Paediatrics Flashcards
What is the pathophysiology of ITP?
Destruction of circulating platelets by anti-platelet IgG autoantibodies
Oppositional defiance disorder behaviours:
(ARE BRATS)
- Annoying
- Rule breaker
- Easily Annoyed
- Blames others
- Resentful
- Argues with adults
- Temper
- Spiteful/ vindictive
Cardiovascular defects associated with Down Syndrome?
- Atrial Septal Defect
- Ventricular Septal Defect
- Atrio-ventricular Septal Defect
Cardiovascular defects associated with Marfan’s syndrome?
- Aortic root dilation
- Mitral valve prolapse
- Aortic regurgitation
webbing
Cardiovascular defects associated with Turner’s syndrome?
- Coarctation of the aorta
- Bicuspid aortic valve
Chromosomal abnormality -> Down syndrome?
Triplication of chromosome 21 (all or part)
- trisomy 21
- translocation -> 3 chromosome 21s
- mosaicism
Chromosomal abnormality -> Turner’s syndrome?
X chromosome abnormality (a whole or part of an X missing)
Sites for eczema?
Infants: head (cheeks, foreheads, skalp), extensor
Children: flexors (wrists, ankles, popliteal fossae and antecubital fossae)
Eczema Treatment
General
- Moisturiser
- Occlusive dressing - up to several times/ day
- Topical corticoseroids Infected
- Systemic antibiotics
- Salt or bleach baths
Persistent pruruitis
• Antihistamine
○ phenergan If really severe
- Calcineurin inhibitors
- TAR
- UV light
- immunosuppressants
Causes of Acyanotic heart disease in infants
L->R shunt
- ASD
- VSD
- AVSD
- PDA
Obstructive
- Aortic Stenosis
- Pulmonary stenosis
- Coarctation of the aorta
Causes of Cyanotic heart disease in infants
R -> L shunt
- Ebstein’s anomoly
- TOF
Other
- Transposition of great arteries
- total anomolous pulmonary drainiage
- tricuspid atresia
- hypoplastic left heart syndrome
Causes of jaundice Day 1
Day 1 - Always pathological
- Congenital Infection
- Hemolytic diseases
○ Erythroblastals faetalis
- Rhesus incompatability
- ABO incompatability
○ G6PD deficiency
Causes of jaundice Day 2 - 2 weeks
- Haemolytic - as above, more commonly present in the first day or 2
- Infection, as above + UTI or other infection
- Physiological/ breastmilk
- Polycythaemia
- Bruising
- CN syndrome
- Dehydration - exacerbating factor
Causes of jaundice >2 Week
Conjugated
- biliary duct obstruction - atresia
- Hepatitis
Unconjugated
• As above
○ Physiological
○ Breast milk
○ Haemolytic - G6DP in particular
○ Polycythamia
• Bowel obstruction
○ Hypothyroidism
Normal baby weight?
2500-4250g
Normal baby height?
48-53cm (50cm)
Normal baby head circumfrence
35cm average
Of the neonatal head bleeds, which one are you most concerned about?
Subgaleal - Baby can bleed out, so want to have IV cannula in if suspicious. Not defined by suture lines.
Also SAH and subdural haemorrhage for neurological complications
Where is a subgaleal haemorrhage?
below the (galeal) aponeurosis but above the periosteum
Where is a cephalhaematoma?
between the skull bone and periostem (cannot cross over bone edge)
Where is a caput succundeum?
Under the scalp but overlies the aponeurosis. Crosses suture lines. (is a oedamatous swelling from pressing against the cervix. Generally resolves after a few days.)
What is the cause of Erb’s palsy?
Upper brachial plexus injury during birth (C5, C6), very common in breech babies and large for gestation age babies.
What is the most common neonatal fracture during birth?
Clavicle
(Humorous is most common long bone fracture)
Risk Factors for Clavicle fracture during birth?
- increased weight,
- operative vaginal delivery,
- shoulder dystocia
What vertebrae is the level of the posterior iliac crests?
L4
what level can you do an LP
Between L3/L4 or L4/L5
What medication do you give to a child who is currently undergoing seizures?
intranasal midazolam
Treatment of thalassaemia major?
- Transfusion
- folate
- Iron chelation
- Splenectomy
- Bone marrow transplant
Signs of lead poisoning?
Mental
○ Irritability
○ Learning difficulties
○ Difficulty concentrating
Blood - anaemia
Abdomen upset
○ Pain
○ Constipation
Kidney failure
Adolescent psychiatric history points
HEADDS
- Home and environment
- Education/ employment
- Alcohol
- Drugs
- Sexuality
- Suicide/ Self harm and depression
Domains of ADHD?
