Paeds peer teaching part 2 Flashcards
Cystic fibrosis treatment
Chest physio High calorie diet CREON tablets for pancreatic enzymes Prophylactin flucox and vaccinations Nebulised dornase alfa Nebulised hypertonic saline Fertility treatment Genetic counselling
If you have two parents who are CF carriers, whats your chance of getting it
25%
What causes breathlessness in anaphylaxis
Angio oedema
Whats the best investigation for cystic fibrosis
Sweat test
Right illiac fossa tenderness
IBD
What type of anaemia do you get from GI blood loss
Microcytic
What happens to albumin in diarrhoea
Low because lost in stool and poorly absorbed because of malabsorption
Best investigation for inflammatory bowel disease
Colonoscopy
Features of both UC and crohns
Diarrhoea Abdo pain Weight loss N and V Faltering growth Delayed puberty Reduced appetite Malaise/ fatigue Fever
Features of IBD unique to crohns
Termina ileum disease (RLQ pain)
Perianal tags, fistulae, abscesses
Gallstones
Features of IBD unique to UC
Left lower quadrant tenderness
Bloody diarrhoea
Macroscopic and microscopic crohns features
Skin lesions, cobblestone mucosa
non caseating granulomata, transmural inflammation
Which IBD do you get toxic megacolon in
UC
Macroscopic and microscopic UC features
Continous, mucosal ulceration. No granulomas. Submucosal inflammation
Crohns induction of remission treatment
Enteral nutrition (modulen) then glucocorticoids
Crohns maintenance of remission treatment
Azathioprine
UC induction of remission treatment
Mesalazine or glucocorticoids
Treatment of toxic megacolon
IV, fluids, glucocorticoids, surgery
Maintenance of remission in UC
Mesalazine
Define coeliac
Autoimmune condition caused by an inflammatory response by the GALT to gliadin (HLA-DR3-DQ2)
Which antibodies are present in coeliac
Tissue transglutaminase
Endomysial cell antibodies
Diagnosis of coeliac
Dont eat gluten for 6 weeks then test for antibodies then endoscopy and biopsy
Microscopic changes in coeliac
Long crypts, lymphocyte infiltration, flattened villi
Magement of coeliac
Gluten free diet
Symptoms of coeliac
Unintended weight loss Fatigue Chronic diarrhoea Flatulence Severe recurrent abdo pain Pale stools
Causes of gastroenteritis
Virus ! (rotavirus, adenovirus, enterovirus)
Bacterial- campylobacter jejuni, E. coli, shigella, salmonella
Clinical features of gastroenteritis
Acute onset diarrhoea and vomitting Fever Lethargy Abdominal pain Poor feeding
If watery diarrhoea returns after gastroenteritis whats going on
Post gastroenteritis syndrome (may have developed lactose intolerance)
When should you take stool samples in gastroenteritis
Not sure of diagnosis Septic Bloody More than 2 weeks Immunocompromised
Management of gastroenteritis
Oral rehydration solution
Breast feed
NG fluids
Hospitalisation if needed
Common symptoms of appendicitis
RLQ pain, worse on movement, Vomiting, fever, peritonism
Diagnosis of appendicitis
Clinical diagnosis
Ultrasound
Treatment of appendicitis
Appendicectomy
Common symptoms of intussusception
Sudden colicky pain, drawing up legs, pale, vomiting, redcurrent jelly stools
Diagnosis of intussusception
Target sign on ultrasound
Management of intussusception
IV fluids and antibiotics
Pneumotic reduction air enema
Laparotomy
Common symptoms of mesenteric adenitis
Mimics appendicitis, pharyngitis, cervical lymphadenopathy
Treatment of mesenteric adenitis
Analgesia
Hydration
Common symptoms of inguinal hernia
Reducible lump in groin, if strangulated= nausea, vomiting, off food, sever pain
Investigation of inguinal hernia
