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Paeds Flashcards

1
Q

Bronchiolitis poem?

A

In kids under 1, there’s a common disease
With cough, snotty nose, crackles and wheeze
Always record the respiratory rate
If it’s severe, they’ll desaturate

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2
Q

Acyanotic vs Cyanotic heart disease examples for each?

A

Acyanotic:

  • VSD
  • ASD
  • PDA
  • pulmonary stenosis
  • aortic stenosis
  • co-arctation

Cyanotic:

  • ToF
  • Transposition of the great arteries
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3
Q 
MURMURS!!
ASD?
VSD? - differentials?
AS / pulmonary stenosis?
PDA?
Innocent murmur?
A

ASD - wide-fixed splitting s2 (delayed closure of P2)

VSD - pan-systolic (burrrrrr) - DDx - MR / TR

AS / PS - ejection systolic

PDA - machinery murmur (continous murmur)

Innocent - soft ejection systolic - LEFT STERNAL EDGE

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4
Q

What keep PDA open? How to close?

A

Open - prostaglandins

Closed

  • indomethacin / ibuprofen
  • Transcatheter occlusion / surgical ligation
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5
Q

VSD Ix + treatment? Small vs Large?

A

ECG (RVH), CXR, ECHO

Small: - None
Large:
- Repair (if risk of Pul HTN)
- Diuretics + ACE-I - for HF

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6
Q

ASD treatment?

A

Trans-catheter closure - via femoral vein + IVC to R atrium

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7
Q

ToF features?

What posture might the kid take - why?

A 
PROVE
(Infundibular) Pulmonary stenosis...causing:
RVH
over-riding aorta
VSD - R-->L shunt
Ejection systolic murmur 
CYANOSIS + CLUBBING
Squatting posture (partially occludes femoral = ^systemic resistance = more blood flow into PA through PDA = better oxygenation)
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8
Q

Surgery for ToF before definitive?

A

Blalock-Taussig shunt = R subclavian to Pulmonary artery

Helps PA flow + helps develop them

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9
Q

Transposition of great arteries:

  • association
  • Mx before definitive operation?
A

MATERNAL DIABETES!!

Prostaglandin infusion - keep PDA - DUCT DEPENDANT LESION
Atrial septostomy - encourage mixing

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10
Q

Down’s syndrome face / head features?

Others?

A

ROSEOLA (n.b. roseola not more common in down’s)
Round face
Occipital flattening (&nasal flattening)
Speckled iris (Brushfield spots) + Squint
Epicanthic folds
Open mouth + protruding tongue
Low set ears
Almond (oval) up-slanted eyes

Others:
Hand - single transverse palmar crease, short fingers, curved little finger
Feet - sandal gap

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11
Q

Down’s associations?

Heart specific? -bit on embryo pls

A 
Duodenal atresia (double bubble)
Hypothyroid, coeliac, Hirschprung's, squint, leukaemia

HEART: - endocardial cushion defect –> failure of septation

  • ASD, VSD
  • AV canal defect - low ASD + high VSD
  • MR + TR
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12
Q

Roseola? What is it?

A

6th disease! 3+3
Mild viral infection - herpes virus 6
Age 6months - 2 years

3 days fever –> 3 days viral macules on chest (i.e. 3+3)

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13
Q

Kawasaki’s age + symptoms?

Major complication?

A

6months-5years
CRASH and BURN (MyHEART as well ;) )

Conjunctivitis (bilateral + non-purulent)
Rash - non-vesicular
Adenopathy (cervical + unilateral)
Strawberry tongue + inflammation of mouth + lips (cracked lips)
Hands/feet - palmer erythema/swelling/desquamation (2-5days after onset)

Fever > 5days (BURN)

Comp - coronary artery aneurysm!! (do ECHO) –> deaths+signif. morbidity

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14
Q

Heart Failure - symps, signs, causes (neonate + infant)

A

symps:
poor feeding, sweating, SOB, poor weight gain, recurrent chest infections

Signs:

  • tachypnoea, tachycardia
  • extra HS - ‘gallop’ rhythm
  • cardiomegaly, hepatomegaly

NEONATES - hypoplastic left heart, co-arctation
- VSD + PDA - L–>R shunts

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15
Q

Rheumatic Fever Tx + Organism

Diagnostic Criteria?

A 
Group A B-haemolytic Strep - PYOGENES
JONES criteria - 2major / 1major+2minor - (JONES PEACE)
Joints - large joint arthritis 
O - carditis 
N - nodules - painless + subcutaneous 
E - erythema marginatum 
S - syndenham's chorea
P - PR interval prolongation 
E - ESR v raised
A - arthralgia 
C - CRP raised 
E - elevated temp

Aspirin
Benpen - help strep throat
Prednisolone - for Syndenhams chorea (consider haloperidol)

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16
Q

Infective endocarditis:
Most common symps?
Signs

A

*Most common - fever, chills, weight loss, poor appetite

FROM JANE:
Fever>38 + tachycardia
Roth spots - eyes, retinal haemorrhage with pale centre
Osler’s nodes - painful red blisters @ terminal phalanges + toes
Murmur - tricuspid w/ s.aureus

Janeway lesions - painless red maculae on thenar eminence
Anaemia/arthritis: subacute - >3 joints (asymmetrical). acute: 1 joint septic
Nail splinter haemorrhages
Embolic phenomena - e.g. stroke

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17
Q

Co-arctation.
Association?
Key sign? Murmur?

