Paediatrics part 2 Flashcards
1
Q
What is wheeze?
A
A physical sign, whistling sounds on expiration and polyphonic
2
Q
why is a wheeze expiratory?
A
In intra thoracic pressure to increase and causes the airways to constrict more
3
Q
Why is a wheeze polyphonic?
A
Different sized airways are affected
4
Q
What can cause wheeze in children?
A
Viral episodic wheeze, asthma, persitent infantile wheeze plus others ( CF, Thracheo-bronchomalacia, Cilliary dyskinesia, GORD, chronic aspiration immune deficiency persistent bacterial bronchitis, Chronic lung disean of the newborn)
5
Q
What age does asthma usually present from?
A
From the age of 5
6
Q
What are the symptoms viral episodic wheeze?
A
No interval symptoms, no excess of atopy, likely to improve with age. No benefit from inhaled steroids, may use oral steroids
7
Q
What are the causes of wheeze pathophysiologically?
A
Inflammation and oedema of the airway, excess mucous, infection
8
Q
What is acute asthma managment?
A
Oxygen if needed bronchodilator, Salbutamol maybe nebuliser, atrovent (ipatropium bromide), prednisilone 1mg/kg if asthma maybe Dexamthasone, Maybe IV steroids hydrocortisone, IV salbutamol bolus, Aminophylline MgSO4 salbutamol infusion
9
Q
What is aminophylline?
A
Respiratory stimulent and respiratory dilator, low therapeutic idex
10
Q
What is the principle of steroid drug ?
A
Minimum oral dose, minimum effective dose
11
Q
What are reasons for failure of asthma treatment?
A
Adherence, diagnosis, environment choice of drugs/devices, bad disease
12
Q
What are the side effects of inhaled steroids?
A
Adrenal supression - dose relates surpression, only 28 cases of adrenal crisis in children on inhaled steroids high doses have impaired adrenal axis
Growth reduction?- yes over 2 years reduce it by 1cm, affects final growth probably
Bones- dose related reduction in mineralised bone density but unlikely to cause fractures
13
Q
How to balance risks of ICS?
A
Minimise dose and maximise targeting, monitor growth and discuss with the family
14
Q
What are upper resp infections?
A
rhinitis, otititis media, pharengitis, tonsilitis larygitis
15
Q
What are lower resp infections?
A
bronchitis, croupd, epiglottitis, thraceitis, bronchiolitis, pneumonia
16
Q
Which resp infections are mainly viral?
A
Rhitistis, pharengitis laryngitis croupd bronchiolitis
17
Q
Which pathology causes tahypnoea?
A
Ones that affect alveoli or respiratory bronchioles affecting gaseous exchange
18
Q
What is the most common respiratory virus in children?
A
Respiratory syncytial virus
19
Q
How do viral infetions tend to progress?
A
They begin in mouth or nose and progress down the airways
20
Q
What can be presentation of respiratory virus?
A
Croup Pneumonia viral exacerbation of asthma, wheezy bronchitis, bronchiolitis all can present in all ways but certain viruses are more likely to present in certain forms
21
Q
What can cause acute stridor?
A
Croup and acut epiglotittis
22
Q
What are viruses that cause croup?
A
Usually para flu
23
Q
What is croup treatment?
A
Steroids single dose to reduce inflammation
24
Q
What is the cause and treatment of Acute epiglottitis?
A
Haemophilus influenzae B usually, try to not upset the child, secure airway, anaesthetist, or ENT surgeon.
25
What are red flags for epiglottitis?
Stridor, Drooling, no barking cough, might posture to open airway,
26
What cause bronchitis?
Moroxella cotaris, haemophilus non B type, and pneumococcal they create biofilms, it doesnt cause tachypnoea, chronic cough,
27
What is the problem with bronchitis?
Chronic can cause bronchiectasis through dammage to the airways
28
What is treatment for bronchitis?
Augmentin treated for 21 days and let airways heal
29
What are DSM-V ADHD criteria?
