paediatrics anki 4 Flashcards
What kind of conjunctivitis doo you see in patients with Kawasaki?
Bilateral and non exudative
Why is aspiring usually contraindicated in children and when is it used as treatment?
Risk of Reye’s syndrome
Used as treatment of Kawaski’s
What kind of vurs is the measles morbillivirus?
Single stranded, enveloped RNA virus
When might the chicken pox rash leave scars?
If blisters have been scratched or infected
When is school exclusion recommended in patients with chicken pox?
In most infectious periods:1-2 days before rash and until all lesions have dried and crusted over (5 days post rash onset)
Who is most at risk from rubella?
Unvaccinated pregnant women due to risk of congenital rubella syndrome
When are rubella outbreaks most common?
In winter and spring
When are patient with rubella most infecitous?
From 7 days before symptoms start to 4 days after rash onset
Who does staphylococcal scalded skin syndrome mainly affect?
Mainly infants: those <5
Adults with renal insufficiency or immune compromise
When are children immunised against whooping cough?
2, 3, 4 months and 3-5 years
Pregnant women
Who should be admitted if presenting with suspected whooping cough?
Infants under 6 months
When should patients with whooping cough be kept off school?
Until 48 hours after commencing antibiotics OR 21 days from symptom onset if no antibiotics
When are pregnant women offered the whooping cough vaccine?
Women who are 16-32 weeks pregnant
When should children with slapped cheek suyndrome be excluded from school?
No exclusion necessary-no infectious once rash emerges
What might fifth disease cause in adults?
Acute arthritis
When are children with Fifth’s disease infectious?
3-5 days before rash onset
Why might parvovirus B19 result in an aplastic crisis?
Reduces erythropoiesis
What organisms commonly cause pneumonia in neonates?
Group B strep
Klebsiella
Staph aureus
What organisms commonly cause pneumonia in infants and young children?
Most common: RSV
S pneumonia
Staph aureus
Also bordatella pertussis, chlamydia trachomatis
What organisms commonly cause pneumonia in children aged >5years?
Mycoplasma pneumonia
Strep pneumoniae
Chlamydia pneumoniae
What symptoms might point more towards a viral cause of pneumonia?
Wheeze
Hyperinflation
When should children with pneumonia be admitted to hospital
O2<93%
Severe tachypnoea
Grunting
Not feeding
When should children with oneumonia be followed up?
At 4-6 weeks
What would you expected to find on spirometry in a patient with asthma?
FEV1 reduced
FVC normal
FEV1/FVC<70%
What should patients who have been hospitalised for an asthma attack be given on discharge?
Oral prednisolone for at least 3 days
Follow up and review of medication and inhaler technique
Trigger for attack investigations
What might you see on a CXR of a patient with croup and why?
Steeple sign
Subglottic narrowing in severe or atypical cases
Whta is bacterial tracheitis?
Pseudomembranous croup
Similar to viral croup but caused by Staph aureus
Rare and a lot more dangerous
What might be seen on a CXR in a patient with bronchiolitis?
Hyperinflation of lungs
Flattening of diaphragm
Horizontal ribs
Increased hilar bronchial markings
When might bronchiolitis prophylaxis be given?
Children <9 months with chronic lung disease/prematurity
Children <2 years with severe immunodeficiency
What is the treatment for bronchiolitis obliterans?
Supportive
Immunosuppressive agents->cyclosporin, prednisone etc
What organism can cause chest infections in patients with cystic fibrosis?
Psuedomonas aeruginosa
What might be seen on an x ray in a patient with acute epiglottitis and why?
Lateral:Thumb sign-Epiglottis swelling
Posterior-anterior:Steeple sign-Subglottic narrowing
What organism most commonly causes viral induced wheeze?
RSV/rhinovirus
What should you consider if you find a focal wheeze in a child and what should you do?
Focal wheeze-> focal airway obstruction->inhaled foreign body/tumour-> urgent senior review
Why are children most prone to otitis media?
Have narrower eustachian tube , more horizontal, less developed immune systems>easier for bacteria to colonise
What would be seen on otoscopy of a patient with otitis media?
Bulging tympanic membrane-> loss of light reflex
What should be used if impetigo is likely caused by MRSA?
Topical mupirocin
When should patients with mpetigo be referred to secondary care?
Suspected complications
Immunocompromised and widespread infection
What is toxic shock syndrome?
severe, life-threatening condition characterized by the sudden onset of shock, multi-organ failure, and rash.
What organisms most commonly cause toxic shock syndrome?
