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Finals revision > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Name the 3 foetal shunts

A

Ductus venosus –> Ligamentum venosum
Ductus arteriosus –> Ligamentum arteriosus
Foramen ovale –> Fossa ovalis

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2
Q

Name 5 features of an innocent murmur

A

Soft
Systolic
L Sternal edge
Silent
Asx

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3
Q

What are the required imaging investigations for a murmur

A

ECG
CXR
Echo

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4
Q

Differentials for an ejection systolic murmur

A

Aortic stenosis
Pulmonary stenosis

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5
Q

Differentials for a pansystolic murmur

A

Mitral regurgitation
Tricuspid regurgitation
VSD

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6
Q

What is the murmur of PDA and what is it associated with

A

Continuous machinery like murmur - beneath left clavicle
Prematurity
Maternal rubella

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7
Q

What is eissenmenger syndrome

A

Transformation of L–>R shunt to R–>L shunt due to increase in pulmonary pressure

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8
Q

What are the signs and symptoms of heart failure

A

SOB - On feeding and exertion
FTT
Sweating
Poor feeding
Recurrent infections

Poor weight gain
Cool peripheries
Hepatomegaly

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9
Q

What are patients with a VSD at risk of

A

Infective endocarditis - Abx provided during surgical procedures

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10
Q

What condition is associated with co-arctation of the aorta

A

Turners

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11
Q

What murmur is associated with co-arctation

A

Systolic murmur - radiation to the back below the left scapula

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12
Q

What are the key features of eissenmenger sydnrome on presentation

A

Cyanosis
Plethoric complexion - polycythaemia
Increased risk of VTE
SOB
Clubbing

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13
Q

Name 4 RF for TOF

A

Diabetic mother
Alcohol consumption in pregnancy
Increased maternal age
Rubella infection
Downs syndrome

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14
Q

Name 3 triggers for tet spells in ToF and why these occur

A

Temporary worsening of R–>L shunt due to an increase in pulmonary resistance or decreased systemic resistance

Crying
Exercise
Breastfeeding

Mx - squatting

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15
Q

What is ebsteins anomaly

A

The tricuspid valve is lower set - a larger atrium and smaller ventricle

L –> R shunt - cyanotic

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16
Q

What is ebsteins anomaly associated with

A

Lithium use
Wolf parkisnons white

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17
Q

What is rheumatic fever

A

AI - Type 2 hypersensitivity to previous infection with Strep pyogenes - typically Pharyngitis

Occurs 2-4 weeks post-infection

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18
Q

What is the criteria for diagnosing rheumatic fever

A

Evidence of recent strp infection
- Hx scarlet feer
- Positive throat swab growing GABHS
- Rising anti-streptolysin O titres

+

2 major or 1 major + 2 minor criteria

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19
Q

Outline the major jones criteria for rheumatic fever

A

JONES
J - Migratory polyarhtiritis

O - Myocarditis

N - SC nodules - Firm mobile painless lesions

E - Erythema marginatum
Red rash with diffuse clear centre

S - Sydenhams chorea

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20
Q

Outline the minor criteria of rheumatic fever

A

C - CRP / ESR
A - Arthralgia
F - Fever
E - Elongated PR

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21
Q

What is the management of rheumatic fever

A

Clear GABHS
- IV BenPen
- 10 d ay course of Pen V

Analgesia
- NSAIDs

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22
Q

What valve defects are assosciated with Rheumatic fever

A

Mitral stenosis
Mitral regurgitation

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23
Q

What are the clinical features of Tonsillitis

A

Sore throat
Pain on swallowing
Red, Inflammed and enlarged tonsills
Fever
Lymphadenopathy
Referred ear pain

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24
Q

What are the clinical features of a Quinsy

A

Trismus - unable to open mouth
Uvula deviation
Voice changes - Hot potato

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25
Q

Name 3 organisms that causes tonsillitis

A

1 - Strep pyogenes
2 - Strep pneumonia
3 - Staph aureus

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26
Q

What are the clinical features of Otitis media

A

Fever
Ear pain
Reduced hearing
Coryzal sx
Cough
Sore throat

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27
Q

What is seen on otoscopy - Otitis media

A

Red inflamed TM
Bulging
Loss of light reflex

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28
Q

Name 4 reasons to prescribe Abx in Otitis media

A

Perforation
< 2 years old and bilateral
Immunocompromised
Systemically unwell
Co-morbidities
<3m old
4 days of sx with no improvement

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29
Q

Name 4 complications of otitis media

A

Facial nerve palsy
Glue ear
Meningitis
Labyrinthitis
Mastoiditis
- Post auricular swelling pushing ear forwards and outwards

