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Paediatrics > Conditions > Flashcards

Conditions Flashcards

1
Q

Biliary atresia

A

Congenital narrowing of bile ducts . Jaundice >14 days term vs >21 days neonate. Kasai procedure. Increase in Conjugated bilirubin detected by direct bilirubin test.

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2
Q

Pyloric stenosis

A

Projectile vomiting and failure to feed and thrive in first few weeks of life. USS abdo and feel olive shaped mass. Hypochloraemic metabolic alkalosis. Ramstedt operation

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3
Q

Sandifers syndrome

A

Torticollis and dystonia after feed . Complication of GO reflux

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4
Q

Causes of bilious vomiting

A

Intestinal obstruction
Meconuim ileus
Hirchsprungs disease
Intussecption
Malrotation with volvulus
Imperforate anus
Oesophageal or duodenal atresia

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5
Q

Hirchsprung’s disease

A

Congenital absence of PNS ganglionic cells in myenteric/auerbach plexus in distal bowel and rectum. FMHX. >24 hrs delay in meconium. 2-4 weeks after birth 20% get hirchsprungs associated entero colitis- fever, abdo distension, sepsis, bloody diarrhoea —> toxic mega colon. RECTAL BIOPSY and abdo x ray

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6
Q

Intussception

A

6mnths-2yrs old. Associated with viral illness, HSP, polyps, meckel’s diverticulum. Sev colickly pain, red currant jelly stool, sausage shaped mass RUQ. USS. Therapeutic enemas/ surgery
Ileocecal valve is common place and most dangerous
Ileo ileo and cecocecal can sometimes self resolve

Lymphoma, appendix, are common lead points

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7
Q

Causes of short stature and investigations

A

Normal: familial, CDGP (delayed bone age)
Endo: GH deficiency, hypoT, cushings
Genetic: DS, turner’s, noonan, prader-Willi
Bone: achondroplasia, osteogenesis imperfecta, rickets
Chronic: coeliac, Ibd

IGF-1, predicted height, bone age, growth velocity

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8
Q

Causes of tall stature

A

Familial, obesity, GH excess, hyperT, precocious puberty, soto, Marian, homocystinuria, klinefelter, fragile X

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9
Q

Precocious puberty define and causes

A

Secondary sexual characteristics <8 yrs for girls or menarche <9yrs or <9yrs boys

Central: hydrocephalus, lesions
Peripheral: CAH, hypoT, gonadal or adrenal tumours (small testes), mccune Albright syndrome, testotoxicosis

Prematurethelarche

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10
Q

Delayed puberty

A

No breast dev by 13yrs. Primary amenorrhoea if no periods or secondary sexual characteristics at 14 vs if secondary sexual characteristics present then at 15. Boys testes <4ml at 14 yrs old.

Central: hypogonadotrophic hypogobadism - CDGP, chronic disease, hypoT, Kallman syn, prader-willi

Hypergonadotrohic hypogobadism- cryptochordism, androgen insensitivity syndrome, galactosasmia, thalassaemia,turners, klinefelters

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11
Q

Innocent murmur

A

Soft, systolic, symptomless, short, situational

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12
Q

Pansystolic murmurs

A

VSD ( left lower stern also border)
Tricuspid regurgitation
Mitral regurgitation

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13
Q

Ejection systolic murmurs

A

Aortic stenosis (right 2nd ICAS)
Pulmonary stenosis (left 2nd ICs)
HCOM 4th ICS left

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14
Q

Mid systolic murmur

A

ASD- crescendo decrescendo at UPPER LEFT STERNAL BORDER with a fixed split 2nd heart sound

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15
Q

PDA murmur

A

Continuous machinery crescendo decrescendo murmur
Diagnosis echo
Monitor until 1 yr and NSAIDs to close
If no closure after one year then surgery

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16
Q

Coarctation of aorta

A

Associated with TURNER’s SYNDROME.
3 days post birth collapsed baby when PDA closes. Weak femoral pulses, lower BP in legs, systolic murmur left infraclavicular and below left scapula. PG infusion

