Paediatrics Flashcards
Prematurity
Premature 26-28 weeks
Increased risk of morbidity,
Cx: RDS, PDA NEC, ROP, IVH
Tx: NGT/OGT feeds +/- TPN
Complications prematurity
Resp Distress syndrome:
Ax: Lack of surfactant
Sx: Tachy, Hypoxic, CXR: Ground glass appearance
Tx: Antenatal steroids, Surfactant, Resp support
PDA
Ax; Failure of ductus arteriosus (connects Aorta-PA) to close leading to L-R shunting, fluid overload and HF
Sx: Continous murmur between clavicles, bounding pulse, Inc pulse pressure
Tx: Ibroprofen/indometacin, Ligation of duct
Nectrotising enterocolitis:
Ax: Ischemia of gut all secondary to infection
Sx: Intolerance to feeds, Abdo distended, vomiting, AXR: Distended loops, thickening, perforation,
Tx: NBM, TPN, Surgery if perf
Cx: Malabsorption, stricture formation
Neonatal sepsis
Ax: Prolonged rupture of membranes, Chorioamnionitis GBS, prematurity.
Sx: Resp distress, apnoea, temp, poor feeding, Infection screen
Tx: Abx
Jaundice
Ax: First 24hrs: Rhesus incompatibility, ABO incompatibility, G6PD, hereditatory spherocytosis,
Day 2-14: Unconj: Physiological/ breast milk
Conj: Biliary atresia, neonatal hep
Sx: Yellow, lethargic, poor feed, Pale stool, Dark urine
Ix: Direct antigen coombs test, FBC, Blood film, LFT,
Tx: Phototherapy, hydration, surgery e.g biliary atresia
Feverish Child
Colour, Activity, Respiratory, Hydration
Meningitis
Ax: Bact: Strep Pneum, H.Influenz, Neiserria menin,
Viral: HSV, Enterovirus, adenovirus
Neonatal: GBS, E coli, Listeria
Sx: Fever, irritabiliy, vomting, bulging fonatanelle in younger
Ix: LP and CSF analysis, CT
Tx: Benzylpenicillin + gent for neonates (Dex if high index of suspicion)
Meningococcal septicemia: Neiserria meningitidis infection
Sx: Fever, non blanching petechia/purpura, shock
Tx: Abx (Ceftriaxone, I.m Benzylpenicillin), fluids
Kawasaki
Ax: Immune mediated inflammatory condition leading to coronary anuerysms
Fever, Rash (blanching), conjunctitivitis, mucosal changes (strawberry tongue), cervical lymph, erythema hands
Ix: Inc inflammatory markers, Echo (aneurysms)
Tx: Immunoglobululin, high dose aspirin
Congenital infections
TORCH Toxoplasmosis Other Rubella CMV HSV
Tx: High dose aciclovir
Febrile convulsions
Ax; Seizure with fever, brief generalised tonic-clonic
Tx: Reassurance, Abx if indicated, Benzo if seizure >5min, Tx status epilepticus
Cx: 1/3 have further febrile convulsion
Epilepsy
Ax: Idiopathic, cerebral palsy, meningitis, head injury, metabolic, genetic
Sx: Generalied: Absence, tonic-clonic, myoclonic, tonic, atonic
Focal/partial:
Frontal lobe: Simple partial (Jaksonian march/todds paresis)
Temporal lobe: Automatisms, sensory phenomena, deja vu
Partial: Vertigo, sensory sx
Occipital: Visual sx
Cerebral palsy
Ax: Disorder of movement and posture fixed insult of developing brain
Sx: Spastic: Inc tone and reflexes, reduced power - hemiplegia, diplegia, quadriplegia
Dystonic: Involuntary movements - athetosis, chorea
Ataxic: Hypotonia, wide based gait, nystagmus, intention tremor
Ix: MRI
Tx: mtd approach,
Cx: Epilepsy, developmental delay, physical problems
Hydrocephalus
Ax: Inc ventricular pressure leading to inc ICP
Communicating: Failure to reabsorb CSF - Post bleed/infection, Arnold chiari, ocer production CSF
Non communicating: Obstruction to csf- tumour, congenital malformation
Sx: Irritability, poor feeding, headache, vomiting, seizure, bulging fontanelle, papilloedema,
Tx: Shunt
Duchenne muscular dystrophy
Ax: Progressive muscle weakness. X linked recessive. Mutation of Xp21 gene which produced dystrophin
Sx: Speech and motor delay, waddling gait, cardiomyopathy, Proximal weakness: Gowers sign positive, muscle wasting, calf hypertorphy, absent reflexes, often wheelchair bound by 8-12 years
Ix: Inc CK, abnormal EMG and nerve conduction, muscle biopsy
Bronchiolitis
Ax: Infection and inflammation of bronchioles. Commonest pathogen RSV. Often <12 months age,seasonal
Sx: Cough, coryza, dfficulty breathing, poor feeding, increased work of breathing (tachypnoea, tracheal tug, subcostal/intercostal recession, head bobbing, grunting), hypoxia, coarse creps, wheeze
Ix: CXR hyperinflation/patchy change
Tx: Supportive: Oxygen, NG feeds, CPAP if severe, Ipratopium nebs
Palivizumab (RSV monoclonal antibody) given monthly ass primary prophylaxis during RSV sx to high risk
Croup
Ax: Viral laryngotracheal infection. 6 months-6 years.
