Paeds

Blue is a behavioural\tantrum condition, goes crazy, holds breath, goes blue, passes out, comes back around, everything hunky dorey...

White is far more sinister and occurs due to exteme vagal tone causing transient asystole, as its cardiogenic its not preceeded by blueness cuz they're not cyanotic.

Congenital deafness, so if mum comes in saying 5 year old billy passes out now and again, ask about hearing and language development since birth.

• Presents with tachycardia, tachypnoea, fever, sweating, nausea vomiting, dehydration.
• Can present with neuro symptoms such as lethargy and seizures. If it does be aware of Reye's syndrome, aspirin induced non inflammatory encephalopathy and hepatotoxicity.

Treat with activated charcoal, correcting metabolic derangments, fluid, alkalinisation of urine and haemodialysis.

A trinucleotide repeat disease caused by CGG repition on the X chromosome. (males more oft affected than females)

Physical phenotype: Tall, flat footed, protruding ears, hyperflexible, long faces.

Intellectually: Learning disability and most common single gene cause of autism.

• Moderate-large VSD
• Coarctation
• PDA

• Tricuspid atresia
• Overiding Aorta
• VSD
• RV hypertrophy

ASD

• Malignant neoplasm of mesenchymal origin.
• Most commonly affects adolescents and young adults, can affect the elderly in assoc with paget's.
• Affects metaphyseal growth plates and causes periosteal elevation (codman's triangle) and sunburst appearence on xray due to calcified spicules.
• Most commonly occurs around the knee or in the upper arm.
• Bone pain, weakness, fracture.
• Commonly goes to lungs, not good if it does.

• Autosomal dominant
• Severe forms can present in the neonatal period . Splenomegaly is common.
• Haemolysis occurs and the blood film can look similar to autoimmune haemolytic anaemia.
• Coombes test is negative cuz it aint autoimmune. Splenectomy after the age of 5 stops further haemolysis and the patient can lead a normal life.

• Avascular necrosis of the femoral head in kids aged 4-10. The bone eventually is reabsobed and replaced but can be deformed and cause arthritis.
• Rx is basically taking load off the joint till everything is hunkey dorey, traction, orthotics, surgery, whatever it takes to maintain funciton.

• Pneumonia
• Cerebellar encephallopathy (commonest extracutaneous site)
• Pancreatitis
• Hepatitis

• Familial
• Constitutional delay
• Chronic conditions
• Endocrine disorders

• Parotitis
• Oophoritis
• and Orchitis

• occur frequently
• Meningo-encephalitis
• Arthritis
• Transverse myelitis
• Cerebellar ataxia
• and Deafness

Rare

• An infectious ilnnes caused most commonly by EBV and then CMV or Toxo.
• Presents with fever, pharyngitis, fatiuge, lethargy, malaise, viral symptoms. Can have rash. Lymphadenopathy, splenomegaly.
• Investigate with monospot test for EBV. treat symptoms and avoid contact sports until spleen is better.

• 4 months - Head control
• 9 months - Sit unsupported
• 12 months - Stand independently
• 18months - Walk independently
• 2yrs - Stands on tiptoe, kicks ball, up and down stairs,
• 3yrs - Up and down stairs alternating steps, jump both feet.

• 3 months - Fix and follw
• 6 months - Reaches for objects
• 9 months - Transfers
• 12 months - Pincer
• 2 yrs - Indicates hand dominance

• 7 months - turns to voice\ polysyllabic babble
• 10 months - constant babble
• 18 months - six words
• 2 years - joins words
• 2.5 years - 3 word sentences

• 2 months - Smiles
• 10 months - Stranger danger
• 18 months - Feeds self
• 2.5 yrs - Symbolic play
• 3.5 yrs - Interactive play

• Prenatal - Genetic abnorms, Metabolic, Teratogenic, TORCH
• Perinatal - Hypoxia\anoxia, Prematurity, Metabolic
• Postnatal - Infection, Anoxia\hypoxia, trauma\headinjury, Metabolic

• Rooting
• Moro
• Placing
• Grasp

Mild fever, some irritability and thats aboooot it.

