Paeds Flashcards
Bronchiolitis poem?
In kids under 1, there’s a common disease
With cough, snotty nose, crackles and wheeze
Always record the respiratory rate
If it’s severe, they’ll desaturate
Acyanotic vs Cyanotic heart disease examples for each?
Acyanotic:
- VSD
- ASD
- PDA
- pulmonary stenosis
- aortic stenosis
- co-arctation
Cyanotic:
- ToF
- Transposition of the great arteries
MURMURS!! ASD? VSD? - differentials? AS / pulmonary stenosis? PDA? Innocent murmur?
ASD - wide-fixed splitting s2 (delayed closure of P2)
VSD - pan-systolic (burrrrrr) - DDx - MR / TR
AS / PS - ejection systolic
PDA - machinery murmur (continous murmur)
Innocent - soft ejection systolic - LEFT STERNAL EDGE
What keep PDA open? How to close?
Open - prostaglandins
Closed
- indomethacin / ibuprofen
- Transcatheter occlusion / surgical ligation
VSD Ix + treatment? Small vs Large?
ECG (RVH), CXR, ECHO
Small: - None
Large:
- Repair (if risk of Pul HTN)
- Diuretics + ACE-I - for HF
ASD treatment?
Trans-catheter closure - via femoral vein + IVC to R atrium
ToF features?
What posture might the kid take - why?
PROVE (Infundibular) Pulmonary stenosis...causing: RVH over-riding aorta VSD - R-->L shunt Ejection systolic murmur
CYANOSIS + CLUBBING Squatting posture (partially occludes femoral = ^systemic resistance = more blood flow into PA through PDA = better oxygenation)
Surgery for ToF before definitive?
Blalock-Taussig shunt = R subclavian to Pulmonary artery
Helps PA flow + helps develop them
Transposition of great arteries:
- association
- Mx before definitive operation?
MATERNAL DIABETES!!
Prostaglandin infusion - keep PDA - DUCT DEPENDANT LESION
Atrial septostomy - encourage mixing
Down’s syndrome face / head features?
Others?
ROSEOLA (n.b. roseola not more common in down’s)
Round face
Occipital flattening (&nasal flattening)
Speckled iris (Brushfield spots) + Squint
Epicanthic folds
Open mouth + protruding tongue
Low set ears
Almond (oval) up-slanted eyes
Others:
Hand - single transverse palmar crease, short fingers, curved little finger
Feet - sandal gap
Down’s associations?
Heart specific? -bit on embryo pls
Duodenal atresia (double bubble) Hypothyroid, coeliac, Hirschprung's, squint, leukaemia
HEART: - endocardial cushion defect –> failure of septation
- ASD, VSD
- AV canal defect - low ASD + high VSD
- MR + TR
Roseola? What is it?
6th disease! 3+3
Mild viral infection - herpes virus 6
Age 6months - 2 years
3 days fever –> 3 days viral macules on chest (i.e. 3+3)
Kawasaki’s age + symptoms?
Major complication?
6months-5years
CRASH and BURN (MyHEART as well ;) )
Conjunctivitis (bilateral + non-purulent)
Rash - non-vesicular
Adenopathy (cervical + unilateral)
Strawberry tongue + inflammation of mouth + lips (cracked lips)
Hands/feet - palmer erythema/swelling/desquamation (2-5days after onset)
Fever > 5days (BURN)
Comp - coronary artery aneurysm!! (do ECHO) –> deaths+signif. morbidity
Heart Failure - symps, signs, causes (neonate + infant)
symps:
poor feeding, sweating, SOB, poor weight gain, recurrent chest infections
Signs:
- tachypnoea, tachycardia
- extra HS - ‘gallop’ rhythm
- cardiomegaly, hepatomegaly
NEONATES - hypoplastic left heart, co-arctation
- VSD + PDA - L–>R shunts
Rheumatic Fever Tx + Organism
Diagnostic Criteria?
Group A B-haemolytic Strep - PYOGENES JONES criteria - 2major / 1major+2minor - (JONES PEACE) Joints - large joint arthritis O - carditis N - nodules - painless + subcutaneous E - erythema marginatum S - syndenham's chorea
P - PR interval prolongation E - ESR v raised A - arthralgia C - CRP raised E - elevated temp
Aspirin
Benpen - help strep throat
Prednisolone - for Syndenhams chorea (consider haloperidol)
Infective endocarditis:
Most common symps?
Signs
*Most common - fever, chills, weight loss, poor appetite
FROM JANE:
Fever>38 + tachycardia
Roth spots - eyes, retinal haemorrhage with pale centre
Osler’s nodes - painful red blisters @ terminal phalanges + toes
Murmur - tricuspid w/ s.aureus
Janeway lesions - painless red maculae on thenar eminence
Anaemia/arthritis: subacute - >3 joints (asymmetrical). acute: 1 joint septic
Nail splinter haemorrhages
Embolic phenomena - e.g. stroke
Co-arctation.
