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ICCP: Child Health > Child Health > Flashcards

Child Health Flashcards

1
Q

what are the components of the HEEADSS assessment?

A 
Home and relationships 
Education and employment 
Eating 
Activities and hobbies 
Drugs and alcohol 
Sex and relationships 
Self-harm, self-image and depression 
Safety and abuse
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2
Q

at what age should a child be walking independently?

A

18 months

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3
Q

at what age is hand preference and persistent primitive reflexes a red flag?

A

6 months

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4
Q

at what age are no smile, no eye contact and head lag red flags?

A

10 weeks

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5
Q

what type of reaction is allergic rhinitis?

A

IgE mediated type 1 hypersensitivity reaction

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6
Q

how is allergic rhinitis managed?

A

oral antihistamines
nasal corticosteroids
nasal antihistamines

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7
Q

what is the recommend volume of milk for babies after 4 days?

A

150ml/kg/day

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8
Q

how is GORD managed in babies?

A

advise- small frequent meals, burping to help milk settle, not over-feeding, keep baby upright after feeding
treatment- gaviscon mixed with feeds, thickened milk/formaula, ranitidine/omeprazole
surgical- fundoplication in severe cases

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9
Q

what is sandifer’s syndrome?

A

a rare condition causing brief abnormal movements associated with GORD in infants. involves torticollis (contraction of neck muscles causing twisting), dystonia (contractions causing twisting, arching and abnormal posture)

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10
Q

what is the classic presentation of pyloric stenosis?

A

projectile vomiting in the first few weeks of life

may have a firm round mass in the upper abdomen

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11
Q

how is pyloric stenosis diagnosed?

A

abdominal ultrasound to visualise the thickened pylorus

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12
Q

how is pyloric stenosis managed?

A

laparoscopic pyloromyotomy

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13
Q

what is the most common cause of gastroenteritis?

A

viral- rotavirus or norovirus

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14
Q

how is a fluid challenge carried out?

A

give a small volume of fluid orally every 5-10 minutes to ensure they can tolerate it. if they can tolerate to they can be managed at home with rehydration solutions (dioralyte). if they fail IV fluids are required

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15
Q

what are the autoantibodies are associated with coeliac disease?

A

anti-tissue transglutaminase (TTG)

anti-endomysial (EMA)

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16
Q

what will intestinal biopsy show in coeliac disease?

A

crypt hypertrophy

villous atrophy

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17
Q

what is hirschprung’s disease?

A

congenital condition where the nerve cells of the myenteric plexus are absent in the distal bowel and rectum. this plexus is responsible for stimulating peristalsis, without this the bowel loses its motility and is unable to pass food

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18
Q

how is paediatric intestinal obstruction managed?

A 
emergency admission 
nil by mouth 
NG tube with free drainage 
IV fluids
surgical management
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19
Q

what is intussusception and when does it occur?

A

the bowel telescopes into itself

typically occurs from 6 months to 2 years

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20
Q

what are the characteristic signs of intussusception?

A

severe colicky abdominal pain
redcurrant jelly stool
RUQ sausage shaped mass on palpation
vomiting

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21
Q

how is intussusception diagnosed?

A

ultrasound

contrast enema

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22
Q

how is intussusception managed?

A

therapeutic enemas- contrast, water or air pumped into the bowel to force the folded bowel into the normal position
surgical reduction- if enemas fail
surgical resection- if perforated or gangrenous

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23
Q

what is rovsings sign?

A

palpation in the LIF causes pain in the RIF

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24
Q

what is mesenteric adenitis?

A

inflamed abdominal lymph nodes. presents with abdominal pain, usually in younger children. often associated with tonsillitis or an URTI. important differential in appendicitis

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25
Q

how is appendicitis managed?

A 
emergency admission to surgical team 
nil by mouth 
IV fluids 
IV antibiotics 
surgery- laparoscopic appendicectomy 
if perforated can manage conservatively with IV antibiotics
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26
Q

what is the first line laxative in paediatric constipation?

