Paediatrics Flashcards
Neurofibromatosis skeletal abnormalities
Neurologic symptoms are varied but relate to location and number of neurofibromas. Skeletal anomalies include fibrous dysplasia, subperiosteal bone cysts, vertebral scalloping, scoliosis, thinning of the long-bone cortex, pseudarthrosis, and absence of the greater wing of the sphenoid bone (posterior orbital wall), with consequent pulsating exophthalmos
Rectal prolapse
Rectal prolapse occurs in 20% of patients with cystic fibrosis who are aged 6 months to 3 years. The appropriate intervention at this point is to order a sweat chloride test to see if this child has cystic fibrosis.
increased intraabdominal pressure,
diarrheal and
neoplastic diseases, malnutrition,
and conditions predisposing to pelvic floor weakness.
Its strong association with cystic fibrosis makes the sweat test mandatory for infants and children with recurrent rectal prolapse.
CF
Cystic fibrosis (CF) is the most common fatal genetic disease affecting Canadian children and young adults
Nasal polyps
tend to occur more often in adult males, with the prevalence increasing in both sexes after age 50.
Any child 12 years or younger who presents with nasal polyps should be suspected of having cystic fibrosis until proven otherwise.
A sweat chloride test, along with a history and clinical examination, is necessary to evaluate this possibility.
Nasal polyps are found in 1% of the normal population, but a full 18% of those with cystic fibrosis are afflicted.
High chloride sweat test
adrenal insufficiency, pseudohypoaldosteronism, hypothyroidism, hypoparathyroidism, glycogen storage disease, vasopressin-resistant diabetes insipidus, malnutrition, hypopituitarism, ectodermal dysplasia, mucopolysaccharidoses, fucosidosis, and pancreatitis. Cf High sweat rate
Bels’ in children
The most common cause of acute onset facial nerve palsy in children has in the past been acute otitis media.
However, Lyme disease (choice A) may be a more common cause in endemic areas than otitis media. 10% retain mild facial weakness and 5% have permanent severe facial weakness.
Therapeutic intervention should include daily and nocturnal eye lubricants to protect the cornea from drying.
Osgood-Schlatter disease
Explanation:
Osgood-Schlatter disease is a common cause of anterior knee pain in the adolescent. It is a stress reaction of the insertion of the patella tendon into the tibia tubercle. The condition previously was more common in adolescent boys near the time of their growth spurt; however, girls are being seen more frequently with this diagnosis owing to more active sports participation. There can be some fragmentation of the ossicles of the developing tibia tubercle or soft tissue involvement of the patella tendon insertion without obvious bony changes. Often there is only a tendonitis of the patella tendon insertion and inflammation of the deep infrapatellar bursa. Clinically, a young teenager who is quite active in sports will complain of pain and swelling over the tibial tubercle. The condition may be unilateral or bilateral.
On examination, there is an obviously swollen, tender, and occasionally warm area over the tibia tubercle. The radiograph can be normal or show fragmentation of the area of patella tendon insertion. The natural history of untreated Osgood-Schlatter disease is relatively benign, if allowed to heal and complications are avoided. Since unusual stress at a time of rapid growth is occurring, limiting the offending sports activity is usually sufficient to relieve the symptoms. Kneeling and squatting should be limited. Physical therapy is occasionally used if there is unusual hamstring tightness. You encountered in patients between 10 and 15 years of age. These patients are often active in sports that involve a lot of jumping. It is thought to be secondary to repetitive microtrauma and traction apophysitis of the tibial tuberosity. Bilateral symptoms are present in 20%-30% of patients. Radiographs may reveal abnormalities, but are rarely indicated in straightforward cases. This condition is usually self-limited, and most patients are able to return to full activity within 2-3 weeks. Treatment includes rest, ice, anti-inflammatory medications, a rehabilitation program, and an infrapatellar strap during activities. Casting and corticosteroid injections are not indicated.
Pneumonia causes by age group
Neonatal (0-1 month): Streptococcus agalactiae (group B strep), E. coli
Infants (1-6 months): Chlamydia trachomatis (afebrile pneumonia), RSV
Children (6 months -5 years): RSV, Parainfluenza virus
Children (5-15 years): Mycoplasma pneumoniae, Influenza virus type A
Young Adults (16-30 years): Mycoplasma pneumoniae
Older Adults: Streptococcus pneumoniae, Haemophilus influenzae
Neonatal pneumonia tends to be caused by organisms that are acquired from the maternal genital tract or the nursery. Group B Strep being the most common.
Acute Iron Intoxication
cute iron intoxication seen exclusively in young children, where even small numbers of tablets can be fatal. Symptoms will be initially vomiting, abdominal pain, bloody diarrhea and then later shock, lethargy, dyspnea and severe metabolic acidosis.
Treatment involves whole bowel irrigation to remove unabsorbed tablets. Deferoxamine is given to remove absorbed tablets. Activated charcoal can’t bind to iron, so will have no benefit.
the most appropriate screening test for vesicoureteral reflux in the initial evaluation of a child with a urinary tract infection?
voiding cystourethrography.
Although renal ultrasonography is less invasive, findings are normal in 50%-75% of patients with reflux.
A DMSA renal flow scan is the best study for detecting renal scarring, but will not detect reflux in children who have not yet developed scarring.
Nuclear cystography is as sensitive for detecting reflux as a standard VCUG, but grading of reflux is less precise and this test will not detect associated bladder abnormalities.
Maintenance I’ve therapy
maintenance hydration is:
0.45% NaCl with 5% Glucose + 20mmol KCl / Liter.
This is often written as D5 ½ NS + 20KCl
The D5 refers to the glucose (dextrose), NS refers to Normal saline which is 0.9% NaCl. ½ NS would refer to 0.45% NaCl.
In this child the potassium is in the upper limit of normal, since normal range is 3.5-5.0.
So, do not add potassium at this time. The maintenance treatment would be with 0.45% NaCl with 5% Glucose. If giving a bolus, you would use 0.9% NaCl normal saline.
(0.2 NaCl with 5% glucose + 20KCl - in the first month of life).
Diff bw appendicitis and mesenteric lymph adenitis
Asking the child to turn to the left side will demonstrate this shift as the area of pain and tenderness will move along with the bowel to the left.
In appendicitis, the pain may initially start around the umbilicus, then moves over to the right iliac fossa. Once it settles there, it does not move around any longer.
Dance sign
The hallmark physical findings in intussusception are
a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign).
Idiopathic Scoliosis
detected in 2 to 3% of children 10 to 16 years,
60 to 80% are girls.
first suspected one shoulder seems higher than the other
or clothes do not hang straight,
but it is often detected during routine physical examination.
Patients may initially report fatigue in the lumbar region after prolonged sitting or standing.
The curve is most pronounced when patients bend forward.
Most curves are convex to the right in the thoracic area and to the left in the lumbar area, so that the right shoulder is higher than the left.
X-ray examination should include standing anteroposterior and lateral views of the spine.
Prompt referral to an orthopedist is indicated. Moderate curves (20 to 40°) are treated conservatively (eg, with a cast or brace) to prevent further deformity. Severe curves (> 40°) can often be ameliorated surgically (eg, spinal fusion with rod placement).
treatment is dependent on the age of the patient and curve progression.
Premenarchal females have a greater chance of curve progression then females one to two years after menarche with similar curves. Curves of less than 25 degrees are observed and reevaluated every four to six months. The stage of pubertal development is important to note because a patient who has attained menarche will only have a small amount of additional growth; therefore, scoliosis will not progress
Diagnosis of unilateral renal agenesis
Failure to visualize renal arteries with Color renal Doppler
