paeds brief Flashcards
1
Q
wheeze is associated with ______
A
viral induced wheeze, asthma and bronchiolitis
2
Q
what is apnoea
A
cessation of breathing for at least 10 seconds
3
Q
what commonly causes sore throat
A
- normally viral in children under 3
- could also be caused by strep pyogenes (beta haemolytic strep)
- epstein barr is a common cause of exudative tonsilitis
4
Q
which criteria indicate the likelihood of a sore throat being caused by a bacrterial infection and what does it include
A
- Centor criteria
- tender lymphadenopathy
- tonsilar exudate
- fever
- absence of cough
5
Q
what is the treatment if strep throat is suspected
A
10 days of penicillin V
6
Q
what is croup
A
acute laryngotracheobronchitis
7
Q
what causes croup most commonly
A
parainfluenza virus
could also be RSV or bacterial
8
Q
A
9
Q
what age is croup most common
A
2
10
Q
management of croup
A
- most get better at home within 24 hours
- children may require hospitalisation due to
- more severe illness
- being under 12 months old
- signs of fatigue or resp failure
- managemnet
- single dose dex or nebulised budesonide
- nebulised adrenaline if need to get to ITU
11
Q
what organism causes acute epiglottitis
A
haemophilus influenzae type B
rare to HiB vaccination
12
Q
age of acute eppiglotitis
A
1-6
13
Q
management of acute eppiglottitis
A
- do not
- lie child down
- examine throat
- upset child (no bloods)
- managed in resus room
- examination of throat under anaesthetic
- cherry red, swollen epiglottis on laryngoscopy
- intubate
- blood cultures
- IV cefuroxime
14
Q
what is bacterial tracheitis
A
- rare but more common than epiglottitis
- often seen as an acute deterioration after a vira infection
- children systemically very unwell
- no drooling
- hoarse voice
15
Q
what organisms commonly cause bacterial tracheitis
A
staphylococcus aureus
H. influenzae
strep spp.
neisseria spp.
16
Q
management of bacterial tracheitis
A
- secure airway
- blood cultures
- IV cefuroxime
17
Q
distinguish croup, acute epiglottitis and bacterial tracheitis
A
18
Q
organism for whooping cough
A
bordatella pertussis
19
Q
how long can whooping cough last
A
3 months
(100 day cough)
20
Q
what is the management of whooping cough
A
erythromycin given early reduces infectivity and complications but does not reduce duration of illness
managment is largely supportive but 1% will need hospital admission
21
Q
what are the two types of LRTIs
A
bronchiolitis
pneumonia
22
Q
what causes bronchiolitis
A
- viruses rather than bacteria
- most commonly RSV
- less commonly
- adenovirus
- influenza
- parainfluenza
- rarely: mycoplasma pneumoniae
23
Q
what would an X ray of bronchiolitis show
A
hyperinflation and patchy consolidation bilaterally
24
Q
what is the management of bronchiolitis
A
supportive
oxygen
some may be ill enough to need ng feeds
25
what does pneumonia mean
inflammation of the lung parenchyma with consolidation within the alveoli
26
what organisms cause pneumonia
* viruses (more common in children \<2)
* RSV
* influenza
* parainfluenza
* adenovirus
* bacteria
* strep pneumoniae (most common)
* s. aureus (common in CF)
* pseudomonas (common in CF)
* HiB (in unvaccinated)
27
what are the classic signs of consolidation on the lungs (pneumonia)
decreased breath sounds
dullness to percussion
crackles
bronchial breathing
28
what three features suggest bacterial pneumonia
polymorphoneuclear leucocytosis
lobar consolidation
pleural effusion
29
first line antibiotic for bacterial pneumonia
oral amoxicillin
30
what are the aims of asthma treatment
no daytime symptoms or waking in the night due to symptoms
no exacerbations
no need for reliever therapy
no limitations on activity
normal lung function
minimal side effects of therapy
31
what's the difference between brown and blue inhalers
* brown - preventors
* ICS
* blue - relievers
* salbutamol
32
describe the steps of asthma therapy
1. regular preventor
* very low dose ICS
2. initial add on preventor
* inhaled LABA
3. additional add on therapies
* if no response to LABA stop it and increase ICS to low dose
* if benefit from LABA but not enough then keep LABA AND increase ICS to low dose
* if still inadequate add LTRA
4. high dose therapy
* increase ICS to medium dose
* addition of theophyline
* refer to specialist
33
what is the carrier rate of CF
1:25
34
incidence of CF
1:2500 live births
35
what is the most common CF mutation
three base pair deletion at F508
36
Common pathogens in CF chest infection
* S.aureus
* H.influenzae
* Pseudomonas
37
what is the gold standard of CF diagnosis
pilocarpine ionotophoresis sweat test
38
what are the cornerstones of CF management
prevention of colonisation and infection of the lungs
effective mucocillary clearance
nutritional support
39
ear ache is usually caused by:
infection of the middle ear
otitis media
40
what is acute otitis media usually caused by
* can follow viral URTI
* can also be bacterial
* s.pneumoniae
* pneumococcus spp.
