Level 2 conditions Flashcards
Birth Asphyxia
Fetal hypoxia + increased co2 –> metabolic acidosis
Treatment:
- Endotracheal intubation
- Adrenaline
- Glucose/fluids if needed
- Phenytoin or diazepam if seizing
- 72 hours Therapeutic cooling - 33.5 degrees
Birthmarks Salmon patch port wine stain strawberry naevus / infantile haemangioma Mongolian spots pigmented naevua sebaceous navus
- Salmon patch = pink mark on face + fades over 2 yrs
- port wine stain = purple lesion, associated with sturge-weber syndrome–> fits
- strawberry naevus = soft, raised red capillary, regresses by school years
- Mongolian spots = blue lesion over bum/legs
- pigmented naevus = moles, eg cafe au lait >4 may indicate neurofibromatosis
sebaceous navus = raised warty naeus on scalp
Cephalohaematoma
Blood between skull and scalp
Doesnt cross suture line
Can cause jaundice
Ddx = caput succadenum - crosses sutures
Haemolytic disease
Rhesus + Abo incompatability
Check with direct Coombs
Management: Rhesus prophylaxis, anti D igG at 28 weeks
Prematurity
Complications
Baby born before 37 weeks
Most issues before 32 weeks
Complications
- Resp Distress + recurrent apnoea
- Patent DA
- Anaemia
- Nec Ent
- Intraventricilar haemorrhage
Resp distress dyrnome
Surfactant deficiency
Preterm, Fhx, C-section,
CF: cyanosis, tachypneaic, accessory muscles, grunting
IVX: CXR, bilateral ground glass, decreased lung volume
Management: Betamethasone or DEX steroids IM if preterm is imminent
Delivery room resus
Administer Abx until pneumonia is excluded
02 therapy CPAP
Small baby IUGR
Symmetrical small head and body = intrinsic eg downs syndrome
asymmetrical big head small body = Extrinsic factors eg maternal malnutrition or placental insufficiency
Talpies
Treatment?
Subluxation of talonavicular joint
Management: USS detection
Treatment: Early orthopaedic referred
1. PONSETI - conservative manipulation, repeated plaster caste, achilles tenotomy, boots and bars
Chicken pox
Varicella Zoster
Itubation 11-21 days
Presentation: rash on head and trunk lasting 2 weeks
Cant go back to school till lesions crusted over
Tx: Acyclovir used in severe cases or those immunisuppresed + paracetemol to control fever
Complications = fluclox if get infectious
Conjunctivitis
Treat with?
Neonatal conjunctivitis usually starts 3rd day of life. If complicated
–> Treat with Neomycin
Can be gonoccocal or chlamydial
Childhood conjunctivitis = red eyes and dischargne
Viral, bacterial and allergic
Food allergy
igE antibodies
Most common = milk, eggs, peanuts
Presentation: Bloody diarrhoea, mucus + abdo pain
FTT, eczema, anaphylaxis
Ivx = igE, exclude coeliac
Management: IM adrenaline in anaphylaxis, most resolve by 2 years except peanut
Infectious mononucleosis
90% caused by EBV /CMV
Prodrome: 3-5 days, headache, low grade fever
Syx: exudative pharygitis, tender lumps, hepatosplenomegaly
Ivx: FBC, monospot test
Treatment: Supportive care for syx, avoid contact sport for 1 month
Kawasaki disease
1,2,3,4,5 1 = tongue strawberry 2 = eyes 3 = lymph nodes 4 = limbs (rash) palms and soles 5 = days temp
Onset 6 months - 4 years
Self limiting vasculitis
Diagnosis = warm CREAM
5 day temp >38.5 Conjunctivitis bilateral Rash Erythema on palms and soles Adenopathy Mucus membranes involved = dry strawberry tongue RISK coronary artery aneurysms!!!!
IVX: bloods, ECG, echo
Treament: High dose, Immunoglobulins IVIg wihtin 10 days
+ Aspirin (only time allowed as can cause reyes syndrome = rapidly progressive encephalopathy)
Measles
Young children
Incubation 8-12 days
(5Cs) - KOLPICK SPOTS - white spots - Cough - Conjunctivits - coryza \+ fever + rash starts on face + spreads
Treatment: Prevention with vaccine
Immunocompromised give Ribavarin
Perioribtal cellulitis
do CT scan to check its not gone into eye to check its not orbital
Infection of peri-orbital skin around eye
Agents: S.aureus, may occur secondary to paranasal/ dental abcess.
Features: Fever, unilateral erythema, tenderness + oedema of eyelid
IVX: if severe and eye movements limited then refer to optimal/ ent
Tx: Ceftriaxone if eye movement visible and if not metronidazole
Brain tumours
30% are?
mean age?
