Paediatrics Flashcards
Primary prevention of childhood accidents
Sait gourds
Speed limits
Teaching road safety
Window safety chaeck
Secondary prevention of childhood accidents
Wear seatbelts
Cycle helmets
Smoke alarms
Laminated safety glass
Tertiary prevention
Teach parents 1st aid
Achondroplasia
- Phenotype
- pathology
- RF
- Surgical Tx
Short limbs/fingers
Large head with frontal bossing
Lumbar lordosis
Autosomal dominant mutation resulting in abnormal cartilage
Parental age at conception
FH (AD)
Limb lengthening with Ilizarov
Acute epiglottis
- Organism
- Features
- What NOT to do
Hib
Rapid onset, High temp, Unwell, Stridor, Drooling saliva
Examine throat with tongue depressor (precipitation airway obstruction)
Apgar score
- Used for?
- 5 categories (0-2 points per category)
- What is a good score
Assess health of a newborn baby
Pulse (present, over 100 = gd) Resp (strong, crying) Colour (pink) Muscle tone (active movement) Reflex (cries on stimulation)
What is a bad situation in Apgar?
Blue
Floppy
No breath
part rate under 60bpm
Severe Asthma attach
- SpO2
- PEF
- Talking
- HR
- RR
- Other
Less than 92%
PEF 33-50% of predicted
Too breathless to talk/feed
HR over 125
(over 140 if under 5)
Over 30
Use of accessory muscles
Life threatening a asthma
- SpO2
- PEF
- Chest
- RR
- Other Observations
SpO2 under 92%
PEF under 33%
Silent chest
Poor resp effort
Agitation, Altered consciousness
Cyanosis
Moderate attack
- SpO2
- PEF
- Other
SpO2 over 92%
PEF over 50%
No other severe features
Treating Acute asthma (mild-moderate)
Bronchodiltor: Salbutamol via spacer
- 1 puff every 30-60s up to a max of 10 puffs
- If symptoms not controlled by inhaler challenge then refer to hospital
- 3-5 day steroid therapy for all exacerbation (Prednisolone)
5 Asthma Step Tx in children over 5
only first 4 steps before referral in under 5s
1: SABA
2: + Pediatric dose ICS
3: + Leukotriene receptor agonist
4: LABA instead of LTRA
5: SABA + MART (instead of ICS+LABA)
What is MART
Maintenance and receiver therapy
Combined ICS and LABA in single inhaler
Used for daily maintenance as well as relief of symptoms
(LABA must have a fast acting component e.g. Formoterol)
ADHD
- epidemiology
- mechanism
Boys more
Low levels of dopamine in frontal areas = low concentration Tx targets this)
ADHD
- diagnosis
Persistent features
5 of the following
cant follow instructions
reluctant to engage with mentally intense tasks
Easily distracted
difficulty completing taks
Unable to play quietly
Talk excessively
Often on the go
Interruptive
doesn’t wait turn
ADHD management
What to do before drug therapy
Look at needs of cold and how life affected (Paediatrician with behaviour disorder interest or CAMHS)
1st line: Non pharma
Drug therapy: Methylphenidate, Lisdeamphetamine
(Both cardiotoxic, do an ECG prior
Autism
- Epidemiology
- 3 features for diagnosis
- Other features
75% male, usually before age of 3
1) Global impairment of language/communication
2) Imparied social relationships
3) Ritualistic and compulsive phenomena
Most have a decreased IQ
Remember this is a spectrum of disease
Autosomal Dominant Vs Autosomal Recessive. How to remember
AR thought of as metabolic
AD more structural
** there are some exceptions
Autosomal Dominant E.G
Achondroplasia ADPKD Ehlers-Danlos FAP SPherocytosis HNPCC Huntingtons Marfans Von hippel Lindau
Autosomal Recessive E.G
CAH CF Phenylketonuria Sickle cell Thalassaemias Wilsons Haemochromatosis
Bronchiolitis
- def
- epi
- cause
- when is it serious
Condition with acute bronchiolar inflammation
LRTI in under 1 (small airways). Higher incidence in winter.
