Paeds 7 Flashcards
How should blood pressure be measured in a child and name some causes of hypertension in a child/ neonate:
Measurement taken with a cuff that is 75% the width of the arm
Neonate:
- renal hypo dysplasia
- Polycystic kidney disease
- Coarctation
- Chronic lung disease
- intracranial hypertension
Children:
- renal disease
- Wilm’s tumour
- Neuroblastoma
- Mineralocorticoid excess
- Raised ICP
*drug related for both
What are hypertrophy of the adenoids associated with?
Snoring
Green rhinorrhoea
Sleep apnoea
COM with effusion
What is the most common cause of sleep apnea?
Enlarged adenoids which may also cause COM with effusion
What is the point of the newborn baby checks?
To assess for any abnormalities and refer if needed
Reassure family and check for normality
What are some structural abnormalities on a new-born baby test which could be found?
DDH
Craniosyntosis
Birthing injuries - Erb’s palsy
Name some things the Guthrie heel prick test examines and how:
CF Sickle cell Congenital hypothyroidism PKU Maple syrup urine disease MCADD
CF: immunoreactive trypsinogen
Thyroid: TFTs
What is the treatment for Meconium aspiration syndrome?
Surfactant ventilation (meconium shuts off surfactant production)
Inhaled nitro oxide
IV antibiotics
*it is a diagnosis of exclusion and is associated with post-term labour and Meconium stained amniotic fluid (MSAF)
In a newborn with jaundice - what things do you want to test for?
Sepsis
Coomb’s test
Haemoglobinopathies testing
What investigations are done into biliary atresia?
Abdominal US
- absence of ducts
HIDA scan
- shows that bilirubin is taken up by the liver but no excreted.
What is the surgical procedure for biliary atresia and what are some complications?
Kasia - Porto - enterostomy
Complications :
- ascending cholangitis
- liver cirrhosis
*20% need a liver transplant
What is oesophageal atresia’s usually associated with?
Usually associated with Tracheo-ospheageal fistulas
*more common in Down’s syndrome
there is also often other defects which include:
- Cardiac
- renal
- ano-rectal
- limb defects
What may be a cause of facecloth matter in the urine in a newborn? what is the treatment and investigations?
Ano-rectal malformation with fistula
Imperforated anus is usually picked up on baby checks. but may present with:
- bowel obstruction
- bilious vomiting
Abdominal x-ray is needed
Treatment:
- nil by mouth
- NG tube
- surgical
How is Gastroschisis management?
NG tube
IV fluids
IV antibiotics
TPN
Primary closure
or
Preformed silo
What is and How is omphalocele managed?
Midline defect. it is a umbilical hernia which has allowed the abdominal contents t leak out.
Minor (contains small amount of gut)
- surgically and discharged 48 hours later
Major:
- dressing to allow keratinisation
- surgically repaired potentially years down the line
What is duodenal atresia highly associated with and what is the x-ray finding?
30% of cases associated with Down’s syndrome
*double bubble sign seen on x-ray
In terms of the red flags for a fever in a child - what are they and what is your next set of actions?
Pale/ Mottled/ Blue appearance
Non- responsive to cues
Appears ill to professional
Does not wake if aroused
Weak or high pitched cry
Grunting
RR>60
Reduced skin turgor
Age < 3 months Non-blanching rash bulging fontanelle Neck stiffness Status Focal neurological or seizures
**any child scoring these should be admitted and worked up for sepsis
Paediatric sepsis:
Proven infection + 2 of the following:
- Fever <36 or >38
- Tachycardia for their age
- Altered GCS
- Reduced peripheral perfusion
- High flow oxygen
- Bloods (blood cultures, lactate, glucose)
- IV or IO antibiotics
- 20ml/kg fluid over 5-10mins
- Early inotropic support (adrenaline)
- Involve senior clinicians early (PICU if inotropes started)
List the four name investigations warranted into henoch schonlein purpura and what are some complications?
Bloods:
- FBC
- U&Es (kidney function)
- Coagulation (rule out coagulopathies)
- Albumin
- complement levels
Orifices:
- urine dip
Complications:
- Glomerulonephritis
- Arthropathy
- pancreatitis
- Intussuception
- Orchitis
What is the treatment for Phenylalanine?
Autosomal recessive condition
Treatment:
- Low pheylalanine diet + amino acid supplementation
- remember it is an essential amino acid
Outline the main causes of a short stature in a child and what are the most useful tools available to help establish if something is pathological?
- useful tools:
- mid parental height
- Growth charts
Dysmorphic features:
- Down’s syndrome
- Turner’s
- Noonans
Abnormal upper to lower body ratio:
- Achondroplasia
- Spinal defects
- Rickets
Normal upper to lower body ratio:
- constitionally small
- SGA without catch up
- chronic disease
- malnourishment
Normal upper to lower body ratio but an abnormal weight to height:
- hypothyroidism
- cushing’s disease
- Growth hormone defects
What are the causes of hypoglycaemia in a child and list some important investigations to conduct:
Endocrine:
- Adrenal insufficiency
- Hypopituitarism
- Insulin therapy
Metabolic:
- Glycogen storage disease
- MCADD
Poisoning:
- Salicylates
- Insulin
Systemic disease:
- sepsis
- Liver disease
Important investigations: Bloods: - Glucose - ABG (if severe lactic acidosis through anaerobic respiration can take place) - ketones
- LFTs (metabolic disease)
- Insulin C-peptide
- Cortisol levels (adrenal hyperplasia)
- Free fatty acid workup (MCADD)
What is the bolus given to a child with severe hypoglycaemia?
2ml/kg bolus of dextrose 10%
*remember to place them on infusion following this.
IM glucagon can be given as well
What is a differential for a seizure where child becomes pale and limp then develops Clonic movement, followed by recovery: list some investigations that should be conducted:
Reflexic Anoxic Seizures
Investigations:
- EEG
- ECG (long QT)
- Glucose
List some places on the body that would raise suspicion for NAI:
Cheeks - may leave petechia marks between fingers from a slap
Ears
Forearms
- raised for defence
Chest/ Abdomen
Genitals
Inner thighs
Soles of feet
What are the clinical findings of someone with tubal sclerosis and what investigations should be undertaken in them?
ASHLEAFS
- Ashgreen spots (fluoresce under UV light)
- Shagreen spots
- Heart rhabomyosarcoma
- Lung/ eye hartomas
- Epilepsy/ learning difficulites
- Angiolipomyomas / cysts of the kidney
- Facial angiofibrosis
- Subungunal angiofibrosis
Investigations:
- Head MRI
- EEG
- Abdominal MRI
- Ophthalmology examination
What chromosomes are implicated in NF-1 and NF-2?
NF - 1
- chromosome 17
NF-2:
- chromosome 22
- more associated with hearing loss and intracranial tumours
What is Struge-Weber Syndrome?
Sporadic vascular disease associated with:
- Port wine stain across V1 distribution
- Leptomeningeal angiomas on the pia matter - causes seizures. Usually con-lateral side
- Abnormal eye vessels causing glaucoma
Investigations:
- MRI
Management:
- seizure control
- Glaucoma control
What are some of the features that suggest there is an underlying pathology to a child’s short stature?
Dysmorphic features
Movement away from mid-parental height
Signs of chronic disease
Poor height velocity
What investigations should be conducted into a short child?
*investigations are guided by symptoms and likely underlying causes i.e. if dysmorphic features then genetic testing.
General test:
Bloods:
- FBC
- U&Es
- TFTs
- LFTs
- Coeliac screen
Orifices:
- faecal calprotectin
X-rays:
- Wrist for bone age
What two things may cause Henock Schonlein syndrome?
URTI
Vaccinations
What examinations and investigations should be done into precious puberty?
Examination:
- Assess genitals in males (testicular size using orchidometer)
- assess skin for any cafe-au-lait spots (McCune- Albright Syndrome)
- Hypothyroidism/ Cushing’s screening
Investigations:
Bloods:
- LH, FSH (raised suggests central cause)
- TFTs
- 17-hydroxyprogesterone (Congenital adrenal hyperplasia)
X-rays:
- wrist x-ray
- MRI head
- Testicular or pelvic US
