Child health Flashcards
APGAR mnemonic stand for?
Activity
Pulse
Grimace
Appearance
Respiration
What is capput succedaneum and how long to resolve?
Oedema collection outside scalp
Self-resolving in a few days
What is cephalohematoma and how long to resolve?
Collection of blood between skull and periosteum
Self-resolving in a few months
Difference between Capput succedaneum and Cephalohematoma?
Capput succedaneum - fluid crosses suture lines
Cephalohematoma - fluid does not cross suture lines
What is Erbs palsy?
Injury to C5/C6 nerves in brachial plexus
When to suspect Erbs palsy?
Lack of movement in arm and:
- Internally rotated shoulder
- Extended elbow
- Flexed wrist facing backwards
Erb’s palsy mx?
Function returns in a few months
What is given antenatally to prevent respiratory distress syndrome?
Mother given dexamethasone
How to prevent neonate hypothermia?
Dry baby, warm towel over head and body, skin-skin with mother
Red flags of neonate infection?
- Suspected mother sepsis
- Signs of shock
- Resp distress > 4 hours after birth
- Seizures
- Term baby needing ventilation
Mx for neonate infection?
Any red flag -> antibiotics
Benzylpenicillin + gentamycin
Common causes of early and late onset neonate infection?
Early onset (<72h) – mother/birth (group B step, e.coli)
Late onset (>72h) – environment (staph e, staph a)
When is neonatal jaundice pathological?
<24 hours or >14 days is prolonged
Causes of neonate pathological jaundice <24 hrs?
Haemolysis:
* Rh incompatibility
* ABO incompatibility
* G6PD deficiency
* Spheroctosysis
Congenital infection
Why is jaundice dangerous in neonates?
Unconjugated bilirubin crossess BBB in neonates -> Kernicterus – seizures, hypotonia, lethargy
Mx of pathological jaundice in neonate
Mx – phototherapy (converts bilirubin)
* Severe -> exchange transfusion
Mx of neonatal abstinence syndrome?
Opiate withdrawal -> Morphine sulphate
Non-opiate withdrawal -> Phenobarbitone
Ix for hypoxic-ischaemic encephalopthy
Sarnat staging
Assess:
- Level of consciousness
- Brainstem and autonomic function
- Motor function
What is apnoea of prematurity and mx?
Immaturity of autonomic system which controls RR & HR
Neonate attached to apnoea monitor which identifies apnoea and provokes tactile stimulation to prompt baby to restart breathing
What is retinopathy of pre-maturity?
Hypoxia -> blood vessels develop
Preterm often get O2 in care, once this is removed, there is rebound neovascularization
Mx of retinopathy of pre-maturity?
Screening every 2 weeks
Mx - Transpupillary laster photocoagulation
Other mx – cryotherapy, anti-VEGF
Mx of neonatal hypoglycaemia?
Asymptomatic -> encourage feeding + monitor
Symptomatic -> Admit + IV 10% dextrose
Causes of jaundice from 24h-2 weeks?
Physiological jaundice
Breast milk jaundice
* May last up to 12w
Infection (UTI)
Bruising
Polycythaemia
Causes of prolonged jaundiced (>2 weeks)
Unconjugated:
* Physiological
* Breast milk jaundice
* Infection – UTI
* High G.I obstruction (pyloric stenosis)
* Congenital hypothyroidism
Conjugated:
* Bile duct obstruction (Biliary atresia)
* Hepatitis
Cause of bacterial meningitis in neonates (<3 months) and mx?
Group B strep
Mx - Cefotaxime + amoxicillin
Cause of bacterial meningitis in >3 months and mx?
Cause - N.menigitis, strep pneumoniae
Mx - Ceftriaxone +/- dexamethasone to reduce neurological dmg
What is Kernig’s test?
Meningitis test
Patient lying flat on back and hip flexed with knees at 90 degrees. Straightening leg stretched meninges -> spinal pain and resistance to movement
What is
Brudzinski’s test?
Meningitis test
Patient lying flat on back and head lift -> involuntary flexion of hip and knees
Px of neonate mengitis?
Hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle
Arched back
Px of child meningitis?
Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness
Seizures
What urgent mx if meningitis suspected prior to hospital transfer?
