Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3A > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

-What is pneumonia?

A

An infection of the lung tissue. It causes inflammation of the lung tissue and sputum filling the airways and alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is shown on an x-ray of pneumonia?

A
  • Consolidation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the presentation of pneumonia?

A
  • Cough
  • High fever
  • Tachypnoea
  • Tachycardia
  • Increased work of breathing
  • Lethargy
  • Delirium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs of pneumonia?

A

Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the characteristic chest signs of pneumonia?

A
  • Bronchial breath sounds
  • Focal coarse crackles
  • Dullness to percussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common cause of pneumonia?

A

Strep Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the common types of pneumonia in unvaccinated children?

A
  • Group B strep contracted during birth
  • Haemophilus influenza
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What bacteria produces a chest x-ray finding of pneumatoceles?

A

S.aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is an atypical pneumonia in children?

A

Mycoplasma pneumonia has extra pulmonary manifestations such as erythema multiforme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the viral causes of pneumonia?

A
  • Respiratory syncytial virus (RSV) is the most common
  • Parainfluenza
  • Influenza virus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the management for pneumonia?

A
  • Amoxicillin used first line- adding macrolide (clarithromycin will cover atypical)
  • Macrolide also be used in Pen allergy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What needs to be tested in children with recurrent LRTI?

A
  • Full blood count rule out leukaemia
  • Chest x-ray to rule out structural abnormality
  • Serum immunoglobulins
  • Test response to previous vaccines- some patients can’t convert IgM to IgG
  • Sweat test for CF
  • HIV test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is croup?

A
  • Typically affects children from 6months to 2 years.
  • It is an URTI and causes oedema in the larynx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common cause of Croup?

A

Parainfluenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some other causes of croup?

A

Influenza
Adenovirus
Respiratory Syncytial Virus (RSV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of croup is associated with a high mortality?

A

Diphtheria- leads to epiglottitis which has a high mortality rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the presentation of croup?

A
  • Increased work of breathing
  • Barking cough
  • Hoarse voice
  • Stridor
  • Low grade fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the management for Croup?

A
  • Oral dexamethasone of 150mcg/kg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the stepwise treatment of croup?

A
  • Oral dexamethasone
  • Oxygen
  • Nebulised budesonide
  • Nebulised adrenalin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the presentation of an acute exacerbation of asthma?

A
  • Worsening shortness of breath
  • Signs of respiratory distress
  • Fast respiratory rate
  • Expiratory wheeze

A silent chest is an ominous sign as the child can’t get enough air to even make a wheeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a moderate severity asthma attack?

A

Peak flow > 50% predicted
Normal speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a severe asthma attack?

A

Peak flow <50% predicted
Sats <92%
Unable to complete sentences in one breath
Signs of respiratory distress

Respiratory rate:
> 40 in 1-5 years
> 30 in > 5 years

Heart rate
> 140 in 1-5 years
> 125 in > 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a life-threatening asthma attack?

A

Peak flow < 33% predicted

Exhaustion and poor respiratory effort

Hypotension

Silent chest

Cyanosis

Altered consciousness / confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the management of an acute asthma attack?

A

Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours

Nebulisers with salbutamol / ipratropium bromide

Oral prednisone (e.g. 1mg per kg of body weight once a day for 3 days)

IV hydrocortisone

IV magnesium sulphate

IV salbutamol- make sure to check potassium levels

IV aminophylline

If not under control then may need intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the key presentations of asthma?

A
  • Episodic symptoms
  • Diurnal variability
  • Typical triggers
  • A history of other atopic conditions such as eczema, hay fever and food allergies
  • Family history of asthma or atopy
  • Bilateral widespread “polyphonic” wheeze heard by a healthcare professional
  • Symptoms improve with bronchodilators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What presentation suggests a diagnosis other than asthma?

A
  • Wheeze only related to coughs or colds
  • Isolated or productive cough
  • Normal investigations
  • No response
  • Unilateral suggests a focal lesion or foreign body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is is used to make a diagnosis of asthma?

A

Spirometry with reversibility testing (in children aged over 5 years)

Direct bronchial challenge test with histamine or methacholine

Fractional exhaled nitric oxide (FeNO)

Peak flow variability measured by keeping a diary of peak flow measurements several times a day for 2 to 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the medical treatment in chidren under the age of 5 with asthma?

A
  • SABA as required
  • Steroid or leukotriene antagonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the treatment for asthma aged 5-12?

A

Start a short-acting beta-2 agonist inhaler (e.g. salbutamol) as required

Add a regular low dose corticosteroid inhaler

Add a long-acting beta-2 agonist inhaler (e.g. salmeterol). Continue salmeterol only if the patient has a good response.

Titrate up the corticosteroid inhaler to a medium dose. Consider adding:

Oral leukotriene receptor antagonist (e.g. montelukast)

Oral theophylline

Increase the dose of the inhaled corticosteroid to a high dose.

Referral to a specialist. They may require daily oral steroids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q
A

Start a short-acting beta 2 agonist inhaler (e.g. salbutamol) as required

Add a regular low dose corticosteroid inhaler

Add a long-acting beta-2 agonist inhaler (e.g. salmeterol). Continue salmeterol only if the patient has a good response.

Titrate up the corticosteroid inhaler to a medium dose.

Consider a trial of an oral leukotriene receptor antagonist (i.e. montelukast),

oral theophylline or an inhaled LAMA (i.e. tiotropium).

Titrate the inhaled corticosteroid up to a high dose.

Combine additional treatments from step 4, including the option of an oral beta 2 agonist (i.e. oral salbutamol).

Refer to specialist.

Add oral steroids at the lowest dose possible to achieve good control under specialist guidance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the problem with giving a child a steroid inhaler?

A
  • Some parents are worried that they can slow growth of up to (1cm) when used long term
  • This effect is dose-dependant meaning it is less of a problem with smaller doses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How often do spacers need to be cleaned?

A

Once a month and make sure they are air dried as static can prevent medication inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a viral induced wheeze?

A

Small children under the age of 3 have small airways. So when the encounter a virus they develop inflammation and oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why are children’s airways more affected with inflammation and oedema?

A

Swelling and constriction of the airway caused by a virus has little noticeable effect on the larger airways of an older child or adult, however due to the small diameter of a child’s airway, the slight narrowing leads to a proportionally larger restriction in airflow.

This is described by Poiseuille’s law, which states that flow rate is proportional to the radius of the tube to the power of four. Therefore, halving the diameter of the tube decreases flow rate by 16 fold.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a major risk factor for a viral induced wheeze?

A

Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the difference between asthma and a viral induced wheeze?

A

Presenting before 3 years of age
No atopic history
Only occurs during viral infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the presentation of a viral induced wheeze?

A

Evidence of a viral illness (fever, cough and coryzal symptoms) for 1-2 days preceding the onset of:

Shortness of breath
Signs of respiratory distress
Expiratory wheeze throughout the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What causes a focal wheeze?

A

Not asthma or viral

If you hear a focal wheeze be very cautious and investigate further for a focal airway obstruction such as an inhaled foreign body or tumour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is Bronchiolitis?

A

Describes inflammation and infection in the bronchioles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the most common cause of Bronchiolitis?

A

RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What ages is Bronchiolitis most comon?

A
  • Most common in under a year- particularly in under 6 months
  • Can occur in older children particularly in premature babies with chronic lung disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the presentation of Bronchiolitis?

A
  • Coryzal symptoms
  • Signs of resp distress
  • Dyspnoea
  • Tachypnoea
  • Poor feeding
  • Mild fever
  • Apnoea’s are episodes where the child stops breathing
  • Wheeze and crackles on auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the signs of respiratory distress?

A
  • Raised Resp rate
  • Use of accessory muscles for breathing
  • Intercostal and subcostal recessions
  • Nasal flaring
  • Head bobbing
  • Tracheal tugging- downward displacement during inspiration
  • Cyanosis
  • Abnormal airway noises
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are some abnormal airway noises?

A

Wheezing is a whistling sound caused by narrowed airways, typically heard during expiration

Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure

Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are reasons for admission with bronchiolitis?

A
  • Aged under 3 months or any pre-existing condition
  • 50-75% reduction in milk intake
  • Clinical dehydration
  • Resp rate over 70
  • Oxygen sats below 92%
  • Head bobbing
  • Apnoea’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the management for bronchiolitis?

