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Phase 3a Medicine > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are the 3 main causes of microcytic anaemia?

How is iron absorbed I want 4 steps

A

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.
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2
Q

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)

A
  • 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
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3
Q

What will the blood work in iron deficient anaemia look like?

A

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

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4
Q

What is the definition of a seizure?
What are 4 Causes of epilepsy?
What are 4 causes of non-epilepsy?

A

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
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5
Q

Vaccinations: what get given at 8 weeks (9 things)

A

Diphtheria, Tetanus, Whooping Cough, Polio, Haemophilus influenza and Hep B

Pneumococcal
MenB
Rotavirus

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6
Q

What vaccinations get given at 12 weeks? 7 things

A

Diphtheria, Tetanus, Whooping Cough, Polio, Haemophilus influenza and Hep B

Rota virus

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7
Q

What vaccinations get done at 16 weeks? 8 things

A

Diphtheria, Tetanus, Whooping Cough, Polio, Haemophilus influenza and Hep B

Pneumococcal

Men B

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8
Q

What vaccinations are done at 1 year?

A

HiB and Men C
Pneumococcal
Measles Mumps and Rubells (MMR vaccination 1)
Men B

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9
Q

What vaccinations are provided yearly for eligible groups?

A

Influenza vaccination

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10
Q

What vaccinations are provided at 3 years and 4 months?

A

MMR (vaccination 2)

Diphtheria, tetanus, whooping cough and polio

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11
Q

Boys and girls aged 12-13?

A

HPV virus (protects against 16,18, 6 and 11)

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12
Q

What is given at 14 yrs old?

A

Tetanus
Diphtheria
Polio

Men ACWY

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13
Q

What is given to people aged 70?

A

Shingles vaccination

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14
Q

When is the whooping cough vaccination given to pregnant women?

A

At 16 weeks

Give flu vaccination at any stage

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15
Q

What is the inner ear made up of?

A

the hearing and balance organs

This includes: cochlea, utricle, saccule and vestibule

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16
Q

What embryologically is the ear made from?

What can embryology cause to a child?

A

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

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17
Q

What layer of tissue is the ear made from?

What type of tissue is the nose containing?

A

The tissue is ectoderm

The tissue in the nose is erectile tissue

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18
Q

How to you control epistaxis of the nose?

A

You can use nasal tampons
Use naseptin
Silver nitrate cautery

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19
Q

What is affected in otitis external?

A

There is the outer ear:

External acoustic meatus and pinnacle

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20
Q 
Who does Glue ear affect ?
What are RF:
What cause it?
What are 3 symptoms 
What are the mangement?
A

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
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21
Q

What are grommets and how do they work?

A

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

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22
Q

What are the 4 main layers of the adrenal gland?

A

Outside to the inside:

  • Zona Glomerulosa (aldosterone0
  • Zona Fasiculata (cortisol)
  • Zona Reticularis (androgens)

Medulla (adrenaline)

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23
Q

How is cortisol released: mention all the stimulation and what it stimulates

A

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

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24
Q

What does cortisol do? 3 things

A

Anti-inflammatory
Causes the breakdown of carbohydrates, lipids and proteins
Lead to a lowered immune response

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25
Q

What is released from the posterior pituitary gland?

A

vasopressin (ADH)

Oxytocin

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26
Q

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

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

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27
Q

How does congenital adrenal hyperplasia present?

A

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.

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28
Q

What will happen if congenital adrenal hyperplasia is not recognised?

A

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

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29
Q

How do you diagnose congenital adrenal hyperplasia?

A

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

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30
Q

How do you treat congenital adrenal hyperplasia?

A

You need to give mineral corticoids (Aldosterone)

Glucocorticoids (hydrocortisone)

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31
Q

What movements will you get in a frontal epilepsy?

A

Jacksonian March

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32
Q

What will you get in temporal seizure as symptoms?

A

De ja vu
Smell and taste weird things
You may get non-purposeful movement
And De ja vu

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33
Q

What can precipitate absence seizures?

A

Hyperventilation

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34
Q

How do you treat the following generalised seizures:

  1. Tonic
  2. Absence
  3. Myoclonic

Focal Seizures

A

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

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35
Q 
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

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

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36
Q

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?

A

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

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37
Q

What would the hormone profile in a Primary and Secondary Hypogonadism individual look like:

How do you treat

A

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

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38
Q

What are causes of Gonadotrophin deficiency in women?

