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2020 Phase 3a (DB) > Paeds from lectures > Flashcards

Paeds from lectures Flashcards

1
Q

What are the red flags for gross-motor development?

A

Not sitting by 12 months
Not walking by 18 months
It is important to rule out muscular dystrophy in boys who are not walking by 18 months

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2
Q

What are the red flags for fine motor development?

A

Hand preference before 18 months

- could indicate a neurological condition such as cerebral palsy

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3
Q

What are the red flags for speech and language?

A

No clear words by 18 months. commonly hearing problem but can be related to a learning disability, autism, or an isolated speech and language problem

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4
Q

What are the red flags for social development?

A

No response to carers’ interactions by 8 weeks
No smiling by 3 months
Not interested in playing with with peers by 3 year

Lack of smiling might be a sign of visual impairment

Children who are later diagnosed with autism/LD may have shown signs of early social developmental delay

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5
Q

What are the red flags for child growth and development?

A
  • Regression of development
  • Poor health/growth
  • Significant family history
  • Findings on examination e.g. microcephaly, dysmorphic features
  • Safeguarding indicators - known to social care, unexplained injuries
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6
Q

What must be checked in boys who fail to walk by 18 months?

A

Creatinine kinase - it is elevated following muscular injury, can be indicative of Duchenne’s

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7
Q

What inheritance pattern is seen in Duchenne’s?

A

X-linked recessive

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8
Q

How do you test for Duchenne’s?

A
  1. CK test
  2. Genetic test with blood sample
  3. Muscle biopsy may be required
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9
Q

What is global developmental delay?

A

Delay in two or more developmental areas

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10
Q

A boy is 20 months old and is not yet walking. What is on the list of differentials?

A
  • Muscular dystrophy
  • Rickets
  • Cerebral palsy
  • Hip dysplasia
  • Neurological (spinal lesion causing mixed UMN, LMN)
  • Environmental (neglect, safeguarding)
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11
Q

What are the red flags for a vomiting child?

A
  • Bile-stained vomit
  • Haematemesis
  • Projectile vomiting
  • Abdominal pain on movement
  • Blood in the stool
  • Severe dehydration
  • Headache or seizures
  • Failure to thrive
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12
Q

What is bile stained vomit indicative of?

A

intestinal obstruction

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13
Q

What does haematemesis indicate?

A

peptic ulceration, gastritis, oesophageal varices

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14
Q

What does projectile vomiting indicate?

A

Pyloric stenosis

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15
Q

Abdominal pain on movement indicates what?

A

Surgical abdomen - eg appendicitis

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16
Q

Blood in the stool indicates what?

A

intussusception, gastroenteritis, nec

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17
Q

Which microorganisms are known to cause bloody stools?

A

E. Coli

Salmonella

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18
Q

What is haemolytic uraemic syndrome?

A

Triad of:

  • Thrombocytopenia
  • Microangiopathic haemolytic anaemia
  • Acute renal failure

Following infection with a particular strain of E.Coli, children may present with jaundice and pallour.

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19
Q

Severe dehydration in a vomiting child might indicate what?

A
  • DKA
  • Severe gastroenteritis
  • Systemic infection
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20
Q

Headache and seizures when combined with vomiting are red flags for what?

A

raised ICP

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21
Q

Failure to thrive and vomiting can be due to?

A

coeliac disease or GORD

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22
Q

What are the cardinal findings in pyloric stenosis?

A
  1. Metabolic alkalosis
  2. Dehydration (with abnormal kidney function)
  3. Hypochloraemia
  4. Hypokalaemia
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23
Q

What does metabolic alkalosis do to bicarbonate levels?

A

Metabolic alkalosis elevates bicarbonate levels`

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24
Q

How do you diagnose pyloric stenosis?

A
  1. U+E
  2. ABG
  3. USS abdo (diagnostic)
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25
Q

How do you treat pyloric stenosis?

A 
Rehydration and correcting electrolyte imbalance
Then pyloromyotomy (Ramstedt's)
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26
Q

What would you find on examination of abdo of child with pyloric stenosis?

