Paediatrics Flashcards
Epiglottitis
Medical emergency
Rapidly progressive infection that leads to inflammation of the epiglottis and adjacent tissues and can rapidly block upper airway - risk of death
Causative organism (most common):
- Haemiphilus influenza B (HiB) - but take cultures
Differentiating signs/symptoms:
- Drooling (cant swallow)
- Soft inspiratory stridor
- Sat Upright, open mouth
- Usually absent cough
Management:
- Endotracheal intubation
- IV certuroxime (antibiotic: cephalosporin)
Bacterial tracheitis
Medical emergency
Characterized by a high fever and rapidly progressive airway obstruction due to accumulation of copious, thick airway secretions. It may present similarly to viral croup but tends to be more severe and rapidly progressive.
Most causative organism: Staph aureus, usually following a URTI (virus predisposing the trachea to bacterial colonisation)
Differentiating signs/symptoms:
- High fever
- Stridor
- Barking cough
- Rapid & difficulty breathing
- Cyanosis
Management:
- Broad spec IV antibiotics (until causative organism identified)
- In severe cases: intubation
- Airway humidification and chest physiotherapy may assist in the clearance of secretions
Bronchiolitis
- A widespread chest infection, predominantly affecting infants aged 1-12 months. This lower respiratory tract disease targets the bronchioles, causing inflammation and congestion.
- 90% are 1-9months, peak incidence 3-6months (very common during winters)
Typical causative organism:
- Respiratory Syncytial Virus (RSV) around 80% of cases
Typical symptoms:
- Dry Cough
- Laboured breathing/breahtlessness
- Wheezing
- Tachypnoea
- **Intercostal recession
- Grunting
- Nasal flaring
SIGN guidelines: make a diagnosis of acute bronchiolitis in an infant with: nasal discharge with wheezy cough, in the presence of fine inspiratory crackles and/or high pitched expiratory wheeze
NOTE: feeding difficulties associated with. W increased dyspnoea is often main reason for hospital admission
Complications:
- Bronchiolitis obliterans (popcorn lung) - rare chronic complication
Bronchiolitis obliterans (constrictive bronchiolitis/popcorn lung)
A pathological condition characterized by permanent obstruction of the bronchioles, the smallest airways in the lung.
Caused from: chronic inflammation that leads to the formation of scar tissue within the bronchioles (also a rare complication of Bronchiolitis)
- Viral infections (Adenovirus most frequent)
- Complication of bone marrow or lung transplants
Signs/Symptoms:
- Dry cough
- Shortness of breath
- Hypoxia
- Wheezing
- Lethargy
Management (supportive no cure):
- Immunosuppresive agents: Tacrolimus, cyclosporin, mycophenolate mofetil, and prednisone have been used to treat bronchiolitis obliterans after transplant.
Common presentations to the GP during the neonatal period (up to 4 weeks)
- Jaundice - Breast milk jaundice, more serious: biliary atresia, infection - UTI, toxoplasmosis, CMV, VZV, HIV, Hep B galactosaemia, hypothyroidism, sepsis, haemolysis (ABO comparability/rhesus disease) = refer to paed unit
- Vomiting - infantile reflux, CMP (cows milk protein). intolerance, more serious: pyloric stenosis, sepsis, duodenal atresia (congenital absence of part of the duodenum)
- Failure to thrive - feeding problems
- infection/sepsis
- “Trivia”
Any child <3months of age w a temp >38 degrees = RED FLAG - refer to paed unit for full sepsis screen
Common paediatric respiratory problems
- RSV Bronchiolitis
- Virul URTIs e.g. rhinovirus, adenovirus, influenza
- Croup - parainfluenza (barking cough)
- Asthma (new or exacerbated, particularly nocturnal cough)
- Acute tonsillitis
Rare respiratory paediatric problems
- Cystic Fibrosis
- Acute epiglottitis
- Foreign body
- Pneumonia
- Cardiac causes
- Malignancy
What is nasal flaring & intercostal recession a sign of?
Respiratory distress
What are you going to do/look for when assessing the respiratory system in neonates/children?
- Cyanosis
- Tachypnoeic (RR)
- Nasal flaring/intercostal recession
- Wheeze/stridor/cough
- Pulse oximetry
- Percussion
- Auscultation
- ENT Examination
What are the normal resp rates in children?
<1 = 30-40 BPM
1-2 = 25-35 BPM
2-5 = 25-30 BPM
5-12 = 20-25 BPM
>12 = 15-20 BPM
GI problems - Presentations in children
- abdominal pain
- vomiting
- diarrhoea
- nausea
- constipation
MSK problems - Presentations in children
- Painful joint(s)
- Limbs - DDH (developmental dysplasia of the hip - should be picked up in neonatal screening but not all are)/Perthes
- Trauma - sprain/fracture/NAI
Joint pain differentials in children
- Transisent synovitis - child maybe has a concurrent viral infection and they get some joint inflammation with it like their hips and knees
- More rarely: inflammatory arthritis (RA), Perthes disease (vascular necrosis of the hip joint), slipped femoral epiphyses, Osgood schlatters (normally in sporty adolescence - overuse injury and needs rest), growing pains
- Even more rarely: bone tumours, infective causes (septic arthritis)
Impetigo treatment
- Topical fuscidic acid (rarely oral flucloxacillin)
- Make sure towels etc aren’t shared
Slapped cheek syndrome
Caused by Parvovirus B19
Self limiting - reassurance and explanation
Molluscum spots
Reassurance - may have for 2 years but do go eventually
Scarlet fever
- Group A streptococcus
- Sand paper rash
- Strawberry tongue - Film over tongue then peels off to reveal a really red tongue
Hand foot and mouth disease
- Cosxsakie or enterovirus
- Self-limiting but very unpleasant, children got extremely Sore mouth
- Papules on hand, feet mouth and sometimes on the buttocks
What is screened for at the GP during the childhood development screening at 6-8 weeks
- Heart sounds
- Red light reflex e.g. for a congenital retinoblastoma
- Hips (barlows/ortalanis = no CDH or DDH)
- Genitalia (e.g. making sure testes have both descended)
- Femoral pulses (??coarctation if any femoral pulse missing)
- Disease notification e.g. Measles to inform public health (Group A strep in England but not in Scotland)
When do children get immunised against MMR?
Just after 1 year for first one then second one = pre-school (3-4)
Cerebral palsy
An outcome to an insult to the developing brain - mostly in neonatal period but maybe later as an infant => a group of disorders of development of movement and posture aka a motor issue, often accompanied with disturbances of sensation, cognition, communication, behaviour and seizures
Basically: at some point there’s been some damage to the brain => No oxygen to brain => softness and lack of white matter => motor damage to the brain
Not a single thing causes it:
- Increases risk: prematurity, small, twins
- Before birth: periventricular leukomalacia, injury to the womb, congenital infection
- During/after birth: Meningitis, head injury, HIE (Hypoxic ischaemic encephalopothy - lack of O2 at come point during delivery)
What is Makaton?
A simplified form of British sign language (BSL) - good for individuals with cerebral palsy
Measles
Highly contagious
- Caused by: measles morbillivirus - a single stranded enveloped RNA virus
- Transmission: droplets from the nose, mouth or throat of infected persons
- Most common in unvaccinated children
Signs/symptoms: develop 10-14 days post-exposure, last 7-10 days
- fever >40
- Corzyal symptoms
- Conjunctivitis
- Maculopapular Rash 2-5 days after onset of symptoms
- Koplik spots: grey discolorations of the mucosal membranes in the mouth
Investigations for suspected measles include:
- 1st: Measles-specific IgM and IgG serology (ELISA), most sensitive 3-14 days after onset of the rash.
- 2nd: Measles RNA detection by PCR, best for swabs taken 1-3 days after rash onset.
Croup (Laryngotracheitis)
A common childhood viral URTI which causes nasopharyngeal inflammation
Spreads from the larynx to the trachea
Generally self-limiting
Occurs mainly in the spring and autumn
Most common viral causative agent: Parainfluenza virus
Affects: 6 months -3 years
Presentation:
- Barking cough
- Stridor
- Non-specific URTI symptoms: fever (<38.5), runny nose, sore throat, cough
- Respiratory distress
NOTE:
- If you suspect croup do NOT examine the back of the throat - patients airway already narrowed and if you check their throat, they become more anxious -> may further reduce the patency of the airway
- Try give O2 mask if hypoxic, but avoid if anxious
- reassure child and parent - children mimic parents so if parent becomes anxious so too will the child and will worsen the already compromised airway
