Paediatrics (Core Conditions) Flashcards

Question

Febrile Seizures | (Explanation and Management)

Answer 1

*_Febrile convulsion:_* *Explanation:* * *Seizure with temperature \>38C without CNS infection (e.g. meningitis)* * *6 months – 6 years* * *Commonest cause of seizures in children* * *Mostly benign – treat underlying* * cause! – Supportive management* * for viral infections* * *Usually tonic-clonic seizures (brief)* * *Increase in incidence if have a 1^st degree relative with febrile seizures* * *Simple febrile seizures _do not_ cause brain damage* * *If \>5 mins requires medical management for seizure* * *Complex febrile seizures e.g. those which are focal, prolonged or repeated in the same illness -\> INCREASE risk of epilepsy* *Management:* * *Reassurance* * *Usually benign* * *Should check if bacterial infection e.g. meningitis (neck stiffness and photophobia -\> not so common in less that 18 months hence, infection screen e.g. blood culture, urine culture and lumbar puncture for cerebrospinal fluid)* * *Fever management* * *Antipyretics (paracetamol/ibuprofen), encourage PO fluids, removing XS clothing* * *Safety netting information & first aid* * *Recovery position, removed hard/sharp objects away, timing* * *999 if holds breath\>30s, convulsion \>5mins* * *Signs of worsening underlying infection/sepsis to return* * *If \>5 mins rescue therapy with buccal midazolam can be supplied* * Causes:* * *Viral infections, OM, tonsillitis, gastroenteritis, post-immunisation*

Answer 2

*Most epilepsy is ‘genetic’* *_Differential diagnosis_* * *INFANT* * *Cardiac arrhythmias* * *Hyperexplexia* * *Structural cardiac lesion* * *Benign myoclonus of infancy • Paroxysmal dystonia* * *Sandifers syndrome/GOR* * *Benign paroxysmal torticollis • Alternating hemiplegia* * *(Infantile spasms)* * *Self-gratification behaviour* * *Shuddering attacks* * *Benign sleep myoclonus* * *TODDLER* * *Cardiac arrhythmias* * *Reflex anoxic seizures* * *Cyanotic breath-holding attacks* * *Hyperekplexia* * *Myoclonus* * *Paroxysmal dyskinesias* * *Sandifer syndrome* * *Benign paroxysmal vertigo/torticollis* * *Migraine* * *Cataplexy* * *Akinetic (drop) attacks* * *(Febrile convulsions)* * *Overflow movements* * *Self-gratification behaviour* * *Stereotypies/ritualistic behaviour (e.g. Children with learning difficulties)* * *Head banging* * *Confusional arousal* * *Night terrors* * *OLDER CHILD* * *Cardiac arrhythmias* * *Neurocardiogenic syncope* * *Reflex anoxic seizures* * *Neurocardiogenic syncope* * *Hyperexplexia* * *Myoclonus* * *TICs* * *Paroxysmal dyskinesias* * *Benign paroxysmal vertigo/torticollis* * *Migraine* * *Eye movement disorders* * *Episodic ataxia* * *Cataplexy* * *Akinetic (drop) attacks* * *Daydreams* * *Hyperventilation panic/anxiety attacks* * *Non epileptic attack disorder* * *Pseudo-syncope or psychogenic syncope* * *Stereotypes/ritualistic behaviour (e.g. Children with learning difficulties)* * *Confusional arousal* * *REM sleep disorders* * *Night terrors* *_\*\*Seizure classification_* * *Classification of seizures (ILAE)* * *Generalised* * *Discharge arises from both hemispheres, includes absence, myoclonic, tonic, tonic-clonic, atonic, may be in combination or in sequence* * *Focal* * *Where seizures arise from one or part of one hemisphere* * *Level of consciousness may be retained/lost or evolve into a secondarily generalised tonic-clonic seizure* * *Manifestations will depend on the part of the brain where the discharge originated and moves to:* * *Frontal seizures* * *Involves motor/pre-motor cortex* * *May lead to clonic movements travel proximally* * *OR seizure with both upper limbs raised high for several seconds* * *Asymmetrical tonic seizures can be seen (bizarre and hypermotor)* * *Temporal lobe seizures* * *Present with strange warning feelings: smell and taste abnormalities, distortions in shapes and sounds* * *Lip smacking* * *Plucking at ones clothing* * *Walking in a non-purposeful manner* * *Deja-vu feelings described* * *Consciousness may be impaired* * *Occipital lobe seizures* * *Cause stereotyped visual hallucinations* * *Parietal lobe seizures* * *Cause contralateral dysaesthesis (altered sensation) or distorted body image*

