Paediatrics Flashcards
1
Q
What are the 3 shunts in the foetal circulation and what do they do?
A
Ductus arteriosus- connects pulmonary artery to aorta allowing bypassing of lungs
Ducuts venosus- connects umbilical veins directly to IVC –> right side of heart bypassing liver
Foramen ovale: shunts blood from RA–> LA directly bypassing RV, pulmonary arteries and lungs
2
Q
Talk through the foetal circulation
A
Aorta pumps blood from LV to the foetal body. Some of it goes into the umbilical arteries which take it to the placenta for nutrients to be gained and waste exchanged. This oxygenated blood then travels via the ductus venosus to the IVC –> RA (bypassing liver). In the heart: the foramen ovale shunts the blood from RA–> LA –> LV and out the aorta bypassing lungs but also some does go to RV and pulmonary arteries where ductus venosus directs its to the aorta again bypassing lungs.
3
Q
What happens at first breath in a foetus? And what triggers cause the 3 shunts in a foetus to close (foramen ovale, ductus arteriosus, Ductus venosus)
A
Resistance to pulmonary blood flow decreases at first breath and volume of blood through the lungs increases. The pressure in LA (which was v low before due to no blood returning from lungs in foetus) now increases and pressure in RA decreases as placenta is removed (less blood coming there). This change in pressure triggers the foramen ovale to close and the decrease in prostaglandins when placenta is removed stimulate the closure of ductus arteriosus. Ductus venosus closes itself when placenta is removed.
4
Q
Is a left to right shunt in congenital heart disease blue or breathless? What are examples of this type of shunt?
A
L–> R - too much O2 blood going to lungs
Breathless - HF sx
Examples: ASD, VSD, PDA
5
Q
Is a right to left shunt in congenital heart disease blue or breathless? What are examples of this type of shunt?
A
R–> L- do2 blood going round body
Blue - cyanotic
Examples: ToF, TGA
6
Q
What is an example of a mixed congenital heart disease?
A
AVSD
7
Q
What congenital heart disease is most associated with Down’s syndrome?
A
AVSD
And VSD
8
Q
What congenital heart disease is most associated with Turner’s syndrome?
A
Coarcation of the aorta Aortic stenosis (Biscupid aortic valve)
9
Q
A little 6 month old has a routine check up. The doctor can hear a soft blowing systolic murmur on the left sternal edge. The murmur is heard louder when the baby lies down and rolls over. Mother says baby has been very well recently with no signs of shortness of breath. What is the likely diagnosis?
A
Innocent murmur
4 S’s- soft, systolic only, left sternal edge and asymptomatic
Varies with posture.
No added sounds or thrills.
10
Q
What are some symptoms of heart failure in an infant?
A
SOB especially on feeding/exertion Poor feeding Faltering growth /poor weight gain Tachypnoea, tachycardia Right heart failure: oedema, hepatomegaly (right side backs up into hepatic veins)
11
Q
What happens in Eisenmenger’s syndrome?
A
Untreatred left to right shunt causes high pulmonary blood flow and vascular resistance. This causes the pulmonary arteries to become thick walled and chronically raised pulmonary pressures. Then the shunt reverses (right to left) and the patient becomes blue/cyanotic (usually around teens). Need a heart and lung transplant to treat.
12
Q
A 2 year old child presents to clinic for a review. Mother reports no changes since the last review, he has been eating and drinking well, growing correctly. He has had a couple of chest infections though but these have gone away without requiring treatment. On examination of chest- you hear an ejection systolic murmur best over upper left sternal edge and a wide fixed split S2. What is the likely diagnosis and what investigation would you want to do?
A
Atrial septal defect: L–R shunt causes increased flow over the pulmonary valve : ESM over upper left sternal edge and split S2.
usually asymptomatic.
Ix: CXR (might have HF signs), ECHO
13
Q
A 1 week year old baby has been bought in by his mother because she is worried he is struggling to get through his feeds without getting short of breath and he is not eating as well or growing properly. On examination of the chest you notice the baby is tachycardia and tachypnoeic, and there is a soft pansystolic murmur heard best over the lower left sternal edge and a loud pulmonary sound. What is the likely diagnosis and what investigations do you want to do?
A
Ventricular septal defect: L-R shunt causing Heart failure symptoms.
Ix: CXR- heart failure signs (ABCDE), ECG, ECHO
14
Q
How do you treat a VSD? How does it differ if small VSD or large VSD?
A
Small VSDs will close spontaneously
Large VSDs: Tx heart failure with ACEi, diuretics. may need higher calorie feeds. Surgery at 3-6 months if uncontrolled.
15
Q
What is a PDA and what happens in the shunt?
A
Patent ductus arteriosus (which connected pulmonary artery to aorta in foetal circulation)
Left to right shunt so blood travels from aorta to pulmonary artery
16
Q
A 1.5 month old baby presents with clinic for review. Mother reports no symptoms at all apart from some poor feeding. She was quite a pre-term baby. On examination of the chest, you hear a continuous machinery like murmur beneath the left clavicle and a maybe you can feel a collapsing pulse. What is the likely diagnosis and what investigations will you do?
A
Patent ductus arteriosus. - failure to close by 1 month
Usually asymptomatic- may have some HF signs eg. poor feeding
Continuous machinery murmur
Ix: CXR- might show HF signs, ECG, ECHO
17
Q
How do you treat a PDA?
A
NSAIDs- indomethacin
If this doesnt work- surgery.
18
Q
What are the components of Tetralogy of Fallot?
A
- VSD
- Overriding aorta
- Pulmonary stenosis
- RVH
19
Q
What genetic condition is associated with ToF?
A
Di-George (22q deletion)
20
Q
What symptoms are associated with ToF?
A
Cyanosis, collapse
Can get hyercyanotic spells- rapid increase in cyanosis –> hypoxia, pallor, SOB, crying
21
Q
What murmur do you hear with ToF?
A
Ejection systolic murmur at the left sternal edge
22
Q
What investigations would you do with ToF and what might you see??
A
CXR: LVH –> ‘boot shaped heart’
ECG
Echo
23
Q
How do you treat ToF and how do you treat the hyper cyanotic spells?
A
ToF: need surgery to close the VSD
Hypercyantoic spells: if doesnt stop after 15 mins: analgesia, sedation, IV propranolol, IVF, bicarb (acidosisP)
24
Q
You are bleeped to come and see a neonate aged day 2 who is looking extremely blue. You can’t hear any murmurs on listening to the heart but the baby is very hypoxic and crying. What could be the likely diagnosis?
A
Transposition of the great arteries- severe cyanosis at day 2 where ductus arteriosus closes
25
What happens in Transposition of the great arteries?
Pulmonary artery and the aorta swap. Aorta is connected to the LV (carrying deO2 blood to the body) and pulmonary artery is connected to the RV (oxygenated blood is going to the lungs)
Life threatening hypoxia usually starts on day 2 where ductus arteriosus closes and stops mixing of do2 and o2 blood.
