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YEAR 4 PAEDS > DR LUYTS HIGH YIELD TOPICS > Flashcards

DR LUYTS HIGH YIELD TOPICS Flashcards

1
Q

2 year old reffered to ED with fever.
1) What are you ddx?

A

Otitis media.
* Recognisable/rapidly diagnosed viral illness:
* Viral exanthum e.g., roseola, measles.
* Seasonal influenza.
* COVID-19.
* Bacterial infection:
* Urinary tract infection.
* Meningitis/encephalitis.
* Pneumonia.
* Arthritis/Cellulitis.
* Sepsis.

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2
Q

2 year old reffered to ED with fever.
2) What is your approach?

A

Does the child appear unwell?
Rapid ABCDE assessment:
Airway
Breathing
Look, listen and feel for:
1. Signs of airway obstruction.
2. Signs of respiratory distress:
a. Respiratory rate.
b. Use of accessory muscles
3. Observe for any chest deformity.
4. Check position of trachea
5. Auscultate chest for:
a. Presence of breath sounds.
b. Abnormal sounds e.g., wheeze, stridor.
6. Assess oxygenation: cyanosis; SpO2.
Circulation Feel and assess:
1. Colour – blue, pink, pale, mottled.
2. Limb temperature – cool or warm.
3. Capillary refill time.
4. Assess state of veins – underfilled/collapsed
5. Pulse rate.
6. Pulse presence, rate, quality, regularity.
7. Blood pressure.
8. Auscultate heart for murmur/pericardial rub
Disability Observe and note:
1. Level of consciousness.
2. Posture – hypotonic, decorticate, decerebrate.
3. Pupil size and reactivity.
Exposure Examine patient properly; maintain dignity

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3
Q

4 year old with a fever.
What are your bedside investigations?

A
  • Capillary blood gas.
    • Blood glucose.
    • Urine dipstix.
    • Naso-pharyngeal aspirate: ‘Flu, COVID, RSV
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4
Q

4 year old with a fever

Otitis media presentation?

A
  • Coryzal prodrome: runny nose, mild fever.
  • Presenting symptoms: fever, sore throat, earache.
    off feeds ± cough.
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5
Q

4 year old with a fever

Complications of otitis media?

A
  • Hearing loss: caused by middle ear effusion.
    sensorineural hearing loss uncommon
  • Balance problems: vestibular problems/labyrinthitis
  • Tympanic membrane: perforation/retraction.
  • Chronic suppurative otitis media.
  • Cholesteatoma/Mastoiditis.
  • Intra-temporal e.g., facial paralysis, periostitis.
  • Intra-cranial e.g., cavernous sinus thrombosis
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6
Q

4 year old with a fever

Presentation of pharyngitis?

A

Coryzal prodrome: runny nose, mild fever.
Presenting symptoms: fever, sore throat, cough.
difficulty swallowing.

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7
Q

Pharyngitis causative organisms?

A

Viral Pharyngitis, Infants and young children:
* Herpangina (enterovirus)
* Respiratory viruses
* SARS-Cov-2
Viral Pharyngitis: Older children and adolescens
EB virus (IM)
* Respiratory viruses
* Herpangina
* SARS-Cov-2

Bacterial Pharyngitis: Infants and young kids:
* Gp A streptococcus
* Other bacteria

Bacterial Pharyngitis:Older children and adolescens
* Gp A streptococcus
* Other bacteria

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8
Q

Outline fever pain?

A

Fever (during past 24 hours)- 1
Purulence (pus on tonsils)-1
Attend rapidly (<3d of onset)-1
Severely inflamed tonsils-1
No cough or coryza-1

Maximum score = 5

Likelihood of isolating
streptococcus
0-1: 13-18%
2-3: 32-56%
4-5 62-65%

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9
Q

4 year old with a fever

and maculopapular rash. What are you ddx?
Describe each one.

A

Roseola infantum (Herpesvirus 6/7):
* Illness of young children – peak age 7 to 13 month.
* Fever for 3-5 days; stops abruptly with rash.
* Cervical, post-auricular and suboccipital LN common.
* Rash persists for 2-4 days; self-limiting condition.

Scarlet fever (Group A Streptococcus):
* Diffuse erythematous eruption following pharyngitis.
* Rash feels like sandpaper; last for a week.
* When rash fades skin peels (fingertips, toes, groin).
* Risk of Rheumatic fever; treat with Penicillin.

Measles (Morbillivirus):
* Cough, coryza and conjunctivitis with fever.
* Rash spreads from face downwards; lasts 3-7 days.
* Complications in about a third; death in 4-10%.
* Asso: respiratory and neurological complications.

