child health Flashcards
A 48 hour old term baby delivered by spontaneous vaginal delivery has not passed meconium - what underlying pathology could be the cause?
Cystic fibrosis - meconium can get stuck in the lumen if its too sticky
6month old baby brought in by parents - snotty, wheezy and coughing lots - seems to be having spells where he doesn’t seem to breathe at all
What is the most likely causative organism ?
Resp. Syncytial virus
how does malrotation volvulus present
With green vomit
Why is TTN (transient tachypnoea of the newborn) more common in C-section than vaginal delivery ?
Due to a delayed clearing of fluid - since babies don’t undergo the same stress as they would via vaginal delivery
For fluid to be cleared from the lungs, the sodium channels need to be activated by adrenaline and this doesn’t happen in C-section sometimes.
What causative organism most commonly causes bronchiolitis ?
Resp. Syncytial virus
what is patau syndrome
A trisomy of 13
Baby presents with microcephaly, small eyes, cleft lip/palate, polydactyly, scalp lesions
What is Pierre-robin syndrome
Micrognathia, posterior displacement of the tongue - which can result in upper airway obstruction
Cleft palate
What is noonan’s syndrome
Webbed neck babies
Pectins excavating
Short stature
Pulmonary stenosis
Features of Williams syndrome
Short stature
Learning difficulties
Friendly, extroverted
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
‘Short, stupit, silly is oor willy’
Features of prader - willi
Hypotonia
Hypogonadism
Obesity
How and why are newborns given vit. K
Intramuscularly usually
They are deficient - reduce risk of haemorrhage (especially at risk if breast fed)
what is the ‘traffic light system’
It is a feverish illness guideline for children under 5 - presenting with fever
Kleinfelter’s syndrome features
KS or 47, XXY
Where males are born with an extra X chromosome
Healthy observation in newborns
RR = 30-60
BPM = 100 - 160
Temp. = 37 degrees Celsius
Management of necrotising fasciitis
Nil by mouth feeding
Clindamycin + cefotaxime
slapped cheek syndrome/erythema infectiosum causative organism
Parvovirus b19
When in doubt - keep on breastfeeding
Lol tips from second years
What are the developmental delay red flags
6 months - not reaching for objects
10 months - no smile or speech
12 months - cannot sit unsupported and has preferential use of one hand
18 months - cannot walk
Red/pink maculopapular rash, present on face and body with lymphadenopathy
Caused by togavirus
What is the disease
Rubella
*kolpik spots (white spots on the buccal mucosa)
This rash starts behind the ears and common complications include: otitis media
What disease is this ?
Measles caused by paramyxovirus
If this diagnosed you MUST tell public health
This rash is very very itchy, and the timeline = macular > papules > vesicles > scabs and is caused by varicella zoster virus
Chicken pox
Management is with Calamine
(CALamine CALms the itch)
*strawberry tongue
= Scarlet fever , caused by Group A strep pyogenes
management of scarlet fever
Oral penicillin V (for 10 years)
Can return to school 24 hours after abx started
Need to notify public health
Features of mumps
Parotitis - earache/pain on eating
Fever, fatigue
What virus causes mumps
Paramyxovirus
What is a common complication of mumps
Orchiditis - inflammation of the testicles
What 2 types of anaemia are associated with slapped cheek syndrome
Sickle cell anaemia
Aplastic anaemia
Rash that appears as vesicles in the mouth and on palms and soles
May have an associated fever and sore throat and is caused by coxsackie virus A16
Hand foot and mouth disease
What is the most common causative organism for UTIs and why
E.coli
Because of vesicoureteral reflux
Management of croup
Oral dexamethasone
Severe = nebulised adrenaline
Management of epiglottitis
Immediate ENT senior help
IV ceftriaxone + oxygen
Do not examine the throat - could make it even worse
Children often adopt the tripod position
Radiological differences of croup and epiglottitis
High chloride concentration on sweat test indicates what disease
CF
CF is an autosomal recessive CFTR gene mutation on chromosome 7
How would a newborn with CF present
Not passing meconium within 1st 24 hours of life
Recurrent Resp. Infection
Malabsorption > due to lack of digestive enzymes
Pancreatitis
what is the causative organism for epiglottitis
H. Influenzae
What is the causative organism for croup
Parainfluenza virus
What causes whooping cough
Bordetella pertussis
Management of whooping cough
Nasal swab is diagnostic
> > oral macrolide ie erythromycin
What can happen if DDH is left untreated
Very shallow or false acetabulum > severe arthritis + shortened limb
What are the investigation for DDH
Initial = Barlow + Ortolani
Diagnostic = US
How long would a baby with DDH be in a pavlik harness for ?
