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415 Cards in this Set
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normal respiratory rate for age <1
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30-40
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HR for age <1
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110-160
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Systolib BP age <1
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70-90
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Classic red flags in paediatric emergency
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Purpuric rash
Bulging fontanelle Biphasic stridor High pitched scream Bile stained vomiting Persistent tachycardia Grunting respiration |
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What are the signs of respiratory distress in a child?
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recession, grunting, nasal flair, accessory muscle use, head bobbling, cyanosis
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Define clinically significant reduced fluid intake for a child
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less than 1/2 of normal
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Define reduced urine output for a child
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<4 wet nappies in 24 hours
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What does decorticate posturing imply?
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a lesion above the brainstem
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What does decerebrate posturing imply?
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a lesion below the brainstem
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What subset of paediatric patients may be seriously ill without showing much change in their ABCD status?
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immune compromised children
early sepsis |
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Management of moderate croup?
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Dexamethasone 0.15mg/kg then review in 3 hours- send home if stable
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Management of severe croup?
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Oxygen
Dexamethasone Adrenaline nebs: 4ml of 1:1000 if airway unstable/fatigue: admit to PICU |
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Management of severe bronchiolitis
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oxygen via mask/nasal prongs: maintains SaO2 >94%
IV fluids Trial of nebulised salbutamol: continue if improvement Nasopharingeal CPAP |
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Are antibiotics useful in managing croup?
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no
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What are the indications for intubation and ventillation of a child with croup?
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PaO2 <50mmHg, rising PaCO2, fatigue, inability to protect the airway, depressed LOC, recurrent apnea
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What is the most common cause of febrile illness in children?
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Viral
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red flags in a vomiting infant?
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bilious vomiting
fever >39 blood in vomitus or stool; severe abdo pain Very young infant |
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normal sleep pattern for an 0-3 month old
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95% sleep during the day every day
take 1/2 to 1 hour to settle many wake up 6 times per night- 2 is most common |
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Normal sleep pattern for 1 year old
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89% have daytime nap for 1-2 hours
Most settle between 6-8pm 80% settle quickly night time awakenings common but only 10% wake more than 3x per night |
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Normal sleep pattern for a 2 year old?
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1/2 have daytine nap, 1/2 wake up during the night and require parental attention
25% take more than 30 min to settle |
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How common is regurgitation in early life and how long does it usually last?
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2/3 reported by parents at 4 months
Mostly resolves by 1 year of age rarely causes problems for the child |
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When is reflux a problem?
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When vomitus is blood stained- may indicate oesophagitis
When it leads to poor growth Apnea/aspiration is very rare Mostly just a cause of crying/irritability rather than being pathological |
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Is barium meal specific for reflux in a child?
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No, results are affected by the way in which the test is performed
Useful for excluding causes of mechanical obstruction such as malrotation |
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How are children treated for reflux?
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No treatment for mist children
Some evidence for thickened feeds Little evidence for positioning Metoclopramide more harm than good PPI if evidence of oesophagitis on endoscopy Fundoplication if severe |
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Is there evidence that food allergy has a role in reflux oesophagitis in children?
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little evidence
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Define primary lactase deficiency>
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Most common form, occurs in individuals greater than 2 years of age
More common in asian and hispanic |
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What is secondary lactase deficiency
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something which has damaged the small bowel
more common than primary lactase deficiency in infancy |
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Define congenital lactase deficiency?
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very rare syndrome
do not survivw without lactose free supplements |
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Define developmental lactase deficiency
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relative lactase deficiency observed in infants <34 weeks of age
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How is lactose intolerance diagnosed?
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2 weeks of lactose free diet
mild cases: hydrogen breath test stool for low pH and reducing substances intestinal biopsies for lactase actrivity rule out: infections, celiac disease |
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Do breastfed infants with lactose intolerance need to stop being breastfed?
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no
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What is the most common cause of frothy stools in the breastfed infant?
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relative lactose malabsorption- getting the carbohydrate rich foremilk rather than the fat-rich hind milk (which slows absorption and allows time for digestion).
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What is the best indicator of the adequacy of milk supply?
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number and heaviness of wet nappies
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What is the expected weight gain of an infant-
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100-200g/week
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How do you manage fussy eating in a toddler?
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reassure parents
make sure than not having excessive milk (not > 200ml/d) or snacks May take up to 10 tries before a new food is accepted realistic portion sizes remove food after 1/2 hour offer 3 meals and 2 snacks/day need 3 serves of dairy/day drink water with meals |
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Define constipation in a child?
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delay or difficulty passing stool that is present for over 2 weeks
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Normal stool frequency in a child?
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1st week of life: 4 x d---> 1 x d by 2 years of age
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Is it normal for some breastfed babies not to have stools for several days or longer?
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yes
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Most common type of constipation in a child?
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functional constipation
holding in stools caused by changes in routine/stressors may lead to soiling and eventially abdominal distension, cramps or reduced oral intake |
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Management of functional constipation?
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disimpation: oral or rectal medication (lactulose, glucerin suppository): <1yr also prune juice, >1 yr also mineral oil
Maintenance: dietary, behavioral modification and medication is necessary--> reduces relapse. Lactulose or mineral oil used. May be necessary for many months until bowel habit returns to normal. |
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Common symptoms of teethin?
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biting, drooling, gum rubbing, irritability, decreased appetitie for solids, mildly raised temperature
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Is a high fever usually associated with teething?
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no
neighter is vomiting, diarrhoea and rashes |
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What is unilateral plagiocephaly and how does it develop?
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more common in males and on the right side, Present from birth
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What is the difference between bilateral and unilateral plagiocephaly?
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unilateral present from birth, bilateral develops postnatally
both exacerbated by sleeping on back Getting more common after back to sleep campaign |
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Differential diagnosis of positional plagiocephaly?
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craniosynostosis, congenital muscular torticollis
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differenc in examination in positional plagiocephally versus craniosynostosis
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normal head circumference, no palpable ridging (as occurs over fused sutre), all fontanelles palpable, no other signs sich as hydrocephalus, develipmental delay
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Indications for investigations in positional plagiocephaly?
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usually none done
consider skull xray if concerned about synostosis, not improving or worstening head shape |
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Natural history of positional plagiocephaly
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gradial improvement in head shape over the next 2 years
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Howe common is nocturnal enuresis?
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very common, 10% of 5 year olds
More common in boys |
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Is family history a factor in norcturnal enuresis?
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yes, more common if positive family history
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Define primary nocturnal enuresis?
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never dry for more than a few months
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Define secondaru nocturnal enuresis:
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was dry for 6 months then wet again
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Which children need professional help for their nocturnal enuresis?
