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327 Cards in this Set
- Front
- Back
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What is the definition of a neonate? |
From birth until 28days of age |
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What is the definition of an infant? |
Under 12m |
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What is the definition of a toddler? |
1-2yo |
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What is the definition of a pre-school child? |
1-5yo |
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What features should be obtained in the birth history? |
Maternal obstetric problems Gestation Details of birth - natural, instruments etc. Birth weight Perinatal problems - admissions, jaundice |
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What are the cut-offs for tachypnoea according to age? |
Neonate >60 Infants >50 Young children >40 Older children >30 |
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What are the physical signs of dyspnoea? |
Nasal flaring Expiratory grunting Use of accessory muscles Recession of chest wall -suprasternal, intercostal Difficulty feeding or speaking |
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What are the normal ranges for pulse rate in children? |
<1yo 110-160 2-5yo 90-140 5-12yo 80-120 >12yo 60-100 |
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What are the features of heart failure in an infant? |
Poor feeding or failure to thrive Sweating Tachypnoea Tachycardia Cardiomegaly Hepatomegaly |
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What are the upper limits for normal systolic BP in children? |
1-5yo 110mmHg 6-10yo 120mmHg |
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What are the contra-indications to vaccination? |
Active pyrexia Previous anaphylaxis to vaccine No live vaccines if immunocompromised |
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What are the live vaccines used in the UK? |
MMR BCG Nasal influenza Shingles |
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What diseases are covered by the 5-in-1 vaccine? |
Diphtheria Tetanus Pertussis Polio Hib |
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What is the UK vaccination schedule for 5-in-1? |
2m 3m 4m Booster 3-4yo Booster 14yo |
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What is the UK vaccination schedule for meninococcus? |
Men B: 2m 4m 12m Men C: 12m 14yo ACWY: 14yo |
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What is the UK vaccination schedule for pneumococcus? |
2m 4m 12m |
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What is the UK vaccination schedule for rotavirus? |
2m 3m |
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What is the UK vaccination schedule for MMR? |
12m 3-4yo |
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What are the side-effects of vaccination? |
Local redness, swelling or tenderness Irritability Fever All managed with paracetamol or ibuprofen |
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What are the features of an effective cough? |
Crying or verbal responses to questions Loud cough Able to breath before coughing Fully responsive |
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What are the features of an ineffective cough? |
Unable to vocalise Quite or silent cough Unable to breath Turning blue |
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What are 5 differentials for hypovolaemia in a child? |
Sepsis Haemorrhage Diarrhoea, vomiting, bowel obstruction DKA Dehydration |
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What are the clinical features of hypovolaemia in a child? |
Tachypnoea Tachycardia Decreased cap refill Sunken eyes and fontanelle Pale, cold skin Dry mucous membranes Decreased urine output |
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What is the management of hypovolaemia? |
ABDCE i.v. fluids - resuscitation, maintenance or replacement Bolus - 20ml/kg of 0.9% saline Fluid requirement for 24hrs: First 10 kg - 100ml/kg Second 10kg - 50ml/kg Subsequent kg - 20ml/kg |
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What are the physical signs of 5% and 10% dehydration in children? |
5% - dry mucuous membrans, decreased urine output 10% - tachycardia, hypotensive |
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What are 5 differentials for purpura in a child? |
Meningococcal septicaemia Henoch-Schölein purpura Low platelets - ITP or ALL DIC Enterovirus |
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What are the clinical features of meningococcal septicaemia? |
Purpuric rash - non-blanching Tachycardia Hypotension Delayed cap refill |
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What is the management of meningococcal septicaemia? |
ABCDE Large, central i.v. access Fluids and antibiotics - ceftriaxone Take bloods and blood cultures |
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What are the clinical features of sepsis in an infant? |
If there is a fever in a <3yo, the diagnosis is sepsis until proven otherwise Poor feeding Lethargy Irritability Fever Rash Tachycardia >150bpm Hypotensive Poor cap refill |
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What is the management of sepsis in an infant? |
ABCDE i.v. fluids and antibiotics: If under 6weeks - ceftaxime and ampicillin If over 6 weeks - ceftriaxone |
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What are 5 differentials for respiratory distress in a child? |
Asthma Croup Anaphylaxis Bronchiolitis Foreign body Epiglottitis |
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What are the clinical features of respiratory distress in a child? |
Nasal flaring Recession - intercostal, subcostal, tracheal tug Head bobbing Barking cough Hoarseness Stridor Tachypnoea Tachycardia |
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What is the management of respiratory distress in a child? |
ABCDE High flow O2 Asthma - salbutamol Croup - nebulised adrenaline Epiglottitis - intubation Anaphylaxis - adrenaline i.m. Bronchiolitis - intubation Foreign body - removal |
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What is the management of an unconscious child? |
ABCDE High flow O2 Check BM Look for signs of raised ICP, infection |
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What are 5 differentials for seizures in a child? |
Febrile seizures Epilepsy Hypoglycaemia Electrolyte imbalance Toxin ingestion |
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What is the management of a seizure in a child? |
ABCDE Maintain airway, supplement with high flow O2 Check BM Stop the seizure: i.v. lorazepam or buccal midazolam or p.r. diazepam Repeat after 10mins If still fitting, get senior help and consider i.v. phenytoin |
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What are the sites of bruising that makes you suspicious of NAI? |
Ears Sides of face and top of shoulder Black eyes Back and sides of trunk Groin or genital Inner thigh Soles of the feet Anything marks a pattern, or bilateral |
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Apart from bruising, name other signs of NAI |
Retinal haemorrhages Bowel injury Burns or scalds - especially if not on front or head Bite marks Torn frenulum Fractures |
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What is the management of NAI? |
Treat the injury if necessary Record everything Document versions of events Use body map to record locations of injuries Photograph injuries with parental consent Check if child is on child protection register Inform: Consultant paediatrician Social worker responsible for child protection Police |
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What are the 4 fields of development? |
Gross motor Fine motor and vision Speech and language Social and behavioural |
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What are general red-flags in development? |
Regression and parental concern at any age |
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What are the red flags of gross motor development? |
Any age: Persistent primitive reflexes Abnormal tone Asymmetry Poor head control at 5m Not sitting independently at 8m Not walking at 18m |
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What are the red flags of fine motor and vision development? |
Using one hand exclusively Lack of transfer at 7m Delayed self-care at 4y |
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What are the red flags of speech and language development? |
Problems with feeding/swallowing No single words by 15m Suspected hearing loss |
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What are the red flag of social development? |
