Paediatrics Flashcards
1
Q
What is the first step of treatment in a child >5 with a confirmed diagnosis of asthma?
A
Very low dose ICS with short acting B2 agonist PRN
2
Q
What is the first add on therapy for children >5 with a confirmed diagnosis of asthma?
A
Inhaled LABA
3
Q
What is the 4th step of treatment in a child >5 with a confirmed diagnosis of asthma?
A
Increase ICS to medium dose and addition of SR theophylline
4
Q
What is the first step of treatment in a child <5 with a confirmed diagnosis of asthma?
A
LTRA with short acting B2 agonist PRN
5
Q
What are the characteristics of an acute severe asthma attack?
A
- SpO2 <92%
- PEF 33-50% of best or predicted
- Can’t complete sentences in one breath or too breathless to talk or feed
- Tachycardic
- Respiratory rate >30bpm (>5 years) or >40 (1-5 years)
6
Q
What are the characteristics of a life-threatening asthma attack?
A
- SpO2 <92%
- PER <33% of predicted
- Silent chest
- Cyanosis
- Poor respiratory effort
- Hypotension
- Exhaustion
- Confusion
7
Q
In bronchiolitis what is the common age group and causative organism?
A
- <2 years
* RSV
8
Q
What are the symptoms of Bronchiolitis?
A
- Coryzal symptoms
- Dry cough
- Difficulty feeding
- Increasing breathlessness
9
Q
What are the signs of Bronchiolitis?
A
- Tachypnoea
- Tachycardia
- Hyperinflation of the chest
- Fine end inspiratory crackles
- Wheeze
10
Q
What is the management of Bronchioloitis?
A
• Supportive
o Humidified oxygen via nasal cannula
o No evidence for steroids, abx or bronchodilators
• If severe full ventilatory support may be required
11
Q
What is the commonest causative organism of Croup?
A
Parainfluenza virus
12
Q
What are the signs and symptoms of Croup?
A
Symptoms:
- Barking Cough
- Fever
- Hoarsness
- Coryza
Signs:
- Stridor
- Chest recession
13
Q
What is the management of Croup?
A
- Supportive
- Give Oral Dexamethasone or Prednisolone
- If severe give nebulised adrenaline and oxygen by facemask
14
Q
Colonisation by which organisms are common in CF?
A
Pseudomonas Auroginsoa and Burkholderia species
15
Q
In neonates which group of organisms commonly cause pneumonia?
A
GBS and gram negative enterococci
16
Q
In children over 5 years which group or organisms commonly cause pneumonia?
A
Mycoplasma pneumonia, streptoccocus pneumoniae and chlamydia pneumoniae
17
Q
What signs would you see in a child with pneumonia?
A
- Tachypnoea
- Nasal flaring
- Chest indrawing
- End inspiratory coarse crackles
- Decreased O2 sats
- Dullness on percussion
18
Q
Which antibiotics would you give in pneumonia for the following age groups:
Newborns?
>5 years?
A
Newborns: Gentamicin or broad spectrum cover
>5 years: Amoxicillin or oral macrolide, if more complicated give co-amoxiclav
19
Q
What is respiratory distress syndrome? What are the risk factors?
A
Disease in neonates caused by a deficiency of surfactant
- Common in <28 week prematurity
- Boys > girls
20
Q
What are the clinical features of respiratory distress syndrome?
A
Within 4 hours of birth:
o Tachypnoea >60 bpm
o Laboured breathing with chest wall recessions and nasal flaring
o Expiratory grunting to create positive airway pressure
o Cyanosis if severe
o Ground glass appearance on CXR
21
Q
What is chronic lung disease of the newborn/bronchopulmonary dysplasia?
A
Infants who still require oxygen after 36 weeks of age
22
Q
What are the complications of meconium aspiration?
A
o Mechanical obstruction
o Chemical pneumonitis
o Predisposition to infection
o The lung will often be overinflated with consolidation and can result in pneumothorax and pneumomediastinum
23
Q
What are the diagnostic criteria for Neurofibromatosis type 1?