A

Anorexia
Lots of sport
Radiation
Auto immune disease

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39
Q

What are the 4 types of leukaemia what is the most common in children?

A

ALL is the most common

Others include:
AML
CLL (seen mainly in elderly)
CML

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40
Q

What is leukaemia:

A

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

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41
Q

What is the pathophysiology of ALL leukaemia?
Who is it common in?

How does it present?

A

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!

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42
Q

What are some specific symptoms/signs for ALL leukaemia?

A

Can also cause CNS involvement: CN3, 4 and 6 palsy

And Gum hypertrophy!

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43
Q

How do you diagnose ALL leukaemia?

A

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.
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44
Q

How do you treat leukaemia?

A

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

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45
Q

What causes JIA? And what needs to have happened to give a diagnosis?

A

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.

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46
Q

What are the 7 categories of JIA?

A
  1. Oligoarthritis
  2. Oligoarthritis >4 joints
  3. Poly arthritis with negative RF
  4. Poly arthritis with positive RF
  5. Systemic: swollen joints, fatigue, muscle aches and fever. Will have a macular salmon pink rash. Common to have anaemia.
  6. Psoriatic arthritis: assymetrical distribution of large and small joints. Got psoriasis and pitting in nails.
  7. Enthestitis related: large joints plus enthestitis involvement. HLA B27 related.
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47
Q

What type of symptoms will you get with JIA?

A

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

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48
Q

What are JIA complications

A 
Delayed puberty
Osteoporosis 
Growth failure 
Delayed puberty
Chronic anterior uveitis
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49
Q

How do you treat JIA?

A

MDT
Physio and exercise
Start on NSAIDs, steroids and methotrexate

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50
Q

What is Autism?
Does it have any links?
What are some of the clinical presentation symptoms of Autism?

A

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

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51
Q

From what age can autism be diagnosed from?
What do they need to exhibit?
Management?

A

From the age of 2
6 or more symptoms across 3 of the core areas

Management:

  • Applied behavioural analysis
  • Occupational therapy
  • Music therapy
  • SALT
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52
Q

What is the definition of ADHD?

A

Inattention
Hyperactivity
Impulsivity

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53
Q

What are some aetiological factors behind ADHD?

A

Maternal smoking
Environmental surroundings
Genetics

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54
Q

ADHD:

  • Give some symptoms of inattention
  • give some symptoms of hyperactivity
  • Give some symptoms of impulsivity?
A
  • 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
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55
Q

How do you diagnose ADHD?

A

you need to talk to the family, parents and teachers

Look at school behaviour

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56
Q

What criteria do you actually have to use to diagnose ADHD?

A

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

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57
Q

How do you manage ADHD?

A

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

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58
Q

What is vesicureteric reflux?

A

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

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59
Q

What is the aetiology of vesicoureteric disease?

A

Increased incidence in families

Commonly happens with other bladder pathology and neuropathic bladder

Tends to settle by late childhood

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60
Q

Why is vesicourteric reflux bad?

A

The urine back tracks into the bladder. This is incomplete emptying and encourages infection

Such as recurrent UTIs and pyelonephritis and long term CKD

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61
Q

What tests must you do on someone that has recurrent UTIs (two or more UTIs)

A

Ultrasound of the renal tract

Micturating cystourethrogram:

DMSA scan

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62
Q

What classes as an atypical UTI?

A

Septicaemia
Non e-coli
Poor urine flow
A raised creatinine

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63
Q

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?

A
  • Zygote
  • Epiblast

Female genital duct? Paramesonephric duct
Male genital duct? M for mesonephric duct

Until 7 weeks gestation

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64
Q

What makes gender change at 7 weeks?

A

The presence of the SRY gene = male

Absence of SRY gene= female

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65
Q

How does the Male reproductive tract develop

A
  • 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
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66
Q

What does the urogenital sinus become?

A

The bladder
Urethra
Prostate gland

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67
Q

How does the female genital tract develop?

A

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

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68
Q

What week are foetus distinguished by sex?

A

Week 12

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69
Q

What is hypoxic ischaemic encephalopathy? What are some causes?

A

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

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70
Q

Give a few aetiology of hypoxic ischaemic encephalopathy?

A

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.

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71
Q

when can you tell a baby has hypoxic ischaemic encephalopathy?

What are the 3 category descriptions?

A

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

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72
Q

What will hypoxic ischaemic encephalopathy show on MRI and EEG?

A

Abnormalities

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73
Q

What is the management of hypoxic ischaemic encephalopathy?

