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Paeds Flashcards

1
Q

Discuss the phases of growth in children

A

Foetal phase: 30% of eventual height
Infantile phase: up to 18mnths, requires good health and thyroid function
Childhood phase: slow and steady prolonged period of growth. Based on genes, good health and thyroid hormones
Pubertal phase: driven by sex hormones. If puberty is early (not uncommon in girls) overall growth will be lower due to earlier fusion of the epiphyseal growth plates

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2
Q

Discuss the pubertal changes seen in females and males

A

Females:

  1. Breast development (12.5years)
  2. Pubic hair growth and rapid height spurt
  3. Menarche 2.5 yrs after initial breast development

Males:

  1. Testicular enlargement
  2. Pubic hair growth
  3. Height spurt

Both sexes

  1. Development of acne
  2. Axillary hair
  3. Body odour
  4. Mood changes
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3
Q

Discuss the causes of short stature

A 
Familial: both parents are short 
Intrauterine growth restriction/prematurity
Constitutional delay of puberty 
Endocrine: Hypothyroidism, GH deficiency
Nutritional deficiency 
Psychosocial deprivation 
Chromosomal disorders
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4
Q

Discuss the investigations for short stature

A 
Plotting previous and current height and weights 
X-ray of wrist and hands 
FBC
U&E's
Karotype 
IgA antibodies 
CPR/ESR
MRI
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5
Q

Discuss the causes of tall stature

A

Familial
Obesity
Secondary : Hyperthyroidism, increase sex steroids, excessive adrenal androgens)
Syndromes: Marfans, Klinefleters, maternal DM

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6
Q

Causes of abnormal head growth

A

A. Microcephaly

  • Familial
  • Autosomnal recessive
  • Congenital infection
  • Acquired insult

B.Macrocephaly

  • > 98th centile
  • Rapid increase = ICP
  • Hydrocephalus
  • Tumour
  • Neurofibromas
  • CNS storgage disorders

C. Craniostanosis
- Premature fusions of sutures (distortion of the head shape)

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7
Q

Define premature sexual development

A

8 years = female
9 years = males

Growth spurt + pubic hair and breast development

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8
Q

Classify precocious puberty

A

True PP: premature activation of the hypothalamic-pituitary-gondal axis

Pseudo PP: excess sex steroids

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9
Q

Discuss the causes of precocious puberty

A 
Gonadotrophin-dependent 
Idiopathic/Familial
CNS lesions (postradiation, tumours)

Gonadotrophin-indepedent
McCune-Albright
Tumours of adrenals or gonads

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10
Q

Define congenital adrenal hyperplasia (CAH)

A

Caused by a defect in pathway that synthesises cortisol to cholesterol
Deficiency in 21-hydroxylase or 11-hydroxylase
Autosomal recessive
Chromosome 6

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11
Q

Clinical features of CAH

A 
Female virilization 
Salt wasting adrenal crisis (mineralcorticoid deficiency) 
Cortisol deficiency (hypoglycaemia, hypotension, shock)
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12
Q

Diagnosis and management of CAH

A

Elevated levels of 17alpha-hydroxylprogesterone
Hyponatraemia
Hypochloridaemia

Management: 
Females (corrective surgery)
Lifelong glucocorticoids 
Mineralcorticoids 
Carry a lifelong steroid replacement card
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13
Q

List the four fields of development

A

Gross motor
Vision + fine motor
Hearing and speech language
Social, emotional and behaviour

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14
Q

List the primitive reflexes

A

Moro: extension of the head, extension of the arms (drop the baby)
Grasp: flexion of fingers when object placed in hand
Rooting: head turns to stimulus near the mouth
Stepping: Feet step when touching the floor

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15
Q

Discuss the physiology of the change in foetal Hb

A

Foetus Hb contains 4 alpha chains, higher affinity for oxygen.
HbF is gradually replaced with HbA
Foetus is born with a good store of iron, folic acid and vitb12

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16
Q

Define anaemia

A

Hb level below the normal limits
neonante < 14g/dL
1-12 months < 10g/dL
1-12years < 11g/dL

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17
Q

Causes of anaemia

A

Impaired red cell production

Increased red blood cell production

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18
Q

Iron deficiency anaemia

A 
Impaired red cell production 
Fatigue
Poor feeding 
Pallor
Pice

Microcytic, hypochromic anaemia ( decreased MCV, decreased MCH)

Oral intake
Iron supplement (sodium iron date)
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19
Q

Red cell aplasia

A

Impaired red cell production

  • Congenital
  • Erythoblastema of the new born
  • Parovirus B19 infection
Low reticulocyte
Low Hb
Normal bilirubin 
Absent RBC precursors on bone marrow 
-ve antiglobin test

Oral steroids
Blood transfusions

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20
Q

Discuss the pathophysiology of increased red blood cell destruction

A

Intravascular ( circulation)
Extravascular (liver/spleen)

Red cell membrane disorders
Red cell enzyme disorders
Haemoglobinopathies

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21
Q

Glucose-6-phophate dehydrogenase deficiency

A

G6PD: rate limiting enzyme pathway (stop oxidative damage)

Neonatal jaundice
Acute haemolysis

Measure G6PD

Avoid triggers ( blood fine outside episodes)

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22
Q

Sickle cell disease

A

Haemoglobinopathies
Autosomal recessive HbsHbs
HbsC = carrier of the disease

Anaemia 
Infection
Painful crisis
Acute anaemia 
Splenomegaly

Hydroxycarbinamide
Opiates + hydration

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23
Q

B-thalasaemia

A

Haemoglobinopathies
Decrease production of beta global chain
Two types major and minor

Anaemia
Growth failure
Haemoposis

Blood transfusions
Bone marrow transplant

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24
Q

Immune thrombocytopenia

A

Most common thrombocytopenia in childhood
Destruction of circulating antibodies by anti platelet IgG autoantibodies

Petechiae
Purpura
Superficial brusing
Epitaxis

Will resolve spontaneously
Severe: oral prednisolone

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25
Q

Causes of anaemia of the newborn

A

Decrease RBS production
- Red cell aplasia

Bleeding

  • Umbilical cord
  • Internal haemorrhage

Haemolytic anaemia

  • Ab destroying the RBC
  • Immune (haemolytic disease of the newborn)
  • Red membrane disorders
  • Red enzyme disorders
  • Abnormal haemoglobin disorders

Blood loss

  • Feto-maternal haemorrhage
  • Twin to twin transfusions
  • Blood loss at delivery

Anaemia of prematurity

  • Decreased EPO production
  • Decrease RBC lifespan
  • Iron and folate acid deficiency
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26
Q

Discuss the traffic light system for identifying a sick child

A
  1. Colour
  2. Activity
  3. Respiratory
  4. Circulation/Hydration
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27
Q

Discuss the pathophysiology of septicaemia

A

Focal infection/proliferation of blood stream
Release of cytokines and endothelial cells
Cause = meninoccal infection ( kids)
Grp B strep ( neonates)

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28
Q

Clinical features of septicaemia

A 
Fever 
Poor feeding 
Miserable/ irritable
Increase HR/RR
Decrease Bp
Shock
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29
Q

Management of septicaemia

A

Antibiotics ( infection specific)
Fluids ( correct hypovolaemia )
Catheter ( regular U/O)
DIC ( FFP/platelet transfusions)

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30
Q

Discuss the pathophysiology of meningitis

A

Inflammation of the menages covering the brain
Inflammatory cells present in the CSF
Bacterial/ viral

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31
Q

List the microorganisms that cause bacterial meningitis

A

Neonates - 3 months: Grp B strep, E.coli, Listeria
1 month- 6 years: Nessieria meningitides, strep pneumonia
> 6 years: Nessieria meningitides, strep pneumonia

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32
Q

Clinical features of meningitis

A

Headache
Photophobia
Neck stiffness

\+ rash 
vomiting 
irritable 
seizures 
poor feeding 
shock
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33
Q

Compare the CSF changes in bacterial vs viral meningitis

A

Bacterial

  • increase WCC
  • increased protein
  • decreased glucose
  • polymorphic cells

Viral

  • increase in WCC
  • normal protein
  • normal glucose
  • lymphocytes
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34
Q

Treatment of bacterial menigitis

A

3rd generation cephalosporin ( cefotaxime/ ceftrixone)
Bactericidal
Works on the beta-lactam
Disrupt the synthesis of the peptidoglycan layer forming the bacterial cell wall
Prevents cross linking of the peptidoglycan

Rifampacin to all household contacts

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35
Q

Discuss the causes and the management of viral meningitis

A 
Enterovirus 
EPV
Adenovirus 
Mumps 
Herpes zooster virus

Rx: Acyclovir

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36
Q

Meningococcal infection

A

Septicaemia + purpuric rash

Rash: non blanching, regular size, neurotic centre

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37
Q

Impetigo

A

Highly contagious strep or staph infection

Erythematous macules = vascular pustular or bulbous
- rupture of the vesicles = honey crusted lesions

Rx: Mild ( topical antiB’s: muciporin)
Narrow ( flucloaxicllin)
May require board spec ( co-amiclav)

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38
Q

Tuberculosis

A

Caused by mycobacterium tuberculosis

A. Unsymptomatic

  • Local inflammation
  • Latent disease
  • Mantoux test +ve
  • Hilar lymphadenopathy on CXR

B. Symptomatic

  • Spread to the lymph system
  • Lung lesion + infected lymph node = Ghon’s complex
  • Fever, Anorexia, Cough, CXR changes
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39
Q

Dx of TB

A

Acid fast bacili and zieh neslon’s stain +ve

Mantoux test +ve

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40
Q

Rx of Tb

A

8/52: Rifampain, Isonazid, Pyrazinamide and Ethabutamol

Further 8/52: Rifampicin, Isoniazid

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41
Q

Kawasaki’s disease

A

Systemic vasculitis
4-6 years old
Asian (Japanese)

Cx: Likely to be immune hyperactivity. Associated with ITPKC gene ( decrease T cells)

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42
Q

Clinical features of Kawasaki’s disease

A 
\+ 5 day fever
Bilateral non purulent conjunctivitis 
Oral mucositis 
Cervical lymphadenopathy 
Polymorphic rash 
Extremity change ( erythema dactlylisis) 
Coronary artery aneurysms
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43
Q

Rx of Kawasaki’s disease

A

IV-IgG immunogloblins
High dose aspirin

Must do echo and cardio F/up

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44
Q

Discuss the transmission of HIV

A

Mother to child ( in vitro)
@ delivery (intrapartum)
Breast feeding (post partum)
Vertical transmission

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45
Q

Dx of HIV in kids

A

> 18 months: antibodies

<18 months: +ve will only confirm exposure not infection due to transplacental maternal abs

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46
Q

Clinical features of HIV

A 
Persistent lymphadenopathy 
Hepatosplenomegaly
Recurrent fever
Parotid swelling 
Thrombocytopenia
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47
Q

Rx of HIV

A

Antiviral treatment

  • Clinical load
  • HIV viral load
  • CD4 count
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48
Q

Discuss the ways to reduce vertical transmission

A

Reduce the viral load of the mother
Avoidance of breast feeding- reduce transmission
Active management of labour and delivery

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49
Q

Causes of prolonged fever

A

Infective

  • Localized infection
  • Bacterial infections
  • Deep abscess
  • Infective endocarditis
  • TB
  • Viral infections

Non-Infective

  • Systemic juvenille arthritis
  • SLE
  • Vasculitis
  • Inflammatory bowel disease
  • Sacrodoisis
  • Malignancy ( leukamia, lymphoma)
  • Drug fever
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50
Q

Discuss the mechanism of action of vaccines

A

Induce immunity via T-cellss
Induce immunological memory
Herd immunity

Active: Live attenuated (MMR,BCG,Rotavirus)

Passive: Inactivated ( whopping cough, tetanus)

Conjugate virus: Polysacchride coat of bacteria ( pneuma, Hib, MenC)
Improvement of the protein carrier
Generates immunological memory

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51
Q

List the types of immunological memory

A
  1. Primary: Intrinsic defect in the immune system

2. Secondary: Caused by a disease or a treatment

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52
Q

List the types of primary immune deficiency

A

T-cell defects

  • Failure to thrive
  • Oral thrush
  • PCP

Examples:
SCID
HIV infection

B-cell defects

  • Bacterial infections
  • Recurrent diahorrae
  • Failure to thrive
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53
Q

Define wheeze and list the different types

A

Whistling sounds, breathlessness or persistent troublesome cough severely affecting the wellbeing of the infant

  1. Transient early wheeze
  2. Persistent and recurrent wheeze
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54
Q

Causes of a wheeze

A 
Transient early wheeze 
Atopic asthma (IgE mediated)
Non atopic asthma
Recurrent aspiration of feeds 
Inhaled foreign body 
Cystic fibrosis
Recurrent anaphylaxis
Congenital abnormality
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55
Q

Discuss the prevalence of wheeze in childhood

A

Transient early wheeze (0-3yrs)
Viral episodic wheeze (3-5yrs)
IgG associated wheeze (5+)

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56
Q

Clinical features of viral episodic wheeze

A

No interval symptoms
No excess atopy
Improvement with age
No benefit from inhaled steroids

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57
Q

Clinical features of asthma

A 
Wheeze (polymorphic)
Symptoms worse at night or early morning 
Triggers
Family hx to atopy
\+ve response to asthma therapy
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58
Q

Investigations for asthma

A

Clinical dx
Record PEFR ( peak expiratory flow rate)
CXR will be normal ( avoid scanning kids)
Skin prick test for common allergies

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59
Q

Management of asthma

A

Stepwise approach
1. Inhaled SABA (Salbutamol)
2. Inhaled SABA + inhaled steroids
3. Inhaled LABA ( must be with a corticosteroid) Seretide
Consider adding in leukotriene receptor agents ( <5yrs) or oral theophylline (>5yrs)
4. Increase steroids to the max dose
5. Oral steroids (prednisolone)