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17
Q

Pulmonary stenosis associations

A

Tetralogy of fallot
Rubella
Noonan syndrome
William syndrome

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18
Q

Tetrology of fallot

A

Pulmonary stenosis, VSD, RVH, overriding aorta
Cyanosis
Associated with rubella, alcohol, diabetes, increased maternal age
Echo BOOT SHAPED HEART
Ejection systolic murmur
Tet spells : squat, O2, B blockers, morphine, IV fluids, phenylephrine, NaHCO3
Pg infusion and aurgwry

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19
Q

Cyanosis heart disease

A

Truncus arteriosus
Transposition of great arteries
Triscuspid atresia
Tetrology of fallot
TAPVR

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20
Q

What heart disease is rubella associated with?

A

PDA

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21
Q

What syndrome is associated with AVSD?

A

Down’s syndrome

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22
Q

What heart disease is associated with turners syndrome?

A

Coarctation of aorta

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23
Q

Bronchiolitis

A

RSV under 1 yo, peaks at 6mnths
Coryzal symptoms that go to chest 1-2 days later.
Admit if under 3 months, pre existing condition, 50-75% normal intake, clinically dehydrated, RR>70, O2<92, signs of mod-severe respiratory distress, apnoeas

Management
NG / IV FLUIDS
SUCTION/ SALINE DROPS
O2- high flow- cpap - intubation

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24
Q

Viral induced wheeze

A

1-2 days fever/cough then goes to chest- resp distress and widespread expiratory wheeze.
Vs asthma- no atopy
Vs bronchiolitis- can occur up to 3yrs
RSV / rhinovirus
Same management as acute asthma- if <92% 3 BTB salbutamol and ipatropium nebs, O2 and steroid. If >92% salbutamol 10 puffs

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25
Q

Acute asthma

A

Mod: PEFR>50% predicted, normal speech
Sev: PEFR<50% predicted, can’t complete sentences, O2>92%, RR >40 if under 5yo vs >30 if >5yo, HR >140 if under 5yo vs >125 if over 5yo.
Life threatening: PEFR <33% predicted, <92% O2, silent chest, cyanosis,

Management for mod- sev
- 10 puffs/2 hrs salbutamol
- salbutamol and ipatroium back to back Nebs up to x3 if <92% (5mg/500mcg)
-pred/dex
-IV hydrocortisone
-IV MgSO4
-IV salbutamol
-IV aminophylline

Step down on 6 puffs / 4hrs 48 hours then 4/6hrs

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26
Q

Chronic asthma

A

2-3 yrs clinical diagnosis
-if improves on treatment
-spirometer with reversibility testing if >5yo , direct bronchial challenge with histamine, FENO, peak flow variability

Management
<5yo SABA, low dose ICS, leukotriene ant
5-12: salbutamol, low dose ICS, LABA, med dose ICS leukoyriene or oral theophylline, high dose ICS

> 12
SABA
low dose ICS
LABA
Medium dose ICS, leukotriene ant, oral theophylline, LAMA tiotropium
High dose ICS
oral steroids

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27
Q

Pneumonia

A

Productive cough & fever
Bronchial breath sounds coarse crackles

Strep pneumoniae
(Also staph aureus, h influenzae, mycoplasma, group a and B strep
RSV, influenza

Amoxicillin And macride

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28
Q

Croup

A

6mnths- 2 yrs
Parainfluenza
Not preceded by corzyal
Barking cough, strider, hoarse voice, low grade fever

Oral dex
O2
Nebuliser budenoside
Nebuliser adrenaline
Intubation

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29
Q

Strider causes

A

Foreign body
Croup
Epiglotitis
Laryngomalacia

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30
Q

Whooping cough

A

Bordetella pertussis

Mild cough/Coryza/fever —> severe paroxysmal cough (can cause vomiting or pneumothorax) with apnoeas and whooping

