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Sharon's Phase 3a > Paeds short > Flashcards

Paeds short Flashcards

KEEP IT SHORT

1
Q

Rubella - urgently notifiable (within 24 hours)

A

Prodrome: fever, coryza, rash and lymphadenopathy

Rash: face to trunk, limb-sparing

Dx: serology rubella-specific IgM antibodies

Mx: supportive, off school until 5 days after rash develops

If unvaccinated pregnant woman: congenital rubella syndrome: cataracts, PDA, deafness

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2
Q

Measles - urgently notifiable

A

Measles morbillivirus

Prodrome: fever >40, coryza, conjunctivitis, Koplik spots (grey spots in Mouth)

2-5 days after: rash behind ears spread to trunk and limbs

Dx: oral fluid sample for measles RNA and measles-specific IgM and IgG

Mx: supportive, off school until 4 days after rash development

Complications: AOM, pneumonia, blindness, subacute sclerosing panencephalitis

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3
Q

Bacterial tonsillitis

A

Strep pyogenes (group A strep)

Centor: fever (>38), exudate, cervical lymphadenopathy, no cough

score 3/4 = abx, 1st line is Phenoxymethylpenicillin (pen V), macrolide if allergy

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4
Q

Pyloric stenosis

A

Hypertrophy of the pyloric sphincter

Key symptom: projectile vomiting post-feed

Key sign: hypokalaemic hypochloraemic metabolic alkalosis

Dx: abdominal ultrasound

Tx: IV fluids, pyloromyotomy

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5
Q

Status Epilepticus

A

Seizure > 5 mins or multiple seizures w/o regaining awareness

Mx: IV lorazepam/buccal midazolam/rectal diazepam, repeat after 10 mins if needed

Then IV Levetiracetam

Then anaesthetist or PICU

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6
Q

Nocturnal enuresis (bedwetting)

A

Primary: never been dry at night

Secondary: previously dry, now lost it (UTI, DMT1)

Dx: hx, examination, urine dip

Secondary - further Ix

Mx: avoid fluid intake before bed, regular toileting

2nd line: enuresis alarm

3rd: desmopressin (ADH analogue)

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7
Q

Cystic fibrosis

A

Autosomal recessive condition due to mutation in CFTR gene on chromosome 7

Impaired ion transport:

  • Thick biliary/pancreatic/ lung secretions
  • Lack of pancreatic lipase in GI, mucus excess + bacterial colonisation in lungs

Ix: newborn heel-prick, sweat test

Mx: chest physio, high-calorie diet, dornase alfa, Creon, salbutamol, prophylactic flucloxacillin

Newborns = meconium ileus

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8
Q

Osteosarcoma

A
  • Malignant bone tumour, mainly affects children and adolescents.
  • Clinical features: prolonged bone pain, bone swelling, decreased ROM.
  • Dx: urgent X-ray within 48hrs (new bony growth - sunburnt look), CT, biopsy
  • Mx: surgical resection, chemo +/= radio
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9
Q

Down Syndrome (Trisomy 21)

A

Clinical features: upward slant to eyes, single palmar crease, hypotonia, leaning difficulties, VSD/ASD

Ix: combined or quadruple test antenatally, chorionic villus sampling, amniocentesis

Mx: MDT: physio, OT, speech + language, educational support, mx of complications, regular check ups

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10
Q

Necrotising enterocolitis

A

Severe GI disease that mainly affects premature infants, intestinal ischaemia and infection

Clinical features: vomiting, bloody stools, abdo distension, acidosis

Dx: abdo x-ray shows dilated bowel loops, pneumatosis intestinalis, pneumoperitoneum

Mx: nil-by-mouth, broad-spectrum abx, Total Parenteral Nutrition , surgical resection

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11
Q

Acute lymphoblastic leukaemia

A

Uncontrolled proliferation of mutated lymphoid progenitor cells, replacing normal haematopoietic cells in the bone marrow

Clinical features: lymphadenopathy (most common), pallor, unexplained petechiae, fever, fatigue

