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Y5 Paeds > MedEd 1 > Flashcards

MedEd 1 Flashcards

1
Q

6 week old baby with persistent vomitting, small volume after feeds. child is upset during feeds, but settles. thriving, well otherwise. Dx?

A

gastroesophageal reflux

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2
Q

6 month old baby with diarrhoea, coliky abdo pain. sx started recently after starting formula.
O/E soft abdo, patches of eczema on flexural surfaces. Dx?

A

cows milk protein intolerance

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3
Q

2y/o with faltering growth
O/E child is small, pale, thin
fallen centiles, now on 2nd for weight.
loose stools.
Dx?

A

coeliac

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4
Q

features of reflux vomit

A

small volume
feed related
upset but settles after
back arching
irritability

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5
Q

red flags of vomitting in baby

A

projectile
bilious
not passing stools
abdo distention
irritable / meningitic
bulging fontanelle
features of NAI
FTT
increased head circ / seizures

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6
Q

what causes GOR

A

physiological
low tone in immature lower oesophageal sphincter

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7
Q

what is GORD vs GOR

A

disease causing Sx that are troublesome

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8
Q

Ix of GOR

A

clinical
+/- endoscopy
+/- pH monitoring

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9
Q

advice for parents for GOR

A

avoid overfeeding
thickeners if formula
gaviscon if breastfed

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10
Q

Ix to distinguish GOR and CMPA

A

CMPA - avoid diary and see if Sx settles

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11
Q

triad of pyloric stenosis signs

A

projectile vomiting
visible peristalsis
palpable olive

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12
Q

RFs for pyloric stenosis

A

male (4:1)
FH

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13
Q

Ix for pyloric stenosis

A

abdo USS
blood gas

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14
Q

abdo USS results of pyloric stenosis

A

antral nipple / target sign

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15
Q

blood gas results of pyloric stenosis

A

low K
low Cl
metabolic alkalosis

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16
Q

Mx of pyloric stenosis

A

pyloromyotomy

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17
Q

normal age range of pyloric stenosis

A

6 weeks to 3 months ish

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18
Q

red flags for diarrhoea

A

poor weight gain / weight loss / faltering growth
continuous sx
night stools
blood / mucous
systemic disease - rash / fever / joint pain

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19
Q

DDx for diarrhoea

A

infection
coeliac
IBD
hyperthyroidism
CMPA
CF
drug induced - laxatives
congenital
overflow constipation

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20
Q

who gets toddlers diarrhoea

A

2-4 (max 1-5)

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21
Q

sx of toddlers diarrhoea

A

explosive diarrhoea
food present in it
well looking child, no growth issues
NO RED FLAGS

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22
Q

Mx of toddlers diarrhoea

A

reassurance
avoidance of triggers

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23
Q

when do kids get coeliac

A

after 6 months of life

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24
Q

Ix of coeliac

A

IgA TTG
IgA level to rule out false negatives
small bowel biopsy only if unclear

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25
Q

sx of coealic in kids

A

diarrhoea
weight loss
FTT
pale
dermatitis herpetiformis
apthous ulcers
peripheral neuropathy / delayed puberty

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26
Q

other conditions that increase your risk of coeliac

A

downs
turners
thyroid disease
T1DM

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27
Q

prevelance of CMPA

A

2-7%

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28
Q

2 types of CMPA

A

IgE or non IgE mediated

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29
Q

Dx of CMPA

A

Hx
skin prick test
elimination diet trial

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30
Q

Mx of CMPA
- formula fed babies
- breastfed babies
- IgE mediated

A
  • formula = hyrolysed formula
  • breast = maternal allergen avoidance
  • IgE mediated = anaphylaxis advice
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31
Q

Sx of CMPA

A

itchy, red skin
N&V, diarrhoea w blood / mucous
food refusal / aversion
sneezing / rhinorrhoea
anaphylaxis !!

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32
Q

Dx of IBD

A

barium radiology
MRI colon
endoscopy / colonoscopy

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33
Q

types of IBD in kids

A

UC
IBD
indeterminate

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34
Q

acute vs maintenance Mx of IBD

A

acute = elemental diet, steroids
maintenance = 5-ASA, AZ, methotrexate, biologics

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35
Q

what is an elemental diet

A

protein shakes for 6 weeks so that the gut can rest
- aim to avoid using steroids but most kids will need the steroids

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36
Q

is FTT a Dx

A

NO - its a Sx

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37
Q

2 day old baby with jaundice. term, SVD, no antenatal concerns.
BR > phototherapy threshold. Had tx.
no haemolysis on film, normal obs and exam. Dx?

