Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

gp academy > 11. AKT: Paediatrics > Flashcards

11. AKT: Paediatrics Flashcards

1
Q

What is Sever’s disease?

A
  • AKA calcaneal apophysitis
  • It is a common cause of heel pain in childhood and early adolescence
  • Occurs in children who are highly active, particularly in sports involving running and jumping
  • Repeated running and jumping leads to a small injury where he calf muscle tendon attaches to the heel bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Management of Sever’s disease?

A
  • Temporary stop or modification of activities
  • Symptoms can be managed with ice packs
  • Sports shoes should be comfortable
  • Inserting gel heel pads into shoes
  • Daily calf-stretching exercises (especially before and after sports)
  • Pain usually settles within 6-12 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When do symptoms of hand, foot and mouth disease usually start?

A

Symptoms usually start 3-7 days after becoming infected and can last from 7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical presentation of hand, foot and mouth disease?

A

Tired
Fever
Rash - can look either like:
* Small, oval white blisters on the palms, soles of the feet, and in mouth
* A red skin rash with a brown scale on it. Rash appears on the outer arms, hands, legs, feet, around the mouth and upper buttocks

Blisters should not be itchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common cause of hand, foot and mouth disease?

A

Coxsackie virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When can children with hand, foot and mouth disease return to school/daycare?

A

Until all fluid in their blisters has dried

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Potential complications of hand, foot and mouth disease?

A
  • Severe hydration
  • Meningitis
  • Pleuritis/myocarditis
  • Onychomadesis (nail shedding) - occurs 2 months after the illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define oppositional defiant disorder

A

Child/adolescent: Persistent pattern of angry or irritable mood, argumentative or defiant behavir and vindictiveness in social, school or work settings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define conduct disorder

A

Child/adolescent: persistent pattern of aggression toward people or animals, destruction of property, deceitfulness or theft, and serious violation of rules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define antisocial personality disorder

A

Adult: behaviours constituting a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some differential diagnoses for conduct disorder?

A
  • Oppositional defiant disorder: defiant but not a violation of rights
  • Intermittent explosive disorder: impulsive, rather than planned
  • Attention deficit hyperactivity disorder
  • Disruptive mood dysregulation disorder
  • Major depressive disorder
  • Bipolar disorder
  • Adjustment disorder
  • Substance use disorder
  • Posttraumatic stress disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of infantile acne?

A
  • Onset: usually starts after age 3 months
  • Rash: comedones, papules and pustules on cheeks and chin
  • Diagnosis: must have comedones present
  • Most cases are mild and resolve by 12 months; however, large comedones can leave permanent pits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of infantile acne?

A

Benzoyl peroxide 5% cream or gel topically, daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical features of toxic erythema of the newborn?

A
  • Affects 50% of full term neonates (uncommon in premature babies)
  • Scattered pink or red marks often with papules and weals scattered over face and rest of the body
  • Lesions are transient
  • Spares the palms and soles
  • Resolves spontaneously over 1-2 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical features of milia?

A
  • Tiny white spots due to accumulation of sweat in blocked pores
  • Most resolve within 4 weeks of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnostic criteria for Kawasaki’s disease?

A

Presence of prolonged unexplained fever for 5 or more days (fever > 38.5C) with atleast 4 of the following:
* Bilateral non-exudative conjunctivitis
* Polymorphous rash
* Cervical lymphadenopathy
* Mucositis - cracked red lips, injected pharynx or strawberry tongue
* Extremity changes - erythema of palms/soles, oedema of hands/feet (acute phase), and periungual desquamation (convalescent phase)

Incomplete cases (i.e. patients who do not fulfil the strict criteria for diagnosis of Kawasaki’s disease but develop coronary artery lesions) are relative common, especially under 1 year of age; suspect the diagnosis in any child with 5 days of unexplained fever and any 1 of the cardinal clinical features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the rash in Kawasaki’s disease

A

Usually begins during the first few days of illness, typically as perineal erythema and desquamation, followed by macular, morbilliform, or targetoid skin lesions of the trunk and extremeties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the key aspects of management for Kawasaki’s disease?