Limited social engagement and gestures Limited social imitative play at 18m Limited pretend play at 2years |
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What are the gross motor developmental milestones? |
6wk - head control 6m - sit without support. Rolls front to back 9m - stands holding on 1yo - walks alone 18m - runs and jumps 2yo - walks upstairs with both feet. Throws ball at shoulder height 3yo - hops on one foot. Walks up stairs one foot 4yo - Walks up and down stairs like adult |
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What are the fine motor and visual developmental milestones? |
6wk - tracks objects 6m - Palmar grasp. Transfer hand to hand 9m - Crude pincer grip 1yo - Fine pincer grip. Throws objects. Tower of 2 blocks 18m - Tower of 4 blocks. Scribbles. Removes clothes 2yo - Tower of 8 blocks. Draws vertical line. Turns pages 3yo - Draws circles. Turns one page at once. Scissor use 4yo - Tower of 12 blocks. Draws cross. |
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What are the speech and language developmental milestones? |
6wk - startles at loud noises 6m - Turns head to sound. Babbles 9m - Responds to own name 1yo - 3 words. Understands nouns. 18m - 6 words. Understands use of nouns - "show me X" 2yo - 2 words joined. Understands verbs 3yo - Understand negatives and adjectives 4yo - Complex instructions and narratives |
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What are the social developmental milestones? |
6wk - social smile 6m - puts objects in mouth. Reaches for bottle. 9m - Stranger danger. Holds and bites food. 1yo - Waves bye. Drinks from beaker with lid. 18m - Imitates everyday activities 2yo - Uses tools to eat 3yo - Shares toys. Plays alone. Eats with fork and spoon. Bowel control. 4yo - Concern for others. Has best friend. Dresses and undresses |
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What are the types of developmental delay? If found, what should be done? |
Global delay - in 2 or more domains Specific delay - in one domain If any of the above, then get detailed: Family history Antenatal history Birth history |
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What aspects are required for valid consent? |
Capacity Voluntariness Sufficient information |
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How does the Mental Capacity Act impact on childcare? |
It is only for >16yo |
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Describe the pressures in the fetal heart? |
Left Atrial pressure is low - little returning from lungs Right Atrial pressure is higher - including blood from placenta Flap valve of foramen ovale is open - due to R to L shunt |
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Describe the pressures of the neonatal heart on first breath? |
Decrease in pulmonary resistance Blood flow through lungs increases Right atrial pressure falls - due to loss of placenta Flap valve of foramen ovale closes Closure of ductus arteriosus |
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What are the changes in peripheral circulation at birth? |
Ductus venosus (connecting placenta and IVC) closes - and forms ligamentum venosum Umbilical arteries - close to form umbilical ligaments |
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What are the common features of innocent murmurs? |
InnoSent ASymptomatic Soft, blowing Systolic only Left Sternal edge |
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What things can exacerbate a innocent murmur? |
Increased CO - exercise Fever Anaemia |
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What are 2 common innocent murmurs? |
Still's murmur - early systolic, with vibration. LLSE Venous hum - continuous. Abolished by compression of the jugular vein |
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What are the clinical features of heart failure in children? |
Breathlessness - on feeding Sweating Poor feeding Recurrent chest infections Hepatomegaly Cardiomegaly |
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What are the 2 main classifications of causes of heart failure? |
Obstructive lesions - leading to Pressure overload (usually in neonates) L to R shunts - leading to Volume overload (usually in infants) |
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What are the obstructive causes of heart failure? |
Neonatal: Pulmonary stenosis - 7% Severe coarctation of the aorta - 5% Critical aortic valve stenosis - 5% Interruption of the aortic arch |
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What are the Left to Right shunt causes of heart failure? |
Infants: VSD - 30% PDA - 10% ASD - 7% |
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What are the classifications of congenital heart disease? |
Acyanotic - but breathless L-R shunts: VSD PDA ASD Obstructive: Pulmonary stenosis Coarctation of the aorta Aortic stenosis Cyanotic: Tetralogy of Fallot Transposition of the Great arteries |
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What is the aetiology of congenital heart defects? |
Largely multifactorial - 80% Maternal disorders: Rubella - PDA SLE - complete heart block DM - increases all defects Maternal drugs: Warfarin - PDA and pulmonary stenosis Fetal alcohol syndrome - ASD, VSD Chromosomal: Down's - ASVD, VSD Turner's - AV stenosis, coarctation William's AS |
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What are the 2 types of ASD? |
Ostium secundum - 80% of all ASDs Ostium primum |
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What is the clinical history of a child with an ASD? |
Asymptomatic in childhood Recurrent chest infections Wheeze L to R shunt develops slowly Heart failure occurs in older children |
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What are the clinical signs of an ASD? |
Ejection, mid-systolic murmur at upper Left sternal edge - the murmur you hear is a pulmonary flow murmur Fixed and wide-split S2 |
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What investigations should be performed in a child with an ASD? |
CXR - cardiomegaly, enlarged pulmonary arteries ECG - may be partial RBBB Echo |
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What is the management of an ASD? |
Only indicated if: - Symptomatic - Right ventricular dilation Catheterisation with insertion of occlusion device |
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What is the most common congenital heart disease? |
Ventricular Septal Defect - 30% PDA - 10% ASD - 7% Pulmonary stenosis - 7% Coarctation - 5% Aortic stenosis - 5% |
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What are the clinical features and management of a small VSD? |
Features Asymptomatic Loud pan systolic murmur at LLSE Management Close spontaneously - need to confirm on follow up Dental hygiene advice - for risk of endocarditis |
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What are the clinical features and management of a medium VSD? |
Features: Slow weight gain Difficulty feeding Recurrent chest infections Harsh, pan-systolic murmur at 3rd and 4th intercostal spaces Management Increase calorie input Many spontaneously improve If in heart failure: - Diuretics - ACE inhibitors |
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What are the clinical features and management of a large VSD? |
Features Heart failure with failure to thrive after 1 week Recurrent chest infections Tachypnoeic Tachycardic Hepatomegaly Soft, systolic murmur if any Management Increase calorie intake Medical - diuretics, ACE inhibitors Surgery @3-6months |
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What are the clinical features of a PDA? |
Bounding or collapsing pulse Wide pulse pressure Continuous murmur - loudest at left clavicle Legs are cyanosed but not the arms |
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What investigations are indicated in VSD? |
CXR - Large: cardiomegaly, enlarged pulmonary arteries, pulmonary oedema ECG - Large: hypertrophy Echo - for anatomy and haeodynamics |
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What investigations are indicated in PDA? |
2-D Echo and Doppler USS CXR ECG |
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What is the management of PDA? |
Treat heart failure medically: - Increase calorie intake - Diuretics - ACE inhibitors If the duct doesn't close itself: - Anti-prostaglandins : Indomethacin, aspirin - Surgery : ligation, coil or occlusion device |
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What are the clinical features of coarctation of the aorta? |
Preductal: Normal at birth Cardiac failure occurs when duct closes and symptoms begin Post-ductal: Asymptomatic due to collateral supply May have leg pains or headache - HTN in right arm - Weak or absent femoral pulse - Radiofemoral delay |