A

physiological jaundice

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38
Q

12 hour old baby with jaundice on PNW. Poor tone, lethargic, resp distress. Dx?

A

early onset neonatal sepsis

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39
Q

3 week old baby at ED has jaundice persistent. first baby of non consanginous parents. pale stools, dark urine. Dx?

A

biliary atresia

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40
Q

what % of babies get jaundice

A

60% term
80% pre term

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41
Q

complication of jaundice in babies

A

kernicterus
- BR crossing BBB and causing profound disability / death

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42
Q

Ix of jaundice in neonate

A

clinical Dx
blood gas
Iab BR
split BR
group and DAT
FBC

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43
Q

Mx of jaundice

A

treat underlying cause
phototherapy / exchange transfusion - depends on level of BR

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44
Q

Sx of neonatal jaundice

A

lethargy
poor feeding

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45
Q

what % of physiological jaundice need Tx

A

1%

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46
Q

3 causes of physiological jaundice

A

increased haemolysis due to shorter lifespan of RBCs
immature hepatic enzyme systems
initial poor feeding / output

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47
Q

which babies get jaundice more

A

breastfed babies

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48
Q

red flags of jaundice in neonates

A

jaundice under 24hrs of life / after 14 days of life (21 in prem)
ABO / RhD incompatability
prev sibling neding photoTx
cephalohaematoma / birth trauma
FH of RBC defect
sepsis
prem

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49
Q

how long can breastmilk jaundice last

A

up to a few weeks

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50
Q

Mx of breastmilk jaundice and why

A

continue breastfeeding - benefits outweight risks
Tx algorithm - phototherapy etc

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51
Q

describe breastmilk jaundice picture

A

begins 3-5 days of life
very well child
breastfed !! - dont assume

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52
Q

what is haemolytic disease of newborn vs ABO incompatability

A

HDoN = RhD incompatability (or ant C/E/Kell/Duffy)
ABOI = AB incompatability

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53
Q

what is needed prior to HDoN and examples of this

A

sensitising events
- prev preg
- APH
- trauma
- antenatal procedure - inc TOP/miscarriage

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54
Q

prevention of HDoN

A

IM anti D to mum after possible sensitizing event
regular screening

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55
Q

Mx of HDoN

A

high risk of severe jaundice –> phototherapy
fetal blood transfusion
exchange transfusion

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56
Q

is HDoN or ABOI more common

A

ABOI

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57
Q

which preg is affected in ABOI vs HDoN

A

ABOI = 1st
HDoN = 2nd

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58
Q

blood film of ABOI vs HDoN

A

ABOI = spherocytosis
HDoN = erythroblastosis

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59
Q

which will have a + DAT , ABOI or HDoN

A

HDoN - strongly +
ABOI can be weakly positive or negative

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60
Q

which is more severe ABOI or HDoN

A

HDoN

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61
Q

haemolytic causes of neonatal jaundice

A

G6PD def
hereditary spherocytosis
PKD (rare)
sepsis
thalassaemia
ABO incompatability
HDoN

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62
Q

define prolonged jaundice

A

> 14 days in term or >21 days in prem

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63
Q

causes of prolonged jaundice

A

immune mediated
red cell defects - G6PD / spherocytosis
enzyme deficiencies
structural causes - biliary atresia
liver disease
infection - CMV etc

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64
Q

Mx of prolonged neonatal jaundice

A

urgent paeds review !!
split BR
blood group / DAT
cultures

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65
Q

why is biliary atresia time critical

A

surgery should be done under 90 days of life

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66
Q

prevelance of biliary atresia

A

1/70,000

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67
Q

associations of biliary atresia

A

pancreatic abnormalities
cardiac anomalies
malrotation
downs
splenic malformation

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68
Q

prevelance of splenic malformation in biliary atresia

A

100%

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69
Q

PC of biliary atresia

A

prolonged jaundice
raised LFTs

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70
Q

what time of BR is raised in biliary atresia

A

conjugate

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71
Q

Ix for biliary atresia

A

abdo exam
LFTs
abdo USS
phenobarbital excretion radionucleotide scan
liver biopsy

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72
Q

Mx of biliary atresia, inc specific surgery name

A

Kasai’s procedure

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73
Q

what % of biliary atresia pts have a liver transplant

A

80%

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74
Q

what can be felt on abdo exam in biliary atresia

A

hepatomegaly

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75
Q

what is kasai procedure

A

joining biliary tree to liver to duodenum

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76
Q

2 day boy, not passed urine since birth. AN scans show bilateral hydronephrosis. Dx?