26
What investigations and management is indicated in Transposition of the great arteries?
Ix: CXR (egg on string- narrow mediastinum + cardiomegaly ), ECG, ECHO
Mx: prostaglandin infusion to maintain the ductus arteriosus until surgery. Definitive: switch vessels in surgery.
27
A little baby aged 2w old presents to clinic as his mother is very worried. He has been short of breath on feeds, not feeding as well, and not thriving. He has a PMH of Down's syndrome. You can't hear a murmur on examination. What is the likely diagnosis?
AVSD: mixing- breathless and blue
At birth: cyanotic. 2-3w: HF symptoms
Common in Down's
28
How will you investigate and treat AVSD?
Ix: ECG- superior axis, CXR- HF signs, Echo
Tx: Tx HF- diuretics, ACEi, BB, increase calorie intake. surgical repair at 3-6m
29
A baby has been cyanotic on birth. on echo you see a large right atrium and a very small right ventricle. What is the diagnosis?
Ebstein's anomaly- tricuspid leaflets attach abnormally and sit posteirorly--> doesnt stop back flow of blood: RA becomes big and RV is tiny. Surgery to treat.
30
A baby has been cyanotic on birth. on echo you see a very small RA and RV. What is the diagnosis?
Tricuspid atresia- only LV works properly - cyanosis. Surgery to treat.
31
What are the symptoms of aortic stenosis?
Can be asymptomatic
| If large: can cause SOB, syncope, chest pain and reduced exercise tolerance.
32
What murmur is heard in aortic stenosis?
ESM in the upper right sternal edge radiating to carotids
33
What is the investigation and treatment in aortic stenosis?
CXR- may show prominent LV (dilates due to aortic valve stenosis)
ECG- LVH
Surgery to treat
34
What are the symptoms of pulmonary stenosis?
usually very stable patients.
35
What murmur is heard in pulmonary stenosis?
ESM over the left upper sternal edge, radiates to baackl
36
What is the investigation and treatment in pulmonary stenosis?
CXR- RVH, ECG- RVH
| Tx: surgery
37
You have been bleeped to come and see this very unwell child. She is very hypotensive and tachycardic and is in shock. She has a PMH of Turner's syndrome. You have asked for oxygen sats and BP to be repeated. BP in the right arm is greater than the left arm and sats in the right foot are lower than in the right hand. You also can't really feel any femoral pulses. What is the likely diagnosis?
Coarctation of the aorta
38
What is Coarctation of the aorta ?
Narrowing of the aorta commonly at the ductus arteriosus
39
Why do you get oxygen sats that are lower in the right foot than in the right hand in Coarctation of the aorta ?
Pre-ductal (before the narrowing)- eg. left subclavian supplies oxygenated blood to the right hand
Post-ductal (after the narrowing)- supplies blood to all of the body - mix of deoyxngeated and oxygenated blood = sats are lower
40
Why do you get BP higher in right arm than left arm & lower limbs in Coarctation of the aorta ?
BP before the narrowing is higher (upper limbs) than BP after the narrowing - lower limbs and L arm
41
What can you see on CXR in coarctation of the aorta?
Rib notching- collaterals
| 3 sign - aortic arch
42
What happens in hypo plastic left heart syndrome?
Complete underdevelopment of the left side of the heart- no mitral or aortic valve. Ascending aorta is very small.
Babies can be quite unwell especially when ductus arteriosus closes. Tx: give alprostadil infusion to keep it open and then needs surgery
43
What are the causes of HF in neonates, infants and children?
Neonates: hypo plastic left heart syndrome, critical AV stenosis, coarctation of the aorta
Infants: shunt- VSD, ASD, PDA
Children: Eisenmenger's , cardiomyopathy
Also - arrhythmia
44
A child comes to clinic as the mother has noticed he has a fever and has been quite run down lately. You can hear a murmur as well on examination which the mother said was not heard on last review. She's also noticed he has some funny spots on his palms and his fingers and the ones of his fingers are painful when you touch them. He also has some dark lines in his nails. PMH: normal birth, had a VSD in infancy which was treated surgically. What is the likely cause and causative organism?
Infective endocarditis
| commonest cause: strep viridians
45
What are some symptoms/signs of infective endocarditis?
Fever
New murmur
Malaise
Anaemia
Janeway lesions, Splinter haemorrhages and Osler's nodes in hands
Roth spots in the eyes
may have haematuria if glomerlonephritis is present
46
How do you investigate and treat infective endocarditis?
Ix: Bloods- FBC, U&E, ESR/CRP, clotting
Blood cultures!- repeated
Echo - see vegetations
Tx: IV Abx eg. ben pen + gentamicin
47
What criteria is used to diagnosis IE?
Duke criteria
48
What is the commonest arrhythmia in children? What would you see on ECG?
Supraventricular tachycardia
| Narrow QRS, tachycardia
49
What are the symptoms of SVT in children?
Heart failure sx: SOB, poor feeding, failure to thrive
50
How do you treat SVT in children?
Vagal maneouvres- Valsalva/ carotid sinus massage/ ice pack to face in babies
IV adenosine - blocks the AV node and restarts
If v unstable: electrical cardio version
51
What conditions are babies at risk of when their mum has lupus?
Congenital complete heart block due to the anti-Ro or anti-La antibodies in maternal serum.
52
3 year old little boy presents to clinic. He has had 2 days of coryza symptoms but no real fevers. He is off his food but drinking okay. He has had a cough for 1 day which is worsening and associated with a wheeze. He is struggling to breath at bedtime. No regular meds, no allergies, no problems at birth.
What is the likely diagnosis/what are some differentials?
Viral induced wheeze!!- diagnosis
Asthma- bit young
LRTI/bronchiolitis - bit older
Anaphylaxis/foreign body
53
What is the classic ages of presentation for bronchiolitis, viral induced wheeze and asthma?
Bronchiolitis- up to 12m
Viral induced wheeze: 1-4 years old
Asthma: >4/5 years old
54
What are some causes of wheeze?
```
Viral induced wheeze
Bronchiolitis
Asthma
Anaphylaxis
Inhaled foreign body
CF
```
55
What are the signs and symptoms of viral induced wheeze?
Concurrent/pre-ceeding viral URTI: coryza symptoms, no proper fevers, SOB
Expiratory wheeze
No symptoms in between episodes
56
How do you manage viral induced wheeze?
Salbutamol (bronchodilators) to help, will settle on it's own and grow out of it
If severe: hospital admission and steroids
57
A little 4 year old boy has presented to A&E with facial swelling and gasping for air. On examination he has a widespread wheeze and some little bumps all over his body. His parents tell you they were just eating out at a restaurant and it occurred then. He has a known allergy to peanuts. How are you going to manage this patient?
ABCDE assessment
Main thing is to secure the airway
IM adrenaline
IV chlorphenamine + IV hydrocortisone
58
What is the most common causative organism of bronchiolitis and what age does bronchiolitis present in?
RSV !
| <1 year old
59
What are some symptoms and signs of bronchiolitis?
