Year 2: Block 4: Paediatrics > GP paediatrics > Flashcards

GP paediatrics Flashcards

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1
Q

neonatal period is the period up until

A

4 weeks

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2
Q

neonatal jaundice can be

A

physiological or pathological

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3
Q

physiological jaunidce

A

nearly all babies are born with some physiological jaundice the baby transitions from relying on the placenta to clear bilirubin to using its own hepatic system

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4
Q

physiological jaundice is never visible

A

in the first day of life and if a neonate has jaundice within the first 24 hours f life there is always a pathological cause

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5
Q

in physiological jaundice

A

levels of conjugated bilirubin never suprasses

  • 20% of the total serum bilirubin OR
  • 2mg/dl if total serum bilirubin is greater than 5mg/dl
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6
Q

physiological jaundice normally resolved within

A
  • 1 week in a full term infant

- 2 weeks in a premature infant

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7
Q

premature infant

A

gestation less than 37 weeks

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8
Q

prolonged jaundice

A
  • 14 days or more in full term infants

- 21 days or more in pre-term infant

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9
Q

pathological jaundice definition

A

any jaundice that does not satisfy the criteria of being physiological jaundice

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10
Q

causes of pathological jaundice

A
  • Rh incompatibility
  • ABO incompatibility
  • Crigler Najjar syndrome
  • biliary atresia
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11
Q

Rh incompatibility

A

when a Rh negative mother has a resus positive child she produced Rh autoantibodies so if she has another pregnancy with a Rh positive baby the antibodies attack the foetus

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12
Q

ABO incompatibility

A

attack on red blood cells by maternal anti-ABO antibodies

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13
Q

Crigler Najjar syndrome

A

absence of the enzyme UGT1A1 resulting in the inability to conjugate bilirubin causing an indirect hyperbilirunaemia

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14
Q

biliary atresia

A

only prevents in neonates, defect in biliary tract which causes cholestasis, conjugated bilirubin is absorbed into the bloodstream as it cannot be transported into the duodenum therefore= direct hyperbilirunaemia

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15
Q

UTIS in neonates

A

UTI in neonates is associated with bacteramiea and congenital anomalies in the kidney and urinary tract

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16
Q

congenital hypothyroidism

A

INADEQUATE THYROID HORMONE PRODUCTION IN NEWBORN INFANT

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17
Q

Cause of congenital hypothyroidism

A
  • anatomic defect in the thyroid gland (thyroid dysgenesis)
  • inbred error of thyroid hormone synthesis/ metabolism
  • iodine deficniency
  • exposure to anti-thyroid medication during pregnancy
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18
Q

congenital hypothyroidism is the

A

most common neonatal endocrine disorder

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19
Q

symptoms of neonatal hypothyroidism

A

decreased activity, large anterior fontanelle, constipation, weight gain, jaundice, hypotonia, poor feeding

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20
Q

if congenital hypothyroidism goes untreated it causes

A

CRETINISM: severely stunted physical and mental development

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21
Q

if hypothyroidism remains untreated in a mother during pregnancy causes

A
  • increased risk of abortion, pre-eclampsia, placental abruption, postpartum haemorrhage and a pre-term labour
  • foetal neuropsychosocial development resulting in the child having an IQ of less than 7 points in children
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22
Q

gallactosemia

A

mutations in GALT, GALK1 AND GALE GENES, result in inability to process galactose, as these genes code for the enzymes that break down galactose

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23
Q

classic galactossemia is

A

type 1 which is the most common and most severe type if they are not treated with a galactose free diet it can be life-threatening causing failure to gaibn weight and growth, jaundice, liver damage and abnormal bleeding

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24
Q

breast milk intolerance

A

neonatal jaundice associated with breast feeding characterised by indirect hyperbilurinaemia in an otherwise healthy breastfed newborn where there is no other identifiable cause