A

ABCDE
Anti-convulsants to stop the seizures
IV fluids to support kidneys
Treat hypoglycaemia and hypocalcaemia!

IF MILD RECOVERY IS EXPECTED

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74
Q

What is a transient early wheeze?

A

Commonly seem in children below the age of 5

Episodic and caused by RSV

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75
Q

From what age can you start to diagnose asthma?

A

Age 3

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76
Q

What is the pathophysiology of asthma?

A

Bronchial inflammation
Hypersensitivity of the airways
Narowing of the airways

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77
Q

What are some symptoms of asthma

A

Chest Tightness
Wheeze
Cough
SOB

Worse at night and during the morning

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78
Q

What are some investigations you would do for asthma?

A

Peak expiratory flow rate (before and after bronchodilator)
Skin prick test
Chest x-ray

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Perfectly
79
Q

What are the 4 steps of treatment for asthma?

A
  1. Remove allergens. Start the patient on SABA
  2. SABA and anti-muscarinic
  3. SABA, antimuscarinic and steroid
  4. LABA, anti-muscarinic and steroid
  5. Above plus a leukotriene receptor antagonist
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80
Q

What is the management of an acute asthma attack?

A
  • 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
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81
Q

What causes rheumatic fever?

A

Group A beta haemolytic strep with M antigens

Then leads to a hypersensitivity reaction and deposition on the heart valves

How well did you know this?
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82
Q

What 4 systems does rheumatic fever affect

A

The heart
The joints
The skin
The nervous system

83
Q

How often does rheumatic fever present after a pharyngeal infection?

A

2-6 weeks

84
Q

What is the diagnostic criteria for rheumatic fever?

What does it consist of?

A

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

85
Q

What is the management of Rheumatic Fever:

What can be used to prevent it’s reacurrance?

A

Management: you need to give aspirin

To prevent reoccurrences: you need to give benzathine penicillin

86
Q

What is transient synovitis?

What causes it?

What are a few symptoms

How do you manage it?

A

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

87
Q

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?

A

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
88
Q

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?
A

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.
89
Q

What is the Jones Criteria? And what is it used for?

A
  • 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.
90
Q

What is the management of rheumatic fever?

A

Anti-inflammatories like aspirin.

Recurrence Relapse give: benzathine penicillin

91
Q

What are the 5 S’s of an innocent murmur?

A

Soft
Left Sternal Edge
Systolic
A Symptomatic

92
Q

What types of heart disease presents in:

  1. Neonates
  2. Infants
  3. Older children
A
  1. Neonates: GB sepsis, coarctation or aortic stenosis
  2. Infants: high pulmonary flow: ASD, VSD and patent ductus arteriosus
  3. Older children: rheumatic fever, cardiomegaly and eisenmenger’s syndrome
93
Q

What are some symptoms of heart failure?

A

Symptoms include:

  • SOB
  • Sweating
  • Poor feeding
  • Failure to Thrive
  • Recurrent Chest Infections

Poor weight gain
Cool peripheries
Tachycardia and cool peripheries

94
Q

Why do few children have heart failure in the first couple of weeks of life

A

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.

95
Q

What is eisenmenger’s syndrome?

A

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

96
Q

What are some potential causes of cyanosis in a newborn?

A

GBS sepsis
Meconium aspiration
Pulmonary hypertension
Cyanotic heart disease

97
Q

Two causes of a right to left shunt?

A

Transposition of the Great Arteries

Tetralogy of Fallot

98
Q

Common causes of a breathless and blue newborn?

A

ASD

Congenital heart defect

99
Q

What is the most common arrhythmia in children?

A

Supraventricular Tachycardia

100
Q

When do arrhythmias get worse on inspiration or expiration??

A

Inspiration

101
Q

What is a SVT arrhythmia?

What normally causes them?

A

The heart goes between 250-300 bpm

It is caused by a re-entrant tachycardia accessory pathway.

102
Q

What are some symptoms of SVT arrhythmia?

A

SOB
Cyanosis
Poor feeding and failure to thrive

If it happens in utero you get hydrops fetalis

103
Q

How do you manage a SVT?

A

You manage a SVT with:

  • Tissue acidosis correction with positive pressure ventilation achieved
  • Vagal stimulation manoeuvre
  • IV adenosine
  • Pacemakers
104
Q

When is it associated with a Long QT syndrome?
What can it lead to?
What are the symptoms
What is the management?

