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AMK > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

HIGH FEVER, SORE THROAT, SOFT INSPIRATORY STRIDOR AND DROOLING

A

acute epiglottitis - infection of epiglottis caused by Haemophilus influenzae
- it causes oedema of the epiglottis
- causes obstruction of airways and difficulty breathing
- drooling caused by patients not swallowing their saliva due to throat being really sore
- LEAN FORWARDS TO BREATHE

EMERGENCY

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2
Q

CROUP PRESENTATION

A
  • cough and common cold symptoms
  • inspiratory stridor
  • EMERGENCY

caused by parainfluenza virus
barking like cough
hoarseness

dexamethasone

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3
Q

MEASLES PRESENTATION

A

cough, cold like symptoms (cough, sneezing etc) conjunctivitis and white spots in the mouth and maculopapular rash

starts behind the ear then spreads to the rest of the body

INFECTED TILL AFTER 4 DAYS OF INFECTION

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4
Q

TEST FOR MEASLES

A

IgM antibodies from blood or saliva

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5
Q

BABY BORN AT TERM, VAGINAL DELIVERY BUT THERE IS A SWELLING ON BABY’S HEAD

CROSSES SUTURE LINES, BABY IS WELL

A

this is Caput Succedaneum: collection of fluid in the head due to pressure on the head during a vaginal delivery

resolves in a few days

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6
Q

LONG HISTORY OF COUGH, WHEEZE, STINKY AND GREASY LOOSE STOOLS, NASAL POLYPS AND POOR GROWTH

A
  • most likely to be cystic fibrosis
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7
Q

CHILDREN WITH CYSTIC FIBROSIS ARE DEFICIENT OF WHICH VITAMINS

A

A, D, E AND K

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8
Q

NEONATAL JAUNDICE RISK FACTORS

A

PREMATURE BIRTH
BREASTFEEDING

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9
Q

LETHARGY, HEADACHE, SORE THROAT, RUNNY NOSE AND FEVER
RED RASH ON TORSO AND CHEEKS THAT BLANCHES UNDER PRESSRE

A

SLAPPED CHEEK SYNDROME
supportive management

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10
Q

WHICH BILLIRUBIN IS RAISED IN PHYSIOLOGICAL NEONATAL JAUNDICE

A

UNCONJUGATED

  • more rbcs in babies so more turnover so more billirubin is made to be broken down
  • immature liver in babies is not able to break down the unconjugated billirubin into cojugated so babies have more unconjugated billirubin in their blood
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11
Q

SLAPPED CHEEK SYNDROME NAME

A

Erythema infectiosum

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12
Q

FEVER, CHEST PAIN IN THE LAST 24 HOURS IN CHEST AND BACK, AND SHORTNESS OF BREATH AND SICKLE CELL DISEASE

A

ACUTE CHEST SYNDROME

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13
Q

ACUTE ONSET OF CHEST PAIN THAT IS WORSE ON DEEP INSPIRATION AND MOVEMENT

what is it?

A

CONSTROCHONDRITIS

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14
Q

ACUTE BREATHLESSNESS AND PLEURITIC CHEST PAIN BUT NORMAL BREATH SOUNDS - NO CRACKLES OR WHEEZING

A

PULMONARY EMBOLISM

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15
Q

POOLING OF BLOOD WITHIN ORGANS THAT CAUSE WORSENING ANAEMIA
ABDOMINAL PAIN AND PALPABLE MASS IN LEFT UPPER QUADRANT

A

SEQUESTRATION CRISIS

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16
Q

BONE MARROW IS NO LONGER ABLE TO MAKE ENOUGH NEW RED BLOOD CELLS.
SYMPTOMS OF FEVER, MALAISE, PALLOR, SOB, PALPITATIONS

A

APLASTIC CRISIS

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17
Q

TEST FOR DEVELOPMENTAL HIP DYSPLASIA

A

Barlow and ortolani tests

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18
Q

RISK FACTORS FOR DEVELOPMENTAL HIP DYSPLASIA

A

FEMALE, FIRST BORN AND CHILD AND BREECH PRESENTATION

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19
Q

WHAT DOES THE BARLOW AND ORTOLANI TEST INVOLVE?

A

BARLOW - attempt to dislocate the femoral head
ORTOLANI - attempt to relocate the femoral head

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20
Q

VESICULAR RASH ON PALMS, SOLES AND BUCCAL MUCOSA WITH FEVER
what is it and what causes it?