Answer 3

*An umbrella term for a permanent disorder of movement and/or posture and of motor function (usually evident from birth) due to a non-progressive abnormality in the developing brain. Motor disturbances usually accompanied by disturbances of cognition, communication, vision, perception, sensation, behaviour, seizure disorder and secondary musculoskeletal problems* * *Has many causes, only 10% follow hypoxic-ischaemic encephalopathy* * *Usually presents in infancy with abnormal tone and posture, delayed milestones and feeding difficulties* *_Cardinal features_* *Children who have CP are identified as at risk in the neonatal period* * *Abnormal limb and/or trunk posture and tone in infancy with delayed motor milestones, may be accompanied by slowing of head growth* * *Feeding difficulties, with oromotor incoordination, slow feeding, gagging and vomiting* * *Abnormal gait once walking is achieved* * *Asymmetrical hand functioning before 12 months of age* * Diagnosis is made by clinical examination, particular attention to posture and the pattern of tone in the limbs and trunk, hand functioning and gait* * Classification:* * *Spastic (90%)* * *Bilateral, unilateral, not otherwise specified* * *Dyskinetic (6%)* * *Ataxic (4%)* * *Other*

Answer 4

* *_Boys:_* * *Ave age 12 years* * *1st sign 4mls testicular volume (from 2mls)* * *Peak height velocity 10-12mls testicular volume (14 years)* * *_Girls:_* * *Ave age 10 years* * *1st sign breast bud development* * *Peak height velocity breast stage 2-3 (12 years)* * *Menarche occurs breast stage 4 ( 11-13 years)* * *_Abnormal:_* * ![]()*Early \<8 years in girls, \< 9 years in boys* * *Late 13 years girls, 14 years boys* * ![]() * Discordant* *_NOT INVOLVED BUT CAN ADD…_* * ***Precocious Puberty-Causes*** * *Early Puberty?, Progressive?, Concordant?* * *True/Central (Gonadotropin dependant)* * *Idiopathic* * *CNS tumour* * *Neurofibromatosis* * *Septo-Optic dysplasia* * *False (Gonadotropin independent)* * *Peripheral causes* * ***Innocent Discordant Puberty*** * *Premature Thelarche (breast development)* * *Temporary activation of FSH-Oestridiol axis* * *Self limiting and innocent* * *Girls aged 6/12-3 years* * *Never more than stage 3* * *No other signs puberty* * *Normal growth and bone age* * *Pre-pubertal Gonadotrophin levels* * *Premature Adrenarche* * *Normal increase in adrenal androgen release in mid-childhood (6-8 yrs) with maturation zona reticularis* * *Can produce early pubic hair and small growth spurt* * *Care if pubic hair and/or growth continue or if \<6yrs* * *Gy naecomastia* * *Normal Puberty* * *Obesity* * *Testicular/Germ cell tumours, Kleinfelters)* * ***Pathological Discordant early puberty*** * **(False/Gonadotropin independent precious*** * **puberty)*** * *Androgen Excess* * *Congenital adrenal hyperplasia* * *Cushings disease* * *Adrenal neoplasm* * *Breast Development Only* * *Ovarian Hyperstimulation* * *Testicular/Germ cell tumours* * *Testosterone excess* * *Tumours* * *Testotoxicosis* * ***Delayed Puberty- Causes*** * *Constitutional delay in growth and puberty* * *Hypothalamic/Pituitary Disorders (Hypogonadotrophic* * hypogonadism)* * *Idiopathic* * *Isolated gonadotropin deficiency (Kallmans)* * *Pituitary hormone def- post radiation, chemo, surgery, tumour* * *Chronic ill health/ Anorexia* * *Syndromes – Noonans, Prada-Willi* * *Hypergonadotrophic hypogonadism* * *Gonadal dysgenesis – Turners, Kleinfelters, XY gonadal dysgenesis* * *Gonad damage – radiation, chemo, vascular accident* * ***Pathological Discordant Late Puberty*** * *Inadequate Breast Development* * *Gonadal dysgenesis* * *Poland anomaly* * *Inadequate Pubic Hair* * *Androgen Insensitivity* * *Adrenal Failure* * *No Menarche* * *Polycystic Ovary Syndrome* * *Absent Ovaries/Uterus* * *Imperforate uterus* * *Pregnancy* * *No growth Spurt* * *Hypothalamic-pituitary disorders, Skeletal dysplasia*

