Paeds Flashcards
Paeds - Bronchiolitis vs Croup - def? Sx? Ix? Mx? RFs?
Mx:
- Bronchiolitis (from RSV, <1yr) - conservative (simple analgesia) + Palivizumab for prevention
- Croup - oral dexamethasone 0.15mg/kg + neb O2 & adrenaline
Wheeze vs stridor?
- Wheeze – lower/small airways/bronchioles in lungs compressed –> whistling on expiration (exactly like how you whistle) – not during inspiration as stretching lung open so bronchiole diameter increases
- Stridor – narrowing of upper airways/trachea/larynx + tissues floppy –> rattling of airways during inspiration and a little during expiration (louder during inspiration as breath in harder – struggling to draw in air so working really hard)
Acute Asthma Mx in kids
In acute asthma attack breathing fast/hard so CO2 should be very low –> given situation normal/high PaCO2 is ABNORMAL
Long-term asthma Mx in kids?
- <5yrs:
- 1st line – SABA (reliever)
- 2nd line – if atopic –> 8wk trial medium-dose ICS (preventer)
- 3rd line
- Steroid-unresponsive (recurrent Sx <4wks) –> low-dose ICS
- Steroid-responsive (recurrent Sx >4wks) –> another 8wk course medium-dose ICS
- 4th line – LTRA
- 5th line – specialist advice
- 5-16yrs:
- 1st/2nd line - If SABA insufficient to control symptoms or bad enough symptoms at first presentation give SABA + ICS (morning and evening everyday 1 puff)
- 3rd line - Leukotriene receptor antagonist (e.g., montelukast) –> block pro-inflam cytokines from arachidonic acid pathway (w/ COX)
- 4th line - If LTRA not working add on LABA (either continue/discontinue LTRA)
- 5th - If doesn’t work start maintenance & reliever therapy (MART) = 1 inhaler with ICS + LABA (morning and evening everyday) + used for relief as well instead of SABA inhaler
- 6th line – OCS
- 7th line – specialist advice
Spectrum of wheeze in kids
- Can grow out of viral-induced wheeze – small airways more prone to constriction –> as grow this can become less of an issue
- Bronchiolitis is Dx if <1yr instead of viral-induced wheeze
Types of vomiting in kids
GORD Mx in kids
Pyloric stenosis - def? Ix? Mx? In KIDS
Cow’s milk protein allergy in kids
Jaundice breakdown in children?
What is the major concern with jaundice?
Management of jaundice?
< 24 hrs - pathological, usually haemolysis
Haemolytic disorders
* Rhesus haemolytic disease - anaemia, hydrops (2+ compartments oedema) and hepatosplenomegaly
* ABO incompatibility - less severe than above, no hepatosplenomegaly, Hb normal, DAT/Coomb’s +ve
* G6PD def (M>F)
* Hereditary spherocytosis
Congenital Infection - growth restriction, hepatosplenomegaly, thrombocytopenic purpura
2 days-2 wks
* Physiological Jaundice - bilirubin risen as adapting to transition from foetal life
* Breast Milk Jaundice (type of physiological jaundice)
* Dehydration
* Inf
* Other (polycythaemia, Crigler-Najjar syndrome)
> 2 weeks** - persistent/prolonged neonatal jaundice**
* Unconj hyperbilirubinemia (MOST COMMON) - breast milk jaundice (most common), inf (UTI), congen hypothyroidism (coarse facial features)
* Conj hyperbilirubinaemia (>25umol/L) - pale stools + dark urine ± hepatomegaly/poor weight gain. Causes - neonatal hepatitis syndrome, biliary atresia ≥1 bile duct abn narrowed/blocked/absent
Kernicterus - encephalopathy from deposited unconj bilirubin in basal ganglia/brainstem nuclei
* Acute –> lethargy, poor feeding
* Severe: irritability , hypertonia, seizures, coma -> If survive: Choreoathetoid CP (damage to basal ganglia), learning difficulties, deaf
* Kernicterus –> brain damage in severe rhesus haemolytic disease
* RARE NOW with prophylactic anti-D immunoglobulin for rhesus-negative mothers
Management
* Physiological –> reassurance/observe
* Pathological unconj - for phototherapy (+ hydration) +/- exchange transfusion (if Kernicterus)
* Pathological conj: Tx cause, biliary atresia for surgery
* Breast milk jaundice - temporary cessation of breast feeding with supplemental feeding + treat as above
Tx of jaundice in kids
- Very high levels of bilirubin –> kernicterus (in brain)
- IVIG in context of haemolytic diseases (ABO/rhesus haemolytic disease) –
- Rhesus - abs from mother bind to RBCs –> move to spleen, in spleen receptors identify and bind to these abs –> RBCs destroyed.
- Instead IVIG bind to receptors in spleen preventing spleen binding to RBCs
Constipation in kids Mx?
- On exam feel for impacted stool
- Dig into social aspects of constipation – look for precipitants e.g., diet, difficulty outside on home –> consider in conservative management
- Osmotic laxative –> water moves into intestinal lumen from surrounding tissues
- Stimulants –> contraction of intestines helping to pass bolus of faecal matter
Hirschsprung - paeds - def? Ix? Mx?
- No innovation from myenteric/submucosal plexus in HD
- Normally GI system has its own brain – enteric nervous system
Intussusception - paeds - def? Sx? Ix? Mx?
- Rectal air insufflation – pump air from back end to make bowel pop back into shape
- If recurrent –> check for Meckel’s diverticulum - slight bulge to diverticulum present at birth –> technetium-99m pertechnetate scan ‘Meckel’s scan’
Key features of tetralogy of fallot - paeds?
Paeds congenital heart disease - breakdown?
