General Flashcards
What would you expect to see on histology of a wilms tumour?
small round blue cells
what is a condyloma
wart caused by HPV
What does a hydrocele form between?
between the tunica vaginalis layers - comes from a remnant of the processus vaginalis from the peritoneum
how do you remember vaccines
4 2 3 4
What would be seen on CT/MRI of tuberous sclerosis
tubers - calcified subependymal nodules
How do you remember tuberous sclerosis signs?
A SHLEAF spots S hagreen patches H eart rhabdomyosarcoma L ung hamartoma E pilepsy - due to calcifies subependymal nodules A ngiomyolipoma in kidneys F acial angiofibroma
What other conditions is neurofibromatosis assocaited with
MEN1 and 2b
what are the diagnostic criteria for neurofibromatosis
6 or more cafe au lait by puberty greater than 5mm (tend to grow in puberty so must be over 15mm then ) more than one neurofibroma axillary feckles optic glioma lisch nodule sphenoid dysplasia 1st degree relative
What is the difference between a medical and a surgical 3rd nerve pasly
Occulomotor nerve. blood supply limitation affects the inner motor supply first before the outer parasympathetic fibres meaning the pupil is still able to constrict - this is a medical palsy
When there is pressure from something compressing it - the parasympathetic nerves are blocked too and so the pupil is blown.and this may also cause pain.
What are the guidelines for status epilepticus
Midazolam0.5mg/kg/benzo 0.1mg/kg @5mins
Benzo@15mins - 0.1mg/kg IV
phenytoin infusion @25mins 20mg/kg over 20 mins (or phenobarbitol if on phenytoin 20mg/kg over 5 mins)
rapid sequence induction @45mins
How would iron overdose present
initially vomiting and diarhoea due to gastric irritation and then with haematemeis and malaena
Is Hep A a notifiable disease?
yes - you should do your best to not admit these patients due to risk of spread.
what is a meckels diverticulum
an ilael remnant of the embryological vitellointestinal duct which contains gastric mucosa. there is increased risk of ulceration and perf.
what is the first presentation of a migraine in childrren?
abdominal pain - it is usually assocaited with a strong family history and is a diagnosis of exclusion - there would be no blood.
It often occurs with a headacahe, and maybe vomiting with a pale face
What is toddler diarrhoea
Sometimes loose and explosive, other times well formed, most common cause in preschool children around the time of potty training. undigested food is common.
developmental delay of intestinal motility. usually grow out of the diarrhoea by 5 years of age however it can severely delay continence
making suer the diet contains more fat and fibre can help slow transit time.
when is the classic presentation of coeliac
8-24 months
What is acrodermatitis enteropathica
associated with zinc malabsorption - is chill when you give them zinc
moist erythematous plaques often symetrical on the buttock regions and are on face too.
When does malrotation usually occur and what causes it?
Usually in first few days of life with intestinal obstruction due to LADD bands.
Mcburneys point?
over appendix
What is infantile colic
few times a day particularly in the evning have to draw feet towards chest to relieve large vlumes of flatus
name some causes of crying in a baby which may not be obvious diagnnosis.
middle ear infection, fracture UTI, oesophagitis, tortid testicle teething.
What is the management for pyloric stenosis
Admit
intravenous fluids to return acid base and electrolytes to normal
consider pylormyotomy
what should the normal PH of the oesaphagus be
above 4
What is sandifer syndrome
dystonic neck posturing due to GORD.
What is the management of GORD
reassurance Thickening agents 30 degree prone posturing ranitidine or omeprazole nissen fundoplication
ertythema toxicum?
benign slef limiting rash thought to be due to allergy, colonisation of bacteria such as group b strep and adjustment to heat etc.
scalded skin syndrome?
staphylococcal scalded skin - due to release of exfoliative toxin. exhibit nikolksy sign - separation of epidermis on gentle sheering pressure
What are the conttraindications to the MMR?
non-HIV immunodeficiency and neomycin or kanamycin allergy
another live vaccine in the last month
What illnesses predominate in those with t cell deficiencies
Virus and fungal
What is duncan syndrome
Immune deficiency linked to uncontrollable EBV infection so they succumb to intial infection or develop a burkitts lymphoma
What is milia
white pimples on the nose and cheeks from keratin retention and sebaceous material in the follicles.
What is another name fro salmon patches and what are they?
stork bite often on eyelids forehead and nape of the neck from distention of dermal capillaires.
what is another name for neonatal urticaria
erythema toxicum
What is a port wine stain and what is the management?
darker more well demarkated red patch on the face due to vascular malformation of the capilliaries in the dermis. If they are in the trigeminal distribution they need an MRI to check for brain involvement. (sturge weber syndrome)
Management of a strawberry naevus
Watches closely until they are gone. regress after 3-15 months but are associated with complications. eg haemorrhage, thrombocytopenia, can get in way of vision or breathing.