A

Ensuring adequate intake. This could be orally, via NG tube or IV fluids depending on the severity. It is important to avoid overfeeding as a full stomach will restrict breathing. Start with small frequent feeds and gradually increase them as tolerated.

Saline nasal drops and nasal suctioning can help clear nasal secretions, particularly prior to feeding

Supplementary oxygen if the oxygen saturations remain below 92%

Ventilatory support if required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is useful for assessing ventilation in respiratory distress?

A

Capillary blood gases

Rising pCO2- Shows the airways have collapsed and can’t clear CO2

Falling pH- shows the CO2 is building up and not able to buffer the acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is given to high risk babies for bronchiolitis?

A

Palivizumab is given as monthly injection to prevent it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is cystic fibrosis?

A

An inherited autosomal recessive multi-system disease affecting the mucus glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

A mutation on what gene causes CF?

A

cystic fibrosis transmembrane conductance regulatory gene on chromosome 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How does a mutation to the CFTR gene cause disease?

A
  • The CFTR protein gets misfolded and can’t migrate from the RER to the cell membrane
  • The CFTR is a channel protein that pumps chloride ions into various secretions helping to thin them out meaning secretions are left overly thick
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How does CF cause respiratory problems?

A
  • Results in dry airways and impaired mucociliary clearance
  • The low volume thick airway secretions result in reduced airway clearance increasing chances of infection and this chronic inflammation can lead to bronchiectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the GI problems associated with CF?

A
  • Thickened secretions within small and large bowel can make it difficult to pass stools resulting in bowel obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the pancreatic problems associated with CF?

A

Thick pancreatic and bile secretions can block the pancreatic ducts resulting in a lack of digestive enzymes this can also result in pancreatitis and diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the liver problems associated with CF?

A

Thickened biliary secretions may block the bile ducts resulting in liver fibrosis and cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are some other problems associated with CF?

A
  • Can result in pulmonary hypertension leading to right sided heart failure
  • In males there is bilateral absence of vas deferens so it means there is male infertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What if often the first sign of CF in a baby?

A

meconium ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is meconium ileus?

A
  • In babies the first stool passed is called the meconium and it is black and sticky and should be passed within 48 hours
  • In babies with CF the meconium does not pass as it is too sticky so it causes bowel obstruction occurs in 20% of babies with CF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are some signs of CF?

A
  • Low weight
  • Nasal polyps
  • Finger clubbing
  • Crackles and wheezes
  • Abdominal distension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the symptoms of CF?

A
  • Chronic cough
  • Thick sputum production
  • Recurrent respiratory infections
  • Loose, greasy stools (steatorrhea) due to a lack of fat digesting lipase enzymes
  • Abdominal pain and bloating
  • Poor weight and height gain (failure to thrive)

-Parents may report the child tastes particularlysaltywhen they kiss them, due to the concentrated salt in the sweat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

When is CF most often diagnosed?

A
  • It is found during the heel-prick/Guthrie test which screens for CF in babies by looking for serum immunoreactivity trypsinogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the gold standard test for CF?

A

The sweat test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the sweat test?

A

test for CF

  • Pilocarpine is applied to the skin and electrodes are placed either side of the patch with small current to cause skin to sweat
  • The sweat is absorbed and sent to lab for testing a diagnostic test of chloride concentration above **60 mmol/l is diagnostic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are common microbial colonisers in CF?

A
  • Staphylococcus aureus- patients take long term prophylactic flucloxacillin
  • Pseudomonas aeruginosa- can be harder to treat and worsen the prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the management for the respiratory symptoms of CF?

A
  • Chest physiotherapy at least twice a day to remove mucus
  • Exercise
  • Salbutamol
  • Nebulised DNase (dornase alfa wolf) an enzyme that breaks down DNA material in respiratory secretions
  • Nebulised hypertonic saline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the treatment for the GI symptoms of CF?

A
  • CREON tablets helps to digest fats in patients with pancreatic insufficiency (missing lipase)
  • High calorie diet to make up for malabsorption and calories needed for respiratory effort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the prognosis for CF?

A

. Life expectancy is improving and currently the cystic fibrosis trust gives a median life expectancy of 47 years.

  • 90% of patients with CF develop pancreatic insufficiency
  • 50% of adults with CF develop cystic fibrosis-related diabetes and require treatment with insulin
  • 30% of adults with CF develop liver disease
    Most males are infertile due to absent vas deferens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is the new miracle cure for CF?

A

Kaftrio, described by patient groups as a ‘revolutionary drug’, is a triple combination treatment combining three drugs which perform different functions – ivacaftor, tezacaftor and elexacaftor – and tackles the underlying causes of the disease, by helping the lungs work effectively.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is epiglottitis?

A

Inflammation and swelling of the epiglottis caused by infection.

The epiglottis can swell to the point of completely obscuring the airway within hours of symptoms developing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the main cause of epiglottitis?

A

Haemophilus influenza B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the presentation of a potential epiglottitis?

A
  • Sore throat and stridor
  • Drooling
  • Tripod position
  • High fever
  • Muffled voice
  • Septic and unwell appearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the investigations for epiglottitis?

A
  • If patient is unwell and it is suspected then do not perform investigations
  • Lateral x-ray of the neck will show thumb sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the management for epiglottitis?

A
  • Consult an anaesthetist and make sure that the airway is secure
  • Once airway is secure give IV ceftriaxone and dexamethasone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is a common complication of epiglottitis?

A

An epiglottic abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is otitis media?

A
  • Infection of the middle ear which is the space that sits between the tympanic membrane and the inner ear
  • This is where the nerves are found
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What causes otitis media?

A
  • Bacteria enter from the back of the thorat through the eustachian tube
  • A Viral URTI often precedes otitis media
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the most common cause of otitis media?

A

Strep pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the presentation of otitis media?

A
  • Ear pain
  • Reduced hearing
  • Feeling unwell
  • Signs of URTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Examination otitis media?

A
  • Otoscope tympanic membrane will look bulging red and perforation will show discharge and hole in tympanic membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Management otitis media?

A

Most otitis media cases will resolve without antibiotics within around three days, sometimes up to a week. Antibiotics make little difference to symptoms or complications.

Amoxicillin for 5-7 days first-line
Clarithromycin (in pencillin allergy)
Erythromycin (in pregnant women allergic to penicillin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

When should antibiotics be prescribed in otitis media?

A
  • Symptoms lasting longer than 4 days
  • Systemically unwell
  • Immunocompromised
  • Younger than 2 years with bilateral
  • Perforation/discharge in canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is Glue ear?

A

It is known as otitis media with effusion. The middle ear becomes full of fluid and causes ;loss of hearing in that ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the tube that connects the middle ear to the throat called?

A

The Eustachian tube connects the middle ear to the back of the throat. It helps drain secretions from the middle ear. When it becomes blocked, this causes middle ear secretions (fluid) to build up in the middle ear space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is the main symptom of glue ear?

A

Reduction in hearing in that ear.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What will otoscopy show in glue ear?

A

A dull tympanic membrane with air bubbles or a visible fluid level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the management for glue ear?

A

Referral for audiometry to help establish the diagnosis and extent of hearing loss. Glue ear is usually treated conservatively, and resolves without treatment within 3 months.

Children with co-morbidities affecting the structure of the ear, such as Down’s syndrome or cleft palate may require hearing aids or grommets.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are grommets?

A

Tiny tubes inserted into the tympanic membrane by an ENT surgeon. This allows fluid to drain from the middle ear

Grommets usually fall out within a year and don’t need to be reinserted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are some congenital causes of deafness?

A
  • Maternal rubella or CMV
  • Genetic deafness
  • Associated syndromes e.g. down’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are some perinatal causes of deafness?

A
  • Prematurity
  • Hypoxia during or after birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are some causes of birth after birth?

A
  • Jaundice
  • Meningitis and encephalitis
  • Otitis media and glue ear
  • Chemotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

How is a child tested for deafness?

A
  • Newborn hearing screening assessment tests hearing in all neonates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are signs that a child may have hearing difficulties?

A

Ignoring calls or sounds
Frustration or bad behaviour
Poor speech and language development
Poor school performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are audiograms?

A
  • Charts that document the volume at which patients can hear different tones. The frequency in hertz is plotted on x-axis and decibels on Y axis
  • It is recorded as the minimum volume required to hear each frequency, the worse the hearing the lower down on the chart
  • Both air and bone conduction are tested separately
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the symbols used to mark on the chart?

