Paediatrics Flashcards
HIGH FEVER, SORE THROAT, SOFT INSPIRATORY STRIDOR AND DROOLING
acute epiglottitis - infection of epiglottis caused by Haemophilus influenzae
- it causes oedema of the epiglottis
- causes obstruction of airways and difficulty breathing
- drooling caused by patients not swallowing their saliva due to throat being really sore
- LEAN FORWARDS TO BREATHE
EMERGENCY
CROUP PRESENTATION
- cough and common cold symptoms
- inspiratory stridor
- EMERGENCY
caused by parainfluenza virus
barking like cough
hoarseness
dexamethasone
MEASLES PRESENTATION
cough, cold like symptoms (cough, sneezing etc) conjunctivitis and white spots in the mouth and maculopapular rash
starts behind the ear then spreads to the rest of the body
INFECTED TILL AFTER 4 DAYS OF INFECTION
TEST FOR MEASLES
IgM antibodies from blood or saliva
BABY BORN AT TERM, VAGINAL DELIVERY BUT THERE IS A SWELLING ON BABY’S HEAD
CROSSES SUTURE LINES, BABY IS WELL
this is Caput Succedaneum: collection of fluid in the head due to pressure on the head during a vaginal delivery
resolves in a few days
LONG HISTORY OF COUGH, WHEEZE, STINKY AND GREASY LOOSE STOOLS, NASAL POLYPS AND POOR GROWTH
- most likely to be cystic fibrosis
CHILDREN WITH CYSTIC FIBROSIS ARE DEFICIENT OF WHICH VITAMINS
A, D, E AND K
NEONATAL JAUNDICE RISK FACTORS
PREMATURE BIRTH
BREASTFEEDING
LETHARGY, HEADACHE, SORE THROAT, RUNNY NOSE AND FEVER
RED RASH ON TORSO AND CHEEKS THAT BLANCHES UNDER PRESSRE
SLAPPED CHEEK SYNDROME
supportive management
WHICH BILLIRUBIN IS RAISED IN PHYSIOLOGICAL NEONATAL JAUNDICE
UNCONJUGATED
- more rbcs in babies so more turnover so more billirubin is made to be broken down
- immature liver in babies is not able to break down the unconjugated billirubin into cojugated so babies have more unconjugated billirubin in their blood
SLAPPED CHEEK SYNDROME NAME
Erythema infectiosum
FEVER, CHEST PAIN IN THE LAST 24 HOURS IN CHEST AND BACK, AND SHORTNESS OF BREATH AND SICKLE CELL DISEASE
ACUTE CHEST SYNDROME
ACUTE ONSET OF CHEST PAIN THAT IS WORSE ON DEEP INSPIRATION AND MOVEMENT
what is it?
CONSTROCHONDRITIS
ACUTE BREATHLESSNESS AND PLEURITIC CHEST PAIN BUT NORMAL BREATH SOUNDS - NO CRACKLES OR WHEEZING
PULMONARY EMBOLISM
POOLING OF BLOOD WITHIN ORGANS THAT CAUSE WORSENING ANAEMIA
ABDOMINAL PAIN AND PALPABLE MASS IN LEFT UPPER QUADRANT
SEQUESTRATION CRISIS
BONE MARROW IS NO LONGER ABLE TO MAKE ENOUGH NEW RED BLOOD CELLS.
SYMPTOMS OF FEVER, MALAISE, PALLOR, SOB, PALPITATIONS
APLASTIC CRISIS
TEST FOR DEVELOPMENTAL HIP DYSPLASIA
Barlow and ortolani tests
RISK FACTORS FOR DEVELOPMENTAL HIP DYSPLASIA
FEMALE, FIRST BORN AND CHILD AND BREECH PRESENTATION
WHAT DOES THE BARLOW AND ORTOLANI TEST INVOLVE?
BARLOW - attempt to dislocate the femoral head
ORTOLANI - attempt to relocate the femoral head
VESICULAR RASH ON PALMS, SOLES AND BUCCAL MUCOSA WITH FEVER
what is it and what causes it?