30% are medulloblastomas. Mean age is 9y.
2X as common in boys.
Most are Gliomas = astrocytoma’s or medulloblastomas which
have spinal mets at diagnosis
Commonly presents with raised ICP.
Mostly cerebellar signs. DANISH Acronym
•Dysdiachokinesia, Ataxia, Nystagmus, Intention Tremor, Scanning dysarthria, Heel-Shin test positive
Syx: Papilledema, altered LOC, headache, vomiting, behavioural change, bulging fontanelle, raised BP, low HR
May exhibit focal neurological signs depending on site of tumour.
Management
- MRI with contrast. Persistent back pain in children should always warrant an MRI.
- Never do an LP if suspected raised ICP. Can cause coning.
Treatment
Surgery, Radiotherapy and Chemotherapy
Haemophillia
a =8
b=9
Only MEN affected
X -linked autosomal recessive clotting disorder
Syx depend on severity of haemophillia e.g easy brusiing
IVX: increased APPT , clotting screen
Treatment: lifestyle = avoid contact sports forever
IV factor 8 or 9 as prophylaxis
Leukaemia - most common in children?
lymphoma- most common in adolesence?
most common in childhood?
Acute Lymphoblastc Leukaemia (ALL= always little people) Most common childhood malignancy CF: weeks/days quick onset, malaise, anorexia, bone pain, headaches IVX: FBC = thrombocytopenia CXR identifies mediastinal masses Tx- chemo for 3 years
Lymphoma?
Adolesence = Hodgkins due to EBV risk = reed sternberg cells
Childhood = Non hodgkins due to Burkitts
Tx = chemo
Sickle cell Cause of crisis? 1. aplastic? 2. occlusion 3. haemolytic 4. sequestration = sickling within organ
Management?
maintainance fluids?
Autosomal recessive HbSS = anaemia, HbSB = trait
- Present with sudden pain in crisis
1. aplastic due to infection eg PAROVIRS
2. occlusion - thrombotic PAINFUL
3. rare- hb drops
4. sequesttrion pooling of blood in organ - abdo pain
ivx: blood film shows sickles cells
Management:
- Analgesia,
- 02
- keep warm + 38 degrees
- broad spec abx if temp
- 150% normal mainatainance fluids
HbSS prophylaxis oral Pen V, folate supplements, vaccine and bone marrow transplant could cure
Inhialed foreign body
IVX: CXR with lateral views will show hyperinflation of infected side and mediastinal shift
Bronchoscopy to visualise object
Management: A-E
Effective cough –> encourage to cough
Ineffective + conscious = 5 back blows + 5 thrusts
Ineffective + unconscious = open airway, 5 rescue breaths –> CPR 15:2 in child, 3:1 neonate
Middle ear infection = otitis media
Examinaiton
treatment
Very common under 8 years old
Recurrent episodes can cause Glue ear = secretaory otitis media
Presentation:
Infants = high gever, irritability, head rolling, ear rubbing
older children = ear ache, deafness + discharge
Examination: Mild inflammation of tympanic membrane and dialated vessels on handle of malleus
Absent light reflex –> buldging TM and evenrually perforation and discharge.
Treatment: Calpol + allow to burst
If child systemically unwell = antibiotics - oral amoxicillin + paraceteol
if TM performates, can use topical abx eg ciprofloxacin
Surgery : gromet insertion for 1 year
Appendicitis
Ivx:
Management
Presentation: Pain aggrevated by movement, mild fever, centra abdo pain localised to Mcburneys RIF
Guarding, irritable, change in bowel habit
Ivx: Urinalysis abnormal in 1/3, bloods raised WCC + cRP,
USS 90% accurate in diagnosing
Management: Nil by mouth, A-E, Antibiotics, antiemeteics, analgesia, surgical review, appendicetomy
Coaelic disease
Intolerance to Gliadin
RF: Introduction of cereals before 4 months inc risk
Presentation: 8-24 months when starting solids, FTT, abdo distension, irritability, buttock wasting, pale floating stools
Ivx: If Serum tissue Transglutamase iGA (TTG), then small bowel endoscopy ans jejunal biopsy
Shows crypt hyperplasia and villous atrophy
Management: diet of excluding gluten
Risk of GI lymphoma if gluten ingested
Feeding problems
Should weigh?
Kwashikor vs Marsamus
Should weight 2X (age+4) e.g 2 X (5yrs+4) = 18 kg
Kwashikor = normal energy but inadequate protein so swollen abdomen
Marsimus = inadequate energy and protein
Inguinal hernia
more common in?
how to investigate?