A

Visible gastric peristalsis and palpable mass on test feed

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27
Q

How would GORD present in a baby?

A

Vomiting
feeding difficulties
failure to thrive

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28
Q

How is GORD investigated in child?

A
  • pH impedence study
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29
Q

How is GORD managed in a child?

A

Conservatively

  • smaller and more frequent feeds
  • feed thickeners
  • optimise position
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30
Q

How does CMPA present in children?

A
  • chronic vomiting
  • eczema
  • flatulence
  • bloody stools
  • diarrhoea/constipation
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31
Q

How is CMPA investigated?

A

skin prick/specific IgE antibody test

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32
Q

how do you treat CMPA in child?

A

cow’s milk elimination from diet
hypoallogenic infant formula
mother avoids cow’s milk

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33
Q

how does intestinal obstruction present in a child?

A

acute on chronic vomiting - bilious vomit,
constipation
abdo pain

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34
Q

what can cause intestinal obstruction?

A
  • malrotation (esp in first week of life)
  • hirschprung’s
  • meconium ileus
  • necrotising enterocolitis
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35
Q

How is malrotation diagnosed?

A

symptoms include bilious vomiting,

Urgent upper GI contrast study with barium

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36
Q

Why is malrotation dangerous?

A

Can lead to volvulus and infarction of midgut

SMA blood supply to small intestine can be compromised - infarction

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37
Q

How is malrotation treated

A

surgical

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38
Q

What is hirschprung’s

A

absence of ganglionic cells from myenteric plexus of large bowel - results in narrow contracted segment of bowel

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39
Q

How does hirschprung’s present?

A

failure to pass meconium within 48hrs of life

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40
Q

what is hirschprung’s associated with?

A

down’s

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41
Q

what are the clinical features of hirschprung’s?

A

abdo distension
later, bile stained vomit
can lead to enterocolitis from C. Diff infection

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42
Q

how is hirschrpung’s diagnosed?

A

suction rectal biopsy

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43
Q

How is hirschprung’s treated?

A

Enema

Surgical resection of affected colon

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44
Q

What is meconium ileus?

A

blockage of the distal ileum due to abnormally thick and impacted meconium. usually due to CF

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45
Q

how might meconium ileus present?

A
  • failure to pass meconium in the first 48hrs
  • bilious vomit
  • abdo distension
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46
Q

how is meconium ileus diagnosed?

A

XRay Abdo

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47
Q

how is meconium ileus treated?

A

stop feeding, drain bile, enema, if enema fails to disimpact stool, surgery

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48
Q

what is necrotising enterocolitis? (NEC)

A

portion of bowel dies. allows pathogenic colonisation of normal commensal bacteria. can be linked to E. Coli usually occurs in premature infants

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49
Q

how is nec treated?

A

Nil PO
Prevention: breastfeeding and probiotics
antibiotics, surgery

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50
Q

How does NEC present?

A

blood in stool
abdo distension
problems feeding

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51
Q

what does bile stained vomit in first week of life indicate?

A

malrotation until proven otherwise

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52
Q

What is the difference between marasmus and kwashiorkor?

A

marasmus is malnutrition of all nutrients. insufficient energy intake. symptoms include weight loss, failure to thrive etc

kwashiorkor is insufficient protein intake with adequate energy intake

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53
Q

what is intusussception?

A

telescoping of proximal bowel into distal bowel

commonly, ileum moves into caecum via ileocaecal valve

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54
Q

when does intuss usually present?

A

3months to 2 years, more common in boys

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55
Q

what are symptoms of intus?

A
  • severe paroxysmal pain
  • draws knees up to chest, pale
  • vomiting - may become bilious
  • redcurrant jelly stool (blood and mucus)
  • sausage shaped RUQ mass (upper quadrant!)
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56
Q

how is intuss investigated?

A

ultrasound abdo diagnostic (doughnut/target sign)

xray abdo would show distension with absence of air in large bowel

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57
Q

how is intuss treated?

A

rectal air insufflation(aka pneumatic reducation enema) . analgesia, IV fluids if shocked, laparotomy sometimes

IV antibiotics

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58
Q

what is meckel’s diverticulum?

