Neonatal conjuctivitis

"Silver eyed on day 1

Gon home within 7 days

only to return after a week

with trachs on his chlam

and again in a month

when the herpes showed up!"

Day 1:Chemical conjuctivitis

Day 3-7: Gonococcal

After wk 1: Chlamydia

After 3wks: Herpes 

Reye syndrome

Encephalopathy following an acute viral illness  in a child due to aspirin use

high level of ammonia

liver biopsy shows fatty changes

No treatment. supportive care: correct hypoglycemia, anti emetics, electrolytes etc

Rash involving hands and feet

Most rashes don't involve hands and feet. If an acute illness with rash involves hands and feet, think of

• Syphilis (secondary)
• Rocky mountain spotted fever (centrifugal rash)
• Coxsackie virus (hand, foot and mouth disease)

School phobia

School phobia is a seperation anxiety disorder.

It must be present for at least 4 weeks

Order of changes at Puberty

At puberty, it's time to TAG along!
Girls:
Thelarche - breast development (usually the first sign of Gonardache -onset of true central puberty)
Adrenarche: axillary hair and Pubarche- pubic hair (Adrenarche:can preceed true puberty)
Growth acceleration
Then Menarche


Boys:
Testicular growth (due to gonardache)
Adrenarche : axillary and pubic hair
Growth acceleration
Then Spermache

TOF

Tetralogy of Fallot
Pulmonary stenosis+ VSD+overriding aorta+RVH

Cyanotic congenital heart disease (The 5 Ts. others are TGA, Truncus arteriosus, Total anomalous pulm venous return, Tricuspid atresia)

Right to left shunt leads to mixing

May not be cyanotic at birth

Difficulty feeding, polycythaemia, finger clubbing, dyspnoea, FTT, murmur

Tet spells
sudden, marked increase in cyanosis followed by syncope ,often precipitated by crying, feeding or exercise , may also occur on waking up.
It is due to an increase in rt to left shunting of unoxygenated blood following a decrease in systemic vascular resistance or increased pulmonary vascular resistance, favouring the "right to left to aorta shunt"
It can be relieved by squatting or placing child in knee chest position (This increases afterload thus allowing more blood to go thru pulmonary circulation rather than systemic)


Chest x ray shows boot shaped heart and decreased pulmonary vascular markings.

Fanconi anemia

Autosomal recessive

Aplastic anemia


Pancytopenia

Hyperpigmentation

Short stature

microcephaly

hypogonadism

upper limb anomalies

radswiki.net

Cure is BM transplant

Remember

Neonate turns blue when feeding, turns pink when crying = choanal atresia

may be part of the CHARGE Syndrome

Coloboma
Heart defects
Atresia of the choanae
Retardation (mental)
Genitourinary anomalies
Ear anomalies

suspect if you can't pass an intranasal catheter, confirm with  contrast CT.

pseudoseizures

Psychogenic non epileptic seizure
Triggered by emotional stress
Normal EEG
Normal prolactin level following episode unlike in neurogenic seizure in which prolactin is elevated within 20 minutes of seizure.
There may be side to side head movement, pelvic thrusting, eyes may be closed, no post ictal confusion or incontinence
Very easy to be taken as malingearing.
Tmt is psychotherapy +/- antidepressants. Do not use anticonvulsants.

Remember

Physiologic steatorrhoea can occur in neonates especially preterm neonates due to low amounts of bile acids.
Treatment is to replace long chain triglycerides in formular with medium chain trig (which do not require bile acids for digestion).

Do not confuse with CF which will show other features like meconium ileus, family history etc.

Tuberous sclerosis

-a neurocutaneous syndrome

Tubers in the brain

Ash leaf hypopigmented macules on the skin, more visible under uv light (woods lamp), facial angiofibroma, forehead plaques, periungual fibroma,

Retinal harmatoma

Presents in infancy with infantile spasms (seizures)  which may be confused with colic. (may be described as head bobbing, doubling up etc) Treat with ACTH

Dental involement (pits), lung involvement etc

Cardiac harmatoma

There may be learning disabilities, mental retardation or epilepsy.

Bone lesion differentials

Osteoid osteoma:  radioluscent (lytic) centre,usually <1cm surrounded by sclerotic lesion. Benign

Brodie's abscess: form of osteomyelitis, remains subacute for years before converting to chronic (draining) osteo. radioluscent lesion >1cm surrounded by irregular margin of sclerosis. Benign

Osteosarcoma: hard irregular spiculated lesion (moth -eaten or sun burst appearance) with periosteal elevation- Codman's triangle, . Malignant. seen more commonly in Male adolescents. Most common primary bone cancer

Ewing's sarcoma: lytic lesion with periosteal reaction- onion skinning. Malignant. Highly metastatic.Typically seen  in Male adolescsent

Status Epilepticus

Seizure lasting 30mins or more
or
2 or more seizures occuring without interval recovery

TMT:
Benzodiazepine> phenytoin >more phenytoin >Phenobarb>more phenobarb>G.A + Intubate

Pyloric stenosis

Congenital
Infant 4-8 wks old with projectile vomitting which has become more frequent and more forceful
Vomittus is non bilous, occurs after feeding
Visible peristalsis in upper abdo
Failure to thrive
Olive shaped upper abdo mass palpable after vomitting (may however be absent)
Abdo USS  confirms diagnosis: shows thick hypoechogenic ring in pyloric area
Tmt: surgery

Intussusception

2yr old Child with abdo pain
presents with features of small bowel obstruction

red currant jelly stool

sausage shaped abdo mass

USS shows target sign (one tube inside another)

Air contast enema both diagnoses and reduces it in most cases

Paediatric Hip joint pain

Slipped capital femoral epiphysis : Obese adolescent male, referred pain to knee usually present, loss of abduction and internal rotation of hip. Tmt: surgical pinning promptly to avoid avascular necrosis.

Legg-Calve-Perthes disease:  child 4-10yrs, male, avascular necrosis of femoral head, idiopathic. Tmt- splint or surgery

Septic arthritis:  Emergency. Acute onset, warm swollen jt, hematogenous spread following URTI, staph & strep,
hip is externally rotated, X ray usually normal,  wbc count is high, ESR is high.
Do USS guided aspiration- synovial fluid leucocyte >100,000 is definitely SA, do culture.
Tmt : drain immediately, empirical antibiotics nafcillin (or vancomycin ) + cephalosporin

Avascular necrosis in sickle cell anemia: African descent, history suggestive of SS

Transient synovitis:  male child 3-10yrs, following trauma or viral infection.

Exclude septic arthritis. if at least 3 of the following are present, do further workup.

Fever>39°C,
WBC >12,000,
ESR >40 ,
 Refusal to bear weight

Kawasaki Disease

Vasculitis following infection
Child less than 5yrs
Hyperaemic buccal mucosa, strawberry tongue, Fissured lips
Diagnosis is clinical
Criteria: High fever (>39°C) for 5 days + 4 of ffing: unilateral large lymph nodes,
                                                                                     rash,
                                                                                    mouth changes,
                                                                                    limb desquamation/edema
                                                                                    conjuctivitis


Tmt: IVIG and Aspirin. (unlike other rashes in children where aspirin is contraindicated cos of risk of Reye's syndrome )

May be complicated by Coronary artery aneurysm with resultant risk of MI.

Young child with fever, red eyes, red tongue, red palms and rash