A

X – Left sided air conduction
] – Left sided bone conduction
O – Right sided air conduction
[ – Right sided bone conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What will patients with sensorineural hearing loss show on the chart?

A

Both air and bone conduction readings will be more than 20 dB, plotted below the 20 dB line on the chart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What will patients with conductive hearing loss show on the chart?

A

In patients with conductive hearing loss, bone conduction readings will be normal (between 0 and 20 dB), however air conduction readings will be greater than 20 dB, plotted below the 20 dB line on the chart.

In conductive hearing loss, sound can travel through bones but is not conducted through air due to pathology along the route into the ear.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is mixed hearing loss?

A

In patients with mixed hearing loss, both air and bone conduction readings will be more than 20 dB, however there will be a difference of more than 15 dB between the two (bone conduction > air conduction).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Give 3 causes of conductive hearing loss.

A
  1. Glue ear.
  2. Ear wax.
  3. Otitis media.
  4. Perforated ear drum.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Give 3 risk factors for sensori-neural hearing loss?

A

ongenital infection, eg rubella, CMV
Meningitis
Genetics
Consanguinity.
Usher Syndrome
hypoxic-ischemic injury to the brainstem, hemorrhage into the inner ear, toxic effects of bilirubin or aminoglycoside,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Describe the management of sensori-neural hearing loss.

A

Sensori-neural hearing loss is often managed by a paediatrician. Treatments involve hearing aids or cochlea implants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

How would you manage mixed hearing loss?

A

You would address the conductive problem first and then offer a hearing aid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is seen in peri orbital cellulitis?

A
  • In periorbital cellulitis there is fever with erythema, tenderness and oedema of the eyelid or other skin adjacent to the eye
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

How should you treat periorbital cellulitis?

A
  • It should be treated quickly with intravenous antibiotics such as high-dose ceftriaxone to prevent posterior spread which can cause orbital cellulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is a squint?

A
  • It refers to the misalignment of the eyes strabismus
  • In childhood the brain will cope with this misalignment by reducing the signal from the less dominant eye hence a squint
  • If this is not treated the lazy eye becomes disconnected from the brain and the problem becomes worse this is called amblyopia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are the two types of squint?

A

Concomitant (non paralytic) squints are due to differences in the control of the extra ocular muscles. The severity of the squint can vary.

Paralytic squints are rare. They are due to paralysis in one or more of the extra ocular muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Outline the two tests used to detect squints.

A

orneal light reflex test

A Light in shone from a distance at both corneas simultaneously. If the light
reflection does not appear in the same position in the
two pupils, a squint is present

Cover test
The child is encouraged to look at a toy/light. If the
fixing (dominant) eye is covered, the *squinting eye will move to take up fixation.**

Cover test should be performed at different distances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

name some causes of paralytic squints

A

Infections: Infections like meningitis or encephalitis can damage the nerves or areas of the brain responsible for controlling eye movement.

Birth Trauma: During delivery, if there’s trauma or injury to the baby’s head or the nerves controlling eye movement, it can lead to a squint.

Neurological Disorders: Cerebal Palsy and other conidtiosn that hinder muscle control and coordination can also result in paralytic squints.

Tumors or Growth: Any abnormal growths or tumors in or around the eye, brain, or nerves controlling eye movement can put pressure on these structures, causing paralysis or weakness.

Accidents or Injuries:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is a ventral septal defect?

A
  • A congenital hole in the septum between the ventricles
  • They can occur in isolation but are often due to underlying genetic condition such as Down’s or Turner’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

How does blood flow in a ventral septal defect and what is the presentation of it?

A
  • Due to increased pressure in the left compared to the right the blood will flow from right to left through the hole
  • As blood will still flow around the body they will remain acyanotic
  • However this will cause a right side overload and lead to heart failure and increased low into the pulmonary vessels leading to pulmonary hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What is the presentation of a VSD?

A
  • Poor feeding
  • Dyspnoea
  • Tachypnoea
  • Failure to thrive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What murmur does a VSD present with?

A
  • Pan systolic murmur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is the treatment for a VSD?

A
  • Surgery if big hole
  • Increased risk of IE so give antibiotic prophylaxis if surgery is required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What causes a ASD?

A

During the development of the fetus the left and right atria are connected. Two walls grow downwards from the top of the heart, then fuse together with the endocardial cushion in the middle of the heart to separate the atria.

These two walls are called the septum primum and septum secondum

Defects in these two walls lead to atrial septal defects, a hole connecting the left and right atria. There is a small hole in the septum secondum called the foramen ovale. The foramen ovale normally closes at birth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What are the different types of ASD?

A

Ostium secondum, where the septum secondum fails to fully close, leaving a hole in the wall.

Patent foramen ovale, where the foramen ovale fails to close (although this not strictly classified as an ASD).

Ostium primum, where the septum primum fails to fully close, leaving a hole in the wall. This tends to lead to atrioventricular valve defects making it an atrioventricular septal defect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What are some complications of a ASD?

A
  • Stroke instead of PE
  • AF
  • Pulmonary hypertension and HF
  • Eisenmenger syndrome
  • Can cause arrhythmias in early childhood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is the presentation of a ASD?

A
  • Mid systolic cresendo-descendo murmur
  • Also a link to migraine with aura and patent foramen ovale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is Eisenmenger syndrome?

A

Eisenmenger syndrome occurs when blood flows from the right side of the heart to the left across a structural heart lesion, bypassing the lungs. There are three underlying lesions that can result in Eisenmenger syndrome:

Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What causes EMS?

A
  • When pulmonary pressure is greater than the systemic pressure blood begins to flow from the right side of the heart to the left
  • This causes deoxygenated blood to bypass the lungs and enter the body. This causes cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What happens as a consequence of the cyanosis in EMS?

A
  • More RBCs produced leading to polycythaemia which causes plethoric appearance and increases chances of blood clots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What are some findings related to right left shunt?

A

Cyanosis
Clubbing
Dyspnoea
Plethoric complexion (a red complexion related to polycythaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is a risk factor for EMS?

A

Pregnancy can make the problem worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is the prognosis of EMS?

A

Once the syndrome has occurred it is irreversible so should be treated before it occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is a PDA?

A

The ductus arteriosus normally stops functioning within 1-3 days of birth, and closes completely within the first 2-3 weeks of life.

When it fails to close, this is called a “patent ductus arteriosus” (PDA).

The reasons why it fails to close are unclear, but it may be genetic or related to maternal infections such as rubella. Prematurity is a key risk factor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What is the murmur in PDA?

A

a continuous crescendo-decrescendo “machinery” murmur

Have a bounding pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What are the main causes of heart failure in neonates?

A

Hypoplastic left heart syndrome -left side of the heart severely underdeveloped
* Critical aortic valve stenosis
* Severe coarctation of the aorta
* Interruption of the aortic arch
- transposition of the great arteries -

Think - all lead to obstructed systemic circulation, so causes heart failure straight away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is the main causes of heart failure in infants? (1st year of life)

A
  • Large PDA, VSD or ASD
  • Anything that causes mixes of circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is the main causes of heart failure in older children/adolescents?

A

More due to acquired conditions:
Rheumatic fever, cardiomyopathies, Eisenmenger syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What are some symptoms of heart failure in children?

A

Shortness of breath

– Inability to gain weight/poor growth

– Predisposition to recurrent chest infections

– Hepatomegaly

– Signs of specific cause –> e.g., murmur, cardiomegaly, cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is some general management for heart failure in children?

A
  • Bed rest and nurse in semi-upright position: infants in chair/seat.
  • Supplemental oxygen (not in left to right shunt).
  • Diet: sufficient calorie intake.
  • Diuretics.
  • Angiotensin converting enzyme inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

name 3 cyanatoic congenital heart diseases. (Right to left shunts)

A

Tetralogy of Fallot
Transposition of the great arteries
Eisenmenger

132
Q

What are the 4 pathologies of tetralogy of Fallot?

A
  • VSD
  • Overriding aorta
  • Pulmonary valve stenosis
  • Right ventricular hypertrophy
133
Q

What are the risk factors for TOF?

A
  • Rubella
  • Increased age of mother
  • Alcohol consumption in pregnancy
  • Diabetic mother
134
Q

What is the presentation of TOF?

A

Most cases are picked up before the child is born during the antenatal scans. Additionally, an ejection systolic murmur caused by the pulmonary stenosis may be heard on the newborn baby check.

