Paeds Flashcards
Commonest cause of neck lump in children
Lymphadenopathy, history of local infection or general illness
Lymphoma characteristics
Rubbery, painless lymphadenopathy. Associated night sweats and splenomegaly.
Thyroid cyst appearance
Midline between isthmus and hyoid bone, moves upward on protrusn of the tongue. If infected can be painful
What is a cystic hygroma
Congenital lymphatic lesion typically found in the neck
Brachial cyst presentation
Oval, mobile cyst that develops between sternocleidomastoid muscle and the pharync.
What is cervical rib
More common in adult females, cause of thoracic outlet syndrome
Hodgkin lymphoma summary
Reed-Sternberg cell, painless lymphadenopathy (large), B symptoms often uncommon
Diagnosis of Hodgkin lymphoma
Biopsy
Management of Hodgkin lymphoma
Chemo +/- radiotherapy 80% cured
Non-Hodgkin lymphoma summary
May affects B or T cells. Much more common and more common in elderly, may cause vena cava obstruction (facial flushing/swelling)
What is Burkitt’s lymphoma
High-grade B-cell neoplasm, usually in African, malaria endemic areas. Tumour of facial bones
What virus is associated with Burkitt’s lymphoma
EBV - found in almost all cases. Chronic malaria is thought to reduce resistance to this
Peak incidence of ALL
2-5 years old, boys slightly more affected, 80% of childhood leukaemias
Features of ALL
Anaemia (lethargy and pallor)
Neutropaenia (frequent infection)
Thrombocytopaenia (easy bruising, petechiae)
Other features of ALL
Bone pain (secondary to bone marrow infiltration) Splenomegaly Hepatomegaly Fever Testicular swelling
Investigations in ALL
Low Hb Thrombocytopenia Circulating leukaemic BLAST CELLS ON BLOOD SMEAR DIC LP CXR - mediastinal maas (T cell disease)
How is ALL diagnosed
Bone marrow biopsy
What is Wilms tumour
Renal tumour, usually present before 5 with large abdominal mass and haematuria.
Quick retinoblastoma summary
Autosomal dominant, most within first 3 years of life, white pupillary reflex replacing red. May have squint
Glucose-6-dehydrogenase deficiency
Neonatal jaundice, haemolysis causing fever, malaise, abdo pain and dark urine. Precipitated by infection, broad beans and drugs. X-linked recessive
Hereditary spherocytosis summary
Sphere RBCs, commonly presents as neonatal jaundice, anaemia, splenomegaly, aplastic crisis (caused by parvovirus B19). Oral folic acid needed
Most common causative organism for UTI in children
E.coli (80%), proteus, pseudomonas
Predisposing factors for UTI
Infrequent voiding, hurried micturition, neuropathic bladder, vesicoureteric reflux, poor hygiene, STRUCTURAL ABNORMALITY
Presentation of UTI in childhood
Infants - poor feeding, vomiting, irritability
Younger children - abdo pain, fever, dysuria
Older children - dysuria, frequency, haematuria
What features would suggest an upper UTI
Fever >38, loin pain/tenderness
Management of UTI in children
<3 months - referred immediately to paediatrician
Upper UTI admit to hospital (cephalosporin/co-amox for 7-10 days)
>3 months lower UTI - trimethoprim or nitrofuratonin
What is the triad of haemolytic uraemic syndrome
Acute kidney injury
Microangiopathic haemolytic anaemia
Thrombocytopenia
What is the commonest cause of haemolytic uraemic syndrome
E.coli (Shiga toxin producing type)
Also: HIV, pneumococcal infection, SLE
Management of haemolytic uraemic syndrome
Fluids, blood transfusion/dialysis if needed.
Which cranial nerve is most likely to be affected by raised ICP
Abducens VI because it has a very long intracranial course
Red flag symptoms for headache
Growth failure, new onset squint, worse in mornings, torticollis, ataxia, papilloedema, abnormal gait
Prophylactic treatment for migraine
sodium channel blockers (valproate), propranolol
What is a generalised epileptic attack
Arrises from both hemispheres
Investigations for epilepsy
ECG is recommended in all as don’t want to miss long-QT syndrome. EEG if epilepsy suspected
What is West syndrome
Infantile spasms - flexion of head and trunk followed by extension of the arms often on waking
Side effects of valproate
Weight gain, hair loss, teratogenic
Side effects of carbamazepine
Rash, hyponatraemia, ataxia
Side effects of lamotrigine
Rash, insomnia, ataxia
What diet can be used in epilepsy
Ketogenic (high fat, low carb)
Types of muscular dystrophies
Duchenne, Becker, congenital
Features of Duchenne muscular dystrophy
X-linked recessive, deletion of dystrophin gene. Present with waddling gait at around 5 years. Corticosteroids help, CPAP overnight.