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What is the management of coarctation of the aorta? |
Preductal: Prostaglandin infusion to keep duct patent Manage heart failure medically Postductal: Surgical correction via balloon dilation and stenting |
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What are the investigations indicated in coarctation of the aorta? |
Postductal: BP - bilaterally ECG - LV hypertrophy CXR - rib notching, "3" of descending aorta |
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What are the anatomical features of Tetralogy of Fallot? |
Over-riding aorta VSD - large Pulmonary stenosis Right ventricular hypertorphy |
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What are the clinical features of Tetralogy of Fallot? |
Cyanosis May have clubbing Loud single S2 Loud, harsh ejection systolic murmur Can have hyper-cyanotic spells on squatting or exercise |
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What are the findings on investigation of Tetralogy of Fallot? |
Found on antenatal screening CXR - boot shaped heart ECG - R axis deviation, RV hypertrophy |
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What is the management of Tetralogy of Fallot? |
Surgical balloon dilation and stent @ 4-6months Of hyper-cyanotic spell, >15mins: Knees to chest O2 i.v. propranolol - peripheral vasoconstrictor i.v. morphine - to relieve pain and hyperpnoea |
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What are the anatomical features of Transposition of the Great Arteries? |
Aorta arising anteriorly in the Right Ventricle Pulmonary artery arises posteriorly from Left Ventricle Other defects - VSD, ASD - to allow for mixing |
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What are the clinical features of Transposition of the Great Arteries? |
Severe cyanosis - presents at 1-2days when ductus arteriosus closes Profound hypoxia - that is unresponsive to O2 therapy Single and loud S2 |
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What are the findings on investigation of Transposition of the Great Arteries? |
CXR - narrow upper mediastinum ECG - normal Echo |
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What is the management of Transposition of the Great Arteries? |
Newborn: - PGE1 to reopen ductus arteriosus - Surgery to open atrial septum Definitive surgical repair in first few days of life |
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What children are at risk of infective endocarditis? |
All children. Highest risk: Any congenital heart disease - except ostium secundum ASD (very low velocity) Prosthetic material: - VSD - Coarctation - PDA |
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What are the clinical features of infective endocarditis? |
Fever - persistent and low grade Anaemia Splinter haemorrhages Splenomegaly - is common Retinal artefacts Necrotic skin lesions Arthritis or arthralgia Suspect if: Malaise Raised ESR Sustained fever Unexplained anaemia or haematuria |
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What is the clinical management of infective endocarditis? |
High dose i.v. penicillin and aminoglycoside for 6 weeks |
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What is the most common causative agent of infective endocarditis? |
Strep Viridans |
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What are the most common causes of URTIs? |
Viruses - 80-90% - RSV - Rhinovirus - Influenza Bacterial: - Strep pneumoniae - Haemophilus influenzae |
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What are risk factors for respiratory infections? |
Parental smoking Poor socioeconomic status Underlying lung disease Male Significant congenital heart disease Immunodeficiency |
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What are the classifications of respiratory infections? |
URTI Laryngeal and tracheal infection Bronchitis Bronchiolitis Pneumonia |
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What conditions does the term URTI encompass? |
Coryza Pharyngitis and tonsillitis Acute otitis media Sinusitis |
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What are the common causative agents for pharyngitis? |
Viral Group A strep in older children |
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What are the common causative agents for tonsillitis? |
Group A Strep EBV |
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What are the clinical features of bacterial tonsillitis? |
Headache Cervical lymphadenopathy Tonsillar exudate Abdominal pain |
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What is the management of tonsillitis? |
Penicillin or erythromycin (even though 30% of cases are bacterial) Avoid amoxicillin - if EBV, then it causes a widespread maculopapular rash |
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What is the most common age for acute otitis media? |
6-12 months |
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What are the clinical features of acute otitis media? |
Pain Fever Bright, red, bulging tympanic membrane with loss of the light reflex Occasional perforation with exudate |
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What are the most common causes of acute otitis media? |
RSV Rhinovirus Bacteria - pneumococcis, H. influenzae |
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What are the serious complications of acute otitis media? |
Mastoiditis Meningitis |
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What is the management of acute otitis media? |
NSAIDs prn Most cases resolve spontaneously Amoxicillin - reduces duration and risk of hearing loss |
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What is otitis media with effusion? |
Glue ear Recurrent acute otitis media Common between 2-7yo - peak 2-5yo Confirmed with flat trace on tympanometry Most common cause of conductive hearing loss in children |
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What is the management of otitis media with effusion? |
Spontaneously resolve. - Nose trumpet If many in a year: Grommets Adenoidectomy To avoid speech and language delay due to persistent hearing loss |
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What are the indications for tonsillectomy? |
They increase in size until 8yo and then shrink. - Recurrent URTIs - Quinsy - Obstructive sleep apneoa |
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What are the indications for tonsillectomy and adenoidectomy? |
Recurrent otitis media with effusion with hearing loss Obstructive sleep apneoa |
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What are the clinical features of laryngeal/tracheal infection? |
Stridor Hoarseness Barking cough |
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What is the management of acute upper airway obstruction? |
Do not look in the mouth! Assess - ABCDE Nebulised salbutamol Contact anaesthetist |
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What are the causes of upper airway obstruction? |
Common Croup - viral laryngotracheobronchitis Rare Epiglottitis Bacterial tracheitis Smoke or hot air inhalation EBV Diphtheria |
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What is croup? |
Laryngotracheobronchitis 95% are viral Occurs 6months - 6yo = peak at 2yo |
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What are the clinical features of croup? |
Symptoms start and are worse at night - Barking cough - Harsh stridor - Hoarseness Usually preceded by fever and coryza |
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What are the classical findings of croup on CXR? |
Steeple sign - narrowing of the trachea due to inflammation of larynx |
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What is the management of croup? |
Oral prednisolone If severe: Nebulised adrenaline Close monitoring Call anaesthetist |
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What is pseudomembranous croup? |
Is very rare, bacterial tracheitis. Same as viral croup - but with high fever Does not respond to croup therapy and require i.v. Abx |
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What are the clinical features of acute epiglottitis? |
- High fever - Looks septic - pale, tachycardic - Intense painful throat - not swallowing or speaking = drooling on chest - Soft inspiratory stridor - Child sitting immobile, upright with open mouth - to optimise airway |
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What are the causative agents of acute epiglottitis? |
H. Influenzae Most common in 1-6yo Although vaccination has reduced it dramatically |
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What is the clinical presentation of bronchitis in children? |
Cough - that persists for >2 weeks Fever |
