Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

year 3 > Paediatrics: Part 2 > Flashcards

Paediatrics: Part 2 Flashcards

1
Q

What structures produce ADH

A

Suproptic and paraventricular nuclei of the anterior pituitary gland -> stored in posterior.

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

Role of ADH

A

Causes re-absroption of water at the collecting ducts and vasoconstriction (i.e., vasopressin!)

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

What receptor does ADH bind o and what happens

A

V2, causes aquaporins to embed into the cell membrane, only allowing water to move back into the blood to improve blood osmolality

This makes urine more concentrated

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

What is Diabetes Insipidus

A

When too little water is re-absorbed from the urine. Leads to polyuria

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

Why do we get polydipsia in diabetes insipidus

A

Because of reduced osmolality in the blood, causing osmoreceptors to stimulate the thirst centre in the medulla.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Central Diabetes Insipidus vs Nephrogenic Diabetes

A

Lack of ADH -> Central Diabetes Insipidus

REDUCED ADH response by the kidneys -> Nephrogenic Diabetes

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

What structures contribute to central diabetes inspidus

A

Hypothalamus can’t produce ADH

Pituitary gland can’t store ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of central diabetes insiipidus

A
  1. Pituitary Tumours
  2. Head Trauma
  3. Head Surgery
  4. Ischaemic Encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes nephorgenic Diabetes Insipidus

A

More often than not, Hereditary Genetic defects in receptors.

Lithium - Reduces production of aquaporin proteins in collecting duct

Hypokalaemia

Hypercalcaemia

Demeclocycline (aquaporine receptor antagonist)

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

Symptoms of Diabetes Inspidius

A
  1. Polyuria (>3L of dilute urine/day)
  2. Polydipsia

Increase in plasma osmolality: Fatigue, nausea, poor concentration and confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to diagnose DI

A
  1. Blood osmolality Test (>290)
  2. Urine specific Gravity <10006 (too dilute)
  3. Low Hyperosmotic volume concentration
  4. Water Deprivation Test to measure hourly measurements of urine volume (osmolality will stay dilute <300)
  5. Desmopressin test: Causes an increase in urine osmolality by 50% (central), if no change (nephrogenic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Central vs nephrogenic

A

Low ADH vs Normal or High ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of central DI

A

Desmopressin and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of nephrogenic DI

A
  1. Thiazide Diuretics to get rid of Na+

2. Or Amiloride (potassium sparing)

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

What is SIADH

A

The body makes too much ADH

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

What causes SIADH

A
  1. Ectopic ADH secretion from small cell lung carcinoma
  2. CNS surgeryy or head trauma that releases all stored ADH in pituitary gland.
  3. Pneumonia, COPD
  4. Cyclophosphamide (increases ADH receptors on principal cells)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pathophysiology caused by SIADH

A
  1. Increase in ADH = Increased water reabsorption

ECF expands and water moves into ICF to correct but ECF still has a lot of extra cellular fluid = dilution hyponatraemia (Na+ amount is normal but in larger fluid) = euovolaemic hyponatraemia.

NO oedema as. Na+ is the same.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Impacts of SIADH on the body

A
  1. Increased blood volume and pressure
  2. More ANP or BNP to dilate BP and improve GFR to excrete water and Na+
  3. Reduced Renin release from kidneys = less aldosterone and angiotensin 2 to reduce sodium and water reabsorption

Cerebral oedema and Seizures = most important complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnosis of SIADH

A
  1. Hyponatraemia
  2. Reduced serum osmolality
  3. Increased urine osmolality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to treat SIADH

A
  1. Tolvaptan which antagonises vasopressin receptors.
  2. FLuid Resus and IV hypertonic saline.

SLOWLY to prevent osmotic demyelination syndrome.

