Paediatrics Flashcards
1
Q
What is most common cause of paediatric admission?
A
Infection
2
Q
Where is commonest infection in children?
A
Respiritory tract
3
Q
What group of children are in need of care for infeciton?
A
Younger ones
4
Q
What is a challenge with viruses?
A
They can mimic bacterial infections
5
Q
What to do with antibiotic decisions?
A
Assess, give as narrow spectrum as possible, then take samples to help advise in the future.
6
Q
What are difficulties with Abx in children?
A
Tollerability, forulation, toxicities and pharmacokinedics dificult and studies are challenging and often done later
7
Q
What is the problem with chickenpox in children?
A
Fever get broken skin, and then bacterial infection that can be serious
8
Q
What kind of infections can happen after chicken pox?
A
Skin bone joint infections
9
Q
Kawisaki disease what is the importance?
A
Most serious disease for complications, most common cause of aquired heart disease in children
10
Q
What are diagnostic criteria for Kawisaki disease?
A
4/5 fever 5 days plus red swollen hands, fed swollen fee, rash involving body, red bloodshot eyes stomatitis
11
Q
What is the link with inflammation and infection?
A
Infection can cause excessive inflammation and body usually has inflammatory response.
12
Q
What is can fever indicate in children?
A
sepsis, bacterial, Immune diseases, inflammatory, travel
13
Q
What investigations are needed for under 3 months fever?
A
FBC, Blood culture, CRP, urine culture other investigations
14
Q
What to do investigated under 1 month with fever?
A
Lumbarpuncture FBC, bloood cluture CRP urine culture
15
Q
What are the fauses of meningities or encephalitisi in under 3 months?
A
ecoli listeria, pneumonococcus, meningococcus
16
Q
What are the casuitive organisms of meningitis or encephalitis in over 3 months?
A
Meningococcus pneumococcus haemophilus influenza non b
17
Q
When is it likely to stop getting meningitis?
A
After 3 or 4 weeks
18
Q
What tests do to look at immune competency?
A
immunoglobulin levels not so much IgG but the other immunoglobulins
19
Q
What is immune difficicney presentation?
A
Can be an emergency, infections unusually ones or not clearing, IgG, can be presenstation with abnormal blood count with no infection
20
Q
What are the types of immune congentitial issues?
A
Some cant make antibodies some cant make T cells, othere no neutrophils, some can’t make effective neutrophils.
21
Q
What are most common immune defficienty?
A
Antibody defiecienceis, combined cellilar and andibodies then others
22
Q
10 warning signs of immune deffiiceiny?
A
frequent infection, thrush and family history of it
23
Q
What is treatment for immune defficeincy?
A
Prompt treatments, antivitrals and antibacterials
24
Q
What is pasive immunisation?
A
Give you immunoglobulins to help fight off but give no memory
25
What are live vaccines?
MMR BCG nasal flu rotavirus
26
Look at which viruses are included for children?
7 in 1,
27
Look at which viruses are included for children?
7 in 1,
28
Why are vaccines in pregnancy?
for the mother bbut also passes on Immunoglobulines to the child when its been born
29
What is the impact of covid on vaccinations?
The vaccination rate dropped due to interruption with the process
30
What are the congenital or perinatal infection?
HIV maternal, Hep B, CMV, Rubella, HSV VZV more
31
What usually causes cardiorespiratroy arrest in adults?
Primary usually suddene unpredictable, VF or VF success depends on response
32
What is main cuase of cardiac arrest in children?
Usually hypoxia from respiratory failure, myocardial hypoxia results in bradycardia then asystole, neeed to prevent tis by spotting respiratory. The cardiac causes are primary such as congenital
33
What is causes for breathing problems?
Oxygenation or breathing
34
What is respiratory failure?
Mismatch of lung ventilation and perfusion causes reduced oxygenation, inadequate ventilation leads to increase psCO2
35
What to do for breathing assessment?
effort of breathingResp rate work of breathing extra noises, efficacy of breathing: chest expansion, auscultation, pxygemation, effect of breathing HR skin colour mental status
36
What is problem with respiratory rate measure?
If distressed, in pain of have fever it can go up
37
What happens in exhaustion for children breahting?
breathing slows and is pre-terminal sign
38
What are causes of low HR?
Respiratory depresssion from cerebral proble,s children with neuromuscular conditions that can affect breathing, fatigue
39
What are signs of increased effort of breathing?
