Paediatrics 3 (Derm, Renal, Haem, Infectious) Flashcards

Question

When is a lumbar puncture contraindicated?

Answer 1

GCS below 9, haemodynamically unstable, active seizures or post-ictal.

Answer 2

IV antiviral medications to treat the underlying cause: - Aciclovir = treats herpes simplex virus (HSV) and varicella zoster virus (VZV) - Ganciclovir = treat cytomegalovirus (CMV) Repeat lumbar puncture is usually performed to ensure successful treatment prior to stopping antivirals Followup, support and rehabilitation is required after encephalitis, with help managing the complications.

Answer 3

Lasting fatigue and prolonged recovery Change in personality or mood Changes to memory and cognition Learning disability Headaches Chronic pain Movement disorders Sensory disturbance Seizures Hormonal imbalance

Answer 4

- Unprotected anal, vaginal or oral sexual activity - Mother to child at any stage of pregnancy, birth or breastfeeding. This is referred to as vertical transmission. - Mucous membrane, blood or open wound exposure to infected blood or bodily fluids. This could be through sharing needles, needle-stick injuries or blood splashed in an eye.

Answer 5

Mode of delivery will be determined by the mother viral load: - Normal vaginal delivery = is recommended for women with a viral load < 50 copies / ml - Caesarean sections = are considered in patients with > 50 copies copies / ml and in all women with > 400 copies / ml IV zidovudine should be given during the caesarean if the viral load is unknown or there are > 10000 copies / ml

Answer 6

Low risk babies, where mums viral load is < 50 copies per ml = zidovudine for 4 weeks High risk babies, where mums viral load is > 50 copies / ml = zidovudine, lamivudine and nevirapine for 4 weeks

Answer 7

HIV can be transmitted during breastfeeding - not recommended if mothers have undetected viral load, can support them during breast-feeding

Answer 8

- Babies to HIV positive parents - When immunodeficiency is suspected, for example where there are unusual, severe or frequent infections - Young people who are sexually active can be offered testing if there are concerns - Risk factors such as needle stick injuries, sexual abuse or IV drug use

Answer 9

Babies to HIV positive parents are tested twice for HIV: - HIV viral load test at 3 months. If this is negative, the child has not contracted HIV during birth and will not develop HIV unless they have further exposure. - HIV antibody test at 24 months. This is to assess whether they have contracted HIV since their 3 month viral load, for example through breast feeding. If the 3 month test is negative and they are not breastfed, this should be negative.

Answer 10

- Antiretroviral therapy (ART) to suppress the HIV infection - Normal childhood vaccines, avoiding or delaying live vaccines if severely immunosuppressed. - Prophylactic co-trimoxazole (Septrin) for children with low CD4 counts, to protect against pneumocystis jirovecii pneumonia (PCP) - Treatment of opportunistic infections

Answer 11

*Cotton wool * Bag urine * Clean catch (midstream) * Catheter bag urine * In/out catheter * Suprapubic aspirate

Answer 12

Fever Vomiting Lethargy Irritability Poor feeding Failure to thrive less common: Abdominal pain Jaundice Haematuria Offensive urine

Answer 13

Fever Abdominal pain Loin tenderness Vomiting Poor feeding less common Lethargy Irritability Haematuria Offensive urine Failure to thrive

Answer 14

Frequency Dysuria Dysfunctional voiding Changes to continence Abdominal pain Loin tenderness less common Fever Malaise Vomiting Haematuria Offensive urine Cloudy urine

Answer 15

A temperature greater than 38°C Loin pain or tenderness

Answer 16

1. Urine sample (try to get clean catch) Nitrites = bacteria breaks down nitrates into nitrites (better indication of infection) Leukocytes 2. Midstream urine = if nitrite or leukocytes present then urine sent to micro

Answer 17

1. <3 months - Admit and give IV Cefotaxime 2. >3 months with Upper UTI: Oral Cefotaxime/Co-Amoxiclav for 7-10 days 3. >3 months with Lower UTI: Oral Trimethoprim/Nitrofurantoin 4. Safety net advice: Bring child back if still unwell after 48 hours of Abx - trimethoprim - Nitrofurantoin - Cefalexin - Amoxicillin

Answer 18

- vesicoureteric reflux - congenital abnormalities * duplex left kidney * solitary right kidney

Answer 19

urine has a tendency to flow from the bladder back into the ureters. This predisposes patients to developing upper urinary tract infections and subsequent renal scarring.

Answer 20

micturating cystourethrogram (MCUG). - X-ray which looks at the flow of urine

Answer 21

Avoid constipation Avoid an excessively full bladder Prophylactic antibiotics Surgical input from paediatric urology

Answer 22

micturating cystourethrogram USS Dimercaptosuccinic acid (DMSA) scan

Answer 23

(MCUG) investigate atypical or recurrent UTIs in children under 6 months. OR - a family history of vesico-ureteric reflux, - dilatation of the ureter on ultrasound or poor urinary flow. A MCUG is used to diagnose VUR. catheterising the child, injecting contrast into the bladder and taking a series of xray films

Answer 24

(Dimercaptosuccinic Acid) scans should be used 4 – 6 months after the illness to assess for damage from recurrent or atypical UTIs.

