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Paediatrics Flashcards

1
Q

Primary prevention of childhood accidents

A

Sait gourds

Speed limits

Teaching road safety

Window safety chaeck

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2
Q

Secondary prevention of childhood accidents

A

Wear seatbelts

Cycle helmets

Smoke alarms

Laminated safety glass

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3
Q

Tertiary prevention

A

Teach parents 1st aid

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4
Q

Achondroplasia

  • Phenotype
  • pathology
  • RF
  • Surgical Tx
A

Short limbs/fingers
Large head with frontal bossing
Lumbar lordosis

Autosomal dominant mutation resulting in abnormal cartilage

Parental age at conception
FH (AD)

Limb lengthening with Ilizarov

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5
Q

Acute epiglottis

  • Organism
  • Features
  • What NOT to do
A

Hib

Rapid onset, High temp, Unwell, Stridor, Drooling saliva

Examine throat with tongue depressor (precipitation airway obstruction)

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6
Q

Apgar score

  • Used for?
  • 5 categories (0-2 points per category)
  • What is a good score
A

Assess health of a newborn baby

Pulse (present, over 100 = gd)
Resp (strong, crying)
Colour (pink)
Muscle tone (active movement)
Reflex (cries on stimulation)
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7
Q

What is a bad situation in Apgar?

A

Blue
Floppy
No breath
part rate under 60bpm

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8
Q

Severe Asthma attach

  • SpO2
  • PEF
  • Talking
  • HR
  • RR
  • Other
A

Less than 92%

PEF 33-50% of predicted

Too breathless to talk/feed

HR over 125
(over 140 if under 5)

Over 30

Use of accessory muscles

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9
Q

Life threatening a asthma

  • SpO2
  • PEF
  • Chest
  • RR
  • Other Observations
A

SpO2 under 92%

PEF under 33%

Silent chest

Poor resp effort

Agitation, Altered consciousness
Cyanosis

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10
Q

Moderate attack

  • SpO2
  • PEF
  • Other
A

SpO2 over 92%

PEF over 50%

No other severe features

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11
Q

Treating Acute asthma (mild-moderate)

A

Bronchodiltor: Salbutamol via spacer

  • 1 puff every 30-60s up to a max of 10 puffs
  • If symptoms not controlled by inhaler challenge then refer to hospital
  • 3-5 day steroid therapy for all exacerbation (Prednisolone)
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12
Q

5 Asthma Step Tx in children over 5

only first 4 steps before referral in under 5s

A

1: SABA
2: + Pediatric dose ICS
3: + Leukotriene receptor agonist
4: LABA instead of LTRA
5: SABA + MART (instead of ICS+LABA)

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13
Q

What is MART

A

Maintenance and receiver therapy

Combined ICS and LABA in single inhaler

Used for daily maintenance as well as relief of symptoms

(LABA must have a fast acting component e.g. Formoterol)

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14
Q

ADHD

  • epidemiology
  • mechanism
A

Boys more

Low levels of dopamine in frontal areas = low concentration Tx targets this)

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15
Q

ADHD

- diagnosis

A

Persistent features

5 of the following

cant follow instructions

reluctant to engage with mentally intense tasks

Easily distracted

difficulty completing taks

Unable to play quietly

Talk excessively

Often on the go

Interruptive

doesn’t wait turn

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16
Q

ADHD management

What to do before drug therapy

A

Look at needs of cold and how life affected (Paediatrician with behaviour disorder interest or CAMHS)

1st line: Non pharma

Drug therapy: Methylphenidate, Lisdeamphetamine
(Both cardiotoxic, do an ECG prior

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17
Q

Autism

  • Epidemiology
  • 3 features for diagnosis
  • Other features
A

75% male, usually before age of 3

1) Global impairment of language/communication
2) Imparied social relationships
3) Ritualistic and compulsive phenomena

Most have a decreased IQ
Remember this is a spectrum of disease

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18
Q

Autosomal Dominant Vs Autosomal Recessive. How to remember

A

AR thought of as metabolic

AD more structural

** there are some exceptions

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19
Q

Autosomal Dominant E.G

A 
Achondroplasia
ADPKD
Ehlers-Danlos
FAP
SPherocytosis
HNPCC
Huntingtons
Marfans
Von hippel Lindau
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20
Q

Autosomal Recessive E.G

A 
CAH
CF
Phenylketonuria
Sickle cell
Thalassaemias
Wilsons
Haemochromatosis
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21
Q

Bronchiolitis

  • def
  • epi
  • cause
  • when is it serious
A

Condition with acute bronchiolar inflammation

LRTI in under 1 (small airways). Higher incidence in winter.

