Paeds gastro, infection and immunity Flashcards
1
Q
What is the cause of GOR in babies?
A
Inappropriate relaxation of the LOS (functional immaturity)
2
Q
By when does GOR usuallly resolve?
A
12 months - if persistent, may be due to GORD
3
Q
How is GOR diagnosed?
A
Clinical diagnosis
- 24 hour LOS pH monitoring (it should remain above 4)
- OGD
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
5
Q
Recall the management options for GOR
A
- Reassure - it’s v common!
- Must sleep on back
- 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
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
7
Q
At what age does pyloric stenosis present?
A
2-8 weeks
8
Q
Is pyloric stenosis more common in girls or boys?
A
Boys (4 x more common)
9
Q
Recall a genetic association of pyloric stenosis
A
Turner’s syndrome
10
Q
What is the main symptom of pyloric stenosis?
A
Projectile, non-billious vomiting
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
12
Q
Recall some signs of pyloric stenosis
A
Palpable ‘olive’ mass
Visible peristalsis in upper abdomen
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)
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
15
Q
How should pyloric stenosis be managed?
A
- IV slow fluid resuscitation + correct any disturbances:
1.5 x maintenance rate
5% dextrose
0.45% saline - Laparoscopic Ramstedt pyloromyotomy
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
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
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)
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
20
Q
What is intussusception?
A
Invagination of proximal bowel into distant component (telescoping distally)
21
Q
What is the most common site of intussusception?
A
Ileum through to caecum through ileocaecal valve
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
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
24
Q
What are the symptoms of intussusception?
A
Intermittent colicky pain
Vomit - depending on type of intususception, may be bile-stained or not
25
What are the signs of intussusception?
Abdominal distention with sausage shaped mass in RUQ
Emptiness on palpation in RLQ (Dance's sign)
Red-currant jelly stool is a late sign
26
What are the appropriate investigations for intussusception?
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
27
How should intussusception be managed?
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
28
What should be done if there is recurrent intussusception?
Investigate for a lead point
29
What is Meckel's diverticulum?
Ileal remnant of vitello-intestinal duct on anti-mesenteric border containing ectopic gastric mucosa or pancreatic tissue
30
What is the rule used to remember all you need to know about Meckel's diverticulum?
```
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)
```
31
What are the signs and symptoms of meckel's diverticulum?
Mostly asymptomatic
Painless massive PR bleeding if it bleeds
May show billious vomiting, dehydration and intractable constipation
32
How should meckel's diverticulum be investigated?
Technetium scan indicates increased uptake by gastric mucosa
AXR or USS + laparoscopy
33
How should meckel's diverticulum be managed?
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
34
How may volvulus present?
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
35
What is the main sign of volvulus on abdo examination?
Scaphoid abdomen
36
How should volvulus be investigated?
1. Upper GI contrast study (urgently) to assess patency if billious vomiting
2. USS
37
How should volvulus be managed?
Urgent laparotomy
| Untwist the volvulus, mobilise the duodenum, place bowel in a good position and remove any necrotic bowel
38
What is the first thing to exclude in suspected IBS?
Coeliac
39
Recall the signs and symptoms of IBS
```
Abdo pain - often worse before or relieved by defaecation
Explosive loose or mucus stools
Bloating
Tenesmus
Constipation
```
40
Recall the 3 most common causes of paediatric gastroenteritis in decreasing prevalence
1. Rotavirus
2. Campylobacter
3. Shigella/ salmonella
41
If there is bloody diarrhoea in gastroenteritis, which microbes should be considered first?
```
CHESS organisms:
Campylobacter
Hemorrhagic E coli
Entamoeba histolytica
Salmonella
Shigella
```
42
What investigations should be done in a case of gastroenteritis?
AXR to exclude other causes
Stool sample analysis
- for viruses = stool electron microscopy
- for bacteria = stool culture
43
How should paediatric gastroeneteritis be managed?
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
44
What is the safety netting for how long vomiting and diarrhoea should last?
Vomiting: usually 1-2 days, must stop within 3 days
Diarrhoea: 5-7 days, must stop within 2 weeks
45
What is the most accurate marker of dehydration in children?
Weight loss
46
What is the threshold marker of dehydration for clinical dehydration and shock?
5-10% weight loss = clinical dehydration
| >10% weight loss = shock
47
Recall the symptoms of hypernatraemia
Mnemonic: f(ull) of salt
Flushing
Oedema
Fever
Seizures
Agitation
Low urine output
Thirst
48
Recall the symptoms of hyponatraemia
```
SALT LOSS
Stupor
Anorexia
Limp tone
Tendon reflexes reduced
```
Lethargy
Orthostatic hypotension
Seizures
Stomach cramps
49
When are IV fluids (rather than ORS) indicated?
