Paediatric Key conditions Flashcards
(82 cards)
Chronic Asthma - Explanation, assessment, management
- Chronic Asthma - chronic inflammation of the bronchial mucosa associated with mucosal oedema, secretions and constriction of the airway smooth muscle narrows the ariway.
- Diagnosis - Episodic symptoms, wheeze confirmed by heathcar eprofessional, diurnal variability, atopic history, nothign suggestive of alternative diagnosis.
- Mx - Regular preventor (low ICS, or <5then LRTA) -> add on therapy (inahled LABA/LRTA)-> additional controller therapies (increasing ICS to low dose or add LRTA/LABA) -> specialist referral.
Acute asthma - explanation, assessment, management
- Explanation - Commonly from attack triggers.
- Assessment - PEF <33% predicted, 02 sats<92% in high flow O2, silent chest, hypotension, fatigue, poor respiratory effort, reduced level consciousness, agitation.
- Management - O2 -> salbutamol + steroid -> ipratorpium -> call for help + cardiac monitor -> aminophlline, IV salbutamol, Mg sulphate
Explanation, Dx, Management bronchiolitis
- Explanation - inflamamtion of the bronchioles, in response to viral infection, most commonly RSV.
- Clinical - coryza, dry cough, breathing diffiuclties, poor feeding, end inspiratory crackles, wheeze, recessions, nasal flaring.
- Dx- GORD, congenital malformations, asthma, foreign body aspiration
- Mx - humidified oxygen, CPAP may be used if ventilation required and feeding support. Mots make a full recovery in 2 weks but the cough and wheeze can last a whielw ith recurrent episodes and some may develop asthma
Croup:
- Explanation - Croup is viral laryngotracheobronchitis that is most commonly caused by parainfluenza viruses ages 6m-6y
- Clinical - Symptoms LRTi (cough, fever) for a few days then characteristic barking cough, hoarse voice, stridor. Symptoms typiclaly start and worse at night.
- Mx - Observe. Oral or nebulised steroids (single dose dexamethasone or oral prednisolone). If too unwell then inhaled budesonide or IM dexamethasone. Severe then nebulised epinephrine (adrenaline) with oxygen by face mask and observe 2-3hrs till worn off.
Acute Epiglotitis
- Explanation - Caused by H. Influenzae B. It is the swelling of the epiglottitis and sepsus
- Emergency as high risk of airway obstruction
- Clinical - High grade fever, unwell looking, drooling, no cough, soft stridor
Pneumonia - causative organisms, DDx, Mx, complications
- Explanation = Inflammation of the lung parenchyma with consolidation within the alveoli.
- Newborn - GBS, gram negative enterococci
- Infants + young children - RSV/Adenovirus/rhinovirus… Strep pneimonia (most common), HIB (unvacc)…
- 5+ - mycoplasma pneumoniae, strep pneumoniae, chlamydia penumoniae…
- Presentation - fever, cough, increased work breathing, tachypnoea, lethargy, poor feeding.
- Ix - CXR, NPA aspirate for viral PCR, bloods
- Mx - Abs (amox or PO macrolide), pleurla collections (persistent fever after Ab) may need drianage
- Complications - sepsis, acute respiratory distress syndrome, pleural effusion empyema.
- DDx - Otitis media, Rhinnorrhea, Nasal polyps, Pharyngitis, Upper respiratory infections, asthm, bronchiolitis, Bronchitis
Cystic Fibrosis
- Explanation - autosomal recessive disease from mutations in a gene on C7 that encodes cystic fibrosis transmembrane regular (CFTR) protein. Thickened, sticky secretions. Dysregulation of inflammation. Pancreatic ducts block and abrnomal function in sweat glands.
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Clinical - (heel prick screenign most):
- Neonates - myconium ileus
- Children - frequen infection, failure to thrive, wheeze, cough, stetorrhea.
- Ix - Blood spot test with immunoreactive trypsinogen. Gold standard is sweat test with pilocarpine oontophoresis as abnormally salty swear. CF genotype also available for common mutations like DeltaF508
- Mx - proph Abs, physio to clear airway, vaccines, mucolytica, nutritional management (high cal, pancreatic replacement), targeted (lvacaftor/lumacaftor).
