more Flashcards
A four year old boy presents with a bumpy, red rash over his buttocks and pain in his knees. This had occurred around two weeks after an upper respiratory tract infection.
What is the most likely diagnosis?
HSP - HSP consists of a typical symmetrical, palpable, maculopapular rash over the buttocks and extensor surfaces of the arms and legs, arthralgia, abdominal pain, oedema and glomerulonephritis
what causes mesenteric adenines
Yersinia enterocolitica
This patient has mesenteric adenitis. This is a diagnosis of exclusion. Yersinia enterocolitica is the most likely to cause mesenteric adenitis. Mesenteric adenitis is a self-limiting condition.
impetigo treatment for bullous and non bullous
Fluclox, or clarithro if pen allergy when bullous
non bullous = topical fusidic acid and hydrogen peroxide 1%
whooping cough treatment
azithromycin for 5 days
praeder willi chromosome
15
sickle cell puts you at risk of
salmonella osteomyelitis
branchial cyst content
cholesterol crystals
management of swallowed small lego
Most small, non-sharp, ingested foreign objects, such as a LEGO brick, will pass through the gastrointestinal tract uneventfully. The object is already below the diaphragm on the X-ray, indicating it has passed the oesophagus and stomach. Since the child is asymptomatic, no intervention is needed. Parents should be advised to monitor for symptoms such as abdominal pain, vomiting, or failure to pass the object within a few days, and to return if these occur. Although there are no clear unified NICE guidelines on ingested foreign bodies, this is a helpful summary.
exotropia Mx
refer to opthamology to rule out space occupying lesion (amblyopia is treated with patch)
A baby born post-term is delivered and immediately in respiratory distress with low APGAR scores. The mother has no past medical history but was taking medication for pre-eclampsia during the pregnancy. A portable chest x-ray is taken.
What is the x-ray most likely to show?
Bilateral patchy infiltrates
Respiratory distress in a post-term baby with a history of maternal pre-eclampsia raises suspicion for meconium aspiration syndrome (MAS). In MAS, meconium-stained amniotic fluid is aspirated, leading to chemical pneumonitis, airway obstruction, and alveolar collapse. A chest X-ray typically shows bilateral patchy infiltrates, with areas of atelectasis and hyperinflation.
what is bacterial tracheitis
epiglottitis
epiglottitis causes
haem infl, staph aureus if vaccinated
A 3-day-old female neonate presents to the Emergency Department with significant abdominal distension and bilious vomiting. The mother informs you that she has not yet passed meconium.
On examination, the baby appears lethargic and dehydrated. A fever of 38.1 °C is noted.
What is the definitive management for her underlying condition?
Bowel surgery
The presentation above suggests a diagnosis of Hirschsprung’s disease. This patient has some of the red-flag features of constipation: bilious vomiting and not passing meconium within 48 h of birth. Two of the most common causes of failing to pass meconium are cystic fibrosis or Hirschsprung’s disease.
Hirschsprung’s disease is a congenital condition in which the myenteric plexus which forms the enteric nervous system has not developed properly. This leads to segments of aganglionic bowel where there are no parasympathetic nerve cells and thus those areas cannot undergo peristalsis, subsequently causing obsrtuction. Definitive management requires surgical removal of the aganglionic bowel segment.
chance of a second febrile seizure
30-40%
A 15 year old girl has developed a rash on her face and hands. The rash is non-pruritic. She reports feeling weak and lethargic over the last two weeks. She has felt feverish but has not checked her temperature. She is otherwise well. Which serological marker will be presently raised
Erythrocyte sedimentation rate (ESR)
The rash is a malar rash with eyelid involvement, characteristic of juvenile dermatomyositis (JDM). ~50% of patients with JDM are positive for auto-antibodies but they are myositis specific ones. Even with the the antibody profile, ESR is still most likely to be raised in an untreated patient
measles Ix
If after 3 days then Measles-specific immunoglobulin M (IgM) and IgG serology, if rash 48 hours prior then PCR for measles mRNA
A 2-year old boy presents with abdominal pain, bilious vomiting and rectal bleeding. On examination his abdomen appears distended and is tender to palpation worst in the midline and right iliac fossa. An abdominal ultrasound shows a small fluid filled pouch off the distal small intestine.
What is the most likely diagnosis?
meckels diverticulum, often presents in toddlers
crying before collapse
Breath-holding spells, characterised by crying, collapse, cyanosis, and rapid recovery, are self-limiting events with no increased risk of epilepsy or behavioural problems.
often following trauma
oligoarticular JIA with 4 or less joints involved
intra articular methyl prednisolone acetate injections
Anti-tissue transglutaminase (tTG) IgA antibody
This is a classical presentation of coeliac disease. The rash is known as dermatitis herpetiformis. Coeliac is associated with other autoimmune conditions such as type 1 diabetes mellitus and autoimmune thyroid disease.
Total IgA should also be performed incase they are IgA deficient and would have a false negative of the above
children GCS
nec fasc from chicken pox causative organism
This child is presenting with features of necrotising fasciitis, a life-threatening soft tissue infection characterised by severe pain, erythema, swelling, and crepitus due to subcutaneous gas. S. pyogenes, a Group A Streptococcus, is a common cause, particularly following skin breaches such as the vesicles of chickenpox, which provide a portal of entry.
A 6 year old boy is brought to the GP by his mum who is concerned about a new widespread rash. It started around his face but has now spread to his tummy and legs. He has also had a fever during this period which sometimes comes down with paracetamol. He has a past medical history of eczema, and his mum says he is not up to date on vaccinations as they have been moving between countries recently for her husband’s work.
On examination, there are white-grey spots on his buccal mucosae. Other than a fever, observations are normal.
Given the likely diagnosis, which complications is he acutely at risk of developing?
Measles (rubeola) is a highly contagious viral infection that can lead to serious complications, especially in young children. The white-grey spots in the mouth (Koplik spots) are a diagnostic feature. Pneumonia is the most common and serious complication of measles, occurring in about 5-10% of measles cases. The immune suppression caused by measles also makes children more susceptible to secondary bacterial infections such as pneumonia.
sickle cell extra mx
annual influenza vaccine
A 2 year old boy is brought to A&E because his mother noticed fresh blood mixed in with stool in his nappies this morning. He is well otherwise with no other past medical history and his oral intake is normal. On examination, he is alert, active and his observations are normal. There is mild abdominal tenderness without guarding. An abdominal ultrasound is performed, which is normal.
What is the next best investigation for the likely diagnosis?
Technetium scan
This is the most appropriate investigation to confirm the diagnosis of Meckel’s diverticulum, which is suspected in this case based on the presentation of painless rectal bleeding in a young child. The scan detects ectopic gastric mucosa, which is often present in a Meckel’s diverticulum and can cause bleeding due to acid-induced ulceration of the adjacent small bowel mucosa.
A 13 month old boy is reviewed in the General Paediatrics clinic due to concerns over developmental delay as they have not met their fine and gross motor milestones. The pregnancy was normal however they were noted to be hypotonic at birth, and had feeding problems up until he was 6 months old. As a result, the boy is on the 10th percentile for his height. His hands and feet also appear smaller than they should be. He has no other past medical history and is up to date with vaccinations.
Given the likely diagnosis, what is the underlying mechanism?
Uniparental disomy
Prader-Willi syndrome is typically caused by the deletion of a specific region on chromosome 15 or the lack of expression of paternally derived genes due to uniparental disomy (the presence of two maternal copies of chromosome 15). This leads to characteristic features such as hypotonia, feeding difficulties, growth delay, and later developmental delays. It also often results in short stature, small hands, and feet, and mild to moderate intellectual disability.
A 6-year-old boy with intermittent wheeze and breathlessness is diagnosed with asthma after spirometry confirmed reversible airflow obstruction. Despite using a short-acting beta-agonist (SABA) for symptom relief, and regular low-dose inhaled corticosteroid, he has daytime symptoms twice weekly and wakes at night once a fortnight due to wheeze. His parents report good inhaler technique and adherence to treatment.
What is the most appropriate next step in management?
A low-dose ICS and formoterol inhaler is the recommended next step for children aged 5–11 who can manage combination therapy. This is known as maintenance and reliever therapy, or MART. It should be used regularly and for symptom relief. It is suitable for this child given his symptom frequency and night-time disturbances.
A 4 year old boy attends the GP with his mother for a review. He was commenced on twice daily low-dose ICS and salbutamol 12 weeks ago for suspected asthma. Over this period, his symptoms have resolved and he has not had any further wheezy or breathless episodes.
What is the most appropriate management?
NICE guidance recommends stopping both the ICS and salbutamol if symptoms have resolved after an 8–12 week trial in children under 5 years. A 3-month follow-up ensures that symptoms do not recur. This approach helps avoid unnecessary long-term medication use while still monitoring for asthma recurrence. If at the 3 month review symptoms have returned or there has been a hospital admission for wheeze requiring oral steroids, inhalers should be restarted.
A 4 year old girl is brought to the GP by their father who is concerned about her breathing. Since the weather has become colder he has noticed she sometimes wheezes when running and playing with the other kids. She has a history of eczema and her father had asthma when he was young. She is unable to follow the instructions for a reliable peak flow during the consultation.
What is the most appropriate next step?
Trial salbutamol PRN and twice daily inhaled corticosteroids
For children under 5, diagnostic tests such as spirometry and FeNO are often unreliable. NICE guidance recommends a trial of low-dose ICS with PRN salbutamol for 8–12 weeks to evaluate response. After 12 weeks, symptoms should be reviewed and the child can be trialled off inhalers if symptoms have resolved.
Spirometry is generally unreliable in children under 5 due to their inability to perform the required manoeuvres accurately. It is not a first-line test in this age group
