Paediatrics Flashcards
Types of Cerebral Palsy
- Spastic: hypertonia (increased tone) and reduced function resulting from damage to upper motor neurones
- Dyskinetic: problems controlling muscle tone, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. This is the result of damage to the basal ganglia.
- Ataxic: problems with coordinated movement resulting from damage to the cerebellum
- Mixed: a mix of spastic, dyskinetic and/or ataxic features
Dyskinetic: involuntary movements, commonly affecting the hands and feet. The excessive salivation and mastication difficulties observed are indicative of compromised control over facial muscles. This type of cerebral palsy is caused by damage to the basal ganglia and the substantia nigra, which control the coordination of voluntary movements.
Ataxic is not the appropriate choice, as this form of cerebral palsy is characterised by poor coordination and balance, rather than the involuntary movements described in the scenario.
Mixed is not the most suitable option. While it could be considered that multiple types of cerebral palsy can coexist, in this instance, the patient predominantly exhibits symptoms of one specific subtype. There is an absence of substantial evidence for spasticity or ataxia.
Monoplegic does not fit the clinical picture presented. Monoplegic cerebral palsy impacts a single limb; however, bilateral involvement was noted in this case, rendering this choice incorrect.
Spastic would present with hypertonia resulting in muscular stiffness, which does not align with the features observed in this case.
A baby born at 35 weeks gestations via normal vaginal delivery is found to be irritable 48 hours after birth and suffers a convulsion. There is no obvious head trauma or swellings. Which one of the following cranial injuries is most likely to have occurred?
Intraventricular haematoma
Caput succedaneum is caused by pressure on the fetal scalp during the birthing process. It results in a large oedematous swelling and bruising over the scalp. Treatment is not required as the swelling reduces over a few days.
A cephalohaematoma may occur after a spontaneous vaginal delivery or following a trauma from the obstetric forceps or the ventouse. A haemorrhage results after the presidium is sheared from the parietal bone. The tense swelling is limited to the outline of the bone. It reduces over a few weeks - months.
A Subaponeurotic haemorrhage, also known as a subgaleal haemorrhage is rare and is due to a traumatic birth. It may result in the infant losing large amounts of blood.
An intracranial haemorrhage refers to subarachnoid, subdural or intraventricular haemorrhages. Subarachnoid haemorrhages are common and may cause irritability and even convulsions over the first 2 days of life. Subdural can following the use of forceps. Intraventricular haemorrhage mostly affects pre-term infants and can be diagnosed by ultrasound examinations.
Extradural haemorrhage is unlikely to occur during the birthing process.
Chest x-ray in transient tachypnoea of the newborn may show
hyperinflation
fluid in the horizontal fissure
Management of Croup
Administering a single dose of oral dexamethasone (0.15mg/kg) to all children presenting with croup, irrespective of the severity of their symptoms.
What causes acute epiglottitis?
caused by Haemophilus influenza B
Symptom: drooling and stridor but coughing is usually minimal or absent
Otitis Media
caused by Moraxella catarrhalis
Enuresis - Imipramine
This is a tricyclic antidepressant. It can be used in nocturnal enuresis in children who have failed to respond to all other treatments and have undergone specialist assessment.
Enuresis - Oxybutynin
This is an anticholinergic medication that is used for nocturnal enuresis associated with overactive bladder. It is also used for urinary frequency, incontinence and neurogenic bladder instability.
Enuresis - Fluvoxamine
This is selective serotonin re-uptake inhibitor (SSRI) which is used in paediatric obsessive compulsive disorder.
Enuresis - Tolterodine
This is an antimuscarinic drug that is used for symptomatic treatment of overactive bladder associated nocturnal enuresis. Though is not licensed for use in children.
Medication for Cystic Fibrosis
Lumacaftor (correctors) / ivacaftor (potentiators)
- Potentiators increase the amount of time that the CFTR channel is open
- Correctors help the CFTR protein form so that it can move to the cell surface.
Lumacaftor increases the number of CFTR proteins that are transported to the cell surface ivacaftor is a potentiator of CFTR that is already at the cell surface, increasing the probability that the defective channel will be open and allow chloride ions to pass through the channel pore
A 3-year-old child is diagnosed with whooping cough. The cough started around 7 days ago. What is the most appropriate antibiotic therapy?
Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days
If admission is not needed, prescribe an antibiotic if the onset of cough is within the previous 21 days.
A macrolide antibiotic is recommended first-line:
Prescribe clarithromycin for infants less than 1 month of age.
Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
Prescribe erythromycin for pregnant women.
Whooping cough - Diagnostic criteria
Diagnostic criteria
Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
Notifiable disease
Pertussis
What is an umbilical granuloma
An overgrowth of tissue which occurs during the healing process of the umbilicus.
It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid. It is treated by regular application of salt to the wound, if this does not help then the granuloma can be cauterised with silver nitrate.
