paeds- things i forget Flashcards
1
Q
causes of newborn pneumonia
A
group B strep (maternal)
gram negative enterococci
2
Q
causes of pneumonia in infants and young children
A
strep pneumoniae
HiB
Staph aureus
mycobacterium tuberculosis
3
Q
atypical causes of pneumonia
A
mycoplasma pneumoniae
chlamydia pneumonia
4
Q
Tx of pneumonia
A
O2 <92%= admit
Abx- Amoxicillin
can also use clarithromycin, co-amoxiclav, azithromycin
5
Q
Abx used in acute epliglottitis
A
cefotaxime
6
Q
Tx of whooping cough
A
macrolides ! Azithromcyin etc
7
Q
long term RF of an ASD
A
stroke due to a DVT
8
Q
what is Eisenmenger’s syndrome?
A
when an initial L-R shunt (ASD,VSD,AVSD etc) results in pulmonary hypertension
this causes pulmonary pressure to increase greater than systemic pressure- so the shunt changes to R-L, resulting in cyanosis
9
Q
what is Rheumatic fever?
A
cross-sensitivity reaction to group A-B haemolytic strep occuring 2-4 weeks after infection (throat usually)
autoimmune
type II hypersensitivity reaction
10
Q
signs and symptoms of rheumatic fever
A
- high fever
- joint pain (migrating polyarthritis- i.e. moves from joint to joint)
- carditis (myocarditis etc)- leads to chest pain, dyspnoea and palpitations
- mitral regurgitation
- nodules on extensor surfaces
- rash- erythema marginatum
- synedhams chorea
11
Q
what PPI can be used to help manage GORD?
A
Ranitidine
12
Q
presentation of pyloric stenosis
A
projectile vomiting after feeds NO BILE
constipation
dehydration
13
Q
what is exomphalos also known as
A
omphalocele
14
Q
differences between omphalocele and gastrochisis
A
omphalocele is enclosed in peritoneum
gastroschisis is open (i.e. herniating organs are fully visisble)
15
Q
what maternal blood test can be done to confirm a diagnosis of a fetal abdominal wall defect (omphalocele/ gastrochisis)?
A
maternal serum alpha-fetoprotein will be raised
higher in gastroschisis than in omphalocele
16
Q
diagnosing IBD
A
faecal calprotectin
endoscopy
17
Q
DD of bilious vomiting
A
malrotation
atresias (bowel ones only ! )
hirchsprungs
meconium ileus
anorectal malformation
18
Q
DD of non-bilious vomiting (surgical and non-surgical)
A
surgical:
- pyloric stenosis
- oesophageal atresia
- intussusception (can be bile stained early on)
non-surgical:
- GORD
- infections
- coeliac
- appendicitis
- peptic ulceration
19
Q
Tx of biliary atresia
A
Kasai procedure
20
Q
presentation of a congenital diaphragmatic hernia
A
- respiratory distress
- displaced apex beat
- bowel sounds in hemithorax
21
Q
presentation of oesophageal atresia
A
dribbling
polyhydramnios
cyanotic on feeding
respiratory distress and aspiration
coiling of NG tube !!
22
Q
symptoms and sign (X-ray) of duodenal atresia
A
obstruction (constipation etc) and bilious vomiting
double bubble on x ray
23
Q
x ray sign of malrotation w/ volvulus
A
coffee bean sign
24
Q
most common cause of large bowel obstruction?
A
hirchsprungs !
25
difference between indirect and direct inguinal hernia
indirect- through deep ring to superficial ring
direct- through defect in posterior wall of inguinal canal to the superficial ring
26
aetiology of neonatal inguinal hernias
patent processus vaginalis
27
describe Prehn's sign
differentiates between testicular torsion and epididymis
lift testicle:
- pain relieved= epididymis
- pain not relieved= torsion
28
symptoms of Wilsons disease
- Kayser-Fleischer rings
- hepatitis etc
- neurological- dystonia etc (adolescents mostly)
29
causative organism and tx of bacterial skin infection in eczema
organism= staph aureus
Tx= flucloaxcillin
30
describe the steroid ladder in eczema
1st- hydrocortisone
2nd- Eumovate (clobetasol butyrate)
3rd- Betnovate (betamethasone)
4th- dermovate (clobetasol proprionate)
31
causitive organism and presentation of eczema herpeticum
- HSV most common, can also be VSV
child w/ eczema presenting with:
- painful vesicular rash
- fever, lethargy, reduced oral intake
lymphadenopathy
32
management of eczema herpeticum
aciclovir
33
Presentation of Steven-Johnson syndrome
- initially vague upper resp tract infections after starting a new drug
- follow by a rash
rash:
- painful, erythematous macules
severe mucosal ulceration
34
causative drugs of Steven-Johnson syndrome
- sulfonamides
- anti-epileptics
- Penicillin
- NSAIDs
35
presentation of allergic rhinitis
runny, blocked, itchy nose
sneezing
itchy, red, swollen eyes
36
management of allergic rhinitis
non-sedating antihistamines- cetirizine, loratadine, fexofenadine
sedating antihistamines- chlorphenamine (Piriton) and promethazine
nasal corticosteroid sprays- fluticasone/ mometasone
37
type of hypersensitivity reaction in anaphylaxis
severe type 1 hypersensitivity reaction. (IgE) stimulates mast cells to release histamine and other pro-inflammatory chemicals. This is called mast cell degranulation. This causes a rapid onset of symptoms, with airway, breathing and/or circulation compromise.
38
management of anaphylaxis
```
ABCDE
Causes:
o establish airway
o High flow oxygen
o IV fluid - crystalloid
- Early administration of adrenaline IM/IV
```
- Additional:
- Chlopheniramine - antihistamine
o Hydrocortsone
o Salbutamol if wheeze
39
what is a strawberry mark?
cavernous haemangioma
40
what is a port wine stain
capillary haemangioma
permanent !
41
UTI Tx in paeds
<3 months= amoxicillin and gentamicin (IV both)
> 3 months= trimethoprim, nitrofurantoin, amoxicillin
42
features and immediate management of an atypical UTI
- poor urine flow
- abdo mass
- seriously ill
- raised CK
- septicaemia
- no response to Abx in 48h
- non-E Coli infection
management- immediate USS
43
What scan is used to detect renal scarring
DMSA (Dimercaptosuccinic acid scan)
44
scan used to detect vesicouteric reflux
MCUG
| Micturating Cystourethrogram Scan
45
what is vesicouteric reflux
Retrograde flow of urine from bladder into ureter due to developmental anomaly where ureters are displaced laterally and enter bladder directly, rather than at an angle
46
consequences of vesicouteric reflex
- incomplete emptying= increased risk of infection
- pyelonephritis from infrarenal reflux
- increased bladder voiding pressure= renal damage
- reflux nephropathy due to scarring
47
presentation of autosomal recessive polycystic kidney disease
antenatally
oligohydramnios and polycystic kidneys
48
consequences of a lack of amniotic fluid in ARPKD
potter syndrome- leads to dysmorphic features- in the face, pulmonary hypoplasia
49
presentation of nephrotic syndrome
frothy urine
generalised oedema (periorbital, scrotal/ vulval, leg and ankle)
pallor
breathlessness
50
presentation of nephritic syndrome/ acute glomerulonephritis
- haematuria
- proteinuria
- decreased urine output
51
presentation of Alport syndrome
sensorineural deafness
pyelonephritis
haematuria
renal failure
52
what is HSP
IgA mediated autoimmune hypersensitivty vasculitis
can affect all organs
53
triad seen in HSP
- purpura (can be non-blanching)- typically on lower limbs/ buttocks
- arthritis/ arthralgia
- abdo pain
also affects the kidneys- resulting in haematuria and proteinuria
54
triad of signs seen in haemolytic uraemic syndrome
- acute microangiopathic haemolytic anaemia
- thrombocytopenia
- acute renal failure (AKI)
55
Cause of haemolytic uraemia syndrome
Shiga-Toxin producing E.Coli
56
presentation of haemolytic uraemia syndrome
- bloody diarrhoea
- reduced urine output
- haematuria
- abdo pain
- lethargy and irritability
- confusion
- HTN
- Bruising (purpura)
57
complications of measles (which is most common, which is most common cause of death) + other complications
most common= ottitis media
cause of death= pneumonia
other:
- croup
- encephalitis
- subacute sclerosing panencephalitis (chronic complication)
58
aetiology of scarlet fever
strep pyogenes (group A haemolytic strep)
59
how long should children with measles isolate for?
until 4 days after symptoms resolve
60
Tx and isolation of children with scarlet fever
Tx- phenoxymethylpenicillin
isolate until 24h after Abx have started
61
presentation of rubella
- pink macular rash- starts on face then spreads
- lethargy
- low grade fever
- headache
62
isolation rules for rubella
isolate until 5 days after the rash presented
63
aetiology and presentation of roseola infantum
Ax= Herpes virus 6/7
Sx- high fever, coryzal sx, swollen lymph nodes
fever then setlles and is followed by a rash- mild erythematous macular rash
64
isolation rules of roseola infantum
none- if the child is well enough they can attend nursery
65
main complication of roseola infantum
febrile convulsions (temperature can reach up to 40'c)
66
how long is a child with chicken pox infective for?
