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MedEd revision lecture Flashcards

1
Q

6wk baby throwing up small vomumes after feeds, arching back, well and thriving

A

GORD

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2
Q

baby recently started on formula feeds, diarrhoea, colicky pain

A

cows milk protein allergy

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3
Q

differentials for vomiting baby

A

pyloric stenosis
GORD
posseting
Gastroenteritis (D+V)
bowel obstruction
raised ICP
ingesting toxins

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4
Q

GORD counselling

A

very common ~50% babies
poor tone in sphincter and overfeeding
will get better as baby gets better

avoid overfeeding
formula + thickeners
avoidance of cows milk protein (rule out)
consider gaviscon

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5
Q

pyloric stenosis

A

male 4:1

features:
projectile vomiting
palpable olive
visible peristalsis
weight loss
dehydration

Ix:
AUSS- antral nipple sign
blood gas- hypokalaemic hypochloraemic metabolic alkalosis

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6
Q

differentials for diarrhoea

A

Toddlers diarrhoea (1-5yrs frequent, explosive stool containing undigested food)
gastroenteritis
coeliac (>6months)
IBD (older)
CMPI
cystic fibrosis (steatorrhoea)
constipation with overflow

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7
Q

Investigations for coeliac

A

anti TTA abs
+ baseline IgA levels

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8
Q

different cows milk protein intolerance

A

IgE mediated –> anaphylaxis type picture

non IgE –> vomiting diarrhoea

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9
Q

what is hydrolysed formula

A

partially digested milk so prevents allergy in CMPI

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10
Q

neonatal jaundice investigations <24hrs

A

conjugated and unconjugated bilirubin

DAT test

Sepsis screen

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11
Q

why does breastfeeding increase jaundice

A

beta-glucoronidase enzyme increases bilirubin reabsorption in the gut brush boarder

inhibits UDP glucuronosyltransferase which conjugates bilirubin

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12
Q

what is haemolytic disease of the newborn?

A

mainly RhD incompatibility (also anti C, E, kell and duffy)

sensitisation of Rh-ve mother in previous baby

anti Rh Abs cross placenta in next pregnancy

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13
Q

features of ABO incompatibility

A

can be first pregnancy
mother blood group O, baby A or B

weakly positive DAT

jaundice in neonate <24hrs

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14
Q

biliary atresia associations

A

associations:
T21 and 18
intestinal malrotation
cardiac abnormalitis
pancreatic abnormalities
splenic malformation

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15
Q

biliary atresia management

A

urgen surgical referral
Kasai procedure
time critical 80%–> liver transplant

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16
Q

coca cola coloured urine
bad throat infection 3 weeks prior

A

post streptococcal glomerulonephritis

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17
Q

features of obstructive uropathy and examples

A

hydronephrosis or oligohydramnios on antenatal scans
not passed urine within 24hrs after birth

Eg.
posterior urethral valves
Pelviureteric junction obstruction (usually unilateral so may have passed some urine)

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18
Q

what are the features of atypical UTI

A

seriously ill
poor urine flow
abdominal mass
renal dysfunction
not responding to Rx after 48hrs
non E.coli organism (eg. Klebsiella)

