Paeds Flashcards
Infantile spasms
West syndrome
Childhood epilepsy presents in first 4-8 months
More common in males
Carry poor prognosis- serious underlying condition
Features
Salaam attaches; flex ion of head, trunk arms followed by extension of arms
Lasts 1-2 sec, may be repeated up in 50 timers
Progressive mental disability
Investigation
EEG- Hypsarrhythmia in 2/3
CT- diffuse/ localised brain disease
Congenital rubella
Sensorineural deafness Congenital cataracts Congenital heart disease- PDA Growth retardation Hepatosplenomegaly Salt and pepper chorioretinitis CP
Toxoplasmosis
Cerebral calcification Chorioretinits Hydrocephalus Anemia Hepatosplenomeg Cerebral palsy
CMV
Most common congenital infection Growth retardation Purpuric skin lesions Sensorineural deafness Encephalitis/seizures Pneumonitis HSmegaly Anemia Jaundice CP
Estropia
Exotropia
Hypertropia
Hypotropia
Eye moves to nose
Eye moves temporally
Eye moves upwards
Eye moves downwards
Squint
Strabismus - misalignment of the visual axes
Can be concomitant (common) and paralytic (rare)
Diagnosis
Corneal light reflection test
Cover test- cover eyes and watch movement
Mgmt;
Eye patches to prevent amblyopia
Referral to secondary care
Concomitant squint
Due to imbalance in extraocular muscles
Convergent is more common than divergent
Paralytic squint
Due to paralysis of extraocular muscles
Trinucleotide repeat disorders
Associated with anticipation Fragile X CGG Hungtintons CAG Myotonic dystrophy CTG Friedreichs ataxia GAA.
6 in 1
Diphtheria H influenza B Pertussis Polio Tetanus Hep B
Vaccines ages
2 4 6 12 13 months
Vaccines at 2 months
6 in 1
Men B
Rotavirus
PCV- PNEUMOCOCCAL
3 injections + oral drops
Fever common after men B- 2.5mls at injections, 4-6hrs up to 4 doses
Mild diarrhoea after rotavirus- extra milk, wash hands
Loose clothes- sorenes, redness, swelling at site
Vaccines at 4 months
6 in 1
Men B
Rota virus
2 injections and oral drops
Precautions
6month vaccines
6 in 1
PCV
Men C
3 injections
Soreness
Fever
Headaches and irritability
12 months vaccines
MMR
Men B
- rash 6-10 days after MMR- mini measles, not contagious
13 months vaccines
Hib
Men C+ PCV
2 injections
Acute epiglottitis
Most common cause h INFLUENZA
Less common by strep pyogens, pneumonia
Features; Rapid onset High temp Very unwell Stridor Drooling saliva
Developmental dysplasia of the hip
Replacing old term- congenital dislocation of the hip,
Affects 1-3% newborns
RF; Female x6 more likely Breech Family hx Firstborn Oligohydramnios Birth weight <5kg
More common in left hip, 20% are bilateral
Ortolani and Barlow method
US to confirm
Treat;
Most unstable will spontaneously stabilise by 3-6 weeks
Under 4months- pavlik harness
Older- surgery
Palau
Trisomy 13
Microcephalic Small eyes Cleft lip/palate Polydactyl Scalp lesions
Edwards
Trisomy 18 Micrognathia Low set ears Rocker bottom feet Overlapping fingers
Fragile x
Learning difficulties Macrocephaly Long face Large ears Macro orchidism
Noonan syndrome
Webbed neck
Peru’s excavating
Short stature
Pulmonary stenosis
Pierre robin syndrome
Micrognathia
Posterior displacement of the tongue
Cleft palate
Prader willi
Hyptonia
Hypogonadism
Obesity
William syndrome
Short stature
Learning diffficulties
Friendly
Supraventrcular neonatal stenosis
Necrotising entercolitis
One of leading cases of death among premature infants.
Initally symptoms can include feeding intolerance, abdo dissension and bloody stools.
Progress to perforation and peritonitis
Abdo x-ray can show
Dilated bowel loops
Bowel wall oedema
Intramural gas
Portal venous gas
Rigler sign- air in and outside bowel wall
Football sign - air outlining falciform ligament
Chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Usually anterior pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physio
Osgood- schlatter disease
Seen in sporty teens
Pain, Tenderness and swelling over tibial tubercule
Osteochondritis dissecans
Bone underneath the cartilage of a joint dies due to lack of blood flow
Pain after exercise
Intermittent swelling and locking
Patellar subluxation
Medical knee pain due to lateral subluxation of the patella
Knee may give way
Patellar tendinitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on exam
Capput succedaneum
Involves a fluid colllection with poorly defined margins caused by the pressure of the presenting part of the scalp against the dilating cervix during deleviery
Bleeding below scalp above the periosteum
Present at birth
Resolves in days- no treatment
Cross the suture lines
Cephalohaematoma
Develops several hours after birth
Most common in partial region, doesn’t cross sutures
No treatment
Months of resolve
Sub periosteal
Kawasaki disease
Type of vasculitis predominately seen in children
Can be associated with serious complications- including coronary artery aneurysms
Fts;
High grade fever- lasts over 5 days - resistant to anti pyretics
Conjunctival infection
Bright red cracked lips
Strawberry tongue
Cervical lymphadenopathy red palms and soles
ClINICAL DIAGNSOIS
High dose aspirin
IV immunoglobulin
Echo
Croup
URTI in infants and toddlers
Strider- laryngeal oedema and secretions
Usually causes by parainfluenza virus
Usually 6months- 3years
More common in autumn
Features
Strider barking cough
Fever
Coryzal
Admit if morderate to severe croup
Treat with a single dose oral dexamethaosine to all
Hand foot and mouth disease
Self limiting condition affecting children
Caused by coxsackie a16 or enterovirus
Very contagious and typically occurs in outbreaks
Clinical features
Mild systemic upset- sore throat and fever
Oral ulcers
Vesicles on palms and soles
Hydration and analgesia
If unwell should be kept off school until they feel better
X linked recessive
Only males are affected
Affected males can only have unaffected sons and carrier daughters
Vesicoureteric reflux
Abnormal backflow of urine from the bladder into the ureter and kidney
Common enough abnormality - predisposes you UTI
Important to investigate for VUR in children following a UTI
Ureters are displaced laterally, entering the bladder in a more perpendicular fashion
Diagnosis following a micturating cystourethrogram
DMSA scan to look for renal scarring
Asthma management
First line is now an inhaled corticosteroid low dose even prior to formal diagnosis being made.
Next step is laba if over 5 and leukotriene receptor antagonists if under
Saba prn if using more than 3 times per week - not controlled
Bronchiolitis
Characterised by acute bronchiolar inflammation
Rsv is cause in 75-80% of cases
Peak age of incidence is 3-6 months
Higher incidence in winter
Features Coryzal symptoms Dry cough Increasing breathlessness Wheezing Feeding difficulties
Hospital if
Resp rage over 60,dehydration
Humified oxygen
Suction
Ng feeding
Roseloa Infantum
Caused by HHV6 common in infancy
High fever Then Maculopapular rash- not itchy Febrile convulsion in 10-15% Diarrhoea and cough
Complications
Hepatitis
Aspectic meningitis
Hirschsprung disease
Caused by an aganglionic segment of bowel due to failure of development of the Meisser plexus
Rare 1/5000
Important in differential of constipation
Presentations
Neonatal Period- failure or delay to pass meconium
Older; constipation
Abdo dissension
3 times more common in males
Down syndrome
Constipation
Usually under 6 months 3 per day
After 3 once per day
Causes of constipation
Dehydration Low fiber Meds like opiates Anal fissure Over enthusiastic potty training Hypothyroidism Hypercalcaemia Hirschsprung’s disease Learning disabilities
Red flags constipation
Reported from birth or first few weeks Ribbon stools Faltering growth Locomotive delay Abdo distenion
Nocturnal enuresis
Most children achieve nocturnal and day continence by 3 or 4
Enuresis is defined as the involuntary discharge of urine by day or night or both in children over 5 in the absence of congenital or acquired defecting in CNS or urinary tract
Can be primary- never achieved continence
Secondary have been dry for at least 6 months before
Enuresis alarm first line under 7
Desmopressin if over 7
Thread worms
Treat with mebendazole if over 6 months . Single treatment
Anthelmintic and hygiene for all the family
Pyloric stenosis
Typically presents in 2nd to 4th week of life with vomiting
Caused by hypertrophy of the circular muscles of the pylorus
4 in 1000
4 times more common in males
10-15 % have a positive family history
First borns are more commonly affected
Features Projectile vomiting 30mins after feed Constipation and dehydration Palpable mass in upper abdo Hypochloraemic hypokalaemic snd alkalosis
Mgmt with ramstedt pylormyotomy
CF management
Regular - at least twice weekly chest physio and postural drainage
High calorie, high fat diet
Vitamin supplementation
Pancreatic enzyme at every meal
PYLORIC STENOSIS
Males > females
5-10% have a family history
Projectile non bile vomit at 4-6 weeks
Test feed and US needed
Tx w/ ramstedt pyloromyotomy
Acute appendicitis
Uncommon in under 3
If present- usually will present in atypical manner
Mesenteric amenities
Central abdo pain and URTI
Conservative management
Intussception
Telescoping bowel Proximal or at the level of the ileocaecal valve 6-9 months Colicky pain, diarrhoea and vomiting Sausage shaped mass Red jelly stool
Treat; reduction with air insufflation
Malrotation
High calcium at the midline Exomphalos Congenital diaphragmatic hernia Need upper GI contrast study Treatment is by laparotomy
Oesophageal atresia
May present with chocking and cyanoitc spells
Hilary atresia
Jaundice >14days
Increased conjugated bilirubin
Urgent Masai procedure
Intraventricular haemorrhage
Most commonly associated with spastic diplegic cerebral palsy due to anatomical proximity of the corticospinal tracts
Cerebral palsy
Disorder of movement and posture due to a non progressive lesion of the motor pathways in the developing brain
2/1000 births
Abnormal tone early infancy
Delayed motor milestones
Abnormal gait
Feeding difficulties
60% learning difficulties
30% epilepsy
30% squints
20% hearing impairment
Causes of CP
Antenatal 80%- maternal torch infections
Intrapartum 10% birth asphyxia/trauma
Postnatal 10% intraventricular haemorrhage, meningitis, head trauma
Classification of CP
Spastic 70%- hwmiplegia, diplegia, quadriplegia
Dyskinesia
Ataxia
Mixed
Growing pains
Benign idiopathic nocturnal limb pains of childhood Common boys and girls 3-12 Never present at the start of the day No limp No limitation of physical activity Systemically well Normal exam Motor milestones normal Symptoms are often intermittent and worse after a day of vigorous activity
Meningitis in children
Neonatal to 3 months
Group b STREP
E. coli
Listeria
1month- 6years
N. Meningit
Strep pneumonia’s
H influenza
Over 6
- h influenza
Neonatal resus
Dry baby- start the clock
30s - assess tone breathing heart rate
60s gasping or not breathing 5 rescue breaths
Reassess
APGAR score
Activity Pulse Grimace Appearance Resp
Activity apgar
0 ABSENT
1 FLEXED ARMS/LEGS
2 ACTIVE
Pulse
0 absent
1 below 100
2 over 100
1
Grimace
0 floppy
1 minimal response to stimu;action
2 prompt response
Appearance
0 blue/ palse
1Pink body, blue extremities
2 pink
Resp
0 absent
1 slow and irregular
2 vigorous cry
APGAR results
0-3 very low
4-6 mod low
7-10 good state
Fetal alcohol syndrome
Baby may show symptoms of withdrawal at birth- irritable. Hypotonic, tremors
Features Short palpebral fissure Thin vermillion border Smooth/ absent Philtrum Learning Disabilities Microcephaly Growth retardation
Odds of baby with DS
20, 40 45
20 1 IN 1500
40 I IN 100
45 1 IN 50 or greater
Causes of Down syndrome
Non dysfunction 94%
Robertsonian translocation 5%
Mosaic is 1%
Causes of neonatal hypoglycemia
Maternal DM Prematurity IUGR Hypothermia Neonatal septic Inborn errors of metabolism
Labetolol use in mum
Pertussis
Gram neg
2-3 days of coryza then
Coughing bouts- worse at night and after feeds
Inspiratory whoop
Marked lymphocytosis
Nasal swab to diagnose
PCR and serology
Tx with macros due
Li Fraumeni syndrome
A dominant
Mutations in p53
Sarcomas and leukaemias
BRCA 1 & 2
Carried on chromosome 17-1 and 13-2
60% increased risk of breast cancer
55% increased risk ovarian cancer 1 and 23% with 2
Lynch syndrome
A dominant
Colonic cancer and endometrial cancer at young age
80& of affected individuals will get colonic and or endometrial cancer
Gardeners syndrime
A dominant Multiple colonic polyps Skull Oreo a thyroid cancer epidermoid cysts Dermoid tumors Variant of FAP APC Gene on chrom 5
Respiratory distress syndrome
Caused by insufficient surfactant production and immaturity of the lungs
50% born at 26-28 weeks
25% 30-31 weeks
Other risk factors Male Diabetic mothers C section Second born of premature twins
Cf; tachypnoea, intercostal recession, expiratory grunting, cyanosis
CXR ground glasss appearance
Kawasaki disease
Type of vasculitis - usually seen in kids, uncommon
Features- high grade fever> 5days, resistant to anti pyretics
Conjucntival infection
Bright red, cracked lips
Strawberry tongue
Cervical LN
Red palms and soles
Mgmt
High dose aspirin
IV immunoglobulin
Complications; coronary artery aneurysm
Retinoblastoma
Most common ocular malignancy in kids. Diagnosis usually 18months
Absence of red eye reflex
Strabismus
Visual problems
Treat;
Radiation, chemo
Enucleation
Prognosis is excellent
Vitals
1 2, 2-5, 5-12, 12>
<1 HR 110-160 RR 30-40
1-2 HR 100-150 RR 25-35
2-5 HR 90-140 RR 25-30
5-12 HR 80-120 RR 20-25
Moro
Gone at 3-4 months
Grasp
4-5 months gone
Rooting
Gone at 4 months
Stepping
Gone at 2 months
Autism
75% are male Usually develops before 3 Need all 3 of Global impairment of language and communication Impairment of Social relationships Ritualistic and compulsive behaviour
Associated with retts and fragile x
Perthes disease
Degenerative condition affecting the hip joints of children
Usually between 4-8
Avascular necrosis of the femoral head and infarction
5x tomes more common in boys
Fts; Hip pain- develops over weeks Limp Stiffness and reduced range of movement X-ray changes- joint widening, decreased femoral head size
Complications
OA
Premature fusion of the growth plates
Mgmt
Cast and braces, to keep femoral head on acetabulum
Observe if under 6
Epstein’s anomaly
Caused by lithium use in pregnancy
Displacement of the posterior leaflets of the tricuspid valve
Causes TR and TS + enlargement of the right atrium
Acyanotic heart disease
VSD- most common ASD PDA Coarch AS
Cyanotic heart disease
TOF
TGA
Tricuspid atresia
Chickenpox
High infectious
Spread via resp
Infectivity- 4 days before rash and 5 days after rash has appeared- usually they say to keep them out until all lesions have crusted over
Features Fever initally Itchy rash starting on head/trunk before spreading Macular, papular then vesicles Systemic upset is mild
Keep cool, trim nails
Calamine lotion
Rare complications
Pneumonia
Encephalitis
SIDS
Commonest cause of death under 1 year, peaks at 3 months
RF; Prematurity Parental smoking Hyperthermia Putting baby to sleep prone Male Bottle feeding Social classes Winter
Minimal change disease
75% of nephrotic syndrome cases in kids
Most idiopathic
Features
Nephrotic syndrome
Normotension
Renal biopsy- fusion of polo types
Manage
80% steroid responsive
Cyclophosphamide if resistant
Relapse is common
Scarlet fever
Group a strep
More common in 2-6 year old- peak at 4
Incubation period of 2-4 days Fever Malaise Tonsillitis Strawberry tongue Rash- pinhead, first on torso, spares the face- can be flushed, sandpaper texture Desquaimation around fingers and toes Mgmt; Oral penicillin V Notifiable disease Return to school 24hrs after antibiotics
Complications
Otitis media
RF
Acute glomerulonephritis
Scaphoid abdomen and bilious vomiting
Interstitial malrotation
Displaced apex beat and decreased air entry
Diaphragmatic hernia
Coeliac disease in children
Children normally present before 3 following the introduction of cereals into diet
Obesity in children
Common cause; lifestyle factors
Causes; Growth hormone deficiency Hypothyroidism DS Chyshings Prayer- Willi
Consequences; Orthopedic problems Psychological- poor self esteem Sleep apnea Benign intercrainial hypertension Increased dm2, HYPERTENSION, ischaemia heart disease