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60
Q

Reason for failure to respond to treatment

A

Adherence
Bad disease pathology
Choice of drugs/devices
Environment (smoke/pets)

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61
Q

Long-term side effects of steroids

A

Adrenal suppression
Growth suppression
Osteoporosis

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62
Q

Clinical features of a child with chronic asthma

A

Growth and nutrition may be below normal
Chest: Hyperinflation, harrisons sulci, wheeze
Atopic Hx: Allergic rhinitis, Eczema
Time off school

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63
Q

Presentation of acute asthma attack

A 
Wheeze + tachypnoea 
Tachycardia
Use of accessory muscles and recession
\+ve pulse paradoxus
Breathlessness prevents talking

Life threatening

  • Cyanosis
  • Fatigue
  • Drowsiness
  • Silent chest
  • Decreased consciousness
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64
Q

Management of an acute asthma attack

A

Nebulised B2 agonist
Oral or IV steroids
Nebulised ipratropium
Oxygen

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65
Q

List the common pathogens that cause respiratory infection

A

VIRUSES

  • RSV ( respiratory synctical virus)
  • Rhinovirus
  • Parainfluenza virus
  • Adenovirus

BACTERIAL

  • Strep pneumonia
  • Haemophilus influenza
  • Moxerella catarhalis
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66
Q

Pharyngitis

A

Pharynx and soft palate are inflamed
Local lymph nodes are enlarged and tender

Grp A Beta-haemolytic streptococus ( must do throat swab in case of further renal complications)

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67
Q

Tonsillitis

A

Intense inflammation of the tonsils
Caused by Grp A Beta-haemolytic streptococcus and EBV
Bacterial tonsillitis = pencillins
Avoid amoxicillin as will cause maculopapular rash

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68
Q

Acute otitis media

A

6mnths- 12mnths
Tympanic membrane will be bright and bulging ( loos of normal light reflection
Caused by RSV, Rhinovirus, H.Influenza, Moraxella
Analgesics
Give Abs if severe

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69
Q

Clinical features of laryngeal and tracheal infections

A

Stridor
Hoarseness due to inflammation
Barking cough
Degree of dyspnoea

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70
Q

Croup

A

Mucosal inflammation and increased secretions affecting the airway
Narrowing of the trachea

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71
Q

Clinical features of croup

A

Preceding factors

  • Fever
  • Coryza
  • Chest recession @ activity

Hoarseness
Barking cough

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72
Q

Treatment of croup

A 
Oral dexamethasone (0.15mg)
Oral prednisalone (2mg)
Nebulised steroid (Budesomide)
Reduce severity, duration and need for admission

Nebulised epinephrine (adrenaline) + O2 facemask (Beware of rebound affects)

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73
Q

Acute epiglottis

A

Life threatening emergency
Caused by H.Influenza type B
Intense swelling of the epiglottis and surrounding tissues

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74
Q

Clinical features of acute epiglottis

A

High grade fever
Painful throat
Soft inspiratory stridor
Increasing respiratory difficulty

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75
Q

Treatment of acute epiglottis

A 
Managed in a resuscitation room 
Examination under anaesthetic 
Secure the airway 
Blood for culture 
IV abs = cefuoxime ( 3rd generation cephalosporin)
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76
Q

Whopping cough

A

Highly contagious respiratory infection
Caused by bordetella pertussi ( ID via PCR)
An effective vaccine does exist as part of diphtheria, tetanus and pertussis
Infective 7 days post exposure to 3 weeks after cough

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77
Q

Clinical features of whopping cough

A

Catarrhal phase: Coryzal

Paroxysmal phase: Cough ( inspiratory whoop) can last for 3-6 weeks

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78
Q

Treatment of whopping cough

A

Erythromycin given early disease reduces infectivity but does not shorten the course of the illness

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79
Q

Cause of bronchiolitis

A

RSV respiratory syncytial virus

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80
Q

Clinical features of bronchiolitis

A

Corysal symptoms
Dry cough
Increased work of breathing
Feeding difficulty ( increase dyspnoea)

O/E
Increased RR
Subcostal/Intercostal recession
Hyperinflation of the chest
Fine-end inspo crackles 
Increase HR
Cyanosis/Pallor
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81
Q

Treatment of bronchiolitis

A

Supportive care
Humidified oxygen
Fluids if needed

Admit if
Resp distress
Chronic lung pathology
Feeding difficulties

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82
Q

Causes of pneumonia

A

Newborn: Grp B strep
Infants: RSV, strep pneumoniae, Bordetella pertussis, Chylamydia
Children: Mycoplasma pneumonia, strep pneumoniae, chlymadia pneuomia

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83
Q

Clinical features of pneumonia

A 
Fever 
Breathing difficulties
Cough 
Lethargy
Poor feeding 
Unwell child 
O/E
Tachypnoea
Nasal flaring 
Chest indrawing
Increased respiratory rate
Dullness to percuss
Bronchial breathing
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84
Q

Management of pneumonia

A 
ADMISSION
Increase RR
Increase WOB
Grunting 
Decreased feeding

Broad spec abs ( amoxicillin)

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85
Q

Clinical features of UTI

A 
Miserable
Temperature
Vomiting 
Abdo pain 
Fever
Poor feeding
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86
Q

Cause of UTI

A

E.Coli or Kleibsiella

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87
Q

Treatment of UTI

A 
Trimethoprim ( if well)
IV cefuroxime ( if unwell)

Neonates will require an ultrasound of the kidneys to rule out malformation.

Beware of ESBL:
Extended spectrum beta-lactamase producers
Resistant to all penicillins and cephalosporins
Rx: Meropenem

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88
Q

Treatment for osteomyelitis

A

Commonly caused by staph aureus

Rx: IV cefuroxime

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89
Q

Differential Dx of MSK pain

A
  1. Life threatening pain
  2. Pain (-ve swelling)
  3. Pain (+ve swelling)

LIFE THREATENING
Malignancy (leukaemia, bone tumour, lymphoma)
Sepsis (septics arthritis, osteomyelitis)
Non-accidental injury

PAIN -VE SWELLING
Hypermobile joints
Metabolic disease (hypothyroidism)
Tumour (benign)

PAIN +VE SWELLING
Trauma
Infection
JIA
Arthritis
SLE
CF
Sarcoidosis
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90
Q

List the types of JIA

A
  1. Oligoarthritis:
    - 1-4 joints
    - ANA+/ANA-
  2. Polyarticular RF-Ve:
    - Symmetrical
    - Low grade fever
    - Anterior uveitis
  3. Polyarticular RF+Ve:
    - Symetrical large and small joints
    - Rheumatoid +ve
    - Poor prognosis
  4. Psoriatic arthritis
    - Asymetrical arthritis
    - Psoriasis
    - Dactylitis
    - Nail pitting
  5. Enthesistis related arthritis
    - Lower limb large joint arthritis
    - Lumbar spine involvement
    - Anterior uveitis
    - Reiter syndrome
    - HLA B27+
  6. Systemic JIA
    - Arthritis ( + daily fever for >3 days)
    - Evanscant rash (salmon pink)
    - Lymphadenopathy
    - Hepatomegaly +/- splenomegaly
    - Serositis
    - Link with MAS
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91
Q

