Background Flashcards
Infective ddx sore throat
Life threatening (ACTED)
- Abscess
- > usually polymicrobial (Group A strep, s. aureus)
- Candidiasis
- > indicative of immunosuppression
- Thrombophlebitis jugular
- > complication of pharyngitis
- > associated with septic PE
- Epiglottis
- > usually h. influenza in unvaccinated child
- Diphtheria
- > in unvaccinated child
Non life threatening (SIPS AHCE)
- sexually transmitted (rare/abuse/sexually active)
- > gonorrhoea
- > HIV
- influenza and parainfluenza viruses (common)
- pyogenes (common)
- strep species (Group C/G)
- > presents like GAS
- adenovirus (pharyngoconjunctival fever)
- herpetic stomatitis
- coxsachie A virus (hand, foot and mouth/herpangina)
- EBV (infectious mononucleosis)
Complications strep pharyngitis
GRASP FATSO
- Glomerulonephritis
- > immune complex disease
- > complement activation/inflammation
- > light microscopy = proliferative glomerulonephritis
- > IF = granular IgG and C3 deposition (starry sky)
- > electron microscopy = sub epithelial humps
- > clinically = asymptomatic to nephritic syndrome
- Rheumatic fever
- > latent period of approx 3 weeks
- Arthritis
- > less responsive to NSAIDs than polyarthritis
- > less association with carditis than polyarthritis
- Scarlet fever
- > scarlatiniform rash/strawberry tongue/circumoral pallor
- > delayed hypersensitivity to strep exotoxin
- PANDAS
- > paediatric autoimmune neuropsychiatric disorder associated with group A strep
- > controversial existence/autoimmune basis
- > temporal association with tic disorder/OCD
- Fasciitis
- > usually with predisposing trauma
- > due to haematogenous spread
- > spreads along fascia plane (poor blood supply)
- > abrupt pain/erythema/bullae/systemically unwell
- Abscess
- > usually polymicrobial, including GAS
- Toxic shock syndrome
- > rare complication of shock with multi-organ failure
- > due to inflam cytokines and increased cap permeability
- Sinusitis
- > common complication
- Otitis media
- common complication
HFM/Herpangina background
Epidemiology
- both under school age
- can occur in endemics
Aetiology
- virology
- > multiple serotypes of enterovirus species
- > most common enterovirus species is enterovirus A
- > most common group is coxsackie A and enterovirus
Pathophys
- transmission
- > oral ingestion
- > predominately faecal or oral secretions
- > some serotypes from vesicle or respiratory secretions
- > contaminated food, water and fomites
- > shed in stool for several months
- > shed from oropharynx for weeks
Overview bloodspot screening diseases
Harry Potter MAGIC
hypothyroidism (primary congenital)
- epidemiology
- > 40 births/yr in NSW
- aetiology
- > dysgenesis (absence/abnormal thyroid gland)
- pathophys
- > growth retardation
- > intellectual disability
- management
- > daily thyroxine
phenylketonuria (PKU)
- epidemiology
- > 10 births/yr in NSW
- aetiology
- > recessively inherited
- > deficiency in phenylalanine hydroxylase
- pathophys
- > cannot break down amino acid phenylalanine
- > severe intellectual disability
- management
- > low protein diet
medium chain acylCoa dehydrogenase deficiency
- epidemiology
- > 6 births/yr in NSW
- aetiology
- > inability to break down fat
- pathophys
- > coma and liver failure when seriously ill or fasted
- > results in intellectual disability or death
- management
- > avoid fasting
- > IV glucose when unwell
adrenal hyperplasia (congenital)
- epidemiology
- > 6 births/yr in NSW
- aetiology
- > genetic defect
- > deficient in enzyme involved in cortisol biosynthesis
- pathophys
