child health Flashcards
preterm
a birth that occurs before 37 completed weeks of gestation
term
a birth between 37 weeks and 42 weeks of gestation
post-term
a birth that occurs after 42 weeks of gestation
normal weight for a baby
2.5-4kg
what happens in the 3rd trimester
- Daily weight gain of 24g during 3rd trimester
- Approx. 7g of fat per day in last 4 weeks
- Transplacental transfer - iron, vitamins, calcium, phosphate and antibodies
what vitamin should be given at birth
Vitamin K given in the newborn period given to prevent haemorrhagic disease of the newborn - clotting (vitamin K dependent)
list some complications of a pre-term pregnancy
- hypothermia
- Neonatal sepsis
- Respiratory distress syndrome
- Retinopathy of prematurity - usually 6-8 weeks after delivery
a higher apgar score is worse for babys
false - high score is good
give respiratory complications of the newborn
Transient tachypnoea of the newborn (TTN) - fluid in the lungs does not clear away
Pneumothorax
Congenital respiratory disease
- Tracheo-oesophageal fistula
- Diaphragmatic hernia
give cardiac complications of the newborn
Hydrops foetalis - rhesus disease, chromosomal
persistent pulmonary hypertension of the newborn (PPHN)
Congenital heart disease
give initial management of a sick newborn
- Stabilise temperature - 36.5-37.4℃
- Airway and breathing - gentle support (e.g. open airway), consider oxygen as needed
- Circulation - fluids, inotropes
- Metabolic homeostasis - glucose management, correction of acid-base balance
- Antibiotics
give causative organisms of early onset sepsis of the newborn
gram negative group B streptococcus
give causative organisms of LATE onset sepsis of the newborn (after birth)
- Gram negatives
- Staph. aureus
- Coagulase negative staphylococci
management of neonatal sepsis
- Prevention - hand washing, vigilance, infection screening
- Antibiotics
- Supportive measures
which type of jaundice can be Both physiological and pathological
unconjucated
conjugated is always pathological
define prolonged jaundice
over 14 days in a term baby or 21 days in a preterm baby
give investigations for early jaundice
FBC/SBR/DCT, investigate underlying cause
give investigations for prolonged jaundice
FBC/LFTs/SBR/TFTs, further investigation if required
give management for early and prolonged jaundice
early
- Phototherapy
- Adequate hydration
- Resolve underlying cause
prolonged
- Resolve underlying cause
outline NRDS
Affects 75% of infants born before 29 weeks - born before the lungs start producing adequate surfactant
pathophysiology of NRDS
- Inadequate surfactant leads to high surface tension within alveoli
- This leads to atelectasis (lung collapse)
- This leads to inadequate gaseous exchange
clinical presentation of NRDS
- Respiratory distress - tachypoea, grunting, intercostal recessions, nasal flaring, cyanosis
- Worsens over minutes to hours til 2-4 days then gradual improvement
management for NRDS
- Maternal steroid
- Surfactant replacement
- Ventilation (non-invasive preferred over invasive)
define neonatal abstinence syndrome
Refers to the withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy
clinical presentation of NAS
- CNS: irritability, tremors, seizures
- Vasomotor and respiratory: sweating, unstable temperature, tachypnoea
- Metabolic and GI: poor feeding, regurgitation/vomiting, hypoglycaemia
management for NAS
notes should have an alert which allows for extra monitoring and management
kept in hospital for 3 days on a NAS chart to monitor for withdrawals
support in a quiet and dim environment
what BGL defines neonatal hypoglycaemia
BGL < 2.6 mmol/l
presentation of neonatal hypoglycaemia
- Lethargy
- Jitteriness
- Seizure activity
management of neonatal hypoglycaemia
keep baby warm
feed
if unsafe to feed IV glucose
define birth asphyxia
Occurs when a baby doesn’t receive enough oxygen before, during or just after birth
causes of birth asphyxia
- 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
give a major complication of birth asphyxia
Hypoxic Ischaemic Encephalopathy - Multi-organ damage due to tissue hypoxia
what can babies with HIE benefit from
therapeutic hypothermia - reduces the risk of cerebral palsy, developmental delay, learning disability, blindness and death
describe hydrocephalus
> Describes cerebrospinal fluid (CSF) building up abnormally within the brain and spinal cord
- Result of either over-production of CSF or a problem with draining or absorbing CSF