Shock, deterioration, persistent vomiting
50
What are the bolus fluids given in shock?
20mls/kg 0.9% saline over 15 mins (most situations)
10mls/kg 0.9% saline over 60 mins (trauma, fluid overload, heart failure)
51
Recall the day 1, 2, 3, 4, and 5 fluid resucitation requirements in neonates
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
52
Which type of fluid should be used in fluid resus for term neonates?
Isotonic crystalloids with 10% dextrose
53
If giving IV fluids to a hypernatraemic child, what should be the biggest caution?
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)
54
When should Abx be used in gastroenteritis?
Not even indicated when cause is bacterial
Use when:
- SEPSIS
- salmonella < 6 months
- C difficile with pseudomembranous colitis
55
What is the post-gastroenteritis syndrome and how can it be treated?
Introduction of a normal diet results in a return of watery diarrhoea
Treat with oral rehydration therapy
56
What would be seen on biopsy in Crohn's?
Non-caseating epitheloid cell granulomata
57
Recall some important investigations to do for Crohn's disease
1. FBC including iron, folate and B12
2. Faecal calprotectin
3. Colonoscopy and biopsy (cobblestones)
58
How should Crohn's be treated?
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)
59
What is the classical presentation of UC?
Rectal bleeding, diarrhoea, abdo pain
60
What are the appropriate investigations to do in ulcerative colitis?
Same as Crohn's
1. FBC including iron, folate and B12
2. Faecal calprotectin
3. Colonoscopy and biopsy
61
What does histology reveal in UC?
Mucosal inflammation/ ulceration, crypt damage
62
What scores can be used to score paediatric UC?
Paediatric UC Activity Index, Truelove and Witts
63
What is one coexisting condition that it's important to be aware of in ulcerative colitis?
Depression
64
How should UC be managed?
1st line = oral aminosalicylates - may also be used to maintain remission
2nd line - oral corticosteroid
3rd line = oral tacrolimus
Surgery in resistant disease
65
When does UC become an emergency?
In severe fulminating disease
66
What is the usual cause of toddler diarrhoea?
Underlying maturational delay in intestinal mobility
67
Recall some signs and symptoms of toddler diarrhoea
Varying consistency stools: well-formed to explosive and loose, may have bits of undigested vegetable
Child will be well and thriving
68
How is toddler diarrhoea managed?
Increase fibre and fat in diet (whole milk, yoghurts, cheese)
Avoid fruit juice and squash
69
What is the first-line management of constipation?
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
70
Recall some important things to remember in PACES counselling for constipation
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
71
What is Hirschprung's?
An absence of ganglion cells from the myenteric (Auerbach) and submucosal (Meissner’s) plexuses
72
Recall 2 risk factors for Hirschprung's
Down's, Men2a
73
Recall some signs and symptoms of Hirschprung's
Failure to pass meconium in first 24 hours
| Explosive passage of liquid/ foul stools
74
If Hirschprung's doesn't present in first few days of life, what may happen?
May then present in a week or two with life-threatening Hirschprung's enterocolitis (C diff)
75
How should Hirschprung's be investigated?
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
76
What is the management of Hirschprungs?
1st line - bowel irrigation
| Also 1st line - endorectal pullthrough (colostomy followed by anastomosing normally innervated bowel)
77
Recall the principles of management for anal fissure
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
78
Recall all the principles of management for threadworm
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
79
What can cause a temporary lactase deficiency?
Gastroenteritis, Crohn's, coeliac, alcoholism
80
What should be excluded in suspected lactose intolerance?
Gastroenteritis (stool sample)
Crohn's (faecal calprotectin)
Coeliac (anti-tTG/EMA)
81
How is a diagnosis of lactose intolerance made?
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
82
How is secondary lactose intolerance managed?
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
83
Recall 2 genetic associations with Coeliac's?
HLA DQ2 (95%), DQ8 (80%)
84
Recall the symptoms of coeliac in children
Failure to thrive, abdo distention, bloating, irritability
85
When does coeliac disease first present in children?
8-24months after introduction to wheat foods
86
How is coeliac disease diagnosed?
Most sensitive = IgA TTG
| Or (less sensitive) = IgA anti-EMA
87
What other investigations are useful in coeliac disease?
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
88
How should coeliac disease be managed?
