Paediatrics Flashcards
Describe cot death (Sudden Unexplained Infant Death), it’s risk factors and Preventative measures
Refers to unexpected death of infant less than 12 months where a cause is not immediately obvious prior to investigation. It is due to infection, metabolic errors, accidental suffocation and Sudden Infant Death Syndrome which is a still unexpected death after investigation.
Risk increased if:
- poor
- parents are smokers
- baby is male or premature
- winter
- previously sibling affected by SIDS
- co-existing URI
- co-sleeping
Recommend:
- do not overheat baby’s bedroom, aim for 16-20C
- do not use too much bedding
- avoid co-sleeping
- sleep baby facing up
Describe Oppositional Defiant Disorder, its symptoms, and management
A lesser version of conduct disorder, Enduring pattern of negative hostile and defiant behaviour without serious violation of societal norms or the rights of others, which may only be present in one environment.
Symptoms:
- Temper
- argues with adults
- defies adult requests
- deliberately annoys others
- shifts blame
- easily annoyed
- angry/resentful
Management:
- Parent training programs (Triple P)
- Individual cognitive therapy for older children, aims to support young person to approach difficulties and stress through systematic problem solving rather than through jumping to conclusions and engaging in aggression
- multi-agency therapy, work with young person, family, parents, school, criminal justice system
Describe Conduct Disorder, its symptoms, and it’s management
It is a type of behavioural disorder, defined as persistent failure to control behaviour appropriately within socially defined rules.
Symptoms:
- Characterised by persistent antisocial behaviour that violates the rights of others, and age-appropriate social norms.
- Syndrome of core symptoms, defiance of will of someone in authority, aggression, antisocial behaviour.
- There may be aggression to people and animals, destruction of property, theft, truancy, provocative/disobedient behaviour.
Management:
- Parent training programs (Triple P)
- Individual cognitive therapy for older children, aims to support young person to approach difficulties and stress through systematic problem solving rather than through jumping to conclusions and engaging in aggression
- multi-agency therapy, work with young person, family, parents, school, criminal justice system
Describe Attention Deficit Hyperactivity Disorder (ADHD), it’s symptoms, and management.
Most common neurobehavioural disorder in childhood. Commoner in learning-disabled children and if prenatal cannabis exposure.
Symptoms:
- core diagnostic criteria are impulsivity, inattention, and hyperactivity.
- Attention deficit signs: unable to listen/attend closely to detail, unable to sustain attention in play activities, unable to follow instructions, unable to finish homework, unable to organise tasks ending sustained application, unable to ignore extraneous stimuli, unable to remember simple tasks.
- Hyperactivity signs: squirming/fidgeting, on the go all the time, talks incessantly, climbs overly everything, restless, no quiet hobbies, impulsive, blurts out answers, too impatient to take turns or to queue.
Management:
- Diagnosis and treatment should be initiated by a specialist e.g. Psychiatrist/paediatrician
- advice on positive parenting and behavioural techniques
- 1st line regiment is parent training/education programmes +/- CBT for older children
- Drugs such as methyphenidate (Ritalin) may be useful if non-drug treatment fail, or atomoxetine, or combination if severe.
Describe haemolytic uraemia syndrome and its symptoms
It is most common cause of AKI in children. Endothelial damage commonly (90%) from E.coli strain O157 leads to thrombosis, platelet consumption and fibrin strand deposition mainly in renal microvasculature. Strands cause mechanical destruction of RBC’s giving triad of haemolysis, thrombocytopenia and AKI.
Symptoms: Clinical features include abdominal pain, bloody diarrhoea and AKI.
Describe the six-week baby check, it’s main purpose, and what it entails.
It includes a physical examination, a review of development, an opportunity to give health promotion advice, and an opportunity for the parent to express concerns
Main Purpose:
- detect congenital heart disease
- detect development dysphasia of the hip (DDH)
- detect congenital cataract
- detect undescended testes.
Physical Examination:
- a weight check
- measurement of head circumference
- a general assessment of appearance I.e. Colour, behaviour, breathing, activity
- assessment of tone, movements and posture
- assessment of head, fontanelles, face nose palate and symmetry
- assessment of the eyes for presence of red reflex and visual fixing
- assessment of the heart, it’s position, murmurs, rate, femoral pulses, apex beat, ventricular heave,
- assessment of lungs, added sounds and rate (RR over 55 is suspicious), cyanosis, respiratory distress,
- assessment of abdomen, shape, organomegaly, herniae
- assessment of genitalia, normality, testicular descent
- examination of the hips by Barlow and Ortolani tests and by looking for symmetrical skin crease in the thighs. Check for leg length discrepancy.