What is caput succedaneum?
haemorrhage under the skin but above the aponeurosis.
What is the difference between subaponeurotic haemorrhage and cephalohaematoma.
under the aponeurois and does not bulge so much.
1 layer down under the periostium.
both are above the bone.
cephalohaematoma adheres to the margins of the bone.
What two infections commonly affect eczema?
staph and herpes simplex
What is the mechanism for ITP
immune breakdown usually IgG to Glp2b/3a they are opsonised and phagocytosed in the liver.
ADAMTS13 gene
TTP.
Does Hep B cause erythema nodosum?
no
Does OCP cause erythema nodosum?
yes
You find small white spots along the midline fo the palate in a baby? what are they? are they worrying?
epsteins pearls - no
cysts of the gums are not worrying either - epulis or ranula.
What are the phases of growth?
Fetal - 30% - mother factors
Infantile - 15% - Nutrition alone
Childhood - 40% - GH, IGF-1, thyroid, vit D, happiness.
Growth spurt - 15% - sex hormones - fusion of the epiphyseal plates.
What is the treatment for NEC
Broad spectrum abx and fluids
bowel wall odema, perf, free air? pneumatosis intestinalis
flushed appearance with perioral pallor
scarlet fever - usually rash on the trunk first like sandpaper. strep pyogenes usually. group A beta haemolytic strep. desquamation of fingers and toes later.
what is the management for scarlet fever?
mx
throat swab, pen v , 24 hours off school, notify the PHE.
What are the less well known sequelae of cystic fibrosis?
short delayed puberty diabetes nasal polyps male infertility and female subfertility
NO ARTHROPATHY
What is the infectivity window of chicken pox
4 days before rash and 5 days after onset
what is the incubation period for chicken pox
10-21 days
what is enucleation?
removal of the eye - can be a treatment for retinoblastoma
What are the 4 causes of jaundice in a baby less than 24 hours old?
rhesus haemolysis
ABO haemolysis
G6PD
hereditary spherocytosis
What are the causes of jaundice after 2 weeks?
BBC HUG biliary atresia Breast milk jaundice congenital infection e.g CMV/TOXO hypothyroidism UTI galactosaemia
What drug is used to stop bleeding in von willebrands disease
desmopressin
What is found in the GI tract of peutz jeugers? what other signs do they show?
hamartomatous polyps which need to be kept under close observation
pigmentation around mouth and on hands and soles.
50% die from GI cancer by age 60
What is the name for infection of the umbilicus?
omphalitis - usually staph aureus
What is an umbilical granuloma
cherry red lesions around the umbilicus
require silver nitrate or corterization
persistent urachus
wee out of the umbilicus
ASOT titre will help diagnose what? and what is the cutoff?
rheumatic fever >200iu/mL
what is keratoconjuctivitis?
inflammation of cornea and conjuctiva
is infertility assocaited with measles
no
what should an unvaccinated child do if the come into contact with measles
vaccinate within 72 hours
What kind of fever is bronchiolitis assocaited with
low grade.
what is salmeterol
long acting beta agonist
how does episodic viral wheeze present?
wheeze inhale and exhale. often along with an URTI of viral origin.
treatment is symptomatic only
first-line is treatment with short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer
next step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or both
If they are symptomatic betwwen URTI’s and it is thought there are other triggers such as exercise then they should be given montelukast and inhaled corticsteroid for 4-8weeks. this is know as a multiple trigger wheeze
congenital syndrome associated with sensorineural deafness
rubella
What is the most common type of brain tumour in children?
astrocytoma can be benign or malignant (glioblastoma multiforme) These account for 40% of the tumours.
20% will be medullablastoma and will be found in the midline of the posterior fossa
mostly infratentorial and prmary.
what is the squamous remnant from rathke’s pouch?
craniopharyngioma
how does a craniopharyngoma present?
bitemporal inferior quadrantanopia
gas cysts in bowel wall
NEC
what is riglers sign
air inside and outsie the bowel
What would you elicit on palpation of a kidney containing cysts?
often pain
What are the features of typhoid
relative bradycardia and splenomegaly aswell as rose spots and constipation or diarrhoea
What are the features of mono
sore throat lymphadenopathy splenomegaly in 50% (no contact sports for 8 weeks or may rupture) headache malaise haemolytic anaemia with cold agglutitins
How do you test for mono
monospot test in the 2nd week of illness also know as the heterophile antibody test or the paul bunnel
What bacteria are most likely to cause conjuctivitus in a child
HIb and strep.