clinical presentation of hydrocephalus
- Enlarged and rapidly increasing head circumference
- Bulging anterior fontanelle
- Poor feeding and vomiting
- Poor tone
- Sleepiness
Investigations and management of hydrocephalus
transcranial ultrasound
Ventriculoperitoneal shunt
define necrotising enterocolitis
> Disorder affecting premature neonates, where part of the bowel becomes necrotic
- Serious intestinal injury to a relatively immature gut (e.g. premature baby being fed too early) resulting in perforation
clinical presentations of necrotising enterocolitis
- Intolerance to feeds
- Vomiting, particularly with green bile
- Generally unwell
- Distended, tender abdomen
- Absent bowel sounds
- Blood in stools
what is the investigation of choice for necrotising enterocolitis and what will it show
AXR
- Dilated loops of bowel
- Bowel wall oedema
- Gas in bowel wall
- Gas in peritoneal cavity (pneumoperitoneum) indicates perforation
management of necrotising enterocolitis
- Nil by mouth, clindamycin and cefotaxime
- Immediate referral to the neonatal surgical team
describe intraventricular heamorrhage
Bleeding into the ventricles inside the brain; in neonates occurs mainly in premature infants
what is the most common type of intraventricular haemorrhage
Germinal matrix is the most common type - related to perinatal stress affecting the highly vascularised germinal matrix
define jejunal atresia
Congenital anomaly characterised by obliteration of the lumen of the jejunum
clincial presentation of jejunal atresia
Neonates typically present with abdominal distension and bilious vomiting within the first 24 hours of birth
management of jejunal atresia
surgical correction
define malrotation
Congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis
clinical presentation of malrotation
- Most common presentation in the infant is midgut volvulus - presents with bilious (green) vomiting
- Up to 40% of patients with malrotation show signs within the first week of life
give investigations and management for malrotation
upper GI contrast and followthrough
surgical correction
outline meconium ileus (BUBBLY APPEARANCE)
> Refers to a neonatal bowel obstruction of the distal ileum due to abnormally thick and impacted meconium
- Usually a manifestation of cystic fibrosis
- x-ray
define cerebral palsy
Cerebral palsy (CP) is the name given to the permanent neurological problems resulting from damage to the brain around the time of birth (from prenatal to < 1 month postnatal)
give antenatal causes of CP
- Maternal infections
- Trauma during pregnancy
give perinatal causes of CP
- Birth asphyxia
- Pre-term birth
give postnatal causes of CP
- Meningitis
- Severe neonatal jaundice
- Head injury
clinical presentation of CP
progressive
- Mobility problems, spasticity and
orthopaedic problems
- Learning difficulties
- Epilepsy
- Visual/hearing impairment
- Communication difficulties
- Feeding difficulties
- Sleep problems
- Behavioural problems
aetiology of bronchiolitis
RSV
<1 year, usually under 6 months
clinical presentation of bronchiolitis
- Viral URTI symptoms (coryzal symptoms) - running or snotty nose, sneezing, mucus in throat and watery eyes
- Dyspnoea
- Tachypnoea
- Poor feeding
- Mild fever (under 39ºC)
- Apnoeas
- Signs of respiratory distress
- Wheeze and crackles on auscultation
management of bronchiolitis
supportive
define croup
Upper respiratory tract infection causing oedema in the larynx
what is the most common causative organism in croup
parainfluenza virus
clinical presentation of croup
- Increasedwork of breathing
- ‘Barking’cough, occurring in clusters of coughing episodes
- Hoarse voice
- Stridor
- Low gradefever
management of croup
diagnosis is made clinically
single dose of steroid eg dexamethasone
give features of severe asthma
peak flow < 50% predicted
saturations < 92%
unable to complete sentances in one breath
give features of life threatening asthma
peak flow < 33% predicted
saturations < 92%
exhaustion and poor respiratory effort
hypotension
silent chest
cyanosis
give management of moderate to severe asthma attacks
OHSHITMAN
- Oxygen (at least 60%)
- Salbutamol (neb)
- Oral prednisolone/IV Hydrocortisone
- Ipratropium (neb)
- Theophylline (oral)
- Magnesium sulphate (IV)
- An anesthetist (to intubate)
give the most common causes of pneumonia in children
- Bacterial - Streptococcus pneumonia is most common.
