Peadiatrics Flashcards

1
Q

Acute epiglottitis: cause

A

H influenza type B

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2
Q

Acute epiglottitis: vaccine

A

Hib (H influenza type B)

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3
Q

Acute epiglottitis: Sx

A

-rapid onset
-high temperature
-generally unwell/toxic
-stridor
-drooling of saliva
-muffled sound
-‘tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position

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4
Q

Acute epiglottitis: complication

A

airway obstruction

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5
Q

Acute epiglottitis: Dx

A
  1. direct visualization by the senior
  2. Lateral neck Xray: thumb print sign -swelling of the epiglottis
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6
Q

Acute epiglottitis: Mgmt

A

NOTE: if suspected do NOT examine the throat due to the risk of acute airway obstruction
1. Call anesthetist/ENT -secure the airways -endotracheal intubation
2. Oxygen
3. IV antibiotics

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7
Q

Croup: alternative name

A

Laryngotracheobronchitis

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8
Q

Croup

A

Characterized by stridor which is caused by a combination of laryngeal oedema and secretions.

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9
Q

Croup: causative organism

A

Parainfluenza viruses

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10
Q

Croup: age group

A

infants to toddlers (6 months to 3 years)

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11
Q

Croup: features

A

stridor
barking cough (worse at night) -hint
fever
coryzal symptoms

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12
Q

Croup: mild Sx

A

Occasional barking cough
No audible stridor at rest
No or mild suprasternal and/or intercostal recession
The child is happy and is prepared to eat, drink, and play

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13
Q

Croup: moderate Sx

A

Frequent barking cough
Easily audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation
The child can be placated and is interested in its surroundings

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14
Q

Croup: severe Sx

A

Frequent barking cough
Prominent inspiratory (and occasionally, expiratory) stridor at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy or restlessness (a sign of hypoxemia)
Tachycardia occurs with more severe obstructive symptoms and hypoxemia

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15
Q

Croup: Dx

A
  1. Usually diagnosed clinically
  2. chest x-ray: a posterior-anterior view - subglottic narrowing ‘steeple sign’
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16
Q

Croup: admission criteria

A
  1. Mod-severe croup
  2. < 6 months of age
    3.known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
  3. uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
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17
Q

Croup: Mgmt

A

-a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
-prednisolone is an alternative if dexamethasone is not available

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18
Q

Croup: Emergency treatment

A

-high-flow oxygen
-nebulized adrenaline

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19
Q

Croup: prognosis

A

Natural resolution (complete recovery)

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20
Q

Nocturnal enuresis

A

the ‘involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract’

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21
Q

Normal continence: age group

A

usually by 3-4 years of age -day and night

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22
Q

Nocturnal enuresis: Types

A
  1. primary (the child has never achieved continence) 2. secondary (the child has been dry for at least 6 months before)
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23
Q

Primary enuresis (daytime plus >2 years of age: Mgmt

A

Refer to sec care or enuresis clinic

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24
Q

Primary enuresis (only night time plus >5 years of age plus <2 times/week : Mgmt

A

Reassurance

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25
Q

Primary enuresis (only night time plus >5 years of age plus >2 times/week : Mgmt

A

Long term:
1. enuresis alarm
2. reward system

Short term:
1. Desmopressin

If 2x long and short term tx -still bedwetting -> sec care or enuresis clinic

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26
Q

Secondary enuresis: Mgmt

A

Refer to pediatrician

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27
Q

Secondary enuresis: Causes

A

-Child abuse or emotional upset due to change of the environment e.g. addition of new member in the house, change of school/day care etc
-constipation
-diabetes mellitus
-UTI if recent onset

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28
Q

Nocturnal enuresis: Mgmt in a glance

A

A. general advice
-fluid intake
-toileting patterns: encourage to empty bladder regularly during the day and before sleep
-lifting and waking