Severe cases will present with heart failure before one year of age. In milder cases, they can present as older children once they start to develop signs and symptoms of heart failure.

135
Q

What are the signs and symptoms of TOF?

A
  • Cyanosis
  • Clubbing
  • Poor feeding
  • Poor weight gain
  • Ejection systolic murmur
  • Tet spells
136
Q

what is a Tet spell?

A
  • When right to left shunt is increased due to an decrease in the systemic resistance or increase in pulmonary vascular resistance
  • Lots of exercise produces Co2 which reduces vascular résistance
  • These episodes may be precipitated by waking, physical exertion or crying. The child will become irritable, cyanotic and short of breath. Severe spells can lead to reduced consciousness, seizures and potentially death.
137
Q

What is the treatment for a Tet spell?

A
  • Position child with knees to their chest which will increase systemic vascular resistance
  • Beta blockers can relax the right ventricle and improve flow to the pulmonary vessels.

IV fluids can increase pre-load, increasing the volume of blood flowing to the pulmonary vessels.

Morphine can decrease respiratory drive, resulting in more effective breathing.

Sodium bicarbonate can buffer any metabolic acidosis that occurs.

Phenylephrine infusion can increase systemic vascular resistance.

138
Q

What is CoA?

A

Coarctation of the aorta is a congenital condition where there is narrowing of the aortic arch, usually around the ductus arteriosus. The severity of the coarctation (or narrowing) can vary from mild to severe. It is often associated with an underlying genetic condition, particularly Turners syndrome.

Narrowing of the aorta reduces the pressure of blood flowing to the arteries that are distal to the narrowing. It increases the pressure in areas proximal to the narrowing, such as the heart and the first three branches of the aorta.

139
Q

What is the presentation of CoA?

A

*Weak femoral pulses is often the sign**

  • Poor feeding
  • Grey and floppy baby
  • Tachypnoea

Signs over time:
- Left ventricular heave
- Underdevelopment of left arm
- Underdevelopment of legs

140
Q

What is the management of CoA?

A
  • Give prostaglandin E to keep DA open otherwise this worsens symptoms
  • Fix with surgery when ready
141
Q

What is Transposition of the Great Arteries?

A
  • When the attachments of the aorta and pulmonary trunk are swapped
142
Q

What is the presentation of Transposition of the Great Arteries?

A
  • Will often be picked up on scan
  • will develop respiratory distress, tachycardia, poor feeding, poor weight gain and sweating.
143
Q

What is the management Transposition of the Great Arteries?

A

Where there is a ventricular septal defect, this will allow some mixing of blood between the two systems and provide some time for definitive treatment.

A prostaglandin infusion can be used to maintain the ductus arteriosus. This allow blood from the aorta to flow to the pulmonary arteries for oxygenation.

Balloon septostomy involves inserting a catheter into the foramen ovale via the umbilicus, and inflating a balloon to create a large atrial septal defect. This allows blood returning from the lungs (on the left side) to flow to the right side of the heart and out through the aorta to the body.

Open heart surgery is the definitive management. A cardiopulmonary bypass machine is used to perform an “arterial switch” procedure within a few days of birth. If present, a VSD or ASD can be corrected at the same time.

144
Q

What is rheumatic fever?

A
  • An autoimmune condition triggered by streptococcus bacteria causes antibodies to target areas of the boddy
145
Q

What type of hypersensitivity reaction is RF?

A

Type II

146
Q

What bacteria most commonly causes rheumatic fever?

A

group A beta-haemolytic streptococcal, typically streptococcus pyogenes causing tonsillitis

147
Q

What is the presentation of RF?

A

Symptoms 2-4 weeks after sore throat such as:
- Fever
- Joint pain
- Rash
- SOB
- Chorea
- Nodules

148
Q

What are the effects of RF on different body systems?

A
  • Joint involvement: migratory arthritis affecting the large joints, with hot, swollen, painful joints.

-Inflammation throughout the heart, with pericarditis, myocarditis and endocarditis, leads to:

Tachycardia or bradycardia
Murmurs from valvular heart disease, typically mitral valve disease
Pericardial rub on auscultation
Heart failure

  • Subcutaneous nodules and Erythema marginatum rash
  • Chorea if the nervous system
149
Q

What is used to diagnose RF?

A

The jones criteria

150
Q

What is the Jones criteria?

A

Major
J- Joint arthritis
O- organ inflammation
N- Nodules
E – Erythema marginatum rash
S – Sydenham chorea

Minor
F- Fever
E- ECG Changes (prolonged PR interval) without carditis
A- Arthralgia without arthritis
R- Raised inflammatory markers (CRP and ESR)

Two major criteria OR
One major criteria plus two minor criteria

151
Q

What is the management of RF?

A

Pen V for 10 days

152
Q

What are some complications of RF?

A

Recurrence of rheumatic fever
Valvular heart disease, most notably mitral stenosis
Chronic heart failure

153
Q

What causes GORD in a baby?

A

There is immaturity of the lower oesophageal sphincter. It is normal to have reflux and fine if baby keeps gaining weight

90% resolves within a year of birth

154
Q

What are some signs of problematic reflux?

A

Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Reluctance to feed
Pneumonia
Poor weight gain

155
Q

What are some red flags that may make you reconsider GORD?

A
  • Not keeping down any feed
  • Projectile or forceful vomiting
  • Bile stained
  • Haematemesis
  • Abdominal distension
  • Reduced consciousness, bulging fontanelle or neurological signs (meningitis or raised intracranial pressure)
  • Respiratory symptoms (aspiration and infection)
  • Blood in the stools (gastroenteritis or cows milk protein allergy)
  • Signs of infection (pneumonia, UTI, tonsillitis, otitis or meningitis)
  • Rash, angioedema and other signs of allergy (cows milk protein allergy)
  • Apnoeas are a concerning feature and may indicate serious underlying pathology and need urgent assessment
156
Q

What is Sandifer’s syndrome?

A
  • Abnormal movements associated with GORD

Torticollis: forceful contraction of the neck muscles causing twisting of the neck

Dystonia: abnormal muscle contractions causing twisting movements, arching of the back or unusual postures

157
Q

What is the treatment for GORD?

A

In simple cases some explanation, reassurance and practical advice is all that is needed. Advise:

Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keep the baby upright after feeding (i.e. not lying flat)

More problematic cases can justify treatment with

Gaviscon mixed with feeds
Thickened milk or formula (specific anti-reflux formulas are available)
Proton pump inhibitors (e.g., omeprazole) where other methods are inadequate

158
Q

What is pyloric stenosis?

A
  • the pyloric sphincter is a ring of smooth muscle that forms between the stomach and duodenum.
  • Hypertrophy and therefore narrowing of this canal prevents the passage of food
  • Eventually due to increased peristalsis of stomach it will cause projectile vomiting from oesophagus as food can’t reach duodenum
159
Q

What are the key presentations of pyloric stenosis?

A
  • Projectile vomiting (failure to thrive in early weeks of life)
  • Firm round mass like a large olive in upper abdomen
  • Hypochloric on blood gas (metabolic alkalosis) due to vomiting of HCL
160
Q

How is pyloric stenosis diagnosed and managed?

A
  • Abdominal ultrasound for diagnosis
  • a laparoscopic pyloromyotomy (known as “Ramstedt’s operation“).
161
Q

What is Gastroenteritis?

A
  • Gastritis is inflammation of the stomach and presents with nausea and vomiting
  • Enteritis is inflammation of the intestines and presents with diarrhoea

Gastroenteritis is inflammation all the way from the stomach to the intestines and presents with nausea, vomiting and diarrhoea.

162
Q

What are some differentials for diarrhoea?

A

Stools from normal babies can vary from loose stools several times a day to one stool per week. Steatorrhoea means greasy stools with excessive fat content. This suggests a problem with digesting fats, such as pancreatic insufficiency (think about cystic fibrosis).

Other conditions are:
- Infection
- IBD
- Lactose
- Coeliac
- CF
- Toddler’s diarrhoea
- IBS
- Medications

163
Q

What are the viral causes of Gastroenteritis?

A
  • Rotavirus
  • Norovirus
  • Adenovirus
164
Q

What are some signs of severe dehydration and shock seen in gastroenteriris?

A

gns of dehydration:

– Reduced urine output, lethargic, sunken eyes

– However, they are haemodynamically stable (normal BP, normal capillary refill time, warm extremities)

Signs of shock:

– Reduced consciousness, pale skin, appears unwell

– They will start to get haemodynamically compromised –> low BP, high HR, long CRT, cold extremities

165
Q

What is the treatment for gastroenteritis in children?

