child health Flashcards
define innocent murmur
soft systolic murmur
due to physiological conditions outside the heart
inconsequential and disappears as child grows older
common causes of cardiac failure in paediatrics
neonates: PDA, cortication of aorta, cardiomyopathy
infants: VSD, ASD, cardiomyopathy
children: cardiomyopathy
most common causative organism for infective endocarditis
strep. Viridans
dDx of acute cough in a child
URTI
croup
asthma
inhaled foreign body
dDx of acute stridor in a child
croup
epiglotitis
bacterial tracheitis
inhaled foreign body
common causes of pneumonia in children
Viral: RSV, influenza, parainfluenza
bacterial: Strep pneumoniae, mycoplasma (5-14y.o), Grp B strep (neonates)
causes of bronchiolitis
RSV, parainfluenza, influenza A, adenovirus
presentation of bronchiolitis
cough, dyspnoea, wheeze
hyperinflation, crepitations
seasonal - october-april
management of bronchiolitis
self limiting
oxygen
NG feeds and IV fluids if poor feeding
screening for CF
Screening – new-born measurement of immunoreactive trypsin levels on neonatal blood spot (heel prick)
If raised blood sent for genetic testing for CF mutations
Sweat test and genetic testing indicated in those missed by screening but presenting with meconium ileus, failure to thrive, recurrent chest infections or malabsorption
presentation of CF
recurrent chest infections/airway obstruction
pancreatic insufficiency
DIOS, meconium ileus
infertility (absence of Vas, abnormal cervical mucus)
anaemia
diabetes
management of CF
daily physiotherapy
prophylactic Abx (flucloxacillin)
high calorie diet
DIOS/meconium ileus – hydration + lactulose (surgery is 2nd line unless there is complete obstruction or perforation)
Acute RTI - oral amoxicillin (IV tobramycin and ceftazidime if severe) + salbutamol + chest physio + mucolytic
Pancreatic insufficiency – pancreatic enzyme supplements with each meal + fat soluble vitamin supplements
presentation of neonatal sepsis
collapse apnoea or resp. distress seizure poor feeding jaundice
management of hypoxic ischaemic encephalopathy
therapeutic cooling to 33.5C, initiated by 6hrs, lasts 72hrs
how is neonatal cataracts screened
check red reflex after birth
causes of neonatal jaundice
unconjugated
breast milk jaundice, haemolytic anaemias, infections/sepsis, congenital hypothyroidism
conjugated biliary atresia a1 antitrypsin deficiency neonatal hemochromatosis idiopathic neonatal hepatitis
management of neonatal jaundice
phototherapy using UV light fibre optic blankets
exchange transfusion
presentation of downs syndrome
generalised hypotonia
short neck with excess skin at nape
brachycephaly
single palmer crease, short hand/fingers and a sandal tow gap in feet
facial features (prominent epicanthic folds, upward slanting palpebral fissures, protruding tongue, flat nose, low set ears)
presentation of edwards syndrome (trisomy 18)
microcephaly, small chin, low set ears
overlapping fingers
rocker bottom feet - flexed big toe, prominent heels
VSD, ASD, PDA
presentation of patau’s syndrome
holoprosencephaly
structural eye defects
cutis aplasia
cardiac and renal defects
presentation of turner’s syndrome
downward turned mouth, downslanting palprbral fissures
webbed neck, wide spaced nipples, lymphodema
streak gonads, lack of secondary sexual development
short stature
presentation of fragile X syndrome
long face, prominent ears, large chin macroorchidism learning difficulties connective tissue problems, hyperflexibable joints, flat feet behavioural problems: ADD, Autism
causes of intellectual developmental disability
Genetics - down’s, fragile X
acquired - fetal alcohol/drug exposure, rubella
perinatal - intraventricular haemorrhage, hypoxic ischaemic encephalopathy
post natal - brain injury
benefits of breast milk
baby
all the macronutrients needed for growth and metabolism
protects child against infections
promotes development of the gut
reduces cardiovascular disease and autoimmune conditions in the child
mother
reduces risk of breast and ovarian cancer
reduces risk of diabetes
reduces risk of post natal depression
define cerebral palsy
An umbrella term referring to a non-progressive disease of the brain originating during the antenatal, neonatal, or early postnatal period when brain neuronal connections are still developing.
