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EOY4 > Extra Paediatrics > Flashcards

Extra Paediatrics Flashcards

1
Q

Which vaccinations should be given below 2 months old? (4)

A
  • 6 in 1
  • Rotavirus
  • Meng B (2 doses)
  • Pneumococcal PCV
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2
Q

Which vaccinations should be given at 1 years old? (4)

A
  • HIB/ Men C
  • MMR (1st dose)
  • PCV (2nd dose)
  • MenB (3rd dose)
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3
Q

Which vaccinations should be given at 3.5 years old? (2)

A
  • MMR (2nd dose)

- 4 in 1 pre-school booster

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4
Q

Which vaccination should be given between 2 and 10 years old?

A

Flu vaccine every year

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5
Q

Which vaccination should be given between 12 and 13 years old?

A

HPV

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6
Q

Which vaccinations should be given at 14 years old?

A
  • Meningitis ACWY

- 3 in 1 teenage booster

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7
Q

What does the 6 in 1 vaccine protect against?

A

Diptheria

Hepatitis B

Haemophilus Influenza B (HIB) (acute epiglottitis)

Polio

Tetanus

Whooping Cough (pertussis)

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8
Q

What does the 4 in 1 vaccine protect against?

A

Diptheria

Tetanus

Polio

Whooping Cough

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9
Q

What does the HPV vaccine protect against?

A

Human Papillomavirus Strains: 6, 11, 16 and 18

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10
Q

What does the 3 in 1 teenage booster protect against?

A

Diptheria

Tetanus

Polio

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11
Q

What are the contraindications to vaccination?

A

Acute, febrile illness

Allergies to ingredients

Immunodeficiency/compromised - don’t give if primary immunodeficiency or on steroids

BUT GIVE ALL VACCINATIONS EXCEPT TB IF HAVE HIV

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12
Q

Can live vaccinations be given together?

A

Yes, live vaccines should be given together OR separated by > 3 weeks

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13
Q

Describe the rash seen with measles (4)

A

Morbiliform

Erythematous and maculopapular, can become confluent.

Starts specifically behind ears and then spreads to body

Kloplik’s Spots

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14
Q

Describe the onset of the rash seen with measles

A
  • Prodromal Phase = 10-14 days after exposure

Kloplik’s Spots at end of prodromal phase

Symptoms for 2-4 days before rash

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15
Q

For how long should a child with measles be kept off school?

A

5 days after onset of rash

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16
Q

What are the other features associated with measles? (3)

A

Fever above 39 degrees

Coryzal symptoms

Conjunctivitis

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17
Q

What is the management of measles? (4)

A

Supportive as self limiting

Avoid contact with vulnerable people e.g. pregnant

Notifiable disease

MMR vaccine for prevention

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18
Q

What are the complications of measles? (4)

A

Otitis Media

Pneumonia

Encephalitis

Febrile seizures

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19
Q

How does mumps present?

A

Parotid swelling, usually bilateral

Prodromal malaise

Fever

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20
Q

What is the management of mumps?

A

Supportive as self limiting

MMR vaccine

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21
Q

What are 3 potential complications of mumps?

A
  • Orchitis +/- infertility
  • Arthritis
  • Pancreatitis
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22
Q

Describe the rash associated with Rubella

A

Pink, maculopapular

Initially on face then spreads to body then fades after 3 days

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23
Q

What is the onset of the rash associated with Rubella?

A

2-3 weeks after infection

Rash lasts 5 days normally

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24
Q

How long should a child with Rubella be kept off school for?

A

4 days after rash appears

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25
Q

What are the associated symptoms of Rubella?

A

Arthralgia

Suboccipital and postauricular lymphadenopathy

Coryzal symptoms

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26
Q

What is the management of Rubella?

A

Supportive

Notifiable disease

MMR Vaccine

Avoid pregnant women + contact tracing

Avoid contact with vulnerable people

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27
Q

What is the triad of complications seen with Rubella?

A

Heart disease (PDA)

Congenital cataracts

Sensorineural hearing loss (triangle on a baby

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28
Q

Describe the rash associated with Varicella Zoster?