A

Hand-foot mouth disease
caused by: Coxsackie A virus

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21
Q

COXSACKIE B VIRUS CAUSES WHAT

A

myocarditis

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22
Q

TACHYPNOEA AND DISTRESS SHORTLY AFTER BIRTH AND HYPERINFLANTION OF LUNGS AND FLUID IN HORIZONTAL FISSURE

A

TRANSIENT TACHYPNOEA OF NEW BORN (TTN)

  • generally resolves after first day and needs oxgen therapy
  • caused due to delayed reabsorption of fluid in the lungs
  • associated with c-sectionq
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23
Q

DEFICIENCY OF SURFACTANT IN PREMATURE NEONATES: RESPIRATORY DISRESS, TACHYPNOEA, GRUNTING AND CYANOSIS.
BECOMES MORE SEVERE AFTER BIRTH

A

NEONATAL RESPIRATORY DISTRESS SYDROME
- chest x ray shows glass lungs and bell shaped thorax

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24
Q

morbiliform reaction - what is it

A

common in patients with mononucleosis taking amoxicilin

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25
Q

circular rashes that are blister like that happen every time drug is taken

A

fixed drug reaction

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26
Q

rosea rash

A

rash followed after upper RTI

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27
Q

what are urticarial rash

A

hives

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28
Q

joint pain and fever
joint pain for over 6 weeks and pink rash in young child
what is it

A

juvenile idiopathic arthritis

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29
Q

what is juvenile idiopathic arthritis a complication of?

A

anterior uveitis

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30
Q

what does immune thrombocytopenic purport cause

A

rash all over the body

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31
Q

henlock Schonlein Purpura
symptoms

A

purpuric rash over buttocks and extensor surfaces

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32
Q

projectile vomiting after feeds

A

pyloric stenosis
test for this with ultrasound

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33
Q

perianal itching that is worse at night

A

thread worm
treat with mebendazole

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34
Q

coxsackie virus a16
what does it cause

A

fever, rash around mouth and ulcers on hands and feet

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35
Q

patient presents with sore throat and fever
has raised white cells and low platelets and blast cells

presentation: bruising, enalarged lymph nodes and fatigue

what is the most likely diagnosis

A

acute lymphocytic leukaemia - very common in children

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36
Q

potter syndrome

A

pressure in utero due to oligohydramnios

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37
Q

small baby
non-productive cough
not feeding well
high RR
high HR
low BP and low O2

what is the diagnosis

A

bronchiolitis due to RSV virus

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38
Q

when should babies pass meconium by?

A

24 hours after birth
concerning if not

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39
Q

what happens when baby does not pass meconium within 24 hours?

A

no stool
swelling in the abdo
bilious vomiting

  • this means obstruction in the bowels
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40
Q

what is hirschspungs disease

A

within the GI tract the ganglionic layer in the intestinal walls which develops in the neural crest helps with the detection of stool

in this disease - there is a lack of the ganglionic cells so this part of the bowel doesn’t work

so stool cannot be passed

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41
Q

symptoms of hirschspungs disease

A

no meconium passed from baby in over 24 hours
swelling in the abdo
bilious vomiting

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42
Q

management of hirschspungs disease

A

surgical management

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43
Q

investigation for hirschspungs disease

A

investigation is done based on the part where the obstruction is

biopsy

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44
Q

where is the obstruction if stool comes out after doing rectal examination in hirschspungs disease?

A

there is a lack of ganglions in the rectum

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45
Q

why are antibiotics given to children before any procedure if they have ventricular septal defects?

A

to prevent the risk of them developing infective endocarditis

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46
Q

what is the prophylactic medication given for RSV virus

A

Palivizumab (Any monoclonal antibodies)
prevents children against bronchitis

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47
Q

what are the symptoms of RSV

A

very common in young children
runny nose
difficulty breathing
crepitations
cough
child is off feeds

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48
Q

autism presents as what in children?

A

social distancing
playing by themselves
not talking in full sentences
not making eye contact

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49
Q

cerebral palsy presents in children as?

A

stiffness
motor developmental delay

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50
Q

what is the more specific test for bacterial sepsis

A

procalcitonin

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51
Q

chicken pox produces what type of rashes?

A

maculopapular vesicular rashes which are very itchy
all over the face and body

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52
Q

presentation of measles

A

blanching
maculopapular rash all over the body
grey spots in the mouth

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53
Q

complications of measles found in developing countries

A

vitamin A deficiency

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54
Q

common complications of measles

A

Subacute sclerosing panencephalitis -
affects brain and degenerates it
causes loss of cognition and seizures
can affect person up to 10 years of measles infection

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55
Q

what is broncholitis obliterans

A

it is a condition which causes inflammation of the bronchioles
the airways become scarred which then causes them to narrow

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56
Q

what is the most common cause behind broncholitis obliterans

A

adenovirus

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57
Q

what is primary nocturnal enuresis

A

bed wetting as a child

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58
Q

what is given to children with nocturnal enuresis

A

prescribe desmopressin if child is over 7
if not then given enuresis alarm - this detects if there is water in the bed and alarm sets off - reminds child to go to the toilet

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59
Q

what is given if child has nocturnal enuresis and increased frequency of urination

