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Paediatrics Flashcards

1
Q

What is Autism Spectrum Disorder and when does it present?

A
  • Behaviour beyond cultural norms
  • Affects communication, social relatedness, movement, and interpersonal relations.
  • Presents 2-4y
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2
Q

Diagnosis of Autism Spectrum Disorder

A

At least 6 of:

  • Failure to use eye contact, facial expression and body language
  • Lack of socio-emotional repicoty
  • Language delay
  • Lack of spontaneously seeking to share enjoyment
  • Failure to initiate and sustain conversation
  • Stereotyped repetitive words
  • No make believe play
  • Regimented routines
  • Failure to develop peer relationships
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3
Q

Complications/ co-morbidities of autism

A
  • Mental retardation
  • Language delay
  • ADHD
  • Epilepsy (1/4)
  • Learning and attention difficulties
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4
Q

Investigations and managment of autism spectrum disorder

A
  • Ix: Educational psychologist, information from school, SALT assessment
  • Tx: Psychoeducation. MDT- paeds, school, SALT, OT. ?Respiridone ?melatonin to improve sleep
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5
Q

What are the features of ADHD?

A
  • = Neurodevelopmental disorder with Sx <7y in 2 different environments (home and school)
  • Inattention - poor attention to detail, fails to engage with tasks, poor organisation, loses things, distracted, forgetful
  • Impulsivity - Blurts out answers, fails to wait in line
  • Hyperactivity - Fidgets, leaves seat when expected to sit, runs inappropriately, noisy, persistent pattern excessive motor activity
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6
Q

ADHD Ix and Tx

A
  • Ix: Conner’s questionairre, home/ school assessment
  • Tx:
    • Conservative: psychoeducation, involvement of parents, routine
    • Medical: Psychostimulatns (eg methylfenidate) to improve concentration, non-stimulants (eg atomoxetine)
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7
Q

What are the 2 patterns of attachment disorder and their features?

A
  1. Disinhibited- Result of institutional care and no main care giver. ++ friendly with strangers, overreactive
  2. Reactive- Result of abuse/neglect. Fearfullness and hypervigilance
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8
Q

What is attachment disorder?

A

Abnormal social functioning that is aparent during 1st 5y of life, causing significant emotional disturbance. Persists into later childhood.

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9
Q

Treatment of attachment disorder

A
  • Support care givers
  • Nurturing care setting
  • Family therapy, play therapy
  • High risk of other mental health conditions –> screen
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10
Q

What are the main pathogens of pneumonia in different age groups of children?

A
  • Newborn- Bacteria from genital tract eg Group B Strep
  • Infants- RSV, Strep. pneumoniae, HiB
  • >5y- S. pneumoniae, chlamydia pneumoniae
  • Newborn= broad spectrum IV ABx
  • Older infants- ?PO ABx
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11
Q

What might you suspect in a child diagnosed with pneumonia with persistent fever despite 48h ABx?

A

?Parapneumonic effusion –> drainage w/ USS

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12
Q

Indications for admission of a child with pneumonia

A
  • Sats <93%
  • Tachypnoea
  • Respiratory distress
  • Poor feeding
  • <6 months
  • Apnoeas
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13
Q

How might a child with croup present?

A
  • 6m-6y
  • Often in Autumn
  • Stridor
  • Barking cough
  • Temp >38.5
  • Hoarse voice
  • Often preceded by fever and coryza
  • Respiratory distress and cyanosis
  • DON’T EXAMINE THROAT- ?epiglottitis
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14
Q

Croup- investigations and management

A
  • Ix: O2 sats, NPA (parainfluenza)
  • Tx: Usually home.
    1. Humidified air
    2. Dexametasone/pred PO
    3. NEB budesonide
    4. Adrenaline + o2 in severe
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15
Q

How might a child with Bronchiolits present? + RF + organisms

A
  • <2y
  • RF: Prematurity, CF, congenital heart disease
  • Organisms: RSV, S. pneumoniae, H. Influenzae
  • Sx:
    • Coryza –> dry cough –> SOB
    • Poor feeding
    • Apnoeas
    • Crackles
    • Hyperinflation
    • Tachypnoea/Tachycardia
    • Signs of resp distress
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16
Q

Investigations and management of bronchiolitis

A
  • Ix: Obs, NPA, CXR, ?ABG
  • Tx:
    • Conservative- Humidifies o2, NG
    • Medical- IVT, ?trial bronchodilator
    • NIV in severe
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17
Q

What are the key features of Epiglottitis?

A
  • ++ Unwell. DO NOT EXAMINE THROAT
  • Rapid onset, no prodrome
  • No cough
  • Unable to drink, drooling, mouth open
  • Temp >38.5C
  • Stridor (soft)
  • Unable to speak/cry
  • –> Intubation and IV ABx eg cefuroxime
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18
Q

Signs of respiratory distress in a child

A
  • Tachypnoea
  • Tachycardia
  • Low GCS
  • Nose flaring
  • Recessions
  • Sweating
  • Stridor
  • Wheezing
  • Accessory muscles
  • Grunting
  • Cyanosis
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19
Q

Presentation of inhaled foreign body

A
  • Hoarse
  • Cough
  • Dysphonia
  • Haemoptysis
  • Stridor
  • Wheeze
  • SOB
  • Cyanosis
  • Apnoea (complete obstruction)
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20
Q

Congenital heart disease: Types of non-cyanotic (L –> R shunt)

A
  • Atrial septal defect
  • Ventricular septal defect
  • Persistent ductus arteriosus
  • Coarction of aorta
  • Aortic stenosis
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21
Q

Atrial septal defect: Presentation, Ix, Tx

A
  • Murmur- Ejection systolic, ULSE
  • Sx- ASx, recurrent chest inf
  • Ix: ECG (RAD), CXR (cardiomegaly), ECHO
  • Tx: Surgery 3-5y with occlusion device
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22
Q

Ventricular septal defect: Presentation, Ix, Tx

A
  • Small <3mm: ASx, loud pansystolic murmur LLSE
  • Large >3mm: quieter murmur. Sx- HF + SOB, FTT, recurrent chest inf, raised RR/HR
  • Ix: ECG, CXR, ECHO. Cardiomegaly
  • Tx: Small= none. HF= diuretics, ++ calories. Surgery 3-6m.
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23
Q