○ Decreased attention
○ Hyperactivity
○ Impulsivity
MOA of Catapres/ clonidine?
Alpha 2 receptor agonist
What is ritalin also called?
methylphenidate (other brand name is concerta)
What is the classical triad that Haemolytic Uraemic syndrome presents with?
- Microangiopathic haemolytic anaemia
- Thrombocytopaenia
- Acute renal failure
What are the developmental domains?
- Gross motor
- Fine motor
- Social/ personal
- Language
What is Atomoxetine (Strattera )
An ADHD medication, a Noradreniline reuptake inhibitor
What’s the technical name for croup?
Laryngo tracheitis
Clinical Features of Croup?
- Croupy cough - sounds like a seal
- Stridor
- Breathlessness
- Hoarse voice
- Low grade fever
- Often preceded by virus
Viruses causing croup?
○ parainfluenza virus - most common
○ Human metapneumovirus
○ Influenza
○ RSV
DDx for croup?
- epiglottitis
- foreign body
- asthma
- bacterial tracheitis
- retropharyngeal abscess
- anatomical issues (sub-glottic stenosis, laryngo-malacia)
When do you need to treat croup?
Indicated if they have stridor while resting
Treatment of croup?
- Dexamethasone - prednisalone often used but it is probably not as good. Nebulised budesonide can be used but doesn’t seem to be as effective.
- Oxygen -only sometimes appropriate, should be in PICU
- Adrenaline nebulised
- Intubation - if very severe
Bronchiolitis RFs
RFs
- No breast feeding - Ab from the breast milk protect
- Prem babies
- Cardiac or lung conditions
- Decreased immune system
- Tobacco smoke
- Viral exposures - Having siblings
Aetiology of bronchiolitis?
- RSV - the most common cause, but all the viruses can cause it
- Influenza A, B
- Parainfluenza virus
- Rhinovirus
Treatment of bronchiolitis?
Supportive therapy
○ Antivirals don’t have a role, neither to antibiotics,
○ Fluids
○ oral corticosteroids
○ bronchodilaters - can give in some situations (Hx of atopy, past efficacy), salbatumol
- Respiratory support (CPAP)
- Intubation - very rarely needed
Frequency of CF
1 in 2500 births
Chromosome with the CF gene?
Chromosome 7
Tests for CF?
- Heelprick test (screening)
- Sweat test (gold standard)
Symptoms of CF?
Respiratory Symptoms
- Chronic productive cough
- recurrent infections
Gastrointestinal Symptoms
- malabsorption - diarrhoea and fatty stool
- reflux
Gowth issues
- feeding difficulties
- failure to thrive
Complications of CF?
Respiratory
- bronchiectasis
- infections
Growth and metabolism issues
- DM
- Growth issues
- Osteoporosis
- liver disease
- pancreatitis
Genitourinary issues
- Male infertility
- Urinary incontinence
Secondary issues
- Psychological difficulties
- Hearing impairment
What are the most common congenital cardiology conditions?
- VSD (30%)
- PDA (12%)
- ASD (8%)
- pulmonary stenosis (8%)
- aortic stenosis (5%)
- coarctaion of the aorta (5%)
- TOF (5%)
- TGA (5%)
What is the main cardiac condition associated with William’s syndrome?
Aortic stenosis (supra-valvular) (also PS)
What is truncus arteriosus?
Where the aorta and pulmonary artery fail to divide and are one big trunk. (needs to be operated on in first 6 months)
Cardiac conditions associated with Marfan’s?
- Aortic root dilation
- AR
- Mitral Valve prolapse
Features of MPS?
- large heads
- broad nose with flat bridge and upturned nostrils
- coarse and abundant body hair
What does Still’s murmur sound like?
- short,
- mid systolic, ejection murmur
- between LLSE and apex
- low pitched, vibratory, musical quality
What does a Pulmonary flow murmur sound like?
- soft
- “blowing”
- ejection
- best heard pulmonary area, radiates to axilla
- no associated click
What does a carotid bruit sound like?
- short
- mid-systolic
- best heard over neck or back (radiates there)
What does a Venous Hum sound like?
- low pitched
- continuous
- loudest above clavicles
What mechanism is usually responsible for heart failure in neonates as compared to infants?
neonates: obstruction
infants: L-R shunt
What is a boot shaped heart on x-ray a sign of?
TOF
What are the components of TOF?
- VSD
- Overriding aorta
- Pulmonary stenosis
- Right ventricular hypertrophy
Clinical picture of TOF?
Wide spectrum
Variable cyanosis
Loud systolic murmur, gets quieter as obstruction gets worse.
