1
Q
“A” of ABCs of Sick Child
A
2
Q
“B” of ABCs of Sick Child
A
3
Q
“C” of ABCs of Sick Child
A
4
Q
“D” of ABCs of Sick Child
A
5
Q
“E” of ABCs of Sick Child
A
6
Q
“F” of ABCs of Sick Child
A
7
Q
“G” of ABCs of Sick Child
A
Glucose:
• Normal random BGL 3.5-5.5 for children
8
Q
Recognition of Sick Child Summary
A
9
Q
Yale Criteria for Sick Child
A
10
Q
Dehydration classification, symptoms and treatment in children
A
11
Q
Why give Fluids in Kids?
A
12
Q
Signs of dehydration
A
13
Q
How will I give Fluids in Kids
A
14
Q
What fluids to give kids?
A
15
Q
How much fluids to give kids
A
16
Q
How to monitor Fluids in Kids
A
17
Q
Pre-made fluid bags at RCH
A
18
Q
Definition, Epidemiology and Aetiology of Kawasaki Disease
A
Definition:
• Acute vasculitis, especially of the coronary arteries
Epidemiology:
- Vast majority < 5 years (80%)
- Asians populations more likely affected
- One of the most common causes for acquired heart disease
Aetiology
– Unknown. Not contagious
19
Q
Clinical features of Kawasaki Disease
A
20
Q
Investigations and treatment for Kawasaki Disease
A
Ix:
- Echocardiogram
- ↑WBC, ESR, CRP, ↑↑↑Platelets
- Sterile pyuria
Rx:
- IVIg (IV immunoglobulin)
- High-dose aspirin
- No role for steroids
21
Q
Complications and prognosis of Kawasaki Disease
A
Complications:
• Coronary artery aneurysm in 25% of pts if left untreated
Prognosis:
- Acute and usually self-limiting
- Untreated leads to significant morbidity/mortality – Rx < 3% develop CAA
22
Q
Definition of acute bacterial meningitis
A
Acute Bacterial Meningitis
Definition:
- Inflammation of the meninges, which covers the brain and spinal cord, caused by various bacterial species
- Medical emergency that if not treated results in nearly 100% mortality
23
Q
Epidemiology of Acute Bacterial Meningitis
A
24
Q
Aetiology of Acute Bacterial Meningitis
A
25
**Risk factors for Acute Bacterial Meningitis**
**Risk Factors:**
* Recent exposure to an individual with meningoccal or Hib meningitis
* Recent infection (especially URTI or otic infection)
* Recent travel to areas of endemic meningococcal disease (e.g. Sub-Saharan Africa)
* Penetrating head trauma or skull fracture
* Cochlear implant devices
26
**Pathophysiology of Acute Bacterial Meningitis**
**Pathophysiology:**
1. Breach of the CNS either by **haematogenous spread** (most common) or trauma
2. Bacteria multiple once they enter subarachnoid space
3. Bacteria in CSF induce inflammatory cascade and leukocyte migration
4. Results in cerebral oedema, raised ICP and neurological damage
5. Can lead to **Septic shock, DIC**, renal and heart failure
27
**Clinical Features of Acute Bacterial Meningitis**
28
**Physical examination in Acute Bacterial Meningitis**
29
**Investigations and diagnosis of Acute Bacterial Meningitis**
30
**Contraindications of a Lumbar Puncture**
31
**Management of Acute Bacterial Meningitis**
32
**Complications of Acute Bacterial Meningitis**
33
**Prognosis of Acute Bacterial Meningitis**
34
**Definition and Epidemiology of Viral Meningitis**
**Viral (aseptic) Meningitis**
**Definition:**
• Viral infection of the meninges and/or brain tissue (meningo-encephalitis)
**Epidemiology:**
* One of the most common infections of the CNS
* Under-diagnosed since some just present with flu-like symptoms
* Most common in children
* Males \> females
35
**Aetiology and Pathophysiology of Viral Meningitis**
36
**Clinical features of Viral Meningitis**
**Clinical Features:**
* Headaches
* Non-specific signs in infants – irritability, poor feeding, fever, vomiting
* Photophobia, neck or back stiffness
37
**Diagnosis and Management of Viral Meningitis**
38
**Complications and Prognosis of Viral Meningitis**
39
**Definition of the febrile child**
40
**Key factors in assessing a febrile child**
41
**Investigations of the Febrile Child**
42
**Treatment of a Febrile Child**
43
**Definition and Epidemiology of Measles**
**Definition:**
• Measles is a highly infectious disease caused by the measles virus and characterised by a maculopapular rash, cough, coryza, conjunctiivtis and Koplikʼs spots