Persistent Ductus Arteriosis (>1m): Presentation, Ix, Tx

A
  • Presentation: Continual machinery murmur under L clavicle. Collapsing pulse. Usually ASx.
  • Ix: CXR + ECG normal, seen on ECHO
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24
Q

Coarction of the Aorta: Presentation, Ix, Tx

A
  • Presentation: Systolic murmur. Day 1 normal. Day 2 neonatal circulatory failure. No femoral pulses
  • Ix: Severe metabolic acidosis, CXR (cardiomegaly)
  • Tx: Surgery/ stent. Prostaglandins
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25
Q

Aortic Stenosis in children: Presentation, Ix, Tx

A
  • Presentation: Ejection systolic murmur in RSE –> carotids. Most ASx. Exercise intolerance, chest pain, syncope.
  • Ix: ECG (LV hypertrophy), CXR (cardiomegaly)
  • Tx: Balloon valvotomy/ replacement valve
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26
Q

Congenital Heart Disease: Types of cyanotic (R –> L shunt)

A
  • Transposition of the great arteries
  • Tetralogy of Fallot
  • Hypoplastic L Heart syndrome
  • Eisenmenger Syndrome
  • Tricuspid atresia
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27
Q

Transposition of the Great Arteries: Presentation, Ix and Tx

A
  • Cyanosis (++ Day 2) as DA closes
  • Ix: ECG, CXR (narrow upper mediastinum), ECHO
  • Tx: Prostaglandins, balloon septostomy
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28
Q

Tetralogy of Fallot: Presentation, Ix and Tx

A
  • = Large VSD, overriding aorta, subpulmonary stenosis, RV hypertrophy
  • Presentation: Harsh ejection systolic murmur LSE. Sx- cyanosis, irritable, SOB, pallor, cyanotic spells.
  • Ix: CXR- boot shaped heart, ECG- RV hypertrophy, ECHO, catheterisation
  • Tx: Surgery at 6m to close VSD and relieve RV obstruction.
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29
Q

Hypoplastic L heart syndrome: Presentation, Ix and Tx

A
  • = Underdevelopment of L side –> no flow through L side –> no o2 to body. Rely on ductal circulation.
  • Presentation: Profounf acidosis, rapid CVS collapse, weak/ absent peripheral pulses
  • Tx- Surgery, prostaglandins
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30
Q

What is Eisenmenger Syndrome?

A

Large L-R shunt not treated early –> pulmonary arteries thick and resistant. 10-15y shunt reverses –> RHF, cyanosis

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31
Q

Causes of Heart failure in children

A
  • Neonates- Obstructed systemic circulation, hypoplastic L heart syndrome, critical aorta stenosis, interruption of aortic arch
  • Infants- Pulmonary hypertension, VSD, ASD, PDA
  • Older children- R/L HF, Eisenmenger’s, rheumatic heart disease, cardiomyopathy
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32
Q

Presentation of heart failure in children

A
  • SOB - exertion/ feeding
  • FTT
  • Cyanosis
  • Tachycardia/tachypnoea
  • Murmur
  • Enlarged heart
  • Hepatomegaly
  • Recurrent chest infections
  • Poor feeding
  • Sweating
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33
Q

BTS stepwise management for asthma in kids

A
  • ALL THROUGH SPACER
  • INH salbutamol PRN
  • V. low ICS or montelukast in <5y
  • V. low ICS + LABA or montelukast <5y
  • Response to LABA - cont/stop/increase ICS. ?+montelukast
  • Med dose ICS trial. Addition of theophylline. Refer.
  • PO steroid, cont. med dose ICS. Refer.
  • ** personalised asthma action plan **
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34
Q

HR and RR parameters in severe asthma attack in kids

A
  • RR:
    • 2-5y: >40
    • 5-12y: >30
    • 12-18y: >25
  • HR:
    • 2-5y: >140
    • 5-12y: >125
    • 12-18y: >110
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35
Q

Key features of coeliac in children

A
  • RF: T1DM, AI, Down’s
  • Presentation:
    • 8-24m when weaning
    • FTT
    • Abnomal disstention
    • Irritability
    • Muscle wasting
    • Abnormal stools
    • Anaemia
  • Ix: Anti-transglutaminase, biopsy
  • Tx: GF diet. No wheat, barley or rye
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36
Q

What is CF and how does it present?

A
  • = Autosomal recessive disease from Ch 7. Defective CFTR. Mutation= deltaF508
  • Affects exocrine glands - resp tract, pancreas (lipase, amylase, protease), sweat glands.
  • Presentation:
    • Newborn - Dx on screening, meconium uleues
    • Infant - prlonged neonatal jaundice, FTT, recurrent chest infections w/ HiB/Staph A (hyperinfaltion, creps, wheeze), malabsorption –> steatorrhoea. Salty sweat –> dehydration
    • Young child - bronchiectasis, nasal polyps, sinusitis
    • Adolescent - DM, cirrhosis, intestinal obstruction, finger clubbing, sterility in males
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37
Q

Ix and Tx of CF

A
  • Ix:
    • Bedside:
      • Heelprick (high immunoreactive trypsinogen)
      • Sputum sample
      • Sweat test= Dx. ++Chloride
      • Faecal elastase
    • Bloods - LFTs
    • Imaging - CXR
    • Special - genetic testing, spirometry
  • Tx: MDT!!!
    • Cons- chest physio, psych, school support, exercise, vaccinations, high calorie diet, avoid other CF Pt
    • Med- ABx, ?prophylactic ABx eg anti-pseudomonal INH, NEB hypertonic saline, creon, ursodeoxycholic acid, laxatives
    • Surg- lung/ liver transplant
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38
Q

Childhood obesitity - definition, complications, Tx

A
  • Overweight = BMI >91st centile, obese = BMI >98th centile
  • Complications:
    • SUFE
    • Hypoventilation
    • NAFLD
    • PCOS
    • T2DM
    • HTN
    • Higher risk obesity as adults
  • Tx:
    • Cons - healthy eating, physical activity, less TV etc
    • Med/surg- ?orlistat in children >12y with BMI> 40 or >35 w/ complications
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39
Q

Key features of allergic rhinitis in children

A
  • Presentation:
    • Seasonal
    • Conjunctivitis
    • Coryza/ discharge
    • Cough/ sneezing
    • Poor sleep and concentration
  • Ix: IgE, skin testing
  • Tx: Avoid allergens, antihistamines, topical steroids, immunotherapy, decongestants –> montelukast?
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40
Q

