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Whats the difference between blue breath holding and white breath holding?
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.
Long QT syndrome is assoc with...?
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.
Fragile X syndrome is...?
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.
LV hypertrophy occurs in which congenital cardio conditions?
- Moderate-large VSD
What is Fallot's tet?
- Tricuspid atresia
- Overiding Aorta
- RV hypertrophy
Right atrial hypertrophy occurs in which cong.cardio.condition?
- 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.
What is hereditary spherocytosis?
- 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.
What is Legg-Calve-Perthe's disease?
- 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.
Chicken Pox complications?
- Cerebellar encephallopathy (commonest extracutaneous site)
4 broad classes of Causes of short stature?
- Constitutional delay
- Chronic conditions
- Endocrine disorders
Complications of mumps?
- and Orchitis
- occur frequently
- Transverse myelitis
- Cerebellar ataxia
- and Deafness
What is infectious mononucleosis?
How does it present?
How do you manage?
- 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.
Gross Motor Developmental milestones?
- 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.
Fine Motor Developmental Milestones?
- 3 months - Fix and follw
- 6 months - Reaches for objects
- 9 months - Transfers
- 12 months - Pincer
- 2 yrs - Indicates hand dominance
Speech and language milestones?
- 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
Social developmental milestones?
- 2 months - Smiles
- 10 months - Stranger danger
- 18 months - Feeds self
- 2.5 yrs - Symbolic play
- 3.5 yrs - Interactive play
3 broad causes of developmental delay in a child?
some examples of causes within these catgeories?
- Prenatal - Genetic abnorms, Metabolic, Teratogenic, TORCH
- Perinatal - Hypoxia\anoxia, Prematurity, Metabolic
- Postnatal - Infection, Anoxia\hypoxia, trauma\headinjury, Metabolic
What 4 reflexes would you expect a child to have at birth?
Complications of the normal immunisation regime?
Mild fever, some irritability and thats aboooot it.
Contraindications to immunisation?
- Recorded reaction to the same immunisation before
Differential Diagnosis for headache in a kiddy?
- 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
- Viruses, meningitis, sinusitis, hypertension, stress behavioural.
DDx for seizure in a child?
- CNS lesion
- Low Mg\Ca
Complications of obesity in children?
Single most effective way of reducing obesity?
- Orthopaedic probs (sipped femoral head, bow legs, OA)
- Gall bladder disease
- Most effective reduction = Reduce tv time.
Causes, age of presentation, therapies?
- 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)
How do you split Neonatal jaundice up?
Which is\are the worrying period\s?
- 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.
Jaundice with 24 hrs of birth. how do you manage it?
- 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,
HSP - s+s and complications?
- Rash - back of legs and bottom
- Gut involvment - Intussecption
- Testicular swelling\torsion
- Haematuria, Protienuria - send home with dipstix
- Nephrotic, nephritic
- CNS - CVA seizure encephalopathy
HSP rash differentials?
- Meningococcal septicaemia
- Wide carrying angle
- Webbed neck
- broad chest
- low hairline
- low set ears
- Primary amenorrhoea
Pierre robin sequence is...?
Micrognathia, retracting tongue, airway obx, cleft palate.
Batten's disease is?
Horrible stuff...child is fine till 4-5 yrs old, develops visual problems, motor dysfunction, mental impairment, bed ridden usually dead before 20.
What dosage of salbutamol spacer is equivalent to nebulisers?
10 puffs every 4 hours. MAKE SURE YOU SHAKE IT!
Maintenance fluids in a paeds case?
- 100mls for first 10kg
- 50mls for next kgs ad infinitum.
Insulin regimens in a child...?
Good ways to gauge severity of asthma attacks?
- Hosp admissions
- Number of attacks
- How often the use their blue inhaler
- Effect on school attendance.
Cystic fibrosis presents with...?
- Recurrent chest infections
- Rectal prolapse
- Meconium ileus
- sweat test
- Failure to thrive
Hyperbilirubinaemia can cause...?
commonest gastro emergency in kids?
necrotising entero colitis.
DDx for a vesicular rash?
- Chicken pox
- Dermatitis herpetiformis
- Hand foot and mouth.
What is Galactosaemia?
Pattern of inheritance
- 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
What is Bartter's Syndrome?
- Classically: Nephrocalcinosis leading to
- Hypo Na, K, Cl,
Causes of neonatal vomiting?