**Epidemiology:**
* Measles is ubiquitous in non-immunised populations, especially in developing worlds
* Highest incidence in children aged 5-9 years
44
**Aetiology and pathophysiology of Measles**
45
**Clinical features of Measles**
46
**Investigations, diagnosis and management of Measles**
47
**Complications and Prognosis of Measles**
48
**Signs, causative organisms and work-up for Viral Meningio-Enchephalitis**
49
**Definition of Asthma**
**Definition:**
* Chronic respiratory disorder characterised by variable airway inflammation, airway obstruction and airway hyper-responsiveness
* In older children and adults this may lead to permanent structural alterations of the airways (remodelling)
50
**Epidemiology of Asthma**
51
**Aetiology of Asthma**
52
**Risk factors for asthma**
53
**Pathophysiology and classification of Asthma**
54
**Clinical Features of Asthma**
55
**Investigations for Asthma**
56
**Differential Diagnosis of Asthma**
**DDx:**
* Bronchiolitis - no associated atopy. Onset 18-24 months
* Inhaled foreign body - sudden onset of cough, wheeze or choking
57
**Long term management of Asthma**
58
**Acute asthma management**
59
**Asthma treatment summary including MOA and side effects**
60
**Complications and prognosis of Asthma**
61
**Asthma Risk Factors infographic**
62
**Asthma treatment infographic**
63
**Bronchitis:**
* Definition
* Epidemiology
* Aetiology
* Pathophysiology
64
**Bronchitis:**
* Clinical features
* Investigations
* Management
* Prognosis
65
**Definition and epidemiology of Bronchiolitis**
**Bronchiolitis:**
**Definition:**
• Acute viral infection of the LRT characterised by **obstruction** of the small airways with **air trapping**
**Epidemiology:**
* **\< 2 years of age** (most severe 1-2 months), leading cause of hospital admissions in this age group
* Uncommon in children \< 1month or \>2 years - Almost exclusively an infantile disease
* Seasonal – mainly winter
66
**Risk factors for Bronchiolitis**
**Risk factors:**
* \< 3 years – lungs and immune system have not developed fully
* Winter months
* Premature birth - impaired lungs and immune system
* Underlying heart or lung condition - E.g. CF or congenital heart disease
* Passive smoking
* Infants with older siblings – bring the infection home
67
**Aetiology and Pathophysiology of Bronchiolitis**
**Aetiology:**
* **RSV** is the most common cause (\>50%)
* Others: Parainfluenza virus and adenovirus
**Pathophysiology:**
1. Virus infection of the respiratory epithelial cells causing necrosis, inflammation, oedema and mucous secretion/plugging
2. Cellular destruction and inflammation leads to **obstruction of the small airways**
3. Results in **hyperinflation**, cilia dysfunction, atelectasis and **wheezing**
4. Re-growth of the epithelial cell layers does not occur until ~ 2 weeks post infection
68
**Clinical features of Bronchiolitis**
**Clinical Features:**
* Prodrome of 1-3 days of irritating cough, nasal congestion and rhinorrhoea
* **Wheezing** – due to airway narrowing with mucus and necrotic debris
* **Fluctuating** clinical findings – Hallmark of bronchiolitis
* ↑ WOB – Tachypnoea + grunting, nasal flaring, subcostal retraction (common)
* Fever \> 38.5°C
* **Apnoea** may be presenting feature, especially in very young or premature or low birth weight infants (uncommon)
* Worst day 3-4
69
**Investigations, management and prognosis of Bronchiolitis**
**Investigations:**
• Clinical
**Rx:**
* Supportive
* Hospitalise with respiratory distress
* Donʼt use steroids
**Prognosis:**
* Most cases are mild and self-limiting (3-10 days)
* Most get better in 2-3weeks (when resp. epithelium regenerates)
* Only 1% require hospitalisation
70
**Definition of Paediatric Pneumonia**
71
**Epidemiology of Paediatric Pneumonia**
**Epidemiology:**
* Can occur at any age - but more common in children \< 4 years
* Accounts for 13% of all infectious illnesses in infants \< 2 years
* Cause of significant morbidity and mortality in developing countries
72
**Aetiology of Paediatric Pneumonia**
73
**Risk Factors for Paediatric Pneumonia**
**Risk factors:**
* Recent respiratory infection
