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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
Q

characteristics of dyskinetic cerebral palsy

A

uncontrolled movements
slow writhing movements
exacerbated during stress

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26
Q

characteristics of ataxic cerebral palsy

A

wide based gait
intentional tremor
poor coordination
poor balance

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27
Q

extra intestinal features of crohn’s disease

A 
uveitis
erythema nodosum
perianal skin tags
arthralgia
clubbing
oral lesions
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28
Q

systemic features of crohn’s disease

A

fever
weight loss
lethargy

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29
Q

GI features of crohn’s disease

A

diarrhea

abdominal pain

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30
Q

histological marker of crohn’s disease

A

non-caseating epitheloid cell granulomata

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31
Q

how to investigate crohn’s disease

A

bloods - inflammatory markers

endoscope and biopsy

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32
Q

clinical features of ulcerative colitis

A

rectal bleeding
diarrhea
colicky pain

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33
Q

difference in adult vs children in ulcerative colitis

A

adults less likely to have pan colitis

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34
Q

complication of ulcerative colitis

A

fulimnant toxic mega colon

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35
Q

what is coeliac disease

A

autoimmune response to gluten in diet, causes destruction of villous mucosa in proximal small intestines

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36
Q

classical age of presentation of coeliac disease

A

8-24 months depending on gluten introduction into diet

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37
Q

clinical features and presentation of coeliac disease

A 
growth faltering
weight loss
abnormal stools
abdominal distension
buttock wasting
abdominal pain
anaemia
general irritability
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38
Q

what is the diagnostic investigation of coeliac’s disease?

A
  • positive serology, showing antibodies
  • endoscopy and biopsy showing damaged villi
  • resolution of symptoms on gluten free diet
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39
Q

management of coeliac disease

A

diet change under dietician supervision

gluten challenge

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40
Q

what is irritable hip?

A

transient synovitis. acute hip or knee pain, following viral infection.

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41
Q

presentation of irritable hip

A

acute hip or knee pain. preceded by viral infection. limited range of movement. no relief on rest. afebrile or mildly pyrexic

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42
Q

investigations of irritable hip

A

xrays and blood tests to rule out other more serious causes

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43
Q

differentials of hip pains in children

A 
irritable hip
perthes
SUFEs
osteomyelitis
septic arthritis
reactive arthritis
maglinancy
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44
Q

what is developmental displasia of the hip

A

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.

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45
Q

risk factors for developmental displasia of the hip

A

genetic, breech birth, certains swaddling techniques

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46
Q

how to prevent developmental displasia of the hip

A

newborn examination and again at 8 weeks

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47
Q

what is the late presentation of developmental displasia of the hip

A

limp, abnormal gait, shortened leg, limited abduction of hip

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48
Q

how to investigate developmental displasia of the hip

A

ultrasound

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49
Q

management for developmental displasia of the hip

A

splinting, harnesses, surgery.

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50
Q

what is SUFEs

A

slipped upper/capital femoral epiphysis

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51
Q

who gets SUFEs more commonly

A

10-15 year old boys in their growth spurt and also obese.

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52
Q

causes of SUFEs

A

range of causes including trauma, biomechanics, endocrine (obesity, hypothyroidism, hypogonadism)

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53
Q

presentation of SUFEs

A

acute or gradual
limp, abnormal gait
hip pain +/- referred to knee
limited range of motion of hip

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54
Q

complication of SUFEs

A

avascular necrosis of femoral head

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55
Q

diagnosis and management of SUFEs

A

xray and surgery

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56
Q

how does reactive arthritis in children usually present

A

swollen joint

preceded by non-articular infection

57
Q

what causative organisms are more common in reaction childre in children

A

enteric bacteria (salmonella, shigella, campylobacter, yersinia)

in adolescents, STIs like chlamydia and gonoccocus

58
Q

investigation for suspected reactive arthritis

A

bloods will show normal or mildly raised acute phase reactants

xrays show normal

59
Q

management for reactive arthritis

A

supportive - self limiting

60
Q

common causative organism of septic arthritis

A

staph aureus

HiB

61
Q

how does septic arthritis usually spread

A

haematogenous,
but can be local traumatic infection
or from local osteomyelitis

62
Q

presentation of septic arthritis

A 
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
Q

investigation for septic arthritis

A

blood cultures and ESR/CRP
ultrasound
xray to rule out trauma
joint aspirate

64
Q

management of septic arthritis

A

drainage, wash out

antibiotics

65
Q

when to refer to paediatric rheumatology clinic

A

children with chronic polyarthritis

66
Q

what is juvenile iodpathic arthritis

A

chronic arthritis (>6 weeks)
presenting under 16 years old
no other infection or possible cause

