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Year 5 (Alex) > Paeds > Flashcards

Paeds Flashcards

1
Q

Developmental milestones - 6 weeks

A

Valentine’s day

Newborn bb check @ GP

GM: good head control

FM: tracking objects/face

S/L: startles to loud noice

S: social smile

<span><em>(In GP examining bb - check for head control, using steth and watching bb track is w eyes. Someone accidentally bangs room door and bb cries, then parents comforts them and they smile)</em></span>

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2
Q

Developmental milestones - 6 months

A

Summer

GM: sits unsupported with rounded back, rolls tummy (prone) to back (supine)

FM: palmar grasp and transfer hand to hand

S/L: turns head to loud sounds, understands bye bye, babbles

S: puts objects in mouth, shakes rattle, reaches for bottle

<span><em>(Imagine bb on beach in middle of summer. Can sit w rounded back bc 6 is curved - rolling from front to back catching sunrays. Palmar grasp under the palm trees and passing stuff between hands - turn to a loud squawking bird and babbling away, mum says “say bye bye birdie”)</em></span>

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3
Q

Developmental milestones - 9 months

A

End of September - autumn & falling leaves

GM: stands holding on, sits w straight back

FM/V: inferior pincer grip, object permanence

S/L: responds to own name, imitates adult sounds

S: stranger fear, hold and bites food

<em>(Autumn park able to sit up in autumn leaves or stand holding hand. Can pick up leaves w pincer grip. Dad calls name in park and responds. Stranger approaches and cries. Can play peekaboo bc of object permanence and hold and bite food at picnic)</em>

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4
Q

Developmental milestones - 12 months

A

Christmas time

GM: walks alone

FM: Casting bricks/toys (dropping them on the floor), can build a tower of 2 bricks

S/L: shows understanding of nouns “where’s Santa?”, speaks 3 words

S: waves bye bye, hand clapping, plays alone if someone nearby, drinks from beaker w lid

<em>(Walking to Xmas tree, putting small present on top of another. Could understand “Where’s Santa?” and will wave bye bye. 3word vocab “happy new year” - lol realisticlly mama, papa, santa. Claps to Xmas song and drinks festive drink w lid)</em>

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5
Q

Developmental milestones - 18 months

A

2nd summer

GM: runs (16), jumps (18)

FM: scribble to and fro, stack 4 bricks

S/L: shows understanding of nouns “show me the pool”, 1-6 words

S: imitates everyday activities

<em>(Posh resort - running and jumping by pool. Parents give crayon and paper to keep them occ whilst sipping beers - scribble back and forth. Can stack double no. suitcases (LOL) from Xmas. Copies parents.)</em>

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6
Q

Developmental milestones - 2years

A

2nd birthday - “2 themed party”

GM: runs on (2) tiptoes, walks upstairs (2) feet 1 step at a time, throws ball (2) someone

FM/V: draws vertical line, stacks 8 bricks (2 circles in 8), turns (2) pages of book

S/L: shows understanding of verbs, (2)-3 words sentences, 50 word vocab

S: eats skillfully with spoon (2os in spoon)

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7
Q

Developmental milestones - 3 years

A

GM: hops on one foot for (3) steps, walks upstairs 1 foot per step but downstairs 2 feet per step (1+2=3)

FM/V: draw a circle, build a bridge

S/L: understand negatives, understand adjectives

S: Begin share toys, eat alone w/o parents, use fork and spoon, bowel control

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8
Q

Developmental milestones - 4 years

A

Starting reception

GM: Walks up and down stairs in adult manner

FM/V: Draws a cross, build 12 blocks, cut paper in half

S/L: Understands complex instructions

S: Concern/sympathy for others, best friend, bladder control. eats w/o help. dress/undress

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9
Q

What can hand preference under the age of 2 suggest?

A

Cerebral palsy

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10
Q

Traffic light system

A
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11
Q

Vaccination schedule

A

Key

Hib = Haemophilus influenzae B vaccine

PCV = Pneumococcal Conjugate Vaccine

Men B = Meningococcal B vaccine

Men C = Meningococcal C vaccine

Men ACWY = Meningococcal vaccine covering A, C, W and Y serotypes

MMR = Measles, Mumps, Rubella vaccine

HPV = Human Papilloma Vaccine

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12
Q

Mx upper airway in children

A
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13
Q

Signs of resp distress

3Es

A
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14
Q

Asthma

A

Wheezing inbetween viral infections and evidence of allergy

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15
Q

Asthma long term Mx

A
  • Escalate asthma if:
    • Using SABA>3x/week
    • Syx > 3x/week
    • Waking from syx
    • Hospital admission –> steroid use

SABA = short acting beta agonist, i.e., albutamol inhaler (PRN)

ICS = inhaled cortico-steroid, i.e., beclometasone (regular)

LTRA = leukotriene receptor antagonist, i.e., montelukast

LABA = long acting beta agonist

MART = maintenance and reliever therapy (regularly + PRN in 1 inhaler)

*not often diagnosed until 5y/o unless wheezy despite lack of viral infx + strong family hx

*<5y/o if given ICS again - lower dose and long term

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16
Q

Asthma life threatening presentation

A
  • PEFR <33% (peak expiratory flow rate)
  • SpO2 <92%
  • Altered consciousness
  • Arrhythmia
  • Hypotension
  • Cyanosis
  • Poor respiratory effort
  • Silent chest
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17
Q

Acute asthma presentation

A
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18
Q

Asthma exacerbation levels

A
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19
Q

Acute asthma mx

A
  1. Salbutamol nebuliser
    • Helps to open up airway and improve breathing
  2. Ipratroprium (Atrovent) nebuliser
    • Short acting muscarinic antagonist helps relax smooth muscle around bronchi
  3. IV Magnesium sulphate + aminophylline + salbutamol

If life threatening: CALL FOR SENIOR HELP - consider intubation and ventilation

On D/C: Oral prednisolone (3-5 days)

(dampens down inflammation)

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20
Q

Acute epiglottitis presentation

A
  • Stridor
  • Drooling
  • Rapid onset fever
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21
Q

Acute epiglottits cause

A

Haemophilus influenzae B

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22
Q

Bronchiolitis

A

Inflammation of bronchioles (small airways) due to respiratory syncytial virus (RSV) - lower airway problem -> inflamm and mucus narrows airway ->less airflow

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23
Q

Bronchiolitis presentation

A

Under 1 y/o!!

  • Dry cough
  • SOB
  • Wheeze
  • Crackles/crepitation
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24
Q

Bronchiolitis RF

A
  • Formula milk
  • Being younger than 3 months
  • Premature

*Congenital heart disease can cause bronchiolitis to be more severe

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25
Q

Bronchiolitis Ix

A

Clinical diagnosis

  • Resp exam
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26
Q

Bronchiolitis Mx

A

Conservative

  • Self limting 5-7 days
  • Simple analgesia
  • Oxygen as required
    • Intubate and ventilate if really worried
  • Encourage reg feeds
    • NG tube if normal feeds not tolerated

! Can be very severe in vulnerable children, e.g., pre term infant

  • Palivizumab
    • To prevent severe bronchiolitis infx
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27
Q

When to admit Bronchiolitis pt?

A
  • oxygen saturation persistently <92%
  • Feeding affected
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28
Q

Croup

A

Inflammation of the larynx and trachea (URTI) due to parainfluenza (upper airway problem)

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29
Q

Croup presentation

A

6 months - 2 years

  • Barking cough
  • Stridor
  • SOB
  • Fever
  • Coryzal prodrome

OFTEN IN AUTUMN

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30
Q

Croup Ix

A

Clinical diagnosis

  • Resp exam
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31
Q

Croup Mx

A
  • Oral dexamethasone 0.15mg/kg
    • Repeat if still mild stridor following day

If severe (significant airway compromise)

  • Oxygen
  • Nebulised adrenaline
    • To try settle inflammation and open up airways
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32
Q

When to admit child with Bronchiolitis?

A

Consider if:

  • RR >60
  • Difficulty breastfeeding/ inadequate oral fluid intake (50–75% of usual volume)
  • Clinical dehydration
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33
Q

When to admit child with croup?

A

If moderate- severe

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34
Q

Why are children so prone to wheezing?

A

Small airways so only takes small amount of inflammation to narrow airways a bit more to cause whistling sound as air passes through

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35
Q

Multiple trigger wheeze

A

Wheezing due to multiple stimuli (e.g., infection, dust, pollen, smoking, cold air)

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36
Q

Viral induced wheeze

A

Wheezing only during viral infx caused by bronchoconstiction

Usually <3yrs

Acute mx - asthma stairs exactly the same

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37
Q

Wheeze v stridor

A

Wheeze

Caused by small airways narrowing - causes rattling high pitched sound usually during (prolonged) expiratory phase

Stridor

Caused by upper airway obstruction/narrowing of some form - causes harsh sound primarily during inspiration

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38
Q

Laryngomalacia

A

Structural abnormality of the larynx which cause partial obstruction resulting in stridor/noisy breathing

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39
Q

Laryngomalacia mx

A

Self resolving

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40
Q

Pneumonia presentation

A
  • Dyspnoea
  • Fever
  • Tachypnoea
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41
Q

Pneumonia Ix

A
  • Resp exam
    • Reduced air entry to specific area
    • Creptitations ^
  • O2 sats
    • Lowered
  • sputum culture
  • Capillary blood gas
  • CXR
    • Consolidation
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42
Q

Cystic fibrosis

A

Autosomal recessive condition caused by mutation in CFTR gene on Cr7(cystic fibrosis transmembrance conductance regulator - Delta-F508 mutation most common)) leading to failure of chloride secretion.