Association?
Key sign? Murmur?
TURNER’S!
Radio-femoral delay
Systolic murmur over BACK
Only Tx option for Eisenmengers?
heart-lung transplant
Paediatric Basic Life support algorithm?
DR ABC
DANGER:
SAFE approach (shout for help, approach with care, Free from danger, evaluate response)
RESPONSE - ‘are you okay?’
AIRWAY - head tilt, chin lift, jaw thrust
BREATHING:
- look, feel, listen
- 5 RESCUE BREATHS (different to adult as doing this first)
CIRCULATION: - pulse (>60) - CPR if <60
15 CHEST COMPRESSION : 2 BREATHS
999 after 5rounds / 1 minute!!
Common life support q’s:
How long to continue CPR?
When perform CPR in presence of pulse?
What are signs of life?
1.
until further help arrives
until signs of life noted
until exhausted
- <60
thready pulse in collapsed child
no signs of life - spontaneous breathing
spontaneous movement
response to stimulation
Anaphylaxis.
Features
Management algorithm
Mucosal membrane swelling, increased bronchial smooth muscle tone, loss of vascular, ^capillary permeability
Urticarial rash, wheeze, stridor, lips/face/tongue swelling
1.
ABCDE
2.
Call for help & remove allergen
3. Adrenaline IM (repeat after 5mins) 1in1000!!! - 0.15ml <6yrs - 0.3ml 6-12yrs IV fluid bolus - hypotension Neb salbutamol
- (following intial resus)
- IV hydrocortisone
- Antihistamine - chlorphenamine
- Blood IgE panel / skin prick test
- education of apotting anaphylaxis + auto-injectors (i.e. epipen)
Meningococcal sepsis bug? gram pls
Meningitis features
Sepsis features
N. Meningitidis - g-ve diplococcus
Meningitis:
- Neck stiffness
- Kernig’s
- Photophobia
- BULGING FONTANELLE - ^ICP
Systemic sepsis:
- Non-blanching rash
- reduced consciousness
- shock
- multi-organ failure
- DIC
TRAFFIC LIGHT SYSTEM.
General upset for intermediate risk? Amber
AMBER Appears pale (to parent/carer) Mucous membranes dry / reduced intake Behaviour / responsiveness reduced Elevated resp / HR Rigors
V general meningitis Mx?
Additional points if:
If shocked?
If raised ICP
LP
IV ceftriaxone (+dexamethasone)
[BenPen if community]
Shocked:
- No LP
- add bolus 0.9% saline
- consider inotropes
raised ICP:
- NO LP!!!!!!!!
DKA Mx?
What rule for fluid calculation in exam specifically in DKA?!?!?
ABCDE
0.9% saline (NaCl)
Insulin
K+ - to correct it as it falls
If shocked = give bolus - REDUCED FLUID RULE (10ml/kg 0.9% saline)
FLUID RULES:
Dehydration:
-10% if severe = pH <7.1
-5% if mild = pH >=7.1
Reduced fluid rule - DUE TO RISK OF CEREBRAL OEDEMA
- <10kg = 2ml/kg/hr
- 10-40kg = 1ml/kg/hr
0 >40kg = fixed 40ml/hr
Status epilepticus management!
Oh My Lord Phone the Anaesthetist
Oxygen (after ABC)
Midazolam (buccal / rectal diazepam / IV lorazepam)
Lorazepam IV
Phenytoin IV
Rapid induction of anaethesia - risk of aspiration!!
ALL - 3comps + bit on path + Tx for each
Bone marrow failure
- malignant infiltration of bone marrow
- Pancytopaenia
- Transfusion / BM transplant
Neutropenic Sepsis
- low WBC
- Broad spec ABx
Tumour Lysis Syndrome
- Renal failure - SECONDARY to:
- ^urate, ^phosphate, ^ potassium
- AFTER STARTING CHEMO
- hyperhydration, allopurinol, dialysis, rasburicase
- sort ^K+
4 types of child abuse?
Physical (NAI)
Emotional
Sexual
Neglect
Osteogenesis imperfecta what is it / path? genetics? symps/features? 2 associations X-ray features - 2 pls
Group of conditions affecting collagen
Results in brittle bones=prone to #
AD - affects type 1 collagen
Blue sclera Triangular face Lax ligaments Fractures from low force Hearing loss - later on
Aortic regurg
Otosclerosis - conductive deafness
Osteopaenia + multiple healed fractures
Monogolian blue spot What / where are they? Ethnicity? Do they go away? May be confused with?
Blue/grey discolouration present from birth
Buttocks + base of spine (also wrists)
Asian / afro-carribean
Yes after about 5 years
Can be confused with bruising - i.e. ?NAI
Scalded skin syndrome
What is it? Bug?
Appearance?
Where does it affect?