What is Macrophage Activation Syndrome

A 
Potentially fatal 
Dysregulation of T-lymphocytes, 
Natural killer cells activation 
Excessive cytokine production 
Abnormal proliferation of macrophages
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92
Q

Clinical features of MAS

A 
Unrelenting fever
HSM
CNS dysfunction 
Purpuric rash 
Cytopenia 
Increase ferritin

Rx: Steroids, cyclosporin and supportive care

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93
Q

Treatment for JIA

A

NSAID’s
Steroids
DMARD’s (methotrexate)
Biologics (TNF-alpha- inhibitor)

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94
Q

Define osteoporosis

A

A disease characterised by low bone mass and micro architectural detonation of bone tissue, leading to enhanced fragility and an increase in fracture risk.

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95
Q

Causes of osteoporosis in children

A

INHERITED

  • Osteogenesis imperfecta
  • Inborn errors
  • Idiopathic

ACQUIRED

  • Drug induced
  • Endocrinopathies
  • Malabsorption
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96
Q

Aetiology of osteogenesis imperfecta

A

Autodominat condition which results in defects in the typeI collagen genes

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97
Q

Clinical features of osteogenesis imperfecta

A 
Bone fragility
Fractures 
Deformity 
Bone pain
Impaired mobility 
Poor growth
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98
Q

Types of osteogenesis imperfecta

A

I: mild
II: lethal
III: progressively deforming
IV: moderate

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99
Q

Management of osteogenesis imperfecta

A

Bisphosphonates
Pain management
IV pamidronate

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100
Q

Define rickets

A

Failure of mineralisation of growing bone or osteoid tissue

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101
Q

Causes of rickets

A

Nutritional

  • Dark skin
  • Lack of maternal Vit D
  • Diets low in calcium
  • Strict vegan diet

Intestinal absorption

  • Small bowel enteropathy ( coeliac disease)
  • Pancreatic insufficiency
  • Cholestatic liver disease

Defective production of 25(OH)D2
-Chronic liver disease

Target organ resistance to 1,25 (OH)D2
- Mutations in the D receptor gene

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102
Q

Clinical features of rickets

A 
Misery 
Failure to thrive
Frontal bossing of the skull
Bowing of the weight bearing bones 
Seizures 
Hypotonia
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103
Q

Treatment of rickets

A

Balanced diet
Correction of the predisposing risk factors
Treatment of the underlying cause

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104
Q

Define nephrotic syndrome

A

Proteinuria
Decreased albumin
Oedema

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105
Q

Types of nephrotic syndrome

A

Congenital
Steroid sensitive
Steroid resistant

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106
Q

List the investigations of nephrotic syndrome

A 
Urine protein 
FBC
CRP/ESR
Complement leves
Antistreptolysin O and Anti-DNASE B
Throat swab
Hep B and Hep C
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107
Q

Steroid sensitive nephrotic syndrome

A

MACROSCOPIC HAEMATURIA

Rx: 
Oral corticosteroids (60g/m2) 4/52
Decrease to 40g/m2
Gradually decrease steroids 
Dipstick urine for 10 days to check decreasing protein levels

1/3 will resolve directly
1/3 frequent relapse
1/3 infrequent relapse

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108
Q

Steroid resistant nephrotic syndrome

A 
Refer to nephrologist 
Rx: 
Diuretic 
Fluid management
Salt restriction
ACE inhibitors
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109
Q

Congenital nephrotic syndrome

A

Poor prognosis

High mortality

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110
Q

Causes of acute nephritis

A

Post infection
Vasculitis
IgA nephrology
Goodpastures (antiglomerular basement membrane)

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111
Q

Clinical features of acute nephritis

A 
Decrease urine output 
HTN
Oedema 
Proteinuria
Haematuria
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112
Q

Treatment of post strep infection nephritis

A

Increased ASOT
Increased antiDNASE B
Reduced C3 and C4

Rx HTN
Dialysis
Penicillin

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113
Q

Why would a UTI require further investigations

A

If

  • Male
  • Recurrent
  • Unusual organism grown

A. USS: size and drainage of the bladder and kidneys
B. Micturating cytourethrogram ( vesicoureteric reflux)
C. DMSA scan: radionucleotide imaging renal function

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114
Q

List the red flags in paediatric GI

A 
Bile stained vomiting ( intestinal obstruction)
Haematemesis (ulceration)
Projectile vomiting (pyloric stenosis)
Abdo pain/tenderness (Surgical abdo)
Abdo distension (obstruction)
Blood in stool (intusception)
Splenomegaly ( liver disease)
115
Q

Define GORD

A

Involuntary passage of gastric contents into the oesophagus

116
Q

Complications of GORD

A

Failure to thrive
Oesophagitis
Pulmonary aspiration
Dystonic neck posturing

117
Q

Management of GORD

A

Thickening agents (carobel)
H2 receptor antagonists ( ranitidiene)
PPI (omeprozole)
Nissen fundiplication

118
Q

Define pyloric stenosis

A

Hypertrophy of the pyloric muscle causing gastric outlet obstruction

119
Q

Clinical features of pyloric stenosis

A

Projectile vomiting
Hunger
Dehydration
Decreased weight

Will present in a HYPOKALAEMIC, HYPOCHLORAEMIC, METABOLIC ACIDOSIS

120
Q

Treatment of pyloric stenosis

A

Pyloromyotomy

121
Q

Clinical features of appendicitis

A 
Anorexia
Vomiting 
Abdo pain ( localised in the RIF)
Low grade fever 
Tenderness
Guarding
122
Q

Treatment of appendicitis

A

Appendectomy

123
Q

Define intussuseption

A

Invagination of proximal bowel into the distal segment ( ileum into caecum)
3mnths to 2yrs

124
Q

Clinical features of intussuseption

A

Severe colicky pain
Pallor
Red current jelly
Abdo distension and shock

125
Q

Dx and treatment of intussuception

A

Xray of distended bowel and absence of gas in the colon ( arrowhead colon)

Rx: Rectal air insufflation

126
Q

Cause of malrotation of the gut

A

Lack of fixation at dudonjejunal fixture or illogical region

Pc: obstruction or obstruction with compromised blood supply

Bilious vomiting

127
Q

Treatment of malrotation of the gut

A

Voluvulusis is untwisted and duodenum mobilised

128
Q

Causes of gastroenteritis

A 
Rotavirus 
Norovirus
Camblyobacter 
Shigella
E.coli
129
Q

Clinical features of diarrhoea

A

Loose watery diarrhoea

Vomiting

130
Q

List the types of dehydration

A

A. Isonatrameic and hyponatraemic dehydration
Swift in the water from the extra-intra cellular compartments
Can cause an increase in ICP

