Paediatrics Flashcards
What are some clinical signs of respiratory distress?
Grunting
- exhaling against a partially closed glottis
Stridor
Nasal flaring
Trachael tug
Intercostal recession
Paradoxical breathing
- seesaw movement
When should prematurity be corrected on a growth chart till?
2 years
How much weight can a baby loose after born which is normal and what are the normal weight increases expected?
10% loss of birthweight in first 10 days is acceptable.
Weight should double by 4 months and tripled by 1 year.
When is puberty said to have begun in males?
When testes reach 4ml
What is the term for puberty starting early? and how should it be investigated?
Precocious puberty
- females <8 years
- Males <9 years
Central causes: normal puberty happening too early:
- intracranial tumour
- familial
Peripheral causes:
- Adrenal tumour
- McCune-Albright syndrome
Investigations:
- Brain MRI (for pituitary tumours causing GnRH realise)
- USS of ovaries and testes (ovarian/ testicular tumours causing hormones)
- wrist x-ray to assess if it is affecting the bone maturity
- endocrine - hormones and GnRH
- Urine steroid profile (for adrenal tumours)
- TFTs (hypothyroidism can induce early puberty)
Highlight key motor skill milestones and red flags:
6 week: head control
6m: sit up right with support
9 -10m: crawling sit up right unsupported
12m: cruise walk
18m: walking
2 y: running
Red flags:
- 6m no head control
- 12 month no sitting unsupported
- 18 month not walking
Highlight key fine motor skills and visual skills milestones and red flags:
3m: holds objects in palm
6m: transfer objects
9m: immature pincer grip
12m: mature pincer grip
18m: stack bricks
2 years: draw line
3 years: draw circle
Red flags:
- 5m does not hold object in hand
Highlight some key speech and language skill milestones and red flags:
3m: turns to sound
3-6: makes sounds
9m: Double syllable (mama, dada)
12m: Responds to name
12-15 months - 2-6 words
2 year: links words
4 years: - speaking
Red flags:
3m: no response to sound
9m: no babble
<2-6 words 18 months
List some key social skill milestones and red flags:
6w: smile
3m: laugh
9m: waves/ stranger danger
12m: Plays peak a boo
18m: spoon feeds
3year: dresses and toilet trained
Red flags:
- 12 month: no gestures
- 18 months: no play
Where might you find information about the childs immunisations, birth weight ete (something that should be asked for during every consultation):
Red book
What is a key thing in the history that suggests the pregnancy was normal?
If the baby stayed with mum after delivery
What is the important pulse to feel for in children?
Femoral pulse
What is an effective way of working out the constitutional height of a child i.e working out how tall they will be?
Mid-parental height:
Males:
[Fathers height + mothers] + 13 / 2
Females:
[Father’s height + Mothers] - 13 / 2
*normal range is +/- 10 cm
In children what is considered obese?
> 95th centile
What is the definition of a short stature?
2 standard deviation below or 2nd centile for someone their age and sex
Which hormones promotes the fusion of the epiphyseal in children?
Estrogen
Aromatase of testosterone and production of oestrogen in both sexes promotes the fusion of the epiphyseal plates.
Growth spurts are controlled by different hormones at different stages of life - what are they:
Infantile stage 0-2 years:
- Growth Hormone
- Insulin
Childhood phase 2 - pubertal years:
- Growth Hormone
- Thyroxine
Puberty:
- Sex hormones
- Growth hormone
List some investigations to be done into delayed puberty:
Bloods:
- FBC
- LH and FSH
- Serum prolactin
- IGF-1 levels
- Celiac screen
Imaging:
- MRI of brain
- Wrist x-ray
- Pelvis Ultrasound scan
What is the definition of delayed puberty:
Females:
- 13 years old
- Failure of Tanner stage 2
Males:
- 14 years old
- Testes <4ml
What are some causes for short stature?
Normal genetically short
Constitutional delay
Intrauterine growth restriction
Dysmorphic syndromes
- Down’s, - Turner’s
Skeletal dysplasia
Chronic system disease
- IBD, - CKD, Cystic fibrosis
Endocrine disorders
Social circumstances
- very poor social situations
Medication
- Steroids
What should the neck position be in infants and children undergoing resuscitation?
Neutral position in infants, with very slight extension
Children: sniffing position with chin lift
What organism is responsible for croup and how should it be managed?
Parainfluenza
Management:
- Oxygen
- Nebulised adrenaline 5ml 1:1000
- Corticosteroids - dexamethasone (oral if mild)
How is Bronchiolitis diagnosed? and what is the causative agent?
Nasopharyngeal Aspirate for RSV testing
RSV
what are some of the symptoms and How is whooping cough diagnosed, treated and what are some complications:
Symptoms:
- Bouts of coughing fits - especially during the night
- inspiratory whoop
- subconjunctiva haemorrhage
- spells of apnoea
- may vomit at end coughing
- absolute lymphocytosis may be seen
Diagnosed:
- Nasal swab culture
- PCR
Treatment:
- notify public health
- Macrolides within <21 says
- Family prophylaxis
*prophylactic antibiotics for family members
Complications:
- pneumothorax
- bronchiectasis
- seizures
- can last for 100 days
Which condition is associated with micrognathia, posterior tongue displacement and cleft palate?
Pierre- Robin syndrome
Which condition is associated with short stature, webbed neck, over friendly and supraclavicular aortic stenosis? and what kind of face are the described as having?
William’s Syndrome
Elf like face
What condition is associated with micrognathia, low set ears, short stature, overlapping digits and rocker bottom feet?
Edward’s Syndrome
What are some of the clinical findings of a child with Patau syndrome:
Microcephaly - with skin lesions on head Microopathamia Polydactyly Cleft lip Rocker bottom feet
Cyclopia - severe
Elephant trunk nose
What are some complications of Down’s syndrome which may affect the child immediately or affect development?
Congenital heart disease
- AVSD
Cataracts
Hypotonia
- affect ability to feed
- delay in milestones
Intestinal atresia
Thyroid dysfunction
Hearing loss
Developmental impairment
- in the milestones
- leading to learning disabilites
What health checks are recommended for children with Down’s syndrome?
Thyroid tests
Eye checks
Hearing checks
Growth monitoring
- have their own chart
Heart checks
Breathing checks
Blood checks
Following a bronchoscopy sample, why might there by lipid laden macrophages?
Due to aspiration of milk
What symptoms would make one think it is NOT asthma:
Cough only when its cold/ following viral infection
Moist cough/ productive
Signs of finger clubbing (likely something else is going on)
What is the FEV1 post bronchodilator change that is diagnostic in children?
> 12% change
What are the typical symptoms of bronchiolitis?
Dry Cough
Fever - mild
Coryzal symptoms
Poor feeding
Findings:
- Dyspnoea
- Wheeze
- Bilateral findings
- Heading bobbing
- Subcostal recession
Diagnosis:
- Nasal-pharyngeal aspirate for virology
Management:
- oxygen
- fluids (try NG first)
+/- nebulised saline/ salbutamol
*continual monitoring
What samples are needed for suspected TB in a child?
3x early morning sputum samples
or
Gastric aspiration
*gastric aspiration is in young children because they will have swallowed respiratory secretions from the night before.
What is the chromosome affect in cystic fibrosis and and what is the carrier rate?
Chromosome 7
- F508
1/20 are carriers
How is cystic fibrosis now diagnosed?
Guthrie blood spot test:
Immunoreactive trypsinogen
- can be diagnosed within 3 weeks
*trypsinogen is released into the blood because of blocked pancreatic ducts.
This is followed on with a sweat test
- Pilocarpine Iontophoresis (makes one sweat)
- > 60mmol/l of Chloride
- 100mg of sweat
*following from this there is usually specific genetic testing such as F508 deletion testing
What are some signs that a child may have cystic fibrosis which hasn’t been picked up? i.e. they have come from a country where screening is not done:
Meconium ileus
Nasal polyps
Distal small bowel obstruction
- occurs in 10%
Failure to thrive
Delayed puberty
Recurrent chest infections
Signs of Cor pulmonale
What is the management of cystic fibrosis?
Chest physiotherapy x2
Good nutrition
- NG tube
- Gastrostomy
Pancreatic enzymes supplements + vitamins
Prophylactic antibiotics
+
IV antibiotics for infection
What signs may you see of someone with Primary ciliary dyskinesia?
Dextrocardia
or even
- situs inversus (all organs on wrong side)
What factors are taken into account that determine your lung function?
Height
Sex
Age
Ethnicity
List some causes of obstructive lung disease in children:
Asthma
Bronchiolitis
Cystic fibrosis
Primary ciliary dyskineasia
What are some causes of restrictive lung disease in children?
Scoliosis
Neuromuscular disease
- Duchenne muscular
Pulmonary fibrosis
- *if a restrictive pattern is seen further investigations should be done which include:
- transfer factor
- High resolution CT
What are some bronchial challenge testing that are done to diagnose asthma?
6 minute exercise challenge
Histamine provocation
Mannitol challenge test
What is the condition called which results in inflammation of the foreskin in children and how is it treated?
Balanitis
Oral fluids to rehydrate
Genital retraction back of foreskin
+/-
Antibiotics
*complications can be cellulitis
What is the condition called where there is increasing scarring of the foreskin and how is it treated and why?
Balanitis Xerotica Obliterans
Treatment:
- circumcision
*treated because it can cause meatal stenosis
What is the most common cause of acute scrotum in a young child?
Torsion of the epididymal appendage
List some other causes of acute scrotum in children:
Henock Schonlein Puprura
- can induce swelling of testes
Idiopathic scrotal oedema
- not painful just discomfort
- 7-8 years in summer
- settles within 24 hours
What is the formula for working out the predicted functional bladder capacity?
(age x 30) + 30
What is the most common organism to cause meningitis in neonates?
Strep Agalactiae
- group B strep.
in first 48 hours this is from the mother
Name two clinical signs that may be seen in a child with meningism:
Brudzinski sign:
- bending the neck causes the legs to flex
Kernig sign:
- flexing the hip causes neck pain and forces the leg to flex
How can the child’s projected adult height be worked out?
Calculated working out the mid-parental height.
Girls:
(Father’s height + Mother’s Height) - 13 / 2
Boys:
(Father’s height + Mother’s Height)+13/ 2
+/- 10cm is normal
List some causes of short stature:
Familial
Delayed puberty
Growth hormone deficiency
- primary
- acquired (tumour, iatrogenic, trauma, radiation)
Hypothyroidism
Corticosteroid use
Chronic illness
Nutritional deficiency
How can the size of the testes help point to the origins of the cause of precious puberty in males?
Bilateral large testes = central cause
Unilateral large teste = testicular tumour
Bilaterally small testes = adrenal cause, hyperplasia or tumour
What is the most common cause of painless PR bleeding in a child between 1-2 years old?
Merkel’s diverticulum