Key features of mesenteric adenitis

A
  • = Inflammation and swelling of LNs in abdo.Mimics acute appendicitis
  • Presentation:
    • Usually + viral infection
    • Fever
    • Malaise
    • Central abdo pain
    • N+V
    • Diarrhoea
  • Ix: Period of observation - will stay same/ get better
  • Tx: Conservative - HWB, para, IVT
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41
Q

Paeds Development milestones

A
  • Birth - 8w: Primitive reflexes, pull to sit, fix + follow, startles to noise, social smile
  • 6m: sit without support, roll, palmar grasp, transfer hand-hand, babbles
  • 9m: cruising, pincer grip, responds to name, stranger fear
  • 12m: walks unaided, bricks x2, 3 words, waves “bye bye”
  • 18m: runs + jumps, drawing, bricks x4, 1-6 words
  • 2y: Throws ball, stairs 2 feet, bricks x8, 2 words together, eats with spoon
  • 2.5y: kicks ball, draws horizontal line
  • 3y: stairs 1 foot, draw circle, fork and spoon, shares toys
  • 4y: draws shapes, complex instructions, bladder contol, dressing, eats skillfully
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42
Q

Paeds development limit ages

A
  • Motor
    • Head control- 4m
    • Walking - 18m
  • Fine motor + vision:
    • Fix + follow- 3m
    • Transfers- 9m
    • Pincer grip - 12m
  • Speech and language:
    • Babble - 7m
    • 6 words + meaning - 2y
  • Social and emotional:
    • Smile- 8w
    • Feeds self - 18m
    • Symbolic play- 2-2.5y
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43
Q

What is cerebral palsy and what causes it?

A
  • = Chronic disorder of movement and/ or posture
  • Cause= static injury of developing brain
    • 80% antenatal. Vascular occlusion, cortical migration, structural maldevelopment
    • Genetic
    • Congenital infection
    • 10% hypoxic ischaemic injury
    • Post-natal - meningitis, encephalitis, head trauma
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44
Q

Presentation of cerebral palsy

A
  • Presentation:
    • ?Hx prematurity/ hypoxic-ischeamic injury
    • Presentation <2y –> persists
    • Delayed milestones
    • Abnormal limb/ trunk posture
    • Feeding difficulties - incoordination, gagging, vomiting
    • Asymmetrical hand function <12m
    • Primitive reflexes persist
    • Abnormal gait
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45
Q

Clinical forms of cerebral palsy

A
  • Spastic (90%): UMN. Increased tone + brisk reflexes. Spasticity. Paralysis. Dysphagia/ dribbling. Tip toe walking
  • Choreoathetosis/ dyskinetic- invol, uncontrolled, stereotyped movements. Chorea (sudden)/ dystonia (twisting)/ athetosis (writhing). ++ tone awake, not asleep.
  • Ataxic: Genetic. Reduced tone, poor balance. Dealyed motor development.
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46
Q

Ix and Tx of cerebral palsy

A
  • Ix: MRI scan - pyramidal tracks
  • Tx: MDT. Cons- physio. Movement and posture exercises, wheelchair, OT + aids, education
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47
Q

What is Down’s syndrome and how does it present?

A
  • Trisomy 21
  • RF: FHx, maternal age
  • Presentation:
    • Facial appearance - round face, flat nasal bridge, epicanthic folds, brushfield spots on iris, small mouth, protruding tongue, small ears + low folded, flat occiput
    • Small stature, short neck
    • Single palmar crease
    • Delayed motor milestones
    • Learning difficulties
    • Hearing impairment
    • Visual impairment - cataract, swuint, myopia
    • Reduced tone
    • Hyperflexibility
    • At higher risk of: leukaemia, solid tumour, hypothyroid, coeliac, congenital heart defects (40%), epilepsy, dementia, duodenal atresia/hirschprung’s,
48
Q

Ix and Tx of Down’s

A
  • Ix:
    • Antenatal - beta-hCG, PAPA + nuchal translucency –> amniocentesis >15w
    • Suspect at birth - bloods + FISH
    • Newborn screening in Down’s - cardiac, feeding, vision, hearing, thyroid, haematological abnormalities
  • Tx: MDT. Aim to reduce complications
    • Cons- parental support
    • Annual r/v - feeding, bowel, bladder, behavioural disturbance, vision, hearing, resp, cardio
49
Q

Presentation of adenoidal enlargement in kids

A
  • Adenoids enlarge until 8y. Airway narrowing 2-8y
  • Presentation:
    • Difficulty breathing/ noisy
    • Nasal voice
    • Snoring
    • Apnoeas
    • Inc. otitis media
50
Q

Intestinal obstruction in kids - presentation, causes, Ix and Tx

A
  • Causes:
    • Small bowel - duodenal atresia/ stenosis, volvulus, meconium plug, Meckel’s diverticulum
    • Large bowel - ileal atresia, intussesception, Hirschsprung’s, meconium ileus, rectal atresia
  • Presentation:
    • Colicky abdo pain
    • Bilious vomit
    • Abdominal distention
    • Absence of meconium
    • Resonant bowel sounds
  • Ix: USS, AXR
  • Tx:
    • Cons - NG tube, IVT , air enema
    • Med - analgesia
    • Surg
  • Complications - dehydration, perforation, peritonitis
51
Q

Constipation in children - causes, presentation, Ix and Tx

A
  • Normal fequency:
    • 1st week: 4/d
    • 1st year: 2/d
    • >4y = Normal
  • Causes:
    • Babies - Hirschprung’s, anorectal deformity, hypothyroid, hypercalcaemia
    • Dehydration
    • Immobility
    • Toilet training/ stress
  • Sx- abdo pain, infants sit in way to hold poo
  • Ix- detailed dietary Hx, bloods
  • Tx:
    • Diet - increased fluid + fibre
    • Behaviour training
    • Warm water/ vaseline
    • Abdo massage
    • Med - laxatives
52
Q

Key features of non-organic abdo pain in children

A
  • Chemicals from brain/ gut –> hypersensitivity
  • Presentation:
    • Older children
    • Umbilical pain
    • Acute/ insidious, constant/ fluctuating
    • +/- dyspepsia, N+V, early satiety
    • Psychogenic Sx es anxiety + depression
  • Dx of exclusion
  • Tx: reassurance, lifestyle, antispasmodics, TCAs
53
Q

Common organisms of gastroenteritis in children

A
  • Rotavirus - most common. Immunization.
  • Bacterial more common <2y. Include: Salmonella, campylobacter, shigella, E. coli, C. diff, cholera
  • Transmission: faecal-oral. Water, meat, eggs, prev. cooked rice etc.
  • Bacterial - ++ unwell, blood,
  • Ix- stool sample, bloods, culture
  • Tx- Usually supportive- IVT. ABx if ?sepsis
54
Q

How does IBD present in children?

