Flashcards in Paediatrics 1 Deck (138):
How much of their birth weight may a newborn lose in the first few days of life?
Up to 10% normally
3 signs of dehydration?
Dry mucus membranes
Decreased skin turgor
Sunken anterior fontanelle
Most common causative agent of bronchiolitis?
Respiratory syncitial virus RSV
Apart from RSV what viruses commonly cause bronchiolitis? Which has the worst outcome?
Human metapneumovirus hMPV
Adenovirus - most virulent
How is faltering growth generally defined via growth chart?
Falling off growth curve and crossing 2 centile lines
Early symptoms of bronchiolitis?
Looks like viral URTI, low grade fever
Later symptoms of bronchiolitis?
Cough, dyspnoea, wheeze, cyanosis, vomiting, poor feeding etc.
What exam findings are classical of bronchiolitis?
Tachypnoea and tachycardia
Increased work of breathing
Widespread bibasal inspiratory crackles and high pitched expiratory wheeze
Why might liver and spleen be palpable in bronchiolitis?
Hyper expanded lungs
What tests can be done to diagnose bronchiolitis?
NPA and RSV testing via PCR
+/- other viral cultures e.g. adenovirus, hMPV, PIV
Management of non-complicated bronchiolitis?
Usually self limiting after a week or 2, so supportive management with fluids, nutrition and temperature control
What sorts of things indicate severe bronchiolitis disease?
Increased work of breathing - nasal flaring, grunting, intercostal or sub costal recession, tachypnoea, cyanosis -> apnoeas and desaturation
Poor feeding and dehydration
What is the genetic mutation that most often causes CF and what protein does this damage?
CFTR chloride channel protein
Mode of inheritance of CF?
Classical presentation of CF?
Recurrent LRTIs with chronic sputum production, faltering growth
What screening exists for CF?
Guthrie card at day 5-6 for immunoreactive trypsinogen IRT
Then do CFTR testing
What ENT finding in children is almost always linked to CF?
GI presentations of CF?
Steatorrhoea and malabsorbation
Acute or chronic pancreatitis
Liver damage - portal hypertension, varices, haemorrhage
Signs on examination of CF?
Crackles, upper lobe wheeze
What spirometry picture does early CF yield? (Without bronchiectasis)
What is first line investigation for a child presenting with suspected CF?
What organism has a high mortality link with CF?
What type of infertility do most male CF patients have?
What is the trend in asthma gender prevalence with age?
Prepubescent more common in boys
Adulthood more common in women
Major presenting symptoms of asthma?
Cough - dry, non-paroxysmal, typically worse nocturnally
When is asthma traditionally worse?
At night or early morning (diurnal variation)
Also seasonal variation in symptoms - may be worse in cold winter or polleny summer
What is Harrisons sulcus?
A permanent chest wall indentation along costal margins caused by chronic or severe asthma in kids
Over what sort of ages are PEFR and spirometry able to be reliably used on kids?
What is the key spirometry finding which differentiates asthma from COPD?
High reversibility on administration of bronchodilator
What sort of long term management tools are used for childhood asthma?
Have to use an inhaler with a spacer +/- facemask if under 3
Start with inhaled SABAs PRN +/- steroid inhaler or leukotriene regular
3 reasons why spacers are better than no spacers?
Work better - more drug into lungs
Less risk of sore throat, oral candidiasis etc.
Better than nebuliser in an emergency
What is the most important early management step of acute, life threatening asthma attack in kids?
Apart from early steroids, what needs to be given in management of acute asthma in kids?
High flow O2 via mask/nasal cannula aiming for sats 94-98%
B2 agonist inhalers - use spacer +/- face mask
What is the next step of acute asthma management in kids after inhaled B2 agonist?
IV salbutamol, inhaled ipratropium neb
Eventually IV aminophylline
Alternative names for croup?
Laryngotrachietis or laryngotracheobronchitis
Febrile child with hoarseness, cough and stridor. Diagnosis?
What viruses typically cause croup?
Parainfluenzavirus PIV 1,2,3
Pathophysiology behind croup?
Infection with PIV causes subglottic laryngeal mucosal oedema, which is the narrowest part of the paediatric airway hence causing stridor
What does the cough typically sound like in croup?
What is spasmodic croup?
A non-infectious croup variant that occurs at night and is typically recurrent
Early symptoms of croup?
Then acute onset barking cough, stridor, hoarse voice +/- respiratory distress
When is viral croup normally worst? How is this different from spasmodic croup?
Viral croup is worst at night but still occurs in the day, but spasmodic croup occurs only at night
Medical management of croup?
Corticosteroids to reduce laryngeal mucosal oedema
Nebulised adrenaline if respiratory distress may be useful
What is bronchopulmonary dysplasia/chronic lung disease?