Cyanotic:
- Tetralogy of fallot
- Transposition of great arteries
Acyanotic:
- ASD, VSD, AVSD, PDA
Cyanotic congenital heart disease - presentation? Ix? Mx?
Acyanotic congenital heart disease types?
Complications of acyanotic congenital heart disease?
Anaphylaxis in paeds - def? signs? Mx?
- Give nebs Salbutamol if evidence of widespread wheeze
- A-E assessment but EASY as airway is constricted (stop at A)
- Chlorphenamine = antihistamine
- Tip for PACES – give 2 EpiPen’s (one for school, one for parents)
DKA paeds - aims of Tx?
Fluids in DKA in paeds?
- Over 24hrs – give maintenance + ½ deficit (as this is done over 48hrs)
- 20ml/kg 0.9% for normal children, 10ml/kg 0.9% for DKA
Status epilepticus in paeds - def? Ix? Mx?
Developmental dysplasia of hip - screening? Mx?
DDH vs Perthes vs SUFE
- SUFE – obesity, older (10-15yrs) –> internal fixation
- PD – ADHD/short, younger (5-10yrs) –> conservative (analgesia, mobilisation)
- DDH - baby (<1yr), bilateral –> Pavlik harness
What is MAHA - paeds?
- Problem in small blood vessels –> shred RBCs –> schistocytes on blood film
- Mechanism NOT disease
Haemolytic uraemic syndrome - presentation paeds?
- E. coli –> diarrhoea in children, toxin damaging endothelium –> platelet aggregation/consumption –> narrow path of RBCs/slice –> reduction in renal perfusion –> renal failure
- Occurring specifically in glomerular vessels
Thrombotic thrombocytopenic purpura presentation paeds?
- Not enough ADAMTS13 –> more vWF multimers = sticky –> platelet coagulation –> narrow path of RBCs/slice –> reduction in end organ perfusion
- Occurs all over the body with the most obvious area being the brain –> confusion
Disseminated intravascular coagulation - paeds - presentation?
- Exposure to lots of TF (sepsis/tumour/pancreatitis/trauma) –> factor 7 –> 7a –> causes lots of platelet aggregation/consumption + coagulation factor consumption
Preclinical breakdown of paeds haematological conditions - MAHA vs HUS vs TTP vs DIC
Clinical breakdown of paeds haematological conditions - MAHA vs HUS vs TTP vs DIC
Paeds nephrotic vs nephritic syndrome
Clinical breakdown of renal disease - minimal change disease vs post-strep glomerulonephritis vs IgA nephropathy & HSP
Nephritic syndromes - blood/protein loss
Post-streptococcal glomerulonephritis
* 4-6 wks after streptococcal pharyngitis (GAS)/skin infection
* Presentation: oedema, HTN, macroscopic haematuria, proteinuria
* Ix: low C3 lvls, high ASOT
* Mx: BP control
Goodpasture syndrome
* Triad: glomerulonephritis, pul haemorrhage, anti-GDM ab formation
* Haemoptysis + haematuria in SBAs
Alport’s syndrome
* X-linked hereditary + haematuria + hearing loss
* Female carriers may have haematuria
HSP - IgA AI hypersensitivity vasculitis (IgA complexes deposit in small blood vessels of skin/joints/kidneys/GI tract)
* NOTE: IgA nephropathy (Berger’s disease) is renal-specific while HSP is widespread
* Most common vasculitis of childhood <5yrs
* Often preceeding throat/URTI infection (can be GI) - mildly ill, low grade fever
* PC: palpable purpuric rash on buttocks (symmetrical erythematous macular), abdo pain, arthritis/arthralgia, glomerulonephritis
* Dx - clinical Dx: palpable purpura + ≥ diffuse abdo pain/typical histopath (leucocytoplastic vasculitis/prolif glomerulonephritis with IgA deposits)/arthritis or arthraliga/renal involvement (proteinuria/haematuria)
*Ix: urine dip, BP, FBC (can have raised Pl/raised WCC with eosinophilia), ESR (raised), Cr (raised with renal involvement), IgA (raised)
* Mx: normally self-limiting -> refer to hospital ?monitoring for abdo/renal complications
Nephrotic syndrome - urinary protein loss >3.5g/day, low albumin, oedema
Minimal change disease
* SBAs: swollen eyes/testes, 3+ protein on urine dip
* Features: proteinuria, oedema (periorbital/scrotal), low albumin (<30), high lipids, thrombophilia
* Ix: renal biopsy - electron microscopy = fusion of epithelial podocytes “minimal change as such minimal change in pathology”
* Mx: CS (pred)
Give overview of haemorrhagic disease of newborn
Haemorrhagic disease of newborn = Vit K def bleeding (VKDB)
* Vit K low in neonates - req to prod coag factors 2/7/9/10
* Exclusively problem of breast fed babies (bottled milk contains vit K)
* Bleeding sites - umbilicus, mucous membranes, GI tract, circumcision, venepunctures
* IC bleeds can occur - main cause of mortality/morbidity
* Mx: single dose IM Vit K given after birth, if severe bleed may need FFP
Gastro Paeds DDx
Vaccination Schedule
What is the tx for pinworm?
Mebendazole + repeat dose after 2-3wks
Paediatric key congenital syndromes
Causes of meningitis in children
- Neonatal to 3 months - GBS, E. coli, Listeria
- Older - N. meningitidis, S. pnuemo
Primitive reflexes
Dev milestones
Wilm’s tumour overview
Wilm’s tumour - abn prolif metanephric blastema cells
* Most common renal tumour in kids, 3-5yrs
* PC: abdo mass +/- abdo pain, HTN, fever, haematuria, anaemia
* Mx: very treatable - surgery/chemo/radio
