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Child health Flashcards

1
Q

What are the symptoms of a UTI in children aged 0-2 months?

A

Jaundice, fever, failure to thrive, poor feeding, vomiting, irritability

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2
Q

What are the symptoms of a UTI in children aged 2-months to 2 years?

A

Poor feeding, fever, vomiting, strong smelling urine, abdo pain, irritability

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3
Q

What are the symptoms of a UTI in children aged 2-6 years

A

Vomiting, abdo pain, fever, strong smelling urine, enuresis, dysuria, urgency, frequency

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4
Q

What are the symptoms of a UTI in children aged 6 years and above?

A

Fever, vomiting, abdo pain, flank/back pain, strong smelling urine, dysuria, urgency, frequency, enuresis, incontinence

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5
Q

What can be seen in the physical examination of a child with a UTI?

A

Costovertebral tenderness, palpable bladder, suprapupic tenderness to palpation, abdominal tenderness to palpation, palpable bladder, dribbling, poor stream, straining to void

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6
Q

What tests are used to confirm a UTI?

A

FBC, basic metabolic panel, blood culture, renal function studies, electrolyte studies, Urineanalysis

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7
Q

Why is a blood culture done in children with query UTI?

A

To rule out sepsis

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8
Q

Why is a basic metabolic panel done in children with query UTI?

A

For presumptive diagnosis of pyelonephritis

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9
Q

How can a urine sample be collected?

A

Mid stream or via suprapupic aspiration for kids with complications

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10
Q

Which pediatric patients with UTIs are hospitalized?

A

Toxemic or septic
urinary obstruction or underlying disease
cannot tolerate adequate oral fluids or medication
younger than two months with febrile UTI
younger than 1 month

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11
Q

How are UTIs treated?

A

Antibiotics

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12
Q

What are the common pathogens that cause UTIs in children?

A

E coli

Klebsiella, proteus, enterococcus, Staph. saprophyticus, strep. group B, pseudomonas

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13
Q

What site of infection is most common in UTIs for children?

A

Pyelonephritis

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14
Q

What are the risk factors in children for UTIs?

A

Antibiotic therapy, anatomical abnormality, bowel and bladder dysfunction, constipation

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15
Q

What is otitis media?

A

Inflammation of the middle ear

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16
Q

What are the four sub types of otitis media?

A

Acute, otitis media with effusion, chronic suppurative OM, adhesive OM

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17
Q

What are the symptoms and signs of acute otitis media?

A

Otalgia, otorhea, fever, diarrhoea, vomiting, irritability loss of appetite, headache

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18
Q

What are the symptoms of otitis media with effusion?

A

Hearing loss, tinitus, vertigo, otalgia. Can occur after an episode of acute OM

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19
Q

What is chronic supparative otitis media?

A

Persistent ear infection that results in tearing or perforation of the eardrum

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20
Q

What is adhesive otitis media?

A

Thin retracted ear drum becomes sucked into middle ear space and stuck

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21
Q

Which of acute otitis media and otitis media with effusion is treatable by antibiotics?

A

Acute OM

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22
Q

Why is it important to distinguish between acute otitis media and otitis media with effusion?

A

to avoid unnecessary use of antibiotics

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23
Q

How can acute otitis media and otitis media with effusion be differentiated?

A

AOM- TM is bulging

OME tympanic membrane is retracted or in a neurtal position, there is impaired mobility

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24
Q

What colour is the tympanic membrane normally?

A

Translucent pale grey

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25
Q

What does an opaque yellow or blue tympanic membrane suggest?

A

Middle ear effusion

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26
Q

What investigations can be performed for a query otitis media?

A

Tympanocentesis and culture, tympanometry, imaging studies if a complication is suspected

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27
Q

How is otitis media treated?

A

Analgesics, antibiotics for Acute OM. Amoxicillin is the antibiotic of choice

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28
Q

What are teh risk factors for otitis media?

A

Immature immune systems, genetic predisposition, mucus secretion, anatomical abnormalities, allerfies,

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29
Q

What is the most common bacterial pathogen of acute otitis media?

A

Step. pneumoniae, h. influenza, moraxella catarrhalis

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30
Q

What is the most common viral pathogen of acute otitis media?

A

It is merely a risk factor

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31
Q

What are the intratemporal complications of otitis media? Name 10

A

Hearing loss, tympanic membrane perforation, chronic suppurative Otitis media, tympanosclerosis, cholesteatoma, mastoiditis, petrositis, labyrinthitis, facial paralysis, cholesterol granuloma, infectious eczematoid dermatitis

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32
Q

What are the intracranial complications of otitis media?

A

Meningitis, subdural empyema, brain abscess, extradural abscess, lateral sinus thrombosis, otitic hydrocephalus

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33
Q

What is tonsillitis

A

Inflammation of pharyngeal tonsils

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34
Q

What are the presentations of acute tonsilitis?

A

Fever, sore throat, foul breath, dysphagia, odynophagia, tender cervical lymph nodes, airway obstruction, pyrexia, tonsillar exudates

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35
Q

How can airway obstruction manifest in tonsilitis?

A

Mouth breathing, snoring, sleep-disordered breathing, sleep apnea

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36
Q

How is tonsillitis managed?

A

Adequate hypration, analgesics, ibuprofen, caloric intake, tonsilectomy

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37
Q

What are the viral and bacterial causes of tonsilitis?

A

Herpes simplex, EBV, CMV, adeno virus, measles, strp. pyogenes, GAS

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38
Q

WHat are the causes of recurrent tonsillitis?

A

Strep pneumonia, SA, H. influenza

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39
Q

WHat are the causes of chronic tonsillitis?

A

Polymicrobial population

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40
Q

What are the complications of bacterial tonsillitis in children?

A

Rheumatic fever, acute glomerunephritis

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41
Q

What are the classic triad of symptoms seen in bacterial meningitis?

A

Fever, headache and meningeal signs

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42
Q

What symptoms can occurs with bacterial meningitis in neonates? (10)

A

Poor feeding, lethargy, irritability, apathy, fever, seizures, apnea, hypothermia, jaundice, bulging fontanelle, pallor, shock, hypotonia, hypoglycemia, intractable metabolic acidosis, shrill cry

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43
Q

What symptoms can occurs with bacterial meningitis in infants and children? (10)

A

Nuchal rigidity, Opisthotonos, bulging fontalle, convulsions, headache, fever, phototphonbia, irritability, lethargy, anorexia, vomiting, coma

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44
Q

Whatis opisthotonos?

A

spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, some kinds of meningitis, and strychnine poisoning.

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45
Q

What is nuchal rigidity?

A

inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.

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46
Q

What is diagnosis of Bacterial meningitis based on?

A

Bacteria isolated from CSF from Lumbar puncture. Demonstrated meningeal inflammation, bacterial meningitis score

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47
Q

What are the components of the bacterial meningitis score?

A

Positive CSF Gram stain
CSF absolute neutrophil count 1000/µL or higher
CSF protein level 80 mg/dL or higher
Peripheral blood absolute neutrophil count 10,000/µL or higher
History of seizure before or at the time of presentation

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48
Q

What imaging studies can be used for bacterial meningitis? What can they reveal

A

CT an MRI. Can reveal ventriculomegaly and sulcal effacement

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49
Q

WHat blood tests can be done for bacterial meningitis?

A

FBC, blood culture, coagulation studies, elcectolytes, serum glucose (to compare with CSF)

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50
Q

What is done to manage pediatric bacterial meningitis?

A

IV antibiotics. If cause is unknown, then, based on age:< 30 days, ampicillin and an aminoglycoside or a cephalosporin
30-60 days, ampicillin and a cephalosporin; because Streptococcus pneumoniae may occur in this age range, consider vancomycin instead of ampicillin
In older children, a cephalosporin or ampicillin plus chloramphenicol with vancomycin (needs to be added secondary to the possibility of S pneumoniae)

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51
Q

What are the most common causes of pediatric bacterial meningitis?

A

Strep. Pneumonia, Neisseria meningitidis, H. influenza type B

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52
Q

WHat causes the symptoms seen in bacterial meningitis?

A

Intense host inflammatory response to bacterial antigens in subarachnoid space

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53
Q

What is the most common cause of pediatric aseptic meningitis?

A

Viruses (Viri?)

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54
Q

What is the most common viral cause of pediatric aseptic meningitis?

A

Enterovirus

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55
Q

WHat are the symptoms of pediatric aseptic meningitis?

A

Headache neck stiffness, photophobia, rash, diarrhoea, cough, arthralfia, myalgia, sore throat, weakness, lethargy, hypotonia, seizures,

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56
Q

WHat are the signs of pediatric aseptic meningitis?

A

hypothermia, bulging of fontanella, , positive kernig/brudzinski sign,

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57
Q

WHat lab studies should be done for pediatric aseptic meningitis?

A

White blood cell (WBC) count
C-reactive protein (CRP)
Procalcitonin (PCT) – PCT has been suggested as a potentially useful predictor for distinguishing between bacterial and aseptic meningitis but is not yet widely available [41]
Blood glucose (to compare with CSF glucose)
Blood culture to exclude bacterial meningitis
Viral culture of throat swab, nasopharyngeal aspirate, and stool sample
Serology – Save serum for paired convalescent sample comparison of serology at 2-3 weeks following acute illness

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58
Q

What other tests can be done for pediatric aseptic meningitis?

A

LP, CT, MRI, EEG

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59
Q

WHat medications should be used to treat aseptic meningitis?

A

Analgesics

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60
Q

What are the complications of pediatric bacterial meningitis?

A

Seizures, subdural effusions, hydrocephalus

Hearing loss, learning difficulties, cerebral palsy, affect on memory, concentration and balance

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61
Q

What are the symptoms of pediatric asthma?

A

Wheeze, nocturnal cough, shortness of breath, chest tightness, nocturnal, non-productive cough, cough with exercise

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62
Q

What are the signs of an acute pediatric episode of asthma?

A

Breathless at rest, uninterested in feeding, sit upright, talking in words and not sentences, agitated

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63
Q

What are the signs of an imminent respiratory arrest due to pediatric asthma?

A

Drowsiness, confusion

Breathless at rest, uninterested in feeding, sit upright, talking in words and not sentences, agitated

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64
Q

What are the signs seen in a physical examination of a severe episode of asthma?

A

Tachypneoa, tachycardia, use of accessory muscles to breathe, suprasternal retractions, pulsus paradoxus, o2sats <91%, loud, biphasic, inspiratory and expiratory crackles

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65
Q

What is pulsus paradoxus

A

abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg.

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66
Q

What are suprasternal retractions?

A

Substernal retractions are inward movement of the abdomen at the end of the breastbone. Intercostal retractions are inward movement of the skin between the ribs. Severe difficulty breathing is associated with supraclavicular retractions, suprasternal retractions, and sternal retractions.

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67
Q

What is status asthmaticus?

A

a severe condition in which asthma attacks follow one another without pause

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68
Q

What are the findings in a pediatric patient with status asthmaticus?

A

Paradoxical thoracoabdominal movement, absent wheezing, severe hypoxia, brady cardia, pulsus paradoxus disappears

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69
Q

Why does pulsus paradoxus disappear in status asthmaticus?

A

Respiratory muscle fatigue?

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70
Q

What medications are used to control asthma?

A

Inhaled corticosteroids, inhaled cromolyn/nedocromil, long-acting bronchodilators, theophylline, leukotrine modifiers, IgE antibodies

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71
Q

What are the relief medications used to control asthma?

A

Short acting bronchodilators, systemic steroids, Ipratropium

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72
Q

What is the definition of asthma?

A

hronic inflammatory disorder of the airways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy

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73
Q

What is the pathophysiology of asthma?

A

Ventilation perfusion mismatch caused by airway obstruction, hyperinflation and vasoconstriction due to alveolar hypoxia

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74
Q

What causes airway obstruction in asthma?

A

Increased mucus production, bronchoconstriction, chronic inflammation

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75
Q

What tests are used to diagnose asthma?

A

Spiromatey, plethysmography, exercise challenges, metacholine challenge

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76
Q

What is a metacholine challenge?

A

Giving patients metacholine and testing pirometry before and after. Metacholine causes bronchoconstriction, and ccan show reduced FEV1/FVC in patients with normal spirometry readings

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77
Q

What is bronchiolitis?

A

Acute inflammatory injury of the bronchioles, usually caused by a viral infection

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78
Q

Who does bronchiolitis usually effect?

A

Symptomatic in young children

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79
Q

What are the signs and symptoms of bronchiolitis?

