Paediatrics 2 Flashcards
1
Q
Autism clinical features
A
- Social communication impairment and repetitive behaviour can be present before 2-3 years of age
- Often associated with intellectual impairment or language impairment i.e. monotonous tone of voice, interpret speech literally
- Attention deficit hyperactivity disorder (35%) and epilepsy (18%) are also commonly seen in children with ASD.
- ASD is also associated with a higher head circumference to the brain volume ratio.
2
Q
Autism behaviour
A
- Repetitive behaviour, interests and activities= stereotyped and repetitive motor mannerisms, inflexible adherence to non-functional routines or rituals. Children are noted to have a particular way of doing everyday activity. Narrow interests i.e. trains
- Impaired social communication and interaction= children frequently play alone and uninterested in being with other children. Fail to regulate social interaction with nonverbal cues like eye gaze, facial expression and gestures. Fail to form and maintain appropriate relationships and become socially isolated
3
Q
Autism management
A
- Involves educational and behavioural management, medical therapy and family counselling
- Goal is to increase functional independence and quality if life through: Learning and development, improved social skills and improved communication
- Applied behavioural analysis: positive behaviours are encouraged and negative behaviours are ignored
- ASD preschool programme
- Aid to families
Family support and counselling: parental education on interaction with the child and acceptance of his/her behaviour
4
Q
Autism pharmacological interventions
A
no consistent evidence demonstrating medication mediated improvements in social communication
- SSRI’s: help reduce symptoms like repetitive stereotypes behaviour, anxiety and aggression
- Antipsychotic drugs: useful to reduce symptoms like aggression, self-injury
- Methylphenidate: for ADHD
5
Q
Symptoms of biliary atresia
A
- Prolonged jaundice (i.e., jaundice persisting beyond 14 days of life)
- Signs of biliary obstruction such as dark urine and pale or chalky white stool
6
Q
Investigations for biliary atresia
A
- Blood tests
- Hepatic scintigraphy (Technetium-99m scan): The liver will take up the isotope but there will be poor excretion into the bowel, indicating destroyed bile ducts.
- Abdominal ultrasound: This may reveal echogenic fibrosis.
- Cholangiography: This is the definitive diagnostic test, which will fail to show normal architecture of the biliary tree, confirming biliary atresia.
7
Q
Management of biliary atresia
A
Hepatoportoenterostomy (Kasai procedure): This surgery creates a new pathway from the liver to the gut to bypass the fibrosed bile ducts.
8
Q
Cause of bronchiectasis in paediatrics
A
- CF: most common
- Chronic infection: s.pneumonia, s.aureus
- Immunodeficiency: agammaglobulinaemia, HIV, ataxic telangiectasia
- Primary ciliary dyskinesia: autosomal recessive, loss of bronchial cilia
- Youngs syndrome
9
Q
Symptoms of bronchiectasis
A
- Purulent sputum expectoration
- Chest pain
- Wheeze
- Breathlessness on exertion
- Haemoptysis
- Recurrent or persistent infections of the lower respiratory tract
- Signs: finger clubbing, wheeze and inspiratory crackles
10
Q
Investigations for bronchiectasis
A
- CXR
- HRCT: gold standard
- Bronchoscopy: after CT
- Chloride sweat test: for CF
- Spirometry
11
Q
Management of bronchiectasis
A
- Chest physiotherapy
- antibiotics for exacerbations
- Bronchodilators if wheeze
- Most common exacerbations: H.influenza, S.pneumoniae
12
Q
Complications of bronchiectasis
A
- Recurrent infection
- Life-threatening haemoptysis
- Lung abscess
- Pneumothorax
- Poor growth and development
13
Q
Bronchiolitis key features
A
- Common in babies and in young children below 2 years of age
- Usually caused by viruses (mainly RSV), other causes: mycoplasma, adenoviruses
- May be secondary to a bacterial infection
- More serious if bronchopulmonary dysplasia i.e. premature, congenital heart disease or cystic fibrosis
- Palivizumab (RSV vaccine ) is offered to high risk babies ( eg congenital heart disease, babies on home oxygen)
14
Q
Bronchiolitis high risk babies
A
more likely to require admission to hospital:
- Premature babies (< 32 weeks)
- Chronic lung disease (home oxygen)
- Congenital heart disease
- Young babies (less than 12 weeks old)
- Neuromuscular disease
- Consider admission if there are social concerns for example parents with learning difficulties, young parents with poor support, remote location and difficulty accessing care
- These children are given the palivizumab injections in winter
15
Q
Bronchiolitis symptoms
A
- Coryzal features (including mild fever) precede:
- Dry cough
- Increasing breathlessness
- Wheezing, fine inspiratory crackles
- Feeding difficulties associated with increasing dyspnoea and often the reason for hospital admissions
- Increased work of breathing: tachypnoea, nasal flaring, head bobbing, tracheal tug, intercostal/sternal recessions and abdominal breathing
16
Q
Bronchiolitis: NICE recommends immediate referral (usually by 999 ambulance) if they have any of the following:
A
- apnoea (observed or reported)
- child looks seriously unwell to a healthcare professional
- severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
- central cyanosis
- persistent oxygen saturation of less than 92% when breathing air.
17
Q
NICE: NICE recommend that clinicians ‘consider’ referring to hospital if any of the following apply:
A
- a respiratory rate of over 60 breaths/minute
- difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
- clinical dehydration.
18
Q
Bronchiolitis: investigations and management
A
- Investigations: immunofluorescence of nasopharyngeal secretions may show RSV
- Diagnosis is primarily clinical can use CXR
- Management is largely supportive
- Humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
- Nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
- Suction is sometimes used for excessive upper airway secretions
- Severe cases: CPAP, endotracheal intubation and ventilation
- Antiviral therapy: Ribavirin is used in severe cases
19
Q
Bronchiolitis: discharge criteria
A
- Oxygen saturation maintained at >92% for 4 hours including a period of sleep
- Adequate oral intake (75% of normal)
- If babies are seen at the beginning of their illness inform the parents that they need to be carefully observed as they often get worse (day 3) before they get better
20
Q
Bronchiolitis obliterans
A
- A rare chronic complication of bronchiolitis, called popcorn lung
- Lungs are damaged by infection causing overactive cellular repair causing scar tissue to build
- Scarring and narrowing of bronchioles leading to respiratory failure
- Also occurs with lung transplant recipients
- Supportive treatment with immunosuppressive drugs i.e. Tacrolimus, cyclosporin