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What are the clinical features of pertussis? |
- Corysal illness for a week - Paroxysmal cough followed by characteristic inspiratory whoop - can last for 3-6weeks Worse at night - may lead to vomiting |
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What is the management of pertussis? |
Admission to hospital Erythromycin - most effective in coryzal stage - Contacts should be given prophylactically |
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What is the management of severe bronchiolitis? |
Humidified O2 Fluids and feed - NG or i.v. Supportive |
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What are indication for admission in a child with RTI? |
O2 sats <93% Severe tachypnoea Difficulty breathing Grunting apnoea Not feeding |
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What is the management of pneumonia in children of all ages? |
Neonates - broad-spectrum Abx Infants - oral amoxicilin (co-amoxiclav for those not responding) Children >5yo - Oral amoxicillin or erythromycin |
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What are the differential diagnoses for wheeze? |
PANIC! A FAC Post-viral Atopic asthma Non-atopic asthma Infections Cystic fibrosis Aspiration Foreign body Anaphylaxis Congenital abnormalities |
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What are the clinical features of asthma? |
Recurrent, reversible obstruction of the small airways: - Cough - dry, worse at night and triggers - SOB - Wheeze |
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What are the patterns of wheeze in asthmatics? |
Infrequent episodic: Most common (75% of asthmatics) Triggered by viral URTI No atophy SABA Frequent episodic: 20% of asthmatics Usually atopic 70% persists into adulthood SABA + Inhaled steroid + LABA Persistent episodic: 5% asthmatics Require daily brochodilators 90% remain symptomatic in adulthood SABA + inhaled max steroids + LABA + oral steroids |
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What are the categories of acute asthma? |
Moderate: O2 sats >92% PEF >50% Severe: O2 stats <92% Tachypnoeic PEF <50% Too breathless to talk/feed Life-threatening: Severe plus: PEF <33% Silent chest Poor respiratory effort Cyanosis |
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What is the management of acute asthma? |
Moderate: SABA via MDI Consider oral prednisolone for 2-3 days Reassess in 1 hour Severe/Life-threatening: Call ITU O2 via facemask Nebulised salbutamol Oral prednisolone or i.v. if required Nebulised ipratropium Reassess If unresponsive: i.v. salbutamol or aminphylline Magnesium sulphate |
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What are the causes of persistent cough? |
Recurrent RTI Post-RTI : pertussis, RSV Asthma CF GORD Habit cough Cigarette smoke |
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What are the differentials for persistent cough lasting weeks to months? |
Asthma Pertussis RSV Mycoplasma |
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What are the clinical features of Primary ciliary dyskinesia? |
Recurrent productive cough Purulent nasal discharge Chronic ear infections 50% have dextrocardia |
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What is the most common autosomal recessive condition in Caucasians? |
Cystic fibrosis Incidence of 1 in 2,500 births Carrier rate of 1 in 25 There are over 1,000 mutations |
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What is the defective gene in cystic fibrosis? |
CFTR - it is a cAMP-dependent Cl- channel |
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What are the clinical features of cystic fibrosis? |
Lungs: Mucopurulent secretions Chronic infections - pseudomonas aeruginosa Intestinal: Thick viscid meconium - leading to meconium ileus in 20% neonates Pancreas: Decreased enzyme secretion Sweat glands: Excessive Na+ and Cl- in sweat |
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What are the diagnostic procedures for cystic fibrosis? |
Guthrie test: - Genetic (only most common mutations) - Serum immunoreactive trypsinogen (IRT), is raised in CF Sweat test for Na+ and Cl+ concentrations Pancreatic insufficiency - low faecal elastase |
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What are is the management of cystic fibrosis? |
- Monitoring - FEV1 - Physiotherapy - to help with secretions - Antibiotics - prophylactic oral flucloxacillin. Azithromycin for exacerbations - Nebulised DNAse or hypertonic saline - CREON - High calorie diet, 150% of normal - Fat-soluble vitamin supplement - Bilateral, sequential lung transplantation is the only option for end-stage |
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What are the differentials for Apnoea? |
Cessation of breathing for >10sec Obstructive: GORD Obstructive sleep apnoea - adenotonsillar hypertrophy Discoordinate swallowing Infection - pertussis Central: Sepsis Meningitis TBI Seizures |
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What are the red flag symptoms in a vomiting child? |
- Bile-stained = obstruction from malrotation, intussusception - Haematemesis = peptic ulcer, oesophagitis - Projectile vomiting in early life = pyloric stenosis - Vomit at the end of coughing fit = pertussis - Blood in stool = intussusception, gastroenteritis (salmonella or campylobacter) - Bulging fontanelle = raised ICP |
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What are the complications of severe GORD? |
- Failure to thrive - Oesophagitis - Recurrent pulmonary aspiration |
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In what populations is severe GORD more common? |
- Neurodevelopmental disorders - Cerebral palsy - Pre-term infants |
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What are the symptoms of GORD? |
- recurrent vomiting - No weight loss - otherwise well |
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What factors contribute to GORD in infants? |
- Predominantly fluid diet - Mostly horizontal position - Short intra-abdominal length |
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What are the clinical features of colic? |
- Paroxysmal, inconsolable crying or screaming - Drawing up of the knees - Passage of excess flatus - Several times a day, usually the evenings |
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What is mesenteric lymphadenitis? |
Non specific abdominal pain - usually resolves in 48 hours Usually accompanied by a URTI with cervical lymphadenopathy |
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How can a Meckel's diverticulum present? |
Intussusception Volvulus Meckel's Diverticulitis - which presents like appendicitis |
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What are the 3 presentations of recurrent abdominal pain? |
Pain is classically periumbilical, in an otherwise well child 90% are functional: - Irritable bowel syndrome - Abdominal migraine - Functional dyspepsia 10% are organic - usually UTI |
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What are the differentials for acute diarrhoea? |
- Viral gastroenteritis - Bacterial gastroenteritis - Parenteral infections |
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What are the differentials for chronic diarrhoea? |
- Toddler's diarrhoea - commonest in well child - Post-gastroenteritis syndrome - Giardiasis - Failure to thrive - CF, coeliac's, Crohn's - Over-flow from constipation |
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What is the most common cause of gastroenteritis? |
Rotavirus - 60% of cases <2yo |
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What are the causes of bacterial gastroenteritis? |
- Camplyobacter jejuni = Most common, bloody - Shigella, some salmonella = dysentery with blood and pus in stool High fever - Cholera = profuse vomiting and diarrhoea |
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What children are most at risk form dehydration with gastroenteritis? |
- Infants - >6h of diarrhoea in 24h - Vomited >3times in 24h - Unable to tolerate fluids - Malnutrition |
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What clinical features are used to assess fluid status? |
- Appearance - Conscious level - HR - RR - BP - CRT - Urine output - Mucous membranes |
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What are the clinical features of malabsorption? |
- Abnormal stools - Failure to thrive - Specific nutrient deficiencies - Anaemia - Irritability - Buttock wasting - Abdominal distension |
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What is coeliac disease? |
Enteropathy due to immune response to the gliadin fraction of gluten. |
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|
What are the causes of constipation? |