- assessment of the spine
Review of development:
- review feeding and weight gain
- check growth chart
- review vision and hearing
- socially most babies smiling at 6 weeks and have a range of sounds.
Parent concerns?
Health promotion:
- vaccinations
- breast-feeding and weaning advice
- reduce risk of cot death, no smoking, put baby to sleep on its back, avoid falling asleep with the baby in same bed, avoid overheating, avoid bulky or lose items of bedding like pillows and duvets, encourage breast-feeding
Describe Pertussis (Whooping cough), it’s signs, and management
Bordetella pertussis, peak age in infants with second peak in those over 14. Whoops are caused by inspiration against a closed glottis.
Signs: apnoea, bouts of coughing ending with vomiting +/- cyanosis worse at night or after feeds.
Management:
- erythromycin is often used in those likely to expose infants to the disease.
- admit if less than 6 months due to risk of apnoea.
- can be self-limiting and mild.
- vaccine available not always effective.
Describe Hand Foot and Mouth disease, its symptoms and management.
Very common viral infection of children typically caused by Coxsackievirus A16
Symptoms: the child is mildly unwell, develops vesicles on palms, soles and mouth. They may cause discomfort until they heal.
Treatment:
- self-limiting in 1-2wks
- symptomatic control for temperatures. Ensure good oral intake.
Describe Kawasaki Disease and its symptoms
Medium vessel vasculitis of children similar to PAN. Median age is 10 months. Can lead to coronary artery aneurysm and infarction.
Symptoms: Child may present with bilateral non-purulent conjuncitivits, pharyngeal injection, strawberry tongue, pyrexia, diarrohea, neck lymphadenopathy, rash, palmar erythema, fingertip desquamation.
What is meconium?
The first stool of a mammalian infant, unlike faeces it is composed of materials ingested during the time spent in the uterus such as intestinal epithelial cells, mucus, main iota fluid. It is a viscous and stick like tar and is usually a dark olive green and almost oderless.
Describe Meconium Aspiration Syndrome (MAS) and its management.
Occurs in the term/near term infant when meconium, the faecal material that accumulates in the foetal colon during gestation, is passed in utero, leading to meconium stained amniotic fluid (MSAF). MSAF occurs in around 8-25% of births, usually due to foetal distress or advance foetal age. MAS occurs only in 5% of these infants; it is defined as respiratory distress in the infant born through MSAF which cannot otherwise be explained. Aspiration of meconium mostly occur pre-birth. It may lead to airway obstruction, surfactant dysfunction, pulmonary vasoconstriction, infection, and chemical pneumonia is.
Management:
- Intrapartum suctioning of the Oro/nasopharynx is not recommended.
- Endotracheal suctioning is only needed for those infants who aren’t vigorous at birth.
- Surfactant, ventilation, inhaled nitric oxide and antibiotics are all used.
What are the reference intervals for paediatric observations?
Less than 1 year:
- RR 30-40/min
- PR 110-160/min
- Systolic BP 70-90mmHg
2-5yrs:
- RR 20-30/min
- PR 95-140/min
- Systolic BP 80-100mmHg
5-12yrs:
- RR 15-20/min
- PR 80-120/min
- Systolic BP 90-110mmHg
Older than 12yrs:
- RR 2-16/min
- PR 60-100/min
- Systolic BP 100-120mmHg
Describe Retinopathy of Prematurity, its screening, and management.
A disorder of the developing retina. Major risk factors are low birth weight and prematurity. Exposure to supplemental oxygen is a cause, in particular large fluctuations in PaO2, so careful titration of O2 levels has led to a decrease in the incidence of RoP. Abnormal fibrovascular proliferation or retinal vessels am lead to retinal detachment and visual loss.
Screening:
- Screening is recommended if less than 1500g or 32 weeks gestation.
- If less than 27 weeks, screen at 30-31 weeks post-menstrual age.
- If born at 27-32 weeks then screen at 4-5weeks post natal age.
