Peadiatrics Flashcards
Describe the pathology of asthma
Airflow obstruction in asthma is the result of contraction of the airway smooth muscle and swelling of the airway wall due to:
- smooth muscle hypertrophy and hyperplasia
- inflammatory cell infiltration
- oedema
- goblet cell and mucous gland hyperplasia
- mucous hyper secretion
- protein deposition
What is asthma?
Asthma is a chronic inflammatory disorder of the airways. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, coughing (particularly at night or in the early morning).
What are the risk factors for asthma?
RSV, rhinovirus
Atrophy (eczema, allergic rhinitis, allergies)
Tobacco exposure
Exercise or play
What is the six step asthma management plan?
- assess severity
- achieve best lung function
- maintain best lung function (triggers)
- maintain best lung function (medications)
- develop an asthma action plan
- educate and review
How do you complete an initial assessment of acute asthma?
Do they have altered consciousness?
Whatis their oximetry on presentation (>94 mild, <90 severe life threatening)
Do they talk in sentences, phrases, or words?
What is their pulse(<100 mild, >200 severe)
Do they have central cyanosis?
How loud are their wheezes (quiet wheezes can be bad)
What is the PEF?
What is the FEV1?
How do you manage an acute attack of asthma?
Give oxygen if needed, give medications (bronchodilators and steroids), do investigations,
What is croup?
Croup, also own as laryngotracheobronchitis, is a common respiratory disease in children. It is characterised by acute onset barking seal like cough, stridor, hoarse voice, and respiratory distress. The symptoms are a result of upper airways obstruction as a result of inflammation due to viral infection (commonly parainfluenzae virus 1and 3)
What are the four areas of development?
Gross motor, fine motor, language and special senses, and personal social.
What are the different causes of obstructive congenital heart disease?
Causes of obstructive congenital heart disease include aortic stenosis, pulmonary stenosis, and coarctation of the aorta. They present with pallor, decreased urine output, cool extremities, poor pulses, shock, or sudden collapse.
What developmental milestones do you expect at 6 months?
Puts weight on hands whilst prone. Ulnar grasp, transfers objects from hand to hand, begins to babble, responds to name
What developmental milestones do you expect by nine months?
Pulls to stand,ncrawls,mfinger thumb grasp, says momma/dada one word imitations, plays games peek a boo
What developmental milestones do you expect by one year of age?
Walks with support, pincer grasp, 2words, follows one step commands, drinks with cup, waves bye bye
At what point should you be worried that a child is not walking?
You should be worried that a child is not walking by 18 months.
At what point should you be worried about a child’s speech?
You should be worried about a child’s speech if there is less than 3 words at 18 months
What is the rooting reflex?
Rooting reflex is when the infant pursues tactile stimuli near the mouth
What is the Moro reflex?
The Moro reflex occurs when the infant is placed semi upright head supported by the examiners hand and there is sudden withdrawal of the supported head with immediate re support. The reflex consists of abduction and extension of the arms, opening of the hands, followed by flexion and adduction of arms. Absence of the Moro reflex suggests a CNS abnormality, asymmetry suggests a focal motor lesion (eg brachial plexus injury)
What are the reflexes that you can test in a young infant?
Rooting reflex, Moro reflex, gallant reflex, grasp reflex, stepping reflex and babimskis sign
What are the ages at which a child is scheduled for vaccinations?
Birth (hep B) 2 months (hepB, DTPa, HiB, IPV and rotavirus, and pneumococcal conjugate) 4 months (hepB, DTPa, HiB, IPV and rotavirus, and pneumococcal conjugate) 6 months (hepB, DTPa, HiB, IPV, and rotavirus, and pneumococcal conjugate) 12 months (HiB, meningococcal C, MMR) 18 months (chicken pox) 4 years (MMR, DTPa and IPV)
What are the signs of inadequate feeding in newborns?
<6 wet nappies a day after the first week (1stool per days in age for the first week) Sleepy or lethargic <7 feeds per day Weight loss >10% of birth weight Jaundice
What’s the difference between breastmilk jaundice and apbreastfeeding jaundice?
Breast feeding jaundice occurs in the first week or two of life due to the lack of milk production and subsequent dehydration, likely to be a mechanical problem. Breast milk jaundice is rare and can persist up to 4-6 months. It’s not fully understood but is thought to be due to substances in breast milk that inhibit conjugation of bilirubin or increased enterohepatic circulation of bilirubin, likely a biochemical problem.
What causes of failure to thrive produce a decreased weight, normal height and normal head circumference?
Caloric insufficiency, hyper metabolic state, decreased intake, increased losses.
What type of failure to thrive causes decreased weight, decreased height, and normal head circumference?
Structural dystrophies, endocrine disorder, consitutional growth delay, familial short stature
What types of failure to thrive cause decreased weight, decreased height, and decreased head circumference?
Inter uterine insult, genetic abnormality
What is the definition of failure to thrive?
FTT is when weight is <3 centile or less than 80% of expected weight for heir and age. Inadequate caloric intake is the most common factor in poor weight gain.
What are the different organic reasons for failure to thrive?