Urgent IM or IV benzylpenicillin
What is raised in CSF in bacterial meningitis?
Polymorphs, protein
What is raised in CSF in viral meningitis?
Lymphocytes, slightly protein
Px of encephalitis?
Altered consciousness / cognition, unusual behaviour, acute focal neurology, seizures, fever
When is lumbar puncture contraindicated and alternative Ix?
Contraindicated if GCS <9, haemodynamically unstable or active seizures -> CT scan
Mx for HSV or VZV encephalitis?
Aciclovir
Mx for CMV encephalitis?
Ganciclovir
Cause of scarlet fever?
Exotoxin from group A strep (pyogenes)
Px of scarlet fever?
- After throat infection
- Diffuse maculopapular rash with a sandpaper texture
- Red strawberry tongue
- Fever, lethargy, flushed face
Mx of scarlet fever?
Phenoxymethylpenicillin for 10 days
Impetigo cause?
Staph aureus or strep pyogenes
Px of impetigo?
“Golden crusty lesions” usually on face, neck, and hands
Can be bullous or non-bullous
Painful, itchy
Mx of impetigo?
Ix – Swabs
Mx:
* Non-bullous – topical fusidic acid
* Bullous – Flucloxacillin
Px of staphylococcal skin syndrome?
Impetigo complication where toxin separates epidermal skin
Widespread erythema and tenderness of the skin
Nikolsky sign positive
Toxin shock syndrome cause?
Toxin producing staph aureus
Triad of toxic shock syndrome?
- Fever > 39
- Hypotension
- Diffuse erythematous, macular rash
Mx of toxic shock syndrome?
Mx – intensive care
Ab – ceftriaxone + clindamycin
What type of hypersensitivity reaction is rheumatic fever and Px?
Type 2 hypersensitivity
2-4 weeks after strep infection:
* Fever, joint pain, rash, shortness of breath, chorea, nodules
* Carditis
Jones criteria for rheumatic fever?
(JONES FEAR)
Major criteria:
J – Joint arthritis
O – Organ inflammation (carditis)
N – Nodules
E – Erythema margintum rash
S – Sydenham chorea
Minor criteria:
F – Fever
E – ECG changes
A – Arthralgia without arthritis
R – Raised inflammatory markers
Complications of rheumatic fever?
Mitral stenosis, chronic heart failure
What is gingivostomatitis?
HSV infection -> Vesicular lesions on the lips, gums, tongue and hard palate -> painful ulceration & bleeding
+ high fever
When to consider acyclovir for chicken pox?
Consider aciclovir if:
>14 yrs
Immunocompromised
Neonates
Px of chicken pox?
Fever
Whole body vesicular rash (starts trunk/face then spreads peripherally)
Itching and scratching
Px of glandular fever?
Fever, fatigue
Malaise
Tonsillitis
Lymphadenopathy
Splenomegaly
CMV mx?
IV ganciclovir
What causes ‘Slapped cheek syndrome’
Human parvovirus B19
Px of Human parvovirus B19 infection?
Fever, malaise, headache and myalgia followed by rash on face a week later which progresses to a maculopapular rash on the trunk and limbs
Complication of Human parvovirus B19 infection in pregnancy?
Hydrops fetalis
What virus causes hand, foot and mouth disease?
Enterovirus
Enterovirus px
Non-specific febrile illness + blanching rash over trunk with fine petechiae
Loose stools, vomiting
Or
Hand, foot & mouth disease
Measles px?
Fever, coryzal symptoms, conjunctivitis
Rash – starts at ears -> rest of body
- Severe erythematous, macular rash
Koplick spots – greyish white buccal mucosa spots
Px is 10-12 days after exposure
Mumps px?
Flu-like symptoms before parotid swelling – fever, myalgia, lethargy, headache, dry mouth
Parotid swelling – unilateral or bilateral
Rubella px?
Mild erythematous macular rash starting face then spreading to whole body
+ mild fever, joint pain, sore throat, lymphadenopathy
What to ask in history suspecting immunodeficiency?
S – severe (meningitis or peritonsillar abscess)
P – persistent (does not improve with usual antibiotics)
U – unusual (pneumocystis jirovecii)
R – recurrent (appear to have resolved but reapparead)
+ is there a family history of unexplained deaths?