A

movicol

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27
Q

management of constipation

A

correct reversible contributing factors, recommend high fibre diet and good hydration
laxatives

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28
Q

management of faecal impaction

A

disimpaction regime with high dose laxatives

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29
Q

what is the difference between IGE and non-IGE medicated cows milk protein allergy?

A

IGE mediated- cows milk triggers histamine release, reaction within 2 hours of milk being consumed
non IGE mediated- reaction occurs hours to days after consuming milk

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30
Q

what are the 3 shunts present in the fetal circulation?

A

ductus venous- umbilical vein to IVC to bypass the liver
foramen ovale- RA to LA, bypasses the right ventricle and pulmonary circulation
ductus arteriosus- pulmonary artery to aorta, bypasses the pulmonary circulation

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31
Q

what symptoms does a left- right shunt cause?

A

pulmonary hypertension curing breathlessness, difficulty feeding and poor weight gain

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32
Q

what sort of shunt does a patent ductus arteriosus cause?

A

left-right shunt

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33
Q

how is a PDA managed?

A

monitor until 1 year with echocardiograms to see if it will close spontaneously
after 1 year it is unlikely to close spontaneously so a trans-catheter or surgical closure can be performed
can repair earlier if signs of heart failure

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34
Q

what sort of shunt does an atrial septal defect cause?

A

left- right shut causing pulmonary hypertension (breathlessness) and right heart failure

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35
Q

what is eisenmenger syndrome?

A

a complication of a left right shunt. pulmonary hypertension leads to the pulmonary pressure becoming greater than the systemic pressure and the shunt reverses resulting in a right-left shunt. the blood bypasses the lungs and the patient becomes cyanotic

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36
Q

what sort of murmur does an atrial septal defect cause?

A

ejection systolic murmur best heard at upper left sternal edge

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37
Q

what sort of shunt does a ventricular septal defect cause?

A

left-right shunt causing pulmonary hypertension

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38
Q

what sort of murmur does a ventricular septal defect cause?

A

pan-systolic murmur heard best at the left lower sternal border

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39
Q

what murmur is heard in aortic stenosis?

A

ejection systolic heard in arotic area. has a crescendo-decrescendo character and radiates to carotids

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40
Q

what conditions are associated with pulmonary valve stenosis?

A

tetralogy of fallot
William syndrome
Noonan syndrome
congenital rubella syndrome

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41
Q

what is the murmur in pulmonary stenosis?

A

ejection systolic murmur heard best at the left upper sternal edge (pulmonary area)

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42
Q

what condition is coarctation of the aorta associated with?

A

turners syndrome

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43
Q

what are the signs of aortic coarctation?

A

weak femoral pulses
different upper and lower limb BP
systolic murmur below left clavicle and back
low cardiac output and shock- critical coarctation

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44
Q

what is the management of critical coarctation?

A

resuscitate
prostaglandin E to maintain PDA
surgery to correct the coarctation

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45
Q

why is prostaglandin e given in critical coarctation?

A

to maintain the PDA- acts as a lifeline allowing sone blood to flow to the systemic circulation

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46
Q

what happens in transposition of the great arteries?

A

the attachments of the aorta and pulmonary trunk are swapped so the RV pumps blood into the aorta and the LV pumps blood into the pulmonary circulation creating two separate circulations which don’t mix. the patient will be cyanotic

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47
Q

how is transposition of the great arteries managed?

A

prostaglandin infusion- maintain PDA
balloon septostomy- insert a catheter into the foramen oval and inflate a balloon to create a large ASD
open heart surgery- arterial switch

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48
Q

what are the four pathologies in tetralogy of fallot?

A

ventricular septal defect
pulmonary valve stenosis
overriding aorta
right ventricular hypertrophy

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49
Q

what sort of shunt does tetralogy of fallot cause?

A

right-left shunt causing cyanosis

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50
Q

what are risk factors for tetralogy of fallot?

A

rubella infection
mother >40
alcohol consumption in pregnancy
diabetic mother

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51
Q

what is the management of tetralogy of fallot?

