Pediatrics Flashcards
6 wks check
- to evaluate feeding pattern
- to measure growth and weight
- to detect abnormalities not noted in neonatal period
- to assess early development
- to ensure infant-maternal bonding
Signs of Innosent murmur
4 S’s:
‘InnoSent’ murmur = Soft, Systolic, aSymptomatic, left Sternal edge.
aSymptomatic patient
Soft blowing murmur (grades 1-3)
Systolic murmur only, not diastolic
left Sternal edge.
No associated hrt disease!
7 Stages of Childhood
- Newborn, neonate = first month of life
- Infant = 1 month to 1 year
- Toddler = 1 year to 3 years
- Preschool child = 3-5 years
- Schoolchild = 5-18 years
- Child = 0-18 years
- Adolescent = early (10-14); late (15-18)
Causes of childhood wheeze
Transient early wheezing
Atopic asthma (IgE-mediated)
Non-atopic asthma
Recurrent aspiration of feeds
Inhaled foreign body
Cystic fibrosis
Recurrent anaphylaxis in a child with food allergies
Congenital abnormality of lung, airway or heart
Idiopathic.
Assessment of Asthma Severity
Moderate
O2 sats > 92%
Peak flow > 50% predicted
No clinical severe features of severe asthma
Severe
Too breathless to talk or feed
Use of accessory neck muscles
O2 sats < 92%
Resp > 50/min (age 2-5), > 30 (age > 5)
Peak flow < 50% predicted or best value
Life threatening
Silent chest
Poor respiratory effort
Altered consciousness
Cyanosis
O2 sats < 92%
Peak flow < 33% predicted or best value
Diseases associated with DS
Celiac Disease & Lymphoma
Leukemia (56% higher rate than normal)
Atlanto-axial subluxation
Hirschsprung’s disease
DIabetes
Early onset dementia
Causes of Nappy Rash
ACES
Ammonia
Candidia
Eczema
Seborrhea
DDx Croup
croup
bacterial tracheitis
epiglottitis
• foreign body aspiration
• subglotic stenosis: congenital or iatrogenic
• laryngomalacia/tracheomalacia: collapse of epiglottis cartilage on inspiration
Anaphlaxis
DDx to FFT
- Inability to feed: cleft palate, congenital, functional (cerebral palsy)
- Inability to retain food: GORD
- Malaborption: celiac disease or cystic fibrosis
- Ongoing Illness
- Metabolic problems: CAH, hypothyroidism
- Social: neglect
- Nutrition: poor diet
- Down’s or other congenital syndromes sm
How do you diagnose migraines in children
A >= 5 attacks fulfilling features B to D
B Headache attack lasting 4-72 hours
C Headache has at least two of the following four features:
bilateral or unilateral (frontal/temporal) location
pulsating quality
moderate to severe intensity
aggravated by routine physical activity
D At least one of the following accompanies headache:
nausea and/or vomiting
photophobia and phonophobia (may be inferred from behaviour)
Management of migraines in children
Acute management
ibuprofen is thought to be more effective than paracetamol for paediatric migraine
the use of triptans in children should only be initiated by a specialist
sumatriptan nasal spay (licensed) is the only triptan that has proven efficacy but it is poorly tolerated by young people who don’t like the taste in the back of the throat
orodispersible zolmitriptan (unlicensed) is widely used in children aged 8-years and older
side-effects of triptans include tingling, heat and heaviness/pressure sensations
Prophylaxis: the evidence base is limited and no clear consensus guidelines exist
the GOSH website states: ‘in practice, pizotifen and propranolol should be used as first line preventatives in children.
Causes of snoring in children
obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism
Risk of Down Syndrome
risk at 30 years = 1/1000
35 years = 1/350
40 years = 1/100
45 years = 1/30
One way of remembering this is by starting at 1/1,000 at 30 years and then dividing the denominator by 3 (i.e. 3 times more common) for every extra 5 years of age
Recurrence of downs syndrome in mom < 35
1: 100
DDx Organic Causes Constipation
endocrine: hypothyroidism, DM, hypercalcemia
• neurologic: spina bifida
• anatomic: bowel obstruction, anus (imperforate, atresia, stenosis)
• drugs: lead, chemotherapy, opioids
DDx Infertility and Workup
Vomiting in the Newborn Period
Tracheoesophageal Fistula (TEF)
Pyloric Stenosis
Duodenal Atresia
Malrotation of the Intestine
Diseases associated with Down Syndrome
Celiac disease/lymphoma
ALL (1% of DS)
Atlantoaxial dislocation
Hirschsprungs disease (2%)
Diabetes
Early Onset Dementia
Vomiting AFTER the newborn period
Infectious and Inflammatory
• GI causes: gastroenteritis, peritonitis, appendicitis, hepatitis, ulcers, pancreatitis, cholecystitis
• non-GI causes: urinary tract infection (UTI), pyelonephritis, nephrolithiasis, otitis media,
labyrinthitis, meningitis, pneumonia
Anatomic:
GI tract obstruction: intussusception, volvulus, foreign body (e.g. bezoar)
GORD
Central Nervous System
increased intracranial pressure (ICP) (e.g. hydrocephalus, neoplasm)
• drugs/toxins
• migraine, cyclic vomiting
Other
• metabolic/endocrine: DKA, inborn errors of metabolism, liver failure
• poisons/drugs: lead, digoxin, erythromycin, theophylline
• psychogenic: rumination syndrome, anorexia/bulimia
• food allergy
• overfeeding
• pregnancy
When do the following conditions classically present:
1) Pyloric stenosis
2) Infantile Colic
3) Febrile Seizures
4) Infantile Spasms
5) Intussuception
6) SIDS
1) 2-8 weeks
2) 10 days - 3 months
3) 6 months-6 years
4) 4-8 months
5) 3months-3 years
6) < 12 months age (95% by 6 months)
Triad for Intussusception
Classic Triad (only occurs in 15% of patients at presentation): vomiting, abdo pain, passage of blood per rectum
How would you describe SIDS to mother and what recommendations would you give her?