8 times more common in boys
Mainly indirect and caused by patent processes vaginalus
More common on R side due to later sescent
Symptoms are rare = intermittent swelling in groin, occurs when crying, may be visible on cough
IVX: Transilluminaiton to exclude hydrocele
Management: Surgical Herniotomy asap to avoid incarceration
Intussusception
Key signs?
- Target sign on USS + small bowel obst on AXR
- Red current jelly stool 3
- Bile stained vomit
- Drawing up of legs
Management:
- Resusscitation of IV fluids
- Abx + analgesia
- NG if vomiting
- Air enema (radiologically guided air inflation within 12 hrs) - if doesnt work, surgiclal resection of gangrene bowel
Jaundice
Pre hepatic
Hepatic
Post hepatic
Pre hepatic -> unconjugated e.g. haemolysis such as spherocytosis
Hepatic –> Hepatocyte damage eg. hepatitis
= mixed conj and unconj sp Dark urine, normal stools
Post hepatic = conjugated
Obstruction of biliary drainage e.g. biliary atresia, cholecystitis
Dark urine, pale stoos + yellow skin and eyes
Mesenteric adenitis
Inflammation of lymph nodes in abdominal mesentry
Mimics acute appendicits - result of recurrent VIRAL
Presentaiton: central diffuse abdo pain (+ URTI)
Fever, malaise, usually resolves within 48 yrs
Pain less severe than appendix
Ivx: Observation- syx should improve
Large mesentaeric nodes seen at laporoscopy and normal appendix so no action needed
Pyloric stenosis
RF
Syx
treatment?
name of surgery?
-Progressive hypertrophy of pyloric muscle –> gastric outlet obstruction
4 X more common in boys
RF: Fhx, first born
Presentation between 2 + 7 weeks of age
- Vomiting non billous that increases in freq and intensity = PROJECTILE
- Hunger after vomiting and dehydration + weight loss
Olive shaped mass - palpable in R hypo
Ivx: test feeed and see peristalsis in abdo, USS to confirm
Blood gas for metabolic acidosis
Management: IV fluid restricton, NBM, empty stomach with NG tube - DRIP AND SUCK 48 hrs to correct electrolyte imbalance
Treatment: surgery = Ramstedts Pyloromyotomy
Torsion of testicle
most common age?
Presentation:
MUST BE EXCLUDED in any child with scrotal pain
Most common 12 years old
RF: undescened testies
Presentaiton: Sudden onset severe pain, N+V, absent cremesteric reflex
Management: Must be relieved in 6-12 hrs to preserve via surgical exploration
CONTRALATERAL testies fixed also to prevent
Undescended testies
investiations?
Treatment- palpable vs non palpable
Cryptochordism - more common in premature babies
Spontaneous descent may occurs in 1st 6 months of life
Exam: carried out in warm room attempt to bring testies down by sweeing massage in inguinal canal
If palpable = Can be treated with an Orchiopexy via inguinal incision
Impalpable = Laparoscopy to determine management as risk of malignant degeneration if in abdo
Disorders of sexual development
- Klinefelters
- kallmans
- Androgen insensitivity syndrome
Klinefelters = 47XXY = feminisation of male - taller than avergae, lack of secondary sexual charactersiics, infertile, gynaecomastic, small testies
kallmans = lack of smell with delayed puberty in BOY
Androgen insensitivity syndrome aka testicular feminisaiton = 46 XY
- Female phenotype with primary amenorrhoea, undescended testies but breast develop due to testosterone –> oestrogen
Ambiguous genitaelia
Most common is Congenital adrenal hyperplasia
CF male + female
Treatment
CAH autosomal recessive disorder
90% cases caused by 21-hydroxxylase enzyme deficiency
Causes salt loss, hyperplasia of adnreal gland = Acute adrenal crisis
Females: Genitaelia look male - clitoral hyperplasia
Males: Enlarged penis, scrotum pigmented, bilateral. non-palpable undescended testies
IVx: Check Na, K, Glucose, pelvic US
Management: Medical + surgical emergency
Avoid immediate declaration of sex
Counselling for parents
+ STEROIDS FOR LIFE = Glucocorticoid + mineralocorticoids
Precocious puberty
ages?
Less than 8 in girls and 9 in boys Central PP (true) = Gonadotrophin dependent e.g. intracrainal tumours. Puberty occurs due to early activation of hypothalamic gonadal axis
Peripheral PP = Gonadotrophin independent - e.g ovarian/testicular tumours - excess Sex steroidds
CF: premature puberty
Ivx: family history of puberty + evidence of growth acceleration?m
Hypothyroidism
- Congenital
- Acquired
IVx
Treatment
Congenital = lack at birth and causes learning difficulty
Detected at screening in Guthrie test which shows high TSH and low T4.