RSV in 80% (mycoplasma can also)

When assoc with prematurity (bronchopulmonary dysplasia), congenital heart defect or CF

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22
Q

Bronchiolitis

  • Features
  • Investigations
  • Referral to hospital
A

Coryza symptoms ± mild fever

Dry cough

Worsening breathlessness
(Feeding issues assoc commonly why admitted)

Wheeze/fine inspiratory crackles

Immunoflourescence of nasopharyngeal secretions may show RSV

Respiratory distress (chest recession, grunting) RR over 60
Difficulty feeding (breast, bottle)
Clinical dehydration
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23
Q

Management RSV

A

Humidified Oxygen vie head box if sat under 92%

NG feeding if struggling for food/liquid by mouth

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24
Q

RSV prophylaxis

  • Who
  • How
A

If Premature of Chronic lung disease
Significant congenital hart disease

Palivizumab

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25
Concerning causes of bruising in infants/children
NAI ( multiple sites, look for grip marks etc) Coag (Haemophilia, vWB, Liver disease) Thrombocytopenia (ITP, Congenital infection, meningococcal septicaemia, ALL)
26
Caput secundum - desc - features - management
Oedema of scalp at presenting part of head (vertex typically) Due to scalp pushing on cervix/use of ventouse Soft swelling, crosses suture lines Resolves in days - conservative
27
Cephalohaematoma - desc - what is it - common region - Time to resolve
Swelling on newborn head, typically parietal region, doesn't cross suture lines. Bleeding between periosteum and skull up to 3 months to resolve
28
Cerebral palsy - What is it - Manifestations
Disorder of development due to non-progressive lesion in motor pathways of developing brain Abnormal tone in infancy Delayed motor milestones abnormal gait Feeding difficulties
29
Associated non-motor problem CP
Learning difficulties (60%) Epilepsy (30%) Squints (30%) Hearing impairment (20%)
30
Causes of CP
Antenatal: Congenital infection (CMV, rubella, Toxoplasmosis) Cerebral malformation Intrapartum: Birth asphyxia Postnatal: intraventricular haemorrhage, meningitis, head trauma, Periventricular leukomalacia (white matter brain injury assoc with prematurity, poor white matter perfusion)
31
CP Classifications
Spastic (70%) - Hemiplegia - Diplegia - Quadriplegia Dyskinetic (involuntary movements) Ataxic Mixed
32
CP management
MDT approach Spasticity: DIazepam, intrathecal baclofen, Botulinum Toxin, Orthopaedic surgery Anticonvulsants and analgesia where needed
33
Chicken pox - Cause - Shingles
Varicella zoster Shingles: reactivation in dormant virus in dorsal horn. More due to herpes zoster
34
Chicken pox - Spread - Infectivity
Respiratory, can also be caught from shingles Infective 4 days before rash until 5 days after rash appeared
35
Chicken Pox features
Fever Itch, rash (maculopapular) Mild systemic upset
36
Chicken pox Tx
keep cool Calamine lotion School exclusion (5 days from rash onset) Immunocompromised/newborns (permpartum exposure) get Varicella zoster immunoglobulins (VZIG) and the IV acyclovir if chicken pox develop
37
Varicella zoster complications
Pneumonia encephalitis Haemorrhagic chicken pox
38
Types of child abuse
Physical Emotional Sexual Neglect Fabrication of illnesses
39
Observations of neglect
Persistent infestations (e.g. scabies/lice) Tooth decay Fail to attend followup Failure to suitably dress child Poor hygiene, inadequate food provision, Unsafe living env
40
Sexual abuse
Anogenital discomfort Preg in young women 13-15 Anogenital warts/Hep B in young child STI in child under 12
41
Physical abuse
bruising, Fractures (rib, fractures at diff stages of healing) Torn frenulum Burns
42
Factors pointing towards child abuse
Story inconsistent with injury Repeated A&E attendance Late presentation Frightened, frozen, withdrawn
43
Social milestones 6w 3m 6m 9m
6w: Smiles 3m: Laughs 6m: Not shy 9m: Shy, everything taken to mouth
44
Feeding - 12-15 month - 3yr - 5yr
drinks form cup and uses spoon Spoon + Fork Knife + fork
45
Play - 9 month - 18 month - 4 yr
Plays peek-a-boo, waves bye Plays alone Plays with others
46
Newborn screening
Hearing (otolaryngologists-acoustic emissions) Heel-prick (day 5-9) - Hypothyroid - Phenylketonuria - CF - MCADD
47
Mumps: | - Features
Fever, Malaise, Muscle pain, Parotitis ('earache')
48
Rubella features
Pink rash on face before spreading over body Lymphadenopathy: Suboccipital, postauricular
49
Scarlet fever - Cause - features
Reaction to erythrogenic toxins from Group A haemolytic strep (pyogenes) Fever, Malaise, Strawberry tongue, tonsilitis
50