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30
Q

What is seen on Otoscopy of Otitis media with effusion

A

Dull and retracted TM
Air bubbles
Visible fluid level

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31
Q

Name 4 RF for undescended testes

A

Prematurity
AIS
SGA
Low birth weight
FHx

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32
Q

Undescended testis management

A

Unilateral - Refer by 3m and seen by urological surgeon by 6m

Bilateral - Immediate referral to pediatrician for karyotyping

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33
Q

Risks of undescended testis

A

infertility
torsion
cancer

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34
Q

What are the sx of testicular torsion

A

Acute onset and unilateral
red
hot
tender
N+V

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35
Q

Define testicular torsion

A

Twisting os spermatic cord resulting in ischaemia and necrosis

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36
Q

Name 4 signs of testicular torsion

A

Absence of cremaster reflex
-ve Phrens sign
elevation of testicle does not ease pain
High riding testicle

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37
Q

What is screened for in the newborn screening test

A

CF
Hypothyroidsm
Sickle cell
Phenyketonuria
Homocystinuria

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38
Q

Name 4 features of congenitla hypothyroidism

A

macroglossia
hypotonia
slow growth and development
FTT
Poor feeding
Prolonged neonatal jaundice

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39
Q

Name 4 features of CAH - severe

A

Skin hyperpigmentation
Ambiguous genitalia + Enlarged clitorous
Tall for age

Female
Facial hair
Absent periods
Deep voice
Early puberty

Male
Deep voice
Large penis
Small testis
Early puberty

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40
Q

Give 3 biochemical features of CAH

A

hyponatraemia
Hyperkalaemia
Hypoglycaemia
Metabolic acidosis

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41
Q

What is androgen insensitivity syndrome

A

X linked recessive condition due to end-organ resistance to testosterone causing 46XY to have female phenotype

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42
Q

Name 3 features of Androgen insensitivity

A

Priamry amenorrhoea
No axillary or pubic hair
Undescended testis
Breast development - testosterone converted to oestrogen

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43
Q

What ins the investigation for Androgen insensitvitiy

A

Buccal smear or chromosomal analysis

high testosterone - post-puberty

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44
Q

managemnt of androgen insensitivity

A

Counseling - raise as female
Bilateral orchidectomy
Oestrogen therapy

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45
Q

What is DDH

A

Structural abnormality of the hip leading to instability and tendency for dislocation

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46
Q

Name 4 RF for DDH

A

Female
Firstborn
Twins
Oligohydramnios
Breech
FHx

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47
Q

How does DDH present

A

Limp / Abnormal gait
Asymmetry in skin folds
Leg length discrepancy - Galleaze sign
Limited hip abduction
Clunking of hips

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48
Q

What is ortalani test

A

Dislocate anteriorly

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49
Q

What is Barlows test

A

Dislocate posteriorly

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50
Q

What is the investigation for DDH

A

< 4.5 months –> USS
> 4.5 months –> X ray

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51
Q

What is the management of DDH

A

< 6 months - Pavlik harness
> 6 months - surgery

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52
Q

What is transient synovitis and who is it common in

A

transient irritation and inflammation of synovial membrane of the joint - NO FEVER

Males aged 3-10

following Virla URTI 1-2 weeks prior

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53
Q

How does transient synovitits present

A

Low grade fever
Limp
refusal to weight bear
Pain in extremities of movement - internal rotation

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54
Q

How is transient synovitis managed

A

Resolves in 7 days - analgesia if symptomatic

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55
Q

Waht is Perthes disease and who does it commonly affect

A

Avascualr necrosis of femoral head

Children aged: 4 - 12 but more common in 5 - 8

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56
Q

How does Perthe’s disease present

A

Pain in Hip / Knee - worse on activity and releived by rest
Restricted ROM
No hx of trauma

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57
Q

How is perthe’s disease investigated

A

Bloods - normal
X - ray - Widening of joint space and increased femoral head density

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58
Q

How is Perthes disease managed

A

Moderate OR <6y/o - Observe
Physio
bed rest
analgesia

severe OR >6y/o - Surgery

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59
Q

What is the main complication of Perthes disease

A

Premature fusion of growth plates

Soft and deformed femoral head - OA of hip

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60
Q

What is Slippe dupper femoral epiphysis

A

Head of femur is displaced along the growth plate

more common in boys

8 - 15

Obese

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61
Q

How does SUFE present

A

Pt undergoing growth spurt
Pain - Hip / Knee / Thigh
Restriced ROM - Internal rotation
Painful limp
Hx of minor trauma

Trendelenburgs positive

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62
Q

How is SUFE managed

A

Surgery - internal fixation

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63
Q

Who is offered routine screening for DDH

A

1st degree relative of hip issues in early life

Breech at or after 36 weeks

Multiple pregnancy

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64
Q

Name 3 common bacteria causing septic arthiritis

A

Straph aureus - children
Strep pyogenes - neonates
Haemophilus influenza
Neisseria gonorrhea - teenagers

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65
Q

How does septic arthritis present

A

Red
hot
swollen joint
fever
Restricted ROM
Systemically unwell

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66
Q

What investigations are required for septic arthiritis

A

Joint aspiration - MC&S / Gram staining / crystal microscopy
Blood cultures
Bloods

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67
Q

What is osgood-schalatters disease and how doe sit present

A

Inflammation at the tibial tuberosity where the patella ligament inserts

palpable lump at the tibial tuberosity
pain in anterior aspect of knee
pain worse on activity / kneeling / extension