What mx to prevent PCP in immunodeficient patient?
Cotrimoxazole
What mx to prevent fungal infections in immunodeficient patient?
Fluclonazole
What cell is defective in SCID?
T-cells
Px of SCID?
- Persistent, severe diarrhoea
- Failure to thrive
- Opportunistic infections (PCP, CMV, VZV)
- Unwell after vaccinations
What cell is defective in selective IgA deficiency and common px?
B-cells
Recurrent mucinous membrane infections
What is Kawasaki disease?
Systemic medium sized vessel vasculitis
Px of kawaski disease?
Fever >5 days
+ widespread erythematous maculopapular rash
+ skin peeling (desquamation) of palms and soles
+/-:
- Strawberry tongue
- Cracked lips
- Cervical lymphadenopathy
- Bilateral conjunctivitis
Ix in Kawasaki disease?
- Echocardiogram to check for coronary artery aneurysms
- FBC, LFT, urinalysis, ESR
Mx of Kawasaki disease?
High dose aspirin – reduce rx of thormbosis
IV immunoglobulins – reduces rx of coronary artery aneurysms
What is Henoch-Schoenlein purpura
IgA vasculitis affecting skin, kidneys and G.I tract
Px of Henoch-Schoenlein purpura?
Hx - URTI or gastroenteritis
Px – Purpuric rash affecting lower limbs and buttocks in children +/- joint pain, abdo pain, nephritis
- IgA nephritis -> microscopic or macrosocpic haematuria + proteinuria -> nephrotic syndrome
What is juvenile idiopathic arthritis?
Autoimmune arthritis lasting >6 weeks in patient under age of 16
Px of Dow syndrome?
- Hypotonia
- Brachycephaly
- Short neck
- Flattened face/nose
- Prominent epicanthic folds
- Single palmar crease
- Atria-ventricular septal defect
Px of Edward syndrome?
- Prominent occiput
- Small mouth and chin
- Short sternum
- Flexed, overlapped fingers
- Rocker bottom feet (soles are convex)
Px of Patau syndrome?
- Structural defect of brain
- Scalp defects
- Small eyes
- Cleft lip and palate
- Rocker bottom feet (soles are convex)
Px of Turnery syndrome?
- Short stature
- Webbed neck
- Broad chest with widely place nipples
- Underdeveloped ovaries with reduced function (infertile)
- Late or incomplete puberty
- Coarctation of the aorta
What are trisomy 21, 18 and 13?
Trisomy 21 - Down’s
Trisomy 18 - Edward
Trisomy 13 - Patau
Px of klinefelter syndrome?
- Taller height
- Wider hips
- Weaker muscles
- Small testicles
- Reduced libido, infertility
Px of Cri du chat?
- High pitched cry like a cat
- Intellectual disability
- Microcephaly, hypotonia
- Low set, posteriorly rotated ears
Px of DiGeorge syndrome?
- Cleft palate
- Heart defects
- Recurrent infections
- Feeding problems
- Intellectual disability
Px of Williams syndrome?
- Intellectual disability
- Broad forehead
- Starburst eyes
- Flattened nasal bridge, long philtrum
- Very sociable trusting personality
Px of angelman syndrome?
- Happy demeanour
- Fascination with water
- Hand flapping, laughter
- Epilepsy, microcephaly
- Widely spaced teeth
Px of charot-marie tooth?
- Peripheral neuropathy (sensory and motor)
- Abnormal gait, walking difficulties (weak ankles)
- Pes cavus
Px of Marfan syndrome?
- Tall stature
- Long neck
- Long limbs, long fingers
- Hypermobile
- Pectus carinatum or pectus excavatum
Px of Fragile X syndrome?
- Intellectual disability
- Long, narrow face
- Large ears
- Large testicles after puberty
- Hypermobile joints
Px of Prader-Willi syndrome?
- Constant insatiable hunger
- Hypotonia
- Intellectual disability
- Fairer, soft skin that is prone to bruising
- Thin upper lip, narrow forehead
Px of Noonan syndrome?
- Wide space between the eyes (hypertelorism)
- Short stature, broad forehead
- Prominent nasolabial fold
- Webbed neck, widely spaced nipples
Mx of respiratory wheeze?