```
Coryza
Noisy breathing
Poor feeding
Fever
SOB
Signs: diffuse bilateral crackles , wheeze, hyperinflation of chest
```
60
How do you investigate and treat bronchiolitis?
PCR of nasopharyngeal secretions, may do CXR
Tx:
Humidified oxygen if sats <92%
NG tube feeds if feeding <50% of normal
61
What is the indication for ventilatory support in bronchiolitis?
Severe respiratory distress- grunting , nasal flaring, tachypnoea, tachycardia
62
How can you prevent bronchiolitis and who is this prophylaxis given too?
to high risk premature babies: CF, Down's, immunocompropmised
Given palivizumab
63
A 6 year old boy has presented to clinic with worsening symptoms of a cough particularly at night. His mother has also has noticed he is getting quite short of breath on exercising and he's had a few episodes when he's got really badly SOB especially after a tantrum. His symptoms are worse at night and early in the morning. On examination, you can hear an expiratory wheeze but no other signs. PMH: he has had eczema since he was little. What investigation can you do to help confirm your diagnosis?
Peak flow - before and after bronchodilator = shows improvement
Peak flow diary as well showing variability
May do spirometry (obstructive- FEV1/FVC <0.7)
64
What is the definition of asthma?
Hypersensitibity of the bronchi --> bronchial inflammation and mucus production --> bronchospasm and airway narrowing. Reversible airway obstruction.
65
What are some triggers of asthma?
```
Allergens- dust mites, pollen, pets
URTI
Exercise
Cold weather
Emotional upset- crying
Chemical irritants- aerosols
```
66
You start that 6 year old boy who you suspect has Asthma on a SABA - salbumatol inhaler. He comes back in 6 weeks and his mother says he has been using it 5 times a week and his symptoms are still really bad at night. What are you going to ask/check? What medication might you add?
Check inhaler technique- is he using a spacer?
check exactly how many times he is using SABA?
What are the triggers, is he able to avoid them?
Parental smoking/ pets in the house?
Add very low dose ICS (paediatric dose)
67
That 6 year old little boy with asthma taking a SABA + very low dose ICS comes back to clinic. His mother says his symptoms are still uncontrolled and he has had 2 asthma attacks in the last week. What medication are you going to add now?
LRTA - montelukast (NICE) or LABA (BTS) and review in 6-8 weeks
68
If an LRTA hasn't worked in the treatment of asthma, what can you try next?
Stop LRTA and add a LABA in combination with ICS - can try MART
If they are under 5- you would get paeds input
69
You are working in A&E. A 9 year old girl presents with worsening SOB and cough. She is able to talk to you though. On auscultation you hear a widespread expiratory wheeze. Her sats at 98%, RR is 35. What is the diagnosis and what are you going to treat her with?
Moderate asthma exacerbation
Bronchodilators- inhaled SABA 2-4 puffs up to 10 times
Oral prednisolone
70
You are working in A&E. A 9 year old presents with worsening SOB and cough. She is unable to complete full sentences due to breathlessness. Her peak flow is 33-50% best and her sats are 88%. She is tachycardia and tachypnoeic. She has been using her salbutamol inhaler with no effect. What is the diagnosis and how are you going to treat her?
```
Severe asthma exacerbation
High flow oxygen
Salbutamol inhaler (but not worked in this case)
Salbutamol nebs + ipratropium nebs
Prednisolone PO/ hydrocortisone IV
```
71
You are working in A&E. A 9 year old presents with worsening SOB and cough. She is unable to talk, she has poor respiratory effort, peak flow <33%, looks a bit drowsy. She is very hypotensive and her sats are 88%. What is the diagnosis and how are you going to treat her?
Life threatening asthma exacerbation
High flow oxygen
Salbutamol (2.5-5.5mg) + ipratropium nebs
IV hydrocortisone
If these don't work: theophylline/ magnesium sulphate IV/ salbutamol IV
72
You are in the GP and a little 2 year old girl presents with her mother. She has had 2 days of coryza with fevers up to 38 degrees, reduced oral intake and a mild dry cough. She is also pulling at her ears a bit. She doesn't take any medication. Mum smokes at home.
What are your differential diagnosis?
Common cold - URTI
Tonsillitis
Otitis media
Croup/epiglottis - less likely
73
What are the most common causative organisms of the common cold?
Virus- rhinovirus, coronavirus, RSV
74
How would you treat the common cold and when would you admit to hospital?
Rest, paracetamol for pain/fever, fluids.
| Admit: if not eating/drinking at all, suspect epiglottis/croup.
75
A 3 year old girl presents to GP with her mother. She has had 2 days of fevers and coryza symptoms and has reduced oral intake. She says it hurts to swallow. On examination you feel cervical lymphadenopathy and you look in her throat and see inflamed, red tonsils with white spots on them. How are you going to decide what treatment she needs?
```
FeverPAIN score
Fever
Purulence
Attends rapidly within 3 days
Inflamed tonsils
No cough or coryza
2-3 = consider delayed Abx
4-5= Abx
```
76
What's the first line Abx treatment in acute bacterial tonsillitis? What about in a penicillin allergy? What other medications might they benefit from?
Phenoxymethylpenicillin (allergy: erythromycin)
| Other medications: paracetamol/ibuprofen for fever,
77
How do you differentiate acute bacterial tonsillitis from EBV/infectious mononucleosis? What Abx needs to be avoided in EBV?
Glandular fever: much higher fevers, lymphadenopathy, hepatosplenomegaly/abdo pain. May not have responded Abx. may have deranged LFTs
EBV: avoid amoxicillin/amox based drugs - cause a rash in EBC
78
A 2 year old boy presents to A&E as his mother says he's been really unwell this morning. She says he has had a bit of a fever and cold the last few days but today he has a worsening cough, looking like he's struggling to breathe and she can hear a harsh sound when he breathes in. You assess him and his cough sounds quite barking and you can also hear the harsh high pitched sound on inspiration. Given the likely diagnosis, what medication do you want to give immediately?
Croup
Airway is obstructed causing stridor
Give dexamethasone PO
IF can't tolerate PO - nebulised budesonide
79
What signs would concern you about a child’s airway?
```
Stridor
Decreased breath sounds heard
Drooling
Tachypnoea
SOB
Tripod position (leaning forward on hands, neck extended)
Decreasing GCS
Sternal/intercostal recession
Use of accessory muscles
```
80
What is the most common cause of croup?
Viral- parainfluenza, RSV
81
If steroids have not worked to treat the croup and the child has sternal recession and stridor, what else can you try to give?
Adrenaline nebulised
| Oxygen high flow
82
You are working in A&E and a 4 year old boy presents looking very unwell. His mother says this happened very quickly, he has been well recently and about 2 hours ago started struggling to breathe and has been drooling. He is not able to speak to you and you can hear a soft high pitched noise when he breaths in. He has a very high fever and you can see he is leaning forward with his mouth open to order to try and breathe. What are you worried about and what is the most important step in management?
