MedEd 1 Flashcards
6 week old baby with persistent vomitting, small volume after feeds. child is upset during feeds, but settles. thriving, well otherwise. Dx?
gastroesophageal reflux
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?
cows milk protein intolerance
2y/o with faltering growth
O/E child is small, pale, thin
fallen centiles, now on 2nd for weight.
loose stools.
Dx?
coeliac
features of reflux vomit
small volume
feed related
upset but settles after
back arching
irritability
red flags of vomitting in baby
projectile
bilious
not passing stools
abdo distention
irritable / meningitic
bulging fontanelle
features of NAI
FTT
increased head circ / seizures
what causes GOR
physiological
low tone in immature lower oesophageal sphincter
what is GORD vs GOR
disease causing Sx that are troublesome
Ix of GOR
clinical
+/- endoscopy
+/- pH monitoring
advice for parents for GOR
avoid overfeeding
thickeners if formula
gaviscon if breastfed
Ix to distinguish GOR and CMPA
CMPA - avoid diary and see if Sx settles
triad of pyloric stenosis signs
projectile vomiting
visible peristalsis
palpable olive
RFs for pyloric stenosis
male (4:1)
FH
Ix for pyloric stenosis
abdo USS
blood gas
abdo USS results of pyloric stenosis
antral nipple / target sign
blood gas results of pyloric stenosis
low K
low Cl
metabolic alkalosis
Mx of pyloric stenosis
pyloromyotomy
normal age range of pyloric stenosis
6 weeks to 3 months ish
red flags for diarrhoea
poor weight gain / weight loss / faltering growth
continuous sx
night stools
blood / mucous
systemic disease - rash / fever / joint pain
DDx for diarrhoea
infection
coeliac
IBD
hyperthyroidism
CMPA
CF
drug induced - laxatives
congenital
overflow constipation
who gets toddlers diarrhoea
2-4 (max 1-5)
sx of toddlers diarrhoea
explosive diarrhoea
food present in it
well looking child, no growth issues
NO RED FLAGS
Mx of toddlers diarrhoea
reassurance
avoidance of triggers
when do kids get coeliac
after 6 months of life
Ix of coeliac
IgA TTG
IgA level to rule out false negatives
small bowel biopsy only if unclear
sx of coealic in kids
diarrhoea
weight loss
FTT
pale
dermatitis herpetiformis
apthous ulcers
peripheral neuropathy / delayed puberty
other conditions that increase your risk of coeliac
downs
turners
thyroid disease
T1DM
prevelance of CMPA
2-7%
2 types of CMPA
IgE or non IgE mediated
Dx of CMPA
Hx
skin prick test
elimination diet trial
Mx of CMPA
- formula fed babies
- breastfed babies
- IgE mediated
- formula = hyrolysed formula
- breast = maternal allergen avoidance
- IgE mediated = anaphylaxis advice
Sx of CMPA
itchy, red skin
N&V, diarrhoea w blood / mucous
food refusal / aversion
sneezing / rhinorrhoea
anaphylaxis !!
Dx of IBD
barium radiology
MRI colon
endoscopy / colonoscopy
types of IBD in kids
UC
IBD
indeterminate
acute vs maintenance Mx of IBD
acute = elemental diet, steroids
maintenance = 5-ASA, AZ, methotrexate, biologics
what is an elemental diet
protein shakes for 6 weeks so that the gut can rest
- aim to avoid using steroids but most kids will need the steroids
is FTT a Dx
NO - its a Sx
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?
physiological jaundice
12 hour old baby with jaundice on PNW. Poor tone, lethargic, resp distress. Dx?
early onset neonatal sepsis
3 week old baby at ED has jaundice persistent. first baby of non consanginous parents. pale stools, dark urine. Dx?