A

prostaglandin infusion
surgical:
- interim- modified blalock-Thomas-taussing shunt- connects subclavian to pulmonary artery bypassing the stenosis and redirecting blood to the lungs
definitive- total surgical repair

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52
Q

what is nephrotic syndrome?

A

the basement membrane of the glomerulus becomes highly permeable to protein allowing proteins ti leak from the blood into the urine

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53
Q

when and how does nephrotic syndrome present?

A

most common between the ages of 2 and 5

presents with frothy urine, generalised oedema and pallor

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54
Q

what are the classic features of nephrotic syndrome?

A

low serum albumin
high protein content (>3+ protein on urine dip)
oedema

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55
Q

what is the most common cause of nephrotic syndrome in children?

A

minimal change disease

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56
Q

how is nephrotic syndrome treated?

A

high dose steroids (prednisolone)
low salt diet
diuretics to treat oedema
albumin infusions in severe hypoalbuminaemia
antibiotic prophylaxis may be given in severe cases

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57
Q

management of fever in children under 3 months

A

immediate IV antibiotics (ceftriaxone) and a full septic screen
a lumbar puncture should be considered

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58
Q

what are the typical antibiotic choices for children with a UTI?

A

Trimethoprim
nitrofurantoin
cefalexin
amoxicillin

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59
Q

what investigations are done for recurrent UTIs in children?

A

ultrasound scan
DMSA (dimercaptosuccinic acid) scan
micturating cystourethrogram (MCUG)- used to diagnose vesicle-ureteric reflux

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60
Q

what does nephritis cause?

A

reduction in kidney function
haematuria
proteinuria

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61
Q

what are the most common causes of nephritis in children?

A

post-streptococcal glomerulonephritis

IgA nephropathy

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62
Q

what happens in post-streptococcal glomerulonephritis?

A

occurs 1-3 weeks after a B-haemolytic strep infection (e.g tonsillitis caused by strep pyogenes)
immune complexes get stuck in the glomeruli and cause inflammation. this leads to an acute deterioration in renal function, causing an AKI.

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63
Q

what is henoch-schonlein purpura?

A

an IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children.

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64
Q

what are 4 features seen in henoch-schonlein purpura?

A

purpura
joint pain
abdominal pain
renal involvement- IgA nephritis

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65
Q

what investigations are important in henoch-schonlein purpura?

A 
FBC and blood film, CRP- thrombocytopenia, sepsis and leukaemia 
renal profile for kidney involvement 
serum albumin
urine dip- proteinuria 
urine PCR- quantify proteinuria 
BP for hypertension
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66
Q

how is henoch-schonlein purpura managed?

A

supportive- analgesia, rest and proper hydration
may use steroids
monitoring- BP and urine dip

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67
Q

how is enuresis managed?

A

advise and reassurance- reduce fluid at night
encouragement and positive reinforcement
treat any underlying cause
enuresis alarms
pahrmacological treatment

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68
Q

what are the pharmacological options for enuresis?

A

desmopressin- analogue of ADH
oxybutinin- anticholinergic which reduces the contractility of the bladder
imipramine- tricyclic antidepressant

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69
Q

what is the classic triad of symptoms in type 1 diabetes?

A

polyuria
polydipsia
weight loss

70
Q

what is a basal-bolus regime?

A

basal refers to an injection of a long acting background insulin such as Lantus typically in the evening
bolus refers to injection of a short acting insulin such as actrapid usually 3 times a day before meals.

71
Q

what are the major features of DKA?

A

ketoacidosis
hyperglycaemia
dehydration
potassium imbalance

72
Q

how does DKA present?

A 
polyuria, polydipsia 
nausea and vomiting 
weight loss 
acetone smell to breath 
dehydration and subsequent hypotension 
altered consciousness 
symptoms of underlying trigger
73
Q

how is DKA managed?

A

correct dehydration evenly over 48 hours- avoid boluses
insulin infusion
add UV dextrose once blood glucose falls below 14
add K+ to fluids and monitor serum k+

74
Q

what are the categories of features seen in autism spectrum disorder?

A

social interaction
communication
behaviour

75
Q

how is ADHD managed?