* h. influenzae
41
management of otitis media
symptomatic treatment is usually sufficient
abx can reduce symptoms but not complications
42
what is conductive hearing loss usually due to
OME: otitis media with effusion aka glue ear
43
down's syndrome is associated with which congenital heart disease
ASD
44
turner's syndrome is associated with which congenital heart disease
coarctation of the aorta
bicuspid aortic valve
45
noonan syndrome is associated with which congenital heart disease
pulmonary stenosis
46
fetal alcohol syndrome is associated with which congenital heart disease
atrial septal defect
ventricular septal defect
47
describe the different types of cyanosis and what they mean
* central cyanosis
* blue lips, blue tongue
* always pathological
* peripheral cyanosis
* blueness of hands and feet
* can be normal in first 24hrs of life
48
hallmarks of innocent murmurs
an asymptomatic child
a normal cardiovascular examination
systolic or continuous
no radiation
variation with posture
49
what kind of murmur is always pathological and needs investigation
diastolic
50
clinical features of heart failure in infants
poor feeding and breathlessness
faltering growth
excessive sweating
recurrent chest infections
CVS signs
51
initial investigations for suspected heart failure
* ecg
* chest x ray
* diagnosis normally needs echo
52
cxr finding of teratology of fallot
boot shape
53
cxr finding of transposition of great arteries
egg on side
54
what are the two cyanotic congenital heart conditions
teratology of fallot
transposition of great arteries
55
what is the most commonn congenital heart disease
vsd
56
complications of a left to right shunt
permanent irreversable pulmonary HTN
57
compare the three severities of VSD
* small vsd
* pansystolic murmur
* no symptoms
* may close spontaneously but if murmer persists to 12 months do echo to look for complications
* medium vsd
* has symptoms
* treated with diuretics and ACE inhibitors
* spontenous improvement often occurs and surgery can often be avoided
* large
* presents early with cardiac failure
* medical management
* then surgical correction
58
management of ASD
many close spontaneously before school age
management is to prevent heart failure and arrhythmias
transcatheter closure at age of 3-5
if very large might need surgical closure
59
when should the ductus arteriosus close
within hours of delivery
PDA diagnosed if duct doesn't close in 1 month following birth
60
what are the clinical features of a PDA
bounding pulses
wide pulse pressure
continuous machinery hum murmer
61
management of PDA
ibuprofen to inhibit prostaglandin and encourage closure
can also be closed in first few months of life by cardiac catheterisation
62
clinical fetures of teratology of fallot
cyanosis
loud single S2
clubbing in older children if uncorrected
loud ejection systolic murmer
63
what are tet spells
* in teratology of fallot when peripheral vascular resistance falls
* increases right to left shunt
* can be triggered by exertion, emotion, dehydration or illness
* includes
* worsenning cyanosis and pallor
* distress/agitation
* hypotonia
* children squat
64
managmenet of TOF
* treat 'tet' or hypercyanotic events with:
* high flow oxygen
* morphine
* IV fluids
* bicarbonate for acidosis
* intubation and ventilation in severe cases
* definitive treatment is surgical
65
managment of transposition of great arteries
* initial aim is to promote mixing of blood
* infusion of prostaglandin E1 to newborn
* maintains patency of DA
* emergency cardiac catheterisation and atrial septostomy
* life saving procedures
* definitive repair achieved with arterial switch surgery at a few weeks of age
66
67
rheumatic fever is a complication of what and how frequently does it occur
group A beta haemolytic strep
a sore throat
occurs in \<1% of cases of strep throat
68
what age does rheumatic fever affect
5-15
use of antibiotics for bacterial throat infection have made it rare in UK
but is most common cause of cardiac valvular disease worldwide
69
what are the jones criteria and how can they be used
* used to diagnose rheumatic fever
* for diagnosis patient needs to meet required criteria AND have either of:
* two major
* one major and two minor
70
