Paeds Flashcards
1
Q
When are heart defects usually picked up?
A
USS at 20 weeks -> fetal echo
2
Q
Features of a L->R shunt? Common defects? Causes?
A
Breathless / aSx
VSD, PDA, ASD
Maternal Rubella, SLE, diabetes
Warfarin
Downs, Edwards, Patau, turners
3
Q
Features of a R->L shunt ? Usual cause?
A
Cyanotic blue child
Tetralogy of fallot, transposition of the great arteries
4
Q
Fetal circulation ?
Circulation after birth ?
A
Fetal - Low pressure in LA as little blood return from lung
-High pressure in RA as all systemic and placental venous return
-foramen ovale (between atria) and Ductus arteriosus (between Pulm artery and aorta to bypass lungs)
Blood flows R->L
Birth - Breath increases pulmonary blood flow -> increase LA pressure
- No placenta -> decrease RA pressure
- pressure LA>RA so foramen ovale closes
First few days of life - ductus arteriosus closes
5
Q
Most common DD for well baby with a systolic murmur at upper left eternal edge? What to remember?
A
Innocent/physiological murmur
4 Ss
Soft, systolic murmur only, left Sternal edge, aSx
6
Q
well baby with a ejection systolic murmur at upper left sternal edge? Probable cause of this defect? What else to remember?
A
Probably ASD (get increased flow over the pulmonary valve)
Usually due to foramen ovale failing to close
Risk of recurrent chest infections
7
Q
well baby with loud pan systolic murmur ? Prognosis? How would this change if it was a larger defect? Was do you use to judge size? What is risk with large defect? What else would you do with a large defect?
A
VSD (louder = smaller) - tend to spontaneously close
Large VSD -> more Sx Eg breathlessness, failure to thrive
Size of VSD judged in relation to aortic valve
Give surgery 3-6 months to prevent pulmonary hypertension
Eisenmenger’s syndrome
8
Q
What is Eisenmenger’s syndrome?
A
Long standing L->R shunt caused by CHD causes pulmonary hypertension and swap to R->L shunt -> Cyanosis
9
Q
Associations with PDA? Murmur? Mx?
A
Prematurity
Continuous murmur beneath L clavicle
Collapsing and bounding pulse
Closure with coil at 1yr to prevent pulmonary HTN (Eisenmenger’s)
10
Q
Blue pale, irritable, breathless baby
DDx
A
Tetralogy
TGA
AVSD
11
Q
4 Parts of tetralogy of fallot? Seen on X-ray? Mx?
A
Large VSD, overriding aorta, pulmonary stenosis, RV hypertrophy
X-ray - boot shaped heart (due to RVH)
Prostaglandins to keep defect open until surgery at 6/12
12
Q
What happens in TGA? When does it classically present? Associations? Seen on X-ray ? Mx?
A
Aorta connected to RV, Pulm artery to LV
Presents day 2 when ductus arteriosus closes
VSD, ASD, PDA
‘Egg on side’ cardiac shadow
PG to keep defect open until definitive surgery as a neonate
13
Q
AVSD presentation? Associated with which condition?
A
Mixing of blood so blue and breathless
Cyanotic at birth / HF at 2-3 weeks
Downs
14
Q
What can be used to help close defects in hearts ?
A
Prostaglandin inhibitors Eg IV indomethacin / ibuprofen
15
Q
Murmur in AS?
Murmur in PS?
A
AS- LVH, ejection systolic murmur at upper RIGHT sternal edge
PS - RVH, ejection systolic murmur at upper LEFT sternal edge
16
Q
Seen in coarctation of Aorta / hypoplastic left heart syndome?
