Paediatric Revision Lecture - June 2016pdf
Paediatric Revision Lecture - June 2016pdf
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  1. Paediatrics Revision Lecture15thJune 2016Dr Andrew L. SmithMBBS BSc (Hons) AFHEA
  2. Infection and Allergy in ChildhoodCOMPAS Objectives...Allergy and Immune Disease in ChildhoodKnow about the common presentation of allergy in childhood (L2002) Know how to manage acute anaphylaxis in children (L2003) Be able to dagnose common rashes, ear and eye conditions in children and treat them appropriately (L5304) Know the main causes of rashes in children and be able to differentiate between infectious and non-infectious causes (L3087) Know about the major immuno-deficiencies that present in children. (L3413) Infections in ChildhoodKnow the clinical features, causative organisms, diagnosis and management of most common causes of respiratory tract infections, both upper and lower (L2868) Be familiar with the presentation and treatment of common and serious childhood infections (L3950) Be able to recognise the child with Neutropenic sepsis (patient on chemotherapy, bone marrow failure) (L2376) Know the causative organisms, clinical features and management of common childhood infections including meningitis (L2392) Know the differences in performing lumbar punctures in children compared with adults, the indications and possible complications of the procedure (L3029) Understand the significance of a raised temperature in children, how to identify causes, and basics of management, together with advice to parents (L3126) Know about the differential diagnosis of childhood fever (L3951) Be able to dagnose common rashes, ear and eye conditions in children and treat them appropriately (L5304) Know the appropriate investigations for a febrile child at different ages (L3952) Neonatal Disorders -GeneralGeneral TopicsUnderstand the clinical importance and acute treatment of Neonatal infections and common organisms (L1981) Know about the major causes of congenital and neonatal infections and how to diagnose and treat/prevent (L1977) Appreciate the range of illnesses and treatments encountered in the neonatal unit (L3956) Witness neonatal resuscitation and understand basic problems in perinatal adaptation (L3129) Know the causes of the floppy infant (L5302) Understand the importance of temperature control in newborn care (L1982) Normal Newborn and FeedingKnow how to examine a newborn baby and be aware of normal variations compared with significant pathology, and be able to present the findings in an ordered and logical manner and discuss the findings with the parents (L2387) Know how to initiate feeding in a newborn infant (L1978) Understand the adaptation to extra-uterine life with particular reference to cardio-respiratory and metabolic changes (L1980) Jaundice of the NewbornUnderstand the pathophysiology and treatment of Haemolytic Disease of the newborn and other causes of neonatal jaundice (L3120) Premature Birth and Low BirthweightUnderstand the pathophysiology and sequelae of Periventricular haemorrhage (L1984) Describe the risk factors and consequences of Necrotising Enterocolitis (L1987) Understand the physiological basis and treatment of Respiratory Distress Syndrome (L1986) List the consequences of prematurity. Briefly describe the pathology of hyaline membrane disease, necrotising enterocolitis and intraventricular haemorrhage (L1976) Be able to control a newborn infant's temperature in an incubator if necessary (L2347) Surgical Problems in the NeonateKnow the primary defect in Gastroschisis and Exomphalos (L1993) Birth AsphyxiaKnow the causes, grading and sequelae of Hypoxic Ischaemic Encephalopathy (L2865) Puberty and Pubertal ProblemsPuberty and Disorders of Puberty -GeneralUnderstand the physiology of puberty and the associated physical changes (L2659) Childhood EmergenciesChildhood Emergencies -GeneralUnderstand the management of acute trauma in childhood (L3118) Understand the recognition and management of acute exacerbations of chronic disease (L3123) Revise from Phase I, the epidemiology, risk factors, theories on pathogenesis and autopsy features of sudden infant death syndrome (L3134) Be able to interpret oxygen saturation and blood gas readings in an ill child (L2355) Know the diagnosis of acute poisoning in childhood (L2870) Resuscitation of ChildrenBe able to perform effective airway management, ventilation and chest compression in a young child, and be capable of recognising pre-terminal signs in children (L3131) Know about the action of first line resuscitation drugs and their mode of delivery (L2349) Cardio-Vascular Disorders in ChildhoodCardio-Vascular Disorders in Childhood -GeneralBe able to differentiate between significant and innocent heart murmurs (L2334) Know about non-anatomical cardiac disorders in children, including arrhythmias, cardiomyopathy and Kawasaki disease (L5297) Congenital Heart DiseaseKnow the anatomy and physiology of congenital heart disease (L2203) Know the presenting features of cyanotic and acyanotic congenital heart disease (L2204) Understand the role of prostaglandins and