Cl- important to get out of cells into extracellular space to places where you have secretions as Cl- draws water with it, making secretions less viscous and easier to move around/get out.

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43
Q

Main organ systems affected by CF

A
  • Respiratory
    • Thick airway secretions -> encourage bacterial colonisation -> more infx
  • GI
    • Thick pancreatic & biliary secretions -> blockage -> lack of digestive enzymes
  • Endocrine
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44
Q

CF manifestations and mx

A

Respiratory

  • Bronchiectasis
  • Recurrent infx

Mx: Antibiotics (prophylactic flucox) + physiotherapy

GI

  • Pancreatic exocrine insufficiency
  • Diarrhoea
  • Malabsorption

Mx: Vitamin supplementatin + nutritional support (high cal diet)

Endocrine

  • Diabetes mellitus (due to pancreatic endocrine dysfunction)
    • Random blood glucose >11
  • Osteoporosis (due to lack of absorption of ca and other minerals)

Mx: Diabetes mx / Vit D + Ca supplementation

+ MDT input!

*CF itself - Ivacaftor/Lumacaftor
Tries to improve construction of CFTR genes and insertion into membrane

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45
Q

CF Ix

A

Sweat test

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46
Q

CF fertility

A

Male fertility affected as normal sperm but absence of vas deferens -> cant be released

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47
Q

Tracheitis and epiglottitis (the other upper airway disease)

A
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48
Q

Meconium aspiration syndrome presentation

A
  • Born through thick meconium
  • Breathing problems
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49
Q

Meconium aspiration CXR

A

hyper inflated lungs with areas of consolidation

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50
Q

Respiratory distress syndrome Ix

A

CXR: Ground glass

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51
Q

Transient tachypnoea of the newborn presentation

A
  • Tachypnoea within 1st 2h of life
  • Grunting
  • Use of accessory muscles
  • Goes within 24h
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52
Q

Transient Tachypnoea of the newborn Mx

A

Supportive care ± O2

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53
Q

Scarlet Fever cause

A

Group A Streptococcus

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54
Q

Scarlet fever presentation

A
  • Fever
  • Sore throat
  • Strawberry tongue
  • Petechiae (small red spots) visible on the hard and soft palate are called ‘Forchheimer spots’
  • Blanching rash with rough, sandpaper-like texture
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55
Q

Scarlet fever Mx

A

10 day course of phenoxymethylpenicillin (penicillin V)

  • Return to school 24h after commencing abx
  • Notifiable disease
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56
Q

Whooping cough

A

Whooping cough is caused by bacteria bordella pertussis - attach to cillia of upper airway.

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57
Q

Whooping cause presentation

A
  • Short period of coryzal symptoms followed by
  • Onset of paroxysmal bouts of coughing
  • Coughing intense, apnoeic, and may cause vomiting
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58
Q

Whooping cough mx

A

Presenting within 3 weeks start of cough

  • Oral azithromycin or clarithromcyin
    • Eradicate org and try reduce spread

(Admit and IV abx if pt clinically unstable)

Presenting >3 weeks start of cough

  • Advice
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59
Q

Vomiting differentials

A
  • Posset - small volumes, painless, common
    • No cause for concern
  • Cow’s milk protein allergy
  • GORD - larger volume, relatively forceful
    • No cause for concern if growth unaffected
  • Intussusception
  • Pyloric stenosis - forceful, projectile vomiting
    • Red flag requiring further ix
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60
Q

Cow’s milk protein allergy

A

Abnormal immune reaction to a protein found in cow’s milk

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61
Q

Cow’s milk protein allergy presentation

A
  • Vomiting
  • Diarrhoea or constip
  • ±PR bleed - red tinged nappy blood
  • Rash!
    • Common in eczema!
  • ±Wheezing
  • ±Faltering growth
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62
Q

Cow’s milk protein allergy mx

A

If breast fed

  • Mother to avoid dairy

If formula

  • Extensively hydrolysed formula

*If growth still faltering -> lack of compliance or different diagnosis
*Most cases resolve by 5y/o

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63
Q

Duodenal atresia

A

The duodenum, which is the first part of the small intestine just beyond the stomach, is closed off/narrowed rather than being a tube

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64
Q

Duodenal atresia presentation

A

Low birth weight, premature, billious/non bilious vom, upper abdominal swelling

usually occurring within the first 24 to 38 hours of life after the first feeding

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65
Q

Duodenal atresia XR sign

A

double bubble

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66
Q

Duodenal atresia genetic syndrome association

A

Down’s

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67
Q

Duodenal atresia mx

A

NG tube + IV fluids –> surgery

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68
Q

GORD

A

Regurgitation of feed due to immaturity of lower oesophageal sphincter

Common in 1st year of life

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69
Q

GORD Mx

A

Breast fed

  1. Breast feeding assessed by midwife/health visitor
    • Position upright after feeds
  2. Alginate therapy, e.g., Gaviscon infant
    • small droplets given to baby - reacts w contents of stomach to form thickened, foam-like layer at top of stomach contents + generally
  3. PPI or H2 antagonist - omeprazole
  4. Paeds referral

Formula fed

  1. Review feeding hx - smaller and more frequent feeds
  2. Thickened formula or feed-thickeners
  3. Alginate therapy added to formula
  4. PPI or H2 antagonist (4 weeks)- omeprazole
  5. Paeds referral

Usually resolves spontaneously - early weaning may be recc

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70
Q

Intussusception

A

Telescoping of proximal bowel into distal bowel causing an obstruction

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71
Q

Intussusception presentation

A

3 months - 2years

  • Paroxysmal, colicky pain
    • Bouts of abdo pain causing significant distress -> screaming, drawing legs up
  • Pallor
  • Vomiting
    • Non bilious at first, then once intestinal obstruction - vilious
  • Sausage-shaped mass in abdo
  • Red currant jelly stools (blood in stools - late stage feature)
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72
Q

Intussusception Ix

A
  • Abdominal USS
    • Target sign
  • Abdominal XR
    • If obstructed
  • Contrast enema XR (gold standard)
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73
Q

Intussusception Mx

A
  • Rectal air insufflation - pumping air into rectum and stretching out bowel allowing it to pop into place

Consider pathological lead point - an abnormality in tube where intussusception develops

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74
Q

Pyloric stenosis

A

Hypertrophy (narrowing) of pyloric muscle causing gastric outlet (opening from stomach to small intestine) obstruction

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75
Q

Pyloric stenosis presentation

A

2-8 weeks old, M>F

  • Projectile vomiting (non-bile stained)
  • Hungry after feeds
  • Visible persistalsis LUQ
    • stomach tries to push its contents past the obstruction
  • Olive shaped mass o/e
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76
Q

Pyloric stenosis Ix

A
  • VBG
    • Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
  • USS
    • assess pyloric sphincter and see whether enlarged - donut sign
    • Gold standard
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77
Q

Pyloric stenosis mx

A
  • Fluid resus - NBM and NG tube
  • Ramstedt pyloromyotomy
    • Surgical intervention where pyloric sphincter is opened up and relaxed
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78
Q

Constipation differentials

A
  • Foecal impaction
  • Hirschsprung disease
  • Hypothyroidism
  • Hypercalcaemia
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79
Q

Impaction - where can mass most often be felt?

A

left iliac fossa

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80
Q

Constipation mx

A

If impaction -

Disimpaction!

  1. Movicol
    * If unresolved 2 weeks/not tolerated*
  2. Add stimulant laxative

If disimpacting not required/complete,

Maintenance dose movicol

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81
Q

Laxative classes (4)

A
  • Softeners (more an oily material which infiltrates faecal masses and loosens them up)
    • Lactulose
  • Bulking agent (lend indigestible fibre to stool)
    • Fybogel
  • Osmotic laxatives (draw water into intestinal lumens and loosen up stools)
    • Movicol
  • Stimulants (augments intestinal contraction to help move things along)
    • Senokot
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82
Q

Hirschsprung disease

A

Condition in which there is absence of ganglion cells of the myenteric and submucosal plexus -> leads to area of bowel that is unable to contract appropriately to expel contents

Hirschsprung disease is a birth defect in which some nerve cells are missing in the large intestine, so a child’s intestine can’t move stool and becomes blocked.

(nerve fibres and ganglia help coordination contraction of bowels to keep things moving in one direction)

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83
Q

Hirschsprung disease presentation

A

Early in life

  • Delayed/unable to pass meconium
  • Abdominal distension
  • Billious vomiting

Later

  • Chronic hx constipation often later in childhood
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84
Q

Hirschsprung disease Ix

A
  • Abdo XR
    • dilated loops of bowel with fluid levels
  • Full thickness rectal biopsy
    • Observe absence of ganglion cells
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85
Q

Hirschsprung disease Mx

A

Supprotive

  • Bowel irrigation
    • Allow baby to pass meconium

Definitive

  • Anorectal pull-through
    • Removing affected chunk of bowel and re-anastomosing the ends to maintain continence
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86
Q

Hirschsprung associated genetic condition

A

Down’s syndrome

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87
Q

Malrotation

A

Birth defect that occurs when the intestines do not correctly or completely rotate into their normal final position during development

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88
Q

Malrotation presentation

A
  • Bile-stained vomiting
  • Failure to thrive
  • Painful/tender abdomen
    • May also be paroxysmal w pulling up legs
  • Bloating
  • PR bleed/melaena

Usually <1 y/o at presentation

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89
Q

Malrotation Ix

A

upper GI contrast study (gold standard) and USS

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90
Q

Malrotation Mx

A

Laparoscopic Ladd procedure to reposition intestines.