what are the required criteria of jones criteria
* evidence of streptococcal infection. either:
* positive bacterial throat swab
* raised antistreptolysin O titre
71
what are the major criteria of the jones criteria
* polyarthritis (can be fleeting)
* erythema marginatum
* subcutaneous nodules
* carditis
* chorea
72
minor criteria of jones criteria
* fever
* arthralgia
* raised ESR, CRP or WCC
* previous rheumatic fever
* prolonged PR on ECG
73
ecg finding in rheumatic fever
prolonged PR
they may not have this
it is one of the minor criteria
74
acute management of rheumatic fever
* bed rest
* high dose aspirin
* steroids for severe carditis
* diuretics and ace inhibitors for heart failure
* Abx for acute illness and for prophylaxis of endocarditis
* for 5-10yrs
75
what is the most common complication of rheumatic fever
rheumatic valvular disease
76
any child with fever and a murmer what should you expect
endocarditis
77
what is the most common causative organism in endocarditis
strep viridans
this is alpha haemolytic streptococcus
78
79
diagnosis of endocarditis
cross sectional echocardiography can confirm diagnosis but cannot exclude
three blood cultures taken in first 24hrs of admission
80
treatment for infective endocarditis
4-6 weeks of IV abx
e.g. high dose ampicillin
81
investigations in a child presenting with abdominal pain
* urinalysis
* dipstick
* mcs if indicated
* bloods
* fbc
* crp
* lfts if jaundiced
* imaging
* abdo x ray rarely useful
* USS
* can diagnose intussusception
* can sometimes see appendicitis but cannot rule out
82
organic causes of recurrent abdo pain
recurrent UTI
renal calculi
Helicobacter pylori gastritis
IBD
malrotation with intermittent volvolus
gallstones
recurrent pancreatitis
83
compare dehydration and shock with the following features
## Footnote
Sunken eyes and depressed fontanelle
Mucous membranes
Skin turgor
Alertness
HR and RR
Urine output
Skin colour
Extremities
Cap refill
Blood pressure
84
7 red flags with vomiting
bilious vomiting
localised abdo pain
persistent fever
altered consciousness/bulging fontanelle
meningism
petechial rash
respiratory distress
85
vomiting blood in first few days of life could be
swallowing maternal blood
86
acute diarrhoea is most commonly caused by
gastroenteritis
87
what is a positive rovsing sign and what does it mean
palpation of the left iliac fossa causes pain in the right
appendicitis
88
bloody diarrhoea should raise suspicion of
Bacterial gastritis particularly HUS (e.coli)
89
constipation red flags (6)
starts in first few weeks of life
meconium passed \>24 hours
abdo distension or bilious vomiting
faltering growth
delayed walking or lower limb neurology
child protection concerns
90
what age does colic most commonly occur
2 weeks until about 4 months
91
7 differentials for inconsolable crying in an infant
colic
GORD
cows milk protein allergy
incarcerated hernia
intussusception
otitis media
UTI
92
infantile colic managment
benign and has a good prognosis
sympathetic explanation of the condition is helpful but there is no evidence for medication
93
infants at risk of severe GORD
preterm infants
infants with congenital oesophageal anomalies
infants with cerebral palsy
94
complications of GORD in infants and how many develop complications
* 10% infants with symptomatic reflux develop complications
* bronchospasm and wheeze
* recurrent aspiration pneumonia
* oesophagitis
* could lead to haematemasis and anaemia
* faltering growth
95
investigation of GORD
* Diagnosed clinically
* posseting
* vomiting
* crying after feeds
* worse when lying down
* sometimes to confirm diagnosis/assess severity
* 24hr oesophageal pH monitoring in older kids
* endoscopy if suspected oesophagitis
96
management of GORD
* majority will resolve spontaneously by 18 months
* following drugs can be used in severe reflux
* H2 antagonists: ranitidine
* proton pump inhibitors: omeprazole
* prokinetic drugs: domperidone
* reduce lower oesophageal sphincter pressure
* surgery very rarely
* nissen fundoplication
97
pyloric stenosis is due to
hypertrophy of the smooth muscle of the pyloric sphincter
98
complications of pyloric stenosis
weight loss
constipation
dehydration
mild jaundice
99
what is the characteristic electrolyte disturbance in pyloric stenosis
