Misc Flashcards
X ray findings in scurvy
Sub periosteal haemorrhages in long bones
X ray findings in osteopetrosis
Osteogenic (dense) bony lesions
X ray findings in dietary rickets
Widening of the space between the epiphysis and metaphysis and cupping, irregularity and a ragged flaring metaphyseal surface (cupping, splaying and fraying)
Breastfeeding is protective against the development of certain allergies compared to formula T/F
T
However no evidence shown supporting it’s exclusive use past 6 months
If breast feeding is not possible in a family with a strong hx of atopic dermatitis evidence supports the use of hydrolysed cows milk T/F
True
Incomplete fusion of the choroid fissure in the first trimester can lead to what
Coloboma - defective development of the eye in the embryo stage, can be a defect of the iris, retina, optic nerve or eye lid
By how much is successful breast feeding reduced in those who have breast augmentation?
25%
Which is more concerning for child abuse in an infant: a parietal crack fracture or a depressed occipital skull fracture?
Depressed occipital skull fracture - indicated significant force.
Note: accidental fractures tend to be singular and in the parietal region
Cranial bruit may be heard in a patient with Vein of Galen malformation T/F
T - although cranial bruit is not pathognomonic of AVM (may be head in 15% of well children)
Muscle biopsy showing fibrofatty replacement of muscle fibres what disease?
Duchenne muscular dystrophy
A smaller proportional degree of force is required to fracture a child’s ribs than an adults T/F
F - adults ribs are more brittle than children’s
Note: due to this children can also have significant lung injury without rib fractures
When in a shockable rhythm hypothermia can lead to it being refractory to defibrillation T/F
True - should limit to three shocks at temperatures below 30
Any change in administering of drugs in a patient 30-35 degrees during a resus?
Interval between drug doses should be doubled (eg adrenaline every 8 minutes instead of every 4)
Note: 32 degrees is the temp a pt should be warmed to before stopping resus. Below 30 degrees resuscitations drugs are CI
Calc for an uncuffed and cuffed ETT
Uncuffed: internal diameter - (Age/4) + 4
Cuffed: internal diameter - (Age/4) + 3.5
How much is the risk of SIDS increased by sleeping prone?
6x
Which is a more common cause of familial hypophosphataemic rickets X linked or AD
X link is 80% - note this is X link AD so affects males and females
AD is 20%
MMR is safe to give to patients with a hx of anaphylaxis to eggs - T/F
True - it is grown on chick cells, not the egg white or yolk
Bone pain after alcohol consumption is a rare but characteristic manifestation of what disease?
Hodgkin’s lymphoma
Which vaccine is given via intradermal route?
BCG
Presentation of Vitamins K def vs Vit C
Vit K - impaired coag (easy bruising, mucosal bleeding), no hair changes
Vit C - Petechiae, bruising, gingivitis, impaired wound healing. Also joint pain and swelling (due to haemarthosis), lethargy and curly hair, perifollicular haemorrhages and hyperkeratosis
Presentation of Vit A def?
Night blindness and complete blindness
Note: can have bitot spots on exam (hyper pigmented conjunctival plaques)
Presentation of Cu def?
Fragile and abnormally formed hair Skin depigmentation Hepatosplenomegaly Osteoporosis Neurological and MSK disturbances
Breath holding spellings in children are assoc with what nutritional deficiency?
Fe
Phytomenadione is AKA
Vit K
Precursor of prostagladins? What enzyme?
Arachidonic acid
Cyclooxygenase
What inhibits prostagladin synthesis?
Aspirin
Glucocorticoids
Lipoxygenase are involved in the synthesis of?
Leukotrienes
In mechanical ventilation what should tidal volumes be targeted?
4-6ml/kg
Induration at the site of BCG vaccine is seen in 50% of children with what disease?
Kawasaki
The use of pillows increased the risk of SIDS by how much?
x2.5
According to APLS at what blood sugar level is an IV glucose bolus indicated?
< 2.6mmol/l (< 44g/dl)
Features of zn deficiency?
Chronic diarrhoea
Perianal and perioral rash
Reddish hair and alopecia
Ocular changes ( blepharitis, conjunctivitis, photophobia and corneal dystrophy)
Can also have associated candida infections
According to NICE guidelines below what level of 25OH vit D should supplementation be given?
Less than 25nmol/L
Note: 25 - 50 can advise nutrition and lifestyle
What treatment for Kawasaki disease has been shown to decrease the prevalence of coronary artery abnormalities?
IV IG
Note: aspirin is used in the tx but does not seem to have any effect on coronary artery abnormalities.
What is the treatment of Wilson’s disease?
Penicillamine (Cu binder) + vit B6 (to avoid neuropathy) + low Cu diet (avoid excessive chocolate, shellfish and liver)
Baseline urinary Cu and blood ceruloplasmin are the best ways to diagnosis Wilson’s disease T/F
F- overall diagnosis is challenging, baseline Cu is unreliable with low sensitivity and specificity.
