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3 Child health EJR > week 2 > Flashcards

week 2 Flashcards

1
Q

what is important to explain to parents of newly diagnosed T1DM children?

A

fundamental explanation of T1DM
nobody’s fault
can lead a normal life
life long insulin

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2
Q

symptoms of T1DM presentation

A 
polydipsia
polyuria
tiredness
irritable
weight loss
abdominal pain
candida
DKA
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3
Q

what family history is T1DM associated with

A

autoimmune diseases like

hypothyrodism
addisons
coeliacs
rheumatoid arthritis

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4
Q

how to diagnose T1DM

A

random glucose >11.1 or fasting glucose >7
glycosuria
symptoms

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5
Q

management of T1DM

A 
education
insulin
glucose monitoring
diet
long term reviews
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6
Q

common insulin therapy regime

A

1x long acting insulin (e.g. detemir)

multiple short acting insulin before meals or PRN (e.g. novorapid)

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7
Q

important education for newly diagnosed T1DM

A 
insulin regime
carb ratio counting
BM monitoring
insulin pump
detection of hypos/hypers/DKA
diet
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8
Q

complications of T1DM

A

DKA

hypoglycaemia

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9
Q

what is DKA

A

diabetic ketoacidosis. when the body’s insulin levels are so low that energy is metabolised from fats and fatty acids, producing ketones as a waste product causing ketoacidosis

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10
Q

diagnostic triad of DKA

A

ketoanaemia
hyperglycaemia
acidaemia

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11
Q

presention of DKA

A 
dehydration -> shock
N&V
abdominal pain
tachypnea - kussmaul breathing
decreased GCS
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12
Q

signs of DKA

A

hyperglycaemia
acidosis
ketoanaemia
urinary ketones

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13
Q

management of DKA

A

rehydration
SC rapid acting insulin
look for cause

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14
Q

what can cause DKA?

A 
first presentation
infection
steroid medication
alcohol
missing medication
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15
Q

fluid management for DKA - important points

A

reduced bolus amount
add potassium and monitor
IV infusion of insulin
consider glucose if becomes hypoglycaemic

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16
Q

DKA complications

A 
cerebral edema
hypokalaemia
hypoglycaemia
aspiration pneumonia
VTE risk
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17
Q

symptoms of hypoglycaemia in diabetes

A

pallor, irritability
reduced GCS, sleepy
unconsciousness, seizure

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18
Q

management of hypoglycaemia

A

if conscious, PO sweets/carbs
if reduced consciousness, PO dextrose gel
if unconscious, ABCDE approach with IV 10% dextrose, and glucagon

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19
Q

what is cerebral palsy

A

non-progressive abnormality in brain affecting motor function, posture, and or coordination

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20
Q

causes of cerebral palsy

A

80% - antenatal (cerebrovascular event)
10% - birth (hypoxic event)
10% - postnatal (trauma/infection)

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21
Q

clinical presentation of cerebral palsy

A 
abnormal limb, trunk, posture and tone
difficulty feeding
slow head growth
abnormal gait
asymmetric hand function before 12 months
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22
Q

types of CP

A

spastic
dyskinetic
ataxic
other

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23
Q

early signs of cerebral palsy?

A 
poor head and neck muscle control
extended legs and fisting
crossed legs
tip toe gait
unable to weight bear or crawl
asymmetric limb favourability
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24
Q