- 10 puffs SABA + check technique
- More puffs needed? (every hour?) or nebuliser
- Consider prednisolone
Mx of asthma?
- SABA – salbutamol (reliever)
- Inhaled corticosteroids – beclomethasone (preventer)
- Either:
a. + Leukotriene receptor agonists – montelukast
b. + Inhaled LABA - Other options:
a. LAMA – tiotropium
b. Theophylline (narrow therapeutic window)
c. Maintenance and reliever therapy (MART) - ICS + LABA
Ix of asthma?
- Either:
o Fractional exhaled nitric oxide
o Spirometry with bronchodilator reversibility - If diagnostic uncertainty:
o Peak flow variability (diary)
o Direct bronchial challenge test with histamine or methacholine
Acute asthma ABG?
Initially – respiratory alkalosis
Late – respiratory acidosis (very bad)
Moderate acute asthma px and mx?
Px:
- PEFR 50-75% predicted
Mx:
- Nebulised SABA
- Neublised ipratromium bromide
- Oral prednisolone
Severe acute asthma Px and Mx?
Px:
- PEFR 33-50% predicted
- Resp rate >25
- Heart rate >110
- Unable to complete sentences
Mx:
- Oxygen to maintain stats
- Aminophylline infusion
- Consider IV SABA
Life-threatening acute asthma Px and Mx?
Px:
- PEFR <33%
- Sats <92%
- Fatigued
- No wheeze (no air entry at all)
- Shock
Mx:
- Magnesium sulphate
- HCU / ICU admission
- Intubation in worst case
What is croup?
Inflammation of upper airways causing oedema in the larynx in children aged 6months to 2 years
Mainly viral (parainfluenza)
Px of croup?
- Increased work of breathing
- “Barking cough”, occurring in clusters of coughing episodes
- Hoarseness
- Stridor
- Low grade fever
Mx of croup?
Mild -> Oral dexamethasone
Moderate -> Oral dexamethasone + monitor for 2-3hrs
Severe -> Adrenaline, gives 30mins more time, O2 by facemask, IV/oral dexamethasone
What is bronchiolitis?
Inflammation and infection in the bronchioles usually caused by RSV in children under 1 year
Px of bronchiolitis?
Px:
- Coryzal symptoms (viral URTI)
- Signs of respirotry distress
- Dyspnoea
- Tachypnoea
- Poor feeding
- Mild fever
- Wheeze and crackles on auscultation
Signs of resp distress in a baby?
Raised RR
Accessory muscle use:
- Sternocleidomastoid
- Abdominal
- Intercostal
Intercostal and subcostal recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
How long to recover from bronchiolitis?
2-3 weeks?
Mx of bronchiolitis?
Supportive
Typical cause of epiglotitis?
Haemophilus influenza type B
Ix of epiglottis?
Lateral x-ray of neck -> “thumb sign”
Px of epiglottitis?
Sore throat & stridor
Drooling
Sat forward with a hand on each knee
High fever
Odynophagia
What causes whooping cough?
Bordetella pertussis (GM -ve bacteria)
Px of whooping cough?
Mild coryzal symptoms
-> severe coughing fits after a week or more, paroxysmal coughs
Loud inspiratory whoop when cough ends
Complications -> fainting, vomiting, pneumothorax
Ix for pertussis?
Nasal swab -> PCR or bacterial culture
If >2weeks can test for anti-pertussis toxin immunoglobulin G
Prognosis of whooping cough?
Symptoms typically resolve within 8 weeks
- Complication -> bronchiectasis
What does ductus venosus connect?
Umbilical vein to IVC
What causes ductus venosus to close?
- Clamping of umbilical cord
- No flow in umbilical vein
- Few days later -> ligamentum venosum
What does the foramen ovale connect?
Right atrium to left atrium
What causes the foramen ovale to close?
At birth:
1. Decrease in PVR
2. Less pressure in RA
3. LA pressure > RA pressure
4. Foramen ovale closes
5. In few weeks becomes fossa ovalis
What does the ductus arteriosus connect?
Pulmonary artery with aorta
What causes the ductus arteriosus to close?
At birth:
1. Increased blood oxygenation
2. Drop in circulating prostaglandins
3. Closure -> ligamentum arteriosum
Px of PDA?
