Quesmed Flashcards
What is impetigo caused by?
Staph aureus
Strep pyogenes
How does impetigo present?
golden, crusted skin lesions usually around the mouth and nose.
Localied to face impetigo management?
Topical fusidic acid
What is kawasaki disease?
Medium-vessel vasculitis, but the exact mechanisms and triggers are poorly understood.
Criteria for diagnosis of Kawasaki disease include fever for >5 days, and 4/5 of the ‘CREAM’ features:
Conjunctivitis
Rash
Edema/Erythema of hands and feet
Adenopathy (cervical, commonly unilateral)
Mucosal involvement (strawberry tongue, oral fissures etc)
Complication of Kawasaki disease?
Kawasaki disease is rare, but potentially fatal from the complication of coronary artery aneurysms, so it is crucial to perform an echocardiogram to screen for this.
Management of Kawasaki disease?
Treatment of Kawasaki disease is with aspirin and intravenous immunoglobulin (IV Ig). Aspirin is usually avoided in children due to the risk of Reyes syndrome (liver and brain damage).
What is coeliac disease?q
Coeliac disease is an autoimmune condition in which the immune system reacts to protein component of gluten (gliadin) and attacks the small bowel.
Presentation of coeliac disease?
Damage to the small bowel causes malabsorption, resulting in copious loose foul-smelling stool which distends the abdomen. Poor absorption through destroyed villi in the small bowel also leads to weight loss, muscle wasting, abdominal pain and failure to thrive.
Gold standard for diagnosis of coeliac disease?
small bowel biopsy.
Immune destruction of small bowel villi leads to diagnostic biopsy findings of:
Villous atrophy (as enterocytes forming the tips of villi are destroyed) Crypt hyperplasia (basal cells rapidly divide to try to compensate for distal villi cell destruction) Increased epithelial lymphocytes.
Serological markers for coeliac disease include:
Anti-tissue transglutaminase
Anti-endomysial autoantibodies
Antigliadin autoantibodies
Management of coeliac disease
diet excluding gluten, which is in wheat, rye, barley and some oats (oats themselves do not contain gluten, but are often contaminated with gluten during processing).
What is the defenition of pertussis?
severe URTI characterised by severe bouts of spasmodic coughing, which may lead to apnoea in infants, followed by characteristic gasping for breath.
Cause of whooping cough?
It is caused by bordetella pertussis and there has been a recent resurgence even in vaccinated countries due to lower vaccination uptake.
Symptoms seen in pertussis infection:
Cough Inspiratory whooping Rhinorrhoea Post-tussive vomiting Decreased food intake
Management of pertussis?
1st line treatment in children over 1 month of age is with azithromycin.
2nd line treatment in children over 1 month of age is with trimethoprim/sulfamethoxazole
Complications of pertussis?
Apnoea is a rare but life-threatening acute complication of pertussis
Pneumonia either due to bordetella pertusssis or secondary to another organism
Seizure triggered by cerebral hypoxia which can develop during severe cough paroxysms
Otitis media is the most common complication in pertussis and is often seen in the following few weeks
There are many factors in why children might become constipated:
Low fibre diet Dislike of using toilet Pain on passing stool Anal fissure Not recognising sensation of needing to pass stool
Diagnosis of chronic constipation?
Chronic constipation is diagnosed from history and palpation of impacted faeces (hard depressible masses) on abdominal examination. An abdominal ultrasound can also be helpful if the examination is not clear.
Management of chronic constipation?
Treatment of chronic constipation is with a movicol disimpaction regimen, followed by maintenance movicol, in tandem with a high fibre diet and parenting advice about encouraging good toilet habits.
What is hirchsprung’s disease?
As the baby develops in utero, the distal colon is not innervated correctly. The resulting aganglionic colon is shrunken and not able to distend properly. This causes a back pressure of stool trapped in the more proximal colon.
Hirschsprung’s disease can present at birth with:
a delay in passing meconium (>48 hours)
a distended abdomen
forceful evacuation of meconium after digital rectal examination
Hirchsprung’s disease diagnosis?
