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paediatrics 👶🏻 Flashcards

1
Q

classic tetrad for severely infected infants with congenital toxoplasmosis

A

hydrocephalus
chorioretinits
convulsions
cerebral calcifications

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2
Q

what causes toxoplasmosis

A

toxoplasma gondii
eating uncooked meat/exposure to cat faeces

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3
Q

What kind of history will a patient present with who has functional abdominal pain

A

Vague, persistent, central abdo pain
Acute,chronic or cyclic
Girls 8-12
Nausea and vomiting
Fx of functional disorders

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4
Q

What history would a patient with constipation present with

A

Vague abdo pain
Painful defecation
Poor diet and fluid intake
Obesity
Faecal incontinence

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5
Q

On clinical examination of a patient with constipation what would you find

A

Minimal-mild abdo tenderness
Stool in rectum
Abdo distension
Faecal mass palpable

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6
Q

Mx of constipation

A

Stool softening laxatives
Improving water, food and fibre intake

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7
Q

What history would a patient with gastroenteritis present with

A

Vague abdo pain with nausea and vomiting
Diarrhoea +/- mucus
Recent travel, contact with sick person or ingestion of suspicious food/drink

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8
Q

With gastroenteritis, if it last more than 10 days what does that suggest

A

Parasitic or non-infectious cause

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9
Q

On clinical examination of patient with gastroenteritis what would you see

A

Diffuse abdo pain
Abdo distension
Hyperactive bowel sounds
Signs of volume depletion
Low grade fever

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10
Q

What history would a patient with coeliac disease present with

A

Recurrent abdo pain, cramping or distension
Bloating and diarrhoea
Dermatitis herpetiformis
Family history of coeliac disease

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11
Q

On clinical examination of a patients with coeliac disease what would you see

A

Generalised abdo pain or bloating
Underweight or failing to thrive

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12
Q

What history would a patient with TB present with

A

Night fever
Sweating
Cough
Haemoptysis
Poor appetite
Weight loss
Recent travel abroad

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13
Q

Treatment for TB

A

isoniazid
Rifampicin
Ethambutol
Pyrazinamide

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14
Q

History of patient with scarlet fever

A

Under 10
Sore throat
Malaise
GI upset

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15
Q

Clinical examination of pt with scarlet fever will reveal ?

A

Strawberry tongue
Sandpaper-like generalised rash
Fever
Tender cervical lymphadenopathy

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16
Q

Dx scarlet fever

A

Rapid throat swab but abx should be started immediately

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17
Q

Mx scarlet fever

A

Oral phenoxymethylpenicillin 10 days
If PA azithromycin
Children can return to school 24 hours after commencing abx

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18
Q

CREAM
Conjunctivitis
Rash
Erthyema of hands and feet
Adenopathy (cervical)
Mucosal involvement (strawberry tongue, oral fissures)

high grade fevers for >5 days

A

kawasaki disease

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19
Q

Mx of Kawasaki disease

A

High dose aspirin - due to risk of Reye’s syndrome aspirin is usually contraindicated in children
IV immunoglobulin

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20
Q

Sx of staphylococcus toxic shock syndrome

A

High grade fever
Malaise
Erthymematous rash
Syncope
Hypotension

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21
Q

Progression of toxic shock syndrome

A

Initially non specific flu like symptoms possibly with nausea, vomiting and diarrhoea
Then rapid progression to high fever and eruption of widespread rash that covers >90% body surface

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22
Q

Ix toxic shock syndrome

A

CK elevated
Low platelets
Blood, throat or CSF culture: no growth of pathogen

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23
Q

Mx toxic shock syndrome

A

Antibiotics
Fluid resuscitation
Vasopressors
Surgical debridement

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24
Q

Signs and symptoms you would see with coeliac disease paediatric

A

Failure to grow/thrive
buttocks wasting
Foul smelling faeces
Conjunctival pallor
Abdominal distension

