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Its the final countdown > Paeds > Flashcards

Paeds Flashcards

1
Q

a prodromal fever + uni/bilateral parotid gland swelling suggests which condition

A

mumps

flu-like Sx occur few days before swelling

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1
Q

what is the tx for mumps

A

Supportive/ Tx complications self limiting condition

Sx last 1 week

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2
Q

mumps may also present with symptoms of compliocations, what are these?

A

Pacreatitis - abdo pain

orchitis - testicluar pain/selling

meningits/ encephalitis

sensorinural hearing loss

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3
Q

what causes mumps

A

RNA paramyoxyvirus

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4
Q

a pt presents with fever, generalised muscle ache and pain on chewing. what PH notifiable disease could be the cause?

A

mumps

fever
malaise, muscular pain
parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

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5
Q

The NICE guidelines on sepsis recommend LP in children with suspected sepsis who are… (x2) :

A
  • <1m w/ fever
  • 1 - 3 m and are unwell or have a low or high WCC
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6
Q

what should be given in community to children with suspected meningitis and a non-blanching rash

A

IM/IV benzylpenicillin (should not delay transfer).

In true penecillin allergy - prioritise transfer

Doses:
* <1 yo – 300mg
* 1-9 yo – 600mg
* >10 yo – 1200mg

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7
Q

what is the Mx in meningitis for

<3m (x2)

> 3m

A
  • <3 m – cefotaxime plus amoxicillin (listeria)
  • > 3 months – ceftriaxone
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8
Q

give a complication of meningitis

A

hearing loss ** key
seizures/epilepsy
cognitive impairment/learning disability
memory loss
focal neurological deficits (limb weakness/spasticity)

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9
Q

what bone is most commonly affected in osteosarcoma

A

femur

others include tibia, humerous

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10
Q

Sx of bone cancer

A

persistent bone pain ( e.g. 4month Hx)

worse at night - may wake them from sleep

bone swelling, & palpable mass

restricted joint movement

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11
Q

A 12-year-old girl presents to her general practitioner with a 4-month history of a dull, aching pain and swelling in the distal aspect of her right thigh. She is otherwise well. What is the most appropriate next step

A

X-ray within 48hrs

Xray in child w/ unexplained bone ain/ swellign due to sarcoma

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12
Q

What does an X-ray of sarcoma show

A

poorly defined leson in bone
destruction of bone
“fluffy appearance”

periosteal reaction (irritation in lining of the bone) - Sunburst appearance

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13
Q

what blood test would indicate osteosarcoma

A

raised ALP

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14
Q

Mx of osteosarcoma

A

surgical resection
often limb amputation

w/ adjuvant chemo

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15
Q

X-rays in osteosarcoma a triangular area of new subperiostal bone ( sunburst appearance) . what is this area known as

A

Codman triangle

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16
Q

Ewing’s sarcoma appearance on x-ray.

A

‘onion skin’ appearance on x-ray.

( also shows EWS-FLI1 protein on fine-needle aspiration of the tumour)

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17
Q

diagnostic criteria for JIA

A

arthritis
without any other cause
lasting > 6 weeks
in a patient < 16yo

18
Q

what are the 5 subtypes of JIA

A
  • Systemic JIA ( stills disease)
  • Polyarticular JIA (arthritis in >/= 5 joints)
  • Oligoarticular JIA
  • Enthesitis related arthritis
  • Juvenile psoriatic arthritis
19
Q

what are the features of stills disease

A
  • Subtle salmon-pink rash
  • High swinging fevers
  • Enlarged lymph nodes
  • Weight loss
  • Joint inflammation and pain
  • Splenomegaly
  • Muscle pain
  • Pleuritis and pericarditis
20
Q

in stills disease ( systemic arthitis), the following bloods ill be …
ANA
RF
CRP
ESR
PLTS
Serum ferritin

A

ANA -ve
RF -ve
CRP raised
ESR raised
PLTS raised
Serum ferritin raised

21
Q

what are the key differentials for children with fevers >5days

A

kawasaki
still’s disease
rheumatic fever
leukaemia

22
Q

what life-threatenign complication may occur in stills disease

A

macrophage activation syndrome ( MAS

severe activation of immunie system, huge inflammatory response

presents: child with DIC, anaemia, thrombocytopenia, bleeding, non-blanching rash

