Paeds Flashcards
(212 cards)
1
Q
What are the 3 core behaviours of ADHD?
A
Hyperactivity
Inattention
Impulsivity
(HII behaviours) extreme where it is causing
2
Q
What are the DSM criteria for ADHD?
A
at least 6 inattentive symptoms + 6 hyperactive or impulsive symptoms
Present in a primary setting
Developmentally inappropriate
Interferes in life and function
Symptoms in multiple settings
3
Q
What comorbidities are often found with ADHD and autism?
A
Tics Tourette's Asperger's Developmental/ Learning difficulties Sensory difficulties Sleep difficulties
In older people:
- Depression/ anxiety
4
Q
What investigations should be conducted in ADHD?
A
Clinical interview
Classroom (behavioural) observation
Information from third parties
Quantitive behaviour testing (QB)
5
Q
What is the aetiology of ADHD?
A
- GENETIC
- Abnormal dopamine pathways (neurochemical or neuroanatomical)
- Environmental factors
- CNS insults
6
Q
What are the risk factors of ADHD?
A
- prematurity
- foetal alcohol syndromes
- abuse
- substance abuse
- mental health issues
7
Q
What is the management of ADHD?
A
Lifestyle advice:
- education!!! and associated lifestyle management (emotional age of ADHD children are 1/3 less than they should be, e.g. 12y/o has emotional maturity of 9y/o)
- Parenting and school information courses
- balanced diet/ exercise
Medication: Stimulants (2)
- Methylphenidate
- Dexamfetamine
Medication: Non-stimulants
- Atomoxetine
8
Q
What is the presentation of autism?
A
2-4 y/o, boys ++
Issues with:
- COMMUNICATION (abnormal language development, abnormal accents or speech patterns, repetition, poor non-verbal communications- eye contact)
- SOCIAL INTERACTION (2-way relationships) (no desire to interact with others or don’t understand how to navigate social rules- comes across as rude, personal space issues)
- SOCIAL IMAGINATION (inability to play or write imaginatively, rule based play, resists change, positive obsessions/rituals (unlike negative in OCD))
- SENSORY ISSUES
9
Q
What is the management of autism?
A
Social Managements:
- Education
- Applied behavioural analysis
- Learning/ playing tools (visual)
- Communication tools
- Visual planners
10
Q
What are signs of dehydration in children?
A
skin turgor moist mucosal membranes reduced urine output sunken eyes/ fontanel lethargic/ unconscious
11
Q
What is normal fluid requirement for a neonate?
A
1st day: 60ml/kg
2nd day: 90ml/kg
3rd day: 120ml/kg
4th day- 1 month: 150ml/kg
12
Q
What different fluids would you give to a 0-48hr baby, 48hr-1 month baby, 1 month onwards child?
A
0-48hr–> 10% dextrose
48hr-1month–> dextrose, sodium, potassium
1 month onwards–> 0.9% sodium chloride + 5% glucose
13
Q
What is maintenance fluid requirements for children?
A
First 10kg: 100ml/kg
Next 10kg: 50ml/kg
Every other kg: 20ml/kg
if dehydrated; +50ml/kg
if shocked: +100ml/kg + bolus
14
Q
What are symptoms of inattention? (ADHD)
A
- easily distracted
- does not appear to be listening
- difficulty sustaining attention
- forgetful in ADL and loses things
- fails to complete tasks
15
Q
What are symptoms of impulsivity? (ADHD)
A
- interrupts in conversation
- difficulty waiting
- adolescents: risky behaviours- sex, alcohol, drugs, car accidents etc.
16
Q
What are symptoms of hyperactivity? (ADHD)
A
- squirmy/ fidgeting
- runs or climbs excessively/ inappropriately
- excessive talking (girls)
17
Q
Measles:
- Cause
- Presentation
- Complications
- Management
A
Cause
- Viral
Presentation:
- CCCK; cough, coryza, conjunctivitis, Koplick spots
- Fever, malaise
- Rash- discrete maculopapular rash from behind ears/ forehead—> down, to blotchy rash
Complications:
- Pneumonia
- Encephalitis
Management:
MMR vaccine, ribavirin, Vitamin A
18
Q
Mumps:
- Cause
- Presentation
- Complications
- Management
A
Cause
- Virus, accesses parotid glands before disseminating
Presentation:
- Fever, malaise
- Pain swallowing
- PAROTITIS
Complications:
- Orchitis + infertility
- Encephalitis
Management:
- Symptomatic
19
Q
Rubella:
- Cause
- Presentation
- Complications
- Management
A
Cause:
- Virus
Presentation:
- Maculopapular rash- face then to body, not itchy in children
- Insignificant fever
- Lymphadenopathy
Complications:
- Microcephaly in foetus if pregnant lady infected
Management:
- self limiting
20
Q
Herpes Simplex Virus:
- Cause
- Presentation
- Complications
- Management
A
Cause:
- Virus
Presentation:
- Gingivostomatitis (lesions in mouth)
- Cold sores
- Eczema herpeticum (can lead to septicaemia)
- Herpetic whitlow
Management:
- Acyclovir
21
Q
Varicella Zoster Virus:
- Cause
- Presentation
- Complications
- Management
A
Cause:
- Chickenpox virus (is a HSV), very contagious
Presentation: (1-5 y/o)
- initial fever
- vesicular rash (itchy+++)
Complications:
- Shingles in the adult
- Dangerous in immunocompromised- haemorrhagic lesions, DIC
Management:
- Calamine lotion
22
Q
Epstein- Barr Virus:
- Cause
- Presentation
- Investigations
- Complications
- Management
A
Cause:
- Virus (HSV)
Presentation:
- Glandular fever;
- fever, malaise
- extreme fatigue
- severe tonsillopharyngitis, lymphadenopathy
- palatal petechiae
Investigations:
- Positive Monospot test
- Atypical lymphocytes
Complications:
- linked to Burkitt’s lymphoma + nasopharyngeal cancer,
Management:
- Symptomatic
23
Q
Cytomegalovirus:
- Cause
- Presentation
- Complications
- Management
A
Cause:
- Virus (HSV)
Presentation:
- Asymptomatic
- like EBV (severe tonsillopharyngitis)
- like acute hepatitis
Complications:
- congenital CMV
Management:
- symptomatic or
- ganciclovir
24
Q
Roseola Infantum:
- Cause
- Presentation
- Management
A
Cause:
- Virus (HSV, HHV6)
Presentation:
- sudden high fever
- after fever rash
Management:
- Symptomatic
- Ganciclovir
25
Parvovirus B19:
- Cause
- Presentation
- Complications
- Management
Cause:
- Virus, resp transmission
- infects erythroblastoid red cell precursors in bone marrow
Presentation:
- SLAPPED CHEEK
- fever, malaise
- headache
Complications:
- Aplastic crisis in haemolytic anaemias
- Hydrops fetalis
Management:
- symptomatic
26
Hand-Foot-and-Mouth:
- Cause
- Presentation
- Management
Cause:
- Coxsackie virus, hand-foot and mouth
Presentation:
- vesicular rash on hands and feet
- ulcers in and around mouth
- mild systemic features
Management:
- resolves itself
27
What common infections are caused by Staph A?
