Paediatrics Flashcards
Ill neonate - consider…
3
- Sepsis (infection screen including LP)
- Hypoglycaemia
- Metabolic disturbances
Feeding difficulty causes in neonates
4
- Sepsis
- Prematurity
- Heart failure
- Congenital abnormalities (e.g. cleft palate)
Neonatal jaundice - when to admit…
2
- Within 2 hours - jaundice occurs in first 24 hours of life
- Within 6 hours: FIRST occurs after 7 days Prolonged jaundice Unwell Gestational age <35/40 Pale stool and dark urine Poor feeding
Physiological jaundice
=
Day 2 - 10 (increased BR load)
Breast-milk jaundice
=
Day 2 - several weeks
= prolongation of physiological jaundice in breastfed babies, baby well
Pathological jaundice
causes - many, eg of 4
Many causes, eg.
- blood group incompatibility
- sepsis
- metabolic disorders
- biliary atresia
Failure to thrive
=
= significant drop in expected rate of growth compared with other children of similar age/sex
—> use centile/growth charts to track
(Normal to lose 10% bodyweight in first few days of life)
Failure to thrive - prenatal causes
4
- Prematurity
- Maternal malnutrition
- IUGR
- Maternal smoking/alcohol
Failure to thrive - postnatal causes
5
- Feeding problems, e.g. cleft palate
- Reflux
- GI disorders, e.g. malabsorption
- Organ failure
- Neglect
Management of FTT
4
- Dietary input
- Social worker input
- Paediatric input
- Treat underlying cause
Numerical examples of paeds chromosomal abnormalities
3
DEP
- Down’s - trisomy 21
- Edwards - trisomy 18
- Patau’s - trisomy 13
Sex chromosome abnormalities
2
- Klinefelter’s - 47 XXY
2. Turner’s - 45 XO
Down’s syndrome
Features (5)
Associations (4)
Features:
- Smaller ears
- Flat nasal bridge
- Brushfield spots
- Epicanthic folds
- Wide space between 2nd/3rd toes
Associations:
- ALL
- Congenital heart disease
- Hirschprung’s
- Duodenal atresia
Signs of congenital heart abnormalities
4
- FTT
- Murmur
- Poor feeding
- Heart failure symptoms
Congenital abnormalities - broad headings
3
- Heart
- Gut
- Neurological
Congenital heart abnormalities -
Acyanotic v Cyanotic
(4) v (4)
Acyanotic:
- ASD
- VSD
- PDA
- Aortic coarctation
Cyanotic:
- Fallot’s tetralogy
- TGA (transposition of great arteries)
- Pulmonary stenosis
- Tricuspid atresia
Gut congenital abnormalities
3 + info
- Hirschprung’s = development failure of parasympathetic plexus —> constipation.
Mx = surgical removal of affection section - Pyloric stenosis - projectile vomiting approx 3-4 weeks; sometimes visible peristalsis.
Mx = Ramstedt’s pyloromyotomy - TOF = connection between trachea and oesophagus —> higher incidence of aspiration pneumonia.
Mx = surgical correction
Neuro congenital abnormalities
2
- Cerebral palsy
2. Spina bifida
SPINA BIFIDA
Def Types Dx Ix Mx
= NTD - vertebral arch of spinal column absent or incomplete
Can be occulta (overlying skin intact, no protrusion of spinal cord) or cystica (open - visible cystic mass on back, e.g. meningocele)
Dx - prenatally: AFP, anomaly scan, amniocentesis
Ix - full spine examination & check for other abnormalities
Mx - can be treated surgically (in utero or post-natally) to prevent complications, e.g. meningitis
CEREBRAL PALSY
Defn
Cause
Features
Mx
= group of conditions permanently affecting motor (movement) and coordination
Caused by damage to brain before, during or soon after birth
Features - include high or low muscle tone, delayed milestones, etc
Mx - MDT approach, e.g. physio, speech therapy, etc
Talipes equinovarus (club foot)
Foot can’t be placed on ground
Conservative Mx - e.g. ponseti method of stretching/casting
Or surgical, e.g. if fixed deformity
PERTHES
Defn
Demo
So
Mx
= avascular necrosis of femoral head epiphysis
M>F, age 5-10
May have limp, pain in knee/hip
Non-surgical, e.g. analgesia
VS surgical when persists
SUFE
Defn
Demo
Sx
Mx
Epiphysis ‘slipped’ down and back
M>F, age 10-15
May have Iimp, pain in knee/hip/groin
Surgery as may lead to avascular necrosis of femoral head
Irritable hip
Pain and limp eg following infection
Admit if other causes in doubt. Rest and analgesia
JIA (Still’s disease)
Defn
Ix
Mx
Chronic arthritis in <16yo, similar features to adults
Raised inflammatory markers, HLA-B27 may be positive
Mx - physio, med (e.g. aspirin, methotrexate), surgery, urgent ophthalmology review for uveitis
Pulled elbow
Usually under 5’s
Dislocation of radial head
Needs manual reduction
ADHD
Defn
Mx
Triad of
- Inattention
- Hyperactivity
- Impulsiveness
At least more than 1 situation, impairing function, usually under age 7
Rx - methylphenidate (Ritalin)
AUTISM
Dx
Mx
3 essential diagnostic features
- Social impairment (no interest, eye contact, few friends)
- Abnormal behaviour (lack of imagination, stereotyped play)
- Communication impairment (speech, non-verbal)
If high suspicion needs referral, e.g. autism team/CAMHS
ENURESIS
Types (3) Considerations Physical causes? (6) Mx (5) Referral (4)
Types:
- Primary enuresis with day symptoms
- Primary enuresis without day symptoms
- Secondary enuresis (after being dry 6 months)
Consider - fluid intake, volume of urine, access to toilet, home & school issues.
