Childrens Health Flashcards
Yo
Whats the best prognostic factor for children up to the age of 12?
Dad jokes…
What do you call someone with no body and no nose?
NO BODY KNOWS
Did you hear about the guy who invented the knock knock joke?
He won the “NO BELL” prize
Why do crabs never give to charity?
Because they are SHELLFISH
What age is defined as a Neonate?
Birth to 1 month
What age is defined as an infant?
1 month to 1 year
What signs are there of respiratory distress?
- Tracheal tug - Retraction of suprasternal notch - Inter or subcostal indrawing
A child comes in with a loud cough and difficulty breathing, what DD are there?
- Viral Croup - Epiglossitis - Foreign body aspiration - bacterial tracheitis
What does drooling indicate in a child?
Upper airway restriction, present in Epiglottitis and bacterial tracheitis
What is Croup?
Inflammation of the larynx and trachea by a viral cause
What is the most common pathogen for Croup?
Parainfleunza virus
What symptoms can occur in Croup?
Seal bark cough Stridor Acute SoB Corhzal symptoms
What cause of SoB is likely after seeing this?
Strawberry mark = Laryngeal capillary haemangioma
Grows from 12-24 months
When can Larngomalacia cause SoB/ obstruction?
From Birth
Why is Epiglottits becoming less common?
Due to Heamophilis influenza type B
This conditions can quickly lead to airway obstruction
What is the managment of Severe Croup?
Get help - airway managment
Neb. Adrenaline - 1/1000
Oral steroids
Reassure peraent, therefore pt. keeps calm
At what age deos the MMR vaccine start?
Vaccinaiton at 1 year old
What cause of diarrehoa is unlikely after 8 weeks?
Rota virus gastroenteritis due to vaccunation
At what age does the majority of vaccination causes start?
8 weeks
Diptheria
Tetanus
Pertussis
Polio
Heamophilis infeuza type B
Pneumoccal
Mennigoccocal
Ratovirus
How old is this child?
Understands No
Makes simple sounds - “mama” “dada”
Aware of strangers
Plays peeker boo
> 8 weeks if reached development miles stones
How old is this child?
Has simple conversations
Copies others
Takes turns
> 3 years according to developemental milestones
How old is this child?
Smiles
Turns head to sound
Can track objects
Gurgling sound
> 2 months according to developemental milestones
What is Kussaul breathing and what can it indicate?
A form of hyperventilation by long, deep breaths. This increases blow of CO2
Indicates acidosis like that of DKA
Causes of large heart size on peadiatric CXR?
Large L to R chunt
VSD
PDA
Causes of small heart size on peadiatric CXR?
Fallots tetralogy
What does Plethoric mean for lungs in a CXR?
Too much blood going to the lungs leading to increased contrast on lungs.
Cause by L to R shunts, CCF, VSD, PDA
What does Oligaemic mean for lungs in a CXR?
Less blood going to the lungs and therefore lungs are blacker on CXR.
Fallot’s tertralogy
Pulmonary stenosis
What congenital heart conditions cause systolic mumurs?
Fallots tetralogy
VSD
truncus arteriosus
Why are postroglandins used in heart condistions?
Maintain patent the ductus arteriosus. Closure of the duct can be assisted with NSAIDS
What conditions has a “continous cresendo-decresendo machinary mumur?
Patent duct arteriosus
What septal defect has a pansystolic mumur?
Ventral septal defect
What symptoms and sign may a child with cardiac failure have?
SOB, Tachycardia
Poor feeding
Hepatomegaly
Acidosis
Sweating
Management of cardiac failure in children
Diuretics
ACEi
O2
Prostin
Inotropes
What signs are there of respirtory distress in baby?
Nasal flaring
Tachypnoea
Gruniting
Mild head bobbing
Intercostal breathing
Subcostal indrawing
Which conditions are asynotic congential heart diseaes?
Septal defects - VSD, ASD
Coarctation
PDA
Valvular disease
That signs may a baby with coarctation of the aorta have?
Upper limb pulses > lower limb pulse
Associated VSD and bicuspid aortic valve
What conditison are cyanotic CHD?
Fallots tetralogy
Transposition of the greater arteries
What is the clinical presentation of Fallot’s tetralogy?