RSV in 80% (mycoplasma can also)
When assoc with prematurity (bronchopulmonary dysplasia), congenital heart defect or CF
Bronchiolitis
- Features
- Investigations
- Referral to hospital
Coryza symptoms ± mild fever
Dry cough
Worsening breathlessness
(Feeding issues assoc commonly why admitted)
Wheeze/fine inspiratory crackles
Immunoflourescence of nasopharyngeal secretions may show RSV
Respiratory distress (chest recession, grunting) RR over 60 Difficulty feeding (breast, bottle) Clinical dehydration
Management RSV
Humidified Oxygen vie head box if sat under 92%
NG feeding if struggling for food/liquid by mouth
RSV prophylaxis
- Who
- How
If Premature of Chronic lung disease
Significant congenital hart disease
Palivizumab
Concerning causes of bruising in infants/children
NAI ( multiple sites, look for grip marks etc)
Coag (Haemophilia, vWB, Liver disease)
Thrombocytopenia (ITP, Congenital infection, meningococcal septicaemia, ALL)
Caput secundum
- desc
- features
- management
Oedema of scalp at presenting part of head (vertex typically)
Due to scalp pushing on cervix/use of ventouse
Soft swelling, crosses suture lines
Resolves in days - conservative
Cephalohaematoma
- desc
- what is it
- common region
- Time to resolve
Swelling on newborn head, typically parietal region, doesn’t cross suture lines.
Bleeding between periosteum and skull
up to 3 months to resolve
Cerebral palsy
- What is it
- Manifestations
Disorder of development due to non-progressive lesion in motor pathways of developing brain
Abnormal tone in infancy
Delayed motor milestones
abnormal gait
Feeding difficulties
Associated non-motor problem CP
Learning difficulties (60%)
Epilepsy (30%)
Squints (30%)
Hearing impairment (20%)
Causes of CP
Antenatal:
Congenital infection (CMV, rubella, Toxoplasmosis)
Cerebral malformation
Intrapartum: Birth asphyxia
Postnatal: intraventricular haemorrhage, meningitis, head trauma, Periventricular leukomalacia (white matter brain injury assoc with prematurity, poor white matter perfusion)
CP Classifications
Spastic (70%)
- Hemiplegia
- Diplegia
- Quadriplegia
Dyskinetic (involuntary movements)
Ataxic
Mixed
CP management
MDT approach
Spasticity: DIazepam, intrathecal baclofen, Botulinum Toxin, Orthopaedic surgery
Anticonvulsants and analgesia where needed
Chicken pox
- Cause
- Shingles
Varicella zoster
Shingles: reactivation in dormant virus in dorsal horn. More due to herpes zoster
Chicken pox
- Spread
- Infectivity
Respiratory, can also be caught from shingles
Infective 4 days before rash until 5 days after rash appeared
Chicken Pox features
Fever
Itch, rash (maculopapular)
Mild systemic upset
Chicken pox Tx
keep cool
Calamine lotion
School exclusion (5 days from rash onset)
Immunocompromised/newborns (permpartum exposure) get Varicella zoster immunoglobulins (VZIG) and the IV acyclovir if chicken pox develop
Varicella zoster complications
Pneumonia
encephalitis
Haemorrhagic chicken pox
Types of child abuse
Physical
Emotional
Sexual Neglect
Fabrication of illnesses
Observations of neglect
Persistent infestations (e.g. scabies/lice)
Tooth decay
Fail to attend followup
Failure to suitably dress child
Poor hygiene, inadequate food provision, Unsafe living env
Sexual abuse
Anogenital discomfort
Preg in young women 13-15
Anogenital warts/Hep B in young child
STI in child under 12
Physical abuse
bruising, Fractures (rib, fractures at diff stages of healing)
Torn frenulum
Burns
Factors pointing towards child abuse
Story inconsistent with injury
Repeated A&E attendance
Late presentation
Frightened, frozen, withdrawn
Social milestones
6w
3m
6m
9m
6w: Smiles
3m: Laughs
6m: Not shy
9m: Shy, everything taken to mouth
Feeding
- 12-15 month
- 3yr
- 5yr
drinks form cup and uses spoon
Spoon + Fork
Knife + fork
Play
- 9 month
- 18 month
- 4 yr
Plays peek-a-boo, waves bye
Plays alone
Plays with others
Newborn screening