Gram +ve, in clumps
Scalded skin syndrome (flucloxacillin)
Cellulitis! Abscess, osteomyelitis
28
What common infections are caused by Strep B?
Septicaemia (GBS+ve), UTI, Pneumonia
29
What common infections are caused by Strep A?
Sore throat- pharyngitis and tonsillitis
30
What are the causes of CAP?
+ Management
Strep Pneumoniae
Haemophius Influenzae
Atypical- legionella, chlamydophila, mycoplasma
Staph A
Management: oral amoxicillin, clarithromycin, doxycycline
31
What are the causes of HAP?
+ Management
Gram -ve bacilli
Pseudonomas
Aminoglycoside IV, cephalosporin, antipseudonomal penicillin
32
Meningitis/ Encephalitis
| - Causes
Inflammation of the meninges/ the brain
Causes
- Viral (most common)- enterovirus, EBV, adenovirus
- Bacterial- Neonates- Strep B
Older- Neisseria Meningitides, Strep Pneumoniae
- HSV for encephalitis
33
What findings would you see in LP of meningitis or encephalitis
- Raised Lymphocytes
- Raised Protein
- Decreased Glucose
- Cloudy colour if bacterial
34
What is the presentation of meningitis
Presentation
- fever
- headache
- neck stiffness
- photophobia
- Meningococcal purpural rash
- Bulging fontanel
- Kernig's sign (pain on leg extension)
- Brudzinski's sign (hip + knee flexion when flexing neck)
35
What investigations would you carry out for meningitis
Investigation
- Lumbar puncture- raised lymphocytes/ polymorphs,
raised protein, decreased glucose
+ culture
- FBC with differential count
- Blood culture, throat swabs, urine culture
- Rapid antigen screens or PCR of any samples
36
What is the management of meningitis?
Viral: Supportive
Bacterial: Ceftriaxone/cefataxime + dexamethasone
Prophylactic rifampicin given to contacts
37
Meningococcal Septicaemia
Any febrile child with purpuric rash is considered meningococcal septicaemia until proven otherwise!!!!!
- IM BENZYLPENICILLIN in community
- IV cefotaxime or ceftriaxone
38
What are the complications of meningitis?
- Developmental delay
- Hearing impairment
- Vasculitis/ Infarction--> focal lesions/ CN palsies, seizures
- Subdural effusion/ hydrocephalus
- Cerebral abscess
39
Kawasaki Disease
- What is it
- Who does it effect
- Presentation
- Differentials
- Investigations
- Complications
- Management
- systemic vasculitis of small-medium arteries, diagnosis made on clinical features alone
- 6 months- 4 years old
Presentation
- irritability + malaise
- prolonged fever
- conjunctivitis
- red and peeling extremities
- red mucous membranes
- strawberry tongue
- high CRP, ESR, and WCC
Differentials
- Scarlet fever
- Measles
- Toxic shock syndrome
- JIA
Investigations
- Bloods- FBC, CRP, WCC, BNP (cardiac stress)
- Urine dip + culture
- ECG
- Echocardiogram
Complications
- Coronary artery aneurysm!!!!!
Management
- Gammaglobulins
- High anti-inflammatory dose of aspirin
40
What are the 2 stages of allergic response?
Early: within minutes; sneezing, urticaria, angioedema, vomiting, bronchospasm, CV shock
Late: 4-6 hours; nasal congestion, cough and bronchospasm in the lower airway
41
What is eczema?
- exacerbations
- complications
Atopic dermatitis, very itchy
Erythematous, weeping, crusted
Exacerbated by infection, ingestion of allergen, medication, change in environment, stress
Complications are skin infections (staph a or strep) as a result of damaged skin barrier
42
What is the management of eczema?
- Avoid irritants/ triggers
- Emollients
- Topical corticosteroids (e.g. 1% hydrocortisone creams)
- Immunomodulators- tacrolimus
43
What are warts, causes and managements?
Viral- HPV or Poxvirus
Usually disappear naturally, can be treated with salicylic acid, over the counter, or cryotherapy
44
What is the management of scabies?
benzyl benzoate to patient and all close contacts
45
What is the presentation of TB in children?
- Persistent fever
- Persistent cough
- Malaise
- Night sweats
- Weight loss
Signs
- CXR- Gohn Complex, calcifications, bilateral lymphadenopathy
- Histopathology: caseous granuloma
- Positive mantoux test or interferon gamma release assays
- positive sputum culture/ gastric washing (ziehl nielson)
46
What is the management of TB?
Rifampicin (red urine) 6 MONTHS
Isoniazid (burning feet) 6 MONTHS
Pyrazinamide (hepatitis) 2 MONTHS
Ethambutol (optic neuritis) 2 MONTHS
47
What is whooping cough?