- Screening ought to be repeated 1-2 weekly depending on severity of disease. It must be done by an experience ophthalmologist.
Management:
-Diode laser therapy causes less myopia than cryotherapy.
Describe IntraVentricular Haemorrhage (IVH), it’s signs, tests, complications, and management.
Occurs in 25% if birthweight less than 1500g. Preterm infants are at risk of IVH due to unsupported blood vessels in the subependymal germinal matrix and the instability of blood pressure associated with birth trauma and respiratory distress. Delayed cord clamping in press may decrease risk.
Signs: Suspect in neonates who detioriate rapidly, especially in week 1. There may be seizures, bulging fontanelle, and cerebral irritability but many will have no clinical symptoms.
Tests: ultrasound is preferred
Complications: decreased IQ, cerebral palsy, hydrocephalus.
Management: Meticulous nursing, head elevation, circulatory support, seizure control (1st line phenobarbital loading dose 20mg/kg IV as slow injection).
What is Transient Tachypnoea of the Newborn (TTN)?
Respiratory distress due to excess lung fluid, usually resolves after 24h. Treatment is supportive and may include supplemental oxygen and antibiotics.
Describe Respiratory Distress Syndrome (RDS), it’s signs, prevention, and treatment.
RDS is due to a deficiency of alveolar surfactant, which is mainly confined to premature babies. Insufficient surfactant leads to alveolar collapse; re-inflation, with each breath exhausts the baby, and respiratory failure follows. Hypoxia leads to decreased cardiac output, hypotension, acidosis and renal failure. It is the major cause of death from prematurity.
Signs: Respiratory distress shortly after birth (1st 4h) I.e. Tachypnoea more than 60/min, grunting, nasal flaring, intercostal, subcostal and/or sternal recession, and cyanosis. CXR shows diffuse granular patterns (ground glass appearance).
Prevention: Betamethasone or dexamethasone should be offered to all women at risk of preterm delivery from 23-35 weeks, mothers at high risk should be transferred to perinatal centres with experience in managing RDS.
Treatment:
- delay clamping of cord by 3 min to promote placento-foetal transfusion.
- Give oxygen via an oxygen/air blender using the lowest concentration possible.
- If spontaneous breathing stabilise with CPAP (5-6cmH2O)
- Babies at high risk should get surfactant.
- aim for sats between 85-93% to prevent retinopathy of prematurity
- if blood gases worsen, incubate and support ventilation.
Describe PeriVentricular Leukomalacia (PVL), it’s causes, signs, and management.
A form of white matter injury, characterised by the necrosis of white matter near the lateral ventricles. Affected individuals generally exhibit motor control problems and other developmental delays and often develop cerebral palsy or epilepsy later in life.
Causes: It is thought to be due to two major factors, decreased blood or oxygen flow to the PeriVentricular region, and damage to the glial cells. It is thought that initial hypocrite events cause damage to blood-brain barrier which leads to further hypoxic difficulties.
Presentation: Delayed motor development, vision deficits, apnoeas, low heart rates, and seizures. Found on routine US of head.
Management:
- reduce hypoxic and Brady events
- no treatment available
What is the definition of preterm?
A neonate whose calculated gestational age from the last menstrual period is less than 37 weeks
What is the definition of the neonatal period and thus a neonate?
The neonatal period is the 1st 28days of life in a term baby, in a preterm baby it is up to 44 completed weeks of the infants conceptional age I.e. Gestational age + chronological age (e.g. 37+7).
Describe growth charts and how preterm infants are corrected for.
Preterm infants may be plotted on the preterm growth chart or the low birth weight chart if less than 32 weeks gestation. There may be some weight loss in the early days after birth.
Gestational correction: Plot actual age then draw a line back the number of weeks the infant was preterm and mark the spot with an arrow. This is the gestationally corrected centile.
Describe the Child Immunization schedule.
2 months: 5in1 DTaP/IPV/Hib vaccine to protect against five separate diseases, diphtheria, tetanus, whooping cough(pertussis), polio, and haemophilus infleunza type b. PCV vaccine for pneumococcal disease. Rotavirus vaccine. Men B vaccine.
3 months: 5in1 DTaP/IPV/Hib second dose, Men C vaccine, Rotaviris second dose.
4 months: 5in1 DTaP/IPV/Hib third dose. PCV second dose, Men B second dose.
