Paediatrics 2 Flashcards
1
Q
Give some causes of wheeze in a child
A
- Persistent infantile wheeze (small airways / smoking / viruses)
- Viral episodic wheeze (no interval symptoms / triggered by infection)
- Asthma (multiple trigger wheeze) -> persistent symptoms / FHx / atopic
- Other
2
Q
Describe the presentation of ‘viral episodic wheeze’.
A
- No interval symptoms
- No excess of atopy
- Likely to improve with age
- No benefit from regular inhaled steroids
- Use bronchodilators
3
Q
Describe the management of acute asthma
A
- Oxygen, if needed
- B-agonist
- Prednisolone 1mg/kg
- IV salbutamol bolus
- Aminophylline / MgSO4 / Salbutamol infusion
4
Q
Treatment approaches to asthma include preventer and reliever inhalers. What class of drugs are the preventers, and give some examples.
A
Preventers = inhaled steroids
- Beclomethasone
- Budesonide
- Fluticasone
5
Q
Treatment approaches to asthma include preventer and reliever inhalers. What class of drugs are the relievers, and give some examples.
A
B2 agonists eg.
- Salbutamol
- Terbutaline
- Ipratropium Bromide
6
Q
Preventer and reliever inhalers are used to manage asthma. List 5 Add-on therapies which may be used in adjunct to the preventers + relievers.
A
- Long acting B2 agonists
eg. Salmeterol, Formoterol - Leukotriene receptor antagonists eg. Montelukast
- Theophyllines
- Omalizumab (Anti-IgE)
- Protect (High IgE)
7
Q
On choosing a preventer inhaler for an asthmatic child, what considerations should you make?
What class of drugs are used as preventative medication in asthma?
A
- Lowest effective dose
- Minimise oral deposition
- Minimise GI absorption
STEROIDS!
8
Q
On choosing a reliever inhaler for an asthmatic child, what considerations should you make?
What class of drugs are used as reliever medication in asthma?
A
- Age-appropriate device
- Easy to use
- Portable
- Dosage not critical
Drug class: B2-agonists.
9
Q
A child has mild, intermittent asthma. What’s the first line management? (Step 1)
A
- Environment
- Inhaled short acting B2 agonist as required eg. Salbutamol
10
Q
What is meant by ‘regular preventer therapy’ with regards to asthma control in a child? (Step 2)
A
Inhaled steroid eg. Beclametasone
200 - 400mcg / day
11
Q
If regular preventer therapy fails to control a child’s asthma, what therapeutic option is recommended? (Step 3)
A
Add-on therapy:
- Add LABA eg. Salmeterol
- Assess control of asthma (is there a response to LABA)?
12
Q
If a child has persistent poor control due to asthma, what therapeutic management can you recommend? (Step 4)
A
Increase inhaled steroid up to 800 mcg / day
eg. Beclametasone
13
Q
If a child’s asthma is so poorly controlled that they are continuously / frequently using oral steroids, what action should you take?
A
- Refer to respiratory paediatrician
- Use daily steroid tablet in lowest dose providing adequate control
- Maintain high dose inhaled steroid at 800 mcg / day
14
Q
An asthmatic child does not respond to treatment. Give 5 reasons why this might occur.
A
- Adherence (compliance)
- Bad disease
- Choice of drugs / devices
- Diagnosis
- Environment
15
Q
What are the possible side effects of inhaled steroids (when used in the management of asthma)?
A
- May suppress the adrenals
- Might cause brief slowing of growth
- Oral thrush -> educate patient!
16
Q
Give some examples of upper respiratory tract infections in children.
A
- Rhinitis
- Otitis media
- Tonsilitis
- Laryngitis
17
Q
Give some examples of lower respiratory tract infections in children.
A
- Croup
- Epiglottitis
- Bronchiolitis
- Pneumonia
18
Q
Acute stridor is seen in Croup. What is the causative organism of croup?
