Paediatrics Flashcards

(204 cards)

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
What is released from the posterior pituitary gland?
vasopressin (ADH) Oxytocin
26
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
27
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.
28
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
29
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
30
How do you treat congenital adrenal hyperplasia?
You need to give mineral corticoids (Aldosterone) | Glucocorticoids (hydrocortisone)
31
What movements will you get in a frontal epilepsy?
Jacksonian March
32
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
33
What can precipitate absence seizures?
Hyperventilation
34
How do you treat the following generalised seizures: 1. Tonic 2. Absence 3. 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
35
``` 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
36
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
37
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
38
What are causes of Gonadotrophin deficiency in women?
Anorexia Lots of sport Radiation Auto immune disease
39
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
40
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
41
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!
42
What are some specific symptoms/signs for ALL leukaemia?
Can also cause CNS involvement: CN3, 4 and 6 palsy | And Gum hypertrophy!
43
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.
44
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
45
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.
46
What are the 7 categories of JIA?
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.
47
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
48
What are JIA complications
``` Delayed puberty Osteoporosis Growth failure Delayed puberty Chronic anterior uveitis ```
49
How do you treat JIA?
MDT Physio and exercise Start on NSAIDs, steroids and methotrexate
50
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
51
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
52
What is the definition of ADHD?
Inattention Hyperactivity Impulsivity
53
What are some aetiological factors behind ADHD?
Maternal smoking Environmental surroundings Genetics
54
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
55
How do you diagnose ADHD?
you need to talk to the family, parents and teachers Look at school behaviour
56
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
57
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
58
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
59
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
60
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
61
What tests must you do on someone that has recurrent UTIs (two or more UTIs)
Ultrasound of the renal tract Micturating cystourethrogram: DMSA scan
62
What classes as an atypical UTI?
Septicaemia Non e-coli Poor urine flow A raised creatinine
63
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
64
What makes gender change at 7 weeks?
The presence of the SRY gene = male Absence of SRY gene= female
65
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
66
What does the urogenital sinus become?
The bladder Urethra Prostate gland
67
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
68
What week are foetus distinguished by sex?
Week 12
69
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
70
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.
71
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
72
What will hypoxic ischaemic encephalopathy show on MRI and EEG?
Abnormalities
73
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
74
What is a transient early wheeze?
Commonly seem in children below the age of 5 | Episodic and caused by RSV
75
From what age can you start to diagnose asthma?
Age 3
76
What is the pathophysiology of asthma?
Bronchial inflammation Hypersensitivity of the airways Narowing of the airways
77
What are some symptoms of asthma
Chest Tightness Wheeze Cough SOB Worse at night and during the morning
78
What are some investigations you would do for asthma?
Peak expiratory flow rate (before and after bronchodilator) Skin prick test Chest x-ray
79
What are the 4 steps of treatment for asthma?
1. Remove allergens. Start the patient on SABA 2. SABA and anti-muscarinic 3. SABA, antimuscarinic and steroid 4. LABA, anti-muscarinic and steroid 4. Above plus a leukotriene receptor antagonist
80
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
81
What causes rheumatic fever?
Group A beta haemolytic strep with M antigens Then leads to a hypersensitivity reaction and deposition on the heart valves
82
What 4 systems does rheumatic fever affect
The heart The joints The skin The nervous system
83
How often does rheumatic fever present after a pharyngeal infection?
2-6 weeks
84
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
85
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
86
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
87
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
88
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.
89
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.
90
What is the management of rheumatic fever?
Anti-inflammatories like aspirin. Recurrence Relapse give: benzathine penicillin
91
What are the 5 S’s of an innocent murmur?
Soft Left Sternal Edge Systolic A Symptomatic
92
What types of heart disease presents in: 1. Neonates 2. Infants 3. Older children
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
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
94
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.
95
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
96
What are some potential causes of cyanosis in a newborn?
GBS sepsis Meconium aspiration Pulmonary hypertension Cyanotic heart disease
97
Two causes of a right to left shunt?
Transposition of the Great Arteries Tetralogy of Fallot
98
Common causes of a breathless and blue newborn?
ASD | Congenital heart defect
99
What is the most common arrhythmia in children?
Supraventricular Tachycardia
100
When do arrhythmias get worse on inspiration or expiration??
Inspiration
101
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.
102
What are some symptoms of SVT arrhythmia?
SOB Cyanosis Poor feeding and failure to thrive If it happens in utero you get hydrops fetalis
103
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
104
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
105
What is classed as prolonged jaundice?
Jaundice after 2 weeks gestation
106
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
107
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
108
Fluids and FEED lecture: | What percentage of a term baby is water?
75%
109
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
110
How do children loose fluid?
Skin and Lungs Urine Stool
111
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
112
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
113
What are some consequences of dehydration?
Failure to thrive and malnutrition Developmental Delay Constipation UTI
114
How do we get around dehydration in children?
Nature: encourage oral feeding: bottle, breast or formula | Enteral feeding: PEG, jejunostomy or gastrostomy
115
How do you work out a child’s weight ?
(Age +4) x2
116
How do you hydrate a patient who is dehydrated?
``` Maintence Deficit (%was) x50% ```
117
What if a patient is shocked how do you calculate the fluid required?
Maintence Deficient (%) x 100 Bolus 20mls/kph
118
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
119
When would you give a fluid bolus? | How much for each scenarios?
``` Dehydrated Shock (20mls/kg) Diabetic Ketoacidosis (10mls/kg) ```
120
When would reticulocytes be low and high?
Low: lack of production High: haemolysis or blood loss
121
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
122
What are some categories of impairment?
``` Physical Sensory Learning Behavioural/Emotional: depression Neurodevelopmental: ADHD and Autism ```
123
What determines disability:
The biopsychological model
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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
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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 ```
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What are protective factors for MH?
- Easy temperament - Optomistic and good social skills - Sense of belonging and connectivity
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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
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What are some implications for a child with a chronic disease?
- Special education - Developmental Delay - Feeding and Speech problems - Seperation and hospitalisation.
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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
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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
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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
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What are 3 ways to self harm:
Partake in risky behaviour Swallowing objects Cutting Burning
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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
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What are the normal ranges of blood sugar levels?
o Fasting: 3.5-5.6 mmol/l | o Post-prandial: <7.8 mmol/l
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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.
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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.
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What are the 3 criteria for diabetic ketoacidosis?
o Acidosis pH <7.3 o Blood ketones >3 o Blood glucose >11
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How do you treat diabetic ketoacidosis?
Fluids and Potassium Insulin Monitor glucose hourly and ketones 1-2 hours Strict fluid balance
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When do you know they are no longer in diabetic ketoacidosis?
pH is over 7.3 and ketones recovered
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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)
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What are 5 complications of Diabetes:
``` Retinopathy Neuropathy Nephropathy Increased suspectible to infections Problems with pregnancy increased incidence of other AI conditions ```
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Ideal inflation on a chest x-ray?
5-6 ribs seen
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What is translocation?
When part of a chromosome is found elsewhere on another chromosome
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What is a RF for AR inheritance?
Consanguinity
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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
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What are some consequences of a mitochondrial disorder?
Sensory neural deafness Myoclonic Epilepsy Diabetes
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Is prader-wili a paternal or maternal deletion?
Paternal
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Is angelman a paternal or maternal deletion?
Maternal
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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
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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)
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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 ```
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Give 3 causes of malabsorption:
Liver Disease Enteropathy: cows milk intolerance, IBD and coeliac Pancreatic Disease
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Give 3 causes of using two much energy?
``` Chronic Cardiac Disease Chronic GI disease (IBD) Chronic Resp Disease (CF) Tumours Chronic Renal Disease ```
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What are some non organic causes of faltering growth?
``` Maternal anorexia Poor social Support Poverty Child Abuse Poor parental understanding ```
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What are the 3 primitive reflexes? When do they disappear?
Moro Grasp Galant By 4-6 months
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What are the 3 postural reflexes?
Positive Support Reflex Landau Parachute Emerge at 3-8 months
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What does a persistence of the primitive reflexes suggest?
Upper Motor Neuron abnormality
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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.
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What are 4 signs of chronic liver disease?
``` You can get hepatomegaly splenomegaly You can get cirrhosis Portal hypertension Lethargy Malnutrition ```
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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 ```
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4 causes of ascites
``` Secondary renal impairment Fluid redistribution Renal impairment Sodium Retention Hypoalbuminaemia ```
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What would a deficiency in Vit A cause
Night blindness
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WHat a would Vit E deficiency cause?
Peripheral neuropathy and ataxia
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What causes a Vit D deficiency
Rickets | Pathological Fractures
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What treatment do you give for encephalopathy?
You give them | Lactulose and also protein restriction
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Indications for dialysis include
``` HTN Severe acidosis Hypercalcaemia Hyper/Hyponatraemia No treatment ```
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What are the 4 S s of a innocent murmur
Soft Systolic A symptomatic Left Sternal Edge
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What 3 heart conditions occur in neonates?
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
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What are 3 causes of heart disease in infants:
VSD ASD PDA They increase pulmonary flow
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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
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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
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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
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When do arrhythmia increase?
They get acceleration in inspiration
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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.
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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
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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
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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
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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!!
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What factors increase the risk of bronchiolitis?
You have smoking Bronchial-dysplasia CF Congenital Heart Disease
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What is a pan systolic murmur consistent with?
VSD
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WHat is the management of heart disease
You need to give Diuretics Give ACE inhibitors Increased calorie intake
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4 causes of heart failure
sepsis Congenital Arrhythmia Anaemia
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What are 3 causes of nephrotic syndrome?
You can have minimal change syndrome Focal segmental glomerulosclerosis Membranous glomerular disease Congenital Renal disease
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What are the 5 primitive reflexes
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
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What is seen in infantile spasm?
Hyperarrythmias
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What is characteristic of benign Roland is seizures
Central temporal spikes
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What are 3 causes of a squint:
``` Refractive error FH Cataract Retinoblastoma Prematurity ```
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What do you give for neonatal sepsis?
Benzylpenicillin | Gentamicin
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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
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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
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What are causes of jaundice below 24 hours
G6PD deficiency Rhesus disease of the newborn Neonatal congenital infection
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What is the cause of jaundice from 24 hours to 3 weeks
The cause is: - UTI - Breast milk jaundice - Polycythaemia - Biliary Atresia
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What are cause more than 3 weeks:
infection Physiological Hypothyroid Liver disease
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How do you diagnose biliary atresia?
Radioisotopes scan and biopsy | Kauai procedure
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What are 5 features of congenital hypothyroid disease
``` Macroglossia Coarse facial features Short Statue Hypotonia Umbiblical hernia ```
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What is the cause of thyroid disease: - world wide - UK - Consanguinity
- iodine deficiency - thyroid gland deficiency - dyshormongenesis
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What is the treatment for adrenal crisis
Hydrocortisone | IV salbutamol
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What are some examples of what is in Q RISK 2?
``` RA SLE Angina HTN AF BP treatment Smoking Diabetes Age and Gender ```
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What is the target for vaccination % uptake
95%
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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!!
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Is HiB a notifiable disease?
YES
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If under 12 months what is a concerning HR?
Above 160
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What is a concerning measurement in a 12-24 month old for HR?
150
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What about for a 2-5 year old?
Over 140