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if still wetting > 6 years
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Is fluid restriction before bed effective for nocturnal enuresis?
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no, neither is waking up the child at night
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What is the most effective treatment for nocturnal enuresis?
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2/3 dry with alarm use
desmopressin reduces the number of wet nights but the effect is non sustained- advise child not to drink more than 240ml of fluid in the evening to prevent water intoxication |
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From what age is toilet training usually sucessful?
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2 1/2 years
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What are non-atopic wheezers?
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non-allerfic
wheezing associated with viral infections resolves by 5-6 years |
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What are non-atopic wheezers?
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non-allerfic
wheezing associated with viral infections resolves by 5-6 years |
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How often is spirometry done for a paediatric patient?
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at diagnosis and at each follow-up
requires a mental age of 4-6 |
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What are the inhallational medication delivery devices available for children under 6
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MDI with spacer
<4: small spacer with mask >4: small spacer or large spacer, with mouthpiece |
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At what age can an MDI with no spacer be used?
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Age >8
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At what age can breath activated devices be used?
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Age > 6
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Are central or neuromuscular causes more frequent in floppy infants?
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central
e.g. concequences of sepsis, meningitis and hyperbilirubinemia |
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What features on examination of an infant provide a clue that hypotonia is central or neuromuscular?
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central has normal reflexes, neuromuscular has ansent or depressed reflexes
central: depressed alertness, seizures, dysmorphic, nystagmus, no weakness neuromuscular: weakness, alert child that is not moving |
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Features of spinal muscular atrophy type 1
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marked proximal weakness
decreased movement bell-shaped chest mobile, expressive face intellifence is normal tongue fasciculations absent reflexes |
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How do you test for spinal muscular atrophy?
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SMN gene test
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Natural history of ducenne muscular dystrophy
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most common inherited muscle disease
C-linked recessive inheritance affects 1/3500 boys presents in early childhood with muscle weakness loss of independent ambulation cardiomyopathy, respiratory insufficiency death in 2nd/3rd dec |
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Typical clinical pathway to the diagnosis of ducenne muscular dystrophy?
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family history
typical clinical presentation raised CK family history dystrophin gene test |
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What can improve survival in duchenne muscular dystrophy?
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excellend medical care, spinal surgery, ventillation, corticosteroids
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Mechanism of steroids in management of muscular dystrophy?
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exact mechanism not known: positive effect on myogenesis, anabolic effect on muscke mass, stabillization of membranes, attenuation of necrosis, intracellular Ca
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Efficacy of corticosteroids in the management of Duchenne muscular dystrophy?
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long-term early onset therapy may provide prolonged ambulation
respiratory function at 15 years maintained at or above 80% (control is 40%) None require scoliosis surgery (control 50%) side effects: growth suppression cateracts (asymptomatic) osteopenia (asymptomatic) |
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Clinical findings in congenital myopathies?
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hypotonia
facial weaknes --> dysmorphism (ptosis, high palate) resp insufficiency bulbar weakness aspiration scoliosis contractures intelligence normal non-progressive or slowly progressive clinical course |
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What % of illnesses < 5 years of age are acute respiratory infections?
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50%
30% 5-12 95% URTI LRTI- early life and boys |
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What % of ARI's in children are viral and what virusses cause these?
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90%
rhinovirus, rsv piv 123 influenza adenovirus metapneumovirus |
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What % of ari's in children are bacterial?
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10%
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Incidence of paediatric food allergy?
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16% by parent questionairre
1-3% by population based studies |
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What are the types of food allergy?
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IgE mediated and non-Ige mediated
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Clinical features of IgE mediated food allergies
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Short time course < 2hrs
mild moderate or severe can be unpredictable in severity positivve exposure history not always present |
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Define a mild igE mediated food allergy?
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localised facial erythema or utricaria/angioedema
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Define moderatye IgE mediated food allergy?
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generallised utricaria/angioedema/vomiting or both
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Efficacy of corticosteroids in the management of Duchenne muscular dystrophy?
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long-term early onset therapy may provide prolonged ambulation
respiratory function at 15 years maintained at or above 80% (control is 40%) None require scoliosis surgery (control 50%) side effects: growth suppression cateracts (asymptomatic) osteopenia (asymptomatic) |
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Clinical findings in congenital myopathies?
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hypotonia
facial weaknes --> dysmorphism (ptosis, high palate) resp insufficiency bulbar weakness aspiration scoliosis contractures intelligence normal non-progressive or slowly progressive clinical course |
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What % of illnesses < 5 years of age are acute respiratory infections?
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50%
30% 5-12 95% URTI LRTI- early life and boys |
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What % of ARI's in children are viral and what virusses cause these?
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90%
rhinovirus, rsv piv 123 influenza adenovirus metapneumovirus |
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What % of ari's in children are bacterial?
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10%
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Incidence of paediatric food allergy?
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16% by parent questionairre
1-3% by population based studies |
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What are the types of food allergy?
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IgE mediated and non-Ige mediated
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Clinical features of IgE mediated food allergies
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Short time course < 2hrs
mild moderate or severe can be unpredictable in severity positivve exposure history not always present |
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Define a mild igE mediated food allergy?
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localised facial erythema or utricaria/angioedema
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Define moderatye IgE mediated food allergy?
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generallised utricaria/angioedema/vomiting or both
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Define a severe Ige-mediated food allergy?
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generallused utricaria/angioedema and strodor or wheeze
pale/floppy in small infants |
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% BSA in head of child vs adult
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Head of child 18%
Head of adult 9% |
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% BSA in leg of child vs adult
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Leg of child: 14%
Leg of adult 18% |
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Early care of curns
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Wash in chlorhexidine 0.1-0.2%
remove loose, dead keratin early blisters: drain or deroof late blosters: leave dress wounds check tetanus prophylaxis no antibiotics |
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When is bone remodelling expected after a fracture in a child?
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When there is > 2 yrs of growth remaining
fracture is near the metaphysis deformity is in the plane of joint movement |
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When is remodelling not expected in a child who has sustained a fracture?
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intra-articular
diaphiseal fracture with gross angulation, shortening or rotation fractures with deformity at right angles to plain of joing movement |
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Biomechanical differences between child and adult
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ligaments stronger than growth plate
easy to produce epiphiseal separation difficult to produce dislocations or sprains young bone more porous- tolerates more deformation but less compression/tension |
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What is overgrowth after a fracture and where does this occur?
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fracture stimulates longditudional growth- increased blood flow associated with fracture healing stimulates growth plates, loss of tether in periosteum
usually only a concern in the femur which may have 1-2 cm of overgrowth after a fracture |
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How long does it take for phiseal injuries to heal?
