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
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
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
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
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
6
Q
What tests are used to confirm a UTI?
A
FBC, basic metabolic panel, blood culture, renal function studies, electrolyte studies, Urineanalysis
7
Q
Why is a blood culture done in children with query UTI?
A
To rule out sepsis
8
Q
Why is a basic metabolic panel done in children with query UTI?
A
For presumptive diagnosis of pyelonephritis
9
Q
How can a urine sample be collected?
A
Mid stream or via suprapupic aspiration for kids with complications
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
11
Q
How are UTIs treated?
A
Antibiotics
12
Q
What are the common pathogens that cause UTIs in children?
A
E coli
Klebsiella, proteus, enterococcus, Staph. saprophyticus, strep. group B, pseudomonas
13
Q
What site of infection is most common in UTIs for children?
A
Pyelonephritis
14
Q
What are the risk factors in children for UTIs?
A
Antibiotic therapy, anatomical abnormality, bowel and bladder dysfunction, constipation
15
Q
What is otitis media?
A
Inflammation of the middle ear
16
Q
What are the four sub types of otitis media?
A
Acute, otitis media with effusion, chronic suppurative OM, adhesive OM
17
Q
What are the symptoms and signs of acute otitis media?
A
Otalgia, otorhea, fever, diarrhoea, vomiting, irritability loss of appetite, headache
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
19
Q
What is chronic supparative otitis media?
A
Persistent ear infection that results in tearing or perforation of the eardrum
20
Q
What is adhesive otitis media?
A
Thin retracted ear drum becomes sucked into middle ear space and stuck
21
Q
Which of acute otitis media and otitis media with effusion is treatable by antibiotics?
A
Acute OM
22
Q
Why is it important to distinguish between acute otitis media and otitis media with effusion?
A
to avoid unnecessary use of antibiotics
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
24
Q
What colour is the tympanic membrane normally?
A
Translucent pale grey
25
What does an opaque yellow or blue tympanic membrane suggest?
Middle ear effusion
26
What investigations can be performed for a query otitis media?
Tympanocentesis and culture, tympanometry, imaging studies if a complication is suspected
27
How is otitis media treated?
Analgesics, antibiotics for Acute OM. Amoxicillin is the antibiotic of choice
28
What are teh risk factors for otitis media?
Immature immune systems, genetic predisposition, mucus secretion, anatomical abnormalities, allerfies,
29
What is the most common bacterial pathogen of acute otitis media?
Step. pneumoniae, h. influenza, moraxella catarrhalis
30
What is the most common viral pathogen of acute otitis media?
It is merely a risk factor
31
What are the intratemporal complications of otitis media? Name 10
Hearing loss, tympanic membrane perforation, chronic suppurative Otitis media, tympanosclerosis, cholesteatoma, mastoiditis, petrositis, labyrinthitis, facial paralysis, cholesterol granuloma, infectious eczematoid dermatitis
32
What are the intracranial complications of otitis media?
Meningitis, subdural empyema, brain abscess, extradural abscess, lateral sinus thrombosis, otitic hydrocephalus
33
What is tonsillitis
Inflammation of pharyngeal tonsils
34
What are the presentations of acute tonsilitis?
Fever, sore throat, foul breath, dysphagia, odynophagia, tender cervical lymph nodes, airway obstruction, pyrexia, tonsillar exudates
35
How can airway obstruction manifest in tonsilitis?
Mouth breathing, snoring, sleep-disordered breathing, sleep apnea
36
How is tonsillitis managed?
Adequate hypration, analgesics, ibuprofen, caloric intake, tonsilectomy
37
What are the viral and bacterial causes of tonsilitis?
Herpes simplex, EBV, CMV, adeno virus, measles, strp. pyogenes, GAS
38
WHat are the causes of recurrent tonsillitis?
Strep pneumonia, SA, H. influenza
39
WHat are the causes of chronic tonsillitis?
Polymicrobial population
40
What are the complications of bacterial tonsillitis in children?
Rheumatic fever, acute glomerunephritis
41
What are the classic triad of symptoms seen in bacterial meningitis?
Fever, headache and meningeal signs
42
What symptoms can occurs with bacterial meningitis in neonates? (10)
Poor feeding, lethargy, irritability, apathy, fever, seizures, apnea, hypothermia, jaundice, bulging fontanelle, pallor, shock, hypotonia, hypoglycemia, intractable metabolic acidosis, shrill cry
43
What symptoms can occurs with bacterial meningitis in infants and children? (10)
Nuchal rigidity, Opisthotonos, bulging fontalle, convulsions, headache, fever, phototphonbia, irritability, lethargy, anorexia, vomiting, coma
44
Whatis opisthotonos?
spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, some kinds of meningitis, and strychnine poisoning.
45
What is nuchal rigidity?
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.
46
What is diagnosis of Bacterial meningitis based on?
Bacteria isolated from CSF from Lumbar puncture. Demonstrated meningeal inflammation, bacterial meningitis score
47
What are the components of the bacterial meningitis score?
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
48
What imaging studies can be used for bacterial meningitis? What can they reveal
CT an MRI. Can reveal ventriculomegaly and sulcal effacement
49
WHat blood tests can be done for bacterial meningitis?
FBC, blood culture, coagulation studies, elcectolytes, serum glucose (to compare with CSF)
50
What is done to manage pediatric bacterial meningitis?
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)
51
What are the most common causes of pediatric bacterial meningitis?
Strep. Pneumonia, Neisseria meningitidis, H. influenza type B
52
WHat causes the symptoms seen in bacterial meningitis?
Intense host inflammatory response to bacterial antigens in subarachnoid space
53
What is the most common cause of pediatric aseptic meningitis?
Viruses (Viri?)
54
What is the most common viral cause of pediatric aseptic meningitis?
Enterovirus
55
WHat are the symptoms of pediatric aseptic meningitis?
Headache neck stiffness, photophobia, rash, diarrhoea, cough, arthralfia, myalgia, sore throat, weakness, lethargy, hypotonia, seizures,
56
WHat are the signs of pediatric aseptic meningitis?
hypothermia, bulging of fontanella, , positive kernig/brudzinski sign,
57
WHat lab studies should be done for pediatric aseptic meningitis?
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
58
What other tests can be done for pediatric aseptic meningitis?
LP, CT, MRI, EEG
59
WHat medications should be used to treat aseptic meningitis?
Analgesics
60
What are the complications of pediatric bacterial meningitis?
Seizures, subdural effusions, hydrocephalus
| Hearing loss, learning difficulties, cerebral palsy, affect on memory, concentration and balance
61
What are the symptoms of pediatric asthma?
Wheeze, nocturnal cough, shortness of breath, chest tightness, nocturnal, non-productive cough, cough with exercise
62
What are the signs of an acute pediatric episode of asthma?
Breathless at rest, uninterested in feeding, sit upright, talking in words and not sentences, agitated
63
What are the signs of an imminent respiratory arrest due to pediatric asthma?
Drowsiness, confusion
| Breathless at rest, uninterested in feeding, sit upright, talking in words and not sentences, agitated
64
What are the signs seen in a physical examination of a severe episode of asthma?
Tachypneoa, tachycardia, use of accessory muscles to breathe, suprasternal retractions, pulsus paradoxus, o2sats <91%, loud, biphasic, inspiratory and expiratory crackles
65
What is pulsus paradoxus
abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg.
66
What are suprasternal retractions?
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.
67
What is status asthmaticus?
a severe condition in which asthma attacks follow one another without pause
68
What are the findings in a pediatric patient with status asthmaticus?
Paradoxical thoracoabdominal movement, absent wheezing, severe hypoxia, brady cardia, pulsus paradoxus disappears
69
Why does pulsus paradoxus disappear in status asthmaticus?
Respiratory muscle fatigue?
70
What medications are used to control asthma?
Inhaled corticosteroids, inhaled cromolyn/nedocromil, long-acting bronchodilators, theophylline, leukotrine modifiers, IgE antibodies
71
What are the relief medications used to control asthma?
Short acting bronchodilators, systemic steroids, Ipratropium
72
What is the definition of asthma?
hronic inflammatory disorder of the airways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy
73
What is the pathophysiology of asthma?
Ventilation perfusion mismatch caused by airway obstruction, hyperinflation and vasoconstriction due to alveolar hypoxia
74
What causes airway obstruction in asthma?
Increased mucus production, bronchoconstriction, chronic inflammation
75
What tests are used to diagnose asthma?
Spiromatey, plethysmography, exercise challenges, metacholine challenge
76
What is a metacholine challenge?
Giving patients metacholine and testing pirometry before and after. Metacholine causes bronchoconstriction, and ccan show reduced FEV1/FVC in patients with normal spirometry readings
77
What is bronchiolitis?
Acute inflammatory injury of the bronchioles, usually caused by a viral infection
78
Who does bronchiolitis usually effect?
Symptomatic in young children
79
What are the signs and symptoms of bronchiolitis?
Increasing fussiness, poor feeding, apnea, corzya, congestion, low grade feer,
80
What are the signs and symptoms of sever bronchiolitis?
Respiratory distress, cyanosis, tachpnea, nasal flaring, retractions, irritability
81
What are the signs seen in physical examination that raise the suspicion of bronchiolitis?
Tachypnea, tachycardia, fever, retractions, fine rales, hypoxia, otitis media
82
What are used to diagnose bronchiolitis?
Rapid viral antigen amplification testing, ABG, WBC count, CRP, O2 sats, blood cultures, urine analysis, specific gravity, culture, CS analysis, serum chemistries
83
What are the lab tests used for bronchiolitis for?