A
Two or more of the following:
- Six or more café au lait spots >5mm in size before or 15mm in size after puberty
- More than one neurofibroma, an unsightly firm nodular overgrowth of any nerve
- Axillary freckles
- Optic glioma
- One lisch nodule
- Bony lesions from sphenoid dysplasia
- A first degree relative with NF1
24
Q
What are the cutaneous and neurological features of tuberous sclerosis?
A
Cutaneous:
- Depigmented ash leaf shaped patches which fluoresce under UV light
- Roughened patches of skin usually over lumbar spine
- Adenoma sebaceum in a butterfly distribution over he bridge of the nose and cheeks
Neurological:
- Infantile spasms and developmental delay
- Epilepsy that is often focal
- Intellectual impairment
25
What are the causes of non communicating hydrocephalus?
Congenital Malformation
- Aqueduct stenosis
- Atresia of the outflow foramina of the fourth ventricle
- Chiari malformation
Posterior fossa neoplasm or vascular malformation
Intraventricular haemorrhage in preterm infant
26
What are the causes of communicating hydrocephalus?
- Subarachnoid haemorrhage
| - Meningitis
27
What are the signs and symptoms of hydrocephalus in an older child?
Signs of raised ICP:
- Headache
- Vomiting
- Altered level of consciousness
- Back pain
- Papilloedema
- Low heart rate
28
What is the treatment of hydrocephalus?
Insertion of a ventriculoperitoneal shunt or endoscopic creation of a ventriculostomy
29
What is the common cause and clinical characteristics of an extradural haematoma?
Cause: Trauma
Clinical Characteristics: Lucid interval followed by deteriorating consciousness level with seizures, focal neurological signs, dilation of the ipsilateral pupil, paresis of contralateral limbs and false localising uni or bilateral VIth nerve palsy
30
What is the characteristic cause of subdural haematoma in children?
Non accidental injury caused by shaking or direct trauma
31
What is the inheritance pattern of Duchenne muscular dystrophy?
X linked recessive
32
What are the clinical features of Duchenne muscular dystrophy
What is the average age of diagnosis and life expectancy
- Average age of diagnosis: 5.5 years
- Presentation: waddling gait, language delay, climbing stairs 1 by 1 and slow run
- Loss of ambulation around age 10-14
- Respiratory failure or cardiomyopathy is usually the cause of death
- Life expectancy: late 20s
33
How does Beckers muscular dystrophy differ from Duchenne?
Some functional dystrophin is produced
Age of diagnosis is 11, loss of ambulation during late 20s and life expectancy is late 40s to normal.
34
What are the red flag headache symptoms?
Worse lying down or with coughing and straining
Wakes up the child (different from headache on awakening)
Associated confusion and/or persistent nausea and vomiting
Recent change in personality, behaviour or educational performance
35
What are the features of a migraine without aura?
- May last 1-72 hours
- Commonly bilateral
- Pulsatile over the temporal or frontal area
- Accompanied by GI disturbance such as nausea,
vomiting and abdominal pain
- Photophobia and phonophobia common
36
What are febrile seizures and what age range do they occur in?
6months-5 years
Brief usually tonic clonic seizure accompanied by fever not caused by meningitis or encephalitis
37
What are the different types of generalised epileptic seizure?
Absence – Transient loss of consciousness with abrupt onset and termination
Myoclonic – Brief, often repetitive, jerking movements of the limbs, neck or trunk
Tonic – Generalised increase in tone
Tonic-clonic – Rhythmical contraction of muscle groups following the tonic phase. Followed by unconsciousness or deep sleep for up to several hours
Atonic – loss of muscle tone
38
What are the different types of focal epileptic seizure?
Frontal Seizures – motor phenomenon
Temporal lobe seizures – auditory or sensory (smell or taste) phenomena
Occipital – positive or negative visual phenomena
Parietal lobe seizures – contralateral altered sensation
39
How do you diagnose epilepsy in children?
Primarily based on detailed history ideally supported by video of the seizure
Focus should be given to particular triggers and any impairments the child may have
Examination should look for signs of neurocutaneous syndrome or neurological disorder
An EEG is indicated but rarely diagnostic
40
How do you manage epilepsy in children?