A
  • As per adults. 1/4 present children/ adolescents.
  • Faltering growth, pubertal delay
  • UC- 90% pancolitis in children
  • Systemic features - eyes, skin, arthritis, weight loss
55
Q

GORD in children - presentation, Ix, Tx

A
  • Common in infancy. Usually resolves by 12m.
  • Cause- inappropriate relaxation of LOS as a result of functional immaturity.
  • Contributing factors - overfeeding, mainly fluid diet, horizontal posture
  • Presentation:
    • Frequent, non-forceful regurg of milk/ gastric contents
    • Put on weight. Otherwise well.
  • Ix:
    • Usually clinical
    • 24h oesophageal pH monitoring
    • Endoscopy + oesophageal biopsy
  • Tx:
    • Parental reassurance. Feed at 30 degrees
    • ?Thickening agents
    • Serious –> ranitadine (surg)
56
Q

Pyloric stenosis - presentation, Ix, Tx

A
  • = Hypertrophy of pyloric muscle –> gastric outlet obstruction. M:F 4:1
  • Presentation:
    • Projective vomiting
    • Visible peristalsis
    • Olive shaped mass RUQ
    • Hunger after feeding
    • Weight loss
    • Dehydration
    • Hypokalaemia, hyponatraemia, alkalosis, low chloride
  • Ix: Test feed +/- USS
  • Tx:
    • IVT - fluid + electrolyte correction
    • Surg - pyelomyotomy. Post-op feed 6h –> discharge 2h later.
57
Q

Key features of overfeeding in infants

A
  • Reccommended feding vol = 150mL/kg/24h
  • Presentation:
    • Weight gain
    • >8 heavily wet nappies/ d
    • Frequent sloppy, foul smelling bowel motions
    • Extreme flatulance and belching
    • Milk regurg
    • Irritability + sleep disturbance
  • Tx: education
58
Q

Key features of food intolerance/ allergy in children

A
  • Intolerance= hypersensitivity, allergy= IgE mediated
  • Infants - milk/ egg (often resolve by 2y), peanut
  • Children- peanut, tree nut, fish, shellfish. Persist.
  • Presentation:
    • IgE mediated- FTT, urticaria, swelling, anaphylaxis
    • Non-IgE mediated - few hours later. D+V, FTT, abdo pain, eczema, colic
  • Ix:
    • Skin prick test - RAST for IgE
    • 6-12m Sx free –> controlled food challenge
  • Tx:
    • Cons- avoid food, educate on acute Tx
    • Med- antihistamines, anaphylaxis Tx
59
Q

Key features of lactose intolerance

A
  • Commonly post-viral gastroenteritis eg rotavirus
  • Rarely primary congenital lactase deficiency. Severe.
  • Usually transient - 4-6w
  • Older children - lactase levels decline –> intolerance of varying severity
  • Presentation:
    • Diarrhoea
    • Flatus
    • Colic
    • Peri-anal excoriation
    • Stool pH <5
  • Tx: lactose-free formula milk. X soya milk <6m
60
Q

Key features of abdominal migraine

A
  • Presentation: 4% paeds migraines!
    • Nausea +/- vomiting
    • Abdo pain
    • Pallor
    • Headaches
    • Anorexia
    • Strong FHx of migraines
  • Tx:
    • Dietary - avoid citrus, choco, caffeine, solid cheese
    • Drugs - pizotifen, sumitriptan, gabapentin, amitriptylline
61
Q

Key features of cow’s milk protein allergy

A
  • = commonest allergy in infancy. Usually present 3m
  • Presentation: (depends where inflamm)
    • Upper GI - Vomiting, feeding aversion, pain, regurg
    • Small intestine - Diarrhoea, abdo pain, FTT
    • Large intestine- acute colitis w/ blood + mucus
    • Other - wheeze, chronic cough, urticaria, atopic eczema
    • May occur in breast-fed infant when mum drinking milk
  • Ix: Skin prick, IgE
  • Tx:
    • Limit cow’s milk (+goats, soy) intake. Mum- no cow’s milk
    • ?Elemental formula
    • After weaning, intro cow’s milk protein free diet. ?Challenge after 6-12m
  • Majority resolve by 5y.
62
Q

Intussusception- definition, presentation

A
  • = Telescoping of proximal bowel into distal segment. Esp ileocaecal valve.
  • Presentation:
    • <2y. Peak 6-18m
    • Pallor
    • Draw knees up
    • Palpable sausage shaped mass
    • Red current jelly stools
    • Vomit
    • Intermittent colicky pain- 2-3mins –> pale and floppy between.
63
Q

Ix and Tx of intussusception + complications

A
  • Ix: USS - target sign
  • Tx:
    • ABCDE + Resus - IVT
    • Cons - NG, air enema
    • Med - ABx, analgesia
    • Surg - reduction
  • Complications:
    • Dehydration
    • Venous obstruction
    • Small bowel obstrution –> perforation
    • Peritonitis + gut perforation
    • Shock
64
Q

Hepatitis in children - causes, presentation, Ix, Tx

A
  • Presentation:
    • N+V
    • Jaundice
    • Malaise, anorexia
    • RUQ pain
    • Ascites
    • Varices
    • Hepatosplenomegaly
    • Fulminant - Jaundice,
  • Causes:
    • Viral - hep A/B/C/D/E, EBV, HIV, CMV
    • Poisons - paracetamol
    • Wilson’s
    • AI hepatitis
    • Reye’s syndrome - aspirin
    • Neonatal liver disease
    • CF
  • Ix: LFTs, glucose, viral serolosy, paracetmol level, Ix for AI/ hereditary liver disease
  • Tx: supportive, IVT, manage sugar, haemorrhage, cerebral oedema
65
Q