A

Increasing fussiness, poor feeding, apnea, corzya, congestion, low grade feer,

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80
Q

What are the signs and symptoms of sever bronchiolitis?

A

Respiratory distress, cyanosis, tachpnea, nasal flaring, retractions, irritability

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81
Q

What are the signs seen in physical examination that raise the suspicion of bronchiolitis?

A

Tachypnea, tachycardia, fever, retractions, fine rales, hypoxia, otitis media

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82
Q

What are used to diagnose bronchiolitis?

A

Rapid viral antigen amplification testing, ABG, WBC count, CRP, O2 sats, blood cultures, urine analysis, specific gravity, culture, CS analysis, serum chemistries

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83
Q

What are the lab tests used for bronchiolitis for?

A

To exclude other differentials

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84
Q

What is the main treatment for bronchiolitis?

A

O2 ventilation

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85
Q

What are the effects of broncheolar injury?

A

Increased mucus secretion, bronchial obstruction and constriction, alveolar cell death, mucus debris, viral invasion, air trapping, atelectasis, reduced ventilation, ventilation perfusion mismatch, laboured breathing

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86
Q

What cause broncheolar injury?

A

Necrosis of resp epithelium, inflammatory response due to pathogen, inflammation, oedema and debris from infection

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87
Q

What is the most common cause of bronchiolitis?

A

RSV

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88
Q

What is croup?

A

A common, primarily viral pediatric illness that effects the larynx and trachea

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89
Q

What is the most common cause of croup?

A

Parainfluenza viruses

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90
Q

What is the most common cause of croup?

A

Parainfluenza viruses

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91
Q

What can be seen in the history of a patient with croup?

A

Nonspecific resp symptoms (rhinorrhea, sore throat, cough), low grade fever, barking cough, hoarseness, inspiratory stridor, worse symptoms at night

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92
Q

What can be seen in a severe episode of croup?

A

Inspiratory and expiratory stridor, suprasternal, intercosta, and subcostal retractions, hypoxia and hypercarbia, cyanosis

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93
Q

What are the differentials for croup?

A

Measles, pediatric airway foreign body, laryngeal fracture, inhalation injury diphtheria, EBV, peritonsillar abscess

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94
Q

What tests are used to diagnose croup?

A

Mostly a clinical diagnosis

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95
Q

What is the management sstrategies for mild croup?

A

Calming caregiver, no smoking, antipyretic, keep child’s head elevated, encourage oral intake

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96
Q

What medicationscan be used to treat severe croup?

A

Corticosteroids, epinephrine (constricts precapillary arterioles, decreasing capillary hydrostatic pressure), Heliox *helium plus oxygen, increases movement of O2 through airways)

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97
Q

How can children present due to airway foreign bodies?

A

Sudden episode of coughing or choking while eating, followed by wheezing, coughing or strodor
Acute aspiration causing death or hypoxic brain damage
Recurrent/ persistent cough, pneumonia, lung abscess, focal bronchiectasis or hemoptysis

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98
Q

What are the findings due to a foreign body in the airway of children?

A

abnormal airway sounds, like wheezing, or stridor, reduced breath sounds. usually unilateral

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99
Q

What does inspiratory changes in breath sounds imply for the position of the foreign body?

A

In extrathoraxic trachea

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100
Q

What does symmetric changes in breath sounds that are more prominent in the central airway imply for the position of the foreign body?

A

In the intrathoracic trachea

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101
Q

What are the differentials for foreign body aspiration in children?

A

Pediatric asthma, bronchitis, pneumonia

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102
Q

What tests can be done to investigate a foreign body aspirate?

A

CXR, CT, Fluoroscopy, bronchoscopy

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103
Q

What signs can be seen in an xray due to an aspirated foreign body?

A

Object is usually food, and therefore radioopaque. Xray can reveal area of focal overinflation, alectasis, opacification of distal lung

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104
Q

What is the medical treatment of a foreign body aspiration?

A

Use of rigid bronchoscope to remove foreign body if necesscary

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105
Q

What is the pathophysiology of anaphylaxis?

A

Activation of mast cells cause the relaease of inflammatory cytokines, which in turn cause urticaria, angioedema, bronchospasm, bronchorrhea, laryngospasm, increased vascular permeability and decreased vascular tone

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106
Q

What are the common triggers of pediatric anaphylaxis?

A

Foods, medicines, biologic agents, preservatives, latex, unknown causes

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107
Q

What foodstuffs can cause pediatric anaphylaxis?

A

Milks, eggs, wheat, soy, fish, shellfish, legumes, tree nuts

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108
Q

What medicines can cause pediatric anaphylaxis?

A

Antibiotics, local anaesthetics, analgesics, opiates, dextran, radiocontrast media

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109
Q

What biologic agents can cause pediatric anaphylaxis?

A

Venom, blood and blood products, vaccine, allergen extracts

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110
Q

What are the signs and symptoms of pediatric anaphylaxis?

A

Cutaneous symptoms, involvement of at least 2 organ sustems, low BP

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111
Q

What are the cutaneous symptoms of anaphylaxis?

A

Hives, pruritis, facial swellinf

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112
Q

What are the respiratory symptoms of anaphylaxiz?

A

Bronchospasm, strifor, SOB

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113
Q

Qhat are the GI symptoms of anaphylaxis?

A

Crampy abdominal pain, vomiting

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114
Q

What are the differentials for anaphylaxis?

A

Angioedema, asthma, bee strings, carcinoid tumour, exercise induced anaphylaxis, serum sickness, shock, status asthmaticus, syncope, toxicity

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115
Q

What tests can be done to investigate anaphylaxis?

A

Serum histamine and tryptase (raised after attack)

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116
Q

How is anaphylaxis treated?

A

Adrenaline, airway management, BP management

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117
Q

What do newborns with pneumonia present with typically?

A

Poor feeding, irritability, tachypnea, retractions, grunting and hypoxemia

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118
Q

What are the pathogens that can cause pneumonia that spread through vertical transmission?

A

Group B strep,

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119
Q

What agents can cause pneumonia in neonates?

A

Group B strep, listeria, ecoli, klebsiella, respiratory syncytial virus

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120
Q

What do infants with pneumonia present with typically?

A

Cough, tachypnea, retractions, hypoxia, congestion, fever, irritability, decreased feeding

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121
Q

What diagnostic tests can be used to diagnose pediatric pneumonia?

A

O2 sats, capnography, aucutation, sputum culture, serology, CXR, US

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122
Q

Which is better to diagnose pediatric pneumonie, CXR or US?

A

US

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123
Q

What is the resp rate threshold for identifying pneumonia in children <2months?

A

> or = 60

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124
Q

What is the resp rate threshold for identifying pneumonia in children 2-11 months?

A

> or = 50

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125
Q

What is the resp rate threshold for identifying pneumonia in children 12-59 months?

A

> or = 40

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126
Q

What is the treatment for outpatient pneumonia?

A

oral antibiotics

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127
Q

Why aren’t fluoroquinines used in children?

A

Can cause antibiotic resistance ad short term tendon damage

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128
Q

What are the causes of wheeze in children?

A

Bronchospasm, swelling of mucosal lining, excessive mucus secretion, and an inhaled foreign body

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129
Q

What are the signs and symptoms that suggest pediatric sepsis?

A

Fever, tachypnea, tachycardia, cool peripheries, colour changes, decreased activity level, reduced urine output, hypotension, hypothermia, anuria
Ask about: exposure to infecrtions, allergies, immunization, drug allerdies

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130
Q

What lab studies can investigate pediatric sepsis?

A

FBC, PT, coagulation screen, electrolyte levels, Us and Es, LFTs, etiology-specific serologies, urinalysis, CRP, Blood, urine and csf CULTURE

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131
Q

What radiological studies can be used to investigate sepsis?

A

CXR, CT, MRI ECG, LP

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132
Q

How can pediatric sepsis be treated?

A

Fluid resus, support of cardiac output ventilation, maintenance of adequate [hb], correction of physiologic and metabolic derangement, montoring of urine output, antimicrobial agents

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133
Q

What is pediatric testicular torsion?

A

Acute vascular even where spermatic cord gets twisted on its axis, causing loss of blood flow to the testis

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134
Q

What is the main complication of testicular torsion?

A

Loss of testicle

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135
Q

What is the most important factor about treating testicular torsion

A

Surgical emergency, must be treated as soon as possible to avoid loss of testi

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136
Q

What are the two kinds of testicular torsion, and what is the anatomical differentialtion between them?

A

Extravaginal (outside tunica vaginalis) or Intravaginal ( inside tunica vaginalis)

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137
Q

Which type of testicular torsion is more likely in older boys?

A

Intravaginal

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138
Q

Which type of testicular torsion is more likely in perinatal boys?

A

Extravaginal

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139
Q

Why are xtravaginal testicular torsions more common in perinates?

A

The tunica vaginalis takes 6 weeks to adhere

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140
Q

What are the risk factors for perinatal testicular tosion

A

Large birth weight, difficult labor, breech presentation, overreactive cremasteric reflwx

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141
Q

What are the signs and symptoms of testicular torsion?

A

Severe scrotal pain of acute onset, scrotal swelling, erythema, nausea, vomiting, tender, high riding testes with an abnormal orientation, scrotal oedema, absent cremasteric reflex

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142
Q

What are the differntials for testicular torsion?

A

Adrenal haemorrhage, epididymitis, Henoch-Schonlien purpura, orchitis, addendectomy, hydrocele and hernia surgery, varicocele

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143
Q

What tests are done to investigate testicular torsion?

A

Urinalysis, ultrasonography

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144
Q

How is testicular torsion managed?

A

Manual detororsion, surgical exploration

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145
Q

what are the goals of surgical exploration in testicular torsion?

A

Confirming diagnosis, detorsion, assessing viability of involved testis, removal of involved testes, fisation of testis

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146
Q

What is appendicitis?

A

Inflammation and infection of vermiform appendix

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147
Q

What are the complications of appencitis

A

Appendix rupture

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148
Q

What are the symptoms of appendicitis?

A

Anorexia, vague periumbilical pain, followed by migration of pain to r. lower quadrant, vomiting, fever

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149
Q

WHere is appendicits pain at it’s max?

A

McBurney point

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150
Q

What is the Rosing sign and what does it suggest?

A

Pain in RLQ in response to L. sided palpation or percussion. Suggests peritoneal irritation

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151
Q

What is the psoas sign and what does it suggest?

A

place the child on the left side and hyperextend the right leg at the hip. suggests an inflammatory mass overlying the psoas muscle (retrocecal appendicitis)

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152
Q

What is the obturator sign and what does it suggest?

A

internally rotating the flexed right thigh. A positive response suggests an inflammatory mass overlying the obturator space (pelvic appendicitis).

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153
Q

Name five differntials for appendicitis

A

Intussusception, merkel’s diverticulum, ectropic pregnancy, testicular torsion, ovarion torsion, ovarian systs, constipation, gastroentritis, UTI, pyelonephritis

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154
Q

What tests should be used to investigate appendicitis?

A

FBC, IL6,CRP, urinalysis, abdominal radiography, US, CT

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155
Q

What is the treatment for appendicitis?

A

Fluid resus, antibiotic therapy, appendectomy, percutaneous drainage (for intraabdominal abscesses), post op pain management

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156
Q

What are the complications of appendicitis?

A

Perforation, sepsis, wound infection, bowel obstruction, wound dehiscence, infertility, shock, post-op adhesions

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157
Q

What is Intussusception?

A

Segment of intesting invaginates into the adjoining lumen, causing bowel obstruction

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158
Q

What is the complication if intussusception isn’t treated in time?

A

DEATH

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159
Q

What symptoms can be seen in the history of a patients with intussusception?

A

Infant with URTI, vomiting, abdo pain, passage of blood and musus, lethargy

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160
Q

What are the signs of intussusception?

A

R. hypochondrium, palpable sausage shaped mass

Emptiness in RLQ. abdominal distension if obstruction is complete

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161
Q

What is the pain of intussusception like?

A

Colicky, severe, intermittent

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162
Q

What are the imaging studies used for diagnosis of intussusception?

A

Abdominal Xray, US, contrast enema

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163
Q

What are the non operative treatments for intussusception

A

Therapeutic enema- Hydrostatic, pneumatic

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164
Q

What are the surgical treatments for intussusception?

A

Surgical reduction, manually or laproscopically

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165
Q

What are the complications of intussusception?

A

Perforation during reduction, wound infection, intestinal haemorrhage, recurrence, necrosis, bowel perforation, sepsis, hernas, adhesions

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166
Q

How is Hepatitis A virus spread?