MDT Approach
Anti-epileptic therapies primarily based on the epileptic syndrome
41
What is an infantile spasm?
An epilepsy syndrome, presenting in infancy with varying aetiology. It usually presents in clusters and is characteristic of West’s Syndrome
42
What is the commonest type of paediatric brain tumour?
Astrocytoma occurs in 40% of children
43
What is the commonest type of cerebral palsy and what are the characteristics?
Spastic CP – 90% of cases
Damage to the UMN pathway that results in increased tone and reflexes. Can also result in hemiplegia, quadriplegia or diplegia
44
What is the characteristic presentation of cerebral palsy?
Abnormal limb or trunk posture and tone with delayed motor milestones
Feeding difficulties
Abnormal gait
Asymmetric hand function before hand-dominance develops
45
What are the clinical manifestations of mild HIE?
The infant is irritable, responds excessively to stimulation, may have staring of the eyes and hyperventilation and has impaired feeding
46
What are the clinical manifestations of moderate HIE?
The infant shows marked abnormalities of tone and movement, cannot feed and may have seizures
47
What are the clinical manifestations of severe HIE?
No normal spontaneous movements or response to pain
Tone in limbs may fluctuate between hypotonia and hypertonia
Seizures are prolonged and often refractory to treatment
Multi-organ failure
48
What is the management of HIE?
Prompt resuscitation
EEG to monitor for encephalitis or seizures
Anticonvulsants if seizures are present
Management of hypotension and hypoglycamia
Cooling to 33-34 degrees within 6 hours for 72 hours
49
What are the causes of acute nephritis?
Post infectious (Including streptococcus)
Vasclilitis (HSP, SLE etc.)
IgA nephropathy
Anti-glomerular basement membrane disease
50
What are the clinical features of stage 4 and 5 CKD?
```
o Anorexia and lethargy
o Polydipsia and polyuria
o Faltering growth
o Bony deformities
o Hypertension
o Acute on chronic renal failure
o Incidental finding or proteinuria
o Unexplained normochromic, normocytic anaemia
```
51
What is the most common cause of secondary or onset enuresis?
Emotional upset
52
What is the triad of haemolytic uraemic syndrome?
Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia
53
What are the signs and symptoms of Henoch-Schönlein Purpura?
Signs:
Fever
Rash on buttocks and extensor surfaces
Haematuria
Symptoms:
Abdominal pain
Joint pain
54
How long should a patient with Henoch-Schönlein Purpura be followed up for?
At least 6 months to ensure that there is no deterioration in renal function
55
What is the pathophysiology of nephrotic syndrome?
Heavy proteinuria leading to a low plasma albumin and oedema
56
What are the clinical features of nephrotic syndrome?
Periorbital oedema
Scrotal, vulval, leg and ankle oedema
Ascites
Breathlessness due to pleural effusions and abdominal distension
Infection such as periotnitis, septic arthritis, or sepsis due to loss of protective immunoglobulins in the urine
57
What are the characteristic features of sebhorrhaeic dermatitis?
In children <2 months:
- Erythematous scaly eruption on the scalp
- Scales form a thick yellow adherent layer called cradle cap
58
What are the spontaneously resolving rashes present in neonates?
- Milia
- Erythema Toxicum
- Mongolian blue spots
59
What factors are deficient in haemophillia A and B?
A - FVIII
| B - FIX
60
What are the two most common leukaemias in children?
ALL
| AML
61
What are the clinical features of hodgkin lymphoma?
Painless lymphadenopathy - usually on the neck
| B symptoms are rare
62
What are the clinical features of sickle cell disease?
```
Anaemia
Increased susceptibility to infection
Vaso-oclusive crises
Priapism
Splenomegaly
```
63
What is the treatment of an acute crisis of sickle cell disease
Admission to hospital
Oral or IV analgesia
Hydration
If acute chest syndrome, stroke or priapsim consider exchange transfusion
64
What is the epidemiology and inheritance of hereditary spherocytosis and G6PD deficiency?