Febrile convulsions - Presentation, Ix, Tx

A
  • Presentation:
    • 6m-6y, ?FHx
    • Temp >39 eg viral illness
    • Generalised tonic-clonic seizures
    • No focal signs
    • Brief <15m. Quick recovery - should no longer be drowsy by 1h.
    • Complex - Focal, >15mins, >1 ep in a day
  • Ix: Infection screen - cultures, urine dip, LP. EXCLUDE MENINGITIS
  • Tx: Self limiting
    • Cons - educate: strip off, safe area
    • Med- antipyretics
    • >5 mins –> 999
    • >10mins= status epilepticus
  • Risk of recurrence= 1/3. 2% –> epilepsy
66
Q

Presentation of brain tumours in children

A
  • Headache - worse lying down/ in morning
  • Confusion
  • Morning N+V
  • Fits/ seizures
  • Recent change in personality/behaviour/ performance
  • Weight loss/ FTT
  • CN abnormality
  • Torticolis
  • Incoordination, loss of balance
  • Gait change
  • Eye changes
  • Back pain
67
Q

Ix and Tx of brain tumours in children

A
  • Ix:
    • Bedside - Obs, fundoscopy (?papilloedema), BMI, full neuro exam, head circumference, pubertal status
    • Bloods - ?infection
    • Imaging - MRI
    • Special - LP, biopsy
  • Tx: Refer! Same day if high risk
    • Support of carers + of education
    • Palliation
    • Chemo/ radio/ surgery
68
Q

Key features of neonatal epilepsy

A
  • Presentation - lip smacking may be sign of seizure
  • Ix-
    • Bloods - FBC, CRP, glucose, electrolytes
    • LP
  • Tx:
    • Phenobarbital
    • Pyridoaxal phosphate
    • Clonazepam
69
Q

Key features of West Syndrome

A
  • Triad of:
    • Infantile spasms - short tonic contractions of trunk with upward elevation of arms
    • Developmental delay/ regression
    • EEG - hypsarrhythmia
70
Q

Head injury in children - presentation, causes, Tx

A
  • Haemorrhage in kids:
    • Epidural - direct trauma
    • Subdural - direct trauma/ shaking
  • Presentation:
    • ++ Vomiting
    • ++ Crying
    • ++ Headache
    • Bulging fontanalles
    • Seizures
    • Reduced GCS
    • ?Basal skull #
    • Neck stiffness
    • Neuro eg gait change
  • Red flags for NAI: <1y, skull haemorrhage, injury around eye
71
Q

Ix and Tx of head injury in children

A
  • Ix- bloods, CT head
  • Tx:
    • ABCDE
    • Mild - home, written advice
    • Severe - Resus, CT scan, neuro referral
    • Med- analgesia, steroids, diuretics, anticonvulsants
    • ?Surg
72
Q

Treatment of migraines in children

A
  • Dx after at least 5 attacks lasting 1-48h
  • Features:
    • Unilat or bilat in children, pulsatile, mod-severe, aggravated by routine activity.
    • During attack - N+V, photo/phonophobia
  • Cons - avoid triggers, hydration, reg meals/sleep
  • 1st line - Paracetamol, domperidone (tx headache and nausea)
  • Prophylaxis - if frequent enough to affect school. 1st line = pizotofen –> propranalol –> amitryptilline. Sumatriptan if >12y
73
Q

Meningitis organisms in children

A
  • Organisms:
    • Neonates - GBS, E. Coli, listeria monocytogenes
    • Infants - Hib
    • Older children - N. Meningitidis, S. Pneumoniae, Hib
  • Ix- CT head, LP
  • Tx- IM dexamethasone –> IV cefotaxime + Ben Pen
74
Q

Idiopathic Thrombocytopoenia- what is it? Presentation, Ix, Tx

A
  • ITP = AI - type 2 hypersensitivity. Ab to surface platelet antigens secondary to viral infection –> ++ bleeding
  • Presentation:
    • Petechiae/purpura
    • Bruising
    • Non-blanching rash
    • Bleeding - nose, gums, haematuria, rectum
    • Rare - intracranial bleed
  • Ix:
    • FBC (isolated thrombocytopoenia - platelets <150)
    • Blood film to exclude DDx
  • DDx- leukaemia, sepsis, haemophila, NAI, aplastic anaemia
  • Tx: Based on Sx
    • No bleeding - supportive. Education on red flags
    • Mild bleeding - tranexamic acid
    • Specialist - steroids, IV immunoglobulins, splenectomy last resort
75
Q

Henoch Schonlein Purpura - what is it? presentation, Ix, Tx

A
  • = Vasculitis. IgA deposited in BVs. Triggers- URTI (90%)
  • Classically in pre-pubertal boys
  • Presentation: (Triad= Arthralgia, palpable purpura, abdo pain)
    • Abdo pain - diffuse, colicky
    • Joint pain/ swelling - esp lower limbs
    • Palpable painless purpura on buttocks/ backs of legs. Gravity driven.
    • Bloody diarrhoea
    • Renal - microscopic haematuria +/- proteinuria
  • Ix:
    • Bedside- urine dip
    • Bloods- FBC, U+Es
    • Biopsy - crescentic IgA GN
  • Tx:
    • Cons- supportive, self-resolving
    • Med- NSAIDs for joint pain
    • Monitor protein + BP
76
Q

NAI red flags

A
  • Trigger usually inconsolable crying baby :(
  • Bruising - immobile babies, buttocks, cheeks, upper arms, ears, abdo, feet, hands, neck, forearm
  • Scalding/ burns - Post. location, well demarcated lines, sparing of creases, absence of splash marks, glove and stocking appearance
  • Bites
  • Fractures - metaphyseal fracture, rib, femoral
  • Shaken baby - apnoea, retinal haemorrhage, seizure, irritability, lethargy, poor feeding, vomiting, subdural haematoma
  • Oral injuries
  • DON’T ALLOW TO GO HOME
77
Q

Key features of measles

A
  • = RNA Paramyxovirus
  • Presentation:
    • Rash- macularpapular, palmar sparing. Starts behind ears –> spreads
    • Prodrome- 4-5d cold like Sx, cough, fever, conjunctivitis
    • Koplik spots
  • Ix: IgM, IgG
  • Tx:
    • Notifiable disease
    • Supportive, isolation, prevent secondary infection
  • Prevention - MMR
  • Complications - otitis media, deafness, pneumonia, encephalitis
78
Q

