ILOs 1 Flashcards
Give some causes of global developmental delay
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
Give some causes of gross motor delay
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
Give some causes of fine motor delay
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Give some causes of speech and language delay
Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Autism
Cerebral palsy
Neglect
Give some causes of social delay
Emotional and social neglect
Parenting issues
Autism
What are the main types of pneumothorax seen in children?
spontaneous pneumothorax:
- primary spontaneous pneumothorax (PSP): Occurs without underlying lung disease, often in tall, thin, young individuals, associated with the rupture of subpleural blebs or bullae
- secondary spontaneous pneumothorax (SSP): Occurs in patients with pre-existing lung disease, such as asthma, CF and pneumonia. Certain connective tissue diseases such as Marfan’s syndrome are also a risk factor
traumatic pneumothorax
iatrogenic pneumothorax
What are the sxs and signs of a simple pneumothorax?
Symptoms tend to come on suddenly:
dyspnoea
pleuritic chest pain
Signs
hyper-resonant lung percussion
reduced breath sounds
reduced lung expansion
tachypnoea
tachycardia
What is a tension pneumothorax?
a severe pneumothorax
occurs when a one way valve is created between the lung and the pleura, which leads to an accumulation of air within the pleural cavity = increase in intrathoracic pressure
results in the displacement of mediastinal structures that may result in severe respiratory distress and haemodynamic collapse
What are the signs of tension pneumothorax?
tracheal deviation away from the side of the pneumothorax
hypotension, tachycardia, tachypnoea
quiet heart sounds
cyanosis
Management in primary pneumothorax without shortness of breath, and <2cm in size?
discharge and review
Management of pneumothorax with a rim of air >2cm or clinically short of breath (SOB)?
Chest drain insertion
What is the safe triangle for chest drain insertion?
The triangle is located in the mid axillary line of the 5th intercostal space.
It is bordered by:
Anterior edge latissimus dorsi, the lateral border of pectoralis major, a line superior to the horizontal level of the nipple, and the apex below the axilla.
How can you find out a chest drain is in the right place without doing a CXR?
Chest drain swinging: water level rises on inspiration, falls on expiration
How should a suspected tension pneumothorax be investigated and managed?
A tension pneumothorax should not be investigated if suspected but should be immediately decompressed with a needle (14G needle, 2nd intercostal space)
How can poisoning of unknown origin be investigated?
can consult NPIS or TOXBASE for advice
Blood tests, such as toxicological investigations, FBC, U&Es, LFTs, glucose, clotting and arterial blood gases
urine drug screen
ECG
How can poisoning of unknown origin be managed?
can consult NPIS or TOXBASE for advice
Activated charcoal can bind to the poison and prevent absorption - up to 1 hour after ingestion
Alkalinisation of the urine for salicylate poisoning
Haemodialysis for ethylene glycol, lithium, methanol, phenobarbital, salicylates, and sodium valproate
Antidotes (if available) may be given for certain poisons
Give some key clinical features of malnutrition in children
High susceptibility to infections
Slow or poor wound healing
bradycardia, hypotension, and hypothermia
Depleted subcutaneous fat stores
Low skeletal muscle mass
In children, other indicators of undernutrition include:
Wasting: low weight for height
Stunting: low height for age
Underweight: low weight for age
Give some complications of malnutrition
Impaired immunity (increased risk of infections)
Poor wound healing
Growth restriction in children
Unintentional weight loss, specifically the loss of muscle mass
Multi-organ failure
Death
What signs should you look for on examination of a malnourished child?
shock: lethargic or unconscious; with cold hands, slow capillary refill (> 3 s), or weak (low volume), rapid pulse and low blood pressure
signs of dehydration e.g. decreased skin turgor
severe palmar pallor
bilateral pitting oedema
eye signs of vitamin A deficiency
What is Marasmus?
overt loss of adipose tissue and muscle as a result of total calorie insufficiency
children appear emaciated, weak and lethargic, and have associated bradycardia, hypotension, and hypothermia
What is Kwashiorkor?
‘the sickness of the weaning’ - often occurs on cessation of breastfeeding
severe protein deficiency with fair caloric intake
hypoalbuminaemia may cause bilateral pitting oedema and distended abdomen due to ascites
How should you assess a malnourished child?
detailed dietary history and physical examination
anthropometric measurements (including weight, length, and head circumference in younger children)
skinfold thickness and mid-upper-arm circumference (MUAC)
U&Es, LFTs, serum albumin levels
How should you manage a malnourished child?
treat hypoglycaemia
treat / prevent any hypothermia
rehydrate
refeed slowly with regular refeeding bloods
How should you dx and tx hypoglycaemia in a child?
take capillary BM - blood glucose below < 3 mmol/litre = hypoglycaemia
Give 50 ml of 10% glucose solution orally or by nasogastric tube
If the child is unconscious, treat with IV 10% glucose at 5 ml/kg
How can you dx and mx hypothermia in a child?