• Immunosupression
• Recorded reaction to the same immunisation before

• Brain tumor - low threshold of suspicion, REFER!
• Raised ICP - headache nausea vomiting listless diplopia.
• Herpes simplex encephalitis - suspect in any child with headache + seizures\ cns signs
• Migraine
• Viruses, meningitis, sinusitis, hypertension, stress behavioural.

• Febrile
• Meningo-encephalitis
• Epilepsy
• tumor
• CNS lesion
• trauma
• Low Mg\Ca

• Diabetes
• PCOS
• Orthopaedic probs (sipped femoral head, bow legs, OA)
• Gall bladder disease
• asthma
• Most effective reduction = Reduce tv time.

• Caused by blackade of sebum in follicles of sebaceous glands. Often present during puberty.
• Best treated by unblocking follicles - Benzoyl peroxide (keratolytic)
• topical antibiotics or retinoids
• Oral antibiotics in kids over 12 (tetracyclines and erythro)

• Within 24hrs
• Betwen day 2 and week 2
• After week 2

Within 24hrs and longer than 2 weeks are the most worrying. Within 24 hrs means theres haemolysis going on and after 2 weeks its prolonged jaundice risking long term complications.

• Most commonly caused by haemolysis or infection.
• Haemolysis - abo incompat, rhesus disease of the new born, spherocytosis, autoimmune.
• TORCH screen to rule those out.
• managment - coombs,

• Rash - back of legs and bottom
• Arthritis
• Gut involvment - Intussecption
• Testicular swelling\torsion
• Haematuria, Protienuria - send home with dipstix
• Nephrotic, nephritic
• CNS - CVA seizure encephalopathy

• Meningococcal septicaemia
• ITP

45XO

• Wide carrying angle
• Webbed neck
• broad chest
• low hairline
• low set ears
• Hypothyroid
• Diabetes
• Primary amenorrhoea

Micrognathia, retracting tongue, airway obx, cleft palate.

Horrible stuff...child is fine till 4-5 yrs old, develops visual problems, motor dysfunction, mental impairment, bed ridden usually dead before 20.

10 puffs every 4 hours. MAKE SURE YOU SHAKE IT!

• 100mls for first 10kg
• 50mls for next kgs ad infinitum.

• Basal bolus
• Bi daily

• Hosp admissions
• Number of attacks
• How often the use their blue inhaler
• Effect on school attendance.

• Recurrent chest infections
• Rectal prolapse
• Meconium ileus
• sweat test
• steatorrhoea
• Failure to thrive
• infertility

• Kernicterus
• Deafness

necrotising entero colitis.

• Chicken pox
• Dermatitis herpetiformis
• Shingles
• Hand foot and mouth.

• Auto Recessive
• Lack of the enzymes required to turn galactose (product of lactose breakdown) into glucose.
• Jaundice, hypoglycaemia, lethargy, hepatomegaly, cataracts, renal failure, brain damage.
• Rx = Avoid Lactose

• Classically: Nephrocalcinosis leading to
• Polyuria
• Alkalosis
• Hypo Na, K, Cl,
• Dehydration
• FTT

• GORD
• Air swallowing
• Necrotising enterocolitis.

• Get parental heights
• Look at old growth charts
• Chronologically age his bones
• get a gonadotrophin level

• Endocardial cushion then
• AVSD
• then PDA

50% mostly the muscular septum ones.

• Fallot's Tet
• TGA

PDA

• Intercostal Insuction
• Tachycardia
• Hepatomegaly

JVP and Basal creps uncommon in infants.

• neonate - 28 days
• Infant 1-12 months
• Toddler when they start walking.

