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1 - Paeds AE > Paeds revision lectures > Flashcards

Paeds revision lectures Flashcards

1
Q

What is a seizure?

A

An abnormal surge of electrical brain activity.

Clinical phenomena resulting from abnormal and excessive excitability of the neurones of the cerebral hemispheres

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2
Q

What is epilepsy?

A

2 or more unprovoked epileptic seizures

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3
Q

What are the symptomatic causes of seizures?

A

Infection (meningitis/encephalitis)
Metabolic disturbance (hypoglycaemia and calcaemia, hyperammonaemia)
Trauma
Vascular (haemorrhage/stroke)
Toxins (iatrogenic- recreational or prescribed)

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4
Q

What investigations would you do in epilepsy?

A

EEG (normal does not exclude epilepsy and abnormal does not mean epilepsy)
MRI (particularly in focal seizures or if they have other neurological deficits)
Potentially metabolic bloods, LP, Urine
Genetics

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5
Q

What is the main useful thing about an EEG?

A

Classifying the epilepsy after it has been diagnosed

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6
Q

What are the differential diagnoses of seizures in infants ?

A 
Bengign sleep myoclonus
Benign myoclonus of infancy
reflux
Shuddering attacks
Self gratifications
Benign paroxysmal upgaze
Spasmus nutans
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7
Q

What are the differential diagnoses of seizures in early childhood?

A 
Breath holding attcks
Reflex anoxic seizures
Daydreaming
Tics
Stereotypies
Syncope
Parasomnias
Shuddering attacks
Tantrums
Movement disorders
Vertigo type syndromes
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8
Q 
6 months old.
Episodes of shaking head when excited, not with it.
Normal development
Normal examination
Diagnosis?
A

Shuddering attack

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9
Q

18 months old
Lies on floor, stiffens up, crosses legs, starts in high chair.
Flushed, looks happy.
Normal development and normal examination
Diagnosis?

A

Self gratification

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10
Q 
14 year old girl
Feels hot, dizzy
Vision closes in, goes black
Collapses
Can't hear what's going on, can't move
Ok after a couple of minutes.
Diagnosis?
A

Syncope

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11
Q

13 year old girl.
Night time episodes of shaking - all four limbs, rhythmic, unresponsive, sometimes gets up, confused.
Video - brief repetitive jerks of arms/hands
Diagnosis?

A

Clonic seiures

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12
Q

What are the classifications of epilepsy?

A 
Tonic
Clonic (normally repetitive)
Tonic-clonic
Myoclonic (often occurs in isolation)
Atonic
Absence
Epileptic spasm
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13
Q

Summary of childhood absence epilepsy?

A

Starts age 4-7 years
Frequent absence seizures - 5-15 seconds, abrupt offset/onset, precipitated by hyperventilation, multiple times a day
Usually otherwise normal

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14
Q

What is the characteristic ECG in absence epilepsy?

A

Characteristic ECG - 3Hz spike/wave

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15
Q

What is the prognosis of absence epilepsy?

A

Good response to medication

Most outgrow in puberty 10% have generalised tonic clonic seizures in adulthood

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16
Q

Summary juvenile myoclonic epilspsy?

A

Starts usually 12-16 years
More common in girls
Myoclonic seizures
Can occur with absence and general tonic-clonic seizures

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17
Q

Summary genetic generalised epilepsy?

A 
Idiopathic
GTC alone
Age of onset variable over 5 years old
Occur in the morning
Investigate - photosensitivity
Treat - sodium valproate
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18
Q

How do you treat epilepsy?

A

None
Rescue medication - buccal midazolam
Regular medication - depends on seizure type and syndrome
Ketogenic diet
Epilepsy surgery - resective; corpus callosotomy

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19
Q

When should you not prescribe sodium valproate?

A

For girls of childbearing age (after periods start).
Unless it is a last resort.
Need to go on a pregnancy prevention programme

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20
Q

Summary febrile seizures?

A 
Not epilepsy
6 months - 6 years
5% of children have one
Seizure assocaited with fever (rate of rise)
Usually GTC and less than 5 minutes 
Risk of epilepsy in later life - 2-5%
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21
Q

What is a complex febrile seizure?

A

Duration over 15 mins
Focal
Occurs within same illness

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22
Q

What’s in a septic screen?

A 
Blood cultures
MC&S
CXR
LP
Throat swabs/skin swabs
(FBC/CRP)
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23
Q

Why would you do blood cultures?