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3 weeks in femur
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Spead of healing of femoral fractures by age
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3-4 weeks at birth
10-14 weeks in adolescence 14-20 weeks in adulthood |
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What % of fractures under the age of 3 are non-accidental injury?
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25%
suspect with rib, old, corner, bucket handle |
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Biomechanical differences between child and adult
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ligaments stronger than growth plate
easy to produce epiphiseal separation difficult to produce dislocations or sprains young bone more porous- tolerates more deformation but less compression/tension |
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What is overgrowth after a fracture and where does this occur?
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fracture stimulates longditudional growth- increased blood flow associated with fracture healing stimulates growth plates, loss of tether in periosteum
usually only a concern in the femur which may have 1-2 cm of overgrowth after a fracture |
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How long does it take for phiseal injuries to heal?
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3 weeks in femur
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Spead of healing of femoral fractures by age
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3-4 weeks at birth
10-14 weeks in adolescence 14-20 weeks in adulthood |
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What % of fractures under the age of 3 are non-accidental injury?
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25%
suspect with rib, old, corner, bucket handle |
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How soon should you have surgery with an open fracture?
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Within 6 hours
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What are the common newborn fractures and what conditions predispose to these?
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humerus, clavicle, femur
predisposing: high BW, spina bifida, osteogenesis imperfecta |
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Clinical scenario of a "pulled elbow"
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1-4 years
refuses to use arm history not always reliable |
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management of a "pulled elbow"
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supination of flexed elbow
if unsucessful: reconider diagnosis, rest |
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What type of cancer is very common in adults and almost never occurs in children?
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carconoma
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Differences between adult and childhood cancers?
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1-2 step process
not usually associated with lifestyle factors Many tumours highly sensitive to chemotherapy Over 75% of children with cancer are cured permanently |
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Cardinal symptoms of cancer in a child?
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persistent/recurrent fever without a cause
persistent pain esp. bone pain/headache mass purputa pallor strabismus changes in coordination/behavior |
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Most common child hood ca?
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ALL (leukaemia 30% childhood cancer, ALL 80% of leukaemia> CNS > neuroblastoma > NHL > Wims
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Good prognostic factors for childhood ALL?
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Age 2-10, lower WCC, prednisone response, no CNS disease, hyperdiploidy, B- precursor, t(12:21)
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Bad prognostic factors in childhood ALL?
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Infant or age > 10 years
high wcc CNS disease T-cell disease Philadelphia t(4;11) |
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Management of childhood ALL?`
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1 month induction- 98% remission
firther 5-6m "heavy chemo" 1.5 yrs oral 'gentle' maintenance chemo 75% cured CNS: usually intrathecal chemo, sometimes cranial RT |
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What is the ptognosis of whildhood AML like compared to ALL?
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More serious than ALL- best hope is 60% cure- requires very intense chemo (high dose cytosine, leads to prolonged marrow aplasia, requires prolonged inpatient stay)
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Effects of radiation therapy on the brain in children
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may affect neurocognitive function- worse if younger and if supratentorial brain is irradiated
may cause hypopit carcinogenic |
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Where do neuroblastomas arise from?
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adrenal gland or sympathetic nerve trunks
most are abdominal (also thoracic, pelvic, cervical, other) |
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Prognosis of neuroblastoma?
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majority are malignant with poor prognosis- require intesive chemo, surgery, ABMT
Some have favourable biology and are readily cured: better <1yr |
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What is the worst kind of neuroblastoma?
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stage IV in children over 12m
presents with flank mass/other mass unhappy bony metastases e.g. black eyes, lumps anaemia |
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Presentations of neuroblastoma
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newbown with a massive liver
neck mass paraspinal chest mass spinal cord compression adrenal mass on antenatal check |
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What is the age that gets affected by wilms tumour?
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young children- 1-7 yeats
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presenting symptoms of wilms tumour?
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flank mass- can be huge, often painless
haematuria mets to lung/liver |
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management and prognosis of wilms tumour
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surfery/chemo/rt
good prognosis |
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Is renal cell carcinoma common in children?
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no, very rare
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Presentation of T-lymphoblastic lymphoma?
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older child, mediastinal mass, pleural effusion
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Presentation of Burkitt's lymphoma?
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abdominal disease
intussuception abdominal mass marrow/csf disease |
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What age group gets bone sarcomas?
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adolescents/ young afults- corresponds to adolescent growth spurt
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Where do ewings sarcomas grow?
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diaphiseal long bones
axial skeleton extra osseious |
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Genetics of ewing sarcoma?
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t(11;22) leads to EWS-FLI1 fusion transcrip
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Genetics of ewing sarcoma?
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t(11;22) leads to EWS-FLI1 fusion transcrip
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Prognosis of osteosarcoma and wqing sarcoma?
Prognosis of rhabdomyosarcoma? |
80% survival if non-metastatic
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Prognosis of osteosarcoma and wqing sarcoma?
Prognosis of rhabdomyosarcoma? |
80% survival if non-metastatic
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Where does osteosarcoma arise?
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growing ends of long bones
distal femur, proximal tibia and prox humerus may be many month history of growth |
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Where does osteosarcoma arise?
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growing ends of long bones
distal femur, proximal tibia and prox humerus may be many month history of growth |
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Most common soft tissue sarcoma in children?
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rhabdomyosarcoma most common- embryonal and alveolar subtypes
sensitive to chemo and radiotherapy |
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Most common soft tissue sarcoma in children?
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rhabdomyosarcoma most common- embryonal and alveolar subtypes
sensitive to chemo and radiotherapy |
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Genetics of ewing sarcoma?
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t(11;22) leads to EWS-FLI1 fusion transcrip
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Are non-rhabdo sarcomas more or less chemosensitive than rhabdosarcoma?
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less
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Are non-rhabdo sarcomas more or less chemosensitive than rhabdosarcoma?
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less
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Prognosis of osteosarcoma and wqing sarcoma?
Prognosis of rhabdomyosarcoma? |
80% survival if non-metastatic
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Genetics of ewing sarcoma?
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t(11;22) leads to EWS-FLI1 fusion transcrip
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Most common sites of rhabdomyosarcoma in a child?
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22% genitourinatu
18% extremity 16% parameningeal 10% other head and neck |
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Most common sites of rhabdomyosarcoma in a child?
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22% genitourinatu
18% extremity 16% parameningeal 10% other head and neck |
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Genetics of ewing sarcoma?
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t(11;22) leads to EWS-FLI1 fusion transcrip
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Where does osteosarcoma arise?