Do check blood ceruloplasmin, can also do a pencillamine challenge ( if + will show raised urinary Cu > 25umol/24 hour after penicillamine) and raised hepatic Cu on biopsy. Note: serum Cu levels are not helpful.
It is rare for patient’s with Wilsons disease to present with neuro/psych symptoms. T/F
F - 50% will have these symptoms at presentation
In patients with rickets when do features of hypoCa usually present?
In adolescents (ie not seen in younger children with rickets)
Note: other features craniotabes (softening of the skull with delayed fontanelle closure), rachitic rosary, bowed legs (in weight bearing children) delayed dentition.
Aphonic cry is characteristic of what vit deficiency?
Thiamine def (B1)
Other features: lethargy, restlessness, emesis, tachypnea, cyanosis. Late stage - peripheral neuritis and decreased reflexes.
VitB1 is neutralised by boiling
What is Marcus Gunn syndrome also known as ?
“Jaw winking syndrome” - eyelid with ptosis opens wider when pt opens their mouth
Is idiopathic scoliosis more common in males or females?
Females
Note: typically do surgery when curvature is greater than 40 - 50 degrees in otherwise well children. Surgery is done sooner in those with DMD usually around 20 -30 degrees
Initial investigations in a 2 yr old presenting with concern for rickets?
Labs: Ca, alk phos, phos, vit D, PTH
Xrays
Ca, alk phos, phos, vit D, PTH labs findings in nutritional rickets?
Ca, phos: low or normal
Vit D: low
Alk phos, PTH: high
What labs values differentiate hypophosphataemic rickets from other types?
PTH and bicarb will be normal
Note: prox tubular acidosis can also cause hypophos rickets but the bicarb will be low
Obesity in children is defined as BMI > 25 T/F
F - do not use BMI number for obesity def in children. It is BMI > 95% for age and height
Formula for calculation of additional fluid replacement based on % body burns
% burn x weight (kg) x 3
Lead poisoning is assoc with antisocial behaviour T/F
T
Other assoc: Nausea, abdo pain, constipation Blue discolouration of gums, anaemia and pallor Motor neuropathy neuropsych problems, impaired cognition
Symptoms of hydrogen sulphide exposure?
Cough, dyspnoea and sore throat
Smell of garlic what toxin?
Selenium
Arsenic
Smell of bitter almonds what toxin?
Cyanide
Smell of wintergreen what toxin?
Methylsalicylate
Smell of mothballs what toxin?
Naphthalene
Main feature of naphthalene toxicity?
Haemolytic anaemia
Main features of arsenic poisoning?
GI features - nausea, emesis and diarrhoea
Is variegate an acute or chronic porphyria?
Acute
Note: there are 4 acute porphyrias, the other 3 are
acute intermittent porphyria
aminolaevulinic acid dehydratase deficiency porphyria
hereditary coporphyria
Only the acute ones cause neuro features
Features associated with a poor prognosis in carbon monoxide poisoning?
Anaemia
Exposure as a foetus
Pre existing CV disease > resp disease
Acidosis after exposure
What is the equation for anion gap?
What is a normal gap range?
Na - (Cl + Bicarb)
Normal: 10 -12
What is the pathology of Osgood Schlatter Disease?
An inflammation of the patellar ligament at the tibial tuberosity
What does met acidosis in the present of a normal anion gap indicate?
Bicarb loss (rather than excess acids)
Note: Routes for loss are gut or kidney.
What is the main factor that determines the mgmt, treatment and outcome in acute pancreatitis?
The severity (scoring systems used to determine this)
When does the eye develop into a distinct organ?
In the first trimester (by 22 days)
There is an association between Bells palsy and what cardiac abnormality?
Coarctation of the aorta
There is an association between Bells palsy and hypotension T/F
F - hypertension
Otitis media is a known cause of LMN facial palsy T/F
T
Complex regional pain syndrome vs Diffuse idiopathic pain syndrome?
The are both pain amplification syndromes
- CRPS: localised to one particular area such as a foot
- DIPS: diffuse as the name suggests
Where is renin produced?
Juxtaglomerular apparatus
Where does ADH primarily act?
Collecting ducts
Apolipoprotein CII deficiency will lead to what abnormality on a fasting lipid panel?
Elevated TG
Note: normal cholesterol
What is the most common porphyria?
Acute intermittent
NB: autosomal dominant but only 5% of those who have it ever experience an attack
What is the inheritance of porphyria cutanea tarda?
Can be inherited in an AD manner BUT most are actually acquired secondary to alcoholic liver disease
Red flag symptoms for LNs
Non-tender, firm or hard > 2cm progressively enlarging supraclavicular lymphadenopathy Other symptoms such as fever or weight loss
Intestinal bacterial overgrowth is a cause of B12 or folate deficiency?