A

oxybutynin

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60
Q

what is physiological jaundice

A

occurs in neonates because their livers are not fully developed so unable to convert unconjugated bilirubin to conjugated bilirubin
- this builds up in the blood and causes jaundice

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61
Q

management of physiological jaundice

A

it goes away in 7-10 days
found within 24 hours of birth
when baby is slightly jaundiced at birth but levels of bilirubin are in the normal range

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62
Q

what is pathological jaundice

A

jaundice caused by a particular external cause eg. haemolysis due to RH factor or O factor

this can cause a toxic buildup of unconjugated bilirubin

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63
Q

what are the complications of pathological jaundice

A

this can spread through the blood brain barrier and damage the brain

causes athetoid cerebral palsy in the long run

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64
Q

what is turners syndrome

A

XO karyotype condition
affects women
late menopause
small breasts
wide spaced nipples

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65
Q

what is slipped upper femoral epiphysis

A

weakness in the femoral growth plate
happens due to obesity and common in males
common cause of limping in adolescents

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66
Q

perthe’s disease - what is it

A

blood supply to the femoral head is blocked so the head of femur begins to die
weakened bone begins to break apart from the joint

when blood supply is restored - the hip joint heals - but in the duration when it didn’t receive blood, if it loses shape then it can cause stiffness and pain

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67
Q

what is meconium ileus

A

over 48 hour delay in passing stool after birth
and has features of bowel obstruction like bilious vomiting

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68
Q

what is seen on x-ray if baby has meconium ileus

A

‘bubbly’ appearance

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69
Q

what is Noonan syndrome

A

genetic condition that stops normal development in different parts of the body

developmental delays
short stature
heart defects

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70
Q

trisomy 18 is what condition

A

Edwards syndrome

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71
Q

XXY karyotype causes what condition?

A

Klinfelter’s syndrome

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72
Q

trisomy 13 causes what condtion

A

Patau syndrome

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73
Q

bronchiolitis vs bronchiolitis obliterans

A

broncholitis gets better by itself
broncholitis causes permanent narrowing of the airways

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74
Q

symptoms of broncholitis obliterans

A

dry cough
breathlessness
SOB
fever
wheeze
harsh breath sounds
crepitations

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75
Q

symptoms of perthes disease

A

limping
pain in the joint
difficulty rotating the leg
pain that is worse on movement
better on rest

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76
Q

typical presentation of slipped upper femoral epiphysis

A

knee pain

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77
Q

symptoms of Noonan syndrome

A

eyes - down slanting and droopy eyelids
ears - rotated backwards
face - appears droopy and expressionless
head - larger and low hairline

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78
Q

heart conditions caused due to Noonan syndrome

A

valve disorders - pulmonary valve stenosis
hypertrophic cardiomyopathy
ventricular septal defect
irregular heart rhythm

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79
Q

MSK symptoms of Noonan syndrome

A

wide set nipples
spine deformity
sunken sternum
short webbed neck

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80
Q

what is Edwards syndrome

A

affects growth in baby
happens when person has extra copy of chromosome 18
development defects

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81
Q

symptoms of Edwards syndrome

A

low set ears
reduced muscle tone
overlapping fingers eg. finger clubbing
small head

congenital heart diseases
renal failure
bowel wall defects

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82
Q

what is Klinefelter syndrome

A

boys are born with extra copy of X chromosome
affects testicules
lower testosterone
reduced facial hair
enlarged breast tissue
reduced fertility

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83
Q

signs and symptoms of Klinefelter syndrome

A

muscle weakness
delay in speaking
testicles haven’t descended to the scrotum

taller than normal
long legs, broad hips
small penis
difficulty in speaking/reading

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84
Q

what is Patau syndrome

A

physical disabilities
heart diseases
brain/spine abdnormalities
small, poorly developed eyes
extra fingers/toes

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85
Q

what is the foramen ovale

A

it is the opening between the left and right atrium

allows blood to flow from the left to the right atrium

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86
Q

fetal circulation cycle

A
  • oxygenated blood from the placenta goes through the umbilical vein into the IVC
  • it enters the right atrium
  • it goes from the right atrium to the left atrium via the foramen ovale and into the aorta to the rest of the body
  • the lungs are fluid filled so their resistance is high which stops blood circulation to the lungs
  • deoxygenated blood goes to the internal iliac arteries and then umbilical artery and back to the placenta to get oxygenated
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87
Q

how does the foramen ovale close

A

when the baby takes the first breath - the lungs expand
- this causes decrease in resistence
- pressure in the right atrium then decreases
- pressure in the left atrium increases
this causes the foramen ovale to close