A

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

105
Q

What is classed as prolonged jaundice?

A

Jaundice after 2 weeks gestation

106
Q

What type of hyperbiliruminaemia resolves on it’s self?

A

Unconjugated hyperbiliruminaemia: resolves on ourself

Conjugated does not resolve on its self: you get pale stools, dark urine, jaundice and a bleeding tendency

107
Q

What is biliary atresia?
What are the clinical signs or biliary atresia?
What are 2 diagnostic methods?
What is the management of the condition?

A

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

108
Q

Fluids and FEED lecture:

What percentage of a term baby is water?

A

75%

109
Q

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:

A

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

110
Q

How do children loose fluid?

A

Skin and Lungs
Urine
Stool

111
Q

Give 5 causes of dehydration:

A

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
112
Q

What are quantifiable limits of dehydration:

  • Mild
  • Moderate
  • Severe
A

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

113
Q

What are some consequences of dehydration?

A

Failure to thrive and malnutrition
Developmental Delay
Constipation
UTI

114
Q

How do we get around dehydration in children?

A

Nature: encourage oral feeding: bottle, breast or formula

Enteral feeding: PEG, jejunostomy or gastrostomy

115
Q

How do you work out a child’s weight ?

A

(Age +4) x2

116
Q

How do you hydrate a patient who is dehydrated?

A 
Maintence 
Deficit (%was) x50%
117
Q

What if a patient is shocked how do you calculate the fluid required?

A

Maintence
Deficient (%) x 100
Bolus 20mls/kph

118
Q

For older children how much fluid do you give per kg

A

1st 10kg give 100ml/kg
Then next 10kg give 50ml/kg
Then after 20ml ml/kg

Divide this by 24 to get a rate

119
Q

When would you give a fluid bolus?

How much for each scenarios?

A 
Dehydrated Shock (20mls/kg)
Diabetic Ketoacidosis (10mls/kg)
120
Q

When would reticulocytes be low and high?

A

Low: lack of production
High: haemolysis or blood loss

121
Q

What is a definition of a disability?

What is an impairment?

A

When a patient has a mental or physical impairment that results in marked/limitations on every day life

An abnormality or loss of function

122
Q

What are some categories of impairment?

A 
Physical 
Sensory 
Learning 
Behavioural/Emotional: depression 
Neurodevelopmental: ADHD and Autism
123
Q

What determines disability:

A

The biopsychological model

124
Q

WHO-DAS World Health Organisation Disability Assessment Schedule:

A

Generic assessment of health and disability
Used across mental, neurological and addictive disorders.
Applicable acros all cultures and age populations

125
Q

what are 5 RF for paedatric mental health issues?

A 
Difficult temperament 
Low self esteem 
Instable life 
Parents with MH or substance abuse 
Peer rejection or school trauma
126
Q

What are protective factors for MH?

A
  • Easy temperament
  • Optomistic and good social skills
  • Sense of belonging and connectivity
127
Q

Difference between adult and child radiology: give 5

A
  • 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
128
Q

What are some implications for a child with a chronic disease?

A
  • Special education
  • Developmental Delay
  • Feeding and Speech problems
  • Seperation and hospitalisation.
129
Q

What else do you need to think about when communicating with teenagers: Use the mneumonic HEDDSS

A
  • H: Home
  • E: Education
  • D: Drugs and Alcohol
  • D: Depression and Suicide
  • S: Sexual Health
  • S: Spirituality and Sleep
130
Q

What are the WHO-DAS 6 Domains of Functioning

A

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

131
Q

What are some important factors to consider when dealing with disabled children?

A

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

132
Q

What are 3 ways to self harm:

A

Partake in risky behaviour
Swallowing objects
Cutting
Burning

133
Q

What two groups is self harm more common in?

What are 3 RF:

What is a good treatment:

A

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

134
Q

What are the normal ranges of blood sugar levels?

A

o Fasting: 3.5-5.6 mmol/l

o Post-prandial: <7.8 mmol/l

135
Q

What does insulin normally do?

A

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.

136
Q

What happens if there is an insufficient or absent amount of insulin?

A

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.

137
Q

What are the 3 criteria for diabetic ketoacidosis?

A

o Acidosis pH <7.3
o Blood ketones >3
o Blood glucose >11

138
Q

How do you treat diabetic ketoacidosis?

A

Fluids and Potassium
Insulin
Monitor glucose hourly and ketones 1-2 hours
Strict fluid balance

139
Q

When do you know they are no longer in diabetic ketoacidosis?