- Babies = Hirschsprung's, anorectal malformation, congenital hypothyroidism - Dehydration - Psychological or toilet-training issues - Anal fissure - causing pain on defecation - Hypothyroidism |
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|
What are the red flag symptoms in a child with constipation? |
- Failure to pass meconium in first 24h of life = Hirschsprung's - Failure to thrive = Coeliac, hypothyroidism - Gross abdo distention = Hirschsprung, GI dysmotility - Abnormal lower limb neurology = lumbosacral pathology - Sacral dimple, hairy patch = spina bifida - Perianal fissure = Crohn's |
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|
What is Hirschsprung's disease? |
Absence of ganglion cells in the myenteric plexus of the large bowel - resulting in narrow, contracted segment |
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|
Describe the changes to GFR following birth? |
- Low in new born - especially new borns - Rises to adult range at 1-2yo 80-120 ml/min per 1.73m^2 (this is the correction for children) |
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|
What biochemical investigations are indicated in assessing renal function? |
- Plasma creatinine: increases as wight and height does - eGFR - Creatinine clearance: urine collection and bloods - Plasma urea |
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|
What radiological investigations are indicated in assessing renal function? |
- USS = for KUB, structural dilation, stones - DMSA scan = assesses functional defects and scars - MCUG = visualise bladder and urethral anatomy and fucntion - AXR = spinal abnormalities, renal stones |
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|
What congenital abnormalities of the kidney are there? |
- Renal agenesis /Potter's sydnrome = Fatal - Multicystic dysplastic kidney = non-functioning, cystic kidney. No normal renal function in affected kidney - Polycystic kidney disease = autosomal dominant form |
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|
What are the types of polycystic kidney disease? |
Autosomal recessive and autosomal dominant PKD ADPKD - has an incidence of 1 in 1000 Main symptoms of HTN and haematuria |
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|
What are the clinical features of UTI? |
- Non-specific - Fever - Irritability - Lethargy - Poor feeding - Vomitin |
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|
What is the usefulness of urine dipstick in UTI? |
Babies have negative dipstick, but positive culture False negatives are common due to frequent urination. More useful >3yo |
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What are the presentations of UTI? |
- Dysuria and increased frequency - Abdominal pain - Fever - Vomiting and diarrhoea - Haematuria - Recurrence of enuresis |
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What are features of an atypical UTI? |
- Seriously unwell child - Sepsis - Raised creatinine - Poor urine flow - Failure to respond to Abx in 48h - Non-E.coli infections (Klebsiella or pseudomonas) |
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What are the methods of urine collection in children? |
- Pad in nappy - "Clean catch" by parents - Suprapubic aspirate - gold standard, but not used - Bag collection - Catheter |
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|
What are the common causes of UTI? |
- E. Coli - Klebsiella - Proteus; esp in boys - Pseudomonas |
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|
What are predisposing factors to UTI? |
- Structural abnormality - Incomplete bladder emptying : Neurogenic bladder - Vesicouriteric reflux |
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What is the management of UTI? |
All infants <3yo with suspect UTI or if septic - i.v. cefotaxime Infants >3m and children with pyeloneprhtis or upper UTI: - oral co-amoxiclav for 7-10days Children with cystitis or lower UTI: - oral co-amoxiclav for 3 days |
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What is enuresis? |
Involuntary, but otherwise normal voiding, at socially unacceptable times, places - day or night Children should be: Dry by day = 2yo Dry by night = 3yo, but treat if 6-7yo |
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What are the classifications of enuresis? |
Primary nocturnal enuresis - is common. Physically and psychologically well Daytime enuresis - lack of bladder control in child old enough to be continent Secondary enuresis - due to another cause: T1DM, UTI, pscyhological |
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What are the causes of proteinuria? |
Transient increase by febrile illness Persistent - Orthostatic proteinuria - Nephrotic syndrome - Hypertension |
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What are the clinical features of nephrotic syndrome? |
- Proteinuria - Oedema - Hypoalbuminaemia - Periorbital oedema (on waking) - Scrotal oedema - Ankle oedema |
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|
What are the cases of nephrotic syndrome? |
Unknown. - HSP - Vasculidities : SLE - Infections : TB, malaria |
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What is the management of nephrotic syndrome? |
Steroids: - oral prednisolone, 60mg/m^2 for 4 weeks, then reduce dose to 40 EOD No-added salt diet Fluid restriction - for first 7-10days Only use albumin if severely hypovolaemic |
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|
What is the prognosis for nephrotic syndrome? |
90% are steroid-sensitive - 30% resolve - 30% have infrequent relapses - have frequent relapses and become dependent |
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What are the complications of nephrotic syndrome? |
- Hypovolaemia - Thrombosis - Infection - Hypercholesterolaemia |
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|
What are the causes of haematuria? |
Non-glomerular: - Infection - Trauma - Renal calculi - Sickle cell Glomerular: - Acute glomerularnephritis - IgA nephropathy - Familial nephritis = Alport's |
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What is the consequences of acute nephritis? |
Renal inflammation due to deposition of immune complexes: - Decreased urine output and volume overload - HTN - Oedema - Haematuria - Proteinuria - Raised serum creatinine |
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What is the clinical presentation of acute nephritis? |
- Sudden onset illness = 2-3 weeks post-pharyngitis - Coca-cola urine - Facial oedema |
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|
What are the causes of acute nephritis? |
- Post-infectious = usually Strep - Vasculitis = HSP - IgA nephropathy - Alport's syndrome - Goodpasture syndrome |
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What is the management of acute nephritis? |
- Maintain fluid and electrlyte balance - Treat underlying condition - Diuretics only if necessary In severe cases: - Metabolic acidosis - Hyperphosphataemia - Hyperkalaemia |
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What are the clinical features of HSP? |
- Characteristic maculopapular rash on legs and buttocks - Arthralgia - Periarticular oedema - Abdominal pain - Fever Usually between 3-10yo Preceded by URTI |
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What is the management of HSP? |
Symptomatic NSAIDs Self-resolving |
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|
What are the major causes of neonatal death? |
- Immaturity - 60% - Congenital abnormalities - 20% - Intra-partum causes - Infection |
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What is hypoxic-ischaemic encephalopathy (HIE)? |
Any cause of hypoxia, hypercapnia and resulting metabolic acidosis - Asphyxia or failure to breath at birth - Placental complications - abruption - Umbilical compression - Maternal hypo-/hyper-tension |
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What are the Clinical classifications of HIE? |
Begin to manifest 48hours after birth: Mild - irritable, impaired feeding, responds excessively to stimulation Moderate - abnormalities in tone and movement Severe - no normal spontaneous movements, Fluctuating tone |
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What is the prognosis for HIE? |
Mild Complete recovery Moderate Full recovery and feeding normally at 2 weeks have excellent Severe Mortality rate of 30% 80% of survivors have neurodevelopmental delay |
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|
What is the management of HIE? |
Resuscitation and stabilisation - Respiratory support - EEG to detect abnormalities - Anticonvulsants |
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What is a pre-term infant? |