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

What food can cause red urine

A

Beetroot

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

What drug may cause red urine

A

Rifampicin

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

What is proteinuria in children

A

Over 0.15g/24hrs

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

What threshold defines a UTI

A

> 10 ^ 5 microorganisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Clinical features of UTIs in infants
1. VOmiting or diarrhoea 2. Poor feeding/failure to thrive 3. Prolongued Neonatal Jaundice
26
Upper vs lower UTI symptoms
1. Fever, vomiting and loin pain vs dysuria, frequency, mild abode pain and enuresis.
27
Treatment of UTIs in children
Trimethoprim
28
What is the antiobiotic prophylaxis for recurrent UTIs
Trimethoprim oral
29
What is vesicoureteric reflux
1. The retrograde flow of urine from the bladder into the upper urinary tract
30
What causes VUR
1. Post surgery or congenital
31
What are the grades of vesicoureteric reflux
1. Ureter 2. Ureter, pelvis and calyces but no dilatation 3. Mild dilation but no blunting of fornices IV: obliteration of sharp angle of fornices
32
How to diagnose vesicoureteric reflux
1. Micturarting cystourethrogram (urinary etherisation and radio contrast medium) 2. Indirect Cystogram (scan)
33
Surgical treatment for VUR
STING, however they often spontaneously resolve.
34
Pre-Renal causes of AKIs
1. Hypovolaemia (e.g., gastroeneritis, DKA or haemorrhage) 2. Nephrotic syndrome 3. Peripheral vasodilation (sepsis) 4. Drugs (ACE inhibitors)
35
Renal causes of AKIs
1. Acute tubular necrosis 2. Interstitial nephritis 3. Glomerulonephritis 4. HUS 5. Cortical necrosis 6. Pyelonephritis 7. Nephrotoxic drugs (NSAIDs) 8. Tumour lysis syndrome 8. Renal artery thrombosis
36
Post-renal causes of AKI
1. Obstruction 2. Calculi 3. Tumours (rhabdomyosarcoma) 4. Neurogenic bladder 5. Post urethral valves
37
Investigations for AKIs
1. Urinalysis with microscopy, cut,ture and protein:creatinine ratio Myoglobin in urine (rhabdomyolysis) Cultures: Stool E.Coli Throat swab Radiology: US Kidneys and bladder
38
Complications of AKIs
1. Hyperkalaemia 2. Metabolic Acidosis 3. Hypertension 4. Shock 5. Fluid Overload 6. Hypocalcaemia 7. Hyponatraemia
39
How are fluids managed in AKIs
1. Furosemide Monitor Electrolytes at least 12-hourly until stable
40
Indications for Dialysis
1. Severe Heyperkalaemia 2. Urea > 40 mmol/L 3. Rising urea and creatinine 4. Encephalopathy.or seizures 5. Untronctrolled Han 6. Symptomatic fluid overload (cardiac failure)
41
What is the NICe criteria for detecting cute kidney injury
3. Fall in urine outpiut to less than 0.5ml/hr for over 8 hours in children 4. a 25% fall in children egfr over past 7 days
42
When should children be referred for renal replacement therapy
1. Hyperkalaemia 2. Metabolic acidosis 3. Symptoms or complications of uraemia 4. Fluid Overload 5. Pulmonary Oedema
43
Haemodialysis vs peritoneal dialysis
1. Blood is pumped out of body vs using the inside lining of your own belly as a filter.
44
What artery is used in haemodialysis
Femoral or jugular
45
What are the stages of CKD
1. >90 GFR and kidney damage with/without increased GFR 2. 60-89 3. 30-59 4. 5-29 5. <15 mL/min/1.73 m^2
46
Formula for GFR
40 * height (cm) / creatinine (mmol/l)
47
Congenital causes of CKD
1. Renal dysplasia 2. Obstructive uropathies 3. Vesicoureteric reflux nephropathy
48
Hereditary causes of CKF
1. PCKD 2. Nephronophthisis 3. Hereditary Nephritis 4. Cystinosis 5. Oxalosis
49
What are hypospadias
Where the meatus is on the bottom of the urethra.
50
Three types of hypospadias
1. Glanular 2. Midshaft 3. Penoscrotal
51
Clinical presentation of hypospoadias
1. Foreskin appears as a dorsal hood and not circumferential;; 2. Chordee (penis has a hook shape) 3. Inguinal hernia 3. Crytptorchidism (absence of testes from the scrotum) Painful urination, recurrent UTIs, sexual dysfunction and infertility.
52
Investigations for hypospadias
1. Excretory Urogram (Rotation anomalies of kidneys, mental stenosis or vesicoureteral reflux) 2. USS 3. Endoscopy of the urethra to discard urethral anomalies
53
How are hypospadias treated
1. Constructing a new urethra using shaft skin 2. Hormone Therapy (mircopenis) SHOULD NOT UNDERGO CIRCUMCISION
54
What are Epispadias
1. Urethral opening is on the top of urethra
55
What causes epispadias
6th week of gestation: Genital Tubercle grows in a posterior direction (rectally than cranially)
56
Three types of epispadias
1. Penopubic (most severe) 2. Penile 3. Glanular
57
Clinical presentation of epispadias
1. Bladder Exstrophy (incomplete closure of abdomen, we can see th balder) 2. Micropenis 3. Displaced anus and incontinence 4. Vesicoureteral reflux
58
Treatment of Epispadias
Urethroplasty
59
What causes gross haematuria
1. UTIs 2. Irritation of meatus and trauma Nephrolithiasis, SCD, Postinfetcious glomerulonephritis
60
What causes microscopic haematuria
1. Glomerulopathies 2. Hypercalciuria 3. Nutcracker syndrome
61
What is Nutcracker syndrome
Compression of the left renal vein
62
What can cause transient Haematuria
UTIs Truma Fever Exercise
63
What would we consider as the underlying pathology if there was unilateral flank pain radiating to the groin
Obstruction
64
What would the underlying pathology be if a patient presented with flank pain, fever, dysuria and frequency or urgency
Pyelonephritis
65
Where is the haematuria organ if bleeding is happening at the same time as urination
Urethral bleeding
66
Where is the haematuria origin if bleeding is continuous
Bladder, ureter or kidneys
67
Where is the haematuria origin if the bleeding is at the end of urinagtion
Bladder Disease.
68
What is free haemoglobin in urinalysis indicative of
Rhambdomyolysis
69
What would show up on a urinalysis for glomerular bleeding
1. Damaged RBCs | 2. Protein excretion > 100 mg/m^3
70
What would show up on a urinalysis for an extraglomerular disease
1. Urinary RBCs undamaged
71
If the urine culture is negative, what organism could cause UTIs
Adenovirus
72
GOLD standard for nephrolithiasis
Renal USS: Radiopaque stones But misses out uric acid stones, small stones and obstructions
73
What blood test is used to check for post streptococcal glomerulonephritis
Serum C3 raised
74
Examination of congenital uteropelvic junction obstruction
CAUSES hydronephrosis: Palpable abdo mass, UTIs Haematuria Failure to thrive Older children: Intermittent flank pain or abdominal pain Nausea and Vomiting Low Urine Output
75
What diagnostic scan is used to check for hydronephrosis
USS during Dietl's crisis (pain) as dilated renal pelvis causes the abdo pain Diuretic Renography Voiding Cystourethrography
76
What would be seen in a USS for hydronephrosis
Dilated Renal Pelvis w/ collapsed proximal ureter.
77
What is the diruetic venography
Measures washout time, if it takes more than 20 mins = obstruction Blood tests: CBC, Coagulation profile, electrolyte levels and BUN and serum creatinine
78
How to treat hydronephorsis
Pyeloplasty
79
What is an ectopic ureter
Abnormal posterior insertion o the ureter
80
Where can the ectopic ureter insert
Females: Bladder neck, upper urethra, vaginal vestibule or vagina Males: Lower urinary bladder, posterior urethra, seminal vesicles, ductus deferent and ejaculatory duct
81
Presentation of ectopic ureter
1. Epididymo-orchitis 2. Sense of urgency 3. Flank pain 4. UTIs Never present with inctoninence as ectopic ureter is proximal to the external urethral sphincter. Female: Urinary incontinence UTIs Urinary Obstruction
82
Diagnostic for ectopic ureter
1. Renal USS, ureter dilated and abnormally low. | 2. CT or MRI w/ contrast to pinpoint location of the ureter.
83
Diagnosis of Vesicocureteral reflux
Voiding Cystourethrogram
84
What causes vesicoureteral reflux
Usually intravesical ureter is tight by surrounding bladder muscles, stopping it from going back up into the kidneys Congenital short intravesical ureter or abnormally high voiding pressure like posterior urethral valves stop this from happening.
85
Clinical Presentation of vesicoureteral Reflux
1. Recurrent UTIs 2. Urgency 3. Burning sensation when urinating 4. Decreased Urine Output 5. Haematuria
86
What are posterior urethral valves
1. Where the membranous folds within the lumen of the posterior urethra narrow the exit of urine = UTIs and Hydronephrosis
87
Clinical presentation of posterior urethral valves
``` MALES: Urgency Flank Pain Diffiiculty with Voiding Abdominal Distention Resp distress, nausea and vomiting UTIs ```
88
Diagnosis of posterior urethral valves
Voiding Cystourethrogram: Dilated and Elongated Posterior Urethra. Cystoscopy for direct observation of the valves.
89
treatment of Posterior urethral Valves
1. Temporary drainage using a catheter.
90
Most common cause of UTIs
E. coli
91
treatment of pyelonephritis or complicated UTI
1. trimethoprim
92
What is the initial medical treatment of Nocturnal Diuresis
Desmopressin over 7 weeks
93
Indications for desmopressin
If rapid onset or an alarm is inappropriate
94
What is the first line management for nocturnal diuresis
Setting up an alarm as a reward system (wake up when the alarm goes off, go toilet and reset the alarm when your back)
95
What protein levels distinguish nephritic syndrome and nephrotic syndrome
Nephritic: 1-3.5 g/day Nephrotic: >3,5 g/ day
96
Signs and symptoms of nephritic syndrome
1. Peripheral Oedema 2. Perioriibatal oedema 3. HTN 4. Oliguria.
97
Lab tests for nephritic syndrome
1. Glomerular Haematuria 2. Proteinuria 24-hr protein test: 1-3g a day
98
What is rapidly progressive Glomerularnephritis
A rapid decrease in the gFR rates over 3 months
99
Clinical Presentation of Rapidly progressive glomerulonephritis
1. Fatigue 2. Peripheral Oedema 3. Gross Haematuria 4. HTN 5. Decreased Urine Output
100
Signs of nephrotic syndrome
1. Peiprheral and periorbital oedema 2. Ascites 3. Pleural effusion 4. HTN
101
Signs and symptoms of nephrotic syndrome
1. Hypoalbuminaemia 2. Hyperlipidaemia 3. High LDLs and Triglycerides 4. Lipiduria
102
What tests are done for Poststrep glomerulonephortis
1. Antistreptolysin - O 2. Anti-Hyaluronidase 3. Anti-Streptokinase 4. Anti-NAD 5. Anti-DNASE B Antibodies All raised apart from Antri streoptokinase 6. C3 and C4 as these are low, these immune complexes deposit in the sub epithelial space causing inflammation
103
Signs of IGA Nephropathy (nephritic syndrome)
1. Gross Haematuria 2. Flank Pain Accompanied with Acute Upper Respiratory Tract Infections
104
What can be seen on a Kidney Biopsy for IgA Nephorpathy
1. Light Microscope: Mesangial Proliferation | 2. Immunofluorescence and Electron Microscopy: IgA Deposits
105
Extraglomerular signs of IgA Nephropathy
1. Symmetrical Rash 2. Palpable Purpura 3. Migratory Arthritis 4. GI (nausea, vomiting and Abdominal Pain) This is IgA vasculitis
106
What is Alport Sydnrome
Genetic Condition: Renal Failure + Hearing Loss
107
Symptoms of Alport Syndrome
Anterior Lenticonus (anterior part of the lens is conical)
108
Test for alport syndrome
1. C3 - Normal 2. C4 - Normal 3. ANA Antibodies - Neg If low, usually the following: C3 glomerulopathy and Lupus Nephritis - need to be rules out Then genetic testing
109
Treatment of Nephritic Syndrome
1. ACE Inihbitors 2. ARBs: Losartan 3. Furosemide
110
Why is Nifedipine given in post strep glomerlonephritis instead of an ACE Inhibitor
As ACE Inhibitors can cause hyperkalaemia
111
Indications for harm-dialysis in Nephritic syndrome
Volume overload Hyperkalaemia Uremia
112
How is Post strep part of glomerulonephritis treated
Oral Penecillin
113
Treatment of IgA Nephropathy
Glucocorticoids in those with declining eGFR, proteinuria <1 g/ day even when on ACEi, Active disease (proliferative changes in the glomerulus) IV Methylprednisolone 3 days or Oral Prednisolone (2 months and reduced)
114
Treatment of Rapidly Progressive Glomerulonephritis
1. IV Methylprednisolone | 2. Oral Prednisolone or Oral Cyclophophasmide
115
How is IgA Vasculitis treated
1. Naproxen and bed rest | 2. Oral Prednisolone if pain is persistent
116
If Proteinuria > 0.75 g / day, nephroyoc syndrome or rapidly progressive glomerulonephritis, what should be done
IV Methylprednisolone, Oral Prednisolone for 6 months
117
Treatment fo aport syndrome
ACEi or ARBs. for poretinuria
118
What diseases can cause nephrotic syndrome
1. DM 2. HIV 3. Hep B 4. Hep c 4. SLE 5. APL
119
What agent causes acute glomerulonephritis
Staph aureus and salmonella
120
What is the most common nephrotic syndrome seen in children
Minimal Change Disease
121
What is minimal change disease
The negative charges on the foot processes of podocytes stop immunoglobulins from getting through but allows albumin to be lost = minimal change disease as effacement to the membrane can't be seen on light microscopy
122
What is minimal change disease associated with
Idiopathic but associated with Hodgkin's lymphoma
123
Diagnosis of minimal change disease
Electron microscopy to see effacement of foot processes
124
Treatment of minimal change disease
Corticosteroids
125
What triggers haemolytic uraemia syndrome
An episode of bloody diarrhoea
126
What usually causes HUS
E.coli
127
Pathophysiology of HUS
1. E coli attaches to intestinal wall and secretes shigella-like toxin 2. Aborbes by intestinal blood vessels and picked up by eosinophils 3. Taken.to the kidneys to be excreted 4. Endothelial cells have Gb3 receptors with high affinity to shigella-like toxin 5. Shigella-like toxins enters cell preventing aminoacyl-tRNA from binding to the ribosome = NO PROTEIN SYNTEHSIS and APOPTOSIS 6. Then we get thrombotic Thrombocytopenia purpura: Clots form inappropriately from vWF: ADAMTS13 is not active and does not cleave vWF, causing lots for no reason including the kdineys.
128
What is Atypical HUS
No initial diarrhoea, caused by endothelial cell damage or medications or autoimmune causes
129
Triad of findings in HUS
1. Microangiopathic Haemolytic anaemia 2. Thrombocytopenia 3. Acute renal failure
130
What is microangiopathic haemolytic anaemia
Damage caused by platelets which act as boulders. RBCs move over the platelets and disintegrated and are haemolysed. This results in anaemia as there are reduced RBCs. Symptoms of Anaemia Thrombocytopenia purport can cause blood clots in brain (strokes, seizures and fever)
131
Diagnosis of HUS
1. Schisocytes on blood smear (broken down cells from the boulder)
132
Treatment of TTP HUS
Plasmapharessis
133
Treatment of HUS
Supportive
134
Lymphadenopathy in lymphomas vs infections
Infections: Tender and mobile Lymphomas are fixed and non tender
135
Diagnosis of lymphomas
Complete excision and microscopy of the lymph node
136
What cells differentiate between Hodgkin and non-hodgkin lymphomas
Reed-Sternberg cells
137
Properties of reed-sternberg cells
Bilobed nucleus with clear space surrounding it
138
What is the name of th staging system in lymphomas
Ann Arbour Staging System
139
Describe the Ann arbour staging system
1: 1 lymph node 2: Multiple lymph node regions on 1 side of the diaphragm 3: Multiple lymph nodes on both sides of the diaphragm 4: Metastasise to other organs
140
In what stages are Hodgkin's lymphomas seen
Stage I or II
141
In what stages are non-hodgkin's lymphomas seen
Stage III or IV
142
Where do Hodgkin's lymphoma arise from
B-Cells in germinal center
143
Onset of Hodgkin's lymphoma
2 peaks: 15-30 50+
144
What is classical vs non-classical Hodgkin's lymphoma
Classical: Reed-Sternberg cells (CD15 and CD30) Non-Classical: Popcorn cells (CD20 + CD45 positive)
145
What lymph nodes are primarily affected in Hodgkin's lymphoma
1. Cervical 2. Axillary 3. Mediastinal
146
Symptoms of Hodgkin's lymphoma
1. PEL EBSTEIN FEVERS Mediastinal: Cough and SOB by pressing against airways Hoarseness Superior Vena Cava Syndrome Pleural Effusion MINIMAL CHANGE DISEASE
147
Treatment of stage I and II hodgkin's
ABVD
148
Treatment of stage III and IV
BEACOPP
149
Treatment of popcorn cells
Rituximab
150
Difference between lymphadenopathy of Hodgkin's and non Hodgkin's lymphoma
Hodgkin's: Cervical ,mediastinal and axillary Non-hodgkin's: Disseminated
151
Most common type of non-hodgkin's lymphoma
Large B cell LYMPHOMA
152
Name four types of non Hodgkin's lymphoma
1. Large diffuse B cell lymphoma 2. Follicular B cell lymphoma 3. Burkitt Lymphoma 4. Mantle cell lymphoma 5. Marginal Zone Lymphoma
153
Which lymphoma can happen secondary to sjogre syndrome and H. pylori infection
Marginal Zone Lymphoma (non Hodgkin's)
154
treatment of non-hodgkin's lymphoma
R-CHOP
155
What cells form wills tumours
Metanephric blastemal cells
156
Role of metanephric blastemal cells
Used in kidney development
157
What gene is involved in films tumours
11p13 - code for WT1 Mostly idiopathic causes of mutations
158
What is WAGR syndrome