Key features of mumps

A
  • = Paramyxovirus. Infective 7d before and 9d after parotid swelling
  • Presentation:
    • Parotid swelling
    • Fever, headache, malaise, myalgia, anorexia
    • +/- Erythematous rash on extensor surfaces
  • Tx: Supportive. MMR vaccine = prevention
  • Complications - liver involvement, encephalopathy, infertility
79
Q

Key features of Rubella (German Measles)

A

= German measles. Incubation 2-3w

  • Presentation:
    • Arthralgia
    • Maculopapular rash - pink macules
    • Swollen tender LNs
    • Fever
  • Tx: Supportive. Prevention with MMR. Notifiable.
  • Complications- artheritis, in utero malformations
80
Q

Key features of Erythema Infectiosum (Fifth Disease)

A
  • = Parvovirus B19
  • Presentation:
    • Usually quite well
    • Slapped cheeks - firm, red, hot
    • Lace pattern rash on limbs + trunk
    • Slight fever
  • Ix- IgM +ve
  • Tx- supportive
  • Complications with pregnant contacts - hydrops foetalis, death
81
Q

Key features of chicken pox

A
  • = VZV. Highly contagious between school children. Spreads through air/ skin.
  • Presentation:
    • Vesicular rash. Chest –> spreads
    • Fever
    • Malaise
    • Headache
  • Tx: Usually supportive. Aciclovir in severe. Prevention= vaccine.
  • Shingles = reactivation of VZV –> dermatomal distribution.
82
Q

Key features of Roseola

A
  • = HHV-6/7
  • Presentation:
    • High fevers
    • Coryza
    • Irritability
    • Rash - appears as recovery. Papular, red/pink, blanching. Starts trunk. Surrounding halo.
  • Tx- supportive
  • Complications - liver, encephalopathy
83
Q

Key features of scarlet fever

A
  • = Strep pyogenes. 2-4d incubation
  • Presentation:
    • Fever
    • Rash - Perioral sparing. Palpable (sandpaper) on trunk and limbs
    • Sore throat, irritability
    • Strawberry tongue
  • Tx: 10d penicillin V PO (alt azithromycin)
84
Q

Key features of hand, foot and mouth disease

A

= Viral - coxsackie, enterovirus 71

  • Presentation:
    • Ulcers - mouth and tongue
    • Sore throat
    • Anorexia
    • Temp >38
    • Red spots - blisters on hands and feet. Vesicular rash
  • Tx: self resolving - 7-10d. Fluids, paracetamol.
85
Q

Key features of transient synovitis

A
  • ‘Irritable hip’
  • 2-12y. Offen + viral infection
  • Presentation:
    • Sudden onset pain in hip w/ limp. Non-weight bearing.
    • No rest pain
    • Reduced ROM
    • Pain may be referred to knee
    • Afebrile, doesn’t appear ill
  • Ix: NEWS, bloods, joint aspiration if ?septic arthritis. Normal WCC, ESR, X-ray. USS - ?fluid in joint
  • Tx: bed rest - improves in a few days
86
Q

Key features of Perthes Disease

A
  • ‘Painless limp’
  • = Transient avascular necrosis of femoral head due to interruption of blood supply –> revascularisation + reosification over 18-36m.
  • Male > Female. 5-10y.
  • Presentation:
    • Insidious
    • Limp
    • Hip/ knee pain
    • Bilateral 10-20%
    • Antalgic gait
    • Proximal thigh atropy
    • Effusion
    • Groing/ thigh tenderness
    • Reduced ROM
    • Trendelenburg
  • Ix:
    • X-ray both hips + frog views. Increased density in femoral head, fragmented and irregular
    • Bone scan
    • MRI
  • Tx:
    • NSAIDs, walking aids, physio
    • Early + <1/2 femoral head affected - bed rest and traction
    • Late/ severe - maintain in abduction with cast - acetabulum acts as mould for re-ossification
  • Higher risk of arthritis later in life.
87
Q

Key features of SUFE

A
  • = Slipped upper femoral epiphysis. Displacement of epiphysis of femoral head postero-inferiorly.
  • 10-15y. Esp obese adolescent boys. Associated with hypothyroidism/ hypogonadism.
  • Presentation:
    • Limp
    • Hip/ knee pain
    • Acute or insidious
    • O/E reduction in adduction + internal rotation.
  • Ix: X-ray inc frog and lat views
  • Tx: ASAP to prevent avascular necrosis. Surgical fixation.
88
Q

What is Juvenile Idiopathic Arthritis? + Types and presenatation

A
  • = Persistent joint swelling >6w presenting <16y in absence of infection or other cause.
  • Types:
    • Polyarthritis - >4 joints
    • Oligoarthritis - upto 4 joints
    • Systemic - + fever/ rash
  • Presentation:
    • Gelling - stiffness after long periods of rest
    • Morning stiffness and pain
    • Joint swelling
    • Inflammation
    • Long erm –> bone expansion and valgus deformity
89
Q

Management and complications of JIA

A
  • Management: Specialist paeds rheum team
    • Cons - continue sport at school unless flare
    • Med -
      • NSAIDs
      • Joint injections
      • Methotrexate - minimise joint damage. Weekly dose.
      • Avoid systemic corticosteroids
      • Biologics and immunotherapies
  • 1/3 ongoing active disease into adult years.
90
Q

Key features of UTI in children

A
  • Presentation <3m:
    • Fever
    • Vomiting
    • Lethargy, irritable
    • Poor feeding, FTT
    • Abdo pain
    • Offensive urine/ haematuria
  • >3m:
    • Fever
    • Frequency, dysuria, incontinence
    • Abdo pain, loin tenderness
    • Vomiting, diarrhoea
    • Poor feeding, lethargy, irritable
  • Recurrent –> underlying cause eg VUR?
  • Ix:
    • Bedside- urine dip + culture
    • Imaging
      • Abdo USS if <6m or atypical UTI
      • DMSA isotope scan - renal morphology, structure and function. ?scarring
      • MCUG - ?reflux
    • USS and DMSA on any child with proven UTI <8y!!!
  • Tx: (NB to avoid long term damage).
    • Mild - nitrofuranroin
    • Severe - IV cefuroxime/ gentamicin
    • VUR - prophylactic ABx
91
Q

