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
Presentation of turners
Short stature Lymphoedema of hands and feet in neonate, may persist Spoon-shaped nails Webbed neck Widely space nipples Wide carrying angle Congenital heart defects - coarctation of the aorta Delayed puberty Ovarian dysgenesis causing infertility Hypothyroidism Recurrent otitis media Normal intellect
What is roseola
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.
How is pyloric stenosis diagnosed
Pyloric stenosis is definitively diagnosed with an abdominal ultrasound to visualise the hypertrophic sphincter.
Management of pyloric stenosis
surgical with a pyloromyotomy to cut the pyloric sphincter to widen the outlet.
Most likely pathogen in croup
Parainfluenza virus
What vitamins are deficient in CF
poor fat absorption also contributes to deficiency of fat-soluble vitamins (A, D, and K)
Management of RDS
Intratracheal instillation of artificial surfactant.
Additionally, if preterm delivery is suspected, giving the mother glucocorticoids before delivery can increase surfactant production in the baby. Glucocorticoids bind to nuclear steroid receptors to trigger surfactant synthesis.
What is Henoch-schonlein purpura
Most common small vessel vasculitis in children. It most commonly affects children aged 3-5.
Causes of henoch schonlein purpura
commonly preceded by a viral upper respiratory tract infection.
Presentation of henoch schonlein purpura
presents with purpura or petechiae on the lower limbs and abdominal pain, arthralgia, and nephritis (haematuria +/- proteinuria), due to immunoglobulin deposition in the gut, joints and kidneys respectively.
Management of henoch schonlein purpura
admitted for supportive management if their symptoms are severe or they are unable to tolerate sufficient oral fluids. NSAIDs are used for pain relief. Steroids are not used routinely, but can be used if pain does not respond to NSAIDs.
Managament of constipation in children
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.
Why can coarctation of the aorta cause cerebral aneurysms
Reduced perfusion pressures distal to stenosis trigger the renin-angiotensin-aldosterone system with limited effect as this won’t overcome the stenosis. It however will increase perfusion pressures before the stenosis, including the carotids, resulting in higher cerebral perfusion pressures which can cause aneurysms to form
Which of the following is the rate at which chest compressions should be given in a newly born
3:1
What is status epilepticus
life-threatening neurological condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness.
Management of status epilepticus
Supportive care + oxygen + check glucose Buccal midazolam or IV lorazepam IV lorazepam IV Phenytoin and/or IV phenobarbitone Rapid sequence induction with sodium thiopentone in coordination with anaesthetics or intensive care
Aetiology of early onset sepsis
Ascending microorganisms from cervix:
Group B streptococcus
Commonly colonises the genital tract of mothers and may be cleared normally by the mother.
Can cause asymptomatic bacteriuria or UTI in the mother
There is no routine screening for GBS.
Treat with IV benzylpenicillin intrapartum if: previous baby infected with GBS, maternal fever, positive swab/bacteriuria at any point in the pregnancy
Trans-placental:
Listeria, Toxoplasma, Rubella, CMV
The parents of several young children with congenital heart defects are being taught paediatric basic life support.
To what depth should the parents be advised to aim for when performing chest compressions?
One third of the chest depth
What is the double bubble sign on radiography a feature of
Duodenal atresia
Gold standard diagnosis for muscular dystrophy
Muscle biopsy
Gold standard for diagnosis of coeliac
Small bowel biopsy
Diagnosis of EBV
usually made clinically, although a heterophile antibody ‘Paul Bunnell’ test will be positive if performed.
What can an acute EBV infection cause
Hepatomegaly and splenomegaly
How is DDH diagnosed after screening
If DDH is clinically suspected, a hip ultrasound should be ordered.
Management of testicular torsion
Management involves expedited surgical exploration with fixation of the testicles with orchidoplexy.
Management of a hydrocele
Most hydroceles will spontaneously resolve by 12 months. Therefore, management includes observation initially and then surgical correction if they have not resolved by 1 year. This is because there is a significantly increased risk of an indirect inguinal hernia.
Most common cause of croup
Parainfluenza B
Most common cause of epiglottitis
Haemophilus influenza B
What is caput succedaneum
occurs in the newborn as a result of the pressure of the top of the infant’s skull against the dilating cervix during labour. It manifests as a subcutaneous serosanguineous fluid collection superficial to the skull. It does not usually require any treatment and resolves spontaneously over a few days.