A
  • Intravenous immunoglobulin - reduces risk of coronary artery aneurysms
  • Aspirin - high dose if febrile, low dose if afebrile - continued until follow up echocardiography
  • Echocardiography 6 weeks after fever resolution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical features of impetigo?

A
  • Sores usually become coated with a tan/yellowish crust (honey covered look)
  • Superficial peeling on the edge of the sore
  • Usually itchy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Non-pharmacological management of impetigo?

A
  • Daily 10 minute bleach bath may help reduce amount of bacteria on skin
  • Remove crusts from sores with an unused, wet, disposable cloth before applying ointments
  • Cover the sores with a watertight dressing and cut child’s fingernails to reduce scratching
  • Isolate children until atleast 24 hours after starting medical treatment - keep sores covered
  • Wash clothes, towels and bed linen separately from the rest of the family in hot water and dry in sunshine or a hot tumble dryer
  • Toys can be washed using a mild disinfectant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of impetigo?

A
  • Non-endemic (non-remote communities): Staph aureus
  • Endemic (e.g. remote communities): Strep pyogenes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pharmacological managemet of impetigo?

A

Non-endemic:
* Localised skin sores: mupirocin 2% ointment or cream topically to crusted areas, Q8hourly for 5 days
* Multiple skin sores or recurrent infection: Dicloxacillin/flucloxacillin 500mg PO, Q6hourly for 7 days
* Severe penicillin allergy: Trimethoprim+sulfamethoxazole 160+800mg PO, Q12hourly for 3 days

Endemic:
* Benzathine benzylpenicillin IM as a single dose - 1.2million units OR
* Trimethoprim+sulfamethoxazole 160+800mg PO, Q12hourly for 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What age do permanent central incisors erupt?

A

6-7 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you ensure good oral hygiene after dental injury?

A
  • Swab the area with 0.1% chlorhexidine twice a day for 10-14 days to reduce the risk of infection
  • Soft diet will also allow loose teeth to become firmer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you manage a dental avulsion (complete displacement from socket) of a permanent tooth?

A
  • Refer to dental hospital registrar
  • Place tooth in milk or saline (do not use water or scrub tooth)
  • Do not handle tooth root
  • If possible, return tooth to socket and bite down with gauze to hold tooth in position, support tooth with alfoil wrap
  • Best prognosis if “dry-time” less than 60 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What biochemical abnormalities are associated with a hypertrophic pyloric stenosis?

A

Hypochloraemic, metabolic alkalosis with an elevated bicarbonate level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When should hypertrophic pyloric stenosis be suspected?

A

In infants 3-6 weeks old with non-bilious vomiting after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Clinical features of hypertrophic pyloric stenosis?

A

History:
* Gradual onset of non-bilious vomiting after feeds, becoming more forceful and sometimes projectile
* Child is typically hungry and irritable, and easily re-fed after a vomit
* Failure to gain weight, or even weight loss is common

Examination:
* Dehydration
* Visible gastric peristalsis
* Pyloric mass below liver edge - best felt when the stomach is empty after a vomit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is hypertrophic pyloric stenosis diagnosed?

A

Usually confirmed on abdominal ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Differentials for vomiting in infants under 3 months of age?

A
  • Pyloric stenosis
  • Reflux
  • Urinary tract infection
  • Gastroenteritis
  • Sepsis
  • Volvulus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management of hypertrophic pyloric stenosis?

A

Laparoscopic +/- open pyloromyotomy is performed once fluid and electrolyte derangement has been corrected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Causes of bilious vomiting in children (consider distal intestinal obstruction)?

A
  • Reflux
  • Malrotation with volvulus
  • Hirschsprung disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Risk factors for hypertrophic pyloric stenosis?