6/9 Inattentive characteristics, 6/9 Hyperactive/Impulsice symptoms present before 12 years developmentally inappropriate several symptoms in 2 or more settings, clear evidence symptoms interfere/reduce quality of social/academic/ occupational function
30
What are risk factors for ADHD?
Preterm, ODD/CD, mood idosrders faily with ADHD, epilepsy neurodevelmpental conditions aquired brain injury,
31
What causes ADHD?
Genetics, Environmental factors, CNS insults Neuroanatomic neurochemical
32
What are the areas ASD can present?
social communication and repetitive braviour and sensory interests
33
What are ASD communication difficulties?
Strange use f accents, poor non verbal communication gestrure body language, reciprocity, pedantic language very literal dont get idioms and jokes,
34
What are the ASD social interactions?
no desire to interact with others no understanding of social rules, dont understand interactions
35
How does rigid thinking with ASD present?
Imagination play cant do , using toys as objects, rules are fixed, dont like change playing the same games
36
How to differentiate OCD from ASD with fixation?
OCD don't like the obsesion ASD enjoys it
37
When is ASD diagnosed?
When it causes a problem in their lives
38
What causes osteogenesis imperfecta?
Disease of collagen deposition where have the wrong ratio of collagen to minerals
39
What are the features of Osteogenesis imperfecta?
Collapse of axial skeleton bones, short long bones of the body. brittle bone less bone trabecular bone is compressed, bone fragility bone pain impared mobility poor growth deafness
40
What are symproms of OI?
vertebral crush fractures long bone fracturs
41
What are the grades of osteogenesis imperfecta?
Type 1 low grade only get one every year or two
Type 2 lethal
Type 3 proressively deforming
Type 4 moderate
42
What are causes of osteoporosi in children?
```
Inherited/congenital:
Osteogenesis imperfecta
Inborn errors eg galactosemia
Hematological problems
Idiopathic
Acquired:
Drug-induced - especially steroids
Major endocrinopathies
Malabsorption
Immobilisation
Inflammation
```
43
Who is involved in management of Osteogenesis imperfecta?
physition bone targeting drugs, pain associated medical problems, Surgeon long bones spine skull base hearing teeth, therapists muscle strength/mobility social and education
44
What are the main treatments for OI?
Bisphosphonate, work well in kids to help increase bone mass but isnt better bone quality
45
What are the effects of Bisphosphonates on outcomes?
Reduced fracture frequency, Increased vertebral height, supressed bone markers, reduced pain, increased overal mobility, no aderse effect on growth
46
What is rickets?
Deficiency in Vitamin D from lack of sunlight and poor nutrition.
47
What is the process of activation of vitamin D?
D3 cholecaliferol is converted to 25OH vit D in liver then 1,25(OH)2 vit D in kidney
48
What does vitamin D do?
Makes calcium more available, increases absorption from the guy increases calcium release from bone. It as a role in immune function and tolerance
49
What are ideal levels of Vit D?
75 nmol/L but not clear how much this is true
50
What is presentation of rickets in early life?
Hypocalcaemia
51
What are presentation of low vitamin D?
Bowed legs, hypocalcaemic convulsions, gross motor delay, incidnctal x ray findings swollen ankle carpo,pedal spasm
52
What are the dangers of severe vit D deficiency?
Cardiomyopatht, hypocalceamic convulsions
53
What is the pinna made from embryology?
6 Hillocks of his mesoderm 1st and 2nd branchial arches
54
What is emryolocically important about tympanic membrane?
Made of all 3 laters
55
What is microtia?
Poorly formedd ear
56
What are congenital problems with ear?
Absence of auricle/ microtia
Atresia of outer ear canal
Pre auricular sinus
Accessory auricles
Prominent ears
Outer ear abnormalities may herald middle ear problems
Inner ear develops earlier than middle/outer ear
57
What is important about outer ear problems?
Might have a middle ear problem but unlikelly to have inner ear problem
58
What are the syndrome with ear pits?
branchio- oto- renal syndrome
59
What are the middle ear issues?
Abnormal ossibles disrupts conduction, craniofacial syndromes
60
What are risk factors for earing problems?