A
Circulatory collapse at 2 days old
Absent femoral pulses
17
Q
3 year old brought into A&E Difficulty breathing, barking cough, mild intercostal recessions 1- DDx 2- Likely 3- Cause 4- Usual age affected 5- 4 Sx 6- Mx 7- Mx in low o2 sats
A
1 - Croup, asthma, bronciolotis, pneumonia, URTI, acute epiglottis is, Foreign body
2- Croup (Laryngotracheobronchitis)
3- Parainfluenza
4- 6month- 6yr
5- Barking cough, strider, fever, coryzal Sx
6- single dose Dexamethoasone (/pred) 0.15mg/kg
7- high flow O2 and nebuliser adrenaline
18
Q
6month old to GP with 24hr with increased work of reaching, coryzal, lethargy, and reduced oral intake
OE - Fine inspiratory crackles, subcostal recesson, temp 37.9 and SaO2 92%
1- diagnosis
2- cause
3- Mx
4- Prevention
A
1 - bronchiolotis
RSV
Self limiting so supportive (O2 / fluids )
Palivizumab
19
Q
Child refusing to walk and is upset OE - hip is red tender and warm 1- what do you need to rule out and usual cause? 2- investigations 3- management 4 DDx
A
1 - septic arthritis - staph aureus
2 - Joint aspiration + culture, blood cultures
3- IV Abx (flucloxacilin )
4- Transient synovitis
Osteomyelitis - similar presentation to SA
-> MRI / X-ray for diagnosis
DDH Perthes disease Slipped upper femoral epiphysis Non accidental JIA
20
Q
Transient synovitis vs SA
A
viral, less systemically unwell, no pain at rest but painful on internal rotation
-> Normal WWC, CRP, ESR
21
Q
Who do you see DDH in? Signs? Important complication
A
Infant esp preterm
Barlow and ortolani manouvers test in neonatal screening / asymmetric skin folds
Necrosis of the femoral head
22
Q
What is Perthes disease? Who is it seen in? Presentation? Investigation to diagnosis?
A
Avascular necrosis of the femoral epiphysis
Boys 5-10
Insidious limp / hip/knee pain
Shown on X-RAY
23
Q
Who do you see slipped upper femoral epiphysis in? Signs ?
A
10-15 especially obese boys - often follows minor trauma but can be insidious
Reduced abduction / rotation of hip
24
Q
Who would you be worried about non accidental injury in?
A
Fractures before walking age, repeated admissions
25
Presentation of jia ? Usually in? Need to do?
Persistent joint sweeping for over 6 weeks
Usually females
Exclude infection / malignancy
26
2 non abdo causes of abdo pain ?
Testicular torsion
| Lower lobe pneumonia
27
```
3 week baby, no PMH / normal birth
Non projectile vomiting after feeding
O/E - poor weight gain, dehydrated and mass in RUQ
1- Likely diagnosis?
2- Physiology
3- metabolic abnormally is found?
4- radiological features?
5 Mx
```
Hypertrophic pyloric stenosis
2- Hypertrophy of the pylorus causing impaired gastric emptying -> stomach contents leaves as vomit
3- Hypochloraemic hypokalaemic metabolic alkalosis
4- USS -> non passage of gastric contents to proximal duodenum
X-ray -> delayed gastric emptying, peristalstic waves, string sign, beak sign
5 - Stop oral feeds, IV fluids (0.9 NaCl, 5% Dextrose, 20mmol KCl), admit to paeds
1- Atropine (requires long hospital stay)
2- pyloromyotomy (ramstedt’s proceure )
28
```
1yr old
Bile stained vomit, crying in pain and drawing of legs to chest area
1- likely diagnosis
2- pathophysiology
3- most common site
4- signs O/E
5- complications
6- Mx
```
1 - intersusception / obstruction
2- intestine folds into the next part of it causing obstruction
3- terminal ileum / ileo-coecal valve
4- sausage shaped mass in abdo and re currant jelly stool
5- bowel perforation, necrosis, peritonitis
6- enema -> water soluble contrast / air contrast, resection of affected bowel
29
27 week neonate
Resp rate 60, chest wall recession, exploratory grunting, cyanosis
1- diagnosis
2- Likely cause (in premature) - what can be given antenatal?