A
Viral -> Usually Parainfluenza
19
Q
Describe the signs + symptoms seen in a child with croup.
A
- Worse at night
- Barking, seal-like cough
- Stridor
- Recession
20
Q
Croup is usually caused by parainfluenza. Describe the course of the disease in children.
A
- Self limiting
- Spring / Autumn
21
Q
A child in A+E is diagnosed with Croup. What medication should you give them?
A
Steroids!
22
Q
What is the causative organism of acute epiglottis?
A
- Haemophilus influenza B
=> causes a severe, acute illness
23
Q
List 2 diseases that might be caused by meningococcus.
A
- Septicaemia
- Meningitis
24
Q
List 3 diseases caused by Haemophilus influenza B.
A
- Epiglottitis
- Meningitis
- Pneumonia
25
What is 'pneumonia'?
A respiratory disease characterised by inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by viruses or bacteria or irritants.
26
How is pneumonia diagnosed in children?
- History of cough +/or difficulty breathing (<14 days duration) with increased respiratory rate (defined for age)
> 2 months: > 60 / min
2 - 11 months: > 50 / min
> 11 months: > 40 / min
27
What might be seen on an X-ray of a child who has pneumonia?
A dense or fluffy opacity that occupies a portion or whole of a lobe of lung that may or may not contain air bronchograms.
28
When should you consider bacterial pneumonia in a child under 3 years?
- Fever > 38.5oC
- Chest recession
- Resp rate > 50 / min
29
What is the leading causative organism of bacterial pneumonia?
Name some other organisms that can cause pneumonia.
Most common: Pneumococcus
Other bacterial organisms that cause pneumonia:
- H. influenzae type B (Hib)
- S. aureus
- K. pneumoniae
- Mycobacterium tuberculosis
30
What is the most common cause of viral pneumonia in children?
Name some other causative organisms.
Most common: Respiratory Syncytial Virus
Other viral causative organisms:
- Influenza A + B
- Parainfluenza
31
Which organisms might cause pneumonia in a HIV-positive child?
- Mycobacterium tuberculosis
Others
- Pneumocystis jiroveci
- Mycoplasma pneumoniae
32
What is meant by 'oedema'?
What signs + symptoms might a patient with oedema have?
Increase in interstitial fluid
'Swelling', pitting oedema,
Fluid moves under the influence of gravity -> ascites, pleural effusions, pulmonary oedema.
33
Give 4 causes of increased interstitial fluid.
1. Lymph drainage => lymphedema
2. Venous drainage + pressure => venous obstruction
3. Low oncotic pressure (low albumin / protein) => malnutrition, decreased albumin production (liver), increased loss (gut, kidney [nephrotic syndrome])
4. Salt + water retention => kidney (impaired GFR), heart failure
34
What triad of signs indicates Nephrotic Syndrome?
- Heavy proteinuria
- Hypoalbuminaemia
- Oedema
35
What are 'normal' albumin levels?
At what levels of albumin do fluid retention + oedema occur?
Normal: 35 - 45 g/l
Fluid retention + oedema: 25 - 30 g/l
=> Serum albumin is linked to fluid retention.
36
If protein loss occurs (eg. nephrotic syndrome), what other complications is a child susceptible to?
- Infection
| - Thrombosis
37
What are the 2 types of Nephrotic syndrome?
- Steroid sensitive
| - Steroid resistant
38
What would you see in steroid-sensitive nephrotic syndrome?
| Think about: BP? Renal function? Histology?
- Normal BP
- Normal renal function
- No features to suggest nephritis
- Histology: "minimal change"
39
What would you see in steroid-resistant nephrotic syndrome?
| Think about: BP? Renal function? Histology?
- Elevated BP
- Haematuria
- May be impaired renal function
- Features may suggest nephritis
- Failure to respond to steroids
- Histology: various, underlying glomerulopathy, basement membrane abnormality
40
What is the normal range for plasma glucose?
i) fasting
ii) post prandial
Fasting = 3.5 - 5.6mmol/l
Post prandial = <7.8mmol/l
41
Which test is used to diagnose diabetes?