Key features of daytime enuresis in kids

A
  • Lack of bladder control >3y. Should be dry by day at 2y.
  • Causes: neuropathic bladder, detrusor muscle instability, bladder neck weakness, UTI, constipation, ectopic ureter
  • Ix:
    • Bedside - Urine dip + culture
    • Imaging - USS - incomplete emptying, X-ray spine, ?MRI
    • Special - ?urodynamics
  • Tx:
    • Cons - star charts, bladder training, pelvic floor exercises, portable alarm activated by urine
    • Med- oxybutinin
92
Q

Key features of nocturnal enuresis

A
  • Should be dry by night at 3y
  • M:F 2:1
  • Cause= genetically determined delay in sphincter competence. Most pyschologically and physiologically normal.
  • Organic causes: UTI, constipation, DM
  • Ix: Urine sample
  • Management:
    • Cons - explanation, star chart, supportive parents, no punishment
    • –> enuresis alarm
    • Med - desmopressin
93
Q

Key features of HUS

A
  • = Haemolytic Uraemic Syndrome. 2 Types:
    • Atypical - no diarrhoea
    • Epidemic - E. coli 0157 –> toxins cause gastroenteritis and bloody diarrhoea
  • Presentation:
    • Prodrome - gastroenteritis w/ bloody diarrhoea
    • Triad:
      • Thrombocytopoenia
      • Microangiopathic haemolytic anaemia
      • Acute renal failure
    • Pancreas - glucose intolerance, pancreatitis, jaundice
  • Ix:
    • Bedside - stool + urine C+S
    • Bloods - culture, FBC, film, U+Es, LFTs, E. Coli PCR
  • Tx: Early liason with paeds renal team
    • Mainly supportive. Monitor and Tx electrolytes, fluid balance, nutrition, HTN
    • No ABx
    • ?Transfusion ?dialysis
94
Q

Key features of neonatal ‘small for dates’ + risk after birth

A
  • = Birthweight <10th centile for gestational age. Usually small but normal. +/- Preterm +/- IUGR
  • Low birthweight = <2.5kg
  • At birth liable to:
    • Hypothermia
    • Hypoglycaemia - poor fat/ glycogen stores
    • Hypocalcaemia
    • Polycythaemia
95
Q

Neonatal intestinal obstruction - main causes

A
  • Proximal - duodenal atresia, duodenal web, annular pancreas
  • Distal - Ileal atresia, intussusception, Hirschsprung’s, meonium ileus (CF), meconium plug syndrome, anorectal malformation
  • Both - volvulus, pseudoobstruction, SOL (hernia, cyst, tumours)
96
Q

Neonatal intestinal obstruction- presentation, Ix, Tx, complications

A
  • Presentation:
    • Vomiting - green
    • Constipation
    • Abdo pain/ tenderness
    • Reduced appetite
    • No wind/ stool
    • Lethargy
    • Distention
    • Jaundice
    • Dehydration/ sunken fontanalles
  • Ix:
    • NEWS
    • Bloods
    • USS, AXR/ CT
  • Tx:
    • Cons - NG tube, air enema
    • Med - Analgesia
    • Surg
  • Complications:
    • Dehydration and electrolyte imbalance
    • Infection/ peritonitis –> necrotising enterocolitis
97
Q

Key features of Hirschsprung’s Disease

A
  • = Failure of ganglion cells to migrate to hindgut –> lack of peristalsis. Congenital.
  • Sx- no meconium passage, resistant constipation, green bile vomit/ obstruction
  • Ix- AXR, rectal biopsy (no ganglion cells)
  • Tx- Bowel washout, pull through operation.
98
Q

Key features of Meckel’s diverticulum

A
  • = Persistence of embyronic vitelline duct –> GI bleeding, obstruction, imflammation, umbilical discharge
  • Tx: laparotomy, resection
99
Q

Key features of intestinal atresia

A
  • = Complete blockage of bowel. Rare in colon.
  • Presentation:
    • Well at birth
    • –> no passage of meconium
    • –> Intestinal obstruction
  • Ix:
    • Antenatal USS
    • AXR
    • Laparoscopy
  • Tx:
    • NG tube
    • Surgical
100
Q

Key features of neonatal hypoglycaemia

A
  • Esp in 1st hour of life!
  • RF: IUGR/ macrosomia, DM in mum, hypothermia, polycythaemia, ill
  • Presentation:
    • Jittery/ irritable
    • Apnoea
    • Lethargy/ drowsy
    • Seizures
  • Neonates tolerate well - utilise lactate and ketones
  • Tx:
    • Reg BMs
    • IV dextrose
  • Prevention= early feed.
101
Q

Neonatal respiratory distress syndrome - RF, presentation, DDx

A
  • Affects 1/2 babies 28-32w
  • Pneumocytes usually produce surfactant form 30w –> more compliancy and don’t collapse. Premature babies have insufficient surfactant.
  • RF:
    • Premature
    • DM in mum
    • C-section
    • FHx
    • Lack of antenatal steroids
    • Peri-partum hypoxia
  • Presentation: 4-6h
    • Apnoeas + hypoxia
    • Fatigue
    • Signs of respiratory distress
  • DDx: Transient tachypnoea of newborn (c-section, usually term), infection, MAS, pneumothorax, congenital heart disease.
102
Q

Ix and Tx + prevention of neonatal respiratory distress syndrome

A
  • Ix:
    • Bedside - O2 + obs
    • Bloods - ABG, U+Es, glucose, LFTs, culture
    • Imaging - CXR= ground glass appearance, bell shaped thorax, reduced lung vol, air bronchograms. RDS ruled out if normal CXR at 6 hours
    • ECHO if ?heart disease
  • Tx:
    • Resus and stabilise + o2 (91-95%)
    • Surfactant replacement
    • Supportive - monitor bloods, obs, min handling, temps regulation, NG feed
    • NIV
  • Prevention - Mums given steroids if delivering <34w gestation. ABx if PPROM or GBS
103
Q

Complications of neonatal respiratory distress syndrome

A
  • Acute:
    • Alveolar rupture
    • Pulm haemorrhage
    • Procedure associated
    • Patent ductus arteriosis
    • Persistent pulm. HTN
  • Chronic:
    • Bronchopulmonary dysplasia = chronic lung disease. >28d.
    • Retinopathy of prematurity (sats too high)
    • Neurological sequelae
    • Developmental delay
    • More prone to bronchiolitis
104
Q