Dx: immediate specialist referral if unexplained petechiae or hepatosplenomegaly, otherwise 48-hr FBC

Bone marrow biopsy: > 20% blast cells = diagnostic

Mx: chemo, bone marrow transplant

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12
Q

Neonatal jaundice

A

Causes: HDN, sepsis, physiological, breast milk, infection

Clinical features: yellowing of skin and eyes, poor feeding, lethargy, well if physiological or breast milk jaundice

Ix: serum bilirubin levels

Mx:

  • Admit if <24 hrs or >7 days old, if unwell, <35 weeks gestational age
  • Phototherapy or exchange transfusion according to treatment threshold graph
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13
Q

Nephrotic syndrome: minimal change disease

A

Peripheral/facial oedema, proteinuria, hypoalbuminemia

Dx: urine dipstick show 3+/4+ protein, urine protein: creatinine > 200mg/mmol , serum albumin < 25g/L, kidney biopsy

Mx: oral prednisolone

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14
Q

Immune thrombocytopenic purpura

A

Autoimmune disease characterised by reduced circulating platelets. Usually following a viral infection

Clinical features: easy bruising, petechiae, nosebleeds

Dx: FBC (thrombocytopenia), blood film, CRP

Mx: watch and wait as usually self-limiting

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15
Q

Impetigo

A

Staphylococcus aureus

Bullous: fluid-filled lesions > 1cm

Non-bullous: erythematous macule becoming pustules/vesicles

Dries into homey-coloured lesions

Mx:

  • Hydrogen peroxide 1%
  • Face: fusidic acid
  • Abx e.g. flucloxacillin (or clarithromycin) if widespread or bullous
  • Stay off school until 48 hours after tx started
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16
Q

Pertussis (whooping cough)

A

Bordetella pertussis - gram -ve coccobacillus

Clinical features: flu-like, coryza, fever for 1-2 weeks, then intense “whooping” cough fits, maybe vomit, faint or cyanosis after. Young infants: apnoea, no whoop

Dx: PCR + culture of nasopharyngeal swabs or secretions

Mx: < 21 days onset e.g. clarithromycin, admission if <6m or resp complications

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17
Q

Preorbital cellulitis

A

Infection and inflammation of the superficial tissue around the eyes

Clinical features: erythema, swelling, pain, fever, malaise

Mx: immediate empirical oral/IV abx based on severity e.g. flucloxacillin

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18
Q

Infectious mononucleosis (glandular fever)

A

Epstein Barr virus, transmitted via saliva

Clinical features: fever, sore throat, fatigue, hepato/splenomegaly

Dx: clinical, +ve heterophile antibody (Paul Bunnell) test

Mx: maculopapular rash if treated with amoxicillin otherwise supportive

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19
Q

Parvovirus B19 infection (slapped cheek syndrome/5th disease)

A

Prodrome: fever, coryza, and diarrhoea

Then reticular (lace-like) rash across body and bright red cheeks . Perioral and forehead-sparing

Dx: clinical

Mx: supportive, children can go back to school when rash appears as no longer infectious

Can cause hydrops fetalis (oedema) in foetus and aplastic crisis in sickle cell anaemia

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20
Q

Non-accidental injury

A

Clinical features: delayed presentation, inconsistent caregiver history, injuries/bruises at various healing stages, unwitnessed injury, subconjunctival/retinal haemorrhage

Dx: detailed hx, body map and skeletal survey

Mx: inform senior or safeguarding lead, admit for safeguarding while investigations, treat wounds, social service involvement

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21
Q

Juvenile idiopathic arthritis

A

Common paediatric chronic inflammatory joint condition

Persistent joint swelling > 6 weeks before 16yo without infection/other causes

Clinical features: salmon pink rash, fever > 5 days, malaise, joint pain

Dx: negative antinuclear ab and rheumatoid factor, raised CRP

Mx: MDT: paeds, physio, OT, ophthalmologists, NSAIDS, intra-articular (if only affecting a few joints) or oral steroids (systemic disease) for flares e.g. methylprednisolone

