Exam learnings Flashcards
What are the key features of ADEM?
Encephalopathy is a hallmark feature.
Typically occurs <10yrs age.
Transient febrile illness a month prior with lethargy, fevers, headache, vomiting, meningeal signs, seizures.
CSF shows pleocytosis (lymphocytosis).
3-5 day course of IV MP with oral prednisolone for few weeks weaning.
What are the features of paediatric MS?
Non-encephalopathic compared to ADEM.
Recurrent with older age of onset.
20% have family history of condition.
CSF shows oligoclonal bands.
MRI brain showing more defined lesions.
What is the gold standard test for Mauriac syndrome?
Liver biopsy.
Mauriac syndrome is a glycogenic hepatopathy with reversible accumulation of excess glycogen in hepatocytes.
It’s a rare complication of T1DM from poor control (rarely in T2DM).
Presents with deranged LFTs, hepatomegaly, poor growth.
Liver USS cannot distinguish from NAFLD.
No clear correlation but possibly related to mutation in PHKG2 gene.
What are the key features of L-asparaginase?
L-asparaginase has been isolated from strains of E.coli.
It treats ALL and lymphoma with side effects including pancreatitis.
Risk of anaphylaxis increases with each administration with children advised to receive prophylactic anti-histamines and steroids. Adrenaline available as emergency medication.
It is not present in humans.
What is the incubation period for norovirus gastro in children?
12-48hours.
Staphylococcal food poisoning has shorter incubation period of 30mins to 8hrs.
Noroviruses belong to family Caliciviridae.
They are non-enveloped single stranded RNA viruses causing GI and stomach inflammation.
What are the features of congenital syphilis?
Most babies examine normal.
Need high index of suspicion and testing.
Features include;
- Snuffles, hemorrhagic rhinitis
- Osteochondritis/periostitis
- Bullous lesions
- Plantar/palmar rash
- Mucous patches
- Hepatomegaly +/- splenomegaly
Key risk factors for myopia
Usually in children older than 5yrs of age.
Affects 5% preschoolers, 10% school aged children, 30% of adolescents.
Risk factors include family history, prolonged time indoors, prolonged screen time or reading.
What is the least likely symptom in Mycoplasma pneumonia of wheeze, diarrhoea, headache and sore throat?
GI and coryza are unusual symptoms in M pneumoniae except in children <5yrs.
3-15yrs age group, 2-3wk incubation period with immunity not long-lasting.
Gradual onset headache, malaise, sore throat, fever, non-productive cough worsen over first week, resolve in two weeks.
Can reduce course of illness with macrolides like azithromycin.
What are the different causes of precocious puberty?
Idiopathic precocious puberty - gonadotropin releasing/dependent.
Pubertal progression of breast development, pubic hair, growth spurt, menarche.
Hypothalamic harmatomas cause central precocious puberty.
Prolonged untreated hypothyroidism; extremely elevated TSH levels cross react with FSH receptors- central cause.
Ovarian tumours cause peripheral precocious puberty, rare and benign.
60% are germ cell tumour and secrete tumour markers and sex hormones like oestrogens.
Granulosa cell tumours are most common.
Features of non classical CAH?
Premature adrenarche is traditionally defined as development of pubic hair before 8yrs in girls, 9yrs in boys, without evidence of maturation.
Genital hair first, then axillary hair, then body odour.
Affected children have advanced bone age and height velocity, DHEA and androstenedione levels are increased compared to older children at same pubertal stages.
Idiopathic premature adrenarche is slowly progressive and requires no treatment.
Non-classical CAH with systemic androgen effects; marked growth acceleration, bone age >2SD above mean, cystic acne, clitoral/phallic enlargement.
Diagnostic timeline of cerebral palsy.
Clinical exam alone; typically 18-24 months.
Three tools with high sensitivity and specificity in ages up to 5 months CGA.
- general movement assessment (GMA)
- HINE; sensitivity at 3 months CGA
- MRI at term equivalent age; CrUSS can also contribute to early detection
Haematuria by aetiology
Glomerular - macroscopically dark/brown, dysmorphic red cells, RBC casts, proteinuria
Non glomerular- normal red cells, macroscopically more red/pink
Macroscopic haematuria approach
Acute nephritis - oedema, HTN, oliguria
Ix - urine PCR, Cr, albumin, C3,C4, ASOT, ANA, antidsDNA, ANCA (lung involvement)
Only macroscopic - exclude exercise induced with urine sample post exercise
Confirm no microscopic haematuria 72hrs post
Both macro and microscopic haematuria when well
- urine phase contrast microscopy, urine PCR
- Non glomerular isomorphic RC, no casts, no proteinuria; Ix urine MCS, urine Ca:Cr ratio, renal USS, Doppler, coags, CT, AXR
- Glomerular dysmorphic RC, casts, proteinuria; Ix serum urea, Cr, C3,C4, serum IgA, renal US, test family, audiology if pos for Alports, renal biopsy
Microscopic haematuria work up
Recheck 2-3 times weekly/fortnightly
If transient or with infection then no further IX
Otherwise the following;
- urine phase contrast microscopy, UPCr ratio
- Glomerular; Cr, UEC, serum C3,C4, serum IgA, renal USS, consider audiology, renal biopsy
- Non glomerular; renal USS, Doppler, AXR, urine Ca:Cr ratio, urine MCs, coags, 24hr urine Ca, uric acid, oxalate, cysteine if stone seen, CTabdo