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68
Q

What is rickets / osteomalacia

A

defective bone mineralisation causing soft and deformed bone

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69
Q

Name 3 red flags for hip pain in a child

A

child < 3 years old
fever
waking up at night
weight loss
anorexia
night sweats
fatigue
persistent pain
stiffness in morning
swollen or red joint

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70
Q

What is JIA

A

AI mediated Joint pain and swelling in a patient < 16 for more than 6 weeks

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71
Q

What are the main features of JIA

A

Joint pain / swelling / stiffness / deformity

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72
Q

Outline the key features of systemic JIA

A

Salmon pink rash
fevers
lymphadenopathy
weight loss
splenomegaly
pericarditis

ANA + RF - NEGATIVE
ANAEMIA

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73
Q

Outline the management of JIA

A

NSAIDs
Steroids
DMARDS - MXT / Sulfasalazine
Biologics

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74
Q

What is a Wilms tumour and how does it present

A

Tumour of kidney - <5y/o

Abdominal pain
Abdominal mass
Painless haematuria
WL
Fever

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75
Q

What is reflux

A

Involuntary passage of gastric contents up into oesophagus due to relaxation of LOS

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76
Q

RF for GORD

A

Prematurity
Neurological disorder - cerebral palsy

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77
Q

What are the clinical features of GORD in a child

A

Vomiting / regurgitation
arching of the back or neck
distressed after feeding
excessive crying
chronic cough
FTT

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78
Q

What is the management of GORD

A

C -
Positioining after feeds / burping after feeds
Ensure not being overfed
smaller more frequent meals

M
- Bottle fed - thickened formula
- Breastfed - Gaviscon
- PPI

S
- Fundoplication

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79
Q

What are the key features of mesenteric adenitis

A

Inflammed abdominal LN

Fever
Diffuse abdominal pain
Hx URTI / Tonsillitis

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80
Q

What are the key features of Meckel’s diverticulum and how is it investigated

A

GI bleeding
Abdominal pain - RLQ
Intestinal obstruction: Volvulus / Intusussception

Technetium scan

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81
Q

What is intusussception

A

Invagination of bowel into itself - common at ileo-caecal region

more common in boys
3m - 2 years

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82
Q

Name 4 assosciations of intususception

A

Viral URTI
HSP
CF
Meckels diverticulum

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83
Q

How does Intususception present

A

severe colicky abdominal pain
pallor around mouth
screaming and drawing legs up
vomiting - bile
red current jelly stool
absolute constipation

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84
Q

Exam findings of intususception

A

RUQ mass
Abdominal distension

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85
Q

What is the investigation of choice for intusesception

A

USS - Target mass

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86
Q

Name 4 causes of intestinal obstruction

A

Meconium ileus
Hirshprung disease
duodenal atresia
intususcpetion
malrotation with volvulus
strangulated hernia

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87
Q

Investigations for volvulus

A

X - Ray

Contract CT

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88
Q

What is malrotation and what is it associated with

A

congenital anomaly in rotation of midgut

Assosc: Exomphalmos / Congenital diaphragmatic hernia

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89
Q

How does malrotation present

A

1st days of life - 3-7
- bilious vomiting
- abdo pain
- tenderness

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90
Q

Investigation for malrotation

A

Upper GI contrast study - corckscrew

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91
Q

Criteria for IBS diagnosis

A

Abdominal pain or discomfort that is relieved by defecation OR associated with altered bowel habits/stool form
AND at least 2 or
- altered stool passage (straining / urgency)
- bloating
- sx worse with eating
- passage of mucus

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92
Q

Investigations for IBS

A

Coeliac serology
FBC
CRP
ESR
Faecal calprotectin

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93
Q

Features of cows milk protein allergy and management

A

Bloating
abdominal pain
D+V
Urticarial rash
Angiooedema
Wheeze
coughing
crying / irritability

IgE mediated

Formula - hydrolysed formula
breastfed - mum avoids dairy

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94
Q

What is biliary atresia

A

Bile ducts become fibrosed and destroyed leading to conjuagted hyperbilirubinemia

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95
Q

Investigations for biliary atresia

A

Serum bilirubin
USS
Cholangiography

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96
Q

Outline features of an Omphalacele

A

Hernaition of abdominal contents covered by peritoneum

Antenatal USS
Raised AFP

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97
Q

Outline features of Gastroschisis

A

Paraumbilical defect - R of umbilicus

Staged corrective surgery
TPN slowly introduced

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98
Q

Outline features of duodenal atresia
- assosciations
- sx
- Ix

A

Down syndrome
Polyhydrmanios

Bilious vomiting
SBO - absolute constipation + no air pasage

X ray: Double bubble

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99
Q

Whar is coeliac disease

A

AI condition where exposure to gluten causes an immune reaction with inflammation in the small intestine

100
Q

What part of the small bowel is most affected by coeliac disease

A

Jejunum

101
Q

Give 3 RF for coeliac

A

Downs
T1DM
FHx
Thyroid

102
Q

Give 3 clinical features of coeliac

A

weight loss
faltering growth
diarrhea
flatulence
steatorrhoea
abdominal pain
bloating
mouth ulcers
anaemia - pallor
dermatitis hepatiformis - itchy blistering rash
N+V
short stature and wasted buttocks - malnutrition

