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4th year medicine > child health > Flashcards

child health Flashcards

1
Q

viral - coryza symptoms, fever harsh stridor, barking cough usually presents middle of night normally clinically well age 6 months - 6 years coughing +++ acute onset rarely life threatening

A

croup presents middle of night when cortisol is at its lowest

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2
Q

bacterial soft stridor septic, toxic drooling can be any age (2-6yrs) absent cough 3-6 hrs onset classic tripod pose seriously life threatening

A

epiglotittis

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3
Q

bacterial (staph, strep. HIB) barking cough toxic, not drooling any age, mainly <6yrs croupy cough longer hx

A

bacterial tracheitis

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4
Q

epiglottitis - management

A
  • keep child calm - call for anaesthetic and ENT support - O2 - IM/ nebulised adrenaline - can be repeated after 5 mins/ adrenaline infusion if still symptoms - once have control of airway - salbutamol for breathing - dexamethasone oral - budesonide nebs (if can’t take oral dex) - abx: ceftriaxone - fluid resuscitation
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5
Q

stridor more obvious when crying few week hx peaks around 6-9 months epiglottis floppy over larynx gaining weight and afebrile

A

laryngomalacia

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6
Q

which fluid regime is best for full maintenance fluids

A

0.9% NaCl + 5% dextrose always need dextrose in fluids for children

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7
Q

fluid calculations for maintenance fluids

A

for children under 16: 0.9% NaCl + 5% dextrose (or plasmalytte +5% dextrose) - 100mls/kg/day for each of first 10kg - 50ml/kg/day for each of next 10kg - 20ml/kg/day for every further kg e.g. 24kg = (100x10) + (50 x 10) + (20x4)

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8
Q

fluid calculations for bolus fluid

A
  • 20ml/kg 0.9%NaCl in most situations (DKA + shock) - 10ml/kg when: for DKA, trauma, fluid overload, or heart failure
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9
Q

dehydration corrections calculations (and cheat formula)

A

usually over 24hrs MAINTENANCE FLUIDS PLUS %DEHYDRATION most of your body is water –> estimate % lost weigh the child if possible: 1kg weight loss = 1000ml lost estimate clinically if not possible: 3% dry lips 5% tachycardia 7% cap refill going 10% shock e.g. 3% weight loss in 20Kg child: 20kg = 20000g = 20000ml 1%= 200ml, therefore 3%= 600 ml CHEAT FORMULA: 10 x weight x %dehydration = correction

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10
Q

acute asthma/ viral acute wheeze management (4 steps)

A

burst step: 3-2-1 (at once) 1. salbutamol x3 (10 puffs each) 2. atrovent (ipatropium bromide) x 2 3. prednisone x 1 IV bolus step: after 1hr 1. MgSO4 (give over salbutamol if salbutamol toxicity) if not working after 10 mins then: 2. salbutamol 3. aminophylline - side effect of arrythmias - IV hydrocortisone if cannulated IV infusion step 1. aminophylline 2. salbutamol panic step 1. intubate and ventilate stretching out concept: once stable - start stretching out the salbutamol 1hr,2h,3hr,4hr (at 4hrly they can go home)

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11
Q

salbutamol toxicity

A

shivering vomiting high lactate

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12
Q

asthma prevention management (4 steps)

A
  1. very low dose inhaled steroid (or consider montelukast if <5) 2. very low dose inhaled steroid + LABA or montelukast if >5yrs montelukast if <5yrs 3. consider increasing steroid dose or add LABA/montelukast if not already on if <5, needs referral 4. REFERRAL consider theophylline salbutamol inhaler as required consider stepping up when needing 3x per week or waking once per week
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13
Q

shock not able to feel peripheral pulses (femoral) normal glucose, no indication for infection

A

co-arctation of the aorta

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14
Q

most likely causes for baby collapse

A
  1. sepsis 2. congenital heart disease- collapsing on day 3 - duct dependent lesion 3. metabolic
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15
Q

congenital heart disease - right atria?

A

cyanosis - tricuspid atresia - Epstein’s anomaly

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16
Q

tetralogy of fallot

A
  1. VSD 2. overriding aorta 3. right outflow tract obstruction (pushing over outflow tract causing right outflow tract obstruction) 4. right ventricular hypertrophy (right ventricle having to work harder so hypertrophy)
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17
Q

congenital disease - right ventricle

A

cyanosis pulmonary stenosis pulmonary atresia Fallot’s

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18
Q

congenital disease - mixed

A

VSD eisenmengers

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19
Q

congenital heart disease - left atria

A

in shock mild stenosis/ atresia

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20
Q

transposition of great arteries

A

transposition of the great arteries - two separate circuits if you have a duct or VSD with transposition can survive mixing between left to right and right to left not responding to O2 can get worse after 24hrs after birth when the duct closes

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21
Q

congenital heart disease - left ventricle

A

hypoplastic left heart coarctation (can present even if screening is normal) interrupted arch aortic stenosis

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22
Q

timing of presentation for congenital heart disease

A

first few hrs: - pulmonary /aortic atresia/ critical stenosis - hypo plastic heart syndrome first few days: - transposition, tetralogy, large PDA in premature infants - coarctation first few weeks: - aortic stenosis -co-arctation first few months: - any left to right shunt as pulmonary resistance falls e.g. VSD

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23
Q

management of duct dependent lesions

A

prostin IV infusion (prostaglandin E2)

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24
Q

wheeze and crepitations bilaterally in < 1 yrs

A

bronchiolitis almost exclusively under 1yrs viral infection premature babies more often affected RSV URTI, followed by cough peaks at day 5, lasts for 10-14days

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25
Q

bronchiolitis investigations

A

nasopharyngeal aspirate

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26
Q

bronchiolitis management

A

SUPPORTIVE TREATMENT nasal cannulae O2 and NG tube for feeds second line: CPAP, IV fluids third line: salbutamol doesn’t work under 1yrs so doesn’t work for bronchiolitis

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27
Q

wheeze >1yr

A

viral induced wheeze multi-trigger wheeze (viral, exertion, cold air) more likely to have asthma later on after 1yr – B receptors so can respond to salbutamol same management as asthma

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28
Q

wheeze >5yrs

A

asthma can only be diagnosed over 5yrs - show reversibility usually grown out of VIW over 5

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29
Q

sepsis management <1month

A
  • admit - start IV amoxicillincillin (under 1 month - covers listeria) and ceftriaxone - full septic screen incl lumbar puncture (everyone gets LP <1month) - start maintenance fluids
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30
Q

foot and mouth disease - what virus?

