paediatrics Flashcards
AKI in children
3.9 cases per 1000 admissions. significantly higher mortality than those that don’t get aki (15% vs 0.6%)
causes: shock, sepsis, intubation, extracorporeal support, congen cardiac abnormalities.
majority therefore pre-renal causes.
test for serum creatinine if in a high risk group or scenario. (inc diarrhoea)
urine output < 0.3 mL/kg/hour for 24 hours or anuria for 12 hours.
serum creatinine increase to > 3-fold above baseline.
Ix: bloods, urinalysis, urine microscopy, ultrasound.
Rx: monitor, maintain, minimise
stop any ACEi, ARB, NSAIDS, COX.
signs of hypovolaemia- 10ml/kg fluid challenge IV
euvolaemia- 10ml/kg over 1 hour
hypervolaemia- 3-5mg frusi, dialysis if no response.—- if still vbad venesection 5ml/kg.
then treat as per fluid charts.
ADHD
neuro-developmental disorder characterised by inattention, hyperactivity, and impulsivity.
can be primarily inattentive or impulsivity.
symptoms manifest in two or more settings, for example in home and school.- inability to do work, form relations, careless mistakes, not listening etc, loosing things.
RF: strong family history
male, epilepsy.
Dx: need to have symptoms present before age 12. made by clinical history. in uk by specialist.
suggested to use a rating scale but not on its own exclusively.
Rx: pre school children (up to 6)- parent education-
2’- methylphenidate
school age (6+): Psychoeducation + behavioural therapy.
2’- stimulant (methylphenidate, amfetamine)
3’- atomoxetine
discuss anaemia in children
iron deficiency most common cause.
normal anaemia investigations- i.e MVC.
big- folate/ b12
small- iron deficiency (ferritin lower than 20?) or thalassaemia major trait.
normal- consider reticulocyte count- inc– loss.
no inc- consider the nasties.
diagnosis of autism spectrum disorder
A. persistent defects in reciprocal communication and interaction accross multiple contexts.
B. restrictive and repetative interests and patterns of behaviour, at least 2 of stereotyped motor movements speech, inflexibleness of routines, fixated interests, hyper/po reactivity to stimuli
C. must be present in early developmental period
D. causes clinically significant impairment in social, occupational, or other areas of functioning,
E. not better explained by intelectual disability, or global dev delay. may be concurrent but needs to be lower than expected level.
risk factors, ix, rx, autism
male, family history, gestational valproate exposure, genetic inheritance.
Ix: it is a clinical diagnosis based on prev flashcards findings.
questionnaires and tools can help.
Rx: behavioural interventions for family and patient, involve school/ social support
consider speech and language therapy
‘total communication approach’- i.e using as many methods as able to communicate with the patient rather than forcing them to use one.
biliary atresia
a progressive necroinflammatory process involving some or all of the biliary tree.
either congenital absence of formation, or formation and autoimmune destruction, presents in newborn babies/ first few weeks of life.
obstruction then goes onto destroy the liver.
assoc with rotavirus infection maternally.
1 in 10000 babies (very roughly)
S+S: pale stools, hepatomegaly, jaundice lasting longer than 14 days in a newborn. dark urine and faliure to thrive often present.
Ix: serum total or conjugated bilirubin—- over 17 is diagnostic
LFT with high GGT. PT/INR for liver function.
Rx: ideally around 60 days post birth.
if liver functioning - hepatoportoenterostomy
if not functioning - liver transplant
without surgery the condition is fatal. portal htn leads to live failure.
bronchiolitis
an acute viral infection affecting the lower respiratory tract.
causing epithelial destruction, oedema, mucous + inflammatory debris. most common cause of resp admission in under 1s.
respiratory syncytial virus most common cause.
mostly self limiting + symptomatic support.
illness for 10-14/7. cough can persist longer + wheeze.
S+S: cough, wheeze, tacypnoea
RF: <3/12. winter, prematurity, tobacco exposure. + anything congen/immunodef
Ix: pulse ox, ELISA, CXR, PCR.
Rx: supportive – escalate up to ICU
ribavirin - in those with severe disease.
some role for prophylaxis in infants –palivizumab
paediatric candidiasis- specifically management in the paed, associations, treatments.
commonly oral candidiasis
admit if systemic illness, widespread infection (retrosternal pain, pain on swallow)
exclude risk factors (DM in child, hematinic deficiencies + poor hygiene)
Rx: topical antifungal- miconazole oral gel (4/12 and over)
2’- nystatin
hygiene advise, if using corticosted inhaler rinse mouth after.
refer to paediatrician if 2/52 treatment does not work. or sus of immunodef.
discuss paediatric cardiac arrest- the reversible causes. treatment for vt/svt. the most common cause.
respiratory failure is most common cause.- start o2 if 3% below target sats, avoid over oxygenation (unless carbon monoxide)
attempt 2x cannula access. - then IO
fluid bolus 10ml/kg upto 40-60ml/kg in the first hour.