- causes
- symptoms/ presentation
- investigations
- complications
- management
Bordatella Pertussis
Presentation
- coryzal symptoms (catarrh to begin with)
- paroxysmal cough followed by distinctive whoop
- worse at night
- apnoea (child goes blue/ red between coughs)
- epistaxis/ subconjunctival haemorrhage (from coughing)
Investigations
- Pernasal swab culture/ PCR
- FBC- lymphocytosis
Complications
- Pneumonia
- Bronchiectasis
- Seizures
Management
- Macrolides
- prophylaxis for parents
- immunisation!
48
What are the causes of wheeze in preschool children?
- Recurrent viral wheeze (during viral infections) (up until age 3)
- Multiple trigger wheeze (such as cold, dust, foods -can lead to asthma) (ages 3-6)
- Asthma (continues throughout childhood)
49
What is asthma?
What is the pathophysiology of asthma?
Chronic inflammatory condition in the lungs caused by a genetic predisposition + atopy + environmental triggers causing;
REVERSIBLE OBSTRUCTED AIRFLOW
Trigger-->
Bronchial inflammation (oedema, mucus production, WC infiltration (mast cells, neutrophils, eosinophils, lymphocytes))-->
Bronchial hyperresponsive-->
Airway narrowing (airflow restriction)-->
Symptoms (wheeze, cough, breathlessness, chest tightness)
50
What are the symptoms and signs of asthma?
+ investigations
Wheeze (polyphonic)
Cough
Breathlessness
Chest tightness
Diurnal variation- worse at night and morning
Relief between episodes
Positive response to therapy
Investigations
- commonly diagnosed on history and examination
- peak flow (with bronchodilators)
- spirometry (with bronchodilators)
51
What causes acne?
androgenic stimulation of sebaceous glands and increased sebum
inflammation
52
What is the management for acne?
Hygiene advice- not to over clean
Lifestyle- healthy diet, don't pick spots, make up cleansers
Topical retinoid ± benzoyl peroxide
Topical antibiotic
53
What is the management for asthma?
1st Line: Short Acting Beta 2 Agonist e.g. salbutamol, terbutaline
2nd Line: SABA + Inhaled Corticosteroids (e.g. beclametasone, budesonide)
3rd Line: SABA + ICS + Leukotriene receptor antagonist (e.g. Montelukast SE MENTAL HEALTH)
4th Line: SABA + ICS + LABA (e.g. Salmeterol)
Avoid exacerbators
54
What is the management of acute asthma?
O SHIMIE
```
Oxygen
Salbutamol
Hydrocortisone/ prednisolone
Ipratropium
Magnesium
IV Salbutamol/Aminophylline
Escalate care (intubation, ventilaiton etc.)
```
------------------
CO2:
Low- good as they're compensating
Normal- not good, they're not offloading enough CO2 for their resp rate
High- Life threatening
55
Respiratory Syncytial Virus
- what is it
- presentation
- management
Common viral RTI
- cold like symptoms
- mucus
- wheeze
management: conservative
56
Who is at risk of respiratory failure?
- Preterm/ ex-preterm
- Bronchopulmonary dysplasia!
- Haemodynamicall significant congenital heart disease
- Congenital causes of muscle weakness
- Cystic fibrosis
- Immunodeficiency
57
What is bronchopulmonary dysplasia?
Chronic lung disease that effects newborns and infants (usually preterm)
From damage caused by mechanical ventilation effect on immature lungs
Manage with oxygen
More susceptible to lung infection
58
What pathogens commonly cause pharyngitis and tonsilitis?
- Strep A
| - EBV
59
What is otitis media?
- Presentation
- Causative agents
- Management
Inflammation of the middle ear
Common in children due to short eustachian tubes
Presents with ear pain and fever
+ red and bulging tympanic membrane
± pus in the external canal
Recurrent infections in an ear without a patent Eustachian tube, can cause effusion (glue ear) which causes reduced hearing
Caused by: Viruses (RSV, rhinovirus) Bacteria (Pneumococcus, Hib)
Management:
- analgaesia (paracetamol and ibuprofen)
- Amoxicillin if persists
- Grommits for effusion
- Hearing aids
60
What is ALL?
How does Leukaemia present?
(inc. investigations)
ALL- Acute Lymphoblastic Leukaemia, malignancy of lymphocytic cells (that develop into T cells, B cells, NK cells)
- Aged 2-5
Symptoms caused by disseminated disease;
- fatigue/ malaise/ anorexia
- pallor (anaemia)
- infection
- easy bruising/ petechiae/ nose bleeds
- bone pain
- hepatosplenomegaly
- lymphadenopathy
- mediastinal mass
- headaches/nausea/vomiting
- nerve palsies and enlarged testicles
Investigations:
- Blood film: Low Hb, Thrombocytopenia (low platelets), evidence of leukemic blast cells
- Clotting screen: looking for DIC (low fibrinogen, prolonged prothrombin time (PT/PTT), raised D-dimer)
- Lumbar puncture
- Chest x-ray
61
What are risk factors of malignancy in children?
- Down's syndrome
- Immunocompromised (e.g. HIV)
- Family history (retinoblastoma)
62
What is the management of ALL?
Correct anaemia with blood transfusion
Reduce haemorrhage risk with platelet transfusion
Hydration + allopurinol for renal protection
1. Induction- prep (above) + chemotherapy inc steroids until 95% remission
2. Intensification/ Consolidation- high intensity chemotherapy
3. Continuation/ interim maintenance- moderate dose chemotherapy for 3 years (with prophylactic Ab)
4. High dose chemotherapy + bone marrow transplant for relapse
63
What indicates prognosis of ALL?
- cytogenetics of leukemic cells
- white cell count at presentation (tumour load)
- response to treatment
- patient age (poor is <1 or >10)
64
What are the types of brain tumours in children?
Astrocytoma- originate from glial cells in the CNS (sometimes benign) ~40%
Medulloblastoma- from the cerebellum (MOST COMMON MALIGNANT) ~20%
Ependymoma- posterior fossa ~8%
Brainstem glioma
Craniopharyngioma
65
How do CNS tumours present?