6 weeks
at what point do you consider surgery for DDH
When it is persistent > 18 months
What is Perthes
Avascular necrosis of the femoral head
How does Perthes present
Usually in a very active boy with short stature
Unilateral pain or limp > developed over a few weeks
Loss of rotation + loss of abduction
+ve trendelenburg
Hanging rope sign on x-ray, widening of joint space and smaller femoral head w/ patchy density
*hanging rope sign
= Perthes disease
What is the most common cause of hip pain in children
Transient synovitis of the hip
Follows a URTI and is self-limiting , mxm = NSAIDs + rest
*klein lines on x-ray
SUFE - slipped upper femoral epiphyses
Management of SUFE
Urgent pin femoral head surgery as there is risk of avascular necrosis
What is the Kocher criteria used for
Septic arthritis
Mxm of septic arthritis
Urgent irrigation + debridement
IV antibiotics and flucloxacillin
*olive shaped mass in RUQ + projectile vomiting
Pyloric stenosis
management of pyloric stenosis
Ramstedt pyloromyotomy
Child is unwell and floppy, producing red currant jelly stool and there is a palpable sausage mass
On US there is a target/bullseye sign
What disease matches this profile ?
Intussesception - telescoping of small bowel leading to obstruction
*green, bilous vomit
Malrotation w volvulus
Abdo x-ray of necrotising fasciitis
Dilated bowel loops
Bowel wall oedema
Gas in peritoneum
Gas in bowel wall
Which hormone secreted from the hypothalamus triggers the onset of puberty
GnRH
*hypothalamus secretes GnRH which stimulates the production of FSH/LH from anterior pituitary
> circulating FSH/LH act upon the gonads which release the sex hormones (oestrogen + testosterone)
When do children start to engage in symbolic play
18-24 months
When do children use spoons to feed themselves
18 months
When do children engage in parallel play
2.5years - 3 years
When do children become continent of urine
2 years
How many hours a day is a 3 year old recommended to be physically active ?
3 hours - spread throughout the day
How many hours of RIGOROUS/MODERATE intensity exercise should a 12 year old boy have a day ?
1 hour
how many days is a 7 yr old girl recommended to do vigorous activity in a week ?
3 days
what is oral rehydration solution ?
Oral rehydration - treatment of dehydration , replacing sugars and electrolytes and shit
Features of oral rehydration solution
-relies on the sodium-glucose co-transport system (active transport of sodium = osmotic pull for water)
-water absorption is mostly in the jejunum
-UK solution contains less sodium than developing countries
-can easily be made using a combination of salt, sugar and water
is effective contraceptive use a factor in reducing child mortality
Nope
What are the WHO 6 solutions for preventing deaths in under-5s
Red flag for constipation
leg weakness
is passing a stool once a week a red flag for constipation
Nope
When should infants be weaned onto family foods
6 months
Semi-skimmed milk should not be given before x years
2 years
Full fat I modified cows’ milk can be introduced as a drink from x months
12 months
When is the earliest an infant can be introduced to solid foods
4 months
Skimmed milk should not be given before x years
5 years
Common complications of Down syndrome
Congenital heart abnormalities (AVSD)
Acute lymphoblastic leukaemia
Duodenal atresia
Otitis media
When do boys experience their pubertal growth spurt
14 years
What is the first sign of puberty in girls
Breast bud development
What is the first sign of puberty in boys
Testes growth
when is puberty considered precocious
8 in girls
9 in boys
*massive painless GI bleeding in a child between 1-2 ?
