Paediatrics Flashcards
Name 5 categories of child abuse
(PENS-F) Physical Emotional/psychological Neglect Sexual Fabricated/induced illness
When should solid foods be introduced into an infants diet?
6 months
Until what age should breast feeding continue?
2 years
What is the normal cut off for weight loss that should occur during the first week of a child’s life?
They should not lose more than 10% of their birth weight in the first week, and this weight should be regained again by day 14
Describe the breast feeding hormone reflex
AP produces prolactin
PP produces oxytocin
suckling stimulates the AP and PP
Prolactin causes alveolar cells to make milk, and oxytocin lets the milk ‘down’
Baby then suckles and the breast is emptied
FIP (feedback inhibitor polypeptide) is released when the baby is not suckling which inhibits the alveolar cells from making milk
List 4 benefits of breast feeding to the baby
A-D
- less allergies
- close BOND with mother
- Complete nutritional source
- Developmental (high IQ)
Reduced infections (ear, gut, resp) Reduced autoimmune conditions Reduced SIDS risk Reduced cardiovascular disease Increases cognitive ability
List 4 benefits of breast feeding to the mother
E-H
- economic (free)
- fit (helps with weight loss)
- guards (reduces breast, ovarian and uterine cancer risks)
- reduced risk of Haemorrhage post partum
Reduced breast cancer risk Reduced ovarian cancer risk Reduced diabetes risk Helps with weight loss Builds bond with baby Reduces post-natal depression
How is CF inherited, and describe the mutation?
Autosomal recessive
affects 1/2500 births
F508 mutation on chromosome 7 in the CFTR protein
Describe the pathophysiology of CF
Normal CFTR protein = allows chloride ions to leave mucosal cells and enter the lumen of organs
Defective CFTR = chloride ions cannot leave mucosal cells which leads to thickened, sticky secretions which cannot be cleared
Affects many organ systems:
- lungs
- pancreas (exocrine deficiency)
- liver (fibrosis and thick bile)
- reproductive system (non-functioning vans deferens and thickened cervical mucous)
- poor growth and delayed puberty
What ENT complications can CF patient suffer from
Nasal polyps
Sinusitis
What common types of chest infections do CF patients get?
Pseudomonas aeriginosa
Mycobacterium abcessus
Burkholderia cepacia
Describe CF screening
Look for raised IRT (immunoreactive trypsin levels) on neonatal blood spot -> as the pancreatic duct shrivels up antenatally this means that enzymes get backed up into the blood
Genetic testing -> for CFTR mutation e.g. F508
Describe how CF may present
Meconium ileus
Recurrent infections
Failure to thrive
Describe the diagnostic tests for CF
Sweat testing (positive is Cl in sweat is >60mmol/L)
Stool testing (look for reduced faecal elastase)
Describe the treatments of CF
MDT involvement Chest physiotherapy Dieticians ?gastrostomy Prophylactic antibiotics Fat soluble vitamins and enzyme replacement
What is the incidence of down syndrome and the 3 mechanisms of trisomy?
1/1000 births Trisomy 21 caused by: - non-disjunction (90%) - translocation (5%) - mosaicism (1%)
List physical appearance features of a DS child
Prominent epicanthal folds Upward slanting palpebral fissures Small mouth and protruding tongue Round face Low set ears Single palmar crease Poor growth and short stature
List neuro complications of DS
Learning difficulties
Cataracts
Strabismus
Epilepsy
List cardiac complications of DS
Congenital heart disease in 50% children (get ECHO screened after birth)
AV septal defect is common, also VSD and tetralogy of fallot (= POR-V: pulmonary stenosis, overriding aorta, RV hypertrophy, VSD)
List GI complications of DS
Risk of duodenal atresia -> bilious vomiting and double bubble sign on AXR
Imperforate anus
Hirschprung’s disease
GORD
Coeliac disease
Describe screening for DS (invasive and non-invasive)
Non-invasive
- first trimester bloods e.g. B-HCG and PAPP-A + maternal age = risk calculation
- nuchal translucency on USS
Invasive:
- CVS/amniocentesis
What formula is used to calculate fluid requirements for children (not neonates)
4-2-1 rule
First 10kg = 4ml/kg/hr
Second 10kg = 2ml/kg/hr
Remaining kg = 1ml/kg/hr
What are the electrolyte requirements for paeds
Na = 2-4mmol/kg/hr Cl = 2-4mmol/kg/hr K = 1-2mmol/kg/hr
(0.45% NaCl is usually best)
What is the formula used to calculate the desired volume of blood for a child for transfusion?