A

Fecal-oral route

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167
Q

How is liver injury represented?

A

Direct cellular injury that elevates serum liver enzyme levels
Cholestasis that causes jaundice and hyperbilirubinemia
Inadequate liver function that lowers serum albumin levels and prolongs the prothrombin time (PT)

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168
Q

How does Hep A cause liver injury?

A

Viral replication occurs in the liver

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169
Q

What are the symptoms in the prodromal phase of a pediatric hepatitis A infection?

A

Low grade fever, anorexia, vomiting, abdopain (RUQ)

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170
Q

What are the symptoms of a pediatric hepatitis A infection?

A

Diarrhoea, jaundice, dark urine, light coloured stool, anicteric infections

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171
Q

What are the differentials of pediatric hepatitis?

A

Hep A, B, C, Gastroentritis, gall bladder disease surgery, enteroviral infections

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172
Q

What tests can be used to investigate pediatric hepatitis?

A

Bilirubin, LFTs, US, Serology specific for viral hepatitis

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173
Q

What are the five presentations of pediatric hep B?

A

Acute asymptomatic infection with recovery: Serologic evidence only
Acute hepatitis with resolution: Anicteric or icteric
Chronic hepatitis, with or without progression to cirrhosis
Fulminant hepatitis with massive liver necrosis
Coinfection with hepatitis D virus (hepatitis delta virus)

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174
Q

What are the clinical signs of an acute pediatric hep B infection?

A

Anorexia, nausea, malaise, vomiting, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, coryza, jaundice, dark urine, clay-coloured or light stool, abdopain RUQ),

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175
Q

What are the clinical signs of chronic pediatric hep B infections?

A

Fatigue, anorexia, bouts of mild aundice

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176
Q

What are the complications of viral hepatitis?

A

Pancreatitis, myocarditis, typical pneumonia, aplastic anemia, peripheral neuropathy, transverse myelitis

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177
Q

What are the complications of pediatric hep C

A

Fulminant hepatitis (rare)
Cirrhosis, which may result in portal hypertension and liver failure
Hepatocellular carcinoma

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178
Q

What are the extrahepatic manifestations of pediatric hep C

A 
Porphyria cutanea tarda
Sialadenitis resembling Sjögren syndrome
Mooren corneal ulcers, a form of chronic ulcerative keratitis
Type II cryoglobulinemia
Membranoproliferative glomerulonephritis
Non-Hodgkin lymphoma
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179
Q

What is the difference between the presentation of fulminant hepatic failure in adults and children>

A

Ecephalopathy is absent or very late in chilfren

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180
Q

What are the causes of fulminant hepatitis in children?

A

Hep A,B,c,D,E EBV, VZV, CMV, paramyxovirus, adenovirus, hepatotoxic drugs, metabolic disorders

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181
Q

What metabolic dosorders can cause fulminant hepatic failure in children>

A

Neonates-Tyrosinemia, hereditary fructose intolerane, galactosemia, neonatal hemochromatosis, Older children-Wilsons

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182
Q

What is fulminant hepatic failure?

A

severe impairment of hepatic functions or severe necrosis of hepatocytes in the absence of preexisting liver disease.

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183
Q

What is the typical presentation of fulminant hepatic failure in children?

A

Jaundice, fever as prodrome, anorexia, vomiting, abdo pain, fetor hepaticus, poor feeding, irritability, disturbances in slee pattern, deteriorating consciousness, ascites, coma, cerebral aedema, GI bleeding,

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184
Q

What tests can investigate fulminant liver failure?

A

LFTs, FBC, ESR, metabolic panel, U and E, coagulation screen, tests for viral causes, liver biopsy

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185
Q

How is fulminant hepatic failure treated>

A

Supportive care, fluid and electrolyte correction, management of hypo, correction og coagulation, management of renal dysfunction, treatment of specific cause, management of cerebral oedema

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186
Q

What is the pathophysiology if T1DM?

A

Lack of insulin caused by autoimmune attack of pancreatic beta cells

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187
Q

What are the common symptoms of T1DM?

A

Polyuria, polydispsia, polyphagia, lassitude, nausea, blurred vision and fatigue, glycosuria, hyperglycemia, weight loss, keto acidoses

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188
Q

What causes fatigue in t1DM?

A

Muscle weakness from catabolic state of insulin deficiency, hypovolemia and hypokalemia

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189
Q

What causes polyuria in t1DM?

A

Osmotic diueresis due to hypo

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190
Q

What causes blurred vision in T1DM?

A

Effect of hypoosmolar state on lens and vitreous humour (glucose causes swelling, altering the shape and therefore focus of the lens)

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191
Q

What are the tests done for T1DM

A

Impaired glucose tolerance test, glycated hemoglobin studies, urinary albumin tests, BM,

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192
Q

Which test is best for monitoring medium term to long term diabetic control?

A

HbA1c

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193
Q

How long do HbA1c results check for?

A

120 days, lifespan of blood cell

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194
Q

What are the signs of hyperglycemia in children?

A

Can be asymp,

malaise, headache, weakness, ill temper, irritability

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195
Q

What are the signs of glycosuria?

A

Increased urinary frequency and volume, troublesome at night, can lead to enuresis

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196
Q

What causes weightloss in children with t1dm?

A

Insulin deficiency causing uninhibited gluconeogenesis, causing breakdown of preotein and fat. Failure to thrive and wasting can be other symptoms

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197
Q

What are the symptoms of ketoacidosis?

A

Acidotic breathing, severe dehydration, smell of ketones, abdo pain, drowsiness, coma, vominting

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198
Q

How is t1dm managed in children?

A

Glycemic control, insulin therapy, diet and activity

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199
Q

What are the causes of pediatric small bowel obstruction?

A

Intussusception, incarcerated hernias, malrotation of bowel with midgut volvulus, Annular pancreas, post-op adhesions, mesocolic hernia, necrotizing enterocolitis, gastric volvulus, merkel’s diverticulum, prepyloric diaphragm.

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200
Q

What does an incarcerated hernia usually present with?

A

bilious vomiting, abdominal distention, constipation, obstipation). A tender, edematous, slightly discolored to pale mass in the inguinal area may extend down into the scrotum. A swollen, erythematous mass that becomes erythematous to violaceous and is exquisitely tender usually indicates a strangulated hernia. Fever and toxicity suggest frank necrosis

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201
Q

What is malrotation of bowel with midgut volvulus

A

errors of midgut rotation around the superior mesenteric artery axis and the subsequent fixation of the midgut in the peritoneal cavity.Can cause ischaemia and necrosis

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202
Q

WHAT IS mesocolic hernia

A

Nonfixed colonic and duodenal mesenteries lead to formation of potential hernia pouches, which transiently and recurrently entrap the bowel and cause partial obstructions. Mostly asymp

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203
Q

What is necrotizing enterocolitis

A

Primarily effects premature neonates and low birth weight babies. Cuases strictures wish lead to intestinal obstruction. If untreated, leads to death

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204
Q

What does nectrotising enterocolitis usually present with?

A

Temp instability, abdominal distention, bilious vomiting, gross or occult rectal bleeding, abdo tenderness, redness of abdo wall

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205
Q

What is Merker’s diverticulum

A

rue diverticulum (including the 4 layers of the intestinal wall), arising from an incompletely obliterated omphalomesenteric duct. Usually asymp but can cause bleeding, adhesions and small bowel obstruction

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206
Q

What is a prepyloric diaphragm?

A

2-4 mm of fenestrated diaphragm, consisting of 2 mucosal layers, caused by failure of recanalization of foregut in embroyonic stage. .
The typical presentation is vague abdominal pain, nonbilious vomiting, upper abdominal distention, and, in some cases, melena and hematochezia.

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207
Q

What are the signs and smyptoms of pediatric small bowel obstruction?

A

Repetitive abdo pain, vomiting, chronic, partial small owel obstruction, billous vomiting, norexia diarrhea, obstipation, fever

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208
Q

If a pediatric patient presents with billous vomiting

A

IT IS A MEDICAL EMERGENCY

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209
Q

What are the tests that investigate intestine obstruction?

A

Serum electrolyte level, blood urea nitrogen level, vreatinine, glucose, FBC, urinalysis, ABG, stool sample

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210
Q

What can cause hyperkalemia with intestinal obstruction?

A

Incarcerated hernia

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211
Q

What are the imaging tests that investigate intestine obstruction?

A

Abdo x ray, contast studdies, US

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212
Q

Where are the anatomical sites where stenosis or atresia can take place in a new born?

A

Oesophagus, stomach, duodenum, jejunum, Ileum, colon, anus, rectum

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213
Q

What is the term for complete bowel obstruction?

A

Atresia

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214
Q

What is the term for incomplete bowel obstruction?

A

Stenosis

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215
Q

What are the cardinal signs of intestinal obstruction in a neonate?

A 
History of maternal polyhydramnios
Feeding intolerance
Bilious emesis
Delayed passage of meconium
Failure to pass transitional stools
Abdominal distention
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216
Q

What factor causes mortality in pediatric gastroentritis?

A

Dehydration

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217
Q

What are the two mechanisms responsible for acute gastroentritis?

A

Damage to villous brush border of intestine, causing malabsorption of intestinal contents and osmotic diarrhoea
Release of toxins that bind to receptors and cause the release of cl- ions into the lumern, causing secretory diarrhoea

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218
Q

What are the primary functions of doing a history and examination in a pediatric gastroentritis patient?

A

To exclude other causes of vomiting and diarrhoea, to assess the extent of dehydration

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219
Q

What are the symptoms of pediatric gastroentritis?

A

Diarrhoea, vomiting, urination, abdo pain, signs of infection, weightloss, reduced feeding, reduced alertness, increased malaise, lethargy, irritability

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220
Q

What does frequent, watery diarrhoea suggest?

A

Viral gastroentritis

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221
Q

What does diarrhoea with blood or mucus suggest?

A

Bacterial gastroentritis

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222
Q

What does diarrhoea > 14days suggest?

A

Parasitic or non -infectious causes of diarrhoea

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223
Q

If symptoms of vomiting predominate diarrhoea, what does this suggest?

A

GORD, diabetic etoacidosis, pyloric stenosis, acute abdomen, UTI

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224
Q

What does pain that precedes vomiting and diarrhoea suggest?

A

Abdominal pathology rather than gastroentritis

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225
Q

What are the signs of infection in pediatric patients?

A

Fever, chills, myalgia, rash, rhinorrhea, sore throat, cough, immunocompromise

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226
Q

What does absence of tears when crying suggest?

A

Dehydration

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227
Q

What does dry mucus membranes suggest?

A

Dehydration

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228
Q

What does deep acidotic breathing suggest>

A

Dehydration

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229
Q

What does abdominal tenderness, guarding and rebound suggest?

A

Something other than gastroentritis

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230
Q

What does slow return of abdominal pinch suggest?

A

Dehydration

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231
Q

Wjat does a doughy feel to the skin suggest?

A

Hypernatremia

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232
Q

What does jaundice suggest?

A

Hepatitis

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233
Q

What is the most common viral pathogen that causes gastroentritis?

A

Rotavirus

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234
Q

What is the most common bacterial pathogen that causes gastroentritis?

A

Campylobacter, salmonella, shigella, ecoli

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235
Q

What is the most common parasitic pathogen that causes gastroentritis?

A

Giardia and cryptosporidium

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236
Q

What tests should be done on pediatric patients with dehydration?

A

Baseline electrolytes, bicarbonate, urea and creatinine values

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237
Q

What are the signs and symptoms of dehydration?

A

Restless, irritable, sunken eyes, thirsty, drinks eagerly, skin pinch retracts slowly, lethargic or unconscious, not being able to drink or drinking poorly

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238
Q

What tests can be done in a patient with paediatric gastroenritis>

A

Baseline electrolytes, bicarbonate, urea and creatinine values, fecal leukocytes and stool culture, stool analyisis for C.difficile, ova and parasites, FBC and blood cultures

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239
Q

How is dehydration treated?

A

Oral rehydration solution

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240
Q

What are the complications of Crohn’s in children?

A

Growth failure, malnutrition, pubertal delay, bone demineralization, anaemia, jaundice, arthritis, arthralgia

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241
Q

What are the signs and symptoms of crohn’s disease of the small intestine in children?

A

Intestinal malabsorption, abdo pain, growth deceleration, weight loss, anorexia

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242
Q

What are the signs and symptoms of Colonic crohn’s disease in children?

A

Bloody mucopurulent diarrhoea, cramping abdo pain, urgency to defecate

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243
Q

What are the signs and symptoms of crohn’s disease of the perianus in children?