Answer 25

All children under 6 months with their first UTI should have an abdominal ultrasound within 6 weeks, or during the illness if there are recurrent UTIs or atypical bacteria Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks Children with atypical UTIs should have an abdominal ultrasound during the illness

Answer 26

Respond well - USS at 6 weeks atypical UTI + recurrent UTI - USS during acute infection - DMSA scan 4-6 maths after infection - micturating cystourethrogram

Answer 27

Respond well - no scans Atypical UTI - USS in infection - DMSA - MCUG Recurrent UTI - USS within 6 weeks - DMSA - MCUG

Answer 28

Respond to treatment - no scans Atypical - USS in acute infection Recurrent - USS within 6 weeks - DMSA

Answer 29

* Septicaemia/requires IV Abx * Non-E.coli organism * Poor urine flow * Abdominal mass/ bladder mass * Raised creatinine * Failure to respond to treatment within 48hrs

Answer 30

≥2 UTIs, at least one with systemic signs or symptoms ≥3 UTIs without systemic signs or symptoms

Answer 31

* All children under the age of 3 months * Children of any age who are systemically unwell * Children with recurrent UTI Why? * Address dysfunctional elimination syndromes and constipation * Include height, weight, blood pressure and routine testing for proteinuria. This should be performed at least on a yearly basis in all infants and children with renal parenchymal defects.

Answer 32

increase in interstitial fluid

Answer 33

pedal oedema * ascites * pleural effusions, pulmonary oedema * facial puffiness

Answer 34

* Obstruction of lymphatic drainage * Obstruction of venous drainage * Lowered oncotic pressure * Salt and water retention

Answer 35

1. proteinuria 2. hypoalbuminaemia 3. oedema

Answer 36

MC = minimal change disease (idiopathic cause) - HSP - diabetes - intrinsic kidney disease

Answer 37

Periorbital oedema Scrotal, vulval, leg and ankle oedema SOB due to pleural effusions Frothy urine Pallor MC in children aged 2-5 yrs

Answer 38

urine dipstick urinary protein:creatinine ratio Bloods = U+Es and LFTs (so can check albumin)

Answer 39

Congenital Steroid sensitive steroid resistant

Answer 40

Standard course of prednisolone for 1st episode - 60mg for 4 weeks Other considerations: - Na + water moderation - diuretics =furosemide - albumin infusions = for severe hypoalbuminaemia - pen V = antibiotic prophylaxis - measles and varicella immunity

Answer 41

Risk of relapses Hypovolaemia Thrombosis Infection Renal failure

Answer 42

- Haematuria visible (made difference with nephrotic) - hypertension - oedema (can have impaired GFR)

Answer 43

- Post Strep Glomerulonephritis: Occurs 1-3 weeks after a Strep infection - IgA Nephropathy: 1-2 days post infection, often related to HSP which is an IgA Vasculitis

Answer 44

Occurs 1-3 weeks after a beta-haemolytic streptococcus infection such as tonsillitis - immune complexes made up of antigens, antibodies and complement proteins get stuck in the glomeruli of the kidney + cause inflammation -inflammation leads to acute deterioration in renal function e.g. AKI

Answer 45

Blood tests = FBC, U+Es, immunology Throat swabs Urinalysis - haematuria = macroscopic - proteinuria = protein :creatinine - microscopy - RBC cast

Answer 46

Fluid balance - measurement of input/output correction of other balances - potassium and acidosis dialysis (uncommon) penicillin = treatment if strep infection

Answer 47

vasculitis affecting skin, joints, GI tracts and kidneys IgA deposition in glomerulus - palpable purpuric rash - start on back and spread - joint pain - abdominal pain (non-blanching like meningitis but not unwell when come in with rash)

Answer 48

haematuria/proteinuria * nephrotic syndrome * acute nephritis * renal impairment * hypertensio

Answer 49

- Supportive treatment - Immunosuppressant medications to slow disease progression *IgA nephropathy is actually quite nasty: many patients who suffer long term with this can end up needing renal transplants due to the significant damage

Answer 50

A condition in which there is a deficiency of red cells or of haemoglobin in the blood to meet the body’s needs. (in children normal range changes with age)

Answer 51

1. Blood loss Acute haemorrhage Chronic gut bleeding leading to iron deficiency 2. Decreased Production Nutritional deficiency e.g. iron, folate, B12, Vitamin C Bone marrow failure e.g. DBA, TEC Infiltration e.g. Acute Leukaemia, Neuroblastoma, Lymphoma, Osteopetrosis, Storage Disease 3. Increased consumption Acquired e.g. immune, drugs, parasites, MAHA Inherited e.g. red cell membrane defects, enzyme defects

Answer 52

1. reticulocytes - immature RBCS - can signify if RBCs are being made or broken down 2. MCV size - microcytic - microcytic - normoocytic

Answer 53

Iron deficiency Thalassaemia Sideroblastic Anaemia Chronic disease Lead toxicity Copper deficiency Haemoglobin E trait Severe malnutrition

Answer 54

Normal newborn Aplastic anaemia Hypothyroidism Megaloblastic anaemia Increased erythropoiesis Fanconi anaemia PNH Drugs Post splenectomy DBA

Answer 55

Acute blood loss Infection Renal failure Early iron deficiency Bone marrow infiltration Haemolysis (enz/mem) Hypersplenism Drugs Dyserythropoietic anaemia

Answer 56

- MC anaemia in children - LBW dietary - excessive cows milk intake (very low in iron so don't eat much iron in other foods) - malabsorption - bleeding

Answer 57

microcytic, hypochromic, low-normal retics Low ferritin and serum iron, Increased TIBC High ZPP

