Child Health Flashcards
(172 cards)
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
2
Q
at what age should a child be walking independently?
A
18 months
3
Q
at what age is hand preference and persistent primitive reflexes a red flag?
A
6 months
4
Q
at what age are no smile, no eye contact and head lag red flags?
A
10 weeks
5
Q
what type of reaction is allergic rhinitis?
A
IgE mediated type 1 hypersensitivity reaction
6
Q
how is allergic rhinitis managed?
A
oral antihistamines
nasal corticosteroids
nasal antihistamines
7
Q
what is the recommend volume of milk for babies after 4 days?
A
150ml/kg/day
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
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)
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
11
Q
how is pyloric stenosis diagnosed?
A
abdominal ultrasound to visualise the thickened pylorus
12
Q
how is pyloric stenosis managed?
A
laparoscopic pyloromyotomy
13
Q
what is the most common cause of gastroenteritis?
A
viral- rotavirus or norovirus
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
15
Q
what are the autoantibodies are associated with coeliac disease?
A
anti-tissue transglutaminase (TTG)
anti-endomysial (EMA)
16
Q
what will intestinal biopsy show in coeliac disease?
A
crypt hypertrophy
villous atrophy
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
18
Q
how is paediatric intestinal obstruction managed?
A
emergency admission nil by mouth NG tube with free drainage IV fluids surgical management
19
Q
what is intussusception and when does it occur?
A
the bowel telescopes into itself
typically occurs from 6 months to 2 years
20
Q
what are the characteristic signs of intussusception?
A
severe colicky abdominal pain
redcurrant jelly stool
RUQ sausage shaped mass on palpation
vomiting
21
Q
how is intussusception diagnosed?
A
ultrasound
contrast enema
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
23
Q
what is rovsings sign?
A
palpation in the LIF causes pain in the RIF
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
25
how is appendicitis managed?
```
emergency admission to surgical team
nil by mouth
IV fluids
IV antibiotics
surgery- laparoscopic appendicectomy
if perforated can manage conservatively with IV antibiotics
```
26
what is the first line laxative in paediatric constipation?
movicol
27
management of constipation
correct reversible contributing factors, recommend high fibre diet and good hydration
laxatives
28
management of faecal impaction
disimpaction regime with high dose laxatives
29
what is the difference between IGE and non-IGE medicated cows milk protein allergy?
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
30
what are the 3 shunts present in the fetal circulation?
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
31
what symptoms does a left- right shunt cause?
pulmonary hypertension curing breathlessness, difficulty feeding and poor weight gain
32
what sort of shunt does a patent ductus arteriosus cause?
left-right shunt
33
how is a PDA managed?
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
34
what sort of shunt does an atrial septal defect cause?
left- right shut causing pulmonary hypertension (breathlessness) and right heart failure
35
what is eisenmenger syndrome?
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
36
what sort of murmur does an atrial septal defect cause?
ejection systolic murmur best heard at upper left sternal edge
37
what sort of shunt does a ventricular septal defect cause?
left-right shunt causing pulmonary hypertension
38
what sort of murmur does a ventricular septal defect cause?
pan-systolic murmur heard best at the left lower sternal border
39
what murmur is heard in aortic stenosis?
ejection systolic heard in arotic area. has a crescendo-decrescendo character and radiates to carotids
40
what conditions are associated with pulmonary valve stenosis?
tetralogy of fallot
William syndrome
Noonan syndrome
congenital rubella syndrome
41
what is the murmur in pulmonary stenosis?
ejection systolic murmur heard best at the left upper sternal edge (pulmonary area)
42
what condition is coarctation of the aorta associated with?
turners syndrome
43
what are the signs of aortic coarctation?
weak femoral pulses
different upper and lower limb BP
systolic murmur below left clavicle and back
low cardiac output and shock- critical coarctation
44
what is the management of critical coarctation?
resuscitate
prostaglandin E to maintain PDA
surgery to correct the coarctation
45
why is prostaglandin e given in critical coarctation?
to maintain the PDA- acts as a lifeline allowing sone blood to flow to the systemic circulation
46
what happens in transposition of the great arteries?
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
47
how is transposition of the great arteries managed?