A

simple skin tags, fissures, abscesses, fistulae, painful defacation, bright red rectal bleeding, perirectal pain, erythema or discharge

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244
Q

What are the most common skin presentations of Crohn’s?

A

Erythema nodosum, pyoderma gangrenosum

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245
Q

What tests can be done to investigate a child with Crohn’s?

A

FBC to show anemia, Raised CRP and ESR, Albumin (hypoalbuminamia), Folic acid and b12 levels, iron studies, stool sample to rule out infection, faecal calprotectin

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246
Q

What imaging studies can be done with query IBD?

A

MRI, CT,(look at intestinal inflammation) single contrast upper GI radiology with small bowel follow through, abdo US (rule out gallbladder and kidney stones) Colonoscopy, upper endoscopu, video capsule endoscopy

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247
Q

What medication is used to treat children withIBD?

A

5-aminosalicylic acid, anti biotics, nutritional therapy
Corticosteroid and methotrexate
Infliximab or adalimumab
Surgery if all these medications fail

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248
Q

What are the indications for surgery in IBD?

A 
Intractable disease with growth failure
Obstruction or severe stenosis
Abscess requiring drainage
Perianal fistulae
Intractable hemorrhage
Perforation
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249
Q

What is ulcerative colitis>

A

An inflamatory bowel disease characterized by the remitting and relapsing inflammation of the large intestine

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250
Q

What are the complications of ulcerative colitis?

A

Toxic megacolon, colonic malignancy

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251
Q

What are the extraintestinal manifestation of ulcerative colitis in children?

A

Erthroderma nodosum, pyoderma gangrenosum, uveitis, episcleritis, ant. uveitis, arthrits, hepatobiliary disease, thromboembolic disease

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252
Q

What are the signs and symptoms of children with UC?

A

Rectal bleeding, diarrhoea, abdo pain, urge to defecate, hypoalbuminaemia, fever, weightloss, cramps, abdo tenderness, anorexia, anaemia, leukocytosis, delayed growth, guarding, splenomegalu

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253
Q

What is pediatric hypertrophic pyloric stenosis>

A

Functional obstruction of gastric outlet, due to hypertrophy and hyperplasia of muscular layers of the pyloris

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254
Q

What are the signs and symptoms of pyloric stenosis in infants?

A

Intitially infrequent non billous vomiting that progresses to projectile vomiting, slight hematemesis, hunger,

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255
Q

What is the typical presenting age for pyloric stenosis?

A

4-8 weeks of age

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256
Q

When should the pyloris be palpable n pyloric stenosis?

A

infant is supine, after liver is displaced superiorly, downward palpation should reveal pyloric olive near the midline. Mass is best felt after vomiting, or during (or after feeding)

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257
Q

What diagnostic tests can be used for pyloric stenosis?

A

Serum electrolytes to measure effectiveness of fluid resus, US, barium upper GI, endoscopy

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258
Q

What is the diagnostic criteria for pyloric stenosis with US?

A

Muscle wall thickness 3 mm or greater and pyloric channel length 14 mm or greater are considered abnormal in infants younger than 30 days

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259
Q

When should a barium upper GI be used to investigate pyloric stenosis?

A

When US is not diagnostic

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260
Q

WHat signs can be seen in a baium upper GI that indicate pyloric stenosis?

A

elongated pylorus with antral indentation from the hypertrophied muscle
double track” sign when thin tracks of barium are compressed between thickened pyloric mucosa or the “shoulder” sign when barium collects in the dilated prepyloric antrum

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261
Q

When should an endoscopy be used to investigate pyloric stenosis?

A

Patient with atypicalsigns

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262
Q

How should pyloric stenosis be managed?

A

Fluid management, pyloromyotomy

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263
Q

What are the signs and symptoms of pediatric head trauma?

A

Scalp injury, skull fracture, concussion, contusion, intracranial and or subarch. haemorrhage, epidural and/or subdural haematoma, intraventricular haemorrhage, penetrating injury, diffuse axonal injury

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264
Q

What are the possible cpmplications in pediatric patients with head trauma>

A

Cerebral oedema, growth retardation, resp. failure, herniation due to raised ICP

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265
Q

What tests should be used to investigate a child with head trauma?

A

FBC, blood chemistries, coagulation profile, type and crossmatch, ABG, U and E

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266
Q

What imaging should be used to investigate a child with head trauma?

A

CT, MRI and US for neonates with open fontanelles

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267
Q

How are patients with head trauma approached?

A

ABGs

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268
Q

What surgical therapy can be used on a patient with head trauma

A

Surgical decompression, craniotomy, surgical drainage, surgical debridement and evacuation, surgical elevation, decompressive craniotomy with duraplasty

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269
Q

What medications can be used on a child with head trauma?

A

Nondepolarizing neuromuscular blockers (eg, vecuronium)
Barbiturate anticonvulsants (eg, thiopental, pentobarbital, phenobarbital)
Benzodiazepine anxiolytics (eg, midazolam, lorazepam)
Diuretics (eg, furosemide, mannitol)
Anesthetics (eg, fentanyl, propofol)
Anticonvulsants (eg, phenytoin, fosphenytoin)

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270
Q

What are the signs and symptoms of a basilar skull fracture?

A

Loss of consciousness, seizures, and neurologic deficits, prolonged nausea, vomiting, and general malaise, Physical findings such as Battle sign, raccoon eyes, and CSF otorrhea and rhinorrhea, ocular nerve entrapment

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271
Q

What are the signs and symptoms of a contusion?

A

Progressive beurological deterioration secondary to local cerebral oedema, infarcts or late-developing harmatoma

272
Q

What are contusions?

A

Areas of bruising or tearing of the brain tissue, caused by direct head injury

273
Q

What is a concussion?

A

Transient alteration of consciousness due to head trauma

274
Q

What are the signs and symptoms of a epidural haematoma in children?

A

Classic lucid interval between initial LOS and subsequent deterioration. When neurological deterioration starts, hemiparesis, unconsciousness, posturing,and pupillary changes. Compression of brainstem

275
Q

What are the signs and symptoms of a subdural haematoa in children?

A

seizures, full fontanel, anisocoria, resp. distress, symptom of shaken baby syndrome - rense fontanel, increased head circumfrence, poorly thriving infant. Can occur due to birth trauma

276
Q

What is the most common cause for a failure to thrive?

A

Inadequate intake

277
Q

What are the non-organic causes for failure to thrive in a infant due to Inadequate intake?

A

Feeding problems, unsuitable food, lack of interest, child abuse, low socioeconomic status, infant difficult to feed, poor maternal-infant education, maternal depression, poor maternal education

278
Q

What are the organic causes for failure to thrive in a infant due to Inadequate intake?

A

Impaired suck/swallow, chronic illness leading to anemia

279
Q

What are the causes for failure to thrive in a infant due to impaired suck/swallow?

A

Cleft palate, oro-mottor dysfunction, cerebral palsy, neurological disorders

280
Q

What are the causes for failure to thrive in a infant due to anorexia from chronic disease?

A

Crohn’s, chronic renal failure, liver disease, CF

281
Q

What are the causes for failure to thrive in a infant due to inadequate retention?

A

Vomiting, severe GORD

282
Q

What are the causes for failure to thrive in a infant due to malabsorption?

A

CF, latose intolerance, coeliac’s, short gut syndrome, post- necrotising enterocolitis, cholesstatic liver disease

283
Q

What are the causes for failure to thrive in a infant due to failure to utilise nutrients?

A

Chromosolam (down’s), intrauterine growth restriction, extreme prematurity, congenital infection, metabolic disorders (congenital hypothyroidism, storage disorders, amino acid and organic acid disorders)

284
Q

What are the causes for failure to thrive in a infant due to increased requirements?

A

Thyrotoxicosis, CF, malignancy, congenital heart disease, chronic renal failure, chronic infection (HIV) immuno deficiency

285
Q

What tests can be used to investigate a failure to thrive and why?

A

FBC (anaemia, immunodeficiency), U and E (chronic renal failure), LFT (liver disease), TFT, iron studies,CXR and sweat test (CF), karyotype in girls (turner’s), IgA tissue transglutaminase antibodies (coeliac) Urine tests, stool tests

286
Q

What are the signs and symptoms of failure to thrive?

A

Dysmorphic features, malabsorption (distended abdomen, thin buttocks, misery), signs of HF, signs of resp disease (clubbing, chest deformity)

287
Q

How can obesity be assessed in children?

A

Weight charts (overweight is BMI>91st centile, obese is BMI>98th centile)

288
Q

What are the complications of obesity in children?

A

Slipped upper femoral epiphysis, tibia ara, abnormal foot structure, Idiopathic intracranial HTN, hypoventilation syndrome Polycystic ovarian syndrome, T2D, HTN, high cholesterol, asthma, cardiomegalyu, cancer, psychological stuff

289
Q

What are the endogenous causes of obesity?

A

hypothyroidism, cushing’s prader willi

290
Q

What is the management of obesity?

A

Healthier eating, increased exercise, reduced activity free periods

291
Q

What is coeliac disease?

A

Inflammtory response to a part of gluten that causes progressive shortening of intestinal villi

292
Q

What is the typical presentation of coeliac disease>

A

Profound malabsorption at 8-24 months, failure to thrive, abdo distension, buttock wastingm abnormal stools, general irritability, anaemia,

293
Q

What is coeliac disease associated with?

A

T1DM, autoimmune thyroid disease, down’s

294
Q

What screening test is diagnostic for coeliac’s?

A

IgA transglutimaminase antibodies and endomysial antibodies

295
Q

How is coeliac disease managed?

A

No gluten

296
Q

Mutation of what gene causes CF?

A

Cystic fibrosis transmembrane conductance requlator

297
Q

What does the CFTR gene do

A

cAMP dependent chloride channel

298
Q

What is the pathophysiology of CF?

A

Dysfunction of the CFTR gene causes abnormal ion transport, reducing the liquid layer of surfactant, consequently causing ciliry dysfuncton and retention of mucopurulent secretions

299
Q

What is the life expectancy for a newborn with CF?

A

40 years

300
Q

What are the clinical features of CF in infancy?

A

Meconium ileus in newborn period, prolonged neonatal jaundice, failure to thrive, recurrent chest infections, malabsorption, steatorrhea

301
Q

What are the clinical features of CF in a young child?

A

Bronchiectasis, rectal prolapse, nasal polyp, sinusitis

302
Q

What are the clinical features of CF in an older or adolescent child?

A

Allergic bronchopulmonary aspergillosis, sterility in males, DM, intestinal obstruction, pneumothorax, recurrent chest infections, cirrhosis, portal hypertension

303
Q

What are the signs and symptoms of CF?

A

Persistent loose cough, hyperinflation of chest, coarse inspiratory crackles, expiratory wheeze, purulent sputum, finger clubbing

304
Q

What is the gold standard for diagnosis in CF?

A

elevated chloride in sweat test

305
Q

What screening test is used for CF?

A

immunoreactive trypsinogen, from heel prick test

306
Q

How is CF managed?

A

Regular antibiotics, pancreatic replacement therapy, treatetment for DM

307
Q

What is congenital adrenal hyperplasia?

A

A number of recessive conditions that cause adrenoid enlargement

308
Q

What is the most common enzyme defienciency caused by congenital adrenal hyperplasia

A

21 hydroxylase, needed for cortisol biosynthesis. Patients therefore can’t produce aldosterone

309
Q

What does aldosterone deficiency in congenital adrenal hyperplasia cause?

A

Salt loss -low sodium, high potassium

Pituitary overcompensates by overproducing ACTH, increasing production og adrenal androgens

310
Q

What is the typical presentation in females with congenital adrenal hyperplasia?

A

Virilisation of external genitalia-enlarged clitoris, sometimes the fusion of the labia

311
Q

WHat is the typical presentation of a male with congenital adrenal hyperplasia?

A

Enlarged penis, darkening of scrotum

312
Q

WHat is the typical presentation of a salt loser with congenital adrenal hyperplasia?

A

salt losing adrenal crisis

313
Q

What is a salt losing adrenal crisis?

A

occurs at 1-3 weeks of age, presenting with vomitting, weightloss, circulatory collapse and floppiness

314
Q

What is the typical presentation of non-salt losers with congenital adrenal hyperplasia?

A

Tall stature in males,

muscular build, precocious pubarche, adult body colour, pubic hair, acne in males and females

315
Q

What is the classic presentation of allergic rhinitis?

A

coryza, conjunctivitis, cough variant rhinitis post nose drip, chronically blocked nose causing impaired daytime behaviour, sleep disturbance amd cpmcemtration

316
Q

What is allergic rhinitis associated with?