88
Q

what is ventricular septal defect

A

most common congenital heart disease

  • when there is a hole between the left and right ventricles
  • the pressure is higher in the left than right so this is the way the blood flows
89
Q

what is a small/medium/large ventricular septal defect

A

small - no consequences as only small amount of blood moves past the hole
medium - blood from left side will enter right and enter pulmonary circulation

this makes the left side of the heart bigger

large - blood goes from the left to right, causes pulmonary hypertension so then pressure on right side increases, blood moves back to left side

called - Eisenmengers syndrome

90
Q

symptoms of eisenmengers syndrome

A

cyanosis and clubbing in the fingers

restrictive - loud pan systolic murmur
non-restrictive - pulmonary hypertension and heart failure and murmur is softer

91
Q

what is an atrial septal defect

A

hole in the septum that separates the two
- blood flows from left atrium to right
- right side gets bigger
- causes breathlessness
- pulmonary pressure increases due to increased blood flow to right side

  • causes murmur due to increased flow across the pulmonary valve
92
Q

what is patent ductus arteriosus

A

the ductus arteriosus doesn’t close after birth
- happens to babies who are premature and maternal rubella
indomethacin - prostaglandin inhibitor is given - stimulates closure of the duct

93
Q

grades of patent ductus arteriosus

A

silent - very small and no murmur
small - there is a murmur but no effects
moderate - loud murmur, displaced apex beat
large - murmur is silent as pressures have equalised

94
Q

coarctation of the aorta

A

narrowing of the aorta

symptoms:
hypertension
headaches
nosebleeds
cold legs

examination
- weak and delayed pulse in the legs
BP in right arm is higher than left arm

95
Q

why cannot live injections be given to children on chemotherapy

A

because the children will be immunosuppressed and so injecting a live vaccine in them will cause them to get severely ill

96
Q

what is a Hickman line

A

the central line put inside for children who need their bloods taken, give drugs or chemo

always important to check this Hickman line as it can get infected

97
Q

what are the common side effects of chemo therapy

A

anaemia
neutropenia

  • high risk of getting an infection that can develop into sepsis
  • so if a child comes in with fever and neutropenia then treat quickly
98
Q

what is given to children with neutropenia

A

G-CSF to increase WBC count

99
Q

what is the longterm ladder management for asthma

A
  1. preventers - corticosteroids and ICS like becthamethasone
  2. leukotine inhibitors - monterlukast
  3. LABA like salmetrol - has to be prescribed by specialists
100
Q

what is reactive arthritis

A

arthritis that presents post infection

101
Q

what is perthes disease

A

when there is a loss in the blood supply to the hip joint
- this causes some parts of the bone to get ischaemic and die
- this can change the shape of the bone a little bit
- this will mean that when the blood circulation is restored, the bone will not fit perfectly in the joint as it has changed shape
- this will cause difficulty and pain when moving

common in children (boys) aged 5-6 years

102
Q

what is transient tenosynovitis

A

it is the most common cause of hip pain in children under 10
more common in right hip than left
can be due to trauma or infection
- may be post respiratory tract infection
- pain will be on the anterior aspect of the thigh
- inflammation of the synovial joint

103
Q

what is osteomyelitis

A

infection of the bone
- can be due to bacterial infection

symptoms:
- fever
- swelling
- warmth and redness of the area
- fatigue

common in smokers

104
Q

why are most neonates jaundiced when they are born

A

-physiological jaundice
- goes away after 2 weeks
- liver is too small to convert unconjugated bilirubin to conjugated bilirubin
- unconjugated bilirubin builds up
- bilirubin is the product of the death of haemoglobin - too high levels are toxic
- can cause brain damage in neonates

105
Q

when to know if the jaundice in neonates is pathological and not physiological

A

test is done - if the level of bilirubin is higher than a threshold then it is suspected for pathological jaundice

106
Q

what is pathological jaundice

A

when the high levels of bilirubin cannot be dealt by the liver
high levels of unconjugated bilirubin stays in the blood

  • this happens due to higher levels of haemolysis - so higher number or RBCs are broken down
107
Q

what are the two types of unconjugated hyperbilirubinea

A

immune and non immune

immune - eg. RH factor group incompatibility or ABO group
causes haemolytic of the babies blood - raises levels of unconjugated bilirubin

108
Q

when are conjugated bilirubin levels raised?

A

when there is an issue with the liver
eg. Gamma-glutamyl Transferase is an enzyme in the liver that converts unconjugated bilirubin to conjugated
- this enzyme is defected in Gillberts syndrome and Angler Wajjar syndrome -
- this causes raised levels of conjugated bilirubin in the blood

109
Q

what’s biliary atresia

A

congenital disease
- blockage in the bile ducts
- bile cannot flow from the liver into the bowel to be excreted
- so conjugated bilirubin accumulates in the liver

  • do surgery to prolong life
  • should be done in the first 8 weeks of life
110
Q

what is breast milk jaundice

A

found in babies that are exclusively breast fed
there is an inhibitor in the milk that inhibits action of the Gamma-glutamyl Transferase - causes raised unconjugated bilirubin levels

