Child Health Disease Profiles Flashcards
what is term baby
birth between 37 and 42 weeks
what is normal weight for baby
2.5-4kg
how much weight should babies gain during the 3rd trimester
24g per day
when does trans placental transfer occur
3rd trimester
what are transferred in trans placental transfer
iron, vitamin, calcium, phosphate and antibodies
during contraction the baby is in what environment
hypoxic
what does prolonged labour reduce
fetal reserves
how can things like maternal smoking or drug use of mother affect babies for when giving birth
placenta insufficiency so difficult for Abby to cope with hypoxia
stress baby eperiences during labour increases what
adrenaline and cortisol
what does first cry/ breath cause
alveolar expansion
what is a score to measure perinatal adoption
Apgar
when is there decreased pulmonary arterial pressure and increased Pao2
perinatal adaptation
what is the calorific intake in the first 24hrs of baby
little intake
are babies alert immediately after delivery
very
what is given to newborn babies to prevent haemorrhage disease (disorder of clotting)
Vitamin K (prefer intramuscular)
if what is present in infection screen you should give vaccination for immediately
Hep B
Hep B and C, HIV, Syphillis, TB, Group B strep are screened in what
infection screen
what is an anticipatory method used to monitor babies at risk
early warning systems
mothers should have what vaccine
pertussis and influenza
what are some things you want to screen for in newborn
cystic fibrosis, hypothyroid and haemoglobiopathies
things that increase risk of giving birth early
- already had greater than 2 preterm babies
- abnormally shaped uterus
-multiple pregnancy
interval of less than 6 months between pregnancy
-IVF
smoking, alcohol, drugs - poor nutrition, some chronic conditions eg high BP or diabetes, multiple miscarriages or abortions
what babies need more help to stay warm
preterm babies
altered approach to preterm babies
delay cord clamping if possible, keep baby warm, gentle lung inflation(PEEP) and oxygen sat monitor
what does high surface area to body mass of baby result in
more likely to lose heat
babies BMR is what in hypothermia
low
what occurs usually 6-8 weeks after delivery
retinopathy of prematurity
what is early metabolic complication of prematurity
hypoglycaemia and hyponatrermia
what is late metabolic complications of preterm
osteopenia
do you want apgar score to be high or low
high
what is fluid in the lungs that does no clear in newborns
Transient tachypnoea of the newborn
2 examples of congenital respiratory disease of the newborn
tracheo-oesophageal fistula and diaphragmatic hernia
examples of a rhesus disease
hydrops foetalis
some congenital heart disease
tetralogy of allot, transposition of great arteries, coarction of the aorta
what are these; hypoxic ishcaemic encephalopathy, microcephaly, spina bifida
neurological illnesses of the newborn
renal illness of newborn
potters syndrome
muscular illness of newborn
myotonic dystrophy
problems related to glucose of newborn
hypoglycaemia
error of metabolism in newborns can cause
acidosis
potenital management of circulation of newborns
fluids, inotropes
early onset neonatal sepsis is acquired when
before and during delivery
early onset neonatal sepsis type of bacteria
Group B strep
late onset neonatal sepsis organism
coagulase negative staph or staph aureus
symptoms of neonatal sepsis
fever
reduced tone and activity
poor feeding
vomiting
signs of neonatal sepsis
respiratory distress or apnoea
tachycardia or bradycardia
hypoxia
jaundice within 24hrs
when might be a baby be hypoglycaemia
neonatal sepsis
does jaundice occur in most normal term babies and ore term babies
yes
jaundice is caused by hyperbilirubinaemia that is
unconjugated
what hyperbilirubinaemia is always pathological
conjugated
is unconjugated hyperbilirubinaemia always pathological
no can be physiological or pathological
reasons for physiological jaundice
increased RBC breakdown or immature liver
main reason for physiological jaundice in premature babies
immature liver
how long does breast milk jaundice take to resolve
1.5-4 months