A

conservative- education and strategies to manage the child, healthy diet and exercise, elimination of triggers (e.g certain food colourings)
medical- stimulants such as methylphenidate, dexamphetamine and atomoxetine

76
Q

what are the types of cerebral palsy?

A

spastic- hypertonia and reduced function resulting from damage to UMNs
dyskinetic- problems controlling muscle tone, with hypertonia and hypotonia causing athetoid movements and ora-motor problems. result of damage to the basal ganglia
ataxic- problems with co-ordinated movement resulting from damage to the cerebellum
mixed

77
Q

what are causes of cerebral palsy?

A

antenatal- maternal infection, trauma during pregnancy
perinatal- birth asphyxia, pre-term birth
postnatal- meningitis, severe neonatal jaundice, head injury

78
Q

what are signs and symptoms of cerebral palsy?

A

failure to meet milestones
increased/decreased tone generally or in specific limbs
hand preference below 18 months
problems with co-ordination, speech or walking
feeding or swallowing problems

79
Q

what are the grades in hypoxic-ischaemic encephalopathy?

A

?mild- poor feeding, general irritability and hyper-alert, resolves within 24 hours, prognosis normal
moderate- poor feeding, lethargic, hypotonic and seizures, can take weeks to resolve, up to 40% develop cerebral palsy
severe- reduced consciousness, apnoeas, flaccid and reduced reflexes, 50% mortality, 90% develop cerebral palsy

80
Q

what is therapeutic hypothermia?

A

an option to help protect the brain from hypoxic injury in hypoxic ischaemic encephalopathy. involves cooling the core temp of the baby to between 33 and 34 degrees with cooling blankets and hats. it reduces inflammation and neurone loss after the acute hypoxic injury. reduces the risk of cerebral palsy, developmental delay, learning disability, blindness and death

81
Q

what are the common causative organisms of neonatal sepsis?

A 
group B strep
e.coli 
listeria 
klebsiella 
staph aureus
82
Q

what are the usual 1st line antibiotics to treat neonatal sepsis?

A

benzylpenicillin and gentamycin

83
Q

when does physiological jaundice present?

A

2-7 days after birth

84
Q

what is the most common cause of jaundice in the first 24 hours?

A

jaundice in first 24 hours is pathological
neonatal sepsis is the most common, babies should be treated for sepsis if they have any other clinical features or risk factors. can also be caused by haemolysis

85
Q

what are the causes of neonatal jaundice?

A

increased production of bilirubin: haemolytic disease of the newborn, ABO incompatibility, haemorrhage, polycythaemia, sepsis and DIC
decreased clearance of bilirubin: prematurity, breast milk jaundice, neonatal cholestasic, extra hepatic biliary atresia, endocrine disorders

86
Q

what is prolonged jaundice?

A

more than 14 days in full term babies

more than 21 days in premature babies

87
Q

what is haemolytic disease of the newborn?

A

due to rhesus incompatibility of mother (rhesus -ve) and baby (rhesus +ve). the mothers anti-d antibodies attach to the babies RBCs and cause the immune system to attack them leading to haemolysis, causing anaemia and high bilirubin

88
Q

how is neonatal jaundice managed?

A

monitor and plot total bilirubin levels. if levels reach a certain threshold treatment should be commenced
phototherapy- converts unconjugated bilirubin inti isomers that can be excreted
exchange transfusion- if bilirubin levels are extremely high. involves replacing the neonates blood with donor blood

89
Q

what is kernicterus?

A

a type of brain damage caused by excessive bilirubin

90
Q

how does necrotising enterocolitis present?

A 
intolerance to feeds
vomiting- particularly bilious 
absent bowl sounds 
blood in stool 
peritonitis and shock if perforation occurs
91
Q

what are risk factors for NEC?

A 
very low birthweight 
prematurity 
formula feeds 
respiratory distress and assisted ventilation 
sepsis 
congenital heart defects
92
Q

how is NEC managed?