Notifiable disease

Macrolides 21 days or co trimoxazole

Complications: long cough or bronchiectasis

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31
Q

Chronic lung disease of prematurity

A

Risks :
<28 weeks
Required O2/ intubation at birth
RDS

O2 0.01L/min during sleep nasal cannula
Palizivumab injections

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32
Q

CF

A

AR CFTR Chr7 delta F508
1 in 2500
1 in 25 carriers

Doagnosis
Newborn blood test
Pilocarpine sweat test CL>60
CFTR

Mexonium ileus
Recurrent LRTI
steatorrhira
Chronic cough
Salty
Failure to thrive

Staph aureus
Pseudomonas and burkhoderia most dangerous
H influenza
E. coli
Klebsiella

Prophylactic flycloxacillun
Salbutamol
NEbulised DNAse
Nebuliser hypertonic saline
Creon

Monitor diabetes, osteoporosis, liver failure

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33
Q

HSP

A

under 10 yo
Purpuric rash on lower legs and buttocks
Abdo pain
Jt pain
Renal

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34
Q

UTI management

A

<3 months fever iv crftriaxone
>3mnthsnoral

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35
Q

Posterior urethral valve

A

Tissue proximal urethra near bladder causes bilateral hydronephrosis and UTIs

Usually picked up antenatal scan
Ablate

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36
Q

I descended testes

A

At 6-12 months orchidopexy

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37
Q

CMPA

A

under 3 years
Abdo pain and bloating and then allergy symptoms wheeze watery eyes cough rash

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38
Q

Perthes

A

5-8yo boys idiopathic
Disruption of blood flow to femoral head leads to avascular necrosis
Pain in groin/hip/knee, limp, restricted movement
X ray may be normal
Surgery if severe
5% get hip replacement

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39
Q

developmental dysplasia of the hip

A

Dislocation/subluxation of hip
RFs: breech, 1st degree FMHX, multiple pregnancy
USS diagnosis
Barlow and otolini test positive
Pavlik harness <6mnths vs surgery >6mnths w hip spica cast

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40
Q

SUFE

A

Adolescent obese male/ 8-15yo/ slight trauma causes head femur to slip on growth plate
Pain, external rotation , limp
Diagnosis X-ray frog lateral
Internal pinning and fixation of epiphysis

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41
Q

Transient sunovitis

A

3-10yo
Limp can’t weight bear gradual onset
No fever
Viral urti

42
Q

Septic arthritis

A

Single joint <4yo
Rapid onset
Fever
Aspirate
IV flucloxacillin empirical 3-6 weeks

43
Q

Oesteosarcoma

A

10-20yo commonly femur
Swelling and bone pain worse at night
Urgent x ray in 48hrs- sunburst periosteal reaction and fluffy appearance

44
Q

Talipes

A

Equinovarus/calcaneovalgus
Ponseti method: manipulate to normal position, cast, Achilles tenotony, boot nad bars brace until 4yrs old

45
Q

Osteogenesis imperfecta

A

Genetic brittle bones affecting collagen
Hyper mobility
Blue sclera
Triangular face
Scoliosis
Short
Dental problems
Deaf
Jt and bone pain
Bowed legs
Recurrent fractures

M
Bisphosphonates
Vit D

46
Q

Achondroplasia

A

AD
disproportionally small
Frontal bossing
Foramen magnum stenosis

Spinal stenosis
Kyphoscoliosis
Recurrent otitis media
Hydrocephalus
OSA
Obesity

47
Q

Rickets

A

RFs: dark skin, indoor climate, renal disease, autoimmune, IBD/coeliac

Rachitic rosary
Craniotabes
Undeveloped teeth/bones
Pain

X ray osteopenia
Serum vit D < 25
Low Ca and PO4
High ALP and Pth

Treatment
6000 IU ergocalciterol 8-12weeks
Prevent during pregnancy with 400 IU vit D per day

48
Q

Down’s Syndrome

A

Brachycephaly
LD
Dementia

Cataracts/myopia/striabismus
Prominent epicantic folds
Upward slanting palpebreal fissures
Brushfield spots

Recurrent otitis media

Flattened face and nose

Large tongue and small mouth

Atlanto axial instability

Hypothyroidism
Diabetes
Leukaemia

Single palmar crease
Increased sandal gap

Duodenal/jejunal atresia

Investigations
11-14weeks combined test ( increased nuchal thickness > 6mm, decreased PAPPA, increased BHCG)
14-20 weeks triple test (decreased oestriol, increased BHCG, decreased AFP)
14-20 weeks quadruple ( decreased oestriol, decreased AFP, increased BHCG, increased inhibin A)