A

presence of vitelline duct (usually involutes during foetal development)

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59
Q

how does meckel’s present?

A 
can be asymptomatic
can cause 
- GI bleeding
- volvulus
- intusussception
- umbilical discharge
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60
Q

how is meckel’s treated?

A

surgical resection

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61
Q

what is the vitelline duct?

A

joins the yolk sac to the lumen of the midgut in the foetus

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62
Q

what is toddler’s diarrhoea?

A

chronic non-specific diarrhoea in toddlers

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63
Q

how does toddler’s diarrhoea present

A

colicky pain
loose stool with undigested food (“peas carrots”)
inc flatus
abdo distension

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64
Q

how is toddler’s diarrhoea managed?

A

reassurance
increased fat and fiber intake
reduced milk intake
loperamide may be necessary

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65
Q

what is biliary atresia?

A

progressive fibrosis and oblitertion of intra and extrahepatic biliary tree

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66
Q

why is biliary atresia bad?

A

chronic liver failure and death within 2 years

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67
Q

how does biliary atresia present?

A

fine in first 2 days of life, then jaundice (obstructive) = pale stools, dark urine

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68
Q

does biliary atresia cause conjugated or unconjugated bilirubinaemia?

A

conjugated bilirubinaemia

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69
Q

what are two risk factors for biliary atresia?

A

down’s or CFC1 mutation

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70
Q

how is biliary atresia investigated?

A
  1. Measure transcutaneous bilirubin - conjugated bilirubin would be raised.
  2. LFT’s would be abnormal.
  3. ERCP imaging would fail to outline a normal biliary tree.
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71
Q

how is biliary atresia treated?

A

Kasai procedure

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72
Q

What does coffee-bean sign on abdo x ray indicate?

A

sigmoid volvulus

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73
Q

How might a strangulated hernia appear in a child?

A

bilious vomiting

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74
Q

what are the signs of inguinal hernia in a child?

A

can’t get above it, reducible, often indirect in children. needs surgical repair

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75
Q

what are two types of hernias that present in children?

A

diaphragmatic and inguinal

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76
Q

how are hernias treated?

A

surgically

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77
Q

how do diaphragmatic hernias present?

A

tachypnoea, tachycardia, failure of the lungs to develop correctly,
cyanosis

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78
Q

what investigations would you do for IBD

A
  1. endoscopy with biopsy
  2. low serum albumin (protein loss)
  3. microcytic anaemia
  4. high ESR, CRP
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79
Q

how can crohns and uc be differentiated macroscopically?

A

crohn’s = skip lesions, cobblestoning, strictures

uc = continuous, mucosal ulceration

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80
Q

microscopic differences between uc and crohns

A

crohns = non-caseating granulomas, transmural inflammation

uc = no granulomas, submucosal

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81
Q

How is Crohn’s treated?

A 
Enteral nutrition (eg Modulen) for 6-8 weeks
glucocorticoids
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82
Q

How is remission maintained in Crohn’s

A

Azathioprine or mercaptopurine

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83
Q

How is UC treated?

A 
glucocorticoids 
aminosalicylates (mesalazine) (used in remission maintenance)
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84
Q

what is coeliac disease?

A

AI response by GALT to gliadin

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85
Q

which antibodies are found in Coeliac disease?

A

Anti-TTG
endomysial antibodies
anti-gliadin

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86
Q

how is coeliac diagnosed?

A

serum anti-TTG/endomysial.

if positive, endoscopy and biopsy (must have 6 weeks of gluten in diet)

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87
Q

what are the common viruses that cause gastroenteritis?

A

rotavirus
adenovirus
norovirus
enterovirus

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88
Q

what are common bacterial causes of gastroenteritis?

A

Campylobacter
salmonella
shigella
e coli

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89
Q

how does gastroenteritis present?

A 
acute onset d+v, 
fever
lethargy
abdo pain
poor feeding!!!
dehydration!!!
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90
Q

how is gastroenteritis managed?

A
  • oral rehydration soluition
  • continue breastfeeding
  • NG tube fluids
  • hospitalisation if shocked
91
Q

what can develop after gastroenteritis?