* Bronchopulmonary dysplasia - chronic lung condition of infants born preterm
* CF
* Asthma
* Congenital heart disease
* Congenital and acquired immunodeficiency disorders
* Smoking
74
**Pathophysiology of Paediatric Pneumonia**
75
**Clinical Features of Paediatric Pneumonia**
76
**Investigations for Paediatric Pneumonia**
77
**Management of Paediatric Pneumonia**
78
**Complications and prognosis of Paediatric Pneumonia**
79
**Sore throat - serious conditions of exclusion and serious features**
80
**Paediatric assessment of sore throat**
81
**Bacterial Pharyngitis - key organism and key features**
82
**Definition and epidemiology of laryngotracheobronchitis (croup)**
**Laryngotracheobronchitis (croup)**
**Definition:**
• Viral infection of the upper airways characterised by sudden onset seal-like barking cough, stridor, voice hoarseness and respiratory distress
**Epidemiology:**
* Most common cause of stridor in children 3 months – 5years
* Winter months
83
**Aetiology and pathophysiology of laryngotracheobronchitis (croup)**
**Aetiology:**
* Parainfluenza virus (1 or 3)
* RSV (common \< 6 months + wheeze)
* Others: Adenovirus, Influenza A or B, Coronavirus
**Pathophysiology:**
* Upper airways obstruction caused by generalised inflammation and oedema of the airways
* Cellular level, necrosis and shedding of the epithelium
* **Narrowed & subglottic inflammation** is responsible for the seal-like barky cough and stridor
* If upper airways obstruction worsens it can lead to respiratory failure
84
**Clinical Features of laryngotracheobronchitis (croup)**
85
**Investigations and management of laryngotracheobronchitis (croup)**
86
**Prognosis of laryngotracheobronchitis (croup)**
87
**Definition, Epidemiology and Aetiology of Epiglottitis**
**Epiglottitis:**
**Definition:**
* Bacterial infection causing severe epiglottic/supra-glottic inflammation
* **Medical Emergency**
**Epidemiology:**
* 3–7 years
* Year-round disease
**Aetiology:**
* Strep pyogenes, strep pneumoniae, Staph. aureus and previously HiB
* Suspect HiB in young patients with incomplete immunisations
88
**Clinical Features, Diagnosis and Management of Epiglottis**
89
**Prognosis of Epiglottitis**
**Prognosis**
– Good if airway is controlled. Patients can be extubated within a few days (once infection has settled)
90
**Bacterial Tracheitis:**
* Definition
* Epidemiology
* Aetiology
* Clinical Features
* Diagnosis
* Management
91
**Acute Infectious Laryngitis:**
* Definition
* Epidemiology
* Aetiology
* Clinical Features
* Diagnosis
* Management
92
**Definition of Infective Endocarditis**
**Infective Endocarditis:**
**Definition:**
• Infection involving the endocardial surface of the heart, including valvular structures
**Epidemiology:**
* Males \> females
* Half of the patients are \> 60 years
93
**Aetiology and Pathophysiology of Infective Endocarditis**
94
**Clinical Presentation of Infective Endocarditis**
95
**Investigations and Criteria for Infective Endocarditis**
96
**Management and Complications of Infective Endocarditis**
97
**Definition, Epidemiology and Aetiology of Acute Rheumatic Fever**
98
**Criteria for Acute Rheumatic Fever**
99
**Investigation and management of Acute Rheumatic Fever**
100
**Complications and Prognosis of Acute Rheumatic Fever**
101
**Fetal circulation**
102
**Epidemiology of Congenital Heart Disease**
**Epidemiology:**
* Leading cause of death in infancy
* Most are Dx by 1 month
* 30% have mother abnormalities
103
**Clinical Presentation of Congenital Heart Disease**
104
**Aetiology, Risk Factors and Investigations for Congenital Heart Disease**
105
**Grades of murmurs**
106
**Characteristics of Pathological Murmurs**
107
**Innocent murmurs**
108
**Classification of Congenital Heart Disease**
109
**Types of Left-Right Shunts and their Characteristics in Acyanotic Heart Disease**
110
**Types of Obstructive Lesions and their characteristics in Acyanotic Heart Disease**
111
**Types of Obstructive Lesions and their characteristics in Cyanotic Heart Disease**
112
**Admixtures in Cyanotic Heart Disease**
113
**Type of murmur indication which lesion**
114