characteristics of spastic cerebral palsy

A

hypertonicity (tight/stiff/jerky limbs)
scissor gait
limb weakness
toe walking

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25
characteristics of dyskinetic cerebral palsy
uncontrolled movements slow writhing movements exacerbated during stress
26
characteristics of ataxic cerebral palsy
wide based gait intentional tremor poor coordination poor balance
27
extra intestinal features of crohn's disease
``` uveitis erythema nodosum perianal skin tags arthralgia clubbing oral lesions ```
28
systemic features of crohn's disease
fever weight loss lethargy
29
GI features of crohn's disease
diarrhea | abdominal pain
30
histological marker of crohn's disease
non-caseating epitheloid cell granulomata
31
how to investigate crohn's disease
bloods - inflammatory markers | endoscope and biopsy
32
clinical features of ulcerative colitis
rectal bleeding diarrhea colicky pain
33
difference in adult vs children in ulcerative colitis
adults less likely to have pan colitis
34
complication of ulcerative colitis
fulimnant toxic mega colon
35
what is coeliac disease
autoimmune response to gluten in diet, causes destruction of villous mucosa in proximal small intestines
36
classical age of presentation of coeliac disease
8-24 months depending on gluten introduction into diet
37
clinical features and presentation of coeliac disease
``` growth faltering weight loss abnormal stools abdominal distension buttock wasting abdominal pain anaemia general irritability ```
38
what is the diagnostic investigation of coeliac's disease?
* positive serology, showing antibodies * endoscopy and biopsy showing damaged villi * resolution of symptoms on gluten free diet
39
management of coeliac disease
diet change under dietician supervision | gluten challenge
40
what is irritable hip?
transient synovitis. acute hip or knee pain, following viral infection.
41
presentation of irritable hip
acute hip or knee pain. preceded by viral infection. limited range of movement. no relief on rest. afebrile or mildly pyrexic
42
investigations of irritable hip
xrays and blood tests to rule out other more serious causes
43
differentials of hip pains in children
``` irritable hip perthes SUFEs osteomyelitis septic arthritis reactive arthritis maglinancy ```
44
what is developmental displasia of the hip
spectrum of disorders that causes malformation of the hip joint, often the acetabalum. Resulting in dislocation or complete luxation of the femoral head into the pelvis.
45
risk factors for developmental displasia of the hip
genetic, breech birth, certains swaddling techniques
46
how to prevent developmental displasia of the hip
newborn examination and again at 8 weeks
47
what is the late presentation of developmental displasia of the hip
limp, abnormal gait, shortened leg, limited abduction of hip
48
how to investigate developmental displasia of the hip
ultrasound
49
management for developmental displasia of the hip
splinting, harnesses, surgery.
50
what is SUFEs
slipped upper/capital femoral epiphysis
51
who gets SUFEs more commonly
10-15 year old boys in their growth spurt and also obese.
52
causes of SUFEs
range of causes including trauma, biomechanics, endocrine (obesity, hypothyroidism, hypogonadism)
53
presentation of SUFEs
acute or gradual limp, abnormal gait hip pain +/- referred to knee limited range of motion of hip
54
complication of SUFEs
avascular necrosis of femoral head
55
diagnosis and management of SUFEs
xray and surgery
56
how does reactive arthritis in children usually present
swollen joint | preceded by non-articular infection
57
what causative organisms are more common in reaction childre in children
enteric bacteria (salmonella, shigella, campylobacter, yersinia) in adolescents, STIs like chlamydia and gonoccocus
58
investigation for suspected reactive arthritis
bloods will show normal or mildly raised acute phase reactants xrays show normal
59
management for reactive arthritis
supportive - self limiting
60
common causative organism of septic arthritis
staph aureus | HiB
61
how does septic arthritis usually spread
haematogenous, but can be local traumatic infection or from local osteomyelitis
62
presentation of septic arthritis
