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[EDITED] THURSDAY Year 5 Specialties Ludley's > Paeds gastro, infection and immunity > Flashcards

Paeds gastro, infection and immunity Flashcards

1
Q

What is the cause of GOR in babies?

A

Inappropriate relaxation of the LOS (functional immaturity)

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2
Q

By when does GOR usuallly resolve?

A

12 months - if persistent, may be due to GORD

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3
Q

How is GOR diagnosed?

A

Clinical diagnosis

  • 24 hour LOS pH monitoring (it should remain above 4)
  • OGD
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4
Q

Recall the factors affecting choice to refer for GOR

A

Same day referral if haematemesis, melaena or dysphagia

  • Assess by paediatrician if there are:
    1. Red flags (eg faltering growth)
    2. Unexplained IDA
    3. No improvement after 1 y/o
    4. Feeding aversion
    5. Suspected Sandifer’s syndrome

-Refer if there are complications

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5
Q

Recall the management options for GOR

A
  1. Reassure - it’s v common!
  2. Must sleep on back
  3. If breast fed: assess breast-feeding, consider alginate for 1-2 weeks, if not –> pharmacology

If formula-fed: review feeding history, try a smaller, more frequent feed and thickened formula, if doesn’t work, try alginate

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6
Q

What safety net should you watch out for when assessing GORD?

A

Keep an eye on the vomit - if it’s blood-stained or green seek medical attention

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7
Q

At what age does pyloric stenosis present?

A

2-8 weeks

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8
Q

Is pyloric stenosis more common in girls or boys?

A

Boys (4 x more common)

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9
Q

Recall a genetic association of pyloric stenosis

A

Turner’s syndrome

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10
Q

What is the main symptom of pyloric stenosis?

A

Projectile, non-billious vomiting

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11
Q

Recall some other symptoms of pyloric stenosis other than vomiting

A

Weight loss and depressed fontanelle from dehydration and loss of interest in food

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12
Q

Recall some signs of pyloric stenosis

A

Palpable ‘olive’ mass

Visible peristalsis in upper abdomen

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13
Q

What will be the acid-base profile in pyloric stenosis?

A

Hypochloraemic, hypokalaemic metabolic alkalosis (may progress to a dehydrated lactic acidosis - which is the opposite biochemial picture)

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14
Q

What is the best investigation for pyloric stenosis?

A

USS - shows target lesion of >3mm thickness

You also need to do an ABG to guide management

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15
Q

How should pyloric stenosis be managed?

A
  1. IV slow fluid resuscitation + correct any disturbances:
    1.5 x maintenance rate
    5% dextrose
    0.45% saline
  2. Laparoscopic Ramstedt pyloromyotomy
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16
Q

What are the symptoms of colic?

A

Inconsolable crying and drawing up of the hands and feet - child remains distressed in between episodes

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17
Q

What should be considered if the colic is persistent?

A

Cow’s milk protein allergy or reflux
Try:
- 2 week trial of hydrosylate formula followed by
- 2 week trial of anti-reflux treatment

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18
Q

In what age group is appendicitis less common, and what is a more likely cause of similar symptoms in this age group?

A

Rare in under 3s, then it’s more likely to be faecolith (stony mass of impacted faeces)

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19
Q

Recall the management of appendicitis in children

A 
GAME
G: group and save
A: Abx IV
M: MRSA screen
E: eat and drink NBM

Then laparoscopic appendectomy

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20
Q

What is intussusception?

A

Invagination of proximal bowel into distant component (telescoping distally)

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21
Q

What is the most common site of intussusception?

A

Ileum through to caecum through ileocaecal valve

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22
Q

Recall the appearance of stool in intussusception, and the pathophysiology of how this happens

A

Red-currant jelly (blood and mucus) due to venous obstruction and compression –> oedema and mucosal bleeding
This is a LATE sign

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23
Q

What are the causes of intussusception?

A

May be idiopathic
May have a physiological lead point: Peyer’s patch
May have a pathological lead point: malignancy, Meckl’s diverticulum, Henoch-Schonlein purpura

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24
Q

What are the symptoms of intussusception?

A

Intermittent colicky pain

Vomit - depending on type of intususception, may be bile-stained or not

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25
Q

What are the signs of intussusception?

A

Abdominal distention with sausage shaped mass in RUQ
Emptiness on palpation in RLQ (Dance’s sign)
Red-currant jelly stool is a late sign

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26
Q

What are the appropriate investigations for intussusception?

