Paediatrics Flashcards
What are the 3 main causes of microcytic anaemia?
How is iron absorbed I want 4 steps
Iron deficient anaemia (poor intake or absorption i.e coeliac)
Anaemia of chronic disease
Sickle Celled Disease or thalassaemia
- It is absorbed in the duodenum and is AT into the duodenum It is incorporated to make ferritin. The iron that does not bind to the ferritin is released into the blood. This binds to the protein transferrin and is used in the plasma to the bone marrow.
What is the clinical presentation of microcytic anaemia?
How do you treat iron deficient
How do you treat of chronic disease (cause IBD, cancer and RA)
- Fatigue
- SOB and poor feeding
- Pallor
- Angular stomatitis
- Brittle hair and nails
- Pica: inappropriat eating of non food
Treatment:
- Iron deficient: this is improve diet and give iron tablets
- Chronic disease: give the patient EPO and treat cause
What will the blood work in iron deficient anaemia look like?
FBC and blood film: will show microcytic and hypo-chromic anaemia
Low serum ferritin
Low reticulocyte count
In comparison with anaemia of chronic disease the serum ferritin will be normal
What is the definition of a seizure?
What are 4 Causes of epilepsy?
What are 4 causes of non-epilepsy?
Seizure is when you get a sudden disturbances in the neurological function: due to abnormal neuronal firing.
4 causes of epilepsy:
- Idiopathic
- Malignancy
- Cerebral malformation
- Cerebral vascular event
4 causes of non epilepsy:
- Drug induced (toxins)
- Hypoglycaemia
- Neurogenic
- Head trauma and meningitis
Vaccinations: what get given at 8 weeks (9 things)
Diphtheria, Tetanus, Whooping Cough, Polio, Haemophilus influenza and Hep B
Pneumococcal
MenB
Rotavirus
What vaccinations get given at 12 weeks? 7 things
Diphtheria, Tetanus, Whooping Cough, Polio, Haemophilus influenza and Hep B
Rota virus
What vaccinations get done at 16 weeks? 8 things
Diphtheria, Tetanus, Whooping Cough, Polio, Haemophilus influenza and Hep B
Pneumococcal
Men B
What vaccinations are done at 1 year?
HiB and Men C
Pneumococcal
Measles Mumps and Rubells (MMR vaccination 1)
Men B
What vaccinations are provided yearly for eligible groups?
Influenza vaccination
What vaccinations are provided at 3 years and 4 months?
MMR (vaccination 2)
Diphtheria, tetanus, whooping cough and polio
Boys and girls aged 12-13?
HPV virus (protects against 16,18, 6 and 11)
What is given at 14 yrs old?
Tetanus
Diphtheria
Polio
Men ACWY
What is given to people aged 70?
Shingles vaccination
When is the whooping cough vaccination given to pregnant women?
At 16 weeks
Give flu vaccination at any stage
What is the inner ear made up of?
the hearing and balance organs
This includes: cochlea, utricle, saccule and vestibule
What embryologically is the ear made from?
What can embryology cause to a child?
It is made from the 1st and 2nd branch of the pharyngeal arch
Problems with big ears, absent outer ear or absence of the auricle
What layer of tissue is the ear made from?
What type of tissue is the nose containing?
The tissue is ectoderm
The tissue in the nose is erectile tissue
How to you control epistaxis of the nose?
You can use nasal tampons
Use naseptin
Silver nitrate cautery
What is affected in otitis external?
There is the outer ear:
External acoustic meatus and pinnacle
Who does Glue ear affect ? What are RF: What cause it? What are 3 symptoms What are the mangement?
Anyone under the age of 12 but is increased in ages 2-5
Down’s Syndrome and Allergic Rhinitis
In children there are more narrow Eustachian tubes. This makes it harder to have a change in air and fluid pressure. This results in fluid being passed into nearby cells. Can lead to a vacuum forming and fluid to seep out of the middle ear.
Ear pain (ear tugging)
Deafness
Change in personality or decreased effort at school
Management: this includes:
- Watch and Wait
- Ballon treatment
- Grommets
- Hearing aids
What are grommets and how do they work?
happens when you make a slit in the ear drum. Drain the fluid and add a grommet.
This allow air to get into the ear and improves hearing. Grommets eventually fall out after 6-12 months
This is why Glue ear doesn’t affect adults as the Eustachian tubes are wider
What are the 4 main layers of the adrenal gland?