- Air swallowing
- Necrotising enterocolitis.
How do you manage a 14 year old boy with short stature and showing no signs of puberty?
- Get parental heights
- Look at old growth charts
- Chronologically age his bones
- get a gonadotrophin level
Commonest cardiac defect in down's?
- Endocardial cushion then
- then PDA
What percentage of VSDs close spontaneously?
50% mostly the muscular septum ones.
Commonest cause of Cong Cyanotic HD in a newborn?
Cong. Rubella causes what cardiovascular defect?
Common signs of Heart Failure in infancy?
- Intercostal Insuction
JVP and Basal creps uncommon in infants.
what is a Neonate, infant, toddler.
- neonate - 28 days
- Infant 1-12 months
- Toddler when they start walking.
What is intussuception?
When is it most common?
What are the early and late signs?
How do you treat it?
- 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
Say what you can about duchenne's?
- 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.
Risk factors for Endocarditis?
- Structural Congenital heart defect.
- Acquired valvular abnormalities.
- Previous IE
Causes for a fever with petechiae? other than maningicoccal septicaemia and they can be blanching or non blanching.
- HHV6(roseola) and 7
What is Gaucher's disease?
- 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.
4 main derangments in aspirin overdose in a child?
- Raised ICP
If your unsure wether the pregnant mother of a child with chicken pox is immune what 2 blood tests should you perform?
IgG and IgM for V2V2
Diagnostic clues in vomitting infant...
- Bile stained - exclude intestinal obx - intussception, malrotation, hernias.
- Blood - oesophagitis, peptic ulcer, post nasal drip, malrotation.
- Projectile - especially at 2-7 weeks - Pyloric stenosis.
Commonest causes for vom in infant?
Medical causes of acute abdomen in kids?
- Lead poisoning
- Sickle cell
Extra abdominal causes of acute abdomen?
- Lower lobe pneumonia
- Testicular torsion
- Hip\Back pain
- Gynae probs
What grains contain gluten?
Wheat, Barley, Oats, Rye.
Which antobodies would you request for coeliac screening?
What type of antibody are they?
What is the diagnostic test? how much gluten do they need to eat for it to show anything?
- 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
What is a Neuroblastoma?
How can it present\what does it cause?
Whats the prognosis like if found before the age of 1?
- Malignant neoplasm of the sympathetic chain.
- Can present with paresis\paralysis and cauda equina (saddle anasthesia, faecal+urinary incontinence)
- Prognosis good before age 1.
What test must you remember to do before starting a thiopurine on anyone?
TPMT blood test to make sure they have enough enzyme to metabolise the stuff otherwise theyll get toxic quickly.
Whats the treatment for croup?
- Dexamethasone (0.15mg\kg) and antipyretics
- Then Budesonoide nebs
- Then Adrenaline nebs
- Then IV hydrocortisone
Causes of bloody diarhoea in a kid?
- Infective - Ecoli (must treat causes HUS), C.jejuni, Shigella, Typhoid
- Cows milk allergy
How do you chronologically age bone?
X-ray of left hand...
Gruelich and pyle method to determine by the stage of ossification the age of the bone.
Order of infections in CF patients?
Emergency treatment for croup?
- Humidified oxygen.
In general kids need more or less drug per kilo body wt than adults?
Babies born to diabetic mothers have an increased incidence of...?
- Shoulder dystocia and birth injuries
- Congenital abnormalities.
Sites leukaemia can develop?
Bones, testes, meninges
Treatment time for leukaemia?
Poor prognositic signs of leukaemia in children?
- Involving meninges\testes
- Onset before 1 or after 10-12 years of age.
- High initial WBC
How much milk should a baby be drinking?
Complications of Coealiacs if you dont stick to the gluten free diet?
- GI lymphoma
- Vitamin deficiencies
What kind of Feeds can you get for babys?
- 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)
What are the potential problems with...
- 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.
Absoloute contraindications to breast feeding?
- the most common cause of gastroenteritis worldwide and in infants.
- Self limiting. Maintain ORT until passes.
Natural progression of measles in an infected child?
- Prodromal catarrh, conjunctivitis, cough, runny nose.
- Macular confluent rash on the face.
Hand Foot and Mouth is caused by?
A child with
Recurrent abdo pain
Joint pain\ arthralgia
- Familial mediteranian fever.
- Auto recessive
- Autoinflam condition due to mution in MEFV