If the axillary temperature is < 35 °C or does not register on a normal thermometer, assume hypothermia. When a low-reading thermometer is available, rectal temperature (< 35.5 °C) confirms hypothermia
Re-warm the child: Make sure the child is clothed (especially the head); cover with a warmed blanket and place a heater or lamp nearby, or put the child on the mother’s bare chest or abdomen (skin-to-skin)
treat for potential hypoglycaemia and infection
Feed immediately and again every 2 hours
What atrial septal defects may be seen in children?
Ostium secondum : septum secondum fails to fully close, leaving a hole in the wall
Patent foramen ovale: foramen ovale fails to close (although this not strictly classified as an ASD)
Ostium primum: septum primum fails to fully close, leaving a hole in the wall. This tends to lead to atrioventricular valve defects
What are the potential complications of ASDs in children?
Stroke in the context of venous thromboembolism
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right sided heart failure
Eisenmenger syndrome - reversal of left to right shunt due to pulmonary hypertension
What may be heard on auscultation of an ASD?
mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border with a fixed split second heart sound (doesn’t change with inspiration or expiration)
How may ASDs present in children?
may be picked up on antenatal screening / newborn examination
may be symptomatic:
Shortness of breath
Difficulty feeding
Poor weight gain
Lower respiratory tract infections
may be asymptomatic in childhood and present in adulthood with dyspnoea, heart failure or stroke
How can ASDs be managed?
should be referred to a paediatric cardiologist for ongoing management
If the ASD is small and asymptomatic, watching and waiting can be appropriate
can be corrected surgically using a transvenous catheter closure (via the femoral vein) or open heart surgery
anticoagulants (such as aspirin, warfarin and NOACs) are used to reduce the risk of clots and stroke
What conditions are commonly associated with VSDs in children?
Down’s Syndrome and Turner’s Syndrome
What is the usual direction of flow of blood in a VSD? What may this cause?
from left to right
patient remains acyanotic but too much blood flow into the lungs may cause right sided overload / right heart failure
pulmonary hypertension may cause reversal of the shunt (Einsenmengers syndrome)
What sxs may VSDs present with?
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive
What may be heard on auscultation of the chest of a patient with a VSD?
pan-systolic murmur more prominently heard at the left lower sternal border in the third and fourth intercostal spaces
may be a systolic thrill on palpation
How should VSDs be managed?
referred to paediatric cardiologist
small VSDs with no symptoms or evidence of pulmonary hypertension / HF can be watched and often close spontaneously
can be corrected surgically using a transvenous catheter closure via the femoral vein or open heart surgery
increased risk of infective endocarditis in patients with a VSD =antibiotic prophylaxis should be considered during surgical procedures
Give some symptoms of aortic stenosis
fatigue, shortness of breath, dizziness and fainting
sxs typically worse on exertion as the outflow from the left ventricle cannot keep up with demand
severe aortic stenosis will present with heart failure within months of birth.
Describe the murmur heard in aortic stenosis
ejection systolic murmur heard loudest at the aortic area (second intercostal space, right sternal border)
It has a crescendo-decrescendo character and radiates to the carotids
Besides a murmur, what might you find on examination of aortic stenosis?
Ejection click just before the murmur
Palpable thrill during systole
Slow rising pulse and narrow pulse pressure
How can aortic stenosis be investigated and managed?
gold standard for dx is an echocardiogram
monitoring with regular echos, exercise testing and ECGs
Mx options:
Percutaneous balloon aortic valvoplasty
Surgical aortic valvotomy
Valve replacement
Give some complications of aortic stenosis
Left ventricular outflow tract obstruction
Heart failure
Ventricular arrhythmia
Bacterial endocarditis
Sudden death, often on exertion
What conditions may be associated with congenital pulmonary valve stenosis?
Tetralogy of Fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome
Give some signs of pulmonary stenosis found on examination
Ejection systolic murmur heard loudest at the pulmonary area (second intercostal space, left sternal border)
Palpable thrill in the pulmonary area
Right ventricular heave due to right ventricular hypertrophy
Raised JVP with giant a waves