Paediatrics Flashcards
Name the 3 foetal shunts
Ductus venosus –> Ligamentum venosum
Ductus arteriosus –> Ligamentum arteriosus
Foramen ovale –> Fossa ovalis
Name 5 features of an innocent murmur
Soft
Systolic
L Sternal edge
Silent
Asx
What are the required imaging investigations for a murmur
ECG
CXR
Echo
Differentials for an ejection systolic murmur
Aortic stenosis
Pulmonary stenosis
Differentials for a pansystolic murmur
Mitral regurgitation
Tricuspid regurgitation
VSD
What is the murmur of PDA and what is it associated with
Continuous machinery like murmur - beneath left clavicle
Prematurity
Maternal rubella
What is eissenmenger syndrome
Transformation of L–>R shunt to R–>L shunt due to increase in pulmonary pressure
What are the signs and symptoms of heart failure
SOB - On feeding and exertion
FTT
Sweating
Poor feeding
Recurrent infections
Poor weight gain
Cool peripheries
Hepatomegaly
What are patients with a VSD at risk of
Infective endocarditis - Abx provided during surgical procedures
What condition is associated with co-arctation of the aorta
Turners
What murmur is associated with co-arctation
Systolic murmur - radiation to the back below the left scapula
What are the key features of eissenmenger sydnrome on presentation
Cyanosis
Plethoric complexion - polycythaemia
Increased risk of VTE
SOB
Clubbing
Name 4 RF for TOF
Diabetic mother
Alcohol consumption in pregnancy
Increased maternal age
Rubella infection
Downs syndrome
Name 3 triggers for tet spells in ToF and why these occur
Temporary worsening of R–>L shunt due to an increase in pulmonary resistance or decreased systemic resistance
Crying
Exercise
Breastfeeding
Mx - squatting
What is ebsteins anomaly
The tricuspid valve is lower set - a larger atrium and smaller ventricle
L –> R shunt - cyanotic
What is ebsteins anomaly associated with
Lithium use
Wolf parkisnons white
What is rheumatic fever
AI - Type 2 hypersensitivity to previous infection with Strep pyogenes - typically Pharyngitis
Occurs 2-4 weeks post-infection
What is the criteria for diagnosing rheumatic fever
Evidence of recent strp infection
- Hx scarlet feer
- Positive throat swab growing GABHS
- Rising anti-streptolysin O titres
+
2 major or 1 major + 2 minor criteria
Outline the major jones criteria for rheumatic fever
JONES
J - Migratory polyarhtiritis
O - Myocarditis
N - SC nodules - Firm mobile painless lesions
E - Erythema marginatum
Red rash with diffuse clear centre
S - Sydenhams chorea
Outline the minor criteria of rheumatic fever
C - CRP / ESR
A - Arthralgia
F - Fever
E - Elongated PR
What is the management of rheumatic fever
Clear GABHS
- IV BenPen
- 10 d ay course of Pen V
Analgesia
- NSAIDs
What valve defects are assosciated with Rheumatic fever
Mitral stenosis
Mitral regurgitation
What are the clinical features of Tonsillitis
Sore throat
Pain on swallowing
Red, Inflammed and enlarged tonsills
Fever
Lymphadenopathy
Referred ear pain
What are the clinical features of a Quinsy
Trismus - unable to open mouth
Uvula deviation
Voice changes - Hot potato
Name 3 organisms that causes tonsillitis
1 - Strep pyogenes
2 - Strep pneumonia
3 - Staph aureus
What are the clinical features of Otitis media
Fever
Ear pain
Reduced hearing
Coryzal sx
Cough
Sore throat
What is seen on otoscopy - Otitis media
Red inflamed TM
Bulging
Loss of light reflex
Name 4 reasons to prescribe Abx in Otitis media
Perforation
< 2 years old and bilateral
Immunocompromised
Systemically unwell
Co-morbidities
<3m old
4 days of sx with no improvement
Name 4 complications of otitis media
Facial nerve palsy
Glue ear
Meningitis
Labyrinthitis
Mastoiditis
- Post auricular swelling pushing ear forwards and outwards
What is seen on Otoscopy of Otitis media with effusion
Dull and retracted TM
Air bubbles
Visible fluid level
Name 4 RF for undescended testes
Prematurity
AIS
SGA
Low birth weight
FHx
Undescended testis management
Unilateral - Refer by 3m and seen by urological surgeon by 6m
Bilateral - Immediate referral to pediatrician for karyotyping
Risks of undescended testis
infertility
torsion
cancer
What are the sx of testicular torsion
Acute onset and unilateral
red
hot
tender
N+V
Define testicular torsion