others include Group A and B strep, Staph. aureus and H. influenza
- Viral - RSV is the most common viral cause
give signs of pneumonia
- Bronchial breath sounds - harsh breath sounds that are equally loud on inspiration and expiration, caused by consolidation of the lung tissue around the airway
- Focal coarse crackles- caused by air passing through sputum
- Dullness to percussion- due to lung tissue collapse and/or consolidation
- delirium
investigations for pneumonia
- CXR
- Blood cultures if signs of sepsis
management for pneumonia
- Amoxicillin first line
- Macrolide antibiotics e.g. erythromycin can be added to cover atypical pneumonia, or as a monotherapy in penicillin allergic patients
what is the most common heart rhythms in children
SVT
There are four main types:
- atrial fibrillation,
- paroxysmal supraventricular
tachycardia (PSVT),
- atrial flutter
- Wolff–Parkinson–White syndrome
describe infective endocarditis
Rare but severe bacterial infection of the heart valves
aetiology of infective endocarditis
- Gram-positive bacteria most common - includes viridans group streptococci, staphylococci and enteroccoci
- Can also be caused by gram-negatives and fungi
clinical presentation of infective endocarditis
- Most cases of pediatric endocarditis present subacutely - low-grade fever, malaise, myalgias, arthralgias, and headaches
- New or changing heart murmur may be auscultated
management of infective endocarditis
Obtain culture, then start empirical antibiotics, transition to specific antibiotics based on culture results
definition and aetiology of gastroenteritis
Inflammation all the way from the stomach to the intestines
Most commonly viral - rotavirus, norovirus
clinical presentation of gastroenteritis
- Nausea
- Vomiting
- Diarrhoea
management of gastroenteritis
Ensure patient remains hydrated while waiting for diarrhoea and vomiting to settle - aim for oral rehydration, may require IV fluids
investigations and management for pyloric stenosis
- US scan upper abdomen
- Surgery - pyloromyotomy (open or lap)
describe volvulus
Loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction
aetiology of volvulus
- Congenital intestinal malrotation predisposes to midgut volvulus
- Abnormal intestinal contents e.g. meconium ileus can predispose to segmental volvulus
clinical presentation of volvulus
- Abdominal pain
- Abdominal bloating
- Vomiting bile - green
- Constipation
- Bloody stool
give investigations and management for volvulus
AXR
surgery
describe intussusception
The bowel ‘invaginates’ or ‘telescopes’ into itself, narrowing the lumen, which results in a palpable mass in the abdomen and obstruction to the passage of faeces through the bowel
signs and symptoms of inussusception
- Severe, colicky abdominal pain
- Pale, lethargic and unwell child
- Vomiting
- ‘Redcurrant jelly stool’
- Right upper quadrant mass on palpation
- Can be associated with concurrent viral illness
- bring legs up
- sausage shaped mass
- coffee bean sign
give investigations and management for intussusception
US - TARGET sign
air reduction - relieves obstruction in > 85%
surgical reduction
signs of appendicitis
- Tenderness in McBurney’s point
- Rosving’s sign- palpation of theleft iliac fossacauses pain in theRIF
give investigation for children with suspected UTI
Urine clean catch sample with microbiology
give management for UTIs in children
- All children under 3 months with a fever should start immediate IV antibiotics
- Oral antibiotics can be considered in children over 3 months if they are otherwise well
- Children with features of sepsis or pyelonephritis (infection affecting kidney function) will require inpatient treatment with IV antibiotics
give the cause and management of epidymoorchitis in kids
result of retrograde bacterial colonisation via the ejaculatory ducts and vas deferens
analgaesia and antibiotics
where is the appendix of the testis (hydatid of morgagni) located
located at the upper pole of the testis (between the testis and the head of the epididymis)
define hydrocoele
Collection of fluid within the tunica vaginalis that surrounds the testes
clinical presentation of a hydrocoele
- Soft, smooth, non-tender swelling around one of the testes
- Transilluminate with light on examination with a pen torch
management of hydroceles
- Simple hydroceles (no connection with peritoneal cavity) usually resolve within 2 years without having any lasting negative effects
- Communicating hydroceles (have a connection with the peritoneal cavity) are managed surgically
outline inguinal hernia
- Part of the bowel pushes through a weakness in the abdominal muscles
- Soft lump in the inguinal region (in the groin)
- Surgical correction
‘empty scrotum’
undescended testis
when should surgical correction of undescended testis be carried out
6 and 12 months of age if testes still have not descended
outline Bxo balanitis xerotica obliterans
- Chronic inflammatory process which affects the foreskin but can also extend onto the glans and external urethral meatus
- Keratinisation of the tip of the foreskin causes scaring and the prepuce remains non-retractile
- Circumcision
outline Hypospadias
- Congenital defect causing the urethral meatus to be located at an abnormal site, usually on the under side of the penis rather than at the tip
- Surgical correction
what is encephalitis
inflammation of the brain
what is the most common cause of encephalitis
HSV
clinical presentation of encephalitis
- Altered consciousness
- Altered cognition
- Unusual behaviour
- Acute onset of focal neurological symptoms
- Acute onset of focal seizures
- Fever
investigations and management of encephalitis
- Lumbar puncture and imaging
- Antiviral medications - aciclovir treats HSV and VZV
what is the most common bacterial cause of meningitis in children and adults
Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus) in children and adults
what is the most common bacterial cause of meningitis in neonates
groub b strep
what are the most common viral causes of meningitis
hsv and vzv
signs and symptoms of meningitis
-neck stiffness
-photophobia
-altered consciousness or seizures
-non-blanching rash in meningococcal septicaemia
what is the best investigation for sepsis
lumbar puncture
management for bacterial meningitis
- Under 3 months- cefotaxime plus amoxicillin
- Above 3 months- ceftriaxone
- If penicillin allergic: chloramphenicol
- Steroids e.g. dexamethasone to reduce the frequency and severity of hearing loss and neurological damage
treatment of viral meningitis
- Tends to be milder and often only requires supportive treatment
- Aciclovir can be used to treat suspected or confirmed HSV or VZV infection
give clinical features of patients with downs syndrome
- Hypotonia
- Brachycephaly(small head with a flat back)
- Short neck
- Short stature
- Distinctive facial features
- Prominent tongue
- Flattened face and nose
- Prominent epicanthic folds
- Brushfield spots
give complications of downs syndrome
- learning disabilities
- recurrent otitis media
- deafness (glue ear)
- eye => myopia, strabismus, cataracts
- hypothyroidism
- cardiac defects - ASD, VSD, PDA, TOF
- GI issues - Hirschsprungs disease,
duodenal atresia - diabetes and coelic
- leukaemia
outline screening for downs syndrome patients
- High risk of cardiac, visual and hearing defects
- Much more prone to hypothyroidism - check TFTs annually
- Screening for sleep-related breathing disorders e.g. OSA
- Specific growth charts and developmental milestones
clinical presentation of prader-willi syndrome
- At birth - very floppy, ability to suck weak or absent, tube feeding common
- Childhood - hyperphagia (food seeking
and lack of satiety) - Learning difficulties
- Hypogonadism
- Short stature
clinical presentations of Barget-Biedl syndrome
- Visual impairment, renal abnormalities, polydactyly,
learning difficulties, hypogonadism, obesity - Hyperphagia
what is the leading cause of death globally
diarrhoea
give the aetiology of diarrhoea
- rotavirus, E. coli
- Usually caused by faeces-infected water or food
give causes and the result of reactive attachment disorder
- Persistent disregard for the child’s emotional needs for comfort, stimulation and affection
- Persistent disregard for the child’s physical needs
- Repeated changes of the primary caregivers
- As a result of this the child has difficulty forming lasting, loving, intimate relationships
give risk factors for reactive attachment disorder
- Adverse childhood experiences - abuse, neglect, household dysfunction
- Increased likelihood if child is orphaned at a young age
conduct disorder
children with CD are able to form some satisfying relationships with peers and adults
depression
depressed children are often able to form appropriate social relations with those who reach out to them
ADHD
children with ADHD are more able to initiate and maintain relationships
risk factors for TB
- HIV - over 50% of TB cases in Sub-
Saharan Africa are co-infected with HIV - Malnutrition
- Household contact
- middle/lower income countries 95%
clinical presentation of TB
- Chronic cough or fever >2 weeks
- Night sweats
- Weight loss
- Lymphadenopathy
give X-ray finding in TB
- Shadows, lesions, consolidation
- Ghon focus in periphery of mid zone