Cut out all wheat, rye and barley
Dietician referral and annual review
Support sources: Coeliac UK
89
What might be the consequences of non-adherence to diet in coeliac disease?
Micronutrient deficiency, osteoporosis, EATK, hyposplenism
90
What is mesenteric adenitis?
Swollen lymph glands that cause temporary abdo pain following infection
91
What are the signs and symptoms of mesenteric adenitis?
Abdo pain
Nausea and diarrhoea, leading to reduced appetite
Infectious picture
Often preceded by UTI
92
How should mesenteric adenitis be diagnosed?
Definitive diagnosis = laparoscopy showing large mesenteric lymph nodes and normal appendix
More often a diagnosis of exclusion (exclude appendicitis with bloods, urine, MCandS)
93
How should mesenteric adenitis be managed?
Simple analgesia, maybe Abx (but not routine), safety net for increased pain, deterioration
94
What is the pathophysiology of an indirect inguinal hernia?
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
Recall the signs and symptoms of hernia
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
How is hernia diagnosed?
Clinical diagnosis
| Examine supine and standing and try to reduce in order to determine type of hernia
97
Recall 3 risk factors for umbilical hernia
Afro-caribbean
Down's
Mucopolysaccharide diseases
98
How should hernia be managed?
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
How does an umbilical granuloma appear?
Leaks and is watery
100
How is umbilical granuloma treated?
With salt
101
Where are femoral hernias located?
Beneath inguinal canal
102
What is femoral hernia most similar to?
Indirect inguinal hernia
103
What is gastroschisis?
Paraumbilical wall defect --> abdominal contents outside body without a peritoneal covering - immediate surgery
104
What is omphalocele?
Bowel protruding out of the body with a peritoneal covering
105
How should omphalocele be managed?
Closure starting immediately, finishing at 6-12 months
106
What is encoparesis?
Soiling of underwear with stool in children who are past the age of toilet training
107
What is the usual cause of encoparesis?
Constipation with overflow
108
How should encopresis be managed?
Enquire about stressors, changes in medication, food intolerances etc
109
What are the 2 most likely causes of liver failure in children <2 y/o?
HSV infection, metabolic disease
110
What is the most likely cause of acute liver failure in children >2 y/o?
Paracetamol OD
111
What are the signs and symptoms of acute liver failure?
```
Jaundice
Coagulopathy
Hypoglycaemia
Electrolyte disturbance
Encephalopathy
```
112
How should Acute liver failure be managed?
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
Recall some features of poor liver prognosis
Shrinking liver
Falling transaminases
Rising bilirubin
Worsening coagulopathy
114
How should hepatic encephalopathy be managed?
Reduce nitrogen with lactulose
115
How should AI hepatitis be managed?
Prednisolone/ azothioprine
116
How should sclerosing cholangitis be managed?
Ursodeoxycholic acid (aids bile flow)
117
How should Wilson's disease be managed?
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
How is non-alcoholic fatty liver disease managed in children?
```
Weight loss
Statins
Treatment of diabetes
Vit E and C
Ursodeoxycholic acid to improve bile flow
```
119
How should paracetamol OD be managed?
<1 hour: activated charchoal, do paracetamol level 4 hours post ingestio, NAC if indicated
>1 hour: do a paracetamol level, NAC if indicated
120
Recall a long-term complication of mumps, rubella and polio
Mumps: infertile boys, deafness
Rubella: severe deformities to pregnancy
Polio: massive respiratory problems
121
In what age range does Kawasaki disease present?
6 months to 4 years - peak at one year
122
What is Kawasaki's disease?
Systemic vasculitis
123
What is the main cause of mortality in KD?
Coronary aneurism
124
What are the signs and symptoms of Kawasaki disease?
```
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
How is kawasaki disease diagnosed?
CLINICALLY
| Do bloods and echo to guide management
126
How is kawasaki disease managed?
ADMISSION
| IV Ig + high dose aspirin
127
By what vector is malaria spread?
Female anopheles mosquito
128
How fast is the onset of malaria after innoculation?
7-10 days
129
What are the signs and symptoms of malaria?
```
Cyclical fever with spikes
DandV
Jaundice
Anaemia
Thrombocytopaenia
Flu-like symptoms
```
130
What are the appropriate investigations for malaria?
3 thick and thin blood films (thick = parasite, thin = species)
Malaria rapid antigen detection tests
131
What is used for anti-malarial prophylaxis?
Quinine
132
How should malaria be managed?
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
What is the route of transmission of typhoid?
Faeco-oral
134
What are the signs and symptoms of typhoid?