Central cyanosis
Pulmonary oligaemia on CXR
Hypercyanotic episodes (tet spells) Ejection systolic mumur -PS
What heart conditions are associated with T21?
AV septal defects
What does the heal prick test for?
Metabolic conditions
Sickle cell, hypothyroidism, CF and more…
Which heart condition should we not give high concentrations of O2 to?
Patent ductus arteriosus
Maintain duct with prostin infusion
What is Harrison’s sulcus?
in-drawing of the ribs dring inspiration, indicates chornic respiratory condition or week bones
What investigation to consider with reccurent LRTI?
sweat chloride test - CF
Measurement of serum immunoglobulins - Vaccines responce, ?HIV
CT of chest
When should a metered dose inhaler be used?
> 12yo with obvious no coordination problems effecting use of MDI
A newborn has abdominal distension and vominting. Strong FH for CF. What is the likely diagnosis?
Meconium ileus
Testing for CF doesnt occr until 10d
What injuries occur in shaken baby syndrome?
subdural haemorrhage
Retinal bleeding
Hypoxaemic encephalopathy
What differentials to consider with muiltiple bruises?
NAI
Leukaemia
Aplastic anaemia
Child risk factors for abuse?
younger age
increased needs - disability
low birth weight
muitliple births
Parental risk factors for chuld abuse?
Younger parental age
mental illnes
substance abuse
lower social-economic group
Parents experince child abuse
What features of fractures are consistent with NAI?
metphyseal fractures
posterior rib
complex skull fractures
long bone fractures
What features of bruising are consistent with NAI?
Face, buttock, back
Outline of objects
Patern of fingers etc.
What burns would indicate NAI?
Glove-stockng distribution
Uniform shape - circular for cigarette burns
What should be done if there is a child protection concern?
Refer to social services
What bruises are not NAI?
Immune thrombocytopenia
Meningococcal rash
Henoch scholein purpura
Mongolion blue spot
Is this NAI?
No, this is simply a mongolion blue spot
What NAI can cause fractures?
acidental injury
oesteogenesis imperfecta (rare)
Vit C/D copper deficiency
Connective tissue disorders
JOBs syndrome
What red flags are there with peadiatric abdo pain?
poor growth
symptoms regularly waking child
<5yo
Weight loss
Blood in stools
What test is there for coelaics screen
IgA anti-tissue transglutaminase
6w of increased stool frequency ,pale bulky stools, wieght loss, fratique and pallor. FBC shows microcytic aneamia.
A classical history of coeliacs disease. Therefore TTG antibodies
DD for rapid weight loss in adolescent?
Cealiacs
T1 DM
Hyperthyroidism
Mailgnancy
Anorexia Nervosum
IBD
What is lanugo hair?
Soft body hair like that in babies.
Can indicate poor nutrition from loss of fat tissue, like that of anorexia nervosa
What is the acute treatment of anorexia nervosa?
muiltivitamines inc. vit B
increase 0.5-1kg/week
Monitor bloods
Regular ECG
A patient with Anorexia has refugular blood monitoring. Her phosphate drops. What does the indicate?
A fall in phosphate can indicate refeeding syndrome
What types of eatng disorders are there?
Anorexia Nervosa
Bulimia Nervosa
EDNOS - easting disorder not otherwise specified
What features of a history are more typical of Bulimia nervosa?
Bing eating followed by vomiting
Self harm
Normal wieght, unlike AN
What common conditions are accompanied with eating disorders?
OCD
Depression
What is used instead of BMI for grownig, young people?
Weight-height ratio
What common causes of death are there for anorexia nervosa?
Refeeding syndrome - Sudden cardiac death
Suicide
Features of bulimia nervosa?
gastric acid –> dental erosion, callouses on fingers
Parotid enlargement
Normal wieght
What is found on blood test for anorexia nervosa?
WCC
ALT
Phosphate
BMs
Cortisol
WCC, ALT, Phosphate and BMs are normally low
Cortisol (stress) can be high
What features of dehrydration are there in an infant?
Sunken fontanelle and eyes
Dry mucous membrane
Tachycardia
Redeuced CRT, skin turgor
Weight loss
Common cause of gastritis in the UK?
Rota virus
Adeno cirus
What organisms can cause blood in stools?