3- seen on CXR
4 - Mx
5- complications
6- if this baby was c section what could the diagnosis be?
RDS - widespread alveolar collapse with inadequate gas exchange
Lack of surfactant production - give steroids
3- ‘ground glass appearance’
4- o2, ventilation, supportive, surfactant
5- pneumothorax, chronic lung disease
6- CS is a risk factor for transient tachypnea of the new born (too much fluid in the lungs)
30
When does surfactant production start ?
20-24 weeks and increases
| Babies born at 31 weeks still have a 50% risk of RDS
31
When is jaundice in the neonate normal / abnormal? Cause?
<24 hrs - abnormal Eg. Haemolytic ( Rhesus, G6PD deficiency) / infection
>24 hrs - physiological Eg Dehydration / breast milk
immature liver and increased RBC breakdown
After 2 weeks - Bilary atresia
32
Colour of stools in biliary atresia? Other causes for persistent jaundice over 2 weeks ?
```
Pale and dark
Breast milk (max 5weeks), UTI, congenital hypothyroidism
```
33
Complications of neonatal jaundice?
Investigations?
Treatment?
Kernicterus - encephalopathy from unconjugated bilirubin in the brain
Transcutaneous bilirubin meter, diagnosis with serum bilirubin
Plot bilirubin on generation specific chart according to age since birth, phototherapy or exchange transfusion
34
What is NEC? Who is it seen in? Sx? Complications? Mx?
Bacterial invention of ischemic bowel wall
Premature infants
Vomiting, poor feeding, distended abdo, blood in stool
May progress to shock / perforation
IV Abx, total parenteral nutrition, Intensive therapy unit
35
```
4 year old
Ill for 4 days, fever, runn nose, rash and conjunctivitis
O/e temp of 40.5
1- likely diagnosis
2- presentation of rash in this disease
3- how long infective?
4- other Sx?
5- how to confirm diagnosis
6- mx?
7 complications
```
1- measles
2- starts behind the ears, spreads to face and the trunk - maculopapular rash becoming patchy and confluent
3- 4 days before rash - 4 days after rash appears
4- Koplik’s spots (white spots in mouth), non-productive cough
5- saliva swab for measles specific IgM / RNA
6- self limiting - treat Sx, stay at home to prevent spread CONTACT PUBLIC HEALTH
7- Encephalitis, giant cell pneumonia, subacute sclerosing panencephalitis (5-10yr later), febrile convulsions, keratoconjucntivits, corneal ulceration
36
2 year old boy with fever for 5 days, rash, swelling of lips and tongue, conductivitis
O/E - Cervical lymphadenopathy, temp of 39.2 and irritable
1- likely diagnosis?
2- criteria for diagnosis
3- mx
4- complications
1 - Kawasaki
2 - fever >39 for 5 days plus 4/5 of:
A) cervical lymphadenopathy >1.5cm
B) non-vesicular rash
C) bilateral dry conjuctivitis
D) erythema, oedema / desquamataiton of extremities
E) inflammation of lips, mouth and tongue
3- IV IG, aspirin (to reduce thrombosis risk)
Could give corticosteroids, anti TNF, immunosuppressive
4- coronary artery aneurysm -> MUST DO AN ECHO
Cardiac valve disease, MI, cardiac death
37
Pathophysiology of RDS ? Woman is going to give birth prematurely what can you give? Complication of RDS? Signs?
Not enough surfactant -> alveolar collapse
Corticosteroids to the mother, intratracheal surfactant
Pneumothorax, chronic lung disease
Tachypnea, intercostal recession, nasal flaring, tracheal tug
38
What causes transient tachyon earth of the newborn? Risk factor?
Too much fluid in the lungs
| C-section
39
When is jaundice in neonates abnormal? When is it normal and what os the cause?