Acute epiglottitis
| SECURE AIRWAY! get them to ITU/call anaesthetists - they will need intubation and ventilation
83
In a child with acute epiglottitis- once you have secured the airway what other medication needs to be given?
IV cefotaxime
| May give dexamethasone
84
What is the commonest causative organism in acute epiglottis?
H. influenza B
85
What drug can be given as prophylaxis to household contacts in a child with acute epiglottis?
Rifampicin
86
What symptoms might you get in a patient with whooping cough?
Inspiratory whoop
Paroxysmal cough that gets worse - worse at night, can cause vomiting
Struggling to catch breath
Pre-ceeding coryza symptoms
87
What is the organism that causes whooping cough?
Bordetella Pertussis
88
How do you treat whooping cough?
Azithromycin 3 days or Clarithromycin 7 days
| Isolate from school until 48 hours after starting Abx
89
A 2 year old boy presents with a 2 day history of coryzal symptoms, fevers up to 38, reduced oral intake. He is pulling at his ears. On examination of this throat, there are no abnormalities but on otoscope you see a bright red bulging tympanic membrane, with the tympanic membrane looking intact. What is the likely diagnosis and what treatment will you offer?
Otitis media
Usually viral so just supportive treatment - analgesia eg, paracetmaol/ibuprofen
If still unwell after few days= amoxicillin
90
What are some complications of otitis media?
```
Mastoiditis
Facial nerve palsy
T.M perforation
Meningitis
Cerebral abscess
```
91
Why are children more likely to get ear infections?
They have short horizontal Eustachian tubes that have not matured to properly function yet
92
What diagnosis would you think of if you looked in the ear on otoscope and saw a fluid level alone?
Otitis media with effusion
93
What is the main symptom in otitis media with effusion that doesnt occur in otitis media/externa/mastoiditis?
Speech and hearing difficulties ! They may need grommets if it doesnt resolve in 3 months.
94
What diagnosis would you think of if you looked in the ear on otoscope and saw redness and the pinna was pushed forward with redness and swelling behind the ear too?
Mastoiditis- medical emergency!
95
How do you treat mastoiditis?
Admit to hospital for IV Antibiotics - broad spectrum high dose eg. a cephalosporin
May need srugery- drain middle ear/mastoidectomy
96
8 year old boy presents with 2 days of coryza. He has fevers up to 39 degrees and reduced oral intake of food and water. He has a wet cough and some chest pain. He has had previous chest infections treated by the GP, takes no medications. Both parents smoke. What are some differentials?
Pneumonia
TB
CF
97
What are the most common organisms causing pneumonia in neonates?
Group B strep, gram -ve enterococci
98
What are the most common organisms causing pneumonia in infants and young children?
Viral- RSV (most common), influenza, parainfluenza
Bacterial- Strep pneum, H. influenza
Mycoplasma and strep more common in >5 years old
99
What happens in pneumonia?
Acute infection of the lung parenchyma due to virus/bacteria causing impaired gas exchange--> SOB and hypoxia
100
What symptoms or signs does pneumonia in a child present with?
Sx: worsening coryza, wet cough, fever, SOB, poor feeding, localised chest/abdo pain due to pleural irritation
Sig: tachypnoea, tachycardia, crackles on auscultation
101
When would you have to admit a child for suspected pneumonia?
Very low sats (<92), tachypnoea, nasal flaring, grunting, not feeding, prolonged cap refill
102
How would you treat pneumonia? What Abx would you give and what if they had a penicillin allergy?
IV fluids, paracetamol, oxygen (if in hospital)
| Amoxicillin (if allergy: erythromycin)
103
If you suspected chest sepsis what investigations would you undertake?
SEPSIS 6 / BUFALO
| + CXR
104
What is empyema and what specific management would this condition require?
Empyema is pus in pleural space which can occur after pneumonia.
Tx: Chest drain inserting + IV Antibiotics- cefuroxime or according to cultures. Oxygen if sats <92%, IV fluids, paracetamol/ibuprofen for fever
105
What is cystic fibrosis?
AR disorder caused by mutation in CFTR gene on chromosome 7 leading to defective chloride channels --> reduced chloride absorption and increased Na absorption across airway causing increased mucus secretions and impaired ciliary function causing blockage of airways
106
What is the most common gene mutation in CF and what chromosome?
Chromosome 7
| ∆F508 mutation- deletion of that amino acid
107
What organs are affected by CF and what symptoms does that produce?
Resp: recurrent respiratory infections (staph aureus, Hib, pseudomonas), bronchiectasis, nasal polyps and sinusitis
Pancreas: pancreatic duct obstruction due to secretions--> enzyme deficiency and malabsorption
Exocrine glands eg. sweat glands - increased NaCl in sweat
Intestine: meconium ileus in neonates, steatorrhea and distal intestinal obstruction when older
Liver: viscous bile and bile duct blockage: cirrhosis and jaundice
GU: infertility- tubes blockage
108
What investigations are done to diagnose CF?
Newborn screening: Guthrie test- heel prick = measure immunoreactive trypsinogen. If this is raised: screen for common mutations (gene testing)
If mutations present: sweat test- increased concentration of chloride and sodium.
109
How is CF managed? Think through the organs affected?
Psychological support
Respiratory: chest physio to clear secretions, monitor with spirometry regularly, prophylactic Abx- fluclox and prompt treatment of infections. Nebulised hypertonic saline/DNAase to help secretions
Nutritional: CREON /pancreatic enzyme replacement, dietican involved for high calorie and high fat diet. Fat soluble vitamin supplementation- KADE
fertility treatment when older
Liver transplant
Screen for diabetes- OGTT
110
Name some general causes of vomiting in children?
Gastro: GORD, overfeeding, intestinal obstruction eg. intussusception, pyloric stenosis, volvulus, appendicitis when older, coeliac disease
Infection- gastroenteritis, RTI, meningitis
GU: strangulated inguinal hernia, testicular torsion when older
Neuro: migraine, raised ICP
DKA
Pregnancy
111
If a child has bilious vomiting, where is the pathology and what are your differential diagnoses?
```
Obstruction below (distal) the Ampulla of Vater in 2nd part of the duodenum
Differentials: intussusception, malrotation with volvulus, NEC, meconium ileus, Hirshprung's disease
```
112
What happens in gastro-oesophageal reflux?
Transient relaxation of the lower oesophageal sphincter allowing gastric contents to go back into the oesophagus causing heartburn.
113
When does gastro-oesophageal reflux usually resolve by?
12m- start a solid diet, sit more upright
114
When does gastro-oesophageal reflux become gastro-oesophageal reflux disease?
When it starts affecting their growth (failure to thrive), when they get other symptoms like sleeping problems, respiratory problems eg. pulmonary aspiration
115
What investigations would you do in a child with gastro-oesophageal reflux disease if any?
Usually a clinical diagnosis.