A
  • Children need to stay off school for 48 hours after symptoms have resolved
  • Main thing is keeping the child hydrated if they can tolerate fluid then they are okay to carry on and can be discharged
166
Q

What are the antidiarrheal that can be used in gastroenteritis?

A
  • Loperamide but don’t give antiemetic metoclopramide or others
  • Also don’t give medication in E.coli or shigella infections where there is bloody diarrhoea or high fever
167
Q

What are some complications of gastroenteritis?

A

Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain–Barré syndrome

168
Q

What are the features suggesting constipation?

A
  • Less than 3 stools per weeks
  • Hard stools (rabbit dropping stools)
  • Abdo pain
  • Abnormal posture (retentive posture)
  • Overflow soiling
  • Loss of sensation of the need to open bowels
169
Q

What is encopresis?

A
  • Only considered pathological after age of 4, it is where the rectum becomes stretched and losses sensation
  • Large stools remain and only loose stools can bypass and this causes soiling
170
Q

What is a concern of chronic constipation in children?

A

Often patients develop a habit of not opening their bowels when they need to and ignoring the sensation of a full rectum. Over time they loose the sensation of needing to open their bowels, and they open their bowels even less frequently.

171
Q

What are some red flags of constipation in children?

A

Not passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung’s disease)

Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)

Vomiting (intestinal obstruction or

Hirschsprung’s disease)

Ribbon stool (anal stenosis)

Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)

Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)

Failure to thrive (coeliac disease, hypothyroidism or safeguarding)

Acute severe abdominal pain and bloating (obstruction or intussusception)

172
Q

What is the management of constipation?

A
  • High fibre diet and good hydration
  • Start laxatives (movicol is first-line)
  • Faecal impaction may require a impaction regimen
  • Encourage and praise visiting the toilet. This could involve scheduling visits, a bowel diary and star charts.

Laxatives should be continued long term and slowly weaned off as the child develops a normal, regular bowel habit.

173
Q

What are some key differentials for appendicitis?

A
  • Ectopic pregnancy
  • Ovarian cysts
  • Meckel’s diverticulum
  • Mesenteric adenitis
  • Appendix mass
174
Q

What is an umbilical hernia?

A

The herniation of the bowel content through the umbilicus. It is a common finding in neonates and usually asymptomatic

175
Q

What are the two types of inguinal hernias?

A

Direct: the hernia protrudes through the posterior wall of the inguinal canal (20%)

Indirect: hernia protrudes through the deep inguinal ring and into the inguinal canal

176
Q

What are the features of an inguinal hernia?

A
  • Groin swelling
  • Nausea, vomiting, constipation, abdominal pain/discomfort
  • A scrotal mass you can’t get above
  • Is reducible when lying flat
  • Does not trans illuminate
  • Has a positive cough reflex
177
Q

How do you manage a hernia in a child?

A
  • Most hernias can be successfully reduced by taxis (gentle compression in the line of the inguinal canal)
  • If reduction is impossible then emergency surgery is required to reduce the risk of compromise to bowel, testes or ovaries
178
Q
A
179
Q

What is inflammatory bowel disease?

A

An umbrella term for the two main diseases causing inflammation of the GI tract.

180
Q

What are the two main causes of IBD?

A

Ulcerative colitis and Crohn’s disease

181
Q

What is Crohn’s diease?

A

Transmural inflammation of the GI tract (anywhere from mouth to anus).

182
Q

Where is the most commonly affected area of Crohn’s?

A

Terminal ileum and Colon

183
Q

Describe the epidemiology of Crohn’s?

A
  • Has a peak onset in early life (20-40 years).
  • More common in female than male
184
Q

What genetic mutations can cause Crohn’s?

A

CARD15 and NOD2 mutation

185
Q

What is the endoscopic appearance of Crohn’s?

A

Cobblestone appearance

186
Q

What are the signs of Crohn’s?

A
  • Abdominal tenderness
  • Fever
  • Mouth ulcers
  • Rectal examination will show blood, skin tags, fissures and fistulas
187
Q

What are the symptoms of Crohn’s?

A
  • Weight loss
  • Diarrhoea
  • Abdominal pain (most common in RLQ where the ileum is)
  • Lethargy and malaise also symptom
188
Q

What are the investigations for Crohn’s?

A
  • Faecal calprotectin (released by intestines when inflamed)
  • C- reactive protein is a good indication of current inflammation
189
Q

What is the diagnostic investigation for Crohn’s and what will it show?

A

Colonoscopy- will show mucosal inflammation (deep ulcers, skip lesions and cobblestone appearance)

Histology will show transmural inflammation with granulomas and goblet cells

190
Q

What are some immunosuppressants used to treat Crohn’s? Levels of what should be measured before using them?

A
  • Azathioprine
  • Methotrexate
  • Mercaptopurine

Levels of Thiopurine methyltransferase should be measured before using

191
Q

What are the biological therapies used to treat Crohn’s?

A

Infliximab and Adalimumab

192
Q

How would you maintain remission in Crohn’s?

A
  • First line= Azathioprine or mercaptopurine
  • Second line- Methotrexate with Infliximab
193
Q

When and what surgery could be used to treat Crohn’s?

A
  • When distal ileum is inflamed can surgically resect the area to prevent flare ups
  • Also used to treat strictures and fistulas
194
Q

What is Ulcerative colitis?

A

A type of IBD that typically involves the rectum and variable lengths of the colon. Will never spread beyond the ileocecal valve

195
Q

Describe the epidemiology of UC?

A
  • Bimodal peak at 15-25 and 55-70
  • More common in non-smokers
196
Q

What is the gene implicated in UC?

A

HLA-B27

197
Q

What are some other risk factors for UC?

A
  • Non smoker
  • NSAIDs
  • Chronic stress/depression
198
Q

Describe the pathophysiology of UC?

A
  • Ulcers tend to form along the inner surface or lumen of the large intestine and rectum
  • Thought to be autoimmune in nature cytotoxic T cells attack the lining of the colon
  • Also thought that patients have higher proportion of gut bacteria that release sulphides
199
Q

What antibodies are found in patients with UC?

A

p-ANCAs -perinuclear antineutrophilic cytoplasmic antibodies) in their blood - antibodies that target antigens in the body’s own neutrophil

200
Q

What are the signs of UC?

A
  • Abdominal tenderness
  • Fever - in acute UC
  • Tachycardia - in acute severe UC
  • Fresh blood on rectal examination
201
Q

What are some cutaneous signs of UC?

A
  • Erythema nodosum - inflammatory disorder affecting subcutaneous fat.
  • Pyoderma gangrenosum - rapidly enlarging, very painful ulcer.
202
Q

What are the symptoms of UC?

A
  • Diarrhoea
  • Blood and mucus in stool
  • LLQ pain
  • Weight loss
  • Cramping rectal pain
203
Q

What investigations would you do for UC?

A
  • Faecal calprotectin
  • LFT to screen for PSC
  • Raised C-reactive protein
204
Q

What is the gold standard for UC and what would it show?

A

Colonoscopy and biopsy

Would show:
-shallow ulceration
- No inflammation beyond submucosa
- Crypt abscesses
- Goblet cell depletion

205
Q

What is the scoring system used to test the severity of UC?

A

Truelove and Witts’ severity index

206
Q

What is the management for inducing remission in mild UC?

A
  • First line: Aminosalicylate (mesalazine)
  • Second line corticosteroid (prednisolone)
207
Q

What is the management for inducing remission in severe UC?

A
  • First line: IV corticosteroid hydrocortisone
  • Second line IV ciclosporin
208
Q

How would you maintain remission in UC?

A
  • Aminosalicylate, azathioprine, mercaptopurine
    -May use biological therapy e.g., Infliximab if nothing else is working
209
Q

What are the surgical options for UC?

A
  • Removal of the colon and rectum (panproctocolectomy)
  • Left with ileostomy or or J-pouch this is where small intestine is used to make rectum

Surgery will be curative

210
Q

What % of patients with UC will develop colonic adenocarcinoma?

A

3-5%

211
Q

What are the extra intestinal signs of IBD?

A

A PIE SAC
- Ankylosing spondylitis (HLA B27!)
- Pyoderma gangrenosum
- Iritis (aka anterior uveitis)
- Erythema nodosum
- Sclerosing cholangitis
- Aphthous ulcers / amyloidosis
- Clubbing

212
Q

What areas are most affected by coeliac disease?