103
Q

Investigations for coeliac

A

Stool sample - exclude infection

Blood
- IgA level
- Autoantibodies: TTG and EMA
- FBC: Anaemia
- U+E: Vit D def
- LFT: Low albumin secondary to malabsoprtion

OGD and duodenal/jejunal biopsy

104
Q

Histology results for coeliac disease

A

Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytes

105
Q

Complications of coelaic disease

A

Anaemia
Hyposplenism
Osteoporosis
T - cell lymphoma (NHL)

106
Q

Give 3 macroscopic signs of Chrons

A

Mouth to anus
Skip lesions
Fistula
Ulcers and fissures
Cobblestone mucosa
Strictures

107
Q

3 macroscopic signs of UC

A

Mucosal ulceration
Continuous inflammation
Pseudpolyps
Loss of haustral markings

108
Q

3 microscopic signs of Crohns

A

transmural inflammation
Increased goblet cells
non caeseating granuloma

109
Q

3 microscopic signs of UC

A

Mucosal inflammation
decresed goblet cells
No granuloma
crypt abscess

110
Q

complications of crohns

A

obstruction - stricture
fistula
colorectal cancer
gallstones - reduced bile acid reabsorption

111
Q

Extraintestinal features of UC

A

PSC

112
Q

What is Crohns

A

chronic relapsing IBD - characterised by a transmural granulomatous inflammation which can affect any part of the gastrointestinal tract

113
Q

Give 3 sx of crohns

A

crampy abdominal pain
weight loss
diarrhoea
fever

114
Q

3 signs of crohns

A

pallor
clubbing
apthous ulcers in mouth
RLQ tenderness
RIF mass
Perianal skin tags
fistula
perianal abscess

115
Q

3 signs of crohns

A

pallor
clubbing
apthous ulcers in mouth
RLQ tenderness
RIF mass
Perianal skin tags
fistula
perianal abscess

116
Q

3 extra-intestinal manifestations of crohns

A

erythema nodsoum
pyoderma gangrenosum

anterior uveitis - photophobia
episcleritis

arhtiritis
sacro-ilitis

gallstones

renal stones

117
Q

Management of crohns

A

Inducing remission
- 1st line: steroids
- 2nd line: steroids + immunosuppresants
Azathiprine
Methotrexate
Infliximab

Maintaining remission
- 1st line: Azathiprine / Mercaptopurine
- MXT
- Infliximab

118
Q

Differences between crohns and UC presentation

A

Crohns -
non bloody diarrhoea
weight loss more prominent

UC
- Uveitis more common
- PSC

119
Q

which 2 drugs are you required to check TMPT levels before starting

A

Azathioprine
Meracaptopurine

120
Q

Give 3 sx of UC

A

Bloody diarrhoea - containing mucous
tenesmus
urgency
pain in LIF
weight loss
fever

121
Q

Give 3 signs of UC

A

anaemia
clubbing
abdominal distension and tenderness
PR - Blood / mucus

122
Q

Give 3 extra -intestinal features of UC

A

Erythema nodosum
pyoderma ganrenosum

Anterior uveitis
episcleritis

clubbing
asymmetrical arthiritis

PSC

123
Q

Barium enema findings of UC

A

Lead piping - loss of haustral markings
Thumb-printing (bowel inflammation)
Pseudo-polys

124
Q

What imaging shoudl be used in active UC

A

CT
Flexible sigmoidoscopy

AXR / CXR - exclude toxic megacolon

125
Q

Management of UC

A

Induce remission
Mild to moderate
1st line: Topical or oral ASA (Mesalazine)
2nd line: + Steroids
3rd line: + tacrolimus

severe:
1st line: IV corticosteroids
2nd line: IV ciclosporin

Maintaining remission
mild/moderate -
1st line: Aminosalicyclate
2nd line: Azathioprine
surgery

126
Q

What is toxic megacolon

A

Colitis on AXR
Large bowel >6cm and systemic upset

127
Q

long term complications of UC

A

Large bowel obstruction - strictures
colorectal cancer
cholangiocarcinoma

128
Q

Outline pyloric stensois
- defintion
- sx
- signs
- Ix
- mx

A

Hypetrophy of circular muscles of pylorus

presents in 2-4 weeks of life

projectile non-bilious vomiting
constipation
FTT
dehydration

palpable mass - upper abdomen
Hypocholaraemic hypokalaemic metabolic alkalosis

Dx- USS

Mx - Pyloromyotomy

129
Q

Outlien Hirschprungs disease
- definition
- sx
- signs
- Ix
- Mx

A

Congenital aganaglionic myenteric plexus in distal bowel and rectum
unco-ordinated peristalsis leads to fucntional obstruction

common in downs

failure to pass meconium
constipation
abdominal distention
Forecful passage of meconium after PR

AXR
Rectal biopsy

Mx
initial - rectal washout
definitive - surgery

130
Q

Name 2 signs of peritonitis

A

rebound tenderness
percussion tenderness

131
Q

Where is an inguinal hernia in relation to pubic tubercle

A

Superior and medial

132
Q

Describe an direct hernia

A

Due to weakness in the abdominal wall - Hesselbachs triangle
chronic cough / constipation

rarely strangualte

Pressure over deep inguinal ring will not stop herniation
+ve cough reflex

Medial to inferior epigastric vessels

133
Q

Describe an indirect hernia

A

bowel herniates through inguinal canal - patent processus vaginalis
can extend to scrotum
can strangulate

-ve cough reflex on reduction

Lateral to inferior epigastric vessels

134
Q

complications of hernias

A

incarceration
obstruction
strangulation

135
Q

Outline features of femoral hernia

A

More common in females

more likely to strangulate

Irreducible

No cough reflex

Below inguinal ligament
Inferior and lateral to pubic tubercle

136
Q

give 4 causes of secondary constipation

A

Hirschprung
CF
Hypothyroid
sexual abuse
intestinal obstruction

137
Q

Outline Turners syndrome
- chromosomal abnormality
- features
- asossciations
- mx

A

45 XO

Short stature
webbed neck
high arching palete
borad chest with widely spaced nipples
cubitus valgus
underdeveloped ovaries with reduced fucntion
infertile

recurrent OM
co-arctation and bicuspid aortic valve
hypothyroidism
obesity
DM

138
Q

Outline the features of fragile X syndrome

A

Long narrow face
large ears
intellectual disability
large testicles
autism
seizures

139
Q

Features of marfans syndrome

A

long neck
tall stature
long limbs
long fingers
high arch palette
Hypermobility
pectus excavatum / carinatum
mitral / aortic valve prolpase
aortic aneurysm

140
Q

Outline the features of Kleinfelter syndrome and the management

A

tall height
wide hips
gynaecomastia
small testicles
infertility
reduced libido
LD - Affecting language

SLT
Educational support
OT
Testosterone injections
breast reduction surgery

141
Q

Give 3 causes of UTI in children

A

E coli
Klebsiella
Proteus
Psudomonas - structural abnormality

142
Q

3 sx of UTI in a child
- < 3m old
- > 3m old

A

Fever
lethargy
irritability
poor feeding
urinary frequency
vomiting

fever
abdominal pain
vomiting
dysuria
urinary frequency
incontinence

143
Q

Septic screen in a child

A

Bloods
blood cultures
Urine dip and culture
lactate
LP

144
Q

Following a UTI outline the follow up investigations for a child

A

USS
- All children in 1st UTI and under 6m
- atypical –> USS during illness
- recurrent –> USS in 6 weeks

MCUG - Abnormal bladder function and refluc

DMSA - Assess for scarring following UTI (3m)

145
Q

Give 3 signs of an atypical UTI

A

Poor urine flow
Abdo/Bladder mass
Increased Cr
Septicaemia
Non E coli organism

146
Q

Outline VUR
- RF
- Ix
- Mx

A

Ureters displaced laterally and enter directly into the bladder

Affected siblings

MCUG - Diagnostic
DMSA - Extent of scarring

avoid constipation
avoid excessively full bladder
prophylactic Abx

147
Q

Give 4 classical features of Nephrotic syndrome

A

Proteinuria
- Frothy urine

Hypoalbuminaemia

Oedema
- SOB
- weight gain

Hyperlipidaemia
- Xanthelasma

Hypercoagulability
- Loss of antithrombin III

Recurrent infections
- Loss of immunoglobulins

Lethargy

Pallor

148
Q

What is the most common cause of nephrotic disease in children
- what is the management

A

minimal change disease

Prednisolone
low salt diet
diuretics
albumin infusions
antibiotic prophylaxis

149
Q

How are steroid resistant patients with nephrotic syndrome managed

A

ACEi
Immunosuppresants - ciclosporin / tacrolimus

150
Q

Investigations for Nephrotic syndrome

A

Urine dipstick - proteinuria

Urinalysis - raised albumin:Cr

Renal biopsy
- fusion of podocytes and effacement of BM

151
Q

Differentials for scrotal or inguinal swellings

A

Hydrocele
Varicocele
partially descended testis
inguinal hernia
testicular torsion
tumour

152
Q

Give causes of nephrotic syndrome

A

Minimal change disease

Focal segmental glomerulosclerosis
- HIV
- Lithium
- Reflux nephropathy

Membranous nephropathy

Diabetic nephropathy

Amyloidosis

153
Q

Give the 3 key features of nephritic syndrome

A

Haematuria
Hypertension
Oliguria
RBC casts in urine
Sterile pyuria

154
Q

Give 3 causes of nephritic syndrome

A

Rapidly progressive glomerulonephritis

  • Anti-glomerular basement membrane disease
    Haematuria and haemoptysis
  • IgA nephropathy - common following URTI

