Paeds Presentations Flashcards
1
Q
What is the acute management of seizures?
A
Buccal midazolam, rectal diazepam, or IV lorazepam
2
Q
How is a headache managed in paeds?
A
Paracetamol, ibuprofen, or triptans can be used
Treated differently if there are red-flag features
3
Q
What are visual field defects?
A
When any part of the visual pathway is damaged because of a disease or an injury, part of the visual field may disappear
Eg,
- Bitemporal hemianopia: loss of all or part of lateral half of visual field
- Blind-spot enlargement: enlargement of the normal blind spot at the optic nerve head
- Central scotoma: loss of visual function in the middle of the visual field
4
Q
What are peripheral nerve injury palsies?
A
Result from trauma, injury, nerve compression, genetic disorder, or disease like diabetes
Eg. carpal tunnel syndrome
5
Q
What are the different types of brain haemorrhage?
A
- Epidural: between the skull and dura mater. usually very acute
- Subdural: between dura mater and arachnoid mater
- Subarachnoid: between arachnoid and pia mater
- intraparenchymal
6
Q
What is the treatment for a squint?
A
When the eyes point in different directions
Treatment: operation to move the muscles that control eye movement
7
Q
What are some causes of hearing loss in children?
A
Otitis media, genetic disorders, exposure to loud noise, and certain diseases (such as meningitis)
8
Q
What are some causes of vision loss in children?
A
- Glaucoma: when the retinal nerve becomes damaged
- Retinal diseases
- Refractive errors: when the shape of your eye prevents the light from hitting the retina
- Cataract: when the transparent disc in the eye gets cloudy
- Amblyopia: reduced vision in one eye caused by abnormal visual development early in life
- Retinblastoma: a cancer that starts in the retina
9
Q
Why is a CT always done when children come in the migraines?
A
Because early onset migraines could suggest a pituitary tumour
10
Q
What are some causes of abnormal movements in children?
A
- Chorea: involuntary movements
- Myoclonus: sudden brief twitching of muscle groups
- Tremor
- Ataxia: lack of coordination and balance
- Cerebral palsy
11
Q
How does inflammatory bowel disease present in children?
A
Abdominal pain, cramping, blood in the stools, and chronic diarrhoea
Eg. Crohn’s or Ulcerative colitis
12
Q
How does GORD present in children?
A
Vomiting
Gagging
Coughing
Trouble breathing
13
Q
How does a cow’s milk allergy present?
A
It’s an IgE-mediated allergy causing urticaria, itching, cough, wheeze, diarrhoea, colic, constipation
Usually presents within 6 months of life
14
Q
How does malnutrition present in children?
A
Short for their age
Thin or bloated
Weakened immune system
Tiredness
15
Q
How does hepatitis present in children?
A
Same as adults but with developmental delays
Vomiting
Jaundice
Abdo pain
Diarrhoea
16
Q
What are some causes of bloody stool in children?
A
Intestinal infection
Inflammatory bowel disease
Juvenile polyp
17
Q
What is the treatment of peptic ulcers in children?
A
Antibiotics for H-pylori and an antacid
18
Q
Why is BP not a good indicator of health in children?
A
Because they compensate very well and the plumet rapidly
Use respirate and 02 sats instead
19
Q
In which cases in charcoal used in overdose?
A
Used shortly after ingestion if the toxin is still in the GI tract as charcoal stops it’s absorption
20
Q
What is a Wilms tumour?
A
A nephroblastoma (the most common type of paediatric renal caner)
Typically in children under 5
21
Q
What is biliary atresia?
A
A congenital condition when the bile ducts inside or outside the liver don’t develop normally
Causes blockages in the bile ducts
22
Q
What is a hydrocele?
A
A fluid collection in the scrotum that can lead onto an inguinal hernia
They often go away without treatment by age 1. More common in premature babies
23
Q
What causes intestinal obstructions in children?
A
Telescoping of the intestine (intussusception) most commonly
24
Q
What is an ileus?