A

TURNER’S!

Radio-femoral delay
Systolic murmur over BACK

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18
Q

Only Tx option for Eisenmengers?

A

heart-lung transplant

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19
Q

Paediatric Basic Life support algorithm?

A

DR ABC
DANGER:
SAFE approach (shout for help, approach with care, Free from danger, evaluate response)

RESPONSE - ‘are you okay?’

AIRWAY - head tilt, chin lift, jaw thrust

BREATHING:

  • look, feel, listen
  • 5 RESCUE BREATHS (different to adult as doing this first)

CIRCULATION: - pulse (>60) - CPR if <60

15 CHEST COMPRESSION : 2 BREATHS

999 after 5rounds / 1 minute!!

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20
Q

Common life support q’s:
How long to continue CPR?
When perform CPR in presence of pulse?
What are signs of life?

A

1.
until further help arrives
until signs of life noted
until exhausted

  1. <60
    thready pulse in collapsed child
    no signs of life
  2. spontaneous breathing
    spontaneous movement
    response to stimulation
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21
Q

Anaphylaxis.
Features
Management algorithm

A

Mucosal membrane swelling, increased bronchial smooth muscle tone, loss of vascular, ^capillary permeability

Urticarial rash, wheeze, stridor, lips/face/tongue swelling

1.
ABCDE

2.
Call for help & remove allergen

3.
Adrenaline IM (repeat after 5mins) 1in1000!!!
 - 0.15ml <6yrs
 - 0.3ml 6-12yrs 
IV fluid bolus - hypotension 
Neb salbutamol
  1. (following intial resus)
    - IV hydrocortisone
    - Antihistamine - chlorphenamine
    - Blood IgE panel / skin prick test
    - education of apotting anaphylaxis + auto-injectors (i.e. epipen)
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22
Q

Meningococcal sepsis bug? gram pls

Meningitis features
Sepsis features

A

N. Meningitidis - g-ve diplococcus

Meningitis:

  • Neck stiffness
  • Kernig’s
  • Photophobia
  • BULGING FONTANELLE - ^ICP

Systemic sepsis:

  • Non-blanching rash
  • reduced consciousness
  • shock
  • multi-organ failure
  • DIC
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23
Q

TRAFFIC LIGHT SYSTEM.

General upset for intermediate risk? Amber

A 
AMBER
Appears pale (to parent/carer)
Mucous membranes dry / reduced intake 
Behaviour / responsiveness reduced
Elevated resp / HR
Rigors
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24
Q

V general meningitis Mx?
Additional points if:
If shocked?
If raised ICP

A

LP
IV ceftriaxone (+dexamethasone)
[BenPen if community]

Shocked:

  • No LP
  • add bolus 0.9% saline
  • consider inotropes

raised ICP:
- NO LP!!!!!!!!

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25
Q

DKA Mx?

What rule for fluid calculation in exam specifically in DKA?!?!?

A

ABCDE

0.9% saline (NaCl)
Insulin
K+ - to correct it as it falls

If shocked = give bolus - REDUCED FLUID RULE (10ml/kg 0.9% saline)

FLUID RULES:
Dehydration:
-10% if severe = pH <7.1
-5% if mild = pH >=7.1

Reduced fluid rule - DUE TO RISK OF CEREBRAL OEDEMA
- <10kg = 2ml/kg/hr
- 10-40kg = 1ml/kg/hr
0 >40kg = fixed 40ml/hr

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26
Q

Status epilepticus management!

A

Oh My Lord Phone the Anaesthetist

Oxygen (after ABC)
Midazolam (buccal / rectal diazepam / IV lorazepam)
Lorazepam IV
Phenytoin IV
Rapid induction of anaethesia - risk of aspiration!!

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27
Q

ALL - 3comps + bit on path + Tx for each

A

Bone marrow failure

  • malignant infiltration of bone marrow
  • Pancytopaenia
  • Transfusion / BM transplant

Neutropenic Sepsis

  • low WBC
  • Broad spec ABx

Tumour Lysis Syndrome

  • Renal failure - SECONDARY to:
    • ^urate, ^phosphate, ^ potassium
    • AFTER STARTING CHEMO
  • hyperhydration, allopurinol, dialysis, rasburicase
  • sort ^K+
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28
Q

4 types of child abuse?

A

Physical (NAI)
Emotional
Sexual
Neglect

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29
Q 
Osteogenesis imperfecta
what is it / path?
genetics?
symps/features? 
2 associations 
X-ray features - 2 pls
A

Group of conditions affecting collagen
Results in brittle bones=prone to #
AD - affects type 1 collagen

Blue sclera 
Triangular face 
Lax ligaments
Fractures from low force 
Hearing loss - later on

Aortic regurg
Otosclerosis - conductive deafness

Osteopaenia + multiple healed fractures

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30
Q 
Monogolian blue spot 
What / where are they? 
Ethnicity? 
Do they go away?
May be confused with?
A

Blue/grey discolouration present from birth
Buttocks + base of spine (also wrists)

Asian / afro-carribean

Yes after about 5 years

Can be confused with bruising - i.e. ?NAI

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31
Q

Scalded skin syndrome
What is it? Bug?
Appearance?
Where does it affect?

