Paediatrics Flashcards
1
Q
Kawasaki Disease Presentation
A
Fever >5 days
4/5 of CREAM features
- Conjunctivitis
- Rash
- Edema/Erythema
- Adenopathy (cervical, commonly unilateral)
- Mucosal involvement (strawberry tongue, oral fissures)
Raise Suspicion: prolonged fever and red eyes, hands and feet in a child
2
Q
Treatment of Kawasaki Disease
A
Aspirin and Intravenous Immunoglobulin (IVIG)
3
Q
What is pyloric stenosis?
A
Hypertrophy of the pyloric sphincter
4
Q
Presentation of pyloric stenosis
A
Vomiting after feeds: can be projectile (hitting walls)
O/E: palpable, smooth, olive-sized mass (more obvious during feeding)
5
Q
Complications of pyloric stenosis
A
Dehydration
Severe vomiting –> acid base abnormality of hypochloremic hypokalemic metabolic alkalosis
6
Q
Diagnosis of pyloric stenosis
A
Abdominal US
7
Q
Management of pyloric stenosis
A
Surgical with pyloromyotomy to cut the pyloric sphincter to widen the outlet
8
Q
What bacteria causes impetigo?
A
Staphylococcal and Streptococcal bacteria
- commonly staphylococcus aureus
9
Q
Presentation of impetigo
A
Pruritic rash
Golden crust
Face, nose, mouth
10
Q
Management of impetigo
A
Fusidic acid
Oral flucloxacillin
11
Q
Intussusception definition
A
Invagination of proximal bowel into a distal segment passing into the caecum through the ileocaecal valve.
The peak ages are between 3 months and 2 years old.
12
Q
Complications of intussusception
A
Bowel perforation
Peritonitis
Gut necrosis
13
Q
Presentation of intussusception
A
Severe colicky pain - child characteristically draws up his legs
May refuse feeds
Vomiting may be bile stained
Abdo distension
Sausage-shaped mass may be palpated in the abdomen
14
Q
Investigations for intussusception
A
‘Target’ sign on abdominal US (concentric echogenic and hypoechogenic bands)
Can also show complications such as free-abdominal air or presence of gangrene.
15
Q
Management of intussusception
A
Rectal air insufflation or contrast enema (if child is stable)
Operative reduction indicated if:
- failure of non-operative management
- peritonitis or perforation is present
- hemodynamically unstable
16
Q
Other name for Pertussis
A
Whooping Cough
17
Q
Cause of Pertussis
A
Bordetella pertussis
18
Q
Presentation of Pertussis
A
Cough, with prolonged period of coughing per episode
Inspiratory whooping
Rhinorrhoea
Post-tussive vomiting
Apnoeas
19
Q
Management of Pertussis
A
Macrolides typically first-line
Pertussis is a notifiable disease
20
Q
Cause of Glandular Fever
A
Epstein Barr Virus (EBV)
21
Q
Presentation of Glandular Fever
A
Fever
Sore Throat
Fatigue
Hepatomegaly and/or splenomegaly may sometimes be found on palpation
22
Q
Management of Glandular Fever
A
Supportive
Advise against contact sports and heavy lifting for 1 month to minimise risk of splenic rupture.
23
Q
What is Hypoxic Ischaemic Encephalopathy (HIE)?
A
Term for brain damage resulting from ante- or perinatal hypoxia
- lack of oxygen in foetal circulation results in poor supply of oxygen to brain
- ischaemia results in irreversible brain damage, both from primary neuronal death (immediate) and secondary reperfusion injury (delayed).
24
Q
Presentation of HIE
A
Depends on the degree of neurological damage
- Mild: irritability
- Severe: hypotonia, poor responses, prolonged seizures
25
Normal Obs at Birth
HR: 110-170
RR: 35-55
Systolic BP: 50-70
26
Normal Obs at 12 months
HR: 80-140
RR: 30-40
Systolic BP: 70-100
27
Normal Obs at 3-5 years
HR: 80-130
RR: 20-30
Systolic BP: 70-110
28
Normal Obs at 6-11 years
HR: 70-120
RR: 16-25
Systolic BP: 80-120
29
Normal Obs at 12-18 years
HR: 60-100
RR: 12-22
Systolic BP: 100-120
30
Indications for Tonsillectomy
The indications for tonsillectomy in recurrent tonsillitis are
- seven or more episodes in a single year
- five or more episodes/year in two years
- three or more episodes/year in three years
31
What is Perthes Disease?