Answer 58

oral therapy - 6mg/kg/day of elemental iron - reticulocytosis in 72 hrs iron stores replenish by 3 months - treatment needed for 3-6 months constipation common commonest cause of failure is non-compliance address cause- usually diet

Answer 59

- Increased RBC turnover, shortened RBC lifespan - RBCs are fragile- especially abnormal ones - Spleen filters out and breaks down senescent RBCs, and must work overtime, and can result in effective asplenia (e.g. in sickle cell) - RBC degradation products must be handled

Answer 60

Intra corpuscular Haemoglobin Enzyme Membrane Extra corpuscular Autoimmune Fragmentation Hyper splenism Plasma factors

Answer 61

Hydrops fetalis Neonatal hyperbilirubinaemia Neonatal ascites Anaemia/failure to thrive Splenomegaly Cholecystitis/gall stones Hyperbilirubinaemia Leg ulcers Aplastic crisis Thromboembolism

Answer 62

Rh negative mother previously sensitised to Rh pos cells Transplacental passage of antibodies Haemolysis of Rh Pos fetal cells

Answer 63

severe anemia compensatory hyperplasia & enlargement of blood forming organs (spleen and liver)

Answer 64

prevention of sensitization with Rh immune globulin intrauterine transfusion of affected fetuses

Answer 65

x-linked recessive donation due to deficiency of glucose 6 phosphate dehydrogenase Three main presentations: 1. Neonatal jaundice 2. Chronic non-spherocytic haemolytic anaemia 3. Intermittent episodes of intravascular haemolysis Sporadic haemolysis

Answer 66

Typically induced by drugs, fava beans, fever, acidosis Intravascular haemolysis - haemoglobinuria, rigors, fever, back pain Treated by stopping precipitant, transfusion, renal support Bite cells

Answer 67

Commonest hereditary haemolytic anaemia in Europeans - 1/5000; probably rarer in Africa Typically autosomal dominant, but no family history in 25% cases Heterogeneous - deficiencies of spectrin (41.5%), ankyrin (1.5%), band 3 (17%), band 4.2 (21.5%) Clinical effects vary from mild to transfusion dependence; tends to be similar within families

Answer 68

RBCs are spheres and biconcave so clog up and block blood vessels

Answer 69

Offer folic acid and transfuse if necessary - most people once grown up can manage haemolysis splenectomy if severe

Answer 70

Sickle Cell Anaemia (HbSS) Sickle Haemoglobin C disease (HbSC) Sickle Beta Thalassaemia (HbS/β thal)

Answer 71

- Substitution of valine for glutamic acid on β chain (HbS) (single amino acid substitution) - HbS polymerises when deoxygenated leading to sickle shape - Occlusion of the microvascular circulation producing vascular damage, infarcts, pain - Shortened survival of red cells leading to haemolysis

Answer 72

- blood film - newborn heel prick test - sickle solubility - HPLC

Answer 73

- painful crisis - anaemia - dactylitis - chest crisis - auto-splenect = body shuts it off as blocked

Answer 74

1. Education – keeping warm, well hydrated 2. Prophylactic Penicillin V to prevent infection due to splenic hypofunction (anti malarials when required) 3. Ensure immunisations are up to date to prevent infection 4. Screening such as TCD monitoring, G+M 5. Effective pain management (NICE requirement) 6. Prompt treatment of infections 7. Bone Marrow Transplant 8. Hydroxycarbamide 9. New agents e.g. Crizanlizumab, L-Glutamine

Answer 75

Balance of clotting vs bleeding involved platelets, coagulation factors and vascular integrity

Answer 76

Increased plt destruction (Immune) ITP Secondary to infection (HIV, Hepatitis, CMV, EBV, Parvovirus, mumps, measles, pertussis) Drug induced – valproate, ciprofloxacin, ibuprofen, phenytoin, ranitidine, heparin, captopril Autoimmune –Evans syndrome SLE NAIT Hyperthyroidism Increased plt destruction (Non Immune) Microangiopathic (TTP, HUS) Kasabach-Merritt Syndrome Drugs Infection (viral associated haemophagocytic syndrome) (bacterial infection) Disseminated Intravascular Haemolysis Decreased Platelet Production Constitutional (TAR, CAMT) Ineffective thrombopoiesis ( B12, Folate Deficiency, severe iron deficiency)) Infiltration (Leukaemia, Non haem infiltration, Osteopetrosis, storage disease) Metabolic disorders (Ketotic glycinaemia, MMA, Acidaemia) Bone Marrow Failure (Aplastic Anaemia) Disorders of platelet pooling Hypersplenism (Portal Hypertension, Gauchers disease) Pseudothrombocytopenia Platelet activation during blood collection

Answer 77

MC form of immunologic thrombocytopenia - diagnosis by exclusion - brusing - petechiae - important tor review blood film to ensure no evolving bone marrow disorder - treatment = rarely required unless bleeding e.g. steroids, IVIg, Trop-RA

Answer 78

Various errors in clotting cascade Bleeding disorders: hemophilia von Willebrand disease Hypercoagulable states antithrombin, protein C, protein S, FVL, PT mutation, APS

Answer 79

PT = playing tennis = outside Extrinsic pathway PTT = playing table tennis = inside Intirnsic pathway

Answer 80

Commonest inherited bleeding disorder Deficiency of VWF (type 1) Dysfunction of VWF (type 2A, B, M,N) Complete absence of VWF (type 3) Autosomal recessive or dominant for type 3 or 2N