Sometimes in film's tumour, deletion of WT1 causes neighbouring PAX6 gene to also be lost: Wilm's tumour GU malformations Aniridia (no iris) mental Retardation
159
What is Denys-Drash Syndrome
Deletion of neighbouring genes in films' tumour causes early onset nephrotic syndrome and male pseudohermaphroditism
160
What is Beckwith Widemann Syndrome
Deletion of WT1 causes neighbouring gene WT2 to be lost: Wilm's tumour Macroglossia Organomegaly Hemihypertrophy
161
What do metanephric blastemic cells differentiate into
Stromal and epithelial cells
162
What structures are seen in a film's tumour mass
Abortice structures of the nephron: tubules and glomerulus
163
What is a triphasic blastoma
Where blastemal, stroll and epithelial cells are all seen in the mass
164
Clinical presentation of films' tumour
1. HTN 2. Flank mass that's unilateral 3. Haematuria
165
Treatment of film's tumour
1. Nephrectromy and Chemo
166
Clinical presentations of retinoblastomas
1. LEUKOCORIA/ WHITE PUPILLARY REFLEX(abnormal white reflection from the eye) 2. Strabismus (eyes pointing in different directions) 3. Red Eye, tearing, corneal clouding, discolouration of the iris, and hyphema/glaucoma RED FLAG SYMPTOMS
167
What ocular examinations would be done for a retinoblastoma
1. Red Reflex Test (absent) 2. Visual Acuity Tests (decreased) 3. Slit Lamp Examination (ciliary injection or glaucoma) 4. Fundoscopy of both eyes under anaesthesia 5. Dilated fungus examination 6. A and B scan USS for tumour height and thickness, retinal detachment and clarification
168
What would an A scan show
Variable reflectivity
169
What would a B scan show
Mass filling the globe with calcification
170
Why would MRI be needed in a retinobalstoma
Optic Nerve Involvement | 2. Extraocular extension
171
Treatment of retinoblastoma
1. Enucleation: Systemic Chemotherapy with focal consolidation Intraarterial chemotherapy Cryopexy/ laser photocoagulation n AVOID RADIOTHERAPY
172
What cells make up neuroblastomas
Neural Crest Cells
173
Role of neural crest cells
Development of the sympathetic nervous system
174
What is the most common cancer in infants (under 5)
Neuroblastoma
175
What do neural crest cells do in the 5th week of life
They migrate from the cranial end down the spine and start differentiating into the sympathetic ganglions. Also differentiate into: Adrenal Medulla
176
Where do neuroblastoma typically develop
In the adrenal medulla (but can happen anywhere along the sympathetic chain)
177
What cells are founding an undifferentiated neuroblastoma
Mostly Neural Crest Cells (Small Round Blue Cells, little cytoplasms and large nuclei)
178
What structures are specific to poorly differentiated neuroblastomas
Neuropils (bright red network of nerve fibres) More cytoplasm
179
What structures are found specific to differentiating neuroblastomas
1. LOTS OF CYTOPLASM Shwann Stroma (Myelin ingredient)
180
Why do neuroblastomas metastasise so easily
Because they are highly sensitive to CXCL12 cytokines, and migrate to different organs when they sense them (lumph nodes, liver, bones and marrow)
181
Symptoms of neuroblastomas
1. Fever 2. Weight Loss 3. Sweating 4. Fatigue from cytokine release Location: Thorax: grows into lungs - sob Neck: presses on facial nerves (horners syndrome) Spine: Muscle weakness, bowel and bladder problems Adrenal Medulla: Painful abdo mass Bone Marrow: Fatigue, easy bruising and infecions
182
Most common metastasis site for neuroblastoimas
Bones = fractures at the base of the skull! Causes perirobital ecchymosis as fluid builds around the eyes.
183
Diagnosis of neurbolastoma
Serum HMA and VMA (breakdown products of noradrenaline and adrenaline) CT for location and size MRI CBC: bone marrow metastasise
184
Treatment of neurbolastoma
1. Surgery, chemo, medication
185
Which neurbolastoma type has the best prognosis
Differentiating neuroblastoma
186
Name two bone tumours that primarily affect young children
Osteosarcoma Ewing's Sarcoma
187
Presentation of osteosarcoma and Ewing's Sarcoma
1. Dull Pain that isn't improved by NSAIDs 2. Pain is worse at NIGHT 3. Site is swollen and fractures after minor trauma
188
On what bone are osteosarcoma's typically found
Femur and Tibia: The metaphysics
189
On what bone are Ewing's sarcomas found
Diaphysis on the pelvis and femur But may affect spine, chest wall and femur too
190
Where do osteosarcomas and Ewing's sarcomas commonly metastasise to
Lungs (have a cough or dyspnoea)
191
What tissue do osteosarcomas derive from
Neuroectodermal Tissue
192
Investigation findings in osteosarcomas
X Ray: Medullary and cortical destruction Moth -eaten appearance Soft tissue sunburst ossified Codman's triangle (new subperiosteal bone)
193
Lab Test results in osteosarcomas
1. Increased Alkaline Phosphatase (high is poor outcome) and LDH
194
What lab test is checked to see is osteosarcoma therapy is effective
Declining Alkaline Phosphatase rates
195
Treatment of Osteosarcoma
MAP Methotrexate Doxorubicin Cisplatin Surgery More MAP
196
Characteristic radiograph finding in Ewing's Sarcoma
Osteolytic lesions (onion appearance) sharpens fibers (hair on end appearance) Codman's triangle
197
What is Syndeham Chorea
A neurological presentation of rheumatic fever (rapid involuntary movements)
198
What is PANDAS
An Obsessive Compulsive Tic Disorder
199
What infection usually causes PANDAS
Strep A infections (alongside Syndeham chorea, rheumatic fever and glomerulonephritis)
200
What organism usually causes infections in kids from Cats
Bartonella Henselae
201
What is the first line test that should be done in neonatal jaundice and why
Coombs test: If positive, indicates that Rh incompatibility which may be causing haemolytic (antibodies against erythrocytes) If negative: Shows twin to twin transfusion or mother/feotus transfusion (physiological jaundice)
202
What a febrile seizures
These happen between 6 months to five years following a febrile illness (e.g., respiratory tract infection). These are single epsiodes that subside very quickly. However, under 18 months do a lumbar puncture to exclude meningitis
203
What is galactosemia (breast milk jaundice)
A deficiency in GLP, which stops the conversion of galactose to glucose. Milk contains galactose so causes an abidance of these and results in jaundice, failure to thrive, hepatomegaly
204
What is distinctive about breast milk jaundice
Infantile Cataracts
205
What infection is likely to be obtained from plants
Rhus dermatitis, fluid-filled vesicles (type of contact dermatitis from poison ivy, poison sumac and poison oak).
206
A common side effect of the MMR vaccine
A measles-like rash 10-14 days after vaccination, it's non infectious and harmless.
207
E.coli and Cholera vs Shigella
Shigella infection also arises from hand-to hand routes unlike the others which are facet-oral. E.coli causes water diarrhoea while shigella and salmonella cause bloody diarrhoea.
208
What is a complication of HUS
DIC, it is known to complicate HUS.
209
What is Dandy-Walker Syndrome
A congenital brain malformation in which the cerebellar vermis is missing and there is cystic dilation of the fourth ventricle . Causes increased head circumference, bulging fontanelle and problems with nerves controlling the eyes, face and neck.
210
What is fifth disease (erythema infectious)
TWO Presentations: Slapped Cheek Appearance on the face OR Lacy, macular truncal rash the rash does not bother the patient And B symptoms
211
What causes fifth disease
Parvovirus B19
212
Where does fifth disease commonly spread
In daycare (nurseries)
213
What is ITP
It is a transient condition that follows a viral illness/
214
What characterises ITP
THROMBOCYTOPENIA with or without cutaneous bleeding in an otherwise well patient.
215
What is Sturge-Weber SYndrome
A seizure in a child with a unilateral facial birthmark
216
N gonorrhoea infection vs c trachematis infections in children
Gonnorheoa symptoms show up in the first three days vs 5-14 days in chlamidyia.
217
What is the most common cause of acute scrotal swelling in children
Torsion of testicular appendage (mimics epidiymitis as the appendage is above the testes and swells).
218
Where are intracranial germinomas predominantly found
The pineal region or third ventricle (midline of the brain)
219
What is the most common type of pinealoma
Intracranial germinomas
220
Symptoms of a pinealoma
Obstructive hydrocephalus | Parinaud Syndrome
221
What is Parinaud Syndrome
Vertical Gaze and Convergence sight disabilities
222
What CSF levels are elevated in intracranial germinomas
AFP and B-HCG
223
What is Focal Segmental Glomerulosclerosis
Only some glomeruli are affected, and just some of them are diseased = Nephrotic syndrome.
224
What is Leukaemia
Cancer of Bone Marrow Progenitor Cells that spreads into the blood stream
225
How does Leukaemia affect WBC
> 11 x 10^9 cells/Litre
226
Four cells arising from myeloid progenitor cells
1. Basophils 2. Eosinophils 3. Neutrophils 4. Mast Cells
227
Three cells arising from Lymphoid cells
1. T Cells 2. B Cells 3. NK Cells.
228
Role of Basophils
Release histamines during an allergic or asthmatic reaction
229
Role of eosinophils
Recognition cells of PAMPs
230
Role of Mast Cells
First line defence against antigens
231
What is the difference between acute and chronic lleukaemias
ACUTE: Blocking myeloblasts or lymphoblastic progenitor cells from differentiating at all -> immature blast cells Chronic: Blocking differentiating blast cells into basophils, eosinophils etc -> mature blast cells Immature are less likely to be good at their job, so we get more B symptoms. Chronic is often asymptomatic and comes up on routine FBCs as mature blast cells can work well.
232
If in a FBC, the majority of cells are neutrophils, what leukaemia should be suspected
AML or CML
233
If in a FBC, the majority of cells are lymphocytes, what leukaemia should be suspected
CLL or ALL
234
Onset for CML
Found in the elderly
235
What are the phases of CML
THREE (haematopoietic stem cells become more difficult to treat): 1. Chronic Phase: Aymptomatic Symptoms: Fatigue Abdominal Fullness or Early Satiety from Splenomegaly. Frequent infections + Bleeding (WBC and Platelet disfunction) But this is not from neutropenia or thrombocytopenia. It's form LOTS of mature blast cells that can only semi do their work. 2. Accelerated Phase (cellular proliferation accelerates) 3. Blast Phase: Where proliferation of mature blast cells continue -> Acute Leukaemia AML Sometimes even ALL from gene mutation that causes myeloid blast cells to differentiate into lymphoid tissue.
236
CML vs Leukemoid Reaction
Leukemoid is the normal over reaction to Infections or Stressors, causing an increase in WBC that is transient Leukemoid cells take up Leucocyte Alkaline Phosphatase (LAP) but not by CML cells
237
Diagnosis of CML
1. Bone Marrow Biopsy Increased Ratio of Myeloid: Erythroid cells(can increase in infections as well) Chronic: <10% blast cells Accelerated: 10-20% Blast Phase: >20% FISH Analysis for Chromosomal Translocations
238
What karyotype can lead to CML
1. PHILADELPHIA CHROMSOME (9:22 translocation) ABL Tyrosine Kinase (9) switches with BCR gene (22) THIS IS NECESSARY FOR DIAGNOSING CML.
239
Treatment of CML caused by the Philadelphia Chromosome
Tyrosine Kinase Inhibitors: Imatinib
240
What is a problem when treating the Philadelphia chromosome
Can get resistant to Imatinib and result in a blast crisis
241
How do we treat a treatment resistant blast cell crisis to imatinib
Allogeneic Haematopoieticc Stem Cell Transplantation
242
Onset of CLL
Adults and Elderly
243
Symptoms of CLL
Usually Asymptomatic but can cause lymphadenopathy or hepatosplenomegaly Richter Syndrome
244
FBC findings in CLL
1. Anaemia | 2. Thrombocytopenia
245
What causes anaemia and thrombocytopenia in CLL
1. CLL cells infiltrate the bone marrow | 2. CLL cells make auto antibodies against RBCs (AIHA) or Platlets (ITP)
246
How to diagnose AIHA
Positive Direct Coombs Test
247
What is Hypogammaglobulinaemiai n CLL
1. Lots of abnormal Lymphocytes can sometimes make antibodies that attack our OWN cells.
248
What is Richter Syndrome
Transformation of CLL into Diffuse Large B-Cell Lymphoma.
249
Diagnosis of CLL
1. Peripheral Blood Smear: Raised lymphocyte count 2. Smudge Cells (fragile CLL cells that smush easily) 3. Flow Cytometry TO CONFIRM: CD5, CD19, CD23 No Bone Marrow Biopsy needed.
250
Treatment of CLL
RAI System: ``` 0 - Absolute Lymphocytosis 1 - Lymphadenopathy 2- Hepatosplenomegaly 3 - Anaemia (due to infiltration) 4- Thrombocytopenia (due to infiltration) ``` 0-3 = Watchful management as it doesn't usually cause death 3-4 or young: Chemotherapy
251
How to treat AIHA or ITP
Prednisolone
252
What is Hariy Cell Laeukamia
1. Similar to CLL except that it's very symptomatic B-Cell lymphoid neoplasm Pancytopenia: Fatigue, Bleeding and Infections MASSIVE Splenomegaly: Early Satiety and Abdominal Fullness Can rupture Peripheral Blood Smear shows Leukaemia cells with Hair-Like Projections Usually Affects Men
253
Onset of AML
Elderly
254
Environmental RF for AML
1. Exposure to Radiation 2. Chemotherapy 3. Benzene 4. Smoking
255
What Bone Marrow Disorders can lead to AML
1. CML
256
What Inherited Condition can lead to AML
1. Down syndrome
257
How many subtypes of AML are tehre
9
258
Blood and Clinical Findings in AML
1. Immature blast cells infiltrate bone marrow and destroy good cells: Thrombocytopenia + Bleeding Anaemia + Fatigue Neutropenia + Multiple Infections Leukostasis (SO MANY Leukaemia cells they block blood vessels): Local Hypoxia in tissues (dyspnoea, headaches, priapism)
259
Lab findings in AML
Auer Rods
260
In what subtype is leukostaiss most common
M5 Acute Monocytic Laeukemia form (because monocytes are huge)
261
Treatment of leukostaiss
Leukapharesis
262
Symptoms of Acute Monocytic Laeukmia
1. Lymphadenopathy 2. Hepatosplenomegaly 3. Gingival Hyperplasia
263
What is the M3 subtype called
Acute Promyelocytic Leukaemia
264
What is the main consequence found in Acute Ppromyelocytic Leukaemia
DIC: Petiechiae Ecchymoses Bleeding Sites
265
What Gene mutation causes Acute Promyelocytic Leukaemia
15:17 translocation Retinoic Acid Receptor Gene and Promyelocytic Leukaemia Gene.
266
Treatment of AML
1. Chemotherapy and then a Stem Cell Transplant
267
Treatment of Acute Promyelocytic Leukaemia
All-Trans-Retinoic-Acid (ATRA)
268
Major Complication of Chemotherapy
Tumour Lysis Syndrome
269
What is tumour lysis ysndrome
Large tumours are broken down all at once: 1. Hyperkalaemia 2. Hyperphosphataemia 3. Hyperuriciaemia 4. Hypocalcaemia
270
Treatment of tumour lysis syndrome
Rasburicase: Breaks down uric acid into allantoin to be excreted
271
Onset of ALL
CHILDREN (most common form of cancer in children overall)
272
Two types of ALL
Pre-B-Cell Pre-T-Cell
273
Symptoms of Pre-B-Cell ALL
Similar to AML: 1. Marrow failure: Fatigue, infections and bleeding 2. Leukostasis 3. Hepatosplenomegaly 4. Lymphadenopathy CNS: Headaches, meningitis, CN palsies
274
Symptoms of Pre-T-Cell ALL
1. Anterior Mediastinal mass Superior Vena Cava Syndrome (facial swelling) 2. SOB 3. Venous distention in neck and upper chest
275
Peripheral Blood Smear results in ALL
1. Anaemia 2. Neutropenia 3. Thrombocytopenia 4. Lymphoblasts
276
What is the purpose of low cytometry in ALL
To differentiate between B (CD19) and T cells (CD2,3,5,7)
277
What are the phases to ALL chemotherapy called
Three phases: Induction, Consolidation, Maintenance.
278
What classes of drugs are used to treat ALL
1. Anthracyclines 2. Steroids 3. Cyclophosphamides
279
Treatment of ALL
1. CHEMO 2. CNS Prophylaxis as children do not initially present with CNS but 80% do in relapses: Intrathecal Methotrexate 3. Treat Phildelphia Chromosome (Imatinib) Ultimately a Stem Cell Transplant is needed.
280
Role of glial cells
Support brain homeostasis and neuronal functions
281
Name two types of glial cells
Astrocytes (maintain the BBB, and nourishing neurones) Ependymal Cells (Columnar, ciliated cells that line the ventricles and canals)
282
Role of Ependymal cells
Regulate the circulation of CSF
283
What tumour subtype make up most paediatric brain tumours
Infratentorial
284
What is the most common malignant brain tumour
Medulloblastoma
285
Where do medullablastomas originate from
In or around the cerebellum, next to the fourth ventricle
286
What cells do medullablastomas arise from
Embryonic Stem Cells
287
How do medullablastomas metastasise
Through the CSF (drop metastasis) to the base of the spine
288
What is the typical grade of medullablastomas
4
289
What are homer-wright rosettes
The appearance of medulloblastomas: Dense tangles of neurones and neuroglia cells
290
What is the most common benign brain tumour
1. Juvenile Pilocytic Astrocytoma
291
Site of JPA
Mostly in the cerebellum or near the brainstem
292
Grade of JPAs
