Paeds Flashcards
What is suggestive of fabricated or induced illness?
- Multiple unexplained symptoms.
- multiple negative investigations
- perpretrator may induce the child to toxins, or alter laboratory test results, fabricate PHM
- Mother nearly always responsible and often has extensive contact with health services, very compliant
How can you investigate fabricated or induced illness?
Look for exogenous toxins, foreign substances such as blood
How do you manage fabricated or induced illness?
Refer to social care, who have a statutory order to undertake thorough assessment according to strict guidelines. Check the child protection register and call the health visitor
What is the most common cause of chest pain in a child with sickle cell?
Acute sickle chest syndrome. Thrombosis, infection and fat embolism produce pleuritic pain, shortness of breath and fever. There is often consolidation at the bottom. Needs to be managed aggressively.
How do you treat acute sickle chest syndrome?
Acidosis, hypoxia and dehydration need to be corrected> hyper hydration and supplemental oxygen. Analgesia (often IV morphine) and physiotherapy help the child to breath deeply. Start empirical antibiotics such as co-amoxiclav and clarithromycin. Discuss with senior paedatrician and haematologist as may deteriorate and require continuous ventilation, CPAP or intubation. May also require blood transfusion
What should all children with sickle cell receive?
As they develop hyposplenism, they are vulnerable to infection with encapsulated bacteria–> vaccinate and regular penicillin prophylaxis
7 year old girl from Zimbabwe. Fever, worsening headaches, neck stiffness and recurrent otitis media
Bacterial meningitis, most likely due to streptococcus pneumonia that may be secondary to the recurrent otitis media
How should bacterial meningitis be treated?
Commonly iv ceftriaxone and dexamethasone
What primary factors predispose to recurrent infection?
Immune deficiency (antibody, complement, neutropaenia) Chronic granulomatous disease, ataxia telangiectasia
What secondary factors predispose to recurrent infection?
HIV, immunosuppressive drugs, malnutrition, hyposplenism, cystic fibrosis and anatomical difficulties.
What would you see on the blood test of someone with rickets?
High ALP and borderline calcium. Frontal bossing, prominent costochondral junctions (rickety rosary), muscle weakness, tetany and hypocalcaemic fits.
What would point to IDA?
Poor nutritional intake, pallor and microcytic hypochromic anaemia
What is rickets? What are risk factors?
A failure of mineralisation of bones. Dark skin, poor nutritional intake and prolonged breast feeding (milk is a poor source of vitamin D). Diseases that affect the kidney or liver as well as malabsorption.
What is seen on the Xray of rickets?
Swolllen ankles and wrists. Widening of the growth plate, and cupping, splaying and fraying of the metaphysis
What should the ferritin be like in IDA?
Low