<24 hours post birth abnormal - haemolysis / infection
After 24 hours, present in 50% due to liver immaturity and RBC breakdown
-dehydration, breast milk, bile duct obstruction, neonatal hepatitis, brushing
40
Neonatal jaundice ix? Which two treatments? Which complication trying to avoid?
Total serum bilirubin
Phototherapy, exchange transfusion
Kernicterus
41
What is NEC? Who is it typically seen in? Signs? Complications? Mx?
Bacterial invasion of ischemic bowel wall
Premature infants
Vomiting, poor feeding, distended abdomen, blood in stool
Shock / perforation
IV Abx, Total parenteral nutrition (TPN), ITU
42
3 trisomy’s and the chromosome affected?
Downs 21
Patau 13
Edwards 18
43
Downs features? Common defects? Long term complications?
Craniofacial - epicanthic folds, flat nasal bridge, brusfield spots
Congenital heart defect - eg AVSD
Duodenal atresia
Leukaemia / solid tumour risk, hearing impairment, Alzheimer’s, epilepsy
44
When are CHDs usually picked up?
Antenatal USS
45
Cause of murmur in ASD? Type? Who needs treatment?
Increase flow across the pulmonary valve
Systolic murmur at Upper left sternal edge
People with RV compromise need treatment
46
Where is the murmur in VSD? What does a quiet murmur indicate? When is a large VSD a problem? What complication do we need to avoid?
Lower left sternal edge
Quiet murmur -> bigger defect
VSD > aortic valve -> heart failure
Avoid Eisenmenger’s syndrome (R->L shunt)
47
Murmur in PDA ? Mx?
Constant murmur heard below left clavicle
NSAID (inhibit prostaglandins)
OR
Close duct with a coil at 1 year
48
ToF 4 problems
| Seen on X-ray/ why?
PS
Overriding aorta
RVH
VSD
Boot shaped heart - due to RVH
49
What do you need to do in TGA
Maintain PDA -> urgent surgery
50
Jill is a 7 year old girl, and has been brought into A+E after becoming very short of breath playing football. She is known to have asthma.
You do a quick A->E assessment and you find -
A - Speaking in short sentences, airway patent
B - RR 32, equal expansion, bilateral wheeze, use of accessory muscles, 91% O2 on air
C - BP 110/65, CRT <2s, HR 130
D - PEARL, GCS 15/15, BM 5.5
E - no rashes, temp 37.5
What do you want to do next?
What are some features of life threatening asthma ?
Oxygen 15/L via NRB
Assess peak flow
Salbutamol nebulisers
Steroids
```
Silent chest
PEF <33%
Poor resp effort
Hypotension
Exhaustion
```
51
Organs affected in CF?
How to screen babies?
Diagnosis?
Bacteria -> common chronic infection in CF?
Lungs, GI, pancreas, liver, kidneys
Immunoreactive trypsinogen
Sweat test
Pseudomonas aeruginosa
52
```
Bronchiolitis
Age?
Typical organism?
Sx?
Ix?
Mx?
```
90% before 1 year
Respiratory syncytial virus
Breathing difficulties, following coryzal sx
RSV swab, o2 sats
Supportive
53
```
Croup
Age?
Typical organism?
Sx?
Ix?
Mx?
```
6month - 6 years
Parainfluenza
Barking cough, stridor, worse at night
SaO2, AVOID EXAMINATION OF THE THROAT
Oral corticosteroids, O2
-rarely intubation of the airway
54
```
Epiglottitis
Age?
Typical organism?
Sx?
Ix?
Mx?
```
1-6yrs
Usually H influenza (rare in vaccinated children)
Child appears toxic, high grade fever, soft stridor, absent cough, rapid onset
Child often sits upright to optimise airway
Ix - SaO2 - avoid exam of throat
Mx - intubation under GA -> cultures and Abx
55
```
Whooping cough
Age?
Typical organism?
Sx?
Ix?
Mx?