Grade 1 (generally benign)
293
Histological findings of JPA
1. Cysts | 2. Rosenthal Fibres (Worm shaped clumps of neurofibres)
294
Where are ependymal cells found
INFRATENTORIAL (at the cerebellum), as that's where ependymal cells are found
295
Where do ependymomas form
At the fourth ventricle.
296
Grades of ependymomas
1->3
297
What are the appearance of classic ependymomas (grade II)
1. Tumour cells have a round/oval nucleus. | 2. Perivascular Pseudorosette (cells surround a single blood vessel).
298
Most common type of supretentorial tumour
Craniopharygnioma
299
Where do craniopharyngiomas usually dveleop
Near the pituitary gland from remnants of rathe's pouch
300
Outline the embryological process of the pituitary glands
1 Formed by cells of the brain (posterior) and oropharynx (anterior) 2. Cells from oropharynx form the rathe's pouch -> Anterior pituitary gland.
301
Grade of cranipharyngiomas
1
302
Histological findings of crnaiopharyngiomas
1. Cysts 2. Cells that stratify (arranged in layers) 3. A wet keratin appearance.
303
Symptoms of Brain tumours
1. Headaches 2. Nausea 3. Vomiting 4. Seizures Pinealoma: Raised B-HCG and AFP (early onset puberty) Infratentorial tumours can compress the ventricles, blocking CSF -> Hydrocephalus (bulging fontanelles)
304
Diagnosis of Brian tumors
1. Histologic of biopsy MRI brain
305
What genetic disorders can give rise to brain tumours
1. Neurofibromatosis Type 1 2. Neurofibromatosis type 2 3. Tuberous Sclerosis
306
What tumours are seen in NF type 1
Optic Nerve Gliomas | Schwannomas
307
What tumours are seen in NF Type 2
Bilateral Schwannomas
308
What tumours are seen in tuberous sclerosis
Subependymal Giant Cell Astrocytomas
309
What tumours are seen in Von-Hippel-Lindau
1. Renal tumours, phaeochromocytomas, cerebellar and retina hemanioblastomas
310
Charcters of a Brian tumour headache
1. Worsens in the morning, change in position, coughing, sneezing
311
Symptoms of vestibular Schwannomas
Compresses the 8th cranial nerve: Hearing Loss and Tinnitus
312
What is the triad of symptoms seen in increased ICP
CUSHING's HTN Bradycardia Irregular Breathing Patterns.
313
Most common form of glioma
Gliblastoma Multiforme
314
CT findings in glioblastomas
1. Rim of Enhancement as centre is necrotic but peripheral is live 2. Cerebral Metastasis and Lymphoma Crosses the corpus callous (butterfly appearance of the tumour) Low grade gliomas do not usually enhance
315
Symptoms of hemangioblastomas
Secrete erythropoietin -> polycythaemia
316
What are the three structures involved to cause developmental dysplasia of the hip
1. Abnormal development of the acetabulum and proximal femur | 2. Mechanical instability of th ships joint
317
What usually causes developmental dysplasia of the hip
1. Ligament laxity | 2. In Utero positioning
318
Risk Factors for DDH
1. FH 2. Female 3. Breech > 34 weeks 4. Tight Lower Extremity Swaddling
319
Physical examination for DDH
1. Limited Range of Motion 2. Assymetry in limbs 3. Asymmetric Skin Creases in Thigh and Groin
320
Up to 6 months of age, what tests can be done to check for DDH
1. Barlow | 2. Ortolani
321
What is the Barlow test
1. Flex the legs in neutral position and adduct. Put pressure on the knee posteriorly
322
What does a positive Barlow test indicate
A clunk noise, indicating that the head of the femur is moving out the acetabulum
323
What is the Ortolani test
1. The knee is moved away from the midline Pressure put non the trochanter
324
What is a positive ortolans test
Clunk, indicating that the femoral head is dislodging from the acetabulum and relocating in the cavity
325
After 6 months, what examination is done to check for DDH
1. Hip Abduction test
326
What is a positive hip abduction test in DDH
1. Usually abduces to 70 degrees but the ligament laxity involved in DDH causes this abduction to be less than 45 degrees.
327
What should be done following the ortolans or Barlow test
Imaging Study
328
USS scan findings in DDH (<6 months)
Subluxation: abnormal relationship between the femoral head and acetabulum Measures % femoral epiphysis covered by acetabulum
329
What scan is used over 6 months
X Ray: Lateral and Superior positioning of the femoral head and neck Delayed ossification of the femoral head
330
Treatment of DDH
Under 4 weeks: Abduction Splint Over 6 months: Open or Closed Reduction surgery with a Spica Cast Over 6 years: Salvage Osteotomies.
331
Onset of Legg-Calve-Perthies
6 Years
332
What is Legg-Calve-Perthes
Idiopathic Avascular Necrosis of the epiphyses on the proximal femur. Follows with re-vascularisation.
333
Risk Factor for Legg-Calve-Perthies
1. Male 2. Maternal smoking during pregnancy 3. FH of skeletal dysplasias
334
Symptoms of Legg-Calve-Perthies
1. Shorter 2. Hyperactive 3. Quadricepts and Gluteal muscle atrophy 4. Insidious Antalgic Gait
335
What is an antalgic gain
Limp that happens secondary to pain
336
What test can be done to check for Legg-Calve-Perthes
Trendelenburg's test
337
What is Trendelenburg's test
Stand on one leg for 30 seconds without falling
338
What is a positive trendelenburg's test
1. Negative: Level hip Positive: Pelvis DROPs towards unsupported side
339
X-Ray findings in Perthies
1. Joint Space Widening 2. Subchondral Fracture 3. Sclerosis 4. Fragmentation 5. Subchondral collapse of ossification centre.
340
GOLD STANDARD DIAGNOSTIC FOR PERTHIES
MRI for osteonecrosis and revascularisation signs
341
When are lab studies indicated for perthies
Only if there is evidence of pain, to exclude other diagnoses.
342
Lab results for perthies
CBC is normal, ESR and CRP is raised
343
Treatment of Perthies
Under 5: 1. Physical therapy to restore ROM 2. NSAIDs Under 7: Epiphyseal involvement <50% ^ same treatment as above Epiphyseal involvement > 50%: pelvic or femoral osteotomies Salvage procedures.
344
Onset of Slipped Capital Femoral Epiphyses
13-15
345
What is Slipped Capital Femoral Epiphyses
Where the Epiphyses slips down from the metaphyses
346
What causes Slipped Capital Femoral Eiphyses
Obesity Growth Surges Endocrine Disorders: Hypothyroidism, growth hormone deficiency
347
Two types of slipped capital femoral epiphyses
1. Stable and Unstable (can they walk without support?)
348
Symptoms of Slipped Capital Femoral Pelvis
Pain in the hip, thigh, groin or knee Inability to bear weight
349
Physical exam findings in slipped capital femoral pelvis
Reduce internal rotation, abduction and flexion of the hip
350
What is obligatory external rotation
Passively flexed leg, the thigh automatically abducts and externally rotates.
351
What physical exam should be done to check for slipped capital femoral epiphysis
Trenelenburg test positive: Pelvic tilt as unaffected hip is lower There should be obligatory external rotation and a positive trendelenburg test -> Radiography
352
X-Ray findings in Slipped Capital Femoral Epiphyses
1. Klein's Line does not intersect the femoral head (usually should do) 2. Positive Bloomburg's sign (blurred physis) 3. Blanch Sign of Steel
353
GOLD STANDARD for slipped
MRI
354
Other tests for slipped capital
BLOOD TESTS as endocrine involvement
355
Treatment of slipped capital femoral epiphysis
Surgical stabilisation (Placing a screw through the metaphyses and epiphyses to secure them in place).
356
What is transient synovitis
Inflammation of the hip without a clear cause
357
RF for Transient Synovitis
1. Recent Upper Respiratory Infection
358
Physical exam findings in transient synovitis
1. Limited abduction and internal rotation of the hip 2. Tender hip on palpation 3. Can't bear weight
359
GOLD STANDARD for transient synovitis
LOG ROLL: The leg is rolled side to side.
360
What is the positive test in a log roll
Involuntary muscle guarding in the leg.
361
X-Ray findings in transient synovitis
1. Slight demineralisation of the bone in the proximal femur 2. Joint Space Widening 3. Capsular Distention
362
Transient Synovitis vs Septic Arthritis (4)
1. Fever 2. Limp but can bear weight 3. ESR <40 mm/hr 4. Serum WBC <12,000 cells/mm^3
363
Treatment of transient synovitis
NSAIDs
364
Onset of Osteochondrosis (osgood-schlatter)
13-15
365
What is Osgood-Schlatter Disease
Inflammation of tibial tubercle.
366
What causes osgood-schlatter disease
Growth Spurts | Physical Activity
367
Symptoms of Osgood-Schlatter Disease
1. Unilateral Anterior Knee Pain that gets WORSE over time 2. The pain gets worse on movement 3. causes a limp 4. Pain might limit quadriceps flexibility.
368
RF for osgood-schlatter disease
1. Athletic | 2. Male
369
When is imaging done for osgood-schlatter disease
Usually done based on symptoms and RF alone: UNLESS: - Atypical presentation - Unilateral - Severe - Persistent
370
What is seen on physical examination of the knee in osgood-schlatter disease
1. soft tissue swelling ANTERIOR to the tibial tuberosity | 2. Increased density of the tubercle
371
Treatment of osgood-schlatter disease
Activity Modification NSAIDs and Physiotherapy Drilling the tibial tubercle or resection of the tubercle
372
When in gestation, do we give rise to scoliosis
4-6 weeks
373
Onset of scoliosis
No problems until adolescence
374
Symptoms of scoliosis
1. back pain | 2. SOB
375
What is the physical exam special test we need to do in scoliosis
Adam's Forward test
376
What is the Adam's Forward test
Bends forward, while we check for abnormalities
377
What is a positive Adam's Forward test
Tilted shoulders blades Prominence of ribs on one side Uneven waist line
378
Diagnostic tests for scoliosis
1. Scoliometer (to measure difference in shoulder prominence). Significant if over 5 degree difference 2. Radiograph if over 10 degrees: Cobb's Angle Only over 10 degrees as Cobb's Angle is not accurate
379
What is Cobb's Angle
This is the degree measured between the superior vertebra and inferior vertebra. Needs to be at least 10 degrees for a positive scoliosis diagnosis
380
What is the most common soft tissue sarcoma in childhood
Rhabdomyosarcoma: usually causes mass, pain and obstruction of the bladder, pelvis, nasopharynx, orbits
381
What is the main cause a=of limping in 0-5 years
DDH, Transient Synovitis, Septic Argritis, Osteomyelitis,
382
What is the main cause of limping 5-10 years
1. Tranisnet synovitis, Perthes, Septic arthritis | Osteomyelitis
383
What is the main cause of limping from 10-15
1. Slipped femoral, septic, osteomyelitis, osgood-schlatter disease, osetochrondritis, chondromalacia patella Tumours: Ewing;s and osteosarcomas, neuroblastomas Osteoid Osteoma
384
Role of the synovial membrane
1. Remove Debris | 2. Produce Synovial Fluid
385
Inflammatory vs Non-inflammatory arthritis
Pain is symmetrical vs asymmetric pain Pain gets better with use vs pain gets worse with use Prolongued morning stiffness (1+ hours) vs morning stiffness (<1 hr). No extraarticular symptoms.
386
four types of deformities seen in RA
1. Swan-neck (flexion of DIJ, hyperextension of proximal) 2. Bobutonniere (flexion of proximal and extension of DIJ) 3. Ulnar Drift (fingers lean away from the thumb and towards the pinkie from weakened ligaments) 4. Z-deformity (thumbs up)
387
Name a major CNS symptoms from RA
Carpal Tunnel Syndrome
388
What is Caplan's Syndrome
Pneumoconiosis and RA
389
Onset of Juvenile Idiopathic Arthritis
<16
390
RF for Juvenile Idiopathic Arthritis
HLA-B27 and Infections Autoimmune Cytokines move to different parts of the body and cause tissue injury
391
Presentation of Juvenile Idiopathic Arhritis
1. Symmetrical Involvement of the LARGE joints (e.g., the knees or ankles) 2. Worse in the morning or with rest
392
Most common form of juvenile Idiopathic Arthritis
Oligoarticular Arthritis (< 4 Joints) The other form is Polyarticular Arthritis (5+ Joints). Systemic Juvenile Idiopathic Arthritis
393
Symptoms of Systemic Juvenile Idiopathic Arthritis
Salmon Pink Macular Rash w/ Fever
394
Symptoms of Oligoarticular Arthritis
``` Uveitis Enthesitis Daily Spiking Fever Splenomegaly Generalised Adenopathy Pericarditis or Pleuritis. ``` IMPORTANT: Joint involvement can occur weeks or Months after systemic symptoms
395
Diagnosis of Juvenile Idiopathic Arthritis
``` Blood: Leukocytosis Thrombocytosis Anaemia Raised ESR and CRP RF, ANA, Anti-CCP ``` Genetic Testing: HLA-B21
396
Treatment of JIA
Methotrexate
397
What is a menisci
Crescent-Shaped Fibrocartilage Cushions, absorb compressive force
398
Name the two joints in the knee
``` Femoropatellar Joint Tibiofemoral Joint (formed by junction between the condyles) ```
399
What are the main ligaments that are involved in a meniscus tear
1. ACL 2. MCL 3. Lateral Meniscus
400
What test is done to check for meniscus tear
McMurray Test
401
What hormones stimulate babies to start breathing
Adrenaline and Cortisol
402
What causes the closure of the foramen Ovale
The baby's first breath expands the alveoli, decreasing pulmonary vascular resistance. This reduces the pressure in the right atrium, stopping shunting (becomes lower than LA)
403
What molecule keeps the ductus arteriosus open
Prostaglandins. Increase in oxygenated blood reduces prostaglandin levels and the ductus closes
404
What is the lifelong consequence of hypoxia
Hypoxic ischaemia leads to cerebral palsy
405
Outline the principles of neonatal resuscitation
1. Dry and keep the baby warm 2. APGAR Scoring 3. Stimulate breathing by placing baby's head in neutral position and rub with towel. Check of aspired meconium 4. Two cycles of five inflation breaths + chest compressions
406
Why is Vit K immediately given to baby's after birth
Babies are born with a deficiency of Vit K. Need a thigh injection following birth
407
When is a Blood Spot Screening done for babies
5 Days following birth
408
What is the Caput Succedaneum
This is fluid developing on the scalp outside the periosteum, caused by trauma during delivery. Periosteum is a dense layer of connective tissue that lines the outside of the skull and doesn't cross the sutures while fluid in caput succedaneum crosses the suture lines
409
Signs of cephalohaematoma
rheumatic subperiosteal haematoma. As it's under the periosteum, the bulge does NOT cross suture lines. Risk of anaemia and jaundice as the blood in the haematoma breaks down, releasing bilirubin
410
What procedure causes facial paralysis during delivery
Forceps Delivery
411
Management of hypoxic-ischaemic encephalopathy
Therapeutic Hypothermia, cooling the baby's core temperature using cooling blankets and a hat (33 to 34 degrees)
412
How log is therapeutic hypothermia carried out for
72 Hours
413
Causes of Neonatal Jaundice
``` Increased Production of Bilirubin: Haemolytic Disease of the newborn ABO incompatibility Haemorrhage Cephalo-haematoma Polycythaemia Sepsis and DIC G6PD ``` ``` Decreased clearance of bilirubin: Gilbert's Prematurity Neonatal Cholestasis Biliary Atresia Hypothyroidism ```
414
What is a common cause of Jaundice in the first 24 hours of life
Neonatal Sepsis
415
What causes haemolytic disease of the newborn
Caused by incompatibility between Rh+ and Rh-ve blood between the mother and the child transfusion. If a mother is RH-ve and the baby is positive, the mother's immune system makes antibodies against the baby's blood leading to haemolytic and high bilirubin levels.
416
What conditions may cause prolonged Jaundice
G6PD deficiency Hypothyroidism Biliary Attresia
417
Symptoms of Kernicterus
Cerebral Palsy, Seizures, LD and Deafness
418
What is Apnoea
When breathing stops for more than 20 seconds at a time
419
In what babies is apnoea common in
Premature, they become less frequent as gestational age increases
420
What causes premature apnoea
1. Anaemia 2. GORD 3. Infections (which are common in PROM etc)
421
Management of apnoea of prematurity
Tactile Stimulation
422
What is Eczema
Inflammation and thinning of the skin causing dry, red and itchy sore patches
423
Signs of Eczema
Dryer ed and itchy over the FLEXOR surfaces (inside of elbows, knees) and face and neck.
424
Management of Eczema
Emollients Soap Substitutes Methotrexate, oral corticosteroids and azathioprine tacrolimus
425
What corticosteroids may be used in Eczema
Mild: Hydrocortisone Betnovate (betamethasone) Clobetasol Proprionate
426
What medication is given for bacterial infections caused in Eczema
Staph Aureus usually, flucloxacillin
427
RF for psoriasis
First Degree Relatives
428
Signs and Symptoms of Psoriasis
Dry, flaky and Scaly Commonly over the extensor surfaces of elbows and knees (rather than Flexors seen in Eczema) Auspitz Sign: Bleeding from areas that have scraped off Residual Pigmentation of skin after lesion heals Nail Psoriasis (pitting, thickening, and onycholysis)
429
Types of Psoriasis
Plaque Psoriasis Guttate Psoriasis Pustular Erythrodermic
430
Appearance of plaque psoriasis
Thickenes, silver scales commonly seen on the extensor surfaces
431
Appearance of guttate psoriasis
MOST COMMON IN CHILDREN: | Small, raised PAPULES on the trunks and limbs.
432
What triggers guttate psoriasis
Strep Throat
433
Signs of pustular psoriasis
Pustules form UNDER the skin and patients are systematically unwell (medical emergency, hospital admission)
434
Signs of Eryhtrodermic Psoriasis
Skin comes off in large patches (exfoliation) and raw, red. Hospital Admission is needed
435
Management of Psoriasis
Topical Steroids Calcipotriol (Vit D analogue) Calcineurin Inhibitors (tacrolimus) Phototherapy with narrow band UV B light
436
What diseases can cause viral exanthema (widespread rashes)
1. Measles 2. Scarlet Fever 3. Rubella 4. Dukes Disease 5. Parvovirus
437
Onset of Measles
10-12 days after infection
438
Symptoms of Measles
1. Fever 2. Conjunctivitis 3. Koplik Spots on the buccal mucosa (greyish white spots)
439
Where does a measles rash start
On the face, BEHIND THE EARS before spreading to the rest of the body.
440
Complications of measles
``` Diarrhoea Encephalitis/Meningitis Hearing Loss Vision Loss Death ```
441
Characteristics of a scarlet fever rash
Stars on the trunks and spreads outwards
442
Symptoms of Scarlet Fever
``` Flushed face Truncal rash Strawberry Tongue Cervical Lymphadenopathy Flushed Face ```
443
Symptoms of Rubella
Starts on the face and spreads to the rest of the body.
444
How long does the Rubella rash last for
3 Days
445
How long should children stay out of school with Rubella
5 Days
446
Main complication of Parvovirus B19 infection
Aplastic Anaemia
447
Treatment for Urticaria
Fexofenadine
448
How does Chickenpox transmit
Through droplet infection and direct contact with lesions
449
Onset of symptoms in Chicken Pox
10 days to 3 weeks after exposure
450
Complications of Chickenpox
1. Dehydration 2. Conjunctival Leisons 3. Pneumonia 4. Encephalitis
451
Management of chickenpox
Self-limiting and gets better on it's own
452
Treatment of itching in chickenpox
Antihistamines (chlorphenamine)
453
What virus causes Hand, Foot and Mouth Disease
coxsackie A
454
Onset of symptoms in Hand, Foot and Mouth Disease
5 Days
455
Presentation of Hand, Foot and Mouth Disease
Initial upper respiratory tract infection 2-3 days later: Small mouth ulcers then blistering red spots across the body. Spots most noticeable on the hands, mouth and foot
456
What is Molluscum Contagious
Small, flesh coloured papule with a CHARACTERISTIC central dimple. Appear in crops of multiple lesions in a local area.
457
How does molluscs contagious spread
Sharing towels or bedsheets
458
How long does it take for molluscs contagious to resolve
18 Months
459
What is Pityriasis Rosea caused by
Human Herpes Virus
460
Characteristic of Pityriasis Rosea
Produce of fever, tiredness and headache Starts with a characteristic Herald Patch (faint red, pink, scaly and oval shaped lesion 2cm or more in diameter. Usually on the torso Arranged along the lines of the ribs In black people, lesions may be grey or darker than their normal skin colour
461
How long does it take for Pityriasis Rosea to reoslve
3 Months
462
What is Seborrhoeic Dermatitis
An inflammatory skin condition that affects sebaceous glands in the scalp, nasolabial folds and eyebrows
463
Signs of Infantile Seborrhoeic Dermatitis
Crusty, flaky scalp lasting 12 months
464
Management of Infantile Seborrhoeic Dermatitis
Baby Oil White Petroleum Jelly to soften the crusted areas so they can be washed off Clotrimazole
465
What is Seborrhoeic Dermattis of the Scalp
Dandruff!
466
First line treatment for dandruff
Ketoconazole Shampoo for 5 minutes
467
What is Seborrhoeic Dermatitis of the face and body
Crusty, itchy skin on th eyelids, nasolabial folds and ears, back, upper chest
468
Management of Seborrhoeic Dermattis of the face and body
Clotrimazole
469
What is the most common type of fungus that causes ringworm infections
Trichopyton
470
Types of ringworm infectiosn
``` Tinea Capitis Tinea Pedis (athletes foot) Tinea Cruris (Groin) Tinea Corporis (body) Onychomycosis (fungal nail infection) ```
471
Symptoms of athletes foot
Itchy patches between the toes
472
What mites cause Scabies
Sarcoptes Scabiei
473
Symptoms of Scabies
These burrow into the skin causing severe itching and lay eggs causing further infection and symptoms: itchy small red spots with track marks where the mites have burrowed. Classic rash between finger webs
474
Treatment of Scabies
Pemerthrin Cream (leave on 8-12 hours) Oral Ivermectin for difficult to treat Scabies
475
What is Crusted Scabies
Scabies in immunocompromised individuals. Instead of burrowing (so no track marks), it consists of red skin patches that turn scaly plaques.
476
Treatment of Hradlice
Dimeticone 4% And fine combs to nip them out
477
What conditions cause non-blanching rashes
Henoch-Schonlein Purpur (legs and buttocks with joint pain) Meningitis Acute Leukaemias HUS
478
Where does the rash in Non-Bullous Impetigo present
Around the nose or mouth
479
Treatment of Impetigo
Topical Fusidic Acid
480
What gene causes CF
CFTR
481
Most common species that causes bacterial tonsilitis
Group A Strep (strep progenes)
482
Name the four types of tonsils
Adenoid Tubal Palatine Lingual
483
Clinical Presentation of Tonsilitis
1. Fever 2. Poor Oral Intake 3. Headache 4. Vomtiing 5. Abdominal Pain
484
Examinations done for tonsilitis
1. Check the throat 2. Otoscopy (examine the ears to visualise the tympanic membrane) 3. Palpate for Cervical Lymphadenopathy
485
What does a score of 3 or more on the accentor criteria indicate
Probably a bacteria infection
486
What is the FeverPAIN score
1. Fever in the past 24 hours 2. Prurulence (pus on tonsils) 3. Attended within 3 days of the onset of symptoms 4. Inflamted Tonsils (severely inflamed) 5. No cough or coryza
487
Treatment of Tonsilitis
Penecillin V for 10 days Clairthromycine in allergies
488
Management of peritonsilar abscess
Incision and Drainage
489
What condition co=exists with Stevens-Johnson Syndrome
Toxic Epidermal Necrolysis (it's a spectrum of conditions, Steven Johnson is the mild form)
490
Role of the basement membrane
Contains Collagens and Laminis Attaches the Epidermis to the Dermis
491
What type hypersensitivity reactions are Stevens-Johnson syndrome and Toxic Epidermal Necrolysis
4
492
Pathophysiology of Stevens-Johnson Syndrome
Cytotoxic T cells attack the epithelial cells in the mucosa and epidermis Results n Dehydration and Sepsis
493
What distinguishes Stevens-Johnson syndrome and Toxic Epidermal Necrolysis
10% of the body affected = Stevens-Johnson 10-30% = Overlap between both syndromes 30% or higher = toxic epidermal necrolysis
494
What triggers Steven-Johnson Syndrome
Carbamazapine Antibiotics (sulphonamides) Sulfalazine CMV Mycoplasma
495
Symptoms of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis
AFFECTS both mucosal and skin linings 1. Fever Early: Flu like symptoms (sore throat, cough, red eyes and tender pink skin) Dark-Red Centre spots with fluid filled vesicles Skin begins to slough off looking like SEVERE dark burns Nikolsky's sign
496
What is Nikolsky's sign
Slight rubbing of the lesion causes the outer layer to slough off
497
Diagnosis of Stevens-Johnson Syndrome
Biopsy but usually history taking
498
Treatment of Stevens-Johnson
Stop triggering medication and treat any triggering infections Antihistamines IvIg Corticosteroids Pain Medication
499
What is the first line treatment for ADHD in children
Methylphenidate
500
How do we initially manage a child with ADHD
Should be given initially as a 6 week trial
501
Pharmacology of methylphenidate
Dopamine/norepinephrine reuptake inhibitor
502
Second one treatment for ADHD if methylphenidate does not work
lisdexamfetamine
503
What toxicity do these drugs increade
CARDIOTOXIC
504
Diagnosis of ADHD
Persistent symptoms of hyperactivity. There must be 6 features of hyperactivenss in those below 16 and 5 in those above 17
505
What are the major risk factors for Sudden Infant Death Syndrome
1. Prone Sleeping 2. Parental Smoking 3. Bed Sharing 4. Hyperthermia 5. Prematurity
506
What protects against SIDS
Breastfeeding | Room Sharing
507
If a child in a suspected bronchiolitis infection has a fever of 39 degrees, what should be considered as a differnetial
Pneumonia, especially if there are focal crackles. Remember, bronchiolitis has a low grade fever
508
At what weeks is the Meningitis B vaccine given
2 Months 4 Months 12-13 moths
509
When is the 6-1 vaccine given
2 Months, 3 Months and 4 Months
510
What is the 6-1 vaccine
``` diphtheria tetanus whooping cough polio Hib Hepatitis B ```
511
When is the BCG vaccine given
At birth
512
When is the MMR vaccine given
12-13 months
513
When is the Men C/HiB vaccine given
12-13 months
514
When is the flu vaccine given
2-8 years
515
What is the 4 in one vaccine
Diptheria Tetanus Whooping Cough Polio
516
When is the 4-in-1 vaccine given
As a booster for preschool (3-4 years of age)
517
When is the HPV vaccine given
12-13 years
518
When is the 3-in-1 (tetanus, diphtheria and polio) given
13-18 years
519
What is the first sign of puberty in boys
Increase in testicular volume
520
When does growth spurts peak in men
14
521
What is the first sign of puberty in girls
Breast Development
522
In what babies are intraventircular haemorrhages seen
Pre term
523
Signs of intraventricular haemorrhages
Convulsions/seizures within the first 72 hours of birth
524
Treatment of intraventricular haemorrhages
Prophylactic CSF drainage or Intraventricular thrombolysis
525
First line treatment for threadwoem
Single dose of Mebendazole
526
What causes threadworm infections
Swallowing eggs in the environment
527
Signs of threadworm infections
Perianal itching, particularly at night | Girls may have vulval symptoms
528
What is the most common complication of measles
Otitis Media
529
What is the main complication of rubella infections
Arthritis of the small joint
530
What is Ebstein's Anomaly
When the posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle Causes Tricuspid regurgitation (pan-systolic murmur) and tricuspid stenosis (mid-diastolic murmur) Right atrium enlargement VSD has a holostystolic murmur but no diastolic. Tetralogy of fallout presents at 1-2months age rather than in the days after birth
531
How do we treat inspiratory stridor
Oral Dexamethasone
532
What anatomical disease most commonly causes pulmonary hypoplasia
Congenital Diaphragmatic hernia
533
Signs of Noonan Syndrome
Webbed Neck Pectus Excavatum Short Stature Pulmonary Stenosis
534
What CV anomalies are seen in William's syndrome
Supravalvular Aortic Stenosis
535
What is Cri du chat syndrome
LD, feeding difficulties and a CHARACTERISTIC CRY from larynx and neurological problems)
536
Onset of symptoms in Transposition of the great arteries vs Tetralogy of Fallot
Presents within days of life vs presenting within 1-2 months of age
537
Management of neonatal hypoglycaemia
Encourage continue feeding and monitor glucose
538
First line management of intussusception under NICE guidelines
Pneumatic reduction under fluoroscopy guidance
539
What bacteria usually causes epiglottis
H Influenzae
540
Milestones for bricklaying
Tower of 2 - 15 moths Tower of 3 - 18 Months Tower of 6 - 2 years Tower of 9 - 3 Years
541
Drawing milestones for children
``` 18 Months - Circular Scribble 2 Years - Copies vertical Line 3 Years - Copies Circle 4 Years - Cross 5 Years - Square and Triangle ```
542
Milestones for books
15 months - looks at book, pats pages 18 Months - turns several pages at a time 2 Years - turns pages, one at a time
543
AT what age would a child get good pincer grops
12 Months
544
At what age does a child start pointing with their finger
9 Months
545
At what age does a Childs palmar grasp come into play
6 months
546
Treatment of whooping cough
Clarithromycin if cough is within the past 21 days If under 6 months, they need admission.
547
How long should a child be off for school with whooping cough
48 Hours after commencing antibiotics
548
Features of an atypical UTI
1. Seriously ILL 2. Poor urine flow 3. Abdo mass 4. Raised Creatinine 5. Septicaemia 6. Failure to respond to treatment with suitable antibiotics NON E.coli organisms
549
What is Sotos Syndrome
Excessive Physical Growth in the first few years of life, LD but has some Down syndrome like features (a differential for down's)
550
What is the most common condition that neonates get following a c section
Transient Tachypnoea of the newborn. Usually resolves on its own (nasal falling and grunting)
551
In what condition is Elfin Facies founding
William's
552
Signs of foetal alcohol syndrome
1. Microcephaly 2. Shore palpebral fissures 3. Thin upper lip 4. Absent Philtrum 5. LD 9. Cardiac abnormalities
553
Classic features of rubella caused damage to a neonate
1. Cataracts, deafness, cardiac abnormalities
554
What is foetal varicella syndrome
Where the mother has a primary infection in weeks 3-28
555
Clinical Presentation of Foetal Varicella Syndrome
``` Skin Scarring Eye Defects (small eyes, cataracts) ``` Reduced IQ
556
What are the walking milestones at 3 months
1. Little or no head lag | Lying on abdomen with good head control
557
What are the walking milestones at 6 months
Lying on back and can lift feet Pulls self to sitting Rolls dront to back
558
At what age can a baby begin to sit without support
7-8 Months
559
At what age can babies start to crawl
9 Months
560
At what age can babies start to cruise
12 Months
561
At what age can babies start to walk unsupported
13-15 months
562
At what age does a baby squat to pick up a toy
18 months
563
When does a baby start to run
2 Years
564
When can a child hop on one leg
4 Years
565
Where is the lymphadenopathy seen in Rubella
Subocciptal and post auricular
566
What anatomical structures does the rash I Scarlett fever spare?
The mouth/face
567
Murmur in tetralogy of fallout
Ejection Systolic murmur at left sternal edge
568
In what syndrome is polydactyly seen in
Pate
569
A child exhibits abdominal pain with exophalmos, congenital diaphragmatic hernia and duodenal atresia, what is the likely diagnosis
Malrotation
570
In what condition is rocker bottom feet seen in
Edward's
571
What is the most common cause of juvenile hypothyroidism
Autoimmune thyroidtis
572
What is the initial empirical therapy for meningitis in hospital
IV Ceftriaxone
573
What is the first choice therapy of meningitiss in the community, before transfer to hospital
IM Benzylpenecillin
574
What is Roseola Infantum
High Grade Fever prodrome before a rash abruptly starting in the trunk and spreading across the body (kopek spots)
575
When should an osmotic laxative be given vs a stimulant laxative
Osmotic to soften the stool up and stimulant only if the stool is soft
576
Name an osmotic laxative
Polyethylene Glycol 3350 + electrolytes
577
What is maintenance therapy for constipation
Movicol Paediatric Plain
578
What is Chondromalacia Patellae
Softening of the cartilage of the patella
579
RF for chondromalacia Patellae
Characteristically anterior knee pain on walking up and down stairs from prolonged sitting
580
Symptoms of osteochondritis dissecans
Pain after exercise | Intermittent swelling and locking
581
What is Patellar Subluxation
Medial Knee pain due to lateral subluxation of the patella Knee usually gives way
582
RF for patellar tendonitis
Athletic boys
583
Symptoms of patellar tendonitis
Chronic anterior knee pain that worsens after running Tender BELOW the patella on examination
584
Criteria that means children with bronchiolitis should be referred to hospital
Respiratory rate of over 60 BPM Eating 50-75% of normal intake Clinical dehydration
585
What neurodevelopment issue is associate with fragile X syndrome
Autism
586
What condition is increased in VSD
Endocarditis
587
What type of pulse is heard in Patent Ductus Arteriosus
Large volume, bounding, collapsing pulse
588
What prostaglandin antagonist is given to a neonatee for patent ductus arteriosus
Indomethacin (closes the connection
589
What is the triad of shaken baby syndrome
Retinal haemorrheages Subdural Haematoma Encephalopathy
590
In what condition do we see a widened pulse pressure
Patent ductus arteriosus
591
What hart problem is associated with turner's syndrome
Biscupid aortic valve (systolic murmur over the aortic valve)
592
What drugs should be given to children under 3 months
IV Cefotaxime and IV Amoxicillin to cover for Listeria Monocytogenes
593
Diagnosis for CF
CF > 60 on the sweat test Heel Prick Test at day 5 for life
594
What does the heel prick test show that may indicate CF
Increased Immunoreactive Trypsinogen
595
What should be seen in pCO2 for life threatening asthma
It should be NORMAL (4.8-6kPa)
596
What causes osteogenesis Imperfecta
Brittle Bones prone to fractures due to impaired type I collagen synthesis
597
What is the role of Type I Collagen
Forms structural and mechanical scaffold of the bones, tendons, cornea, blood vessel walls and other connective tissues