What screening test is used for strabismus
corneal light reflection test
What are the contraindications to lumbar puncture
reduced GCS less than 9 or fluctuating conciousness focal neurology dilated pupils papillodema abnormal dlls eye movements relative bradycardia and hypertension
at whsat time of year does SIDS occur most?
winter
what are the risk factors for SIDS
maternal drug use twin male sex bottle feeding overwrapping smoking prematurity social classes 4 and 5
siblings should be screened for inborn errors of metabolism.
What are the assocaited non-motor problems in CP?
learning difficulties (60%) epilepsy (30%) squints (30%) hearing impairment (20%)
What are the treatments used for spasticity relief in CP?
oral diazepam, oral/intrathecal baclofen, botox.
What is beckwith weidemann syndrome
macrosomia
macroglossia
hypoglycaemia
what diseases present at birth with macroglossia
bekwith weidermann
hypothyroidism
what would you find on x ray of a child with TTN
hyperinflation and maybe some fluid in horizontal fissure. it usually lasts 1-2 days
how do you diagnose pertussis
nasal swab
what is the management of pertussis
Oral macrolide if presents in the first 21 days - only reduces spread.
Cows milk protein allergy
3-6% of all infants usually resolves by age 5
breastfed less likwly to get it
What is the difference between esotropia and exotropia?
eso - nose
exo - temporalally
hyper - superior
hypo - inferiorly
What causes ebsteins anomaly
use of lithium in pregnancy
tricuspid regurg
tricuspid stenosis
RAH
How quickly does bilirubin need to be measured in a newborn baby presenting with jaundice
within 2 hours if its in the first day and within 6 hours if its after 24 hours
it needs to be reassessed every 6 hours
appropriate levles are relative to age
How shoudl bilirubin levels be measured in a newboarn baby
transcutaenous bilirubinoeter should be used unless they are born before 35 weeks in which case the serum bilirubin should be used
if the transcutaenous measurement is over 250, or if it is over the threshold for treatment in their age group, use the serum to check it.
What should babies with ABO haemolytic disease be given?
IVIg 500mg/kg over 4 hours
What are the risk factors for kernicterus
rapidly rising bilirubin or level over 340micromol/l
which immunoglobulins do not cross the placenta
IgM (IgG anti A/B hamolysin, but not sure about IgA)
what is the treatment for infantile spasms
vigabatrin
when do most innate reflexes dissapear
usually around 4 months
stepping reflex around 2
What are the risk factors for surfactant lung defieicny
prematurity male sex diabetes c section delivery second born of prem twins
What are the 4 different types of crisis in sickle cell disease and how do they present?
PAINFUL(THROMBOTIC) - vaso-occulsive - precipitated by dehydration and infection or deoxygenation. may occur in hands and feet, lungs, spleen, brain, penis.
SEQUESTRIAN - sickling within organs such as the lung or spleen and cause pooling of blood
APLASTIC - parvovirus infection - suden drop in hb
HAEMOLYTIC - rare - fall in hb due to haemolysis
What is the protein defect in HOCM
Autosomal Dominant disorder of beta myosin heavy chain or myosin binding protein.
1in500
Why do you need to do an x ray in ALL
associated with mediastinal mass
what are the 5 stages of therapy in ALL
Induction Consolidation +CNS protection Interim maintenance Delayed Intensification Continuing maintenance - 2years in girls and 3 years in boys.
What are the triad of features in mccune albright syndrome and what causes them?
precosious puberty
cafe au lait spots
fibrous dysplasia
ovarian cysts secreting oesrtogen
in which gender is precocious puberty more likely to be pathalogical?
boys
Name signs of clinical dehydration
dry mucous memranes prolonged cap refill reduced skin turgor cold extremeties weak pulse
Why should you examine the testicles in suspected precocious puberty?
boys tend to have a pathology behind early puberty
enlarged testes - likely to be gnrh dependant and is being secreted from the brain. may indicate tumour
small testes - likely to be an adrenal cause
one large testis - testicular tumour
How do you differentiate causes of early puberty in girls
based on the order of development. if norml is gnrh dependant rather than if it is wibbly wobbly there may be an androgen excess
What ages count for delayed puberty in girls and boys
14 and 15 respectively
a weak testosterone to use in younger boys to kickstart a bit of catch up growth
oxandrolone
What is the enzyme missing in Congenital adrenal hyperplasia?