Post streptococcal glomerulonephritis
- Antistreptolysin O titres

HSP

SLE

155
Q

Investigations for nephritic syndrome

A

Hx - urti

Urinalysis
- RBC casts
- Sterile pyuria
- Protein quantification

Bloods
- Cr
- U+E

Renal biopsy

156
Q

Outline post strep glomerulonephritis, investigations and required management

A

Immune complexs deposited in BM cause inflammation and acute deterioration –> AKI

Hx tonsilitis / +ve throat swab / Anti strep O titres

supportive mx
If: HTN or oedema develop - Antihypertensives and diuretics

157
Q

Outline IgA nephropathy, Investigations and management

A

IgA deposits in nephrons of kidney causing inflammation

renal biopsy - IgA deposits and glomerular mesnagial proliferation

supportive
Immunosuppresants - steroids

158
Q

Name the 4 classical features of HSP

A

Purpura - red or purple / palpable under skin

Joint pain - swollen and painful

Abdominal pain
- hemorrhage
- intussusception
- bowel infarction

Renal involvement
- Haematuria
- Nephritic or nephrotic syndrome

159
Q

What is HSP and what triggers it

A

IgA vasculitis leading to

URTI - Strep pyogenes
Gastroenteritis

160
Q

Give 4 causes of non blanching rash

A

Meningococcal septicaemia
Leukemia
HSP
HUS
ITP

161
Q

Investigations for HSP

A

FBC and film - thrombocytopenia / sepsis / leukemia

U+E

Albumin

CRP - Sepsis

Blood cultures - sepsis

Urine dipstick + protein:Cr - proteinuria

BP - Hypertension

162
Q

What is the management and monitoring required for HSP

A

Rest and hydration
steroids - shorten duration of illness

Urine dipstick - renal involvement
BP - Hypertension

163
Q

What is HUS

A

Thrombosis in small blood vessels triggered by shigga toxin - E coli0157

164
Q

triad for HUS

A

Haemolytic anaemia
AKI
Thrombocytopenia

165
Q

what increases the risk of HUS

A

Use of Abx or loperamide in patients with gastroenteritis

166
Q

Clinical features of HUS

A

E.coli - bloody diarrhoea

Reduced urine output
haematuria
dark brown urine
abdominal pain
bruising
lethargy
fever

167
Q

Investigations and management of HUS

A

Urine dipstick - haematuria

Bloods
Normocytic anemia
Thrombocytopenia
Raised WCC + LDH
Coombs test -ve

Supportive
- IV fluids

168
Q

Give 4 causes of primary enuresis

A

FHx - variation in normal development
overactive bladder
fluid intake
failure to wake
psychological distress

169
Q

give 4 causes of secondary enuresis

A

chronic constipation
UTI
TIDM
New psycholoigcal issues - stress / school
Abuse

170
Q

What is secondary enuresis

A

child begins wetting the bed when they have previously been dry at night fro 6m

171
Q

Give 4 features of a simple febrile convulsion

A

lasts <15 minutes
GTC
No recurrentce in 24 hours
complete recovery in 1 hour

172
Q

Give 3 features of a complex febrile seixure

A

15-30 minutes
focal seizure
repeat seizure in 24 hours

173
Q

Features of juvenille myoclonic epilpesy

A

after waking - clumsiness
myoclonic seizure
GTC
Absence seizure

Mx - valporate

174
Q

3 features of hydrocephalus

A

bulging anterior fontanelle
sleepiness
poor tone
poor feeding

175
Q

What is cerebral palsy

A

Permanent non-progressive neurological issues due to brain damage during birth

176
Q

Give 5 causes of cerebral palsy

A

maternal infections
birth asphyxia
pre-term birth
meningitis
neonatal jaundice
head injury

177
Q

classifications of cerebral palsy

A

spastic - UMN damage

dyskinetic - basal ganglia damage
atheoid movements
oro motor issues
due to - HIE / Kerneticus

ataxic - cerebellum
problems with co-ordianted movements

178
Q

Clinical features of cerebral palsy

A

failure to meet developmental milestones
increased or decreased tone
hand preference <18m
Abnormal gait
feeding or swallowing issues
LD
Primitive reflexes > 6m

179
Q

Role of surfactant

A

reduces surface tension
maximises alveolar SA
Increases lung compliance - reduces force needed to expand alveoli

180
Q

componentes of APGAR score

A

colour
pulse
respiration
grimace - response to stimulation
muscle tone

181
Q

What is Erbs palsy

A

Damage to C5/6 nerves in brachial plexus during birth

internally rotated shoulder
extended elbow
flexed wrist
lack of movement in arm

182
Q

Features of congenital rubella

A

At risk during first 3m

congenital cataracts
PDA
LD
Hearing loss

183
Q

Features of congenital varicella

A

At risk during first 28 weeks

Microcepahly
skin scarring
limb hypoplasia
cataracts

184
Q

reducing risk of SIDS

A

Put baby on back when unsupervised

Put them at the foot of the bed

make sure head is uncovered

keep cot clear of toys

avoid smoking aorund child

avoid co-sleeping

185
Q

Outline retinopathy of prematurity

A

Babies born before 32 weeks - screened

Abnormal development of retinal blood vessels due to oxygenation

186
Q

What are the causes of physiological jaundice

A

underdeveloped liver
high concentration of RBC

187
Q

What is kerneticus

A

Build of of unconjugated bilirubin in basal ganglia leading to brain dmage

188
Q

Management of neonatal jaundice

A

Measure total bilirubin levels and plot on treatment chart

Phototherapy
breakdown bilirubin into products that can be excreted in bile and urine without conjugation

exchange transfusion

189
Q

Outline respiratory distress syndrome

A

occurs below 32 weeks gestation - due to lack of surfactant production

high surface tension leads to lung collapse and inadequate gas exchange
- hypoxia / hypercapnia / respiratory distress

