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Child Health Flashcards

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USMLE® Step 1 flashcards
1
Q

Haemorrhagic disease of the newborn

A

Bleeding problem that occurs in a baby during the first few days of life.

Babies are normally born with low levels of vitamin K, an essential factor in blood clotting.

A deficiency in vitamin K is the main cause of hemorrhagic disease in newborn babies.

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2
Q

Haemorrhagic disease of the newborn Mx

A

Vitamin K: IM or oral

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3
Q

hypoxic ischaemic encephalopathy

A

Brain injury caused by oxygen deprivation to the brain, also commonly known as intrapartum asphyxia.

Hypoxia (lack of oxygen), ischaemia (restriction of blood flow to brain) and encephalopathy (malfunctioning of the brain)

The newborn’s body can compensate for brief periods of depleted oxygen, but if the asphyxia lasts too long, brain tissue is destroyed. Leads to cerebral palsy and multisystem organ damage

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4
Q

hypoxic ischaemic encephalopathy signs/symptoms

A

events that could lead to hypoxia during the perinatal or intrapartum period

acidosis (pH < 7) on the umbilical artery blood gas

features of mild, moderate or severe HIE (see below) or evidence of multi organ failure.

Poor Apgar scores – active resuscitation required

Neurodevelopmental sequalae

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5
Q

hypoxic ischaemic encephalopathy causes

A
  • Maternal shock
  • Intrapartum haemorrhage
  • Prolapsed cord, causing compression of the cord during birth
  • Nuchal cord, where the cord is wrapped around the neck of the baby
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6
Q

hypoxic ischaemic encephalopathy Mx

A

active resuscitation required: ongoing optimal ventilation, circulatory support, nutrition, acid base balance
• monitoring and treatment of seizures
• therapeutic hypothermia: protect brain from hypoxic injury (reduce inflammation and neurone loss)

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7
Q

Neonatal Jaundice: physiological jaundice

A

exaggerated with prematurity and immature liver – increased risk of kernicterus

  • Fetal red blood cells break down more rapidly than normal red blood cells, releasing lots of bilirubin.
  • Normally this bilirubin is excreted via the placenta, however at birth the foetus no longer has access to a placenta to excrete bilirubin. Additionally liver systems have not fully matured
  • This leads to a normal rise in bilirubin shortly after birth, causing a mild yellowing of skin and sclera from 2 – 7 days of age.
  • This usually resolves completely by 10 days.
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8
Q

Neonatal Jaundice: Increased production of bilirubin

A
  • Haemolytic disease of the newborn
  • ABO incompatibility
  • Haemorrhage including Intraventricular haemorrhage
  • Cephalo-haematoma (scalp and the skull)
  • Polycythaemia
  • Sepsis and (DIC)
  • G6PD deficiency
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9
Q

Neonatal Jaundice: Decreased clearance of bilirubin:

A
  • Prematurity
  • Breast milk jaundice
  • Neonatal cholestasis
  • Extrahepatic biliary atresia
  • Endocrine disorders (hypothyroid and hypopituitary)
  • Gilbert syndrome
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10
Q

Jaundice in first 24 hours?

A

first 24 hours of life is pathological. This needs urgent investigations and management. Neonatal sepsis is a common cause. Babies with jaundice within 24 hours of birth need treatment for sepsis if they have any other clinical features or risk factors.

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11
Q

Breast milk Jaundice why?

A

Components of breast milk inhibit the ability of the liver to process the bilirubin. Breastfed babies are more likely to become dehydrated if not feeding adequately.

Inadequate breastfeeding may lead to slow passage of stools, increasing absorption of bilirubin in the intestines.

Keep on breastfeeding – just extra support

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12
Q

Prolonged Jaundice

A
  • More than 14 days in full term babies
  • More than 21 days in premature babies
  • biliary atresia, hypothyrodisim and G6PD deficiency common causes
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13
Q

Neonatal Jaundice Ix

A

FBC & blood film for polycythaemia or anaemia
- Conjugated bilirubin: elevated levels indicate a hepatobiliary cause
- mother and baby for ABO or rhesus incompatibility
• Direct Coombs Test (direct antiglobulin test) for haemolysis
• Thyroid function, particularly for hypothyroid
• Blood and urine cultures if infection is suspected.
• Glucose-6-phosphate-dehydrogenase (G6PD) levels for G6PD deficiency

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14
Q

Neonatal Jaundice Mx

A

Phototherapy

Exchange transfusion

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15
Q

Hypothermia - which babies at risk?