A

Bacteraemia/sepsis

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24
Q

What is sepsis

A

Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death

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25
Q

What can cause sepsis?

A

Anything: bacterial, viral, fungal, parasitic

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26
Q

What are the red flags for sepsis

A

Inappropriate tachycardia
Temperature <36 or >38.5
Altered mental states (sleeping, irritability, lethargic, floppiness)
Reduced peripheral perfusion/ prolonged cap refil/ reduced urine output

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27
Q

What is bacteraemia?

A

Presence of bacteria in the blood stream - not sepsis

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28
Q

What are the important causes of bacteraemia in neonates?

A

Group B strep
E. coli
Listeria
Coagulase negative staph (if they have complex neonatal history)

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29
Q

What are the important causes of bacteraemia in infants/young children

A 
Strep pneumonia
H influenza
Staph aureus
Group A strep
Neisseria meningitidis
Gram negative organisms (E.coli)
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30
Q

What are the important causes of bacteraemia in adolescents?

A

Neisseria meningitidis
Staph aureus
Group A strep
Strep pneumonia

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31
Q

What are the important causes of bacteraemia in adolescents?

A

Neisseria meningitidis
Staph aureus
Group A strep
Strep pneumonia

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32
Q

What are the clinical features of UTI in infants and young children?

A 
Fever 
Lethargy
Vomiting/diarrhoea
Poor feeding
Failure to thrice
Prolonged jaundice
Sepsis
Ferile convulsions
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33
Q

What are the clinical features of UTI in older children?

A 
Dysuria 
Frequency
Fever ± rigors
Lethargy, reduced appetite
Vomiting/diarrhoea
Abdominal (loin) pain
Febrile convulsions (<6 years)
Incontinence/enuresis
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34
Q

What would you find on dipstick of UTI?

A

Protein, white cells, nitrates

35
Q

What would you investigate for and how after a UTI?

A

Underlying structural abnormalities - US
Renal scarring - DMSA (radioisotope scan)
Vesico-ureteric reflux - MSUG (micturating cystourethrogram)

36
Q

How long do you wait to do a DMSA scan after an infection and why?

A

3 months otherwise the infection would cause a false positive

37
Q

What is the main organism that causes epiglottis?

A

HiB

38
Q

What is the main organism that causes bacterial thracheitis?

A

Staph aureus

39
Q

What is the main organism that causes pneumonia in neonates?

A

Group B strep

E.Coli

40
Q

What is the main organism that causes pneumonia in young children?

A 
RSV 
Strep penumonia
H. influenza
Staph aureus
Chlamydia trachomatis
41
Q

What is the main organism that causes pneumonia in older children?

A

Strep pneumonias
Mycoplasma pneumoniae
Staph aureus
TB

42
Q

How would you treat empyema

A

Chest drain
Urokinase
Prolonged antibiotics
Consider underlying immune deficiency

43
Q

What is the main organism that causes meningitis in neonates?

A

Group B strep
Gram negative organisms
Listeria monocytogenes

44
Q

What is the main organism that causes pneumonia in young children?

A

Neisseria meningitidis
Strep pneumniae
H influenza

45
Q

Name a gram negative diplococci

A

Neisseria meningitidis

46
Q

Name a gram positive diplococci

A

Strep pneumonia

47
Q

Name a gram negative coccobacilli

A

H influenza

48
Q

How do you treat septic arthritis?

A

Surgical drainage and antibiotics

49
Q

How do you treat osteomyelitis?

A

Antibiotics

50
Q

US is best imaging for in the joint, why?

A

Great for excluding infection
Both sides
Is there an effusion?
Is there a subperiosteal abscess?

51
Q

MRI is best imaging for in the bone, why?

A

Gold standard
Especially for complex cases
BUT may involve GA/sedation

52
Q

What are the main things to look for in septic arthritis?

A 
Non weight-bearing
Pyrexia >38.5
WCC >12
ESR >40
CRP >20
53
Q

What are the clinical tests for DDH?

A

Barlow: subluxes/dislocates a hip posteriorly
Ortolani: relocates a dislocated hip

54
Q

What is the time difference between acute and chronic diarrhoea?

A

14

55
Q

Causes of acute diarrhoea?

A

Infection - viral (rotavirus, noravirus, enterovirus), bacterial (salmonella, shigella) or protozoal

56
Q

What is haemolytic uraemic syndrome (HUS) triad?

A

Anaemia, uraemia, multisystem disease

57
Q

What organism causes HUS?