To exclude other differentials
84
What is the main treatment for bronchiolitis?
O2 ventilation
85
What are the effects of broncheolar injury?
Increased mucus secretion, bronchial obstruction and constriction, alveolar cell death, mucus debris, viral invasion, air trapping, atelectasis, reduced ventilation, ventilation perfusion mismatch, laboured breathing
86
What cause broncheolar injury?
Necrosis of resp epithelium, inflammatory response due to pathogen, inflammation, oedema and debris from infection
87
What is the most common cause of bronchiolitis?
RSV
88
What is croup?
A common, primarily viral pediatric illness that effects the larynx and trachea
89
What is the most common cause of croup?
Parainfluenza viruses
90
What is the most common cause of croup?
Parainfluenza viruses
91
What can be seen in the history of a patient with croup?
Nonspecific resp symptoms (rhinorrhea, sore throat, cough), low grade fever, barking cough, hoarseness, inspiratory stridor, worse symptoms at night
92
What can be seen in a severe episode of croup?
Inspiratory and expiratory stridor, suprasternal, intercosta, and subcostal retractions, hypoxia and hypercarbia, cyanosis
93
What are the differentials for croup?
Measles, pediatric airway foreign body, laryngeal fracture, inhalation injury diphtheria, EBV, peritonsillar abscess
94
What tests are used to diagnose croup?
Mostly a clinical diagnosis
95
What is the management sstrategies for mild croup?
Calming caregiver, no smoking, antipyretic, keep child's head elevated, encourage oral intake
96
What medicationscan be used to treat severe croup?
Corticosteroids, epinephrine (constricts precapillary arterioles, decreasing capillary hydrostatic pressure), Heliox *helium plus oxygen, increases movement of O2 through airways)
97
How can children present due to airway foreign bodies?
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
98
What are the findings due to a foreign body in the airway of children?
abnormal airway sounds, like wheezing, or stridor, reduced breath sounds. usually unilateral
99
What does inspiratory changes in breath sounds imply for the position of the foreign body?
In extrathoraxic trachea
100
What does symmetric changes in breath sounds that are more prominent in the central airway imply for the position of the foreign body?
In the intrathoracic trachea
101
What are the differentials for foreign body aspiration in children?
Pediatric asthma, bronchitis, pneumonia
102
What tests can be done to investigate a foreign body aspirate?
CXR, CT, Fluoroscopy, bronchoscopy
103
What signs can be seen in an xray due to an aspirated foreign body?
Object is usually food, and therefore radioopaque. Xray can reveal area of focal overinflation, alectasis, opacification of distal lung
104
What is the medical treatment of a foreign body aspiration?
Use of rigid bronchoscope to remove foreign body if necesscary
105
What is the pathophysiology of anaphylaxis?
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
106
What are the common triggers of pediatric anaphylaxis?
Foods, medicines, biologic agents, preservatives, latex, unknown causes
107
What foodstuffs can cause pediatric anaphylaxis?
Milks, eggs, wheat, soy, fish, shellfish, legumes, tree nuts
108
What medicines can cause pediatric anaphylaxis?
Antibiotics, local anaesthetics, analgesics, opiates, dextran, radiocontrast media
109
What biologic agents can cause pediatric anaphylaxis?
Venom, blood and blood products, vaccine, allergen extracts
110
What are the signs and symptoms of pediatric anaphylaxis?
Cutaneous symptoms, involvement of at least 2 organ sustems, low BP
111
What are the cutaneous symptoms of anaphylaxis?
Hives, pruritis, facial swellinf
112
What are the respiratory symptoms of anaphylaxiz?
Bronchospasm, strifor, SOB
113
Qhat are the GI symptoms of anaphylaxis?
Crampy abdominal pain, vomiting
114
What are the differentials for anaphylaxis?
Angioedema, asthma, bee strings, carcinoid tumour, exercise induced anaphylaxis, serum sickness, shock, status asthmaticus, syncope, toxicity
115
What tests can be done to investigate anaphylaxis?
Serum histamine and tryptase (raised after attack)
116
How is anaphylaxis treated?
Adrenaline, airway management, BP management
117
What do newborns with pneumonia present with typically?
Poor feeding, irritability, tachypnea, retractions, grunting and hypoxemia
118
What are the pathogens that can cause pneumonia that spread through vertical transmission?
Group B strep,
119
What agents can cause pneumonia in neonates?
Group B strep, listeria, ecoli, klebsiella, respiratory syncytial virus
120
What do infants with pneumonia present with typically?
Cough, tachypnea, retractions, hypoxia, congestion, fever, irritability, decreased feeding
121
What diagnostic tests can be used to diagnose pediatric pneumonia?
O2 sats, capnography, aucutation, sputum culture, serology, CXR, US
122
Which is better to diagnose pediatric pneumonie, CXR or US?
US
123
What is the resp rate threshold for identifying pneumonia in children <2months?
> or = 60
124
What is the resp rate threshold for identifying pneumonia in children 2-11 months?
> or = 50
125
What is the resp rate threshold for identifying pneumonia in children 12-59 months?
> or = 40
126
What is the treatment for outpatient pneumonia?
oral antibiotics
127
Why aren't fluoroquinines used in children?
Can cause antibiotic resistance ad short term tendon damage
128
What are the causes of wheeze in children?
Bronchospasm, swelling of mucosal lining, excessive mucus secretion, and an inhaled foreign body
129
What are the signs and symptoms that suggest pediatric sepsis?
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
130
What lab studies can investigate pediatric sepsis?
FBC, PT, coagulation screen, electrolyte levels, Us and Es, LFTs, etiology-specific serologies, urinalysis, CRP, Blood, urine and csf CULTURE
131
What radiological studies can be used to investigate sepsis?
CXR, CT, MRI ECG, LP
132
How can pediatric sepsis be treated?
Fluid resus, support of cardiac output ventilation, maintenance of adequate [hb], correction of physiologic and metabolic derangement, montoring of urine output, antimicrobial agents
133
What is pediatric testicular torsion?
Acute vascular even where spermatic cord gets twisted on its axis, causing loss of blood flow to the testis
134
What is the main complication of testicular torsion?
Loss of testicle
135
What is the most important factor about treating testicular torsion
Surgical emergency, must be treated as soon as possible to avoid loss of testi
136
What are the two kinds of testicular torsion, and what is the anatomical differentialtion between them?
Extravaginal (outside tunica vaginalis) or Intravaginal ( inside tunica vaginalis)
137
Which type of testicular torsion is more likely in older boys?
Intravaginal
138
Which type of testicular torsion is more likely in perinatal boys?
Extravaginal
139
Why are xtravaginal testicular torsions more common in perinates?
The tunica vaginalis takes 6 weeks to adhere
140
What are the risk factors for perinatal testicular tosion
Large birth weight, difficult labor, breech presentation, overreactive cremasteric reflwx
141
What are the signs and symptoms of testicular torsion?
Severe scrotal pain of acute onset, scrotal swelling, erythema, nausea, vomiting, tender, high riding testes with an abnormal orientation, scrotal oedema, absent cremasteric reflex
142
What are the differntials for testicular torsion?
Adrenal haemorrhage, epididymitis, Henoch-Schonlien purpura, orchitis, addendectomy, hydrocele and hernia surgery, varicocele
143
What tests are done to investigate testicular torsion?
Urinalysis, ultrasonography
144
How is testicular torsion managed?
Manual detororsion, surgical exploration
145
what are the goals of surgical exploration in testicular torsion?
Confirming diagnosis, detorsion, assessing viability of involved testis, removal of involved testes, fisation of testis
146
What is appendicitis?
Inflammation and infection of vermiform appendix
147
What are the complications of appencitis
Appendix rupture
148
What are the symptoms of appendicitis?
Anorexia, vague periumbilical pain, followed by migration of pain to r. lower quadrant, vomiting, fever
149
WHere is appendicits pain at it's max?
McBurney point
150
What is the Rosing sign and what does it suggest?
Pain in RLQ in response to L. sided palpation or percussion. Suggests peritoneal irritation
151
What is the psoas sign and what does it suggest?
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)
152
What is the obturator sign and what does it suggest?
internally rotating the flexed right thigh. A positive response suggests an inflammatory mass overlying the obturator space (pelvic appendicitis).
153
Name five differntials for appendicitis
Intussusception, merkel's diverticulum, ectropic pregnancy, testicular torsion, ovarion torsion, ovarian systs, constipation, gastroentritis, UTI, pyelonephritis
154
What tests should be used to investigate appendicitis?
FBC, IL6,CRP, urinalysis, abdominal radiography, US, CT
155
What is the treatment for appendicitis?
Fluid resus, antibiotic therapy, appendectomy, percutaneous drainage (for intraabdominal abscesses), post op pain management
156
What are the complications of appendicitis?
Perforation, sepsis, wound infection, bowel obstruction, wound dehiscence, infertility, shock, post-op adhesions
157
What is Intussusception?
Segment of intesting invaginates into the adjoining lumen, causing bowel obstruction
158
What is the complication if intussusception isn't treated in time?
DEATH
159
What symptoms can be seen in the history of a patients with intussusception?
Infant with URTI, vomiting, abdo pain, passage of blood and musus, lethargy
160
What are the signs of intussusception?
R. hypochondrium, palpable sausage shaped mass
| Emptiness in RLQ. abdominal distension if obstruction is complete
161
What is the pain of intussusception like?
Colicky, severe, intermittent
162
What are the imaging studies used for diagnosis of intussusception?