67
Q

how many types of JIA are there

A

7

68
Q

what are the 7 types of JIA

A 
polyarthritis (RF +ve)
polyarthritis (RV -ve)
oligoarthritis
systemic arthritis
psoriatic arthritis
enthesitis related arthritis
undifferentiated arthritis
69
Q

fever pattern of systemic JIA?

A

fever spikes in evenings

70
Q

management of JIA?

A

steroids
methotrexate/DMARDs
biologics

71
Q

which HLA is associated with JIA

A

HLA-B27 is associated with enthesitis related arthritis

72
Q

why are UTIs especially important to diagnose in children?

A

scaring - adult kidney disease
UT anatomical abnormality
VUR can cause a lot of complications

73
Q

complications with vesicoureteric reflux

A

backflow causing pyelonephritis
back pressure causing kidney damage
causes incomplete voiding

74
Q

most common causative organisms for UTIs

A

E coli
klebsiella
proteus

75
Q

common organism causing UTI in urinary catheterised patient

A

pseudomonas

76
Q

presentation of infants with UTI

A 
unwell
fever
vomiting
loin tenderness
offensive urine
poor feeding
77
Q

presentation of UTI in children

A 
dysuria/frequency/urgency
abdominal pain
fevers +/- rigors
lethargy
anorexia
vomiting
nocturia
78
Q

purpose of investigations in UTIs

A

find out why the child is getting UTI

79
Q

what investigations can be done in UTI in children

A

ultrasound
DMSA
MCUG

80
Q

what does DMSA look for

A

scaring

81
Q

what does MCUG look for

A

reflux

82
Q

when to use prophylactic antibiotics in UTI children

A

recurrent UTIs

83
Q

how to obtain urine sample in infants

A

clean catch
nappy pad
in-and-out catheter
suprapubic aspirate

84
Q

how to interprete urine dip stick in UTI children

A

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
Q

what are kocher’s rules/criteria

A

Non-weight-bearing on affected side
ESR > 40
Fever > 38.5 °C
WBC count > 12,000

86
Q

common viral causes of gastroenteritis

A 
rotavirus
norovirus
adenovirus
coronavirus
astrovirus
87
Q

common bacterial causes of gastroenteritis

A 
salmonella
campylobacter jejuni
shigella
cholera
ecoli
cdiff
88
Q

associated symptoms of infection with campylobacter jejuni?

A

severe abdominal pain

89
Q

associated symptoms of infection with shigella

A

high fever

90
Q

key symptom of cholera infection

A

rice water diarrhea

91
Q

other than viral and bacteria, what else can cause gastroenteritis? give 2 examples

A

protozoans - giardia or crptosporidium

92
Q

most acute complication of gastroenteritis

A

dehydration -> shock

93
Q

why are children more susceptible to dehydration and shock

A

higher surface area to body weight ratio, leading to higher insensible water loss

94
Q

important questions to ask in someone presenting with gastroenteritis

A

recent travel
contacts
food
animal exposure

95
Q

difference between isonatraemia/hyponatraemia and hypernatraemia dehydration

A

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
Q

presentation of gastroenteritis

A 
diarrhea
vomiting
fever
abdominal pain
distension
dehydration
97
Q

what surgical disorders can mimic gastroenteritis

A 
pyloric stenosis
intussusception
acute appendicitis
necrotizing enterocolitis
Hirschsprung disease
98
Q

what infections can mimic gastroenteritis

A

septicaemia, meningitis

RTI, ENT infection, Hepatitis A, UTI

99
Q

What metabolic disorder can mimic gastroenteritis

A

Diabetic ketoacidosis

100
Q

what malabsorptive causes can mimic gastroenteritis

A

cows milk protein allergy
lactose intolerance
coeliac disease

101
Q

what features to assess in shock

A 
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
Q

what investigations can be done for gastroenteritis

A

usually none, but can do stool culture or blood culture

103
Q

management for gastroenteritis

A

rehydration - oral or IV

104
Q

symptoms of kawasaki disease

A 
fever
red eyes
red/cracked lips and tongue
red swollen fingers and toes
diffuse rash
cervical lymph node swelling
105
Q

what causes epiglottitis

A

HiB

106
Q

symptoms of epiglottitis

A

high fever
severe throat pain - drooling
soft stridor
sitting upright with open mouth