Born at <34 weeks of gestation or Newborns that become seriously ill Best outcome is those aged >32weeks |
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|
What are the major medical problems of the preterm infant? |
- Resuscitation at birth - Respiratory - Metabolic - Nutrition - Jaundice - PDA - Temperature control |
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What is Respiratory Distress Syndrome (RDS) in the preterm? |
aka hyaline membrane disease Deficiency in surfactant = alveolar collapse It is common in infants born <28Wks Glucocorticoids are given antenatally if preterm delivery is anticipated |
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What are the clinical features of RDS in the preterm? |
Develop within 4 hours of birth: - Tachypnoea - Laboured breathing - Expiratory grunt - Cyanosis (if severe) |
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What are the contents of breastmilk? |
- Antibodies = IgA, IgM, IgE - Bifidus factor - Lactoferrin - Iron - Lysozyme - Lymphocytes - High protein - High fat - PUFA - Calcium |
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What are the risks of alternatives to breastmilk? |
Formula or cow's milk - necrotising enterocolitis Paraenteral - septicaemia, venous thrombosis Iron deficient anaemia |
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|
What is Preterm Brain Injury? |
Haemorrhages - most happen in first 72hours, due to: - perinatal asphyxia and RDS Occur in caudate nucleus Small = do not increase risk of CP Large = Can be: - Unilateral and cause CP. - Intraventricular bleeds and cause raised ICP and hydrocephalus |
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What are the clinical features of necrotising enterocolitis? |
Mainly affects preterms in first few weeks of life - Stops feeding - Vomiting - Distended abdomen - Fresh blood in stool |
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|
What are the characteristic findings on AXR of necrotising enterocolitis? |
- Distended loops of bowel - Intramural air - Air under diaphragm |
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|
What is the management of necrotising enterocolitis? |
- Stop oral feeds - Give broad-spectrum Abx - Parenteral feeds - Surgery if bowel perforation 20% morbidity and mortality |
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|
What is retinopathy of prematurity (ROP)? |
Vascular proliferation which may cause retinal deattachement or fibrosis. Is associated with uncontrolled use of high O2 |
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|
What is bronchopulmonary dysplasia (BPD)? |
Lung damage due to pressure and volume trauma from artificial ventilation Characteristic CXR: - Widespread opacification - Cystic changes May develop pulmonary HTN and recurrent infections |
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|
What is kernicterus? |
Encephalopathy due to deposition of unconjugated bilirubin Manifests: - Lethargy - Poor feeding - Irritability - Hypertonia |
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|
What factors predispose to jaundice in the newborn? |
- High physiological Hb at birth - RBC lifespan is 70days - Hepatic bilirubin metabolism is less efficient |
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|
What might neonatal jaundice be indicative of? |
Underlying pathology: - Haemolytic anaemia - Infection - Metabolic disease - Liver disease |
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|
What are the causes of jaundice in <24hour of life? |
Haemolytic disorder: - Rhesus incompatibility - ABO incompatibility - G6PD deficiency - Spherocytosis - Pyruvate kinase deficiency Congenital infection |
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What are the causes of jaundice 24hours - 2 weeks of life? |
- Physiological jaundice - Breast mild jaundice - Infection = UTI - Haemolytic anaemias - Bruising - Crigler-Najjar syndrome |
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What are the causes of jaundice >2 weeks of life? |
Unconjugated: - Physiological or breast milk jaundice - Infection = UTI - Hypothyroidism - Haemolytic anaemia - Pyloric stenosis Conjugated - Bile duct obstruction - Neonatal hepatitis |
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What is the management of jaundice in the newborn 2d-2Wk? |
Encourage milk and fluid intake Regular monitoring of bilirubin to see plateau Phototherapy Exchange transfusion - Required for dangerously high bilirubin |
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|
What is persistent or prolonged neonatal jaundice? |
Jaundice in babies >2 weeks of age - or 3 weeks if preterm Biliary atresia is a key differential in this age group. But this will be conjugated hyperbilirubinaemia and the baby will pass pale stools and dark urine |
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|
Name the main stages of growth and the factors responsible in each |
Fetal (the fastest) - Size of mother, placental nutrition Infant - Adequate nutrition, largely "genetic" Childhood - Pituitary GH, then IGF1, Thyroid hormone, Vit. D Puberty - Sex hormones (testosterone and estradiol), GH |
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|
What measurements are done to assess growth? |
- Weight - Height - Parents height and target height range - Height velocity - Bone age - Tanner stage for puberty |
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|
What investigations are performed in a child with stunted growth? |
- Bone age - FBC - Creatinine and U&Es - ESR - TSH - Karyotype |
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|
What is the onset of puberty in females? The first signs and age of delayed puberty? |
8-13yo - Breast development at 8.5-12-5yo is the first - Then pubic hair - Menarche is 2.5years after start of puberty. Average age = 13.5yo Delayed puberty = 14yo |
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What is the onset of puberty in males? The first signs and age of delayed puberty? |
9-14yo - Testicular volume >4ml is the first - Pubic hair 10-14yo - Height spurt when testicular vol. 12-15ml Delayed puberty = 15yo |
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|
What are the causes of short stature? |
- Familial - Constitutional delay of growth and puberty - Endocrine: - Hypopituitarism - GH deficiency - Cushing syndrome - Nutritional: - Crohn's - Coeliac - Chronic renal failure - Chromosomal: - Turner - Prader-Willi |
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|
What are the characteristics of constitutional delay of growth and puberty? |
- Short stature during childhood - Below parental height range - Reduced height velocity in later childhood - Not in puberty - Delayed bone age - They do increase in height once they reach puberty Family history - More common in males |
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|
What are the indications for exogenous GH therapy? |
- GH deficiency - Turner's syndrome - Prader-Willi syndrome - Intrauterine growth restriction - Chronic renal failure |
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|
What are the differentials for an inguino-scrotal swelling? |
Inguinal hernia - Indirect is most common, due to patent processus vaginalis Hydrocele - Due to patent processus vaginalis Undescended Testes |
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|
What are the differentials for undescended testes? |
- Retractile - Palpable : cannot be manipulated down - Impalpable : inguinal canal, abdo, or absent - Cryptorchism : undescended in normal path - Ectopic : in abnormal path; thigh, base of penis - Anorchism - Polyorchism |
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|
What are the indications for orchidopexy? |
For cryptorchism - true undescended testes - Maintain spermatogenesis - Monitoring - Reduced malignant transformation - Prevent trauma - Prevent torsion |
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|
What are the differentials of an acute scrotum? |
- Testicular torsion - Orchitis - Torsion of testicular appendage - Obstructed inguinal hernia - Trauma - Primary scrotal oedema - Tense hydrocele |
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|
What are the clinical features of testicular torsion? |
Usually 10-16yo - Testes is high - Very tender = will not let you examine - Sudden onset pain - Pain is not always scrotal, abdo is common |
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|
What is the management of testicular torsion? |
Surgical repair - requires bilateral fixation |
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|
What is torsion of testicular appendage? |
Hydatid of Morgagni is an embryological remnant on top of the testis that can get twisted. Pain increases over 1-2 days Affects boys prior to puberty "Blue dot" sign |
