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LSHTM > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Global burden of childhood pneumonia

A

-Top infectious cause of death in children <5
-98% pneumonia deaths occur in LMICs
->700,000 annual deaths [15% of under 5 mortality]

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2
Q

WHO - severe paediatric pneumonia - signs

A

Cyanosis
Grunting
Inability to drink
Head bobbing
Altered consciousness
SpO2 <90%
Convulsions
Vomiting everything taken in

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3
Q

PERCH study

A

Largest pneumonia aetiology study

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4
Q

Paediatric pneumonia - pathogens

A

Virus [61%] - RSV, rhinovirus, human metapneumovirus, parainfluenza

Bacteria [27%] - Penumococcus, haemophilus influenzae, staphlyococcus

TB [6%]

Fungi [5%] - pneumocystic jirovecii

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5
Q

Paediatric tropical neurology - burden

A

1/3rd children present with neuro signs/symptoms

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6
Q

Cranial neuropathies in TB meningitis

A

Through cavernous sinuses:
-III [oculomotor]
-IV [trochlear]
-V1 + V2 [Ophthalmic + maxillary]
-VI [abducens]

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7
Q

TB meningitis - clinical staging

A

1 = fever, meningism
2 = CN palsies, seizures
3 = coma

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8
Q

Paediatric neurology - motor/sensory exam

A

Pyramidal = weak, spasticity, hyper-reflexia
Basal ganglia/thalami = normal power + reflexes, choreathoid, dystonia
Cerebllum = ataxia, slurred speech, nystagmus
Cord = weak, sensory level, hyper-reflexia below level
Peripheral = weak, flaccid, areflexia

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9
Q

Paediatric neurology - trigger for anti-NDMA encephalitis

A

HSV encephalitis

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10
Q

TB meningitis paediatric - probability criteria

A

Marais, 2010 = uniform case definition, for all ages, numeric score based on clinical, CSF, neuro-imaging and evidence of TB

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11
Q

Diarrhoea in children - epidemiology

A

2nd leading cause of death in <5s globally
Mortality declining
Extremes of age most at risk

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12
Q

Diarrhoea in children - risk factors

A

For acquiring diarrhoea:
-Infants and children
-Immunosuppression
-Exposure to faecal-oral contamination
-Not breastfeeding [WHO recommendation = exclusive for 6 months, minimum of 2 years]

For morbidity and mortality:
-Undernutrition
-Extremes of age
-Poor supportive care
-Causative pathogen = neurotoxin [C botulinum, S aureus, Bacillus caerus], enterotoxin [cholera], and cytotoxin [shiga, EHEC, C diff, C perfringens]

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13
Q

Diarrhoea in children - causative pathogens

A

Top causes:
-Rotavirus
-Shigella
-Norovirus
-Adenovirus
-Cryptosporidium
-ETEC
-Shigella

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14
Q

Diarrhoea in children - Initial management

A

Rehydration
Zinc supplementation = restores mucosal barrier integrity, promotes production of antibodies and circulating lymphocytes and prevents chlorine secretion
Continued feeding and prevention

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15
Q

Diarrhoea in children - treatment plans

A

Plan A = treatment at home [no dehydration]
-ORS
-Zinc supplements

Plan B = some dehydration
-ORS in clinic over 4 hrs
-Zinc supplements
-Continue feeding
-Safety netting

Plan C = severe dehydration
-IV fluid treatment
-Down-staging as patient response - ORS as soon as child can drink
In malnutrition = IV treatment on if shocked

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16
Q

Diarrhoea in children - ORS components

A

NaCl, trisodium citrate, KCl, glucose

In acute malnutrition - ReSoMal = less sodium, lower osmolality

17
Q

Diarrhoea in children - classification of dehydration

A

Severe = 2 or more of:
-Lethargy or unconscious
-Sunken eyes
-Unable to drink
-Skin pinch >2s

Some dehydration = 2 or more of:
-Restlessness
-Sunken eyes
-Drinks/thirsty
-Skin pinch slow

No dehydration

18
Q

Diarrhoea in children - persistent diarrhoea [>14 days]

A

Monitor nutritional status
Consider HIV
Stool microscopy - isospora, cryptosporidium
Other infection - pneumonia, UTI
Chronic diarrhoea - may lead to environmental enteric dysfunction [EED]

19
Q

Diarrhoea in children - prevention

A

WASH
Breastfeeding
Nutrition

20
Q

Child maltreatment - burden

A

1 billion children experience physical, sexual or emotional violence each year

21
Q

Childhood vaccinations - special characteristics of infant immunity

A

Initial protection mainly from innate immunity and maternal antibodies

Majority of antibody transfer occur after 28 weeks gestation

22
Q

Childhood vaccinations - core vaccination [birth]

A

BCG
OPV [IPV from 6 weeks]
Hepatitis B

23
Q

Childhood vaccinations - core vaccinations [from 6 weeks]

A

Rotavirus
Hib
Pneumococcal
Diptheria-tetanus-pertussis [DTP]
IPV

24
Q

Childhood vaccinations - core vaccinations [from 9-12 months]

A

Rubella
Measles

25
Q

Childhood vaccinations - core vaccinations [antenatal + adolescent]

A

Antenatal = maternal tetanus toxoid

Adolescent = HPV

26
Q

Childhood vaccinations - vaccination rates

A

More than 22 million children undervaccinated

14.3 million zero-dose children

60^ from 10 countries:
Angola, Brazil, DRC, Ethiopia, India, Indonesia, Mozambique, Nigeria, Pakistan, Philippines

LSHTM (47 decks)

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