Paeds peer teaching part 2 Flashcards
1
Q
Cystic fibrosis treatment
A
Chest physio High calorie diet CREON tablets for pancreatic enzymes Prophylactin flucox and vaccinations Nebulised dornase alfa Nebulised hypertonic saline Fertility treatment Genetic counselling
2
Q
If you have two parents who are CF carriers, whats your chance of getting it
A
25%
3
Q
What causes breathlessness in anaphylaxis
A
Angio oedema
4
Q
Whats the best investigation for cystic fibrosis
A
Sweat test
5
Q
Right illiac fossa tenderness
A
IBD
6
Q
What type of anaemia do you get from GI blood loss
A
Microcytic
7
Q
What happens to albumin in diarrhoea
A
Low because lost in stool and poorly absorbed because of malabsorption
8
Q
Best investigation for inflammatory bowel disease
A
Colonoscopy
9
Q
Features of both UC and crohns
A
Diarrhoea Abdo pain Weight loss N and V Faltering growth Delayed puberty Reduced appetite Malaise/ fatigue Fever
10
Q
Features of IBD unique to crohns
A
Termina ileum disease (RLQ pain)
Perianal tags, fistulae, abscesses
Gallstones
11
Q
Features of IBD unique to UC
A
Left lower quadrant tenderness
Bloody diarrhoea
12
Q
Macroscopic and microscopic crohns features
A
Skin lesions, cobblestone mucosa
non caseating granulomata, transmural inflammation
13
Q
Which IBD do you get toxic megacolon in
A
UC
14
Q
Macroscopic and microscopic UC features
A
Continous, mucosal ulceration. No granulomas. Submucosal inflammation
15
Q
Crohns induction of remission treatment
A
Enteral nutrition (modulen) then glucocorticoids
16
Q
Crohns maintenance of remission treatment
A
Azathioprine
17
Q
UC induction of remission treatment
A
Mesalazine or glucocorticoids
18
Q
Treatment of toxic megacolon
A
IV, fluids, glucocorticoids, surgery
19
Q
Maintenance of remission in UC
A
Mesalazine
20
Q
Define coeliac
A
Autoimmune condition caused by an inflammatory response by the GALT to gliadin (HLA-DR3-DQ2)
21
Q
Which antibodies are present in coeliac
A
Tissue transglutaminase
Endomysial cell antibodies
22
Q
Diagnosis of coeliac
A
Dont eat gluten for 6 weeks then test for antibodies then endoscopy and biopsy
23
Q
Microscopic changes in coeliac
A
Long crypts, lymphocyte infiltration, flattened villi
24
Q
Magement of coeliac
A
Gluten free diet
25
Symptoms of coeliac
```
Unintended weight loss
Fatigue
Chronic diarrhoea
Flatulence
Severe recurrent abdo pain
Pale stools
```
26
Causes of gastroenteritis
Virus ! (rotavirus, adenovirus, enterovirus)
| Bacterial- campylobacter jejuni, E. coli, shigella, salmonella
27
Clinical features of gastroenteritis
```
Acute onset diarrhoea and vomitting
Fever
Lethargy
Abdominal pain
Poor feeding
```
28
If watery diarrhoea returns after gastroenteritis whats going on
Post gastroenteritis syndrome (may have developed lactose intolerance)
29
When should you take stool samples in gastroenteritis
```
Not sure of diagnosis
Septic
Bloody
More than 2 weeks
Immunocompromised
```
30
Management of gastroenteritis
Oral rehydration solution
Breast feed
NG fluids
Hospitalisation if needed
31
Common symptoms of appendicitis
RLQ pain, worse on movement, Vomiting, fever, peritonism
32
Diagnosis of appendicitis
Clinical diagnosis
| Ultrasound
33
Treatment of appendicitis
Appendicectomy
34
Common symptoms of intussusception
Sudden colicky pain, drawing up legs, pale, vomiting, redcurrent jelly stools
35
Diagnosis of intussusception
Target sign on ultrasound
36
Management of intussusception
IV fluids and antibiotics
Pneumotic reduction air enema
Laparotomy
37
Common symptoms of mesenteric adenitis
Mimics appendicitis, pharyngitis, cervical lymphadenopathy
38
Treatment of mesenteric adenitis
Analgesia
| Hydration
39
Common symptoms of inguinal hernia
Reducible lump in groin, if strangulated= nausea, vomiting, off food, sever pain
40
Investigation of inguinal hernia
Clinical exam- rule out testicular torsion
41
Treatment of inguinal hernia
Early surgical intervention
42
Symptoms of irritable bowel syndrome
Pain relieved on defecation, bloating, mucus in stool, lethargy
43
Treatment of irritable bowel
Small regular meals, eliminate triggering foods
44
Symptoms of abdominal migraine
Pain lasting 2-72 hours, nausea, vomiting, anorexia, pallor
45
Treatment for abdominal migraine
Analgesia, avoid triggers, prophylaxis
46
What type of bilirubinaemia causes jaundice in the first 24 hours
Unconjugated
47
Causes of jaundice in first 24 hours
```
Haemolytic disease of the newborn
Hereditary spherocytosis
G-6-PD deficiency
Sepsis
TORCH infections
Crigler-najjar syndrome
```
48
Causes of jaundice after 2 weeks
Biliary atresia
Hypothyroidism
UTI
Gilbert syndrome
49
Jaundice investigations
```
Bilirubin chart
FBC
Blood film
Unconjugated and conjugated
Blood typing of mother and baby
Direct Coombs test
```
50
What does the direct coombs test look for
Haemolysis
51
How does the molecule go from haem to conjugated bilirubin
Haem
Biliverdin
Unconjugated Bilirubin
Conjugated bilirubin
52
What is biliary atresia
Narrowing blockage or absence of part of the biliary tree. Leads to a conjugated bilirubinaemia
53
Presentation of biliary atresia
severe jaundice at day 2 (high conjugated), pale white stools
54
Biliary atresia treatmtent
Ultrasound of gall bladder and bile ducts
TBIDA radioisotope scan
Kasal surgery
55
Anti D injections
Given at 28 weeks and again at birth or after a sensitisation event
56
Kliehauer test
Assess how much fetal blood mixed with the mothers blood
57
Hereditary spherocytosis presentation
Newborn with jaundice and splenomegaly
58
Describe hereditary spherocytosis pathology
Autosomal dominant. Sphere shaped red blood cell.
| Aplastic crisis if also parvovirus
59
Investigations of spherocytosis
FBC, Blood film, Coombs test
60
Treatment of spherocytosis
Splenectomy
Cholecystectomy
Folate
Penicillin for life
61
G6PD deficiency pathology
Baby picks up infection and turns yellow. X linked recessive.
62
G6PD triggers and presentation
Infection, medication or broad beans causes splenomegaly and gall stones
63
Investigations of G6PD deficiency
Heinz bodies on blood film
| G6PD enzyme assay
64
G6PD fun fact
Caused by fava beans and Heinz bodies is a sign of it
65
Gilberts syndrome
Unconjugated bilirubin. Cos cant conjugate bilirubin. Jaundice only during illness, exercise or fasting
66
Crigler Najjar
Jaundice at birth, death by 2.
67
Neonatal hepatitis presentation
IUGR, jaundice, failure to thrive, itchy rash, dark urine and hepatomegaly
68
Neonatal hepatitis investigation
Liver biopsy shows multinucleated giant cells and rosette formation
Derranged LFTs
69
What is breast feeding/ physiological jaundice
Appears day 3, peaks at 7 then goes.
Foetal Hb has shorter lifespan and newborn liver cant cope.
Can randomly happen more in breastfed
70
Jaundice, hypotonia and large tongue
Hypothyroidism (ioidine, hormonal dysgenesis, autoimmune thyroiditis later in childhood)
71
Key symptoms of hypothyroidism
Delayed puberty and development, puffy face, macroglossia, short stature, cretinism
72
Hypothyroidism investigations
Heel prick test, ultrasound of the neck, TSH levels high
73
Treatment of hypothyroidism
Levothyroxine
74
Galactosaemia presentation
Jaundice, vomiting and poor feeding worsened by cows milk feeding. GALT enzyme missing.
Cataracts
75
Galactosaemia treatment
Both mum and baby need to stop dairy. Breastfeed only
76
Kernicterus
Convulsions, lethargy, poor feeding, coma, cerebral palsy, learning difficulties and death because unconjugated bilirubin has crossed the BBB
77
Wilsons disease pathology
Reduced caeruloplasmin.
| Kayser fleischer rings, parkinsonism, rickets, jaundice
78
Investiagtions of wilsons disease
Increased 24hr copper urine, reduced serum caeruloplasmin. Penicillamine and zinc treatment
79
Alpha 1 antitrypsin
Less A1AT so more neutrophil elastase. Neonatal jaundice and bleeding. Worse with breastfeeding. Look for serum levels. Make sure they dont smoke
80
Febrile seizures
Seizure in association with fever with no definable intracranial cause.
81
What is status epilepticus
Over 30 mins
82
What classes as a simple febrile seizure
Generalised tonic clonic lasting up to 24 hours and not recurring within 24 hours
83
Treatment of febrile seizures
Paracetamol and ibuprofen, education and reassurance
84
What do you call seizures that happen in sleep
Benign neonatal sleep myoclonus or parasomias
85
What do you call seizures that happen when feeding
Sandifer syndrome/ GORD
86
Describe syncope
Older child, prodromal pallor, rapid recovery. Situational
87
Neonatal life support
Dry the baby
Get help, open airway, feel for breathing, 5 rescue breaths (cover nose holes, neutral neck position). Check for signs of circulation.
15 chest compressions (tips of fingers):2 rescue breaths
88
Where do you check for circulation in a newborn
Brachial and femoral
89
APGAR what does it stand for
```
Activity (muscle tone)
Pulse
Grimace (reflex irritability)
Appearance (skin colour)
Respiration
```
90
What are the scores for activity in apgar
absent=0, 1= flexed limbs, 2= active
91
What are the scores for pulse in apgar
absent=0, 1= less than 100, 2=more than 100
92
What are the scores for grimace in apgar
floppy=0, 1=minimal response, 2=prompt response
93
What are the scores for appearance in apgar
Blue, pale=0, pink body, blue extremities=1, pink=2
94
What are the scores for respiration in apgar
absent=0, slow and irregular=1, virgorous cry=2
95
Whats a very low apgar
Below 3
96
Whats a good apgar
Above 7
97
When should you do apgar
1, 5 and 10 minutes
98
What is on the guthrie card/ heel prick test
```
Congential hypothyroidism
Cystic fibrosis
Sickle cell disease
Phenylketonuria
MCADD
MSUD
IVA
GA1
HCU
```
99
What are the neonatal infections
```
TORCH
Toxoplasmosis
Rubella
CMV
Herpes simplex
```
100
Toxoplasmosis neonatal
Hydrocephalus, cerebral palsy
101
Rubella neonatal
Sensorinueral deafness, growth retardation, cerebral palsy, purprual skin lesions
102
Herpes simplex neonatal
Limb hypoplasia and corticol atrophy- give baby Varicella Zoster Immune globulin (VZIG)
103
Transient tachypnoea of newborn
After emergency C section. Physiological pulmonary oedema. CXR= hyperinflation of the lungs and fluid in the horizontal fissure.
Should resolve by itself
104
Respiratory distress syndrome
Early. Tachypnoea, intercostal recession and is cyanosed. CXR= ground glass appearance, indistinct heart border and air bronchograms.
Give mum dexamethasone and baby surfactant and oxygen
105
Meconium aspiration syndrome
post term, mum smokes and has HTN. Meconium stained amniotic fluid.
CXR= Patchy infiltrates, atelectasis, coarse streaking of both lungs.
Suctioning is the treatment
106
Neonatal sepsis (group B strep)
Premature and prolonged ROM.
Fever, reduced tone and activity. RDS. Hypoglycaemia.
BenPen and Gentamicin.
Then blood cultures, CRP and LP
107
Persistent pulmonary hypertension of newborn
Failure of transition to adult circulation. Respiratory syndromes, Maternal SSRI or aspirin.
108
Chronic lung disease of prematurity/ bronchopulmonary dysplasia
Still requires oxygen 28 days after delivery.
Scarring and reduced alveolar surface area.
Resp symptoms.
CPAP and caffeine
109
Apnoea of prematurity
Premature baby stops breathing for more than 20s.
IV caffeine
Tactile stimulation when alerted by apnoea monitors
110
Intraventricular haemorrhage
Premature babies within first 3 days. Go into shock, hydrocephalus. Vitamin K is the treatment
111
Cephalohaematoma
Several hours after birth. Doesnt cross suture lines, blood under parietal region.
112
Caput succedaneum
Present at birth, forms over vertex and crosses suture lines. Resolves in days
113
Neonatal seizure causes
```
Hypoxic ischaemic encephalopathy
Intracranial haemorrhage
Meningitis
Tuberous sclerosis
Fetal withdrawal syndrome
```
114
Hypoxic ischaemic encephalopathy
Asphyxia at birth
Sarnat staging system
Therapeutic hypothermia treatment
115
Necrotising enterocolitis presentation and pathology
Bacterial invasion of ischaemic bowel. Feeding intolerance, distended abdomen, bloody stools and green vomit
116
Investigation and treatment of NEC
Dilated bowel loops,
air in portal tract,
air under diaphragm, intramural air. Riglers and football sign.
Nil by mouth, IV fluids, IV broad spectrum abx and laparotomy
117
Retinopathy of prematurity
Retinal blood vessel formation is stimulation by hypoxia. So is prevented by too much oxygen.
Scar, detach, blind.
Treat with transpupillary diode laser therapy
118
Congenital diaphragmatic hernia
RDS, heart sounds louder on the right, tinkling bowel sounds.
Bochdalek hernia.
NG feed, intubate and ventilate then surgery
119
Whats the difference between gastroschisis and omphalocele
Gastroschisis has no peritoneal layer whereas the omphalocele protrudes into umbilical cord
120
Initially baby seems fine but then collapses and turns blue.
Transposition of the great arteries, happens when ductus arteriosis closes.
Echo
Prostaglandin E2
Arterial switch procedure
121
Coarctation of the aorta
Newborn is floppy, grey and tachypnoeic. Weak femoral pulses and radiofemoral delay.
Do 4 limb blood pressure
Prostaglandin E2 then surgery
122
How does cyclooxygenase inhibition affect the phyioslogical changes within the first 48 hours of birth
Promotes ductus arteriosus closure
123
Neonatal cyanosis causes
```
Tricuspid atresia
Transposition of the great arteries
Tetralogy of fallot
AVSD
Eisenmenger syndrome
```
124
Non blanching rash causes
```
Meningitis
ALL
Congenital bleeding disorders
ITP
HSP
Non accidnetal injury
```
125
Henoch Schonlein Purpura
Purpuric non blanching rash on buttocks and legs, abdo pain and joint pain.
IgA vasculitis
Skin, kidneys, GI
Self limiting
126
Kawasaki disease
Fever over 5 days and conjucitivitis, tongue and mucous membranes, desquamification, cervical lymphadenopathy
Aspirin and IV IG
Coronary aneurysms
127
Meningococcal sepitcaemia
Blood culture and LP, send blood for meningococal PCR
IM BenPen
Cefotaxim
Less than 3 months= add amoxicillin for Strep
Give dexamethasone too
128
Rheumatic fever
After tonsilitis.
Swollen large limbs, heart infection, murmurs and pericardial rub.
Strep pyogenes.
Throat swab.
NSAIDs and long term prophylactic Abx to prevent endocarditis
129
Whats the criteria called for rheumatic fever
JONES
| Joint, heart, nodules, erythema marginatum, sydenham chorea
130
Chicken pox (varicella zoster virus)
Vesicular rash. Blistering. Starts and trunk or face.
Keep cool, trim nails.
Varicella Zoster Immunoglobulin (VZIG) if newborn
131
Shingles (herpes zoster virus)
Acute, unilateral painful blistering rash in dermatomal distribution.
Can cause pneumonia and encephalitis.
Aciclovir
(VZIG for non immune mothers)
132
Candida
Inflamed rash, satellite lesions and oral lesions. Topical imidazole. Cease the use of a barrier cream.
133
Nappy rash
Dont use talcum powder.
| Leave nappy off as much as possible, dry bottom, change regularly. Use a mild hydrocortisone
134
Impetigo
Exfoliative toxins made by staph aureus. Golden crust. Swabs for diagnosis.
Topical fusidic acid
Oral flucoxacillin
135
Erythema infectiosum (slapped cheek)
```
Non specific symptosm and slapped cheek red rash.
Parvovirus B19.
Spreads to upper arms.
Foetal hydrops.
Sickle cell can turn aplastic crisis.
```
136
Roseola infantum
High fever, maculopapular rash and convulsions. (starts on chest)
Human herpes 6
137
Scarlet fever
sandpaper rash on torso, spares the face, strawberry tongue
S pyogenes
Penicillin V
Swab throat
138
Hand foot and mouth disease
Coxsackie A16 virus
Blistering red spots on hands feet and mouth after normal cold.
Very contagious but self limting
139
Staphylococcal scalded skin syndrome
Nikolskys sign- seperation of skin on gentle pressure.
S. Aureus bacteria produces exfoliative toxins.
Flucoxacillin
Fusidic accid
fluid and electrolyte management
Paracetamol
140
Toxic shock syndrome
Staphylococcal exotoxin
Leaving tampons in too long.
High fever, signs of shock, diffusion desquamating erythematous rash.
ABCDE, oxygen, IV broad spectrum abx, IVIG
141
Measles
Prodrome, koplik spots (buccal mucosa), rash starts behind ears
Encephlaitis, otittis media, panencephaltiis.
Give MMR. You have immunity from mum until 9 months
142
Erythema multiforme
Widespread target lesions. Pyrexia, stomatitis, muscle and joint aches.
Hypersensitivity reaction.
Resolves.
143
Molluscum contagiosum
Viral. Flesh coloured papules with a central dimple.
| Salicylic acid
144
Scabies
Incredibly itchy, between the fingerwebs then whole body.
Sarcoptes scaibiei.
Permethrin cream.
Wash everything
145
Ringworm
Itchy circular erythematous and scaly well demarcated rash.
Fluconazole orally
Miconazole cream.
Steroids make fungal infections worse
146
Seborrhoeic dermatitis
Cradle cap
147
Eczema
Dry, red, itchy over flexor surfaces in infancy then extensor in young children.
Emolients and special soaps, avoid triggers.
Wet wraps
Hydrocortisone for as little time as possible (skin thinning and telangiectasia)
148
Psoriasis
Scaly, dry, flakey, raised and rough on extensor surfaces. Keratinocyte proliferation.
Topical corticosteroids and vitamin D analogues
149
Salmon patch
Flat red or pink on face. Fade in a couple of months
150
Infantile hemangioma
Strawberry marks. Rapidly increase in size for first 6 months then shrink and disappear by 7 years
151
Capillary malformation
Port wine marks.
Unilaterally normally on face, chest and back.
Permanent and receptive to hormones.
152
Cafe au lait spots
More than 6 before 5 could be neurofibromatosis
153
Mongolian spots
Lower back or buttocks. Darker skinned. Dissapear by age 4
154
Congenital meloncytic naevi
Normal moles
155
Slipped upper femoral epiphysis
Obesity, puberty growth surge.
Limping, pain on movement in all directions.
Management= immobilisation, analgesia, screw fixation
156
4-10 year old limb
Transient synovitis
Perthes disease
JIA
157
Septic arthritis
```
Streptococci neonatally
Staph aureus afterwards
Acute pain and swelling, fever, rigors.
Kocher modified criteria.
Joint aspiration, blood cultures, splinting, IV abx, surgical drainage
```
158
Developmental dysplasia of the hip
Barlow and ortolani tests
Painless limp, limited abduction, assymetrical skin folds.
Family history, breech, oligohydramnios.
Ultrasound and plain radiograph
159
Perthes disease
Avascular necroissi of the femoral head.
Limp in the absence of trauma. groin pain, limited rom, muscle wasting.
Pain relief, physio or surgery
160
Transient synovitis
Sudden onset limp. No rest pain. Well child. Blood and X Ray.
Rest and simple analgesia
161
JIA
Joint inflammation presenting before 16 for atleast 6 weeks. With absence of cause.
Systemic JIA- temperatures and salmon pink rash.
Physio, NSAIDs, intra articular corticosteroid injections
