Paeds Flashcards
“Kawasaki disease is a type of m____ - s___ v____ v____
“Kawasaki disease is a type of systemic, medium-sized vessel vasculitis”
What kind of ethnicity and gender does Kawasaki disease tend to affect?
Japanese and Korean boys
What is the most important investigation to do in Kawasaki disease? What does it screen for?
Echocardiogram to check for coronary artery aneurysm
What might trigger Kawasaki disease?
Infection
List the features of Kawasaki disease
CRASH and BURN: Conjunctivitis Rash (non vesicular, peeling) on palms and soles Adenopathy (cervical) Strawberry tongue Hand and feet swelling Burn (fever) Other: dry red lips and mouth, pancarditis, coronary arteritis/aneurysm
What is the treatment for Kawasaki disease?
- Single dose IV immunoglobulin
- Aspirin (after acute phase) is only given to children who have cracked hands, lips and strawberry tongue
What causes Scarlet Fever? Which organism is the most common cause?
Reaction to toxins from Group A haemolytic streptococci (streptococcus pyogenes)
What is the mode of transmission for Scarlet fever
Respiratory route via infected water droplets
What are the symptoms of Scarlet Fever?
Fever Malaise, headache, N&V Sore throat Strawberry tongue Sandpaper rash with circumoral sparing
Management for scarlet fever?
Oral penicillin V for 10 days
When can a child return to school after Scarlet fever infection?
24 hours after commencing antibiotics
Complications of scarlet fever?
Otitis media (most common)
Rheumatic fever
Acute glomerulonephritis
Symptoms of bone marrow failure in ALL?
Anaemia: lethargy and pallor
Neutropaenia: frequent and severe infection
Thrombocytopaenia: abnormal bleeding, easy bruising, petechiae
Non-bone marrow failure symptoms of ALL?
Hepatomegaly
Splenomegaly
Bone pain
Lymphadenopathy
What kind of vasculitis is Henoch Schonlein purpura?
IgA mediated small vessel vasculitis
Describe the pattern of rash seen in HSP
Palpable, purpuric rash over the buttocks and extensor surfaces of arms and legs
Features of HSP?
purpuric rash
abdominal pain
polyarthritis
Haematuria, renal failure
What is the treatment for HSP?
Analgesia for arthritis, otherwise treatment is supportive as it is a self limiting condition with good prognosis
What causes ITP?
Type 2 hypersensitivity reaction
Pathophysiology of ITP?
Production of antibodies target and destroy platelets
How does ITP timeline progress?
Often a history of recent viral illness and onset of symptoms after 24-48 hours. Most patients will remit spontaneously within 3 months
Symptoms of ITP?
Bleeding
Bruising
Petechial/purpuric non-blanching rash
What symptoms would make you consider a differential of ALL instead of ITP?
Hepatosplenomegaly, lymphadenopathy
What proteins are antibodies directed against in ITP?
glycoprotein 2b-3a or 1b complex
When would you treat ITP?
Only required if patient is actively bleeding or have a severe thrombocytopaenia
What treatments for ITP?
Prednisolone
IV immunoglobulins
Blood transfusion if needed
Platelet transfusions temporarily
Some non-medical/lifestyle advice for ITP?
- Avoid contact sport
- Avoid IM injections and procedures such as lumbar puncture
- Avoid NSAIDs, aspirin and other anticoagulants
Name the types of cerebral palsy followed by symptoms and location of lesion
Spastic (70%) - tight and stiff muscles, hypertonia, scissor gait, toe walking - UMN
Dyskinetic (athetoid) - involuntary movements, dystonia, chorea - basal ganglia
Ataxic - shaky, uncoordinated, clumsy - cerebellum
General symptoms of cerebral palsy?
Pain (tight muscles, stiff joints) Sleep disorder Eating difficulties Speech difficulty Learning disability
Causes of jaundice in 1st 24 hours
This is ALWAYS pathological:
- Rhesus haemolytic disease
- ABO haemolytic disease
- Hereditary spherocytosis
- G6PD deficiency
How do blood test/film results differ between Rhesus haemolytic disease, hereditary spherocytosis and G6PD?
- All 3 will have a normocytic anaemia with reticulocytosis and bilirubinaemia
- blood film will show: nucleated RBCs, spherocytes, Heinz bodies/bite cells respectively
- Direct and indirect Coombs strongly positive in Rhesus disease
- Coombs test negative in spherocytosis and G6PD
What are the risks of prolonged and high levels of bilirubin?
Kernicterus - brain damage due to high bilirubin
How does breast milk jaundice occur?
Components of breast milk inhibit ability of liver to process bilirubin
After how long is jaundice considered “prolonged”?
> 14 weeks in full term babies
>21 weeks in premature babies
What are some causes of prolonged jaundice
Biliary atresia
Hypothyroidism
Breast milk jaundice
Prematurity
Speech and hearing milestones: 3 months, 9 months, 12 months, 2 years
- Turns toward sound
- Says mama and dada
- Knows and responds to own name, knows 2-6 words, understands simple commands
- Combines 2 words
At what stage would you refer a child for delay in speech and hearing milestones?
18 months and not knowing 2-6 words
Fine motor and vision milestones: 6 months, 12 months
- Palmar grasp
- Good pincer grip
What symptom in a young child <12 months is abnormal and prompts investigation for cerebral palsy?
Hand preference seen <12 months
Gross motor milestones: 7-8 months, 12 months, 13-15 months, 2 years, 4 years
- Sits unsupported
- Cruising
- Walking unsupported
- Runs
- Hops
Social behaviour and play milestones: 12 months, 18 months, 2 years, 4 years
- Waves bye bye
- Solitary play
- Parallel play
- Associative play
At what age would you expect your child to be shy towards strangers?