what is a common cause of jaundice in the first 24 hours of life
neonatal sepsis
what could be as a result of high levels of conjugated bilirubin
biliary atresia, Total parental nutrition, hypothyroidism, cystic fibrosis, trisomy 21
what is prolonged jaundice in a term baby and in a pre term baby
over 14 days in a term baby or 21 days in a preterm
is jaundice in the first 24hrs of life physiological or pathological
PATHOLOGICAL
what test to do if got early jaundice
FBC, serum bilirubin level and DCT (Coombs test)
tests done for prolonged jaundice
FBC< serum bilirubin level, liver function tests and thyroid function tests
treatment for early jaundice
phototherapy, hydration and underlying cause
what affects 75% of infants born before 29 weeks
respiratory distress syndrome
medical term for lung collapse
atelectasis
how does respiratory distress affect co2 levels
hypercapnia
respiratory distress affects what in lungs
alveoli
signs of respiratory distress
tachypnoea, grunting, intercostal recession (undraping between the ribs), nasal flaring, cyanosis
when should respiratory distress then gradually improve
2-4 days
management of respiratory distress
maternal steroid and surfactant replacement and ventilation
what can cause respiratory distress
acidosis and hypoglycaemia
what refers to the withdrawal symptoms that happens in neonates of mothers that used substance in pregnancy
neonatal abstinence syndrome
substances that can cause neonatal abstinence syndrome
opiates, methadone, cocaine, cannabis, alcohol
CNS symptoms of neonatal abstinence syndrome
irritability, tremors and seizures
baby could be — in neonatal abstinence syndrome
sweating
babies with neonatal abstinence syndrome kept in hospital for how long
least 3 days
how could a neonate with neonatal abstinence syndrome be supported
quiet and gentle dim environment with gentle handling and comforting
neonatal hypoglycaemia is defined as
blood glucose levels below 2.6mmol/L
3 signs of neonatal hypoglycaemia
lethargy, jitteriness and seizure activity
what helps prevent hypoglycaemia in neonate
early feed and keeping baby warm
how warm should keep neonate
36.6-37.2
in hypoglycaemia baby would rather enterally feed than
feed baby with IV glucose
what do do if neonate is recurrently hypoglycaemic
hypoglycaemia screen
what occurs when a baby doesn’t receive enough oxygen before, during or just after birth
birth asphyxia
causes of brith asphyxia
maternal shock, intrapartum haemorrhage, prolapsed chord or nuchal cord
what is nuchal chord
cor dis wrapped around the neck of the baby
complication of birth asphyxia
hypoxic ischaemic encephalopathy
what is hypoxic ischaemic encephalopathy
multi organ damage due to tissue hypoxia
babies with what can benefit from therapeutic hypothermia
hypoxic ischaemic encephalopathy
what does therapeutic hypothermia do to babies with HIE
reduce risk of cerebral palsy, developmental delay, learning disability, blindness and death
what is floppy baby
neonatal hypotonia
baby with low muscle tone is
neonatal hypotonia
floppy baby has what features
lack of head control, increased range of movement, frog legged, feels like they ll fall out of your grasp
what investigations for neonatal hypotonia
Bloods, neurology review and imaging
central neonatal hypotonia has
normal strength
anterior horn neonatal hypotonia has
generalised weakness
neuromuscular neonatal hypotonia has
weakness in face, eyes an bulbar
muscle neonatal hypotonia has
weakness is proximal more than distal eg face
nerve neonatal hypotonia
weakness id greater distally than proximally
what imaging for neonatal hypotonia
cranial US and MRI
would you use next generation sequencing or acqh for blood for neonatal hypotonia
NGS
what interventions for neonatal hypotonia
resp and feeding support, physio,
treatment for spinal muscular atrophy
RNA targeted therapy
difference between neuromuscular and muscle neonatal hypotonia
neuromuscular has normal DTRs and muscle has decreased DTRs
difference between neuromuscular and muscle neonatal hypotonia
neuromuscular has normal DTRs and muscle has decreased DTRs
what neonatal hypotonia is often describes as alert