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|
What are the clinical features of orchitis/epididymitis? |
- Slow onset - Tender and inflamed - Pyrexial Is due to viral or bacterial cause. Usually in sexually active children |
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|
What are the clinical features of primary scrotal oedema? |
- Non-tender, inflamed scrotum - Very red; like nappy rash Due to superficial Staph infection |
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|
What are the indications for circumcision? |
- Pathological phimosis - Recurrent balanoposthitis (inflammation of glans and foreskin) - Recurrent UTIs |
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|
What is the clinical presentation of pyloric stenosis? |
2-7 weeks of age - Vomiting : increases with frequency and forcefulness every time = becoming projectile - Hunger after vomiting - Weight loss - Olive-shaped mass in RUQ |
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|
What is the management of pyloric stenosis? |
Initial priority is fluid and electrolyte balance Pyloromyotomy |
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|
What is the clinical presentation of intussusception? |
Most common in infancy: 3m-2yo - Paroxysmal, colicky pain and pallor - Refuse feeds - May vomit ?bile, depending on site - Sausage-shaped mass in abdo - Passage of red-currant jelly |
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|
What are factors that predispose to intussusception? |
- Mesenteric lymphadenopathy - Meckel's diverticulum - Polyps |
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|
What is the clinical presentation of malrotation of the gut? |
First few days of life - Bilious vomiting - Abdominal obstruction |
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|
What are causes of acute abdominal pain? |
- Intussusception - Malrotation - Appendicitis - Incarcerated inguinal hernia - Testicular torsion - DKA - UTI - Lower lobe pneumonia |
|
|
What is the most common mode of inheritance of genetic conditions? |
Autosomal dominant Male and female offspring each have a 50% chance of inheriting abnormal gene from affected parent Examples: HD Myotonic dystrophy |
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|
What is the risk of having an affected child with 2 carrier parents for an autosomal recessive condition? |
25% Examples: - Cystic fibrosis - Friedrich's ataxia |
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|
What are examples of X-linked recessive conditions? |
- Colour-blindness - DMD - G6PD deficiency - Haemophilia A - Fragile X |
|
|
What conditions are screened for antenatally in the UK? |
- Down's syndrome : all women over 35yo - Sickle cell anaemia - Thalassaemia - Haemoglobinopathies - Congenital abnormalities |
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|
What conditions are screened for in newborns? |
Guthrie: - Congenital hypothyroidism - CF - Phenylketouria - MCAD deficiency Examination: - Congenital cataract - Congenital deafness - Congenital heart defects - Developmental dysplasia of the hip - Cryptorchism |
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|
What are some physical features of Down's syndrome? |
- Round face - Epicanthic folds - Protruding tongue - Flat occiput - Short neck - Single palmar crease - Wide sandal gap - Congenital heart defects |
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|
What are late complications of Down's syndrome? |
- Learning difficulties - Cataracts - Hypothyroidism - Alzheimer's disease |
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|
What are some physical features of Turner's syndrome? |
- Lymphoedema of the hands and feet at birth - Short stature - Neck webbing or thick neck - Wide carrying angle - Widely spaced nipples |
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|
What are the complications of Turner's syndrome? |
- Congenital heart defects - Delayed puberty - Infertility - Hypothyroidism - Renal abnormalities - Pigmented moles - Recurrent otitis media |
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|
What are some physical signs of William's syndrome? |
Spontaneous microdeletion in Chr7 - Mental disability - Socially outgoing - Very high verbal fluency - Elf-like face - Long philtrum - Heart defects - Hyprecalcaemia |
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|
What are some physical signs of Fragile X? |
Trinucleotide expansion in FMR1 gene - Moderate/severe learning difficulties - Macrocephaly - Macro-orchidism : post-pubertally - Long face - Large, everted ears - Broad forehead |
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|
What are the values for Hb in children? |
Birth at term - high: >14g/dL 1-12months = 10g/dL 1-12 years = <11g/dL Blood volume is 80ml/kg |
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|
What are the main differnetials for a microcytic, hypochromic anaemia? |
- IDA - Beta-Thalassaemia trait - Alpha-Thalassaemia trait |
|
|
What is the most common cancer of childhood? |
Acute Lymphocytic Leukaemia - ALL Peaks 1-9yo Philadelphia chromosome (Bcr/Abl) Has a cure rate of >80% |
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|
What are the clinical features of ALL? |
- Bleeding - Limp - Fatigue - East bruising - Petechial rash - Hepato- spleno-megaly - Lymphadenopathy - Orchidomegaly |
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|
What are the haematological findings of ALL? |
Pancytopenia: - Neutropenia - Thrombocytopenia - Lymphopenia WCC can be high, but is a poor prognostic indicator Blast cells on blood film and biopsy |
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|
What are the clinical features of Wilm's tumour? |
Nephroblastoma - 80% of cases <5yo - Abdominal pain - Heamaturia - HTN 80% cure rate if no metastasis |
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|
What are the clinical features of neuroblastoma? |
Malignant tumour from the sympathetic chain - usually in adrenal gland - Abdominal mass: firm, non-tender - Weight loss - Hepatomegaly - Lymphadenopathy - Raised urinary metanephrines |
|
|
What are causes of cervical lymphadenopathy? |
Acute: - Reactive to local infection - Cervical adenitis : bacterial infection of adenoids Persistent: - Reactive to local infection - Neoplasia : lymphoma or neuroblastoma |
|
|
What are features in the history that will indicate cause of cervical lymphadenopathy? |
- Constitutional symptoms: B-symptoms - Rash : viral exanthemata - Pets : cat scratch fever, toxoplasmosis - Family history of TB - Drugs |
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|
What are causes of a maculopapular rash? |
- Rubella : macular only - Measles : first on neck and then spread - HHV6/7 - Enterovirus |
|
|
What are causes of a purpuric rash? |
- Meningococcal septicaemia - HSP - Enterovirus - Thrombocytopenia |
|
|
What are cases of a vesicular rash? |
- Chickenpox - Shingles - Herpes simplex - Hand, foot and mouth disease |
|
|
What are causes of desquamation? |
- Post-scarlet fever - Kawasaki's disease |
|
|
What are the clinical features of measles? |
- Fever that resolves in 3days - Malaise - Maculopapular rash: spreads from face to body - Cough - Coryza - Conjunctivitis - Koplik's spots |
|
|
What are the complications of measles? |
- Viral meningitis - Orchitis |
|
|
What are the clinical features of rubella? |
Mild disease: - Low grade fever - Maculopapular rash, not itchy, appears with fever - Prominent lymphadenopathy |
|
|
What are the features of congenital rubella? |
- Cardiac defects = PDA - Cerebral defects - Ophthalmic defects - Auditory defects |
|
|
What are the clinical features of scarlet fever? |
Caused by Strep Pyogenes - Sore throat - Fever - Bright red tongue "strawberry" - Rash: 12-48 hours after fever, start on chest Management = penicillin |
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|
What are the clinical features of Kawasaki's disease? |
Affects 6m - 4yo - Persistent fever for >5days that doesn't respond to NSAIDs - Cervical lymphadenopathy - Viral conjunctival infection - Extreme irritability - Papular rash - Red and oedematous hands with desquamation Management = i.v. Ig and aspirin Echo - for aneurysms |
|
|
What are the clinical features of chicken pox? |
For 3-5 days: - Fever - Itchy, vesicular rash in their 100s New onset fever or persistent high fever at start = secondary bacterial infection Management = supportive = Aciclovir in immunocompromised |
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|
What are the most common causative agents of menignitis? |
Viral (most common) - enterovirus, EBV, adenovirus Bacterial: Over 80% of cases are <16yo - Neonatal = Group B Strep, E. Coli, Listeria - Child = NHS |
|
|
