haem bits

Question 1

kawasaki disease

Answer 1

type of vasculitis predominantly seen in kids

Question 2

kawasaki features

Answer 2

high grade fever which lasts >5days - resistant to antipyretics
- conjuctival injection
- bright red, cracked lips
- strawberry tongue

red palms of hands + soles of feet - later peel

Question 3

kawasaki disease diagnosis

Answer 3

clinical, no specific test

Question 4

kawasaki management

Answer 4

high dose aspirin!
-> (aspirin normally contraindicated due to Reyes)

IV immunoglobulins

Echocardiogram -> screening test for coronary artery aneurysms (complication)

Question 5

complication of kawasaki disease

Answer 5

coronary artery aneurysm

echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms

Question 6

iron def anaemia in kids

Answer 6

commonest nutritional disorder of childhood, affecting 10% of UK kids

prevalence higher in -
- asian
- afrocaribbean
- chinese

Question 7

causes of iron def anaemia in kids

Answer 7

• socioeconomic - iron supplemented milk formulas may be more expensive
• unmodified cow’s milk - poor source of iron, not absorbed well
• ethnic origin - Asian mothers may introduce solids later

Question 8

prevention of iron def anaemia in kids

Answer 8

supplementary iron in milk
dietary education
free formulas for at risk infants

Question 9

Henoch-Schonlein purpura (HSP)

Answer 9

IgA mediated small vessel vasculitis
- some overlap with IgA nephropathy

seen in kids following infection

Question 10

Henoch-Schonlein purpura presentation

Answer 10

palpable purpuric rash (with localised oedema) ove buttocks + extensor surfaces of arms + legs
abdo pain
polyarthritis
features of IgA nephrpathy - haematuria, renal failure

Question 11

Henoch-Schonlein purpura management

Answer 11

analgesia for arthralgia
mx of nephropathy = supportive
usually self-limiting - 1/3 relapse

BP + urinanalysis should be monitored

Question 12

immune/idiopathic thrombocytopenic purpura (ITP)

Answer 12

immune-mediated reduction in the platelet count
- antibodies are directed against glycoprotein IIb/IIIa or Ib-V-IX complex

example of type II hypersensitivity reaction

Question 13

immune/idiopathic thrombocytopenic purpura (ITP) hypersensitivity reaction type

Answer 13

type II hypersensitivity reaction

Question 14

what may precede immune/idiopathic thrombocytopenic purpura (ITP)

Answer 14

infection or vaccination

(more acute reaction than in adults)

Question 15

immune/idiopathic thrombocytopenic purpura (ITP) presentation

Answer 15

• bruising
• petechial or purpuric rash
• bleeding is less common + typically presents as epistaxis or gingival bleeding

Question 16

immune/idiopathic thrombocytopenic purpura (ITP) investigations

Answer 16

• FBC - isolated thrombocytopenia
• blood film

bone marrow examination if atypical features - lymph node enlarge, splenomegaly, high/low white cells

Question 17

immune/idiopathic thrombocytopenic purpura (ITP) management

Answer 17

usually, no treatment is required
avoid contact sports

if platelets <10/signif bleeding;
- oral/IV corticosteroid
- IV immunoglobulins
- platelet transfusions in emergency (active bleeding) only temporary fix (will be destroyed by circulating antibodies)

Question 18

Reye’s syndrome

Answer 18

severe, progressive encephalopathy affecting kids that is accompanied by fatty infiltration of liver, kidneys + pancreas

assoc with aspirin use

Question 19

management of Reye’s syndrome

Answer 19

peak incidence = 2yrs
- hx of preceding viral illness
- encephalopathy - confusion, seizure, cerebral oedema, coma
- fatty infiltration of liver, kidneys + pancreas
- hypoglycaemia

Question 20

management of Reyes syndrome

Answer 20

supportive

prognosis - 15-20% mortality