Child's health Flashcards
1
Q
When does ductus arteriosus close?
A
Day 2 of life
2
Q
What congenital heart defect is seen in Down’s Syndrome?
A
cAVSD (complete)
3
Q
What genetic syndrome is coarctation of the aorta associated with?
A
Turner syndrome (45, X)
4
Q
what does CPAP stand for?
A
Continuous Positive Airways Pressure
5
Q
What is long QT syndrome often mistakenly diagnosed as in children?
A
Epilepsy
Long QT syndrome is associated with sudden LOC during exercise, stress or emotion
6
Q
Features suggestive of a cardiac cause of syncope:
A
Symptoms on exercise - potentially dangerous
FH of sudden unexplained death
Palpitations
7
Q
Infecting agent in Rheumatic fever?
A
An abnormal immune response to infection with Group A haemolytic streptococcus
(same that causes tonsillitis)
8
Q
What causes leukaemia?
A
When a white blood cell starts multiplying out of control
9
Q
List the white blood cells
A
Lymphoblasts (B lymphocytes, T lymphocytes)
Granulocytes (eosinophiil, neutrophil, basophil)
10
Q
What does ALL result from?
A
Infiltration of the bone marrow or other organs with leukaemic blast cells
11
Q
What CFs does bone marrow infiltration present with?
A
ANAEMIA: pain, lethargy
NEUTROPENIA: infection
THROMBOCYTOPENIA: bruising, petechiae, nose bleeds, bone pain
12
Q
What are the CFs as a result of the reticulo-endothelial infiltration in ALL?
A
hepatosplenomegaly
lymphadenopathy
13
Q
What are the CFs as a result of other organ infiltration in ALL?
A
CNS: headaches, vom, nerve palsies
Testicular enlargement
14
Q
Why might ALL present like meningitis?
A
Petechiae ‘rash’ (from the easy bruising in ALL).
- But this would actually be meningococcal septicaemia as is this as soon as there is a rash!
15
Q
Ix ALL:
A
BLOOD COUNT:
- anaemia
- WCC up or down
- neutropenia
- thrombocytopaenia
- blast cells
BONE MARROW
LP
16
Q
Peak age ALL
A
4-7yrs
17
Q
Prognosis ALL
A
80%
18
Q
Good prognostic factors ALL
A
Age 2-10
Female
WCC <50
No CNS disease
19
Q
ALL classification:
A
Common
B and T cell
20
Q
ALL treatment
A
Stratified into risk groups A B & C
Consolidation and CNS treatment
Intensification
Maintenance (girls 2yrs, Boys 3yrs)
21
Q
Causes of macrocytic anaemias
A
Vitamin B12 deficiency (including pernicious anaemia)
Folate deficiency
22
Q
Causes of microcytic, hypochromic anaemia:
A
Iron deficiency
Thalassaemia
Chronic inflammatory disease
23
Q
What does a low reticulocyte count mean?
A
Lack of production
24
Q
What does a high reticulocyte count mean?
A
Haemolysis / blood loss
25
Causes of anaemia classified by mechanism:
decreased production
increased consumption
increased loss
26
Tx Sickle cell disease
Pneumococcal, influenza, meningococcal vaccines
Prophylactic penicillin
27
What infection might cause aplastic crisis in sickle cell disease?
Parvovirus B19
28
What presents with a large abdo mass, haematuria, anorexia, fever?
Wilms' tumour
| A nephroblastoma
29
2 paediatric bone tumors and which is most common?
Osteogenic sarcoma (more common)
Ewing Sarcoma
30
What do neuroblastomas arise from?
Neural crest tissue in the adrenal medulla and SNS
31
Raised levels of what in the urine are suggestive of neuroblastoma?
Catecholamine levels
32
CFs brain tumour
Behaviour change, tired, raised ICP, focal neuro
```
Headache (worse lying down)
Vomiting (esp on morning waking)
Papilloedema
Squint
Nystagmus
Ataxia
Personality change
```
33
Whats the most common brain tumour type? and where?
Astrocytoma
Cortex, hypothalamus, thalamus
34
Diagnosis of Kawasaki disease?
CRASH and BURN (Fever >5 days) + other features
Conjunctivitis (bilateral + non-purulent)
Rash
Adenopathy (cervical + unilateral)
Strawberry tongue + cracked lips
Hands / feet – erythema + desquamation
35
What is Kawasaki diseae?
A systemic vasculitis
36
Ix Kawasaki disease
```
FBC:
High platelets (thrombocytosis) ,
```
echo (inpatient) and one at 6 weeks to look for cornary artery aneyursms
37
Mx Kawasaki
Mx: oral aspirin, (anti-inflamatory, antiplatelet agent
IV immuniglobuin (dampens down immune response to vasculitis)
Echo inpt and cardio referal (for echo 6 weeks later)
38
Causes of neonatal collapse
1. ** Sepsis
2. Cardiac (duct dependent lesion)
3. PPHN
4. Metabolic
5. NIA
39
What causes PPHN?
a. Meconium aspiration
b. Infection (from PROM, group B strep carrier)
c. Congentical abnormalities of the heart and lungs
40
What happens in PPHN?
is a condition caused by a failure in the systemic circulation and pulmonary circulation to convert from the antenatal circulation pattern to the "normal" pattern.
In a fetus, there is high pulmonary vascular resistance and low pulmonary blood flow as the fetus does not use the lungs for oxygen transfer. When the baby is born, the lungs are needed for oxygen transfer and need high blood flow which is encouraged by low pulmonary vascular resistance.
41
Management of neonatal collapse
Airway / breathing
- intubation and ventilation
- NG tube
Circulation
- Lines (UAC/UVC/peripheral cannula)
- Fluid resus (10 mls/kg 0.9% NaCl)
- Inotropes (dopamine/dobutamine)
Disability
- Glucose (2mls/kg 10% glucose if hypoglycaemia)
- Assess neurology (think about therapeutic hypothermia)
Investigations
- CXR/AXR, Echo, FBC/CRP/cultures
Antibiotics
Treat underlying cause
42
What is bronchiolitis and what age group does it occur in?
Acute infection of lower airways
The very young (usually <1yr)
43
What classically causes bronchiolitis?