why
hypochloraemic hypokalaemic metabolic alkalosis
due to loss of gastric acid contents
then kidneys retain H ions at expense of potassium
100
managment of pyloric stenosis
correction of fluid and electrolyte abnormalities
difinitive treatment is ramstedt pyloromyotomy
101
what is the most common surgical emergency
appendicitis
102
common associated symptoms with appendicitis other than the pain
anorexia
nausea
vomiting
diarrhoea
constipation
103
diagnosis and investigations of appendicitis
* usually clinical
* FBC
* CRP
* abdo US may confirm but cannot exclude
104
management of appendicitis
appendicectomy
if there is diagnostic uncertainty, a period of observation may be indicated
105
what is mesenteric adenitis
* inflammation of the intraabdominal lymph nodes that can mimic appendicitis
* commonly follows viral infection
* URTI
* gastroenteritis
* obs in hospital since diagnosis difficult
* management is conservative
106
peak age of incidence of intussusception
5-10 months
107
commonest site of intussusception
ileum into caecum
108
classical presenting triad of intussusception
* paroxysmal abdo pain
* screaming, becomes pale, draws legs to chest
* abdo mass
* sausage shaped
* redcurrent jelly stool
* late sign
* compromise in blood supply to bowel causes blood and mucus to be mixed in
109
what will the vomiting be like in intussusception if there is some
bilious
110
US finding in intussusception
doughnut or target sign
111
management of intussusception
air or barrium enemas
if this fails aroscopy or laparotomy will be needed
112
what is hirschprung's
* aka congenital aganglionic megacolon
* aganglionic segment between bowel and colon is contracted
* more common in males and children with down's syndrome
113
hirschprung's presentation
* infants in neonatal period
* delayed passage of meconium \>48hrs
* intestinal obstruction with bilious vomiting
* older children
* chronic severe constipation from birth
* absence of faeces in narrow rectum
* abdo distension
114
diagnosis hirschprungs
confirmation is by absence of ganglion cells on suction biopsy of rectum
115
management of hirschprungs
surgical resection of involved area of colon
anastamoses normally innervated bowel with anus
ladd's procedure
116
causes of small bowel obstruction
duodenal atresia (associated with downs)
malrotaion with volvolus
strangulated inguinal hernia
meconium ileus
117
118
causes of large bowel obstruction
hirschprung's disease
imperforate anus
rectal atresia
119
what is the most causative virus of gastroenteritis
rotavirus
120
how to calculate maintenance fluids
100mL/kg/24hrs for first 10kg
50ml/kg/24hrs for second 10kg
20ml/kg/24 hrs after that
121
what proportion of IBD have their first presentation in childhood
1/4
122
in the paediatric settin is crohns or UC more common
crohns is twice as common as UC
123
compare crohns to UC
* crohns
* occurs anywhere from mouth to anus
* transmural inflammation
* granulomatous inflammation
* ulcerative colitis
* colon only
* mucosa only involved
* nongranulomatous inflammation
124
complications of CD and UC
* crohns
* strictures
* abscesses
* fistulae
* 5-6x increased risk of colon cancer
* UC
* toxic megacolon
* risk of PSC
* 20-30x increased risk of colon cancer
125
diagnosis of IBD
colonoscopy and biopsy
126
faecal calprotectin is a marker of what
inflammation of the gut
127
chrons management
* steroids to induce remission
* immunosuppressive agents for maintenance
* mesalazine
* azithioprine
* antitumour mabs
* infliximab
* surgery if medical treatment fails
128
UC management
steroids
immunosuppressive agents needed
surgery when medical treatment fails - subtotal colectomy and ileostomy can be curative
129
which HLA type is associated with coeliac and how close is the association
HLA-DQ2 is found in 95% of affected individuals
130
investigations in coeliac
* IgA tissue transglutaminase with total IgA
* there may be IgA deficiency where IgG can be measured instead
* definitive diagnosis is by duodenal/jejunal biopsy
* villous atrophy
131
jaundice with pallor indicates
a haemolytic episode e.g. G6PD deficiency
132
what is marasmus
undernourishment causing a child's weight to be significantly low for their age.