Hand, Foot and Mouth - Cause - Features
Coxsakie virus Sore throat, Fever, Vesicle in mouth, on plasma and soles of feet
51
Patau syndrome - Chr - Features
Trisomy 13 Microcephaly, small eyes, Cleft lip/Palate, Polydactyly
52
Edwards - Chr - Features
E for Edwards and Eighteen - trisomy 18 Low-set ears, rocker bottom feet, overlapping of fingers
53
Prader- Willi features
Hypotonia Hypogonadism Obesity
54
Coeliac in children - Cause - Complication
Sensitivity to gluten (Anti-tissue Transglutaminae) Villous atrophy and malabsorption
55
When do children present with coeliac
Around Age of 3 - when cereals introduced
56
Coeliac in children genetics
HLA- DQ2/DQ8 in up to 95%
57
Features of coeliac in children
Coincide wit introduction of cereals ``` Failure to thrive Diarrhoea Abdo distension Anaemia May go undiagnosed ```
58
Coeliac diagnosis
Jejunal biopsy = subtotal villous atrophy, crypt hyperplasia, intraepithelial lymphocytes Anti-endomysial and anti-gliadin antibodies
59
Acyanotic congenital heart defects (left to right)
VSD (most common, 30%) ASD Patent ductus arteriosus Other: Coarctation of aorta Aortic stenosis
60
Cyanotic Congenital Heart defects
Tetralogy of Fallot (initially left to right until Eisenmenger's) Transpositioning of great arteries Tricusp atresia
61
Congenital Rubella Features
``` Sensorineural deafness Cataracts Glaucoma Heart disease (e.g. PDA) Cerebral palsy (less common) ```
62
Diagnosis of constipation (2+ out of)
Fewer than 3 stools a week Type one on Bristol chart (rabbit droppings) Overflow (loose, smelly, passed without sensation) Pain/Bleeding with bowel movements Straining Appetite improves with stool Hx of constipations Painful bowel movements
63
Constipation causes
Idiopathic ``` Dehydration Low fibre Medications (opiates) Anal fissure Hypothyroidism Hirschprung's Hypercalcaemia LEarning difficulty ```
64
Red flags for secondary cause of constipation
Constipation like symptoms from birth (meconium over 48hrs from birth) Ribbon stools Weakness in legs, locomotor delay Abdo distension
65
Amber flags for secondary cause of constipation
Faltering growth Disclosure/evidence suggesting possible child abuse
66
What needs assessment prior to Tx constipation? | what features to look for?
Faecal impaction Severe constipation (Long since opened bowels, pain) Palpable mass in abdo
67
Treatment of impaction
Movicol Paediatric plan (glycol 3350+) If no disimpaction after 2 weeks then give stimulant (Senna - Sennokot)
68
Constipation maintenance therapy
Diet: not used alone, ensure enough fluids and fibre 1st line movicol Add stimulant laxative if no response Add Lactulose to Senna if movicol not tolerated Continue meds until a regular bowel habit is establishes then reduce dose gradually
69
Cows milk protein allergy - Features - Pathology - Tx
Regurgitation/vomit, diarrhoea, atopic eczema, colic (crying, irritable), wheeze Both immediate (IgE: Allergy) and Delayed (non-IgE: intolerance) reactions Skin prick, IgE (RAST) for cow's milk protein. Hydrolysed milk 1st line Usually resolves by1-2 yrs age. Challenge according to milk ladder
70
Croup | - Def, Epidemiology & Cause
URTI in infants and older toddlers Parainfluenza majority of cases
71
Croup Features
Stridor Barking cough (worse at night - lower endogenous steroid) fever Coryzal symtpms
72
Signs of severe croup (Should be admitted)
Frequent barking cough Prominent stridor (inspiratory and expiratory) Sternal recession Distress, agitation or lethargy (Hypoxaemia)
73
Management of Croup In Emergency?
Single dose oral Dexamethasone (0.15mg/kg) High flow O2, Nebulised adrenaline
74
Nitrogen washout test - What does it test - What is diagnostic
100% O2 given and then ABG done Distinguishes cardiac from non cardiac cyanosis A pO2 of less than 15kPa indicates congenital heart disease
75
CF - Genetics, defect & effect - Organs - Carrier rate
Autosomal recessive Cystic fibrosis transmembrane conductance regulator gene (CFTR) Chr 7 Defective Cl transport = viscous secretions Lungs, pancreas, bowel (obstruction), Fertility 1 in 25
76
CF organisms that may colonise
Staph aureus Pseudomonas aeruginosa Burkholderia cepacia Aspergilus
77
CF diagnosis
Screening (Monospot blood test): Immunoreactive trypsinogen IF +ve screening: High sweat chloride (over 60mEq/L) Genetic testing (blood or salivary sample)
78
CF Features
Meconium ileus Recurrent chest infections Malabsorption (Steatorrhoea, Failure to thrive) Male infertility, female sub fertility, DM, Short, Rectal prolapse (bulky stools), nasal polyps
79
CF management
Regular (2X a day) chest physio High calorie diet, inc high fat + vit supps Pancreatic enzymes with meals Heart and lung transplant
