Paediatrics (Quesmed) Flashcards
What is the APGAR score used to assess and what is it?
It assesses the state of a newborn baby at 1, 5 and 10 minutes
Appearance- (Colour of Child)
- 2- pink
- 1- blue peripherally and pink centrally
- 0- blue all over
Pulse
- 2>100bpm
- 1<100bpm
- 0- non detectable
Grimace- response to stimulation
- 2- crying on stimulation scores
- 1- grimace
- 0- no response
Activity
- 2 flexed limbs that resist extension
- 1 some flexion
- 0 floppy baby
Respiration
- 2 for strong cry
- 1 for weak cry
- 0 for respiratory effort
What should be done if the baby’s APGAR Score is 3 or low?
Resuscitation- 5 breaths via 250ml bag-valve mask
If there is visible meconium on inspection of the mouth, then Suction is not needed- otherwise SUCTION
Urgent Stimulation and Reassessment if APGAR 5
Which virus causes Acute Epiglottitis?
Haemophilus Influenzae B
What are the signs of Acute Epiglottitis? (7)
How does the child look like in general
What is a late stage sign?
1-6 year old children
(Fever, Painful throat for swallowing and breathing, muffled voice)
High fevers
Toxic looking child (Drooling, Struggling to Breath and sometimes even a barking cough that would make it seem like Croup but the toxic appearance makes Acute Epiglottitis more likely)
Painful sore throat that prevents child from speaking or swallowing
Cough is either MINIMAL or ABSENT- so only really sore throat- Usually NOT PRODUCTIVE even when it happens
Child sits immobile- upright with open mouth
Soft Inspiratory Stridor (late sign) and rapidly increasing respiratory difficulty over hours
How is Acute Epiglottitis managed?
Emergency
Senior ENT, Anaesthetic and Paediatric Support is needed asap
- Do NOT examine the child outside of senior support
- Securing the airway is FIRST LINE (Endotracheal Intubation may be necessary
- After the airway is secure, take Cultures and Examine the Throat
- Treat with IV Antibiotics (Cefuroxime)
What are the differences between Acute and Chronic Leukaemia?
Acute- due to impaired cell differentiation- leads to a large number of Malignant Precursor Cells in the bone marrow
Chronic- excessive proliferation of Mature Malignant Cells but cell differentiation itself is Unaffected
What is the difference between Myeloid and Lymphocytic Leukaemia?
Myeloid- Myeloid Precursor Cells- like Neutrophils
Lymphocytic- Lymphocytes like B Cells
What are the signs, diagnosis and management of Acute Myeloid Leukaemia?
Acute Myeloid- Marrow (Blood Stuff) and Infiltration (Big Stuff)
PLUS GUM
AML- AUER
Most common Acute Leukaemia in Adults
Associated with Myelodysplastic Syndromes
Signs
- Bone Marrow Failure (Anaemia, Bleeding, Bruising Infections)
- Infiltration (Hepatomegaly, Splenomegaly and Gum Hypertrophy)
Diagnosis-
- Leucocytosis usually (although can also be high or low), therefore diagnosis is better through Bone Marrow Biopsy
- AUER RODS on Biopsy
Management- Chemotherapy or Bone Marrow Transplants
Prognosis- Death occurs within 2 months without treatment, only 20% 3 year survival rate even with treatment
What are the signs, diagnosis and management of Acute Lymphocytic Leukaemia?
ALL has them ALL (i.e. Loads of Symptoms)
Acute Lymphocytic-
- Marrow (Blood Stuff)
- Infiltration (Big Stuff (minus Gum)- and NOW the BONES are hurting as well cos ALL is ALL out))
- A NERVOUS TESTICLE
- Painless LYMPHADENOPATHY
- PLUS Fever
ALL- BLAST
Most common cancer in Children- abnormal proliferation of Lymphoid Progenitor Cells
- Higher risk with Down Syndrome
Signs
- Marrow Failure (Anaemia- so Fatigue, Bleeding and Bruising because of Low Platelets, Infections due to Low WBC)
- Bone Pain (due to Organ Infiltration)
- Painless Lymphadenopathy
- Hepatosplenomegaly
- CNS Involvement (Cranial Nerve Palsies and Meningism)
- Testicular Infiltration (Painless Unilateral Testicular Enlargement)
- and FEVER
Diagnosis-
- Leucocytosis
- BLAST CELLS on Blood Film and Bone Marrow Analysis
Management-
- Chemotherapy Regimens
Prognosis- CURE RATE of 70-90% in Children
What are the signs, diagnosis and management of Chronic Myeloid Leukaemia?
Chronic Myeloid-
- Marrow (Blood Stuff)
- Infiltation (Big Stuff)
- plus B SYMPTOMS (Weight Loss, Fever, Night Sweats)
- Also GOUT (CML is HENRY VIII)
CML- -PHIL
Middle-Aged Patients
Involves the PHILADELPHIA CHROMOSOME
Signs-
- COMMON SIGNS- Massive Splenomegaly, Bleeding (due to Thrombocytopaenia) and GOUT
- WEIGHT LOSS
- Fatigue
- FEVER
- Sweating
- GOUT AS WELL
Diagnosis-
- Leucocytosis (raised myeloid cells- all the -phils and monocytes)
Management- Chemotherapy
Prognosis- Median Survival is 5-6 years
What are the signs, diagnosis and management of Chronic Lymphocytic Leukaemia?
- NOTHING
- Marrow (Blood Stuff) is rare
- Infiltration (Big Stuff)
- B Symptoms (seen in all Chronic Ones)
- Painless Lymphadenopathy- seen in Lymphocytic Leukaemias)
CLL- SMUDGE
Most Common in Male Patients over 60 years old- Proliferation of Functionally Incompetent Malignant B Cells
Signs-
- TYPICALLY ASYMPTOMATIC (unlike ALL)
- Painless Lymphadenopathy (seen in both Lymphocytic Leukaemias)
- HEPATOSPLENOMEGALY
- B Symptoms (Weight Loss, Night Sweats, Fevers)
- LESS COMMON- Marrow Failure (Anaemia, Bleeding/ Bruising, Infections)- assume Acute if these show up
Diagnosis-
- Lymphocytosis
- Blood test- SMUDGE CELLS- cells damaged as they lack Cytoskeletal Protein
Management- Chemotherapy
Prognosis- 1/3 of cases don’t progress, 1/3 progress slowly, 1/3 actively progress
What are the 3 signs of Severe Asthma Exacerbation and 7 signs of Life-threatening Asthma Exacerbation in children?
Resp, Heart, PEF
CHESS PW
Severe
- Respiratory Distress (use of Accessory Muscles, Breathlessness- so inability to complete sentences, Resp Rate>40/min (1-5yo)/ >30/min (>5yo)
- Heart Rate >140bpm (1-5 yo)/ >125bpm (>5yo)
- PEF that is 33-50% of predicted
Life-threatening
- Confusion
- Hypotension
- Exhaustion
- Silent Chest on Auscultation
- Saturations of O2<92%
- PEF<33% of Predicted
- Weak or No Respiratory Effort
What is the management of an Asthma Attack in Children?
What is needed to discharge?
When should they be admitted into hospital?