Hearing (otolaryngologists-acoustic emissions)
Heel-prick (day 5-9)
- Hypothyroid
- Phenylketonuria
- CF
- MCADD
Mumps:
- Features
Fever, Malaise, Muscle pain, Parotitis (‘earache’)
Rubella features
Pink rash on face before spreading over body
Lymphadenopathy: Suboccipital, postauricular
Scarlet fever
- Cause
- features
Reaction to erythrogenic toxins from Group A haemolytic strep (pyogenes)
Fever, Malaise, Strawberry tongue, tonsilitis
Hand, Foot and Mouth
- Cause
- Features
Coxsakie virus
Sore throat, Fever, Vesicle in mouth, on plasma and soles of feet
Patau syndrome
- Chr
- Features
Trisomy 13
Microcephaly, small eyes, Cleft lip/Palate, Polydactyly
Edwards
- Chr
- Features
E for Edwards and Eighteen - trisomy 18
Low-set ears, rocker bottom feet, overlapping of fingers
Prader- Willi features
Hypotonia
Hypogonadism
Obesity
Coeliac in children
- Cause
- Complication
Sensitivity to gluten (Anti-tissue Transglutaminae)
Villous atrophy and malabsorption
When do children present with coeliac
Around Age of 3 - when cereals introduced
Coeliac in children genetics
HLA- DQ2/DQ8 in up to 95%
Features of coeliac in children
Coincide wit introduction of cereals
Failure to thrive Diarrhoea Abdo distension Anaemia May go undiagnosed
Coeliac diagnosis
Jejunal biopsy = subtotal villous atrophy, crypt hyperplasia, intraepithelial lymphocytes
Anti-endomysial and anti-gliadin antibodies
Acyanotic congenital heart defects (left to right)
VSD (most common, 30%)
ASD
Patent ductus arteriosus
Other:
Coarctation of aorta
Aortic stenosis
Cyanotic Congenital Heart defects
Tetralogy of Fallot (initially left to right until Eisenmenger’s)
Transpositioning of great arteries
Tricusp atresia
Congenital Rubella Features
Sensorineural deafness Cataracts Glaucoma Heart disease (e.g. PDA) Cerebral palsy (less common)
Diagnosis of constipation (2+ out of)
Fewer than 3 stools a week
Type one on Bristol chart (rabbit droppings)
Overflow (loose, smelly, passed without sensation)
Pain/Bleeding with bowel movements
Straining
Appetite improves with stool
Hx of constipations
Painful bowel movements
Constipation causes
Idiopathic
Dehydration Low fibre Medications (opiates) Anal fissure Hypothyroidism Hirschprung's Hypercalcaemia LEarning difficulty
Red flags for secondary cause of constipation
Constipation like symptoms from birth (meconium over 48hrs from birth)
Ribbon stools
Weakness in legs, locomotor delay
Abdo distension
Amber flags for secondary cause of constipation
Faltering growth
Disclosure/evidence suggesting possible child abuse
What needs assessment prior to Tx constipation?
what features to look for?
Faecal impaction
Severe constipation (Long since opened bowels, pain)
Palpable mass in abdo
Treatment of impaction
Movicol Paediatric plan (glycol 3350+)
If no disimpaction after 2 weeks then give stimulant (Senna - Sennokot)
Constipation maintenance therapy
Diet: not used alone, ensure enough fluids and fibre
1st line movicol
Add stimulant laxative if no response
Add Lactulose to Senna if movicol not tolerated
Continue meds until a regular bowel habit is establishes then reduce dose gradually
Cows milk protein allergy
- Features
- Pathology
- Tx
Regurgitation/vomit, diarrhoea, atopic eczema, colic (crying, irritable), wheeze
Both immediate (IgE: Allergy) and Delayed (non-IgE: intolerance) reactions
Skin prick, IgE (RAST) for cow’s milk protein.
Hydrolysed milk 1st line
Usually resolves by1-2 yrs age. Challenge according to milk ladder
Croup
- Def, Epidemiology & Cause
URTI in infants and older toddlers
Parainfluenza majority of cases
Croup Features
Stridor
Barking cough (worse at night - lower endogenous steroid)
fever
Coryzal symtpms
Signs of severe croup (Should be admitted)
Frequent barking cough
Prominent stridor (inspiratory and expiratory)
Sternal recession
Distress, agitation or lethargy (Hypoxaemia)
Management of Croup
In Emergency?
