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Year 4 > Child health 3 > Flashcards

Child health 3 Flashcards

1
Q

Bacteraemia vs septicaemia

A

> bacteraemia = presence of bacteria in the BS
septicaemia = presence of pathogens in the BS -> sepsis

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2
Q

Diagnosing infections

A

> urine
blood tests & culture
CXR
lumbar puncture for CSF
resp secretions
swabs

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3
Q

Croup

A

> viral
hoarse voice
barking cough
resp distress

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4
Q

Epiglottis

A

> Bacterial
child looks septic, drooling, soft stridor
avoid examining
call for senior help

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5
Q

chemoprophylaxis

A

> refers to the administration of a medication for the purpose
of preventing disease or infection

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6
Q

When should vaccines be avoided

A

during febrile illness

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7
Q

absolute CI to vaccines

A

> Absolute CI: severe local or generalised reaction previously
Not given when on systemic steroids or immunosupression

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8
Q

Gap between ig and live vaccine administration

A

12 week gap between human immunoglobulin and live vaccine administration

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9
Q

vaccines: egg allergy

A

influenza, yellow fever, hepatitis A

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10
Q

What could be causing a pyrexia of unknown origin

A

> Infectious diseases – bacterial, viral, fungal, parasitic
Connective tissue disorders
Malignancy
Miscellaneous
• Drug fever
• Inflammatory bowel disease
• Sarcoidosis

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11
Q

Kawasaki disease

A

> fever lasting 5+ days without any other cause
at least 4 out of 5:
• Bilateral non-purulent conjunctivitis
• Polymorphous rash
• Cervical lymphadenopathy
• Peripheral peeling / oedema / erythema
• Oral mucous membrane changes

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12
Q

Causes of stridor in children

A

> Croup
acute epiglottis
laryngomalacia
inhaled foreign body

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13
Q

Features of inhaled foreign body

A

> Features are of sudden onset
coughing
choking
vomiting
stridor

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14
Q

Laryngomalacia

A

> Congenital abnormality of the larynx.
Infants typical present at 4 weeks of age with:
stridor

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15
Q

What is croup

A

> upper resp TI seen in infants and toddlers
stridor from laryngeal oedema and secretions
caused by parainfluenza viruses
more common in autumn

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16
Q

CF of croup

A

> cough - barking, worse at night
stridor (do not examine throat at the risk of prec airway obstruction)
fever
coryzal symptoms
inc work of breathing e.g. retraction

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17
Q

Grading severity of croup

A

> Image

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18
Q

Ix for croup

A

> Most diagnosed clinically
if a CXR is done:
PA view will show subglottic narrowing - steeple sign
lateral view will show swelling of the epiglottis - thumb sign

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19
Q

Mx of croup

A

> single dose of dexamethasone to all kids regardless of severity
predinsolone is the alt

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20
Q

Emergency Tx of croup

A

> high-flow oxygen
nebulised adrenaline

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21
Q

Epiglottitis

A

> caused by haemophilus influenza type B -> swelling can completely occlude airways -> life threatening
children vaccinated against haemophilus (higher risk in unvaccinated kids)

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22
Q

Presentation of epiglottitis in exams

A

> unvaccinated child presenting with a fever, sore throat, difficulty swallowing that is sitting forward and drooling and suspect epiglottitis.

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23
Q

Presentation Suggesting Possible Epiglottitis

A

> Patient presenting with a sore throat and stridor
Drooling
Tripod position, sat forward with a hand on each knee
High fever
Difficulty or painful swallowing
Muffled voice
Scared and quiet child
Septic and unwell appearance

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24
Q

investigations for epiglottitis

A

> if ppt acutely unwell then do not perform Ix
XR of neck shows thumb sign - soft tissue shadow that looks like a thumb pressed into the trachea.

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25
Q

Mx of eoglottitis

A

> do not distress the child
prepare to intubate
once airway is secure:
IV antibiotics (e.g. ceftriaxone)
Steroids (i.e. dexamethasone)

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26
Q

Common complication of epiglottitis

A

A common complication to be aware of is the development of an epiglottic abscess, which is a collection of pus around the epiglottis. This also threatens the airway, making it a life threatening emergency. Treatment is similar to epiglottitis.

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27
Q

Mx of mild croup at home

A

> Symptoms usually resolve within 48 hours, although some episodes may last for up to one week.
Parents/carers should be advised to give paracetamol or ibuprofen to control fever and pain and to seek urgent medical advice if there is any deterioration.
Hospital admission may be required in some cases, for example if there is chronic lung disease, congenital heart disease, immunodeficiency, respiratory rate of over 60 breaths/minute, high fever, or inadequate fluid intake.

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28
Q

croup - what is an indicatio for admission

A

Croup: audible stridor at rest is an indication for admission

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29
Q

Mild croup

A

> Occasional barking cough with no stridor at rest
No or mild recessions
Well looking child

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30
Q

Moderate croup

A

> Frequent barking cough and stridor at rest
Recessions at rest
No distress

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31
Q

Severe croup

A

> Prominent inspiratory stridor at rest
Marked recessions
Distress, agitation or lethargy
Tachycardia

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32
Q

most common cause of stridor in infants

A

laryngomalacia - made worse by eating

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33
Q

Bronciolotis

A

> acute bronchiolar inflammation
Caused by RSV
LTRI -> wheeze
Peaks in winter

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34
Q

what can cause bronchiolitis to be more severe

A

> premature
CF
congenital HD

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35
Q

features of bronchiolitis

A

> coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory crackles (not always present)

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36
Q

Immediate referral for bronchiolitis

A

> apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.