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91
Q

Malrotation complication

A

Volvulus - A volvulus happens when the intestine becomes twisted. This causes an intestinal blockage.

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92
Q

Meckel’s diverticulum

A

Congenital diverticulum of the small intestine

Meckel’s diverticulum is an outpouching or bulge in the lower part of the small intestine. The bulge is congenital (present at birth) and is a leftover of the umbilical cord.

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93
Q

Meckel’s diverticulum presentation

A

Usually asyx

  • Abdo pain mimicking appendicitis
  • Rectal bleed
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94
Q

Meckel’s diverticulum Ix

A

Technetium scan

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95
Q

Meconium ileus

A

Meconium is blocking the last part of the baby’s small intestine (ileum) –> bowel obstruction.

Happens as meconium is more viscous and stickier than usual

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96
Q

What condition is meconium ileus often caused by?

A

Cystic fibrosis

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97
Q

Meconium ileus Ix

A
  • Sweat test for CF
  • Abdo XR
    • distended coils of small bowel, but no fluid levels.
  • PR contrast studies
    • can be therapeutic
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98
Q

Meconium ileus Mx

A
  • PR contrast studies
    • May dislodge meconium plugs
  • NG acetyl cysteine
    • Liquifies meconium

If not, surgery

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99
Q

Mesenteric adenitis

A

Inflamed abdominal lymph glands

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100
Q

Mesenteric adenitis presentation

A

URTI and generalised abdominal pain

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101
Q

Necrotising enterocolitis

A

Intestinal tissue is inflamed and starts to die. This can lead to perforation, allowing intestinal contents to leak into abdomen.

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102
Q

Necrotising enterocolitis presentation

A

First 2 weeks life

  • Feeding intolerance
  • Abdominal distension
  • Bilious vomiting
  • Melaena
  • ±signs of sepsis
  • Common in premature infants
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103
Q

Necrotising enterocolitis Ix

A
  • Abdo exam
    • Reduced bowel sounds
  • Abdo XR
    • Dilated asymmetrical bowel loops
    • Bowel wall oedema
    • Air inside & outside bowel wall (Rigler sign)
    • Air outlining falciform ligament (football sign)
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104
Q

Congenital diaphragmatic hernia

A

Herniation of abdominal organs into the chest cavity due to incomplete formation of the diaphragm

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105
Q

Congenital diaphragmatic hernia presentation

A

Respiratory distress

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106
Q

Congenital diaphragmatic hernia Ix

A
  • Cardio + resp exam
    • Heart sounds absent on LHS
    • Tinkling sounds heard (bowel)
  • Abdo exam
    • Scaphoid abdomen (raised level of chest where abdo is)
  • CXR
    • Bowel loops can be seen in thoracic cavity
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107
Q

Congential diaphragmatic hernia Mx

A

Initial

  • Intubation and ventilation
    • NG tube with aim of keeping air out of gut

Definitive:

Surgical repair of diaphragm

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108
Q

Neonatal jaundice causes

A

<24 hours -> Pathological

Haemolytic

  • Rhesus incompatibility
  • ABO incompatibility
  • G6PD deficiency
  • Pyruvate kinase deficiency
  • Hereditary spherocytosis

Congenital

  • Toxoplasmosis
  • Others (e.g., syphilis)
  • Rubella
  • CMV
  • HSV

24 hours - 2 weeks

  • Physiological
    • Common
    • Increased RBC breakdown following birth - trauma
    • Decreased bilirubin metab due to immature liver
    • Breast milk jaundice
  • Pathological (causes as above and below)

>2 weeks

  • Biliary atresia
    • abnormal development of biliary tree
      • pale sools, bruising
  • Congenital hypothyroidism
  • Neonatal hepatitis
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109
Q

ABO incompatibility jaundice

A

mother has the blood type O (and therefore has antibodies against A and B cells) and her newborn is of blood type A or B

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110
Q

Neonatal jaundice Ix

A

<24 hours

  • Serum bilirubin
  • Group and save
  • DAT test (Coombs’/direct antibody test)
    • See whether antibody binding to neonate blood cells
    • Autoimmune haemolytic anaemia
  • FBC + CRP
  • Blood culture

>2 weeks

  • TSH
  • LFTs
  • Bilirubin
    • Transcutaneous (TC) bilirubin
      • Non invasive
      • Less accurate - more for screening
      • Used if jaundice >24h or born >35weeks (lower risk of pathological cause of jaundice)
    • Serum bilirubin
      • Used if jaundice at <24h or born <35 weeks gestation
  • Hepatobiliary scintigraphy/nadionucleotide scan
    • If considering biliary atresia
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111
Q

Neonatal jaundic Mx

A
  1. Phototherapy
    • Light therapy (eyes protected and temp monitored) where unconjugated bilirubin converted to water-soluble pigment which can be excreted
    • Bilirubin checked every 6-12h via heel prick test blood gas
  2. Intensified phototherapy
    • +/- IVIG
      • Primarily used in ABO or rhesus haemolytic disease

*carry on until 5 boxes below line on trx threshold graph:)

or Exchange transfusion - removal of infant blood and replaced w donor blood

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112
Q

Biliary atresia presentation

A

jaundice, pale stools and dark urine

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113
Q

Biliary atresia Ix

A
  • High levels conjugated bilirubin
    • Liver is doing its thang but not able to excrete through biliary duct into bowel
  • USS abdo - contracted/absent GB
  • Liver biopsy
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114
Q

How is biliary atresia managed?

A

Surgical intervention - Kasai procedure

removing the blocked bile ducts and gallbladder and replacing them with a segment of child’s small intestine

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115
Q

Neonatal jaundice complx

A

Kernicterus

Unconj bilirubin can cross BBB and deposit in basal ganglia -> can result in cerebral palsy

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116
Q

Antenatal resp-cardio adaptation

A
  • Oxygenated blood from umbilical vein
  • Foramen ovale
    • Right to left shunt (due to lower Pa on RHS)
  • Ductus arteriosus
    • Less resistance to go to aorta rather than pulm arteries
  • Lungs are non functional (high pulmonary vascular resistance)
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117
Q

Innocent murmurs

A
  • Systolic
  • Soft / low amplitude
  • Change position when breathing
  • Single
  • Short duration
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118
Q

2 types of congenital cyanotic heart diseases

A

Cyanotic heart failure = right to left shunt (deoxygenated blood in systemic circ)

  • Transposition of the great arteries
  • Tetralogy of fallot
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119
Q

Main features of cyanotic heart disease

A

Cyanosis onset

  • Within days -> TGA
  • Within months -> TOF (+murmur)

(When exerting themselves, e.g., feeding)

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120
Q

Transposition of the great arteries

A

Aorta and pulmonary trunk are switched around

Two completely separate circuits

  • RHS (aorta) is systemic - goes to body and back
  • LHS (pulm trunk) goes to lungs and back

*Ductus arteriosus maintains life by allowing blood from LHS (oxygenated) to mix with RHS and aorta -> rest of body

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121
Q

Abnormalities in tetralogy of fallot

A
  1. Pulmonary stenosis
    • Narrowing of pulmonary valve -> lots of resistance going back towards RHS of heart
  2. Ventricular septal defect (VSD)
    • Allows blood to mix between 2 sides of heart
  3. Overriding aorta
    • Large proportion of outflow from heart going through aorta over pulmonary artery
  4. Right ventricular hypertrophy
    • RHS having to pump against higher pressure than used to due 1) and 3)
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122
Q

TofF murmur

A

systolic ejection murmur at the left upper sternal border

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123
Q

Cyanotic heart disease ix

A
  • Pulse oximetry
    • TGA - suddenly profoundly hypoxic as DA is closing
  • Hyperoxia test
    • Sats probe placed on infant then + high flow O2 -> check if improvement
      • TGA - no improvement as circuits are separate and sats probe only showing peripheral sat
  • CXR
    • TGA: egg on a string
    • TOF: boot shaped heart
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124
Q

Cyanotic heart disease mx

A
  • IV prostaglandin infusion
    • Maintain patency of DA
  • Surgery
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125
Q

Acyanotic heart disease (4)

A

Defects in embryological development of heart or its major vessels (left to right shunt w/ exception of CoA)

  • Ventricular septal defect (VSD)
    • Hole in septum betwen ventricles
    • Most common
  • Atrial septal defect (ASD)
    • Hole in spetum between atria
  • Patent ductus arteriosus (PDA)
    • Ductus arteriosis remains open beyond 1 month (usually shuts before 1 month)
  • Coarctation of the aorta
    • Narrowing of aorta
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126
Q

Acyanotic heart disease presentation

A

Asymptomatic, or HF signs:

  • Fatigue
  • SOB
  • Exercise intolerance
  • Poor feeding/failure to thrive
  • (Systolic) murmur
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127
Q

Murmurs associated w/ ASD, VSD and PDA

A
  • VSD: systolic murmur at left sternal border
  • ASD: soft midsystolic murmur at the upper left sternal border with splitting of the 2nd heart sound (S2)
  • PDA: continuous ‘machinery’ murmur over left clavicle
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128
Q

AVSD complx and association

A

May lead to pulmonary hypertension + associated with Down syndrome

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129
Q

PDA mx

A
  • NSAIDs
    • e.g., indomethacin
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130
Q

Coarctation of aorta specific sign

A

Brachio-femoral delay

Can feel strong brachial pulse, but delayed and v weak or even absent femoral pulse

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131
Q

Acyanotic heart disease complx

A
  • Heart failure (SOB)
  • Faltering growth
  • Recurrent chest infx
  • Infective endocarditis
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132
Q

Anaphylaxis

A

Severe allergic reaction

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133
Q

Anaphylaxis presentation

A
  • Stridor
  • Angioedema
  • Urticaria
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134
Q

Anaphylaxis Mx

A
  1. Call for help +
  2. A to E
    * 2 large bore cannulae
  3. Lie patient flat
  4. Definitive (to carry on if anaphylaxis persists / refractory anaphylaxis)
  5. IM Adrenaline 1:1000
    • age adjusted doses
  6. Repeat after 5 mins if needed
  7. IV fluid challenge - crystalloid
  8. IM or slow IV chlorphenamine + hydrocortisone

Upon d/c

  • Safety net
    • Avoiding allergen (if known)
  • EpiPen
  • Allergy clinic
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135
Q

Diabetic ketoacidosis

A

Pancreatic beta cells are not producing insulin -> serum glucose concentration increases considerably and increased ketone generation.