RHD treatment
Symptommatic (aspirin, bed rest)
IM benpen (every month for 10 years)
If carditis severe - Steroids
Manage complications (arrhythmias, HF)
Clinical Picture of Kawasaki’s disease?
- Erythema of
○ Tongue - strawberry tongue
○ Lips
○ Palms +/- edema of the back of hands, desquamation of fingers
○ Soles
○ Perineum - rash
○ Peri-anal
○ BCG vaccine site
- Fever - resistant to antipyretics
- Swelling of conjunctiva - Bilateral, Exudative
Management of Kawasaki’s?
- IVIG - 10 days
- Aspirin - for at least 6-8 weeks
Complications of Kawasaki’s?
- Coronary artery aneurysm
- Depressed myocardial contractility
- Myocardial failure
What is the rule of 2s?
For Meckel’s Diverticulum
- 2% of population • 2% become symptomatic • 2 feet from terminal ileum
- 2 inches long
- 2 types of tissue (pancreatic and gastric)
- 2/3 have ectopic mucosa
Complications of Meckel’s Diversticulum?
○ Lead point for intussusception
○ Cause volvulus - still has fibrous connection to umbilicus that bowel flops over
○ Inflammation - diverticulitis
○ Seem like an appendix/ appendicitis
○ acid secretion -> ulcer
X-ray signs of intussusception?
- Target sign
- Crescent sign
Treatment for intussusception?
- enema (can try several times)
- surgery
How early can babies start cow’s milk?
12 months
Medical term for breast development
Thelarche
Medical term for appearance of first pubic hair?
Pubarche
What are causes of precocious puberty?
- Tumours
- Trauma,
- Irradiation
- Familial
- “treated gonadotrophin-independent puberty” (Congenital adrenal hyperplasia)
Causes of Congenital Hypothyroidism?
- Dyshormonegenesis (genetic)
- Hypopituitarism
- Thyroid agenesis
- Iodine deficiency
Classic signs of oesophageal atresia?
- Frothing - unable to swallow saliva,
- Subcostal recession - resp distress
- Cannot tolerate feeds
- +/- polyhydramnios Hx - from inability to swallow
Ix for oesophageal atresia
- NGT attempt
- X-ray (gas in stomach means there’s a fistula)
- USS (if other Sx)
What are the 2 major abdomnial wall defects?
- Gastroschesis (no sac)
- Exomphalos/ amphalocele (with sac)
What is the significance of green vomit in a neonate?
bile = Midgut malrotation with volvulus until proven otherwise = surgical emergency
Midgut malrotation with volvulus treatment?
IV antibiotics and fluids
Immediate surgery or imaging
Acute testicular pain in children Ddx?
- Testicular torsion
- Testicular appendage torsion
- Epididymitis
- Orchitis
- Idiopathic Scrotal oedema
- Appendicitis
- Inguinal hernia
- Renal stone
Testicular pain in children Ix?
- Scrotal exploration
- Urinalysis - can help with a really obvious UTI
- Not USS - not helpful
What is paraphimosis?
Foreskin does not come back up, causes swelling and oedema which creates a positive feedback loop
What is balanitis?
inflammaiton of the forekin
(penis can be 3-4x normal size)
what is priapsim?
erection > 4h
What is phimosis?
Foreskin unable to be retracted
What is hypospadius?
When the urethral opening is on the ventral (bottom) surface of the penis (usually the glans)
Where is Gastroschesis?
right of the midline
Undescended testis happens how often on each side?
- 50% right only, 25% left only, 25% bilateral
In what age group is appendicitis most common?
peak 10-15 years (rare before 2)
What is the lifetime incidence of appendicitis?
6%
Is appendicitis more common in boys of girls?
boys (2:1)
Paediatric inguinal hernia treatment?
Reduce if possible, bot not if septic.
All need surgery.
What portion of boys have a hydrocoele?
80%
Which testis is torted more commonly?
The left (L is lower than right), generally torted medially
Peak age of testicular appendage torsion?
7-11
What is the testicular appendage (that’s commonly torted) called?
Hyatid of Morgagni
Clinicall appearance of Hyatid of morgagni torsion
Testicular pain - Acuity and severity of pain reduced compared to testicular torsion
Nil other accompanying symptoms
No movement restiriciton
Pathognomic blue dot sign (visible infarcted appendage) - in 25% of cases
Cremesteric reflex present, normal orientation as opposed to testicular torsion
What is the management of suspected torted Hyatid or Morgagni
If unsure - Scrotal exploration
If blue-dot - Non-operative (simple analgaesia + rest)
If persistent (>48h) - Exploration & removal of appendage