What are the differentials for afebrile seizure? |
- Breath-holding attacks - Reflex anoxic attacks - Syncope - Migraine - Hypoglycaemia - Head trauma |
|
|
What are the types of generalised epilepsy in childhood? |
Infantile spasms = West syndrome - 4-6mo - Violent flexor spasms Lennox-Gastaue syndrome - 1-3yo - Drop attacks Childhood absence epilepsy - 4-12 years - Absence seizures, 30sec - Can be induced by hyperventilation Juvenile myoclonic epilepsy - myoclonic seizures upon waking |
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|
What are the types of focal epilepsy in childhood? |
Benign childhood epilepsy with centrotemporal spikes - 4-10yo - Tonic-clonic with facial focus after waking or asleep Early-onset benign childhood occipital epilepsy - 1-14 years - Unresponsive episodes of eye deviation |
|
|
What are the diagnostic features of congenital adrenal hyperplasia? |
- Hyponatraemia - Hyperkalaemia - Metabolic acidosis - Hypotension |
|
|
What is the most common cause of acute hip pain in children? |
Transient synovitis "irritable hip" 2-12yo Accompanied by viral infection - No pain at rest - Sudden onset pain in hip, or limp - Well child : afebrile Management = bed rest, improves in few days |
|
|
What are the clinical features of Perhtes disease? |
Avascular necrosis of the femoral epiphysis followed by revascularisation and reossification over 18-36m - Insidious onset of limp and hip/knee pain |
|
|
What are the risk factors for developmental dysplasia of the hip? |
- Breech or Caesarian delivery - Female sex - Family history |
|
|
What is the management of developmental dysplasia of the hip? |
If younger than 8 months: - Fix hip in abduction - Keep in harness and adjust every 2 weeks If older: - open reduction - may need adult hip replacement |
|
|
What are the findings on physical exam of talipes equinovarus? |
- Heel rotated inwards (varus) and in plantar flexion (equinus) - Thin calf muscles - Affected foot is shorter - Forefoot adducted |
|
|
What are causes of reactive arthritis? |
Is the most common form of arthritis in childhood Enteric bacteria - salmonella, shigella, campylo Viruses STIs |
|
|
What are the clinical features of reactive arthritis? |
- Transient joint swelling <6weeks - Often ankles or knees - Low grade fever Follows an extra-articular infection Management = Nothing, NSAIDs |
|
|
What are causative organisms of septic arthritis? |
- Staph aureus - Strep - H.Influenzae |
|
|
What are the clinical features of septic arthritis? |
Most common <2yo - Painful joint - Reduced mobility - Erythematous - Warm |
|
|
What is the management of septic arthritis? |
USS of joint - with aspiration for culture - Refer to orthopods Long-course of antibiotics: - i.v. flucloxacillin (with ceftriaxone in young to cover Hib) |
|
|
What are the causative organisms of osteomyelitis? |
- Staph aureus - H. Influenzae - Strep |
|
|
What are the clinical features of osteomyelitis? |
- Fever - Painful, immobile joint - Swelling - Extreme tenderness on movement |
|
|
What is the management of osteomyelitis? |
Refer to orthopods Long course of Abx: - Start on i.v. flucloxacillin (with ceftriaxone in young for Hib) - When clinical recovery of acute-infection is manage = switch to oral Abx |
|
|
What are the benefits of early i.v. antibiotics in osteomyelitis? |
Prevents: - bone necrosis - chronic infection - Limb deformity - Amyloidosis |
|
|
What are the clinical features of juvenile idiopathic arthritis? |
- Is a chronic swelling of a joint(s) that presents at <16yo - Persists for >6weeks - In the absence of infection or other cause - Gelling : stiff joints - Morning joint stiffness and pain - Intermittent limp |
|
|
What are the complications of JIA? |
- Chronic anterior uveitis - Flexion of contractors of joints - Growth failure - Amyloidosis |
|
|
What are the clinical features of dyskinetic cerebral palsy? |
- Fluctuating tone - Frequent involuntary movements - Worse on movement or stress |
|
|
What percentage of children wth cerebral palsy also have learning difficulties? |
60% |
|
|
What is the most common refractive error in young children? |
Hypermetropia It should be corrected early to avoid irreverisble visual damage |
|
|
What are the general features of spastic cerebral palsy? |
Brisk tendon reflexes Extensor plantar response |
|
|
What are the causes of cerebral palsy? |
Majority are due to infection - either maternal or congenital 10% are due to hypoxic-ischaemic injury |
|
|
What is the prevalence of ASD (autism)? |
3-6 in 1,000 births |
|
|
What is the second most common heritable cause of mental retardation? X-linked dominant |
Fragile X |
|
|
At what age does SIDS most commonly occur? |
2-4 months |
|
|
What is the commonest cause of septacaemia in neonates? |
Pneumococcus |
|
|
What is the commonest cause of septic shock? |
Meningococcal infection |
|
|
Do female carriers of Fragile X have learning difficulties? |
Yes - a high proportion 20% of males with a mutation are phenotypically normal |
|
|
For 2 carrier parents, the risk of having an affected child by an autosomal recessive condition is? |
25% |
|
|
What are the cytogenetic reasons for trisomy 21? |
95% are non-disjunction 4% translocation 1% mosaicism |
|
|
What is the definition of a preterm birth? |
Before 37 weeks gestation |
|
|
Low birthweight |
Less than 2,000g |
|
|
Very low birthweight |
Less than 1,500g |
|
|
Extremely low birthweight |
Less than 1,000g |
|
|
Is given in most hospitals to babies at birth to prevent haemorrhagic disease of the newborn |
Vitamin K |
|
|
Post-term is defined as |
>42 weeks gestation |
|
|
Term birth |
37-42 weeks gestation |
|
|
Infants who still have an oxygen requirement at 36 weeks are described as having... |
Bronchopulmonary dysplasia |
|
|
What is the most common cause of prolonged/persistent unconjugated hyperbilirubinaemia? |
Breast milk jaundice |
|
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What is the mortality and morbidity of sever HIE? |
>30% mortality 80% Neurodevelopmental delays |
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What bacteria is a common cause of early onset sepsis in the UK, with: Pneumonia on day 1 Septaecaemia Meningitis |
Group B Streptococcus |
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What is the most common cause of ambiguous genitalia? |
Congenital adrenal hyperplasia |
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What is the most common cause of short stature? |
Familiar short stature |
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What clinical features are suggestive of pyloric stenosis? |
- Constant hunger, even after vomiting - Visible gastric peristalsis - Weight loss - Hyperchloraemic alkalosis with low plasma K+ |
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What should be avoided when treating children with EBV? |
Ampicillin or amoxicillin |
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What is the most common form of primary HSV illness in children? |
Gingivostomatitis |
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What is the most common cause of viral croup? |
Parainfluenza virus |
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What are the most common pathogens of tonsillitis? |
Group A Strep EBV |
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What heart defect gives: - Soft pansystolic or no murmur - Loud pulmonary second sounds - Tachypnoea - Tachycardia - Hepatomegaly |
Large VSD |
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What heart defect gives: - Ejection systolic murmur at upper LSE - Soft or absent P2 - Right ventricular hypertrophy |
Pulmonary stenosis |
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What heart defect gives: - systemic HTN in right arm - Ejection systolic murmur at upper sternal edge - Radiofemoral delay |
Coarctaion of the aorta - postductal |
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What heart defect gives: - Right ventricular hypertrophy - VSD - Abnormal position of the aorta - Pulmonary valve stenosis |
Tetralogy of Fallot |
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What heart defect gives: - Clubbing in older children - Loud hard ejection systolic murmur at LSE from day 1 - Single second heart sound - Normal CXR and ECG |
Tetralogy of Fallot |
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What heart defect gives: - Loud pan systolic murmur at LLSE - quite pulmonary second sound |
Small VSD |
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What heart defect gives: - Ejection systolic or pansystolic murmur - Fixed and wide split second HS |
ASD |
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What are the clinical features of mumps? |
Fever Malaise Parotitis - inflammation of parotid is first sign |