A

Superficial staph infection

Thin walled bullae - rapidly burst
erythematous base - looks like a burn

skin folds + axilla affected

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32
Q 
Vaccines?
8 week
12 week 
16 week
1 year
Pre-school booster 
14 years

extra? i.e. girls / flu jab age?

A

DTPP - diptheria, tetanus, polio, pertusiss
HiB - H. influenza B

8 weeks - 2/12

  • 6 in 1 - DTPP, HiB, Hep B
  • Pneumococcal
  • Men. B
  • Rotavirus (oral)

12 weeks - 3/12

  • 6 in 1 - DTPP, HiB, Hep B
  • Rotavirus (oral)

16 weeks - 4/12

  • 6 in 1 - DTPP, HiB, Hep B
  • Pneumococcal
  • Men. B

1 year

  • HiB with Men C
  • Pneumococcal
  • Men B
  • MMR

Pre-school

  • 4 in 1 - DTPP
  • MMR

14 years

  • 3 in 1 - DTP (no pertussis)
  • Men ACWY

EXTRAs:

  • Annual Flu jab - age 2-7
  • HPV x2 - Girls 12-13
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33
Q 
Turner syndrome
Path/Genetics 
Features 
Associations 
Diagnosis
Management: drugs + monitor what?
A

1in2500 born girls!
Complete / partial absence of one of X chromosomes

SHORT STATURE + INFERTILITY
Neck webbing
Broad chest - wide nipples
Cubitus valgus - elbow angle out body wider

COARCTATION OF AORTA (?other cardiac defects aswell)
renal anomalies, AI thyroiditis, diabetes, learning difficulties, HTN, MIDDLE EAR DISEASE

Karyotype analysis

MDT - incl endocrine

  • GH - optimise final height
  • sex hormone replacement
    • oestrogen - induce secondary sexual charact
    • progesterone - induce menstruation
  • IVF - for fertility
  • Monitor - BP, diabetes, thyroid disease, hearing loss
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34
Q

GORD
Why does it occur? - think structural
When is it diagnosed over colic?
Complications of gord?

Management:

  • simple measures
  • stepwise approach
A

IMMATURE LOWER OESOPHAGEAL SPHINCTER

Colic = many babies pull legs up, arch backs and scream after feeds 
GORD 
 - constantly miserable
 - coughing / wheezing after feeds 
 - failing to put weight on

Comps:

  • faltering growth / failure to thrive (vomming milk)
  • oesophageal stricture (acidity in oesoph)
  • Resp comps
    - apnoeic episode
    - reccurent micro-aspiration w/ wheeze/pneumonitis
Mx
Simple: 
 - wind baby
 - smaller, more frequent feeds
 - keep baby upright during feeds 
 - add thickeners to feeds

Stepwise:

  • Trial thickened formula = 2 weeks
  • alginate = 2weeks (GAVISCON)
  • ONLY if others failed + comps = PPI / H2 receptor antagonist:
    - omeprazole / ranitidine
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35
Q 
GI RED FLAGS = to query other Dx? 
Projectile vomit? 
Green, bile stained vomit? 
Chronic diarrhoea? 
Haematemesis / melena?
Persists beyond 1 year? 
Acutely unwell with vomiting?
A

?Pyloric stenosis

?Obstruction / NEC / Gastroenteritis

?Cows milk protein allergy

? cause of bleeding

?UTI / other

?Sepsis

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36
Q

Gastroenteritis
Bugs. More commonly viral or bacterial?
Treatment?

A

VIRAL - more common!
- rotavirus, adenovirus
Bacteria:
- Salmonella, Campylobacter, E.coli

SELF-LIMITING
some need admission for rehydration

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37
Q

Signs of dehydration

A 
Dry mucus membranes
reduced urine output - less wet nappies? 
reduced skin turgor
sunken eyes / fontanelle 
tachycardia
lethargic/irritable
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38
Q 
Haemolytic Uraemic Syndrome (HUS)
Aetiology, bugs? 
Path
Commonest cause of what in kids? 
TRIAD??
Best Ix? What is seen?
Mx?
A

1-2 after onset of diarrhoea - E.coli (also shigella, campylobacter)
E.coli ‘shiga toxin’ –> endothelial damage in kidneys –> activation of coag cascade + microvasc thrombosis –> platelet aggregation (CONSUMPTION THROMBOCYTOPAENIA) –> fibrin/mesh partly occludes renal vessels (AKI) –> mesh shreds RBCs + fragments them (HAEMOLYTIC ANAEMIA w/ SHISTOCYTES)

commenest cause of AKI! (in kids)

TRIAD - AKI, LOW PLATELETS, HAEMOLYTIC ANAEMIA

FBC + Blood film

  • SCHISTOCYTES
  • low platelets, low Hb

Mx:

  • supportive +/- transfusion
  • dialysis for AKI
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39
Q

Pyloric stenosis
path/what is it?
Age?

CLASSIC FEATURE?

IX - classic findings?

Mx?