- Oxygen and Steroids (Oral Prednisolone daily for 5 days)
- !! Give NEBULISED SABA with O2 if there are life threatening features
///////// - Inhaled (if not life-threatening or worse) Salbutamol
- Nebulised (if Life-threatening) Salbutamol
- Add Nebulised Ipratropium Bromide (if Severe/ Life threatening)
//////// - If O2 saturations remain below 92%, then add Magnesium Sulphate
- If Severe or Life Threatening Asthma, add Aminophylline
Contact Senior if they are not responding to Salbutamol or Ipratropium
To DISCHARGE-
- Stable on their discharge medication for 24 hours
- Inhaler Technique is fine
- PEF>75%
Admit if-
- Life threatening Asthma Attack
- Severe Asthma Attack where they did not recover following initial treatment
- Pregnant/ Past History of Near-Fatal Asthma (ALWAYS Admit them despite whether they recover or not)
What are the signs of Otitis Media in general in Children?
What 2 things are seen in Otitis Media that is unusual?
what kind of disease does it usually follow?
Pain (Ear) and Discharge (NOT seen in OTITIS EXTERNA)
FEVER
Irritability
ANOREXIA AND VOMITING
(usually presents following a Viral Upper Resp Tract Infection)
What are the 4 types of Otitis Media and what are their signs?
Acute Otitis Media (Ear is like a Bag full of Infection)
- Deep seated pain
- HEARING LOSS
- Fever
- Rapid Onset with feeling of Aural Fullness followed by Discharge when the Tympanic Membrane Perforates with Relief of Pain
- Tympanic Membrane shows injection of Blood Vessels and then Diffuse Erythema
- In Children it is usually following a BACTERIAL INFECTION
Benign Chronic Otitis Media- (The Dry Hole)
-Dry Tympanic Membrane Perforation without signs of Chronic Infection
Chronic Secretory Otitis Media- (Glue Ear) (The ONLY one you need to call ENT Surgeons for if it is RECURRENT so that grommets can be inserted)
- Hearing loss MAINLY but also may be Persistent Pain- lasting a Couple Weeks
- Drum looks abnormal- REDUCED MOBILITY of the MEMBRANE (Retracted Tympanic Membrane)
Chronic Suppurative Otitis Media- (Pus-filled Hole)- Otorrhoea for > 6 weeks
- Persistent Purulent drainage through Perforated Tympanic Membrane
- History of Recurrent Ear Infections and Intermittent Ear Pain
- Antibiotics and Surgical Intervention to treat
What is the management of Otitis Media?
What 2 medications are given if antibiotics are not needed?
Tympanic Membrane Examination
If under 3 months- Admit them if temperature is 38C or more or if they have any Complications of Otisis Media and maybe if they are Systemically Unwell
Otherwise, treat their pain and fever with Paracetamol or Ibuprofen
Most children do NOT require Antibiotics- DELAYED Antibiotic strategy can work as well- ask them to take antibiotics if symptoms don’t go away after 4 DAYS
Give Antibiotics if:
- Systemically Unwell (but don’t need admission)
- At risk of Complications (immunocompromised)
- Perforated Tympanic Membrane
- Under 3 months old
- Under 2 years old with BILATERAL Infection
- Symptoms persist for 4 or more days
What are the 7 Complications of Otitis Media?
F(7)ML P(6)M BS
What is Petrositis lead to?
Facial Nerve Palsy- Nerve 7 LMN Disease- relieved y treatment of Otitis Media
Mastoiditis- Post Auricular Swelling- pushing Auricle Out and Forward
Labyrinthitis- Inflammation of Semicircular Canals- Vertigo, Imbalance and Nausea and Vomiting
Petrositis- Otorrhoea, Pain deep in Ear and Eye, Ipsilateral Nerve 6 Palsy- leads to GRADENIGO SYNDROME
Meningitis- Sepsis, Photophobia, Phonophobia, Headache, Vomiting
Brain Abscess- Sepsis and Cranial Nerve Signs
Sigmoid Sinus Thrombosis- Sepsis, Swinging Fever and Meningitis (so Meningitis with a Swinging Fever)
What is Acyanotic Heart Disease and what are the 3 types?
Congenital Heart Defects that do NOT cause Cyanosis- they can be caused by Foetal Alcohol Syndrome
- Ventricular Septal Defect
- Coarctation of Aorta
- Patent Ductus Arteriosus
What are the 3 ways Acyanotic Heart Disease is detected and what is the investigation to diagnose it?
- Antenatal Imaging
- Auscultation of Murmur
- Presenting in Heart Failure
Usually Diagnosed by
- Echocardiography
What is the management of Acyanotic Heart Disease?
What is the main condition that should be managed in Acyanotic Diseases?
Depends on the clinical status of the patient and the specific defect
General management-
- Managing Heart Failure if present
- Surveillance of Defect if the patient is well and not Decompensating
- Surgical Correction of the Defect is needed
Most small septal defects close spontaneously whereas the large ones require an intervention
- A Patent Ductus Arteriosus may respond to NSAID treatment, otherwise requires Surgical Intervention
- Coarctation of Aorta can be corrected with Angioplastic Interventions
What are the 6 causes of Anaemia due to Reduced RBC Production and 5 causes of Anaemia due to Increased Erythrocyte Destruction?
Reduced RBC Production
- Folic Acid Deficiency
- Iron Deficiency
- B12 Deficiency
- Red Cell Aplasia (Parvovirus B19 Infection)
- Chronic Renal Failure
- Chronic Inflammation
Increased Erythrocyte Destruction
- Sickle Cell Disease
- Thalassaemia
- Glucose 6 Phosphate Dehydrogenase Deficiency
- Hereditary Spherocytosis
- Haemolytic Disease of the Newborn
What are 4 facts about Iron Deficiency Anaemia in Babies?
It is a common cause of Anaemia in Infants and Children
Can be Caused by Reduced Iron Intake, Poor Iron Absorption and/or Chronic Blood Loss (Menstruation)
Excessive Ingestion of Cow’s Milk can cause Iron Deficiency in Infants as it is Low on Iron and it Reduces Iron Absorption
Children and Infants with Iron Deficiency may present with Pica (Urge to eat non-food things like Soil) to compensate for the missing mineral
What are the signs of Anaphylactic Shock?
ABCGS
Airway- swollen lips/ tongue, sneezing
Breathing- Wheezing, Shortness of Breath
Cardia- Tachycardia/ Hypotension/ Shock, Angioedema
Gastrointestinal- Abdominal Pain, Diarrhoea, Vomiting
Skin- Urticaria, Pruritus, Flushed Skin
How is Anaphylactic Shock managed?
Adrenaline
4
4
4
Adrenaline (1:1,000, IM)- 300mcg for 6-12 year olds
General Management (4)
- Remove Trigger
- Call for help early
- Lie patient down flat and raise their legs
- Administer Adrenaline
When Skills and Equipment are available (4)
- Manage Airways and Administer High-flow Oxygen
- IV Fluids if Shocked
- Administer Hydrocortisone (this is Not Urgent)
- Attach Patient to Monitoring
Patients should be monitored for 6-12 hours in case of a rebound episode
Newly Diagnosed patients and their carers should have the following before they are discharged (4):
- Counselling on Adrenaline Auto-Injectors
- Supply of 1 Auto-Injectors
- Written Advice
- Referral to Local Allergy Services for a Follow Up
What are the symptoms of Asthma in children?
Cough, Breathlessness, Wheeze and Chest Tightness
Widespread Wheeze heard on Auscultation of the Chest during an Acute Episode
4 Investigations
- Serial Peak Flow Readings when both symptomatic and asymptomatic- as airflow obstruction is reversible
- Those with high probability of Asthma can be started on SABA
- Spirometry should be performed where possible
- If Unclear, FeNO tests may be needed
What is the stepside management of Asthma in Children?