A

Eczema, sinusitis, adenoidal hypertrophy, asthma

317
Q

What are the two types of allergic rhinitis?

A

atopic, nonatopic

318
Q

What is the treatment of allergic rhinitis?

A

Second gen antihistamine (topically or systemically), tolpical nasal or eye corticosteroids, cromoglycate eye drops, leukotriene receptor antagonists, nasal decongestants, allergen immunotherapy

319
Q

What are the signs of congenital hearing impairment?

A

Failure to acheive speech and language milestones

320
Q

What are the causes o aquired hearing loss in thechildren?

A

In utero infection, hyperbilirubinaemia, bacterial meningitis, mechanical ventilation, ototoxic meds, low birth weight, otitis media, mumps, measles, head trauma

321
Q

What in utero infections can cause hearingloss?

A

toxoplasmosis, rubella, cmv, herpes, syphilis (TORCHS)

322
Q

WHat genetic conditions can cause hearing loss in children?

A

Waardenburg syndrome, branchio-oto-renal syndrome, otosclerosis, neurofibromatosis type 2, pagat’s, Usher’s, pendred

323
Q

What lab tests can be done to investigate congenital hearing impairment?

A

Molecular testing, FBC, U and E, creatinine, TFT, urinalysis, autoimmune profile, specific IgM for TORCH, CT, MRI, auditory brainstem response, audiometry, otoacoustic emissions

324
Q

What treatments are available for congenital hearing impairment?

A

Treating any middle ear disease, hearing amplification, assistive learning devices, cochlear implant

325
Q

What are the organic causes of constipation?

A

Hypothyroidism, hypercalcaemia, urinary concentrating defect, Hirschsprung’s disease

326
Q

What are the organic causes of constipation?

A

Withholding, toilettraining issues, changes in diet, changes in routine, medications, lactose intolerance, family history

327
Q

What are the complications of constipation?

A

Anal fissures, rectal prolapse, faecal impaction

328
Q

What is mild constipation defined as?

A

Faeces is not palpable per abdomen

329
Q

How is mild constipation treated in children?

A

Stool softeners, stimulant laxatives

330
Q

How is severe constipation in children treated?

A

Evacuation of rectum, 1-2 weeks of faecal softeners, large doses of oral laxatives, oral macrogol solution

331
Q

After what age is faecal soiling abnormal?

A

4

332
Q

What can be caused by faecal soiling?

A

Faecal retention

333
Q

What must be done for faecal retention?

A

rectum emptying

334
Q

What is the definition of low birth weight in children?

A

Below 10th percentile

335
Q

What are the types of growth restriction that cause babies to be small for dates?

A

Assymetrical and symmetrical

336
Q

What is asymmetrical growth restriction?

A

Weight or abdominal circumfrence lies on a lower percentile than head

337
Q

What does asymmetrical groth retardation suggest?

A

Placenta fails to provide adequate nutrition late in the pregnancy. Brain is spared at expense of liver glycogen and skin fat

338
Q

What are the causes of asymmetrical growth retardation?

A

Pre-eclampsia, multiple pregnancy, maternal smoking, idiopathic

339
Q

What is the typical outcome for asymmetric growth retardation?

A

Baby rapidly puts on weight after birth

340
Q

What is symmetrical growth restriction?

A

Head circumfrence is also reduced

341
Q

What does symmetrical growth retardation suggest?

A

Prolonged period of poor uterine growth, or wrong uterine age

342
Q

What are the causes of symmetrical growth retardation?

A

Normal, fetal chromosomal disorder, congenital infection, alcohol abuse, chronic medical condition or malnutrition

343
Q

What is the typical outcome for symmetric growth retardation

A

Baby might remain small permanently

344
Q

What type of growth restriction is more common?

A

Asymmetric

345
Q

What are the complications of intrauterine growth restriction?

A

Intrauterine hypoxia, death, asphyxia during labour and delivery, hypothermia (relatively large surface area), hypoglycaemia (due to poor liver stores), hypocalcaemia, polycythaemia

346
Q

What is recurrent abdominal pain?

A

A childhood pain that can disrupt activities and lasts for at least 3 months

347
Q

Where is the pain felt in recurrent abdominal pain typically?

A

Periumbilical

348
Q

What are the other symptoms of recurrent abdo pain?

A

NONE

349
Q

What is the common cause for recurrent abdo pain?

A

strss, which causes altered bowel motility that children percieve as pain

350
Q

What are the possible GI causes of recurrent abdopain?

A

IBS, constipation, IBD, malrotatation, dyspepsia, gastroentritis, abdominal migraine, peptic or gastric ulceration

351
Q

What are the gynaeclogical vauses of recurrent abdo pain?

A

Dysmenorrhea, ovarian cysts, pelvic inflammatory disease?

352
Q

What are the hepatic or pancreatic causes of recurrent abdo pain?

A

Hepatitis, gallstones, pancreatitis

353
Q

What are the urinary causes of recurrent abdo pain?

A

UTI, ,pelvi ureteric junction obstruction

354
Q

What symptoms suggest an organic cause of recurrent abdo pain?

A

Empigastric pain at night, haematemesis (duodenal ulcer0
Diarrhoea, weight loss, blood in stool (IBD)
vomiting (pancreatitis)
Jaundice (liver disease)
Dysuria, enuresis (UTI)
billious vomiting, abdo distension (malrotation)

355
Q

how is recurrent abdo pain investigated?

A

Avoid unnecescary investigations - thorough history, inspection of perineum for anal fissures, check growth, urine microscopy, abdo ultrasound. Investigate further only if there is a suspicioun of another condition

356
Q

Whatis the long term prognosis of recurrent abdo pain?

A

Half of affected children are symptom free radidly, 1/4 take 1 month to resolve,, 1/4 symptoms continue as migraine, functional dyspepsia or IBS

357
Q

Describe a tension headache

A

Symmetrical headache of gradual onset, described as tightness, band or pressure,

358
Q

What are the causes of a tension headache?

A

Stress and/or anxiety
Poor posture
Depression

359
Q

What management is used for a tension headache?

A

NSAIDS (ibuprofen, naprozen, tramadol, indomethacin, ketaprofen), aspirin, Paracetomol, barbiturites,Ergot alkaloids

360
Q

What are the complications of tension headaches?

A

Overreliance on nonprescription caffeine-containing analgesics
Dependence on/addiction to narcotic analgesics
GI bleed from use of NSAIDs
Risk of epilepsy 4 times greater than that of the general population

361
Q

Causes of respiratory distress in children?

A

Asthma, anaphylaxis, foreign body, infections, tension pneumothorax, congenital heart problems, pericarditis

362
Q

Which typically presents with a higher temperature, pneumonia or bronchiolitis?

A

Pneumonia

363
Q

What are the three main presentations in respiratory symptoms in children?

A

Cough, wheeze, stridor

364
Q

What can cause stridors?

A

Croup, epiglottitis, inhaled foreign body

365
Q

What can cause cough in children?

A

URTI, pneumonia, asthma, inhaled foreign body, pertussis, CF

366
Q

What can cause a wheeze in children?

A

Asthma, bronchiolitis, viral induced, foreign body

367
Q

All UTI <1 yr must be

A

followed up with USS, DMRCA

368
Q

What is the age of onset of croup?

A

6-24 months

369
Q

What is another name of croup?

A

Acute laryngotracheobronchitis

370
Q

What does croup start with?

A

Corzyal prodrome

371
Q

When does the croup usually happen?

A

middle of the night

372
Q

What is the age of onest of epiglottitis?

A

2-7 years

373
Q

Why shouldn’t you stick something down an epiglottitis case?

A

Can cause airway closure

374
Q

What does epiglottitis usually present with?

A

Toxicity, high fever, onset overhours, drooling, reluctant to peak, slight or absent cough, cherry red epiglottitis

375
Q

What is the commonest cause of epiglottitis,

A

HiB

376
Q

What is the age of onset of foreign bodies?

A

2-5 years

377
Q

What is the age of onset of laryngomalacia?

A

newborn

378
Q

What is the presentation of laryngomalacia?

A

Presents at birth and persists, worse on crying, gets better with age

379
Q

How can baby’s with whooping cough present?

A

apnea

380
Q

What is the typical age of onset of pertussis?

A

babies, pre immunization

381
Q

How is stridor managed?

A

Don’t examine the throat, contact anaethetist, reduce anxiety, observe for hypoxia, administer adrenaline neb i

382
Q

What is the presentation of whooping cough?

A

Low grade fever, paroxysmal or spasmoidic cough, followed by inspiratory whoop, worse at night, persists for months

383
Q

How is whooping cough investigated?

A

Nasal swab for pertussis

384
Q

What is the purpuse of antibiotics in whooping cough

A

control the spread

385
Q

What is a wheeze caused by?

A

Bronchospasm, expiratory sound caused by partial obstruction of lower airways, inflmmatory process caused by allergym infection, foreign body, mucus oversensitisationW

386
Q

How long does whooping cough last?

A

hundred days

387
Q

Where in expiration is a mild wheeze heard?

A

End

388
Q

What is the age of onset of bronchiolitis?

A

0-18 months

389
Q

What are the red flags for respiratory illness?

A

Clubbing, recurrent infection, persistent tachypnea, failure to grow or gain weight, restriction of activity

390
Q

What is the emergency treatment for croup?

A

Adrenaline neb

391
Q

Does controlling temperature prevent febrile convulsions?

A

No

392
Q

How is fever in children managed?

A

Monitor for signs of dehydration and petechial rash, paracetomol and ibuprofen in children with temp >38 who are distressed and unwell

393
Q

What are the causes of fever?

A

Meningitis, UTI, sepsis, Gastroentritis, tonsilitis, otitis media, RTI, septic arthritis, pneumonia,

394
Q

What are the signs of meningitis in babies?

A

Crying, distressed, lifeless, bulging fontanelle, poor appetitie, fever

395
Q

What are the investigations involved into UTI

A

MCUG, DMSA, USS

396
Q

What are the treatment goals of investigations into UTI?

A

Treat infection, prevent scarring, prevent recurrence

397
Q

What is impetigo?

A

Localized, contagious, staph or strep skin infection

398
Q

Who is the classic patient of impetigo?

A

Infants and young children

399
Q

Where is impetigo likely to appear?

A

On pre-existing skin disease, face, neck and hands

400
Q

What does impetigo look like?

A

Erythematous macules that may become vsicular/pustular or even bullous

401
Q

What does rupture of impetigo pustules cause?

A

confluent honey colourd vesicles

402
Q

How does impetigo spread to other parts of the skin?

A

autoinoculation of infected exudate

403
Q

How is mild impetigo treated?

A

Topical antibiotics

404
Q

How is severe impetigo treated?

A

broad spectrum antibiotics

405
Q

What is a febrile seizure>

A

Seizure accompanied by a fever in the absence of intracranial infection due to bacterial meningitis or viral meningitis

406
Q

What are the types of febrile seizures in children?

A

Simple and complex

407
Q

What are the complications of simple febrile seizures?

A

None

408
Q

What are the complications of complex febrile seizures?

A

4-12% risk of developing epilepsy

409
Q

What does a febrile seizure look like?

A

A brief, tonic-clonic seizure with a rapid rise in temp

410
Q

What is an important differential of febrile seizures that must betreated immediately?

A

Bacterial meningitis

411
Q

What percentage of migraines occur without an aura?

A

90

412
Q

What is the typical description of a migraine inchildren?

A

1-72 hours, bilateral (can be unilateral), pulsitile, over frontal or temporal areas, worse with activity, accompanied by photophobia, phonophobia, nausea, vomiting, abdo pain

413
Q

What are the preminotary symptoms of a migraine?

A

Tiredness, difficulty concentrating, autonomic symptoms

414
Q

What are the common features of a visual aura

A

Hemianopia,scotoma, fortification spectra

415
Q

What is a scotoma?

A

Small area of vision loss

416
Q

What is a fortification spectra

A

Seeingzigzag lines

417
Q

What are uncommon forms ofheadaches?

A

Familial, basilar type, spordiac, hemiplegic migraine, periodic syndromes (cyclical vomiting, abdominal migraine, BPV)

418
Q

What are familial migraines linked to?

A

Calcium channel defect, dominantly inherited

419
Q

What are the signs of a basilar type migraine?

A

Vomiting, nystagmus and cerebellar signs

420
Q

What is a cyclicalvomiting migraine?

A

Recurrent, stereotyped epsode of vomiting and intense nausea, associated with pallor and lethargy. Child is well inbetween

421
Q

What is an abdominal migraine?