• When a proximal segment of bowel peristalsis against an aperistaltic segment and causes telescoping. Can be caused by tumors, peyers patches, HSP or idiopathic.
• Most common in 3 months - 3 years old BOYS.
• Early signs are colicky abdo pain and non-bilious vomit.
• Late signs are Red currant jelly stools
• Treat with air\water enema

• X-linked recessive obv cuz only boys get it.
• Presents with delayed walking and speech. Cardiomyopathy scoliosis and most importantly calf pseudo hypertrophy, where the muscle is replaced with datty\fibrous tissue and it looks big but is non functional.

• Structural Congenital heart defect.
• Acquired valvular abnormalities.
• Previous IE
• HOCM

• Enterovirus
• HHV6(roseola) and 7

• Accumulation of Sphingolipids due to lack of glucocerebrosidase.
• These lipids accumulate in macrophages which then accumulate in the liver, spleen, bone, skin, kidney, brain.
• Cause organomegaly, skin tinting, bony erosions.

• Coagulopathy
• Raised ICP
• Hyoglycaemia
• Hyperammonaemia

IgG and IgM for V2V2

• Bile stained - exclude intestinal obx - intussception, malrotation, hernias.
• Blood - oesophagitis, peptic ulcer, post nasal drip, malrotation.
• Projectile - especially at 2-7 weeks - Pyloric stenosis.

• Reflux
• Gastroenteritis
• LRTI\UTI\meningitis
• Posset\regurg

• Gastroenteritis
• Hepatitis
• Pyelonephritis
• DKA
• HSP
• Lead poisoning
• IBD
• Constipation
• Sickle cell

• Lower lobe pneumonia
• Testicular torsion
• Hip\Back pain
• Gynae probs

Wheat, Barley, Oats, Rye.

• Anti-ttg
• Antiendomysial
• IgA - thats why you shud do an IgA titre to cuz coelliacs have a decreased igA
• Jejunal biopsy looking for sub-total villous atrophy and lymphocytic infiltrates. 6g\day for 6 weeks

• Malignant neoplasm of the sympathetic chain.
• Can present with paresis\paralysis and cauda equina (saddle anasthesia, faecal+urinary incontinence)
• Prognosis good before age 1.

TPMT blood test to make sure they have enough enzyme to metabolise the stuff otherwise theyll get toxic quickly.

• Dexamethasone (0.15mg\kg) and antipyretics
• Then Budesonoide nebs
• Then Adrenaline nebs
• Then IV hydrocortisone

• Infective - Ecoli (must treat causes HUS), C.jejuni, Shigella, Typhoid
• IBD
• Intussception
• Cows milk allergy

X-ray of left hand...

Gruelich and pyle method to determine by the stage of ossification the age of the bone.

• Hib
• Staph
• Pseudomonas

• Humidified oxygen.
• Dexamethasone

More

• Hypoglycaemia
• Shoulder dystocia and birth injuries
• Congenital abnormalities.

Bones, testes, meninges

• 2yrs girls
• 3 yrs boys

• Involving meninges\testes
• Onset before 1 or after 10-12 years of age.
• High initial WBC

150ml\kg\day

• GI lymphoma
• Subfertility
• Vitamin deficiencies

• Modified cows milk. Whey then caesin
• Broken down cows milk to polypeptides
• Super broken down to amino acids
• High energy feeds for chronic diseases or kids that need to gain. (1kcal\ml whereas other are .66Kcal\ml)

• Cow and goat are essentially the same so if you have allergy thats an issue.
• Oat mik doesnt have a lot of energy in it.
• Rice milk has quite high levels of arsenic.
• Soya has high levels of phytoestrogens and can mess around with babys hormones.

• Lithium
• Chemo
• Galactosaemia

• the most common cause of gastroenteritis worldwide and in infants.
• Self limiting. Maintain ORT until passes.

• Prodromal catarrh, conjunctivitis, cough, runny nose.
• Macular confluent rash on the face.

Coxsakie

• Familial mediteranian fever.
• Auto recessive
• Autoinflam condition due to mution in MEFV