Paeds 5 Flashcards
What are some poor prognostic factors for ALL?
<1 years, >10 years old WCC >50 T cell markers Non - Caucasian Male BCR ABL
What classical features are found on examination of a child with coeliac disease? and list some other differentials for the disease:
Distended abdomen
Pale
Wasting of the gluteal muscles
Dermatitis herpetiformis
- this isn’t always found
Differentials:
- IBD
- IBS
- Cystic fibrosis
- Bacterial over growth
Outline some general causes of failure to thrive:
Increased metabolic demand:
- congenital heart disease
- recurrent infection
- malignancy
- hyperthyroidism
Inadequate absorption:
- coeliac disease
- cystic fibrosis
- pancreatic insufficiency
Poor intake:
- reflux
- cleft palate
- neurological defects
Environmental:
- poor access
- poor economics
- maternal depression
List some causes of non-biological causes of failure to thrive:
Low socioeconomic status
- unable to afford good food
Inadequate intake
- insufficient food offered
Maternal depression
- poor feeding
Neglect
In a child with coeliac disease what food groups can they not eat from? and is coeliac disease for life?
Wheat
Rye
Barley
if diagnosis is before <2 years old a trial of gluten can be done in childhood with jejunum biopsies taken to check for changes.
some children may recover.
What are the major causes of conjugated bilirubin?
TORCH infections
Biliary atresia
Neonatal hepatitis
List the three main causes of non-pathological or life threatening causes unconjugated bilirubin in the neonate:
Breast milk
Hypothyroidism
Polycythemia
In a child with jaundice how often should bilirubin levels be taken?
2-4 hours with careful monitoring
What are the signs of kernicterus?
Opisthotonus - arching of the back
Sleepiness
Hypotonia
Poor feeding
Poor munro response
High pitched cry
What are some mild signs of dehydration in a child and what are some severe signs?
Mild:
- sunken eyes
- sunken fontaelle
- reduced skin turgor
severe:
- dry nappies
- weak pulse
- reduced BP
Which babies are at risk of severe bronchiolitis?
Preterms Low birth weight Chronic lung disease Congenital heart disease Immuno-deficiency
*Palivizumab can be given to these kids as prophylaxis
What are the types of Undescended testes and what is the investigations and management?
Two major types:
- palpable and non palpable (Cryptorchidism)
- Retractile and non-retractile
Investigations:
Palplable is clinical
Non-palpable: laparoscopy
Management:
Palpalble: Inguinal orchiopexy (done at 3 months)
- and beta - hCG
Non-palpable: laparoscopic surgery
**bilateral non-palpable testes requires genetic workout
Complications:
- fertility
- Seminomas’
- Cosmetic
Which babies get an US of the hips to check for DDH and when is this done?
Anyone with 1st degree relative
Breech presentation
Multiple pregnancy
Barlow/ Ortolani findings
Outpatients in 2 weeks if clunk identified
Outpatients within 6 weeks if risk factor identified
What signs suggest over feeding rather than an underlying condition?
> 200ml/kg/ day
Over fed babies will have normal growth and look healthy. Will usually only have vomiting as a the symptom
What are the causes of GORD in a child?
Immature muscular
Neurological illness
- cerebral palsy
Liquid only
- Recumbent positioning
Positioning
What is a syndrome that can be seen in neonates with GORD which involves the neurological system?
Sandifer syndrome
- Torticollis
- Opisthotonus
What are some risk factors to colic? and what is the diagnostic criteria?
< 5 months
Exposure to cigarette smoke
Formula fed
Diagnosis:
- > 3 hours per episode
- > 3 days a week
- > 3 weeks
What are the red flags for constipation?
> 48 hours of meconium
Distention of abdomen
Neurological disorders
- locomotor failure
Ribbon stools
Excessive vomiting
What are the two type of Cow’s milk protein intolerance seen in children and how do they present?
Two types:
- IgE mediated (type I hypersensitivity)
- Non- IgE mediated (type IV hypersensitivity)
IgE:
- 2-4 hour onset
- Urticarial rash
- pruritus’
- Angioedema **this can potentially be fatal and helps distinguish it from non-IgE
- colic
- D&V
- Respiratory wheeze
- rhinosinusitis symptoms
Non- IgE:
- 48- 2 week onset
- eczema rash
- pruritus’
- Colic
- Bloody diarrhoea
- Respiratory wheeze
Treatment:
- hydrolysed formula
- if being breast fed ask mother to not drink cow’s milk
What is Baclofen and when is it used?
Baclofen is a muscle relaxant.
used in cerebral palsy to help relax tight muscles.
Regarding injection sites for DM, should they be rotated around on and why?
Yes
- avoids complications such as lipohypertrophy and lipodystrophy
What is the effective of growth hormone on blood glucose levels?
Increases blood glucose level
- supresses insulin
*this is why you can do a glucose suppression test in acromegaly
Give account for relative hyperglycaemia seen in the morning of teenagers:
Increased sex and GH hormones increases cortisol and release of sugars.
- dawn phenonium
Any girl who is primary amenorrhoeic, should they have karyotyping carried out?
Yes they should
- to rule out turners syndrome
What is tested for to confirm a diagnosis of congenital adrenal hyperplasia?
17 hydroxyprogesterone
- it accumulates due to lack of 21 hydroxylase
other tests:
- ACTH
- renin
- cortisol
*serum steroid is diagnostic as well
What is the typical management of ITP and should you give steroids?
Observation and advice.
