Paeds revision Flashcards
1
Q
what can cause physiological jaundice
A
Increased RBC breakdown:
- Increased RBC in uterus to increase oxygen delivery to fetus
- RBC no longer needed so breaks down
Immature liver
2
Q
causes of pathological jaundice (if <24 hours - always pathological)
A
Haemolytic disease:
- ABO incompatibility
- Rhesus disease of newborn
- G6PD deficiency
- Spherycytosis
3
Q
how can ABO incompatibility cause jaundice
A
Mom is O and fetus is A,B, or AB
Blood type A,B, or AB all carry antigens not present in O
Unlike antibodies formed against Rh factor, these antibodies are IgM and do not cross the placenta
Infant is not born anemic, as in Rh sensitized infant
Blood and antibodies are exchanged during delivery of placenta
Destruction of RBCs may occur after delivery for up to 2 weeks of age
Less severe
4
Q
4 causes of prolonged jaundice (>14 days)
A
Jaundice >14 days
- Infection
- Metabolic: Hypothyroid, hypopituitarism, galactosaemia
- Breast milk jaundice (resolves by 1.5-4 months)
- Biliary atresia
5
Q
what does a diabetic mother increase the risk of
A
neonatal jaundice
6
Q
when can a transcutaneous bilirinometer be used
A
in neonates >35 weeks gestation and >24 hours old
if level under 250umol/L and not had treatment
7
Q
investigations for neonatal jaundice
A
- serum bilirubin
- total and conjugated bilirubin
- Blood group of mother and baby + direct coombes test
- U&E’s
- Infection screen
- G6PD
- LFT’s
- TFT’s
8
Q
how often should bilirubin levels be measured during phototherapy
A
- Repeat 4-6 hours after starting to make sure not still rising
- 6-12 hourly once level is stable or reducing
9
Q
when his exchange transfusion indicated
A
Signs of acute bilirubin encephalopathy or threshold graphs
e.g. kernicterus
10
Q
at what level of serum bilirubin does neonatal jaundice occur from
A
> 100umol/L
50% neonates
11
Q
what is Kramer’s index
A
level of bilirubin needed for baby to appear jaundiced in that area
12
Q
what can kernicterus lead to
A
coreoathetoid palsy (type of cerebral palsy)
13
Q
what can cause conjugated jaundice in the first 24 hours of life
A
- neonatal hepatitis
- congenital infections: CMV, rubella, syphilis
14
Q
symptoms of mild HIE
A
- poor sucking
- irritability
- hyperalert
- mild hypotonia
15
Q
4 features of moderate HIE
A
- lethargy
- seizures
- abnormalities of tone
- need for NG feeding
16
Q
4 features of severe HIE
A
- coma
- prolonged seizures
- severe hypotonia
- failure to maintain spontaneous respiration
17
Q
management of HIE and when can it not be done
A
active cooling (33-35)
not if premature (36 weeks or below)
18
Q
criteria used for active cooling in HIE
A
TOBY criteria: Criteria A: - Apgar <5 at 10 mins - Cord blood pH <7 - Base deficit =16
Criteria B:
- Altered consciousness
- Abnormal tone
- Abnormal primitive reflexes
Need criteria from A and B
19
Q
what is a stalk mark/ salmon patch also called
A
naevus simplex - most common form of birth mark
20
Q
what is port wine stain also called
A
naevus flammus - doesn’t go away, more noticeable with hormones
21
Q
what can port wine stain also be part of
A
webber’s syndrome - seizures, learning disorder, glaucoma
22
Q
how can strawberry naevi be treated if problematic
A
propanolol
23
Q
why must Mongolian spots be documented
A
look like bruises - come up in safe guarding
24
Q
what is acrocyanosis
A
bluish colour of hands and feet of the newborn - caused by poor peripheral circulation
25
common non-toxic rash in neonates
erythema toxicum:
- widespread pustular rash
- tends to get worse then improves
- appears within 72 hours
26
features of transient neonatal pustular melanosis
- Widespread pustules
- Presence of pigmented macules
- Present from birth
- Benign and idiopathic
27
where is cephalohaematoma located
beneath periosteum - does NOT cross suture lines
unlike subglial haematoma - does cross suture lines