```
Infants who have not had first jab - usually <4 months
Bordetella pertussis
Week of coryzal -> paroxysmal cough which lasts up to 6 weeks -> whooping cough
Ix - nasal swab
Mx - erythromycin -> eradicates and prevents spread of B pertussis
56
Septic arthritis usual cause? Ix? Mx?
Acute inflammation of the joint - need to treat quickly to prevent joint damage
Typically caused by S.aureus
Blood cultures, joint aspiration (+culture)
IV antibiotics (probably Fluclox)
57
Usual hip pathology in infants? Age 4-10? Teens?
DDH
Perthes disease
Slipped upper femoral epiphysis
58
Hip pain quick onset suggests? Prolonged fever?
Infective
| JIA
59
Causes of limp?
```
Septic arthritis
Transient Synovitis
Osteomyelitis
Perthes disease
Developmental dysplasia of the hip
Slipped capital femoral epiphysis
Juvenile idiopathic arthritis
Also - malignancy, NAI
```
60
Henry, a 6 week old baby boy, has seen a multiple doctors over the past 2 weeks because of vomiting. He has been started on omeprazole and thickened feeds to treat a presumptive diagnosis of reflux.
His parents are concerned as he remains unwell. They bring him to A+E for another review. His vomiting is worse and occurs after every feed. He has less wet nappies, lethargy and some weight loss.
DDs of vomiting?
```
V: Intracranial haemorrhage
I: UTI*; Gastroenteritis*; Meningitis; Otitis media
T: Trauma; NAI
A: Coeliac
M: GORD*; Pyloric stenosis*; Intussusception; Hirschprung’s
I: Overfeeding
N: Intracranial tumour
D: Malrotation of midgut
```
61
Surgical sieve mnemonic ?
```
VITAMIN D
Vascular
Infective / inflammatory
Trauma
Autoimmune
Metabolic
Iatrogenic / idiopathic
Neoplastic
Developmental / degenerative
```
62
Pyloric stenosis common age? Classical features? Seen on blood gas? What would test feeding demonstrate?
Pathology?
3-6weeks
Vomiting during/after feeds, increasing frequency and force, projectile, hunger after feeds, weight loss
Hypochloraemic, hypokalaemic metabolic alkalosis
Peristaltic massed from left to right - olive shaped mass on USS
The pylorus is normal at birth. There is progressive hypertrophy of the pyloric muscle resulting in gastric outlet obstruction. This manifests as vomiting and results in the loss of HCl and hypovolemia. The kidneys attempt to compensate for the loss of acid by retaining protons in exchange for potassium.]
63
Hypocloraemic hypokalaemic metabilic alkalosis
| Ph? pCO2? HCO3? Electrolytes ? Which feature indicates metabolic alkalosis ?
pH = raised
pCO2 = often raised as body tries to compensate for alkalosis
HCO3 = raised – tells you this is a metabolic alkalosis
Often a raised base excess
Low electrolytes (K and Cl)
64
Ix and management in pyloric stenosis ?
Test feeding demonstrates peristaltic massed from left to right
USS -> olive shaped mass
Initial stabilise - fluid (0.45% saline and 5% dextrose) with supplemental KCl if needed
Ramstedt’s pyloromyotomy - eerily performed and minimal complications
65
GORD aetiology? Sx? Ix?
40% of infants and usually begins before 8 weeks old
5% have more than 6 episodes / day
Resolves by 1 year in 90%
```
Sx
Recurrent regurgitation or vomiting, choking / life threatening can occur
Resp problems Eg cough, apnea wheeze
Aspiration pneumonia can occur
Feeding / failure to thrive
```
Ix
Usually not required but can do upper GI imaging and pH study
66
Mx of GORD ? If more pronounced / failure to thrive / distressed?
```
Reassure that should reduce over time
Review feeding hx and assess breast feeding technique
Prevent over feeding
Smaller more frequent feeds
Try thickened feeds
Trail of alginate therapy
```
Add in PPIs
67
```
Intussusseption
Pathology?
Usual age?
Sx?
Signs?
Ix?
Mx?