A

Small for dates / Preterm
o Low stores of brown fat
o Little subcutaneous fat
o Larger surface area: vol

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16
Q

Hypothermia Mx

A 
Dry
Hat 
Skin to skin 
blanket 
Heated mattress 
incubator
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17
Q

Intraventricular Hemorrhage

A

bleeding into the brain’s ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space.

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18
Q

Intraventricular Hemorrhage classification grades

A

Grade 1 and 2 : Neurodevelopmental delay up to 20% and Mortality 10%

Grade 3 and 4: Neurodevelopmental delay up to 80% and Mortality 50%

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19
Q

Necrotizing enterocolitis (NEC)

A

Disorder affecting premature neonates, where part of the bowel becomes necrotic. Usually affects babies in the first week of life. It is a life-threatening emergency.
• Death of the bowel tissue can lead to bowel perforation.
• Bowel perforation leads to peritonitis and shock.

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20
Q

Risk factors for NEC

A
  • Very low birth weight or very premature
  • Formula feeds (it is less common in babies fed by breast milk feeds)
  • Respiratory distress and assisted ventilation
  • Sepsis
  • Patient ductus arteriosus and other congenital heart disease
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21
Q

NEC signs/symptoms

A

Intolerance to feeds/poor feeding

Vomiting, particularly with green bile
• Generally unwell – decreased activity 
• Distended, tender abdomen
• Absent bowel sounds
• Blood in stools
• Perforation leading to peritonitis and shock
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22
Q

NEC Ix

A 
FBC - thrombocytopenia, neutropenia, CRP and blood cultures 
- Cap blood gas: metabolic acidosis 
- stool cultures 
- AXR: Pneumatosis 
intestinalis 
 & Pneumoperitoneum
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23
Q

NEC Mx

A
  • stop feeding orally
  • PN with IV fluids and broad spectrum antibiotics
    NG tube - drain fluid and gas
    Surgery - remove dead tissue and temp stoma
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24
Q

Tetralogy of Fallot

A

Four defects include a ventricular septal defect (VSD), pulmonary valve stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy)

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25
Q

Tetralogy of Fallot

A
  • VSD: blood flow between ventricles.
  • “overriding aorta” refers to the fact that the entrance to the aorta (the aortic valve) is placed further to the right than normal
  • right ventricle contracts and sends blood upwards, the aorta is in the direction of travel of that blood, therefore a greater proportion of deoxygenated blood enters the aorta from the right side of the heart.
  • Pulmonary stenosis promotes blood through VSD and into aorta - cyanosis
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26
Q

Tetralogy of Fallot signs/symptoms

A
  • Cyanosis (blue discolouration of the skin due to low oxygen saturations)
  • Clubbing
  • Poor feeding & weight gain
  • Ejection systolic murmur heard loudest in the pulmonary area (second intercostal space, left sternal boarder) – pulmonary stenosis
  • “Tet spells”: intermittent symptomatic periods where the right to left shunt becomes temporarily worsened, precipitating a cyanotic episode (SVR decreases or PVR increases): irritable, cyanotic and short of breath
  • Severe cases will present with heart failure before one year of age.
  • In milder cases, they can present as older children once they start to develop signs and symptoms of heart failure.
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27
Q

Tetralogy of Fallot Mx

A 
Tet spell: squat when a tet spell occurs (increases SVR)
- supplementary oxygen 
- beta blockers (relax RV)
- IV fluids - increase preload
- morphine 
-sodium bicarbonate 
- phenylephrine infusion - increase SVR
• Neonates: Prostaglandin infusion – ductus arteriosus is opened (blood flow from aorta back to pulmonary arteries)

Corrective surgery by 6 months

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28
Q

Transposition of great arteries

A

aorta and pulmonary artery swap

life threatening - no connection - cyanosed

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29
Q

Transposition of great arteries signs/symptoms

A

A patent ductus arteriosus or ventricular septal defect can initially compensate by allowing blood to mix between the systemic circulation and the lungs

However: within few weeks of life:
o Respiratory distress, tachycardia, poor feeding, poor weight gain and sweating.