Outside to the inside:
- Zona Glomerulosa (aldosterone0
- Zona Fasiculata (cortisol)
- Zona Reticularis (androgens)
Medulla (adrenaline)
How is cortisol released: mention all the stimulation and what it stimulates
Cortisol Releasing Hormone (CRH) is released from the hypothalamus
This then stimulates the anterior pituitary gland to release ACTH
ACTH then acts on the Zona Fasciulta in the adrenal gland and causes it to release cortisol
Cortisol stimulates androgen release from the Zona Reticularis
Adrenaline release from the medulla
What does cortisol do? 3 things
Anti-inflammatory
Causes the breakdown of carbohydrates, lipids and proteins
Lead to a lowered immune response
What is released from the posterior pituitary gland?
vasopressin (ADH)
Oxytocin
What type of inheritance is congenital adrenal hyperplasia?
Why is it super important to get a diagnosis?
What population is more common in?
What pathophysiology does it cause?
A.R.
As it can cause an adrenal crisis and massive salt losing situation
Ashkenazi Jews
The idea that there is a 21-hydroxylase deficiency and this means that you get a high serum 17-hydroxuprogesterone
How does congenital adrenal hyperplasia present?
In females it is easy as it presents as ambiguous genitalia and enlarged clitoris
In males it is harder: may be penile enlargement and subtle hyperpigmentation.
They will later present after 7-14 days with vomiting, weight loss, lethargy and hyponatraemia and hyperkalaemia.
What will happen if congenital adrenal hyperplasia is not recognised?
You can get crisis in boys by 7-14 days after birth.
Nausea, Vomiting, dehydration, weight loss and lethargy,. Alongside hyponatraemia and hyperkalaemia.
By aged 2-4 you will get early virilisation
How do you diagnose congenital adrenal hyperplasia?
The condition is caused by 21 hydroxylase deficiency
This means that they patient will have a higher serum 17 hydroxuprogesterone level.
Look at pelvic US for organs
Bone Age
Karotyping
How do you treat congenital adrenal hyperplasia?
You need to give mineral corticoids (Aldosterone)
Glucocorticoids (hydrocortisone)
What movements will you get in a frontal epilepsy?
Jacksonian March
What will you get in temporal seizure as symptoms?
De ja vu
Smell and taste weird things
You may get non-purposeful movement
And De ja vu
What can precipitate absence seizures?
Hyperventilation
How do you treat the following generalised seizures:
- Tonic
- Absence
- Myoclonic
Focal Seizures
Tonic: you need to give sodium valproate and carbamazepine
Absence: sodium valproate and lamotrigone
Myoclonic: sodium valproate and carbamazepine
Focal seizures: carbamazepine and sodium valproate
What is a febrile seizure? When do they occur? What triggers them? What are the 3 types: What investigations should you do?
What are some differentials:
A febrile seizure is a seizure caused by a viral illness and not by another infective or neoplasticism cause
They occur between the ages of 6 months and 5 yrs and have FH element
Triggers include: viral infections such as tonsillitis and otitis media.
The three types:
- Simple: less than 15 mins and no repeat in 24 hours
- Complex: focal symptoms and duration longer than 24 hours or recurrence in illness.
- Febrile status epileptoicus: longer than 30 mins
Investigations: U&E, FBC, LFT you need to do blood cultures and ESR and glucose. Need to do urine microscopy and LP in kids under 12 months
Post ictal fever, syncope and breath holding episodes are also possible causes
What is Gonadotrophin Deficiency classed as in girls and boys?
What diagnosis tests do you need to do:
In a Male: give a cause of primary and secondary hypogonadism?
Classed as 13 in girls and
14 in boys
In boys you need to look at LH, FSH, Testosterone, GnRH levels and karotyping
In females you need to do they same but look at oestrogen not testosterone.;
IN A MALE:
- Primary hypogonadism is caused by damage to Ledwig cells so loss in testosterone. Causes no sperm. But elevated LH and FSH
Cause: klienfelters
- Secondary hypogonadism: caused by problems in the pituitary gland. Meaning that low GnRH. Prader will I and Kallman syndromes are examples
What would the hormone profile in a Primary and Secondary Hypogonadism individual look like:
How do you treat
Primary:
- Will have high LH and FSH and normal testosterone
Secondary:
- low levels of LH and FSH and low testosterone
Give replacement oestrogen or testosterone
What are causes of Gonadotrophin deficiency in women?
Anorexia
Lots of sport
Radiation
Auto immune disease
What are the 4 types of leukaemia what is the most common in children?
ALL is the most common
Others include:
AML
CLL (seen mainly in elderly)
CML
What is leukaemia:
It is over-proliferation of the immature blast blood cells in the bone marrow.
These cells have no function and can fill up the bone marrow so there’s little space for the functioning cells
What is the pathophysiology of ALL leukaemia?
Who is it common in?
How does it present?
ALL affects the B and T lymphocytes. Meaning that it is a malignancy of the immature lymphoid cells.