A
  • Medications: exposure to macrolide antibiotics
  • Family history in first-degree relatives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a red flag for expressive language in a 12 month old?

A

Does not use “mama”, or “dada” or “papa” to call parent - not using two syllable babble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Differential diagnosis for expressive language delay?

A
  • Isolated language delay
  • Language delay as part of a more general developmental condition
  • Hearing impairment
  • Poor linguistic environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Clinical features of migraine with or without aura?

A
  • Pain location: unilateral or bilateral
  • Pain quality: pulsatile
  • Headache pattern: acute recurrent
  • Associated symptoms: nausea, vomiting, photophobia, phonophobia, can have aura with focal neurological symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical features of tension-type headache?

A
  • Pain location: bilateral
  • Pain quality: pressing/tightening (non-pulsatile)
  • Headache pattern: chronic non-progressive
  • Associated symptoms: none - but may be precipitated by significant stress i.e. emotional distress, poor sleep, missed meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Clinical features of cluster headache?

A
  • Pain location: Unilateral, often around the eye
  • Pain quality: variable (sharp, burning, throbbing or tightening)
  • Headache pattern: acute, recurrent
  • Associated symptoms: autonomic symptoms i.e. ipsilateral conjunctival injection, tearing, rhinorrhoea, eyelid swelling, facial sweating, meiosis or ptosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Differentials for acute recurrent headaches in children?

A
  • Migraine
  • Cluster headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Differentials for chronic nonprogressive headache in children?

A
  • Tension type headache
  • Anxiety, depression
  • Somatization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Differential diagnosis for chronic progressive headache in children?

A
  • Tumour
  • Benign intracranial hypertension
  • Brain abscess
  • Hydrocephalus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are common triggers for migraines in children?

A
  • Stress
  • Skipped meals
  • Illness
  • Exercise
  • Heat
  • Menstruation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Red flags in the assessment of headache?

A
  • Altered level of consciousness
  • Increasing head circumference centiles
  • Abnormal head position
  • New focal neurological abnormalities
  • Signs of raised ICP (papilloedema, ataxia, bradycardia with hypertension)
  • Signs of meningism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

When to refer a patient with migraines?

A
  • They need to acute treatment (analgesics or triptans) for more than 8 to 10 days per month and do not respond to prophylaxis in the usual dose range
  • They have isolated aura without headache
  • The diagnosis is uncertain
  • Neurological symptoms are prolonged
  • The usual headache pattern deteriorates suddenly
  • They often need emergency department or hospital treatment or have to take days off work due to migraine
45
Q

Management of migraine in children?

A

Migraine can be short lived in children and resolved with two to three hours sleep

Behavioural therapy for prophylaxis:
* Cognitive behavioural therapy
* Relaxation
* Hypnotherapy

Pharmacotherpay:
* Ibuprofen or paracetamol usually sufficient
* Nausea: ondansetron
* Children older than 6: sumatriptan 10 to 20mg intranasally. If symptoms recur, wait at least 2 hours before repeating the dose (no more than 2 doses in 24 hours)

Migraine prophylaxis in study has not been studied

46
Q

Describe patellofemoral pain syndrome

A
  • Patellofemoral pain syndrome refers to idiopathic pain arising from the anterior knee or patellofemoral region
  • Insidious onset
  • Generalised ache around or behind the patella
  • Pain aggravators (activities needing knee flexion): running, walking up or down stairs, and prolonged sitting
47
Q

Management of patellofemoral pain syndrome?

A

Physiotherapy programme - may include Vastus Medialis Oblique strengthening

48
Q

Differential diagnosis for anterior knee pain?

