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Peer Teaching Notes Flashcards

1
Q

What is the bilirubin cycle?

A
  • Hb broken down to unconjugated bilirubin (haemolysis)
  • Unconjugated bilirubin + albumin-> insoluble in water
  • Travels to liver-> where conjugated
  • Conjugated soluble + excreted by small intestine or into liver then back to blood (come out via kidneys)
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2
Q

What are pathological causes of jaundice that present within 24 hours of life?

A
  • Haemolytic disease of the newborn (rhesus disease)
  • ABO incompatibility
  • Red cell anomalies-> G6PD, congenital spherocytosis
  • Congenital infection-> TORCH
  • Haematoma
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3
Q

What are the congenital diseases listed by the TORCH mnemonic?

A
  • Toxoplasmosis
  • Other-> syphilis, varicella, mumps, parvovirus, HIV
  • Rubella
  • Cytomegalovirus
  • Herpes simplex
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4
Q

What are pathological causes of jaundice that present between 24 hours and 14 days of life?

A
  • Increased bilirubin due to shorter RBC lifespan
  • Decreased conjugation by immature hepatocytes
  • Absence of gut flora-> impede elimination of bile pigment
  • Breastfeeding
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5
Q

What are pathological causes of jaundice that present for over 14 days in neonates (prolonged jaundice) and are due to unconjugated bilirubin?

A
  • Sepsis-> UTI, meningitis
  • Breastfeeding
  • Hypothyroidism
  • Neonatal hepatitis
  • Hepatic enzyme deficiency
  • Enclosed bleeding
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6
Q

What are pathological causes of jaundice that present for over 14 days in neonates (prolonged jaundice) and are due to conjugated bilirubin?

A
  • Sepsis-> TORCH
  • TPN
  • Galactosaemia
  • Cystic fibrosis
  • Alpha-1 antitrypsin deficiency
  • Biliary atresia
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7
Q

When is jaundice in neonates always pathological?

A

If presents within <24 hours of life

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8
Q

What is the pathophysiology of haemolytic disease of the newborn?

A
  • RhD -ve mum delivers RhD +ve baby
  • Leak of foetal red cells into her circulation may cause production of anti-D IgG antibodies-> isoimmunisation
  • Sensitisation events-> threatened miscarriage, APH, mild trauma, amniocentesis, CVS, ECV
  • Subsequent pregnancy-> cross placenta + cause disease
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9
Q

What are some sensitisation events that can trigger haemolytic disease of the newborn?

A

Threatened miscarriage, APH, mild trauma, amniocentesis, CVS, ECV

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10
Q

How is haemolytic disease of the newborn detected?

A
  • Screening-> indirect Coombs test

- D-antibodies-> identify -ve mums who aren’t sensitised and stop disease from happening

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11
Q

When is anti-D given in pregnancy?

A
  • 28 weeks +/- 34 weeks
  • Contains antibodies-> get rid of +ve antigens in blood before mum produces own
  • May be given after sensitising events
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12
Q

What should happen if mum is rhesus -ve but already has antibodies?

A
  • Monitor antibody level
  • US baby-> check complication signs
  • Take blood from baby-> anaemia + need for transfusion
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13
Q

What are the serious complications of haemolytic disease of the newborn?

A
  • Hydrops fetalis
  • Polyhydramnios
  • Post natal-> SC oedema, pericardial effusion, pleural effusion, ascites, hepatosplenomegaly
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14
Q

What is hydrops fetalis?

A

Often life-threatening condition in which foetus has excess fluids around the heart, liver and abdomen

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15
Q

How might neonatal jaundice be investigated?

A
  • FBC
  • Enzyme assays
  • Blood film
  • Infection screening
  • Direct Coombs test
  • Transcutaneous bilirubin
  • LFTs
  • Serum bilirubin
  • TORCH screen
  • Blood group
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16
Q

How might neonatal jaundice be managed?

A
  • UV phototherapy

- Exchange transfusion

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17
Q

What is the definition of full term?

A

40 weeks

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18
Q

What is the definition of premature?

A

<37 weeks

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19
Q

What is the definition of low birth weight?

A

<2500g

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20
Q

What is the definition of very low birth weight?

A

<1500g

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21
Q

What is the definition of extremely low birth weight?

A

<1000g

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22
Q

What is the definition of small for gestational age?

A

Weight below 10th centile at any gestational age

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23
Q

What is symmetrical intrauterine growth restriction?

A

All growth parameters are symmetrically small

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24
Q

What is asymmetrical intrauterine growth restriction?

A

Weight centile is less than length + head circumference centile

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25
Q

What causes symmetrical intrauterine growth restriction?

A
  • Insult in early pregnancy
  • Chromosomal abnormalities
  • Constitutionally small
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26
Q

What causes asymmetrical intrauterine growth restriction?