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37
Q

Ix for bronchiolitis

A

immunofluorescence of nasopharyngeal secretions may show RSV

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38
Q

Mx of bronchiolitis

A

> humidified O2 if sats under 92%
nasogasrric feeding if can’t feed enough by mouth
suction if excessive upper airway secretions

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39
Q

peak incidence of bronchiolitis

A

> aged 3-6 months

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40
Q

what necessitates referral to hospital in bronchiolitis

A

In bronchiolitis, the presence of grunting necessitates immediate referral to hospital - grunting shows severe resp distress

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41
Q

red flags under 5

A

> Red flags in febrile under 5s; RUSH G! Recessions (moderate or severe) - indicating increased work of breathing
Unarousable - indicating reduced consciousness
Skin colour changes (blue/mottled) - indicating severe cyanosis
Hydration - reduced skin turgor - indicating severe dehydration
Grunting - increased work of breathing

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42
Q

perthes disease is more common in

A

boys. Primary school kids

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43
Q

what is the diagnosic test for hirschsprungs disease

A

rectal biopsy - definitive

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44
Q

GORD in babies presentation

A

Infant < 8 weeks, presents with milky vomits after feeds, often after being laid flat, excessive crying → ? GORD

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45
Q

duodenal atresia presentation

A

> ould typically present earlier in life, possibly a few hours after birth. It would present with projectile and bilious vomiting

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46
Q

GE pres in an infant

A

Gastroenteritis is commonly caused by a viral infection, typically resulting in a fever and tachycardia. This could be associated with stool changes,

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47
Q

cardiac deficit assoc w fragile X

A

MVP

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48
Q

What is associated w kartagners syndrome

A

bronchiectasis

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49
Q

Perthes disease classical presentation

A

> 4-8 year old boy
irritable hip, limp (progressive), and reduced range of motion, despite no history of trauma or systemic symptoms
X ray can demonstrate epiphyseal sclerosis
usually unilateral

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50
Q

ToF features

A

> PROVE
pulmonary stenosis
RVH
Overriding aorta
VSD
Ejection systolic murmur

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51
Q

What inc risk of autism

A

> Trinucleotide repeat disorder of X chromosome
fragile X -> autism

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52
Q

what determines degree of cyanosis and severity in TOF

A

Right ventricular outflow obst

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53
Q

NSAIDs (ibuprofen) use in chicken pox

A

NSAIDs can increase the risk of necrotising fasciitis in patients with chicken pox

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54
Q

Mx of acute limp for kids

A

Urgent assessment should be arranged for a child < 3 years presenting with an acute limp - NICE guidance states transient synovitis is rare in this age group and septic arthritis more common - an urgent specialist assessment is therefore indicated for a child < 3 years with an acute limp.

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55
Q

Transient synovitis pres

A

> acute
after viral infection normally
more common in boys

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56
Q

Septic arthititis/ osteomyelitis

A

unwell child, high fever

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57
Q

Juvenile idiopathic arthiritis - limp

A

may be painless

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58
Q

DDH - diagnosis

A

> usually detected in neonates
6x more common in girls

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59
Q

Perthes vs SUFE

A

> Perthes - 4-8 (primary school kids)
avascular necrosis
SUFE - 10 -15 (secondary school), associated w obesity,
displacement of femoral head posteriorly

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60
Q

first signs of puberty

A

> girls: breast development
boys: testicular volume increases

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61
Q

ToF pres

A

: Cyanosis or collapse in first month of life, hypercyanotic spells. Ejection systolic murmur at left sternal edge

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62
Q

TGA vs TOF

A

> Cyanotic congenital heart disease presenting within the first days of life is TGA.
Cyanotic congenital heart disease presenting at 1-2 months of age is TOF

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63
Q

Red flag pointing at hirschsprungs

A

delayed passage of meconium

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64
Q

Infant with bilious vomiting & obstruction → ?

A

intestinal malrotation

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65
Q

chickenpox CF

A

prodrome of raised temperature before the rash begins on the torso and face

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66
Q

What can be given for chickenpox

A

topical calamine lotion

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67
Q

first lines for GORD

A

Breastfed infants: Prescribe a 1-2 week trial of an alginate e.g. Gaviscon)

Bottle fed baby: Prescribe a 1-2 week trial of feed thickener i

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68
Q

prophylaxis for aspleic/ hypospleic ppts

A

> 5 yr pneumococcal booster

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69
Q

labetolol use in mother increases risk of

A

hypoglycaemia, measure BG levels of baby

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70
Q

Most common presentation of neonatal sepsis

A

Grunting and other signs of respiratory distress are the most common presentation of neonatal sepsis

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71
Q

triad of fat embolism

A

> Triad of symptoms:
Respiratory
Neurological
Petechial rash (tends to occur after the first 2 symptoms)

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72
Q

Organisms causing post splenectomy sepsis:

A

> Streptococcus pneumoniae
Haemophilus influenzae
Meningococci

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73
Q

most common cause of neonatal sepsis

A

group B strep (strep agalactiae)

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74
Q

hypothermia - rapid rewarming can lead to

A

rapid rewarming can lead to peripheral vasodilation and shock

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75
Q

billous vomiting on first day is likely due to

A

atresia

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76
Q

referral for acute stridor

A

> moderate croup: paeds
foreign body aspiration: ENT
epiglottitis: A&E
Anaphylaxis (IM adrenaline -> ED)

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77
Q

viral URTI symptoms

A

> nasal discharge, nasal obstruction, sore throat, headache, cough, tiredness and general malaise.

