Terms in this set (111)
What does bile stained vomit signify?
What causes projectile vomiting in the first few weeks of life?
What causes vomiting at the end of paroxysmal coughing?
What causes blood in the stool?
what causes 'red currant jelly' stools?
features of intususseption
paroxysmal abdominal colicky pain (infant will typically draw knees up and turn pale)
blood stained stool (red currant jelly)
sausage shaped mass in RLQ
What can cause bulging fontanelles and/or seizures?
raised intracranial pressure
What are the 3 shunts in foetal circulation?
Where does the ductus venous carry blood from/to?
Umbilical vein to Inferior Vena Cava
Where does the ductus arteriosus carry blood from/to?
Pulmonary trunk to aorta
Where does the foramen ovale carry blood from/to?
Right atrium to left atrium
What causes closure of the foramen ovale?
Left atrial pressure > Right atrial pressure
What causes closure of the ductus arteriosus?
Drop in prostaglandins
Increased O2 levels
Removal of placenta
Congenital cyanotic heart defects (decreased pulmonary flow)
Tetralogy of Fallot
Transposition of the Great Arteries
Congenital acyanotic heart defects (increased pulmonary flow)
Ventricular septal defect
Atrial septal defect
Atrioventricular septal defect
Patent ductus arteriosus
Pulmonary or aortic stenosis
Coarctation of aorta
What direction does the blood flow in acyanotic heart defects?
left --> right
What direction does the blood flow in cyanotic heart defects?
right --> left
Signs of patent ductus arteriosus
Signs of VSD
high pitch, pan-systolic murmur
Genetic risk factor for AVSD
Trisomy 21 (Down's)
What are the 4 defects of Tetralogy of Fallot?
Ventricular septal defect
Pulmonary valve stenosis
Right ventricular hypertrophy
Maternal risk factors for Tetralogy of Fallot
Signs of Tetralogy of Fallot
End systolic murmur
(+/- end diastolic murmur)
RBBB on ECG
Where does coarctation of the aorta usually occur?
At the insertion of the ductus arteriosus (distal to left subclavian)
What defect is associated with aortic coarctation?
bicuspid aortic valve (80% of cases)
Signs of aortic coarctation
CXR - rib notching, cardiomegaly
mid-late systolic murmur
Signs of Kawasaki disease
fever > 5 days
bilateral conjunctivitis without exudate
erythema of oral mucosa ('strawberry tongue')
What are Harrison sulci?
depressions at the base of the thorax associated with the muscular insertion of the diaphragm
What causes Harrison sulci?
chronic asthma or obstructive respiratory disease
Signs of a life threatening asthma attack
Pathogens that cause tonsillitis
Group A β-haemolytic streptococcus
The Centor Criteria to aid diagnosis of bacterial tonsillitis
tender anterior cervical lymph nodes
absence of cough
history of fever
Why are children more prone to otitis media?
Short, horizontal Eustachian tubes
Serious complications of acute otitis media?
What is glue ear?
otitis media with effusion
How can conductive hearing loss caused by OME in children be resolved?
Mode of inheritance of cystic fibrosis?
What is the defective protein in cystic fibrosis?
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR)
Most frequent genetic mutation that causes cystic fibrosis?
Gold standard test for cystic fibrosis
(Cl >60 mmol indicates CF)
Respiratory features of cystic fibrosis
reduction in airway surface liquid
increased viscosity of mucus
impaired ciliary function
chronic infection with atypical organisms (e.g. Pseudomonas)
GI features of cystic fibrosis
pancreatic enzyme insufficiency
Signs of cystic fibrosis on examination
hyperinflation of chest (due to air trapping)
Coarse inspiratory crepitations
Complications of CF
hepatomegaly and abnormal liver function
distal intestinal obstruction
recurrent chest infections
infertility in males
Signs of dehydration in children
reduced skin turgor
How is drug absorption different in neonates?
higher gastric pH
How is drug distribution different in children?
larger extracellular and body water compartments in infants
changes in blood brain barrier permeability
changes in circulating plasma proteins
How is renal function different in children?
Renal function worst a birth then reaches adult capacity around 2 years
What pathogen causes Scarlet Fever?
group A beta-haemolytic strep
What pathogen causes measles?
what type of rash does measles present with?
red maculopapular rash (morbiliform)
starts at the back of the ears then spreads down the head and trunk
what type of rash does scarlet fever present with?
erythematous papular ('sandpaper') rash
first appears on the trunk then spreads to the limbs
what pathogen causes slapped cheek syndrome?
what pathogen causes eczema herpeticum?
herpes simplex virus
what pathogen causes chicken pox?
varicella zoster virus
what pathogens cause hand, foot and mouth disease?
what is a 'barking cough' associated with?
what organism causes Croup?