Superficial staph infection
Thin walled bullae - rapidly burst
erythematous base - looks like a burn
skin folds + axilla affected
Vaccines? 8 week 12 week 16 week 1 year Pre-school booster 14 years
extra? i.e. girls / flu jab age?
DTPP - diptheria, tetanus, polio, pertusiss
HiB - H. influenza B
8 weeks - 2/12
- 6 in 1 - DTPP, HiB, Hep B
- Pneumococcal
- Men. B
- Rotavirus (oral)
12 weeks - 3/12
- 6 in 1 - DTPP, HiB, Hep B
- Rotavirus (oral)
16 weeks - 4/12
- 6 in 1 - DTPP, HiB, Hep B
- Pneumococcal
- Men. B
1 year
- HiB with Men C
- Pneumococcal
- Men B
- MMR
Pre-school
- 4 in 1 - DTPP
- MMR
14 years
- 3 in 1 - DTP (no pertussis)
- Men ACWY
EXTRAs:
- Annual Flu jab - age 2-7
- HPV x2 - Girls 12-13
Turner syndrome Path/Genetics Features Associations Diagnosis Management: drugs + monitor what?
1in2500 born girls!
Complete / partial absence of one of X chromosomes
SHORT STATURE + INFERTILITY
Neck webbing
Broad chest - wide nipples
Cubitus valgus - elbow angle out body wider
COARCTATION OF AORTA (?other cardiac defects aswell)
renal anomalies, AI thyroiditis, diabetes, learning difficulties, HTN, MIDDLE EAR DISEASE
Karyotype analysis
MDT - incl endocrine
- GH - optimise final height
- sex hormone replacement
- oestrogen - induce secondary sexual charact
- progesterone - induce menstruation
- IVF - for fertility
- Monitor - BP, diabetes, thyroid disease, hearing loss
GORD
Why does it occur? - think structural
When is it diagnosed over colic?
Complications of gord?
Management:
- simple measures
- stepwise approach
IMMATURE LOWER OESOPHAGEAL SPHINCTER
Colic = many babies pull legs up, arch backs and scream after feeds GORD - constantly miserable - coughing / wheezing after feeds - failing to put weight on
Comps:
- faltering growth / failure to thrive (vomming milk)
- oesophageal stricture (acidity in oesoph)
- Resp comps
- apnoeic episode
- reccurent micro-aspiration w/ wheeze/pneumonitis
Mx Simple: - wind baby - smaller, more frequent feeds - keep baby upright during feeds - add thickeners to feeds
Stepwise:
- Trial thickened formula = 2 weeks
- alginate = 2weeks (GAVISCON)
- ONLY if others failed + comps = PPI / H2 receptor antagonist:
- omeprazole / ranitidine
GI RED FLAGS = to query other Dx? Projectile vomit? Green, bile stained vomit? Chronic diarrhoea? Haematemesis / melena? Persists beyond 1 year? Acutely unwell with vomiting?
?Pyloric stenosis
?Obstruction / NEC / Gastroenteritis
?Cows milk protein allergy
? cause of bleeding
?UTI / other
?Sepsis
Gastroenteritis
Bugs. More commonly viral or bacterial?
Treatment?
VIRAL - more common!
- rotavirus, adenovirus
Bacteria:
- Salmonella, Campylobacter, E.coli
SELF-LIMITING
some need admission for rehydration
Signs of dehydration
Dry mucus membranes reduced urine output - less wet nappies? reduced skin turgor sunken eyes / fontanelle tachycardia lethargic/irritable
Haemolytic Uraemic Syndrome (HUS) Aetiology, bugs? Path Commonest cause of what in kids? TRIAD?? Best Ix? What is seen? Mx?
1-2 after onset of diarrhoea - E.coli (also shigella, campylobacter)
E.coli ‘shiga toxin’ –> endothelial damage in kidneys –> activation of coag cascade + microvasc thrombosis –> platelet aggregation (CONSUMPTION THROMBOCYTOPAENIA) –> fibrin/mesh partly occludes renal vessels (AKI) –> mesh shreds RBCs + fragments them (HAEMOLYTIC ANAEMIA w/ SHISTOCYTES)
commenest cause of AKI! (in kids)
TRIAD - AKI, LOW PLATELETS, HAEMOLYTIC ANAEMIA
FBC + Blood film
- SCHISTOCYTES
- low platelets, low Hb
Mx:
- supportive +/- transfusion
- dialysis for AKI
Pyloric stenosis
path/what is it?
Age?
CLASSIC FEATURE?
IX - classic findings?
Mx?
commenest surgical emergency in infancy!
Hypertrophy of gastric pylorus muscle (sphincter)
3-12weeks
NON-BILLOUS PROJECTILE VOMIT (yellow)
Watch for hyperperistalsis
HYPOKALAEMIC, HYPOCHLORAEMIC METABOLIC ALKALOSIS
U+Es - low potassium, low chloride
USS - thickened+lengthened pyloric muscle
Cap blood gas - metabolic alkalosis (i.e. high bicarb + BE)
Mx:
- ABC + nil by mouth
- NG tube
- IV access - fluid resus + maintenance
- Ramstedts pyloromyotomy
Pyloric stenosis buzzwords - i.e. Ix findings?