Clinical exam- rule out testicular torsion
Treatment of inguinal hernia
Early surgical intervention
Symptoms of irritable bowel syndrome
Pain relieved on defecation, bloating, mucus in stool, lethargy
Treatment of irritable bowel
Small regular meals, eliminate triggering foods
Symptoms of abdominal migraine
Pain lasting 2-72 hours, nausea, vomiting, anorexia, pallor
Treatment for abdominal migraine
Analgesia, avoid triggers, prophylaxis
What type of bilirubinaemia causes jaundice in the first 24 hours
Unconjugated
Causes of jaundice in first 24 hours
Haemolytic disease of the newborn Hereditary spherocytosis G-6-PD deficiency Sepsis TORCH infections Crigler-najjar syndrome
Causes of jaundice after 2 weeks
Biliary atresia
Hypothyroidism
UTI
Gilbert syndrome
Jaundice investigations
Bilirubin chart FBC Blood film Unconjugated and conjugated Blood typing of mother and baby Direct Coombs test
What does the direct coombs test look for
Haemolysis
How does the molecule go from haem to conjugated bilirubin
Haem
Biliverdin
Unconjugated Bilirubin
Conjugated bilirubin
What is biliary atresia
Narrowing blockage or absence of part of the biliary tree. Leads to a conjugated bilirubinaemia
Presentation of biliary atresia
severe jaundice at day 2 (high conjugated), pale white stools
Biliary atresia treatmtent
Ultrasound of gall bladder and bile ducts
TBIDA radioisotope scan
Kasal surgery
Anti D injections
Given at 28 weeks and again at birth or after a sensitisation event
Kliehauer test
Assess how much fetal blood mixed with the mothers blood
Hereditary spherocytosis presentation
Newborn with jaundice and splenomegaly
Describe hereditary spherocytosis pathology
Autosomal dominant. Sphere shaped red blood cell.
Aplastic crisis if also parvovirus
Investigations of spherocytosis
FBC, Blood film, Coombs test
Treatment of spherocytosis
Splenectomy
Cholecystectomy
Folate
Penicillin for life
G6PD deficiency pathology
Baby picks up infection and turns yellow. X linked recessive.
G6PD triggers and presentation
Infection, medication or broad beans causes splenomegaly and gall stones
Investigations of G6PD deficiency
Heinz bodies on blood film
G6PD enzyme assay
G6PD fun fact
Caused by fava beans and Heinz bodies is a sign of it
Gilberts syndrome
Unconjugated bilirubin. Cos cant conjugate bilirubin. Jaundice only during illness, exercise or fasting
Crigler Najjar
Jaundice at birth, death by 2.
Neonatal hepatitis presentation
IUGR, jaundice, failure to thrive, itchy rash, dark urine and hepatomegaly
Neonatal hepatitis investigation
Liver biopsy shows multinucleated giant cells and rosette formation
Derranged LFTs
What is breast feeding/ physiological jaundice
Appears day 3, peaks at 7 then goes.
Foetal Hb has shorter lifespan and newborn liver cant cope.
Can randomly happen more in breastfed
Jaundice, hypotonia and large tongue
Hypothyroidism (ioidine, hormonal dysgenesis, autoimmune thyroiditis later in childhood)
Key symptoms of hypothyroidism
Delayed puberty and development, puffy face, macroglossia, short stature, cretinism
Hypothyroidism investigations
Heel prick test, ultrasound of the neck, TSH levels high
Treatment of hypothyroidism
Levothyroxine
Galactosaemia presentation
Jaundice, vomiting and poor feeding worsened by cows milk feeding. GALT enzyme missing.
Cataracts
Galactosaemia treatment
Both mum and baby need to stop dairy. Breastfeed only
Kernicterus
Convulsions, lethargy, poor feeding, coma, cerebral palsy, learning difficulties and death because unconjugated bilirubin has crossed the BBB
Wilsons disease pathology
Reduced caeruloplasmin.