A

coxackie virus

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31
Q

hand foot and mouth disease presentation

A

blanching papular rash - palms and soles, face, nappy area fever tonic-clonic seizure

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32
Q

macular

A

flat to skin erythematous skin think measles

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33
Q

maculopapular

A

bobles background of erythematous skin

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34
Q

vesicles

A

raised fluid filled herpes - varicella, zoster, simplex

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35
Q

non-blanching rash

A

petechial purpuric - meningococcal sepsis/DIC - ITP - idiopathic thrombocytopaenic Purpura - low platelets - HSP - Henoch-Schonlein Purpura - ?leukaemia

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36
Q

NON-BLANCHING rash developed over 24hrs rash on BUTTOCKS AND DOWN LEGS* blood in urinalysis* runny nose and mild cough tummy pain joint pain otherwise well and bloods normal

A

henoch- Schonlein purpurn multi-system vasculitis blood in urinalysis: develop glomerular nephritis –> blood in urine

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37
Q

croup management

A

supportive treatment - oral dexamethasone 0.1/kg - taken immediately regardless of severity

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38
Q

bacterial tracheitis - management

A

80% need intubation ceftriaxone + flucoxacillin

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39
Q

laryngomalacia management

A

management: anti-reflux, no treatment needed if gaining weight

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40
Q

8-month old crying inconsolably vomiting recurrent jelly like diarrhoea * diagnosis?

A

intussusception

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41
Q

bilious vomiting (green)

A

volvulus obstruction below level of ampulla

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42
Q

4 yrs 2hrs * abdo pain unilateral swollen and tender testis * fever diagnosis and most appropriate management

A

testicular torsion at two hrs still salvageable –> EMERGENCY SURGERY ultrasound in children insensitive appendicitis would develop over a day or so

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43
Q

12 yr old girl sharp abdo pain 12hrs most important investigation?

A

pregnancy test rule out ectopic think about pregnancy from ~10yrs

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44
Q

causes of acute abdo pain <1yrs

A

pyloric stenosis intussusception obstruction

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45
Q

4-6wks old milky projectile vomiting non bilious hungry after vomiting hyperc diagnosis?

A

pyloric stenosis

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46
Q

causes of acute abdo pain 1-4yrs

A

intussusception (appendicitis)

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47
Q

pyloric stenosis management

A

investigation: ultrasound hypokalemic hypochloremic metabolic alkalosis - correct potassium correct chloride high bicarb - correct rehydration

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48
Q

non-organic pathology - recurrent abdominal pain

A

change of school periumbilical pain changes to home pain associated with headache

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49
Q

causes of acute abdo pain 5-11yrs

A

intussusception appendicitis testicular torsion

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50
Q

causes of acute abdo pain 12yrs +

A

appendicitis testicular torsion/ectopic pregnancy

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51
Q

8yrs old 12hr diffuse abdo pain vomiting background 2 weeks of polyuria and weight loss glucose + ketones in urine diagnosis and management

A

DKA diagnosis: - diabetic - blood glucose >11 - ketones –> metabolic acidosis - acidosis management: - most important: refer for urgent admission under medical team - resus fluids - give insulin to turn off acidosis and correct glucose - VTE prophylaxis - electrolyte monitoring - education about diabetes

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52
Q

henoch-Schonlein purpura investigations and management

A

investigations: - urine dipstick - blood pressure - assessment for fluid overload and nephrosis to detect signs of renal impairment (develop glomerular nephritis (blood in urine) management: - usually self limiting - immunosupression - steroids

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53
Q

recurrent UTI

A

recurrent: - 2 or more upper tract - 1 upper and 1 or more lower tract - 3 or more lower tract

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54
Q

atypical UTI

A
  • poor urine flow - abdominal/bladder mass - rise in creatinine - sepsis - unresponsive - non E.coli UTI
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55
Q

atypical UTI investigations

A

<6 months - ultrasound during infection - DMSA within 4-6 months - MCUG 6months-3yrs: - USS during infection - DMSA 4-6months >3yrs: USS during infection

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56
Q

simple UTI investigations

A

simple UTI: responds to Tx within 48hrs < 6 months - USS within 6 weeks - if abnormal: MCUG 6months- 3yrs: - none >3yrs none

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57
Q

recurrent UTI investigations

A

< 6months: - USS during infection - DMSA 4-6 months - MCUG 6months-3yrs: - USS 6 weeks - DMSA 4-6months >3yrs: - USS 6 weeks DMSA 4-6 months given to all ages with recurrent UTI

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58
Q

DMSA VCUG

A

DMSA: radioactive isotope - shows longer damage - to detect renal parenchymal defect VCUG: fluoroscopy, diagnosis of vesicoureteral reflux (urine up from bladder to kidneys)

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59
Q

space occupying lesion red flags

A

signs of raised ICP - early morning headache and vomiting - worsening headaches over time - changes in personality/ behaviour - papilloedema - seizure

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60
Q

headaches with aura unilateral throbbing

A

migraine

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61
Q

previously well fever tonic-clonic seizure blood sugar normal diagnosis and management

A

febrile seizure (normally resolve at 5 mins) management: - 0 mins: O2, BM, IV access - 5mins: benzo (midazolam, diazepam) (IV/IO/buccal/PR) - 15mins: benzo (IV/IO) - 25mins: phenytoin IV - 45mins: anaesthesia if no IV access: buccal midazolam/ rectal diazepam

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62
Q

24hr hx limp no hx trauma preceding viral illness limited internal rotation of hip*

A

transient synovitis investigations: - normal WCC - normal ESR - normal x-ray - USS: fluid in joint management: - rest - analgesia

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63
Q

24hr hx limp no hx trauma preceding viral illness limited internal rotation of hip* diagnosis, investigations and management

A

transient synovitis investigations: - normal WCC - normal ESR - normal x-ray - USS: fluid in joint management: - rest - analgesia

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64
Q

fever and limp fever, unwell erythematous and tender with effusion unwilling to weight bare hip held flexed diagnosis and investigations

A

septic arthritis investigations: - URGENT bloods - blood culture - ESR raised WCC normal/high USS: fluid in joint x-ray: normal/ widened joint space management: - joint aspiration - IV abx - analgesia, rest

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65
Q

developmental dysplasia of the hip

A

age 1-4yrs suspect if limp

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66
Q

developmental dysplasia of the hip …..

A

age 1-4yrs suspect if limp …

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67
Q

perches disease …..

A

age 5-10 incideous onset pain + limp leg length discrepancies diagnosis on plain X-ray and MRI

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68
Q

slipped upper femoral epiphysis - SUFE …..

A

10-15yrs displacement of femoral epiphyseal head plain radiography surgical fixation

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69
Q

18months bottom shuffling unable to walk crawled at 10 months other development normal

A

bottom shuffling alternative to walking - delays walking discharge arranging for further review in 6 months if still not walking at 2yrs then arrange further assessment

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70
Q

developmental milestones: smiling sitting words walking

A

smiling: 6 weeks sitting: 6/7 months few words: 1 yr walking: 1 yr

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71
Q

pale

A

anaemic/ shocked

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72
Q

pale and jaundiced

A

haemolytic anaemia

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73
Q

drooling

A

epiglottitis

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74
Q

recently moved from abroad and don’t have red book. what vaccinations are they missing? and what screening?

A

unimmunised: measles/ epiglottitis/ meningitis no Guthrie screening: thyroid, PKU, cystic fibrosis

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75
Q

mum has a new boyfriend

A

child abuse

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76
Q

unsupervised

A

foreign body aspiration wasn’t there to see it be inhaled

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77
Q

6 or more days of fever

A

Kawasaki disease

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78
Q

mum unable to let go of your hand

A

myotonic dystrophy hereditary so mum may have it too

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79
Q

rash with amoxicillin

A

Epstein barr virus

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80
Q

irritability

A

meningitis

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81
Q

white spots inside of cheek

A

measles (Koplick spots)

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82
Q

fat teenager limping

A

slipped upper femoral epiphysis SUFE

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83
Q

gower’s sign positive (struggling to stand up and having to walk up their legs)

A

Duchenne’s

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84
Q

egg on side appearance on heart

A

Transposition of great arteries

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85
Q

heart appears boot shaped on CXR

A

tetralogy of fallout

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86
Q

double buble AXR

A

duodenal atresia

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87
Q

confusion/ hallucinating

A

encephalitis/opathy

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88
Q

barking cough

A

croup

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89
Q

birthday party

A

anaphylaxis - eg to peanut butter sandwhich parent wasn’t there to tell them they can’t have it

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90
Q

back arching in neonate

A

reflux

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91
Q

boy unwell but sister unaffected

A

x-linked condition?

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92
Q

causes of stertor (snoring noise)

A
  • tonsilitis - retropharyngeal abscess - decreased consciousness
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93
Q

causes of stridor (inspiratory)

A
  • anaphylaxis - croup - epiglottitis - foreign body - diphtheria - laryngomalacia - subglottic stenosis (after extended intubation)
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94
Q
  • web at back of throat - ball neck - inflammation which can be seen from outside the neck - stridor - abroad
A

diphtheria

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95
Q

causes of wheeze

A

asthma viral induced wheeze bronchiolitis pneumonia

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96
Q

5yrs stop and stares 20-30 times a day for the past month can last btwn 5-15secs can happen even when she is actively playing diagnosis and investigations

A

absence seizures EEG - expected to show 3Hz generalised spike-and-wave pattern on EEG

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97
Q

septic screen in <3 months old

A
  • bloods: FBC, lactate - blood culture - urinalysis - LUMBAR PUNCTURE - IV ABX - fluids - O2 if needed
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98
Q
  • generalised tonic - clonic seizure - brief (1-2 mins) - viral infection - 6months - 3yrs diagnosis
A

febrile convulsion

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99
Q

slapped cheeks rash: virus?

A

parovirus B19

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100
Q

roseola: virus?

A

HHV6

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101
Q

purpuric rash with fever and weight loss for a month diagnosis?

A

leukaemia

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102
Q

average age of menarche in the UK

A

13yrs

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103
Q

sexual precocity before what age in girls and boys

A

girls: before 8 boys: before 9

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104
Q

what staging system measures breast, pubic hair and genital development

A

tanner staging

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105
Q

what stage of breast development is at the peak height velocity for girls

A

breast stage 2-3 (early)

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106
Q

what stage of testes development is at the peak height velocity for boys

A

12-15ml testes (late) (stage 3/4)

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107
Q

calculation for mid parental height for boy and girl

A

mothers height plus fathers height in cm divide by 2 - then add 7cm for boy - then minus 7cm for girl

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108
Q

target parental range calculation

A

to mid parental height: +/- 10cm for boys +/- 8.5cm for girls

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109
Q

factors affecting height

A
  • familial short stature - intrauterine growth retardation - constitutional delay in growth and puberty (commonest reason) - later developers - familial
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110
Q

delayed puberty can be diagnosed at what age

A

absence of puberty by: - 14yrs for girls - 15yrs for boys

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111
Q

commonest cause of delayed puberty

A

constitutional delay

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112
Q

management for constitutional delay

A

girls: oestradiol boys: - testosterone injection for 4 months once a month

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113
Q
  • hypogonadotrophic hypogonadism (low gonadotrophs - LH & FSH) - absence of smell - doesn’t respond to testosterone diagnosis
A

Kallmans syndrome

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114
Q
  • hypergonadotrophic hypogonadism - doesnt respond to testosterone - XXY chromosomes
A

Kleinfelters syndrome

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115
Q

what is hypogonadotrophic hypogonadism

A

low gonadotrophs - LH & FSH

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116
Q

what is Hypergonadotrophic hypogonadism

A
  • testes not responding to gonadotrophs - leads to +ve feedback on pituitary gland which produces excess gonadotrophs to try compensate
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117
Q

investigations for short stature

A
  • record birth weight - record both parental final heights - measure height velocity - if poor: - FBC (iron deficiency anaemia, macro cystic anaemia), U&Es, TFTs (hypothyroidism), coeliac scan - karyotype in alll girls (turners syndrome - XO)
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118
Q

central precocious puberty how to diagnose

A
  • onset of breast development before 8yrs - onset of testicular development (vol >4ml) before 9yrs - due to early activation of HPG axis
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119
Q

most common cause of central precocious puberty in boys and girls

A

girls 90% idiopathic boys - 75% structural CNS abnormality -> craniofaringioma - excess FSH & LH –> testes growth –> precocious puberty

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120
Q

pseudo- precocious puberty what is it and causes

A

showing secondary sexual characteristics but not from testes (from adrenal gland) causes sex steroids from adrenal: - congenital adrenal hyperplasia - adrenal tumour - premature adrenarche - cushings syndrome sex steroids from gonad: - ovarian tumour, cyst - McCune-Albright syndrome - testotoxicosis - HCG - secreting tumours

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121
Q

congenital adrenal hyperplasia most common deficiency disorder?

A

21-hydroxylase deficiency

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122
Q

congenital adrenal hyperplasia what is it

A
  • autosomal recessive disorder - pituitary picks up that not making cortisol - however the only thing that can be made is male androgens at the cost of aldosterone - EXCESSIVE ANDROGEN AND ALDOSTERONE DEFICIENCY
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123
Q

diagnosis of CAH

A

raised levels of 17 alpha

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124
Q

girl presentation of CAH

A

girls: - clitoromegaly - fused labia majora - bones more ossified - initially tall then short