A
  • Patellofemoral pain syndrome: pain in or around the anterior knee that intensifies when the knee is flexed during weight bearing activities
  • Articular cartilage injury: possible history of trauma
  • Iliotibial band syndrome: typically presents as lateral pain and tenderness over the lateral femoral epicondyle
  • Osgood schlatter disease: tenderness and swelling at patella tendon insertion at the tibial tubercle in an adolescent
  • Sinding-Larsen-Johansson syndrome: tenderness at the patellar tendon insertion at the inferior pole of the patella in an adolescent
  • Patellar instability/subluxation: intermittent pain with the sensation of instability of movement of the patella
  • Pes anserine bursitis: pain usually described as medial rather than anterior
  • Plica syndrome: may be medial or lateral to the patella
  • Prepatellar bursitis: swelling anterior to the patella following trauma
49
Q

What is required for a febrile neonate <28 days of age?

A

Investigations:
* Full blood count
* CRP
* Blood cultures
* Urine cultures
* Cerebral spinal fluid culture
* +/- chest x ray

Management:
* Empiical intravenous antibiotics

50
Q

Differentials for children with a fever?

A

Viral infections

Bacterial infections:
* Urinary tract infection
* Pneumonia
* Meningitis
* Bone and joint infections
* Skin and soft tissue infections
* Mastoiditis
* Bacteremia
* Sepsis

Fever for >5 days:
* Kawasaki’s disease
* Paediatric inflammatory multisystem syndrome - if there is a history of Covid-19 infection

51
Q

How would you instruct a parent to collect a clean catch urine?

A
  • The perineal/genital area should be cleaned with saline soaked gauze for 10 seconds before collecting midstream or clean catch
  • Gently rub the child’s suprapubic area with gauze soaked in cold fluid
52
Q

When is the peak severity of bronchiolitis?

A

2-3 days of illness with resolution over 7-10 days

53
Q

What are some red flags to look for in bronchiolitis?

A
  • Cough
  • Tachypnoea
  • Chest wall retractions
  • Widespread crackles or wheeze
  • Fever
54
Q

Management of bronchiolitis?

A
  • Management is mainly supportive
  • Oxygen therapy: start when oxygen saturations are persistently <90%
  • Hydration/Nutrition
  • Medications are not indicated in the treatment of isolated bronchiolitis
55
Q

Describe moderate bronchiolitis

A
  • Respiratory rate: increased
  • Use of accessory muscles: moderate chest wall retractions, suprasternal retraction, nasal flaring
  • Oxygen saturation: 90-92% (in room air)
  • Feeding: may have difficulty with feeding or reduced feeding
56
Q

Describe severe bronchiolitis

A
  • Respiratory rate: marked increase or decrease in respiratory rate
  • Use of accessory muscles: marked chest wall retractions, marked suprasternal retraction, marked nasal flaring
  • Oxygen saturation: <90%
  • Feeding: reluctant or unable to feed
57
Q

What is the management for mild/moderate acute asthma flare in a child 6 years or over?

A

Salbutamol 100microg 4-12 puffs Q20-30minutely for the first hour and re-assess within minutes

58
Q

What is the management for mild/moderate acute asthma flare in a child 1-5 years old?

A

Salbutamol 100microg 2-6 puffs Q20-30minutely for the first hour and re-assess within minutes

59
Q

What is the most common cause of obstructive sleep apnea in children?

A

Enlarged tonsils and adenoids

60
Q

What are some possible causes of obstructive sleep apnea in children?

A
  • Enlarged tonsils and adenoids
  • Obesity
  • Allergic rhinitis
  • Medical conditions associated with muscle weakness, hypertonia and craniofacial abnormalities including retro/micrognathia
  • Previous upper airway surgery including repair of cleft palate
  • Syndromes such as Down Syndrome or achondroplasia
61
Q

What are some features on history that suggest obstructive sleep apnea in a snoring child?

A
  • Snoring or noisy breathing during sleep present for three or more nights per week
  • Difficult breathing while asleep (including increased effort of breathing, choking, gasping or snorting during sleep)
  • Parents who report being afraid of their child’s health because of the child’s breathing while asleep
  • Frequent daytime mouth breathing
  • Witnessed obstructive apnea during sleep (parent describes cessation of airflow with clear ongoing breathing effort)
62
Q

Management for mild to moderate OSA?