598
What is type I osteogenesis Imperfecta
Mild bone fragility, usually no fractures until toddlers begin to walk Minimal Malformations
599
Complications of type I osteogenesis Imperfecta
Hearing loss following menopause
600
What is type III-IX Osteogenesis Imperfecta
Moderate to dever fractures Moderate malformations; short stature
601
Complications of osteogenesis imperfect in types III-IX in children
High risk of hearing loss Compared to Type I, these result in earlier onset of hearing loss in adults (even before menopause)
602
What is the most lethal type of osteogenesis Imperfecta
Type III - most people die in utero due to severe fractures
603
How is the height of someone with osteogenesis Imperfecta affected
Present with shortt stature
604
What genetic mutation causes osteogenesis Imperfecta
COL1A1 or COLL1A2
605
Symptoms of Osteogenesis Imperfecta
1. Pathologic fractures with little trauma, short stature, scoliosis 2. Skull malformations may causes localising focal signs in the brain 3. Blue sclera causing decreased collagen and exposure of choroidal veins 4. Hearing loss from ossification in the middle/inner ear 5. Dentinogenesis imperfect (blue teeth/transluscent) 6. Hypermobility of ligaments, joints and skin 7. Easy Bruising
606
Prenatal USS scans for type II (lethal form)
1. Micromelia (small, underdeveloped extremities) 2. Decreasedbone mineralisation 3. Multiple bone fractures
607
X-Ray postnatal scan findings in osteogenesis Imperfecta
1. Thinning of cortical bone 2. Wormian bones: Small, irregular bones between cranial sutures 3. Cystic Metaphyses 4. Popcorn calcifications along the metaphases and epiphyses of long bones
608
Lab Tests for osteogenesis Imperfecta
1. Raised serum alkaline phosphatase | 2. Raised Uricalcaemia
609
Biopsy findings in osteogenesis Imperfecta
Disorgansied bone: reduced cortical and trabecular width and increased bone remodelling
610
Treatment for osteogenesis Imperfecta
1. Bisphosphanates Fracture management, replacing rods with intramedullary rods
611
In what region of the bone is osteomyelitis seen in
Metaphyseal part of the bone
612
Where do infections in osteomyelitis originate from
Respiratory, GI or ENT or Skin sites
613
What other conditions may a patient with osteomyelitis present with
Septic arthritis if spreads to a neighbouring joint haematological
614
Through what structure does osteomyelitic infections spread thorugh
The medullary canal
615
What structures are seen in Chronic osteomyelitis
Sequestrum (dead, avascular bone) Involucrum (new bone)
616
What is Brodie's Abscess
Bone abscesses become surrounded by thick, fibrous tissue and sclerotic bone
617
What are the symptoms of Osteomyelitis
Initial: ``` Irritability Reduced appetite Tacchycardia Malaise LOW GRADE Fever or afebrile ``` Specific: Warm, swelling and point tenderness/ceelulitis Joint Stiffness
618
What is the infective agent if only a single joint is inflamed
Bacterial
619
What infective agent usually causes Osteomyelitis
Staph Aureus (MRSA)
620
RF for Osteomyelitis
1. Posttrauma | 2. Post Surgery
621
Other than staph aureus, what can cause vertebral osteomyelitis
M. TB
622
In Sickle Cell Disease, what is the most common infective agent in osteomyelitis
1. Salmonella and Strep. Pneumoniae
623
What is the most infective agent of osteomyelitis in open wound injuries
E. coli
624
Where can Osteomyelitis spread
Vertebral Osteomyelitis Soft Tissue (abscess) Septic Thrombophlebitis Sepsis and Shock
625
GOLD STANDARD for osteomyelitis
Bone Biopsy with Histological examination MRI
626
Most common infective agents in Septic Arthritis
Staph Aureus | N. Gonnorheoae
627
What is the most common cause of disproportionate short stature in infants
Achondroplasia
628
Pathophysiology of achondroplasia
Mutations in the Fibroblast Growth Factor Receptor 3 (FGFR3), causes abnormal function of the epiphyseal plates -> short bones.
629
Features of achondroplasia
1. Short Digits 2. Bow Legs 3. Disproportionate Skull 4. Foramen Magnum Stenosis
630
What causes a disproportionate skull
Skull base grows and fuses via endochondral ossification = flattened mid face and nasal bridge The cranial vault grows and fuses via membranous ossification = frontal bossing
631
Endochondral ossification vs membranous ossification
Forming bone through cartilage vs forming bone on the mesenchyme Long Bones vs Flat Bones
632
Role of Osteoblasts
Mineralistaion of bone
633
Role of Ostoeclasts
Bone Resorption (respiration of th ecalcified matrix)
634
Role of Osteocytes
Nutrition
635
Where is lamellar bone found and how does this look under a microscope
80% Cortical | Arranged in Sheets
636
What is Woven Bone
Collagen arranges randomly after healing bones or relatively made bones
637
Impetigo vs Necrotising Fasciitis
No Pain vs Severe Pain
638
Symptoms common in impetigo and Folliculitis
Itchiness
639
Characteristics of Severe in Necrotising Fasciitis vs Erysipelas
High with abrupt onset vs Persistent
640
Differences in rash in impetigo vs cellulitis vs folliculitis
Vesicular vs Macular Erythema vs Folliculitis
641
What causes non-bulllous impetigo
Lesions develop on previously damaged skin (scrapes and bites) BUT NON PAINFUL (just itchy) Regional adenopathy
642
What does impetigo look like
GOLD PLAQUES that are crusted (over 2cm in diameter) Over face and extremities that heal without scarring
643
What is bulls impetigio
Lesions are vesicle filled (bullae) Multiple lesions around the trunk, nose, mouth, buttocks PAINFUL and lesions occur on intact skin NO regional adenopathy
644
How long should children with impetigo be taken off school for
Until infection resolves
645
What is Erysipelas
Infection of Connective Tissues
646
What agent causes Erysipelas
Strep. Pyogenes
647
Signs of Erypsipelas
Affects Face: Swollen, Red and Tender with blebs!
648
How is club foot treated
Ponseti Method: The foot is rotated and put into a cast in normal position. Achilles Tenechtomy to make this easier
649
Genetic inheritance of achondroplasia
X-linked dominant
650
What causes rickets (osteomalacia)
Lack of Vit D CKD, malabsorption disorders, dark skin colour
651
Presentation of Rickets
1. Bowing of the legs 2. Knock Knees 3. Rachitic Rosary (where ribs expand at the costchodnral junction = lumps 4. Craniotabes (soft skull from delayed suture closure and frontal bossing 5. Delayed teeth development
652
Lab results for Rickets
``` X-Ray: Low serum Calcium Low Serum Phosphate Raised Serum Alkaline Phosphatase Raised PTH levels ```
653
Why are breastfed babies at a higher risk of rickets
Vit D defcieicny in breast milk while fortification of vitamin d is in formula feeds.
654
Treatment Vit D deficiency
Ergocalciferol
655
What is Kawasaki Disease
A type of vasculitis affecting 1-5 year olds
656
How long does Kawasaki disease last
5 Days Sometime up to 12 days without intervention
657
Symptoms of Kawasaki Disease
CRASH Bilateral Bulbar Conjunctival Injection (photophobia or discomfort or pain to light exposure) Polymorphous Rash (Happens during first few days due to light sensitivity) lymphAdenopathy: Anterior cervical nodes overlying the sternoclidomastoid muscles Strawberry Tongue Oedema of the hands/feet Irritability, rhinorrhoea, cough and vomiting
658
Most common complication of Kawasaki Disease
Coronary Artery Disease (MI, HF and Arrythmias)
659
What is atypical Kawasaki Disease
Unexplained fever in infants under 7 months without CRASH symptoms Suspected Kawasaki: only matches 2/3 of these ymptoms
660
Management of Kawasaki Disease
IvIg (8-12 hours) | Aspirin
661
What syndrome is Aspirin associated with
Reye's Syndrome: Rapidly Progressing Encephopathy
662
How to protect against Reye Syndrome
Varicella and Influenza vaccine
663
What is Refractory Kawasaki Disease
Persistent Fever (24 hours) after initial therapy Afebrile then develops a fever
664
In what children are refractor Kawasaki disease seen in
Male | <6 month old
665
Treatment of Refractory Kawasaki Disease
Second dose of IvIg
666
What are TORCH infections
``` Toxoplasma Gondii Other Agents: SYphilis, Parvovirus 19, Varicella Zoster Virus, Listeria Rubella Cytomegalovirus Herpes Simplex Virus (HSV-2) ```
667
Why are torch infections grouped together
Spread vertically though either the placenta or breast milk
668
General symptoms of TORCH infections
1. Delayed Growth 2. Hepatosplenomealy (jaundice) 3. Thrombocytopenia (low platelet count)
669
How does toxoplasmosis spread
In pregnant individuals: Contact with cat faeces or consumption of undercooked meat
670
Symptoms of Toxoplasmosis
Pregnant: Asymptomatic Foetus: Spreads in first 6 months of pregnancy and causes severe symptoms: Tiad of Choriore Tinitis (white and yellow scars), Hydropchephalus (enlargement of ventricles leads to macrocephaly) and Intracranial Calcifications
671
Symptoms of Parvovirus 19 in pregnant women
Arthritis: of the hands, wrists, knees and feet (SYMMETRICAL) Decreased RBC production (pure red blood cell aplasia) = absence of reticiculocytes
672
Complications of Parvovirus B19 in unborn babies
Hydrops Fetalis as anaemia = dropped RBC ocunt , causing BP to raise and fluid leaking out of capillaries
673
What is Congenital Varicella Syndrome
Low Birth Weight Limb Atrophy Microcephaly Also cataracts and brain degeneration (LDs)
674
Signs of Listeria infections
Gastroenteritis signs
675
What is congenital Rubella Syndrome
1. Deafness 2. cataracts 3. Congenital Heart Defects LEADS TO PATENT DUCTUS ARTERIOSUS (a machinery murmur) Blueberry muffin rash
676
Causes of CMV
Sexual Contact | Organ Transplantation
677
Signs of CMV in neonates
1, Blueberry Muffin rash Petechiae
678
What is the difference between characteristics of autosomal dominant vs autosomal recessive conditions
Recessive: Metabolic (e.g., Freidrich's ataxia) Dominant: Cause structural problems (Familial Adnenomatous polyposis)
679
What is FAP
It is an inherited form a colon cancer which starts as polyps that teenager can get
680
What are Dermoid cysts
A scale like cyst present from birth as a result of defects in embryonic fusion. They contain appendages such as teeth, hair etc.
681
At what sites are dermoid cysts commonly seen
Midline of the neck, posterior to the pinna of the ear and external angle of the eye
682
What is a dermoid tumour
Occur in patients with FAP, these are non aggressive tumours that arise from musculoaponeurotic tissue of the bad walls. Usually abdominal, intraabdominal or extraabdominal
683
What ar eextraabdominal manifestations of demsoid tumours
come out of the musculature of shoulders, backs, thigh and chest wall
684
ITP vs ALL vs Aplastic Anaemia
No hepatosplenomegaly vs hepatosplenomegaly vs none No bone pain vs bone pain sv none Anaemia is proportionate to bleeds vs anaemia is not proportionate to bleeds vs disproportionate to bleeds
685
What is the first management step of suspected acute epiglottis
High flow oxygen DO NOT EXAMINE the throat
686
What infective agent cause acute epiglottis
Haemophilus Influenza B
687
Signs of Chicken Pox
Prodrome: Fever, then an itchy vesicular rash starting on the head/trunk before spreading. Initially macular and then becomes vesicular
688
Incubation period of chicken pox
10-21 days
689
How long should. child be off school for for chickenpox
Until 5 days after the rash has appeared (when the lesions have all crusted over)
690
What does the National hearing Test for Newborns consist of
The Otoacoustic Emission test
691
What is the follow up test if the otoacoustic emission test is abnormal
Auditory Brainstem Response Test
692
Peak incidence of ALL
2-5 Years
693
What harness is given to children if DDH doe snot re-solve by 6 weeks
A Pavlik harness
694
Appearance of the abdominal wall in congenital diaphragmatic hernia
Concave (scaphoid abdomeen)
695
Characteristic of the rash in JIA
Salmon pink (Salmon J ump I n the A ir)
696
Differences in typical eczema presentations in an infant vs younger children
Infant, usually affects the face and trunks rather than flexors or extensors In young children, usually affects the EXTENSORS rather than the flexors Older children (teenagers), usually affect the flexors as usual.
697
Management of a UTI in infants less than 3 months
Refer immediately to a paediatrician
698
Management of a UTi in children over the age of 3 months
Consider admission and given broad range antibiotics (cephalosporins or co-amoxiclav) for 7-10 days
699
management of a UTI in children over 3 months old with a lower UTI
3 Day antibiotic course
700
RF for Cleft Palate
SMoking Benzodiazepines Anti-Epileptics Trisomy 18, 13 and 15
701
Management of chickenpox
1. CALAMINE LOTION to stop itching
702
What is Gastrochisis
Congenital defect in the anterior abdominal wall lateral to the umbilicus
703
Management of gastrochisis
Vaginal Delivery with immediate surgical intervention
704
Management of an Omphalocele
C-Section with a staged repair as there may not be enough space on a newborn foetus to do the whole thing
705
At what age to most children reach urinary continence
3-4 years old
706
What gene is affected in Cystic Fibrosis
CFTR gene
707
Most common ethnicity that get CF
European descent
708
Pathophysiology of CF
CFTR is responsible for pumping out Cl ions into secretions. Chloride is puroesinsible from drawing in water into mucous membranes CFTR pumps is not here in CF, causing dry mucous membranes which get excreted in sweat
709
What causes acute pancreatitis in CF
Proteases and Lipases cannot go anywhere, eventually resulting in inflammation
710
What causes recurrent infections CF
Thickened mucous stops mucociliary action, which wafts bacteria away
711
Extra pulmonary and GI symptoms of CF
Infertility (lack of a vas deferent) Digital Clubbing Nasal Polyps Allergic Bronchopulmonary Aspergiliosus (Hypersesinsitivty to aspergilliosus infections)
712
What cross-transmissions are we most concerned about in CF
Pseudomonas Aerguinosa | Staph Aureus
713
Radiological findings in Osteomyelitis
Soft tissue oedema Radioluscency in a part of where the joint should be or ending of a long bone
714
What neurodevelopment problems can lead to Perthes
ADHD!
715
Testicular torsion of the appendages vs Testicular Torsion
Tetsicular torsion o the appendix will have cremasteric reflexes whilst is tetsicular torsion, this wold be negative
716
What are saber shins
Sign of Syphilis: anterior bowing tibias Hutchinson Teeth: Notched in teeth
717
A 15-year old patient presents with sudden right eye pain. His pain resolves without treatment. There is usually a warm, red lump on the eye. What is the likely diagnosis
Hordeolum: Acute focal infection caused by Staph Aureus
718
What causes blueberry muffin syndrome and in which conditions is this seen in
Extramedullary Haematopoiesis CMV Rubella VZV Herpes Also, haemolytic anaemia or Hereditary Spherocytosis
719
What is a neurological complication of measles
Subacute Scleorising Panencephalitis (just think: Meningitis occurs in children after 10 years of contracting measles, this is in the same vein)
720
What wouldd be seen in stool analysis of a child with lactase deficiency
Highly acidic stool (but normal meconium ileum): Lactose Intolerance
721
How is vesicoureteral reflux managed
1. Usually surveillance, with imaging, urine culture and periodic urinalysis. This is because, VUR usually resolves spontaneously in younger children. Consider antibiotic prophylaxis and surgical repair if this persist after one year of age.
722
In what parents does nondisjunction of chromosomes usually give rise to Down's, Edward's and Patau's
MATERNAL Meitotic nondisjunction
723
Signs of Hypothyroidism in Neonates
``` Chronic JAUNDICE Poor Feeding Constipation Increased Sleeping Reduced Activity Slow Growth ```
724
Name two antibodies found in hypothyroidism
Antithyroglobulin antibodies Anti Thyroid Peroxidase antibodies
725
In what lobe does HSV-1's encephalitis usually affect
Temporal (HALLUCINATIONS - e.g., change sin smell and taste) - think HSV-1 caused encephalitis
726
What strain of HSV is more likely to cause Herpes recurrences
HSV-2 over HSV-1
727
Describe the metabolic activation of Vit D
Vit D is metabolised in the liver -> 25 (-OH) Vit D by 25-Hydroxylase Goes to the kidneys and is converted by 1-alpha- hydroxyls to 1,25 (-OH)D (calcitriol - active form of Vit D)
728
Role of Calcitriol
Increases absorption of Calcium ions from the GI system Increases uptake of phosphates and calcium ions from the renal tubules
729
Role of PTH
Reabsorption of Ca2+ and PO43- from the bone and into the blood stream Also boosts 1,alpha hydroxyls activity: Increased resorption of Ca2+ and increased EXCRETION of PO43-
730
What are the specific symptoms of rickets
Craniotabes (soft tissue in skull) Delayed fusion of the fontanelles Bowing of the legs (Genu Varum) Protruding abdomen and front skull bone. Rachitic Rosary: Little bumps along the chest due to enlargement of the chest wall