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125
Q

boy presentation of CAH

A
  • classically with SALT LOSING CRISIS at 6 weeks (low Na, high K (low aldosterone –> low Na + high K), acidosis, low glucose, and shocked) vomiting, weight loss and circulatory collapse
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126
Q

management of salt losing crisis in baby with CAH

A

IV hydrocortisone STAT

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127
Q

simple virilising CAH

A

excessive growth and precocious puberty with no aldosterone deficiency

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128
Q
  • bitemporal hemianopia - increased growth with no other signs of increased androgen - acromegalic symptoms
A

cerebral gigantism impinging on optic nerve gives bitemporal hemianopia

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129
Q
  • webbed neck - shield chest - nipples pointing outward - left heart lesions - bicuspid aortic valve - kidney abnormalities - intellectual development delay - gain weight and lose height
A

turners syndrome XO

horseshoe kidney

hypothyroidism

gonadotrophins elevated

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130
Q

investigation management of turners syndrome

A
  • test with carrier type: XO - oestrogen replacement therapy for life - ovaries don’t develop - ovarian failure - growth hormone - epithelial dysplasia –> growth hormone replacement
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131
Q
  • off feeds - prolonged jaundice - constipation - coarse voice - coarse facies - large tongue - hoarse cry diagnosis
A

congenital hypothyroidism

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132
Q

how is congenital hypothyroidism normally picked up

A

screening on day 5 - Guthrie test (heel prick) (high TSH, low T4) will not pick up central hypothyroidism (low TSH)

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133
Q

most common cause of congenital hypothyroidism

A

maternal iodine deficiency

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134
Q

levels of TFTs for hashimotos thyroiditis

A

low T4 high TSH positive thyroid peroxidase antibodies

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135
Q
  • more common in Down’s & turners children - more common in females - goitre is common - classical features of growth failure and delayed bone age - underperformance at school
A

acquired hypothyroidism

136
Q

if goitre what investigation should be done

A

USS goitre as well as TFTs

137
Q

management of hypothyroidism

A

levothyroxine

138
Q

hyperthyroidism and graves disease diagnosis TFTs

A

high T4 low TSH USS if goitre graves: autoantibodies against TSH receptor

139
Q

management for hyperthyroidism

A
  • carbimazole - beta-blockers for acute symptom relief - surgery or radioiodine
140
Q
  • postural hypotension - increased pigmentation of skin and mucosa (ACTH build up) - hypoglycaemia - changes in body hair distribution diagnosis
A

Addison’s disease

141
Q

adrenal crisis:

A

vomiting dehydration shock hypoglycaemia vascular collapse (low BP) renal shut down low Na high K

142
Q

investigations for Addison’s disease

A

U&Es synacthen test cortisol measurement

143
Q

management for Addison’s disease

A

IV hydrocortisone saline glucose in acute adrenal crisis

144
Q

management of type 2 diabetes

A

weight loss metformin

145
Q

management for type 1 diabetes

A

MDI - short acting insulin for meals - insulin pump therapy continuous glucose sensors - aim to maintain glycerinated haemoglobin <48

146
Q

familial tall stature

A

excentuated tall genes - tall women tend to marry tall men no treatment

147
Q

atopy triad

A

asthma eczema allergic rhinitis (hay fever)

148
Q

how to diagnose asthma

A

spirometry gold standard - test with salbutamol

149
Q

management of chronic asthma under 5s

A
  • SABA - inhaled corticosteroid (budesonide, beclometasone) or/and leukotriene (monteleukast) - refer
150
Q

chronic asthma management - 5-12yrs

A
  • SABA - inhaled corticosteroid (200-400mcg) - LABA (salmeterol) - max dose ICS (800mcg) - theophylline + referral - oral corticosteroids + referral
151
Q

acute asthma staging: mild, moderate, severe and life threatening

A

mild: PERF>75%, SaO2>92% moderate: PERF>50%, SaO2>92% severe: PERF<50%, SaO2<92% heart rate: >125 (>5yrs), >140 (1-5yrs) RR: >30 (>5yr), >40 (1-5) life threatening: PERF <33% SaO2 <92%, cyanosed, tachycardia, hypotensive, exhaustion, silent chest

152
Q

management for acute asthma - dependent on mild, moderate, severe and life threatening

A

O2 face mask mild-moderate: - SABA - if improving 30-40mg oral prednisolone - discharge with 3 days steroids, review inhalers and technique severe: - neb salbutamol (5mg) - neb terbutaline (10mg) (SABA) - oral prednisolone 30-40mg (IV hydrocortisone alt) - consider admission life threatening: - ABG - CXR - PICU - IV salbutamol bolus - IV hydrocortisone 100mg

153
Q

wheeze triggered by coryzal illness fever common in first 2-3yrs diagnosis

A

viral induced wheeze

154
Q

what virus causes croup

A

parainfluenza virus

155
Q

management for croup

A

oral dexamethasone (or prednisolone) if severe: neb adrenaline and O2

156
Q

most common autosomal recessive mutation in cystic fibrosis

A

F508

157
Q

infant poor weight gain steatorrhoea (bulky and pale) recurrent chest infections pancreatic insufficiency prolonged jaundice diagnosis

A

cystic fibrosis

158
Q

diagnostic tests for cystic fibrosis

A
  • Guthrie tet - at 5days - sweat test ([Cl-]>60) - genetic testing
159
Q

management for cystic fibrosis

A

medical: - mucolytics: neb hypertonic saline/ DNase - ivacaftor/lumacaftor microbiology: - abx prophylaxis - H.influenza, s.aureus, p.aeruginosa physiology: - chest & exercise physio dietician: - signs of diabetes - croon supplements for pancreatic dysfunction - high calorie diets surgical: - lung or liver transplant

160
Q

what bacteria causes epiglottitis and therefore what is used to prevent it

A

haemophilus influenza haemophilus influenza vaccine

161
Q

management for epiglottitis

A

ceftriaxone rifampicin for household contacts fluids

162
Q

investigations for laryngomalacia

A

barium/ contrast swallow - check for inhaled foreign body - vascular ring - pushing into oesophagus

163
Q

moro reflex and when is it present?

A

head extension causes abduction followed by adduction of arms present from birth to around 3-4 months

164
Q

grasp reflex and when is it present?

A

flexion of fingers when object placed in palm present from birth to around 4-5months

165
Q

which virus causes respiratory syncytial virus

A

bronchiolitis

166
Q

test for bronchiolitis

A

nasopharyngeal aspirate for RSV PCR

167
Q

management for bronchiolitis

A

hydration nutrition analgesia O2

168
Q

coryza symptoms fever dry cough course crackles in one area on respiratory exam CXR - local consolidation diagnosis?

A

pneumonia

169
Q

bacteria and viruses causing community acquired pneumonia <3wks 3wks - 3mnths 4mnths - 5yrs 5yrs - adolescence

A

<3wks: - bacteria: e.coli, GBS, L.monocytogenes (maternal transmission) 3wks - 3mnths: - bacteria: chlamydia trachomatis (maternal transmission - also have sticky eye (conjunctivitis) that doesn’t go away with topical abx - give macrolides), s.pneumoniae - virus: adeno, influenza, parainfluenza, RSV 4mnths - 5yrs: - c.pneumoniae, m.pneumoniae, s.pneumoniae, H.influenza virus: same 5yrs - adolescence bacteria: same as above

170
Q

CAP management

A

amoxicillin alternatives: co-amoxiclav, erythromycin, azithromycin, clarithromycin second line: macrolide if no response to first line - used if mycoplasma or chlamydia pneumonia pneumonia associated with influenza: co-amoxiclav

171
Q

from underdeveloped country/ recently visited few week hx anorexia, weight loss, dry cough diagnosis?

