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Year 5 > Paediatrics 5 > Flashcards

Paediatrics 5 Flashcards

1
Q

Quinolone antibiotics

A
  • Ofloxacin, Levofloxacin and Ciprofloxacin. Side effects:
  • Tendon damage and tendon rupture, notably in the Achilles tendon
  • Lower seizure threshold (caution in patients with epilepsy)
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2
Q

Epiglottitis

A

Acute epiglottitis is rare but serious infection caused by Haemophilus influenzae type B. Prompt recognition and treatment is essential as airway obstruction may develop. There is a Hib vaccine so has become rare

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3
Q

Features of epiglottitis

A
  • Rapid onset
  • High temperature, generally unwell
  • Stridor
  • Drooling of saliva
  • No cough, muffled voice
  • Tripod position: the patient finds it easier to breather if they are leaning forwards and extending their neck in a seated position
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4
Q

x-ray of epiglottitis

A
  • In lateral view there will be swelling of the epiglottis- the thumb sign
  • A posterior- anterior angle will show subglottic narrowing, called the steeple sign
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5
Q

Management of epiglottitis

A
  • Immediate senior involvement including providing emergency airway support i.e. anaesthetics, ENT.
  • Endotracheal intubation may be necessary then transfer to ICU
  • If suspected do not examine the throat due to risk of acute airway obstruction: should only be done by senior staff who can intubate if necessary. Senior staff can use a laryngoscope to visualise the airway after securing the airway
  • Oxygen
  • Intravenous antibiotics i.e. cefuroxime
  • May give steroids (dexamethasone)
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6
Q

Infantile spasms (West syndrome)

A
  • Peaks: 4-7 months, can be as late as 12 months
  • Infantile spasms – sudden jerks of the neck, trunk or limbs (Salaam attack) followed by a few seconds of tonic posturing
  • Shortly after waking or when falling asleep
  • Clustered – several to hundreds in runs, cries at the end
  • May be secondary to serious neurological abnormality i.e. tuberous sclerosis, encephalitis, birth asphyxia or may be idiopathic
  • Insidious onset with subtle spasms that increase over time
  • Encephalopathy/regression – loss of visual alertness and smile
  • West syndrome is a combination of infantile spasms, hypsarrhythmic pattern on ECG and regression
  • Treatment: vigabtrin and steroids
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7
Q

Benign epilepsy with centro-temporal spikes (BECTS)/Rolandic epilepsy

A
  • Typical age of onset: 3-12 years, spontaneous remission by mid adolescence
  • From sleep. ECG shows centro-temporal spikes activated by sleep
  • Focal onset – facial or perioral
  • Sensory and/or motor
  • Tingling of one side of the mouth
  • Expressive aphasia or guttural sounds
  • Post-ictal drooling
  • Can experience secondary generalization with brief tonic-clonic movements
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8
Q

Childhood absence epilepsy

A
  • Typical age of onset: 4-8 years, more common in girls
  • Brief arrest of speech and activity (typically <5 sec)
  • Perioral or periocular flickering movements may be seen
  • Unrousable during
  • Rapid recovery, as if nothing ever happened
  • Occurs tens or even a hundred times a day
  • Can be induced by hyperventilation
  • EEG shows 3HZ generalised spike and wave pattern
  • Treatment: sodium valproate, ethosuximide
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9
Q

Juvenile myoclonic epilepsy

A
  • Treatment: usually good response to sodium valproate
  • Typical age:12-18
  • Often present with their first generalized tonic-clonic seizure
  • GTC seizures often preceded by several myoclonic jerks
  • Awareness retained during myoclonic jerks: history of dropping objects while preparing breakfast is common
  • Absences occur in up to one third
  • ECG shows polyspike discharges followed by irregular 1-3 HZ slow waves
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10
Q

Lennox-Gastaut syndrome

A
  • May be an extension of infantile spasms, onset 1-5 years
  • Features: atypical absences, falls, jerks
  • 90% have moderate-severe mental handicap
  • ECG: slow spike
  • Treatment: ketogenic diet may help
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11
Q

Medications for status epilepticus

A
  • Wait 5 minutes to give the first dose of benzodiazepine
  • Secure the airway
  • Give high-concentration oxygen
  • Check blood glucose levels
  • IV lorazepam, repeated after 10 minutes if the seizure continues
  • Only give 2 doses of benzos in total
  • If seizure persists the final step is IV phenobarbital or phenytoin
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12
Q