HYPOCHLORAEMIC, HYPOKALAEMIC, METABOLIC ALKALOSIS
Why lose K+ in Pyloric stenosis - 2 reasons
Why no alkalaosis in gastroent, but is in PS?
- lose stomach acid - K lost as KCl
- dehydration kicks off RAAS - K+ lost (aldosterone)
in gastroent = BOTH stomach acid + alkali small bowel contents –> evens out
Intussusception Emergency? Age? What may trigger it? Features? Diagnostic Ix - CHARACTERISTIC FINDING? Management?
DDx if reccurent - 2 pls
EMERGENCY!!
6mnths - 2yrs
Preceding viral illness - lymph node ‘lead point’
Episodic pain, indrawing of legs, pallor
RECURRANT JELLY STOOL - late sign (blood+pus in stool)
TARGET SIGN - on USS (diagnostic)
ABC
Air enema reduction / surgery
Polyp / meckel’s diverticulum
Coeliac disease What is it? 2 antibodies present? Genetics? Features Ix + diagnostic test? - What do you see - TRIAD Associations? Tx?
Comps if left undiagnosed?
Autoimmune allergy to gluten in wheat/barley/rye
Anti tissue transglutaminase Abs (Anti-tTg)
Anti endomysial Abs (Anti-EMA)
HLA-DQ2 + DQ8
Steatorrhoea
Faltering growth + short stature - kid smallest in class
5-6 loose stools per day
Distended abdo
Wasted buttocks
Pallor (anaemia) - iron deficient
Serology - Abs HLA testing Jejunal biopsy - DIAGNOSTIC - villous cell atrophy - crypt hyperplasia - lymphocytic infiltrate
DERMATITIS HERPETIFORMIS!!!!
other AI - pernicious anaemia, Hashimoto’s, T1DM
Lifelong gluten free diet
Gluten re-challenge if diagnosed <2years / diagonstic uncertainty (e.g. cows milk protein allergy)
Anaemia, faltering growth, osteopaenia = if left undiagnosed
UC or Crohns more common in kids?
CROHNS - childhood + adolescence
Cow’s milk protein allergy
Immunology?
Features?
Mx?
Do they grow out of it - if so what age?
IgE or IgG associated
Widespread urticaria, facial swelling
Loose stools, failure to thrive, colic/GORD
Severe - anaphylaxis type thing - wheeze, stridor, blood/mucus in stool, shock/collapse
Confirmed in blood with cows milk challenge
Skin prick test
IgE in blood - RAST test
Mx:
AVOID COW’S MILK
- in breastfed babies - mother avoid cows milk
- in formula fed - hypoallergenic extensively hydrolysed / amino-acid formula
Antihistamines - if allergic reaction
Adrenaline = if bad
Usually grow out of it by 5
Signs of resp distress?
Head bobbing Nasal flaring Tracheal tug Tachypnoea Recessions Use of accessory muscles
Bronchiolitis Age? Bug? Features? - rule of 3's (how long does disease last)? Ix? In what cases are these done? Mx? - what not to give?
kids under 1
RSV!!! others: adenovirus, influenza, parainfluenza
9 DAY ILLNESS
- 3 days - coryza + harsh cough
- 3 days ill w/ fever (<39), wheeze, fine inspiratory crackles, breathlessness
- 3 days recovering
NOT DONE UNLESS SERIOUS - i.e. CYANOSIS
- cap blood gas - resp acidosis?
- nasal swab - resp viruses
- ?cxr - not routine
Mx:
- Fluids, oxygen, resp support (if needing admission)
- if Severe! = HDU/PICU - CPAP, IV fluids
DO NOT GIVE
- STEROIDS
- ABX, BRONCHODILATERS
What prompts admission for bronchiolitis?
DRAMAS
Dehydration Resp rate >70 / marked increased WOB - recession/grunting Apnoeic episodes Milk/fljuid intake <50% of normal Appearance - ill / exhausted Sats <92%
Children that are high risk for bronchiolitis? 4 things
What are they given during autumn winter - monthly IM for 6 months
Premature
Chronic lung disease
CF
Congenital heart disease
Palivizumab - monoclonal AB to RSV
Asthma Ix + signs of severe asthma?
5 PROPS
Peak flow - <50% best/predicted RR >30 O2 sats <92% Pulse >125/min Sentances - too breathless to talk
Life threatening asthma?
33, 92 CHEST
PEF < 33% best/predicted Sats < 92% .... and any one of: - Cyanosis - Hypotension - Exhausation w/ poor resp effort - Silent chest - Tired / confused (i.e. reduced conscious level)
CHRONIC ASTHMA MANAGEMENT
>5?
<5?