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growing ends of long bones
distal femur, proximal tibia and prox humerus may be many month history of growth |
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Components of the HEADSS interview?
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home
education exercise/nutrition activities sex social suicide |
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Components of the HEADSS interview?
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home
education exercise/nutrition activities sex social suicide |
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Prognosis of osteosarcoma and wqing sarcoma?
Prognosis of rhabdomyosarcoma? |
80% survival if non-metastatic
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Most common soft tissue sarcoma in children?
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rhabdomyosarcoma most common- embryonal and alveolar subtypes
sensitive to chemo and radiotherapy |
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Prognosis of osteosarcoma and wqing sarcoma?
Prognosis of rhabdomyosarcoma? |
80% survival if non-metastatic
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Define puberty?
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10-16 years
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Where does osteosarcoma arise?
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growing ends of long bones
distal femur, proximal tibia and prox humerus may be many month history of growth |
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Define puberty?
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10-16 years
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Where does osteosarcoma arise?
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growing ends of long bones
distal femur, proximal tibia and prox humerus may be many month history of growth |
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Define youth?
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12-24
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Define youth?
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12-24
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Most common soft tissue sarcoma in children?
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rhabdomyosarcoma most common- embryonal and alveolar subtypes
sensitive to chemo and radiotherapy |
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Are non-rhabdo sarcomas more or less chemosensitive than rhabdosarcoma?
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less
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Most common sites of rhabdomyosarcoma in a child?
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22% genitourinatu
18% extremity 16% parameningeal 10% other head and neck |
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Most common soft tissue sarcoma in children?
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rhabdomyosarcoma most common- embryonal and alveolar subtypes
sensitive to chemo and radiotherapy |
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Define young adulthood?
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18-30
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Are non-rhabdo sarcomas more or less chemosensitive than rhabdosarcoma?
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less
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Define young adulthood?
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18-30
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Are non-rhabdo sarcomas more or less chemosensitive than rhabdosarcoma?
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less
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Components of the HEADSS interview?
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home
education exercise/nutrition activities sex social suicide |
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Most common sites of rhabdomyosarcoma in a child?
|
22% genitourinatu
18% extremity 16% parameningeal 10% other head and neck |
|
|
|
Components of the HEADSS interview?
|
home
education exercise/nutrition activities sex social suicide |
|
|
|
Define puberty?
|
10-16 years
|
|
|
|
Most common sites of rhabdomyosarcoma in a child?
|
22% genitourinatu
18% extremity 16% parameningeal 10% other head and neck |
|
|
|
Components of the HEADSS interview?
|
home
education exercise/nutrition activities sex social suicide |
|
|
|
Define youth?
|
12-24
|
|
|
|
Define puberty?
|
10-16 years
|
|
|
|
Define young adulthood?
|
18-30
|
|
|
|
Define puberty?
|
10-16 years
|
|
|
|
Define youth?
|
12-24
|
|
|
|
Define youth?
|
12-24
|
|
|
|
Define young adulthood?
|
18-30
|
|
|
|
Define young adulthood?
|
18-30
|
|
|
|
average duration of sleep a 16 year old needs?
|
8 1/2 hours per night
required nightly sleep duration declines during adolescence |
|
|
|
Changes in sleep during adolescence
|
fall asleep and wake later
marked reduction in slow-wave sleep: 40% decline from age 10 to age 20--> less restorative sleep REM sleep decreases in absolute terms but remains constant as a proportion of sleep time increased daytime sleepiness yo-yo sleeping Australian adolescents do not get enough sleep: less than americans esp. on sunday/school nights |
|
|
|
Use of actigraphy?
|
define sleep cycles together with sleep diary
|
|
|
|
average duration of sleep a 16 year old needs?
|
8 1/2 hours per night
required nightly sleep duration declines during adolescence |
|
|
|
What is delayed sleep phase disorder?
|
unusually long circadian rhythm
7-16 prevalence in adolescents and young adults up to 40% have a positive family hx |
|
|
|
Changes in sleep during adolescence
|
fall asleep and wake later
marked reduction in slow-wave sleep: 40% decline from age 10 to age 20--> less restorative sleep REM sleep decreases in absolute terms but remains constant as a proportion of sleep time increased daytime sleepiness yo-yo sleeping Australian adolescents do not get enough sleep: less than americans esp. on sunday/school nights |
|
|
|
Prevalence of insomnia in adolescents?
|
1/4 have at least 1 symptom
diagnostic insomnia has a point prevalence of 4-5% in adolescents |
|
|
|
DSM IV diagnosis of insomnia?
|
– Difficulty initiating sleep
– Difficulty maintaining sleep – Early morning waking – Non-restorative sleep All of the above should have occurred in the preceding 4 weeks causing significant impairment &/or distress |
|
|
|
Use of actigraphy?
|
define sleep cycles together with sleep diary
|
|
|
|
Causes of insomnia with an adolescent?
|
primary (heeadsss)
part of psych disorder drug and medication related |
|
|
|
What is delayed sleep phase disorder?
|
unusually long circadian rhythm
7-16 prevalence in adolescents and young adults up to 40% have a positive family hx |
|
|
|
% of adolescents that report being victims of cyber bullying?
|
50-70%
|
|
|
|
Prevalence of insomnia in adolescents?
|
1/4 have at least 1 symptom
diagnostic insomnia has a point prevalence of 4-5% in adolescents |
|
|
|
Are cyber bullying perpetrators more commonly female or male?
|
female
|
|
|
|
DSM IV diagnosis of insomnia?
|
– Difficulty initiating sleep
– Difficulty maintaining sleep – Early morning waking – Non-restorative sleep All of the above should have occurred in the preceding 4 weeks causing significant impairment &/or distress |
|
|
|
Major health issues in adolescents?
|
1. mental health: anxiety disorders and depression
2. chronic illness and disability 3. reducing or avoiding risk for future ill health 20-30% of adolescents report their health as poor 22% asthma 15% adhd |
|
|
|
Causes of insomnia with an adolescent?
|
primary (heeadsss)
part of psych disorder drug and medication related |
|
|
|
% of adolescents that report being victims of cyber bullying?
|
50-70%
|
|
|
|
Are cyber bullying perpetrators more commonly female or male?
|
female
|
|
|
|
Major health issues in adolescents?
|
1. mental health: anxiety disorders and depression
2. chronic illness and disability 3. reducing or avoiding risk for future ill health 20-30% of adolescents report their health as poor 22% asthma 15% adhd |
|
|
|
average duration of sleep a 16 year old needs?