Avascular necrosis of the femoral head in children aged 4-8. Disruption of blood flow to the femoral head causes ischaemia.
32
Presentation of Perthes Disease
Gradual onset limp and hip pain.
Pain can also be referred to the knee.
Pain persisting for >4 weeks should raise suspicion
33
Diagnosis of Perthes Disease
Hip X-Ray: shows sclerosis and fragmentation of the epiphysis.
34
Management of Perthes Disease
Depends on extent of necrosis
<50% of the femoral head: can resolve with conservative measures like bed rest and traction.
>50% of the femoral head: plaster cast keeping the hip abducted or osteotomy may be required. Poorer outcomes and carries ^risk for degenerative arthritis later in life.
35
What is necrotising enterocolitis?
Bowel of premature infant becomes ischaemic or infected
36
Risk factors for necrotising enterocolitis
Prematurity
Low birth weight (LBW)
Non-breast milk feeds
Sepsis
Acute hypoxia
Poor intestinal perfusion
37
Clinical Features of necrotising enterocolitis
First 3 weeks of life
Vomiting (may be bile streaked)
Bloody stools
Abdominal distension
Absent bowel sounds
Signs of systemic compromise inc. acidosis on blood gas
38
Investigations for necrotising enterocolitis
Abdo X-Ray
- dilated bowel loops
- Pneumatosis intestinalis (gas within bowel wall)
- portal venous gas
- Pneumoperitoneum
39
Management for necrotising enterocolitis
NG tube
Broad spectrum Abx
Total parenteral nutrition to rest bowel
IV fluids and ventilation
Surgery to resect necrotic section of bowel may be necessary --> essential if bowel perforation
40
Complications of necrotising enterocolitis
Fatal in 1/5 cases
Long-term implications: having a stoma or short gut syndrome
41
What anti-depressant is suitable for children?
Fluoxetine
42
What is a Wilm's tumour?
Nephroblastoma
An embryonic tumour from the developing kidney.
43
Epidemiology of Wilm's tumour
Most common in children <5 years
Peak incidence between 3-4 years of age
44
Presentation of a Wilm's tumour
Abdo mass that doesn't cross midline
Abdo distension
Haematuria
Hypertension
Otherwise asymptomatic unless grown large enough to cause pain or infiltrate other abdo structures
45
Diagnosis of a Wilm's tumour
Suspected nephroblastoma: CT chest, abdomen and pelvis
Definite diagnosis and staging confirmed via renal biopsy
--> small round blue cells may be seen on histology
46
Management and prognosis of a Wilm's tumour
Surgical options (nephrectomy), chemotherapy and radiotherapy
Excellent prognosis with over >90% 5-year survival rate
47
In NICU, what consequence of artificial ventilation is routinely screened for?
Retinopathy of prematurity
48
What is Ventricular Septal Defect? (VSD)
A birth defect of the heart in which there is a hole in the wall that separates the ventricles of the heart
49
What murmur is heard in ventricular septal defect?
Pansystolic murmur (harsh) best heard at the left lower sternal edge
50
What vaccines are contra-indicated in a patient with an egg allergy?
Yellow Fever
Influenza vaccine - if had been admitted to PICU for egg allergy
51
What vaccines are contra-indicated for a patient with a history of intussusception?
Rotavirus vaccine
52
What is Turner's Syndrome?
A condition that results in females when one of the X chromosomes is missing or partially missing.
53
Presentation of Turner's Syndrome
Short stature
Lymphoedema of hands and feet in neonate
Webbed neck
Widely spaced nipples
Delayed puberty
Ovarian dysgenesis causing infertility
Hypothyroidism
Spoon-shaped nails
Congenital heart defects
Normal intellect
Recurrent otitis media
54
Management of Turner's Syndrome
Growth hormone therapy
Oestrogen replacement to allow development of secondary sexual characteristics
55
Complications of Turner's Syndrome
^ risk of cardiovascular disease
--> ^ risk of aortic stenosis (from bicuspid valve) and aortic dissection (from coarctation of the aorta)
56
Chromosomal abnormality seen in Turner's Syndrome
XO karyotype
57
Most common congenital heart defect seen in Turner's Syndrome
Bicuspid aortic valve (most common)
Coarctation of the aorta
58
First line pharmacological treatment of ADHD in children >6yo
Mehtylphenidate
59
Rickets results from a deficiency in what?