A
The intolerance of oral intake due to inhibition of the gastrointestinal propulsion without signs of mechanical obstruction
Often associated with surgery, medications, trauma, peritonitis, or severe illness
25
What is Henoch-Schoenlein purpura?
An autoimmune often triggered by an URTI where blood vessels become inflamed
It can affect blood vessels in the intestines and kidneys and small blood vessels causing a rash called purpura
26
What is the difference between nephrotic and nephritic?
Nephrotic: affects glomeruli and causes lots of proteins in urine
Nephritic: caused by inflamed glomeruli and causes haematuria
27
What causes DIC in paeds?
Disseminated intravascular coagulation causes abnormal clotting in the body
It's always a secondary process caused by a variety of underlying disorders (eg, sepsis, trauma, or malignancy)
28
What causes hyposplenism?
Eg. sickle cell disease, celiac disease, alcoholic liver disease, hepatic cirrhosis, lymphomas and autoimmune disorders
29
How is hyposplenism diagnosed?
Pitted RBC counts or a 99Tc-labelled radiocolloid scan of the spleen
30
What is Kawasaki's disease?
Swelling of blood vessels throughout the body
Full recovery after 6-8 weeks, treatment offered if the fever lasts 5+ days
Treatment: gamma globulin
31
What is the difference between Duchenne's and Becker's muscular dystrophy?
Both caused by mutations in dystrophin
In Duchenne's, there is no dystrophin present and in Becker's there is still some present making it less severe
32
What is idiopathic arthritis?
It affects children between 6 months-16 years. There's no cure
Caused by combinations of genes and environment
33
What causes croup?
Parainfluenza virus
34
What is Cushing's syndrome in paeds?
A multisystem disorder that results from the prolonged exposure to excess glucocorticoids
35
What are some causes of cardiac arrest in children?
Most commonly hypoxia and hypovolaemia
Toxins
Tamponade
Tension pneumothorax
Thromboembolic event
Trauma
36
What are some causes of respiratory arrest in children?
Infections
Asthma
Anaphylaxis
Foreign body
Airway anomalies
Pulmonary oedema
Chest wall and thoracic cavity abnormalities
37
What is epiglottitis?
Inflammation of the epiglottis caused by haemophilus influezae type B (HiB)
Rare now because of the vaccine
38
What are some presentations of diabetic ketoacidosis in children?
Abdominal tenderness, abdominal pain, nausea, and vomiting
Often misdiagnosed as gastroenteritis
39
What are some caused or raised ICP in children?
Brain injury
Intracranial infections
Hepatic encephalopathy
hydrocephalus
40
What are some musculoskeletal deformities seen in children?
- Hip dysplasia: the hip socket doesn't fully cover the ball portion
- Legg-Calvé-Perthes disease: when the ball bit of the femur temporarily looses blood supply causing it to become inflamed and irritated
- Slipped capital femoral epiphysis: when the femoral epiphysis is abnormally displaced relative to the neck and head of femur
- Osgood-Schlatter disease: an overuse injury to the patellar tendon causing pain below the knee joint
- Patellofemoral syndrome: overuse injury causing pain behind and around the patella
- Radial head subluxation: when the radial head slips causing inability to supinate the forearm
41
What are some causes of AKI in children?
Most commonly Haemolytic uraemic syndrome (HUS)
Can be infections, toxins, disruption to blood flow
42
What are some causes of CKD in children?
5-14 yrs: birth defects and genetics
15-19 yrs: nephrotic syndrome and lupus
43
What are some causes of haematuria in children?
Bladder/kidney infections
Kidney stones
Problems with urinary tract
Medication
44
What are some causes of hypertension in children?
Overweight
Hyperthyroidism
Kidney disease
Cardiac disease
Coarctation of the aorta
45
What are some causes of oedema in children?
Heart disease
venous obstruction
Nephrotic syndrome
Lymphatic dysfunction/obstruction
46
What is a neuroblastoma?