> 1 in 150 aminocentesis

49
Q

Noonan syndrome

A

AD

Broad forehead
Downward sloping eyes and ptosis and hypertelorism
Low set ears
Webbed neck
Short stature
Pulmonary stenosis
Lymphoedema
JMML / neuroblastoma
LD
Bleeding disorders
Cryptorchism

50
Q

Fragile X syndrome

A

Tall long face
Speech delay
Small testicles
LD
seizures
Autism
Hyper mobile

51
Q

Klinefelter syndrome

A

Male XXY

taller
Wider hips
Small testicles
Gynaecomastia
Infertility

Associated w diabetes, osteoporosis and breast cancer increased risk

Testosterone injections

52
Q

Turner syndrome

A

45 XO

Small
Webbed neck
Widely spaced nipples
Cubitus valgus
Downward sloping eyes w ptosis
High arched palate
Undeveloped ovaries

O P replacement
GH therapy

Associated w COARCTATION OF AORTA
recurrent otitis media and UTIs
Osteoporosis
LD
Diabetes
HypoT

53
Q

Marfan syndrome

A

AD if till in

Tall, arachnodactylyl
Hypermobility
High arched palate
Downward sloping palpebral fissures

Associated
Pneumothorax
Lens and joint dislocations
Aortic aneurysm
Mitral and aortic regurg
Reflux
Scoliosis

54
Q

Prader Willi syndrome

A

Constant insatiable hunger
hypotonia
LD

Management
GH for muscles

55
Q

Angelmann syndrome

A

Happy
Water fascination
Widely spaced teeth
LD
ataxia

Epilepsy
Microcephaly

56
Q

William syndrome

A

Broad forehead
Starburst eyes
Sociable

Supravalbular aortic stenosis
HyperCa

57
Q

Digeorge syndrome

A

C- cleft lip/palate
A- abnormal facies
T- thymus undeveloped/ T cell abnormalities
C-cardiac abnormalities
H-hyper parathyroidism- hypocalcaemua - seizure
22 chromosome deletion

58
Q

Idiopathic thrombocytopenic pupura

A

Type II hypersensitivity under 10 yo
Low plt only (exclude leukamia)
Bleeding and bruising

70% resolve in 3 months
If plt<10- prednisolone, IV IgG, plt transfusion
Avoid contact sports, NSAIDs, blood thinners, IM injections

Complications
Anaemia
Intracranial haemorrhage
GI bleed
Chronic ITP

59
Q

Thalassaemia

A

Alpha (chr16) vs beta (Chr11- minor, intermedia, major)

Prominent forehead and malar eminences
Jaundice
Splenimrgalu
Microcytic anaemia
Gallstones

Blood transfusions
Splenectomy
BMT

60
Q

Hereditary spherocytosis

A

AD
jaundice
Gallstones
Anaemia
Splenimegaly

Aplastic crisis associated w parvovirus B19

I: spherocytes on blood film and increased MCHC and reticulocytes

Folate
Splenectomy

61
Q

G6PD deficiency

A

X linked recessive

GP6D protects against reactive oxidative species forming. When deficient it can’t protect and therefore haemolytic occurs causing jaundice, gallstones, splenomegaly and anaemia- in response to infection/meds/anti malarials/fava and broad beans

I
Enzyme assay
Heinz bodies blood film

62
Q

Leukaemia

A

ALL most common around 2-3 years old
80% cured
Associated w radiation during pregnancy, DS, noonan, klinefelter, fanconi’s anaemia

2% present with a limp

Pancytopenia with random increased WBC

63
Q

Tonsillitis and tonsillectomy criteria

A

Viral global symptoms
Group A strep focal symptoms

Probability it is bacterial:
CENTOR >3
1. Absence of cough
2. tonsillar exudate
3. Lymphadenopathy (anterior cervical)
4. Fever >38°

FEVER PAIN >4
F- fever
P- purulence
A- attended within 3 days onset
I- inflamed tonsils
N- no cough /coryzal

