LEVEL 1 CONDITIONS!!!! Flashcards
Neonatal jaundice
CAUSE?
when should it appear?
when is it pathological?
treatment?
complications?
tests:
- jaundice in neonate spreads head down
Cause: immature hepatocytes cant conjugate bilirubin -
breastfeeding prolongs this
appears on day 2-3 and peaks day 5
pathological within first 24 hours and should resolve within 10 days (preterm babies or breast fed 3/4 weeks)
Tx –> phototherapy and exchange transfusion.
IV ig if RH issue
complication: Acute bilirubin Encephalopathy or Kernicterus (histological deep yellow staining of brain tissue)
Tests: subcut bilirubin and serum bilirubin. if before 24 hrs, direct coombs for incompatibility.
if conjugated bilirubin +25% then post hepatic so refer to surgeon.
Immunisations Birth 8 weeks 12 weeks 16 weeks 1 year 3 year 4 months 2-8 years 12-13 M+F 14yrs
Birth –> Hrp B if mother infected and BcG to high risk (TB)
8 weeks –> Men B vaccine + Rotavirus gastroenteritis + pneumococcal + Infanrix Hexa (6) = Diptheria, tetanus, hepatitis B, polio, Haemo influenza B, pertussis whooping cough
12 weeks –> Infranix Hexa (6) + Rotavirus
16 weeks –> Infranix Hexa (6) + pneumoccal + MenB
1 year –> HiB + Men C = menitorax, + Pneumococcal, MMR + men B
3 year 4 months –> DTap/ IPV + MMR
2-8 years –> Influenza
12-13 M+F –> HPV 2 doses
14yrs –> Men A + Revaxis = (Tetanus, Diptheria and polio)
Meningitis
viral - most common cause?
bacterial- most common cause?
Presentation
ivx
treatment
changes in CSF
VIRAL - self limiting. most common: EBV, CMV, herpes, mumps, enterovirus
BACTERIAL-
Common cause neonate: group B strep, E.coli, listeria monocytogene
>6 yrs: strep pneumoniae, neiseria meningitides, haemo influenza
presentation:
Nuchal rigidity, Kernkigs + brundski sign
low threshold for infants as not classic syx
young: lethargy, poor feeding, non-blanching peuperic rash
older: neck stiffness, fever, headache,
ivx: LP to confirm diagnosis and identify organism. dont perform if raised ICP
Treatment:
1. <3months= Cefotxime + amoxicillin
2.over >3 months CEFTRIAXONE + vancomycin
Henoch Schonlein Purpura
Common in who?
Presentation + Tests
Management???
- Ig A mediated vasculitis from viral or bacterial infection in 2-11 years + boys
- RED-PURPLE NON BLANCHING RASH over legs and buttocks, skin swollen (Differentiate from meningitis with lack of neck stiffness)
- TRIAD of Arthritis, Colicky abdo pain and purpuric rash
- Moderate/severe –> rectal bleeding, arthralgia, deranged u+es
- IVX: bloods, culture, fbc, u+e, urine dip
- Tests: platelet count is normal unlike DIC
Test for nephritis as can have worse prognosis
- Most resolve within 6 weeks TX: 1. Paracetamol/ Nsaids for arthralgia 2. Corticosteroids for abdo pain and arthritis 3. Immunoglobulins
Severe –> Resus, steroids and renal review
Complications: kidney disease, orchitis, vasculitis, pulmonary haemorrhage, intusccuscetion
Septicaemia
CF
TX
Meningococcal Sepsis = most common cause of infectious death
CF: fever, SOB, Rigors, hypovol, widespread maculopapular rash becomes non-blanching
TX = IV BEN PEN + BUFALO
If meningitis
under 3 month s= cefotoxime
over 3 months =ceftriaxmine
Complications: DCI, aki, deafness, amputation
If cellulitis, penicillin
Prophylaxis close contacts given 2 days RIFAMPICIN
Iron deficiency anaemia
Treatment
MICROcytic HYPOchronic
Cause: infection, malabsorption, PICA, meckels,
Syx: pallor, lethargy, slow feeding, breathless
IVX: low MCV = lots of small RBC
low ferritin indicates low Fe stores
TFT to rule out hypothyroidism
Treatment = Ferritin 5mg/kg eg Sytron for 3 months
Screen for thalassaemia if no improvement
Asthma
IVX
Management
Reversible igE OBSTRUCTIVE
RF: atopic, FHX, obesity, premature, maternal smoking
Presentation; cough, worse at night, SOB, wheeze
LIFE THREATENING = 33, 92 chest + c02 normal
IVX: Spirometry if over 5 , FEV1/FVC less than 70%
Bronchiodilator reversibility 12% FEV = indicative
Management 1. SABA 2 + very low ICS (or LTRA if under 5) 3 + Very low ICS + LTRA (under 5) or LABA over 5 4 Increased to low ICS 5 specialist help
- Be careful with steroids for impaired growth, adrenal suppression, oral candidiasis
Bronchiolotis
Caused by?
