Paediatrics Flashcards
Diagnostic criteria for Kawasaki disease
Non remitting fever for at least 5 day and 4 or more of the following:
Bilaterally injected conjunctiva
Polymorphic rash, blanching
Edema and erythema of hands and feet
Adenopathy - usually cervical unilateral and more that 1.5cm in size
Mucus membrane involvement such as injected tonsils and strawberry tongue and fissured lips (fissured lips help differentiate between other diseases such as scarlet fever and measles which do not have this feature)
CREAM
Atypical Kawasaki is fever with 2-3 of these symptoms
Management of Kawasaki disease
IV immunoglobulins 2g/kg as a single dose. Occasionally a second dose is indicated
High dose aspirin 7.5mg/kg qds and then low dose aspirin, potentially for life
Baseline echo as soon as diagnosis made and then follow up echo and 2 and 6 weeks (check f/u echo may also be 4 weeks)
May also require steroids
Infliximab can be used if iv immunoglobulins are contraindicated
May need coagulation
Investigations for Kawasaki disease
CBC - high white cells, low platelets or high platelets usually low initially and then elevate)
UEs - hyponatraemia. Some research suggests this can help determine severity.
LFTs - low albumin, elevated ALT
ECHO - to look for coronary aneurysms
Kawasaki is a clinical diagnosis. Bloods help to build a clinical picture but not specific to Kawasaki.
What is Kawasaki disease
A vasculitis affecting small to medium arteries and has a tendency towards coronary arteries.
Eitiology is unknown but usually has a prior illness to trigger
Patient presents with a murmur what other associated features would concern you?
Infants:
Poor feeding tolerance, failure to thrive, respiratory symptoms or cyanosis
Older children:
Chest pain, syncope, exercise intolerance, syncope, family history of sudden death
Features of innocent murmurs in children
Usually systolic,
asymptomatic
No radiation
No associated thrill
4 most common, innocent murmurs in children
- Stills murmur (mid systolic mid left sterna border - Erbs point)
- Pulmonary flow murmur (mid systolic upper left eternal border 2nd intercostal space)
- Venous hum (diastolic heard over jugular venous area)
- Supraclavicular systolic murmur
Diagnostic criteria for rheumatic fever
Evidence of streptococcal infection plus 2 major criteria or 1 major and 2 minor criteria
Major criteria for diagnosis of rheumatic fever
Carditis usually manifests as mitral regurgitation Poly arthritis Erythema merginatum Subcutaneous nodules Chores
Minor criteria for diagnosis of rheumatic fever
Arthralgia Fever High esr High crp Prolonged QR interval
symptoms of shigellosis
watery stools with mucus and blood pain fever dehydration seizures (?febrile vs. complication of shigellosis
symptoms of cryptosporidium
self limiting watery diarrhoea sometimes mucoid rarely blood or leukocytes
symptoms of vibrio
abdominal pain or cramps nausea vomiting fevers and chills stools watery up to 15+ a day sometimes bloody
symptoms of rotavirus
watery non-bloody diarrhoea, vomiting
low grade fever and abdominal cramps
symptoms of giardias
abdominal cramps bloating nausea watery diarrhoea NOT associated with fever
Nikolsky’s sign
Stapyhlococcal scalded skin syndrome - intact blisters extend laterally with gentle pressure.
what is SSSS
staphylococcus scalded skin syndrome - characterised by bull and epidermal sloughing as well as systemic features such as malaise, fevers and chills.
steven-Johnson rash
begins as macule that develop into papule, vesicles, bullae and urticarial plaques or confluent erythema.
risk factors for development of VSD
maternal diabetes, phenylketonuria and alcohol during pregnancy.
genetic risk factors
what is hyperbilirubinaemia
> 170umol/L
When is hyperbilirubinaema pathologic?
when it presents in the first 24 hours of life and is higher than 291 umol/L or rises by more than 85umol/L/day or signs and symptoms present suggesting disease.
when should phototherapy by initiated for hyperbilirubinaemia?
bili level >256umol/L 29-48 hours old
308umol/L 49-72 hours
342umol? infants older than 72 hours
second line treatment for hyperbilirubinaemia
exchange transfusion
prevalence of congenital heart disease
1%
why does VSD usually require early surgical closure compared with ASD
higher pressure gradient between the ventricles
pulmonary vascular resistance
pulmonary hypertensions
Eisenmenger’s syndrome are all more likely to occur in VSD
What is Eisenmenger’s syndrome
R to L shunt
symptoms include: cyanosis, Pulmonary hypertension, and erythrocytosis.
Risk factors for cerebral palsy
10% intrapartum asphyxia
10% post natal insult
associated with low birth weight
Spastic cerebral palsy
characteristics and area of brain involvement
Truncal hypotonia in first yr
Increased tone, increased reflexes, clonus
monoplegia, hemiplegia, diplegia, or quadriplegia
UMN of pyramidal tract Diplegia associated with periventricular leukomalacia in premature babies Quadriplegia associated with HIE (asphyxia), higher incidence of intellectual disability
Athetoid/ dyskinetic cerebral palsy characteristics and area of brain involved
Athetosis (involuntary writhing movements)
± chorea (involuntary jerky movements)
Can involve face, tongue (results in dysarthria)
Basal ganglia (may be associated with kernicterus)
Ataxic cerebral palsy characteristics and area of brain involved
Poor coordination, poor balance (wide based gait)
Can have intention tremor
Cerebellum
mixed cerebral palsy characteristics
multiple motor patterns and accounts for 10-15% of cases
febrile seizure
a convulsion in the presence of a temperature over 38 with the absence of inter cranial pathology or electrolyte imbalance which usually settle by the age of 6.
commonly caused by URTI and viruses
most common neurological condition in children
chance of having a second febrile seizure
30-50%
simple febrile seizure
generalised seizures lasting less than 15 minutes and do not recur within 24 hours
Complex febrile seizures
focal
over 15 minutes
multiple within 24 hours
criteria for febrile seizure
- convulsion associated with fever over 38
- older than 6 months, younger than 6 years
- absence of CNS infection or inflammation
- absence of acute systemic metabolic abnormality
- no history of afebrile seizures
managing a febrile seizure
appropriate to put child into prone position
A- E monitoring circulation and respiration
if longer than 5 minutes - should be treated (IV Lorazepam)
risk of developing epilepsy after febrile seizure
9% if there are other risk factors
2% if typical febrile seizures compared to 1% of general population