Maternal drugs, family history, Prematurity Jaundice Anatomical abnormalities
61
What is otitis externa?
Painful inflammed EAM Pinna treat with microsucction topical antibiotics
62
What is otitis media?
Glue ear infection eustatacian tube dusfunction, fluid in middle ear can be painless self limiting but risks of complications mastoiditis,
63
What could happen with chromic ititis media?
Cholesteatoma
64
What is treatment for otitis media?
Conservatice do nothing eustachian tube autoinflation, ventilation tubes Grommit, hearing aids alternative to surgical intervention where it is
65
What is cause of cronically discharging ear?
Perforation, retraction pockets, chronic supparative otitis media, cholesteatoma
66
What is a cholesteatoma?
Chronic infections, repeated infections offensive discharge can see perforation, causes chronic discharge
67
What are the structture of the ear drum?
Mesoderm is missing from top section making it weaker
68
Why are cholesteatomas important?
Damage to middle ear inner ear structures, ossicles and facial nerve
69
How do you treat choleseatoma?
Dry safe ear, perforation close it, remove it if you can preserve it
70
What is acute mastoiditis?
Boggy swelling behind ear, acute mastoiditis is a paediatric emergency, itsan abscess
71
What are ear foreign bodies treatment?
Try to get it out if you can then call ent if not possible
72
What are nasal problems in babies?
They are obligate nasal breathers so they need it to be patent
73
What is choanal atresia?
blockage at the back of the nose septim not working
74
What can cause craniofacial abnormalities?
syndromic, down apert pfeiffer crouzon treacher collins, May have problems with airway, OSA midfacial hypoplasia,
75
What is signs and symptoms of nasal foreing body?
Single sided foul discharge or blood
76
What is treatment of nose bleeds?
Stop nose picking, cut nails, remove antimicrobials, topical naseptin silver nitrate cutery surgical treatment electrocautery
77
What is an issue with unilateral heavy nosebleeds in boys unprovoked?
Nasopharengel angiofibroma
78
What is asscoiated with natal polyps?
Cystic fibrosis
79
What is the smallest part of child throat?
Subglottis so can get stuck below the vocal chords
80
What is laryngomalacia?
stridor worse on feeding and exertion worse when supine only if failure to thrive and increased WOB
81
What is sleep apneoa in kids?
Not to do with obesity, tensils and adenoids Obstructive sleep apneoa
82
What is hostory of sleep apnoea?
Snoring with period breaks
83
What are common asthma triggers?
Common cold, exercise, emotions stress smoking, pollution, pet/animal allergy, pilen house dust mite, weather changes moulds perfumes aerosols
84
What age do you do lung function test for asthma?
After 5 years
85
What is complete control of asthma?
No need for relieve, no datime symptoms no night awakening no exacerbations nolimitations on life
86
When do you use a spacer?
Always in children
87
What colours of spacers are there and who are they form?
Orange premature babies, yellow 1 to 4 years, 4 and above Volumatic spacer clear or green
88
What is the complication of malrotation?
bowel ischaemia,
89
What colour vomiting is pyloric stenosis?
Milky as bile cant get past it
90
What is bilestained vomiting?
Green vomiting
91
When is pyloric stenosis most likely to occur?
4 weeks
92
When is malrotation likely to present?
in the first 24 hours
93
What can cause bile vomitting?
Sepsis and malroation
94
What is gold standard investigation for malrotation?
NG upper GI with contrast xray
95
What is examination findings in pyloric stenosis?
feeling olive sized lump that is the sphincter, abdominal distension may see peristalsis
96
How to image pyloric stenosis?
Ultrasound
97
What blood resulsta are likely in pyloric stenosis?
Hypokalaemic, hyponatraemic (may get artificial rise from dehydration), Hypochloraemia, hypochloraemic, high pH Base excess becomes more positive
Hypochloraemic metabolic alkalosis
98
What causes low potassium in vomitting?
Lose Hydrogen ions causing alkalosis, potassium hydrogen exchanger in kidneys tries to correct it.
99
What can act as lead points for interssuception?
Meckles diverticulum, bowel tumours, peyers patch (ideopathic)
100
What are the triad of symptoms for interssuception?
crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools
101
What are most common causes of acute abdominal pain?
Non-specific, appendicitis
102
What is guarding?
Tense abdominal muscles. can be voluntary or involuntary. Involuntary is important, as indicates peritonitis
103
What is the best symptoms for appendicitis?
```
M igration of pain
A norexia
G uarding
N ausea
E levated temperature
T enderness in RIF
```
104
What can cause vomiting physiologically?
Toxic material in lumen, visceral pathology, vestribular disturbance cns disturbance
105
What are the important questions for vomiting?
ilious or non-billious vomiting, bloody or non-blody, projectile no-projectile age of presentation, febrile afebrile, nausea abdo pain distension diarrhoes and constipation, headache, changes in vision polyuria polydipsia weifht losss
106
What are red flags for vomiting?
Meningism, costovertebral tenderness abdominal pain
107
What diseases are the changes in common pathology for vomiting?
Mostly surgical early on then, more infectious or inflammatory
108
What are the consequences of vomiting?
Hypo kaleamic chloraemic alcalosis, nutritional issues can cause mallory-weis tear, tears of oesophagus, dental caries, oesophageas stricutre barrett's metaplasia broncho-pulmonary aspiration, Anaemia
109
What are the antiemetics?
Antihistamine H1 receptore, dopamine antagonist procholrperazine D2, serotonin antagonist ondansteron 5HT-3, steroid Dexametason, Neurokinin receptor antagonist
110
How common is reflux?
Most t - 4 monts have it, 41% 3-4 months possset after 1.5 years its much lower
111
What is history of GORD in infants?
Faltering growth, Oesophagitis stricture, Apoea, Wha aspiration wheezing hoarsness Iron deficiency aneamia, Seizure- like events
112
What are the investigation for GORD?
pH study, Barium swallow and meal endoscopy, Impedence study, picks up acid and others
113
How can you manage GORD?
Feeding position, Thicken feeds, Change feeds, Drugs antacid H2 blocker PPI, Surgery, fundoplication ( tighening the upper sphincter
114
what is carabel?
Thickener
115
What are the risk factors for GORD?
prematurity, others
116
What is an allergy versus intollerance?
Allergy is immune mediated. thre are IgE mediated non IgE and mixed cell mediated
117
What acre cows milk protein allergy?
Caseins whey proteins in cows milk causes vomitting possibly with dairy (2-7.5% prevalence) it is more than one system, Skin, resp and gastro
118
What are resp symptoms for cows milk protein allergeis?
Wheezy nasal itching sneezing rhinorrhoea or congestion
119
What is management of CMPA?
elemination of diet, hyrolysed or amino acid feeds
120
What is lactose intolerance in children?
lactase apears late in foetal life and falls after 3 years, unlikely to be primary, late onset common in oriental background,
121
What are the lactose intollerance in children symptoms?
Explosive watery stools, abdominal distension, flatulence audible bowel sounds.
122
What are tests for lactose intollerance?
Small bowel biopsy, yrogen breath test elimination diet
123
What is Encopresis?
Involuntart fecal soiling or incontinence secondary to chronic constipation
124
What are the symptoms of constipation for diagnosis?
Two or fewer defecatons per week, at least one episode of faecal incontinence retentive posturing or stool mass
125
What causes constipation?
Posssibly a cycle of painful defactation voluntary withholding causes harder stools leading to more pain, then cycles roung
126
What are red flags with constipation?
delayed passage of meconium, fever vomitting bloody diarrhoea, failure to thrive, tight empty recti, wot presence of palpable abdominal faecal masss, abnormal neurological exam
127
What are causes of constipation differentials?
Hirshsprung's disease, anorectal intestinall dysplasia, spina bifida, neuromuscular disease hypothyrodi, hyper calceamia coelica disease medications
128
What are long term complications of constipation?
Megacolon, anal fissures overflow incontincence behavioural problems
129
When to perform stool microbiology?
bloody mucous, suspect sepsis, foreignt travel child is immunocompromised
130
When to treat diarrhoea with antibiotics?
if bacterial GE complicated by cepticaemia or systemaic infections or malnourisehd
131
What is hypernatreaemic dehydration?
Unusual but serious irribible, water shifts from intracellular to extracellular, rehydration should be slow
132
What does faecal calprotectin test for?
Inflammation
133
What are the treatments for crohn's diasease?
special diet can be as good as steroids,
134
When is surfactant and alveoli usually made?
after 24 weeks alveoli increase surfactant increases after a while
135
What is chronic lung disease of prematurity?
officially needing oygen at 36 weeks corrected age, reduced lung volume, reduces alveolar surface diffucsion defect
136
When is the brainstem fully myelinated?
32 to 34 weeks
137
What is the implications of brainstem non myelination?
transient apnoea of the newborn, also bradycardia
138
What is used to treat apnoea in preterm?
caffeine
139
Why are ventricular bleeding bad in neonates?
Become hypovolaemic, and hypoperfusion of the brain
140
What does the umbilical vein go to?
Ductus venosis, to inferior vena cava
141
What happens at birth to a foeatus circulation?
resistance in lungs increases, causing FO to close and ductus arteriosis closes to stop the shunt to the lungs.
142
What are the three categories of congenital heart disease?
Narrowings, holes and conections, or complex
| Duct dependant or non dependant or cyanotic or not
143
What is most common defect?
VSD 3-4/1000 ;eft to right shunt causes increasd flow to lungs most close on their onwn
144
What is the signs of VSD?
Pansystolic mumer on loudest on left lower sternal edge can have thrill gallop rhythm. can have tachypnoea, poor feeding failure to thrive
145
What are the problems with ASD?
Left to right shunting increased blood to lungs, low velocity shunt usually not murmur so get pulmonary flow murmur, can cause arrhythmias in early adult hood
146
What are signs of ASD?
Pulmonary flow murmur, fixed splitting of S2
147
What is AVSD?
Poor septum between atria and ventricles,
148
What are signs of AVSD?
Murmur of valcular regurgitation rater than septal defects. Thrill gallop rhyhm, active precordium, poor feeding faulure to thrive, tachypnoea
149
What is epidemiology of PDA?
Up to 60% 30 weeks prem.
150
What kind of murmur does PDA sound like?
Left sternal edge or clavicular area, murmur all the time machinary like
151
How to manage ASD?
Rarely cause symptoms but close if found at 3-4 years, for moderate to sever ones
152
What is management of VSD and PDA?
moderate to severe, or symptomatics optimise feeds to thrie diuretics and surgical closure of the valve
153
What are signs of AS?
Weak femorals thrill ejection systolic murmur loudest in aortic area radiating to carotids.
154
What are symptoms of AS?
Reduced exercise tollerance, fatigue poor feeding syncope collapse.
155
What is the 2nd most common stenosis in children?
pulmonary stenosis Often radiates to the bacl
156
What is the role of the PDA in coarctation of the aorta?
The duct supplies the lower limbs, pre and post ductal saturations are lower than preductal.
157
What are signs of Coarctation of aorta?
Weak femorals compared to brachials,
158
What are the common cyantotic conditions?
Transposition of the great arteries, tetralogy of fallot?
159
What allows survival in the transposition of the great arteries?
Need ASD VSD or PDA to allow mixing of oxygenated blood
160
What are intervention for transposition of great arteries?
spetotomy and kep PDA open
161
What is tetralogy of fallot associated with?
Di George syndrome
162
What is total anomalus pulmonarty venous return?
Very blue sick pink blood form lungs goes to right intead of left
163
What syndromes are associated with congenital heat disease?
Trisomy 21, Turner's syndrome, williams syndrome, Di George syndrome, Noonans syndrome
164
What congential cardiac defects are associated with trisomy 21?
AVSD, TOF, VDS
165
What conditions are associated with turner's syndrome?
Coarctation AS bicuspid aortic valve and aortic dissection in later life
166
What is associated with williams sydrome?