OGTT
Diabetes:
Fasting = > 7.0 mmol/l
Post OGTT = >11.1mmol/l
HbA1c = > 6.5%
42
What is the pathophysiology of Type 1 Diabetes?
B-cell destruction leading to no insulin production.
43
What is the pathophysiology of type 2 diabetes?
T2DM due to:
- progressive insulin secretory defect => very low insulin production
OR
- Insulin resistance
44
What is the mainstay of treatment for type 1 diabetes?
Insulin
45
What is the mainstay of treatment for type 2 diabetes?
Treat with insulin and / or diet and exercise
46
Which 2 genes are associated with Type 1 diabetes?
HLA-DR3
| HLA-DR4
47
What are the actions of insulin?
- Stimulates glucose uptake from blood
- Lowers blood sugar
- Stimulates conversion of glucose to glycogen in the liver
48
How does Type 1 diabetes present?
Early:
- Pre-symptomatic
- Symptomatic
Late:
- DKA
49
Describe the pathophysiology of DKA.
- Insulin deficiency + glucagon excess =>
- Increased blood ketones + increased blood glucose
- Vomiting, osmotic diuresis => Fluid + electrolyte depletion
- Acidosis => cellular dysfunction, cerebral oedema, shock
50
How should you manage DKA?
- Fluid
- Insulin
- Monitor glucose hourly
- Monitor electrolytes, especially K+ and Ketones
- Very strict fluid balance
- Hourly neuro obs
51
What are the autonomic signs of hypoglycaemia?
- Irritable / Anxious
- Hungry
- Nauseous / shaky
- Sweaty / palpitations / pallor
52
What are the neuroglycopenic signs of hypoglycaemia?
- Dizzy, headache
- Drowsy
- Visual problems
- Problem concentrating
- Convulsions
53
A child is having a mild hypoglycaemic episode. How should you manage them?
- Check blood glucose to confirm
- Give 3-5 glucose tablets or 60-100mls lucozade
- Wait 10 minutes => if no improvement, repeat
- Follow up with longer acting carb (bread / biscuit)
=> Check blood glucose in 15 minutes.
54
A child is having a severe hypoglycaemic episode. How should you manage them?
- Do not attempt to give anything by mouth
- Glucagon: Sub cut / IM injection
- Wait 10 minutes
- When conscious, give sugar
55
What 'practical stuff' needs to be considered for a newly diagnosed diabetic?
- Injections
- Dietary guidance
- Carb counting
- Advice on exercise
- Hypoglycaemia education
- Sick day rules
56
Who would be involved in the MDT for a newly diagnosed diabetic?
- Liaison with school
- Paediatric Diabetic Specialist Nurses
- Frequent outpatient appointments
- Diabetes UK / Local groups
57
What are the aims of paediatric diabetes management?
- Normal growth and development
- As normal a childhood as possible
- Transition with optimal HbA1c to help prevent complications
- Avoidance of XS or severe hypos
58
What are the main complications of diabetes in the paediatric population?
- Reduced life expectancy
- DKA kills :(
- 30-40% develop microalbuminuria
- May require laser treatment for retinopathy
- Nephropathy
59
How is diabetes monitored in the paediatric population?
- HbA1c => 3 month profile
| - Blood glucose log book
60
A child with Type 1 diabetes presents for their check up. What examinations should you conduct?
- Eyes
- Urine
- Feet
- Blood pressure
- Injection sites
61
What are important things to remember when managing a child with DKA?
- Fluid before insulin
BUT
- watch the fluid => children get cerebral oedema => this can kill
62
Why does poor growth cause concern?
- Illness / neglect / deprivation
- Growth is a barometer of a child's physical and emotional well being
- social + economic circumstances
63
How should growth of a child be assessed?