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78
Q

signs of URTI

A

> Erythema or injection of the back of the throat
Nasal discharge
Tender cervical lymphadenopathy
Mild fever

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79
Q

chickenpox CF

A

> Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild

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80
Q

Measles CF

A

> Prodrome: irritable, conjunctivitis, fever
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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81
Q

Spots seen in measles

A

koplik spots - white spots on buccal mucosa

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82
Q

mumps CF

A

> Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral

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83
Q

rubella CF

A

> Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

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84
Q

Erythema infectiosum

A

> slapped cheek syndrome
caused by parovirus B19
Lethargy, fever, headache

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85
Q

rash in erythema infectosum

A

‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

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86
Q

scarlet fever CF

A

> Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue

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87
Q

Rash in scarlet fever

A

> fine punctate erythema sparing the area around the mouth (circumoral pallor)

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88
Q

hand, foot and mouth disease is caused by

A

Caused by the coxsackie A16 virus

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89
Q

H F and M features

A

> Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

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90
Q

infectivity of chicken pox

A

> 4 days before rash
infectious until all lesions crusted over (isolate from school)

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91
Q

newborns and IC patients and chicken pox

A

> IC and newborns w peripartum exposure should get varicella zoster immunoglobulin
consider IV aciclovir if CP develops

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92
Q

post exposure prophylaxis for CP

A

> sign exposure
risk of severe infection: IS, pregnancy, neonates
no ab to VZV
. Give varicella zoster immunoglobulin

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93
Q

Rf for shingles

A

> age
HIV
immunosuppression - steroids, chemo

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94
Q

features of shingles

A

> most commonly affects T1-L2 dermatomes
burning pain over affected deratome, may be severe enough to interfere w sleep
rash - macular but then becomes vesicular
rash does nort cross the midline - stays within dermatome

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95
Q

Mx of shingles

A

> paracteamol/ NSAIDs first line for pain relief
Amitryptine can be used second
oral steroids if severe pain as 3)

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96
Q

Antivirals in shingles

A

> if moderate/ severe w RD
aciclovir or famciclovir
reduced incidence of post herpertic neuralgia

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97
Q

complications of shingles

A

> post herpetic neuralgia - most common
herpes zoster ophthalmicus
herpes zoster oticus (Ramsay Hunt syndrome): may result in ear lesions and facial paralysis

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98
Q

NSAIDs can be used in

A

shingles but not CP

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99
Q

features of kawasaki disease

A

> high fever, lasts more than 5 days - resistant to AP
conjunctivitis
bright red cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel

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100
Q

complication of kawasaki

A

coronary artery aneurysm - screened for using echo

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101
Q

Mx of kawasaki

A

> high dose aspirin
IV immunoglobulin

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102
Q

Measles pathogen

A

> RNA virus
aerosol transmission
incubation period 10-14 days

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103
Q

Ix of measles

A

> IgM antibodies can be detected within a few days of rash onset

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104
Q

Mx of measles

A

> admission may be considered in immunosuppressed or pregnant patients
notifiable disease → inform public health

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105
Q

Comps of measles

A

> otitis media: most common
pneumonia: most common cause of death
encephalitis - usually 1-2 weeks after onset

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106
Q

unvaccinated child who has come into contact w measles

A

give MMR vaccine within 72 hrs

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107
Q

when does mumps tend to occur

A

> RNA virus
winter and spring

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108
Q

Spread of measles?

A

> by droplets
respiratory tract epithelial cells → parotid glands → other tissues
infective 7 days before and 9 days after parotid swelling starts

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109
Q

Mx of measles

A

> rest
paracetamol for high fever/discomfort
notifiable disease

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110
Q

complications of measles

A

> orchitis (mainly post-pubertal males)
hearing loss - usually unilateral and transient

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111
Q

comps of rubella

A

> arthiritis
myocarditis
thrombocytopenia

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112
Q

incubation period for rubella

A

> incubation period is 14-21 days and individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash.

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113
Q

rubella in pregnancy: congenital rubella syndrome

A

> sensorineural deafness
congenital cataracts
congenital HD - e.g. patent DA
Cerebral palsy

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114
Q

diagnosis of rubella

A

> IgM ab raised
check serology for parovirus b19

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115
Q

Mx of rubella

A

> suspected cases of rubella in pregnancy should be discussed with the local Health Protection Unit
non immune mothers should be offered MMR in post natal period
MMR should not be given to women known to be pregnant/ attempting to be (avoid pregnancy 28 days after MMR)

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116
Q

Eryrthema infecriosum - school exclusion

A

not required - no longer infectious by the time rash occurs

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117
Q

scarlet fever pathogen

A

Group A haemolytic streptococci (usually Streptococcus pyogenes

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118
Q

Rash of scarlet fever

A

> pinhead rash - usually on torso and spares palms and soles
children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
rough sandpaper texture
desquamination occurs later in the course of the illness, particularly around the fingers and toes

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119
Q

Mx of scarlet fever

A

> oral penicillin V for 10 days
patients who have a penicillin allergy should be given azithromycin
children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease

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120
Q

comps of scarlet fever

A

> otitis media: most common
rheumatic fever
acute glomerulonephritis

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121
Q

Mx of HFM

A

> symptomatic Tx
school exclusion not required

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122
Q

pneumonia CF

A

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

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123
Q

Signs of pneumonoa

A

> can indicate sepsis secondary to pneumonia
tachycardia, tachypnoea, hypoxia, hypotension, fever, confusion

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124
Q

exam findings of pneumonia

A

> crackles - coarse
dull to percussion
bronchial breath sounds

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125
Q

pathogen causing pneumonia in pre-vaccinated infants

A

Group B strep occurs in pre-vaccinated infants, often contracted during birth as it often colonises the vagina.

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126
Q

most common cause of pneumonia

A

strep

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127
Q

most common viral cause of pneumonia

A

rsv

128
Q

acute bronchitis vs pneumonia

A

> History: Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia.
Examination: No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.

129
Q

When should ab be used for acute brochitis

A

> systemically unwell, co-morbidities, CRP 20-100 (delayed prescription) or CRP > 100 - immediate
use doxycycline

130
Q

Traffic light system - green

A

> normal colour, normal response to cues, awake
normal skin and eyes
no amber or red signs

131
Q

Mx of fever - green

A

managed at home

132
Q

Traffic light system - amber

A

> pallor
no smile, not responding to cues, decreased activity, wakes only w prolonged stimulation
nasal flaring, tachpnoea,
O2 sats less than 95% on air
crackles
reduced urine output
CRT over 3 seconds
dry mucous membranes
poor feeding

133
Q

RR in amber kids (fever)

A

> > 50 in kidsaged 6 -12 months
40 In kids over 12 months

134
Q

pulse in amber kids

A

> > 160 beats/minute, age <12 months
150 beats/minute, age 12-24 months
140 beats/minute, age 2-5 years

135
Q

other features of the amber kid

A

• Age 3-6 months, temperature >=39ºC
• Fever for >=5 days
• Rigors
• Swelling of a limb or joint
• Non-weight bearing limb/not using an extremity

136
Q

red (high risk) fever

A

> pale/ mottled/ ashen/ blue
no resp to cues, appears ill, does not wake or does not stay awake
weak cry
reduced skin turgor

137
Q

resp signs of red fever

A

> resp rate > 60
moderate/ severe chest indrawing

138
Q

red fever - other criteria

A

> under 3 months w a fever over 38 degrees
bulging foantanella
neck stiffness
non blanching rash
status epilepticus
focal neuro signs/ seizures

139
Q

Mx of amber fever

A

> safety net or refer to paeds

140
Q

red fever Mx

A

urgent referral to paeds

141
Q

immunisation for whooping cough

A

> immunised at 2, 3, 4 months
and 3-5 yrs
immunisation does not offer lifelong protection
pregnant women

142
Q

Features of whooping cough

A

> catarrhal phase: sim to VURTI, lasts 1-2 weeks
Paroxysmal phase: cough increases in severity
covalescent phase: cough subsides over weeks to months

143
Q

Cough In whooping cough

A

> coughing bouts are usually worse at night and after feeding, may be ended by vomiting & associated central cyanosis
inspiratory whoop
may be spells of apnoea
persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures

144
Q

diagnostic criteria for whooping cough

A

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
> Paroxysmal cough.
> Inspiratory whoop.
> Post-tussive vomiting.
> Undiagnosed apnoeic attacks in young infants.

145
Q

diagnosis of whooping cough

A

> nasal swab culture
PCR and serology

146
Q

Mx of whooping cough

A

> infants under 6 months with suspect pertussis should be admitted
in the UK pertussis is a notifiable disease
an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread
ab prophylaxis for household conacts

147
Q

school exclusion for whooping cough

A

school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

148
Q

whooping cough vaccine is offered to pregnant women in weeks

A

Women who are between 16-32 weeks pregnant will be offered the vaccine.

149
Q

meningitis vs meningococcal septicaemia vs meningococcal meningitis

A

> meningitis: inflammation of meninges
Meningococcal septicaemia refers to the meningococcus bacterial infection in the bloodstream.
Meningococcal meningitis is when the bacteria is infecting the meninges and the cerebrospinal fluid

150
Q

Pathogens in meningitis

A

> meningococcus (neisseria)
strep pneumonia
neonates: group B strep - susually contracted during birth

151
Q

presetation of meningitis

A

> fever
neck stiffness
vomiting
headache
photophobia
altered consciousness
seizures

152
Q

what is a sign of meningococcal septicaemia

A

non blancing rash

153
Q

signs of meningitis in neonates/ infants

A

non-specific signs and symptoms, such as hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle.

154
Q

Ix for meningitis

A

> lumbar puncture:
Under 1 month presenting with fever
1 to 3 months with fever and are unwell
Under 1 year with unexplained fever and other features of serious illness

155
Q

Tests in meningitis

A

Kernigs, Brudzinkis

156
Q

Kernigs test

A

involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees. This creates a slight stretch in the meninges. Where there is meningitis it will produce spinal pain or resistance to movement.

157
Q

Brudzinskis test

A

involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest. In a positive test this causes the patient to involuntarily flex their hips and knees.

158
Q

Community management of menigitis AND non blanching rash

A

immediately give IV or IM benzylpenicillin and transfer to hospital (in the case of penicillin allergy focus on transferring to hosp)

159
Q

Hospital Mx of meningitis

A

> lumbar puncture for CSF
Blood culture
tests for meningococcal PCR
Ab

160
Q

abs used in meningitis in the hosp

A

> Under 3 months – cefotaxime plus amoxicillin (the amoxicillin is to cover listeria contracted during pregnancy)
Above 3 months – ceftriaxone
add vancomyci if recent travel or prolonged ab exposure
steroids (to reduce hearing damage) - dexamethasone

161
Q

Mx of menigitis - inform

A

PHE - notifiable disease

162
Q

Post exposure prophylaxis for meningitis

A

> highest risk for those in contact w the child 7 days before symptom onset
single dose of ciprofloxacin or rifampicin

163
Q

viral meningits causes

A

> HSV
VZV
enterovirus

164
Q

Tx of viral meningitis

A

aciclovir

165
Q

CSF analysis for meningitis

A

> the immune system releases neutrophils in response to bacteria and lymphocytes in response to viruses.

> image

166
Q

Bacterial meningitis results

A

> Cloudy appearance (bacteria swimming in CSF)
high protein, low glucose (eating glucose)
high neutrophils

167
Q

Viral meningitis results

A

> clear appearance (viruses aren’t alive)
proteins midly raised/ normal
normal glucose
high lymphocytes
negative culture

168
Q

meningitis comps

A

> hearing loss
cerebral palsy
epilepsy

169
Q

Mx of septic shock in kids

A

> IV fluids aggressively
if this fails, transfer to high dependency unit or ICU where ionotropes like noradrenaline can be used

170
Q

Signs if sepsis

A

> prolonged CRT
fever or hypothermia
poor feeding
inconsolable/ high pitched cry/ weak cry
floppy
skin changes - cyanosis, mottled, pale, ashy

171
Q

It is worth remembering that all infantsunder 3 monthswith a temperature of38ºC or above

A

need to be treated urgently for sepsis, until proven otherwise.

172
Q

immediate management of paed sepsis

A

> O2 if shock or levels under 94%
IV access
blood tests and culture (FBC, U&E, CRP, clotting screen (INR), blood gas for lactate and acidosis)
urine dipstick
ab - within 1 hr
fluids if shock or if lactate above 2mmol/L

173
Q

additional tests in sepsis

A

> CXR: pneumonia
abd US
LP: meningitis
Meningococal PCR
Serum cortisol: adrenal crisis

174
Q

Sepsis - ab use

A

> continue for 5-7 days
stop when there is low suspicion of bacterial infection, patient is well, blood cultures and CRP results are negative at 48 hrs

175
Q

Which vaccines are given to neonates at risk

A

> BCG if RF - (e.g. Tuberculosis in the family in the past 6 months).
hep B - birth, 4 weeks, and 1 yr

176
Q

2 months - vaccines

A

> ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B

177
Q

3 months - vaccine

A

> 6 in 1
oral rotavirus vaccine
PCV

178
Q

4 months - vaccibe

A

> 6 in 1
men B

179
Q

12-13 months vaccines

A

> Hib / men c
MMR
PCV
men B

180
Q

2-8 yrs vaccines

A

flu - annual

181
Q

3-4 yrs vaccines

A

4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR

182
Q

12-13 yrs vaccine

A

HPV

183
Q

13-18 yrs vaccie

A

> 3 in 1 teenage booster - tetanus, diptheria, polio
men ACWY

184
Q

females of child bearing age susceptible to rubella vaccine

A

mmr - exclude pregnancy before vaccinating and avoid pregnancy for one month after

185
Q

pregnant females vaccies

A

> pertussis
DPT
influenza - inactivates

186
Q

over 65s vaccines

A

> influenza - annual
pneumococcal

187
Q

herpes zoster vaccine

A

> aged 65 and 70-79

188
Q

which vaccine is not routinely given in the first 6 months of life

A

mmr

189
Q

Most common cause of viral meningitis in adults

A

enterovirus (e.g. coxsackie)

190
Q

men B schedule mneumonic

A

> B is second letter of the alphabet = 2 months

> second dose = double this -> 2 x 2 = 4 months

> Third dose = triple this -> 4 x 3 = 12 months

191
Q

when not to do a LP

A

Suspected bacterial meningitis: an LP should not be done if there signs of severe sepsis or a rapidly evolving rash - possible raised ICP
> Do LP for meningitis BUT NOT meningococcal septicaemia

192
Q

Cushings reflex

A

> bradycardia
HTN
CI TO LP!!!

193
Q

who gets the HPV vaccine

A

All boys aged 12-13 (school year 8) are now offered the HPV vaccine as well as girls

194
Q

when not to use dexamethasone in meningitis

A

> child under 3
meningococcal septicaemia: non blanchig rash

195
Q

Prematurity =

A

> birth before 37 weeks gestation
under 28 weeks: extreme pretrm
28-32 weeks: very preterm
32-37 weeks: moderate-late preterm

196
Q

associations of prematurity

A

> social deprivation, smoking, alc, drugs
overweight, underweight mother
twins

197
Q

In women with a history of preterm birth or an ultrasound demonstrating a cervical length of 25mm or less before 24 weeks gestation there are two options of trying to delay birth:

A

> prophylactic vaginal progesterone: discourages labour
prophylactic cervucal cerclage - putting a suture in cervix to hold it closed

198
Q

options to improve outcomes for preterm labour

A

> tocolysis with nifedepine
maternal corticosteroids
IV Mg sulphate

199
Q

risks of prematurity

A

> resp distress syndrome
intraventricular haemorrhage
NEC
chronic lung disease, hypothermia, feeding problems, infection, jaundice
Hearing problems

200
Q

retinopathy of prematurity

A

> imp cause of visual impairment in babies born before 32 weeks
overoxygenation e.g. during ventilation -> proliferation of retinal blood vessels (neovascularisation)

201
Q

long term effects of prematurity

A

> chronic lung disease of prematurity
LDs
resp tract infections
CP

202
Q

Neonatal apnoea

A

> very common in premature neonates
occurs in almost all babies under 28 weeks
brief periods of stopping breathing, oxygen desat, bradycardia

203
Q

management of neonatal apnoea

A

> apnoea monitors
tactile stim to prompt baby to breathe
IV caffiene can be used to treat recurrent episodes

204
Q

CXR of resp distress syndrome

A

> ground glass appearance

205
Q

what is resp distress syndrome

A

> ffects premature neonates, born before the lungs start producing adequate surfactant - commonly below 32 weeks
not enough surfactant -> lung collapse -> inadequate gas exchange -> resp distress

206
Q

incidence of resp distress reduced by

A

antenatal steroids ie. Dexamethasone in mother -> inc surfactant

207
Q

Mx of resp distress

A

> intubation and V if severe
endotracheal surfactant
CPAP
O2

208
Q

comps of neonatal resp distress

A

> pneumothorax
apnoea
retinopathy of prem more common
hearing and visual impairment

209
Q

neonatal abstinence syndrome

A

> withdrawal symptoms happen in neonates of mothers who used substances in pregnancy

210
Q

Withdrawal from most opiates, diazepam, SSRIs and alcohol occurs between after birth

A

3 – 72 hours

211
Q

withdrawal from methadone and other benzos occurs between

A

24 hrs and 21 days

212
Q

Symptoms of neonatal withdrawal

A

> tachypnoea
sweating
unstable T and pyrexia
poor feeding, vomiting, hypoglycaemia
irritable, high pitched cry, tremors, seizures

213
Q

medical management of NAS

A

> Oral morphine sulphate for opiate withdrawal
Oral phenobarbitone for non-opiate withdrawal
SSRIs don’t need medical Tx

214
Q

risks of SIDs

A

> usually within first 6 months
prematurity
Low birth weight
male baby
smoking in pregnancy

215
Q

reducing risk of SIDS

A

> Baby on their back
keeping head uncovered
cot clear of toys and blankets
avoid smoking
avoid co sleeping
If co-sleeping avoid alcohol, drugs, smoking, sleeping tablets or deep sleepers

216
Q

major RF for SIDs

A

> sleeping baby prone
bed sharing
prematurity
paternal smoking
hyperthermia - overwrapping or head covering

217
Q

protective factoirs against SIDS

A

> BF
room charing but not bed sharing
use of dummies

218
Q

MMR and pregnancy

A

> Pregnant women should not receive the MMR vaccination, as this is a live vaccine. Non-immune women should be offered the vaccine after giving birth.

219
Q

features of congenital rubella syndrome

A

> Congenital cataracts
Congenital heart disease (PDA and pulmonary stenosis)
Learning disability
Hearing loss

220
Q

chickenpox in pregnancy

A

> can lead to varicella pneumonitis, hepatitis or encephalitis
fetal varicella syndrome
severe neonatal varicella infection

221
Q

checking for immunity to VZV in pregnancy

A

> prev CP: safe and immune
check IgG levels if doubt: positive indicates immunity
not immune: give IV VZV ab within 10 days of exposure

222
Q

when is aciclovir used for CP in pregnancy

A

If the chickenpox rash starts in pregnancy, they may be treated with oral aciclovir if they present within 24 hours and are more than 20 weeks gestation.

223
Q

congenital varicella syndrome

A

> cp within 28 weeks of gestation
fetal growth restriction
microcephaly, hydrocephalus, LDs
scars and skin issues following dermatomes
limb hypoplasia
cataracts

224
Q

congenital CMV symptoms

A

> growth restriction
seizures
microcephaly
hearing loss and vision loss

225
Q

triad of congenital toxoplasmosis

A

> intracranial calcification
Hydrocephalus
Chorioretinitis

226
Q

congenital zika syndrome features

A

> Microcephaly
Fetal growth restriction
Other intracranial abnormalities, such as ventriculomegaly and cerebellar atrophy

227
Q

congenital rubella, toxoplasmosis, CMV can all cause

A

Cerebral palsy

228
Q

Newborn physical examination

A

> first by 72 hrs
second at 6-8 weeks old
The examinations include a full general physical examination & detailed examination of: eyes, heart, hips, and testes

229
Q

physical exam of the newborn should involve

A

> congenital cataracts
congenital hd
ddh
undescended testes

230
Q

At 6to8weeks, assess the baby’s

A

social smiling and visual fixing and following.

231
Q

newborn blood spot

A

> at 5 days
sickle cell, CF, congenital hypothyroidism, PKU, MCADD, MSUD, IVA, GA1, HCU

232
Q

Hearing test used in newborns

A

> otoacoustic emission
The presence of a soft echo indicates a healthy cochlea

233
Q

if otoacoustic emission test is anbormal,

A

use auditory brainstem response test

234
Q

jaundice in the first 24 hrs

A

> always pathological
can be caused by: rhesus haemolytic disease, ABO haem disease, GDP6 def, hereditary spherocytosis

235
Q

jaundice in days 2-14

A

> common, usually physiological
more common in breastfed babies

236
Q

If there are still signs of jaundice after 14 days (21 days if premature) a prolonged jaundice screen is performed, raised conjugated bilirubin could indicate

A

Biliary atresia

237
Q

causes of prolonged jaundice (after 14 days)

A

> biliary atresia
hypothyroidism
breast milk jaundice
prematurity
congenital infections such as CMV

238
Q

physiologyical jaundice

A

> fetuses have more fragile rbcs
can no longer excrete via placenta
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.

239
Q

Babies with jaundice within 24 hours of birth need treatment for

A

sepsis if they have any other clinical features or risk factors.

240
Q

jaundice in pre-emies

A

> higher risk of kernicterus - brain damage due to high levels of bilirubin
immature liver

241
Q

what is hemolytic disease of the newborn

A

> Hemolysis and jaundice in the neonate caused by incompatibility between rhesus >antigens
When a woman that is recessed D negative becomes pregnant with a recess D positive child the mother will produce antibodies against this and has then become sensitized
This normally does not cause problems during the first pregnancy during subsequent pregnancies the anti D antibodies can cross a placenta if the if the fetus is rhesus positive this can lead to hemolysis

242
Q

What occurs during hemolytic disease of the newborn

A

hemolysis which leads to anemia and high bilirubin levels

243
Q

What are three important causes of prolonged jaundice

A

Billy Atresia hypothyroidism and GDP 6 deficiency

244
Q

Investigations for neonatal jaundice

A

Full blood count and blood film for polycythaemia or anaemia
Conjugated bilirubin: elevated levels indicate a hepatobiliary cause
Blood type testing of 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. Suspected sepsis needs treatment with antibiotics.
Glucose-6-phosphate-dehydrogenase (G6PD) levels for G6PD deficiency

245
Q

Management of neonatal jaundice

A

> Management of neonatal jaundice depends on treatment threshold charts
Phototherapy is normally enough to correct it but exchange transfusions may be required (removing blood from the neonatal and replacing it with Donna blood )

246
Q

kernecticus

A

> Type of brain damage that results from excessive bilirubin
Presents with a less responsive floppy drowsy baby with poor feeding
Causes permanent damage to the central nervous system causing cerebral palsy learning difficulties and deafness

247
Q

Extra hepatic biliary atresia is more common in

A

Females than males

248
Q

What is the most common type of bilibi atresia

A

Atresia of the left and right ducks to the level of the Porter Hepatis

249
Q

what is the typical presentation of biliary atresia

A

> Patients typically present in the first few weeks of life with:
Jaundice extending beyond the physiological two weeks
Dark urine and pale stools
Appetite and growth disturbance

250
Q

Signs of biliary atresia

A

> Jaundice
Hepatomegaly with splenomegaly
cardiac murmurs

251
Q

Test results in Billery Atresia

A

> Total bilirubin may be normal, whereas conjugated bilirubin is abnormally high
Alpha 1 antitrypin deficiency may be a cause of cholesterol
Sweat chloride test cystic fibrosis

252
Q

Management of Billy Atresia

A

Surgical intervention is the only definitive treatment - Kasai procedure. Liver transplanation may be required if this fails

253
Q

Neonat and lung surfactant

A

> type two alveola cells start producing subactone between 24 and 34 weeks gestation - Free time babies have problems with reduced pulmonary surfactant

254
Q

Cardio respiratory treat changes at birth

A

> A strong First breath is needed to expand previously collapsed alveoli adrenaline and cortisol are released in response to labor to stimulate respiratory effort
The baby’s first breath expands alveoli reducing pressure in the right atrium -> this then caused his closure of the foramen ivale

255
Q

What drops after birth cause enclosure of the ductus arteriosus

A

> Prostaglandins drop after birth which causes closure of the ductus arteriosus which then becomes a ligamentum arteriosum

256
Q

ductus venosus Closure

A

The ductus venosis stops functioning immediately after birth because the umbilical cord is clamped so there is no blood flow to umbilical veins . The doctors of the Gnosis clauses a few days later to become the ligamentum venosum

257
Q

Features of congenital hypothyroidism

A

Prolonged neonatal jaundice, Paul feeding , Constipation tiredness slow growth and development

258
Q

Management of congenital hypothyroidism

A

> Investigations include TFT thyroid ultrasound and thyroid antibodies
Levothyroxine in once a day

259
Q

What kind congenital growth hormone deficiency be a result of

A

Growth hormone is produced by the anterior pituitary gland . Deficiency can be from genetic mutation GH1 or empty sella syndrome

260
Q

Growth hormone deficiency may present at birth or in neonates with:

A

> Micropenis (in males)
Hypoglycaemia
Severe jaundice

261
Q

GH def in older kids presents as:

A

> Poor growth, usually stopping or severely slowing from age 2-3
Short stature
Slow development of movement and strength
Delayed puberty

262
Q

Growth hormone stimulation test

A

Measures response to medications that normally stimulate growth hormone release for example insulin glucagon

263
Q

Management of GH deficiency

A

Dailysubcutaneousinjections ofgrowth hormone(somatropin)

264
Q

Is what is congenital adrenal hyperpleasure caused by

A

> Congenital deficiency of 21 hydroxylase
This leads to under production of cortisol and aldosterone under too much androgens from birth
Inherited in an autosomal recessive pattern

265
Q

What is the action of aldosterone

A

Released by the adrenal gland in response to renin. actson the kidneys to increase sodium resorption and increase potassium secretion into the urine

266
Q

CAH pathophys

A

> 21-hydroxylase is the enzyme responsible for converting progesterone into aldosterone and cortisol
Extra progesterone is converted into testosterone instead -> Patient has low aldosterone low cortisol but abnormally high testosterone

267
Q

severe CAH presentation

A

> females - ambiguous genitals w enlarged clitorus
Patients with more severe CAH present shortly after birth with hyponatraemia, hyperkalaemia and hypoglycaemia.

268
Q

CAH pres in females

A

> tall, Facial hair, Absent peroidsDeep voice and early puberty

269
Q

CH presentation in males

A

Tall, deep voice, Large penis, small testicles, early puberty

270
Q

What are skin change to people with CAH get

A

hyperpigmentation because AP produces extra ACTH which is structurally similar to melanin

271
Q

Management of CAH

A

> Hydrocortisone, fludrocortisone to replace aldosterone 4

272
Q

what is associated w increased morbidity for CF

A

Chronic infection withPseudomonasandBulkholderiain CF are associated with increased morbidity and mortality - Bulkholderia is a CI against lung transplantation

273
Q

rotavirus timings

A

Two months + three months

274
Q

How does androgen insensitivity syndrome present

A

Groin swellings from undescended testes primary amenaria nor pubic hair. Breast development occurs

275
Q

most common cause of ambiguous genitalia

A

CAH, AIS does not cause amb genitals

276
Q

congenital rubella is associated w ? Murmur

A

patent ductus arteriosus, causing a machinery murmur.

277
Q

congenital sensorineural deafness

A

> CMV: deafness, rubella: cataracts and deafness

278
Q

what other causes of cyanotic heart disease

A

> right to left shunt
ASD, VSD, Patent ductus arteriousus, transposition if the great arteries

279
Q

Eisenmenger syndrome.

A

Patients with ventral septal defect atrial septal defect or a patent doctors arteriosus are usually not cyntotic because the pressure on the left side of the heart is greater than the right side so blood flows into the right side. If pulmonary pressure increases beyond systemic pressure blood flows from right to left across the defect causing cyanosis

280
Q

What are the complications of congenital heart disease

A

> Heart failure arrhythmias endorcarditis pulmonary hypertension eisenmenger syndrome

281
Q

types of ASD

A

> Patent foramen ovale
ostium secondum and osteiyn primum

282
Q

ASD

A

> blood moves from left -> RA
Overload in RA
blood still goes to lungs to get oxygenated si no cyanosis
right heart strain and pulmonary HTN

283
Q

How does ASD lead to eismengers

A

> Pulm HTN -> increased right pressure -> pulm pressure > systemic pressure -> blood moves in opposite direction from right to left -> blood bypasses lungs leading to cyanosis

284
Q

atrial septal defect pres

A

> often picked up on antenatal scans or newborn examination
can present in adulthood
dyspnoea secondary to pulm HTN and right sided HF
AF ir flutter

285
Q

stroke in DVT patients

A

> ASD causes stroke in patients w DVT (clot enters systemic circulation and goes straight to brain)

286
Q

ASD murmur

A

> systolic cresendo decresendo murmur loudesr at upper left sternal edge
fixed split second heart sound

287
Q

Mx of ASD

A

> can be corrected surgically percutaneous transvenous catheter closure or open heart surgery
AC such as aspirin, warfarin, DOACs used to reduce risk of clots

288
Q

conditions associated VSD

A

downs syndrome and turners syndrome

289
Q

VSD murmur

A

> pansystolic mumur heard at left lower sternal edge in third and 4th ICS

290
Q

increased risk of ? With VSD

A

IE. Give antibiotic prophylaxis during surgical

291
Q

coarctation of the aorta =

A

> narrowing of the aorta usually around the DA
associated turners syndrome

292
Q

pres of coarctation of the aorta

A

> systolic murmur below left infraclavicular area
four limb blood pressure: difference in BPs
left ventricular heave

293
Q

ix for coarctation

A

CT angio

294
Q

how can coarctation of the aorta present

A

> Percutaneous balloon angioplasty (stretching the stenosis), potentially with a stent inserted
Open surgical repair
medical management of HTN

295
Q

Peripheral cyanosis vs central cyanosis

A

> peripheral: looking blue
central cyanosis when conc of hb exceeds 5g/dl

296
Q

nitrogen washout test

A

> differentiate between cardiac vs non cardiac causes
The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken.
A pO2 of less than 15 kPa indicates cyanotic congenital heart disease

297
Q

causes of cyanosis congenital HD

A

> TOF
transposition of the great arteries
tricuspid atresia

298
Q

mx of cyanotic congenital heart disease

A

> supportive care
prostaglandin E1 e.g. alprostadil - used to maintain patent ductus arteriosus

299
Q

acrocyanosis

A

> often seen in healthy newborns
cyanosis around mouth and hands/ feet
occurs immediately after birth in healthy infants

300
Q

features of TOF

A

> ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta

301
Q

TOF - clinical features

A

> cyanotic episodes
ejection systolic murmur

302
Q

cyanotic spells in TOF

A

> unrepaired TOF infants may develop episodic hypercyanotic ‘tet’ spells due to near occlusion of the right ventricular outflow tract
features of tet spells include tachypnoea and severe cyanosis that may occasionally result in loss of consciousness
they typically occur when an infant is upset, is in pain or has a fever

303
Q

Chest XR findings of TOF

A

> CXR: Boot shaped heart
ECG: LVH

304
Q

Mx of TOF

A

> Surgical repair
cyanotic episodes may be helped by beta-blockers to reduce infundibular spasm

305
Q

when is patent DA more often

A

> usually, the ductus arteriosus closes with the first breaths due to increased pulmonary flow which enhances prostaglandins clearance
more common in premature babies, born at high altitude or maternal rubella infection in the first trimester

306
Q

features of patent DA

A

> Left subclavian thrill
continuous ‘machinery’ murmur
large volume, bounding, collapsing pulse
heaving apex beat

307
Q

Mx of patent DA

A

> Indomethacin or ibuprofen - given to the neonate inhibits prostaglandin synthesis (closes connection)

308
Q

what is ebsteins anomaly

A

> low insertion of the tricuspid valve -> large atrium and large ventricles - atrialisation of the RV

309
Q

lithium exposure in utero can cause

A

ebsteins anomaly

310
Q

associations w ebsteins anomaly

A

> PFO, ASD, WPW

311
Q

CFs of ebsteins anomaly

A

> cyanosis, prominent a waves in the distended JVP
hepatosplenomeg
tricuspid regurg

312
Q

murmur of ebsteins anomaly

A

pansystolic murmur, worse on inspiration

313
Q

ECG finding of ebsteins anomaly

A

RBBB -> widely split S1 and S2

314
Q

ACEi as a teratogen

A

Renal dysgenesis
Craniofacial abnormalities

315
Q

alcohol as a teratogen

A

Craniofacial abnormalities

316
Q

aminoglycosides as a teratogen

A

Ototoxicity

Year 4 (9 decks)

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