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pg 28 Flashcards

1
Q

¸What is the clinical examination of meningitis?

A

• Inspect: Fever, rash, unwell
• Meningisim:
o Neck stiffness: Hands on occiput sides (near ears), Rotate head,
Chin to chest, hold it there for 10 secs. (Assessing for resistance
to movement).
o Brudzinski sign: Flexion of the neck with child supine causes
flexion of the hips and knees.
o Kernig sign: Bend their knee with your hands on hamstrings and
the other supporting the thigh. Straighten: Positive if there is hamstring spasm or back pain, or flexion of the opposite leg on
extension.
o Papilledema and fontanelles.
o Focal neurological signs

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2
Q

Kawasaki disease

CP:

A

o High fever (> 5 days and difficult to manage)
o Strikingly miserable
o Non-purulent Conjunctivitis, strawberry tongue, lip cracking
o Hand and foot swelling, erythema, rash or peeling
o Inflammation of BCG scar.

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3
Q

Kawasaki disease

INVX

A

o Inflammatory markers

o Cardiac ECHO

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4
Q

Kawasaki disease

TX:

A

o IVIG
o High dose aspirin
o +/- Warfarin
o +/- Immunosuppression

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5
Q

Outline the UK immunisation schedule?

A 
Birth: BCG, HB (if high risk)
• 1 month: HB (If at risk)
2-3-4 months: HB (If at risk), 5 in one (DTAP, POLIO, HIF), PCV, Rota, and
MEN-B.
• 1 yr: MMR, HIB/MENC, MEN b, PCV, Hib
• 3 yrs: MMR, 4 IN one (remove Hib)
• 2-7: Flu shot each year.
• 12-13 girls: HPV
• 14 yrs: MENC ACWY, 3 in one
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6
Q

immunodeficiency syndromes

CP:

A

o Recurrent infections (Ear, sinus, lung, skin)
o Severe infections (Bone, brain, sepsis)
o Prolonged complicated infections
o Failure of antibiotics to clear infection
o Prolonged or recurrent diahorrea with Failure to thrive
o Deep sited and skin abscesses.
o Reactions to live vaccines
o Prolonged warts
o Opportunistic infections (candidiasis)

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7
Q

immunodeficiency syndromes

INVX:

A

o FBC with WBC differential
o IG levels and IgG subsets
o Compliment levels
o Special tests and genetics

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8
Q

immunodeficiency syndromes

Mgt:

A

o Anti-microbial prophylaxis
o Anti-biotic treatment
o Screen for end organ damage

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9
Q

examination findings in atopic child?

A
  • Mouth breathing
  • Allergic salute
  • Swollen and pale inferior turbinate
  • Allergic conjunctivitis with Dennie-Morgan folds and discoloration
  • Atopic eczema
  • Chest hyperinflation and Harrison sulcus
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10
Q

clinical features,
of food
hypersensitivity?

A
  • 6% of children are affected.
  • Allergic (Cow milk protein allergy)
    o IgE-mediated:
    Onset within 2 hours
    Mild: Urticaria and itchy skin & facial swelling.
    Severe: Wheeze, stridor, abdominal pain, vomiting and
    diarrohea, Shock and collapse.
    o Non-IgE: beyond 2 hrs. GI symptoms.
  • Non-allergic (Transient lactose intolerance).
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11
Q

Diagnosis of food

hypersensitivity?

A

Skin prick test (Most useful); wheel > 8 mm. Blood IgE

levels. Gold standard: Supervised food challenge.

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12
Q

Management of food

hypersensitivity?

A

Food avoidance with dietician advice (Traces,
Alternatives and nutritional deficiency avoidance). Written management
plan, carry epipen all the time. (Technique and expiry date).

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13
Q

Prognosis of food

hypersensitivity?

A

Egg and milk resolve but nut and fish do not.

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14
Q

What should the child with severe eczema be screened for?

A

Egg allergy (40%) with skin prick or blood test.

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15
Q

clinical presentation of hay fever?

A
  • Conjunctivitis
  • Rhinitis
  • Chronic nasal congestion sleep disturbance and impaired day time
    behaviour and concentration
  • Aden hypertrophy: Snoring, sleep apnoea, irritability and somnolence
    during the day.
  • Chronic cough
  • Sinusitis
  • Eczema, asthma
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16
Q

How is hay fever managed?

A 
2nd G antihistamine, 
topical steroid, 
cromogylcate, 
Monteleukast,
decongestants (< 7 days)
Allergen immunotherapy
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17
Q

How is urticaria classified and treated?

A
  • Acute: Hours (drug), days (viral)
  • Chronic > 6 weeks
  • Physical
  • NSAIDS-induced
  • C1 esterase inhibitor deficiency (just angioedema)
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18
Q

What is the prognosis and management of insect bite allergy?