731
Lab results in Rickets and Osteomalacia
Low Vit D Low Blood Ca2+ = Raised PTH = Low PO43- Raised Alkaline Phosphatase
732
Most common symptoms seen in Vit D deficiency
Bowed legs
733
First Line Treatment of OI and Rickets
OI: Bisphosphonates Rickets: DO NOT GIVE BISPHOSPHONATES as it makes Rickets worse, only give Vit D as it's caused by Vit D Deficiency
734
What are the two types of 21-HYdroxylase Deficiency
1. Salt-Losing (loss of Aldosterone and Cortisol) | 2. Non Salt-Losing: Only Cortisol Deficiency
735
Why do we get androgen excess in CAH
Because 17-Hydroxypregnenolone and 17-Hydroxyprogesterone are used to make Testosterone AND cortisol. Without 21-Hydoxylase, cortisol can't be made, so there is an excess of 17s which are converted into testosterone instead = high androgen levels
736
Signs of Classic CAH
``` Girls: Atypical Genitalia (genital ambiguity): ``` ``` Enlarged Clitoris Urogenital Sinus (urethra and vagina have the same opening) ``` Partial or Complete Fusion of Labial FOlds Internal Female Reproductive System normal Boys: Normal External Genitalia Hyperpigmentation of the scrotum Enlarged Phallus (penis)
737
Consequences of salt-losing CAH
1. Hyponatraemia 2. Hyperkalaemia 3. Failure to Thrive This is not seen in Non Salt-Losing as there is no aldosterone deficiency Simple Virilization form (Non-Salt Losing): Just has accelerated growth of axillary and pubic hair
738
Why is skin hyperpigmentation characteristic of CAH
Because a lack of cortisol levels stimulates an increase in ACTH by the anterior pituitary gland. A byproduct of ACT is MSH (Melanin Stimulating Hormone) which causes pigmentation in the skin
739
Management of CAH
1. Cortisol Replacement (Hydrocortisone) 2. Aldosterone Replacement (Fludrocortisone) Correctiev Surgery in Females
740
Consequences of CAH
Adrenal Crisis: Hypotension, vomiting, abdominal pain, mental status changes, hypoglycaemia, electrolyte imbalances
741
How to treat and Adrenal Crisis
IV Dextrose
742
What is Non-Classic CAH
1. Typical Genitalia at birth that has manifestation of symptoms in adolescents instead (e.g., Hirsutism, Acne, Primary Amenorrhoea, PCOS and Precocious Puberty in males)
743
Other than 21-Hydroxylase deficiency, what other enzyme may cause CAH
11-beta-Hydroxylase Deficiency | 3-beta- Hydroxyls Deficiency
744
Name some pathologies that cause hydrocephalus
Aqueductal stenosis (narrowing of the cerebral aqueduct that connects the third and fourth ventricles) Arachnoid cysts Arnold-Chiari Malformation Chromsomal abnormalities and infections
745
When do the cranial bones in babies usually fuse
2 Years of age
746
What is a complication of Ventriculoperitoneal shunting to treat hydrocephalus
Intraventricular haemorrhage
747
What is the Hirschberg's test
Shining a light in a kid's eye and seeing if the light source from the reflection is symmetrical and central
748
What is Palgiocephaly
It is the squishing of the baby's head from the way they are sleeping. 3-6 months This has become more common from people telling parents to lay babies on the back of their head to reduce the risk of Sudden Infant Death Syndrome
749
Management of Plagiocephaly
Reassurance, Plagiocephaly Helmets
750
What is Brachycephaly
This is the flattening of the back of the baby's head
751
What is Ebstein's Anomaly associated with
WPW Syndrome
752
What endocrinological finding would be found in Fragile X Syndrome
macroorchidism: Elevated Gonadotrophic Levels
753
What is Otitis Media
Inflammation of the External Auditory canal
754
What infective agents usually cause Otitis Media
Strep Pneumoniae These enter the back of the throat through the Eustacian Tube
755
Clinical Presentation of Otitis Media
PRODROME: Viral Upper Respiratory Tract Infection 1. Ear Pain 2. Pruritis 3. Discharge 4. hearing Loss
756
On examination of an otoscope in Otitis Media, what would be seen
A bulging red, inflamed membrane - Can perforate in which case a Hoel wold be seen.
757
Management of Otitis Media
Resolves without antibiotics Simple Analgesia REMEMBER: Admission if, <3 months and over 38 degrees 3-6 months and over 39 degrees.
758
Complication of Otitis Media
RARE: Mastoiditis
759
When should antibiotics be given in Otitis Media
Co-Morbidities Bilateral Otitis Media Ear Discharged
760
What antibiotic is given for Otitis Media
Amoxicillin for 5 days
761
What is increasing the prevalence of Kawasaki Disease
Preceeded by a COVID-19 infection
762
What is Glue Ear
Reduction of hearing, it is otitis media with effusion (the acoustic meatus is FULL of fluid)
763
Signs of Glue Ear on examination
Dull tympanic membrane with air bubbles or visible fluid
764
Management of Glucosee Ear
Audiometry to help diagnosis Resolves without treatment under 3 months Grommets (tiny tubes inserted into the tympanic membrane) by an ENT surgeon
765
Where do Epixstasis originate from
Kiesselbach's Plexus (nasal mucosa at the front of the nasal cavity that contains lots of blood vessels
766
Triggers for nosebleeds
1. Picking 2. Colds 3. Nose blowing, chases in weather
767
Management of a nosebleed
Sit up and tilt head forwards 2. Squeeze soft part of nostrils together for 10-15 minutes 3. Spit any blood in the mouth rather than swallowing
768
What is a septic screen
1. Lumbar Puncture 2. Urine Culture 3. Full Blood count/culture/CRP
769
When would a CXR be indicated in an unwell child with nonspecific symptoms
WBC > 20 | Temp > 39 degrees
770
What is the first line management plan for children under 3 months if unwell or WBC <15 or >15
IV antibiotics
771
What is the treatment of meningitis under 3 months of age
Cefotaxime + Amoxicillin
772
Signs of Meningococcal Septicaemia
Rapid onset of shock, Tachypnoea, cold hands and feet and flu like symptoms
773
What would be seen on an ECHO for Kawasaki disease
Blood vessel inflammation supplying the heart - can cause coronary artery aneurysms
774
Risk Factors for COVID
Obesity Comorbidities Male Age
775
Name four vaccines that are live attenuated
MMR BCG Nasal Flu Rotavirus
776
Name an inactivated vaccine
Whole cell pertussis
777
Name a vaccine that contains toxins
dTAP
778
What type of vaccine is flu and Men B
Cell wall/ envelop components
779
How do we prevent vertical transmission of HIV
1. Use antenatal antiretroviral 2. Avoid labour and birth canal (elective C Section) 3. Avoid Breastfeeding
780
Signs of HIV in children
1. Chronic Diarrhoea 2. Cerebral Palsy Recurrent bacterial and viral infection Lymphadenopathy and Hepatosplenomegaly Pneumocystis carinie, candida, herpes, VZV
781
What vaccines must be avoided in a child with HIV
Live, attenuated vaccines: BCG, MMR, Rotavirus
782
Whatdual medication is given for active TB in children
Isoniazid + Pyridoxine Then Mantoux test after 6 weeks
783
What is the Mantoux test
PPD tuberculin skin test, injected into the skin and then forms an induration
784
What is done if the Mantoux test is positive
Continue Isoniazid + Pyridoxine for 6 months
785
If the Mantoux test is negative, what should be done
INF-gamma release assay
786
Diagnostic interventions for TB
X-Ray | CT Thorax
787
What is primary TB
Signs of infection soon after exposure: Usually Asymptomatic After 3 weeks: Cell-Mediated Immunity Formation of a granuloma to wall off TB -> Caseaous necrosis This forms a Ghon Focus
788
How does TB affect the Hilar Lymph Nodes
TB is carried by immune cells through lymph or extension of Ghon focus into the nodes = Caseation in the hilarity lymph nodes to = Ghon Complex
789
Where are ghon focus found
Lower lobes of the lungs
790
What is Ranke Complex
Fibrosis and calficiation of the fibroma surrounding complexes - seen on an X Ray
791
What causes reactivation of TB
AIDS or Aging Where TB breaks through the complexes and migrates up towards the upper lobes of the lungs (as they're aerobic and need oxygen). Memory T cells come into the place = more caseous necrosis However, these are weaker and capitate -> allowing spread of TB
792
Impact of reactivated TB in the lungs
Broncho-Pneumonia
793
Types of Miliary TB
``` Meningitis POTT Disease Adrenal Glands (Addison's) Hepatitis cervical lymphadenitis ```
794
What type of vaccine is Polio and Yellow Fever
Live Attenuated
795
In which conditions is Hep B vaccine contraindicated
Allergies to Baker's Yeast (it is a vaccine component)
796
When should the Hep B vaccine be given
THREE DOSES Within 24 hours if HbaAg in mother is negative and the baby is over 2000g Within 1 month if HbsAg is negative in mother but <2000g 2nd: Then given at 1-2 months 3rd: Given at 6 months
797
Side Effects of MMR
1. Seizures | 2. tThrombocytopenia
798
When should MMR vaccine be delayed
Recent IvIg, or blood transfusions/ platlets With about 3-11 months
799
What is different about the IM and nasal spray influenza vaccine
IM is inactivated, Nasal spray is live, attenuated
800
What is a consequence of Influenza vaccine
GBS
801
Social Milestones
2 Months: Baby Smiles 4 Months: Explore Parent's Face 6 Months: Prefer to play by themselves + Feel anxious around stranges 9 Months: Wave Goodbye + Stranger Anxiety 12 Months: Dressing, Point at pictures, separation anxiety 18 Months: Kids play next to each other but do not interact 2 Years: Throws tantrums/ Say No a lot Possessiveness 3 Years: Share Toys Easily Separated from parents Show Empathy Play with others 4 Years: Fantasy Play (like tea parties) 5 Years: Close friends + Play games with rules
802
What is an osteoid osteomalacia
A unilateral benign tumour found on th along bones of the body - causes pain but usually asymptomatic
803
Onset of Osteoid Osteoma
Teenagers or early adulthood
804
When is Dexamethasone contraindicated in the treatment of meningitis
In children under the age of 3 months old
805
How do we diagnose constitutional growth delay
Short stature compared to the rest of the class and parents describe themselves as 'late bloomers'. Usually normal sized at brith, and then experience a deceleration in growth until 3 years and then grow normally again. However, this causes a drop off in the growth curve during adolescents as they will go through puberty later (think 3rd percentile or less compared to peers).
806
How does Scarlett fever and rheumatic fever correlate
Both can arise after strep throat infections but Rheumatic fever can develop AFTER Scarlett fever if not treated properly
807
Describe the types of attachment styles
Anxious: Negative view of self, Positive view of others and dependant Avoidant: Positive view of self, negative view of others, Independent and puts up walls Fearful Attachment: Negative view of self, negative view of others, Disorganised, seeks + avoids closeness
808
What is the biggest risk factor in ADHD
Twins
809
What is first line management in ADHD
Parent education and training CBT No medication in pre-school! Methylphenidate + SNRI
810
Four types of Strabismus
Esophoria (eye drifts towards nose) Exophoria (Eye drifts away from nose) Hyperphoria (Eye deviates up) Hypophoria (Eye deviates down)
811
What is Anisometropia
This is the difference in refractive error between the eyes.
812
How do we examine Strabismus
Cover test: Cover eye and get child to focus on a detailed target
813
Signs of Pseudostrabismus
1. Facial asymmetry 2. Unilateral ptosis 3. Deep set or prominent eyes
814
What is Amblyopia
Defective visual acuity which persists after correction of refractive error and removal of any pathology: Strabismus amblyopia It is a LAZY EYE
815
Treatment of Amblyopia
Refractive Adaptation (wear glasses) Occlusion of better eye Atropine drops to dilate the pupil and paralyse accommodation
816
Surgical treatment of strabismus
Esotropia: Bilateral media rectus recession Exotropia: Bilateral lateral rectus recession
817
Management of Strabismus
Botulinum Toxin
818
What causes Dandy-Walker Syndrome
Warfarin use during pregnancy - also causes nasal hypoplasia
819
What cells are seen in a blood smear for G6PD deficiency
Bite Cells
820
What causes ambiguous genitalia (e.g., a blind ending vagina) in males
5-alpha hydroxyls deficiency (elevated testosterone to dihydrotestosterone levels)
821
What is Trachoma
C. Tracheomatis infection of the eyes, leading to blurred vision and corneal ulcers/ inwards eyelashes. Very prevalent worldwise
822
E.Coli vs Norovirus infection
Both are water diarrhoea but Norovirus and Rotavirus are associated with abdominal cramping while E.Coli isn't There's no vomiting in E.coli infections but there is in Norovirus and Rotavirus infections
823
IN what genetic condition is coarctation of the aorta commonly seen in
Turner Syndrome - remember, has a bicuspid aortic valve (aorta symptoms)
824
What is Liddle Syndrome
Impaired functioning of the ENac channels of the renal tubules leading to hypertension and hypokalaemia
825
What is primary hyperaldosteronism
Dysfunction of the adrenal gland itself. Secondary is a problem elsewhere in the body causing too much aldosterone release.
826
``` Define the following: Camptodactyly Macrodactyly Phocomelia Syndactyly ```
Camptodactyly - Fixed flexion deformity in th proximal IPJ (usually the fifth finger) Macrodactyly - Overgrowth of one ore more of the digits Phocomelia - Shortening of a limb close to the body (thalidomide) Syndactyly - Presence of adjacent toes or fingers joined by soft tissue (webbed feet)
827
What organism causes viral conjunctivitis
Adenovirus
828
Signs of viral conjunctivitis
Reduced visual acuity Bilateral conjunctival injections BILATERAL infection think either chlamidya/gonorrhoea or viral conjunctivitis
829
What happens to serum maternal AFP levels in Gastrochisis and Omphaloceles
Elevated
830
Omphalocele vs Gastrochisis (in appearance not location)
Omphalocele - can be associated with an extracorporeal liver and has a membranous sac Gastrochisis - No membrane (free floating) and intracorporeal liver.
831
Management of in-toeing (pigeon toe)
Reassurance and follow-up - benign and resolves on own
832
Signs of DiGeorge Syndrome
TRIAD: Thymus hypoplasia (immune deficiency) Parathyroid hypopplasia (hypocalcaemia) Truncus Arteriosus High and broad nasal bridge Long face Narrow palpebral fissures and cleft palate
833
CV signs of DiGeorge Syndrome
Widened pulse pressure | Systolic Ejection murmur at LOWER LEFT STERNAL BORDER - truncus arteriosus
834
What genetic condition is closely linked to Truncus Arteirosus
DiGeorge Syndrome
835
Two conditions associated with thyme hypopplasia
``` DiGeorge Syndrome Ataxic Telangiectasia (nystagmus and can't stand still) ``` Thymic hypoplasia happens after puberty, where its stroma is replaced bay adipose tissue.
836
What causes otitis externa
SWIMMER'S EARS Inflammation of the ear that presents with ear pain, swelling of the ear canal with discharge and loss of hearing. Pseudomonas Aerguinosa and Staph Aureus
837
What can cause an anion gap metabolic acidosis
MUDPILES: ``` Methanol Ureaemia DKA Propylene Glycol Iron Tablets Lactic Acidosis Ethylene Glycol Salicylates ```
838
Main cause of otitis media
Strep Pneumoniae - remember, it's usually a throat infection that spreads up the tympanic membrane
839
What additional immunisations do children with SCD need
Pneumococcal polysaccharides and meningococcal vaccines
840
What is the most commonly injured ligament in the knee
The anterior cruciate ligament THE MAIN DAMAGE CAUSED IN NON-CONTACT SPORTS PEOPLE.
841
What is the most common complication of the seasonal influenza
Otitis Media
842
What is gower's sign
To stand up from lying down on their belly - to check for Duchenne's muscular dystrophy
843
Acute Otitis Media vs Otitis Media with Effusion
Otitis Media with effusion is asymptomatic - no ear pain.
844
What is Malignant Otitis Externa
Infections of the outer ear seen in diabetic patients (immunocompromised) - pseudomonas aerguinosa and strep pneumoniae.
845
Ependymoma vs Medullablastoma vs Pilocytic Astrocytoma
Ependymoma - 4th Ventricle Medullablastoma - Cerebellar vermis Pilocytic Astrocytoma - Cerebellar hemispheres (looks like an enhancing nodules on a CT)
846
IgA Nephropathy vs Post-streptococcal glomerulonephirtis
IgA nephropathy occurs concurrently with URTI Post-Strep glomerulonephritis occurs 2-3 weeks following a URTI Both cause haematuria
847
What is the most common complication of Cleft Palate
Otitis Media
848
What is the main aspect of Tetralogy of Fallot that determines the severity and clinical presentation of the disease
Pulmonary Stenosis
849
Signs of Shigellosis
Bloody stools, mucous and small in volume High grade fever, so must be treated with Azithromycin
850
Shigella vs Salmonella
Salmonella should only be treated with Fluid and Electrolyte replacement only Shigella - Must give antibiotics
851
What would be seen in a patient's stool sample for Shigela
Polymorphonuclear leukocytes on a methylene blue stain