21 hydroxylase - causes female virulisation or male makes them bigger (not usually noticed)
results in hypoaldosteronism in 80% causing a low sodium and a raised potassium
What is it called when there is non worrying abnormal growth of the skull?
plagiocephaly
need to rotate their position gets better when they become more upright.
what is it called when there is premature fusion of bones in the skull?
craniosynostosis
most commonly affecting the saggital suture causing a long narrow skull
what are the 3 sutures of the skull called?
coronal
sagital
lamboid
HGow do you differentiate plagiocephaly and craniosynostosis
feel the sutures for fusions.
What deficiency is seen is prader willi
GH as well as?
how do you diagnose CAH?
raised levels of the 17 alpha hydroxyprogesterone.
in salt losers - 80% - they will have low sodium high potassium, metabolic acidosis and hypoglycaemmia.
How long should you breats feed for?
6 months. if possible.
What type of bilirubin is seen in breast milk jaundice?
unconjugated
malnutrition with and without odema?
marasmus without and kwashiorkor with odema
What is the optic disc
the point where the optic nerve enters the eyeball - swelling here is known as paillodema
how would an abducens palsy present
Those with sixth nerve palsy therefore experience horizontal double vision which is worse when looking towards the affected side
What is the MOST concerning feature which would make you give IM adrenalin ein anaphylaxis
wheeze. more so than BP and lip swelling
What is seen on histology of hirschprungs
absence of ganglion cells with larege acetylcholinesterase positive nerve trunks
What should be done to get an emergncy urine dsample in a child?
in out urinary catheter with septic technique
What is the typical way to catch urine in a child?
clean catch by asking th mother to hold the baby over a sterile foil bown until urination occurs.
At how many months do group b strep, listeria, and ecoli and other coliforms stop causing meningitis?
3 months.
other causes which are more common such as neisseria start causing disease from 1 month upto 6 years (strep and haemophilus)
What pathogens use the most and the least sugar in the CSF?
Viral doesnt use much atall, where as bacteria udse much more and TB uor mycobacterium use LOADS leaving very little glucose left.
What pathogens produce the most protein in the CSF?
viral infections are churning out relatively little protein as they arent doing as much without the cell host. bacteria produce much more rapidly and mycobacterium chuck out LOADS of protein.
Where is the infection in osteomyelitis and what are the most common sites in children?
in the metaphysis
most commonly in the dital femur and proximal tibia
How long does it take for x ray changes to show with osteomyelitis? what would you see?
7-10 days.
subperiosteal bone rarefaction. soft tissue swelling
What is torticollis and what is the most common cause in children?
wry neck, due to a sternomastoid tumour
What are the similarities and differences between transient synovitis and septic arthritis.
SIMILARITIES: Both are a pinful joint which cannot be walked on
DIFFERENCES:
Septic: much more ill, will need cultures and join aspiration showing signs of infection, they will have a high fever and pain will not go on rest. and can cause severe joint damage if not treated.
Transient: often associated with recent or current viral infection but they will be systemically quite well and pain will improve on rest. They should be given rest and analgesia for a week. there is a small risk of developing perthes.
What is the definitive test for diagnosing septic arthritis?
joint aspiration and culture
What are the extra articular signs of systemic onset JIA
salmon pink rash with malaise, lymphadenopathy, hepatosplnomegaly, serositis.
they may have high acute phase reactants aswell.
How long do you have to have joint swelling for without the presence of underlying infection to be classed as JIA?
6 weeks
oligo upto 4 joints
poly more than 4
systemic - other features
other features: morning joint stiffness and pain
chronic inflamation would lead to thivkenin gof the synovium.
complications include lengthening of bones creating discrepancies or valgous knees (knock)
How does rickets present in a baby?
neuromuscular irritability
apnoea
stridor
seizures
ping pong ball skull
what food contains high vitamin D
eggs and fish
What is the managemtn of an inguinal hernia
if it is irreducable then operation straight away
reducable likely to wait for a couple of days after reduction for swelling to go down.
What trype of hypospadias is merely cosmetic?
glanular
other more ever types include coronal or midshaft
What is a phimosis
inability to retract the forskin - often presents after 5 years of age. there is often whitish scarring of the foreskin. can cause urethral meatus stenosis too
What is a paraphimosis?
when th foreskin is retracted but cannot return
often requires GA to return.