111
Q

what type of jaundice does cystic fibrosis cause

A

can cause unconjugated and conjugated jaundice
- mucus can build up and block the bile ducts
- but very likely to be picked up on in early age
- children will also have weight Loss, fatigue and failure to thrive

112
Q

what is therapy is used in jaundice

A

phototherapy -

113
Q

what are the symptoms of SLE in children

A

butterfly rash on the face
other systemic issues
malar rash
swelling
pain in joints

114
Q

symptoms of juvenile idiopathic arthritis

A

rheumatoid arthritis that happens in children
salmon-pink rash
on the legs and knees

115
Q

symptoms of chrondomalacia patellae

A

swelling of the patella but no systemic symptoms

116
Q

osgood disease - what is it

A

similar to perthes but doesn’t cause weight loss or fever

117
Q

Henoch-Schönlein Purpura

A

inflammatory disease of the small blood vessels
starts off with symptoms of: fever, rash on legs, abdo pain
- then red or purple spots start to appear on the skin

118
Q

what is whooping cough

A

it is a bacterial infection caused by pertussis
it is the bacteria that is given a vaccine for in the DPT vaccine

  • causes cough then inspiratory gasp
  • runny nose
  • fever
    and cyanosis

use macrolide antibiotic - clarithromycin
doesn’t treat the infection - it reduces the chances of child passing it onto someone else

119
Q

what is transposition of the great arteries

A

when the pulmonary artery and aorta are switched in places

deoxy blood from the body come to heart but then gets repumped back to the body

oxygenated blood comes from the lungs but goes back to the lungs

procedure done to correct this - atrial switch procedure
complication of the correction is - tricuspid regurgitation

120
Q

what is Reyes syndrome

A

aspirin shouldn’t be given to children younger than 12 years

causes acute liver failure

raised bilirubin
INR is prolonged
raised lactate
raised creatinine

121
Q

What is diphtheria

A
  • highly infectious
  • affects nose and throat
  • rare in UK
  • part of the DPT vaccine

symptoms:
- fever
- sore throat
- swollen cervical lymphs
- difficulty breathing
- thick grey-white coating that covers back of throat

can also cause blisters and ulcers on the legs, feet and hands

122
Q

what is tetanus

A

survives for a long time outside the body
found in the soil or poo of animals
part of the DPT vaccine for children

can get infected by: cuts on skin, burns etc

symptoms:
stiffness of jaw muscles
muscle spasms
fever
sweating
tachycardia

123
Q

what is Pertussis

A

part of the DPT vaccine

  • whooping cough
    chest infection - common in babies

symptoms:
runny nose
sore throat
between coughs children gasp for air
redness of face
can become cyanosed

124
Q

polio in children

A
  • given to children 3 times
    at 12 weeks old, 3yrs4months and 14 years booster

spreads from contaminated poo

symptoms
- fever
- tiredness
- headaches
- vomiting
- muscle pain - in serious cases can cause paralysis

125
Q

Haemophilus influenzae type b (Hib)

A

it can cause
meningitis
septicaemia
pneumonia

spread via nose and throat of healthy people

126
Q

hepatitis B - vaccine given to children

A

infection of the liver
spread via bloods and bodily fluids

symptoms:
loss of appetite
being sick
diarrhoea
abdo pain
jaundice

127
Q

MMR Vaccine

A

measles - cold like symptoms and red eyes, white spots in mouth, watery eyes, measles rash,

Mumps - causes swelling in the parotid gland, can cause swelling of testis and ovaries, deafness, fever, headache etc

Rubella - German measles - causes red/pink rash, swollen lymph nodes, fever, aching joints
rash - pink/red coloured
itchy
starts behind the ears then spreads to the head and neck

128
Q

what is a moro reflex?

A

a startled reflex
baby’s response to a loud noise
they will tilt their head back and stretch out their legs and arms and maybe start to cry

  • goes away after 3-6 months
129
Q

rickets - what is it and what does it cause

A

it is vitamin D deficiency - caused due to reduced sun exposure in children - esp those who have coloured skin

children who are breast fed for a long time are also at risk as breast milk is not a good source of vitamin D

symptoms of this - bowed legs, wrist and ankle swelling, muscle weakness and delayed walking

130
Q

scurvy - what is it and symptoms

A

causes bone pain and easy bruising

vitamin c deficiency

131
Q

foetal alcohol syndrome

A

cause behind developmental delay
children will have developmental delay
will have delayed motor skills
poor coordination
difficulty in language and social skills

132
Q

what is discoid eczema

A

eczema that has circular lesions

133
Q

transient tachypnoea of the newborn

A

happens 2 hours after delivery
goes away after 72 hours
child will be breathless and have low O2 sats

134
Q

what is tuberous sclerosis

A

genetic condition that causes benign tumours to develop in different parts of the body
can cause developmental delays
seizures
behavioural problems