Single dose oral Dexamethasone
(0.15mg/kg)
High flow O2, Nebulised adrenaline
Nitrogen washout test
- What does it test
- What is diagnostic
100% O2 given and then ABG done
Distinguishes cardiac from non cardiac cyanosis
A pO2 of less than 15kPa indicates congenital heart disease
CF
- Genetics, defect & effect
- Organs
- Carrier rate
Autosomal recessive
Cystic fibrosis transmembrane conductance regulator gene (CFTR) Chr 7
Defective Cl transport = viscous secretions
Lungs, pancreas, bowel (obstruction), Fertility
1 in 25
CF organisms that may colonise
Staph aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergilus
CF diagnosis
Screening (Monospot blood test): Immunoreactive trypsinogen
IF +ve screening:
High sweat chloride
(over 60mEq/L)
Genetic testing (blood or salivary sample)
CF Features
Meconium ileus
Recurrent chest infections
Malabsorption (Steatorrhoea, Failure to thrive)
Male infertility, female sub fertility, DM, Short, Rectal prolapse (bulky stools), nasal polyps
CF management
Regular (2X a day) chest physio
High calorie diet, inc high fat + vit supps
Pancreatic enzymes with meals
Heart and lung transplant
Referral
Doesn’t smile at 10 weeks
Cant sit unsupported at 12 weeks
Cannot walk at 18 months
Fine/gross motor problems possible cause
CP
e.g. hand preference, global motor impairment
Speech and language problems cause
Hearing
Env deprivation
General developmental delay
Developmental dysplasia of the hip:
- Def
- RF
- Testing/diagosis
- Tx
Improper formation of hip acetabulum
Female Breech birth FH 1st born Oligohydramnios
Barow (dislocate) & Ortolani (relocate) femoral head
USS if clinical suspected
Most will stabilise by 3-6 weeks Pavlic harness (flexion, abduction orthosis)
Older children may need surgery
Fine motor milestones
- 6 months
- 9 months
- 12 months
Hold in palmar grasp
Pass objects from one hand to the other
Point with finger, early pincer
Good pincer grip
Brick building
Tower of 2
Tower of 3
Tower of 6
Tower of 9
15 months
18 months
2 years
3 years
Gross motor milestones
3 months 6 months 7-8 months 9 months 13-15 months 2 years
Little/No head lag on being pulled up, good head control
Rolls front to back
Sits without support
Pulls to stand, crawl
Walks unsupported (refer at 18 mnths)
Runs, stairs with hand rail
Speech and hearing milestones
3 months 6 months 9 months 12 months 2.5 years 3 years
Turns to sound
Double syllable ‘adah’ ‘erleh’
mama and dada, understand “no”
Responds to own name
Vocal over 200
short sentences
Common cause of gastroenteritis in children
Rotavirus
Hydration status categories in children
Clinical dehydration
Clinical shock
What is seen in clinical dehydration
Decrease urine output Dry mucosa Tachycardia/tachypnoea Sunken eyes Normal peripheral pulses Normal cap refill Warm extremities
What is seen in clinical shock
Decreased Level of consciousness
Cold extremities
Pale/Mottled skin
Tachycardia/Tachypnoea
Weak peripheral pulses & hypotension
Prolonged cap refill
Who is at inc risk dehydration
Younger than 1 low birth weight diarrhoea (6+ stools in 24 hrs) vomit (3X in 24 hours) infants who have stopped breast feeding
Fluid bolus in dehydration
Crystalloid
20ml/kg over 10 min in children
Fluid maintenance
Hourly fluid maintenance:
First 10 Kg 4ml per kilo
Second 10 Kg 2ml per kilo
Above 20 Kg 1ml per kilo
Causes og chronic diarrhoea in children
Most common: Cows milk intolerance (lactose)
Coeliac
Down syndrome features
- Face/Head
- Organs
- Other
Epicanthic folds
Protruding tongue, small ears, round face, flat occiput
Hirschprung’s, Duodenal atresia, Congenital heart defects
Single palmar crease, Hypotonia,
Cardiac complications Down’s
VSP
ASP (secundum - enlarged foramen ovale. Most common Congenital heart defect)
Tetralogy of Fallot
PDA
Later complications of Down’s syndrome
Subfertility/Infertile(men)
- sperm or preg problems
Learning difficulties
Resp infections
ALL
Alzheimer’s
RF for Down syndrome
Maternal age, esp over 35
Downs pathophys
Dislocation or translocation of Chr 21
Eczema
- Pres and prognosis
- distribution
Typically presents before 6 months. clears in 50% baby 5 years and 75% by 10 years of age