What is recurrent infection of the foreskin and glans called
recurrent balanoposthitis
usually responds to warm baths and broad spectrum abx
How do you diagnose ITP
by exclusion and therefore blood film is oftewn the most appropriate investigation
OR if there is lymphadenopathy or suspected leukaemia then BM aspirate needs to be done
what acid base disturbance is seen in pyloric stenosis
hypochloraemic alkalosis
low sodium and potassium
What would differentiate between pyloric stenosis and GORD
unlikely to lose weight in GORD
Galactosaemia
Bilirubinaemia - conjugated Cataracts D+V E.coli sepsis hepatomegaly and kidney disease LD
What is the management for paracetamol overdose?
consider activated charcoal if less than 4 hours.
otherwise plot paracetmaol levels on the chart and start N-acetyl cysteine (this isuaually at about 4-8 hours
What are the side effects of metoclopramide?
can cause acute dystonias and neuroleptic malignant syndrome?
it is used as an antiemetic and acts at the d2 recepter as an antagonist
What is the treatment for an acute dystonia?
procyclidine - anticholinergic
What is infant respiratry distress syndrome more commonly known as?
surfactant deficiency
white out on CXR
What are the red flag signs for a sick child?
pale/mottled/blue
weak/high pitched continuous cry
unresposive to stimulation
grunbting
RR>60 with severe chest indrawing
reduced skin turgor
<3 months
bulging fontanelle
Centor?
exudate
fever
lymphadenitis
NO cough
Treatment for head lice
only if living lice are found - :
MALATHION, dimeticone, isopropyl myristate, cyclomethicone
wet combing
treatmewnt of nephrogenic DI
thiazide
How do you diagnose RSV
rapid antibody test of nasopharangeal secretions
treatment for bronchiolitis
supportive - humidified oxygen
start toilet traning?
2 (takes about a year or more)
how long does scabies still have an itch?
upto 4-6 weeks
distinguisher between b thal and IDA?
bilirubin level raised in thal, also a lower mcv which is characteristically too low given the mild anaemia in thal
When is Men C first given
1 year (along with the HIB instead of everything else
What common observation does not come into the sick child guidelines
BP
pertussis treatment
macrolide
clari <1month
azithromysin most
pregnant erythromycin
must be wwithin 21 days of the cough starting
What age can children speak in 3-5 word sentences
3
Cuases of fail to pass mec
CF, hirsch
how does CF present
MEC ILIEUS
UTI treatment under 3 months
ADMIT
Uti treatment over 3 months
if lower - as normal
if upper consider admission and give veph/co amoxy for 7-10 days
How do you diagnose heart failure in a baby?
poor feeding
breathless(worse on exertioni.e feeding)
When do left to right shunts present? why?
greater than 2 weeks because this is when the pulmonary resistance begins to fall
frequent attendance to A and E rather than GP
-
DDH treatment?
check at 3-6 weeks as largely resolve investigate after this
4-5 months = pavlik harness
Say mamma and dadda
9-10 months
Risk of further febrile convulsion after first
30%
exclusion from school for roseola?
none
nost common cause of death upto 1 year?
SIDS - most common at 3 motnhs
do you get infertility with measles?
no
what temp would make you consider pneumonia over brinchiolitis
39 or more
look for renal scarring
DMSA
bekwith weiderman
big tongue
hypoglycaemia
macrosomia
What do you NOT get in a baby with hypothyroidism
hpoglycaemia
you do get a biig tongue and an umbilical hernia and floppiness though
percentage of kids with cows milk allergy
3-6%
choanal atresia presentaiton
cyanosis when feeding kind of like a breath holding attack
how many doses is Men b
3
how many doses is IPV
5
asks who what ?
3
asks when why how?
4
how do you recognise diaphagmatic hernia
shifted apex beat
insert NG tube.
PPHN recognition?
high presure
cyanosed
left ot right shunting
OLIGAEMIA
signs of a frontal lobe seizure
repetitive jerky cyclical movements which may be missed
what is SUDEP
sudeen unexpected death in epilepsy
threadworm organism
enterobius vermicularis
scaphoid chest
diaphragmatic hernia
ground glass lungs in newborn
surfactant deficiency
3 primary features of ASD?
global language impairment and communication
ritualistic behaviours
impairment of social relationships
what are the aerly signs of CP
asymetric hand function before 12 months
delayed motor milestones
abnomral limb tone or posture
what is the maximal dose of beta agonists
10 puffs every 10-20 mins
likely need to refer to hospital if this does not resolve it
what lewvels of saturations distinguish moderate attack from lifethratening or severe
less than 92 percent
use PEF to distinguish these two 33% cutoff
when does laryngomalacia present
4 weeks and has likely been since
kasai procedure
biliary atresia
What is reflex anoxic also known as?
breath holding or response to pain or emotional stimulus
us7ually between 6 months and 3 years
what are petit mal seizures
absence
drop attacks?
lennox gustaut
hysarrythmia
infantile spaspms
vigabitran
what is irritable hip also known as
transient synovitis
most common - may need to aspirate to rule out septic