9 months
At what age would you refer for delay in gross motor milestones?
18 months still not walking unsupported
Complications of measles?
- Otitis media most common
- Pneumonia most common cause of death
- Encephalitis
Features of measles?
Prodomal phase there is irritability, conjunctivitis, fever.
Koplik spots
Rash behind ears then spreads to whole body
Doses of adrenaline for life support in:
- Adult cardiac arrest
- Adult anaphylaxis
- Adult cardiac arrest
1mg - Adult anaphylaxis 0.5ml 1:1,000 IM
Paediatric compression:ventilation ratio? Rate?
15:2 at 100-120beats/min
Estimated weight calculation for 0-12months?
(0.5*months)+4
Estimated weight calculation for 1-5years?
(2*years)+8
Estimated weight calculation for 6-12years?
(3*years)+7
How many ml/kg of fluid for child in cases of trauma/DKA/cardiac pathology?
10ml/kg of 0.9% saline
How many ml/kg of fluid for child in cases other than trauma/DKA/cardiac pathology?
20ml/kg of 0.9% saline
How to calculate the daily fluid requirements for children?
100ml/kg for first 10kg
50ml/kg for next 10kg
20ml/kg thereafter
Adrenaline dose for anaphylaxis in <6 month old?
0.1-0.15ml 1 in 1000
Adrenaline dose for anaphylaxis in 6 month-6years
0.15ml 1 in 1000
Adrenaline dose for anaphylaxis in 6-12 year old
0.3ml 1 in 1000
Adrenaline dose for anaphylaxis in adults and children >12 years
0.5ml 1 in 1000
Most common cause of meningitis in <3 months?
GBS from mother at birth
Most common cause of meningitis in older children?
Neisseria meningitidis
What is Kernig’s test
Flex a hip and knee to 90. Straighten the knee whilst hip is flexed. Positive test causes neck pain as it stretches the meninges
What is Brudzinski’s test
Flex the patient’s chin to chest. causes an involuntary flexion of hip and knees
Treatment of suspected meningitis in the community?
Stat dose of benzylpenicillin and transfer to hospital
Treatment of meningitis in hospital setting? How does it differ in patients younger and older than 3 months?
Send for blood culture and lumbar puncture. Whilst waiting, administer empirical antibiotics.
< 3 months: cefotaxime + amoxicillin
> 3 months: ceftriaxone
When is lumbar puncture contraindicated in meningitis? Why?
contraindicated if there is meningococcal sepsis due to risk of coning
What pathology has a murmur in the mitral area?
Mitral regurgitation
What pathology has murmur in the tricuspid area?
Tricuspid regurgitation
Which pathology can be best heard in the left lower sternal border?
VSD
Which pathology can be heard in aortic area?
aortic stenosis
Which pathology can be heard in pulmonary area?
pulmonary stenosis
What pathology can be heard at 4th intercostal space on the left sternal border?
hypertrophic obstructive cardiomyopathy
Where can you hear VSD? How does the murmur sound
left lower sternal border, pan-systolic murmur
Where can you hear ASD? How does the murmur sound?
heard at upper left sternal border. Mid-systolic crescendo-decrescendo murmur with fixed split 2nd heard sound
Where can you hear PDA? How does the murmur sound?
heard under left clavicle. Machinery murmur with crescendo-decrescendo
What murmur is heard in Tetralogy of Fallot?
Pulmonary stenosis - ejection systolic heard in pulmonary area
Features of Patau syndrome (Trisomy 13?)
Microcephaly small eyes Cleft lip/palate Polydactyly Scalp lesion
Features of Edward’s syndrome (trisomy 18)?
Micognathia
Low set ears
Rocker bottom feet
Overlapping fingers
What kind of genetic condition is Fragile X?
X linked, trinucleotide repeat of CGG
Features of Fragile X?
Learning difficulty Macrocephaly Large testes Large face Large ears
Features of Noonan syndrome?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Features of Prader-Willi syndrome
Hypotonia
Hypogonadism
Obesity
Which is the most common primary malignant bone tumour?
osteosarcoma
Where does osteosarcoma affect?
metaphyseal region of long bones (femur, tibia, humerus)
What does x-ray of osteosarcoma show?
Sunburst pattern of Codman triangle
Where does Ewing’s sarcoma occur?
pelvis and long bones
What does x-ray of Ewing’s sarcoma show?
onion skin appearance
What is osteochondroma
most common benign bone tumour at the cartilage-capped bony projection on the external surface of bone
What is osteoma
Benign overgrowth of bone most typically occurring on skull
What is the most common organism causing osteomyelitis?
Staph aureus
What causes osteomyelitis in sickle cell patients?
Salmonella
Features of Reyes syndrome?
- Encephalopathy
- Liver failure
Treatment of Reyes syndrome?
Supportive, may require ITU admission
What murmur is heard in transposition of great arteries?
Loud S2
How much weight can a baby lose before considering referral?
Up to 10% weight in 1st week of life
Features of hand foot and mouth disease?
- Vesicles in mouth
- Blistering soles and palms
- Blanching rash
- Fever
Treatment of hand foot and mouth disease?
-Supportive
Difference between conjugated and unconjugated bilirubin?
Conjugated bilirubin is soluble so it appearance on urine. Unconjugated bilirubin has normal urine
Give examples of unconjugated vs conjugated jaundice?
Conjugated: biliary atresia, CF, hepatitis
Unconjugated: G6PD, breast milk jaundice