Cancers that start in early nerve cells (called neuroblasts) of the sympathetic nervous system
90% of cases happen <10yrs
47
What causes sickle cell anaemia?
Caused by a mutation to haemoglobin causing a deformed shape
48
When do clinical features of sickle cell anaemia first appear?
3-6 months of age
(When the foetal haemoglobin fall in proportion to adult haemoglobin)
49
What are some signs and symptoms of sickle cell anaemia?
- Acute or chronic pain: due to vaso-occlusion
- Pallor, weakness and lethargy: due to chronic haemolysis, transient red cell aplasia or splenic sequestration
- Growth restriction
- Delayed puberty
- Splenomegaly: due to increased haemolysis in the spleen. Notably recurrent splenic infarcts usually cause asplenism by two years of age
- Recurrent infections: as there is an increased risk of infection from encapsulated bacteria including pneumococcus, Haemophilus influenzae type b, meningococcus and salmonella species.
- Jaundice: due to increased haemolysis
50
What are some reasons for hospitalisation with sickle cell anaemia?
- vasoocclusive crisis
- Acute chest syndrome (leading cause of death): fever, cough, tachypnoea, dyspnoea, sputum production, new-onset hypoxia
- Aplastic crisis: temporary cessation of erythropoiesis usually precipitated in parvovirus B19 infection
- Sequestration: sudden enlargement of the spleen due to haemorrhage within it
51
What is a sickle solubility test?
When blood with HbS is mixed with sodium dithionite a precipitate is formed and the solution becomes turbid.
When blood with normal haemoglobin is mixed with sodium dithionite the solution remains clear
51
Which tests are required for diagnosis of sickle cell anaemia?
Haemoglobin electrophoresis
- measures haemoglobin levels and looks for abnormal types
Sickle cell anaemia: there is no HbA, 80-95% HbSS and 1-20% HbF
Sickle cell trait: both HbA and HbS are present on electrophoresis
51
What are some triggers for sickle cell complications?
Cold temperatures
Dehydration
Exhaustion: may lead to lactic acidosis
Alcohol: may cause dehydration
Smoking: may cause the acute sickle chest syndrome
52
What preventative measures are put in place for sickle cell anaemia complications?
Oral penicillin prophylaxis
Vaccinations
Folic acid supplementation
Hydroxycarbamide (increase HbF)
Gene therapy and bone marrow transplants are sometimes an option
53
What is pancytopaenia?
Low levels of RBC's, WBC's, and platelets
54
What are some causes of short stature in children?
Growth hormone deficiency
Genetics
Malnutrition (or GI Diseases)
Delayed puberty
Syndromes
55
What is Prader-Willi syndrome?
Causes hypotonia, feeding difficulties, poor growth, delayed development, learning difficulties
56
What is Russell-Silver syndrome?
Characterized by intrauterine growth restriction (IUGR), poor growth after birth, a relatively large head size, a triangular facial appearance, a prominent forehead, body asymmetry and significant feeding difficulties
Often needs growth hormone supplements
57
What is meant by failure to thrive?
When the child has failed to develop and grow normally
Eg. weight and height
58
What causes tall stature in children?
- Excessive growth hormone
- Hyperthyroidism
- Precocious puberty
- Lipodystrophy
- Chromosome disorders, such as Trisomy X (47, XXX female), Klinefelter Syndrome (47, XXY), XYY syndrome (47, XYY male)
- Fragile X syndrome
59
What are the some consequences of starting your period early?
Early menstruation causes shorter and more irregular menstrual cycles, bleeding between cycles and results in a higher risk of suffering from primary dysmenorrhea
60
What are some causes of urinary incontinence in children?
- Anxiety
- ADHD
- Genetics
- Constipation putting pressure on the bladder
- Diabetes
- Antidiuretic hormone (ADH) deficiency
- Obstructive sleep apnoea (OSA)
- Overactive bladder
61
What is an overactive bladder?
When someone regularly gets a sudden and compelling need or desire to pass urine
Treated with pelvic floor exercises, scheduled toilet trips, healthy weight, bladder training
62
What is the difference between polyuria and polydipsia?
