Paeds central cyanosis Flashcards
(51 cards)
Neurological causes of central cyanosis
Apnoea of prematurity
Infection (meningitis, encephalitis)
Intraventricular haemorrhage
Seizure
Neuromuscular disorders -> central cyanosis
Neonatal myasthenia gravis
Phrenic nerve injury
Spinal muscular atrophy type 1
Haematological causes of central cyanosis
Haemaglobinopathies - Impaired oxygen saturation
Polycythaemia - Elevated haemoglobinin low oxygen saturation
Metabolic causes of central cyanosis
Severe hypoglycaemia
Inborn errors of metabolism
Mechanism: Hypoventilation decreased/absent respiratory effort secondary to lethargy, seizures ±apnoea
Innocent murmur characteristics (also see murmur types on revision lecture)
Systolic – diastolic pathological
Soft – never above Grade II
Small – does not radiate
Short – never pansystolic
Single – never with extra sounds
Sweet – never harsh sounding
Sensitive – varies with position
What are the red flags of constipation
Failure to pass meconium <24h = Hirschprung disease
Faltering growth = Hypothyroidism, Coeliac disease
Gross abdominal
distension= Hirschprung disease, Other GI dysmotility
Abnormal lower limb neurology = Lumbosacral
pathology
Sacral dimple = Spina bifida occulta
Position. patency,
appearance of anus = Abnormal anorectal anatomy
Perianal bruising or multiple fissures = Sexual abuse
Perianal fistula, abscess, fissure = Crohn’s disease
Electrolyte disturb = HypoK or HyperCa
What are the conditions associated with turners
Associated anomalies
*CHD (particularly coarctation).
*Renal (single horse-shoe shaped
kidney).
*Hypothyroidism.
*Ovarian dysgenesis with infertility.
*Normal intellectual function in most
cases
Status epilepticus
Generalised convulsive SE defined as:
‘generalised convulsion lasting ≥30-minutes’ –or
‘successive convulsions over 30-minutes so
frequent that patient does not recover
consciousness between them
Causes of floppy infant
Central Nervous
System
* Dysgenesis.
* Degeneration.
* Encephalopathy
NM junction
* Myasthenia.
* Botulism
Muscle
* Dystrophies.
* Inflammatory
Metabolic
Congenital
myopathies.
* Myotonic
disorders
Peripheral nerve
* Hereditary motor/sensory
neuropathies.
* Guillain-Barre
Anterior horn cell
* SMA.
* Polio/Coxsackie
Spinal cord
* Syringomyelia.
* Birth trauma.
Management of ITP in children
Ensure diagnosis: Diagnosis of exclusion
Exclude sinister diagnoses.
Use history, examination and blood film
* Reassure parents that severe bleeds are rare even with low platelets
* NO need for hospitalisation
* Activity restrictions where risk of head trauma e.g., trampoline
* Not be given any IM injections
* Avoid anti-platelet (aspirin and NSAIDs) and anti-coagulant medications
* Seek immediate medical advice following falls/bumps to head.
* Have 24-hour access.
* Treatment for life-threatening bleeds: steroids, IVIg, platelet TF.
* Benign, self-limiting condition.
* 80% remit spontaneously within 6-8 weeks.
What might you see in nephrotic syndrome of children
Assessment of oedema (lower limb, sacral, scrotal, ascites, pleural effusion).
* Cardiovascular status and perfusion (volume status):
* Overload: tachycardia, HT, respiratory distress, warm, hepatomegaly, raised JVP.
* Hypovolaemia: tachycardia, hypertension, cool peripheries, delayed capillary refill.
Why does minimal change disease cause swollen scrotum and eyes
Hypoalbuminemia (Low Blood Albumin)
- Massive proteinuria (>3.5 g/day in adults or >40 mg/m²/hr in kids) → drops serum albumin.
- Low albumin reduces plasma oncotic pressure → fluid leaks into tissues (third spacing).
Increased Sodium Retention
- Compensatory activation of the renin-angiotensin-aldosterone system (RAAS) → kidneys retain salt/water → worsens edema
How to manage nephrotic syndrome in children
Aim to induce remission with oral steroids (most in 7-14 days) and induce diuresis.
* Gastroprotection– not normally given.
* Manage hypovolaemia:
gentle fluid restriction ± no added salt.
diuretics and albumen if worsening or severe.
* Risk of thrombosis: compression stockings and low molecular weight heparin.
* Infection prophylaxis: oral Penicillin V and pneumococcal vaccination.
* Discharge planning and parental education.
What are the gross motor milestones at 6 weeks
Good head control
Raises head to 45 deg when on tummy
stabilises head when raised to sitting position
What are the fine motor skills at 6 weeks
Tracks objects/ face
What are speech and language skills in 6 weeks
Startles at loud noises
What are the social skills at 6 weeks
Social smile
WHat are the gross motor skills at 6 months
Sit without support, rounded back
Rolls from tummy to backt
WHat are the fine motor skills at 6 months
Palmar grasp
Transfer hand to hand
WHat are the speech and language skills at 6 months
Turns head to loud sounds
Understand bye bye
Babbles
WHat are the social skills at 6 months
Puts objects to mouth
Shakes rattle
Reaches for bottle/breast
What are the gross motor skills at 9 months
Stands holding on
STraight back sitting
What are the fine motor skills at 9 months
Inferior pincer grip
Object permanence
What are the speech and language skills at 9 months
Responds to own name
Imitates adult sounds