Abdominal Xray, US, contrast enema
163
What are the non operative treatments for intussusception
Therapeutic enema- Hydrostatic, pneumatic
164
What are the surgical treatments for intussusception?
Surgical reduction, manually or laproscopically
165
What are the complications of intussusception?
Perforation during reduction, wound infection, intestinal haemorrhage, recurrence, necrosis, bowel perforation, sepsis, hernas, adhesions
166
How is Hepatitis A virus spread?
Fecal-oral route
167
How is liver injury represented?
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)
168
How does Hep A cause liver injury?
Viral replication occurs in the liver
169
What are the symptoms in the prodromal phase of a pediatric hepatitis A infection?
Low grade fever, anorexia, vomiting, abdopain (RUQ)
170
What are the symptoms of a pediatric hepatitis A infection?
Diarrhoea, jaundice, dark urine, light coloured stool, anicteric infections
171
What are the differentials of pediatric hepatitis?
Hep A, B, C, Gastroentritis, gall bladder disease surgery, enteroviral infections
172
What tests can be used to investigate pediatric hepatitis?
Bilirubin, LFTs, US, Serology specific for viral hepatitis
173
What are the five presentations of pediatric hep B?
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)
174
What are the clinical signs of an acute pediatric hep B infection?
Anorexia, nausea, malaise, vomiting, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, coryza, jaundice, dark urine, clay-coloured or light stool, abdopain RUQ),
175
What are the clinical signs of chronic pediatric hep B infections?
Fatigue, anorexia, bouts of mild aundice
176
What are the complications of viral hepatitis?
Pancreatitis, myocarditis, typical pneumonia, aplastic anemia, peripheral neuropathy, transverse myelitis
177
What are the complications of pediatric hep C
Fulminant hepatitis (rare)
Cirrhosis, which may result in portal hypertension and liver failure
Hepatocellular carcinoma
178
What are the extrahepatic manifestations of pediatric hep C
```
Porphyria cutanea tarda
Sialadenitis resembling Sjögren syndrome
Mooren corneal ulcers, a form of chronic ulcerative keratitis
Type II cryoglobulinemia
Membranoproliferative glomerulonephritis
Non-Hodgkin lymphoma
```
179
What is the difference between the presentation of fulminant hepatic failure in adults and children>
Ecephalopathy is absent or very late in chilfren
180
What are the causes of fulminant hepatitis in children?
Hep A,B,c,D,E EBV, VZV, CMV, paramyxovirus, adenovirus, hepatotoxic drugs, metabolic disorders
181
What metabolic dosorders can cause fulminant hepatic failure in children>
Neonates-Tyrosinemia, hereditary fructose intolerane, galactosemia, neonatal hemochromatosis, Older children-Wilsons
182
What is fulminant hepatic failure?
severe impairment of hepatic functions or severe necrosis of hepatocytes in the absence of preexisting liver disease.
183
What is the typical presentation of fulminant hepatic failure in children?
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,
184
What tests can investigate fulminant liver failure?
LFTs, FBC, ESR, metabolic panel, U and E, coagulation screen, tests for viral causes, liver biopsy
185
How is fulminant hepatic failure treated>
Supportive care, fluid and electrolyte correction, management of hypo, correction og coagulation, management of renal dysfunction, treatment of specific cause, management of cerebral oedema
186
What is the pathophysiology if T1DM?
Lack of insulin caused by autoimmune attack of pancreatic beta cells
187
What are the common symptoms of T1DM?
Polyuria, polydispsia, polyphagia, lassitude, nausea, blurred vision and fatigue, glycosuria, hyperglycemia, weight loss, keto acidoses
188
What causes fatigue in t1DM?
Muscle weakness from catabolic state of insulin deficiency, hypovolemia and hypokalemia
189
What causes polyuria in t1DM?
Osmotic diueresis due to hypo
190
What causes blurred vision in T1DM?
Effect of hypoosmolar state on lens and vitreous humour (glucose causes swelling, altering the shape and therefore focus of the lens)
191
What are the tests done for T1DM
Impaired glucose tolerance test, glycated hemoglobin studies, urinary albumin tests, BM,
192
Which test is best for monitoring medium term to long term diabetic control?
HbA1c
193
How long do HbA1c results check for?
120 days, lifespan of blood cell
194
What are the signs of hyperglycemia in children?
Can be asymp,
| malaise, headache, weakness, ill temper, irritability
195
What are the signs of glycosuria?
Increased urinary frequency and volume, troublesome at night, can lead to enuresis
196
What causes weightloss in children with t1dm?
Insulin deficiency causing uninhibited gluconeogenesis, causing breakdown of preotein and fat. Failure to thrive and wasting can be other symptoms
197
What are the symptoms of ketoacidosis?
Acidotic breathing, severe dehydration, smell of ketones, abdo pain, drowsiness, coma, vominting
198
How is t1dm managed in children?
Glycemic control, insulin therapy, diet and activity
199
What are the causes of pediatric small bowel obstruction?
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.
200
What does an incarcerated hernia usually present with?
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
201
What is malrotation of bowel with midgut volvulus
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
202
WHAT IS mesocolic hernia
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
203
What is necrotizing enterocolitis
Primarily effects premature neonates and low birth weight babies. Cuases strictures wish lead to intestinal obstruction. If untreated, leads to death
204
What does nectrotising enterocolitis usually present with?
Temp instability, abdominal distention, bilious vomiting, gross or occult rectal bleeding, abdo tenderness, redness of abdo wall
205
What is Merker's diverticulum
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
206
What is a prepyloric diaphragm?
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.
207
What are the signs and smyptoms of pediatric small bowel obstruction?
Repetitive abdo pain, vomiting, chronic, partial small owel obstruction, billous vomiting, norexia diarrhea, obstipation, fever
208
If a pediatric patient presents with billous vomiting
IT IS A MEDICAL EMERGENCY
209
What are the tests that investigate intestine obstruction?
Serum electrolyte level, blood urea nitrogen level, vreatinine, glucose, FBC, urinalysis, ABG, stool sample
210
What can cause hyperkalemia with intestinal obstruction?
Incarcerated hernia
211
What are the imaging tests that investigate intestine obstruction?
Abdo x ray, contast studdies, US
212
Where are the anatomical sites where stenosis or atresia can take place in a new born?
Oesophagus, stomach, duodenum, jejunum, Ileum, colon, anus, rectum
213
What is the term for complete bowel obstruction?
Atresia
214
What is the term for incomplete bowel obstruction?
Stenosis
215
What are the cardinal signs of intestinal obstruction in a neonate?
```
History of maternal polyhydramnios
Feeding intolerance
Bilious emesis
Delayed passage of meconium
Failure to pass transitional stools
Abdominal distention
```
216
What factor causes mortality in pediatric gastroentritis?
Dehydration
217
What are the two mechanisms responsible for acute gastroentritis?
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
218
What are the primary functions of doing a history and examination in a pediatric gastroentritis patient?
To exclude other causes of vomiting and diarrhoea, to assess the extent of dehydration
219
What are the symptoms of pediatric gastroentritis?
Diarrhoea, vomiting, urination, abdo pain, signs of infection, weightloss, reduced feeding, reduced alertness, increased malaise, lethargy, irritability
220
What does frequent, watery diarrhoea suggest?
Viral gastroentritis
221
What does diarrhoea with blood or mucus suggest?
Bacterial gastroentritis
222
What does diarrhoea > 14days suggest?
Parasitic or non -infectious causes of diarrhoea
223
If symptoms of vomiting predominate diarrhoea, what does this suggest?
GORD, diabetic etoacidosis, pyloric stenosis, acute abdomen, UTI
224
What does pain that precedes vomiting and diarrhoea suggest?
Abdominal pathology rather than gastroentritis
225
What are the signs of infection in pediatric patients?
Fever, chills, myalgia, rash, rhinorrhea, sore throat, cough, immunocompromise
226
What does absence of tears when crying suggest?
Dehydration
227
What does dry mucus membranes suggest?
Dehydration
228
What does deep acidotic breathing suggest>
Dehydration
229
What does abdominal tenderness, guarding and rebound suggest?
Something other than gastroentritis
230
What does slow return of abdominal pinch suggest?
Dehydration
231
Wjat does a doughy feel to the skin suggest?
Hypernatremia
232
What does jaundice suggest?
Hepatitis
233
What is the most common viral pathogen that causes gastroentritis?
Rotavirus
234
What is the most common bacterial pathogen that causes gastroentritis?
Campylobacter, salmonella, shigella, ecoli
235
What is the most common parasitic pathogen that causes gastroentritis?
Giardia and cryptosporidium
236
What tests should be done on pediatric patients with dehydration?
Baseline electrolytes, bicarbonate, urea and creatinine values
237
What are the signs and symptoms of dehydration?
Restless, irritable, sunken eyes, thirsty, drinks eagerly, skin pinch retracts slowly, lethargic or unconscious, not being able to drink or drinking poorly
238
What tests can be done in a patient with paediatric gastroenritis>
Baseline electrolytes, bicarbonate, urea and creatinine values, fecal leukocytes and stool culture, stool analyisis for C.difficile, ova and parasites, FBC and blood cultures
239
How is dehydration treated?
Oral rehydration solution
240
What are the complications of Crohn's in children?
Growth failure, malnutrition, pubertal delay, bone demineralization, anaemia, jaundice, arthritis, arthralgia
241
What are the signs and symptoms of crohn's disease of the small intestine in children?
Intestinal malabsorption, abdo pain, growth deceleration, weight loss, anorexia
242
What are the signs and symptoms of Colonic crohn's disease in children?