If no response to treatment/severe may do urine dipstick to rule out UTI, bloods, oesophageal ph monitoring, upper GI endoscopy
116
A 1.5 year old baby presents with his mother. She says he is vomiting frequently, especially after feeds. She is concerned now because he is losing weight and looks more unwell than before. She is breastfeeding him. What treatment are you going to start given the likely diagnosis?
This is GORD
Want to rule out overfeeding first
1. Lifestyle: sit him up when eating, small regular meals and Add thickeners to foods / alginates eg. Gaviscon
2. Omeprazole (PPI)
If very severe: may need paeds surgery input
117
A 4 week old baby has presented with his mother as she says he is vomiting frequently particularly after feeds. She says its forceful , almost projectile like vomiting but is not green. She is concerned because he seems to not be gaining any weight. He often looks hungry after each meal as well and will happily have more milk. What is common electrolyte imbalance associated with this condition?
Pyloric stenosis
Hypokalaemic, hypochloraemic metabolic acidosis - lose stomach acid with H, NaCl and K. Loss of water causes ADH production to retain water and salt- hyperNa initially then hypoNa.
118
What is the pathophysiology behind pyloric stenosis?
Pyloric sphincter hypertrophy causing intestinal obstruction
119
How do you diagnose pyloric stenosis?
US abdomen
120
How do you treat pyloric stenosis?
IV fluids to correct imbalance and NG tube
| Definitive: surgical- Ramsted's pyloromyotomy
121
A little baby, 6 weeks old, presents with her mother. Mother is concerned as baby is having episodes of inconsolable crying and screaming, drawing up her knees and passing excess flatus. It has been happening for over 3 hours a day, every day this week for 4 weeks. She has not been losing weight according to the charts and has no other signs on examination. What is the likely diagnosis?
Colic- >3 hours, >3 times a week, >3 weeks = rule of 3s
| Normal examination, afebrile, not losing weight
122
What are some causes of acute abdominal pain? medical v surgical gastro and extra organs
Medical:
- Gastroenteritis
- Constipation
- Non-specific abdo pain
- Renal calculi
- IBD
- IBS
- Mesenteric adenitis
Surgical:
- Appendicitis
- Intussusception
- Volvulus and malrotation
- Inguinal hernia strangulated
- Inflamed meckel's diverticulum
- Pancreatitis
Extra:
- Testicular torsion
- Pneumonia (lower lobe)
- UTI
- DKA
- Gynae pathology
123
Gastroenteritis: what organism produces severe abdo pain and blood in stool. Gram -ve, comma shaped on gram stain ?
Campylobacter jejuni
124
Gastroenteritis: what organism produces dystenry like infections- high fever, blood + pus in stool, pain
Shigella
125
Gastroenteritis: what organisms produce profuse diarrhoea and severe dehydration?
Cholera, E coli
126
How do you class dehydration - in terms of clinical signs and percentage of body weight lost?
Mild dehydration: loss of <5% of body weight.
Moderate dehydration: loss of 5-10% of body weight
- Slightly reduced skin turgor, decreased urine output, tachycardia, dry mucuous membranes, weak pulse. If can tolerate oral fluids: give oral.
Severe dehydration: loss of >10% of body weight
- Reduced skin turgor, oligoruia, tachycardia and low BP, raised CRT, dry mucuous membranes, absent pulse, sunken fontanelle, decreased GCS , sunken eyes, cool peripheries. Needs IV fluids.
127
What are some causes of constipation?
Poor diet- lack of water, reduced fibre intake
Hirshprung's disease
Hypercalcaemia
Hypothyroidism
Anal fissure
Psychological - toilet training/unpleasant toilets
128
What are some red flag features to look out for when assessing a child with constipation?
```
Failure to pass meconium in first 24h
Gross abdo distension
Faltering growth
Vomiting
Severe pain
Absent bowel sounds
Abnormal neurology
Abnormal appearance of anus eg. bruising/fistula
```
129
What is the most common maintenance regime prescribed in constipation?
Macrogol eg. movicol + stimulant eg Senna
130
You are bleeped to see a neonate who has just been born 10 hours ago and has yet to pass meconium. She has also vomited a couple of times and on examination you think her abdomen looks slightly distended. You do a PR examination and on withdrawing your finger, meconium and flatus is released. What is diagnostic investigation for this condition?
Hirschprung's disease
| Diagnostic: rectal biopsy to see the ganglionic cells
131
What is the pathophysiology behind Hirschprung's disease?
Aganglionic megacolon- absent ganglionic cells in large bowel leaving a narrow segment which doesn't relax causing an obstruction
132
How might Hirschprung's disease present in a slightly older child?
Constipation
Abdominal mass
Abdominal distension
Bilious vomiting
133
How do you treat Hirschprung's disease?
Surgical - resect affected segment and anastomosis of normal bowel to rectum
134
A 10 year old girl presents to A&E with abdo pain. On history taking you find out in started in the centre and has moved to the right side. She is also vomiting and has a bit of a fever. On examination, She is tender in the abdomen particularly on the right and tender on percussion. Palpation of the left iliac fossa also causes pain in the right iliac fossa. Given the diagnosis, what investigations and treatment are you going to do?
Appendicitis: umbilical pain moving to RIF. Percussion tenderness, Rosving's sign +, fever, vomtiing
A-E assessment
Bedside: urine dipstick, pregnancy test
Bloods: FBC, U&E, CRP/ESR, clotting, group and save (for theatre), LFTs, blood cultures
Imaging: do not delay but can do US
Analgesia
IV fluids - normal saline
Antibiotics - amoxicillin before surgery
Needs to be sent to surgery for appendectomy
135
A 10 year old girl presents to A&E with abdo pain in the right hand side. It started there and there is no radiation. The pain is intermittent. She has a fever but has had no vomiting and is eating fine. She says she has had a bit of a cold recently. On examination, there is no guarding of the abdomen but lymph nodes can be felt. Given the diagnosis, what investigations and treatment are you going to do?
Mesenteric adenitis: preceding cough/cold, fever but no vomiting/anorexia. No guarding on abdomen, lymph nodes present.
Ix: Bloods: FBC, U&E, CRP/ESR, clotting, LFTs, blood cultures. But classically WCC and CRP wont be raised
Analgesia - Paracetamol
Encourage rest and fluids
136
A 1 year old baby,Jack, presents to A&E with his mother who says her baby has been suffering with stomach pains for the last couple of days. They are intermittent, colicky pains but she says Jack is screaming crying in pain and drawing up his legs. He has not been feeding at all and has vomited twice- which contained some green stuff and his stool has been dark red and looks like jelly. He looks very unwell on examination and has a palpable mass in RUQ. Given the likely diagnosis, how are you going to manage him?
Intussusception
A to E assessment of Jack
Bloods- FBC, U&E, CRP/ESR, clotting, group and save, LFTs
Imaging: Abdo X ray, US ABDO ! - shows target sign
NG tube and IV fluids
Air enema!
If that fails/peritonitic/perforated- surgical laparotomy
137
What is Meckel's diverticulum?