What should be offered to patients on ICS?
Spacer preferred in children
1) Inhaled SABA PRN and CONSIDER monitored Inhalation of Very Low to Low dosed Inhaled ICS
2) Add Very Low dosed ICS (or LTRA if <5 years old)
3) Very Low dose ICS AND (<5 years old= add LTRA, >5 years old= add LTRA or LABA) (so both this time)
—-Add-on therapies-
- No response to LABA- stop LABA and increase ICS to Low Dose
- If some benefit from LABA but not enough, increase ICS to Low Dose
- If benefit from LABA and Low Dose ICS but inadequate, Consider Trial of LTRA
High-dose Therapies-
- Increase ICS to Medium Dose
- Addition of Theophylline (or other 4th Drug)
- Refer to specialist care
If the above is still not enough, use Daily Steroid Tablet and maintain Medium-dose ICS. Consider Other treatments to minimise steroid use
OFFER INFLUENZA VACCINATION TO PATIENTS ON ICS as they are IMMUNOCOMPROMISED
What are the signs of Atrial-Septal Defect?
remember SSS
May be Asymptomatic
Ejection-Systolic Murmur on Auscultation and Fixed Split Second Heart Sound
Loudest on Left-Sternal Edge and is a Flow Murmur through the Pulmonary Valve
May present with Heart Failure
How is Atrial-Septal Defect Managed and Diagnosed?
What are its 2 complications?
Diagnosed via Echocardiogram
Management depends on the severity of the lesion. Most are managed Conservatively but some may require Surgery. they are kept under Surveillance through routine Echocardiograms
2 Complications-
- Heart Failure- Occurs in Patient’s 20s or 30s
- Paradoxical Embolism
How is ADHD managed in Children?
Conservative- Behavioural Techniques and Extra Support at School
Medical- Stimulant medication like Methylphenidate increases activity of Frontal Lobe. If Methylphenidate does not help, then switch to Atomexitine
MAIN SIDE EFFECT of Methylphenidate= Growth Suppression due to Appetite Suppression
How does Autism Spectrum Disorder present in children?
What 2 conditions are associated with ASD?
In its most severe form:
- Children with Autism are not able to understand that other people have thoughts and feelings and prefer to play alone and avoid eye contact
- Children with Autism have SPEECH AND LANGUAGE DELAY, Monotonous Tones of Voice with Limited Expression and problems using Pronouns. They also interpret speech literally and have problems with the use of Idioms
- In terms of behaviour, they have Narrow Interests, Ritualistic Behaviours that rely on heavy routine and Stereotyped Movements (Rocking, Flapping Hand Movements))
ASDs are associated with Learning Difficulties
!!! About 25% of children with ASD may also have Seizures
!!! Down Syndrome is commonly associated with ASD
What is the management of Autism Spectrum Disorders?
MDT management needed with extra support to the family
Applied Behavioural Analysis can help- encouraging positive behaviours and discouraging negative behaviours
<10% of children with ASD can live independently as adults
What is Bacterial Tracheitis and how is it managed?
What causes it?
It is a rare condition that presents similar to a VIRAL CROUP but the child would have a HIGH FEVER and RAPIDLY PROGRESSIVE AIRWAY OBSTRUCTION with COPIOUS THICK AIRWAY SECRETIONS
It is most commonly caused by Staphylococcus Aureus, typically following an Upper Respiratory Tract Infection
It is managed via IV Antibiotics in Severe Cases and May require Intubation
If Croup with Fever (>38.5C) and does not resolve following medication, THINK BACTERIAL TRACHEITIS
What is Biliary Atresia and how does it present and how is it diagnosed?
What type of Jaundice is present?
How big is the liver?
Also rule out ALPHA 1 AT DEFICIENCY
What is the main complication?
The bile ducts of an infant are fibrosed and destroyed which leads to hyperbilirubinaemia, liver failure with HEPATOMEGALY and death
It presents as prolonged obstructive conjugated jaundice (>14 days) and biliary obstruction- dark urine and white stool
Diagnosis-
- Raised CONJUGATED bilirubin and DERANGED LFTs
- Hepatic Scintigraphy highlights the liver but has poor excretion into the bowel as the bile ducts connecting the liver to the bowel have been destroyed
- Abdominal ultrasound reveals Echogenic Fibrosis
- Definitive diagnosis is confirmed with Cholangiography which fails to show normal architecture of the biliary tree
Complications
- Liver Disease and Hepatocellular Carcinoma
How is Biliary Atresia managed?
Surgery- Hepatoportoenterostomy (Kasai Procesure)
How do Brain Tumours present in children? (3)
Persistent headaches that are worse in the morning
Signs of raised ICP
Seizure in an older child with NO past history of seizure and NO fever
What are the 5 types of brain tumors in children?
Astrocytoma (most common)
- Pilocystic astrocytoma (doesnt cross midline)
- Glioblastoma multiforme (crosses midline- more aggressive)
Medullablastoma (second most common- highly aggressive)
Meningioma (tumours of arachnoid cells in meninges)
Craniopharyngioma (pituitary- can lead to homonymous hemianopia)
Ependymomas (tumours of the cells of the ventricular system- lateral etc.)
What is the diagnosis and management of Brain Tumors in Chidlren?
Diagnosis- MRI or CT
Management- Depends on tumor size and staging- Chemotherapy, Radiotherapy and Surgery
What is a Branchial Cyst and how is it managed?
Embryological remnant from development of branchial arches- painful cyst in front of sternocleidomastoid
(Posterior to sternocleidomastoid and hyperechoic= Lymphatic Malformation)
(Moves on swallowing= Thyroglossal Cyst)
Management- Conservatively or Surgery
What are the 3 advantages of breastfeeding for mothers and children?
Mothers-
- Reduction in risk of diabetes
- Reduction in risk of breast cancer
- Reduction in risk of ovarian cancer
Children-
- Protection against infection
- Protection against eczema
- Protection against Sudden Infant Death Syndrome
What is Breast Milk low in so supplementation is needed?
Vitamin D
Risk of Hepatitis B and HIV to be transferred to baby through breastfeeding?
HIV mothers should REFRAIN from breastfeeding
Hepatitis B mothers do not need to refrain, provided the child is immunised
What are the issues with breastfeeding?
Sore Nipples
Blocked Ducts
Mastitis/ Abscess- may need ORAL ANTIBIOTICS and DRAINAGE
Thrush and Breastfeeding/ DUCTAL CANDIDIASIS
Insufficient Milk
When is breastfeeding contraindicated??
3 infections
2 others
1 thing that is safe that you should remember is safe
Mother taking amiodarone
Neonatal Galactosaemia
Mother has HIV
Mother has active HSV
Mother has TB infection
(IBUPROFEN is SAFE)
What are Reflex Anoxic Seizures?
Benign causes of SEIZURES in children due to Temporary Lack of Blood Flow. This is because of the VAGUS NERVE BEING OVERACTIVE
Precipitant- sudden pain or vomiting
Child recovers quickly once oxygen is given so management is just REASSURANCE
What are Breath Holding Attacks?
Young children cry so much, they hold their breath and faint- may turn blue and jerk limbs
Management- Just reassurance, they’ll be fine
What is Bronchiolitis?
Chest infection- winter epidemic at 1-12 month olds
Caused by Respiratory Syncytial Virus
What are the signs of Bronchiolitis?
Is the cough productive?
What 2 red flags warrant O2 asap?
What are the crackles and breathing like?