Parainfluenza virus 1
features of infantile colic
recurrent inconsolable crying, drawing up of the legs, usually occurs in evening
when does infantile colic usually occur?
2 weeks-4 months of age
differential diagnosis for inconsolable crying
cow's milk protein allergy
why is GORD extremely common in infancy?
predominantly fluid diet, horizontal posture, short length of oesophagus
clinical features of GORD in children
recurrent vomiting, but putting on weight normally, otherwise well
complications of GORD in children
faltering growth, oesophagitis, iron deficiency anaemia, pulmonary aspiration, dystonic neck posturing
management of GORD in infants
smaller, more frequent feeds
acid suppression (H2 antagonists/PPIs)
Nissen fundoplication (if severe/unresponsive)
what is pyloric stenosis?
congenital hypertrophy of pyloric smooth muscle
incidence of pyloric stenosis
1-5/1000 live births
5x more common in boys
usually between 2-8 weeks of age
clinical features of pyloric stenosis
persistent, non-bilious, projectile vomiting
olive shaped mass in RUQ
what would you expect to see on ABG in pyloric stenosis?
hypochloraemic hypokalaemic metabolic alkalosis
why do you get a metabolic alkalosis in pyloric stenosis?
loss of acidic gastric contents (H+ ions)
why do you get hypochloraemia in pyloric stenosis?
loss of Cl- ions in gastric contents (hydrochloric acid)
why do you get hypokalaemia in pyloric stenosis?
kidneys attempt to maintain normal pH by retaining H+ at the expense of K+
management of pyloric stenosis
correction of dehydration and electrolyte abnormalities before surgery (Ramstedt's procedure)
investigation of choice for intususseption
management of intususseption
reduction by air insufflation (under radiological control)
why is appendicitis rare in infants?
lumen of appendix is wider and well drained
clinical features of appendicitis
central abdominal pain that moves to RIF, aggravated by movement
guarding over RIF
what is defined as complicated appendicitis
presence of appendix mass, abscess or perforation
management of complicated appendicitis
IV antibiotics prior to surgery
what is mesenteric adenitis?
inflammation of the mesenteric lymph nodes, thought to provoke a peritoneal reaction
clinical features of mesenteric adenitis
What is Hirschsprung's disease?
congenital absence of ganglion cells in the myenteric and submucosal plexus for a variable segment of bowel
clinical presentation of Hirschsprung's disease
delayed passage of meconium (>24-48hrs)
investigations for Hirschsprung's disease
management of Hirschsprung's disease
surgical resection of involved colon, initial colostomy followed by anastomosis of normal bowel to anus
definition of constipation
delay or difficulty in defecation for >2 weeks
constipation red flags
1st few weeks of life,
>24 hr delay in passing meconium,
delayed walking/lower limb neurology,
abdominal distension/vomiting, child protection concerns
definition of pneumonia
inflammation of the lung to parenchyma with consolidation of the alveoli
signs of increased work of breathing in children
recession (subcostal or intercostal)
key features that suggest bacterial pneumonia
pathogens that cause pneumonia in neonates (<1 month)
group B streptococci
pathogens that cause pneumonia in infants
pathogens that cause pneumonia in children
Group A streptococci
Mycoplasma pneumoniae (>5 years)
1st line management of pneumonia in children
2nd line management in complicated or unresponsive pneumonia in children
management of severe pneumonia in children
Cefuroxime + Flucloxacillin
management of pneumonia in Mycoplasma suspected (older children)
Macrolide (azithromycin, clarithromycin)
indications for hospital admission in a child with pneumonia
O2 sats <92%
inability to maintain adequate fluid/feeding intake
management of empyema
evaluate by USS
drainage via small bore chest drain
surgery if necessary
what should be considered in recurrent of persistent pneumonia?
inhaled foreign object
main causative pathogen of bronchiolitis
infants at high risk of bronchiolitis
chronic lung disease
congenital heart disease
<6 weeks of age
what can be given to high risk infants to prevent RSV infection?
features of mild bronchiolitis
management of mild bronchiolitis
manage at home
features of moderate bronchiolitis
sats <92% in air
management of moderate bronchiolitis
admit to hospital
IV or NG fluids
features of severe bronchiolitis
Severely ↑ WOB
hypoxia in air
management of severe bronchiolitis
admit to ICU/HDU
high inspired O2
intubation and ventilation
prognosis of bronchiolitis
most infants make a full recovery within 2 weeks, some may have recurrent episodes of cough and wheeze over the next few years and may go on to develop asthma