A

tuberculosis

172
Q

investigations for tuberculosis

A
  • CXR, CT thorax - tuberculin/ Mantoux skin test - interferon -gamma release assay
173
Q

vaccine for tuberculosis

A

BCG vaccine

174
Q

difference between hydrocele and hernia and how to distinguish

A

hydrocele is fluid when the gap is too small to allow the loop of gut through. hernia is when the gap is bigger so allows gut to pass through hydrocele: - slow to fill, slow to empty - due to small channel (small in morning and gets bigger throughout day) - can get above the swelling - it transilluminates

175
Q

what side are inguinal hernias more common on and which type of inguinal hernia is more common in children/adults

A

R:L 3:1 more common in males indirect hernias more common in children direct hernias more common in adults

176
Q

inguinal hernia management

A

herniotomy prems: within 2 wks infants: within 1 month child: elective incarcerated hernias which have been reduced: same admission Incarcerated and unable to reduce: emergency repair

177
Q

investigation for hydrocele

A

transillumination

178
Q

when should testes have fully descended by?

A

continue to descend with first couple months should have descended by 1st yr

179
Q

complications of undescended testes

A
  • infertility - tumours (less likely to feel abnormalities) - torsion - cosmetic
180
Q

management for UNILATERAL undescended testes

A
  • palpable - orchidopexy (surgery to move testicle) - impalpable - laparoscopy - first line orchidopexy staged procedure
181
Q

management for BILATERAL undescended testes

A
  • palpable - orchidopexy - impalpable IS IT A BOY? - genetic testing laparoscopy orchidopexy microvascular transplant
182
Q

umbilical hernia when are they common in childhood management

A

usually few weeks after birth most get better by themselves if complicate –> surgery

183
Q

non- bilious projectile vomits after every feed hungry baby 2-8 weeks of age

A

hypertrophic pyloric stenosis - gastric outlet obstruction

184
Q

investigations for hypertrophic pyloric stenosis

A

gold standard - USS - clinical exam (to feel stenosis), test feed - blood gas: metabolic hypochloraemic alkalosis (as throwing up gastric acid)

185
Q

management for hypertrophic pyloric stenosis

A
  • rehydration, NG tube, correct electrolyte abnormalities - Ramstedt pyloromyotomy - splitting muscle - can be done laparoscopically
186
Q

what is the blood gas result in pyloric stenosis

A

metabolic hypochloraemic alkalosis

187
Q

what is a test feed

A

test for pyloric stenosis pass NG tube examine from left feed/put air down watch for visible peristalsis feel for tumour

188
Q

what is physiological phimosis

A

tight foreskin unable to retract foreskin very common in babies (should be able to retract by puberty) not an indication for circumcision

189
Q

how to distinguish between pathological phimosis and a normal physiological phimosis

A

pull foreskin back and seeing inner mucosa everting out with no scar tissue - physiological phimosis

190
Q

irretractable foreskin urine spraying when urinating the foreskin balloons

A

phimosis

191
Q

definite indications for circumcision

A
  • pathological phimosis - BXO - Balantis Xerotica Obliterans - inflammatory –> scarring of foreskin that it can’t be retracted
192
Q

relative indications for circumcision

A
  • single kidney and recurrent UTI - recurrent balanoposthitis - infection of foreskin and glands - paraphimosis - when you pull back the foreskin and it can’t go back forwards if left long enough due to oedema (ring constriction) - trauma - viral warts
193
Q

what is BXO

A
  • bzalantis xerotica obliterans - inflammatory –> scarring of foreskin that it can’t be retracted - can cause urinary retention if left untreated as scar tissue can completely cover the penis tip
194
Q

from what age can you get BXO

A

does not occur before 5yrs

195
Q

differentials for pain in scrotum and management

A
  • torsion of hydatid of Morgagni - most common - testicular torsion - epididymo-orchitis - idiopathic scrotal oedema - incarcerated hernia management: - scrotal exploration procedure if testicular torsion likely or if any doubt of diagnosis
196
Q

unilateral acute pain in scrotum oedema erythema black dot beneath skin on pressing that point it is the most tender spot

A

Hydatid of Morgagni – appendix testes - sits by epidemics - can twist on itself and become ischaemic and necroses and fall off – presents in same way as testicular torsion - can see a black dot beneath the skin and if you press it and that is the most tender spot then can confirm diagnosis

197
Q

treatment for Hydatid of Morgagni

A

analgesia - pain should go in 1 to 2 days

198
Q
  • unilateral acute sudden onset testicular pain - oedema - erythema - one testicle higher than the other - absent cremasteric reflex - testes with abnormal orientation diagnosis?
A

testicular torsion cremasteric reflex - rub inside of thigh and see if cremasteric muscles contracting

199
Q

oedema, erythema on scrotum - erythema extends beyond scrotum diagnosis and treatment

A

idiopathic scrotal oedema doesn’t need any treatment, will go away in a few days

200
Q

differentials for child with bilious vomiting

A

malrotation and volvulus intussusception

201
Q

what does malrotation of the gut increase the risk of

A

volvulus

202
Q

what causes primary idiopathic intussuception

A

secondary to lymphoid hyperplasia of Peyers Patches in terminal ileum following a viral infection

203
Q

colicky abdo pain abdo mass vomiting distension red current jelly stool dehydration SHOCK diagnosis?

A

intussusception

204
Q

investigations for intussusception

A
  • clinical examination - sausage-shaped right hypochondrium and emptiness in right lower quadrant (Dance’s sign) - USS - diagnostic – transverse - TARGET sign – longitudinal - tubular mass if still in any doubt - contrast enema
205
Q

management of intussusception

A

resus (before air enema) - IV fluids - NG tube - Abx pneumatic reduction (air enema- pump air into anus to push intussusception back into place)

206
Q

contraindications to pneumatic reduction in intussusception? alternative management?

A

contraindications: - peritonitis - shock - perforation - known pathological lead point NEVER IGNORE BILE STAINED VOMITING - SURGICAL EMERGENCY until proven otherwise (acute perforation - put needles into abdo to relieve pressure) if contraindication then go straight to theatre - surgical reduction: manual reduction necrotic or perforation -> resection

207
Q

three most common childhood cancers

A

leukaemia brain & spinal lymphoma

208
Q

what cancers are you predisposed to with downs syndrome which cancer does it help with

A

more likely to get leukaemias less likely to get brain tumours

209
Q

which cells does acute lymphoblastic leukaemia (85% of acute leukaemia) affect?

A

B cell 85% T cell 15%

210
Q

fever off food swollen glands - cervical LYMPHADENOPATHY no improvement with abx new BRUISES not wanting to walk - BONE PAIN examination: - SPLENOMEGALY - HEPATOMEGALY - PETECHIAL RASH diagnosis?

A

acute lymphoblastic leukaemia (ALL) petechial rash - reduced platelet count –> haemorrhage –> DIC

211
Q

investigations and management for ALL

A

investigations: - microscopy management: - chemotherapy - 99% cure rate - long term side effects of treatment

212
Q

B symptoms: - fever - night sweats - weight loss - unexplained persistent supraclavicular lymphadenopathy - non tender, firm, growing mediastinal involvement - 60% axillary nodes palpable diagnosis?

A

Hodgkins disease (lymphoma)

213
Q

management of Hodgkins lymphoma

A
  • radiotherapy
214
Q

side effects of radiotherapy

A
  • thyroid disease – hypothyroidism - 30% – hyperthyroidism - 5% - heart disease - growth - great tissue - increased breast cancer - screen at 30 instead of 40
215
Q
  • cough and wheeze - orthopnoea - no hx asthma - SWOLLEN FACE - reduced appetite, weight loss diagnosis?
A

high grade non-hodgkins lymphoma - T cell SVC obstruction by lymph nodes –> can’t get fluid out of head –> significant oedema

216
Q

management for high-grade non-hodgkins lymphoma

A

steroids

217
Q

investigation for high-grade non-hodgkins lymphoma

A

CXR - MEDIASTINAL wide - swollen lymph nodes in mediastinal region LYMPHOMA UNTIL PROVEN OTHERWISE

218
Q

intussusception above 2/3yrs diagnosis?

A

LYMPHOMA (NON-HODGKINS B cell) UNTIL PROVEN OTHERWISE head, neck, abdo

219
Q

most common malignant CNS tumour

A

medulloblastoma - brain tumour

220
Q

2 wk hx vomiting: early morning no diarrhoea headaches: worse in morning clumsy: poor coordination, avoiding activities examination: - truncal ataxia (like drunk) - diplopia - double vision - lateral gaze paresis - papilloedema diagnosis?

A

brain tumour - medulloblastoma - most common type typical age: 7-10yrs

221
Q

investigations for medulloblastoma

A

CT head - mass - transependymal oedema - sign of raised pressure (typically very anterior)

222
Q

types of medulloblastoma in order of prognosis

A

WNT - wingless good prognosis (leaky blood brain barrier so chemo gets in) SHH - sonic hedgehog childhood prognosis better than adults Group 4 Group 3 worst prognosis

223
Q
  • back pain - - extremity weakness - sensory dysfunction - bowel/bladder dysfunction
A

spinal cord tumour back pain uncommon in healthy children EMERGENCY

224
Q

investigations for spinal cord tumour

A

MRI

225
Q

presentation of CNS tumours - infants

A
  • MACROCEPHALY - failure to thrive - lethargy - vomiting - head tilt - tumour in foramen magnum - development - delay or regression
226
Q
  • constipation/ diarrhoea - fever - off legs/ screams when changing nappy - painful examination: - DISTENDED ABDO - MASS - wasted limbs - elevated BP - PANDA EYES diagnosis? and differential?
A

neuroblastoma differential: non-accidental injury

227
Q

investigations for neuroblastoma

A

MRI - mass with section going posteriorly - can lead to cord compression USS LDH/ uric acid check BP urine catecholamines AFP/B HCG

228
Q

management of neuroblastoma

A
  • CHEMOTHERAPY - high dose intensity every 10 days - then SURGICAL reduction - then high dose CHEMO (all at same time) and STEM CELL RESCUE (bone marrow transplant) - then RADIOTHERAPY - then DIFFERENTIATION therapy and IMMUNOTHERAPY
229
Q

well distended abdomen haematuria HTN non-tender unilateral abdo mass diagnosis and differentials

A

Wilms tumour tumour tends to take up all free space differentials: UTI nephritis

230
Q

longstanding knee pain tender tibia regular analgesia unable to sleep - PAIN AT NIGHT examination: tender tibial tuberosity restricted knee flexion swelling proximal tibia diagnosis

A

bone tumours - osteosarcoma, Ewings sarcoma

231
Q

investigations for bone tumour

A
  • X-ray - MRI - significant soft tissue madd around tumour, lots of blood vessels coming out into mass - bone scan - can see primary lesion due to high turnover of bone - CXR - CT chest - mets in chest - bloods
232
Q

what kind of tumour comes from mesenchymal cells with characteristics of striated muscle - worse prognosis in legs as can grow large before being seen - good prognosis in vagina - less mets

A

rhabdomyosarcoma

233
Q

management for rhabdomyosarcoma

A

brachytherapy - high dose radiotherapy for localised target action

234
Q
  • well child - non-articular and poorly localised (shins, calves, backs of knees) - bilateral - intermittent with pain free intervals - normal Gait - occur late in day/ night - normal clinical examination diagnosis?
A

growing Pains can’t say its growing pains if associated with swelling or specific point tenderness

235
Q

exaggerated response to pain

A

chronic regional pain syndrome

236
Q
  • prior to 16yrs - persisting for at least 6 weeks - arthralgia: pain in joint - arthritis: swelling, tenderness, limited range of motion - enthesitis: inflammation at insertion of tendon, ligament, joint capsule diagnosis
A

juvenile idiopathic arthritis long term joint damage

237
Q

which genetics are associated with juvenile idiopathic arthritis

A

HLA (e.g. HLA B27) and non-HLA related genes (cytokine TNFa)

238
Q

difference between JIA and systemic JIA

A

JIA: auto-immune systemic: auto-inflammatory

239
Q

most common type of juvenile idiopathic arthritis

A

oligoarticular JIA

240
Q
  • 2-12 yrs - less than 5 joints affected - large joints - limping - worse in morning - lasts a few hrs each day - FHx psoriasis - +/- Uveitis - ANA +ve diagnosis
A

oligoarticular JIA

241
Q

investigations for oligoarticular JIA

A
  • X-ray: soft tissue swelling - CRP, ESR, FBC, U&Es, LFTs all normal - screen for ANA - with ANA+ve oligoarticular JIA –> uveitis –> if left can be sight threatening
242
Q

two peaks - 2-12 yrs - adolescence - more than 5 joints affected - several yrs of joint pain - knees, ankles, hands, shoulders, hip -worse at end of day after activity - unable to walk long distances - joint often click - otherwise well investigations: bloods normal can be RF+ve diagnosis?

