Paediatrics Flashcards
1
Q
Developmental milestones for a 6 week old
A
- Holds head briefly in ventral suspension
- Some head lag
- Primitive reflexes
- Symmetrical limb movement
- Holds fist closed
- Turns to light
- Fixes and follows through 90o, especially faces
- Cries
- Responds to mother’s voice
- Startles to noises
- Smiles
2
Q
Developmental milestones for a 3-4 month old baby
A
- No head lag
- Raises chest (resting on elbows) when prone
- More vigorous limb movement
- Holds objects placed in hand
- Reaches for objects
- Fixes and follows through 180o
- Cooing
- Quietens to mother’s noises
- Laughs
3
Q
Developmental milestones for a 5-6 month old baby
A
- Sits supported/unsupported with a curved back
- Lifts chests on extended arms when prone
- Rolls front to back and back to front
- Brings objects to midline
- Transfers objects between hands
- Consciously releases objects
- Starts mouthing objects
- Early babbling
- Happy screams
- No stranger anxiety
4
Q
Developmental milestones for a 8-9 month old baby
A
- Sits unsupported with a straight back
- May crawl/bum shuffle
- Early pincer grip
- Looks for fallen objects
- Developed babbling - repetitive consonants
- Says ‘mama’ and ‘dada’
- Stanger anxiety
- Plays peekaboo
5
Q
Developmental milestones for a 10 month old baby
A
- Pulls to stand
- Cruising
- Developed pincer grip
- Understands no
- Understands concept of bye bye
6
Q
Developmental milestones for a 12 month old baby
A
- Early walking - unsteady/broad based gait
- Bangs objects together
- Casts objects
- Object permanence - looks for hidden toys
- Points at things
- Few individual words
- Imitates sounds and speaks jargon with conversational intonation
- Understands name and simple objects
- Finger feeds
- Holds spoon and attempts use
- Waves bye bye/claps
- Points to convey excitement or desire
7
Q
Developmental milestones for a 15 month old baby
A
- Confident walking
- Builds towers of 2-3 bricks
- Turns thick cardboard pages
- Obeys simple commands
- Can identify simple objects
- Uses cup and spoon
8
Q
Developmental milestones for an 18 month old baby
A
- Squats to pick up objects
- Runs
- Builds towers of 4 blocks
- To and fro scribble
- Points to pictures in books
- Turns pages in books a few at a time
- 10-20 words including common objects
- Common two word phrases
- Points to body parts
- Removes socks/shoes
- Imitative play/domestic mimicry
9
Q
Developmental milestones for a 2 year old baby
A
- Jumping
- Kicks ball
- Climbs stairs two feet per stair/holding on
- Circular scribble
- Draws straight lines
- Build towers of 6 blocks
- 50+ words
- Links words together to make 2-3 word sentences
- Understands functions of objects and verbs
- Obeys two-part commands
- Feeds with fork and spoon
- Starts toilet training
- Temper tantrums
- Plays alongside other children
- Symbolic play
10
Q
Developmental milestones for a 3 year old child
A
- Rides a tricycle
- Climbs stairs with one foot per step and goes down stairs with two feet per step
- Copies a circle
- Builds a tower of 9 blocks
- Copies a bridge and a stair with 6 blocks
- Knows several nursery rhymes
- Complex 4-5 word sentences
- State first and last name
- ‘What’ and ‘who’ questions
- Understands predisposition
- Understands sizes
- Washes hands
- Plays with other children
- Understands concept of sharing
- Pretend play
11
Q
Developmental milestones for a 4 year old
A
- Hops
- Walks up and down stairs like an adult
- Copies a cross
- Copies stairs with 10 blocks
- Can tell descriptive account of events
- Uses ‘why’, ‘when’ and ‘how’
- Understands negatives and three part commands
- Undresses but can not dress independently
- Understands turn taking
12
Q
Developmental milestones for a 5 year old
A
- Skips
- Catches ball
- Copies a triangle/square
- Tells a complex story using all tenses
- Dresses independently, including zips and buttons
- Can eat with a knife and fork
- Chooses and names best friends
- Imaginative play, role playing or making up stories
13
Q
Developmental indications for referral at 6-8 weeks
A
- Asymmetrical Moro reflex
- Unable to fix and follow
- Not smiling
- Excessive head lag
- No startle to sound
- Absent red reflex
14
Q
Developmental indications for referral at 12 weeks
A
- Persistent squint
15
Q
Developmental indications for referral at 8 months
A
- Persistent primitive reflexes
- Not vocalising
16
Q
Developmental indications for referral at 1 year
A
- Hand preference
- Not responding to their own name
17
Q
Developmental indications for referral at 18 months
A
- Not walking
18
Q
Developmental indications for referral at 2 years
A
- No/few words
19
Q
Developmental indications for referral at 3 years
A
- Not speaking in sentences
- Not interacting with other children
- Not following simple commands
- Unable to use the toilet
- Unable to use a spoon
20
Q
Routine assessment of a newborn
A
- Top to toe examination
- Red reflex
- Feeding
- Bladder and bowels opened
- Weight
- Head circumference
- DDH screen
- Heart sounds
- Newborn hearing screen
21
Q
Routine assessment at 7-14 days old
A
- Reassessed to ensure adequate feeding
- Any parental anxieties or maternal mental health concerns
- Guthrie blood spot test
22
Q
Routine assessment at 6 weeks old
A
- Repeat newborn examination
23
Q
Routine assessment at 8-12 months
A
- Full developmental check
- Growth and feeding
24
Q
Routine assessment at 2-2.5 years
A
- Full developmental check
- Discussion of any social developmental concerns
25
Define global developmental delay
Developmental delay in 2 or more areas of development
26
Causes of developmental delay
- Congenital neurological defects
- Acquired neurological defects
- Congenital infection
- Acquired infection
- NM disorders
- Endocrine abnormalities
- Genetic syndromes
- PDD
- Nutritional deficiencies
27
Investigations to consider in a child with developmental delay
- FBC + haematinic: iron deficiency anaemia, B12, folate deficiency
- U&Es: renal function, hyponatremia
- Creatinine kinase: DMD
- TFTs: hypothyroidism
- LFTs: underlying metabolic disorder
- Bone profile and vitamin D: vitamin D deficiency
- Hearing test
28
Reassuring signs in a baby with a heart murmur
- Pink with normal O2 sats
- No respiratory distress
- Quiet, intermittent, positional murmur
- Good feeding
- Normal BPs in each limb
29
Components of the APGAR score
```
Appearance
Pulse
Grimace/reflex irritability
Activity/muscle tone
Respiratory effort
```
30
Conditions which are screened for in the Guthrie test
- Neonatal hypothyroidism
- CF
- Sickle cell disease
- PKU
- Medium chain AcylCoA dehydrogenase deficiency
- Homocystinuria
- Maple syrup urine disease
- Isolvaeric academia
- Glutaric aciduria type 1
31
Risk factors for neonatal hypoglycaemia
- Maternal diabetes
- Maternal preeclampsia
- Maternal beta blocker use
- IUGR
- SGA/LGA
- Prematurity
- Macrosomia
- Foetal hypothermia
- Foetal sepsis
- Foetal hyperinsuliaemia
- Foetal polycythaemia
- Perinatal stress
- HIE
- BW syndrome
- Nesidioblastosis
32
Symptoms of neonatal hypoglycaemia
- Lethargy
- Poor feeding/refusal to feed
- Jitteriness
- Seizures
- Apnoea
- Hypothermia
- Irritability
- Pallor
- Weak/high pitched cry
- Hypotonia
- Coma
- Rapid and irregular respirations
- Hunger
33
Investigations for neonatal hypoglycaemia
- Blood glucose
- True blood glucose level
- C-peptide
- Lactate
- Metabolic screen
34
Management of neonatal hypoglycaemia
- Monitor blood sugars regularly in at risk neonates
- Good feeding
- Temperature maintenance
- IV dextrose infusion if required
35
Main causative organisms in early onset neonatal sepsis
- GBS
| - E. Coli
36
Risk factors for early onset neonatal sepsis
- Group B strep in a previous pregnancy
- Maternal GBP, bacteriuria or infection in current pregnancy
- Prolonged rupture of membranes
- Preterm birth following spontaneous preterm labour
- Foetal distress without adequate explanation
- Intrapartum maternal fever
- Suspected/confirmed chorioamnionitis