A

obstructive uropathy

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77
Q

4F in A&E due to facial swelling, abdo distention. afebrile, low BP. ++++ proteinuria. Dx?

A

nephrotic syndrome

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78
Q

6y/o in A&E with coke coloured urine, bad throat infection 3 weeks ago, otherwise well with no rashes. Dx?

A

post strep glomerulonephritis

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79
Q

what % of babies pass urine in 24hrs

A

90%

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80
Q

what Dx do you not want to miss in a bbay that has not passed urine in first 24hrs

A

pelviureteric junction obstruction

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81
Q

what is a posterior urethral valve

A

mucosal fold in posterior urethra (males) leading to obstruction

82
Q

Ix in posterior urethral valve

A

MCUG

83
Q

Mx of posterior urethral valve

A

suprapubic catheter
resection

84
Q

Signs of PJO

A

unilateral
hydronephrosis noted on antenatal scans

85
Q

Mx of PJO

A

ureteroplasty

86
Q

what is the main cause of UTI in kids

A

e.coli 80%

87
Q

atypical UTI features

A

seriously ill
poor urine flow
abdo mass
renal dysfunction
not responding to tx in 48hrs
non e coli organism

88
Q

when are UTIs more common in boys than girls

A

<6 months

89
Q

what % of first presentation UTI have renal scarring

A

15%

90
Q

name an atypical UTI organism

A

klebsiella

91
Q

what is a wilms tumour

A

nephroblastoma

92
Q

prevelance of wilms tumour

A

1 in 10000 (5% of childhood cancers)

93
Q

age of wilms tumours

A

95% in under 10s

94
Q

PC of wilms tumour

A

asymptomatic massive abdo mass found during bathing
+/- abdo pain +/- HTN

95
Q

Dx of wilms tumour

A

abdo USS
CT / MRI

96
Q

Mx of wilms tumour

A

nephrectomy

97
Q

what is the most common glomerular disorder of childhood

A

nephrotic syndrome

98
Q

triad of nephrotic syndrome

A

proteinuria
hypoalbuminaemia
oedema

99
Q

causes of nephrotic syndrome

A

minimal change disease
congenital
cancer
infections
immune disorders

100
Q

Mx of nephrotic syndrome

A

prednisolone 60mg/m2/day for 4-6 weeks, then wean
diuretics and low salt diet
daily urine dips +/- ABx prophylaxis

101
Q

why do you give ABx prophylaxis in nephrotic syndrome

A

glomerular issue so they lose lots of Ig in the urine and can become unwell with strep

102
Q

define remission from nephrotic syndrome

A

negative urinalyis on first morning urine for 3 mornings

103
Q

define relapse of nephrotic syndrome

A

3+ proteinuria on three or more consecutive days urine dip

104
Q

define frequently relapsing nephrotic syndrome

A

2 relapses in 6 months

105
Q

define steroid resistant nephrotic syndrome

A

no remission after 4 weeks of tx

106
Q

complications of nephrotic syndrome

A

infection - s.pneumo
thrombosis
hypovolaemia
drug toxicity

107
Q

indications for renal biopsy in nephrotic syndrome

A

congenital nephrotic syndrome
<1 year or >12 years
gross / persistent haematuria
low c3
HTN
impaired renal func
steroid resistant

108
Q

coca cola urine

A

post strep glomerulonephritis

109
Q

PC of PSGN

A

reddish brown (coke) coloured urine 10-14days after strep throat / skin infection

110
Q

cause of PSGN

A

deposition of immune complexes in glomeruli

111
Q

Ix of PSGN with results

A

throat swab
ASOT
low C3
normal c4

112
Q

tx of PSGN

A

supportive

113
Q

general features of glomerulonephritis

A

haematuria
proteinuria
nephrotic syndrome
acute nephritic syndrome - oliguria, HTN