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25
Presentation of measles
Fever >40 Coryzal sx Conjunctivitis followed by a rash 2-5 days after onset of sx Koplik spots Lasts about 5 days
26
Other names for fifth disease
Parvovirus B19 Slapped cheek syndrome Erythema infectiosum
27
Presentation of fifth disease
Prodrome of fever, Coryza and diarrhoea Bright red rash on cheeks followed by lacy rash on extremities
28
What is roseola
Aka sixth disease Common disease of infancy caused by human herpes virus 6
29
Complications of roseola
Febrile convulsions
30
Presentation of roseola
Febrile and lethargic for up to 5 days Blanching, rose pink macular rash erupts and covers trunk typically Can spread to face and limbs Cervical lymphadenopathy
31
Mx of roseola
Supportive
32
What history would a patient with asthma present with
Family history Wheezing triggered by change in Weather, Environmental tobacco smoke, exercise, emotion Tachypnoea Dry night time cough
33
What history would a patient with bronchiolitis present with
Under 1 year Seasonal - common in winter Passive tobacco exposure Cough increased in severity over time
34
Features of bronchiolitis
Coryzal symptoms cough Increasing breathlessness Wheezing Feeding difficulties
35
In what cases is bronchiolitis more severe
Bronchopulmonary dysplasia e.g premature Congenital heart disease Cystic fibrosis
36
Causes of bronchiolitis
Most cases = respiratory syncytial virus RSV
37
What is a common complication seen in bronchiolitis caused by RSV
Hyponatraemia
38
What history would a typical patient with croup present with
Male Between 6 months and 6 years Seal like barking cough worse at night Stridor Incidence in autumn/winter Mild fever
39
Mx of croup
Dexamethasone Supportive Adrenaline nebuliser in emergency
40
What causes croup
Upper airway infection Vast majority of cases caused by parainfluenza virus Other viruses include adenovirus, RSV and influenza
41
What history would a typical patient with acute epiglottis present with
Hib unvaccinated 2-6 years of age Drooling High fever, generally unwell looking child Patient finds it easier to breathe if leaning forward and extending neck Stridor
42
Mx of epiglottis
Immediate senior involvement DO NOT EXAMINE THROAT Secure airway Oxygen
43
Clinical features of intussusectpion
6-18 months Severe colicky abdo pain (draws you legs and turns pale) Vomiting Sausage shaped mass in RUQ Red-currant jelly stool Abdo distension
44
Mx of intussusception
Rectal air insufflation
45
What would you see on an abdo x ray for intussusception
Target sign +/- free abdo air
46
Clinical features of meckels diverticulum
Asymptomatic OR parent Vitelli-intestinal duct OR painless rectal bleeding OR abdo pain, intussusception, obstruction
47
Describe the tripod position and what is this indicative of
Upright leaning forward with extended neck and open mouth Acute epiglottis
48
Mx of acute epiglottitis
Call senior to intubate and secure airway Then o2 and IV abx
49
Describe wheeze
Monophonic or polyphonic musical sound louder on expiration due to narrowing in lower airway
50
Describe Stridor
Single note occurs in inspiration due to upper airway obstruction
51
Clinical features of neonatal sepsis
Resp distress Tachycardia Apnoea Change in mental status Jaundice Seizures Poor feeding Abdominal distension Vomiting In order of prevalence
52
Describe neonatal resuscitation if baby is not breathing
5 inflation breaths If no improvement - optimise airway and repeat 5 breaths Once airway is established check pulse If HR <60 ventilate 30 seconds If still<60 chest compressions
53
Presenting features of necrotising enterocolitis
<3 weeks old Bike streaked vomit Absent bowel sounds Abdo distension Bloody stools
54
Risk factors for necrotising enterocolitis
Premature birth
55
Dx of necrotising entercolitis
Abdo x ray
56
What would you see on an abdo x ray of a necrotising enterocolitis patient
Dilated bowel loops Pneumotosis intestinalis Portal venous gas Pneumoperitoneum
57
Mx of necrotising enterocolitis
Drip and suck (IV fluids and antibiotics, nil by mouth so NG tube aswell) Surgical resection of necrotic bowel
58
Presenting features of acute epiglottis
High fever Toxic appearance Inspiratory Stridor Drooling Absence of cough
59
CXR for acute epiglottis would show ?
Thumb sign
60
Triggers for DKA
Infection Non compliance Inappropriate dose alteration First presentation of T1DM Myocardial infarction
61
For paediatric patients coming in when would a CT head in 1 house be indicated
GCS <=13 (14 if <1yo) Post traumatic seizure Basal skull fracture (And more)
62
Red flags in a feverish child that you should urgently refer for paediatric assessment
Pale, mottled,ashen or blue skin No response to social cues Appears ill to a healthcare professional Does not wake or if roused does not stay awake Weak high pitched or continuous cry Grunting Reduced skin turgor Bulging Fontanelle, neck stiffness, non-blanching rash Age<3 months with temp >=38 Status epilepticus, focal seizures, focal neurological deficits
63
features of foetal alcohol syndrome