Acquired: F>M, hashitmotos, dry skin, cold intolerance
Thyroid imaging and TFT
Management: Levothyroxine 10-15mg / kg a day
Obesity
Drug Tx if severe
under 12 BMI > 98th centile, over 12 years = BMI over 30
Presentation: Fat and short = hypothyroid/ cushing
Fat + tall = feeding too much
Tx: Increase exercise, monitor diet
Orlistat if severe obesity
Breath holding attack
Age group
Common aged 6 months to 18 months
Child upset, stops breathing and turns pale/grey- transient LOC. rapid full recovery
DDx = Reflex Anoxic seizure
- Sudden pain, deathly grey, syncope, stiff, convulsions.
Child wakes up drowsy
Management: stay calm and lie on side
Epilepsy
Tonic = increased tone Clonic = contractions
Treatment:
- Acute = rectal diazepam or Buccal midazolam
- Sodium Valproate (not when female teenager)
- Carbamazepine for focal
Head injury
A-E Immediate CT scan if LOC < 5mins, suspicion of nonaccedental > 3 episodes of vomting amnesia > 5 mins and abnoral drowsiness
Tx: secure C spine, decompress, control ICP
Hydrocephalus
Management
Obstruction of CSF flow
CF: large head, buldging fontanelle, fixed downward gaze
Ivx: measure head circumference, cranial USS
Management: Venticular peritoneal shunt 1st line
Migraine
Treatment
10% with aura
Presentation: pulsating pain, N+V, photophobia, headache on awakening
Treatment:
- Simple analgesia
- Triptan
- Domperidone = antiemetic
- Prophylaxis with B blocker + Pizotifen (antihistamine)
Plagiocephaly
Flat head syndrome
Tics
Tourettes tx?
Twitch like movement
1 in 10 children - presents at 6 years
Worse when inactive and dissapears when concentrating
Management: ignore the tic,
Tourettes - motor and vocal tics
Management: Clonidine and Risperidone
HAemolytic uraemic syndrome -HUS
TRaid?
Treatment?
Triad 1. Acute renal failure 2. Haemolytic anaemia 3. Thrombocytopenia Most common cause AKI in children
CF: Ecoli common cause-
Fever, vomiting, weakness + Bloody diarrhoea, liver jaundice
Ivx: bloods, anaemia, thrombocytopenia, stool and urine culture
Management: report to local authority
1. dialysis and ECULIZUMAB
Nephrotic syndrome
commonest cause in kids?
How to treat this?
- Proteinuria + low albumin and oedema
No.1 Cause in kids = minimal change disease
CF: oedema, periorbital when waking up
Management: hospitlise!!!
- Fluid restriction and low salt diet
- PREDNISOLONE 6 weeks
- Diuretics
- Penicillin during relapses
“mininmal change disease= dont see much change at the start of disease”
Impetigo
Golden honey comb crust
Due to staph aureus
Highly contagious + complicates eczema
ivx- skin swab for sensitivity
Management: EXCLUSION FROM SCHOOL
Avoid itching Topical Fluclox if bullous
Non bullous - fusidic acid topic
Nappy rash and thrush
Flexures spared!!
