Paediatric Study #2 Flashcards
Definition of Precocious puberty
‘development of secondary sexual characteristics before 8 years in females and 9 years in males’
Two main subtypes of Precocious Puberty are?
1. Gonadotrophin dependent (‘central’, ‘true’)
due to premature activation of the hypothalamic-pituitary-gonadal axis
FSH & LH raised
2. Gonadotrophin independent (‘pseudo’, ‘false’)
due to excess sex hormones
FSH & LH low
The medical name for “nits” and what is first line diagnosis/treatment?
pediculosis capitis
Diagnosis:
- Wet comb
Treatment:
- treatment is only indicated if living lice are found
- a choice of treatments should be offered - malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone
- household contacts do not need to be treated unless they too are affected
What is an efficient way to reduce the imapct of hypoxic brain damage in an neonates?
Therapeutic Hypothermia/therapeutic cooling
It is only licensed to be used in neonates >36 weeks gestational age
A swelling on the newborns head that typically develops several hours after delivery is likely to be?
A cephalhaematoma
- A swelling between the skull and the periosteum
- Doesn’t cross suture lines
- Most commonly in the parietal region
- can take up to 3 months to resolve
Features of Interssusception
What is the likely age for this to occur?
- paroxysmal abdominal colic pain
- during paroxysm the infant will characteristically draw their knees up and turn pale
- vomiting
- bloodstained stool - ‘red-currant jelly’ - is a late sign
- sausage-shaped mass in the right upper quadrant
Likely age is 8-16months
Treatment of interssusception and best way to image?
Image via USS to see a target shaped sign
Treatment:
- Reduction by air insufflation
- If peritonitic or this doesn’t work then surgery is required
Jaundice <24h is always pathological.
Your differentials are?
- rhesus haemolytic disease (RHD)
- ABO incompatibility
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- hereditary spherocytosis
Jaundice <24 hrs is always pathological.
What investigations should you do?
Immediate Blood film analysis
- This would show bite and blister cells in G6PD deficiency or spherocytes in hereditary spherocytosis.
An osmotic fragility test or a Coombs Test (showing RHD) would also be helpful
Jaundice >14 days is reason for concern.
What investigations should you do?
- conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention
- direct antiglobulin test (Coombs’ test)
- TFTs
- FBC and blood film
- urine for MC&S and reducing sugars
- U&Es and LFTs
because urinary tract infection or hypothyroidism may be the underlying cause.
Causes for ‘prolonged jaundice’ (>14days in newbordns or >21 days in prems)
- biliary atresia
- hypothyroidism
- galactosaemia
- urinary tract infection
- breast milk jaundice
- congenital infections e.g. CMV, toxoplasmosis
What sleeping issues can downs syndrome cause?
Snoring
Due to reduced tone of the upper airways and a large tongue/adenoids.
Obesity is also a contributing factor.
Projectile vomiting in an infant of 2-4weeks, with a failure to weight gain.
A palpable mass may be present.
What is this and how do we diagnose
likely Pyloric stenosis.
- Due to hypertropy of the circular muscles of the pylorus
- Constipation/dehydration may be present
Identify on USS
Child will have hypochoraemic hypokalaemic alkalosis