CXR - Ground glass

Mx
- IM steroids
endotracheal surfactant
O2

190
Q

complications of respiratory distress syndrome

A

pneumothorax
infection
apnoea
NEC

191
Q

What is necrotising enterocolitis

A

Part of the bowel becomes necrotic and can lead to perforation - peritonitis - shock

192
Q

Give 4 RF for NEC

A

Prematurity
Low birth weigth
formula feeds
Sepsis
assited ventilation and respiratory distress

193
Q

Clinicla features of NEC

A

Intolerance to feeds
vomiting - bilious
distended tender abdomen
absent bowel sounds
blood in stools

194
Q

AXR findings in NEC

A

Dilated loops o fbowel
bowel wall oedema
Pneumatosis intestinalis - gas in bowel wall
Pneumoperitoneum
football sign

195
Q

Management of NEC

A

NBM
IV fluids
TPN
Abx

196
Q

RF for neonatal sepsis

A

Vaginal BGS colonisation
GBS in previous pregnancy
Chorioamnionitis
prematurity
Prolonged ROM

197
Q

Features of neonatal sepsis

A

fever
reduced tone
poor feeding
respiratory distress
vomiting
tachycardia
hypoxia
jaundice within 24hrs
seizures

198
Q

What is Kawasaki disease and give 5 clinical features

A

systemic medium vessel vasculitis

CRASH + BURN
Bilateral non purulent conjunctivitis
Maculopapular rash
Cervical lymphadenopathy
Strawberry tongue - red toungue with large papillae
Desquamations - hands and feet

Fever - 39 degrees for 5 days

199
Q

Investigations for kawasaki disease and management

A

Bloods
FBC - Anaemia / Leukocytosis / Thrombocytosis
LFT - Hypoalbuminaemia
CRP
Echo - coronary artery aneurysms

High-dose aspirin - reduce thrombosis risj
IV immunoglobulins - reduce aneurysms risk

200
Q

What is ADHD

A

Inability to concentrate affecting persons ability to carry out everyday tasks consistent across at least 2 settings

201
Q

Give 4 features of ADHD and the management

A

short attention span
quickly moving from one activity to another
Easily distracted
Does not wait their turn
constantly fidgeting
impulsive behaviour
excessive talking

C - Parental education programes

Methylphenidate
Lisdexamfetamine

202
Q

What is required prior to giving ADHD medication

A

Baseline ECG

203
Q

what is autism

A

Autism is a neurodevelopmental condition characterized by impairment in social interaction and communication as well as repetitive stereotyped behaviour, interests, and activities

204
Q

Give 4 clinical features of autism

A

Impaired social interaction
- play alone
- not interested in being with other kids
- Unable to read non-verbal cues
- fail to form and maintain relationships

communication
- delay in language development
- difficulty with imaginative behaviour
- repetitive use of words or phrases

repetitive behaviors / interests
- repetitive mannerisms
- strict rules and routines
- intense and deep interests

Intellectual imparement

Language imapirement

205
Q

Management of ASD

A

Early educational and behavioral interventions

CAMHS

SLT

Specially trained educators

Family support and counselling

206
Q

Outline mumps
- Pathogen
- Clinical features
- Management

A

Paramyxovirus

Headache / Myalgia / Malaise

Parotitis - unable to open mouth

Orchitis - severe painful swelling of testicles

Deafness

Mx
- IV fluids
- Analgesia and antipyretics

207
Q

Outline nappy rashes

A

contact dermatitis
Itchy / red /
- flexures spared
- erythematous scaled apperance

candida
- includes flexures
- satelite lesions
- Beefy red

208
Q

define allergy

A

Hypersensitivity reaction initiated by specific immunoglobulins

209
Q

define hypersenitivity

A

Objectively reproduceable symptoms or signs following a defined stimulus (e.g. food, drug, venom) at a dose tolerated by a normal person

210
Q

define atopy

A

Tendency to produce IgE in response to ordinary exposure to allergens – Asthma / hayfever / conjubctivitis / eczema

211
Q

Outline measels
- sx
- Ix
- mx
- school exclusion

A

CCCK
Coryzal sx
Conunctivitis
Cough
Koplik spots - white spots on buccal mucosa
Fever
Rash - Maculopapular

IgG detected in blood

Supportive - fluids and analgesia
school exclusion - 4 days from onset of rash

212
Q

Give 4 complications of rubella

A

Menigitis
Hearing loss
vision loss
death

213
Q

Outline rubella
- sx
- Ix
- Mx
- school exclusion

A

Maculopapular rash - starts on face –> Whole body
Lymphadenopathy - suboccipital and post auricualr
fever
Headache
Joint pain