Slapped cheek or Fifth disease (Parvovirus B19):
* Mainly affects primary school children.
* Fever lasts 2-5 days; then malar erythema.
* Followed several days later by lace-like rash on body.
* Associations: arthralgia, aplastic anaemia, GBS

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10
Q

4 year referred to ED with fever

and vesicular rash.What are you ddx?
Describe each one.

A

Chicken pox (Herpes zoster – Herpes type 3):
* Incubation period 14-16 days (range 10-21 days).
* >90% of susceptible household contacts infected.
* Rash in crops over body; new lesions stop after 4d.
* Asso: acute cerebellar ataxia, encephalitis, LRTI.

Erythema multiforme (Herpes 1 commonest):
* Immune mediated typically self-limiting.
* Evolves over 3-5 days; resolves in 14 days.
* Mucocutaneous condition with target skin lesions.
* Mucosal blisters – favour mouth; also urogenital.

Herpes simplex virus infection (Herpes virus 1):
* Affects 66% worldwide in low/middle income.
* Presentation depends whether 1○ or 2○ infection.
* 1○: gingivitis with generalised oral vesicles.
* 2○: reactivation – localised vesicular lesion.

Hand foot and mouth disease (Coxsackie A16):
* Common, mild, self-limiting illness.
* Mainly affects children <5 years.
* Vesicle and ulcers in mouth, palate and pharynx.
* Macules, then blisters on palms and soles - later peel.

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11
Q

Paeds Sepsis 6 bundle?

A
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12
Q

Macular or maculopapular rash ddx?

A
  • Viruses: Roseola infantum, Slapped cheek, Measles, Rubella.
  • Bacteria: Scarlet fever, Rheumatic fever, Typhoid fever, Lyme’s disease.
  • Others: Kawasaki Disease, Juvenile Rheumatoid arthritis.
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13
Q

Vesicular, bullous and pustular rash Ddx?

A
  • Viruses: Herpes simplex, Herpes zoster, Hand foot and mouth disease.
  • Bacteria: Boils, Impetigo, Staphylococcal scalded skin syndrome.
  • Others: Erythema multiforme, TEN, SJS.
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14
Q

Petechial or purpuric rash ddx?

A
  • Viruses: Enterovirus, Adenovirus and other viral infections.
  • Bacteria: Meningococcal and other bacterial sepsis, Infective endocarditis.
  • Others: Henoch-Schonlein purpura, Immune thrombocytopenia, Leukaemia.
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15
Q

4-year-old with a fever for 5 days, rash and erythema of lips & oral mucosa.

A
  • Kawasaki disease
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16
Q

Fun facts about Kawasaki?

For OSCE

A
  • One of the most common vasculitides in children; also occurs in adults.
  • Acute self-limiting an acute self-limiting inflammatory disorder affecting predominantly medium sized arteries, particularly coronary arteries causing aneurysms in 15-25% if untreated.
  • Commonest causes of acquired heart disease in children in developed countries.
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17
Q

Diagnostic criteria for Kawasaki?

A
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18
Q

Management of kawasaki?

A
  • Needs ECG, CXR and cardiac ECHO.
  • Treatment: IV Ig; Aspirin - high dose in acute phase followed by low dose maintenance.
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19
Q

Lab findings in kawasaki?

A
  • Systemic inflammation with mild anaemia, leucocytosis with left shirt and thrombocytosis (end of week 2).
  • Raised ferritin (acute phase reactant).
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20
Q

4 year old with acute onset fever and headache. Ddx?

A
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21
Q

Think of some cough types, what is the diagnosis and what inv would you do?

A
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22
Q

4 year old with acute onset fever, cough and dyspnoea. What is the treatment algorithm for severity of the infection?

A
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23
Q

2 year old referred to ED with fever.
1) other symptoms?
2) Inv and findings
3) Treatment?

A
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24
Q

Indication for ultrasound for a UTI in children?

A
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25
Q

How to prevent UTIs in children?

A
  • Use the potty more often:
  • Time child’s potty sessions:
    Young children hold their pee as they don’t want to take breaks from their play.
    After experiencing a UTI, may be afraid to pee as it might burn.
    Ask child to empty bladder every 2-3 hours.
  • Empty bladder completely:
    Some children don’t empty bladder completely when peeing.
    Just pee enough to make sensation go away because they are in a hurry to go back to play.
    Ask child to ‘double pee’ each time; or try again before wiping.
  • Proper wiping:
    Wipe from front to back.
  • Stay hydrated:
  • Avoid constipation:
  • Choice of clothing:
    Cotton underpants are recommended.
    Avoid nylon, synthetic, tight-fitting underwear.
  • No bubble baths:
    Frothy soapy water can lead to skin irritation.
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26
Q

6-year-old boy presents to ED acute onset fever and a limp.

