Paeds Peer Teaching 2 Flashcards
List the VACTERAL association.
- Vertebral (scoliosis / hypoplasia)
- Anal atresia (imperforate anus)
- Cardiac (VSD / ASD / Tetralogy)
- Trachea-Oesophageal fistula
- Oesophageal atresia
- Renal / radial aplasia
- Limb defects (hypoplastic thumb, polydactyly, syndactyly)
List the ‘CHARGE’ associations.
- Colomboma (pupil defect)
- Heart defect
- Choanal atresia (blockage of nasal passage)
- Retardation of growth / development
- Genital hypoplasia
- Ear anomalies
Who’s involved in the MDT if a child has a cleft lip / palate?
- Surgeon
- Orthodontist
- SALT
A child had a cleft lip / palate. When would repairs be carried out?
Lip repair: 3 months
Palate repair: 9 months
List 4 things which contribute to morbidity in a child with cleft lip / palate.
- Poor feeding
- Milk aspiration
- Speech delay
- Conductive hearing loss
What is ‘spina bifida’?
Failure of neural tube to close in first trimester.
What causes spina bifida?
- Insufficient folic acid
- Drugs (valproate, carbamazepine)
What are the 3 grades of defect seen in spina bifida?
- Occulta: hidden defect, hairy lower back, often asymptomatic
- Meningocele: meninges protrude but not exposed, spinal cord intact
- Myelomeningocele: open lesion, severe weakness and disability.
What is the pathophysiology of DDH?
- Shallow acetabulum doesn’t cover femoral head -> dislocatable
Which 2 tests are used for DDH?
- Barlow’s: dislocation
- Ortolani: relocation
Risk factors for DDH?
- Breech presentation
- Family History
- Prematurity
- Twins
Treatment for DDH?
- Pavlik harness
- Surgical reduction
Late signs of undiagnosed DDH?
- Unilateral limp
- Leg dragging
- Restricted movement
What are the 4 classes of developmental milestones?
- Gross motor
- Fine motor / vision
- Speech / language
- Social
A child of 6 weeks should be able to:
- Stabilise head
- Social smile
- Eye tracks movement
A child of 6 months should be able to:
- Sit unsupported
- Palmar grasp at 5 months
At what age should a child be walking?
9 - 18 months
Define cerebral palsy.
Permanent, non-progressive movement disorder due to a lesion of the developing brain.
What are the pre-natal risk factors for cerebral palsy?
- Cerebral malformation
- Infection (TORCH)
- Metabolic
What are the perinatal risk factors for cerebral palsy?
- Hypoxia
- Intrapartum trauma
- Prematurity complications
What are the post natal risk factors for cerebral palsy?
- Head trauma
- Stroke
- Meningitis
How would a child with Cerebral palsy present?
Spasticity (70% = UMN signs)
- rigidity
- hypereflexia / tonic
- Weakness
- Delayed milestones
- poor co-ordination
- Persistent primitive reflexes
What are the 4 types of Cerebral Palsy?
- Hemiplegic
- Diplegia
- Ataxia
- Athetoid (dyskinetic)
List some problems associated with Cerebral Palsy.
- Epilepsy
- Audiovisual development
- Respiratory problems
- Poor growth
- Intellectual disability
Risk factors for Cerebral palsy?
- Preterm birth
- Twins
- Maternal infection
- Difficult delivery
How is cerebral palsy diagnosed?
Clinical diagnosis - CT / MRI indicated if ?cause or ongoing conditions eg.: ? hydrocephalus ? SDH ? AVM ? Malignancy
Treatment for Cerebral palsy?
- Early MDT involvement
- Physio
- Paediatrician
- Orthopod
- OT
- Dietician
- Community Liaison
Vaccinations:
What should you do if child is feverish or younger than indicated?
- Delay the vaccine
What kind of vaccine should be given to the immunocompromised?
- Live attenuated vaccine
What is in the 6 in 1 vaccine, and when should it be given?
Given at 2 / 3 / 4 months
- Diphtheria
- Tetanus
- Pertussis
- Polio
- HiB
- Hep B
What kind of vaccine is the MMR vaccine?
When should it be given?
Given at 1y and 3yrs+4m
- Live attenuated vaccine
- Maternal Ig protection for approx 1 year.
MMR should be given at 6 months if there is an outbreak.
Describe Measles.
- Maculopapular rash
- Fever
- URTI
- > complicated encephalitis
Describe Mumps.
- Swollen parotids
- Fever
- Subfertility in men.
Describe rubella.
- Mild fever
- Rash
Maternal infection = fetal abnormalities.
List some signs of moderate / severe dehydration.
- Tachycardia
- > 2 Cap refill time
- Weak pulses
- Mottling
- Cold
- Cyanosis
- Coma
- Hypotension is a late finding and may occur after coma
What fluid should you give STAT if moderate / severe dehydration?