risk factors for cerebral palsy
prematurity maternal illness (thyroid, TORCH, factor V leiden) birth asphyxia neonatal sepsis head injury prior to 3 years
what are the TORCH infections
toxoplasmosis other (syphilis, VZV, parvovirus) rubella cytomegalovirus HSV
presentation of cerebral palsy
motor abnormalities (delayed development, paralysis, weakness, ataxia, chorea)
spasticity
feeding difficulties
speech impairment/delay in speech development
delay in cognitive/intellectual development
complications of cerebral palsy
epilepsy
behavioural problems
poor growth
osteoporosis
management of cerebral palsy
physiotherapy
speech and language therapy
botulinum toxin
surgery
presentation of neural tube defects
paralysis or sensory loss in legs LL weakness and loss of reflexes neurogenic bladder and bowel hydrocephalus chiari II malformation - learning difficulties
management of NT defects
neurosurgical repair of the cele - antenatally or by 3 months
ventriculoperitoneal shunt for hydrocephalus
IV Abx to prevent neonatal meningitis
presentation of musclular dystrophy
DMD - onset at 3, wheelchair by 12
BMD - onset at 11, wheelchair not needed/in later life
loss of limb strenghth loss of muscle tone and reflexes calf hypertrophy scoliosis and lumbar lordosis positive gowers sign
diagnosis of muscular dystrophy
genetic testing
elevated creatinine kinase
monitor resp and cardio function
management of muscular dystrophy
genetic counselling physiotherapy oral pred resp support (positive pressure ventilation) scoliosis surgery
define febrile seizure
A febrile seizure as a seizure occurring in the presence of fever in a child between the ages of 6 and 60 months who do not have an intracranial infection, metabolic disturbance, or history of afebrile seizures
presentation of febrile seizure
simple = tonic clonic with no focal features for < 10mins complex = focal features or >10mins or recurrent seizures within 24 hrs
majority are simple, last 5 mins and has a rapid recovery
follows a recent fever/infection
investigations for a febrile seizure
clinical diagnosis - routine investigations (imaging and bloods) not required for first simple seizure
rule out menigitis if there is nuchal rigidity = LP
EEG and MRI if recurrent complex seizure or less the 6 months old
management of febrile seizures
paracetamol
if ongoing for > 5mins = diazepam
presentation of osteomylitis
acutly unwell child pyrexic local erythema and tenderness (often near metaphysis) recent history of VZV is common night pain limp
management of osteomyelitis
bone aspiration if abscess
IV Abx
splintage of the limb
presentation of juvenile idiopathic arthritis
persistent joint swelling in one or more joints
EMS
asymptomatic anterior uveitis
salter harris classification
classification of growth plate injuries
I to V
what is perthes disease
necrosis of part of the femoral capital epiphysis and growth disturbance in the physeal and articular cartilage leading to deformity of the femoral head and degenerative joint disease
presentation of perthes disease
mainly occurs in 4-8 year olds
groin/knee pain
limp#
reduced hip abduction and internal rotation
presentation of a slipped upper femoral epiphysis (SUFE)
early adolescence
hip pain - may have referred knee pain
affect limb often externally rotated - foot points out while walking
associated with hypothyroidism, chronic renal failure, radiotherapy, growth hormone therapy
what is DDH
neonatal hip instability
acetabular dysplasia with or without subluxation and frank dislocation of the hip joint
presentation of DDH
screened for at birth and 6 weeks - positive barlows and ortilani test
in older children limp asymmetrical groin creases leg length discrepancy reduced hip abduction
causes of chronic diarrhoea in children
toddler's diarrhoea constipation overflow post infectious foot intolerance e.g. lactose IBD malabsorption (CF, coeliac)
causes of acute diarrhoea in children
infections (rotavirus, enterovirus, E coli, salmonella)
starvation stools
intussusception
investigations for a bleeding/bruised child
FBC, coag BC, WCC, CRP (infection) XM (major haemorrhage) BP and urinalysis (HSP) skeletal survey, CT head, retinoscopy (NAI)
presentation of idiopathic thrompocytopenia
acute onset bruising/petechiae
absence of systemic symptoms
epistaxis common following a recent viral illness
management of ITP
limit high impact activities platelet transfusion if bleeding IVIG steroids splenectomy
haemophilia summary
type A = factor 8 deficiency
type B = factor 9 deficiency
presents with spontaneous joint/muscle bleed or from minor trauma, raised lumpy bruises
investigations - prolonged APTT, clotting screen
management with recombinant factor administration IV
von willie brand disease summary
deficiency of factor 8: VWF ratio = decrease platelet adhesion
presents with mucosal bleeding (gums, GI, epistaxis, menorrhagia), prolonged bleeding post trauma
investigations: prolonged APTT, reduced F8:VWF, no platelet aggregation on co factor assay
manage with prophylactic desmopressin or recombinant factor 8 for bleeding episodes
