Child Health Flashcards
What age range would normally have vitals within these parameters?
Heart Rate - 110-160
Resp. Rate - 30-40
Syst. Blood Pressure - 70-90
<1 year old
What age range would normally have vitals within these parameters?
Heart Rate - 100-150
Resp. Rate - 25-35
Syst. Blood Pressure - 80-95
1-2 years
What age range would normally have vitals within these parameters?
Heart Rate - 80-120
Resp. Rate - 20-25
Syst. Blood Pressure - 90-110
5-12 years
Which of the following accounts for the majority of child presentations?
- Bronchiolitis/URTI/Croup
- Pneumonia/LRTI
- Gastroenteritis
Bronchiolitis/URTI/Croup - accounts for 28% of presentations
Gastroenteritis accounts for 8.8%
Pneumonia/LRTI accounts for 6.2%
‘Stertor’ is heard during inspiration/expiration
What is stertor a sign of?
Stertor is heard during inspiration
Sign of pharyngeal obstruction e.g. tonsils
‘Stridor’ is heard during inspiration/expiration
What is stridor a sign of?
Stridor is heard during inspiration
Sign reflects supraglottic narrowing i.e. upper airway obstruction
When assessing a patient with stridor, what can be listened for to give a clue as to the cause?
Is the sound biphasic i.e. heard in both inspiration and expiration?
If the problem is extra-thoracic, stridor typically is in inspiration only but may still be heard on expiration
If the problem is intrathoracic, stridor is biphasic with a loud expiratory noise
Child patient presents to A&E with new onset stridor
What are the differentials?
Viral croup
Epiglottitis (rare since HiB vaccine)
Inhaled foreign body
Acute allergic reaction
Other infections
Airway burns and scalds from smoke/steam
What causes viral croup most commonly?
How would these patients present?
Viral croup is most commonly caused by parainfluenza virus
Patients more commonly present in spring and autumn, have stridor, a barking cough, hoarse voice and sometimes a mild fever
What causes epiglottitis?
How would a patient present?
Haemophilus influenza type B
Patients present very unwell - septic
High fever, stridor
Drooling
What conditions might cause wheeze in a child?
Asthma
Bronchiolitis and other infections
CF
Chronic lung disease
Aspiration lung injury/GORD
Moderate allergic reaction
Foreign body
Vocal cord palsy
What is the most common cause of infectious diarrhoea? What are the main causative organisms?
Viruses
Bacteria
Parasites
Viruses are the most common cause of infectious diarrhoea
Commonly caused by norovirus, adenovirus and rotavirus
Bacterial causes include E.coli 0157, c. diff, salmonella, campylobacter and cryptosporidium
Parasitic causes giardia (and others…)
How is diarrhoea defined?
>3 stools a day
What is “toddler’s diarrhoea”?
Benign condition due to ‘colonic immaturity’
Can have up to 10 stools a day, but otherwise completely healthy child
Self limiting and improves by age 5-6
How common is GORD in infants?
What investigations might you do and how might you manage it
GORD is extremely common in infancy
Generally benign and self-limiting, with 98% resolving by age 2
Investigations include assessment of potential overfeeding and possible cow’s milk protein allergy
Management is reassurance, gaviscon initially and maybe add ranitidine if necessary
Coeliac disease - what is it, what are the symptoms and how do you screen for it?
Autoimmune enteropathy to gluten occuring in genetically susceptible patients (99.5% are either HLA DQ2 or HLA DQ8 positive)
Symptoms are diarrhoea, pale stools, abdominal bloating, failure to thrive and anaemia
Screening is done by testing for tissue transglutaminase (tTG) and anti-endomesial antibodies (EMA)
What is the gold standard for diagnosing coeliac disease
Endoscopy with duodenal biopsy which shows crypt hyperplasia and flattening of villi
However, if patient is a child diagnosis may be made on classical appearance + elevated tTG to 10 times normal limit
What are some of the other conditions associated with Coeliac Disease?
Type 1 Diabetes Mellitus
Autoimmune thyroid disease
Juvenile Chronic Arthritis
Down’s Syndrome
Turner Syndrome
William Syndrome
What are some of the symptoms of Crohn’s Disease?
Where might it present extra-intestinally?
Diarrhoea (with blood in Crohn’s colitis), weight loss, anaemia, abdominal pain, peri-oral and peri-anal lesions
Extra-intestinal manifestations include liver, eyes, skin, and also possibly myopathies, neuropathies and cardiopathies