|
8 1/2 hours per night
required nightly sleep duration declines during adolescence |
|
|
|
Changes in sleep during adolescence
|
fall asleep and wake later
marked reduction in slow-wave sleep: 40% decline from age 10 to age 20--> less restorative sleep REM sleep decreases in absolute terms but remains constant as a proportion of sleep time increased daytime sleepiness yo-yo sleeping Australian adolescents do not get enough sleep: less than americans esp. on sunday/school nights |
|
|
|
Use of actigraphy?
|
define sleep cycles together with sleep diary
|
|
|
|
What is delayed sleep phase disorder?
|
unusually long circadian rhythm
7-16 prevalence in adolescents and young adults up to 40% have a positive family hx |
|
|
|
Prevalence of insomnia in adolescents?
|
1/4 have at least 1 symptom
diagnostic insomnia has a point prevalence of 4-5% in adolescents |
|
|
|
DSM IV diagnosis of insomnia?
|
– Difficulty initiating sleep
– Difficulty maintaining sleep – Early morning waking – Non-restorative sleep All of the above should have occurred in the preceding 4 weeks causing significant impairment &/or distress |
|
|
|
Causes of insomnia with an adolescent?
|
primary (heeadsss)
part of psych disorder drug and medication related |
|
|
|
% of adolescents that report being victims of cyber bullying?
|
50-70%
|
|
|
|
Are cyber bullying perpetrators more commonly female or male?
|
female
|
|
|
|
Major health issues in adolescents?
|
1. mental health: anxiety disorders and depression
2. chronic illness and disability 3. reducing or avoiding risk for future ill health 20-30% of adolescents report their health as poor 22% asthma 15% adhd |
|
|
|
When do most mental health problems start?
|
75% start in adolescents
50% of depressed adolescents undiagnosed |
|
|
|
Risk factors for language disorder in a child
|
family history
hearing impairment preterm VLBW intellectual disacility autism spectrum seizure dioseders genetic e.g. fragile X, Down, Williams, NF1, VCF, Duchenne, XXY |
|
|
|
Components of autistic disorder
|
onset before 3 years; more than 6 items
qualitative social impairment qualitative impaired communication restricted/stereotyped behavior |
|
|
|
DSM IV for asbergers
|
qualitative social impairment
restricted/stereotyoed behavior significant impairment no general langualge delay no cognitive/self help/ curiosity delay |
|
|
|
What are the two types of ADHD?
|
Impusive (much more common in boys, early referral, social rejection, language/speech disorder, motor) vs
Inattentive (issues with organisation/memory planning, boys >= girls, late referral) |
|
|
|
What is selective mutism?
|
anxiety diorder in the social context of speaking
behavior of silence not abscence of speech more common infemales- mean onset 4 yrs fmily hx of anxity |
|
|
|
What are adrenergic agonists used for in child psychiatry?
|
aggression
|
|
|
|
What are TCA's used for in child psychiatry?
|
anxiety, adhd
|
|
|
|
When do milk teeth develop?
|
start in utero and fully developed by 6m
|
|
|
|
When do primary teeth erupt?
|
6-36m
|
|
|
|
How many primary teeth are there?
|
20
|
|
|
|
When do permanent teeth erupt?
|
6-18 yrs
|
|
|
|
What bacteria are present in dental caries?
|
s. mutans
lactobacillus infant mouth: 6-30m |
|
|
|
Can caries be transmitter vertically?
|
yes- high rates if mother has dental decay
approximately 75% of all caries are found in 20% of children modification of mother's flora is possible |
|
|
|
Which children are at risk for caries?
|
special needs
mothers with high caries rates inappropriate prolonged feeding later order offspring low ses mother's education level |
|
|
|
When is dental trauma most common
|
two peaks: 2-4 and 8-10 years
maxillary anterior teeth usually a single tooth includes both hard and soft tissues |
|
|
|
Should you replace avulsed primary teeth?
|
no, can damage the oermanent tooth
|
|
|
|
Should you replace a permanent tooth?
|
yes, replace immeadiately'if not possible place in milk/saline
|
|
|
|
When do milk teeth develop?
|
start in utero and fully developed by 6m
|
|
|
|
When do primary teeth erupt?
|
6-36m
|
|
|
|
How many primary teeth are there?
|
20
|
|
|
|
When do permanent teeth erupt?
|
6-18 yrs
|
|
|
|
What bacteria are present in dental caries?
|
s. mutans
lactobacillus infant mouth: 6-30m |
|
|
|
Can caries be transmitter vertically?
|
yes- high rates if mother has dental decay
approximately 75% of all caries are found in 20% of children modification of mother's flora is possible |
|
|
|
Which children are at risk for caries?
|
special needs
mothers with high caries rates inappropriate prolonged feeding later order offspring low ses mother's education level |
|
|
|
When is dental trauma most common
|
two peaks: 2-4 and 8-10 years
maxillary anterior teeth usually a single tooth includes both hard and soft tissues |
|
|
|
Should you replace avulsed primary teeth?
|
no, can damage the oermanent tooth
|
|
|
|
Should you replace a permanent tooth?
|
yes, replace immeadiately'if not possible place in milk/saline
|
|
|
|
How do you test visual acuity in the verbal child? (2-5)
|
Kay pictures test
Sheridan Gardener test (single letters, linear) Snellen chart (5+) |
|
|
|
Epidemiology of retinoblastoma
|
present before age 3 in 75%
Bilateral 25% Germile mutation 25% Somatic mutation 75% Associated with chromosome 13 |
|
|
|
Presenting signs od retinoblastoma?
|
leukocoria
strabismus secondary glaucoma uveitis |
|
|
|
Management of preseptal cellulitis
|
Admit to hospital
iv antibiotics imaging of no better in 48 hours |
|
|
|
Management of orbital cellulitis?
|
admit to hospiral
IV antibiotics CT scan head and obits drain abscess if present |
|
|
|
When is early surgery for protisis indicated?
|
when it is interfering with visual development
otherwise defer surgery until age 4-5 |
|
|
|
Is decreased vision a common cause of reading difficulties in a child?
|
no, usually due to a specific learning disability
|
|
|
|
In the foetus, how much of the cardiac output is from the right ventricle?
|
2/3--> 85% of this goes into the aorta via the ductis and 15% enters the lungs via the pulmonary arteries
|
|
|
|
How does blood det back to the placent within the foetus
|
descending aorta00> internal iliac arteries --> umbilical arteries --> placents
|
|
|
|
What happens to oxygenated blood within the foetus?
|
placenta--> umbilical vein--> ductus venosus--> IVC--> foramen ovale--> LA/LV--> ascending aorta and coronaru circulation
|
|
|
|
When does the PDAclose?