What is Becker muscular dystrophy
Same gene as Duchenne, a less severe form and presents later
Brain haemorrhage in children
Most common extradural from injury - lucid interval where seem okay.
Subdural indicates shaken baby syndrome
SAH very rare
Conditions tested for in newborn screening
Cystic fibrosis, sickle cell disease, congenital hypothyroidism, phenylketonuria, galactosaemia, homocytinuria
5 Signs of kernicterus
Irritability, poor feeding, seizures, coma, opisthotonus (muscle spasm)
Diseases associated with Down’s syndrome
Atrioventricular septal defect, duodenal atresia, Hirschprung’s disease, hypothyroidism, coeliac disease, apnoea, leukaemia, Alzheimer’s
What chromosome abnormality is Edwards syndrome
Trisomy 18
What chromosome abnormality is Patau syndrome
Trisomy 13
What chromosome abnormality is Turner’s syndrome
45 X
3 signs of Turner’s syndrome on foetal ultrasound
Foetal oedema of neck hands and feet
Cystic hygroma
Structural heart/kidney defects
What chromosome abnormality is fragile X
X-linked recessive - trinucleotide repeat
What blood test result would indicate Duchenne’s muscular dystrophy
Raised creatinine kinase
Duchenne’s muscular dystrophy mode of inheritance
X-linked recessive
Features of congenital adrenal hyperplasia
Low mineralocorticoids - vomiting, dehydration, weight loss. Loow cortisol - hypoglycaemia, clitoral hypertrophy, penis enlargement
What is the risk of treating hyponatraemia quickly
Cerebral oedema causing damage to myelin sheath in brainstem (pons). Can cause paralysis, dysphagia and dysarthria
X-ray finding for tetralogy of Fallot
Boot-shaped heart, right sided aortic arch
4 causes of heart failure in the neonate
Severe coarctation of the aorta
Critical aortic valve stenosis
Hypoplastic left heart syndrome
Interruption of the aortic arch
3 causes of heart failure in infant
(due to L-R shunt)
VSD
ASD
Patent ductus arteriosus
3 causes of heart failure in older child
Eisenmenger syndrome
Rheumatic heart disease
Cardiomyopathy
3 factors which contribute to airway narrowing in asthma
Bronchial muscle contraction
Mucosal inflammation
Increased mucous production
Severe asthma attack features
Inability to complete sentences
Pulse >140
RR >40 (>5yrs)
Peak flow 35-50% predicted
Features of life threatening asthma attack
Silent chest LOC/exhaustion Cyanosis Peak flow <33% predicted Poor respiratory effort Normal or raised PaCO2
Features of ADHD
INATTENTION HYPERACTIVITY IMPULSIVENESS impaired concentration distractibility difficulty taking turns fidgety
Treatment for ADHD
CBT, methylphenidate (stimulant medicine - increase dopamine)
Side effects of methylphenidate
Dry mouth
Loss of appetite
Insomnia
Erythema multiforme and causes
Rash with target lesions
Penicillin, NSAIDs, phenytoin, HSV!
Name 2 complications of eczema
Cellulitis (gram positive cocci) - treat with flucloxacillin Eczema Herpeticum (herpes simplex) - acyclovir
Complications of chicken pox
Secondary bacterial infection - toxic shock syndrome
Encephalitis/cerebellitis
DIC
Purpura fulminans
What are Fraser guidelines used for
To give contraception to under 16s
Conditions of Fraser guidelines
Understands professionals advice Cannot be persuaded to inform their parents Likely to continue without contraception Physical or mental health will suffer In best interests
What is Gillick Competence
Child <16 must be able to understand advice given
3 causative organisms of meningitis <3
Group B strep
E.coli
Listeria
4 features of an innocent murmur
aSymptomatic
Soft blowing
Systolic murmur
Left Sternal edge
3 symptoms of toxic shock syndrome
Fever >39
Hypotension
Diffuse erythematous macular rash
Treatment of toxic shock syndrome
Ceftriaxone, Intravenous immunoglobulin
Causes of sensorineural hearing loss
Congenital rubella, HIE, meningitis
5 causes of stridor
Croup Epiglottitis Laryngomalacia Bacterial tracheitis Foreign body
What is the triad of Henoch-Schonlein Purpura
Purpura (buttocks/extensor surfaces)
Arthritis
Abdominal pain
What is the first sign of puberty
Breast development
Testicular enlargement
Signs of ASD on asucultation
Ejection systolic murmur at the left sternal edge.
Splitting of the second heart sound
What murmur is heard in VSD
Pansystolic murmur at lower left sternal edge
reverse correlation to noise volume
Signs of PDA
Continuous machinery murmur
Increased pulse pressure, collapsing pulse
Features of growing pains
Never present at start of day No limp No limitation of movement Systemically well Normal examination Worse after a day of vigorous activity
What can cause erythrocytosis
smoking, alcohol or polycythaemia vera
Cause of neutrophilia
cancer or result of chemotherapy, viral infection such as hepB/C or HIV, medications (antipsychotics, carbimazole) or autoimmune disorders
What liver enzyme may be raised in osteomalacia, rickets, vit D deficiency or primary bone tumours
raised ALP
Infectious mononucleosis need to knows
a maculopapular rash develops in 99% who take amoxicillin whilst they have infectious mononucleosis (note amox not treatment for mono)
What electrolyte imbalance does congenital adrenal hyperplasia cause
Hyponatraemia (low aldosterone), hyperkalaemia, metabolic acidosis
What areas are protected from chemotheraputic agenst
CNS and testes
What is penacillamine and what is it used for
Copper chelating agent, used in Wilson’s disease
What therapy can be given to those with sickle cell disease
Hydroxycarbamide - prevents vaso-occlusive complications
blood transfusions
prophylactic penicillin - as have splenectomy
bone marrow transplant - curative but risky
Which clotting factor deficiency is haemophilia A
VIII
What clotting factor deficiency is haemophilia B
IX
What is the final product of the coagulation cascade
fibrin
Symptoms of septic arthritis
Single swollen joint, severe pain, pyrexia, no tolerate passive movement, cannot weight bear
What scan can be used to show effectiveness of lymphoma treatment
PET scan - uses a radioactive tracer to show areas of high uptake (cancer)
age group of Perthes disease
5-10 years
Causes of limp in children 1-3 years
missed DDH, septic arthritis, transient synovitis, leukaemia
Causes of limp in children 11-16
slipper upper femoral epiphysis (obesity RF), reactive arthritis and sports injuries
What does a double bubble sign on abdominal x-ray indicate
duodenal atresia
What defects can lead to Eisenmenger syndrome
ASD
VSD
PDA
Physiology of Eisenmenger’s
High pressure in pulmonary artery due to left to right shunt causes changes in pulmonary microvasculature leading to pulmonary hypertension and subsequent reversal of the shunt
Features of Eisenmenger’s
Original murmur disappear cyanosis clubbing right ventricular failure (lack of oxygen causes polycythemia) Polycythaemia leads to haemoptysis and embolism
What is the treatment for Eisenmenger’s
heart-lung transplantation
What should be given first for moderate DKA
IV fluids (0.9 saline) and 1 hour later SC insulin at 0.1units/kg/hr (over 48 hours)
What blood results would you see in DKA
Hyperglycaemia acidosis ketonaemia mildly raised creatinine low bicarbonate
What is the progression of a chickenpox rash
papules>vesicles>papules>crusts
Features of Turner’s syndrome
hypothyroidism congenital heart defects coarctation of the aorta bicuspid aortic valve webbed neck short stature widely spaced nipples
JIA summary
Most common chronic inflammatory joint disease in children.
Defined as persistent joint swelling >6 weeks duration before the age of 16.
95% have disease separate from RA
Complications of JIA
Chronic anterior uveitis Flexion contractures of the joints growth failure anaemia osteoporosis amyloidosis
Presentation of JIA
Most are oligoarthritis affecting 1-4 joints (mostly knee, ankle or wrist) associated with uveitis.
Other presentations are enthesitis, psoratic, systemic
Systemic JIA presentation
(around 9% of JIA) pyrexia salmon-pink rash lymphadenopathy arthritis uveitis anorexia
Management of JIA
NSAID/analgesic steroid joint injection methotrexate systemic corticosteroids TNF-alpha/inteleukin
Common causes of Stephen-Johnson syndrome
penicillin phenytoin lamotrigine allopurinol sulphonamides carbamazepine NSAIDs OCP mumps flu HSV EBV
Symptoms of Steven-johnson syndrome
Maculopapular rash with target lesions being characteristic
Mucosal incolvement
fever
arthralgia
Lennox-Gastaut summary
extension of infantile spasms
1-5yrs
abscences, falls jerks
90% moderate-severe mental handicap
Typical juvenile myoclonic apilepsy
infrequent generalized seizures often in morning
daytime absence seizure
sudden myoclonic seizure
Characteristic features of fragile-X
learning difficulties global developmental delay large head long face large ears prominent mandible mitral valve prolapse poor muscle tone
Features of Kallmann syndrome
delayed puberty small penis small testes no body hair reduced sense of smell poor balance learning difficulties
What is Klinefelter syndrome
delayed puberty
lack of secondary sexual characteristics
tall stature
learning difficulties
rash of dermatitis herpetiformis
itchy bullous rash affecting extensor surfaces
What does cholesterol correlate with
inversely with albumin
Complications of nephrotic syndrome
frequent relapses hypercholesterolaemia hypovolaemia infection thrombosis
what is the most common cause of nephrotic syndrome in children
minimal change disease
distribution of rash in henoch-scholen purpura
symmetrically distributed over buttocks and extensor surfaces of arms, legs and ankle
symptoms of henoch-schonlen purpura
rash joint pain abdominal pain glomerulonephritis fever
what is alginate therapy
feed thickeners/gaviscon
what does ottitis media look like on otoscope
red, bulging and tender tympanic membrane
what does ottitis media with effusion look like on otoscope
grey tympanic membrane, loss of cone of light reflex and a visible fluid level behind the membrane.
You would also expect hearing loss
What are some serious complications of ottitis media
acute mastoiditis
intracranial abscess
what is the feverpain score used for
to assess whether pharyngitis is due to a bacterial infection and hence whether it needs antibiotics
fever pain scoring
Everything 1 point, max 5
- fever in past 24 hours
- absence of cough or coryza
- symptom onset <3 days
- purulent tonsils
- severe tonsil inflammation
at what score on feverpain would you consider delayed antibiotics
2-3
at what score on the feverpain would you give antibiotics
4-5
what is naevus flammeus
port wine stain - congenital and on face
treatment of faecal impaction
disimpaction regimen:
osmotic laxative
ITP need to knows
it is typically benign and resolves spontaneously after 6-8 weeks
NSAIDs should be avoided
contact sports should be avoided
ITP presentation
petechiae following a viral illness
low platelets
when would you prescribe antibiotics for otitis media
under 2 years with bilateral infection
antibiotic of choice for otitis media
amoxicillin
what is the name of the surgical treatment for Hirschprungs
Swenson procedure
which syndrome has microganthia (small lower jaw)
Edward’s syndrome
which syndrome has polydactyly
Patau’s
which syndrome has pectus excavatum
Noonans
whichh syndrome has macrocephaly
fragile x
what is second line to methylphenidate for ADHD
lisdexamfetamine
what is given for viral induced wheeze
salbutamol via a spacer
steroids are not helpful in viral induced wheeze!
common signs/symptoms of nec
abdominal distension vomiting visible intestine loops rectal bleeding lethargy feeding intolerance
how is nec diagnosed
abdominal xray show
dilated bowel loops
bowel wall oedema
gas within wall of intestine.
what heart defect is William’s syndrome associated with
supravalvular aortic stenosis (not cyanotic)
what can be used for acute asthma attack
nebulised salbutamol/ipratropium, high flow o2, corticosteroids.
Second line for severe attacks would be IV treatments
treatment for impetigo
if small a short course of hydrogen peroxide may be used. Otherwise topical antibiotics (fusic acid) or oral flucloxacillin may be used
what is cryptorchidism
undescended testes:
1 retractile (can be pulled into scrotum)
2 palpable
3 impalpable (may be in inguinal canal, abdominally or absent)
when to refer for undescended testes
bilateral - 6-8 weeks (to be seen within 2 weeks)
unilateral - refer at 4-5 months
when should orchidopexy be performed
around 12 months
what is the treatment of choice for intussusception
rectal air insufflation
when would antibiotics be required for gastroenteritis
if suspicious of sepsis, immunocompromised or spread of infection
eczema treatments
1st line emolients
non-sedating antihistamine (cetirizine) with severe itching
topical corticosteroids if persistent
what is the commonest presentation of a varicocele
asymptomatic!
may have a dull ache
what does a red swollen warm testicle indicate
epididymitis or orchiditis
BUT CONSIDER TORSION
what does severe sharp pain in scrotum indicate
torsion but suspect with any abdo pain
some causes of jaundice <2 weeks
polycythemia
infection
physiological
rhesus incompatibility
how to correct acidosis due to DKA in children
fluids, DO NOT use sodium bicarbonate (but this can be used in adults)
side effects of topical corticosteroids
acne
striae
telangiectasia
thinning of skin
definition of JIA
a child presenting with joint swelling of >6 weeks duration in the absence of infection or any other defined cause
more common in girls
secondary care for JIA
refer to ophthalmology as at risk of anterior uveitis which can lead to blindness!
what type of seiures are febrile convulsions
tonic clonic
slapped cheek syndrome cause
parvovirus B19
treatment for croup not responsing to dexamethasone
oxygen + nebulised adrenaline
histology in coeliac disease
intraepithelial lymphocytes
normal thickness mucosa
villous atrophy
crypt hyperplasia
what disease has a cobblestone appearance
Crohn’s disease
does toddlers diarrhoea cause faltering growth
no
does vomiting cause faltering growth
can do