80
Referral
Doesn't smile at 10 weeks Cant sit unsupported at 12 weeks Cannot walk at 18 months
81
Fine/gross motor problems possible cause
CP e.g. hand preference, global motor impairment
82
Speech and language problems cause
Hearing Env deprivation General developmental delay
83
Developmental dysplasia of the hip: - Def - RF - Testing/diagosis - Tx
Improper formation of hip acetabulum ``` Female Breech birth FH 1st born Oligohydramnios ``` Barow (dislocate) & Ortolani (relocate) femoral head USS if clinical suspected ``` Most will stabilise by 3-6 weeks Pavlic harness (flexion, abduction orthosis) ``` Older children may need surgery
84
Fine motor milestones - 6 months - 9 months - 12 months
Hold in palmar grasp Pass objects from one hand to the other Point with finger, early pincer Good pincer grip
85
Brick building Tower of 2 Tower of 3 Tower of 6 Tower of 9
15 months 18 months 2 years 3 years
86
Gross motor milestones ``` 3 months 6 months 7-8 months 9 months 13-15 months 2 years ```
Little/No head lag on being pulled up, good head control Rolls front to back Sits without support Pulls to stand, crawl Walks unsupported (refer at 18 mnths) Runs, stairs with hand rail
87
Speech and hearing milestones ``` 3 months 6 months 9 months 12 months 2.5 years 3 years ```
Turns to sound Double syllable 'adah' 'erleh' mama and dada, understand "no" Responds to own name Vocal over 200 short sentences
88
Common cause of gastroenteritis in children
Rotavirus
89
Hydration status categories in children
Clinical dehydration Clinical shock
90
What is seen in clinical dehydration
``` Decrease urine output Dry mucosa Tachycardia/tachypnoea Sunken eyes Normal peripheral pulses Normal cap refill Warm extremities ```
91
What is seen in clinical shock
Decreased Level of consciousness Cold extremities Pale/Mottled skin Tachycardia/Tachypnoea Weak peripheral pulses & hypotension Prolonged cap refill
92
Who is at inc risk dehydration
``` Younger than 1 low birth weight diarrhoea (6+ stools in 24 hrs) vomit (3X in 24 hours) infants who have stopped breast feeding ```
93
Fluid bolus in dehydration
Crystalloid 20ml/kg over 10 min in children
94
Fluid maintenance
Hourly fluid maintenance: First 10 Kg 4ml per kilo Second 10 Kg 2ml per kilo Above 20 Kg 1ml per kilo
95
Causes og chronic diarrhoea in children
Most common: Cows milk intolerance (lactose) Coeliac
96
Down syndrome features - Face/Head - Organs - Other
Epicanthic folds Protruding tongue, small ears, round face, flat occiput Hirschprung's, Duodenal atresia, Congenital heart defects Single palmar crease, Hypotonia,
97
Cardiac complications Down's
VSP ASP (secundum - enlarged foramen ovale. Most common Congenital heart defect) Tetralogy of Fallot PDA
98
Later complications of Down's syndrome
Subfertility/Infertile(men) - sperm or preg problems Learning difficulties Resp infections ALL Alzheimer's
99
RF for Down syndrome
Maternal age, esp over 35
100
Downs pathophys
Dislocation or translocation of Chr 21
101
Eczema - Pres and prognosis - distribution
Typically presents before 6 months. clears in 50% baby 5 years and 75% by 10 years of age Infants: Face and trunk Older: Flexor surfaces and creases
102
Eczema Tx
Avoid irritants Emollients (large amounts) Topical steroids
103
Febrile convulsion - def - when - type of seizure & how long
seizure provoked by fever usually in early viral infection as temp rises rapidly Usually brief (under 5 min) Tonic-Clonic
104
Link of febrile seizure to epilepsy
A RF for epilepsy
105
Fetal alcohol features
Thin vermillion (hypoplastic upper lip) Absent filtrum Learning difficulties Microcephaly Growth retardation Epicanthic folds
106
How is fever risk stratified in children
Green Amber Red
107
What should be assessed in all children with fever
Temperature Heart rate Resp rate Cap refill
108
Features of Amber (intermediate risk
Pallor Not responding to social cues/Dec activity Nasal Falring, tachypnoea (over 40 Breaths a min) O2 sats less than 95% ``` Tachycardia over 140bpm Cap refill over 3 s Dry mucous membrane reduced urine Temp over 39 Non-weight bearing limb ```
109
Features of red (high risk)
Pale/mottled/blue No response to social cues Not rousable Weak Grunting, Tachypnoea, RR over 60, Chest recessions/accessory muscle use Reduced skin turgor, inc cap refill Temp over 39, non-blanching rash, Blueing fontanelle, Neck stiffness, focal neurology, status epileptics
110
Management of an 'Amber' child
Safety net: know who to call/where to bring if gets worse
111
Management of a 'red' child
Urgent admission/referral to paediatrics
112
What is common cause of GORD in infants
Overfeeding with bottle
113
What are Gastroschisis and Exomphalos
Disorders of anterior abdo wall development
114
What is Responsible for growth spurt
GH
115
When to give CT head in children
Lost consciousness over 5 min NIA suspected Vomiting Amnesia Focal signs Dangerous mechanism of injury
116
Most common causes of headache in children
Most common = Migraine with aura (Ibuprofen) Tension (2nd)
117
Cause of conductive hearing loss
Secretory otitis media Down's syndrome
118
Cause of Sensorineural hearing loss
Congenital infection (Rubella) Acquired: meningitis, head injury Cerebral palsy
119
Hirschprungs: - Cause - Pres - Assoc
Aganglionic segment. Failed development of Auerbach/Meissners plexuses Failure/delay to passing meconium Older: Constipation, abdo distension More in Males., Downs
120
Causes of hypertension in children
Renal vascular/parenchymal disease Coarctation of aorta Phaemchromocytoma CAH
121
Hypospadias - def - location - tx
Ventral urethral meatus Usually distal Surgical correction before age of 2 (uses foreskin)
122
Causes of hypotonia
Downs Prader-Willi Hypothyroidism Cerebral Palsy (may precede spasticity) Guillain Barre Myathenia gravis
123
Immunisation at birth
BCG | Hep B
124
Immunisation 2 / 3s / 4 months
6-1 vaccine (diphtheria, tetanus, whooping cough, polio, Hit, Hep B) Oral Rotavirus Pneumococcal conjugate vaccine Men B
125
Immunisation 12-13 month
``` Hib Men C MMR Pneumococcal conjugate Men B ```
126
2-8 years Immunisation
Flu vaccine
127
Immunisation 3-4 years
'4-in-1 pre-school booster' (diphtheria, tetanus, whooping cough and polio) MMR
128
Immunisation 12-13 y.o. girls
HPV vaccination
129
What vaccine given in university Freshers
Men ACWY
130
Infant colic
Excessive crying in infant under 3 month occurs in 20%, cause unknown
131
What Features in a physiological murmur
``` Soft-blowing Postural variation No Radiation No thrill No added sounds (clicks) No other symptoms ```
132
Intraventricular haemorrhage - Adult/Premature/Neonates - Complication - Tx
Intraventricular bleeding Traumatic head injuries Spontaneous due to blood clot Birth trauma/delicate neonatal CNS Hydrocephalus Supportive, Intraventricular thrombolysis, VP shunt in hydrocephalus
133
Intussusception - Desc - Common site - Features
Telescoping of one portion of bowel into distal bowel Ileo-caecal Abdo colic pain, Vomiting, Red-currant jelly, Sausage shaped mass in Right lower quadrant
134
Intussusception - Investigation - Tx
USS (target shaped mass) Air insufflation Surgery if 1st line fails and signs of peritonitis
135
Jaundice in Newborn - When always pathological (what causes) - when physiological and mech
First 24 hours (Rhesus haemolysis, ABO heamolysis, Spherocytosis, G6PDD) 2-14 days physiological as fatal Hb replaced by adult
136
In prolonged neonatal jaundice what is worry? | Tx?
Biliary atresia (lack of biliary ducts) Raised conjugated bilirubin (Liver has conjugated) Surgery
137
JIA - Clinical features - Investigations
``` Pyrexia Rash (salmon pink) Lymphadenopathy Arthritis Uveitis Anorexia/weight loss ``` ANA positive RF -ve
138
Kawasaki disease - disease type - Important complication
Vasculitis predominantly seen in children Coronary artery aneurysms
139
Kawasaki disease - Features - Diagnosis
High grade fever, Red/cracked lips, strawberry tongue, cervical lymphadenopathy, red palms/soles eventually peel Clinical diagnosis, no specific investigation
140
Kawasaki disease Management
High dose aspirin (one of few indications for this in children - Reyes risk) IV Ig Echo (for coronary aneurysms
141
Chondromalacia patellae - pathology - Who - pres - Tx
Softening of cartilage of patella Teenage girls Anterior knee pain (esp up and down stairs) Physio = good response
142
Osgood-Schlatter - Who - Pres
Sporty teen Pain, tenderness, swelling over tibial tubercle
143
Limp in child, Obese
Slipped upper femoral epiphysis | femoral head displaced posteriorly
144
Limp, child unwell/fever
Septic arthritis/osteomyelitis
145
Measles - Virus type - Spread - Features
RNa Droplet spread 1) Prodrome: irritable, fever, conjunctivitis 2) Koplik spots (white spots on buccal mucosa) - before rash 3) Rash: starts behind ears then to whole body (maculopapular)
146
Measles - Ix - Tx - Complications
IgM to Measels supportive, notifiable disease Encephalitis, febrile convulsion, myocarditis
147
Meckel's Diverticulum - What is it - Rule of 2's
Congenital remnant of vitelline duct. Diverticulum off small intestine 2% pop, 2ft from ileocaecal, 2 inches long
148
Meckel's Diverticulum Usually asymptomatic, but possible pres:
``` Abdo pain (mimic appendicitis) Rectal bleeding Intestinal obstruction (volvulus, intussusception) ```
149
Meckel's Diverticulum Tx
Surgical removal (resection and re-anastomosis)
150
Meningitis investigations
LP (unless raised ICP signs) and PCR Blood cultures and PCR if no LP
151
What signs of inc ICP CI LP?
``` Focal neurological signs Papilloedema Bulging fontanelle DIC Cerebral herniation (resp impairment) ```
152
Management of meningitis: - 4 Catergories. - How are contacts tx
Antibiotics: IV cefotaxime (+ Amoxicillin if under 3m) Steroids: Ddx given if H.Influenzae Fluids: treat shock with colloid Cerebral monitoring: monitor resp, may need mechanical ventilation Ciprofloxacin
153
Meningitis cause: - Neonatal - 3m - Up to 6yr - Over 6
GBS (from mother, esp prem, PRM) E.coli Listeria Neisseria meningitidis Strep Pneumoniae Haemophilus influenzae Neisseria meningitidis Strep Pneumoniae
154
Mitochondrial disease - Inheritance - Disease types
Inherited only from affected mothers (fathers don't contribute any cytoplasm) Rare neurological diseases
155
MMR - Type of vaccinator and against what - When given - CI
Live vaccine against measles, mumps and rubella 2 doses: 12-15 months and also 3-4 years Preg, Immunosuppression, allergy, another live vaccine within 4 weeks
156
Napkin rash Irritant dermatitis Vs Candida
Dermatitis: most common. irritant effect of urinary ammonia&faeces, Creases spared Erythematous rash involving flexures. Charecteristic satellite lesions (Tx: imidazole)
157
Napkin rash general management
Use disposable nappies Expose napkin to air when poss Mild steroid (1% hydrocortisone) in severe
158
NEC - Why important - Initial pres - Ix + what shown
One of leading causes of death in prematurity Feeding intolerance, abdo distension bloody stools Abdo x-ray - dilated bowel loops - Bowel wall oedema, pneumonitis intestinal (intramural gas) - air both inside and outside bowel wall
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NEC pathophys
Intestinal immaturity (poor barrier function, immune defence, motility) Abnormal bacterial colonisation And/Or hypoxic ischaemic injury And/Or Formula feeding = NEC
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NEC complication
Abdo perforation, peritonitis, death
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NEC Tx
Stop oral feeding | Abx: Cefotaxime, Vancomycin
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What is tested for in Heel-Prick (Guthrie) test
Immunoreactive trypsinogen (CF) Sickle cells TSH (congenital hypothyroidism Phenylketonuria - amino acid metabolism error can impair brain development
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Nephrotic syndrome - triad - peak incidence - cause in most
Peripheral oedema, Proteinuria, Hypoalbuminaemia 2-5 yrs Minimal change disease 90% respond to high dose steroids Other features: hyperlipidaemia, hypercoagulable
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Newborn resus
1) dry baby and maintain temp 2) assess tone, resp and heart rate 3) 5 inflation breaths (to keep lungs open) 4) reassess chest 5) if HR under 60 compression and ventilation 3:1
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Noctural enuresis: - Possible causes - Tx (behavioural, short term control)
UTI, Constipation, T1DM Star charts Desmopression
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Primary Vs Secondary enuresis
Primary: never been continent Secondary: previously continent
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Causes of obesity in children
Lifestyle by FAR the most secondary: - Downs - Cushings - Prader-Willi - GH deficiency
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Consequences of obesity in children
Ortho: slipped femoral epiphyses Psych: poor self esteem, bullying Sleep apnoea Long-term: Inc incidencee T2DM and IHD
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Where is BCR ABLE oncogene seen typically
CML
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What is an oncogene
Cancer promoting gene derived from mutated normal gene | Only one mutation needed
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TSG
Tumour supressor genes repress cellular proliferation Mutation inactivates Two mutations = no suppression of cellular division
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TSG Eg
p53 Retinoblastoma BRCA 1&2
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Paediatric BLS
Check responsive Shout for help Open airway (look/listen/feel for breathing) 5 rescue breaths Check circulation 15 chest compressions:breaths
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Other Associations with oesophageal atresia
Trachea-Oesophageal fistula Polyhydramnios VACTERL
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Perthes' Disease - def - who - Features