anterior horn cell
what is a hydrocephalus
cerebrospinal fluid building up abnormally within the brain and spinal chord
enlarged and rapidly increasing head circumference and bulging anterior fontanelle
hydrocephalus
management of hydrocephalus
ventriculoperitoneal shunt
part of the bowel becomes necrotic in neonates
necrotising enterocolitis
what can cause necrotising enterocolitis
premature baby being fed too early
necrotising enterocolitis symptoms
vomiting green bile, intolerance to feeds, distended tender abdomen with absent bowel sounds and blood in stools
gas in peritoneal cavity in necrotising enterocolitis indicates what
perforation
what does the abdominal X-ray in neonate with necrotising enterocolitis show
dilated bowel, bowel wall oedema and gas in bowel
management of necrotising enterocolitis
nil by mouth and clindamycin and cefotaxime
in neonates when bleeding into the ventricles inside the brain
intraventricular haemorrhage
what is the most common type of intraventricular haemorrhage
germinal matrix
condition that is obliteration of the lumen of the jejunum
jejunal atresia
how does jejunal atresia present
abdominal distenson and bilious ( yellow-greenish) vomitting within the first 24 hrs of birth
how does jejunal atresia present
abdominal distenson and bilious ( yellow-greenish) vomitting within the first 24 hrs of birth
treating jejunal atresia
surgery
malrotation presents with – vomit
green
investigation for malrotation is
upper gi contrast and followthrough
treatment of malrotation is
surgery
what is usually a manifestation of cystic fibrosis
meconium ileus
what is meconium ileus
abnormally thick meconium causing obstruction to the distal ileum
what is caused by a weakness in muscle around the groin
inguinal hernia
cerebral palsy can be from prenatal to less than— post natally
1month
post natal causes of cerebral palsy
meningitis, severe neonatal jaundice and head injury
genetic disease that causes muscles weakness and wasting
duchennes muscular dystrophy
aetiology for duchennes
defect gene for dystrophin on the X chromosome - X linked recessive
how can girls affect duchennes
they can be carriers
where do boys develop weakness first
around pelvis
what age do boys present with deuchennes
3-5years
gowers sign is
deuchennes
lack of eye contact and delay in smiling
autism or reactive attachment disorder
a child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm, or distress
inhibited reactive attachment disorder
- a child who displays excessive familiarity with strangers, indiscriminate sociability or lack of selectivity in their choices of attachment figure
disinhibited reactive attachment disorder
can childhood experiences interact with genetics
yes
what can differentiate reactive attachment disorder from autism
coventry grid
The presence of three or more of the following criteria in the past 12 months with at least one criterion present in the past 6 months:
- Aggression to people or animals
- Destruction of property
- Decietfulness or theft
- Serious violation of rules
conduct disorder
some evidence of – being at greater risk of conduct disorder
twins
not recommendeed but can be used in severe cases - drug that can help with impulsivity and aggressive behaviour
risperidone
trisomy 21 is what condition
down syndrome
what are these signs of:
- hypotonia, brachycephaly (small head with a flat back), short neck, short stature, prominent tongue, flattened face and nose, prominent skin folds, brush field spots (spots in eye)
down syndrome
Down syndrome often have recurrent
otitis media
what are cardiac defects that occur in 1 in 3 of Down syndrome
atrial and ventricular septal defects, patent ductus arterious and tetralogy of fallot
go issues in Down syndrome
hirschsprungs disease and duodenal atresia
Down syndrome are predisposed to developing what
diabetes and coeliac
what is more common in adults with downs
dementia
what is more common in children with downs
leukaemia
what occurs in 10-20% of downs syndrome
hypothyroidism
what sleeping disorders should you screen for in downs
obstructive sleep apnoea
2 genetic causes of severe obesity