1-12 month olds
Cough, Laboured Breathing, Wheeze, Tachypnoea, Nasal Flaring, FEVER (High-grade in Pneumonia)
(Breathing Hard and Fast- so hard you’re using Big Nostrils)
NASAL FLARING or RR>70 is a RED FLAG- may need O2
NON PRODUCTIVE COUGH (productive in Pneumonia)
May also be FINE CRACKLES (Focal in Pneumonia)
What is the management of Bronchiolitis?
What 2 things make patients at risk of Bronchiolitis?
ORaS
Pavilizumab Prophylaxis if at risk- CONGENITAL HEART DEFECTS/ CYSTIC FIBROSIS
Oxygen Therapy
RIBAVIRIN
Supportive Care
What metabolic condition is Bronchiolitis associated with?
Hyponatraemia
What is the rare complication of Bronchiolitis?
Which pathogen causes it?
- Bronchiolitis Obliterans
Narrowing of airways due to Chronic Inflammation which causes Scar Tissue
Caused by ADENOVIRUS, not RSV, OR transplants
How is Bronchiolitis Obliterans diagnosed and managed?
CXRs may often appear normal
so CT/ Lung Biopsy needed
- FEV1 is decreased (16-21%)
Management-
- No cure
- Immunosuppressants like Cyclosporin, Mycophenolate Mofetil, Tacrolimus and Prednisone can treat it POST-TRANSPLANT
What is Caput Succedaneum?
Cephalohaematoma is the main differential if it doe NOT cross the suture line
Pressure of top of Infant’s skull against the Dilating Cervix during Labour
Presents as Subcutaneous Serosanguineous Fluid Collection superficial to cranium but below the skin. It CROSSES SUTURE LINES (like a blister when your foot has been rubbing against the show lol)
Management- resolves on its own
Which antibiotics are not safe in Breastfeeding?
Ciprofloxacin (causes Joint Problems)
Nitrofurantoin (G6PD Deficiency)
Teicoplanin
Clindamycin (antibiotic associated colitis)
Co-trimoxazole
Most antibiotics cause loose motions in the baby or tummy aches- they don’t need treatment
What antibiotics are not safe in Pregnancy?
Ciprofloxacin (Joint Problems)
Nitrofurantoin (G6PD Deficiency)
Teicoplanin
Clindamycin (Antibiotic-associated Colitis)
Co-trimoxazole
Most antibiotics cause loose motion or tummy aches in the baby- they don’t need treatment for this
What analgesia are not safe in Pregnancy?
Aspirin (causes Reye’s Syndrome)
Codeine
Dihydrocodeine is the preferred Opiate Analgesic for stronger painkillers but observe baby for drowsiness
How long should breastfeeding be done for?
1st hour to 6 months of life- no other foods
What is Cerebral Palsy?
Permanent movement issues due to CNS damage
It does NOT get worse though (non-progressive)
What are the causes of Cerebral Palsy?
2,5
Before Birth-
- Hypoxic Ischaemic Encephalopathy (suspect if PROLONGED DELIVERY)
- Infection
After Birth-
- Meningitis
- Haemorrhage
- Trauma
- Medication Toxicity
- Kernicterus (high amount of bilirubin enters baby’s brain) (wouldn’t be due to breastmilk jaundice though)
Idiopathic
What are the classifications of Cerebral Palsy?
Spastic (90% of patients with CP have spastic features)-
- damage to PYRAMIDAL PATHWAYS
- Increased TONE and REFLEXES, Clasp Knife, Flexed hip and elbow
- may be MONOPLEGIC, DIPLEGIC, HEMIPLEGIC
- Scissor Walking- due to Periventricular Lesion
Dyskinetic/ Athetoid (this is usually due to KERNICTERUS)-
- Damage to Basal Ganglia
- Choreiform Movements (involuntary movements)
- Signs of Parkinsonism
Ataxic-
- Damage to CEREBELLAR PATHWAYS
- Uncoordinated movements (lack of balance and coordination)
- Signs of cerebellar lesions
What is the management of Cerebral Palsy?
Specialist and MDT input to deal with complications-
- Physiotherapy, Occupational therapy, Speech and Language therapy and Dietician input due to swallowing difficulties
Medical management-
- BACLOFEN for the spasms
- Botox Injections for Contractures
Surgical Management-
- Orthopaedic Surgery for MSK deformities
- General Surgery for PEG feeding tube
What is the presentation and management of Chickenpox?
What kind of spots are they? and where do they first appear and then spread to?
How do the spots transform?
due to HUMAN HERPES VIRUS 3 (Varicella)
Can take up to 3 weeks for symptoms to appear after exposure
(so remember the number THREE)
Raised, Red Itchy Spots on the face or chest that spread to the rest of the body
They then become small Fluid-filled Blisters that then Crust up
Conservative management as it is Self-Limiting
- Simple measures are to keep fingernails short and wear long clothing to avoid scratching
What are the Verbal Scores for the Children GCS?
(other sections are the same as normal, but M6 is Spontaneous Movement for under 5 year olds and Obeys Command for over 5 years old)
Over 5-
- V5= Orientated to Place or Person
- V4= Confused
- V3= Inappropriate Words
- V2= Incomprehensible Sounds
- V1= No Response
Under 5-
- V5= Alert, Babbles, Coos, or Sentences to Normal Abilities
- V4= Less than normal ability
- V3= Cries to Pain
- V2= Moans to Pain
- V1= No Response
What is Coarctation of the Aorta and How does it Present?
What condition is it associated with?
What 2 H’s are seen?
It is when the Aorta Narrows (usually location is just before DUCTUS ARTERIOSUS)
It is associated with TURNER’s Syndrome
May be asymptomatic OR
- Systolic Murmur- heard LOUDEST BETWEEN SHOULDER BLADES
- Radio-femoral and maybe Radio-radial Delay
- Hypertension
- Heart Failure
- If Coarctation is severe, the infant has Shock once the Ductus Arteriosus closes
What is the management of Coarctation of the Aorta?
- Monitored via Echocardiography and Antihypertensives to control the BP
- Angioplasty and Stent Insertion may be needed as Intervention
- If they have Shock, give them Prostaglandins to keep the Ductus Arteriosus open
What are the main complications of Coarctation of the Aorta and Atrial-Septal Defects?
Coarctation of Aorta= Cerebral Strokes due to Cerebral Aneurysms and Hypertension
Atrial-Septal Defects= Ischaemic Stroke (due to Paradoxical Embolism)
What is Coeliac Disease? (Paediatrics)
T-cell mediated autoimmune inflammation of the small bowel
The sensitivity to Prolamin results in VILLOUS ATROPHY and MALABSORPTION
What is Coeliac Disease associated with and when does it present?
And what are the possible differentials?
HLA-DQ2 gene and other autoimmune conditions T1DM
It presents at INFANCY and at 50-60 YEARS OLD
(Crohn’s presents at Adolescence)
(Cystic Fibrosis has high Trypsinogen, also look for Resp Infections and Meconium Ileus)
(Cow’s Milk Allergy= Rash over Face, Reflux, Colicky pain)
What are the symptoms of Coeliac Disease?
What is seen if it is severe?
(Spots, Bruises, Short, Butt)
Do NOT forget Anaemia and Steatorrhoea!!