Answer 5

*N_ew-born screening programme_* * *Newborn screening aims to detect treatable conditions prior to their clinical presentations and allow early treatment to improve outcome* * *It is offered to ALL new-born babies on day 5-7 of life with drops of blood from a heelprick collected onto filter paper* * *Conditions tested:* * *Cystic fibrosis* * *Congenital hypothyroidism* * *It is important in screening as:* * *It is common* * *Preventable cause of severe learning difficulties* * *Haemoglobinopathies* * *6 inborn errors of metabolism*

Answer 6

*_Plotting growth charts_* * ![]()*The growth failure can be identified from the child’s height falling across the centile lines plotted on a height velocity chart. This allows growth failure to be identified whilst the child’s height is still above the 2nd centile* * *Two accurate measurements preferable 1 year apart allow the calculation of height velocity in cm/year* * *This is plotted at the midpoint in time on a height velocity chart* * *Disadvantage of these calculations is that they are highly dependent on the accuracy of the height measurements and so tend not to be used outside specialist growth clinics* *_Explanation_* * *Is defined as a height below the second centile (i.e. 2SDs below the mean)* * *Most will be normal, as they just have short parents* * *However, the further the child is below the centiles the more likely it is a pathological cause* * *Following growth centile lines for length/height, weight and head circumference* * *Consider familial, low birth weight, constitutional delay of growth and puberty, syndromes and skeletal dysplasia’s* * *Faltering growth with crossing of centile lines?* * *Consider endocrine (including therapeutic corticosteroids), nutrition/chronic illness, psychological deprivation* * *There may be problems from being teased or bullied at school, low self-esteem, often considered disadvantaged in most competitive sport. Often adults assume they are younger than their true age* *_Assessment of growth_* * *Two accurate measurements preferable 1 year apart allow the calculation of height velocity in cm/year* * *This is plotted at the midpoint in time on a height velocity chart* * *Disadvantage of these calculations is that they are highly dependent on the accuracy of the height measurements and so tend not to be used outside specialist growth clinics* *_Causes_* * *Familial* * ![]()*Following growth centile within predicted range for parental height* * *Severe intrauterine growth restriction or prematurity* * *Short from birth (but normal mid-parental height)* * *Constitutional delay in growth and puberty* * *Short stature accentuated by delayed puberty, delayed bone age* * *Can get GH treatment by 4 years old* * *Chromosomal disorder/syndromes (have dysmorphic features)* * *Turner* * *Noonan* * *Down* * *Russel-Silver* * *Nutritional/long-term illness (common cause)* * *Gastrointestinal (coeliac, Crohn’s disease), chronic kidney disease, cystic fibrosis, congenital heart disease* * *Falling off height centiles. Weight centile \< height centile. Delayed bone age* * *Psychosocial deprivation* * *Emotional deprivation/neglect* * *Endocrine (falling off height centiles. Weight centile \> height centile. Ie short and overweight. Marked delayed bone age)* * *Hypothyroidism (usually growth failure and excess weight gain)* * *Growth hormone deficiency* * *Corticosteroid excess, Cushing syndrome, iatrogenic* * *IGF-1 deficiency* * *Extreme short stature (rare)* * *Disproportion* * *Skeletal dysplasia – legs \> back* * *Storage disorders – back \> legs*

