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Year 5 > Paediatrics 8 > Flashcards

Paediatrics 8 Flashcards

1
Q

Neonatal hypoglycaemia

A

Normal term babies often have hypoglycaemia especially in the first 24hrs of life but without any sequelae as they can utilise alternate fuels like ketones and lactate. Normally <2.6 mmol/L. Transient hypoglycaemia in the first few hours after birth is common.

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2
Q

Causes of Persistent/severe neonatal hypoglycaemia

A

Preterm birth (<37 weeks), maternal diabetes mellitus, IUGR, Hypothermia, Neonatal sepsis, Inborn errors of metabolism.

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3
Q

Features of neonatal hypoglycaemia

A
  • May be asymptomatic
  • Autonomic (hypoglycaemia -> changes in neural sympathetic discharge)= jitteriness, irritable, tachypnoea, pallor
  • Neuroglycopenic= poor feeding/sucking, weak cry, drowsy, hypotonia, seizures
  • Other features: apnoea, hypothermia
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4
Q

Management of neonatal hypoglycaemia

A
  • Asymptomatic: encourage normal feeding (breast or bottle), monitor blood glucose
  • Symptomatic or very low blood gas: admit to the neonatal unit, intravenous infusion of 10% dextrose
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5
Q

Neonatal sepsis: common organisms

A

Neonatal sepsis: severe infection occuring in infants <90 days. Can be early onset (within 72 hours of life) or late onset (after 72 hours of life)

Common organisms: Group B strep (GBS), E.coli, Listeria, Klebsiella. Late onset is caused byy S.aureus and s.epidermis

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6
Q

Neonatal sepsis risk factors and clinical features

A

Risk factors= vaginal GBS colonisation, GBS sepsis in previous baby, maternal sepsis, chorioamnionitis, prematurity, PPROM

Clinical features= fever, poor feeding, reducing tone, respiratory distress, vomiting, tachycardia, hypoxia, jaundice within 24 hours, seizures, hypoglycaemia, shock or multi-organ failure

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7
Q

Neonatal: treating for presumed sepsis

A
  • If there are two or more risk factors or clinical feature of neonatal sepsis start antibiotics. If 1 monitor for 12 hours
  • Give IV benzylpenicillin during childbirth if risk factors are present
  • Antibiotics should be given within 1 hour of making the decision to start them
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8
Q

Investigations for neonatal sepsis

A
  • Blood cultures should be taken before antibiotics are given
  • Check a baseline FBC and CRP (repeat 24-36hr after antibiotics)
  • CXR if chest source
  • Perform a lumbar puncture if suspect meningitis or neurological symptoms (e.g. seizures)
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9
Q

Management of neonatal sepsis

A

Antibiotic choice= Benzylpenicillin and gentamycin are first line. Cefotaxime can be given in lower risk babies

Ongoing management

  • Check the CRP again at 24 hours and check the blood culture results at 36 hours:
  • Consider stopping the antibiotics if the baby is clinically well, the blood cultures are negative 36 hours after taking them and both CRP results are less than 10.
  • Check the CRP again at 5 days if they are still on treatment:
  • Consider stopping antibiotics if the baby is clinically well, the lumbar puncture and blood cultures are negative and the CRP has returned to normal at 5 days.
  • Consider performing a lumbar puncture if any of the CRP results are more than 10.
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10
Q

Nephrotic syndrome

A

triad of

  • proteinuria (> 1 g/m^2 per 24 hours)
  • hypoalbuminaemia (< 25 g/l)
  • oedema
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11
Q

Nephrotic syndrome symptoms

A
  • Most patients have periods of remission and relapses
  • Susceptibility to infections
  • Frothy urine and reduced output
  • Increased risk of blood clots
  • Hyperlipidaemia (hypercholesteraemia), Hypertension
  • Xanthelasma: deposits of cholesterol around the eye
  • Fatigue
  • Leukonychia: changes to the nail bed
  • Periorbital oedema, ascites, peripheral oedema
  • Breathlessness: pulmonary oedema, pleural effusion
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12
Q

Nephrotic syndrome causes

A

Causes= glomerulosclerosis, glomerulonephritis, HIV/Hepatitis, lupus, diabetes, sickle cell anaemia, HSP, certain types of cancer i.e. leukaemia.