Meckels diverticulum is the most common cause
Features of rickets
Kyphoscoliosis
Joint Widening
Aching bones and joints
Lower limb abnormalities - bow legs + knock knees
Rickety rosary
Harrisons
What is the most common cause of ambiguous genitalia
Congenital adrenal hyperplasia
A neonate is found to have a left subclavicular thrill, a heaving apex beat and a continuous machinery like murmur
What is the correct management
This baby has patent Ductus arteriosus
Therefore give indomethacine to the Neonate postnatally
When should circumcision NOT be performed in children ?
Hypospadias
Risk factors for neonatal sepsis
Low birth weight
Maternal chorioamnionitis
Premature
Mother who has had a previous baby with GBS infection
What is first line treatment for febrile seizures
Buccal Midazolam
What is Rhesus disease
Antibodies in a pregnant woman’s blood destroy her baby’s blood cells
Aka haemolytic disease of the foetus and newborn
How to treat Rh incompatibility
Phototherapy using bilirubin lights
Also IV immunoglobulins
(This would be an obstructive jaundice)
A test for RhD antibodies
Coombs test
What is ABO incompatibility
This happens when a mothers blood type is O
And her baby’s is A or B
The mothers immune system may react and make antibodies against the baby’s blood cells
Treatment of ABO incompatibility
Phototherapy
Example of active immunity
Vaccines
Example of passive immunity
Transplacental transfer from mother to unborn baby
What diseases can immunity be granted passively
Hep B
Rabies
Varicella zoster
Diphtheria
Botulin
What are the 2 mechanisms of active immunity
Natural infection
Vaccines
What are the two mechanisms of passive immunity
Transplacental transfer
Artificial human IgG
Rotavirus, shingles, MMR, polio are types of what vaccine
Live attenuated (whole pathogen)
Flu and rabies are types of what vaccines
Inactivated whole organisms vaccine
What are some examples of recombinant protein vaccines
Hep B
HPV
MenB
Toxoid vaccines protect against what diseases
Diphtheria
Tetanus
Pertussis
What is a conjugate vaccine
Polysaccharide + immunogenic protein ie Hib , MenC , MenACWY
How is herd immunity calculated
Depends on transmissibility and infectiousness , and social mixing proportions
Eg herd immunity to be achieved for measles is 90% but for mumps is 75-85%
What is generally the percentage needed to be achieved for herd immunity
95%
What is in the 6 in 1
Tetanus
Pertussis
Diphtheria
Hep B
Polio
Hib
Clinical suspicion of what childhood infections should be reported to practitioners immediately due to public health ris
Diphtheria
Meningococcal
Smallpox
Hib
Pertussis
Typhoid
Measles
Polio
SARS
@ 4 weeks what vaccines given to baby
MMR and DTaP (4in1 = diphtheria , tetanus , polio, pertussis )
@ 8 weeks - what vaccines
Hib HepB , IPV , DTaP
@ 12 weeks - what vaccines
DTaP , Hib Hep B , rotavirus , PCV13
@ 16 weeks - what vaccines
DTaP , Hib , Hep B and Men B
At about 1 year old - what vaccines to be given
Men C and B , Hib , PCV13 , MMR
@ 3 -5 years old - what vaccines
MMR and DTaP
@ 2 years and beyond - what vaccines
Flu (annually)
What age do kids get HPV vaccine
12-13 years old
At what age do kids get IPV, Men ACWY and Td (tetanus + diphtheria)
13-14yrs
What is APGAR scoring
A = appearance
P = Pulse
G = grimace
A = activity
R = respiration
Antibiotic of choice for suspected bacterial infection in babies (sepsis)
Benzyl penicillin (is a gram + and - cover)
(Gentamicin is a further gram - cover)
(Cefotaxime as well is an option for gram + and - cover)
What is covered in the TORCH screen
Toxoplasma
Others (hep b and syphilis)
Rubella
CMV
Herpes
What is TTN
Transient tachypnoea of the newborn
- most common in C-section babies
- due to a delay in clearing lung fluid (dependant on active epithelial Na channels —> usually activated through stress by vaginal delivery)
When should TTN resolve
Within the first 24 hours of life
TTN x-ray ?