A

nil by mouth, IV fluids, TPN and antibiotics
NG tube with free drainage
may need surgery to remove dead bowel tissue. may be left with a temporary stoma

93
Q

what are causes of neonatal intestinal obstruction with bilious vomiting

A 
malrotation and volvulus 
duodenal atresia (if obstruction distal to ampulla of Vater)
jejunoileal atresia 
meconium ileum, meconium plug syndrome 
Hirschsprung's disease
94
Q

how is neonatal intestinal obstruction managed?

A 
refer to surgical team 
nil by mouth 
NG/OG tube for free drainage 
fluid resuscitation if signs of shock 
maintenance fluids plus ml for ml replacement of NG aspirate
95
Q

how does meconium aspiration present?

A

bluish skin colour
breathing problems
limpness at birth
dark, greenish staining or streaking of the amniotic fluid

96
Q

how is meconium aspiration managed?

A 
suction as soon as head is seen 
antibiotics 
respiratory support if necessary 
temperature control 
admit to SCBU if necessary
97
Q

how is transient tachyponea of the neonate treated?

A

supportive care:
supplemental oxygen
ventilatory support- CPAP
IV fluids/NG feeding if breathing is too fast for feeds

98
Q

how does transient tachypnoea of the neonate present?

A

cyanosis
rapid breathing- RR>60
increased work of breathing: nostril flaring, head bobbing, intercostal/subcostal recessions

99
Q

what is the most common cause of bronchiolitis?

A

respiratory syncytial virus (RSV)

100
Q

how does bronchiolitis present?

A 
coryza symptoms 
signs of respiratory distress- increased RR, use of accessory muscles, intercostal/subcostal recessions, nasal flaring, head bobbing, tracheal tug, cyanosis, abnormal airway noises 
poor feeding 
episodes of apnoea 
mild fever (under 39)
wheeze and crackles on auscultation
101
Q

when does bronchiolitis typically occur?

A

under 1 year

102
Q

how is bronchiolitis managed?

A

supportive management
ensure adequate feeding- orally, NG or IV fluids, little and often
saline nasal drops and nasal suctioning
supplementary oxygen if sats below 92%
ventilatory support- high flow oxygen, CPAP, intubation

103
Q

when does viral induced wheeze occur?

A

typically under 3

104
Q

how does viral induced wheeze present?

A

evidence of viral illness for 1-2 days before onset of :
shortness of breath
signs of respiratory distress
expiratory wheeze throughout chest

105
Q

management of chronic asthma?

A
  1. short acting B2 agonist (salbutamol) as required
  2. add a regular low dose ICS
  3. add a LABA (salmeterol)
  4. titrate up ICS to medium dose. consider adding a leukotriene receptor agonist (montelukast), oral theophylline or a LAMA (tiotropium) in over 12s
  5. increase dose of ICS to high dose
  6. refer to specialist, may need oral steroids
106
Q

what are the severity grades in acute asthma?

A

moderate- peak flow >50% predicted, speech normal
severe- peak flow <50% predicted, unable to complete sentences, signs of respiratory distress, RR >40 in 1-5s, >30 in over 5s, HR>140 in 1-5s, >125 in over 5s
life threatening- peak flow <33% predicted, sats 92%, exhaustion and poor respiratory effort, hypotension, silent chest, cyanosis, altered consciousness/ confusion

107
Q

management of acute asthma?

A

oxygen, antibiotics if infective
mild cases- managed as outpatient with 4-6 salbutamol puffs every 4 hours
moderate to severe- stepwise approach:
1. salbutamol via spacer: 10 puffs every 2 hours
2. nebulisers with salbutamol/ ipratropium bromide
3. oral prednisolone
4. IV hydrocortisone
5. IV magnesium sulphate
6. IV salbutamol
7. IV aminophylline
8. ICU

108
Q

what are the characteristic chest sounds in pneumonia?

A

bronchial breath sounds
focal coarse crackles
dullness to percussion

109
Q

what are the common causes of pneumonia?

A

strep pneumonia- most common
group A strep- strep pyogenes
group B strep- often contracted during birth
staph aureus
heamophilus influenza
mycoplasma pneumonia- has extra pulmonary manifestations

110
Q

what is the 1st line antibiotics in pneumonia?