What is duodenal atresia
congenital malformation in which the duodenum does not recanalise and so is not patent. This obstruction causes bilious vomiting.
Additionally, it may be associated with polyhydramnios, because the baby cannot ingest amniotic fluid properly and so the volume of amniotic fluid builds up.
Duodenal atresia is associated with:
Approximately 25% of cases are associated with Downs syndrome (trisomy 21)
Annular pancreas
Other intestinal atresias
VACTERL association
Management of duodenal atresia
Duodenal atresia must be repaired surgically. Duodenoduodenostomy involves reconnecting the closed proximal and distal segments of the duodenum in order to relieve the obstruction.
How does hand, foot and mouth disease present
presents with blisters on the hands and feet and ulcerations on the tongue and a fever. The rash usually presents in the context of another illness, usually the common cold.
What is a morbilliform eruption
characterised by a generalised maculopapular rash. This child presented with lymphadenopathy, fever, abdominal pain and sore throat most likely as a result of infectious mononucleosis, not bacterial tonsillitis. Morbilliform reactions are extremely common in patients with infectious mononucleosis taking Amoxicillin.
In adults, Parvovirus B19 presents with what
Arthralgias
Which of the following routinely tested for substances is raised in physiological jaundice?
Unconjugated bilirubin
What is reye’s syndrome
Poorly understood condition that results from aspirin treatment of viral infections in children.
Presnetation of reye’s syndrome
Abnormal liver function tests, vomiting and encephalopathy (slurred speech, lethargy, coma and potentially death).
Presentation of Ewing’s sarcome
Bone pain particularly occurring at night
A mass or swelling
Restricted movement in a joint
Management of Ewing’s sarcoma
Referral to a specialist centre
Neo-adjuvant chemotherapy: vincristine, ifosfamide, doxorubicin and etoposide (VIDE) is a common combination
Surgery: may involve limb sparing surgery with a bone graft and reconstruction or a partial/complete amputation
Adjuvant chemotherapy or radiotherapy
What is VSD
birth defect of the heart in which there is a hole in the wall (septum) that separates the two lower chambers (ventricles) of the heart.
Presentation of VSD
may be asymptomatic if they are small, and may simply be noted on routine scans. Large VSDs present with shortness of breath on exertion (for example, whilst breastfeeding in infancy). As the work of breathing is greatly increased, there might be poor weight gain as energy is diverted to breathing instead of growing.
Drugs that may prolong the QT interval include:
Macrolides Quinolones Tricyclics Antipsychotics Ondansetron Metoclopramide Amiodarone Quinidine Sotalol
Presentation of ALL in children
Any children presenting in GP with bruising, enlarged lymph nodes and systemic illness should be referred for specialist assessment.
Lymphadenopathy is the most common sign in ALL.
Other symptoms which may be present include: hepatosplenomegaly, pallor or petechiae, fever, fatigue, dizziness, weakness, and epistaxis.
Classic presentation of measles
Development of a fever above 40 degrees
Coryzal symptoms
Conjunctivitis followed by a rash about 2-5 days after onset of symptoms
Koplik spots are small grey discolourations of the mucosal membranes in the mouth and appear 1-3 days after symptoms begin during the prodrome phase of infection. They are pathognomonic for measles infection.
What is silent chest
occurs because of bronchoconstriction so severe that there is not enough air movement to produce even an audible wheeze
What happens to salt in bronchioloitis
Hyponatraemia is commonly seen as a complication in bronchiolitis caused by respiratory syncytial virus (RSV).
What is henoch schonlein purpura
most common small vessel vasculitis in children. It most commonly affects children aged 3-5.
How does henoch schonlein purpura preset
Purpura or petechiae on the lower limbs and abdominal pain, arthralgia, and nephritis (haematuria +/- proteinuria), due to immunoglobulin deposition in the gut, joints and kidneys respectively.
Mnaagement of henoch schonlein purpura
Supportive management if their symptoms are severe or they are unable to tolerate sufficient oral fluids. NSAIDs are used for pain relief. Steroids are not used routinely, but can be used if pain does not respond to NSAIDs.
How does measles present in children
presents with a characteristic erythematous, blanching maculopapular rash all over the body, preceded by a fever, cough, runny nose or conjunctivitis and grey spots (Koplik’s spots) inside the cheeks
Immune thrombocytopienia purpura
Autoimmune disease of unknown cause where the number of circulating platelets is reduced.
Follows on from viral infection
Management of immune thronbocytopienia purura
Platelet transfusions should be avoided in the absence of life-threatening bleeding. Steroids are used in persistent cases, and splenectomy may be considered in refractory cases.
X ray findings of osteosarcoma
new bony growth and a periosteal reaction causing a sunburnt appearance are typical of osteosarcoma.
What is genomic imprinting
where gene expression is influenced by whether the gene was inherited from the mother or father.
What is biliary atresia
paediatric condition where the bile ducts become progressively fibrosed and obliterated, which obstructs the flow of bile and presents as cholestasis in the first few weeks of life.
Risk factors for sepsis include:
Age less than 1 year
Impaired immune function (e.g. diabetes, splenectomy, immunosuppressant medication, cancer treatment)
Recent surgery in the last six weeks
Breach of skin integrity (burns/cuts/skin infections)
Presence of an indwelling catheter or line
Presentation of measles
Development of a fever above 40 degrees
Coryzal symptoms
Conjunctivitis followed by a rash about 2-5 days after onset of symptoms
Koplik spots are small grey discolourations of the mucosal membranes in the mouth and appear 1-3 days after symptoms begin during the prodrome phase of infection. They are pathognomonic for measles infection.
What is necrotising enterocolitis
condition in which the bowel of premature infants becomes ischaemic and infected.
Presentation of necrotitisng enterocolitis
presents with vomiting (which may be bile streaked) and rectal bleeding (fresh blood in stool)
Wbat is a strangulated hernia
hernia that is cutting off the blood supply to the intestines and tissues in the abdomen.
How do strangulated hernias present
Strangulated hernias present with abdominal pain and vomiting
Hernias can have an intermittent history of pain as the hernias are still reducible. Strangulated hernias are problematic as the blood supply to the part of the bowel that forms the hernia is blocked. The bowel that forms the hernia becomes ischaemic and necrotic. This can lead to sepsis.
How is Ladd’s operation performed
performed, either open or laparoscopically, by untwisting the midgut volvulus, fixing the malrotated bowel in the correct location, removing Ladd’s bands (congenital adhesions) and performing an appendicectomy.
Contraindication to vaccine when immunosuppressed
children with immunosuppression (e.g. from confirmed severe primary immunodeficiencies, chemotherapy or other immunosuppressive medications, or radiotherapy) should not receive live attenuated vaccines, such as the MMR vaccine, inhaled influenza vaccine or the varicella vaccine.
What is malrotation
rare but extremely important diagnosis to make. In malrotation, early in development the midgut rotates and fixates in an abnormal position. This abnormal position makes the bowel more prone to volvulus (twisting around the mesentery) and compression of the duodenum by peritoneal bands (called Ladd bands).
What is congenital hypothyroidism
partial or complete loss of function of the thyroid gland (hypothyroidism) that affects infants from birth (congenital).
Most common cause of congenital hypothyroidism
most common cause of congenital hypothyroidism is a failure in thyroid development or migration.
Globally, the most common cause of congenital hypothyroidism is iodine deficiency. However, this is extremely rare in the UK.
How does congenital hypothyroidism present
presents with an enlarged tongue (macroglossia), constipation, hypotonia, jaundice, poor feeding and poor brain development.
Presentation of measles
characteristic erythematous, blanching maculopapular rash all over the body, preceded by a fever, cough, runny nose or conjunctivitis and grey spots (Koplik’s spots) inside the cheeks.
Presentation of benign rolandic seizures
children characteristically have a tonic seizure overnight. This might be noticed by the parents if the child makes noises, or the child falls out of bed. They might also go unrecognised, but parents note that they find the child sleeping on the floor or with messy bedsheets in the morning.
What can infection of parvovirus in first half of pregnancy cause
severe foetal anaemia that can precipitate hydrops foetalis and subsequent miscarriage
Where is a VSD heard loudest
Lower left sternal edge
What is a VSD
birth defect of the heart in which there is a hole in the wall (septum) that separates the two lower chambers (ventricles) of the heart.