biliary atresia
what % of babies get jaundice
60% term
80% pre term
complication of jaundice in babies
kernicterus
- BR crossing BBB and causing profound disability / death
Ix of jaundice in neonate
clinical Dx
blood gas
Iab BR
split BR
group and DAT
FBC
Mx of jaundice
treat underlying cause
phototherapy / exchange transfusion - depends on level of BR
Sx of neonatal jaundice
lethargy
poor feeding
what % of physiological jaundice need Tx
1%
3 causes of physiological jaundice
increased haemolysis due to shorter lifespan of RBCs
immature hepatic enzyme systems
initial poor feeding / output
which babies get jaundice more
breastfed babies
red flags of jaundice in neonates
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
how long can breastmilk jaundice last
up to a few weeks
Mx of breastmilk jaundice and why
continue breastfeeding - benefits outweight risks
Tx algorithm - phototherapy etc
describe breastmilk jaundice picture
begins 3-5 days of life
very well child
breastfed !! - dont assume
what is haemolytic disease of newborn vs ABO incompatability
HDoN = RhD incompatability (or ant C/E/Kell/Duffy)
ABOI = AB incompatability
what is needed prior to HDoN and examples of this
sensitising events
- prev preg
- APH
- trauma
- antenatal procedure - inc TOP/miscarriage
prevention of HDoN
IM anti D to mum after possible sensitizing event
regular screening
Mx of HDoN
high risk of severe jaundice –> phototherapy
fetal blood transfusion
exchange transfusion
is HDoN or ABOI more common
ABOI
which preg is affected in ABOI vs HDoN
ABOI = 1st
HDoN = 2nd
blood film of ABOI vs HDoN
ABOI = spherocytosis
HDoN = erythroblastosis
which will have a + DAT , ABOI or HDoN
HDoN - strongly +
ABOI can be weakly positive or negative
which is more severe ABOI or HDoN
HDoN
haemolytic causes of neonatal jaundice
G6PD def
hereditary spherocytosis
PKD (rare)
sepsis
thalassaemia
ABO incompatability
HDoN
define prolonged jaundice
> 14 days in term or >21 days in prem
causes of prolonged jaundice
immune mediated
red cell defects - G6PD / spherocytosis
enzyme deficiencies
structural causes - biliary atresia
liver disease
infection - CMV etc
Mx of prolonged neonatal jaundice
urgent paeds review !!
split BR
blood group / DAT
cultures
why is biliary atresia time critical
surgery should be done under 90 days of life
prevelance of biliary atresia
1/70,000
associations of biliary atresia
pancreatic abnormalities
cardiac anomalies
malrotation
downs
splenic malformation
prevelance of splenic malformation in biliary atresia
100%
PC of biliary atresia
prolonged jaundice
raised LFTs
what time of BR is raised in biliary atresia
conjugate
Ix for biliary atresia
abdo exam
LFTs
abdo USS
phenobarbital excretion radionucleotide scan
liver biopsy
Mx of biliary atresia, inc specific surgery name
Kasai’s procedure
what % of biliary atresia pts have a liver transplant
80%
what can be felt on abdo exam in biliary atresia
hepatomegaly
what is kasai procedure
joining biliary tree to liver to duodenum
2 day boy, not passed urine since birth. AN scans show bilateral hydronephrosis. Dx?
obstructive uropathy
4F in A&E due to facial swelling, abdo distention. afebrile, low BP. ++++ proteinuria. Dx?
nephrotic syndrome
6y/o in A&E with coke coloured urine, bad throat infection 3 weeks ago, otherwise well with no rashes. Dx?
post strep glomerulonephritis
what % of babies pass urine in 24hrs
90%
what Dx do you not want to miss in a bbay that has not passed urine in first 24hrs
pelviureteric junction obstruction
what is a posterior urethral valve
mucosal fold in posterior urethra (males) leading to obstruction
Ix in posterior urethral valve
MCUG
Mx of posterior urethral valve
suprapubic catheter
resection
Signs of PJO
unilateral
hydronephrosis noted on antenatal scans
Mx of PJO
ureteroplasty
what is the main cause of UTI in kids
e.coli 80%
atypical UTI features
seriously ill
poor urine flow
abdo mass
renal dysfunction
not responding to tx in 48hrs
non e coli organism
when are UTIs more common in boys than girls
<6 months
what % of first presentation UTI have renal scarring
15%
name an atypical UTI organism
klebsiella
what is a wilms tumour
nephroblastoma
prevelance of wilms tumour
1 in 10000 (5% of childhood cancers)
age of wilms tumours
95% in under 10s
PC of wilms tumour
asymptomatic massive abdo mass found during bathing
+/- abdo pain +/- HTN
Dx of wilms tumour
abdo USS
CT / MRI
Mx of wilms tumour
nephrectomy
what is the most common glomerular disorder of childhood
nephrotic syndrome
triad of nephrotic syndrome
proteinuria
hypoalbuminaemia