*Leading cause of death under 12 months of age
- peak incidence 2-4 months
- put in supine position, no smoking in house, avoiding overheating, place feet near end of bed, dont overcrowd the cot, dont sleep with infant
- pacifiers appear to be protective
- 3-5 time increase chance if sibling died of SIDS
Infections:
Infectious Mononucleosis
Pertussis
Varicella (chicken pox)
Roseola
Measles
Mumps
Rubella
Erythema Infectiosum
Mono (EBV):
incubation:1-2 months
Kissing disease, 2-3 day prodrome of malaise/anorexia before fever, tonsillar exudate, lymphadenopathy, hepatosplenomegaly, pharingitis, any “itis” (hepatitis, arthritis, nephritis, myocarditis), chronic fatigue*
resolves over 2-3 weeks
*Do not give amoxicillin/ampicillin or you get a rash!!
Complications: aseptic meningitis, encephalitis, guillian-barre, splenic rupture
Diagnose: monospot test, CBC + differentials looking for atypical lymphocytes
Treat: supportive (rule out strep throat), no sports for 6-8 weeks
Pertussis (bordetella Pertussis):
Whooping cough, incubation 6-20 days, infective 1 week before paroxysms to 3 weeks after, greatest incidence in children <1 and adolescents
Catarrhal phase: 1-2 weeks, mild cough and coryza (most contagious)
Paroxysmal phase: 2-4 weeks, intense cough, may vomit, pressure can result in subconjunctival hemorrhage, rectal prolapse, hernias
Diagnosis:
PCR of nasopharyngeal swab/aspirate, often clinical by paroxysms of cough in afebrile child
complications: otitis media, encephalopathy, seizures, resp: atelectasis, subq emphysema
Tx: Erythromycin, isolate until 5 days of tx, helps with infectivity but not course of illness*, erythromycin for all household contacts
Varicella:
Incubation 10-21 days, infective 1-2 days before rash until all vesicles are crusted
maternal infection in first/early second trimester risk of congenital varicella syndrome (low birth weight, CNS abnormalities, digit/limb abnormalities, eye defects)
complications: 2-HAP-E
2ndary bacterial infections, hepatitis, ataxia, pneumonia, encephalitis
Tx: supportive, acyclovir if severe, immunocompromised, neonates
Roseola (HH6 virus):
incubation:5-15 days
High fever (>39.5), URTI symptoms, pharynx, tonsils and tympanic membrane erythematous, cervical lymphadenopathy, fever ceases before rash (non-pruritic macules that coalesce and disappear in 1-2 days)
Tx: supportive
Complications: febrile seizures, encephalitis
Measles:
incubation: 10-14 days, infectivity: 4 days pre-rash, spread airborne
Prodrome: 3 C’s (cough, coryza, conjuctivitis), Koplik spots, maculopapular rash spreads over face and then descends over body over 3 days
Diagnose clinical and serology measles IgM
tx: Supportive and symptomatic
complications: 2ndary bacterial infections, encephalitis
Mumps (paramyxovirus):
Incubation: 12-25 days, infectivity: 7 days before parotitis and 7 days after, spread by droplets
diagnose by urine and saliva for viral serology
fever, headache, parotitis (bilateral, pushes earlobes up and out), myalgia, malaise
tx: supportive
complications: orchitis, infertility, pancreatitis, GN
Rubella:
incubation: 14-21 days, infective 7 days pre-rash and 5 days post-rash
diagnose by serology for rubella IgM
nonspecific URT symptoms, then maculopapular rash on face then spreads over entire body, pruritic, disappears by 4th day
symptomatic tx, prognosis excellent
Complications: arthritis/arthralgia, encephalitis
Erythema Infectiosum (5th disease, slap-cheek):
Parvovirus B19, incubation 4-14 das, infective prior to onset of rash, first 7-10 days is flu-like illness, day 10-17 is when rash appears on cheek, may be pruritis, fades in days to weeks
tx: supportive
complications: arthritis, infection during pregnancy can lead to fetal hydrops**, aplastic crisis
DDx Purpuric Rash
Disorders of Homeostasis
1) Thrombocytopenia: ITP, TTP, HUS, DIC
2) Disorders of coagulation: von willibrand disease, hemophilia, liver disease
**Disorders of Vascular Integreity **
Trauma, Infection (N. gonorrhea), HSP, Vitamin C deficicency
Pattern of eczema in:
Infants
Younger Children
Older Children
- in infants the face and trunk are often affected
- in younger children eczema often occurs on the extensor surfaces
- in older children a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck
Secondary Causes of Constipation
dehydration
low-fibre diet
medications: e.g. Opiates
anal fissure
over-enthusiastic potty training
hypothyroidism
Hirschsprung’s disease
hypercalcaemia
learning disabilities
Causes of Microcephaly
Causes of Macrocephaly
Familial macrocephaly
Raised intracranial pressure
Hydrocephalus - progressive or arrested
Chronic subdural haematoma
Cerebral tumour