Cause of B12 deficiency
Note: folate levels would be normal or high because small bowel bacteria increase the synthesis of folate
Presentation and mgmt of incarcerated vs strangulated hernia?
Both presents with symptoms of obstruction. Patient with a strangulated hernia will also be toxic
Incarcerated: manual reduction and then surgery in 2-3 days or emergency surgery if patient is too unwell. Abx not routinely used
Strangulated: emergency surgery +/- abx
What is the formula for BMI calculation?
Weight (kg)/ height (m)2
XP Analog LCP formula should be used the treatment of what?
PKU
Girls who are sexually abused have a higher rate of STIs than boys T/F
T - about 8% of abused girls will have a positive STI screen.
Night terrors typically occur during the first 1/3 of sleep (non REM) and the child is not easily calmed T/F
T
Other features of night terrors: assoc with autonomic features (tachycardia, diaphoresis and flushing), child usually does not remember the episode in the morning.
Note: nightmare have the opposite findings
When should middle of the night feedings be stopped in infants?
Between 4-6 months
What is the treatment for complex regional pain syndrome?
Physical and occupational therapy
Note: tends to be minimally response to analgesia. Steroids are not indicated
Features on exam of complex regional pain syndrome?
Allodynia
Localised autonomic dysfunction with edema, coolness or excess warmth, mottling and/or sweatiness
Eagle Barrett syndrome is also known as? 3 main features?
Prune belly
Aplasia or hypoplasia of abdominal muscles
Bilateral undescended testes
Urinary tract abnormalities - esp renal dysplasia
Note: also associated pulm hypoplasia, gut malrotation, cardiac abnormalities, MSK abnormalities
What does a high anion gap acidosis indicate?
Build up of some unmeasured acid in the blood
Note: high gap is > 12
Osmolar gap formula
Cause of normal or high osmolar gap acidosis?
Formula: measured - calculated where calculated (2 x [Na] + [glucose]/18 + [BUN]/2.8)
Normal (<10) excess of endogenous acids (eg ketones in DKA)
High (> 10) excess of exogenous acids (eg acids from ethylene glycol intoxication)
The rule of 9 is used to calculate burns % in children T/F
F - can only be used in those > 14 yrs. Younger children use the Lund and Browder chart
Partial thicken burns > than what % need to be referred to a burns centre?
> 10%
Other criteria:
burns involving face, hands, feet, perineum or major joints
full thickness burns
electrical, chemical or inhalation burns
pre existing medical conditions or concomitant trauma
no qualified personnel or equipment at the hospital
special needs - eg child abuse, substance abuse
What is the classic triad of Klippel-Feil syndrome?
Short webbed neck
Low hairline
Restriction of neck movement (due to C vertebrae fusion)
Note: other associated abnormality - hypo plastic scapula (Sprengel deformity); GU abnormalities; auditory system abnormality; cardiac
Definition of an increased arm span?
if arm span - height is greater than or equal 2.5 inches
Indications for head CT in trauma?
CT
- GCS < 15
- Altered mental status
- Signs of basal skull fracture
CT or observations for
- Emesis
- Loss of consciousness
- Severe headache
- Severe mechanism ( motor vehicle collision with ejection, rollover, or fatality; biker or pedestrian without a helmet vs. vehicle; head struck by a high-impact object; or fall > 5 feet)
Note: per PECARN for those > 2 yrs
X ray findings in Vit C deficiency?
Thin boney cortex
Ground glass appearance to bones
Sharply outlines epiphyseal ends (AKA white line of Frankel)
Haemolytic anaemia in premature infants can be associated with what vitamin deficiency?
Vit E
Note: can also develop oedema and thrombocytosis. Vit E levels are more accurately quantified when measured alongside serum lipids because high lipids increase serum vit E levels. A Vit E/serum lipid ratio < 0.8mg/g is abnormal
Testing for Sickle Cell trait is recommended as routine screening in college athletes T/F
T - sudden death can been attributed to extertional rhabdomyolysis (aka extertional sickling)
Maintenance fluid calculation by weight?
Fluid deficit calculation by weight?
100/50/20
100 ml/kg for first 10 kg
50 ml/kg for next 10kg
20ml/kg for remaining kg
Fluid deficient = percentage dehydration x weight in ml
eg 5% dehydration for a 25kg child
0.05 x 25,000 ml
Features of Cu deficiency?
Anaemia and neutropenia
Features of hypervitaminosis A
Malaise, anorexia, dry skin and mucus membranes, hair loss, seborrheic skin changes
Hepatosplenomegally
Pseudotumor cerebri
Mental status changes
X ray: long wavy cortisol hyperostosis of the bones, often sparing the metaphysical areas
Type 1 vs type 2 error
Type 1: concluding there is a difference in outcomes when there is not (eg rejecting the null hypothesis when it is actually true). p value
Type 2: concluding there is no difference when there actually is (eg failing to reject the null hypothesis when it is false)
Null hypothesis = default hypothesis; it says there will be no difference in outcomes
