Minimal Paediatrics Flashcards
Triad of ADHD:
- Hyperactive
- Impulsive
- Inattention
Rx of ADHD
Conservative: parenting education + training
CBT for older children
Medical: methylphenidate (ritalin)
Atomoxetine
Features of cerebral palsy:
Acquired CNS injury prior to age 2 may present with: Delayed motor development CNS signs- weakness, paralysis Learning disability Epilepsy
4 forms of cerebral palsy:
- Spastic hemiplegia- pyramidal lesion, arms > legs
- Spastic diplegia- legs > arms, scissoring gait, internal rotation, adduction, knee extension, plantar flexion
- Spastic quadraplegia- most severe, low IQ + seizure associated
- Dyskinetic (athetoid)- unwanted involuntary actions de to basal ganglia affected, dysarthria
What is bronchiolitis in children and it’s causes?
Bronchiole inflammation- LRTI
Signs: coryza then cough, low fever, wheeze, inspiratory crackles, intercostal recession
Causes: Resp syncitial virus (RSV)
Mycoplasma, parainfluenza (more Croup URTI), adenovirus
Which childhood illness are parainfluenza and respiratory syncitial virus typically associated with?
Parainfluenza- croup, URTI (stridor, barking cough)
Dexamethosone
RSV- bronchiolitis, LRTI (wheeze, crackles)
Doesn’t need steroids + bronchodilators routinely
How does the preferred antibody test for coeliac test change if investigating those under 18 months?
IgA anti-gliadin
If IgA deficient, measure IgG anti-gliadin
Villous atrophy on duodenal biopsy
What are the signs of a patent ductus arteriosis?
General: failure to thrive, pneumonia, CCF
Cardiac: collapsing pulse, loud S2
systolic pulmonary murmur or continuous machinery hum
Rx to close patent ductus arteriosis?
NSAIDs: ibuprofen or indomethacin (reduce prostaglandin level)
Steroids prior to labour if pre-term
Causes of congenital cyanotic heart disease?
5T's: Tetralogy of Fallot Transposition of great arteries Tricuspid atresia Truncus arteriosis Total anomalous pulmonary venous return
3 key features of autism:
Impaired social communication
Impaired imagination
Restricted range of interests
30% coexistent epilepsy
Rx of Croup:
4 year old with stridor, barking cough- URTI laryngotracheobronchitis
Mild/moderate: dexamethasone PO or prednisolone PO
Severe: nebulised adrenaline
Differential of Croup to be excluded:
Bacterial tracheitis- mucosal sloughing, not cleared by coughing, risks occluding the airway
Continuous or biphasic stridor may be present, barking cough
Moderate high fever- appears toxic
Epiglossitis- avoid examining throat, swollen epiglottis
Haemophilis influenzae, cephalosporin + intubate
Drooling secretions
Softer stridor
Muffled voice, no cough
Tests for cystic fibrosis in newborns?
Sweat test >60mmol Na+
DNA test
Immunoreactive trypsin
Screening: newborn blood spot Guthrie test
Features of Cystic Fibrosis treatment:
Respiratory: postural draining, chest physiotherapy
Antibiotic prophylaxis, mucolytics
Lung transplant
Gastro: increased calorie intake
Creon, omeprazole (increases duodenal pH for absorption), ADEK vits
Diabetic review
How is developmental dysplasia of the hip diagnosed?
Ortolani + Barlow manoeuvres
USS at 2-4 weeks in those high risk: Older mum or positive FHx Oligohydramnios, high birth weight Postmaturity Breech birth, caesarian for breech
Clinical features that may be associated with Down’s syndrome:
Mental + growth retardation Cardiac malformation- VSD, ASD, AVSD, patent ductus Duodenal atresia Reduced lung capacity Leukaemia Hearing loss Alzheimer's
What are febrile convulsions?
Single tonic clonic symmetrical generalised seizure lasting under 20 minutes, associated with a raised temperature.
Signs it’s something else:
Focal CNS sigs
1+ attack in 24 hours
Seizures last >15 minutes
Rx of febrile convulsion:
Recovery position if >5minutes
Benzodiazepines
Paracetamol syrup
Rx of infant gastro oesophageal reflux?
Feed thickening
Antacid
Gaviscon
Extreme cases- fundoplication
A child has purpura, how does the child being ill and platelet count affect likely diagnosis?
Ill + low platelets: meningococcal septicaemia, leukaemia, DIC, HUS
Ill + normal platelets: virus- measles, vasculitis- kawasaki (high plts)
Well + low platelets: ITP, rarely anaplastic anaemia
Well + normal platelets: Henoch Schönlein
How does pyloric stenosis present?
At 3-8 weeks: projectile large volume vomits, non-bilious, within minutes of feed
Baby always hungry, anxious
Signs: olive-sized pyloric mass
Tests and management of intussecpition?
USS
Rx:
- Air enema reduction
- Laparoscopic reduction- NG tube, cross match
Diagnostic criteria for Kawasaki:
Fever for 5 days + 4 of: Bilateral non-purulent conjunctivitis Neck lymphadenopathy Dry fissured lips, strawberry tongue Polymorphous rash Extremity changes: desquamation, arthralgia, palmar erythema
Complication: coronary artery aneurysm
What aspects of neonatal jaundice are abnormal?
Onset before 24 hours of birth: sepsis, ABO incompatibility, Rhesus disease, red cell abnormalities
Prolonged lasting >14 days: breastfeeding, sepsis, CF, hypothyroid
Encephalopathic (kernicterus): lethargy, hypertonic, arched neck
Long term sequelae of kernicterus?
Acute bilirubin encephalopathy:
Athetoid movements
Deafness
Low IQ
Prevention: phototherapy, plasma exchange transfusion
Phototherapy converts bilirubin into soluble products for excretion
What is a neuroblastoma and where do they occur:
Primary childhood malignancy from neural crest cells
Occurs in adrenal glands
Along spinal cord, neck, chest, abdo, pelvis- can cause proptosis
MIBG scan
VMA or HVA levels in urine
What tests are required to diagnose transient synovitis of the hip?
FBC, ESR/CRP
Plain films
USS ± aspiration
Diagnosis of exclusion
Features of Turner’s syndrome:
Short stature Hyperconvex nails Wide carrying angle Ptosis, nystagmus Webbed neck Broad chest, hypoplastic breasts, inverted nipples Coarctation of aorta Lymphoedema, gonad dysgenesis