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19
Q

most common paeds solid tumor

A

Wilms tumour
nephroblastoma

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20
Q

large abdo mass found during bath time, asymptomatic

A

wilms tumour

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21
Q

facial swelling, abdo distension, protein in urine, hypotension

A

nephrotic syndrome

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22
Q

triad in nephrotic syndrome

A

proteinuria
oedema
hypoalbuminaemia

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23
Q

causes of nephrotic syndrome

A

congenital
minimal change disease

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24
Q

management of nephrotic syndrome

A

daily urine dip
pred 60mg BD for 4-6 weeks then wean
low salt diet
diuretics

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25
when to refer for nephrotic syndrome
haematurea low C3 signs of renal impairment/ HPTN steroid resistant
26
complications of nephrotic syndrome
inc risk of thrombosis infection- strep pneumonea hypovolaemia drug toxicity
27
features of post strep glomerulonephritis
previous strep infection ~2weeks prior coca cola urine low C3
28
features of IgA nephropathy
days after URTI IgA deposition in glomerulus C3 usually normal
29
features of HSP
70% will have renal involvement eg. haematurea, protein uria GI symptoms purpuric rash on buttocks and back of legs arthralgia previous URTI
30
Haemolytic uraemic syndrome
Hx of recent bloody diarrhoea (E.coli 0157) triad: MAHA, thrombocytopenia (petechiae), AKI
31
Dialysis criteria for HUS
32
erythema toxicum counselling
nothing to worry about babies reaction to being outside of uterus moves around well child no management required may last for 1 month but will get better in weeks
33
what is port wine stain associated with?
sturge weber syndrome --> epilepsy, hemiplesia, learning difficulties
34
Causes of erythema multiforme
infection: EBV, HSV, mycoplasma, chlamydia Abx: penicillins, sulphonamides SLE malignancy
35
features of scarlet fever
widespread sandpaper like rash fever strawberry tongue sore throat
36
complications of scarlet fever
mastoiditis meningitis pleural effusion post strep glomerulonephritis rheumatic fever
37
erthyema marginatum
immune response to GAS infection
38
Erythema migrans
single target lesion- lymes disease
39
Features of measles
rash starting on head then moving down - spares hands and feet koplik spots 2-3 prodrome followed by rash high fever self limiting but risk of complications
40
causes ofCafe au lait spots
neurofibromatosis type 1 ataxic telagectasia fanconis anaemia mccune albright syndrome (fibrous dysplasia of bone, CAL spots and precocious anaemia) russel silver syndrome gauchters disease
41
features of neurofibromatosis type 1
autosomal dominant chrom 17 over 6 cafe au lait > neurofibromas axilliary/ inguinal frecklys optic glioma Lisch nodules osseous lesions 1st degree relative
42
Tubero sclerosis features
aut dom on chrom 9 epilepsy intellectual impairment retinal haematomas
43
neonatal sepsis RFs
prolonged rupture prematurity maternal fever Hx of GBS neonatal resuscitation
44
specific buzz for the following infections CMV Rubella Parvovirus toxoplasmosis
CMV- jaundice and thrombocytopenia Rubella- heart disease, cataracts and deafness parvovirus toxoplasmosis- hydrocephalus
45
encephalitis
inflammation of the brain infective or autoimmune major: altered GCS, lethergy, personality changes minor: fever, seizures, focal neurology, CSF WCC >5 causes: HSV, toxo, enteroviruses
46
toxic shock syndrome
exaggerated immune response to toxins in infection usually GAS, staph aureus, psuedo, klebsiella fever, rash, vomiting, diarrhoea, lymphopenia common after recent surgery or burn- high risk of infection
47
Diagnosis of T1DM
fasting glucose >7.9 random >11.1 2hr post prandial >11.1 2 of the above on separate occasions
48
Mx and counselling of newly diagnosed T1DM
1. same day MDT referral to paeds DM team -for diagnosis education: -lifestyle -education on insulin therapy - risks of diabetes - risks of DKA and hypos secondary care: - 4 clinics a year with HbA1c Mx screening - micro and macrovascular complications from age of 12 - screening for autoimmune diseases - diabetic foot checks psychosocial support daily basal bolus rapid release insulin injections before meals + long acting glucose continuous BM measurements
49
glucose targets in T1DM
fasting 4-7 random 4-7 post prandial 5-9
50
symptoms and PC of T1DM
polyuria polydipsia weight loss
51
what counts as a hypo episode
glucose <4mmol/L
52
symptoms of hypogylcaemic episode
53
management of hypo
54