HS: 1 in 5000, autosomal dominant, mostly caucasians
G6PD: High prevalence in central african, medittereanean and far eastern populations. X-linke.
65
What are the clinical features of juvenile idiopathic arthritis?
Peristent joint swelling > 6 weeks
Stiffness after periods of rest
Morning joint pain
66
What is the first line management of juvenile idiopathic arthritis?
Ensure management by a paediatric rheumatological MDT
NSAIDs and Analgesia for symptomatic relief of pain
Methrotrexate
67
What are the clinical features of osteomyelitis?
Markedly painful and immobile limb
Acute febrile illness
Swelling and intense pain over the site of infection
68
What are the characteristics of reactive arthritis and the common causative infections?
Transient joint swelling of the ankles or knees (oligoarthritis)
Enteric organisms: salmonella, Shigella, Campylobacter
69
What are the characteristics of slipped upper femoral epiphysis?
Displacement of the femoral epiphysis postero-inferiorly
Present with limp, hip pain
Most common in children aged 10-15
70
What are the causes of limp in children?
```
Avascular necrosis (aged 5-10)
Transient synovitis (aged 2-12, follows a viral infection)
Slipped upper femoral epiphysis (aged 10-15)
```
71
What are the characteristics and examples of a left to right cardiac shunt?
Breathless or asymptomatic
Examples: ASD, VSD, PDA
72
What are the characteristics and some examples of Right to left cardiac shunts?
Blue
Tetralogy of Fallot, Transposition of the great arteries
73
What are the causes of cardiac failure in Neonates, Infants and Older children?
```
Neonates:
(Obstructed systemic circulation)
- Critical aortic valve stenosis
- Severe coarctation of the aorta
- Interruption of the aortic arch
```
```
Infants:
(High pulmonary blood flow)
- VSD
- AVSD
- Large persistent ductus arteriosus
```
```
Older Children:
(Right or left heart failure)
- Eisenmenger's syndrome
- Rheumatic heart disease
- Cardiomyopathy
```
74
What are the clinical features of heart failure in children?
Symptoms:
- Breathlessness
- Sweating
- Poor Feeding
- Recurrent chest infections
Signs:
- Poor weight gain
- Tachypnoea
- Tachycardia
- Heart Murmur
- Enlarged heart
- Hepatomegaly
- Cool peripheries
75
What are the clinical features of Atrial Septal Defects?
Symptoms:
- Commonly asymptomatic
- Recurrent chest infections
- Arrythmias from the 4th decade of life
Signs:
- Ejection systolic murmur loudest at left sternal edge
- Fixed and widely split second heart sound
76
What is the mangement of an atrial septal defect?
Cardiac catherterisation and insertion of occlusion device if ASD is significant
77
What are the clinical features of a small ventricular septal defect?
- Up to 3 mm in diameter
- Asymptomatic
- Loud pansystolic murmur at lower left sternal edge
- Spontaenous resolution
78
What are the clinical features of a large ventricular septal defect?
- Greater than 3 mm in diameter
Symptoms:
- Heart failure with breathlessness and faltering growth after 1 week of age
- Recurrent chest infections
Signs:
- Tachnpnoea, Tachycardia
- Hepatomegaly
79
What is the management of a large ventricular septal defect?
1. Heart failure drug therapy - Diuretics + Captopril
2. Maintain adequate calorie intake
3. Surgery at 3-6 months of age
80
What are the 4 features of tetralogy of fallot
- Large VSD
- Overriding of the aorta
- Pulmonary stenosis
- Right ventricular hypertrophy
81
What is the management of ToF?
- Initially medical until definitive surgical management at 6 months: Closure of the VSD and relief of right ventricular outflow obstruction
Hypercyanotic cells should be managed as follows:
- Sedation and pain relief
- IV propranolol
- IV fluid
- Bicarbonate
- Muscle paralysis and artificial ventilation
82
What is the management of paediatric acne?