A

commenest surgical emergency in infancy!
Hypertrophy of gastric pylorus muscle (sphincter)
3-12weeks

NON-BILLOUS PROJECTILE VOMIT (yellow)
Watch for hyperperistalsis

HYPOKALAEMIC, HYPOCHLORAEMIC METABOLIC ALKALOSIS

U+Es - low potassium, low chloride
USS - thickened+lengthened pyloric muscle
Cap blood gas - metabolic alkalosis (i.e. high bicarb + BE)

Mx:

  • ABC + nil by mouth
  • NG tube
  • IV access - fluid resus + maintenance
  • Ramstedts pyloromyotomy
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40
Q

Pyloric stenosis buzzwords - i.e. Ix findings?

A

HYPOCHLORAEMIC, HYPOKALAEMIC, METABOLIC ALKALOSIS

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41
Q

Why lose K+ in Pyloric stenosis - 2 reasons

Why no alkalaosis in gastroent, but is in PS?

A
  • lose stomach acid - K lost as KCl
  • dehydration kicks off RAAS - K+ lost (aldosterone)

in gastroent = BOTH stomach acid + alkali small bowel contents –> evens out

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42
Q 
Intussusception 
Emergency? 
Age? 
What may trigger it?
Features?
Diagnostic Ix - CHARACTERISTIC FINDING?
Management?

DDx if reccurent - 2 pls

A

EMERGENCY!!
6mnths - 2yrs
Preceding viral illness - lymph node ‘lead point’

Episodic pain, indrawing of legs, pallor
RECURRANT JELLY STOOL - late sign (blood+pus in stool)

TARGET SIGN - on USS (diagnostic)

ABC
Air enema reduction / surgery

Polyp / meckel’s diverticulum

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43
Q 
Coeliac disease 
What is it?
2 antibodies present?
Genetics? 
Features
Ix + diagnostic test? - What do you see - TRIAD
Associations? 
Tx?

Comps if left undiagnosed?

A

Autoimmune allergy to gluten in wheat/barley/rye

Anti tissue transglutaminase Abs (Anti-tTg)
Anti endomysial Abs (Anti-EMA)

HLA-DQ2 + DQ8

Steatorrhoea
Faltering growth + short stature - kid smallest in class
5-6 loose stools per day

Distended abdo
Wasted buttocks
Pallor (anaemia) - iron deficient

Serology - Abs 
HLA testing 
Jejunal biopsy - DIAGNOSTIC
 - villous cell atrophy
 - crypt hyperplasia
 - lymphocytic infiltrate

DERMATITIS HERPETIFORMIS!!!!
other AI - pernicious anaemia, Hashimoto’s, T1DM

Lifelong gluten free diet
Gluten re-challenge if diagnosed <2years / diagonstic uncertainty (e.g. cows milk protein allergy)

Anaemia, faltering growth, osteopaenia = if left undiagnosed

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44
Q

UC or Crohns more common in kids?

A

CROHNS - childhood + adolescence

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45
Q

Cow’s milk protein allergy
Immunology?
Features?
Mx?

Do they grow out of it - if so what age?

A

IgE or IgG associated

Widespread urticaria, facial swelling
Loose stools, failure to thrive, colic/GORD
Severe - anaphylaxis type thing - wheeze, stridor, blood/mucus in stool, shock/collapse

Confirmed in blood with cows milk challenge
Skin prick test
IgE in blood - RAST test

Mx:
AVOID COW’S MILK
- in breastfed babies - mother avoid cows milk
- in formula fed - hypoallergenic extensively hydrolysed / amino-acid formula

Antihistamines - if allergic reaction
Adrenaline = if bad

Usually grow out of it by 5

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46
Q

Signs of resp distress?

A 
Head bobbing
Nasal flaring
Tracheal tug 
Tachypnoea 
Recessions 
Use of accessory muscles
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47
Q 
Bronchiolitis 
Age? 
Bug?
Features? - rule of 3's (how long does disease last)?
Ix? In what cases are these done? 
Mx? - what not to give?
A

kids under 1
RSV!!! others: adenovirus, influenza, parainfluenza

9 DAY ILLNESS

  • 3 days - coryza + harsh cough
  • 3 days ill w/ fever (<39), wheeze, fine inspiratory crackles, breathlessness
  • 3 days recovering

NOT DONE UNLESS SERIOUS - i.e. CYANOSIS

  • cap blood gas - resp acidosis?
  • nasal swab - resp viruses
  • ?cxr - not routine

Mx:

  • Fluids, oxygen, resp support (if needing admission)
  • if Severe! = HDU/PICU - CPAP, IV fluids

DO NOT GIVE

  • STEROIDS
  • ABX, BRONCHODILATERS
48
Q

What prompts admission for bronchiolitis?

A

DRAMAS

Dehydration 
Resp rate >70 / marked increased WOB - recession/grunting
Apnoeic episodes 
Milk/fljuid intake <50% of normal
Appearance - ill / exhausted 
Sats <92%
49
Q

Children that are high risk for bronchiolitis? 4 things

What are they given during autumn winter - monthly IM for 6 months

A

Premature
Chronic lung disease
CF
Congenital heart disease

Palivizumab - monoclonal AB to RSV

50
Q

Asthma Ix + signs of severe asthma?

A

5 PROPS

Peak flow - <50% best/predicted
RR >30
O2 sats <92%
Pulse >125/min
Sentances - too breathless to talk
51
Q

Life threatening asthma?

A

33, 92 CHEST

PEF < 33% best/predicted
Sats < 92% .... and any one of: 
 - Cyanosis
 - Hypotension 
 - Exhausation w/ poor resp effort
 - Silent chest
 - Tired / confused (i.e. reduced conscious level)
52
Q

CHRONIC ASTHMA MANAGEMENT
>5?
<5?