133
causes of jaundice in first 24 hrs of life
* excess haemolysis
* immune
* rhesus incompatibility
* ABO incompatibility
* non-immune (intrinsic red cell defects)
* G6PD deficiency
* Spherocytosis
* congenital infections
* TORCH, hepatitis and syphilis
134
causes of jaundice between 24hrs and 2 weeks
* most common cause is physiological jaundice
* breast milk jaundice
* infection
* bruising
* excess haemolysis
* ABO incompatibiltiy
* G6PD deficiency
* spherocytosis
135
causes of jaundice after two weeks of life
* breast milk jaundice
* infections
* haemolysis
* ABO incompatibility
* Rh incompatibility
* G6PD deficiency
* Spherocytosis
* biliary atresia
* neonatal hepitits
* hypothyroidism (should have been screened as newborn)
136
treatment of biliary atresia
kasai procedure but many still require a liver transplant by the age of 20
137
investigations for babies presenting with prolonged jaundice (more than 2 weeks)
138
what is potter's syndrome
bilateral renal agenesis
oligohydramnios due to lack of foetal urine
death
139
vesicoureteric reflux is a major cause of
CKD in children
140
what is the most common causative agent in UTI in children and what are some others
* most common is e.coli
* proteus
* klebsiella
* pseudomonas
* enterococcus
141
causes of acute nephritis
* most commonly post-streptococcal glomerulonephritis
* 10-14 days after a throat or skin infection
* henoch schonlein purpura
* IgA nephropathy
* SLE
* haemolytic uraemic syndrome
142
acute nephritis is characterised by
haematuria
reduced renal function
hypertension
(there may be oedema and proteinuria but these are less common than in nephrotic syndrome)
143
compare acute nephritis and nephrotic syndrome using
## Footnote
Aetiology
Gross haematuria
Hypertension
Oedema
Urinalysis
Serum C3 and C4
Anti-DNase B / antistreptolysin O titre
Treatment
144
what is the triad for nephrotic syndrome
proteinuria
hypoalbuminaemia
oedema
145
causes of nephrotic syndrome
* minimal change disease (most common)
* focal segmental glomerulosclerosis
* membranous glomerulonephritis
146
treatment for minimal change disease
4 weeks of high dose prednisolone
147
what is the most common cause of AKI in a previously healthy child
haemolytic uraemic syndrome
148
what is haemolytic uraemic syndrome
shiga toxin producing E.coli leads to red blood cell fragmentation in the kidney and thrombocytopenia
ABX ARE CONTRAINDICATED AS THEY INDUCE SHIGA TOXIN PRODUCTION
149
management of undescended testis
carry an increased risk of malignancy, subfertility and torsion
treatment is by orchidopexy if they have not descended by 6 months
150
distinguishing a hydrocoele from an inguinal hernia on examination
hydrocoele it is possible to get above it and it cannot be reduced
it transilluminates
151
treatment for hydrocoele
usually no treatment needed as it will resolve spontaneously
152
management of inguinal hernias
surgery promptly - the risk is strangulation
153
differential diagnoses of an acute scrotum
epididymo orchitis
idiopathic scrotal oedema
torsion of the testicular appendix
154
most common cause of ambiguous genitalia
congenital adrenal hyperplasia of an XX individual
155
what is the commonest vasculitis in children
henoch schonlein purpura
156
how does HSP affect the skin, joints, GI system and kidneys?