B. Hypernatraemic dehydration
Extracellular fluid is hypertonic
Doughy child

131
Q

Post gastritis syndrome

A

Watery diarrhoea syndrome

Temporary lactose intolerance “ Climtest”

132
Q

Causes of constipation

A

Hirschsprung disease
anorectal abnormalities
Hypothyroidism
Hypercalcaemia

133
Q

Red flag symptoms of constipation

A 
First few weeks of life 
Meconium passed > 24hrs 
Faltering growth
Delayed walking/ Lower limb neurology
Abdominal distension or vomiting
134
Q

Treatment of constipation

A

Laxatives
Regular bowel habit
May require psychological support

135
Q

Define Hirchsprung disease

A

Absence of ganglion cells from mesenteric and submucosal plexus of the large bowel

136
Q

Clinical features of Hirschsprung disease

A

Failure to pass meconium in the first 24hrs
Abdo distension
Bilious vomiting

137
Q

Dx and treatment of Hirschsprung disease

A

Barium enema

Rx: Colostomy and anastomosing parts of the colon

138
Q

Define toddler diarrhoea

A

Chronic non specific diarrhoea
Persistent loose stools

Maturational delay in gut motility = intermittent explosive diarrhoea

139
Q

Define infantile colic

A

Recurrent inconsolable crying
Drawing up the legs
Lasts about 4 months

140
Q

Causes of inconsolable crying

A 
Colic
GORD
Cow's milk allergy
Otitis media
Incarcerated hernia
UTI
Intussusception
141
Q

Clinical syndromes of protein-energy malnutrition

A

MARASMUS

  • Wasted
  • Wizened
  • Withdrawn
  • Apathetic

KWASHIORKOR

  • Occurs in children weaned late from the breast
  • High starch diet
  • Wasting
  • Oedema
  • Depigmented skin
  • Angular stomatitis
  • Hepatomegaly
142
Q

Define Meckels Diverticulum

A

Remnant of the foetal vital-intestinal duct

Contains ectopic gastric mucosa

143
Q

Clinical features of Meckels Diverticulum

A

Painless
Severe rectal bleeding due to peptic ulceration

Rx: Surgical

144
Q

Types of eczema in children

A

Infantile seborrhoeic eczema
Atopic eczema
Napkin dermatitis

145
Q

Presentation of infantile seborrhoea eczema

A

First two months of life
Scaly non itchy rash
Cradle cap, face, flexures and napkin area

Rx: Topical steroids and emollients

146
Q

Clinical features of eczema

A

Dry red itchy rash
Extensors (young)
Spreads to the flexures (old)

147
Q

Dx of eczema

A

Clinical dx
IgE is raised
Food and environmental allergens

148
Q

Treatment of eczema

A

MILD

  • Emollients
  • Mild topical steroid

MODERATE

  • Emollients
  • Moderate topical steroids
  • Topical calcineurin inhibitors
  • Wet wraps

SEVERE

  • Emollients
  • Potent topical steroids
  • Topical calcineurin inhibitors
  • Wet wraps
  • Phototherapy
  • Systemic treatment
149
Q

Effects of steroids on children

A 
Reduced bone density 
Reduced immunity 
Stunted growth 
Suppression hypothalamic adrenal axis
Weight gain
150
Q

Causes of napkin dermatitis

A

Irritant contact dermatitis
Candidiasis
Seborrhoeic dermatitis

151
Q

Define Steve-Johnson Syndrome

A

Immune complex hypersensitivity disorder

Often caused by an adverse drug reaction (Phenytoin, Anti-psychotics, Allopurinol, sulfsazine)

152
Q

Clinical features of Steve-Johnson Syndrome

A

Lower resp tract infection

Clusters of mucocutaneous lesions (palms. soles.dorsums of the hand)

153
Q

Treatment of Steve-Johnson Syndrome

A

Supportive care

154
Q

Define anaphylais

A

Severe hypersensitivity reaction that manifests with respiratory difficultly and cardiovascular distress

155
Q

Pathophysiology of anaphylaxis

A

Rapid degranulation of mast cells and basophils with systemic release of inflammatory mediators, capillary leak, mucosal oedema and smooth muscle contraction.

  • Immunologic: mediated by IgE or immune complexes/complement
  • Non-immnunologic: systemic mast cells/basophil degranulation
156
Q

Treatment of anaphylaxis

A 
Remove allergen where possible
IM adrenaline (1mg/kg) 
IV hydrocortisone and antihistamine can be used to dampen down the response.
157
Q

Treatment of acne vulgaris

A

Topical treatment with keratolytic agents (Benzoyl peroxide)
UV light
Oral antibiotics: low dose therapy with minocycline or oxytetracycline
Vitamini A analogue (13-cis-retinoic acid) for severe acne

158
Q

Define Henoch-Schönlein Purpura (HSP)

A

IgA mediated autoimmune hypersensitivity vasculitis of childhood
Usually preceded by a respiratory infection

159
Q

Clinical features of HSP

A

Skin purpura
Arthritis
Abdominal pain
GI bleeding
Orchitis
Low grade fever
Erythematous macular rash (will become purpuric lesions)
Renal disease (nephritis, can develop into end stage renal failure)
Microscopic haematuria with moderate proteinuria

160
Q

Risk factors for developing HSP

A

Infections

  • Grp A streptococci
  • Mycoplasma
  • EBV
Vaccinations 
Environmental allergens  (Drug and food allergies)
161
Q

Dx of HSP

A

Clinical dx

Investigations will reveal
Increased WCC
Increased ESR
Increased IgA

Must to autoantibody screen

162
Q

List the most common paediatric malignancy

A 
Leukaemia 
Brain tumours 
Lymphoma 
Neuroblastoma
Nephroblastoma
163
Q

Clinical features of Acute lymphoblastic leukaemia

A

BM features

  • Anaemia
  • Thrombocytopenia (bleeding)
  • Leukopenia (infections)

Pallor
Malaise
Anorexia
Lympadenopathy

164
Q

Key finding on investigation of ALL

A

Increase lymphoblasts
Decrease RBC
Decrease platelet
BM aspirate = > 20% blasts

165
Q

Treatment of acute lymphoblastic leukaemia

A 
Induction 
Consolidation 
Interm maintenance 
Delayed intensification 
Maintenance

Girls maintenance = 2 yrs
Bos maintenance = 3yrs

166
Q

Types of CNS tumours

A

Astrocytoma
Medulloblastoma
Glioma of the brainstem
Craniopharyningoma

167
Q

Presentation of SOL in the brain

A 
Headache ( worse on lying down)
Vomiting ( morning time)
Papilloedema 
Ataxia 
Nystagmus 
Back pain 
New onset seizures
168
Q

Types of lymphoma

A

Hodgkins (adolescences)

Non-Hodgkins ( childhood)