from 4 days prior to the rash till 5 days after/ until all lesions have scabbed
67
causative organism of impetigo
superficial skin infection by staph aureus/ strep pyogenes
68
isolation rules for impetigo
48h after commencement of treatment/ until all lesions have healed
69
clinical presentation of diptheria
sore throat, fever, lymphadenopathy and respiratory distress (usually presents as a stridor)
O/E- back of the throat will appear covered in a thick grey substance
70
polio- aetiology, transmission, clinical presentation
VIRUS
faecal-oral transmission
- can be asymptomatic
- generalised Sx- fever, malaise, headache
some cases can have CNS involvement- aseptic meningitis
- rarely can get paralytic polio- attacks spinal cord
71
TB- presentation and diagnosis
presentation:
- cold abscess- firm, painless abscess in the neck (no inflammation or erythema)
- lethargy
- fever
- weight loss
- cough w/wo haemoptysis
- lympadenopathy
- erythema nodosum
Dx:
- Ziehl- Neelsen stain
- Mantoux test
72
isolation rules with Coxackie's (Hand foot and mouth)
stay of school until feeling systemically well
73
what glands are classically swollen in mumps?
parotid glands
74
what is infectious mononucleosis also known as?
glandular fever
75
classic presentation of infectious mononucleosis
sore throat, lymphadenopathy
may develop itchy rash after taking amoxicillin
76
most common complication of meningitis in kids
deafness (sensorineural hearing loss)
77
most common complication of meningitis in kids
deafness (sensorineural hearing loss)
78
meningitis Tx:
- under 3 months
- over 3 months
- GP
under 3 months= cefotaxime and amoxicillin
over 3 months= ceftriaxone and dexamethasone
GP= Benzylpenicillin
79
presentation of toxic shock syndrome
high fever
hypotension
diffuse erythematous macular rash
80
Tx of toxic shock syndrome
ceftriaxone and clindamycin
81
types of Herpes- the virus and what is causes (3-7)
HHV3- VZV- chicken pox and shingles
HHV4- EBV- glandular fever
HHV5- cytomegalovirus
HHV6/7- Roseola
82
management of candidiasis in children
oral antifungal- nystatin
83
what is tuberous sclerosis
A multisystem disorder characterised by the forma5on of hamartomas in
many organs, commonly the brain, skin and kidneys
autosomal dominant !
84
clinical presentation of tuberous sclerosis
- epilepsy- focal and infantile spasms
- ash leaf macules
- adenoma sebacum
- Shagreen patches
- Poliosis
- learning difficulty
85
Tx of tuberous sclerosis
vigabatrin
86
Diagnostic criteria for anorexia
- weight <85% predicted
- BMI <17.5kg/m2
- fear of gaining weight with persistent behaviour that intereferes with weight gain
- feeling fat when underweight
87
cardiovascular malformations due to anorexia
bradycardia
hypotension
QT prolongation
Arrhythmia's
88
what hormones/ electrolytes are low/ high in anorexia
LOW- glucose, potassium, phosphate, TSH, FSH, LH, oestrogen
HIGH- T3/T4, LFT, GH, cortisol, cholesytokinin, cholesterol
89
red flags for anorexia
BMI <13 or below 2nd centile
weight loss >1kg/ week
temp <34.5
BP <80/50
SaO2 <92%
weakness in muscles
90
what extra signs are seen in bulimia to differentiate from anorexia
- binge eating
- vomiting/ exercise etc
- oesophagitis
- Russell's sign
- gastric dilation
- cardiomyopathy- due to laxative use
91
what medication can help in bulimia
Fluoxetine (SSRI)- reduces binging and purging
92
what must be avoided in a pt with a suspected Wilms tumour
renal biopsy !!
93
absent red reflex- what is the biggest concern?
retinoblastoma
94
presentation of osteogenesis imperfecta
- history of fractures
- small stature
- dental problems
- hypermobility
- BLUE SCLERA
- bone deformities (bowed legs, scoliosis)
95
what is Kohler's disease
avascular necrosis of the navicular bone that occurs in young children and presents with pain on the dorsal and medial surface of the foot.
96
presentation of a discoid meniscus
- 'popping' sound heard
- pain
- locking of the joint
