Paediatrics 2 Flashcards
Jaundice
Pathological
Physiological
Prolonged
In the first 24 hours
2-14 days
> 14 days
Causes of pathological jaundice (4)
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
G6PD
Causes of prolonged jaundice
biliary atresia hypothyroidism galactosaemia urinary tract infection breast milk jaundice congenital infections e.g. CMV, toxoplasmosis
Tests for prolonged jaundice
conjugated and unconjugated bilirubin direct antiglobulin test (Coombs' test) TFTs FBC and blood film urine for MC&S and reducing sugars U&Es and LFTs
Raised conjugated bilirubin could indicate which condition?
Mx
biliary atresia –> urgent surgery
Juvenile idiopathic arthritis (JIA)
Definition
Pauciarticular JIA definition
Antibody
Associated with which extrarticular issue?
arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks
4 or less joints are affected
ANA
Anterior uveitis
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel =
Mx
Complication
Ix for screening
Kawasaki
- High dose aspirin
- IV IG
Coronary artery spasm
ECHO as screening
Limping child
Name the condition
Limp may be painless
Juvenile arthritis
Limping child
Name the condition
Usually detected in neonates
6 times more common in girls
Development dysplasia of the hip
AP mimicking appendicitis
Rectal bleeding
Obstruction
Mx Surgery
Meckel’s diverticulum
Meningitis
Contraindications for LP
focal neurological signs papilloedema significant bulging of the fontanelle DIC signs of cerebral herniation meningococcal septicaemia
Meningitis
Mx
< 3 months: IV amoxicillin + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
Meningitis
When would you give dexamethasone?
frankly purulent CSF
CSF white blood cell count > 1000
raised CSF white blood cell count with protein conc >1
bacteria on Gram stain
Meningitis
Common organisms
Neonatal to 3 months (3)
Group B Strep
(E. coli
Listeria)
Meningitis
Common organisms
1 month to 6 years (3)
Neisseria meningitidis
(Streptococcus pneumoniae
Haemophilus influenzae)
Meningitis
Common organisms
Greater than 6 years (3)
Neisseria meningitidis
Streptococcus pneumoniae
Common age of achieving day and night time continence
3-4yo
Nocturnal enuresis
Mx
Look for underlying causes
Advice of diet, fluid intake, star charts etc
< 7yo - enuresis alarm
> 7yo - desmopressin
Meningococcal septicaemia Mx Dosages <1yo 1-10yo >10yo
IV benpen
300mg, 600mg, 1200mg
Umbilical cord contains?
How many arteries and how many veins?
two umbilical arteries and one umbilical vein
Mx umbilical hernia versus paraumbilical
likely resolve on its own by 1-3yo
unlikely with paraumbilical
cherry red lesions surrounding the umbilicus
may bleed on contact and be a site of seropurulent discharge
=
Mx
Umbilical granuloma
chemical cautery with topically applied silver nitrate
urinary discharge from the umbilicus
associated with other urogenital abnormalities.
Persistent urachus
umbilical discharge that discharges small bowel content
Persistent vitello-intestinal duct
left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat =
Mx
If needing to keep it open give?
PDA
indomethacin or ibupofen
to inhibit PG synthesis to help close it
PGE1
hip pain: develops progressively over a few weeks
limp
stiffness and reduced range of hip movement
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
More common in boys than girls
4-8yo
Perthes
What is the Caterall staging?
Staging for Perthes
Stage 1 Clinical and histological features only
Stage 2 Sclerosis with or without cystic changes and preservation of the articular surface
Stage 3 Loss of structural integrity of the femoral head
Stage 4 Loss of acetabular integrity
Perthes disease
Mx
Management
To keep the femoral head within the acetabulum: cast, braces
If less than 6 years: observation
Older: surgical management with moderate results
Operate on severe deformities
Prognosis
Most cases will resolve with conservative management.
usually presents by 6 months e.g. with developmental delay
child classically has fair hair and blue eyes
learning difficulties
seizures, typically infantile spasms
eczema
‘musty’ odour to urine and sweat*
=
AD/AR
Chrm
Diagnosed through which investigations?
PKU
AR
Chrm 12
Guthrie test (heel prick)
hyperphenylalaninaemia
phenylpyruvic acid in urine
Define precocious puberty
‘development of secondary sexual characteristics before 8 years in females and 9 years in males’
What does thelarche mean?
What does adrenarche mean?
thelarche (the first stage of breast development)
adrenarche (the first stage of pubic hair development)
Precocious puberty
Classification
- Gonadotrophin dependent
due to premature activation of the hypothalamic-pituitary-gonadal axis
FSH & LH raised - Gonadotrophin independent
due to excess sex hormones
FSH & LH low