Shigella
E coli 0157
Rota virus
Campylobacter
(also thing intersusspection)
1yo with history of paroxysmal, severe colicky pain. Child draws legs up. There is vominting and red current jelly stools. MLD?
Intussesception
What cuases red current jelly stools in intussesception?
Mucus and blood
Red flags in vomiting?
Bulgind frontanelle
Bile, blood in vomit
Abdo pain and distention
Blood in stools
Projectile vomit
What is the most likely diagnosis for vomiting with paroxysmal cough?
Wooping cough
At what age can solid foods be introduced?
6 months of age
Synmptoms of hyper natraemia?
Jittery movements
Increased muscle tone
Hyperreflexia
Convulsions
Drowsiness or coma
Symptoms of hyponatraemia?
Weakness
fatigue
headache
confusion
Nausea and vomiting
What organisms can cause infective diarrehoa by a secretory mechaism?
Cholera
Ecoli
C diff
What organisms can cause infective diarrhoea via a mucosal invasiion mechanism?
Campylobacter
Rota virus
Salmonella
shigealla
Therefore they cause blood and WCC in stools
Which organisms which cuase diarrhoea are notifiable?
Cholera
Giardia
Salmonella
Camplylobacter
(this in not exhaustive)
What organisms can cause Haemolytic Ureamic syndrome?
E coli 0169
Heamolysis and renal failure can occur
LDH raised in heamolysis
What does the picture?
Intussusception
diagnose from USS
Draw this picture in OSCE
Immunisations 8 weeks
6 in 1 - diphtheria, tetanus, polio, whooping cough, haem influenza, hep BPneumococcal Meningococcal group BRotavirus
Immunisations 12 weeks
6 in 1 - diphtheria, tetanus, polio, whooping cough, haem influenza, hep BRotavirus
Week 16 immunisations
6 in 1 - diphtheria, tetanus, polio, whooping cough (pertussis), haem influenza, hep BPneumococcal Meningococcal group B
Immunisations 1 year old
Haemophilia influenza, meningococcal group CPneumococcal Measles, mumps, rubella Meningococcal group B
Immunisations 3 years and 4 months
4 in 1 - diphtheria, tetanus, polio, pertussis Measles, mumps, rubella MMR
Girls age 12-13 immunisations
HPV 16 and 18 ( and 6 and 11- genital warts )2 doses given 6-24 months apart
14 year old immunisations
3 in 1 - diphtheria, tetanus, polio Meningococcal groups A, C, W, and Y
Immunisations aged 65
Pneumococcal And influenza annually
70 year old immunisations
Shingles
2 months developmental milestones - language/comms
Coos and gurgling soundsTurns head towards sound
8 months developmental milestones - language/comms
understands nomama/dada sounds
18 months developmental milestones - language/comms
says 10 words says no and shakes head
3 years developmental milestones - language/comms
understands words such as in/on/under carries a convo with 2-3 sentences
2 months developmental milestones - social/emotional
begin to smile at peopletries to look at parentssucks on hand to sooth
8 months developmental milestones - social/emotional
stranger awareness has favourite toy
18 months developmental milestones - social/emotional
temper tantrums points at something interesting
3 years developmental milestones - social/emotional
shows concern if friend cryingtakes turns in games copies adults and friends
2 months developmental milestones - cognitive/fine motor
begins to follow things with eyes begins to act bored
8 months developmental milestones - cognitive/fine motor
transfers from one hand to the other picks up cereal with thumb and index finger plays peak a boo
18 months developmental milestones - cognitive/fine motor
scribbles on own follows 1 step verbal commands
3 years developmental milestones - cognitive/fine motor
copies a circle with a pencil does jig saw 3-4 pieces
normal obs <4 month old
RR 30-39HR 110-159 Systolic BP 50-59
normal obs 4 month old - 2 years
RR 25-34 HR 100-149Systolic BP 60-69
Normal Obs 2-5 years
RR 20-29 HR 80-119 systolic BP 70-84
normal obs 5-12 year old
RR 20-29 HR 70-119 Systolic BP 80-89
Normal obs >12 year old
RR 15-24HR 65-99 Systolic BP 85-89
neonatal heel prick tests for…
sickle cell cystic fibrosishypothyroidism isovalaric acidaemiaphenylketonuria homocystinuria (HCU)MCAD deficiency
in a tachycardia/pnoe baby always check
