Neuro / Inf / Derm / Haem / ENT

Question 1

Seizures - important questions to ask in history

Answer 1

Prodrome - N+V / dizzy / temp / pale / confusion
During - Twitching / duration / incontinence
Post - Confusion / cognition diminished / memory?

Question 2

non epileptic causes of seizure

Answer 2

Hyperthermia (Febrile) / Hypoglyc / head inj / stroke / brain surgery

Question 3

febrile temp - ? / most comm age / important to exclude? / T if severe

Answer 3

seizure caused by severly elevated temp
most commonly aged 3 months –> 3 years old

Exclude Meningitis! (neck stiff etc) and encephalitis

if seizure lasts >5 mins then refer to hosp and give anticonvulsants and diazepam

Question 4

neonatal hypotonia - CF / C

Answer 4

when pulling to sitting by arms, head/neck lag obvious + when baby lain prone over hand, back isnt straight

CF - no neck control / limp feeling / non-weight bearing / decrease suckling / weak cry

C - cerebral palsy, meningitis, prematurity

Question 5

Initial SIgns of Meningitis

Answer 5

Gastroent / cry / convulsions / apnoea / bulging fontanelles / head retraction

Question 6

Gait abnorm examples

Answer 6

Trendel - perthes, slipped upper fem , dev dysplasia
high step - spina bif, polio, charcot-marie tooth
spastic - diplegic/quadriplegic

Question 7

what categories should developmental delay be split into?

Answer 7

genetic, pre, peri and post natal insults

Question 8

signs of increased ICP and people at risk

Answer 8

RF - head injuries / suspected neuro inf / intra cranial mass

CF - bulging fontanelle, headache, vomiting, focal, change behaviour, diplopia, squint

Question 9

if Hb down (anaemic) in kids, what is important to ask?

Answer 9

diet, travel, ethnicity (hereditary causes)

Question 10

DDx of anaemia in kids

Answer 10

ICD, thalassaemia, folate or b12 low, haemolytic conditions, bone marrow failure

Question 11

important Investigations

Answer 11

FBC (WCC) ESR up(chronic dis), Blood film + reticulocytes

Question 12

hereditary/congen haemolytic conditions

Answer 12

GSTEPS (spherocytosis most common in N euro)

Question 13

cause of child with bruising

Answer 13

NAI (always suspect), sepsis, major haem, DIC, coag disorder, HS Purp

Question 14

hints for NAI

Answer 14

cluster bruises, bruises away from bony prominences

Question 15

causes of lymphadenopathy

Answer 15

Malignant - ALL/AML, lymphoma, Hodgkins, neuroblastoma
Infecton - TB, viral inf (CMV,EBV,HIV), bact lymphadenitis
AI - sarcoid, SLE, kawasakis

Question 16

Tox Erythro Necrolysis

Answer 16

life threatening, skin detachment, linked to drug reaction

Question 17

steven johnson syn

Answer 17

drug reaction, hypersensitivity, can lead to TEN

Question 18

erythema multiform

Answer 18

hypersens to drugs, less severe than SJS

Question 19

urctaria

Answer 19

histamine release, can be chronic (>6 weeks), many diff causes

Question 20

molluscum contagiosum

Answer 20

viral, spread direct contact, look like red shiny nodular moles

Question 21

scabies

Answer 21

burrows, infestation, worse at night, widespread

Question 22

pityriasis rosea

Answer 22

christmas tree rash on back

Question 23

kawasaki’s - CF

Answer 23

Fever >5 days, irritable, eye involvment, infalmed lips, cerv lymphadenopathy, widespread rash + cheeks red

Question 24

rubella

Answer 24

viral / fever / rash differs in appearance

Question 25

measles

Answer 25

self limting in adults / viral / many red patches (not nodular)

Question 26

hen scholen purp

Answer 26

non blanching rash + joint pain

Question 27

scarlet fever - ? / CF / C / I / T

Answer 27

``` bacterial infection CF - fever rash (sandpaper cheeks and chest), sore throat, strawberry tongue C - group A beta strep I - rapid strep test T - pen V ```

Question 28

if GCS is used in adults, what is used in kids and at what age?

Answer 28

if under 4 years, use Childrens coma scale.

Question 29

negative signs following head injury

Answer 29

feeding down, hard to waken, irritable, anything out of the normal

Question 30

indications for CT head in child?

Answer 30

suspected NAI, post seizure (+no hx of epilepsy), decreased GCS, openskull fx, focal neuro def

Question 31

immediate treatment of burns

Answer 31

ABCDE maintain fluids + check UO make warm analgesia

Question 32

port wine stain - CF / prog / assoc triad / T

Answer 32

thick red patch persists through life and grows proportionately assoc with Stuge-Webber syn (Glaucoma, port wine face, brain abnorm) T - laser

Question 33

who gets mongolian spots?

Answer 33

asian and afro american babies

Question 34

Staph scalded skin synd - ? / CF / T

Answer 34

Staph Aur infection CF - blisters (large and PAINFUL), tender erythema, fever, conjunctivitis, irritable T - can be life threatening, give IV ABxs

Question 35

Meningitis in kids - Assoc cond / I / T / complications

Answer 35

assoc cond - ottitis media / purpura (menigococcal) I - LP, FBC, BM, CUltures T - empirical : Neonate = ecoli and Beta heam strep most common so CEPHALOSPORIN + BEN PEN / 3 weeks >3 months = Menigococcus/ pneumococcus most com high dose AMPICILLAN/ 10 days comp - seizures, cerebral oedema, hyponatraemia, deafness, drug fever, mental handicap

Question 36

signs of immunodef hx and exam

Answer 36

CF - recurrent infection, failure to thrive, PCP or CMV infections, haematological insuff (Hb or pltelets), neuro signs o/e - pale, distended abdo, chronic cough, rashes, hepatosplenomeg, anal crusting (indicates chronic diarr)

Question 37

most common form deafness in kids (congenitally)

Answer 37

sensori-neural

Question 38

Causes deafness in kids - Acquired and Congen

Answer 38

Acquired: Pre Natal - TORCH Peri N - SCBU babies suffering hypoxia/jaundice/ certain ABxs Post - Meningitis / Head Inj / ototoxic drugs Congen: syndrome related or non-syn related (AR mutated gene) x-linked - turners/alports

Question 39

screening and testing hearing in neonates

Answer 39

within first hours of life: Otoacoustic emissions + audioligical responses 6-18 months - distraction testing 2-4 years - conditioned response audiometry 5+ years - pure tone audiogram