A

post-infective lactose intolerance

92
Q

what is mesenteric adenitis?

A

swollen lymph glands in abdomen - causes pain

usually due to viral infection (can be bacteria)

93
Q

what are the symptoms of mesenteric adenitis?

A 
pain
fever
d+v
prodromal sore throat/cold
cervical lymphadenopathy
94
Q

how is mesenteric adenitis treated?

A

analgesia and hydration

95
Q

list 3 differential diagnoses in a vomiting child?

A
  • inguinal hernia
  • irritable bowel syndrome
  • abdominal migraine
96
Q

how might an inguinal hernia present?

A
  • reducible lump in groin

- if strangulated - severe pain, nausea, vomiting, off food

97
Q

how is inguinal hernia investigated?

A

clinical exam - rule out testicular torsion

98
Q

how does irritable bowel syndrome present?

A

pain relieved on defecation, bloating, mucus in stool, lethargy, clinical diagnosis (after ruling out other diagnoses)

99
Q

how is IBS treated?

A

small regular meals, eliminate triggering foods

100
Q

what is abdominal migraine?

A

pain lasting 2-72 hours, nausea, vomiting, anorexia, pallour

101
Q

how is abdo migraine treated?

A

analgesia, avoid triggers, prophylaxis

102
Q

abdo migraine investigations?

A

search for triggers, rule out DDs

103
Q

what is kernicterus?

A

high levels of unconjugated bilirubin deposit in basal ganglia.

104
Q

what does kernicterus cause?

A

encephalopathy with seizures

choreoathetoid cerebral palsy

105
Q

what 2 categories of disorders cause pathological jaundice in first 24 hrs?

A

congenital infection

haemolytic disorders

106
Q

which haemolytic disorders can cause jaundice in first 24hrs?

A 
rhesus incompatibility
ABO incompatibility
G6PD
spherocytosis
pyruvate kinase deficiency
107
Q

which congenital infections can cause jaundice in first 24 hrs?

A
  • toxoplasmosi
  • CMV
  • rubella
  • syphilis
  • herpes
  • hepatitis

(TORCH infections)

108
Q

what is physiological jaundice?

A

from 24 hrs to 2 weeks, due to breakdown of fetal haemoglobin

109
Q

how is physiogical jaundice treated?

A

phototherapy

exchange transfusions

110
Q

what is the type of jaundice that occurs in first 24 hrs?

A

pathological
always unconjugated
can be caused by SEPSIS

111
Q

what can sepsis cause in a newborn?

A

jaundice, esp if first 24hrs

112
Q

what are the TORCH infections?

A 
Toxoplasmosis
other (eg syphilis) 
rubella
cytomegalovirus
hepatitis/herpes
113
Q

what are the causes of jaundice after 14 days?

A 
biliary atresia
hypothyroidism
galactosaemia
UTI
gilbert syndrome
114
Q

what can pyloric stenosis also cause?

115
Q

how is pathological jaundice investigated?

A

torch screening

coomb’s test

116
Q

how does phototherapy work?

A

light converts bilirubin to water soluble pigment

117
Q

give 3 causes of unconjugated hyperbilirubinaemia

A 
physiological jaundice
breast milk jaundice
infection
hypothyroidism
haemolytic cause
118
Q

give 2 causes of conjugated hyperbilirubinaemia

A

biliary atresia

neonatal hepatitis syndrome

119
Q

what is the triad of symptoms for choledocal cyst?

A

intermittent abdo pain
jaundice
RUQ mass

120
Q

if untreated, what do choledocal cysts cause?

A

cirrhosis and enlarged liver

  • ascites
  • signs of portal hypertension
121
Q

what are choledocal cysts?

A

cystic dilatation of bile ducts

122
Q

what is neonatal hepatitis syndrome?

A

caused by viruses/metabolic syndromes

123
Q

what does neonatal hepatitis cause?

A

hepatomegaly and splenomegaly

124
Q

how does neonatal hepatitis present?