Answer 81

1. Mediates the adherence of platelets at sites of endothelial damage helping form platelet plug 2. Binds and transports FVIII, protecting it from degradation

Answer 82

Easy bruising Epistaxis Menorrhagia Mucosal bleeding Following surgery or trauma

Answer 83

Clotting often shows prolonged APTT (not always!) VWD screen – FVIII, VWF:Ag, VWF activity Further investigations can be performed to identify type 1 from 2: Function:antigen ratio <0.6 RIPA Multimer Analysis Genetic analysis

Answer 84

1. Tranexamic Acid An antifibrinolytic useful for menorrhagia or mucosal bleeding Given pre procedures IV 10mg/kg and orally 15-25mg/kg tds for other bleeding or post operatively 2. Desmopressin Used to elevate FVIII and VWF levels by releasing endothelial stores. Given IV, SC or intranasal Perform a DDAVP trial if possible to assess response Excessive fluid intake can reduce sodium so restrict fluid to 1L for 24 hours post dose Avoid use if <2 years or monitor sodium closely and avoid if know atherosclerosis Avoid in Type 2B as thrombocytopenia due to clearance of large multimers. 3. VWF- containing concentrates Given if DDAVP inadequate or contraindicated Voncento, Wilate Given as IV bolus 12-24 hours as required by bleeding and levels. Plasma products so ensure hepatitis vaccinations given pre where possible

Answer 85

A = def factor VIII (MC) B = def factor IX X-linked recessive = boys Prolonged bleeding Muscle bleeds Joint bleeds > arthritis and deformity Treatment Factor VIII/IX Complications of treatment

Answer 86

Mild Severe bleeding with major trauma or surgery. Spontaneous bleeding rare Moderate Occasional spontaneous bleeding, prolonged bleeding with minor trauma or surgery Severe Spontaneous bleeding into joints or muscles

Answer 87

Abnormality in the maturation of a bone marrow cell - this abnormal white blood cell keeps being made

Answer 88

Acute myeloid lymphoblastic leukaemia ALL = MC (80% cure rate) Acute myeloid leukaemia = next most common

Answer 89

Persistent fatigue Unexplained fever Failure to thrive Weight loss Night sweats Pallor (anaemia) Petechiae and abnormal bruising (thrombocytopenia) Unexplained bleeding (thrombocytopenia) Abdominal pain Generalised lymphadenopathy Unexplained or persistent bone or joint pain Hepatosplenomegaly

Answer 90

If suspected urgent full blood count within 48 hours. - Full blood count, which can show anaemia, leukopenia, thrombocytopenia and high numbers of the abnormal WBCs - Blood film, which can show blast cells - Bone marrow biopsy - Lymph node biopsy maybe for staging Chest xray CT scan Lumbar puncture Genetic analysis and immunophenotyping of the abnormal cells

Answer 91

primarily treated with chemotherapy (long for 2 yrs) Other therapies: Radiotherapy Bone marrow transplant Surgery

Answer 92

Involuntary urination - bed wetting = nocturnal enuresis - during the day = diurnal enuresis

Answer 93

The child has never managed to be consistently dry at night - MC cause is a variation on normal development + family history

Answer 94

- variation on normal development - family history of delayed dry nights - overactive bladder - fluid intake - failure to take - psychological distress - secondary causes e.g. chronic constipation, UTI, learning disability or cerebral palsy

Answer 95

- 2 week diary - reassure parents children under 5 yrs will resolve - Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet - Encouragement and positive reinforcement. Avoid blame or shame. Punishment should very much be avoided. - Treat any underlying causes or exacerbating factors, such as constipation - Enuresis alarms = wakes child up stopping them from urinating - Pharmacological treatment

Answer 96

where a child begins wetting the bed when they have previously been dry for at least 6 months.

Answer 97

Urinary tract infection Constipation Type 1 diabetes New psychosocial problems (e.g. stress in family or school life) Maltreatment

Answer 98

the child has become dry at night but still has episodes of urinary incontinence during the day Urge incontinence = is an overactive bladder that gives little warning before emptying Stress incontinence = describes leakage of urine during physical exertion, coughing or laughing.

Answer 99

Desmopressin = taken at bedtime with the intention of reducing nocturnal enuresis Oxybutinin = anticholinergic that reduces the contractibility of the bladder Imipramine = tricyclic antidepressant, relax bladder and tighten sleep

Answer 100

Urethral meatus (opening of urethra) in males is abnormally displaced to the ventral side (underside) of the penis, towards the scrotum - congenital - diagnosed on examination of newborn

Answer 101

- referral to specialist urologist mild cases = may not require treatment Surgery is usually performed after 3-4 months of age surgery aims to correct the position of the meatus and straighten the penis

Answer 102

Difficulty directing urination Cosmetic and psychological concerns Sexual dysfunction

Answer 103

Involves thrombosis in small blood vessels throughout the body, usually triggered by Shiga toxins from either E.coli O157 or Shigella

Answer 104

1. Microangiopathic haemolytic anaemia 2. Acute kidney injury 3. Thrombocytopenia (low platelets)

Answer 105

First have gastroenteritis = diarrhoea that turns bloody within 3 days A week after the onset of diarrhoea HUS develops: Fever Abdominal pain Lethargy Pallor Reduced urine output (oliguria) Haematuria Hypertension Bruising Jaundice (due to haemolysis) Confusion