Vitamin D
60
What is Coeliac disease?
A T cell-mediated inflammatory autoimmune disease affecting the small bowel in which sensitivity to prolamin results in villous atrophy and malabsorption
61
Associations of coeliac disease
Positive FHx
HLA-DQ2 allele
Other autoimmune disease (such as type 1 diabetes mellitus)
62
Symptoms of Coeliac Disease
Gastro
- abdo pain
- distension
- N&V
- Diarrhoea
- Steatorrhoea
Systemic
- Fatigue
- Weight loss or failure to thrive
- General appearance: pallow, short stature, wasted buttocks, features of vitamin deficiency due to malabsorption (e.g. bruising due to vit K deficiency)
- Dermatitis herpetiformis
63
Diagnosis of Coeliac Disease
Stool culture to exclude infection.
First line: Anti-TTG IgA antibody
if +ve, for definitive diagnosis:
Gold standard: OGD and duodenal/jejunal biopsy. Carried out before and after gluten withdrawal.
Histology revelas subtotal villous atrophy, crypt hyperplasia, and intra-epithelial lymphocytes.
64
Complications of Coeliac Disease
Anaemia (secondary to iron, B1 or folate deficiency)
Hyposplenism (therefore a susceptibility to encapsulated organisms)
Osteoporosis
65
Causative organism for Hand, Foot and Mouth disease
Coxsackie virus A16
66
When is chickenpox no longer infectious?
When all the lesions have crusted over
67
What is hydrocephalus?
The result of an excess of cerebrospinal fluid (CSF) accumulating in the brain ventricular system.
Puts pressure on the brain parenchyma and can have devastating neurological consequences if not recognised and treated
68
Causes of non-communicating hydrocephalus
Something obstruct the flow through the ventricular system:
- a congenital malformation (e.g. stenosis of the aqueduct or a Chiari malformation)
- a tumour or vascular malformation in the posterior fossa
- an intraventricular haemorrhage (premature infants are particularly at risk)
69
Causes of communicating hydrocephalus
A failure to reabsorb CSF occurs from an insult to the arachnoid villi.
Examples include meningitis and subarachnoid haemorrhage
70
Presentation of hydrocephalus
Enlarged head circumference
Bulging of anterior fontanelle
Distention of veins across the scalp
Late sign: 'sunsetting' of the eyes, where upward gaze is limited
71
Diagnosis of hydrocephalus
Cranial US (through anterior fontanelle, whilst still open in first few months of life)
or
MRI/CT of the brain
72
Management of hydrocephalus
Insertion of a ventriculoperitoneal shunt: to move excess CSF into the abdominal cavity where it is reabsorbed.
Carers should be counselled to look out for signs of a blocked or infected shunt
73
Features of innocent murmurs
6 S's
Soft
Systolic (not all diastolic pathological)
Sensitive (changes w/ child's position/alongside respiration)
Short (not holosystolic)
Single (no additional sounds)
Small (localised, non-radiating)
74
Presentation of rickets
Aching bones and joints
Poor growth and development
Bow leg deformity
Delayed dentition
Weakness
Constipation
75
Neonatal Respiratory Distress Syndrome cause
Lack of surfactant
--> surfactant lowers surface tension in alveoli, helping to keep them open
--> lack of, increases surface tension causing alveolar collapse, triggering resp distress
--> made from around 26 wks, but adequate levels not achieved until 35 wks
76
CXR for Neonatal Respiratory Distress Syndrome
Ground glass appearance
77
Management of Neonatal Respiratory Distress Syndrome
Intratracheal instillation of artificial surfactant.
If preterm delivery expected, give mother glucocorticoids before delivery to ^ surfactant production in baby.
78
Mechanism of Henoch Schonlein Purpura
Small vessel vasculitis
79
Presentation of Henoch Schonlein Purpura
Purpura or petechiae on the vuttocks and lower limbs
Abdominal pain
Arthralgia
Nephritis (haematuria +/- proteinuria)
May be pyrexial
HSP commonly preceded by a viral upper respiratory tract infection
80
Management of Henoch Schonlein Purpura
NSAIDs for analgesia and anti-inflammatory effect
Antihypertensives may be needed to control BP
After episode: regular urine dips for 12 months to check renal impairment
81
What is meconium ileus?