Infants: Face and trunk
Older: Flexor surfaces and creases
Eczema Tx
Avoid irritants
Emollients (large amounts)
Topical steroids
Febrile convulsion
- def
- when
- type of seizure & how long
seizure provoked by fever
usually in early viral infection as temp rises rapidly
Usually brief (under 5 min)
Tonic-Clonic
Link of febrile seizure to epilepsy
A RF for epilepsy
Fetal alcohol features
Thin vermillion (hypoplastic upper lip)
Absent filtrum
Learning difficulties
Microcephaly
Growth retardation
Epicanthic folds
How is fever risk stratified in children
Green
Amber
Red
What should be assessed in all children with fever
Temperature
Heart rate
Resp rate
Cap refill
Features of Amber (intermediate risk
Pallor
Not responding to social cues/Dec activity
Nasal Falring, tachypnoea (over 40 Breaths a min)
O2 sats less than 95%
Tachycardia over 140bpm Cap refill over 3 s Dry mucous membrane reduced urine Temp over 39 Non-weight bearing limb
Features of red (high risk)
Pale/mottled/blue
No response to social cues
Not rousable
Weak
Grunting, Tachypnoea, RR over 60, Chest recessions/accessory muscle use
Reduced skin turgor, inc cap refill
Temp over 39, non-blanching rash, Blueing fontanelle, Neck stiffness, focal neurology, status epileptics
Management of an ‘Amber’ child
Safety net: know who to call/where to bring if gets worse
Management of a ‘red’ child
Urgent admission/referral to paediatrics
What is common cause of GORD in infants
Overfeeding with bottle
What are Gastroschisis and Exomphalos
Disorders of anterior abdo wall development
What is Responsible for growth spurt
GH
When to give CT head in children
Lost consciousness over 5 min
NIA suspected
Vomiting
Amnesia
Focal signs
Dangerous mechanism of injury
Most common causes of headache in children
Most common = Migraine with aura (Ibuprofen)
Tension (2nd)
Cause of conductive hearing loss
Secretory otitis media
Down’s syndrome
Cause of Sensorineural hearing loss
Congenital infection (Rubella)
Acquired: meningitis, head injury
Cerebral palsy
Hirschprungs:
- Cause
- Pres
- Assoc
Aganglionic segment. Failed development of Auerbach/Meissners plexuses
Failure/delay to passing meconium
Older: Constipation, abdo distension
More in Males., Downs
Causes of hypertension in children
Renal vascular/parenchymal disease
Coarctation of aorta
Phaemchromocytoma
CAH
Hypospadias
- def
- location
- tx
Ventral urethral meatus
Usually distal
Surgical correction before age of 2 (uses foreskin)
Causes of hypotonia
Downs
Prader-Willi
Hypothyroidism
Cerebral Palsy (may precede spasticity)
Guillain Barre
Myathenia gravis
Immunisation at birth
BCG
Hep B
Immunisation 2 / 3s / 4 months
6-1 vaccine (diphtheria, tetanus, whooping cough, polio, Hit, Hep B)
Oral Rotavirus
Pneumococcal conjugate vaccine
Men B
Immunisation 12-13 month
Hib Men C MMR Pneumococcal conjugate Men B
2-8 years Immunisation
Flu vaccine
Immunisation 3-4 years
‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR
Immunisation 12-13 y.o. girls
HPV vaccination
What vaccine given in university Freshers
Men ACWY
Infant colic
Excessive crying in infant under 3 month
occurs in 20%, cause unknown
What Features in a physiological murmur
Soft-blowing Postural variation No Radiation No thrill No added sounds (clicks) No other symptoms
Intraventricular haemorrhage
- Adult/Premature/Neonates
- Complication
- Tx
Intraventricular bleeding
Traumatic head injuries
Spontaneous due to blood clot
Birth trauma/delicate neonatal CNS
Hydrocephalus
Supportive, Intraventricular thrombolysis,
VP shunt in hydrocephalus
Intussusception
- Desc
- Common site
- Features
Telescoping of one portion of bowel into distal bowel
Ileo-caecal
Abdo colic pain, Vomiting, Red-currant jelly, Sausage shaped mass in Right lower quadrant
Intussusception
- Investigation
- Tx
USS (target shaped mass)
Air insufflation
Surgery if 1st line fails and signs of peritonitis
Jaundice in Newborn
- When always pathological (what causes)
- when physiological and mech
First 24 hours
(Rhesus haemolysis, ABO heamolysis, Spherocytosis, G6PDD)
2-14 days physiological as fatal Hb replaced by adult
In prolonged neonatal jaundice what is worry?
Tx?
