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Sheff 3a > Paeds 2017 > Flashcards

Paeds 2017 Flashcards

1
Q

Most common vasculitis in children?

A

HSP

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2
Q 
4 years old 
Rash develops around neck and then spreads to limbs and trunk 
Also has a sore throat..
Diagnosis? 
Organism type? 
Natural history and features
A

Scarlet fever
Group A b-haemolytic strep (strep pyogenes)

Prodromal
-Vomiting, sore throat, headache, abdo pain, fever

-> Rash develops after 24-48hrs
Enlarged tonsils
Strawberry tongue
Haemorrhagic spots on palate

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3
Q

Scarlett fever Ix? Mx? Complications ?

A

Ix
Throat swab and culture
Rapid antigen test
FBC

Mx 
Isolation 
Penicillin for 10 days 
Rest, fluids 
Notifiable disease

Complications
Rheumatic fever!
Post strep glomerulonephritis

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4
Q

What is scalded skin syndrome? Who affected? Features? Mx?

A

Staphylococcus toxin
Affects young children

Fever, malaise
Crusting local infection around eyes and mouth
Erythema / peeling

Mx
Admit
IV flucloxacilin
Topical fusidic acid

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5
Q

A newborn who was delivered at 32 weeks after a PROM develops a high fever and floppiness. He has not been feeding and appears to be in respiratory distress. The baby is inconsolable.
Likely organism?

A

Strep. Agalactiae - meningitis

Group B strep

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6
Q 
Bacterial meningitis CSF
Appearance?
Polymorphonuclear cell ratio?
Lymphocyte? 
Protein?
Glucose?
A

Appearance Yellowish, turbid

Polymorphonuclear cell ratio - Markedly increased

Lymphocyte? - Normal / slightly increased

Protein? - Markedly increased

Glucose? - Decreased

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7
Q 
Viral meningitis CSF
Appearance?
Polymorphonuclear cell ratio?
Lymphocyte? 
Protein?
Glucose?
A

Appearance - clear

Polymorphonuclear cell ratio? - Slightly increased / normal

Lymphocyte? - Markedly increased

Protein? - Slightly increased / normal

Glucose? - Normal

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8
Q 
TB meningitis CSF
Appearance?
Polymorphonuclear cell ratio?
Lymphocyte? 
Protein?
Glucose?
A

Appearance? - Yellowish and viscous

Polymorphonuclear cell ratio? - Slightly increased or normal

Lymphocyte? - Markedly increased

Protein? - increased

Glucose? - Decreased

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9
Q 
Fungal meningitis CSF
Appearance?
Polymorphonuclear cell ratio?
Lymphocyte? 
Protein?
Glucose?
A

Appearance? - Yellowish and viscous

Polymorphonuclear cell ratio? - Slightly increased / normal

Lymphocyte? - Markedly increased

Protein? - Slightly increased / normal

Glucose? - Normal / decreased

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10
Q

When are mothers screened for group B strep? What happens if they are positive?
What are the risk of infection?
What can it cause in newborn?

A

3rd trimester - vaginal and anal swabs
-> intrapartum antibiotic prophylaxis

Risks
Preterm labour
PROM >18hrs
Intrapartum fever

Newborn
Sepsis
Meningitis
Stillbirth

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11
Q

Causes of meningitis
Neonate
1-6yrs
>6yrs

A

N - Group B strep, E. coli, listeria monocytogenes

1-6 - N meningitides, S pneumonia, H influenza

Over 6 - N meningitides, S pneumonia

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12
Q

3 stages of whooping cough?

A
  1. Catarrhal Phase- cold like symptoms, lasts 1 week.
  2. Paroxysmal phase- spasmodic cough, lasts 3-6 weeks.
  3. Convalescent phase- symptoms decrease for several months.
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13
Q

A 9 year old girl is brought to the GP by her mother.
She has developed a redness in both her cheeks which will not go away.
She was unwell with a week off school a week ago with a sore throat and fever, but has been well in herself ever since.
Organism?
What should pregnant women who in contact of a case do?

A

Parvovirus B19

Seek medical advice

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14
Q

A 3 year old comes in with Stridor. You make a quick clinical diagnosis of Croup. The child is very distressed and sats are at 92%. You give the child oxygen, but what are you going to give to treat the child?
The child is too distressed to take oral medication.

What scoring system can be used for croup?

A

Nebulised Budesonide and adrenaline

Modified Wesley scoring system for croup
Score of 1-17
>6 = severe croup

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15
Q

Abx in epiglottis?

A

IV ceftriaxone

Call anaesthetist to secure airway

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16
Q

Cause of mumps?

Complications?

A

Paramyxovirus

Orchitis - 25% of post pubertal men 
Meningitis
Encephalitis 
Pancreatitis 
Deafness (rare) 
Spontaneous abortion of pregnancy
17
Q

Congenital vs non congenital presentation of rubella?

A

Congenital - Cataracts, deafness, cardiac defects

Non congenital - macular rash beginning behind ears and spreading to the trunk

18
Q

Ix and Mx in rubella

A

Ix
Serology / PCR
FBC - low WCC

Mx
Keep from school until 4 days after rash clears
Sx management

19
Q

A 3m old boy who has Cystic fibrosis is approaching November. He needs to be immunised to prevent more serious complications from common infections in children his age at this time.
What vaccine should he receive? What illness is this to protect from ?