A
  1. Abdo USS: may show donut sign (think: intUSSusception)
  2. AXR (may be normal)
  3. Barium/ gastrogaffin enema if have one of 3 Ps:
    - Perforation
    - Peritonitis
    - Pale complexion
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27
Q

How should intussusception be managed?

A

It’s an emergency

If stable:

  • Fluid resuscitation
  • Enema: pneumatic - forces bowel to un-telescope - take x rays throughout

If unstable:

  • Don’t mess about with contrast, go in with open surgery
  • Remove any non-viable bowel
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28
Q

What should be done if there is recurrent intussusception?

A

Investigate for a lead point

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29
Q

What is Meckel’s diverticulum?

A

Ileal remnant of vitello-intestinal duct on anti-mesenteric border containing ectopic gastric mucosa or pancreatic tissue

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30
Q

What is the rule used to remember all you need to know about Meckel’s diverticulum?

A 
Rule of twos
2 years old
2 x more common in boys
2 feet from ileocaecal valve
2 inches long
2 different mucosae (gastric and pancreatic)
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31
Q

What are the signs and symptoms of meckel’s diverticulum?

A

Mostly asymptomatic
Painless massive PR bleeding if it bleeds
May show billious vomiting, dehydration and intractable constipation

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32
Q

How should meckel’s diverticulum be investigated?

A

Technetium scan indicates increased uptake by gastric mucosa
AXR or USS + laparoscopy

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33
Q

How should meckel’s diverticulum be managed?

A

If asymptomatic, leave it alone!

If symptomatic:
Bleeding: excise diverticulum with blood transfusion
Obstruction: excise diverticulum and lyse adhesions
Perforation/ peritonitis: Excise with perioperative Abx

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34
Q

How may volvulus present?

A
  1. At any age, after lying quiescent for ages
  2. In first few days of life, with obstruction and possible compromised blood supply –> abdo pain, billious vomiting, peritonism etc
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35
Q

What is the main sign of volvulus on abdo examination?

A

Scaphoid abdomen

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36
Q

How should volvulus be investigated?

A
  1. Upper GI contrast study (urgently) to assess patency if billious vomiting
  2. USS
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37
Q

How should volvulus be managed?

A

Urgent laparotomy

Untwist the volvulus, mobilise the duodenum, place bowel in a good position and remove any necrotic bowel

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38
Q

What is the first thing to exclude in suspected IBS?

A

Coeliac

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39
Q

Recall the signs and symptoms of IBS

A 
Abdo pain - often worse before or relieved by defaecation
Explosive loose or mucus stools
Bloating
Tenesmus
Constipation
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40
Q

Recall the 3 most common causes of paediatric gastroenteritis in decreasing prevalence

A
  1. Rotavirus
  2. Campylobacter
  3. Shigella/ salmonella
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41
Q

If there is bloody diarrhoea in gastroenteritis, which microbes should be considered first?

A 
CHESS organisms: 
Campylobacter
Hemorrhagic E coli
Entamoeba histolytica
Salmonella
Shigella
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42
Q

What investigations should be done in a case of gastroenteritis?

A

AXR to exclude other causes
Stool sample analysis
- for viruses = stool electron microscopy
- for bacteria = stool culture

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43
Q

How should paediatric gastroeneteritis be managed?

A

Rehydration

Learn these maintenance fluid volumes:
0-10 kg = 100mls/kg

10-20kgs = 1000mls + 50ml/kg for each kg over 10kg

20+ kgs = 1500mls + 20 mls/kg for each kg over 20kgs

If <5 use IV fluids and maintain with oral rehydration solution

If >5, give 200mls after each

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44
Q

What is the safety netting for how long vomiting and diarrhoea should last?

A

Vomiting: usually 1-2 days, must stop within 3 days

Diarrhoea: 5-7 days, must stop within 2 weeks

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45
Q

What is the most accurate marker of dehydration in children?

A

Weight loss

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46
Q

What is the threshold marker of dehydration for clinical dehydration and shock?

A

5-10% weight loss = clinical dehydration

>10% weight loss = shock

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47
Q

Recall the symptoms of hypernatraemia

A

Mnemonic: f(ull) of salt
Flushing

Oedema
Fever

Seizures
Agitation
Low urine output
Thirst

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48
Q

Recall the symptoms of hyponatraemia

A 
SALT LOSS
Stupor
Anorexia
Limp tone
Tendon reflexes reduced

Lethargy
Orthostatic hypotension
Seizures
Stomach cramps

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49
Q

When are IV fluids (rather than ORS) indicated?