A condition where the baby's first stool is so thick and sticky it causes intestinal obstruction
82
Associations with meconium ileus
90% associated with cystic fibrosis
--> calcium channel mutation causes the mucous in the meconium to be excessively thick
83
Presentation of meconium ileus
No meconium passed within 48 hours from birth
Signs of intestinal obstruction
84
Diagnosis of meconium ileus
Abdo X-Ray: 'bubbly' appearance of the intestines with a lack of air-fluid levels
85
Management of meconium ileus
'Drip and suck'
--> IV fluids and stomach drainage with an Ryles tube
Along with enemas to remove the meconium
Surgery may be necessary in severe cases
86
What is coarctation of aorta?
A narrowing of the aorta, typically just before the ductus arteriosus
87
Presentation of coarctation of aorta
Systolic murmur: typically loudest between the scapulae
Radio-femoral delay
Hypertension
Heart failure
If severe neonates present in shock once the ductus arteriosus closes due to low perfusion after coarctation
88
Associations of coarctation of aorta
5% of babies with Turner's syndrome are born with coarctation of the aorta
89
Management of coarctation of aorta
Monitored via echocardiography
Antihypertensives needed for BP if needed
Most cases requiring intervention are corrected via angioplasty and stent insertion
Neonates presenting in shock need prostaglandin to keep the ductus arteriosus patent until the defect is corrected
90
Rash on both cheeks and fever. URTI symptoms.
1. Diagnosis?
2. Causative organism?
3. Treatment?
4. Infectious?
1. Slapped Cheek Syndrome/Fifth Disease
2. Parvovirus B19
3. Self-limiting & usually resolves within one week
4. Once rash appears, no longer infectious
91
Blisters on hands and feet. Grey ulcerations in the buccal cavity.
1. Diagnosis?
2. Causative organism?
3. Treatment?
4. Infectious?
1. Hand, foot and mouth disease
2. Coxsackie virus A16
3. Self-limiting and usually resolves in one week
4. Do not need to be isolated
92
Coarse ed rash on the cheeks, sore throat, headache fever. Bright red tongue.
1. Diagnosis?
2. Causative organism?
3. Treatment?
4. Infectious?
1. Scarlet Fever
2. Streptococcus species
3. 10 days of phenoxymethylpenicillin
4. Infectious until 24 hours after first dose of Abx
93
Erythematous, blanching maculopapular rash all over body. Preceded by a fever, cough and conjunctivitis. White spots inside buccal cavity.
1. Diagnosis?
2. Causative organism?
3. Treatment?
4. Infectious?
1. Measles
2. Measles virus
3. Self-limiting, immunisation encouraged bc of complications.
4. Infectious from 4 days before the rash to around 4 days after. Highly infectious
94
Maculopapular vesicular rash that is itchy.
1. Diagnosis?
2. Causative organism?
3. Treatment?
4. Infectious?
1. Chicken pox
2. Varicella zoster virus (human herpes virus 3)
3. Supportive unless the patient is:
- a neonate
- immunocompromised
- adolescent presenting within first 24 hours of rash onset
- pregnant
Then antiviral treatment
4. Infectious from 1-2 days before the rash until every single lesion has crusted over.
95
Lace-like red rash across the whole body with a high fever.
1. Diagnosis?
2. Causative organism?
3. Treatment?
4. Infectious?
1. Roseola
2. Human Herpes Virus 6
3. Self-limiting, supportive management
4. ?
96
Rash beginning on the head and spreading down the trunk. Postauricular lymphadenopathy.
1. Diagnosis?
2. Causative organism?
3. Treatment?
4. Infectious?
1. Rubella
2. Rubella virus
3. Self-limiting, supportive management
Vaccine exists due to risk of in-utero complications that occur as a result of a pregnant woman being infected.
4.
97
What is testicular torsion?
Emergency
When tissues around the testicle are not attached well. Can cause the testes to twist around the spermatic chord, when this happens it cuts off the blood flow to the testicle.
98
Complications of testicular torsion
If not treated immediately can lead to damage to or death of a testicle due to lack of blood supply.