diuretics in the acute management of congenital heart disease (L2205) Respiratory DisordersGeneral Outcomes for Childhood Respiratory DisordersUnderstand the physiological basis and treatment of Respiratory Distress Syndrome (L1986) Understand that wheezing in childhood may result from Foreign Body Inhalation (L2201) Understand why fluid overload may occur in children with respiratory disease (L3128) Asthma in ChildhoodKnow the causes of wheezing in children of different ages. This should include knowledge of the clinical features and management of Bronchiolitis, Asthma and Foreign Body inhalation. (L2199) Be able to recognise the clinical features and manage an acute asthma attack in a child (L2377) Be able to recognise, assess and treat children with Asthma (L2378) Know the clinical features and management of cystic fibrosis (L2866) Know the commonly used inhaler devices and how to explain their use to families and children (L2869) Respiratory Infections in ChildrenKnow the clinical features, causative organisms, diagnosis and management of most common causes of respiratory tract infections, both upper and lower (L2868) Know how to treat children with Bronchiolitis (L2197) Neurological Disorders and Disability in ChildhoodDevelopmental Disorders and Disability in ChildhoodAppreciate the psychosocial effects of neuro-developmental disability (L2169) Be able to carry out a basic developmental examination of a child at key stages of 6 weeks, 12 months and 3 years and present the findings in an ordered and logical manner (L2170) Be able to recognise from a developmental history the child with Learning difficulties. Be aware of the multidisciplinary team involved in the management of learning difficulties (L2172) Know the physical and developmental features, clinical signs, and multidisciplinary management of Down's syndrome (L2181) Understand the psychosocial effects of neuro-developmental disability (L3122) Understand the importance of a multidisciplinary team in the care and management of a child with neuro-developmental disability in the context of multidisciplinary care and hospital versus community care (L2184) Be aware of the role of non-medical staff in therapy (physiotherapists, occupational therapists, play specialists, speech and language therapists, psychologists, nursery and school staff (L2384) Neurological Disorders of Childhood -GeneralKnow the causative organisms, clinical features and management of common childhood infections including meningitis (L2392) Be able to perform a history, examination and investigations for a child with a neurological disorder (L5299) Be able to differentiate static and progressive neurological disease in childhood (L5298) Know the causes of the floppy infant (L5302) Know the clinical features and investigation of Neuromuscular Disorders in childhood (L5300) Epilepsy in ChildhoodUnderstand the spectrum of paediatric Epileptic disorders (including febrile convulsions) and the principles of management and treatment (L3127) Cerebral PalsyUnderstand the pathophysiology and sequelae of Periventricular haemorrhage (L1984) Know the presentation, clinical signs, and multidisciplinary management of Cerebral Palsy (L2180) Haematological DisordersHaematological Disorders of Childhood -GeneralKnow about the genetic basis and management of Haemophilia (L5308) Anaemia in ChildhoodKnow the causes and treatment of iron deficiency in childhood (L2864) Haemoglobinopathies -General (exc. Sickle Cell)Know the clinical presentation, management and molecular basis of haemoglobinopathies (L2186) Sickle Cell Disease in Childhood -GeneralKnow the clinical features of Sickle Cell Crisis in children (L2187) Know the management of Sickle Cell Disease in children (L2188) Haematological Malignancies in Childhood -GeneralBe able to recognise the child with Neutropenic sepsis (patient on chemotherapy, bone marrow failure) (L2376) Be able to identify the main presenting features of childhood malignancy and basic principles of management (L2361) Know about the presentation and treatment of childhood leukaemia (L3953) Know the treatment needed for a patient with Neutropenic sepsis (patient on chemotherapy, bone marrow failure) (L2189) Gastrointestinal DisordersGeneral Outcomes for Childhood Gastrointestinal DisordersKnow the clinical presentation, investigation and management of the common gastrointestinal problems seen in children (L2216) Appreciate the clinical features, differential diagnosis and management of abdominal pain in childhood, including appendicitis, abdominal sepsis, Idiopathic (including psychological) causes, inflammatory bowel disease and rare diseases (e.g. porphyrias). (L1988) Know the primary defect in Gastroschisis and Exomphalos (L1993) Understand that abdominal pain may result from Inflammatory bowel disease (L2218) Understand the causes and management of Malabsorption syndromes in childhood (L2219) Understand the presentation and management of Inflammatory Bowel Disease in childhood (L2222) Acute Abdomen in ChildrenAppreciate the clinical features, differential diagnosis and management of abdominal pain in childhood, including