Diseases... Flashcards
Management of asthma >5 years
- SABA
- Regular 200-400mcg/day corticosteroids
- Add LABA
If good response, continue… If not enough, increase to 400mcg/day
(stop if no response at all) - Increase up to 800mcg/day
- Maintain higher steroid dose, and refer
Management of asthma for under 5 yr old
- SABA
- Regular corticosteroids 200-400mcg/day
- If 2-5, trial leukotriene antagonist
If under 2, refer to resp paed - Refer to resp paed
Presentation of Pyloric stenosis
PPP
Projectile vomiting (2-4 weeks old) after feed
Palpable mass
Paristalsis visible
2-4 per 1000
Causes and definition of prolonged jaundice of new born
If signs of jaundice after 14 weeks then test for
➡️ conjugated (if high could be biliary atresia—> urgent surgery!)
➡️ Coombs test (indicates antibody mediated RBC destruction, Rh etc)
➡️ TFTs (hypothyroidism)
➡️ FBC and blood film U&E LFTs
Galactosaemia
Uti
Breast milk jaundice
Congenital infection (CMV, toxoplasmosis)
Causes of pathological jaundice within first day
Within first 24hr Rh haemolytic disease ABO Haem disease Heriditary spherocytosis Glucose 6 phosphodehydrogenase
Minimal change disease presentation, management and prognosis.
T cell mediated damage to glomerular basement membrane
80% of nephrotic syndrome is caused by MCD in children.
Presents as nephrotic syndrome… (Proteinuria 3G/24hr, hypoalbuminaemia lessthan30g/L, oedema [esp periorbital and Bilat leg, worse in morning])
Frothy urine
Normotensive
Renal biopsy shows fusion of podocytes on electron microscope
80% respond to steroids, use cyclophosphamide if not
1/3 have just one episode, 1/3 have infrequent relapses, 1/3 have frequent relapses that stop before adulthood
2 year old patient who has foul smelling diarrhoea 5times a week, with abdo pain. Bloated abdo, wasted buttocks, dropped 2 centile lines. What investigation do you perform?
IgA TTG antibodies (for coeliacs)
Patients often present before 3, as cereals (gluten) is added to diet. Repeated exposure leads to villous atrophy, and malabsorption
HLA DQ2 is associated in 95%
Jejunal biopsy shows villous atrophy
Cyanotic congenital heart disease
These are right to left (blue baby) Transposition Fallot tricuspid or pulmonary atresia total anomalous pulmonary venous return (TAPVR) Hypoplastic left heart syndrome.
Acyanotic congenital heart disease
Left to right…breathless baby
ASD
VSD
PDA
Coarctation
If pulmonary hypertension develops then watch out for shunt reversal and Eisenmenger
Dx of 3 yr old with flank pain and abdo mass
Wilms’ nephroblastoma is one of the most common childhood malignancies. It typically presents in children under 5 years of age, with a median age of 3 years old.
Features
➡️abdominal mass (most common presenting feature)
➡️flank pain
➡️painless haematuria
➡️other features: anorexia, fever
➡️unilateral in 95% of cases
➡️metastases are found in 20% of patients (most commonly lung)
Mx of Kawasaki’s disease
high dose aspirin
IV immunoglob
and echo to look for coronary artery anneurysm
(*Kawasaki disease is one of the few indications for the use of aspirin in children,due to the risk of encephalopathy === Reye’s syndrome…rash, vom, liver dam)
Why is aspirin nearly always contraindicated in kids?
Reye's syndrome - rapidly progressive encephalopathy ...Rash (hands and feet) ...Vomiting ...Fatty liver ...Hyperammonemia ...Hypoglycaemia
(Kawasaki disease is one of the few indications for the use of high dose aspirin in children)
sausage-shaped mass in the right lower quadrant and USS showing a target-like mass. Diagnosis and management?
Intussusception so Pneumatic reduction under fluoroscopic guidance
APGAR score
(All 0, 1 or 2) Appearance Pulse (over 100 = 2p) Grimace (Reflex irritability) Activity Respiration
Red flags indicating that childhood constipation may be due to underlying disease
No recent change in diet meconium passed after 48hr Reported in first week of life distended abdo ribbon stool previously weak legs REMEMBER, ALWAYS START CONSTIPATION MEDICALLY (movicol paediatric plain, then add senna)
