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child health Flashcards

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1
Q

define innocent murmur

A

soft systolic murmur
due to physiological conditions outside the heart
inconsequential and disappears as child grows older

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2
Q

common causes of cardiac failure in paediatrics

A

neonates: PDA, cortication of aorta, cardiomyopathy
infants: VSD, ASD, cardiomyopathy
children: cardiomyopathy

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3
Q

most common causative organism for infective endocarditis

A

strep. Viridans

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4
Q

dDx of acute cough in a child

A

URTI
croup
asthma
inhaled foreign body

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5
Q

dDx of acute stridor in a child

A

croup
epiglotitis
bacterial tracheitis
inhaled foreign body

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6
Q

common causes of pneumonia in children

A

Viral: RSV, influenza, parainfluenza
bacterial: Strep pneumoniae, mycoplasma (5-14y.o), Grp B strep (neonates)

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7
Q

causes of bronchiolitis

A

RSV, parainfluenza, influenza A, adenovirus

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8
Q

presentation of bronchiolitis

A

cough, dyspnoea, wheeze
hyperinflation, crepitations
seasonal - october-april

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9
Q

management of bronchiolitis

A

self limiting
oxygen
NG feeds and IV fluids if poor feeding

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10
Q

screening for CF

A

Screening – new-born measurement of immunoreactive trypsin levels on neonatal blood spot (heel prick)
If raised blood sent for genetic testing for CF mutations
Sweat test and genetic testing indicated in those missed by screening but presenting with meconium ileus, failure to thrive, recurrent chest infections or malabsorption

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11
Q

presentation of CF

A

recurrent chest infections/airway obstruction
pancreatic insufficiency
DIOS, meconium ileus
infertility (absence of Vas, abnormal cervical mucus)
anaemia
diabetes

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12
Q

management of CF

A

daily physiotherapy
prophylactic Abx (flucloxacillin)
high calorie diet

DIOS/meconium ileus – hydration + lactulose (surgery is 2nd line unless there is complete obstruction or perforation)
Acute RTI - oral amoxicillin (IV tobramycin and ceftazidime if severe) + salbutamol + chest physio + mucolytic
Pancreatic insufficiency – pancreatic enzyme supplements with each meal + fat soluble vitamin supplements

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13
Q

presentation of neonatal sepsis

A 
collapse
apnoea or resp. distress
seizure
poor feeding
jaundice
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14
Q

management of hypoxic ischaemic encephalopathy

A

therapeutic cooling to 33.5C, initiated by 6hrs, lasts 72hrs

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15
Q

how is neonatal cataracts screened

A

check red reflex after birth

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16
Q

causes of neonatal jaundice

A

unconjugated
breast milk jaundice, haemolytic anaemias, infections/sepsis, congenital hypothyroidism

conjugated
biliary atresia
a1 antitrypsin deficiency
neonatal hemochromatosis
idiopathic neonatal hepatitis
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17
Q

management of neonatal jaundice

A

phototherapy using UV light fibre optic blankets

exchange transfusion

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18
Q

presentation of downs syndrome

A

generalised hypotonia
short neck with excess skin at nape
brachycephaly
single palmer crease, short hand/fingers and a sandal tow gap in feet
facial features (prominent epicanthic folds, upward slanting palpebral fissures, protruding tongue, flat nose, low set ears)

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19
Q

presentation of edwards syndrome (trisomy 18)

A

microcephaly, small chin, low set ears
overlapping fingers
rocker bottom feet - flexed big toe, prominent heels
VSD, ASD, PDA

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20
Q

presentation of patau’s syndrome

A

holoprosencephaly
structural eye defects
cutis aplasia
cardiac and renal defects

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21
Q

presentation of turner’s syndrome

A

downward turned mouth, downslanting palprbral fissures
webbed neck, wide spaced nipples, lymphodema
streak gonads, lack of secondary sexual development
short stature

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22
Q

presentation of fragile X syndrome

A 
long face, prominent ears, large chin
macroorchidism
learning difficulties
connective tissue problems, hyperflexibable joints, flat feet
behavioural problems: ADD, Autism
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23
Q

causes of intellectual developmental disability

A

Genetics - down’s, fragile X
acquired - fetal alcohol/drug exposure, rubella
perinatal - intraventricular haemorrhage, hypoxic ischaemic encephalopathy
post natal - brain injury

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24
Q

benefits of breast milk

A

baby
all the macronutrients needed for growth and metabolism
protects child against infections
promotes development of the gut
reduces cardiovascular disease and autoimmune conditions in the child

mother
reduces risk of breast and ovarian cancer
reduces risk of diabetes
reduces risk of post natal depression