A

polyarticular JIA

243
Q

extra features when polyarticular JIA is RF+ve

A
  • more erosive changes: rheumatoid nodules - RF+ve more likely to go into adulthood - more symmetric - needs more aggressive treatment
244
Q

child FEVER- intermittent systemic symptoms RASH - trunk & armpits JOINT PAIN markedly raised CRP AND ESR - triple normal value FBC - normocytic anaemia and thrombocytosis lymphadenopathy hepatosplenomegaly

A

systemic JIA

245
Q

child FHx psoriasis psoriasis + joint pain nail pitting dactylitis psoriatic ski lesions 50% ANA +ve 30% HLA B27 +ve

A

psoriatic JIA

246
Q

adolescence single joint pain, swelling inflammatory bowel disease HLA B27 +ve linked to juvenile ankylosing spondylitis aortitis

A

enthesitis -related arthritis

247
Q

investigations for JIA

A

first line blood tests: - FBC (including blood film) - U&Es, creatinine, LFTs - CRP, ESR specialist tests: - ANA - oligoarticular, SLE - HLA B27 - enthesitis, psoriatic - RF - polyarticular synovial fluid aspirate - non/ infective X-ray, USS, bone scan, CT, MRI

248
Q

which JIA is uveitis most common with? treatment for JIA uveitis? complications of uveitis?

A

most common: oligoarticular (with ANA+ve) treatment: - local steroids - DMARDs - BDMARDs complications: - cataract - keratin precipitates - synechiae - vision impairment - blindness

249
Q

treatment for JIA

A

non-pharmacological: - healthy diet - vit D - exercise - physio, OT - heat packs, warm baths - footwear, orthotics pharmacological: - NSAIDs - steroids (oral, intravenous, intra-articular) - DMARDs (methotrexate,leflunomide, sulfasalazine) - bDMARDs (etanercept, infliximab & adalimumab- anti TNF), (tocilizumab- antil IL6), (anakinra - antil IL1)

250
Q

3 risk factors for chronic fatigue?

A
  • socioeconomic deprivation - mood - infection EBV - glandular fever –> chronic fatigue
251
Q

screening investigations to exclude differentials for chronic fatigue

A

FBC, ESR, CRP, U&Es, creatinine, TFTs

252
Q

management for chronic fatigue

A

advice about sleep and activity: - do not oversleep 7-8hrs - anchor wake up time activity management: - monitor activity - should be halfway btwn what you do in a good day and a bad day consider referral to specialist: - refer to paediatrician 6 weeks

253
Q

chronic disabling pain - extreme pain even on light touch stop using part of body that is painful diagnosis and management

A

allodynia - chronic pain syndrome management: - antidepressant (amitriptyline, duloxetine) - neuropathic pain (gabapentin, pregabalin) not opioids for children - will get addicted

254
Q

what does stridor suggest

A

URT obstruction

255
Q

stridor management

A

don’t upset child O2 adrenaline neb dexamethasone remove any foreign body

256
Q

what does a delayed cap refill suggest?

A

shock

257
Q

what is decorticate posture and what does it mean

A

hands into CORE damage to corticospinal tracts in brain

258
Q

what is decerebrate posture and what does it mean

A

hands out damage to brain stem

259
Q

what is unilateral dilated pupil a sign of

A

brainstem coning through foramen magnum - from bleeding, tumours in brain

260
Q

what does bum shuffling of a baby lead to in walking development

A

slower walking development

261
Q

at what age would a child be rolling

A

4/5 months

262
Q

at what age should a child be sitting

A

6 months

263
Q

stroke in developing brain before the age of two affecting Childs movement and posture speech might be affected hand pronated, foot extended and pronated tone increased reflexes increased diagnosis

A

cerebral palsy

264
Q

one shoulder higher than the other or pelvis tilted

A

scoliosis

265
Q

when is scoliosis of less concern when does scoliosis get worse

A
  • when the head is above their bottom - when you can put them back int a straight line gets worse: - growth spurt - gastroscopy inserted - good nutrition
266
Q

what is usually the first sign of Duchenne muscular dystrophy

A

speech delay

267
Q

spina bifida is a lower motor neurone disease. what condition is it associated with

A

hydrocephalus

268
Q

what is Gower’s manoeuvre and what is it a sign of

A

muscle weakness around hip gurdle climbing up legs longer time to stand up

269
Q

speech development milestones for making and understanding language

A

1 year = 1 word 2 yrs = two word sentences 3 yrs = 3 word sentences 1 yr = 1 step command (put that under the chair) 2 yrs = 2 step command (put that under Lauras chair)

270
Q

what is Landau-Kleffner syndrome and how does it affect speech

A

epilepsy where you start to lose language after 4yrs due to seizures

271
Q
  • hypopigmented spot - seborrheic acne - tubers - blobs on CT (calcified nodules in brain) - fibroma - on nail - leash nodules - refer to ophthalmologist - shagreen patch cause autism like phenotype diagnosis
A

tuberous sclerosis

272
Q

chromosome 46 xx del 15q11-13 uniparental dysomy for chromosome 15 from dad- (two copies from dad) ataxic gait giggly lack of language severe seizures diagnosis

A

Angelman syndrome

273
Q

two copies of chromosome 15 from mum

A

Prader-Willi syndrome

274
Q

places to measure temperature in a child - under 4 weeks - over 4 weeks

A

under 4 wks: electronic under axilla over 4 wks: infrared tympanic temperature

275
Q

red - high risk for fever - emergency care presentation

A
  • pale/mottled/ ashen/ blue skin, lips or tongue - no response - appearing ill - grunting - RR > 60 - moderate/ severe chest undrawing - reduced skin turgor - bulging fontanelle
276
Q

amber - intermediate risk for fever - emergency care presentation

A
  • pallor of skin, lips or tongue - wakes only with prolonged stimulus - nasal flaring - dry mucous membranes - reduced urine output - rigors
277
Q

green - low risk fever - emergency care presentation

A
  • fever but otherwise well - normal colour of ski, lips and tongue - awake - normal skin, eyes
278
Q

which groups do these belong to in the traffic light risk system: - fever + tachycardia - fever + tachypnoea

A

amber group

279
Q

fever non blanching pietichial rash lesions >2mm in diameter (purpura) off food cap refill time >3s neck stiffness

A

meningococcal disease

280
Q

fever neck stiffness bulging fontanelle decreased level of consciousness convulsive status epilepticus

A

meningitis

281
Q

fever focal neurological signs focal seizures decreased level of consciousness

A

herpes simplex encephalitis

282
Q

fever tachypnoea crackles nasal flaring chest indrawing cyanosis O2 sats <95%

A

pneumonia

283
Q

fever vomiting poor feeding lethargy irritability abdo pain/ tenderness urinary frequency or dysuria offensive urine or haematuria

A

UTI

284
Q

fever swelling of a limb or joint not using an extremity non-weight bearing

A

septic arthritis

285
Q

what is the commonest cause of acquired heart disease in childhood in developing countries

A

Kawasaki disease

286
Q

ADHD

A

inattention hyperactivity impulsivity persistent

287
Q

first line mx ADHD

A

methylphenidate (for children over 5)

288
Q

side effect of methylphenidate

A

stunted growth weight and height should be monitored every 6 months cardiotoxic baseline ECG

