Paediatrics Flashcards
What’s the big risk of cryptorchidism?
testicular cancer
The peak incidence occurs in the 3rd and 4th decades of life
Couple of symptoms associated with this? …
Wilm’s tumor, also known as nephroblastoma, is a cancer of the kidneys that typically occurs in children
- a painless, palpable abdominal mass
- may be haematuria and hypertension
- 10% associated with genetic syndromes
What’s this?
+ causative organism, and main risk associated with it.
Staphylococcus aureus (most common) or Streptococcus pyogenes, or MRSA
Tiny pustules or vesicles that evolve rapidly into honey-coloured crusted plaques.
Mx: Keep clean, wash hands after touching, avoid scratching. Flucloxacillin if systemic, otherwise topically fusidic acid.
Facts of
Peristalsis is disrupted leading to colicky abdominal pain and vomiting.
Lymphatic and venous obstruction occurs, causing ischaemia
Most common cause of intestinal obstruction in patients aged 5 months to 3 years and accounts for up to 25% of abdominal emergencies in children up to age 5.
most caused by; viral (50%), including rotavirus
How does Intussusception present in children?
- sudden onset
- paroxysms of colicky abdominal pain
- early vomiting - bile stained
- palpable mass (often right upper quadrant)
- absence of bowel in the lower right quadrant (Dance’s sign)
- later; mucoid and bloody ‘redcurrant’ stools.
- neurological signs possible
- dehydration, pallor, shock, irritability, sweating.
Investigations and management for Intussusception
- Abdominal x-ray (maybe normal at beginning)
- CT/MTI scanning
- Ultrasound - investigation of choice
- Bowel enema - barium. Good standard investigation
Management: Early diagnosis reduces need for open surgery.
Resus: nasogastric tube and IV fluids.
Rhesus disease
Rhesus disease only happens when the mother has rhesus negative blood (RhD negative) and the baby in her womb has rhesus positive blood (RhD positive)
Why is hypoglycaemia a concern with paeds?
High metabolic demands of an illness
Too ill to feed
Glycogen stores in the liver are limited.
hypothermia more likely; SA of children and infants is high
Patent Ductus Arteriosus (PDA)
Closes at birth to form ligamentum arteriosum. FACTS
(other two fetal shunts are ductus venosus and foramen ovale)
Common in preterm babies. 5-10% of all congenital heart defects.
connects the main pulmonary artery to the aorta.
Shents blood blood from the right ventricle to bypass the fetus’s fluid-filled lungs. Closes functionaly in 12-18 hours, anatomically in 2-3 weeks.
Tx: NSAIDs
How does PDA present? (Patent Ductus Arteriosis)
(small PDA is asymptomatic)
Large PDA; resp infections, feeding difficulties, poor growth, failure to thive due to HF.
Typically preterm babies in 2-3 nd week of life.
Shunting causes increases pulmonary flow and breathlessness.
>> aortic pressure causes a shunt to pulmonary artery; pulmonary hypertension leading to cardiac failure and pulmonary oedema/ haemorrhaging.
tachycardia, tachypnoea.
Tx: NSAIDs (preterm), maybe surgery, diuretics
Asymptomatic: wait one year, check for spontaneous closure.
Investigations: echocardiography
Tetralogy of Fallot characteristics
- most common cyanotic congenital heart disease (1:3,600 )
- VSD (ventricular septal defect) - important
- overriding aorta
- right ventricular outflow obstruction - important
- right ventricular hypertrophy
How does Tetralogy of Fallot present?
- Severe cynosis at birth
- Failure to thrive
- NB. most cases of TOF are diagnosed antenatally (low oxygen sats)
trisomy 21 is a big risk factor and antenatal ultrasound is used to diagnose possible TOF.
What’s this?
Tetralogy of Fallot
Why do babies have a higher respiratory rate?
They have fewer alveoli (properly developed at age 8)
If baby is still snuffy at eight week check, what could this indicate?
PDA
(and associated pulmonary hypertension/ oedema)
why is glucose assessment so important with babies?
Because myocardium is an obligatory user of carbohydrates.
Why do infants have a high heart rate?
Because CV system is immature and it can’t stretch (therefore can not increase stroke volume). Compensates by increasing HR.
why do you have to be careful with fluid therapy with infants?
Because heart can’t stretch and increase stoke volume (still immature). Compensates by >> HR.
What is chronic lung disease of prematurity
(BPD - Bronchopulmonary Dysplasia)
Inflammation and scarring in the lungs; usually premature babies on ventilation under pressure.
Cell changes; dysplasia in smaller airways and lung alveoli, making breathing difficult.
BPD also can be due to; trauma, pneumonia, and other infections.
Along with asthma and cystic fibrosis, BPD is one of the most common chronic lung diseases in children
What is Primary ciliary dyskinesia?
Rare genetic disorder that causes defects in the action of cilia in the respiratory tract.
Consequence; reduced or absent mucus clearance from the lungs, and susceptibility to chronic recurrent respiratory infections, including sinusitis, bronchitis, pneumonia, and otitis media.
What is Laryngomalacia ?
congenital softening of the tissues of the larynx. This is the most common cause of noisy breathing in infancy.
Approximately 30% of congenital heart disease is thought to be related to genetic syndromes accompanied by extra-cardiac anomalies.
Name some (5)
Williams syndrome
Noonan Syndrome
DiGeorge synfrom (22q11 deletion Syndrome)
Down Syndrome
Turner Syndrome
What is Noonan Syndrome?
(many symptoms)
Genetic condition that can lead to short stature and congenital heart disease.
CHD; pulmonary value stenosis, hypertrophic cardiomyopathy, septal defects.
What is Juvenile idiopathic arthritis (JIA)?
joint inflammation presenting in children under the age of 16 years and persisting for at least six weeks, with other causes excluded.
How does Juvenile idiopathic arthritis present?
50% of JIA is oligoarticular. This affects 1-4 joints in the first six months. 70% of patients are ANA positive.
More common in females, and usually presents < 6 years age.
Typically presents with 1-2 swollen joints causing stiffness and <rom></rom>
<p>Systemic JIA; >> temperature, lymph node enlargement, rash (pink salmon)</p>
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What is Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux?
abnormal flow of urine form bladder to kidneys.
Usually diagnosed in children and infants.
Can be congenital (can resolve naturally), or secondary (>> pressure in bladder).
UTIs are a common symptom.
Threadworms
Female may be seen at night emerging from the anus to lay eggs.
Female threadworms lay an average of 11,000 tiny eggs, which are invisible to the naked eye
Eggs are usually laid at night whilst the child sleeps. The eggs are accompanied by an irritant mucus, which causes intense pruritus and scratching. The eggs get on to the hands and from there to the mouth to re-infect.
This is the most common helminthic (parasitic worm) infection in the UK.
Prevalence is highest between the ages of 5 and 9 years but all ages may be affected.
Girls presenting before puberty with vaginal discharge, urinary tract infection, or nocturnal enuresis should be checked for threadworm.
Tx: Mebendazole is the drug of choice in adults and in children older than 2 years. It is given as a single oral dose, and is best repeated after two to three weeks in case re-infection has occurred. Mebendazole kills the worms.
What are is West’s Syndrome?
Infantile Spasms
The peak incidence is between 4 and 7 months of age, with 90% starting under 1 year of age. It is confined to infants and very small children
Spasms begin with a sudden, rapid, tonic contraction of the trunk and limb muscles, with gradual relaxation over 0.5 to 2 seconds. Contractions can last 5 or 10 seconds. They may range from a gentle nodding of the head to a powerful movement of the body.
The spasms tend to occur in clusters. There may be dozens of them
They tend to occur just before sleep or on awaking.
What is Hirschsprung’s disease?
This arises when innervation of a segment of bowel (commonly sigmoid colon) fails to develop.
Normal peristalsis cannot occur in the affected segment, leading to chronic constipation or bowel obstruction (if segment is large).
Maybe detected at birth as a meconium ileus.
Delayed passage of meconium is very important, as can be diagnostic of Hirschsprung’s disease.
How do you treat minimal change diease in children that causes nephrotic syndrome?
oral steroids and refer to paediatrics
Recurrent serious respiratory tract infections and weight loss in a child would prompt thoughts of which disease?
cystic fibrosis
NB. Nasal polyps are also associated with cystic fibrosis.