Normally most derive from B cell precursors
It is more common in those who have a genetic predisposition have X Rays in pregnancy or have DOWNs syndrome
Clinical Presentation:
- Bruising
- Bleeding gums and epistaxis
- Splenomegaly
- More common infections
- Fatigue, SOB, paleness
- Lymphadenopathy
Can also cause CNS involvement: CN3, 4 and 6 palsy
And Gum hypertrophy!
What are some specific symptoms/signs for ALL leukaemia?
Can also cause CNS involvement: CN3, 4 and 6 palsy
And Gum hypertrophy!
How do you diagnose ALL leukaemia?
You need to do a FBC and Blood Film
- Will have high WCC and blast cells visible
- Need to do a bone marrow biopsy and a CXR and LP.
How do you treat leukaemia?
You need to give blood and platelets
Probably will be neutropenia: so give prophylactic abs
To prevent tumour lysis syndrome give allopurinol.
Systemic Chemo and Spinal Chemo alongside a Bone marrow transplant
What causes JIA? And what needs to have happened to give a diagnosis?
JIA: is juvenile idiopathic arthritis that is when you get persistently swollen joints for more than 6 weeks when under the age of 16 yrs old. In the absence of infection.
What are the 7 categories of JIA?
- Oligoarthritis
- Oligoarthritis >4 joints
- Poly arthritis with negative RF
- Poly arthritis with positive RF
- Systemic: swollen joints, fatigue, muscle aches and fever. Will have a macular salmon pink rash. Common to have anaemia.
- Psoriatic arthritis: assymetrical distribution of large and small joints. Got psoriasis and pitting in nails.
- Enthestitis related: large joints plus enthestitis involvement. HLA B27 related.
What type of symptoms will you get with JIA?
Pain and stiffness in joints (worse on a morning)
Reds warm and swollen joints
Fatigue and limp
Reduced ROM
Deterioration in mood and more irritable
May get joint deformity
What are JIA complications
Delayed puberty Osteoporosis Growth failure Delayed puberty Chronic anterior uveitis
How do you treat JIA?
MDT
Physio and exercise
Start on NSAIDs, steroids and methotrexate
What is Autism?
Does it have any links?
What are some of the clinical presentation symptoms of Autism?
Autism is a disability in which individuals struggle with social and communication skills.
It has a genetic link component
Some of the clinical presentation:
- Avoiding eye contact
- Lack of social interaction: like their own company, do not appreciate others thoughts.
- Delayed speech and language disorders (pedantic speech and lack of facial expression)
- Co-morbidities with learning difficulties, seizures
They may also be non verbal: prefer to hand flap and have ritualistic behaviour
From what age can autism be diagnosed from?
What do they need to exhibit?
Management?
From the age of 2
6 or more symptoms across 3 of the core areas
Management:
- Applied behavioural analysis
- Occupational therapy
- Music therapy
- SALT
What is the definition of ADHD?
Inattention
Hyperactivity
Impulsivity
What are some aetiological factors behind ADHD?
Maternal smoking
Environmental surroundings
Genetics
ADHD:
- Give some symptoms of inattention
- give some symptoms of hyperactivity
- Give some symptoms of impulsivity?
- Give some symptoms of inattention
Decreased concentration
Lack of focus
Easily distractible
Forgetful and disorganised
- give some symptoms of hyperactivity
Not able to sit still
Fidgeting
Noisy playing
- Give some symptoms of impulsivity?
poor sense of danger
Blurts out answers
Interrupts others
How do you diagnose ADHD?
you need to talk to the family, parents and teachers
Look at school behaviour
What criteria do you actually have to use to diagnose ADHD?
Connor’s Behavioural Scale
Qb test
Use DSM V criteria of more than 6 months of hyperactivity, inattention or impulsivity. That interferes with functioning or development before 12 years old that interrupts more than 2 settings
How do you manage ADHD?
You need to ask the patients to set strict rules
Have a good reward system
Have a supportive school environment
If really you can use medication: such as stimulants These decrease inactivity and improve concentration
What is vesicureteric reflux?
This is a congenital abnormality at the vesicoureteric junction
Means the ureters are displaced laterally or just enter the bladder directly rather than at an angle.
This can lead to reflux and associated issues such as hydronephrosis and UTIs
What is the aetiology of vesicoureteric disease?
Increased incidence in families
Commonly happens with other bladder pathology and neuropathic bladder
Tends to settle by late childhood
Why is vesicourteric reflux bad?
The urine back tracks into the bladder. This is incomplete emptying and encourages infection
Such as recurrent UTIs and pyelonephritis and long term CKD
What tests must you do on someone that has recurrent UTIs (two or more UTIs)
Ultrasound of the renal tract
Micturating cystourethrogram:
DMSA scan
What classes as an atypical UTI?
Septicaemia
Non e-coli
Poor urine flow
A raised creatinine
Sex Differentiation:
What do a male sperm and female oocyte create?