Answer 106

Medical emergency 1. hospital admissions and supportive management with treatment of: - Hypovolaemia (e.g., IV fluids) - Hypertension - Severe anaemia (e.g., blood transfusions) - Severe renal failure (e.g., haemodialysis) Self limiting and most patients fully recover with good supportive care

Answer 107

When the foreskin is tight and is difficult to pull back from the end of the penis - normal in babies and young boys - most boys cannot pul there foreskin back before 5yrs old but sometimes not till 10 yrs old

Answer 108

Not a problems unless these symptoms are seen: - swelling and tenderness - pain when peeing or a weak flow of pee - blood in urine - frequent urinary tract infections (UTIs) - bleeding or a thick discharge from under the foreskin or an unpleasant smell – these are signs of an infection (balanitis) - painful erections, which can make having sex difficult

Answer 109

usually loosens as they get older if its causing problems: - steroid creams or gels (topical steroids) to help soften the foreskin - antibiotics if the foreskin or head of the penis is infected - surgery – removal of the foreskin (circumcision) or a procedure where small cuts are made in the tip of the foreskin so it can be pulled back more easily (usually only suitable for children)

Answer 110

Chronic atopic condition cased by defects in the normal continuity of the skin barrier. leading to inflammation in the skin

Answer 111

dry, red, itchy and sore patches of skin over the flexor surface - periods where the condition is well controlled - and then flares where it worsens

Answer 112

maintenance - emollients = put on as often as possible esp after washing and before bed (use instead of soap) e.g. E45, hydrofoil ointment, diprobase cream, Aveeno cream Flares - thicker emollients - topical steroids = want to use weeks steroid for shortest period required to control skin e.g. Hydrocortisone

Answer 113

Viral skin infection caused by the herpes simplex virus - usually occurs in a patient with a pre-existing skin condition

Answer 114

- patient with eczema - develop widespread painful, vesicular rash - fever - lethargy - irritability - reduced oral intake - lymphadenopathy

Answer 115

Viral swabs Aciclovir - mild or moderare with oral - severe with IV

Answer 116

A spectrum of the same pathology - disproportional immune response causes epidermal necrosis SJS = affects <10% of body surface are TEN = affects >10% of body surface area

Answer 117

Medications Anti-epileptics Antibiotics Allopurinol NSAIDs Infections Herpes simplex Mycoplasma pneumonia Cytomegalovirus HIV

Answer 118

Start with non-specific symptoms of: - fever - cough - sore throat, mouth and eyes - itchy skin then develop: - purple or red rash - blisters Then - skin starts to break away and shed leaving the raw tissue underneath - pain, erythema, blistering - eyes can become inflamed and ulcerated - can affect urinary, lungs and internal organs

Answer 119

Medical emergency - admitted to dermatology or burns unit Steroids Immunoglobulins Immunosuppressants

Answer 120

Secondary infection: The breaks in the skin can lead to secondary bacterial infection, cellulitis and sepsis. Permanent skin damage: Skin involvement can lead to scarring and damage to skin, hair, nails, lungs and genitals. Visual complications: Depending on the severity, eye involvement can range from sore eyes to severe scarring and blindness.

Answer 121

Condition caused by IgE-mediated type 1 hypersensitivity reaction May be: seasonal = e.g. hay fever Perennial = (year round) for examples house dust mite allergy Occupational = associated with school or work environment

Answer 122

Runny, blocked and itchy nose Sneezing Itchy, red and swollen eyes Allergic rhinitis is associated with a personal or family history of other allergic conditions (atopy).

Answer 123

Tree pollen or grass allergy = leads to seasonal symptoms (hay fever) House dust mites and pets can lead to persistent symptoms, often worse in dusty rooms at night. Pillows can be full of house dust mites. Pets can lead to persistent symptoms when the pet or their hair, skin or saliva is present Other allergens lead to symptoms after exposure (e.g. mould)

Answer 124

avoid the trigger - hoovering and changing pillows regularly - good ventilation - minimise contact with pets medication: - oral antihistamines = taken prior to exposure * sedating = chlorphenamine and promethazine * non-sedating = cetirizine, loratadine and fexofenadine

Answer 125

Aka Hives - Small itchy lumps that appear on skin - Patchy erythematous rash - localised or widespread

Answer 126

Caused by the release of histamine and other pro-inflammatory chemicals by mast cells in the skin may be part of an allergic reaction in acute urticaria or an autoimmune reaction in chronic idiopathic urticaria

Answer 127

- Allergies to food, medications or animals - Contact with chemicals, latex or stinging nettles - Medications - Viral infections - Insect bites - Dermatographism (rubbing of the skin)

Answer 128

An autoimmune condition = antibodies target mast cells and trigger them to release histamines and other chemicals 1. Chronic idiopathic urticaria - recurrent episodes of chronic urticaria without a clear underlying cause or trigger 2. Chronic inducible urticaria - episodes that can be induced by certain triggers e.g. sunlight, temp change, exercise, strong emotions 3. autoimmune urticaria - underlying autoimmune condition such as systemic lupus erythematous

Answer 129

1. Antihistamines e.g. fexofenadine 2. oral steroids = short course for severe flares If severe: - Anti-leukotrienes such as montelukast - Omalizumab, which targets IgE - Cyclosporin

Answer 130

Life threatening medical emergency - caused by severe type 1 hypersensitivity reaction - IgE stimulates mast cells to rapidly release histamine (mast cell degranulation)

