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Yr 5 - paeds > MSK/nephro/endo > Flashcards

MSK/nephro/endo Flashcards

1
Q

key signs of rickets

A

bowed legs, bone pain, stunted growth, dental manifestations

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2
Q

what does an xray show of rickets

A

cupping, fraying, metaphysical widening

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3
Q

MX of rickets

A

Vit D3, calcium, phosphorus supplements, diet and lifestyle

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4
Q

Ddx for rickets

A

osteogenesis imperfecta (brittle bone disease where there is a defect in collagen metabolism) –> blue sclera and hearing loss

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5
Q

blood results for rickets

A

low vit D, high ALP

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6
Q

signs of hypothyroidism in newborn

A

prolonged jaundice, hoarse cry, lethargy, poor feeding, constipation

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7
Q

why is it important to pick up hypothyroidism on newborn test

A

if diagnosed late –> impaired neurocognitive development and growth

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8
Q

at what centile is a child clinically overweight

A

91st

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9
Q

Dx of T1DM

A

fasting > or equal to 7 or random > or equal to 11.1

if asymptomatic this must be demonstrated on two separate occasions

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10
Q

what does insulin normally do

A

-facilitates uptake of glucose into muscle, liver, adipose via GLUT4

-stop lipolysis and enhance glycolysis

-anabolic

-increase protein synthesis

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11
Q

what may cause a false elevated HbA1c

A

splenectomy , iron deficiency

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12
Q

what may cause a falsely low HbA1c

A

splenomegaly and haemolytic anaemia

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13
Q

Ix for diabetes insipidus

A

24 hr urine collection (>3L), urine and serum osmolality, water deprivation test

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14
Q

acquired causes of cranial diabetes insipidus

A

idiopathic, tumour, trauma, infections

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15
Q

Mx of nephrogenic diabetes insipidus

A

Tx any underlying cause (lithium toxicity or hypercalcaemia), can use thiazide diuretics, low salt diet

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16
Q

what is neonatal thyrotoxicosis

A

affects some infants whose mums have graves - should self limit by 1-3 months

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17
Q

what is the Mx of DDOH

A
  • most unstable hips should resolve spontaneously by 3-6 weeks
    -pavlik harness if < 6 months which can hold the femoral head in the acetabulum
    -older children need surgery
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18
Q

signs of DDOH

A

clunking, asymmetry in skin folds, discrepancy in leg length

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19
Q

X-ray signs of perthes

A

joint space widening and decrease in femoral head size

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20
Q

which way is the displacement in SUFE

A

posterior (neck moves backwards)

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21
Q

O/E of SUFE

A

leg in external rotation with limited internal rotation

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22
Q

what method is used to manipulate the club foot and cast it

A

ponseti

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23
Q

associations with club foot

A

CP and oligohydraminos

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24
Q

what is a toddler fracture

A

an oblique tibial fracture in infants (needs a cast for 3 weeks)

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25
Q

most common organism in septic arthritis

A

staph aureus

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26
Q

Abx for septic arthritis

A

flucloxacillin

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27
Q

kocher criteria for septic arthritis

A

refusal to weight bear, raised WCC, raised ESR and fever > 38.5

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28
Q

how does osteosarcoma present

A

bone pain, worse at night, may have a bone swelling (normally affects 10-20-y)

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29
Q

Xray findings of osteosarcoma

A

periosteal reaction (sunburst appearancE) + fluffy appearance

30
Q

complications of osteosarcoma

A

pathological bone fractures, mets, amputation, poor prognosis

31
Q

what sarcoma shows an onion skin appearance

A

ewing (this presents in same way to osteosarcoma but is less common)

32
Q

what is the definitive diagnosis of a bone cancer

A

bone biopsy

33
Q

red flags of hip pain

A

<3 years, pain at night, fever, night sweats, swelling

34
Q

presentation of JIA

A

joint pain for >6 weeks, joint swelling, fever and pink salmon rash

35
Q

what is stills disease

A

systemic JIA (swinging fevers, pink salmon rash, raised inflammation markers)

36
Q

why is contrast used in imaging

A

enhance blood vessels so allows solid organs to be visualised better

37
Q

poor prognostic factors for ALL

A

age <1 or >10, WCC > 50, CNS involvement

38
Q

RF of leukaemia

A

DS, Li Fraumeni, exposure to ionising radiation, EBV

39
Q

Ix for leukaemia

A

FBC (lots of blast cells and pancytopenia)
Blood film - blast cells
BM biopsy - blast cells + do immunophenotyping and cytogenetics to classify the disease and for risk stratification
U+E
coag
CXR!! this is important to identify any mediastinal mass