Stridor wheeze, crackles
40
What is the level of oxygen when you have cyanosis?
less than 70%
41
wHAT IS NORMAL RANGE OF SPO2 TO AIM FOR?
94-98
42
What can affect spo2 reading?
High pco2 or movement
43
What can cause increased HR?
Infection hypoxia hypercarbia
44
What is Respiratory decompsensation?
Increase in resp rate or sudden fall in resp rate, exhaustion and drops GCS reduced interaction with caregivers
cant remover co2 or get on o2 fast enoug
45
Assessig circulatory state?
Pulse heart rate, Perfusions central peripheral target organ perfusion, blood pressure preload, urine output
46
Where to assess pulse in baby?
In femoral brachial more than radial or carotid
47
What can affect heartrate artifactually?
Fever pain anxiety anxiety and shock
48
What is most common heart arrhythmia in children?
SVT
49
What is normal cap refill time?
less than 2 sec
50
What are erly signs of cerebral hypoperfusion?
loss of interest in surroundings, irritablility agitation, late signs drowsiness loss of consciousness hypotonia
51
How to assess urine output in childerne?
Ask about changing nappy or use urinary catheter
52
What is compensated shock?
The arterial blood pressure is mainteanes
53
What is decompensated shock?
When blood pressure drops
54
What is AVPU?
alert voice response to pain or unresponsive
55
What is decorticate posturing?
Arms drawn to chest feed togetger
56
What is decerebrate posturing?
Exetended arms internal rotated legs
57
What is lowest GCS?
3
58
What is each section out of for GCS?
M1-6 E1-4 V1-5
59
What represents a sever neurological drop in GCS?
1 or 2 points can be a lot
60
What to look for in exposure of ABCDE assessment?
Respect dignity, rashes, injuries, environment temperature, equipment.
61
Ho to describe status fo child?
stable in failure decompensated or compensated
62
What is management of compensated respiratory failure?
Child friendly approach in parents arms, O2 therapy monitoring, specifica therapy reassess seek senior help
63
What to do in decompensated resp failure?
ABCDE approach open maintain airway,o2 15l/min bag mask ventilation, assess adequacy of centilation, reassess and monitor HR Pulse oximetry RR
64
What to do in compensated circulatory failure? assess airway oxygen, monitorpulse oximetry HR, RR and BP,
assess airway oxygen, monitorpulse oximetry HR, RR and BP, IV or IO access IO if cant get IV, Fluid bolus20ml/kg plasmalyte or o.9% NaCl, Reassess after any intervention,
65
What is probelem with giving fluid bolus sometimes?
Heart conditions that could cause overload as might need ionotropes instead
66
What proportion of baby is water?
75% preterm 90%
67
What is different about babys body to do with water?
Lose fluid faster, lowr response to thirst independance and glomerular filtration, increased surgface mass metabolism respiratory rate.
68
What categoris can causes of dehydration come into?
Decreased intake or absorption, Increased losses
69
What are the signs of dehydrateion?
Mild 5% thirst dry lips restlessness, irritibility, moderate, sunken yeses reduced turgor decreased urine output, severe cold mottled peropheries, hypotension, anuria, reduced consciousness
70
What is chronic fluid deprevation?
Falure to thrive malnutriotion, constipation, urinart tract infectiosn
71
What are best ways to replace fluids in less than 6 months?
Mothers milk, or formulas
72
What are the infant formula?
Hungry baby to reduce hunger, antireflux tickend fluids, lactose free, Cows milk protein allergty formula so can have hydrolyed fluids amino acid based, goat milk formula or soy formula from 6months
73
What are non oral types of nutrition?
Nasogastric orogastric, nasoduodenal and oriduodenal or can do Percutantiosu endoscopic gastrostomy, gastrostomy, jejunostomy
74
What is solution for malabsorption if GI tract isnt happened?
Central access
75
When to use fluids in children?
not dehydrates for surgery give maintenance, if they are mildly dehuydrated, maintenance plus deficit, FOr very sick maintenance defecit and bolus
76
What type of fluid do you use in neonates?
10% glucose in neonates.
77
What happens to fluid diven in neonates?
Increase almost every day
78
What to do to check not dilutiong blood?
Monitor electrolyes every day
79
How to estimate child weight?
(Age+4)*2 = Weight
80
What fluid do we do for children?