Congenital abnormality of small bowel
Outpouching of the bowel that is caused by failure of the vitello-intestinal duct to disappear (connects gut and umbilicus)
138
How does Meckel's diverticulum present?
Mostly asymptomatic
Can have painless PR bleeding and constipation
Can get strangulated/obstructed
139
What is the diagnostic test for Meckel's diverticulum?
Technetium scan
140
How do you treat Meckel's diverticulum?
If massive bleeding: A-E, fluids, blood, transfusion
If asymptomatic : no treatment
If sx: surgical resection
141
You are bleeped to see a 1 week old neonate as the nurses say he's vomiting up green liquid. He has done it a few times and on palpation of his stomach he looks pain. Observations show tachycardia and hypotensive. What is the diagnosis?
MALROTATION/VOLVULUS
| Bilious vomiting in 1st week of life- need to rule this out
142
What is the commonest cause of intestinal malrotation/volvulus?
Ladd bands
Congenital abnormality where normal rotation of small bowel as a foetus doesn't occur, Ladd bands obstruct duodenum and causes a volvulus which causes infarction.
143
How do you manage intestinal malrotation/volvulus?
Stabilise baby
Upper GI contrast study - see corkscrew sign
Tx: urgent laparotomy to untwist bowel and divide the Ladd's bands
144
Name some causes of faltering growth in a child?
Malabsorption: CF, IBD, Coeliac disease, cow's milk protein allergy
Impaired suck/swallow: CF, cleft palate
Feeding problems: wrong formula, not enough given
Severe gastro-oesophageal reflux
increased metabolic demand: congenital heart disease, liver disease, chronic renal failure
145
A little girl presents with her mother to clinic. She is complaining of abdominal pain going on for a few months now and has not been getting any better. The pain is typically worse after she eats pasta and rice and mother has noticed her stools have been quite loose and difficult to flush. She is not growing as well as she should be on her charts and she feels very tired. On examination you note her adomen is slightly distended and she has an erythematous rash on her legs. She has PMH of T1 diabetes. What is the likely diagnosis and what is the rash on her legs called?
Coeliac disease
| Dermatitis herpetiformis
146
How would you investigate a patient with suspected coeliac disease?
Bedside: stool sample ?
Bloods: FBC, U&E, CRP, LFTs, iron studies. IgA + anti-TTG antibody. Endomyseal antibiodies
Imaging: small bowel/duodenum biopsy- villous atrophy and crypt hyperplasia
147
What are the complications that may occur if a child with coeliac disease doesnt follow a gluten free diet?
Osteoporosis
Small bowel cancer
Fe def anaemia
Infertility problems when older
148
A 4 month old baby, Chloe, is brought into clinic by her mother. Mother says Chloe has been struggling with vomiting and diarrhoea for a few months now as well as crying a lot more than usual. She says the stools are very loose and difficult to flush. She has noticed some blood in the stool. Chloe is bottle fed and has a PMH of asthma and eczema. What is the likely diagnosis? What are the two types?
Cow's milk protein allergy
IgE mediated: cutaneous reactions- lip swelling, urticaria , may have SOB, + GI sx . immediate reaction
non-IgE mediated: later presentation- GI pain, diarrhoea, blood in stools, excessive crying.
149
Chloe has been diagnosed with cow's milk protein allergy. What is the first line treatment?
Avoid that milk and prescribe hydrolysed formula
| Should settle by 12 months
150
You suspect a child to have malnutrition as she is not growing appropriately on the growth chart for her age and gender. What questions do you want to ask her mother?
Pregnancy- drugs, alcohol, placental problems, medications
Infancy- how many bottles is she drinking and how often? if breastfeeding- how long and how often? Are there any other symptoms - diarrhoea or vomiting? any problems with bladder?
Child: any other illnesses, any other sx eg. rash in coeliac, abdo pain, greasy hard to flush stools, joint pain in IBD, mouth ulcers, any allergies.
151
A 2 year old boy has come in with his mum as he has had some loose stools over the past few days. Mum describes it as about 3 stools a day for 2 days of varying size and consistency. Sometimes she can see undigested food in the stool. The little boy is growing appropriately and has been eating and drinking fine since, he looks well on examination. What is the likely diagnosis and treatment?
Toddler's diarrhoea- common due to delay in intestinal motility maturation
Tx: reassurance, increase fibre and fat in diet to slow down gut transit
152
A 12 year old girl presents to clinic. She is complaining of worsening abdominal pain that she describes is cramps along with episodes of diarrhoea and some nausea and vomiting. She feels she is losing weight. She also complains of her eyes feeling gritty and she has some mouth ulcers. Given the likely diagnosis what investigations are you going to do on her?
Crohn's disease!
Bloods: FBC, U&E, CRP/ESR, faecal calprotectin, iron studies
Imaging: CT/MRI abdomen
Special tests: ileocolonoscopy
153
What might you see on ileocolonoscopy in a patient with Crohn's disease?
Transmural skip lesions
Mucosal inflammation
Fissures and ulcers --> cobblestone appearance
Fistula's
154
What are the extra-GI symptoms of Crohn's?
```
Uveitis
Arthralgia
Anaemia
Mouth ulcers
Perianal skin tags
Erythema nodosum
```
155
How do you treat Crohn's? Inducing remission and maintenance
inducing remission: steroids- prednisolone
| Maintenance: azothioprine , methotrexate, infliximab
156
A 12 year old girl presents to clinic. She is complaining of worsening abdominal pain that she describes is cramps along with episodes of diarrhoea accompanied with bleeding from her bottom. She also notices some white discharge on the stool too. She also feels like she doesnt empty her bowel completely when she goes for a poo. Given the likely diagnosis, what would you see on ileocolonoscopy?
Ulcerative colitis
| Superficial mucosal inflammation and ulceration. doesnt extend through bowel.
157
What are some complications of IBD?
Toxic megacolon- dilated colon, needs emergency surgery
Fistula- Crohn's
Abscesses
Colon cancer- UC
158
How would you treat UC? inducing remission and maintenance?
Remission: aminosalicylates eg. mesalazine, if severe: oral steroids
Maintenance: aminosalylates eg. mesalazine or immunosuppressants - azathioprine
159
You are on the ward and you go to see a neonate who is suffering from bilious vomiting after being born yesterday . They have had an X ray which shows the 'double bubble' sign. What is the diagnosis?
Dudoenal atresia - bilious vomiting within a couple of hours-days of birth
Double bubble- - dilation of duodenum and stomach
160
How do you treat duodenal atresia?
Give IV fluids and take to surgery
161
You are doing a ward round check on a little baby where the nurses tell you she has been vomiting after feeds and has had an episode of aspiration. She has some vertebral problems and cardiac defects too. You try and pass a NG tube down and it doesn't work. What is the likely diagnosis?
Oesophageal atresia- blind ending oesophagus. usually associated with tracheo-oesophageal fistula - abnormal congenital connection between the oesophagus and trachea
162
What group of conditions is oesophageal atresia/tracheo-oesophageal fistula associated with?
VACTERL
163
How do you investigate and treat oesophageal atresia?
Ix: CXR- might see air under diaphragm if oesophageal atresia is caused by TOF
Tx: surgical excision of atresia and fistula
164
A neonate is on the ward and has a defect in their anterior abdominal wall adjacent to the umbilicus. There is no peritoneum or sac covering this defect and gastric contents is protruding through. What is the diagnosis and how will you manage it?
Gastroschiasis. Not associated with trisomy's
| Tx: cover the gastric contents with cling film, fluid resus, NG tube and surgery within a few hours .
165
A neonate is on the ward and has a defect in their anterior abdominal wall in their umbilicus. The herniation is covered by peritoneum. The neonate has also been diagnose with Down's syndrome. What is the diagnosis and how will you manage it?
Oomphalocele. - associated with cardiac defects and Trisomy's.
Cover sac with dressing, surgical repair to close.
166
You are assessing a newborn baby who has become increasingly SOB and cyanotic. You listen to the chest and abdomen and hear tinkling bowel sounds over the chest wall. How are you going to manage this given the diagnosis?
congenital diaphragmatic hernia - bowel sound heard over chest wall
CXR: mediastinal shift, presence of bowel shadow
Tx: NG tube & IV fluids, intubate and ventilate, surgical repair - excise hernia and repair defect in abdo wall
167
You are bleeped to see a little neonate as the nurses are concerned she is yellow. She is clinically jaundiced and the nurses have told you her stools have been quite pale recently. On palpation she has some hepatomegaly. She had a normal birth weight. What is the most important diagnosis to rule out in a neonate with jaundice and pale stools?
Biliary atresia
168
What investigations will you do in a neonate with suspected biliary atresia?
Bloods: LFTs- raised GGT, bilirubin- raised conjugated
Abdominal Ultrasound - shrunken/absent gallbadder
Cholangiogram +/- liver biopsy: atresia of biliary tree
169
How do you treat biliary atresia?
Hepatoportoenterostomy (liver failure if this doesnt work)
| Replace fat soluble vitamins - KADE
170
Another little neonate presents with jaundice and hepatomegaly. However, she also has splenomegaly and a low birth weight. What could be the likely cause and how could you confirm this?
Neonatal hepatitis syndrome (differs from biliary atresia as has splenomegaly early and low birth weight)
Confirm with cholangiogram/liver biopsy
171
What are the symptoms and signs of acute liver failure (decompensated) in children?
Jaundice
Encephalopathy - confusion, irritability, drowsiness
Bleeding problems
Nausea and vomiting
172
What investigations would you want to do in a child with acute liver failure?
Bloods: LFTs- raised transaminases, bilirubin, clotting- PT/INR, FBC, U&Es
May do CT head if heavily raised ammonia
173
A 12 year old boy has come with his mother to clinic because he has been referred from the GP due to ongoing jaundice. Jack looks yellow on observation and describes some abdominal pain as well. On palpation, you can feel some hepatomegaly. Jack's mum also says there have been changes in his mood and behaviour and he's not doing as well in school recently but they cannot figure out why. On examination of his eyes you see some gold rings. Given the likely diagnosis, what investigations are you going to do?
Wilson's disease
Ix:
Bedside: full abdo exam, raised urinary copper excretion
Bloods: FBC, U&E, LFTs- raised transaminases, raised bilirubin, serum ceruloplasmin- low
Imaging: liver biopsy
174
How do you treat Wilson's disease? If severe hepatic failure vs stable
Stable: Copper chelating agnets eg. pencillamine, zinc
| Acute failure: liver transplant
175
What is the most common hepatitis in children?
C. vertical transmission
176
How do you treat hepatitis C?
Monitor in <3 years old- resolves spontaneously
| If >3 years old: pegylated interferon, sofosbuvir
177
Is hepatitis A a chronic or acute disease? How does it present?
Acute
| Mostly asymptomatic
178
Is hepatitis B a chronic or acute disease? How does it present?
Both - perinatal trasmission
In infants: asymptomatic
When older: signs of hepatitis- N&V, abdo pain, jaundice, lethargy
179
Mother has routine hepatitis testing which shows active Hep B infection (surface antigen positive). What needs to be given to the baby at birth?
Hepatitis B vaccination
| hepatitis B immunoglobulin
180
What is the most common organisms causing fever in a neonate?
Group B strep!
| E.coli, Listeria
181
How would you manage early onset (<72h) neonatal fever/infection?
SEPSIS 6- bloods and blood cultures importantly.
Tailor eg. CXR
LP if raised CRP
Abx: IV - benzylpenicillin and gentamicin
182
How would you manage late onset (>72h) neonatal fever/infection?
SEPSIS 6- bloods and blood cultures importantly.
Tailor eg. CXR
LP if raised CRP
Abx: IV - flucloxacillin + gentamicin
183
What are the most common causes of bacterial meningitis in neonates?
Group B strep, Listeria monocytogenes
184
What are the most common causes of bacterial meningitis in babies >3 months?
Neisseria meningitides, Strep pneum
185
What symptoms and signs will you look out for in meningitis?
Sx: Fever, neck stiffness, photophobia, reduced feeding, drowsiness
Signs: decreased GCS, Kernig's sign- can't straighten leg with hip flexed, Brudzinki's sign- hip and knees flex when neck is flexed, bulging fontanelle, neuro signs
186
How will the CSF findings differ between viral and bacterial meningitis?
Bacterial: turbid colour, polymorphonuclear leukocytes/neutrophils, glucose low, protein high
Viral: clearer colour, lymphocytes, glucose low, protein normal
187
What antibiotics do you give for bacterial meningitis? in community and hospital
Community: IM ben pen
Hospital: IV cefotaxime/ceftraixone + IV amoxicillin if <3 to cover for listeria. May give dexamethasone too.
188
What can you give for prophylaxis of meningococcal meningitis to close contacts?
Ciprofloxacin
189
How would you manage meningococcal septicaemia?
```
Sepsis 6 - bufalo
ABCDE assessment of child
Oxygen
IV access: bloods- FBC, U&E, CRP, LFTs, VBG- lactate
IV fluids- 0.9% NaCl bolus
Urine output- measure or catheterise
IV Abx- IV ceftriaxone
```
190
What is the most common cause of encephalitis and how would you treat?
HSV. Treat with acyclovir.
191
Parent comes to you with 3 year old child who has had a fever for 5 days now. Mum is a nurse so has been managing at home with nurofen but is started to get worried now because she notices child has red eyes, red tongue, a red rash all over its body and red hands and feet. No recent illnesses prior to this.
o/e you find some cervical lymphadenopathy
What is the likely diagnosis and what is the criteria of symptoms?
```
Kawasaki's syndrome
CRASH and BURN (fever >5 days) + 4/5 of crash
C: conjunctivitis
R: rash over body
A: adenopathy- cervical
S: strawberry tongue
H: hands and feet- red and oedematous
```
192
What do we worry about particularly in a child with Kawasaki's disease and what tests will we do as a result?