114
Q

difference between IgAN and PSGN

A

IgAN - days after strep URTI / gastro / UTI
PSGN - weeks post strep URTI / skin

115
Q

how do c3 levels differ between IgAN and PSGN

A

IgAN - normal
PSGN - low

116
Q

pathogenesis of IgAN

A

IgA depositions causing inflammation

117
Q

complication of IgAN

A

10-15% get HTN +/- renal failure

118
Q

Tx of IgAN

A

ACEi

119
Q

what is the most common cause of vasculitis

A

HSP

120
Q

is there renal involvemet inHSP

A

YES - 70%

121
Q

PC of HSP

A

abdo pain
arthritis
haematuria / proteinuria
purpura
recent URTI

122
Q

Mx of HSP

A

self limiting and supportive
NSAIDs
monitor renal func
steroids have limited role

123
Q

which HSP kids have worse outcome

A

renal involvement

124
Q

age range of HSP

A

2-6 years old

125
Q

how can HUS be distinguished from HSP in exams

A

HUS has recent history of bloody diarrhoea and they are SICK

126
Q

triad of HUS

A

microangiopathic haemolytic anaemia
thrombocytopaenia
acute renal failure

127
Q

what can HUS cause commonly in kids

A

renal failure

128
Q

what infection do 90% of HUS pts have prior to HUS

A

E.Coli 0157

129
Q

Mx of HUS

A

fluid management
blood products transfusion
dialysis if needed

130
Q

dialysis criteria

A

persistent acidosis
diuretic resistant overload
refractory hyperkalaemia
uraemia sx

131
Q

what is erythema toxicum

A

red rash anywhere on body
BENIGN
can be pustules / macules / papules

132
Q

time frame of erythema toxicum

A

occurs within first 24hrs and persists 1-2 weeks

133
Q

how can erythema toxicum change

A

changes position on body and distribution (migratory)

134
Q

Tx of erythema toxicum

A

nothing - will go away by itself

135
Q

PC of neonatal pustulosis melanosis

A

superficial fragile pustules, which can rupture and leave pigmented macule under which fades after 3 months

136
Q

Tx of neonatal pustulosis melanosis

A

none (same as erythema toxicum)

137
Q

what is a strawberry naevus

A

birth mark
infantile haemangioma - benign collection of BVs

138
Q

RFs of strawberry naevus

A

low birth weight
advanced maternal age
multiple preg
PET / placenta praevia

139
Q

feautres of strawberry naevus

A

solitary
head / neck
blanches
starts flat then progresses to be raised

140
Q

what does multiple strawberry naevis indicate

A

internal organ involvement

141
Q

growth of strawberry naevus

A

grows over first year then involutes

142
Q

Ix of strawberry naevus

A

abdo USS

143
Q

Mx of strawberry naevus

A

topical beta blockers
surgery / embolisation

144
Q

complications of strawberry naevus

A

bleeding
infection
local sx
ulcerate

145
Q

what is salmon patch / stalk bite / naevus simplex

A

benign capillary vascular malformation

146
Q

what does stalk bite look like

A

pink / red flat patch usually on nape of neck
irregular borders
blanches on compression

147
Q

progression of stalk bite

A

usually fades in first 2 years of life but never fully disapears

148
Q

who gets stalk bites

A

40% people
male and female equally

149
Q

prevelance of port wine stain

A

0.3%

150
Q

what is a port wine stain

A

capillary vascular malformation

151
Q

features of port wine stain

A

large flat red / purple patch on skin with well defined border
usually on face

152
Q

what sydrome is port wine stain ass/w

A

sturge weber syndrome (cavernous haemangioma of trigeminal nerve)

153
Q

progression of port wine stain

A

nothing - they will not go away on their own

154
Q

other features of sturge weber syndrome

A

port wine stain
epilepsy
LD

155
Q

3 y/o with fever, hepatosplenomegaly, enlarged tonsils and widespread rash. dx?

A

erythema multiforme

156
Q

what is erythema multiforme

A

red papules and target lesions
acute, self limiting
symmetrical
can involve lips / tongue etc

157
Q

causes of erythema multiforme

A

infections - HSV, EBV, chlamydia, mycoplasma
drugs - penicillin, sulfonamides
AI - SLE
malignancy

158
Q

what causes scarlet fever

A

group a strep pyogenes

159
Q

features of rash in scarlet fever inc timing

A

rough sandpaper rash, worse in skin fold
occurs 48hrs after fever
salmon pink

160
Q

tx of scarlet fever

A

penicillin V

161
Q

complications of scarlet fever

A

suppurative - otitis media, mastoiditis, tonsillar abscess, meningitis, endocarditis, invasive group a strep (bad pleual effusions)
non suppurative - rheumatic fever, PSGN