Answer 7

* *Most common cause of thrombocytopenia in children.* * Immune destruction of platelets by autoantibodies* * Presentation* * *Usually presents in children aged 2-10* * *Often 1-2 weeks after viral infection* * *Petechiae, purpura, superficial bruising* * *Epistaxis* * *Uncommon to get profuse bleeding* * Diagnosis of exclusion – rule out more sinister causes* * Acute leukaemia, Aplastic Anaemia* * *Organomegaly* * *Lymphadenopathy* * *Anaemia or neutropenia* *Investigations* * *Full Blood Count – low platelets* * *Blood Film* * *(Bone Marrow Biopsy)* *Treatment* * *Observation. Self-resolves in 6-8 weeks.* * *May need steroids or IV Ig*

Answer 8

*_Presentation:_* * *Non-Blanching rash (100%)* * *Buttocks* * *Extensor surfaces of legs/arms* * *Painful, swollen joints (60-80%)* * *Abdominal pain (80%)* * *Haematuria (20-60%)*

Answer 9

*Eczema can either be atopic (where there is evidence of IgE antibodies to common allergens) or non-atopic* * *Atopic eczema* * *Classified as an allergic disease as many affected children have family history of allergy, at least 50% develop allergic diseases and IgE antibodies to common allergens.* * *Filaggrin gene mutations have been identified as the key genetic risk factor for eczema development due to impairment of skin barrier function, which then leads to cutaneous sensitisation to inhalant and food allergens* * *Meaning that this gene mutation predisposes to food allergy, asthma and hay fever as well as asthma* * *Screening by skin prick or IgE blood testing should be considered* *_Clinical features_* * *Rashes may itch (pruritus) -\> main symptom at all ages and this results in scratching and exacerbation of the rash* * *Excoriated areas become erythematous, weeping and crusted* * *Distribution of the eruption tends to change with age* * *Infants* * ![]()*Face and scalp predominately affected* * *Older children* * *Skin flexures (cubital and popliteal fossae)* * *Frictional areas (e.g. neck, wrists and ankles)* *_Management_* * *Avoiding irritants and precipitants* * *Avoid soap and biological detergents* * *Clothing next to skin should be pure cotton (AVOID nylon and pure woollen garments)* * *Nails cut short to REDUCE scratching* * *Allergens avoided* * *Emollients* * *Moistening and softening the skin* * *Applied literately 2 or more times a day and after a bath* * *Ointments preferable to creams when skin is very dry* * *Topical corticosteroids* * *Used with care* * *Applied to areas 1 or 2 times a day (kept to a minimum)* * *Applied thinly and on face AVOIDED* * *Excessive use can cause thinning of skin as well as systemic side effects* * *Immunomodulators* * *Tacrolimus ointment* * *Occlusive bandages* * *Helpful over limbs when scratching is a problem* * *Worn overnight and can be used in the day* * *Antibiotics, antiviral agents and antihistamines* * *Antibiotics with hydrocortisone can be applied topically* * *Systemic antibiotics used when more widespread bacterial infection* * *Itch suppression with oral antihistamines* * *Dietary elimination* * *Most common food allergens are egg and cow’s milk* * *Dietary elimination should be carried out with a dietician advice* * *Psychosocial support* * *Parents and child need advice, help and support from other health professionals.* * *Eczema society provides support and education about the disorder*