- Maintian good hygeine
- Topical treatments, sunshine, topical antibiotic and topical retinoids can be useful
- In severe acne consider antibiotic therapy with tetracyclines or oral isotretinoin
83
What is the management of paediatric eczema?
- Avoidance of irritants and precipitants
- Emmollients
- Topical Corticosteroids
- Immunomodulators when corticosteroids have proven innaffective
- Occlusive bandages to prevent excessive itching and lichenification
- Psychosocial support if needed
84
What are common causes of erythema multiforme?
- HSV
- Mycoplasma pneumoniae
- Other infections
- Drug reactions
- Idiopathic
85
What are causes of erythema nodosum?
- Streptoccocal infection
- Primary TB
- IBD
- Drug Reactions
- Idiopathic
86
What is Steven-Johnson Syndrome?
Severe bullous form of erythema multiformed that invloves the mucus membrane. Is characterised by detachment of the epidermis from the dermis.
Causes:
- Infection
- Vaccination
- Drug Reactions
87
What is the management of Steven-Johnson syndrome?
- Requires specialist burns unit support
- Remove the cause
- Dress with topical antibacterial agents
- Fluid and pain management
88
What is the triad of symptoms in Autism?
- Impaired social interaction
- Delayed speech and language
- Imposition of routines with ritualistic behaviours
89
A 13 kg child presents with shock. How would you administer fluids in this child?
Initial fluid resuscitation with 0.9% saline @ 20ml/kg therefore 260mls of fluid.
Then over 24 hours rehydration therapy + maintenance fluids:
Shock ~ 10% dehydration therefore 10% of 1300gms = 130mls/kg rehydration
Normal maintenance = 100mls/kg for the first 10k kg of weight + 50mls/kg for the next 10kg of weight
Therefore: 1150mls
Total Fluids in 24 hours: 2840ml
= 118mls/hour
90
A 22 kg child presents with DKA causing shock. How would you manage this patient?
pH = 7.0
ABC Approach
As in shock you need initial fluid bolus however in DKA you give 10ml/kg therefore in this child a bolus of:
220ml
Next establish severity of DKA - pH is <7.1 therefore it is classed as severe and you correct for 10% dehydration: 2200mls
Give maintenance at reduced volumes as in DKA high volumes can cause cerebral oedema, in a 22kg child give 1ml/kg/hour therefore: 22ml/hour
2200/24 = 91
+ 22
= 113ml/hour
Give maintenance and rehydration fluids as 0.9% sodium chloride with additional 20mmol pottassium chloride per 500ml until glucose is <14mmol then give normal saline
1 hour after initiation of fluids give insulin infusion
91
What is the management of anaphylaxis?
1. ABCDE Approach (Likely to see swelling and hoarsness of airway, tachypnoea, wheeze and a pale clammy child)
2. IM 1:1000 Adrenaline - repeat if needed after 5 minutes
3. Establish a stable airway, give high flow oxygen
4. Fluid resuscitation
5. IM Chlorpheniramine
6. IM Hydrocortisone
7. Consider salbutamol
92
What is the management of status epilepticus?
-ABCDE Approach
0 Mins - Maintain Airway, give high flow oxygen and check glucose
5 mins - If possible obtain vascular access and give IV/IO lorazepam or Buccal midazolam
15 Mins - IV/IO lorazepam and call for senior help. Prepare phenytoin
25 mins - Senior help is needed. Seek ICU advice. Give phenytoin IV/IO over 20 minutes. Anaethetist must be present at this stage
45 mins - Rapid sequence induction of anaesthesia with thiopental
93
What are the clinical features of diabetes?
- Polydipsia
- Polyuria
- Weight loss
- Secondary enuresis
- Skin Sepsis
- Candida Infections
94
What are the clinical features of a DKA?
- Acetone smell on breath
- Vomiting
- Dehyrdration
- Abdominal Pain
- Hyperventilation
- Hypovolaemic shock
- Drowsiness
- Coma
95
What are the clinical features of congenital hypothyroidism?