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136
Q

DKA presentation

A
  • Polyuria -> dehydration
  • N+V
  • Thirsty
  • Abdo pain
  • Unexplained weight loss
  • Coma
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137
Q

Ketones

  • How are they produced?
  • How are they useful?
  • How are they harmful?
A
  • Ketone bodies are produced during B-oxidation of fatty acids when body is low on glucose supply.
  • Ketones allow brain to continue functioning in a time when glucose is scarce.
  • They are acidic -> enzyme dysfunction -> coma & death:(
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138
Q

Actions of insulin (2)

A
  • Reduces serum glucose concentration via
    • push glucose into hepatic glucose store
    • push glucose into tissues
  • Block ketone generation (within liver)
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139
Q

DKA Mx

A
  • IV fluid resuscitation
    • Shock
      • Bolus 20ml/kg 0.9%NaCl over 15 mins
    • Not in shock
      • Bolus 10ml/kg 0.9% NaCl over 1h
      • Deficit * weight (in kg) * 10 –> total deficit vol(ml) /48h
        • pH>7.1 = 5%
        • pH<7.1 = 10%
      • Maintenance fluids

Fluid choice: 0.9% NaCl + 40mmol KCl, then once glucose <14mmol/L add 5-10% dextrose

  • Insulin

Long term

  • Education
  • Family support
  • Insulin rotating sites
  • MDT care: diabetic nurse, dietician, paeds
  • Annual r/v
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140
Q

IV Fluid resuscitation

A

Bolus (if in shock) + replacement fluid + maintenance fluid

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141
Q

How much bolus fluid for fluid resus?

A

20ml/kg/10mins

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142
Q

How much replacement fluid for fluid resus?

A

100ml/kg/24h

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143
Q

How much maintenance fluid for fluid resus?

A

100ml/kg for first 10kg +

50ml/kg for 2nd 10kg +

20ml/kg thereafter

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144
Q

CIs for LP

A
  • Raised ICP
  • Profoundly impaired consciousness
  • Focal signs
  • Focal or prolonged fits
  • Cardio-pulmonary compromise (ie in shock or needing artificial ventilation)
  • Local skin infection
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145
Q

Neonatal sepsis signs

A
  • Respiratory distress (85%)
  • Grunting
  • Nasal flaring
  • Use of accessory respiratory muscles
  • Tachypnoea
  • Tachycardia
  • Apnoea
  • Change in mental status/lethargy
  • Jaundice
  • Seizures
    • if cause of sepsis is meningitis
  • Poor/reduced feeding
  • Abdominal distention
  • Vomiting
  • Temperature

*Frequently, the symptoms will be related to the source of infection (e.g. pneumonia + respiratory symptoms, meningitis + neurological symptoms)

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146
Q

Status Epilpeticus

A

Single continuous seizure or repetitive seizures ± recovery period of consciousness lasting 5 or less mins.

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147
Q

Status epilepticus Ix

A
  • Glucose
  • U&E
  • Calcium
  • Anticonvulsant levels
  • Toxicology screen
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148
Q

Status epilepticus Mx

A
  1. IV Lorazepam
    * If no IV access –> rectal diazepam or buccal midazolam*
    * *after 10 mins**
  2. IV Lorazepam (2nd dose)
  3. Phenytoin infusion
  4. General anaesthesia
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149
Q

Testicular torsion

A

Rotation of testicle leading to lack of blood supply as the spermatic cord which brings blood to scrotum is twisted

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150
Q

Testicular torsion presentation

A
  • Severe testicular pain
  • Nausea and vomiting
  • Swelling of the testis with overlying erythema
  • Absent cremaster reflex
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151
Q

Achondroplasia presentation

A
  • Short stature
  • Macrocephaly
  • Bowing of legs
  • Trident config of hands

(Dwarfism vibes)

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152
Q

Developmental dysplasia of the hip

A

Condition in neonates where acetabulum is shallow -> head of demur does not actually sit within acetabulum and can slip out quite easily

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153
Q

DDH presentation in non-neonates

A

Painles intermittent limp

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154
Q

DDH RF

A
  • female sex: 6 times greater risk
  • breech presentation
  • family history
  • firstborn children
  • oligohydramnios
  • birth weight > 5 kg
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155
Q

DDH Ix

A
  • Barlow and Ortolani manoeuvres during newborn infant screening check
  • USS at 6 weeks (if suspcion from B&O test)
    • If present with possible DDH beyond 6/12, hip XR
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156
Q

DDH Mx

A
  • Spontaneous resolution
  • Pavlik harness
    • Holds infant’s hips in a flexed position -> helps burrow head of femur into acetabulum
  • Surgery
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157
Q

Duchenne muscular dystrophy

A

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle deterioration and weakness

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158
Q

DMD presentation

A
  • Onset in early childhood
  • Walking on tip toes
  • Enlarged calves
    • Calf pseudohypertrophy
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159
Q

DMD cause

A

Alterations of a protein called dystrophin which helps keep muscle cells intact

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160
Q

DMD Ix

A
  • Gower’s sign
    • +ve
    • child uses arms to stand up from a squatted position
  • CK
    • Raised
  • Genetic testing
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161
Q

What is the systemic onset of Juvenile Idiopathic Arthritis called?

A

Still’s disease

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162
Q

Osgood schlatter disease

A

inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia)

163
Q

Osgood schlatter disease presentation

A
  • Active child/teen
  • Pain on one KNEE
  • Systemically well
164
Q

Osgood schlatter Mx

A

Rest, ice, analgesia, stretching + strengthening exercises

165
Q

Osteogenesis imperfecta presentation

A
  • Bowing of legs
  • Prone to fractures
  • Discolouration of sclera
166
Q

Osteomyelitis

A

bacterial infection from another part of the body spreads to the bone

167
Q

Osteomyelitis presentation

A
  • Fever
  • Fussiness or irritability
  • Tiredness
  • Area of infected bone:
    • Tenderness or pain
    • Not using the affected arm, leg or other part of the body
    • Swelling/redness
168
Q

Osteomyelitis v transient synovitis

A

Transient synovitis is response to a previous infx - does not present until days-weeks after infx

169
Q

Perthes disease

A

Avascular necrosis of femoral head

too little blood is supplied to the ball portion of the hip joint (femoral head). Without enough blood, this bone becomes weak and fractures easily.

170
Q

Perthes disease presentation

A
  • 5-10 year olds
  • Gradual onset of limp
  • Gradual onset of HIP pain
  • Pain on internal rotation and abduction
171
Q

Perthes disease RFs

A
  • Short stature
  • Hyperactivity
172
Q

Perthes disease trx

A
  • Analgesia + mobilisation
  • Surgery
173
Q

Rickets presentation

A
  • Pain
    • Bones affected can be sore and painful
    • Reluctant to walk/ waddling/ tire easily
  • Skeletal deformities
    • Thickening of the ankles, wrists and knees
    • Bowed legs
    • Soft skull bones
  • Dental problems
    • Delay in teeth coming through and increased risk of cavities
  • Poor growth and development
  • Fragile bones
    • Weaker and more prone to fractures
174
Q

Septic arthritis presentation

A
  • Severe joint pain
    • sually in just 1 joint, that started suddenly
  • Swelling around a joint
  • Skin around a joint has changed colour
  • High temperature
175
Q

Juvenile idiopathic arthritis

A

Arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks

176
Q

Still’s presentation

A
  • pyrexia
  • salmon-pink rash
  • lymphadenopathy
  • arthritis
  • uveitis
  • anorexia and weight loss
177
Q

Still’s/JIA Ix

A
  • ANA
    • May be positive
  • Rheumatoid factor
    • Negative
178
Q

Slipped upper femoral epiphysis (SUFE)

A

Fracture through growth plate resulting in slippage of femur
head of the femur slips off the neck of the bone at the growth plate

179
Q

SUFE presentation

A
  • 10-15 year old (often obese)
  • Gradual onset of limp
  • Gradual onset of hip or knee pain
  • Pain on internal rotation and abduction
180
Q

SUFE RFs

A
  • Obesity
  • Endocrine abnormalities
    • hypothyroidism
    • hypogonadism
181
Q

SUFE Mx

A

Internal fixation to realign two components of femur

182
Q

Transient synovitis

A

inflammation of the synovial lining of the hip joint

(a type of reactive arthritis)

183
Q

Transient synovitis presentation

A
  • Acute onset limp
  • Fever
    • Generally preceeded by viral URTI 1-2 weeks prior
184
Q

Limp/ hip pain + fever Mx

A

Referral for same-day assessment -MRI

(in case of septic joint)

185
Q

Likely cause of spiral fracture and mx?