``` pain redness, swelling, tenderness over join if hip can be referred to knee pyrexial and generally unwell of child limp, reduced range of movement ```
63
investigation for septic arthritis
blood cultures and ESR/CRP ultrasound xray to rule out trauma joint aspirate
64
management of septic arthritis
drainage, wash out | antibiotics
65
when to refer to paediatric rheumatology clinic
children with chronic polyarthritis
66
what is juvenile iodpathic arthritis
chronic arthritis (>6 weeks) presenting under 16 years old no other infection or possible cause
67
how many types of JIA are there
7
68
what are the 7 types of JIA
``` polyarthritis (RF +ve) polyarthritis (RV -ve) oligoarthritis systemic arthritis psoriatic arthritis enthesitis related arthritis undifferentiated arthritis ```
69
fever pattern of systemic JIA?
fever spikes in evenings
70
management of JIA?
steroids methotrexate/DMARDs biologics
71
which HLA is associated with JIA
HLA-B27 is associated with enthesitis related arthritis
72
why are UTIs especially important to diagnose in children?
scaring - adult kidney disease UT anatomical abnormality VUR can cause a lot of complications
73
complications with vesicoureteric reflux
backflow causing pyelonephritis back pressure causing kidney damage causes incomplete voiding
74
most common causative organisms for UTIs
E coli klebsiella proteus
75
common organism causing UTI in urinary catheterised patient
pseudomonas
76
presentation of infants with UTI
``` unwell fever vomiting loin tenderness offensive urine poor feeding ```
77
presentation of UTI in children
``` dysuria/frequency/urgency abdominal pain fevers +/- rigors lethargy anorexia vomiting nocturia ```
78
purpose of investigations in UTIs
find out why the child is getting UTI
79
what investigations can be done in UTI in children
ultrasound DMSA MCUG
80
what does DMSA look for
scaring
81
what does MCUG look for
reflux
82
when to use prophylactic antibiotics in UTI children
recurrent UTIs
83
how to obtain urine sample in infants
clean catch nappy pad in-and-out catheter suprapubic aspirate
84
how to interprete urine dip stick in UTI children
nitrate +ve is highly indicative, but -ve does not mean it's not leucocyte +ve should be in conjunction with nitrite +ve OR clinical symptoms. Send for culture to confirm if leucocyte and nitrate -ve, repeat or culture if history supports
85
what are kocher's rules/criteria
Non-weight-bearing on affected side ESR > 40 Fever > 38.5 °C WBC count > 12,000
86
common viral causes of gastroenteritis
``` rotavirus norovirus adenovirus coronavirus astrovirus ```
87
common bacterial causes of gastroenteritis
``` salmonella campylobacter jejuni shigella cholera ecoli cdiff ```
88
associated symptoms of infection with campylobacter jejuni?
severe abdominal pain
89
associated symptoms of infection with shigella
high fever
90
key symptom of cholera infection
rice water diarrhea
91
other than viral and bacteria, what else can cause gastroenteritis? give 2 examples
protozoans - giardia or crptosporidium
92
most acute complication of gastroenteritis
dehydration -> shock
93
why are children more susceptible to dehydration and shock
higher surface area to body weight ratio, leading to higher insensible water loss
94
important questions to ask in someone presenting with gastroenteritis
recent travel contacts food animal exposure
95
difference between isonatraemia/hyponatraemia and hypernatraemia dehydration
isonatraemia/hyponatraemia dehydration results in water shifting from ICF to ECF leading to brain swelling hypernatraemia dehydration leads to ICF to ECF shift in water, leading to brain shrinkage.
96
presentation of gastroenteritis
``` diarrhea vomiting fever abdominal pain distension dehydration ```
97
what surgical disorders can mimic gastroenteritis
``` pyloric stenosis intussusception acute appendicitis necrotizing enterocolitis Hirschsprung disease ```
98
what infections can mimic gastroenteritis
septicaemia, meningitis | RTI, ENT infection, Hepatitis A, UTI
99
What metabolic disorder can mimic gastroenteritis
Diabetic ketoacidosis
100
what malabsorptive causes can mimic gastroenteritis
cows milk protein allergy lactose intolerance coeliac disease
101
what features to assess in shock
``` general appearance conscious level eyes/pupils skin colour skin turgor heart rate breathing rate blood pressure skin mottled? CRT peripheral pulses mucous membranes urine output ```