12-13months: Hib/Men C booster, MMR vaccine, PCV third dose, Men B third dose.
2,3 and 4 years pls school years one and two: Annual children flu vaccine.
From 3years and 4 months up to starting school: MMR second dose, DTaP/IPV pre school booster.
12-13 Years girls only: HPV vaccine
At what age does one have capacity to consent to sexual activity?
13 years, sexual activity under this age is considered rape regardless of consent. Legally consent is not possible until 16.
Describe Hypoxic-Ischaemic Encephalopathy, it’s symptoms, management
Brain injury due to birth asphyxia/RDS.
Symptoms: Lethargic, hypotonia, sluggish or absent grasping, Moro and sucking reflexes. Period of apnoea. Seizures. Pupils may be dilated, fixed or poorly reactive to light.
Management:
- ensure adequate ventilation
- avoid large fluctuations in blood pressure and oxygen levels.
- avoid hypo/hyperglycaemia
- avoid hyperthermia.
- treat seizures
- hypothermia therapy, NNT = 7
Describe Patent Ductus Arteriosus (PDA), its symptoms, and management.
An acyanotic cause of congenital heart disease. Due to failure of the Ductus Arteriosus to close after birth. Normally PDA closes in response to a rise in PaO2.
Symptoms: Failure to thrive, Pneumoniae, CCF, SBE, collapsing pulse, thrill, loud S2, systolic pulmonary area murmur, or continuous machinery hum that may radiate to back. ECG may show LVH.
Management:
- dexamethasone in preterm labour helps close PDAs.
- watch and wait and consider surgical closure if not spontaneous closure.
Describe Persistent Pulmonary Hypertension with reference to normal physiological changes at birth, its symptoms, and management.
With our first breath pulmonary vascular resistance falls, and there is a rush of blood to our lungs. This is partly mediated by endogenous nitric oxide. This breath initiates changes from foetal to adult circulation, a process which may be interrupted in various conditions e.g. Meconium aspiration, pneumonia, RDS, diaphragmatic hernia, group B strep infection, and pulmonary hypoplasia.
Symptoms: Tachypnoea (more than 60), grunting, intercostal/subcostal recessions, cyanosis, mottled skin, lows sats with oxygen.
Management:
Usually requires inhaled nitric oxide and high frequency oscillatory ventilation. May require extracorporeal membrane oxygenation
Describe Necrotising EnteroColitis (NEC), its risk factors, signs, and management.
An inflammatory bowel necrosis.
Risk Factors: Prematurity is the chief risk factor. If weight is less than 1500g 5-10% develop NEC. Other risks factors include enteral feeds, bacterial colonisation, mucosal injury, rapid weight gain.
Signs: Abdominal distension, blood/mucus PR, may be tenderness and perforation if severe and so signs of shock, DIC. Pneumatosis intestinalis (gas in the gut wall seen on X-Ray) is pathognomonic.
Management:
- Stop oral feeding
- culture faeces, cross match, monitor platelets, less than 100 is severe.
- give antibiotics e.g. Cefotaxime + vancomycin
- liaise early with surgical team, laparotomy may be neccessary if progressive distension or perforation.
Describe Oesophageal atresia, it’s signs and management.
Often occur with tracheo-oesophageal fistula, but may occur without. Is there air in the bowel?
Prenatal Signs: polyhydraminos (too much amniotic fluid), small stomach. Postnatal signs: cough, airway obstruction, increased secretions, blowing bubbles, distended abdomen, cyanosis, aspiration. Commonly diagnosed on inability to pass a catheter into roam have, X-Ray’s show it coiled in the oesophagus. There may also be duodenal atresia, shown on X-ray by double bubble sign.
Management:
- stop feeding
- suck out the oesophageal pouch.
- Primary surgical repair is possible in majority of cases and in 50% there are other anomalies.
Describe Hirschsprung’s Disease, and it’s management.
Occurs in 1/5000 births. Congenital absence of ganglia in a segment of colon. Leading to functional GI obstruction, constipation, and mega colon. Faeces may be felt per abdomen, and PR exam may reveal a tight anal sphincter and explosive discharge of stool and gas. It is 3 times as common in males.
Complications: GI perforation, bleeding, ulcers, EnteroColitis, short gut syndrome afternoon Surrey,
Management:
-excision of aganglionic segment +/- colostomy.