Kayser fleischer rings, parkinsonism, rickets, jaundice
Investiagtions of wilsons disease
Increased 24hr copper urine, reduced serum caeruloplasmin. Penicillamine and zinc treatment
Alpha 1 antitrypsin
Less A1AT so more neutrophil elastase. Neonatal jaundice and bleeding. Worse with breastfeeding. Look for serum levels. Make sure they dont smoke
Febrile seizures
Seizure in association with fever with no definable intracranial cause.
What is status epilepticus
Over 30 mins
What classes as a simple febrile seizure
Generalised tonic clonic lasting up to 24 hours and not recurring within 24 hours
Treatment of febrile seizures
Paracetamol and ibuprofen, education and reassurance
What do you call seizures that happen in sleep
Benign neonatal sleep myoclonus or parasomias
What do you call seizures that happen when feeding
Sandifer syndrome/ GORD
Describe syncope
Older child, prodromal pallor, rapid recovery. Situational
Neonatal life support
Dry the baby
Get help, open airway, feel for breathing, 5 rescue breaths (cover nose holes, neutral neck position). Check for signs of circulation.
15 chest compressions (tips of fingers):2 rescue breaths
Where do you check for circulation in a newborn
Brachial and femoral
APGAR what does it stand for
Activity (muscle tone) Pulse Grimace (reflex irritability) Appearance (skin colour) Respiration
What are the scores for activity in apgar
absent=0, 1= flexed limbs, 2= active
What are the scores for pulse in apgar
absent=0, 1= less than 100, 2=more than 100
What are the scores for grimace in apgar
floppy=0, 1=minimal response, 2=prompt response
What are the scores for appearance in apgar
Blue, pale=0, pink body, blue extremities=1, pink=2
What are the scores for respiration in apgar
absent=0, slow and irregular=1, virgorous cry=2
Whats a very low apgar
Below 3
Whats a good apgar
Above 7
When should you do apgar
1, 5 and 10 minutes
What is on the guthrie card/ heel prick test
Congential hypothyroidism Cystic fibrosis Sickle cell disease Phenylketonuria MCADD MSUD IVA GA1 HCU
What are the neonatal infections
TORCH Toxoplasmosis Rubella CMV Herpes simplex
Toxoplasmosis neonatal
Hydrocephalus, cerebral palsy
Rubella neonatal
Sensorinueral deafness, growth retardation, cerebral palsy, purprual skin lesions
Herpes simplex neonatal
Limb hypoplasia and corticol atrophy- give baby Varicella Zoster Immune globulin (VZIG)
Transient tachypnoea of newborn
After emergency C section. Physiological pulmonary oedema. CXR= hyperinflation of the lungs and fluid in the horizontal fissure.
Should resolve by itself
Respiratory distress syndrome
Early. Tachypnoea, intercostal recession and is cyanosed. CXR= ground glass appearance, indistinct heart border and air bronchograms.
Give mum dexamethasone and baby surfactant and oxygen
Meconium aspiration syndrome
post term, mum smokes and has HTN. Meconium stained amniotic fluid.
CXR= Patchy infiltrates, atelectasis, coarse streaking of both lungs.
Suctioning is the treatment
Neonatal sepsis (group B strep)
Premature and prolonged ROM.
Fever, reduced tone and activity. RDS. Hypoglycaemia.
BenPen and Gentamicin.
Then blood cultures, CRP and LP
Persistent pulmonary hypertension of newborn
Failure of transition to adult circulation. Respiratory syndromes, Maternal SSRI or aspirin.
Chronic lung disease of prematurity/ bronchopulmonary dysplasia
Still requires oxygen 28 days after delivery.
Scarring and reduced alveolar surface area.
Resp symptoms.
CPAP and caffeine
Apnoea of prematurity
Premature baby stops breathing for more than 20s.