A

pH is over 7.3 and ketones recovered

140
Q

What is hypoglycemia?

What are some symptoms?

A

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)
141
Q

What are 5 complications of Diabetes:

A 
Retinopathy 
Neuropathy 
Nephropathy 
Increased suspectible to infections 
Problems with pregnancy 
increased incidence of other AI conditions
142
Q

Ideal inflation on a chest x-ray?

A

5-6 ribs seen

143
Q

What is translocation?

A

When part of a chromosome is found elsewhere on another chromosome

144
Q

What is a RF for AR inheritance?

A

Consanguinity

145
Q

What is a non mendelian inheritance?

A

When it is not purely down to gentic inheritence. But also environment. I.e. Neural Tube defects: with genetic risk and folic acid

146
Q

What are some consequences of a mitochondrial disorder?

A

Sensory neural deafness
Myoclonic Epilepsy
Diabetes

147
Q

Is prader-wili a paternal or maternal deletion?

A

Paternal

148
Q

Is angelman a paternal or maternal deletion?

A

Maternal

149
Q

What is faltering growth?

A

When an infant is failing to gain or grow adequately.

This is generally a fall across 2 centiles on a growth chart

150
Q

What are some key causes of faltering growth?

A
  • Not enough food in
  • Poor absorption or food
  • Too much energy used
  • Abnormal central control of growth and appetite (GH and thyroid)
151
Q

Give 4 causes of poor intake?

A 
o	Breast feeding poorly 
o	Bottle feeds too dilute 
o	Juice drinker 
o	Exclusion diet 
o	Vomiting i.e. GORD
152
Q

Give 3 causes of malabsorption:

A

Liver Disease
Enteropathy: cows milk intolerance, IBD and coeliac
Pancreatic Disease

153
Q

Give 3 causes of using two much energy?

A 
Chronic Cardiac Disease 
Chronic GI disease (IBD)
Chronic Resp Disease (CF)
Tumours 
Chronic Renal Disease
154
Q

What are some non organic causes of faltering growth?

A 
Maternal anorexia 
Poor social Support 
Poverty 
Child Abuse 
Poor parental understanding
155
Q

What are the 3 primitive reflexes?

When do they disappear?

A

Moro
Grasp
Galant

By 4-6 months

156
Q

What are the 3 postural reflexes?

A

Positive Support Reflex
Landau
Parachute

Emerge at 3-8 months

157
Q

What does a persistence of the primitive reflexes suggest?

A

Upper Motor Neuron abnormality

158
Q

What is the definition of self harm?

A

Deliberate intent to hurt oneself

e.g. associated with suicidal ideas and can include cutting, burning and overdose.

159
Q

What are 4 signs of chronic liver disease?

A 
You can get hepatomegaly splenomegaly 
You can get cirrhosis 
Portal hypertension 
Lethargy 
Malnutrition
160
Q

What are some causes of chronic liver disease?

A 
Hep B or C 
Autoimmune hepatitis 
Wilson’s Disease 
Cystic Fibrosis 
Alpha-1 antitrypsin disease 
Drugs like NSAIDs and nitrofurantoin
161
Q

4 causes of ascites

A 
Secondary renal impairment 
Fluid redistribution 
Renal impairment 
Sodium Retention 
Hypoalbuminaemia
162
Q

What would a deficiency in Vit A cause

A

Night blindness

163
Q

WHat a would Vit E deficiency cause?

A

Peripheral neuropathy and ataxia

164
Q

What causes a Vit D deficiency

A

Rickets

Pathological Fractures

165
Q

What treatment do you give for encephalopathy?

A

You give them

Lactulose and also protein restriction

166
Q

Indications for dialysis include

A 
HTN 
Severe acidosis 
Hypercalcaemia 
Hyper/Hyponatraemia 
No treatment
167
Q

What are the 4 S s of a innocent murmur

A

Soft
Systolic
A symptomatic
Left Sternal Edge

168
Q

What 3 heart conditions occur in neonates?

A
  1. Coarctation of aorta
  2. Aortic Valve stenosis
  3. Hyper plastic left hear

Then you have transposition of the great arteries and also tetralogy of Fallot

169
Q

What are 3 causes of heart disease in infants:

A

VSD
ASD
PDA

They increase pulmonary flow

170
Q

What are 4 symptoms of heart failure?