The necrotic testicle must be surgically removed, this can effect fertility.
99
Presentation of testicular torsion
Sudden onset, severe pain in one testicle
Often follows minor trauma
High riding in the scrotum
Unilateral loss of cremaster reflex
No relief in pain on elevation of the testicle (negative Prehn's sign)
100
Management of testicular torsion
Expedited surgical exploration with fixation of the testicles with orchidoplexy
101
Presentation of Osteosarcoma
Pain and swelling with a prolonged onset are characteristics
Typically occurs in the metaphyses of long bones
102
Diagnosis of Osteosarcoma
X-Ray: new bony growth and a periosteal reaction causing a sunburnt appearance.
Signs seen on X-Ray should prompt an urgent full body CT in order to assess for any metastases.
Definitive diagnosis: confirmed using bone biopsy
103
Management of osteosarcoma
MDT approach, may include surgery, radiotherapy and chemotherapy
104
Presentation of Ewing's Sarcoma
- teenagers and young adults
- pelvis, thigh bone and shin most commonly affected
- bone pain particularly occuring at night
- a mass or swelling
- restricted movement in a joint
105
Investigations for Ewing's sarcoma
X-Ray: lamellated (onion skinning) periosteal reaction visible
MRI: typically shows a large mass w/ evidence of necrosis
Histology: small blue round cells visible w/ clear cytoplasms on haematoxylin and eosin staining
Definitive diagnosis: bone biopsy
106
What is Fragile X syndrome?
Genetic condition caused by a CGG trinucleotide repeat in the FMR1 (fragile X mental retardation 1) gene on the X chromosome, affecting synaptic development.
107
Presentation of Fragile X sydrome
A long face
Large, protruding ears
Intellectual impairment
Macroorchidism (large testes) - post-pubertal
Social anxiety
Autistic spectrum features
108
Other name for slapped cheek syndrome
Fifth disease
Erythema infectiosum
109
What is Hirschsprung's disease?
As the baby develops in utero, the distal colon is not innervated correctly.
The resulting aganglionic colon is shrunken and not able to distend properly.
This causes a back pressure of stool trapped in the more proximal colon.
110
Presentation of Hirschsprung's disease
Present at birth:
- a delay in passing meconium (>48 hours)
- a distended abdomen
- forceful evacuation of meconium after digital rectal examination
111
Diagnosis of Hirschsprung's disease
Rectal suction biopsy
112
Management of Hirschsprung's disease
Definite management: Removal of the section of aganglionic colon and the healthy bowel is pulled through
113
What is patent ductus arteriosus?
When the ductus arteriosus remains patent after 4 weeks
114
Presentation of patent ductus arteriosus
May be asymptomatic or present with signs of heart failure
Classical murmur: continuous 'machine-whirring' murmur throughout the cardiac cycle
115
Management of patent ductus arteriosus
Only required if baby is symptomatic.
NSAIDs: inhibit prostaglandins synthesis which normally help maintain ductal patency.
Medical closure of PDAs are more successful in premature babies.
8% will require surgical ligation to close the ductus arteriosus
116
Perinanal/vulval itching in a child
Worse at night
No abnormalities on examination
Threadworm
117
1st line treatment of threadworm
oral Mebendazole
118
Most common congenital heart defect in infants of diabetic mothers
Transposition of the great vessels
119
which anatomical anomaly determines the extent of cyanosis in Tetralogy of Fallot (TOF)?
Pulmonary stenosis
- the greater the level of right ventricular outflow obstruction, the less unoxygenated blood reaches the lungs with each beat, the greater the stenosis will be
120
adolescent, localised pain of several months duration with no traumatic event or associated injury and an associated mass on examination
Osteosarcoma
121
Cause of congenital heart block
Maternal Systemic Lupus Erythematosus (SLE)
--> linked to the presence of maternal anti-Ro and/or anti-La antibodies
122
Most common cause of bacterial meningitis in neonates <3 months
Group B strep
123
Most common cause of bacterial meningitis in children >3 months
Neisseria meningitidis or Streptococcus pneumoniae
124
Most common viral causes of meningitis
Herpes simplex virus (HSV), enterovirus and varicella zoster virus
125
Presentation of meningitis
Fever, neck stiffness, vomiting, headache, photophobia, altered consciousness, seizures.