Abdominal pain
Abdominal Distension
Nausea and Vomiting
Diarrhoea
Steatorrhoea (if severe)
(Imagine tummy is full on diarrhoea and vomiting and so full that its ballooning so distension)
Systemic Symptoms-
- Fatigue and Weight Loss (due to Low Absorption)
- Pallor (ANAEMIA)
- Short Stature and Wasted Buttocks (if severe) (MALNUTRITION)
- VITAMIN DEFICIENCY (like Bruising due to Vitamin K Deficiency)
Dermatological (if severe)= Dermatitis Herpetiformis (itchy lesions over bum and extensors (arms, legs, trunk))
What investigations should be ordered if Coeliac Disease is suspected?
Do the Antibodies before Biopsy
Then Bloods
A.B.B.
ANTIBIOTICS=
- Anti-TTG IgA is First Line (check their IgA level as well as they may be IgA Deficient- if so then measure Anti-TTG IgG instead)
- If this doesn’t work as well (Weakly Positive) then Anti-Endomyseal Antibody as well
NICE do not recommend HLA-DQ2 if non specialist or Anti-Gliadin
OTHER TESTS=
GOLD STANDARD- OGD and SMALL BOWEL BIOPSY= refer if Positive serological test or Negative with High Suspicion
Stool Culture- Exclude Infection
Histology shows= VILLOUS ATROPHY, CRYPT HYPERPLASIA and INTRAEPIPHELIAL LYMPHOCYTES (cos lymphocytes are breaking villi down and making the crypts bigger)
BLOODS=
= FBC- Microcytic Anaemia cos of Iron Deficiency, Normocytic Anaemia cos of Chronic Inflammation or Macrocytic Anaemia due to Folate Deficiency
= U&Es and Bone Profile (Vitamin D absorption may be affected)
= LFTs (Albumin may be low due to Malabsorption)
= Iron, B12, Folate (Anaemia stuff)
What is the management of Coeliac Disease?
Life-long Gluten Free Diet and monitor them to make sure they are following it
What are the complications of Coeliac Disease?
4
Anaemia (due to B12, Iron or Folate Deficiency)
Hyposplenism (and therefore susceptibility to organisms)- AUTOIMMUNE HYPOSPLENISM
OSTEOPOROSIS (so DEXA scan)
Enteropathy-associated T Cell Lymphoma (rare type of Non-Hodgkin’s)- because of the Intraepithelial T Lymphocytes
What is Conduct Disorder and what are the signs and management?
What is the main differential?
Physical aggression, Destructive Behaviour and Stealing in under 18’s
Prognosis is generally poor-
- 50%= Antisocial Personality Disorder
- 50%= Substance Misuse
- 40%= Become Young offenders
Oppositional Defiant Disorder= Anger and Temper, but no Aggression, No Destruction and No Stealing
What is Congenital Adrenal Hyperplasia and what are the signs?
1) Sexual Features
2) Loss of Fluid
Genetic Defect in one of the enzymes involved in the synthesis of hormones in the adrenal cortex
Signs
- Ambiguous Genitalia
- Virilisation (female has male features)
- HYPOTENSION due to DEHYDRATION and VOMITING
- Precocious (Early) Puberty (so these ambiguous changes are more evident)
What are the 2 types of Congenital Adrenal Hyperplasia?
What is lost more than it should be and what is gained more than it should be?
What is low in Salt Wasting but normal in Virilising?
What does the Hyperkalaemia lead to?
Salt Wasting CAH
- 21-hydroxylase deficiency
- Leads to Cortisol and Aldosterone deficiency
- This leads to High levels of ACTH Production- this leads to Adrenal Hyperplasia
- This leads to Androgen Steroids production- Testosterone and DHEA
- Low Aldosterone may not lead to symptoms at birth as baby has Mineralocortoid supply from placenta
- Few weeks after birth though- Large amounts of Sodium are lost and Potassium is retained. Leads to Blood Volume Loss and HYPOTENSION. the high amounts of Potassium leads to Metabolic Acidosis and Vomiting and therefore DEHYDRATION
Virilising CAH
- Residual 21-hydroxylase activity may be retained so Aldosterone levels are normal
- Exposure to high levels of Testosterone leads to female fetuses being VIRILISED- leading to Ambiguous Genitalia (same with BOTH TYPES of CAH btw)
- In males, no changes like this but can cause Early puberty
What is the management of Congenital Adrenal Hyperplasia?
Intravenous Saline (if Salt-Wasting) and give Hydrocortisone to replace low Glucocorticoids and Mineralocorticoids
Lifelong Treatment with deficient hormones (Glucocorticoids and Mineralocorticoids)
Virilised Females- need Surgery
What is Congenital Heart Block and what are the signs?
Which maternal condition is it associated with?
No coordination between Atria and Ventricles- so P waves are dissociated from QRS complexes
Causes- most commonly associated with maternal SYSTEMIC LUPUS ERYTHEMATOSUS. Linked to Maternal Anti-Ro and Anti-La antibodies
Presentation- May range from being Asymptomatic to Severe Heart Failure.
- Neonates may be Bradycardic or Circulatory Shock
MOST CHILDREN- no symptoms for first few years of life and then Syncope and Pre-Syncope
How is Congenital Heart Block managed?
Pacemaker if Symptomatic
How is Hypothyroidism managed in Paediatrics (same symptoms as adults)? And what are the TWO side effects of this? B,H,
What is the most common cause of HYPOTHYROIDISM?
LEVOTHYROXINE is FIRST LINE
Side effects- Osteoporosis and Cardiac Arrhythmias (Weak Bones and Buzzed Heart)
AUTOIMMUNE THYROIDITIS
What are the signs of Congenital Hypothyroidism?
Hypotonia (FLOPPY)
Macroglossia (Large Tongue)
UMBILICAL HERNIA
Reduced Feeding
Constipation
Remember Floppy and Umbilical Hernia
How is Constipation in children defined and what are the common causes?
Child defecates less than 3 times a week or has difficulty passing stool- may also be overflow diarrhoea
- Most common Cause is diet
- LOW FIBRE diet
- Dislike of using toilet
- Pain on passing stool
- not recognising sensation of needing to pass stool
How is Constipation in children defined and what are the causes?
Child defecates less than 3 times a week or has difficulty passing stool- may also be overflow diarrhoea
- Most common Cause is diet
- LOW FIBRE diet
- Dislike of using toilet
- Pain on passing stool
- Not recognising sensation of needing to pass stool
How is Constipation managed and diagnosed?
Diagnosis-
- History and palpation of hardened faeces on abdominal examination
Management-
- Movicol Disimpaction Regimen
- Then Maintenance Movicol, alongside a High Fibre Diet and advice about encouraging Good Toileting Habits
What is Hirchsprung’s Disease and what are the signs?
The distal colon of the baby is not innervated properly so the AGANGLIONIC colon is shrunken and not able to distend properly- this causes a back pressure of stool trapped in the proximal colon
AT BIRTH maybe–
- Delay in passing MECONIUM (>2 days and no first poop)
- Distended abdomen
- Forceful evacuation of meconium after Digital Rectal Examination
POOR RESPONSE to MOVICOL REGIMENS may occur and POOR WEIGHT GAIN
How is Hirchsprung’s diagnosed and managed?
Diagnosis- Rectal Suction Biopsy
Management- Removal of Aganglionic Colon and Healthy Bowel is pulled through
What is the difference in DRE for Constipation and Hirchsprungs?
Constipation- Hard stools
Hirchsprungs- Explosive release of liquid faecal matter
What is Croup and what are the causative organisms?
AKA Laryngotracheobronchitis
Caused by:
- Parainfluenza- MAIN cause
- ADENOVIRUS, INFLUENZA, RSV
Usually 6 months to 6 years
What are the signs and management of Croup?
What should be given if there is concerns about the airway?
What should be done if there is an audible stridor AT REST or if the child is UNDER 6 months?
Barking, seal cough (apparently leads to Productive)
Stridor (ADMIT IF THERE IS A STRIDOR AT REST !!!!!!!!!!!!!!!!!!!!)
FEVER
Coryza
Management
- MILD- Dexamethasone
- SEVERE- Oxygen and Nebulised Budesonide. (Supplemental Oxygen is MAINSTAY for Bronchiolitis)
If significant concerns about airway- Nebulised Adrenaline
Make sure they do NOT CRY as this can worsen the Croup
What is Cyanotic Heart Disease and what are 3 examples?
Congenital Heart Disease that results in a Right to Left Shunt
1) Transposition of the great arteries (Pulmonary Artery and Aorta have swapped their insertion)
2) Pulmonary and Tricuspid Atresia (so the right side of the heart is a Dead end)
3) Tetraology of Fallot (Pulmonary Stenosis and Large Ventricular Septal Defect shunting at the Ventricular Level)- also OVERRIDING AORTA and RIGHT VENTRICULAR HYPERTROPHY
How are Cyanotic Heart Diseases diagnosed and managed?
Usually antenatally during scans
- Presentation occurs within first few weeks of life with babies being VISIBLY CYANOTIC
- ECHOCARDIOGRAPHY can help characterise the anatomy and the heart function
Management-
- Surgical Correction or Heart transplant
- Prostaglandin E can be given to delay Ductus Arteriosus closing
- AVOID Ibuprofen as it causes the Ductus Arteriosus to close faster
What are saturations like for Transposition of the Great Arteries?
Babies can maintain Normal Saturations if Large VSD (so NO MURMUR) and Patent Ductus Arteriosus (whose murmurs are not heard until pressure builds up) to compensate the Transposition of the Great Arteries
So when the ductus does close, saturations can fall due to Right-to-Left Shunting. Giving Oxygen does not make a difference as Pulmonary Circulation is already saturated well
What is Cystic Fibrosis and what are the causes of Cystic Fibrosis?
Autosomal Recessive Disorder- causes LUNG INFECTIONS and LIMITS ability to breathe
Cause- Mutations affecting CFTR protein (most common one affects the DELTA Protein)
What is the pathophysiology of Cystic Fibrosis?
Respiratory System-
- Thick Mucus in lungs
- !!!!!!!!!!!!SINUSITIS and NASAL POLYPS is also very common. Patients usually have Pseudonomas colonisation by 20 years old
Digestive System-
- Reduced Pancreatic Enzyme Secretion inhibits the absorption of Fat which causes Steatorrhoea
- This leads to the deficiency of Fat-Soluble Enzymes (Vitamin ADEK)
- Poor Absorption of fat leads to Poor Weight Gain
- Damage to Pancreas puts patients at risk of Diabetes
Reproductive System-
- Seminiferous Tubes get blocked- most men with Cystic Fibrosis are unable to conceive naturally
- Fertility is also lower in women due to Thicker Cervical Membrane
How does Cystic Fibrosis present in Neonates, Infants, Toddlers and Older Children?
Remember DELAYED PUBERTY
Neonates-
- Meconium Ileus due to the Thick Mucus making the Meconium Thicker
- Treated with GASTROGRAFFIN ENEMA
Infants- (like NaCli with breathing issues)
- Salty Sweat
- Faltering Growth
- Recurrent Chest Infections
Toddlers- (NaCli with digestive issues)
- Faltering Growth
- Recurrent Chest Infections
- MALABSORPTION
Older Children-
- Faltering Growth
- Recurrent Chest Infections
- MALABSORPTION
- DELAYED onset Puberty
How is Cystic Fibrosis diagnosed and managed?
Diagnosis-
- Sweat Test (Definitive and better)- High Chloride
- Heel Prick Test- High Trypsinogen
Management- (Clear the Chest, give them ABD, support the Pancreas and VACCINATE)
- MDT management
- Chest Physiotherapy to clear Mucus and prevent Pneumonia
- Medical management- Antibiotics, Bronchodilators and Secretion-thinners (Dornase Alfa)
- Pancreatic Enzyme Replacement (CREON) and Vitamin supplementation (ADEK)
- INFLUENZA and PNEUMOCOCCAL Vaccinations
- LAST RESORT= Lung Transplant
What does Zinc Deficiency cause?
ACRODERMATITIS ENTEROPATHICA
- Rash
- Hairloss
- Diarrhoea
What does Vitamin B3 deficiency cause?
Pellagra (the 3 D’s)
- Dermatitis
- Diarrhoea
- Dementia
What is Delayed Puberty and what are the causes?
3 low
3 high
No puberty by 14 in boys and 13 in girls
Most common cause is Constitutional Delay (confirmed with WRIST XRAY- Epiphyseal Plates are late to fuse)
Rarer Causes
- Low gonadotrophin- Hypothyroidism, Systemic Disease (Cystic Fibrosis or Coeliac Disease), Pituitary Disorders
- High gonadotrophin- Chromosomal Disorders (Klinefelters and Turners), Congenital Adrenal Hyperplasia, Hypogonadism (like after Chemotherapy)
What are the 9 signs of Depression (5 needed for diagnosis (at least 2 weeks or longer))?
Sad most of the day
Change in sleep
Change in physical activity
Change in Weight and Appetite
Fatigue
Concentration affected
Anhedonia
Guilt/ Worthlessness
Suicidality
What are the 6 main differentials for Depression?
1) Neurological (Parkinson’s, Dementia, Multiple Sclerosis)
2) Endocrine Disorders (Thyroid/ Hypo or Hyperadrenalism)
3) Drugs (Steroids, Isoretinoin, Alcohol, Beta blockers, Benzodiazepines, Methyldopa)
4) Chronic Conditions (Diabetes, Obstructive Sleep Apnoea, Long-standing infections like Mononucleosis)
5) Neoplasms and Cancers
6) Other Psychiatric Conditions- Bipolar Disorder, Schizophrenia, Dementia, Seasonal Affective Disorder)
What is the management of Depression generally?
How long should antidepressants be carried on for?
1st Line- Group CBT/ Low Intensity Psychological Interventions
2nd Line- Pharmacological Therapy (SSRIs) / CBT
Antidepressants should be continued for at least 6 MONTHS after Remission, gradually reducing over a 4 WEEK PERIOD
IF Actively Suicidal= then URGENT REFERRAL, so SCREEN for this asap
If SEVERE= Start with Pharmacological and add on Psychological Therapy
- ECT for Life-threatening (but can cause memory loss and risk of damage to teeth as it is an Induced Seizure)
What is the management of Depression in Children?
Mild- watchful waiting and healthy habits
Moderate to severe- refer to CAMHS
- First Line- Psychological Therapy
- FLUOXETINE- first line in children
- Admission if risk of self harm and suicide
What is Developmental Dysplasia of the Hip? What are the risk factors?
Ball of the Femur and Acetabulum of the Pelvis do not articulate properly
5 Fs for Risk Factors
- Firstborn
- Female
- Fanny First (Breech Presentation)
- Fluid (Oligohydramnios)
- Family History
What is the screening, diagnosis and management of Developmental Dysplasia of the Hip?
Screening- 2 Manouevres
- Barlow (To find out if there is Posterior Dislocation)
- Ortalani (Relocation of the Dislocated hip on Abduction of Hip)
Diagnosis- Hip Ultrasound
Management-
- Mild= sorts itself out in first few months (if no noticeable symptoms)
- Severe= PAVLIK Harness or Surgery
GALLEAZI TEST= if there is shortening, this helps figure out if it is the Tibia or the Femur
What is the most common cause of Hip Pain in Children? and how is it treated?
Transient Synovitis
- Treated with NSAIDs and Bed Rest
What are the 9 differentials for VOMITING in CHILDREN?
When should Whooping Cough be suspected?
1= normal
4= tummy
4- not tummy
Posseting- Small amounts of white fluid is common after feeds in infants (this is normal)
Testicular Torsion- If testicular pain
Brain Tumour- If neurological signs
Infection- More FORCEFUL vomits may be signs of infection, so ENT EXAMINATION is recommended for all vomiting children
Whooping Cough- Vomiting after long periods of Coughing (especially if UNVACCINATED)- Bordetella Pertussis
GORD- Large volume regurgitation can be GORD- manage with Positioning and Burping advice
Pyloric Stenosis- PROJECTILE vomiting in Young Boys whilst Palpable OLIVE Mass is felt at 6-8 weeks, after feeding- Surgery needed
GI Obstruction- If BILIOUS vomiting- like Malrotation
Appendicitis- Vomiting with Appendicitis type pain
What are the causes of vomiting in Older Children?
If more acute- Diabetic Ketoacidosis
If more chronic- Migraine/ Chronic Vomiting
Early morning headaches- RAISED ICP
In teenagers- consider pregnancy (CHECK PREGNANCY FIRST) , drugs and alcohol
What kind of infection does Mesenteric Adenitis follow usually?
An Upper Respiratory Tract Infection
What is Duodenal Atresia and what 3 conditions are associated with it?
Duodenum has a blind end and is NOT patent as a result. So it obstructs the Duodenum
- Down’s Syndrome
- Other Intestinal Atresias
- VACTERL association (Vertebral defects, Anal atresias, Cardiac defects, Tracheooesophageal fistula, Renal anomalies and Limb abnormalities)
What are the 3 signs of Duodenal Atresia
What is it associated with?
Is the vomiting bilious?
May be associated with Polyhydramnios as the baby can not ingest amniotic fluid normally
Distended Abdomen
Vomiting may be Bilious or Non-bilious
How is Duodenal Atresia diagnosed and managed?
Abdominal X ray (Double Bubble)
- One gas bubble visible in the Stomach, and one in the proximal part of the Duodenum, proximal to the Atresia
- Due to air from the stomach being between the Pyloric sphincter and the blind end of the Duodenum
Management- Surgical Repair- Duodenoduodenostomy (reconnecting proximal and distal segments of duodenum)
What is Eisenmenger Syndrome?
The reversal of a left-to-right shunt to a right-to-left shunt
So it is only seen in patients with a shunt to begin with-, like AtrioSeptal Defect
So it is an Acquired Right-to-Left Shunt
This is due to Increased Pulmonary Pressures changing the Pulmonary Vasculature and leading to Pulmonary Hypertension
What are the signs and management of Eisenmenger Syndrome?
WHEN DOES IT PRESENT?
Occurs in LATE TEENS
Includes Cyanosis and Right Heart Failure
Management- Best treatment by prevention by promptly treating Left-to-Right Shunts
- Otherwise treat the Syndrome itself with Heart-Lung Transplant or Palliation
What kind of murmur is heard with Left-to-Right Shunts?
Holosystolic Murmur loudest at Left Sternal Edge
What are 4 common Enterovirus conditions?
Hand, Foot and Mouth Disease- Coxsackie A
Myocarditis- Coxsackie B
Poliomyelitis- Poliovirus
- Mostly Asymptomatic
- A quarter of children have Upper Respiratory Tract symptoms
- MAY be PARALYSIS if the CNS is affected
Meningitis- Echovirus can cause an Aspectic Meningitis
How do you determine the right dose for children?
WETFLAG mnemonic
Weight-
- 1-5 years old= (Agex2)+8
- 6-12 years old= (Agex3)+7
Energy- 4J/kg
Tube size- (Age/4) +4 (cm)
Fluids- 20ml/kg on normal Saline bolus (10ml/kg if Trauma or Heart Failure)
Lorazepam- 0.1mg/kg
Adrenaline- 10micrograms/kg
Glucose- 2ml/kg of 10% dextrose
What is Ewing’s Sarcoma? And what are its signs?
It is the second most common bone cancer in children
It starts with LOWER body bones-
- Bone pain at NIGHT
- Mass or swelling
- Restricted movement in a joint
How is Ewing’s Sarcoma diagnosed and managed?
Bone Biopsy is Definitive
- Histology will show small blue round cells with clear cytoplasms
Xray shows LAMELLATED PERIOSTEAL REACTION (onion skinning)
MRI shows a large mass with Necrosis
Management- Surgery, Radiotherapy and Chemotherapy
What are some causes of Hydrocephalus?
Meningitis
Traumatic Brain Injury
Haemorrhage
What are 3 examples of Innocent Murmurs in Children and what are the 6 S’s that summarise them?
Still’s Murmur
Venous Hum
Acute Infective Illness
The 6 S’s
- Soft
- Systolic (as ALL diastolic murmurs are pathological)
- Sensitive (changes with child’s position and respiration)
- Short (not holosystolic)
- Single (no additional sounds)
- Small (localised, non radiating)
What is the management of Innocent Murmurs in Children?
Often made prominent when the child has a Febrile Illness
Management- the best option is to review the child in a few weeks. If the murmur persists, then Echocardiogram.
How are Febrile Convulsions diagnosed and managed?
What type of seizure usually occurs? and How is this seizure managed?
6 MONTHS to 5 YEARS OLD
What are the chances of it recurring?
What condition most likely causes it?
Febrile seizures are seizures associated with fevers
They are usually SHORT and Tonic Clonic
Management-
- Manage seizure like all other seizures- Benzodiazepam
- Find the Source of the fever and treat that
- Parents should be advised on Anti-Pyretics and not to use them prophylactically
Prognosis- it does NOT increase the chances of Epilepsy if simple. Complex= lasts for a LONG time or happens MULTIPLE times with the same fever
30-40% recurrence chance
Caused by Roseola Infantum
What are the Maintenance (not Acute) Fluid and Electrolyte requirements in children?
What is the fluid bolus that should be given for Acute Fluid Resuscitation?
1st 10 kg of bodyweight- 100ml/kg/day
2nd 10kg of bodyweight- 50ml/kg/day
Remaining bodyweight- 20ml/kg/day
Sodium- 2-4mmol/kg/day
Potassium- 1-2mmol/kg/day
Acute Fluid Resuscitation- 10ml/kg (give 2 then call for help)
How much fluid should be given to treat Fluid Deficit in children?
Percentage dehydration- ((Normal Weight- Current Weight)/Normal Weight) multiplied by 100
Multiply % dehydration by their normal weight (just the number, don’t divide by 100) (fluid deficit) then multiply this by 10
(So basically Normal Weight-Current Weight x 1,000)
Give this fluid over 1-2 days with their normal fluids
What is Foetal Alcohol Syndrome?
It is a condition resulting from In-Utero Alcohol Exposure
Signs-
- Functional/ Structural Nervous System Abnormalities (decreased cranial size, structural brain abnormalities, problems with attention, cognition)
- Growth Impairments (low birth weight, decelerating birth weight over time)
- Specific facial abnormalities (short palpebral fissures, smooth philtrum and thin upper lip)
There is NO CURE- just to support throughout life
What are the signs of Fragile X Syndrome and what is the management?