oedema
causes of nephrotic syndrome
minimal change disease
congenital
cancer
infections
immune disorders
Mx of nephrotic syndrome
prednisolone 60mg/m2/day for 4-6 weeks, then wean
diuretics and low salt diet
daily urine dips +/- ABx prophylaxis
why do you give ABx prophylaxis in nephrotic syndrome
glomerular issue so they lose lots of Ig in the urine and can become unwell with strep
define remission from nephrotic syndrome
negative urinalyis on first morning urine for 3 mornings
define relapse of nephrotic syndrome
3+ proteinuria on three or more consecutive days urine dip
define frequently relapsing nephrotic syndrome
2 relapses in 6 months
define steroid resistant nephrotic syndrome
no remission after 4 weeks of tx
complications of nephrotic syndrome
infection - s.pneumo
thrombosis
hypovolaemia
drug toxicity
indications for renal biopsy in nephrotic syndrome
congenital nephrotic syndrome
<1 year or >12 years
gross / persistent haematuria
low c3
HTN
impaired renal func
steroid resistant
coca cola urine
post strep glomerulonephritis
PC of PSGN
reddish brown (coke) coloured urine 10-14days after strep throat / skin infection
cause of PSGN
deposition of immune complexes in glomeruli
Ix of PSGN with results
throat swab
ASOT
low C3
normal c4
tx of PSGN
supportive
general features of glomerulonephritis
haematuria
proteinuria
nephrotic syndrome
acute nephritic syndrome - oliguria, HTN
difference between IgAN and PSGN
IgAN - days after strep URTI / gastro / UTI
PSGN - weeks post strep URTI / skin
how do c3 levels differ between IgAN and PSGN
IgAN - normal
PSGN - low
pathogenesis of IgAN
IgA depositions causing inflammation
complication of IgAN
10-15% get HTN +/- renal failure
Tx of IgAN
ACEi
what is the most common cause of vasculitis
HSP
is there renal involvemet inHSP
YES - 70%
PC of HSP
abdo pain
arthritis
haematuria / proteinuria
purpura
recent URTI
Mx of HSP
self limiting and supportive
NSAIDs
monitor renal func
steroids have limited role
which HSP kids have worse outcome
renal involvement
age range of HSP
2-6 years old
how can HUS be distinguished from HSP in exams
HUS has recent history of bloody diarrhoea and they are SICK
triad of HUS
microangiopathic haemolytic anaemia
thrombocytopaenia
acute renal failure
what can HUS cause commonly in kids
renal failure
what infection do 90% of HUS pts have prior to HUS
E.Coli 0157
Mx of HUS
fluid management
blood products transfusion
dialysis if needed
dialysis criteria
persistent acidosis
diuretic resistant overload
refractory hyperkalaemia
uraemia sx
what is erythema toxicum
red rash anywhere on body
BENIGN
can be pustules / macules / papules
time frame of erythema toxicum
occurs within first 24hrs and persists 1-2 weeks
how can erythema toxicum change
changes position on body and distribution (migratory)
Tx of erythema toxicum
nothing - will go away by itself
PC of neonatal pustulosis melanosis
superficial fragile pustules, which can rupture and leave pigmented macule under which fades after 3 months
Tx of neonatal pustulosis melanosis
none (same as erythema toxicum)
what is a strawberry naevus
birth mark
infantile haemangioma - benign collection of BVs
RFs of strawberry naevus
low birth weight
advanced maternal age
multiple preg
PET / placenta praevia
feautres of strawberry naevus
solitary
head / neck
blanches
starts flat then progresses to be raised
what does multiple strawberry naevis indicate
internal organ involvement
growth of strawberry naevus
grows over first year then involutes
Ix of strawberry naevus
abdo USS
Mx of strawberry naevus
topical beta blockers
surgery / embolisation
complications of strawberry naevus
bleeding
infection
local sx
ulcerate
what is salmon patch / stalk bite / naevus simplex
benign capillary vascular malformation
what does stalk bite look like
pink / red flat patch usually on nape of neck
irregular borders
blanches on compression
progression of stalk bite
usually fades in first 2 years of life but never fully disapears
who gets stalk bites
40% people
male and female equally
prevelance of port wine stain
0.3%
what is a port wine stain
capillary vascular malformation
features of port wine stain
large flat red / purple patch on skin with well defined border
usually on face
what sydrome is port wine stain ass/w
sturge weber syndrome (cavernous haemangioma of trigeminal nerve)
progression of port wine stain
nothing - they will not go away on their own
other features of sturge weber syndrome
port wine stain
epilepsy
LD
3 y/o with fever, hepatosplenomegaly, enlarged tonsils and widespread rash. dx?