Supravalcular aortic stenosis, PA stenosis
167
What is assiciated with Di Gearoge syndrome
interrupted aortic arch, turncus arteriosis, TOF VSD PDA
168
Noonans syndrome what conditions are related to it
PS LVH
169
What is important with neuro historytaking?
Neurogenetic or neurometabolic conditions birth history and developmental, is there regresion
170
Why does motor development start head to toe?
Pyramidal development.
171
when should primitive reflexed disappear?
After 6 months or so
172
What is the use of head circumference?
Show microcephally or macrocephally might lead you to a diagnosis
173
what is plagiocephally?
asymetrical skulls unilateral premature closure of lamboid and coronal suture
174
What is gowers sign?
Hip girdal weakness can be duchenne muscular dustrophy,
175
What is brachycephaly?
Premature fusion of coronal suturea flat oxyput not moving
176
What is trigonocephaly?
Triangle at from
177
What is scaphocephaly dolicocephaly?
From extreme prematurity
178
What is exycephaly?
Tower skull
179
What is sturge weber syndrome?
Get port wine stain in trigeminal nerve often get epilepsy
180
What are the measure for facial abnormality?
Interpupullary distance, inner canthal distance outer canthal, interalar distane, philtral lent upper lip thikness lowerlip thickness, intercommisural distance
181
What is Rett sydrome?
Women only get 9 month normal development then decline
182
What is paroxysmal tonic upgase?
Initially benign with negative investigation and evential complete resolution, similar picture from oteher conditions
183
What is the worry with opsoclonus myoclonus syndrome?
Could have nuroblastoma, different to nystagmus
184
What is Hyperkeplexia?
get siezure whentapped on forehead, causes apnea and bradycardia
185
Who can request genetics tests?
Anyone if it s relevant to their role
186
When can clinical geneticsreferrals be made?
Preconceptual scans, antenatally, Paediatrics, family members after diagnosis, carrier testing adult onset conditions. postmortem,
187
What genetic disrders are ordered?
Chromosomal anormalites singly gene disorters dominant recesssive or x linked, genetic and environmental
188
How useful is a microarry?
Can pick up 30% of children with developmental delay
189
Whe does tortion testicular happen?
After birth, puberty but can happen at any time.
190
What are sumptoms of testicular torsion?
Very severe pain, nausea vomiting, late signs are redness and swelling tender testicle
191
What is a tortion of appendix testis?
Upper pole of testicle, mimics torsion usually not as severe often in prepubertal boys, can be seen as blue dot, may be acute
192
How can you tell its idiopathic scrotal oedema?
swelling and rednress that often is less tender but also extens around the perenium as well as scrotum
193
When is a circumcision indicated in children?
Balanitis xerotica obliterans causes sclerosis of the urethra
194
Who deals with hypospadias?
urology
195
If there is a hypospadia what do you need to check and why?
Check testes if not hterhe could have congenital adrenal hyperplasia
196
Which type of inguinal hernia do children usually get?
Indirect through the ring
197
How to distinguesh hernia and hydrocele?
hydrocele is more transiluminable, can get above a hydrocele, but cant get above the hernia. to do with the inguinal rings
198
Who get inguinal hernias?
More urgent in children, more boys 80%,
199
What are some common head and neck lumps?
Lymph nodes
200
What are lymph node swelling red flags?
Greater than 2cm, infammed for 2 weeks, enlarging
201
What are the umbilical problems?
Reminents of vitelline duct, can attatch to meckles diverticulum, the urachus from the umbilicus
202
What do you do with umbilical heria?
Don't operate unless causing problems
203
What is gastroschisis?
Bowel is outside the body with no covering bowel exposes, reduce surgicaly
204
What is exophalos?
Bowel in the umbilical cord and bowel covered coexists with congenital abnormalitiess
205
What can cause acute respiratory distress?
Oesophageal atresis, congenital diaphragmatic hernia, congenital airway malformations
206
What is assicaiated with diodenal atresia?
Trisomy 21 VACTERL
207
What is hirshprungs disease?