Answer 131

Exposure to allergen Urticaria Itching Angio-oedema, with swelling around lips and eyes Abdominal pain Additional symptoms that indicate anaphylaxis are: Shortness of breath Wheeze Swelling of the larynx, causing stridor Tachycardia Lightheadedness Collapse

Answer 132

A – Airway: Secure the airway B – Breathing: Provide oxygen if required. Salbutamol can help with wheezing. C – Circulation: Provide an IV bolus of fluids D – Disability: Lie the patient flat to improve cerebral perfusion E – Exposure: Look for flushing, urticaria and angio-oedema IM adrenaline = repeated after 5 mins if required Antihistamines = Chlorphenamine or Cetirizine Steroids = IV hydrocortisone

Answer 133

1. observation = as biphasic reactions can occur - confirmed by measuring the serum mast cell try-take within 6 hrs of event 2. education for child and family 3. Adrenaline Auto-Injector = given to all children with anaphylactic reactions

Answer 134

a condition caused by a type of staphylococcus aureus bacteria that produces epidermolytic toxins - these toxins are protease enzymes and break down proteins that hold skin cells together

Answer 135

under 5 yrs old 1. generalised patches of erythema on the skin - skin looks thin and wrinkled 2. then fluid filled blisters called bull form - burst and leave very sore, erythematous skin (looks like burnt/scalded skin) 3. systemic symptoms: fever, irritability, lethargy, dehydration

Answer 136

Positive in scalded skin syndrome Where very gentle rubbing of the skin causes it to peel away.

Answer 137

most patients require admission and treatment with IV antibiotics - manage fluid and electrolyte balance

Answer 138

Macules = flat, non palpable lesions, <10mm Papules = elevated lesions, <10mm Plaques = palpable lesions, >10mm, elevated/depressed compared to skin Vesicles = small, clear, fluid filled blisters

Answer 139

occurs as body's reaction to erythrogenic toxins produced by strep pyogenes - peak 2-6yrs old - spread via resp route (sneezing, coughing)

Answer 140

sandpaper rash fever vomiting abdo pain strawberry tongue

Answer 141

10 day course of penicillin - school exclusion till 24hrs after commencing abs - notifiable disease

Answer 142

German measles - caused by togavirus - rare in uk now that MMR has been introduced - more common during winter

Answer 143

low grade fever rash beginning in face and spreading across whole body palatal petechia sub occipital and post auricular lymphadenopathy

Answer 144

Supportive treatment

Answer 145

caused by parvovirus B19 occurs in all ages

Answer 146

slapped cheek rash fever headaceh coryza glove and stock rash clinical diagnosis but can do serology

Answer 147

supportive, no longer infectious once rash appears complications - someone with haemolytic anaemia > infection can trigger aplastic crisis, pancytopenia - in pregnant women > cause hydros fetalis in baby

Answer 148

affects children <2yrs old caused by HHV-6

Answer 149

Known as '3 day fever' rose coloured rash starts from trunk, spread peripherally Nagayama spots: enanthem on uvula and soft palate self resolving within 2-5 days may have febrile convulsions prior to rash supportive treatment

Answer 150

Genetic defect in the protein chains that make up haemoglobin - with in Alpha or beta chains - autosomal recessive RBCs are more fragile and break down more easily

Answer 151

Microcytic anaemia (low mean corpuscular volume) Fatigue Pallor Jaundice Gallstones Splenomegaly Poor growth and development Pronounced forehead and malar eminences

Answer 152

Full blood count = shows a microcytic anaemia. Haemoglobin electrophoresis = is used to diagnose globin abnormalities. DNA testing = can be used to look for the genetic abnormality

Answer 153

chromosome 16 - Monitoring the full blood count - Monitoring for complications - Blood transfusions - Splenectomy may be performed - Bone marrow transplant can be curative

Answer 154

Chromosome 11 Minor - one abnormal and one normal gene - only requires monitoring Intermedia - 2 defective genes OR 1 defective + 1 deletion gene - blood transfusion and iron chelation Major - no functioning beta global genes - Severe microcytic anaemia Splenomegaly Bone deformities Management: -regular transfusions, - iron chelation and splenectomy. - Bone marrow transplant can potentially be curative.

Answer 155

rare genetic disorder - progressive deficiency of all bone marrow production of RBCs, WBCs and platelets - increases risk of developing AML

Answer 156

Birth 150 – 235 grams/litre 2 – 4 weeks 135 – 190 grams/litre 4 – 8 weeks 95 – 130 grams/litre (normal dip = negative feedback due to high Hb levels at birth) (transition at 6 months from fetal to adult haemoglobin) 2 months – 6 years 110 – 140 grams/litre 6 – 12 years 115 – 155 grams/litre Female age 12 – 18 120 – 160 grams/litre Male aged 12 – 18 130 -160 grams/litre

Answer 157

MC = physiologic anaemia of infancy Anaemia of prematurity Blood loss Haemolysis Twin-twin transfusion (blood is unequal distributed between twins) Haemolysis: - Haemolytic disease of the newborn (ABO or rhesus incompatibility) - Hereditary spherocytosis - G6PD deficiency

Answer 158

the more premature the infant, the more likely they are to require 1 or more transfusions for anaemia - Less time in utero receiving iron from the mother - Red blood cell creation cannot keep up with the rapid growth in the first few weeks - Reduced erythropoietin levels - Blood tests remove a significant portion of their circulating volume