Transfusion volume = Hb (g) (desired - actual) x Weight (kg) x 4
Describe fluid boluses given to children in resus:
Always give 20ml/kg of 0.9% NaCl and then reassess in resus
Except give 10ml/kg in DKA, cardiogenic shock or haemorrhagic shock
Describe the presentation of pyloric stenosis
(hypertrophy of pyloric muscle causing gastric outlet obstruction)
Projectile vomiting soon after feeding (no bile)
A hungry baby with weight loss -> they become dehydrated and eventually not interested in feeding
Common 2-6 weeks
5M : 1F
Maternal family history
How is pyloric stenosis diagnosed?
Low Na and K are found -> metabolic alkalosis
Carry out a test feed and an USS will show peristalsis and a thickened pylorus
O/Ex: a pyloric mass which feels like an olive is palpable in the RUQ
How is pyloric stenosis treated?
Fluid resuscitate and correct electrolytes (0.45% saline, 5% dextrose, potassium supplementation)
Definitive mgx: pyloromyotomy
What is malrotation?
When the normal rotation and fixation of the bowel that should happen during 4-12wks gestation does not. The caecum lies close to the duodenal-jejunal flexure. There is a narrow midgut mesentery which is liable to volvulus.
How is malrotation diagnosed and treated?
Diagnosis -> barium contrast studies
Tx: resus, laparotomy and ladds procedure
What is NEC and how does it present?
Necrotising enterocolitis = an acute inflammatory disease which occurs in premature infants where there is bacterial invasion and necrosis of the bowel.
Presentation: Obstruction with bilious vomiting is the normal presentation in the first few days of life but can present later -> distended abdomen, blood in stool, bilious vomiting, pyrexia and feeding intolerance
How is NEC treated?
Conservative: fluids and abx
Surgical: bowel resection and stoma formation
What is atresia of the intestine?
A congenital narrowing or absent section of the intestine
Can occur anywhere in GI tract, but most commonly jejunum/ileum
What genetic condition is duodenal atresia linked with?
30% of infants with duodenal atresia have Down’s syndrome
What is Hirschprung’s disease?
An aganglionic piece of bowel (i.e. which lacks special nerve cells) is present. This means the muscle in this area cannot perform peristalsis and poo gets stuck in the bowels.
Commonly occurs at the anus and progresses upwards
Causes bowel obstruction and enlargement of the colon
How does Hirschprung’s disease present
90% present with delayed passage of meconium
Later presentations = abdominal distension, constipation, failure to thrive
What is intussusception and at what age does it present
Full thickness invagination of proximal bowel into distal bowel segment (commonly at ileo-caecal area)
Peak age = 2 months - 3 yrs
What are the symptoms of intussusception
TRIAD:
- abdominal pain
- redcurrant jelly stools (due to blood stained mucous)
- vomiting (maybe bilious depending on intuss site)
How is intussusception diagnosed and treated?
Dx: USS -> will show a target lesion/doughnut sign
Tx:
Resus if needed
Rectal air insufflation (air enema) is both diagnostic and therapeutic -> ONLY if no peritonitis
Surgery if peritonitis is present
What is meconium ileus/plug?
When the meconium which is sticky can form a plug or become blocked in the bowel
90% of cases, the child has cystic fibrosis
What are the presenting features of meconium ileus?
Delayed meconium passage (ie. not within the first 24hrs of delivery)
Feeding reluctantly
Bilious vomiting
How is meconium ileus diagnosed?