> 5 = SAME AS ADULTS - but remove LTRA after step 3 –> whereas in adults it becomes (+/- LTRA)
<5 - essentially STOP AT STEP 3
- SABA
- SABA + 8week trial moderate ICS
- SABA + ICS + LTRA
ACUTE ASHTMA MANAGEMENT - kids
mild/moderate?
severe?
mild/moderate:
- inhaled salbutamol - SPACER NOT NEBULISER
- oral prednisolone
Severe = OSHITMS
Asthma
Description
Age
Associations
Reversible airway obstruction
usually >5
History of atopy? - hayfever, allergy, eczema
Viral induced wheeze What is it? Typical age? Important point/question to ask that can exclude asthma? Mx?
Wheeze episode - associated w/ viral URTI
typically children <5years
absence of strong atopy hx - eczema, hayfever
Treat as acute asthma - but only give steroids if pre-existing/suspected asthma
Croup Description? Bug? Age? Features? If severe - what added + what sats? Mx? if mild / mod / severe
Acute viral laryngotracheobronchitis
PARAINFLUENZA (others: RSV, influenza)
6months to 6years
Mild fever, hoarse voice
BARKING COUGH
STRIDOR
+/- resp distress (severe = marked + <94% sats)
Mx
Every child = DEXAMETHASONE +/- adrenaline nebs
Moderate (some resp distress + features) - add neb budesonide
Severe (marked resp distress + constant features) - add neb adrenaline
Epiglottitis
Bug? - common cause of this?
Difference in severity to croup - differentiating feature (other than barking cough)?
Mx?
SERIOUS!!
H.influenza - due to HiB vaccine
Very unwell + toxic (croup = mild-severe)
DROOLING - not seen in croup
LEAVE ALONE - get ENT/anaesthetist
Abx after securing airway
Bronchiolitis vs Croup vs Viral Wheeze Age In Common - maybe a bit too obvious hehe Typical differences / characteristic features Basic mx for each
Common features:
- ^WOB
- ^RR
Bronchiolitis
<1years
expiratory Wheeze, inspiratory crackles
Supportive Mx
Croup
6months - 6years
Barking cough, inspiratory stridor, NO crackles
Dexamethasone
Viral induced Wheeze
<5years
Wheeze, NO STRIDOR, NO CRACKLES
Bronchodilators (i.e. same as acute asthma)
Cystic fibrosis
AD or AR?
Mutation?
Brief path –> lead on to what this causes –> symps
Main bug in CF infections?
Ix - what is seen on each?
MDT - who’s involved?
AR!! F508 mutation
Mutation = abnormal CFTR (CF transmembrane conductase regulator protein) –> responsible for Cl transport!
= Thick secretions
= Pancreatic insufficiency (DM + Malabsorption)
+ Recurrent chest infections / Bronchiectasis
= Faltering growth / poor health / failure to pass meconium / chronic wet cough / clubbing (bronchiec)
Pseudomonas aeruginosa (H.influ, S.aureus, Klebsiella)
Newborn screening - ^ immunoreactive trypsin
Genetics - F508
Sweat test - GOLD = ^chloride - 2 abnormal for Dx
CXR - hyperinflation, bronchial thickeneing
Sputum - C+S
MDT:
- Dietician
- Physio
- Medical
- GP, Resp, GI, Endocrine, Paediatrician
- Nurses
Nephrotic syndrome (Non-proliferative)
Type in Kids? Other 2 types pls
TRIAD?
What is low, what is high? - i.e. in blood
What else is lost - 2 things? - what does this increase risk of - 2 things pls
Ix? what you looking for?
Minimal change in KIDS!
Membranous
FSG
Proteinuria, Oedema, Hypoalbuminaemia
Albumin low
Hyperlipidaemia –> compensatory liver protein synthesis
Loss of immunoglobulins - infection
Loss of anti-thrombin III - risk of clots!
FBC - haematocrit (intravascular volume depletion) + infection
U+E & creatinine - renal function
LFT - albumin
Urine - frothy, +++protein
Mx:
Steroids - pred
IV albumin = if fluid depleted
Penicillin prophylaxis
Nephritic
Most common type (hint:what bug) + other 2 pls
TRIAD?
Post-infective GN (strep)
IgA nephropathy
Rapidly progressive i.e. cresenteric (i.e. Vasculitis / Anti-GBM)
Haematuria - RBC casts
Oliguria/AKI
HTN
HSP - Henoch Schonelein purpura
What is it? What does it usually follow
Age?
TRIAD?
Ix? - what you checking for?
Mx?
IgA vasculitis
often recent URTI - Group A strep - Pyogenes
3-10years old
Abdo pain, arthropathy, Purpuric rash
Also renal involvement - i.e. Nephritic (sometimes nephrotic)
ankles, knees, elbows
Urinalysis - is it nephritic?
BP - HTN?
Intussuception ix
Paracetamol - pain
Steroids - kidneys
ITP
What is it? what does it usually follow
Features? where do you see it?
Ix - what do you see?
Mx? What to avoid - why?
Immunologically mediated destruction of platelets
Often 1-2 weeks after viral URTI
Petechiae + purpura - buttocks extensors
Ix:
Normal Hb, normal WCC
Low Platelets
IV immunogolobulin (IVIg) + steroids Transfusion
Avoid NSAIDs + contact sport (risk of incranial haemorrhage)
Transient synovitis - commenest cause of limp in child What is it? Usually preceded by? Age? Gender? Features? Ix? Mx?
Transiently inflamed synovium of hip joint
usually following viral infection
2-12years. M>F
Unilateral painful limp - may refer to thigh/knee
No pain at rest
Mildly decreased ROM
Child well, NO fever
FBC, CRP, X-Ray, Cultures - all NORMAL
USS - joint effusion
analgesia - NSAIDs
Self-limiting - few days
Septic arthritis Most common bug? Features? Ix? Dx confirmed by? Mx? Comp if left untreated?
S. Aureus
Acute painful hip pain at rest
Child unwell + fever
Reluctance to move hip - decreased ROM
CRP + WCC^
Joint aspiration = confirm Dx
Abx + surgical drain
Joint destruction if left alone
Perthe's Disease What is it? What can it lead to Age? Gender? Features? Ix? Mx? Prognosis?
Ischaemia of femoral epiphysis - can lead to ANV of femoral head
5-10 years. M>F
INSIDIOUS onset - initially painful
Decreased ROM - esp abduction + internal rotation
X-ray - initially ^ fem head density + later irregular fem head edge
Conservative management
Surgery if severe
Good prog if
SUFE - Slipped upper femoral epiphysis
What is it? Direction?
Age? Gender? Other RF?
Features - what may bring it on?
Displacement of femoral head - posteriorly + medially
10-15 years. M>F. Obesity
Acute painful - often after minor trauma (may refer to knee)
Reduced ROM - esp abduction + internal rotation
JIA
Definition
RheumF? exception to this
Types - quick def for each
Mx options?
Arthritis for >6weeks under the age of 16
RF -ve –> except in some girls with polyarticular
Oligoarticular - <=4 joints (60%)
Polyarticular >=5joints (20%)
Systemic: Still’s disease (10%)
Others: enthesitis related, psoriatic (10%)
Mx:
- MDT - physio, OT, educational input
- Analgesia - paracetamol, NSAIDs
- Intra-articular steroid injection - oligo esp
- DMARDS - Methotrexate, anti-TNFs
Systemic JIA - aka Still’s disease
Age? Gender?
Features?
Ix?
DDx fever+ myalgia?
<5. M=F
Acute illness w/
- HIGH SWINGING FEVER
- SALMON COLOURED MACULAR RASH
Lymphadenopathy + hepatosplenomegaly
Pleurisy + pericarditis
SLE, Kawasakis, Rheumatic fever, Leukaemia, reactive arthritis
Oligo-articular
Age? Gender?
What joints affected? Distribution
Extra feature 1/3rd get? what +ve test pops up?
2-6years. F>M
Medium joints - NOT HIPS
- wrists, knees, ankles, elbows
ASYMMETRICAL
Anterior uveitis - ANA +ve
Poly-articular
What joints affected? Distribution?
What joint is spared - so unlike…
Any joints - SYMMETRICAL
- hands, wrist, knees
- neck / temporo-mandibular joint
Spares MCPJs - unlike RA
Measles
Bug?
Incubation period. Infectivity?
Features?
is it notifiable?
Comps?
RNA Mobillivirus
10 day incubation
infectious until day 5 of rash
4 C’s - cough, conjuctivitis, coryza, cranky
Koplik spots
Maculopapular rash - from behind ears to face+trunk
YESSSSS
Pneumonia, encephalitis
Mumps
Incubation? Infectivity?
Features?
Comps?
2-3week incubation
7 days from onset of parotid swelling
Fever typically 4 days w/ uni then bilateral parotitis
Comps - orchitis, viral meningitis
Rubella
Features?
If in pregnancy?
Notifiable?
Well child
Low grade fever
Lymphadenopathy - posterior auricular + occipital
Congenital rubella syndrome = if pregnant mother gets it - risk to fetus
YEP IT IS!
Chicken pox
Bug?
Incubation. Infectivity?
Features? timeline of tings pls
Comps?
Mx?
VZV
2-3weeks (long like mumps)
Infectious 7 days from start of rash
Fever w/ widespread rash
Papules –> vesicles –> pustules –> crust
Comps:
- 2ndary bacterial skin infection
- chickenpox pneumonia
Mx:
Aciclovir
Calamine lotion - antihistamime/emollient
5 DAYS OFF SCHOOL
Slapped cheek disease - 5th disease!
Bug?
Features?
What can virus affect –> why is this a key worry in sickle cell pts?!?!?