Biliary atresia (lack of biliary ducts)
Raised conjugated bilirubin (Liver has conjugated)
Surgery
JIA
- Clinical features
- Investigations
Pyrexia Rash (salmon pink) Lymphadenopathy Arthritis Uveitis Anorexia/weight loss
ANA positive
RF -ve
Kawasaki disease
- disease type
- Important complication
Vasculitis predominantly seen in children
Coronary artery aneurysms
Kawasaki disease
- Features
- Diagnosis
High grade fever, Red/cracked lips, strawberry tongue, cervical lymphadenopathy, red palms/soles eventually peel
Clinical diagnosis, no specific investigation
Kawasaki disease Management
High dose aspirin (one of few indications for this in children - Reyes risk)
IV Ig
Echo (for coronary aneurysms
Chondromalacia patellae
- pathology
- Who
- pres
- Tx
Softening of cartilage of patella
Teenage girls
Anterior knee pain (esp up and down stairs)
Physio = good response
Osgood-Schlatter
- Who
- Pres
Sporty teen
Pain, tenderness, swelling over tibial tubercle
Limp in child, Obese
Slipped upper femoral epiphysis
femoral head displaced posteriorly
Limp, child unwell/fever
Septic arthritis/osteomyelitis
Measles
- Virus type
- Spread
- Features
RNa
Droplet spread
1) Prodrome: irritable, fever, conjunctivitis
2) Koplik spots (white spots on buccal mucosa) - before rash
3) Rash: starts behind ears then to whole body (maculopapular)
Measles
- Ix
- Tx
- Complications
IgM to Measels
supportive, notifiable disease
Encephalitis, febrile convulsion, myocarditis
Meckel’s Diverticulum
- What is it
- Rule of 2’s
Congenital remnant of vitelline duct. Diverticulum off small intestine
2% pop, 2ft from ileocaecal, 2 inches long
Meckel’s Diverticulum Usually asymptomatic, but possible pres:
Abdo pain (mimic appendicitis) Rectal bleeding Intestinal obstruction (volvulus, intussusception)
Meckel’s Diverticulum Tx
Surgical removal (resection and re-anastomosis)
Meningitis investigations
LP (unless raised ICP signs) and PCR
Blood cultures and PCR if no LP
What signs of inc ICP CI LP?
Focal neurological signs Papilloedema Bulging fontanelle DIC Cerebral herniation (resp impairment)
Management of meningitis:
- 4 Catergories.
- How are contacts tx
Antibiotics: IV cefotaxime (+ Amoxicillin if under 3m)
Steroids: Ddx given if H.Influenzae
Fluids: treat shock with colloid
Cerebral monitoring: monitor resp, may need mechanical ventilation
Ciprofloxacin
Meningitis cause:
- Neonatal - 3m
- Up to 6yr
- Over 6
GBS (from mother, esp prem, PRM)
E.coli
Listeria
Neisseria meningitidis
Strep Pneumoniae
Haemophilus influenzae
Neisseria meningitidis
Strep Pneumoniae
Mitochondrial disease
- Inheritance
- Disease types
Inherited only from affected mothers (fathers don’t contribute any cytoplasm)
Rare neurological diseases
MMR
- Type of vaccinator and against what
- When given
- CI
Live vaccine against measles, mumps and rubella
2 doses:
12-15 months and also 3-4 years
Preg, Immunosuppression, allergy, another live vaccine within 4 weeks
Napkin rash
Irritant dermatitis
Vs
Candida
Dermatitis: most common. irritant effect of urinary ammonia&faeces, Creases spared
Erythematous rash involving flexures. Charecteristic satellite lesions
(Tx: imidazole)
Napkin rash general management
Use disposable nappies
Expose napkin to air when poss
Mild steroid (1% hydrocortisone) in severe
NEC
- Why important
- Initial pres
- Ix + what shown
One of leading causes of death in prematurity
Feeding intolerance, abdo distension bloody stools
Abdo x-ray
- dilated bowel loops
- Bowel wall oedema, pneumonitis intestinal (intramural gas)
- air both inside and outside bowel wall
NEC pathophys
Intestinal immaturity (poor barrier function, immune defence, motility)
Abnormal bacterial colonisation And/Or hypoxic ischaemic injury
And/Or
Formula feeding
= NEC
NEC complication
Abdo perforation, peritonitis, death
NEC Tx
Stop oral feeding
Abx: Cefotaxime, Vancomycin
What is tested for in Heel-Prick (Guthrie) test
Immunoreactive trypsinogen (CF)
Sickle cells
TSH (congenital hypothyroidism
Phenylketonuria - amino acid metabolism error can impair brain development
Nephrotic syndrome
- triad
- peak incidence
- cause in most
Peripheral oedema, Proteinuria, Hypoalbuminaemia
2-5 yrs
Minimal change disease