135
Q

what is third nerve palsy

A

when the eye looks down and out at rest

136
Q

what is fourth nerve palsy

A

the eye cannot look down and inwards towards the midline
superior clique muscle is paralysed

patient may present with eye looking up and in at rest
head may be tilted to compensate for this

137
Q

what is sixth nerve palsy

A

lateral rectus muscle is paralysed
eye cannot look away from the nose (abduct horizontally)

138
Q

orbital cellulitis features

A

extreme case of pre septal cellulitis
painful eye movements
swollen eye lid
erythema

139
Q

pre septal cellulitis features

A

swollen eye lid
erythema
mild fever

  1. visual impairment
  2. diplopia - double vision
  3. painful eye movements
140
Q

retinitis pigmentosa

A

cause behind retinal degeneration
causes history of night blindness and reduced visual fields

141
Q

what drops are used for acute angle closure glaucoma

A

pilocarpine - reduces intraocular pressure which causes closure of the eye ball

142
Q

nephroblastoma - what is it

A

Wilm’s tumour
embryonic tumour that is found in the kidneys

most common abdo mass in children
causes symptoms of

  • haematuria
  • hypertension
    -fever
  • abdo mass
143
Q

the pertussis virus can cause?

A

whooping cough

144
Q

grunting is a sign of?

A

respiratory distress in babies

145
Q

neonatal respiratory distress syndrome

A

common in premature babies
- due to not enough pneumocystis - so not enough surfactant is produced
- there is not enough surfactant in the plural space
- this increases surface tension
- so the alveoli cannot expand properly
- can cause the lungs to collapse

  • give artificial surfactant
146
Q

coxsackie virus causes what disease?

A

hand, foot and mouth disease

147
Q

what is juvenile idipathic arthritis

A

rheumatoid arthritis in young children
- gradual onset
- morning stiffness
no systemic symptoms
pain in the joints

148
Q

symptoms of patent ductus arteriosis

A

baby will have a collapsing pulse
machine like murmur
bradycardia
episodes of when they stop breathing

149
Q

what medication can be given to help in patent ductus arteriosis

A

indomethacin - it causes vasoconstriction which causes the duct to close

150
Q

what is intestinal malrotation

A

is when during the foetal development, the mid gut rotates and blocks off the blood supply

  • this causes a ‘corkscrew’ appearance on the Xray
  • it also is a big cause behind bilious green vominting
  • it is managed by a surgical procedure (Ladd bands)
151
Q

jejunal atresia

A

causes bilious vomiting in newborn babies
abdominal distension
but on X ray - looks like a ‘triple bubble’

152
Q

duodenal atresia

A

bilious vomiting in babies
abdo distension
X ray appearance - ‘double bubble’

153
Q

meconium ileus

A

when the large intestine is blocked due to the meconium being really thick - can be due to mucus
this causes a ‘bubbly’ looking Xray

154
Q

most common congenital heart defect in neonates with diabetic mothers?

A

transposition of the great arteries

155
Q

diagnostic test for CF

A

sweat test - 2 electrodes on skin which causes sweating, the sweat is analysed for sodium chloride which is high in CF

the transmembrane protein transports sodium chloride, and water
if there is dysfunction in this then sodium chloride levels increase

children with CF ‘taste salty’
it causes respiratory and pancreatic secretions to become thick so this causes obstruction

156
Q

what is meckels diverticulum

A

most common congenital abnormality of the intestine
it is a bulging left over of the umbilical cord
the vitelline duct does not close properly in the 5th week of feral development leaving this pouch behind

  • common presentation is GI bleeding
157
Q

antibodies for coeliac disease

A

anti TTG antibodies
small bowel biopsy for young children

158
Q

Kawasaki disease - what is it

A

affects coronary arteries
it can cause aneurysm development
do echocardiogram

159
Q

nocturnal enuresis - what factors affect It

A

bladder capacity
ability to wake up and use toilet
amount of urine that is being produced

160
Q

pathology behind nocturnal enuresis

A

ASH increases at night so more water is retained
which is why urine is dark in the morning and concentrated

this is nocturnal ADH secretion
this is not fully developed in children

which is why desmopressin is given as a treatment for children who are bed wetting

161
Q

factors that increase incontinence chances

A

bladder capacity - it is reduced in children but improves with age

caffeine irritates the bladder
UTI - Inflammation of the bladder so it is more irritated

162
Q

what is given in overactive bladder

A

urge incontinence

oxybutynin

163
Q

coarctation of the aorta

A

it is a congenital narrowing of the aorta

it causes a systolic murmur heard at the scapula
and also radio-femoral delay

babies with turners syndrome also have coarctation of the aorta

164
Q

Vesicouretric reflux - what is it

A

when the urine travels back up the ureters due the valves not working properly
this can cause recurrent UTIS

