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
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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
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3
Q

Describe the management of acute asthma

A
  • Oxygen, if needed
  • B-agonist
  • Prednisolone 1mg/kg
  • IV salbutamol bolus
  • Aminophylline / MgSO4 / Salbutamol infusion
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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
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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
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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)
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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!

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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.

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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

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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

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11
Q

If regular preventer therapy fails to control a child’s asthma, what therapeutic option is recommended? (Step 3)

A

Add-on therapy:

  1. Add LABA eg. Salmeterol
  2. Assess control of asthma (is there a response to LABA)?
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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

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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
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14
Q

An asthmatic child does not respond to treatment. Give 5 reasons why this might occur.

A
  1. Adherence (compliance)
  2. Bad disease
  3. Choice of drugs / devices
  4. Diagnosis
  5. Environment
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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!
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16
Q

Give some examples of upper respiratory tract infections in children.

A
  • Rhinitis
  • Otitis media
  • Tonsilitis
  • Laryngitis
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17
Q

Give some examples of lower respiratory tract infections in children.

A
  • Croup
  • Epiglottitis
  • Bronchiolitis
  • Pneumonia
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18
Q

Acute stridor is seen in Croup. What is the causative organism of croup?

A

Viral -> Usually Parainfluenza

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19
Q

Describe the signs + symptoms seen in a child with croup.

A
  • Worse at night
  • Barking, seal-like cough
  • Stridor
  • Recession
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20
Q

Croup is usually caused by parainfluenza. Describe the course of the disease in children.

A
  • Self limiting

- Spring / Autumn

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21
Q

A child in A+E is diagnosed with Croup. What medication should you give them?

A

Steroids!

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22
Q

What is the causative organism of acute epiglottis?

A
  • Haemophilus influenza B

=> causes a severe, acute illness

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23
Q

List 2 diseases that might be caused by meningococcus.

A
  • Septicaemia

- Meningitis

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24
Q

List 3 diseases caused by Haemophilus influenza B.

A
  • Epiglottitis
  • Meningitis
  • Pneumonia
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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