A

Anti-inflammatory medication options
* Intranasal corticosteroids
* Leukotriene receptor antagonists

63
Q

What are some red flags when evaluating paediatric constipation?

A
  • Infants presenting less than six weeks of age
  • Delayed passage of meconium - most infants pass meconium in the 1st 24 hours of life (consider hirschsprung disease or anorectal malformation)
  • Ribbon like stools - consider anorectal malformation
  • Weight loss/poor growth
  • Persistent vomiting
  • Abdominal mass (not consistent with large faecal mass)
64
Q

What are some causes for constipation?

A

Medical:
* Coeliac disease
* Hypothyroidism
* Hypercalcemia
* Slow transit constipation
* Neurological disorders

Surgical:
* Hirschsprung disease
* Meconium ileus
* Anatomical malformations of anus
* Spinal cord abnormalities

65
Q

What is hirschsprung disease?

A

It is a congenital absence of ganglion cells in the distal rectum and extends proximally into the colon for a variable distance

66
Q

What genetic disorder is highly associated with Hischsprung disease?

A

Trisomy 21

67
Q

How can a patient with Hirschsprung’s disease present?

A

Distal intestinal obstruction:
* Bilious emesis
* Abdominal distention
* Failure to pass stool

  • Hirschsprung associated enterocolitis - sepsis-like picture with fever, vomiting, diarrhoea and abdominal distention which can progress to toxic megacolon
  • Chronic constipation
  • Failure to thrive
68
Q

What is the management of hirschsprung disease?

A

Surgical resection of the aganglionic segment of bowel

69
Q

What is erythema nodosum?

A
  • It is a cutaneous reaction pattern occuring in the deep dermal and subcutaneous tissues
  • Lesions present as painful erythematous indurated plaques and nodules, usually on the lower legs (particularly the anterior tibial region); however, they can occur elsewhere
  • Lesions typically resolve over two to three weeks, leaving discoloration but no scarring
70
Q

What is the management for erythema nodosum?

A

First line:
* Bed rest
* Non steroidal anti inflammatory drugs
* Leg elevation, compression bandages and stockings may assist recovery
* The underlying cause should be treated

Second line:
* prednisolone 25 mg daily for two weeks, then taper the dose according to response

71
Q

What are the causes of erythema nodosum?

A

Bacterial infections:
* beta hemolytic streptococci (especially following pharyngitis)
* Mycobacterium tuberculosis
* Yersinia
* Mycoplasma
* Chlamydia

Other infections:
* Coccidioidomycosis
* Histoplasmosis
* Dermatophytosis
* Viruses: Hep B, Hep C, HIV, EBV, Herpes simplex virus

Inflammatory bowel disease

Sarcoidosis

Behcet syndrome

Drugs:
* Sulfonamides
* Oral contraceptives

Malignancies:
* Lymphoma
* Leukaemia

Pregnancy

Idiopathic

72
Q

What is ewing sarcoma?

A
  • Primary malignant bone tumour
  • Occurs most often in the bones of the trunk (pelvis, scapula, ribs) or in the mid shaft of long bones such as the femur
  • Peak incidence: 10-15 years old
73
Q

What investigations must be done when Henoch-Schoenlein purpura is suspected?

A
  • Urinalysis - looking for macroscopic haematuria or significant proteinuria
  • Blood pressure - looking for hypertension

Followup schedule:
* Weekly for first month
* Fortnightly from weeks 5-12
* Single reviews at 6 and 12 months
This is to identify if there is renal involvement

74
Q

What are the features of henoch schoenlein purpura?

A

Clinical diagnosis - features include a rash, and one or more of:
* Arthritis/arthralgia
* Abdominal pain
* Nephritis

75
Q

What is the most common cause of henoch schoenlein purpura?