What type of cell are gametes?
What duct gives the female genital duct ?
What duct gives the male genital duct?
How long are you sexless until?
- Zygote
- Epiblast
Female genital duct? Paramesonephric duct
Male genital duct? M for mesonephric duct
Until 7 weeks gestation
What makes gender change at 7 weeks?
The presence of the SRY gene = male
Absence of SRY gene= female
How does the Male reproductive tract develop
- SRY gene positive
- Ledwig cells produce testosterone which grows the mesonephric ducts
- testosterone makes dihydroxytestosterone makes the scrotum, penis etc
- Serotoli cells secrete anti-mullerian hormone this makes the paramesonephric ducts regress
What does the urogenital sinus become?
The bladder
Urethra
Prostate gland
How does the female genital tract develop?
SRY gene negative
Means that paramesonephric duct persist as no MIS and testosterone
Mesonephric duct regresses
PM duct becomes: uterus, ovaries and the upper 1/3rd of the vagina
What week are foetus distinguished by sex?
Week 12
What is hypoxic ischaemic encephalopathy? What are some causes?
When the foetal brain placental or pulmonary blood supply is compromised.
Causes cardiorespiratory depression.
Leading to metabolic acidosis and hypercarbia or hypoxia
Important cause of brain damage, death and disability
Give a few aetiology of hypoxic ischaemic encephalopathy?
You can get failure of gas exchange across placenta (uterine rupture or placental abruption)
Interruption of umbilical blood flow: i.e cord prolapse or shoulder dystopia
Inadequate placental perfusion: maternal hypo/hypertension.
Other causes include IUGR and embryological difficulties.
when can you tell a baby has hypoxic ischaemic encephalopathy?
What are the 3 category descriptions?
You can tell by 48 hours after the asphyxia
Mild: they are irritable, excessive to stimulus and impaired feeding or breathing
Moderate: abnormalities of tone or movement. Cannot feed and may have seizures.
Severe: no response to pain, hypotonic and prolonged seizures has multi organ failure
What will hypoxic ischaemic encephalopathy show on MRI and EEG?
Abnormalities
What is the management of hypoxic ischaemic encephalopathy?
ABCDE
Anti-convulsants to stop the seizures
IV fluids to support kidneys
Treat hypoglycaemia and hypocalcaemia!
IF MILD RECOVERY IS EXPECTED
What is a transient early wheeze?
Commonly seem in children below the age of 5
Episodic and caused by RSV
From what age can you start to diagnose asthma?
Age 3
What is the pathophysiology of asthma?
Bronchial inflammation
Hypersensitivity of the airways
Narowing of the airways
What are some symptoms of asthma
Chest Tightness
Wheeze
Cough
SOB
Worse at night and during the morning
What are some investigations you would do for asthma?
Peak expiratory flow rate (before and after bronchodilator)
Skin prick test
Chest x-ray
What are the 4 steps of treatment for asthma?
- Remove allergens. Start the patient on SABA
- SABA and anti-muscarinic
- SABA, antimuscarinic and steroid
- LABA, anti-muscarinic and steroid
- Above plus a leukotriene receptor antagonist
What is the management of an acute asthma attack?
- Moderate: You want to give nebs of salbutamol and oral prednisone
- Severe: Not working give some O2 therapy alongside
- Life threatening: O2, BRONCHODILATORS , IV HYDROCORTISONE AND IV MAGNESIUM SULPHATE
What causes rheumatic fever?
Group A beta haemolytic strep with M antigens
Then leads to a hypersensitivity reaction and deposition on the heart valves
What 4 systems does rheumatic fever affect
The heart
The joints
The skin
The nervous system
How often does rheumatic fever present after a pharyngeal infection?
2-6 weeks
What is the diagnostic criteria for rheumatic fever?
What does it consist of?
It is the Jones Criteria
You need 1 major or 2 minors alongside a positive ASO titre
Major: endocarditis, pericarditis, polyarthitis of the ankles and knees, erythema marginatum and subcutaneous nodules
Minor: fever, prolonged PR interval and polyarthralgia
What is the management of Rheumatic Fever:
What can be used to prevent it’s reacurrance?
Management: you need to give aspirin
To prevent reoccurrences: you need to give benzathine penicillin
What is transient synovitis?
What causes it?
What are a few symptoms
How do you manage it?
Sudden Acute hip pain in children 2-12.
Normally presents following a viral infection
Child will have hip pain, a limp and may have knee pain. Will be afebrile.
Investigations: X ray and joint aspiration
You manage it with bed rests. Increased risk of perthe’s disease
What is the cause of bacterial endocarditis? 2 causes
Whom is it common in?
What is the pathophysiology of the condition?
What are some signs and symptoms?
What is the diagnosis method?
What is the management of the condition?