A

Chickenpox

Small macules over head, trunk and proximal limbs

Becomes vesicular and is ITCHY

Then crusts over

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29
Q

What is the onset of the rash associated with varicella zoster?

A

Has a prodrome

Rash progresses over 12-14 hours

Crusting = 5 days after onset

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30
Q

What is the management of varicella zoster virus?

A

Manage symptoms e.g. calamine lotion/chloramphenamine if >1yo

Oral Aciclovir if >14 yo

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31
Q

What is the causative organism of scarlet fever?

A

Group A Streptococcus

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32
Q

Describe the rash associated with scarlet fever?

A

Erythematous, blanching rash on abdomen and chest

Punctate, rough and sandpapery

Particularly visible in skin folds

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33
Q

Describe the onset of the rash associated with scarlet fever

A

Rash appears 12-48 hours after initial symptoms

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34
Q

What are the other symptoms of scarlet fever?

A

Strawberry tongue

Cervical lymphadenopathy

Pharyngitis

Fever (<38.3)

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35
Q

What is the management of scarlet fever?

A

Notifiable disease

Phenoxymethylpenicillin (GAS)

Symptom management

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36
Q

What is the causative organism of hand, foot and mouth disease?

A

Coxsackie A16 Virus

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37
Q

Describe the rash seen with hand, foot and mouth disease

A

Ulcers within the oral cavity

Macules and papules on dorsum of hands and heel margins

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38
Q

Describe the onset of the rash seen with hand, foot and mouth disease

A

Prodrome of 12-36 hours

Mouth ulcers come first

Hands and feet follow

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39
Q

What are the associated symptoms of HFMD?

A

Sore throat

Low grade fever

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40
Q

What is the management of HFMD?

A

Supportive

Can attend school (enterovirus as faecal-oral)

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41
Q

Describe the rash seen with Parvovirus B19?

A

Erythematous

Looks like ‘slapped cheek’

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42
Q

What is the onset of the rash associated with parvovirus B19?

A

Prodromal phase = 2-5 days

Rash lasts 1-2 weeks

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43
Q

What are the associated symptoms with Parvovirus B19?

A
  • Myalgia
  • Low grade fever
  • Runny nose
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44
Q

What is the management of Parvovirus B19?

A

Supportive

Avoid pregnant ladies

Follow up for FBC (susceptible individuals at risk of aplastic anaemia – get pancytopaenia)

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45
Q

What is the causative organism of Roseola Infantum?

A

Human Herpes Virus 6

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46
Q

Describe the rash seen with Roseola Infantum

A

Cranial erythema (like a halo)

Erythematous and maculopapular and on trunk.

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47
Q

Describe the onset of Roseola Infantum

A

Fever appears then goes away and then gets rash = often misdiagnosed

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48
Q

What are the associated symptoms of Roseola Infantum?

A

Really, really hot >40 – RoseohmygoditsHOT

Febrile seizures are v common

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49
Q

What are the management and complications of Roseola Infantum?

A

Supportive management

Encephalitis is a complication and can use antivirals in this case

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50
Q

What is the main complication of scarlet fever to be worried about and why?

A

Post-strep glomerulonephritis (most common cause of AKI in kids)

Can be caused by any group A strep

If a child has urinary symptoms ask about recent infections

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51
Q

What is other main complication of scarlet fever and how is this managed?

A

Rheumatic fever and therefore acquired valvular disorders

Give empirical abx (pen v)

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52
Q

What is the Jones’ Criteria for Rheumatic Fever?

A

J oints = Arthritis

O (heart) = Cardiac Disease

N odules = rheumatic

E rythema Marginatum (target rash)

S yndenhams Chorea ( sudden onset jerky movements and confusion)

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53
Q

What is a worrying complication of Parvovirus B19 in vulnerable individuals and why?

A

Can cause aplastic crisis

Affects reticulocytes (RBC precursor cells)

Bad for SCD/thalassaemia/haemaglobinopathy/G6PD as knocks out reticulocytes

54
Q

Why should children infected with parvovirus B19 avoid pregnant women?

A

Can cross the placenta and infect susceptible babies = miscarriage

55
Q

When should premature babies be vaccinated?