10 - 20ml/kg of 0.9% Saline bolus
What fluid should you give as maintenance fluid in kids?
0.9% saline + 5% dextrose + 10mmol KCl
What are the total daily fluid requirements?
1st 10kg = 100ml/kg/day
2nd 10kg = 50 ml/kg/day
Remainder = 20ml/kg/day
In a 27kg child, what amount of fluid should you give them for maintenance fluids?
1st 10kg = 100 x 10 = 1000
2nd 10kg = 50 x 10 = 500
3rd 7kg = 20 x 7 = 140
= 1640ml/day (68ml/hr)
Neck swelling history.
Fever, duration and onset
- Thyroid screen
- Vaccination Hx
How should you examine a kid’s neck swelling.
Infected - mobile + tender
Malignant - fixed and matted
Look in the mouth and throat - don’t poke anything down the throat if airway.
Common sites = lymph nodes (anterior chain), parotid, thyroid, mastoid.
Investigations for a neck swelling?
- FBC: raised WCC in infection, atypical lymphocytes if EBV
- Throat culture if ?Group A Strep
- Amylase if ?Mumps
- TFTs if ?thyroid
Describe Mastoiditis.
- Medical emergency -> meningitis, sinus thrombosis
- Ear pushed out / previous otitis media
- IV ABx + mastoidectomy
Describe Parotitis (Mumps)
- Parotid swelling
- Fever + malaise
- Scrotal pain
- Raised amylase
- IgG / IgM antibodies
- Fluids + analgesia
- ?Subfertility
Describe IgG and IgM levels in infection.
Recent infection: High IgG and high IgM
Previous infection or vaccination: High IgG + Normal IgM
No previous exposure: Normal IgG + Normal IgM
How does ?Hodgkin’s Lymphoma present?
- Firm, non-tender lymphadenopathy.
- Fevers, night sweats, weight loss, fatigue
- Hepatosplenomegaly
What is Hodgkin’s lymphoma associated with?
- Immunosuppression
- Previous EBV
What investigations should you do if ?Hodgkin’s lymphoma?
- Lymph node biopsy: Reed-Sternberg cells
- FBC
- Staging CT / MRI
What treatment should you give for Hodgkin’s Lymphoma?
- Radiotherapy
- Chemotherapy
- MAB (eg. Rituximab, a CD20 antagonist)
A premature baby might have an intraventricular haemorrhage. What signs might they have?
- Seizures
- Bulging fontanelle
A premature baby has Retinopathy of Prematurity. Why?
- Exposure to O2 is a cause
A prem baby has Respiratory distress syndrome.
Why?
What would you seen on CXR?
What would you do?
- Underdeveloped lungs
- Ground glass XR
- Give surfactant / O2 / CPAP
Prem baby has NEC. What signs do they have?
Prevention of NEC?
Management?
- Failure to thrive
- Breast milk is preventative
- Supportive Mx + surgery
Prem baby has sepsis. What are you going to do?
- Full workup including:
- Bloods
- Urine
- CSF: ?Group B Strep / E. coli
- Give Abx -> gentamicin / BenPen
Kawasaki’s pneumonic?
CRASH and BURN (Fever > 5 days)
- Conjunctivitis (bilateral and non-purulent)
- Rash
- Adenopathy (cervical and unilateral)
- Strawberry tongue + cracked lips
- Hands + feet: erythema + desquamation
Treatment for Kawasaki’s?
- Aspirin
- IV Ig
- ECHO + Cardio referral (risk of coronary artery aneurysm)
Describe Perthe’s disease.
- 4-8yo boys
- Avascular necrosis of the femoral head
Describe SUFE.
- Obese
- Adolescent male
- Groin pain
Describe Septic Arthritis.
- Red, hot, swollen, tender, mono arthritis, systemic upset
- Urgent Abx + aspirate + wash out + orthopod opinion
Describe JIA
- Persistent swelling
- Can’t walk up stairs
- Extra-articular involvement
Describe Osgood-Schlatter disease.
- Young, athletic teens
- Swelling below knee
Describe Duchenne’s.
- Proximal weakness
- Boys
- Gower’s sign
- Respiratory involvement
What might make you suspicious of NAI?
- History incompatible with injury / unclear Hx
- Delay in seeking medical attention
- Multiple fractures, retinal haemorrhage, torn frenulum
- Injury in a non-ambulatory / totally dependent child
What fractures increase the index of suspicion for NAI?
- Metaphysical corner fracture (shaking)
- Rib fracture
- Skull fracture
What bruises increase the index of suspicion for NAI?
- Ear
- Cheeks
- Buttocks
- Forearms
- Neck