B. reward systems (e.g. Star charts)
NICE recommend these ‘should be given for agreed behavior rather than dry nights’ e.g. Using the toilet to pass urine before sleep

C. enuresis alarm generally first-line for children have sensor pads that sense wetness high success rate

D. desmopressin particularly if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family

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29
Q

Vesicoureteric reflux (VUR)

A

The abnormal backflow of urine from the bladder into the ureter and kidney - dilatation of pelvicalyceal system - recurrent UTIs - renal scarring - renal failure

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30
Q

Pathophysiology of VUR

A

Congenital abnormality of insertion of ureters in the urinary bladder (displaced laterally, entering the bladder in a more perpendicular fashion than at an angle) -can be seen on ultrasound

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31
Q

VUR: Possible presentations

A

A. antenatal period: hydronephrosis on ultrasound

B. recurrent childhood urinary tract infections

C. reflux nephropathy - chronic pyelonephritis secondary to VUR - renal scar may produce increased quantities of renin causing hypertension

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32
Q

VUR: Dx

A

A. initial:
Ultrasound

B: Gold standard:
Micturating cystourethrogram (not done >3 years of age)

C: recurrent UTI with suspected renal/parenchymal damage:
DMSA - Technetium scan -can be booked in 4-6 months after the acute UTI

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33
Q

VUR: Mgmt

A

A: Low dose abx prophylaxis (mostly trimethoprim)

B. If Tx failed or parenchymal damage -surgery (ureter reimplantation)

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34
Q

Neck lumps:

lateral neck mass -non translucent

A

Branchial cyst

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35
Q

Neck lumps:

lateral (along or near sternocleidomastoid) neck mass- translucent

A

Lymphangioma

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36
Q

Neck lumps:

ant midline neck mass- painless, mobile, moves up with tongue protusion

A

Thyroglossal cyst

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37
Q

Neck lumps:

midline neck mass- moves up with swallowing

A

Goiter

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38
Q

Neck lumps:

Fluctuant lump that transilluminate usually evident at birth

A

Cystic hygroma

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39
Q

Neck lumps:

Pulsatile lateral neck mass which doesn’t move on swallowing

A

Carotid aneurysm

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40
Q

Neck lumps:

Pulsatile lateral neck mass which doesn’t move on swallowing

A
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41
Q

Neck lumps:

midline lump in the neck that gurgles on palpation
ass with dysphagia, regurgitation, aspiration and chronic cough
more common in older men

A

Pharyngeal pouch

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42
Q

Neck lumps:

Rubbery, painless lymphadenopathy,
associated with night sweats and splenomegaly

A

Lymphoma

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43
Q

Neck lumps: Mgmt

A

Initially: U/S
If suspicious: FNAC

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44
Q

Asthma: severe attack

A

SpO2 < 92%
PEF 33-50% best or predicted
Too breathless to talk or feed
Heart rate
>125 (>5 years)
>140 (1-5 years)
Respiratory rate
>30 breaths/min (>5 years)
>40 (1-5 years)
Use of accessory neck muscles

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45
Q

Asthma: life threatening

A

SpO2 <92%
PEF <33% best or predicted
Silent chest
Poor respiratory effort
Agitation
Altered consciousness
Cyanosis

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46
Q

Asthma: Moderate
2-5 years of age

A

SpO2 > 92%
No clinical features of severe asthma

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47
Q

Asthma: Moderate
>5 years of age

A

SpO2 > 92%
PEF > 50% best or predicted
No clinical features of
severe asthma

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48
Q

Acute asthma: Mgmt-mild to moderate

A

Bronchodilator:
give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)
give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat beta-2 agonist and refer to hospital

Steroid therapy:
should be given to all children with an asthma exacerbation
treatment should be given for 3-5 days

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49
Q

Acute asthma: Mgmt-severe to life threatening

A

transferred immediately to hospital.

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50
Q

PEFR

A

all children >5 years of age

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51
Q

Asthma: Mgmt <5 years
newly diagnosed

A

Short-acting beta agonist (SABA)

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52
Q

Asthma: Mgmt <5 years
Not controlled on previous step
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking

A

SABA + an 8-week trial of paediatric MODERATE-dose inhaled corticosteroid (ICS)

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53
Q

Asthma: Mgmt <5 years
next step

A

SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA)

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54
Q

Asthma: Mgmt <5 years
next step

A

Stop the LTRA and refer to an paediatric asthma specialist

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55
Q

Asthma: Mgmt 5 -16 years

A

almost same as in adults

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56
Q

Maintenance and reliever therapy (MART)

A

A form of combined ICS and LABA treatment in which a single inhaler, containing both ICS and a fast-acting LABA, is used for both daily maintenance therapy and the relief of symptoms as required

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57
Q

Paediatric low dose ICS

A

<= 200 micrograms budesonide or equivalent

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58
Q

Paediatric mod dose ICS

A

200 micrograms - 400 micrograms budesonide or equivalent

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59
Q

Paediatric high dose ICS

A

> 400 micrograms budesonide or equivalent

60
Q

Silent chest: Mgmt

A

intubation

61
Q

acute asthma exacerbation: Mgmt

A

O2
Salbutamol neb (back to back)
Ipratropium neb (can be mixed with B agonist)
steroids (oral or IV hydrocortisone)

62
Q

acute asthma exacerbation: Mgmt
next step if sx still not improving

A

Senior consultation
IV salbutamol
IV MgSO4
IV aminophyline

63
Q

Acute asthma:
child develops SOB, tachypnea and drowsiness even after O2 and salbutamol

A

Cap gas -ABG -to look for resp acidosis

64
Q

Sudden onset
coughing
choking
stridor
vomiting

A

Foreign body
Laryngoscopy

65
Q

congenital abnormality
presents at 4 weeks of age
stridor

A

Laryngomalacia

66
Q

Travel Hx
Watery diarrhea
foul -smelling stools
weight loss
flatulence
bloating
Sx >10 days

A

Giardiasis

67
Q

Giardiasis: Dx

A

stool for ova and parasite
ELISA/PCR

68
Q

Giardiasis: Mgmt

A

Metronidazole
personal hygeine

69
Q

Came back from 3rd world country e.g. Kenya
watery diarrhea
abdo cramping

A

E. Coli (traveler’s diarrhea)
Self limited - 72 hours

70
Q

Hx of travel
High grade fever >40
headache
body aches
bloody diarrhea

A

Campylobacter jejuni

71
Q

bloody diarrhea

A

Campylobacter jejuni
Shigella
Salmonella

72
Q

MCC diarrhea in peads

A

Rota virus

73
Q

Gastric infection -diarrhea
areflexia
weakness

A

GBS

74
Q

Diarrhea
Renal impairment
Hemolysis

A

HUS-hemolytic uremic syndrome

75
Q

Diarrhea
RUQ pain

A

Entamoebae Histolytica
amoebiasis

76
Q

H/o long term abx use
Diarrhea

A

Clostridium difficile (Pseudomembranous colitis)

77
Q

Clostridium difficile (Pseudomembranous colitis): Mgmt

A

oral metronidazole or oral vancomycin

78
Q

Diarrhea after eating poultry

A

Salmonella

79
Q

sudden onset diarrhea just after eating

A

Staphylococcus aureus (toxin)

80
Q

Bed ridden patient
diarrhea
stony hard stool on PR exam

A

Fecal impaction

81
Q

Toddler (6 months to 2 years)
minor injury -fever -pain
vigorous crying
turns blue
hold breathing
then LOC: 1-2 mins
rapid recovery

A

Blue breath holding spells
reassurance

82
Q

Toddler (6 months to 2 years)
minor injury -fever -pain
attempt to cry
turns pale
hold breathing
may have jerky movements/upward deviation of eyes
no tongue biting
then LOC: 1-2 mins
rapid recovery

A

White breath holding attacks
or Reflex anoxic seizures
or Reflex asystolic syncope

83
Q

Breath holding spells: Mgmt

A

Reassurance
Check ferritin
Tx iron def if present
child in a recovery position usually for 1-2 mins

84
Q

5 week old child
pale stools
dark urine
low weight for age
hepatomegaly

A

biliary atresia

85
Q

biliary atresia: Dx

A

LFT -raised conjugated bilirubin

86
Q

biliary atresia: Mgmt

A

Surgery

87
Q

Jaundice in the first 24 hours

A

always pathological.

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

88
Q

Jaundice in the neonate from 2-14 days

A

More common
physiological
more commonly seen in breastfed babies

89
Q

Jaundice after 14 days or 21 days if premature (prolonged): screening tests

A

conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention
direct antiglobulin test (Coombs’ test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs

90
Q

Jaundice after 14 days or 21 days if premature (prolonged): Causes

A

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

91
Q

8 week child
FTT
pale urine
yellow stool
hepatomegaly
vomiting
poor feeding

A

Galactosemia

92
Q

jaundice >14 days
constipation
protruding tongue
cold mottled skin
hypoactive
floppy muscles
FTT
flat nose
widely set eyes

A

Hypothyroidism
Thyroxine up to 2 years of age

93
Q

4-8 years old boy
late walker >18 months
Gower sign pos
proximal m weakness
waddling gait -cant run
raised CK levels
some resp/cardiac manifestation
X linked recessive

A

Duchene Muscular Dystrophy
DMD

94
Q

Duchene Muscular Dystrophy
DMD: Dx

A

Raised CK
Muscle biopsy
Genetic testing -obligatory after m biopsy

95
Q

Duchene Muscular Dystrophy
DMD: muscle biopsy

A

mutation defect in dystrophin protein in the straited muscle

96
Q

X linked recessive

A

DMD
Hemophilia

97
Q

Autosomal dominant

A

Huntington’s disease -anticipation
Neurofibromatosis
Autosomal adult kidney disease
BRCA 1 gene -incomplete penetrance

98
Q

Autosomal recessive

A

Cystic fibrosis
Sickle cell anemia
CAH -21 hydroxylase def
Thalassemia

99
Q

Autosomal Dominant:
If one parent is affected

A

50% chance of a child -affected
25% chance of a grandchild -affected

100
Q

Autosomal recessive:
If both parents are carriers

A

25% chance of a child -affected

50% chance of a child -carrier

101
Q

X linked recessive:
if mother is a carrier

A

50% chance of a male child to be affected

102
Q

No gastric bubble

A

Jejunal atresia

103
Q

single gastric bubble

A

gastric/pyloric atresia

104
Q

double bubble sign

A

duodenal atresia
malrotation
volvulus

105
Q

triple bubble sign

A

Jejunal atresia

106
Q

sudden onset bilious vomiting in neonate
Xray -double bubble sign
bleeding PR

A

malrotation/volvulus

107
Q

malrotation/volvulus: Dx

A

Abdominal Xray
Barium enema

108
Q

malrotation/volvulus: Rx

A

ABCDE
NG decompression
Refer to pediatrics
Laparotomy/resection

109
Q

3-8 weeks neonate usually male and first born
projectile non bilious vomiting
constipation or dehydration +/-
hypochloraemic, hypokalaemic alkalosis
palpable mass in the upper abdodmen

A

Pyloric stenosis

110
Q

Pyloric stenosis: Dx

A

U/S: Thickened pylorus

111
Q

Pyloric stenosis: next or urgent step

A

Check K+ levels

112
Q

Pyloric stenosis: Tx

A

correct dehydration and electrolyte abnormality

NGT
Ramstedt pyloromyotomy

113
Q

-6-18 months child usually a male child
-paroxysmal colicky abdominal pain
-inconsolable crying
-knees up
-turn pale
-vomiting
-bloodstained stool - ‘red-currant jelly’ - late sign
-sausage-shaped mass in the right upper quadrant