- Suspected/confirmed maternal sepsis during labour or within 24 hours of birth
- Suspected or confirmed infection in a baby in a multiple pregnancy
37
Signs/symptoms of neonatal sepsis
- Temperature instability
- Vomiting
- Respiratory distress, apnoea, tachypnoea, increased respiratory support requirement
- Brady/tachycardia
- Pallor, cyanosis, mottling
- Hypotension
- Encephalopathy
- Altered tone
- Unexplained bruising, petechiae or excessive bleeding
- Hypo/hyperglycaemia without reason
- Lethargy/drowsiness
- Local signs of infection
- Seizures
- Jaundice
- Poor urine output
- Poor tolerance of handling
38
Investigations to consider in neonatal sepsis
- Blood gas
- FBC
- Inflammatory markers
- Blood culture
- Lumbar puncture
- Urine culture
- CXR
- AXR
- Nasopharyngeal aspirate
- Stool culture
- Skin swabs
39
Management of early onset neonatal sepsis
IV Ben Pen + Gent within 1 hour, for at least 36-48 hours
| 7-10 days for positive blood culture, 3 weeks for positive CSF culture
40
Causative organisms of late-onset neonatal sepsis
- GBS
- Staphylococcus
- Colioforms
- Pseudomonas
41
Risk factors for late onset sepsis
- Prolonged hospitalisation
- Presence of foreign bodies
- Congenital malformations
- Parenteral nutrition
42
Management of late-onset neonatal sepsis
IV Cefotaxime + Gent within 1 hour
| 7-10 days for positive blood culture, 3 weeks for positive CSF culture
43
Causes of jaundice within 24 hours of birth
- Rhesus incompatibility
- ABO incompatibility
- G6PD deficiency
- Hereditary spherocytosis
- Infection
44
Causes of jaundice between 48 hours and 2 weeks post birth
- Breast-feeding jaundice
- Physiological jaundice
- Polycythaemia
- Resolving cephalohaematoma
45
Causes of prolonged jaundice after birth (2 weeks)
- Biliary atresia
- Hypothyroidism
- UTI
- Neonatal hepatitis
- Physiological/breast-feeding
46
Investigations to consider in a baby with jaundice
- Bilirubin level - total + conjugated vs unconjugated
- FBC and blood film
- Coomb's test
- CRP
- Blood culture
- TFTs
- LFTs
- Urinalysis
47
Management options for neonatal jaundice
- UV phototherapy
- Exchange transfusion
- Ig therapy
48
Main complication of unconjugated bilirubinaemia
Kernicterus
49
Causes of HIE
- Antepartum haemorrhage
- Cord prolapse
- Cord obstruction
- Shoulder distocia
50
Clinical features of HIE
- Floppy baby
- Little/no respiratory effort
- Irritability
- Hypertonia
- Seizures
- Multi-organ failure
- Long-term neurodisability
51
Risk factors for intraventricular haemorrhage
- LBW
- Preterm birth
- Severe RDS
- Perinatal asphyxia
52
Diagnostic investigation for intraventricular haemorrhage
Cranial US
53
Causes of neonatal seizures
- Infection
- Hypoglycaemia
- Intraventricular haemorrhage
- Neonatal cerebrovascular events
- Cerebral malformation
- HIE
- Withdrawal
- Electrolyte imbalance
- Head injury
- NAI
54
Investigations in neonates with seizures
- Cranial US
| - Cerebral Function Analysing Monitor
55
Causes of congenital heart disease
- Chromosomal disease
- Intrauterine infection
- Maternal disease
- Drugs in pregnancy
56
4 abnormalities in Tetralogy of Fallot
- Pulmonary stenosis
- Overriding aorta
- VSD
- Right venticurlar hypertrophy
57
Name the congenital heart disease
- Systolic murmur in the upper left sternal edge
- Hyper-cyanotic spells
- Heart failure or cardiogenic shock
- Boot shaped heart on CXR
TOF
58
Management of an acutely unwell neonate with TOF
- Prostaglandin infusion
| - Urgent referral for cardiac surgery
59
Management of hypercyanotic spells in TOF
- 'Knees to chest' position
- High flow O2
- IV morphine and beta blockers
60
Name the congenital heart disease
- Most common cyanotic heart disease seen in neonates
- Cyanosis
- Circulatory compromise
- 'egg on side' CXR
- Normal ECG
Transposition of the great arteries
61
Management of transposition of the great arteries
- PG infusion
- Balloon atrial septostomy
- Corrective surgery
62
Name the congenital heart disease
- Mild/moderate cyanosis
- Progresses to pulmonary congestion and heart failure
Truncus arteriosus
63
Name the congenital heart disease
- Cyanosis
- 'Snowman in a snowstorm' CXR
Total anomalous pulmonary drainage
64
Management of TAPD
- PG infusion
| - Surgical correction
65
Name the congenital heart disease
- Cyanosis soon after birth
- Systolic murmur at lower left sternal edge OR continuous murmur below left clavicle
Tricuspid atresia
66
Management of tricuspid atresia
Surgical correction and Fontan circulation
67
Name the congenital heart disease
- Down syndrome
- Heart failure
- cyanosis
- ejection systolic murmur at ULSE + pansystolic murmur at apex
- Loud, fixed splitting of S2
AVSD
68
Name the congenital heart disease
- Down syndrome or foetal alcohol syndrome
- Heart failure
- Systolic murmur at LLSE
- Pulmonary plethora on CXR
VSD
69
Name the congenital heart disease
- Down syndrome
- Heart failure
- Soft systolic murmur in UPSE
- Fixed splitting of S2
ASD
70
Name the congenital heart disease
- Prematurity
- Continuous machinery murmur heard midway below left clavicle
- +/- early systolic murmur at ULSE
- Bounding pulses
PDA
71
Management of PDA
- Diuretics or fluid restriction
- Paracetamol or indomethacin
- Surgical ligation or percutaneous coil closure
72
Name the congenital heart disease
- Rheumatic fever OR Turner syndrome OR William syndrome
- Asymptomatic
- Heart failure
- Chest pain
- Syncope
- Harsh ejection systolic murmur over URSe
- Slow rising pulse
- Narrowed pulse pressure
- Soft S2
Aortic stenosis
73
Name the congenital heart disease
- Turner syndrome
- Asymptomatic
- Weak femoral pulses
- Relative hypertension in upper limbs
- CV collapse
- Murmur heard radiating to back/between clavicles
Coarctation of the aorta
74
Name the congenital heart disease
- Noonan syndrome OR William syndrome OR alagille syndrome
- Asymptomatic
- Cyanosis
- Ejection systolic murmur at ULSE, radiates to back
- Ejection click
Pulmonary stenosis
75
Name the murmur
- Continuous hum below right clavicle
- Decreases when patient is supine or pressure applied to neck
Venous hum
76
Name the murmur
- Early soft systolic murmur in LLSE or URSE with musical quality
- Increased when patient is supine
Still's murmur
77
Name the murmur
| - Ejection systolic murmur at ULSE, DOES NOT radiate to back
Pulmonary flow murmur
78
Key characteristics of an innocent murmur
- Systolic
- Soft
- Small
- Short
- Single
- Sweet
- Sensitive
79
Common accidental injury sites
- Head: parietal bone, occiput and forehead
- Nose
- Chin
- Elbows
- Palms of hands
- Knees
- Shins
80
Common NAI sites
- Ears
- eyes
- Soft tissues of cheeks
- Intra-oral injuries
- 'triangle of safety'
- Forearms
- Inner aspects of arms
- Back and side of trunk
- Chest and abdomen
- Groin/genitals
- Inner aspects of thighs
- Soles of feet
81
Red flags for NAI
- well demarcated bruises with specific implement patterns
- Bruises not on bony prominences
- bilateral injuries
- bruises that can not be ages accurately
- regular edges to burns
- spiral, oblique or metaphyseal fractures
- Inconsistent story describing injury
- fractures in non-mobile children
82
Examples of neglect
- Poor diet
- Failure to meet health needs
- Failure to achieve educational achievement
- Poor hygiene
- failure to protect from danger
- Failure to provide protection from witnessing violence
- Failure to provide emotional warmth
83
Examples of emotional abuse
- Lack of emotional warmth/love
- Constant criticism
- Placing developmentally inappropriate expectations on children
- Bullying
- Witnessing or hearing or maltreatment
- Exploitation/corruption
84
Risk factors for child abuse
- Domestic violence
- Parental mental health problems
- Parental drug/alcohol abuse
- Previous maltreatment of other children
- Disability in the child
- Known maltreatment of animals
- Parents who have suffered sexual abuse
- Vulnerable/unsupported parents
85
What should you do if you suspected a child is being abuse?
