Paediatrics Flashcards
Define Cerebral Palsy
A group of disorders with a permanent non-progressive motor deficit diagnosed before the age of 5.
Prevalence of Cerebral Palsy
2/1000 Live Births
Aetiology of Cerebral Palsy
Variable, includes low birth weight, prematurity (Ex 33/40 or less), Multiple pregnancy, Perinatal Asphyxia or other Acquired Brain Injury.
What are some Pre-Natal Causes of Cerebral Palsy?
Congenital abnormalities, CVA, Infective in 1st or 2nd trimester (ie: TORCH infections), Genetic, Metabolic abnormality like Iodine deficiency, Toxic (rare).
What are some Peri-Natal Causes of Cerebral Palsy?
Obstructed Labour, Antepartum Haemorrhage, Cord Prolapse, Neonatal Hypoglycaemia, Untreated Jaundice.
What are some Post-Natal Causes of Cerebral Palsy?
Infection, Injury (Drowning, MVA), CVA, Sepsis, Malaria
What is the functional classification of Cerebral Palsy?
Gross Motor Functional Classification Score (GMFCS)
Scored on a scale of 1 to 5, with 1 being completely independent not requiring assistance and 5 having no independence requiring full care. Plays into Management, Prognosis and Associated Issues.
What are the types of Cerebral Palsy?
Spastic, Dyskinetic, Ataxic (may be mixed)
What are the features of Spastic Cerebral Palsy?
Clasp Knife Spasticity.
Corticospinal Tract Injury.
Underlying Weakness.
What are the features of Dyskinetic Cerebral Palsy?
Involuntary movements.
Whole Body Dystonia.
-includes sustained muscle contractions causing a twisted or abnormal posturing.
Athetosis: slow writhing of distal limbs.
Chorea: rapid jerky involuntary movements.
What are the features of Ataxic Cerebral Palsy?
Fine Tremor worse on Initiation.
Poor Balance.
Hypotonia.
Diagnosis of Exclusion.
How does Cerebral Palsy Present?
1st 6-18 months.
Failure to reach normal motor milestones, unusual floppiness (persistent head lag) or unusual stiffness (early crawling).
What are the developmental implications of Cerebral Palsy?
Impaired spatial learning, effort, independence and also social consequence understanding.
Parents treat the child differently due to imposed disability, less complex words and teaching.
Other disturbances, feeding, irritability or sleeping.
Less interaction with friends and may be victimised.
What are some therapeutics/surgeries used in Cerebral palsy?
Botulinum - to reduce spasticity, only in mobile muscles.
IntraThecal Baclofen (ITB) - to reduce tonic and active spasticity.
Diazepam (Low Dose) - to reduce spasticity, ease sleeping and help with behavioural disturbances.
Dorsal Rhizotomy - sever nervous innervation of certain muscles for comfort.
Contracture Release - Orthopaedic Surgery to assist in comfort for severe contractures.
What are some diagnoses to consider in a 2 y.o. presenting with Fever and Rapid Breathing for 24 hours?
Pneumonia
Urinary Tract Infection
Meningitis
When would you order a chest X-ray in a young child?
If unwell enough to require admission to hospital, otherwise not required according to guidelines.
What is the treatment for community acquired pneumonia in a young child?
Oxygen to maintain saturations 92%
What organisms commonly cause pneumonia in a Neonate?
Group B streptococcus
Gram Negative Enterobacteria
What organisms commonly cause pneumonia in a Preschooler?
RSV, ParaInfluenzae, Adenovirus, Rhinovirus, Influenza and CMV.
More propensity for viral pneumonia.
What organisms commonly cause pneumonia in older children?
Strep. pneumoniae
Mycoplasma pneumoniae
Chlamydia pneumoniae
What are some specific features of streptococcus pneumonia?
Respiratory distress without a cough, due to origin in alveoli.
Fever should subside quickly post antibiotics.
What is your next step if a patient has a pleural effusion as a complication of pneumonia?
Do an Ultrasound to determine if simple of complex fluid.
Look for loculations.
What is the treatment for an Empyema in a child?
Should drain but if unable continue antibiotics at a high dose for a prolonged course.
Have to include staph, mycoplasma and strep cover.
Put a drain into the space and use fibrinolytics or a VATS depending on the hospital.
What antibiotic do you for Mycoplasma pneumonia?
Roxithromycin
What antibiotic(s) do you use for pneumonia in a Neonate?
I.V. Benzylpenicillin and Gentamicin
What is the management plan if Asthma is worsening due to poor compliance?
Establish the blocks to compliance, tools to improve compliance, inhaler technique, written asthma action plan.
What are important questions in determining the severity of a patient’s Asthma?
Symptom frequency between exacerbations.
Nocturnal symptoms between exacerbations.
Exacerbation frequency and effect.
What type of asthma is the most common?
Intermittent episodic asthma, persistent is relatively rare.
What Investigation is used in exercise induced?
Exercise Bronchial Provocation Test
What are some Dx you would consider in Exercise Induced Wheeze and SOB?
Functional (normal) Cardiac Respiratory (Stridor) Vocal Chord Dysfunction (mimics Asthma) Anxious Allergy
What are the Diagnostic Signs of Vocal Chord Dysfunction?
Paradoxical adduction of vocal chords during inspiration.
Inspiration difficulty, stridor not wheeze.
What is the management of Vocal Chord Dysfunction?
Speech therapy
Psychotherapy if indicated
Anticholinergics have a role.
