Paeds 5 Flashcards
What factor may be deficient in von Willebrand disease?
Factor VIII
vWF binds to factor VIII and stops Factor VIII from degrading. Reduced vWF is therefore associated with low FVIII levels as gets degraded degrades.
What is the most common organism causing impetigo?
Both staphylococcus aureus and streptococcus cause impetigo, but Staph. aureus is more common
Describe rash in chickenpox
Itchy rash that starts centrally (face, scalp or torso).
The rash starts as a macular rash before quickly developing into vesicular lesions which later scab over and heal.
What genetic syndrome presents with:
- webbed neck
- pectus excavatum
- short stature
- pulmonary stenosis
Noonan syndrome
Karyotype for noonan syndrome?
Normal (46,XX or 46,XY)
What is the investigation of choice for stable children with suspected Meckel’s diverticulum?
A technetium scan
What are some poor prognostic factors for ALL?
1) Male sex
2) <2y or >10y presenting age
3) Having B or T cell surface markers
4) WCC >20 at diagnosis
What investigation is considered most appropriate to confirm the diagnosis of Duchenne’s?
Genetic testing
Dose of dex in croup?
0.15mg/kilo
What damaged in spastic cerebral palsy?
UMNs in periventricular white matter
Mx of phimosis (a non-retractable foreskin) if <2y?
In children less than 2 years of age, phimosis is NORMAL and will most likely resolve with time
What are some causes of obesity in children?
1) GH deficiency
2) Hypothyroidism
3) Down’s syndrome
4) Cushing’s syndrome
5) Prader-Willi syndrome
What are some risk factors for surfactant deficit lung disease?
- prematurity
- male sex
- diabetic mothers
- Caesarean section
- second born of premature twins
What is the cause of Fragile X syndrome?
Trinucleotide repeat –> expansion of CGG trinucleotide repeat in FMR1 gene.
What diagnosis should be considered in a croup-like presentation that does NOT respond to dexamethasone & nebulised adrenaline?
Bacterial tracheitis
What is bacterial tracheitis?
A potentially life-threatening condition characterised by rapidly progressing airway obstruction and abundant, thick airway secretions, alongside high fever.
It generally follows a viral URTI.
What is bacterial tracheitis most commonly caused by?
Staph. aureus
Key signs & symptoms of bacterial tracheitis?
- stridor
- barking cough
- high fever
- SOB
Mx of bacterial tracheitis?
Abx therapy
Conduct disorder vs oppositional defiant disorder?
Conduct - young people presenting with antisocial behaviours e.g. stealing, physically harming people or animals, setting fires.
Oppositional defiant - less severe version of conduct disorder, present with difficult behaviours e.g. refusing to follow rules and consistently blaming others.
What is the underlying genetic defect in Fragile X?
Trinucleotide repeat in the FMR1 gene
What test can be done in DDH to determine whether the leg length shortening is femoral or tibial?
Galeazzi test
what is the biggest risk factor for stillbirth?
IUGR
Why can an AXR be normal in intestinal malrotation?
If it is an intermittent or partial volvulus –> does not cause dilated bowel loops or dilated stomach.
Mx of intestinal malrotation?
Urgent laparotomy
Which consequence of artificial ventilation in premature babies is routinely screened for?
Retinopathy of prematurity
1st line mx of impetigo?
Hydrogen peroxide 1% cream
Consider adding topical Abx e.g. fusidic acid (or mupirocin if fusidic acid resistance is suspected)
Mx of EXTENSIVE impetigo?
Oral flucloxacillin
School exclusion in impetigo?
Children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing Abx treatment
Which organism causing osteomyelitis are patients with sickle cell at risk of?
Salmonella typhi
In ALL, ‘sanctuary sites’ exist.
What are these?
Parts of the body which the chemotherapy will not reach, and therefore would have to be monitored for relapse.
1) Testes
2) CNS
Role of penicillamine?
Copper chelating agent in Wilson’s
What is there a deficiency of in haemophilia A?
Factor VIII
What is there a deficiency of in haemophilia B?
Factor IX
What investigation can be used to monitor treatment response in Hodgkin lymphoma?
PET scan
Mx of PID if the patient has a coil that was recently inserted (<48h)?
Treat with broad spectrum Abx for 14 days and leave the coil in.
If there is no response wthin 48h to the Abx, remove the coil and prescribe any other necessary emergency contraceptives (if appropriate).
Which class is safe to use for UTIs in any stage of pregnancy?
Cephalosporins
Give some causes of a raised Ca125
- ovarian cancer
- ascites
- adenomyosis
- endometriosis
- menstruation
- breast cancer
- ovarian torsion
- endometrial cancer
- liver disease
What can be offered in endometriosis if the COCP is contraindicated?
Progesterone only contraceptive e.g. pill, implant IUS
Investigations in UTI in infant <6m?
Typical UTI –> US only (within 6w of infection)
Atypical –> US (during infection), MCUG & DMSA
Recurrent –> US, MCUG & DMSA
Investigations in UTI in child 6m - 3y?
Typical –> none
Atypical –> US (during infection), DMSA
Recurrent –> US (within 6w), DMSA
Investigations in UTI in child ≥3y?
Typical –> none
Atypical –> US (during)
Recurrent –> DMSA & US (within 6w)
Give some features of an atypical UTI in paeds
- septicaemia/requires IV Abx
- non E. coli UTI
- poor urine flow
- abdominal mass/bladder mass
- raised creatinine
- failure to respond to treatment (suitable Abx) in 48h
Define recurrent UTIs in paeds
2 or more UTIs, with at least 1 with systemic symptoms or signs
or
3 or more UTIs without systemic symptoms or signs
Mx of periumbilical cellulitis?
IV flucloxacillin + benzylpenicillin