Respiratory Syncytial virus (RSV)
44
CFs bronchiolitis
Coryzal symptoms (including mild fever) precede:
- dry cough
- increasing breathlessness
- wheezing, fine insp crackles (not always present)
- feeding difficulties associated with increasing dyspnoea
45
Mx Bronchiolitis
O2
Support feeds
Patience
POSSIBLY
- Respiratory support (high flow, CPAP, intubation + ventilation)
- Nebulised adrenaline
-->supportive care
46
What is a NPA and why is it useful in bronchiolitis?
Nasopharyngeal Aspirate (to diagnose causative agent)
Useful to avoid other investigations and to decide if need segregate kids if in ITU (RSV is highly contagious)
47
What is sepsis?
Dysregulated host response leading to end organ dysfunction (hypotension, tachycardia etc.)
48
Causative agents in sepsis?
Meningococcal disease (caused by neisseria meningitidis)
Streptococcal Group A infection
(in neonates: GBS)
(Also can be viral, fungi, parasites)
49
Ix for sepsis
```
FBC
U&Es
LFTs
CRP
Cultures
Gas (including lactate)
```
50
Mx sepsis
- O2 to keep sats >94%
- Fluid resus: 20ml per kilo, 0.9% saline
- Broad spectrum Abx : cefotaxime
- Appropriate escalation: intensive care, inotropes
- DIC: FFP + platelet transfusions
51
What do inotropes do?
Incrased the strength of mucscular contraction
52
What is asthma?
| What age?
Reversible airways obstruction
| Usually >5 yrs of age
53
To assess control + Hx of asthma, what 4questions to ask?
- How often are you using blue inhaler?
- How many courses of oral steroids in last 6 months?
- Hospital admissions etc.?
- Have you ever been to intensive care?
54
Treatment of acute asthma ?
1. Bronchodilators: salbutamol (10 puffs via spaces), or ipratropium if on O2
2. Steroids: oral steroids if theyre ok, IV hydrocortison if a bit sicker
Rarely: magnesium, aminophyline, salbutamol IV - if you do that they need to go to ITU
55
What to check acute asthma inpt before you send them home?
Check inhaler technique
Compliance with their meds
Are you sure you're taking the brown one everyday? (beclamethasone)
56
What are the cardiac causes of neonatal collapse?
Duct dependent systemic lesions:
- Coarctation of the aorta
- Critical aortic stenosis
Duct dependent pulmonary circulation
- Pulmonary atresia
- TOF
Both: TGA
57
Normal value of pH
7.35 - 7.45
58
Normal value of pO2
10 - 14 kPa
59
Normal value of pCO2
4 - 6 kPa
60
Normal value bicarbonate
HCO3-
22 - 26
61
Normal base excess
- 2 to + 2
62
Normal lactate value
< 2
63
What conditions might cause Respiratory Acidosis?
Inefficient ventilation: asthma, pneumonia, bronchiolitis, preterm neonates
64
What condition might cause Respiratory Alkalosis?
Hyperventilation (and tingling fingers)
65
What conditions might cause Metabolic acidosis?
Sepsis, DKA
66
What conditions might cause Metabolic Alkalosis?
Profuse vomiting, Diuretics
67
Causative organism scarlett fever?
Group A strep
68
CFs (general) scarlet fever
sudden fever
sore throat
red strawberry tongue
69
CFs (progression) scarlet fever
Skin = sandpaper-like feel
Pastia lines = red streaks in body folds
70
Mx scarlet fever
Oral penicilin for 10 days
71
Complications scarlet fever?
```
Rheumatic fever
Otitis media
Pneumonia
Septicaemia
Glomerulonephritis
Death!
```
72
Causitive agents in meningitis?
Neisseria meningitidis
| Group B strep
73
Community Mx of meningits?
IM benzylpenicilin
74
What is given to prevent hearing loss from meningitis?
Dexamethasone
75
What are the causes of breathless congenital heart disease? And what direction is the shunt?
ASD
VSD
PDA
L --> R
76
What are the causes of cyanotic congenital heart disease? And what is the direction of the shunt?
5Ts:
1. Truncus arteriosus
2. ** Transposition of the great arteries
3. ** Tricuspid atresia
4. Tetralogy of fallot
R --> L
77
What is the most common congenital heart defect?
VSD
78
CFs VSD?
Tachycardia
Tachyopnea
FTT
HF
**Pansystolic murmur (L lower sternal edge)
79
Mx VSD?
Small: will close spontaneously
Large: surgical closure + diuretics
80
CFs ASD?
Commonly none
Tachypnoea
FTT
Wheeze
**Ejection systolic murmur (L upper sternal edge)
81
What does the DA connect?
The aorta to the pulmonary artery
82
CFs PDA
Tachypnoea
FTT
Bounding pulse
**Continuous machine-like murmur (below L clavicle)
83
Mx ASD?
Small: will close spontaneously
Large: surgical closure
84
Mx PDA
NSAIDs (ibuprofen - to close)
or
Surgical ligation
85
4 components tetralogy of fallot?
1. Pulmonary stenosis
2. Overriding aorta
3. VSD
4. Right ventricle hypertrophy
86
CFs ToF
```
Severe cyanosis
Hypercyanotic spells on: exercise, crying, defecating
Squatting on exercise
**Ejection systolic murmur
Clubbing of fingers and toes (late)
```
87
Mx ToF
Surgery at 6 months
- Close VSD
- Relieve pulmonary outract obstruction
88
What happens in transposition of great arteries?
Pulmonary artery and aorta swap (2 independent loops)
| - RV -> aorta -> body -> RA
- LV -> PA -> lungs -> LA
its only the PDA keeping them alive
89
CFs Transposition of the great arteries
Present on day 2 of life (after DA closes) with severe life-threatening cyanosis
90
Mx Transposition of the great arteries
KEY: want to improve mixing
1. Maintain PDA (prostaglandin infusion)
2. Surgical: atrial septostomy and arterial switch procedure
(to close - ibuprofen)
91
What can cardiac outflow obstruction be divided into?
Well child:
- Pulmonary stenosis
- Aortic stenosis
Sick child:
- Coarctation of the aorta
92
What happens in pulmonary stenosis?