Describe Pyloric Stenosis, its presentation, investigations, and management.
An acute surgical problem, 4 times more common in males, and with a FHx in 5-10%.
Presentation:
- Presents at 3-8wks with vomiting which occurs after feeds and becomes projectile (e.g. Vomiting over far end of the cot).
- It is distinguished from other causes of vomiting by the following: the vomit does not contain bile, there is no diarrohoea, baby is alert, anxious and alway hungry possibly dehydrated and malnourished.
- Vomiting is large volume and minutes after a feed.
Investigations:
- Examination, observe for left-to-right LUQ peristalsis during a feed, seen in late-presenting babies. Try to Palpate the olive-side pyloric mass by standing on the baby’s left side palpating with the left hand at the lateral border of the right rectus in the RUQ, during a feed from a bottle of the left breast.
- U+Es may show a hypochloraemic, Hypokalaemia metabolic alkalosis which needs to be corrected before surgery.
- USS if -ve examination
Management:
- correct electrolyte disturbances before surgery
- ramstedt’s pyloromyotomy/ endoscopic surgery.
Describe intussusception, it’s presentation, and management.
The most common cause of intestinal obstruction in children. The small bowel telescopes as if were swallowing itself by invagination. 3 times more common in men.
Presentation: Typically at 5-12months but can be any age, with episodic, intermittent inconsolable crying, with drawing the legs up (colic) +/- vomiting +/- blood PR (like red-currant jelly). A sausage shaped abdominal mass may be felt.
Management:
- pre-op, resuscitate, crossmatch, NG tube.
- least invasive is USS and reduction with air enema.
- If reduction by air fails laparoscopy/laparotomy is needed.
- Necrotic bowel will need to be resected.
Describe a Medulloblastoma, it’s presentation, and management.
Midline cerebellar embryonal tumour (inferior vermis).4 times more common in males, peak age is around 4yrs.
Presentation: headache, papilloedema due to increased ICP, speech difficulty, truncal ataxia +/- falls.
Management:
-surgical resection + radio/chemotherapy
Describe Neuroblastoma, it’s presentation, and management.
Thought of as a embryonal neoplasm, derived from sympathetic Neuroblasts. Presents in decreased frequency from birth to 5yrs of age. Some forms regress others are highly malignant. It is the most-common solid tumour in the under 5s.
Presentation: in children unilateral proptosis may be the 1st sign. Abdominal swelling. Commonly metastasise to lymph nodes (lymphadenopathy), scalp, bone (pancytopaenia +/- osteolytic lesions). 97% have raised urinary excretion of catecholamines.
Management:
- refer to specialist centre
- Excision if possible and chemotherapy (e.g. Cyclophosphamide + doxorubicin)
Describe Wilms’ Nephroblastoma, it’s presentation, and management.
Commonest renal tumour of childhood 6-7% of all malignancies. It is an undifferentiated mesodermal tumour of the intermediate cell mass. Median age of presentation is 3.5yrs and 95% of tumours are unilateral.
Presentation: Fever, flank pain, abdominal mass. On USS renal pelvis distortion, hydro nephrotic may be seen. CT/MRI provide the detailed anatomical information need for surgical planning.
Management: Avoid biopsy, nephrectomy + vincristine and actinomycin for 4 weeks pre-op can cure.
-More advanced sages need 3-drug regimen + radiotherapy
Describe Cow’s Milk allergy, it’s presentation and management.
Common, occurs in up to 7% of children. Most children with milk allergy outgrow it (average 5 years for IgE mediated and 3 years for non IgE mediated).
Presentation: Usually in infancy. Allergy may be IgE mediated with rapid onset of symptoms such as urticaria or angioedema or non-IgE mediated, producing more delayed symptoms such as eczema
Management: Exclusion of cows’ milk protein from diet including diet of breastfeeding mother under dietician supervision.
-Use of alternative formulas such as fully hydrolysed or Soy.
Describe Allergic Rhinosinusitis, it’s presentation, and management.
May be seasonal, high risk in 5-14year olds. Caused by IgE-mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells.
Presentation: Chil with sneezing, pruritis, rhinorrhoea. May notice Denny Morgan lines, allergic shiner, allergic salute.
