Paeds new Flashcards
Cx of maternal DM
On foetus:
- macrosomia
- IUGR
- congenital abnormalities
At birth: shoulder dystocia, obstructed labour, brachial plexus injury etc
In neonate:
- hypoglycaemia
- RDS
- Polycythaemia
- hypertrophic cardiomyopathy
Foetal alcohol syndrome presentation
face:
- maxillary hyperplasia
- saddle shaped nose
- absent philtrum
- short upper lip
Growth restriction, developmental delay, cardiac defectss
Which maternal bleeding disorder can cross to the foetus, and what will it cause
Immune Thrombocytopoenic purpura
because maternal IgG crosses the placenta and damages foetal platelets
Risk of intracranial haemorrhage following birth trauma
What is HIE
Hypoxic brain injury caused by a significant hypoxic event immediately before or during delivery
Causes of HIE
- failure of gas exchange across placernta (prolonged contractions, placental abruption, uterine rupture)
- interruption of umbilical blood flow (cord compression/prolapse)
- inadequate maternal placental perfusion
- compromised foetus (anaemia, IUGR)
- failure of CR adaptation at birth > failure to breathe!!
NEC symptoms
stops toleratging feeds
vomiting (bile stainsed)
abdo distension
rectal bleeding
NEC on AXR
distended loops of bowel
thickened bowel wall
intramural gas
gas in portal tract
Important investigations for prolonged jaundice
serum bilirubim (total, conjugated)
TFT (hypothyroidism)
LFT (neonatal hepatitis)
liver uss (cholecodal cyst,biliary atresia)
what is the key presentation of PPHTN of newborn
CYANOSIS
What ix should you get urgently for PPHTN
echo - to exclude congenital cyanotic heart defect
What can cause PPHTN
- idiopathic
- RDS
- MAS
- birth asphyxia
How do you manage PPHTN
inhaled nitric oxide (vasodilator)
sildenafil (vasodilator)
high freq oscillatory ventilation
ECMO
management of clinically dehydrated child (UNDER/OVER 5YO)
UNDER 5YO:
- give ORAL REHYDRATION SOLUTION
- 50 ml/kg over 4 hours (fluid deficit replacement) + maintainance
+ monitor response to rehydration
OVER 5YO:
- 200mls ORS after each loose stool
When do you give IV fluid in dehydrated child’
if child is shocked
if child is vomiting the ORS
If red flag sx despite ORS
give 20ml/kg bolus if septic > if no response, second bolus + consider why isn’t he responing=?!? if responding, then proceeed normally (maintainance + deficit)
Coeliac follow up management
avoid gliadin
refer to dietician
review annually
advise risk of EATL and micronutrient deficiency
red flag fts in septic child
fever >38 if under 3m, >39 if under 6m colour pale/cyanosed/mottled reduced consciousness, neck stiffness, status epilept, focal neuro sign resp distress bile stained vomit severe dehydration/shock
safety net for febrile child
fever >5 days signs of dehydration non-blanching rash seizure child generally unwell
most likely consequence of bacterial meningitis - and explain why
hearing impairment
because of inflammatory damage to cochlear hair cells
best investigation for bronchiectasis
chest CT
Describe presentation of chondromalacia patella
Repeated extension (e.g. walking upstairs)causes pain and grating feeling \+ crepitus / small effusion
mx with physio
Describe presentation of Osgood Schattler
Overly Sporty boys - knee pain after exercise + swelling + tenderness
Describe what happens to bone of Osteomalacia Patella
cracking in cartilage and bone
Presentation of spina bifida occulta
gradual sx onset
in childhood
lower back pain
gait disturbance
scoliosis
neuro difficulties (bowel and bladder dysfunction)
How do you manage Hep C in neonate if mother is infected?
No treatment until 3 years of age!
Vertical infections may resolve spontaneously
which form of viral hep is most dangerous in pregnancyh
Hep E -fulminant hepatic failure, high mortality rate
how do you manage inguinal hernia depending on age?
ALWAYS do surgery
- if neonate: high risk of strangulation, perform urgently
- if > 1yo: lower risk, elective surgery
perform HERNIOTOMY (without mesh)
explain how and when you UPSCALE management in CONTACT (IRRITANT) dermatitis
mild erythema + asymptomatic child: use barrier protection
If rash appears inflamed + causing discomfort + children over 1: addtopical hydrocortisone 1% (7 days)
If nappy rash persists + bacterial infection is
suspected / confirmed: oral flucloxacillin 7 days
describe candida nappy rash
does NOT spare skinfolds
satellite lesions
RF for sudden infant death
child: male, 1-6 yo, low birth weight
family: low income, no qualif, overcrowding, maternal age >21, smoking/alcohol
How does hydroxycarbamide work and how long does it take to cause improvement in sickle cell?
works by increasing concentration of foetal Hb
good if recurrent painful crises / acute chest syndrome
takes about 2 months to cause improvement
when do you need to call an ambulance in a seizing child
if seizure does not stop within 5 mins of giving midazolam
Sickle cell anaemia - traits
SICKLED MP
Stroke, cerebral injury, cognitive defect
Infections (hyposplenism)
crises (splenic, sequestration, chest, pain)
kidney (papillary necrosis, neprotic syndrome)
liver (gallstones)
eyes (retinopathy)
dactilitis (impaired growth)
mesenteric ischaemia
Priaprism
associated signs with congenital hypothyroidism
macroglossia
umbilical hernia
how can you distinguish hydradid of morgagni from testic torsion
Hydradid of morgagni:
- pain less severe
- cremasteric reflex present
- blue dot sign
tetratolgy of fallot acute episodes of SOB management
analgesia, oxygen > phenylephrine (for vasoconstriction, to increase vascular resistance > reduce RtoL shunt)
what is acrodermatitis enteropathica
AR metabolic disorder characterised by malabsorption of zinc, resulting in: - diarrhoea, - inflammatory rash around mouth/anus - hair loss
rapid test for EBV
MONOSPOT test
what is the biggest risk with roseola infantum
risk of FEBRILE SEIZURE
who do you admit with asthma
severe / life threatening asthma
in what order does anaphylaxis present as wheeze / stridor?
Wheeze first!
then stridor if very severe
whooping cough how long are they infection
48 h after starting to take antibiotic
or 21 days if no antibiotic
what tumour is likely to cause bone pain
osteoid osteoma