* skin
* purpuric rash on extensor surfaces and buttocks
* GI tract
* abdo pain
* GI bleeding
* intussusception
* Joints
* arthralgia
* swelling of large joints
* Kidneys
* glomerulonephritis
* hypertension
* microscopic haematuria
* proteinuria
157
what ig is responsible for HSP
IgA
158
diagnosis of HSP
* clinical diagnosis
* normal platelet count and coagulation exclude other causes of purpura
159
management of HSP
HSP is usually self limiting
treatment usually supportive with pain relief
steroids only if severe
160
what is the most common cause of thrombocytopenia in childhood?
Idiopathic thrombocytopaenic purpura
161
what's the difference between IgE mediated allergies and non IgE mediated allergy
* IgE mediated
* asthma
* acute allergy
* alaphylaxis
* non-IgE
* cows milk protein allergy
* eczema
* IgE --\> mast cell and basophil degranulation. classically have biphasic response with early and late component
* non IgE --\> less well understood
162
investigating suspected allergies
* there is no test for non IgE mediated allergies - just trial elimination and re-introduction
* IgE allergy testing
* Skin prick testing
* wheal more than 3mm larger than negative control is a positive result
* negative predictive value better than positive predictive value
* so history important
163
management of anaphylaxis
* remove allergen
* IM adrenaline (epinephrine) 1µg/kg 1:1000
* if out of hospital an epi pen should be used
* IV hydrocortisone
* IV antihistamine (chlorphenamine)
* back to back salbutamol nebs
164
what does a maculopapular rash look like
has both macules and papules
i.e. areas that are flat and non-palpable as well as lesions that are fluid filled and raised
165
examples of vesicular rashes
166
examples of maculopapular rashes
viral exanthems like rubella, measles, roseola infantum
any viral infection
scarlet fever
kawasakis
167
examples of haemorrhagic rashes
meningococcal sepsis
acute leukaemia
idiopathic thrombocytopenic purpura
Henoch-Schonlein purpura (usually legs and buttocks)
bleeding disorders
168
three different varieties of eczema
atopic eczema
infantile seborrhoeic eczema
napkin dermatitis
169
% of children affected by eczema
10-20%
170
management of eczema
* step wise approach
1. regular use of emollients
2. topical steroids of appropriate potency
3. topical tacrolimus and pimecrolimus
171
what are the topical steroids in order of increasing potency
* help every budding dermatologist
1. hydrocortisone (least potent)
2. eumovate
3. betnovate
4. dermovate (most potent)
172
what is eczema herpeticum and what is the managment
* secondary infection of eczema with HSV
* potentially very serious
* treatment with aciclovir
173
what is infantile seborrhoeic eczema, where does it normally occur on the body, what age and what is the treatment
* mild eczema
* common in first 2 months of life
* scaly and non itchy
* initially on scalp - cradle cap
* may spread to involve face, flexures and nappy area
* treatments is with emollients and mild topical steroids
174
rashes in the nappy areas can be due to
candidiasis
irritant contact dermatitis (nappy rash)
seborrhoeic dermatitis
175
distinguishing true nappy rash from candidiasis
* in true nappy rash the inguinal folds are spared since it's the contact with urea that causes it
* candidias will involve the skin folds
176
management of nappy rash
frequent nappy changes
barrier creams
exposure to air can hasten recovery
177
management of candidiasis
topical and oral antifungals such as nystatin
178
bacteria for acne
propionibacterium acnes
179
acne treatment
* keratolytic agents
* benzoyl peroxide
* topical antibiotics
* clindamycin
* low dose oral antibiotics
* doxycycline
* vitamin A analogues
* 13 cis retinoic acid
* only prescribed by specialists
180
what's an important consideration with roaccutane
it's teratogenic so councel teenage girls about this
181
what is erythema multiforme
target lesions possibly with macules, papules and bullae
if there is mucous membrane involvement it's called stevens-johnson syndrome
most commonly caused by HSV or EBV
self limiting and idiopathic
182
erythema nodosum is caused by what
IBD
tuberculosis
strep infections
183
what is the virus that causes molloscum and is it infectious
molloscipoxvirus
low infectivity
184
management of molloscum
usually resolves spontaneously within 6 months to two years
185
what is tinea capitis
scalp ringworm
itchy alopecia
occasional boggy inflammatory masses called kerion
186
what is tinea corporis
body ringworm
187
what is tinea pedis
athletes foot
188
what are the tineas treated with
* mild infections: treated with topical antifungal preparations such as clotrimazole or miconazole
* severe infections: require systemic treatment with oral griseofulvin for several weeks
189