102
what investigations can be done for gastroenteritis
usually none, but can do stool culture or blood culture
103
management for gastroenteritis
rehydration - oral or IV
104
symptoms of kawasaki disease
``` fever red eyes red/cracked lips and tongue red swollen fingers and toes diffuse rash cervical lymph node swelling ```
105
what causes epiglottitis
HiB
106
symptoms of epiglottitis
high fever severe throat pain - drooling soft stridor sitting upright with open mouth
107
cough is usually present in epiglottitis - T or F
false, cough is quite minimal if even, compared to croup
108
why should the mouth/throat not be examined in epiglottitis
might cause it to close
109
management for epiglottitis
alert ENT/anaesthetist intubation/tracheostomy antibiotics
110
what are the risk factors for having coeliac's disease
T1DM autoimmune thyroid disease Down's syndrome 1st degree family history of coeliac's
111
which part of the brain is affected in each type of cerebral palsy - spastic, dyskinetic, ataxic?
spastic - cerebral/mortor cortex (inhibited inhibition) dyskinetic - basal ganglia (initiation of movement) ataxic - cerebellum (coordination, balance)
112
complications in later life of cerebral palsy ?
``` pain (due to stiffness/hypertonicity) learning disabilities SALT problems epilepsy visual/hearing problems bladder problems sleep disorders hip dysplasias behavioural problems ```
113
how is cerebral palsy diagnosed?
clinically or MRI if unsure
114
management approach of cerebral palsy ?
MDT
115
investigations in suspected food allergy/intolerance
skin-prick tests IgE blood tests endoscopy and biopsy food challenge under supervision
116
common age for atopic eczema in children
after 2 months old, most resolve by 12 years
117
what can cause an itchy rash in children?
``` atopic eczema chicken pox urticaria/alllergy insect bites scabies fungal infections pityriasis rosea ```
118
what rash often causes a 'herald patch'
pityriasis rosea
119
how does the rash in pityriasis rosea progress
starts off as a herald patch (anywhere) and then progresses to have a christmas tree distribution on the back
120
what is haemolytic disease of the newborn?
antibodies produced by the mother transfer to fetus causing destruction of red blood cells in fetus,
121
what is the most common cause of HDN?
rhesus factor, or ABO group
122
how does HDN happen?
e.g. rh-factor. if mother is rh-ve and father is rh+ve, and baby is rh+ve, mother might contact rh factor and sensitise towards it. during second or subsequent pregnancies, mother will have large amounts of rh antibodies and might cross to placenta and attack baby
123
newborn features of HDN
``` pallor, anaemia jaundice, kernicturus hepatosplenomegaly hydrops fetalis edema, effusions, ascites ```
124
causes of jaundice <24hours age
haemolytic disorders (rhF, ABO, G6PD def) congenital infection fetal bleeding
125
how is rh factor HDN prevented?
rhesus factor immunoglobulins
126
how is physiological jaundice diagnosed?
diagnosis of exclusion
127
when does physiological jaundice present?
24h - 2 weeks
128
investigations in neonatal jaundice
``` bilirubin levels LFTs haemolytic d/o - blood type/rh/G6PD def TFTs infections imaging ```
129
how does breast milk jaundice present?
baby is usually well | jaundice can last from 6 weeks to 4 months
130
blood bilirubin level is physiological jaundice?
200 micromol/L
131
4 more common causes of fetal respiratory distress
transient tacyhpnea of the newborn meconium aspiration pneumonia respiratory distress syndrome
132
why does Respiratory distress syndrome (RDS) happen?
defieciency is lung surfactant, leading to lung collapse and hypoxia
133
how can RDS be prevented in preterms?
steroids to mother during labour
134
signs of RDS of neonate?
tachypnea >60 RR laboured breathing grunting on expiration cyanosis
135
what cardiovascular abnormality is associated with RDS?
patent ductus arteriosus
136
cause of hypoxic ischaemic encephalopathy
RDS | cord/placental hypoxia
137
signs of HIE
``` irritability poor feeding motor abnormalities - dysfunction seizures multiorgan failure ```
138
treatment for HIE
hypothermia therapy

3 Child health EJR (3 decks)

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