Normal up to age 5, common up to age 10.
Physical cause?
- Overactive bladder
- Diabetes
- UTI
- Chronic constipation
- Neuro disorders
- Child maltreatment
Mx: (depending on stage and type)
1. Reassured if appropriate
2. Potty by bed for access, encourage pre-sleep urination
3. Rewards system e.g. star charts
4. Enuresis alarm (£50-100)
5. Desmopressin (can be short term or long term use) - usually age 7 and above, oral or sublingual
—>mimics ADH (so reduces urine production). HypoNa can happen therefore fluid restrict with only sips from 1 hour before taking to 8 hours after taking.
No evidence of adverse effects if taken long term
Referral more likely (e.g. enuresis clinic) if:
- Daytime wetting
- Secondary enuresis
- Recurrent UTIs
- Physical cause
MEASLES
Org
Sx (2)
Mx
Notify?
Rubeola virus
- Erythematous maculopapular rash
- Koplik spots
Supportive treatment
Notify - Y
MUMPS
Org
Sx
Mx
Notify?
Mumps virus
- Parotitis
- Epididymio-orchitis/oophoritis
Supportive treatment
Notify - Y
RUBELLA (German measles)
Org
Sx
Mx
Notify?
Rubivirus
- Rash starts behind ears
- Arthritis/arthralgia
Supportive treatment
Notify - Y
SCARLET FEVER
Org
Sx
Mx
Notify?
Streptococcus pyogenes
- Strawberry tongue
- Sandpaper rough rash
Penicillin V qds 10/7
Notify - Y
SLAPPED CHEEK SYNDROME
Org
Sx
Mx
Notify?
Parvovirus B19
Erythematous facial rash
Supportive treatment
Notify - N
CHICKENPOX
Org
Sx
Mx
Notify?
Varicella zoster
Macules, papules, clear vesicles, pustules
Supportive treatment
Notify - N
HAND, FOOT & MOUTH DISEASE
Org
Sx
Mx
Notify?
Coxsackie A16
- Ulcers in mouth
- Macules/papules on hands/feet
Supportive treatment
Notify - N
WHOOPING COUGH
Org
Sx
Mx
Notify?
Bordetella Pertussis
- Coughing fits
- Whooping
- Vomiting
—> Clarithromycin if <1mo
—> Azithromycin/clarithromycin if >1mo (non-pregnant)
Notify - Y
ANAPHYLAXIS
Mx
Adults & >12:
0.5mg (0.5ml of 1 in 1000) adrenaline IM
> 12 (small):
0.3mg (0.3ml of 1 in 1000)
6-12y:
0.3mg (0m3ml of 1 in 1000)
Up to 6y:
0.15mg (0.15ml of 1 in 1000)
MENINGITIS
Mx
Adults & >10:
1.2g Benzylpenicillin IM/IV
1-9y:
600mg
<1y:
300mg
CHILD MALTREATMENT
4 types & when to suspect
1. PHYSICAL Bruising/lacerations/thermal injury/fracture when not mobile, Bruising on non-bony areas, Bruising in clusters, Lacerations on areas usually covered, Human bite mark, Delayed presentation
- EMOTIONAL
Persistent punishing (e.g. for bedwetting)
Persistent rejection/scapegoating
Persistent inappropriate threats/discipline - SEXUAL
Genital/anal/perianal injury without explanation
STI/pregnancy in <13
Sexualised behaviour in pre-pubertal child - NEGLECT
Failure to seek appropriate medical care
Persistently smelly/dirty
Child safeguarding measures
4
- Child protection register
(Confidential details of children who are at risk of abuse/neglect) - Child protection plan
(Assesses likelihood of harm/Goals to reduce risk/Assigns responsibility and actions/Outline ongoing monitoring) - Local safeguarding children boards
(In every local authority - responsible for multi-agency co-ordination and monitoring) - Serious case reviews
(Undertaken where abuse or neglect has taken place/suspected and where death or serious harm has taken place)