Group A strep
S.aureus
MRSA
Why is clindamycin used in toxic shock syndrome?
Inhibits the produciton of superantigen
Whta condition is this rash likely to be seen in?
Scarlet fever
Why is fetal circulation different?
Lungs don’t work so are bypassed and bloods need to get to placenta and back
When might murmurs be further investigated in children?
Murmur louder than 2/6
Diastolic
Louder on standing
Symptomatic->failure to thrive, feeding difficulty, cyanosis or SOB
Where would a murmur caused by mitral regurgitation be heard the loudest?
5th intercostal space
Mid clavicular line
Where would a murmur caused by tricuspid regurgitaiton be heard the loudest?
5th IC Left sternal border
Where would a murmur form a ventricular septal defect be heard loudest?
Left lower sternal border
Where would a murmur caused by aortic stenosis be heard the loudest?
2nd IC Right sternal border
Where would a murmur caused by pulmonary stenosis be heard loudest?
2nd IC Left sternal border
Where would a murmur caused by hypertophic obstructive cardiomyopathy be heard the loudest?
4th IC Left sternal border
Within how many days does the ductus arteriosus close?
Stops functioning within 1-3 days of birth
Closes completely within first 2-3 weeks
What murmur is associated with a patent ductus arteriosus?
Continuous crescendo-descrescendo ‘machinery’ murmur that may continue during second heart sound
Why are patients with atrial spetal defects more susceptible to strokes from DVTs?
Clot can travel from right atrium to left atrium across ASD-> left ventricle->aorta-> brain-> large stroke
What murmur would you find in a patient with an ASD?
Mid-systolic crescendo-decrescendo murmur loudest at the upper left sternal border with a fixed split second heart sound
What might be the only indication of coarctation of the aorta in a neonate?
Weak femoral pulses
What kind of murmur is associated with coarctatin of the aorta?
Mid-systolic heard below the left clavicle and below the left scapula, maximal over the back
Why is prostaglandin E used for treatment of the coarctaiton of the aorta?
Keeps the ductus arteriosus open so blood is able to flow through into the systemic circulation distal to the coarctation
Where does the narrowing typically occur in coarctation of the aorta?
Just before the ductus arteriosus
What murmur is associated with a VSD?
Loud, harsh, pan-systolic murmur heard most in left lower sternal border in 3rd and 4th IC space
May be a systolic thrill on palpation
What part of the tetralogy of fallot determines the degree of severity of the cyanosis
Pulmonary stenosis
When is tetralogy of fallot most commonly diagnosed?
Antenatal scans
Newborn baby check
Heart failure symptoms
Why might a pehnylephrine infusion be used to treat a tet spell?
Increases systemic vascular resistance
Why might morphine be used to treat a tet spell?
Decreases respiratory drive resulting in more effective breathing
Why might beta blockers be used to treat a tet spell?
Relax right ventricle and improve flow to pulmonary vessels
Why might IV fluids be used to treat a tet spell?
Increases the pre-load, increasing the volume of blood flowing to the pulmonary vessels
What might be seen on a CXR in a patient with transposition of the great arteries
Egg-on-side appearance
When do patients with Ebstein’s anomaly typically present?
A few days post birth when the ductus arteriosus closes
What murmur is associated with congenital aortic valve stenosis
Crescendo decrescendo ejection systolic murmur
Heard loudest at 2nd IC, R sternal border
Radiates to carotids
What murmur is associated with congenital pulmonary valve stenosis
Ejection systolic murmur
Loudest at 2nd IC left sternal border
When might desmopressin be used as a treatment for nocturnal enuresis?
> 7 years and still struggling
Need rapid control e.g. child going to a sleep over may be offered a short term course
What is the typical triad of haemolytic uraemic syndrome?
AKI
Thrombocytopenia
Microangiopathic haemolytic anaemia
Which is more commmon: primary or secondary haemolytic uraemic syndrome
Secondary(AKA typical)
What might be seen on an FBC in a patient with haemolytic uraemic syndrome?
Hg<8-microagniopathic haemolytic anaemia
Negative Coombs test
Thrombocytopenia
High platelets
What might be seen on a blood film in a patient with haemolytic uraemic syndrome?
Fragmented blood film
Schistocytes
Helmet cells
What might you see in the U&Es of a patient with haemolytic uraemic syndrome?
AKI
High urea and creatinine
What might you see on a stool culture in a patient with haemolytic uraemic syndrome?
Evidence of STEC infection: OCR for Shiga toxins
What might be seen in a patient’s coagulation studies if they have suspected haemolytic uraemic syndrome?