289
Q

child on SABA + ICS + LRTA for asthma next line

A

swap LRTA for LABA

290
Q

causes of heart failure in children <2 weeks old

A

coarctation of aorta left-to-right shunts

291
Q

causes of heart failure in children >2 weeks old

A

VSD as the pulmonary vasculature resistance begins to fall

292
Q

most common causes of acyanotic congential heart disease

A
  • ventricular septal defects (most common) - atrial septal defect - patent ductus arteriosus - coarctation of aorta - aortic valve stenosis
293
Q

most common causes of cyanotic congential heart disease

A
  • tetralogy of fallot - transposition of great arteries - tricuspid atresia
294
Q

when does tetralogy of fallot present

A

1-2 months

295
Q

when does transpotition of great arteries present

A

at birth

296
Q

repeated flexion of head/arms/trunk followed by extension of arms 4-8months

A

infantile spasms salaam attacks 1-2seconds but may be repeated up to 50 times

297
Q

drawing up of legs

A

infantile colic

298
Q

pneumatosis intestinalis on AXR

A

pneumatosis intestinalis on AXR is a hallmark of necrotising enterocolitis usually in 2-3 days following birth pneumonitis intestinalis (gas cysts in bowel wall) abdo distension

299
Q

scarlet fever mx

A

phenoxymethylpenicillin 5 days

to treat strep pyogenes

fever responds to antipyretics

can lead to rheumatic fever and post strep glomerulonephritis

300
Q

hirschsprung’s disease

A

neonatal period: failure or delay to pass meconium older children: constipation, abdominal distension failure of parasympathetic - bowels dont contract more common in males downs syndrome

301
Q

downs syndrome features

A

face:

  • upslanting palpebral fissures
  • epicanthic folds
  • brushfield spots in iris
  • protruding tongue
  • small low-set ears
  • round/flat face

flat occiput

single palmar crease

pronounced ‘sandal gap’ btwn big and first toe

hypotonia

congenital heart defects

duodenal atresia

hirschsprung’s disease

302
Q

cardiac complications of downs syndrome

A
  • endocardial cushion defect (atrioventricular septal defect) - most common - ventricular septal defect - secundum atrial septal defect - tetralogy of fallot isolated patent ductus arteriosus
303
Q

later complications of downs syndrome

A

subfertility learning difficulties short stature repeated respiratory infections acute lymphoblastic leukaemia hypothyroidism alzheimer’s disease atlantoaxial instability

304
Q

diagnosis

A

DiGeorge

CATCH 22

C - cleft palate

A - abnormal fascies

T- thymic hypoplasia

C- cardiac defects

H - hypocalcaemia

22 - chromosome 22 deletion

abnormal facies: small jaw, small upper lip, low set ears, short stature, learning difficulties

305
Q
A
306
Q

Fragile X syndrome

A
307
Q

gross motor developmental milestones

A

sits without support: 7-8 months (refer at 12)

crawls: 9 months

walks unsupported: 13-15 months (refer at 18)

runs: 2yrs

rides a tricycle using pedals, walks up stairs without rail: 3yrs

hops on one leg: 4yrs

308
Q

measles features

A

RNA paramyxovirus

prodrome: irritable, conjunctivitis, fever

koplik spots ( before rash): white spots (grain of salt) in mouth

rash: starts behind ears then to whole body - discrete maculopapular rash

309
Q

ix and mx measles

A

ix: IgM antibodies

Mx: supportive

notifiable disease: inform public health

310
Q

high grade fever > 5 days

resistant to antipyretics

bright red, cracked lips

strawberry tongue

red palms and soles which later peel

conjunctivitis

A

kawasaki disease

clinical diagnosis

311
Q

mx kawasaki disease

A

high-dose aspirin

IVIG

echo - screen for coronary artery aneurysms

312
Q

most common cause of gastroenteritis in children

A

rotavirus

diarrhoea + vomiting and fever for the first 2 days

313
Q

causes of chronic diarrhoea in infants

A

most common cause in the developed world is cows’ milk intolerance

toddler diarrhoea: stools vary in consistency, often contain undigested food

coeliac disease

post-gastroenteritis lactose intolerance

314
Q

continous machinery murmur

A

patent ductus arteriosis

mx: indomethacin - closes connection

315
Q

disorders of sex hormones

A
316
Q

primary hypogonadism

XXY

A

Klinefelter’s syndrome

primary hypogonadism: low testosterone, high LH

features:

  • taller
  • lack of secondary sexual characteristics
  • small firm testes
  • infertile
  • gynaecomastia
317
Q

Kallmans syndrome

A

hypogonadotrophin hypogonadism

low LH causes low testosterone

features:

  • boy
  • delayed puberty
  • anosmia: loss of smell
318
Q

androgen insensitivity syndrome

A

x-linked recessive

46XY but female phenotype

high LH, normal/high testosterone

have end organ resistance to testosterone

features:

  • primary amenorrhoea
  • undescended testes - groin swelling
  • breast development
319
Q

cytomegalovirus - congenital

A

growth retardation

purpuric skin lesions

sensorineural deafness

seizures

320
Q

congenital toxoplasmosis

A

cerebral calcification

chorioretinitis

hydrocephalus

321
Q

congenital rubella

A

sensorineural deafness

congenital cataracts

congenital heart disease (patent ductus arteriosus)

glaucoma

322
Q

speech and hearing developmental milestones

A
323
Q

fine motor and vision milestones

A
324
Q
A
325
Q

faecal impaction mx children

A

polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)

maintenance therapy: Movicol Paediatric Plain

326
Q

meckel’s diverticulum

A

abdo pain

rectal bleeding - most common cause of painless massive GI bleed btwn 1-2yrs

intestinal obstruction

327
Q

fifth disease (erythema infectiosum)

A

slapped-cheek syndrome

caused by parvovirus B19

lethargy, fever, headache

slapped-cheek rash spreading to proximal arms and extensor surfaces

328
Q

intussusception features

A

paroxysmal abdominal colic pain

during paroxysm - draw knees up and turn pale

vomiting

bloodstained stool - red-current jelly - late sign

sausage-shaped mass in RUQ

329
Q

ix and mx for intussusception

A

Ix: USS - target-like mass

mx: first line: reduction by air insufflation under radiological control

used to be barium enema

if this fails or child has signs of peritonitis - surgery

330
Q

GORD first line medical treatment in infants

A

alginate therapy e.g. gaviscon

331
Q

child <5

haematuria

unilateral loin mass

A

Wilms tumour

nephroblastoma

children <5yrs - median age of 3yrs

unexplained enlarged abdo mass in children - Wilms tumour - review in 48hrs

Mx: nephrectomy, chemo, radio if advanced

332
Q

child immunisation schedule

A
333
Q

childhood syndromes

A
334
Q

phenylketonuria (PKU) features

A

autosomal recessive

chromosome 12

usually presents by 6months with developmental delay

child classically has fair hair and blue eyes

learning difficulties

seizures

eczema

‘musty’ odour to urine and sweat

screened in Guthrie ‘heel prick’ test 5-9 days of life

335
Q

fluids for children

A

4th year medicine (8 decks)

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