A

Should receive their routine vaccinations according to chronological age; there should be no correcting for gestational age.

Born prior to 28 weeks gestation should receive their first set of immunisations at hospital due to risk of apnoea.

56
Q

Define a febrile convulsion

A

A single, tonic-clonic, symmetrical and generalised seizure lasting <15mins

Peak age is 6 months - 5 years

57
Q

Why do febrile convulsions occur?

A

↑temperature, usually during the early stages of a viral infection.

There is no intracranial infection

Child is otherwise normal but there is a 1-2% chance they will go on to develop epilepsy

58
Q

What advice should be given to the parent of a child who has had a febrile seizure?

A

Reassurance

Advice to give paracetamol/ibuprofen early in illness

Advice to put child in recovery position

Still drowsy after 1 hour is not normal and requires medical attention

59
Q

What is the acute management of a epilepsy in children?

A

Lasts > 5mins = emergency ambulance

OR

Buccal Midazolam as rescue therapy if the seizure lasts >5mins and has been recommended by a specialist.

Then wait 10 mins and call an ambulance after if hasn’t stopped

60
Q

What is a reflex anoxic seizure?

A

Seizure following cyanosis due to high emotional stimulation (provoked) ⇢ breath holding

Sleep for ~30 mins after and usually grow out of

61
Q

Which cancer is most common in children?

A

Acute Lymphoblastic Leukaemia

62
Q

Which children are more at risk of ALL?

A

Trisomy 21/Down’s syndrome

63
Q

What is the typical epidemiology of ALL in children?

A

Affects children of all ages but the main peak is between 2-5 years old

Boys > Girls

64
Q

Describe the clinical presentation of ALL in children

A

Insidious presentation and depends on where is infiltrated:

Differential Diagnosis
Bruising = ITP, trauma, non-accidental injury

Recurrent infections = immunocompromised

Lymphadenopathy = Reactive + hx of infection

Pancytopenia = other malignancy or aplastic anaemiaGeneral = fatigue and malaise
Bone Marrow =
Bone Pain
Pancytopenia
Anaemia = pallor
Neutropenia = ↑infections
Thrombocytopenia = epistaxis, brusing, petechiae

Reticulo-Endothelial System - precursors settle in these tissues
Hepatosplenomegaly
Lymphadenopathy

65
Q

Give 4 differentials for ALL and how they might present

A

Bruising = ITP, trauma, non-accidental injury

Recurrent infections = immunocompromised

Lymphadenopathy = Reactive + hx of infection

Pancytopenia = other malignancy or aplastic anaemia

66
Q

Which blood tests should be done if ALL is suspected?

A

FBC
Pancytopenia: low Haemaglobin (anaemia), WBC (neutropenia) and platelets (thrombocytopenia)

OR Anaemia + lymphocytosis

Blood Film
Presence of blast cells

67
Q

What imaging/invasive tests should be done if ALL is suspected?

A

Bone Marrow aspirate is needed to diagnose

CXR - exclude a mediastinal mass (may obstruct airway)

LP is CNS is involved

68
Q

What is the acute management of ALL in children?

A

Stabilise patient - blood transfusion, abx, platelets

?TLS protection

?Steroids if mediastinal mass present

69
Q

What is the long term management of ALL in children?

A

Combination Chemo + steroid

Supportive care - platelets + red cells

Prophylactic antifungals - prevents Pneumocystis Pneumonia

70
Q

Why give Allopurinol/Rasburicase in tumour lysis syndrome?

A

Rapid cell lysis = hyperuricaemia

Allopurinol prevents Uric Acid formation by acting on Xanthine Oxidase so prevents hyperuricaemia SO prevents kidneys from rapid cell lysis

Rasburicase = urate oxidase so converts uric acid to allantoin = more easily excreted

71
Q

Define hypersensitivity

A

The objectively reproducible symptoms or signs following exposure to a specific stimulus at a dose that is tolerated by a normal person

72
Q

What are the 4 types of hypersensitivity reaction and the antibodies that mediate them

A

I = A - Acute or Allergy. IgE mediated

II = B - AntiBody - IgG or IgM mediated

III = C - immune Complex (depositions of antibody-antigen complexes)

VI = D = Days/Delayed - Cell-mediated by T cells and Macrophages

73
Q

Define allergy

A

A hypersensitivity reaction initiated by specific immunological mechanisms leading to disease.