Presentation of VSD
may be asymptomatic if they are small, and may simply be noted on routine scans. Large VSDs present with shortness of breath on exertion (for example, whilst breastfeeding in infancy). As the work of breathing is greatly increased, there might be poor weight gain as energy is diverted to breathing in1stead of growing.
What is Hirschsprung disease
Caused by an absence of ganglion cells in the myenteric and submucosal plexuses. It typically occurs in the rectosigmoid. Diagnosis is through rectal suction biopsy. Management is surgical, with removal of the aganglionic segment.
Fragile X syndrome presents with features including:
A long face Extra large testicles Jaw and ears Social anxiety Autistic spectrum features
What is fragile X syndrome
genetic disease caused by a trinucleotide repeat in the FMR1 (familial mental retardation 1) gene. Fragile X syndrome is the most common inherited cause of learning disabilities.
What is oesophageal atresia
describes a blind-ending oesophagus. It is more common in trisomies – Downs/Pataus/Edwards
Scarlet fever presents with a course red rash and other non-specific symptoms such as
Sore throat
Headache
Fever.
What organism is acute epiglottitis caused by?
Haemophilus influenza B
which anatomical anomaly determines the extent of cyanosis in Tetralogy of Fallot (TOF)?
Pulmonary stenosis
What is mesenteric adenitis
Presents with a history of diffuse abdominal pain in the context of a previous upper respiratory tract infection. There may be a low-grade fever with generalized abdominal tenderness. Examination of the mouth may reveal pharyngitis. Children usually present being quite well with no alteration in appetite. US abdomen will show enlarged mesenteric lymph nodes with a normal appendix. Importantly, the appendix may not always be visualized on US abdomen, so clinical presentation must be taken into account when ruling out appendicitis.
WHat is pierre robin sequence
genetic condition in which an infant is born with micrognathia (small jaw), glossoptysis (posterior tongue) and often cleft palate. As a result the infant may have breathing or feeding difficulties shortly after birth. It is associated with cleft palate.
What is retinopathy of prematurity
ause of visual impairment in premature babies.
The mechanism of retinopathy of prematurity is thought to involve free radicals. Supplemental oxygen therapy creates free radicals which damage the retina and trigger proliferation of blood vessels on the retina. This can lead to retinal fibrosis, retinal detachment and ultimately blindness.
Babies born at less than 32 weeks gestation or less than 1.5kg birth weight should be screened for retinopathy of prematurity with fortnightly fundoscopy by an ophthalmologist.
What is the treatment of retinopathy of prematuirty
firstly through prevention by careful administration of supplemental oxygen, and with laser therapy.
Presentation of all
Lymphadenopathy is the most common sign in ALL.
Other symptoms which may be present include: hepatosplenomegaly, pallor or petechiae, fever, fatigue, dizziness, weakness, and epistaxis
Treatment of transient synovitis
Treated using NSAIDs and bedrest for up to 6 weeks.
What is eisenmenger syndrome
describes the reversal of a left-to-right shunt (patent ductus arteriosus, atrial septal defect, or ventricular septal defect) to a right-to-left shunt.
General red flags of vomiting
With vomiting in children, there are several general and specific red flags. General red flags indicate that a child is significantly dehydrated by vomiting, for example if the child is drowsy or floppy, has dry mucous membranes and sunken eyes
Specific red flags of vomiting may indicate a particular diagnosis:
Projectile vomiting around 6-8 weeks of age: pyloric stenosis
Bile-stained (green) vomit and abdominal distention: intestinal obstruction
Bloody stool with vomiting: Campylobacter/Salmonella gastroenteritis, intussusception
Paroxysmal coughing to the point of vomiting: whooping cough
Seizures/bulging fontanelle with vomiting: raised intracranial pressure
What is tuberous sclerosis
autosomal-dominant, neurocutaneous, multi-system disorder characterised by cellular hyperplasia, tissue dysplasia, and multiple organ hamartomas.
What is bacterial tracheitis
rare but dangerous condition that is similar to viral croup but the child has a high fever and has rapidly progressive airway obstruction with copious thick airway secretions
What is hypoxic ischemic encephalopathy
term for brain damage resulting from ante- or perinatal hypoxia.
Management of hypoxic ischemic encephalopathy
Management of HIE depends on presentation, and includes respiratory support, anticonvulsant therapy, and careful fluid balance, electrolyte monitoring and inotropes. Cooling the baby to induce mild hypothermia can also prevent further damage by secondary reperfusion injury.