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30
Q

Transposition of great arteries Mx

A

Prostaglandin infusion: maintain ductus arteriosus (blood from aorta to pulmonary arteries)

surgery

  • balloon septostomy: create atrial septal defect
  • open heart surgery is definitive management
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31
Q

Coarctation of the aorta

A

aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts.

  • Narrowing of the aorta reduces the pressure of blood flowing to the arteries that are distal to the narrowing.
  • It increases the pressure in areas proximal to the narrowing, such as the heart and the first three branches of the aorta.
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32
Q

Coarctation of the aorta signs/symptoms

A
  • weak femoral pulse
  • radiofemoral pulse
  • hypertension and ejection systolic murmur
  • CXR: Rib notching 3-5
  • ECG: LVH
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33
Q

Coarctation of the aorta Mx

A
  • In mild cases patients can live symptom free until adulthood without requiring surgical input, and in severe cases patients will require emergency surgery shortly after birth.
  • In cases of critical coarctation where there is a risk of heart failure and death: Prostaglandin E is used keep the ductus arteriosus open while waiting for surgery
  • Surgery or stent by the age of 5 to avoid pulmonary hypertension or end organ damage
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34
Q

Hypoplastic heart

A

left side of the heart is severely underdeveloped. It may affect the left ventricle, aorta, aortic valve, or mitral valve

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35
Q

TAPVD

A

Pulmonary veins connect straight into systemic circulation

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36
Q

Patent Ductus Arteriosus

A

The ductus arteriosus (shunt: trunk of the pulmonary artery to the proximal descending aorta) normally stops functioning within 1-3 days of birth and closes completely within the first 2-3 weeks of life.

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37
Q

PDA pathology

A

aorta is higher than that in the pulmonary vessels, so blood flows from the aorta to the pulmonary artery.
• This creates a left to right shunt where blood from the left side of the heart crosses to the circulation to the right side.
• increases the pressure in the pulmonary vessels causing pulmonary hypertension, leading to right sided heart strain as the right ventricle struggles to contract against the increased resistance.
•lead to right ventricular hypertrophy.
increased blood flowing through the pulmonary vessels and returning to the left side of the heart leads to left ventricular hypertrophy.

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38
Q

PDA signs/symptoms

A
  • Shortness of breath
  • Difficulty feeding
  • Poor weight gain
  • Lower respiratory tract infections
  • Continuous machine murmur below left clavicle
  • Thrill, collapsing pulse, failure to thrive and loud S2
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39
Q

PDA management

A

oral or IV ibuprofen
• After 1 year of age it is highly unlikely that the PDA will close spontaneously and trans-catheter or surgical closure can be performed.
• Symptomatic patient or those with evidence of heart failure as a result of PDA are treated earlier.

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40
Q

Persistent Pulmonary Hypertension of the Newborn (PPHN)

A

defined as the failure of the normal circulatory transition that occurs after birth

marked pulmonary hypertension that causes hypoxemia secondary to right-to-left shunting of blood at the foramen ovale and ductus arteriosus..

BP in lungs does not drop, blood does not go to lungs, blood does not get oxygenated. Persistent pulmonary hypertension

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41
Q

Persistent Pulmonary Hypertension of the Newborn (PPHN) Ix

A

• Pre and post O2 sats (more than 3% difference)
o Pre: right hand
o Post: left foot
• Echo: right to left shunt
• Persisting desaturation despite intensive oxygen use

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42
Q

PPHN Mx

A 
Ventilation 
O2
NO
Sedation
Inotropes 
ECMO
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43
Q

Transient tachypnoea of the newborn (TTN)

A

benign, self-limited condition that can present in infants of any gestational age, shortly after birth.