A

> 5 = SAME AS ADULTS - but remove LTRA after step 3 –> whereas in adults it becomes (+/- LTRA)

<5 - essentially STOP AT STEP 3

  • SABA
  • SABA + 8week trial moderate ICS
  • SABA + ICS + LTRA
53
Q

ACUTE ASHTMA MANAGEMENT - kids
mild/moderate?
severe?

A

mild/moderate:

  • inhaled salbutamol - SPACER NOT NEBULISER
  • oral prednisolone

Severe = OSHITMS

54
Q

Asthma
Description
Age
Associations

A

Reversible airway obstruction
usually >5
History of atopy? - hayfever, allergy, eczema

55
Q 
Viral induced wheeze 
What is it?
Typical age? 
Important point/question to ask that can exclude asthma?
Mx?
A

Wheeze episode - associated w/ viral URTI
typically children <5years
absence of strong atopy hx - eczema, hayfever

Treat as acute asthma - but only give steroids if pre-existing/suspected asthma

56
Q 
Croup
Description?
Bug?
Age?
Features? If severe - what added + what sats?
Mx? if mild / mod / severe
A

Acute viral laryngotracheobronchitis
PARAINFLUENZA (others: RSV, influenza)
6months to 6years

Mild fever, hoarse voice
BARKING COUGH
STRIDOR
+/- resp distress (severe = marked + <94% sats)

Mx
Every child = DEXAMETHASONE +/- adrenaline nebs
Moderate (some resp distress + features) - add neb budesonide
Severe (marked resp distress + constant features) - add neb adrenaline

57
Q

Epiglottitis
Bug? - common cause of this?
Difference in severity to croup - differentiating feature (other than barking cough)?
Mx?

A

SERIOUS!!
H.influenza - due to HiB vaccine

Very unwell + toxic (croup = mild-severe)
DROOLING - not seen in croup

LEAVE ALONE - get ENT/anaesthetist
Abx after securing airway

58
Q 
Bronchiolitis vs Croup vs Viral Wheeze
Age
In Common - maybe a bit too obvious hehe
Typical differences / characteristic features
Basic mx for each
A

Common features:

  • ^WOB
  • ^RR

Bronchiolitis
<1years
expiratory Wheeze, inspiratory crackles
Supportive Mx

Croup
6months - 6years
Barking cough, inspiratory stridor, NO crackles
Dexamethasone

Viral induced Wheeze
<5years
Wheeze, NO STRIDOR, NO CRACKLES
Bronchodilators (i.e. same as acute asthma)

59
Q

Cystic fibrosis
AD or AR?
Mutation?
Brief path –> lead on to what this causes –> symps

Main bug in CF infections?

Ix - what is seen on each?

MDT - who’s involved?

A

AR!! F508 mutation

Mutation = abnormal CFTR (CF transmembrane conductase regulator protein) –> responsible for Cl transport!
= Thick secretions
= Pancreatic insufficiency (DM + Malabsorption)
+ Recurrent chest infections / Bronchiectasis

= Faltering growth / poor health / failure to pass meconium / chronic wet cough / clubbing (bronchiec)

Pseudomonas aeruginosa (H.influ, S.aureus, Klebsiella)

Newborn screening - ^ immunoreactive trypsin
Genetics - F508
Sweat test - GOLD = ^chloride - 2 abnormal for Dx
CXR - hyperinflation, bronchial thickeneing
Sputum - C+S

MDT:

  • Dietician
  • Physio
  • Medical
    • GP, Resp, GI, Endocrine, Paediatrician
  • Nurses
60
Q

Nephrotic syndrome (Non-proliferative)
Type in Kids? Other 2 types pls
TRIAD?
What is low, what is high? - i.e. in blood
What else is lost - 2 things? - what does this increase risk of - 2 things pls

Ix? what you looking for?

A

Minimal change in KIDS!
Membranous
FSG

Proteinuria, Oedema, Hypoalbuminaemia

Albumin low
Hyperlipidaemia –> compensatory liver protein synthesis

Loss of immunoglobulins - infection
Loss of anti-thrombin III - risk of clots!

FBC - haematocrit (intravascular volume depletion) + infection
U+E & creatinine - renal function
LFT - albumin
Urine - frothy, +++protein

Mx:
Steroids - pred
IV albumin = if fluid depleted
Penicillin prophylaxis

61
Q

Nephritic
Most common type (hint:what bug) + other 2 pls
TRIAD?

A

Post-infective GN (strep)
IgA nephropathy
Rapidly progressive i.e. cresenteric (i.e. Vasculitis / Anti-GBM)

Haematuria - RBC casts
Oliguria/AKI
HTN

62
Q

HSP - Henoch Schonelein purpura
What is it? What does it usually follow

Age?
TRIAD?
Ix? - what you checking for?
Mx?

A

IgA vasculitis
often recent URTI - Group A strep - Pyogenes
3-10years old

Abdo pain, arthropathy, Purpuric rash
Also renal involvement - i.e. Nephritic (sometimes nephrotic)

ankles, knees, elbows

Urinalysis - is it nephritic?
BP - HTN?
Intussuception ix

Paracetamol - pain
Steroids - kidneys

63
Q

ITP
What is it? what does it usually follow
Features? where do you see it?
Ix - what do you see?