- > low cortisol
- > increased ACTH
- > adrenal gland hyperplasia
- > high androgens and mineralocorticoids
- > disordered regulation of metabolism, salt, response to infection, sex characteristics
- management
- > hormone replacement
- > salt supplementation
galactocaemia
- epidemiology
- > 3 births/yr in NSW
- aetiology
- > deficiency in Gal-1-PUT
- pathophys
- > build up in galactose in blood
- > liver failure and sepsis (potentially lethal)
- > cirrhosis, renal tubular acidosis, cataracts, ID
- management
- > low galactose diet
inborn errors of metabolism (other rare)
-collectively account for approximately 20 births/year in NSW
cystic fibrosis
Neonatal sepsis background
Epidemiology
- incidence increases with decreasing GA
- Risk factors
- > maternal GBS infection
- > chorioamnionitis
- > intrapartum maternal temp >38
- > premature
- > membrane rupture >18hrs
- > metabolic disturbance (reduces immune function)
Aetiology
- > GBS
- > E. coli
- > S. aureus (late onset sepsis)
- > coagulase negative staph (premature infants)
- > listeria monocytogenes (rare)
- > herpes
Pathogenesis
- vertical transmission (early onset)
- > maternal genital tract
- > contaminated amniotic fluid
- horizontal transmission (late onset)
- > contact with care provider and environment
- > forceps and electrodes
- > disruption of skin/mucosa (eg. canula)
Complications of prematurity
Mortality and morbidity rates increase with decreasing GA and birth weight
Short-Term =GRINCHES
- glucose
- respiratory
- > RDS
- > apnea of prematurity
- intraventricular haemorrhage
- NEC
- cardiovascular
- > PDA
- > BP
- hypothermia
- eyes (retinopathy of prematurity)
- sepsis
Medium-Term (infancy/early childhood) = BANGERS
- bronchopulmonary dysplasia
- abuse
- neurodevelopmental
- > developmental delay
- > cognitive and social impairment
- > psychiatric illness
- > cerebral palsy
- growth impairment
- enteritis
- respiratory infections
- SIDS
Long-term = KIILO
- kidney disease
- insulin resistance
- IHD
- lung disease (chronic of prematurity)
- obesity
RDS background
Epidemiology
- over 90% of incidences RDS occur in extreme pre-term
- still significant risk for late pre-term
Aetiology
- Immature lungs
- Low quantity/quality surfactant
Pathophys
- Low quantity/quality surfactant
- > atelectasis
- > decreased compliance/ventilation
- Pulmonary oedema and inflammation due to
- > airway damage due to high pressures
- > low eNAC expression = reduces alveolar fluid clearance
- Pulmonary oedema
- > worsens compliance/ventilation
- Inflammation
- > inactivates surfactant
- Shunting
- > atelectasis/vasoconstriction = high pulmonary pressures
- > right to left shunting across FO/DA
- Hypoxaemia
- > due to poor ventilation/shunting
DDx constipation
Functional is most common
- > ADHD
- > ASD
Medical
- > coeliac
- > hypothyroid
- > diabetes
- > spinal cord pathology
- > hypercalcaemia
- > excessive cow milk
- Surgical
- > hirschprungs
- > meconium ileus
- > ano-rectal anomaly
Bronchiolitis background
Epidemiology
- 1 in 30 under
- only occurs in 0-1yr old
Aetiology
- RSV (majority)
- Rhino
- Influenza
- Coronavirus
Pathophys
- Begins as URTI
- > spreads to lower respiratory tract over 1-3 days
- Infection of small airway
- > inflammation
- > oedema
- > mucus secretion
- Outcome
- > obstruction
- > hyperinflation
- > wheezing
- > atelectasis
DDx wheezing child
Bronchiolitis (if <1yr old) Viral pneumonitis (if >1yr old) Asthma (if >1 yr old) Viral induced wheeze (if <6yrs old) Foreign body aspiration Mediastinal mass CCHD Pneumothorax Pneumonia Anxiety