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22
Q

Neonatal respiratory distress syndrome

A

Deficiency of surfactant in lungs = alveolar collapse

Preterm infants < 35weeks

Clinical features: respiratory distress: tachypnoea, nasal flaring, grunting and intercostal recession

Ix: X-ray: ground-glass appearance = oedema in alveoli

Mx: if preterm birth suspected, maternal corticosteroids to help foetal surfactant production

Neonate: Intratracheal artificial surfactant

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23
Q

Duchenne muscular dystrophy

A

Most common type of muscular dystrophy, X-linked recessive (boys)

Clinical features: muscle wasting, weakness, difficulties with movement, hypertrophic calves

Gower’s sign: use hands to climb up the legs when rising from floor

Dx: creatinine kinase, then genetic testing

Mx: MDT, exercise, physio, wheelchairs, mobility aids, glucocorticoids, genetic counselling

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24
Q

Meningococcal infection - notifiable

A

Neisseria meningitidis

Clinical features: fever, lethargy, headache, rigors, vomiting, non-blanching purpuric rash, hypovolaemic shock

Dx: blood culture, CSF

Mx: DO NOT DELAY empirical IV abx, then treat based on sensitivities and local guidelines

<3 months = cefotaxime

> 3 months = ceftriaxone

Ciprofloxacin for close contacts

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25
Q

Type 1 diabetes mellitus

A

Destruction of insulin-producing beta-cells in the pancreas

Clinical features: polydipsia, polyuria, lethargy, weight loss

Dx:

  • Oral glucose tolerance test > 11.1mmol/L
  • Random BM > 11.0mmol/L
  • Fasting BM > 7.0mmol/L
  • HbA1c: >6.5% or 48 mmol/mol)

Mx:

Basal-bolus insulin regime - long-acting at night and short-acting before meals

Hypo: sugary snack if conscious, IV dextrose/IM glucagon if unconscious

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26
Q

Neonatal sepsis

A

Severe infection in infants < 90 days

Early onset within 72 hrs of life - Group B Strep (S. agalactiae)

Late-onset after 72 hrs - Staph. aureus

Clinical features: feeding difficulties, fever, respiratory distress, reduced GCS

Dx: FBC, CRP, blood cultures, LP for meningitis, CXR for meconium aspiration. Add urine sample if late onset

Mx: early onset = empirical IV benzylpenicillin and gentamicin, then based on culture results

Late onset = broad spectrum (IV flucloxacillin + gentamicin)

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27
Q

Febrile convulsions

A

Seizures that occur during febrile illness

Simple: tonic-clonic, <15 mins, does not occur again in same illness

Complex: focal, > 15 minutes, multiple seizures without recovery in between

Dx: bloods to identify infection, LP if meningitis suspected, EEG if recurrent

Mx: ensure safety, recovery position after, call ambulance if > 5 mins

28
Q

Testicular torsion

A

Twisting of the testicle around the spermatic cord

Clinical features: sudden onset severe unilateral testicular pain, loss of cremaster reflex, persistent pain despite elevation (negative Prehn’s sign)

Dx: urgent surgical exploration and bilateral orchidopexy (fixation), whirlpool sign on testicular doppler

29
Q

UTI

A

Infection of the urethra, bladder, ureters or/and kidneys

E.coli most common

Clinical features:

  • Infant: fever, lethargy, vomiting, poor feeding, urinary frequency
  • Older: fever, abdo pain, vomiting, dysuria, urinary frequency

Dx: urine dipstick (clean-catch sample), nitrites = UTI, nitrites + leukocytes = UTI, only leukocytes = not UTI unless clinical evidence

Tx: trimethoprim, nitrofurantoin, amoxicillin, admit if < 3m with fever

30
Q

Hernia

A

A protrusion of an internal organ through its surrounding wall, inguinal hernia protrude through the inguinal canal

If strangulated (stuck) and compromised blood supply: severe pain, vomiting, signs of bowel obstruction, non-reducibility, swelling and tenderness in affected area

Mx

Inguinal: surgical intervention - emergency herniotomy

Abdominal: surgical release of affected bowel

31
Q

Wilm’s tumour (nephroblastoma)

A

Embryonic renal malignancy in children.