gases glucose ammonia to look for primary cardiac or respiratory failure
ivacaftor and lumacaftor
personalised treatments for delta F508 CFTR mutations. helps to get the channel to the cell membrane and enables it to work better
mesalazine
5-ASA analogue used first line in ulcerative collitis
tacrolimus
immunosuppresive drug used mainly to prevent organ rejection after a transplant. also used 3rd line in ulcerative colitis
nonblanching rash- ill child- neck stiffness- fever
meningococcal disease
neck stiffness, bulging fontanella, decreased consciousness, fever
bacterial meningitis
focal neuro signsdecreased level of consciousnessfocal seizuresfever
encephalitis
fever, bilateral conjunctival injection, change in mucous membrane, change in extremities, polymorphous rash, cervical lymphadenopathy
kawasaki disease
fever, irritability, dyspnoea, dysphonia, drooling saliva
epiglottitis, h. influenzae type B
if think child abuse
do child protection medical assessment. By social services. Hx and exam, growth chart, obs, body map, photos. Child must be questioned away from parents or carers
Risk of rapid weight loss eg anorexia
refeeding syndrome, hypoglycaemia, risk of infection, cardiac arrhythmias
differentials of rapid weight loss
coeliac diseaseT1DMhyperthyroidismmalignancyanorexiaIBDdepression
treating eating disorder
admit to stabilise physically, start vitamins, regular obs, monitor bloods, contact local eating disorder team. diet plan, IV fluids if needed.
diarrhoea in infant
usually rotavirus. could be adenovirus.
paroxysmal severe colicky pain, pallor ,red currant jelly stool.
intussusception
red flags associated with vomiting
blood, bile, abdo tenderness and distention, blood in stool, bulging fontanelle
treatment for campylobacter
erythromycin
c. diff treatment
metronidazole or vancomycin
haemolytic anaemia, AKI, low platelet count
haemuolytic uraemic syndrome. usually preceded by infection
barking cough
croup
treatment of croup
consider admissionoxygenoral dexamethasoneparacetamol
hypotension. bronchoconstriction or airway compromise in setting of allergy
anaphylaxis
breathless baby esp when feeding
heart failure
high chloride in sweat test
cystic fibrosis. sweat test is gold standard
most common features of CF
chronic resp infection, malabsorption or failure to thrive, prolonged diarrhoea, infertility, meconium ileus,
differentials of abdo pain in children
gastroenteritis, HSP, UTI, IBD, acute appendicitis, DKA, poisoning , intussusception, meckel’s diverticulum, abdominal migraines
treatment for meningitis in children
ceftriaxone and if under 3 months give with amoxicillin to cover listeria
UTI in children
need to do renal ultrasound scan, micturating urogram, DMSA to detect any structural abnormalities
non blanching rash on legs and buttocksswollen and painful jointschild wellno hepatosplenomegaly or lymphadenopathy
HSP
non blanching rash, pallor, lymphadenopathy, hepatosplenomegaly,
ALL
white reflex in eyes
retinoblastoma or congenital cataracts
lump in abdo. blood in urine
wilms tumour. nephroblastoma
Seizure treatment
lorazepam x2phenytoin
causes of delayed walking
global developmental delays, spina bifida, duchenne muscular dystrophy, developmental dysplasia of the hip, cerebral palsy, rickets
not sitting or walking by 18 months, floppy, weak arms and legs, speaking problems, scissoring of legs, high tone.
cerebral palsy- ask about infections in pregnancy, difficult birth, head injury, meningitis
treatment of cerebral palsy
physio, sspeech therpay, OT, medications for muscle stiffness
progressive muscle weakness, loss of walking, scoliosis, resp weakness
Duchenne muscular dystrophy
treatment of duchenne muscular dystrophy
steroids can slow progression of weakness but not a cure
treatment of DKA
fluids, insulin. slowly correct
what age does the anterior fontanelle close by
18-24 months
positive kernigs sign
leg positioned with 90 degree flexed thigh and knee
subsequent extension of the knee is painful
due to meningitis or subarachnoid haemorrhaage
positive brudzinskis sign
neck flexion leads to flexion of the thigh and knee
due to severe neck stiffness
sign of meningitis
