Pediatrics Flashcards
Meningitis
A: Viral is self-limiting, bacterial can be fatal.
Neonates: strep. B, E. Coli,
Adults: srep. pneumoniae, N. Meningitidis.
Elderly: Listeria
(Also TB)
S: Kernig’s sign (Laid down - Unable to straighten leg when hip is flexed to 90 degrees), Brudzinksi’s sign (Laid down - patient flexes hips and knees when trying to lift head up). Fever, chills, headache, photophobia, neck stiffness, non-blanching rash may be present.
D: Blood tests (raised CRP), and cultures, CT/MRI then lumbar puncture (as raised ICP/lesion contraindicates LP).
T: IV ceftriaxone started immediately. In adults, the vancomycin ampicillin should be considered. A four day course of dexomethasone is also recommended in pneumococcal.
Cerebral palsy
A: Early childhood, lesion of developing nervous system. Prenatal causes: hypoxia, congenital infection, chromosomal, toxins, malformation.
Intrapartum: hypoxia, intracranial haemorrhage.
Postnatal: trauma, meningitis/encaphalitis, bilirubin encephalopathy, hydrocephalus.
S: Developmental delay, joint contracture, epilepsy, visual and hearing impairment, poor growth, feeding issues.
D: History and exam to classify.
Spastic: increased in muscle tone and “plegia”.
Athetoid: Common from billirubin encephalopathy, writhing and choreform “dancing” movements.
Ataxic: Mixed.
T: Multidisciplinary team, phsyio.
Erb’s palsy
A: Birth injury, commonly breech delivery / large baby / narrow canal. Damage to C5 C6.
S: Wiater’s tip sign: elbow held in extension, forearm pronated, wrist flexed.
Klumpke’s palsy
A: Birth injury, commonly breech delivery / large baby / narrow canal. Damage to C7, C8 and T1
S: Affects intrinsic hand muscles, flexion of wrist and fingers, ipsilateral Horner’s syndrome.
T: Usually improves over a few weeks, but physiotherapy prevents contractures.
Hypoxic-ischaemic encephalopathy (HIE)
A: Hypoxic ischaemia resulting in depletion of brain phosphocreatine and ATP and a rise in lactate.
S: Depends on severity, hyper-alert, poor feeding, seizures, hypotonic, lethargic, comatose.
D: Abnormal cardiotocography, fetal blood sample
Neonatal respiratory distress
S: tachypnoea (>60bpm), grunting, tachycardia, cyanosis
A: Transient tachypnoea of the new born (delay in the re-absorption of lung fluid), meconium aspiration syndrome (meconium causes pneumonitis), respiratory distress syndrome (lack of surfactant from premature birth, which is why premature mothers should be given glucocorticoids 24 hours before delivery), pneumonia, pneumothorax.
Exomphalos
A: Abdominal contents protrude through umbilicus, often with other congenital abnormalities.
D: Antenatal karyotype recommended.
T: 35% mortality, cover with clingfilm and close.
Gastroschisis
A: Herniation of bowel without covering sac, usually lateral to umbilicus.
T: Wrap in clingfilm, IV fusion of dextrose, pass NG tube.
Necrotising enterocolitis
A: Ischaemia of bowel wall, accelerated by feeding with milk. Occurs in 10% of very low birth weight babies.
S: Vomiting (can be bile stained), abdominal distension, stool with fresh blood.
D: AXR shows distended loops of bowel
T: Stop oral feeds, IV antibiotics
Hypoplastic left heart syndrome
A: Underdevelopment leaves the left side of the heart unable to maintain effective cardiac output.
S: Circulatory collapse, peripheral pulses weak/absent, breathlessness and severe acidosis.
D: ECG, ECHO confirms
T: Resuscitation and prostagladins to keep the duct patent. Norwood’s procedure will be performed surgically 3-5 days later.
Bronchiolitis
A: Usually from the respiratory synctial virus (RSV).
S: Respiratory distress, crackles, hyperinflation, apnoea, wheeze.
D: CXR if diagnosis is in doubt, nasopharnygeal aspirate if hospitalised
T: Usually lasts a week. Supportive measures, severe cases may need hospitalization for oxygen/feeding.
Whooping cough (pertussis)
A: Bordatella pertussis
S: 2-3 days coryza (inflammation of mucous membrane of nose), then characteristic spasmodic (brief) cough followed by an inspiratory whoop. Spasms worse at night and can lead to vomiting, epistaxis and subconjunctival haemorrhage.
D: Culture nasal swab
T: Immunisation. Erythromycin
Malrotation
A: Occurs from incomplete rotation of the gut in foetal life.
S: Usually presents in first 4 weeks of life. Bilious vomiting, abdominal distension
D: Upper GI contrast studies
T: Surgery
Hirshsprung’s disease
A: Absence of ganglion cells from the myenteric and submucosal plexuses in the bowel.
S: Delayed passage of meconium, bowel obstruction, enterocolitis or constipation.
D: Rectal biopsy
T: Regular rectal washouts, temporary colostomy.
Undescended testes (Cryptorchidism)
A: 50% of undescended testes descend spontaneously by 6 months of age, and are unlikely to occur after this.
3% of term babies, 30% of preterm babies.
S:
Palpable undescended testes: Testes palpable at the inguinal canal but can’t be manipulated in to the scrotum
Impalpable testes: They may be in intra-abdominal, within the inguinal canal or absent.
Retractile testes: May be manipulated into the scrotum but the self retract into the inguinal region due to an overactive cremasteric muscle.
T: Surgery is rarely required.
