Paedatrics Flashcards
What is impetigo?
What is a major RF for it?
Impetigo is a skin infection that is caused by a staph or a strep infection. It is very common in young children, highly infectious.
Major RF is pre existing skin disease already like eczema
What are the two types of impetigo?
Non Bullous (the more common form. You get the typical honey coloured rash etc)
Bullous: looks thinner more ulcerative. tends to be in the perianal, torso and limbs
What is the classical clinical presentation of impetigo?
You get runny nose, a bit itchy. crusty honey coloured lesions. Generally more obvious on the face. Auto inoculation to other areas.
How do you treat/manage impetigo?
You give antibacterial cream.
Get rid of nasal carriage by nasal cream
V infective so don’t go to school.
Moderate/severe: may need systemic or IV abx
What is Measles?
Is it a notifiable disease?
Is a RNA virus
Yes it is a notifiable disease
How can you remember the presentation of Measles?
The 4 Cs Cranky Coryza Conjunctivitis Cough
You also have a rash that spreads from the ears through the rest of the body.
And Koplik spots on buccal membrane
Fever
What are 3 complications of measles?
pneumonia
encephalitis
deafness
What is the scientific name for croup?
laryngotracheobronchitis
How does croup present?
It presents mostly in young children 6 months to 6 years.
Generally fever and coryza beforehand.
Barking cough, hoarseness. That is worse at night.
What is the organism that causes croup?
Parainfluenza virus
How do you treat croup?
You treat it with dexamethasone
Steroid Nebs
If v bad give Nebs Adrenaline and Oxygen.
If you suspect croup but they have lots of airway secretion? What is the most likely diagnosis and how do you treat this?
Pseudomembranous Croup
Management IV abx and intubation
What are the two phases of whooping cough called? And what symptoms are shown in each phase?
- Catarrhal phase: 1 week of coryza symptoms
- Paroxysmal phase: coughing phase followed by the characteristic whoop. Here the child can go red/blue in the face and mucous can flow out of their nose/mouth.
Presentation can be via apnoea or sub conjunctival haemorrhage as well.
How would you diagnose whooping cough?
You would do a perinasal swab and see marked lymphocytosis on a FBC
How would you treat whooping cough?
Do you need to contact trace?
Erythromycin
Yes. Give erythromycin to all contacts
What are two likely causative organisms in peri-orbital cellulitis?
S Pneumoniae
H Influenzas
What additional tests do you need to do in orbital cellulitis?
CT scan to exclude infection
LP to exclude meningitis
What is the causative organism of epiglottis ?
H influenza
What age is epiglottis common in?
It is common in children aged 1-6 yrs
What symptoms are common in epiglottis?
- High Fever, ill looking
- Painful throat. Sat forward. Inspiratory stridor.
- Saliva running down face.
How do you manage someone with epiglottis?
Need to secure the airway
Abx cefuroxime
Need to give prophylaxis to the entire household.
What is the treatment of candida/nappy rash in children?
You can give barrier cream/ointment (as prevention)
Steroid Cream +/- Anti fungal cream
What foods can cause a listeria infection?
Sprouts
Deli meats
Unpasteruised milk
Soft cheese
What are some of the symptoms/complications of having a listeria infection?
Symptoms: spontaneous abortion, meconium staining of liquor, neonatal sepsis, preterm delivery.
Then complications include sepsis, meningitis and pneumonia
What antibiotic do you give in listeria infection?
Penicillin
is listeria gram +ve or -ve ?
Gram positive
What is treatment pathway for symptomatic TB?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
All 4 for 4 months
Then R + I for the remaining 2 months.
If asymptomatic for TB what is the treatment?
Rifampicin and Isoniazid
for 3 months
What type of pathogen is Rubella?
Is it notifiable?
It is a RNA Virus
It is a notifiable disease
How does rubella present?
You get a macular rash and sub occipital lymphadenopathy.
What are the complications of Rubella in utero?
Exposed in the first 4 weeks you get eye malformations
weeks 4-8 you get cardiac deformity
8-12 weeks= deafness
What is the most common cause of Otitis Media?
The most common cause is viral i.e. RSV or rhinovirus
Bacterial causes include S pneumoniae and H influenzae
What are 3 complications of otitis media?
- Mastoiditis
- Meningitis
- Glue Ear
What is Perthe’s Disease?
This is when you get avascular necrosis of the femoral head
What are some RF for Perthe’s Disease?