Oxygen dependence after 36 weeks corrected age (gestation + chronological)
What are the two biggest contributing factors to the development of BPD?
Birth weight (low)
2 major causes of BPD?
Need for artificial ventilation early in life
What is the typical progression in BPD baby?
Born very early (around 26 weeks), ventilated at birth then CPAP then eventually supplemental O2
Prophylaxis against RSV?
Palivizumab - vaccine for RSV indicated for at-risk kids e.g. BPD, heart disease, CF
What is Kartagener's syndrome?
Primary ciliary dyskinesia + dextrocardia with situs invertus
What investigation is best for bronchiectasis?
Most common causative agents of pneumonia in newborns?
Most common causative agents of pneumonia in infants?
Often viral pneumonia e.g. RSV
Otherwise HiB, strep pneumoniae
What helps to differentiate between pneumonia and bronchiolitis/other acute respiratory illnesses?
Focal chest signs - inspiratory crackles, dull percussion, reduced resonance, reduced air entry
What is the most important underlying pathophysiological feature in otitis media?
Eustachian tube dysfunction
3 reasons why kids are more predisposed to otitis media?
Developmental immaturity of Eustachian tube
Immature immune system
Frequent URTIs causing bacterial colonisation of tube
2 most common pathogens implicated in childhood otitis media?
3 common presenting symptoms of otitis media?
Otalgia which is worse when supine
What features of a history are more suggestive of OME than AOM?
What investigation is key to investigating OM?
4 things to comment on when observing the tympanic membrane?
4 factors that contribute to urinary stasis (therefore acting as risk factors for UTIs in children)?
At what age do kids start to develop 'classic' symptoms of UTI?
Age of 2
Major underlying pathophysiological feature in recurrent UTIs in children?
Vesico-ureteric reflux VUR
Apart from urinary stasis, other RFs for childhood UTIs?
Spinal lesions incl spina bifida
Pattern of symptoms with increasing age for UTIs in kids?
More non-specific the younger they are
Generally fever, irritability, lethargy -> nausea vomiting abdo pain -> loin pain, typical LUT symptoms
What is the generally accepted standard for urine collection in kids? Alternative?
Otherwise plastic bag method, nappy collection pads or catheter/SPA
3 imaging techniques for investigating UTIs in children?
USS - stones, renal size and outline etc.
Micturating Cystography MCG - VUR
DMSA scan - renal parenchymal defects
What investigation is best for demonstrating VUR in kids?
What investigation is best for demonstrating renal parenchymal defects in kids?
What is Kawasaki disease and who does it affect?
Systemic vasculitis disease affecting kids from 6m to 4 years, typically around age of 1
What is the key symptom of Kawasaki disease that must be present to make a diagnosis?
Fever for over 5 days
5 'accessory' symptoms of Kawasaki disease?
Non-exudative bilateral conjunctivitis
Mucous membranes become red and dry, cracked lips, strawberry tongue
Polymorphous non-vesicular rash
Red oedematous palms and soles -> peeling of fingers and toes
Complications of Kawasaki disease?
Coronary and peripheral aneurysms
Gallop heart rhythm
Over what sort of time period do the symptoms of Kawasaki disease last?
Around 4 weeks, complications arising in 2nd month
What disease can cause a BCG scar to become inflamed?
What is characteristic about the fever in Kawasaki disease?
High and difficult to control, acute onset
Child disproportionately irritable
What blood abnormality occurs in Kawasaki disease that can have risk of thrombosis? Prevention of this?
In whom does Henloch-Schonlein Purpura HSP occur?
Young boys - 3-10 yrs old
What is HSP often preceded by and so when does it more commonly occur?
Viral URTI and so more common in winter months
What is the pathophysiology of HSP?
Exaggerated immune response to antigen exposure causing an inflammatory vasculitis and complement deposition in organs
4 common symptoms of HSP?
Colicky abdo pain and bleeds
What is the rash like in HSP?
Buttocks down, on extensors of legs and ankles. Trunk sparing
Purpural palpable rash
What joints are typically affected in HSP?
What urinary abnormalities are commonly present in HSP?
Micro/macroscopic haematuria, proteinuria
Potential renal complications of HSP?
What is a febrile seizure?
A seizure in the absence of intracranial infection accompanied by a fever (>37.8 degrees axillary)
In what age of kid do febrile seizures occur?
6m to 5 years, peak around 18m
What feature of a temperature determines how likely it is to result in febrile seizures?
The speed of the rise
What type of seizure is a febrile seizure?
When in the course of an infection is a febrile seizure most likely to occur?
Early on when temp rapidly rising
4 factors that make febrile seizures more likely to occur?
Lower temperature at onset
Shorter duration of illness pre-seizure
What 3 things constitute 'complex' febrile seizures?
