paeds Flashcards
(211 cards)
define colic and what advice would you give parents?
paroxysmal crying with pulling up of the legs for over 3 hours on 3+ days of the week for at least 1 week.
Reassure parents and advise them to do what they can to reduce stress e.g. enlist family/friends help
Movement (carry cot on wheels), let the baby finish the breast first (hind milk easier to digest), warm baths, burping baby, belly rubs.
What is cows milk protein intolerance?
Immune mediated allergic response to naturally occurring milk proteins whey and casein. Can be IgE-mediated, non-IgE mediated or mixed.
Describe the pathophysiology underlying CMPI
IgE mediated = Type 1 hypersensitivity - CD4+ TH2 cells stimulate B cells to produce IgE antibodies -> mast cell degranulation + cytokine release in an anaphylactic response on re-exposure to allergens after sensitisation
Non-IgE mediated = T cell activation against CMP
How does a CMPI usually present?
<3/12 in formula/mixed fed infants. Tends to be more severe and acute onset after feeding in IgE mediated.
vomiting, abdo pain ± colic, reflux, diarrhoea, pruritis, erythema, atopic eczema, lower resp tract sx (cough, SOB, wheeze), can get urticaria, angio-oedema of lips/tongue/face, anaphylaxis, severe = faltering growth
Risk factors for CMPI
atopy or a family history of atopy
Differential diagnosis for ?CMPI
allergic reaction to other food/non-food allergen
anatomical abnormality - meckels, pyloric hypertrophy, etc
chronic GI disease - reflux, coeliac, IBD, gastroenteritis
pancreatic insufficiency - hx CF?
UTI
How is ?CMPI investigated?
Usually clinical dx but may refer for RAST testing for specific IgE antibodies if faltering growth + 1 sx, 1 acute systemic or severe delayed reaction, atopy, clinical/persistent parental suspicion.
Mx of CMPI
Refer to pads if severe sx e.g. failure to thrive
Counsel parents - many will grow out of it (55% IgE by 5, non-IgE most by 3), elimination diet with re-evaluation in 6-12m(/until 9-12/12) to assess tolerance - refer parent to MAP guidelines milk ladder
Nutritional counselling and regular growth monitoring
Formula fed = trial extensively hydrolysed formula, if still symptomatic or very severe then 2nd line AA formula
Breast fed = mom eliminates cows milk from her diet
A 6 month old baby boy is brought into the GP by his mother with a rash on his bottom, O/E well-demarcated erythematous maculopapular rash with slight scaling in areas, skin folds are spared.
What is the likely diagnosis and what management would you advise?
Irritant dermatitis nappy rash
Mx - use disposable nappies as these retain less moisture, change them frequently and ideally have nappy-free periods, careful drying and use of emollient/barrier creams such as sudocream.
a 9 month old baby is brought into the GP by his father with a rash on his bottom. O/E there is an erythematous maculopapular rash affecting the bottom and inguinal folds, with papular satellite lesions, superficial pustules and scaling seen.
What is the likely diagnosis + appropriate management?
Candida dermatitis nappy rash (affects skin folds, satellite lesions)
Mx - use disposable nappies and change frequently, ideally have nappy-free periods, careful drying, use of emollients and topical imidazole, cease use of barrier creams until candida has settled.
a 1 year old is brought to the GP by her mother with a rash on her bottom. O/E there is are salmon pink patches on with scaling on the bottom and inguinal folds, you also note diffuse, yellow, greasy scales on the scalp.
What is the likely dx + appropriate mx?
Seborrheic dermatitis nappy rash (+ cradle cap)
Mx - use disposable nappies and change frequently, ideally have nappy-free periods, careful drying, use of emollients barrier creams e.g. sudocream.
Differential diagnosis for vomiting in an infant
Posseting - effortless regurgitation of milk during feeds
Physiological - as long as it is not significant or excessive (destroying carpets=?pathological)
Overfeeding - >150ml/kg/day
Gastro-oesophageal reflux or gastritis
Pyloric stenosis - projectile vomiting ~8wks
Any infection - UTI, infective gastroenteritis
Adverse food reaction e.g. CMPI
Rarer - pharyngeal pouch, obstruction (bilious vomiting), RICP, DKA
A 6month old is brought to the GP with a 9 hour history of fever. Her mother reports her to be getting worse - increasingly ‘out of it’ and drowsy, taking less feed than usual (around half), she last had a wet nappy approximately 8 hours ago. O/E she is drowsy and does not interact with you, little reaction to parents, no skin rashes, HR 165, CRT3s, RR 53, temp 39, O2 sats 94% on air.