Can be IgE mediated or non-IgE mediated

74
Q

Define atopy

A

A personal or familial tendency to produce IgE in response to ordinary exposure to potential allergens

75
Q

Define anaphylaxis

A

A severe, potentially life threatening generalised or systemic hypersensitivity reaction.

The onset is rapid and has a multi system involvement (airway/breathing/ circulation + skin/mucosal changes)

76
Q

Give 4 examples of IgE mediated allergies

A

Anaphylaxis

Urticaria

Acute Asthma

Acute Rhinitis

77
Q

Give 3 examples of non-IgE mediated allergies

A

Coeliac Disease

Contact Dermatitis

Dermatitis herpetiformis

78
Q

Describe the main differences between IgE and non-IgE mediated allergies

A

IgE = Acute onset + fast resolution with SPECIFIC symptoms

Non-IgE = Longer onset post ingestion, symptoms are NON-SPECIFIC

79
Q

How does a food intolerance occur?

A

No immunological mechanism behind it

Lack of enzyme to digest
Sensitivity to additives e.g. sulphites
Psychological stress response to a certain food

80
Q

What happens during sensitisation (first stage of allergy timeline)?

A

Antigen taken up by APCs (macrophage or dendritic cell) and presented to T cellss

T cells become TH2s and release interleukines

ILs activate Eosinophils and cause B cell class switching to produce specific IgE

IgE can attach to mast cells

81
Q

What happens during the early part of the second stage of the allergy timeline?

A

IgE attaches to mast cells = degranulation

Histamine, protease/tryptase and leukotriene release

82
Q

What happens during the late part of the second stage of the allergy timeline?

A

TH2, eosinophils and basophils etc are recruited to the site of exposure

More immune cells are therefore attracted even after the allergen has gone

83
Q

What are the long term investigations for allergy?

A

Bloods
Skin Prick Test
Immunoassay - Western Blot/ELISA that are specific for IgE

84
Q

What is the long term, conservative management for allergy?

A

Patient/Parent = Allergy Education (avoidance of food/cross allergens) and an Allergy Plan/ ID

Clinician = Risk Assessment and consider an Adrenaline Auto-Injector (AAI)
+ give information on biphasic response*.
Give info on support websites
Involve dietician and allergy nurse

85
Q

What is the long term medical management for allergy?

A

Adrenaline Auto-Injector

Immunomodulation/glucocorticoids?

86
Q

What is the MOA for adrenaline during anaphylaxis?

A

QISS QIQ
At normal concentrations, adrenaline has a higher affinity for β2 adrenoceptors than for α1 receptors

At higher concentrations i.e. therapeutic dose it also activates α1

This causes:
Bronchodilation via stimulation of B2 adrenoceptors
Vasoconstriction (and therefore increasing BP as peripheral vascular resistance increases) via stimulation of A1 adrenoceptors

87
Q

Give 3 indications for adrenaline

A

Anaphylaxis/angioedema +/- circulatory involvement

Acute hypotension

Can be nebulised for treatment of Croup (if not managed with corticosteroids)

88
Q

Give 4 indications for 1 Adrenaline Auto-Injector

A

Allergy to high risk foods e.g. nuts (does this mean you????)

Previous Hx of anaphylaxis

Idiopathic anaphylaxis

Moderate - severe asthma + food allergy

89
Q

Give 5 indications for a second Adrenaline Auto-injector

A

Moderate - severe asthma + food allergy

Can’t get to hospital easily e.g. live very rural

Have concurrent mast cell disease

Previous history of anaphylaxis + more than 1 dose adrenaline needed

Previous near death anaphylaxis

90
Q

When should a child with a fever be admitted? (5)

A

Temp >38

> 5 days in duration

<3 months

Non-blanching rash

Bulging fontanell

91
Q

What characterises nephrotic syndrome?