107
Q

cough is usually present in epiglottitis - T or F

A

false, cough is quite minimal if even, compared to croup

108
Q

why should the mouth/throat not be examined in epiglottitis

A

might cause it to close

109
Q

management for epiglottitis

A

alert ENT/anaesthetist
intubation/tracheostomy
antibiotics

110
Q

what are the risk factors for having coeliac’s disease

A

T1DM
autoimmune thyroid disease
Down’s syndrome
1st degree family history of coeliac’s

111
Q

which part of the brain is affected in each type of cerebral palsy - spastic, dyskinetic, ataxic?

A

spastic - cerebral/mortor cortex (inhibited inhibition)
dyskinetic - basal ganglia (initiation of movement)
ataxic - cerebellum (coordination, balance)

112
Q

complications in later life of cerebral palsy ?

A 
pain (due to stiffness/hypertonicity)
learning disabilities
SALT problems
epilepsy
visual/hearing problems
bladder problems
sleep disorders
hip dysplasias
behavioural problems
113
Q

how is cerebral palsy diagnosed?

A

clinically or MRI if unsure

114
Q

management approach of cerebral palsy ?

A

MDT

115
Q

investigations in suspected food allergy/intolerance

A

skin-prick tests
IgE blood tests

endoscopy and biopsy

food challenge under supervision

116
Q

common age for atopic eczema in children

A

after 2 months old, most resolve by 12 years

117
Q

what can cause an itchy rash in children?

A 
atopic eczema
chicken pox
urticaria/alllergy
insect bites
scabies
fungal infections
pityriasis rosea
118
Q

what rash often causes a ‘herald patch’

A

pityriasis rosea

119
Q

how does the rash in pityriasis rosea progress

A

starts off as a herald patch (anywhere) and then progresses to have a christmas tree distribution on the back

120
Q

what is haemolytic disease of the newborn?

A

antibodies produced by the mother transfer to fetus causing destruction of red blood cells in fetus,

121
Q

what is the most common cause of HDN?

A

rhesus factor, or ABO group

122
Q

how does HDN happen?

A

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
Q

newborn features of HDN

A 
pallor, anaemia
jaundice, kernicturus
hepatosplenomegaly
hydrops fetalis
edema, effusions, ascites
124
Q

causes of jaundice <24hours age

A

haemolytic disorders (rhF, ABO, G6PD def)
congenital infection
fetal bleeding

125
Q

how is rh factor HDN prevented?

A

rhesus factor immunoglobulins

126
Q

how is physiological jaundice diagnosed?

A

diagnosis of exclusion

127
Q

when does physiological jaundice present?

A

24h - 2 weeks

128
Q

investigations in neonatal jaundice

A 
bilirubin levels
LFTs
haemolytic d/o - blood type/rh/G6PD def
TFTs
infections
imaging
129
Q

how does breast milk jaundice present?

A

baby is usually well

jaundice can last from 6 weeks to 4 months

130
Q

blood bilirubin level is physiological jaundice?

A

200 micromol/L

131
Q

4 more common causes of fetal respiratory distress

A

transient tacyhpnea of the newborn
meconium aspiration
pneumonia
respiratory distress syndrome

132
Q

why does Respiratory distress syndrome (RDS) happen?

A

defieciency is lung surfactant, leading to lung collapse and hypoxia

133
Q

how can RDS be prevented in preterms?

A

steroids to mother during labour

134
Q

signs of RDS of neonate?

A

tachypnea >60 RR
laboured breathing
grunting on expiration
cyanosis

135
Q

what cardiovascular abnormality is associated with RDS?

A

patent ductus arteriosus

136
Q

cause of hypoxic ischaemic encephalopathy

A

RDS

cord/placental hypoxia

137
Q

signs of HIE

A 
irritability
poor feeding
motor abnormalities - dysfunction
seizures
multiorgan failure
138
Q

treatment for HIE

A

hypothermia therapy

3 Child health EJR (3 decks)

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