A

An idipathic recurrent disorder with bouts of abdominal pain in the midline lasting 1-72 hours. Pain is moderate to severe and asssociated with vasomotor symptoms, nause and vomiting

422
Q

What signs suggest a headache caused by raised ICP diue to a space occupying lesion?

A

Cranial bruits, papillodeama, torticollis, abnormal gait, new onset squint, facial nerve palsy, visual field defects, growth failure

423
Q

What are the red flags in a headache history?

A

Headache worse on lying down, coughing, wakes child up at night
Confusion, morning or persitent vomiting and nausea
Recent change in behaviour, personality or learning development

424
Q

What are the types of brain tumours seen in children?

A

Brainstem glioma, craniopharyngioma, astrocytoma, ependymoma, medulloblastoma

425
Q

What is a highly malignant astrocytoma called?

A

Glioblastoma multiforme

426
Q

Where does a medulloblastoma arise?

A

Midline of post. fossa

427
Q

How does a medullablastoma seed?

A

through CNS via CSF. Spinal metastasis are common

428
Q

Where does an ependymoma arise?

A

Posterior fossa, behaves like medulloblastoma

429
Q

What is the most common brain tumour in children?

A

Astrocytoma

430
Q

What does excess protein due to overfeeding cause?

A

Azotaemia, hypertonic dehydration, hyperammonaemia and metabolic acidosis

431
Q

What does excess carbs due to overfeeding cause?

A

Hyperglycaemia, hypercapnia, fatty liver

432
Q

What does excess fats due to overfeeding cause?

A

Hyperlipidaemia and fat overload syndrome

433
Q

What are the mechanical complications of overfeeding?

A

Intolerance of nasogastric volume, osmotic diarrhoea,

434
Q

What is autistic spectrum disorders defined as?

A

Children who fail to acquire normal social and commnications skills

435
Q

Is autistism more prevalent in boys or girls

A

Boys

436
Q

What is the typical presentation age of autistic spectum disorders?

A

2-4, when language and social skills normally rapidly expand

437
Q

What are the three main features of autistic spectum disorders?

A

Impaired social interaction, imposition of routine with ritualistic or repetitive behaviour, speech and language disorders

438
Q

What are the signs of an impaired social interation

A

Prefers playing alone, does not seek comfort, shre pleasures or form close friendships, does not appreciate that other people have feelings, gaze avoidance, lack of joint attention, socially or emotionally inappropriate behaviours, lack of appreciation of social cues

439
Q

What are the signs of speech and language disorders in children?

A

Delayed development, over-literal interretation of speech, impaired comprehension, monotonous speech, formal pedantic language, refers to self ads ‘you’ repeats questions or commands, limited use of facial expression or gestures

440
Q

Whatare the signs of repetitive behaviour?

A

Forcing rituals on self or others, with violent tantrums if disrupted, poverty of imagination, concrete play, unusual stereotypical movements (hand flapping, tiptoe gait), peculiar interests, restriction in behaiour repertoire

441
Q

What are the co morbidities of autism spectrum disorders?

A

General learning problems, epilepsy (presents in adolescene), ADHD

442
Q

What is GORD?

A

Involuntary passage of gastric contents into the oesophagis

443
Q

In who is GORD really common?

A

<1 yr

444
Q

When does GORD usually resolve

A

Aft 12 months of age

445
Q

What causes GORD?

A

Inappropriate relaxation of LOS due to functional immaturity

446
Q

What are the contributing factors of GORD?

A

Short oesophagus, mostly liquid diet, mainly horizontal posture

447
Q

What are the symptoms of GORD?

A

Vomiting

448
Q

What are the complications of GORD?

A

Failure to thrive, oesophagitis, recurrent pulmonry aspiration, dystonic neck posture, apparent life threatening events

449
Q

In who is severe GORD more common in?

A

Children with cerebral palsy or other neurological conditions, preterm babies, following surgery for oesophageal atresia

450
Q

How is GORD investigated?

A

24 hr pH monitoring to quantify degree of acid reflux, 24 hr impedance monitoring, endoscopy to exclude other causes

451
Q

How is mild GORD treated?

A

Parenta reassurance, thickening agents, positioning in a 30 degree head up position after feeding

452
Q

How is severe GORD treated?

A

Acid supression, surgery is only for kids with complications

453
Q

What acid suppression is used to treat GORD?

A

H2 receptor antagonists, PPI

454
Q

What is the most common cause of respiratory distress in term babies?

A

Transient tachypnea or the newborn

455
Q

What causes transient tachypnea of the newborn?

A

Delay in reabsorbtion og lung liquid

456
Q

What increases the risk of transient tachypnea of the newborn?

A

C-section

457
Q

What can a chest xray show in the trnsient tachypnea of newborns?

A

fluid in the horizontal fissure

458
Q

What management is necesscary for transient tachypnea of the newborn?

A

Additional ambient oxygen

459
Q

How long does transient tachypnea of the newborn take to settle?

A

usually in the 1st day of life, but can take a few days

460
Q

What are the signs of respiratory distress in newborns?

A

expiratory grunting, tachypnea, cyanosis, chest recessions, work of breathing, nasal flaring

461
Q

What type of chest recession is considered troubling?

A

Sternal and subcostal

462
Q

What are the less common causes of respiratory distress in newborns?

A

Meconium aspirationm milk aspiration, respiratory distress syndrome, pneumothorax, persistent pulmonary hypertension of the newborn, pneumonia

463
Q

What are the rare causes of respiratorydistress in the newborn?

A

Pulmonary haemorrhage, diaphragmatic hernai,airway obstruction, pulmonary hypoplasia, trachio-oesophageal fistula

464
Q

What are the non pulmonary causes of respratory dstress in the newborn?

A

Congenital HD, severe anaemia, metabolic acidosis, intracranial birth trauma / encephalopathy

465
Q

When is meconium aspirationmost common?

A

With increasing geestational age

466
Q

When is meconium passed before birth?

A

In response to fetal hypoxia

467
Q

How does meconium cause aspiration?

A

The aspirated meconium acts as mechanical obstruction and causes a chemical pneumonitis, and predisposes to increased infection

468
Q

What are the complications of meconium aspiration?

A

Over inflated lungs, air leaks, pneumothorax, pneumomediastinum, persistent pulmonary hypertension

469
Q

How is meconium aspiration usually managed?

A

Artificial ventilation

470
Q

What is worrying about maternal autoimmune thrombocytopenic purpura?

A

Maternal IgG crosses placenta to damage fetal platelets

471
Q

What does maternal autoimmune thrombocytopenic purpura cause?

A

Fetal thrombocytopenia

472
Q

What are the complications of fetal thrombocytopenia?

A

Intracranial haemorrhage post st birth trauma

473
Q

What are the signs of autoimmune thrombocytic purpura?

A

Thrombocytopenia, petechia at birth

474
Q

How is thrombocytopenia in infants treated?

A

IV immunoglobin, platelet transfusion

475
Q

What is cerebral paslsy?

A

Abnormal movement and posture causing activity limitation due to non-progressive disturbances occuring in the fetal or infant brain

476
Q

What is the most common cause of motor problems in children?

A

Cerebral palsy

477
Q

Is the lesion in cerebral palsy progressive or non progressive?

A

Non progressive

478
Q

If the lesion in cerebral pasly in non preogressive, why do symptoms emerge over time?

A

They reflect cerebral maturation, as in, deficits are only identifiable at certain developmental stages

479
Q

What is the most common cause of cerebral palsy?

A

Antenatal

480
Q

What are the antenatal causes of cerebral palsy?

A

Vascular occlusion, cortical migration disorders, structural maldevelopmenet of the brain, genetic syndromes, congential infections

481
Q

What are the postnatal causes of cerebral palsy?

A

Hypoxic ischaemic injury during delivery, brain damage from periventricular leucomalacia, meningitis, encephalitis, ecephalopathy, head trauma from accidental or non accidental injury, symptomatic hypo, hydrocephalus, hyperbilirubinaemia

482
Q

What are the early symptoms of cerebral palsy?

A

Abnormal limb and/or trunk posture and tone in infancy, with delayed motor milestones, feedind difficulties, oromotor incoordination, slow feeding, gagging, vomitingm abnormal gait, asymmetric hand function, persistence of primitave reflexes

483
Q

What are the subtypes of cerebral palsy?

A

Spastic, ataxic, dyskinetic

484
Q

What is the most common subtype of cerebral palsy?

A

Spastic

485
Q

Where does the damage occur in spastic cerebral palsy?

A

Upper motor neurone (pyramidal or corticospinal tract)

486
Q

WHat are the symptoms associated with spastic cerebral palsy?

A

Increased tone, brisk reflexes, faster the muscle is tretched the greater the resistence

487
Q

What are the three types of spastic cerebral palsy?

A

Hemiplagia quadraplegia, diplegia

488
Q

hat are the signs of hemiplagic spastic cerebral palsy?

A

Unilateral involvement of hand , arm or leg arm more likely, facial sparing, fisting of affected hand flexed arm, pronated fore arm asymmetric reaching r hand function, tiptoe gait on affected side. Limbs may initially be hypotonic, but spsticity becomes predominant feature

489
Q

When does hemiplagic spastic cerebral palsy usually present?

A

4-12 months

490
Q

What are the signs of a quadraplegic spastic cerebral palsy?

A

All four limbs are affected, oft severely, trunk is involved, tendency to opisothonos, poor head control, low central tone,seizure, microencephaly, intellectual impairment

491
Q

What is opisothonos?

A

Extensor posturing

492
Q

WHat are the signs of a diplegic spastic cerebral palsy?

A

All four limbs are affected, but legs more than arms, walking is abnormal, functional use of hands is difficult

493
Q

What are diplegic spastic cerebral palsy associated with?

A

Preterm babies ue to periventricular brain damage

494
Q

What are the signs of a dyskinetic cerebral palsy?

A

Chorea, athetosism dystonia, impaired intellect floppiness, poor trunk co-ordination, delayed motor development, primitive reflexes dominate

495
Q

What causes the signs in dyskinetic cerebral palsy?

A

Danage to basal ganglia or extra pyramidal pathways

496
Q

What are the causes of dyskinetic cerebral palsy?

A

Hyperbilirubinaemia, hypoxic ischaemic encephalopathy of the newborn

497
Q

What are the signs of ataxic cerebral encephalopathy?

A

Early trunk and limb hypotonia, poor balance, delayed mtor development. Ataxic gait, incordinated movements, intention tremor

498
Q

Whaere do lesions cause ataxic cerebral palsy?

A

Cerebellum or connections

499
Q

What is the most common cause of ataxic cerebral palsy?

A

Genetic disorders

500
Q

What is an exanthem?

A

Widespread rash accompanied by fever malaise and headache.

501
Q

What causes an exanthem?

A

Reaction to toxin produced byorganism or damage to skin by organism, or immune response

502
Q

What are exanthems usually caused by?

A

Viruses

503
Q

What are the more common causes of childhood exanthems?

A

Chicken pox, measles, rubella, roseola, parvovirus b19

504
Q

What are the less common viral causes of exanthems?

A

HIV, small pox, viral hepatitis, EBV, herpes virus 6 and 7, papular acroderatitis, eythema multiforme

505
Q

What are the bacterial causes of exanthems?

A

Staph toxin (sepsis, Staph. scalded skin syndrome), Step. toxin 9scarlet fever, toxic shock), kawaski disease

506
Q

What are the signs and symptoms of exanthems?

A

Non-specific rash widespread more extensive on trunk than extremities, fever, malaise headache anorexia, abdo pain, irritability, myalgia

507
Q

What are the signs and symptoms of chicken pox?

A

Itchy red papules progressing to vesicles on stomach back and face, then spreading elsewhere. Headache, high fever, cold-lik symptoms, vomiting and diarrhoea

508
Q

What is the treatment of chicken pox?

A

Trim fingernails, warm bath, moisturising cream, paracetomol, calamine lotion, oral antihistamines, oral acyclovir

509
Q

What are the signs and symptoms of measles?

A

Early symptoms are like the common cold, with conjunctivitis (sore red eyes) and cough. Small white spots called Koplik spots may be seen in the mouth. A red blotchy rash appears on the face on the third day of the illness, spreads to the trunk, and becomes more generalised over the next few days.

510
Q

What is the incubation period of measles?

A

Ranges from 7–14 days (average 10–11 days).
Patient usually have no symptoms.
Some may experience symptoms of primary viral spread (fever, spotty rash and respiratory symptoms due to virus in the blood stream) within 2–3 days of exposure.