Coronary artery aneurysms so will do an Echo
193
What is Kawasaki's disease?
Systemic vasculitis
194
How will you manage a child with Kawasaki's disease?
Ix: Bedside: nil. Bloods: FBC, U&E, LFTs, bilirubin, CRP, blood cultures
Imaging: Echo for coronary artery aneurysms.
Tx:
IV Immunogolbulin and aspirin
195
A 5 year old boy comes with his mum as he has had a fever for 5 days now. He has been a little under the weather recently with a cold. Mum is worried now because he now has a bright red tongue and a rash over his body which feels rough to touch. On examination you can feel cervical lymphadenopathy. What is the likely diagnosis and causative organism?
Scarlet fever
| Organism: strep pyogenes- Group A strep
196
How do you treat scarlet fever? What else do you need to do given the diagnosis?
Pencillin V for 10 days
| Inform PHE
197
What are some complications of scarlet fever?
Post-strep glomerulonephritis
Mastoiditis
Deafness
198
When and what investigations would you do in scarlet fever?
Throat swab, blood cultures
| ONLY if uncertainty about clinical diagnosis, allergy to penicillin
199
A 10 year old presents with his mother to A&E as he has developed a full body skin rash and some blistering. He had a recent URTI that was settling and now this rash has appeared. The rash has now developed into painful blisters and he also has pain in his eyes and ulceration of his mouth causing it to be difficult to eat and drink. What is the diagnosis and how will you manage it?
Steven Johnson's syndrome: triggered by viral URTI's in kids
Management:
Admit to hospital, IV fluids as dehydrated, analgesia, dressings onto burns to heal, topical antibiotics.
200
What are the two most common causes of toxic shock syndrome? and RF for each
Strep pyogenes - associated with skin infections
| Staph aureus- tampon use and barrier contraceptives
201
What is the risk in toxic shock syndrome to patient?
Multiorgan failure due to toxins release
202
How do you treat toxic shock syndrome?
IV fluids immediately, need ICU monitoring
IV antibiotics: clindamycin + ben pen/vancomycin
Surgical debridement if infection
203
A child comes to clinic as the mother is worried he has had a cough and a fever that has not been getting better for quite a few days now. He has been off his food and irritable as well lately and a new rash all over his body has appeared. The rash looks erythematous and slightly raised papules. You look in the mouth and see some white spots. Given the likely diagnosis, what treatment will you offer?
Measles
| Only supporitve- paracetamol/ibuprofen and vitamin A supplementation
204
What are the complications that can develop from measles infection?
Otitis media - most common
Encephalitis - seizures
Pneumonia
205
A child comes to clinic as the mother is worried he has had a fever that has not been getting better for 4 days now. He has been off his food and irritable as well. He is complaining of earache when eating and swallowing. There is a swelling in the lower part his cheeks. Given the likely diagnosis, what treatment will you offer?
Mumps
| Treatment is supportive
206
What are the complications that can develop from mumps infection?
Meningitis and encephalitis
Orchitis
Hearing loss- one ear
207
A child comes into A&E because the mother is worried about this new rash that has developed on the child's arms and legs. He also has a rash on his cheeks that is painful. He has recently been a bit under the weather with a mild fever and headache but not very unwell. What is the likely diagnosis and causative organism ?
Slapped cheek syndrome/erythema infectiosum
| Caused by parvovirus B19
208
How do you manage slapped cheek syndrome/erythema infectiosum?
supportive: paracetamol/ibuprofen
209
What is the worry of slapped cheek syndrome/erythema infectiosum infection in a child with sickle cell anaemia/thalassaemia?
Can precipitate an aplastic crisis- bone marrow stop making RBCs
210
A little boy has chicken pox and his mother has called up the practice for advice on how to handle it. What do you tell her? He has no other medical conditions and takes no medication.
Keep the child cool, keep the skin moisturised with emollients and calamine lotion
To reduce itching: trim nails and give antihistamines
Give paracetamol for the fever
211
A little boy has chicken pox and his mother has called up the practice for advice on when he can go back to school, what do you tell her?
Once all the lesions have crusted over
212
A little boy has chicken pox and his mother has called up the practice for advice on how to handle it. What do you tell her? He has underlying atopic dermatitis.
Keep the child cool, keep the skin moisturised with emollients and calamine lotion
To reduce itching: trim nails and give antihistamines
Give paracetamol for the fever
Also give oral aciclovir due to the underlying atopic dermatitis.
213
What does HSV-1 classically cause in children?
gingovostomatitis- lips, tongue, gums eg. cold sores and skin lesions eg. eczema herpeticum
214
What does HSV-1 classically cause in children?
Genital lesions
215
A little 1 year old is brought in by mother because her child has been unwell recently with a high fever. She was managing at home okay and wasn't worried but now the fever has settled, a rash has appeared on the neck and trunk and spreading to the arms. She has also had an episode of what the mum describes as a seizure this morning but there were no epileptic features and the baby has no neurological deficit now. What is the likely diagnosis?
Roseola infantum or sixth disease
216
Roseola infantum or sixth disease causative organism?
Human herpes virus 6
217
A child comes in with his father who is saying he has had a fever for a couple of days. The child has been off his food and this is due to some oral ulcers in his mouth which you can see and around his mouth. There are also some vesicles on his palms and soles of his feet but no where else. What is the likely diagnosis and causative organism?
Hand, foot and mouth disease
| Cx: coxsackie virus A16
218
What drug is given with RIPE Tb treatment in order to reduce the risk of peripheral neuropathy associated with isoniazid?
Pyridoxine
219
What can be given to newborn's of HIV infected mothers to reduce the risk of them developing HIV?
ART eg. zidovudine
220
What symptoms can a child with IgA deficiency get?
Recurrent chest infections --> bronchiectasis
Recurrent GI infections
Malabsorption: coeliac disease, ulcerative colitis
221
What vaccinations are given at 8w (2m)?
```
Dr PIMP
DPI: 6 in 1- diphtheria, tetanus, polio, pertussis, Hep B, Hib
R: rotavirus
M: Men B
P: pneumococcal
```
222
What vaccinations are given at 12w (3m)?
Dr PI
DPI: 6 in 1- diphtheria, tetanus, polio, pertussis, Hep B, Hib
R: rotavirus
223
What vaccinations are given at 16w (4m)?
D PIMP
DPI: 6 in 1: diphtheria, tetanus, pertussis, polio, Hep B, Hib
Men B
Pneumcoccal
224
What vaccinations are given at 1 year?
```
IMP + MMR
Hib B + Men C
Men B
Penumoccoal
MMR
```
225
What vaccinations are given at 2- 8 years?
Influenza
226
What vaccinations are given at 3 years, 4 months?
DPMMr
Diphtheria, tetanus
pertussis and Polio
MMR
227
What vaccinations are given at 12-13 years?
HPV
228
What vaccinations are given at 14 years old?
```
TDPM
Tetanus
Diphtheria
Polio
Men ACWY
```