A

Recent upper respiratory tract infection is present in 50% of cases, commonly viral or group a streptococcus infections

76
Q

What do you do if you find hypertension, macroscopic haematuria or significant proteinuria in a case of henoch schoenlein purpura?

A
  • Formal urine microscopy and urine protein-creatinine ratio
  • EUC and albumin
77
Q

What are some complications of henoch schoenlein purpura?

A
  • Intussusception
  • Orchitis
  • Diffuse alveolar haemorrhage
  • Encephalopathy
78
Q

What is the management of henoch schoenlein purpura?

A

Mild pain:
* Bed rest an elevation of the affected area
* Regular paracetomol and a short course of non steroidal anti inflammatories e.g. ibuprofen (10mg/kg TDS) or naproxen (10mg/kg BD) if not contraindicated

Moderate pain:
* Steroids in children with moderate to severe abdominal and joint pain - does not impact on the rate of long term renal complications

79
Q

Does henoch schoenlein purpura recur?

A

In 25-35% of patients, HSP recurs at least once, within 4 months of the initial presentation

80
Q

When do you do a whole body dexa scan for a female paediatric patient with an eating disorder?

A

After one year of underweight, or earlier if they have bone pain or recurrent fractures

81
Q

What is the non pharmacological management of croup?

A
  • Minimise handling to avoid worsening of symptoms
  • Keep the child calm eg sitting quietly, reading or watching tv
  • Keep the child with parents to reduce distress
  • Allow the child to adopt a comfortable position that minimises airway obstruction
82
Q

What is the pharmacological management of mild to moderate croup?

A
  • Prednisone 1mg/kg (up to 50mg) PO, as a single dose
  • Note: if oral steriods not tolerated -> budesonide 2mg inhalation via nebuliser; repeat every 12 hours for up to 48 hours, as required
83
Q

Clinical features of epstein barr virus infection (glandular fever, infectious mononucleosis)?

A
  • Severe sore throat
  • Fever
  • Nausea
  • Lymphadenopathy: usually symmetrical and involves the posterior cervical chain
  • Splenomegaly: more than 50%
  • Hepatomegaly
  • Rash
  • Fatigue
  • Palatal petechiae
84
Q

How do you confirm ebv infection?

A
  • Infectious mononucleosis test / heterophile antibody test / monospot test
  • EBV serology
  • Note: in a patient with a compatible syndrome ana negative heterophile antibody, the monospot test can be repeated since this test can be negative during the first week of clinical illness
85
Q

Why do you not give amoxicillin in suspected EBV?

A

A maculopapular rash will occur

86
Q

How long should a patient with ebv infection and splenomegaly wait before returning to contact sports?

A

At least three weeks

87
Q

What are the clinical features of testicular torsion?

A
  • Sudden severe pain
  • Scrotal swelling
  • Impaired gait
  • Tender
  • High riding or horizontal testicle
88
Q

When is physiological knock knees (genu valgum) seen?

A
  • 3-5 years
  • Resolves by age 8
89
Q

What are some indications for specialist referral in knock knees (genu valgum)?

A
  • Persistent knock knees beyond age 8
  • Intermalleolar separation greater than 8cm
  • Asymmetrical deformity
  • Progressive deformity or lack of spontaneous resolution
  • Pain
  • After traumatic event
90
Q

When is physiological bowlegs (genu varum) seen?

A
  • From birth until 2-3 years of age
91
Q

If there is concern about knock knees (genu valgum), what do you measure and how often?

A

Intermalleolar distance every 6 months

92
Q

If there is concern about bow legs (genu varum), what do you measure and how often?

A

Intercondylar distance every 6 months

93
Q

What are some indications for specialist referral in bow legs (genu varum)?

A
  • Persistence of bow legs after 3 years of age
  • Intercondylar separation > 6cm
  • Asymmetrical deformity
  • Progressive deformity or lack of resolution
  • Pain
  • After a traumatic event
94
Q

What clinical features make asthma more likely in a child?