A
  • Mild: Local swelling
  • Moderate: generalised urticaria
  • Severe: Anaphylaxis.
  • Mild-moderate => Reassurance
  • Severe: Carry epipen.
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19
Q

Stridor is

A

Upper airway obstruction inspiratory

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20
Q

Wheeze is

A

Lower airway

Expiratory

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21
Q

causes of tonsillitis?

What is the treatment?

A

Viral, EBV, Strep-A

Penicillin for 10 days in strep A

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22
Q

What is Scarlet fever?

A

• GAS bacteria
• Fever => Tonsillitis, sand-paper rash, flushed cheeks with peri-oral
sparing, strawberry tongue.
• TX: penicillin V
• Complications: Glomerulonephritis and rarely RF

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23
Q

causes of acute

otitis media?

A

o Mostly viral (RSV, Rhino)

o Bacterial: Pneumococcus, non-typable H.Flu, Moraxella

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24
Q

complications of acute

otitis media?

A

Meningitis

Mastoiditis

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25
Q

treatment of acute

otitis media?

A

Regular analgesia, Amoxicillin if still unwell after 2 days

Antibiotics marginally shorten the duration of pain but does not prevent hearing loss

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26
Q

What is Glue ear?

What is the treatment?

A

A cause of hearing loss and subsequent speech and language delay.
OM with effusion => Conductive hearing loss on audiometry (after 4
years), dull retracted TM on tympanometry.

TX: Grommets, adenoidectomy

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27
Q

indications for Tonsillectomy?

A

Severe recurrent OM

Peri-tonsillar abscess (quinsy)

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28
Q

indications for Adenotonsillectomy?

A

OME => hearing loss

OSA (Absolute indication)

29
Q

child with
stridor
DDX

A 
o Croup
o Acute epiglottitis 
o Bacterial Tracheitis
o Inhaled foreign body
o Anaphylaxis
o Recurrent/ chronic (Laryngomalycia)
30
Q

child with

stridor Management

A

o O2
o Nebulised steroids +/- Adrenaline +/- Call Anaesthesia.
o Observe SATS
o Do not examine the throat

31
Q

Acute epiglottitis

A

Hib, < 6 yrs, over hours, Toxic child with high
fever, muffled voice, soft whispering stridor and drooling.

Call for help (anaesthesia, senior paediatrician, ENT
surgeon)
Intubate and transfer to ICU
Blood cultures
IV cefuroxime for 5 days
Rifampicin prophylaxis for contacts
32
Q

Croup

A

Parainfleunza virus, 2nd year, over days.
Croyza =>
severe parking cough, hoarse voice, harsh rasping stridor.
Nebulised steroids, warm moist air, observe

33
Q

What is bacterial Tracheitis (Pseudomembranous croup)?

A

Just like epiglottitis

Caused by staph

34
Q

bronchiolitis cause

A

RSV in 80% of cases

35
Q

bronchiolitis features

A

Dry wheezy cough + Resp distress

36
Q

bronchiolitis investigations

A

Oximetry, ABG, CXR

37
Q

bronchiolitis Mgt steps

A

humidified O2 from head box + monitor for apnoea+/- fluids (NG or
IV).
Admission criteria: Apnoea, Sats <90, PO intake < 75%, severe resp
distress.

38
Q

What is bronchiolitis obliterans?

A

Recurrent cough and wheeze, if caused by

adenovirus

39
Q

prevention of bronchiolitis?

A

Palivizumab to high risk PREMS (NNT= 17)

40
Q

DDX of acute respiratory distress in infants?

A
  • Bronchiolitis
  • Viral wheeze
  • Pneumonia
  • HF
  • Foreign body
  • Anaphylaxis
41
Q

DDX of wheeze?

A
  • Viral episodic
  • Multiple trigger
  • Asthma
  • CF
  • Chronic aspiration
  • Recurrent anaphylaxis
42
Q

Chronic Asthma Sx

A 
Cough, wheeze, breathlessness, chest tightness
o Episodic
o Non-viral riggers
o Diurnal (worse at morning and night)
o Response to bronchodilators
43
Q

Chronic Asthma signs

A

o Polyphonic expiratory wheeze
o Harrison sulcus (chronic airway obstruction)
o Atopy

44
Q

Chronic Asthma investigations

A

o Spirometry
o Serial Peak flow
o Skin prick

45
Q

Chronic Asthma tx steps 1-5

A

1: SABA PRN
2: + inhaled steroids (200-400) (from now on can use LTRA)
3: + LABA, up steroids (800) (From now on can use SR
theophylline)
4: Up steroids (1600)+ carry steroid card, refer if < 5 yrs.
5: + PO steroids

46
Q

Acute asthma assessment

A

A

A: Appearance and awareness:
o Normal consciousness => Not life-threatening
o Can speak => Not severe

47
Q

Acute asthma management Moderate

A

o Inhaled salbutamol (up to 10 puffs)

o PO prednisolone (1-2 mg/g, up to 40)

48
Q

Acute asthma assessment

B

A

B: Breathing/ Beak flow
o RR: Poor guide
o Recessions: Intercostal => Accessory muscles => poor effort
(life-threatening)
o Auscultation => Wheeze => silent (life threatening)
o BF: > 50, < 50, < 33

49
Q

Acute asthma assessment C

A

C: Circulation/ colour
o Tachycardia: better than tachypnea, affected by B agonists.
o Hypotension-Arrhythmia: Life-threatening.
o Cyanosis: life-threatening.
o Sats (< 92% = severe or life-threatening).