A

Triad of:

Proteinuria
Hypoalbuminaemia
Oedema

92
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change glomerulonephritis

+ hyperlipidaemia + hyper coagulable state + predisposition to infections

93
Q

What is the most common cause of hypothyroidism in children?

A

Autoimmune thyroiditis

94
Q

What are the Fraser guidelines?

A

Guidelines that are used to assess if a patient who has not yet reached 16 years of age is competent to consent to treatment, e.g. contraceptions

95
Q

What are the 5 components of the Fraser guidelines?

A
  • Understands professional advice
  • Can’t be persuaded to inform parents/professional can inform parents
  • Likely to begin/continue to have sex anyway regardless
  • Physical/mental health will suffer without the contraception
  • Best interests require the contraception
96
Q

Does a 16 year old person have capacity to consent?

A

Yes if 16+

under can also have capacity if they can understand what is involved

97
Q

What happens if the parent does not consent but the child (~14-16) does consent?

A

Do what the child wants but get it in writing

98
Q

What happens if a competent child does not consent to treatment?

A

The person with parental responsibility/the court can authorise the treatment if it is within the best interests of the child (unless you’re in Scotland but good thing you aren’t)

99
Q

What is the pathophysiology of a slipped upper femoral epiphysis?

A

Growth of the femur occurs at the end of the bone around the developing cartilage surrounding the growth plate (physis = metaphysis = widened shaft + epiphysis = end of bone)

SUFE = epiphysis is displaced posteroinferiorly and therefore moves off the physis which is weaker and underdeveloped

100
Q

How does a SUFE normally present?

A

Fat boys aged 10-16

Normally unilateral but 20% = bilateral
Pain in: Hip, ant thigh, groin +/- knee
Loss of internal rotation

Stable can usually weight bear but unstable cannot

101
Q

What is the difference between a stable and unstable SUFE?

A

LODER classification

stable = can walk with or without crutches
unstable = cannot walk no matter what + higher risk of complications
102
Q

What are the complications of a SUFE?

A

Epiphyseal slip progresses = early osteoarthritis

Avascular necrosis of the femoral head

Malunion = poor growth?

103
Q

What is the pathophysiology behind perthes disease?

A

Interruption of the blood supply to the femoral head leading to avascular necrosis

Some self healing after initial ischaemia and subsequent remodelling of the bone = distortion and abnormally shaped epiphysis

Leads to abnormal ossification

104
Q

Describe the blood supply to the femoral head

A

Intracapsular = medial femoral circumflex

Extracapsular = ?

105
Q

What are the investigations and definitive treatment of a SUFE?

A

Ix = Frog leg lateral x-ray of BOTH hips

Tx = Surgery. Internal fixation of the affected hip

106
Q

What is the presentation of Perthes’ Disease?

A

Boys aged 3-11

Usually unilateral but 15% are bilateral

Pain = hip, knee + limp. Pain is worsened by activity and relieved by rest

Limited internal rotation and abduction

107
Q

What is the management of Perthes’ Disease?

A

Hip Xray - widening of joint space + reduced femoral head that is also flattened

Self limiting so just focus on symptom reduction

108
Q

What is osteomyelitis and what is the pathophysiology in children?

A

Infection within the bone that either spreads:
Haematogenously (acute) e.g. staph aureus, GBS, E. Coli, Secondary to nearby infections/vascular disease or directly from trauma/surgery e.g. staph aureus

Pus lifts the periosteum which interrupts blood supply leading to the formation of necrotic fragments

109
Q

What is the most common causative agent of osteomyelitis in children with sickle cell disease?

A

Salmonella

110
Q

Which bones are more at risk of osteomyelitis?

A

Highly vascular ones e.g. long bone metaphases like the distal femur

111
Q

What is the presentation of osteomyelitis?

A

Gradual pain + warm, swollen erythematous joint

+ systemic signs of infection

112
Q

What are the investigations for osteomyelitis?

A

Bed - baseline obs for A to E

Bloods - FBC, blood culture, CRP

Imaging - Diagnosis confirmation = MRI but changes don’t show for ~12 days

113
Q

What is the treatment for osteomyelitis?