Normal
What might you do if a child is having atypical/recurrent UTI’s?
Consider further investigations or prophylaxis
Secondary care referral
What is vesicoureteral reflux?
Urine flows backwards from bladder into ureters and potentially into the kidneys, sometimes resulting in recurrent UTI’s
What is Wilms’ tumour?
AKA nephroblastoma
Malignant embryonic tumour originating from the developing kidney
What should be avoided in patient with phimosis/paraphimosis?
Forcible retraction
Can cause scarring
What might suggest an atypical presentation of nephrotic syndrome
<1 yrs
Poor response to steroids
What would be seen on light microscopy in a patient with minimal change disease?
Nothing
What would be seen on electron microscopy in a patient with minimal change disease?
Fusion of podocytes and effacement of foot processes
What is used to treat patient with minimal change disease if they don’t respond well to steroids?
Cyclophosphamide/ciclosporin
What would be seen on light microscopy in a patient with post strep glomerulonephritis?
Hypercellular glomeruli
What would be seen on lectron microscopy in a patient with post strep glomerulonephritis
Subendothelial ‘humps’ (immune complex deposition)
What would be seen on immunofluorescence in post strep glomerulonephritis
Starry sky appearance-IgG, IgM and C3 deposits along GBM and mesangium
What might be tested in a patient with likely rapidly progressive GN?
ANCA
What should be monitored in patients on testosterone therapy?
Polycythaemia(effect on erythropoeisis)
Changes in bone mineral density(DEXA scans)
Prostate status
LFTs: synthetic hormones can affect liver status
What is Turner’s syndrome?
Condition only affects females and is caused by either only having one chromosome or a deletion of the short arm of one of the X chromosomes45XO/45,X
Will gonadotrophin levels be high or low in patients with Turner’s syndrome?
High-elevated
What is the triple test(Down’s syndrome)?
14-20 weeks
B-HCG(higher)
AFP(lower)
Serum oestriol(lower)
What si the quadruple test (Down’s syndrome)?
Same as triple test but also includes inhbin A(higher)
What routine follow up investigations should be done for patients with Down’s syndrome?
Regular thryoid checks(2 yearly)
Echo to diagnose cardiac defects
Regular audiometry
Regular eye checks
What is William’s syndrome?
Neurodevelopmental disorder caused by a microdeletion on chromosome
Usually random deletion rather than inherited
What is transient synovitis?
Self-limiting condition characterised by the temporary inflammation of the synovial lining of the hip joint, often resulting in a limp in affected children
Whhat red flags in a child with a limp migh prompt an urgen specialist assessment
Fever
Appears unwell, abnormal observations
<3 years old
What organisms are usually implicated in septic arthritis?
S.aureus-most common
Others: gonococcus, streptococcus spp, gram negative bacillli
What joints are most commonly affect by septic arthritis?
Hips
Knees
Ankle
What might be seen on examinatin of a patient with osgood schlatter
Swelling and tenderness over tibial tubercleI severe: visible/palpable lump at tibial tuberosity
What tests are done in a clinical exam to screen for developmental dysplasia of the hip
Barlow test: attempts to dislocate articulate femoral head(downward pressure on knees through femur to see if it dislocates posteriorly)
Ortolani test(attempt to relocate dislocated femoral head(palms on knees and thumbs on inner thigh and 4 fingers on outer thigh, abduct hips under pressure to see if it will dislocate anteriorly)
What test results would be found in a patient with polyarticular JIA
RF: mostly negativeIf positive: tends to happen more in adolescents and disease pattern more like RA in adults
What test results would be found in a patient with oligoarticular JIA?
Usually normal/mildly elevated inflammatory markers
ANA often positiveRF usuaally negative
What is torticollis?
Painful neck-> local MSK irritation causing pain and spasms in neck muscle
Which leukamia is most common in children?
ALL
Where is a bone marrow biopsy taken from?
Iliac crest
What symptoms indicate Richter’s transformation?
Patients become very unwell suddenly with one of:
Fever with no infection
Weight loss
Night sweats
Nausea
Abdominal pain
Lymph node swelling
Where do metastatic brain tumours that spread to the brain most commonly come from?
Lung-most common
Breast
Bowel
Skin-melanoma
Kidney
What would be seen on histology in a patient with a pilocytic astrocytoma?
Rosenthal fibres(corkscrew eosinophilic bundle)
Where does a medulloblastoma arise from and where does it spread to?
Within the infratentorial compartment-> spreads through the CSF
What would you expect to see on histology in a patient with a medulloblastoma?