28
what is G6PD deficiency
x-linked recessive disease that increases RBC sensitivity to oxidative stress- so increased breakdown leading to jaundice
29
what is hereditary spherocytosis
abnormality of RBC membrane = more likely to haemolyse = jaundice
30
when does respiratory distress syndrome usually occur (ground glass appearance on CXR)
those born before 28 weeks due to absence of lung surfactant
begins being produced around 24 weeks (from type II pneumocytes)
31
2 things making RDS more likely to occur at any gestation
- meconium liquor
| - diabetic mothers
32
3 complications of RDS
- pneumothorax
- bronchopulmonary dysplasia
- chronic lung disease
33
how is RDS managed
antenatal and neonatal steroids
respiratory support + administering surfactant
34
causes of symmetrical SGA
intrinsic cause: often in first trimester - either normal small or congenital infection/genetic condition
35
causes of asymmetrical SGA
extrinsic cause: placental, maternal HTN/ renal/cardiac disease, pre-eclampsia, maternal substance abuse
36
when does GORD tend to resolve
12 months
usually more severe in children with neurological disorders e.g. cerebral palsy
37
how is GORD managed in uncomplicated cases
- education and reassurance
- feed thickeners
- positioning 30 degrees after feeds
38
how is more severe GORD managed
- PPI or H2RA (Ranitidine)
- antacids or alginates
- reserved use of pro kinetics
- surgery: Nissen's
39
when does pyloric stenosis present
2-5th week of life - very rare after 12 weeks
40
definition of diarrhoea in infants and toddlers
>10kg/day of stool in an infant or toddler
persistent loose or watery stools 3+ times a day
41
definition of diarrhoea in an older child
>200g/kg/day
3+ times a day
42
how long must diarrhoea be present for it to be chronic
>4 weeks
43
investigations for persistent diarrhoea
- Stool sample and culture
- Faecal calprotectin
- Faecal elastase
- Bloods: U&E's, TFT's, LFT's, CRP, immunoglobulins, coeliac antibodies
- Faecal alpha 1 antitrypsin for protein losing enteropathy
- USS abdomen
- Endoscopy and biopsies
44
what is acute gastroenteritis
a clinical syndrome often defined by increased stool frequency (eg, ≥3 loose or watery stools in 24 hours or a number of loose/watery bowel movements that exceeds the child's usual number of daily bowel movements by two or more), with or without vomiting, fever, or abdominal pain
45
how is gastroenteritis managed
1. Fluid replacement to prevent dehydration
2. Zinc supplementation
3. Rota virus and measles vaccinations
4. Promotion of only breastfeeding and vitamin A supplementation
5. Encourage handwashing
46
how long do D&V usually last in gastroenteritis
1. Vomiting: usually lasts 1-2 days and stops within 4 days
| 2. Diarrhoea: usually lasts for 5-7 days and stops within 2 weeks
47
how would suspected coeliac disease be investigated
1. FBC, LFT's, TFT's, Ferritin
2. Immunoglobulins, coeliac's antibodies- tGA, EMA
3. Endoscopy & duodenal biopsy - if antibodies high and high suspicion
4. HLA DQ2/8 if trying to avoid biopsy
48
some rogue things to ask about in a paeds abdo history
- lightheadedness, fatigue, dizziness
- anxiety/depression in family
- separation anxiety
- social phobia
- bullying
49
what should be examined in an abdo pain exam
- abdo exam
- plot height and weight on growth chart
- clubbing
- anal signs
50
investigations into abdo pain
- urine dip
- bloods: FBC, glucose (DKA, diabetes), CRP, LFTs, TFTs
- coeliac antibodies
- abdo USS
51
how does UC tend to present (3)
- diarrhoea/ increased frequency
- colicky abdo pain
- bloody stool
52
4 extra-intestinal manifestations of UC
- uveitis
- pyoderma gangrenous
- erythema nodosum
- ankylosing spondylitis
53
4 main complications of UC
- fulminant colitis
- haemorrhage
- toxic megacolon
- colorectal cancer
54
5 main presentations of Crohn's disease