Key features of transient tachypnoea of the newborn

A
  • = Lung fluid fails to resorb.
  • Term babies, esp after c-section
  • Presentation:
    • Tachypnoea
    • Recessions
    • Nasal flaring
    • Grunting
    • +/- cyanosis
  • Ix:
    • CXR - fluid on horizontal fissure
  • Tx: Supportive. Resolves 24h.
105
Q

Key features of meconium aspiration syndrome

A
  • 5% term babies with meconium stained liquor –> MAS
  • Hypoxia –> peristalsis –> reflex gasping –> meconium aspiration –> inhibits surfactant + pneumonitis
  • RF: Foetal distress, post-term, maternal drug abuse
  • Presentation:
    • Meconium stained liquor
    • Low Apgar score
    • Resp distress- tachypnoea, cyanosis
  • Ix:
    • ECG - ?pulm hypertension
    • Bloods - ABG (resp acidosis), U+Es, FBC, CRP, culture
    • Imaging - CXR (patchy infiltrate, hyperinflation), lung USS
  • Tx:
    • Supportive - o2, airway suction, ventillatory support
    • Med- surfactant replacement, broad spec ABx, +/- steroids and antisurfactants
  • Usually subsides 2-4d. Increased risk of asthma.
106
Q

Key features of hypoxic ischeamic encephalopathy

A
  • = Brain injury due to perinatal asphyxia
  • Causes:
    • Maternal HTN
    • Foetal compromise - IUGR, anaemia
    • Placental failure - abruption
    • Umbilical failure - cord prolapse, cord compression
    • Failure to breath at birth
  • Presentation:
    • Mild - irritability, hypoventilation, hypertonia, poor feeding
    • Mod - abnormal movement, hypotonia, seizures
    • Severe - no spontaneous movements/ pain response, fluctuating tone, prolonged seizures, multiorgan failure
  • Tx:
    • Resus + stabilise
    • Mild hypothermia - cooling therapy to reverse hypoxia
  • Prog - mild recover completely, mod recovery by 2w or long term issues, severe- mortality 30-40%, 80% neurodevelopmental disability
107
Q

Key features of neonatal sepsis

A

Early onset infection (<48h)

  • Bacteria from birth canal - GBS, listeria monocytogenes
  • RF: PPROM, chorioamnionitis
  • Presentation- resp distress, apnoea, temp instability
  • Ix - CXR, septic screen
  • Tx- IV ABx: BenPen, amox + gent. At least 48h.

Late Onset (>48h)

  • Esp in NICU - catheters, tracheal tube, invasive procedures. Most common organism = staphylococcus epidermidies
  • Presentation- Fever, resp distress, jaundice, seizures, neutropoenia, irritability, high or low glucose, shock, abdo distention, temp instability, vomiting, bulging fonanalles
  • Tx: Fluclox + gent –> vancomycin?
108
Q

Newborn jaundice - why and what causes it?

A
  • Haemolysis of FBC in first few days of life + hepatic bilirubin metabolism less efficient
  • <24h causes:
    • Haemolysis= unconjugated
    • Rh/ ABO incompatibility –> haemolytic disease of the newborn
    • G6PD deficiency - Esp Mediterranean, Middle East, Far East, S American
    • Congenital infection
  • 24h-2w causes:
    • Physiological
    • Breast-milk jaundice - more prolonged. Enterohepatic bilirubin
    • Infection - less fluids, haemolysis
    • Dehydration
    • Haemolysis
    • Bruising eg ventouse
    • Polycythaemia - more RBCs being broken down
    • Crigler-Najjar syndrome - inborn error of metabolism
  • >2 weeks causes (prolonged):
    • Physiological/ breast milk
    • Infection
    • Hypothryoid - heel prick test
    • Haemolytic anaemia
    • High GI obstruction
    • Bile duct obstruction
    • Neonatal hepatitis
109
Q

Causes of congenital infection = TORCH

A
  • Toxoplasmosis
  • Other - HIV, syphilis, measles
  • Rubella
  • CMV
  • HSV
110
Q

Ix and Tx of neonatal jaundice

A
  • Ix:
    • Bilirubin - heel prick
    • Bilirubinometer - check severity
    • Coomb’s test - RBC clump?
    • TORCH screening
    • FBC - infection, RBCs
  • Tx:
    • Hydration
    • 1st line - phototherapy. Break down bili.
    • Exchange transfusion
    • Tx underlying cause
111
Q

What is Kernicterus?

A
  • = Complication of neonatal jaundice. Bilirubin neuro toxicity. Unconjugated bilirubin > albumin binding capacity –> crosses BBB
  • Presentation:
    • Early - Lethargy, poor feeding
    • Late - Irritability, increased muscle tone
112
Q

Key features of haemorrhagic disease of the newborn

A
  • AKA Vit K deficient bleeding. Vit K doesn’t pass freely from Mum to baby and less Vit K in mum’s milk after colostrum.
  • Babies at risk: <37w, forceps/ventouse/c-section, hypoxia at birth, maternal co-morbidity + meds in pregnancy (lower Vit K)
  • Presentation:
    • Bleeding eg heel prick test, umbilical cord
    • Bruising
    • Haematuria
    • Bleeding after procedures
  • Ix: Exam, obs, coags, clotting factors, PIVKA (non-carboxylated clotting factors)
  • Tx:
    • IVT
    • Vit K 1-2mg parenteral
    • FFP (10-20ml/kg) in life threatening
    • Bloods transfusion - ifi shock
  • Prevention - single dose IM vit K at birth (1mg IV Vit K for those at risk). PO version - birth, 2, 4 weeks.
113
Q

What’s involved in Heel Prick / Blood Spot test at 5d?

A
  • Sickle Cell
  • CF
  • Congenital hypothyroidism
  • Inherited metabolic diseases:
    • Phenyketonuria
    • Maple syrup urine disease
    • Isovaleric acidaemia
    • Gluteric aciduria type 1
    • MCADD
    • HCU
114
Q

Key features of developmental dysplasia of hip

A
  • ‘Clicky hip’ on newborn exam
  • RF: F>M, breech, FHx, 1st child, oligohydramnios, birth weight >5kg
  • O/E - Barlow and ortaloni test
  • Ix- USS
  • Tx- Most spont 3-6w, harness, surgery
115
Q

Key features of laryngomalacia

A
  • = Floppy epiglottis
  • Noisy breathing –> worse on eating. Stridor
  • Tx- usually self limiting. Surgery if signs of resp distress/ FTT

Finals!!! (19 decks)

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