A

jaundice, failure to thrive, dark urine (conjugated)

125
Q

what is the difference in presentation between neonatal hepatitis and physiological jaundice

A

physiological jaundice is unconjugated therefore normal urine

hepatitis presents with dark urine

126
Q

Is PKU AD or AR?

A

Autosomal recessive

127
Q

What are the symptoms of PKU?

A
  • Seizures
  • Skin rashes
  • Microcephaly
  • Musty odour to breath, skin, urine
  • Fair hair/blue eyes
128
Q

How is PKU diagnosed?

A

Heelprick (Guthrie test)

129
Q

What is the treatment for PKU?

A

Low protein diet and amino acid supplements.
Regular phenylalanine level checks
No aspartame as this is converted into phenylalanine.

130
Q

What does the heelprick test test for?

A
  • Sickle Cell
  • CF
  • Hypothyroidism
  • Metabolic conditions (PKU etc)
131
Q

What can cause wheezing in a child?

A
  • Asthma
  • Bronchiolitis
  • Viral induced wheeze
  • Pneumonia
132
Q

What can cause stridor in a child?

A
  • Croup
  • Epiglottitis
  • Bacterial tracheitis
  • Diptheria
  • Laryngomalacia
  • Inhaled foreign body
  • Angioedema/anaphylaxis
133
Q

What is head bobbing a sign of?

A

respiratory distress

134
Q

What changes happen to the airway in asthma?

A
  • bronchospasm
  • mucosal swelling and inflammation
  • increased mucous production
135
Q

how does asthma present?

A
  • intermittent dyspnoea
  • wheeze
  • cough
  • diurnal variation
  • decreased exercise tolerance :/
  • decreased sleep quality
136
Q

how is asthma diagnosed?

A
  • clinical
  • FEV1/FVC <0.7
  • reversibility with bronchodilator
  • FeNO >=35ppb
137
Q

What are the signs of severe asthma attack

A
  • unable to talk

- use of accessory muscles

138
Q

signs of life threatening asthma attack?

A
  • silent chest
  • bradycardia
  • poor resp effor
  • altered consciousness
  • cyanosed
139
Q

how is an asthma attack managed acutely?

A
  • ABCDE
  • High flow O2
  • Nebulised Salb
  • IV hydrocortisone
  • ipratropium bromide nebs
  • MgSO4
  • salbutamol IV
140
Q

what must be monitored if you give IV salbutamol?

A

cardiac monitoring for hypokalemia

141
Q

How is hyperkalaemia treated?

A

insulin and dextrose

142
Q

how is chronic asthma managed in >5

A
  1. salbutamol (SABA)
  2. low dose ICS
  3. salmeterol (LABA)
  4. increase ICS
  5. montelukast (oral leukotriene receptor antagonist)
  6. increase ICS to high dose
143
Q

how is asthma managed in <5

A

salbutamol, ICS, oral montelukast

144
Q

what pathogen causes bronchiolitis

A

most common LRTI in children

usually RSV, or parainfluenza virus

145
Q

how does bronchiolitis present?

A

coryza - runny nose congestion etc
breathlessness
poor feeding

146
Q

what are the signs of bronchiolitis?

A
  • fine end respiratory crackles
  • high pitched wheeze
  • cyanosis (on feeding)
147
Q

How is bronchiolitis diagnosed?

A

PCR analysis of nasal secretions

CXR may show hyperinflation

148
Q

what does wheeze and inspiratory crackles indicated?

A

bronchiolitis!!!

149
Q

what causes airway narrowing and alveolar collapse in bronchiolitis?

A

mucus production and inflammation

150
Q

what conditions make bronchiolitis worse?

A

Aged less than 2y with:

  • down’s
  • CF
  • prematurity
151
Q

a baby with bronchiolitis has <75% normal intake of milk. is this bad?

A

<75% is bad

<92% sats is bad

152
Q

how is bronchiolitis prevented in at-risk children?

A

palivizumab, once monthly vaccination

153
Q

what is palivizumab

A

monoclonal antibody against RSV

  • CF
  • Down’s
  • Premature
  • Immunodeficient
  • Chronic lung disease
154
Q

how is bronchiolitis treated?