0.9% sodium chloride+5% glucose(+/- KCl 10-20mmol/500ml)
81
Why don't start Potassium for children?
Need to know if they are in defecite and if they are urinating
82
What is the volume and rate for a child?
first 10 kg give 100ml/kg/24hr
next 10kg 50ml/kg
every other Kg 20ml/kg
83
What is easy way to remember fluids?
1L for first 10kg, .5L for second 10 kg plus 20ml* rest of weight
84
How to correct fluid deficit?
Mild dont correct, mild 5 percent, severe 10%.
Use deficit(%)*10*weight in Kg In litres
this is to add to the rate
85
When do you use fluid bolus?
When it's an emergency
86
What fluid to use for fluid bolud?
Normal saline 0.9%
87
What is volume rule for bolus?
10mls/Kg
88
What to monitor in children on IV fluids?
RR and O2 sats, HR and BP, Temperature, Neurological status, Fluid balance, U&E
89
What type of diabetes do children often have?
Type 1 or genetic types
90
What are the 4 main symptoms of diabetes type 1?
Toilet thirsty, tired and thinner
91
Why is glycosuria bad?
Have a very high level of glucose in the blood if have in the urine
92
What is normal blood glucose?
fasting 3.5-5.6 postprandial <7.8 random glucose >11.1 if symptomatic or 22.2 if asymptomatic.
Fasting over>7.0*2, OGTT Peak>11.1 two hours after 75g oral glucose
93
What is normal ketones level?
above 0.6 is worrying
94
What are 3 things for Diabetic ketoacidosis?
Acidotic ketotic and hyperglycaemia
95
What leads to DKA?
Cells don't get the glucose from insufficient or absent glucose, then break down fats and protein and this causes ketones. and glucacon is secreted so get more release of glucsoe as cells are in low
96
What happens in DKA physiologically symptoms and sings?
Insuling def and glugagon excess causes increase ketones and blood glucoses leading ot osmotic diuresis vomiting and fluid electrolyte deplletion that can case cellular dysfunction, cerebreal oedema and shock
97
What is management of DKA?
Fluids(be careful with fluid shifts), Insulin, Monitor glucose hourly, Monitor electrolytes, especially K+ and ketones-2-4 hourly, Very strict fluid balance hourly I/O hourly neruo obs.
98
How long to leave giving insulin in DKA and why?
1-2 hours and because causes more of a fluid shift
99
What are in new diagnosis bloods?
Antibodies, and other autoimmune disease and bloods
100
What are serious complications of DKA?
Cerebral oedema, Shock, hypokalaemia, aspiration, thrombus
101
What is normal DMT1 treatment?
basal bolus, so take long acting once a day and then bolus before they eat carbohydrates.
102
What is classed as hypoglycaemia in diabetic children?
4
103
What are symptoms of hypoglycaemia?
Irritable hungry nauseous shaky anxious sweaty palpitations pallor neuroglycopenic, confused drowsy heartn cisula problems headache slurred speech.
104
Hypomanagement diabetes?
Fast acting sugars glucose tablets glucose gel glucose containt food or drink, not chocolate
follow up wiht longer acting carbohydrate
105
How long should hypo correct?
15 mins
106
What is emergency treatment for hypoglycaemia?
Glucagon
107
How often if checkup for diabetes?
every 3 months
108
What to check for regular diabetes?
annual eye screen, feet, urine BP, Injection site and Annual bloods to screen for any other conditions
109
When should transition from paediatrics diabetes to adult?
from 12 when appropriate for them
110
Why are things different for adult diabetes?
More new things to deal with live living alone or other substances
111
Why are things different for adult diabetes?
More new things to deal with live living alone or other substances
112
What are the symptoms of juvenile idiopathic arthritis?
swollen stiff painful joint for 6 weeks or more and all other causes are ruled out
113
What do you need to rule out JIA?
Infection septic arthritis and malignancy
114
What is initial treatment for JIA?
Steroids injection of IV or oral
115
What is used for long term treatment of JIA?
methotrexate
116
What other medications are used for treatment resistant JIA?
Biological therapies, newer therapies, repeat steroids,
117
What are the complications of JIA?
Uveitis mechanical damage, side effects of MTX nausea lowered immunity
118
What can the effects of chronic illness be spit into?
Biological( delayed growth/ puberty), psycholgical ( sick role regression mental health vody image), social ( decreased independence, failure of peer relationships , poor school attendand and family dynamics)
119
What is important for JIA in teenagers?