Mx? What to avoid - why?

A

Immunologically mediated destruction of platelets
Often 1-2 weeks after viral URTI

Petechiae + purpura - buttocks extensors

Ix:
Normal Hb, normal WCC
Low Platelets

IV immunogolobulin (IVIg) + steroids 
Transfusion

Avoid NSAIDs + contact sport (risk of incranial haemorrhage)

64
Q 
Transient synovitis - commenest cause of limp in child
What is it? Usually preceded by?
Age? Gender?
Features?
Ix?
Mx?
A

Transiently inflamed synovium of hip joint
usually following viral infection

2-12years. M>F

Unilateral painful limp - may refer to thigh/knee
No pain at rest
Mildly decreased ROM
Child well, NO fever

FBC, CRP, X-Ray, Cultures - all NORMAL
USS - joint effusion

analgesia - NSAIDs
Self-limiting - few days

65
Q 
Septic arthritis 
Most common bug?
Features?
Ix? Dx confirmed by?
Mx?
Comp if left untreated?
A

S. Aureus

Acute painful hip pain at rest
Child unwell + fever
Reluctance to move hip - decreased ROM

CRP + WCC^
Joint aspiration = confirm Dx

Abx + surgical drain
Joint destruction if left alone

66
Q 
Perthe's Disease 
What is it? What can it lead to
Age? Gender?
Features? 
Ix?
Mx? Prognosis?
A

Ischaemia of femoral epiphysis - can lead to ANV of femoral head

5-10 years. M>F

INSIDIOUS onset - initially painful
Decreased ROM - esp abduction + internal rotation

X-ray - initially ^ fem head density + later irregular fem head edge

Conservative management
Surgery if severe

Good prog if

67
Q

SUFE - Slipped upper femoral epiphysis
What is it? Direction?
Age? Gender? Other RF?
Features - what may bring it on?

A

Displacement of femoral head - posteriorly + medially

10-15 years. M>F. Obesity

Acute painful - often after minor trauma (may refer to knee)
Reduced ROM - esp abduction + internal rotation

68
Q

JIA
Definition
RheumF? exception to this
Types - quick def for each

Mx options?

A

Arthritis for >6weeks under the age of 16

RF -ve –> except in some girls with polyarticular

Oligoarticular - <=4 joints (60%)
Polyarticular >=5joints (20%)
Systemic: Still’s disease (10%)
Others: enthesitis related, psoriatic (10%)

Mx:

  • MDT - physio, OT, educational input
  • Analgesia - paracetamol, NSAIDs
  • Intra-articular steroid injection - oligo esp
  • DMARDS - Methotrexate, anti-TNFs
69
Q

Systemic JIA - aka Still’s disease
Age? Gender?

Features?

Ix?

DDx fever+ myalgia?

A

<5. M=F

Acute illness w/

  • HIGH SWINGING FEVER
  • SALMON COLOURED MACULAR RASH

Lymphadenopathy + hepatosplenomegaly
Pleurisy + pericarditis

SLE, Kawasakis, Rheumatic fever, Leukaemia, reactive arthritis

70
Q

Oligo-articular
Age? Gender?
What joints affected? Distribution
Extra feature 1/3rd get? what +ve test pops up?

A

2-6years. F>M

Medium joints - NOT HIPS
- wrists, knees, ankles, elbows

ASYMMETRICAL

Anterior uveitis - ANA +ve

71
Q

Poly-articular
What joints affected? Distribution?
What joint is spared - so unlike…

A

Any joints - SYMMETRICAL
- hands, wrist, knees
- neck / temporo-mandibular joint
Spares MCPJs - unlike RA

72
Q

Measles
Bug?
Incubation period. Infectivity?

Features?

is it notifiable?

Comps?

A

RNA Mobillivirus
10 day incubation
infectious until day 5 of rash

4 C’s - cough, conjuctivitis, coryza, cranky
Koplik spots
Maculopapular rash - from behind ears to face+trunk

YESSSSS

Pneumonia, encephalitis

73
Q

Mumps
Incubation? Infectivity?

Features?

Comps?

A

2-3week incubation
7 days from onset of parotid swelling

Fever typically 4 days w/ uni then bilateral parotitis

Comps - orchitis, viral meningitis

74
Q

Rubella

Features?

If in pregnancy?

Notifiable?

A

Well child
Low grade fever
Lymphadenopathy - posterior auricular + occipital

Congenital rubella syndrome = if pregnant mother gets it - risk to fetus

YEP IT IS!

75
Q

Chicken pox
Bug?
Incubation. Infectivity?
Features? timeline of tings pls

Comps?

Mx?

A

VZV

2-3weeks (long like mumps)
Infectious 7 days from start of rash

Fever w/ widespread rash
Papules –> vesicles –> pustules –> crust

Comps:

  • 2ndary bacterial skin infection
  • chickenpox pneumonia

Mx:
Aciclovir
Calamine lotion - antihistamime/emollient
5 DAYS OFF SCHOOL

76
Q

Slapped cheek disease - 5th disease!
Bug?
Features?

What can virus affect –> why is this a key worry in sickle cell pts?!?!?
Risk if infection in pregnancy?