Murmur (continuous crescendo-decrescendo “machinery” murmur):
- Small PDA can be asymptomatic and present in adulthood with heart failure
- Additional px – Shortness of breath, difficulty feeding, poor weight gain, LRTI
Mx of PDA?
Monitor until 1 year with ECHO
> 1 year, unlikely to physiologically close -> surgery
Px of atrial septal defect?
- Mid-systolic, crescendo-decrescendo murmur loudest at left sternal border
- Fixed splitting of second heart sound (closure of aortic and pulmonary valves at different times)
- Childhood px – SOB, difficulty feeding, poor weight gain, LRTI
- Adulthood – dyspnoea, heart failure or stroke
Px of VSD?
Pan-systolic murmur heard at left sternal border in 3rd & 4rth ICS
Possible systolic thrill on palpation
What is Eisenmenger syndrome?
Left to right shunt in heart reverses to become right to left shunt -> blood bypasses lungs and cyanotic patient
What is coarctation of the aorta?
Narrowing of the aortic arch around ductus arteriosus
-> Reduced pressure in arteries distal to narrowing
-> Increased pressure proximally to narrowing such as heart, first three branches of aorta
Px of coarctation of the aorta?
- Low BP in arteries distal to narrowing (weak femoral pulse)
- High BP in arteries proximal to narrowing
- Systolic murmur in left infraclavicular area and below left scapula
- Infancy:
o Tachypnoea
o Poor feeding
o Grey and floppy baby - Other:
o Left ventricular heave (due to LVH)
o Underdeveloped of limbs distal to narrowing
When do we give prostaglandins to keep ductus arteriosus open?
Coarctation of aorta and tetralogy of Fallot
What congenital conditions make-up tetralogy of fallot?
- Ventricular septal defect
- Overriding aorta (aorta further to right than normal)
- Pulmonary valve stenosis -> ejection systolic murmur
- Right ventricular hypertrophy
Px of tetralogy of fallot?
- Cyanosis
- Clubbing
- Poor feeding / weight gain
- Ejection systolic murmur heard loudest in 2nd ICS left sternal edge
Px of aortic valve stenosis?
Ejection systolic murmur loudest at 2nd ICS right sternal border
- Crescendo-descendo
- Radiates to carotids
Mild – Incidental murmur
Severe – fatigue, SOB, dizziness & fainting
- Symptoms worse on exertion
What is pulmonary valve stenosis associated with?
- Tetralogy of Fallot
- William syndrome
- Noonan syndrome
- Congenital rubella syndrome
Px of pulmonary valve stenosis?
Ejection systolic murmur loudest at 2nd ICS, left sternal border
- Palpable thrill
- Right ventricular heave
- Raised JVP
Mild – Incidental murmur
Severe – fatigue, SOB, dizziness & fainting
- Symptoms worse on exertion
Initial mx for baby reflux?
- Small, frequent meals
- Keep baby upright after eating
- Alter cot position
Mx for problematic reflux?
- Gaviscon with feeds
- Thickened milk formula
- PPI (omeprazole)
- Faltering growth -> empty stomach faster (domperidone)
Dx and Mx of pyloric stenosis?
Dx – abdominal ultrasound
Mx – laparoscopic pyloromyotomy
- Widened pylorus
What is biliary atresia?
Section of bile duct is narrowed or absent -> cholestasis
P - prolonged jaundice (>14 days from birth)
Dx and Mx of biliary atresia?
Dx – high levels of conjugated bilirubin
Mx – Kasai portoenterostomy
Px of intussessecption?
Bowel telescopes into itself
- Severe colicky abdo pain
- “Redcurrant jelly stool”
- Sausage-shaped RUQ mass on palpation
- Intestinal obstruction / vomiting
Dx and Mx of intussusception?
Dx – ultrasound or contrast enema
Mx:
- Therapeutic enema
- Surgical reduction
Dx and Mx of Hirschsprung’s disease?
Ix – Abdo x-ray
Dx – Rectal biopsy
- Absence of ganglionic cells
Mx – fluid resuscitation
- If Hirschsprung-associated enterocolitis -> antibiotics
What is Hirschsprung’s disease?
Congenital disease where nerve cells of myenteric plexus are absent in distal bowel and rectum
Causative organism of gastroenteritis associated with fried rice left at room temperature?