Often found incidentally as abdominal mass

Clinical features: asymptomatic, abdominal pain, haematuria, lethargy, fever, hypertension, weight loss

Dx: abdo ultrasound, CT staging, biopsy for confirmation

Mx: surgical excision and removal of affected kidney (nephrectomy)

32
Q

Paediatric basic life support

A

If infant or child unresponsive

  1. Open airway
  2. If not breathing normally, 5 rescue breaths with bag-mask ventilation
  3. If no signs of life, 15 chest compressions (100 - 200 compressions/ min, lower half of sternum) then 2 rescue breaths
  4. Repeat compressions and breaths in 15:2 ratio
33
Q

Moderate asthma exacerbation

A
  • Peak flow > 50% predicted
  • Tachypnoea but <40 if 1 - 5 yo and <30 if >5 yo
  • Tachycardia but < 140 if 1 - 5 yo and < 125 if >5 yo
  • SpO2 > 92%
  • Speaks in full sentences
34
Q

Severe asthma exacerbation

A
  • Peak flow 33 - 50% of predicted
  • Respiratory distress: accessory muscles
  • Can’t speak in full sentences
  • Tachypnoea >40 if 1-5 yo and >30 if >5yo
  • Tachycardia >140 if 1-5 yo, >125 if >5yo
  • SpO2 < 92%
35
Q

Life-threatening asthma

A

33, 92, CHEST

  • Peak flow <33% predicted
  • SpO2 <92%
  • Cyanosis + confusion/altered consciousness
  • Hypotension
  • Exhaustion
  • Silent chest/poor respiratory effort
  • Tachycardia
36
Q

Mx of asthma exacerbation in children

A

Stepwise

  • O2 between 94 to 98%
  • Inhaled salbutamol
  • Nebulised salbutamol
  • Nebulised ipratropium
  • Senior for consideration of IV magnesium sulphate, IV salbutamol or aminophylline

All patients given oral steroids (e.g. prednisolone) or IV hydrocortisone if not tolerated

37
Q

Asthma

A

Chronic inflammatory airway condition leading to reversible airway obstruction. The smooth muscles of airways are hypersensitive and respond and constrict in response to stimuli, causing airflow obstruction.

38
Q

Clinical features of asthma

A

Dry cough, wheeze, SOB, tight chest

O/E: widespread expiratory wheeze, hyperinflated chest, respiratory distress during exacerbation

Things that point towards asthma in a hx

  • Diurnal pattern - worse in morning and night
  • Interval symptoms - symptoms between exacerbations
  • Personal or family hx of atopy
  • Non-viral triggers e.g. dust, cold air, exercise
39
Q

Dx asthma

A
  • Under 5: hx and examination and treat based on findings

Over 5:

  • First line (quesmed): spirometry and bronchodilator reversibility, FEV1 improvement of 12% or more = dx asthma
  • If inconclusive = fractional exhaled nitric oxide (FeNO). > 35 ppb = positive
  • Offer PERF variability monitoring at the same time as FeNO. PERF variability > 20% + FeNO = dx asthma
  • If only PERF variability OR FeNO positive, trial bronchodilator to help confirm or refute dx
40
Q

Mx asthma in under 5 year olds

A
  1. salbutamol inhaler (with spacer)
  2. trial moderate dose corticosteroids for 8 weeks
  3. If response, continue low-dose inhaled corticosteroids (e.g. beclomethasone)
  4. Leukotriene receptor antagonist (e.g. montelukast)
  5. Refer to secondary care
41
Q

Mx asthma 5 - 16 years olds

A
  1. Salbutamol inhaler
  2. low-dose ICS
  3. LTRA
  4. If LTRA not effective, change to LABA (e.g. salmeterol)
  5. MART (maintenance and reliever therapy) with combined fast-acting LABA + low-dose ICS
  6. Change low-dose ICS to moderate dose
  7. Secondary care referral for e.g. high-dose ICS
42
Q

Complete asthma control in a patient

A
  • No daytime symptoms
  • No night-time waking
  • No limitations on activities including exercise
  • Normal lung function
  • Minimal side effects from medication
43
Q

Intussusception

A

Invagination/telescoping of proximal segment of bowel into distal segment - commonly ileum into caecum

Clinical features: severe colicky pain, vomiting, redcurrant jelly stool (blood-stained mucus, late), sausage-shaped abdominal mass

Ix: abdominal ultrasound: target/donut sign

Mx: air/contrast enema, surgical reduction if ineffective

44
Q

Bronchiolitis

A

1 - 12 months, inflammation of bronchioles.