If progressed to meningococcal septicaemia can present with a non-blanching rash
126
Presentation of meningitis is neonates
More nonspecific
Symptoms such as hypotonia, poor feeding, lethargy, and a bulging fontanelle
127
Investigations for meningitis
Lumbar puncture
- !!never if raised ICP!!
Blood test for meningococcal PCR
Blood cultures
128
Difference between bacterial and viral CSF (meningitis)
Appearance: Bacterial = cloudy Viral = clear
Protein: Bacterial = high Viral = mildly raised/normal
Glucose: Bacterial = low Viral = normal
White Cell Count: Bacterial = high neutrophils Viral = high lymphocytes
Culture: Bacterial = bacteria Viral = negative
129
Management of viral meningitis
Often supportive
Aciclovir can be used to treat suspected or confirmed HSV or VZV infection
130
Community management of meningitis
Suspected meningitis AND a non-blanching rash should receive urgent IM or IV benzylpenicillin prior transfer to hospital
131
Management of bacterial meningitis
IV Abx as per local guidelines
Typically, cefotaxime plus amoxicillin in <3 months, ceftriaxone in >3 months
Steroids should be given to reduce chances of complications (Dexamethasone 4 times daily for 4 days >3 months)
132
Complications of meningitis
Hearing loss, seizures and epilepsy, cognitive impairment and learning disability, memory loss, cerebral palsy
133
Paediatric Sepsis 6
High flow oxygen
Obtain IV/IO access and take blood tests (blood gas, lactate, blood glucose, blood cultures)
Abx: IV or IO
Fluid resuscitation
Involve senior clinicians early
Consider inotropic support
134
Infective causes of encephalitis
Most common: HSV (HSV-1 in children, HSV-2 in neonates)
VZV, cytomegalovirus, EBV, enterovirus, and influenza virus
135
Presentation of encephalitis
Altered consciousness, altered cognition, unusual behaviours, headache, psychiatric symptoms, acute onset of focal neurological symptoms or seizures, fever
136
Ix for Encephalitis
Lumbar puncture: send CSF for viral PCR testing
CT can if LP contraindicated
MRI scan after LP to visualise brain
HIV testing recommended in all patients with encephalitis
137
Management of encephalitis
IV antiviral: Aciclovir until results available
Aciclovir for HSV and VZV
Ganciclovir for CMV
138
Complications of encephalitis
Lasting fatigue, change in personality/mood, learning disability, headaches, chronic pain, movement disorders, seizures
139
Presentation of mumps
Initial period of flu like symptoms involving muscle aches, lethargy, reduced appetite, headache.
Then get parotid gland swelling a few days later
140
Diagnosis of mumps
PCR testing on a saliva swab to test for antibodies to mumps virus
NOTIFIABLE DISEASE
141
Managemnet of mumps
Supportive with rest, fluids and analgesia
Usually self-limiting and lasts around 1 week
!!Notifiable Disease!!
142
Complications of mumps
Pancreatitis, testicular pain, meningitis or encephalitis, sensorineural hearing loss
143
Causative organism for acute epiglottitis
Haemophilus influenzae type B (HiB)
144
Symptoms of acute epiglottitis
High fever
toxic appearance
drooling
absence of cough
inspiratory stridor
tripod position: immobile/leaning forward with extended neck + open mouth
Unvaccinated
145
Mx of acute epiglottitis
do NOT inspect airway
Call senior airway staff to intubate and secure airway
Oxygen + IV Abx (e.g. cefuroxime)
146
Wheeze vs stridor
Wheeze:
Monophonic or polyphonic musical sound louder on expiration die to narrowing in lower airway
Stridor:
single note which occurs on inspiration due to upper airway obstruction
147
Differentials for wheeze
Asthma
URTI
Bronchiolitis
Allergy
GORD
Foreign body aspiration
148
Differentials for stridor
Acute epiglottitis
Croup
Laryngomalacia
Anaphylaxis
Bacterial Tracheitis
Foreign body aspiration
149
Features of diabetic ketoacidosis
Polydipsia, polyuria
N+V
Dehydration
Abdo pain
Acetone-smelling breath ('pear drops')
Kussmaul breathing
Drowsiness, coma
Hypovolaemic shock
150