Bacillus cereus
Causative organism of gastroenteritis associated with raw or undercooked pork?
Yersinia enterocolitica
Causative organism of gastroenteritis associated with eggs?
Salmonella
Staph A enterotoxin
Causative organism of gastroenteritis associated with faeces contaminated drinking water, swimming pools, food
Shigella
Campylobacter jejuni spread?
Raw or improperly cooked poultry
Untreated water
Unpasteurised milk
Dx of gastroenteritis?
Stool sample -> microscopy, culture and sensitivities
Gastroenteritis associated with nurseries?
Rotavirus
Gastroenteritis associated with sudden outbreaks?
Norovirus
Mx of Giardiasis?
Metronidazole
Stool pattern of constipation?
<3 a week
Hard large stools or rabbit droppings
Overflow soiling - very loose, smelly stool passed without sensation
Mx of constipation?
High fibre diet and good hydration (give extra water)
Regular toileting and behavioural interventions (praise visiting the toilet)
Start laxatives (Movicol)
Mx of faecal impactation?
Movicol + polyethylene glycol 3350
o + stimulant if no response in 2 weeks
Auto-antibodies involved in coeliac disease?
Anti-TTG
Anti-EMA
Anti-DGPs
(IgA)
Px of coeliac disease?
- Failure to thrive in young children
- Diarrhoea, fatigue, weight loss
- Mouth ulcers
- Anaemia secondary to iron, B12 or folate deficiency
- Dermatitis herpetiformis – itchy blistering skin rash
Dx of coeliac disease?
Check IgA levels are normal and raised anti-TTG / raised anti-EMA
Biopsy would show crypt hypertrophy and villous atrophy
Mnemonic for Crohns?
N – No blood or mucus
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Transmural (full thickness) inflammation
S – Smoking is a rx
Mnemonic for ulcerative colitis?
C – Continuous inflammation
L – Limited to colon and rectum
O – Only superficial mucosa affected
S – Smoking Is protective
E – Excrete blood and mucus
U – Use aminoacylates
P – Primary sclerosing cholangitis
Extra-intestinal px of IBD?
- Finger clubbing
- Erythema nodosum
- Pyoderma gangrenosum
- Episcleritis & scleritis
- Inflammatory arthritis
Screening for IBD?
- Bloods (raised CRP indicates active inflammation)
- Screening – Faecal calprotectin (raised when intestines are inflamed)
Crohn’s Mx?
Inducing remission:
1. Steroids (oral prednisolone or IV hydrocortisone)
2. Add immunosuppressant under guidance
o Azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab
Maintaining remission:
1. Azathioprine or mercaptopurine
2. Alternative – methotrexate, infliximab, adalimumab
Surgical resection of distal ileum if needed
Mx of UC?
Inducing remission:
- Mild-moderate:
1. Aminosalicylate (mesalazine)
2. Corticosteroids
- Severe:
1. IV corticosteroids
2. IV ciclosporin
Maintaining remission:
- Aminosalicylate
- Azathioprine
- Mercatopurine
Surgery to remove colon or rectum
Triad of T1DM?
o Polyuria
o Polydipsia
o Weight loss
DKA px?
Hyperglycaemia, dehydration, acidosis
o + N&V, “fruity breath”, altered consciousness
Mx of DKA?
Correct dehydration over 48h, give fixed rate insulin infusion
Mx of T1DM?
- Subcut insulin
o Basal – Lantus
o Bolus before meals– Novorapid - Monitoring dietary carbohydrate intake
- Monitor BG levels
What do adrenal glands produce?
Steroid hormones:
- Cortisol
- Aldosterone
Types of adrenal insufficiency?
Primary - Damaged adrenal glands
Secondary - Inadequate ACTH stimulating adrenal glands due to loss or damage of pituitary
Tertiary - Inadequate CRH from hypothalamus
Biochemistry of primary adrenal insufficiency?
Low cortisol
High ACTH
Low aldosterone
High renin
Biochemistry of secondary adrenal insufficiency?
Low cortisol
Low ACTH
Normal aldosterone
Normal renin
What causes tertiary adrenal insufficiency?
Long term oral steroids (>3 weeks) which suppresses the hypothalamus
Px of adrenal insufficiency in children?
