Paeds (Neonates, Development, Haem, Immuno, Inf) Flashcards
APGAR Scoring
Act (M Tone) PR Grimace (Reflex) Appearance (Colour) RR
Hypoxic-Ischaemic Encephalopathy Mx
Neonatal ICU
Therapeutic Hypothermia: Cooled to 33-34
(Reduce Inflamm + N loss from Hypoxia)
Hypoxic-Ischaemic Encephalopathy Causes
Mat Shock,
Intrapartum Haem,
Prolapsed cord (+/- Nuchal cord)
Causes of Neonatal Jaundice
Physiological
Pathological
Physiological (2-7 days): Self-resolves w/in 10 days
(High conc of fragile Fetal RBCs, Immature Liver, Lack Placenta to excrete)
Pathological (w/in 24hrs):
Increased Prod:
HDN, ABO Incompatability, Haem, Sepsis/DIC
Decreased Clearance:
Prematurity, Neonatal Cholestasis, Biliary Atresia, HypoTh
Prolonged Jaundice Def + Mx
(Full-term: > 14 days, Pre-term: > 21 days):
Total BiliR monitoring (Tx threshold chart: X: Age, Y: BiliR)
PhotoTx (Converts unconjugated BiliR -> Harmless Isomers, Excreted in Urine/Bile)
Measure rebound BiliR 12-18hrs later
Faltering growth Def
Birthweight > 91st centile w/ drop of > 3 centile spaces
Birthweight: 9th + 91st centile w/ drop of > 2 centile spaces
Birthweight < 9th centile w/ drop of > 1 centile spaces
Gross Motor Milestones
9mo: Sit Unsupported (Red flag at 12mo)
12mo: Stand + Cruising (Walk w/ Aid)
18mo: Walk unaided (Red flag at 2yo), Squat + pick-up objects
2yo: Run + Kick
Fine Motor Milestones
12mo: Pincer grasp, Use crayons, Hand preference (Red flag < 12mo)
18mo: Use spoon
Express Language Milestones
1yo: Single words (Red flag at 18mo)
2yo: Combines 2 words
Receptive Language Milestones
6mo: Resp to Voice
9mo: Listens to speech
12mo: Follows simple instructions
18mo: Understands nouns (1 Keyword)
2yo: Understands Verbs (2 Keywords)
3yo: Understands Adjectives (3 Keywords)
Personal/Social Milestones
9mo: Cautious w/ strangers
12mo: Engages w/ others (Red flag at 18mo), Waves + Claps
18mo: Initiates Activities
2yo: Plays next to others, Dry throughout day
3yo: Seeks others for play (Red flag > 3yo), Bowel control
Developmental Red Flags
Loss of milestone Slowed/Absent Development Asymmetry (Hand preference < 12mo) Unable to hold object at 6mo Unable to sit unsupported at 12mo Unable to stand independently at 18mo No words/interest in others at 18mo Unable to walk (w/out Aid) at 2yo Unable to run at 2.5yo
Sickle Cell Patho + Screening
(Auto-recess, beta-Hb Abnormality):
Screened for at Newborn Heelprick/Spot test (+ mother’s who are carriers/at increased risk)
Sickle Cell Anaemia Mx
Avoid dehydration (+ other triggers: NSAIDs)
Fully Vaccinate
Prophylactic Penicillin V
Hydroxycarbamide (Stim Prod of Fetal Hb)
Sickle Cell Crises
Vaso-occlusive
(Painful Occluion + Ischaemia)
Splenic sequestration
(Mx: Supp Fl +/- Splenectomy)
Aplastic
(Triggered by Parvoirus B19, Self-resolves w/in 1wk)
Acute Chest Synd
(Fever, SOB, Cough, New CXR Infiltrates)