Raised ICP: headache, nausea, vomiting, confusion, dizziness, visual disturbances, nystagmus, ataxia
Focal neurological signs (personality change, nerve palsies)
Back pains, limb weakness, bowel/ bladder dysfunction
66
What is the management of CNS malignancies?
Surgery for most- managing hydrocephaly/ removing lesion
Radio/chemotherapy
67
What is Lymphoma?
Tumour of Lymphocytic cells (T cells, B cells, NK cells) aggregating within the lymph nodes
68
What is the most common lymphoma in children vs adolescent?
Children: Non-Hodgkins Lymphoma
Adolescent: Hodgkins Lymphoma
69
What is the clinical presentation of Hodgkin's and Non-Hodgkin's Lymphoma? + whats the difference
h- painless lymphadenopathy, hepatosplenomegaly, ±systemic features (fatigue, sweating, fever, anorexia, pruritus, recurrent infections, anaemia- pallor)
Reed-Sternberg cells on lymph node biopsy in Hodgkin's
70
What investigations would you do for ?lymphoma or leukaemia?
- FBC (WCC, Hb, MCV, platelets)
- Clotting screen (?DIC)
- Ferritin
- Blood film (?Leukaemic blast cells)
- LDH
- Lymph node biopsy (?reed sternberg cells)
- Lumbar puncture
- CXR- ?mediastinal lymph node enlargement
- CT scan to assess extent of disease
71
What is the management of Lymphoma?
- Stage the disease (Ann Arbor)
- Chemotherapy
- Stem cell transplants
72
Where does a Neuroblastoma arise?
Neural crest cells, classically from adrenal medulla
73
What is the presentation of a neuroblastoma?
Classically; abdominal mass, but can be wider spread along Sympathetic Nervous System
Abdominal symptoms:
- mass
- pain
- haematuria
- constipation
- htn
- weight loss
74
What is the presentation of a neuroblastoma?
Classically; abdominal mass, but can be wider spread along Sympathetic Nervous System
Abdominal symptoms:
- mass/ hepatomegaly
- pain
- haematuria
- constipation
- htn
- weight loss
Other symptoms:
- cervical lymphadenopathy
- periorbital bruising
- proptosis
75
What is Wilm's tumour and how does it present?
Tumour of embryonic renal tissue (nephroblastoma), common in <5yo
Presents:
- abdominal mass with haematuria
- symptoms of abdominal mass/ general symptoms of malignancy
76
What is the management of Wilm's tumour?
Chemotherapy and then resection
±more chemo ± radiotherapy
80% survival
77
What causes retinoblastoma?
RB1 gene mutation
78
How does a retinoblastoma present?
- LOSS OF RED REFLEX
- strabismus (cross eyed)
- Visual changes
- eye pain
79
What are the characteristics or an acute upper airway restriction?
- stridor (rasping sound)
- hoarseness in voice
- barking cough
- dyspnoea
- cyanosis
- chest recessions (subcostal, intercostal, sternal)
80
What is croup?
Laryngotracheobronchitis
Mucosal inflammation, and increased secretions
+ subglottic oedema causing narrowing of the trachea
81
What are the causes of croup?
Symptoms?
Viral- Parainfluenza
Symptoms:
- Coryza + fever
- Hoarseness
- barking cough
- stridor
82
What is the management of laryngotracheobronchitis? (croup)
```
- Inhalation of warm air
STEROIDS++
- dexamethasone
- prednisolone
- nebulised steroids budesonide
```
- adrenaline + oxygen if severe
83
What is croup+ thick airway secretions?
Staph A infection!!!
Manage with IV antibiotics (cefuroxime) and intubation
84
What is epiglottitis caused by?
How does it present?
What is the management?
Hib, commonly associated with septicaemia
- minimal or no cough
- saliva drooling++
- toxic appearance
- quick onset
- reluctant to speak or swallow
Management
- intubation/ ventilation
- ENT + anaesthetist referral urgent
- Ab
85
What is the presentation of bronchiolitis?
- Coryzal symptoms
- dry cough
- dyspnoea
- APNOEA
- subcostal/ intercostal recession
- hyperinflation of the chest (prominent sternum
- fine inspiratory crackles
-
86
What is the presentation of bronchiolitis?
- Coryzal symptoms, inc low grade fever
- dry cough
- dyspnoea
- APNOEA
- subcostal/ intercostal recession
- hyperinflation of the chest (prominent sternum, liver displaced downwards)
- fine inspiratory crackles
- tachycardia
- cyanosis
- pallor
87
What are the risk factors of bronchiolitis?
- Prematurity
- bronchopulmonary dysplasia
- underlying lung disease
- congenital heart disease
88
What is the management of bronchiolitis?
- Supportive
- Humidified oxygen
- Fluids
- beta agonists not given as no beta receptors <6 months
89
What is the most common causative agent of pneumonia in;
Newborns
Infants
Children
Newborns; organisms from maternal GU tract- Strep B or Gram -ve enterococci
Infants: RSV, Strep Pneumonia (lobar) , Haemophilus Influenza
Children: Mycoplasma/ Strep/ Chlamydia Pneumoniae
90
What is the presentation of pneumonia in children?
- high fever
- cough
- tachypnoea +
- coryzal symptoms
- bronchial breathing, unilateral coarse crackles
± wheeze
- nasal flaring, chest indrawing
- Bacterial infection- neck/ abdo pain (pleural irritation)
91
What is the management for Pneumonia?
- Oxygen
- analgesia
- fluids
- IV benpen
- oral amoxicillin or co-amoxiclav
92
What is the presentation of a UTI in young children?
Non-specific
- fever
- malaise
93
What investigations would you do for ?pneumonia?
- Blood culture
| - CXR
94
What are the associated risks of steroid use in children (e.g. asthmatics)?
- adrenal suppression
- growth suppression
- osteoporosis
95
What is the pathophysiology and management of bronchiectasis ?
- inflammation --> airway damage --> mucocilliary clearance impaired--> increased infection--> inflammation etc.
Management:
- physiotherapy to clear
- management of infection
- fluids/ oxygen
96
What is the pathophysiology of cystic fibrosis?