Usually asymptomatic and picked up on screening but if missed:
- Faltering growth
- Feeding problems
- Prolonged jaundice
- Constipation
- Pale, cold, mottled, dry skin
- Coarse face
- Large tongue
- Goitre
- Umbilical hernia
- Delayed development
96
What are the biochemical features of congenital adrenal hperplasia?
- High levels of 17alpha-hydroxy-progesterone
- Low Na
- High K
- Metabolic Acidosis
- Hypoglycaemia
97
What are the clinical features of congenital adrenal hyperplasia?
- Virilisation of external genitalia in female infants with clitoral hypertrophy and variable fusion of the labia
- Enlarged penis and pigmented scrotum in males
- Salt loosing adrenal crisis presenting with vomiting, weight loss, hypotonia and circulatory collapse
- Tall Stature
98
What is the management of congenital adrenal hyperplasia?
- Females may require corrective surgery to their genitalia
- Lifelong glucocorticoids to suppress ACTH
- Mineralocorticoids in event of salt loss
- Monitoring of grwoth, skeletal maturity and plasma androgens
- Additional hormone replacement to cover illness or surgery
99
What are the categories of precocious puberty?
- Gonadotrophin dependent - Premature activation of the hypothalamic-pituitary-gonadal axis. Sequence of pubertal development will be normal (cosonant)
- Gonadotrophin independent - Excess sex steroids outside the pituitary gland. The sequence of pubertal development will be abnormal (dissonant)
100
What is the management of precocious puberty?
- Management is directed towards identifying and treating any underlying pathology
- In girls treatment is sometimes required to delay menarche (this is important as this is the point at which growth is capped) - this treatment is with gonadotrophin releasing hormone analouges
101
What is biliary atresia?
Progressive fibrosis and obliteration of the extrahepatic and intrahepatic biliary tree. Without intervention chronic liver failure will develop and death will occur within 2 years.
102
What are the clinical features of biliary atresia?
- Mild jaundice and pale stools
- Normal birthweight followed by faltering growth
- Hepatomegaly is present initially
- Splenomegaly develops due to portal hypertension
103
What is the management of biliary atresia?
- Palliative surgery with a Kasai hepatoportoenterostomy which bypasses the fibrosed ducts and allows drainage of bile
- Early surgery will increase the success rate
- Nutritional supplementation is essential
- If the surgery fails liver transplantation is indicated
- Disease will eventually progress to cholangitis, cirrhosis and portal hypertension
104
What are the clinical features of Coeliac disease?
- Failure to thrive
- Abdominal distension
- Non specific abdominal symptoms
- Mild anaemia
- Abnormal stools
105
What investigations are indicated in Coeliac disease?
- Tissue transglutaminase test
(this is not necessarily specific or sensitive enough for diagnosis)
- Mucosal biopsy - this is the diagnostic test
106
What is the management of constipation in children?
-Ensure adequeate oral fluid intake and good toileting habits
Mild:
- Consider laxative such as movicol (polyethylene glycol 3350) +/- a stimulant laxative such as senna
- If good response then continue movicol for a minimum of 6 months with titration of dose to ensure regualar stools
Impaction:
- Disimpaction regime of movicol (1-2 weeks of escalating dose)
107
What is the management of GORD in children?
Uncomplicated:
- Excellent prognosis and can be managed purely through parental reassurance and alterin the size and consistency of feeds
Significant GORD:
- Omeprazole
- Ranitidine
Unresponsive GORD:
- Surgical management (Nissen Fundoplication)
108
What is Hirchsprung disease and what are the clinical features?
Absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel
Clinical Features:
- Presentation usually in the neonatal period with failure to pass meconium within the first 24 hours
- Abdominal distension
- Bile stained vomit
- DRE may reveal a narrowed segment of bowel and on removal of the figner there will be a release of liquid stool
109
What is the management of Hirschsprung Disease?
Surgery - Colostomy and anastomoses of innervated colon to the anus
110
What are the clinical features of intussusception?
- Paroxysmal, severe colicky pain with pallor
- Refusal of feeds
- Bile stained vomit
- Sausage shaped mass
- Passage of reduccrant jelly stool
- Abdominal distension and shock
111
What is the management of intussusception?
