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Year 2: Block 4: Paediatrics > GP paediatrics > Flashcards

GP paediatrics Flashcards

1
Q

neonatal period is the period up until

A

4 weeks

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2
Q

neonatal jaundice can be

A

physiological or pathological

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3
Q

physiological jaunidce

A

nearly all babies are born with some physiological jaundice the baby transitions from relying on the placenta to clear bilirubin to using its own hepatic system

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4
Q

physiological jaundice is never visible

A

in the first day of life and if a neonate has jaundice within the first 24 hours f life there is always a pathological cause

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5
Q

in physiological jaundice

A

levels of conjugated bilirubin never suprasses

  • 20% of the total serum bilirubin OR
  • 2mg/dl if total serum bilirubin is greater than 5mg/dl
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6
Q

physiological jaundice normally resolved within

A
  • 1 week in a full term infant

- 2 weeks in a premature infant

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7
Q

premature infant

A

gestation less than 37 weeks

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8
Q

prolonged jaundice

A
  • 14 days or more in full term infants

- 21 days or more in pre-term infant

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9
Q

pathological jaundice definition

A

any jaundice that does not satisfy the criteria of being physiological jaundice

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10
Q

causes of pathological jaundice

A
  • Rh incompatibility
  • ABO incompatibility
  • Crigler Najjar syndrome
  • biliary atresia
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11
Q

Rh incompatibility

A

when a Rh negative mother has a resus positive child she produced Rh autoantibodies so if she has another pregnancy with a Rh positive baby the antibodies attack the foetus

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12
Q

ABO incompatibility

A

attack on red blood cells by maternal anti-ABO antibodies

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13
Q

Crigler Najjar syndrome

A

absence of the enzyme UGT1A1 resulting in the inability to conjugate bilirubin causing an indirect hyperbilirunaemia

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14
Q

biliary atresia

A

only prevents in neonates, defect in biliary tract which causes cholestasis, conjugated bilirubin is absorbed into the bloodstream as it cannot be transported into the duodenum therefore= direct hyperbilirunaemia

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15
Q

UTIS in neonates

A

UTI in neonates is associated with bacteramiea and congenital anomalies in the kidney and urinary tract

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16
Q

congenital hypothyroidism

A

INADEQUATE THYROID HORMONE PRODUCTION IN NEWBORN INFANT

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17
Q

Cause of congenital hypothyroidism

A
  • anatomic defect in the thyroid gland (thyroid dysgenesis)
  • inbred error of thyroid hormone synthesis/ metabolism
  • iodine deficniency
  • exposure to anti-thyroid medication during pregnancy
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18
Q

congenital hypothyroidism is the

A

most common neonatal endocrine disorder

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19
Q

symptoms of neonatal hypothyroidism

A

decreased activity, large anterior fontanelle, constipation, weight gain, jaundice, hypotonia, poor feeding

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20
Q

if congenital hypothyroidism goes untreated it causes

A

CRETINISM: severely stunted physical and mental development

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21
Q

if hypothyroidism remains untreated in a mother during pregnancy causes

A
  • increased risk of abortion, pre-eclampsia, placental abruption, postpartum haemorrhage and a pre-term labour
  • foetal neuropsychosocial development resulting in the child having an IQ of less than 7 points in children
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22
Q

gallactosemia

A

mutations in GALT, GALK1 AND GALE GENES, result in inability to process galactose, as these genes code for the enzymes that break down galactose

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23
Q

classic galactossemia is

A

type 1 which is the most common and most severe type if they are not treated with a galactose free diet it can be life-threatening causing failure to gaibn weight and growth, jaundice, liver damage and abnormal bleeding

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24
Q

breast milk intolerance

A

neonatal jaundice associated with breast feeding characterised by indirect hyperbilurinaemia in an otherwise healthy breastfed newborn where there is no other identifiable cause

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25
Q

breast milk intolerance persists

A

longer than physiological jaundice and develops and the first 4-7 days of life

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26
Q

causes of neonatal vomiting

A
  • paediatric GORD
  • cows milk protein intolerance
  • pyloric stenosis
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27
Q

paediatric GORD

A

caused by immaturity of the lower oesophageal sphincter causing transient lower oesophageal relaxation causing retrograde flow of gastric contents into the oesophagus

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28
Q

cows milk protein intolerance

A

allergy which most commonly affects children in their first year of life, can be IgE or non-IgE mediated

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29
Q

neonatal sepsis is classified as

A

early onset or late onset

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30
Q

early onset neonatal sepsis is associated with

A

the acquisition of micro-organisms from the mother i.e. transplacental infection or an ascending infection form the cervix which may be caused by organisms that colonise a females GU tract and the neonate acquires the micro-organisms as it passes down the colonised birth canal at delivery

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31
Q

common micro-organism associated with early onset neonatal sepsis

A
  • group B strep
  • e.coli
  • coagulase negative staph aureus
  • haemophilia influenza
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32
Q

late onset neonatal sepsis si acquired from the

A

neonates environment

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33
Q

common micro-organisms in late onset neonatal sepsis

A
  • coagulase negative staph
  • staph aureus
  • e.coli
  • klebsiella
  • pseudomonas
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34
Q

what is sepsis

A

a potentially life threatening complication of an infection, sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body, the inflammation can then trigger a cascade of changers that can damage multiple organ systems causing them to fail

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35
Q

sepsis can progress to

A

septic shock where blood pressure drops dramatically which can cause death

36
Q

to be diagnosed with sepsis you must have

A

at least 2 of the following symptoms plus a probable or confirmed infection

  • fever greater than 38.3 or less than 36
  • heart rate greater than 90
  • resp rate greater than 20bpm
37
Q

severe sepsis

A

is sepsis and one of the following

  • decreased urine output
  • abrupt changes in mental status
  • decreased platelet count
  • difficulty breathing
  • abnormal heart pumping function
  • abdominal pain
38
Q

septic shock

A

signs and symptoms of severe sepsis plus a low blood pressure which does NOT respond to adequate iV fluid resuscitation

39
Q

paediatric presentations to GP

A
  • respiratory problems
  • GI problems
  • dermatology problems
  • MSK problems
40
Q

common respiratory problems in paediatrics

A
  • bronchiolitis
  • croup
  • asthma
41
Q

bronchiolitis

A

acute inflammatory injury of the bronchioles usually caused by a viral infection most commonly the respiratory syncytial virus (RSV)

42
Q

most common cause of bronchiolitis

A

respiratory syncytial virus

43
Q

bronchiolitis occurs primarily

A

in children between the ages of 2-6 months of age

44
Q

symptoms of bronchiolitis

A

breathing difficulties, cough, decreased feeding, irritability, wheeze or crepitations heard on auscultation

45
Q

other causes of bronchiolitis

A

human metapneumovirus, adenovirus, parainfluenza virus

46
Q

croup is also known as

A

laryngeotacheobronchitis

47
Q

what is croup

A

inflammation of the upper respiratory tract predominantly the larynx and the trachea but it may affect the bronchi and is caused by a viral infection

48
Q

symptoms of croup

A

non-specific symptoms of a viral URTI (runny nose, sore throat, fever, cough) which progresses over a few days to cause the classical BARKING cough and hoarseness, symptoms tend to be worse at night. stridor may be hear and there may be a mild to moderate fever

49
Q

most common cause of croup

A

parainfluenza virus types 1,2,3 and 4

50
Q

other causes of croup

A

RSV, adenovirus, rhinovirus, enterovirus, measles, metapneumovirus, influenza virus types A and B (type A is associated with severe croup)

51
Q

management of croup

A
  • oral dexamethasone for all

- nebulised adrenal in emergency

52
Q

asthma

A

constriction of the bronchioles causing an obstructive lung defect resulting in wheezing, diurnal cough, chest tightness and difficult breathing

53
Q

rare respirator presentation in GP

A
  • cystic fibrosis
  • acute epiglottis
  • foreign body inhalation
54
Q

cystic fibrosis

A

autosomal recessive disease caused by mutation in the CFTR gene on chromosome 7

55
Q

cystic fibrosis results in

A
  • high sodium content of sweat because CFTR does not absorb chloride ions which remain in the lumen and prevent sodium reabsorption
56
Q

cystic fibrosis causes pancreatic insufficieny because

A

the production of pancreatic enzymes is normal but defects in ion transport produces relative dehydration of pancreatic secretions causing their stagnation in the pancreatic ducts

57
Q

cystic fibrosis causes respiratory disease because

A

dehydration of the airway surfaces which reduces muco-cilliary clearance and increases bacterial colonisation, local bacterial defences are impaired by local salt concentrations and bacterial adherence is increased by changes in cell surface glycoprotein increased bacterial colonisation and reduced material clearance causes inflammatory lung damage due to an exuberant neutrophilic response involving mediators such as IL-8 and neutrophil elastase

58
Q

cystic fibrosis causes biliary disease because

A

defective transfer across the bile duct causes reduced movement of water in the lumen so the bile becomes concentrated causing plugging

59
Q

cystic fibrosis causes GI disease because

A

of intra-luminal water deficiency

60
Q

acute epiglottitis

A

acute inflammation of the epiglottis which is rapidly progressive

61
Q

usual age of presentation of acute eppiglotitis

A

in children between the ages of 2- 5 years old

62
Q

most common cause of acute epiglottitis

A

haemophilia influenza but can also be caused by strep pneumonia

63
Q

why is children epiglottis different to an adults epiglottis

A

because it is more anterior and superior

64
Q

symptoms of acute epiglottis

A

fever, severe sore throat, drooling, muffled hot potato voice

65
Q

management of acute epiglottis

A

IV ceftriaxone and emergency AIRWAY MANAGEMENT

66
Q

FOREIGN BODY INHALATION

A

right bronchi is the most common site for foreign bodies to become lodged

67
Q

respiratory rate in children aged less than 1

A

30-40

68
Q

respiratory rate in children between 1-2

A

25-35

69
Q

respiratory rate in children between 2-5

A

25-30

70
Q

respiratory rate in churn between 5-12

A

20-25

71
Q

repsiroaty rate in children over 12

A

15-20

72
Q

medical causes of abdominal pain from birth to 1 year

A
  • gastroenteritis
  • UTI
  • constipation
73
Q

surgical causes of abdominal pain from birth to 1 year

A
  • intussusception
  • volvulus
  • incarcerated hernia
74
Q

other causes of abdominal pain from birth to 1 year

A
  • infantile coli

- hirssprungs disease

75
Q

medical causes of abdominal pain in 2-5 years old

A
  • gastroenteritis
  • UTI
  • constipation
76
Q

surgical causes of abdominal pain in 2-5 year old

A
  • intussusception
  • volvulus
  • appendicitis
77
Q

other causes of abdominal pain in 2-5 years old

A
  • mesenteric lymphadenitis
  • hence schenlen purpura
  • DKA
  • sickle cells disease
78
Q

medical causes of abdominal pain in 6-11 years

A
  • gastroenteritis
  • UTI
  • constipation
79
Q

surgical causes of abdominal pain in 6-11 years

A
  • appendicitis
  • trauma
  • testicular torsion
80
Q

other causes of abdominal pain in 6-11 years

A
  • mesenteric lymphadenitis
  • abdominal migraine
  • hence schoenlen purpura
  • DKA
  • sickle cell disease
  • pneumonia
  • functional abdominal pain
81
Q

medical causes of abdominal pain in 12-18 years

A
  • gastroenteritis
  • UTI
  • constipation
82
Q

surgical causes of abdominal pain in 12-18 years

A
  • appendicitis
  • trauma
  • ovarian torsion
  • testicular torsion
83
Q

other causes of abdominal pain in 12-18 years

A
  • dysmenorrhoea
  • DKA
  • mittelschmerz
  • ectopic pregnancy
  • pelvic inflammatory disease
  • IBD
84
Q

dermatological presentaiotn

A
  • erythema infectiosum
  • molluscs contagiousm
  • impetigo
  • hand foot and mouth disease
  • scarlet fever
85
Q

scarlet fever

A

complication of a strep throat infection usually caused by group A strep most common in children under 10 years old

86
Q

symptoms of scarlet fever

A

fever, redness of tongue with tiny white spots, sore throat, erythematous rash over cheeks abdomen and chest

87
Q

red flags in paediatrics

A
  • unresponsive to social cues and difficult to rouse
  • health professional very worried
  • weak, high pitched or continues cry
  • grunting respiration or apnoea epidosed where Sp02 is less than 90%
  • severe tachycardia/ tachypnoea or bradycardia
  • no wet napped or not passed urine in the last 18 hours
  • non- blanching purpuric rash/ mottled ashen or cyanotic
  • temperature less than 36 degrees of if under 3 months greater than 38 degrees

Year 2: Block 4: Paediatrics (14 decks)

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