More common in Males
Age 1-8
Mostly caucasian
How does Perthe’s disease present?
Pain in the hip or knee
Antalgic Gait
10-15% is likely to bilateral
What investigations are necessary for Perthe’s Disease?
You need to do FBC, ESR/CRP
X Rays
MRI arthrogram
What is the management of Perthe’s Disease?
You can do physio
Not any good? Do surgery
What factors are low in Von willebrand’s Disease?
you have low levels of factor 7 and vWF
What does the clotting screen of someone with VWD look like?
normal or APTT may be slightly increased
What is the diagnostic method of choice for Cystic Fibrosis in young children?
Sweat Test or via newborn heel prick test with immuno-reactive trypsinogen (IRT)
What is the diagnostic method of choice for CF in older children/adults?
Genetic Testing
What is the treatment for someone with CF?
So there is no treatment for someone with CF.
You just need to manage the symptoms:
Pancreatic insufficiency: give Creon and supplements/high calorie diet.
Prophylactic abx, anti fungals etc
Patient needs 2x daily physio and regular FEV measured
What is seen on the blood work of someone with Haemophilia A?
You will see
Low Factor 8 and prolonged APTT
How do you treat haemophilia A?
You give them prophylactic infusions of factor 8
If an acute bleed occurs give Factor 8, desmopressin and anti-fibrinolytic
How do you treat haemophilia B acutely?
Factor 9 infusion
Anti-fibrinolytic
Desmopressin
What are 3 common organisms that cause encephalitis?
HSV
EBV
CMV
VZV
What are two bacterial causes of encephalitis?
TB
Malaria
Secondary to meningitis
What is the triad presentation for encephalitis?
Altered mental state
Headache
Fever
can also have focal neurological deficits
What are two infections you want to do for encephalitis?
What will they show?
LP which will show high lymphocytes. Send for PCR + culture and sensitivity
MRI head
what is the management of encephalitis?
Acyclovir
Anti seizure medication (primidone)
What is the stages for spot develop in chicken pox? (4 stages)
macule
papule
vesicle
crust
What is the aetiology of retinoblastoma?
Inheritable via recessive inheritance
Non inheritable via mutation
What is the presentation of retinoblastoma?
The presentation of retinoblastoma is generally leukocoria of one of the eyes. You can then get irritation of that eye (localised redness etc).
Issues with seeing and a squint may develop.
Can get CNS involvement and also if v progressed external swelling.
How do you diagnose a retinoblastoma?
Ophthalmoscope
MRI scan to look at the underlying structures
How do you treat the retinoblastoma?
Cryotherapy
Photocoagulation
Radiotherapy/ Chemotherapy
If v advanced enucleation
How is prader willi syndrome inherited?
What chromosome is affected?
Maternally
Chromosome 15
What is the presentation of prader willi at birth?
Hypotonia
Poor feeding
Sleepiness
Failure to thrive
Generally blue eyes and blonde hair
What is the presentation of prader willi in toddlers?
Developmental Delay
Growth restriction
Behaviour and Learning difficulties
Excessive appetite due to too much Ghrelin
How do you manage prader willi syndrome?
You manage PW syndrome by dietician review and controlling food consumption
What is Edwards Syndrome?
Trisomy of chromosome 18
second most common trisomy behind Downs Syndrome
How does Edwards Syndrome present?
Wide spaced nipples
Rocker bottom feet
Clenched fists
Microcephaly
Heart congenital abnormalities i.e. ASD or VSD
Deformed ears, cleft lip/palate or small mouth/jaw
What is Klinefelter’s Disease?
What conditions are at increased risk with this condition?
When a patient has XXY
Breast Cancer
Osteoporosis
Diabetes Mellitus
Autoimmune Conditions
How does Klinefelter’s Disease present?
It presents through being very tall, wide hips, gynaecomatasia, sparse facial and pubic hair
infertility and minor delay in learning/developmental issues
Is Wilm’s Tumour an inherited condition?
Yes.
It is also a form of kidney cancer. If a child is high risk of developing a tumour. Do regular US scans.
What is nocturnal enuresis?
When does it generally stop?
This is when you have bedwetting with no control at night.
Due to a lax sphincter. SO is generally ok by age 7.
2/3rds of children have an affected parent.
How can you manage Nocturnal Enuresis?
You can have a star chart
Enuresis alarm
Short term desmopressin
Bone Tumours:
What is an Ewings Sarcoma?
