General paeds + WRAP UP Flashcards
At what ages to children receive vaccinations?
Birth, 6 wks, 4 months, 6 months, 12 months, 18 months, 4 years, 12 years
What vaccinations are given at each age?
Birth - Hep B 6 weeks - Hep B, DPT (diptheria, pertussis, tetanus), Haemophilus influenzae type B, polio, pneumococcus, rotavirus 4 months - same as 6wks 6 months - same but without rotavirus 12 months - Haemophilus influenzae type B, meningococcal C, MMR 18 months - MMR, varicella, DPT 4 years - DPT, polio 12 years - DPT, HPV
What is the contagious period of viral illnesses?
From 1 daysbefore onset of fever/rash until 24hours after fever has finished
What should parents do if they suspect child’s spots are chicken pox?
Draw a circle around the spots, if they turn into blisters within 24 hours then probably chicken pox
What rashes are associated with a high fever?
Meningococcal Kawasaki disease Stevens Johnson Cocksackie/hand-foot-mouth disease Glandular fever HSP Measles, Mumps Scarlet fever Roseola 5th disease
What rash conditions are medical emergencies? How do the rashes appear?
Diptheria: membrane forming on throat/tonsils, swollen lymph glands, dysphagia
Meningococcal disease: non-blanching, purpuric papular rash, signs of meningism
What is the difference between petechiae and purpura?
Petechiae = pin-point non-blanching lesions Purpura = larger non-blanching lesions >2mm
What rashes are reportable to the public health unit?
Diptheria, Measles, Meningococcal
What are some neurocutaneous lesions that are important to look for on developmental examination?
Cafe-au-lait spots
Shagreen patch
Cutaneous angiofibromas
Axillary/inguinal freckling
What are some common causes of leukaemia?
Radiation exposure
Chemicals and drugs
Genetics
Viruses
What are some common symptoms/signs of leukaemia in children?
Symptoms related to infiltration or decreased production of other cells
FEVER in absence of infx
Increased risk of infection, anaemia, bruising
Bone pain, splenomegaly, lymphadenopathy
Compare and contrast AML and ALL
Table from toronto notes
What is a complications of a very high WCC?
Leukostasis
- Increased WCC causing aggregation and clumping - most commonly affects lungs and brain - local hypoxaemia
Explain the pathophysiology of leukaemia
Flow chart from notes
Malignant transformation of lymphoid progenitor cells –> uncontrolled proliferation of these progenitor cells in the bone marrow –> lymphoblasts replace normal cells in the BM –> pancytopaenia
- Anaemia (lethargy, pale)
- Thrombocytopaenia (bruising, petechiae)
- Neutropaenia (infection)
+ bone pain, joint pain
What defines the neonatal period?
First 28 days of life
Describe the APGAR scoring system
Total score out of 10, each thing worth 0-2 points
Poor (0-4), Fair (5-7), Good (8-10)
Appearance (blue/pale, body pink and extremeties blue, all pink)
Pulse (0, <100, >100)
Grimace (reflex) - no response, grimace, cough
Activity (tone) - limp, some flexion, active
Respiration - absent, slow/irregular, good
What are some of the nutritional challenges of a premature baby?
- Difficult coordinating sucking/swallowing/breathing because this develops at 34-36weeks
- Immature gag reflex - risk of aspiration
- Immature GIT and enzymes (limits absorption)
- Immature liver/metabolism - hypoglycaemia and jaundice
What are some findings on newborn check that are cause for urgent investigation?
General: respiratory distress, jaundice >24hours, poor tone, cyanosis, seizures, altered LOC
Head/neck: bulging fontanelles, subgaleal haemorrhage, non-patent nares
Chest: apnoeic episodes, weak/absent pulses, poor pulse oximetry
Abdo: bilious vomiting, non-patent anus
GU: non-descended testes, testicular torsion, ambiguous genitalia, no poop in 24hrs
What are reflex anoxic seizures?
Reflex anoxic seizures are paroxysmal, spontaneously-reversing brief episodes of asystole triggered by pain, fear or anxiety. Anoxic seizures are non-epileptic events caused by a reflex asystole due to increased vagal responsiveness.
What are the differentials for a seizure in a child?
Epilepsy Febrile seizure Meningitis Head injury Breath holding attack Reflex anoxic seizures Infantile spasm
Explain the APGAR score
Appearance (colour) Pulse rate Grimace (reflexes) Activity (tone) Respiratory rate
How do you define failure to thrive?
Failure to achieve the growth potential expected for a child
The term is usually applied when the growth crosses two or more centile lines downwards on a standard growth chart
What examinations will you do for a child with a seizure?
ABCDEFG
- Full set of obs especially temperature
- Cranial nerve - focal symptoms
- Look for any dysmporphia
- Look for any neurocutaneous symptoms
- Assess development
What investigations will you do for a child with a seizure?
- Full obs
- BSL
- UA
- FBC and differentiated WCC
- EUC
- If concerned, EEG, MRI
What is the definition of status epilepticus and how will you manage it?
Seizing for >5 minutes or multiple without recovery in between
- Call for help
- ABCDEFG
- Ensure safety
- Put on monitoring, put on oxygen, think about IV access
- IM medazolam or IV
- Give another dose at 5 minutes if still seizing
- Still seizing at 20 mins give IV/IO phenytoin
What is the definition of prematurity?
<37 weeks gestation
What are some complications of prematurity?
Temperature instability Hypoglycaemia Jaundice Respiratory distress syndrome Feeding
What are some complications of extreme prematurity?
Retinopathy of prematurity Hearing loss Respiratory distress PDA Necrotising enterocolitis Anaemia
What are some risk factors for neonatal hypoglycaemia?
Prematurity GDM Hypothermia Macrosomia or small baby Poor feeding Unwell
What are the clinical findings of a baby with hypoglycaemia?
CNS excitation: high pitched cry, irritable, seizures, jitteriness
CNS depression: poor feeding, lethargy, apnoea, coma
Catecholamine response: pale, sweaty, tachy
How do you manage a baby with hypoglycaemia?
Oral/NG formula or dextrose
What are you looking for with the red eye reflex in a newborn examination?
White - retinoblastoma
Absent or white - congenital cataracts
What are the ‘do not miss’ things on newborn examination?
Jaundice <24 hours, bulging fontanelles, central cyanosis, poor tone, bilious vomiting, non-patent nares, non-patent anus, resp distress, weak pulses, organomegaly, testicular torsion, ambiguous genitalia, no meconuim after 24hours