PEN V 10 days

Complications:
Otitis media
Quinsy (abscess treated with co-amoxiclav incision and drainage)
Scarlet/rheumatic fever
Post strep glomerulonephritis/reactive arthritis

Tonsillectomy requirements:
1. Recurrent - >7 in one year, >5 2 yrs, >3 for 3 yrs
2. Recurrent abscesses (>2)
3. Snoring/breathing difficulties

64
Q

Otitis media

A

Strep pneumoniae

Management:
1. Resolve 3 days with simple analgesia
2. Delayed prescription if no resolve in 3 days
3. Amoxicillin 5 days if
-otorrhea
-<2years and bilateral
- <3mnths and fever >38° or 3-6mnths and fever >39° ADMIT

COmplications
-glue ear (hearing loss- Eustachian tube blocked, 3mnths resolves or grommets)
-hearing loss
-perforation
-mastoiditis
-abscess

65
Q

Febrile convulsions

A

6mnths- 5 yo

Simple:
Under 15mins
Generalised tonic clonic
No recurrence in 24hrs

Complex
15-30mins
Focal/partial
Recurrence in 24hrs

Status epilepticus >30 mins

1in3 risk of further FC
>5mins phone ambulance
Some discharged with buccal midazolam or rectal diazepam
2.5% risk of epilepsy compared to 1.8% general population. Increased if FMHX, complex FC. Neurodevelopmental disorder.

66
Q

Seizure differentials

A

All ages:
HYPOGLYCAEMIA- GLUCOSE
CARDIAC ARRHTJYMIA - ECG

babies:
-sandifer’s syndrome
-benign sleep myoclonus (disappears 6-8mnths)
-shaken baby syndrome

toddlers:
- breath holding spells ( cyanosis: after crying- cyanosis vs reflex anoxic seizure- startled, vasobagal response and heart stops and seizure)
-motor stereotypes/tics
-self gratification

Older
Psuedoseizure
Tics
BPPV/ torticollis

Or epilepsy
-generalised tonic clonic (sodium valproate)
-atonic (drop, associated w Lennox-gastaut sun, EEG spike and wave, associated with sleep, <3min- sodium valproate)
-absence - ppt by hyperventilation, 3 second spike and wave EEG, perioral/ocular flickering (na valproate if >12trs onset)
-juvenile myoclonus - 12-18yo gen tonic clonic Na val

-focal - carbamazepine
-BREC (benign rolandic epilepsy w contra temporal spikes) - focal, sleep, prodrome parathesia, post ictal hypersalivation, 3-13yrs male

Infantile spasm 3-6mnths make
Sudden flexor contractions clustered around waking, wests syndrome
EEG hysparrhthmia
Prednisolone, vigabatrin, ACTH

67
Q

Hydrocephalus

A

Causes
Aqueducts stenosis congenital
Arachnoid cysts
Arnold chiari malformation

Rapidly increasing head circumference
Sunset sign eyes
Bulging anterior fontanelle
Poor feeding
Sleepy
Poor tone

M
Ventriculo peritoneal shunt

68
Q

Squint

A

Idiopathic
Cerebral palsy
Retinoblastoma
Hydrocephalus
Trauma

Hirschbergs test
Cover test

Manage w patch <8yo

69
Q

Cerebral palsy

A

Cause
HIE
maternal infections
Birth trauma
Meningitis
Sev neonatal jaundice
Head injury

Types
Spastic/pyramidal
Dyskinesia/athetoid
Ataxic
Mixed

Hand preference before 18 months

70
Q

Meningitis

A

NHS
neonatal : GBS, listeria, E. coli
HSV/Vzv/entero virus
C neoformans

Fever hypotonia bulging ant fobtanelle non blanching pupuric if meningococcal

LP if <1mnth and fever, 1-3mnths fever and unwell, <1yr unexplained fever and serious illness

Stat IM/IV benpen in primary care if meningococcal suspected

<3mnths cefotaxime and amoxicillin
>3mnths ceftriaxone and dex 4 days
Contacts single dose ciprofloxacin

