Week 121 Growth Faltering Flashcards
Called to see 48 hour old baby girl. They are grunting and cyanotic. All pulses are palpable and there is no murmur on auscultation of chest. 02 sats are 55% on room air. Which of the following congenital cardiac lesions is most likely?
Aorta comes off right ventricle Pulmonary artery off left ventricle So how does the baby survive before birth? Ductus arteriosus But what happens at birth?
Transposition of great arteries
Ductus arteriosus
Ductus arteriosus allows blood to bypass lungs during fetal life
Closes at birth as lungs are now functioning
A newborn baby presents with shock, poor perfusion of distal limbs and absent femoral pulses. What is the most likely congenital cardiac lesion?
Coarctation of the aorta
Problem with descending aorta
What would a machine like murmur indicate?
Patent ductus arteriosus
Cyanotic murmurs
Tetralogy of Fallot
Transposition of great arteries
CT - cyanotic murmurs begin with T
Cardiac murmur summary
Cyanosed with murmur - Tetralogy of Fallot
Cyanosed without murmur - TGA
No femoral pulses other pulses normal - Coarctation
Continuous machine like murmur which radiates to back - PDA
A 6 month old girl born in Bangladesh is referred by GP as she is not growing normally along centiles. Born on 50th centile now below 2nd centile despite good intake. Two previous chest infections but was not admitted, looks thin but not pale. Abdomen not distended and soft on palpation. Which investigation is most likely to give you diagnosis?
Cystic fibrosis
Diagnosed with sweat test
Excess chloride ions in sweat
Respiratory symptoms
No GI symptoms
Coeliac usually presents at 6 months
A midwife asks you to review a baby on postnatal ward as she is worried it is hypotonic. Baby is hypotonic and has unusual looking face. He has a flat nasal bridge, almond-shaped eyes and prominent epicanthic folds and low set ears. His genitalia are normal. What is the most likely cause of these signs?
Down syndrome
3 copies of chromosome 21
Amniocentesis or CVS definite diagnosis
Common signs= decreased muscle tone at birth
- excess skin at nape of neck
- flattened nose
- upward slanting ears
- small ears and mouth
- Wide, short hands with short fingers
- Separated joints between the bones of the skull
- single palmar crease
- White spots on colours of eyes
Foetal alcohol syndrome features
Low nasal bridge Epicanthal folds Short palpebral fissures Flat midface and short node Thin upper lip Micrognathia Indistinct philtrum Minor ear abnormalities
4 y/o girl is referred with growth faltering. Weighed 3.5 kg at birth and grew along 50th centile for weight, length and head circumference. Since 1st birthday her growth has tailed off and height is now well below 4th centile with weight on 9th centile. Admitted to neonatal unit when she was a neonate due to hypoglycaemia and jaundice. What investigation is most likely to reveal her underlying problem?
Growth hormone test
Short stature
Delayed bone age
Normal rate of growth til 6-12 months then falls off
A 2 y/o girl is referred to GP with 6 week history of foul-smelling diarrhoea associated with weight loss. O/E her abdomen looks full and slightly distended. Which of the following is the most appropriate first line investigation that would identify the cause?
TTG IgA
Coeliac disease
Autoimmune associated with gluten
Often presents at 6 months old - age of weaning (Giveaway)
Questions to ask in failure to thrive
Was their birth weight and height normal?
What is their growth velocity?
Did it happen at 6 months? Coeliac
What are the parental heights?
Bone age? Delayed - growth hormone deficiency
Gut instinct - does this sound pathological?
End target of growth hormone acting through IGF1 is
Chondrocytes
What has least influence on a Childs growth in the first year of life
Hormones
What are the 2 types of small children /malnutrition?
Acute- wasted
Chronic- Stunted