90% respond to high dose steroids
Other features: hyperlipidaemia, hypercoagulable
Newborn resus
1) dry baby and maintain temp
2) assess tone, resp and heart rate
3) 5 inflation breaths (to keep lungs open)
4) reassess chest
5) if HR under 60 compression and ventilation 3:1
Noctural enuresis:
- Possible causes
- Tx (behavioural, short term control)
UTI, Constipation, T1DM
Star charts
Desmopression
Primary Vs Secondary enuresis
Primary: never been continent
Secondary: previously continent
Causes of obesity in children
Lifestyle by FAR the most
secondary:
- Downs
- Cushings
- Prader-Willi
- GH deficiency
Consequences of obesity in children
Ortho: slipped femoral epiphyses
Psych: poor self esteem, bullying
Sleep apnoea
Long-term:
Inc incidencee T2DM and IHD
Where is BCR ABLE oncogene seen typically
CML
What is an oncogene
Cancer promoting gene derived from mutated normal gene
Only one mutation needed
TSG
Tumour supressor genes repress cellular proliferation
Mutation inactivates
Two mutations = no suppression of cellular division
TSG Eg
p53
Retinoblastoma
BRCA 1&2
Paediatric BLS
Check responsive
Shout for help
Open airway (look/listen/feel for breathing)
5 rescue breaths
Check circulation
15 chest compressions:breaths
Other Associations with oesophageal atresia
Trachea-Oesophageal fistula
Polyhydramnios
VACTERL
Perthes’ Disease
- def
- who
- Features
Degenerative condition of hip due to avascular necrosis of femoral head (epiphyseal) due to impaired blood supply
5 x more in Boys, 4-8 years
Hip pain develops over weeks, reduced ROM,
Perthes diagnosis
Xray:
- Early: widening joint space
- Late: decreased femoral head size/flattening
Perthes Complications
OA
Premature fusion of growth plates
Perthes Managemnt
Keep femoral head within acetabulum (casts, braces)
Over 6 yrs: Surgical. Operate on severe deformities
Phenyketonuira:
- Genetics
- Enzyme + role
- High phenylalanine causes ..
- Heel-Prick result
- Manage
Autosomal recessive
Phenyalanine hydroxylase (breaks down phenylalanine)
Learning difficulties and seizures
Hyperphenylalaninaemia
Diet restrictions of amino acid rich foods
Pneumonia in children
- Treatment
Amoxicillin 1st line
Prader-Willi
- Chr
- Features
Long arm of chromosome 15
Hypotonia during infancy Short dysmorphic features Hypogonadism/infertility Childhood obesity Behavioural problems in adolescence
Precocious puberty
- who normally
- what is
- Central/true Vs False
Girls
puberty before the age of 8
Central = premature activation of hypothalamic-pituitary-gonadal axis (high FSH/LH)
False = FSH&LH low, due to excess sex hormone
Usually idiopathic or familial and follow a normal course of puberty
Puberty
- Age in boys/girls
Males: testicular growth 12 yrs (over 4ml)
Growth spurt at 14
Females: Treat dev at 11, menarche at 13 (11-15)
Pyloric stenosis
- When pres
- Cause
- Epi
2nd-4th week with vomiting
hypertrophy of circular muscles of the pylorus
4X more in men
Pyloric stenosis:
- Features
- Diagnosis
- Tx
Projectile vomiting (30min after feed)
Constipation and dehydration
Palpable mass in upper abdo (olive)
Hypochloraemic, hypokalaemia alkalosis from persistent vomiting
USS to diagnose
Ramstedt pylorotomy to Tx
Retinoblastoma
- Def
- when diagnosed
- Pathophys
Most common ocular malignancy in children
18 months
Loss of functions of Rb TSG on Chr 13
Retinoblastoma
- Features
- Tx
- Prognosis
Absent red-reflex (replaced with white pupil - Leukocoria)
Strabismus (inward misalignment of eye)
visual problems
External be a, radiation, chemo, photocoagulation, enucleation
90% survive into adulthood
Scarlet fever:
- what causes
- who
- Spread
Reaction to toxins produced by Group A strep (Pyogenes)
Children aged 2-6
Respiratory spread (droplet)
Scarlet fever:
- Features
- Management
Fever Malaise (N&V, headache) Sore throat Strawberry tongue Fine punctate rash (pinhead, sandpaper) Desquamation around fingers and toes
Oral penecillin V (phenoxymethylpenicillin)
Azithromycin if allergic
Scarlet fever usually mild, may be complicated by…
Otitis media (most common)
Rheumatic fever (Group A strep)
Acute glomerulonephritis (immunisation complex mediated)
Shaken baby
- Triad
- Cause
1) Retinal haemorrhage