- Growth velocity charts
| - Consideration for a variety of factors, including parental heights, social inequalities + ethnic background
64
When considering a child's growth, disproportion can give clues to a diagnosis. What would you be considering if a child had short limbs?
Hypochondroplasia
65
When considering a child's growth, disproportion can give clues to a diagnosis. What would you be considering if a child had a short back and long legs?
Delayed puberty
66
Why might a head circumference measurement be unreliable?
Inaccuracy
- Faulty technique
- Faulty equipment (wrongly positioned or calibrated)
- Un-cooperative children
67
What does an orchidometer measure?
Testicular size
68
At what age is 'delayed puberty' considered in i) girls and ii) boys?
Girls: > 13 years
Boys: > 14 years
69
At what age is puberty considered to be early in i) girls and ii) boys?
Girls: < 8 years
Boys: < 9 years
70
In normal puberty, what are the first signs of puberty in i) girls and ii) boys?
Girls: Breast buds
Boys: Testicular enlargement
71
Name 3 common problems associated with puberty / delayed puberty.
- Poor growth => failure to thrive
- Psychosocial deprivation
- Stretch marks / overweight
72
List 5 factors that affect birth weight.
- Maternal size + weight
- Parity
- Gestational diabetes
- Smoking
- Paternal size
73
Describe a baby's growth after birth.
- A third show catch-up growth
- A third maintain birth weight centile
- A third show catch-down growth
74
What is the purpose of 'thrive lines' on growth charts?
Help to differentiate pathology from normal 'catch-down' growth.
75
If a child is failing to thrive, what factors should you consider which may be indicative of why this child is FTT?
- Vomiting
- Dysmorphic features
- Diarrhoea
- Poor social circumstances
- Actual weight loss
- Weight > 2 major centiles below height.
76
List 6 causes of short stature.
- Constitutionally small => small parents
- Idiopathic short stature => usually small at birth
- Psychosocial
- Delayed puberty
- Chronic disease
- Endocrine causes => Striae => ? Cushing's
77
Obesity drives growth. How would you differentiate between a child who has an endocrine problem vs a child who has nutritional obesity?
Nutritional obesity: Tall + fat
Endocrine problem: Short + fat
78
Define 'failure to thrive'.
Failure to gain adequate weight or achieve adequate growth at a normal rate for age
OR
suboptimal weight gain in infants and toddlers.
79
What would be seen on a growth chart if a child is failing to thrive?
The child falls across 2 major centile lines
| at least 2 growth measurements are needed; 3-6 months apart
80
List some causes of 'Failure to Thrive' in children.
- Inadequate calorie intake
- Inadequate calorie absorption
- Excessive calorie loss
- Excessive calorie requirements
- Failure of utilization of absorbed calories
81
List some organic causes for inadequate calorie intake (which may lead to failure to thrive).
- Impaired suck / swallow
=> neurological disorder eg. cerebral palsy
=> cleft palate
- Chronic illness
=> chronic renal failure
=> liver disease
82
List some non-organic / environmental causes for inadequate calorie intake (which may lead to failure to thrive).
- Inadequate availability of food
- Psychosocial deprivation
- Neglect or child abuse
83
List some causes for inadequate calorie absorption, which may lead to failure to thrive.
- Enteropathy eg. coeliac, giardia
- Food intolerance eg. Cow's milk protein allergy, Lactose intolerance
- Short gut syndrome
- Pancreatic disease
84
List some causes for excessive calorie loss, which may lead to failure to thrive.
- Vomiting eg. gastro-oesophageal reflux, pyloric stenosis
| - Protein losing enteropathy
85
List some causes which require excessive calorie requirements, and which may lead to failure to thrive.
- Chronic illness eg. cardiac, renal, respiratory, GI, chronic infection (immune deficiency)
- Thyrotoxicosis
- Malignancy
- Abnormal movement disorder.