1-12 months developmental milestones
6-8 weeks GM: supports head FM: tracks with eyes past midline LH: orients eyes to sounds, coos S: smiles
6 months
GM: sit with support, rolling
FM: transfers, hand to mouth, grasping
LH: head to sound, responds to name, different sounds on need
S: interested in people, recognises familiar faces
9 months
GM: crawls, stands with support, pulls to stand
FM: pincer grip
LH: understands no, babbling
S: stranger anxiety, favourite toy, peek a boo
12 months
GM: walks with support, cruises
FM: points, bangs objects together, should not prefer one hand
LH: mumma, dadda
S: waves, preference for caregiver, using objects
18 months - 5 years developmental milestones
18 months GM: runs, throws FM: scribbles vertically, handedness LH: six words, can point to some body parts S: uses spoon and cup, points to items
2 years
GM: stairs, kicks ball
FM: scribbles horizontally
LH: two word sentence, follow simple command
S: helps in dressing, parallel play, interest in children
3 years
GM: jumps, catches ball
FM: draws circle, use scissors
LH: 3 word sentences, name, age and sex, some colours
S: dresses with supervision, interactive play, makes friends
4 years GM: hopping FM: draws square LH: 4 word sentences, asks why and how S: imaginative play, toilet trained, dresses self
5 years GM: skips FM: draws triangle LH: 5 word sentence, fluent speech, tells stories S: understands rules, sense of humour
DDx stridor
Supraglottic
- Epiglotitis
- Foreign body
- Tonsilar enlargement
- Retropharyngeal abscess
Glottic
- Anaphylaxis
- Croup
- Laryngospasm
- Diptheria
Infraglottic
- Bacterial tracheitis
- Tracheomalacia
- Foreign body
- Vascular rings
- Tumour
Croup background
Epidemiology
-6 months to 6 years old
Aetiology
- RSV most common
- Other
- > influenza
- > parainfluenza
- > coronavirus
Pathophys
- Laryngotracheobronchitis
- > upper airway inflammation
- > obstruction
Whooping cough background
Epidemiology
- Highest incidence <6 months
- > decreases with age
Aetiology
- Organism
- > bordetella pertussis
- > occasionally bordetella parapertussis
- Transmission
- > aerosol droplets
- > highly infectious
- > 80% household contacts develop clinical illness
- > infectious just before and for 3 weeks post cough
- Vaccination
- > illness still occurs but generally less severe
Pathophys
- Catarrhal stage
- > 1-2 weeks
- Paroxysmal stage
- > approx 6 weeks
- Convalescent stage
- > 2-3 weeks
Gastroenteritis background
Epidemiology
-occurs in almost all children <5years
Aetiology
- Viral (over 75%)
- > rotavirus most common
- > astrovirus
- > adenovirus
- > norovirus
Pathophys
- Transmission
- > faecal-oral
- > rotavirus may spread by respiratory droplets
Gastroenteritis DDx
Infective
- Viral
- Bacterial
- > e coli
- > salmonella
- > campylobacter
- > shigella
- > vibrio cholera
- > staph aureus
- Protozoal
- > giardia
- > entamoeba histolytica
Antibiotic
- Adverse effect
- Pseudomembranous colitis
- > c difficile
Intussecpition
Appendicitis
Coeliac
Cystic fibrosis
Inflammatory
- Crohns
- UC
UTI
Sepsis
Hypoglycaemic ketosis
Intussusception background
Epidemiology
-75% of incidence before 12 months
Aetiology
- Idiopathic
- > previous viral infection
- > hyperplasia of peyers patches/lymphoid tissue
- Pathological
- > tumours
- > polyps
- > meckels
- > HSP
Pathophys
- Telescoping
- > lead point moves into distal bowel lumen
- Regions
- > ileocolic most common
- > ileoileo
- > colocolonic
- Outcome
- > mesentery dragged in = venous congestion
- > ischaemia/necrosis/perforation
- > obstruction