A

amoxicillin- add a macrolide (erythromycin) to cover atypical pneumonia

111
Q

what age does croup affect?

A

6 months to 2 years

112
Q

what are the most common causes of croup?

A 
parainfluenza- most common 
influenza 
adenovirus 
RSV 
used to be caused by diphtheria which lead to epiglottis but vaccination prevents this
113
Q

what is the classic presentation of croup?

A 
increased work of breathing 
braking cough 
hoarse voice 
stridor 
low grade fever- 37.5- 38.5
114
Q

management of croup

A

most cases just need supportive treatment

severe cases- oral dexamethasone, oxygen, nebulised budesonide, nebulised adrenaline, intubation if requires

115
Q

what is the typical cause of epiglottitis?

A

haemophilus influenza type B

now rare due to vaccination

116
Q

how does epiglottitis present?

A 
sore throat 
stridor 
drooling 
tripod position 
high fever- >38.5 
difficulty or painful swallowing 
muffled voice
117
Q

what is thumb sign?

A

sign of epiglottitis on lateral X ray of the neck

118
Q

management of epiglottitis

A

don’t distress patient as it could cause the airway to close
ensure airway is secure- contact anaesthetist may need intubation or tracheostomy
IV antibiotics- ceftriaxone
steroids- dexamethasone

119
Q

what is the gene mutation responsible for cystic fibrosis?

A

a mutation of the cystic fibrosis transmembrane conducts regulatory gene on chromosome 7

120
Q

what are the key consequences of cystic fibrosis?

A

low volume thick airway secretions that reduce airway clearance resulting in bacterial consolidation and susceptibility to infections
thick pancreatic and biliary secretions causing blockage of the ducts resulting in lack of digestive enzymes
congenital absence of the vas deferent in males resulting in male infertility

121
Q

what is meconium ileus pathognomic of?

A

cystic fibrosis

122
Q

what is the gold standard diagnostic test for cystic fibrosis?

A

sweat test

123
Q

management of cystic fibrosis

A 
chest physiotherapy, exercise 
high calorie diet 
CREON tablets- replace lipase 
prophylactic antibiotics 
bronchodilators 
nebulised DNase- can break down secretions 
nebulised hypertonic saline 
vaccination 
lung transplant, liver transplant, fertility treatment
124
Q

signs of inhaled foreign body

A 
increased work of breathing 
stridor, drooling altered voice 
asymmetric chest movement 
tracheal deviation 
focal wheeze or decreased breath sounds 
recurrent or persistent consolidation
125
Q

signs of inhaled foreign body on chest x ray

A 
visible foreign body 
segmental or lobar collapse 
hyperinflation distal to obstruction 
mediastinal shift 
pneumothorax 
pulmonary abscess and bronchiectasis
126
Q

what are the dysmorphic features in downs syndrome?

A 
hypotonia 
bradycephaly- small head with flat back 
short neck 
short stature 
flattened face and nose 
prominent epicanthic folds 
single palmar crease 
upward sloping palpebral fissures
127
Q

what are the screening tests for downs syndrome and when are they performed?

A

combined test- 11 and 14 weeks

quadruple test- 14 and 20 weeks

128
Q

what are infantile spasms?

A

also known as west syndrome

a rare disorder starting at around 6 months, characterised by full body spasms

129
Q

what are the options pharmacological management of epilepsy?

A

sodium valproate- 1st line in most forms of epilepsy
carbamazepine- 1st line in focal seizures
phenytoin
ethosuximide
lamotrigine

130
Q

management of status epilepticus

A

start timer, ensure airway
after 5 minutes- IV/IO lorazepam, buccal midazolam or rectal diazepam
if not stopped after 10 minutes- IV/IO lorazepam
optional- paraldehyde
after another 10 minutes- give phenytoin or phenobarbitone (if already on phenytoin) infusion
after 20 minutes of starting infusion- rapid sequence induction with thiopental

131
Q

what are febrile convulsions?