50
Q

Acute asthma management Severe and life threatening:

A

o High flow O2
o Nebulised Salbutamol/ Ipratropium
o Steroids: IV hydrocortisone

51
Q

Acute asthma management

If no response:

A

Consider (IV SABA, MgSo4, theophylline)

ICU, intubation and mechanical ventilation, CXR, ABG

52
Q

Acute asthma management

If response:

A

TX for 4 hrs
Discharge on steroids (1 week)
Review meds, technique,
F/U

53
Q

Acute asthma management

If response:

A

TX for 4 hrs
Discharge on steroids (1 week)
Review meds, technique,
F/U

54
Q

different types of inhalers and how do you choose them?

A

MDI (with spacer for all children)+ face mask if < 2
Powder inhaler
Breath actuated MDI (simpler)
Nebuliser (if O2 needed, at home in brittle asthma)

55
Q

Bordetella pertussis
PC
Dx

A

Paroxysmal cough + inspiratory whoop or apnoea => Vomiting

Culture from pre-nasal swap, blood film (lymphocytosis)

56
Q

What is persistent cough? What is the DDX?

A

Cough lasting > 8 weeks or not improving > 4 weeks

Recurrent URTI
Certain infections RSV, pertussis, mycoplasma, TB), asthma,
CF,
inhaled foreign body, bacterial bronchitis, Aspiration (reflux),
habit cough

57
Q

pneumonia causes

A

Strep-B => RSV => Pneumococcus.

58
Q

pneumonia Sx

A

URTI => Cough, fever, anorexia, lethargy, unwell, localised
chest or abdominal pain, or neck stiffness (peritoneal irritation,
bacterial)

59
Q

pneumonia Signs

A

Tachypnea (the most sensitive sign), Nasal flaring, chest indrawing, crackles

Classical (rare): Bronchial breathing, dullness, decreased breath
sounds and sats.

60
Q

pneumonia INVXL

A

CXR, bloods, Nasopharyngeal aspirate, Oximetry

61
Q

pneumonia Mgt:

A

o Admit if (grunting, recurrent apnoea, sats < 92%, inability to
maintain PO intake)
o O2, IV fluids, analgesia, Amoxicillin.
o If fever persists despite 2 days of antibiotics => suspect pleural
collection (CXR: blunting of the costovertebral angle) => US
guided drainage and fibrinolysis.
o No follow-up unless there is lobar collapse or atelectasis (CXR in 1 month).

62
Q

Cystic fibrosis Pathophysiology = Thick secretions

Genetics:

A

Class 2 mutation; Change in F508; defective CFTR folding;
never makes it to surface. Lumicaftor (increases number that makes it to surface).
Class 3 and 4: defective function, G551D, use potentiator (Ivacaftor)

63
Q

possible clinical examination findings in CF patients?

A 
o Chest hyperinflation
o Harrison’s sulcus
o Coarse inspiratory crepitation
o Expiratory wheeze
o Chest infection
o Clubbing
64
Q

What is PCD, Kartagners syndrome?

A

o Recurrent chest infections => Bronchiectasis
o Chronic Ear infections
o CE: Situs inversus.
o DX: cilia examination from nasal brush
o TX: Chest physio, ENT follow-up and antibiotics

65
Q

What are the indications of tracheostomy in children?

A 
o Narrow upper or lower airways
o Neuromuscular weakness
o Need for long-term
o Weaning of
o Airway protection
66
Q

sleep disordered breathing causes:

A 
o Adenotonsillar hypertrophy
o Severe obesity
o Down syndrome
o Cerebral palsy
o DMD
67
Q

sleep disordered breathing Mgt:

A

o Night oximetry
o Sleep study
o Night CPAP
o Adenotonsillectomy

68
Q

sleep disordered breathing

Symptoms:

A 
o Loud snoring
o Witnessed apnoea
o Sleep disturbance and restlessness
o Day-time sleepiness or hyperactivity
o Learning and behavioural problems
o Faltering growth
69
Q

What are the methods and indications of long-term ventilation?

A

BiPAP
CPAP via facemask or nasal mask
tracheostomy

Indications: BPD, NMD

X My Sunflower summary (6 decks)

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