prader wili syndrome and barget biedl syndrome
what genetic cause of obesity causes visual and renal impairment
barget biedl sydrome
what is responsible for at least 1/4 of all pneumonia deaths in HIV infected infants
pneumocystis jiroveci
can breast feeding prevent pneumonia
yes
what is the leading cause of death in under 5 globally
diarrhoea
diarrhoea causative organisms
rotavirus, e.coli
what is diarrhoea usually caused by
faeces infected water or food
management for diarrhoea
oral rehydration solution and zinc supplements
glucose and sodium creates osmotic pull for
water
where is the oral rehydration solution mostly absorbed
jejunum
what is the % of babies born with HIV with HIV infected mothers without intervention
15-45%
when can HIV transmission occur
pregnancy, delivery, breastfeeding
intervention if mum got HIV
- maternal lifelong antiretroviral treatment
-screen and treat other sexual transmitted diseases - infant prophylaxis with co-trimoxazole for 6 weeks
what is the clinical presentation of abby with HIV
recurrent or severe childhood illnesses eg otitis media, diarrhoea
what is the test for HIV in babies under 18 months
PCR for HIV DNA or RNA
what is the test for HIV in babies greater than 18 months
antibody test
what immunological count for HIV to stage
CD4+
should all children with HIV get treatment regardless of clinical stage
yes
what is HAART
2 NRTIs and 1 NNRTI or protease inhibitor
what is a NRTI
nucleoside reverse transcriptase inhibitor
example of NRTI
abacavir
what is a NNRTI
non- neucleoside reverse transcriptase inhibitor
example of a NNRTI
efavirenz
example of a protease inhibitor
kaletra
what is a complication of the treatment for HIV and how can it be resolved
Immune reconstitution inflammatory system (IRDS) and with NSAIDs
do most children infected with M. tuberculosis develop tb
no
what does developing tb depend on
competence of the immune system to resist multiplication of the infection
risk factors for tb
HIV, malnutrition and household contact
tb length of cough or fever
greater than 2 weeks
what is the primary site of infection in tb
ghon focus
where is the ghost focus in the lung
periphery of mid zone
military shadowing is
military tb
what tb test is low yield in children
ziehl Neelson stain
what is the Mantoux tuberculin skin test used to detect
tb
what tb test is not used in children under 5
interferon gamma release assays
latent tb treatment
RI for 3 months or I for 6 months
what is the parasite that causes malaria
Plasmodium from female anopheles mosquito
what is the parasite that causes the most severe malaria as it crosses the blood brain barrier
P. falciparum
what is the clinical presentation like for malaria
very variable
what is the management for malaria
aremisinin- based combination therapy for 3 days
severe malaria - artesunate IV or IM
what is a protein energy malnutrition from only having carbs resulting in oedema
Kwashiokor
malnutrition resulting in low body weight
marasmus
diagnosing severe acute malnutrition
- mid-arm circumference less than 115mm
- weight for height under 3 SD
-oedema of both feet
when can malnutrition patients be treated as outpatients
have an appetite and are clinically well and alert
some treatment for outpatients fo malnutrition are
investigate cause, vitamin A, de- worm, Therapeutic food and check vaccinations
examples of ready to use therapeutic food
peanut butter, dried milk, vitamins and minerals
what should be given immediately on admission if severely malnourished
feed or glucose due to risk of hypoglycaemia
when is the only time to use IV route for rehydration in malnutrition
shock
what is not suitable for severely malnourished children
oral rehydration solution
giving iron early in malnutrition aggregates what
infection
is primary or sensory epilepsy more common
secondary
bronchiolitis is most commonly due to
RSV ( respiratory syncytial virus)
bronchiolitis generally occurs in children under
1
croup causes what
oedema in the larynx
croup is commonly caused by what virus
parainfluenza
barking cough
croup
does croup have runny nose, sneezing mucus in throat and watery eyes
no but bronchiolitis does