Small blue cells
Rosette pattern of cells with many mitotic figures
Where does a neuroblastoma arise from?
Neural crest of adrenal medulla(most commonly) and sympathetic nervous system
When is surgery indicated for a patient with intussusception?
Non-operative management has failed
Child presents with peritonitis or perforation
Child is haemodynamically unstable
When should a PPI be considered for a child with GORD?
Unexplained feeding difficulties( refusing feeds, gagging, choking)
Distressed behaviour
Faltering growth
What part of the CNS is affected by spastic cerebral palsy?
Damage to pyramidal pathways-UMN’s-> increased tone
When should the APGAR score be assessed?
1 minute, and 5 minutes
If low: repeat at 10 minutes
What might a low APGAR score at 5 minutes be associated with?
Cerebral palsy
When does surfactant production start and when does it reach adequate levels?
Starts at 26 weeks
Adequate levels at about 35 weeks
What is transient tachypnoea of the newborn?
Parenchymal lung disorder characterised by pulmonary oedema caused by delayed resorption and clearance of total alveolar fluid
Mc cause of respiratory distress in term babies
Why do normal term babies often get transient hypoglycaemia?
Common in first few hours after birth
Can utilise alternate fuels like ketones and lactate so no sequelae
Which side is gastroschisis most common on?
Right side
Which organs are usually implicated in gastroschisis?
Usually small intesine
Rare: stomach and liver too
Which is associated with a higher mortality rate: exompahlos or gastroschisis?
Exomphalos
What is VACTER syndrome?
Verterbal defects
Anorectal malformations
CVR defects
Tracheo-oesophageal defects
Oeophageal atresia
Renal abnormalities
Why does necrotising enterocilitis affect premature infants?
Lack of defence mechanisms in bowels(gastric acid and digestive enzymes)
What would be seen on an abdominal x-ray in a patient with necrotising enterocilitis
Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis(intramural gas)
Pneumoperitoneum(indicator of severe disease-Rigler sign or Football Sign)
What staging system is used to classify necrotising enterocilitis
Bell’s classification
When is jaundice considered normal/pathological in newborns?
First 24 hours-ALWAYS pathological
2-14 days: common and usually physiological
>14 days: prolonged jaundice-should be investigated
What might a raised conjugated bilirubin level in a neonate suggest
Biliary atresia-> important differential
Rule out with USS/
What is toxoplasma gondii and how is it transmitted?
Protozoan parasite
Consumption of undercooked meats or exposure to cat faeces
What is the treatment for congenital CMV infection?
gangiciclovir
What problems might someone with a cleft lip/palate experience?
Feeding: orthodontic devices
Speech
Increased risk of otitis media
What might be done for pregnant women with a known GBS infection?
Offer intrapartum IV antibiotic propylaxis -penicllin
What would be seen on EEG of a patient with Lennox Gastaut syndrome
Slow spike
What would be seen on EEG in panayiotopoulos syndrome?
Multiple shifting foci predominantly in the occipital region
What would be seen on EEG of a patient with benign rolandic epilepsy
During sleep: centro-temporal spikes
When is it a red flag for a child tp not fix and follow light/face?
3 months
Where does neuroblastoma most commonly metastasise to?
Bone
WHat kind of tumour is a Ewing’s sarcoma?
Primitive neuroectodermal tumour
Which bones are affected by Ewing’s sarcoma
Limbs-mc
Pelvis
Ribs
Vertebrae
What staging system is used to classify Hodgkin’s lymphoma?
Used to be Ann Arbor staging
Now Lugano classification
What is von Willebrand disease?
Inherited bleeding disorder characterised by a reduced quantity or function of Von Willebrand factor
When is the neonatal blood spot screening performed?
5-9 days of life
When do beta thalassaemia major patients become symptomatic?
Levels of HbF(doesn’t contain beta globin) fall
Should be replaced by HbA(2 alpha and 2 beta globin chains) but no beta globin in beta thalassaemia major
What monitoring is required for patients with beta thalassaemia
Ferritin 3 monthly
Annaul assessment of cardiac, liver, endocrine, audiology and ophthalmology
What screening is done for thalassaemia in the UK?
Maternal MCH<27pg, iron studies and HPLC If negative, DNA studies/analysis to look for alpha thalassaemia if pregnant woman and baby’s father are from ‘at risk’ parts of the world
During pregnancy allows option for therapeutic abortion of affected fetus
What screening is available in the UK for sickle cell?
Most cases are picked up on in newbon screening programme
Screening offfered during pregnancy
What kind of hypersensitivity reaction is ITP?
