Paediatrics PDF

Paeds cardiology: Congenital HD: o Acyanotic causes: VSD (most common), ASD, PDA, Coarctation, A valve stenosis o Cyanotic(T): tetralogy, Transposition, Tricuspid atresia ▪ N.B days-months following birth tetralogy > transposition but at BIRTH → trans...

Paeds cardiology: Congenital HD: o Acyanotic causes: VSD (most common), ASD, PDA, Coarctation, A valve stenosis o Cyanotic(T): tetralogy, Transposition, Tricuspid atresia ▪ N.B days-months following birth tetralogy > transposition but at BIRTH → transposition > tetralogy o General Fx: Poor feed, SOB, sweat, hepatomegaly o Manage (cyanotic): ▪ Supportive + prostaglandin E1 (alprostadil) Patent ductus arteriosus (PDA) → open duct between pulmonary trunk and descending aorta (deoxy blood → descending aorta) o Assoc premature, maternal rubella 1st trimester o Continuous machine murmur, (AR fx) collapsing pulse, wide pulse pressure, o Manage: indomethacin/ibuprofen ▪ If Assoc with another congenital HD operable, then prostaglandin E1 till surgery Tetralogy of Fallot: o VSD + RVH + Overriding aorta + pulmonary stenosis (RV outflow tract obstruction) o CFx: ▪ Cyanosis (Tet spells – episodic cyanosis), ▪ ej sys due to pulm stenosis, ▪ R sided aortic arch, RL shunt, o CXR → boot-shaped heart, ECG → RVH o Manage: surg, b-blocks for cyanotic episodes Transposition of the great arteries o Cfx: Cyanosis, tachypnoea, Loud S2, o CXR → ‘egg-on side’ o Manage: prostaglandin to maintain ductus arteriosus until surgery Innocent murmurs: o Venous hums: continuous blowing just below clavicles o Still’s murmur: low pitch ↓L sternal edge (AP-T-M). o Characteristics: soft blowing in pulm area, short buzz in aortic area: ▪ May vary w/ posture, ▪ localised w/ no radiation, ▪ no diastolic component, ▪ no thrill, ▪ no sounds, ▪ asymptomatic, ▪ no other abnormalities. Aortic stenosis in children (Cardiology) o In children: William syndrome, coartaction, turner’s o In children, >60mmhg → balloon valvulo Hypertension in children (Cardiology) o Most common cause of 2ndary → renal parenchymal disease o Others: phaemochromo, CAH, coarctation, renal vascular Paeds gastro: Idiopathic constipation o After few weeks of birth, o 4.5 month then do x-ray rather than Us o Cfx: ▪ Barlow → dislocate articulated femoral head ▪ Ortolani → relocate dislocated femoral head ▪ Other Fx: leg asymm, asymm knees when hip/knee b/l flexed + ↓abduction of hip in flexion o Manage: ▪ Pavik harness if children 4-5 → surg Hypotonia (floppiness) o ^^ + encephalopathy in newborn period → hypoxic ischemic enceph o Causes: incl – cerebral palsy (hypotonia precede spasticity), Juvenile idiopathic arthritis (JIA), still’s disease o Arthritis in someone 38.5oC + non-weight bear + ↑ESR + ↑WCC Slipped Capital femoral epiphysis o 10-15yrs, obese o FX: pain (hip/groin/med-thigh/knee), ↓int rotation whilst flexed ▪ ^^ n.b can be B/L few times o IX: X-ray (AP + lateral → frog leg) o Manage – Internal fixation o Complication: OA, avasc femoral, Chondroly, leg-length disparaty Transient synovitis: o Acute hip pain following recent viral infection, o 3-8 years age o Fx: limp/refuse to weight bear, groin-hip pain, +/- low grade fever ▪ IF fever >38, refer to paeds specialist Paeds surgical/vascular: o Kawasaki: o