A

More than one of:
* Wheeze
* Difficulty breathing
* Feeling of tightness in the chest
* Cough

And any of:
* Symptoms worse at night and in the early morning
* Symptoms triggered by exercise, exposure to pets, cold air, damp air, emotions, laughing
* Symptoms occur when child doesn’t have a cold

95
Q

What clinical feature indicates conjugated hyperbilirubinaemia?

A
  • Acholic/pale stools
  • Dark urine
96
Q

What is a cause of conjugated hyperbilirubinaemia?

A
  • Biliary atresia
  • Idiopathic neonatal cholestasis
  • Congenital hypopituitarism
  • Congenital CMV
97
Q

What are some causes of unconjugated hyperbilirubinaemia?

A
  • Blood group incompatibility
  • Cephalohaematoma
  • Hereditary spherocytosis
  • G6PD deficiency
  • Congenital hypothyroidism
  • Physiological jaundice
  • Breastfeeding jaundice
  • Breast milk jaundice
98
Q

When should a unilateral undescended testis be referred?

A

3 months of age

99
Q

Clinical features of blocked tear duct?

A
  • Watery eyes
  • Eyelids may be red and swollen
  • Sticky yellowish-green discharge
100
Q

What is the management of nasolacrimal duct obstruction?

A

Medical management:
* Massage the nasolacrimal sac
* Wash with salt water as needed
* Apply warm compresses
* Apply chloramphenicol eye drops or ointment until tears become clear

If persisting for more than 3 months above the age of 12 months old -> refer for nasolacrimal duct probing

101
Q

Clinical features of a dacrocystocele?

A
  • Swelling of the skin overlying the lacrimal sac and the upward displacement of the medial canthal tendon
  • Prompt referral to an ophthalmologist is required
  • Complications: infection, breathing difficulties from nasal obstruction
102
Q

When should primary immunodeficiencies be suspected in children?

A
  • Severe infection
  • Infection with unusual or opportunistic organisms
  • Recurrent infection - more than expected for age (eg healthy toddlers may have 5 to 10 minor infections per year, often more if attending childcare)
  • Recurrent infection at the same site may also be due to anatomical abnormality (e.g. Meningitis and anatomical defects in the blood brain barrier)
103
Q

Clinical features of primary immunodeficiencies in children?

A
  • Poor growth (especially slow to gain weight)
  • Chronic diarrhoea
  • Four or more middle ear infections within one year
  • Persistent thrush in the mouth, skin or elsewhere after one year old
  • In adequate response to antibiotics ( 2 or more months of antibiotics with little effect)
  • Recurrent, severe or prolonged fractions with common pathogens eg adeno virus
  • Persistent lymphopenia
  • Family history of immunodeficiency
104
Q

What are labial adhesions/labial fusion?

A
  • Normal variant which develops from three months (not present at birth) and resolve spontaneously by 6-8 years old when oestrogen levels increase at puberty
  • They occur when the medial edges of the labia minora become adherent due to a combination of thin vaginal mucosa and minor irritation
  • There is no relationship between labial fusion and any other medical conditions
105
Q

What is the management for labial adhesions/labial fusion?

A

Provided the child is able to avoid easily, no treatment is needed

106
Q

What is the most common cause of abnormal head shape in an infant?

A

Deformational plagiocephaly - as a result of repeated external pressure to an infant skull for an extended time. Before or after birth e.g. Without altering position

107
Q

What is craniosynostosis?

A
  • It is a premature fusion of one or more cranial sutures, which causes skull growth restriction
  • Sagittal suture is the most commonly affected
  • Requires surgical intervention
108
Q

What is the management of deformational plagiocephaly?

A
  • Encourage supervised tummy time
  • Alternate the babies head position during day sleeps
  • Encourage carrying or sitting the baby out of the pram to relieve external pressure
  • Referred to a paediatric physiotherapist if there is evidence of torticollis
109
Q
A

gp academy (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions