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Rabiah's 3a > Paeds > Flashcards

Paeds Flashcards

1
Q

Bac Meningitis Ix and Tx for children?

Different for < 3 and > 3 months

A

Stat IM benpen if in community

Blood cultures, LP, meningococcal PCR

If in hospital:
< 3 months old = IV cefotaximine + IV amox

> 3 months old = IV ceftriaxone (+ poss dexamethasone)

Inform public health

Single dose ciprofloxacin as post-exposure prophylaxis

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2
Q

Encephalitis Ix and tx

A

1) LP to send CSF for PCR testing
CT if LP contraindicated (active seizures, hemodynamically unstable)
2) MRI
HIV testing for all

Aciclovir for herpes and VZV
Ganciclovir for CMV
Repeat LP to ensure successful tx before antivirals are stopped

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3
Q

What type of rash with toxic shock syndrome

A

Diffuse, erythematous macular rash

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4
Q

What causes Scarlet Fever

A

Strep. Pyogenes (group A haemolytic streptococci)

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5
Q

Scarlet fever tx

A

Oral benpen for 10 days
Notify public health

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6
Q

Haemolytic uraemic syndrome triad

A

AKI, normocytic anaemia, thrombocytopenia

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7
Q

Whooping cough Ix

A

Nasal-pharyngeal swab with pertussis

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8
Q

Whooping cough Tx

A

Macrolide e.g. clarithro for 2 weeks
Prophylactic abx to close contacts
Isolation for 21 days after symptom onset or 5 days after abx
Report to PHE

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9
Q

Whooping cough organism

A

Bordetella Pertussis (gram -ve bacillus)

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10
Q

Hirschsprung’s diagnostic Ix

A

GOLD = rectal suction bopsy testing for ganglionic cells

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11
Q

Kallman’s syndrome’s pathophysiology and mode of inheritence

A

Failure of GnRH-secreting neurons to migrate to hypothalamus

X-linked recessive

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12
Q

Kallman’s syndrome pres

A
  • Delayed puberty
  • Lack of smell (anosmia) - mann you can’t smell
  • Low testo, LH, FSH (all of them)
  • Clef lip/palate
  • Visual/ hearing defects
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13
Q

Kallman’s tx

A

Testo or gonadotrophin supplementation

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14
Q

Congen Adrenal Hyperplasia pathophysiology and mode of inheritance

A

21-hydroxylase def causing underproduction of aldosterone and cortisol, and prog gets turned into testo = overproduction of testo

Autosomal recessive

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15
Q

CAH pres

A
  • Females with virilized genitalia
  • Low Na, K, hypoglycaemia
  • Poor feeding, vomiting, dehydration
  • Arrhthmias
  • Hyperpigmentation
  • Females = tall, facial hair, absent periods, deep voice, early puberty
  • Males = tall, deep voice, early puberty, large penis, small testicles
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16
Q

CAH tx

A
  • Coristol replacement (hydrocortisone)
  • Aldosterone replacement (fludrocortisone)
  • Surgery if needed
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17
Q

Distinguishing between CAH and PCOS?

A

17-hydroxyprog levels

normal = PCOS
high = CAH (bc lack of 21-hydroxylase, so prog isn’t getting used up as much)

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18
Q

Androgen insensitivity syndrome mode of inheritance

A

x-linked recessive

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19
Q

Androgen Insensitivity syndrome pres

A

Extra androgens get turned into oestrogen (basc opposite of CAH right, bc then the prog gets turned into testo, here its going to oestrogen)

Genetically male (46XY), but with external female phenotype (genitalia, breasts) but no internal uterus, tubes, ovaries, etc.

Testes present in inguinal canal or abdo, producing Anti-mullerian hormone as usual

Lack of pubic, facial hair
Lack of muscles
Taller than average
Infertile
Often present in infancy with inguinal hernias containing testes, or primary amenorrhoea

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20
Q

Androgen insensitivity syndrome increases risk of what cancer

A

Testicular (therefore, remove testes - bilateral orchidectomy)

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21
Q

Neuroblastoma pathophysiology

A

tumour arising from neural crest tissue in adrenal medulla and sympathetic nervous system

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22
Q

Neuroblastoma pres

A

< 5 years old

  • Abd mass
  • Pallor, weight loss
  • Hepatomegaly
  • Bone pain, limp
  • Cervical lymphadenopathy
  • Periorbital bruising
  • Skin nodules
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23
Q

neuroblastoma ix

A
  • RAISED urinary catecholamine levels
  • biopsy
  • bone marrow sampling
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24
Q

Wilm’s tumour pres and Ix

A

Most common renal tumour <5 years old

  • LARGE ABD MASS found incidentally in a well child
  • 1st Ix = US
  • Gold = biopsy/ histology
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25
Q

Osteosarcoma area

A

Metaphyseal region of long bones prior to epiphyseal closure

radiographs show Codman triange (area of new subperiosteol bone) with sunburst appearance

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26
Q

Ewings Ix

A

Xray showing onion skin appearance

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27
Q

Osteosarcoma associated with hx of?

A

Retinoblastoma

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28
Q

What indicates if a retinoblastoma is hereditary?

A

If it is bilateral - it is autosomal dominant (chromosome 13)

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29
Q

Retinoblastoma key pres

A

White pupillary reflex (leukocoria) replaces red one
Squint

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30
Q

Key blood test finding suggesting hepatoblastoma

A

Raised a-fetoprotein

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31
Q

Osteogenesis imperfecta pathophysiology and mode of inheritance

A

Autosomal dominant

Genetic mutation affecting the formation of collagen, resulting in brittle bones susceptible to fractures

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32
Q

Osteogenesis imperfecta pres

A
  • Recurrent, inappropriate fractures
  • Hypermobility
  • Triangular face
  • Easy bruising
  • Grey/blue sclera
  • Deafness from early adulthood
  • Dental problems
  • Barrel shaped rib cage
  • Short/ skinny
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33
Q

Osteogenesis imperfecta tx

A

Bisphosphonates, vit D supplementation, physio

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34
Q

What level of 25-hydroxyvit D establishes diagnosis of rickets

A

<25 nmol/L

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35
Q

rickets pres

A
  • bowing of legs (legs curving outwards) in toddlers
  • knock knees in older
  • rachitic rosary (ends of ribs expand causing lumps on chest)
  • craniotabes (soft skull, delayed closure of sutures)
  • kyphoscoliosis
  • harrison’s sulcus
  • delayed teeth
  • widening of joints
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36
Q

prevention and tx of rickets

A

prevent - 400 IU vit D supplements
tx - ergocalciferol (vit D) + calcium supplements

37
Q

THC IS SO GOOD

A

0-5 = Toddler’s fracture, Haemophilia A (hemoarthrisis), Congenital hip dysplasia

5-10 = Idiopathic femoral head (Perthe’s), transient Synovitis

10-15 = Slipped upper femoral epiphysis, OsGOOD shlatters

38
Q

Typical RF for osteomyelitis

A

males < 10 yrs
open bone fractures
orthopaedic surgery
immunocomprised
sickle cell anaemia
HIV
TB

39
Q

osteomyelitis vs septic arthritis: infections of…?

A

osteomyelitis = infection of bone

septic arthritis = infection of cartilage and synovial fluid

40
Q

causes of septic arthritis:

most common?

in sexually active teenagers?

other cause?

A

staph aureus

neisseria gonorrhoea

group A strep (pyogenes)

41
Q

causes of osteomyelitis:

most common?

patients with sickle cell?

A

staph aureus

salmonella

42
Q

perthe’s ix

A

xray (poss normal)
blood tests, inflam markers
technetium bone scan

43
Q

perthe’s pathophysiology

A

disruption of blood flow to epiphysis of femur (head) causing avascular necrosis

44
Q

slipped upper femoral epiphysis typical RF

A

obese, adolescent male undergoing growth spurt

45
Q

slipped upper femoral epiphysis sign

A

wanting to keep hip in external rotation, with restricted internal rotation

46
Q

transient synovitis typical onset

A

after a viral URTI

47
Q

DDH RF

A
  • fhx
  • breech pres 36 weeks onwards
  • high birth weight
  • oligohydramnios
  • female
  • multiple preg
48
Q

DDH tx

A

pavlik harness if baby < 6 months, kept on permanently

surgery if > 6 months

49
Q

Barlow’s test

A

attempts to dislocate articulated femoral head (like a wheelbarrow, aggressive, dislocating)

50
Q

Ortolani test

A

attempts to relocate dislocated femoral head

51
Q

JIA diagnosis made when

A

arthritis without any other cause for > 6 weeks in pts < 16 yrs

52
Q

JIA pres

A
  • salmon-pink rash
  • high swinging fever
  • enlarged lymph nodes
  • weight loss
  • joint pain and inflam
  • splenomegaly
  • muscle pain
53
Q

polyarticular vs oligoarticular JIA

A

poly = 5 joints or more
oligo = 4 joints or less

54
Q

what is the most common JIA and what are the classic features

A

oligoarticular JIA

  • girls < 6 yrs
  • larger joints affected (knees, ankles, elbows)
  • anterior uveitis (refer to optho)
55
Q

how does enthesitis related arthritis present

A

male children > 6 yrs
HLA-B27 gene
possible signs of psioriasis or IBD

56
Q

Absence seizure tx

A

1st = ethosuximide
2nd = male - sodium val, female - lamotrigine or levetiracetam

avoid carbamazepine

57
Q

myoclonic seizures tx

A

males - sodium val
females - levetiracetam

58
Q

tonic or atonic seizures

A

males - sodium val
females - lamotrigine

59
Q

seizures ix

A

always refer for specialist review before any drugs
1st EEG
2nd MRI

60
Q

Acute lympho leukaemia blood tests + corresponding pres

A
  • anaemia (lethargy, pallor)
  • neutropenia (frequent or severe infections)
  • thrombocytopenia (easy bruising, petechiae)
61
Q

how do these types of cerebral palsy pres:

  • spastic
  • dyskinetic
  • ataxic
A

spastic - increased tone, either hemi, di or quadriplegia

dyskinetic - oro-motor (drooling, trouble feeding) + athetoid movements (slow writhing movements of hand and feet)

ataxic - cerebellar signs

62
Q

3-5 yrs old child
non-blanching purpuric rash on legs + buttocks
abd or joint pain

A

IgA small cell vasculitis - HSP

63
Q

Croup organism

A

Parainfluenza virus

64
Q

Croup tx

A

single dose dexamethasone 0.15mg/kg immediately regardless of severity

+ nebulised adrenaline

65
Q

croup most common complication

A

otitis media

66
Q

bronchiolitis prophylaxis

A

palvizumab monthly vaccine

67
Q

what can happen after taking amoxicillin

A

morbilliform eruption - a drug-induced generalized maculopap rash

68
Q

Asthma >5yrs management (7 steps)

A

1: SABA PRN - Salbutamol
2: Add LOW DOSE (<200mg) ICS Preventer therapy – Budesonide, Beclomethasone
3: Add LTRA - Montelukast
4: Remove LTRA, Add LABA - Salmeterol
5: Switch ICS/LABA for ICS MART: Formoterol and ICS
6: Add a separate LABA
7: High dose ICS (>400mcg), referral

69
Q

Asthma <5yrs management (4 steps)

A

1: SABA PRN - Salbutamol
2: SABA + 8 week trial of MODERATE DOSE (200-400mg) ICS, after stopping, if symptoms reoccur within 4 weeks, restart ICS as low-dose maintenance therapy
3: SABA + low dose ICS + LTRA
4: Stop LTRA and refer to specialist

70
Q

saba via spacer dose

A

up to 10 puffs every 4 hrs

71
Q

newborn resus steps

A
  • dry / wrap, stimulate, keep warm
  • assess colour, tone, breathing, HR
  • ensure open airway
  • if not breathing - 5 inflations
  • re-assess
  • consider CPAP, head/jaw position, suction, etc
  • if HR not detected, 3:1 compressions to ventilation
    Increase o2 to 100%
  • Consider intubation
  • Re-assess every 30 seconds
  • Vascular access and drugs
72
Q

resp distress syndrome typical pres

A

premature baby
diabetic mother

73
Q

What signs are seen in transient tachy of newborn and what is a RF

A

hyperinflation lungs
fluid in horizontal fissure
c section is a RF

74
Q

CF pres

A

chronic cough
thick sputum
steatorrhoea
abd pain + bloating
salty tasting
failure to thrive
nasal polyps
clubbing
crackles and wheezes
congenital bilateral absence of vas deferens (male infertility)
meconium ileus

75
Q

CF ix

A
  • screened day 5-9 after birth with newborn bloodspot test showing raised IRT
  • gold = sweat test >60mmol/L
  • genetic test CFTR gene via amniocentesis during preg
76
Q

CF tx if homozygous for delta F508 mutation

A

lumacaftor / lycaftor (orkambi)

77
Q

APGAR score includes

A

Appearance (colour)
Pulse (HR)
Grimace (reflex irritability)
Activity (tone)
Respiration

78
Q

what does TORCH stand for

A

Toxoplasma gondii
Other (treponema pallidum, VZV, parvovirus B19, HIV)
Rubella
CMV
HSv

79
Q

how could rubella in a mother and infant pres

A

lympadenopathy
polyarthritis
rashes

congenital rubella syndrome = deafness, clouding of eyes (cataracts), loss of bilateral fundal reflexes, rash, heart defects

79
Q

Congenital CMV pres

A

Can’t hear
Microcephaly
(CMV)
chorioretinitis
seizures
intracranial calcifications

80
Q

GORD tx

A

1-2 weeks alginate therapy (Gaviscon), reduce vol feeds/ more frequent

If 1-2 yrs old with persistent heartburn/ pain - 4 week trial PPI or H2RA

81
Q

appendicitis pres

A

murphy’s triad - low grade fever, nausea/vomiting, RIF pain

pain worse on coughing, can’t hop onto right leg due to pain

Rovsing’s sign - palpation of LIF causes pain in RIF

tenderness at McBurney’s point on palpation

82
Q

appendicitis ix

A

1st US
gold CT

83
Q

meckel’s diverticulum pres + ix

A

RLQ pain
rectal bleeding
1-2 yrs old
obstruction due to intussusception + volvulus

technetium scan

84
Q

what are the four Fs of toddler diarrhoea

A

Fat (give them a higher fat diet)
Fluid (avoid excessive)
Fruit juices (limit, fructose absorption is poor in children)
Fibre (increase)

85
Q

jaundice ix in newborns

A

Transcutaneous bilirubinometry if >35 weeks gest + baby is >24 hrs

86
Q

what is kernicterus + how is it treated

A

bilirubin induced encephalopathy and irreversible neurological damage: > 360umol/L

risk of cerebal palsy, etc.

tx = exchange transfusion

87
Q

Neonatal hypoglycaemia cut off

A

<2.6mmol/L

88
Q

if very hypo, e.g. <1mmol/L, how do you treat

A

admit to neonatal unit and give IV 10% dextrose regardless of if symptomatic or not

Rabiah's 3a (4 decks)

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