|
functionally after 10-15 hrs as a result of increased PaO2 and changes in prostiglandin metabolism
closes permanently within 2-3 weeks with combination of thrombosis, intimal prolif and fibrosis |
|
|
|
When does the ductus venosus close?
|
starts shortly after birth- due to a cessation of umbilical venous return
complete closure 3-7 days after birth |
|
|
|
What does the child switch from right to left ventricular dominance?
|
Throughout adolescence, complete by adulthood
|
|
|
|
When does heart rate peak in a child
|
From 3 weeks-3months, then slowly frops to adult level
|
|
|
|
Which children get endocarditis prophylaxis
|
prosthetic valves
history of endocarditis post cardiac transplant with valvulopathy rhumatic heart disease with valve pathology selected congenital heart disease- unrepaired cyanotic congenital heart disease, palliative shunts, conduits, prosthetic material first 6m, prosthetic material with residual defect |
|
|
|
Frequency of congenital heart disease?
|
6-8/1000 live births
commonest congenital defect |
|
|
|
Most common congenital heart disease?
|
VSD- 30-35%
PDA- 10-11% |
|
|
|
Do most casesn of congenital heart disease have a clear aetiological explanation?
|
no, most unexplained
|
|
|
|
What are the features of an innocent murmur
|
normal peripheral examination
systolic varies with body position grade 1-3- no thrill enhanced when ill ejection musical/vibratory |
|
|
|
What are the innocent murmurs of childhood?
|
stills
pulmonary flow carotid bruit venous hum |
|
|
|
What is the difference between the ECG of a young child and an adult?
|
"right sided" forces predominant initially- right acis deviation in newbown- by 12 years of age axis is normal
|
|
|
|
VSD on a CXR
|
increased pulmonary vascular markings
cardiomegaly |
|
|
|
What does the child switch from right to left ventricular dominance?
|
Throughout adolescence, complete by adulthood
|
|
|
|
When does heart rate peak in a child
|
From 3 weeks-3months, then slowly frops to adult level
|
|
|
|
Which children get endocarditis prophylaxis
|
prosthetic valves
history of endocarditis post cardiac transplant with valvulopathy rhumatic heart disease with valve pathology selected congenital heart disease- unrepaired cyanotic congenital heart disease, palliative shunts, conduits, prosthetic material first 6m, prosthetic material with residual defect |
|
|
|
Frequency of congenital heart disease?
|
6-8/1000 live births
commonest congenital defect |
|
|
|
Most common congenital heart disease?
|
VSD- 30-35%
PDA- 10-11% |
|
|
|
Do most casesn of congenital heart disease have a clear aetiological explanation?
|
no, most unexplained
|
|
|
|
What are the features of an innocent murmur
|
normal peripheral examination
systolic varies with body position grade 1-3- no thrill enhanced when ill ejection musical/vibratory |
|
|
|
What are the innocent murmurs of childhood?
|
stills
pulmonary flow carotid bruit venous hum |
|
|
|
What is the difference between the ECG of a young child and an adult?
|
"right sided" forces predominant initially- right acis deviation in newbown- by 12 years of age axis is normal
|
|
|
|
VSD on a CXR
|
increased pulmonary vascular markings
cardiomegaly |
|
|
|
Give some examples of cyanotic congenital heart disease?
|
TOF
TGA Truncus arteriosus Tricuspid atresia Total anomalous pulmonary venous circulation Ebstain anomaly/single ventricle |
|
|
|
Pathogenesis of impetigo
|
S.aureus and rarely GAS
Release toxin that splits the epidermis at the stratum corneum- split results in blister formation |
|
|
|
Management of impetigo
|
Collect skin swabs for culture and sensitivity
oral antibiotics 7-10 days decolonization: skin and linen 2-4 weeks, nasal with bactroban |
|
|
|
Causes of folliculitis in children?
|
staph aureus
dermatophytes pseudomonas |
|
|
|
Predisposing factors to staph aureus folliculitis
|
atopic dematitis
shaving of legs butt worms |
|
|
|
Management of staph aureus folliculitis?
|
As for impetigo: 7-10 days oral abx, decolonization, culture and sensitivity
|
|
|
|
Presentation of dermatophyte-related folliculitis?
|
pustular folliculitis- grouped pustules with peripheral expansion
may be colonised with staph usually acquired from pet e.g. guinea pig |
|
|
|
Diagnosis and management of pustular folliculitis?
|
KOH microscopu and fungal culture
treated with griseofulvin 8-10 weeks |
|
|
|
Diagnosis and management of folliculitis caused by pseudomonas?
|
scattered pustules around rhe trunk
heated pools, spas diagnosis confirmed by culture Manage by avoiding exposure |
|
|
|
Is tinea usually unilateral or bilateral?
|
unilateral e.g. 1 foot
|
|
|
|
Classic appearance of scalp infection by tinea?
|
incomplete alopecia, short/lustreless hairs +/- flourescence with woods light
scalp: scaling, pustules, kerion lymphadenopathy |
|
|
|
Management of cutaneous tinea
|
topical antifungals for 6 weeks after confirming diagnosis with scrapings (microscopy and culture)
oral griseofulvin given for patients with widespread infection, pustular infection, groin, hands,feet affected |
|
|
|
Management of scalp tinea?
|
oral griseofulvin for 2-3 weeks
|
|
|
|
Management of nail infections by tinea
|
take a few nail clippings- false negatives are common
loceryl nail colour lamisyl for 3-6 months |
|
|
|
How do children acquire molluscum contagiosum?
|
poxvirus which is spread through direct contact or water
|
|
|
|
Management of molluscum contagiosum
|
Resolve spontaneously over 6-12m as immune response occurs- papules develop erythema as immune response is underway
aim of management is to minimise spread- showering without sponges, pat dry with towel Induce an early immune response- imiquimod cream, gently prick, cryotherapy in older patients |
|
|
|
Management of herpes symplex?
|
topical antivirals in localised infection
systemic antivirals if atopic dermatitis/widespread infection |
|
|
|
Treatment of HPV infections in children?
|
treatment is aimed at stimulating an immune response
topical therapy, cryotherapy |
|
|
|
Management of staph aureus colonization in atopic dermatitis?