2 causes: strep viridans and strep pneumonia
It is common in children with congenital heart disease in particular VSD and coarctation of the aorta
The pathophysiology: is that damaged heart valves allow easy access for platelet and fibrin deposition and this allows organisms to grown.
Clinical presentation:
- New murmur
- Fever
- Malaise
- Headache and night sweats
- Osler nodes
- Janeway lesions
- Splinter haemorrhages
- Roth Spots
Diagnostic method:
- Dukes Criteria
- Need 3 positive blood cultures form different sites before abc
- ECHO and bloods i.e CRP, ESR, will show anaemia and neutrophilia
Management:
- Give IV abx )penicillin and aminoglycosides for 6 weeks
- May need to give a new heart valve
Rheumatic Fever:
- What does it cause?
- What is it caused by?
- What does it affect?
- How many weeks does it take post pharyngeal infection?
- What criteria do you use to diagnose?
It causes structural heart disease
It is caused by Group A beta haemolytic strep with M antigens
It affects the joints, skin, heart and nervous system
Takes roughly 2-6 weeks
Diagnosis:
- The Jones Criteria
- Need two major or one major and two minors. Plus supporting evidence of a strep infection i.e. a raised ASO titre.
- Major: pericarditis or endocarditis, subcutaneous nodules, erythema marginatum (happens on the trunks and limbs and spreads) and polyarthritis of the ankles, knees and wrists.
- Minor: fever, polyarthralgia and a prolonged PR interval on ECG.
What is the Jones Criteria? And what is it used for?
- Need two major or one major and two minors. Plus supporting evidence of a strep infection i.e. a raised ASO titre.
- Major: pericarditis or endocarditis, subcutaneous nodules, erythema marginatum (happens on the trunks and limbs and spreads) and polyarthritis of the ankles, knees and wrists.
- Minor: fever, polyarthralgia and a prolonged PR interval on ECG.
What is the management of rheumatic fever?
Anti-inflammatories like aspirin.
Recurrence Relapse give: benzathine penicillin
What are the 5 S’s of an innocent murmur?
Soft
Left Sternal Edge
Systolic
A Symptomatic
What types of heart disease presents in:
- Neonates
- Infants
- Older children
- Neonates: GB sepsis, coarctation or aortic stenosis
- Infants: high pulmonary flow: ASD, VSD and patent ductus arteriosus
- Older children: rheumatic fever, cardiomegaly and eisenmenger’s syndrome
What are some symptoms of heart failure?
Symptoms include:
- SOB
- Sweating
- Poor feeding
- Failure to Thrive
- Recurrent Chest Infections
Poor weight gain
Cool peripheries
Tachycardia and cool peripheries
Why do few children have heart failure in the first couple of weeks of life
You have a patent ductus arteriosus. Meaning that there is little chance of heart failure.
Once this duct closes you get your heart failure: due to cyanosis and metabolic acidosis, collapse and death.
What is eisenmenger’s syndrome?
The idea that there is a shunt right to left and you get a very irreversible raised pulmonary vascular resistance. Resulting in a raised pulmonary arterial Pressure and flow
Only solution is a heart and lung transplant
What are some potential causes of cyanosis in a newborn?
GBS sepsis
Meconium aspiration
Pulmonary hypertension
Cyanotic heart disease
Two causes of a right to left shunt?
Transposition of the Great Arteries
Tetralogy of Fallot
Common causes of a breathless and blue newborn?
ASD
Congenital heart defect
What is the most common arrhythmia in children?
Supraventricular Tachycardia
When do arrhythmias get worse on inspiration or expiration??
Inspiration
What is a SVT arrhythmia?
What normally causes them?
The heart goes between 250-300 bpm
It is caused by a re-entrant tachycardia accessory pathway.
What are some symptoms of SVT arrhythmia?
SOB
Cyanosis
Poor feeding and failure to thrive
If it happens in utero you get hydrops fetalis
How do you manage a SVT?
You manage a SVT with:
- Tissue acidosis correction with positive pressure ventilation achieved
- Vagal stimulation manoeuvre
- IV adenosine
- Pacemakers
When is it associated with a Long QT syndrome?
What can it lead to?
What are the symptoms
What is the management?
It is associated with late childhood and is AD inherited
It can lead to ventricular tachycardia
Symptoms are syncope on exertion or sudden death
It is caused by channelopathies of the sodium, calcium,potassium channels leading to a loss or gain of function
Management: need to put a cardiac pacer in
What is classed as prolonged jaundice?
Jaundice after 2 weeks gestation
What type of hyperbiliruminaemia resolves on it’s self?
Unconjugated hyperbiliruminaemia: resolves on ourself
Conjugated does not resolve on its self: you get pale stools, dark urine, jaundice and a bleeding tendency
What is biliary atresia?