Polydipsia: an increase in thirst
Polyuria: frequent urination
63
What causes polydipsia?
Diabetes mellitus
Diabetes insipidus
Medications
Pregnancy
64
What are some causes of learning difficulties?
Hypoxia during pregnancy, head trauma, early childhood illness, seizures, certain syndromes, prematurity
65
What are the different types of developmental delay?
Cognitive
Motor
Social
Emotional
Speech
66
What are dysmorphic features?
Abnormal differences in body structure
67
What is cerebral palsy?
A group of disorders that affect a person's ability to move and maintain balance and posture
Decreases life expectancy
68
What is the pathophysiology behind asthma?
Bronchoconstriction, airway inflammation, and mucous impaction
69
What is bronchiolitis?
An infection that causes inflammation and mucous build up in the airways
Most common cause: respiratory syncytial virus (RSV)
70
What is the pathophysiology of cystic fibrosis?
Causes changes in how a Cl- moves in and out of cells, resulting in thick, sticky mucus in the respiratory, digestive and reproductive systems
Causes obstruction and atrophy of ducts and tubes
71
What is bronchiectasis?
A chronic condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection
Most often linked to cystic fibrosis or COPD
72
What are the main causes of pneumonia in children?
1st: Streptococcus pneumoniae
2nd: Haemophilus influenzae b (HiB)
3rd: RSV
73
What are the most common causes of pneumothorax in children?
Diseases like cystic fibrosis, whooping cough, and asthma increase the chances
74
What is obstructive sleep apnoea?
When the walls of the throat relax and narrow during sleep, interrupting normal breathing
Most common if children have large tonsils or glands
75
What causes stridor in children?
An upper airway obstruction
Laryngomalacia is the most common cause of inspiratory stridor in the neonatal period and early infancy and accounts for as many as 75% of all cases
76
What is parasuicide?
Apparent attempted suicide without the actual intention of killing yourself
77
What causes feeding difficulties?
Prematurity
Oral-motor difficulties
Reflux
Allergies
Developmental delay
78
What is a ventricular-septal defect?
When there is a hole in the septum that divides the ventricles
79
What is respiratory distress syndrome?
Occurs in premature babies whose lungs are not fully developed and lack surfactant
80
What causes jaundice in babies?
Too much bilirubin because babies have more blood cells that don't live as long so are broken down
81
What causes palpitations in children?
Premature babies have an irregular hart beat
82
What's included in the newborn examination?
- Height, weight, and head circumference and calculate percentiles
- Review HR (90-160)
- Review RR (30-60)
- Pulse oximetry (60%-90%)
- Feel the head sutures and fontanelles for asymmetries
- Eyes: Red reflex, coloboma
- Ears: normally developed?
- Mouth: abnormalities? palpate top of mouth for cleft palate. Check babies suck
- Assess patency of nose if resp distress
- Neck: thyroglossal cyst?, Clavicular fractures
- Listen to heart and lungs
- Liver: normal to fell liver and kidneys
- Check for patient rectum
- Inspect genitalia
- Inspect hip stability, spine, fingers, and toes
- Neuro exam: overall tone (should be balled up), check suck, rooting reflex, grasp reflex, moro reflex, deep tendon reflexes
83
What is a coloboma?
When the pupil isn't contained roundly but leaks into the iris
Can be genetic, environmental, result of pregnancy problems like alcohol intake
Associated with CHARGE syndrome
84
What is CHARGE syndrome?
Coloboma
Heart defects
Atresia choanae (also known as choanal atresia)
Growth retardation
Genital abnormalities
Ear abnormalities
70% survive to age 5
85
What is the moro reflex?
Suddenly lower infant and the arms will come up and spread and shake and come back in again
If there is asymmetry, can indicate nerve damage
85
What is a rooting reflex in babies?
Involuntary muscle response to stimulation of their mouth
If you stroke the mouth, the baby will follow the sensation