A

a seizure that occurs in children when they have a high fever.
only occur in children between the ages of 6 months and 5 years

132
Q

what are complex febrile convulsions?

A

partial or focal seizures
last more than 15 minutes or
occurs more than once during a single febrile illness

133
Q

what is the risk of developing epilepsy after a febrile convulsion?

A

1-8% in general population
2-7.5% after a simple febrile convulsion
10-20% after a complex febrile convulsion

134
Q

what is an abdominal migraine?

A

present with episodes of central abdominal pain lasting >1 hour. may occur in children before they develop typical migraines

135
Q

what is idiopathic thrombocytopenia purpura?

A

a purpuric non-blanching rash caused by thrombocytopenia (low platelet count)

136
Q

how does idiopathic thrombocytopenia present?

A

usually in children under 10
often a history of recent viral illness
the onset of symptoms is usually over 25-48 hours
bleeding- from gums, epistaxis or menorrhagia
bruising
petichial or purpuric rash

137
Q

what type of hypersensitivity reaction is ITP caused by?

A

type 2

138
Q

management of idiopathic thrombocytopenia purpura

A 
treatment is only required if active bleeding or severe thrombocytopenia:
prednisolone 
IV immunoglobulins 
blood transfusions 
platelet transfusions
139
Q

what is pancytopenia?

A

a combination of low RBCs (anaemia), WBCs (leukopenia), and platelets (thrombocytopenia) caused by suppression of cell lines in leukaemia

140
Q

diagnosis of leukaemia

A

FBC- anaemia, leukopenia, thrombocytopenia and high levels of abnormal WBCs
blood films- can show best cells
bone marrow biopsy
lymph node biopsy
further tests for staging- chest x ray, CT scan, lumbar puncture, genetic analysis and immunophenotyping of abnormal cells

141
Q

how is leukaemia managed?

A

chemotherapy
radiotherapy
bone marrow therapy
surgery

142
Q

what are the types of hypersensitivity reactions?

A

type 1: IgE antibodies to a specific allergen trigger mast cells and basophils to release histamines and cytokines causing an immediate reaction. typical food allergy reaction
type 2: IgG and IgM antibodies react to an allergen and activate the complement system leading to direct damage to local cells e.g haemolytic disease of the newborn
type 3: immune complexes accumulate and cause damage to local tissues e.g henoch-schonlein purpura
type 4: T cells are inappropriately activated causing inflammation and damage to local tissues e.g organ transplant rejection

143
Q

management of anaphylaxis

A

IM adrenaline
antihistamines- cetirizine, chlorphenamine
steroids- IV hydrocortisone

144
Q

when is a lumbar puncture reccommended in children?

A

under 1 month presenting with fever
1-3 months with fever and are unwell
under 1 year with unexplained fever and other features of serious illness

145
Q

what is kernig’s and brudzinski’s test?

A

kernig’s- involves lying a patient on their back, flexing one hip and knee to 90 degrees then slowly straightening the knee. will produce spinal pain or resistance to movement in meningitis
brudzinski’s- involves lying the patient flat and lifting their head and neck off the bed to flex their chin to the chest. in a positive test this will cause the patient to involuntarily flex their hips and knees

146
Q

management of meningitis

A

community: urgent injection of benzylpenicillin prior to transfer to hospital
hospital: antibiotics (cefotaxime plus amoxicillin in under 3 months, ceftriaxone above 3 months), steroids

147
Q

differences in the lumbar puncture in viral and bacterial meningitis

A

bacterial- cloudy appearance, Hugh protein, low glucose, high neutrophils
viral- clear appearance, mildly raised protein, normal glucose, high lymphocytes

148
Q

what is the antibiotic choice in bacterial tonsillitis?

A

phenoxymethylpenicillin (penicillin V)

149
Q

how is glue ear managed?

A

conservative- usually resolves in 3 months

may need grommets to drain the fluid

150
Q

what is the pain ladder in children?

A
  1. paracetamol or ibuprofen

2. morphine

151
Q

what is a greenstick fracture?

A

only one side of the bone breaks

152
Q

what is a salter-harris fracture?