A

Shock, deterioration, persistent vomiting

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50
Q

What are the bolus fluids given in shock?

A

20mls/kg 0.9% saline over 15 mins (most situations)

10mls/kg 0.9% saline over 60 mins (trauma, fluid overload, heart failure)

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51
Q

Recall the day 1, 2, 3, 4, and 5 fluid resucitation requirements in neonates

A

Day 1: 50-60mls/kg/day

Day 2: 70-80mls/kg/day

Day 3: 80-100mls/kg/day

Day 4: 100-120mls/kg/day

Day 5: 120-150mls/kg/day

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52
Q

Which type of fluid should be used in fluid resus for term neonates?

A

Isotonic crystalloids with 10% dextrose

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53
Q

If giving IV fluids to a hypernatraemic child, what should be the biggest caution?

A

Take care with cerebral oedema (rapid reduction in plasma sodium concentration and osmolality will lead to a shift of water into the cerebral cells and may result in seizures and cerebral oedema)

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54
Q

When should Abx be used in gastroenteritis?

A

Not even indicated when cause is bacterial

Use when:

  • SEPSIS
  • salmonella < 6 months
  • C difficile with pseudomembranous colitis
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55
Q

What is the post-gastroenteritis syndrome and how can it be treated?

A

Introduction of a normal diet results in a return of watery diarrhoea

Treat with oral rehydration therapy

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56
Q

What would be seen on biopsy in Crohn’s?

A

Non-caseating epitheloid cell granulomata

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57
Q

Recall some important investigations to do for Crohn’s disease

A
  1. FBC including iron, folate and B12
  2. Faecal calprotectin
  3. Colonoscopy and biopsy (cobblestones)
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58
Q

How should Crohn’s be treated?

A
  1. Induce remission:
    - Nutritional management
    - replace diet with whole protein modular diet - excessively liquid, for 6-8 weeks.
    The products are easily-digested and replace lost weight
  • Pharmacological management: steroids (prednisolone)
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59
Q

What is the classical presentation of UC?

A

Rectal bleeding, diarrhoea, abdo pain

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60
Q

What are the appropriate investigations to do in ulcerative colitis?

A

Same as Crohn’s

  1. FBC including iron, folate and B12
  2. Faecal calprotectin
  3. Colonoscopy and biopsy
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61
Q

What does histology reveal in UC?

A

Mucosal inflammation/ ulceration, crypt damage

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62
Q

What scores can be used to score paediatric UC?

A

Paediatric UC Activity Index, Truelove and Witts

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63
Q

What is one coexisting condition that it’s important to be aware of in ulcerative colitis?

A

Depression

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64
Q

How should UC be managed?

A

1st line = oral aminosalicylates - may also be used to maintain remission
2nd line - oral corticosteroid
3rd line = oral tacrolimus
Surgery in resistant disease

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65
Q

When does UC become an emergency?

A

In severe fulminating disease

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66
Q

What is the usual cause of toddler diarrhoea?

A

Underlying maturational delay in intestinal mobility

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67
Q

Recall some signs and symptoms of toddler diarrhoea

A

Varying consistency stools: well-formed to explosive and loose, may have bits of undigested vegetable
Child will be well and thriving

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68
Q

How is toddler diarrhoea managed?

A

Increase fibre and fat in diet (whole milk, yoghurts, cheese)
Avoid fruit juice and squash

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69
Q

What is the first-line management of constipation?

A

All first line:
1. Advise behavioural interventions (eg schedueled toileting, bowel habit diary, reward system)
2. Advise diet and lifestyle (adequate fluid intake)
3. Medication:
step 1 = movicol paediatric plan (dose escalates for 2 weeks)
Step 2: maintain for 6 months

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70
Q

Recall some important things to remember in PACES counselling for constipation

A

Explain movicol takes some time to work (dose increases over 2 weeks)
Encourage child sitting on loo after mealtimes to use reflex
Advise a star chart to aid motivation

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71
Q

What is Hirschprung’s?

A

An absence of ganglion cells from the myenteric (Auerbach) and submucosal (Meissner’s) plexuses

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72
Q

Recall 2 risk factors for Hirschprung’s

A

Down’s, Men2a

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73
Q

Recall some signs and symptoms of Hirschprung’s

A

Failure to pass meconium in first 24 hours

Explosive passage of liquid/ foul stools

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74
Q

If Hirschprung’s doesn’t present in first few days of life, what may happen?

A

May then present in a week or two with life-threatening Hirschprung’s enterocolitis (C diff)

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75
Q

How should Hirschprung’s be investigated?

A
  1. AXR (if obstruction)
  2. Contrast enema (showing dilated distal and narrowed proximal segments)
  3. Definitive diagnosis is via suction-assisted full-thickness rectal biopsy showing absence of ganglion cells
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76
Q

What is the management of Hirschprungs?

A

1st line - bowel irrigation

Also 1st line - endorectal pullthrough (colostomy followed by anastomosing normally innervated bowel)

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77
Q

Recall the principles of management for anal fissure

A

Ensure stools are soft and easy to pass (conservative)
Increase dietary fibre and fluid intake
Anal hygeine
Safety net: seek further help if not healed within 2 weeks

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78
Q

Recall all the principles of management for threadworm

A

Single dose of an anti-helminth (mebendazole) for the whole household

Advise rigorous hygeine for 2 weeks if on mebendazole, or 6 weeks if using hygeine measures alone

Exclusion from school/ nursery is not required

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79
Q

What can cause a temporary lactase deficiency?

A

Gastroenteritis, Crohn’s, coeliac, alcoholism

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80
Q

What should be excluded in suspected lactose intolerance?

A

Gastroenteritis (stool sample)
Crohn’s (faecal calprotectin)
Coeliac (anti-tTG/EMA)

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81
Q

How is a diagnosis of lactose intolerance made?

A

It’s a clinical diagnosis

  • trial a 2 week lactose-free diet and see how symptoms are
  • Breath hydrogen test: early rise in H2 following CHO ingestion
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82
Q

How is secondary lactose intolerance managed?

A

Cut out dairy to allow time to heal

May need calcium and vit D supplements

Digestive ensymes can be taken in a capsule before eating lactose until gut matures/ heals

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83
Q

Recall 2 genetic associations with Coeliac’s?

A

HLA DQ2 (95%), DQ8 (80%)

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84
Q

Recall the symptoms of coeliac in children

A

Failure to thrive, abdo distention, bloating, irritability

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85
Q

When does coeliac disease first present in children?

A

8-24months after introduction to wheat foods

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86
Q

How is coeliac disease diagnosed?

A

Most sensitive = IgA TTG

Or (less sensitive) = IgA anti-EMA

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87
Q

What other investigations are useful in coeliac disease?

A

FBC and blood smear to look for anaemia
In older children/ adults: OJD and biopsy can confirm diagnosis
In younger children there is no histopathological confirmation

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88
Q

How should coeliac disease be managed?

A

Cut out all wheat, rye and barley
Dietician referral and annual review
Support sources: Coeliac UK

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89
Q

What might be the consequences of non-adherence to diet in coeliac disease?

A

Micronutrient deficiency, osteoporosis, EATK, hyposplenism

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90
Q

What is mesenteric adenitis?

A

Swollen lymph glands that cause temporary abdo pain following infection

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91
Q

What are the signs and symptoms of mesenteric adenitis?

A

Abdo pain
Nausea and diarrhoea, leading to reduced appetite
Infectious picture
Often preceded by UTI

92
Q

How should mesenteric adenitis be diagnosed?

A

Definitive diagnosis = laparoscopy showing large mesenteric lymph nodes and normal appendix
More often a diagnosis of exclusion (exclude appendicitis with bloods, urine, MCandS)

93
Q

How should mesenteric adenitis be managed?

A

Simple analgesia, maybe Abx (but not routine), safety net for increased pain, deterioration

94
Q

What is the pathophysiology of an indirect inguinal hernia?

A

Towards the end of pregnancy the process vagialis allows passage of testicles from abdomen to scrotum
When this passage fails to close, abdo lining/ bowel can protrude through defect

95
Q

Recall the signs and symptoms of hernia

A

Scrotal sac enlarged, contains palpable loops of bowel, fluid (does not always transilluminate)
Swelling or bulge may be intermittent and can appear on crying or straining

96
Q

How is hernia diagnosed?

A

Clinical diagnosis

Examine supine and standing and try to reduce in order to determine type of hernia

97
Q

Recall 3 risk factors for umbilical hernia

A

Afro-caribbean
Down’s
Mucopolysaccharide diseases

98
Q

How should hernia be managed?