- usually self resolves following 6-8 weeks
- if child injuries head they should come to A&E due to risk of bleed
Steroids are not recommended until the diagnosis is absolutely certain due to risk of it being leukaemia
What viruses are associated with type I diabetes, and what other conditions should you screen for at diagnosis?
Enteroviruses
Mumps
CMV
Other diseases to screen for at diagnosis:
- coeliac disease
- Thyroid disease
What advice would you give to a child who is newly diabetic?
Technique of injections
Sick day rules
- increase monitoring
- up insulin if needed
Hypo recognition and management
Importance of moving injection sites
When should insulin be started in a child with DKA? and what monitoring are you going to do of a child with DKA?
Start insulin 1 hour after initiating fluid therapy
Monitoring during treatment:
- Blood glucose level
- BP
- HR
- GCS
- ECG (for hypokalamia)
Can prematurity be associated with delay in milestones?
Yes
What is the only absolute indication for circumcision?
and
What is an absolute contraindication for circumcision?
Balanitis Xerotica Obliterans
Hypospadius
- often foreskin is used to repair the defect
If a child is dehydrated how much fluid should they receive?
You should aim to correct the dehydration in 48 hours.
This is achieved by:
- If 5% dehydrated: Add 50mls/kg on top of maintenance fluid over 48 hours
- if 10% dehydrated: Add 100mls/kg on top of maintenance fluid over 48 hours
Whats the pathology, risk factors and management of retinopathy of prematurity?
Excessive oxygen shuts off vascular endothelial growth factor in the retina creating relative hypoxia
- this leads to excessive blood vessel formation damaging retina.
Risk factors:
- preterm <32 weeks
- oxygenation
- low birth weight
Management:
- 90-95% oxygen
- Laser therapy
Outline some of the differences in ABCDE management of a child:
Airway:
- <6 months obligated nasal breathers
- Larger heads - more prone to flopping forward
- larger tongue
- horseshoe epiglottis
*head bobbing in children is accessory muscle use
Breathing:
Circulation
- higher HR due to reduced stroke volume
- Higher circulating volume per Kg but overall lower so minimal blood loss may be a lot to a child
- urine output <1ml/kg
- *IO access is often needed over IV
Disability:
- AVPU
- Posture (hypotonic?)
- Fontanelle
- Glucose
*glucose bolus 2ml/kg of dextrose followed by infusion
Exposure:
- bruising
- skin rashes
Prior to given fluids what things should you check in a paediatric patient?
Clinical condition
Weight
Input/ output
BP
Bloods which have recently being done
In which settings are the fluid boluses and maintenance fluids different and what are they?
DKA, Major Haemorrhage , trauma
10ml/kg bolus
0-10kg = 2ml/kg/ hour 10-40kg = 1ml/kg/ hour >40kg = fixed volume of 40ml/kg/ hour
Which of the manoeuvres for DDH do what?
Barlow’s
- dislocates
Ortalini
- reconnects
List some causes of a neonate presenting with shock:
Sepsis - No.1
Congenital cardiac disease
Metabolic
- hypoglycaemia
Surgical
- malrotation
- NEC
Outline your management of a child with croup:
Mild (no symptoms at rest)
- Dexamethasone 0.15mg/ kg
- discharge home
Moderate (symptoms at rest)
- Dexamethasone 0.15mg/ kg
- admit for observations
Severe: (high RR, severe stridor, distressed)
- Oxygen
- Nebulised adrenaline 5ml 1:1000
- Dexamethasone IV
- PICU support
What are the types of spina-bifida and what are some complications and what are some treatment of the more severe forms?
Spina -bifida occult
Meningocele
Myelomeningocele
Complications:
- Hydronephrosis (atonic bladder)
- hydrocephaly (Arnold Chari formation)
- Constipation/ incontinence
- Spinal tethering
- Shunt blocking *presents with change in behaviour
- ADHD
- seizures
Investigations:
- Anomaly scan 20 weeks
- Alpha-fetal protein levels (high)
- MRI of head and spine (Arnold Charlie malformation)
- US of abdomen (usually for meningocele initially)
Management:
- Surgical closure
- Physiotherapy
- Intermittent catherization and
- Orthopaedics
- Seizure medication
What is called when there is neural tube defect causing protrusion of the brain and meninges in the skull?
Encephalocele
What are some of the clinical signs and complications of Duchene muscular dystrophy? investigations and management:
X-linked
Signs:
- Trendelenburg gait
- Pseudohypertrophy of the calve muscles
- Gower’s sign
- Kyphoscoliosis
Comorbidities:
- Cardiomyopathy
- Respiratory distress
- GORD
- intellectual impairment
Investigation:
- Creatine kinase level
- Dystrophin (can be done by biopsy)
Management:
- Nutrition
- ACE + Beta blockers
- Respiratory support (BiPAP, tracheostomy)
- Surgery (lengthen tendons)
- Corticosteroids
What are the differences in DMD and BMD?
DMD:
- out of frame deletion
- More common
- more severe
- Early onset ~ 3 years
- Life expectancy ~20 years old
BMD:
- in frame deletion
- less common
- less severe
- Around 10 years old
- 40 years old life expectancy
In suspected congenital heart disease what immediate tests do you want?
Echocardiogram
ECG
CXR
What are some differentials on auscultation of a wheezy chest?
Asthma
Viral induced wheezed
Bronchiolitis
Bronchiectasis (CF)
List some causes of collapse with poor respiratory effort in a 6 week old baby:
Sepsis
Congential cardiac disease
NAI
Post seizures