Bloody mucopurulent diarrhoea, cramping abdo pain, urgency to defecate
243
What are the signs and symptoms of crohn's disease of the perianus in children?
simple skin tags, fissures, abscesses, fistulae, painful defacation, bright red rectal bleeding, perirectal pain, erythema or discharge
244
What are the most common skin presentations of Crohn's?
Erythema nodosum, pyoderma gangrenosum
245
What tests can be done to investigate a child with Crohn's?
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
246
What imaging studies can be done with query IBD?
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
247
What medication is used to treat children withIBD?
5-aminosalicylic acid, anti biotics, nutritional therapy
Corticosteroid and methotrexate
Infliximab or adalimumab
Surgery if all these medications fail
248
What are the indications for surgery in IBD?
```
Intractable disease with growth failure
Obstruction or severe stenosis
Abscess requiring drainage
Perianal fistulae
Intractable hemorrhage
Perforation
```
249
What is ulcerative colitis>
An inflamatory bowel disease characterized by the remitting and relapsing inflammation of the large intestine
250
What are the complications of ulcerative colitis?
Toxic megacolon, colonic malignancy
251
What are the extraintestinal manifestation of ulcerative colitis in children?
Erthroderma nodosum, pyoderma gangrenosum, uveitis, episcleritis, ant. uveitis, arthrits, hepatobiliary disease, thromboembolic disease
252
What are the signs and symptoms of children with UC?
Rectal bleeding, diarrhoea, abdo pain, urge to defecate, hypoalbuminaemia, fever, weightloss, cramps, abdo tenderness, anorexia, anaemia, leukocytosis, delayed growth, guarding, splenomegalu
253
What is pediatric hypertrophic pyloric stenosis>
Functional obstruction of gastric outlet, due to hypertrophy and hyperplasia of muscular layers of the pyloris
254
What are the signs and symptoms of pyloric stenosis in infants?
Intitially infrequent non billous vomiting that progresses to projectile vomiting, slight hematemesis, hunger,
255
What is the typical presenting age for pyloric stenosis?
4-8 weeks of age
256
When should the pyloris be palpable n pyloric stenosis?
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)
257
What diagnostic tests can be used for pyloric stenosis?
Serum electrolytes to measure effectiveness of fluid resus, US, barium upper GI, endoscopy
258
What is the diagnostic criteria for pyloric stenosis with US?
Muscle wall thickness 3 mm or greater and pyloric channel length 14 mm or greater are considered abnormal in infants younger than 30 days
259
When should a barium upper GI be used to investigate pyloric stenosis?
When US is not diagnostic
260
WHat signs can be seen in a baium upper GI that indicate pyloric stenosis?
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
261
When should an endoscopy be used to investigate pyloric stenosis?
Patient with atypicalsigns
262
How should pyloric stenosis be managed?
Fluid management, pyloromyotomy
263
What are the signs and symptoms of pediatric head trauma?
Scalp injury, skull fracture, concussion, contusion, intracranial and or subarch. haemorrhage, epidural and/or subdural haematoma, intraventricular haemorrhage, penetrating injury, diffuse axonal injury
264
What are the possible cpmplications in pediatric patients with head trauma>
Cerebral oedema, growth retardation, resp. failure, herniation due to raised ICP
265
What tests should be used to investigate a child with head trauma?
FBC, blood chemistries, coagulation profile, type and crossmatch, ABG, U and E
266
What imaging should be used to investigate a child with head trauma?
CT, MRI and US for neonates with open fontanelles
267
How are patients with head trauma approached?
ABGs
268
What surgical therapy can be used on a patient with head trauma
Surgical decompression, craniotomy, surgical drainage, surgical debridement and evacuation, surgical elevation, decompressive craniotomy with duraplasty
269
What medications can be used on a child with head trauma?
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)
270
What are the signs and symptoms of a basilar skull fracture?
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
271
What are the signs and symptoms of a contusion?
Progressive beurological deterioration secondary to local cerebral oedema, infarcts or late-developing harmatoma
272
What are contusions?
Areas of bruising or tearing of the brain tissue, caused by direct head injury
273
What is a concussion?
Transient alteration of consciousness due to head trauma
274
What are the signs and symptoms of a epidural haematoma in children?
Classic lucid interval between initial LOS and subsequent deterioration. When neurological deterioration starts, hemiparesis, unconsciousness, posturing,and pupillary changes. Compression of brainstem
275
What are the signs and symptoms of a subdural haematoa in children?
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
What is the most common cause for a failure to thrive?
Inadequate intake
277
What are the non-organic causes for failure to thrive in a infant due to Inadequate intake?
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
What are the organic causes for failure to thrive in a infant due to Inadequate intake?
Impaired suck/swallow, chronic illness leading to anemia
279
What are the causes for failure to thrive in a infant due to impaired suck/swallow?
Cleft palate, oro-mottor dysfunction, cerebral palsy, neurological disorders
280
What are the causes for failure to thrive in a infant due to anorexia from chronic disease?
Crohn's, chronic renal failure, liver disease, CF
281
What are the causes for failure to thrive in a infant due to inadequate retention?
Vomiting, severe GORD
282
What are the causes for failure to thrive in a infant due to malabsorption?
CF, latose intolerance, coeliac's, short gut syndrome, post- necrotising enterocolitis, cholesstatic liver disease
283
What are the causes for failure to thrive in a infant due to failure to utilise nutrients?
Chromosolam (down's), intrauterine growth restriction, extreme prematurity, congenital infection, metabolic disorders (congenital hypothyroidism, storage disorders, amino acid and organic acid disorders)
284
What are the causes for failure to thrive in a infant due to increased requirements?
Thyrotoxicosis, CF, malignancy, congenital heart disease, chronic renal failure, chronic infection (HIV) immuno deficiency
285
What tests can be used to investigate a failure to thrive and why?
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
What are the signs and symptoms of failure to thrive?
Dysmorphic features, malabsorption (distended abdomen, thin buttocks, misery), signs of HF, signs of resp disease (clubbing, chest deformity)
287
How can obesity be assessed in children?
Weight charts (overweight is BMI>91st centile, obese is BMI>98th centile)
288
What are the complications of obesity in children?
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
What are the endogenous causes of obesity?
hypothyroidism, cushing's prader willi
290
What is the management of obesity?
Healthier eating, increased exercise, reduced activity free periods
291
What is coeliac disease?
Inflammtory response to a part of gluten that causes progressive shortening of intestinal villi
292
What is the typical presentation of coeliac disease>
Profound malabsorption at 8-24 months, failure to thrive, abdo distension, buttock wastingm abnormal stools, general irritability, anaemia,
293
What is coeliac disease associated with?
T1DM, autoimmune thyroid disease, down's
294
What screening test is diagnostic for coeliac's?
IgA transglutimaminase antibodies and endomysial antibodies
295
How is coeliac disease managed?
No gluten
296
Mutation of what gene causes CF?
Cystic fibrosis transmembrane conductance requlator
297
What does the CFTR gene do
cAMP dependent chloride channel
298
What is the pathophysiology of CF?
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
What is the life expectancy for a newborn with CF?
40 years
300
What are the clinical features of CF in infancy?
Meconium ileus in newborn period, prolonged neonatal jaundice, failure to thrive, recurrent chest infections, malabsorption, steatorrhea
301
What are the clinical features of CF in a young child?
Bronchiectasis, rectal prolapse, nasal polyp, sinusitis
302
What are the clinical features of CF in an older or adolescent child?
Allergic bronchopulmonary aspergillosis, sterility in males, DM, intestinal obstruction, pneumothorax, recurrent chest infections, cirrhosis, portal hypertension
303
What are the signs and symptoms of CF?
Persistent loose cough, hyperinflation of chest, coarse inspiratory crackles, expiratory wheeze, purulent sputum, finger clubbing
304
What is the gold standard for diagnosis in CF?
elevated chloride in sweat test
305
What screening test is used for CF?
immunoreactive trypsinogen, from heel prick test
306
How is CF managed?
Regular antibiotics, pancreatic replacement therapy, treatetment for DM
307
What is congenital adrenal hyperplasia?
A number of recessive conditions that cause adrenoid enlargement
308
What is the most common enzyme defienciency caused by congenital adrenal hyperplasia
21 hydroxylase, needed for cortisol biosynthesis. Patients therefore can't produce aldosterone
309
What does aldosterone deficiency in congenital adrenal hyperplasia cause?
Salt loss -low sodium, high potassium
| Pituitary overcompensates by overproducing ACTH, increasing production og adrenal androgens
310
What is the typical presentation in females with congenital adrenal hyperplasia?
Virilisation of external genitalia-enlarged clitoris, sometimes the fusion of the labia
311
WHat is the typical presentation of a male with congenital adrenal hyperplasia?
Enlarged penis, darkening of scrotum
312
WHat is the typical presentation of a salt loser with congenital adrenal hyperplasia?
salt losing adrenal crisis
313
What is a salt losing adrenal crisis?
occurs at 1-3 weeks of age, presenting with vomitting, weightloss, circulatory collapse and floppiness
314
What is the typical presentation of non-salt losers with congenital adrenal hyperplasia?
Tall stature in males,
| muscular build, precocious pubarche, adult body colour, pubic hair, acne in males and females
315
What is the classic presentation of allergic rhinitis?
coryza, conjunctivitis, cough variant rhinitis post nose drip, chronically blocked nose causing impaired daytime behaviour, sleep disturbance amd cpmcemtration
316
What is allergic rhinitis associated with?