Rectal suction biopsy.
Management of Hirchsprung’s disease?
Definitive management of Hirschsprung’s disease is through removal of the section of aganglionic colon.
A 7 year old girl presents to the GP with her mother. Over the last 24 hours she has developed a rash all over her face and body, which is itchy. She has not eaten much and appeared very sleepy to her mother. She was previously well and is up to date with all scheduled immunisations. On examination she has a maculopapular vesicular rash, which blanches under pressure, with signs of excoriation over her face and whole body.
Diagnsosi?
Chicken pox
What is noctural enuresis?
Wetting the bed at night is extremely common in young children as they learn to gain voluntary control of the bladder sphincters. It is considered normal until the age of 5
Management of noctural enuresis?
Depends on underlying cause
children and parents should be counselled that bedwetting is very common, and that the child should not be blamed in any way.
Star charts are a useful initial conservative approach.
The first-line is generally a nocturesis alarm, which is a device that detects water in the underwear and activates an alarm. This alerts the child that they need to wake up and go to the bathroom. Alarms are generally very effective in training children.
Children over the age of 7 can trial DDAVP, synthetic ADH, if the alarm has failed or rapid control is needed. This drug increases water re-absorption and reduces urine production overnight.
Diagnosis of hydroceles?
confirmed with an ultrasound scan, which demonstrate simple fluid accumulated around the testicle.
Total daily fluid requirements in children:
1st 10kg of bodyweight at100ml/kg/day
2nd 10kg of bodyweight at 50ml/kg/day
Remaining bodyweight at 20ml/kg/day
Defenition of biliary atresia?
Rare condition where the bile ducts of an infant are progressively fibrosed and destroyed, leading to conjugated hyperbilirubinaemia, liver failure and death if not treated.
Biliary atresia presentation
Biliary atresia presents with prolonged jaundice (yellow skin and scleral icterus that persists beyond 14 days of life) with signs of biliary obstruction (dark urine and chalky white stool).
Diagnosis of biliary atresia
Investigations in biliary atresia will show a raised conjugated bilirubin and deranged liver function tests.
A hepatic scintigraphy (technetium-99) radioisotope scan will highlight the liver (takes up the isotope) but poor excretion into the bowel (as the bile ducts connecting the liver and the gut have been destroyed).
Abdominal ultrasound reveals echogenic fibrosis.
Definitive diagnosis of biliary atresia is confirmed with cholangiography, which will fail to show normal architecture of the biliary tree.
Management of biliary atresia
Management of biliary atresia is surgical. This involves a hepatoportoenterostomy (Kasai procedure), which creates a new pathway from the liver to the gut to bypass fibrosed ducts.
The newborn neonatal resuscitation pathway is as follows:
Birth
Dry baby and perform initial check- assess tone, breathing and heart rate
If gasping or not breathing- open airway, give five inflation breaths and consider oxygen and ECG monitoring
Reassess- look for improvement and response in heart rate and chest movement during inflation
If chest not moving- optimise airway control, repeat inflation breaths, give oxygen (if not given already), consider ECG monitoring (if not already doing so) and look for a response
If no increase in heart rate at this point, re-assess for chest movement and repeat above steps if necessary
When chest is moving- if heart rate <60 bpm, ventilate for 30 seconds
At this point, reassess heart rate- if heart rate still <60 bpm, commence chest compressions at a rate of 3:1
Continue this process, re-assessing every 30 seconds- if heart rate remains <60 bpm, consider venous or osseous access and administering drugs
Throughout process: Keep the parents updated, and keep a record of time and timings of interventions
Managemnet of croup?
The management can be remembered with the acronym ODA:
Oxygen (humidified)
Dexamethasone PO 0.15mcg/kg or budesonide neb 2mg
Adrenaline nebulised (5ml 1:5000)
Rubella in pregnancy complications
Rubella poses a serious risk to unvaccinated pregnant women. Congenital rubella infection (in the first 20 weeks of pregnancy) can cause cataracts, deafness, patent ductus arteriosus, brain damage.
What is roseola?
Roseola is a very common childhood infection that classically causes a few days of fever followed by a widespread rose-pink macular rash with surrounding pale white halos. The fevers can be high (40 degrees). Roseola is the most common trigger for febrile seizures
What are the causes of roseola?
Human herpes virus 6 is the pathogen responsible for roseola
What is Meconium ileus
condition where the baby’s first stool (meconium) is so thick and sticky that it causes intestinal obstruction.
The vast majority of meconium ileus (around 90%) is associated with cystic fibrosis, where the chloride channel mutation causes the mucous in the meconium to be excessively thic
Presentation of meconium ileus?
Delay in passing meconium (>48 hours until the baby’s first poo) and can present with signs of obstruction (bilious green vomiting).
Diagnosis of meconium ileus?
Diagnosed with abdominal X-ray, which shows characteristic findings of a ‘bubbly’ appearance of the intestines with a lack of air-fluid levels.
Management of meconium ileus?
managed with ‘drip and suck’ (stomach drainage with an NG ryles tube, and IV fluids), along with enemas to remove the sticky meconium. In severe cases, surgery may be necessary
Causes of jaundice in less than 24 hours after birth
Haemolytic disorders (Rh incompatibility, ABO incompatibility, G6PD, spherocytosis), Infection (TORCH Screen is indicated)
Causes of jaundice 24 hours- 14 days after brith
Physiological jaundice, breast milk jaundice, dehydration, infection, haemolysis, bruising, polycythaemia, Crigler-Najjar Syndrome
Causes of jaundice more than 14 days after birth
Physiological jaundice, breast milk jaundice, infection (esp UTI), hypothyroidism, G6PD, pyloric stenosis, bile obstruction (biliary atresia), neonatal hepatitis
What is potters syndrome
Describes the typical physical appearance caused by pressure in utero due to oligohydramnios, classically due to bilateral renal agenesis.
Facial signs of potters syndrome
Flattened ‘parrot-beaked’ nose
Recessed chin
Prominent epicanthal folds
Low-set, cartilage-deficient ears (known as ‘Potter’s ears’)
What is acute epiglottitis
rapidly progressive infection causing inflammation of the epiglottis (the flap that covers the trachea) and tissues around the epiglottis that may lead to abrupt blockage of the upper airway and death.
Presentation of acute epiglottisi
Most common in children aged 1-6 years (similar age group to Croup)
High fever, ill, toxic looking child (septicaemia)
Intensely painful throat preventing child from speaking or swallowing; saliva drools down the chin
Soft inspiratory stridor and rapidly increasing respiratory difficulty over hours
Child sits immobile, upright with open mouth to optimise airway
Cough minimal or absent
Presentation of osteosarcoma
Pain and swelling with a prolonged onset are characteristic.
Presentation of acute ototis media
Acute otitis mediia often follows an URTI with an acute onset of pain (hence, this is why the child is irritable and tugging on his ear). The fluid behind the eardrum will build up and may burst the ear drum causing a discharge and a sudden relief of pain.
The build-up of fluid behind the ear drum results in a conductive hearing loss (Rinne’s test).
Indications for abx in acute otitis media
Perforated eardrum
<2 years old and bilateral
Present for ≥4 days
<3 months old
When does hand dominance develop?
2 years old
Children less than 18 months shouldnt have hand dominance
Presentation of coeliac disease
Damage to the small bowel causes malabsorption, resulting in copious loose foul-smelling stool which distends the abdomen. Poor absorption through destroyed villi in the small bowel also leads to weight loss, muscle wasting, abdominal pain and failure to thrive.
What human herpes virus is chickenpox?
Human herpes virus 3
What is oppositional defiant disorder
paediatric psychiatric diagnosis in which children show persistent defiant and hostile behaviour towards figures of authority, like a parent or teacher. The behaviour is not significant enough to be a serious disability in social functioning, like the more serious diagnosis of conduct disorder.