Twisting os spermatic cord resulting in ischaemia and necrosis
Name 4 signs of testicular torsion
Absence of cremaster reflex
-ve Phrens sign
elevation of testicle does not ease pain
High riding testicle
What is screened for in the newborn screening test
CF
Hypothyroidsm
Sickle cell
Phenyketonuria
Homocystinuria
Name 4 features of congenitla hypothyroidism
macroglossia
hypotonia
slow growth and development
FTT
Poor feeding
Prolonged neonatal jaundice
Name 4 features of CAH - severe
Skin hyperpigmentation
Ambiguous genitalia + Enlarged clitorous
Tall for age
Female
Facial hair
Absent periods
Deep voice
Early puberty
Male
Deep voice
Large penis
Small testis
Early puberty
Give 3 biochemical features of CAH
hyponatraemia
Hyperkalaemia
Hypoglycaemia
Metabolic acidosis
What is androgen insensitivity syndrome
X linked recessive condition due to end-organ resistance to testosterone causing 46XY to have female phenotype
Name 3 features of Androgen insensitivity
Priamry amenorrhoea
No axillary or pubic hair
Undescended testis
Breast development - testosterone converted to oestrogen
What ins the investigation for Androgen insensitvitiy
Buccal smear or chromosomal analysis
high testosterone - post-puberty
managemnt of androgen insensitivity
Counseling - raise as female
Bilateral orchidectomy
Oestrogen therapy
What is DDH
Structural abnormality of the hip leading to instability and tendency for dislocation
Name 4 RF for DDH
Female
Firstborn
Twins
Oligohydramnios
Breech
FHx
How does DDH present
Limp / Abnormal gait
Asymmetry in skin folds
Leg length discrepancy - Galleaze sign
Limited hip abduction
Clunking of hips
What is ortalani test
Dislocate anteriorly
What is Barlows test
Dislocate posteriorly
What is the investigation for DDH
< 4.5 months –> USS
> 4.5 months –> X ray
What is the management of DDH
< 6 months - Pavlik harness
> 6 months - surgery
What is transient synovitis and who is it common in
transient irritation and inflammation of synovial membrane of the joint - NO FEVER
Males aged 3-10
following Virla URTI 1-2 weeks prior
How does transient synovitits present
Low grade fever
Limp
refusal to weight bear
Pain in extremities of movement - internal rotation
How is transient synovitis managed
Resolves in 7 days - analgesia if symptomatic
Waht is Perthes disease and who does it commonly affect
Avascualr necrosis of femoral head
Children aged: 4 - 12 but more common in 5 - 8
How does Perthe’s disease present
Pain in Hip / Knee - worse on activity and releived by rest
Restricted ROM
No hx of trauma
How is perthe’s disease investigated
Bloods - normal
X - ray - Widening of joint space and increased femoral head density
How is Perthes disease managed
Moderate OR <6y/o - Observe
Physio
bed rest
analgesia
severe OR >6y/o - Surgery
What is the main complication of Perthes disease
Premature fusion of growth plates
Soft and deformed femoral head - OA of hip
What is Slippe dupper femoral epiphysis
Head of femur is displaced along the growth plate
more common in boys
8 - 15
Obese
How does SUFE present
Pt undergoing growth spurt
Pain - Hip / Knee / Thigh
Restriced ROM - Internal rotation
Painful limp
Hx of minor trauma
Trendelenburgs positive
How is SUFE managed
Surgery - internal fixation
Who is offered routine screening for DDH
1st degree relative of hip issues in early life
Breech at or after 36 weeks
Multiple pregnancy
Name 3 common bacteria causing septic arthiritis
Straph aureus - children
Strep pyogenes - neonates
Haemophilus influenza
Neisseria gonorrhea - teenagers
How does septic arthritis present
Red
hot
swollen joint
fever
Restricted ROM
Systemically unwell
What investigations are required for septic arthiritis
Joint aspiration - MC&S / Gram staining / crystal microscopy
Blood cultures
Bloods
What is osgood-schalatters disease and how doe sit present
Inflammation at the tibial tuberosity where the patella ligament inserts
palpable lump at the tibial tuberosity
pain in anterior aspect of knee
pain worse on activity / kneeling / extension
What is rickets / osteomalacia
defective bone mineralisation causing soft and deformed bone
Name 3 red flags for hip pain in a child
child < 3 years old
fever