A
  • The small bowel in particular the jejunum
  • There will be crypt hyperplasia and atrophy of intestinal villi
213
Q

What are the symptoms of coeliac?

A
  • Failure to thrive
  • Diarrhoea
  • Weight loss
  • Mouth ulcers
  • Anaemia
  • Dermatitis herpetiformis

Can also present with neurological symptoms

214
Q

What condition is often linked to coeliac?

A

T1DM

215
Q

What are the genes associated with coeliac?

A

HLA-DQ2 gene (90%)
HLA-DQ8 gene

216
Q

What are the antibodies tested for in coeliac?

A

Tissue transglutaminase antibodies (anti-TTG)
Endomysial antibodies (EMAs)

Remember to calculate total IgA as it can be low which will give negative test

217
Q

What will a endoscopy show in coeliac?

A

Crypt hypertrophy
Villous atrophy

218
Q
A
219
Q

What is marasmus?

A

When a child in deficient in all macronutrients and in it the child has a wasted, wizened appearance. Oedema is not present

Affected children are often withdrawn and apathetic

220
Q

Define kwashiorkor - when is it commonly seen?

A

kwashiorkor is a type of malnutrition caused by protein deficiency. It mainly occurs in children who are weaning off breast milk, while marasmus can develop in infants.]

If your diet has a lot of carbohydrates and very little proteins, you may develop kwashiorkor

Will cause swelling in the stomach often seen when children are breastfed for too long

221
Q

What is Hirschsprungs?

A

Is a congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum

222
Q

What is the pathophysiology of Hirschsprungs disease?

A
  • The absence of the parasympathetic ganglion cells. In development these nerves start higher in the GI tract and migrate down
  • The area of the colon that is affected will vary from patient to patient. If the entire colon is affected this is called total colonic aganglionosis
223
Q

What is associated with Hirschsprung’s?

A
  • Family history
  • Down syndrome
  • Neurofibromatosis
  • Waardenburg syndrome
  • Multiple endocrine neoplasia type II
224
Q

What are the symptoms of Hirschsprung’s?

A
  • Acute intestinal obstruction shortly after birth
  • Delay in passing meconium
  • Chronic constipation
  • Abdominal pain and distension
  • Vomiting
  • Poor weight gain and failure to thrive
225
Q

What is Hirschsprung-Associated Enterocolitis?

A
  • Is inflammation and obstruction of the intestine occurring in 20% of neonates with the condition
  • It presents with fever, abdominal distention and diarrhoea 2-4 weeks after birth
  • It can lead to toxic megacolon and bowel perforation.
226
Q

How is Hirschsprungs diagnosed?

A

Rectal biopsy which will show the absence of ganglionic cells

227
Q

What is the management of Hirschsprungs?

A

Surgical resection of the aganglionic section of the bowel

228
Q

What is Intussusception?

A

Where the bowel “invaginates” on itself and telescopes into itself

This thickens the overall size of the bowel and narrows the lumen. This leads to a palpable mass and obstruction to faeces

typically between 6 months to 2 years and more common in boys

229
Q

What conditions can cause Intussusception?

A
  • Concurrent viral illness
  • Henoch-schonlein purpura
  • CF
  • Intestinal polyps
  • Meckel diverticulum
230
Q

What are the key presentations of Intussusception?

A
  • Redcurrant jelly stool
  • Right upper quadrant mass on palpation, this is described as sausage shaped
231
Q

What are some other presentations of Intussusception?

A
  • Severe colicky abdominal pain
  • Pale lethargic and unwell child
  • Vomiting
  • Intestinal obstruction
232
Q

What is used to diagnose Intussusception?

A
  • Ultrasound
  • Contrast enema
233
Q

What is used to treat Intussusception?

A
  • Enemas can be used to reduce the Intussusception
  • Surgical resection
234
Q

What is Meckel diverticulum a remnant of?

A
  • It is an outpouching or bulge in the lower part of the small intestine which contains ectopic gastric mucosa or pancreatic tissue
235
Q

What can Meckels diverticulum lead to?

A

The pouch releases acid like the stomach which over time can cause ulcers to develop in the small intestine

These can worsen and bleed which shows as blood in the poo, it can also leak the liquid inside the small intestine into the abdomen

236
Q

Give 3 signs of Meckel diverticulum?

A

Generally asymptomatic, but may present with bleeding or intussusception or volvulus:

  1. Severe rectal bleeding
  2. Intussusception
  3. Volvulus
237
Q

Give some causes that could be behind Chronic non-specific diarrhoea in small children (Previously known as toddlers diarrhoea

A

undiagnosed coeliac disease
or excessive ingestion of fruit juice, especially apple
juice.

temporary cow’s milk allergy following gastroenteritis, when a trial of a cow’s milk protein free diet may be helpful.

dysmotility of the gut (a form of irritable bowel syndrome)

So rule out Coealiac and Cows milk allergy first

238
Q

Describe what ‘Colic’ is

A

The term ‘colic’ is used to describe a common symptom complex that occurs during the first few months of life.

Paroxysmal, inconsolable crying or screaming often
accompanied by drawing up of the knees and passage
of excessive flatus takes place several times a day.

239
Q

What is Cow’s milk protein allergy?

A
  • A condition affecting infants and young children under 3 years
  • It involves hypersensitivity to the protein in cow’s milk.
240
Q

What are the two types of Cow’s milk protein allergy?

A
  • IgE mediated that involves a rapid response within 2 hours of digestion
  • Non IgE mediated where a reaction occurs more slowly over several days
241
Q

What is the presentation of Cow’s milk protein allergy?

A
  • Usually presents before one year of age, it may be apparent when weaned from breast milk to formula milk or food containing milk
  • Can present in breast fed babies and mother is consuming dairy products
242
Q

What are the symptoms of Cow’s milk protein allergy?

A
  • Bloating and wind
  • Abdo pain
  • Diarrhoea
  • Vomiting
  • Urticarial rash
  • Facial swelling
  • Cough
  • Sneezing
  • Watery eyes
  • Eczema
243
Q

How can Cow’s milk protein allergy be diagnosed?

A

Skin prick testing

244
Q

What is the management for Cow’s milk protein allergy?

A
  • Breast feeding mothers to avoid dairy products
  • Replace formula with special hydrolysed formula
  • Children will outgrow it so progress up milk ladder
245
Q

What is the difference between Cow’s milk protein allergy and Cow’s milk intolerance?

A

No allergic symptoms but GI symptoms present

246
Q

What is biliary atresia?

A

A congenital condition where a section of the bile duct is either narrowed or absent resulting in Cholestasis

247
Q

What are the signs and symptoms of biliary atresia?

A

Conjugated bilirubin is excreted in bile therefore biliary atresia prevents the excretion of it resulting in:

  • Significant jaundice lasting more than 14 days in term babies and 21 days in preterm babies
248
Q

What will tests show in biliary atresia?

A

A high proportion of conjugated to unconjugated bilirubin

249
Q

What is the management of biliary atresia?

A

“Kasai portoenterostomy” involves attaching a section of the small intestine to the opening of the liver, where the bile duct normally attaches

250
Q

What is physiological jaundice in neonate?

A
  • Babies have lots of RBCs and they are more fragile, also break down more easily
  • This will cause mild yellowing of skin and sclera 2-7 days of age and resolved by 10
251
Q
A
252
Q

What is a risk of high levels of bilirubin?

A

Kernicterus:

Now rare due to good treatment of jaundice

Bilirubin crosses the blood brain barrier
Excessive bilirubin causes direct damage to the central nervous system

Presents with less responsive, floppy, drowsy baby with poor feeding

Leads to permanent damage (cerebral palsy, learning difficulties, deafness

253
Q

What is used to treat jaundice in new-borns?

A

Phototherapy

254
Q

What things would you typically see in Neonatal jaundice syndrome?

A

Baby has intrauterine growth restriction, Jaundice, failure to thrive, itchy rash, dark urine and hepatomegaly.

255
Q

What would a liver biopsy show in neonatal hepatitis syndrome? What blood tests would you do?

A

Liver biopsy will show: Multinucleated giant cells & Rosette formation.

This will both ↑unconjugated + ↑ conjugated bilrubin.

With associated deranged LFT’s

256
Q

What is a choledochal cyst? How may they present?