71
Q

Sepsis

A

<3mnths >38° treat

72
Q

Neonatal jaundice

A

Physiological 2-7 days post birth
Pathological in first 24hrs (worried about sepsis/abo etc)

Increased production
-ABO incompatibility
-Rh (haemolytic disease of newborn)
-haemorrhage/IVH
-GP6D deficiency
-polycythameia

Decreased output
-breast milk jaundice
-biliary atresia (>14days in term baby, >21 days preterm)
-cholestasis
-Gilbert/crigler najjar syndrome
-hypothyroidism
-prematurity

I
-SBR and chart
-FBC (haemolytic anamei)
-direct bilirubin (CB- biliary atresia)
-direct Coombs test (ABO)
-TFTs
-LFTs
-blood cultures
-GP6D

M
phototherapy- stop when 5 boxes below treatment line. Check 12-18hrs SBR.
Treatment exchange transfusion

73
Q

Scarlet fever

A

2-6 yrs old
Group A strep

Fever (24-48hrs)
Sore throat
Malaise headache
Sandpaper rash torso flexures
Circimoral facial pallor
Desquamation

Oral PenV 10 days

Complications
Rheumatic fever 20 days later
Otitis media
Post strep glomerulonephritis

74
Q

Vaccines at 8 weeks

A

6 in 1 (diptheria/tetanus/hepB/Hib/polio/pertussis)
MenB
Oral rotavirus

75
Q

Vaccines at 12 weeks

A

6 in 1 (diptheria/tetanus/Hib/HepB/pertussis/polio)
Pneumococcal
Oral rotavirus

76
Q

Vaccines at 16 weeks

A

6 in 1
MenB

77
Q

1 year vaccines

A

MMR
Men B
Pneumococcal
2 in 1 (Hib, menC)

78
Q

3yrs 4mnths

A

4 in 1 (diptheria tetanus pertussis polio)
MMR

79
Q

Yearly vaccine 2-8

A

Nasal flu

80
Q

12-13yrs

A

HPV x2

81
Q

14yrs vaccine

A

3 in 1 (tetanus, diptheria, polio)
Men ACWY

82
Q

Infective mononucleolis

A

EBV

Fever sore throat fatigue
Lymphadenopathy splenomegaly tonsillar enlargement

Investigations
Monospot (6weeks to develop)
IgM early
IgG immunity

2-3 weeks recovery avoid alcohol and contact sports

Complications
Chronic fatigue
Haemolytic anaemia
Thrombocytopenia
Splenic rupture
Glomerulonephritis

83
Q

Mumps

A

Resp droplet spread

Prodrome
Parotid gland swelling
Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss

PCR and antibody
Notifiable

Supportive

84
Q

Encephalitis

A

Usually HSV 1/2 or VZV

Empirical acicckovir

85
Q

What prevents HIE?

A

Therapeutic hypothermia

86
Q

Caput succedaneum

A

Crosses sutures

87
Q

Neonatal sepsis

A

Group B strep
E. coli
Listeria
Klebsiella
Staph aureus

RFs PROM, maternal infection, GBS previous baby, prematurity

Benzylpeniccilin and gentamicin
CRP at 24hrs
Blood cultures at 36 hrs
If CRP<10 and blood cultures negative then stop

88
Q

Issues of prematurity

A

IVH
ROP
feeding difficulties
RDS/apnoeas
Bradycardia
Hypoglycaemia
Hypothermia
Increased infections
Necrotising enterocolitis
Jaundice

89
Q

RDS

A

<32 weeks
CXR ground glass appearance
Endotracheal surfactant to manage
Dex to prevent

90
Q

Necrotising enterocolitis

A

RFs
Prematurity
Formula fed
Sepsis
PDA
RDS/ventilation

Intolerance to feeds. Bilious vomiting. Blood in stools. Distended tender abdo. Absent BS.