511
Q

What is the prodrome period of measles

A

Generally occurs around 10–12 days from exposure.
Appears as fever, malaise and loss of appetite, followed by conjunctivitis (red eyes), cough and coryza (blocked or runny nose).
2–3 days into the prodromal phase, Koplik spots appear. These are blue-white spots on the inside of the mouth opposite the molars, and occur 24–48 hours before the exanthem (rash) stage.
Symptoms usually last for 2–5 days but in some cases may persist for as long as 7–10 days.

512
Q

What are the rash stages of measles?

A

Red spots ranging from 0.1–1.0cm in diameter appear on the 4th or 5th day following the start of symptoms.
This non-itchy rash begins on face and behind the ears. Within 24–36 hours it spreads to the entire trunk and extremities (palms and soles rarely involved).
The spots may all join together, especially in areas of the face.
Rash usually coincides with the appearance of a high fever >/= 40C.
Rash begins to fade 3–4 days after it first appears. To begin with it fades to a purplish hue and then to brown/coppery coloured lesions with fine scales.

513
Q

What is the treatment of measles?

A

Paracetomol, fluid, humidifier, nutritional support

514
Q

What are the complications of measles?

A

Fatal diarrhoea, apendicitis, hepatitis, pancreatitis, ulceration, deafness, laryngobronchitis, croup, pneumoonia, myro carditis, pericarditis, conjunctivitis, glomerunephritis, renal failure, subacute sclerosisng panencephalitis

515
Q

What are the signs and symptoms of rubella?

A

Rash, swollen glands and fever

516
Q

What is rosela’s signs and symptoms?

A

High fever, URTI, irritability, redness, rose pink rash that blanch, halo of pale skin around spot

517
Q

What s parvovirus b19?

A

Slapped cheek syndrome

518
Q

What is the most common autosomal trisomy?

A

Down’s

519
Q

What is the mosy common genetic cause of learning disorders?

A

Downs

520
Q

What causes down’s?

A

trisomy 21

521
Q

What are the typical craniofacialappearance of down’s

A

Small mouth, small ears, protruding tongue, round face, upslanted palpebral fissures, flat occiput, third fontanelle, brushfield spots in iris, epicanthic folds

522
Q

What are the non facial signs of down’s?

A

Hirschsprung’s disease, duodenal atresia, congenital heart problems, Small neck, single palmar crease, sandal like appearance of the foot, hypotonia

523
Q

What are the complications associated with Down’s?

A

Epilepsy, Alzeihmer’s, visual impairment from squints, cataracts and myopia, hearing impairment form secretory otitis media, delayed milestones, learning impairment, risk of hypothyroidism, coeliac disease, increased susceptibility toinfection, small stature, risk of atlanto-axial instability

524
Q

How is down’s tested?

A

Fluorescent in situ hybridisation

525
Q

What percentage of Down’s survive past 1 yr?

A

85%

526
Q

Wht are the three causes of trisomy 21?

A

Meiotic non-dysjunction, translocation, mosaicism

527
Q

What is the most common cause of trisomy 21?

A

Meitic non-dysjunction

528
Q

What are the causes of jaundice in infants less than 1 day?

A

Rhesus incompatibility, ABO incompatibility, G6PD deficiency, sperocytosis, pyruvate kinase deficency

529
Q

What are the causes of jaundice from 24 hours to 2 weeks of age?

A

Congenital disorders, physiological jaundice, breast milk jaundice, Hemolyisis, bruising, polycythaemia, crigler-najjar syndrome

530
Q

What are the causes of unconjugated jaundice in infants older than 2 weeks?

A

Physiological, breast milk, infection, hypothyroidism, hemolytic anaemia, high gastic obstuction

531
Q

What are the causes of conjugated jaundice in infants older than 2 weeks?

A

Bile duct obstruction, neonatal hepatitis

532
Q

What causes physiological jaundice?

A

Bilirubin rising from infanting adapting to the transition from fetal life

533
Q

What causes breast milk jaundice?

A

Increased enterohepatic circulation of bilirubin

534
Q

How should neonates with signs of respiratory distress be investigated?

A

CXR, monitoring of HR, RR, O2 and circulation

535
Q

How should infants with respiratory distress be treated?

A

Circulatory support, mechanical ventilation, ambient o2 as needed, treatment of cause

536
Q

What causes the haemolytic disease of the newborn?

A

Immune problem due to antibodies destroying RBCs

537
Q

What are the antibodies produced in the haemolytic anaemia of the newbornn?

A

Anti-D, anti A or anti B, anti-kell

538
Q

How do the antibodies form in haemolytic anaemia of the newborn?

A

Mother is negative for relevant antigen, baby is positive, mother forms antibodies against the baby and this crosses the placenta giving rise to the fetal or neonatal anaemia

539
Q

How is the haemolytic anaemia of the newborn tested?

A

Positive direct anti-globulin test

540
Q

What is Edward’s syndrome?

A

Trisomy 18

541
Q

What is Patau’s?

A

Trisomy 13

542
Q

What is turner’s syndrome?

A

45X

543
Q

What usually happens to fetueses with 45X?

A

Early miscarriage

544
Q

What are the clinical features of edwards?

A

Low birth weight, prominent occiput, flexed, overlapping fingers, short sternum, small mouth and chin, rocker-bottom feet, cardiac and renal malformations

545
Q

What are the clinical features of patuau’s?

A

Structural defect of brain, scalp defects, small eyes, eye defects, cleft palate, polydactyly, cardiac and renal malformations

546
Q

What are the clinical features of turner’s?

A

Lymphodema of hands and feet in neonate, kilonychia, short stature, neck webbing, wide carrying angle, widely spaced nipples, congenital hd, delayed puberty, ovariand dysgenesis, infertility, hypothyroidism, renal anomalies, pigmented moles, recurrent otitis media, normal intellectual function

547
Q

What is klinefelter’s syndrome?

A

47xxy

548
Q

List 10 autosomal dominant disorders?

A

Tuberous clerosis, otosclerosis, huntington’s, marfans, osteogenesis imperfecta, achondroplasia, neurofibromatosis, ehlors-danlos, myotonic dystrophy, noonan’s

549
Q

list 10 autosomal recessive disorders

A

Thalassemia, CF, oculocutaneous albinsm, wednig-hoffman, tay-sach’s, sickle cell, phenylketonuria, glycogen storage dirorders, hurler’s friedrich’s ataxia, congenital adrenal hyperplasia

550
Q

What is the definition of birth asphyxia?

A

Critical reduction in O2 delivery to fetus antenatally, during labour or delivery that produces a lactic acidosis and render poor condition atbirth.

551
Q

What does birth asphyxia cause?

A

Hypoxic ischaemic encephalopathy

552
Q

What test can be done for birth asphyxia?

A

Fetal cardiotocography, fetal blood or cord blood analysis

553
Q

What is the definition of hypoxic ischaemic encephalopathy?

A

Clinical manifestation of brain injury u to 48 hours after asphyxia, whether antenatal intrapartum or post partum

554
Q

What are the three grades of hypoxic ischaemic encephalopathy?

A

Mild, moderate and severe

555
Q

What is mild hypoxic ischaeic encephalopathy?

A

Infant is irritable, responds excessively to stimulation, staring, hyperventilation and impaired feeding

556
Q

What is moderate hypoxic ischaemic encephalopathy?

A

Marked abnormality of tone and movement, cannot feed, seizures

557
Q

What is severe hypoxic ischaemic encephalopthy?

A

No dpontaneoud movements or response to pain, tone fluctuates between hypotonia and hypertonia, seizures are prolonged, multi-organ failure

558
Q

How is hypoxic ischaemic encephalopathy treated?

A

resus and stablisation to reduce amount of damage: resp support, anticonvulsants, eeg monitoring, fluid restriction, hypotension treatment, monitoring and treatment of possible hypos and electrolyte imbalances

559
Q

What is the prognosis of hypoxic ischaemic encephalopathy?

A

Mild is expected to recover, if moderate reduces in less than 10 days, prognosis is good, if it’s severe, then prognosis isnt too shiny

560
Q

What is the possible cause of attachement disorders?

A

Absence of adequate social and emotional caregiving in childhood

561
Q

What are the signs and symptoms of attachment disorders?

A

Child rarely seeks comfort when distressed and rarely responds to said comfort, has minimal social and emtional rrsponses to others, has episodes of unexplained irritability, sadness or tearfullness, limited expressions of positive affect or joy, inadequate basic emotional or social caretaking

562
Q

What are the signs of attachetn disorders?

A

Signs of neglect, such as undernutrition, growth retardation, excessive appetitie, physical maltreatment

563
Q

What re the complications of attachemnt disorders?

A

Cognetive and language delays, accademic difficulties, difficulties in social setting, stereotypies, pervasive anger and resentment, refusal to cooperate, defiant behaviour

564
Q

What is the treatment of attachement disorders?

A

Correcting behaciour of primary caregivers

565
Q

Who is affected by ADHD more?

A

Boys

566
Q

What is the possible cause for ADHD?

A

Genetics and dysfunction of neurons that use dopamine as a receptor

567
Q

What are the signs and symptoms of ADHD?

A

Short tempered, poor social behaviour, interrupt, bad at sharing, low concentration, poor attention span, poor impulse control , fidgetym disorganised, poor at school, low self essteem,

568
Q

How ias ADHD treated?

A

Advice hon how to build concentration, self esteem , self occupation

569
Q

What medications are used to treat ADHD?

A

Stimulants like dexphetamine, methylphenidate or datomexitine

570
Q

How does ADHD medication work?

A

Reduces excessive motor activity, improves attention and focuses behaviour

571
Q

What are the types of generalised seizures?

A

Absence, tonic, myoclonic, tonic-clonic, atonic

572
Q

EHat are the types of focal seizures?

A

Frontal, temporal, occipital, parietal

573
Q

What can be seen in a frontal seizure?

A

Motor or premotor cortex,jacksonian march, asymmetric tonic seizures

574
Q

What is the most common type of focal seizures?

A

Temporal

575
Q

What can be seen in a temporal seizure?

A

Strange warning or aura, w/ smell or taste abnormalities, lip smacking, plucking at clothing, deja vu, jamais vu

576
Q

What can be seen in an occipital seizure?

A

Distortion of vision

577
Q

What can be seen in a parietal lobe seizure?

A

Contralateral dysaesthesia, distorted body image

578
Q

How are seizures investigated?

A

EE (24 hr), MRI, CT, metabolic investigatins

579
Q

What is west syndrome?

A

Violent flexor spasms of the head, trunk and limbs followed by extenrion or arms,lasting 1-2 secs, in 20-30 cycles. Can be misinterpretedas colic.

580
Q

What age does west syndrome present?

A

4-6 months

581
Q

What is the complication of West syndrome?

A

Lerning disability, epilepsy

582
Q

What is lenox-gastaut sundrome

A

mostly drop attackes, tonic seizures and atypical absences. Neurodevelopmental arrest and behaviour siorder

583
Q

What is the age onset of lennox-gautaut?

A

1-3 yrs

584
Q

What is the usual presentation age of chilhood absence epilepsy?

A

4-12 yrs

585
Q

Are girls or boy more likely to get childhood absence epilepsy?

A

Girls

586
Q

What can trigger absence seixures?

A

Hyperventilation

587
Q

What is benign epilepsy with centrotemporal spikes?

A

Tonic clonic seizures in sleep,simple focal seizures w/ awareness of abnormal feelings in tongue and distontion of face

588
Q

What is status epilepticus?

A

Seizure lasting 30min

589
Q

What are the causes of congenital hypothyroidism?

A

Maldescent of thyroid and athyrosis, dyshormonogenesis, isodine deficiency, TSH deficiency

590
Q

What are the symptoms of hypothyroidism in children?

A

Coldskin,dry skin, thin hair, constipation, failure to thrive, obeseity, learning difficulries, coarse facies, large tongue, prolonged jaundice, bradycardia short stature

591
Q

What can cause parathyroid disorders in children?

A

Digeorge’s, addisons

592
Q

What are the features of adrenal cortical insufficency?

A

Hyponatremia, hyperkalaemia, vomiting, lethargy, hypo, dehydration, hypotension, circulatory collapse, brown pigmentation, growth failure

593
Q

How is an adrenal crisis treated?

A

IV saline, glucose, hydrocortisone

594
Q

What aew rh inborn errors of metabolsim?

A

Phenylketonuria, homocystinuria, tyrosinaemia, falactosaemia, glycogen storage disorders

595
Q

How is self harm screened for?