A
  • nebulised saline
  • NG/orogastric feed
  • humidified oxygen
  • IV fluids
155
Q

what does hepatosplenomegaly, pallour, fever suggest?

A

leukaemia and anaemia

156
Q

what does hepatosplenomegaly and high WCC indicate?

157
Q

which leukaemia is more common?

A

Acute lymphoblastic leukaemia

Acute myeloid leukaemia is less common

158
Q

what blood test results indicate aplastic anaemia?

A

pancytopaenia

159
Q

what substances are elevated in tumour lysis syndrome

A

PULP:

Potassium
Uric acid
Lactate dehydrogenase
Phosphate

160
Q

what happens in acute leukaemia?

A

In acute leukaemia the white cells undergo a genetic change causing failure of differentiation, dysregulated proliferation and clonal expansion. The bone marrow fails to produce normal cells such as HB, neutrophils or platelets.

161
Q

how are patients with ALL with high WCC treated?

A

priority is to prevent tumour lysis syndrome

  • hyperhydration
  • allopurinol
  • platelet transfusion
162
Q

a child with ALL develops a fever. Which is the best antibiotic?

A

broad-spectrum

= gentamycin/Piptazobactam

163
Q

what is CFTR?

A

membrane protein/chloride channel

found in lungs and pancreas

164
Q

which mutation causes CF?

A

DeltaF508 on chromosome 7

165
Q

what are the key signs and symptoms of CF?

A

Thick pancreatic and biliary secretions - causes blockage of the ducts

Congenital absence of vas deferens

meconium ileus

166
Q

why are CF patients more likely to have recurrent infections?

A

thick secretions - reduced clearance - bacterial colonisation

167
Q

what might you see on examination of patient with CF?

A
  • nasal polyps
  • finger clubbing
  • failure to thrive
  • salty tasting baby
  • foul smelling floaty stool
168
Q

what is the gold standard for CF diagnosis?

A

chloride sweat test

169
Q

what genetic testing is available for CF in fetus?

A

genetic testing for CFTR gene via amniocentesis

170
Q

which bacteria are CF pts particularly susceptible to?

A

Staph, pseudomonas

171
Q

how is staph treated in CF?

A

prophylactic fluclox

172
Q

how is pseudomonas treated in CF?

A

nebulised Abx - tobramycin

Oral ciprofloxacin

173
Q

How are pancreatic enzymes replaced in CF?

A

creon tablets and high calorie diet

174
Q

what is dornase used for?

A

break down of DNA material in secretions, makes secretions less viscous and easier to clear

175
Q

how is male infertility treated in CF?

A

testicular sperm extraction

176
Q

what is epiglottitis caused by?

A

haemophilus influenzae B

177
Q

what are the signs of epiglottitis?

A 
drooling
sore throat
dysphagia
stridor!!
fever
sepsis
178
Q

how does epiglottitis look like with laryngoscopy?

A

beefy red stiff epiglottis

179
Q

how does epiglottitis present on XR of neck?

A

thumb sign

180
Q

how is epiglottitis treated?

A

ITU to protect the airway
- nasotracheal tube insertion
IV ceftriaxone + dexamethasone

181
Q

which antibiotic is used for epiglottitis?

A

IV Ceftriaxone

182
Q

with what antibiotic are close contacts of epiglottitis given prophylaxis?

A

rifampicin

183
Q

a child from a foreign land, drooling, unable to speak or swallor, INSPIRATORY STRIDOR, symptoms improve by sitting upright and leaning forward. what is this/

A

epiglottitis

184
Q

would you do a throat exam in a child with croup or epiglottitis?

185
Q

what is croup?

A

laryngo-tracheo-bronchiolitis

186
Q

how does croup present?

A 
children 6m-6y
stridor
barking cough
hoarse voice
coryzal
187
Q

what virus causes croup?

A

parainfluenza virus causes an URTI and oedema in the larynx

188
Q

how is croup treated?

A

dexamethasone 0.15mg/kg
Oxygen
nebulised budesonide
nebulised adrenalin

189
Q

how does pneumonia present?

A 
cough
fever
tachypnoea
signs of resp distress
hypotension, confusion, shock
190
Q

what is the most common cause of pneumonia?

A

strep pneumoniae

191
Q

which is the most common cause of pneumonia in neonates and unvaccinated infants?

A

Group B strep in neonates!!

192
Q

when might Hib cause pneumonia?

A

unvaccinated child

193
Q

what are the xray findings of staph aureus pneumonia?

A

pneumatoceles - round air filled cavities

consolidations in multiple lobes

194
Q

which bacteria (causative of pneumonia) may also present with erythema multiforme?

A

mycoplasma pneumonia

- may develop red circular rash

195
Q

what is the most common type of intussusception?

A

ileo-colic/ileo-caecal

196
Q

what can act as a lead point in intussu?

A

lymph nodes
polyps
appendix

197
Q

with what conditions is intus associated?

A

HSP
gastroenteritis
lymphoma

198
Q

what would PR exam of patient with intuss show?

A

blood on glove (apparently pathognomonic)

199
Q

what investigations would you do for pneumonia?

A

CXR - look for consolidation

Blood cultures

200
Q

how do you treat pneumonia in neonates?

A

IV broad spectrum Abx

201
Q

how do you treat pneumonia in older children?

A

1st line: amoxicillin (co-amox if complicated)

2nd line - erythromycin

202
Q

how is mycoplasma pneumoniae treated?

A

mycoplasma = intracellular, must use macrolides eg erythromycin (covers atypical)

203
Q

what is viral induced wheeze?

A

RSV/rhinovirus caused inflammation and oedema in the airway causes wheeze

204
Q

how do you differentiate asthma from viral induced wheeze?

A
  • less than 3 years of age
  • no atopic history
  • only occurs during viral infections (coryza, fever, cold like symptoms)
205
Q

how is viral induced wheeze treateD?

A

supplementary oxygen
salbutamol
oral montelukast or steroid if salb not working
steroids if history of asthma

206
Q

which organisms cause otitis media?

A

Strep pneumoniae

Hib

207
Q

what are the symptoms of otitis media?

A
  • fever
  • pain
  • otorrhoea
  • generally unwell
208
Q

what are the extracranial complications of otitis media?

A

mastoiditis

tympanic membrane perforation

209
Q

what are the intracranial complications of otitis media?

A

meningitis

abscess

210
Q

how is otitis media treated?

A

Analgesia,

Abx - amox/co-amox

211
Q

how is recurrent otitis media treated?

A

grommet - keeps middle ear aerated and prevents fluid build up

212
Q

When might a grommet be indicated?

A

recurrent otitis media
chronic otitis media and effusion
eustachian tube dysfunction

213
Q

what is glue ear?

A

otitis media + effusion

214
Q

what are the 3 types of hearing loss?

A
  1. conductive
  2. sensorineural
  3. mixed
215
Q

what causes conductive hearing loss?

A
  1. glue ear
  2. ear wax
  3. perforated drum
  4. otitis media
216
Q

how is sensorineural hearing loss treated?

A

hearing aids
cochlear implants
refer to paeds for tx

217
Q

How is mixed hearing loss managed?

A

treat conductive cause and then offer hearing aid

218
Q

what is mastoiditis?

A

middle ear inflammation leads to destruction of air cells in mastoid bone and abscess formation

219
Q

how does mastoiditis present?

A

tender mastoid

protruding ear

220
Q

how is mastoiditis treated?

A

hospitalisation
IV Abx
myringotomy (allows draining of fluid from middle ear)
mastoidectomy

221
Q

what are the risks of mastoiditis?

A

meningitis
sinus thrombosis
it is a medical emergency

222
Q

how is duchenne’s muscular dystrophy inherited?

223
Q

what does sore throat in unvaccinated child and stridor suggest?

A

epiglottitis, caused by hib

224
Q

what LFT result helps in the diagnosis of biliary atresia?

A

elevated conjugated bilirubin

other liver enzymes and bile acids are raised, but can’t be used to differentiate between different types of bilirubin

2020 Phase 3a (DB) (20 decks)

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