169
Q

Clinical features of hodgkins

A

Painless
Asymetrical
Spread continuously to adjacent lymph node

B symptoms

  • Fever
  • Weight loss
  • Night sweats
170
Q

Investigations of Hodgkins

A

LN excisions biopsy = REED STENBERYG CELLS

171
Q

List the staging system of Hodgkins

A

Ann Arbour (1-4)

172
Q

Treatment of Hodgkins

A

Combination chemo
ABVD regimen
BMT if relapse

173
Q

Clinical features of Non-Hodgkins lymphoma

A

Painless
Symmetrical
Discontinuous spread

BM Features

  • Pancytopenia
  • Hyper viscosity
174
Q

Types of non-hodgkin lymphoma

A

B-cell

  • Small cell lymphocytic
  • Diffuse large B cell
  • Low or high grade

T-cell

  • Anaplastic
  • Enteropathy
175
Q

Treatment of Non-Hodgkin lymphoma

A

R-CHOP regimen
BMT

If low grade only treat when symptomatic

176
Q

Explain the pathophysiology of neuroblastoma

A

Arise from the neural crest cells in adrenal medulla and SNS
Benign to highly malignant
<5yrs

177
Q

Clinical features of neuroblastoma

A 
Pallor 
Wt loss
Abdo pain 
Hepatomegaly 
Bone pain
178
Q

Investigations of neuroblastoma

A

Increase urinary catecholamines

179
Q

Explain the pathophysiology of Wilms tumour

A

Originates from embryonal renal tissue

180
Q

Clinical features of Wilms tumour

A 
Abdo pain 
Anorexia
Anaemia
HTN 
Haematuria
181
Q

Explain pathophysiology of retinoblastoma

A 
Malignant tumour of the retinal cells 
Bilateral tumour 
Hereditary RBI gene 
White pupillary reflex ( loos of red reflex) 
Squint
182
Q

Discuss the physiology of foetal circulation

A

Foramen ovale and ductus arteries can remain patent beyond the neonatal period

Foetus: left atria @ low pressure, little blood returning from the lung, increase pressure @ right atria

BREATHES

Resistance to pulmonary blood falls
Increase in blood flow to the lungs
Increase in left atria pressure

Pressure changes = Foreman ovale to close

183
Q

Dx of congenital heart disease

A 
Antenatal murmur 
Heart murmur
Cyanosis
Shock: low cardiac output
Cardiac failure
184
Q

Types of congenital heart disease

A

Acyanotic (breathless)

Cyanotic (blue)

185
Q

List the features of an innocent murmur

A

Asymptomatic patient
Soft blowing murmur
Systolic murmur
Left sternal age

186
Q

Classify and list the types of left to right shunts

A

Acyanotic condition

  1. Atrial septal defect (ASD)
  2. Ventricular septal defect (VSD)
  3. Patent ductus arteriosus (PDA)
187
Q

Clinical features of ASD

A

Recurrent chest infections

Ejection systolic murmur

188
Q

Treatment of ASD

A

Occlusion device using cardiac catherisation

189
Q

Clinical features of VSD

A

Breathlessness
Heart failure
Recurrent chest infections

Pansystolic murmur

190
Q

Treatment of VSD

A

Small: will close spontaneously

Large: Heart failure rx with diuretics

191
Q

Physiology of patent ductus arterious

A

Connects the aorta to the left pulmonary artery
Closes by 4th day

Risk factors

  • Preterm infant
  • Down syndrome
  • High altitudes
192
Q

Clinical features of PDA

A

Asymptomatic

Bounding pulse

193
Q

Classify and list the types of right to left shunts

A

Cyanotic

  1. Teratology of Fallot
  2. Transposition of the great arteries
194
Q

Anatomical features of TOF

A

Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

195
Q

Clinical features of TOF

A

Murmur
Cyanosis
Tet spells

Harsh ejection systolic murmur

196
Q

Treatment of TOF

A

Management of Tet spells

  • Morphine
  • Sodium bicarbonate
  • Propranolol

Definitive treatment is surgical

197
Q

Anatomical features of transposition of the great arteries

A

Aorta connected to the right ventricle
Pulmonary artery connect to the left ventricle

Blue blood to the body
Red blood to the lungs

198
Q

Clinical features of transposition of the great arteries

A

Cyanosis

Loud singular second heart sound

199
Q

Management of transposition of the great arteries

A

Immediate

  • Infusion of prostaglandin E1 to reopen the ductus arteriosus
  • Emergency cardiac catherization and therapeutic ballon arterial septostomy
200
Q

List the obstructive lesions in congenital heart disease

A

Coarctation of the aorta (COA)
Aortic stenosis
Pulmonary stenosis

201
Q

Features of coarctation of the aorta

A

Narrowing of the aorta
Clinical dx is weak or absent femoral pulses
Asymptomatic child

202
Q

Features of aortic stenosis

A

Thrill
Asymptomatic murmur

Rx: Surgical or ballon valvotomy

203
Q

Pathophysiology of rheumatic fever

A

Sequela of group A beta-haemolytic streptococcal infection

Abnormal immune response

204
Q

Clinical features of RF

A

Polyarthritis
Fever
Malaise

Pericarditis
Myocarditis
Endocarditis

Erythema marginatum: pink macules on trunk and limb

205
Q

Dx and Rx of rheumatic fever

A

Clinical dx of Ducketts Jones criteria
High dose aspirin
Steroids

Prevention is with penicillins

206
Q

Infective endocarditis

A

Child with fever and significant heart murmur

Rx: 4-6 weeks of IV antibiotics (High dose ampicillin + amino glycoside)

207
Q

Cardiac arrhythmias in children

A

Supraventricular tachycardia

Narrow complex tachycardia with P waves after the QRS complex

Rx: Synchronised DC cardioversion

208
Q

Down syndrome (trisomy 21)

A 
Trisomy 21
1 in 650 
Craniofacial appearance 
Delayed motor milestones 
Learning difficulties 
Increase susceptibility to infection
Epilepsy
Alzheimer's disease
209
Q

Edwards syndrome

A

Trisomy 18

Die at infancy or birth

210
Q

Pateaus syndrome

A

Trisomy 13

Die at birth or infancy

211
Q

Turners syndrome

A 
4 (X,)
Short stature
Webbed neck
Delayed puberty 
Hypothyroidism

Rx: GH, oestrogen

212
Q

Klinefleters syndrome

A 
(47, XXY)
Infertility 
Hypogonadism
Normal pubertal development 
Gynaecomastia
Tall stature
213
Q

Unstable genetic mutations

A

Unstable expansion of the trinucleotide repeat
Eg Fragile X syndrome
- Learning difficulties
- Fault @ CGC trinucleotide

214
Q

Mitochondrial inheritance

A

own DNA not maternal DNA
Clusters of overlapping phenotypes
Eg: Leber hereditary optic neuropathy

215
Q

Examples of uniparent disomy

A

Prader-willi syndrome

  • hypotonia
  • developmental delay
  • hyperplasia
  • obesity
  • paternal chromosome 15