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25
breast milk intolerance persists
longer than physiological jaundice and develops and the first 4-7 days of life
26
causes of neonatal vomiting
- paediatric GORD - cows milk protein intolerance - pyloric stenosis
27
paediatric GORD
caused by immaturity of the lower oesophageal sphincter causing transient lower oesophageal relaxation causing retrograde flow of gastric contents into the oesophagus
28
cows milk protein intolerance
allergy which most commonly affects children in their first year of life, can be IgE or non-IgE mediated
29
neonatal sepsis is classified as
early onset or late onset
30
early onset neonatal sepsis is associated with
the acquisition of micro-organisms from the mother i.e. transplacental infection or an ascending infection form the cervix which may be caused by organisms that colonise a females GU tract and the neonate acquires the micro-organisms as it passes down the colonised birth canal at delivery
31
common micro-organism associated with early onset neonatal sepsis
- group B strep - e.coli - coagulase negative staph aureus - haemophilia influenza
32
late onset neonatal sepsis si acquired from the
neonates environment
33
common micro-organisms in late onset neonatal sepsis
- coagulase negative staph - staph aureus - e.coli - klebsiella - pseudomonas
34
what is sepsis
a potentially life threatening complication of an infection, sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body, the inflammation can then trigger a cascade of changers that can damage multiple organ systems causing them to fail
35
sepsis can progress to
septic shock where blood pressure drops dramatically which can cause death
36
to be diagnosed with sepsis you must have
at least 2 of the following symptoms plus a probable or confirmed infection - fever greater than 38.3 or less than 36 - heart rate greater than 90 - resp rate greater than 20bpm
37
severe sepsis
is sepsis and one of the following - decreased urine output - abrupt changes in mental status - decreased platelet count - difficulty breathing - abnormal heart pumping function - abdominal pain
38
septic shock
signs and symptoms of severe sepsis plus a low blood pressure which does NOT respond to adequate iV fluid resuscitation
39
paediatric presentations to GP
- respiratory problems - GI problems - dermatology problems - MSK problems
40
common respiratory problems in paediatrics
- bronchiolitis - croup - asthma
41
bronchiolitis
acute inflammatory injury of the bronchioles usually caused by a viral infection most commonly the respiratory syncytial virus (RSV)
42
most common cause of bronchiolitis
respiratory syncytial virus
43
bronchiolitis occurs primarily
in children between the ages of 2-6 months of age
44
symptoms of bronchiolitis
breathing difficulties, cough, decreased feeding, irritability, wheeze or crepitations heard on auscultation
45
other causes of bronchiolitis
human metapneumovirus, adenovirus, parainfluenza virus
46
croup is also known as
laryngeotacheobronchitis
47
what is croup
inflammation of the upper respiratory tract predominantly the larynx and the trachea but it may affect the bronchi and is caused by a viral infection
48
symptoms of croup
non-specific symptoms of a viral URTI (runny nose, sore throat, fever, cough) which progresses over a few days to cause the classical BARKING cough and hoarseness, symptoms tend to be worse at night. stridor may be hear and there may be a mild to moderate fever
49
most common cause of croup
parainfluenza virus types 1,2,3 and 4
50
other causes of croup
RSV, adenovirus, rhinovirus, enterovirus, measles, metapneumovirus, influenza virus types A and B (type A is associated with severe croup)
51
management of croup
- oral dexamethasone for all | - nebulised adrenal in emergency
52
asthma
constriction of the bronchioles causing an obstructive lung defect resulting in wheezing, diurnal cough, chest tightness and difficult breathing
53
rare respirator presentation in GP
- cystic fibrosis - acute epiglottis - foreign body inhalation
54
cystic fibrosis
autosomal recessive disease caused by mutation in the CFTR gene on chromosome 7
55
cystic fibrosis results in
- high sodium content of sweat because CFTR does not absorb chloride ions which remain in the lumen and prevent sodium reabsorption
56
cystic fibrosis causes pancreatic insufficieny because