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
48
what are the four pathologies in tetralogy of fallot?
ventricular septal defect
pulmonary valve stenosis
overriding aorta
right ventricular hypertrophy
49
what sort of shunt does tetralogy of fallot cause?
right-left shunt causing cyanosis
50
what are risk factors for tetralogy of fallot?
rubella infection
mother >40
alcohol consumption in pregnancy
diabetic mother
51
what is the management of tetralogy of fallot?
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
52
what is nephrotic syndrome?
the basement membrane of the glomerulus becomes highly permeable to protein allowing proteins ti leak from the blood into the urine
53
when and how does nephrotic syndrome present?
most common between the ages of 2 and 5
| presents with frothy urine, generalised oedema and pallor
54
what are the classic features of nephrotic syndrome?
low serum albumin
high protein content (>3+ protein on urine dip)
oedema
55
what is the most common cause of nephrotic syndrome in children?
minimal change disease
56
how is nephrotic syndrome treated?
high dose steroids (prednisolone)
low salt diet
diuretics to treat oedema
albumin infusions in severe hypoalbuminaemia
antibiotic prophylaxis may be given in severe cases
57
management of fever in children under 3 months
immediate IV antibiotics (ceftriaxone) and a full septic screen
a lumbar puncture should be considered
58
what are the typical antibiotic choices for children with a UTI?
Trimethoprim
nitrofurantoin
cefalexin
amoxicillin
59
what investigations are done for recurrent UTIs in children?
ultrasound scan
DMSA (dimercaptosuccinic acid) scan
micturating cystourethrogram (MCUG)- used to diagnose vesicle-ureteric reflux
60
what does nephritis cause?
reduction in kidney function
haematuria
proteinuria
61
what are the most common causes of nephritis in children?
post-streptococcal glomerulonephritis
| IgA nephropathy
62
what happens in post-streptococcal glomerulonephritis?
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.
63
what is henoch-schonlein purpura?
an IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children.
64
what are 4 features seen in henoch-schonlein purpura?
purpura
joint pain
abdominal pain
renal involvement- IgA nephritis
65
what investigations are important in henoch-schonlein purpura?
```
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
```
66
how is henoch-schonlein purpura managed?
supportive- analgesia, rest and proper hydration
may use steroids
monitoring- BP and urine dip
67
how is enuresis managed?
advise and reassurance- reduce fluid at night
encouragement and positive reinforcement
treat any underlying cause
enuresis alarms
pahrmacological treatment
68
what are the pharmacological options for enuresis?
desmopressin- analogue of ADH
oxybutinin- anticholinergic which reduces the contractility of the bladder
imipramine- tricyclic antidepressant
69
what is the classic triad of symptoms in type 1 diabetes?
polyuria
polydipsia
weight loss
70
what is a basal-bolus regime?
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
what are the major features of DKA?
ketoacidosis
hyperglycaemia
dehydration
potassium imbalance
72
how does DKA present?
```
polyuria, polydipsia
nausea and vomiting
weight loss
acetone smell to breath
dehydration and subsequent hypotension
altered consciousness
symptoms of underlying trigger
```
73
how is DKA managed?
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
what are the categories of features seen in autism spectrum disorder?
social interaction
communication
behaviour
75
how is ADHD managed?
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
what are the types of cerebral palsy?
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
what are causes of cerebral palsy?
antenatal- maternal infection, trauma during pregnancy
perinatal- birth asphyxia, pre-term birth
postnatal- meningitis, severe neonatal jaundice, head injury
78
what are signs and symptoms of cerebral palsy?
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
what are the grades in hypoxic-ischaemic encephalopathy?
?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
what is therapeutic hypothermia?
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
what are the common causative organisms of neonatal sepsis?
```
group B strep
e.coli
listeria
klebsiella
staph aureus
```
82
what are the usual 1st line antibiotics to treat neonatal sepsis?
benzylpenicillin and gentamycin
83
when does physiological jaundice present?
2-7 days after birth
84
what is the most common cause of jaundice in the first 24 hours?
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
what are the causes of neonatal jaundice?
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
what is prolonged jaundice?
more than 14 days in full term babies
| more than 21 days in premature babies
87
what is haemolytic disease of the newborn?
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
how is neonatal jaundice managed?
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
what is kernicterus?
a type of brain damage caused by excessive bilirubin
90
how does necrotising enterocolitis present?