AXR
How is meconium ileus treated?
NGT -> to drain bile from stomach
Stop feeds
IV fluids +/- Abx
May need an enema/stoma/surgery
Later -> CF testing
What is biliary atresia and how does it present?
Progressive and idiopathic necrotising inflammation of part/all of the biliary tree
S/Sx: jaundice, pale stools and hepatomegaly
How is biliary atresia treated?
Tx: urgent hepato-porto-enterostomy (to allow bile to flow out of the duct system into the gut)
70% children need liver transplant
Long term Mgx: optimising growth and nutrition
What is the formula to estimate a child’s weight based on their age?
(Age + 4) x 2 (in kg)
List the paediatric indications for a CT head
Witnessed LOC for >5 mins Amnesia >5 mins 3 or more episodes of discrete vomiting Signs of fractured base of skull A post traumatic seizure with no history of epilepsy
List 5 causes of bilious vomiting
Intussusception Meconium plug Hirschprung's disease Necrotising enterocolitis Gastroenteritis
Describe the differences between foetal and adult circulations AND what happens when the baby is born
- Ductus venosus - carries nutrient rich, oxygenated blood straight from the mother’s placenta to the foetal inferior IVC and into the RA of the heart (bypassing the liver)
- Foramen ovale - allows blood to pass RA -> LA (bypassing the lungs which are not yet functioning)
- Ductus arteriosus (becomes ligamentum arteriosum) - allows any blood which does pass into the RV and pulmonary artery to move straight from PA -> aorta (avoiding the lungs)
When baby takes first breath, this reduces pulmonary vascular resistance, there is an increase in LA filling as blood is returning from the now functioning lungs and the foramen ovale closes.
What is transient tachypnoea
Normally during labour the infant’s chest is squeezed as it passes through the birth canal and this helps to clear fluid from the lungs, however often infants can suffer from transient tachypnoea following a C-section when their lungs have not been squeezed as it can take several hours for the lung fluid to be resorbed, resulting in laboured & rapid breathing.
Describe respiratory distress syndrome
Deficiency of surfactant, often in premature babies, lowers surface tension leading to widespread alveolar collapse and inadequate gas exchange
Common in infants born < 28 weeks as type 2 pneumocytes have not secreted enough surfactant, rare at term but may occur in infants of DIABETIC mothers
Clinical signs = >60 breaths/min, laboured breathing
Tx: antenatal steroids (before birth)
Describe how choanal atresia may present?
Episodic cyanosis which is worse when the baby feeds and improves when they cry (due to occlusion of bone/soft tissue at the back of the nostril)
Why are pre-term infants at increased risk of infection?
As IgG is transferred across the placenta in the final trimester
Describe the common pathogens that can cause early and late onset infections in newborn infants
- Early onset sepsis (within 48hrs of birth)
Usually due to bacteria which ascended the birth canal and entered the amniotic fluid. Caused by E.COLI and mother may have fever during labour. Presents with resp distress, apnoea and temperature instability - Late onset sepsis (>48hrs from birth)
Nosocomial or environmental infections
STAPH EPIDERMIS is the most common pathogen in NICU from indwelling catheters - GROUP B STREP can cause LATE AND EARLY infection
20% of women have vaginal carriage of this bug
Colonised mothers can be given prophylactic Abx
Describe the neonatal resus flow chart
- As soon as baby is born, it will sit on mother for 1 minute and start the timer on the resuscitaire (delayed cord clamping occurs
- Baby is then brought over to resuscitaire and stimulate with towel for a few seconds
- Assess tone, breathing and HR
- If not breathing/gasping -> give 5 inflation breaths (3 seconds long) and LOOK FOR CHEST MOVEMENT
- If still not good chest movement, consider 2 person technique and repeat the 5 inflation breaths
- Once chest is moving, assess HR (if <60 then provide ventilation breaths, if >60 then ask senior!) -> may needs sats probe and tailored O2 etc.