Hand-foot mouth disease
caused by: Coxsackie A virus
COXSACKIE B VIRUS CAUSES WHAT
myocarditis
TACHYPNOEA AND DISTRESS SHORTLY AFTER BIRTH AND HYPERINFLANTION OF LUNGS AND FLUID IN HORIZONTAL FISSURE
TRANSIENT TACHYPNOEA OF NEW BORN (TTN)
- generally resolves after first day and needs oxgen therapy
- caused due to delayed reabsorption of fluid in the lungs
- associated with c-sectionq
DEFICIENCY OF SURFACTANT IN PREMATURE NEONATES: RESPIRATORY DISRESS, TACHYPNOEA, GRUNTING AND CYANOSIS.
BECOMES MORE SEVERE AFTER BIRTH
NEONATAL RESPIRATORY DISTRESS SYDROME
- chest x ray shows glass lungs and bell shaped thorax
morbiliform reaction - what is it
common in patients with mononucleosis taking amoxicilin
circular rashes that are blister like that happen every time drug is taken
fixed drug reaction
rosea rash
rash followed after upper RTI
what are urticarial rash
hives
joint pain and fever
joint pain for over 6 weeks and pink rash in young child
what is it
juvenile idiopathic arthritis
what is juvenile idiopathic arthritis a complication of?
anterior uveitis
what does immune thrombocytopenic purport cause
rash all over the body
henlock Schonlein Purpura
symptoms
purpuric rash over buttocks and extensor surfaces
projectile vomiting after feeds
pyloric stenosis
test for this with ultrasound
perianal itching that is worse at night
thread worm
treat with mebendazole
coxsackie virus a16
what does it cause
fever, rash around mouth and ulcers on hands and feet
patient presents with sore throat and fever
has raised white cells and low platelets and blast cells
presentation: bruising, enalarged lymph nodes and fatigue
what is the most likely diagnosis
acute lymphocytic leukaemia - very common in children
potter syndrome
pressure in utero due to oligohydramnios
small baby
non-productive cough
not feeding well
high RR
high HR
low BP and low O2
what is the diagnosis
bronchiolitis due to RSV virus
when should babies pass meconium by?
24 hours after birth
concerning if not
what happens when baby does not pass meconium within 24 hours?
no stool
swelling in the abdo
bilious vomiting
- this means obstruction in the bowels
what is hirschspungs disease
within the GI tract the ganglionic layer in the intestinal walls which develops in the neural crest helps with the detection of stool
in this disease - there is a lack of the ganglionic cells so this part of the bowel doesn’t work
so stool cannot be passed
symptoms of hirschspungs disease
no meconium passed from baby in over 24 hours
swelling in the abdo
bilious vomiting
management of hirschspungs disease
surgical management
investigation for hirschspungs disease
investigation is done based on the part where the obstruction is
biopsy
where is the obstruction if stool comes out after doing rectal examination in hirschspungs disease?
there is a lack of ganglions in the rectum
why are antibiotics given to children before any procedure if they have ventricular septal defects?
to prevent the risk of them developing infective endocarditis
what is the prophylactic medication given for RSV virus
Palivizumab (Any monoclonal antibodies)
prevents children against bronchitis
what are the symptoms of RSV
very common in young children
runny nose
difficulty breathing
crepitations
cough
child is off feeds
autism presents as what in children?
social distancing
playing by themselves
not talking in full sentences
not making eye contact
cerebral palsy presents in children as?
stiffness
motor developmental delay
what is the more specific test for bacterial sepsis
procalcitonin
chicken pox produces what type of rashes?
maculopapular vesicular rashes which are very itchy
all over the face and body
presentation of measles
blanching
maculopapular rash all over the body
grey spots in the mouth
complications of measles found in developing countries
vitamin A deficiency
common complications of measles
Subacute sclerosing panencephalitis -
affects brain and degenerates it
causes loss of cognition and seizures
can affect person up to 10 years of measles infection
what is broncholitis obliterans
it is a condition which causes inflammation of the bronchioles
the airways become scarred which then causes them to narrow
what is the most common cause behind broncholitis obliterans
adenovirus
what is primary nocturnal enuresis
bed wetting as a child
what is given to children with nocturnal enuresis
prescribe desmopressin if child is over 7
if not then given enuresis alarm - this detects if there is water in the bed and alarm sets off - reminds child to go to the toilet
what is given if child has nocturnal enuresis and increased frequency of urination
oxybutynin
what is physiological jaundice
occurs in neonates because their livers are not fully developed so unable to convert unconjugated bilirubin to conjugated bilirubin
- this builds up in the blood and causes jaundice
management of physiological jaundice
it goes away in 7-10 days
found within 24 hours of birth
when baby is slightly jaundiced at birth but levels of bilirubin are in the normal range
what is pathological jaundice
jaundice caused by a particular external cause eg. haemolysis due to RH factor or O factor
this can cause a toxic buildup of unconjugated bilirubin
what are the complications of pathological jaundice
this can spread through the blood brain barrier and damage the brain
causes athetoid cerebral palsy in the long run
what is turners syndrome
XO karyotype condition
affects women
late menopause
small breasts
wide spaced nipples
what is slipped upper femoral epiphysis
weakness in the femoral growth plate
happens due to obesity and common in males
common cause of limping in adolescents
perthe’s disease - what is it
blood supply to the femoral head is blocked so the head of femur begins to die
weakened bone begins to break apart from the joint
when blood supply is restored - the hip joint heals - but in the duration when it didn’t receive blood, if it loses shape then it can cause stiffness and pain
what is meconium ileus
over 48 hour delay in passing stool after birth
and has features of bowel obstruction like bilious vomiting
what is seen on x-ray if baby has meconium ileus
‘bubbly’ appearance
what is Noonan syndrome
genetic condition that stops normal development in different parts of the body
developmental delays
short stature
heart defects
trisomy 18 is what condition
Edwards syndrome
XXY karyotype causes what condition?
Klinfelter’s syndrome
trisomy 13 causes what condtion
Patau syndrome
bronchiolitis vs bronchiolitis obliterans
broncholitis gets better by itself
broncholitis causes permanent narrowing of the airways
symptoms of broncholitis obliterans
dry cough
breathlessness
SOB
fever
wheeze
harsh breath sounds
crepitations
symptoms of perthes disease
limping
pain in the joint
difficulty rotating the leg
pain that is worse on movement
better on rest
typical presentation of slipped upper femoral epiphysis
knee pain
symptoms of Noonan syndrome
eyes - down slanting and droopy eyelids
ears - rotated backwards
face - appears droopy and expressionless
head - larger and low hairline
heart conditions caused due to Noonan syndrome
valve disorders - pulmonary valve stenosis
hypertrophic cardiomyopathy
ventricular septal defect
irregular heart rhythm
MSK symptoms of Noonan syndrome
wide set nipples
spine deformity
sunken sternum
short webbed neck
what is Edwards syndrome
affects growth in baby
happens when person has extra copy of chromosome 18
development defects
symptoms of Edwards syndrome
low set ears
reduced muscle tone
overlapping fingers eg. finger clubbing
small head
congenital heart diseases
renal failure
bowel wall defects
what is Klinefelter syndrome
boys are born with extra copy of X chromosome
affects testicules
lower testosterone
reduced facial hair
enlarged breast tissue
reduced fertility
signs and symptoms of Klinefelter syndrome
muscle weakness
delay in speaking
testicles haven’t descended to the scrotum
taller than normal
long legs, broad hips
small penis
difficulty in speaking/reading
what is Patau syndrome
physical disabilities
heart diseases
brain/spine abdnormalities
small, poorly developed eyes
extra fingers/toes
what is the foramen ovale
it is the opening between the left and right atrium
allows blood to flow from the left to the right atrium
fetal circulation cycle
- oxygenated blood from the placenta goes through the umbilical vein into the IVC
- it enters the right atrium
- it goes from the right atrium to the left atrium via the foramen ovale and into the aorta to the rest of the body
- the lungs are fluid filled so their resistance is high which stops blood circulation to the lungs
- deoxygenated blood goes to the internal iliac arteries and then umbilical artery and back to the placenta to get oxygenated
how does the foramen ovale close
when the baby takes the first breath - the lungs expand
- this causes decrease in resistence
- pressure in the right atrium then decreases
- pressure in the left atrium increases
this causes the foramen ovale to close
what is ventricular septal defect
most common congenital heart disease
- when there is a hole between the left and right ventricles
- the pressure is higher in the left than right so this is the way the blood flows
what is a small/medium/large ventricular septal defect
small - no consequences as only small amount of blood moves past the hole
medium - blood from left side will enter right and enter pulmonary circulation
this makes the left side of the heart bigger
large - blood goes from the left to right, causes pulmonary hypertension so then pressure on right side increases, blood moves back to left side
called - Eisenmengers syndrome
symptoms of eisenmengers syndrome
cyanosis and clubbing in the fingers
restrictive - loud pan systolic murmur
non-restrictive - pulmonary hypertension and heart failure and murmur is softer
what is an atrial septal defect
hole in the septum that separates the two
- blood flows from left atrium to right
- right side gets bigger
- causes breathlessness
- pulmonary pressure increases due to increased blood flow to right side
- causes murmur due to increased flow across the pulmonary valve
what is patent ductus arteriosus
the ductus arteriosus doesn’t close after birth
- happens to babies who are premature and maternal rubella
indomethacin - prostaglandin inhibitor is given - stimulates closure of the duct
grades of patent ductus arteriosus
silent - very small and no murmur
small - there is a murmur but no effects
moderate - loud murmur, displaced apex beat
large - murmur is silent as pressures have equalised
coarctation of the aorta
narrowing of the aorta
symptoms:
hypertension
headaches
nosebleeds
cold legs
examination
- weak and delayed pulse in the legs
BP in right arm is higher than left arm
why cannot live injections be given to children on chemotherapy
because the children will be immunosuppressed and so injecting a live vaccine in them will cause them to get severely ill
what is a Hickman line
the central line put inside for children who need their bloods taken, give drugs or chemo
always important to check this Hickman line as it can get infected
what are the common side effects of chemo therapy
anaemia
neutropenia
- high risk of getting an infection that can develop into sepsis
- so if a child comes in with fever and neutropenia then treat quickly
what is given to children with neutropenia
G-CSF to increase WBC count
what is the longterm ladder management for asthma
- preventers - corticosteroids and ICS like becthamethasone
- leukotine inhibitors - monterlukast
- LABA like salmetrol - has to be prescribed by specialists
what is reactive arthritis
arthritis that presents post infection
what is perthes disease
when there is a loss in the blood supply to the hip joint
- this causes some parts of the bone to get ischaemic and die
- this can change the shape of the bone a little bit
- this will mean that when the blood circulation is restored, the bone will not fit perfectly in the joint as it has changed shape
- this will cause difficulty and pain when moving
common in children (boys) aged 5-6 years
what is transient tenosynovitis
it is the most common cause of hip pain in children under 10
more common in right hip than left
can be due to trauma or infection
- may be post respiratory tract infection
- pain will be on the anterior aspect of the thigh
- inflammation of the synovial joint
what is osteomyelitis
infection of the bone
- can be due to bacterial infection
symptoms:
- fever
- swelling
- warmth and redness of the area
- fatigue
common in smokers
why are most neonates jaundiced when they are born
-physiological jaundice
- goes away after 2 weeks
- liver is too small to convert unconjugated bilirubin to conjugated bilirubin
- unconjugated bilirubin builds up
- bilirubin is the product of the death of haemoglobin - too high levels are toxic
- can cause brain damage in neonates
when to know if the jaundice in neonates is pathological and not physiological
test is done - if the level of bilirubin is higher than a threshold then it is suspected for pathological jaundice
what is pathological jaundice
when the high levels of bilirubin cannot be dealt by the liver
high levels of unconjugated bilirubin stays in the blood
- this happens due to higher levels of haemolysis - so higher number or RBCs are broken down
what are the two types of unconjugated hyperbilirubinea
immune and non immune
immune - eg. RH factor group incompatibility or ABO group
causes haemolytic of the babies blood - raises levels of unconjugated bilirubin
when are conjugated bilirubin levels raised?