What genetic abnormality causes it?
Caused by CGG repeat in the FMR1 gene on the X chromosome
Signs- (Socially Awkward Clicking Horse)
- Long face and Large protruding ears
- Intellectual impairment
- Macroorchidism (Large testes)
- Social Anxiety and Autism Spectrum
- MITRAL VALVE PROLAPSE
- Echolalia (Repeating what you say)
Management
- Support throughout life- MDT
What are the 5 points in the Fraser Guidelines (required to give advice to <16 year olds about sexual health without breaking confidentiality)?
1) They are mature and intelligent
2) They can not be persuaded to tell the parents or allow the doctor to tell them
3) They are likely to have sexual intercourse with or without contraception
4) Their mental health will suffer unless they receive advice
5) The advice or treatment is in their best interests
What are the signs and management of Gastrooesophageal Reflux in Children?
What type of motion is seen in GORD?
(VERY VERY COMMON IN INFANCY- common cause of vomiting)
(if NOT BILIOUS or STAINED and happens AFTER EATING)
Signs-
- Milky vomit after feeding
- Crying/ Irritability
- Arching of the back and Drawing up of the KNEES TO CHEST
(These movements may be mistaken for Seizures)
Management-
- Keep baby upright after feeding and keep cot on an incline
Medical- GAVISCON and OMEPRAZOLE (Quesmed also said Alginate)
Surgical- FUNDOPLICATION
What is Gastroenteritis and what are the main bacterial and viral causes?
Common Cause of DIARRHOEA and VOMITING after ingestion
Bacterial-
- Staphylococcus Aureus- cooked meats and creams
- Cereus- Reheated Rice
- Perfringens- Reheated or cooked meat
- E-coli - if recently TRAVELLED to ASIA/ AFRICA
Viral-
- Rotavirus (most common cause in infants)
- Norovirus (most common cause in all ages)
- Adenoviruses (resp infections as well)
How is Gastroenteritis managed?
Fluid Replacement (WATER) and antibiotics if severe
Antibiotics if:
- Systemically unwell
- Immunosuppressed
- Elderly
Specific antibiotics (Stay Clean, Cook Everything, Clean Thoroughly)
- Salmonella or Shigella- Ciprofloxacin
- Campylobacter- Erythromycin
- Cholera- Tetracycline
What is Henoch-Schonlein Purpura?
What are the signs and management?
RESP-> HSP -> RENAL
(PURPURA on EXTENSORS, ABDO PAIN, ARTHRITIS)
ACHY TUMMY, JOINTS, LOWER LIMBS and BUM
Small vessel vasculitis- in 3-5 year olds
Signs- PANAF
- Purpura or petechiae on Buttocks and Lower Limbs
- Abdominal Pain
- Arthralgia (Knee and Ankles usually)
- Nephritis (Haematuria and Proteinuria)
- Usually happens after an UPPER RESPIRATORY INFECTION
- May have fever
Diagnosis- Biopsy with immunofluorescence for C3 and IgA- but rarely don- Pick DIPSTICK over this for investigations
Management-
- NSAIDs for analgesia
- Antihypertensives for blood pressure
- Urine dipstick for a year to check for renal function
What are the signs, diagnosis and management of Hodgkin’s Lymphoma?
What are the 2 markers of poor prognosis?
Signs
- Alcohol-Induced PAIN in Lymph Nodes
- Cervical or Supraclavicular Non-tender Lymphadenopathy
- Symptoms caused by compression of surrounding structures- !!!!!!!SHORTNESS OF BREATH/ ABDOMINAL PAIN
- B symptoms (weight loss, night sweat, fatigue)- only seen in 30% of patients
- Hepatosplenomegaly
Diagnosis-
- Lymph Node Biopsy- REED STERNBERG CELLS
- !!!!!!!!!Low Hb (Anaemia) and Raised LDH is poor prognosis
Management- Chemotherapy
What are the causes and management of Hydrocele?
FLUCTUANT AND TRANSILLUMINATES (on Ultrasound)
Causes- Processus Vaginalis does not close (the path the testes take to descend)
Management- Most resolve within a year, so wait ONE YEAR, then surgical correction if still not resolved
Prognosis if untreated- Inguinal Hernia
What are the causes of a Communicating and Non-communicating Hydrocephalus?
Non-communicating- there is an OBSTRUCTION in the Ventricular system
- Congenital Malformation (AQUEDUCT STENOSIS or CHIARI MALFORMATION)
- Tumour or Vascular Malformation in the Posterior Fossa
- Intraventricular Haemorrhage (consider in PREMATURE infants)
Communicating- Failure to reabsorb CSF
- Meningitis
- Subarachnoid Haemorrhage
- Traumatic Brain Injury
What is the diagnosis and management of Hydrocephalus?
(From the ventricles to the peritoneum)
Diagnosis- Cranial Ultrasound or CT/MRI of the brain
Management- Ventriculoperitoneal Shunt to move CSF to the abdominal cavity (look out in case the shunt gets infected though)
What is the ICP in Hydrocephalus and what are the signs of this?
Remember Victor and VILS
RAISED ICP
Signs-
- Vomiting
- Irritability
- Lethargy
- Sunsetting of Eyes
Hydrocephalus- Tense Anterior Fontanelle, Distended Scalp Veins
What are the features of Hypotestosteronism?
(FAT, SLOW, SAD, not Sexual male)
What 2 conditions is this associated with- or it can lead to?
Weight Gain
Lethargy
Erectile Dysfunction and Loss of Libido
Depression
Gynaecomastia
- Associated with Infertility and OSTEOPOROSIS
How is Hypotestosteronism managed?
What 4 things do you monitor?
Low Testosterone= BONE, LIVER, BLOOD, Prostate
HRT (give them testosterone)
Monitor for-
- Polycythaemia (testosterone affects erythrocytosis)
- Bone mineral density (DEXA)
- Prostate status
- LFTs (hormones affect Liver Function)
What is Hypoxic Ischaemic Encephalopathy?
what is the Immediate and Delayed effects?
What are pre intra and post partum causes?- 1,2,1
It is Brain Damage resulting from antenatal or perinatal Hypoxia
Primary Neuronal Death (Immediate) and Secondary Reperfusion Injury (Delayed)
Caused by anything that causes HYPOXIA
- Pre-Partum (PLACENTAL ABRUPTION)
- During Delivery (Prolonged Delivery, Cord Compression)
- Post-Partum (Prolonged Respiratory Arrest)
What are the signs of Hypoxic Ischaemic Encephalopathy? How is it diagnosed and managed?
Annoyed or (Floppy and Seizures)
5 steps to treat:
remember the Oxygen, transport of oxygen and medium for transport
plus hypothermia and seiziures
Ranging from Mild (Irritability) to Severe (Hypotonia, Poor Responses, Prolonged Seizures)
Diagnosis- EEG monitoring and multiple MRI scans
Management-
- Respiratory Support
- Anticonvulsant Therapy
- Careful Fluid Balance and Electrolyte Monitoring
- The use of INOTROPES
- COOLING THE BABY TO INDUCE HYPOTHERMIA protects against Secondary Reperfusion Injury
What is Immune Thrombocytopaenic Purpura?
Autoimmune disease of an unknown cause where the Number of Platelets is reduced
In Children it is SELF LIMITING
Adults- CHRONIC RELAPSING