A
  • Insult late in pregnancy

- Placental insufficiency

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27
Q

What type of intrauterine growth restriction is higher risk?

A

Asymmetrical

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28
Q

What can cause a baby to be small for gestational age?

A
  • Poverty
  • Twins
  • Small parents
  • Congenital infection
  • Constitutionally small
  • Placental insufficiency
  • Smoking
  • Hypertension
  • CVD
  • Diabetes
  • Pre-eclampsia
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29
Q

What can cause prematurity?

A
  • Unknown
  • PMH of prematurity
  • Malnutrition
  • Poverty
  • Smoking
  • GU infection
  • Chorioamnionitis
  • Pre-eclampsia
  • Polyhydramnios
  • Twins
  • Diabetes
  • Uterine malformation
  • Placenta praevia/abruption
  • PROM
  • Accidentally induced labour
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30
Q

How should a baby born very prematurely (eg 27 weeks) be managed?

A
  • Paediatrician must be present
  • Room at 26 degrees
  • Don’t dry baby
  • Put under heaters
  • Place in plastic bag
31
Q

What are the components of the APGAR score?

A
  • Appearance (skin colour)
  • Pulse rate
  • Grimace reflex
  • Activity (muscle tone)
  • Respiration
32
Q

What are the different scores for the components of APGAR?

A
  • Appearance (skin colour)-> blue/pale all over (0), blue at extremities (1), no cyanosis (2)
  • Pulse rate-> absent (0), <100bpm (1), >100bpm (2)
  • Grimace reflex-> no response to stimulation (0), grimace on suction/aggressive stimulation (1), cry on stimulation (2)
  • Activity (muscle tone)-> none (0), some flexion (1), flexed arms + legs that resist extension (2)
  • Respiration-> absent (0), weak/irregular/gasping (1), strong + robust cry (2)
33
Q

What is respiratory distress syndrome?

A

Lack of surfactant causes respiratory issues in newborn

34
Q

What are the signs of respiratory distress syndrome?

A
  • Grunting
  • Head bobbing
  • Tachypnoea
  • Intercostal recession
  • Nasal flaring
35
Q

How is respiratory distress syndrome managed?

A
  • Intrapartum steroids (dexa or betamethasone)-> help lungs develop
  • Delayed cord clamping
  • Oxygen
  • Intubate + ventilate if needed
  • Surfactant-> down ET tube
36
Q

How much fluids are neonates typically prescribed for a bolus?

A

20ml/kg

37
Q

How are maintenance fluids calculated and prescribed in paeds?

A
  • 100ml/kg/day for first 10kg weight
  • 50ml/kg/day for second 10kg of weight
  • 20ml/kg/day for weight over 20kg
38
Q

How much maintenance fluids would a 45kg 12 year old girl be prescribed?

A
  • 100ml x 10kg= 1000ml
  • 50ml x 10kg = 500ml
  • 20ml x 25kg = 500ml
  • 2000mls in 24 hours = 83ml/hour
39
Q

What are some differentials for a collapsed neonate?

A
  • Hypoglycaemia
  • Hypothermia
  • Sepsis
  • Dehydration
  • Coronary Heart Disease
40
Q

What would a normal LP result consist of?

A
  • Pressure 5-20
  • Looks normal
  • Protein normal
  • Glucose normal
  • Gram stain normal
  • WCC normal
41
Q

What would a bacterial LP result consist of?

A
  • High pressure
  • Turbid/cloudy
  • High protein
  • Low glucose
  • Positive gram stain (usually)
  • High WCC
42
Q

What would a viral LP result consist of?

A
  • Normal or mild increased pressure
  • Clear appearance
  • Low/normal protein
  • Glucose normal
  • Normal gram stain
  • High glucose CSF:serum ratio
  • WCC high
43
Q

What would a fungal/TB LP result consist of?

A
  • Fibrin web appearance
  • Low to normal protein
  • Low glucose
  • High WCC
  • Monocytes
44
Q

What is an example of a group B streptococcus?

A

Strep agalactiae-> gram positive

45
Q

How is group B streptococcus infection transmitted?

A

Colonise vaginal + GI tracts in healthy women-> can give to baby through birth

46
Q

What is the most frequent cause of early onset (<7 days) infection in neonates?

A

group B streptococcus

47
Q

What are the signs and symptoms of group B streptococcus infection?

A
  • Temperature change
  • Tachycardia
  • Respiratory-> grunting, nasal flaring, accessory muscles, tachypnoea, apnoea
  • Behaviour-> poor/reduced feeding, lethargy
  • Skin-> rash, mottled, jaundice
  • Abdominal-> vomiting, abdo distension, diarrhoea, abdo pain, knees up to chest
48
Q

What is pre-natal group B streptococcus infection (GBS)?

A

Baby infected during pregnancy

49
Q

What is early onset group B streptococcus infection (GBS)?