Focal, prolonged (>15mins) or more than one in same illness
2 options that can be given in febrile seizure if been going on for 5 mins?
Rectal diazepam or buccal midazolam
What important differential cause must be suspected in any young child who has a febrile seizure?
What are the majority of causative infections in febrile seizures?
Viral URTIs, tonsillitis, OM
What infection can cause an afebrile seizure?
Important more serious causes of febrile seizures?
Prognosis for febrile seizures?
Recurrence rate around 30-40%
Long term damage (brain damage, epilepsy) is rare
Both of the above depend on simple/complex and recurrence RFs
In what age is bronchiolitis found mostly?
Around 6m to 1yr, rare after 2
At what age is croup found?
Up to age of 6
At what age is necrotising enterocolitis found?
Typically within few days of 40 weeks gestation - often in first few days, rare after 3m
What is the age of child in which febrile seizures occur?
6m to age of 5 or 6
What is the management of febrile seizure duration?
5 mins call doctor or bring in
>15 mins is a complex seizure
>30 mins is status epilepticus
4 ways in which a febrile seizure might be called complex?
Occurring early in illness
Occurring more than once in same illness
Partial or focal in nature
Lasting >15 minutes
Major contraindication to all vaccines?
Previous severe allergic reaction to vaccine
Situation which should prompt caution when giving any vaccine?
Moderate-severe illness in child
2 live vaccines? What implications do these have?
Can't give if child immunocompromised
What vaccination can't be given if child has SCID or other severe immunodeficiency (besides the lives)?
2 major RFs for Down's syndrome?
What is often the first thing noticed in a baby with Down's syndrome?
What haematological abnormality can occur in Down's syndrome?
Transient myelodysplasia of newborn (like transient leukaemia and polycythaemia)
Also increased risk of AML, ALL
Head and face features suggestive of Down's syndrome?
Slanted palpebral fissures
Low, flat nasal bridge and upturned nose
Ears - low set or other abnormalities
No philtrum, small upper lip, protruding tongue
Hand and feet features of Down's syndrome?
Single palmar crease
Short, curved little finder
Short broad hands
Gap between hallux and second toe
What things should be screened for in Down's syndrome?
Congenital heart defects
GI defects - oesophageal, duodenal, anal atresia, coeliacs etc.
Cataracts and glaucoma
What common endocrine abnormality is associated with Down's syndrome?
When does infantile colic tend to resolve? What typifies it?
By about 4m
Inconsolable crying and indrawing of knees (particularly evening) but is a diagnosis of exclusion
What must be excluded to suggest diagnosis of infant colic?
Cows milk protein intolerance
Differentials for childhood wheeze?
Pneumonia - esp atypical
Cardiac wheeze (heart failure)
2 areas of Sx of hypoglycaemia?
Neuroglycopenic Sx of hypoglycaemia?
Headache, irritability, drowsiness, LoC, coma, seizures
Adrenergic Sx of hypoglycaemia?
Sweating, tremor, pallor, hunger, tachycardia/tachypnoea, visual disturbance
Rash classical of rubella?
Maculopapular, distinctly rose-like
What eye signs are suggestive of rubella?
Pain on upwards and lateral eye movement
When is MMR given?
12-13 months and then 3-5 years
5 contraindications to MMR?
Another live vaccine given in prev 3 weeks
Risk of MMR vaccine?
Fever +/- rash for couple of days around 1 week after vaccine
NO autism or IBD link
Why MMR as opposed to single jabs?
Single jabs require private healthcare - not on NHS (MMR recommended by WHO and RCPCH)
No evidence to say they are as effective or safer than combined
Poor compliance likely
Wouldn't be fully immunised until age 7; more vulnerable to disease
Important things to remember regarding inhaler advice for kids?
Check expiry date
Can use more than one puff, 30s apart
If need to use more than 3 times per week see GP
Advice regarding spacer use in kids?
5 tidal breaths or 10s in babies (with mask)
Wash once per week - hot soapy water, drip dry
Replace every 3-6 months
What must have happened for coeliac to present?
What can occur transiently post-gastroenteritis, causing flatus diarrhoea bloating and abdominal cramps with certain foods?
Carbohydrate e.g. Lactose intolerance
What does weight gain, delayed puberty, TATT and dry skin/coarse hair suggest in a teenager?
When does DMD or BMD present? How?
Around 2-3 years, starting with proximal muscle weakness
5 causes of language delay in kids?
Deafness e.g. OME
Articulation problem e.g. Cleft palate
Lack of stimulus (?neglect)
Describe oppositional defiant disorder?
Loses temper easily, argues with adults and defies requests
Deliberately annoys others
Describe conduct disorder?
Bullying, threatening, intimidation
Cruelty to animals
Differentials for a febrile convulsion?
Seizure or paediatric epileptic syndrome
Reflex anoxic seizure
Breath holding spell