Paeds Flashcards
a prodromal fever + uni/bilateral parotid gland swelling suggests which condition
mumps
flu-like Sx occur few days before swelling
what is the tx for mumps
Supportive/ Tx complications self limiting condition
Sx last 1 week
mumps may also present with symptoms of compliocations, what are these?
Pacreatitis - abdo pain
orchitis - testicluar pain/selling
meningits/ encephalitis
sensorinural hearing loss
what causes mumps
RNA paramyoxyvirus
a pt presents with fever, generalised muscle ache and pain on chewing. what PH notifiable disease could be the cause?
mumps
fever
malaise, muscular pain
parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
The NICE guidelines on sepsis recommend LP in children with suspected sepsis who are… (x2) :
- <1m w/ fever
- 1 - 3 m and are unwell or have a low or high WCC
what should be given in community to children with suspected meningitis and a non-blanching rash
IM/IV benzylpenicillin (should not delay transfer).
In true penecillin allergy - prioritise transfer
Doses:
* <1 yo – 300mg
* 1-9 yo – 600mg
* >10 yo – 1200mg
what is the Mx in meningitis for
<3m (x2)
> 3m
- <3 m – cefotaxime plus amoxicillin (listeria)
- > 3 months – ceftriaxone
give a complication of meningitis
hearing loss ** key
seizures/epilepsy
cognitive impairment/learning disability
memory loss
focal neurological deficits (limb weakness/spasticity)
what bone is most commonly affected in osteosarcoma
femur
others include tibia, humerous
Sx of bone cancer
persistent bone pain ( e.g. 4month Hx)
worse at night - may wake them from sleep
bone swelling, & palpable mass
restricted joint movement
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
X-ray within 48hrs
Xray in child w/ unexplained bone ain/ swellign due to sarcoma
What does an X-ray of sarcoma show
poorly defined leson in bone
destruction of bone
“fluffy appearance”
periosteal reaction (irritation in lining of the bone) - Sunburst appearance
what blood test would indicate osteosarcoma
raised ALP
Mx of osteosarcoma
surgical resection
often limb amputation
w/ adjuvant chemo
X-rays in osteosarcoma a triangular area of new subperiostal bone ( sunburst appearance) . what is this area known as
Codman triangle
Ewing’s sarcoma appearance on x-ray.
‘onion skin’ appearance on x-ray.
( also shows EWS-FLI1 protein on fine-needle aspiration of the tumour)
diagnostic criteria for JIA
arthritis
without any other cause
lasting > 6 weeks
in a patient < 16yo
what are the 5 subtypes of JIA
- Systemic JIA ( stills disease)
- Polyarticular JIA (arthritis in >/= 5 joints)
- Oligoarticular JIA
- Enthesitis related arthritis
- Juvenile psoriatic arthritis
what are the features of stills disease
- Subtle salmon-pink rash
- High swinging fevers
- Enlarged lymph nodes
- Weight loss
- Joint inflammation and pain
- Splenomegaly
- Muscle pain
- Pleuritis and pericarditis
in stills disease ( systemic arthitis), the following bloods ill be …
ANA
RF
CRP
ESR
PLTS
Serum ferritin
ANA -ve
RF -ve
CRP raised
ESR raised
PLTS raised
Serum ferritin raised
what are the key differentials for children with fevers >5days
kawasaki
still’s disease
rheumatic fever
leukaemia
what life-threatenign complication may occur in stills disease
macrophage activation syndrome ( MAS
severe activation of immunie system, huge inflammatory response
presents: child with DIC, anaemia, thrombocytopenia, bleeding, non-blanching rash
what are the features of polyarticular JIA
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
oligoarthritis presentation
</= 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
what specialty infolvement is needed in Oligoarticular JIA Mx
opthalmologists, as this condition linked to anterior uveitis
enthesistis- related JIA usually affects what group of people
male >6yo
what specialty involvement is needed in enthesitis-related JIA Mx
opthalmologists, as this condition linked to anterior uveitis( like oligoarthiritis JIA )
Mx JIA
- 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)
describe amblyopia
affected eye in strabismus becomes passive, brain ignores signals from this eye –> lazy eye
2 types of squint
concomitant - imbalance in extraocular muscle control
paralytic squint (rare)- paralysis in at least 1 extra ocular muscle
5 causes of squint
- idiopathic ( healthy children)
- Hydrocephalus
- Cerebral palsy
- SOL ( e.g. retinoblastoma)
- Trauma
special tests in squints - what is the Hirschberg’s test
shine pen-torch 1m from pt, observe light reflection in cornea
normal: central & symmetrical reflection
squint: deviation from centre
special tests in strabismus -Cover test. how does it work
- 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) )
before what age should tx for squint start
8, as visual fields still developing
Mx in squint
occlusive patch on good eye
patch with atropine drops on good eye –> blurs vision
a pt with bronchiolitis is admitted into hospital, below what Sats should oxygen be given?
<92%
give humidified oxygen
otherwise, mx of bronchiolitis is supportive
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?
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
1 IM dose of Vit. K is given to newborns because….
deficient in Vit K - given to prevent impairment of creation of clotting factors ( Haemorrhagic disease of the new born)
risk factors for meconium aspiration
delivered post-term (42weeks)
maternal HTN
pre-eclampsia
chorioamnionitis
smoking
substance abuse
It causes respiratory distress, which can be severe.
how does the rash in scarlet fever differ to that in measles
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)
jejunal biopsy is an investigation used to diagnose coeliac disease. What antibodies can be used in screening
anti-endomysial antibodies
anti-gliadin antibodies