A

Conservative

Medical = 6 weeks of abx! Vancomycin + Cefotaxime until culture is known

Surgical = abscess drainage/removal of sequestra

114
Q

What are the causes of anaemia in children that have a LOW reticulocyte count?

A

Parvovirus B19 (slapped cheek) so do serology

Diamond Blackfan (v v v v v rare) BM aspirate?

115
Q

What are the causes of anaemic children that have a HIGH reticulocyte? How can they be further classified?

A

Raised bilirubin = haemolysis (Membrane disorder = h. spherocytosis, Enzyme disorder = G6PD, Haemaglobinopathy = SCD, thallassaemia)

Normal bilirubin = Blood loss (acute = fetomaternal, chronic = VWB, Meckels), Impaired production = Fe/Folate - coeliac/IBD/B12 - vegan mother deficiency)

116
Q

What are the risk factors for anaemia in children?

A

NM = Age (adolescent females), a baby from a multiple pregnancy

M = Delayed intro of iron containing foods, poor diet (poverty, veganism), preterm, LBW

117
Q

What is the management of anaemia in children?

A

Oral Fe supplements for 3 months
Max 200mg per day in 2-3 divided doses

Don’t take with milk/tea/eggs/chappatis
Take with OJ as vitamin C increases iron intake

118
Q

What is the definition of Idiopathic Thrombocytopenic Purpura?

A

A type of thrombocytopenic purpura defined as an isolated LOW platelet count with a NORMAL bone marrow in the absence of other causes of low platelets.

Platelets are destroyed by IgG

119
Q

What are the definitions of mild, moderate and severe thrombocytopenia?

A 
Mild = Platelet levels between 50-150
Moderate = 20-50 + increased risk of bleeding in surgery or trauma
Severe = <20 + increased risk of spontaneous bleeding
120
Q

What is the usual presentation of ITP?

A

Age 2-10 years
1-2 weeks after a viral illness

Petechiael rash/purpuric/bleeding/bruising/epistaxis

V rarely = intracranial haemorrhage

121
Q

What are the investigations that should be done for a child presenting with ITP?

A

Mainly a clinical diagnosis but want to rule out ALL

Bloods = FBC and blood film to rule out malignancy. Also serology e.g. viral, autoimmune, Anti-platelet if non-accidental injury suspected

BM aspirate if abnormal signs/steroids part of management

122
Q

What is the treatment for acute ITP?

A

Conservative = self limiting but avoid NSAIDs and contact sports as these prevent platelet aggregation. Give 24hr access to hospital

Medical = Oral prednisolone/IV Anti-D/ IVIG if significant bleeding or affecting QOL

123
Q

What is the treatment for chronic ITP?

A

Counted as low platelets after 6 months

Screen for SLE and follow medical management

124
Q

What is Henoch Schonlein Purpura? What type of hypersensitivity reaction is it?

A

An acute immune complex-medicated reaction (small vessel vasculitis) so is type 3 hypersensitivity

125
Q

What is the common presentation of HSP?

A

Rash = purpuric + blanching
Arthralgia = usually knees/ankles
Abdominal pain

More common in girls
Preceding URTI

126
Q

What are the bedside and blood tests to investigate HSP?

A

ESR, U&E (renal involvement is common), IgA

Urinalysis = proteinuria
BP

127
Q

What is the management of HSP?

A

Self limiting so supportive

Can give steroids but not usually

Important thing is detection and prevention of CKD so need follow up urinalysis for ~8 weeks

128
Q

How could a migraine present in a child?

A

Bilateral/frontal headache lasting 1-48hr

Nausea and vomiting

any 2 of photophobia, phonophobia, visual/sensory aura, +/- vertigo/abdo pain

Made worse by physical activity

129
Q

What is the acute management of migraine in a child?

A

Paracetamol/Ibuprofen

Domperidone for nausea or sumatriptan if >12

130
Q

WHAT IS the prophylactic management of migraine in a child? When would this be started?

A

3 month trial of pizotifen then propranolol if that doesn’t work

Disrupting school/social activity on a regular basis

also work on stress management/sleep/triggers

EOY4 (22 decks)

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