- pubertal delay
- abdo pain
- diarrhoea
- weight loss
- growth failure
55
extra-intestinal manifestations of Crohn's
- uveitis
- Erythema nodosum
- Perianal tags
- Arthralgia
- Fever, weight loss, lethargy
- Strictures
- Anal fistulas
- Cobblestone, patchy appearance
56
how can crohn's lead to masses
fibrotic thickenings of bowel wall + non-caseating granulomas
57
investigations for IBD
1. Blood tests (Anaemia), CRP, ESR
2. Stool tests: Faecal calprotectin + Faecal pathogens
3. Endoscopies, colonoscopy
4. Ultrasound, MRI, barium X-ray
58
how is crohn's managed
1. Nutritional therapy:
- Whole protein feed replacement
- Exclusion diets
2. 5-ASA and sulphalazine
3. Corticosteroids
4. Methotrexate
5. Infliximab
6. Surgery commonly needed
59
how is UC managed
depends on severity of the disease - Sulphasalzine - Corticosteroids - Antibiotics - Surgery - Azathioprine - Infliximab
60
associated symptoms to ask about in paeds MSK history
- rash
- fever
- weight loss
- night sweats
61
VITAMIN CD causes of MSK problems
- Vascular - haemophilia, haemangioma
- Infection - septic arthritis, osteomyelitis, reactive arthritis
- Trauma
- Autoimmune - JIA, IBD, lupus, HSP
- Metabolic
- Iatrogenic
- Neoplasia - leukaemia
- Congenital - CDH
- Degenerative - Perthes, SUFE
62
how is transient synovitis managed
- reassurance - improves within a week
- NSAIDs for pain
- safety net (SA) - i.e. come back if high temp, increasing pain, night pain, no weight bearing, other joints, goes on for 2+ weeks
63
when does Perthe's disease most commonly occur
avascular necrosis of femoral hear due to interruption of blood supply - M>F, ages 5-10
64
how is Perthe's disease investigated
- blood tests usually normal
- bilateral hip XR including frog position
- if still suspected MRI or bone scan
65
how is Perthe's disease managed
1. early disease with <50% of femoral head:
- Bed rest + traction
2. Late disease:
- Femoral head needs to be covered by acetabulum to reossify epiphysis
66
when do growing pains occur
at NIGHT (pain free in the day)
usually 3-5 year olds and 8-12 year old
67
management of growing pains
reassurance
massage and analgesia
stretching
safety netting
68
ARTHRITIS mnemonic for swollen joint differentials
```
A: acute septic arthritis
R: Reactive: to infection
T: Trauma + safeguarding
H: Haematological- Haemophilia, leukaemia
R: Rheumatological: juvenille idiopathic, Juvenille dermatomyositis, lupus
T: TB
I: Immunological: HSP
S: Sarcoidosis
```
69
when does JIA occur
>6 weeks in under 16 year olds
70
3 main types of JIA
1. Polyarthritis: affecting >4 joints
2. Oligoarthritis: affecting = 4 joints
3. Systemic: arthritis with fever and rash
71
extra-articular complication of JIA
anterior uveitis
72
investigations for JIA
1. Hb: anaemia of chronic disease possible
2. WCC: leucocytosis
3. Platelets: thrombocytosis
4. ESR: RAISED
5. CRP: normal or raised
ANA: negative or positive
6. RF: can be positive or negative
7. X-ray
73
1st and 2nd line medical managements of JIA
- 1st line = NSAIDs and intra-articular steroids
| - 2nd line = methotrexate
74
2 things to monitor in methotrexate use
- LFTs
| - FBC (for BM suppression)
75
what is benign joint hyper mobility syndrome also known as
EDS type 3
76
how can systemic juvenile arthritis present
- daily fever spikes (QUOTIDIAN)
- transient pink rash
- decreased appetite
77
how is systemic JIA managed
1. Systemic steroids- oral if possible, IV if severe
2. Steroid sparing meds: methotrexate
3. Biologics
4. Physiotherapy and OT input
78
CREAM for Kawasaki disease symptoms
- Conjunctivitis (bilateral, non-exudative)
- Rash (polymorphous non-vesicular)
- Edema (or erythema of hands and feet)
- Adenopathy (cervical, unilateral?)
- Mucosal involvement (erythema or fissures, strawberry tongue)
79
how is Kawasaki disease managed
- high dose IV immunoglobulin
- aspirin
- steroids???