A

Infected within first week of life

50
Q

What is late-onset group B streptococcus infection (GBS)?

A

Infected with GBS after 1 week to several months of age

51
Q

How is group B streptococcus infection managed?

A
  • Intrapartum antibiotic prophylaxis
  • Testing when RFs present + infection
  • Aware of GBS +ve mums-> monitor for risks, 14 days antibiotics, observation, head circumference measurement
52
Q

Differential diagnoses for non-blanching rash?

A
  • Sepsis
  • Meningococcal septicaemia
  • Non-accidental injury
53
Q

What are the risk factors for Non-accidental injury?

A
  • Birthweight <2500g
  • Maternal age <30
  • Unwanted pregnancy
  • Stress
  • Poverty
54
Q

When should Non-accidental injury be suspected?

A
  • Disclosure by child
  • Odd incongruous story
  • Delayed presentation
  • Multiple presentation with injuries
  • History inconsistent with child’s development
  • Efforts to avoid exam
  • Unexplained fractures
  • Any injury in baby
  • Buttock or perineum injury
  • Facial injury-> torn lingual frenulum, retinal haemorrhage, bulging fontanelle
  • Cigarette burns
  • Finger mark bruising (petechiae)
  • STIs
55
Q

What investigations could be done in suspected Non-accidental injury?

A
  • Skeletal survey
  • Coagulation
  • CT/MRI head
  • Ophthalmology
56
Q

What is the definition of weight faltering?

A

Weight falling through centile spaces, low weight for height or no catch-up from low birth weight

57
Q

What is the definition of growth faltering?

A
  • Crossing down through length/height centiles as well as weight
  • Low height centile or less than expected from parental
58
Q

What can cause faltering growth?

A
  • Increased requirement
  • Inadequate retention of food
  • Impaired suck/swallow
  • Psychosocial deprivation
  • Inadequate availability of food
  • Chronic illnesses leading to anorexia
  • Malabsorption
  • Failure to utilise nutrients
59
Q

What are some investigations for FTT?

A
  • FBC
  • Urinalysis
  • U+Es
  • LFTs
  • Coeliac screen
  • Sweat test (CF)
60
Q

What can cause a positive sweat test?

A
  • Cystic fibrosis
  • Malnutrition
  • Adrenal insufficiency
  • Hypothyroidism
  • Hypoparathyroidism
  • G6PD
61
Q

What does the neonatal blood spot test screen for?

A
  • Cystic fibrosis
  • Congenital hypothyroidism
  • Sickle cell disease
  • 6 inborn errors of metabolism-> inc phenylketonuria
62
Q

When is the neonatal blood spot test done?

A

Between day 5 and 8 of life

63
Q

What happens after a neonatal blood spot test?

A
  • Affected-> direct referral to paeds
  • Get all results within 6 weeks
  • Recorded in red book
64
Q

What are the investigations for cystic fibrosis?

A
  • Genetic tests
  • Sweat test-> high chloride + low sodium
  • Sinus X ray + CT
  • CXR
  • CT thorax
  • Spirometry
  • Sputum microbiology
65
Q

What causes cystic fibrosis?

A

Mutation on CFTR gene on chromosome 7

66
Q

What effect does cystic fibrosis have?

A

Dehydration of secretions affecting systems relying on these eg lungs + pancreas

67
Q

What mode of inheritance is cystic fibrosis?

A

Autosomal recessive

68
Q

What effects does cystic fibrosis have on the lungs?

A
  • Thick mucous-> chronic inflammation + infections
  • Neutrophilic airway inflammation
  • Organisms-> s.aureus, H.influenzae, S.pneumoniae, P.aeruginosa
69
Q

What are some of the signs of cystic fibrosis?

A
  • Clubbing
  • Crackles
  • Wheeze
  • Cyanosis
  • Frequent infections
  • FEV1-> obstructive
  • Meconium ileus
70
Q

How is cystic fibrosis managed?

A
  • Avoid other CF patients-> may spread infections
  • Lung physio-> 3x daily
  • Exercise
  • Prophylactic antibiotics-> double dose if unwell
  • High calorie + high fat diet
  • Creon-> enzymes for digestion
  • Lung transplant
71
Q

How does cystic fibrosis affect the GI system?

A
  • Malabsorption-> need more energy through food
  • Steatorrhoea-> malabsorption
  • Thickened pancreas secretions-> block movement of enzymes + cause damage to pancreas (‘itis)
  • Atrophy + progressive fibrosis of exocrine glands
  • Neonates-> meconium ileus, rectal prolapse
72
Q

Which vitamins are fat soluble?

A

ADEK

73
Q

What are some complications of cystic fibrosis?

A
  • GI obstruction
  • Impaired glucose tolerance
  • GI obstruction
  • Liver failure
  • Osteoporosis
  • Fragility fractures

Paeds (3 decks)

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