of lung - primary site of infection - Bilateral hilar lymphadenopathy
- ‘Miliary shadowing’ = miliary TB
give treatment for active TB
Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for 4 months, then Rifampicin and Isoniazid for a further 2 months
treatment of latent TB
Rifampicin and Isoniazid for 3 months OR Isoniazid for 6 months
what age do febrile seizures take place
6 months - 5 years
management of febrile seizures
- Identify and manage underlying infection
- Control the fever with simple analgesia such as paracetamol and ibuprofen
- Reassure parents
what is the most common cause of syncope in children
vasovagal episodes
define a vasovagal episode
Type of reflex syncope, involves vagal stimulation triggered by emotional distress or orthstatic stress
give triggers of vasovagal episodes
prolonged standing, emotional stress, pain, the sight of blood
management of vasovagal episodes
- Reassurance
- Education - avoidance of triggers, how to avert faint through manoevers to increase venous return e.g. horizonal gravity neutralisation position
outline reflex anoxic seizures
- Occur when the child is startled, most commonly a minor bump to the head
- The vagus nerve sends strong signals to the heart - causes it to stop beating
- child will go pale, lose consciousness
and may start to have some seizure-
like muscle twitching - Within 30 seconds the heart restarts and the child becomes conscious again
management for reflex anoxic seizures
After excluding other pathology and making a diagnosis, educating and reassuring parents is the key to management
outline epilepsy
- Umbrella term for a condition where there is a tendency to have seizures
- Seizures are transient episodes of abnormal electrical activity in the brain
epilepsy investigations
Investigations include electroencephalogram (EEG) and MRI brain
epilepsy management
- Education about how to manage seizure
- Anti-epileptic medication
describe chickenpox
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
describe measles
Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
describe mumps
muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
describe rubella
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
describe erythema infectiousum
Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
describe scarlett fever
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
describe hand, foot and mouth disease
Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet
what condition can mimic appendicitis.
meckels diverticulum
what organism causes impetigo
staph. aureus
strep. pyogenes
what is the most common ocular malignancy seen in children
retinoblastoma
features of kawasakis
Dry cracked lips
Bilateral conjunctivitis
Peeling of skin on fingers and toes
Cervical lymphadenopathy
Red rash over trunk
what is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years
meckels diverticulum
what investigation is contraindicated in patients with any sign of meningococcal septicaemia
lumbar puncture
what age do umbilical hernias usually resolve by
3
complication of kawasakis
coronary artery aneurysm
red flags for development
6 months = not reaching for object
10 months = no smile or speech
12 months = cannot sit unsupported & has preferential use of one hand (cerebral palsy)
18 months = cannot walk
antenatal causes of CP (think olympics)
TORCH
Toxoplasmosis
Rubella
CMV
Herpes simplex
what is the most common cause of UTI in children
Cause = E. Coli (80%)
“Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium”
Ix for vesicoureteric reflux
Micturating cystourethrogram
most common complication of measles
otitis media
what is the cause of scarlett fever
Group A Strep Pyogenes
management for scarlett fever
Oral Penicillin V (10 days)
cause of mumps
Paramyxovirus
complications of slapped cheek syndrome
Sickle cell anaemia 🡪 sickle cell crisis
Aplastic anaemia
Spontaneous abortions in pregnancy <20wks
management for UTI < 3 months
IV ABX
management for UTI > 3 months
PO ABX
management for upper UTI in kids
admission
management for acute epiglottitis
Immediate senior ENT help
IV Ceftriaxone + Oxygen
Do not examine the throat
what sign is seen on X ray in epiglottitis
thumb print sign
what sign is seen on X ray in croup
steeple sign
what is the mode of inheritance in CF
Autosomal recessive: CFTR gene mutation 🡪 Chromosome 7
cause of epiglottitis
H. Influenzae
investigation and management for pertussis
Dx: nasal-swab
-mycin ABX
how do you differentiate between septic arthritis and transient synovitis of the hip
CRP is norm in TS
management of neonatal sepsis
IV Benzyl-penicillin + gentamicin