Angleman Syndrome

  • Cognitive impairment
  • facial appearance
  • Ataxia
  • Epilepsy
  • Maternal chromosome 15
216
Q

Principle of gene based therapies

A

Involves the repair, suppression or artificial introduction of genes in genetically abnormal cells

217
Q

Cystic Fibrosis

A

Autosomal dominant condition
Chromosome 7
CF transmembrane conductance regulator gene (CFTR)
ATP responsive chloride channel
Mutation DF508
Sodium transport across the respiratory epithelium
Composition of the cell surface glycoprotein

218
Q

Key clinic features of cystic fibrosis

A 
High sodium sweat 
Pancreatic insufficiency 
Biliary disease 
GI disease 
Resp disease
219
Q

Muscular dystrophy

A

Duchenne’s

  • X- linked recessive condition
  • Deletions in the dystrophin gene
  • Abnormal high CK level
  • Progressive condition
  • Delayed motor signs ( not walking by 18 months is huge)

Becker’s

  • Abnormal dystrophin gene
  • Proximal muscle wasting and weakness
  • X-lined recessive pattern
  • Variable prognosis
220
Q

Noonan syndrome

A

“Male Turners Syndrome”

  • Autosomal dominant
  • Mutations in the MAPK pathway
  • Short stature
  • Broad and webbed neck
  • Sternal deformity
  • Developmental delay
  • Increased bleeding tendency
221
Q

Williams syndrome

A

Infantile Hypercalcaemia

  • Mental disability
  • Unusual facies
  • Supravavular aortic stenosis
  • Connective tissue abnormalities
  • Intellectual disability
222
Q

Define a seizure

A

Sudden disturbance in neurological function caused by abnormal or excessive neuronal discharge

223
Q

Causes of seizure

A

Epileptic seizure

  • Malformation
  • Idiopathic
  • Infection
  • Cerebral tumour
  • Neurodegenerative disorder
  • Neurocutanous syndromes

Non epileptic seizure

  • Febrile
  • Hypoglycaemic
  • Hypocalcaemia
  • Hypernatraemia
  • Head trauma
  • Meningitis
  • Toxins
224
Q

Define febrile convulsion

A

Seizure associated with fever in a child between 6months and 6 years of age
Brief ( 1-2 minutes)
Tonic-clonic in nature
Rx: Treat the infection

225
Q

List the types of paroxysmal disorders

A 
Breath holding attacks 
Reflex anoxic seizures 
Syncope
Migraine
BVP
226
Q

Breath holding attacks

A

Temper tantrums in toddlers
Crying
Turns blue
Loss of consciousness

Rx: Behaviour modifications

227
Q

Types of Epilepsy

A 
Generalised 
Focal 
- Frontal 
- Temporal 
- Occipital 
- Parietal
228
Q

General management of epilepsy

A

Anti-epileptic drug therapy ( lowest dose possible to ensure seizure free)
Ketogenic diet
Vagal nerve stimulation
Surgery

229
Q

Define hydrocephalus

A

Enlargement of the cerebral ventricles due to excessive accumulation of cerebrospinal fluid

Caused by either a

  • Intraventricular obstruction
  • Extraventricular obstruction

Rx: Ventriculoperitoneal shunt

230
Q

Causes of hydrocephalus

A

Intraventricular obstruction

  • Congenital malformation
  • Intraventricular haemorrhage
  • Brain tumour

Extraventricular obstruction

  • Subarachnoid haemorrhage
  • TB meningitis
231
Q

Define cerebral palsy

A

Group of conditions affecting motor function and posture due to non progressive lesion of the developing brain

232
Q

Causes of cerebral palsy

A

Antenatal
- Congenital infections (Toxoplasmosis, CMV, Rubella)

Intrapartum
- Birth asphyxia

Postnatal

  • Hypoxia-ischaemic encephalopathy
  • Intraventricular haemorrhage
  • Meningitis
  • Encephalitis
233
Q

Types of cerebral palsy

A

Spastic cerebral palsy

  • Hemiparesis
  • Diplegia
  • Quadriplegia

Ataxic cerebral palsy

  • Damage to the cerebellum
  • Hypotonia and poor balance

Dyskinetic cerebral palsy

  • Hypotonia
  • Delayed motor development
234
Q

Infantile spasms (West syndrome)

A

Uncommon form of epilepsy
4-6 months
Violent flexor spasms of head, trunk and limbs followed by extension
Poor prognosis

235
Q

Classification of neonatal jaundice

A
  1. First 24hrs (ALWAYS PATHOLOGICAL)
    - Sepsis: GBS or Herpes zooster virus
    - Haemolysis: ABO incompatibility or rhesus incompatibility (Hb will drop very quickly)
  2. 24-48hrs
    - Normal physiological ( Breast fed babies)
    Rx: phototherapy
    - Sepsis ( as above)
  3. > 14 days
    - Prolonged jaundice
    High levels of conjugate bilirubin
    Screen for
    GBC
    DCT
    FBC
    SBR
    TFT’s

Metabolic causes

  1. Gal-1-put
  2. G6PD
  3. Gilberts syndrome
  4. Alpha 1 antitrypsin

USS of the liver: Look for the binary tree atresia

Note uncojuncated bilirubin will cross the blood brain barrier
Result in kernicterus ( build up of bilirubin in the basal ganglia)

236
Q

List the core symptoms of ADHD

A

Inattention

  • easily distracted
  • does not listen when spoken to
  • dislikes task requiring mental effort
  • hard to follow instructions

Hyperactivity

  • squirms and fidgets
  • cannot sit still
  • talks excessively

Impulsivity

  • blurts out answers to questions
  • difficulty waiting turn
  • poor road safety
237
Q

Diagnosis of ADHD

A

Clinical interview
Behavioural observation
Information from 3rd parties

238
Q

Rating scale used for ADHD

A

Conner’s

Always must screen for comorbidities or organic causes

239
Q

Treatment of ADHD

A

Education and parenting support
School support and liaison ( behavioural management)

Medication 
Not for preschool kids 
- Methylpendiate 
- Atomexitine
- Lisdexameftaime

Psychosocial treatment

  • CBT
  • Family therapy
  • Art and music therapy
240
Q

Define autism spectrum disorder

A

Abnormal or impaired development before the age of 3

Abnormal functioning in social interaction, communication and repetitive behaviour

241
Q

Core symptoms of autism

A

Persistent deficits in social communication and social interaction across multiple contexts
Restricted repetitive patterns of behaviour, interests or activities.