Why is it nevessary to treat this? |
may exacerbate atopic dermatitis through superantigen mechanism
treat with antibacterial bath oil/ low dose bactrim |
|
|
|
When is food intolerance likely to be a significant factor in atopic dermatitis?
|
1st 2 yrs of life
eggs and nuts > cows milk > wheat |
|
|
|
Common forms of paediatric psorriasis?
|
facial
flexural scalp guttate |
|
|
|
Management of paediatric psorriasis?
|
treat triggering factors: strep infection, medications
Topical therapy: steroids, tar, dithranol, diavonex Phototherapy: sunlight, UVB Oral therapy: methotrexate, cyclosprin |
|
|
|
Issues with haemangioma over the eye?
|
high risk of occular complications
oral steroids started to prevenet further growth |
|
|
|
What id the main problem with large haemangiomas over the face?
|
can give rise to a residual cosmetic defect
give oral steroids to minimise growth |
|
|
|
Where can haemangiomas be a marker for an underlying defect
|
gluteal cleft- spinal/urogenital
mandibular area- laringeal |
|
|
|
What is PHACE?
|
P- posterior cranial fossa abnormalities
H- haemangiomas A- arterial anomalies C-- coarctation of the aorta E- eye abnormalities |
|
|
|
Treatment options for haemangioma?
|
oral and intralesional steroids
vincristine interferon |
|
|
|
Clues towards aetiology in a pale/anaemic child?
|
short- aplasia
long- iron deficiency, inherited anaemia |
|
|
|
What does a pale and yellow child with red urine most likely have?
|
intravascular haemolysis
|
|
|
|
What do bacterial infections sicj as skin pustules, pneumonia, bacteraemia indicate?
|
neutrophil disorder: neutropenia
chronic granulomatous disease leukocyte adhesion disorder |
|
|
|
What do viral and fungal infections indicate
|
immunodeficiency
|
|
|
|
Neonatal neutropenia indicates?
|
sepsis, alloimmune
|
|
|
|
Neutropenia in infancy indicates?
|
viral, autoimmune, congenital
|
|
|
|
Neutropenia in childhood indicates?
|
drug induced, viral, leukaemia, marrow infiltration
|
|
|
|
Neutropenia + vomiting in infancy?
|
B12 deficiency
|
|
|
|
Neutropenia + malabsorption?
|
Schwachman syndrome, pearson syndrome
|
|
|
|
Neutropenia + periodic mouth ulcers and fevers?
|
cyclical neutropenia
|
|
|
|
Risk factors for DDH?
LIMITED ABDUCTION IN FLEXION |
female (6x)
packing family history breech birth race |
|
|
|
Incidence of DDH?
|
4/1000 dislocatable/dislocated
|
|
|
|
Imaging of DDH?
|
< 6m- ultrasound
> 6m- xray Indications: family history, breech, abnormal signs |
|
|
|
Management of DDH?
|
open or closed reduction- brace in flexion and abduction
pavlik harness, dennis browne brace, hip spika |
|
|
|
Age and gender disoribution of transient synovitis?
|
Age 2-5
M: F 3:2 Aetilogy: unknown, viral sinovitis |
|
|
|
Clinical features of transient synovitis?
|
pain, limp, stiffness, positive trandelenberg
|
|
|
|
Management of transient synovitis?
|
rest, NSAIDS
|
|
|
|
Prognosis of transient synovitis?
|
95% recover in 2 weeks
5% Perthes disease |
|
|
|
Age, sex and incidence of perthes disease?
|
Age 4-10
Male 4x 1/1000- 10% bilateral |
|
|
|
Management of Perthes disease
|
Key is containment- either non-operative with a brace or with pelvic or femoral osteotomy
|
|
|
|
Bad prognostic factors in pethes disease
|
Late age of onset >8, whole head involvement, lateral subluxation
|
|
|
|
Outcome of perthes disease
|
OA at age 40-50%
|
|
|
|
Age and sex distribution of SCFE?
|
Male 12-15
Female 10-13 M:F 3:2 Incidence is increaseing |
|
|
|
Clinical presentation of SCFE?
|
obesity
pain limp out-toeing |
|
|
|
Outcome of SCFE?
|
OA by age 50
50% need THR |
|
|
|
Differences in airway anatomy between adult and child?
|
Large cranium tends to buckle airway
Nasal breathers 4-6m Large tongue Small face, mandible, cephalad larynx |
|
|
|
When are children obligate nasal breathers?
|
4-6 months
|
|
|
|
Difference in breathing mechanics in adults and children?
Difference in breathing physiology in adults and children? |
Horizontal ribs, fewer trype 1 fibres- early fatigue, thin chest wall
rely on diaphrafmatic breathing higher rr tidal vol 7-10ml/kg |
|
|
|
Most common cause of cardiac arrest in a child?
|
hypoventillation
|
|
|
|
How much blood volume lost until child manifests minimal signs of shock?
|
25%
|
|
|
|
How much blood volume is lost when a child is clinically hypotensive?
|
45%
|
|
|
|
Blood volume in a child?
|
80ml/kg
|
|
|
|
Volume of fluid bolus in hypovolaemiac child?
|
10-20ml/kg
crystalloid x 3 then blood |
|
|
|
Normal urien output in a child?
|
Up to 1ye- 2ml/kg/hr
toddler- 1.5ml/kg/hr Older child 1ml/kg/hr Adult 0.5ml/kg/hr |
|
|
|
Modified GCS in a child
|
Best verbal response
5- appropriate words or social smile, fixes, follows 4- cries but consolable 3- persistently irritable 2- restless and agitated 1- no response |
|
|
|
Difference between chest trauma in adult and a child?
|
lung contusion in abscence of tib fracture possible
mobile mediasdtinum remember to decompress stomach |
|
|
|
Are young parents a risk factor for a battered child?
|
yes
|
|
|
|
Signs of intucusseption on abdominal ultrasound?
|
target lesion/doughnut sign/psudokidney sign
|
|
|
|
Fluid recussitation of a baby with pyloric stenosis prior to surgery?
|
bolus saline and mantenance 1/2 normal saline- add potassium when passes urine
remember initially with have metabolic alkalosis and later will be acidotic |
|
|
|
Invidence of epilepsy, arthritis, cp per 1000 children
|
epilepsy 2.9
arthritis 2.2 cp 1.3 diabetes 1.0 |
|
|
|
Define arthritis
|
either joint swelling/effusion or 2 or more of: tenderness or pain on movement, limited movement, increased warmth
|
|
|
|
What are the classification criteria for JIA?
|
onset < 16 yrs of age
Duration > 6 weeks exclusion of other causes: trauma, infection, malignanay, mechanical, haemarthroses, paediatric pain synromes, autoimmune disease |
|
|
|
Is there a diagnostic test for JIA?
|
nil
|
|
|
|
Testing for septic arthritis?
|
joint aspirate and culture, blood culture
|
|
|
|
Diagnosis of osteomyelitis?