IVX
When to admit?
management
vaccine to prevent?
Caused mainly by Respiratory Syncital Virus
Rare over 2 years
CF: Early –> coryxal, dry cough, mild fever, cold syx
CF: Late –> wheeze, poor feeding, apnoea, crackles, tracheal tug, hypoxia
IVX: nasopharyngeal swab fr RSV + CXR - show atelectasis and consolidation
Management:
- ADMIT IF <3 months, sats under 92&, Resp distress, apnoeas or dehydrated
Humidified 02 via nasal cannula Salbutamol over 12 months old CPAP if severe \+ PAVLIZUMAB monthly to RSV high risk groups Otitis media common
Croup
Age?
Cause?
PREsentation? Classic syx
management
6 months - 3 years
cause: Parainfluenza
Presentation: SUDDEN onset, seal like BARKING cough
Stridor, hoarse voice, resp distress
SEVERE = aggitation, lethargy
DDx = allergic reaction, Eppiglotits (drooling)
Management: do NOT examine throat
admit if RR >60
1. mild/mod = Dexamethasone
2. Severe = dex + Neb adrenaline + 02 therapy
Pneumonia
IVX
Management
older children
adolescent
Presentation: high grade fever, chest recessions, inc RR, cough, wheeze
IVX: CXr NOT routine
Nasopharangeal swab
Management: paracetemol, fluids, check had pneumococcal vaccine, nasal cannula if sats drop below 92%
TX: Amoxicillin older children
Erythromycin adolescents
or IV- co amoxiclav
URTI - tonsillitis and pharygntits
Centor criteria?
Can trigger what complications?
Centor criteria
- Score of 3+ give ABX
1. Fever
2. Absence of cough
3. Tonsillar exudate
4. anterior cervical lymphadenopathy
5. Temp <38
6. age 3-14
TX: antibiotics Penicillin or Erythromycin for 10 days
May get scarlet fever rash due to infection
Can preceed Acute Glomerulonephritis or acute rheumatic fever
Wheeze
Cause
treatment under 6 months and over
Common in young infants <2
Cause: atopic asthma, CF, congential lung abnormality, recurrent aspiration of feeds
Presentation: high pitched narrow airways
Low pitched wider airways
Monophonic = one obstruction
Polyphonic = multiple
Viral wheeze = no crackles and common <5 - child is completely well in between and presents similar to asthma
Treatment: >6 months Bronchodialtators eg salbutamol
Under 6 months Ipratropium
Avoid steroids
Cystic fibrosis
Presentation
IVX:
Management
When ABX?
Other treatments
Autosomal recessive - thickened mucus and secretions
Presentation: cough, wheeze, SOB, phlemg, meconium ileus, pancreatitis, diabetes, FTTm salty sweat
IVX: Guthrie/ heel prick test at 8 days old
Management: Physioherapy 2 X a day + postural mucus drainage
Annual Flu vaccine, bronchodialtor and mucolytics
Abx when child is well= FLUCLOXACILLIN
- IV when unwell and Oral Ciprofloxacin for chest infections
Lactulose to treat intenstinal obstructions
Nutrition = pancreatic supplements
Treat meconium ileus with enema
Constipation
Causes?
treatment for feacal impaction?
+ if not worked by 2 weeks?
Causes: Idiopathic, low fibre, hisrchprungs, hypothyroi, coaelic, sexual abuse
Children under 1 year = poor appetite that improves with passage, retentive posture (flexed back)
Children over 1 year = distress on passing stool
CF: anal pain on pooping, palpable abdo mass
Overflow diarrhoea
IVX: only if organic cause suspected eg TFT, coaelic screen
Management: Diet - increase fluids and fibre
Behavioural - toilet training
3 month treatment
1. Movicol 1st line (osmotic)
2. Lactulose (osmotic)
+ add oral stiumulant - Senna if movicol not working by 2 weeks
Gastroenteritis
Syx
Cause
IVX
Management
Key differentials
Syx: increase stool frequency +- vomiting, fever and abdo pain- watery diarrhoea
cause = Rotatvirus 50% cases or bacterial
IVX: stool cultures if suspect sepsis - blood mucus present?
Stool sample for C.diff toxin
Mangement: Vaccine against rotavirs 8 + 12 weeks
Oral rehydration therapy - syx resolve in 1 week
C.diff = Vancomycin + Metronidazole
Cholera - ampicillin
GORD
age in which its normal?
Presentation
Non-forceful regurgiation of gastric contents -> oesophagus - more common in asthma
Normal under 1 year, over 1 year =GORD
(Posseting is normal = bringing food up after feed)
Presentation: Irritabiloty, resistance + arching of back in response to feeds, FTT, apnoea
IVX: clinical diagnosis but if atypical = 24hr oesopageal PH monitoring or endoscopy and biopsy to identify oesophagitis
Management: Positioning to 30 degrees,
Reassurance, milk thickener
Alginate if frequent reflux and PPIs eg Ranitidine
Vomiting- Red flags Bile stained Haematemeis? Projecile vom? Vomiting end of coughing? Abdo tenderness Abdo distension? Blood in stool? Buldging fontanelle Failure TT
Management
Bile stained = Intestinal obstruction
Haematemeis = peptic ulcer, oesophagitis, nasal bleed
Projecile vom = pyloric stenosis 1st weeks of life
Vomiting end of coughing = whooping cough
Abdo tenderness = surgical abdomen
Abdo distension = Obstruction
Blood in stool = intrasussception, salmonella
Buldging fontanelle = Raiced ICP
Failure TT = chronic GI
If projectile begins at 2-7 weeks excluse pyloric stenosis
Management: fluids and treat cause
Diabetes mellitus
IVX
annual monitoring
DKA numbers
Peaks aged 5-7 ans onset of puberty
- Autoimmune destruction of B cells
CF: early- polydipsia, polyria, weightloss, excess tiredness
Late: DKA, vomiting, dehydration, abdo pain
IVX: Diagnosis = symptomatic child and RBG >11.1
Management: admit for education, insulin therapy and diet - carb counting. Aim 4-6mmol/L
Start child on insulin pump with short acting before meal + long acting in evening
Assume T1DM unless obese + do GTT
Annual monitoring: Kidney with early morning urine for microalbunaemia, retinopathy, dyslipideamia and HTN.
DKA numbers: <7.3 ph, bicarb <15, Ketones >3 and blood glucose > 11
Failure to thrive
Sub optimal weight gain in children
Weight better indicator in young child and heigh in older children
IVX: Plot on growth chart = height, weight and head circumference
Mild fall - 2 centiles, severe = 3
IVX: FBC, coleaic antibody screen, sweat test, LFT
Management: specialised infant formulaes, paediatric dietitican, hospitalisation child <6 months with FTT
Cerebral palsy
Spastic types
Non spastic types
Non-progressive Cerebral lesion
Spastic = 80% cases
- Hemiplegia: unilateral side: flexed arm afftected more than leg
- Diplegia: all 4 limbs but legs affected more
- Quadraplegia: all 4 limbs + trunk involvement
Non-spastic
- Ataxic: Poor coordination, ataxic gait, wide base
-Dyskinetic: involuntary movementents worse on movement
- Atheoid: writing movements
CF: abnormal posture, delyed motor milestones and feeding difficulty.
IVX: Diagnosis is clinical
Complications: can manifest in all systems
Management: Physiotherapist, MDT, family support and educational assistance
Febrile Fit
AGE?
how long is normal
abnormal –> treatment?
Occurs between 6 months and 5 years in normal kids
Causes: Temp above 38, convulsions <5 mins
IVX: infection screen, ENT exam- must find infection source eg LP
Management: A-E, time convulsion, prolonged seizure >5 mins = rectal diazepam or buccal midazolam
Give Antipyretic - paracetemol and first aid principles
Urinary tract infection
IVX:
under 6 months
over 6 months
6 month post infection
management
under 3 months
over 3 months LUTI
over 3 months UUTI
Whats VUR
Infants have non-secific syx–> fever, vomiting, lethargy, offensive urine
Children syx: same as adult eg dysuria, freq, abdo pain
IVX: Culture- mid stream urine clean catch
Examine, Urinalysis,
Under 6 months = Renal USS
Over 6 months = MCUG - micturating and dye x-ray passing urine
6 months post infection = DMSA nuclear medicine isotpe to show scarring
MANAGEMENT: (usually e,.coli)
Under 3 months = IV abx until fever goes then oral
Over 3 months LUTI = PO trimethoprim or nitro 3 days
Over 3 months UUTI = 10 days PO Co-amoxiclav
VUR = vesicle-ureteric reflex retroflow from bladder causes renal scarring diagnosed via micturaing cystourethrogram
Eczema
IVX
Management
Complications
Chronic, relapsing itchy skin conditions - atopic
CF: erythema, weapiness, crusting, intense itching, starts in infancy,
Distributation <2 months face + trunk
Older = flexure and friction surfaces
IVX: skin prick and IgE blood testing
Management: advise to avoic scratching and trifffers
Emoillients frequent and liberally
1. Topical Corticosteroids eg 1% hydrocortisone
2. Immunomodulators Tacrolimus short term
3, Itch supression = antihistamine
Complications: Excezema hepeticum (HSV1), bacterial/fungal infection so treat with abx fluclox and IV acylclovir
Septic Arthritis
Common site?
CF:
IVX
Management
RED HOT SWOLLEN JOINT
1. Knee > hip > ankle
Most common under 2 years
Cause - staph aureus or HIB if multiple sites
CF: decreased range of movement, acutely unwell, febrile, holding limb still
Ivx: blood cultures, WCC, CRP, ESR, US of deep joints
X-ray = shows widening of joint space
Aspiration of joint space for micro and culture
Bone scan if multiple sites
Management: IV flucloxacillin then PO 4-6 weeks
Rest, pain relief and surgical draining
Downs sydnrome
Trisomy 21
Either 1) non-dysfunction at meiosis, 2) robertsonian translocation 3) Mosaicism
CF: upslanting eyes, small mouth, protruding tongue, hearing and visual impairments, single palmar crease, hypotonia, AVSD, tetrology of fallout, delayed gross motor milestones
IVX: screening test combined or quadruple test
Diagnosis: CVS/amniocentesis
Management: hip USS, child development services
Complications: CHD, oesophageal atresia, early onset dementia, deafness
Squint Concomitant (non-paralytic)
Non-concomitant (paralytic)
Concomitant (non-paralytic) = Refractive error and treat with glasses or surgery - squint doesnt vary with with gaze
Non-concomitant (paralytic) = varies wth gaze paralysis of cranial Nerve 3,4, or 6. Sinister underlying tumour? It has a magnitude that varies as the person shifts his or her gaze up, down, or to the sides
Causes: retinoblastoma, trauma, cataracts
IVX: corneal light reflex, H test, Cover test
management: Refer to opthalmolgy
eye patch, eye muscle exercises, correct refractive error
A manifest squint is obvious from plain observation
Convergent = goes towards
Divergent = goes away
Behavioural problems
Crying babies and colic
Sleeping problems
Temper tantrum
Unwanted/ aggresive behaviour
Infnatile colic = < 3months, crying associated with hunger or over feeding often in evening. Non consolable, flushed. Cys for >3 hours a day 3 daysa. week for 3 weeks.
Sleeping: Most children sleep through by 3 months
Sleep hygiene = Routine at bedtime, sleep alone
Sleep terrors B>G
Temper tantum common 2-3 years
Time out one minute for each year of chils age
Aggressive behaviour - star charts, time out, consistent
Epiglottitis
LIFE THREATENING swelling of epiglottis Most common age 1-6 years Presentation: = 4 Ds DROOLING, DYSPHAGIA, DYSPNOEA, DYSPHONIA - Systemically unwell + fever, painful cherry red throat
Management: NOT EXAMINE THROAT
- sepsis pathway = BUFALO
- Endotracheal intubation
- iv fluids 7-10 days
- abx- CEFTRIOXONE + STEROIDS
- Rifampicin to close contacts
Eneuresis
Age for which treatment
Drugs?
Under 5 = reassure, check for organic causes
5-7 = Star charts and ?alarms or drugs
7+ = alarms and drugs
Drugs for night time wetting
1) Desmopressin
- -Tablets or sublingual melts
- Give at bedtime
- Warn about excessive drinking
2) Imipramine second line (TCA)
Day time wetting = Oxybutynin anticholinergic
Petichiea
Purpura
Echymosis
Petichiea 1-2 mm
Purpura 3mm
Echymosis > 5mm
perthes disease
avascular nercrosis femoral head