the production of pancreatic enzymes is normal but defects in ion transport produces relative dehydration of pancreatic secretions causing their stagnation in the pancreatic ducts
57
cystic fibrosis causes respiratory disease because
dehydration of the airway surfaces which reduces muco-cilliary clearance and increases bacterial colonisation, local bacterial defences are impaired by local salt concentrations and bacterial adherence is increased by changes in cell surface glycoprotein increased bacterial colonisation and reduced material clearance causes inflammatory lung damage due to an exuberant neutrophilic response involving mediators such as IL-8 and neutrophil elastase
58
cystic fibrosis causes biliary disease because
defective transfer across the bile duct causes reduced movement of water in the lumen so the bile becomes concentrated causing plugging
59
cystic fibrosis causes GI disease because
of intra-luminal water deficiency
60
acute epiglottitis
acute inflammation of the epiglottis which is rapidly progressive
61
usual age of presentation of acute eppiglotitis
in children between the ages of 2- 5 years old
62
most common cause of acute epiglottitis
haemophilia influenza but can also be caused by strep pneumonia
63
why is children epiglottis different to an adults epiglottis
because it is more anterior and superior
64
symptoms of acute epiglottis
fever, severe sore throat, drooling, muffled hot potato voice
65
management of acute epiglottis
IV ceftriaxone and emergency AIRWAY MANAGEMENT
66
FOREIGN BODY INHALATION
right bronchi is the most common site for foreign bodies to become lodged
67
respiratory rate in children aged less than 1
30-40
68
respiratory rate in children between 1-2
25-35
69
respiratory rate in children between 2-5
25-30
70
respiratory rate in churn between 5-12
20-25
71
repsiroaty rate in children over 12
15-20
72
medical causes of abdominal pain from birth to 1 year
- gastroenteritis - UTI - constipation
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surgical causes of abdominal pain from birth to 1 year
- intussusception - volvulus - incarcerated hernia
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other causes of abdominal pain from birth to 1 year
- infantile coli | - hirssprungs disease
75
medical causes of abdominal pain in 2-5 years old
- gastroenteritis - UTI - constipation
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surgical causes of abdominal pain in 2-5 year old
- intussusception - volvulus - appendicitis
77
other causes of abdominal pain in 2-5 years old
- mesenteric lymphadenitis - hence schenlen purpura - DKA - sickle cells disease
78
medical causes of abdominal pain in 6-11 years
- gastroenteritis - UTI - constipation
79
surgical causes of abdominal pain in 6-11 years
- appendicitis - trauma - testicular torsion
80
other causes of abdominal pain in 6-11 years
- mesenteric lymphadenitis - abdominal migraine - hence schoenlen purpura - DKA - sickle cell disease - pneumonia - functional abdominal pain
81
medical causes of abdominal pain in 12-18 years
- gastroenteritis - UTI - constipation
82
surgical causes of abdominal pain in 12-18 years
- appendicitis - trauma - ovarian torsion - testicular torsion
83
other causes of abdominal pain in 12-18 years
- dysmenorrhoea - DKA - mittelschmerz - ectopic pregnancy - pelvic inflammatory disease - IBD
84
dermatological presentaiotn
- erythema infectiosum - molluscs contagiousm - impetigo - hand foot and mouth disease - scarlet fever
85
scarlet fever
complication of a strep throat infection usually caused by group A strep most common in children under 10 years old
86
symptoms of scarlet fever
fever, redness of tongue with tiny white spots, sore throat, erythematous rash over cheeks abdomen and chest
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red flags in paediatrics
- unresponsive to social cues and difficult to rouse - health professional very worried - weak, high pitched or continues cry - grunting respiration or apnoea epidosed where Sp02 is less than 90% - severe tachycardia/ tachypnoea or bradycardia - no wet napped or not passed urine in the last 18 hours - non- blanching purpuric rash/ mottled ashen or cyanotic - temperature less than 36 degrees of if under 3 months greater than 38 degrees
Year 2: Block 4: Paediatrics
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