How would this child be stratified and what should the management plan be?
Amber - ‘out of it’ apathy, not responding to social clues, no smile, drowsy; RR>50, O2 <95, HR>160, CRT>3s, poor UO and half feeding.
Mx - need to ensure they are seen face to face, no known dx = refer to paeds for further assessment, otherwise may be able to safety-net - verbal and/or written info on warning symptoms, how to access further healthcare, follow up appt and liaise with other HCP (e.g. out of hours providers to ensure direct assessment if needed).
A 1yr old is brought to the GP with a 9 hour history of fever. Her mother reports her to be getting worse - increasingly drowsy and tearful, taking less feed than usual (around half), she last had a wet nappy approximately 8 hours ago. O/E she is pale and appears ill, is crying weakly, and shows subcostal recession and moderate chest wall indrawing. HS 1+2+0, abdo SANT, chest crackles heard L base. HR 165, CRT3s, RR 61, temp 39, O2 sats 94% on air.
How would this child be stratified and what should the management plan be?
Red - pale, weak cry, appears ill to HCP, tachypnoea, moderate chest indrawing
mx - urgent referral to paeds specialist to be seen within 2h.
How would you manage a severely unwell child with no obvious source of fever?
Sepsis 6 + urine ± LP
Urine dip for UTI (>3m; younger clean catch MC&S)
FBC, U&Es, blood culture, CRP, VBG
CXR
LP if clinically indicated
Fluids - bolus 20ml/kg if lactate >2
Abx - 0-1m = cefotaxime + amoxicillin + gentamicin, 1-3m = ceftriaxone + amoxicillin, >3m = ceftriaxone
When and in whom would you expect to see an intraventricular haemorrhage?
Within first 72h of life, pre-mature neonate with very low birthweight (<1.5kg)
How are IVHs usually diagnosed? Clinical sx and Ix
Often asymptomatic but may see seizures, cerebral irritability, bulging fontanelle, hydrocephalus due to clot obstructing CSF outflow.
Premature <32/40 = cranial US on day 4-7 to assess; >32 weeks if clinically indicated.
How are IVHs managed and what complications may arise?
Mx - supportive care, hydrocephalus may require shunt insertion
Complications - learning disability, cerebral palsy, hydrocephalus. May recover completely.
What is neonatal apnoea and what causes it? How is it prevented and managed?
Failure to make respiratory effort for over 20 seconds, or less than 20 seconds with accompanying bradycardia
Causes - prematurity, infection, hypothermia, aspiration, congenital heart disease. Prevent with maternal IM corticosteroids.
Mx - physical stimulation and IV caffeine
What is retinopathy of prematurity?
Incomplete maturation of the retina in-utero usually seen in <32/40, vascularisation of the retina begins centrally spreading outwards and is driven by hypoxia. Baby born early means O2 drives abnormal BV development - friable and grow outside the plane of the retina = liable to bleed into the eye which can cause retinal scarring, detachment and blindness. This is exacerbated by O2 supplementation.
How is retinopathy of prematurity picked up/diagnosed and managed?
babies born before 32 weeks gestation or with very low birthweight (<1.5kg) are screened for it.
- Born =<27/40 = screen at 30-31 weeks gestational age
- Born >27wks = screen 4-5 weeks of age
Screen at least every 2 weeks by ophtho until sufficient vascularisation of retina, rx diode laser therapy
Define neonatal sepsis
Serious bacterial or viral blood infection in first 28d of life, it can be classed EONS (in first 72h of life) or LONS (onset between 3 and 28d of life)
Which are the most likely causative organisms in early onset neonatal sepsis?
Group B streptococcus and E.Coli, coagulase negative staph, H.Influenzae, listeria
Risk factors for early onset neonatal sepsis
Mother - known carrier of GBS (prev baby with GBS sepsis, prenatal test), UTI, intrapartum pyrexia 38+, ROM 18+hrs, evidence of maternal chorioamnionitis