General Paeds 3

Question 1

What is henoch-schonlein purpura?

Answer 1

IgA mediated small vessel vasculitis. Overlap with IgA nephropathy.

Question 2

What are the features of HSP?

Answer 2

Palpapable purpuric rash with localised oedema over buttock and extensor surfaces of arms and legs.
Abdominal pain.
Polyarthritis.
Features of IgA nephropathy

Question 3

What is the treatment and prognosis of HSP?

Answer 3

Treatment - analgesia for arthralgia, supportive management if develops nephropathy.
Prognosis is excellent. Continue to monitor BP and urinalysis for evidence or renal involvement. If urinalysis becoems abnormal then do urine MC&S and urine PCR.

Question 4

Risk factors for iron deficiency anaemis in paeds?

Answer 4

Prematurity,
Low birth weight,
Multiple births,
Exclusive breastfeeding beyond 6months,
Delayed weaning,
Excessive cow milk consumption,
Adolescent females who started menstruation and have nutritionally deficient diets.
Malabsorption disease.

Question 5

Investigations and treatment of IDA in paeds?

Answer 5

Ix - bloods
Rx - iron supplementation for 3 months. Co-administration of vitamin C can help absorption. Dietary advice. Caution in kids who drink lots of milk as this chelates iron.

Question 6

What are the features of Kawasaki disease?

Answer 6

Seen mainly in children. It presents with:
- Main complications are coronary artery aneurysm
CRASH and burn
C - conjunctival injection/conjunctivitis
R - Rash (maculopapular and then desquamation)
A - adenopathy (cervical)
S - strawberry tongue (or cracked lips_
H - Hands/feet erythema
Burn - Fever > 5 days - think kawasaki if fever for > 5 days.

Question 7

What are the investigations for kawasaki disease?

Answer 7

Usually clinical diagnosis but can do the following:
FBC: Anaemia, leukocytosis and thrombocytosis.
LFTs: Hypoalbuminaemia and elevated LFTs.
Raised inflammatory markers eg, ESR.
Urinalysis may show WBCs.
ECHO: coronary artery pathology

Question 8

What are the three phases seen in kawasaki disease?

Answer 8

Acute phase - child most unwell with fever, rash and lymphadenopathy.
Subacute phase - acute symptoms settle, desquamation and arthralgia occurs. Highest risk of coronary artery aneurysms forming.
Convalescent stage - remaining symptoms settle

Question 9

What is the management of Kawasaki disease?

Answer 9

Two first line treatments:
1. High dose aspirin to reduce risk fo thombosis (one of the few senarios where aspirin is used in children)
2. IV immunoglobulin to reduce risk of coronary aneurysms.

Question 10

Risk with aspirin in kids?

Answer 10

Reye syndrome - progressive encephalopathy and fatty infiltration of liver, kidneys and pancreas.

Other causes: preceding viral illness

Question 11

What is the most common cause of pneumonia in children?

Answer 11

Strep pneumoniae in under 5s
Mycoplasma pnenumonia in 5-14y

Question 12

Risk factors for LRTIs

Answer 12

Things that increase risk of aspiration:
Prematurity,
Cerebral palsy,
Neuromuscular conditions
Epilepsy

Question 13

What is the management of pneumonia in paeds?

Answer 13

First line - amoxicillin.
Add macrolides if no response to above or if mycoplasma or chlamydia is suspected.
Co-amoxiclav recommended if pneumonia associated with influenza.

Question 14

Presentation of meningitis in children?

Answer 14

Irritable cry,
Vomiting,
Lethargy,
Poor feeding,
Fever,
Bludging fontanelle,
Apnoea,
Seizures,
Resistance to flexion

Question 15

Most common causative organisms for meningitis in neonates - 3 months old?

Answer 15

Group B streptococcus - acquired from mother at birth.
E.coli
Listeria monocytogens

Question 16

Most common causative organisms for meningitis in children 1 month to 6 years?

Answer 16

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenza

Question 17

Most common causative organisms for meningitis in children greater than 6 years?

Answer 17

Neisseria meningitidis
Streptococcus pneumoniae

Question 18

What are the investigations for meningitis in children?

Answer 18

1. Lumbar puncture, if contraindicated then only blood cultures and PCR for meningococcus should be obtained
2. Blood cultures and PCR,
3. Bloods
4. Culture of other areas - urine, stool and throat/respiratory PCR

Question 19

Contraindications for an LP in paeds?

Answer 19

Focal neurological signs,
Papilloedema,
Bulging of fontanelle,
DIC,
Cerebral herniation.
Meningococcal septicaemia

Question 20

What is the management of Meningitis in Paeds?

Answer 20

1. Antibiotics:
   < 3 months give IV amoxicillin and IV cefotaxime
   > 3 months give IV cefotaxime/ceftriaxone
2. Steroids: Only if over 3 months and if LP shows purulent CSF,
   WCC> 1000, bacteria on gram stain.
3. Fluids
4. Cerebral monitoring
5. Public health notification and contact prophylaxis

Question 21

What are the following definitions in children:
Overweight
Obese

Answer 21

Overweight - BMI > 91st centile
Obese - BMI > 98th centile

Question 22

Risk factors for obesity in children?

Answer 22

Asian children,
Female children,
Taller children

Question 23

What are the causes for obesity in children?

Answer 23

Growth hormone deficiency,
Hypothyroidism,
Down’s syndrome,
Cushing’s syndrome,
Prader-Willi syndrome

Question 24

Consequences of obesity in children?

Answer 24

Orthopaedic problems (Blount’s disease, slipped upper femoral epipyses, MSK pains.
Psychological consequences,
Sleep apnoea,
Benign intracranial hypertension,
Longer term: T2DM, HTN and ischemic heart disease.

Question 25

What is Plagiocephaly?

Answer 25

When the head is flattened on one side causing it to look asymmetrical