Paeds ILAs - 5 and 6 Flashcards by Jack Hogg

Developmental milestones at 6 months

Head control
Sits unsupported - Arched back

VFM

Palmar grasp
Passes objects from one hand to the other

HSL

Babbles
Turns in response to sound

Social

Puts objects in mouth
Shakes rattle
Reaches for bottle

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Developmental milestones at 12 months

GM
- Cruises for 10 metres

VFM

Refined pincer grip
Puts blocks in a cup

HSL

Knows and responds to name
Knows 2/3 words

Social
- Drinks from a cup with both hands

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Primitive reflexes and significance

Moro reflex - Sudden loss of support

Arm abduction
Arm adduction
Crying

Persisting after 4 months - Sign of UMN lesion

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What is cerebral palsy

Non-progressive disorder of movement and position
Occurs in the developing brain

Symptoms may appear to change over time - This is because as the child gets older the things they cannot do become more apparent

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Cerebral palsy aetiology

Antenatal - 80%

Infection
Genetics
Vascular occlusion

Intrapartum

HIE
Asphyxia
Trauma

Post-partum

Trauma
Meningitis
Periventricular leukomalacia

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Cerebral palsy early features

Poor feeding

Delayed motor milestones
Asymmetrical hand function < 12 months
Persistent primitive reflexes

Abnormal tone
Abnormal gait

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Spastic cerebral palsy

80-90% - Damage to motor cortex - UMN signs

Hemiplegic

Arm and leg
Face sparing
Tip toe walk
Asymmetrical hand

Diplegic - Periventricular leukomalacia
- Knock-kneed gait

Quadriplegic

All 4 limbs
Extensor posturing

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Dyskinetic cerebral palsy

Problem in the basal ganglia - Extrapyramidal tracts

Associated with HIE and kernicterus

Chorea
Athetosis
Dystonia

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Ataxic cerebral palsy

Lesion in the cerebellum

Broad gait
Hypotonia
Poor balance

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Cerebral palsy MDT

Occupational therapy 
S/L
School 
Paediatrician 
Neurologist 
Social worker 
Physiotherapy

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Cerebral palsy risk factors

Twins
Prematurity
Maternal infections
Difficult delivery

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Cerebral palsy associations

Learning difficulties 
Epilepsy 
Squint 
Deafness 
Poor feeding - Poor growth

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Cerebral palsy investigations

MRI 
Cytogenetic 
Metabolic profile 
Biopsy and histopathology 
EEG

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Absence seizure presentation

Child stops what they’re doing
Remains conscious

Can occur with hyperventilation

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Absence seizure investigations

EEG 3Hz
Hearing test
ADHD assessment

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Absence seizure management

Valproate

Ethosuximide

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Juvenile myoclonic epilepsy presentation

Teenage girls

Myoclonic jerks - Suddenly throwing things

History of absence seizures

JME investigations and management

Investigations - EEG - Polyspike and wave

Management - Valproate

Types of strabismus (squint)

Paralytic

Nerve palsy
Can only move the eye in certain directions

Non-paralytic

Misalignment
Can move the eye in all directions

Manifesto - Always present
Latent - Comes and goes

Strabismus investigations

ONLY IF PARALYTIC

Cover test

Ask the child to focus on an object
Cover one eye
Observe movement of uncovered eye
Cover other eye and repeat

Strabismus management and complications

Management - Patching

Complications - Amblyopia

RDS presentation

Tachypnoea
Intercostal recession
Expiratory grunting
Cyanosis

RDS risk factors

Prematurity

26-28 weeks - 50%
30-31 weeks - 25%

Maternal diabetes
CS
Male
Second born of premature twins

RDS prevention

Dexamethasone

Delayed cord clamping - 45 seconds

RDS investigations

CXR - Ground glass

RDS management

O2 CPAP Surfactant therapy - Through ET tube

RDS complications

Pneumothorax BPD Retinopathy Renal failure

BPD

Chronic lung disease Occurs due to mechanical ventilation and oxygen supplementation Requires long-term oxygen therapy

BPD investigations

O/E - Crackles and wheeze CXR - Round radiolucent areas - Fibrosis CT - Mosaic lunch parenchyma

BPD management

Dexamethasone Palivizumab O2

Neonatal jaundice < 24 hours

BAD ``` Rhesus incompatibility ABO incompatibility Hereditary spherocytosis G6PD Infection Sepsis ```

Neonatal jaundice | 24 hours - 2 weeks

NORMAL Dehydration Infection Physiological Bleeding

Neonatal jaundice > 2 weeks

BAD High conjugated bilirubin = Biliary atresia! ``` Cystic fibrosis Congenital hypothyroidism Pyloric stenosis Hepatitis Infection ```

Neonatal jaundice investigations

Conjugated bilirubin Unconjugated bilirubin Coombs test Blood film FBC U/E LFT TFT Urinalysis

Kernicterus

Deposition of unconjugated bilirubin in the basal ganglia Presentation - Arching of back - Seizures - Comas Complications - Learning difficulties - Sensorineural deafness - Cerebral palsy

Necrotising enterocolitis

Bacterial infection of ischaemic bowel wall Inflammatory bowel necrosis due to premature GI tract Risk factors - Cow's milk

NEC presentation

Bilious vomiting Distended abdomen - Tense, shiny and red Blood in stool Decreased bowel sounds Palpable abdominal mass Shock

NEC investigations - AXR

Intramural gas Distended bowel Thickening of the bowel Perforation - Pneumoperitoneum Rigler sign - Air inside and outside the bowel wall Football sign - Air outlining the falciform ligament

NEC investigations - Bloods

Thrombocytopenia Neutropenia Acidosis

NEC management

Broad spectrum abx Cefotaxime Vancomycin Gentamicin NG tube - Decompress Surgery - Bowel resection

NEC complications

Perforation Peritonitis Short bowel syndrome - Following surgery