Paeds Flashcards
What causes physiological neonatal jaundice (>24hrs)? 3 things
Billirubin production due to shorter RBC lifespan
Low conjugation due to hepatic immaturity
Absence of gut flora impedes elimination of bile pigment
Give 4 causes of neonatal jaundice within 24hrs?
Sepsis
Rhesus haemolytic disease
ABO incompatibility
Red cell anomalies (spherocytosis)
State 4 causes of prolonged (>14 days) jaundice?
Breastfeeding Sepsis Hypothyroidism CF Galactosaemia Biliary atresia
How do you treat neonatal jaundice?
Phototherapy - converts unconjugated bilirubin to soluble products
Exchange transfusion - warmed blood through umbilical vein with removal via artery
Give 5 complications of prematurity?
Hypothermia Apnoea Bradycardia Infection Difficulty feeding Hypoglycaemia Anaemia
Give 3 risk factors for prematurity?
Young maternal age Multiple pregnancy Maternal illness Smoking Alcohol Infection
What is kernicterus?
High levels of unconjugated bilirubin in the basal ganglia causing acute encephalopathy with irritability, poor feeding and high pitch crying. Can lead to athetoid cerebral palsy.
Give 4 areas Downs Syndrome can affect?
Respiratory
Cardiovascular
Ears
GI
Give 4 causes of IUGR?
Multiple pregnancy Placental insufficiency Maternal smoking Congenital infections Genetic syndromes
Give 6 features that can be seen in Down’s syndrome?
Neonatal hypotonia Flat occiput Epicanthic folds Round face Protruding tongue Strabismus Nystagmus 5th finger clinodactyly Sandal gap
Give 4 causes of respiratory failure?
Upper airway-foreign body, epiglottis, croup
Lower airway-asthma, bronchiolitis, pneumonia
Neuro-head injury, meningitis, raised ICP
State 2 genetic ways Downs syndrome occurs?
Non-disjunction
Robertsonian translocations
Give 4 signs of respiratory distress in a child?
Tachypnoea Subcostal, intercostal and sternal recession Nasal flaring Use of abdominal muscles Tracheal tug
Give 5 clinical features of respiratory failure in kids?
SOB Tachypnoea Cyanosis Nasal flaring Grunting Recession Restlessness
What causes croup?
Para-influenza virus
RSV
Give 3 signs of severe croup?
Increased work of breathing
Cyanosis
Restlessness
How do you manage croup?
O2
Dexamethasone OR Prednisalone
Nebulized adrenaline
ITU
Give the pathology of bronchiolitis?
Bronchioles become inflamed
Secrete mucus
Oedema and necrosis cause obstruction of the airways
Give 2 investigations of choice for Bronchiolitis?
CXR - hyperinflation & collapse/consolidation
Nasopharyngeal aspirate (NPA) - RSV using immunofluorescence
State the causative organism of bronchiolitis?
RSV (respiratory syncytial virus)
What are the indications for admission in Bronchiolitis? 4 things?
Poor feeding Apnoea >50 bpm Dehydration Exhaustion
What is the prophylactic treatment for Bronchiolitis?
Monoclonal antibody (palivizumab) providing passive immunity through winter months
Give 4 ways intussusception might present in a child?
Episodic:
Crying
Drawing the legs up
Vomiting Blood PR (red currant jam) Sausage shaped abdominal mass
How is intussusception investigated and subsequently treated?
USS
Reduction by air enema
Give 4 common organisms causing gastroenteritis?
Rotavirus
Norovirus
E. Coli
Campylobacter
Give 6 parameters for assessing dehydration?
Pulse BP Mucous membranes Urine output Skin turgor Fontanelles CRT
How do you calculate fluid deficit in a child?
Weight (kg) x percentage dehydration (%) x 10 = Fluid deficit (ml)
What is the normal APGAR score & when would you consider resuscitation?
7-10 is normal
Below 3 must be resuscitated
Give key milestones in child development? 1 month/ 6 month/ 12 month
Gross Motor, Fine motor, Language, Social
1 month GM: Lift head FM: Track with eyes L: Coo S: Track parents
6 month GM: Sit up FM: Raking grasp L: Babbles S: Stranger anxiety
12 month GM: Walk FM: Pincer grip L: Mama/Dada S: Imitate parents
What are the congenital infections? (TORCH)
Toxoplasmosis Other (Syphilis) Rubella Cytomegalovirus Hepatitis HIV
When and who does pyloric stenosis mostly affect?
First 4-6 weeks of life
First born male infants
Which investigations can be taken and what would they show in pyloric stenosis? 2 investigations
Ultrasound: Thickened and elongated pyloric muscle
Bloods: Hypochlorimic, Hypokalaemic and Metabolic alkalosis
Give 4 causes of developmental delay?
Severe learning disabilities (Downs, Fragile X and Cerebral palsy)
Intrauterine infections (TORCH)
Fetal alcohol syndrome
Congenital hypothyroidism
Inborn errors of metabolism
Abuse & Neglect
When should you worry about the growth of a child?
Weight under 2nd centile
Height under 2nd centile
When height and weight cross 2 centiles
What is the management of pyloric stenosis?
Rehydration
Surgery: Pyloromyotomy
What is hirschsprungs disease and how can you treat it?
Congenital absence of ganglia in a segment of colon leading to obstruction, constipation and megacolon
Treat with excision of segment +/- colostomy
Give 2 common causes of malabsorption in children?
Coeliac disease
Cystic fibrosis
Give 3 complications of tonsillitis in children?
Otitis media
Peritonsillar abscess
Post streptococcal glomerulonephritis
Give 2 organisms implicated in Otitis media in children?
Strep. Pneumoniae
Haemophilus influenzae
What causes epiglottis and why is not around anymore?
Haemophilus influenzae
Hib vaccine introduction
How can you investigate reflux in children?
Barium swallow
PH monitoring probe
How can you manage simple reflux in children? 4 things
Nursing infant in upright position
Thickening agents
Gaviscon
Drugs: PPI, H2 receptor blockers, Domperidone
What are the possible causes of bile stained vomit in a child? 3 things
Duodenal atresia
Ileal atresia
Malrotation of small bowel
Complex febrile convulsions in children have the same features as simple ones. There are some differences. What are they? 3 things
Seizure focal or prolonged >15mins
Many seizures occurring in close succession
Status epilepticus
Give 4 features of a simple febrile convulsion in children?
Single seizure lasting <15mins
Neurologically normal before and after
Normal neurodevelopment
Fever not due to CNS infection
What is status epilepticus?
Continuous seizure activity >30mins
OR Series of seizures without full recovery in between
Give 3 common associations of cerebral palsy?
Epilepsy
Learning difficulties
Hearing & visual loss
Incontinence
Give 4 causes of cerebral palsy?
Prenatal- infections (TORCH)
Perinatal - Hypoxic ischaemic encephalopathy, Trauma
Post natal - Meningitis, head trauma, encephalitis
Give 4 tests for diagnosing cystic fibrosis?
Sweat test
Antenatal test - chorionic villus sampling
Karyotyping
Guthrie test
Give 3 causes of a global developmental delay in children?
Chromosomal abnormality - Downs, Turners, Klinefelters Foetal alcohol syndrome Abuse and neglect Congenital hypothyroidism Trauma CNS malformation
Give 6 causes of failure to thrive in children?
Poor nutrition Abuse and neglect Unskilled feeding Malabsorption Down syndrome Ongoing illness