waking up at night
weight loss
anorexia
night sweats
fatigue
persistent pain
stiffness in morning
swollen or red joint
What is JIA
AI mediated Joint pain and swelling in a patient < 16 for more than 6 weeks
What are the main features of JIA
Joint pain / swelling / stiffness / deformity
Outline the key features of systemic JIA
Salmon pink rash
fevers
lymphadenopathy
weight loss
splenomegaly
pericarditis
ANA + RF - NEGATIVE
ANAEMIA
Outline the management of JIA
NSAIDs
Steroids
DMARDS - MXT / Sulfasalazine
Biologics
What is a Wilms tumour and how does it present
Tumour of kidney - <5y/o
Abdominal pain
Abdominal mass
Painless haematuria
WL
Fever
What is reflux
Involuntary passage of gastric contents up into oesophagus due to relaxation of LOS
RF for GORD
Prematurity
Neurological disorder - cerebral palsy
What are the clinical features of GORD in a child
Vomiting / regurgitation
arching of the back or neck
distressed after feeding
excessive crying
chronic cough
FTT
What is the management of GORD
C -
Positioining after feeds / burping after feeds
Ensure not being overfed
smaller more frequent meals
M
- Bottle fed - thickened formula
- Breastfed - Gaviscon
- PPI
S
- Fundoplication
What are the key features of mesenteric adenitis
Inflammed abdominal LN
Fever
Diffuse abdominal pain
Hx URTI / Tonsillitis
What are the key features of Meckel’s diverticulum and how is it investigated
GI bleeding
Abdominal pain - RLQ
Intestinal obstruction: Volvulus / Intusussception
Technetium scan
What is intusussception
Invagination of bowel into itself - common at ileo-caecal region
more common in boys
3m - 2 years
Name 4 assosciations of intususception
Viral URTI
HSP
CF
Meckels diverticulum
How does Intususception present
severe colicky abdominal pain
pallor around mouth
screaming and drawing legs up
vomiting - bile
red current jelly stool
absolute constipation
Exam findings of intususception
RUQ mass
Abdominal distension
What is the investigation of choice for intusesception
USS - Target mass
Name 4 causes of intestinal obstruction
Meconium ileus
Hirshprung disease
duodenal atresia
intususcpetion
malrotation with volvulus
strangulated hernia
Investigations for volvulus
X - Ray
Contract CT
What is malrotation and what is it associated with
congenital anomaly in rotation of midgut
Assosc: Exomphalmos / Congenital diaphragmatic hernia
How does malrotation present
1st days of life - 3-7
- bilious vomiting
- abdo pain
- tenderness
Investigation for malrotation
Upper GI contrast study - corckscrew
Criteria for IBS diagnosis
Abdominal pain or discomfort that is relieved by defecation OR associated with altered bowel habits/stool form
AND at least 2 or
- altered stool passage (straining / urgency)
- bloating
- sx worse with eating
- passage of mucus
Investigations for IBS
Coeliac serology
FBC
CRP
ESR
Faecal calprotectin
Features of cows milk protein allergy and management
Bloating
abdominal pain
D+V
Urticarial rash
Angiooedema
Wheeze
coughing
crying / irritability
IgE mediated
Formula - hydrolysed formula
breastfed - mum avoids dairy
What is biliary atresia
Bile ducts become fibrosed and destroyed leading to conjuagted hyperbilirubinemia
Investigations for biliary atresia
Serum bilirubin
USS
Cholangiography
Outline features of an Omphalacele
Hernaition of abdominal contents covered by peritoneum
Antenatal USS
Raised AFP
Outline features of Gastroschisis
Paraumbilical defect - R of umbilicus
Staged corrective surgery
TPN slowly introduced
Outline features of duodenal atresia
- assosciations
- sx
- Ix
Down syndrome
Polyhydrmanios
Bilious vomiting
SBO - absolute constipation + no air pasage
X ray: Double bubble
Whar is coeliac disease
AI condition where exposure to gluten causes an immune reaction with inflammation in the small intestine
What part of the small bowel is most affected by coeliac disease
Jejunum
Give 3 RF for coeliac
Downs
T1DM
FHx
Thyroid
Give 3 clinical features of coeliac
weight loss
faltering growth
diarrhea
flatulence
steatorrhoea
abdominal pain
bloating
mouth ulcers
anaemia - pallor
dermatitis hepatiformis - itchy blistering rash
N+V
short stature and wasted buttocks - malnutrition
Investigations for coeliac