Admit to hospital for safety and report to safeguarding officer
86
Risk factors for T1DM
- Family history
- Viruses
- early cow's milk consumption
- Other dietary factors
87
Clinical features of T1DM
- Short history of symptoms
- Polyuria/nocturia/enuresis
- Thirst
- Weight loss
- Fatigue
- Behavioural changes
- Blurred vision
- Polyphagia
- recurrent infections
- Abdo pain/nausea and vomiting
- Respiratory distress
- Hypovolemia/dehydration/shock
- Coma
88
Diagnostic criteria for diabetes
Symptomatic +
- Fasting glucose >7 OR
- Random glucose >11.1
```
Asymptomatic
+ 2 fasting glucose >7 OR
+ 2 random glucoses >11.1 OR
+ 1 fasting glucose >7 + 1 random glucose >11.1
+ OGTT 2 hour result 11.1 OR
+ HbA1c >48
```
89
Investigations to consider in T1DM
- FBC
- U&Es
- LFTs
- Bone profile
- HbA1c
- Autoimmune disease screen
- GAD antibodies
90
Sick day rules in diabetes
- Keep taking insulin
- Eat as you can manage
- Check sugars more often
- Check ketones
91
Triad of DKA
1) Ketonaemia
2) Hyperglycaemia
3) Acidosis
92
Symptoms of DKA
- Dehydration
- Nausea and vomiting
- Kussmaul respirations
- Pear drop breath
- Abdominal pain
- Fatigue
- Reduced consciousness
93
Investigations in DKA
- Blood glucose
- Blood/urinary ketones
- ABG
- U&Es
- FBC
94
Management of DKA
1) Assess fluid status
2) Fluid bolus (in severe DKA)
3) Maintenance fluids with K+
4) Insulin
95
Monitoring in DKA
- Hourly assessment
- Continuous ECG
- Blood tests 2 hours after treatment then 4 hourly
- Fluid balance
96
Complications of DKA
- Cerebral oedema
- Hypokalemia
- Hyperkalemia
- Aspiration pneumonia
- Hypogylcaemia
- VTE
97
Symptoms of hypoglycaemia
- Anxiety
- Tachycardia
- Headache
- Abdo pain
- Ataxia
- Weakness
- Confusion
- Personality changes
- Seizures
- Coma
98
Management of hypoglycaemia
Conscious:
1) 10-20g rapidly absorbed glucose PO
2) Recheck glucose in 15 mins
3) Repeat if necessary
4) Long-acting carb
Unconscious:
1) IM/SC glucagon
2) 2ml/kg 10% glucose
99
Influences of growth at different ages
- 0-1: nutrition
| - Pre-pubertal child: GH
100
Red flags for short stature in children
- lower height centiles
- large disparity between child's height and mid-parental height
- dysmorphic features
- signs of chronic illness
- increased weight:height ratio
- Disproportionate upper:lower segment ratios
- Rapid reduction in height velocity
101
Causes of short stature
- Familial short stature
- Constitutional delay or growth and puberty
- Idiopathic
- SGA
- GH deficiency
- Endocrine disease
- SHOX gene mutations
- Noonan syndrome
- Russell-Silver syndrome
- Prader-Willi syndrome
- Skeletal dysplasia
- Chronic illness
102
Investigations in children with short stature
- FBC
- U&Es
- LFTs
- Vit D
- TFTs
- TTG
103
Red flags for tall stature in children
- Recent growth acceleration
- Large disparities in child's height and mid-parental height
- Dysmorphic features
- Chronic illness
- Disproportionate upper: lower segment ratios
104
Causes of tall stature in children
- Precocious puberty
- Sex hormone deficiency
- Excess adrenal androgens
- GH excess
- Hyperthyroidism
- Klinefelter syndrome
- Marfan syndrome
- Homocystinuria
- Soto syndrome
- BW syndrome
105
Define precocious puberty
Onset of puberty before 8 in girls and 9 in boys
106
Risk factors for precocious puberty
- Female
| - Elevated BMI
107
Causes of precocious puberty
- Idiopathic
- Pituitary tumours
- CAH
- Adrenal/ovarian/testicular tumours
- Cushing's
- Hyperthyroidism
- McCune-Albright syndrome
108
Investigations in precocious puberty
- Baseline and stimulated LH/FSH, oestrogen and testosterone
- Adrenal androgens
- TFTs
- Imaging
- Bone age X-ray
109
Define delayed puberty
Absence of any signs of puberty by age 13.5 in girls and 14 in boys
110
Causes of delayed puberty
- Constitutional delay
- Hypogonadotrophic hypogonadism e.g. Kallmann, pituitary tumour, systemic disease
- Hypergonadotrophic hypogonadism e.g. Turner, Klinefelter, gonadal trauma
111
Investigations for delayed puberty
- Baseline bloods
- Wrist x-ray
- Baseline and stimulated FSH, LH, oestrogen, testosterone
- Karyotype
- Imaging
112
Symptoms of GORD
- Persistent/recurrent regurgitation
- Feeding difficulties/food refusal or crying after feeds
- Arching of neck/back
- Respiratory symptoms
- Sore throat/hoarseness
- Apnoeic episodes
113
Management of GORD in infants
1) Lifestyle changes
2) Medication
- Breast-fed babies: 1-2 weeks of antacid
- Formulae fed: thickened feeds
- Older children: 4 week trial ranitidine/omeprazole
114
Risk factors for pyloric stenosis
- Males
- Firstborns
- Strong FH
115
Symptoms of pyloric stenossi
Onset between 3-4 weeks old
- Non-bilious projectile vomiting
- Secondary haematemesis
- Lethargy
- Weight loss/failure to thrive
- Constipation
- Thin but hungry infant
- Dehydration
- Visible gastric peristalsis
- Palpable tumour (olive shaped mass) - DIAGNOSTIC
116
Investigations in pyloric stenosis
- ABG: hypochloremic hypoklaemic alkalosis
- U&Es
- Abdominal US: pyloric thickness >4mm, pyloric muscle length >18mm, failure of fluid passage pass pylorus despite vigorous gastric peristalsis
- Contrast studies: string sign
117
Management of pyloric stenosis
- NG tube insertion and suction
- Stopping of oral feeds
- IV fluid bolus and maintenance fluids/replacement fluids
- Ramsted's pyloromyotomy
118
Causes of intussusception
- Meckel Diverticulum
- Peutz-Jegher polyps
- Small bowel lymphoma
119
Clinical features of intusussception
Symptoms between 2 months and 2 years old, usually <1
- Sudden colicky abdominal pain every 10-20 mins
- Pallor
- Bilious vomiting
- Redcurrant jelly stool
- Weak/lethargic
- Dehydration
- Tachycardia
- Sausage-shaped mass in RUQ
120
Investigations for intusussception
- Routine bloods
- ABDO US: target sign
- Abdo xray
121
Management of intusussception
- Appropriate fluid resus
- Broad spectrum IV antibiotics
- PNEUMATIC REDUCTION ENEMA
- Urgent laparotomy: failed air enema, highly distended abdomen, peritonism
122
Complications of intusussception
- Ischaemia and necrosis
- Haemorrhage
- Perforation
- Infection
- Recurrent
- Death
123
Clinical features of mesenteric adenitis
Presents in <15s
- acute abdo pain
- fever
- malaise
- anorexia
- nausea
- diarrhoea
- headache
- pharyngitis
- cervical lymphadenopathy
- may have preceding URTI
124
Management of mesenteric adenitis
- Reassurance
| - Hydration
125
Clinical features of infantile colic
Presents in first few weeks of life
- Excessive/inconsolable crying
- crying worse in late afternoon/evening
- drawing knees up to chest
- arching of back
- systemically well child
126
Diagnostic criteria for infantile colic
Child whose crying lasts >3 hours per day on >3 days per week and has persisted >3 weeks in absence of other causes
127
Management of colic
- Reassurance
- Soothing techniques
- Exclusion of cow's milk
- Simethicone drops
- Lactose drops
128
Clinical features of Meckel diverticulum
- Asymptomatic
- Rectal bleeding
- Ulceration
- Intussusception
- Volvulus
- Diverticulitis
- Umbilical abnormalities
- Neoplasm
129
Investigation for Meckel diverticulum
- Meckel scan
130
Management of Meckel diverticulum
Surgical excision of diverticulum and adjacent ileal segment
131
Clinical features of constipation
- Infrequent bowel movement
- Excessive foul-smelling flatulence
- Irregular stool texture
- Passing occasional large stools or frequent small pellets
- Not wanting to go to the toilet
- Overflow diarrhoea
- Abdominal pain and bloating
- poor appetite
- Fatigue
- Irritability
- Occasional blood in stools
- Encopresis
132
Differentials for childhood constipation
- Hirschsprung's disease
- Bowel obstruction
- Spinal cord compression
- Imperforate anus
- Hypothyroidism
- Coeliac
- Electrolyte abnormalities
133
Management options for childhood constipation
1) Lifestyle changes
2) Disimpaction therapy with oral Macrogol +/- Senna
3) Maintenance therapy e.g oral macrogol
134
Clinical features of Toddler's diarrhoea
- Child aged between 6 months and 5 years
- Diarrhoea lasting over a number of weeks followed by a period of normal stools
- Stools containing undigested foods
- Mild abdo pain
- Systemically well child
135
Red flags in childhood diarrhoea
- Blood or mucus in stool
- Faltering growth
- Fever
- Severe abdo pain
- Vomiting
- Incontinence
136
Management of Toddler's diarrhoea
- Limit fruit juice and carbonated drinks
- Avoid excessive fluid intake
- Increase fat content of diet
- Optimise dietary fibre
137
Clinical features of NEC
- Abdominal symptoms in a previously stable premature baby upon starting feeds e.g. stops tolerating feeds, abdominal distention, abdo pain, bloody stools
138
Investigation of choice for NEC
Abdo X-ray:
- Small bowel dilatation
- Pneumatosis intestinalis (DIAGNOSTIC)
- Fixed dilated loop of bowl
139
Management of NEC
- NBM
- Commence IV fluids and TPN
- Insert large bore NG tube on free drainage
- IV broad spectrum antibiotics
140
Main cause of morbidity in CDH
Lung hypoplasia
141
Clinical features of CDH
- RDS in first few mins of life
- Mediastinal shift
- Scaphoid abdomen
- Bowel sounds on chest auscultation
142
Investigations for CDH
- Normally diagnosed on antenatal US
- CXR
- US
- GI contrast study
143
Risk factors for gastrochisis
- Young maternal age
- Maternal smoking
- Maternal substance abuse
144
Management of gastrochisis
- Venous access
- NG tube drainage
- Broad spectrum antibiotics
- Fluids as necessary
- TPN
- Primary closure or preformed silo
145
Management of exomphalos
Minor: can be operated on shortly after birth
Major: opening covered with dressings, surgical closure at a later date
146
Causes of meconium ileus
- CF
- Ano-rectal malformation
- Hirschsprung's disease
147
Classic presentation of meconium ileus
- Baby does not pass meconium in 48 hours after birth
- Abdominal distention
- Vomiting
148
Investigations of meconium ileus
- Abdo X-ray
- Gastrografin enema
- CF investigation
149
Management of meconium ileus
- air enema
- rectal washouts
- laparotomy
150
Differentials for bilious vomiting
- Malrotation
- Duodenal/intestinal atresia
- HD
- Anorectal malformation
151
Investigations for malrotation
- US
| - URGENT UPPER GI CONTRAST STUDY (diagnostic): corkscrew sign
152
Risk factors for Hirschsprung's disease
- Male
- FH
- Down syndrome
153
Clinical features of Hirschsprung's disease
- Failure to pass meconium
- Progressive abdo distention
- Bilious vomiting
154
Gold standard investigation for Hirschsprung's disease
Rectal biopsy
- Anorectal manometry
- Plain abdo Xray
- Lower GI contrast studies
155
Management of Hirschsprung's disease
- Anorectal washouts
- Stoma formation
- Surgical correction
156
Complications of Hirschsprung's disease
- Enterocolitis
- Faceal soiling
- Chronic constipation
157
Clinical features of biliary atresia
- Term babies with normal birth weight
- Jaundice soon after birth, which worsens
- Dark urine and pale stool
158
Investigations for biliary atresia
- Serum bilirubin - total and conjugated
- US scan
- Hepatobiliary iminodiacetic acid
- Liver biopsy (definitive)
159
Management of biliary atresia
- Surgical correction (Kasai procedure)
- Antibiotics
- Vitamin A, D, E, K supplementation
160
Red flags in URTIs in children
- Multiple episodes/continuous symptoms
- Faltering growth
- Focal signs
- Other infections
- Unusual organisms
161
Clinical features of tonsillitis
- Sore throat
- Dysphagia
- Tender lymph nodes
- Ear pain
- Fever
- Halitosis
- Lethargy
- Malaise
162
Causes of croup
- Parainfluenza
- Adenovirus
