Jaundice
- Up to 70% of neonates
- Pathological if appears in first 24 hr
- Starts in the head and moves down
- Appearance below the waist is a warning sign
Kernicterus- Etymology
- "Kern" or kernel plus "icterus" or yellow
- Due to yellow staining of basal ganglia
- Acute diagnosis
- Abnormalities of tone
- Hypertonia, or hypotonia, or variation between the two
- Lethargy
- High pitched cry
- Arching the back and spine (retrocollis or opisthotonus)
- Fever
- Consequences
- Hearing loss or deafness
- Athetoid cerebral palsy
- Refers to the slow, writhing involuntary movements that
occur
- Impairment of eye movements especially
upward gaze
- Dystonia
Hyperimmunoglobulin E syndrome- Association with deep tissue infection?
- FATED
- Coarse facies
- Cold staph abscesses
- Retained primary teeth
- Increased IgE
- Dermatologic problems [eczema]
Antipsychotic side effects- Tardive dyskinesia
- Characterized by repetitive, involuntary, purposeless movements
- From neuroleptic-induced dopamine supersensitivity in the nigrostriatal pathway, with the D2 dopamine receptor being most affected
- Neuroleptic malignant syndrome
- Muscle cramps and tremors, fever, symptoms of autonomic nervous system, alterations in mental status
- Iincreased muscular activity and rhabdomyolysis => raised CPK
Common variable immunodeficiency- Group of approximately 150 primary immunodeficiencies (PIDs)
- Common set of features but different underlying causes
- Most commonly encountered primary immunodeficiency
- Features:
- Hypogammaglobulinemia
- Poor titer response to vaccination with polysaccharide and protein antigens
- Recurring infections involving the ears, eyes, sinuses, nose,
bronchi, lungs, skin, GI tract, joints, bones, CNS, parotid glands, etc.
- Viral infections that usually respond to antivirals
- Enlarged lymph nodes, spleen
- Fatigue
Otitis media- AKA glue ear
- Organisms:
- Streptococcus pneumoniae (most common)
- Pseudomonas aeruginosa, nontypeable Haemophilus influenzae, Moraxella catarrhalis
- Haemophilus influenzae in older adolescents/adults
Azithromycin
- Macrolide antibiotic
- Derived from erythromycin
- Used to treat or prevent middle ear infections, strep throat, pneumonia, typhoid, sinusitis
- Also as prophylaxis for those with impaired immunity (e.g. immunodeficiency)
Vitamin D deficiency- Signs
- Brittle nails
- Wide wrist
- Prominent forehead
- Causes
- NOT just insufficient intake
- e.g. Renal, liver, receptor problems
- => Do a full bloods workup when checking Vit D levels to exclude secondary causes
Naevi- Melanocytic
- Derived from melanocytes
- e.g. Your standard mole; Mongolian spot
- Epidermal
- Derived from keratinocytes
- Connective tissue
- Derived from connective tissue cells like adipocyte and fibroblasts
- V. rare
- Vascular
- Derived from structures of the blood vessels
- e.g. Haemangioma
Headache history- Characteristics
- Location
- Character
- Severity and effect on ability to carry out daily activities
- Frequency and duration
- Including number of days missed from school
- Triggers
- Fatigue/sleep deprivation, caffeine (including cola), specific foods, hunger, stress, exercise, menses, motion sickness, perfume
- Aggravating and relieving factors
- Associated symptoms
- Constitutional symptoms suggestive of underlying systemic pathology
- Fever, rash, decreased or fluctuating level of consciousness, irritability, confusion, hallucinations, seizures, possibility of unobserved head trauma
- Symptoms suggestive of migraine
- Nausea and vomiting, photophobia and phonophobia, osmophobia
- Symptoms suggestive of aura
- Visual, sensory, cognitive or motor manifestations which may precede headache onset, occur concomitantly with it or occur after the headache
- Autonomic symptoms
- Pallor, flushing, syncope, tachycardia
- Symptoms suggestive of complicated migraine or migraine variant
- Can be specifically enquired about but these syndromes are rare in children and are usually diagnoses of exclusions
- Past medical history and social/emotional factors
- Co-existing medical disorders
- In particular conditions associated with immune dysfunction (increasing probability of systemic disorder with secondary headache)
- Emotional and social factors which may precipitate TTH
- Social turmoil, academic failure, bullying etc
- Symptoms of depression
- Family and treatment history
- Family history of migraine, especially maternal
- FHX positive in 70 per cent
- Medication previous tried
- History of excessive medication use?
- Suggestive of analgesic induced headache or rebound headache
- Physical examination
- Vital signs, including blood pressure
- Growth parameters, including head circumference
- General examination
- Specifically assessing for evidence of underlying systemic disease
- Neurological examination
- To look for any clinical evidence of underlying neurological pathology
- Should include:
- neurocutaneous lesions
- cranial bruit
- meningism
- fundoscopy: papilloedema, retinal haemorrhages
- spine: deformity suggesting occult spinal dysraphism
- signs of unobserved head trauma
Notes- Isotretinoin
- AKA roacutane
- Induces apoptosis in sebaceous gland cells (and lots of other places!)
- Retinoid
- Used primarily for severe cystic acne
- Levetiracetam
- Anticonvulsant for epilepsy
- Monotherapy for partial seizures / adjunct for others
- AKA Kepra
- Less bone marrow side effects than carbamazepine etc.
- Dopamine pathways
- Nigrostriatal
- Mesocortical
- Mesolimbic
- Tuberoinfundibular
- Anterior fontanelle: 9-18 months
- Anaemia => Splenomegaly
- Sacral pit
- Quite common
- If you can see the bottom, don't worry
- If not, needs investigation
- c.f. spina bifida occulta
- Anaemia is a CAUSE as well as a consequence of decreased appetite
- Too much iron causes haemosiderosis
- Don't confuse with haemochromatosis :)
- Don't forget to consider CENTRAL causes of nausea/vomiting
- ADH secretion from posterior pituitary craniopharyngioma
- Frontal (as well as cerebellar) lesions can cause ataxia
- Headache:
- Changes in handwriting?
- Clumsy?
- Mood/personality changes?
- Tuberous sclerosis
- Non-malignant tumors grow in the brain, as well as kidneys, heart, eyes, lungs, skin
- Symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, lung and kidney disease
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