```
intolerance to feeds
vomiting- particularly bilious
absent bowl sounds
blood in stool
peritonitis and shock if perforation occurs
```
91
what are risk factors for NEC?
```
very low birthweight
prematurity
formula feeds
respiratory distress and assisted ventilation
sepsis
congenital heart defects
```
92
how is NEC managed?
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
what are causes of neonatal intestinal obstruction with bilious vomiting
```
malrotation and volvulus
duodenal atresia (if obstruction distal to ampulla of Vater)
jejunoileal atresia
meconium ileum, meconium plug syndrome
Hirschsprung's disease
```
94
how is neonatal intestinal obstruction managed?
```
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
how does meconium aspiration present?
bluish skin colour
breathing problems
limpness at birth
dark, greenish staining or streaking of the amniotic fluid
96
how is meconium aspiration managed?
```
suction as soon as head is seen
antibiotics
respiratory support if necessary
temperature control
admit to SCBU if necessary
```
97
how is transient tachyponea of the neonate treated?
supportive care:
supplemental oxygen
ventilatory support- CPAP
IV fluids/NG feeding if breathing is too fast for feeds
98
how does transient tachypnoea of the neonate present?
cyanosis
rapid breathing- RR>60
increased work of breathing: nostril flaring, head bobbing, intercostal/subcostal recessions
99
what is the most common cause of bronchiolitis?
respiratory syncytial virus (RSV)
100
how does bronchiolitis present?
```
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
when does bronchiolitis typically occur?
under 1 year
102
how is bronchiolitis managed?
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
when does viral induced wheeze occur?
typically under 3
104
how does viral induced wheeze present?
evidence of viral illness for 1-2 days before onset of :
shortness of breath
signs of respiratory distress
expiratory wheeze throughout chest
105
management of chronic asthma?
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
what are the severity grades in acute asthma?
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
management of acute asthma?
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
what are the characteristic chest sounds in pneumonia?
bronchial breath sounds
focal coarse crackles
dullness to percussion
109
what are the common causes of pneumonia?
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
what is the 1st line antibiotics in pneumonia?
amoxicillin- add a macrolide (erythromycin) to cover atypical pneumonia
111
what age does croup affect?
6 months to 2 years
112
what are the most common causes of croup?
```
parainfluenza- most common
influenza
adenovirus
RSV
used to be caused by diphtheria which lead to epiglottis but vaccination prevents this
```
113
what is the classic presentation of croup?
```
increased work of breathing
braking cough
hoarse voice
stridor
low grade fever- 37.5- 38.5
```
114
management of croup
most cases just need supportive treatment
| severe cases- oral dexamethasone, oxygen, nebulised budesonide, nebulised adrenaline, intubation if requires
115
what is the typical cause of epiglottitis?
haemophilus influenza type B
| now rare due to vaccination
116
how does epiglottitis present?
```
sore throat
stridor
drooling
tripod position
high fever- >38.5
difficulty or painful swallowing
muffled voice
```
117
what is thumb sign?
sign of epiglottitis on lateral X ray of the neck
118
management of epiglottitis
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
what is the gene mutation responsible for cystic fibrosis?
a mutation of the cystic fibrosis transmembrane conducts regulatory gene on chromosome 7
120
what are the key consequences of cystic fibrosis?
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
what is meconium ileus pathognomic of?
cystic fibrosis
122
what is the gold standard diagnostic test for cystic fibrosis?
sweat test
123
management of cystic fibrosis
```
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
signs of inhaled foreign body
```
increased work of breathing
stridor, drooling altered voice
asymmetric chest movement
tracheal deviation
focal wheeze or decreased breath sounds
recurrent or persistent consolidation
```
125
signs of inhaled foreign body on chest x ray
```
visible foreign body
segmental or lobar collapse
hyperinflation distal to obstruction
mediastinal shift
pneumothorax
pulmonary abscess and bronchiectasis
```
126
what are the dysmorphic features in downs syndrome?
```
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
what are the screening tests for downs syndrome and when are they performed?
combined test- 11 and 14 weeks
| quadruple test- 14 and 20 weeks
128
what are infantile spasms?
also known as west syndrome
| a rare disorder starting at around 6 months, characterised by full body spasms
129
what are the options pharmacological management of epilepsy?
sodium valproate- 1st line in most forms of epilepsy
carbamazepine- 1st line in focal seizures
phenytoin
ethosuximide
lamotrigine
130
management of status epilepticus
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
what are febrile convulsions?
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
what are complex febrile convulsions?
partial or focal seizures
last more than 15 minutes or
occurs more than once during a single febrile illness
133
what is the risk of developing epilepsy after a febrile convulsion?
1-8% in general population
2-7.5% after a simple febrile convulsion
10-20% after a complex febrile convulsion
134
what is an abdominal migraine?
present with episodes of central abdominal pain lasting >1 hour. may occur in children before they develop typical migraines
135
what is idiopathic thrombocytopenia purpura?
a purpuric non-blanching rash caused by thrombocytopenia (low platelet count)
136
how does idiopathic thrombocytopenia present?
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
what type of hypersensitivity reaction is ITP caused by?
type 2
138
management of idiopathic thrombocytopenia purpura
```
treatment is only required if active bleeding or severe thrombocytopenia:
prednisolone
IV immunoglobulins
blood transfusions
platelet transfusions
```
139
what is pancytopenia?
a combination of low RBCs (anaemia), WBCs (leukopenia), and platelets (thrombocytopenia) caused by suppression of cell lines in leukaemia
140
diagnosis of leukaemia
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
how is leukaemia managed?
chemotherapy
radiotherapy
bone marrow therapy
surgery
142
what are the types of hypersensitivity reactions?
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
management of anaphylaxis
IM adrenaline
antihistamines- cetirizine, chlorphenamine
steroids- IV hydrocortisone
144
when is a lumbar puncture reccommended in children?
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
what is kernig's and brudzinski's test?
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
management of meningitis
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
differences in the lumbar puncture in viral and bacterial meningitis
bacterial- cloudy appearance, Hugh protein, low glucose, high neutrophils
viral- clear appearance, mildly raised protein, normal glucose, high lymphocytes
148
what is the antibiotic choice in bacterial tonsillitis?
phenoxymethylpenicillin (penicillin V)
149
how is glue ear managed?
conservative- usually resolves in 3 months
| may need grommets to drain the fluid
150
what is the pain ladder in children?
1. paracetamol or ibuprofen
| 2. morphine
151
what is a greenstick fracture?
only one side of the bone breaks
152
what is a salter-harris fracture?
a growth plate fracture
153
what is transient synovitis?
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
is transient synovitis associated with fever?
no
155
how does systemic JIA (stills disease) present?
```
subtle salmon pink rash
high swinging fevers
enlarged lymph nodes
weight loss
joint inflammation and pain
splenomegaly
muscle pain
pleuritis and pericarditis
```
156
what is macrophage activation syndrome (MAS) and how does it present?
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
what is enthesitis-related arthritis?
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
what gene is associated with enthesitis related arthritis?
HLA B27- also associated with IBD and psoriasis
159
what surfaces does eczema typically effect?
flexor surfaces
| face and neck
160
what is the steroid ladder?
mild: hydrocortisone- 0.5%,1%,2.5%
moderate: eumovate
potent: betnovate
very potent: dermovate
161
what are the treatment options in impetigo?
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
how does testicular torsion present?
```
unilateral testicular pain
may have abdominal pain and vomiting
firm swollen testicle
elevated testicle
absent cremasteric reflex
abnormal testicular lie, rotation (posterior position)
```
163
how is testicular torsion managed?
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
what are the types of attachment disorder?
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
what are differential diagnoses to consider in non-accidental injury?
coagulopathy- may lead to excessive bruising and haemathrosis.
osteogenesis imperfecta- fractures more likely. skeletal survey would show decreased bone density
166
what investigations are important in non accidental injury?
skeletal surgery- repeated at 11-14 days
CT head- in acute presentation
MRI head- non-acute presentation
CT if suspecting rib fractures
167
what is the course of measles infection?
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
what is another name for the symptoms that parvovirus B19 causes?
slapped cheek syndrome
169
what is a characteristic finding in scarlet fever?
strawberry tongue- white coating with red spots
170
what is the cause of mumps?
paramyxovirus
171
how does mumps present?
parotitis- swollen parotid glads
non-specific symptoms- fever, headache, malaise, muscle aches
epididymo-orchitis
oophoritis
172
how does rubella present?
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