Eczema, sinusitis, adenoidal hypertrophy, asthma
317
What are the two types of allergic rhinitis?
atopic, nonatopic
318
What is the treatment of allergic rhinitis?
Second gen antihistamine (topically or systemically), tolpical nasal or eye corticosteroids, cromoglycate eye drops, leukotriene receptor antagonists, nasal decongestants, allergen immunotherapy
319
What are the signs of congenital hearing impairment?
Failure to acheive speech and language milestones
320
What are the causes o aquired hearing loss in thechildren?
In utero infection, hyperbilirubinaemia, bacterial meningitis, mechanical ventilation, ototoxic meds, low birth weight, otitis media, mumps, measles, head trauma
321
What in utero infections can cause hearingloss?
toxoplasmosis, rubella, cmv, herpes, syphilis (TORCHS)
322
WHat genetic conditions can cause hearing loss in children?
Waardenburg syndrome, branchio-oto-renal syndrome, otosclerosis, neurofibromatosis type 2, pagat's, Usher's, pendred
323
What lab tests can be done to investigate congenital hearing impairment?
Molecular testing, FBC, U and E, creatinine, TFT, urinalysis, autoimmune profile, specific IgM for TORCH, CT, MRI, auditory brainstem response, audiometry, otoacoustic emissions
324
What treatments are available for congenital hearing impairment?
Treating any middle ear disease, hearing amplification, assistive learning devices, cochlear implant
325
What are the organic causes of constipation?
Hypothyroidism, hypercalcaemia, urinary concentrating defect, Hirschsprung's disease
326
What are the organic causes of constipation?
Withholding, toilettraining issues, changes in diet, changes in routine, medications, lactose intolerance, family history
327
What are the complications of constipation?
Anal fissures, rectal prolapse, faecal impaction
328
What is mild constipation defined as?
Faeces is not palpable per abdomen
329
How is mild constipation treated in children?
Stool softeners, stimulant laxatives
330
How is severe constipation in children treated?
Evacuation of rectum, 1-2 weeks of faecal softeners, large doses of oral laxatives, oral macrogol solution
331
After what age is faecal soiling abnormal?
4
332
What can be caused by faecal soiling?
Faecal retention
333
What must be done for faecal retention?
rectum emptying
334
What is the definition of low birth weight in children?
Below 10th percentile
335
What are the types of growth restriction that cause babies to be small for dates?
Assymetrical and symmetrical
336
What is asymmetrical growth restriction?
Weight or abdominal circumfrence lies on a lower percentile than head
337
What does asymmetrical groth retardation suggest?
Placenta fails to provide adequate nutrition late in the pregnancy. Brain is spared at expense of liver glycogen and skin fat
338
What are the causes of asymmetrical growth retardation?
Pre-eclampsia, multiple pregnancy, maternal smoking, idiopathic
339
What is the typical outcome for asymmetric growth retardation?
Baby rapidly puts on weight after birth
340
What is symmetrical growth restriction?
Head circumfrence is also reduced
341
What does symmetrical growth retardation suggest?
Prolonged period of poor uterine growth, or wrong uterine age
342
What are the causes of symmetrical growth retardation?
Normal, fetal chromosomal disorder, congenital infection, alcohol abuse, chronic medical condition or malnutrition
343
What is the typical outcome for symmetric growth retardation
Baby might remain small permanently
344
What type of growth restriction is more common?
Asymmetric
345
What are the complications of intrauterine growth restriction?
Intrauterine hypoxia, death, asphyxia during labour and delivery, hypothermia (relatively large surface area), hypoglycaemia (due to poor liver stores), hypocalcaemia, polycythaemia
346
What is recurrent abdominal pain?
A childhood pain that can disrupt activities and lasts for at least 3 months
347
Where is the pain felt in recurrent abdominal pain typically?
Periumbilical
348
What are the other symptoms of recurrent abdo pain?
NONE
349
What is the common cause for recurrent abdo pain?
strss, which causes altered bowel motility that children percieve as pain
350
What are the possible GI causes of recurrent abdopain?
IBS, constipation, IBD, malrotatation, dyspepsia, gastroentritis, abdominal migraine, peptic or gastric ulceration
351
What are the gynaeclogical vauses of recurrent abdo pain?
Dysmenorrhea, ovarian cysts, pelvic inflammatory disease?
352
What are the hepatic or pancreatic causes of recurrent abdo pain?
Hepatitis, gallstones, pancreatitis
353
What are the urinary causes of recurrent abdo pain?
UTI, ,pelvi ureteric junction obstruction
354
What symptoms suggest an organic cause of recurrent abdo pain?
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
how is recurrent abdo pain investigated?
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
Whatis the long term prognosis of recurrent abdo pain?
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
Describe a tension headache
Symmetrical headache of gradual onset, described as tightness, band or pressure,
358
What are the causes of a tension headache?
Stress and/or anxiety
Poor posture
Depression
359
What management is used for a tension headache?
NSAIDS (ibuprofen, naprozen, tramadol, indomethacin, ketaprofen), aspirin, Paracetomol, barbiturites,Ergot alkaloids
360
What are the complications of tension headaches?
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
Causes of respiratory distress in children?
Asthma, anaphylaxis, foreign body, infections, tension pneumothorax, congenital heart problems, pericarditis
362
Which typically presents with a higher temperature, pneumonia or bronchiolitis?
Pneumonia
363
What are the three main presentations in respiratory symptoms in children?
Cough, wheeze, stridor
364
What can cause stridors?
Croup, epiglottitis, inhaled foreign body
365
What can cause cough in children?
URTI, pneumonia, asthma, inhaled foreign body, pertussis, CF
366
What can cause a wheeze in children?
Asthma, bronchiolitis, viral induced, foreign body
367
All UTI <1 yr must be
followed up with USS, DMRCA
368
What is the age of onset of croup?
6-24 months
369
What is another name of croup?
Acute laryngotracheobronchitis
370
What does croup start with?
Corzyal prodrome
371
When does the croup usually happen?
middle of the night
372
What is the age of onest of epiglottitis?
2-7 years
373
Why shouldn't you stick something down an epiglottitis case?
Can cause airway closure
374
What does epiglottitis usually present with?
Toxicity, high fever, onset overhours, drooling, reluctant to peak, slight or absent cough, cherry red epiglottitis
375
What is the commonest cause of epiglottitis,
HiB
376
What is the age of onset of foreign bodies?
2-5 years
377
What is the age of onset of laryngomalacia?
newborn
378
What is the presentation of laryngomalacia?
Presents at birth and persists, worse on crying, gets better with age
379
How can baby's with whooping cough present?
apnea
380
What is the typical age of onset of pertussis?
babies, pre immunization
381
How is stridor managed?
Don't examine the throat, contact anaethetist, reduce anxiety, observe for hypoxia, administer adrenaline neb i
382
What is the presentation of whooping cough?
Low grade fever, paroxysmal or spasmoidic cough, followed by inspiratory whoop, worse at night, persists for months
383
How is whooping cough investigated?
Nasal swab for pertussis
384
What is the purpuse of antibiotics in whooping cough
control the spread
385
What is a wheeze caused by?
Bronchospasm, expiratory sound caused by partial obstruction of lower airways, inflmmatory process caused by allergym infection, foreign body, mucus oversensitisationW
386
How long does whooping cough last?
hundred days
387
Where in expiration is a mild wheeze heard?
End
388
What is the age of onset of bronchiolitis?
0-18 months
389
What are the red flags for respiratory illness?
Clubbing, recurrent infection, persistent tachypnea, failure to grow or gain weight, restriction of activity
390
What is the emergency treatment for croup?
Adrenaline neb
391
Does controlling temperature prevent febrile convulsions?
No
392
How is fever in children managed?
Monitor for signs of dehydration and petechial rash, paracetomol and ibuprofen in children with temp >38 who are distressed and unwell
393
What are the causes of fever?
Meningitis, UTI, sepsis, Gastroentritis, tonsilitis, otitis media, RTI, septic arthritis, pneumonia,
394
What are the signs of meningitis in babies?
Crying, distressed, lifeless, bulging fontanelle, poor appetitie, fever
395
What are the investigations involved into UTI
MCUG, DMSA, USS
396
What are the treatment goals of investigations into UTI?
Treat infection, prevent scarring, prevent recurrence
397
What is impetigo?
Localized, contagious, staph or strep skin infection
398
Who is the classic patient of impetigo?
Infants and young children
399
Where is impetigo likely to appear?
On pre-existing skin disease, face, neck and hands
400
What does impetigo look like?
Erythematous macules that may become vsicular/pustular or even bullous
401
What does rupture of impetigo pustules cause?
confluent honey colourd vesicles
402
How does impetigo spread to other parts of the skin?
autoinoculation of infected exudate
403
How is mild impetigo treated?
Topical antibiotics
404
How is severe impetigo treated?
broad spectrum antibiotics
405
What is a febrile seizure>
Seizure accompanied by a fever in the absence of intracranial infection due to bacterial meningitis or viral meningitis
406
What are the types of febrile seizures in children?
Simple and complex
407
What are the complications of simple febrile seizures?
None
408
What are the complications of complex febrile seizures?
4-12% risk of developing epilepsy
409
What does a febrile seizure look like?
A brief, tonic-clonic seizure with a rapid rise in temp
410
What is an important differential of febrile seizures that must betreated immediately?
Bacterial meningitis
411
What percentage of migraines occur without an aura?
90
412
What is the typical description of a migraine inchildren?
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
What are the preminotary symptoms of a migraine?
Tiredness, difficulty concentrating, autonomic symptoms
414
What are the common features of a visual aura
Hemianopia,scotoma, fortification spectra
415
What is a scotoma?