- RSV
- Measles
163
Clinical features of croup
- More common in winter
- Child age 6 months to 3 years
- 1-3 days of coryza
- Mild fever
- Breathlessness
- Baking cough, worse at night
- Inspiratory stridor
- Signs of respiratory distress
164
Management of coup
- Reassurance
- Analgesia
- Oral steroids
- + Nebulised adrenaline (if stridor at rest)
- + oxygen (if stridor at rest with agitation or lethargy)
165
Risk factors for bronchiolitis
- Age <3
- Season
- Premature birth
- Bronchopulmonary dysplasia
- Low muscle tone
- passive smoke exposure
- Impaired airway clearance and function
- Congenital heart disease
- Down syndrome
166
Cause of bronchiolitis
RSV
167
Clinical features of bronchiolitis
- Preceding URTI symptoms
- Dry episodic cough
- Tachypnoea
- Signs of increased work of breathing
- Hyperinflation
- Crackles
- Wheeze
- Reduced air entry
- Poor feeding
- Apnoea
- Afebrile/low grade fever
- Systemically well child
168
Management of bronchiolitis
- Minimal handling
- Nasal suction
- Oxygen/ventilation
- IV fluids/tube feeding
- Respiratory support
169
Clinical features of asthma
- Wheeze
- Cough
- Chest tightness
- Difficulty breathing
- Diurnal and seasonal variation
- Multiple triggers
- Associated atopy
- Responds to appropriate treatment
- Tachypnoea
- Increased work of breathing
- Decreased O2 sats
- Reduced air entry
- Hyperinflation
170
Chronic asthma management in an under 5
1) SABA
2) Very low dose ICS OR LTRA
3) Add LTRA
4) Consider increasing ICS dose
5) Refer to specialist care
171
Chronic asthma management in >5s
1) SABA
2) ICS
3) LABA OR LTRA
4) increase steroid or add LABA or LTRA
5) Refer to specialist care
172
Features of a severe asthma attack
- Sats <92%
- PEF 33-50%
- Too breathless to talk in sentences/eat
- Accessory muscle use
173
Features of a life-threatening asthma attack
- Sats <92%
- PEF <33%
- Poor respiratory effort
- Altered consciousness
- Hypotension
- Tachycardia
- Exhaustion
- Cyanosis
- Silent chest
- Confusion
174
Management of an acute asthma attack
1) Inhaled/nebulised salbutamol
2) Oral prednisolone OR IV hydrocortisone
3) Admit to hospital and reassess after 20 minutes
4) add nebulised ipratropium bromide if required (can be repeated back to back 3 times)
5) IV salbutamol, Mag sulphate or aminophylline
175
Features of salbutamol toxicity
- Metabolic acidosis
- Rising lactate
- Hypokalemia
176
Clinical features of CF
- Failure to pass meconium
- Meconium ileus/ bowel obstruction
- Thick viscous meconium
- Prolonged neonatal jaundice
- Failure to thrive
- Large appetite
- Wet cough
- Recurrent URTIs
- Chronic sinusitis
- Nasal obstruction/nasal polyps
- Genital abnormalities in males
- Steatorrhoea
- Rectal prolapse
- Diabetes
- Cirrhosis and portal hypertension
- Finger clubbing
- GORD
177
Management of CF
- Prophylactic oral/nebulised antibiotics
- Prophylactic oral antifungals
- Nebulised hypertonic saline
- Chest physio
- Nebulised DNAse
- Bronchodilators
- Pancreatic enzyme supplements
- Micronutrients
- High calorie diet
- H2RA or PPI
- Insulin
178
Long term monitoring required in CF patients
- Serial CXR
- Abdominal US
- Bone scan
- Glucose tolerance test
179
Long term complications of CF
- CF-related diabetes
- CF-related liver disease
- Infertility
180
Cause of pertussis
Bordetella pertussis
181
Clinical features of pertussis
- Catarrhal phase
- Fever
- Paroxysmal whooping cough leading to vomiting or apnoea
182
Investigations of pertussis
- Postnasal swab in first few weeks of illness
| - FBC
183
Management of pertussis
- Reassurance
- Admit if: <6 months, oxygen requirement
- Erythromycin to reduce infectiveness if presenting within 21 days of symptom onset
- Report to PUBLIC HEALTH
- Keep away from others for 5 days after starting antibiotics or 21 days after start of cough
184
Complications of pertussis
- Subconjuctival haemorrhage
- Rib fractures
- Pneumothorax
- Hernia
- Fainting
- Intraventricular haemorrhage/hypoxic brain injury
185
Guidance to prevent SUDI
- Always put babies to sleep on their backs with their feet at the bottom of the cot
- Use a hard or safety-approved surface
- Do not co-sleep
- Keep soft objects out of the baby's bed
- Do not smoke
- Do not allow the room to get too hot or cold
- Do not use a dummy with a string or cord attached
- Seek medical attention if baby becomes unwell
186
Clinical features of a brain tumour
- Headache
- Vomiting
- Visual signs/symptoms
- Motor signs/symptoms
- Behavioural change
- Drowsiness
- Seizures
- Bulging fontanelles
187
Investigation for a child with a suspected brain tumour
URGENT CT/MRI brain
188
Clinical features of a neuroblastoma
- Most common in children <5
- Pallor
- Weight loss
- Malaise
- Abdo mass
- Bone pain, limp
- Lymphadenopathy
- Spinal cord compression
- Bone marrow compression
- Diarrhoea
- Hypertension
189
Clinical features of a Wilms tumour
- Most common in children <4
- Palpable abdo mass
- Haematuria
- Hypertension
190
Clinical features of bone tumours
- Common in teenagers and young adults
- Pain
- Swelling
- Pathological fractures
191
Clinical features of rhabdomyosarcoma
- More common in children <10
- Palpable abdo mass
- Pain
- Urinary obstruction
- Nasal obstruction
192
Risk factors for inguinal hernia
- Prematurity
| - Male sex
193
Clinical features of an inguinal hernia
- Reducible lump
- Intermittent lump
- Discomfort/heaviness
- Strangulation: erythematous overlying skin, nausea, vomiting, severe pain and tachycardia
194
Management of an inguinal hernia
- Babies <6 months: hernia repair within 2 weeks of presentation
- Older children: elective surgery, unless hernia is irreducible (SURGICAL EMERGENCY)
195
Complications of inguinal hernia
- Strangulation
- Infection
- Bleeding
- Testicular atrophy
- Damage to spermatic cord structures
196
Conditions associated with undescended testes
- Prader-Willi syndrome
- Kallmann syndrome
- CAH
- Exomphalos
- Gastroschisis
197
Management of undescended testes
Palpable
- Elective inguinal orchidopexy at 3 months (3-6 months apart in bilateral cases)
Impalpable
- Laparoscopy and movement or removal of the testes depending on location
198
Complications of undescended testes
- Infertility
- Malignancy
- Cosmetic/psychological complications
199
Management of symptomatic phimosis
- Topical corticosteroid cream for 4 weeks with gentle retraction
- Foreskin preserving surgery or circumcision
200
Complications of circumcision
- Bleeding
- Inclusion cysts
- Damage to glans and urethra
- Infection
201
Risk factors for hypospadias
- Children with vertebral abnormalities, anorectal malformation, cardiac defects, tracheo-oesphageal fistulas
- FH
202
3 features of hypospadias
- Chordee
- Hooded foreskin
- Abnormal site of anterior meatus
203
Management of hypospadias
Surgical correction
204
Causes of PUJ obstruction
- Urethral stricture
- Abnormal ureteric folds
- Crossing vessels compressing the ureter
205
Investigations in PUJ/VUJ obstruction
- Antenatal/postnatal US
- Repeat postnatal US at 6 days and 6 weeks
- MCUG
- MAG3 renography
- Serial US scans
206
Management of PUJ obstruction
- Prophylactic trimethoprim
| - Pyeloplasty
207
Complications of pyeloplasty
- Anastomotic leak
- Narrowing at side of anastomosis
- Continued deterioration of renal function
208
Management of VUJ obstruction
- Ureter reimplantation OR stenting for 6 months
209
Gold standard investigation for VUR
MCUG
210
Management of VUR
Medical
- prophylactic antibiotics
- laxatives
- anticholinergics and bladder training
Surgery:
- Circumcision
- STING procedure
- Reimplantation of ureters
- Nephrectomy
211
Indications for surgical management in VUR
- Patient develops breakthrough infections
- Deterioration in renal function
- New renal scars
- Failure of medical treatment
- Bilateral grade IV/V disease
212
Most common cause of renal failure in children
Posterior urethral valves
213
Clinical features of PUV
- Distended bladder
- Hydronephrosis
- Difficulty in passing urine
- UTIs
- Renal failure
214
Investigations in PUV
- US scan within 24-48 hours of life
| - MCUG (gold standard)
215
Management of PUV
- Immediate bladder drainage
- Empirical prophylactic antibiotics
- Stabilisation of kidney function
- Valve ablation or vesicostomy
216
Complications of PUV
- Renal failure
- Dysfunctional abnormal bladder
- Infertility
217
Clinical features of anaphylaxis
- Stridor/wheeze
- Abdo cramps
- Nausea and vomiting
- Diarrhoea
- Hypotension
- Tachycardia
- Shock
- Urticaria/angioedema
218
Management of anaphylaxis
Acute:
- Resus using ABCDE
- Remove allergen if possible
- Adrenaline IM
- Chlorpheniramine
- Hydrocortisone
Long term:
- Allergen avoidance
- Skin prick testing and immunoassay testing
- Epipen prescription
- Allergen-specific immunotherapy
219
Clinical features of cow's milk protein allergy
- Onset between 2-8 weeks old
- Systemically well child
- Blood tinged stool
- Change in stool frequency
- Skin changes
220
Management of cow's milk protein allergy
- Elimination of cow's milk in maternal diet OR
- Protein hydrolysate formula milk
- Re-introduction of cows milk protein at 9 months
221
Risk factors for lactose intolerance
- Increasing age
- East Asian ethnicity
- Gastroenteritis
- Coeliac disease
- IBD
222
Clinical features of lactose intolerance
- Diarrhoea
- Abdo pain
- Flatulence
- Bloating/distention
223
Investigations for lactose intolerance
- Food diary
- Low faecal pH
- Reducing substances in the stool
224
Management for lactose intolerance
- Lactose restriction
- Vitamin D and calcium supplements
- Lactase enzyme replacement
225
Routine vaccines given at 2 months
- 6 in 1
- Men B
- Rotavirus
226
Vaccines in the 6 in 1
- Diptheria
- Tetanus
- Polio
- Pertussis
- HiB
- Hep B
227
Routine vaccines given at 3 months
- 6 in 1
- Pneumococcal
- Rotavirus
228
Routine vaccines given at 4 months
6 in 1
| - Men B
229
Routine vaccines given at 1 year
- HiB/Men C
- Pneumococcal
- MMR
- Men B
230
Routine vaccines given at 2-7 years
- Influenza annually
231
Routine vaccines given at 3 years 4 months
- DTPP
| - MMR
232
Routine vaccines given at 12-13 years
- HPV
233
Routine vaccines given at 14 years
- DTP
| - Men ACWY
234
Side effects of vaccinations
- localised side effects e.g swelling, redness, discomfort
- Fever
- Malaise and rash
- Anaphylaxis (rare)
235
CI to vaccinations
- Acute febrile illness or moderate/severe illness
- Immunosuppression (live vaccines)
- Previous anaphylactic reaction
- Pregnancy (live vaccines)
236
'Amber' features of severity in an unwell child
- Pallor
- Abnormal response to social cues
- No smiles
- Wakes with prolonged stimulation
- Reduced activity
- Nasal flaring
- Tachypnoea (>50 in <12 months, >40 in >12 months)
- O2 sats <95%
- Chest crackles
- Tachycardia (>160 in <1s, >150 in 1-2, >140 in >2s)
- Cap refill >3s
- Dry mucous membranes
- Poor feeding
- Reduced urine output
- Age 3-6 months
- Temp >39
- Fever for >5 days
- Rigors
- Swelling of a limb/joint
- Non-weight bearing limb/not using a limb
237
'Red' features of severity in an unwell child
- Pale/mottled/ashen/blue
- Unresponsive to social cues
- Appears ill
- Asleep or does not stay awake
- Weak/high-pitched/continuous cry
- Unresponsive
- Grunting
- Tachypnoea (>60)
- Moderate/severe chest recession
- Sats <92%
- Reduced skin turgor
- Deteriorating BP
- Age <3 months
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
238
Septic screen in <3 months old
- Bloods
- Urine MC&S
- CXR
- LP
239
How long should children with pertussis stay off school?