Inability to feed (eg reflux, poor breast milk supply), vomiting/diarrhoea, pancreatic insufficiency, coeliac disease, cystic fibrosis, renal disease (eg renal tubular disease), congenital hypothyroidism, hypopituitarism, diabetes mellitus type 1, diabetes insipidus, cardiac disease, malignancies, chronic infections, SLE, syndromes, GH deficiency, Foetal alcohol syndrome, TORCH infections.
What are the non organic causes of failure to thrive?
Malnutrition, inadequate nutrition, errors in formula, neglect, abuse, picky eaters
What are the organic causes of childhood obesity?
Cushing’s syndrome, prader Willi, carpenter, Turner syndrome, hypothyroidism,
What is infantile colic?
Infantile colic occurs in 10% of infants. There are unexplained paroxysms of crying for >3 hours a day for >3 days per weeks in an otherwise healthy well fed baby. It is generally regarded as a lack of the normal peristaltic movement in the GI tract. Peaks at 6-8weeks of age, child cries, pulls up legs, and passes gas soon after feeding
What are the characteristics of innocent heart murmurs?
Innocent heart murmurs are asymptomatic, they are generally systolic ejection murmurs, that are less than grade 3 (thrill not palpable), there may be a physiological splitting of S2, there are no extra sounds or clicks, and the murmur varies with a change in position.
What are the characteristics of pathological murmurs?
Pathological murmurs are associated with symptoms and signs of cardiac disease (FTT, excercise intolerance). All diastolic, pan systolic, or continuous murmurs (except venous hum) are pathological. They may be greater than a grade 3, may have a fixed split or a single S2, extra sounds or clicks may be present.
What are the five different types of innocent heart murmurs?
Peripheral pulmonary stenosis, Still’s murmur, venous hum, pulmonary ejection murmur, shura clavicular arterial bruit.
What is a stills murmur?
Stills murmur is a benign heart murmur that is heard on the lower left sternly border or apex and has a ‘musical’ and ‘vibratory’ quality to it.it is a systolic ejection murmur that occurs in children aged 3-6 years.
What is the ductus arteriosus?
The ductus arteriosus shunts blood from the pulmonary artery to the aorta in foetal circulation( and in reverse in adult circulation if still patent). When it closes it becomes the ligamentum arteriosus.
Describe the flow of foetal circulation.
Placenta (oxygenated blood)-> umbilical artery -> ductus venosus -> IVC -> RA -> foramen ovale -> LA -> LV ->aorta -> body
Describe the flow of deoxygenated blood in the foetal circulation.
Deoxygenated blood return via the SVC to the RA -> 1/3 of blood entering the RA does not flow through the foramen ovale and instead flow through foramen ovale -> RV -> pulmonary arteries -> ductus arteriosus -> aorta -> systemic circulation -> systemic circulation -> placenta for reoxygenation.
What is the ductus venosus?
The ductus venosus is a blood vessel in foetal circulation that allows oxygenated blood to bypass the liver, travelling from the umbilical vein to the ductus venosus to the IVC. When it closes up it later becomes the ligamentum venosum.
What happens to the umbilical vein after birth?
After birth the umbilical vein is no longer used and will close up within a week of the babies birth. It is replaced by a fibrous cord that be ones known as the round ligament of the liver (also called the ligamentum terres hepaticus). It extends from the umbilicus to the transverse fissure where it joins with the falciparum ligament to seperate the right and left lobes of the liver.
Describe the changes to foetal circulation at birth.
With the first breath the lungs open up and pulmonary resistance decreases allowing pulmonic flow. The low resistance placenta separates so that the systemic circulation then becomes a high resistance system and the ductus venosus closes. The closure of the foetal shunts and the changes in the pulmonic/systemic resistance mean that normal adult circulation is achieved. The increases in pulmonic flow increase the left atrial pressure leading to foramen ovale closure. Increased oxygen concentration in blood after birth leads to decreased prostaglandins leading to closure of the ductus arteriosus.
What does CHARGE syndrome stand for?
Coloboma of the eye, heart defects, atresia of the nasal chloanae, retardation of growth and development, genital and/or urinary abnormalities, ear abnormalities and deafness.
You find a boot shaped heart on CXR. What conditions do you expect?
Boot shaped heart or tricuspid atresia.
You find an egg shaped heart on CXR. What do you suspect?
Transposition of the great arteries.
You see a snowman shaped heart on CXR. What condition do you suspect?
Total anomalous pulmonary venous return.
If someone has congenital heart disease and they are cyanotic, which conditions do you expect?
5 Ts and hypoplastic left heart syndrome. The 5 Ts are: tetralogy of fallot, transposition of the great arteries, total anomalous pulmonary venous drainage, tricuspid atresia, or truncus arteriosus. In cyanotic heart disease, think of right to left shunts
What are the causes of congenital heart disease that do not present with cyanosis?
These are causes that are either obstructive or that cause a left to right shunt. Obstructive causes are coarctation, aortic stenosis, pulmonic stenosis. L->R shunt is caused by ASD, VSD, PDA, atrioventricular septal defect.
If a left to right shunt is not treated, what are some of the pathological changes that are seen in the body?
There is pulmonary hypertension, left ventricular dilatation and dysfunction, increased right ventricular pressures and hypertrophy, and eventual right to left shunts.