What are the clinical signs or biliary atresia?
What are 2 diagnostic methods?
What is the management of the condition?
IS when the extra hepatic biliary tree and intrahepatic biliary ducts have been destroyed or absence
Clinical signs:
- PERSISTENT JAUNDICE FOR 14 DAYS
- Failure to thrive
- Muscle wasting
- Pruitus, dark urine, pale stools and epistaxis
Diagnosis: look at LFTs and do an ultrasound then biopsy
Management:
0- Need to do Kasai procedure
0- Medical: abx and ursodeoxycholic acid
Fluids and FEED lecture:
What percentage of a term baby is water?
75%
Fluids and FEED lecture:
What are the fluid requirements for an infant:
What are the fluid requirements for a toddler:
What are the fluid requirements for an older child:
What are the fluid requirements for an infant: 150ml/kg/day
What are the fluid requirements for a toddler: 100ml/kg/day
What are the fluid requirements for an older child: change varying on age and gender
How do children loose fluid?
Skin and Lungs
Urine
Stool
Give 5 causes of dehydration:
Decreased intake:
- Child neglect
- Food refusal (anorexia)
- Problems with swallowing i.e cerebral palsy or GORD
- Vomiting i.e URTI or gastroenteritis
Increased loss:
- Gastroenteritis
- IBD or stoma losses
- Increased requirements: sepsis, burns or CF
What are quantifiable limits of dehydration:
- Mild
- Moderate
- Severe
Mild <5% and thirst, dry lips and irritable
Moderate (5-10%): sunken eyes, reduced skin turgor and decreased urine output
Severe (>10%): reduced consciousness, cold peripheries and no urine
What are some consequences of dehydration?
Failure to thrive and malnutrition
Developmental Delay
Constipation
UTI
How do we get around dehydration in children?
Nature: encourage oral feeding: bottle, breast or formula
Enteral feeding: PEG, jejunostomy or gastrostomy
How do you work out a child’s weight ?
(Age +4) x2
How do you hydrate a patient who is dehydrated?
Maintence Deficit (%was) x50%
What if a patient is shocked how do you calculate the fluid required?
Maintence
Deficient (%) x 100
Bolus 20mls/kph
For older children how much fluid do you give per kg
1st 10kg give 100ml/kg
Then next 10kg give 50ml/kg
Then after 20ml ml/kg
Divide this by 24 to get a rate
When would you give a fluid bolus?
How much for each scenarios?
Dehydrated Shock (20mls/kg) Diabetic Ketoacidosis (10mls/kg)
When would reticulocytes be low and high?
Low: lack of production
High: haemolysis or blood loss
What is a definition of a disability?
What is an impairment?
When a patient has a mental or physical impairment that results in marked/limitations on every day life
An abnormality or loss of function
What are some categories of impairment?
Physical Sensory Learning Behavioural/Emotional: depression Neurodevelopmental: ADHD and Autism
What determines disability:
The biopsychological model
WHO-DAS World Health Organisation Disability Assessment Schedule:
Generic assessment of health and disability
Used across mental, neurological and addictive disorders.
Applicable acros all cultures and age populations
what are 5 RF for paedatric mental health issues?
Difficult temperament Low self esteem Instable life Parents with MH or substance abuse Peer rejection or school trauma
What are protective factors for MH?
- Easy temperament
- Optomistic and good social skills
- Sense of belonging and connectivity
Difference between adult and child radiology: give 5
- The anatomy is different
- They cooperate less
- Different fracture pattern: as plastic bones
- Need to take into account the parents
- lower SA so need a higher image resolution
What are some implications for a child with a chronic disease?
- Special education
- Developmental Delay
- Feeding and Speech problems
- Seperation and hospitalisation.
What else do you need to think about when communicating with teenagers: Use the mneumonic HEDDSS
- H: Home
- E: Education
- D: Drugs and Alcohol
- D: Depression and Suicide
- S: Sexual Health
- S: Spirituality and Sleep
What are the WHO-DAS 6 Domains of Functioning
WHO-DAS 6 Domains of Functioning:
o Cognition: understanding and communicating
o Mobility: moving and getting around
o Self-care: hygiene, dressing, eating and staying alone
o Social: interacting with other people
o Life activities: domestic responsibilities, leisure and work
o Participation: joining in community activities
What are some important factors to consider when dealing with disabled children?
o Disabled children are more likely to live in poverty
o Parents are more likely to be unemployed
o Higher rates of mental health needs
o Poorer physical health and lower life expectancy
What are 3 ways to self harm:
Partake in risky behaviour
Swallowing objects
Cutting
Burning
What two groups is self harm more common in?