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25
define cerebral palsy
An umbrella term referring to a non-progressive disease of the brain originating during the antenatal, neonatal, or early postnatal period when brain neuronal connections are still developing.
26
risk factors for cerebral palsy
``` prematurity maternal illness (thyroid, TORCH, factor V leiden) birth asphyxia neonatal sepsis head injury prior to 3 years ```
27
what are the TORCH infections
``` toxoplasmosis other (syphilis, VZV, parvovirus) rubella cytomegalovirus HSV ```
28
presentation of cerebral palsy
motor abnormalities (delayed development, paralysis, weakness, ataxia, chorea) spasticity feeding difficulties speech impairment/delay in speech development delay in cognitive/intellectual development
29
complications of cerebral palsy
epilepsy behavioural problems poor growth osteoporosis
30
management of cerebral palsy
physiotherapy speech and language therapy botulinum toxin surgery
31
presentation of neural tube defects
``` paralysis or sensory loss in legs LL weakness and loss of reflexes neurogenic bladder and bowel hydrocephalus chiari II malformation - learning difficulties ```
32
management of NT defects
neurosurgical repair of the cele - antenatally or by 3 months ventriculoperitoneal shunt for hydrocephalus IV Abx to prevent neonatal meningitis
33
presentation of musclular dystrophy
DMD - onset at 3, wheelchair by 12 BMD - onset at 11, wheelchair not needed/in later life ``` loss of limb strenghth loss of muscle tone and reflexes calf hypertrophy scoliosis and lumbar lordosis positive gowers sign ```
34
diagnosis of muscular dystrophy
genetic testing elevated creatinine kinase monitor resp and cardio function
35
management of muscular dystrophy
``` genetic counselling physiotherapy oral pred resp support (positive pressure ventilation) scoliosis surgery ```
36
define febrile seizure
A febrile seizure as a seizure occurring in the presence of fever in a child between the ages of 6 and 60 months who do not have an intracranial infection, metabolic disturbance, or history of afebrile seizures
37
presentation of febrile seizure
``` simple = tonic clonic with no focal features for < 10mins complex = focal features or >10mins or recurrent seizures within 24 hrs ``` majority are simple, last 5 mins and has a rapid recovery follows a recent fever/infection
38
investigations for a febrile seizure
clinical diagnosis - routine investigations (imaging and bloods) not required for first simple seizure rule out menigitis if there is nuchal rigidity = LP EEG and MRI if recurrent complex seizure or less the 6 months old
39
management of febrile seizures
paracetamol | if ongoing for > 5mins = diazepam
40
presentation of osteomylitis
``` acutly unwell child pyrexic local erythema and tenderness (often near metaphysis) recent history of VZV is common night pain limp ```
41
management of osteomyelitis
bone aspiration if abscess IV Abx splintage of the limb
42
presentation of juvenile idiopathic arthritis
persistent joint swelling in one or more joints EMS asymptomatic anterior uveitis
43
salter harris classification
classification of growth plate injuries | I to V
44
what is perthes disease
necrosis of part of the femoral capital epiphysis and growth disturbance in the physeal and articular cartilage leading to deformity of the femoral head and degenerative joint disease
45
presentation of perthes disease
mainly occurs in 4-8 year olds groin/knee pain limp# reduced hip abduction and internal rotation
46
presentation of a slipped upper femoral epiphysis (SUFE)
early adolescence hip pain - may have referred knee pain affect limb often externally rotated - foot points out while walking associated with hypothyroidism, chronic renal failure, radiotherapy, growth hormone therapy
47
what is DDH
neonatal hip instability | acetabular dysplasia with or without subluxation and frank dislocation of the hip joint
48
presentation of DDH
screened for at birth and 6 weeks - positive barlows and ortilani test ``` in older children limp asymmetrical groin creases leg length discrepancy reduced hip abduction ```
49
causes of chronic diarrhoea in children
``` toddler's diarrhoea constipation overflow post infectious foot intolerance e.g. lactose IBD malabsorption (CF, coeliac) ```
50
causes of acute diarrhoea in children
infections (rotavirus, enterovirus, E coli, salmonella) starvation stools intussusception
51
investigations for a bleeding/bruised child
``` FBC, coag BC, WCC, CRP (infection) XM (major haemorrhage) BP and urinalysis (HSP) skeletal survey, CT head, retinoscopy (NAI) ```
52
presentation of idiopathic thrompocytopenia
acute onset bruising/petechiae absence of systemic symptoms epistaxis common following a recent viral illness
53
management of ITP
``` limit high impact activities platelet transfusion if bleeding IVIG steroids splenectomy ```
54
haemophilia summary
type A = factor 8 deficiency type B = factor 9 deficiency presents with spontaneous joint/muscle bleed or from minor trauma, raised lumpy bruises investigations - prolonged APTT, clotting screen management with recombinant factor administration IV
55
von willie brand disease summary
deficiency of factor 8: VWF ratio = decrease platelet adhesion presents with mucosal bleeding (gums, GI, epistaxis, menorrhagia), prolonged bleeding post trauma investigations: prolonged APTT, reduced F8:VWF, no platelet aggregation on co factor assay manage with prophylactic desmopressin or recombinant factor 8 for bleeding episodes