- Most commonly irritant dermatitis
Can cause 2 bacterial or candidial
Thrush =. Bright red rash clearly demarcated
Satellite lesions beyond border
tx: NYASTATIN cream and oral if needed
Management: Barrier cream, frequent changing of nappy
Severe = leave off nappy for a few days and steroid cream
Stevens Johnsons
Cf
Management
SEVERE erythema multiforme
Affects skin, genitals, eyes and mucous membranes
CF: prodrome of fever, cough, sore throat
Abrupt rash –> widespread blisters and arthralgia
Management: ICU or burns unit
Hydration and emolient ointment
Systemic corticostroids
Identify cause (eg penicillin)
Developmental dysplasia of hip
Congential dislocation as acetabulum is shallow and doesnt cover hip
CF: hip instability, subluxation
F>M, must resolve by 9 weeks of birth
Found at baby checks Barlow - dislocate and otolani re-locates
6 weeks- 4 months hip USS
4 months + x-ray
Management: PAVLICK harness, if doesnt work surgery
Irritable hip / reactive arthritis
= reiters
cant see, pee, climb a tree
Autoimmunue attack on hoiny after GI or GU infection
Cause: Chlamydia, Shigella, group A strep rheumatic fever
CF: 1-4 weeks after infection develop joint swelling
Ivx: raised ESR and CRP, XR normal
Management: NSAIDS naproxen
Steroids
rheumatic fever = penicillnin
Juvenille idiopathic arthritis
Under 16 years old- unkknow cause of autoimmune arthritis
Oligoarticular > 6 joints, poly 6+ or systemic
Cause: Synovium is targeted organ for inflammation
CF: swelling, joint pain, morning stiffness
IVx: rheumatoid factor, ANA+, ESR, cRP, imaging
Management: steroid joint injections, NSAIDs, methotrexate
Limping child
RED FLAG = nocturnal pain, redness, swelling, stiffness, weight loss
pGals + urgent referral if <3 years or red flags
Rickets / vit d deficiency
Cause: low sun exposure, low dietary intake, CKD, medications eg antiepileptics
CF: bowing of legs, delayed tooth eruption, progressive knock knees, skull softening, delayed walking
Ivx: ALP, phosphate, vit D and ca, u+es
Management: oral high dose vit D and Ca, safe sun exposure, diet
Autistic spectrum disorder
- impaired social interaction
- Global impairment of speech and language
- Imposition of routines with ritualistic behaviour
Ivx: Refer to autism team + multidisciplinary support
Blindness
Visual acuity <3/60 in one eye of child <16
Deafness
Conductive e,g otitis media
Sensorineural eg genetic inherited, preterm, antenatal infection
ivx: otoscope and refer
Developmental delay Sit with support - singles words - walks well - 2 word sentences 6 blocks, 9 blocks
red flags
- Sit with support 6 months old
- singles words 1 years
- walks well 18 months
- 2 word sentences 2 years
6 blocks 2 years
9 blocks 3 years
Anxiety
Syx: hyperarousal, heightened sense of danger, irritable
Management: CBT, SSRI and self help
ADHD
Treatment?
Drugs?
How often to monitor and why
Impulsivity, Inattention and Hyperactivity
Treatment: Behavioural and family counselling - positive reinforcement
Educational intervention - involve school
Drugs: METHYPHENIDATE = RITALIN
- monitor weight and height every 6 months
SE: decreased appetite, poor sleep, tics
Necrotising Enterocolitis
Common in pre-term and first week, formula fed babies
Presentation: Abdo distension, poor temp control, bloody stool, shock
Ivx: AXR, CRP, stool culture
Treatment; breast milk, If high risk give antenatal corticosteroids + abx prophylaxis
–> Nill by mouth, laporotomy resection
Henoch Schoelen purpura triad
Arthritis, colicky abdo pain + purpuric rash in boys
Delayed puberty
- Constitutional
- Hypothalamaic Hypogonadism
- Hypogonadotrophic Hypogonadism
Absence of puberty develpment by 14 for females and 15 for males
- Constitutional = family history of delay
- Hypothalamaic Hypogonadism = low FSH and LH due to chronic ilness eg chrons, malnutrition
- HypERgonadotrophic Hypogonadism = e.g Klienfelters, turners = high FSH and LH
ivx: LH, FSH, serum testosterone and estradiol, TFT
Tx: Tesosterone for male to induce sexual development and oestradiol in females
Phenyketonuria
CF:
Autosomal recessive - Phelyalanine cant be converted to tyrosine present 6- 12 month sold
CF: Fair hair, blue eyes and eczema + –> Seizures
Musty odour
Ivx: Guthrie test + urinalysis. HIGH KETONES in urine
Management: dietary change to low phenylalanien + high tyrosine and protein food
monitor blood plasma phenylalaine regularly
Slapped cheek
dangerous for?
PArovirus
Erythema infectiosum
Dangerous aplastic crisis in Sickle cell
patent ductus arteriosus sound like?
Treat?
Continuous ‘machinery’ murmur
Treat = indomethacin or ibupofen = anti prostaglandin
Croup memory aid
“para” troup
Parainfluenze
bronchiolits memory aid
RSV=B
7 S of innocent murmer
Soft Systolic Short S1+2 normal Standing and sitting variation symtomless Special tests normal
Dowsn syndrome complicatons
- cardiac?
others?
Cardiac = endocardial cushion defect + VSD - Subfertility - ALL - Alzheimers - HIRSHSPRUNGS - Repeated resp infections
time frame difference for Henoch-Schonlein purpura, and Post infectious glomerulonephritis?
HSP vasculiis = days after due to igA nephritis
Post infectious = several weeks after infection
The first-line antibiotics for necrotising enterocolitis.
clindamycin and cefotaxime
age for perthes disease?
under 8 - (i went to perth when i was 8)