What is an osteosarcoma?
Ewings is common in the shoulder blades and hips (generally weird places)
Osteosarcoma is more common in older adolescent children. Happens in the long bones
How do bone tumours typically present?
They typically present with nocturnal pain. Localised bone swelling. Swelling over the area, difficulties walking.
Systemic signs: weight loss, tiredness or night sweats
What organism is responsible for Hand Foot and Mouth Disease?
Coxsackie A virus
How does Hand foot and mouth disease present?
Painful itchy lesions on hand feet and mouth.
Can be systemically unwell, malaise, loss of appetite, fever etc.
Management: supportive off school until blisters heal
What condition does Parvo virus cause?
What two groups do you have to be careful around?
Can cause slapped cheek syndrome
Pregnant ladies and immunocompromised individuals as can cause an aplastic crisis.
Note the patient will feel prodromally unwell as well.
If you looked under the microscope. What would the diphtheria organism look like?
gram positive aerobe.
What is the presentation of diphtheria?
You get a false grey membrane over the tonsils
Purlent and bloody discharge from the nose
Trouble with breathing, swallowing and talking
Generally unwell: fever, malaise and anorexia
What is the management of diphtheria?
Erythromycin
Also give it to close contacts
Are exomphalmos/gastroschisis generally diagnosed antenatally or postally?
Antenatally.
Describe what exomphalmos is?
Who is it common in?
How do you treat it?
Protrusion of the abdominal contents through the umbilical ring. Covered by a transparent sac.
RF: include trisomy and other congenital abnormalities.
Mx: surgery
Describe what gastroschisis is?
Who is it common in?
How do you treat it?
Is when you have the abdominal contents protruding adjacent to the umbilicus. No covering sac
Common in those who use alcohol or ibuprofen in pregnancy.
Treatment: cover in clingfilm and then do surgery
What are two likely organisms to cause septic arthritis?
S aureus
H Influenzas
How does septic arthritis present?
Erythematous, warm and tender joint
Reduced ROM and movement from the affected joint. Febrile and a limp
How do you investigate and manage septic arthritis?
You investigate it with blood cultures, joint aspiration
Note joint x ray will be normal up to 7 days post infection
Management: need debridement, IV and and immobilisation.
What tumour marker will be raised in hepatoblastoma?
raised alpha feet protein
Where are brain tumours common in children?
Infra tectorial and posterior fossa
What is used to stage astrocytoma brain tumours?
WHO grading 1-4
What is the most common type of brain tumour?
Gliomas such as astrocytomas or olidgodendrogliomas.
What is Osgood Schlatter’s Disease?
What is the pathophysiology?
This is a condition involving the knee
Common in adolescents.
You get multiple small avulsion fractures where the quad muscle inserts. Common in growth spurts.
In Osgood Schlatter’s Disease what makes the pain worse (2 things)?
Pain is worse with exercise
Pain is worse on knee extension or against resistance
How do you manage Osgood Schlatter’s Disease?
You manage it through rest, NSAIDs, physio
What is a neuroblastoma?
What cell does it arise from?
Arises from the neural breast cells found in the adrenal medulla and sympathetic nervous system.
Very common under the age of 5 and very malignant.
How does a neuroblastoma presents?
It presents with fatigue, anorexia and weight loss + vomiting
Abdominal mass
Periorbital bruising due to metastatic disease of the orbit. Gives raccoon eyes.
Blueberry muffin appearance due to skin mets/
bone pain causing weakness, limping and paralysis
How do you diagnose neuroblastoma?
You diagnose it through CT and biopsy the lesion
How do you manage neuroblastoma?
Surgical resection
Radiotherapy and Chemotherapy
What is the inheritance pattern of osteogenesis imperfecta?
What does it affect?
It is an autosomal dominant inheritance condition.
It affects type 1 collage: sclera, joints, bones, tendons and teeth
What are some of the symptoms of osteogenesis imperfecta?
You can get increased joint laxity
increased bone fragility. Increasing bone fractures and thus pain and deformity.
Impaired mobility
Impaired growing
Ligamentous Laxity.
What conditions is Osteogenesis Imperfecta associated with?
Valvular prolapse
Hernias
Deafness
Blue appearance of the sclera
What is the criteria used to classify Osteogenesis imperfecta?
The Silence Criteria
What is the management of osteogenesis imperfecta?
The management is:
Bisphosphonates
Fracture splinting and also intramedullary rods may have to be placed in.