**Description, exam and management of Functional Constipation**
115
**Hirschsprung's Disease:**
* Description
* Investigation
* Differential Diagnosis
* Management
* Complications
116
**Definition of Diarrhoea**
117
**Aetiology of Diarrhoea**
118
**Clinical Work Up for Diarrhoea**
119
**Pathophysiology of Diarrhoea**
120
**Life-threatening conditions associated with Diarrhoea**
121
**Definition and Epidemiology of Gastroenteritis**
**Definition:**
* Inflammation of the GIT caused usually by a viral infection
* Usually self-limiting but can lead to morbidity and mortality 2° to dehydration and electrolyte imbalances
**Epidemiology:**
* Most common cause of death in children of developing world (associated with poverty and poor hygiene)
* 95% of gasteroenteritis hospitalisations occur in children \< 5 years
122
**Aetiology and Risk Factors of Gastroenteritis**
123
**Pathophysiology of Gastroenteritis**
124
**Clinical Features, Investigations and Diagnosis of Gastroenteritis**
125
**Management, Complications and Prognosis of Gastroenteritis**
126
**Definition of Vomiting and Nausea**
127
**Red Flags for Vomiting**
128
**Aetiology of Vomiting**
129
**_Age specific aetiologies of vomiting_**
**Oesophageal Atresia and Tracheo-oesophageal Fistula in Neonates and infants:**
* Description
* Presentation
* Diagnosis
* Management
130
**_Age specific aetiologies of vomiting_**
**GORD in Neonates and Infants:**
* Description
* Features
* Investigation
* Diagnosis
* Management
131
**_Age specific aetiologies of vomiting_**
**Pyloric Stenosis in Neonates and Infants:**
* Description
* Presentation
* Investigations
* Management
132
**_Age specific aetiologies of vomiting_**
**Duodenal Atresia in Neonates and Infants**
* Description/Causes
* Presentation
* Investigation
* Management
133
**_Age specific aetiologies of vomiting_**
**Malrotation with Volvolus in Neonates and Infants**
* Description
* Type
* Clinical Features
* Investigation
* Management
134
**_Age specific aetiologies of vomiting_**
**Intussusception in Neonates and Infants**
* Description
* Clinical Features
* Investigation
* Management
* Complications
* Prognosis
135
**_Age specific aetiologies of vomiting_**
**Adrenal Insufficiency in Neonates and Infants**
136
**Age specific Aetiologies of vomiting in older infants and children**
137
**Age specific Aetiologies of vomiting in Adolescents**
138
**Electrolyte disturbances in vomiting**
139
**Aetiology of Acute Renal Failure in Children**
**Aetiology:**
* Acute tubular necrosis from severe dehydration
* Acute post-streptococcal GN
* Haemolytic uraemic syndrome
140
**Pathophysiology of Acute Renal Failure in Children**
141
**Clinical Features of Acute Renal Failure in Children**
**Clinical Features:**
* Unwell patient with Oliguria
* Macroscopic haematuria
* Bloody diarrhoea followed by reduced urine output
* Periorbital oedema or abdominal oedema
* Headache and signs of dehydration
* Seizures
* Fevers, rash, signs of infection, fluid retention
142
**Investigations for Acute Renal Failure in Children**
143
**Management for Acute Renal Failure in Children**
144
**Definition of Glomerulonephritis**
145
**Aetiology of Glomerulonephritis**
146
**Pathophysiology of Glomerulonephritis**
147
**Classification of Glomerulonephritis**
148
**Clinical Presentation of Glomerulonephritis**
149
**Investigations and Management of Glomerulonephritis**
150
**Complications and Prognosis of Glomerulonephritis**
151
**Post-strep Glomerulonephritis**
152
**Definition and Epidemiology of Haemolytic Uraemic Syndrome**
153
**Aetiology and Pathophysiology of Haemolytic Uraemic Syndrome**
154
**Clinical Presentation of Haemolytic Uraemic Syndrome**
155
**Investigations and diagnosis of Haemolytic Uraemic Syndrome**
156
**Management and Prognosis of Haemolytic Uraemic Syndrome**
157
**Definition and Epidemiology of Henoch-Schonlein Purpura**
158
**Aetiology and Pathophysiology of Henoch-Schonlein Purpura**
159
**Clinical Presentation of Henoch-Schonlein Purpura**
160
**Investigation and Diagnosis of Henoch-Schonlein Purpura**
161
**Management and Prognosis of Henoch-Schonlein Purpura**
162
