Paediatric Diseases Flashcards
Whats bronciolitis? Whatbare some assc RFs? And the epidimiology?
Resp condition characterised by coryza, followed by a bronchiolitic dry, wheezy cough, breathlessness, poor feeding, hyperinflation of chest and expiratoty wheeze in infants.
Aetilogy- 75% RSV, there may be multiple causative agents- rhinovirys, parainfluenza, influenza or adenovirus.
Assc
RF severe disease- prematurity +/- chronic lung disease (CLD) , congenital/ aquired lung disease, congenital heart defects (CHD) and immunodeficiency.
Protective: breastfeeding and avoidance of parental smoking
Epidimiology- commonest LRTI in infants, esp 3-6M
Winter epidemics
Vomitting- what happens?
Projectful expulsion of stomach contents through mouth
Regurgitation: return of partially digested food from the stomach to mouth.
Red flags- bilous, blood, projectile, abdo distention, tenderness, high fever, dehydration signs.
Inv- CBC, electrolytes, BUN, Cr, amylase, lipase, glucose done routinely.
Sick child- ESR, venous glood gases, C+S (blood, stool) , imaging
Tx- rehydration, treat cause.
How would you investigate diarrhoea?
Acute: stool sample for culture and serology (C+S) , electron microscopy for viruses, C. Difficile toxin, microscopy- leukocytes suggestive of invading pathogen, blood and urine cultures,
Blood work.
Chronic:
Serial heigts, wts, growth percentiles. If good, stool culture.
Red flags- poor growth, chronic rash, serious infx, hospitalisations for dehydration.
Stool: consistency, pH, microscopy, occult blood, C+S, C. Difficle toxin
Urinalysis, urine culture
CBC, CRP, electrolytes, albumin, Ca2+, PO4-3, Mg2+, Fe, ferritin, folate.
Sweat chloride, celiac screen, TFts, HIV test, lead levels.
CXR, upper GI series
Specialised tests- endoscopy, small bowel biopsy.
How would you investigate gastroenteritis?
Hx- non- specific :diarrhoea, vomitting, fever, anorexia, headache, myalgia, abdo cramps
B+ parasitic agents commoner in older (2-4Y) + recent infx contacts 24-48hrs of exposure have sx.
O/E- febrile, dehydrated- asses.
Inv- not necessary in young kids
Stool analysis- leukocytes/ erythrocytes suggest H or parasitic etiology. pH
B- bloody D. Viruses non usually.
Mx- early feeding advisable
Antiemetics help vomiting but worsen diarrhoea.
Antidiarrhoeals NOT indicated.
Antimicrobials if indicated.
Notify public health authorities if appropriate
Promote regular hand washing and retirn to schl 24-48 hrs after D stops
Rotavirus vaccine
What happens in celiac?
Assc with increased prevalence of IgA deficiency. tTG is an IgA detecting test.
Avoid- BROW
Barley, Rye, Oats, Wheat .
Milk peotein allergy- ?
Immune mdiated mucosal injury - IgE and non IgE mediated.
50% allergic to soy milk as well.
Whats infectious mononucleoisis?
Systemic viral infx caused by EBV with multivisceral involvment, “the great imitator”
Peak :15-19Y
EBV- member of herpes
Transmission- saliva - kissing disease and sexual activity (less commonly” , incubation period: 1-2mo.
RFs
Infectious contacts, secually active, multiple sex partners.
O/E febrile, unwell, fevere, malaise, headaches, abdo pain (LUQ)
Inv
Monospot test- heterophil antibody test, false +ve with HIv, SLE, lympoma, rubella, parovirus
Mx
Supportive: fluids, rest, analgesics for sore throat
Splenic enargment not obvious for all- avoid sports contacts for 6-8w
If airway obstruction from enlarged stuff- admit for steroids
Acyclovir does NOT reduce sx or duration/ earlier return to school.
Prognosis
1-2w or months
Splenic rupture, Guillain -Barre syndrome
What happens when kids limp?
Abnormality of gait, (term applied to rhytmic movement of the whole body in walking.
It can be painful or painless and cause varies with age.
Most common cause: of acute limp in a well child- ‘is irritable hip’.
Dx NOT to miss: Septic arthritis, osteomyelitis.
O/E:
Watch kid walking.
‼️ fever- bone or joint infx,
Skin rashes,
Range of movement, point tenderness or signs of inflammation,
Unequal leg length
Spinal abnormality- hairy patch (spina bifida)
Neurological signs:
Check tone, power, reflexes.
Investigations: Imaging: Xrays, Uss of hip joint Nuclear medicine: isotope bone scans Bloods: FBC, acute phase reactions Blood cultures if febrile (SA)
What are some causes of a limp according to diffeent ages?
All ages—> Trauma, Septic arthritis/ osteomyelitis
1-2Y Congenital dislocation of hip, (developmental dysplesia of the hip, Cerebral Palsy
3-10Y —> transient synovitis (irritable hip) , perthes disease, rarities: JIA, Leukemia
11-15Y—-> slipped upper femoral epiphysis, Osgood-Schlatter disease,
Rarities: Bone tumours, JIA, Hysteria.
What are some causes of acute monoarthritis?
Septic arthritis: fever and inability to move
Irritable hip: recent cold
Haemophilia: easy bruising
Juvenile idiopathic arthritis: chronic pain and swelling
Trauma- immediate sx, no chronicity.
Causes of poluarthritis:
Inflammatory: juvenile idiopathic arthritis, SLE, Henoch- Schonlein purpura.
Infectious/ Reactive:
Viral, mycoplasma, rheumatic fever.
Painful joint!!
SA can destroy joint within 24hrs, XRay no good,
ASPIRATE.
What happens in neurological probs?
Improstant sx:
Paroxysmal episodes: fits, faints, funny turns
Headache
Vomitting
Importnat signs
Focal neurology
Altered consciousness level or coma
Need to distinguish between true epileptic seizures (fits) from faints and funny turns.
What are the commonest heamatological problems ?
Haematopoiesis happens in liver., sleppn and lymph nodes. Commences in bone marrow on 4-5th M gestation.
At birth, haematopoietic activity mostly in long bones.
Lifespan of peripheral blood cells:
Red cells: 120days
Platelets: 10 days
Neutrophils: 6-7hrs
Haemaglobin concentration:
High at birth: 14-20g/dL
Falls to 9-13g/dL at 2-3M in term infants
Anaemias
Thalassaemias
Iron deficiencies
Sickle cell disease
What happens in thalassaemia?
Hereditary anemias caused by defects in globin chains.
A thalassaemia- reduced synthesis of a globin chains
beta- reduced synthesis of b- globin chains.
Due to mutations
These mutations precipitate in membrane damage and either:
1. Cell death within bone marrow (ineffectibe erythropoiesis)
OR
2. Premature removal by spleen haemolytic anaemia.