Small area of vision loss
416
What is a fortification spectra
Seeingzigzag lines
417
What are uncommon forms ofheadaches?
Familial, basilar type, spordiac, hemiplegic migraine, periodic syndromes (cyclical vomiting, abdominal migraine, BPV)
418
What are familial migraines linked to?
Calcium channel defect, dominantly inherited
419
What are the signs of a basilar type migraine?
Vomiting, nystagmus and cerebellar signs
420
What is a cyclicalvomiting migraine?
Recurrent, stereotyped epsode of vomiting and intense nausea, associated with pallor and lethargy. Child is well inbetween
421
What is an abdominal migraine?
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
What signs suggest a headache caused by raised ICP diue to a space occupying lesion?
Cranial bruits, papillodeama, torticollis, abnormal gait, new onset squint, facial nerve palsy, visual field defects, growth failure
423
What are the red flags in a headache history?
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
What are the types of brain tumours seen in children?
Brainstem glioma, craniopharyngioma, astrocytoma, ependymoma, medulloblastoma
425
What is a highly malignant astrocytoma called?
Glioblastoma multiforme
426
Where does a medulloblastoma arise?
Midline of post. fossa
427
How does a medullablastoma seed?
through CNS via CSF. Spinal metastasis are common
428
Where does an ependymoma arise?
Posterior fossa, behaves like medulloblastoma
429
What is the most common brain tumour in children?
Astrocytoma
430
What does excess protein due to overfeeding cause?
Azotaemia, hypertonic dehydration, hyperammonaemia and metabolic acidosis
431
What does excess carbs due to overfeeding cause?
Hyperglycaemia, hypercapnia, fatty liver
432
What does excess fats due to overfeeding cause?
Hyperlipidaemia and fat overload syndrome
433
What are the mechanical complications of overfeeding?
Intolerance of nasogastric volume, osmotic diarrhoea,
434
What is autistic spectrum disorders defined as?
Children who fail to acquire normal social and commnications skills
435
Is autistism more prevalent in boys or girls
Boys
436
What is the typical presentation age of autistic spectum disorders?
2-4, when language and social skills normally rapidly expand
437
What are the three main features of autistic spectum disorders?
Impaired social interaction, imposition of routine with ritualistic or repetitive behaviour, speech and language disorders
438
What are the signs of an impaired social interation
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
What are the signs of speech and language disorders in children?
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
Whatare the signs of repetitive behaviour?
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
What are the co morbidities of autism spectrum disorders?
General learning problems, epilepsy (presents in adolescene), ADHD
442
What is GORD?
Involuntary passage of gastric contents into the oesophagis
443
In who is GORD really common?
<1 yr
444
When does GORD usually resolve
Aft 12 months of age
445
What causes GORD?
Inappropriate relaxation of LOS due to functional immaturity
446
What are the contributing factors of GORD?
Short oesophagus, mostly liquid diet, mainly horizontal posture
447
What are the symptoms of GORD?
Vomiting
448
What are the complications of GORD?
Failure to thrive, oesophagitis, recurrent pulmonry aspiration, dystonic neck posture, apparent life threatening events
449
In who is severe GORD more common in?
Children with cerebral palsy or other neurological conditions, preterm babies, following surgery for oesophageal atresia
450
How is GORD investigated?
24 hr pH monitoring to quantify degree of acid reflux, 24 hr impedance monitoring, endoscopy to exclude other causes
451
How is mild GORD treated?
Parenta reassurance, thickening agents, positioning in a 30 degree head up position after feeding
452
How is severe GORD treated?
Acid supression, surgery is only for kids with complications
453
What acid suppression is used to treat GORD?
H2 receptor antagonists, PPI
454
What is the most common cause of respiratory distress in term babies?
Transient tachypnea or the newborn
455
What causes transient tachypnea of the newborn?
Delay in reabsorbtion og lung liquid
456
What increases the risk of transient tachypnea of the newborn?
C-section
457
What can a chest xray show in the trnsient tachypnea of newborns?
fluid in the horizontal fissure
458
What management is necesscary for transient tachypnea of the newborn?
Additional ambient oxygen
459
How long does transient tachypnea of the newborn take to settle?
usually in the 1st day of life, but can take a few days
460
What are the signs of respiratory distress in newborns?
expiratory grunting, tachypnea, cyanosis, chest recessions, work of breathing, nasal flaring
461
What type of chest recession is considered troubling?
Sternal and subcostal
462
What are the less common causes of respiratory distress in newborns?
Meconium aspirationm milk aspiration, respiratory distress syndrome, pneumothorax, persistent pulmonary hypertension of the newborn, pneumonia
463
What are the rare causes of respiratorydistress in the newborn?
Pulmonary haemorrhage, diaphragmatic hernai,airway obstruction, pulmonary hypoplasia, trachio-oesophageal fistula
464
What are the non pulmonary causes of respratory dstress in the newborn?
Congenital HD, severe anaemia, metabolic acidosis, intracranial birth trauma / encephalopathy
465
When is meconium aspirationmost common?
With increasing geestational age
466
When is meconium passed before birth?
In response to fetal hypoxia
467
How does meconium cause aspiration?
The aspirated meconium acts as mechanical obstruction and causes a chemical pneumonitis, and predisposes to increased infection
468
What are the complications of meconium aspiration?
Over inflated lungs, air leaks, pneumothorax, pneumomediastinum, persistent pulmonary hypertension
469
How is meconium aspiration usually managed?
Artificial ventilation
470
What is worrying about maternal autoimmune thrombocytopenic purpura?
Maternal IgG crosses placenta to damage fetal platelets
471
What does maternal autoimmune thrombocytopenic purpura cause?
Fetal thrombocytopenia
472
What are the complications of fetal thrombocytopenia?
Intracranial haemorrhage post st birth trauma
473
What are the signs of autoimmune thrombocytic purpura?
Thrombocytopenia, petechia at birth
474
How is thrombocytopenia in infants treated?
IV immunoglobin, platelet transfusion
475
What is cerebral paslsy?
Abnormal movement and posture causing activity limitation due to non-progressive disturbances occuring in the fetal or infant brain
476
What is the most common cause of motor problems in children?
Cerebral palsy
477
Is the lesion in cerebral palsy progressive or non progressive?
Non progressive
478
If the lesion in cerebral pasly in non preogressive, why do symptoms emerge over time?
They reflect cerebral maturation, as in, deficits are only identifiable at certain developmental stages
479
What is the most common cause of cerebral palsy?
Antenatal
480
What are the antenatal causes of cerebral palsy?
Vascular occlusion, cortical migration disorders, structural maldevelopmenet of the brain, genetic syndromes, congential infections
481
What are the postnatal causes of cerebral palsy?
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
What are the early symptoms of cerebral palsy?
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
What are the subtypes of cerebral palsy?
Spastic, ataxic, dyskinetic
484
What is the most common subtype of cerebral palsy?
Spastic
485
Where does the damage occur in spastic cerebral palsy?
Upper motor neurone (pyramidal or corticospinal tract)
486
WHat are the symptoms associated with spastic cerebral palsy?
Increased tone, brisk reflexes, faster the muscle is tretched the greater the resistence
487
What are the three types of spastic cerebral palsy?
Hemiplagia quadraplegia, diplegia
488
hat are the signs of hemiplagic spastic cerebral palsy?
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
When does hemiplagic spastic cerebral palsy usually present?
4-12 months
490
What are the signs of a quadraplegic spastic cerebral palsy?
All four limbs are affected, oft severely, trunk is involved, tendency to opisothonos, poor head control, low central tone,seizure, microencephaly, intellectual impairment
491
What is opisothonos?
Extensor posturing
492
WHat are the signs of a diplegic spastic cerebral palsy?
All four limbs are affected, but legs more than arms, walking is abnormal, functional use of hands is difficult
493
What are diplegic spastic cerebral palsy associated with?
Preterm babies ue to periventricular brain damage
494
What are the signs of a dyskinetic cerebral palsy?
Chorea, athetosism dystonia, impaired intellect floppiness, poor trunk co-ordination, delayed motor development, primitive reflexes dominate
495
What causes the signs in dyskinetic cerebral palsy?
Danage to basal ganglia or extra pyramidal pathways
496
What are the causes of dyskinetic cerebral palsy?
Hyperbilirubinaemia, hypoxic ischaemic encephalopathy of the newborn
497
What are the signs of ataxic cerebral encephalopathy?
Early trunk and limb hypotonia, poor balance, delayed mtor development. Ataxic gait, incordinated movements, intention tremor
498
Whaere do lesions cause ataxic cerebral palsy?
Cerebellum or connections
499
What is the most common cause of ataxic cerebral palsy?
Genetic disorders
500
What is an exanthem?
Widespread rash accompanied by fever malaise and headache.
501
What causes an exanthem?
Reaction to toxin produced byorganism or damage to skin by organism, or immune response
502
What are exanthems usually caused by?
Viruses
503
What are the more common causes of childhood exanthems?
Chicken pox, measles, rubella, roseola, parvovirus b19
504
What are the less common viral causes of exanthems?
HIV, small pox, viral hepatitis, EBV, herpes virus 6 and 7, papular acroderatitis, eythema multiforme
505
What are the bacterial causes of exanthems?
Staph toxin (sepsis, Staph. scalded skin syndrome), Step. toxin 9scarlet fever, toxic shock), kawaski disease
506
What are the signs and symptoms of exanthems?
Non-specific rash widespread more extensive on trunk than extremities, fever, malaise headache anorexia, abdo pain, irritability, myalgia
507
What are the signs and symptoms of chicken pox?
