passmed random rashes, resp and gastro illnesses Flashcards
feverish
looks sickly and flushed
diffuse maculopapular rash across chest and back and small white papules on the inside of his cheeks
what is the most frequent complication of this condition
Otitis media
sx of the bronchiits which is also a complication of measals
lower respiratory infection, is a complication of measles but is not as common as otitis media. This would typically present with a persistent productive cough, dyspnoea, wheezing and malaise
how quickly should an unvaccinated child who comes into contact with measals be treated with MMR
72hours
what is the mode of inheritance in haemophilia A
x linked recessive - so no male to male transmission
tetralogy of fallot what murmur is heard
ejection systolic murmur
VSD murmur heard
pansystolic murmur
mild systemic upset
oral ulcers
vesicles on the palms and soles
hand foot and mouth
chest compresssion rate in paed BLS
15:2
100-120/min
infants use the two thumb technique
characteristic features of kawasaki disease- CRASH and burn
C: conjunctivitis (bilateral).
R: rash (non-vesicular).
A: adenopathy (cervical).
S: swollen, strawberry tongue.
H: hand swelling (or feet).
Burn: fever lasts >5 days and is very high.
cardiac abnormality seen in turners - 3 things
bicuspid aortic valve
arotic root dialtion
coarctation of aorta
pink maculopapular rash on the face which spreads to the whole body. There is also suboccipital and post-auricular lymphadenopathy
rubella
baby with no femoral pulse at 6-8weeks what should you do -and what condition are you thinking of
discuss with paeds - thinking of coarctation of aorta
neonatal sepsis prestns with vague signs what are these
poor feeding
grunting lethargy
resp distress
jaundice
seizures and abdo distention
what causes neonatal sepsis
group b strep
e coli
ealy onset is GBS
late normally staph epidermidits or psdueo
cows milk protein intolerance presents like
gastrointestinal upset and itching or atopy.
Acute lymphoblastic leukaemia may present with haemorrhagic or thrombotic complications due to
DIC
dx of acute epoglottis
flexible larynoscopy
under age of 2 eczema presetns on face and extensor surfaces true or false
true
what is an umbilical grnauloma
An umbilical granuloma is an overgrowth of tissue which occurs during the healing process of the umbilicus. It is most common in the first few weeks of life. On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid. It is treated by regular application of salt to the wound, if this does not help then the granuloma can be cauterised with silver nitrate.
threadworm how to treat
one of dose of mevendazole for whole fmaily and hygiene measures
most common cause of cardiac arrest in children
resp causes such as bronchiolitis - crackles,wheezing and increased respiraotry effort, hypoxia, history of poor feeding, cough and fever
sx of threadworms
perianal itching, particularly at night
girls may have vulval symptoms
An 18-year-old male presents to his local GP surgery. He is due to start university in two months time and has been told by his friends that he should ‘have a vaccine’ before he starts. He identifies himself as ‘White British’, has no past medical history of note and is due to study history at the University of Birmingham. Which one of the following vaccines should he be offered as part of routine NHS immunisation?
13-18 years ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY
prodome of raised temperature pre illness
chickenpox
post fever in chcikenpox what comes next and how does the rash present
itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
pyloric stenosis what metabolic abnromality
Hypochloremic hypokalemic metabolic alkalosis
The most likely diagnosis here is pyloric stenosis. Due to vomiting up stomach contents which is acidic (hydrogen chloride - HCl), the patient will be hypochloraemic. Potassium is also lost in the vomitus.