Stool sample - exclude infection
Blood
- IgA level
- Autoantibodies: TTG and EMA
- FBC: Anaemia
- U+E: Vit D def
- LFT: Low albumin secondary to malabsoprtion
OGD and duodenal/jejunal biopsy
Histology results for coeliac disease
Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytes
Complications of coelaic disease
Anaemia
Hyposplenism
Osteoporosis
T - cell lymphoma (NHL)
Give 3 macroscopic signs of Chrons
Mouth to anus
Skip lesions
Fistula
Ulcers and fissures
Cobblestone mucosa
Strictures
3 macroscopic signs of UC
Mucosal ulceration
Continuous inflammation
Pseudpolyps
Loss of haustral markings
3 microscopic signs of Crohns
transmural inflammation
Increased goblet cells
non caeseating granuloma
3 microscopic signs of UC
Mucosal inflammation
decresed goblet cells
No granuloma
crypt abscess
complications of crohns
obstruction - stricture
fistula
colorectal cancer
gallstones - reduced bile acid reabsorption
Extraintestinal features of UC
PSC
What is Crohns
chronic relapsing IBD - characterised by a transmural granulomatous inflammation which can affect any part of the gastrointestinal tract
Give 3 sx of crohns
crampy abdominal pain
weight loss
diarrhoea
fever
3 signs of crohns
pallor
clubbing
apthous ulcers in mouth
RLQ tenderness
RIF mass
Perianal skin tags
fistula
perianal abscess
3 signs of crohns
pallor
clubbing
apthous ulcers in mouth
RLQ tenderness
RIF mass
Perianal skin tags
fistula
perianal abscess
3 extra-intestinal manifestations of crohns
erythema nodsoum
pyoderma gangrenosum
anterior uveitis - photophobia
episcleritis
arhtiritis
sacro-ilitis
gallstones
renal stones
Management of crohns
Inducing remission
- 1st line: steroids
- 2nd line: steroids + immunosuppresants
Azathiprine
Methotrexate
Infliximab
Maintaining remission
- 1st line: Azathiprine / Mercaptopurine
- MXT
- Infliximab
Differences between crohns and UC presentation
Crohns -
non bloody diarrhoea
weight loss more prominent
UC
- Uveitis more common
- PSC
which 2 drugs are you required to check TMPT levels before starting
Azathioprine
Meracaptopurine
Give 3 sx of UC
Bloody diarrhoea - containing mucous
tenesmus
urgency
pain in LIF
weight loss
fever
Give 3 signs of UC
anaemia
clubbing
abdominal distension and tenderness
PR - Blood / mucus
Give 3 extra -intestinal features of UC
Erythema nodosum
pyoderma ganrenosum
Anterior uveitis
episcleritis
clubbing
asymmetrical arthiritis
PSC
Barium enema findings of UC
Lead piping - loss of haustral markings
Thumb-printing (bowel inflammation)
Pseudo-polys
What imaging shoudl be used in active UC
CT
Flexible sigmoidoscopy
AXR / CXR - exclude toxic megacolon
Management of UC
Induce remission
Mild to moderate
1st line: Topical or oral ASA (Mesalazine)
2nd line: + Steroids
3rd line: + tacrolimus
severe:
1st line: IV corticosteroids
2nd line: IV ciclosporin
Maintaining remission
mild/moderate -
1st line: Aminosalicyclate
2nd line: Azathioprine
surgery
What is toxic megacolon
Colitis on AXR
Large bowel >6cm and systemic upset
long term complications of UC
Large bowel obstruction - strictures
colorectal cancer
cholangiocarcinoma
Outline pyloric stensois
- defintion
- sx
- signs
- Ix
- mx
Hypetrophy of circular muscles of pylorus
presents in 2-4 weeks of life
projectile non-bilious vomiting
constipation
FTT
dehydration
palpable mass - upper abdomen
Hypocholaraemic hypokalaemic metabolic alkalosis
Dx- USS
Mx - Pyloromyotomy
Outlien Hirschprungs disease
- definition
- sx
- signs
- Ix
- Mx
Congenital aganaglionic myenteric plexus in distal bowel and rectum
unco-ordinated peristalsis leads to fucntional obstruction
common in downs
failure to pass meconium
constipation
abdominal distention
Forecful passage of meconium after PR
AXR
Rectal biopsy
Mx
initial - rectal washout
definitive - surgery
Name 2 signs of peritonitis
rebound tenderness
percussion tenderness
Where is an inguinal hernia in relation to pubic tubercle
Superior and medial
Describe an direct hernia
Due to weakness in the abdominal wall - Hesselbachs triangle
chronic cough / constipation
rarely strangualte
Pressure over deep inguinal ring will not stop herniation
+ve cough reflex
Medial to inferior epigastric vessels
Describe an indirect hernia