Pulmonary valve leaflets partially fused together, obstructs RV outflow
93
CFs Pulmonary stenosis?
Asymptomatic
** Ejection systolic murmur (Left upper sternal edge)
Palpable thrill
94
What happens in aortic stenosis?
Aortic valve leaflets partially fused together, obstructs LV outflow
95
CFs aortic stenosis?
Reduced exercise intolerance
CP / syncope on exertion
Carotid thrill
** Ejection systolic murmur (R upper S.E)
96
What happens in coarctation of aorta, and where?
Narrowing of the aorta
Commonly at DA
Acute circulatory collapse at day 2 when duct closes --> severe obstruction to LV outflow
97
CFs coarctation of the aorta
Acute circulatory collapse at day 2 when duct closes:
- sick baby w severe HF
- absent femoral pulses
- severe metabolic acidosis
- BP may be arms > legs
They become more severe with age:
- Asymptomatic
- Then S.O.B, arterial hypertension, intermittent claudication
* *Ejection systolic murmu (L upper S.e)
- Radial/radial:femoral delay
98
Mx Coarctation of the aorta
Stent and surgical repair
99
What heart defect is more common in Turner's syndrome? - and what is TS?
Coarctation of the aorta
45, X
100
What are the 4 S's of a harmless murmur?
Soft
Systolic
aSymptomatic
L Sternal edge
101
Ix for a harmless murmur?
Antenatal ECHO
| Neonatal ECHO, ECG, CXR
102
What syndrome occurs in a long-standing left-right shunt in a congenital heart defect?
Eisenmenger's syndrome
103
What happens in Eisenmenger's syndrome?
long standing L to R shunt increases Pul pressure over time, leading to thickening of pulmonary arteries, which causes RVH and increases pressure in RV, reversing the shunt R to L (cyanotic)
104
CFs Eisenmenger's syndrome
10-15yr old, severely cyanosed
original murmur may disappear
clubbing
right ventricular failure
haemoptysis, embolism
105
Mx Eisenmenger's syndrome
Heart-lung transplantation
106
CFs Rheumatic fever
Latent interval of 2-6 weeks following pharngeal infection
Then: polyarthritis, mild fever + malaise
107
Name of criteria for diagnosing Rheumatic fever?
Jones Diagnostic Criteria
108
Mx acute rheumatic fever?
Anti-inflammatory agents (aspirin)
| Corticosteroids
109
How to prevent the recurrence of rheumatic fever?
Monthly injections of benzathine penicillin
110
Causative agent infective endocarditis?
Staph aureus
| Group B streptococci
111
Causative pathogen croup
Parainfluenza virus
112
Age of occurence croup?
6mo - 6yrs.
| Peak 2yrs
113
CFs Croup
```
Barking cough (seal like)
Stridor
Hoarseness
Breathlessness
Poor feeding
```
Preceded by fever, worse at night
114
Mx Croup (general)
Oral dexamethasone
115
Mx Croup if severe (before escalation to ICU)
High flow O2
| Nebulised adrenaline
116
Pathogens tonislitus
Group A beta-haemolytic strep
| Epstein-Barr Virus
117
Mx tonsilitis
Penicilin (or erythromycin if allergic)
Hosp admission for IV fluids and analgesia if can't swallow
118
What is acute epiglottitis
Life threatening medical emergency
Upper airway obstruction
Intense swelling of epiglottis and surrounding tissue
119
Causative pathogen epiglottitis?
Haemophilis influenzae B
120
How to diagnose otitis media?
Examination of the tympanic membrane:
| - Bright red and bulging, with loss of normal light reflection
121
Causative pathogen otitis media?
Bacterial: Pneumococcal infection (caused by strep pneumoniae) or HIB
Viral: RSV + rhinovirus
122
Rx otitis media
Regular analgesia for 1 wk
| Amoxicillin (if child remains unwell for 2-3 days)
123
CFs otitis media
Fever
| Pain in ear
124
What can recurrent ear infections lead to? and what is its CFs?
Otitis media with effusion
Asymptomatic apart from reduced hearing
125
Mx OME
Usually resolves spontaneously
| Grommets +/or adenoidectomy
126
Idications for removal of both the tonsils and adenoids
Recurrent OME with hearing loss
| Obstructive sleep apnoea (absolute indication)
127
What is stridor
A rasping sound heard on inspiration
128
Mx acute epiglottitis?
dont examine throad
Call anesthetist to intubate
IV Cefuroxime
129
Causative organism whooping cough?
Bordetella Pertussis
130
Symptoms whooping cough
Inspiratory whoop
| Spasms of cough - worse at night, cause vomiting, cyanosis, epistaxis (nosebleeds) and subconjunctival haemorrhages
131
Paroxysmal phase in whooping cough
3-6 wks but can persist for months (100 day cough)
132
Ix whooping cough
Per Nasal Swab culture
133
Mx whooping cough
```
azithromycin
School exclusion (for 2 days after commencing Abx)
```
134
Epidemiology Bronchiolitis
Most common LRTI in children
| Incidence increases in winter
135
CFs bronchiolitis
Coryzal
Breathlessness
Poor feedsing
136
Signs of resp distress in bronchiolitis?
```
Nasal flaring
Head bobbing
Subcostal or intercostal recessions
Tracheal tug
Grunting
```
137
Other signs of resp distress in bronchiolitis
Fine end inspiratory crackles
High pitched wheeze
Cyanosis (on feeding)
138
Ix bronchiolitis
PCR analysis of nasal secretions
| CXR: hyperinflation
139
Rx bronchiolitis
Supportive - humidified O2, NG feeds, fluids
140
Prevention for bronchiolitis
Palivizumab
- monoclonal antibody
- IM once per month through autumn and winter
- CF, immunocompromised, congenital heart disease, Downs, preterm babies
141
Asthma pathophysiology
Chronic inflamatory disorder of lower airways secondary to hypersensitivity
Reversible airway obstruction:
- bronchospasm
- musocal swelling and inflammation
- mucous plug
142
CFs asthma
```
intermitted dyspnoea
wheeze
diurnal variation
sputum production
etc.