Fluid in the horizontal fissure
*ground glass appearance and air bronchograms on CXR
Respiratory distress syndrome
What babies are given vitamin K straight after delivery
TRICK QUESTION
All babies are
Why does ABO incompatibility cause jaundice
The mothers blood produces antibodies to the babies red cells — some of which cross the placenta , entering babies circulation — these antibodies continue to attack and break down babies RBCs at an increased rate —> leading to increases bilirubin
Most common type of brain tumour in children
Astrocytoma - Brain and spinal cord tumour
Most often found in cerebrum but also in cerebellum
What is global delay
Significant delay in >2 developmental areas
What are the developmental mile stone red flags
6 months —> not reaching for objects
10 months —> no smile or speech
12 months —> cannot sit unsupported and has preferential use of one hand
18 months —> cannot walk
Cause of cerebral palsy
TORCH (80%)
(Toxoplasma, rubella, cmv, herpes simplex)
Management of cerebral palsy
Oral diazepam & oral baclofenac for spasticity
- Gower’s sign
Muscular dystrophy
(When they used their hands to push on legs to stand)
What is Duchenes muscular dystrophy ?
It is an x-linked condition - due to malformation of the dystrophin gene
How does Duchene’s muscular dystrophy present ?
Boys aged 1-6 who are struggling to walk
Proximal muscle wasting
Hypertrophy of the calves
+Gower’s
Investigation for muscular dystrophy
Increased serum creatinine kinase
What is the management of muscular dystrophy
There is poor prognosis - usually die in 20s
Symptomatic control
*bulging fontanelle
Describes the presentation of meningitis in neonates
Management of a bulging Fontanelle
Mannitol 0.5g/kg over 10 minutes
Most common organisms causing meningitis in babies <3 mo
MEN-IN-GEL-ITIS
GEL -
Group B strep.
E.coli
Listeria monocytogenes
How to treat meningitis in babies at the GP
IM or IV benpen (before even calling 999)
Management of meningitis in the hospital
<3 mo = Cefotaxime + Amox.
>3 mo = ceftriaxone + dexamethasone
Post exposure prophylaxis for meningitis in babies
Rifampicin or ciprofloxacin
Most common causative org. In uti
E.coli due to vesicoureteric reflux
Diagnosis of uti in babies
Abdominal USS
Urine dipstick / or clean catch sample in babies
Management of lower uti in babies over 3 months
PO antibiotics for THREE days
Either trimethoprim or nitrofurantoin
Maannagemt of lower uti in babies under 3 months
IV amox. + gentamicin
Management for upper UTI in babies of any age
Admit to hospital for IV amoxicillin + gentamicin
How to investigate for vesicoureteric reflux
Mistrusting cystourethrogram
Cause of measles
Paramyxovirus
*kolpik spots
measles
(They are white spots on the buccal mucosa)
What is the most common complication of measles
Otitis media
Think mEARsles
Causative organism for rubella
Togavrus
Causative organism for scarlet fever
Group A strep pyogenes
Management of scarlet fever
Oral penicillin V (10 days) notify public health
Cause of mumps
Paramyxovirus
What is the main complication of mumps
Orchiditis
Cause of erythema infectiosum
Aka slapped cheek syndrome , parvovirus b19
Causative organism for hand foot n mouth
Coxsakie virus A16
Management for hand foot n mouth
Is self limiting
Suspicion of epiglottis ?
Send them straight to senior ENT specialists
*steeple sign
Croup
*thumb print sign
Epiglottis I
Why is there male infertility in cystic fibrosis
Bilateral absence of vas deferens
Management of whooping cough
Oral macrolide (erythromycin etc)
Diagnostic test for whooping cough
Nasal swab
Medication in CF
Lumacaftor
What investigation is contraindicated in meningococcal septicaemia
Lumbar puncture
Treatment of transposition of the great arteries
Prostaglandin E1
Treatment for Patent ductus arteriosus
Indomethacin
Gold standard investigation for pyloric stenosis
Abdominal ultrasound
Forceps delivery can lead to what in a baby
Elevated bilirubin (haemolysis due to bruising)
At what age should hearing be formally tested first
Newborn - in the otoacoustic emission test
