2

According to the NICE guideline, for children three years or older with recurrent UTI, ultrasound imaging of the urinary tract is recommended within six weeks of the acute infection and DMSA is recommended at four to six months. NICE defines recurrence as 2 or more UTIs in 6 months. If the ultrasound is abnormal then a MCUG may be considered. Although MCUG is not performed routinely it should be considered if the following features are present: dilatation on ultrasound; poor urine flow; non-E. coli infection; family history of vesico-ureteric reflux (VUR).

Answer 3

Sublingual desmopressin is an appropriate management option for bedwetting in children and young people who need rapid short-term control!!! SE: Hyponatremia Intermittent oral desmopressin is the treatment of choice for short-term control of enuresis. It may be useful to reduce the risk of bedwetting on nights spent away from home (such as holidays or sleepovers). In the longer-term treatment of enuresis, for children who are unable to use, or fail to respond well to an enuresis alarm, consider referral to a specialist to confirm the diagnosis, and consider longer treatment with daily desmopressin (not recommended for initiation in primary care). The use of intranasal desmopressin is no longer recommended due to the relatively high risk of inadvertent overdose and consequent hyponatraemia. It is important to fluid restrict from one hour before until eight hours after taking desmopressin for treatment of childhood nocturnal enuresis!*****

Answer 4

The UK-WHO growth charts can be used for all ethnic groups and should be used for all infants however they are fed. Gestational correction should continue until at least one year of age and until two years for infants born before 32 weeks.

Answer 5

In infants under the age of four weeks, body temperature should be checked with an electronic thermometer in the axilla. In older children aged four weeks to five years, body temperature can be checked by either an electronic or a chemical dot thermometer in the axilla or an infra-red tympanic thermometer. Forehead chemical thermometers are discouraged as they are unreliable!!!

Answer 6

Intussusception describes the invagination of one portion of the bowel into the lumen of the adjacent bowel, most commonly around the ileo-caecal region. Intussusception usually affects infants between 6-18 months old. - Intermittent, severe, crampy, progressive abdominal pain - Inconsolable crying during paroxysm the infant will characteristically draw their knees up and turn pale - Vomiting - Bloodstained stool - 'red-currant jelly' - is a late sign - Sausage-shaped mass in the right upper quadrant Ix: Ultrasound, may show a target-like mass. - the majority of children can be treated with reduction by air insufflation under radiological control, which is now widely used first-line compared to the traditional barium enema. - if this fails, or the child has signs of peritonitis, surgery is performed.

Answer 7

Progressive fibrosis and obliteration of the bile ducts → bile cannot drain → cholestasis, jaundice, hepatocellular injury. Leads to portal fibrosis, cirrhosis, and liver failure if untreated. Usually presents within first few weeks of life. - Persistent jaundice (>14 days) - Conjugated (direct) hyperbilirubinaemia - Pale / clay-coloured stools Lack of bile pigment in stool - Dark urine excreted in urine Hepatomegaly Poor weight gain / irritability Cholestasis, malabsorption Later: splenomegaly

Answer 8

5 years. The majority of children achieve day and night time continence by 3 or 4 years of age. Enuresis may be defined as the 'involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract' Nocturnal enuresis can be defined as either primary (the child has never achieved continence) or secondary (the child has been dry for at least 6 months before)

Answer 9

The clinical picture is suggestive of gastro-oesophageal reflux disease (GORD). In bottle fed infants, reduce the volume if over-feeding is an issue; if correct feed volumes, advise a two-week trial of smaller volumes more frequently. Next, advise a two-week trial of formula thickening, either pre-thickened formulas or added to a formula of choice. For both breastfed and bottle-fed infants, if these interventions have been ineffective, you can recommend a two-week trial of alginates administered in the middle of the feed. If the infant continues to be symptomatic, the next line of treatment is a four-week trial of a proton pump inhibitor or a histamine-2-receptor antagonist. However, Ranitidine is not available in the United Kingdom at present due to ongoing investigations about safety. Infants with suspected GORD should be referred to a specialist for assessment and further investigation if there is persistent faltering growth and/or symptoms despite medical management.