Describe the components of the APGAR score
Appearance (blue/pink with blue extremities/pink)
Pulse (absent/<100/>100)
Grimace (floppy/minimal response to stimulation/maximal response to stimulation)
Activity = ‘muscle tone’ (absent/flexed arms and legs/active)
Respiration (absent/slow and irregular/vigorous cry)
Define the cut off for neonatal jaundice and list 3 reasons why newborns can become visibly jaundiced:
Serum bilirubin >85umol/L
- Shorter RBC lifespan (70 days not 120) therefore more breakdown and Hb production
- Newborns have a lot of RBC’s!
- Hepatic bilirubin metabolism (converting UC -> C) is less effective in the first few days of life
Define ‘prolonged jaundice’ and what can cause it
Prolonged = >14 days in a term infant and >21 days in a preterm infant
The commonest cause of prolonged jaundice is breast feeding (mechanism unclear, but thought to be due to increased enterohepatic circulation of BR)
List causes of 1) unconjugated, 2) conjugated hyperbilirubinaemia
1) Unconjugated = most common type, caused by:
- haemolytic disease (ABO incompat, Rh factor)
- physiological
- breast feeding
- hypothyroidism
- infection (sepsis/UTI)
2) Conjugated = rarer, but most common cause to rule out is BILIARY ATRESIA
What complication can occur with unconjugated hyperbilirubinaemia?
Unconjugated BR can be deposited in the brain causing kernicterus (encephalopathy, as bilirubin is neurotoxic and can present with lethargy and poor feeding, occurs when serum BR levels >400umol/L)
How is neonatal jaundice treated?
1) Phototherapy using 450nm wavelength of light (converts the UCBR into soluble pigment which can be excreted)
2) Exchange transfusion
List the top 5 causes of respiratory distress in the neonate
- Transient tachypnoea of the newborn (delayed resorption of lung fluid)
- Respiratory distress syndrome (surfactant deficiency)
- Meconium aspiration
- Pneumothorax
- Infection
List the top 5 causes of cyanosis in the neonate
- Any cause of respiratory distress
- Persistent pulmonary hypertension
- Congenital (cyanotic) heart disease
- Tracheo-oesophageal fistula
- Diaphragmatic hernia
List signs of dehydration in a child:
Tearless, sunken eyes Sunken fontanelles Reduced tone Drowsy Reduced skin turgor Cold peripheries Increased CRT Reduced urine output
What does an abnormal Galleazi test suggest?
The shorter femur = DDH on that side!
List RFx for DDH (developmental dysplasia of the hip):
Female gender
Breech delivery
Positive family history of DDH
What investigative method is used to diagnose DDH?
USS
What bone complications can arise from DDH?
Avascular necrosis
Osteoarthritis
Re-dislocation
How is DDH treated?
Babies wear Pavlik harness
Surgical reduction if this fails/discovered later in life
List indications for urinalysis in children
Infection (all infants <1yr with unexplained temp) Haematuria ?Sexual abuse Failure to thrive Abdominal pain Hypertension Neonatal prolonged jaundice
List methods of collecting urine from children
Cotton wool in nappy Clean catch Bag Suprapubic aspiration Indwelling catheter
How do you collect an MSSU (mid stream specimen of urine)?
Should be a MID stream specimen of urine
Ask parents to clean the perineum of the infant or child (from front to back)
Should be a “clean catch” into a foil dish- no touching the inside of the dish
Then decanted into a urine pot
Why might nitrites not be present in the urine sample of infants <1yr?
As the urine must have been in the bladder for at least 4 hours for nitrates to form
What does a low specific gravity suggest?
Dilute urine
List indications for using a peak flow meter
Diagnostic
Monitor response to treatments
Marker of severity in exacerbations
Counsel how to use a peak flow meter
Set the counter back to zero before starting
Hold so that your fingers don’t obstruct the dial (from beneath/both hands)
Sit up straight/perform standing
Take a breath in to completely fill your lungs
Make a good seal on the mouthpiece, make sure teeth/tongue aren’t in the way
Blow out into the peak flow as hard and as fast as you can
Look at the counter after you perform the test (make a note)
You usually Take the best of 3 goes.
You should ensure that their technique is good enough that the repeatability of the best 2 are within 10%.
Counsel how to use an inhaler + spacer
Shake well before use
Remove cap
Check expiry date on the inhaler
Prime before first use/if not used for weeks (with one puff)
Keep chin up and create tight seal
Breathe out before using
Breathe in over 2-4 seconds starting as you deliver the puff
Give enough time for inhaler to reset (at least 30 seconds!) before next puff (5-10 breaths in a spacer). Breaths MUST be slow to ensure the drug doesn’t hit the back of the throat and you get optimum delivery to the lungs.
If using a steroid inhaler can advise using just before brushing teeth in morning/evening
We would never advocate using a MDI (metered dose inhaler) without a spacer. Only if there wasn’t one available, but we would always encourage them to have one with their Salbutamol. (Use spacers up to ~5yrs old)
What are the ‘paeds’ sepsis 6?
- IV access and bloods
- Antibiotics
- Fluid resus
- Involve senior/specialist early
- Oxygen
- Consider inotropic support early
What proportion of 3 month olds experience GORD
50%
What complications can arise if GORD is not treated in infants?
Failure to thrive
Oesophagitis
Aspiration pneumonia
When does paediatric coeliac disease commonly present?
During weaning at 6-9 months when gluten-containing foods are introduced into the diet
How does paeds coeliac present?
Failure to thrive Malabsorptive symptoms Fatty pale stools Muscle wasting Distended abdomen
How is coeliac disease diagnosed (describe specific features to look for!)
anti-TTG antibody Duodenal mucosal biopsy, looking for: 1) Villous atrophy 2) Crypt hyperplasia 3) Increased intra-epithelial lymphocytes
List 5 causes of paediatric diarrhoea
- Starvation (green, watery mucous)
- Response to infection elsewhere e.g. pneumonia
- Infection of GI system e.g. E.coli, salmonella
- Surgical - intussusception
- Surgical - Hirschprung’s disease
What is the most common causative agent of gastroenteritis in children?
Rotovirus
Describe Meckel’s diverticulum
A type of TRUE (contains all 4 layers of the bowel wall) diverticulum, occurs congenitally
- 2inches long
- 2 feet from the ileocaecal valve
- affects 2% of the population
- presents ~2yrs of age
What are the most common organisms that cause septic arthritis in children?
Staph aureus
Strep pneumoniae
List 6 causes of hepatomegaly in paeds
- Infection/inflammation e.g. hepatitis/autoimmune conditions
- Congestive cardiac failure/Budd-Chiairi
- Infiltration (e.g. by tumours such as neuroblastoma)
- Obstruction of the biliary system -> biliary atresia, gallstones
- Storage disorder (of glycogen, lipids, metals, CF)
- Idiopathic
List 5 causes of splenomegaly in paeds
- Infection (EBV/CMV)
- Haematological (hereditary spherocytosis/sickle cell)
- Inflammatory disorders e.g. sarcoidosis, RA
- Cirrhosis and liver disease e.g. portal HTN, portal vein thrombosis
- Neoplastic
What are the top 6 causes of rectal bleeding in paeds?
- Local e.g. anal fissure
- Blood swallowed from epistaxis
- Gastroenteritis
- Intussusception
- IBD
- Acid ulceration
List RFx for paeds IBD
- Bottle feeding
- FHx of IBD / FHx of AI conditions e.g. RA, thyroid disease
- Parental smoking
- Peri-anal signs (50% of paeds crohn’s will have diagnostic signs on inspection)
Name 4 bacteria which can cause bloody gastroenteritis
- E.coli
- Yersinia
- Salmonella
- Campylobacter
- Shigella
- C.Diff
What is the most common gene mutation in achondroplasia?
FGFR3
List the 5 most common intrauterine infections
TORCH
- toxoplasmosis
- other (syphilis)
- rubella
- cytomegalovirus
- HSV (herpes simplex virus)
Name the teratogenic effects of the following drugs if taken in pregnancy:
- Phenytoin
- Carbemazipine/sodium valproate
- Lithium
- Warfarin
- Tetracycline
- Phenytoin - cleft palate, cardiac defects…
- Carbemazipine/sodium valproate - neural tube defects
- Lithium - Ebstein’s anomaly (= TRAD: tricuspid incompetence, RV enlargement, ASD, dysrhythmias)
- Warfarin - frontal bossing, cardiac defects
- Tetracycline - teeth discolouration
List the three phases of growth
Infantile -> from conception to 2 years (GH and thyroxine dependent)
Childhood (2 yrs to adolescence)
Pubertal phase - from adolescence until final height reached (controlled by sex steroids and ends when epiphyseal fusion occurs)
What is the formula used to correct for plotting the growth of premature babies?
Baby’s current age (weeks) - (40 - gestation in weeks at birth)
What complication can occur in paeds DKA if resuscitation fluids are given too soon
Cerebal oedema
What infective agent causes acute epiglottitis?
Haemophilus influenza B
At what age does epiglottis commonly present and how?
2-6yrs
Stridor & drooling
Sudden onset
Pyrexia >38
List the viruses which can cause acute croup
PAIR viruses
- parainfluenza
- adenovirus
- influenza A/B
- RSV
At what age does croup commonly present and how?
6 months - 3 years
Inspiratory stridor and barking cough
How is croup treated?
Oxygen
Steroids (oral dex)
Nebulised adrenaline if worsens
What is the causative agent of acute bronchiolitis?
RSV (respiratory syncytial virus) commonly
Sometimes bacterial
At what age does bronchiolitis commonly present and how?
6 weeks - 6 months
Coryzal symptoms and a progressive wheeze
What is the causative agent of pertussis?
An UTRI caused by bordetella pertussis bacteria (childhood vaccine is advised)
How does pertussis normally present, and how is it treated?
Common <6 months
Inspiratory whoop / whooping cough
Treat with Abx
Describe the salter harris classification of growth plate injuries:
SALTER
- A # Straight across the growth plate
- A # Above the growth plate (metaphysis!!!)
- A # below (Low) the growth plate (epiphysis!!!)
- A # Through the growth plate
- A # Entire growth plate is Rammed together
Describe a greenstick vs a buckle fracture
Greenstick = bend in a bone and the cortex is broken on one side
Torus = slight bulge of the radial cortex (but cortex is still in tact)
What is Perthe’s disease?
Avascular necrosis of the femoral head in children
Idiopathic and cause unknown
Presents 4-10 years
Presents with groin/hip/knee pain and limp
Reduced hip abduction + internal rotation
Treatment = rest+/- surgery
Describe SUFE, the age it normally presents at and how?
Slipped upper femoral epiphysis 10-16yrs Presents with pain and limping Obesity is the main risk factor Can be bilateral Is a type 1 salter harris #
What type of fracture in children is pathognomic of non-accidental injury/
Metaphyseal (bucket handle) fracture
What are the NICE guidelines for the investigation of UTI’s in children 6 months-3yrs for
a) atypical infection?
b) recurrent infection?
a) Atypical infection -> USS at the time, and DMSA scan 4 months later
b) Recurrent infection -> USS 6 weeks after the scan and DMSA 4 months later
How can you differentiate a cephalohaematoma from caput succadaneum?
Cephalohaematoma is sub-periosteal, therefore does not cross the suture lines
Caput can cross the midline and extend over suture lines
Describe the AMPLE mnemonic used to take a side history in A&E
A - allergies M - medications P - PMHx L - last meal/drink E - environment, more about the event
What is the underlying worry with a ‘boggy’ skull?
That there is an underlying skull fracture
Describe categories of pathology that could cause a ‘limping’ child
Tiny TIM!
Tumour Trauma Infection Inflammation Mechanical MSK
Describe neuroblastoma
Tumour of neural crest cells, commonly in adrenals but can present anywhere in sympathetic NS
Common presentation of a limping child as bone is a common met site
Usually <5yrs
Describe Ewing’s sarcoma and osteosarcoma and how they are differentiated
Ewing’s sarcoma = primary bone tumour (malignant), presents in teens
Osteosarcoma = primary bone tumour (malignant), presents in teams and second peak in elderly
Ewing’s -> moth-eaten, lucent lesions
Osteo -> blastic white lesions with periosteal reactions (Codman’s triangle) - google pics!
What is the most common infective agent in osteomyelitis in children?
Staph aureus
Describe Reiter’s syndrome
M>F
- urethritis
- arthritis (reactive - no infection in joint!)
- conjunctivitis
- +/- plantar fasciitis
Describe transient synovitis of the hip
Hip held flexed and externally rotated
Proceeded by coryzal illness
Also called irritable hip
3-10yrs
Pain may be referred to the knee
Bloods may show slight inflammation and USS may show effusion
Just conservative rest and analgesia until can weight bear again
Describe the pathophysiology behind DMD and BMD
DMD = duchenne muscular dystrophy (x-linked recessive - only M affected!- show's Knight's move inheritance where a carrier mother with an affected father passes the disease onto her son) BMD = Becker's muscular dystrophy
DMD = out of frame mutation in the DMD gene which means abnormal ‘dystrophin’ protein is made, which usually acts as an intracellular linking protein for fibrin molecules -> this means that muscles cannot contract properly
BMD = less severe as it is an ‘in-frame’ mutation, so muscle weakness is not as severe
Why should aspirin not be given to children?
Can cause Reye’s syndrome
vomiting, rapid breathing, can cause brain and liver damage
Define cerebral palsy
A group of permanent (usually non-progressive) disorders affecting motor and postural functioning, usually attributable to a disturbance that occurred to the developing fetal brain
List differentials for proteinuria in the child
- minimal change disease
- FSGS
- membranous glomerulonephritis (antiphospholipase A receptor)
List differentials for haematuria in the child
- IgA nephropathy
- Post-infectious glomerulonephritis
- Goodpasture’s syndrome (antibodies against T4 collagen on basement membranes of lungs and kidneys causing haematuria and haemoptysis)
- vasculitic causes (MPA and GwP)
List the diagnostic features of ADHD
Attention deficit hyperactivity disorder
- inattention
- hyperactivity
- impulsitivy
List the diagnostic features of ASD
Autistic spectrum disorder
- repetitive, stereotyped behaviour
- difficulty with social interactions
- impaired communication
What is included in an adolescent HEADS screen
Home life Education Activities and hobbies Drugs/drinking Sex/smoking/suicide
What are the features of Kawasaki disease
CRASH & burn (fever)
- conjunctivitis
- strawberry RED tongue
- lymphAdenopathy (cervical)
- skin on hands and feet dry
- rash on hands
- persistent fever for >5 days
Describe the causative agent and the features of paediatric hand, foot & mouth disease
What is it’s treatment?
Caused by coxsackie A virus
Pink/grey blisters on hands/feet and in mouth, which peel off after a week and leave no scarring
Treatment = supportive + analgesia
Describe the flow chart for the management of childhood asthma
- SABA (salbutamol)
- Low dose ICS
Still uncontrolled,
<5yrs = LTRA (T for tiny)
>5yrs = LABA (A for adult)
List 3 cyanotic paediatric cardiac disorders
3T’s
- Tetralogy of fallot
- Transposition of great arteries
- Tricuspid atresia
Describe the features in tetralogy of fallot
CYANOTIC = PORV
- Pulmonary stenosis (R outflow obstruction)
- Over-riding aorta
- RV hypertrophy
- VSD
Describe the features of Ebstein anomaly
TRAD
- Tricuspid incompetence
- RV enlargement
- ASD
- Dysrhythmias