Degenerative condition of hip due to avascular necrosis of femoral head (epiphyseal) due to impaired blood supply 5 x more in Boys, 4-8 years Hip pain develops over weeks, reduced ROM,
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Perthes diagnosis
Xray: - Early: widening joint space - Late: decreased femoral head size/flattening
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Perthes Complications
OA | Premature fusion of growth plates
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Perthes Managemnt
Keep femoral head within acetabulum (casts, braces) Over 6 yrs: Surgical. Operate on severe deformities
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Phenyketonuira: - Genetics - Enzyme + role - High phenylalanine causes .. - Heel-Prick result - Manage
Autosomal recessive Phenyalanine hydroxylase (breaks down phenylalanine) Learning difficulties and seizures Hyperphenylalaninaemia Diet restrictions of amino acid rich foods
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Pneumonia in children | - Treatment
Amoxicillin 1st line
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Prader-Willi - Chr - Features
Long arm of chromosome 15 ``` Hypotonia during infancy Short dysmorphic features Hypogonadism/infertility Childhood obesity Behavioural problems in adolescence ```
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Precocious puberty - who normally - what is - Central/true Vs False
Girls puberty before the age of 8 Central = premature activation of hypothalamic-pituitary-gonadal axis (high FSH/LH) False = FSH&LH low, due to excess sex hormone Usually idiopathic or familial and follow a normal course of puberty
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Puberty | - Age in boys/girls
Males: testicular growth 12 yrs (over 4ml) Growth spurt at 14 Females: Treat dev at 11, menarche at 13 (11-15)
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Pyloric stenosis - When pres - Cause - Epi
2nd-4th week with vomiting hypertrophy of circular muscles of the pylorus 4X more in men
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Pyloric stenosis: - Features - Diagnosis - Tx
Projectile vomiting (30min after feed) Constipation and dehydration Palpable mass in upper abdo (olive) Hypochloraemic, hypokalaemia alkalosis from persistent vomiting USS to diagnose Ramstedt pylorotomy to Tx
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Retinoblastoma - Def - when diagnosed - Pathophys
Most common ocular malignancy in children 18 months Loss of functions of Rb TSG on Chr 13
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Retinoblastoma - Features - Tx - Prognosis
Absent red-reflex (replaced with white pupil - Leukocoria) Strabismus (inward misalignment of eye) visual problems External be a, radiation, chemo, photocoagulation, enucleation 90% survive into adulthood
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Scarlet fever: - what causes - who - Spread
Reaction to toxins produced by Group A strep (Pyogenes) Children aged 2-6 Respiratory spread (droplet)
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Scarlet fever: - Features - Management
``` Fever Malaise (N&V, headache) Sore throat Strawberry tongue Fine punctate rash (pinhead, sandpaper) Desquamation around fingers and toes ``` Oral penecillin V (phenoxymethylpenicillin) Azithromycin if allergic
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Scarlet fever usually mild, may be complicated by...
Otitis media (most common) Rheumatic fever (Group A strep) Acute glomerulonephritis (immunisation complex mediated)
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Shaken baby - Triad - Cause
1) Retinal haemorrhage 2) Subdural haematoma 3) Encephalopathy Intentional shaking of a child 0-5 years old
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RF for sudden infant death syndrome (largest killer in 1st year of life)
``` Prone sleeping Parental smoking Prematurity Bed sharing Over wrapping (hyperthermia) ```
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Sudden infant death syndrome protective factors
Breastfeeding Room sharing Use of dummies
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Slipped femoral epiphysis - Who - What - When commonly - Pres
10-15 year old obese boys Postero-inferior displacement femoral head Acute presentation following trauma OR Chronic persistent symptoms Hip, Groin, Medial thigh or knee pain Lost internal rotation of hip
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Surfactant deficient lung disease (RDS) - who - cause
Premature infants Insufficient surfactant production and structural immaturity of lungs
