Paeds - Misc Flashcards
Recurrent otitis media
Common at 2-7 years
Conductive hearing loss
- Speech difficulties
- Learning problems
JIA aetiology and clinical features
Arthritis in under 16s
Lasting > 3 months
Arthritis
- Stiffness after periods of rest
- Morning joint stiffness
Systemic - FLAAAPy SALMON
- Fever
- Lymphadenopathy
- Anterior uveitis
- Anorexia
- Arthritis
- Pink rash - SALMON
JIA investigations
FBC
- Anaemia
- WCC ^
- ESR ^
- Ferritin ^
ANA +ve
Rh can be -ve
LFT ^
Albumin - LOW
JIA management
NSAIDS
Prednisolone
Mehotrexate
Tocilizumab - IL-6
Anakinra - IL-1
JIA complications
Chronic anterior uveitis Anaemia of chronic disease Osteoporosis Growth failure Valgus deformity
Perthe’s disease aetiology and presentation
Chronic - Boys aged 4-10
- Short stature
- LBW
- Passive smoking
- Low SE status
Clinical features
- Unilateral
- Hip and knee pain
- Limited ROM
- Roll test - Guarding and spasm
Perthe’s disease investigations / management / complications
XR
- Flattening and fragmentation of epiphysis
- Sclerosis
- Widening of joint
MRI
Bone scan
Management
- Bed rest and traction
- Surgery < 6 years
Complications - Premature fusion of growth plates
DDH aetiology and presentation
Breech Birth weight < 5kg Family Hx Female First born C-section
8 week check
- Asymmetrical skin creases
- Unequal length
- Limited abduction
DDH investigations and management
Barlow’s - Dislocates
Ortolani’s - Relocates
Management
- 60% resolve spontaneously - 3-6 weeks
- Pavlik cast < 4/5 months
- Surgery in older children
Transient synovitis presentation
3-10 years
Not weight bearing
Look well
Unilateral pain on walking and extreme ranges
No pain at rest
Previous respiratory infection
Mild fever
Transient synovitis investigations / management / complications
ESR - NORMAL
XR - NORMAL
USS - Fluid in joint
Rest
Analgesia
Complications - Perthe’s 3%
NAI
History doesn’t match presentation
Delayed presentation
Torn frenulum
Retinal haemorrhage
Cheek, neck, buttocks and forearms
Skull fracture
Rib fracture
Non-ambulatory child - Cerebral palsy?
Osteogenesis imperfecta aetiology and presentation
Autosomal dominant
Type 1 collagen
Multiple fractures
Scoliosis
Triangle face
Blue sclera
Dental deformity
Deafness - Due to otosclerosis
Hernia and valve prolapse
Osteogenesis imperfecta investigations and management
DEXA
Skeletal survey
Biopsy - Skin/bone
ALP ^
Management
- Alendronic acid
- Synthetic calcitonin
- PT
- Analgesia
Bone neoplasm types and presentation
Osteosarcoma
Ewing’s
Chondrosarcoma
Painful
Rapid growing limb
Rickets aetiology
Lack of vitamin D / calcium
Decreased intake
- Oily fish
- Eggs
- Fortified cereal
Lack of sunlight
Liver disease
Renal disease
Decreased calcium absorption - GI disease
Rickets presentation
Bowed legs
Painful limbs
Fractures
Motor delay
Hypotonia
Hypocalcaemia features
- Tetany
- Arrhythmias
Rickets investigations and management
Calcium - LOW PTH ^ Phosphate - LOW Vit D - LOW ALP ^
Management - Vit D
Osgood schlatters
Pain better on rest
Worse on movement - Running and jumping
Inflammation of the tibial tuberosity
Athletic adolescents
Management - Physio
Chondromalacia
Adolescent female
Pain on standing from sitting and walking up stairs
Management - Physio
Neuroblastoma aetiology and presentation
Arises from…
- Neural crest tissue of adrenal medulla
- Sympathetic nervous system
Abdominal mass Pallor Weight loss Bone pain and limp Hepatomegaly
RACCOON EYES
Neuroblastoma investigations
Urinary…
- Catecholamines ^
- Vanillylmandelic acid ^
- Homovanillic acid ^
AXR - Calcification
CT
Biopsy
Retinoblastoma pathophysiology
Autosomal dominant
Loss of function
- Retinoblastoma tumour suppressor gene on chromsome 13
10% hereditary
Retinoblastoma presentation
18 months
Absence of red-reflex
Replaced by white pupil - Leukocoria
Pain/redness around the eye
Strabismus
Visual problems
Retinoblastoma management and prognosis
Enucleation
+ Radiotherapy
+ Chemotherapy
Photocoagulation
90% survival
Hepatoblastoma presentation
Asymptomatic?
Abdominal mass
Ascites
Itchy skin
Jaundice
B symptoms
Hepatoblastoma investigations / management / prognosis
CT/MRI
AFP ^
Surgical resection
Liver transplant
5 year survival = 15%
Wilm’s tumour aetiology and presentation
Embryonic renal tissue
Loss of WT1 gene
Abdo mass
Painless haematuria
HTN
Flank pain
Anaemia - Haemorrhage into tumour
Wilm’s tumour investigations and management
CT
USS
MRI
Nephrectomy
± Chemo
± Radio
CNS tumour
^ ICP
- Headache
- Papilloedema
- N/V
FND
Ataxia
Nystagmus
Squint
Infants
- Developmental delay/regression
- Head circumference ^
MRI
Surgery ± Chemo/Radio
Effects of cancer treatment
Subfertility
Secondary cancers
Psychosocial
Growth retardation
Effects of chemo
- N/V
- Hair loss