A

E.Coli O157

58
Q

What organs can cause of chronic diarrhoea?

A

Normally intestinal but can be liver or pancreas as well

59
Q

6 features of colitis?

A 
Diarrhoea
Cramping lower abdominal pain
Urgency
Tenesmus (feeling like there's more stool to come)
Nocturnal stooling
Mucus and blood
60
Q

What are the causes of colitis?

A

Infective
Inflammatory
Other

61
Q

What are the infective causes ?

A

Viral - enterovirus
Inflammatory - crohns, UC
Other - allographs (transplant from others)

62
Q

12 year old
Lethargy and diarrhoea for 3 months
Since holiday in Greece where she had D&V
Vomiting settled, diarrhoea hasn’t, she started to feel unwell.
Developed perianal disease, what investigations?

A

Stool MC&S
If bloods are abnormal, might be helpful, if normal, not that helpful
Faecal calprotectin (raised with any cause of rectal bleeding, so not specific)

63
Q

Calprotectin

A

Produced by immune cells, involved in inducing apoptosis in unhealthy cells.

64
Q

What is Crohn’s disease of the mouth called?

A

Orofacialgranulomatosis

65
Q

What are the things specific to Crohn’s?

A

Mouth to anus
Skip lesions
Transmural
Strictures and perforations

66
Q

What are the things specific to UC?

A

Colon only
Confluent disease
Uniform disease (all ulcers look the same)
Superficial inflammation
Toxic megacolon with perforation (only cause of perforation in UC)

67
Q

What is toxic megacolon?

A

UC for over 7cm
In school aged children >6cm
Any younger than that >5cm

68
Q

What are the causes of toxic megacolon?

A

UC
C.Diff
Immunocompromised

69
Q

What are the stages of treatment of colitis in IBD?

A

Induction of remission (steroids) and maintenance of remission (5-aminosalicylates)

70
Q

How do you induce remission in small bowel disease?

A

Liquid nutritional therapy

71
Q

How do you treat IBD remission?

A

Steroids then steroid sparing agents (azathioprine)

72
Q

How do you treat poor disease control?

A

Biological agents (anti-TNF) (infliximab and adalimumab)

73
Q

How do ou tret terminal ileitis?

A

TI resection and right hemiclectomy

74
Q

How do you treat unresponsive Crohn’s colitis?

A

Sub-total colectomy

75
Q

What are the causes of chronic diarrhoea due to small bowel disease?

A

Coeliac disease

Post enteritis syndrome (lactose intolerance temporarily)

76
Q

What are the features of small bowel diarrhoea?

A

No colitic features
Abdominal pain is central, poor appetite, nutritional deficiencies (mainly iron and calcium)
Steatorrhoea, lactose malabsorption (depending on cause)

77
Q

What 4 things happen when coeliacs ingest gluten?

A
  1. Gluten taken up by dendritic cells and presented on HLA DQ2
  2. Forms a complex with matrix TTG
  3. Recognised by TH1 cells, produce IFN-gamma and TNF alpha and IL-15
  4. Recruits B cell binds to TTG-gluten-APC construct, makes anti-TTG (stimulated to class switch by IgA by TH1 cell)
78
Q

What are the histological features of coeliac disease?

A
  1. Villous atrophy
  2. Crypt hypertrophy
  3. Intraepithelial lymphocytosis
  4. Infiltration of lamina propria
79
Q

What are the pancreatic causes of diarrhoea?

A

All the causes of chronic pancreatitis
CF
Rare paediatric diseases (congenital pancreatic atresia)

80
Q

What is trypsin?

A

Protease enzyme

81
Q

What are the symptoms of diarrhoea due to pancreatic exocrine insufficiency?

A

Fat malabsorption - failure to thrive and catastrophic weight loss
Fat soluble vitamin deficiency : ADEK (eyes, bones, nerves and bleeding)
Measure exocrine function by faecal elastase

82
Q

Signs of acute pancreatitis?

A

Grey Turner or Cullen’s sign (rare in children)

83
Q

Clinic features of acute pancreatitis

A

Severe dyspepsia, epigastric pain, sepsis, shock

84
Q

SE of prednisolone

A

Eyes: glaucome, cataracts
CVS: cardiomyopathy, HTN, post surgery or infarct dehisence
MSK: proximal myopathy, stunting, osteoporosis
Brain: depression, mania, poor sleep
Skin: bruising, striae, fat redistribution
Pancreatitis, avascular across of femoral head
Infection: latent TB

1 - Paeds AE (24 decks)

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