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