Itchy red papules progressing to vesicles on stomach back and face, then spreading elsewhere. Headache, high fever, cold-lik symptoms, vomiting and diarrhoea
508
What is the treatment of chicken pox?
Trim fingernails, warm bath, moisturising cream, paracetomol, calamine lotion, oral antihistamines, oral acyclovir
509
What are the signs and symptoms of measles?
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
What is the incubation period of measles?
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
What is the prodrome period of measles
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
What are the rash stages of measles?
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
What is the treatment of measles?
Paracetomol, fluid, humidifier, nutritional support
514
What are the complications of measles?
Fatal diarrhoea, apendicitis, hepatitis, pancreatitis, ulceration, deafness, laryngobronchitis, croup, pneumoonia, myro carditis, pericarditis, conjunctivitis, glomerunephritis, renal failure, subacute sclerosisng panencephalitis
515
What are the signs and symptoms of rubella?
Rash, swollen glands and fever
516
What is rosela's signs and symptoms?
High fever, URTI, irritability, redness, rose pink rash that blanch, halo of pale skin around spot
517
What s parvovirus b19?
Slapped cheek syndrome
518
What is the most common autosomal trisomy?
Down's
519
What is the mosy common genetic cause of learning disorders?
Downs
520
What causes down's?
trisomy 21
521
What are the typical craniofacialappearance of down's
Small mouth, small ears, protruding tongue, round face, upslanted palpebral fissures, flat occiput, third fontanelle, brushfield spots in iris, epicanthic folds
522
What are the non facial signs of down's?
Hirschsprung's disease, duodenal atresia, congenital heart problems, Small neck, single palmar crease, sandal like appearance of the foot, hypotonia
523
What are the complications associated with Down's?
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
How is down's tested?
Fluorescent in situ hybridisation
525
What percentage of Down's survive past 1 yr?
85%
526
Wht are the three causes of trisomy 21?
Meiotic non-dysjunction, translocation, mosaicism
527
What is the most common cause of trisomy 21?
Meitic non-dysjunction
528
What are the causes of jaundice in infants less than 1 day?
Rhesus incompatibility, ABO incompatibility, G6PD deficiency, sperocytosis, pyruvate kinase deficency
529
What are the causes of jaundice from 24 hours to 2 weeks of age?
Congenital disorders, physiological jaundice, breast milk jaundice, Hemolyisis, bruising, polycythaemia, crigler-najjar syndrome
530
What are the causes of unconjugated jaundice in infants older than 2 weeks?
Physiological, breast milk, infection, hypothyroidism, hemolytic anaemia, high gastic obstuction
531
What are the causes of conjugated jaundice in infants older than 2 weeks?
Bile duct obstruction, neonatal hepatitis
532
What causes physiological jaundice?
Bilirubin rising from infanting adapting to the transition from fetal life
533
What causes breast milk jaundice?
Increased enterohepatic circulation of bilirubin
534
How should neonates with signs of respiratory distress be investigated?
CXR, monitoring of HR, RR, O2 and circulation
535
How should infants with respiratory distress be treated?
Circulatory support, mechanical ventilation, ambient o2 as needed, treatment of cause
536
What causes the haemolytic disease of the newborn?
Immune problem due to antibodies destroying RBCs
537
What are the antibodies produced in the haemolytic anaemia of the newbornn?
Anti-D, anti A or anti B, anti-kell
538
How do the antibodies form in haemolytic anaemia of the newborn?
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
How is the haemolytic anaemia of the newborn tested?
Positive direct anti-globulin test
540
What is Edward's syndrome?
Trisomy 18
541
What is Patau's?
Trisomy 13
542
What is turner's syndrome?
45X
543
What usually happens to fetueses with 45X?
Early miscarriage
544
What are the clinical features of edwards?
Low birth weight, prominent occiput, flexed, overlapping fingers, short sternum, small mouth and chin, rocker-bottom feet, cardiac and renal malformations
545
What are the clinical features of patuau's?
Structural defect of brain, scalp defects, small eyes, eye defects, cleft palate, polydactyly, cardiac and renal malformations
546
What are the clinical features of turner's?
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
What is klinefelter's syndrome?
47xxy
548
List 10 autosomal dominant disorders?
Tuberous clerosis, otosclerosis, huntington's, marfans, osteogenesis imperfecta, achondroplasia, neurofibromatosis, ehlors-danlos, myotonic dystrophy, noonan's
549
list 10 autosomal recessive disorders
Thalassemia, CF, oculocutaneous albinsm, wednig-hoffman, tay-sach's, sickle cell, phenylketonuria, glycogen storage dirorders, hurler's friedrich's ataxia, congenital adrenal hyperplasia
550
What is the definition of birth asphyxia?
Critical reduction in O2 delivery to fetus antenatally, during labour or delivery that produces a lactic acidosis and render poor condition atbirth.
551
What does birth asphyxia cause?
Hypoxic ischaemic encephalopathy
552
What test can be done for birth asphyxia?
Fetal cardiotocography, fetal blood or cord blood analysis
553
What is the definition of hypoxic ischaemic encephalopathy?
Clinical manifestation of brain injury u to 48 hours after asphyxia, whether antenatal intrapartum or post partum
554
What are the three grades of hypoxic ischaemic encephalopathy?
Mild, moderate and severe
555
What is mild hypoxic ischaeic encephalopathy?
Infant is irritable, responds excessively to stimulation, staring, hyperventilation and impaired feeding
556
What is moderate hypoxic ischaemic encephalopathy?
Marked abnormality of tone and movement, cannot feed, seizures
557
What is severe hypoxic ischaemic encephalopthy?
No dpontaneoud movements or response to pain, tone fluctuates between hypotonia and hypertonia, seizures are prolonged, multi-organ failure
558
How is hypoxic ischaemic encephalopathy treated?
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
What is the prognosis of hypoxic ischaemic encephalopathy?
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
What is the possible cause of attachement disorders?
Absence of adequate social and emotional caregiving in childhood
561
What are the signs and symptoms of attachment disorders?
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
What are the signs of attachetn disorders?
Signs of neglect, such as undernutrition, growth retardation, excessive appetitie, physical maltreatment
563
What re the complications of attachemnt disorders?
Cognetive and language delays, accademic difficulties, difficulties in social setting, stereotypies, pervasive anger and resentment, refusal to cooperate, defiant behaviour
564
What is the treatment of attachement disorders?
Correcting behaciour of primary caregivers
565
Who is affected by ADHD more?
Boys
566
What is the possible cause for ADHD?
Genetics and dysfunction of neurons that use dopamine as a receptor
567
What are the signs and symptoms of ADHD?
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
How ias ADHD treated?
Advice hon how to build concentration, self esteem , self occupation
569
What medications are used to treat ADHD?
Stimulants like dexphetamine, methylphenidate or datomexitine
570
How does ADHD medication work?
Reduces excessive motor activity, improves attention and focuses behaviour
571
What are the types of generalised seizures?
Absence, tonic, myoclonic, tonic-clonic, atonic
572
EHat are the types of focal seizures?
Frontal, temporal, occipital, parietal
573
What can be seen in a frontal seizure?
Motor or premotor cortex,jacksonian march, asymmetric tonic seizures
574
What is the most common type of focal seizures?
Temporal
575
What can be seen in a temporal seizure?
Strange warning or aura, w/ smell or taste abnormalities, lip smacking, plucking at clothing, deja vu, jamais vu
576
What can be seen in an occipital seizure?
Distortion of vision
577
What can be seen in a parietal lobe seizure?
Contralateral dysaesthesia, distorted body image
578
How are seizures investigated?
EE (24 hr), MRI, CT, metabolic investigatins
579
What is west syndrome?
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
What age does west syndrome present?
4-6 months
581
What is the complication of West syndrome?
Lerning disability, epilepsy
582
What is lenox-gastaut sundrome
mostly drop attackes, tonic seizures and atypical absences. Neurodevelopmental arrest and behaviour siorder
583
What is the age onset of lennox-gautaut?
1-3 yrs
584
What is the usual presentation age of chilhood absence epilepsy?
4-12 yrs
585
Are girls or boy more likely to get childhood absence epilepsy?
Girls
586
What can trigger absence seixures?
Hyperventilation
587
What is benign epilepsy with centrotemporal spikes?
Tonic clonic seizures in sleep,simple focal seizures w/ awareness of abnormal feelings in tongue and distontion of face
588
What is status epilepticus?
Seizure lasting 30min
589
What are the causes of congenital hypothyroidism?
Maldescent of thyroid and athyrosis, dyshormonogenesis, isodine deficiency, TSH deficiency
590
What are the symptoms of hypothyroidism in children?
Coldskin,dry skin, thin hair, constipation, failure to thrive, obeseity, learning difficulries, coarse facies, large tongue, prolonged jaundice, bradycardia short stature
591
What can cause parathyroid disorders in children?
Digeorge's, addisons
592
What are the features of adrenal cortical insufficency?
Hyponatremia, hyperkalaemia, vomiting, lethargy, hypo, dehydration, hypotension, circulatory collapse, brown pigmentation, growth failure
593
How is an adrenal crisis treated?
IV saline, glucose, hydrocortisone
594
What aew rh inborn errors of metabolsim?
Phenylketonuria, homocystinuria, tyrosinaemia, falactosaemia, glycogen storage disorders
595
How is self harm screened for?
Problems longer than a month, planned overdose/suicide for longer than 3 hours, alone in the house, hopelessness, sadness
596
What are the signs and symptoms of self-injury?
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
What are the forms of self harm?
Cutting, scratching, burning, carving words or symbols int skin, hitting or punching, piercing skin, pulling out hair, persistent picking/ interefering with wound healing
598
wHAT ARE THE CAUSES OF DAYTIME ENURESIS?
Ectopic ureter, neuropthic bladder, concdentrating on something else, detrusor instability, blader neck weakness, constipation, lack of attention to bladder sensation
599
By what age should children have urinary contro ?
3-5
600
What are the signs of a neuropathic bladder?
Distended bladder, abnormal perineal sensation,n, anal toneor reflexes and fait. Sensory loss of S2, S3, S4.
601
What can cause girls to be ry during the day but wet at night?
Ectopic ureter into vagina
602
How is daytime enuresis investigated?
Urine sample, microcopy, culture and sensitivity, if needed, US, MRI for spinal lesions
603
How can non neurological daytime enuresis be treated?
pelvic floor exercises, pad with alarm, anticholinergic / adrenergic drugs to reduce bladder contractions, ephedrine to increase tone at bladder neck
604
What are the nocturnal causes of enuresis?
UTI, faecal retention, polyuria due to diabetes (osmotic diuresis)
605
What is transient synovitis?
Irritable hip usually occuring eith or after a viral infection.
606
WHat is the typical age of presentation of transient synovitis?
2-12 years
607
What are the signs and symptoms of transient synovitis?
Sudden onset of pain with limp, no pain at rest, decreased rande of movement, pain refferred to the knee, child is afebrile
608
What are the blood test results that usually come from transient synovitis?
Neutrophil count raised, EESR may be raised
609
What is the differece betwen transient synovitis and septic arthritis of the hip?
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
What can transient synovitis be the presentaton for?
Perthes, slipper upper femoral epiphysis
611
What occurs in nephrotic syndrome?
Heavy proteinuria causing low plasma albumin and anaemia
612
What are the secondary causes of nephrotic syndrome?
Henoch-schonlein purpura, SLE, malaria, bee stings
613
What are the clinical signs of nephrotic syndorme?
Periorbital oedema (on waking), ascites, sccrotal, vulvula or leg oedema, breathlessness due to pleural effusion and abdo distension
614
What is the complication of nephrotic syndrome?
Renal failure, hypovolemia, thrombosis, pneumococcal infection, hypercholestrolaemia
615
What is the first sign of nephrotic syndrome?`
Periorbital oedemaW
616
What are the types of nephrotic syndromes?
Steroid sensitive, steroid resistant and congenital
617
Which is the most common type of nephrotic syndrome?
Steroid sensitive
618
Wat investigations are performed on patients with nephrotic syndrome?
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
What are the features of steroid sensitive nephrotic syndrome?
1-10 years of agem macroscopic haematuria, , complement and renal function normal
620
What is the management of steroid sensitive nephrotic syndrome?
Oral corticosteroids, renal biopsy of unresponsive
621
What are the types of physical abuse?
```
Bruising
Scalding/Burns
Bites
Fractures
Oral Injuries
Neurological Injuries
```
622
What is the commonest injury in physical abuse?
Bruising
623
How are accidental and non accidental bruises differntiated?
Accidental -splashes
| Non-accidental - Dipping
624
What are the common fracture sites due to abuse?
Ribs, femoral, metaphyseal fractures (tibia, usually bilateral and symettrical)
625
What is the commonest cause of fatal childabuse?
Shaken baby syndrome
626
What are the clinical indicators of shaken baby syndrome>
Apnoea, retinal haemorrhage, seizure, lethargy, irritability, poor feeding, vomiting, subdural haematoma
627
What are the signs of neglect?
```
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
What is Atopic dermatitis?
Chronic, pruritic, inflammatory skin disease of unknown arigin, associated with IgE
629
What is atopic dermatitis associated with?
Food allerfy, asthma, allergic rhinitis
630
What are the classic features of atopic dermatitis?
Pruritis, early onset, ecxema, atopy, xerosis
631
Describe a lesion of atopic dermatitis
Erythematous, lichenified and possibly exudative plaque. crusting is common
632
What are the causes of atopic dermatitis?
Genetics, infection, hygiene, food allergy, climate, tobacco
633
Name 5 possible differentials for atopic dermatitis
Allergic contact dermatitis, scabies, immunodeficiency, plaque psoriasis, zinc deficiency, tinea corporis, seborrheic dermatitis, impetigo
634
What is the treatment of atopic dermatitis?
Moisturizers topical steroids and immunomodulators if necessary
635
WHAT ARE THE CHARACTERISTICS OF HENOCH SCHLONLEIN PURPURA?
Charqacteristic skin rsh, arthralgia, periarticular oedema, adominal pain, glomerulonephritis
636
Who is the typical patient of henoch schonlein purpura?
3-10, male, in winter and fter a URTI
637
Describe the rash seen in henoch sconlein purpura
Symmetrical rash over buttocks, extensorso f legs and arms, starts of urticarial, turns maculopapular and into purpura. Palpable for weeks
638
What is the most common arthritis in children?
Reactive arthritis
639
What are the charecteristics of reactive arthritis?
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
What is the treatment for reactve arthritis in children?
None or NSAIDS
641
How can septic arthritis be caussed in children?
Haematogenous spread, puncture wound, infected joints, adjacent osteomyelitis spreading into joint vieal capsule inserts
642
What is the most common pathogen that causes septic arthritis in children?
Staph. A
643
What is the classical presentation of septic arthritis in children?
Acutely unwell, febrile, erythematous, warm, acutely tender joint, reduced movementlimp, psudoparalysis of limb as infants hold it super still
644
How is septic arthritis investigated in children?
SR, CRP, blood cultures, US of deep joints, X rays to exclude trauma
645
How is septic arthritis treated in children?
IV antibiotics, joint immobilisation, joint wsh out if necesscary
646
What are the most common congenital heart lesions?
Left to right shunts, right to left shunts, common mixing, outflow obstuction
647
What can cause right to left shunts in babies?
Tetralogy of fallot, transposition of great arteries
648
Whatcan cause left to right shunts in babies?
VSD, ASD, persistent arterial duct
649
What can cause cause outflow obstruction in neonates?
Pulonary stenosis, aortic stenosis, coarctation of aorta
650
What is the presentation of congenital HD?
Antenatal cardiac US diagnosis, cyanosis, shock, HF, murmur
651
What are the symptoms of HF in a neonate?
Breathlessness (on feeding or exertion), sweatinf, poor feeding, recurrent chest infections, cyanosis, tachycardia, tachypnoea, cardomegaly, hepatomegaly, col peripheries, murmur, poor growth
652
What are the signs of an ASD?
None, wheeze, recurrent chest infection, srrhytmias, ejection systolic murmur best heard and upper left sternal eddge, fixed and widely split secod heart sound
653
How are SDs investigated?
CXR, ECG, eho
654
How are septal defects treated?
Surgery, occlusion device
655
What are the clinical features of small VSDs?
A symp, pan systolic murmur at lower L. sternal edge quiet pulmonary second sound
656
WHat are the clinical features of large VSDs?
HF with breathlessness, recurrent chest infections, active precordium, tachycardia, tachypnea and hepatomegaly, apical mid diastolic murmur, soft pansystolic murmmur
657
What complications can be avoided by giving children with VSDs treatment?
Failure to thrive, permanent lung damage, HF
658
What are the clinical features of a petent ductus arteriosus?
Continuous murmur behind left clavicle, collapsing pulse
659
What fine motor development should be visible by 6 months?
Fixes and follows (6 weeks)
Reaches for objects
Palmar grasps (6 months)
Trunk control developing (sits with support by 6 months
660
What gross motor development should be visible by 6 months?
Develops head control
| Primitive reflexes
661
What speech development should be visible by 6 months?
babbling
662
What social development should be visible by 6 months?
Social smile, recognises faces
663
What gross motor development should be visible by 1 yr?
Sits without support (9 months)
Bum shuffle/Crawling *
Pull to stand Cruising First steps
664
What fine motor development should be visible by 1 yr?
Pincher grasp (9-10 months)
Object Permanency
Follows small objects
665
Whatspeech and hearing development should be visible by 1 yr?
Babbling, first words, hearing by distraction
666
What social development should be visible by 1 yr?
Stranger awareness developing
Understands simple commands
Uses objects appropriately (comb)
667
What are the red flags in terms of development from birth to a year?
```
Smile Absent Between 6 weeks
Persistent primitive reflexes > 6 months
Absent babbling > 6 months
Absent stranger anxiety > 7 months
Squinting past 8 weeks
```
668
What gross motor development should be visible by 18 months?
Walks well
Stops and retrieves objects
Climbing
669
What fine motor development should be visible by 18 months?
Tower 2-3 cubes
| Scribbles
670
What speech and hearing development should be visible by 18 months?
Speaks 6-12 words
Understands cup/siblings names
Echolalia
671
What social development should be visible by 18 months?
Uses spoon
Symbolic play
Indicates wants without crying
672
What gross motor development should be visible by 2 yr?
Kicks ball
| Climbs stairs 2 feet per step
673
What fine motor development should be visible by 2 yr?
Copies vertical line
| Tower 8 bricks
674
What speech and hearing development should be visible by 2 years
2-3 word sentences
Knows 5-6 body parts
Selects toys e.g. give me the cow
675
What social development should be visible by 2 yr?
Parallel play
Tantrums
Removes a garment
676
What are the red flags in terms of development from birth to 3 year?
```
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
Name one thing from each domain of development in a three to four year old
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