86
List some causes of 'failure of utilisation of absorbed calories', which may lead to failure to thrive.
- Chromosomal abnormalities
- Prenatal growth failure
- Metabolic abnormalities eg. hypothyroidism, glycogen storage disease, etc
87
When taking a history for a child ?failure to thrive, what should you ask about?
- Feeding Hx / Dietary Hx
- Systemic Hx: cough, lethargy, vomiting, diarrhoea
- Birth Hx: gestation + birth weight
- Pregnancy Hx (smoking)
- Development
- Family Hx
- Psychosocial Hx
88
When examining a child ?failure to thrive, what examinations should you conduct?
- Weight, height, head circumference => plot on a growth chart
- Heights of parents
- General examination
- Developmental assessment
89
Who would be involved in the MDT managing a child ?failure to thrive?
- Primary Care (Health Visitor)
- Dietician
- SALT
- Clinical psychologist
- Social services
90
What are the main drivers of growth in infancy?
- Nutrition
- Insulin + IGF
- Thyroxine
91
Why are infants vulnerable to malnutrition?
- High energy requirements => rapid growth
- Low density diet (milk)
- Higher morbidity
- Dependence on others for all food.
92
Why might faltering growth occur?
```
- Infant factors:
> low appetite
> minor or serious illness
> subtle neurodevelopmental delay
- Maternal factors
- Pre- and perinatal factors
- Social factors
```
93
List some adverse effects of faltering growth.
- Cognitive delay
- Feeding + behaviour problems
- Low maternal self-esteem
94
What interventions might be put in place for a child who is ?failure to thrive?
- Meal time organisation
| - Behaviour management
95
Describe the composition of breast milk from Day 1 to 7 post partum.
```
Days 1 -3: Colostrum
Days 3 - 7: Transitional
Day 7+: Mature
=> foremilk
=> hindmilk
```
*initial weight loss will be seen.
96
What is the expected weight gain of a child aged 0 - 3 months?
200g per week
97
What is the expected weight gain of a child aged 3 - 6 months?
150g per week
98
What is the expected weight gain of a child aged 6 - 9 months?
100g per week
99
What is the expected weight gain of a child aged 9 - 12 months?
75g per week
100
What foods should babies under 6 months avoid?
- Wheat + gluten
- Nuts + seeds
- Eggs
- Fish + shellfish
- Citrus fruit
- Liver + unpasteurised cheeses
101
What is the recommended feeding for children aged 6 - 9 months?
- Milk: 500-600mls daily (over 4 feeds)
- 3 meals a day => all food groups
- Textures and finger foods
102
When should you consider vitamin supplementation for a child under 5 years?
0-6 months: if exclusive breastfeeding + poor maternal diet
6-12 months: if breast fed or formula fed and <500mls formula milk daily
Children under 5 years
103
Which 2 vitamin deficiencies are common in children?
- Iron deficiency
| - Vitamin D deficiency
104
List 3 common problems associated with infant feeding.
- Colic
- Posseting
- Gastro-oesophageal reflux disease
105
Why is hearing important?
- Primary measure of communication
- Hearing is a prerequisite for speech development
- Hearing loss can result in developmental delays + academic underachievement
106
When is a child's hearing tested?
- Universal newborn screen
- Follow on from newborn screen (targeted follow up)
- School entry
- If concerns are identified
- In accordance with treatment protocol
eg. Chemotherapy, Cystic Fibrosis, Head trauma affecting temporal region (skull fracture).
107
What are the aims of a hearing test?
- Measure hearing threshold (dB)
- be frequency specific (Hz)
- obtain single ear information (if possible)
108
What are the 4 different levels of hearing loss?
- Mild
- Moderate
- Severe
- Profound
109
How do we test hearing? What are the 2 modalities?
- Objective testing
| - Behavioural testing
110
Objective testing forms part of a child's hearing assessment. What is the audiologist looking for when conducting this test?
- Otoacoustic emissions
| - Auditory brainstem response
111
Behavioural testing forms a part of a child's hearing assessment. What does this assess?
- Distraction testing
- Visual reinforcement Audiometry
- Performance testing
- Pure tone audiometry
- Speech discrimination testing
112
What are the 3 types of hearing loss?
- Conductive hearing loss
- Sensori-neural hearing loss
- Mixed hearing loss
113
Give examples of behavioural changes which might occur with temporary hearing loss.
- Appears to daydream => more 'with it' when nearer the teacher
- Asks for repetitions of instructions, or watches other children.
- Withdraws and does not mix well.
- Irritability or atypical aggression.
114
How might conductive hearing loss be managed?
- Most conductive losses resolve themselves over time, or are operable.
- Hearing aids may be offered for persistent losses
- In the case of permanent conductive losses, Bone Anchored Hearing Aid (BAHA) may be fitted.
115
How might sensori-neural hearing loss be managed?
- Hearing loss usually permanent
- Managed by hearing aids
- Aim to raise the level of hearing so that as much speech is as audible as possible
- In the case of profound hearing losses, cochlear implants may be recommended.
116
How might mixed hearing loss be managed?
- The conductive element will be addressed first
| - A hearing aid will be issued to help make all parts of speech audible, especially the high frequencies.
117
What conditions warrant a referral to Audiology?
- Any suspicion of hearing loss
- Speech delay
- Behaviour issues
- Meningitis
- Head injury
- Chemotherapy
118
Why have the incidence of twin pregnancies increased since the late 1970s?
Due to the introduction of IVF
119
A baby's cardiovascular system has to adapt to life ex-utero. How does it do this?
- Closure of fetal shunts
- Perfusion of the lungs
- Fall in pulmonary artery pressure
- Increase in cardiac outpit
- Foetal lung fluid removed
120
A baby's respiratory system has to adapt to life ex-utero. How does it do this?
- Lungs filled with air
- Surfactant released
- Gas exchange
121
Besides cardio-respiratory adaptation, what other adaptations does a baby have to make such that it can survive ex-utero?
- Control of own movements
- Independent hormonal responses
- Thermoregulation
- Feeding
- Immunocompetence
- Conversion to adult Haemoglobin
122
When does implantation happen?
Weeks 1 - 2 following missed period
123
A baby is classed as 'very low birth weight'. How much do they weigh?
Less than 1500g
124
A baby is classed as 'extremely low birth weight'. How much do they weigh?
Less than 1000g
125
A baby is classed as 'incredibly low birth weight'. How much do they weigh?
Less than 750g
126
A premature baby's lungs are immature. Describe the structure of the lungs.
- Little or no surfactant (it's retained in type 2 pneumocytes)
- Alveoli are absent at 24 weeks (then exponential increase towards term)
- Lung damage is made worse by: oxygen, sepsis, ventilation.
127
How is a diagnosis of 'Chronic Lung Disease of Prematurity' made?
Needing oxygen at 36 weeks corrected age.
128
What is the pathophysiology of chronic lung disease of prematurity?
- Reduced lung volume
- Reduced alveolar surface area
- Diffusion defect
129
What are the health implications of Chronic Lung Disease of Prematurity?
- Increased mortality
> SIDS rate increased x7
- Recurrent admissions
130
What are the neurological consequences of prematurity?
- Brain cells still developing + migrating
- Not all synapses are formed
- Brainstem not yet myelinated
- Changes in cerebral blood flow
- Changes in oxygen + carbon dioxide levels
131
What is the pathophysiology of 'Apnoea of prematurity'?
- Brainstem not myelinated fully until 32 - 34 weeks.
- 'Forget' to breathe (frequently associated with bradycardia)
- Made worse by sepsis.
132
What are the treatments options for Apnoea of prematurity?
Physical: NCPAP, Stimulation
Drugs: Caffeine(!)
133
What are the 'early years' implications of prematurity?
- Increased need for special schooling
| - Increased need for learning support
134
What are the benefits of breastfeeding for the infant?
- Fewer infections
- Less immune-driven / allergic disease
- Reduced risk of NEC
- Reduced risk of SIDS
- Higher IQ + better cognitive development
135
What are the maternal benefits of breastfeeding?
- Reduces risk of breast, uterine, ovarian and endometrial cancers
- Promotes postpartum weight loss
- Optimum child spacing
- Less medical expense
- More ecological
- Delays fertility
136
Prem babies can't suckle. How can we help them to feed?
- Support prem babies with IV fluids / parental nutrition
- Start small volumes of expressed breast milk
- Steadily build to full feeds
- Monitor growth
- Suck and swallow starts from 32 - 34 weeks
137
What are the 2 types of jaundice? (in prem babies)
| When does jaundice require investigation?
Unconjugated
Conjugated
Jaundice lasting more than 3 weeks needs investigation.
138
What are the causes of unconjugated jaundice?
- Haemolysis
- Prematurity
- Sepsis
- Dehydration
- Metabolic disease
139
Give a complication of unconjugated jaundice.
High levels can cause kernicterus.
140
How is unconjugated jaundice treated?
- Phototherapy (blue light, 450nm)
| - Exchange transfusions
141
What might cause conjugated jaundice? Is this worrying?
Caused by:
- Prolonged parenteral nutrition
- NEC
- Sepsis
- Metabolic / anatomical problems
High levels of conjugated bilirubin are not a worry.
142
Premature babies may develop sepsis due to an immature immune system. Which infective agents might cause this sepsis?
- Group B Strep
- Pseudomonas
- Coagulase negative staphylococcus
143
Why are prem babies more susceptible to developing sepsis?
During the last 3 months of gestation, there is active IgG transfer.
- the more premature you are, the less IgG you get
- Cell-mediated immunity is less active, as well.
- Multiple invasive procedures
- Plastic tubes are not patrolled by the immune system :(
144
Describe the pathophysiology of retinopathy of prematurity.
- Hyperoxic insult
- Arrest of normal vascular growth
- Fibrous ridge forms
- Vascular proliferation
- Retinal haemorrhages
- Retinal detachment
- Blindness
145
What is the treatment for retinopathy of prematurity (ROP)?
Laser therapy (if there are high-risk changes seen).
146
What should you NEVER forget about when working with prem babies?
THE PARENTS
- Antenatal counselling
- Post delivery counselling
- Prognostic counselling
- Regular updates
- Palliative care / bereavement counselling
147
What is the law regarding the treatment of prem babies?
- You have a duty of care to treat patients + the parental wishes are paramount BUT
- They cannot force you to administer therapy that you believe in ineffective
- INDEED forcing treatment upon someone could be assault. BUT
- as you have a duty of care, you may want to treat when the parents do not wish the same.
148
Which pathogens cause Acute Otitis Media in children under 5?
Respiratory pathogens:
- S. pneumoniae
- H. influenza
- M. catarrhalis
- S. progenies
149
Give some symptoms of a child presenting with acute otitis media.
Pain
Pyrexia
Unwell
Otorrhoea (discharge from the ear(s))
150
What features in a paediatric history would point you towards a diagnosis of acute otitis media?
- Otalgia (ear ache)
- URTI
- Ear tugging
151
List 2 extra cranial complications of acute otitis media.
- Mastoiditis: presents with ear protrusion and post-auricular swelling and redness
- Tympanic membrane perforation
152
List 5 intracranial complications of acute otitis media.
- Meningitis
- Extradural abscess
- Subdural abscess
- Cerebral abscess
- Lateral sinus thrombosis
153
What is the treatment for acute otitis media?
- ? Viral: short period of observation (24-48h)
- Analgesia
- Antibiotics use is contentious!
154
What is the management for recurrent acute otitis media?