48 hours from commencing antibiotics
OR
21 days from onset of illness if not antibiotic treatment
240
Complications of pertussis
- Pneumonia
- Seizures
- Encephalopathy
- Vomiting
- Conjunctival haemorrhage
- Facial oedema
241
Clinical features of chickenpox
- Discrete erythematous maculopapular rash with some vesicles and crusting
- Itch
- Systemic symptoms but fairly well
242
Diagnosis of chickenpox
Usually clinical, can be backed up with PCR or serology
243
Management of chickenpox
Symptomatic
Acyclovir if treatment indicated
244
How long should children with chickenpox stay off school?
Until all vesicles have crusted over
245
Cause of Hand foot and mouth disease
Coxsackie virus
246
Clinical features of hand foot and mouth disease
- Discrete erythematous papules around mouth/tongue and palms and soles
- Associated GI symptoms
- Systemically well
247
How long should children with hand foot and mouth stay off school?
They don't need to stay off school as long as they feel well
248
Management of hand foot and mouth disease
None
249
Cause of impetigo
Staph Aureus
250
Clinical features of impetigo
- Most common in 2-5 years old
- Itchy, flaky, raised crusted golden lesions and surrounding erythema
- Systemically well
251
Management of impetigo
- Mild: topical antiseptic wipes, Topical fusidic acid
| - Extensive or not responding to treatment: Oral flucloxacillin
252
How long should children with impetigo stay off school?
Until all lesions are crusted and healed
OR
48 hours after commencing antibiotics
253
Clinical features of measles
- Prodromal fever, coryzal symptoms, cough, conjunctivitis, Koplik spots, malaise
- Widespread erythematous maculopapular 'lacy' rash starting on face and spreading distally
- cervical lymphadenopathy
- Systemically unwell
254
Diagnosis of measles
Throat swab
255
Management of measles
- supportive
- IgG to immunocompromised patients
- Vaccinate contacts
256
How long should children with measles stay off school?
4 days from the onset of the rash
257
Complications of measles
- Otitis media
- Pneumonia
- Encephalitis/meningitis
- Seizures
- Late onset subacute sclerosing panencephalitis
258
Cause of scarlet fever
Strep infection
259
Risk factors for scarlet fever
- Chickenpox
- Recent childbirth
- Alcoholism
- Immunosuppression
260
Clinical features of scarlet fever
- Confluent erythematous macular sandpaper rash with perioral sparing
- Strawberry tongue
- Associated cough, sore throat, otalgia, sinusitis
- Systemically unwell
261
Management of scarlet fever
10 days penicllin/amoxicillin
262
How long should children with scarlet fever stay off school?
24 hours after commencing antibiotic treatment
263
Complications of scarlet fever
- Rheumatic fever
- Sepsis
- Pneumonia
- Endocarditis/pericarditis
- Arthritis
- Osteomyelitis
- Nec fasc
264
Cause of slapped cheek disease
Parvovirus B19
265
Clinical features of slapped cheek disease
- Prodromal URTI
- Bright red rash on both cheeks
- May be followed by an itchy widespread papular rash
- Systemically unwell
266
How long should children with slapped cheek stay off school?
They don't need to stay off school
267
Clinical features of eczema herpeticum
- Redding and painful scaly lesions with sparing of the skin creases and the eyes
- Punched out lesions
- Systemically unwell
268
Management of eczema herpeticum
- IV Acyclovir
- URGENT derm referral
- opthamology referal if there is eye involvement
269
Inheritance method of achondroplasia
Autosomal dominant
270
Clinical features of achondroplasia
- Short limbs
- Thoracolumbar kyphosis
- Disproportionately short stature
- Megalencephaly with prominent forehead
- Midfacial hypoplasia
271
Inheritance method of Marfan syndrome
Autosomal dominant
272
Clinical features of Marfan syndrome
- Heart defects
- Ophthalmological defects
- Spontaneous pneumothorax
- Tall/thin stature
- Long limbs
- Spinal scoliosis
- Recurrent hernias
273
Inheritance method of CF
Autosomal recessive
274
Inheritance method of sickle cell anaemia
Autosomal recessive
275
Inheritance method of haemophilia
X-linked recessive
276
Inheritance method of DMD and BMD
X-linked recessive
277
Inheritance method of red- green colour-blindness
X-linked recessive
278
Inheritance method of Prader-Willi syndrome
Paternal allele silencing on chromosome 15
279
Clinical features of Prader-Willi syndrome
- Learning difficulties
- Short stature
- Severe hypotonia and poor feeding in neonates
- Hyperphagia and obesity
- Hypogonadism
280
Inheritance method of Angelman syndrome
Maternal allele silencing on chromosome 15
281
Clinical features of Angelman syndrome
- Unusually happy disposition with inappropriate laughing/clapping
- Characteristic facial appearance
- Severe learning difficulties and developmental delay
- Seizures
- Ataxia
282
Inheritance method of Beckwith-Wiedemann syndrome
Silencing of maternal alleles on chromosome 11
283
Clinical features of Beckwith-Wiedemann syndrome
- Neonatal macrosomia
- Hemi-hypertrophy
- Neonatal hypoglycaemia
- Macroglossia
- External ear abnormalities
- Exomphalos
- Increased childhood cancer risk, especially Wilms tumour
284
Inheritance method of Fragile X syndrome
Increasing CGG repeat in FMR1 gene on X chromosome
285
Clinical features of Fragile X syndrome
- Learning difficulties
- Prominent ears and jaw
- Stereotypical hand movements
- Seizures
- Hyperactivity
- Macro-orchidism
286
Clinical features of Down syndrome
- Low birth weight
- Hypotonia
- Upslanting palpebral fissures and epicanthic folds
- Brachycephaly
- Low set ears
- Depressed nasal bridge
- Large protruding tongue
- Singular palmar creases
- Clinodactyly
- Brushfield spots
- Sandal gap
287
Neonatal screening required in Down syndrome
- Echo
- FBC or spun PCV
- TFTs
- Hearing screen at 8 months old
- Vision screens throughout childhood
288
Complications of Down syndrome
- OSA
- Cardiac abnormalities
- Respiratory tract infections e.g. otitis media
- Structural GI abnormalities e.g. duodenal atresia, Hirschsprung's disease
- Susceptibility to infection
- T1DM
- Coeliac disease
- Seizures
- Early onset Alzheimers
- Increased frequency of leukaemia
- Hypothyroidism
- Short stature and atlanto-axial instability
- Cataracts and visual impairment
- Developmental delay/learning difficulties
- Poor feeding
- Psychological disorders
289
Edward syndrome
Trisomy 18
290
Clinical features of Edward syndrome
- Dysmorphic facies: small jaw, low set ears, prominent occiput
- Flexed, overlapping fingers
- Clenched fists
- Rocker bottom feet
- Hammer toes
- Growth restriction
- Cardiovascular malformation
- GI malformation
- Renal defects
- Neurological defects
- Developmental delay
291
Patau syndrome
Trisomy 13
292
Clinical features of Patau syndrome
- LBW
- Cardiac malformations
- Facial defects: microcephaly, scalp defects, ear abnormalities, cleft lip/palate, nasal malformation
- Nervous system defects
- GI malformation
- GUI malformation
- Limb abnormalities: rocker bottom feet
293
Turner syndrome
XO
294
Clinical features of Turner syndrome
- Lymphoedema of hands and feet after birth
- Short stature
- Broad/webbed neck with low hairline
- Shield-shaped chest with widely spaced nipples
- Wide carrying angles of the arms
- Hypoplastic nails
- High arched palate
- Cystic hygroma
- Structural renal abnormalities
- Coarctation of the aorta
- Non-immune foetal hydrops
295
Investigations for a child with ?Turner syndrome
- Karyotype testing
- LH/FSH levels: usually high in <4, low in 4-10 the high in >10s
- TFTs
- U&Es
- Fasting blood glucose and HbA1c
- Renal US
- Echo/Cardiac MRI
- Hearing assessment
296
Management of Turner syndrome
- GH supplementation
