Paeds Extras Flashcards
what is strabismus?
if untreated, what can it lead to?
misalignment of one or both of the eyes
high risk of amblyopia if constant and unilateral
what are the 4 (8) types of strabismus?
esotropia - eye turned in
exotropia - eye turned out
hypertropia - eye turned up
hypotropia - eye turned down
tropia = manifest
phoria = latent (only elicited on covering eye) so double these
difference between latent or manifest squints?
manifest squint is present when the eyes are open and being used (tropias)
latent squint the eye turns only when it is covered or shut (phorias)
causes of stabismus in children?
hereditary
refractive error
neurological e.g retinoblastoma
known neuro defects (CP)
craniofacial synostosis
what is amblyopia?
what is it also known as?
Defective visual acuity which persists after
correction of the refractive error (with glasses) and removal of any pathology
aka lazy eye
what are the 3 main treatments for amblyopia and when should they be done by?
refractive adaptation - wear special glasses for a certain amount of time (16-18 weeks)
occlude the better eye - eye patch
dilate the better eye with eye drops (atropine)
should be done as early as possible as better prognosis but definitely by 7 if possible
what are the possible treatments for childhood stabismus?
Conservative
- Optical – glasses / CL
- Prisms
- Orthoptic exercises
Surgery
Esotropia – bilateral medial rectus recession or medial rectus recession and lateral rectus resection
Exotropia – bilateral lateral rectus recession or lateral rectus recession + medial rectus resection
Vertical strabismus – surgery depends on the type and ocular movements
Botulinum Toxin- Inject muscle under ketamine anaethesia in children
Medial rectus in esotropia
Lateral rectus in exotropia
when is it normal to have transient eye misalignments?
in first few months of life
that are:
transient
improving from age 2 months onwards
gone - ‘normal eye alignment’ – age 4 months onwards
when should you urgently refer a strabismus?
sudden onset
or other neuro signs/symptoms
whats the difference between concomitant and incomitant?
whats more common in children?
Concomitant (non-paralytic) where the size of the deviation does not vary with direction of gaze
Incomitant (paralytic) where the direction of gaze does affect the size, or indeed presence, of the squint.
Concomitant and begin early in childhood, typically between the ages of 2-4 years.
Incomitant strabismus occurs both in childhood and adulthood as a result of neurological, mechanical or myogenic problems affecting the muscles controlling eye movements.
how does acute leukaemia present in children?
Signs/symptoms related to:
Bone marrow failure: anaemia, pallor, lethargy (dyspnoea, neutropenia), fever, thrombocytopenia, spontaneous bruising, blleding of gums etc
Organ infiltration – superficial lympathdenopathy, hepatosplenomegaly, bone pain (ALL only), skin infiltration (AML only), resp symptoms secondary to mediastinal lymphnodes
whats the pneumonic to remember symptoms of kawasaki disease?
CRASH AND BURN
(burn is the temperature)
- C- conjunctivitis (non purulent)
- R- rash
- A – adenopathy
- S – strawberry tongue
- H – hands and feet desquamation
what is the criteria used to diagnose kawasaki disease?
Kawasaki disease – 1 required criteria and 4 additional criteria
Required
- Fever for at least 5 days generally high and spiking, persisting for 1-2 weeks or longer
additional
- Changes in arms or legs – redness, swelling, induration of hands/feet, desquamation of fingers and toes may occur
- Polymorphic exanthem involving trunk and extremities (differen kinds of rash)
- Painless, non-exudative bilateral bulbar conjunctival injection
- Strawberry tongue, redness and cracking of lips, no mouth ulcers
- Cervical lympahdemopaly
- Rule out other diseases with similar findings
what is kawasaki caused by?
what blood test results might you see?
caused inflammation of some of the arterties in body
raised ESR
thrombocytosis - increase platelet count
What is the classic presentation of scarlet fever in a child?
when you have strep throat, can turn into this bacterial ilnesss.
Red rash over most of the body, red lines in the folds of skin, flushed face, high fever, sore throat, headache
rash which started behind ears might be…
in an unwell child
in a well child
unwell child - measles
well child - rubella
most common complication from kawasaki disease?
coronary artery aneurysm
what investigation would you do after kawasaki disease?
cardiac echo
what medication do you give children with kawasaki disease?
whats a bad side effect from it?
aspirin
Reyes – acute liver failure and encephalopathy
what fluid bolus do you give to a shocked child:
most cases?
DKA or trauma?
20ml/kg of 0.9% NaCl
give 10ml/kg of 0.9% sodium chloride in DKA - cerebral oedema risk,
and same in trauma (first clot = best clot)
when giving fluids in DKA, what period do you want to do it over? and why?
over 48 hours instead of 24 like normal
this is because of the risk of cerebral oedema
how do you calculate manintence fluids in children?
what do you give them?
Weight Daily (ml/24h)
First 10 kg 100ml/kg
Next 10kg 50ml/kg
Next ..kg 20ml/kg
0.9% NaCl + 5% glucose (+/- KCL)
how do you calculate fluid deficits in children?
5 or 10%
% x 10 x kg
so 5 x 10 x kg
or 10x10xkg
what fluids and how much do you give to a neonate (first month of life)?
- Day 1: 60/ml/kg/day,
- day 2: 90ml/kg/day
- day 3 – 120 ml/kg/day
- day 4- 150ml/kg/day
0.9% NaCL + 10% glucose
what does a HIGH TSH (thyroid stimulating hormone) indicate?
TSH is how much your pituitary is telling your thyroid to make thyroid hormone.
TSH will be high if there is no negative feedback loop to bring it back down – therefore your thyroid is not responding to it and you have hypothyroidism
(so high TSH doesn’t = hyperthyroidism, because its the stimulating hormone thats high not thyroid itself!)
what are the diseases screened for on the newborn screening test?
congenital hypothyroidism, sickle cell, Cystic fibrosis
+ 6 metabolic diseases:
aceyclo coa dehydrogenase deficiency, homocystinuria, maple syrup urine disease, glutaria acidemia type 1, isovalerica acidemia
what is the pathology in CAH?
In CAH there is no enzyme which produces aldosterone and cortisol (the sex hormone enzyme is still there though)
because there is excess of the substrate and the enzyme that makes the sex hormone is still there, LOADS Of sex hormones are made. so
testosterone there is masculisation of the genitals in girls (virilisation) = will have enlarged clit (so is normal in boys) - so girls are picked up from birth but boys can go undiagnosed
So no cortisol – no source of energy or compensatory mechanisms as this is the stress hormone, - drop BP and glucose
or aldosterone - can’t control fluid balance
so boys will present collapsed and shocked at a very young age normally