- Analgesia
- Repeat antibiotic courses
- Abx prophylaxis
- Grommet insertion
155
What is the common name for 'Otitis media with effusion'?
Glue ear
156
Who is affected by glue ear? What can glue ear cause?
- Children aged 2 - 5 years
| - Glue ear can cause hearing loss
157
List some predisposing factors to glue ear.
- Older sibling
- Male sex
- Parental smoking
- Immune deficiency / allergy
- Anatomical abnormalities eg. cleft palate
158
What is the treatment / management for glue ear?
- Watch and wait for 3/12
- 50% will get better
- No medical treatment
- Ventilation tubes
- Adenoidectomy
- Hearing aids
159
How might a child with hearing loss present?
- Parental concern
- Speech development
- Behaviour
- Education
- Screening
160
Why is hearing screening so important for speech development?
- Limited time for speech development
- Outside of this window, no scope to develop speech
- Children discovered having been deprived of contact with speech - never develop speech
161
When are screening tests for hearing loss conducted?
- At birth
- Health visitor distraction test
- School entrance
162
List 4 risk factors of sensorineural hearing loss (SNHL).
- Family Hx
- SCBU (Special Care Baby Unit)
- Consanguinity
- Syndromic
163
Give 4 ways in which deafness rehabilitation is conducted.
- Grommets
- Amplification Hearing Aids
- Bone Conduction Hearing Aids
- Cochlear Implantation
164
What are the indications for a tonsillectomy?
- Recurrent acute tonsillitis (more than 7 episodes per year)
- Biopsy
165
List 3 causes of snoring in children.
- Simple snoring
- Sleep disordered breathing
- Obstructive sleep apnoea
166
How are snoring disorders diagnosed in children?
Clinical assessment + sleep studies
167
What are the anatomical causes for snoring in children?
- Tonsils / adenoids
- Lingual tonsil
- Macroglossia
- Enlarged inferior turbinates / deviated septum
168
List some complications of a tonsillectomy.
- Pain
- Bleeding
- No evidence to suggest more prone to other infections
169
List the types of chronic diarrhoea presenting in childhood.
- Spurious: over / underfeeding; constipation
- Chronic, non-specific diarrhoea
- Malabsorption
- Enteric infection
- Inflammatory bowel disease
- Drug induced
- Non-intestinal pathology: neuroblastoma, thyroid disease
170
A child presents with diarrhoea. What points should you consider?
- Is it really diarrhoea?
- Is dietary intake enough to gain weight?
- Description of the stools
- Frequency, time of day
- General health - resp symptoms??
- Drug Hx
- Family Hx
- PMH / Surgery
171
What is Cow's Milk protein allergy associated with?
- Atopic diseases
172
What percentage of infants show symptoms suggesting adverse reactions to cow's milk?
5 - 15%
| Note: estimates of CMPA vary from 2 - 7.5%
173
What are the symptoms of a child who has CMPA?
| Cow's Milk Protein Allergy
- Vomiting / Diarrhoea
- Abdo pain
- Intestinal bleeding (gross or occult)
- Malabsorption
174
How is CMPA treated?
| Cow's Milk Protein Allergy
Formula feeds
175
Who gets Toddler's Diarrhoea?
- Children aged 6 - 20 months
| - 90% have normal stools by 3 years of age
176
Describe the symptoms of Toddler's Diarrhoea.
- Normal growth
- 3 - 4 stools / day
- 1st stool of day large; others small
- Stools contain mucus + undigested food
- Diarrhoea recurrent or persistent
- No relation to diet
- FHx of functional bowel symptoms
177
Describe the pathophysiology of Giardiasis infection.
Protozoan: cystic form in stool; motile trophozoite in small intestine
- Villous atrophy, esp. with IgA deficiency
178
How is Giardiasis diagnosed?
| What's the treatment?
Diagnosis: cysts in stool or motile forms in jejunal juice
Treatment: 3/7 high dose metronidazole