```
143
Dx asthma
clinical
FEV1:FVC <70%
bronchodilator reversibility - FEV1 improvement by 12% or more
144
What should you monitor for with IV salbutamol?
Hypokalaemia
145
Cystic fibrosis pathophysiology
Autosomal resessive defect in CFTR
- codes cANP regulated chloride channels in cell membranes (Chr 7)
- causes increased viscosity of secretions and blockage of narrow passageways
146
Clinical features CF
Reduction in air surface liquid layer & impaired ciliary function retention of secretions:
- chronic endobronchial infection - pseudomonas, staph aureus
Pancreatic ducts blocked by thick secretions --> maldigestion, malab and steatorrhea
- neonates present with meconium ileus
Later in life : DM, delayed puberty, male infertility, female subfertility
147
What do most CF pts die of?
Respiratory failure
148
Dx CF
Guthrie heel prick screening test
Sweat test (Cl ions markedly increased)
Feacal elastase (low levels)
Gene abnormalities in CFTR protein
149
Mx CF
1. Aim to prevent progression of lung Dx and maintain adequate nutrition
2. High cal, high fate diet
3. Chest PT and postural draining
4. Pancreatic enzyme replacement therapy (PERT)
5. Prophylactic Abx (? flucloxacillin)
150
What infections are you especially worried about in CF?
Pseudomonas aeruginosa
| Staphylococcal aureus
151
DDx stridor other than croup and epiglottitis?
Foreign body
| Anaphylaxis
152
Most common cause of pneumonia in younger children?
Viral: RSV
153
Most common cause of pneumonia in older children?
Bacteria: streptococcus pneumoniae or mycoplasma pneumoniae
154
What Abx for pneumonia?
1stL: amoxicillin
If severe: co-amoxiclav or Cefotaxime
155
Triad in nephrotic syndrome
Hypoalbuminaemia
Proteinuria
Oedema (peripheral, scrotal/vulval, periorbital, ascites)
156
Common causes Nephrotic syndrome
Minimal change disease
Focal-segmental glomerulosclerosis
Post-streptococcal nephrities
157
Tx Nephrotic syndrome
Steroid sensitive: 85%-90%
- Prednisolone oral
Steroid resistant
- Diuretics, salt restriction, ACE-I, NSAIDs
- Cyclophosphamide +/- ciclosporin (both immunosuppresants)
158
Triad in Haemolytic Uraemic Syndrome
Acute renal failure
Thrombocytopenia
Haemolytic anaemia
159
What does Haemolytic Uraemic Syndrome follow?
A prodrome of bloody diarrhoea - E. Coli / shigella
160
CFs Haemolytic Uraemic Syndrome
Abdo pain
Decreased urine output
Normocytic anaemia
161
Ix Haemolytic Uraemic Syndrome
Fragmented blood film
Stool culture
FBC
162
Mx Haemolytic Uraemic Syndrome
Supportive + Dialysis
| Plasma exchange if severe
163
Henoch-Schonlein Purpura Triad
Purpura (raised like sandpaper)
Arthritis (knees and ankles)
Abdo pain
164
What does Henoch-Schonlein Purpura follow?
URTI - Strep pyogenes (a.k.a. Group A strep)
165
CFs Henoch-Schonlein Purpua?
Rash on buttocks and extensor surfaces of limbs
Haematuria
Proteinuria
Oedema
166
Mx Henoch-Schonlein Purpura
Oral prednisolone
167
UTI Px in infants
Poor feeding
Vom
Irritability
168
UTI Px in younger children
abdo pain, fever, dysuria
169
What Ix for all infants with an unexplained fever of >38 degree
Urine sample
170
Mx UTI <3mo old
Immediate referral to paediatrician
| IV Abx e.g. Cefotaxime
171
Mx UTI >3mo
Oral Abx e.g. co-amoxiclav
172
When should Abx prophylaxis be considered for UTIs?
With recurrent UTIs
173
Features of atypical UTI
Seriously ill
Poor urine flow
Abdo mass / bladder mass
Elevated creatinine
Septicamiea
Failure to repond to Tx with appropriate Abx within 48hrs
Infection with organism other than E. coli
174
When might transient proteinuria occur?
During febrile illness or after exercise
175
CFs acute nephritis?
Decreased UO & volume overload
HTN ~--> seizures
Oedema (round eyes)
Haematuria + proteinuria
176
Causes acute nephritis
Post infectious (including sterptococcus)
Vasculitis (Henech Schonlein Purpura)
IgA nephropathy
177
Mx Acute nephritis
Fluid + electrolyte balance
Diuretics
Monitor for rapid deterioration in renal function
178
Features of West syndrome, and what does EEG show
Head nodding, arm jerk,
Hypsarrhythmia
179
What is febrile convulsion and when to treat?
Single tonic clonic <20m, high fever, treat if >5m
180
What is status epilepticus defined as?
>30 min tonic-clonic but treat at 5m
181
Mx status epilepticus?
Buccal Midazolam --> IV lorazepam --> IV phenytoin --> Rapid sequence intubation
182
When does the newborn physical exam happen and what does it test for?
Within 72hrs of birth and + 6 weeks
Full body but mainly hips, heart, eyes, genitalia
183
When is Guthrie's test carried out?
Day 5-8
184
When is school screening?
Starting reception and high school
Tests vision, growth, obesity @4yr, and obesity @11yr
185
What are the 2 tests for developmental dysplasia of the hip?
Barlow's (dislocation)
| Ortolani's (relocation)
186
What is spina bifida and what causes it?
Failure of neural tube to close in first trimester
Insufficient folic acid
Drugs (valporate, carbamezapine)
187
RFs for DDH
Breech presentation
Family Hx
Prematurity
188
6 week key developmental milestone
Social smile, eye tracks movement
189
Key developmental milestone 5 months
Palmar grasp
190
When do babies walk?
9-18 months
191
Cerebral Palsy definition
Permanent, non-progressive movement disorder due to a lesion of the developing brain
192
Causes of CP prenatally
Cerebral malformation (80%)
Infection (TORCH)
Metabolic
193
Causes of CP perinatally
Hypoxia
Intrapartum trauma
Prematurity complications
194
Post natal causes of CP
head trauma
stroke
meningitis
195
Presentation of spastic CP
```
UMN signs
Rigidity
Hypereflexia/tonia
Weakness
Delayed milestones
Poor co-ordination
Persistent primitive reflexes
```
196
Hemiplegic spastic CP features
Unilateral arm > leg spasticity, tiptoe gait and dystonic posture
197
Diplegic spastic CP features
Bilateral leg > arm spasticity, knock-knee gait, most common
198
Ataxic CP features
Poor coordination
Cerebellar lesions
Ataxic gait
Intention tremor
199
Athetoid (dyskinetic) CP cause and features
Basal ganglia lesion due to bilirubin encephalopathy or hypoxic-ischaemic injury
Extrapyramidal signs and fluctuating hyper/hypotonic
200
Associated problems CP
```
Epilepsy
Audiovisual development problems
Resp problems
Poor growth
Intellectual disability
```
201
RFs CP
Pretem birth
Twins
Maternal infection
Difficult delivery
202
Ix Clinical CP
MRI/ CT if ? cause or ongoing conditions e.g. hydrocephalus, ?SDH, ? AVM ? malignancy
203
Mx CP
Early MDT involvement
| Physio / paeds / SALT / Orthopod /OT / dietitian / community liason
204
CFs Measles
Maculopapular rash
Fever
URTI
--> complicated encephalitis
205
CFs Mumps
Swollen parotids
Fever
Subfertility in men
206
CFs Rubella
Mild fever + rash
Maternal infection
Foetal abnormalities
207
Paeds CPR
100-120 bpm
1/3rd chest compression depth
5 rescue breaths -> 15 chest compressions --> 2:15
208
Signs of moderate / severe dehydration
```
Tachycardia
>2CRT
Weak pulses
Mottling
Cold
Cyanosis
Coma
```
209
Bolus in hypovolaemia?
20ml / kg of 0.9% saline STAT
210
When is a normal bolus amount contra-indicated?
In DKA, trauma, neonates
| give 10ml/kg instead!
211
What fluid for maintenance?
0.9% saline + 5% dextrose + 10mmol KCl
212
Specific features of non-accidental injury
Metaphyseal corner fracture (shaking)
Rib fracture
Skull fracture
213
Bruising places in a NAI
```
ear
cheeks
buttocks
forearms
neck
```
214
What would make you suspeicious of a NAI?
History incompatible with injury / unclear history, delay seeking medical attention
Multiple fractures, retinal haemorrhage, torn frenulum
Injury in a non-ambulatory / totally dependent child
215
Concise features of Septic Arthritis?
Red, hot, swollen, tender, monoarthritis, systemic upset.
216
Management of septic arthritis?
Urgen Abx, aspirate + washout + orthopod opinion
217
Concise features of Duchenne's (childhood limp)
Proximal weakness,
Boys
Gower's sign
Resp involvement
218
Who does Perthe's disease affect and what causes it?
4-8 yo boys
| Avascular necrosis of femoral head
219
Features of slipped capital femoral epiphysis (childhood limp)
obese
adolescent
male
groin pain
220
Complications of prematurity
Intraventricular haemorrhage
Retinopathy of prematurity
RDS
NEC
Sepsis
221
What 2 CFs for intraventricular haemorrhage?
Seizures
| Bulging fontanelle
222
What is a cause of retinopathy of prematurity?
Exposure to O2
223
RDS X-ray finding
Ground glass XR
224
Respiratory Distress Syndrome Mx
Give surfactant
O2
CPAP
225
Feature of NEC
Failure to thrive
226
What is preventative of NEC?
Breast milk
227
Rx NEC
Supportive
| And surgery
228
CFs Mastoiditis?
Medical emergency --> meningitis, sinus thrombosis,
Ear pushed out / previous otitis media
229
Mx Mastoiditis
IV Abx +/- mastoidectomy
230
Parotitis (mumps) CFs
Parotid swelling
Fever
Malaise
Scrotal pain
231
Ix mumps (and alternative name)
Parotitis
- Raised amylase
- IgG/IgM antibodies
232
Mx Mumps and what to watch out for!
Fluids/analgesia
Subfertility!
233
What does high IgG + high IgM mean?
Recent infection
234
What does high IgG and normal IgM mean?
Previous infection or vacciantion
235
What does normal IgG and normal IgM mean?
No previous exposure
236
Difference on examination of neck swelling between infected and malignant?
Infected = mobile and tender
Malignant = fixed and matted
DONT POKE ANYTHING!
237
Place of bruising in Non accidental injury
```
Ear
Cheeks
Buttocks
Forearms
Neck
```
238
What does lithium in pregnancy cause? and what is it?
Ebstein's anomoly
= Displacement of the septal + tricuspid calve, making the RA huge
239
Boot shaped heart on CXR
Tetralogy of Fallot
240
Egg on side on CXR
ToGA
241
What is rheumatic heart disease?
Scarring and fibrosis of valve tissue of the heart --> mitral stenosis
242
What agents cause common cold?
Rhinoviruses
RSV
(hence Abx are not effective)
243
RFs for bronchiolitis
```
Prematurity
Bronchopulmonary dysplasia
CF or congenital heart disease
Maternal smoking
Immunodeficiency
```
244
What should be given to all children with an acute exacerbation of asthma?
Steroid therapy for 3-5 days (e.g. prednisolone)
245
What would blood in the stool make you think of?
Intussusception
| Gastroenteritis (from either salmonella, or campylobacter)
246
What would vomiting at the end of paroxysmal coughing make you think of?
Whooping cough (Pertussis)
247
What would bile-stained vomit make you think of?
Instestinal obstruction (esp. intussusception, malrotation and strangulated inguinal hernia)
--> assess for shock + dehydration
248
What causes normal gastro-oesophaegeal reflux?
Inappropriate relaxation of lower oesophageal sphincter due to functional immaturity, should resolve by 12m of age
249
Mx simple GOR
parental reassurance
feed thickening
upright posture at 30degrees after feeds
250
Mx worse GOR
Acid suppression
1. H2 receptor antagonist (e.g. ranitidine)
2. PPIs e.g. lanzoprazole
251
If GOR fails to respond to acid repression what should you consider?
Cow's milk protein allergy
252
Presenting age of pyloric steonisis and hallmark feature
```
2-7wks
Projectile vom (non-bilious)
```
253
CFs Pyloric stenosis
Weight loss, FTT, hungry after feeds
| Visible gastric peristalsis, palpable abdo mass on feeding
254
Ix pyloric stenosis
Hypkalaemic, hypochloraemic, metabolic alkalosis
USS abdo (diagnostic)
255
Mx pyloric stenosis
Rehydration and correct electrolyte imbalance
Surgical : Ramstedt's pyloromyotomy
256
CFs intussusception
Severe paroxysmal abdominal colic pain
Child draws knees up to chest, becomes pale, screaming in pain
Vomiting – may become billious
Blood and mucous in stool – REDCURRENT JELLY
RLQ abdo mass – SAUSAGE SHAPED
257
Ix intussusceptin
USS : target sign
| Abdo XR: absence of gas in large bowel, distended small bowel
258
CFs malrotation
Day 1-3 : failure to pass meconium, abdo pain, tender, BILIOUS vomiting
Later: with peritonitis or ischaemic bowel
259
Mx intussusception
1. Air enema reduction
| 2. Surgery
260
Causes of intussusception
Viral --> increase in peyer's patches, OR, a lead point e.g. Mickel diverticulum or polyp
261
Causative organism Peptic ulcer
Helicobacter pylori
262
Rx Peptic ulcer
PPI: omeprazole
If h.pylori suspected: amoxicillin and metronidazole
263
Ix Peptic ulcer
C breath test
| as H. pylori produces urease
264
Most common cause gastroenteritis in the DEVELOPED world?
Viral : rotavirus
265
Bacterial causes of gastroenterisis and what are they suggested by?
Suggested by blood in the stools
Campylobacter jejuni
Shigella --> high fever
Salmonella
266
CF gastroenteritis
Shock from dehydration in infant
e.g. dry mucous membranes, sunken fontanelle, cold extremities
267
Ix gastroenterisis
none usually
| stool culture if septic / immunocompromised / recent travel
268
Mx gastroenteritis
Fluids (oral if poss)
Abx only if sepsis suspected, or recent travel
ORAL REHYDRATION SOLUTION
269
Difference between clinical dehydration and shock
CD (5-10%)
- irritable, lethargic
- tachy in HR and RR
- CRT and pulses normal
Shock (>10%)
- CRT >2s
- RR + HR tachy
- pale or mottled
- skin turgor and BP decreased
- decreased LOC
270
Cardinal features of malabsorption
Abnormal stools: hard to flush, bad odour
FTT or poor growth
Specific nutrient deficiencies
271
Serology coeliac disease
IgA tissue transglutaminase antibodies
| Endomysial antibodies
272
Biopsy coeliac disease
JEJUNAL
Villous atrophy
Crypt hypertrophy
Increased intraepithelial lymphocytes
273
When do ppl outgrow toddler diarrhoea?
Age 5
274
Exacerbating factors toddler diarrhoea?
Excessive consumption of fresh fruit juice
275
Mx toddler's diarrhoea
Adequate fat in diet (slows gut transit), and fibre
276
Dx Crohn's disease
Upper GI endoscopy, ilieocolonoscopy & small bowel imaging
Biopsy
277
Histological marker Crohn's disease
Non-caseating epitheloid cell granulomata
278
Dx + confirmation of relapse in Crohn's?
Raised inflamm markers (platelet, ESR, CRP)
Iron deficiency anaemia
Low serum albumin
279
Rx relapse in Crohn's
Immunosuppresants : methotrexate
280
Rx UC
FOR MILD: Aminosalicylates e.g. mesalazine
ALSO: topical / systemic steroids (depending on if its confined to the rectum of not)
281
Causes of constipation in babies
Hirschsprung disease
Anorectal abnormalities
Hypothyroidism
Hypercalcaemia
282
Causes of constipation in children
Issues w toilet training, unpleasant toilet or stress
| Precipitated by dehydration or painful anal fissure
283
Treatment pathway for constipation
1. Balanced diet and sufficient fluids
Sit on toilet after meal times --> utilise the gastrocolic reflex
2. A stool softner e.g. movicol
3. An osmotic laxative e.g. lactulose
4. A stimulant laxative e.g. senna
5. Enema or manual evacuation (under anaesthetic)
284
What syndrome is Hirshsprung's disease associated with, and gender?
Trisomy 21
| Boys >> girls
285
What is Hirshsprung's disease?
Large bowel obstruction
Absence of ganglionic cells from myenteric plexus of large bowel
Results in a narrow, contracted segment of bowel
286
Clinical features Hirshsprung's disease
Abdo distension
Later bile stained vomit
Can lead to entercolitis from C Diff infection
287
Presentation Hirshsprung's disease
Presentation – failure to pass meconium within 48hrs of life
288
Ix Hirshsprung's disease
Rectal examination
- Narrow segment. Withdrawl causes flow of liquid stool and flatus
Suction rectal biopsy (diagnostic)
289
Mx Hirshsprung's disease
Enema’s
| Surgical resection of affected colon (3-stage procedure)
290
Overal all risk of a subsequent febrile seizure
1 in 3
291
Which febrile seizure increases chance of epilepsy?
Complex febrile seizure
| they last 15-30mins and are focal seizures
292
2 types of paroxysmal disorders : "funny turns"
1. breath-holding episodes (precipitated by anger --> blue --> limp)
2. reflex anoxic seizures (precipitated by pain --> pale --> sometimes brief seizure)
- cause: cardiac asystole from vagal inhibition
293
Px Duchenne Muscular Dystrophy
Waddling gait and / or language delay.
| Have to mount stairs one-by-one
294
Prognosis Duchenne's
late 20s
| Due to resp failure or cardiomyopathy
295
Mx Duchenne's
```
Exercise
Keep good sitting posture
Splints
Corticosteroids to maintain walking
CPAP at night due to weakend muscles
```
296
Inheritance in Duchenne's
X-linked recessive disorder
297
What is osteomyelitis?
Infection of the metaphysis (growth plate) of long bones
298
Pathogen in osteomyelitis AND septic arthritis?
Staph Aureus
299
Presentation osteomyelitis
Painful immobile limb
| + Acute febrile illness
300
Dx osteomyelitis
+ve blood cultures
| increased WBC count
301
How can transient synovitis be differentiated from septic arthritis?
SA is:
- more acute
- severe pain @ rest
- worse on any movement attempt
302
How to differentiate between septic arthritis and osteomyelitis
SA: pain over joint
OM: pain over bone
303
Ix septic arthritis
Increased WCC and acute phase reactants
XR: widening of joint space + soft tissue swelling
Joint aspiration under USS for organisms & culture
304
Rx septic arthritis
1. Abx (after culture): flucloxacillin
| 2. Washing out/ surgical drain
305
Name 4 ptimitive reflexes
Stepping
Moro
Grasp
Rooting
306
When should primitive reflexes disappear by?
6 months, if persist --> pathology
307
types of CP
Spastic
Dyskinetic
Ataxic
308
What is the hallmark of spastic CP?
Dynamic catch
(tone is velocity dependent, the faster the muscle is stretched, the greater resistence it will have)
Clasp-knife
309
4 Features Autistic Spectrum disorders
Impaired social interaction
Speech and language disorder
Imposition of routines with ritualistic and repetitive behaviour
Co-morbidities
310
Rx Autistic Spectrum disorders
Applied behavioural analysis (ABA)
311
Which type of hearing loss presents at brith and is usually irreversible?
Sensorineural hearing loss
312
Causes of conductive hearing loss?
OME
Downs
Wax
313
Mx conductive hearing loss
Conservative
Amplification
Grommets
314
Klinefelter syndrome genetic
47, XXY
315
Most common presentation of klinefelter syndrome
infertility (puberty may seem normal)
316
Features of klinefelter syndrome
Tall stature
hypogonadism w small testes
gynaecomastia in adolescene
317
What counts as low birth weight?
<2500g
Smoking reduces BW
318
What is a pre-term baby?
gestation <37weeks
319
What is a post-term baba
Gestation >/= 42 weeks
320
What does maternal diabetes make a newborn more prone to?
Through macrosomnia:
hypoglycaemia
polycythaemia (raised haematocrit)
321
What does apgar score do and when is it done?
Used to describe baby's condition at 1 and 5 mins after delivery
score out of 10
322
What are the elements of the apgar score?
1. HR
2. Resp effort
3. Muscle tone
4. Reflex irritability
5. Color
323
Role of vitamin K to neonates?
Given IM to all neonates to prevent haemorrhagic disease ofthe newborn
324
Causes of hypoxic-ischaemic encephalopathy
1. failure of gas exchange across the placenta: excessive contractions, placental abruption
2. interruption of umbilical blood flow: cord compression
3. inadequate maternal placental perfusion: maternal hypo/hyper tension, often with IUGR
4. failure of cardioresp adaptation at birth: failure to breath
325
Respiratory distress syndrome, what is it?
Deficiency of surfactant, which lowers surface tension --> widespread alveolar collapse + inadequate gas exchange
v. common <28 weeks
326
Rx antenatal to prevent RDS
Glucocorticoids
327
CXR of RDS
"ground glass" appearance of lungs
328
Complications RDS
Pulmonary interstitial emphysema
Pneumothorax
(prevent by ventilating at lowest pressures you can get away with)
329
Rx Pre-term brain injury
LP
Ventricular tap
Ventricularperitoneal shunt
330
What happens in retinopathy of prematurity?
Babies used to hypoxic environment, when faced with increasd O2, vascular proliferation --> retinal detachment
331
Rx retinopathy of prematurity
Laser therapy decrases visual impairment
332
Acute manifestation kernicterus
Lethargy
| poor feeding
333
What type of CP might survirors of kernicterus develop?
Choreoathetoid CP
334
Haeomlytic diseases that cause pathological jaundice
Rhesus haemolytic disease
ABO incompatability
GP6D deficiency
335
What must you worry about in jaundice >2wks of age, and how to recognise
Biliary atresia
- hard liver, swollen abdo, grey stools, dark urine
- Kasai procedure
Also: congenital hypothyroidism
336
Ix neonatal jaundice (split into 3 categories)
Haemoglobin: FBC
Biochem: Serum B
MOs: blood film
337
Mx jaundice
Phototherapy
| Exchange transfusion
338
When does menarhce occur in girls?
2.5yrs after start of puberty
Breast development is age 8.5-12.5
339
Menstruation: normal cycle length, blood loss length and volume
21-45 days
3-7 days
<80ml
Ix if clots or using >6 pads per day: ? von Willebrand disease?
340
Ix abnormally early or late puberty
Wrist and band X-ray for bone age
| USS pelvic in females: uteine size and thickness
341
How to calculate genetic target heigt centile + range
(Mean of mum and dad's height)
- 7cm for a girl
+ 7cm for a boy
342
Causes of short stature
```
Familial
IUGR + extreme prematurity
Endocrine e.g. hypothy or GH deficiency
Chronic illness e.g. Crohn's, coeliac (FBC)
Psychosocial deprvation
```
343
Rx short stature
SC biosynthetic GH
344
Causes tall stature
familial
obestity
secondary e.g. hyperthyroidism
Syndromes e.g. marfans, Klinefelters
345
Rx tall stature
testosterone or oestrogen therapy
346
Definition premature sexual development
Development of secondary sexual characteristics before 8yrs in female, and before 9 yrs in male
Its called precocious puberty when accompanied by a growth spurt
347
2 types of precicious puberty
1. Gonadotropin-dependent: premature activation of the HPG axis
- e.g. familial, CNS abnormalities, hypothy
2. Gonadotropin-independent (LH and FSH low): from excess sex steroids (exogenous sex steroids)
e. g. CAH, tumors,
348
define delayed puberty
Absence of pubertal development by age 14yrs in female, and age 15yrs in male
349
Causes delayed puberty
1. constitutional delay
2. low gonadotropin secretion e.g. systemic disase, anorexia, too much exercise
3. high gonadotropin secretion e.g. klinefelters, turners, aquired gonadal damange
350
What gene determines sex?
SRY gene on Y chromosome
351
What happens in congenital adrenal hyperplasia?
deficiency of enzyme 21-hydroxylase
| cant produce aldosterone --> salt loss
352
Female presentation CAH
virilisation of external genitalia
353
Male presentation CAH
salt losing adrenal crisis at 1-3 weeks of age
| vomiting + weightloss, floppy
354
Dx CAH
VERY raised 17alpha-hydroxypogesterone in blood
salt losers: met aci, low na
355
Mx CAH
```
lifelong glucocorticoids (to supress ACTH levels)
mineralcortioids if there is salt loss
```
356
Rx salt-losing adrenal crisis
IV hydrocortisone, saline + glucose IV
357
Causes of failure to thrive
1. inadequte intake (either inorganic/env, or organic)
2. inadequate retention
3. malab
4. increased requirements
5. failure to utilise nutrients
358
sources of vitamin d in food
fish liver oil
fatty fish
egg yolk
359
What is osteomalacia?
failure of mature bone to mineralise
360
Causes of rickets:
1. nutritional (primary) rickets: living in N with dark skin, diets low in calcium, phosphorus and vit D, strict vegan diets
2. intestinal malab
361
Dx rickets
Serum calcium : low / normal
Phosphorus low
25-hydydroxyvit D low
PHT high
X-ray: cupping + fraying of metaphysis and wideneed epiphyseal plate
362
Rx rickets
Advice re balanced diet
Correction of RFs
Daily vit D3 - cholecalciferol
363
What is obesity?
>98th centril of UK 1990 reference chart for age + sex
| What is overweight? >91st centrile
364
Epstein-Barr Virus aka Glandualr fever CFs
fever
malaise
tonsilopharyngitis
lymphadenopathy
365
Dx EBV
Positive monospot test
| Large T cells on blood film
366
What can parvovirus B19 cause in the fetus?
Hydrops
367
Causeative organism hand,foot and mouth?
Coxsackie virus A16
368
What causes chickenpox?
Primary varicella zoster infection
369
Cfs chicken pox
fever, itchy , vesicular rash that is Px for up to 7 days
370
Exposure chickenc pox
Resp droplets,
| very contagious in viral shedding stage
371
Complications chicken pox
1. secondary bacterial infection
| 2. encephalitis
372
Rx chicken pox (immunocompromised or adolescent)
1. if immunocompromised, acyclovir initially
| 2. if adult / adolescent: valaciclovir
373
CFs measles
```
Koplick spots (on buccal mucosa)
Maculopapular rash (flat red area on skin covered with small bumps)
```
fever, cough, runny nose
374
Reduction of vertical transmission of HIV
Avoid Br feeding
Use of antiretroviral drugs
Elective C-sec to avoid contact with birth canal
375
Progression of rash in chicken pox
Papules vesicles pustules crusts
376
Ix food allergy and intollerance
RAST test (radioallergosorbent test) or skin prick test
377
Rx for anaphylactic reactions
IM adrenaline
378
Cause of lactose intolerance
Post-viral gastroenteritis lactase deficiency e.g. rotavirus
379
Rx lactose inloterance
lactose-free formula milk
380
What do the CFs of cows milk protein allergy depend on?
Where the location of the inflammation is
381
Rx cows milk protein allergy
Maternal exclusion of cows milk if br fed
382
Rx allergic rhinitis
antihistamines e.g. loratidine
| topical nasal corticosteroids e.g. comoglycate eye drops
383
Rx inguinal hernia
'Irreducible' can be reduced after opiod analgesia + sustained gentle compression
384
Classification of undescended testis
Retractible
Palpable
Impalpable
385
Ix for undescended testes?
USS
Laparoscopy
(hormonal)
386
Indications for surgery in undescended testes?
Feriity: they need to be below body temp
Malignancy
Cosmetic: to insert prosthetic if absent
387
When must testicular torsion be relived by for testicular viabilty?
6-12 hrs of onset of symptoms
388
Classical triad of T1DM
polydipsia
polyuria
weight loss
389
CFs DKA
```
acetone on breath
vom
dehydration
abdo pain
hypervent due to acidosis (kussmaul breathing)
hypovolaemic shock
drowniess, coma and death
```
390
What is diagnositc of DM?
Random BM >11.1 mmol/L
PLUS glycosuria + ketonuria
Fasting >7mmol or raised HbA1c are helpful
391
Initial Mx T1DM
1. Educational program
2. Insulin
- rapid acting (novorapid)
- short acting (actrapid)
- intermediate acting
- very long acting
392
Injection sites in DM, and why rotate?
SC tissue : upper arm, front and side of thight, buttocks, abdo
to prevent lipohypertrophy
393
How often is HbA1c checked and what does it show?
at least 3 times per year
shows the average sugars prev 6-12 weeks
aim for 4-6mmol
394
Symptoms of a hypo
<2.6mol
hunger, tum ache, sweatiness, faint dizzy
can --> seizures + death
395
Rx hypoglycamia
lucozade tablets / glucogel
396
Ix DKA
```
BM > 11.1
U&Es
Creatinine (dehydration)
severe metabolic acidosis
urine glucose + ketones
cardiac monitor for T wave changes of hypokalaemia ***
```
397
Mx DKA
```
ABC
fluids
insulin (not bolus!!)
K + Na
dextrose after a while
```
398
Cause hypoglycaemia
Excess insulin
B-cell tumor
drug induced e.g. sulphonylurea
if without hyperinsulinaemia: liver disease
399
Cause congenital hypothyroidism
maldescent of the thyroid
400
CF cong hypothyroidism
congenital: FTT, feeding problems, prolonged jaundice, constipated, large tongue
acquired: short, dry skin, Learning disability, obesity
401
When is Rx for nocturnal enuresis considered, and the Rx pathway?
>6yrs old
1. explanation
2. star charts
3. enuresis alarm
4. desmopressin (synthetic analogue of ADH)
402
Atopic eczema causes of exacerbation
bacterial infection
ingestion of allergen
humidity
psych stress
403
Mx atopic eczema pathway
1. avoid irritants
2. emotioents e.g. aqueous cream
3. topical corticosteroids (SE: thinning of skin)
4. Occlusive bandages
EXTRA
5. Abx for infected eczema
6 Dietary eliiation of cows milk, egg, soya
7. Psychosocail support