Management:
- antihistamines
- nasal douching
- nasal steroids
Describe Diabetic Ketoacidosis, it’s presentation, investigations, and management.
A medical emergency. Ketoacidosis is an alternative metabolic pathway that occurs in starvation states, an breaks down protein giving acetone as a by product. In diabetic Ketoacidosis there is excessive glucose but because of lack of insulin this cannot be taken up into cells pushing the body into a starvation state where Ketoacidosis occurs.
Presentation: Gradual drowsiness, committing and dehydration in a type 1 diabetic. May also be history of polyuria, polydipsia, lethargy, anorexia. Signs of dehydration and ketotic breath occur later deep and rapid (Kussmaul) breathing.
Investigations:
- Urinalysis (glucose, ketones)
- BM (hyperglycaemia greater than 11mmol/L)
- Blood Gas (Acidaemia pH less than 7.3) (Severity on pH e.g. Mild = less than 7.3, moderate less than 7.2, severe less than 7.1)
- Bloods, U+Es, Glucose, HbA1c, Cultures (if pyrexial), FBC.
- ECG (looking for peaked t-waves hyperkalaemia)
Management:
-DR ABCDE Assessment
-Be wary of sudden fluid changes as risk of cerebral oedema.
-Fluid status examination + fluids replacement
-IV fluids for 1h then IV insulin, unless able to orally rehydrate and SC insulin.
-Monitor bloods stop insulin when ketones less than 1mmol/L if glucose falls to less than 14mmol/L give dextrose alongside fluids.
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Describe Eosinophillic Oesophagitis, its symptoms, and management
An allergic inflammatory condition of the oesophagus. Mostly described in children but can occur in adults. Food allergy may play an important role. More common in males.
Symptoms: difficulty swallowing, food impaction, regurgitation, vomiting, deceased appeitite. Diagnosed on OGD which does, ridges, furrows and scalloping of oesophagus.
Management: Dietary evaluation, allergy removal.
-corticosteroids and NSAIDs for remission. Antihistamines.
Describe the APGAR Neonatal Assessment.
A score of 0-2 for each:
- Appearance, 2 = Pink, 1 = blue limbs, 0 = all blue or white
- Pulse, 2 = more than 100, 1 = less than 100, 0 = pulseless
- Grimace, 2 = coughs well on suction, 1 = depressed cough on suction, 0 = no response
- Activity, 2 = Active, good muscle tone flexed arms and legs that resist extension, 1 = Limb flexion, 0 = absent
- Respiratory effort, 2 =strong cry, 1 = slow irregular cry. Gasping 0 = absent
Describe Congenital Diaphragmatic Hernia, it’s signs, and management.
A developmental defect in the diaphragm allowing herniation of abdominal contents into chest. Leads to impaired lung development (pulmonary hypoplasia and pulmonary hypertension). May be diagnosed on prenatal ultrasound, postnatal CXR.
Signs: Difficult resuscitation at birth, respiratory distress, Bowles sounds in one hemithorax (usually left and heart heard on right).
Management:
- post-nasally insert a large bore nasogastric tube when diagnosis is suspected. At birth if prenatal diagnosis. The aim is to keep all air out of the gut.
- Face mask ventilation is contraindicated so immediately intubation, ventilate and paralyse with minimal pressures.
- surgical correction neccessary m
What are babies born to diabetic mothers at risk of?
-3x more malformation rates (sacral agenesis almost exclusive to this group, CVS + CNS more common), babies may e too large or growth restricted. Neonatally they may be hypoglycaemic, Hypokalaemia, low magnesium, higher risk of RDS, polycythaemic so more neonatal jaundice.
What is Erb’s Palsy
Damage to brachial plexus C5, C6 damage affects supra scapular, musculocutaneous and axillary nerves. This leads to paralysis of supraspinatus (abduction), infraspinatus (internal rotation), biceps (supination), brachialis (flexion of elbow), deltiod (abduction) and teres minor (external rotation). As a result the arm is held internally rotated, pronated, extended, and adducted in the waiters tip position. Difficult deliveries in neonates can produce this sign.
Describe Bronchiolitis, its symptoms, tests, and management.
The big lung infection in infants. Typical cause is RSV, also mycoplasma, adenovirus, parainfluenza. Those under 6 months are most at risk. Usually self-limiting.