- echo
80
pathophysiology of bronchiolitis
- IgE mediated reaction to virus (RSV)
- Increased mucus production and bronchiole oedema
- Leading to bronchiole constriction and hyperinflation of the chest + atelectasis
81
what can increase the risk of bronchiolitis
- preterm
- smoke exposure
- breast feeding <2 months (NB: bronchiolitis presents with problems feeding!)
82
when should urgent hospital admission for bronchiolitis be carried out
- Apnoea
- Child looks seriously unwell
- Severe respiratory distress: grunting, cyanosis, intercostal recession
- RR >70
- Oral intake <50%
- Oxygen sats below 92%
83
main causes of croup
parainfluenza
| RSF
84
how is a child with croup managed at home
1. Dexamethasone: 0.15mg/kg PO
2. Keep well hydrated
3. No need for antibiotics- viral infection, so reassure
4. symptoms resolve within 48 hours
5. Safety net: drowsy, off food and drink, lethargy, stridor, wheeze, getting very ill
6. Paracetamol and ibruprofen for symptom relief
85
treatment for croup in hospital
1. Dexamethasone 0.15mg/kg
2. Nebulised adrenaline
3. Keeping child calm
4. IV fluids +/- NG tube and feeding
5. Oxygen therapy
6. ENT and anaesthetist input
86
scoring system for croup
Westley scoring
87
first line antibiotic for bacterial pneumonia in 1-17 years
amoxicillin (clarithromycin if penicillin allergic)
doxycycline can be used from 12-17 years
88
1st choice Abx in severe pneumonia
co-amoxiclav
89
important risk factors to ask about in asthma history
- neonatal (pre-term birth)
- family history of atopy
- smoking in family
- pets
- poor housing
90
first 2 steps in asthma management in children under 5
1. Start PRN salbutamol with spacer
2. Add in ICS of 200-400mcg daily OR leukotriene receptor antagonist if cannot use corticosteroid
- Start at a low dose if possible of ICS
91
3rd step in asthma management in children under 5
1. Medications review
2. If taking ICS- add in LRA
3. If taking LRA- add in ICS 200-400mcg
step 4 = REFER
92
first 2 steps in asthma management in children aged 5-12
1. SABA as required with spacer
2. Add in ICS: 200-400mcg daily
- 200mcg is good starting dose
93
3rd step in asthma management in children aged 5-12
1. Add in a LABA
2. Assess response of LABA:
- If good response then continue
- If benefit but still not enough increased ICS to 400mcg
3. If no response to LABA:
- Stop and increase ICS to 400mcg daily
4. If control still not good:
- LRA or Theophylline
94
4th step in asthma management children aged 5-12
increase ICS to 800mcg per day
95
5th step in asthma management children aged 5-12
- daily steroid tablet at lowest dose
- keep ICS at 800mcg
- referral
96
things to counsel parents on in asthma management
- information and education
- avoiding triggers
- up to date with immunisations
- inhaler technique
97
what is red and amber flag pyrexia
red flag = 38 degrees in child <3 months
amber flag = 39 degrees in child 3-6 months
98
features of febrile convulsions
- can't prevent even with paracetamol
- generalised TC seizures
- unconscious and post-ictal
- 6 months - 6 eyars
99
3 risk factors for developing epilepsy relating to febrile convulsions
- atypical (still only 1%)
- abnormal neurology prior to event
- Fix of epilepsy
100
main criteria for Kawasaki's + 5 extra (must have 4/5)
1. Fever lasting >5 days
Presence of 4/5:
- Changes in extremitites: desquamation, erythema, oedema
- Rash
- Bilateral, non-purulent conjunctivitis
- Cervical lymphadenopathy
- Changes in lips/oropharnyx: cracked lips or red tongue
101
difference between petechiae, purpura and ecchymosis
```
petechiae = <2mm
purpura = 2-10mm
ecchymosis = >10mm
```
102
what is done in a neonatal/child sepsis screen
BUFALO:
- Blood cultures
- Urine sample
- CXR
- Lumbar puncture
- Viral nose swab
- FBC, CRP, U&E's, LFT's
- GLUCOSE
103
when should a lumbar puncture be considered
febrile under 1 and almost always under 6 months
104
3 main causes of meningitis in neonates
GBS
E. coli
Listeria
105
4 long term consequences of meningitis
- cerebral palsy
- deafness
- epilepsy
- coning and death
106
how much weight is a child expected to gain daily from 10 days - 6 months
30g/day
107
how to calculate expected weight of children from 1-10 years
2 x (age + 4)
108
normal head circumference at birth, 1 year and 2 years
birth = 35cm
1 year = 47cm
2 years = 49cm
109
how to work out milk requirement
after 5-7 days from birth:
- 150ml/kg daily
so if 5kg = 750ml daily
110
how is calorie needs daily worked out in <1 years
110kcal/kg day
so if 5kg = 550 calories
111
how is calorie needs daily worked out in >1 years
1000 + (100 x age)
so 8 years old 1800 calories
112
what is overweight and obesity classed
overweight >91st centile
| obese >98th centile
113
which screening procedures are done at birth, 1 week and 8 weeks
- birth = eyes, heart, hips, hearing
- 1 week = Guthrie - PKu, hypothyroidism, CF, haemoglobinopathies, acylcarnitine
- 8 weeks = general exam by GP
114
at what age are children dry by day and dry at night
- day = 2-3 years
| - night = 4-5 years
115
at what age is encopresis abnormal
over 4 years
116
when should a newborn micturate, pass meconium and regain any lost birthweight
- micturition and meconium in first 48 hours
| - regain any lost birthweight by day 10 (more than 10% is abnormal)
117
Which airway position is used for:
a) . Infants (<1 year)
b) . Children 1-6
c) . Children 6-12 upwards
a) . Neonates/infants: neutral
b) . Children: sniffing morning air
c) . Older children: Head-tilt-chin-lift
118
3 Es of assessing breathing
- Effort: signs of respiratory distress
- Efficacy: sats, chest expansion, CO2 levels
- Effects: HR, RR, consciousness, skin mottling, cyanosis
119
3 pre-terminal breathing signs
- silent chest
- cyanosis
- O2 <85% on air
120
fluid bolus in children
20ml/kg of 0.9% saline and assess response
121
how is disability responded to
1. Protect airway
2. GCS <8 then ET tube- call anaesthetist
3. Recovery position if vomiting
4. Give IM glucose if is less than 4mmol/L
5. Seizures = benzo's
122
what is assessed in exposure
1. Temperature
2. Expose with dignity:
- Rashes
- Cuts, bruises, trauma
- Signs of seizure activity
3. Full hx and exam
4. PMH and drug chart
5. Investigation results
123
when would a child need to be referred for a murmur
- symptomatic: SOB, cyanosis, failure to thrive, problems feeding, chest pain
- diastolic murmur
- louder when standing
- louder than grade 2
124
3 pan systolic murmurs
1. Mitral regurgitation
- Loudest at 5th intercostal, mid-clavicular
2. Tricuspid regurgitation:
- Loudest at 5th intercostal, left sternal edge
3. Ventricular septal defect
125
3 ejection systolic murmurs
1. Aortic stenosis:
- Loudest at 2nd intercostal, right sternal edge
2. Pulmonary stenosis:
- Loudest at 2nd intercostal, left sternal edge
3. Hypertrophic, obstructive cardiomyopathy
126
3 causes of mid diastolic murmurs
- mitral stenosis
- ASD
- tricuspid stenosis
127
cause of early diastolic murmur
aortic regurgitation
128
what causes a constant murmur
PDA
129
what is Still's murmur
early systolic grade 1-3 murmur best heard supine at the apex of the heart and has a vibratory musical quality
130
what is examined in the NIPE
1. Weight, length, HC
2. Hips: Barlow's + Ortoloni's
3. Testes
4. Eyes
5. Heart + pulses & color
6. everything else: fontanelle, spine, abdomen, urinary, meconium passage
131
when to refer for bilateral vs unilateral undescended testes
- bilateral = more concerning so refer early
| - unilateral = refer in 4-6 weeks
132
which 9 conditions are screened for via heel prick
1. Hypothyroidism
2. CF
3. Sickle cell
4. Phenylketonuria
5. Homocysteinuria
6. Maple syrup urine disease
7. Medium chain acyl- coA
8. Isovaleric acidaemia
9. Gltaric aciduria type 1
133
how are inguinal hernias treated
- reduction with opiates
| - if doesn't work/risk of strangulation = surgery
134
where is a hydrocele located
within the tunica vaginalis
135
what causes a hydrocele
incomplete closure of processus vaginalis = too small for bowel contents but peritoneal fluid enters
136
management of hydrocele
usually resolve by 18-24 months after this consider surgery
137
management of umbilical hernia
- 96% close spontaneously by 3 months
- if not closed by 3-5 months = unlikely to close by themselves
- repaired before school for cosmetic reasons
138
3 investigations for undescended testes
- USS
- hCG injection to check to see if they're testes - should release testosterone
- laparoscopy if unsure
139
3 risks of undescended testes
- infertility
- testicular cancer
- torsion
140
what is phimosis
inability to retract foreskin - physiological at birth
pathological - white scarring of foreskin, often over 5 years
141
when is it uncommon to have appendicitis
under age of 3 - think of something else
142
how is appendicitis treated
NPO + IV hydration, analgesia, antiemetics, and antibiotics with anaerobic and gram (-) coverage
Laproscopic appendectomy is definitive. Exploratory surgery if no appendix found.
In perforation, antibiotics until afebrile with a normalized WBC count. Should be closed by delayed primary closure.
In abscess formation, broad spec antibiotics and percutaneous drainage. Appendectomy 6-8 weeks later
Trials of just abx
143
where is intussusception most common
near ileo-caecal valve
144
2 causes of intussusception
- viruses: enlarged peers patches
| - polyps
145
intussusception presentation
- bilious vomiting
- paroxysmal colicky pain - may bring knees to chest and arch back
- pallor
- refusal to feed
- sausage shaped mass
- redcurrant jelly stool (late)
- shock (perforation?)
146
how is intussusception managed
- no peritonitis = gas inflation reduction by radiologist
| - peritonitis = operative reduction
147
what to ask in an obstruction history
past history of surgery (adhesions causing obstruction?)
148
what is bell-clapper deformity
testes not anchored to scrotum - increases risk torsion
149
how is pyloric stenosis diagnosed
- test feed
| - abdominal USS
150
biggest risk factor for NEC
prematurity
151
AXR finding for NEC
pneumatosis intestinalis (intramural bowel gas)
152
how is NEC managed
- NBM and TPN
- broad spec antibiotics
- artificial ventilation and cardiac support
- perforation needs laparotomy
153
what is oesophageal atresia associated with in 80% of cases
tracheo-oesophageal fistula
154
what is TOF and OA associated with (VATERL)
Vertebral
Anorectal
Tracheo-oEsophageal
Radial Limb deformities
155
what is malrotation
abnormal rotation around superior mesenteric artery during embryonic development - often causes volvulus (usually 1st month of life)
156
difference between exomphalos and gastroschisis
- exomphalos = umbilical hernia at birth where some abdo organs are pushed into umbilical cord - detected via USS at 18 weeks, 50% risk chromosomal abnormality
- gastroschisis = extrusion of abdo contents through abdo folds not covered by peritoneum - lateral to umbilicus
157
signs of CDH
- Problems with resuscitation/early breathing
- Displaced apex beat
- Lack of bowel sounds in abdomen
- Poor air entry in chest
158
main problem with CDH
pulmonary hypoplasia in utero = high mortality
159
2 main types of CDH
1. Bochadlek hernia: postero-lateral- most common
| 2. Morgagni: anteromedial
160
management of CDH
do NOT BVM
intubation and ventilation, correction of acidosis and hypercapnia and surgery
161
growth plate - what is it stimulated and inhibited by
the area just below the head of a long bone in which growth in bone length occurs; the epiphyseal plate
Stimulated by: Growth hormones, IGF-I, thyroid hormones, Oestrogen, PTH
Inhibited by: Cytokine, certain drugs, high dose steroids/oestrogen
162
how much growth per year is there in pre-pubescent children
3-4cm
163
how accurate is mid parental centile
4/5 have adult height within +/- 6cm of predicted adult height
164
how is bone age measured
X ray of left hand
- gaps seen where there is no epiphysis
- age 5 = start to see epiphysis
- age 15 = epiphysis seals (growth stops)
165
stature in Turner's syndrome (45XO)
short
166
endocrine causes of short stature
- Hypothyroidism
- Pseudohypoparathyroidism
- Growth hormone deficiency
- Delayed/precocious puberty
- Cushing's disease: ACTH secreting pituitary adenoma
- Cushing's syndrome- often iatrogenic, such as steroids
- Anything which affects puberty
167
when does growth hormone deficiency present
1-2 years - often becomes evident only after age 3
168
pathological vs nutritional obesity
```
pathological = short and fat
nutritional = tall and fat
```
169
pathological cause of obesity
Cushing's disease - increased cortisol = weight gain
but higher steroids = growth inhibition of epiphyses
170
where are androgens produced
adrenal gland
171
Tanner staging of puberty in girls
Tanner stages:
1. Stage 1:
- No signs of puberty
2. Stages 2-3:
- Any breast enlargement/pubic or axilla hair
3. Stages 4-5:
- Started periods with signs of pubertal features
172
Tanner staging of puberty in boys
1. Stage 1:
- High voice only + no signs
2. Stages 2-3
- Any of deepening of voice, Early pubic/axilla hair, Testicular/penile enlargment
3. Stages 4-5:
- Any of: voice broken, facial hair, adult size penis, pubic and axilla hair
173
what is used to assess testicular volume
prader orchidometer
174
what is central precocious puberty
Concordant:
Premature activation of puberty axis:
- Puberty happening in the right order, often idiopathic or CNS disorder
- In boys is often pathological: brain tumour
- In girls: idiopathic, non pathological
175
what is peripheral precocious puberty
Pseudo pre puberty where the release of sex hormones is independent of GnRH release
- Not happening in the right order
- Discordant
- Such as hair but no testicular enlargment
176
what is virilization
the development of male physical characteristics (such as muscle bulk, body hair, and deep voice) in a female or precociously in a boy, typically as a result of excess androgen production.
- Due to increased adrenal androgen secretion
177
investigations for precocious puberty
- Bone age (would usually be increased)
- TFT's (overactive can cause early puberty)
- Oestridiol, testosterone
- Pituitary function tests
- Scan of adrenals and pelvis
- MRI
178
delayed puberty in girls vs boys
girls = no signs by age 13, no menarche after 15
boys = no signs by age 14 (v common)
179
5 causes of hypogonadotrophin hypogonadism (pituitary)
- Constitutional delay
- Kalman's syndrome
- BMI <17
- Chronic disease
- Tumours
180
3 causes of hypergonadotrophin hypogonadism - problem with testes or ovaries/adrenals = GnRH/LH or FSH v high
- Turner's syndrome
- Kleinfelter's syndrome
- cryptorchidism
181
signs and symptoms of Turner's syndrome
- Can have differing BP's in each arm + absent radial pulses (coarctation of aorta)
- Horseshoe kidney
- Webbing of neck
- Low hair line
- Short stature
182
how is Turner's managed
oestrogen - maintain bone health
183
primary vs secondary bed wetting (nocturnal enuresis = 2+ times a week)
primary = no period of dry nights for at least 6 months
secondary = bedwetting after prior dryness for at least 6 months
184
4 differentials for nocturnal enuresis
- UTI
- constipation
- neurological, spina bifida
- diabetes
185
short term treatment for nocturnal enuresis (e.g. for sleepovers, school trips)
desmopressin - take 1-2 hours before bed
186
1st and 2nd line long term managements for nocturnal enuresis
1. enuresis alarm (buzzer goes off when wet)
| 2. antimuscarinic - oxybutanin OR TCA - imipipramine
187
which laxatives are used for constipation
firstly- Osmotic softeners:
1. Laxido/MOvical 1-4 daily
2. Lactulose: 5-10ml BD
secondly:
1. Senokot for 6-12 years
2. Sodium picosulphate for 4-10 years
188
5 gross motor red flags
- asymmetrical neonatal reflexes
- persistent neonatal reflexes
- not weight bearing by 12 months
- exclusive toe walking
- not walking by 18 months
189
3 fine motor red flags
- fixed squint
- not fixing and following by 6 weeks
- hand preference before 18 months
190
4 social/speech and language red flags
- no smile by 6 weeks
- no babbling by 12 months
- no words or doesn't understand commands by 18 months
- unintelligible speech by 2.5 years
191
pathognomonic sign of DMD
Gower's sign - compensating for weak pelvic muscles = uses hands and knees to stand then pushes down on thighs
toe walking also common
might also have calf muscle hypertrophy
192
some differentials for speech delay
- Bilingual household
- Hearing problem
- Tongue tie, cleft palate
- ASD
- NEGLECT
193
4 motor cerebral palsy's
1. Spastic: most common, with increased tone
- Motor cortex damaged
2. Athetoid: writhing, uncontrolled movements
- Basal ganglia damaged
3. Ataxic: cerebellar signs- balance, shaking and positioning
- Cerebellar damage
4. Mixed
194
GMFCS 1
Child very mildly affected:
- Can walk
- Up stairs with railing
- Balance, speed and coordination reduced
195
GMFCS 2
- Walk in most settings, difficulty with long distances and uneven terrain
- Use of railings on stairs
- May use mobility aids, wheels over long distance
- Difficulty walking and running
196
GMFCS 3
- Hand-held mobility aid indoors
- Wheelchair long distance
- Stairs with assistance and supervision
197
GMFCS 4
- Powered motor assistance or physical assistance from others (pushed on wheelchair)
- May walk supported shortly at home
198
GMFCS 5
- Wheelchair in all situations- powered
| - May need straps due to lack of posture
199
prenatal causes of CP
- Abnormal cerebral development: chromosomal, maternal infection
- Periventricular leukomalacia: prematurity, maternal infection:
- Intraventricular haemorrhage
- Stroke
200
intra-partum / postnatal causes of cerebral palsy
- Birth asphyxia
- CNS infection
- hypoglycaemia
- Head injury
- Stroke
- Hyperbilirubinaemia
201
how does CP present
- Motor delay
- Abnormal posture
- Abnormal movements
- Spascity
- Epilepsy
- Feeding and nutritional problems
- Bladder infections & incontinence
- Constipation
202
nutritional and feeding problems in CP
- coordination of suck and swallow
| - spasticity: uses more energy so tend to need more calories per day
203
what can be used to manage spasticity with CP
- baclofen
- selective botox injection s
- orthopaedics
204
shaken baby triad
- retinal haemorrhage
- subdural haematoma
- encephalopathy
205
4 signs of TOF
- cyanosis
- right to left shunt
- ejection systolic murmur - pulmonary stenosis
- boot shaped heart
206
how is Perthe's disease managed before age 6
conservatively - most resolve on their own
if over 6 or severe deformity then do surgical reduction
207
how common is GORD
40% infants often in first 2 weeks of life
208
why does GOR/GORD happen
Baby's have an immature LOS so can easily reflux up feed
- Also have a shorter oesophagus under diaphragm (more in thorax) so reflux more common
- Stomach is also very small
209
most common cause of GORD
over feeding >150ml/kg/day - therefore first line management is to reduce feed quantity and position at 30 degrees during feeding
210
what does cerebral palsy increase the risk of
GORD
211
when does GORD usually resolve by
12 months
212
2nd and 3rd line and 4th line managements for GORD
2nd line = feed thickener
3rd line = 2 weeks of alginates (e.g. Gaviscon)
4th line = PPI or H2RA - referral to paediatrics
213
when is there an exception to the 20ml/kg fluid bolus in paediatrics
10ml/kg in:
- DKA
- cardiac pathology
- trauma
214
estimated weight calculated in 0-12 month olds
(0.5 x age in months) + 4
215
estimated weight calculated in 1-5 year olds
(2 x age) + 8
216
estimated weight calculated in 6-12 year olds
(3 x age) + 7
217
what imaging technique for pyloric stenosis
USS - shows thickened pylorus
218
what investigation for GORD
pH study
219
what is double bubble sign for
duodenal atresia
220
how is intussusception treated
air enema reduction
221
2 investigations for appendicitis
- AXR: showing appendicolith
| - USS: non-compressive blind ending structure >6mm
222
what's used for ovarian cyst imaging
USSL then repeat at 6 weeks to see if it has resolved
whirlpool sign on USS
223
what is round pneumonia
type of pneumonia only seen in children
224
what is seen on CXR of foreign body
- hyperinflated lung in partial obstruction - radiolucent
| - OR in complete obstruction = lung collapse