how is scabies diagnosed
identification of mites or ova in scrapings from burrows or vesicles
190
what is the treatment of scabies
permathrin cream 5% applied to whole body
two treatments 1 week apart
can take several weeks for the pruritis to subside after successful treatment as hypersensitivity persists - this can be treated with oral antihistamines
191
what is pediculosis capitis
headlice
192
summarise glasgow coma scale
193
what is the difference between general and focal seizures
general - abnormal electrical activity originates from both hemispheres
focal - abnormal electrical activity originates from one hemisphere
194
features of tonic clonic seizures and are they generalised or not
* tonic phase
* clonic phase
* loss of consciousness
* postictal drowsiness
can be febrile seizures
they are generalised
195
features of absence seizures and are they generalised or focal
brief unawareness lasting a few seconds
no loss of posture
immediate recovery
may be very frequent
associated with automatisms - blinking and lip smacking
196
what is the peak age of onset of childhood absence epilepsy
peak onset 6-7 years
197
describe childhood absence epilepsy
absence seizures typically lasting 5-15 seconds but there may be up to several 100 a day
episodes induced by hyperventilation
198
what do you see on an EEG in childhood absence epilepsy
generalised bilaterally synchronous three per second spike wave discharges
199
what is the management and prognosis of childhood absence epilepsy
prognosis is good with spontaneous remission in adolescence
sodium valproate and ethosuximide are first line but medication is not required for infrequent absences
200
what is another name for infantile spasms
west syndrome
201
what is the peak onset of west syndrome
4-6 months
202
describe the seizures in west syndrome
sudden flexor spasms of the head, trunk and limbs
followed by abduction and adduction of the limbs
remember that this will be happening in a baby under 6 months age
203
what will the EEG show in west syndrome?
hysparrhythmia
204
what is the management and prognosis of west syndrome
prognosis poor
seizures often intractable
often learning difficulties
treatment is with adrenocorticotrophic hormone or vigabatrin
205
what age do febrile convulsions occur
6 months to 6 years of age
206
what is the most common cause of seizures in childood
febrile convulsions
207
what are the clinical features of febrile convulsions
1-2 minutes typically
generalised, tonic clonic
208
what three things would make a febrile convulsion 'complex' rather than 'simple'
* any three of the following make it complex:
* longer than 15 minutes
* focal
* recurring within 24hrs
209
management of febrile convulsions
identification and treatment of underlying infection
regular anti-pyretics
prolonged convulsions treated as per status
210
prognosis following febrile convulsion
* in simple prognosis is good
* child may have another febrile convulsion in their life but generally grow out of this by 6
* slightly higher risk of developing epilepsy than the rest of the population
* even more so if it was a complex seizure
211
what is the insulin dose when managing DKA in children
0.1 units/kh/hr
212
what is the treatment of kawasakis
IV Ig and high dose PO aspirin
213
causative organism in osteomyelitis in children
staph aureus
214
what is the management of oteomyelitis
IV cefuroxime or IV flucloxacillin
6 weeks of treatment - switch to PO once improving
215
OGTT result in a) diabetes b) impaired glucose tolerance
diabetes: \>11.1mmol/l
impaired glucose tolerance: 7.8-11mmol/l
216
criteria for diagnosis of JIA
more than 6 weeks of pain and stiffness in a joint with no other cause found and they are under 16 years of age
217
what is CAH
AR disease - most common cause of insufficient cortisol and mineralocorticoid secretion
218
why do you give aspirin to children with kawasakis
they have high platelets - thrombocytosis - so they are at risk of thrombosis
219
management of pneumonia
IB ben pen if acutely unwell
PO amoxicillin if stable
220
fasting plasma glucose in a) diabetes b) impaired glucose tolerance c)euglycaemia
* a) diabetes \>7mmol/l
* b) impaired glucose tolerance: 5.7-7mmol/l
* c) euglycaemia 3.5-5.6mmol/l
221
characteristic electrolyte finding in congenital adrenal hyperplasia
salt losing adrenal crisis
hyponatraemic hyperkalaemic metabolic acidosis
no aldosterone so losing salt and retaining potassium
222
name a condition of hypogonadotropic hypogonadism with total anosmia
kallman syndrome
223
what is the cause of kallman syndrome
failure in the correct production or activity of gonadotropin-releasing hormone by the hypothalamus. This results in low levels of the sex hormones testosterone in males or oestrogen and progesterone in females.