852
Where are Rhabdomyosarcomas typically found
On the head and neck region
853
What test would confirm diagnosis of Rhabdomyosarcoma
Desmin-positive on biopsy (also would be seen in the neighbouring lymph nodes that have inflamed)
854
What causes neonatal respiratory distress syndrome in preterm babies
Lack of lung surfactant which is needed for surface tension to allow the alveoli to open up.
855
How do we treat bacterial sepsis
IV Fluids + Antibiotics
856
What part of the bowel does coeliac's affect
The JEJUNUM
857
Difference in diagnosing the cause of multiple UTIs in children over 6 months
Under 6 months - MCU only if vesicoureteral reflux is indicated Over 6 months - it is likely that vesicoureteral reflux has already been diagnosed (Only use a USS within 6 weeks and a DMSA scan 4-6months later)
858
Signs of congenital Hypothyroidism
Hypotonia Macroglossia Umbilical Hernia Reduced feeding and constipation
859
When should broad beans be avoided
in 65PD deficiency as they precipitate oxidative stress
860
What foods must be avoided in a child with phenylketonuria
Diet Fizzy Drinks - contains aspartame which is a rich source of phenylalanine ``` Wheat Products (to a smaller degree) Dairy ```
861
What fruits must be avoided in patients with birch pollen oral allergy syndrome
Stoned Fruits
862
Ratio of compression to breath ratio: difference between neonates and infants/children
Infants/Children - 15:2 Neonates - 3:1
863
What is a common complication of Bronchiolitis in neonates
Hyponatraemia - seizures
864
What medications can cause prolonged QT intervals
``` Macrolides (Clarithromycin) Quinolones Tricyclics Antipsychotics Ondansetron Metoclopramide Amiodarone Quinidine Sotalol ```
865
What condition is Ladd's operation used for
MALROTATION OF VOLVULUS
866
What is the first line intervention for 'late bloomers'
X-Ray of the hands and wrists
867
What is Waterhouse-Friederichen Syndrome
Adrenal haemorrhage and septic shock
868
What causes Waterhouse-Friderichen Syndrome
N.meningitidis infection - especially from meningococcal septicaemia
869
What specific inflammatory marker is used to detect bacterial sepsis
Procalcitonin
870
What happens to the skin in Kawasaki Disease later on in its progression
Skin Peeling
871
How is Reye's syndrome managed
Supportive Management
872
Acute otitis media vs otitis media with effusion on examination
With effusion - retracted tympanic membrane that is non-inflamed Acute otitis media - tympanic membrane rupture (as a potential complication)
873
When should Children with acute otitis media be treated with oral antibiotics
Only if they have fevers/systemic symptoms
874
What type of cerebral palsy occurs due to kernicterus
Dyskinetic/athetoid cerebral palsy (affects the basal ganglia)
875
What structure is damaged in Spastic cerebral palsy
Periventricular damage from ischaemia
876
How far should the depth be in child compressions
1/3rd of the depth
877
What type of laxative is Senna and when is it used
Stimulant - as second line after movicol
878
What is the main complication of aspiration of meconium
Pneumothorax, the baby goes into Respiratory Distress and desaturates very quickly
879
What is the main investigation that should be used to differentiate between septic and transient synovitis
Joint Aspiration
880
If a child presents with squint, what is the first line management
Squint = deviating eye Goes away after 8 weeks and then referral to paediatric team where the stronger eye is patched
881
What is preseptal cellulitis
Infection of the superficial tissues around one eyelid.
882
Preseptal cellulitis vs orbital cellulitis
Prseptal - Just the eyelid is involved Orbital - Deeper structures affected
883
Management of Orbital Cellulitis
AGGRESSIVE management - Admission for IV antibiotics and surgical decompression Compared to Preseptal cellulitis which just needs antibiotics
884
What is the main complication of coarctation of aorta
Cerebral aneurysms Reduced perfusion activates RAAS, increasing the pressure before the stenosis
885
How often does bilirubin need to be checked during non UV phototherapy
4-6 hours Then 6-12 hours after levels starts to decline
886
When should phototherapy be intensified
If bilirubin levels continue to rise or stay the same after 6 hours
887
When is exchange transfusion treatment indicated for Jaundice
If the threshold for bilirubin quantity hits 450 micromoles/L
888
Describe the stepwise management to an asthmatic attack
1. Inhaled Salbutamol 2. Nebulised salbutamol 3. Nebulised Ipratropium 4. If O2<92%, nebuliser magnesium sulphate 5. Oral or IV steroids 6. IV Salbutamol 7. Aminophylline
889
How is hypoglycaemia corrected
IM Glucogan - outside hospitals Inside - IV Dextrose solution
890
What colour will the baby look in Meconium Aspiration
Green
891
What is a key sign seen in Transient Tachypnoea of the New Born on an X-Ray
Fluid in the lung lobes - it's caused by delayed resorption of fluid in the lungs
892
What causes mesenteric adenines
A preceding Upper Respiratory Tract Infection
893
Mesenteric Adenines vs Apendicitis
Mesenteric Adeninitis has no abdominal guarding while appendicitis does!
894
What is vasovagal syncope
Happens in children, will fall down and then have a seizure with rapid recovery (caused by vasodilation and a drop in BP)
895
What is Vitamin C deficiency
Scurvy: Swollen gums, anaemia and corkscrew hair
896
What is the complication of B3 deficiency
TRIAD: Dermatitis Diarrhoea Dementia
897
Management of Scarlet Fever
Stay off school for 24 hours after first dose of antibiotics
898
What is Parvovirus infection also known as
Erythema Infectionosum
899
Describe the stages of Parvovirus infection
Initial headache, fever and coryza Sudden bright red cheeks/ more lacy in pattern over the trunks
900
What is the first line intervention in Epiglottitis
Intubation before ANYTHING else
901
How do we diagnose Reye's Syndrome
Liver Biopsy
902
WILMS tumour vs Neuroblastoma
Neuroblastomas cross the midline on an X-Ray WILMS tumours do not
903
Describe the processes for child resuscitation
1. Open Airway 2. If not breathing properly: 5 Breaths 3. If no signs of life: 10 chest comrpessions Then 15: 2 chest compressions to breaths
904
What compound in the blood is an indicator for sepsis
Lactate Levels (they are usually elevated) - a sign of sepsis
905
First Line Investigation for suspected Sepsis
``` Blood Tests for: LFTs U and E's CRP Blood Culture Clotting Screen ABG for lactate ```
906
What medication is given alongside steroid therapy
Penecillin V - it's an immunosuppressant
907
Symptoms of a varicocele
Asymptomatic
908
What is the difference between treating adults and children with DKA
Children should not be given IV Sodium Bicarbonate
909
Side Effects of corticosteroids
Acne Striae (stretch marks) telangiectasia Skin Thinning
910
What should be the first line referral for someone with suspected Idiopathic Juvenile Arthritis
Refer to Ophthalmology to check for anterior uveitis - causes blindness
911
What is a febrile seizure
This happens DURING an infection while afebrile happens following an infection
912
At what age do babies pass things between their hands
6 months
913
Onset of Cerebral Palsy
Within the first years of life (can happen before birth too)
914
What is Diplegia
Affects all four limbs but mostly the legs
915
How is cerebral palsy diagnosed
Primarily clinical, but can be supported by MRI/ CT
916
Side effects of valproate
Weight Gain | Hair Loss
917
What is juvenile myoclonic epilepsy
Jerking of the muscles in the first two hours in the morning Treat with Lamotrigine/ Sodium Valproate
918
What triggers JME
Lack of sleep, fatigue and alcohol Triggered by flickering lights Usually comes back after stopping medications
919
A complication of ventilators
Pneumothorax
920
Initial investigation for Perthes vs GOLD STANDARD
Initial - X Ray Gold Standard - MRI as necrosis can't be seen on an X Ray
921
What is the initial investigation for Slipped Upper Femoral Epiphyses vs GOld STandard
Again, X-Ray of both hips Gold: MRI
922
What is the main extra-articular disease we need to be worried about in Idiopathic Juvenile Arthritis
Uveitis - remember to refer to opthalmology
923
Radiological investigations for a UTI 0-6 months
If atypical: Acute USS DMSA 4-6 months later
924
Radiological investigations for a UTI (6 months - 3 years)
If atypical: Acute USS and DMSA 4-6 months later If recurrent: Just the DMSA scan 4-6 months later
925
Radiological investigations for a UTI at 3 years
If Atypical: Acute USS If Recurrent: USS within 6 weeks DMSA 4-6 months
926
Management of Vesicoureteral reflux
Antibiotic prophylaxis for UTIs and then reassure parents.
927
Pyloric Stenosis vs GORD
Pyloric stenosis: Weight loss GORD: Weight gain/normal. Both are non-bilious vomiting
928
What is the most common cause of paediatric cardiac arrests
Asystole
929
Psoriasis vs Eczema
Psoriasis is not pruritic
930
What fluid should be given to children/patients with increased ICP
IV Hypertonic saline to draw fluid out of the brain
931
What organism usually causes seizures in bronchiolitis
Adenovirus
932
Are NSAIDs a contraindication to breastfeeding
No
933
How often should Retinopathy of prematurity be screened for
Every 2 weeks using a fundoscopy
934
What structure causes an inguinal hernia
Patent processus vaginalis
935
At what age can a child name their favourite colour
3
936
At what age can a c child count to 10
4
937
When does a child string three or four words together to form a sentence
3 Years
938
Osgood-Schlatter vs Patellar Tendonitis
Pain worse DURING activity vs pain AFTER activity
939
What is the most common presentation of neonatal sepsis
Respiratory distress
940
What antibiotics are given as part of sepsis management
IV gentamicin and Benzylpenecillin
941
What side of the lungs in Congenital Diaphragmatic hernia commonly seen
Left On an X-Ray, you would see bowel loops in the thoracic cavity
942
What pulses are checked in infants
Brachial and Femoral
943
Treatment for mycoplasma pneumonia
Macrolides: Erythromycin
944
What is the greatestt risk factor for meconium aspiration
Post-Term Delivery
945
Peak incidence of bronchiolitis
3-6 months
946
Normal Heart Rate for healthy infants
100-160 BPM
947
At what age does a child say 'mama' and 'dada'
9-10 months
948
First line management of an inguinal hernia
Urgent referral for surgery, children under 1 are at a higher risk of strangulation
949
What structure is persistent in inguinal hernias
patent processus vaginalis
950
First line management of umbilical hernias
Wait and watch
951
What is the rule for surgical correction of an inguinal hernia
< 6 weeks = correction in 2 days < 6 months = correction within 2 weeks < 6 years = correction within 2 month s
952
When do umbilical hernias resolve by
3 Years
953
Antibiotic therapy for adults with pneumonia
Mild: Amoxicillin Moderate: Amoxicillin/Doxycycline + Clarithromycin/Erythromycin Severe: Co-Amoxiclav + Clarithromycin
954
Antibiotic therapy for children with pneumonia
Mild: Amoxicillin Moderate: Amoxicillin + Clarithromycin Severe: Co-Amoxiclav
955
When are macroliddes given for pneumonia in children
Erythromycin/Clarithromycin if atypical pathogens are suspected
956
What condition can amoxetine be used for as second line
ADHD
957
What is Micrognathia
Undersized jaw
958
Th likelihood of recurrence for febrile convulsions
30-40%
959
What is the main cancer that can come from Coeliac's
Lymphoma
960
How often should retinopathy of prematurity be screened for
Fortnightly fundoscopy
961
What is a consequence for premature newborns undergoing artificial ventilation
Retinopathy of prematurity (increased radicals from O2)
962
When is the first dose of hepatitis B given
Within 48 hours of birth
963
When are the next doses of Hep B given, how many are there in total
1 month, 2 months, 12 months (booster)
964
When is the booster for Hep B given
12 months and 3 years
965
When is the PCV vaccine given
4 months | 13 months
966
At what age does a child have 2-6 vocabulary
15 months
967
At what age does a child have 50 word vocab
14 months
968
At what age does a child have 200+ word vocabulary
30 months
969
When are babies reviewed by the GP as part of the screening programme
6-8 weeks 1 Year
970
First choice oral antibiotic for Pyelonephritis (ignore trimethoprim), according to NICE
Cefalexin
971
First choice IV antibiotic for pyelonephritis
Co-Amoxiclav
972
How does UTI management for pyelonephritis differ according to age
Under 3 months: sent to paediatric specialust + IV antibiotics FIRST over 3 months: Oral antibiotics (if tolerated) then IV antibiotics
973
How are Posterior Urethral Valves diagnosed
USS ABdomen during pregnancy usually But MCUG and a cystoscopy can help too
974
Diagnosis of Whooping Cough
Per Nasal PCR, not culture
975
What should be done for all children with a first seizure that presents to GP
Referral to Paeds
976
When should a EEG be performed to diagnose epilepsy
ONLY AFTER THE SECOND SEIZURE, as it may come back as normal with only one.
977
What can be done to increase the sensitivity of an EEG
Sleep-deprived EEG (boosts from 40 to 80%) - they can sleep in clinic to monitor brain activity Hyperventilation
978
What is the first line investigation for a first time seizure
Watch and Wait
979
When is an MRI indicated to help the diagnosis of a seizure
Focal Seizures
980
What is congenital valproate syndrome
Malformations that form as a result of sodium valproate use by pregnant mothers
981
What is a first-fit clinic
A specialist clinic ran for first time seizures
982
When can a transcutaneous bilirubin be used
Over 24 hours old + over 35 weeks old.
983
When is a transcutaneous bilirubin measurement indictaed
If parents/midwife on review feels that the baby might be jaundiced. Can just be done at home rather than admission to hospital. Within 24 hours of age, this will always require hospitalisation
984
What cells are involved in dermatitis
T-Cell mediated
985
What is the main consequence of congenital hypothyroidism in children
Intellectual Disability
986
How many moles of KCL are used in saline given to children
0.9% NaCl, 20mmol KCL
987
What causes hypernatraemia
Dehydration
988
What causes hyponatraemia
Increased saline
989
How is EBV transmitted
Saliva or Respiratory Secretions Food or drinks sharing Kissing
990
Onset for EBV (infectious mononucleosis)
15-24
991
Signs of Infectious Mononucleosis
Fever Pharyngitis (might come with neck stiffness) or Tonsilitis Lymphadenopathy (exudative or non-exudative) Palatal Petechiae Hepatosplenomegaly
992
What lymph nodes are commonly swollen in infectious mononucleosis
Posterior Cervical Lymph Nodes
993
Why do we get palatal petechiae in infectious mononucleosis
Infected epithelial cells on the palate inflame
994
What causes hepatosplenomegaly in mono
Connects to the lymph tissue that has CD8 cells moving through from the posterior cervical nodes to the liver and spleen
995
Complication of mono
Splenic Rupture
996
What kind of rash is seen in infectious mononucleossi
Not all the time: Pink macule or patches on trunk and arms - NON ITCHY
997
What can mono be misdiagnosed as
STREP THROAT, Scarlet fever etc
998
What test is done to diagnose mono
MONOSPOT TEST: Shows clumping of RBCs on a positive test result
999
Problem with mono spot tests
They produce false negatives in: Children under 4 Early infections Neither have produced heterophiles antibodies
1000
If the mono spot test is a false negative, what test should be done in children
EBV-Specific antibody testing: IgM VCA or IgG (EBMA as a marker of late infection)
1001
Why should contact sports be avoided in EBV
Prevent splenic rupture
1002
Complications of EBV
1. Burkitt Lymphoma (Non-Hodgkin) | 2. Nasopharyngeal carcnioma from EBV infecting epithelial cells
1003
What virus causes infectious mononucleosis
EBV (Human Herpesvirus 4)
1004
How is Lymphoma monitored
PET, for metastases a PET is first line
1005
What is persistent pulmonary hypertension of the newborn
Physiologically, the right ventricle pressure and pulomary pressure decreases when the baby breathes for the first time. Sometimes, errors keep pulmonary pressure high, causing PPHT
1006
Signs of Persistent Pulmonary Hypertension for the newborn
High mean arterial pulmonary artery pressure High after load in the right ventricle
1007
What is the function of a grommet
Facilitates eustachian tubes to develop, only buys time
1008
Why are Grommets used for Otitis Media with Effusion
Just reduces pain with discharge
1009
Otitis Media vs Externa
Lots of wax vs some wax from skin sloughing + pain on the tragus
1010
First Line treatment for Impetigo in systemically well individuals
1% Hydrogen Peroxide Then fusidic acid or PO Flucloxacillin if unwell

year 3 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions