Paediatrics Flashcards
What are the Developmental milestones of gross motor?
3 mths - neck holding
5 mths - rolls over
6 mths - sits in tripod fashion (sitting w own support)
8 mths - sitting w/o support
9 mths - stands holding on (w support)
12 mths - creeps well; walks but falls; stands without supports
15 mths - walks alone; creeps upstairs
18 mths - runs; explores drawers
2 yrs - walks up & downstairs (2 feet/steps); jumps
3 yrs - rides tricycle; alternate feet going upstairs
4 yrs - hops on one foot
What are the components of TOF?
Ventricular septal defect
Right ventricular hypertrophy
Pulmonary stenosis
Overriding of aorta
What are the surface markings of liver?
Upper border: 4th ICS in midclavicular line
Lower border: 9th ICS in midclavicular line
Lateral border: 6th rib in midaxillary line
What are the functions of liver?
Synthetic: albumin, gluconeogenesis, coagulation factors and protein C, S and antithtombin
Metabolism: sugar, fat & protein
Excretion: bilirubin
Detoxification: drugs and hormones (estrogen)
Storage: Vitamin A (lasts for 6 mths), vitamin B12, glycogen reservoir, iron and copper
Secretory: bile - for absorption of fats
Protective: reticuloendothelial system helps in destruction of bacteria
Miscellaneous: produces heat
What are the indications of splenectomy?
S: splenic abscess, massive splenomegaly
H: hypersplenism, hemolytic anemia
I: idiopathic thrombocytopenic purpura (chronic)
R: rupture of spleen: trauma
T: thrombosis of splenic vein - extrahepatic portal HTN
S: staging laparotomy in Hodgkin disease & lymphoreticular malignanciea
What are the functions of spleen?
• Reservoir for platelets, factor VIII, monocytes, erythrocytes & leucocytes
• Hematopoiesis in fetus
• repair & destruction of RBCs (Graveyard of RBCs)
• Immune functions: produces IgM, properdin and tuftsin. Macrophages in seen help in phagocytosis
What are the indications of femoral vein cannulation/ femoral line?
• Secure or long-term venous access that is not available using other sites
• Inability to obtain peripheral venous access or intraosseous infusion
• IV infusion of fluids and drugs for patients in cardiac arrest
• IV infusion of concentrated or irritating fluids
• IV infusion of high flows or large fluid volumes if placement of large-bore (eg, 18 or 16 gauge) peripheral venous catheters or other CVCs is not feasible
• Hemodialysis or plasmapheresis
• Transvenous cardiac pacing (see video How to Insert a Transvenous Pacemaker) or pulmonary arterial monitoring (Swan-Ganz catheter)*
• Placement of inferior vena cava filter
• Need for central venous access in patients with superior vena cava syndrome
Contraindications of femoral line?
Absolute C/I:
• Intra-abdominal hemorrhage or regional trauma
• Femoral vein thrombosis
• Local infection at the insertion site
• Antibiotic-impregnated catheter in an allergic patient
Relative C/I:
• Coagulopathy, including therapeutic anticoagulation*
• Local anatomic distortion (traumatic or congenital), or gross obesity
• History of prior catheterization of the intended central vein
• Uncooperative patient (should be sedated if necessary)
• Ambulatory patient
Differentiate between simple and complex febrile seizures
Simple febrile seizures:
- Primary generalized
- Usually tonic-clonic attack associated with fever
- Seizure lasts for max of 15 mins
- No recurrence within 24 hrs
Complex febrile seizures:
- Focal
- More prolonged (> 15 mins)
- Reoccur within 24 hrs
What are the symptoms of febrile seizures?
- body stiffness
- limbs twitching, shaking and jerking
- loss of consciousness
- vomiting or urinate during seizure
- frothing at mouth
- irregular breathing
- moan or cry
What are the risk factors for recurrence of seizures?
Major:
- Age < 1 year
- Duration of fever < 24 hrs
- Fever 38-39C (100.4-102.2F)
Minor:
- Family h/o febrile seizures
- Family h/o epilepsy
- Complex febrile seizure
- Daycare
- Male gender
- Lower serum sodium at time of presentation
What is acute flaccid paralysis?
Clinical syndrome characterized by rapid onset of weakness progressing to maximum severity within several days to weeks
Flaccid = absence of spasticity or other upper motor neurons
What are the common causes of acute flaccid paralysis?
- Guillain-Barre Syndrome
- Poliomyelitis
- Transverse myelitis
- Traumatic neuritis
What is Landry Guillain-Barre Syndrome?
- Known as acute inflammatory demyelinating polyradiculoneuropathy. Due to hypersensitivity, there is immunological reaction directed against the myelin sheath of the peripheral nerves.
- Post-infective disease causing generalized paralysis and areflexia
- Involves spinal root, peripheral nerve and occasionally cranial nerve
What are the predisposing factors of Guillain Barre Syndrome?
- Infections (Epstein Barr virus, measles, mumps, rubella, varicella, Hepatitis A and B, bacterial infections like Campylobacter jejuni)
- SLE
- Hodgkin disease
- sarcoidosis
- immunosuppression
- rabies vaccine
What is cerebral palsy?
- brain damage that causes loss of muscle control
- a neurodevelopmental disease; poor development or a part of the brain
Congenital non-progressive disorder (doesn’t get worse over time) of posture and movements often associated with movements and epilepsy and abnormalities of speech, vision and intellect.
Results from a defect or lesion of the developing brain (abnormal brain development, often before birth)
What are the causes of cerebral palsy?
Prenatal causes:
- infection
- hypoxia
- metabolic
- toxic
- genetic: chromosomal abnormalities
- cerebral infarction
- drugs: teratogenic
- anomalies of brain
Natal causes:
- hypoxia
- birth trauma of brain
- low birth weight and prematurity
Postnatal causes:
- Infections
- Toxins
- Head trauma
- Metabolic: hypoglycemia (causes brain fuel deprivation), hyperbilirubinemia (high bilirubin can cross the blood brain barrier and damage the brain and spinal cord)
What are the clinical features of cerebral palsy?
- Delayed motor and mental milestones
- Abnormal reflexes: persistence of primitive reflexes, failure to develop maturational/postural responses
- Abnormal muscle tone (hypertonic/hypotonic)
- Abnormal movements/seizures
- Definite hand preference before 1 year (hemiplegia)
- Skeletal deformities and joint contractures (secondary to spastic muscles)
- Growth disturbances
- Gait abnormalities
- Problems with posture, balance, coordination, walking, speech, hearing, vision, swallowing, bowel and bladder
What are the types of cerebral palsy?
a) Spastic CP
- most common
- tightness/stiffness of muscles resulting from a lesion in the upper motor neuron. The ability of some of these neurons to receive GABA (inhibitory neurotransmitter) impaired > neurons are overexcited > hypertonia (abnormal increase in muscle activity)
- Pt can have Windswept deformities (abduction and external rotation of one hip with adduction and internal rotation of another hip)
- Other features: hip dislocation, pelvic tilt, scoliosis and rib deformities, muscle shortening, dystonic posture, abnormal limb growth and contractures
- Associated clinical features: feeding difficulty, constipation, reflex esophagitis
b) Dyskinetic CP
- damage/injury to basal ganglia (role: initiate and prevent movements) > unable to prevent movements > involuntary extrapyramidal movements
- Child is hypotonic at birth
- At 1-3 yrs of age: abnormal movements patterns emerge (dystonia - random, slow, uncontrolled movements in limbs/trunk, chorea - random, dance-like movements, athetosis & choreoathetosis)
c) Ataxic (without order)
- damage to cerebellum (helps with coordination and fine movements) and the adjacent brainstem
Clinical features:
hypotonia in all 4 limbs
intellectual impairement
intention tremors (your hands start shaking when you reach for something)
reflexes: decreased/absent
gait: Wide-based gait
cerebellar signs: gross incoordination, impaired writing skills, dysmetria (lack of ability to judge distances correctly), hypotonia, ataxic gait, nystagmus is rare
d) Hypotonic/Atonic CP
- Rare. Lesion may be in frontal lobe and basal ganglia
- Occurs in early gestational period or soon after birth due to asphyxia neonatarum
Characteristic features:
- Hypotonia generalized o limited to lower limbs
- Hyperreflexia: Deep tendon reflex exaggerated
- Severe mental defect
- Forester’s sign: when lift the child by holding axilla, there will be flexion of hips. Later they will develop dystonia or spasticity
e) Dystonic CP
- abnormalities of posture movements
- trunk and proximal limbs are affected
- slow and persistent movement
- abnormal movements involving head and neck
f) Mixed CP
- Both pyramidal & extrapyramidal types
- Features of spasticity and choreoathetosis often coexist along with ataxic movements
What are the phases of dyskinetic CP?
Hypotonic phase: at birth
Dystonic phase: by 4 mths of life; no head control persistence of primitive reflexes, mass movements, sluggish tendon jerks)
Stage of involuntary movements: 1-3 years
What are the investigations to be done for cerebral palsy?
To rule out other disorders:
- urine screening test
- TORCH
- EEG
- CT scan of brain
- MIR
- nerve biopsy
- X-Ray spine
- X-Ray skull
- Myelogram
- Genetic evaluation: chromosome analysis
- Metabolic work-up: to rule out inborn errors of metabolism
- EMG
Diagnostic tests:
- Hip radiographs
- MRI/CT scan of brain
- Gait analysis
- EMG (electromyography)
What are the causes of uniform abdominal distension?
Fluid: ascites
Flatus
Fetus: pregnancy
Fat: obesity
Feces: intestinal obstruction
What are the causes of localized abdominal distention?
Localized ascites
Large bowel obstruction
Cyst (ovarian or peritoneal)
Tumors (kidney masses, neuroblastoma)
Fetus in early pregnancy
Lower abdomen: distended bladder
Upper abdomen: organomegaly (liver or spleen)
What is the normal bowel sound frequency?
Small bowel (10-15 per min)
Large bowel (3-5 per min)
What are the conditions in which there is increased/decreased bowel sound frequency?
Increased:
Intestinal obstruction
Hyperthyroidism
Diarrhea
Decreased/absent:
Peritonitis
Hypokalemia
Paralytic ileus
What are the grades of hepatomegaly?
Mild (<4 cm below the right subcostal margin)
Moderate (5-7 cm below the right subcostal margin)
Massive (>7 cm below the right subcostal margin)