TRIAD

  1. Social interaction
  2. Imagination/ Rigid pattD erns of behaviour
  3. Poor range of activities/ interests
242
Q

Management of ASD

A

Early intensive behavioural intervention +/- speech therapy
Parent training
Support
Social skills training
Drugs ( Risperidone- aggression, melatonin- sleep, SSRI’s - repetitive behaviour)
Benefits: Disability living allowance

243
Q

List the types of hearing loss

A

CONDUCTIVE

  • Glue ear
  • Ear wax build up
  • Middle ear infection
  • Perforated eardrum

SENSORY

  • Damage to the cochlea
  • Permanent
  • Manage with hearing aids
244
Q

When are the test of auditory function performed

A

NEWBORN
- Conduct in the prescences of high risk

7-9 months
- All children

18-24 months

  • speech discrimination tests
  • in kids with suspected hearing loss

School entry

  • Sweep test
  • Screen all children
245
Q

Features of periorbital cellilutisis

A

Eyelid oedema
Erythema
Chemosis

Orbital signs
Proptosis
Gaze restriction
Blurred vision

246
Q

Treatment of periorbital cellulitis

A

Fluoxicillin

Cefotaxime

247
Q

Define vesicoureteric reflux

A

Urine refluxes up to the ureter during voiding
Predisposing to infection
Screening siblings due to strong genetic component
Dx with micturating cystourethrogram

248
Q

Haemolytic uraemic syndrome

A

Common cause of acute renal failure in children

Associated with diarrhoea from Shigella or E.coli

Features

  • Glomerular microangiopathic haemolytic anaemia (RBC fragmentation
  • Thrombocytopenia

Management

  • Supportive
  • Antibiotics are contraindicated as they induce expression and release of Shigella endotoxin.
249
Q

Features of amblyopia

A

Defective visual acuity, persists post correction of the refractive error and removal of pathology

250
Q

Treatment of amblyopia

A

Refractive adaption
Occlusion of good eye
Atropine eye drops in the good eye

Aim: equal vision in both eyes

251
Q

Causes of undescended testes

A

Common congenital genitourinary anomaly

252
Q

Treatment of undescended testis

A

Treatment is by orchidopexy

Increased risk of malignancy, sub fertility and torsion

253
Q

Causes of congenital hypothyroidism

A 
Developmental defects (thyroid agencies)
Dyshormonogenesis (inborn error of thyroid hormone synthesis)
254
Q

Clinical features of congenital hypothyroidism

A

Prolonged neonatal jaundice
Feeding problems

Coarse facies 
Large fontanelle 
Large tongue 
Hypotonia 
Goitre

Rx: Thyroxine

255
Q

Define Kallamans syndrome

A

Hypogonadotropic Hypogonadism

Delayed puberty and impaired sense of smell

256
Q

Define Perthes disease

A

Osteonecrosis of the femoral head prior to skeletal maturity.
Leads to growth disturbance with temporary ischaemia of the upper femoral epiphysis
Cycle of avascular necrosis with flattening and fragmentation of femoral head.

Insidious limp between 3-12 years
Intermittent pain
Mild disease: analgesia and activity restriction
Moderate/ Severe: fixation of the hip in abduction

257
Q

Define transient synovitis

A 
Children 2-12 
Sudden onset hip ain 
Limp
Refusal to weight bear on the affected side 
Supportive care
Resolves in 2 weeks
258
Q

Define developmental dysplasia of the hips

A

Spectrum of hip instability ranging from a dislocated hip to hip with various degrees of acetabular dysplasia.

259
Q

Clinical features of developmental dysplasia of the hips

A 
Delayed walking 
Painless limp
Waddling gait 
More common in girls 
Allis sign ( shortened femur)
260
Q

Management of development dysplasia of the hips

A

<8 months

  • Fixing the hips in abduction
  • Pavlik or Von Rosen harness

Older children need surgery

261
Q

Cause of osteomyelitis

A

Haematogenous in origin or secondary to an infected wound
Starts at the metaphysics
Staphaureus or Grp B strep

262
Q

Clinical features, diagnosis and treatment of osteomyelitis

A

Fever
Refusal to move affected limb
Systemically unwell
Tenderness over affected bone

Increase in acute phase reactants
+ve blood cultures

TREATMENT
IV Abx
Several weeks of oral abx

263
Q

Define septic arthritis

A

Purulent infection of the joint space

Lead to bone destruction and considerable disability

264
Q

Clinical features of septic arthritis

A

Fever
Irritability
Refusal to weight bear
Pseudoparalysis

265
Q

Treatment of septic arthritis

A

Prolonged IV antibiotics

266
Q

Define kohler’s disease

A

osteochondrosis of the tarsal navicular bone.

267
Q

Define Osgood-schlatters disease

A

caused by multiple small avulsion fractures from contractions of the quadriceps muscles at their insertion into the proximal tibial apophysis

268
Q

Clinical features of measles

A

Prodrome ( 4 C’s)

  • Cough
  • Coryza
  • Conjunctivitis
  • Cranky

Koplik spots

Rash appears ( starts behind the ears)

269
Q

Treatment of measles

A

Isolate
(Hospitalisation if immunocompromised)
Adequate nutrition (Catabolism is very high)
Treat any secondary bacterial infection

270
Q

Cause and clinical features of rubella

A 
Rubivirus 
Devastating effect on the foetus in pregnant women 
Low grade fever 
Pink-red maculopapular rash 
Generalised lymphadenopathy
271
Q

Pregnancy and rubella

A

Rubella is a notifiable disease

All pregnant women should be screened for anti rubella IgG/ IgM

272
Q

Cause of chickenpox

A 
Varicella zoster virus 
Transmitted by 
- Droplet infection 
- Direct contact 
- Contact with soiled materials
273
Q

Clinical features and treatment of chicken pox

A

Brief coryza period
Itchy vesicular rash

Symptomatic treatment in healthy children
Immunocompromised: VZIG

274
Q

Causes and clinical features of diphtheria

A

Corynebacterium diphtheria

Tonsillitis + polyneuritis ( starting with the cranial nerves)
Bronchopneumonia
Muffled voice

275
Q

Treatment of diphtheria

A

Diphtheria antitoxin and erythromycin

276
Q

Cause and clinical features of polio

A

Poliovirus ( enterovirus) spread by faecal oral transmission
Fever
Headache
Malaise

277
Q

Causes of scarlett fever

A

Endotoxins released from Strep progenies

278
Q

Clinical features of scarlett fever

A

Sore throat
Fever
Rash on chest, axillae or behind the ears

Pin prick blanching rash
Facial flushing with circumpolar pallor
Strawberry tongue

279
Q

Treatment of Scarlett fever

A

Penicillin 10 days

280
Q

Clinical features of coxscakie virus

A

Aseptic meningitis
Myocarditis
Pericarditis

281
Q

Clinical features and treatment of encephalitis

A

Flu-like prodrome
Decreased consciousness
Odd behaviour
Fits and vomiting

Causes

  • Parovirus
  • HSV
  • TB
  • Mycoplasma
  • TB

Treatment depends on the cause

282
Q

Define child abuse

A

Deliberate infliction of harm,bullying or neglect or failure to prevent harm

283
Q

Define neglect

A

Persistent failure to meet a child’s basic psychological needs to result thats that is likely to result in serious impairment of the child’s health and development

Paediatrics (3 decks)

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