- autosomal recessive disorder
Mutation of the Cystic Fibrosis Transmembrane conductance Regulator gene
Causes impaired chloride transport into mucus (which thins it)
CF:
Thick mucus--> impaired ciliary function + retention of mucopurulent secretions
---> multisystem pathology
97
How is cystic fibrosis diagnosed?
- Newborn screening test
- clinical presentation with recurrent chest infections, faltering growth, malabsorption , meconium ileus
On examination: finger clubbing, hyperinflated chest, expiratory wheeze, inspiratory crepitation
Sweat test:
- increased Cl in the sweat
98
How does CF effect the lungs + management?
Viscous mucus causes trapping of bacteria+ recurrent infections (Staph A, H. Influenzae)
Recurrent infections leads to damaged airways (can cause bronchiectasis and abscesses)
+ persistent loose cough and producing purulent sputum
Management:
- physiotherapy to clear sputum
- prophylactic antibiotics (Fluclox)
- Nebulised DNase or hypertonic saline to decrease viscosity of sputum
- lung transplant
99
How does CF effect the pancreas + management?
Thick mucus blocks the exocrine pancreatic duct, therefore products (lipase, amylase and proteases) can't flow through.
There is pancreatic exocrine insufficiency. Therefore there is failure to thrive, maldigestion, malabsorption.
Patients pass frequent large, pale, greasy and offensive stools.
Low elastase in faeces.
Managed with oral pancreatic enzyme replacement, ursodeoxycholic acid to improve bile flow
Also develop diabetes mellitus
100
What are the causes of a Left-->Right shunt?
atrial septal defects (secundum ASD or partial AVSD)
ventricular septal defect
persistant ductus arteriosus
101
What signs would you see in a child with an atrial septal defect?
ejection systolic murmur (heard over pulmonary valve- upper left sternal edge- due to increased blood flow)
split second heart sound
102
What are the cyanotic heart conditions?
- deoxygenated blood being circulated
(Bypass the lungs) (Right--> Left shunt)
1. One big trunk--> Truncus Arteriosus
2. Two interchanged vessels--> Transposition of the great vessels
3. Tricuspid atresia
4. Tetralogy of Fallot
5. Five words- Total Anomalous Pulmonary Venous Return
103
What is the tetralogy of fallot?
1. Pulmonary Stenosis
2. Right ventricular hypertrophy
3. Overriding aorta
4. Ventricular septal defect
104
What are the acyanotic heart conditions?
- Less oxygenated blood being circulated
Left--> Right shunt
- ASD
- VSD
- AVSD
- PDA
105
What are the signs of a ventricular septal defect?
Small: asymptomatic
- loud pansystolic murmur and lower left sternal edge
- quiet pulmonary second sound
Large:
- heart failure, breathlessness and failure to thrive after 1 week
- soft pansystolic/ no murmur
- mid-diastolic murmur
CXR findings: cardiomegaly, enlarged pulmonary arteries, pulmonary oedema, increased pulmonary vascular markings
106
What investigations do you do for ?congenital cardiac abnormality?
- CXR
- cardio echogram
In cyanosis:
- hyperoxia test
107
What diseases cause clubbing in children?
- CF
- Tetralogy of Fallot
- Chronic IBD
108
How does heart failure present in neonates+ infants?
- breathlessness
- sweating
- poor feeding + failure to thrive
- recurrent chest infections
- tachypnoea/ tachycardia
- heart murmurs
- cardiomegaly
- hepatomegaly
109
What are the causes of heart failure in neonates?
OBSTRUCTIVE OF FLOW (duct dependant circulation)
- severe aortic stenosis
- coarctation of the aorta
- interruption of the aortic arch
- hypoplastic left heart syndrome
110
What are the causes of heart failure in infants?
HIGH PULMONARY BLOOD FLOW leading to uncompensated pulmonary oedema (due to left to right shunt)
- AVSD
- VSD
- Large persistant ductus arteriosus
111
What are the causes of heart failure in older children?
- After initially compensated left to right shunt: Eisenmenger's syndrome (increased pulmonary resistance, causing a right to left shunt- cyanosis)
- rheumatic heart disease
- cardiomyopathy
112
What are the causes of cyanosis in the neonate?
Cardiac:
- cyanotic congenital heart conditions
Respiratory:
- RDS (surfactant deficiency)
- Meconium aspiration
- Pulmonary hypoplasia
Persistant pulmonary hypertension of the newborn (failure of the pulmonary vascular resistance to fall)
Infection: GBS, TORCH
Inborn error of metabolism- acidosis and shock
113
What are the clinical features of a persistant ductus arteriosus?
small- asymptomatic
continuous murmur
bounding pulse
114
How do you manage a large patent ductus arteriosus?
closure with a coil or occlusion device
| surgical ligation
115
What is the management of a cyanotic heart disease?
ABCDE--> stabilise airways and ventilate
Prostaglandin infusion
Manage underlying cause
116
What is the management of tetralogy of fallot?
- surgery at 6 months
medical management before:
- propanolol
117
What are the causes of being cyanotic and breathless?
Complete mixing-
- complete ASVD
- tricuspic atresia
118
What is the management of heart failure in children?
ABCDE
Prostaglandins in the neonate
Medical: - digoxin, ACEi (captopril), diuretics (furosemide)
- Surgical repair of the cause
119
What is the presentation of infective endocarditis?
+causative agents
+ investigations
+ management
- fever malaise
- raised ESR
- anaemia
- haematuria
+ viral or staph A
- anaemia and pallor
- splinter haemorrhages
- splenomegaly
Investigations:
- blood cultures
- echo (vegitations)
120
What is cerebral palsy?
Non-progressive lesion on motor pathways in the developing brain, leading to abnormalities in movement and posture
121
What is the presentation of cerebral palsy?
symptoms develop over time
- Abnormal motor development (e.g. can't sit up/ support own head)
- abnormal posture
- feeding difficulties
- abnormal gait
- asymmetric hand function <12m
- persisting primitive reflexes
Other:
- Learning difficulties
- Epilepsy
- Squints/ visual impairment
- hearing impairment
- speech and language disorders
- joint disorders- e.g. scoliosis, contractures, subluxation
122
What is the aetiology of cerebral palsy?