23
Q

what are the features of polyarticular JIA

A

symmetrical arthritis
small joints - hands& feet
large joints - hips & knees
minimal systemic sx - mild: fever, anaemia, reduced groeth

seronegaive (-ve RF) - most children
seropositive - some older pts, more like RA

24
Q

oligoarthritis presentation

A

</= 4 joints
usually a monoarthritis
larger joints ( knee, ankle)
females <6yo

associated with - anterior uveitis (so referral to opthalmologist is required)

RF-ve
ANA +ve

25
Q

what specialty infolvement is needed in Oligoarticular JIA Mx

A

opthalmologists, as this condition linked to anterior uveitis

26
Q

enthesistis- related JIA usually affects what group of people

A

male >6yo

27
Q
A
28
Q

what specialty involvement is needed in enthesitis-related JIA Mx

A

opthalmologists, as this condition linked to anterior uveitis( like oligoarthiritis JIA )

29
Q

Mx JIA

A
  • NSAIDs, such as ibuprofen
  • Steroids oral/IM/ intra-artricular in oligoarthritis
  • DMARDs (methotrexate, sulfasalazine and leflunomide)
  • Biologic therapy (e.g anti-TNF: etanercept, infliximab and adalimumab)
30
Q

describe amblyopia

A

affected eye in strabismus becomes passive, brain ignores signals from this eye –> lazy eye

31
Q

2 types of squint

A

concomitant - imbalance in extraocular muscle control

paralytic squint (rare)- paralysis in at least 1 extra ocular muscle

32
Q

5 causes of squint

A
  1. idiopathic ( healthy children)
  2. Hydrocephalus
  3. Cerebral palsy
  4. SOL ( e.g. retinoblastoma)
  5. Trauma
33
Q

special tests in squints - what is the Hirschberg’s test

A

shine pen-torch 1m from pt, observe light reflection in cornea
normal: central & symmetrical reflection
squint: deviation from centre

34
Q

special tests in strabismus -Cover test. how does it work

A
  • cover 1 eye, ask pt to focus on an object
  • move cover to opposite eye
  • watch previously covered eye
  • the eye will back out of the squint ( If this eye moves inwards, it had drifted outwards when covered (exotropia) )
35
Q

before what age should tx for squint start

A

8, as visual fields still developing

36
Q

Mx in squint

A

occlusive patch on good eye
patch with atropine drops on good eye –> blurs vision

37
Q

a pt with bronchiolitis is admitted into hospital, below what Sats should oxygen be given?

A

<92%

give humidified oxygen
otherwise, mx of bronchiolitis is supportive

38
Q

an 8 month old child presents with tummy pain and intermittent vomiting with yellow contents.

abdominal examination reveals a mass in the upper abdomen

what is the mx?

A

Mx reduction by air insufflation under radiological control
(or surgery in peritonitis)

Dx: intussusception - red currant jelly stool is a late presentation (occurs when the condition has progressed to a point where there is significant bowel obstruction, ischemia and bleeding. )
typical exam - mass in upper abdo

39
Q

1 IM dose of Vit. K is given to newborns because….

A

deficient in Vit K - given to prevent impairment of creation of clotting factors ( Haemorrhagic disease of the new born)

40
Q

risk factors for meconium aspiration

A

delivered post-term (42weeks)
maternal HTN
pre-eclampsia
chorioamnionitis
smoking
substance abuse

It causes respiratory distress, which can be severe.

41
Q

how does the rash in scarlet fever differ to that in measles

A

scarlet fever - (rough) sandpaper rash, 12-48hrs post fever onset, starts on the neck, spreads to the chest and back

measles - blotchy rash which starts on the face and spreads downwards ( flat red spots which merge into larger patches)

42
Q

jejunal biopsy is an investigation used to diagnose coeliac disease. What antibodies can be used in screening

A

anti-endomysial antibodies
anti-gliadin antibodies

43
Q
A

Its the final countdown (23 decks)

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