functional or structural nervous system abnormalities growth impairment specific facial abnormalities e.g. short palpebral fissures, smooth philtrum and thin upper lip
64
what is an important and common side effect of methylphenidate
appetite suppression and subsequent growth suppression
65
inheritance pattern of duchennes muscular dystrophy
x linked recessive inherited genetic defect that reduces the expression of dystrophin
66
presentation of duchennes muscular dystrophy
muscle wasting and weakness in early childhood children may have bulky-appearing muscles as degenerated muscle is replaced by fat parents may notice that the child "slips through their hands" when they pick them up
67
causes of jaundice in the first 24 hours
always pathological - rhesus haemolytic disease - ABO haemolytic disease - hereditary spherocytosis - glucose-6-phosphodehydrogenase deficiency
68
jaundice in the neonate from 2-14 days ?? what causes this
this is common and usually physiological more commonly seen in breastfed babies
69
jaundice after 14 days of life in a newborn, what do you do?
a prolonged jaundice screen is performed
70
causes of prolonged jaundice (>14 days) in a newborn
biliary atresia hypothyroidism galactosaemia UTI breast milk jaundice prematurity congenital infections
71
what is staphylococcal scalded syndrome and how does it present
severe desquamating rash that affects infants presentation: systemically ill child presents with superficial fluid-filled blisters with acute-onset erythroderma with a positive Nikolsky sign, oral mucosa is usually unaffected
72
Nikolsky sign
slight pressure on skin causes peeling of superficial epidermis positive is SSSS, TEN and pemphigus vulgaris
73
mx SSSS
IV abx and supportive treatment
74
what enterovirus causes hand-foot-and-mouth disease
typically Coxsackie A
75
presentation of henoch-schonlein purpura
purpuric rash classically over lower limbs abdo pain arthralgia
76
what is ALL
acute lymphoblastic leukaemia most common paediatric cancer
77
clinic presentation of ALL
pallor unexplained bruising persistent fatigue hepatosplenomegaly lymphadenopathy increased susceptibility to infection so they might be having a huge reaction to a simple infection most common in children 2-5 years
78
mx ALL
treatment included chemotherapy and stem cell transplantation
79
investigations for measles
3-14 days after onset of sx - measles specific IgG and IgM serolgy 1-3 days - PCR
80
most common complication associated with measles
acute otitis media
81
presentation of rubella
nonspecific sx coryzal sx arthralgia rash that spreads from face to reset of body sparing limbs lymphadenopathy
82
what are the characteristic features of congenital rubella infection
cataracts deafness patent ductus arteriosus - machine-like murmur brain damage purpuric skin rash aka "blueberry muffin" rash
83
presentation of mumps
high fever and multiple organ involvement most common - parotitis 2nd most common - orchitis - swelling of the testicles other rare presentations include deafness aseptic meningitis encephalitis
84
investigating mumps
saliva specific IgM
85
how is impetigo presented
pruritic rash on the face usually with golden crusting usually presents in infants and school age children
86
management of impetigo
topical fusidic acid is the first line oral flucloxacillin can be used if still persists
87
when infected with impetigo when can children return to school
48 hours after abx therapy or after the lesions have crusted over
88
1st and 2nd line mx tonic clonic seizures
1st - sodium valporate 2nd - lamotrigine/carbamezapine
89
1st and 2nd line mx focal seizures
1st - carbamezapine/lamotrigine 2nd - sodium valporate
90
what are atonic seizures
brief lapses in muscle tone known as drop attacks
91
what is status epilepticus
medical emergency defined as when a seizure lasts longer than 5 minutes or they have 2 or more seizures without regaining consciousness in interim
92
mx of status epilepticus
A-E IV lorazepam twice then final step is IV phenytoin or IV phenobarbital
93
what are febrile convulsions
type of seizure that occurs in children with high fevers not caused by epilepsy or any underlying neurological condition appears in 6 months - 5 years old
94
management of febrile convulsions
Identify and treat the underlying cause of high fever control fever with simple analgesia
95
what is west syndrome aka infantile spasms
rare disorder that occurs in infants aged around 6 months characterised by a cluster of full-body spasms poor prognosis
96
management of west syndrome
prednisolone and vigabatrin
97
EEG findings for West syndrome
hyps arrhythmia
98
what are benign rolandic seizures?
occurs in 3-10-year-olds and almost exclusively in sleep generalised tonic clinic seizures in their sleep excellent prognosis - most outgrown by puberty EEG findings - centrotemporal spikes
99
what is a Wilm's tumour
embryological tumour from developing kidney most common abdomen tumour in children especially under 5
100
presentation of Wilm's tumour
abdominal mass that does not cross the midline abdominal distension haematuria
101
diagnosis of Wilms tumour
initial ix: USS diagnostic : biopsy

Clinical Medicine (26 decks)

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