Paediatrics

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Author:
grignoter
ID:
192359
Filename:
Paediatrics
Updated:
2013-03-19 17:46:13
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paediatrics medicine
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Description:
Paediatrics
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  1. Apgar Score Components
    • Appearance: blue or pale / peripheral cyanosis / pink
    • Pulse: absent / <100 / >100
    • Grimace to stimulation: absent / feeble / cry or pull away
    • Activity: flaccid / some flexion / active flexion resisting extension
    • Respiration: absent / weak, irregular or gasping / strong cry
  2. Interpreting the Apgar Score
    Maximum score is 10

    >7 is normal, especially immediately after birth when cyanosis is common

    <3 is critical, intubation may be indicated
  3. Normal Blood Pressure in Children
    90 + age (years)

    over

    55 + age (years)
  4. Approximate Body Weight for Children
    (age in years + 4) x 2
  5. Approximate Body Weight in Infants
    • 3 months - 6kg
    • 6 months - 8kg
    • 9 months - 9kg
    • 12 months - 10kg
  6. Respiratory Rate in Children
    • 1 month - 60
    • 1 year - 30
    • 10 years - 15
  7. Advantages of Breast Feeding
    • Bonding
    • Reduced solutes - sodium, phosphate and proteins
    • Eczema - lower incidence
    • Allergy protection - including reduce intolreance of cow's milk
    • Sterilisation not required
    • Taurine - promotes development
    • Macrophages
    • IgA and higher IQ
    • Lactoperoxidase, lysosyms, lactoferrin, long-chain fatty acids
    • Kot death reduction
  8. Innocent Murmurs
    • Symptom-free
    • Systolic
    • Split second sound
    • Sternal edge (left)
    • Small area (pulmonary only)
    • Soft
  9. Transposition of the Great Arteries
    • RV --> aorta
    • LV --> pulmonary artery trunk
    • duct-dependent circulation
    • unwell
    • cyanosis and acidosis when duct closes
    • switch operation required for definitive management
  10. Transposition of the Great Arteries on CXR


    • narrow mediastinum
    • egg-on-side appearance of heart
  11. Coarctation of the Aorta
    • non-cyanotic
    • shock
    • poor perfusion of limbs distal to coarctation
    • absent femoral pulses
  12. Eisenmenger's Syndrome
    • cyanotic heart disease
    • presents in teenage years
    • septal defects
    • over time, the right ventricle hypertrophies
    • RVH --> reversal of flow --> L to R shunt --> cyanosis
  13. Patent Ductus Arteriosis
    • loud machinery-like murmur
    • heart failure
  14. Duct Dependent Circulations
    • transposition of the great arteries
    • coarctation of the aorta
    • critical aortic stenosis
    • hypoplastic left heart syndrome
  15. Presentation of Duct Dependent Circulations
    heart failure during first week of life

    left outflow obstruction means blood only reaches systemic circulation via PA --> ductus
  16. Congenital Left to Right Shunts
    • VSD
    • ASD
    • PDA
    • shunts are BACKWARDS!
  17. Presentation of Congenital Left to Right Shunts
    • breathless
    • blood is being shunted backwards
    • volume overload in lungs and right heart
    • pulmonary oedema
    • systemically poor perfusion
    • septal defects or PDA
  18. Congenital Right to Left Shunts
    • tetralogy of Fallot
    • transposition of the great arteries
    • shunts are FORWARDS, bypassing lungs
  19. Presentation of Congenital Right to Left Shunts
    • blue
    • blood bypasses the lungs
    • poor oxygenation
    • heart failure at greater than 1 week old
  20. Precocious Puberty
    • < 8 in girls
    • < 10 in boys
    • brain MRI, gonadotrophin levels, sex steroid levels
  21. True Precocious Puberty
    • normal sequence suggesting intact HPG axis
    • commoner in girls
    • more likely to be pathological in boys
    • > 80% idiopathic
    • intracranial pathology: tumours, haemorrhage, hydrocephalus, neurofibromatosis, cerebral palsy
    • primary hypothyroidism
  22. Pseudo Precocious Puberty
    • abnormal sequence
    • girls: hair + growth without breast buds
    • boys: puberty features but small testes
    • gonadotrophin-independent
    • usually extra-cranial
  23. Causes of Pseudo Precocious Puberty
    • adrenal virilizing tumours
    • congenital adrenal hyperplasia
    • Cushing's syndrome
    • testicular or ovarian malignancy
    • gonadotrophin secreting tumours (hepatoblastoma)
    • McCune-Albright syndrome
  24. McCune-Albright Syndrome
    • sporadic genetic condition
    • ovarian cysts --> oestradiol --> precocious puberty
    • cafe-au-lait spots
    • polyostotic fibrous dysplasia (normal bone replaced by cysts)
  25. Premature Pubarche
    presence of pubic hair without other signs of puberty
  26. Premature Thelarche
    appearance of breast tissue without maturation of the nipple or other signs of puberty
  27. Tanner Stages of Pubic Hair
    • 1. none (< 10)
    • 2. small amount, downy (< 11.5)
    • 3. coarse, curly (< 13)
    • 4. extends across pubis (< 15)
    • 5. medial thighs (> 15)
  28. Tanner Stages of Testes
    • 1. <1.5ml (< 9 )
    • 2. < 6ml, skin thins (< 11)
    • 3. <12 ml, scrotum enlarges (< 12.5)
    • 4. < 20ml, scrotum enlarges further (< 14)
    • 5. > 20ml, adult scrotum and penis (> 14)
  29. Tanner Stages of Breasts
    • 1. no glandular tissue, areola follows skin contour (< 10)
    • 2. buds, areola widens (< 11.5)
    • 3. breast elevates and extends beyond areola (< 13)
    • 4. increased size, areola and nipple form secondary mound (< 15)
    • 5. adult size (> 15)
  30. Mild Dehydration (5%)
    • weight loss 5% (infant) or 3% (teenager)
    • thirsty
    • everything else normal
  31. Moderate Dehydration (10%)
    • weight loss 10% (infant) or 6% (teenager)
    • thirsty, restless, lethargic, irritable, drowsy
    • tachycardia
    • weak pulses
    • orthostatic hypotension
    • slightly decreased skin turgor and sunken fontanelle
    • dry mucous membranes
    • deep respirations
    • oliguria
  32. Severe Dehydration (15%)
    • weight loss 15% (infant) or 9% (teenager)
    • drowsy, limp, cold, sweaty, cyanotic, comatose
    • tachycardia and hypotension
    • decreased pulse
    • poor perfusion, mottled
    • reduced skin tugor
    • very dry mucous membranes
    • sunken fontanelle
    • absent tears
    • deep and rapid breathing
    • anuria

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