A

They are cystic dilatations of the extrahepatic biliary
system

They present with neonatal jaundice or, in
older children, presentation is with abdominal pain, a
palpable mass, jaundice, or cholangitis

257
Q

What do you do to investigate a choledocal cyst? How do you manage it?

A

ultrasound or magnetic resonance cholangiopancreatography.

Treatment is by surgical excision of the cyst

258
Q

Name some causes of acute liver failure in children <2 years old

A

Infection (most common
is herpes simplex)
Metabolic disease
Seronegative hepatitis
Drug induced
Neonatal
haemochromatosis

259
Q

Give some causes of vomitting in Infants due to infections

A

Gastro-oesophageal reflux
Feeding problems
Infection:
* Gastroenteritis
* Whooping cough
(pertussis)
* Meningitis
Infection – including pyelonephritis,
septicaemia, meningitis
Appendicitis

260
Q

Give some causes of vommitng in children due, to obstruction

A

Intussusception
* Malrotation
* Volvulus
* Adhesions
* Foreign body – bezoar
Plyoric stenosis
* Atresia – duodenal,
other sites
Hirschprungs disease

261
Q

What are the symptoms of a UTI in children?

A

Fever may be only symptom, always exclude a UTI in a child with a fever

Baby symptoms:
- Lethargy
- Irritability
- Vomiting
- Poor feeding

Infant/children symptoms:
- Abdo pain- suprapubic
- Vomiting
- Dysuria
- Frequency
- Incontinence

262
Q

When is diagnosis of acute pyelonephritis made?

A
  • Temp greater than 38
  • Loin pain or tenderness
263
Q

What are the two indications of a UTI?

A
  • Nitrites- E.coli and other gram neg break down nitrates into nitrites
  • Leukocytes- they are white blood cells normally found in small quantities in the urine an increase can suggest a UTI

Nitrites are a better indication of a UTI

264
Q

What is the management for a UTI in a patient under 3 months?

A
  • They should start immediate IV antibiotics (ceftriaxone)
  • Have a full septic screen

Consider a lumbar puncture

265
Q

What is the treatment for over months olds with a UTI?

A

IF symptoms of pyelonephritis or sepsis admit for IV antibiotics if not use oral such as:
- Trimethoprim
- Nitrofurantoin
- Cefalexin
- Amoxicillin

266
Q

What is the risk of having pyelonephritis?

A

Can lead to scarring in the tissue and reduction of kidney function

267
Q

What is the criteria for USS in children with UTIs?

A
  • Children under 6 months with first UTI should have an ultrasound within 6 weeks or during if there are recurrent or atypical
  • Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks
  • Children with atypical UTIs should have an abdominal ultrasound during the illness
268
Q

What is used to asses damage from recurrent or atypical UTIs?

A

DMSA scan will be performed 4-6 months after the illness.

It tells you how well the material is taken up by the kidneys and if there is any damage

269
Q

What is vesico-uteric reflux and how is it investigated?

A
  • When urine flows back into the bladder from the ureters

It is diagnosed using MCUG and managed:
- Avoid constipation
- Avoid full bladder
- Prophylactic antibiotics
- Surgical input

270
Q

According to NICE, what is the specific anitbiotics you should use to treat UTIs with

Cystitis/Lower UTI
Acute Pyelonephritis

A

Cystitis - oral antibiotic treatment should be started with trimethoprim (if there is low risk of resistance), or nitrofurantoin

Acute Pyelonephritis - oral antibiotic treatment should be started, with either cefalexin, or co-amoxiclav.

271
Q

What is the treatment for UTI in children?

A

Infants younger tahn 3 months - 2-4 IV cefuroxime (1st gen Ceph, cant get through BBB so need to rule out meningitis). followed by oral - full septic screen, bloods, cultures, lactate

Systemically well children - Treat with 3 days oral antibiotics. Advised to return if no better at 24-48hrs for reassessment - Trimethoprim

Systemically unwell - (Fever > 38 +/- loin pain / tenderness) Treat with 7-10 days oral antibiotics

(Consider IV antibiotics according to clinical judgement. Use lower threshold for IV antibiotics in younger children, those with significant risk factors and severely ill.)

272
Q

What is MCUG?

A

Micturating cystourethrogram (MCUG) should be used to investigate atypical or recurrent UTIs in children under 6 months. It is also used where there is a family history of vesico-ureteric reflux, dilatation of the ureter on ultrasound or poor urinary flow. A MCUG is used to diagnose VUR.

It involves catheterising the child, injecting contrast into the bladder and taking a series of xray films to determine whether the contrast is refluxing into the ureters. Children are usually given prophylactic antibiotics for 3 days around the time of the investigation.

273
Q

What is enuresis?

A

Failure to control urination normally controlled in the day by 2 years and at night by 3-4 years

274
Q

What is primary nocturnal enuresis?

A
  • When a child has never been consistently dry at night often a normal variation in children aged 5 and above
275
Q

What are the causes of primary nocturnal enuresis?

A

Overactive bladder. Frequent small volume urination prevents the development of bladder capacity.

Fluid intake prior to bedtime, particularly fizzy drinks, juice and caffeine, which can have a diuretic effect

Failure to wake due to particularly deep sleep and underdeveloped bladder signals

Psychological distress, for example low self esteem, too much pressure or stress at home or school

Secondary causes such as chronic constipation, urinary tract infection, learning disability or cerebral palsy

276
Q

What is secondary enuresis?

A

When a child starts wetting the bed when previously being dry for at least 6 months

277
Q

What are causes of secondary enuresis?

A
  • UTI
  • Constipation
  • T1DM
  • New psychosocial problems
  • Maltreatment

Always think about abuse and safeguarding, particularly with deliberate bedwetting, punishment for bedwetting (despite parental education) or unexplained secondary nocturnal enuresis.

278
Q

What is the pharmological treatment for enuresis?

A

Desmopressin is an analogue of vasopressin (also known as anti-diuretic hormone). It reduces the volume of urine produced by the kidneys. It is taken at bedtime with the intention of reducing nocturnal enuresis.

Oxybutinin is an anticholinergic medication that reduces the contractility of the bladder. It can be helpful where there is an overactive bladder causing urge incontinence.

Imipramine is a tricyclic antidepressant. It is not clear how it works, but it may relax the bladder and lighten sleep.

279
Q

What is the treatment for over months olds with a UTI?

A

IF symptoms of pyelonephritis or sepsis admit for IV antibiotics if not use oral such as:
- Trimethoprim
- Nitrofurantoin
- Cefalexin
- Amoxicillin

280
Q

What are some pre-renal causes of AKI?

A

Shock- due to fluid or blood loss or sepsis

Decompensated liver disease- Hepatorenal syndrome

GI loses

281
Q

What are some intrarenal causes of AKIs?

A

Vascular:
– haemolytic uraemic syndrome - most common type of renal
– vasculitis
– embolus

  • Tubular:
    – acute tubular necrosis
    – ischaemic
    – toxic - drugs
  • Glomerular:
    – glomerulonephritis
  • Interstitial:
    – pyelonephritis
282
Q

What are some postrenal causes of AKI?

A

Obstruction
- Congenital e.g. posterior urethral valves
- Acquired e.g. blocked urinary catheter

283
Q

What is hepatorenal syndrome?

A
  • Liver cirrhosis leads to portal hypertension, in response to this portal blood vessels dilate causing blood to pool there
  • This causes a lack of blood volume elsewhere including the kidneys

Leads to hypotension in the kidney and activation of the RAAS. This causes renal vasoconstriction, which combined with low circulation volume leads to starvation of blood to the kidney

Hepatorenal syndrome is fatal within a week or so unless liver transplant is performed

284
Q

How do you treat prerenal failure?

A

circulation and fluid balance meticulously monitored
urgently corrected with fluid replacement and circulatory support

285
Q

Hyperkalaemia is a complication of AKI, and can lead to a cardiac arrest. How can you manage hyperkalaemia?

A
  1. IV stat of Calcium Gluconate - Stabilisation of the myocardium
  2. Variable rate insulin with dextrose infusion - to increase cellular uptake of potassium = Reduction of serum potassium
  3. oral calcium resonium - Reduction of total body potassium - treat underlying cause
286
Q

CKD classification - outline the stages GFR 1-5 entail?

