Paeds (Neuro, CVS, Resp, GI, Renal) Flashcards
Headache Sx Red Flags
Persistent in < 6yo Duration > 6 months Change in severity/pattern Worse w/ coughing/straining Worse overnight/early morning Early morning N+V Behaviour changes (Uncooperative) Seizures Rapid/Faltering growth, Developmental regression
Headache Signs Red Flags
Abnormal Neuro Ex (Ataxia, Weakness, Squint/Head tilt)
Papilloedema
Cranial bruit
Growth Abnormality (Obesity, Abnormal/Early Pubertal changes)
Febrile Convulsions Features
(6mo-5yo)
Seizures occurring w/ High Fever (no underlying pathology)
Febrile Convulsions Mx
Tx Fever (Paracetamol, Ibuprofen)
Infantile Spasms Features
West Syndrome
(4mo – 2yo)
Clusters of whole-body spasms (1sec) w/ full recovery (+/- Ext of Limbs)
Infantile Spasms Mx
Prednisolone, Vigabatrin
Cerebral Palsy Cause
Brain Injury => Permanent, Non-progress Disorder of movement + Posture
(Caused by Inf, Hypoxia, Haem, Trauma, Malformation)
Cerebral Palsy Classification
I: Walks w/out limitations
II: Walks w/ limitations
III: Walks w/ hand-held mobility device
IV: Self-mobility w/ limitations
V: Transported in manual wheelchair
Cerebral Palsy Types
Spastic (UMND)
Ataxic (Cerebellum)
Dyskinetic (Basal Ganglia => Dystonia, Chorea, Athethosis)
Epilepsy Mx: Focal New Ton-Clon Est Ton-Clon Atonic/Tonic/Myoclonic Absence Pregnant
Focal: Carbamazepine, Lamotrigine
New Ton-Clon: Na-Val, Lamotrigine
Est Ton-Clon: Lamotrigine
Atonic/Tonic/Myoclonic: Na-Val
Absence: Ethosuximide, Na-Val
Pregnant: Lamotrigine, Levitiracetam
Muscular Dystrophy Def
Spinal M Atrophy Def
MD: Progress Weakness/Wasting of M
=> Gowers sign (Downward Dog -> Tripod -> Standing Up)
SMA: Progress loss of LMN w/in Spinal Cord
=> Hypotonia, Hyporeflexia, Atrophy, Fasciculations
Hydrocephalus Patho + Cause
(Abnormal build-up of CSF w/in brain + spinal cord)
Caused by:
Overproduction,
Abnormal drainage (Acqueductal Stenosis, Arachnoid cysts, Cerebellum herniation)
Normal Prod of CSF + movement
CSF created by Choroid plexus + walls of Lat Ventricles
- > 3rd Ventricle
- > Cerebral Acqueduct
- > 4th Ventricle
- > Dural Venous Sinus
Hydrocephalus Mx
CSF (Ventriculo-peritoneal) Shunt
Innocent Murmurs Features
Soft Short Symptomless Systolic Situation-dependent (Quiet w/ Standing)
PDA Features
Normal S1
Continuous Cres-Decres machine-like
(Difficult to hear S2)
ASD Features
Mid-systolic, Cres-decres at L sternal edge
w/ fixed split S2 – no change w/ Insp/Exp
VSD Features
Pan-systolic, L sternal edge 3rd/4th IC space
+/- systolic Thrill on palpation
Coarctation of Aorta Features - 4
Grey, floppy baby w/ Limb Hypoplasia
Weak Fem Pulses
Systolic Murmur
LV Hypertrophy
Coarctation of Aorta Mx
IV PGs (maintain DA) Surg (Correct Coarctation + Ligate DA)
Tetralogy of Fallot Patho
Pulmon Stenosis
VSD
Overriding Aorta
RV Hypertrophy/Strain
Tetralogy of Fallot Features
Poor Feeding/Weight gain Tet Spells (Intermittent Cyanotic episodes) Eject-Systolic murmur Clubbing Cyanosis
Transposition of GA Mx
IV PGs
Cardiopulmon bypass
Arterial switch Surg
Resp Distress Features
Raised RR Cyanosis Use of accessory M (SCM, Abdo, Ext IC) IC/SC recessions Nasal flaring, Head-bobbing, Tracheal tugging Abnormal airway noises (Exp Grunting)
Epiglottitis Patho + Sx
Inflamm of Epiglottis caused by Haemophilus B in Unvaccinated Child
Fever,
Sore Throat/Diff swallowing,
Stridor,
Quiet child w/ Muffled voice in Tripod position
Epiglottitis Mx
No throat swabs (=> Airway Obstruct)
Mx: Avoid distressing (Keep parents close) Secure Airway, IV Abx (Ceftriaxone) +/- Steroids, Check Vaccination (HiB)
Bronchiolitis Patho
Inflamm of Bronchioles (Resp Synctival V)
Affects the V small airways in neonates (<1yr)
– only requires little Inflamm/Mucus to cause obstruction
Bronchiolitis Sx - 5
Coryzal Sx (Rhinits, Sinusitis, Sneezing, Fever) S.O.B, Tachypnoea/Resp distress, Apnoea episodes, Wheeze + crackles on Auscultation Poor Feeding
Bronchiolitis Mx
Rest, Fluids, Adequate Intake Paracetamol Supp O2 Palivizumab (mAb targeting RSV) - given to Premature babies or w/ Cong HD
Bronchiolitis Ix
CBG:
Raised pCO2: Airway collapse
pH < 7: (Resp) Acidosis
Hypoxia: (T2) Resp Fail
Bronchiolitis Admission
Age < 3 months Comorbidity (Prematurity, Downs, CF) Dehydration Reduced milk intake (< 50-75%) RR > 70, SpO2 < 92%, Apnoeas, Resp Distress
Croup Cause + Patho
Caused by:
Parainfluenzae V, Influenzae V, AdenoV, RSV
URTI in 6 months – 2yo => Oedema of Larynx (+/- Epiglottitis)
Croup Ix + Mx
Ix: Westley Scoring
Fluids, Rest, Isolation
PO Dexamethasone 150 micrograms/Kg
Whooping Cough Cause + Patho
URTI caused by Bordatella Pertussis
Whooping Cough Sx
Fever, Mild dry cough, SOB
Coughing fits (w/ Loud Inspiratory Whoops)
(+/- Apnoeas, Fainting, Vom, Pneumothorax)
Whooping Cough Mx + Admission criteria
(Normally resolves by 8wks):
Notify Public health
If w/in 21 days: Abx (PO Azithromycin) + Prophylactic Abx for contacts
Admission:
Apnoeas, Cyanosis, Severe fits
Asthma vs Viral-Induced Wheeze
Occurs in children < 3yo (VIW)
No Hx of Atopy (VIW)
Not Exercise/Cold-sensitive (VIW)
Triggered by Viral Inf (VIW)
Asthma Mx (< 5yo)
SABA
SABA + ICS
+ LTRA
Asthma Mx (5-16yo)
SABA SABA + ICS LABA + ICS \+ LTRA (+/- LAMA - Ipratropium/Tiotropium) (+/- Aminophylline)
Chronic LD of Prematurity Mx:
Prevention
Tx
Prevention:
2x IM Betamethasone doses (24hrs apart)
Mx:
CPAP (Maintain airway + avoid over-oxygenation => Resp Fail)
Caffeine (Stim Resp effort)
Monthly Inj of Palivizumab (Protect against RSV + Bronchiolitis)
CF Patho + Features
(Auto-Recess): Mutation of CF Transmembrane Conductance Reg Gene => Abnormal Cl- channels:
Thick Pancreatic/Biliary secretions (=> Blockage + Enzyme Def)
Thick airway secretions (=> Blockage + Inf)
Congenital Bilat absence of Vas deferens (Normal healthy sperm, no Ducts => Infertility)
CF Ix
Newborn Spot testing
Sweat test (Cl- conc: > 60mmol/L)
Amniocentesis/Chorionic villus sampling (w/ genetic testing for CFTR gene)
CF Mx
Exercise + Chest Physio (Improves Lung funct)
Bronchodilators (Reverse Bronchoconstriction)
Neb Dnase (Dornase-alpha): Breakdown DNA (Reduce viscosity of secretions)
Prophylactic Flucloxacillin (Reduce Bact Inf – S. Aureus)
Vaccinations (Pneumococcal, Influenzae, Varicella)
High-calorie diet (Malabsorption) + CREON (Replace Lipase enzymes)
Abdo Pain Red Flags - 8
Fever Dysphagia Persistent/Bilious Vomiting Abdo tenderness Night-time pain Weight loss (Fail to Thrive) Severe Chronic Diarrhoea Rectal bleeding
Biliary Atresia Patho,
Narrow/Absent Bile Duct =>
Cholestasis + Persistent Jaundice (High conjugated BiliR)
Biliary Atresia Mx
Kasai Portoenterostomy
Attach S Intestine -> Liver opening: Relieves Jaundice + aids digestion
Hirschprungs D Patho + Features
Absence of parasympathetic N cells w/in Myenteric plexus (=> Reduced peristalsis)
Aganglionic bowel cannot relax (=> Excess constrict w/ Prox bowel obstructed + distended)
=> Meconium Delay > 24hrs, (Chronic constipation from birth)
Hirschprungs D Ix + Mx
AXR (Intestinal Obstruct), Rectal biopsy (Absence of ganglionic cells)
Mx:
NBM
NGT + IV Fluids,
Surg (Remove diseased bowel => Pull-through + form End-colostomy)
Intusussception Eped + Patho
(6mo-2yo, M comm: <9mo, ass w/ Concurrent Viral Inf – Enlargement of Peyers patches)
Invagination of Prox bowel (Ileum of S Intestine) -> Dist bowel (Caecum of L Intestine)
Intusussception Sx + Ex
Severe Colicky Abdo Pain,
Vom,
Red-currant jelly Stool
O/E:
Thickened bowel wall (Sausage-shaped RUQ mass)
Constipation
Intusussception Ix + Mx
USS, Contrast enema
Mx:
Therapeutic Enema,
Surg reduction,
If gangrenous/perf: Surg resection
UTI Mx
PO Trimethoprim 3 days,
(If < 3mo: IV Abx)
(If upper UTI: IV 4 days w/ PO 10 days)
UTI Referral/USS Indications
Younger than 6mo
Severe/Atypical (Fail to Resp to Abx, Non-Ecoli Inf, Oliguria, Raised Cr, Abdo/Bladder mass)
Recurrent Inf (> 2 Upper, Upper + Lower, > 3 Lower)
USS Abnormality Mx + Indications
DMSA scan:
Injection of Dimercaptosuccinic Acid w/ gamma-camera to view empty patches w/in Kidneys (Scarring)
If Vesico-ureteric Reflux suspected (FHx, Poor UO, Dil on USS, non E-coli UTI) =>
MCUG: Micturating Cystourethrogram (X-ray w/ contrast to identify any reflux)
Causes of Nephrotic Synd
Min change D, Intrinsic Kidney D (Focal Segmental Glomerulosclerosis), Systemic Illness (HSP, DM, Inf – HIV, Hep, Malaria)
Nephrotic Synd Ix
(Oedema)
Low serum Albumin
High Urine Protein (High A:Cr)
(Renal Biopsy)
Nephrotic Synd Mx - 5
High dose Pred 4wks (Weaned off for 8wks)
Low salt diet (+/- Diuretics => Reduce Oedema)
Albumin Infusion (If severe HypoAlb)
Abx prophylaxis
(If Steroid-resist: ACEi + Immunosuppression: Cyclosporin, Tacrolimus)
Nephritis Patho + Sx
Inflamm of Nephrons w/in Kidneys =>
Reduced Kidney Funct (Low eGFR)
Haematuria
Proteinuria
Causes of Nephritis
Post-strep GN:
Occurs 1-3wks post Tonsillitis (beta-haemolytic S.Pyogenes)
IgA Nephropathy:
Deposition of IgA Immune complexes w/in Nephrons (Post-URTI/GI Inf)
Nephritis Ix
Post-Strep:
(+) Throat swab,
(+) Anti-Streptolysin O Ab’s
IgA: Renal biopsy (IgA deposits)
Nephritis Mx
Post-strep:
ACEi/ARB + Diuretic (Reduce HT + Oedema)
IgA:
Immunosupp (Steroids, Cyclophosphamide)
Wilms Tumour Patho + Sx
(< 5yo):
Renal/Abdo mass (=> Abdo Pain), Haematuria HT Fever Weight loss Lethargy
Wilms Tumour Ix
Abdo USS (Assess size + location),
CT/MRI (Staging + Metastases)
+/- Biopsy (Grade)
Wilms Tumour Mx
Surg Excision (+/- Nephrectomy), \+/- Chemo/RadioTx
Post Urethral Valve Patho + Sx
(Extra tissue at Prox end of Urethra => Obstruct):
Diff/Weak Urination,
Chronic retention (=> Palpable bladder),
Recurrent UTIs
Post Urethral Valve Ix
Abdo USS (Enlarged Bladder w/ Bilat hydronephrosis)
MCUG (Tissue + reflux)
Cystoscopy (View Urethra + Bladder)
Post Urethral Valve Mx
(Temp catheter),
Cystoscopy (View Urethra + Ablation/Excision)
Cryptorchidism Mx
If < 6mo: watch + wait
If 6-12mo: Orchidopexy (Surg correction)
Hypospadias Ix + Mx
(Identified during Newborn Ex)
Surg correction at 3-4mo
Hydrocoele Features
Soft,
Smooth,
Non-tender
Transilluminates
Hydrocoele Ix + Mx
Confirm on USS (Excl Tumour, Haematoma, Varicoele, Hernia)
If simple: Self-resolve w/in 2yrs
If communicating: Surg removal/ligation of Processus Vaginalis
Monitoring Asthma control
Confirm Adherence
Review Technique
(Shake + Breathe out, Press + Breathe in, Hold breath > 10s, Wait 30s, Repeat)
Minimise exposure to Triggers, Allergens, Smoke
Constipation Red Flags - 7
Meconium Ileus (CF, Hirschprungs)
Fail to Thrive (HypoTh, Coeliacs)
Sacral dimple (Spina Bifida Occulta)
Abnormal Anal position/tone (Anorectal Abnormality)
Abnormal LL (Lumbosacral Abnormality)
Perianal bruising/fissures (Sexual Abuse)
Perianal fissures/Fistulas/strictures (CD)