presentation of a brain tumour
raised ICP (morning headaches, vomiting, papilloedema) focal seizure neurological deficit endocrine disorders
investigation for suspected brain tumours
brain/spinal MRI
tumour biopsy
endocrine screen
CSF cytology and tumour markers
differentials for a child with an abdominal mass
neuroblastoma
wilm’s tumour
hepatoblastoma
germ cell tumour
biochemical disturbances seen in tumour lysis syndrome
hyperuricaemia
hyperkalaemia
hypophosphatemia
hypocalcaemia
if untreated can lead to AKI, seizures, cardiac arrhythmias, death
management of tumour lysis syndrome
IV fluids
allopurinol
manage hyperkalaemia (insulin/dextrose, calcium gluconate, calcium resonium, salbutamol)
dialysis
presentation of measles
prodrome (fever, coryza, cough, koplik spots)
maculopapular rash behind ears, migrates to face then trunk
complications: otitis media, interstitial pneumonitis
presentation of chicken pox
fever malaise headache abdo pain itch crops of erythematous macules, papules and vesicles
infectious period of chicken pox
2 days before symptoms to 5 days post rash
management of chicken pox
supportive
aciclovir for high risk patients
vaccination for high risk patients
post exposure prophylaxis (VZ IVIG) if immunocompromised
presentation of parvovirus B19
low grade fever
malaise
maculopapular spots on cheeks (gives slapped cheeks appearance)
rash on trunk and limbs (lacy appearance)
presentation of mumps
prodrome (fever, anorexia, headache)
painful salivary and submandibular gland swelling
presentation of rubella
prodrome (coryza, tender cervical lymphadonopathy)
fine maculopapular rash - face spreads to trunk
arthralgia
most common causes of meningitis in children
bacterial: neisseria meningitidis, strep pneumonia
viral: enterovirus, HSV (meningoencephalitis)
presentation of bacterial meningitis in a child
fever, lethargy high pitched or irritable cry (cannot be soothed by parents) poor feeding apnoeic or cyanotic attacks seizure bulging fontanelle
management of bacterial meningitis
suspected
IV ceftriaxone
+ amoxicillin and gentamicin if under 6 weeks
confirmed
N. menigiditis = cefotaxime fir 7 day
strep. pneumonae = cefotaxime for 14 days
presentation of meningococcal meningitis/sepsis
fever + petechial/purpuric rash
hypovolaemic shock
DIC
metabolic derangements (low, K, Ca, Mg, PO4)
complications of prematurity
sepsis PDA RDS ROP osteopenia NEC intraventricular haemorrhage
what is potters syndrome
bilateral renal agenesis
indications for dialysis
severe volume overload severe hyperkalaemia symptomatic uraemia severe metabolic acidosis removal of toxins
causes of HTN in young people
coarctation of aorta
pheochromocytoma or neuroblastoma (catecholamine release)
congenital adrenal hyperplasia
renal tumour, renal parenchymal disease (release of renin)
management of minimal change GN
prednisolone furosemide if symptomatic oedema pneumococcal vaccination penicillin prophylaxis for risk of encapsulated organism salt/fluid restriction
causes of deafness in children
acquired
pre natal - rubella infection
perinatal - hypoxia, kernicterus
postnatal - menigitis, head injury, ototoxic drugs e.g. cisplatin
congenital
usher’s, pendred’s
management if deafness in children
hearing rehab with bilateral, digital, behind-the-ear hearing aids
cochlear implantation
most common cause of nasal obstruction in children
hypertrophy of the adenoids
associated with snoring and green rhinorrhoea
management of irritant contact napkin dermatitis
frequent nappy changes
avoidance of soaps and wipes
emollient and zinc based preparation after each nappy change
topical steroid if inflamed
if candida infection (satellite papules and pustules) - clotrimazole
what is juvenile plantar dermatosis
erythema, hyperkeratosis and fissuring of the anterior plater surface
associated with sweating and sports footwear
management of juvenile plantar dermatoses
avoidance of occlusive footwear and synthetic socks
aluminium hydrochloride to reuce sweating
urea based emollients for hyperkeratosis and fissuring
steroids
what is impetigo
highly contagious skin infection cause by s aureus
annular erythema with honey colour crust, may become bullous
management of impetigo
flucloxacillin
prevention of spread
dont share towels or bath with other children
antiseptic in bath
molluscum contagiosum
small pearly umbilicated papules causes by MCV.
self limiting
management of tinea capatis
ketaconazole shampoo
oral griseofulvin or terbinafine
investigations for Down’s
screening: maternal b HCG, PAPP-A, nuchal translucency on US, maternal age
those deemed high risk offered chorionic villous sampling and amniocentesis.
duodenal atresia presentation
bilious vomiting after birth
double bubble finding on abdominal x ray
associated with downs
presentation of intussesception
classic triad of abdominal pain, red current jelly stools and vomiting
signs: abdominal mass, distention, pallor, absent bowel sounds
X ray: target lesion/doughnut sign
management of intussesception
contrast enema (air enema) +/- Abx surgical reduction +/-resection