  • needs surgery
165
Q

presentation of GORD in babies

A

recurrent vomiting
chronic cough
and slow growth

this is due to the oesophageal spincter growing slowly in premature babies which can cause reflux

166
Q

when should babies start walking

A

18months

167
Q

what is intussusception

A

it is when a part of the bowel collapses in itself making a telescope like shape
it causes jelly stools and a sausage mass in the abdomen
abdo discomfort
baby is in a lot of pain and holds legs up

do lapratomy

168
Q

what is benign Rolandic epilepsy

A

it is a type of epilepsy that is common in children 3-13 years
- they generally outgrow it after puberty
- have seizures in the night
- CENTOTEMPORAL SPIKES ON EEG

168
Q

what is benign Rolandic epilepsy

A

it is a type of epilepsy that is common in children 3-13 years
- they generally outgrow it after puberty
- have seizures in the night
- CENTOTEMPORAL SPIKES ON EEG

169
Q

eye condition in premature babies due to prematurity

A

prematurity that requires the administer of foetal oxygen is a risk for premature retinopathy

due to abnormal and uncontrolled development of blood vessels in the eye

170
Q

What sort of symptoms does a ventricular septal defect

A

Ventricular septal defect a lot left lower standard edge, harsh pansystolic murmur.

Will be Heard which will cover the whole systole and will extend from the first and second hearts down and children present with failure to thrive

  • if left untreated - can cause pul. hypertension as shunting will start happening r-l

eisenmengers syndrome

171
Q

What symptoms are seen in mitral stenosis

A

Mid diastolic murmer
I would generally be a history of rheumatic fever in the child

172
Q

What are the features of a patent ductus arteriosus?

A

It will present with a machine like Mama, which is continuous at the left upper sternal edge

This is due to a left right shunting of blood so more blood is going to the lungs increased risk of respiratory tract infections and also left sided. Hypertrophy children would present with failure to thrive.

173
Q

What are the features of aortic septal defect?

A

It is a acyanotic, congenital heart condition

Blood will be chanting from left to right or starts with normal. More blood will be going to the right side which would create an ejection systolic murmur in the pulmonary area. Generally will not be heard in the beginning but as the symptoms get worse, you can start to hear it.

In this condition, more oxygenated blood is entering back into the Pulmonary system and deoxygenated blood and up, going back through the body

174
Q

What are the acyanotic congenital heart defect?

A

Ventricle septal defect, patent, ductus arteriosus, and atrial septal defect

175
Q

What are the cyanotic congenital heart defect?

A

Transposition of the great arteries and tetralogy of fallout

176
Q

What is tetralogy of fallot characterised by

A

ventricular septal defect, overriding aorta, pulmonary stenosis and right ventricular hypertrophy.

177
Q

What are the features in transposition of the great arteries

A

In this condition, the right artery and right ventricle are connected to the aorta and the left artery and a ventricle and connect to the pulmonary artery.

So in this case, the right side which has deoxygenated blood pumps blood through the aorta into the systemic circulation

oxygenated blood which comes from the left side of the heart, is connected to the pulmonary artery and goes into the pulmonary circulation

In this case, the baby will be very cyanotic as no oxygen will be reaching the body

In this case, the only way the baby can survive is, if they had a ASD VSD or a PDA. This will allow the mixing of oxygenated blood into the systemic circulation. If this is not there, then the baby can die.

177
Q

What is the immediate management used for transposition of the great arteries

A

Step one is to give prostaglandin that will allow the doctors arteriosus to remain open and this will allow the mixing of the blood

In any normal situation, the doctors arteriosus stays open for 24 to 48 hours after birth and then closes, but giving prostaglandin will allow this to remain open

The doctors arteriosus closes due to the drop in prostaglandin after birth

Step two is to do an atrial septostomy, so make a hole in the heart to allow the mixing of blood

then the switching operation is done

177
Q

What are the features of tetralogy of fallot

A

There is pulmonary stenosis in which the pulmonary artery is more narrow. This obstruction means that less blood enters the pulmonary circulation. This makes the right side bigger because it has to work harder.

  • due to the right ventricular hypertrophy, there is increase pressure on the side of the heart. This causes the shunting to be from right to left

This is the VSD, and due to the overriding aorta it means that deoxygenated blood passes the lungs and goes from the right ventricle into the left ventricle, and then into the water, and then into the systemic circulation. So deoxygenated blood gets passed around the body.

178
Q

What are some of the symptoms of tetralogy of fallot seen in children?