Respiratory syncytial virus

Clinical features: preceding coryza 1 - 3 days, cough, fever (<39), tachypnoea, chest recessions, wheeze/crackles

Mx: usually supportive (adequate fluids, nutrition, calpol if fever), hospital admission if RR >60, <50% oral intake, SpO2 < 92%, cyanosis, apnoea, respiratory distress (grunting, recession, tracheal tugging) - O2 therapy if <90% and NG tube if not tolerating oral

Prevention: palivizumab injection (mAb)

45
Q

Kawasaki’s disease

A

> 5 days fever, sore throatand CREAMPie

  • C - conjunctivitis
  • R - rash (erythematous, maculopapular)
  • oE - oEdema/erythema,
  • A - adenopathy
  • M - mucosal inflammation (strawberry tongue, cracked lips),
  • Peeling of skin of palms and feet (desquamation)

Ix: ECG, echo

Mx: IV immunoglobin + high-dose aspirin, regular echocardiogram for risk of coronary artery aneurysms

46
Q

Croup

A

6m - 2yrs, URTI causing laryngeal oedema

Parainfluenza virus

Clinical features: prodromal coryza, seal-bark cough, inspiratory stridor, respiratory distress (intercostal, subcostal, sternal recessions, grunting, nasal flaring)

Ix: clinical, SpO2

Mx: 0.15mg/kg oral dexamethasone + supportive, consider hospital if:

  • Respiratory distress, high fever, RR>60, cyanosis, lethargy/agitation, reduced fluid intake and wet nappies, < 3 months, chronic disease e.g. heart, CF
47
Q

Acute epiglottitis

A

Inflammation of the epiglottis, 1 - 6 years old

Haemophilus influenzae type B (HiB) - if not up to date with immunisation

Clinical feature - acute onset, high fever “toxic-looking” child - drooling, struggling to breathe, can’t speak, minimal cough, inspiratory stridor, tripoding!

Mx:

  • DON’T EXAMINE THE THROAT + AIRWAY AS IT CAN MAKE OSTRUCTION WORSE!
  • Call senior paediatrician, ENT and anaesthetist to secure airway, e.g. endotracheal intubation, IV abx, e.g. cefuroxime.
48
Q

Developmental dysplasia of hip

A

The femoral head and acetabulum do not articulate correctly.

RFx: Female, firstborn, breech, FHx

Clinical features: limited hip abduction, asymmetrical thigh skinfolds

Ix: Barlow’s (posterior dislocation) and Ortolani’s (relocation on hip abduction), if positive refer for hip USS

Mx: mild = observation. More severe = Pavlik harness for 6 - 12 weeks or surgical correction

49
Q

ADHD

A

Triad of hyperactivity, impulsivity and inattention

Dx: CAMHS psychiatrist via history + examination, behavioural observations, teacher/parent reports/rating scales, neuropsychological testing

Mx:

Behaviour: CBT, psychoeducation, extra support at school

Medical: methylphenidate if > 5yo, monitor weight, height, BP, HR as can impact growth

50
Q

Ventricular septal defect

A

Congenital cardiac defect where there is a hole in the ventricular sputum

Clinical features:

  • Asymptomatic if small
  • Larger VSD: Exertional SOB, fatigue, failure to thrive, difficulties with feeding
  • Undetected: heart failure or Eisenmenger’s syndrome
  • pan systolic murmur at lower left sternal border