Meningitis
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Causative organisms -
- Neonataes - GBS, Listeria monocytogenes, E.Coli
- 1m-6m - Neisseria Meningitides, Streptococous Pneumoniae, Haeophilus influenza
- 6m+ - N/meningitides, strep pneumoniae
- Viruses - Enterovirus, EBV, adenovirus, mumps
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Presentation
- Fever, headache, vomiting/poor feeding, droswiness, photophobia, hypotonia, seizures.
- Purpuric rash, neck stiffness, bulgign fontanelle, back arching brudxinski/kernig sign, atered consicousness, shock, focal neurology
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Diagnosis- FBC, CRP, Coag, U&E, LFTs, blood glucose, blood gas, cultures, viral PCR, lumbar puncture.
- LP Bacterial = tubrid, increased polymorphs, increased protein, decreased glucose
- LP viral = clear, increased lymphocytes, normal or icnreased protein, N/decreeased glucose
- Mx - IV Abs (cephalosporin), dexamethasone in bacterial infeciton over 3m supprotive therapy.
Otitis Media
- Explanation - infection of the middle ear, often followign viral URTI (But cna be bacterial). RSV, rhinovirus, strep pneumonia, haemophilusinfluenza, moraxella catarrhalis. Children has shorte,r more horizontla eustachian tubes.
- Presentation - non specific - fever, tachy, vom, distress, pain in ear. Red, bulging eardrum, loss of light reflex, purulent discharge (if perforated). Hearing loss/developmentla delay if recurrent (glue ear-OMEffusion, conductive hearing loss.)
- Management -Reassurance (self resloves 3-5days), analgesia, Abs onyl if not getting better.
Impetigo
- Explanation - Hihgly contagious skin infection commonly on the face in infants and young children, especially if pre-existing skin disease
- Clinical - Eryhtmeatous macules develop into honey coloured crusted lesions.
- Causes - Streptococcal infection
- Mx - Topical Abs for mild (mupirocin) but more severe needs systemic Abs (flucloxicillin). Nasal cream containing chlorhexidine + neomycin to eradicated source reinfection in nose.
- Complications - Cellulitis, lymphadenitis, rarely scarlett fever, glomerulonephritis, staph scaled skin syndrome.

Chicken Pox (Varicella Zoster Virus)
- Explanation - varicella zoster virus, highly contagious, av incubation 2wks and infectious 2days before rash until all lesions crusted over.
- Clinical - coryzal period, ichy rash (macules-> papules -> vesicles-> crist over). New crops over 3-5days.
- Complications - (immuncompetent or newborn infant if mother developed) - secondary bacterial infection
- Mx - symptomatic but for severe/immunsuppressed then acyclovir. VSV immunoglobulin for pasisve immunity for immunosuppressed or newborn if mother developed 7days before/after birth. Vaccine not routinely given in UK

UTI
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Presentation -Usually non specific
- infants - fever, vom lethargy, poor feeding, irritability
- Older children - fever, dysuria, increased requency, abdo pain, vom, incontinence
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Urine invetsiagtions- Urine analysis, urine culture + sensitivity (E.Coli + klbesiella). Nothign else unless concerned about sepsis
- Start Abs if +Leukocytes, +Nitrates OR -Leukocytes +Nitrates. Send for culture if Leukocytes but no nitrates
- Explanation - microorganisms in UT. Uuslaly abcteria from GIT.
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Management - good clinical ev or <3m = Abs.
- Upper UTI/pyelonephritis = Cefalexin or Co-amoxiclav
- Lower UTI = trimethoprim
- <3m = IV Abs
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Further:
- <1 = US (structural problems <6w), DMSA (4-6m after to check renal parenchymal defects), MCUG (renal reflux check).
- 1-3 = US, DMSA,
- 3+ = US
Gastroenteritis
- Expalantion - Infection of the GIT
- Causative organisms - Mostly Rotavirus in developed countries. Or (campylobacteria - gripes, lood diarrhea), E.cOl 157 (farms)
- Presentation - diarrhea, vom, fever, poor feeding, shock
- Ix - not usually but could do stool culture, U&Es, glucose, blood cultures, dehydration assess
- Weight loss, fontanella, CRF on chest, sunken eyes, skin turgor on abdo
- Electrolyte explanation -
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Management - Correct dehydration (oral/IV fluid). Abs only if suspected sepsis, immunC, malnourished
- clincial dheydration - 50mL/kg ORS 4hours
- SHock - 20mL/kg 0.5% salien rapud and can repeat with 0.9% slaine asdding 100mL/kg to maintainence
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Maintainence fluids:
- 100mL/kg/24h for 0-10kg bodyweight
- 50mL/kg/24h for 10-20kg bodyweight
- 20mL/kg/24h for >20kg bodyweight
If diarrhoea continues, give additional 5mL/kg ORS for each large watery stool.
Assessment dehydration + fluid

GORD
- Expalnation - Invol passage of gastric contents into oeosphagus. Can be from functional immaturity LES, predominately fluid diet, horizontal posture, short intra-abdo length oesophagus. reflux is common but GORD causes problems
- Assessment - Most clinical but can do: 24h oesophagela pH monitor/impedeance studies in infants, barium studies (anatomical problems), endocscopy (oeosphagitis suspected)
- Clinical - recurrent vom or regurg after feeds, discomfort lyign flat afer feed, usually well + nromal growth. In those older, heartburn, epigastric pain,vom.
- Mx - Reassurance resolve by 12/18m. More torublesome then smaller, thicker, more frequent feeds. Can also have alginate therapy (Gaviscon), 4week trial PPI/H2 receptor anatagonist.
- Complications - faltering growth from vomiting, oeosphagitis, recurrent pulmonary apsiration, dystonic neck posturing.
Celiac disease
- Explanation - Autoimmiune disease, gluten ingestion reuslts in damage to mucosa of proximal small intestine with subsequent atrophy of villi and loss of absroptive surface.Family predisposition HLA-DQ2, caucaisan, othe rautoimmine,downs, turners syndrome.
- Presentation - Mlaabsorption (8-24after weaning), falteirng growth (+ buttock wasting), abdo pain, distention, abnormal stools. Also non specific - anaemia.
- Invetsiagtion - Serological screening (Anti-tTG, EMA Abs +), mucosal changes of small intestine on biopsy.
- Management -Gluten free diet or risk micronutrient def, osteopenia and malignancies.
IBD overview
- Crohns = mouth to anus, non caseating epitheliod cell granulomata. Transmural
- UC = COnfined to colon, mucosal inflammationa and crypt cell damage.
- Presentation - Abdo pain, diarrhe,a failure to thrive, weight los,s delayedpuberty, oral lesions, arthralgia etc.
- Ix - FBC, CRP/ESR, fecal elastase, biopsy
- Crohns Mx - nutritional therpay, systemic steroids, immunsupressana, Anti-TNF (infliximab)
- UC - Aminosalicylates (Mesalazine), topical or systemic steroids, immunsuppressants.
Obesity
- Causes - Excess calories, reduced activity, prevalence in family, endocrine, chromsoomal (cushings, hypothyroidism, Prader-Willi)
- Consequences - Long temr health risks (DM, hypertension, ischaemic heart disease), emotional disturbance, obstructive sleep apnea.
- BMI = WEIGHT (kg) /HEIGHT^2 (m)
- Overweight >91st centile
- Obese >98th centile
- Prevention - decreased fat, fruit, veg, reduce screen time, physical activity, education
- Mx - drug treatment for over 12 and BMI>40 (extreme obesity) or >35 and complications. Orlistat (reduce absroption dietary fat-> steatorrhea), bariatric surgery.
Flaterign Weight
- Classification - Mild (falls across 2 centile lines), severe (3centile lines). The more drop when already in bad centile, the more concerning.
- Exam - ABCDE, weight/height/lenght/headC, nutritional status, chronci illnes,s neuro/developmental, organic/non organic signs.
- Ix - none other than sometime bloods, stools, environment assess
- Mx - determine severity, dpeend son cause, supportive hospital, outpatient 9diary, dietician…), cousnelling
- Causes - Inadquate nutrional intake, inadequate abdorption nutrients, psychologicla deprivation, neglect/child abuse, underlying patho, excessive enrgy expenditure form underlying problems, inadequate retention, malabsorption, failure to utilise nutrients, increased requirements.
Hepatomegaly Causes
- Infection – congenital, infectious mononucleosis, hepatitis, malaria, parasitic infection
- Hematological – sickle cell anemia, thalassemia
- Liver disease – chronic active hepatitis, portal hypertension, polycystic disease
- Malignancy – leukaemia, lymphoma, neuroblastoma, Wilms tumour, hepatoblastoma
- Metabolic – glycogen and lipid storage disorders
- CV – heart failure
- Apparent – chest hyperexpansion from bronchiolitis or astma.
Appendicitis
- Explanation - Infalmamtion of appendix secondary to obstruction (usually by faecolith or lymphoid hyperplasia).
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Clinical -
- Abdo pain (perimbulical -> sharper, RIF) worse on movement. Anorexia, nausea, com, diarrhea, constipation.
- Fever, tenderness + guarding in RIF (McBurneys point 1/3 RASIS to umbilicus). If unwell, signs peritonist like high temp, abnormal obs.
- Red flags - Perforated can cause peritonitis >40C, profuse vom, severe tender/guarding or absent bowel sounds.
- Ix - FBC (increased WCC), CRP, US
- Mx - Obs, analgesia, fluid resus, IV Abs if concerned perforation and unwell. Appendicectomy withiV Ab cover.
- COmplications - Perforation, sespsis, pelvic abscess, appendiceal mass
Pyloric Stenosis
- Explanation - Due to hypertrophy of smooth muscle of pylorus cuasing gastric outlet obstruction. More in bodys 2-8ks life.
- Clinical - Persistent, projectile nonbilious vomiting after feeds. Infant remains hungry and eager to feed after vomiting. Weight loss, constipation, dheydration, mild jaundice after few days.
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Dx -
- Test feed- gastric peristsalss waves L->R. Pyloric mass in RUQ
- CBG - Hyperchloraemic metabolic alkalosis with low plasma sodium + potassium from vom
- US
- Mx - Rehydration, correct electrolyte imbalances, pyloromyotomy
Key Milestones + Red Flags
- Red flags - 10w not smiling, 9m left hadn preferences, 19m not wlaking, 2 1/2 not putting words together
- Newborn - wriggle, startled to loud noise, cry
- 3m - tummy time, vocalisation, giggling, smiling
- 6m - sitting, rolling, palmar grasp, undestand no, weane to solid food
- 9m - crawling, hold furniture, pincer grip, mama, stranger awareness
- 12m - walking (mostly furniture), casting, clap, peekaboo, driknk from cup (2hands), hold spoon
- 18m - run, climb, jump, scribble, single words
- 2 yrs - run, kick ball, throw (not catch), read book, 50siungle words, tantrums
- 3yrs - nursery, hop, copy circle, name friends, imaginative play
- 4yrs - reception, up/down stairs like adults, learn to write name, tell stories, toliet trained, knife/fork
Causes for developmental delay - Genetic (downs, fragile X…), injury, CNS malformation, endocrine.metabolic (hypoT), neurocutaneous, idiopathic.
Autistic specturm disorder
- Explanation = pervasive developmental disorder presenting in childhood, lifelong.
- Rf = 1st degree rel with schixophrenia, soidum valproate inpreg, gestational age <35, learnign dis…
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Clinical =
- Impaired reciprocal social interaction - hard forming relatipnships, avoid eye contact, reduced response to others emotion
- Impaired communication - delayed speech, language develpment
- Restricted itnerests + repetitive behaviours
- Comorbities - learning + attention problems, seizures…
- Asperger- high functioning. Normal intelligence etc but still problems.