Answer 10

Pyloric stenosis typically presents in the second to fourth weeks of life with vomiting, although rarely may present later at up to four months. It is caused by hypertrophy of the circular muscles of the pylorus. Features: - '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 - hypochloraemic, hypokalaemic alkalosis due to persistent vomiting Diagnosis is most commonly made by ultrasound. Management is with Ramstedt pyloromyotomy. Infantile pyloric stenosis is an important differential diagnosis in young babies presenting with persistent vomiting. It is more common in males and usually presents at four to six weeks with projectile vomiting of stomach contents. Babies with pyloric stenosis remain hungry and keen to feed. On examination a right upper quadrant mass may be palpable. Further investigation is warranted in any baby failing to thrive.

Answer 11

Diagnosis: fine-toothed combing of wet or dry hair Management: - treatment is only indicated if living lice are found - a choice of treatments should be offered - malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone household contacts of patients with head lice do not need to be treated unless they are also affected Permethrin not licensed for children.

Answer 12

Cefalexin is recommended as the first-line oral antibiotic for pyelonephritis in a child. Co-amoxiclav is also an option but only if a urine culture result is available and confirms sensitivity.

Answer 13

Nasolacrimal duct obstruction is the most common cause of a persistent watery eye in an infant. It is caused by an imperforate membrane, usually at the lower end of the lacrimal duct. Around 1 in 10 infants have symptoms at around one month of age. The discharge is watery or mucoid. - teach parents to massage the lacrimal duct. - symptoms resolve in 95% by the age of one year. Unresolved cases should be referred to an ophthalmologist for consideration of probing, which is done under a light general anaesthetic

Answer 14

Scarlet fever is a reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes). It is more common in children aged 2 - 6 years with the peak incidence being at 4 years. - 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. Mx: - Oral penicillin V for 10 days - patients who have a penicillin allergy should be given azithromycin - children can return to school 24 hours after commencing antibiotics - scarlet fever is a notifiable disease

Answer 15

Infestation with threadworms (Enterobius vermicularis, sometimes called pinworms) is extremely common amongst children in the UK. Infestation occurs after swallowing eggs that are present in the environment. Threadworm infestation is asymptomatic in around 90% of cases, possible features include: - perianal itching, particularly at night - girls may have vulval symptoms Diagnosis may be made by the applying Sellotape to the perianal area and sending it to the laboratory for microscopy to see the eggs. However, most patients are treated empirically. CKS recommend a combination of anthelmintic with hygiene measures for all members of the household. PO Mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists

Answer 16

Acute epiglottitis is rare but serious infection caused by Haemophilus influenzae type B. - Rapid onset - high temperature, generally unwell - Stridor - Drooling of saliva - 'tripod' position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position. If suspected do NOT examine the throat due to the risk of acute airway obstruction. Diagnosis is made by direct visualisation but this should only be done by senior staff who are able to intubate if necessary

Answer 17

Softening of the cartilage of the patella. Common in teenage girls. Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting. Usually responds to physiotherapy

Answer 18

Laryngomalacia is the most common congenital laryngeal abnormality characterised by flaccidity of the supraglottic structures. The larynx is soft and floppy as a result and collapses during breathing. Presents within the first few weeks of life (typically at 4-6 weeks) with noisy respiration and inspiratory stridor. - Inspiratory stridor : high-pitched and crowing. This is usually intermittent, occurring in the supine position e.g. when the child lies on its back, when feeding or when agitated. - Symptoms increase in severity during the first 8 months but tend to resolve by 18-24 months. - Respiratory distress, failure to thrive and cyanosis are rare. Mx: - 99% of cases usually resolve spontaneously by 18-24 months. - Symptomatic relief may be provided by hyperextending the neck during episodes of stridor. - Surgical intervention is only required with severe respiratory distress.

Answer 19

Roseola infantum (occasionally sixth disease) is a common disease of infancy caused by the human herpes virus 6 (HHV6). Typically affects children aged 6 months to 2 years. Features: - high fever: lasting a few days, followed later by a maculopapular rash. - Nagayama spots: papular enanthem on the uvula and soft palate febrile convulsions occur in around 10-15% - diarrhoea and cough are also commonly seen School exclusion not usually seen.

Answer 20

Seborrhoeic dermatitis is a relatively common skin disorder seen in children. It typically affects the scalp ('Cradle cap'), nappy area, face and limb flexures. Cradle cap is an early sign which may develop in the first few weeks of life. It is characterised by an erythematous rash with coarse yellow scales. Management: - Reassurance that it doesn't affect the baby and usually resolves within a few weeks. - Massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.. if severe/persistent a topical imidazole cream may be tried

Answer 21

Croup is a form of upper respiratory tract infection seen in infants and toddlers. It is characterised by stridor which is caused by a combination of laryngeal oedema and secretions. Parainfluenza viruses account for the majority of cases. peak incidence at 6 months - 3 years - cough - barking, seal-like worse at night - stridor - remember, the throat should be not examined due to the risk of precipitating airway obstruction - fever - coryzal symptoms - increased work of breathing e.g. retraction Mx: Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity. Emergency treatment - high-flow oxygen - nebulised adrenaline

Answer 22

Febrile convulsions are seizures provoked by fever in otherwise normal children. They typically occur between the ages of 6 months and 5 years and are seen in 3% of children. - usually occur early in a viral infection as the temperature rises rapidly - seizures are usually brief, lasting less than 5 minutes - are most commonly tonic-clonic children who have had a first seizure OR any features of a complex seizure should be admitted to paediatrics!!! - parents should be advised to phone for an ambulance if the seizure lasts > 5 minutes - regular antipyretics have not been shown to reduce the chance of a febrile seizure occurring - if recurrent febrile convulsions occur then benzodiazepine rescue medication may be considered this should only be started on the advice of a specialist (e.g. a paediatrician) - Rectal diazepam or buccal midazolam may be used. The overall risk of further febrile convulsion = 1 in 3 (30%) - Risk factors for developing epilepsy include a family history of epilepsy, having complex febrile seizures and a background of neurodevelopmental disorder. children with no risk factors have a 2.5% risk of developing epilepsy. if children have all 3 features the risk of developing epilepsy is much higher (e.g. 50%)

Answer 23

Barlow test: attempts to dislocate an articulated femoral head. Ortolani test: attempts to relocate a dislocated femoral head. Other important factors include: - symmetry of leg length - level of knees when hips and knees are bilaterally flexed - restricted abduction of the hip in flexion Ultrasound is generally used to confirm the diagnosis if clinically suspected. however, if the infant is > 4.5 months then x-ray is the first line investigation

Answer 24

Whooping cough (pertussis) is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. Sometimes called the 'cough of 100 days'. Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features: - Paroxysmal cough. - Inspiratory whoop. - Post-tussive vomiting. - Undiagnosed apnoeic attacks in young infants. - In the UK pertussis is a notifiable disease. - An oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread. Household contacts should be offered antibiotic prophylaxis. - Antibiotic therapy has not been shown to alter the course of the illness. - School exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

Answer 25

< 1 year 300 mg 1 - 10 years 600 mg > 10 years 1200 mg

Answer 26

If the history is suggestive of an IgE-mediated allergy: - offer a skin prick test or blood tests for specific IgE antibodies to the suspected foods and likely co-allergens If the history is suggestive of an non-IgE-mediated allergy: - Eliminate the suspected allergen for 2-6 weeks, then reintroduce. NICE advise to 'consult a dietitian with appropriate competencies about nutritional adequacies, timings and follow-up'

Answer 27

Nephrotic syndrome is classically defined as a triad of - Proteinuria (> 1 g/m^2 per 24 hours) - Hypoalbuminaemia (< 25 g/l) - Oedema In children the peak incidence is between 2 and 5 years of age. Around 80% of cases in children are due to a condition called minimal change glomerulonephritis. The condition generally carries a good prognosis with around 90% of cases responding to high-dose oral steroids. - Other features include hyperlipidaemia, a hypercoagulable state (due to loss of antithrombin III) and a predisposition to infection (due to loss of immunoglobulins).

Answer 28

Labial adhesions describe the fusion of the labia minora in the midline. It is usually seen in girls between the ages of 3 months and 3 years and can generally be treated conservatively. Spontaneous resolution tends to occur around puberty. Features may include: - problems with micturition including pooling in the vagina - on examination thin semitranslucent adhesions covering the vaginal opening between the labia minora are seen, which sometimes cover the vaginal opening completely. - Conservative management is appropriate in the majority of cases if there are associated problems such as recurrent urinary tract infections. - Oestrogen cream may be tried if this fails surgical intervention may be warranted

Answer 29

- Chewable 'teething' rings - Simple analgesia (paracetamol or ibuprofen) - Topical analgesics or numbing agents are not recommended. - Oral choline salicylate gels should not be prescribed to teething children due to a risk of Reye's syndrome.

Answer 30

Retinoblastoma is the most common ocular malignancy found in children. The average age of diagnosis is 18 months. - Absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom!! - strabismus - visual problems - Enucleation is not the only option depending on how advanced the tumour is other options include external beam radiation therapy, chemotherapy and photocoagulation. Prognosis - Excellent, with > 90% surviving into adulthood.

Answer 31

Irritant dermatitis = The most common cause, due to irritant effect of urinary ammonia and faeces. Creases are characteristically spared!!! Candida dermatitis: Typically an erythematous rash which involve the flexures and has characteristic satellite lesions

Answer 32

A child with impetigo should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment.

Answer 33

Umbilical hernia are relatively common in children and may be found during the newborn exam. Usually no treatment is required as they typically resolve by 3 years of age.

Answer 34

Ibuprofen is thought to be more effective than paracetamol for paediatric migraine. triptans may be used in children >= 12 years but follow-up is required. - Sumatriptan nasal spay (licensed) is the only triptan that has proven efficacy but it is poorly tolerated by young people who don't like the taste in the back of the throat. it should be noted that oral triptans are not currently licensed in people < 18 years. Side-effects of triptans include tingling, heat and heaviness/pressure sensations.

Answer 35

- Give 5 rescue breaths - Infants use brachial or femoral pulse, children use femoral pulse. - 15 chest compressions:2 rescue breaths chest compressions should be 100-120/min for both infants and children 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

Answer 36

NICE advises against using NSAIDs in children with chickenpox after a literature review by UK Medicines Information highlighted an increased risk of necrotising fasciitis.

Answer 37

Newborn: Otoacoustic emission test. All newborns should be tested as part of the Newborn Hearing Screening Programme. A computer-generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea. Newborn & infants: Auditory Brainstem Response test. May be done if otoacoustic emission test is abnormal. 6-9 months: Distraction test Performed by a health visitor, requires two trained staff.

Answer 38

A breastfed baby with GORD should have a trial an alginate (e.g. .Gaviscon) first line.

Answer 39

This condition is characterised by a fragment of bone in the knee joint that becomes detached due to a lack of blood supply. The fragment and its overlying cartilage can then move around inside the joint, causing symptoms such as pain, swelling, and locking - all symptoms described by this patient. It's most common in adolescents and young adults, particularly those who are active or participate in sports.

Answer 40

Ophthalmia neonatorum simply means infection of the newborn eye. Conjunctivitis occurring in the first 28 days of life. Responsible organisms include - Chlamydia trachomatis - Neisseria gonorrhoeae Suspected ophthalmia neonatorum should be referred for same-day ophthalmology/paediatric assessment.

Answer 41

Bowlegs are common in children aged between 1 and 3 years old, as their legs are adjusting to bearing weight during walking. In most cases, physiological genu varum resolves spontaneously by the age of 4 years as the child grows.

Answer 42

Screening for DDH: the following infants REQUIRE a routine ultrasound examination: - 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 all infants are screened at both the newborn check and also the six-week baby check using the Barlow and Ortolani tests.

Answer 43

if the issue is a non-retractile foreskin and/or ballooning during micturition in a child under two, an expectant approach should be taken in case this is physiological phimosis which will resolve in time. Forcible retraction can result in scar formation so should be avoided. Personal hygiene is important. If the child is over 2 years of age and has recurrent balanoposthitis or urinary tract infection then treatment can be considered.

Paediatrics Flashcards

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