bowel herniates through inguinal canal - patent processus vaginalis
can extend to scrotum
can strangulate
-ve cough reflex on reduction
Lateral to inferior epigastric vessels
complications of hernias
incarceration
obstruction
strangulation
Outline features of femoral hernia
More common in females
more likely to strangulate
Irreducible
No cough reflex
Below inguinal ligament
Inferior and lateral to pubic tubercle
give 4 causes of secondary constipation
Hirschprung
CF
Hypothyroid
sexual abuse
intestinal obstruction
Outline Turners syndrome
- chromosomal abnormality
- features
- asossciations
- mx
45 XO
Short stature
webbed neck
high arching palete
borad chest with widely spaced nipples
cubitus valgus
underdeveloped ovaries with reduced fucntion
infertile
recurrent OM
co-arctation and bicuspid aortic valve
hypothyroidism
obesity
DM
Outline the features of fragile X syndrome
Long narrow face
large ears
intellectual disability
large testicles
autism
seizures
Features of marfans syndrome
long neck
tall stature
long limbs
long fingers
high arch palette
Hypermobility
pectus excavatum / carinatum
mitral / aortic valve prolpase
aortic aneurysm
Outline the features of Kleinfelter syndrome and the management
tall height
wide hips
gynaecomastia
small testicles
infertility
reduced libido
LD - Affecting language
SLT
Educational support
OT
Testosterone injections
breast reduction surgery
Give 3 causes of UTI in children
E coli
Klebsiella
Proteus
Psudomonas - structural abnormality
3 sx of UTI in a child
- < 3m old
- > 3m old
Fever
lethargy
irritability
poor feeding
urinary frequency
vomiting
fever
abdominal pain
vomiting
dysuria
urinary frequency
incontinence
Septic screen in a child
Bloods
blood cultures
Urine dip and culture
lactate
LP
Following a UTI outline the follow up investigations for a child
USS
- All children in 1st UTI and under 6m
- atypical –> USS during illness
- recurrent –> USS in 6 weeks
MCUG - Abnormal bladder function and refluc
DMSA - Assess for scarring following UTI (3m)
Give 3 signs of an atypical UTI
Poor urine flow
Abdo/Bladder mass
Increased Cr
Septicaemia
Non E coli organism
Outline VUR
- RF
- Ix
- Mx
Ureters displaced laterally and enter directly into the bladder
Affected siblings
MCUG - Diagnostic
DMSA - Extent of scarring
avoid constipation
avoid excessively full bladder
prophylactic Abx
Give 4 classical features of Nephrotic syndrome
Proteinuria
- Frothy urine
Hypoalbuminaemia
Oedema
- SOB
- weight gain
Hyperlipidaemia
- Xanthelasma
Hypercoagulability
- Loss of antithrombin III
Recurrent infections
- Loss of immunoglobulins
Lethargy
Pallor
What is the most common cause of nephrotic disease in children
- what is the management
minimal change disease
Prednisolone
low salt diet
diuretics
albumin infusions
antibiotic prophylaxis
How are steroid resistant patients with nephrotic syndrome managed
ACEi
Immunosuppresants - ciclosporin / tacrolimus
Investigations for Nephrotic syndrome
Urine dipstick - proteinuria
Urinalysis - raised albumin:Cr
Renal biopsy
- fusion of podocytes and effacement of BM
Differentials for scrotal or inguinal swellings
Hydrocele
Varicocele
partially descended testis
inguinal hernia
testicular torsion
tumour
Give causes of nephrotic syndrome
Minimal change disease
Focal segmental glomerulosclerosis
- HIV
- Lithium
- Reflux nephropathy
Membranous nephropathy
Diabetic nephropathy
Amyloidosis
Give the 3 key features of nephritic syndrome
Haematuria
Hypertension
Oliguria
RBC casts in urine
Sterile pyuria
Give 3 causes of nephritic syndrome
Rapidly progressive glomerulonephritis
- Anti-glomerular basement membrane disease
Haematuria and haemoptysis - IgA nephropathy - common following URTI
Post streptococcal glomerulonephritis
- Antistreptolysin O titres
HSP
SLE
Investigations for nephritic syndrome
Hx - urti
Urinalysis
- RBC casts
- Sterile pyuria
- Protein quantification
Bloods
- Cr
- U+E
Renal biopsy
Outline post strep glomerulonephritis, investigations and required management
Immune complexs deposited in BM cause inflammation and acute deterioration –> AKI
Hx tonsilitis / +ve throat swab / Anti strep O titres
supportive mx
If: HTN or oedema develop - Antihypertensives and diuretics