In children the peak incidence is between 2 and 5 years. Around 80% of cases in children are due to minimal change glomerulonephritis. Under renal biopsy there are no abnormalities. 90% of cases responding to high-dose oral steroids (good prognosis)

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13
Q

Effects of steroid treatment

A
  • Short term: behaviour change (irritability, mood swings), increased appetite, gastric irritation
  • Long term: changes to facial appearance, weight gain, hypertension, hyperglycaemia, osteopenia, immunosuppression
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14
Q

Management of nephrotic syndrome

A
  • High dose steroids (i.e. prednisolone): given over 4 weeks then gradually weaned over the next 8
  • Low salt diet
  • Diuretics may be used to treat oedema
  • Albumin infusions may be required in severe hypoalbuminaemia
  • Antibiotic prophylaxis may be given in severe cases
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15
Q

Nephrotic syndrome: investigations and complications

A

Investigations
- Urine dipstick, MSU
- FBC, U&E, LFT, Ca+2, CRP, glucose
- Serum and urine immunoglobulins
- Autoimmune screen
- Hep B&C, HIV
- Chest x-ray: to show pleural effusion
- Ultrasound of the kidneys, renal biopsy

Complications nephrotic syndrome: Hypovolaemia, Thrombosis, Infection, acute or chronic renal failure, relapse

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16
Q

Non-accidental injury

A

Any bodily injury in a child that has been deliberately inflicted upon them, or any injury where the caregiver has failed to prevent such injury

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17
Q

NAI history

A
  • Most often occurs in children <2 years old
  • Often delayed presentation with injury
  • Caregiver history may be inconsistent in terms of: Changing narratives, Narrative not matching up with the severity/type of injury shown
  • Injury is unwitnessed
  • Evidence of drug or alcohol use in the household
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18
Q

NAI examination

A

findings will vary based on type of injury inflicted

  • Injuries of varying ages
  • Presence of burns or scalds
  • Multiple or clustered bruising
  • Bruises on arms, legs or face consistent with gripping
  • Subconjunctival haemorrhage
  • Retinal haemorrhage
  • Human bite marks
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19
Q

NAI- radiology

A

A full skeletal survey may be required
- Rib fractures
- Skull fractures / cranial bleeds
- Metaphyseal corner fractures (occur due to a twisting/pulling motion on a limb)
- Finger fractures
- Clavicle fractures
- Bloods to exclude organic causes such as clotting disorders or haematological malignancy

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20
Q

NAI management

A
  • Always inform a senior if you suspect non-accidental injury. Every workplace will additionally have a named safeguarding lead you can contact
  • Admit the child for safeguarding while investigations continue. Ensure other children at home are also safe.
  • Management of injuries
  • Clear and thorough documentation is vitally important
  • Contact social care to see if the child/caregiver is known to them already
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21
Q

NAI risk factors

A
  • Substance abuse or mental health condition
  • Excessive crying- can trigger shaking of baby
  • Unintended pregnancy
  • Developmental problems
22
Q

Obesity: NICE recommends

A
  • consider tailored clinical intervention if BMI at 91st centile or above.
  • consider assessing for comorbidities if BMI at 98th centile or above
23
Q

Obesity risk factors

A
  • Asian children: four times more likely to be obese than white children
  • female children
  • taller children: children with obesity are often above the 50th percentile in height
24
Q

Causes of obesity in children

A
  • growth hormone deficiency
  • hypothyroidism
  • Down’s syndrome
  • Cushing’s syndrome
  • Prader-Willi syndrome
25
Q

Consequences of obesity in children

A
  • orthopaedic problems: slipped upper femoral epiphyses, Blount’s disease (a development abnormality of the tibia resulting in bowing of the legs), musculoskeletal pains
  • psychological consequences: poor self-esteem, bullying
  • sleep apnoea
  • benign intracranial hypertension
  • long-term consequences: increased incidence of type 2 diabetes mellitus, hypertension and ischaemic heart disease
26
Q

Risk factors for obesity in children

A
  • growth hormone deficiency
  • hypothyroidism
  • Down’s syndrome
  • Cushing’s syndrome
  • Prader-Willi syndrome
27
Q

Otitis media

A

Bacteria transfer more easily in children from the nasopharynx due to a shallower Eustachian tube angle. Infection of the middle ear. Often preceded by viral URTI. Most common causes: S.pneumoniae, H.influenzae.

28
Q

Signs and symptoms of otitis media

A
  • Symptoms: ear pain (young children may pull at affected ear), reduced hearing, fever, coryza, vomiting, balance issues, vertigo
  • Signs: fever, red eardrum, if discharging (suppurative) suggests perforation, sometimes red pinna
  • Otoscopy: bulging red inflamed membrane
29
Q

Types of otitis media

A
  • Benign chronic otitis media: dry tympanic membrane perforation without chronic infection
  • Chronic secretory otitis media (glue ear): presents as persistent pain, lasting a couple of weeks after the initial episode. The drum looks abnormal and shows reduced mobility of the membrane
  • Chronic Suppurative Otitis Media: diagnosed when there is persistent purulent drainage through the perforated tympanic membrane
30
Q

Management of otitis media

A
  • Investigations: usually none (swab if recurrent/grommets in situ)
  • Conservative: reassurance, ‘delayed prescription’, safety net advice
  • Medical: simple analgesia/antipyretics. 5 days amoxicillin/erythromycin IF systemically unwell/AOM for > 4 days/ comorbidities (e.g/ congenital heart disease/chronic lung disease/immunocompromise)
  • Surgical: refer to ENT surgeon if recurrent episodes or complications
31
Q

Otitis media: when to admit

A
  • Admit any children under 3 months with a temperature of >38. Or 3-6 months >39 or children with suspected acute complications such as meningitis, mastoiditis or facial nerve palsy.
  • Consider admitting any children who are very systemically unwell.
  • Otherwise, treat pain and fever with paracetamol or ibuprofen. Should resolve in 3 days without antibiotics
32
Q

Otitis media complications

A
  • Extra-cranial: Facial nerve palsy, Mastoiditis, Petrositis, Labrynthitis
  • Intra-cranial: Meningitis, Sigmoid sinus thrombosis, Brain abscess
33
Q

Overfeeding signs

A

Really common, uses feeding to settle babies. No sense of ‘fullness’

Signs:
- More than average weight gain
- 8 or more wet nappies per day
- Loose stool
- Milk regurgitation
- Irritability
- Sleep disturbances

34
Q

Pancytopaenia

A

Pancocytopaenia: simultaneous presence of anaemia, leukopenia and thrombocytopaenia

Refer to haematologist

35
Q

Paediatric causes of Pancytopaenia

A
  • Bone marrow failure or suppression: aplastic anaemia, Leukaemia, Myelodysplastic syndrome, Metastatic cancer
  • Infection: EBV, CMV, sepsis, TB
  • Drug induced: Chemo, medication
  • Autoimmune: SLE, HLH
  • Hypersplenism
36
Q

Peptic ulcer disease and gastritis

A
  • GI disorders caused by H.pylori or NSAID
  • Smoking and alcohol are risk factors
  • PUD involves formation of ulcers in the stomach or duodenum
  • Gastritis can be acute or chronic
  • Clinical features: Epigastric pain, Dyspepsia, anaemia, GI bleeding
37
Q

Causes of peripheral nerve injuries

A
  • Traumatic causes: fractures and dislocations, penetrating injuries, stretch injuries
  • Compressive: Carpal tunnel syndrome (compression of median nerve), cubital tunnel syndrome)
  • Inflammatory: Vasculitis, sarcoidosis
  • Infectious: Lyme disease, HIV
38
Q