Antenatal (80%):
- vascular occlusion
- gene deletions/ chromosomal abnormalities
- antenatal infection
During birth:
- hypoxic brain injury
Post natal:
- Periventricular Leukomalacia- death of tissue around ventricles (secondary to ischaemia or haemorrhage- ?haem problems)
- Meningitis
- Encephalitis
- Hypoglycaemia
- Trauma
123
What are the types of Cerebral Palsy?
1. Spastic - hemiplegia, tetraplegia, diplegia
2. Ataxic- cerebellar dysfunction- hypotonia, poor balance and coordination
3. Dyskinetic- involuntary muscle movements e.g. chorea
124
What is the management for Cerebral Palsy?
MDT- physio, occupational, speech and language, dietician
Botox injections for spasticity
125
How do you OBJECTIVELY assess hearing loss in children?
```
Otoacoustic emissions ( babies screening)
Auditory brainstem response (in older children)
```
126
How do you SUBJECTIVELY assess hearing loss in children?
```
distraction testing (6-18m)
visual reinforcement audiometry (10m-3y)
performence testing
```
127
What is intussuseption?
| + where is it most common?
Invagination of the proximal bowel into the distal bowel.
Most commonly ileum passing into the caecum through the ileocaecal valve,
128
What is periorbital cellulitis?
- presentation
- management
** medical emergency **
URTI followed by painful swollen eye
- proptosis
- red colour vison
```
Management:
- URGENT ENT AND OPTHALM INVOLVEMENT
- Imaging
- Incision and drainage
IV Abx
```
129
What are the causes of prematurity?
Multiple gestation
Polyhydramnios
Uterine abruption
Antepartum haemorrhage
```
Intrauterine infection:
Chorioamnionitis
CV
Preterm prolonged rupture of membranes
Maternal UTI
```
IUGR
Congenital malformations
Pre-eclampsia
Maternal hypertension
Maternal chronic disease
Cervical weakness
130
What are the foetal problems associated with maternal diabetes mellitus?
increased risk of:
congenital malformations- e.g. cardiac
IUGR- microvascular disease
Macrosomia- maternal hyperglycaemia
131
What are the neonatal problems associated with maternal diabetes mellitus?
Hypoglycaemia- hyperinsulinism (give early feeding)
Respiratory distress syndrome- delayed lung maturation
Hypertrophic cardiomyopathy
Polycythaemia
132
What does use of SSRIs during pregnancy cause for the newborn?
Persistant pulmonary hypertension
133
What are the features of foetal alcohol syndrome?
Face: Eyes: small palpebral fissure, epicanthal folds
Nose: low nasal bridge (saddle), short, upturned nose
Lips: absent philtrum, thin upper lip
Micrognathia
Growth restriction
Mental retardation
Cardiac defects- VSD
134
What abnormalities does maternal rubella infection cause?
Deafness
Cataracts
Growth restriction
135
What abnormalities does maternal CMV infection cause?
sensorineural hearing loss
| Hepatosplenomegaly and petechiae
136
What abnormalities does maternal Varicella zoster infection cause?
skin scarring
ocular + neurological damages
digital dysplasia
neonatal infection
137
What abnormalities does maternal rubella, CMV, toxoplasmosis and syphilis cause?
```
Congenital heart disease- patent DA
Hepatosplenomegaly
Petechiae
anaemia
deafness
intracerebral calcification
```
138
What is included in the APGAR score?
1. Heart rate (/2) (absent, <100bpm or >100bpm)
2. Respiratory effort (/2) (absent, gasping/irregular or regular/strong cry)
3. Muscle tone (/2) (flaccid, some flexion, good flexion/ active)
4. Reflex irritability (/2) (none, grimace, cry/cough)
5. Colour (/2) (blue, blue extremities only, pink)
139
How do you resuscitate the neonate?
- -------temperature control throughout--------
1. Airway in neutral positioning (level)
2. Ventilation Breaths (repeat and then intubate if necessary)
3. Chest compressions
4. Drugs: adrenaline (for poor HR). Sodium bicarb (if lactic acidosis). Dextrose+ NaCl fluids (volume)
140
How do you thermally control the neonate?
Skin to skin
Blankets
Under the heat lamp (resus)
In a plastic bag (preterm)
141
What is assessed in a NIPE?
Birthweight
Gestational age
Head circumference
General inspection: movements, colour (plethoric, pale, jaundice)
Fontanelle: sutures, tense or soft
Face: any deformities
Eyes: red reflex, retinal vessels
Palate: cleft palate
Heart, lungs, abdomen
Femoral pulses
Genitalia, anus
Developmental dysplasia of the hip (barlow and ortolani)
142
What are the complications in macrosomia?
```
Birth trauma
Shoulder dystocia + Erb's palsy
Difficult delivery (asphyxiation)
Hypoglycaemia (due to hyperinsulinaemia)
polycythaemia
```
143
Why is IM vitamin K given to newborns?
to prevent haemorrhagic disease of the newborn
144
What causes GORD in the neonate?
Inappropriate relaxation of the lower oesophageal sphincter due to functional immaturity
+fluid diet, horizontal posture, short oesophagus
145
What are the complications of GORD?
Failure to thrive
Iron deficiency anaemia
Recurrent pneumonia (pulmonary aspiration)
Oesophagitis- haematemesis
146
What is the presentation of GORD in infants?
Recurrent vomitting episodes
| ± poor weight gain
147
What is the management of GORD?
- Food thickeners
- head prone up position after feeds
- Proton pump inhibitor (e.g. omeprazole, lansoprazole)
- H2- receptor antagonist (e.g. ranitidine)
Surgery
148
Who is at increased risk of GORD?
```
CF
Neuromuscular problems
Previous oesophageal or diaphragm surgery
Preterm infants
Bronchopulmonary dysplasia
```
149
What is the pathophysiology of pyloric stenosis?
