Miscellaneous Flashcards
Neonate age range
First 28 days of life
Infant age range
Up to 1 year
Features of a mild-moderate allergic reaction (4)
- Facial swelling
- Urticaria
- Itchy/ tingling in mouth/ throat
- Gastro: vomiting, diarrhoea, abdominal discomfort
Features of anaphylaxis ABCDE
Airway
- Angioedema of airway
- Tongue swelling
- Stridor
- Hoarse voice
Breathing
- Tachypnoea
- Hypoxia
- Wheeze
Circulation
- Shock/ hypotension
- Weak pulse
- Pale/ cold extremities
Disability
- Reduced consciousness/ drowsiness
- Eyes: swelling, conjunctivitis
Exposure
- Urticaria
Management of mild-moderate allergic reaction
If symptoms have resolved
- Observation for a few hours
- Discharge with antihistamines (chlorphrenamine)
- Consider allergy clinic review
If symptoms still present
- Oral antihistamines +/- oral steroids
- Observe for few hours
Initial management of anaphylaxis
ABCDE management
- Establish airway
- Maintain O2 >92%
- Fluid resuscitation
- IM adrenaline every 5 mins, max 3
- IV adrenaline if IM fails
Post-resus management of anaphylaxis
IM or slow IV Antihistamine (chlorphrenamine) or hydrocortisone
Oral anti-histamine/ prednisolone follow up
Adrenaline autoinjector for future events
Kawasaki’s disease epidemiology
Typically affects children < 5
Feature of Kawasaki’s disease (ARDIO)
LymphAdenopathy
- Anterior cervical
Polymorphus Rash
- Due to light sensitivity
Distal changes of the extremities
- Erythema of hands and feet
Conjunctival injection
- Causing eye discomfort/ photophobia
Oral mucosa and lip changes
- Strawberry tongue
- Injected lips/ pharynx
Investigations for kawasaki’s disease
FBC
- Neutrophilia
- Leucocytosis
- Increased platelets (in second week)
U+Es
- Hyponatraemia
CRP (>50) and ESR (>80)
ECG
Urine MCS
- Pyuria
Throat swab
Echocardiogram
Which children with Kawasaki’s disease are at the most risk of coronary artery aneurysm?
Age < 6 months and >5
Management of Kawasaki’s disease + follow up
> 10 days from onset
- Low dose aspirin
- 3-5mg/kg/day for 6-8 weeks
<10 days / high risk of complications
- High dose IV IG 2g/Kg + high dose aspirin
Follow up echo with 7 days
Which vaccinations are required after treatment of Kawasaki’s disease?
Most likely to cause Reye syndrome with aspirin
- Varicella
- Influenza
Definition of juvenile idiopathic arthritis
Arthritis in age < 16 for > 6 weeks, with other causes excluded
Subtypes of JIA
Oligoarticular (most common)
Polyarticular RF positive and negative
Enthesitis-related
Juvenile Psoriatic
Systemic onset
Feature of systemic onset JIA
Daily fevers for at least 2 weeks that quickly becomes normal
Salmon pink rash
Lymphadenopathy
Enlarged spleen and liver
Serositis
Arthritis
Causes of primary noctrual enuresis
Primary nocturnal (never been dry at night) - Normal in <5
Has family history
Causes
- Overactive bladder
- High fluid intake
- Failure to wake
- Psychological distress
Causes of secondary enuresis
Wetting bed after at least 6 months of being dry at night
Causes
- UTI
- Constipation
- DM
- Psychosocial
- Abuse
Diurnal enuresis
- Causes
Daytime incontinence
Causes
- Learning disability
- Overactive bladder/ stress incontience
- Constipation
- Psychosocial
- Recurrent UTI
Management of enueresis
Non-pharmacological
- Enuresis alarm
Pharmacological
- Has to be started by specialist
_____ is the first line pharmacological treatment for nocturnal enuresis
Desmopressin
- Taken at bedtime
______ is the first line medication for an overactive bladder
Oxybutinin
________ is a tricyclic antidepressant that can be used for nocturnal enuresis
Imipramine
Transient synovitis is associated with _______
Recent Hx of a Viral URTI
Transient synvoitis typically presents in ages ____ and is more common in ______
Age 3-10
Boys > girls
Presentation of transient synovitis
Typically, generally well
- Mild/ no fever
Limp + difficulty weight-bearing
Mild-moderate hip pain
Normal/ mild hip restriction
________ must be ruled out before diagnosing transient synovitis
Septic arthritis
Transient synovitis typically improves significantly in ______ and fully resolves in __________
48 hours
1-2 weeks
Perthes disease arises from _______ of the ________
Avascular necrosis of the femoral epiphysis
Complications of perthes disease
Chronic pain
Hip osteoarthritis
Perthes disease typically presents in ages ____ and is more common in ______
4-12
Boys
Osgood-Schlatter disease is caused by inflammation at the _______
Tibial tuberosity
Osgood-Schlatter disease typically presents in age _______ and presents primarily with ______
Age 10-15
Anterior knee pain
Pathophysiology of Osgood-Schlatter disease
Inflammation of the tibial epiphyseal plate
- Arises from stresses like running/ jumping
Small avulsion fractures arising from patella tendon pulling small bone pieces.
Presentation of Osgood-Schlatter diease
Anterior knee pain
- Worsens with movement
Swelling at tibial tuberosity
- Tender during active inflammation
_______ and ______ of the knee worsen pain in Osgood-Schlatter disease
Kneeling and extension
Management of Osgood Schlatter disease
Avoiding stressing activity
Icing
NSAID
After active inflammation
- Stretching
- Physiotherapy to strengthen tendon
Slipped upper femoral epiphysis commonly presents in ages ______ and in _____ children
Ages 8-15 (boys)
Obese children
Risk factors for a slipper upper femoral epiphysis
History of trauma
Obesity
Rapid growth spurt
Hypothyroidism
Features of slipped upper femoral epiphysis
ACUTE Hip pain
- Radiating to groin/ knee/ thigh
- Prefer hip at external rotation
Restricted hip movement
- Especially internal rotation
Painful limp
Shortened affected limb
Initial investigation for slipped upper femoral epiphysis (SUFE)
Pelvic X Ray
Management of slipped upper femoral epiphysis (SUFE)
Surgery
Brittle bone syndrome is known as ________
Osteogenesis imperfecta
Osteogenesis imperfecta is caused by…
Group of genetic disorders
- Typically leads to abnormal Type 1 collagen formation
Osteogenesis imperfecta is inherited in _______ fashion but mutations may be ______
Autosomal dominant
De novo
The least severe form of osteogenesis imperfecta is ______ and the perinatally lethal type is _______
The least severe form of osteogenesis imperfecta is ______ and the perinatally lethal type is _______
Least severe= type 1
Lethal type= Type 2
Presentation of osteogenesis imperfecta
Physical features
- Blue/ grey sclera
- triangular face
- Short stature
MSK features
- Dental problems
- Bone deformities: bow legs, scoliosis
- Joint/ bone pain
Functional
- Hypermobility
- Deafness from early adulthood.
Presentation of osteogenesis imperfecta
Physical features
- Blue/ grey sclera
- triangular face
- Short stature
MSK features
- Dental problems
- Bone deformities: bow legs, scoliosis
- Joint/ bone pain
Functional
- Hypermobility
- Deafness from early adulthood.
Children are more likely to have _____ and _______fractures compared to adults
Greenstick and buckle/torus fractures
- As they have more cancellous, spongy bone,
A salter harris fracture occurs at ______
The growth plate
Salter-Harris growth plate fracture classification
- Type 1-5
SALTR
Type 1
- Straight through physis
Type 2
- Above the physis (metaphysis)
Type 3
- Below the physis (epiphysis)
Type 4
- Through the physis, metaphysis and epiphysis
Type 5
- Crush
Gaucher’s disease is particularly prevalent in which population?
Ashkenazi jews