What are 3 RF:
What is a good treatment:
Those who have suffered physical or sexual abuse in childhood or those from the LGBTQ+ community
RF: depression, bullying, physical or sexual abuse
Family therapy or CBT
What are the normal ranges of blood sugar levels?
o Fasting: 3.5-5.6 mmol/l
o Post-prandial: <7.8 mmol/l
What does insulin normally do?
o Stimulated by a high blood sugar. This promotes insulin release from the pancreas.
o Insulin causes increase glucose uptake from the blood by muscle, kidney and fat cells
o Insulin causes Glucose to be converted to glycogen
o Reduces the amount of glucagon released.
What happens if there is an insufficient or absent amount of insulin?
o Muscle cell breaks down to amino acids that are converted to glucose in the liver.
o Fat cells and increased glucagon are broken down into fatty acids that make ketones.
o As such there are increased amounts of ketone and glucose in the blood stream.
o Increased ketones in the blood lead to vomiting, osmotic diuresis, fluid and electrolyte depletion. Eventually leading to cerebral oedema and shock.
What are the 3 criteria for diabetic ketoacidosis?
o Acidosis pH <7.3
o Blood ketones >3
o Blood glucose >11
How do you treat diabetic ketoacidosis?
Fluids and Potassium
Insulin
Monitor glucose hourly and ketones 1-2 hours
Strict fluid balance
When do you know they are no longer in diabetic ketoacidosis?
pH is over 7.3 and ketones recovered
What is hypoglycemia?
What are some symptoms?
This is when the blood sugar is below 4 mmol.
Symptoms include: confused, light headed, dizzy, visual loss, hungry, nausea, palpitations and sweaty
Treatment:
- Mild: glucose tablets:
- Moderate: glucogel
- Severe: glucagon (IM)
What are 5 complications of Diabetes:
Retinopathy Neuropathy Nephropathy Increased suspectible to infections Problems with pregnancy increased incidence of other AI conditions
Ideal inflation on a chest x-ray?
5-6 ribs seen
What is translocation?
When part of a chromosome is found elsewhere on another chromosome
What is a RF for AR inheritance?
Consanguinity
What is a non mendelian inheritance?
When it is not purely down to gentic inheritence. But also environment. I.e. Neural Tube defects: with genetic risk and folic acid
What are some consequences of a mitochondrial disorder?
Sensory neural deafness
Myoclonic Epilepsy
Diabetes
Is prader-wili a paternal or maternal deletion?
Paternal
Is angelman a paternal or maternal deletion?
Maternal
What is faltering growth?
When an infant is failing to gain or grow adequately.
This is generally a fall across 2 centiles on a growth chart
What are some key causes of faltering growth?
- Not enough food in
- Poor absorption or food
- Too much energy used
- Abnormal central control of growth and appetite (GH and thyroid)
Give 4 causes of poor intake?
o Breast feeding poorly o Bottle feeds too dilute o Juice drinker o Exclusion diet o Vomiting i.e. GORD
Give 3 causes of malabsorption:
Liver Disease
Enteropathy: cows milk intolerance, IBD and coeliac
Pancreatic Disease
Give 3 causes of using two much energy?
Chronic Cardiac Disease Chronic GI disease (IBD) Chronic Resp Disease (CF) Tumours Chronic Renal Disease
What are some non organic causes of faltering growth?
Maternal anorexia Poor social Support Poverty Child Abuse Poor parental understanding
What are the 3 primitive reflexes?
When do they disappear?
Moro
Grasp
Galant
By 4-6 months
What are the 3 postural reflexes?
Positive Support Reflex
Landau
Parachute
Emerge at 3-8 months
What does a persistence of the primitive reflexes suggest?
Upper Motor Neuron abnormality
What is the definition of self harm?
Deliberate intent to hurt oneself
e.g. associated with suicidal ideas and can include cutting, burning and overdose.
What are 4 signs of chronic liver disease?
You can get hepatomegaly splenomegaly You can get cirrhosis Portal hypertension Lethargy Malnutrition
What are some causes of chronic liver disease?
Hep B or C Autoimmune hepatitis Wilson’s Disease Cystic Fibrosis Alpha-1 antitrypsin disease Drugs like NSAIDs and nitrofurantoin
4 causes of ascites
Secondary renal impairment Fluid redistribution Renal impairment Sodium Retention Hypoalbuminaemia
What would a deficiency in Vit A cause
Night blindness
WHat a would Vit E deficiency cause?
Peripheral neuropathy and ataxia
What causes a Vit D deficiency
Rickets
Pathological Fractures
What treatment do you give for encephalopathy?
You give them
Lactulose and also protein restriction
Indications for dialysis include
HTN Severe acidosis Hypercalcaemia Hyper/Hyponatraemia No treatment
What are the 4 S s of a innocent murmur
Soft
Systolic
A symptomatic
Left Sternal Edge
What 3 heart conditions occur in neonates?