162
Q

cause of erythema marginatum

A

immune reaction - delayed response to group a strep
occurs in 10% cases with rheumatic fever

163
Q

tx of erythema marginatum

A

penecillin

164
Q

features of erythema marginatum

A

target looking - red on the outside, paler on the inside

165
Q

mneumonics for rheumatic fever signs

A

CASES (major)
carditis
arthritis
subcut nodules
erythema marginatum
sydenhams chorea

FRAPP (minor)
fever
esr / crp raised
arthralgia
prolonged pr interval
previous rf

166
Q

describe erythema migrans

A

solitary bullseye lesion
- red papule with annular red ring

167
Q

cause of erythema migrans

A

lyme disease

168
Q

tx of erythema migrans

A

doxycycline

169
Q

sx of measles

A

high fever
cough
coryzal sx 2-3 days before rash

170
Q

describe measles rash

A

starts at head, 2 days post fever, and spread to body
morbilliform rash
palms and feet spared
koplik spots in mouth

171
Q

mx of measles

A

low risk of comps due to vaccination
self limiting

172
Q

complications of measles

A

encephalitis / meningitis

173
Q

parvovirus rash features

A

slapped cheek
3-4d after fever starts

174
Q

cafe au lait spots with axillary freckling

A

neurofibromatosis type 1

175
Q

bone lesions, cafeau lait spots and prococious puberty

A

mccune albright syndrome

176
Q

what % of NF is type 1 vs 2

A

90% type 1

177
Q

inheritance of NFT1

A

AD

178
Q

chromosome of NFT1

A

17

179
Q

diagnostic criteria of NFT1

A

> 2 of:
6 cafe au lait spots
2 neurofibromas / 1 plexiform neurofibroma
axillary / inguinal freckling
optic glioma
lisch nodules
osseous lesions
1st degree relative

180
Q

tuberous sclerosis features

A

epilepsy / seizures
developmental impairment / LD
retinal hamartomas
renal angiomas
cardiac rhabdomyomas
shagreen patches
hypopigmented macules

181
Q

chromosome of tuberous sclerosis

A

9

182
Q

inheritance of tuberous sclerosis

A

AD

183
Q

cafe au lait differentials

A

NFT 1
tuberous sclerosis
ataxic telangiectasia
fanconi’s anaemia
mccune -albright
russel silver syndrome
gaucher’s disease
normal

184
Q

most common organism causing early onset neonatal sepsis

A

GBS

185
Q

2y/o with fever, reduced conciousnes, spreading purpuric rash. Dx?

A

meningococcal meningitis

186
Q

4y/o 6/7 fever, red eyes, swollen hands and feet, widespread maculopapular rash. Dx?

A

kawasaki

187
Q

which babies get e.coli early neonatal sepsis

A

recurrent UTI in mum

188
Q

Rfs for neonatal sepsis

A

prem
prolonged ROM
maternal fever
maternal GBS
resus at birth

189
Q

neonatal jaundice and thrombocytopaenia

A

CMV

190
Q

neonatal congenital heart disease, cataracts, deafness

A

rubella

191
Q

severe foetal anaemia / hydrops fetalis

A

parvovirus

192
Q

hydrocephalus in neonate

A

toxoplasmosis

193
Q

Dx criteria of encephalitis

A

major - altered mental status, lethargy, personality change >24hrs
minor - fever, seizures, focal neurology, CSF WBC >5, abnormal imaging / EEG
AND exclude trauma / metabolic / tumour / alcohol / abuse

194
Q

mortality of encephalitis

A

10%

195
Q

infectious causes of encephalitis

A

TORCH
cmv / toxo / MMR / enterovirus / syphillis

196
Q

what is toxic shock syndrome

A

infection with toxin producing bacterium causing exaggerated immune response –> multi organ failure

197
Q

causes of toxic shock

A

group a strep - scarlet fever, tonsilitis, cellulitis
burns /scalds
surgical wounds / deep abscesses (staph aureus infection)
retained POC / tampons

198
Q

Mx of TSS

A

resus
IV ABx
IV Ig

199
Q

features of kawasaki

A

fever over 5 days
bilateral non purulent conjucitivitis
cervical lymphadenopathy
rash
red / cracked lips
swelling / peeling of hands and feet

200
Q

Tx of kawasaki

A

IVIG
aspirin

201
Q

complications of Kawasaki

A

coronary artery aneurysms

Y5 Paeds (13 decks)

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