56
presentation of a brain tumour
``` raised ICP (morning headaches, vomiting, papilloedema) focal seizure neurological deficit endocrine disorders ```
57
investigation for suspected brain tumours
brain/spinal MRI tumour biopsy endocrine screen CSF cytology and tumour markers
58
differentials for a child with an abdominal mass
neuroblastoma wilm's tumour hepatoblastoma germ cell tumour
59
biochemical disturbances seen in tumour lysis syndrome
hyperuricaemia hyperkalaemia hypophosphatemia hypocalcaemia if untreated can lead to AKI, seizures, cardiac arrhythmias, death
60
management of tumour lysis syndrome
IV fluids allopurinol manage hyperkalaemia (insulin/dextrose, calcium gluconate, calcium resonium, salbutamol) dialysis
61
presentation of measles
prodrome (fever, coryza, cough, koplik spots) maculopapular rash behind ears, migrates to face then trunk complications: otitis media, interstitial pneumonitis
62
presentation of chicken pox
``` fever malaise headache abdo pain itch crops of erythematous macules, papules and vesicles ```
63
infectious period of chicken pox
2 days before symptoms to 5 days post rash
64
management of chicken pox
supportive aciclovir for high risk patients vaccination for high risk patients post exposure prophylaxis (VZ IVIG) if immunocompromised
65
presentation of parvovirus B19
low grade fever malaise maculopapular spots on cheeks (gives slapped cheeks appearance) rash on trunk and limbs (lacy appearance)
66
presentation of mumps
prodrome (fever, anorexia, headache) | painful salivary and submandibular gland swelling
67
presentation of rubella
prodrome (coryza, tender cervical lymphadonopathy) fine maculopapular rash - face spreads to trunk arthralgia
68
most common causes of meningitis in children
bacterial: neisseria meningitidis, strep pneumonia viral: enterovirus, HSV (meningoencephalitis)
69
presentation of bacterial meningitis in a child
``` fever, lethargy high pitched or irritable cry (cannot be soothed by parents) poor feeding apnoeic or cyanotic attacks seizure bulging fontanelle ```
70
management of bacterial meningitis
suspected IV ceftriaxone + amoxicillin and gentamicin if under 6 weeks confirmed N. menigiditis = cefotaxime fir 7 day strep. pneumonae = cefotaxime for 14 days
71
presentation of meningococcal meningitis/sepsis
fever + petechial/purpuric rash hypovolaemic shock DIC metabolic derangements (low, K, Ca, Mg, PO4)
72
complications of prematurity
``` sepsis PDA RDS ROP osteopenia NEC intraventricular haemorrhage ```
73
what is potters syndrome
bilateral renal agenesis
74
indications for dialysis
``` severe volume overload severe hyperkalaemia symptomatic uraemia severe metabolic acidosis removal of toxins ```
75
causes of HTN in young people
coarctation of aorta pheochromocytoma or neuroblastoma (catecholamine release) congenital adrenal hyperplasia renal tumour, renal parenchymal disease (release of renin)
76
management of minimal change GN
``` prednisolone furosemide if symptomatic oedema pneumococcal vaccination penicillin prophylaxis for risk of encapsulated organism salt/fluid restriction ```
77
causes of deafness in children
acquired pre natal - rubella infection perinatal - hypoxia, kernicterus postnatal - menigitis, head injury, ototoxic drugs e.g. cisplatin congenital usher's, pendred's
78
management if deafness in children
hearing rehab with bilateral, digital, behind-the-ear hearing aids cochlear implantation
79
most common cause of nasal obstruction in children
hypertrophy of the adenoids | associated with snoring and green rhinorrhoea
80
management of irritant contact napkin dermatitis
frequent nappy changes avoidance of soaps and wipes emollient and zinc based preparation after each nappy change topical steroid if inflamed if candida infection (satellite papules and pustules) - clotrimazole
81
what is juvenile plantar dermatosis
erythema, hyperkeratosis and fissuring of the anterior plater surface associated with sweating and sports footwear
82
management of juvenile plantar dermatoses
avoidance of occlusive footwear and synthetic socks aluminium hydrochloride to reuce sweating urea based emollients for hyperkeratosis and fissuring steroids
83
what is impetigo
highly contagious skin infection cause by s aureus | annular erythema with honey colour crust, may become bullous
84
management of impetigo
flucloxacillin prevention of spread dont share towels or bath with other children antiseptic in bath
85
molluscum contagiosum
small pearly umbilicated papules causes by MCV. | self limiting
86
management of tinea capatis
ketaconazole shampoo | oral griseofulvin or terbinafine
87
investigations for Down's
screening: maternal b HCG, PAPP-A, nuchal translucency on US, maternal age those deemed high risk offered chorionic villous sampling and amniocentesis.
88
duodenal atresia presentation
bilious vomiting after birth double bubble finding on abdominal x ray associated with downs
89
presentation of intussesception
classic triad of abdominal pain, red current jelly stools and vomiting signs: abdominal mass, distention, pallor, absent bowel sounds X ray: target lesion/doughnut sign
90
management of intussesception
``` contrast enema (air enema) +/- Abx surgical reduction +/-resection ```

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