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Summary Paediatrics revision notes for medical school
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  • Pediatrics
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  • Imperial College London (ICL)

Comprehensive revision notes covering all areas of paediatrics required for medical school final exams and postgraduate exams such as the MSRA. 100+ pages of concise, user-friendly and structured notes with a lot of images to aid your learning and help you efficiently revise. Also features a compre...

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  • January 4, 2023
  • 146
  • 2018/2019
  • Summary

Subjects

  • medical school
  • medicine
  • imperial
  • 4th year
  • 5th year
  • revision notes
  • msra
  • final year
  • paediatrics
  • paeds
  • university
  • uni
  • gp
  • gp

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  • Imperial College London (ICL)
  • Unknown
  • Pediatrics
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PAEDIATRICS NOTES

Immunisation Schedule
Summary:
• BCG is given to infants at high risk of TB infection.
• “5 in 1” vaccine against diphtheria, tetanus, pertussis, Hib and inactivated
polio is given at 2 months, 3 months and 4 months. “6 in 1” includes
hepatitis B vaccination.
• Pneumococcal conjugate vaccine is given at 2 months, 4 months and 12
months.
• Meningococcal group B vaccine is given at 2 months, 4 months and 12
months.
• Rotavirus vaccine is given orally at 2 months and 3 months.
• Booster Hib and MenC are both given at 12 months.
• MMR is given at 1 year and at 3 years 4 months.
• A diphtheria, tetanus, pertussis and polio booster is also given at 3 years 4
months.
• HPV vaccine is given to girls at 12-13 years.
• Tetanus, diphtheria and polio booster and meningococcal ACWY
conjugate vaccine are given at 14 years.

Diseases included in the vaccination programme:
• Diphtheria – infection causes local disease with membrane formation
affecting the nose, pharynx and larynx, but it can also cause systemic
disease with myocarditis and neurological manifestations.
• Pertussis – whooping cough.
• Hib – causes invasive disease in young children.
• Poliovirus – most infected children will be asymptomatic or have a mild
illness, but some develop aseptic meningitis, and 1% will develop paralysis.
• Meningococcus – meningitis and meningococcal sepsis.
• Pneumococcus – rare but severe invasive pneumococcal illness in under-
2s
• HPV – protects against HPV16 and HPV18, the two subtypes most
associated with cervical cancer.
• BCG –TB

Absolute CI = acute current illness or previous severe adverse reaction.
Vaccinations should be postponed if the child is acutely unwell at the time (however, minor infection without any fever or systemic
features is not a contraindication). Relative CI = immunosuppression, egg allergy (egg is present in flu vaccine and MMR vaccine).

Complications include:
• Swelling and discomfort at injection site
• Mild fever and malaise
• Some vaccines, e.g. MMR, are followed by a mild form of the disease 7-10 days later
• More serious reactions, including anaphylaxis, can occur but are very rare


Keywords in paeds SBAs: • Give amoxicillin to treat feverish illness, child comes
• Pale = anaemia, shocked back two days later with florid rash = EBV (NOT allergy
• Pale and jaundiced = haemolytic anaemia to amoxicillin)
• Drooling = epiglottitis • Irritability = meningitis
• Recently moved from abroad and doesn’t have red book • Confusion = encephalitis/encephalopathy
= unimmunised (epiglottitis, pertussis, diphtheria, no • Port wine stain = Sturge-Weber
Guthrie screening – thyroid, PKU, cystic fibrosis) • Fat teenager with limp = SUFE (slipped upper femoral
• Mum has a new boyfriend = child abuse epiphysis)
• Pins and needles in hands (in context of chest pain etc.) • Gower’s sign positive = Duchenne’s muscular dystrophy
= panic attack • Cap refill >3 seconds = shocked
• 5 days of fever = Kawasaki’s • Boot-shaped heart on chest X-ray = tetralogy of Fallot
• Mum unable to let go of your hand = myotonic • Barking cough = croup
dystrophy (is autosomal dominant) • Has been to a birthday party = anaphylaxis