A

1 >90 Normal or increased GFR with other evidence of renal damage*
2 60–89 Slight decrease GFR with other evidence of renal damage*
3 A - 45–59, 3 B - 30–44 = Moderate decreased GFR with or without evidence of other renal damage
4 15–29 Severe decreased GFR with or without evidence of renal damage
5 <15 Established renal failure

287
Q

What are some features of late stage renal failure in children?

A
  • Anorexia
  • Polydipsia and polyuria
  • Failure to grow
  • Bone deformities
  • Hypertension
  • Proteinuria
  • Normocytic anaemia
288
Q

What is nephrotic syndrome?

A

When the basement membrane in the glomerulus becomes highly permeable to protein. This allows them to leak from the blood into the urine

289
Q

What is the classic triad of nephrotic syndrome?

A
  • Low serum albumin
  • High urine protein content (frothy urine)
  • Oedema
290
Q

What are three other features in nephrotic syndrome?

A
  • Deranged lipid profile: high cholesterol and triglycerides
  • High BP
  • Hyper-coagulability
291
Q

What is the most common cause nephrotic syndrome?

A

Most common cause is minimal change disease which causes over 90% of cases in children under

292
Q

What are some other causes of nephrotic syndrome?

A

Intrinsic kidney disease;
- Focal segmental glomerulosclerosis
- Membranoproliferative glomerulonephritis

Systemic illness
- HSP
- Diabetes
- Infection

293
Q

What is the management for nephrotic syndrome?

A

High dose steroids (i.e. prednisolone)
Low salt diet
Diuretics may be used to treat oedema
Albumin infusions may be required in severe hypoalbuminaemia
Antibiotic prophylaxis may be given in severe cases

294
Q

What is the regime for steroid treatment for nephrotic syndrome?

A

High dose steroids are given for 4 weeks and then gradually weaned over the next 8 weeks:

80% of children will respond to steroids, and are referred to as steroid sensitive

80% of steroid sensitive patients will relapse at some point and need further steroids

Patients that struggle to wean steroids due to relapses are referred to as steroid dependant

Patients that do not respond to steroids are referred to as steroid resistant

In steroid resistant children, ACE inhibitors and immunosuppressants such as cyclosporine, tacrolimus or rituximab may be used.

295
Q

What are some complications of nephrotic syndrome?

A
  • Hypovolaemia
  • Thrombosis
  • Infection
  • Acute or chronic renal failure
  • Relapse
296
Q

What is nephritic syndrome?

A

Refers to inflammation within the nephrons of the kidneys causing:
- Reduction in kidney function
- Haematuria
- Proteinuria

297
Q

What are the two main causes of nephritic syndrome?

A

Post-streptococcal glomerulonephritis and IgA nephropathy (Berger’s disease).

298
Q

What is a typical case of Post-Streptococcal Glomerulonephritis?

A

Symptoms 1-3 weeks after a beta haemolytic streptococcus infection such as tonsillitis

Management is supportive but may need treatment for hypertension

299
Q

What is IgA nephropathy?

A

IgA nephropathy is also known as Berger’s disease. This condition is related to Henoch-Schonlein Purpura, which is an IgA vasculitis. IgA deposits in the nephrons of the kidney causes inflammation (nephritis). When a renal biopsy is taken the histology will show “IgA deposits and glomerular mesangial proliferation”.

It usually presents in teenagers or young adults.

Management involves supportive treatment of the renal failure and immunosuppressant medications such as steroids and cyclophosphamide to slow the progression of the disease.

300
Q

What is Henoch-Schonlein Purpura?

A

It is a IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children.

It occurs due to IgA deposits in blood vessels

301
Q

What commonly triggers HSP?

A

Upper airway or GI infection and is most common in children under 10

302
Q

What are the 4 classic features of HSP>

A

Purpura (100%),
Joint pain (75%),
Abdominal pain (50%)
Renal involvement (50%)

303
Q

Where is affected by the rash in HSP?

A

Legs and buttocks

304
Q

What joints are most affected in HSP?

A

Knees and ankles

305
Q

What are the GI symptoms of HSP?

A

Abdominal pain is indicative of gastrointestinal involvement. In severe cases, it can lead to gastrointestinal haemorrhage, intussusception and bowel infarction.

306
Q

What are the investigations for HSP?

A

Rule out meningococcal septicaemia leukaemia, Idiopathic thrombocytopenic purpura and haemolytic uraemic syndrome

  • There are many different sets of criteria for diagnosing HSP, the most recent being the EULAR/PRINTO/PRES criteria from 2010. This requires the patient to have palpable purpura (not petichiae) + at least one of:

Diffuse abdominal pain
Arthritis or arthralgia
IgA deposits on histology (biopsy)
Proteinuria or haematuria

307
Q

What is hypospadias?

A

A condition affecting males where the opening of the urethra is abnormally displaced towards the underside of the penis.

Can also be displaced down the shaft of the penis

There can also be an associated condition called chordee, where the head of the penis bends downwards.

308
Q

What are the complications of Hypospadias ?

A

Difficulty urinating
Cosmetic and psychological concerns
Sexual dysfunction

309
Q

What is Haemolytic uraemic syndrome?

A

It involves thrombosis in small blood vessels throughout the body triggered by shiga toxins from E.coli or shigella

310
Q

What increases the risk of HUS in someone with a recent episode of gastroenteritis?

A

Antibiotics and anti-motility medication (e.g., loperamide)

311
Q

What is the classic triad of HUS?

A

Microangiopathic haemolytic anaemia
Acute kidney injury
Thrombocytopenia

312
Q

Describe the pathophysiology of HUS?

A

The formation of blood clots consumes platelets, leading to thrombocytopenia. The blood flow through the kidney is affected by thrombi and damaged red blood cells, leading to acute kidney injury.

Microangiopathic haemolytic anaemia (MAHA) involves the destruction of red blood cells (haemolysis) due to pathology in the small vessels (microangiopathy). Tiny blood clots (thrombi) partially obstruct the small blood vessels and churn the red blood cells as they pass through, causing them to rupture

313
Q

What is the classic presentation of HUS?

A

Diarrhoea which turns bloody within 3 days. Around a week after the onset of diarrhoea features of HUS will occur

314
Q

What are the symptoms of HUS?

A
  • Fever
  • Abdo pain
  • Lethargy
  • Pallor
  • Reduced urine output
  • Haematuria
  • hypertension
  • Bruising
  • Jaundice (due to haemolysis)
  • Confusion
315
Q

What is the management of HUS?

A

Stool culture is used to establish the causative organism.

HUS is a medical emergency and requires hospital admission and supportive management with treatment of:

Hypovolaemia (e.g., IV fluids)
Hypertension
Severe anaemia (e.g., blood transfusions)
Severe renal failure (e.g., haemodialysis)

316
Q

What are the inactivated vaccines?

A

Polio
Flu vaccine
Hepatitis A
Rabies

317
Q

What are the subunit/conjugate vaccines?

A

Pneumococcus
Meningococcus
Hepatitis B
Pertussis (whooping cough)
Haemophilus influenza type B
Human papillomavirus (HPV)
Shingles (herpes-zoster virus)

318
Q

What are the live vaccines?

A

Measles, mumps and rubella vaccine: contains all three weakened viruses

BCG: contains a weakened version of tuberculosis

Chickenpox: contains a weakened varicella-zoster virus

Nasal influenza vaccine (not the injection)

Rotavirus vaccine

319
Q

What are the vaccine at 8 weeks?

A

6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)

Meningococcal type B

Rotavirus (oral vaccine)

320
Q

What are the vaccines given at 12 weeks?

A

6 in 1 vaccine (again)
Pneumococcal (13 different serotypes)
Rotavirus (again)

321
Q

What are the vaccines given at 16 weeks?

A

6 in 1 vaccine (again)
Meningococcal type B (again)

322
Q

What are the vaccines given at 1 year?

A

2 in 1 (haemophilus influenza type B and meningococcal type C)
Pneumococcal
MMR
Meningococcal type B

323
Q

What vaccine is given yearly from ages 2-8?

A

Influenza virus (nasal vaccine)

324
Q

What vaccine is given at 3 years and 4 months?

A

4 in 1 (diphtheria, tetanus, pertussis and polio)
MMR vaccine (again)

325
Q

What vaccine is given at 12-13 years?

A

Human papillomavirus (HPV) vaccine (2 doses given 6 to 24 months apart)

326
Q

What vaccine is given at 14 years?

A

3 in 1 (tetanus, diphtheria and polio)
Meningococcal groups A, C, W and Y

327
Q
A

3A (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions