Ques med Peads Flashcards
What is the most common cause of nephrotic syndrome in children?
-Minimal changes disease
-Roughly accounts for 70% of cases of nephrotic syndrome
What is minimal changes disease typically characterised by?
-oedema
-frothy urine (excess protein in urine)
-often follows a viral upper respiratory tract infection
-also causes fatigue and weight gain due to fluid retention
Why is it called minimal changes disease?
-it is marked by minimal or no changes visible under light microscopy, but more subtle changes can be detected using electron microscopy
What are the investigations that should be carried out in a patient with suspected minimal change disease?
-Urine: look for proteinuria, WBC and blood in urine
-Blood tests: low albumin and elevated cholesterol
-Kidney biopsy: only done when patients do not respond to initial treatment to confirm diagnosis
What is the management of minimal change disease?
-1st line: Corticosteroids: Prednisolone
-2nd line: Other immunosuppressants e.g. ciclosporin
How to manage oedema and prevent further complication in minimal change disease?
-Fluid restriction and reduced salt intake
-In severe cases with significant fluid overload: Administer albumin and furosemide
What is the definition of ITP?
-An autoimmune condition with a reduction of circulating platelets leading to easy purport, superficial bleeding into skin, mucotenesous bleeding.
What type of hypersensitivity reaction in ITP and what components are involved?
-It is a type II hypersensitivity reaction where by the spleen produces antibodies that are directed against the glycoprotein IIb/IIIa or ib-V-IX complex
What are the main clinical features of vitamin K deficiency?
Increased propensity to bruising and if severe enough, internal bleeding
Why are breastfed babies at a bigger risk of vit K deficiency?
Breast milk has lower levels of vitamin K compared to formula
Pathogen causing hand foot and mouth disease?
Coxsackie virus A16
Diagnosis of rubella?
serological testing, look for rubella specific IgM antibodies
What virus is rubella caused by?
Rubella tagovirus
What symptoms is rubella characterised by?
Fever, coryza, arthralgia, rash (begins on face and moves to trunk, spares the limbs) , lymphadenopathy (classically post-auricular)
How is rubella spread?
Through respiratory droplets
How is rubella managed?
-Supportive (analgesia and antipyretics)
-Isolate diagnose individual
What is the biggest risk of rubella?
Rubella poses a serious risk to unvaccinated pregnant=t women - causing congenital rubella syndrome, which can cause severe fatal abnormalities
What are fatal abnormalities that rubella can cause?
-Cataracts
-Deafness
-PAD
-Brian damage
What can be used to confirm glandular fever?
A heterophiles antibody “Paul Bunnell’
What is the tretament for bilary atresia?
Hepatoportoenterostomy (Kasai procedure): This surgery creates a new pathway from the liver to the gut to bypass the fibrosed bile ducts.
What investigation is used for measles?
Diagnosis is primarily achieved by measles-specific IgM and IgG serology, and measles RNA detection by PCR
What is hydrocele?
-A pathological accumulation of serous fluid in a sac-like cavity specifically around the testicle
-It typically presents as an enlarged scrotum
What is a nephroblastoma or wilms tumour?
-A malignant embryonic tumour originating from the developing kidney.
-It represents the most common abdominal tumour in paediatric patients
What are the features of a nephroblastoma?
Abdominal mass, abdominal distension, haematuria, and hypertension
At what age does a nephroblastoma present?
-5 years
-Peak incidence between 3-4 years
What are the signs and symptoms of nephroblastoma?
-A palpable abdominal mass that does not cross the midline, although it may be bilateral in up to 5% of cases.
-Abdominal distension
-Haematuria
-Hypertension
-Often asymptomatic unless the tumour grows sufficiently large to cause pain or disrupt other abdominal structures.
What is the management of nephroblastoma?
-Surgical resection
-Adjunctive chemo
-Prognosis - generally excellent 990% 5 years)
What are the investigations of a wilms tumour/nephroblastoma?
-CT scan of the chest, abdomen, and pelvis (spread disease)
-Definitive diagnosis and staging are confirmed via renal biopsy, which may reveal small round blue cells on histology. (This finding is not exclusive to nephroblastomas)
What is seen on USS for intussusception?
A classic ‘target’ sign on abdominal ultrasound is seen as concentric echogenic and hypogenic bands, demonstrating the invagination of a bowel segment into an adjacent one.
What enzyme deficiency is caused by congenital adrenal hyperplasia?
21-hydroxylase deficiency
What are the signs of Roseola?
-Initial fever lasting upto 5 days with high fevers reaching to 40
-As the fever subsides a blanching, rose-pink macular rash erupts, predominantly over the trunk but may also spread to the face and limbs
what is the first step in resuscitating a neonate?
The first step is to inflate the lungs by giving 5 breaths via a 250 ml bag-valve mask
What is used to stage for puberty?
Tanner staging
What is slapped cheek syndrome?
Erythema infectiosum
How does erythema infectiosum present?
-initial headache, fever, and cold-like symptoms
-Followed by a rash developing over the following few days; appearing bright red on the cheeks and more lacy in pattern over the rest of the body
What is Prader Willi syndrome?
-Genetic condition that is inherited by genomic imprinting
- A gene on chromosome 15 is imprinted such that the child only expresses the maternally inherited version of the gene
What are the key signs and symptoms of prader willi syndrome?
-Hypotonia and poor feeding in infancy
-Developmental delay in early childhood
-Learning disabilities
-Short stature
-Hyperphagia (excessive hunger) and resultant obesity in older childhood. Anecdotal reports suggest that children with Prader-Willi Syndrome may consume non-food items out of excessive hunger.
Fitting child - 2 doses of buccal Midazolam, what should be given next?
IV Leviteracetam, Phenytoin or Valproate
What virus is acute epiglottitis caused by?
Haemophilus influenza B (Hib)
Down’s syndrome heart abnormality?
-Eisenmenger syndrome - due to ventricular septal defect
-Reversal of L-R cardiac shunt to R-L due to pulmonary hypertension
What is amniotic fluid embolism?
Amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse
what is the triad of amniotic fluid embolism ?
coagulopathy, hypoxia and hypotension
Where is lidocaine injected?
Pudneal nerve - pudeneal nerve block
What is the regime for medical termiation of pregnancy?
-Oral mifepristone 200mg (antiprogesterone)
-Buccal, vaginal, sublingual misoprostol 800mg (prostaglandin analogue) 24-48 hours later
How to identify premature rupture of membranes?
Actim-PROM vaginal swab detects insulin-like growth factor binding protein-1 (IGFBP-1) in vaginal fluid
What causes inguinal hernia in childremn?
-Almost always indirect in children and are caused by failure of the processus vaginalis to obliterate
-More commin in boys and on the right
What is the first line investigation for asthma?
-Spirometry and BDR (bronchodilator reversibility)
-Positive result confirms presence of an obstructive airway pattern
Clinical findings in PDA?
Collapsing pulse
When does moro reflex disappear?
6 months
-spread out arms
-pulls arms
-starts crying
What is malrotation?
Abnormal development of the midgut during embryogenesis, which increases the bowel’s propensity for volvulus and duodenal compression by Ladd bands.
How does malrotation present?
Bilious vomiting on the first day of life
What is the gold standard for malrotation?
Upper GI contrast study
What is tuberous sclerosis?
An autosomal dominant neurocutaneous syndrome typified by cellular hyperplasia, tissue dysplasia, and hamartomas in multiple organs
What are the signs and symptoms of tuberous sclerosis?
-Neurological: Infantile spasms with hypsarrhythmia as seen on electroencephalogram; seizures/epilepsy
-Skin: Ash leaf macules; shagreen patches; facial angiofibromas; subungual fibromas
-Cognitive: Learning disabilities
-Renal: Angiomyolipomas
-Cardiac: Cardiac rhabdomyomas
What kind of reaction occurs when take amoxicillin with glandular fever?
Morbilliform Eruption