|
fever, pinpoint bone tenderness, xrays normal early
bone scan or mri is helpful |
|
|
|
are xrays likely to be diagnostic in osteomyelitis?
|
no, likely to be normal early on
|
|
|
|
Major criteria for acute rheumatic fever (SPACE)
|
subcut nodules
pancarditis arthritis chorea erythema marginatum |
|
|
|
Minor criteria for rheumatic fever
|
fever
arthralgia increased inflammatory markerts increased ESR/CRP prolonged PR |
|
|
|
Clinical picture of reactive arthritis
|
arthritis 1-3 weeks after infection
|
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
|
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What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
|
|
What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
|
|
What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
|
|
What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
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|
What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
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What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
|
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What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
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What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
|
|
|
What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
|
|
|
Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
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Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
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Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
|
|
|
What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
|
|
What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
|
|
Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
|
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Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
|
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Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
|
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Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
|
|
What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
|
|
|
Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
|
|
|
Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
|
|
|
What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
|
|
|
Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
|
|
Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
|
|
Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
|
|
|
Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
|
|
|
What kind of symptoms make you think of malignancty manifesting as arthritis?
|
fever, weight loss
pain out of proportion to physical findings night pain hepatosplenomegaly lymphadenopathy metaphiseal lucensies on XRAY |
|
|
|
What joint disease diagnoses do you think of if child refuses to weight bear?
|
septic arthritis/osteomyelitis
malignancy reactive arthritis |
|
|
|
What are growing pains?
|
no relation to growth
onset 3-10 years usually limited to calves, thigh, shins bilateral occurs at night normal physical exam |
|
|
|
Types of JIA?
|
50% oligoarthritis- 4 joints or less
30% polyarthritis- 5 joints or more 10% systemic arthritis- stills Others: enthesitis, psoriatic, unclassified |
|
|
|
Features of stills disease
|
M=F
fever rash arthritis hepatosplenomegaly lymphadenopathy serositis- pericarditis anemia, high esr, high crp, high platelets |
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What is special about the fever of systemic JIA?
|
It is a quotidian fever- a fever which returns below baseline
Evanescent salmon coloured rash correlates to between fever spikes |
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Features of oligoarticular JIA?
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Age <5, girls > boys
large joints: knee is most common 80% ANA poditive RF negative |
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Complication of oligoarticular JIA
|
20% uveitis
knee flexion contracture quadriceps atrophy leg length discrepancy |
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Does uveitis in JIA parallel disease course?
|
no
also asymptomatic- requires screening eye exams associated with positive ANA |
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What are the types of polyarticular JIA?
|
RF negative and RF positive (which is pretty much juvenile RA- symmetric small and large joints, rheumatoid nodules in >30%- and has a pretty bad prognosis)
RF negative: small and large joints, uveitis in 10%, TMJ, 50% ANA, c-spine, growth disturbance |
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Prognosis of JIA?
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approx 1/3 remitt, mostly in 1st 5 yrs
best prognosis oligo- 1/2 1/3 of stills 24% RF -ve poly NO RF positive |
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What is HSP?
|
Small vessel leukocytoclastic vasculitis- affects capillaries and venules
skin (scalp, scrotum- palpable purpura), joints, GIT (bowel angina), kidneys |
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Acute morbidity in HSP?
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GIT
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Chronic morbidity in HSP?
|
GI complications
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Management of HSP?
|
NSAIDS
severe abdominal pain may warrant steroids urine BP needs to be followed up |
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risk of recurrence of HSP?
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30%
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How common is it for a child to have lupus?
|
20% <18
More common in blacks, hispanics and asians F 4-5x Average age at dx 11-14 |
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Infant mortality in aboriginal people?
|
15/1000
vs 5 in non-indigenous |
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Prevalence of anemis in aboriginal children?
|
39%
correlates with poor cognitive functioning and defecits in psycholotor development |
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Epidemiology of otitis media in aboriginal children?
|
40% of children affected by chronic otitis media
25% had a perforated tympanic membrane |
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Management of acute otitis media in aborginal children?
|
consider antibiotics earlier
newer single dose antibiotics- e.f. azithro, roxithro, IM cephtriaxone |
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Management of recurrent otitis median in aboriginal children?
|
long-term prophylactic antiviotics- amoxicillin at half of its therapeutic dose for 3-6m
Insetrtion of tympanostomy tubes referral to ENT if >3 x AOM in 6m or 4 in 12m |
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Management of chronic suppurative OM
|
aural toilets
self management : breathing, blowing, cough topical antiseptic: povidone, acetic acid until debris is clear and hole is visible topical antibiotics e.f. sofradex |
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Does conjugate pneumococcal vaccine have an effect on chronic suppurative otitis media in aboriginal children?
|
yes, reduces AOM, recurrent AOM and need for surfery
|
|
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|
Antibiotic prescribed for indigenous people with boild
|
clindamicin for adults, bactrim for children
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Associations of acanthosis nigricans
|
associated with obesity or endocrinopathies e.g. hypothyroidism, hyperthyroidism, acromegaly, PCOS, DM or Cushings
Paraneoplastic- GI/uterine adenocarcinoma, most commonly stomach = acanthosis nigricans maligna |
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What medications can cause acanthosis nigricans
|
medications that lead to insulin resistance/increased levels of insulin- glucocorticoids, nicain, insulin, OCP and protease inhibitors
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Pathophysiology of acanthosis nigricans?
|
insulin/IGF- stimulates the epidermal keratinocytes and causes epidermal fibroblast migration
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Assessment of pain in kids
|
>4 - faces pain scale
>7- visual analogue scale |
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Paracetamol dosing in kids
|
varies with age
don't need loading q4-6hrs: 90mg/kg/d 1st 24 60 2nd day >8d 30mg/kg/d + LFT's |
hepatotox following chronic use at therapeutic conc- so review all paracetamol prescriptions in 48 hours
if risk factors/prolonged use consider LFT's/INR (fasting, vom, dehydr, sepsis, liver dis)Oxycodone dose in kids?`2-4mg/kg evere 4h |
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|
Morphine dose in kids
|
<1m 50-100ug/kg IV
> 1m: 100-200ug/kg/IV oral o.2-0.5mg/kg/ q4hrs |
oral dosing: 3x
slow release : 3x oxycodone: 2x hydromorphone 7x codeine 200x |
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|
Define failure to thrive
|
mild crosses 2 centiles while severe crosses 3
|
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Problems with cow's milk as opposed to breast
|
poorly available iron
increased protein, sodium, PO4 load less vit C and essential fatty acids cows milk colitis risk |
can introduce small amts at 6m as custard/cheese
full cream milk at 12m |