2) Subdural haematoma
3) Encephalopathy
Intentional shaking of a child 0-5 years old
RF for sudden infant death syndrome (largest killer in 1st year of life)
Prone sleeping Parental smoking Prematurity Bed sharing Over wrapping (hyperthermia)
Sudden infant death syndrome protective factors
Breastfeeding
Room sharing
Use of dummies
Slipped femoral epiphysis
- Who
- What
- When commonly
- Pres
10-15 year old obese boys
Postero-inferior displacement femoral head
Acute presentation following trauma OR Chronic persistent symptoms
Hip, Groin, Medial thigh or knee pain
Lost internal rotation of hip
Surfactant deficient lung disease (RDS)
- who
- cause
Premature infants
Insufficient surfactant production and structural immaturity of lungs
RDS risk
- 26-28 weeks
30-31 weeks
- When surfactant produced and role
50%
25%
Around 28 weeks
Helps reduce surface tension of lungs
RF for RDS
Prematurity
Male
Diabetic mother
C-section
SDLD (RDS) clinical features & CXR features
Tachypnoea, intercostal recession, expiratory grunting, cyanosis
Surfactant deficiency lung disease management
Maternal corticosteroids to induce lung maturation (given with nifidepine/terbutaline tocolytics)
Oxygen, assisted ventilation
Exogenous surfactant (Exosurf)
Tetralogy of Fallot
- type of congenital heart disease
- four features
Cyanotic
1) VSD
2) Over-riding aorta
3) Pulmonary stenosis (determines cyanosis degree)
4) Right ventricular hypertrophy
TOF other features
Ejection systolic murmur (pulmonary stenosis)
CXR: boot shaped heart, ECG: RVH
TOF management
surgical repair (2-stage procedure)
Complication of TOF
Eisenmengers (need heart & lung transplant)
TSG EGs
p53 APC (colorectal) BRCA 1&2 (Breast, ovary) NF1 Rb
Turner syndrome
- Genetic abnormality
- Features
- Inc risk of..
45XO
Short, primary amenorrhoea, webbed neck, bicuspid aorta, coarctation of aorta
AI disease (Thyroiditis, Crohn’s)
Undescended testis
- Complications
- Tx
Infertility
Torsion
Testicular cancer
Orchidopexy: move to scrotum (done at around 1yr age)
UTI in children
- diff to adult manage
- Organism
- Predisposing factors
Should always be investigated for underlying cause and kidney damage
E.coli (80%)
Infrequent voiding, constipation (obstructive)
Vesicoureteric reflux
Poor hygiene: wiping back to front (girls)
UTI in children
- who
- pres
- urine collection
- Tx
Boy more until 3m
poor feeding, vomiting
Abdo pain, dyuria, frequency, haematuria
Upper UTI: loin pain, temp over 38
Clean catch (best), pads, invasive (suprapubic aspiration)
Under 3m = referral
LUTI: Trimethoprim
UUTI: Cephalosporin, co-amoxiclav
Vesicoureteric reflux
- def
- complication
- pathophys
- Ix & diagnosis
abnormal back flow of urine from bladder into the ureter/kidney
UTI, renal scarring in 35%
Lateral displacement. More perpendicular (rather than angle) = shorter intramural course of ureter.
Micturating cystogram for diagnosis
DMSA scanner renal scarring
Whooping cough
- Cause
- immunisation times & problem
Gram -ve Bortadella pertussis
2,3,4 months then 3-5 years
(Pregnancy vaccination campaign as newborns vulnerable)
Immunisation and infection don’t provide lifelong immunity
Whooping cough presentation & diagnosis & complications
2-3 days of coryza before:
cough bouts: may cause vomiting, central cyanosis
inspiratory whoops (forced inspiration against glottis)
symptoms 10-14 weeks
Ix
Nasal swabs, PCR and serology, marked lymphocytosis
Comp:
subconjunctival haemorrhages, pneumonia, Bronchiectasis, seizures
Whooping cough management
Oral macrolide: Clarithromycin or erythromycin (to reduce spread of disease, doesn’t alter symptoms)
Wilm’s tumour
- what
- who
- pres
Nephroblastoma
Children under 5
abdo mass (can cause constipation like symptoms), painless haematuria
Anorexia
fever
Wilms tumour Tx
Nephrectomy, chemotherapy, Radiotherapy
Prognosis: 80% cure rate.
Why no aspirin in children
Reyes syndrome (Brain and Liver dysfunction)
Who is affected in X-linked recessive
Only males
male to male transmission never seen, can only have unaffected sons or carrier daughters
Goes on the principle that affected father X heterozygous mother = VERY rare
Septic screen
CXR
Urine & blood culture
LP