- IV fluid resuscitation as required
- If no signs of peritonitis then rectal air insufflation is 75% successful
- Remaining 25% require surgery
112
How will Hepatitis B serology demonstrate: Acute infection, Chronic infection and Immunisation?
Acute:
- HB Core Antibody +
- HB Surface Antigen +
Chronic:
- HB Core antibody +
- HB Surface antigen +
Immunisation
- HB Surface antibody +
113
What are the clinical features of a viral hepatitis?
- Nausea
- Vomiting
- Abdominal Pain
- Lethargy
- Jaundice
114
What are the clinical features of acute liver failure?
- Jaundice
- Encephalopathy (Irritability, confusion, drowsiness, aggression)
- Coagulopathy
- Hypoglycaemia
- Electrolyte disturbance
115
What is the management of Aute liver failure?
-Early referral to paediatric liver centre
Stabilisation:
- IV Dextrose to maintaine blood glucose
- Prophylactic antibiotics and antifungal agents
- Prevention of haemorrhage with Vitamin K
- Prevention of cerebral oedema with fluid restriction and mannitol diuresis if required
116
What are the clinical features of necrotizing enterocolitis?
- Feed intolerance
- Vomiting
- Abdominal Distension
- Fresh blood in stool
- Can present with shock
117
What is the management of NEC?
- Stop oral feeds
- Broad spectrum antibiotics
- Parenteral nutrition
- Mechanical ventilation and circulatory support as required
- Surgery indicated if bowel perforation present
118
What are the causes of jaundice within the first 24 hours of life?
- Haemolysis (unconjugated bilirubin) - Rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, spherocytosis
- Can also be caused by congenital infection (conjugated bilirubin)
119
What are the causes of jaundice between 24 hours and 14 days of life?
- Physiological jaundice
- Breast milk jaundice
- Dehydration
- Infection
120
What are the causes of jaundice after 14 days of life?
- Biliary Atresia (IMPORTANT TO RULE OUT)
- Breast milk jaundice
- Infection
- Congeintal hypothyroidism
121
What is Kernicterus (neonatal jaundice)
- Encephalopathy resulting from deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei
- Can occur when the level of unconjugated bilirubin exceeds the albumin binding capacity of bilirubin in the blood
- Neurotoxic effects vary in severity
- Symptoms include: Irritability, hypertonia, seizures and coma
122
How do you mangae neonatal jaundice?
- Phototherapy (converts unconjugated bilirubin into a harmless water soluble pigment that is then excreted in urine
- Exchange transfusion
123
What are the clinicla features of pyloric stenosis?
- Vomiting with increasing frequency and forcefulness overtime until it becomes projectile
- Hunger post vomiting until dehydration leads to a lack of interest in feeding
- Weight loss
- Hypochloraemic metabolic acidosis
124
How do you treat pyloric stenosis?
- Correction of fluid and electrolyte imbalances with IV fluids
- Definitive treatment is pyloromyotomy (feeds can be reinitatied within 6 houts and discharge is at 2 days)
125
What are the clinicla features of Patau's Syndrome (Trisomy 13)
- Structural defect of the brain
- Scalp Defects
- Small Eyes and other eye defects
- Cleft lip and palate
- Polydactyly
- Cardiac and renal malformations
126
What are the clinical features of Edward's Syndrome (Trisomy 18)
- Low birthweight
- Prominent occiput
- Small mouth and chin
- Short sternum
- Flexed, overlapping fingers
- Rocker-bottom feet
- Cardiac and renal malformations
127
What are the clinical features of Down's Syndrome (Trisomy 21)
- Round face and flat nasal bridge
- Up slanted palpebral fissures
- Epicanthic folds
- Brushfield sports in iris
- Small mouth an dprotruding tongue
- Small ears
- Flat occiput and third fontanelle
- Short neck
- Single palmar creases
- Hypotonia
- Congenital heart defects
- Duodenal atresia
- Hirchsprung disease
128
What are the clinical features of Noonan Syndrome?