A

Correct urgently

  1. If < 6 weeks old, correct <2 days
  2. If < 6 months old, correct <2 weeks
  3. If <6 year old, correct <2 months
99
Q

How does an umbilical granuloma appear?

A

Leaks and is watery

100
Q

How is umbilical granuloma treated?

101
Q

Where are femoral hernias located?

A

Beneath inguinal canal

102
Q

What is femoral hernia most similar to?

A

Indirect inguinal hernia

103
Q

What is gastroschisis?

A

Paraumbilical wall defect –> abdominal contents outside body without a peritoneal covering - immediate surgery

104
Q

What is omphalocele?

A

Bowel protruding out of the body with a peritoneal covering

105
Q

How should omphalocele be managed?

A

Closure starting immediately, finishing at 6-12 months

106
Q

What is encoparesis?

A

Soiling of underwear with stool in children who are past the age of toilet training

107
Q

What is the usual cause of encoparesis?

A

Constipation with overflow

108
Q

How should encopresis be managed?

A

Enquire about stressors, changes in medication, food intolerances etc

109
Q

What are the 2 most likely causes of liver failure in children <2 y/o?

A

HSV infection, metabolic disease

110
Q

What is the most likely cause of acute liver failure in children >2 y/o?

A

Paracetamol OD

111
Q

What are the signs and symptoms of acute liver failure?

A 
Jaundice
Coagulopathy
Hypoglycaemia
Electrolyte disturbance
Encephalopathy
112
Q

How should Acute liver failure be managed?

A

Referral to a national paediatric liver centre
To stabilise the child:
- IV dextrose (due to hypoglycaemia)
- broad spectrum Abx and anti-fungals to prevent sepsis
- IV vit K and PPIs to prevent haemorrhage
- Fluid restriction and mannitol

113
Q

Recall some features of poor liver prognosis

A

Shrinking liver
Falling transaminases
Rising bilirubin
Worsening coagulopathy

114
Q

How should hepatic encephalopathy be managed?

A

Reduce nitrogen with lactulose

115
Q

How should AI hepatitis be managed?

A

Prednisolone/ azothioprine

116
Q

How should sclerosing cholangitis be managed?

A

Ursodeoxycholic acid (aids bile flow)

117
Q

How should Wilson’s disease be managed?

A

Zinc (blocks intestinal copper resorption)

Trientine/ penicillinamine (increases urinary Cu excretion)

Pyridoxine (vit B6, prevents peripheral neuropathy)

Symptomatic treatment for tremor, dystonia and speech imprediment

118
Q

How is non-alcoholic fatty liver disease managed in children?

A 
Weight loss
Statins
Treatment of diabetes
Vit E and C
Ursodeoxycholic acid to improve bile flow
119
Q

How should paracetamol OD be managed?

A

<1 hour: activated charchoal, do paracetamol level 4 hours post ingestio, NAC if indicated

> 1 hour: do a paracetamol level, NAC if indicated

120
Q

Recall a long-term complication of mumps, rubella and polio

A

Mumps: infertile boys, deafness

Rubella: severe deformities to pregnancy

Polio: massive respiratory problems

121
Q

In what age range does Kawasaki disease present?

A

6 months to 4 years - peak at one year

122
Q

What is Kawasaki’s disease?

A

Systemic vasculitis

123
Q

What is the main cause of mortality in KD?

A

Coronary aneurism

124
Q

What are the signs and symptoms of Kawasaki disease?

A 
CRASH and Burn
C - conjunctivitis
R - rash (polymorphous, begins at hands and feet)
A - Adenopathy
S - Strawberry tongue
H - hands and feet swollen

Burn (fever >5 days)

125
Q

How is kawasaki disease diagnosed?

A

CLINICALLY

Do bloods and echo to guide management

126
Q

How is kawasaki disease managed?

A

ADMISSION

IV Ig + high dose aspirin

127
Q

By what vector is malaria spread?

A

Female anopheles mosquito

128
Q

How fast is the onset of malaria after innoculation?

129
Q

What are the signs and symptoms of malaria?

A 
Cyclical fever with spikes
DandV
Jaundice
Anaemia
Thrombocytopaenia
Flu-like symptoms
130
Q

What are the appropriate investigations for malaria?

A

3 thick and thin blood films (thick = parasite, thin = species)
Malaria rapid antigen detection tests

131
Q

What is used for anti-malarial prophylaxis?

132
Q

How should malaria be managed?

A

Arrange immediate admission
Notify PHE
Treatment is very variable
Non-falciparum: chloroquinine

Mild falciparum (not vomiting): ACT (Artemisinin Combination Therapy) and Atovaquone-proguanil

Severe/ complicated falciparum: IV Artesunate is first line

133
Q

What is the route of transmission of typhoid?

A

Faeco-oral

134
Q

What are the signs and symptoms of typhoid?

A 
May be bradycardic 
Cough
Malaise
Anorexia
Diarrhoea or constipation by 2nd week
Rose spots on trunk
135
Q

How is typhoid diagnosed?

A

Blood culture is diagnostic

136
Q

How should typhoid be managed?

A

1st line = IV ceftriaxone

2nd line = PO azithromycin

137
Q

What is the vector of dengue virus?

A

Aedes aegyptii mosquito

138
Q

Where is dengue usually imported from?

A

SE Asia and South Africa

139
Q

What are the expected FBC abnormalities in Dengue?

A

Low WCC, low platelets and low Hb

140
Q

What are the signs and symptoms of dengue?

A

Retro-orbital headache
Sunburn-like rash
High fever and myalgia
Hepatomegaly and abdo distention

141
Q

What is dengue haemorrhagic fever?

A

It’s the secondary infection by a different strain that causes severe capillary leakage –> hypotension and haemorrhagic manifestations
Due to partial host reponse augmenting severity of host infection

142
Q

How should dengue haemorrhagic fever be managed?

A

Fluid resuscitation

143
Q

What is the gold standard investigation for dengue diagnosis?

A

PCR viral antigen, serology IgM

144
Q

What is the pathogen that causes mumps?

A

Mumps paramyxovirus

145
Q

How is mumps transmitted?

A

Respiratory secretions

146
Q

For how long is mumps infectious?

A

For 5 days before and 5 days after the parotid swelling

147
Q

What are the signs and symptoms of mumps?

A

Asymptomatic in 30% Headache, fever and parotid swelling

148
Q

Recall the 2 key investigations for mumps

A

Oral fluid IgM sample

Amylase in blood is raised

149
Q

How should mumps be managed?

A

Notify HPU, isolate for 5 days from time of parotid swelling
Supportive care (rest, analgesia)
Safety net for complications

150
Q

What are the possible complications of mumps?

A 
Mumps orchitis (leading to infertility)
Viral meningitis (encephalitis)
Deafness (unilateral and transient)
151
Q

How is measles transmitted?

A

Respiratory secretions

152
Q

For how long is measles infectious?

A

4 days before and 4 days after rash

153
Q

Recall the signs and symptoms of measles

A

Prodrome of high fever, irritability, conjunctivitis and febrile convulsions
Maculopapular rash (face/ neck –> hands/ feet)
Koplick spots (small white spots surrounded by red ring in mouth)
Cough
No lymphadenopathy

154
Q

What investigations should be done in suspected measles?

A

1st line is measles serology (IgM/ IgG) from Oral fluid test (OFT)
2nd line is PCR of blood/ saliva

155
Q

How should measles be managed?

A

Notify HPU
Isolate for 4 days following development of rash
Rest and supportive treatment
Immunise close contacts
Safety net the complications of encephalitis/ SSPE/ otitis media (most common), pneumonia

156
Q

What is SSPE?

A

Sub-acute Sclerosing Panencephalitis
Seen 7 years after measles infection
Measles has been dormant in CNS
signs and symptoms = dementia and death

157
Q

What type of virus causes rubella?

158
Q

What is the infectious period of rubella?

A

1 week before to 5 days after rash onset

159
Q

Recall the signs and symptoms of rubella

A

Prodrome of mild fever or sometimes asymptomatic
Pink maculopapular rash (face –> whole body) which fades pretty quickly
In 20% there are Forcheimer spots (red spots on soft palate)
Lymphadenopathy (none in measles)
No koplik spots or conjuntivitis

160
Q

How should rubella be investigated?

A 
Rubella serology (IgG and IgM) from oral fluid test
RT-PCR is 2nd line
161
Q

How should rubella be managed?

A

Notify HPU, isolate for 4 days after development of rash
Supportive care
Safety net the complications (haemorrhagic complications due to thrombocytopaenia)

162
Q

Recall some other names for this roseola infantum

A

Fifth disease/ erythema infectiosum/ slapped cheek

163
Q

How is parvovirus B19 transmitted?

A

Respiratory secretions/ vertically

164
Q

Which cells does pB19 infect?

A

RBC precursors

165
Q

What is the infectious period of parvovirus?

A

10 days before to 1 day after the rash develops

166
Q

Recall the signs and symptoms of parvovirus B19

A

1st: asymptomatic or coryzal illness for 2-3 days then latent for 7-10 days
2nd: most commonly, erythema infectiosum - ‘red slapped cheek’ rash on face
Progresses to maculopapular (‘lace like’) rash in trunk and limbs

167
Q

How should parvovirus B19 be investigated?

A 
B19 serology (IgG and IgM) - similar to rubella
2nd line is RT-PCR
168
Q

How should pB19 be managed?

A

Supportive (virus, fluids, analgesia, rest)
No need to stay off school or avoid pregnant women (once rash develops it’s not really infectious)
Complications to safety net = anaemia, lethargy, pregnancy

169
Q

What is the infectious period of VZV?

A

48 hours before rash to last crusted over lesion

170
Q

What are the stages of the rash appearance in chickenpox?

A

Papule –> vesicle –> crust

171
Q

How should VZV be investigated?

A

Clinical diagnosis

172
Q

How shoulod VZV be managed?

A

Supportive, no ibuprofen, keep home from school

173
Q

What advice would you give to parents if their child has VZV?

A

Keep their nails short

174
Q

When should you admit in VZV?

A

Pneumonia, encephalitis, dehydration

Secondary bacterial superinfection (sudden high fever, toxic shock, necrotising fasciitis)

Purpura fulminans: large necrotic loss of skin from cross-activation of anti-viral Abs

175
Q

What is the pathogen that causes hand, foot and mouth disease?

A

Usually coxsackie A16

Atypical: coxsackie A6

Severe: enterovirus 71

176
Q

What are the signs and symptoms of hand, foot and mouth disease?

A

Painful, itchy, vesicular lesions on hands, feet, mouth and buttocks
Mild systemic features- fever, sore throat, spots in mouth - develop into ulcers

177
Q

How should hand, foot and mouth disease be managed?

A

Supportive
Will clear in 7-10 days
Safety net for dehydration

178
Q

What pathogen causes roseola infantum?

179
Q

What is another name for roseola infantum?

A

Sixth disease

180
Q

Describe the epidemiology of roseola infantum

A

Most children infected by age 2 - it’s highly infectious for the whole period of disease

181
Q

What are the signs and symptoms of roseola infantum?

A

High fever and malaise for 3-4 days, followed by generalised macular rash (small pink spots) that goes neck –> arms - non-itchy

Febrile convulsions in 10-15%
Sore throat, lymphadenopathy, coryzal symptoms, D+V
Nagayama spots (spots on the uvula and soft palate)

182
Q

How should roseola infantum be investigated?

A

HHV6/7 serology (IgG or IgM)

Measles and rubella serology - as these have a similar presentation

183
Q

How should roseola infantum be managed?

A

Supportive, no need to stay off school, safety net the complications: febrile convulsions

184
Q

How should children be investigated for HIV?

A

<18 months: PCR of virus at birth, on discharge, at 6w, 12w and 18 months

> 18 months: antibody detection via ELISA

185
Q

How should childhood HIV be managed?

A

Cord clamped asap and bathed straight after birth

Zidovudine monotherapy for 2-4w (if low/med risk) or PEP combination 4w (if high risk)

Women not to breastfeed

Give all immunisations

186
Q

What are the general signs and symptoms of T cell defects?

A

Severe viral and fungal infections

187
Q

What are the general signs and symptoms of B cell defects?

A

Severe bacterial infections

188
Q

What are the general signs and symptoms of neutrophil defects?

A

Recurrent bacterial infections and invasive fungal infections

189
Q

What are the general signs and symptoms of NK cell defects?

A

Recurrent viral infections

190
Q

Give six examples of T cell defects

A 
SCID
HIV 
Ataxia telangiectasia
DiGeorge syndrome
Wiskott-Aldrick syndrome
Duncan disease
191
Q

Give four examples of B cell defects

A

Bruton’s agammaglobulinaemia
Common variable ID
Hyper IgM
IgA deficiency

192
Q

Given an example of a neutrophil defect disease

A

Chronic granulomatous disease

193
Q

Give two examples of NK defects

A

Classical and functional NK cell deficiency

194
Q

What are the 2 main signs and symptoms of leukocyte adhesion deficiency?

A

Delayed separation of umbilical cord

Chronic skin ulcers

195
Q

What are the 2 main signs and symptoms of complement defects?

A

Recurrent bacterial infections (especially encapsulated bacteria) and SLE-like illness

196
Q

What is hyper-IgE also known as?

A

Job/Buckley syndrome

197
Q

What are the signs and symptoms of hyper-IgE?

A

Eczema, coarse facial features, recurrent RTIs, cold abscesses, candidiasis

198
Q

What is the pathophysiology (briefly) of ataxia telangiectasia?

A

Defective DNA repair causing T cell defect

199
Q

What are people with ataxia telangiectasia at increased risk of?

200
Q

What are the signs and symptoms of ataxia telangiectasia?

A

Cerebellar ataxia, developmental delay, telangiectasia in the eyes

201
Q

What is the inheritance pattern of Wiskott-Aldrich syndrome?

202
Q

At around what age does Wiskott-Aldrich syndrome present?

203
Q

What are the signs and symptoms of Wiskott-Aldrich syndrome?

A

WATER: Wiskott-Aldrich Thrombocytopaenia, Eczema, Recurrent infections

204
Q

How can Wiskott-Aldrich syndrome be differentiated from ITP?

A

WAS presents around 7 months but ITP is more like 4 years

205
Q

What is the cause of eczema in Wiskott-Aldrich syndrome?

A

Raised IgA and IgE

206
Q

What is the cause of recurrent infection in Wiskott-Aldrich syndrome?

A

Low IgG and IgM

207
Q

How is Wiskott-Aldrich syndrome managed?

A

IVIg –> HSCT

208
Q

What is the inheritance pattern of Duncan disease?

209
Q

What is the pathophysiology of duncan disease?

A

Inability to generate a normal response to EBV

210
Q

What are the signs and symptoms of duncan disease?

A

Death in initial EBV or development of a secondary B cell lymphoma

211
Q

How does a non-IgE mediated allergy present?

A

Erythema, atopic eczema, GORD, change in frequency of stools, blood/mucus in stools, constipation, food aversion

212
Q

What should an allergy-focused history contain?

A

Classification (speed, onset, severity, reproducability)

Atopic hx (personal or FH)

Food diary

Details of food avoidance and why

Details of any feeding history (age of weaning etc)

Cultural/ religious factors

Any previous elimination trials

213
Q

What are the 2 tests that can be done for allergy?

A

Test 1 = skin prick test

Test 2 = measurement of specific IgE antibodies

214
Q

When would you refer to a specialist for allergy?

A

Faltering growth, severe atopic eczema, multiple allergies, persisting suspicion, history of an acute systemic/ severe delayed reaction

215
Q

How should allergy be managed?

A

Specialist care if indicated
Avoid relevant foods
MDT - advice from paediatric dietician to avoid nutritional deficienciesTeach family and child how to manage allergic attack
Written information + adequate training

216
Q

What are the classifications of allergic rhinitis?

A

Intermittent vs persistent
Mild vs severe
Seasonal vs perennial

217
Q

What other differentials need to be ruled out in suspected allergic rhinitis?

A

Nasal polyps
Deviated nasal septum
Mucosal swelling/ depressed and widened nasal bridge

218
Q

How is occasional symptomatic relief achieved in allergic rhinitis?

A

Any age: intranasal azelastine (type of antihistamine)

2-5 y/o –> oral certirizine

219
Q

How is frequent symptomatic relief achieved in allergic rhinitis?

A

If main issue is nasal blockage/ polyps: intranasal beclomethasone

If main issue is sneezing/ discharge: intranasal CS or oral antihistamine

220
Q

What is SCIT?

A

Subcutaneous Immunotherapy
Used to administer specific allergen immunotherapy
SC injection on a regular basis for 3-5 years
Can provide protection for any years but has risk of inducing anaphylaxis

221
Q

Who is most likely to develop a cow’s milk protein allergy?

A

Formula-fed children

222
Q

How should cow’s milk protein allergy be investigated?

A

Same as ‘food allergy’

223
Q

How should cow’s milk protein allergy be managed?

A

Trial cow’s milk elimination diet for 2-6 weeks:

  • In breast-fed babies, mother should exclude cow’s milk protein from her diet
  • consider prescribing daily 1g calcium and 10mcg vit D-

In formula-fed babies, replace cows milk based formula with hypoallergenic formula

224
Q

What is the most common complication of measles?

A

Acute otitis media

225
Q

Describe the presentation of meconium ileus

A

Large volumes of billious vomiting

[EDITED] THURSDAY Year 5 Specialties Ludley's (10 decks)

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