Transient synovitis vs septic arthritis?

A
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27
Q

Ddx for atraumatic limp?

A
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28
Q

Common conditions with abx therpay and the duration?

A
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29
Q

Child present with a cough

What would you cover in the hx?

A
30
Q

Causes of chronic cough in children and RF/ mechanisms?

A
31
Q

Braindump croup

A
32
Q

Causes of acute stridor?

A
  • Acute epiglottitis
  • Bacterial tracheitis
  • Severe LN swelling
  • Tonsillar abscess
  • Retropharyngeal abscess
  • Measles
  • Diphtheria
  • Acute laryngeal oedema (allergy)
  • Inhaled foreign body
  • Inhalation of smoke or hot fumes
  • Trauma to throat
  • Hypocalcaemia
  • Psychological (VCD)
33
Q

Braindump bronchiolitis?

A
34
Q

Child presents to doctor with wheeze and breathlessness

1) ddx and facts about them

A
35
Q

Aims of asthma managment?

A
36
Q

What shows inadequate symptoms control in asthma?

A
37
Q

Think of asthma medicines.
What are their MOA
What are their adverse effects?

A
38
Q

Causes of central cyanosis in the newborn?

A
39
Q

What is choanal atresia?

A
40
Q

What is laryngomalacia?

A
41
Q

What is microganthia?

A
42
Q

What is congential lobar emphysema?

A
43
Q

What is congenital diaphragmatic hernia?

A
44
Q

What are the findings an the ddx for the following?

A
45
Q

Characteristics of innocent murmus?

A
46
Q

Grading of murmurs?

A
47
Q

Causes of abdo pain in children?

A
48
Q

An 8-month-old child presents to ED with spasms acute abdominal pain.

Intussussception brain dump

A
49
Q

Constipation braindump

presentaion, red flags and assoc sympts

A
50
Q

Distinguish between normal, clinical dehydration and clinical shock?

A
51
Q

When is dehydration more likely?

A
52
Q

Diarhoea

How to treat:
Without dehydration
Clinical dehydration
Shock

A
53
Q

Causes of vomiting in children?

A
54
Q

What is:
Posseting
Regurgitation
Vomitting

A
55
Q

GORD braindump

causes, complications, management

A
56
Q

Pyloric stenosis brain dump

A
57
Q

A 10 year old boy referred for concern about growth.

What is short stature?
How do you measure growth failure
How to assess height?

A
58
Q

Causes of short stature

A
59
Q

Abnormalities in downs syndrome?

A
60
Q

Causes of downs syndrome?

A
  • Meiotic non-dysjunction (94%)
  • Robertsonian translocation (5%)
61
Q

Clinical features of turners?

A
62
Q

Classifications of headaches?

A
63
Q

Red flags for space occupying lesions?

A
64
Q

Child presents with seizure

what are your ddx?
Which inv would you do?
What is status epilepticus?

A
65
Q

Brain dump epilepsy syndromes

A
66
Q

Causes of floppy infant?

A
67
Q

What is spinal muscular atropy?

A
  • Autosomal recessive.
  • Degeneration of the anterior horn cells.
  • Defect in Survival Motor Neurone 1 (SMN1) gene.
  • Leading to progressive denervation and weakness of skeletal muscles.
  • Variable presentation (5 types) depends on SMN2 gene (backup) numbers.
68
Q

Brainsump Duchenne Muscular dystrophy?

A

X-linked recessive.
Most common inherited neuromuscular disease – affects 1 in 3600 boys.
Deletion of dystrophin gene.
Leads to progressive myofiber necrosis.

Clinical features
Diagnosis at about 5 years; although present much earlier with with waddling gait ± language delay.

Muscle pseudohypertrophy (especially in calves) due to fat deposition.

Gower’s sign – typically starts at 3 years and develops at 5-6 years; using hands to climb over body to stand.

Weak back muscles cause kyphoscoliosis

Also: cardiomyopathy, GE reflux
intellectual impairment.

Life expectancy: 20 years.

69
Q

Braindump ITP

A
70
Q

Braindump nephrotic syndrome

A
71
Q

Aetiology of neonatal jaundice?

A
72
Q

Developmental milestones?

A

YEAR 4 PAEDS (19 decks)

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