Answer 159

- caused by incompatibility between the rhesus antigens on the surface of the RBCs of the mother and foetus if mother is rhesus D NEGATIVE - and baby is positive = mother will produce antibodies to the rhesus D antigen 1. usually fine in first pregnancy = sensitisation 2. in later pregnancies = mothers antibodies attach to fetal RBCs causing them to attack their own RBCs 3. haemolytic > anaemia > high bilirubin levels

Answer 160

direct Coombs test

Answer 161

- iron deficiency anaemia - blood loss = menstruation

Answer 162

Microcytic anaemia (low MCV indicating small RBCs) Normocytic anaemia (normal MCV indicating normal sized RBCs) Macrocytic anaemia (large MCV indicating large RBCs)

Answer 163

TAILS T – Thalassaemia A – Anaemia of chronic disease I – Iron deficiency anaemia L – Lead poisoning S – Sideroblastic anaemia

Answer 164

3 As and 2 Hs for normocytic anaemia: A – Acute blood loss A – Anaemia of Chronic Disease A – Aplastic Anaemia H – Haemolytic Anaemia H – Hypothyroidism

Answer 165

Megaloblastic anaemia is caused by: B12 deficiency Folate deficiency Normoblastic macrocytic anaemia is caused by: Alcohol Reticulocytosis (usually from haemolytic anaemia or blood loss) Hypothyroidism Liver disease Drugs such as azathioprine

Answer 166

Tiredness Shortness of breath Headaches Dizziness Palpitations Worsening of other conditions Pica = dietary cravings for abnormal Hair loss = iron deficiency anaemia Koilonychia = spoon shaped nails (iron deficiency) Angular chelitis = iron deficiency Atrophic glossitis = smooth tongue due to atrophy of the papillae (iron deficiency) Brittle hair + nails = iron deficiency Jaundice = haemolytic anaemia Bone deformities = thalassaemia

Answer 167

Full blood count for haemoglobin and MCV Blood film Reticulocyte count Ferritin (low iron deficiency) B12 and folate Bilirubin (raised in haemolysis) Direct Coombs test (autoimmune haemolytic anaemia) Haemoglobin electrophoresis (haemoglobinopathies) reticulocytes = immature RBCs

Answer 168

spontaneous low platelet count causing a purpuric rash (non-blanching) - type 2 hypersensitivity reaction - caused by the production of antibodies that target and destroy platelets

Answer 169

Recent viral illness - bleeding = from the gums, epistaxis or menorrhagia - Bruising - Petechial or purpuric rash = caused by bleeding under the skin

Answer 170

Urgent FBC - low platelet count

Answer 171

may be required if the patient is actively bleeding - Prednisolone - IV immunoglobulins - Blood transfusions if required - Platelet transfusions only work temporarily (antibodies will start destroying them again)

Answer 172

MC inherited cause of abnormal and prolonged bleeding - autosomal dominant - glycoprotein called von willebrand factor = needed for platelet adhesion and aggregation in damaged vessels

Answer 173

Type 1= a partial deficiency of VWF and is the most common and mildest type Type 2 = reduced function of VWF Type 3 = complete deficiency of VWF and is the most rare and severe type

Answer 174

easy, prolonged or heavy bleeding Bleeding gums with brushing Nosebleeds (epistaxis) Easy bruising Heavy menstrual bleeding (menorrhagia) Heavy bleeding during and after surgical operations

Answer 175

Doesn't require daily treatment only needed in response to significant bleeding/trauma or in preparation for operations - Desmopressin (stimulates the release of vWF from endothelial cells) - Tranexamic acid - Von Willebrand factor infusion - Factor VIII plus von Willebrand factor infusion

Answer 176

severe inherited bleeding disorder - haemophilia A = deficiency of factor VIII - haemophilia B = factor IX X- linked recessive disease (all X chromsomes need to have abnormal gene to have haemophilia = so men only need it on their one x chromosome compared to women needing it on both X chromosomes)

Answer 177

IV clotting factors VIII or IX

Answer 178

Potentially fatal contagious bacterial infection - mainly affects nose and throat and sometimes skin - spreads through airborne droplets

Answer 179

Usually mild. Smptoms often develop gradually, beginning with a sore throat and fever. In severe cases, a grey or white patch develops in the throat, which can block the airway, and create a barking cough similar to what is observed in croup. May involve lymph node swelling, and can involve skin, eyes and genitals

Answer 180

Polio is the common name of poliomyelitis, an acute clinical disease caused by a poliovirus. - flu like prodrome - Pre-paralytic stage: fever, increased HR, headache, vomiting, neck stiffness, tremor, limb pain - Paralytic stage: LMN/bulbar stage +/- respiratory failure

Answer 181

Acid fast Rod bacilli Non-motile + non-spore forming Acid fast staining (Zeihl Neelsen stain) = red --> doesn't take up gram stain due to mycolic acid capsule Resistant to phagocytic killing. Slow growing (15-20 hrs)

Answer 182

1. Macrophages struggle to clear TB due to its waxy mycolic acid capsule. 2. Instead of being broken down and cleared, A focal caseating granuloma typically forms in the lower lobe known as a Ghon focus. 3. The Ghon focus can then spread to the Hilar Lymph nodes in the lungs, which together form a ghon complex These ghon complexes can under go fibrosis and calcification, leading to the appearance of ranke complexes on xray

Answer 183

- occurs after primary infection, immune system encapsulates sites of infection and stop the progression of the disease. - Patients remain asymptomatic and the bacteria remains dormant, resulting in negative sputumcultures but a positive Mantoux test. - These patients are not infectious. However, if patients are immunocompromised, the disease can progress or reactivate at a later stage to become active TB.