Type 2
When would a bone marrow biopsy be done for ITP?
Atypical features:Lymphadenopathy/splenomegaly/changes in WCC
Failure to resolve/respond to treatment
Used to rule out malignancy
Why are platelet transfusions only a temporary measure in ITP?
Circulating antibodies will destroy the platelets-> giving more will increase rate of platelet destruction
What is thrombotic thromocytopenic purpura?
Disorder caused by abnormally cleaved vWF due to abnormal ADAMST13 activity->platelet aggreagation, thrombus formation and systemic microangiopathy
What is thelarce?
First stage of breast development
Which is more common and which is more concerning: precocious puberty in females or males?
Mc in females
More concerning: males-usually has an organic cause
What might be needed in a salt-losing crisis in patients with congenital adrenal hyperplasia?
Fluids
Sodium chloride replacement
When should invesigations be considered in children with obesity?
BMI>98th centile
Waist: height ratio >0.5
What should be investigated in children with obesity?
Associated comorbidities
BP
Fasting lipid profile, insulin and glucose levels
Liver and endocrine function
Pubertal status assessment
Psychological assessment
What might be seen on physical exam of a patient with pica
Signs of nutritional deficiencies->pallor, spoon-shaped nails etc)GI sx->perforations, obstructions
Dental erosions/abrasions
Psychiatric sx: ASD, OCD sx
When should a referral be made to dermatology for eczema?
Severe and not responded to optimum topical tx after 1 week(urgent referral)
Dx uncertain
Current management not working
Tx resistant facial eczema
Contact allergic dermatitis suspected
When would you consider an ENT referral for allergic rhinitis
Red flag features suggesting an alternative/serious diagnosis
Refractory cases
Allergen testing is needed
What is urticaria?
(Hives) rapid development of itchy erythematous raised wheals that may vary in shape and size
Typically resolve in hours to days
Can occur anywhere in the boday
When might a referral to derm/immunology be considered for urticaria
Painful /persistent-vasculitis
Not wwell controlled
Angioedema and no wheals that don’t respond
Acute severe due to food/latex allergy
Chronic inducible urticaria-solar/cold urticaria
What provides evidence of a recent strep infection in rheumatic fever
Raised/rising strep antibodies
Positive throat swab
Positive rapid group A streptococcal antigen test
What secondary prophylaxis might be used for patients with rheumatic fever
Those who have carditis and persistent valve disease
Prophylactic abx to prevent recurrence of rheumatic fever: phenoxymethylpenicllin
When is congenital heart block most likely to develop?
Between 18th and 25th week gestatioin
Prenatal scans: fetal bradycardia-reduce risk of progression from first/second degree heart block to complete heart block
What things would you look at to assess dehydration in a child?
General appearance-confidence
Eye: sunken
Mucous membranes: dry
Tears: absent
Skin turgor
HR, Resp rate, cap refill, BP
Urine output
Weight loss
What would be seen on colonoscopy with biopsy in a patient with Crohn’s disease
Skip lesions
Cobblestone mucosa
Rose thorn ulcers
Non caseating granulomas
What should be done before starting a patient on biologics therapy like infliximab
CXR: check for TB as can reactivate latent TB
When might surgery be used in treatment of Crohn’s disease
Control fistulae
Resection of strictures
Rest/defunctioning of bowel
What is ulcerative colitis?
Chronic relapsing remitting inflammatory disease that primarily affects the large bowel
Affects rectum first then extends to part of colon then whole colon
Does not spread beyond ileocaecal valve or to small bowel
What would be seen on colonoscopy and biopsy and barium enema in a patient with Ulcerative colitis
ColonoscopY: continuous inflammation starting at rectum that doesn’t go beyond submucosa
Biopsy: loss of goblet cells, crypt abscesses, lymphocytes
Barium enema: lead-piping inflammation and pseudo polyps
What symptoms might a B12 deficiency cause in children?
Anaemia
Peripheral neuropathy
What symptoms might zinc deficiency cause?
Dermatitis
Increased infections
What might a vitamin C deficiency cause?
Scurvy
What is toddler’s diarrhoea?
Chronic non-specific diarrhoea usually in 1-5 yr olds
What should be prescribe for breastfeeding mother’s eliminating cow’s milk protein from their diet?
Calcium supplements
Why do children with neonatal hepatitis get FTT?
Decreased intestinal bile flow->imapired fat digestion+vitamin absorption
How should pulses be checked in children and infants?
Carotid pulse: children >1yr
Brachial/femoral: infants