Need to support transition to adult services and increased independance in care for own disease
120
What is a structure to ask people with JIA or any adolescent with chronic disease?
Home
Education
Activities
Drugs and alcohol
Depression and Suicide
Sexual health
Spirituality
121
What are implacations of children being small?
High surface area/volume ratio, so if we bring a small baby for a study room has to be bigger. smaller equipment needed, fit torso on a small plate,
122
What is a challenge with cooperation for radiology?
Hard to get children to stay still or cooperate with the scan. they are more scared for interventions. can't do aspirates as easily.
123
What is play therapy for in radiology?
Try to let children get used to te idea of the scanner and help them do it
124
What is difference to anatomy in children?
Smaller, some bones are not ossified, growth plates,
125
What is the effect if growth plate is damaged?
The growth will slow or stop in that area.
126
What is a n apophysis?
An extra growth plates of bone for tendons to attach to with a muscle
127
What is the difference in bone structure in children?
The bones are flexible and plastic. so can get greenstick fractures that adults dont get
128
What is the use of fontanells in immaging?
They allow the ultrasound imaging of the brain.
129
Why is it more of a danger to radiate children?
Their cells are dividing so more sensitive to radiation changes.
130
Which scans are best for children?
Ultrasound, MRI compliance is a challenge. CT nuclear medicine and PET are more of a challenge
131
What to think about when requesting scans in children?
Why do you want it what is differential diagnosis, what am i trying to demonstrate will the child cooperate,
132
What is growth like in children?
Gain in weight is not the only thing, Grow
133
Why do we monitor growth?
It is narrowly defined in healthy children wiht adequate nutrition and emotionally supportiv enevironment and can show an underlying issue
134
What affects growth?
Pregnancy related factors infections smoking, genetics, food, endocrine factors psycosocail factors
135
Where do children grow bone?
At thegrowth plate, epyhysis
136
What regulates bone growth?
Endocrine signals, nutrition, ECF inflammatory cytokines (hypoxia sepsis acidocsis acan all affect growth)
137
How to assess growth?
Measure routine screening record on charts, interpretation action
138
What to ensure with height measurement?
Backs to the backboard, hold head level shoes and socks off
139
What can you measure in babies?
Head circumference, height and weight
140
What is genetic target height?
average height of parenta +-7depending on boys or girls
141
What are growth velocity charts like?
Fastest grwoth in 2-3 years then slows and get another growth spurt at puberty
142
What affects eary growth the most?
Nutrition
143
What affects mid childhood growht the most?
Endocrine factors
144
What affects growth at puberty?
The closing of the growth plates from oestrogen
145
Why do boys usually grow taller than girls?
They go through puberty later
146
What are the common growth problems in children?
Failure to thrive, short stature and overgrowth
147
What is likely to cause failure to thrive?
Vomitting diarrhoea dysmphic features,
148
What are red flags in growth failure to thrive?
Weight more than 2 centils less than height. and
149
What can cause short stature?
Phsycosocial, genetics, malnutrition, constitiunitonal idiopathic, enironmentalphsyical disease skeletal disease, turner's syndroem, endocrine
150
What are two causes of overgrowht?
with impared final heigh or with increased final height
151
What can cause overgrowth with impaired final height?
precocous puberty, congenital adrenal hyperplasia, McCun-albright syndrome hyperthyroidism
152
What is sequence of puberty in women?
Breast buds, pubic hair growth and height spurt and menarche
153
What is the sequence of male puberty?
testicular enlargment pubic hair growth eight spurt
154
What is the sequence of male puberty?
testicular enlargment pubic hair growth eight spurt
155
When is delayed puberty?
14 years in bosy and 13 in girls
156
WHat is precocious puberty?
less than 8 for girls less than 9 for men
157
How to stage male puberty?
tanner stages, testicular size pubic hair,
158
What is beginning of puberty in boys?
3mls testicle size exceeded
159
What is used to stage women puberty?
tanner stages
160
What is beginning of puberty in girls?
Palpable breast buds
161
What is skeletal maturity?
shows Growth in compatison to chronological age.
162
What does high bone age help in assessment?
Allow you to see what endocrine stage they are at
163
Why might babies have a small period or breast bud?
There are high lebeld of GnRH in the body at birth efore they are born
164
What is a limp?