appendicitis, abdominal sepsis, Idiopathic (including psychological) causes, inflammatory bowel disease and rare diseases (e.g. porphyrias). (L1988) Know the common surgical problems throughout childhood: both acute and chronic; recognition, management, and prognosis; preparing a child and family for the operating theatre (L1991) Be capable of taking a history and examining a child with acute abdominal pain. (L1989) Coeliac DiseaseBe able to recognise the clinical presentation and understand the pathological features of Coeliac disease (L2206) Nutritional and Feeding Problems in ChildhoodBe able to take a history of childhood feeding and understand the causes of feeding problems in childhood (L2207) Know how to manage a child with nutritional problems, including plotting weight and height charts accurately, and appreciating the significance of changes in the centiles (L2389) Renal and Urinary Tract Disorders in ChildhoodRenal and Urinary Tract Disorders in Childhood -GeneralKnow the pathophysiology, clinical presentation, investigation and management of the common urinary tract problems seen in children (L2210) Understand the importance and difficulties of methods of urine collection in the diagnosis of urinary tract infections, and the difficulties in interpretation of the results (L3108) Know about the presentation, investigation and treatment of childhood enuresis (L3954) Know about the presentation and management of nephrotic syndrome, nephritis and renal failure in childhood (L3955) Disorders of the Endocrine System Endocrine Disorders of Development and GrowthBe able to assess childhood growth using a centile chart and understand the different endocrine causes of abnormal growth (L2328) Know the causes and treatment of Childhood Rickets (L2863) Psychiatric / Psychological Problems in ChildhoodPsychiatric / Psychological Problems in Childhood -GeneralUnderstand the effect of chronic medical or developmental problems on the family unit (L3104) Be able to recognise the child with Autistic Spectrum Disorder (L2027) Be able to carry out a mental state examination of a child and present the findings in an ordered and logical manner (L2004) Understand psychological development at different ages (L2043) Behavioural Problems in Childhood -GeneralKnow the presentation, clinical signs and multidiciplinary management of ADHD (L2032) Know the multidiciplinary management of Behavioural problems of early childhood (L2037) Know the presentation and clinical signs of behavioural problems of early childhood (L2040) Be able to describe observed behaviours clearly in a confident manner (L2005) Be able to discuss what needs to be considered when assessing behaviour and mental health problems (L2025) Be able to make informed decisions about whether observed behaviours are inappropriate (L2026) Understand that many childhood presenting complaints have no organic basis and to be able to confidently and confidentially explore these areas with the family (L2044) Congenital and Genetic Abnormalities General Outcomes for Congenital and Genetic AbnormalitiesKnow important elements of history, examination and diagnostic tests for the dysmorphic child and suspected childhood genetic disorders (L1994) Describe the role of the clinical geneticist (L3498) Know the primary defect in Gastroschisis and Exomphalos (L1993) Know about the major causes of congenital and neonatal infections and how to diagnose and treat/prevent (L1977) Know the major features of chromosomal syndromes (trisomies and microdeletion syndromes) (L1999) Be able to outline the process of genetic counselling (L1997) Be able to explain the inheritance and recurrence risk of monogenic disorders with dominant, recessive or X-linked inheritance (L1996) Know the clinical features and genetics of important chromosomal and single gene disorders (L1995) Down's SyndromeKnow the physical and developmental features, clinical signs, and multidisciplinary management of Down's syndrome (L2181) Child Protection, Health Promotion and Social PaediatricsChild and SocietyKnow the aims and methods of child health promotion and the professionals involved and list the core programme on offer to all children in the district where you worked (L2390) Understand the involvement of families and the importance of non-medical management in the management of children with a range of paediatric conditions (L3115) Understand the influence of socio-economic status on neonatal and childhood illness (L3114) Be able to discuss accident prevention in the home and the environment (L2351) Understand the influence of home factors in relation to hospital and community practice and on the health of the child (L3113) Understand the link between smoking, drug and alcohol intake and its impact on children's health (L3117) Understand and appreciate the overlap and interface with primary care and community child health, and with other specialists in patient management (L3098) Understand the effects of social deprivation/neglect on the psychological development of the child (L2183) Be able to describe the aims and methods of child health promotion and