Thalassaemia Patho + Sx
(Auto-recess, Hb chain Abnormality):
Excess Haemolysis = >
Jaundice,
Splenomegaly,
BM Expansion (+/- => #)
Thalassaemia Mx
Monitor FBC,
Blood Transfusions,
(+/- Splenectomy, BM Transplant)
Cause of Iron Overload
(Occurs w/ Thalassaemia):
Recurrent Haem + creation of new RBCs
Transfusions
Increased Fe Absorption in gut
Iron Overload Mx
Monitor Ferritin + Transferrin saturation (Both Raised),
Limit Transfusions, (+/- Iron chelation)
Hereditary Spherocytosis/Elliptocytosis Sx + Ix
Sx: Jaundice, Anaemia, Splenomegaly, Gallstones
Ix:
FBC (Raised Reticulocytes, MCHC - Mean Cell Hb Conc)
Blood film (Spherocytes/Elliptocytes)
Hereditary Spherocytosis/Elliptocytosis Mx
Folate Supp,
Splenectomy (+/- Cholecystectomy),
(Acute crisis: Transfusions, BM Transplant)
G6PDH Def Patho, Triggers
(X-linked Recess):
Lack of protection from Oxidative stress/ROS => Increased Haemolysis
Triggers:
Inf,
Drugs (Antimalarials, Sulfonylureas, Sulfasalazine, Trimethoprim, Nitrofurantoin, Cipro),
Broad/Fava beans
G6PDH Def Features
Neonatal Jaundice, Intermittent Jaundice (In Resp to Triggers), Anaemia, Gallstones, Splenomegaly
G6PDH Def Ix + Mx
Blood Film (Heinz bodies: Denatured Hb w/in RBCs)
Mx:
Avoid Triggers,
Acute Crisis: Transfusions
Classification of Allergies
Type 1 (Immediate): IgE => Mast cells + Basophils (Food Allergy, Allergic Rhinitis)
Type 2: IgG + IgM => Act Complement system:
(HDN, Transfusion React)
Type 3: Immune complexes accumulate:
(SLE, RA)
Type 4 (Cell-mediated): Inappropriate Act of T-cells (Organ Transplant Rejection, Contact Dermatitis)
Allergy Ix + Anaphylaxis Ix
Skin prick test: (Specific Allergens w/in solution => Sens react)
Patch test: (Allergens placed on skin for 2-3 days => Contact Dermatitis)
RAST: (Measure Total + Specific IgE levels w/in Blood: shows Sens)
Food challenge: (Monitor for Allergic react)
Anaphylaxis
Serum Mast cell Tryptase 6hrs Post Anaphylaxis
(Confirms Mast cell degranulation + Anaphylaxis)
ITP Patho + Mx
Post-Inf Immune React targeting Plt’s => Thrombocytopaenia
Mx:
Steroids
If Plt < 0.5: Plt’s + IVIg
IM Features
Rash
Lymphadenopathy
Fever
Splenomegaly
IM Ix + Mx
Blood Cult
EBV Spot test
Mx: (Self-resolves w/in 2-3wks), Avoid: Alc (=> Liver Damage), Contact Sports (Exsanguination), Amox (Itchy, Maculopap Rash)
Mumps Features
(Mumps V):
Fever
Parotid Gl swelling + Pain,
Myalgia
+/- Pancreatitis, Orchitis, Meningitis, SN Hearing Loss
Mumps Ix+ Mx
Saliva/Throat Swab (w/ Viral PCR)
Mx: (Self-resolves w/in 1wk),
Supp (Rest, Analgesia, Fluids),
Notify Public Health,
Safetynet
Hep B Viral Markers:
HbcAg (IgM, IgG) HBsAg HBeAg HBV DNA HBsAb
HbcAg:
IgM (High in Acute, Low in Chronic),
IgG (If HBsAg (-): Past Inf)
HBsAg: Act Inf (Given in Vaccine)
HBeAg: Acute-phase Inf (correlates w/ Inf Severity)
HBV DNA: Viral Load
HBsAb: Immune (Vaccinated, Past/Current Inf)