A

NAI

Admit and alert safeguarding team

186
Q

What is the main aim of primary haemostasis?

A

Platelet plug formation

Endothelial injury -> vWF (kind of like adaptor) sticks onto exposed subendothelial structures -> platelets (brown) bind to vWF or even directly onto subendothelial structures -> platelets become activated & bind to e/o -> fibrinogen (inactivated) slots itself between platelets

+ vWF exists as multimers before being cleaved -> v sticky and prone to stick onto endothelium even in absence of injury; cleaved by ADAMTS13

187
Q

What is the aim of secondary haemostasis?

A

Formation of fibrin (from fibrinogen) by coagulation cascade

Tissue factor is a protein found on cells that make up your tissues that’s exposed only when there is endothelial damage -> tissue factor exposure activates factor VII-> VIIa (extrinsic pathway) -> no. enzyme reactions -> conversion of fibrinogen to fibrin -> fibrin mesh keeps platelets together

188
Q

Microangiopathic haemolytic anaemia (MAHA)

A

Red cell breakdown in small vessels resulting in anaemia.

Obstruction in small vessel, usually platelet plug, causing RBCs to be damaged (shearing) when passing through vessel.

*Mechanism not disease in itself

189
Q

Haemolytic uraemic syndrome triad

A

Haemolysis (due to MAHA) + thrombocytopenia (low platelets) + renal failure

190
Q

Cause of haemolytic uraemic syndrome

A

E. coli O157:H7

E. coli produces shiga-like toxin –> causes glomerular endothelial damage –> platelet plug formation (c) –> RBC gets fragmented/non-intact (a) in trying to pass –> poor end organ, kidney, perfusion (b) -> renal failure

3 features: (a) haemolytic, (b) uraemic, (c) thrombocytopaenia

191
Q

HUS presentation

A
  • Bloody diarrhoea
  • Pale
  • Poor UO
  • Nosebleed
192
Q

HUS Ix

A
  • FBC
    • Low Hb
    • Low Plt
  • Creatinine
    • High due to poor renal function
193
Q

Henoch-Schönlein purpura

A

capillaries become inflamed and damaged

194
Q

HSP presentation

A
  • raised red or purple spots (purpura) non-blanching
    • confined to buttocks, extensor surfaces of legs and arms
  • joint pain
  • abdo pain

(some overlap with ALL!)

195
Q

HSP Ix

A
  • BP
    • May be raised
  • Urinarlysis
    • +Protein
  • RBC
    • NORMAL platelet level
  • Kidney function
196
Q

HSP Mx

A

Self-resolving

+paracetamol/NSAIDs if pain

197
Q

Immune/Idiopathic thrombocytopaenia

A

Immune-mediated reduction in platelet count

198
Q

ITP presentation

A
  • Bruising
  • Petechial or purpuric rash
    • widespread
  • Splenomegaly
    • Atypical feature
  • (Recent cold)
199
Q

ITP Ix

A
  • FBC
    • Isolated low platelets
  • Blood film
  • Bone marrow biopsy
    • IF ATYPICAL FEATURES/ failure to respond to trx
200
Q

ITP Mx

A
  • Usually no trx
    • Resolves in around 80% children within 6/12
  • Avoid activities that may result in trauma
    • E.g., contact sports

If platelet VERY low (<10), or significant bleeding

  • Oral/IV corticosteroid
  • IV Ig
  • Platelet transfusion
    • in emergencies, but only temp as they are desroyed by circulating antibodies
201
Q

Thrombotic thrombocytopaenic purpura pentad

A

MAHA + thrombocytopaenia + renal failure + fever + altered mental state

202
Q

TTP presentation

A
  • Confusion
203
Q

Cause of TTP

A

ADAMTS13 deficiency –> increased sticky, uncleaved, vWF multimer -> stick onto endothelial wall –> platelet plug formation –> insufficient end organ perfusion

204
Q

Disseminated Intravascular Coagulation

A

Clotting within blood vessels throughout body

205
Q

Cause of DIC

A

Excessive tissue factor exposure most commonly due to sepsis, tumour and pancreatits.

Excessive exposure tissue factor –> excessive activation factor of extrinsic pathway –> lots of tiny clots formed –> very depleted platelets (anticoag) and clotting factors (procoag) due to increased consumption

*We exist in a procoag state (bc historically we are more at risk of bleeding to death), and the anticoag state adjusts itself in response to procoag levels. When all factors are gone -> tips towards not clotting at all

206
Q

DIC presentation

A
  • Widespread bleeding from orfices
  • Fever
  • Shock
207
Q

DIC Ix

A
  • aPTT (increased)
  • PT (increased)
  • Platelet (low)
208
Q

Haemophilia presentation

A
  • Painful joint with limited range of movement
  • Swelling on bumping limb
  • Bluish discolouration/purpuric rash to the overlying skin
209
Q

Haemophilia Ix

A
  • FBC
  • ESR
  • CRP
    • May be lil raised
  • PT and bleeding time is normal
  • APTT
    • elevated
210
Q

Lymphoma

A

Cancer of the lymph nodes

211
Q

Lymphoma presentation

A
  • Swollen glands - painless lymphadenopathy
  • Pruritus
  • B symptoms in poorer prognosis
    • Fever
    • Nightsweats
    • Weight loss
212
Q

Non Hodgkin’s Lymphoma

A
  • 90% of lymphomas
  • B or T cell
  • Affects multiple groups of nodes
213
Q

Hodgkin’s lymphoma

A
  • Only affects B cells
  • Usually only affects single group of lymph nodes in 1 specific area
  • Reed-sternberg cells
    • owl
214
Q

SCD Presentation

A
  • Intermittent abdominal pain
  • Generalised aches
  • Pale, febrile and icteric
  • Splenomegaly
  • Swelling of wrists and fingers
215
Q

Nephritic syndrome

A

Inflammation of glomerulus and nephrons

*Leaky walls –> blood and protein leaking out into tubule

216
Q

Nephritic syndrome causes & presentation

A
  • IgA Nephropathy* –> abdo pain, rash, arthritis
  • Henoch-Schonlein purpura –> abdo pain, purpuric rash, arthritis
    • related to IgA however it is widespread whereas IgA is renal
  • Post-streptococcal glomerulonephritis** –> HTN
  • Haemolytic uraemic syndrome
  • SLE
  • Goodpasture’s syndrome

*occurs 5-7 days post resp/GI infx
** occurs 4-6weeks post group A streptococcal infx (pharyngitis, skin)

217
Q

Nephritic syndrome Ix

A
  • Urine dipstick
    • Blood
    • Protein
  • Creatinine
    • increased
218
Q

Nephritic syndrome mx

A
  • IgA Nephropathy
    • BP control ± steroids
  • Henoch-Schonlein purpura
    • Self-resolving ± steroids
  • Post-streptococcal glomerulonephritis
    • BP control
219
Q

Nephrotic syndrome

A

Heavy proteinuria + hypoalbuminaemia + oedema

*Increased VTE risk due to proteinuria –> clotting factor lost in abundance is antithrombin3 (main anticoag in body)

220
Q

Nephrotic syndrome presentation

A
  • Puffy eyes
  • URTI
  • Abdo bloating
  • Oedema of ankles, sacrum
221
Q

Nephrotic syndrome causes

A

Podocyte effacement

*Podocytes integral in maintaining barrier to proteins at interface between glomerulus and bowmans capsule

  • Minimal change disease
  • Focal segmental glomerulosclerosis (more adults)
  • Membranous glomerulonephritis (more adults)
222
Q

UTI Presentation

A
  • Vomiting
  • Fever
  • Poor feeding
  • ±stomach pain
  • ±dysuria
223
Q

Chicken pox complx in immunocompromised child

A

Pneumonitis

224
Q

Cytomegalovirus presentation

A
  • Fever
  • Aching muscles
  • Tiredness
  • Rash
  • Sore throat
  • Swollen glands
225
Q

What pathogen is Glandular Fever caused by?

A

Epstein Barr Virus (EBC)

*Glandular Fever a.k.a infectious mononucleosis

226
Q

Glandular fever presentation

A
  • Pyrexia
  • Tender, swollen lymph glands, mainly in the neck (and often in the armpits and groin)
  • Red, spotty rash
227
Q

Glandular fever Ix

A
  • FBC
    • High WCC
  • CRP
    • High
  • Monospot test
    • Atypical/reactive lymphocytes
228
Q

Glandular Fever Mx

A

Arrange admission if:

  • Stridor
  • Dehydration or difficulty swallowing fluids.