40
Q

Maintenance Tx for leukaemia

A

2 years for girls and 3 years for boys

41
Q

when is rasburicase used instead of allopurinol for the Tx of tumour lysis syndrome

A

when it is high risk (WCC > 50)

42
Q

LT complications of leukaemia / lymphoma

A

stunted growth, infertility, secondary cancers, avascular necrosis

43
Q

when is a Dx of leukaemia given from bone marrow biopsy

A

when there are >20% blast cells

44
Q

how is lymphoma different to leukaemia

A

it involves mature cells which arise from sites outside of the bone marrow

45
Q

on what chromosome is the beta globin gene which mutates in SCD

A

chromosome 11 (glu to val)

46
Q

how to recognise acute chest syndrome (vascocculsion of microvasculature which causes infarction

A

pain! fever, cough, tachypnoea, dyspnoea, new onset hypoxia and will see pulmonary infiltrates on CXR

47
Q

Mx of acute chest syndrome

A

antibiotics, oxygen, pain relief, may give transfusion

48
Q

what is a sequestration crisis in SCD

A

sickling blocks blood vessel which causes pooling of blood in spleen which causes An acute drop in Hb - may need splenectomy

49
Q

what does haemoglobin electrophoresis show for SCD

A

no HBA but you get HbSS

50
Q

Mx of SCD in general

A

-avoid triggers of vasoocculsive crisis like cold temperatures, dehydration, exhaustion

-prevent infection (5 yearly pneumococcal and annual influenzae)

-hydroxycarbamide

-transfusion

-genetic counselling

51
Q

other complications of SCD

A

-avascular necrosis
-transfusion associated complications
-cholecystitis
-hyposplenism

52
Q

what would bloods results show for DIC

A

low platelets, raised APTT, PT and D dimer

-MAHA on blood film - schistocytes

53
Q

Ix for anaemia in children

A

-reticulocyte count
-MCV
-blood film
-B12/folate
-direct Coombs

54
Q

why do we get anaemia of prematurity

A

less time in utero receiving iron from mother
-red blood cells cannot keep up with rapid growth
-blood tests

55
Q

why do babies get a physiological anaemia

A

at birth get increased oxygen, negative feedback on EPO so reduced production of RBC

56
Q

what’s the basics of thalassaemia

A

defective Hb so get haemolytic anaemia –> spleen removes it so get splenomegaly. Get extramedulallary haematopoesis with the body trying to keep up.

57
Q

MX of thalassaemia

A

transfusions, iron chelation, splenectomy

58
Q

causes of microcytic anaemia other than B12 and folate D

A

liver disease, hypothyroidism

59
Q

causes of pancytopenia

A

chemo, leukaemia, EBV, aplastic anaemia, hypersplenism

60
Q

RF for bed wetting

A

family history, behavioural problems, obesity

61
Q

when is bed wetting normal util

A

age 5

62
Q

Atypical UTI

A

-non Ecoli
-not responding to Abx in 48 hours
-v unwell
-poor urine flow
-abdominal mass

63
Q

criteria for US in UTI

A

-<6 months
-atypical
-3LUTI
-2UUTI

64
Q

MX of UTI if < 3 months

A

IV abx and full septic screen AND ALWAYS ADMIT TO HOSPITAL

65
Q

Signs of a posterior urethral valve

A

UTI, weak stream, palpable bladder

66
Q

MX of posterior urethral valve

A

ablation of extra urethral tissue on cystoscopy

67
Q

give a range of causes of CKD in the infant

A

-ARPKD
-Wilms tumour
-recurrent UTI
-congenital - renal dysgenesis
-PSGN
-MCD
-HUS (thrombocytopenia, anaemia, AKI)

68
Q

what is a neuroblastoma

A

tumour in nerves that can invade the kidneys and secrete increasing urinary catecholamines

69
Q

complications of CKD

A

-uraemic pericarditis and encephalopathy
-electrolyte abnormality
-growth problems
-anaemia
-BMD
-hyperparathyroidism

70
Q

nephrotic diseases

A

MCD
FSGS
membranous

71
Q

MX of HUS

A

fluid rehydration, haemofiltration, steroids,

NO ROLE FOR ABX

72
Q

symptoms of HUS

A

blood diarrhoea, reduced urine output, abdo pain, bruising, hypertension, jaundice

Yr 5 - paeds (4 decks)

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