Symptoms: Coryzal precedes cough, low fever, tachypnoea, wheeze, inspiratory crackles, apnoea, intercostal recession +/- cyanosis. Signs that prompt admission include poor feeding, RR greater than 50/min, apnoea, dehydration, rib recession, patient or parental exhaustion.
Tests: CXR if severe, may show hyperinflation, Blood gases, FBC.
Management:
- O2 stop when sats above 92%
- nasogastric feeds,
- don’t routinely use bronchodilators and steroids
- supportive
- infants younger than 24 months with chronic lung disease, infants who are younger than 12 months who were born before 29 weeks, who have specific types of heart disease may be given a special medication palivizumab to protect against RSV.
Describe Neonatal Jaundice, it’s causes, tests, and management.
Occurs in 60% of neonates, most do not require treatment. It is due to raised bilirubin. When severe or not managed Kernicterus a permanent form of brain damage may occur.
Causes:
- after 24hr usually Physiological due to increased bilirubin production in neonates due to shorter RBC lifespan, decreased bilirubin conjugation due to hepatic immaturity, and absence of gut flora impedes elimination of bile pigment.
- Within 24 hr may be rhesus haemolytic disease, ABO incompatibility, Red cell anomalies (congenital spherocytosis, G6PD deficiency
- prolonged jaundice after 14days may be due breastfeeding, sepsis, hypothyroidism, CF, biliary atresia.
Tests: FBC, Film, Blood group, Coombs test, Urinalysis. TFTs and sweat test in prolonged jaundice.
Management:
- use bilirubin chart, if in treatment zone treat with phototherapy which uses light energy to convert bilirubin to soluble products.
- if severe consider Exchange transfusion, warmed blood 160ml/Kg (double volume) given ideally via umbilical vein with removal via umbilical artery. Monitor ECG, U+E, Ca2+, bilirubin, clotting, FBC and glucose.
Describe Autism Spectrum Disorders (ASDs), its symptoms, and treatment
A developmental disorder consisting of a triad of impaired reciprocal social interaction, impaired imagination (+/- abnormal verbal and nonverbal communication), and restricted repertoires of activities and interests. If one child is affect the risk of the next pregnancy being affected is 5-10%. There is associated epilepsy in 30%.
Symptoms: diagnosis depends on having more than 6 symptoms, with at least 2 A symptoms, and one each from B and C.
- A symptoms, unawareness of the existence and feelings of others, abnormal response to being hurt, impaired imitation, repetitive play, bad at making friends.
- B symptoms, little babbling and few facial expression or no gestures in infancy, avoids mutual gaze, odd speech (echolalia (repetition) and odd use of words, difficulty in initiating or sustaining reciprocal roles in conversations.
- C symptoms, stereotyped movements (hand-flicking, spinning, head-banging), preoccupation with parts of objects, marked distress over changes in trivia, insists on following routines in precise detail, narrow fixations.
Treatment:
- Early intensive behavioural intervention +/- speech therapy +/- special schooling. Starts at 3yrs old
- Parent training helps communication, enriches parent knowledge, enhances parent-child interaction, and decreased parental maternal depression.
- Social skills training, Benefits available.
- Drugs have small role, fish oils may help with tantrums and self harm, atomextine may help with hyperactivity
What is Asperger’s Syndrome?
Autistic features without autistic aloneness or linguistic difficulty. It is less severe than autism. It is possible to teach better recognition of emotions and how to predict emotional response.
Why do Adolescents exhibit more risk-taking behaviours?
Frontal lobe thought to be involved in control impulsivity, in adolescents the frontal lobe is still developing so there is deceased impulsivity control and therefore more risk-taking behaviours.
Describe Measles, its symptoms, and management.
It is a noticeable disease caused by a RNA paramyxovirus. Spread via droplets.
Symptoms: Prodromal phase of cough, conjunctivitis, and pyrexia (often greater than 40C). Kolpik spots (clustered, white lesions on the buccal mucosa opposite the upper 1st + 2nd molars) are pathognomonic. Rash follows which starts behind ears as discrete maculo-Papular rash and spreads to become confluent
Management:
- isolate and treat in hospital
- ensure adequate nutrition and hydration
- treat any secondary infections.
- complications include encephalitis, subacute sclerosing panencephalitis, febrile convulsions, giant cell pneumonia, keratoconjunctivitis, myocarditis.
