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