A

Problems longer than a month, planned overdose/suicide for longer than 3 hours, alone in the house, hopelessness, sadness

596
Q

What are the signs and symptoms of self-injury?

A

Scars, fresh cuts, scrathces, bruises or other wouunds, feeling of helplessness, persistent questions of personal identitty, difficulty in interpersonal relationships, keeping sharp objects, instability

597
Q

What are the forms of self harm?

A

Cutting, scratching, burning, carving words or symbols int skin, hitting or punching, piercing skin, pulling out hair, persistent picking/ interefering with wound healing

598
Q

wHAT ARE THE CAUSES OF DAYTIME ENURESIS?

A

Ectopic ureter, neuropthic bladder, concdentrating on something else, detrusor instability, blader neck weakness, constipation, lack of attention to bladder sensation

599
Q

By what age should children have urinary contro ?

A

3-5

600
Q

What are the signs of a neuropathic bladder?

A

Distended bladder, abnormal perineal sensation,n, anal toneor reflexes and fait. Sensory loss of S2, S3, S4.

601
Q

What can cause girls to be ry during the day but wet at night?

A

Ectopic ureter into vagina

602
Q

How is daytime enuresis investigated?

A

Urine sample, microcopy, culture and sensitivity, if needed, US, MRI for spinal lesions

603
Q

How can non neurological daytime enuresis be treated?

A

pelvic floor exercises, pad with alarm, anticholinergic / adrenergic drugs to reduce bladder contractions, ephedrine to increase tone at bladder neck

604
Q

What are the nocturnal causes of enuresis?

A

UTI, faecal retention, polyuria due to diabetes (osmotic diuresis)

605
Q

What is transient synovitis?

A

Irritable hip usually occuring eith or after a viral infection.

606
Q

WHat is the typical age of presentation of transient synovitis?

A

2-12 years

607
Q

What are the signs and symptoms of transient synovitis?

A

Sudden onset of pain with limp, no pain at rest, decreased rande of movement, pain refferred to the knee, child is afebrile

608
Q

What are the blood test results that usually come from transient synovitis?

A

Neutrophil count raised, EESR may be raised

609
Q

What is the differece betwen transient synovitis and septic arthritis of the hip?

A

Septic arthritis: high fever, looks unwell, pain at rest, no movement of hip, neutophils and ESR are super raised
Transient synovitis: no to mild fever, looks fine, pain on movement, neutrophis and esr are normal to slightly raised

610
Q

What can transient synovitis be the presentaton for?

A

Perthes, slipper upper femoral epiphysis

611
Q

What occurs in nephrotic syndrome?

A

Heavy proteinuria causing low plasma albumin and anaemia

612
Q

What are the secondary causes of nephrotic syndrome?

A

Henoch-schonlein purpura, SLE, malaria, bee stings

613
Q

What are the clinical signs of nephrotic syndorme?

A

Periorbital oedema (on waking), ascites, sccrotal, vulvula or leg oedema, breathlessness due to pleural effusion and abdo distension

614
Q

What is the complication of nephrotic syndrome?

A

Renal failure, hypovolemia, thrombosis, pneumococcal infection, hypercholestrolaemia

615
Q

What is the first sign of nephrotic syndrome?`

A

Periorbital oedemaW

616
Q

What are the types of nephrotic syndromes?

A

Steroid sensitive, steroid resistant and congenital

617
Q

Which is the most common type of nephrotic syndrome?

A

Steroid sensitive

618
Q

Wat investigations are performed on patients with nephrotic syndrome?

A

Dipstick, FBC, ESR, CRP, Us and Ez, complement, malaria screen, antiteptolysin O or anti-DNAse, urine microscopy and culture, hep B and c screen

619
Q

What are the features of steroid sensitive nephrotic syndrome?

A

1-10 years of agem macroscopic haematuria, , complement and renal function normal

620
Q

What is the management of steroid sensitive nephrotic syndrome?

A

Oral corticosteroids, renal biopsy of unresponsive

621
Q

What are the types of physical abuse?

A 
Bruising
Scalding/Burns
Bites
Fractures
Oral Injuries  
Neurological Injuries
622
Q

What is the commonest injury in physical abuse?

A

Bruising

623
Q

How are accidental and non accidental bruises differntiated?

A

Accidental -splashes

Non-accidental - Dipping

624
Q

What are the common fracture sites due to abuse?

A

Ribs, femoral, metaphyseal fractures (tibia, usually bilateral and symettrical)

625
Q

What is the commonest cause of fatal childabuse?

A

Shaken baby syndrome

626
Q

What are the clinical indicators of shaken baby syndrome>

A

Apnoea, retinal haemorrhage, seizure, lethargy, irritability, poor feeding, vomiting, subdural haematoma

627
Q

What are the signs of neglect?

A 
Smelly or dirty
Unwashed clothes
Inadequate clothing
Abnormal hunger
Frequent and untreated nappy rash
Unclean living environment 
Lack of heating
Left alone for long periods of time
Taking on the role of carer for others
628
Q

What is Atopic dermatitis?

A

Chronic, pruritic, inflammatory skin disease of unknown arigin, associated with IgE

629
Q

What is atopic dermatitis associated with?

A

Food allerfy, asthma, allergic rhinitis

630
Q

What are the classic features of atopic dermatitis?

A

Pruritis, early onset, ecxema, atopy, xerosis

631
Q

Describe a lesion of atopic dermatitis

A

Erythematous, lichenified and possibly exudative plaque. crusting is common

632
Q

What are the causes of atopic dermatitis?

A

Genetics, infection, hygiene, food allergy, climate, tobacco

633
Q

Name 5 possible differentials for atopic dermatitis

A

Allergic contact dermatitis, scabies, immunodeficiency, plaque psoriasis, zinc deficiency, tinea corporis, seborrheic dermatitis, impetigo

634
Q

What is the treatment of atopic dermatitis?

A

Moisturizers topical steroids and immunomodulators if necessary

635
Q

WHAT ARE THE CHARACTERISTICS OF HENOCH SCHLONLEIN PURPURA?

A

Charqacteristic skin rsh, arthralgia, periarticular oedema, adominal pain, glomerulonephritis

636
Q

Who is the typical patient of henoch schonlein purpura?

A

3-10, male, in winter and fter a URTI

637
Q

Describe the rash seen in henoch sconlein purpura

A

Symmetrical rash over buttocks, extensorso f legs and arms, starts of urticarial, turns maculopapular and into purpura. Palpable for weeks

638
Q

What is the most common arthritis in children?

A

Reactive arthritis

639
Q

What are the charecteristics of reactive arthritis?

A

transient joint swelling (,6weeks) of ankles or knees, with evidence of previous extra-articular infection, low grade fever, ESR and RP are mildly elevated,

640
Q

What is the treatment for reactve arthritis in children?

A

None or NSAIDS

641
Q

How can septic arthritis be caussed in children?

A

Haematogenous spread, puncture wound, infected joints, adjacent osteomyelitis spreading into joint vieal capsule inserts

642
Q

What is the most common pathogen that causes septic arthritis in children?

A

Staph. A

643
Q

What is the classical presentation of septic arthritis in children?

A

Acutely unwell, febrile, erythematous, warm, acutely tender joint, reduced movementlimp, psudoparalysis of limb as infants hold it super still

644
Q

How is septic arthritis investigated in children?

A

SR, CRP, blood cultures, US of deep joints, X rays to exclude trauma

645
Q

How is septic arthritis treated in children?

A

IV antibiotics, joint immobilisation, joint wsh out if necesscary

646
Q

What are the most common congenital heart lesions?

A

Left to right shunts, right to left shunts, common mixing, outflow obstuction

647
Q

What can cause right to left shunts in babies?

A

Tetralogy of fallot, transposition of great arteries

648
Q

Whatcan cause left to right shunts in babies?

A

VSD, ASD, persistent arterial duct

649
Q

What can cause cause outflow obstruction in neonates?

A

Pulonary stenosis, aortic stenosis, coarctation of aorta

650
Q

What is the presentation of congenital HD?

A

Antenatal cardiac US diagnosis, cyanosis, shock, HF, murmur

651
Q

What are the symptoms of HF in a neonate?

A

Breathlessness (on feeding or exertion), sweatinf, poor feeding, recurrent chest infections, cyanosis, tachycardia, tachypnoea, cardomegaly, hepatomegaly, col peripheries, murmur, poor growth

652
Q

What are the signs of an ASD?

A

None, wheeze, recurrent chest infection, srrhytmias, ejection systolic murmur best heard and upper left sternal eddge, fixed and widely split secod heart sound

653
Q

How are SDs investigated?

A

CXR, ECG, eho

654
Q

How are septal defects treated?

A

Surgery, occlusion device

655
Q

What are the clinical features of small VSDs?

A

A symp, pan systolic murmur at lower L. sternal edge quiet pulmonary second sound

656
Q

WHat are the clinical features of large VSDs?

A

HF with breathlessness, recurrent chest infections, active precordium, tachycardia, tachypnea and hepatomegaly, apical mid diastolic murmur, soft pansystolic murmmur

657
Q

What complications can be avoided by giving children with VSDs treatment?

A

Failure to thrive, permanent lung damage, HF

658
Q

What are the clinical features of a petent ductus arteriosus?

A

Continuous murmur behind left clavicle, collapsing pulse

659
Q

What fine motor development should be visible by 6 months?

A

Fixes and follows (6 weeks)
Reaches for objects
Palmar grasps (6 months)
Trunk control developing (sits with support by 6 months

660
Q

What gross motor development should be visible by 6 months?

A

Develops head control

Primitive reflexes

661
Q

What speech development should be visible by 6 months?

A

babbling

662
Q

What social development should be visible by 6 months?

A

Social smile, recognises faces

663
Q

What gross motor development should be visible by 1 yr?

A

Sits without support (9 months)
Bum shuffle/Crawling *
Pull to stand  Cruising  First steps

664
Q

What fine motor development should be visible by 1 yr?

A

Pincher grasp (9-10 months)
Object Permanency
Follows small objects

665
Q

Whatspeech and hearing development should be visible by 1 yr?

A

Babbling, first words, hearing by distraction

666
Q

What social development should be visible by 1 yr?

A

Stranger awareness developing
Understands simple commands
Uses objects appropriately (comb)

667
Q

What are the red flags in terms of development from birth to a year?

A 
Smile Absent Between 6 weeks
Persistent primitive reflexes > 6 months   
Absent babbling > 6 months
Absent stranger anxiety > 7 months
Squinting past 8 weeks
668
Q

What gross motor development should be visible by 18 months?

A

Walks well
Stops and retrieves objects
Climbing

669
Q

What fine motor development should be visible by 18 months?

A

Tower 2-3 cubes

Scribbles

670
Q

What speech and hearing development should be visible by 18 months?

A

Speaks 6-12 words
Understands cup/siblings names
Echolalia

671
Q

What social development should be visible by 18 months?

A

Uses spoon
Symbolic play
Indicates wants without crying

672
Q

What gross motor development should be visible by 2 yr?

A

Kicks ball

Climbs stairs 2 feet per step

673
Q

What fine motor development should be visible by 2 yr?

A

Copies vertical line

Tower 8 bricks

674
Q

What speech and hearing development should be visible by 2 years

A

2-3 word sentences
Knows 5-6 body parts
Selects toys e.g. give me the cow

675
Q

What social development should be visible by 2 yr?

A

Parallel play
Tantrums
Removes a garment

676
Q

What are the red flags in terms of development from birth to 3 year?

A 
No 1st word except mama/dada >18 months
Not walking independently >18 months
No joining of two words by 2 years
Hand dominance <18 months
No imitative play >18 months
Can’t follow 1 step commands >15 months
677
Q

Name one thing from each domain of development in a three to four year old

A

Gross motor:Hops and stands on one foot up to five seconds
Goes upstairs and downstairs without support
Kicks ball forward
Throws ball overhand
Catches bounced ball most of the time
Moves forward and backward with agility
Fine motor:Copies square shapes
Draws a person with two to four body parts
Uses scissors
Draws circles and squares
Begins to copy some capital letters
Language: Understands the concepts of “same” and “different”
Has mastered some basic rules of grammar
Speaks in sentences of five to six words
Speaks clearly enough for strangers to understand
Tells stories
Social:nterested in new experiences
Cooperates with other children
Plays “Mom” or “Dad”
Increasingly inventive in fantasy play
Dresses and undresses
Negotiates solutions to conflicts
More independent
Imagines that many unfamiliar images may be “monsters”
Views self as a whole person involving body, mind, and feelings
Often cannot distinguish between fantasy and reality

FOCP (12 decks)

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