Otherwise:

  • Paracetamol/ibuprofen for pain and fever syx
  • Advise
    • Syx 2-4weeks
    • Tiredness is common and often last syx to resolve
    • Exclusion from school not necessary
    • Limit spread by avoiding kissing/ sharing eating or drinking utensils, and to thoroughly clean all items that may have been contaminated by saliva.
229
Q

Hand foot and mouth disease cause

A

Coxsackie A16 virus, although other group A and B Coxsackie viruses may be causative

230
Q

Hand, foot and mouth disease presentation

A

vesicular eruptions (ulcers) in the mouth and papulovesicular lesions of the distal limbs

+ fever

231
Q

HSV complication

A

Encephalitis

232
Q

Kawasaki disease

A

An illness that causes inflammation in blood vessels throughout the body

233
Q

Kawasaki disease presentation

A

CRASH

  • Conjunctivitis (bilaterally)
  • Rash
  • Adenopathy
    • Cervical lymphadenopathy
  • Strawberry tongue/cracked lips
  • Hands and feet sweeling

& burn
Child under age of 5 + fever >5 days

234
Q

Kawasaki disease Ix

A
  • Echo
    • Check for complx of coronary artery aneurysm
235
Q

Kawasaki disease Mx

A

IV Ig (Gama globulin)

/

High dose aspirin

236
Q

Lymphadenitis presentation

A
  • Fever
  • Warm, tender enlarged lymph node on one side (usually in the neck, but can also be in the arm pit or groin)
  • Skin redness over the lymph nodes
237
Q

Measles presentation

A
  • Fever + cold like syx
  • Lymphadenopathy
  • Koplik spots in mouth
  • Flat red spots (maculopapular) that appear on the face at the hairline
    • Spread downward to the neck, trunk, arms, legs, and feet
238
Q

Complication of measles

A

Otitis media

239
Q

Parvovirus B19 presentation

A
  • “Slapped cheek” rash appearance
    • Spreading to trunk and extremities
  • Fever
240
Q

What can Parvovirus B19 result in

A

Aplastic crisis in SCD pts

(rapid fall in hemoglobin levels associated with few or no reticulocytes - immature RBC)

241
Q

What is Roseola caused by?

A

Human Herpes Virus-6

242
Q

Roseola presentation

A
  • High fever (greater than 39.5°C) for 3 to 7 days.
  • Rash on torso and spread to arms, legs, back, face
    • Atfer the fever disappears
243
Q

Rubella presentation

A
  • Low-grade fever
  • Pink-ish rash
  • Mild conjunctivitis
  • Swollen and enlarged lymph nodes
  • Cough
  • Runny nose
244
Q

Threadworms cause

A

Enterobius vermicularis

245
Q

Threadworms presentation

A
  • Asymptomatic (90%cases)
  • perianal itching, particularly at night
  • girls may have vulval symptoms
246
Q

Threadworms Ix

A

applying Sellotape to the perianal area and sending it to the laboratory for microscopy to see the eggs

(however mostly treated empirically)

247
Q

Threadworms Mx

A
  • Hygiene measures for all household
  • Mebendazole
    • Single dose for whole household
248
Q

Sudden infant death syndrome RFs

A
  • prone sleeping
  • parental smoking
  • bed sharing
  • hyperthermia and head covering
  • prematurity
249
Q

Risk of maternal alcohol use

A

Foetal alcohol syndrome

  • Microcephaly (small head)
  • Absent philtrum
  • Cardiac abnormalities
  • Reduced IQ

(depending on severity)

250
Q

Foetal Alcohol syndrome presentation

A
  • Jittery baby
  • Sensitive to external stimuli
  • Poorly developed philtrum
251
Q

Risk of maternal smoking

A

Increased risk of

  • Miscarriage
  • Stillbirth
  • Pre-term labour
252
Q

Risk of Rubella infx during preg

A
  • Cataract
  • Deafness
  • Cardiac abnormalities

± jaundice, hepatosplenomegaly, microencephaly, reduced IQ

*Most at risk first 16 weeks.

253
Q

Attention Deficit Hyperactivity Disorder features/criteria

A
  • Hyperactivity
  • Impulsivity
  • Inattention
  • Psychological, social or educational impairment that is pervasive
    • 2 or more settings
254
Q

ADHD Mx

A

<5 y/o

  • ADHD-focused group parent-training programme

>5y/o

  • Training programme
  • Medication
    1. Methylphenidate
    2. Lisdexamphetamine
    3. Atomoxetine or Guanfacine
    • Monitor height, weight & ECG
255
Q

Autism spectrum disorder features

A
  • Impaired social interaction
    • Not seeking close friendships/socially inappropriate behaviour/not understanding other’s feelings
  • Speech & language disorder
    • Literal interpretation of speech/monotonous speech
  • Routines and ritualistic behaviours
    • Fixed ideas/interests/routines
256
Q

ASD comorbidities

A
  • Seizures
  • MH disorders
257
Q

ASD Mx

A

Behavioural modification

258
Q

Cerebral palsy

A

Permanent disorder of movement and/or posture and of motor function due to a non-progressive* abnormality in the developing brain

(*brain damage does not change/evolve- same throughout life but manifestations will vary as child grows)

259
Q

Cerebral palsy classification (3)

A
  • Spastic (90%)
  • Dyskinetic
  • Ataxic
260
Q

Cerebral palsy causes

A
  • Antenatal (80%)
    • Intracranial haemorrhage/ischaemia
    • Genetic syndromes
    • Congenital infx
  • Perinatal
    • Hypoxic-ischaemic injury
  • Postnatal
    • Intracranial infx
    • Trauma
    • Hydrocephalus
261
Q

Cerebral palsy presentation

A
  • Abnormal tone
  • Delayed motor milestones
  • Feeding abnormalities
  • Asymmetrical hand function at <12 months
    • Hand preference
  • Persistence of primitive reflexes
262
Q

(spastic) Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected?

A

Motor cortex

263
Q

Difficult balance, cannot build block of towers, hyperreflexia (description of ataxic CP). Where is lesion?

A

Cerebellum

264
Q

What would warrant paeds referral re febrile convulsions?

A

Still drowsy 2h after seizure

265
Q

Focal seizures presentation

A
  • Period of being difficult to communicate with
  • Sleepy/falls asleep after
  • No memory of abn event
266
Q

Epilepsy Mx

A
  • Tonic clonic, tonic, atonic, myoclonic - Sodium valproate
    • ​but not in F of child bearing age
  • Absence - Ethosuximide
  • Focal - Lamotrigine
267
Q

Congenital infections (main 5)

A

Toxoplasmosis

Others

Rubella

CMV

Herpes

268
Q

Congenital infections keypoints

A

Toxoplasmosis

  • Undercooked meat, raw eggs, handling cat litter
  • Higher risk later in preg
  • Baby: Usually no immediate syx then jaundice, lymphadenopathy, retinitis, developmental delay

Others

  • Syphilis, VZV, Parvovirus B19

Rubella

  • Highest risk in 1st trimester
  • Vaccinate mother pre conception
  • Baby: deafness, cataracts, congenital heart disease (PDA)

CMV

  • Most common intrauterine infx
  • Baby: low birth weight, microcephaly, seizures, hepatosplenomegaly, learning disability, deafness

Herpes

  • Occurs when mother has active genital herpes during childbirth
  • Baby: skin, eyes, mouth disease
269
Q

What is the genetic abnormality for Turner’s syndrome?

A

45X

270
Q

What are the features of Turner’s syndrome?

A
  • Wide or weblike neck
  • Low-set ears
  • Broad chest with widely spaced nipples
  • Bicuspid aortic valve and coarctation of aorta
  • High, narrow roof of the mouth (palate)
271
Q

What is the genetic abnormality for Klinefelter’s syndrome?

A

47XXY

272
Q

What are features of Klinefelter’s syndrome?

A
  • Taller than average stature
  • Longer legs, shorter torso and broader hips for M
  • Absent, delayed or incomplete puberty
  • Post puberty, less muscle + facial and body hair for M teen
273
Q

What are the featues of Fragile X syndrome?

A
  • Balance problems
  • Shaky hands
  • Numbness in hands and feet
  • Unstable mood
  • Memory loss & cognitive problems
  • Primary ovarian insufficiency in F
  • Enlarged testes post pubert in M
274
Q

What is the genetic abnormality for Patau’s syndrome?

A

Trisomy 13

275
Q

What is the genetic abnormality for Patau’s syndrome?

A

Trisomy 13

276
Q

What are the features of Patau’s syndrome?

A
  • Abnormally small eye or eyes (micropthalmia)
  • Absence of 1 or both eyes (anophthalmia)
  • Reduced distance between the eyes
  • Problems with development of nasal passages
277
Q

What is the genetic abnormality for Edward’s syndrome?

A

Trisomy 18

278
Q

What are the features of Edward’s syndrome?

A
  • Microcephaly (small head)
  • Malformed and low set ears
  • Microagnathia (small mouth &/or jaw)
  • Cleft palate/cleft lip
  • Clenched fists
  • Club feet
  • Rocker bottom feet
279
Q

What is the genetic abnormality for Down’s syndrome?

A

Trisomy 21

280
Q

Down’s syndrome features

A
  • Face
    • upslanting palpebral fissures (eyes)
    • epicanthic folds (eyes)
    • Brushfield spots in iris
    • protruding tongue
    • small low-set ears
    • round/flat face
  • Head
    • Flat occiput (back of head)
  • Hands/feet
    • Single palmar crease
    • Pronounced ‘sandal gap’ between big and first toe
  • Hypotonia
281
Q

Prader willi presentation

A
  • Voraciously hungry kid
  • Hypotonia
  • Almond eyes
282
Q

Acne

A

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells.

283
Q

Acne Mx

A

Mild-moderate

  • Benzoyl peroxide
  • Benzoyl peroxide + clindamycin
  • Adapalene
  • Azelaic acid

If not responding

  • Oral antibiotics
    • Lymecycline or doxycycline for max 3 months
  • Consider COCP (F)

Specialist referral - roccutane is popular trx option (extensive side effect profile)

  • Severe
  • Scarring
  • Marked
  • Psych distress
  • Multipl treatment failure
284
Q

Eczema presentation

A

Dry, scaly rash - typically occurring on flexor regions

285
Q

Eczema Mx

A
  • Emollients
    • Liberal use regularly
    • Skin has lost its ability to act as a barrier - trying to sustain barrier
  • Steroids
    • Mild: hydrocortisone 1%
    • Moderate: Betamethasone valerate 0.025%, Clobetasone butyrate 0.05%
    • High: Betamethasone valerate 0.1%, Mometasone
  • Calcineurin inhibitors
286
Q

What is this presentation?

A

Impetigo

Staphylococcal or streptococcal infection that presents with golden-crust like rash (often on face)

287
Q

Impetigo Mx

A

Localised

  • Topical fusidic acid

Extensive

  • Oral flucloxacillin
    • Clarithromycin if pen allergic

No school until lesions dry and scab over

288
Q

Scalded skin syndrome presentation

A
  • Skin feels off
  • Fever
  • Irritability
  • Rash
289
Q

Salmon patch presentation

A

Flat, pink lesion. May change colour, e.g., darker when bb cries

290
Q

Retinoblastoma

A

Rare eye cancer in young children

291
Q

UTI Treatment

A

Not requiring admission

  • PO co-amox (Augmentin duo) or PO cephalosporin 5-7/7

Inpt

  • IV cefotaxime + gentamicin 10/7
292
Q

Acute lymphoblastic leukaemia presentation

A
  • Recurrent sore throat
  • Pallor
  • Joint pain
  • Massive hepatomegaly
  • Petechial rashes
293
Q

Acute leukaemia Ix

A
  • FBC
    • Hb low
    • WCC high
    • Plt low
    • Neutrophils low
  • Bone marrow biopsy
    • Definitive
294
Q

Suspected ALL

A

Send to A&E

295
Q

NAI Mx

A

to involve more senior help

An on-call team for safeguarding children in every acute Trust.
During the day, the named nurse for child protection is likely to be the right person to contact. On-call, there will be a named consultant.

296
Q

Caput succedaneum

A

lumps caused by scalp swelling due to pressure

crosses suture lines

297
Q

Cephalohaematoma

A

blood that collects between a newborn’s scalp and skull

does not cross suture lines

298
Q

What can foreign body present with?

A

Unilateral nose bleed

299
Q

Urinary continence at night Mx

A
  • Positive reward system
  • Enuresis alarm
  • Desmopressin melts administered e/ night
300
Q

At what age does enuresis become a problem?

A

From 5!

301
Q

Meningococcal speticaemia presentation

A
  • Temperature
  • Reduced cap refill
    • Bulging fontanelles
  • Generally unwell
302
Q

What is this presentation?

A

Slate grey nevi (Mongolian blue spots)

303
Q

What is this presentation?

A

Malar rash

304
Q

What can cause malar rash?

A

Rosacea

Lupus

305
Q

What is non-blanching rash indicative of?

A

Neisseria meningitidis

306
Q

What is this presentation and what to prescribe?

A

Umbilicated papules in molluscum contagiosum

Do nothing!

307
Q

What is this presentation?

A

Blanching rash on trunk due to post-viral rash/reactive rash/ exanthem

308
Q

What is this presentation and how to manage?

A

Eczema herpeticum

Eczema hx with exposure to HSV

Send to A&E!

309
Q

What is this presentation and what to prescribe?

A

Mild erythema nappy rash

Barrier preparation to protect skin - Zinc, castor oil

(+Regular nappy changes, nappy-free time)

310
Q

What is this presentation and what to prescribe?

A

Satellite lesions - nappy rash due to candida

Prescribe clotrimazole cream

311
Q

What is this presentation and what to prescribe?

A

Chicken pox

Do nothing

312
Q

What is this presentation and what to prescribe?

A

Scabies

Treat with permethrin

313
Q

Phimosis

A

Tight foreskin

314
Q

Phimosis presentation

A
  • Foreskin ballooning on urination
  • Non-retractile
315
Q

Infantile spasms presentation

A

Infant with episodes of throwing arms forward with fists clenched

316
Q

Reflex anoxic seizures presentation

A
  • Child falls
  • Parents pick them up
  • Tonic-clonic seizure
  • Completely well afterwards.
317
Q

Breath-holding attacks presentation

A
  • Cry and then be silent while holding their breath
  • Turn blue or grey
  • Be floppy or stiff, or their body may jerk
  • Faint for 1 or 2 minutes
  • Sleepy or confused for a while afterwards
318
Q

Absence seizure presentation

A
  • Sudden loss of awareness
  • Suddenly stop talking/what they are doing and stare blankly into space
  • Not response to people talking to them
319
Q

CKD presentation

A
  • Polydipsia (with no dysuria)
  • Hypertensive
  • Poor growth
  • Anaemic/pale
320
Q

Tonsilitis complx

A

Quinsy’s

(Abscess between one of your tonsils and wall of throat)

321
Q

Temper tantrum presentation

A
  • Screaming
  • Kicking
  • Biting
  • Crying
322
Q

Chicken pox presentation

A

Itchy maculovesicular rash w fever started on chest and spread to arms

323
Q

Chicken pox developed cool peripheries -> Dx?

A

Viral meningitis

324
Q

Neonate exposure to chickenpox mx

A

IV VZIG

325
Q

Fussy eater blood film results

A

hypochromic microcytic anaemia and low ferritin

326
Q

Constipation + 1 ep blood streaked poop Mx

A

reassure

327
Q

What is West syndrome and what does it show on EEG?

A

Infantile spasms (+developmental delay) shows hypsarrhythmia on EEG.

328
Q

Which TB drug can cause discolouration of tears/urine? (reddish-brown)

A

Rifampicin

329
Q

Bacterial tonsillitis Mx

A

Phenoxymethylpenicillin

Clarithryomycin in pen allergic

330
Q

Benign intracranial hypertension headache presentation

A
  • Throbbing
  • Worse in morning
  • N+V
331
Q

Migraine Mx

A
  • Headache diary
  • NSAIDs
  • Nasal triptan, e.g., nasal sumatriptan
    • if NSAIDs don’t work
332
Q

Hypoglycaemia newborn Mx

A

Asymptomatic

  • Breast feed

Symptomatic

  • Oral/IV glucose
333
Q

Wilm’s tumour (nephroblastoma)

A

Kidney ca affecting children which develops from nephroblast cells

334
Q

Wilm’s tumour presentation

A
  • Painless abdominal distension
  • Haematuria
335
Q

Neuroblastoma presentation

A
  • Painful abdominal bloating
  • Abdo mass on palpation
  • Haematuria
336
Q

Traveller’s diarrhoea + derranged LFTs

A

Hepatitis A infx

337
Q

Screen for latent TB - when is it considered +?

A

Mantoux Tuberculin skin reaction test

Induration/firm swelling:

1) ≥5mm if recent contact someone w infectious TB
2) ≥10mm children under 5
3) ≥15mm no RFs

^Start anti-TB Trx

*IGRA (Interferon gamma release assay) also offered in immunocomproised

338
Q

Central precocious puberty Ix

A

gonadotropin stimulation test

339
Q

On newborn check, inverted ankles and plantar flexed

A

Clubfoot - talipes equinus

340
Q

ittery baby - what should your first test be?

A

Capillary blood glucose

341
Q

Kid with diarrhoea for the last few months, with pieces of vegetables undigested, otherwise healthy

A

Toddler’s diarrhoea

342
Q

Girl goes to pakistan. Develops macular rash. High fever for 5 days. HR was 70bpm. Cause?

A

Typhoid (relative bradycardia!)

343
Q

Cannot examine ear directly, lump behind ear

A

mastoiditis

344
Q

Sickle cell anaemia patient with hb of 40 and low reticulocyte count, Howell-Jolly bodies cause

A

Parvovirus B19 - causing aplastic crisis

345
Q

Kid take medication for UTI, becomes anaemic and jaundiced, irregularly contracted cells and polychromasia

A

G6PD deficiency

346
Q

Maternal T1DM increases risk of what condition in newborn?

A

Neural tube defects

347
Q

kid fighting with brother, sustains injury where elbow is flexed and pronated, pain on supination. What is the injury?

A

Subluxation of the radial head

348
Q

Child with a single enlarged lymph node in posterior cervical neck, had a viral infections one week age. How would you manage it?

A

reassurance and watchful waiting (Most cases of cervical lymphadenopathy are self-limited and require no treatment other than observation w f/u in 2 weeks)

If lymphadenopathy has not resolved after 2–4 weeks, arrange urgent referral to an ear, nose, and throat surgeon for further investigation, depending on clinical judgement.

349
Q

Kid from Pakistan whose parents are first cousins has acute respiratory failure and pneumocystis pneumonia, what dx?

A

SCID

Most primary immunodeficiencies are inherited in an autosomal recessive pattern; therefore, they are more common in areas with high rates of consanguineous marriage

350
Q

neonate with fever, sunken fontanelle and reduced right leg movement, most likely dx?

A

Osteomyelitis

351
Q

Bilateral undescended testes in a phenotypically male newborn examination, most likely dx?

A

Klinefelter’s

(if phenotypically F, androgen insensitivity syndrome)

352
Q

Kid with acute otitis media, high temperature. What to do next?

A

Admit if: <3/12 w temp >38.5
Consider admit if: <3/12, or 3-6/12 and temp >39
Systemically unwell: immediate abx prescription
Systemically well: reassure (paracetamol) and r/v

353
Q

15 year old girl who had generalised abdominal pain and then now right iliac fossa pain, she had a cough and coryza a few days previously. What is the most likely diagnosis?

A

mesenteric adenitis

354
Q

Hearing difficulties in a 7 year old boy, which test would you do?

A

Pure tone audiometry

355
Q

3 year old girl well-kempt, who has reached developmental milestones, nursery comments that she does not speak much, her mother says at home she is well-behaved and plays alone quietly. Most likely diagnosis?

A

selective mutism

356
Q

10 month old child with UTI infection by non-E coli organism. USS was normal. What ix needed?

A

micturating cystourethrogram (MCUG)

357
Q

Child migrated to the UK from Pakistan, with a history of recurrent chest infections and dropped some centiles on the growth chart. Most def ix?

A

Sweat test

358
Q

Parents have noticed beer-coloured urine in a girl following URTI, what diagnosis?

A

Ig A Nephropathy (recent), Post-strep glomerulonephritis (weeks)

359
Q

Neonate with red sticky eyes and purulent discharge - most likely cause?

A

2-5 days post birth: N. Gonorrhoea

5-12 days (?up to 28): C. Trachomatis

360
Q

Young boy with swelling around eye. Which medication do you want to give?

A

Chloramphenicol

361
Q

Child with JIA has weight gain, abdominal striae and plethoric face. What drug is he likely on?

A

Steroids

362
Q

Child had sore throat, was given abx, a few days later a rash appeared. What is the likely cause of sore throat?

A

EBV

363
Q

Child with non-blanching rash and fever at GP. What immediate tx to give?

A

IM benzylpenicillin

364
Q

Trisomy 21 most common cardiac defects (in descending order) x3

A
  1. AVSD
  2. VSD
  3. ASD

Pulmonary atresia

Mild coarctation of the aorta???

365
Q

A 15 year old boy has 3 weeks of cough, weight loss, night sweats and fever. He moved to the UK from India 3 years ago. His chest x-ray is show in the image (can’t find exact image but showed some left upper zone shadowing I think). Which investigation is regarded as the gold standard for diagnosis for his underlying condition?

A

Sputum culture (gold-standard for active pulmonary TB)

366
Q

A 3 year old girl in the paediatric Emergency Department has conjunctival pallor, lethargy and dark urine. Last week she finished a course of nitrofurantoin for a urinary tract infection. Her blood results are as follows: Hb 70 g/L (110-140), WBC 3.2 x 10^9/L (5.0 - 12.0), platelets 520 x 10^9/L (150 - 400), albumin 37 g/L (30 - 50), bilirubin 75 umol/L (<21), ALT 18 IU/L (0 - 29), ALP 130 IU/L (60 - 425). Which is the most likely underlying diagnosis?

A

G6PD deficiency

367
Q

A 7 year old boy has a history of recurrent chest infections, persistent sinusitis and has been prescribed multiple courses of antibiotics. He has bibasal crepitations and a right-sided apex beat. Which is the most likely underlying diagnosis?

A

Primary ciliary dyskinesia

Kartagener syndrome: Primary ciliary dyskinesia (no cilia movement-> mucus plugs -> bacterial colonisation -> chronic bronchiectasis) + persistent sinusitis (impaired mucociliary clearance -> recurrent sinus infx) + dextrocardia (no cilia movement -> heart stays on RHS during embryogenesis)

368
Q

A 3 day old baby girl is not feeding well. Her temperature is 36.7C, heart rate 180 bpm, respiratory rate 66 breaths per minute. There is a systolic murmur and femoral pulses are not palpable. Which is the most likely diagnosis?

A

Coarctation of the aorta

369
Q

A 5 year old boy in the paediatric Emergency department recently had a sore throat and now has a rash across her lower legs. She is afebrile but has abdominal pain and joint pains in both legs. Her full blood count result is as follows: Hb 110 g/L (115 - 140), WCC 10.3 x 10^9/L (3.8 - 10), neutrophils 6 x 10^9/L (150 - 400). Which is the most likely diagnosis?

A

Acute lymphoblastic leukaemia

370
Q

A 7 year old girl has breast buds but no pubic hair. Her height is on the 98th centile and her weight is on the 75th centile. She is otherwise fit and well. There is no significant family history. Investigations show: bone age of 10 years, FSH 3.2 IU/L (<1), LH 3.4 IU/L (<1). Which is the most likely diagnosis?

A

Central precocious puberty

371
Q

A 3 year old boy attends the Emergency Department after an episode of sudden onset jerky movements of both arms and legs for 5 minutes, which stopped before the ambulance arrived. His current observations are: temperature 38.5C, pulse 130 bpm, blood pressure 100/90 mmHg, respiratory rate 25 breaths per minute, oxygen saturation 98% breathing air. He has had a coryzal illness for 24 hours and is otherwise fit and well. He is alert, with a blood glucose of 4.5 mmol/L (3.0 - 6.0) and neurological examination is normal. Which is the most appropriate next step in management?

A

Prescribe oral antipyretics and observe

(Observe as first time, benzodiazepine rescue med given if seizure >5 mins)

372
Q

Coeliac disease

A

Coeliac disease is a condition where your immune system attacks your own tissues when you eat gluten.

373
Q

Coeliac signs/syx

A
  • Fatigue/weakness
  • N+V
  • Failure growth
  • Abdo distension
  • Atrophic buttock muscle
374
Q

Coeliax Ix

A
  • Gold standard: duodenal biopsy
  • Bloods
    • IgA Anti TTG
    • Anti-endomysial
    • Serum IgA deficiency
375
Q

Coeliax Mx

A
  • Lifelong gluten free diet
  • Pneumococcal polysaccharide vaccine/pneumovax as hyposplenic
376
Q

What other conditions are coeliac associated with?

A
  • Enteropathy associated T cell lymphoma
  • Erethyma Herpetiformis
377
Q

Volvulus Mx

A
  • Admit to hospital
  • Prepare for surgery
  • NG tube to empty GI contents
    • Keeps fluid and gas from building up
  • IV fluids
  • IV abx
378
Q

Wilson’s disease

A

Autorecess mutation in Cr13 -> reduced synthesis of caeruloplasmin (copper binding protein) and defective excr copper in bile leading to accum of copper in liver, brain, kidney and cornea

379
Q

Wilson’s disease presentation

A

fatigue, worsining school performance + change in behaviour + jaundice + kayser-fleischer rings in cornea

380
Q

Wilson’s disease Ix

A
  • Serum caeruloplasmin (low)
  • Liver biopsy - high levels of copper in liver
381
Q

Wilson’s disease mx

A

penicillamine - promotes copper excr +ophthal + pt + school support

382
Q

Meningitis 2ndry care mx

A
  • Admit pt
  • Senior input
  • Start IV abx*
  • Send urine, blood and CSF for M, C&S
  • Start maintenance IV fluids

* <3/12: IV cefotaxime and amoxicillin
>3/12: IV ceftriaxone

383
Q

Acute epiglottitis mx

A

Urgent referral to ENT, paeds, anaesthetics (visualisation under GA + intubation)
IV ceftriaxone

384
Q

Query septic arthritis Mx

A
  • FBC
  • CRP
  • Blood cultures
  • Joint aspirate
  • Refer for an orthopaedic opinion

hip septic arthritis, aspiration needs to be done emergently by ortho

385
Q

T1DM dx criteria

A
  • Symptoms +
  • Biochemical:
    • Fasting ≥7.0mmol/L
    • Random ≥11.1mmol/L
    • 2 hours post load > 11.1
    • HbA1c > 48

*If no symptoms 2 tests

386
Q

Nephrotic syndrome Mx

A

reducing dose of steroids (pred).

If steroid resistant > specialist

387
Q

DKA dx criteria

A

All 3:

  • Ketonaemia ≥3, or 2+ ketonuria
  • Glucose ≥11mmol, or known DM
  • Bicarb < 15mmol &/or venous pH < 7.3
388
Q
A
389
Q

FB inhalation presentation

A

Short hx of dyspnoea and cough

390
Q

FB inhalation XR

A

Increased volume of translucency + unilateral hyperinflation

391
Q

Acute appendicitis Ix

A

USS

If inconclusive, CT (gold standard)

392
Q

Newborn testing

1) When?
2) Which tests?

A

1) 4-5 weeks

2) Otoacoustic emission test
then auditory brain response test (if former strange result)

393
Q

Clubfoot mx

A

Ponseti method casting

394
Q

Neuroblastoma Ix

A

Urine catecholamines: VMA and HVA high

395
Q

Hirschsprung disease chromosmal defect

A

Cr 10

396
Q

Crohns v UC endoscopy

A

Crohns: skip lesions and strictures from mouth to anus (esp terminal ileum)

UC: contunous distribution w/ no structures from rectus to colon

397
Q

Crohns v UC biopsy

A

Crohns: transmural deep colon ulceration, cobble stone mucosa, granulomas

UC: mucosal lesions, crypt abscesses, pseudopolyps

398
Q

Most common childhood arrhythmia

1) PC
2) Mx

A

SVT

PC: younger children - HF symptoms, older - syncope

Mx: 1) Vagal manouvre 2) IV adenosine

399
Q

SCD - painful vaso-occlusive crisis mx

A
  1. Analgesia (avoid morphine)
  2. PO + IV fluids
  3. If evid bact infx -> Abx
  4. If low O2 -> O2
400
Q

Minimal change disease complx

A

DVT

401
Q

Neonatal life support

A

APGAR scores at 1, 5 and 10 mins
Assessing: colour, tone RR, HR

  1. Dry/stimulate
    * If gasping/not breathing*
  2. 5 inflation breaths
  3. Consider suction if visible obstruction
  4. Repeat inflation breaths
  5. 3 chest compressions : 1 ventilation breath
402
Q

Chondromalacia patellae presentation

A
  • Knee pain, no trauma
  • Creptius palpable when knee extended
  • Grating sensation
403
Q

Chondromalacia patellae mx

A

Rest and analgesia

Year 5 (Alex) (4 decks)

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