undescended testicle when to review
in 3 months
surgeon seen before 6 motnhs
seziure at night, partial eg only parathesia affecting face but secondary generalisation may also occur such as tonic clonic movement of an arm
child normal
4-12
benign rolandic epilepsy
6 months to 5 years following a sudden increase in temperature such as viral infection - what seizure type
febrile convulsion
4-6months of life, characterised by flexion of head trunk and limbs followed by extension of arms - salaam attacks - EEG hypsarrhythmia
infantile spasm
features of CF
neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
recurrent chest infections (40%)
malabsorption (30%): steatorrhoea, failure to thrive
other features (10%): liver disease
Other features of cystic fibrosis
short stature
diabetes mellitus
delayed puberty
rectal prolapse (due to bulky stools)
nasal polyps
male infertility, female subfertility
1st 24hr jaundice what diff
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
over 14 days jaundice
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
jaundice is more common in breastfed babies
mechanism is not fully understood but thought to be due to high concentrations of beta-glucuronidase → increase in intestinal absorption of unconjugated bilirubin
prematurity
due to immature liver function
increased risk of kernicterus
congenital infections e.g. CMV, toxoplasmosis
crawls
9months
sit withou suppor twhen
7-8months
wlaks
13-15mon
slow to meet developmental milestones and feeding difficulties
cerebral palsy
explanation of oro-motor porblems and athetoid movemnt in dyskinetic cerebral palsy
The athetoid movements are shown in this stem by the slow writhing movements of his hands and feet and also the difficulty of holding onto objects. Patients with dyskinetic cerebral palsy experience difficulty in holding objects due to fluctuating muscle tone. The oro-motor problems are evidenced by this child’s drooling.
newborn hearing screen
Otoacoustic emission test is used to screen newborns for hearing problems - if this abnormal Auditory Brainstem Response test
At what age would the average child start to say ‘mama’ and ‘dada’?
9-10mon
A mother presents with her baby to the GP for review. She asks for advice regarding her milestones and explains that her son was born was born prematurely at 32 weeks gestation.
With the premature age in mind, when should this baby begin to show a responsive social smile?
6 to 8 weeks is the normal age when a child should show a responsive smile. The reference range of the corrected age is 40 weeks. In this case, the baby was born at 32 weeks gestation which means 8 weeks have to be backdated. So 14 to 16 weeks is the answer.
The corrected age is taken into consideration when looking at milestones until the age of 2.
fever followed later by rahs - rose pink macules and papules - starts on trunk and spreads to limbs
roseola infantum
herald patch and mutlipe smaller oval scaly plauqes distributed along skin cleavage lines in xmas tress apttern
pityriasis rosea
differentiate cardiac from non-cardiac causes of cyanosi sin neonate
nitrogen washout test
what keeps PDA open
alprostadil
tx for children of meningitis
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
A 4-year-old boy is brought in by his mother. He was mildly unwell yesterday with a fever, lethargy and sore throat. Today, his mum is alarmed as she has noticed ‘blisters’ in and around his mouth and he is reluctant to eat or drink. On examination the child looks miserable, but not unwell, his temperature is 38.2ºC and he has a mix of shallow ulcers and erythematous papules scattered over his hard palate, tongue and lips. Examining further you also notice that there are a few erythematous maculopapular lesions along the sides of his fingers, around his right heel and over his buttocks. What is the most likely diagnosis?
hand foot and mouth
how should you feed people with CF
High calorie and high fat with pancreatic enzyme supplementation for every meal
Small testes in precocious puberty
Adrenal hyperplasia
managment of hypoglycaemia in a newborn
asx
sx
asx- encourage normal feeding - breast or bottle nad montiro blood glycose
sx - admit to neonate uni, IV of 10% dextrose
You are reviewing a 9-month-old child with suspected bronchiolitis. Which one of the following features should make you consider other possible diagnoses?
temperature of 40
A low-grade fever is typical in bronchiolitis. NICE state the following:
Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.
problem with the valve in her ureters, with some backflow of urine from the bladder up towards the kidneys. ix of choice
Micturating cystography
At what age would the average child acquire the ability to sit without support?
The answer (6-8 months) includes the 6 months as stated in the MRCPCH Development Guide. Most other sources suggest a slightly later age of 7-8 months.
Short stature + primary amenorrhoea
turner
DDH imaging
US usually
if over 4.5 months then Xray
most stabalise 3-6 weeks
pavlik harness in children younger than 4-5 motnhs
amily law reform act of 1969
those over 16 can consent to treatment, but cannot refuse treatment under 18 unless there is one consenting parent, even if the other disagrees’.
apgar scores when
1,5 and then if poor again at 10minutes
managemnt of SUFE
internal fixation across growth plate
joint widening on xr
rickets
after advice for enuresis what next
alarm after star chart
risk factors for DDH
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
how to tx biliary atresia
surgical tx early
what is toddler diarrhoea
Toddler’s diarrhoea is a benign condition that causes the child no problems. It is due to the fast transit through their digestive system and often contains undigested food. It requires no treatment. It is prudent to plot their height and weight to ensure no severe underlying diagnosis is present such as coeliac, which would present with the child falling centiles on the growth chart.
sx umbilcial hernia
repair 2-3 years
whooping cough exlcusion from school how long
48hr
cf tx
lumacaftor and ivacaftor - homozygous for delta F508
SUFe
xr both elgs
MEn b vacine when
2, 4, and 12 months
surgical repair then keep PDA open
PDA close with ndomethacin if dosent worrant that
5TS of cyanotic heart disease
Tetralogy of fallot
Transposition of great vessels (TGA)
Tricuspid atresia
Total anomalous pulmonary venous return
Truncus arteriosus
floppy neonate unrepsonsive what should you do first
dry baby and note time
A 5-month-old boy presents to the emergency department, following a 1-week history of a persistent dry cough and difficulty feeding. His notes indicate that he had presented a week ago with a mild fever and coryzal symptoms. He has no other past medical history. On examination, the respiratory rate is 56/min and a wheeze is heard bilaterally on auscultation. There are no signs of an increased work of breathing and chest expansion is symmetrical. His temperature is 37.5ºC and oxygen saturation is 98% on room air.
Which of the following is the most appropriate next step in the management?
Bronchiolitis does not require antibiotics, children requires supportive management only
primary headache in children
migraine
intial mx of hirschprung to prevent what
rectial washouts and bowel irrigation
Serial rectal irrigation should be performed before surgery to help prevent enterocolitis.
sandpaper rash
scarlet fever
A 30-year-old woman with cystic fibrosis is attending her regular check-up with the respiratory nurse. Over the last 4 months, she has received three courses of antibiotics for chest infections, which is an increase from her normal requirements. Additionally, she describes feeling more tired than usual and has lost approximately 2kg in the last 3 months.
What therapy may be appropriate to manage this woman’s developing condition?
CF DM
tapering of the upper trachea.
croup
Diabetes (new onset) with weight loss, age 60 years and over
pancreatic cancer
when is a NIPE doen
first 72hours of life
then also 6-8weeks later
cx of both a sunken and bulging fontanelle
Sunken fontanelle = ?dehydration
Bulging fontanelle = ?raised ICP
neonate what is classed as tachyP
~30-50 resps/minute
Tachypnoea > 60 resps/minute
infant what is classed as TachyP
~20-30 resps/minute
Tachypnoea > 50
most common batceria detetched in diarrhoea
The most frequently identified organisms causing bacterial diarrhea are Escherichia coli (most common worldwide), Shigella, Salmonella, Campylobacter (most common in children), Yersinia, and Clostridium spp.
sclerosis of the right upper femoral epiphysis and moderate of resorption of the femoral head.
perthes more common in boys
perthes mx under 6
observe
over surgery
when do you use a pvlick harness
in A Pavlik harness is used in developmental dysplasia of the hip.
restricted internal rotation painful hip
leg can be held in external rotation
SUFE - 20% bilat
ewing sarcoma
boys 10-20 , pelvis and long bones, periods of rapid growth throughout childhood
pain worse at night
swelling lump - diagnosed after fracture due to bone weakened
onion ski on XR
most common type of primary malignant once in children
occurring in middle of long bones.
osteosarcoma
sunburst
VF - 3rd shock adrenaline and amiodarone
4 Hs and Ts when in cardaic arrest
after 5 shocks with amiodarone and adrenaline given - what dose to you titrate down to of amiodarone
150mg
raised anion gap MUDPILES
methanol
uraemia
DKA
paraldehyde
isoniasid
lactic acidosis
ethyleen glycol
rhabdo
salciylates
metformin plus AKI - side effect leading to
lactic acidosis
how much calcium gluconate should you give someone in hyperklamaia
10 to 20 mL of 10% calcium gluconate diluted in 50 to 100 mL dextrose or normal saline intravenously over 10 minutes is recommended.
binding agent for potassium in the bowel to reduce high potassium
lokelma
why do you use furosemide in hyperkalami a
push potassium back into the cell
moa lokelma - sodium zirocnium
Lokelma increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract. Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, thereby lowering serum potassium level.
side effect of neb salbutamol
tachy cardia
when you give insulin and dextrose will they rebound
yes - need to recheck
is a midly elevated amaylase seen in anything else other than pancreatitis
yes small bowel obstruction
also if you cannot see the large bowel on xray may be becuase it has collapsed due to small bowel being so dilated
biliary atresia presentation
Biliary atresia can present with prolonged jaundice (present > 14 days of age), hepatomegaly, splenomegaly, abnormal growth, cardiac murmurs if associated cardiac abnormalities are present
triad of shaken baby syndrome
Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of the shaken baby syndrome
differecnce between presentation of infantile spasms and colic
In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the ‘spasms’
Newborn babies are relatively deficient in vitamin K. This may result in impaired production of clotting factors which in turn can lead to haemorrhagic disease of the newborn (HDN). Bleeding may range from minor brushing to intracranial haemorrhages
Breast-fed babies are particularly at risk as breast milk is a poor source of vitamin K. Maternal use of antiepileptics also increases the risk
because of this what are they offered - one off what
Both oral and IM routes of vitamin K are licensed for neonates, but IM should be recommended to parents due to reduced concerns about compliance and shorter (one-off) treatment duration
features of vesicouteric reflex
bnormal backflow of urine from the bladder into the ureter and kidney. It is a relatively common abnormality of the urinary tract in children and predisposes to urinary tract infection (UTI), being found in around 30% of children who present with a UTI. As around 35% of children develop renal scarring it is important to investigate for VUR in children following a UTI
Pathophysiology of VUR
ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
therefore shortened intramural course of the ureter
vesicoureteric junction cannot, therefore, function adequately
difference between androgen insenstivity and congential adrenal hyperplasia
Congenital adrenal hyperplasia would likely be diagnosed much earlier than puberty and is typically characterised by ambiguous genitalia and other symptoms of adrenal insufficiency, such as arrhythmias and vomiting.
andorgen
primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol
what is a cephaloheamatoma
A cephalohaematoma appears as a swelling due to bleeding between the periosteum and the skull. It is most commonly noted in the parietal region and is associated with instrumental deliveries. The swelling usually appears 2-3 days following delivery and does not cross suture lines. It gradually resolves over a number of weeks.
what is caput succadeneum
Caput succadeneum is commonly seen in newborns immediately after birth. It occurs due to generalised superficial scalp oedema, which crosses suture lines. It is associated with prolonged labour and will rapidly resolve over a couple of days.
the ejection systolic murmur in tetralogy of fallot is caused by what amnd why
Note the murmur is a result of pulmonary stenosis, not the ventricular septal defect as this is too large to produce a murmur.
Generalised tenderness seen in what in kids
Generalised in mesenteric adenitis and peritonitis.
intial mx of suspected cyanotic congential heart disease in a newborn
Initial management of suspected cyanotic congenital heart disease
supportive care
prostaglandin E1 e.g. alprostadil
used to maintain a patent ductus arteriosus in ductal-dependent congenital heart defect