erythema multiforme
what is erythema multiforme
red papules and target lesions
acute, self limiting
symmetrical
can involve lips / tongue etc
causes of erythema multiforme
infections - HSV, EBV, chlamydia, mycoplasma
drugs - penicillin, sulfonamides
AI - SLE
malignancy
what causes scarlet fever
group a strep pyogenes
features of rash in scarlet fever inc timing
rough sandpaper rash, worse in skin fold
occurs 48hrs after fever
salmon pink
tx of scarlet fever
penicillin V
complications of scarlet fever
suppurative - otitis media, mastoiditis, tonsillar abscess, meningitis, endocarditis, invasive group a strep (bad pleual effusions)
non suppurative - rheumatic fever, PSGN
cause of erythema marginatum
immune reaction - delayed response to group a strep
occurs in 10% cases with rheumatic fever
tx of erythema marginatum
penecillin
features of erythema marginatum
target looking - red on the outside, paler on the inside
mneumonics for rheumatic fever signs
CASES (major)
carditis
arthritis
subcut nodules
erythema marginatum
sydenhams chorea
FRAPP (minor)
fever
esr / crp raised
arthralgia
prolonged pr interval
previous rf
describe erythema migrans
solitary bullseye lesion
- red papule with annular red ring
cause of erythema migrans
lyme disease
tx of erythema migrans
doxycycline
sx of measles
high fever
cough
coryzal sx 2-3 days before rash
describe measles rash
starts at head, 2 days post fever, and spread to body
morbilliform rash
palms and feet spared
koplik spots in mouth
mx of measles
low risk of comps due to vaccination
self limiting
complications of measles
encephalitis / meningitis
parvovirus rash features
slapped cheek
3-4d after fever starts
cafe au lait spots with axillary freckling
neurofibromatosis type 1
bone lesions, cafeau lait spots and prococious puberty
mccune albright syndrome
what % of NF is type 1 vs 2
90% type 1
inheritance of NFT1
AD
chromosome of NFT1
17
diagnostic criteria of NFT1
> 2 of:
6 cafe au lait spots
2 neurofibromas / 1 plexiform neurofibroma
axillary / inguinal freckling
optic glioma
lisch nodules
osseous lesions
1st degree relative
tuberous sclerosis features
epilepsy / seizures
developmental impairment / LD
retinal hamartomas
renal angiomas
cardiac rhabdomyomas
shagreen patches
hypopigmented macules
chromosome of tuberous sclerosis
9
inheritance of tuberous sclerosis
AD
cafe au lait differentials
NFT 1
tuberous sclerosis
ataxic telangiectasia
fanconi’s anaemia
mccune -albright
russel silver syndrome
gaucher’s disease
normal
most common organism causing early onset neonatal sepsis
GBS
2y/o with fever, reduced conciousnes, spreading purpuric rash. Dx?
meningococcal meningitis
4y/o 6/7 fever, red eyes, swollen hands and feet, widespread maculopapular rash. Dx?
kawasaki
which babies get e.coli early neonatal sepsis
recurrent UTI in mum
Rfs for neonatal sepsis
prem
prolonged ROM
maternal fever
maternal GBS
resus at birth
neonatal jaundice and thrombocytopaenia
CMV
neonatal congenital heart disease, cataracts, deafness
rubella
severe foetal anaemia / hydrops fetalis
parvovirus
hydrocephalus in neonate
toxoplasmosis
Dx criteria of encephalitis
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
mortality of encephalitis
10%
infectious causes of encephalitis
TORCH
cmv / toxo / MMR / enterovirus / syphillis
what is toxic shock syndrome
infection with toxin producing bacterium causing exaggerated immune response –> multi organ failure
causes of toxic shock
group a strep - scarlet fever, tonsilitis, cellulitis
burns /scalds
surgical wounds / deep abscesses (staph aureus infection)
retained POC / tampons
Mx of TSS
resus
IV ABx
IV Ig
features of kawasaki
fever over 5 days
bilateral non purulent conjucitivitis
cervical lymphadenopathy
rash
red / cracked lips
swelling / peeling of hands and feet
Tx of kawasaki
IVIG
aspirin
complications of Kawasaki
coronary artery aneurysms