A

Parvovirus B19

low grade fever for few days –> developing bright red cheeks

virus can affect erythroblasts in bone marrow –> can cause aplastic crisis in sickle cell!!

Infection in preg:
- fetal anaemia, HF, death

77
Q

Scarlet fever
Bug?
Age?
Features - course of disease?

Mx?
How long it last?

Notifiable?

A

Group A strep - pyogenes
2-10years

high fever + sore throat
2 days later - rough rash on face, upper chest, armpits
flushed red cheeks + strawberry tongue w/ tonsilitis

Penicillin V - BenPen

Fever lasts 4 days –> Rash peels in a week

YESSIRRRRR

78
Q

Term baby weeks?

A

37-42 weeks

79
Q 
Port wine stain 
what is it. When does it appear?
Distribution 
does it increase in size, appearance?
Association + path?
Features of this?
A

Present at birth - red ‘stain’ on face
Maxillary/opthalmic distribution
Flat + does not increase in size

Sturge-Weber syndrome - neuro disorder
Formed due to abundance of capillaries near surface of skin
(NB - will also have meninges problems on same side)

Seizures, glaucoma, hemiparesis

80
Q

2 things you can get single transverse palmar crease in?

A

Down’s

Fetal alcohol syndrome

81
Q

2 potential causes of absent unilateral red light reflex?

A

retinoblastoma

congenital cataract

82
Q 
Carvenous hemangioma 
What is common name?
When does it appear? 
Does it increase in size?
What is it not associated - thus making it different from port wine stain 
Does it go away? when?
A

Strawberry naevus
NOT AT BIRTH

get bigger boi - lil red bump on head

with intracranial abnormalities - i.e. so no sturge weber

Goes away by 5th birthday

83
Q

2 tests for congenital dysplasia of the hip? which is which 0_o ?

A

Ortolani - dislocate

Barlow - reduce

84
Q

What is seen in talipes equinavarus? Tx?

A

Club foot!

Physio/surgery

85
Q

What is physiological jaundice of newborn? When would be worried it might be pathological?

What causes physiological?

A

> 24hours after birth (typically day2-5)
resolves by 2 weeks

High RBC volume + decreased RBC survival
immature hepatic enzymes

pathological if <24hours

86
Q

Haemolytic jaundice
Causes (other than physiological)

Test to do that could narrow down cause?

Problem with unconjugated bilirubin - comps?

A

Sepsis
Immune destruction - ABO incompatibility, rhesus
Congential - G6PD, hereditary spherocytosis

Positive Coomb’s test

REMEMBER HAEMOLYSIS = UNCONJUGATED BILIRUBIN
 - can cross BBB!!!! lead to: 
kernicterus - damage to basal ganglia 
encephalopathy 
dyskinetic cerebral palsy
87
Q 
Billiary atresia
What is it? 
Features?
Ix
Mx - when should it take place?
A

Congenital abnormalty - blockage/absence of bile ducts –> untreated = liver failure

Jaundice, pale stools, dark urine

imaging of hepatobiliary system

Surgery - Kasai hepataportoenterostomy / liver transplant
BEFORE 2 MONTHS!

88
Q

Management of significant jaundice?

A

Hydration - throguh good feeding
Continue to breastfeed - whatever the cause
Phototherapy - breaks down bilirubin
Exchange blood transfusion

89
Q

What complication of prematurity = leads to cerebral palsy?

A

HEADS (from tune)

- Hypoxic ischaemic damage!!

90
Q

RDS
Path?

Diagnosis (i.e. 1 Ix + features)
Mx

A

Deficiency of surfactant - from type 2 pneumocytes
- production begins 24-28weeks = adequate by 35weeks

resp distress symps - ^WOB, ^RR - in first 24hrs
CXR - ground glass shadowing, air bronchograms

Resp support - oxygen, CPAP, ventilation
Surfactant via ET tube
Can give antenatal steroids - to promote lung dev

91
Q 
NEC
Seen in what babies?
Path/features 
symps 
Ix
Mx
A

PREMATURE!!
Bowel ischaemia, inflam, necrosis, perforation

poor feed tolerance, abdo distention, bloody stools, vomiting

X-ray - pneumatosis intestinalis - air in intestinal wall

Bowel rest - NBM, TPN, ABx
Surgery to remove section of bowel

92
Q

Commenest childhood seizure?

A

FEBRILE CONVULSIONS

93
Q

Febrile convulsions
Age?
Association?
Typical seizure type/length? describe complex seizure

Mx?
Factors that ^risk of future epilepsy

A

6months - 5years
FEVER! - sudden increase in temp
generalised + short in duration (<5mins)
[Complex = >15mins, focal features, recurring in same illness]

ABC (+DEFG)
Symptomatic relief for fever, find cause +/- ABx

^Risk:

  • Complex seizure
  • FH of epilepsy
  • neuro abnormalities on examination / dev delay
94
Q

Epilepsy define

Can EEG exclude epilepsy?

A

chronic brain disorder w/ recurrent (2+) non-febrile seizures - in absence of acute cerebral insult

NO! EEG = normal in 50% w/ epilepsy

95
Q

Absence epilepsy
Age?
What is it? What can precipitate it?
How long it last?

EEG features? IMPORTANT!!

Tx
does it last?

A

4-10years
Transient LoC - often with open, blinking eyes / twitching mouth movements
Hyperventilation can precipitate

<30seconds

EEG - 3Hz spike and wave abnormaltiy - 3 per second spike and wave!

Valproate / ethosuximide

Usually grow out of by adolescence

96
Q 
West syndrome 
Is it bad? 
What is it?
Any associations? 
TRIAD?
Tx? prog, go on to develop other things?
A

BAD bro
infantile spasms in 1st year of life

1/3rd = major organic disorders

  • tuberous sclerosis
  • hypoxic ischaemic encephalopathy

TRIAD:

  • INFANTILE SPASMS
  • DEVELOPMENTAL DELAY
  • HYPSARRHYTHMIA ON EEG

Tx:
Pred / vigabatrin

Poor prog - w/ long term dev + behavioural difficulties
most go on to have other seizure types

97
Q

4 domains for developement?

A

Gross motor
Fine motor / vision
Hearing/language
Social/behaviour

98
Q

3 months dev?

A

Raises head and chest when prone
follows moving object
vocalises
Smiles (6-8weeks), Laughs

99
Q

Dev milestones:

6months

A

Sits without support
Palmar grasp (5months), Transfers hand to hand
Turn head to loud sounds, Babbles
Reaches for bottle

100
Q

Dev milestones:

9months

A

pulls to stand, crawls
Point with finger
responds to name
Takes everything to mouth

101
Q

12months dev milestones!!!

A

Walks alone/one hand held (9-18months)
Neat pincer grip
1-3words - mama, dada
Waves byebye

102
Q

18months dev milestones

A

SHOULD WALK - refer if not. runs/jumps
Tower of 2-4bricks, Hand preference
6-12 words
drinks from cup / uses spoon

103
Q

What age can kids copy a circle? Ride a tricycle?

A

3years

104
Q

What age can kids draw cross? Hop on 1 leg?

A

4years

105
Q

Triangle draw kids? Knows name, age, address?

A

5 years

106
Q

Cerebral palsy - an ‘umbrella term’
Definition - when can it occur?
Clinical diagnosis, but what Ix is it supported by?

A

NON-PROGRESSIVE brain lesion = manifests as motor or postural abnormaltiies

lesion can occur at any point between conception + 3years old

MRI - PERIVENTRICULAR LEUCOMALACIA - caused by hypoxic ischaemic damage to ya head (i.e. in PREMS)

107
Q

4 common presentations of cerebral palsy
- split into 2 categories

Types of movements - 2 pls in one of the types

A

SPASTIC: - most common

  • Hemiplegia - vertical half
  • Diplegia - horizontal half
  • Quadriplegia

DYSKINETIC - involuntary movement disorder

  • chorea - jerky
  • athetosis - writhing
108
Q

Spastic diplegia features

[ excluding UMN features!! ]

A

Adduction at hips + scissoring gait
Flexion at knee + genuvalgus
Plantar flexion at ankles + equinovarus - tiptoe gait
Rotation + swaying of trunk

109
Q

Complications of cerebral palsy?

A

Epilepsy + learning disability
Speech + swallowing problems - PEG tube?
Spasicity + contractures

110
Q

Cerebral palsy causes?

A

Commonly unknown

In utero:
- TORCH

Perinatal:

  • Birth asphyxia
  • PREMATURE
  • Kernicterus –> i.e. why haemolytic anaemia of neborn may cause it!! (due to unconjugated bilirubin)

After delivery:

  • Brain injury
  • Meningitis / encephalitis
111
Q

Congenital infections? 5 pls

A 
TORCH
Toxoplasmosis
Other - HIV, measles, parvovirus, hepatitis
Rubella
CMV
Herpes simplex
112
Q

Duchenne muscular dystrophy
Genetics?
Age?
Features - a bit of timeline

Key Ix?

A

X-linked! Frameshift mutation in dystrophin gene
**loss of dystrophin –> muscle cell damage

Boys 3-5years = onset

Waddling gait
Gower’s sign!! - to stand uses hands to climb up legs
Proximal muscle weakness - wheelchair by age 9-12
Diaphragmatic weakness
Scoliosis / contractures
Cardiomyopathy

Clumsiness / motor delay
Cognitive impairment

Genetic testing
Creatinine Kinase

113
Q

Breath holding attacks
Age?
Features - i.e. the process?

A

6months - 2 years

Pain/anger --> then brief cry 
kid takes deep breath and stops breathing 
turns blue + limbs extend
LOC
few convulsive jerks 
NO POST-ICTAL phase
114
Q

Reflex anoxia seizures
Age?
What is it + features?
Triggers?

A

infants + toddlers
similar to faint in older kid/adult

vagal activation = bradycardia
kid goes pale + collapses
potenital tonic-clonic

noxious stimulus - e.g. knock to the head

115
Q

Autism TRIAD of impairment

age they present with?

A

typically <3years

Reciprical social interaction - poor eye contact, difficulty establishing/maintaining friends

Social communication - delayed/disordered speech, lack of gestures, absent imaginative play

Restricted, repetitive stereotyped behaviours + interests

116
Q

ADHD
Triad?
Diagnostic criteria?
Mx?

A

Inattentiveness, Hyperactivity, Impulsivity

Symptoms must be present before 7years old + observed in more than 1 setting (home + school)

Mx: - combination of behavioural + meds
- RITALIN - methylphenidate

Mnemonics / quick learn (7 decks)

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