Peripheral nerve injuries management

A
  • Non-surgical: pain control (NSAIDs, opioids, gabapentin) and physiotherapy
  • Surgery: in severe injuries can do nerve grafting or nerve transfers
  • Routine follow up
39
Q

Peritonitis

A
  • Inflammation of the peritoneum typically caused by bacterial or fungal infection or perforation
  • Other causes: abdominal trauma or surgery, pancreatitis, cirrhosis with ascites, PID
  • Clinical features: severe abdominal pain which is diffuse, N+V, tenderness, rigidity, fever and tachycardia. May have had recent surgery or predisposing conditions like appendicitis
  • Imaging: US or CT
  • Paracentesis of peritoneal fluid confirms the diagnosis
  • Management; IV broad-spectrum antibiotics and surgery to remove the source
  • Complications: sepsis, abscess formation, bowel obstruction
40
Q

Prematurity and risk factors

A

Prematurity: birth of baby at<37 weeks gestation. Particularly vulnerable at 24-28 weeks

Risk factors= Social deprivation, smoking, Alcohol, Drugs, Overweight or underweight mother, maternal co-morbidities, twins, family hsitory, congenital abnormalities, uterine abnormalities, polyhydramnios

41
Q

Delaying labour

A
  • Prophylactic vaginal prostaglnadins
  • Prophylactic cervical cerclage
42
Q

What to give to improve outcomes antenatally

A
  • Tocolysis i.e. nifedipine: suppresses labour, allows steroids to be given
  • Maternal corticosteroids: given before 35 weeks gestation to reduce respiratory distress
  • US and CTG to monitor fetus
  • Senior obstetrician and neonatal paediatrician present at birth
  • IV Magnesium sulphate: can be offered before 34 weeks gestation and helps protect the baby’s brain
  • Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby
43
Q

Prematurity: issues in early life

A
  • Respiratory distress syndrome, Hypothermia
  • Hypoglycaemia, Poor feeding
  • Apnoea and bradycardia
  • Neonatal jaundice
  • Intraventricular haemorrhage
  • Retinopathy of prematurity, hearing problems
  • Necrotising enterocolitis
  • Immature immune system and infection
44
Q

Prematurity: long term effects

A
  • Chronic lung disease of prematurity
  • Learning and behavioural difficulties
  • Susceptibility to infections, particularly respiratory tract
  • Hearing and visual impairment
  • Cerebral palsy
45
Q

Pyloric stenosis

A

Pyloric stenosis typically presents in the second to fourth weeks of life with vomiting, although rarely can present later up to four months. It is caused by hypertrophy of the circular muscles of the pylorus. More common in males, first borns and with family history

46
Q

Pyloric stenosis features

A
  • ‘projectile’ vomiting, typically 30 minutes after a feed. Non-billious
  • constipation and dehydration may also be present
  • a palpable mass may be present in the upper abdomen
  • hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
  • Failure to thrive, if examined after feeding you can see peristalsis in the abdomen
47
Q

Pyloric stenosis diagnosis

A

Diagnosis is most commonly made by ultrasound. A ‘target sign’ may be seen

48
Q

Pyloric stenosis management

A

Management involves laparoscopic pyloromyotomy (known as Ramstedt’s operation). Until the procedure should be nil by mouth and kept on IV fluids.. Prior to surgery insert NG tube to drain fluid. Severely dehydrated babies may require acute fluid resuscitation.

49
Q

Paediatrics causes and treatment of raised ICP

A

Causes: haematoma, tumour, excessive CSF, Hydrocephalus

Treatment- reducing ICP through Mannitol injections or Hypertonic saline solution

50
Q

Hydrocephalus

A
  • When CSF builds up abnormally within the brain and spinal cord
  • Due to overproduction of CSF or problems draining it
  • Congenital causes: aqueductal stenosis, arachnoid cysts, arnold-chiari malformation
  • Presentation: enlarged and rapidly increasing head circumference, bulging anterior fontanelles, poor feeding and vomiting, poor tone, sleepiness
  • Management: VP shunt- which drains the CSF from the ventricles into the peritoneal cavity

Year 5 (24 decks)

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