SVT or VT- if decompensated- cardioversion 1J/kh up to 4j/kg.
if not decomp- adenosine
if non shockable- iv adrenaline 0.1mg/kg in 1:10000 solution. - 1st dose ASAP.
further adrenaline 3-5 mins intervals.
consider and correct the 4H and 4T.
Hypoxia
Hypovolaemia
Hyper/hypokalaemia, metabolic
Hypothermia/hyperthermia
Thromboembolism (coronary or pulmonary)
Tension pneumothorax
Tamponade (cardiac)
Toxic/therapeutic disturbance.
chickenpox
acute infectious viral disease
varicellar zoster
vesicular rash, fever, malaise.
transmission by droplet or personal contact. incubation 1-3 weeks.
Ix: clinical diagnosis
Rx: generally no treatment for children under 14.
if over 14 and within 24 hours of onset consider acyclovir
if immunocompromised - admit if complications (encephalitis etc) - supportive care as needed
if the itch is mad -Chlorphenamine if over 1 year old.
discuss congenital heart disease classifications
left to right shunts- typically acyanotic.
e.g septal defects (atrial, ventral or atrioventral), patient ductus arteriosus, anomalous pulmonary venous connection. ——– cyanosis only occurs if large and not repaired, or dev pulm vasc disease.
right to left shunts– deox blood reaching aorta +/- inc or dec pulm blood flow.
e.g tet of fallot, transposition of great arteries, ebsteins anomaly
obstructive valvular and non valvular
left vent outflow obstruction
coarctation of aorta
pulm valve stenosis
aortic valve sten.
discuss Ventral septal defect
most common CHD 20% of all cases.
classified as
A- outlet - may be large
B- perimembranous- often solitary and close on own.
C- inlet
D- muscular- most common, vast maj close within 2 years.
if small may be asymptomatic
if larger- presents 6-8 weeks after birth tacycardia, pnoea, pallor, poor feeding, poor weight gain.- related to pulm oedema.
– if large most will develop pulm vasc obstructive disease. after 2 years.
holosystolic murmur, left vent hypertrophy on ecg. big heart on cxr
Rx: if small leave
if big - diuretics, closure surgically or catheterlly.
atrial septal defect
4-5% of all CHD
found in 40% of downs syndrome pts.
? may present with left axis deviation on ECG.
cardiomegaly, increaced pulm markings on CXR. some pulm oedema but can be mild.
Rx: if complete- repair between 3-6 months of age.
lifelong follow up- 15% get aggressive mitral regurg.
patent ductus arteriosus
ductus usually closes within the first 24 hours of birth
persistent patency occurs in 1-2000– around 10% of all CHD
RF: low birth weight, born at altitude.
S+S: continuous murmur
increased pulmonary blood flow, a wide pulse pressure, and ‘bounding’ pulses.
gradual increase in cyanosis as the disease progresses. initially may be limited to lower body.
Ix: crx, ecg, echo will allow for visualisation.
Rx: NSAIDS initially to try and get to close.- 10mg/kg loading. 5mg/kg for 2 doses.
surgical ligation 2nd line.
if older or adult- coiled.
discuss tetralogy of Fallot
most common cyanotic CHD, representing 4% to 8% of all defects
can occur on own, or as part of di george syndrome.
4 abnormalities: outflow ventral septal defect
overriding aorta
right ventricular outflow tract obstruction
right ventricular hypertrophy.
S+S: progressive cyanosis (right to left shunt) and dyspnoea as a young chilld.
may squat to shunt
2’ erythrocytosis.
loud ejection systolic murmur with radiation to both axilla (RVOT obstruction)
‘tet spells’ where there is a rapid onset of sob can occur. - need treatment- reduced RV outlet flow. - may die
Ix: cxr- boot shaped heart (25%), pulse ox, echo.
Rx: hypercyanotic spells- consider beta blocker (2nd line after knees to chest/ manoeuvres to help)
new-born and very poorly- give a prostaglandin E1- keep Ductus arteriosus open (alprostadil)
if that doesn’t work- surgery/ shunt/ coil
surgery is definitive, no formal recs due to complexity + variation.