Risk if infection in pregnancy?
Parvovirus B19
low grade fever for few days –> developing bright red cheeks
virus can affect erythroblasts in bone marrow –> can cause aplastic crisis in sickle cell!!
Infection in preg:
- fetal anaemia, HF, death
Scarlet fever
Bug?
Age?
Features - course of disease?
Mx?
How long it last?
Notifiable?
Group A strep - pyogenes
2-10years
high fever + sore throat
2 days later - rough rash on face, upper chest, armpits
flushed red cheeks + strawberry tongue w/ tonsilitis
Penicillin V - BenPen
Fever lasts 4 days –> Rash peels in a week
YESSIRRRRR
Term baby weeks?
37-42 weeks
Port wine stain what is it. When does it appear? Distribution does it increase in size, appearance? Association + path? Features of this?
Present at birth - red ‘stain’ on face
Maxillary/opthalmic distribution
Flat + does not increase in size
Sturge-Weber syndrome - neuro disorder
Formed due to abundance of capillaries near surface of skin
(NB - will also have meninges problems on same side)
Seizures, glaucoma, hemiparesis
2 things you can get single transverse palmar crease in?
Down’s
Fetal alcohol syndrome
2 potential causes of absent unilateral red light reflex?
retinoblastoma
congenital cataract
Carvenous hemangioma What is common name? When does it appear? Does it increase in size? What is it not associated - thus making it different from port wine stain Does it go away? when?
Strawberry naevus
NOT AT BIRTH
get bigger boi - lil red bump on head
with intracranial abnormalities - i.e. so no sturge weber
Goes away by 5th birthday
2 tests for congenital dysplasia of the hip? which is which 0_o ?
Ortolani - dislocate
Barlow - reduce
What is seen in talipes equinavarus? Tx?
Club foot!
Physio/surgery
What is physiological jaundice of newborn? When would be worried it might be pathological?
What causes physiological?
> 24hours after birth (typically day2-5)
resolves by 2 weeks
High RBC volume + decreased RBC survival
immature hepatic enzymes
pathological if <24hours
Haemolytic jaundice
Causes (other than physiological)
Test to do that could narrow down cause?
Problem with unconjugated bilirubin - comps?
Sepsis
Immune destruction - ABO incompatibility, rhesus
Congential - G6PD, hereditary spherocytosis
Positive Coomb’s test
REMEMBER HAEMOLYSIS = UNCONJUGATED BILIRUBIN - can cross BBB!!!! lead to: kernicterus - damage to basal ganglia encephalopathy dyskinetic cerebral palsy
Billiary atresia What is it? Features? Ix Mx - when should it take place?
Congenital abnormalty - blockage/absence of bile ducts –> untreated = liver failure
Jaundice, pale stools, dark urine
imaging of hepatobiliary system
Surgery - Kasai hepataportoenterostomy / liver transplant
BEFORE 2 MONTHS!
Management of significant jaundice?
Hydration - throguh good feeding
Continue to breastfeed - whatever the cause
Phototherapy - breaks down bilirubin
Exchange blood transfusion
What complication of prematurity = leads to cerebral palsy?
HEADS (from tune)
- Hypoxic ischaemic damage!!
RDS
Path?
Diagnosis (i.e. 1 Ix + features)
Mx
Deficiency of surfactant - from type 2 pneumocytes
- production begins 24-28weeks = adequate by 35weeks
resp distress symps - ^WOB, ^RR - in first 24hrs
CXR - ground glass shadowing, air bronchograms
Resp support - oxygen, CPAP, ventilation
Surfactant via ET tube
Can give antenatal steroids - to promote lung dev
NEC Seen in what babies? Path/features symps Ix Mx
PREMATURE!!
Bowel ischaemia, inflam, necrosis, perforation
poor feed tolerance, abdo distention, bloody stools, vomiting
X-ray - pneumatosis intestinalis - air in intestinal wall
Bowel rest - NBM, TPN, ABx
Surgery to remove section of bowel
Commenest childhood seizure?
FEBRILE CONVULSIONS
Febrile convulsions
Age?
Association?
Typical seizure type/length? describe complex seizure
Mx?
Factors that ^risk of future epilepsy
6months - 5years
FEVER! - sudden increase in temp
generalised + short in duration (<5mins)
[Complex = >15mins, focal features, recurring in same illness]
ABC (+DEFG)
Symptomatic relief for fever, find cause +/- ABx
^Risk:
- Complex seizure
- FH of epilepsy
- neuro abnormalities on examination / dev delay
Epilepsy define
Can EEG exclude epilepsy?
chronic brain disorder w/ recurrent (2+) non-febrile seizures - in absence of acute cerebral insult
NO! EEG = normal in 50% w/ epilepsy
Absence epilepsy
Age?
What is it? What can precipitate it?
How long it last?
EEG features? IMPORTANT!!
Tx
does it last?
4-10years
Transient LoC - often with open, blinking eyes / twitching mouth movements
Hyperventilation can precipitate
<30seconds
EEG - 3Hz spike and wave abnormaltiy - 3 per second spike and wave!
Valproate / ethosuximide
Usually grow out of by adolescence
West syndrome Is it bad? What is it? Any associations? TRIAD? Tx? prog, go on to develop other things?
BAD bro
infantile spasms in 1st year of life
1/3rd = major organic disorders
- tuberous sclerosis
- hypoxic ischaemic encephalopathy
TRIAD:
- INFANTILE SPASMS
- DEVELOPMENTAL DELAY
- HYPSARRHYTHMIA ON EEG
Tx:
Pred / vigabatrin
Poor prog - w/ long term dev + behavioural difficulties
most go on to have other seizure types
4 domains for developement?
Gross motor
Fine motor / vision
Hearing/language
Social/behaviour
3 months dev?
Raises head and chest when prone
follows moving object
vocalises
Smiles (6-8weeks), Laughs
Dev milestones:
6months
Sits without support
Palmar grasp (5months), Transfers hand to hand
Turn head to loud sounds, Babbles
Reaches for bottle
Dev milestones:
9months
pulls to stand, crawls
Point with finger
responds to name
Takes everything to mouth
12months dev milestones!!!
Walks alone/one hand held (9-18months)
Neat pincer grip
1-3words - mama, dada
Waves byebye
18months dev milestones
SHOULD WALK - refer if not. runs/jumps
Tower of 2-4bricks, Hand preference
6-12 words
drinks from cup / uses spoon
What age can kids copy a circle? Ride a tricycle?
3years
What age can kids draw cross? Hop on 1 leg?
4years
Triangle draw kids? Knows name, age, address?
5 years
Cerebral palsy - an ‘umbrella term’
Definition - when can it occur?
Clinical diagnosis, but what Ix is it supported by?
NON-PROGRESSIVE brain lesion = manifests as motor or postural abnormaltiies
lesion can occur at any point between conception + 3years old
MRI - PERIVENTRICULAR LEUCOMALACIA - caused by hypoxic ischaemic damage to ya head (i.e. in PREMS)
4 common presentations of cerebral palsy
- split into 2 categories
Types of movements - 2 pls in one of the types
SPASTIC: - most common
- Hemiplegia - vertical half
- Diplegia - horizontal half
- Quadriplegia
DYSKINETIC - involuntary movement disorder
- chorea - jerky
- athetosis - writhing
Spastic diplegia features
[ excluding UMN features!! ]
Adduction at hips + scissoring gait
Flexion at knee + genuvalgus
Plantar flexion at ankles + equinovarus - tiptoe gait
Rotation + swaying of trunk
Complications of cerebral palsy?
Epilepsy + learning disability
Speech + swallowing problems - PEG tube?
Spasicity + contractures
Cerebral palsy causes?
Commonly unknown
In utero:
- TORCH
Perinatal:
- Birth asphyxia
- PREMATURE
- Kernicterus –> i.e. why haemolytic anaemia of neborn may cause it!! (due to unconjugated bilirubin)
After delivery:
- Brain injury
- Meningitis / encephalitis
Congenital infections? 5 pls
TORCH Toxoplasmosis Other - HIV, measles, parvovirus, hepatitis Rubella CMV Herpes simplex
Duchenne muscular dystrophy
Genetics?
Age?
Features - a bit of timeline
Key Ix?
X-linked! Frameshift mutation in dystrophin gene
**loss of dystrophin –> muscle cell damage
Boys 3-5years = onset
Waddling gait
Gower’s sign!! - to stand uses hands to climb up legs
Proximal muscle weakness - wheelchair by age 9-12
Diaphragmatic weakness
Scoliosis / contractures
Cardiomyopathy
Clumsiness / motor delay
Cognitive impairment
Genetic testing
Creatinine Kinase
Breath holding attacks
Age?
Features - i.e. the process?
6months - 2 years
Pain/anger --> then brief cry kid takes deep breath and stops breathing turns blue + limbs extend LOC few convulsive jerks NO POST-ICTAL phase
Reflex anoxia seizures
Age?
What is it + features?
Triggers?
infants + toddlers
similar to faint in older kid/adult
vagal activation = bradycardia
kid goes pale + collapses
potenital tonic-clonic
noxious stimulus - e.g. knock to the head
Autism TRIAD of impairment
age they present with?
typically <3years
Reciprical social interaction - poor eye contact, difficulty establishing/maintaining friends
Social communication - delayed/disordered speech, lack of gestures, absent imaginative play
Restricted, repetitive stereotyped behaviours + interests
ADHD
Triad?
Diagnostic criteria?
Mx?
Inattentiveness, Hyperactivity, Impulsivity
Symptoms must be present before 7years old + observed in more than 1 setting (home + school)
Mx: - combination of behavioural + meds
- RITALIN - methylphenidate