```
May be bradycardic
Cough
Malaise
Anorexia
Diarrhoea or constipation by 2nd week
Rose spots on trunk
```
135
How is typhoid diagnosed?
Blood culture is diagnostic
136
How should typhoid be managed?
1st line = IV ceftriaxone
| 2nd line = PO azithromycin
137
What is the vector of dengue virus?
Aedes aegyptii mosquito
138
Where is dengue usually imported from?
SE Asia and South Africa
139
What are the expected FBC abnormalities in Dengue?
Low WCC, low platelets and low Hb
140
What are the signs and symptoms of dengue?
Retro-orbital headache
Sunburn-like rash
High fever and myalgia
Hepatomegaly and abdo distention
141
What is dengue haemorrhagic fever?
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
How should dengue haemorrhagic fever be managed?
Fluid resuscitation
143
What is the gold standard investigation for dengue diagnosis?
PCR viral antigen, serology IgM
144
What is the pathogen that causes mumps?
Mumps paramyxovirus
145
How is mumps transmitted?
Respiratory secretions
146
For how long is mumps infectious?
For 5 days before and 5 days after the parotid swelling
147
What are the signs and symptoms of mumps?
Asymptomatic in 30% Headache, fever and parotid swelling
148
Recall the 2 key investigations for mumps
Oral fluid IgM sample
| Amylase in blood is raised
149
How should mumps be managed?
Notify HPU, isolate for 5 days from time of parotid swelling
Supportive care (rest, analgesia)
Safety net for complications
150
What are the possible complications of mumps?
```
Mumps orchitis (leading to infertility)
Viral meningitis (encephalitis)
Deafness (unilateral and transient)
```
151
How is measles transmitted?
Respiratory secretions
152
For how long is measles infectious?
4 days before and 4 days after rash
153
Recall the signs and symptoms of measles
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
What investigations should be done in suspected measles?
1st line is measles serology (IgM/ IgG) from Oral fluid test (OFT)
2nd line is PCR of blood/ saliva
155
How should measles be managed?
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
What is SSPE?
Sub-acute Sclerosing Panencephalitis
Seen 7 years after measles infection
Measles has been dormant in CNS
signs and symptoms = dementia and death
157
What type of virus causes rubella?
Togavirus
158
What is the infectious period of rubella?
1 week before to 5 days after rash onset
159
Recall the signs and symptoms of rubella
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
How should rubella be investigated?
```
Rubella serology (IgG and IgM) from oral fluid test
RT-PCR is 2nd line
```
161
How should rubella be managed?
Notify HPU, isolate for 4 days after development of rash
Supportive care
Safety net the complications (haemorrhagic complications due to thrombocytopaenia)
162
Recall some other names for this roseola infantum
Fifth disease/ erythema infectiosum/ slapped cheek
163
How is parvovirus B19 transmitted?
Respiratory secretions/ vertically
164
Which cells does pB19 infect?
RBC precursors
165
What is the infectious period of parvovirus?
10 days before to 1 day after the rash develops
166
Recall the signs and symptoms of parvovirus B19
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
How should parvovirus B19 be investigated?
```
B19 serology (IgG and IgM) - similar to rubella
2nd line is RT-PCR
```
168
How should pB19 be managed?
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
What is the infectious period of VZV?
48 hours before rash to last crusted over lesion
170
What are the stages of the rash appearance in chickenpox?
Papule --> vesicle --> crust
171
How should VZV be investigated?
Clinical diagnosis
172
How shoulod VZV be managed?
Supportive, no ibuprofen, keep home from school
173
What advice would you give to parents if their child has VZV?
Keep their nails short
174
When should you admit in VZV?
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
What is the pathogen that causes hand, foot and mouth disease?
Usually coxsackie A16
Atypical: coxsackie A6
Severe: enterovirus 71
176
What are the signs and symptoms of hand, foot and mouth disease?
Painful, itchy, vesicular lesions on hands, feet, mouth and buttocks
Mild systemic features- fever, sore throat, spots in mouth - develop into ulcers
177
How should hand, foot and mouth disease be managed?
Supportive
Will clear in 7-10 days
Safety net for dehydration
178
What pathogen causes roseola infantum?
HHV6
179
What is another name for roseola infantum?
Sixth disease
180
Describe the epidemiology of roseola infantum
Most children infected by age 2 - it's highly infectious for the whole period of disease
181
What are the signs and symptoms of roseola infantum?
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
How should roseola infantum be investigated?
HHV6/7 serology (IgG or IgM)
| Measles and rubella serology - as these have a similar presentation
183
How should roseola infantum be managed?
Supportive, no need to stay off school, safety net the complications: febrile convulsions
184
How should children be investigated for HIV?
<18 months: PCR of virus at birth, on discharge, at 6w, 12w and 18 months
>18 months: antibody detection via ELISA
185
How should childhood HIV be managed?
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
What are the general signs and symptoms of T cell defects?
Severe viral and fungal infections
187
What are the general signs and symptoms of B cell defects?
Severe bacterial infections
188
What are the general signs and symptoms of neutrophil defects?
Recurrent bacterial infections and invasive fungal infections
189
What are the general signs and symptoms of NK cell defects?
Recurrent viral infections
190
Give six examples of T cell defects
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SCID
HIV
Ataxia telangiectasia
DiGeorge syndrome
Wiskott-Aldrick syndrome
Duncan disease
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191
Give four examples of B cell defects
Bruton's agammaglobulinaemia
Common variable ID
Hyper IgM
IgA deficiency
192
Given an example of a neutrophil defect disease
Chronic granulomatous disease
193
Give two examples of NK defects
Classical and functional NK cell deficiency
194
What are the 2 main signs and symptoms of leukocyte adhesion deficiency?
Delayed separation of umbilical cord
| Chronic skin ulcers
195
What are the 2 main signs and symptoms of complement defects?
Recurrent bacterial infections (especially encapsulated bacteria) and SLE-like illness
196
What is hyper-IgE also known as?
Job/Buckley syndrome
197
What are the signs and symptoms of hyper-IgE?
Eczema, coarse facial features, recurrent RTIs, cold abscesses, candidiasis
198
What is the pathophysiology (briefly) of ataxia telangiectasia?
Defective DNA repair causing T cell defect
199
What are people with ataxia telangiectasia at increased risk of?
Lymphoma
200
What are the signs and symptoms of ataxia telangiectasia?
Cerebellar ataxia, developmental delay, telangiectasia in the eyes
201
What is the inheritance pattern of Wiskott-Aldrich syndrome?
X-linked
202
At around what age does Wiskott-Aldrich syndrome present?
7 months
203
What are the signs and symptoms of Wiskott-Aldrich syndrome?
WATER: Wiskott-Aldrich Thrombocytopaenia, Eczema, Recurrent infections
204
How can Wiskott-Aldrich syndrome be differentiated from ITP?
WAS presents around 7 months but ITP is more like 4 years
205
What is the cause of eczema in Wiskott-Aldrich syndrome?
Raised IgA and IgE
206
What is the cause of recurrent infection in Wiskott-Aldrich syndrome?
Low IgG and IgM
207
How is Wiskott-Aldrich syndrome managed?
IVIg --> HSCT
208
What is the inheritance pattern of Duncan disease?
X-linked
209
What is the pathophysiology of duncan disease?
Inability to generate a normal response to EBV
210
What are the signs and symptoms of duncan disease?
Death in initial EBV or development of a secondary B cell lymphoma
211
How does a non-IgE mediated allergy present?
Erythema, atopic eczema, GORD, change in frequency of stools, blood/mucus in stools, constipation, food aversion
212
What should an allergy-focused history contain?
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
What are the 2 tests that can be done for allergy?
Test 1 = skin prick test
| Test 2 = measurement of specific IgE antibodies
214
When would you refer to a specialist for allergy?
Faltering growth, severe atopic eczema, multiple allergies, persisting suspicion, history of an acute systemic/ severe delayed reaction
215
How should allergy be managed?
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
What are the classifications of allergic rhinitis?
Intermittent vs persistent
Mild vs severe
Seasonal vs perennial
217
What other differentials need to be ruled out in suspected allergic rhinitis?
Nasal polyps
Deviated nasal septum
Mucosal swelling/ depressed and widened nasal bridge
218
How is occasional symptomatic relief achieved in allergic rhinitis?
Any age: intranasal azelastine (type of antihistamine)
| 2-5 y/o --> oral certirizine
219
How is frequent symptomatic relief achieved in allergic rhinitis?
If main issue is nasal blockage/ polyps: intranasal beclomethasone
If main issue is sneezing/ discharge: intranasal CS or oral antihistamine
220
What is SCIT?
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
Who is most likely to develop a cow's milk protein allergy?
Formula-fed children
222
How should cow's milk protein allergy be investigated?
Same as 'food allergy'
223
How should cow's milk protein allergy be managed?
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
What is the most common complication of measles?
Acute otitis media
225
Describe the presentation of meconium ileus
Large volumes of billious vomiting