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RDS risk - 26-28 weeks 30-31 weeks - When surfactant produced and role
50% 25% Around 28 weeks Helps reduce surface tension of lungs
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RF for RDS
Prematurity Male Diabetic mother C-section
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SDLD (RDS) clinical features & CXR features
Tachypnoea, intercostal recession, expiratory grunting, cyanosis
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Surfactant deficiency lung disease management
Maternal corticosteroids to induce lung maturation (given with nifidepine/terbutaline tocolytics) Oxygen, assisted ventilation Exogenous surfactant (Exosurf)
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Tetralogy of Fallot - type of congenital heart disease - four features
Cyanotic 1) VSD 2) Over-riding aorta 3) Pulmonary stenosis (determines cyanosis degree) 4) Right ventricular hypertrophy
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TOF other features
Ejection systolic murmur (pulmonary stenosis) | CXR: boot shaped heart, ECG: RVH
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TOF management
surgical repair (2-stage procedure)
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Complication of TOF
Eisenmengers (need heart & lung transplant)
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TSG EGs
``` p53 APC (colorectal) BRCA 1&2 (Breast, ovary) NF1 Rb ```
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Turner syndrome - Genetic abnormality - Features - Inc risk of..
45XO Short, primary amenorrhoea, webbed neck, bicuspid aorta, coarctation of aorta AI disease (Thyroiditis, Crohn's)
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Undescended testis - Complications - Tx
Infertility Torsion Testicular cancer Orchidopexy: move to scrotum (done at around 1yr age)
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UTI in children - diff to adult manage - Organism - Predisposing factors
Should always be investigated for underlying cause and kidney damage E.coli (80%) Infrequent voiding, constipation (obstructive) Vesicoureteric reflux Poor hygiene: wiping back to front (girls)
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UTI in children - who - pres - urine collection - Tx
Boy more until 3m poor feeding, vomiting Abdo pain, dyuria, frequency, haematuria Upper UTI: loin pain, temp over 38 Clean catch (best), pads, invasive (suprapubic aspiration) Under 3m = referral LUTI: Trimethoprim UUTI: Cephalosporin, co-amoxiclav
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Vesicoureteric reflux - def - complication - pathophys - Ix & diagnosis
abnormal back flow of urine from bladder into the ureter/kidney UTI, renal scarring in 35% Lateral displacement. More perpendicular (rather than angle) = shorter intramural course of ureter. Micturating cystogram for diagnosis DMSA scanner renal scarring
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Whooping cough - Cause - immunisation times & problem
Gram -ve Bortadella pertussis 2,3,4 months then 3-5 years (Pregnancy vaccination campaign as newborns vulnerable) Immunisation and infection don't provide lifelong immunity
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Whooping cough presentation & diagnosis & complications
2-3 days of coryza before: cough bouts: may cause vomiting, central cyanosis inspiratory whoops (forced inspiration against glottis) symptoms 10-14 weeks Ix Nasal swabs, PCR and serology, marked lymphocytosis Comp: subconjunctival haemorrhages, pneumonia, Bronchiectasis, seizures
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Whooping cough management
Oral macrolide: Clarithromycin or erythromycin (to reduce spread of disease, doesn't alter symptoms)
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Wilm's tumour - what - who - pres
Nephroblastoma Children under 5 abdo mass (can cause constipation like symptoms), painless haematuria Anorexia fever
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Wilms tumour Tx
Nephrectomy, chemotherapy, Radiotherapy Prognosis: 80% cure rate.
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Why no aspirin in children
Reyes syndrome (Brain and Liver dysfunction)
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Who is affected in X-linked recessive
Only males male to male transmission never seen, can only have unaffected sons or carrier daughters Goes on the principle that affected father X heterozygous mother = VERY rare
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Septic screen
CXR Urine & blood culture LP

Final (26 decks)

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