Ix: ECG (LVH), CXR (cardiomegaly), echo to confirm Dx and grading

Mx: most will self-resolve, larger VSD = diuretics + ACEi for HF, high-energy feeds for growth, surgical closure

51
Q

ASD (atrial septal defect)

A

Acyanotic heart disease as left to right shunt

Symptoms

  • None (commonly)
  • Poor feeding, failure to thrive
  • Recurrent chest infections/wheeze
  • Arrhythmias (40+)

Signs

  • Hepatomegaly
  • Oedema
  • Ejection systolic murmur particularly at the upper left sternal edge
52
Q

Diabetic ketoacidosis

A

Complication of T1DM: hyperglycaemia, ketonaemia and metabolic acidosis

Clinical features: N+V, dehydration, abdominal pain, hyperventilation, altered mental status

Ix: blood glucose (>11.1mmol/L), arterial blood gas (pH < 7.3), blood ketone levels (> 3mmol/L)

Mx:
- Senior paediatricians
- ABCDE
- initial bolus fluid of 10ml/kg of 0.9 NaCl over 15 mins
- Rehydrate over 24 hours and avoid fluid bolus to reduce risk of cerebral oedema
- Give fixed-rate insulin infusion + IV dextrose once glucose below 14mmol/L
- Treat underlying cause e.g. sepsis

53
Q

Coeliac disease

A

Autoimmune disease where the immune system reacts to gluten and attacks the small bowel

Clinical features: abdominal pain, steatorrhoea, fatigue, failure to thrive, dermatitis herpetiformis

Dx: anti-tissue transglutaminase (TTG) IgA antibodies + total IgA levels, anti-TTG IgG if IgA deficiency, IgA anti-endomysial antibodies (EMA)

Gold standard is OGD (oesphagogastroduodenoscopy) and duodenal/jejunal biopsy - villous atrophy and crypt hyperplasia

Mx: life-long gluten free diet

54
Q

Hirschsprung’s disease

A

Congenital condition, absence of parasympathetic ganglion cells from the colon (ranges from small area to entire colon) and rectum

Clinical features: delay in passing meconium, chronic constipation since birth, abdominal pain and distention, vomiting, failure to thrive

Dx: abdominal x-ray, rectal biopsy to confirm dx

Mx: surgical removal of affected section of the bowel.

55
Q

Acute otitis media

A

Acute inflammation of the middle ear - viral or bacterial

Clinical features: fever, malaise, pain in affected ear, preceding viral URTI

Dx: clinical with otoscopy

Mx:

Most cases: supportive and analgesia

Abx = amoxicillin or clarithromycin

Consider admission if:

  • < 3 months + fever > 38
  • 3 - 6 months + fever > 39
  • Severe

Consider immediate abx if:
- systemically unwell
- High risk of complications
- Bilateral and under 2yo

Delayed abx

  • For use after 3 days if no improvement
56
Q

Patent ductus arteriosus

A

Ductus arteriosus remains open > 1 month after birth

Clinical features: asymptomatic, feeding difficulties, failure to thrive, or signs of heart failure, characteristic “machine-whirring” continuous murmur at upper left sternal border

Mx: only if symptomatic

  • NSAIDs inhibits prostaglandin synthesis = closes PDA or paracetamol
  • Surgical ligation rarely
57
Q

Sickle cell disease

A

A genetic disorder causing dysmorphic shape of RBCs - autosomal recessive and affects the beta-chain of haemoglobin - HbS

Afro-Caribbean, Hispanic or Mediterranean

Symptoms from complications

  • Vaso-occlusive crises - severe pain from tissue ischaemia
  • Anaemia due to increased RBC haemolysis

Mx: acute: IV opiates, oxygen therapy, IV fluids, top-up transfusions, abx if infection

Long-term: hydroxyurea increase HbF, regular transfusions, folic acid, iron chelation, prophylactic penicillin, regular influenza and pneumococcal vaccines

58
Q

Cerebral palsy

A

Group of non-progressive permanent movement disorders due to damage to CNS area involved in motor control

Clinical features: depends on site and extent of lesion, delays in reaching milestones, spasticity, increased deep tendon reflexes, increased muscle tone