It is caused due to delay in clearance of fetal excess lung fluid after birth

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44
Q

Transient tachypnoea of the newborn (TTN) Signs/symptoms

A

ineffective gas exchange, respiratory distress, and tachypnea

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45
Q

Respiratory distress syndrome

A

occurs <32 weeks gestation

Surfactant deficiency
o Inadequate surfactant leads to high surface tension within alveoli.
o This leads to atelectasis (lung collapse), as it is more difficult for the alveoli and the lungs to expand.
o This leads to inadequate gaseous exchange, resulting in hypoxia, hypercapnia (high CO2) and respiratory distress.

• Structural immaturity

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46
Q

secondary causes of respiratory distress syndrome

A

intubation and ventilating

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47
Q

respiratory distress syndrome signs/symptoms

A 
Respiratory distress
•Tachypnoea
o Grunting
o Intercostal recessions
o Nasal flaring
o Cyanosis
• Worsen over minutes to hours
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48
Q

respiratory distress syndrome Ix

A

CXR: Ground glass appearance

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49
Q

respiratory distress syndrome Mx

A

antenatal Dexamethasone -increase surfactant

Intubation and ventialtion
endotracheal intubation
CPAP

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50
Q

Microcephaly

A

condition where the head (circumference) is smaller than normal. Microcephaly may be caused by genetic abnormalities or by drugs, alcohol, certain viruses, and toxins that are exposed to the fetus during pregnancy and damage the developing brain tissue.

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51
Q

Neonatal sepsis risk factors

A
  • Vaginal GBS colonisation
  • GBS sepsis in a previous baby
  • Maternal sepsis, chorioamnionitis or fever > 38ºC
  • Prematurity (less than 37 weeks)
  • Early (premature) rupture of membrane
  • Prolonged rupture of membranes (PROM)
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52
Q

Neonatal sepsis organisms

A

Early Onset
o Gp B Streptococcus
o Gram negatives

Late Onset
o Coagulase negative staphylococci
o Gram negatives
o Staph Aureus

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53
Q

Neonatal sepsis signs/symptoms

A
  • Fever
  • Reduced tone and activity
  • Poor feeding
  • Respiratory distress or apnoea
  • Vomiting
  • Tachycardia or bradycardia
  • Hypoxia
  • Jaundice within 24 hours
  • Seizures
  • Hypoglycaemia

Red flags
o Confirmed or suspected sepsis in the mother
o Signs of shock
o Seizures
o Term baby needing mechanical ventilation
o Respiratory distress starting more than 4 hours after birth
o Presumed sepsis in another baby in a multiple pregnancy

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54
Q

Autism features

A

1) Communication
2) social interaction
3) Imagination
4) repetitive
5) sensory issues

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55
Q

ADHD Triad

A

consistent across all settings

  • Hyperactivity
  • inattention
  • impulsivity
56
Q

ADHD medication

A

Methylphenidate (“Ritalin“)
Dexamfetamine
Atomoxetine

57
Q

Attachment disorders

A

Secure, ambivalent and avoidant attachment

58
Q

Insecure - Avoidant attached adolescents –Type A

A
  • Hard to engage
  • View relationships as unimportant
  • Don’t feel a huge need for other people
  • Seen as cold – reported (often falsely) as lacking empathy and remorse
59
Q

Insecure – ambivalent attached adolescents – Type C

A
  • Disruptive, ‘attention seeking’ and difficult to manage
  • Insecure and coercive
  • Can alternate between friendly charm and hostile aggression
  • Display antisocial behaviour, impulsivity, poor concentration
  • Feel a growing sense of unfairness and injustice –lots of complaining
60
Q

Reactive attachment disorder

A

Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before the age of five and is associated with grossly pathological care.

61
Q

Reactive attachment disorder subtypes

A

Inhibited
• Refers to children who continually fail to initiate and respond to social interactions in a developmentally appropriate way
- Example: A child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm or distress

Disinhibited
• Refers to a child who has an inability to display appropriate selective attachments
- Example: A child who displays excessive familiarity with strangers. indiscriminate sociability or lack of selectivity in their choices of attachment figure

62
Q

RAD Mx

A 
Family Tx
Individual Tx
Play Tx
Medication 
Special education
63
Q

Conduct disorder

A

repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms or rules are violated

64
Q

CD features

A 
•	The presence of three or more of the following criteria in the past 12 months with at least one criterion present in the past 6 months
o	Aggression to people or animals
o	Destruction of properly
o	Deceitfulness or theft 
o	Serious violation of rules
65
Q

CD types

A

Mild to Moderate
o Restricted to family environment

Severe
o Unsocialised – predominantly violent behavior and more likely to be dealt within the criminal justice system
o Socialised - more covert antisocial acts or better ability to avoid getting involved with criminal justice system

66
Q

Constipation - underlying serious organic disease to exclude

A

Hirschsprung’s, thyroid
coeliac, anorectal abnormalities, neuromuscular

consider if onset is from early infancy or refractory to treatment

67
Q

Constipation Mx

A

High fibre diet & good hydration

laxatives e.g. movicol

68
Q

Red flags of constipation

A
  • Delay in passage of meconium > 24 hours after birth
  • Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
  • Vomiting (intestinal obstruction or Hirschsprung’s disease)
  • Ribbon stool (anal stenosis)
  • Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)
  • Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
  • Failure to thrive (coeliac disease, hypothyroidism or safeguarding)
  • Acute severe abdominal pain and bloating (obstruction or intussusception)
69
Q

Headaches

A 
o Headache on waking
o Worse with coughing or bending
o Associated vomiting - especially in the morning
o visual disturbance
o Gait disturbance
o Cranial nerve palsy
70
Q

Obstruction: Neonates causes

A
  • Meconium ileus
  • Hirschsprung’s disease
  • Oesophageal atresia
  • Duodenal atresia
  • Intussusception
  • Imperforate anus
  • Malrotation of the intestines with a volvulus
  • Strangulated hernia
71
Q

Meconium Ileus

A

bowel obstruction that occurs when the meconium in your child’s intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine called the ileum

associated with CF

72
Q

Meconium Ileus signs/symptoms

A
  • Presents with failure to pass stool or vomiting in the first 2 days of life
  • Distended loops of bowel are seen through abdominal wall
  • A plug may show one firm mass of meconium in one such loop
  • Tiny bubbles may be seen in the meconium (inspissated)
73
Q

Meconium Ileus Mx

A 
Milk feed stropped 
NG tube - drain 
Antibiotics 
Enema: dissolve meconium 
Temp stoma 
Blood test: CF
74
Q

Jejunal atresia

A

characterized by partial or complete absence of the membrane connecting the small intestines to the abdominal wall (the mesentery).

small intestines (the jejunum) to twist around an artery that supplies blood to the colon (the marginal artery).

75
Q

Jejunal atresia Mx

A

Surgery and PN

76
Q

Duodenal atresia

A

2nd part of duodenum

77
Q

Duodenal atresia signs/symptoms and Ix

A

presents with bilious of non-bile-stained vomiting

AXR: Double bubble and no gas within bowel distally

78
Q

Duodenal atresia Mx

A

NG tube
IV fluids
Surgery

79
Q

Malrotation with volvulus

A
  • Malrotation happens when the intestine doesn’t turn like it should.
  • A volvulus happens when the intestine becomes twisted.
  • This causes an intestinal blockage.
  • Most will present in the first month of life
  • When the bowel twists around the superior mesenteric artery
  • If DEJ flexure is low – twist very easily around the
80
Q

Malrotation with volvulus signs/symptoms

A

vomiting bile, stomach pain, diarrhoea or constipation, and bloody stools.

Non-symmetrical creases

Laddering – sign of bowel obstruction

Green vomiting is a sign that this could be going on

81
Q

Malrotation with volvulus Mx

A

NG tube - fluid and gas
IV fluids
Surgery: Ladd procedure

82
Q

Pyloric stenosis

A

Hypertrophy (thickening) and therefore narrowing of the pylorus prevents food traveling from the stomach to the duodenum as normal

83
Q

Pyloric stenosis signs/symptoms

A

Presents at 3-8 weeks, vomiting after feeds and is projectile: within few minutes of feed

Does not contain bile: obstruction is high

No diarrhoea: Constipation is likely

Alert, hungry: malnourished and dehydrated: generally failing to thrive

Observe left to right LUQ peralistalis during feed

Olive sized pyloric mass: RUQ

Severe water and NaCl deficit: urine and plasma Cl- vital tests: guide resuscitation and surgery. Cl- > 90mmol-1

If hypochloraemia, hypokalaemia and metabolic alkalosis (baby is vomiting HCl acid from stomach) – don’t rush to surgery

84
Q

Pyloric stenosis Mx

A

Electrolytes - correct
NG tube
Laparoscopic pyloromyotomy

85
Q

Intussusception (Telescoping of the bowel)

A

one segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage). Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines

Thickens overall bowel and narrows lumen

6 months to 2 years and more common in boys

86
Q

Intussusception signs/symptoms

A

Severe, colicky abdominal pain

Pale, lethargic and unwell child

Right upper quadrant mass on palpation. This is described as “sausage shaped”

Vomiting

Intestinal obstruction

Episodic intermittent inconsolable crying with drawing of legs up (colic) +/- vomiting +/- blood PR (Redcurrent jelly stool)

87
Q

Intussusception Ix and Mx

A

Ix: USS (target lesion) and contrast enema

Mx: therapeutic enemas. If this fails, laproscopy or laparotomy

88
Q

Appendicitis signs/symptoms

A

Typically starts as central abdominal pain, that moves down to the right iliac fossa (RIF) over time and eventually becomes localised in the RIF.

On palpation of the abdomen there is tenderness in McBurney’s point (1/3rd distance from ASIS to the umbilicus)

Loss of appetite: Anorexia
• Slight vomiting
• Slight fever and tachycardia
• Rovsing’s sign (palpation of the left iliac fossa causes pain in the RIF)
• Guarding
• Rebound tenderness is increased pain when quickly releasing pressure on the right iliac fossa – suggests peritonitis
• Percussion tenderness - suggests peritonitis

89
Q

Appendicitis Ix and Mx

A

Raised inflammatory markers
USS
CT

Mx: diagnostic laparoscopy followed by appendectomy

90
Q

Hydatid of Morgagni

A

The appendix testis (or hydatid of Morgagni) is a vestigial remnant of the Müllerian duct (paranephric duct – female), present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time.

91
Q

Balanitis Xerotica Obliterans

A

Chronic, often progressive disease, which can lead to phimosis (tight foreskin) and urethral stenosis, affecting both urinary and sexual function.

92
Q

Hypospadias

A

urethral meatus (the opening of the urethra) is abnormally displaced posteriorly on the penis.

93
Q

Hypospadias Mx

A
  • Mild cases may not require any treatment
  • Surgery is usually performed after 3 – 4 months of age
  • Surgery aims to correct the position of the meatus and straighten the penis
94
Q

Hydrocele

A

collection of fluid within the tunica vaginalis that surrounds the testes.

95
Q

simple vs communicating hydrocele

A

Simple:
• Simple hydroceles are common in newborn males. They occurs where fluid is trapped in the tunica vaginalis.
• Usually this fluid gets reabsorbed over time and the hydrocele disappears

Communicating
- tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size.

96
Q

Hydrocele main s/s and Mx

A

Transilluminate with light

Mx:
simple - resolve within 2 years
communicating - surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele (the processus vaginalis).

97
Q

cryptorchidism signs/symptoms

A

might be palpable in the inguinal canal (in the inguinal region)

Undescended testes in older children or after puberty hold a higher risk of testicular torsion, infertility and testicular cancer.

98
Q

cryptorchidism Mx

A

watchful waiting - most descend in first 3-6 month

Orchidopexy (surgical correct) - 6 and 12 months

99
Q

Bronchiolitis

A

Acute inflammatory injury of the bronchioles
• Viral – RSV (most common), adenovirus, coronavirus, rhinovirus

Most common in 6 month olds, gen < 1 year

100
Q

Bronchiolitis signs/symptoms

A

Coryzal symptoms
Signs of respiratory distress
o Raised respiratory rate
o Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
o Intercostal and subcostal recessions – skin sucks in
o Nasal flaring
o Head bobbing
o Tracheal tugging – see trachea sucking in with each breath
o Cyanosis

dyspnoea
tachypnoea 
poor feeding 
mild fever 
apnoeas 
harsh breath sounds, wheeze and crackles
101
Q

Bronchiolitis Mx

A
  • Oxygen if below 92%
  • adequate intake e.g. NG tube
  • CPAP
  • Ventilatory support
  • Palivizumab
102
Q

Croup

A

• Larygnotracheobronchitis

Caused by: Parainfluenza (most common), influenza, adenovirus and RSV

children 6 months-2 years

103
Q

croup signs/symptoms

A
  • Increased work of breathing
  • “Barking” cough, occurring in clusters of coughing episodes
  • Hoarse voice
  • Stridor
  • Low grade fever
  • Chest wall is coming in on breathing
104
Q

Croup Mx

A

Most managed at home

Oral dexamethasone
Oxygen 
Nebulised budesonide
Nebulised adrenalin
Intubation and ventilation
105
Q

Asthma vs viral induced wheeze

A
  • Presenting before 3 years of age
  • No atopic history e.g. hayfever, eczema or food allergies
  • Only occurs during viral infections
106
Q

Asthma in children diagnosis

A

not diagnosed until 2-3 years old
intermediate vs high probs of asthma - trial
• Spirometry with reversibility testing (in children aged over 5 years)
• Direct bronchial challenge test with histamine or methacholine
• Fractional exhaled nitric oxide (FeNO)
• Peak flow variability measured by keeping a diary of peak flow measurements several times a day for 2 to 4 weeks

107
Q

Asthma Mx (under 5)

A
  1. Start a short-acting beta-2 agonist inhaler (e.g. salbutamol) as required
  2. Add a low dose corticosteroid inhaler or a leukotriene antagonist (i.e. oral montelukast)
  3. Add the other option from step 2.
  4. Refer to a specialist
108
Q

Pneumonia signs/symptoms

A
  • Cough (typically wet and productive)
  • High fever (> 38.5ºC)
  • Tachypnoea
  • Tachycardia
  • Increased work of breathing
  • Lethargy
  • Delirium (acute confusion associated with infection)
109
Q

Meningitis signs/symptoms

A

• Fever, neck stiffness, vomiting, headache, photophobia, altered consciousness and seizures

110
Q

Neonatal Meningitis signs/symptoms

A

hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle.

111
Q

Encephalitis Mx

A

o Aciclovir treats herpes simplex virus (HSV) and varicella zoster virus (VZV)
o Ganciclovir treat cytomegalovirus (CMV)
o Treat with antibiotics before lumbar puncture as sepsis is deadly
o Start acyclovir empirically in suspected

112
Q

UTI

A

Fever may be the only symptom of a urinary tract infection, especially in young children.

Always consider (and exclude) a urinary tract infection in a child with a temperature, unless there is a clear alternative source of infection.

113
Q

UTI Mx

A

All children under 3 years with a fever – IV antibiotics (e.g. ceftrianxone) and septic screen including blood cultures, bloods and lactate

> 3 years – oral antibiotics if well enough

114
Q

UTI Ix

A

<6 months: Abd USS within 6 weeks

DMSA scan 4-6 months after illness - scarring

Vesico-ureteric reflux (VUR)

MCUG

115
Q

Fits, faints and funny turns

A 
febrile seizures 
vasovagal episode 
Reflex anoxic seizures
Breath holding attacks 
Behavioural episodes 
Epilepsy 
Arrhythmias
116
Q

Nipple trauma Mx

A
  • Observe feed and review positioning and attachment/Check pump use
  • May need to rest and express if Mum can’t stand to have baby on but revisit where nipple will be with effective attachment
  • Lanolin, barrier cream to aid moist wound healing
  • Leave a few drops of breast left to dry on nipple may be soothing and protective
  • Pain relief
117
Q

Engorgement Causes

A 
o Delay in first feed
o Ineffective positioning and attachment
o Restricted feeding
o Ineffective emptying
o Supplementation
118
Q

Engorgement signs/symptoms

A
  • The breasts look shiny because of the oedema and can be painful.
  • The milk does not flow well due to increased pressure in the breast.
  • The breast(s) maybe red
  • The mother may be feverish.
  • They will feel lumpy and be painful for the mother.
119
Q

Engorgement Mx

A

continue to express and ensure good attachment
• Mild analgesia, e.g. Paracetamol or Ibruprofen will help discomfort and reduce the temperature.
• Cold compresses, cold gel packs or cold, uncooked cabbage leaves can soothe and reduce oedema after or between feeds

120
Q

Mastitis Mx

A

Flucloxacillin 1g

Clindamycin 450mg TDS

121
Q

formula-fed infants and vitamins?

A

formula-fed infants should not be given vitamin supplements if they consume more than 500ml infant formula per day. If under, they should take A, C and D vitamins

122
Q

Vit D and formula

A

• By 2 weeks of age breastfed babies should be given a supplement of 8.5 to 10mg of vitamin D per day up to one year of age (infant formula has added vitamin D so babies consuming ≥500ml formula a day do not require vitamin D supplements) (51% SMINS, SG 2017)

123
Q

Weaning period for breastfeeding

A

4 months min

6 months

124
Q

Cows milk

A

Can be gradually introduced as a drink from 12 months

Semi-skimmed milk should not be given before 2 years

Skimmed milk should not be given before 5 years

125
Q

Live virus vaccine

A

attenuated organism, replicates in host

e.g. OPV, measles, mumps, rubella, varicella, rotavirus, flu

126
Q

Inactivated vaccines

A

Suspensions of killed organisms

e.g. whole cell pertussis (whooping cough), whole cell typhoid

127
Q

Subunit vaccines

A
  • Toxoids e.g. diphtheria toxoid, tetanus toxoid, pertussis toxoid
  • Polysaccharides e.g. pneumococcal, typhoid (Vi
128
Q

Conjugate vaccines

A
  • polysaccharide attached to immunogenic proteins

* e.g. Hib, MenC

129
Q

Contraindications to vaccines

A

• Confirmed anaphylaxis reaction to previous dose of same antigen or vaccine component
• Live vaccines:
Immunosuppression (primary, radiotherapy, high-dose steroids/other drugs, HIV)
o Pregnancy
• Egg allergy (yellow fever, flu)
• Severe latex allergy
• Acute or evolving illness – defer till resolved/ stabilised

130
Q

Gross Motor development

A 
Head control: 3 months
Sitting balance: 6 months
Crawling: 9 months
Standing: 12 months
Walks alone:14 months     
Runs/pick toy without falling: 18 months
Stairs2 feet/tread:		24 months
Stairs – alternate feet                  36 months
Hops: 48 months
131
Q

Fine Motor and vision

A

Hand regard in midline: 3 months
Grasps toy: Palmar 6 months
Scissor grasp: 9 months
Pincer grasp: 12 months
Tower of 3-4 bricks: 18 months
Tower of 6-7/scribble 24 months
Tower of 9 bricks/copies circle 36 months
Draws simple man 48 months

132
Q

Hearing and language

A

Vocalises 3 months
• Babbles 6 months
• Imitates sounds 9 months
• Knows name 12 months
• 2 body parts/5-20 words 18 months
• Simple instructions/50+ words 24 months
• Complex instructions/asks questions 36 months
• Can tell stories of experiences 48 months

133
Q

Social behaviour and play

A

• Social smile 6 weeks
o if not there by 8 weeks – concerned – parent baby bond
• Pleasure on friendly handling 3 months
• Plays with feet/friendly with strangers 6 months
• Plays peek-a-boo/stranger awareness 9 months
• Drinks from cup/waves bye-bye 12 months
• Feeds with spoon 18 months
• Symbolic play/puts on some clothes 2 years
• Pretend interactive play/toilet-trained 3 years
• Understands turn-taking/dresses fully 4 years

134
Q

Red flags for development

A

Asymmetry of movement – child is not using one hand at all

Not reaching for objects by 6 months

Unable to sit unsupported by 12 months

Unable to walk by 18 months → check CK

No speech by 18 months

Concerns re vision or hearing

Loss of skills

135
Q

APGAR Score

A 
Objective measure of perinatal adaptation
Score out of 10
0, 1 or 2 per component
o	Heart rate
o	Respiratory rate
o	Responsiveness
o	Tone 
o	Colour
“Normal”  > 8

Medical Diseases (18 decks)

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