A

Children present with cyanotic spells in which the left ventricle goes into spasm.

loud murmur heard on upper sternal edge
hypoxic and cyanotic

baby goes blue

The way to manage this is giving morphine to reduce the heart rate and blood pressure

Phenylephiline - This increases systemic pressure and causes the shunt to reverse and go from right to left

to left -> right

179
Q

management of impetigo

A

topicsl hydrogen peroxide cream
fusicidic acid

send to school after 48 hours off starting sntibiotics
or after crusting over

180
Q

lice symptoms

A

itchy neck and rash

pediculuous capitis

mgt - wet combing
insecticide dimethicone gel - can be used in pregnant

mathalion aqueous liquid

181
Q

how to refain from school in chicken pox

A

until lesions have crusted over

182
Q

chicken pox appearance

A

starts with fever then rash
starts at the head then spreads over the body

183
Q

causative organism of measles

A

parxmyovirus

184
Q

most common complication of measles

A

otitis media, pneumonia and encephalitis

185
Q

feature of mumps

A

swelling on the face
and can also sometimes get epiorchitis - swelling of the testes

supportable management

complication is pancreatitis

186
Q

features of rubella

A

also known as German measles

rash that spares the limbs

togavirus

headache
low grade fever
spotty and red all over rash - forcheimer spots on the soft pallet of the mouth

187
Q

complications of rubella

A

serious risk to pregnant women - in first 20 weeks
can cause cataracts, ductus arteriosus and Brian damage

can’t give mmr vaccine to pregnant women

188
Q

molluscum contagiosa features

A

small dome shaped pupils with a central umbilication

pearly coloured
itchy
painless

contagious

  • generally clears after a few months
189
Q

roseola infantam features

A

really high fever

after fever suddenly the rash appaers
maculopapapular rash
blanching
starts on the trunk and spreads outwards

human herpes virus 6

supportive management

190
Q

slapped check syndrome features

A

parvovirus

fever
diarrhoea

slapped cheeks

can cause aplastic crisis - aneamia in children

contagious until rash appears

191
Q

scarlet fever features

A

strep progenes

swollen tonsils
sandpaper rash
strawberry tongue - white coating on the red tongue
sore throat
headache and fever

192
Q

management of scarlet fever

A

throat swab

oral penicillin for 10 days

can return to school 24 hours after antiobtics have been started

193
Q

Wilms nephroblastoma

A

buzz words ‘ painless palpable lump in the RUQ of abdo’

common in children under 5
refer in 48 hours
spreads quickly

new lump in the abdo

194
Q

what is the most common kidney cancer in children

A

wilms tumour - very common in children under 5

195
Q

investigation of intussecpition

A
  • ultrasound
196
Q

intussecpition features

A

the colon folds in on it self
severe abdo pain
sausage shaped mass in RUQ pain
red current stool
children draw up legs

targets seen in the ultrasound

197
Q

management of intussuception

A

air enema - pass air through the bowel

most common cause of bowel obstruction in children

198
Q

necrotising enterocolitis features

A
  • premature infants
  • necrosis of the bowel
    gas within the bowel wall
    intolerance to feeds

x-ray shows:
dilated bowel loops and within the bowel wall
air in the bowel and biliary tree

199
Q

what is hirchsprungs disease

A

delaying in passing of the meconium (24hours)
chronic constipation
the end section of the bowel is not innervated so there is delay in passing of meconium

  • baby passes poo after sticking finger up the anus
  • associated with Down syndrome
200
Q

management of hirchsprungs disease

A

renal biopsy is gold standard

rectal washouts,
or do surgery

201
Q

volvulus sign on x ray

A

coffee bean sign

202
Q

abdominal migraine

A

abdo pain lasting an hour but everything else is normal

203
Q

mesenteric adenitis features

A

can mimic appendicitis

  • rebound tenderness and very painful
    no fever or other systemic upset
    follows recent viral infection

enlarged mesenteric lymph nodes but normal appendix

204
Q

appendicitis in children features

A

pain
very very painful
nausea and vomiting
fever will be there
very rigid abdo

205
Q

jaundice presentation before 24 hours

A

always pathological

G6PD deficiency
haemolytic anaemia

206
Q

jaundice presentation after 24 hours

A

often normal - physiological jaundice due to the liver

common in breast fed babies

207
Q

jaundice presentation after 14 days

A

do further investigation :

hypothyroidism
biliary atresia
UTI
congenital infections
or autoimmune haemolytic anaemia

208
Q

Gilberts sydrome

A

presentation of jaundice in older children (teens)
generally during stressful times

209
Q

pyloric stenosis features

A

ABG - metabolic alkalosis

projectile vomiting
poor feeding
failure to thrive
olive shaped mass in the epigastric region
poor weight gain

210
Q

pyloric stenosis investigation

A

ultrasound of abdo

211
Q

management of pyloric stenosis

A

laparoscopic pyloromyotomy

212
Q

GORD in babies features

A

vomiting after larger feeds
milky
due to over feeding
after being laid flat
crying while feeding

213
Q

side effects of PPIS in babies

A

high sodium in gaviscon can cause vomiting and constipation

214
Q

nocturnal enuresis - management

A
  1. enuresis alarm and reduced fluid intake before bed
  2. desmopressin (short term control)

AMK (27 decks)

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