Hypertrophy or the pyloric muscle resulting in gastric outlet obstruction
150
What is the presentation of pyloric stenosis?
2-7 weeks
Projectile vomiting !!
Hunger after vomiting
weight loss if delayed presentation
dehydration
151
What pH imbalance is noted in pyloric stenosis?
Hypochloraemic metabolic acidosis with low sodium and potassium
Everything reduced!! Due to vomiting
152
How do you diagnose pyloric stenosis?
Give feed and observe
- gastric peristalsis
- examine "olive" in RUQ
USS if necessary
153
What is the management of pyloric stenosis?
Correct fluid balance (0.45% saline with dextrose and potassium)
Surgical correction: pyloromyotomy
154
What are common causes of acute abdominal pain?
```
Appendicitis
Intussusception
Intestinal obstruction
Peritonitis
Hernias- inguinal or umbillical
Trauma
```
```
Diabetic ketoacidosis
Hepatitis
Pyelonephritis
UTI
IBS
IBD
Crohn's
Peptic ulcer
GORD
Gastroenteritis
Gynae
```
155
What is the presentation and management of appendicitis?
Presentation:
- Abdominal pain: initially central and then localises to the right iliac fossa (aggravated by movement)
- vomiting
- anorexia
Signs:
- Low grade fever
- Flushed face
- Tenderness with guarding in RIF
Investigation:
- Bloods (FBC (WCC), U+Es)
- Abdominal X-ray if needed
Management:
- Regular clinical review
- Appendicectomy
156
What is intussusception?
Invagination of proximal bowel loop into a distal segment
Commonly: ileum--> caecum (through iliocaecal valve)
157
What is the presentation of intussusception?
+ investigations
Peak presentation: 3m-2y
```
Paroxysmal, severe, colicky pain with pallor
Anorexia and vomiting
Palpable abdominal mass
**Redcurrant jelly stool**
Distention, shock
```
Abdo Xray: dilated small bowel, absence of air in large bowel
158
What is the complications of intussusception?
Mesenteric venous occlusion--> fluid aggregation, bleeding--> perforation + gut necrosis--> sepsis
159
What is the management of intussusceptions?
Fluid resus
Air enema- Rectal air insufflation
Surgical correction if peritonitic/ suspect perforation
160
Meckel's diverticulum:
- What is it
- Complications
- Management
Ileal duct remnant which contains gastric mucosa or pancreatic tissue
Usually asymptomatic
Can present as: rectal bleeding, intussusception, volvulus, diverticulitis
Management:
Surgical resection
161
What does bilious vomiting indicate?
Bowel obstruction!
162
What is malrotation?
No dudodenojejunal flexure or ileocaecal region fixture of mesentery, so bowel can rotate on itself, causing volvulus and obstruction ± necrosis
163
What is the management of peptic ulcers?
H. pylori investigation: stool sample, biopsy, 13C breath test
H. pylori +ve: amoxicillin and metronidazole
164
What is the presentation of gastroenteritis?
Watery stools
Vomiting
Dehydration: reduced urine output, pale/mottled skin, hypotension, cold, tachycardic, tachypnoeic, reduced tissue turgor, increased capillary refill, dry mucous membranes, sunken fontanelle,
165
What is coeliac disease?
Immunological response against gliadin in gluten
Causes damaging inflammation of the proximal small intestine.
Results in lost villi and flattened mucosa
166
What is the classical presentation of coeliac disease?
8-24 months
Depends on when gluten is introduced into diet
Failure to thrive
Non-specific GI symptoms (pain, discomfort)
Anaemia (iron-deficiency)
Abdominal distention
Or identified in screening of at risk groups (T1DM, autoimmune thyroid disease, Down's, Family Hx)
167
How do you diagnose coeliac disease?
Serology screening: IgA tissue transglutaminase antibodies + endomysial antibodies
Endoscopic small intestinal biopsy: increased intraepithelial lymphocytes + villous atrophy, crypt hypertrophy
168
What is the management of coeliac disease?
Removal of gluten from diet
169
What is the cause of an inguinal hernia?
+ management
Patent processus vaginalis ( peritoneum that descends with testes embryologically) allows herniation of bowel loop through inguinal canal
± hydrocoele from peritoneal fluid
Management: surgical correction
170
What is the management of gastroenteritis?
oral fluid rehydration solution
| - increases fluid reabsorption so child stays hydrated until organism is flushed out
171
How do you manage toddler's diarrhoea?
- assess for coeliacs
- assess cow's milk allergy and trial without
Will improve with age
172
What is Crohn's disease?
transmural, focal subacute or chronic inflammatory disease
Commonly affects the distal ileam and proximal colon
Diagnosed with endoscopy and histology of biopsy
173
What is the histological landmark of Crohn's disease?
Non-caseating epithelioid cell granulomata
174
What is the presentation of Crohn's?
Growth failure
Delayed puberty
Abdo pain, weight loss and diarrhoea
Fever, lethargy and weight loss
Mouth ulcers, perianal tags, uveitis, arthralgia, erythema nodosum
175
What is the managemetn for Crohn's in children?
whole protein modular feeds
oral steroids
immunosuppression (e.g. azathioprine)
monoclonal antibodies
176
What is the management of constipation in children?
Often self resolve
advise on hydration and good fibre intake
laxatives (e.g. Movicol Paediatric Plain)
177
What is Hirschsprung Disease?
no ganglion cells in parts of the large bowel (myenteric and submucosal plexus)
Results in a narrow, contracted section of the colon
178
How does Hirschsprung present?
```
Neonatal period:
Intestinal obstruction:
Failure to pass meconium
Abdominal distention
Bile stained vomit
```
179
What is the management of Hirschsprung disease?
Surgical
180
Causes of not passing meconium?
```
Hirschsprung's
Cystic Fibrosis (meconium ileus)
Small bowel syndrome
Foetal distress (already passed)
Anorectal malformation
```
181
What causes jaundice in the first 24 hours?