What is transient synovitis?
Benign cause of limp in children from inflammation of the synovial lining of the hip joint.
What does coxsackie A cause
causes hand-foot-mouth disease (vesicles on the hands, feet and buccal mucosa, and fever).
What does coxsackie B cause
causes myocarditis.
What does polio cause
Polio is now eradicated in the western world. In unvaccinated individuals, polio most commonly is asymptomatic. About a quarter of people develop relatively mild symptoms of an upper respiratory tract infection, diarrhoea and vomiting. In 1% of infections, the virus affects the CNS which leads to paralysis. If severe and involving the diaphragm, children require ventilatory support (you may have seen pictures of ‘iron lungs’ used for respiratory support in the 1950s). Paralysis may persist if anterior horn cells are completely destroyed, leading to muscle wasting.
What does echovirus cause
aseptic meningitis and a febrile illness in children.
What is a reflex anoxic seizure
common benign cause of seizure in children from a temporary lack of blood flow to the brain.
What is west syndrome
Infantile spasms (West syndrome) is a form of epilepsy which starts around age 4-8 months.
Presentation of West syndrome
In West syndrome, children have seizures with myoclonic jerking, referred to as ‘jack knife’ spasms that occur in clusters.
Diagnosis of west syndrome
Infantile spasms are diagnosed by the history and by characteristic EEG findings of hypsarrhythmia.
Presentation of tetralogy of fallot
commonly diagnosed antenatally, or on detection of a murmur in the first few months of life. Babies can present with tet spells, which are acute episodes of cyanosis. During a tet spell, pulmonary stenosis causes a right-to-left shunt of deoxygenated blood across the ventricular septal defect. This results in hypoxia, causing pain (inconsolable crying) and cyanosis
Management of tet spells
managed with analgesia and supplemental oxygen. A last line medication is a vasoconstrictive agent (e.g. phenylephrine). Vasoconstriction will help to increase systemic vascular resistance, reducing the right-to-left shunt and improving cyanosis.
JIA presentation
initially presents with systemic signs of high fevers, malaise and a characteristic salmon pink rash. This is followed by joint pain in one or multiple joints.
Management of Kawasaki disease
Treatment of Kawasaki disease is with aspirin and intravenous immunoglobulin (IV Ig). Aspirin is usually avoided in children due to the risk of Reyes syndrome (liver and brain damage)
Presentation of foetal alcohol syndrome
functional or structural nervous system abnormalities e.g. decreased cranial size, structural brain abnormalities, abnormal neurological signs
growth impairment e.g. low birth weight, decelerating weight over time
specific facial abnormalities (e.g. short palpebral fissures, smooth philtrum and thin upper lip)
How is biliary atresia definitevly diagnosed
Cholangiography
5 components to APGAR score
Appearance, Pulse, Grimace, Activity, Respiration.
Incubation period of chicken pox
21 days
What is transient synovitis
benign cause of limp in children from inflammation of the synovial lining of the hip joint.
What distinguishes between transient synovitis and septic arthritis
Fever > 38.5ºC
Refusal to weight bear on affected side
Raised Inflammatory markers: ESR > 40; CRP > 20
Raised White Cell Count > 12000 cells/mm^3
Presentation of osteosarcoma
Pain and swelling with a prolonged onset are characteristic.
WHat is necrotising enterocolitis?
condition in which the bowel of premature infants becomes ischaemic and infected.
How does necrotising enterocolitis present
presents with vomiting (which may be bile streaked) and rectal bleeding (fresh blood in stool).
Management of necrotising enterocolitis
managed with broad-spectrum antibiotics (to cover both anaerobic and aerobic bacteria) and parenteral nutrition (to rest the bowel). Supportive treatment with IV fluids and ventilation are also crucial. Surgery to resect necrotic sections of bowel may be necessary, and is essential in cases of bowel perforation.
What causes bronchioloitis obliterans
Adenovirus