the professionals involved and list the core programme on offer to all children in the district where you worked (L2171) ImmunisationKnow the live vaccines and their contraindications (L3137) Know the recommended schedule of immunisation and the major contradictions and be able to discuss with parents (L3094) Know the programme and professional groups involved in Child Surveillance and Immunisation in the UK (L3093) Have observed the administration of immunisations and be familiar with the current UK immunisation schedule (L5305) Child ProtectionKnow the major forms of child abuse (Neglect, Physical, Emotional & Sexual abuse) (L3509) Know the presentation and clinical signs of Neglect, Emotional and Sexual child abuse (L2042) Know and recognise the signs of Physical child abuse (L2174) Know the legal measures available for the protection of children (L2176) Understand the Child Protection procedures and appreciate the importance of close liaison with all professionals dealing with child abuse (including social services, police, medical, education services) (L2001) Understand the effects of social deprivation/neglect on the psychological development of the child (L2183)
  3. General PlanFoetal MedicineNeonatesChildhood IllnessAdolescent Medicine
  4. Foetal Medicine
  5. Foetal Health•The foetus receives all of its nutritional and metabolic requirements from the placenta.•Maternal Factors causing placental insufficiency:•Hypertension inc. Pre-eclampsia•Diabetes•Infections•Other Factors•Monochorionic Multiple Pregnancies (Twin-twin transfusion syndrome)•Placental abruption
  6. Some DefinitionsIntrauterine Growth Restriction (IUGR) -Poor growth of the foetus in-utero. May be:•Asymmetrical –e.g. ‘head-sparing’ where brain development is prioritised•Placental insufficiency•Symmetrical –generalised small growth•Chromosomal abnormalities•InfectionsSmall for Gestational Age (SGA)/Small for Dates -A baby born <10thcentile for weight •90% show catch up growth in the first 2 years•There is evidence that SGA babies are at increased rick of coronary artery diseaseLarge for Gestational Age -Born >90thCentile for weightNote:•An SGA baby may have suffered from IUGR, but it could be normal forthat baby.•Equally, a baby may have suffered IUGR but not be SGA
  7. Some more definitions•Preterm –born before 37 weeks gestation•Low Birth Weight (LBW) -<2500g•Very LBW -<1500g•Extremely LBW -<1000g•Stillbirth–Born dead (no signs of life) after 24 weeks gestation•Stillbirth rate –the number of stillbirths per every 1000 live-births andstillbirths•Perinatal mortality –the number of stillbirths and deaths in the first week of life per 1000 births•Neonatal Mortality –Death before the age of 28 days•Infant mortality –Death in the first year of lifeIndependent of gestational age
  8. Congenital Infections•These are infections of maternal origin, affecting the foetus in-utero.•Main Culprits –“TORCH” •Toxoplasmosis•‘Other’ –inc. Syphilis, Parvovirus, VZV, HIV•Rubella•Cytomegalovirus•Herpes Simplex•There can be many similarities between the infective syndromes, e.g. IUGR, hepatosplenomegaly, eye problems.•Generally, the earlier in the pregnancy, the worse outcome for the baby.•They may be contracted during labour
  9. Question Timea.Toxoplasmab.Rubellac.Syphilisd.CMVe.Parvovirus B19f.Varicellag.HSVh.Group B Strep.i.Listeria1.Neonate with cataracts, deafness, machinery murmur over praecordium and salt-and-pepper retinopathy.2.Neonate found to have hydrocephalus, chorioretinitis and intracranial calcifications.3.Neonate born with scarring around the abdomen and short arms with abnormal hands4.Neonate noted to have nasal congestion and a rash on the palms and soles with hepatosplenomegaly
  10. Question Time –Answersa.Toxoplasmab.Rubellac.Syphilisd.CMVe.Parvovirus B19f.Varicellag.HSVh.Group B Strep.i.Listeria1.Neonate with cataracts, deafness, machinery murmur over praecordium and salt-and-pepper retinopathy. B2.Neonate found to have hydrocephalus, chorioretinitis and intracranial calcifications. A3.Neonate born with scarring around the abdomen and short arms with abnormal hands.F4.Neonate noted to have nasal congestion and a rash on the palms and soles with hepatosplenomegaly C
  11. Congenital Toxoplasmosis•Toxoplasma gondii –obligate intracellular protozoan. •Caught from undercooked meat/kitten litter•May cause intrauterine death in first trimester or be asymptomatic at birth.•~10% show classic triad of:•Hydrocephalus•Chorioretinitis•intracranial calcifications•Also: low IQ, convulsions, deafness, hepatosplenomegaly, jaundice•Treatment –long term treatment with Pyrimetamine, Sulfadiaxine, calcium folinate and/or Spiramycin
  12. Congenital Rubella•Characteristically causes:•sensorineural deafness, cataracts and salt-and-pepper retinopathy.•Congenital heart disease (PDA, Pulmonary Stenosis)•Blueberry muffin rash•Also, IUGR, microcephaly, low IQ, cerebral calcifications•Most severe if contracted in first trimester, minimal risk to foetus after 18 weeks.•Non-immune mothers cannotreceive MMR during pregnancy as it is a live-vaccine.
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