IV caffeine
Tactile stimulation when alerted by apnoea monitors
Intraventricular haemorrhage
Premature babies within first 3 days. Go into shock, hydrocephalus. Vitamin K is the treatment
Cephalohaematoma
Several hours after birth. Doesnt cross suture lines, blood under parietal region.
Caput succedaneum
Present at birth, forms over vertex and crosses suture lines. Resolves in days
Neonatal seizure causes
Hypoxic ischaemic encephalopathy Intracranial haemorrhage Meningitis Tuberous sclerosis Fetal withdrawal syndrome
Hypoxic ischaemic encephalopathy
Asphyxia at birth
Sarnat staging system
Therapeutic hypothermia treatment
Necrotising enterocolitis presentation and pathology
Bacterial invasion of ischaemic bowel. Feeding intolerance, distended abdomen, bloody stools and green vomit
Investigation and treatment of NEC
Dilated bowel loops,
air in portal tract,
air under diaphragm, intramural air. Riglers and football sign.
Nil by mouth, IV fluids, IV broad spectrum abx and laparotomy
Retinopathy of prematurity
Retinal blood vessel formation is stimulation by hypoxia. So is prevented by too much oxygen.
Scar, detach, blind.
Treat with transpupillary diode laser therapy
Congenital diaphragmatic hernia
RDS, heart sounds louder on the right, tinkling bowel sounds.
Bochdalek hernia.
NG feed, intubate and ventilate then surgery
Whats the difference between gastroschisis and omphalocele
Gastroschisis has no peritoneal layer whereas the omphalocele protrudes into umbilical cord
Initially baby seems fine but then collapses and turns blue.
Transposition of the great arteries, happens when ductus arteriosis closes.
Echo
Prostaglandin E2
Arterial switch procedure
Coarctation of the aorta
Newborn is floppy, grey and tachypnoeic. Weak femoral pulses and radiofemoral delay.
Do 4 limb blood pressure
Prostaglandin E2 then surgery
How does cyclooxygenase inhibition affect the phyioslogical changes within the first 48 hours of birth
Promotes ductus arteriosus closure
Neonatal cyanosis causes
Tricuspid atresia Transposition of the great arteries Tetralogy of fallot AVSD Eisenmenger syndrome
Non blanching rash causes
Meningitis ALL Congenital bleeding disorders ITP HSP Non accidnetal injury
Henoch Schonlein Purpura
Purpuric non blanching rash on buttocks and legs, abdo pain and joint pain.
IgA vasculitis
Skin, kidneys, GI
Self limiting
Kawasaki disease
Fever over 5 days and conjucitivitis, tongue and mucous membranes, desquamification, cervical lymphadenopathy
Aspirin and IV IG
Coronary aneurysms
Meningococcal sepitcaemia
Blood culture and LP, send blood for meningococal PCR
IM BenPen
Cefotaxim
Less than 3 months= add amoxicillin for Strep
Give dexamethasone too
Rheumatic fever
After tonsilitis.
Swollen large limbs, heart infection, murmurs and pericardial rub.
Strep pyogenes.
Throat swab.
NSAIDs and long term prophylactic Abx to prevent endocarditis
Whats the criteria called for rheumatic fever
JONES
Joint, heart, nodules, erythema marginatum, sydenham chorea
Chicken pox (varicella zoster virus)
Vesicular rash. Blistering. Starts and trunk or face.
Keep cool, trim nails.
Varicella Zoster Immunoglobulin (VZIG) if newborn
Shingles (herpes zoster virus)
Acute, unilateral painful blistering rash in dermatomal distribution.
Can cause pneumonia and encephalitis.
Aciclovir
(VZIG for non immune mothers)
Candida
Inflamed rash, satellite lesions and oral lesions. Topical imidazole. Cease the use of a barrier cream.
Nappy rash
Dont use talcum powder.
Leave nappy off as much as possible, dry bottom, change regularly. Use a mild hydrocortisone
Impetigo
Exfoliative toxins made by staph aureus. Golden crust. Swabs for diagnosis.