A

Intussusception

114
Q

Intussusception: Dx

A

U/S: target sign or doughnut sign

115
Q

Intussusception: Tx

A

-Air insufflation: air enema
-if fails : barium enema
-if fails or signs of peritonitis -surgery (laparotomy)

116
Q

Male child -2-3 y/o
painless bleeding PR

A

Meckel’s diverticulum

117
Q

Meckel’s diverticulum: Rule of 2s

A

2% of the population
2 feet from the ileocaecal valve
2 inches long

118
Q

Meckel’s diverticulum: complication

A

rectal bleeding:

Meckel’s diverticulum is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years

intestinal obstruction:

secondary to an omphalomesenteric band (most commonly), volvulus and intussusception

119
Q

Meckel’s diverticulum: Dx

A

‘Meckel’s scan’ -radioisotope scan uses 99m technetium pertechnetate, which has an affinity for gastric mucosa

mesenteric arteriography- in more severe cases e.g. transfusion is required

Definitive Dx: Laparotomy

120
Q

Meckel’s diverticulum: Tx

A

Surgical resection

121
Q

painful bleeding PR

A

Intussusception
volvulus

122
Q

RNA paramyxovirus

A

Measles

123
Q

Measles: incubation period

A

spread by aerosol transmission

infective from prodrome until 4 days after rash starts

incubation period = 10-14 days

124
Q

Measles: Sx

A

3 C’s
conjunctivitis
coryza
cough

High grade fever 105

Koplik spots

diarrhea -10%

No cervical LN enlargement

125
Q

Koplik spots

A

typically develop before the rash

white spots (‘grain of salt’) on the buccal mucosa

126
Q

Measles: rash

A

starts behind ears then to the whole body
discrete maculopapular rash becoming blotchy & confluent
desquamation that typically spares the palms and soles may occur after a week
often itchy

127
Q

Measles: Dx

A

IgM antibodies can be detected within a few days of rash onset

128
Q

Measles: Mgmt

A

mainly supportive
admission may be considered in immunosuppressed or pregnant patients
notifiable disease → inform public health

129
Q

Measles: complications

A

otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis

130
Q

Measles: Mgmt of contacts

A

if a child not immunized against measles comes into contact with measles then MMR should be offered (vaccine-induced measles antibody develops more rapidly than that following natural infection)
this should be given within 72 hours

131
Q

Rubeola

A

Measles

132
Q

German Measles

A

Rubella

133
Q

-maculopapular rash from face and downwards
-low grade fever
-enlarge LN -occipital, cervical, postauricular
-Forschheimers’s spot on the soft palate

A

Rubella

134
Q

Rubella: Mgmt

A

supportive

135
Q

difference between rubella and measles

A

In rubella:

  1. enlarge LN
  2. spot on soft palate and not buccal
136
Q

Roseola infantum

A

Roseola

137
Q

Sudden onset high grade fever
non itchy rash starting from chest and legs and then spread to the rest of the body

A

Roseola

138
Q

Erythema infectiosum

A

fifth disease
parvo virus B19

139
Q

bright red rash on cheeks or rest of the body -slapped cheek appearance

itchy esp. if involves feet and soles

A

Erythema infectiosum

140
Q

painful ulcers on tongue

grey blisters on hand and feet

A

Hand foot mouth disease

141
Q

Hand foot mouth disease: causative organism

A

Coxsackie virus

142
Q

all viral rashes: Mgmt

A

Supportive tx
Reassurance

143
Q

if:
photophobia
rash
neck rigidity

A

Meningitis

144
Q

suspected UTI in >3 months old baby

A

Urine dip

145
Q

leucocyte esterase and nitrites are negative on urine dip

A

no abx
no urine MCS

146
Q

leucocyte esterase or nitrites or both are positive on urine dip

A

abx and send urine MCS