Child Health 5

Question 1

What are the 5 stakes of CKD?

Answer 1

1. GFR >90 : Normal renal function but structural abnormality or persistent haematuria or proteinuria
2. GFR 60 - 89 : Mildly reduced function, asymptomatic
3. GFR 30 - 59 : Moderately reduced function, renal osteodystrophy
4. GFR 15 - 29 : Severely reduced function with metabolic derangement and anaemia. Start considering replacement
5. GFR <15 : End stage renal failure, they require replacement. [V. uncommon in children]

Congenital and familial causes are much more common in children.

Question 2

What defines hypertension?

Why do you need to investigate?

What are the causes? [no specifics]

Answer 2

BP over the 95th percentile for height, age and sex on 3 or more occasions

There is usually an underlying cause of hypertension in children and the long term health-risks are substantial

• • Congestive heart failure
• • Stroke
• • Hypertensive encephalopathy

Normally secondary to renal, cardiac or endocrine pathology.

Question 3

What are the specific causes of hypertension in children?

Answer 3

RENAL

• Renal parenchymal disease (Scarring)
• Renovascular
• ADPKD, ARPKD
• Renal tumours

COARCTATION OF THE AORTA

CATECHOLAMINE EXCESS

• • Phaeochromocytoma
• • Neurobastoma

ENDOCRINE

• • • Congenital Adrenal Hyperplasia
• • • Cushing Syndrome or corticosteroid therapy
• • • Hyperthyroid

ESSENTIAL
- - - - Diagnosis of exclusion.

Question 4

How can hypertension present in children?

Answer 4

1. Vomiting
2. Headaches
3. Facial Palsy
4. Hypertensive retinopathy
5. Convulsions
6. Proteinuria.

Infants

7. Faltering growth
8. Cardiac failure

Question 5

What does bilateral hydronephrosis in a male infant require?

Answer 5

Investigation to exclude posterior urethral valves.

Question 6

How are renal abnormalities divided?

Answer 6

Parenchymal abnormalities

Drainage abnormalities

Question 7

What is the treatment focus for children with cerebral palsy throughout their childhood.

what pharmaceuticals are available?
-

Answer 7

Early intervention services (0-3 years) include physiotherapy (PT), occupational therapy (OT), and speech therapy,
- Directed towards educating and assisting the family in the helping the child to achieve developmental milestones, feeding skills, and communication.

During school years, treatment is directed at optimising mobility and independence through the use of adaptive equipment, activities of daily living training, strengthening of weak muscles, and stretching of spastic muscles; in later childhood, surgery may be necessary for correction of soft tissue and bony deformities.

In adolescence and adulthood, treatment emphasis is on promoting a healthy lifestyle through the use of fitness and exercise, preventing deformity, and maintaining function.

SUMMARY: OT/PT/SPEECH THERAPY

ORTHOSES

ADAPTIVE EQUIPMENT

PHARMA:

BOTULINUM TOXIN A

PHENOL

ETHYL ALCOHOL

Question 8

What is the basis for an epileptic seizure?

Answer 8

Epileptic seizures are due to excessive and hypersynchronous electrical activity, typically in neural networks in all or part of the cerebral cortex

Question 9

What are the clinical features of severe and life threatening asthma?

Answer 9

From the NUH guidelines.

1. Can’t complete sentences in one breath or too breathless to talk or feed.
2. SpO <92% in air
3. Silent chest
4. HR >140 in 2-5 HR >125 in >5
5. RR >40 in 2-5 >30 in >5
6. Cyanosis
7. Poor respiratory effort
8. Fatigue or exhaustion
9. Agitation or reduced level of consciousness.

Question 10

Differential on sudden onset breathing difficulty in a 2 year old?

Answer 10

1. Foreign body
2. Viral induced wheeze
3. Anaphylaxis
4. Croup (barking wet cough) - ill over days though
5. Epiglottitis - comes on over hours.