Asymetric gait deviation from normal age-appropriate gait pattern
165
What to ask in history for limp?
age (to look at age specific things), where is it painful how long for,
166
What to ask in history for limp?
age (to look at age specific things), where is it painful how long for,
167
What are common misleading factors in history?
Trauma is not always the cause of pain, the site may be refered
168
How to examine limp?
Assess gait, look(attitude, swelling asymmetry, redness bruise rash, muscle wasting/atrophy) feel (Limb temperature, swelling effusion tenderness lymph nodes) move check for pain, characteristics of the movement muscle tone strength measure. inspection
169
What is the attitude of a limb why is it important?
The position of the limb. This can give you ideas about swelling as body changes the position to be the least painful
170
What is Galleazi test?
Tests for leg length discrepancy
171
What scans can you order for a limp?
x-ray with two views, localised collection with ultrasound or MRI for malignancy or infection
172
Red flags for limping children?
unable to weight bare, fever, systemic illness, severe pain, limp or pain worsening, pain waking at night, redness swelling and stifness, weight lsoss anorexia
173
When to refer limp?
uncertainty of cause of limp, septic arthritis or osteomyelitis
174
What is septic arthritis definition?
Infection of the joint, fever 38.5oC inability to weight bear, CRP>20mg/L WBC>12
175
What is perthe's disease?
Idiopathic asvascular necrosis of femoral head often 4 to 10 years old, femoral head will be damadged. wide neck fragmented head,
176
What is slipped upper femoral epyphysis?
When the epiphysis moves from the head of the femur and get refered knee pain
177
What is dodlers fracture?
Undisplacesd spirla fracture of lower third of the tibia
178
What is transient synovitis of the hip?
Get synovial inflamation that comes and goes on its own often in 5 year olds,
179
In under 3s what is most common causes of limp?
Septic artritis or Osteomyelitis, less likely transient synovitis
180
What is codman triangle?
Periostial reaction creating a tringular shadown near a tumour
181
What things can cause rashes in children?
Birthmarks and baby rashes
Viral rashes
Bacteria
Fungi and Yeasts
Protozoa
Insects
Humans
182
Where is caverous haemangioma bad?
Having one near your eye or were it might knock or bleed or in airway.
183
What are a flat persistent red areapresent from birth?
Capillarity haemangioma usually dont go away.
184
What is a mongolian blue spot?
May look like bruises on dark skin?
185
What are prodromal symptoms of shingles?
Itching or burning before the rash
186
What is the measals symptoms?
Cough conjunctivitist coryza koplik's spots looks like kawisaki disease
187
What is the rash for rubella?
Rash starts on face vague lacy ill defined not itchy
188
what is 5th disease,?
Slapped check parvovirus 19
189
HHV6 what is it?
Mild rash very unhappy baby nonspecific rash
190
What are the symptoms for coxsakie disease?
Sore lumps on hands feet or mouth. hand food an mouth disease
191
What is exzema herpeticum?
Herpes infection in exzema ridden skin Medical emergency
192
What causes warts and verrucas?
HPV rough edges.
193
What is golden crusty rashes?
Staph aureus impetigo very contagiousWh
194
What can cause cervical absecce pr lymphadeniti?
staphyloccocus infection
195
What is a rorry with peeling skin?
Scalded skin syndrome from toxins
196
What can mimmic meningococcal infection?
HSP
197
What causes strawberry tongue, and redness sparing mouth?
Scarlet fever
198
What is a genital rash with satelite regions?
Candida infections
199
What causes cerebral calcification and retina damage?
Toxoplasma gondii
200
What can cause familiall rashes?
Scabies
201
What areas are important for paediatric histories?
Presenting complaint, HPC, Past medical hostory, perinatal history, Growth and developental history, drug and allergies history, immunisation history family history social history systemic enquiry.
202
What to take in perinatal history?
Where were born, type of delivery, maternal diseases, what gestation weight, post natal problems, feeding,
203
What is growth and developmental history?
How well they are developing compared to general age. When to walk, sit unsupported, fix and follow. Growth from growth charts schooling learning development
204
What is different in family and social history in paeds?
Who is at home in the family, who is who, how many children are thre from same parents, family history (could be maternal pregnancy) things run in the family.
social who at home who looks after, do they live in tow houses, do they have social care involved, support network.
205
What is important in adolescents?
HEADSS
206
What is important with examination of a child?
observation, ensure the child is comfortable as possible, get down to their level,
207
What vaccinations do children recieve?
Diptheria tetanus, polio, hep B haemophilus influenzae type b, whooping ough, rotavirus, Meningitis B penumococcal vaccine, Meningitis C MMR Flu vaccine, men ACWY HPV
208
What vaccinations are given at 8 weeks?
6 in 1 (Tetanus, Diptheria, Polio, Hib (Haemophilius influenzae type b) Whooping cough, Hep B and Rotavirus and meningitis B
209
What vaccinations are given at 12 weeks?
6 in 1 2nd dose, pneumococcal vacine and rotavirus 2nd dose
210
What vaccinations are given at 16 weeks?
6 in 1 and men b
211
When do children get the flu Jab?
2 to 10 years
212
When do children get MMR and 4 in one preschool booster?
3 years 4 months
213
What is in the 4 in one pre school booster
TDP and whooping cough
214
What is a gelastic siezure?
A laughing siezure
215
What is cataplexy?
A collapse caused by laughing or high emotional levels
216
What is a UTI?
Growth of bacteria in urinary tract
217
What is upper tract UTI?
Pyelonephritis often more ill with vomiting etc
218
Why is UTI important in children?
quite common, 50% recurrence, 50% ave structural abnormaliry, can have long term complications
219
What are the long term complicaations of UTI?
Kidney scarring, hypertension and CKD
220
When to suspect UTI?
Younger than 3 months fevere vomit lethargy irritability, poor feeding failure to thrives lesss likely to be abdominal pain Jaundices haematuria, offensive urine
Older children, frequency dysuria, dysfunctional voiding changes to continence abdo pain loin tenderness, fever malais vomiting haematuria offensive cloudy urine.
221
When to get a urine sample?
Fever with no focus, symptoms and signs of UTI, unexplained fever of 38 or higher, younder than 3 months with suspected UTI
222
How to get urine sample?
Clean catch. or tell them what to do
223
What is SPA?
suprapubic aspiration, inserta a needle to get a sample of urine.
224
What does pseudomonas UTI indicate?
could be structural abnormality
225
Who needs admitting?
less than 3 month olds, systemically unwell, significant risk factors
226
How long do you treat lower UTI under 3 months?
3 days with no systemic illness
227
What is treatment for upper UTI?
7-10 days oral antibiotics
228
Who do you worry about with UTI?
Atypica or recurrent (two or more with systemic sympromts
229
What is atypical UTI?
Speticaemia non ecoli, urine stream poor
230
What are investiagation of UTI atypical?
Ultrasound of renal tract, MCUG micturatiny cystourethrogram catheterise the patient and see dye
231
what does MCUG tell you?
Vesicoureteric reflux, bladder Posterior urethral valve
232
How is vesicoureterc reflux grades?
How much the ureter is filled how much of the kidney is dialated and the ureter
233
What is DMSA scan?
Radionuclide imaging, dimercaptosuccinic acid scan, relative renal function showing scaring
234
when are children followed up?
All children under the age of 3 months, systemically unwell recurrent UTI
235
What does swelling indicate?
Fluid is in the wrong areas
236
What does swelling indicate?
Fluid is in the wrong areas
237
What can casue oedeme?
Poor lymph drainage, turners syndrome, venous drainage or pressure, lowered oncotic pressure low albumin or brotein (malnutrition liver isssues gut or kidney loss), Salt and water retention kidney impared GFR heart failure
238
What causes nephrotic syndrome?
The podocytes are letting protein through because they are swollen
239
What is best way to get proteinuria measured?
Protein creatinine ratio
240
What defines nephrotic syndrome?
Proteinuria, hypoalbuminaemia and periperal oedema
241
What are risks of Nephrotic syndrome?
Thrombosis increased risk of infection from concentration of urine
242
What are 3 types of nephrotic sndrome in children?
Congenital, steroid sensitive and steroid resistant NS
243
What is presentation of steroid sensitive nephrotic ssndrome?
Normal BP macroscopic haematureia, normal renal function, no features to suggest nephritis responst to steroid
244
What suggests steroid resistant nephtotic sndroem?
Haematuria impared kidney function,
245
When is minimal change disease most likely?
In under 5s gets less likely as get older boys more than girls more common in asian subcontinet
246
What is the problem wiht minimal change in childrne?
Frequent relapses 8/10 most grow out of it. 95 % grow out of it
247
What is treatment of nephrotic syndrome?
Steroids prednisilone, supportime measures, sodium moderation diuretics Pen V
248
What can define nephritic syndrome?
Haematuria, proteinuria, impared GFR, Salt and water retention
249
What is post infections glomerulonephritis?
Gen infectionon skin or throat get group a strep and gent antigen antibody compleces that activate complement in the glomerulus
250
What to investigate for post strep glomerulonephritis?
FBC U and E complement throat swabs
251
What is manangment of post strep glomerulonephritis?
Fluid balane correction of imbalance dialysis if needed, penicillin to treat it
252
What is prognosis for post strep glomerulonephritis?
Usually fully recover not recurrent no long term implication for renal function
253
What is affected in HSP?
Skin joints gut kidneys
254
What rash is HSP?
Papular rash with bumps on extensor surfaces
255
What type of kidney issues can HSP cause?
Nephritis or Nephrotic
256
What is HSP nephritis?
IgA deposition, variable renal presentation, haematuria, proteinuria, nephrotic, syndrome, acute nephritis, renal impairment, hypertension can get end stage renal disease
257
Why is childhood malignancy important?
Common cause of death despite being quite rare
258
What are challenges of childhood survial of malignancy?
New problems identifeid as late effects life long follow up needed
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What are the types of cancers in children?
Very few carcinomas, embryonal tumours are rare in adults but common in children Wilma neuroblastoma rhabdommysosarcoma leukaemia bone tumpurs and lumphomas
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What are the likely causes of childhood cancer?
Not usually genetic double hit theory genetic susceptibility and environmental change, mutation in oncogenes
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Why do children take a long time to get diagnosed with cancer?
It's rare and symptoms could be quite rare
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How does cancer present?
Lymphadenopathy organomegaly soft tissue mass bone marrow filtration airways restriction
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What could be significant for malignanct causes?
Pale tired lump in neck early morning hheadache abnormal red reflex proptosis recurrent discarch ear
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When to consider malignancy?
challenge diagnosies, retake history consider if not getting better
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What does leukaemia present as?
Fever, fatigue, frequent infections, luymphadenopathy hepator and or splenomegaly anaemia bruising petechia, bone or joint pain, Blasts and pancytopenic
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What are investigation on leukaemia?
Blood film, serum chemistry CXR bone marrow aspirate lumbar puncture
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What is need for lumbar puncture?
To see if they have CNS disease as part of staging
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What are ALL treatment?
Induction consolidation interim maintenance, delayed intensification then maintenance. Maybe high risk patiets for haemopoetic stem cell transplantation
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What are symptoms of CNS tumours?
Headache, vomiting papilloedema squint focal neurology
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When to scan with headache?
Papilloedema, neuro signs, recurrent headache, vomitting short stature
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What is treatment for most brain tumours?
Resected
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When do you give radiotherapy in children brain tumour?
Serious later effects in under 3s
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When to suspect malignant lymphadenopathy?
Persistant, without infection, unusual site supraclaviculaar, fevere weight los enlarged liver/spleen CXR
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What can abdominal masses present with?
Child may present with mass or pain haematuria constipation hypertension weight loss
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What are most common abdominal masses?
Wilms tumour (eye metastisies) neuroblastoma
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What is neuroblastoma treatment?
surgery if resectable then chemotherapy immunotherapy
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What is wilms tumour treatment?
Chemotherapy before surgery then remove kidney. radioterapy for abdominal or pulmpnary disease
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What is retinoblastoma presentation?
Loss of red reflex
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What are some of the late effects of treatment?
Endocrine- growth development, intellectual, cardiac toxicity, renal toxicity fertility, psychological
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What is ADHD?
Inattentiveness hyperactivity and impulsiveness
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What causes ADHD?
Not sure but very high heritability, probably genetic
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Why are more boys found to have it than girls?
Girls present slightly differently as they can disguise it well
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What is the main concern with ADHD?
It is risky with impulsive behaviour that could be dangerous.
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What is pervasiveness for ADHD?
Should have symptoms in all aspects of their life not just at home or school
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How is ADHD diagnosed?
Connors questionaire for parent and patient,s chool observation and developmentla history
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What condition is important to look at with ADHD?
Autism specturm disorder substance misuse depression anxiety oppositional defiant disorder eating disorders
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What can the medication fo rADHD do?
improve ability to concentrate control impulses plan ahead and follow through with tasks. Might still ahve forgetfulness emotional problems social awkwardness. It doesn't cure it just reduce symptoms
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What is the way ADHD medications work?
Sending neurone doesnt send enought transmitter, or receptors ma not getr onto receptors or they may get reabsorbed before they bind. The medications are stimulant or non-stimulants, tey target the rransmitters stimulants target dopamine, non-stimulants target norepinephrine can impreove impulsivity
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What are the stimulant profiles?
Can acti in 30-90 minutes and can last for 3 -12 hours depending on which one
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What are on stimulent profiles?
Takes 2 to 4 weeks to happen
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What are side effects of stimulants?
Loss of appetite trouble sleeping, uncommon side effects includ anxiety agitation headaches tics and psychosis
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What are side effects of atomoxetine?
Moodiness uncommon nausea loss ofappetite, sluggishmess
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What are side effects of alpha-2 adrenergics?
Sleepiness fatigue uncommon side effects loss of appetite drop in BP nausea
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What are the risks with stimulants?
Could cause weight loss and impact height. Use caution wiht heart problems
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What are the risks with atomoxetine?
Rare incidence of liver complications
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What is effectivenes of ADHD medications?
80% stimulants 50% for the non stimulants
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How to initiate ADHD treatment?
start once a day, then increase 3 xD then increase dose then switch to longer acting
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Why should we treat inflammatory conditions?
They cause damage to joints
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What is a TNF alpha inhibitor?
Infliximab adalimumab golimumab certrolizumab pegol etanercept
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What are the IL1 inhibitors?
anakinra
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What are IL 6 inhibitor?
Tocilizumab
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What is under juvenile idiopathic arthritis?
Oligoarticular persistent, polyarticular- RhFnegative, Polyarticular- RhF positie Oligoarticular extendied systemic arthritis psoriatic arthritis, enthesistis related arthritis
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What is JIA?
onset before 16th birthday, no identified underlying case persistent joint swelling or painful restriction of movement lasting at least 6 weeks
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What is oligoarticular JIA?
Fewer than 4 joints affected often knee ankle or knee chronic anterior uveitis
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What is poliarticular JIA?
Small jints of hands and feet more dammage to joints it is more agresssive,
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What is psoriatic JIA?
Polyarticular pattern of arthritis psoriasis may be present or may have psoriasis happens later, strong genetic link, and nail pitting dactylitis
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What is enthesitis related arthritis?
precursor to ankylosisng spondylitis,
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What is systemic arthritis?
auto inflammatory condition but mainly systemic presentation daily high spiking fever, lymphadenopathy rash, organomegaly,
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What is a way to examine young peoples msk system?
pGALS
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What can affect childhood development?
Biological social environmental factors
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What is the healthy child programme?
A way to keep track of children to development involces NIPE x2 and new baby review, 1 year old and 2 years old
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What do health visitor assessments do?
They can asses development with ASQ-3 questionaire to monitor helth developent and monitor growth then can reer on if needed
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what are the areas of evelopment?
Gross motor, fine motor/Vision, speech language and hearing, social/selfcare
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What is sequence for gross motor development?
Head control raises head to 45 degreees, sit without support, walks carrying toy running jumping throwing a ball, run tiptoe walk upstars throw a ballneed more
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What is the sequence for fine motor?
fix and follow, palmar grasp, hand to hand, inferior grip, object permanence,inferior pincer grip, crawling walking with hand hold stands alone tower of 3 cubes scribbles handednessneed more
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What is the sequence of speech language
startle to noise, respond to own name and mama dada, 2-3 single words recognition of objects. two words together two step comand need more
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What is the sequent of social development?
smile to parten, stranger danger, uses spoon well imitates every day activities , feeding spoon fork, dry in dayneed more
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What are growth motor red flags?
Lack ehad movement 4 months, sitting 12 months walking 18 months
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What are red flags for fine morot?
Not reaching for objects 6 months handedness by 18 months
320
Red flags for speech and language?
No first words by 15 months
321
What can cause childhood delay in development?
Genetics, factors in pregnancy MCA infarct, Exposure to drugs and alcohol Factors around birt prematurity birth asphixia Factors in childhood, conditions imparement environmental factors abuse neglect low stimulation
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Who might be involved in developmental problems?
SALT, Physiotherapy, OT, Audiology opthalmology, sleep workshop, MAST early years inclusions support SENCO, child learning disability team, local support groups the local offer.