Dx: brain MRI to assess damage

Mx:

  • Physio, occupational therapy, speech and language therapy
  • Baclofen for muscle spasms and Botox for contractures
  • Surgical for MSK deformities or releasing tendons
59
Q

Chickenpox (varicella zoster virus)

A

Intubation period up to 21 days

Fever, fatigue, loss of appetite

  • Distinctive rash: starts as raised red, itchy spots on face or chest, spread to rest of body
  • Then small, fluid-filled vesicles over next few days
  • Within 5 days, lesions crust over and heal

Mx: measures to prevent spread and infection e.g. keep fingernails short, long-sleeve shirts, oatmeal baths and calamine lotion, paracetamol

School exclusion 1 - 2 days before rash development - most infectious

60
Q

Scarlet fever - notifiable urgently

A
  • Cause: group A streptococcal infection (Streptococcus pyogenes)
  • Most common in children 5–12 years.
  • Fever, sore throat, headache 1 - 2 days before rash
  • Classic ‘sandpaper-like’ maculopapular rash that starts on chest or abdomen and spreads, with flushed cheeks and perioral sparing.
  • White-coated, sore or swollen tongue or strawberry tongue
  • Associated with lymphadenopathy
  • Only bacterial cause of childhood exanthema
  • Mx
    10 days antibiotics (phenoxymethylpenicillin or erythromycin), infectious until after 1st abx dose

Complications: glomerulonephritis, rheumatic fever, invasive group A strep

61
Q

Roseola infantum/sixth disease

A

Human herpes virus 6

Initial high fever > 40, up to 5 days

Then blanching, rose-pink macular rash over trunk but can spread to face and limbs

Rhinorrhoea, sore throat and lymphadenopathy

Mx: paracetamol or ibuprofen, hydration and nutrition

Once fever resolves, child can go back to school

62
Q

Gastro-oesophageal reflux (GOR)

A

Immaturity of the lower oesophageal sphincter, allowing stomach content to flow back into the oesophagus

Vomiting post-feeds (usually milky), poor feeding, poor weight gain

Mx: small frequent feeds, burping regularly, not overfeeding, gaviscon, thickened milk/special anti-reflux formula, PPI if ineffective

63
Q

Depression

A
  • Mood changes: anhedonia, sadness
  • Cognitive changes: excess guilt
  • Physical: excessive sleep, lack of sleep, fatigue

Dx: psychiatric, medical history and examination e.g. Patient Health Questionnaire for Adolescents (PHQ-A)

Mx: refer to CAMHS if active suicide ideation, moderate to severe

  • CBT
  • Family and school support
  • fluoxetine
64
Q

Anaphylaxis

A

Acute, life-threatening allergic reaction characterised by wheezing (difficulties breathing), inspiratory stridor, hypotension, angioedema

Mx:
- ABCDE

Adrenaline (1:1000) IM

  • < 6months: 100 - 150 micrograms
  • 6m - 6y: 150 micrograms
  • 6 - 12y: 300 micrograms
  • > 12y: 500 micrograms

Post-crisis, observe for 6 - 12 hours in case of bi-phasic reaction

65
Q

Tetralogy of Fallot

A

Pulmonary stenosis, right ventricular hypertrophy, VSD and overriding aorta

  • detected at 20-week anomaly scan
  • Cyanosis
  • Poor feeding and growth
  • Tet spells (reversal of shunt to R to L)

Dx: SpO2, echo to confirm, CXR might show boot-shaped heart

Mx: corrective surgery at 3 - 6 months

Tet spells: place infant on back and flex knees, O2 in hospital, propranolol

66
Q

Meconium aspiration

A

Meconium = first faeces passed by newborns, thick and dark green in colour.

“Meconium-stained liquor” is when meconium is passed just before delivery into the amniotic fluid

Can cause meconium aspiration if foetus inhales this = respiratory distress

CXR = aspiration pneumonitis (patchy infiltrates)

Mx: O2 therapy, antibiotics

67
Q
A

Sharon's Phase 3a (7 decks)

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