A 
You can get 
Sweating 
Poor Feeding 
recurrent chest infections 
Breathlessness

You can also get poor weight gain, tachypnoea and tachycardia also hepatomegaly and oedema

171
Q

What are 3 signs of RHS failure

A

SO you can get sacral and ankle oedema

In babies you can get scrotal oedema and also pulmonary hypertension/tricuspid regurg

172
Q

What are 4 causes of cyanosis in a neonate?

A

The 4 causes of cyanosis include:

  • meconium aspiration
  • cyanotic heart disease
  • pulmonary hypertension
  • septicaemia secondary to GBS
173
Q

When do arrhythmia increase?

A

They get acceleration in inspiration

174
Q

What is SVT?

A

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.

175
Q

What are some symptoms of SVT?

A

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

176
Q

What is the treatment of arrhythmia?

A

Your treatment is tissue acidosis correction with ventilation
VAGAL stimulation
IV adenosine
Cardio version

You then maintenance with soltalol

177
Q

What is the cause of congenital heart block?

A

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

178
Q

What is Long QT syndrome?

A

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!!

179
Q

What factors increase the risk of bronchiolitis?

A

You have smoking
Bronchial-dysplasia
CF
Congenital Heart Disease

180
Q

What is a pan systolic murmur consistent with?

A

VSD

181
Q

WHat is the management of heart disease

A

You need to give Diuretics
Give ACE inhibitors
Increased calorie intake

182
Q

4 causes of heart failure

A

sepsis
Congenital
Arrhythmia
Anaemia

183
Q

What are 3 causes of nephrotic syndrome?

A

You can have minimal change syndrome
Focal segmental glomerulosclerosis
Membranous glomerular disease

Congenital Renal disease

184
Q

What are the 5 primitive reflexes

A
  1. Palmar: to 2-3 months
  2. Rooting: to 1 month
  3. Moro to 6 months
  4. Tonic neck reflex: 7 months
  5. Parachute reflex: 7-8 months
185
Q

What is seen in infantile spasm?

A

Hyperarrythmias

186
Q

What is characteristic of benign Roland is seizures

A

Central temporal spikes

187
Q

What are 3 causes of a squint:

A 
Refractive error 
FH
Cataract 
Retinoblastoma 
Prematurity
188
Q

What do you give for neonatal sepsis?

A

Benzylpenicillin

Gentamicin

189
Q

What do you do when neonatal blood glucose is below 2.5

Preterm

Term baby

A

Pre-Term: You give them IV bolus of dextrose

Term: you feed them —> glucogel —> IV bolus

190
Q

What 4 pre term screening methods do you do in neonates

A

You do:

  • Retinopathy of prematurity
  • You look at the lungs for BPD
  • You look at the brain for intraventricular haemorrhage
  • Hearing
191
Q

What are causes of jaundice below 24 hours

A

G6PD deficiency

Rhesus disease of the newborn

Neonatal congenital infection

192
Q

What is the cause of jaundice from 24 hours to 3 weeks

A

The cause is:

  • UTI
  • Breast milk jaundice
  • Polycythaemia
  • Biliary Atresia
193
Q

What are cause more than 3 weeks:

A

infection
Physiological
Hypothyroid
Liver disease

194
Q

How do you diagnose biliary atresia?

A

Radioisotopes scan and biopsy

Kauai procedure

195
Q

What are 5 features of congenital hypothyroid disease

A 
Macroglossia 
Coarse facial features
Short Statue 
Hypotonia 
Umbiblical hernia
196
Q

What is the cause of thyroid disease:

  • world wide
  • UK
  • Consanguinity
A
  • iodine deficiency
  • thyroid gland deficiency
  • dyshormongenesis
197
Q

What is the treatment for adrenal crisis

A

Hydrocortisone

IV salbutamol

198
Q

What are some examples of what is in Q RISK 2?

A 
RA
SLE 
Angina 
HTN 
AF
BP treatment 
Smoking 
Diabetes
Age and Gender
199
Q

What is the target for vaccination % uptake

A

95%

200
Q

When do you need to notify PHE for Rheumatic Fever, AIDS or Whooping Cough or TB?

A

You need to phone or email within 24 hours!!

201
Q

Is HiB a notifiable disease?

A

YES

202
Q

If under 12 months what is a concerning HR?

A

Above 160

203
Q

What is a concerning measurement in a 12-24 month old for HR?

A

150

204
Q

What about for a 2-5 year old?

A

Over 140

Phase 3a Medicine (9 decks)

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