```
Pathology: Telescoping of one portion of the bowel into an immediately adjacent segment -> Restriction of blood supply and oedema of the bowel wall rapidly leads to obstruction and potential gangrene/ perforation.
Aetiology: Most commonly 3-12 months
Symptoms: Paroxysmal colicky abdominal pain; Bile stained vomiting; Redcurrant jelly stools
Signs: Shock; Palpable sausage shaped mass in RUQ; Redcurrant jelly on PR
Investigation: Target (or doughnut) sign on USS; Proximal dilation on AXR
Management: Resuscitate with fluid and place NG tube. Reduction w/ air enema. Laparotomy with failure.
68
```
Hirschprungs disease
Pathology?
Aetiology?
Sx?
Ix?
Mx?
```
Other cause of failure to pass meconium?
Pathology: Congenital agenesis of the colonic ganglion -> function GI obstruction, constipation and mega colon. 1 in 5000 births.
M:F = 4:1
Aetiology: Mainly neonatal; may present in older children with chronic constipation
Symptoms: Abdominal distention, failure of passage of meconium within the first 48 hours of life and repeated vomiting.
Signs: Abdomen distended with faeces. PR = Tight anal sphincter; Explosive discharge of stools and gas
Investigation: AXR (dilated lower bowel); Suction biopsy of the aganglionic segment.
Management: Excision of the aganglionic segment +/- colostomy
Cystic fibrosis
69
Chris, a 4 year-old boy is brought to the emergency department by his parents with a history of increasing numbers of red spots on his legs over the past 6 days. They took him to two different family doctors and have tried various creams. The spots have spread to his buttocks and his arms, and now his legs are sore and look swollen. He has also had abdominal pains.
On examination he looks well with age-appropriate vital signs, but he is reluctant to move his lower limbs
Difference between petechial and purpurin rash?
His is petechial - what is the most likely cause?
Petechial are smaller - up to 3mm
Henoch-schonlein purpura
70
```
Henoch-schonlein purpura pathology?
Aetiology?
Commonly preceded by?
Triad common in diagnosis?
Natural history?
Management?
Complication?
```
Autoimmune self limiting mediated by IgA small vessel vasculitis
Children aged 2-8 (most common vasculitis in children)
1 - Purpuric rash on the limbs (mainly lower) and buttocks
2- joint pain / swelling
3- abdominal pain
Upper respiratory tract infection 1-3 weeks ago
Joint pain lasts <48 hrs
Abdo pain <72hrs
Resolution of rash in 4-6 weeks
Supportive management with treatment of renal complications
-> check U&Es (Half develop nephritis but v few have long term issues)
71
A child with petichae ... indications they are unwell?
Irritable / lethargic
Abnormal vital signs
Poor peripheral circulation
```
OR
Petichae progress extent in 4 hours in A&E
Purpura (>2mm) develop
Bloods - WBC <5 or >15
-CRP>8
```
72
H olly, a 3/52 old child, comes in with to A+E with a non blanching rash. She is less responsive than normal, tachpnoeic and tachycardic and her capillary refill is 4 seconds peripherally
What is the likely causative organism in neonate? In young children?
What is your management plan? MX in older than 3 months?
Neonates: group B streptococci, Listeria monocytogenes, Escherichia coli.
Infants and young children: H. influenzae type b, if younger than 4 years and unvaccinated; Neisseria meningitidis, Streptococcus pneumoniae.
Children 3 months and older and young people should be given intravenous ceftriaxone as empirical treatment before identification of the causative organism. If calcium-containing infusions are required at the same time, cefotaxime is preferable.
Children younger than 3 months should be given intravenous cefotaxime plus either amoxicillin or ampicillin. NB: ceftriaxone should not be used in premature babies or in babies with jaundice, hypoalbuminaemia or acidosis, as it may exacerbate hyperbilirubinaemia.
73
Immediate / delayed complications of meningitis?