sick day rules for T1DM
Blood glucose monitoring: every 2 hours Ketone testing (urine/blood) if ill or hyperglycaemia: every 2 hours Increase insulin (10-20% total daily dose) Adequate fluid intake (sugar-free): 100mls/hour If vomiting continuously >4h or ketone levels not reducing: hospital
55
RFs for T2DM in paeds
Family history Obesity Ethnicity After puberty
56
where anatomically is the obstruction in stridor
larynx to carina
57
what noise is made in obstruction above the larynx
stertor- snoring noise eg. tonsillitis, retropharyngeal abscess, decreased conciousness
58
causes of stridor
anaphylaxis croup epiglottitis bacterial tracheitis foreign body diptheria laryngomalacia subglottic stenosis (ex prem requiring intubation)
59
principles of mananagement of upper airway obstruction
1. keep child calm 2. oxygen if needed 3. call senior paediatrician, ENT, anaesthetics 4. extreme -> adrenaline neb first 5. then dex 0.15mg/kg (max 0.6mg/kg)- takes about 4hrs 6. budesonide nebuliser 7. treat underlying cause eg. anaphylaxis fluids, epiglottis abx
60
what is the mechanism of grunting
forcing air out of a closed glottis
61
when is the peak age of laryngomalacia and how is it managed
6-8weeks doesnt usually require intervention UNLESS failing to gain weight afebrile if not gaining weight -> referral to ENT for laryngoscope potentially surgery, anti reflux eg. omeprazole
62
why have you got to be cautious with fluids in trauma?
because you clot first with your best clotting factors and if you give too many fluids you risk bursting the clots and you're left with less good clotting factors and risk of bleeding
63
signs of salbutamol toxication
shivering / tremor vomiting high lactate hypokalaemia and arrhythmias
64
steps of acute asthma management
1. burst step 3x10 puffs salbutamol every 4 hrs 2x atrovent prednisolone orally (atopy history) 2. IV bolus step MgSO4 salbutamol aminophylline 3. infusion step aminophylline salbutamol 4. panic step intubate and ventilate ward management 1hrly salbutamol -> 2 hourly sal --> 3hrly sal --> 4hrly salbutamol --> home
65
what is a worrying sign on ABG in asthma
normal or high C02 as retaining and sign of tiring
66
collapsed baby main diagnoses
sepsis sepsis SEPSIS congenital heart disease inborn errors of metabolism (low glucose, high lactate) Non accidental injury
67
Right-sided heart problem
cyanotic heart disease
68
left sided heart problem
acyanotic shock pulmonary overload/ oedema
69
cyanotic heart diseases
Tricuspid atresia Transposition of the great arteries Tetralogy of fallot (VSD, overriding aorta, right outflow obstruction, right ventricle hypertrophy Pulmonary stenosis/ atresia Eienmengers (long time shunting to the right, lungs become overloaded and high pressure causing blood direction to reverse and shunt to the left hence becoming cyanotic) Ebsteins anomaly?
70
when does the PDA classically close?
day 4-5 of life
71
Acyanotic congenital heard disease
AVSD (T21)/ VSD mitral stenosis/ atresia co-arctation aortic stenosis ebsteins?
72
timing of CHD
first few hours atresia/ critical stenosis hypoplastic heart first few days Transposition, tetralogy, large PDA coarctation weeks aortic stenosis months right heart problems
73
duct dependent CHD
critical aortic stenosis HLHS transposition Ebsteins tricuspid atresia pulmonary atresia
74
How do distinguish causative organism in bronchiolitis (generalised creps and wheeze)
naso-pharyngeal aspirate - looking for host of viruses eg. RSV, rhinovirus, adenovirus, parainfluenza, covid
75
describe the course of illness in bronch
starts with coryzal development of resp distress over 3-4days peaks day 5 lasts 10-14 days
76
bronchitis podium
breathing: 1. no support 2. oxygen if <90-92% 3. CPAP/ vasotherm 4. Intubate and ventilate feeding 1. little and often feeds 2. NG feeds 3. IV fluids SUPPORTIVE MANAGEMENT
77
overview of wheeze in terms of age and diagnosis
under 1 year --> broncholitis 1-5yrs --> viral induced wheeze 5ish --> multi trigger wheeze over 5 --> asthma
78
under 4 weeks antibiotics for sepsis
cefotaxime (less risk of cholestasis than ceftriaxone) amoxicillin to cover listeria
79
antibiotics in sepsis for >4weeks
cefriaxone
80
papular rash - discrete raised lesions
think hand foot and mouth
81
macular rash- flat to the skin cant feel when stroke
maculAr -MMR
82
maculopapular rash
any normal viral rash
83
vesicular rash
varicella zoster, herpes
84
pustular rash
staph/ impetigo
85
petechial (<2mm) purpuric (>2mm)
think meningococcal sepsis/ DIC ITP HSP leukaemia
86
most important things to do when pt having a seizure
oxygen check BM start a timer call for help

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