Failure of normal ganglion cells to complete migration. missing ganglion cells missing progressive distension, need usually wasouts then pull through operation
208
What is meconium ileus?
Associated with CF, thick intestinal secretions for m pelets blociing terminal ilium.
209
What is NEC?
THe bacteria overgrow in the premature bowel leading to infection and can get perforation
210
What is a strabismus?
Misalignment of visual axes,
211
What are types of strabismus??
Esotropia Exotropia hypertropia hypotropia, manifest latent or
212
What is latent strabismus?
When they are aligned but when covered there is one that splits off exophoria
213
What causes strabismus?
Either hereditary or refractive error often uncorrected hypermetropia anisometropia and develipment of amblyopia
loss of vision neurological defects (acute onset and have other signs) anatomical mechanical effects febrile illness
214
What is amblyopia?
reduced vision in one eye after correction of any refractive error
215
When is a sqint normal?
Before 4 months
216
What to ask in stabismus history?
Type when does it happen family history birth history and general health
217
How to detect strabismus?
Corneal reflections should be symetrical. Cover test, cover and uncover for manifest and alternat for latent strabismus.
218
What is pseudostrabismus?
Epicanthus, narrow or wide interpupillary distance, facial asymetry, unilateral ptosis deep set or prominent eyes
219
What is the problem wiht strabismus?
can affect acuity
220
What are treatmetn of amblyopia?
Refrative adaptation weraing refractive glasses, occlusion therapy block good eye, atropine drops/ointment in better seeing to dilate the pupil and paralyse accommodation, blurs the vision
221
What is treatment for strabismus?
optical recraction or hypermetropia, prisms orthoptic exercises
222
How much weidht is it ok for babies to lose in the first week?
10% up to
223
What is definition of faltering or concerning growth?
Dropping 1 centile if a small child or dropping more than 3 in a larger child
224
What are good predicters for height?
Mid parental height and progress along centile
225
What are the general classification of causes of failure to thrive?
Poor intake, malabsorption, excessive expenditure and endocrine or psychosocial
226
What are causes of intake?
Breast-feeding poorly, bottle feeds too dilute, Juice driners, cleft palate, exclusion diets, deuromuscular disorder, Vomiting, eating disorders
227
What are symptoms of GORD?
Resp/ENT, aspiration pneumonia bronchospam wheeze, apnoeas, cyanotic eposodes cought stridor hoarsness, otitis media glue ear, Oesopjagitis, chest epigrastric pain, irritability, anaemia, haematemesis, dysphagia, peptic stricture causing obstruction
228
What can cause malabsorption?
Cows's milk protein allergy enteropathy liver disease, pancreatic. (CF schwanchmann-diamond syndrome, enzyme deficiency chronic pancreatitis and failure
Diarrhoes
229
What is diarrhoea often a symptom of?
Malabsorption of some form
230
How to diagnose cows milk protein allergy?
Not got a diagnostic test, trial removing protein
231
What is post-infective diarrhoea?
Diarrhoea after infection related mucosal interity which gives an inflammatory diarrhoea.
232
What do you need to make sure when doing TTG test for coealiac?
That they don't have IGA deficiency
233
What are the disacaridase defieciency?
Lactose sucrase-isomaltase, fructose
234
What do you do to screeen for IBD?
CRP, ESR, FBC, Albumin Fawcal calprotectin,
235
How to approach diarrhoea?
If no systemic sympromts do food related diary and modifiying diet if not changes, Total IgA, anteendomysial IgA TTG CRP, ESR, FBC LFT, Possibly faecal elastace faecaes MC&S parasite and virus screen calprotectin
Nutrition approace, Ferritin RBC TIBC folate, vitb12 ADE clotting micronutrients bone profile
With systemic symptoms might want endoscopy sweat test for CF,
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What are main food allergens?
Dairy soy wheat egg nuts and fish
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What treatments to avoid in children?
Anti-diarrhoeals might not help and masque problems
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What can cause chronic excess energy expendatere?
Congenital heart disease, Chronic renal failureCF inflammation tumourse catabolic states