- Deep groove in philtrum
- Widely spaced eyes that are usually pale blue or blue green
Low set ears that are rotated backwards
- High arched palate
- Small lower jaw
- Short neck
- Neck Webbing
- Occasional mild learning difficulties
- Pectus excavatum
- Short stature
- Congenital heart diease (PS, ASD)
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What are the clinical features of Prader-Willi Syndrome
- Narrow forehead
- Almond shaped eyes
- Triangular mouth
- Hypotonia
- Neonatal feeding difficulties
- Faltering growth in infancy
- Obesity
- Hypogonadism
- Developmental delay
- Learning Difficulties
130
What are the clinical features of Turner Syndrome (45 X)?
- Lymphoedema of hands and feet in neonate which can eprsit
- Spoon shaped nails
- Short stature
- Neck webbing or thick neck
- Wide carrying angle
- Widely spaced nipples
- Coarctation of the aorta
- Delayed puberty
- Ovarian dysgenesis
- Hypothyroidism
- Renal anomalies
- Pigmented moles
131
What are the clinical features of Klinefelter Sundrome? (47XXY)
- Infertility
- Hypogonadism with small testes
- Pubertal development will be normal
- Gynaecomastia in adolescence
- Tall stature
- Intelligence in the normal range
132
What are the commonest causative organisms of bacterial meningitis in Neonates and Older Children?
Neonates (think vaginal bacteria):
- GBS
- E-Coli
- Listeria
Infants and Older:
- Neisseria Meningitides
- Haemophilus influenzae B
- Streptococcus pneumoniae
133
What are the clinical features of impetigo?
- Erythematous macules --> vesicular or pustular lesions on the face, neck and hands
- On ruptures of the lesions a characteristic honey coloured crusty lesion is produced
134
What is the management of impetigo?
- Topical Antibiotics (mild disease)
- Oral antibiotics (more severe) - flucoxacillin has better efficacy but is poorly tolelrated, co-amoxiclav is better tolerated
- Keep child off school until lesions are dry
135
What are the clinical features of periorbital cellulitis?
- Fever
- Erythema and tenderness around the eye
- Oedema around the eye
136
What is the management of periorbital cellulitis?
- High dose IV ceftriaxone to prevent posterior spread
137
What are the types of infection seen in HSV infection?
- Asymptomatic
- Gingivostomatitis
- Eczema herpeticum
- Herpetic whilows
- Eye disease
- Disseminated
138
What are the clinical features of an EBV infection?
- Fever
- Malaise
- Tonsilitis
- Lymphadenopathy
- Petechiae on the soft palate
- Splenomegaly and hepatomegaly
- Maculopapular rash
- Jaundice
139
What are the clinical features of Measles?
- Spread by droplets
- Fever
- Rash (maculopapular rash that becomes blotchy and confluent)
- Koplik Spots (white spots on buccal mucosa
- Conjunctivitis and coryza
- Cough
140
What are the clinical features of Mumps?
- 15-24 day incubation period
- Onset with fever, malaise and parotitis
- Fever should resolve within 3-4 days
- Generally mild and self limiting
141
What are the clinical features of Kawasaki's Disease?
CRASH AND BURN:
- Conjunvtivitis
- Rash
- Adenopathy
- Strawberry Tongue
- Swollen erythematous hands
- 5 days of fever
142
What is the management of Kawasaki's Disease?
- Treatment with IV immunoglobulin
| - Aspirin
143
What are the clinical features of Malaria?
- Fever
- Diarrhoea
- Vomiting
- Flu like symptoms
- Jaundice
- Anaemia
- Thrombocytopenia
144
What is the treatment for active TB?
RIPE
- Rifampacin, Isoniazid, Pyrazinamide and Ethambutol for 2 months
- Rifampacin and Isoniazid for a further 4 months
145
What are the clinical features of Fragile X syndrome?
In Males:
- Learning difficulties
- Large, low set ears, long thin face and high arched palate
- Macroorchidism
- Hypotonia
- Autisim is more prevalent
- Mitral valve prolapse
In Females
- Normal to mild symptoms