**ALWAYS PATHOLOGICAL**
Rhesus disease or ABO incompatibility
Other enzyme or haem problems: G6PD, spherocytosis, polycythaemia
TORCH
182
What causes jaundice from 2-14 days?
Physiological:
Increased RBC breakdown (foetal Hb has a shorter half life)
Immature enzymes- slower conjugation
Increased conjugated bilirubin being absorbed into enterohepatic circulation
Breastfeeding jaundice (most common)- continue feeding, increases enterohepatic circulation
OR early presentation of prolonged jaundice...
183
What causes prolonged neonatal jaundice after 2 weeks?
```
Congenital hypothyroidism
Biliary atresia
Prolonged breastfeeding jaundice
Pyloric stenosis
Bile duct obstruction
Hepatitis
```
184
What is the complication (and presentation) of neonatal jaundice?
KERNICTERUS
in the basal ganglia
- neurological signs- seizures, coma, lethargy, poor feeding, death, deafness
185
What investigations are done in neonatal jaundice?
```
FBC, Blood film, and blood group
LFTs (deranged in biliary atresia)
TFTs
Blood cultures
Urine dip (sepsis)
Abdo/ biliary USS
```
186
What is the management of neonatal jaundice?
Phototherapy (slow)
Exchange transfusion
187
What is bronchopulmonary dysplasia?
Infants with oxygen therapy requirements for at post-menstrual age of 36 weeks
188
What is the pathophysiology of bronchopulmonary dysplasia?
Lung damage due delayed lung maturation
189
What are the chest X-ray findings in bronchopulmonary dysplasia?
Widespread consolidation
| Cystic changes
190
What is the management of bronchopulmonary dysplasia?
Continued oxygen therapy;
mechanical ventilation
CPAP
high-flow nasal cannula
±low dose corticosteroid therapy
191
What are the risk factors of bronchopulmonary dysplasia?
Prematurity
Low birth weight
Neonatal respiratory infection
192
What conditions is a patient with bronchopulmonary dysplasia at higher risk of?
Poor growth
Recurrent respiratory infections - Bronchiolitis
GORD
CP
193
What are the most common causes of sepsis?
Staph A
Strep Pneumonia
Neisseria Meningitidis
E. Coli
194
What is the presentation of sepsis?
Fever
Malaise, irritable, lethargy
Poor feeding
```
Tachycardia
Tachypnoea
Low blood pressure
Purpuric rash (meningococcal)
Shock- sweating, confused, LoC
Multiorgan failure
```
195
What investigations should be done in sepsis?
```
Blood cultures
Urine output monitoring
Urinalysis
Lactate
Oximetry
```
196
What is the management for sepsis?
Broad spectrum antibiotics
| Fluid rescus- bolus + maintenance + 10% dehyd. for shock (i.e. extra 100ml/kg)
197
What fluid boluses are given?
20ml/kg
```
Unless:
Trauma
Neonate
DKA
in which case 10 ml/kg
```
198
What is the difference between neonatal and infant/child resus?
Neonate:
5 rescue breaths
then 3:1 compression: breaths
Infant/child:
5 rescue breaths
then 15:2 compression: breaths
199
What is necrotising enterocolitis?
Inflammation and ischaemia of bowel leading to necrosis
200
What is the presentation of necrotising enterocolitis?
Few days/ weeks after birth
Poor feeding
Vomiting (sometimes bile stained)
Abdominal distention
Fresh blood in stool
201
What are the abdominal Xray findings in necrotising enterocolitis?
distended bowel loops
thickening bowel wall (intramural gas)
Gas in portal tract and under diaphragm
202
What are the risk factors/ causes for necrotising enterocolitis?
Prematurity
SGA
Cow's milk feeders
```
"Causes":
- largely unknown
TORCH infections
GBS
E coli
```
203
What are the risk factors for intraventricular haemorrhage in neonates?
Prematurity
SGA
Perinatal asphyxia
RDS
204
When does intraventricular haemorrhage normally occur?
First 72 hours of life
205
What is retinopathy of prematurity?
+ management
Dysregulated vascular proliferation leads to potential retinal detachment, fibrosis and blindness
Laser therapy and intravitreal anti-VEGF
206
What is periventricular leukomalacia?
+ causes
+ prognosis
Degeneration and the formation of cysts in the periventricular white matter
As a result of hypoxia, prematurity
Causes cerebral palsy, epilepsy
207
What is HUS?
Haemolytic Uraemic Syndrome;
Triad of:
1. Renal railure
2. Microangiopathic Haemolytic anaemia
3. Thrombocytopaenia
208
What is the pathophysiology of HUS?
Secondary to GI infection.
Toxins cause thrombotic reaction in renal endothelium.
This leads to thrombocytopaenia and microangiopathic haemolytic anaemia.
209
What is the presentation of HUS?
Abdo pain
vomiting
haematuria
bloody diarrhoea
apyrexial
210
What is the management of HUS?
Supportive + dialysis
211
What is a BRUE?
Presentation
Investigations
Management
Briefly Resolved Unexplained Event
Presentation:
- sudden +brief
- LOC/ unresponsive
- Cyanosis/ pallor
- Absent/ decreased breathing
- Change in tone (hyper/hypo)
* *+++ ASYMPTOMATIC ON PRESENTATION **
Investigations:
ABCDE/ bedside investigations; obs, glucose, plot height/ weight, ECG, full systems examination
Bloods: FBC, U+E
Imaging: as required
Management: Safety net and reassurance
- diagnosis of exclusion -
212
Neonatal Sepsis
Presentation
Causative Organisms
Risk Factors
Management
Presentation:
- Respiratory distress: grunting, increased effort, nasal flaring, use of accessory muscles, tachypnoea
- lethargy
- febrile
- lots of nonspecific symptoms: abdo distention, jaundice, poor feeding, apnoea, vomiting etc.
Causative organisms: GBS, E. Coli
Risk Factors:
- Maternal GBS
- Maternal fever of any source
- Prolonged rupture of membranes
- Prematurity
- Low birth weight
Management:
- IV BenPen + Gentamicin
- Supportive: oxygen, fluids, thermal regulation