A

Palivizumab - RSV

Bronchiolitis

20
Q

When would you admit with bronchiolitis

A

Poor feeding <50% as this is inadequate to maintain hydration

Lethargy 
Apnea 
RR>70 
Severe chest wall recession
Cyanosis
Nasal flaring or grunting
Sats <94%
Uncertainty regarding diagnosis
21
Q

Which virus causes measles ?

Lab diagnosis? Given to close contacts?

A

Paramyxovirus

IgM for measles in saliva

Post exposure prophylaxis

22
Q

A baby presents with a gold crusty plaque on his hand.
It began with small vesicles after he had a small graze here.
His axillary lymph nodes are enlarged.
What is this condition?
Usual cause?
RF?

A

Impetigo
Staph aureus / strep pyogenes

Eczema
Poor hygiene
Minor trauma

23
Q

2 types of presentation of impetigo ?

A

Non bullous
1 - Erythermatous Macules
2 - Vesicles / pustules
3 - Honey crusted plaque

Bullous
Occur on face, trunk, extremities, perineum
-Associated with eczema
Systemic malaise

24
Q

A 1 year old boy develops a rash which begins with papules, then becomes vesicular then pustular then crusty.
1 week later he then has a regression of development, and no longer is attempting to stand and walk. He is drowsy, irritable and no longer orientating to the same stimuli he used to.
What has occurred?

A

Encephalitis - Varicella zoster

25
Q

Which medication do you avoid with chicken pox?

What can you give in severe / immunocompromised?

A

NSAIDS - risk of necrotising disease

-Acyclovir

26
Q

Basically what happens in Reyes? Brain sx?

A

Asprin + viral illness causes liver damage and encephalopathy

Causes dearth of heaptocytes -> Ammonia gets into blood -> passes through blood brain barrier

Quiet, sleepy vomiting, seizures, altered mental state -> Coma -> Death

27
Q

Reyes Ix? Mx?

A

Bloods - Rasied ammonia, raised tansaminases
Increased PT time
Hypo/hyperglycaemia

Mx
Monitoring
Supportive
Manage brain swelling - Mannitol

28
Q

Baby born at 32 weeks gestation following prolonged rupture of membranes. Mother has a fever (38.7°C) during delivery.
8 hours after birth, the baby seems to be having trouble breathing.
In the second day after birth the child is alternately lethargic and irritable and refuses to feed.
The child’s temperature is variable and has reached 39.3°C.
Diagnosis?
Ix?
Mx?

A

Neonatal sepsis [Maternal fever, PROM, premature]
Probably group B strep

Septic screen - LP, cultures, CRP, FBC, CXR

IV Abx / Fluids

29
Q

Mx of RDS

A

Surfactant

Oxygen via NC CPAP

30
Q

Common early complication of RDS? Ix? Mx?

A

Pneumothorax

Trans-illumination of the chest
2- X-ray

Mx
Oxygen
±Chest drain

31
Q

What common complication in pneumothorax babies? Area affected?
Two types?
Ix?
Mx?

A

Brain injury - germinal matrix

Intraventricular haemorrhage, paraventricular haemorrhage

Transcranial USS
LP

VP shunt

32
Q

Two more serious DDx of croup ?

A

Pseudomembranous croup (bacterial tracheitis)

Acute epiglottis

33
Q

Usual cause of psuedomembranous croup? Features? Mx?

A

S aureus
High fever / toxic child
Airway secretions -> rapid obstruction

Secure airway
IV cefotaxime + clindamycin

34
Q 
Features of CF 
Diagnosis as new born? 
Infant features? 
Child features?
Adolescent features?
A

Guthrie test

Infancy
Meconium ileus
Prolonged neonatal jaundice
Failure to thrive
Recurrent chest infections
Malabsorption and steatorrhoea

Child
Bronchiectasis
Sinusitis

Adolescents
Allergic bronchopulmonary aspergillosis
Diabetes mellitus
Cirrhosis and portal HTN
Distal intestinal obstruction syndrome
Sterility in males
35
Q

Mx of CF

A

Review annually
Resp:

Older children – spirometry, FEV1 indicates severity
Physiotherapy 2x daily
Airway clearing
Abx Prophylaxis: Oral flucloxacillin, nebulised Ciprofloxacin for Pseudomonas
Bilateral lung transplant in end stage

Nutrition:
Pancreatic replacement
High calorie diet
Fat soluble vitamin supplements

36
Q 
Vaccination schedule 
What’s in 6 in 1? When?
Rotavirus?
Pneumococcal?”
Men B?
Hib and Men C?
MMR?
Parts of 4-in1? When?
A

6-in-1: Diphtheria, Tetanus, Whooping Cough, Polio, Hib, Hepatitis B.
8, 12 and 16 weeks

Rotavirus
8 and 12 weeks

Pneumococcal
8 and 16 weeks

Meningitis B
8 and 16 weeks then at 1 year

Hib and Meningitis C
1 year of age

MMR
1 year and 3 years 4 months

4-in-1: Diphtheria, Tetanus, Whooping cough, Polio
3 years and 4 months

37
Q

What s in 3-in-1 teenage booster?? When?

A

3-in-1 teenage booster
Given at 14 years
Diphtheria, Tetanus and Polio

38
Q

When do you get Men ACWY? Chicken pox? HPV? Tb? Flu?

A

Men ACWY
14 year olds and freshers

Chickenpox
If risk of transmitting to immunocompromised sibling

HPV
at 14 if you’re a lady

Tb for at risk babies / travel

Flu - At risk

Sheff 3a (30 decks)

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