Outline IgA nephropathy, Investigations and management
IgA deposits in nephrons of kidney causing inflammation
renal biopsy - IgA deposits and glomerular mesnagial proliferation
supportive
Immunosuppresants - steroids
Name the 4 classical features of HSP
Purpura - red or purple / palpable under skin
Joint pain - swollen and painful
Abdominal pain
- hemorrhage
- intussusception
- bowel infarction
Renal involvement
- Haematuria
- Nephritic or nephrotic syndrome
What is HSP and what triggers it
IgA vasculitis leading to
URTI - Strep pyogenes
Gastroenteritis
Give 4 causes of non blanching rash
Meningococcal septicaemia
Leukemia
HSP
HUS
ITP
Investigations for HSP
FBC and film - thrombocytopenia / sepsis / leukemia
U+E
Albumin
CRP - Sepsis
Blood cultures - sepsis
Urine dipstick + protein:Cr - proteinuria
BP - Hypertension
What is the management and monitoring required for HSP
Rest and hydration
steroids - shorten duration of illness
Urine dipstick - renal involvement
BP - Hypertension
What is HUS
Thrombosis in small blood vessels triggered by shigga toxin - E coli0157
triad for HUS
Haemolytic anaemia
AKI
Thrombocytopenia
what increases the risk of HUS
Use of Abx or loperamide in patients with gastroenteritis
Clinical features of HUS
E.coli - bloody diarrhoea
Reduced urine output
haematuria
dark brown urine
abdominal pain
bruising
lethargy
fever
Investigations and management of HUS
Urine dipstick - haematuria
Bloods
Normocytic anemia
Thrombocytopenia
Raised WCC + LDH
Coombs test -ve
Supportive
- IV fluids
Give 4 causes of primary enuresis
FHx - variation in normal development
overactive bladder
fluid intake
failure to wake
psychological distress
give 4 causes of secondary enuresis
chronic constipation
UTI
TIDM
New psycholoigcal issues - stress / school
Abuse
What is secondary enuresis
child begins wetting the bed when they have previously been dry at night fro 6m
Give 4 features of a simple febrile convulsion
lasts <15 minutes
GTC
No recurrentce in 24 hours
complete recovery in 1 hour
Give 3 features of a complex febrile seixure
15-30 minutes
focal seizure
repeat seizure in 24 hours
Features of juvenille myoclonic epilpesy
after waking - clumsiness
myoclonic seizure
GTC
Absence seizure
Mx - valporate
3 features of hydrocephalus
bulging anterior fontanelle
sleepiness
poor tone
poor feeding
What is cerebral palsy
Permanent non-progressive neurological issues due to brain damage during birth
Give 5 causes of cerebral palsy
maternal infections
birth asphyxia
pre-term birth
meningitis
neonatal jaundice
head injury
classifications of cerebral palsy
spastic - UMN damage
dyskinetic - basal ganglia damage
atheoid movements
oro motor issues
due to - HIE / Kerneticus
ataxic - cerebellum
problems with co-ordianted movements
Clinical features of cerebral palsy
failure to meet developmental milestones
increased or decreased tone
hand preference <18m
Abnormal gait
feeding or swallowing issues
LD
Primitive reflexes > 6m
Role of surfactant
reduces surface tension
maximises alveolar SA
Increases lung compliance - reduces force needed to expand alveoli
componentes of APGAR score
colour
pulse
respiration
grimace - response to stimulation
muscle tone
What is Erbs palsy
Damage to C5/6 nerves in brachial plexus during birth
internally rotated shoulder
extended elbow
flexed wrist
lack of movement in arm
Features of congenital rubella
At risk during first 3m
congenital cataracts
PDA
LD
Hearing loss
Features of congenital varicella
At risk during first 28 weeks
Microcepahly
skin scarring
limb hypoplasia
cataracts
reducing risk of SIDS
Put baby on back when unsupervised
Put them at the foot of the bed
make sure head is uncovered
keep cot clear of toys
avoid smoking aorund child
avoid co-sleeping
Outline retinopathy of prematurity
Babies born before 32 weeks - screened
Abnormal development of retinal blood vessels due to oxygenation
What are the causes of physiological jaundice
underdeveloped liver
high concentration of RBC
What is kerneticus
Build of of unconjugated bilirubin in basal ganglia leading to brain dmage
Management of neonatal jaundice
Measure total bilirubin levels and plot on treatment chart
Phototherapy
breakdown bilirubin into products that can be excreted in bile and urine without conjugation
exchange transfusion
Outline respiratory distress syndrome
occurs below 32 weeks gestation - due to lack of surfactant production
high surface tension leads to lung collapse and inadequate gas exchange
- hypoxia / hypercapnia / respiratory distress
CXR - Ground glass
Mx
- IM steroids
endotracheal surfactant
O2
complications of respiratory distress syndrome
pneumothorax
infection
apnoea
NEC
What is necrotising enterocolitis
Part of the bowel becomes necrotic and can lead to perforation - peritonitis - shock
Give 4 RF for NEC
Prematurity
Low birth weigth
formula feeds
Sepsis
assited ventilation and respiratory distress
Clinicla features of NEC
Intolerance to feeds
vomiting - bilious
distended tender abdomen
absent bowel sounds
blood in stools
AXR findings in NEC
Dilated loops o fbowel
bowel wall oedema
Pneumatosis intestinalis - gas in bowel wall
Pneumoperitoneum
football sign
Management of NEC
NBM
IV fluids
TPN
Abx
RF for neonatal sepsis
Vaginal BGS colonisation
GBS in previous pregnancy
Chorioamnionitis
prematurity
Prolonged ROM
Features of neonatal sepsis
fever
reduced tone
poor feeding
respiratory distress
vomiting
tachycardia
hypoxia
jaundice within 24hrs
seizures
What is Kawasaki disease and give 5 clinical features
systemic medium vessel vasculitis
CRASH + BURN
Bilateral non purulent conjunctivitis
Maculopapular rash
Cervical lymphadenopathy
Strawberry tongue - red toungue with large papillae
Desquamations - hands and feet
Fever - 39 degrees for 5 days
Investigations for kawasaki disease and management
Bloods
FBC - Anaemia / Leukocytosis / Thrombocytosis
LFT - Hypoalbuminaemia
CRP
Echo - coronary artery aneurysms
High-dose aspirin - reduce thrombosis risj
IV immunoglobulins - reduce aneurysms risk
What is ADHD
Inability to concentrate affecting persons ability to carry out everyday tasks consistent across at least 2 settings
Give 4 features of ADHD and the management
short attention span
quickly moving from one activity to another
Easily distracted
Does not wait their turn
constantly fidgeting
impulsive behaviour
excessive talking
C - Parental education programes
Methylphenidate
Lisdexamfetamine
What is required prior to giving ADHD medication
Baseline ECG
what is autism
Autism is a neurodevelopmental condition characterized by impairment in social interaction and communication as well as repetitive stereotyped behaviour, interests, and activities
Give 4 clinical features of autism
Impaired social interaction
- play alone
- not interested in being with other kids
- Unable to read non-verbal cues
- fail to form and maintain relationships
communication
- delay in language development
- difficulty with imaginative behaviour
- repetitive use of words or phrases
repetitive behaviors / interests
- repetitive mannerisms
- strict rules and routines
- intense and deep interests
Intellectual imparement
Language imapirement
Management of ASD
Early educational and behavioral interventions
CAMHS
SLT
Specially trained educators
Family support and counselling
Outline mumps
- Pathogen
- Clinical features
- Management
Paramyxovirus
Headache / Myalgia / Malaise
Parotitis - unable to open mouth
Orchitis - severe painful swelling of testicles
Deafness
Mx
- IV fluids
- Analgesia and antipyretics
Outline nappy rashes
contact dermatitis
Itchy / red /
- flexures spared
- erythematous scaled apperance
candida
- includes flexures
- satelite lesions
- Beefy red
define allergy
Hypersensitivity reaction initiated by specific immunoglobulins
define hypersenitivity
Objectively reproduceable symptoms or signs following a defined stimulus (e.g. food, drug, venom) at a dose tolerated by a normal person
define atopy
Tendency to produce IgE in response to ordinary exposure to allergens – Asthma / hayfever / conjubctivitis / eczema
Outline measels
- sx
- Ix
- mx
- school exclusion
CCCK
Coryzal sx
Conunctivitis
Cough
Koplik spots - white spots on buccal mucosa
Fever
Rash - Maculopapular
IgG detected in blood
Supportive - fluids and analgesia
school exclusion - 4 days from onset of rash
Give 4 complications of rubella
Menigitis
Hearing loss
vision loss
death
Outline rubella
- sx
- Ix
- Mx
- school exclusion
Maculopapular rash - starts on face –> Whole body
Lymphadenopathy - suboccipital and post auricualr
fever
Headache
Joint pain
Supportive
Avoid pregnant women
5 days from onset of rash
Outline slapped cheeck
- organism
- sx
- Ix
- Mx
- school exclusion
Parvovirus B19
fever
malaise
myalgia
rash - maculopapular on body
Only required if: Pregnant / Thal / SCD / HS / Haemolytic anaemia
Check FBC and reticulocyte count - apalstic anaemia
Once rash formed no longer infectious
Give 4 complication of measels
OM
Pneumonia
Encephalitis
Febrile convulsions
Causative organism for roseola infantum
Human herpes virus 6
Outline Hand foot and mouth
Coxsackie A16
Mouth ulcers
Blistering red spots across body
Outlien scarlet fever
- organism
- sx
- Ix
- mx
Group A strep - strep pyogenes
fever
malaise
headache
sore throat
strawberry tongue
rash - sandpaper texture
flushed appearance with circumferential pallor
Throat swab and culutre
Oral penicillin V for 10 days
- Azithromycin
return to school 24hrs after Abx
How does Bronchioloitis present
Cough
Coryzal - watery eyes / runny nose / sneezing
Rhinorrhoea
fever
wheeze
decreased feeding
Increased WOB
Give 4 signs of respiratory distress
Nasal flaring
Head bobbing
Tracheal tug
Recessions
Use of accessory muscles
Cyanosis
define wheeze
Polyphonic expiratory noise from lower airways - indicates airway narrowing
define stridor
high pitched inspiratory noise caused by obstruction of upper airway
define grunting
exhaling on a closed glottis
Give 4 reasons to admit a child with bronchioloitis
clinical dehydration
O2 required
Decreased oral intake
Resp distress
Apnoea
Parents don’t feel confident in caring for them at home
High resp rate
Management of bronchiolitis
NG feed
Humidified O2
IV fluids
What is a prophylactic treatment option for bronchiolitis and identify who is eligible
Palivizumab - MAB
Monthly injection
CHD
Ex premature
What is viral induced wheeze
Acute wheezy illness due to viral infection
Name 3 features that indicate VIW as opposed to asthma
Sx before 3 years of age
No atopic hx
Only occurs during viral illness
How is VIW managed
Acute asthma
Outline bacterial tracheitis
- what is it
- causative organism
- key features
- mx
Rare condition similar to croup
Staph aureus
Croup sx
Fever
Rapidly progressing airway obstruction
Iv Abx
Causative organism of whooping cough
Bordatella pertussis
Clinical features of whooping cough
coryzal sx
low grade fever
coughing bouts - worse at night or after feeds
- sudden
- recurring
- inspiratory whoop
vomiting
apnoeic spells
Outline the investigations and management of whooping cough
Nasopharyngeal swab –> PCR testing
Notifiable disease
Admit patients under 6m
Erythromycin
School exclusion for 48hrs after Abx
Name 3 complications of whooping cough
Bronchiectasis
subconjunctival hemorrhage
seizure
5 features of epiglottitis
Sore throat
Fever
Drooling
Muffled voice
Tripod position
Pain on swallowing
Septic looking child
Name 4 causative pathogens for croup
Parainfluenza
RSV
Adenovirus
Influenza
4 features of croup
Increased OWB
Barking cough
hoarse voice
stridor
fever
Give 4 clinical features of pneumonia in children
cough
fever
tachypnoea
tachycardia
increased WOB
Give 4 signs of pneumonia in children
bronchial breath sounds
focal coarse crackles
dullness to percussion
Causative organisms of pnumonia in:
neonates
young children
children
group B strep
s pneumoniae / RSV / H.Influenzae
Investigations and management of penumonia in children
Sputum cultures
throat swabs - bacterial culture and PCR
Amoxicillin
What is croup
Infection of upper airway causes inflammation and upper airway obstruction
Give 3 RF for neonatal respiratory distress syndrome
Maternal diabetes
C section
hypothermia
FHx
What is seen on CXR of RDS
Ground glass appearance
What is cerebral palsy
Permanent non progressive neurological disorder due to brain damage at birth causing abnormal movements and posture
Give 4 features of cerebral pasly
moement disorder
delayed milestones
FTT
Epilepsy
cosntipation
sleep disturbance
contractures
Classifications of cerebral palsy
Spastic
Ataxic
Dyskinetic
Mixed