mild croup is treated with
corticosteroid eg dexamethasone
treatment for severe group
dexamethasone, oxygen, adrenaline
what kind of wheeze would be heard throughout the chest in acute asthma
expiratory wheeze
how can the chefs sound in acute asthma attack
tight
peak flow is what in kids SEVERE acute asthma attack
less than 50%
resp rate of severe asthma attack
1-5 years old is GREATER THAN 40
older than 5 years is GREATER THAN 30
heart rate in acute severe asthma attack in kids is
1-5 years is GRATER THAN 140
older than 5 years is GREATER THAN 125
MILD ASTHMA ATTACK IN KIDS TREATMENT
SALBUTAMOL INHALERS 4-6 PUFF EVERY 4 HRS
ACUTE ASTHMA PNEUMONIC FOR TREATMENT
OSHITMAN
what causes sputum to fill the airways and alveoli
pneumonia
what is the most common viral cause of childhood pneumonia
RSV
what is the cough like in kids pneumonia
wet and productive
a high fever in kids is greater than
38.5
what are bronchial breath sounds
harsh breath sounds that are equally loud on inspiration and expiration
dullness to percussion is caused by
lung tissue collapse and or consolidation
what is focal coarse crackles caused by
air passing through sputum
signs of pneumonia in kids
bronchial breath sounds, focal coarse crackles, dullness to percuss
when would you take blood cultures in kids pneumonia
if signs of sepsis
first line in kids pneumonia
amoxicillin
in kids pneumonia what is used if allergic to penicillin or to cover atypical
macrolide eg erythromycin
what is the most common rhythm disturbance in kids
SVT
4 types of SVT in kids
a fib, paroxysmal SVT, atrial flutter, wolff Parkinson white syndrome
what is the heart rate in SVT
150-270
SVT presents with
palpitations
gram neg or pos that cause the majority of organisms responsible for paediatric infective endocarditis
positive
what may be auscultated in paediatric IE
new or changing heart murmur
joint pain and headaches can be symptoms in
paediatric IE
when should you start antibiotics in infective endocarditis
after you have obtained culture then transition to specific antibiotics based on culture results
what is gastroenteritis
inflammation all the way from the stomach to the intestines
is gastroenteritis most commonly viral or bacterial
viral eg rota or norovirus
gastroenteritis causes
nausea, vomiting, diarrhoea
wha should you ensure in gastroenteritis treatment
remains hydrated while waiting for diarrhoea and vomiting to settle
where is the pylorus
from the stomach to the first part of the small intestine
projectile vomiting that most commonly occurs after the baby is fed
pyloric stenosis
congenital pyloric stenosis most commonly occurs when
between 2-12 weeks
will vomit from pyloric stenosis have bile in it
No so vomit will be milky
signs in congenital pyloric stenosis
dehydration
peristalsis across the abdomen
may feel abdominal mass
investigation in congenital pyloric stenosis
US
what is the surgery for pyloric stenosis
Pyloromyotomy
volvulus results in
bowel obstruction
congenital malrotation predisposes to volvulus where
midgut
meconium ileum can predispose to what kind of volvulus
segmental
investigation for volvulus
air
do babies have constipation or diarrhoea in volvulus
constipation
what can the stool be like in volvulus
bloody
what results in narrowing of the lumen resulting in a palpable mass in the abdomen and obstruction to the passage of faeces
intussusception
redcurrant jelly stool
intussusception
where is the mass on intussusception
right upper quadrant
target sign on ultrasound
intussusception
what is air reduction the management for
intussusception
symptoms of intussusception
severe, sharp well localised abdominal pain
pale, lethargic and unwell
vomiting
inflammation of the appendix
appendicitis
what is the main differential for an acute abdomen presentation in a child
appendicitis
where does appendicitis pain begin
central
where does appendicitis pain move down to
right iliac fossa
classic features in appendicitis
anorexia, nausea and vomiting and moderate temperature
tenderness in mcburneys point
appendicitis
what is rovings sign in appendicitis
palpation of the left iliac fossa causes pain in the RIF