- Coarctation of aorta
- Aortic Valve stenosis
- Hyper plastic left hear
Then you have transposition of the great arteries and also tetralogy of Fallot
What are 3 causes of heart disease in infants:
VSD
ASD
PDA
They increase pulmonary flow
What are 4 symptoms of heart failure?
You can get Sweating Poor Feeding recurrent chest infections Breathlessness
You can also get poor weight gain, tachypnoea and tachycardia also hepatomegaly and oedema
What are 3 signs of RHS failure
SO you can get sacral and ankle oedema
In babies you can get scrotal oedema and also pulmonary hypertension/tricuspid regurg
What are 4 causes of cyanosis in a neonate?
The 4 causes of cyanosis include:
- meconium aspiration
- cyanotic heart disease
- pulmonary hypertension
- septicaemia secondary to GBS
When do arrhythmia increase?
They get acceleration in inspiration
What is SVT?
This is a common form of arrhythmia in children and is characterised by a HBP of 250-300 bpm. As such it means that the cause is a re entrant tachycardia leading to premature activation of the atrium.
What are some symptoms of SVT?
You will have poor cardiac output
You will pulmonary oedema
You will have heart failure in neonates
Poor feeding and also blue tinge to skin, breathless, tired or sweating
You will see narrow complexes on ECG and you will probably not see P waves
What is the treatment of arrhythmia?
Your treatment is tissue acidosis correction with ventilation
VAGAL stimulation
IV adenosine
Cardio version
You then maintenance with soltalol
What is the cause of congenital heart block?
The presence of anti-Ro and anti-La antibodies in the maternal blood
It prevents normal electrical development of the heart.
As such you get atrophy and fibrosis of the AV node
You need to insert a pacemaker ASAP
What is Long QT syndrome?
This is when you get a sudden loss of consciousness during exercise, stress of emotion
Normally happens in late childhood
It can lead to sudden death
It is inherited by autosomal dominant and causes channelopathies
NEED To put a pacemaker in!!
What factors increase the risk of bronchiolitis?
You have smoking
Bronchial-dysplasia
CF
Congenital Heart Disease
What is a pan systolic murmur consistent with?
VSD
WHat is the management of heart disease
You need to give Diuretics
Give ACE inhibitors
Increased calorie intake
4 causes of heart failure
sepsis
Congenital
Arrhythmia
Anaemia
What are 3 causes of nephrotic syndrome?
You can have minimal change syndrome
Focal segmental glomerulosclerosis
Membranous glomerular disease
Congenital Renal disease
What are the 5 primitive reflexes
- Palmar: to 2-3 months
- Rooting: to 1 month
- Moro to 6 months
- Tonic neck reflex: 7 months
- Parachute reflex: 7-8 months
What is seen in infantile spasm?
Hyperarrythmias
What is characteristic of benign Roland is seizures
Central temporal spikes
What are 3 causes of a squint:
Refractive error FH Cataract Retinoblastoma Prematurity
What do you give for neonatal sepsis?
Benzylpenicillin
Gentamicin
What do you do when neonatal blood glucose is below 2.5
Preterm
Term baby
Pre-Term: You give them IV bolus of dextrose
Term: you feed them —> glucogel —> IV bolus
What 4 pre term screening methods do you do in neonates
You do:
- Retinopathy of prematurity
- You look at the lungs for BPD
- You look at the brain for intraventricular haemorrhage
- Hearing
What are causes of jaundice below 24 hours
G6PD deficiency
Rhesus disease of the newborn
Neonatal congenital infection
What is the cause of jaundice from 24 hours to 3 weeks
The cause is:
- UTI
- Breast milk jaundice
- Polycythaemia
- Biliary Atresia
What are cause more than 3 weeks:
infection
Physiological
Hypothyroid
Liver disease
How do you diagnose biliary atresia?
Radioisotopes scan and biopsy
Kauai procedure
What are 5 features of congenital hypothyroid disease
Macroglossia Coarse facial features Short Statue Hypotonia Umbiblical hernia
What is the cause of thyroid disease:
- world wide
- UK
- Consanguinity
- iodine deficiency
- thyroid gland deficiency
- dyshormongenesis
What is the treatment for adrenal crisis
Hydrocortisone
IV salbutamol
What are some examples of what is in Q RISK 2?
RA SLE Angina HTN AF BP treatment Smoking Diabetes Age and Gender
What is the target for vaccination % uptake
95%
When do you need to notify PHE for Rheumatic Fever, AIDS or Whooping Cough or TB?
You need to phone or email within 24 hours!!
Is HiB a notifiable disease?
YES
If under 12 months what is a concerning HR?
Above 160
What is a concerning measurement in a 12-24 month old for HR?
150
What about for a 2-5 year old?
Over 140