Treatment for seizures

A
  • Tonic-clonic= sodium valproate (levetiracetam if female)
  • Focal= carbamazepine or lamotrigine
  • Absence= sodium valproate or ethosuximide
  • Atonic= sodium valproate (lamotrigine if female)
  • Myoclonic= sodium valproate (lamotrigine if female)
  • Infantile spasms= prednisolone, vigabatrin
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13
Q

Febrile convulsions

A

Seizures provoked by fever in otherwise normal children, typically occurs between 6 months and 5 years. Diagnosed on history

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14
Q

Febrile convulsions clinical features and febrile status epilepticus

A

Clinical features= usually occur early in a viral infection as the temperature rises rapidly. Seizures are usually brief, lasting less than 5 minutes. Are most commonly tonic-clonic. Have a short postictal period

Febrile status epilepticus describes a febrile seizure that lasts for 30 minutes or longer, or there are a series of seizures, without full recovery, lasting for 30 minutes or longer.

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15
Q

Simple febrile convulsions

A
  • <15 minutes
  • Generalised seizures
  • Typically no recurrence within 24 hours
  • Should be complete recovery within the hour
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16
Q

Complex febrile convulsions and management

A

Complex febrile convulsions= 15-30 minutes, focal or partial seizures. Have a long postictal period. May occur multiple times during the same febrile illness

Management following a seizure: children who have had a first seizure or any feature of a complex seizure should be admitted to paediatrics

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17
Q

Febrile seizure: advise for parents

A
  • Stay with child, put pillow under head
  • Put them in the recovery position and dont put anything in their mouth
  • Phone for an ambulance if the seizure lasts > 5 minutes
  • Regular antipyretics dont reduce the chance of a febrile seizure occurring but can cause comfort
  • Dont sponge the child to cool them down
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18
Q

Febrile seizure: ongoing management

A
  • If recurrent febrile convulsions occur then benzodiazepine rescue medication may be considered: this should only be started on the advice of a specialist (e.g. a paediatrician). rectal diazepam or buccal midazolam may be used
  • Children who’ve had a first seizure or any feature of a complex seizure should go to hospital
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19
Q

Risk factors for further febrile seizures

A

age of onset <18 months, fever <39 degrees, shorter duration of fever before the seizure, family history of febrile convulsions. Slightly increases risk of developing epilepsy especially if risk factors.

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20
Q

Prognosis of febrile seizures

A
  • 1 in 3 children will have at least one more febrile convulsion
  • Simple febrile convulsions: do not affect development
  • Complex febrile convulsions last for a long time and/or occur multiple times in the same febrile illness. Complex febrile convulsions are associated with a significantly increased risk of epilepsy, around 4-12%.
  • A febrile seizure is a seizure (convulsion) which occurs in a febrile child (between the ages of 6 months and 5 years) and is not caused by a central nervous system infection.
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21
Q

Fractures paediatrics

A
  • Fractures, single or multiple, in children without a medical condition predisposing them to fragile bones, should be investigated for NAI.
  • Fractures of different ages, especially where there is no documentation of caregivers seeking medical attention, are highly suspicious of NAI.
  • Metaphyseal corner fractures – reported as almost pathognomonic of NAI.
  • Occult rib fractures is also a common finding in infants/children who have been grabbed by the chest and squeezed/shaken.
  • Spiral fractures are a result of twisting forces: suspicious of NAI
22
Q

Fractures in children

A
  • Children have more cancellous bone, which is the spongy, highly vascular bone in the centre of long bones whereas adults have more cortical bone
  • More likely to have greenstick fracture where one side of the bone breaks whilst the other side stays intact and buckle fracture
23
Q

Salter-Harris grade

A

The higher the Salter-Harris grade, the more likely the fracture is to disturb growth.

SALTR mnemonic:

  • Type 1: Straight across
  • Type 2: Above
  • Type 3: BeLow
  • Type 4: Through
  • Type 5: CRush
23
Q

Pain management

A

Codeine and tramadol are not used in children as there is unpredictability in their metabolism. Aspirin is contraindicated in children under 16 due to the risk of Reye’s syndrome (except in certain circumstances such as Kawasaki disease). Pain ladder:

  • Step 1: Paracetamol or ibuprofen
  • Step 2: Morphine
24
Q

GORD paediatrics

A
  • Happens in babies due to immaturity of the lower oesophageal sphincter. If normal growth not a problem
  • 90% stop having it by 1
24
Q

Symptoms of GORD babies

A
  • Chronic cough
  • Hoarse cry
  • Distress, crying or unsettled after feeding
  • Reluctance to feed
  • Vomiting/regurgitation
  • Pneumonia
  • Poor weight gain
25
Q

Red flags for vomiting

A
  • Not keeping down any feed(pyloric stenosis or intestinal obstruction)
  • Projectileorforceful vomiting(pyloric stenosis or intestinal obstruction)
  • Bile stainedvomit (intestinal obstruction)
  • Haematemesisormelaena(peptic ulcer, oesophagitis or varices)
  • Abdominal distention(intestinal obstruction)
  • Reduced consciousness,bulging fontanelleorneurological signs(meningitis or raised intracranial pressure)
  • Respiratory symptoms(aspiration and infection)
  • Blood in the stools(gastroenteritis or cows milk protein allergy)
  • Signs of infection(pneumonia, UTI, tonsillitis, otitis or meningitis)
  • Rash,angioedemaand othersigns of allergy(cows milk protein allergy)
  • Apnoeasare a concerning feature and may indicate serious underlying pathology and need urgent assessment
26
Q

Conservative management of GORD babies

A
  • Small frequent meals
  • Burping regularly to help settle milk
  • Not over feeding
  • Keep the baby upright after feeding but should still sleep on the back
27
Q

Medical management of GORD babies

A
  • Gaviscon mixed with feeds
  • Thickened milk or formula (specific anti-reflux formulas are available)
  • Proton pump inhibitors (e.g., omeprazole) or H2 receptor agonists where other methods don’t work
  • In severe cases may need further investigations with a barium meal and endoscopy. Surgical fundoplication in severe cases
28
Q

Glue ear

A

Build up of middle ear fluid causing hearing loss in affected ear (often self limiting). No acute inflammation, often follows AOM.

29
Q

Glue ear presentation

A
  • Presentation: ear fullness/popping/pain; hearing loss (loud TV, poor communication, speech/language delay, difficulty at school)
  • Signs: yellow, retracted tympanic membrane, fluid level/bubbles behind it, loss of light reflex
30
Q

Glue ear investigations

A
  • Hearing test: audiometry/McCormick toy test if preschool with repeat in 3 months
  • Audiometry: to see extent of hearing loss
  • McCormick toy test: the child is shown 7 pairs of toys whose names sound similar (e.g. tree and key, plane and plate) and asked at different volumes to indicate a particular toy
  • Otoscopy
31
Q

Glue ear management

A
  • Conservative: reassure parents that majority self-resolve, safety net, advice to speak loudly/clearly, face child, turn off competing sounds
  • Grommets
  • Medical: no evidence for antihistamines, decongestants or antibiotics
32
Q

Glue ear: when do children benefit from grommet insertion

A
  • Bilateral OME for >3 months
  • Hearing loss >25 dB in better ear
  • Hearing loss and social/educational
33
Q

Haemolytic disease of the newborn

A
  • When a woman that is rhesus-D negative react to rhesus D antigens from the newborns and produce antibodies
  • The sensitisation process happens in the first pregnancy and then the reaction happens in further ones
34
Q

Management of haemolytic disease of the newborn

A
  • Anti-D are given to rhesus negative mothers: at 28 weeks and birth
  • Also give at sensitisation events: antepartum haemorrhage, Amniocentesis procedure, abdominal trauma. Is given 72 hours after sensitisation event
35
Q

Kleinhauer test

A
  • Occurs at 20 weeks gestation
  • See’s how much fetal blood has passed into the mothers blood. To determine whether further doses of anti-D are required
36
Q

Criteria for immediate request of CT scan

A
  • Loss of consciousness lasting more than 5 minutes (witnessed)
  • Amnesia (antegrade or retrograde) lasting more than 5 minutes
  • Abnormal drowsiness
  • Three or more discrete episodes of vomiting
  • Clinical suspicion of non-accidental injury
  • Post-traumatic seizure but no history of epilepsy
  • GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department
  • Suspicion of open or depressed skull injury or tense fontanelle
  • Any sign of basal skull fracture (haemotympanum, panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
  • Focal neurological deficit
  • If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
  • Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 m, high-speed injury from a projectile or an object)
37
Q