Answer 184

Immunocompromised patients may develop secondary TB when latent TB reactivates - Patients are infectious. - Reactivation typically occurs in the lung apex where pO2 is highest, as mycobacteria are aerobic. bacteria can spread locally, to form caseating granulomata, or systemically (miliary TB).

Answer 185

Miliary TB - Where immune system cannot control the infection and it becomes disseminated Extrapulmonary TB - where TB infects other areas

Answer 186

often nonspecific: - prolonged fever, - malaise, - anorexia, - weight loss - focal signs of infection (e.g. lymph node swelling in TB lymphadenitis).

Answer 187

Latent Disease - Mantoux Test/tuberculin skin test - can be positive if have had BCG Interferon Gamma release assay

Answer 188

Patchy Consolidation Ghon Complex Granulomatous Lesions Hilar Lymphadenopathy - (enlargement) Pleural Effusion

Answer 189

Doesnt necessarily need Tx If risk of reactivation then: 6 months of isoniazid with pyridoxine or 3 months of isoniazid, pyridoxine and rifampicin

Answer 190

RIPE: Combination Abx for 6-12 months R – Rifampicin for 6 months I – Isoniazid for 6 months P – Pyrazinamide for first 2 months E – Ethambutol for first 2 months Pyra zina mide Etham but ol

Answer 191

Haematuria (orange urine)

Answer 192

Peripheral Neuropathy Can also be a trigger for SLE

Answer 193

Hepatitis, Also gout, and joint pain

Answer 194

Eye problems optic neuritis

Answer 195

Impetigo is a superficial bacterial skin infection Most common cause - staphylococcus aureus, also streptococcus pyogenes

Answer 196

staphylococcus aureus bacteria produces toxins (exfoliative toxins) that breakdown the proteins that hold skin cells together - cause 1-2 cm fluid filled vesicles to form on the skin. - “golden crust” typically occurring around the nose or mouth

Answer 197

non-bullous impetigo = no blisters bullous impetigo = fluid-filled blisters (bullae) are present. - less common Bullous is more common in <2 year olds, and almost always caused by staph aureus.

Answer 198

Non- bullous = hydrogen peroxide 1% cream - for people who are not systemically unwell or at a high risk of complications = topical antibiotic e.g. Fusidic acid Widespread impetigo - oral flucloxacillin

Answer 199

Systemic Symptoms - They may be feverish and generally unwell. In severe infections when the lesions are widespread, it is called staphylococcus scalded skin syndrome.

Answer 200

Nappy rash is skin inflammation, mainly due to a reaction of the skin to urine and poo. - Switching to highly absorbent nappies (disposable gel matrix nappies) - Change the nappy and clean the skin as soon as possible after wetting or soiling - Use water or gentle alcohol free products for cleaning the nappy area - Use a thin layer of barrier cream - Ensure the nappy area is dry before replacing the nappy - Maximise time not wearing a nappy

Answer 201

- Rash extending into the skin folds - Larger red macules - Well demarcated scaly border - Circular pattern to the rash spreading outwards, similar to ringworm - Satellite lesions, which are small similar patches of rash or pustules near the main rash - oral thrush

Answer 202

Treatment topical antifungal (imidazole). Cease the use of a barrier cream until the candida has settled Canesten® cream has been used to treat fungal nappy rash for 25 years. Active ingredient clotrimazole

Answer 203

A severe systemic reaction to staphylococcal exotoxin. Toxin-producing S. aureus and group A streptococci Leaving tampons in too long, female barrier contraceptives, any break in the skin, nasal packing for nose bleeds characterized by: * fever over 39° C * hypotension * diffuse erythematous, macular rash.

Answer 204

This is an emergency, ABCDE approach. Oxygen IV Broad spec Abx + IV IG IV Fluids Surgical debridement

Answer 205

Salmon patch - Flat red or pink patches on a baby’s eyelids, neck or forehead at birth. They’re the most common type of vascular birthmark and occur in around half of all babies. Infantile Haemangioma - strawberry marks, are raised marks on the skin that are usually red, occur in 5% of birth, more common in girls. Rapidly increase in size for the first six months before shrinking

Answer 206

Port wine stain - discoloration of the human skin caused by a vascular anomaly (a capillary malformation in the skin). Mikhail Gorbachev famously had one on his forehead Café au lait spots, = flat, hyperpigmented birthmarks. They are caused by a collection of pigment-producing melanocytes in the epidermis of the skin. Multiple of these birth can be a sign of neurofibromatosis type 1

Answer 207

Mongolian spots - More common in darker-skinned people and usually occur over the lower back or buttocks. now called congenital dermal melanocytosis - patches of darker brown skin congenital melanocytic naevi - normal moles - pink patch with rough border

Answer 208

Coxsackievirus A16 is the most common cause, and enterovirus 71 is the second-most common cause

Answer 209

Tiredness, sore throat, cough, temperature Then small mouth ulcers appear, Then discrete red spots appear on hands, feet and around the mouth, Then spots may blister

Answer 210

Diagnosis is made based on the clinical appearance of the rash. There is no treatment for hand, foot and mouth disease. Management is supportive, with adequate fluid intake and simple analgesia such as paracetamol if required. The rash and illness resolve spontaneously without treatment after a week to 10 days