Paediatrics 2 Flashcards

Question 1

Q

Biliary Atresia

Answer

A

Congential condition - bile ducts narrow or absent.

Build-up of conjugated bilirubin = jaundice

Bile ducts transport bile liver > bowel

Bilirubin conjugated in liver, excreted in bile > urine/stool

Question 2

Q

Presentation of biliary atresia

Answer

A

-Physiological jaundice from day 2 - 7 due to increased breakdown and turnover of RBC = unconjugated bilirulin

Biliary atresia = persistant jaundice > 14d in term babies and 21d in premature
Biliary atresia = ↑conjugated bilirubin, physiolgical jaundice = ↑unconjugated bilirubin

Question 3

Q

Diagnosis and management of biliary atresia

Answer

A

1st line: blood test for conjugated and unconjugated bilirubin

1st line imaginig: USS

Mx:

Kasai portoenterostomy = remove bile duct, attach small intestine to liver where bile duct was, bile in liver directly drains into intestines
Liver transplant later

Question 4

Q

Hypoxic-ischaemic encephalopathy (HIE)

Answer

A

Neonates, result of hypoxia during birth = ischaemic brain injury
Results in cerebral palsy, developmental delays, cognitive deficits or death

Asphyxia (deprivation of O2) in brain = maternal shock, intrapartum haemorrhage, prolapsed cord

Question 5

Q

Diagnosis of HIE

Answer

A

Hypoxia (during perinatal or intraparum period)
Acidosis (pH < 7 or base deficit ≥ 12-16 mmol/L) on umbilical ABG
Poor Apagar score (e.g. < 5 at 10min)
Features of HIE
Mild (grade 1) - resolve 24hrs
Moderate (severe) - lethargy , hypotonia (flaccid), suppressed reflexes (absent), possible seizure, possible CP or developmental delay (90% possibility)

Question 6

Q

Management of HIE

Answer

A

Neonatal ICU
Supportive: neonatal resus and ongoing otipmal ventilation, circulatory support, nutrition, acid-base balance and tx of seizures
Therapeutic hypothermia: 33 - 34c for 72hrs, then gradual warming over 6-12hrs

Question 7

Q

Cerebral Palsy

Answer

A

Permenant neuro problems from brain damage at birth.
Ranges from wheelbound and depedent on others for ADLs to subtle coordination/mobility problems

Causes:
- Antenatal: maternal infections, trauma
- Perinatal: birth asphyxia, prematurity
- Postnatal: meningitis, severe neonatal jaundice, head injury

Question 8

Q

Presentation of cerebral palsy

Answer

A

There are different types and patterns but I think it is too much detail

Failure to meet milestones
Increased or decreased tone - general or specific limbs
Hanf preference < 18m
Feeding/swallowing problems
Learning difficulties

Popular OCSE station, CP signs are reliable and patients are stable. Get good at assessing and recongising patterns of UMN and LMN lesions

DDx of UMN lesions: brain injury or tumour

Question 9

Q

Management of cerebral palsy

Answer

A

When asked “management will invovle a MDT approach”
Physio - stretch and stregthen muscles
OT - manage daily activites, adaptations, equipment
SALT
Dieticians
Orthopaedic surgeons: release contratures and lengthen tendons (tenotomy)
Paeds - muscle relaxant (baclofen), anti-epiletptic drugs, glycopyrronium bromide (drooling)

Question 10

Q

Conjuctivitis

Answer

A

Purulent discharge, injection, eyelid swelling with first 48hrs of life = ?gonococcal infection
Urgent gram-stain, culture, tx (e.g. IV 3rd gen cephalosporin) to prevent permenant vision loss
Clamydia trachomatis = purulent discharge, eyelid swelling at 1 - 2 weeks old, tx: oral erythromycin 2w, tx mother + partner

Question 11

Q

Henoch-Schonlein Pupura (HSP)

Answer

A

IgA vasculitis - purpic rash lower limbs > buttocks, inflammation and blood leak from small blood vessels

Criteria (many, but EULAR/PRINTO/PRES criteria):
- Diffuse abdominal pain
- Arthritis or arthralgia
- IgA deposits on histology (biopsy)
- Proteinuria or haematuria