Head injury management

A
  • Assess GCS
  • Immobilise cervical spine
  • Manage pain effectively as it can lead to rise in intracranial pressure
  • Always involve safeguarding in the initial assessment of a head injury
  • MRI can assess ligament and disc injuries suggested by CT scan, or problems with the cervical spine and vascular injuries
38
Q

Henoch schonlein purpura

A

The most common small vessel vasculitis in children. It most commonly affects children aged 3-5. IgA vasculitis. Tetrad of rash (palpable purpura), abdominal pain, arthritis/arthralgia and renal disease. Can follow an upper respiratory infection. Majority of cases in children

39
Q

Hypertension in children

A

Hypertension is defined as BP ≥95th centile for age, sex and height centile on three or more occasions, with maximum of ≥140/90 which is the adult definition of hypertension.

40
Q

HSP presentation

A
  • Purpura or petechiae on the buttocks and lower limbs (non blanching)
  • Abdominal pain: can get bloody stools, N+V
  • Arthralgia/arthritis- joint pain and swelling (knees and ankles)
  • Nephritis (haematuria +/- proteinuria)
  • May be pyrexial
  • HSP is commonly preceded by a viral upper respiratory tract infection
  • Other symptoms: scrotal pain and oedema, headache, seizure and uveitis
41
Q

Diagnosis of HSP

A

palpable purpura, not due to thrombocytopenia or coagulopathy, and one or more of the following:

  • Abdominal pain (usually diffuse, with acute onset)
  • Arthritis or arthralgia (acute onset)
  • Renal involvement (proteinuria, hematuria)
  • Leukocytoclastic vasculitis or proliferative glomerulonephritis, with predominant IgA deposition.
  • Is diagnosed clinically but can biopsy the affected organ to confirm
42
Q

Management of HSP

A
  • NSAIDs for analgesia and their anti-inflammatory effect
  • Steroids: if severe abdominal pain or nephrotic range proteinuria with declining renal function
  • Rapidly progressing nephritis: corticosteroids, immunosuppressants and plasmapheresis
  • Antihypertensives may be needed to control blood pressure
  • After an episode of HSP, children should have regular urine dips and BP checks for 6 months
43
Q

Prognosis of HSP

A
  • The majority of cases of HSP recover completely
  • 1/3 of patients have a second episode of HSP
  • Long-term renal impairment occurs in about 1/5 patients with significant proteinuria
44
Q

HSP complications

A
  • Hypertension
  • Oedema
  • Orchitis- inflammation of the testicles causing pain and swelling
  • Intussusception- blockage in the bowel
45
Q

Hepatitis B

A
  • Transmitted by blood and bodily fluids
  • Most recover in in 2 months but can become chronic. Less likely then in adults
  • Neonates with hepatitis B positive mothers are given both the hepatitis B vaccine and Hepatitis B immunoglobulin infusion
  • Infants are given an additional hepatitis B vaccine at 1 and 12 months of age. Also get it as part of the 6 in 1 vaccine at 8, 12 and 16 weeks
  • Hepatitis B positive mothers can breastfeed if their babies are properly vaccinated
  • Most chronic patients are asymptomatic and do not need treatment
46
Q

Hepatitis C

A
  • Vertical transmission occurs 5-15% of the time, no measures known to reduced transmission
  • Children tend to be asymptomatic
  • If born to positive mother tested at 18 months. Mothers are allowed to breastfeed (no transmission risk) unless nipples are bleeding then stop
  • Often clear virus spontaneously but can become chronic
  • > 3 give pegylated interferon and ribavirin but treatment tends to be delayed till adulthood
47
Q

Inguinal hernia types

A
  • Indirect inguinal hernia: most common in children. Abdominal contents protrude through the deep inguinal ring into the inguinal can and through the superficial inguinal ring into the groin
  • Direct inguinal ring: more common in adults. Weakness in the posterior wall of the inguinal canal (Hesselbach’s triangle)
48
Q

Inguinal hernias risk factors and clinical features

A
  • Risk factors: prematurity, male, family history
  • Clinical features: groin swelling
  • Associated symptoms: nausea, vomiting, constipation, abdominal pain/discomfort
  • Examination: inguinal mass that you cant get above. Reducible when lying flat, does nottransilluminate, and has a positivecough reflex. If strangulated will appear irreducible and tense
49
Q

Inguinal hernia investigations and management

A
  • Investigations: diagnosed clinically but can confirm with US and use CT if features of obstruction or strangulation
  • Management: surgical repair

Year 5 (24 decks)

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