Supportive
Avoid pregnant women

5 days from onset of rash

214
Q

Outline slapped cheeck
- organism
- sx
- Ix
- Mx
- school exclusion

A

Parvovirus B19

fever
malaise
myalgia
rash - maculopapular on body

Only required if: Pregnant / Thal / SCD / HS / Haemolytic anaemia
Check FBC and reticulocyte count - apalstic anaemia

Once rash formed no longer infectious

215
Q

Give 4 complication of measels

A

OM
Pneumonia
Encephalitis
Febrile convulsions

216
Q

Causative organism for roseola infantum

A

Human herpes virus 6

217
Q

Outline Hand foot and mouth

A

Coxsackie A16

Mouth ulcers
Blistering red spots across body

218
Q

Outlien scarlet fever
- organism
- sx
- Ix
- mx

A

Group A strep - strep pyogenes

fever
malaise
headache
sore throat
strawberry tongue
rash - sandpaper texture
flushed appearance with circumferential pallor

Throat swab and culutre

Oral penicillin V for 10 days
- Azithromycin

return to school 24hrs after Abx

219
Q

How does Bronchioloitis present

A

Cough
Coryzal - watery eyes / runny nose / sneezing
Rhinorrhoea
fever
wheeze
decreased feeding
Increased WOB

220
Q

Give 4 signs of respiratory distress

A

Nasal flaring
Head bobbing
Tracheal tug
Recessions
Use of accessory muscles
Cyanosis

221
Q

define wheeze

A

Polyphonic expiratory noise from lower airways - indicates airway narrowing

222
Q

define stridor

A

high pitched inspiratory noise caused by obstruction of upper airway

223
Q

define grunting

A

exhaling on a closed glottis

224
Q

Give 4 reasons to admit a child with bronchioloitis

A

clinical dehydration
O2 required
Decreased oral intake
Resp distress
Apnoea
Parents don’t feel confident in caring for them at home
High resp rate

225
Q

Management of bronchiolitis

A

NG feed
Humidified O2
IV fluids

226
Q

What is a prophylactic treatment option for bronchiolitis and identify who is eligible

A

Palivizumab - MAB
Monthly injection

CHD
Ex premature

227
Q

What is viral induced wheeze

A

Acute wheezy illness due to viral infection

228
Q

Name 3 features that indicate VIW as opposed to asthma

A

Sx before 3 years of age
No atopic hx
Only occurs during viral illness

229
Q

How is VIW managed

A

Acute asthma

230
Q

Outline bacterial tracheitis
- what is it
- causative organism
- key features
- mx

A

Rare condition similar to croup

Staph aureus

Croup sx
Fever
Rapidly progressing airway obstruction

Iv Abx

231
Q

Causative organism of whooping cough

A

Bordatella pertussis

232
Q

Clinical features of whooping cough

A

coryzal sx
low grade fever
coughing bouts - worse at night or after feeds
- sudden
- recurring
- inspiratory whoop
vomiting
apnoeic spells

233
Q

Outline the investigations and management of whooping cough

A

Nasopharyngeal swab –> PCR testing

Notifiable disease
Admit patients under 6m

Erythromycin

School exclusion for 48hrs after Abx

234
Q

Name 3 complications of whooping cough

A

Bronchiectasis
subconjunctival hemorrhage
seizure

235
Q

5 features of epiglottitis

A

Sore throat
Fever
Drooling
Muffled voice
Tripod position
Pain on swallowing
Septic looking child

236
Q

Name 4 causative pathogens for croup

A

Parainfluenza
RSV
Adenovirus
Influenza

237
Q

4 features of croup

A

Increased OWB
Barking cough
hoarse voice
stridor
fever

238
Q

Give 4 clinical features of pneumonia in children

A

cough
fever
tachypnoea
tachycardia
increased WOB

239
Q

Give 4 signs of pneumonia in children

A

bronchial breath sounds
focal coarse crackles
dullness to percussion

240
Q

Causative organisms of pnumonia in:
neonates
young children
children

A

group B strep

s pneumoniae / RSV / H.Influenzae

241
Q

Investigations and management of penumonia in children

A

Sputum cultures
throat swabs - bacterial culture and PCR

Amoxicillin

242
Q

What is croup

A

Infection of upper airway causes inflammation and upper airway obstruction

243
Q

Give 3 RF for neonatal respiratory distress syndrome

A

Maternal diabetes
C section
hypothermia
FHx

244
Q

What is seen on CXR of RDS

A

Ground glass appearance

245
Q

What is cerebral palsy

A

Permanent non progressive neurological disorder due to brain damage at birth causing abnormal movements and posture

246
Q

Give 4 features of cerebral pasly

A

moement disorder
delayed milestones
FTT
Epilepsy
cosntipation
sleep disturbance
contractures

247
Q

Classifications of cerebral palsy

A

Spastic
Ataxic
Dyskinetic
Mixed

Finals revision (17 decks)

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