Topical fusidic acid
Oral flucoxacillin
Erythema infectiosum (slapped cheek)
Non specific symptosm and slapped cheek red rash. Parvovirus B19. Spreads to upper arms. Foetal hydrops. Sickle cell can turn aplastic crisis.
Roseola infantum
High fever, maculopapular rash and convulsions. (starts on chest)
Human herpes 6
Scarlet fever
sandpaper rash on torso, spares the face, strawberry tongue
S pyogenes
Penicillin V
Swab throat
Hand foot and mouth disease
Coxsackie A16 virus
Blistering red spots on hands feet and mouth after normal cold.
Very contagious but self limting
Staphylococcal scalded skin syndrome
Nikolskys sign- seperation of skin on gentle pressure.
S. Aureus bacteria produces exfoliative toxins.
Flucoxacillin
Fusidic accid
fluid and electrolyte management
Paracetamol
Toxic shock syndrome
Staphylococcal exotoxin
Leaving tampons in too long.
High fever, signs of shock, diffusion desquamating erythematous rash.
ABCDE, oxygen, IV broad spectrum abx, IVIG
Measles
Prodrome, koplik spots (buccal mucosa), rash starts behind ears
Encephlaitis, otittis media, panencephaltiis.
Give MMR. You have immunity from mum until 9 months
Erythema multiforme
Widespread target lesions. Pyrexia, stomatitis, muscle and joint aches.
Hypersensitivity reaction.
Resolves.
Molluscum contagiosum
Viral. Flesh coloured papules with a central dimple.
Salicylic acid
Scabies
Incredibly itchy, between the fingerwebs then whole body.
Sarcoptes scaibiei.
Permethrin cream.
Wash everything
Ringworm
Itchy circular erythematous and scaly well demarcated rash.
Fluconazole orally
Miconazole cream.
Steroids make fungal infections worse
Seborrhoeic dermatitis
Cradle cap
Eczema
Dry, red, itchy over flexor surfaces in infancy then extensor in young children.
Emolients and special soaps, avoid triggers.
Wet wraps
Hydrocortisone for as little time as possible (skin thinning and telangiectasia)
Psoriasis
Scaly, dry, flakey, raised and rough on extensor surfaces. Keratinocyte proliferation.
Topical corticosteroids and vitamin D analogues
Salmon patch
Flat red or pink on face. Fade in a couple of months
Infantile hemangioma
Strawberry marks. Rapidly increase in size for first 6 months then shrink and disappear by 7 years
Capillary malformation
Port wine marks.
Unilaterally normally on face, chest and back.
Permanent and receptive to hormones.
Cafe au lait spots
More than 6 before 5 could be neurofibromatosis
Mongolian spots
Lower back or buttocks. Darker skinned. Dissapear by age 4
Congenital meloncytic naevi
Normal moles
Slipped upper femoral epiphysis
Obesity, puberty growth surge.
Limping, pain on movement in all directions.
Management= immobilisation, analgesia, screw fixation
4-10 year old limb
Transient synovitis
Perthes disease
JIA
Septic arthritis
Streptococci neonatally Staph aureus afterwards Acute pain and swelling, fever, rigors. Kocher modified criteria. Joint aspiration, blood cultures, splinting, IV abx, surgical drainage
Developmental dysplasia of the hip
Barlow and ortolani tests
Painless limp, limited abduction, assymetrical skin folds.
Family history, breech, oligohydramnios.
Ultrasound and plain radiograph
Perthes disease
Avascular necroissi of the femoral head.
Limp in the absence of trauma. groin pain, limited rom, muscle wasting.
Pain relief, physio or surgery
Transient synovitis
Sudden onset limp. No rest pain. Well child. Blood and X Ray.
Rest and simple analgesia
JIA
Joint inflammation presenting before 16 for atleast 6 weeks. With absence of cause.
Systemic JIA- temperatures and salmon pink rash.
Physio, NSAIDs, intra articular corticosteroid injections