Septic shock, DIC, coma (could have loss of protective airway reflexes) , cerebral oedema, raised ICP, septic arthritis, pericardial Effusion
Subdural effusion
Seizures
Delayed:
Hearing loss, cranial nerve dysfunction, seizures, paralysis, hydrocephalus, cognitive defects, ataxia, blindness, Waterhouse-Friderichsen syndrome
74
How many children aged 1-18 months get subdural effusion in meningitis? What are the RF?
40% - young, rapid onset, high CSF, low WCC
75
Child had coryzal sx last week. Now mother noticed lesions in child’s mouth and -> rash...
diagnosis? Transmission? Signs and sx? Mx? Complication?
Measles
Airborne - resp droplets
Signs and Symptoms
Prodrome: cough, coryza, conjunctivitis, Koplik spots, fever
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Management: Supportive + vaccinate contacts
```
Complications
encephalitis
giant cell pneumonia
subacute sclerosing panencephalitis (5-10y later)
febrile convulsions
keratoconjunctivitis, corneal ulceration
```
76
What are Koplik spots?
White spots before rash in measles, ‘grain of salt’ on buccal mucosa
77
```
Child presents with rash, low grade fever and subocciptal and postauricular lymphadenopathy
Diagnosis?
Transmission?
Signs and sx?
Mx?
```
Rubella
Airborne - resp droplets
Signs and Symptoms
Prodrome of low grade fever or none at all
Maculopapular rash often first sign of infection
Initially on face then spreading to whole body
Lymphadenopathy (suboccipital and postauricular nodes)
Management: Supportive + vaccinate contacts
Complications
Encephalopathy and arthralgia occur rarely
78
16 year old
Fever malaise and facial swelling
Diagnosis? Transmission? Sx and signs? How long infective? Mx? Complications ?
Mumps
Airborne - resp droplets
Fever, malaise, parotitis
Infective up to 7 days after parotid swelling
Supportive + vaccinate contacts
Orchitis
Viral meningitis / encephalitis
79
A 2-year-old who has had a fever for the past 7 days is noted to have conjunctivitis, erythema and oedema of the hands and feet, cracked lips and a strawberry tongue
Diagnosis? Aetiology? Signs and sx? Mx?
Kawasaki
Peak 6months-5years, M>F, Far East more
```
high-grade fever (> 5 days)
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel
```
Management: Aspirin + IV Ig
80
What is Meckles diverticulum?
True diverticulum in the ileum due to a incomplete reduction in the Vitelline duct
[true because it involves all 3 layers of bowel wall]
81
What is the opthalomesenteric duct?
Vitelline - connects the hold sac to the midgut
82
Signs and sx of meckles?
Gi bleeding - stool - anaemia
Pain and tenderness
Bowel obstruction - pain bloating diarrhoea constipation and vomiting
Diverticulitis
83
Difference between diverticulosis and diverticulitis? Most common location for diverticula?
Losis - just having diverticula in the bowl
Itis - inflammation of diverticula (Often get less bleeding as vessels become scared by inflammation)
Sigmoid colon
84
Diagnosis of meckles?
Technetium (radioactive) given IV which shows diverticulum
CT - worm like
Stool smear - test for blood
FBC - and haematocrit
85
Mx of meckles?
Surgery if bleeding
Join bowel back together
Iron tablets / transfusion if severe bleeding
86
Sx of good pastures? Cause? Type of hypersensitivity ? Risk factors?
Type of lung / kidney disease?
Haemoptysis and haematuria
Anti basement membrane (collagen IV)
Type 2 hypersensitivity reaction
Riskfactors
Genetic - HLA-DR15
Environmental - smoking, infection, hydrocarbon solvents (dry cleaning)
Restrictive lung disease [low FVC and FEV1:FVC ratio], nephritic kidney disease
87
Diagnosis of good pastures? Treatment
Biopsy of kidney - inflamed basement membrane
Immunoflouresce
Corticosteroids
Immunosupression
Plasmapheresis