feeling every bump on the way to hospital so pain on movements suggests
peritonitis
what are these signs in: tenderness in mcburneys point, rovings sign, guarding on abdominal palpation, rebound tenderness, percussion tenderness, painful movements
appendicitis
treatment in appendicitis
appendectomy
what is the main investigation in appendicitis
mainly clinical based on presentation and raised inflammatory markers but can do US if uncertain
urinary tract includes
urethra, bladder, ureters and kidneys
UTI are more common in
girls
investigation in UTI
urine clean catch sample with microbiology
what should all children under 3 moths with a fever should start
IV ANTIBIOTICS
oral antibiotics can be considered when child’s over
3 months
what is pyelonephritis
infection affecting kidney function
what brings blood to the scrotum
spermatic chord
what is epididymoorchitis
bacterial infection of the epididymis progressing to testes
where is the appendix testis located
upper pole of the testis
what is a hydrocele
collection of fluid within the tunica vaginalis that surrounds the testes
soft and smooth and non tender swelling of one of the testes
hydrocele
hydrocele investigation
transilluminate
difference between simple and communicating hydrocele
connection with peritoneal cavity in communicating
soft lump in the inguinal region
inguinal hernia
part of the bowel pushes through a weakness in the abdominal muscles
inguinal hernia
how to manage inguinal hernia
surgery
empty scrotum means
undescended testes
management in undescended testes
wait 3- 6 months as in most cases the testes will descend in this time
what is prepuce
foreskin
is foreskin retractable in most newborns
no
retractibility of f skin increases with what
age
does non retractable forekin need intervention
no
what is chronic inflammatory process which affects the foreskin but can also extend on to the glans and external urethral meatus
Bxo balanitis xerotica obliterans
there is keratinisation of the tip of the foreskin in what
Bxo balanitis xerotica obliterans
management for Bxo balanitis xerotica obliterans
circumcision
fskin cannot be returned to its original position after being retracted
paraphimosis
urethral meatus is located at abnormal site
hypospadias
inflammation of the brain
encephalitis
most common cause of encephalitis
HSV
encephalitis symptoms
altered consciousness, unusual behaviour
investigations for encephalitis
lumbar puncture and imaging
treatment for encephalitis
antiviral medications
what medication treats HSV and VZV
aciclovir
what is meninges
lining of the brain and spinal chord
what is meningitis
inflammation of the meninges
mengiitis organism in neonates is
Group B strep
bacterial organsim in meningits for children and adults
Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus)
- Fever
- Neck stiffness
- Vomiting
- Headache
- Photophobia
- Altered consciousness and seizures
meningitis
non blanching rash can be present in
meningitis
does absence of rash exclude meningitis
no
investigation for meningitis
lumbar puncture
bacterial meningitis management
- Under 3 months- cefotaximeplusamoxicillin
- Above 3 months- ceftriaxone
- If penicillin allergic: chloramphenicol
- Steroids e.g. dexamethasone are also used in bacterial meningitis to reduce the frequency and severity of hearing loss and neurological damage
does viral meningitis tend to be more severe than bacterial
no viral is milder
treatment for viral meningitis
aciclovir
what seizures occur in children with a high fever
febrile
what is the most common cause of syncope in children
vasovagal episode
breath holding attacks typically occur between
6-18 months and most outgrow by 4/5 years of age
reflex anoxic seizures occur when
child is startled eg minor bump to head
heart stops beating for no longer than 30 secs in what seizures
reflex anoxic
tendency to have seizures
epilepsy
what are seizures
transient episodes of abnormal electrical activity in the brain
investigations for epilepsy
EEG and MRI brain
can control fever with what
paracetamol and ibuprofen
vasovagal episode is triggered by
emotional or orthostatic stress eg prolonged standing, sight of blood