when there is an issue with the liver
eg. Gamma-glutamyl Transferase is an enzyme in the liver that converts unconjugated bilirubin to conjugated
- this enzyme is defected in Gillberts syndrome and Angler Wajjar syndrome -
- this causes raised levels of conjugated bilirubin in the blood
what’s biliary atresia
congenital disease
- blockage in the bile ducts
- bile cannot flow from the liver into the bowel to be excreted
- so conjugated bilirubin accumulates in the liver
- do surgery to prolong life
- should be done in the first 8 weeks of life
what is breast milk jaundice
found in babies that are exclusively breast fed
there is an inhibitor in the milk that inhibits action of the Gamma-glutamyl Transferase - causes raised unconjugated bilirubin levels
what type of jaundice does cystic fibrosis cause
can cause unconjugated and conjugated jaundice
- mucus can build up and block the bile ducts
- but very likely to be picked up on in early age
- children will also have weight Loss, fatigue and failure to thrive
what is therapy is used in jaundice
phototherapy -
what are the symptoms of SLE in children
butterfly rash on the face
other systemic issues
malar rash
swelling
pain in joints
symptoms of juvenile idiopathic arthritis
rheumatoid arthritis that happens in children
salmon-pink rash
on the legs and knees
symptoms of chrondomalacia patellae
swelling of the patella but no systemic symptoms
osgood disease - what is it
similar to perthes but doesn’t cause weight loss or fever
Henoch-Schönlein Purpura
inflammatory disease of the small blood vessels
starts off with symptoms of: fever, rash on legs, abdo pain
- then red or purple spots start to appear on the skin
what is whooping cough
it is a bacterial infection caused by pertussis
it is the bacteria that is given a vaccine for in the DPT vaccine
- causes cough then inspiratory gasp
- runny nose
- fever
and cyanosis
use macrolide antibiotic - clarithromycin
doesn’t treat the infection - it reduces the chances of child passing it onto someone else
what is transposition of the great arteries
when the pulmonary artery and aorta are switched in places
deoxy blood from the body come to heart but then gets repumped back to the body
oxygenated blood comes from the lungs but goes back to the lungs
procedure done to correct this - atrial switch procedure
complication of the correction is - tricuspid regurgitation
what is Reyes syndrome
aspirin shouldn’t be given to children younger than 12 years
causes acute liver failure
raised bilirubin
INR is prolonged
raised lactate
raised creatinine
What is diphtheria
- highly infectious
- affects nose and throat
- rare in UK
- part of the DPT vaccine
symptoms:
- fever
- sore throat
- swollen cervical lymphs
- difficulty breathing
- thick grey-white coating that covers back of throat
can also cause blisters and ulcers on the legs, feet and hands
what is tetanus
survives for a long time outside the body
found in the soil or poo of animals
part of the DPT vaccine for children
can get infected by: cuts on skin, burns etc
symptoms:
stiffness of jaw muscles
muscle spasms
fever
sweating
tachycardia
what is Pertussis
part of the DPT vaccine
- whooping cough
chest infection - common in babies
symptoms:
runny nose
sore throat
between coughs children gasp for air
redness of face
can become cyanosed
polio in children
- given to children 3 times
at 12 weeks old, 3yrs4months and 14 years booster
spreads from contaminated poo
symptoms
- fever
- tiredness
- headaches
- vomiting
- muscle pain - in serious cases can cause paralysis
Haemophilus influenzae type b (Hib)
it can cause
meningitis
septicaemia
pneumonia
spread via nose and throat of healthy people
hepatitis B - vaccine given to children
infection of the liver
spread via bloods and bodily fluids
symptoms:
loss of appetite
being sick
diarrhoea
abdo pain
jaundice
MMR Vaccine
measles - cold like symptoms and red eyes, white spots in mouth, watery eyes, measles rash,
Mumps - causes swelling in the parotid gland, can cause swelling of testis and ovaries, deafness, fever, headache etc
Rubella - German measles - causes red/pink rash, swollen lymph nodes, fever, aching joints
rash - pink/red coloured
itchy
starts behind the ears then spreads to the head and neck
what is a moro reflex?
a startled reflex
baby’s response to a loud noise
they will tilt their head back and stretch out their legs and arms and maybe start to cry
- goes away after 3-6 months
rickets - what is it and what does it cause
it is vitamin D deficiency - caused due to reduced sun exposure in children - esp those who have coloured skin
children who are breast fed for a long time are also at risk as breast milk is not a good source of vitamin D
symptoms of this - bowed legs, wrist and ankle swelling, muscle weakness and delayed walking
scurvy - what is it and symptoms
causes bone pain and easy bruising
vitamin c deficiency
foetal alcohol syndrome
cause behind developmental delay
children will have developmental delay
will have delayed motor skills
poor coordination
difficulty in language and social skills
what is discoid eczema
eczema that has circular lesions
transient tachypnoea of the newborn
happens 2 hours after delivery
goes away after 72 hours
child will be breathless and have low O2 sats
what is tuberous sclerosis
genetic condition that causes benign tumours to develop in different parts of the body
can cause developmental delays
seizures
behavioural problems
what is third nerve palsy
when the eye looks down and out at rest
what is fourth nerve palsy
the eye cannot look down and inwards towards the midline
superior clique muscle is paralysed
patient may present with eye looking up and in at rest
head may be tilted to compensate for this
what is sixth nerve palsy
lateral rectus muscle is paralysed
eye cannot look away from the nose (abduct horizontally)
orbital cellulitis features
extreme case of pre septal cellulitis
painful eye movements
swollen eye lid
erythema
pre septal cellulitis features
swollen eye lid
erythema
mild fever
- visual impairment
- diplopia - double vision
- painful eye movements
retinitis pigmentosa
cause behind retinal degeneration
causes history of night blindness and reduced visual fields
what drops are used for acute angle closure glaucoma
pilocarpine - reduces intraocular pressure which causes closure of the eye ball
nephroblastoma - what is it
Wilm’s tumour
embryonic tumour that is found in the kidneys
most common abdo mass in children
causes symptoms of
- haematuria
- hypertension
-fever - abdo mass
the pertussis virus can cause?