Answer 10

*_Capillary blood sampling_* * *Is used when small volumes of blood are necessary for analysis e.g. FBC, blood gas and blood glucose.* * *Usually a procedure best suited to neonatal feet but can be used in older children e.g. fingers if venepuncture not possible* * *Plantar heal surface outside the medial and lateral limits of the calcaneus bone in the young infant* * *Finger or toe of older child* * *Procedure:* 1. *Warm the site to encourage vasodilation and good perfusion* 2. *Hold foot dorsiflexed* 3. *Clean with alcohol swab* 4. *Gently massage the area and occlude blood supply using tourniquet* 5. *Apply a tiny amount of soft white paraffin -\> encourages drop formation* 6. *Puncture skin and collect drops of blood in sample containers* 7. *Avoid excess squeezing as falsely cause high K+ levels and haematocrit and bruising* 8. *Stop excess bleeding with gauze* ![]() *_Interpretation_* *_Heal prick test_* * Newborn heal prick screening involves taking a blood sample to find out if your baby has 1 of 9 rare but serious health conditions. * Most babies won't have any of these conditions but, for the few who do, the benefits of screening are enormous. * Early treatment can improve their health, and prevent severe disability or even death. * When your baby is 5 days old, a healthcare professional will prick their heel and collect 4 drops of blood on a special card. * You can ease any distress for your baby by cuddling and feeding them, and making sure they're warm and comfortable. * Occasionally, the sample may need to be taken when your baby is 6, 7 or 8 days old. * Conditions it tests for: 1. Sickle cell disease 2. Cystic fibrosis -\> measure immunoreactive trypsinogen 3. Congenital hypothyroidism -\> measure TSH * Can lead to impaired growth and mental development 4. Phenylketonuria * Body is unable to break down a substance called phenylalanine -\> builds up in brain and blood 5. Medium-chain acyl-Co-A dehydrogenase deficiency * Fat cannot be broken down as usual 6. Homocystinuria (HCU) 7. Maple syrup urine disease (MSUD) 8. Glutaric aciduria type 1 (GA1) 9. Isovaleric acidaemia (IVA) ***_Principles of Newborn bloodspot screening_*** The principles of screening include the following: * Each condition is a serious disorder. * The condition occurs with sufficient frequency for screening to be cost-effective. * A cheap reliable screening test is available. * Early treatment/intervention is beneficial * Consequences of non-treatment may be severe.

Answer 11

*_Principles_* * *To obtain cerebrospinal fluid (CSF)sample for laboratory analysis of for therapeutic CSF drainage in communicating hydrocephalus* * *L3-L4 intervertebral space* * *Contraindications:* 1. *Thrombocytopaenia* 2. *Coagulation defect* 3. *Raised intracranial pressure* 4. *Significant cardiorespiratory compromise (as position may risk in cardiorespiratory arrest* 5. *Local skin infection* * *Procedure:* 1. *Place child on their side with back along a firm surface* 2. *Someone experienced hold child* 3. *Locate L4 spinous process* 4. *Using a strict antiseptic technique clean area* 1. *Inject local anaesthetic if \>6months* 5. *Slowly advance needle until the “give” as the dura is penetrated* 6. *Remove stylet and wait for CSF to drain* 1. *If not fluid coming out advance slowly and withdraw stylet slowly till CSF fluid drains* 7. *Allow 3-5 drops of CSF to drain into each bottle* 8. *To measure CSF pressure attach 3 way-tap before collecting samples and direct fluid into manometer.* 9. *If CSF drainage -\> drain as much CSF as required* 10. *Remove needle and apply sterile gauze swab with pressure* 11. *Cover site with adhesive plaster or aerosol dressing* *_Interpretation_* * *CSF composition: (normal values)* 1. *Lymphocytes \<5/mm^3* 2. *No polymorphs* 3. *Protein \<0.4g/L* 4. *Glucose \>2.2mmol/L* 5. *Pressure \<200mm* * *Subarachnoid haemorrhage* 1. *Xanthochromia (yellow supernatant on spun CSF)* * *Raised protein: Meningitis, MS, Guillain-Barre syndrome* * *Very raised CSF protein: Spinal block OR severe bacterial meningitis* * *CSF in meningitis:* 1. *Bacterial* * *Often turbid* * *Polymorphs* * *Cell count 90-1000 or more* * *\<1/2 plasma glucose* * *Protein \>1.5* * *Bacteria in smear & culture* 2. *Tuberculous* * *Appearance: often fibrin web* * *Mononuclear cells* * *Cell count 10-1000* * *\<1/2 plasma glucose* * *1-5g/L protein* * *Bacteria often NONE on smear* 3. *Viral* * *Appearance: usually clear* * *Mononuclear cells* * *Cell count 50-1000* * *\>1/2 plasma glucose* * *\<1g/L protein* * *Bacteria often NONE seen or culture*

Answer 12

Urine Microscoppy Urine Culture and sensitivity test

Paediatrics (Core Conditions) Flashcards

(43 cards)