- Transdermal oestrogen replacement therapy
- Vitamin D and calcium supplementation
- Avoidance of obesity
- Egg donation and IVF
297
Complications associated with Turner syndrome
- Coarctation of the aorta
- Hypoplastic left heart syndrome
- Aortic aneurysm and aortic dissection
- Streak ovaries and primary ovarian failure
- Infertility
- Myopia
- Otitis media
- Renal structural abnormalities
- Hypothyroidism
- Increased risk of T1DM, osteoporosis, coeliac disease, IBD
298
Definition of a febrile covulsion
A fit that occurs in a child with a temperature >38 and the absence of CNS infection, metabolic imbalance or a neurological condition
299
Clinical features of a febrile convulsion
- Children 6 months to 6 years
- Only occurs with a temp >38
- Can be simple, complex or status, but usually simple
- Usually last <5 mins
- Associated with rapid and full neurological recovery
300
Management of febrile seizures
- Assess for cause of fever
- Temperature control with paracetamol
- Patient education - risk of recurrence, seek medical help if seizures last <5 minutes and call an ambulance if they last >5 mins
- PR diazepam if seizure lasts >5 mins
301
Indications for admission in a febrile seizure
- First febrile seizure
- Seizure lasting >15 mins
- Focal seizure
- Seizure recurring within same febrile illness within 24 hours
- Incomplete recovery after 1 hour
- Child <18 months
- parental anxiety
- Suspected serious cause of infection
- No apparent focus of infection
302
Investigations in an afebrile seizure
- Full set of obs
- FBC
- U&Es
- Calcium
- Magnesium
- Vitamin D
- Metabolic work up
- Blood glucose
- Anti-epileptic medication levels
- ECG
- EEG
- CT/MRI head
- LP
303
Indications for hospital admission in an afebrile seizure
- Age <1
- GCS <15 1 hour after seizure
- Signs of raised ICP
- Generally unwell
- Meningism
- Signs of respiratory aspiration
- High parental anxiety
- Complex seizures
304
Define epilepsy
>2 unprovoked seizures at least 1 day apart which are thought to arise from abnormal electrical activity in the brain
305
Causes of epilepsy
- Idiopathic
- Genetic
- Structural
- Metabolic brain disorders
- Immune disease
- Infection
306
Investigations to help support a diagnosis of epilepsy
- Home video recording
- EEG
- MRI
- Genetic tests
307
Define status epilepticus
Seizure or repeated seizures lasting >30 mins without regaining of consciousness
308
Causative organisms of meningitis in those <3 months
- GBS
- E coli
- Listeria
309
Causative organisms in meningitis in those 3 months to 16 years
- Strep pneumoniae
- N. meningitides
- HiB
310
Antibiotics for meningitis in <3 months old
- Cefotaxime + amoxicillin
311
Antibiotics for meningitis in >3 months old
- Ceftriaxone
| - Corticosteroids
312
Risk factors for cerebral abscess
- Local infection
- Head injury/skull fracture
- Systemic infection
- Congenital heart disease
- Intracranial shunts
313
Clinical features of a cerebral abscess
- Systemic upset
- Fever
- Vomiting
- Headache
- Drowsiness
- Seizures
- Bulging fontanelles
- High-pitched cry
- Neck stiffness
- Abnormal movements/tone
- Changes in personality/speech
314
Risk factors for CP
- Male sex
- Antenatal infection
- Multiple pregnancy
- Low/high birth weight
315
Causes of CP
- Antenatal infection
- Antenatal radiation exposure
- Intraventricular haemorrhage
- Periventricular leukomalacia
- Congenital malformations
- Hypoxic ischaemic injury during delivery
- Postnatal hyperbilirubinaemia
- Neonatal hypoglycaemia
- Neonatal cerebral infarcts
- Meconium aspiration syndrome
- Hydrocephalus
- Head injury
- CNS infection
316
Clinical features of CP
- Motor difficulties
- Hearing and visual problems
- Feeding difficulties/faltering growth
- Aspiration pneumonia
- Dental caries
- Behavioural difficulties
- Communication difficulties
- Bladder/bowel dysfunction
- Skeletal deformities
- Intellectual impairment
- Seizures
317
3 main subtypes of CP
1) Spastic
2) Extrapyramidal
3) Ataxic
318
Clinical features of hemiplegic spastic CP
Arms and legs on one side affected:
- flexed pronated arms with clenched fist
- hand preference before 12 months
- difficulty in hand manipulation
- circumduction gait
- Toe-hell gait
- delayed walking
- Sparing of the face
- Spasticity greatest in anti-gravity muscles
319
Clinical features of diplegic spastic CP
Lower limbs affected:
- Commando crawl
- Scissoring of lower legs
- Severely delayed walking
- Toe heel gait with feet help in Equinovarus position
- Underdeveloped legs
320
Clinical features of quadriplegic spastic CP
Features of hemiplegic and diplegic CP in all 4 limbs
- Increased tone
- Decreased spontaneous movement
- Swallowing difficulties
- Weak such
- seizure disorders
- Significant intellectual impairment
- Associated developmental abnormalities
321
Clinical features of extrapyramidal CP
- Poor head control
- Hypotonia in infancy and dyskinetic movement as they develop
- Speech and feeding problems
322
Clinical features of ataxic CP
- Hypotonia
- Intention tremor
- Poor coordination
- Broad-based unsteady gait
- Delayed motor development
323
Indications for CT/MRI in a child with a headache
- Focal neurological signs
- Signs of raised ICP
- Headaches worse on lying down
- Confusion
- Altered consciousness
- Change in personality
- Abnormal gait
- Growth failure
- Diplopia
- Facial nerve palsy
- Visual field defects
- Seizures
- Atypical auras
- Thunderclap headaches
- Known existing secondary cause
324
Indications for CT head in a child with head injury
ONE of:
- GCS <14 if >1 or <15 if <1 on ED arrival
- GCS <15 more than 2 hours post injury
- Post-trauma seizure with no history of epilepsy
- Suspected NAI
- Suspected open or depressed skull fracture
- Tense fontanelle
- Signs of basal skull fractures: panda eyes, Battle's signs, Haemotympanum, CSF leakage
- Child <1 with bruise, swelling or laceration on head measuring >5cm
- Focal neurological deficit
OR TWO of:
- Witnessed loss of consciousness
- Three discrete episodes of vomiting
- Abnormal drowsiness
- Amnesia >5 mins
- Dangerous mechanism of injury
325
Indications for spinal CT in a child with a head injury
- Plain Xray would be technically difficult/inadequate
- Strong clinical suspicion of injury despite normal x-ray
- GCS <13 on initial assessment
- Focal peripheral neurological signs
- Definitive diagnosis of C-spine injury is needed urgently
- Patient is having other body areas scanned
- Patient has been intubated
326
Management of a child with a minor head injury
Discharge home with appropriate red flag advice
327
Management of a child with possible signs of an intracranial bleed but no indications for CT head
Admit and observe for at least 4 hours (12-24 hours for skull fractures)
328
Causes of raised ICP
- Traumatic brain injury
- Hydrocephalus
- Brain tumour
- Infection
- Metabolic upset
- Idiopathic intracranial hypertension
329
Clinical features of raised ICP
- Headache
- Vomiting
- Visual signs and symptoms
- Motor signs and symptoms
- Growth and developmental abnormalities
- Behavioural changes
- Diabetes insipidus
- Seizures
- Altered consciousness
- Papilloedema
- Sunset sign
- Retinal haemorrhage
- Pupillary abnormalities
- Cushing's sin: bradycardia, hypertension, fluctuating consciousness and irregular respiration
330
Management of raised ICP
- Elevation of bed head to 30o
- Maintain airway
- Maintain adequate ventilation and circulation
- Antipyretics
- Analgesia, sedation +/- neuromuscular blockage
- Seizure prophylaxis
- Hyperosmolar therapy: 3% NaCl bolus
- Fluids restriction
- Surgical decompression
331
Clinical features of DMD/BMD
DMD onsets in early childhood, BMD onsets around age 10.
- Delayed walking
- Frequent falls
- Developmental delay
- Waddling gait/Trendelenburg gait
- Muscle hypertrophy, particularly in the calves
- Gower's sign
- Kyphoscoliosis
- Cardiomyopathy
- Respiratory failure
- GORD
- Intellectual impairment
- Seizures
332
Investigations in DMD/BMD
- Creatinine kinase: elevated
- Dystrophin gene mutation testing
- Muscle biopsy
333
Management of DMD/BMD
- Optimisation of nutrition
- Prompt management of infection
- Close cardiac monitoring
- Respiratory support
- Physio/OT
- Calcium, Vit D, Bisphosphonate therapy
- Corticosteroids
- Surgical procedures
334
Clinical features of myotonic dystrophy
Autosomal dominant
- Hypotonia
- Facial muscle weakness
- Breathing, feeding problems
- Dysarthria
- Arrhythmias, cardiomyopathy
- Hypothyroidism
- Adrenal insufficiency
- Immunological deficiency
- Cataracts
- Intellectual impairment
335
Diagnosis of myotonic dystrohy
Genetic testing
336
Risk factors for neural tube defects
- Previous child with a neural tube defect
- Poor maternal nutrition
- Lack of folic acid intake during pregnancy
337
Types of neural tube defects
- Spina bifida
- Meningocele: protrusion of the meninges through the skull and vertebrae
- Myelomeningocele: protrusion of the meninges and spinal cord through the vertebrae
- Encephalocele: protrusion of brain and meninges through a midline skull defect
338
Clinical features of spina bifida
- Skin lesions in sacral region
| - Associated neurological dysfunction
339
Clinical features of meningocele
- Hydrocephalus
- Midline fluctuant mass in back covered by skin
- Bladder and bowel dysfunction
340
Clinical features of myelomeningocele
- Bladder/bowel incontinence
- CSF leak
- Muscle weakness/paralysis
- Hydrocephalus
- Sensory loss
- Cranial nerve palsies
- Scoliosis
341
Management of neural tube defects
Surgical correction (+/- CSF shunt)
342
Complications of encephalocele
- Cerebral abnormalities
- Hydrocephalus
- Visual defects
- Microcephaly
- Cognitive loss
- Seizures
343
Define microcephaly
Head circumference which is more than 3 SDs below the mean for age and sex
344
Causes of microcephaly
- Isolated microcephaly
- Down syndrome
- Edward syndrome
- Congenital infection
- Foetal alcohol syndrome
- Ischaemic/hemorrhagic stroke
345
Causes of hydrocephalus
- Infection
- Haemorrhage
- Tumour
- Trauma
- Choroid plexus papilloma
346
Clinical features of hydrocephalus
- Bulging fontanelle
- Broadening forehead
- Enlarging head circumference
- Sunsetting of pupils
- Irritability, lethargy or drowsiness
- Muscle spasticity with brisk reflexes
- Dilated scalp veins
- Headache
- Signs of raised ICP
- Confusion
- Blurred vision
- Urinary/faecal incontinence
347
Diagnosis of hydrocephalus
Cranial US
| MRI - GOLD STANDARD
348
Management of hydrocephalus
- Acetazolamide + Furosemide
| - VP shunt
349
Clinical features of transient synovitis
- Children aged 2-12
- Sudden onset limp with hip/knee pain
- Absence of rest pain
- Decreased range of motion, especially internal rotation
- Limb held in position of greatest comfort (typically flexed, abducted and slightly externally rotated)
- Preceding/accompanying URTI
- Systemically well child
350
Management of transient synovitis
- Rest and simple analgesia
| - Should resolve within 2 weeks
351
Clinical features of reactive arthritis
- Preceding GI infection or STI 2-4 weeks before joint symptoms
- Acute fever, malaise and fatigue
- Mono or polyarthritis affecting knees, ankles, hands and feet
- Sacroileitis
- Heel pain
- Plantar fasciitis
- Urethritis
- Conjunctivitis
- Keratoderma blennorrhagia
- Circinate balanitis
- Macules and pustules
352
Investigations for reactive arthritis
- Inflammatory markers
- FBC
- HLA-B27
- Microbiology
- Joint aspiration
- Plain X-ray
353
Management of reactive arthritis
- Rest
- Joint immobilisation
- Physio
- NSAIDs
- Intra-articular steroids or systemic steroids
- Antibiotics
354
Prognosis for reactive arthritis
- 1/3 develop recurrent/chronic disease
- 1/3 have functional limitation due to destructive arthritis
- 1/3 recover
355
Define JIA
Joint inflammation presenting before 16 years old and persisting for at leas 6 weeks in the absence of infection or other defined cause
356
Treatment of JIA
- Physio
- NSAIDs
- Intra-articular injection
- Oral steroids and DMARDs
357
Complications of JIA
- Growth failure
- Anterior uveitis
- Amyloidosis
- Osteoporosis
358
Clinical features of osteogenesis imperfecta
- Osteopenia
- Bone fragility and fractures
- Ligament laxity
- Blue sclera
- Hypermobile joints
- Hearing loss
- Multiple Wormian bones in skull
- Short stature
- Dental problems
359
Investigations in osteogenesis imperfecta
- Antenatal US
- Play Xray
- Bone densitometry
- Genetic testing
360
Management of osteogenesis imperfecta
- Physio
- Rehab and prompt splinting of fractures
- Bisphosphonates
- Surgery
361
Risk factors for nephrotic syndrome
- Asian
- Male
- Previous infection
- Medications e.g. NSAIDs
- SLE
- Diabetes
- HIV
- FH
- Previous nephrotic syndrome
362
Causes of nephrotic syndromr
- Minimal change disease
- FSGS
- Membranous nephropathy
- Membranoproliferative GN
363
Clinical features of nephrotic syndrome
- Children aged 2-6
- Proteinuria
- Hypoalbuminaemia
- Oedema e.g. peri-orbital
- Discomfort related to swelling or skin breakdown
- Weight gain
- Abdo distention
- Fatigue
- Foamy urine
- Increased infections
- Poor growth and development
364
Investigations in nephrotic syndrome
- Serum albumin
- Urine dipstick
- Early morning protein/albumin: creatinine ratio
- 24 hour urinary protein
- Lipid profile
- Renal function
- Urinary sodium
- TFTs
- FBC
365
Management of nephrotic syndrome
High dose corticosteroids for 4 weeks
- BP monitoring
- Dietary sodium restriction
- Prophylactic penicillin
- Fluid management
- Vaccination
- Immunomodulatory agents
366
Complications of nephrotic syndrome
- Infection
- Intravascular hypovolemia
- Hypercoaguability
367
Bacterial causes of UTI
- E. coli
- Proteus
- Klebsiella
- Enterococcus
- Staph
368
Risk factors for UTI
- Sex: male <6 months, then female
- Constipation
- VUR
- Congenital abnormalities of the urinary tract
- Previous UTIs
- Encopresis
- Nephrolithiasis
- Uncircumcised boys
369
Clinical features of a UTI in children
- Changes in urine appearance and smell
- Increased urinary frequency, urinary incontinence
- Dysuria
- Abdo pain
- Fevers/rigors
- Nausea and vomiting
- Poor growth
- Poor feeding
- Irritability
- Sleepiness
- Jaundice
- Difficulty breathing
370
Features of an atypical UTI
- Serious illness
- Poor urine flow
- Abdo or bladder mass
- Spinal lesion
- Renal dysfunction
- Sepsis
- Failure to respond to suitable antibiotics in 48 hours
- Infection with non-E.coli organisms
371
Define recurrent UTIs
- 2+ episodes of UTI with pyelonephritis OR
- 1 episode of UTI with pyelonephritis + 1 episode with cystitis OR
- 3+ episodes of UTI with cystitis
372
Investigations in UTI
- Urine culture: clean catch, MSU, catheter, urine bag
- Urine dipstick
- FBC
- BP & U&Es
373
Further investigations for UTI (e.g. recurrence)
- Renal US
- MCUG
- DMSA
374
Indications for IV antibiotics in UTI
- Children <3 months
- Acutely unwell children
- Persistent vomiting
375
Complications of UTI
- Sepsis
- Renal abscess
- Pyelonephritis
- AKI/CKD
- Hypertension
- Hydronephrosis
376
Risk factors for recurrent UTIs
- Children <6 months
- Female
- Underlying renal tract abnormalities
- Uncorrected predisposing factors
- Renal abscess
- Hydronephrosis
377
Causes of enuresis
- Physiological
- Bladder instability
- Bladder neck muscle weakness
- Neurogenic bladder
- Anatomical abnormalities
- Urinary concentration defects e.g. T1DM, diabetes insipidus, renal disorders
- UTIs
- Constipation
- Emotional upset
- Developmental delay
- Maltreatment
- Primary neurological deficit
378
Investigations in enuresis
- Diary of fluid intake, toileting and bedwetting
- Urine C&S
- Bladder US
- Spinal MRI
- Urodynamic studies
379
Management of enuresis
- Lifestyle advice
- Reward system
- Bell-pad alarms
- Desmopressin
- Tricyclics/anticholinergics
380
Clinical features of HSP
- Children age 3-10
- More common in males
- Non-blanching purpuric rash over buttocks and extensor surfaces of limbs
- Arthralgia, especially in knees and ankles
- Abdo pain
381
Investigations in HSP
- BP
- Urine dipstick
- U&Es
- Albumin
382
Management of HSP
- Monitor in primary care until resolution
- Simple analgesia (AVOID NSAIDs)
- Long term follow up with repeat U&Es
383
Indications for referral to nephrology in HSP
- Nephrotic range proteinuria
- Renal dysfunction
- Hypertension
- Macroscopic haematuria
384
Complications of HSP
- GN
- GI involvement
- CNS involvement
- Orchitis
- Pulmonary vasculitis
385
Treatment of eczema with secondary bacterial infection
Mild: antiseptic washes, topical antibacterial cream
Widespread: oral antibiotics, topical corticosteroid
386
Management of infantile seborrheic dermatitis
- Reassurance
- Emollients
- Frequent shampooing
- Removal of scales with gentle brushing
387
Management of headlice
Topical pediculicides e.g. Permethrin, phenothrin or malathion
388
Risk factors for DDH
- Female
- FH
- First born
- Breech presentation at delivery
- Maternal oligohydramnios
- Associated neuromuscular disorders
389
Clinical features of DDH
- Neonates and infants
- Asymmetry of the skin folds around the hip
- Painless limp
- Limited abduction
- Child walking on toes on affected side
- Leg length discrepancy
390
Investigations for DDH
- US in neonates
| - Plain Xray in older children
391
Management of DDH in a newborn
- Double nappies
| - Harness
392
Management of DDH in a child 6 months-6 years
- Gradual closer reduction
| - Formal open reduction if this fails
393
Management of DDH in a child over 6
Open reduction
394
Complications of DDH
- OA
- Subluxation of the hip
- Spinal changes
395
Risk factors perthes disease
- Male
- Caucasian
- Age: 4-8
- FH
- LBW
- Low SES
- Delayed skeletal ages
396
Clinical features of Perthes disease
- Limp following physical exertion in the absence of trauma
- Groin pain
- Antalgic gait
- Trendelenburg sign
- Limited range of movement
- Muscle wasting
- Leg length discrepancies
397
Investigations for Perthe's disease
- FBC and inflammatory markers
- Plain AP and lateral X-rays
- MRI
- Radioisotope scanning
398
Features of Perthe's disease on X-ray
- Collapse/flattening of the femoral head
- Sclerosis from reduced resorption and relative osteopenia of the rest of the bone
- Widening of the joint space
- Subchondral fractures, partial collapse and femoral head fragmentation
- Coxa magna
- Subluxation
399
Management of Perthes disease
Mild/moderate:
- No weight bearing
- NSAIDs
- Regular physio
Severe disease, patient over 6, failure of conservative management, immobilisation required:
- Varus osteotomy of femur
- Innominate osteotomy of pelvis
400
Complications of Perthe's disease
- Joint stiffness
- Leg length discrepancy
- Coza magna
- Osteoarthritis
- Premature fusion of growth plates
- Hinged abduction
401
Poor prognostic indicators for Perthe's disease
- Female
- Onset after age 6
- >50% femoral head involvement
- Lateral displacement of femoral head
- Subluxation
402
Risk factors for SUFE
- Male
- Obesity
- Pubertal growth spurt
- Caribbean ethnicity
- Delayed skeletal maturity
- Endocrine disorders
403
Clinical features of SUFE
- Child aged 10-15
- Referred ipsilateral knee pain
- Limping
- Hip, thigh or knee pain
- Pain on movement in all directions
- Reduced range of motion, progressive loss of abduction and internal rotation
- Shortened and externally rotated leg
404
Investigations in SUFE
- Plain AP and frog leg lateral X-rays
| - MRI
405
Radiological features of SUFE
- Steel sign
- Widening of ipsilateral growth plate
- Decreased epiphysis height
- Klein's line
406
Management of SUFE
Mild/moderate:
- Analgesia
- No weight bearing
- Cannulated screw insertion under X-ray guidance
Severe:
- Analgesia
- No weight bearing
- Corrective osteotomy and pinning
Prophylactic fixation of the other hip
407
Complications of SUFE
- Avascular necrosis
- Coxa vera
- Secondary OA
- Contralateral SUFE
- Chondrolysis
408
Risk factors for septic arthritis
- Prematurity
- Penetrating injury
- Diabetes mellitus
- Joint surgery
- Hip or knee prosthesis
- Skin infection
- Immunocompromise
- Sickle cell disease
409
Clinical features of septic arthritis
- Acute pain and swelling of a joint
- Overlying joint erythema
- Severely restricted joint movement
- Joint effusion
- Posture changes
- Systemically unwell
410
Investigations in septic arthritis
- FBC
- Inflammatory markers
- Blood cultures
- US scan
- X-ray
- Joint aspiration
411
Management of septic arthritis
- Splint joint
- IV antibiotics
- URGENT surgical drainage and irrigation
412
Complications of septic arthritis
- Joint stiffness
- Septic dislocation
- Osteonecrosis
- Shortening of the limb
- Secondary OA
413
Risk factors for osteomyeltitis
- Penetrating injury
- Diabetes
- Skin infection
- Immunocompromise
- Sickle cell disease
- Chronic steroid use
414
Clinical features of osteomyelitis
- Markedly painful, immobile limb
- Febrile illness
- Preceding URTI, skin lesion or injury
- Warm, swollen, erythematous skin
- Toxaemia
415
Investigations in osteomyelitis
- FBC
- Inflammatory markers
- Blood cultures
- Plain X-rays
- MRI
- Bone biopsy
416
Management of osteomyelitiss
- Analgesia
- Splint limb
- URGENT IV antibiotics
- Surgical exploration and drainage if no improvement in 36 hours
417
Complications of osteomyelitis
- Bone abscess
- Bacteraemia
- Chronic osteomyelitis
- Altered bone growth
- Pathological fracture
- Septic arthritis
418
Causes of conductive hearing loss
- Down syndrome
- Craniofacial abnormalities
- Otitis media with effusion
- Wax deposition
419
Causes of sensorineural hearing loss
- Genetic syndromes e.g. Alport
- Prenatal infection
- Birth trauma/birth hypoxia
- Meningitis
- Ototoxic drugs e.g. Gentamicin, Cisplatin
420
Clinical features of acute otitis media
- Common in children aged 6 months to 2 years
- Otalgia
- Pyrexia
- Systemically unwell
- Blood/fluid discharge from ear
- Red bulging tympanic membrane/perforation
421
Management of otitis media
Analgesia unless antibiotics indicated (amoxicillin)
422
Indications for antibiotics in acute otitis media
- Bilateral
- Systemically unwell
- Neonates/very young children
- Persistent non-resolving infection
423
Complications of acute otitis media
- Tympanic membrane perforation
- Chronic otitis media with effusion
- Labyrinthitis
- Mastoiditis
- Intracranial complications
424
Clinical features of qunisy
- Trismus
- Hot potato voice
- Drooling
- Odynophagia
- Lethargy
- Systemically unwell
- Pyrexia
- Affected tonsil, uvula and soft palate pushed towards centre of mouth
425
Clinical features of epiglottitis
- Children 3-5 years
- Rapidly progressive symptoms with no coryzal prodrome
- High fever
- Drooling
- Dysphagia
- Significant distress
- Stridor
- Laboured breathing
- Muffled/quiet voice
426
Management of epiglottitis
- DO NOT EXAMINE
- Intubate
- Broad spectrum IV antibiotics e.g. ceftriaxone
- Nebulised steroids or adrenaline
427
Advantages of breastfeeding
- Provides infants with right amount of nutrients for health growth and development
- Easily absorbed by infants
- Not complicated by infections
- Contains antibodies
- Numerous longterm health benefits
- Stimulates release of oxytocin
- Facilitates postpartum weight loss
- Contraceptive effect
- Lowers risk of ovarian and breast cancer and osteoporosis in mothers
- Saves time and money
- Bonding opportunity
428
Contraindications to breastfeeding
- Active TB in mother
- Mother with breast cancer undergoing chemotherapy
- Syphilitic or herpetic lesions on breast or nipple
- Infant inborn errors of metabolism causing intolerance
- HIV positive mother
- Mothers using illicit drugs
- Mothers who develop VZV 5 days prior to or 2 days post delivery
429
Define faltering growth/failure to thrive
Significant interruption in the expected rate of growth compared with other children of the same gender and age
430
Causes of faltering growth
- Anatomical abnormalities
- Prolonged exclusive breastfeeding
- Intestinal obstruction
- Malabsorptive diseases
- Recurrent infections
- Congenital heart disease
- Chronic pulmonary disease
- Endocrine disease
- Teratogenic exposure in utero
- IUGR, prematurity or LBW
- Genetic syndromes or inborn errors of metabolism
- Anaemia
- Poverty
- Inappropriate diet
- Coercive feeding
- Distractions at mealtimes
- Social isolation
- Life stressors
- Poor parenting skills
- Neglect
- Parental mental health issues
431
Risk factors for childhood obesity
- Prematurity
- LGA
- Poor maternal weight in pregnancy
- Gestational diabetes
- Preeclampsia
- Ethnicity
- Low SES
- Endocrine disorders
- Genetic syndromes
432
Clinical features of vitamin B1/thiamine deficiency
- Beriberi: symmetrical peripheral neuropathy, cardiomegaly, heart failure, peripheral oedema
433
Clinical features of vitamin B2/riboflavin deficiency
- Glossitis
- Chellitis
- Oedema of mucous membranes
- Seborrheic dermatitis
434
Clinical features of vitamin B3/niacin deficiency
- Dementia
- Dermatitis
- Diarrhoea
435
Clinical features of vitamin B5/pantothenic acid deficiency
- Parasthesia in the extremities
436
Clinical features of vitamin B6/pyridoxine deficiency
- Glossitis
- Chellitis
- Depression
- Irritability
- Seizures
- Confusion
437
Clinical features of vitamin B7/biotin deficiency
- Hair loss
- Dry, scaly skin
- Chellitis
- Glossitis
- Seborrheic dermatitis
438
Clinical features of vitamin B9/folate deficiency
- Neural tube defects
| - Macrocytic anaemia
439
Clinical features of vitamin B12 deficiency
- Megaloblastic anaemia
- Amnesia
- Irritability
- Subacute combined degeneration of the spinal cord
440
Clinical features of vitamin C deficiency
- Scurvy
- Easy bruising
- Bleeding gums
- Follicular hyperkeratosis
- Parafollicular haemorrhage
- Impaired wound healing
- Weakness
- Arthralgia
- Neuropathy
441
Clinical features of vitamin E deficiency
- Neurological deficits
| - Haemolytic anaemia
442
Clinical features of vitamin K deficiency
- Easy bleeding/bruising
443
Clinical features of vitamin A deficiency
- Xerophthalmia
- Dryness, fragility and clouding of the cornea
- Bilot's spots
- Corneal keratomalacia
- Corneal ulceration and scarring
- Night blindness, severe visual impairment and complete blindness
- Dry, scaly skin
- Dry hair
- Broken finger nails
- Impaired immunity
444
Risk factors for vitamin D deficiency
- Dark skin
- High latitudes
- Winter
- Excessive use of sunblock and protective clothing
- Staying indoors
- Being exclusively breastfed beyond 3-6 months
- Inadequate maternal consumption
- Maternal vitamin D deficiency during pregnancy
- Premature birth
- Medications
- Impaired intestinal absorption
- Liver/kidney disease
445
Clinical features of vitamin D deficiency
- Asymptomatic
- Seizures
- Cardiomyopathy
- Poor growth
- Delayed walking
- Tooth decay/enamel hypoplasia
- Bone pain
- Osteomalacia
446
Investigations in vitamin D deficiency
- 25hydroxy vitamin D
- Alk phos: increased
- PTH: increased
- 1,25-dihydroxyvitamin D: raised or lowered
447
Vitamin D supplementation recommendation in UK
Recommended for all children between 6 months and 5 years old