Sx: Barking cough, hoarse voice, difficulty breathing, stridor, inc work breathing, hypoxia
Tx: Dexamethasone po or neb budenoside
Epiglottitis
Ax: Bacterial infection and inflammation of epiglottis. Heam influenze B immunisation
Sx: Fever, stridor, drooling, minimal cough
Whooping cough
Ax: Bronchitis caused by Bordetalla pertussis infection
Sx: Coryza for 2-3 days followed by spasmodic episodes of coughing ending with an inspiratory whoop
Tx: Supportive
Cystic fibrosis
Ax: Autosomal recessive disorder affecting CFTR gene chromosome 7. Na-Cl channel dysfunction causing thick secretions in lungs and pancreas
Sx: FTT, recurrent chest infections, steatorrhea, malapsorption
Ix: Sweat test (elevated Na and Cl), CXR: Bronchiectasis
Tx: Regular physio, bronchodilators/inhaled steroids, Abx, pancreatic enzyme supplements, high cal diet
Cx: Meconium ileus, obstruction, diabetes, liver cirrhosis, pancreatitis, infertility
Colic
Ax: Persistent crying/discomfort in a healthy thriving infant ? secondary to cows milk intolerance
Sx: Crying.
Tx: Reassurance, consider trial of cow’s milk exclusion/hydrolysed milk
Pyloric stenosis
Ax: Hypertrophy of gastric pylorus causing upper GI obstruction
Sx: Projectile milky vomits after every feed, constangly hungry, WL, Palpable olive mass in right upper abdomen, dehydration
Ix: Hyperchloremic, hypokalemic, met alk
Tx: NBM, correct electrolytes with IV, NG, surgery
Allergic colitis
Ax: Commonest cause of non-infectious diorrhoea in infants
Sx: Diorrhea with blood and mucus. FTT. Most common allergy is cows milk protein
Ix: Eosinophilia, raised Ig E,
Tx: Exclude and offer substitute milk
Gastroenteritis
Ax: Upto 60% rotavirus (other virus: adeno/noro)
Bacterial: Campylobacter, salmonella, shigella
Sx: Acute vomting, diorrhea, fever, blood in stool, dehydration
Ix: Stool MC&S, U&E
Tx: ORT, IV fluids. Acute sx resolve within 1-2 days. Diorrhea persist 2 weeks.
Hirschprings
Ax: Absent ganglion cells in anorectum.
Sx: Delayed passage of meconium, acute bowel obstruction, chronic constipation
Tx: Excision or bypass of aganglionic intestine. May involve interval colostomy.
Cx: Enterocolitis: Profuse diarrhoea and hypovolemic shock
Malrotation
Ax: Failure of midgut to rotate during embryogenesis.
Sx: bile stained vomit infant, GORD, vomiting, abdo pain older child
Tx: Surgical
Cx: Volvulus and acute bowel obstruction
Biliary atresia
Ax: Atresia of extrahepatic biliary system leading to disrupted flow and excretion of bilirubin
Sx: Prolonged jaundice, pale stools, dark urine,
Ix: Conjugated hyperbilirubinaemia, Inc ALP and liver enzymes
HSP
Ax: Small vessel vasculitis. Peak 4-6 years. Often precided by viral illness
Sx: Purpuric rash, predominantly thigh and buttock distribution, abdo pain and large joint arthiritis
Ix: Haematuria on urine dip, htn
Cx: IgA nephritis
Tx: Supportive, analgesia, steroids if significant abdo pain/renal involvement. Usually self limiting within 1 week
Coorctation of the aorta
Ax:Associated with Turner syndrome. Often coexists with VSD
Sx: Absent/weak femoral pulses, HTN in arms but not legs. Radio fermoral delay
Tetraology of fallot
Ax: VSD, RVH, Overriding aorta, RV outflow tract obstruction (pulmonary stenosis)
Most common type of cyanotic congenital heart disease. Associated with DiGeorge (22q11 deletion)
Sx: May present with cyanosis on closure of the duct. Ejection systolic murmur. Single second heart sound. Cyanotic spells when crying/upset. Squat to increase venous return. Clubbing.
Ix: ECG R axis deviation, RVH/strain, Echo, Small heart cxr
Cx: Ventricular arrythmia
Tx: Acute spells: Oxygen, morphine, propranalol, surgical repair at 6 months. Symptomatic infants may require shunt to increase pulmonary blood flow
Transposition of great arteries
Ax: Aorta arises from RV and pulmonary artery arises from left ventricle creating two parallel circulations. Mixing of blood maintained via PDA/foramen ovale/VSD
Sx: Cyanosis at birth or presentation when duct closes
Ix: Egg on side appearance of heart cxr, Echo
Cx: Pulmonary/aortic stenosis. coronary artery disease
Tx: Baloon atrial septostomy as emergency. Surgical arterial swicth repair
Rheumatic fever
Ax: Immune response following Group A strep infection leading to valvular disease
Jones criteria. Requires 2 major or 1 major and 2 minor
Major: Carditis, fever, polyarthiritis, erythema marginatum, subcutaneous nodules, chorea
Minor: Polyarthralgia, Inc ESR/CRP, Inc PR, Previous hx of Rheum fever, Inc antistreplosyin O titre
Cx: Mitral stenosis, but could affect other valves
Tx: Anti-inflammatory drugs, high dose aspirin, proph abx
Malignancies
Neuroblastoma-Neuroendocrine tumour from SNS. Usually adrenal but can arise anywhere along sympathetic chain
Wilms: Nephroblastoma. Painless abdo swelling, haematuria, WL, HTN
Rhabdomyosarcoma: Tumour at skeletal tissue
Bone tumours: Osteosarcoma, Ewings sarcoma. Can present as pain, swelling and pathological fractures of long bones. Adolescent boys
Retinoblastoma: Malignancy of retinal cells. Absent red reflex, squint, visual sx
Genetics
Chromosomal: Extra or missing chromosomes. Usually caused by nondysjunction, also translocation and mosaicism.
Autosomal dominant: Neurofibromatosis, marfans, huntingtons
Autosomal recessive: CF, Sickle cell disease
X linked recessive: Duchenne, Fragile X
Imprinting (only one copy of gene expressed): Praderwilli, Angleman
Downs Syndrome
Ax: Trisomy 21. 47 XX+21
Sx; Dysmorphic features: Round face, flat occiput, protruding tongue, epicanthic folds, upslanting palpebral features, single palmer crease, sandal gap
Ix: Chromosomes, echo, TFT, tissue transglutimase,
Cx: Hypothyroids, congenital heart disease (AVSD), leukemia, duodenal atresia, ceoalic, Alzheimers, hearing/visual impairment, life expectancy 50
Tx: Developmental/learning support
Turners
Ax: 45X0, females, Oedematous hands and feet as neonate, short stature, webbed neck, widely spaced nippels, wide carrying angle, horseshoe kidney, normal IQ
Ix: Chromosomes, echo
Cx: Coarctation of arota
Kleinfelter’s syndrome
Ax: 47XXY, Tall stature, small testes, gynaecomastia, behavioural problems
Cx: Infertility
Fragile x
Ax: X linked recessive, Low IQ, prominent ears, enlarged testicles
Developmental milestones
Speech and language:
6 months: Turns to voice, squeals
1 year: Says 2 or 3 words. Understands more
2 year: Asks for food/drink. Knows few body parts
3 years: Asks questions. Counts to 10. Few nursery rhymes
4 years: First and last name (may be earlier)
Social
6 months: Smiles to mirror, friendly to all
1 year: Can understand certain phrases, shy with strangers
2 years: Takes off shoes, socks
3 years: Dress and undress fully if helped
4 years: self toileting
Fine motor
6 months: Palmer grasp, Starting to transfer
1 year: Casts objects, picks small objects
2 years: Draws vertical line, 6 tower block, turns pages of book
3 years: Draws circle, 9 tower block
4 years: Draws cross
Gross motor
6 months: Good head control, sits momentarily, rolls over
1 year: Sits well, can cruise
2 years: Up stairs one at a time, kick, throw and run
3 years: Upstairs alternative feet, walk on tip-toes
4 years: Downstairs alternative feet
Failure to thrive
Ax: failure to maintain normal rate of growth, GORD, Coeliac, crohns, CF, hypothryroidism,