- Nausea and vomiting
- Poor weight gain or weight loos
- Reduced appetite
- Abdominal pain
- Muscle weakness or cramps
- High ACTH -> bronze hyperpigmentation
Dx of adrenal insufficiency?
Short synacthen test
Mx of adrenal insufficiency?
Replace steroids:
- Hydrocortisone (glucocorticoid)
- Fludrocortisone (mineralocorticoid)
What is adrenal crisis?
Severe addisons due to a trigger - infection, trauma, acute illness, sudden withdrawal of steroids
Px:
- Reduced consciousness
- Hypotension
- Hypoglycaemia, hyponatraemia and hyperkalaemia
Mx of adrenal crisis?
ICU:
- Parenteral steroids, IV fluids, correct hypoglycaemia
Growth hormone px?
Neonates:
* Micro-penis
* Hypoglycaemia
* Severe jaundice
Children:
* Poor growth
* Short stature
* Delayed puberty
Ix / Mx of growth hormone deficiency?
Ix – Growth hormone stimulation test
MRI brain for pituitary / hypothalamus issues
Mx – Daily subcut GH (somatropin) + monitor
What commonly happens before LOC event suggestive of syncope?
- Prolonged standing
- Lightheaded
- Sweating
- Blurring or clouding vision
What happens during a LOC event suggesting seizure?
- Head turning and abnormal limb positions
- Tonic clonic activity
- Tongue biting
- Cyanosis
Ix after syncope?
- ECG (assess for arrhytmia)
- Echocardiogram (if structural heart disease suspected)
- Bloods, U&Es, BM
Mx of generalised tonic-clonic seizures?
- Sodium valproate
- Lamotrigine or carbamazepine
Mx of focal seizures?
- Lamotrigine or carbamazepine
- Sodium valproate or levetiracetam
Px of focal seizure?
Seizure starts in temporal lobe affecting hearing, speech, memory and emotions
- Hallucinations
- Memory flashbacks
- Déjà vu
- Doing strange things on autopilot
Mx of infantile spasms?
- Prednisolone
- Vigabatrin
Febrile convulsion mx?
Paracetamol + Ibuprofen
When to consider an MRI after a seizure?
o <2 years of age
o Focal seizures
o No response to first line anti-epileptic mx
Advice for seizures?
- Shower instead of bath
- Cautious swimming, with heights, traffic, hot or electrical equipment
- During seizure -> recovery position + soft object under head
- If >5 mins -> call ambulance
S/e of phenytoin?
Folate and VitD deficiency -> megaloblastic anaemia, osteomalacia
S/e of sodium valproate?
Teratogenic, liver damage, hair loss, tremor
S/e of carbamazepine?
agranulocytosis, aplasticanaemia
S/e of lamotrigine?
Stevens-johnson syndrome or DRESS syndrome, leukopenia
What is status epilepticus?
Seizure lasting more than 5 minutes or 2+ seizures without regaining consciousness
Mx of status epilepticus?
- Secure airway
- High concentration oxygen
- Assess cardiac and respiratory function
- Check BM
- Gain IV access
Then pharmacological mx:
1. IV lorazapeam
2. 10 mins later -> repeat IV lorazepam
3. No response -> IV phenobarbital or phenytoin
Causes of cerebral palsy?
Antenatal:
- Maternal infections
- Trauma during pregnancy
Perinatal:
- Birth asphyxia
- Pre-term birth
Postnatal:
- Meningitis
- Severe neonatal jaundice
- Head injury
Types of cerebral palsy?
- Monoplegia – one limb affected
- Hemiplegia – one side of the body affected
- Diplegia – four limbs are affects, mostly legs
- Quadriplegia – four limbs affected more severely +/- seizures, speech disturbance
Px of cerebral palsy?
- Failure to meet milestones
- Increased or decreased tone
- Hand preference < 18 months
- Problems with coordination, speech or walking
- Feeding or swallowing problems
- Learning difficulties
Px of congenital hydrocephalus?
- Sutures of skull close at 2 years of age -> enlarged and rapidly increasing head circumference
- Bulging anterior fontanelle
- Poor feeding and vomiting
- Poor tone, sleepiness
Mx of congenital hydrocephalus?
VP shunt (CSF drained into peritoneal cavity)