A

a growth plate fracture

153
Q

what is transient synovitis?

A

sometimes referred to as irritable hip. it is temporary irritation and inflammation of the synovial membrane
common in children aged 3-10
often associated with a viral URTI

154
Q

is transient synovitis associated with fever?

A

no

155
Q

how does systemic JIA (stills disease) present?

A 
subtle salmon pink rash 
high swinging fevers 
enlarged lymph nodes 
weight loss 
joint inflammation and pain 
splenomegaly 
muscle pain 
pleuritis and pericarditis
156
Q

what is macrophage activation syndrome (MAS) and how does it present?

A

a complication of systemic JIA
there is severe activation of the immune system with a massive inflammatory response.
presents with an acutely unwell child with DIC, anaemia, thrombocytopenia and a non-blanching rash.
key finding- low ESR

157
Q

what is enthesitis-related arthritis?

A

the paeds version of the seronegative spondlyoarthropathy group of conditions (ankylosing spondylitis, psoriatic arthritis, reactive arthritis). enthesitis is inflammation at the point at which the tendon insets into a bone.

158
Q

what gene is associated with enthesitis related arthritis?

A

HLA B27- also associated with IBD and psoriasis

159
Q

what surfaces does eczema typically effect?

A

flexor surfaces

face and neck

160
Q

what is the steroid ladder?

A

mild: hydrocortisone- 0.5%,1%,2.5%
moderate: eumovate
potent: betnovate
very potent: dermovate

161
Q

what are the treatment options in impetigo?

A

hydrogen peroxide 1% cream
if unsuitable 5 days of topical fusidic acid or mupirocin
oral flucloxacillin- if severe or widespread or in bullous impetigo

162
Q

how does testicular torsion present?

A 
unilateral testicular pain 
may have abdominal pain and vomiting 
firm swollen testicle 
elevated testicle 
absent cremasteric reflex 
abnormal testicular lie, rotation (posterior position)
163
Q

how is testicular torsion managed?

A

nil by mouth, analgesia
scrotal ultrasound can confirm the diagnosis (whirlpool sign) but should not delay transfer to theatre
surgical exploration of the scrotum
orchiopexy- correcting the position of the testicles and fixing them
orchidectomy- removal of the testicle if there is necrosis

164
Q

what are the types of attachment disorder?

A

reactive attachment disorder- consistent pattern of inhibited, emotionally withdrawn behaviour to adult caregivers, rarely seeks comfort when distressed
disinhibited attachment disorder- excessively and inappropriately friendly towards people they don’t know

165
Q

what are differential diagnoses to consider in non-accidental injury?

A

coagulopathy- may lead to excessive bruising and haemathrosis.
osteogenesis imperfecta- fractures more likely. skeletal survey would show decreased bone density

166
Q

what investigations are important in non accidental injury?

A

skeletal surgery- repeated at 11-14 days
CT head- in acute presentation
MRI head- non-acute presentation
CT if suspecting rib fractures

167
Q

what is the course of measles infection?

A

prodrome (10 days after exposure)- fever, cough, coryza, conjunctivitis
kolpiks spots- small, red spots with a bluish white speck in the centre, 2-3 days after first symptoms
rash- 2-4 days after prodromal symptoms. begins on the forehead and neck and spreads involving the trunk and the limbs over 3-4 days

168
Q

what is another name for the symptoms that parvovirus B19 causes?

A

slapped cheek syndrome

169
Q

what is a characteristic finding in scarlet fever?

A

strawberry tongue- white coating with red spots

170
Q

what is the cause of mumps?

A

paramyxovirus

171
Q

how does mumps present?

A

parotitis- swollen parotid glads
non-specific symptoms- fever, headache, malaise, muscle aches
epididymo-orchitis
oophoritis

172
Q

how does rubella present?

A

features present 2-3 weeks after exposure
rash- typically starts on face and neck and spreads, lasts 3-5 days
lymphadenopathy- may precede the rash and last for 2 weeks
arthritis and arthralgia
non-specific symptoms

ICCP: Child Health (1 decks)

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