,Causes of common paediatric emergency presentations:

Shock Respiratory Distress Drowsy, unconscious or seizing Surgical Emergencies
Hypovolaemia Upper airway obstruction - Post-ictal Acute abdomen:
- Sepsis (stridor) - Status epilepticus e.g. appendicitis or
- Dehydration – e.g. - Croup - Infection (meningitis or peritonitis
gastroenteritis - Epiglottis encephalitis)
- Diabetic ketoacidosis - Foreign body - Head injury (trauma or non- Intestinal obstruction:
- Blood loss – trauma - Congenital accidental injury) - Intussusception
malformations - Drug or poison ingested - Malrotation
- Trauma - Intracranial haemorrhage - Bowel atresia or
stenosis


Maldistribution of fluid
- Sepsis Metabolic problems:
- Arrhythmias Lower airway disorders - Diabetic ketoacidosis
Cardiogenic - Asthma - Hypoglycaemia
- Arrhythmias - Bronchiolitis - Electrolyte (Ca, Mg, Na)
- Heart failure - Pneumonia disturbances
Neurogenic - Pneumothorax - Inborn error of metabolism
- Spinal cord injury

In paediatrics, arrest is usually due to hypoxia from respiratory failure, neurological failure or shock.



Presentation Common causes Less common causes
Fever Upper respiratory tract infection (coryzal Bacteraemia
illness e.g. common cold) Pneumonia
Otitis media Osteomyelitis/septic arthritis
Pharyngitis Meningitis/encephalitis
Skin infections TB
Urinary tract infection HIV
Viral infections Imported fever (malaria/dengue/typhoid)
Gastroenteritis Kawasaki disease
Rheumatological/connective tissue disease
Inflammatory bowel disease
Malignancy
Breathing difficulty Bronchiolitis Heart failure
Asthma/viral-induced wheeze Laryngomalacia (in infants)
Croup Acidosis
Pneumonia Cystic fibrosis
Persistent cough Bronchiolitis Inhaled foreign body
Pneumonia Pertussis (whooping cough)
Asthma TB
Gastro-oesophageal reflux (in infants) Bronchiectasis (e.g. cystic fibrosis)
Aspiration (esp. in neurodisability) Psychosocial/habit spasm
Post-nasal drip/sinusitis
Diarrhoea and/or Gastroenteritis Inflammatory bowel disease
vomiting Constipation with overflow Malabsorption
Toddler diarrhoea Food allergy
Food poisoning Pyloric stenosis
Malrotation/volvulus
Diabetic ketoacidosis
Appendicitis
Psychosocial/behavioural




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,Abdominal pain Mesenteric adenitis Lower lobe pneumonia
Chronic constipation Obstruction (e.g. intussusception, hernia)
Appendicitis Intra-abdominal mass (faecal, tumour, organomegaly)
UTI/pyelonephritis Diabetic ketoacidosis
Somatisation Henoch-Schonlein purpura
Hepatitis A prodrome
Sickle cell disease
Rectal bleeding Fissure in ano Inflammatory bowel disease
Enteric infection (Campylobacter, E. coli, Food allergy
Shigella) Meckel’s diverticulum
Intussusception
Headache Tension headache Meningitis/encephalitis
Migraine Sinusitis
Myopia/hypermetropia Raised ICP (space-occupying lesion, idiopathic
Post-ictal intracranial HTN)
Fits/faints Febrile convulsion Meningitis/encephalitis
Vasovagal syncope CNS injury (including hypoxia)
Breath-holding attacks Hypoglycaemia
Idiopathic epilepsy Hypocalcaemia (rickets)
Infantile spasms (West syndrome)
Limp/joint pain Reactive arthritis Osteomyelitis
Trauma (including non-accidental) Septic arthritis
Slipped upper femoral epiphysis
Developmental dysplasia of hip
Osteochondritis
Systemic onset juvenile idiopathic arthritis
Vitamin D deficiency (rickets)
Sickle cell disease
Haemophilia
Malignancy (leukaemia, osteosarcoma)
Deliberate self- Depression Psychiatric conditions
harm Psychosocial problems e.g. bullying Emotional/sexual child abuse
Eating disorders
Non-blanching rash Minor trauma Purpura fulminans due to N. meningitidis infection
(bruising-purpura) Enteroviral infection Henoch-Schonlein purpura
Raised superior vena cava pressure Haemophilia A and B
(Valsalva manoeuvres) Leukaemia
Idiopathic thrombocytopenic purpura Non-accidental injury
Von Willebrand disease
Other rashes/skin Viral exanthema (measles, VZV, Fungal infection (ringworm, tinea)
lesions parvovirus, HHV6) Erythema multiforme
Streptococcal/staphylococcal infection Erythema nodosum
(impetigo, scarlet fever, toxin-mediated) Eczema herpeticum
Eczema Non-accidental injury
Acne Stevens-Johnson syndrome
Rashes of the newborn
Insect bites/scabies
Molluscum
Allergic reactions Food allergy Drug reaction (including Stevens-Johnson)
Eczema Urticaria
Allergic rhinitis Anaphylaxis
Acute wheeze
ENT/eye problems Otitis media Foreign body
Otitis externa Injury
Conjunctivitis (infectious, allergic, Sinusitis/mastoiditis
inflammatory) Peripheral orbital cellulitis
Pharyngitis Retinoblastoma




3

, Lumps and bumps Lymphadenopathy (has many causes) Solid tumours
Bruising Pregnancy
Hernia Rickets (swollen wrists/ribs)
Urinary problems UTI Nephrotic syndrome
Enuresis (primary or secondary) Nephritic syndrome
Diabetes mellitus Renal stones
Jaundice beyond Haemolysis Viral hepatitis (A, B, C, E)
the neonatal period Gilbert syndrome Metabolic disorders
Gallstones
Pallor Iron deficiency anaemia G6PD deficiency
Thalassaemia Leukaemia
Sickle cell disease
Atypical recurrent Children with frequent sequential Primary and secondary immunodeficiency disorders,
infections infections & normal immunity including HIV

Obesity Simple obesity – excess calorie intake and Cushing’s syndrome
inadequate exercise PCOS
Faltering growth Caloric insufficiency Chronic illness (cyanotic heart disease, coeliac disease,
Neglect/child abuse cystic fibrosis, inflammatory bowel disease, diabetes
Constitutional delay mellitus, rickets)
Diabetes mellitus Chr abnormality (Down’s, Turner’s)
Endocrine (hypothyroidism, inborn errors of
metabolism)
Eating disorder (anorexia/bulimia)
Immunodeficiency
Abnormal puberty Constitutional delay
Premature thelarche/adrenarche/menarche
Short stature Constitutional delay Renal tubular acidosis
Familial short stature Glucocorticoid excess
Chronic disease (cystic fibrosis, cyanotic GH deficiency
heart disease, coeliac disease, sickle cell CNS disease (tumours)
disease, thalassaemia) Turner’s syndrome
Inflammatory bowel disease Noonan syndrome
Hypothyroidism Prader-Willi syndrome
Down’s syndrome
Malnutrition
Developmental Environmental understimulation Congenital/inherited conditions
delay Neglect Chromosomal rearrangements
Iron deficiency Single gene defects (Duchenne muscular dystrophy,
Cerebral palsy storage disorders, inborn errors of metabolism)
Brain dysplasia
Vitamin D deficiency
Learning Hearing impairment Specific learning impairments (ADHD, dyslexia,
difficulties/slow Visual impairment dysgraphia, auditory processing disorders)
school progress Low IQ
Poor social skills Autism Parenting issues
and delayed
language
Chronic pain or Somatisation Fabricated illness
unexplained Induced illness
symptoms
Dysmorphic Down’s syndrome Inborn errors of metabolism
features or Turner’s syndrome Congenital infection
congenital Noonan’s syndrome Teratogenesis e.g. foetal alcohol syndrome
abnormalities




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