**Definition and Aetiology of Nephrotic Syndrome**
163
**Pathophysiology of Nephrotic Syndrome**
164
**Clinical Features of Nephrotic Syndrome**
**Clinical Features:**
* Periorbital oedema, peripheral oedema or anasarca (generalised oedema) develops later
* Hx of recent viral illness
* Absence of haematuria • Normotensive
165
**Investigations and Diagnosis of Nephrotic Syndrome**
166
**Management and Complications of Nephrotic Syndrome**
167
**Definition and Epidemiology of UTI in Children**
168
**Aetiology of UTI in Children**
169
**Risk Factors of UTI in Children**
170
**Pathophysiology of UTI in Children**
171
**Clinical Features of UTI in Children**
172
**Investigations of UTI in Children**
173
**Management of UTI in Children**
174
**Complications and Prognosis of UTI in Children**
175
**Foetal Circulation**
176
**Transition of Foetal Circulation at Birth**
177
**Shunt closure after delivery**
178
**Patent Ductus Arteriosus**
179
**Patent Foramen Ovale**
180
**Definition and Epidemiology of Cystic Fibrosis**
181
**Aetiology and Pathophysiology of Cystic Fibrosis**
182
**Clinical Features of Cystic Fibrosis**
183
**Investigations for Cystic Fibrosis**
184
**Management of Cystic Fibrosis**
185
**Complications and Prognosis of Cystic Fibrosis**
186
**Neonatal check - Inspection**
187
**Neonatal check - Head and Neck**
188
**Neonatal check - Chest**
189
**Neonatal check - Abdomen**
190
**Neonatal check - Hips and Feet**
191
**Barlow and Ortolani's test + Developmental Dysplasia of Hip**
192
**Neonatal Heel Prick Test**
193
**Definition and Epidemiology of Neonatal Jaundice**
**Definition:**
• Neonatal jaundice is a rise in serum bilirubin \> 3x normal, in the first 28 days of life
**Epidemiology:**
* All infants develop elevated bilirubin levels in the 1st week of life
* Affects 50-70% of term babies and 80% of preterm babies
* Infants with severe hyperbilirubinaemia are at risk of Bilirubin-induced Neurological Dysfunction
194
**Aetiology of Neonatal Jaundice**
195
**Risk Factors of Neonatal Jaundice**
**Risk Factors:**
* Decreased gestational age
* Maternal diabetes - Mothers have 3x more β-glucaronidase in their breast milk --\> neonatal jaundice
* East Asian - genetic factors
* Decreased caloric intake and weight loss
* Breastfeeding
196
**Classification and Pathophysiology of Neonatal Jaundice**
197
**Clinical Features of Neonatal Jaundice**
198
**Investigations for Neonatal Jaundice**
199
**Management of Neonatal Jaundice**
200
**Complications of Neonatal Jaundice**
201
**Description of Respiratory Distress in Infants**
202
**Definition and Epidemiology of Infant Respiratory Distress Syndrome**
203
**Aetiology of Infant Respiratory Distress Syndrome**
204
**Pathophysiology of Infant Respiratory Distress Syndrome**
205
**Clinical Features of Infant Respiratory Distress Syndrome**
206
**Investigations and Diagnosis of Infant Respiratory Distress Syndrome**
207
**Differential Diagnosis of Infant Respiratory Distress Syndrome**
208
**Management of Infant Respiratory Distress Syndrome**
209
**Complications of Infant Respiratory Distress Syndrome**
210
**Neonatal period and evaluation of the new born**
211
**Newborn Screening**
212
**Definition of Pre-term baby**
213
**Epidemiology of Pre-term baby**
214
**Risk Factors of Pre-term baby**
215
**Physiological challenges of Pre-term baby**
216
**Complications of Pre-term baby**
217
**Definition and key points to note about Failure to Thrive**
218
**Normal patterns of growth in the context of Failure to Thrive**
219
**Aetiology for Failure to Thrive**
220
**History questions to ask for Failure to Thrive**
221
**Examinations to cover for Failure to Thrive**
222
**Investigations for Failure to Thrive**
223
**Disease entities relating to Failure to Thrive**
224
**IBD in children**
225
**Advantages of breastmilk and contraindications for breastfeeding**
226
**Supplements for feeding infants**
227
**Breast Milk Vs Cow's Milk**
228
**Advice on introducing foods to infants**
P2
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Decks in class (5)
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