FX: High-grade fever >5days (resistant to antipyretics) ▪ Strawberry tongue & cracked red-bright lips ▪ Cervical(neck) lymphadeno ▪ Conjunctival injection ▪ Palms & sole red → peels o Clinical o Manage ▪ Aspirin high dose, ALT IVIG & echocardio screen for (Coronary artery aneurysms) o Umbilical disorder: o Umbilical hernia – Assoc: premature (spontane self), down’s, mucopolsyacc stor disease, afro-carib o Paraumbilical – (1000/uL, ▪ ↑Csf WBC & protein > 1g/L, ▪ bacteria on gram stain o 100 | 3 years → pure tone audiometry Immunisation: o Contrain iF: anaphy to previous vac dose, or component of vac ▪ Delay if: current infect/febrile illness ▪ Contrain live vac → preg/immunosuppress ▪ Avoid DTP vaccine if evolving/unstable neuro disorder ▪ MMR: allergy neomycin, received another live within 4 weeks, IVIG within 3 months  Known malaise/fever/rash after 1st dose MMR after 5-10days for 2-3day ▪ Rotavirus: cannot give immune from 15wks age & 24 wks. age (1st & 2nd respective) o Schedule: Birth BCG* 2 months 6-1** + Rota + Men B 3 months ^^ But PCV instead of men B 4 months ^^ + men B only 12-13months Men B MMR PCV 2-8yrs Flu annual 3-4yrs 4-1** MMR 12-13 HPV 13-18 3-1** ▪ * - BCG only if at risk ▪ **: Diptheria Tetanus Whooping/bordella Polio H influenza B Hep B o 2T (Tetanus & dipTheria) o 2P (Polio & Pertussis → whooping) o 2B (H influenza B and hep B) 4 – 1: o -ve 2B 3-1: o -ve whooping (DTP remainder) ▪ Newborn jaundice: o 1st 24hrs: Rhesus/ABO hemoly, hereditary sphero, G6PD o 2-14 days: physiological (esp breastfed) o >14days(21 if premature): ▪ Biliary atresia (conjug & unconjug test → may need surg) ▪ B milk jaundice: breastfed ▪ Also: prematurity, congenital infect (CMV/toxoplasmosis) McCune Albright syndrome (random mutation) o Precocious puberty, Café-au lait spots, polyostotic fibrous dysplasia, short stature Microcephaly: 6months o Manage: underlying?, enuresis alarm (1st line), alt desmopressin (Short term) Obesity – BMI tailored intervention if >91 centile, co-morbidities assess if >98 o Common Fx: lifestyle, Asian, Female, taller, o Conditions: GH deficient, hypothyroid, down, cushing, Prader willi o Consequences: ortho, psycho, sleep apnoea, benign ICH, T2DM/HTN/IHD Pyloric stenosis (*categorize*)  o 2nd-4th week of life, due to hypertrophy of pylorus muscles o Fx: project vomit typically 30mins after feed, palpable mass in abdomen ▪ Hypochloraemia, hypokalaemia alkalosis o Ix: US, manage → ramstedt pyloromyotomy Shaken baby syndrome o Triad: Retinal haemorrhage + Subdural hematoma + encephalopathy o Due to intentional shaking (0-5yrs age) Snoring causes: o Not-obvious: hypothyroid, down, recur tonsillitis, nasal (polyps, septum, hypertrophic nasal turbinate) Sudden infant death: commonest cause of death in 1st year of life o RFS: ▪ baby sleep prone, ▪ parental smoking, ▪ prematurity, ▪ bed sharing, ▪ hyperthermia/head covering o Protective factors: breastfeeding, room sharing (not bed sharing), using dummies (pacifiers) Urinary tract infection in children: investigation o 6months age ^^ → no need for img unless atypical infection/recur infection ▪ Atypical fx: seriously ill/septicaemia, ↓urine flow, Abdo/bladder mass, ↑creatinine, antibiotics no response in 48hrs, non-E.coli orgs ▪ IX: MCUG for