Paeds - Misc Flashcards
UK Vaccination Programme
Vaccination Schedule
Specific/Additional Vaccines
Contraindications for Vaccination
Other
1.) Vaccination Schedule
- at birth: BCG (if at increased risk)
- 2 months (3): rotavirus (PO), MenB, 6-in-1 (HepB, HiB, whooping cough, diphtheria, tetanus, polio)
- 3 months (3): rotavirus, ‘6-in-1’, PCV (pneumococcal)
- 4 months (2): Men B, 6-in-1 vaccine
- 12 months (4): MMR, HiB, PCV, MenB+C
- influenza: annually to all children ages 2-17yrs old
- pre-school booster (2): MMR, 4-in-1 (whooping cough, diphtheria, tetanus, polio)
- 12-13yrs: HPV
- before university (13-18): 3-in-1 (diphtheria, tetanus, polio), Men ACWY
2.) Specific/Additional Vaccines
- BCG: if at ↑exposure or risk of severe disease (TB)
- varicella: those at most risk of serious illness
- rabies: lab staff, wildlife or animal control etc.
- tick-born encephalitis/typhoid/yellow fever: travellers visiting endemic areas
3.) Contraindications for Vaccination
- temporary deferral: acutely unwell e.g. fever >38.5°C, on immunoglobulin therapy
- previous anaphylaxis to a vaccine/component (rare)
- live vaccines in primary/acquired immunodeficiency (must be T-cell related, not just IgA or IgG deficiency)
- live vaccines: BCG, rotavirus, influenza, MMR, varicella, typhoid, yellow fever
- immunosuppressive therapy e.g. chemo, steroids etc.
4.) Other
- vaccines should be given to premature babies according to their chronological age
- the first vaccine in severely premature babies (<28wks) should be given in the hospital rather than GP
- if the MMR is given late, the repeat dose should be given 3 months after the initial dose
Downs Syndrome (Trisomy 21)
Dysmorphic Features
Complications:
Hearing and Vision
Cardiac Abnormalities
Gastrointestinal
ENT
Endocrine
Respiratory
MSK
Growth and Development
Haematological
1.) Dysmorphic Features
- short stature, hypotonia, single palmar crease
- H+N: brachycephaly (small head with a flat back), short neck, flattened face, flat nasal bridge
- upslanting palpebral fissures, prominent epicanthic folds, low-set small folded ears, Brushfield spots in iris
2.) Hearing and Vision
- congenital cataract, infantile glaucoma, strabismus and nystagmus, predominantly conductive hearing loss
3.) Cardiac Abnormalities - affect 40-60% of children
- most common heart defect is AVSD (20%)
- others: ASD, VSD, PDA, tetralogy of Fallot
4.) Gastrointestinal - occurs in 7% of cases
- oesophageal atresia or trachea-oesophageal fistula, duodenal atresia and imperforate anus
- a slight ↑ in Hirschsprung’s, but worse outcomes
5.) Others
- ENT: ↑risk of infections and sleep apnoea (OSA)
- endocrine: increased risk of hypothyroidism
- respiratory: recurrent chest infections due to silent aspiration and impaired immune function
- MSK: hypotonia can cause early feeding difficulties
↑risk of atlantoaxial dislocation –> neck pain
- growth and development: poor growth and short stature, variable developmental delay
- haematological: transient myeloproliferative disorder in neonates, ↑risk of acute myeloid leukaemia
- Alzheimer’s dementia
Other Childhood Syndromes
Other Trisomies
Turner Syndrome
Kleinfelter Syndrome
Other Syndromes
1.) Other Trisomies
- Patau’s (47 XX/Y+13): microcephaly, small eyes, cleft lip/palate, polydactyly, scalp lesions, rocker-bottom feet
- Edward’s (47 XX/Y+18): micrognathia, low-set ears, overlapping of fingers, rocker-bottom feet
2.) Turner Syndrome - when a female has a single X chromosome (45XO), features include:
- physical: short stature, webbed neck and widely spaced nipples (are classical), others: high arching palate, down-sloping eyes w/ ptosis, cubitus valgus
- underdeveloped ovaries: primary amenorrhea, delayed/incomplete puberty, infertility
- cardiac abnormalities: bicuspid aortic valve and aortic coarctation cause an ejection systolic murmur
- associated conditions: HTN, DM1/2, obesity, recurrent AOM and UTIs, hypothyroidism, osteoporosis, LD
- increased likelihood of suffering from X-linked recessive conditions e.g. haemophilia
3.) Klinefelter Syndrome - when a male has an extra X chromosome (47XXY), presents in puberty with:
- taller, wide hips, weak muscles, gynaecomastia
- reduced libido, small testicles, infertility
- shyness, subtle learning difficulties
4.) Other Syndromes
- Fragile X: X-linked dominant, macrocephaly, long face, large low-set ears, large testicles, mitral valve prolapse, learning difficulties, ADHD, ASD, seizures
- Noonan: short stature, webbed neck, pectus excavatum, pulmonary stenosis
- Pierre-Robin: micrognathia, posterior displacement of the tongue (may cause airway obstruction), cleft palate
- Prader-Willi: hypotonia, hypogonadism, obesity
Acute Lymphoblastic Leukaemia
Pathophysiology
Clinical Features
Poor Prognostic Factors
1.) Pathophysiology - malignant change in one of the lymphocyte precursor cells causing acute proliferation of a single type of lymphocyte, usually B-lymphocytes
- most common cancer in children (peaks at 2-4years) and accounts for 80% of childhood leukaemia
- it can also affect adults over 45 (associated with the Philadelphia chromosome (t(9:22) translocation
- often associated with Downs syndrome
2.) Clinical Features
- sx of anaemia, thrombocytopenia and leukopenia
- failure to thrive, organomegaly, lymphadenopathy
- bone pain (secondary to bone marrow infiltration)
- fever is present in up to 50% of new cases due to an infection or as a constitutional symptom
- testicular swelling in children
- blood film shows blast cells
3.) Poor Prognostic Factors
- diagnostic age: <2 or >10 years, non-Caucasian, M>F
- WBC count at diagnosis: >20
- T or B cell surface markers
Cerebral Palsy
Pathophysiology
Clinical Features
Classification
Management
1.) Pathophysiology - disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain, causes include:
- antenatal (80%): cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)
- intrapartum (10%): birth asphyxia/trauma
- postnatal (10%): meningitis, head-trauma, IVH
2.) Clinical Features
- feeding difficulties, abnormal tone early infancy, delayed motor milestones, abnormal gait
- associated non-motor problems: learning difficulties, hearing impairment, epilepsy, squints
3.) Classification
- spastic (70%): hypertonia due to damage to UMNs, causing hemiplegia, diplegia or quadriplegia
- dyskinetic: damage to the basal ganglia and the substantia nigra causing athetosis (slow, involuntary, and writhing movement) and oro-motor problems
- ataxic: damage to the cerebellum –> cerebellar signs
- mixed
4.) Management - MDT approach is needed
- treatments for spasticity include oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy
- anticonvulsants, analgesia as required
Microcephaly and Macrocephaly
1.) Microcephaly - head circumference < 2nd centile
- normal variation or familial (small child w/ small head)
- congenital infection, perinatal brain injury e.g. HIE
- Patau syndrome, fetal alcohol syndrome, craniosynostosis
2.) Macrocephaly
- fragile X syndrome