I
FBC (decreased plt and neutropenia)
Cap gas metabolic acidosis
CRP
Blood culture
AXR- distended loops PNEUMATOSIS INTESTINALIS - gas in bowel wall

M
TPN
IV fluids and NG drain
Surgery

91
Q

Kawasaki disease

A

5 day >39°
Widespread maculopapular rash
Desquamation hands and soles
Strawberry tongue
Crusted lips
Bilateral conjunctivitis
Cervical lymphadenopathy

I
FBC- increased WCC and plt, decreased Hb
LFTs- increased enzymes, decreased albumin
ESR
Urinalysis increased WCC
ECHO

2-4 weeks is subacute phase with risk of coronary artery aneurysms

High dose aspirin
IV iG

92
Q

What syndrome can cause regression of developmental milestones?

A

Retts syndrome
(X linked

93
Q

Rheumatic fever

A

2-4 weeks autoimmune post-strep
Type II hypersensitivity

Diagnosis: 2 major or one major and 2 minor

Major JONES
J- joint migratory polyarthritis
O- organ inflammation (carditis/SOB)
N- subcutaneous Nodules
E- Erythema marginatum
S-syndenham chorea

Minor FEAR
F-fever
E- ECG changes
A- arthralgia
R- raised CRP/ESR

M
PENV
aspirin and steroids for carditis
NSAIDs
Prophylactic antibiotics forever to prevent recurrence

Complications
Recurrence
Mitral stenosis
Chronic heart failure

94
Q

Juvenile idiopathic arthritis

A

Autoimmune inflammation for over 6 weeks in under 16yo with no other cause

  1. Still’s disease
    -high swinging fevers
    -salmon pink rash
    -pleuritic/pericarditis
    -splenomegaly
    -lymphadenopathy
    Macrophage activation syndrome - DIC
  2. Polyarticular >5jts
    -mild fever anaemia
  3. Olgioarticular <4jts , girls <6yo
    -ANA +ve
    -anterior uveitis
  4. Ethesitis-related
    Male >6yo
    Anterior uveitis
    IBD
  5. Juvenile psoriatic arthritis
95
Q

Measles

A

Infective until 4 days after rash

Prodrome: conjunctivitis, fever, coryzal
Koplik spots
Behind ears maculopapular rash spreading with desquamation of palms and soles

Complications
Otitis media
Pneumonia
Encephalitis
SSPE

96
Q

Rubella

A

Stay off school 5 days

Mild fever
Sore throat
Jt pain
Lymphadenopathy
Erythematous macular rash spreading from face

C
Thrombocytopenia
Encephalitis

97
Q

Parvovirus B19

A

Prodrome of mild fever, coryza, aches
Slapped cheeks reticular rash raised and itchy (non infectious)

C
Aplastic anaemia
Encephalitis
Myocarditis
Hepatitis
Nephritis
Hydrops fetalis

98
Q

Roseola infantum

A

HHV6
Go to school!!!
High fever suddenly 3-5 days then disappears

Coryza/sore throat/ lymphadenopathy
Nagayama spots on soft palate (red)
Then mild eryethamtous non itchy rash

C
Febrile convulsions
Hepatitis
Meningitis

99
Q

Chicken pox

A

VZV
Droplet spread / direct contact

Fever first!
Vesicular lesions on trunk and face spreading out
(Non contagious once they scab)

Complications
Bacterial superinfection
Pneumonia
Encephalitis
Conjunctival lesions
Shingles/Ramsay hunt syndrome

ACICLOVIR if immunocompromised, >14yo presenting in 24hrs, neonates, risk of complications

OFF SCHOOL UNTIL 5 DAYS AFTER RASH

100
Q

Hand foot mouth

A

Coxsackie A

URTI— mouth ulcers — blistering red spots on hands feet mouth

Fluid and analgesia

101
Q

Pityriasis rosea

A

Young adults
HHV6/7
Prodrome
Rash herald patch to Christmas tree pattern faint pink itchy

3mnths resolve

102
Q

When to scan for UTI??

A

If atypical then do MCUG, DMSA, USS during illness…
-non E. coli UTI
-not responding to abx in 48hrs
-bladder mass
-poor stream
-septicaemia
/seriously I’ll
-increased Cr

Recurrent UTIs MCUG, DMSA, USS 6 weeks after
-UTI leading to 2 pyelonephritis
-UTI leading to 3 Cystitis
-UTI leading to 1 cystitis and 1 pyelo

Paediatrics (2 decks)

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