224
glood goes through what to reach the baby from the placenta
blood goes through what to reach the placenta from baby
placenta --\> umbilical vein --\> baby
baby --\> umbilical artery --\> placenta
225
what are the bacterial prophylaxis drugs
rifampicin
ciprofloxacin
226
treatment for ESBL e.coli
meropenem
227
treatment of precocious puberty
GnRH superagonists suppress the pulsatility of GnRH action
228
HbA1c in a) diabetes b) impaired glucose tolerance c) euglycaemia
* diabetes: \>6.5%
* impaired glucose tolerance 5.7-6.4%
* euglycaemia 4-5.6%
229
biochemical diagnosis of CAH
* raised lecvels of 17-alpha-hydroxy-progesterone
* biochemical abnormalities:
* hyponatraemic hyperkalaemic metabolic acidosis with hypoglycaemia
230
how do you treat mycoplasma pneumoniae pneumonia
erythromycin
clindamycin
231
managmenet of conductive hearing loss
wait - it normally goes away
grommett insertion
232
what do you see in the bloods of kawasaki
high: crp, esr, wcc and platelets
233
croup treatment
beclamethasone
234
what mode of inheritance is osteogenesis imperfecta
ad
235
where is the defect in osteogenesis imperfecta
in the genes for type 1 collagen
236
two genes involved in type 1 diabetes
HLADR3
HLADR4
237
what is the inheritance pattern for spherocytosis
autosomal dominant
238
treatment for UTI in children
IV cefuroxime
PO trimethoprim if stable
239
when is the brainstem myelinated and what can this do to prems
32/34 weeks gestation
can cause apnoea of prematurity
240
treatment for apnoea of prematurity
nasal cpap
caffeine to stimulate
241
acute otitis media organisms
s. pneumoniae
h. influenzae
242
meningitis organisms by age and antibiotic therapy
243
why are prem babies at greater risk of infection
IgG transfer happens in the last 3 months of pregnancy
244
what syndrome is associated with biliary atresia
down's syndrome
245
what is first line treatment for retinoblastoma
laser therapy
246
what chromosomw is the rb1 gene on
13
247
first line for focal seizures
carbamazepine
248
criteria for tonsillectomy
\>7 episodes of acute tonsilitis in a year
OSA or sleep deprived breathing
249
common causes of diarrhoea
adenovirus
rotavirus
giardia
250
what test for lactose intollerance
hydrogen breath test
251
what is lactose hydrolysed into
glucose and galactose
252
skin change from coeliac
dermatitis herpeteformis
253
treatment of giardiasis
three days high dose metronidazole
254
analgesia for paediatric fracture
paracetamol
oromorph
255
coeliac HLA
DQ2 and DQ8.
256
what is hypospadias
When the urethral opening is on the under side of the penis.
257
which abx to reduce risk of neonatal infections in a pre-term baby
Benzylpenicillin (50mg/kg BD).
Gentamicin (5mg/Kg OD).
258
when can you start feeding a prem baby
35 weeks - this is when suckling reflex develops
259
medication for general seizures
Ethosuxamide or Sodium Valporate.
260
ethosuxamide side effects
rash
nausea
d&v
261
sodium valproate side effects
weight gain
hair loss
teratogenic
262
what can absence seizures evolve into
JME
263
signs of JME
Clumsiness and GTCS that occur shortly after waking and are often provoked by sleep deprivation.
264
demographics of students affected by ADHD
4 - 7 % of school age children
Male : Female = 4:1
265
name an ADHD med
methylphenidate - it's a stimulant
266