whooping cough
grunting is a sign of?
respiratory distress in babies
neonatal respiratory distress syndrome
common in premature babies
- due to not enough pneumocystis - so not enough surfactant is produced
- there is not enough surfactant in the plural space
- this increases surface tension
- so the alveoli cannot expand properly
- can cause the lungs to collapse
- give artificial surfactant
coxsackie virus causes what disease?
hand, foot and mouth disease
what is juvenile idipathic arthritis
rheumatoid arthritis in young children
- gradual onset
- morning stiffness
no systemic symptoms
pain in the joints
symptoms of patent ductus arteriosis
baby will have a collapsing pulse
machine like murmur
bradycardia
episodes of when they stop breathing
what medication can be given to help in patent ductus arteriosis
indomethacin - it causes vasoconstriction which causes the duct to close
what is intestinal malrotation
is when during the foetal development, the mid gut rotates and blocks off the blood supply
- this causes a ‘corkscrew’ appearance on the Xray
- it also is a big cause behind bilious green vominting
- it is managed by a surgical procedure (Ladd bands)
jejunal atresia
causes bilious vomiting in newborn babies
abdominal distension
but on X ray - looks like a ‘triple bubble’
duodenal atresia
bilious vomiting in babies
abdo distension
X ray appearance - ‘double bubble’
meconium ileus
when the large intestine is blocked due to the meconium being really thick - can be due to mucus
this causes a ‘bubbly’ looking Xray
most common congenital heart defect in neonates with diabetic mothers?
transposition of the great arteries
diagnostic test for CF
sweat test - 2 electrodes on skin which causes sweating, the sweat is analysed for sodium chloride which is high in CF
the transmembrane protein transports sodium chloride, and water
if there is dysfunction in this then sodium chloride levels increase
children with CF ‘taste salty’
it causes respiratory and pancreatic secretions to become thick so this causes obstruction
what is meckels diverticulum
most common congenital abnormality of the intestine
it is a bulging left over of the umbilical cord
the vitelline duct does not close properly in the 5th week of feral development leaving this pouch behind
- common presentation is GI bleeding
antibodies for coeliac disease
anti TTG antibodies
small bowel biopsy for young children
Kawasaki disease - what is it
affects coronary arteries
it can cause aneurysm development
do echocardiogram
nocturnal enuresis - what factors affect It
bladder capacity
ability to wake up and use toilet
amount of urine that is being produced
pathology behind nocturnal enuresis
ASH increases at night so more water is retained
which is why urine is dark in the morning and concentrated
this is nocturnal ADH secretion
this is not fully developed in children
which is why desmopressin is given as a treatment for children who are bed wetting
factors that increase incontinence chances
bladder capacity - it is reduced in children but improves with age
caffeine irritates the bladder
UTI - Inflammation of the bladder so it is more irritated
what is given in overactive bladder
urge incontinence
oxybutynin
coarctation of the aorta
it is a congenital narrowing of the aorta
it causes a systolic murmur heard at the scapula
and also radio-femoral delay
babies with turners syndrome also have coarctation of the aorta
Vesicouretric reflux - what is it
when the urine travels back up the ureters due the valves not working properly
this can cause recurrent UTIS
- needs surgery
presentation of GORD in babies
recurrent vomiting
chronic cough
and slow growth
this is due to the oesophageal spincter growing slowly in premature babies which can cause reflux
when should babies start walking
18months
what is intussusception
it is when a part of the bowel collapses in itself making a telescope like shape
it causes jelly stools and a sausage mass in the abdomen
abdo discomfort
baby is in a lot of pain and holds legs up
do lapratomy
what is benign Rolandic epilepsy
it is a type of epilepsy that is common in children 3-13 years
- they generally outgrow it after puberty
- have seizures in the night
- CENTOTEMPORAL SPIKES ON EEG
what is benign Rolandic epilepsy
it is a type of epilepsy that is common in children 3-13 years
- they generally outgrow it after puberty
- have seizures in the night
- CENTOTEMPORAL SPIKES ON EEG
eye condition in premature babies due to prematurity
prematurity that requires the administer of foetal oxygen is a risk for premature retinopathy
due to abnormal and uncontrolled development of blood vessels in the eye
What sort of symptoms does a ventricular septal defect
Ventricular septal defect a lot left lower standard edge, harsh pansystolic murmur.
Will be Heard which will cover the whole systole and will extend from the first and second hearts down and children present with failure to thrive
- if left untreated - can cause pul. hypertension as shunting will start happening r-l
eisenmengers syndrome
What symptoms are seen in mitral stenosis
Mid diastolic murmer
I would generally be a history of rheumatic fever in the child
What are the features of a patent ductus arteriosus?
It will present with a machine like Mama, which is continuous at the left upper sternal edge
This is due to a left right shunting of blood so more blood is going to the lungs increased risk of respiratory tract infections and also left sided. Hypertrophy children would present with failure to thrive.
What are the features of aortic septal defect?
It is a acyanotic, congenital heart condition
Blood will be chanting from left to right or starts with normal. More blood will be going to the right side which would create an ejection systolic murmur in the pulmonary area. Generally will not be heard in the beginning but as the symptoms get worse, you can start to hear it.
In this condition, more oxygenated blood is entering back into the Pulmonary system and deoxygenated blood and up, going back through the body
What are the acyanotic congenital heart defect?
Ventricle septal defect, patent, ductus arteriosus, and atrial septal defect
What are the cyanotic congenital heart defect?
Transposition of the great arteries and tetralogy of fallout
What is tetralogy of fallot characterised by
ventricular septal defect, overriding aorta, pulmonary stenosis and right ventricular hypertrophy.
What are the features in transposition of the great arteries
In this condition, the right artery and right ventricle are connected to the aorta and the left artery and a ventricle and connect to the pulmonary artery.
So in this case, the right side which has deoxygenated blood pumps blood through the aorta into the systemic circulation
oxygenated blood which comes from the left side of the heart, is connected to the pulmonary artery and goes into the pulmonary circulation
In this case, the baby will be very cyanotic as no oxygen will be reaching the body
In this case, the only way the baby can survive is, if they had a ASD VSD or a PDA. This will allow the mixing of oxygenated blood into the systemic circulation. If this is not there, then the baby can die.
What is the immediate management used for transposition of the great arteries
Step one is to give prostaglandin that will allow the doctors arteriosus to remain open and this will allow the mixing of the blood
In any normal situation, the doctors arteriosus stays open for 24 to 48 hours after birth and then closes, but giving prostaglandin will allow this to remain open
The doctors arteriosus closes due to the drop in prostaglandin after birth
Step two is to do an atrial septostomy, so make a hole in the heart to allow the mixing of blood
then the switching operation is done
What are the features of tetralogy of fallot
There is pulmonary stenosis in which the pulmonary artery is more narrow. This obstruction means that less blood enters the pulmonary circulation. This makes the right side bigger because it has to work harder.
- due to the right ventricular hypertrophy, there is increase pressure on the side of the heart. This causes the shunting to be from right to left
This is the VSD, and due to the overriding aorta it means that deoxygenated blood passes the lungs and goes from the right ventricle into the left ventricle, and then into the water, and then into the systemic circulation. So deoxygenated blood gets passed around the body.
What are some of the symptoms of tetralogy of fallot seen in children?
Children present with cyanotic spells in which the left ventricle goes into spasm.
loud murmur heard on upper sternal edge
hypoxic and cyanotic
baby goes blue
The way to manage this is giving morphine to reduce the heart rate and blood pressure
Phenylephiline - This increases systemic pressure and causes the shunt to reverse and go from right to left
to left -> right
management of impetigo
topicsl hydrogen peroxide cream
fusicidic acid
send to school after 48 hours off starting sntibiotics
or after crusting over
lice symptoms
itchy neck and rash
pediculuous capitis
mgt - wet combing
insecticide dimethicone gel - can be used in pregnant
mathalion aqueous liquid
how to refain from school in chicken pox
until lesions have crusted over
chicken pox appearance
starts with fever then rash
starts at the head then spreads over the body
causative organism of measles
parxmyovirus
most common complication of measles
otitis media, pneumonia and encephalitis
feature of mumps
swelling on the face
and can also sometimes get epiorchitis - swelling of the testes
supportable management
complication is pancreatitis
features of rubella
also known as German measles
rash that spares the limbs
togavirus
headache
low grade fever
spotty and red all over rash - forcheimer spots on the soft pallet of the mouth
complications of rubella
serious risk to pregnant women - in first 20 weeks
can cause cataracts, ductus arteriosus and Brian damage
can’t give mmr vaccine to pregnant women
molluscum contagiosa features
small dome shaped pupils with a central umbilication
pearly coloured
itchy
painless
contagious
- generally clears after a few months
roseola infantam features
really high fever
after fever suddenly the rash appaers
maculopapapular rash
blanching
starts on the trunk and spreads outwards
human herpes virus 6
supportive management
slapped check syndrome features
parvovirus
fever
diarrhoea
slapped cheeks
can cause aplastic crisis - aneamia in children
contagious until rash appears
scarlet fever features
strep progenes
swollen tonsils
sandpaper rash
strawberry tongue - white coating on the red tongue
sore throat
headache and fever
management of scarlet fever
throat swab
oral penicillin for 10 days
can return to school 24 hours after antiobtics have been started
Wilms nephroblastoma
buzz words ‘ painless palpable lump in the RUQ of abdo’
common in children under 5
refer in 48 hours
spreads quickly
new lump in the abdo
what is the most common kidney cancer in children
wilms tumour - very common in children under 5
investigation of intussecpition
- ultrasound
intussecpition features
the colon folds in on it self
severe abdo pain
sausage shaped mass in RUQ pain
red current stool
children draw up legs
targets seen in the ultrasound
management of intussuception
air enema - pass air through the bowel
most common cause of bowel obstruction in children
necrotising enterocolitis features
- premature infants
- necrosis of the bowel
gas within the bowel wall
intolerance to feeds
x-ray shows:
dilated bowel loops and within the bowel wall
air in the bowel and biliary tree
what is hirchsprungs disease
delaying in passing of the meconium (24hours)
chronic constipation
the end section of the bowel is not innervated so there is delay in passing of meconium
- baby passes poo after sticking finger up the anus
- associated with Down syndrome
management of hirchsprungs disease
renal biopsy is gold standard
rectal washouts,
or do surgery
volvulus sign on x ray
coffee bean sign
abdominal migraine
abdo pain lasting an hour but everything else is normal
mesenteric adenitis features
can mimic appendicitis
- rebound tenderness and very painful
no fever or other systemic upset
follows recent viral infection
enlarged mesenteric lymph nodes but normal appendix
appendicitis in children features
pain
very very painful
nausea and vomiting
fever will be there
very rigid abdo
jaundice presentation before 24 hours
always pathological
G6PD deficiency
haemolytic anaemia
jaundice presentation after 24 hours
often normal - physiological jaundice due to the liver
common in breast fed babies
jaundice presentation after 14 days
do further investigation :
hypothyroidism
biliary atresia
UTI
congenital infections
or autoimmune haemolytic anaemia
Gilberts sydrome
presentation of jaundice in older children (teens)
generally during stressful times
pyloric stenosis features
ABG - metabolic alkalosis
projectile vomiting
poor feeding
failure to thrive
olive shaped mass in the epigastric region
poor weight gain
pyloric stenosis investigation
ultrasound of abdo
management of pyloric stenosis
laparoscopic pyloromyotomy
GORD in babies features
vomiting after larger feeds
milky
due to over feeding
after being laid flat
crying while feeding
side effects of PPIS in babies
high sodium in gaviscon can cause vomiting and constipation
nocturnal enuresis - management
- enuresis alarm and reduced fluid intake before bed
- desmopressin (short term control)