What is Wilm’s tumour
most common abdominal tumour in children.
Presentation of Wilm’s tumour
Abdominal mass that doesn’t cross the midline (but may be bilateral in up to 5% of cases)
Abdominal distension
Haematuria
Normally otherwise asymptomatic unless tumour has grown so large that it is causing pain or infiltrating/disrupting other abdominal structures
What is transient tachyponea of the newborn
parenchymal lung disorder characterised by pulmonary oedema resulting from delayed resorption and clearance of foetal alveolar fluid
Why should aspirin not be given to children under 12
Associated with Reye’s syndrome
What is Reye’s syndrome
acute liver failure and non-inflammatory hepatic encephalopathy which occurs in children under 12 who are given aspirin during the acute phase of a viral infection. Liver biopsies show microvesicular steatosis and venous collapse.
Treatment of Reye’s syndrome
supportive, and often requires ITU admission. Lactulose can be used to lower ammonia levels.
Who has parental responsibility
A mother always has parental responsibility
A father usually has parental responsibility if he is:
Married to the child’s mother
Listed on the birth certificate (for births after 2003, depending on which part of the UK the child was born in)
If the parents of a child are married when the child is born, or if they’ve jointly adopted a child, both have parental responsibility.
Married step parents and registered civil partners – have to obtain parental responsibility from the courts
How can you lose parental responsibility
Parental responsibility awarded by the courts can only be removed by the courts
Parental responsibility is not lost by divorce or separation
Parental responsibility is not lost even if the parent has no contact with the child
Parental responsibility is not lost even if there is no financial contribution
What is used to diagnoose Meckels’ diverticulum
A technetium scan, using radioactive metastable technetium-99, will highlight ectopic gastric mucosa in a symptomatic Meckels’ diverticulum. This is the commonest cause of per rectal bleeding in a child.
How does measles present
characteristic erythematous, blanching maculopapular rash all over the body, preceded by a fever, cough, runny nose or conjunctivitis and grey spots (Koplik’s spots) inside the cheeks.
How is vesicoureteric reflux diagnosed
diagnosed by a MCUG scan. MCUG is a diagnostic test to visualise the radioactive dye refluxing up into the ureters and/or kidneys.
Scarring of the kidneys is investigated using a DMSA test.
Sepsis screen in undr 3 months
include blood cultures, urine cultures and CSF cultures - as well as microbiological sampling from any other site relevant to that case which may be cause for infection.
Clinical features in infants of HF
Difficulty feeding Faltering growth Young children Exercise intolerance Abdominal pain and vomiting (especially upon exertion) Fatigue Poor appetite
In slapped cheek what does the sign of a rash indicate
The child is no longer infectious
What is a duodenal atresia
Congenital malformation in which the duodenum does not recanalise and so is not patent. This obstruction causes bilious vomiting.
Additionally, it may be associated with polyhydramnios, because the baby cannot ingest amniotic fluid properly and so the volume of amniotic fluid builds up.
Diagosis of duodenal atresia
diagnosed with a characteristic finding of a ‘double bubble’ on abdominal x-ray (one gas bubble visible in the stomach, and one gas bubble visible in the most proximal (patent) part of the duodenum prior to the atresia).
Management of duodenal atresia
repaired surgically. Duodenoduodenostomy involves reconnecting the closed proximal and distal segments of the duodenum in order to relieve the obstruction.
There is a 5% mortality risk associated with the initial repair.
When patient has meningococcal infection what should close contacts and household members get?
ciprofloxacin as prevention of spread of the disease. A suitable alternative would be rifampicin.
How can anaphylaxis sometimes occur?
As a bi-phasic reaction with second reaction occuring 4-6 hours after the inital one
First line SSRI in under 18s
Fluoxetine SSRI- Only drug of this class licensed for under 18s
Measles presentation
presents with a characteristic erythematous, blanching maculopapular rash all over the body, preceded by a fever, cough, runny nose or conjunctivitis and grey spots (Koplik’s spots) inside the cheeks.
Scarlet fever presentation
Sore throat
Headache
Fever.
What is scarlet fever caused by?
Streptococcal infection
What is Potters syndrome
describes the typical physical appearance caused by pressure in utero due to oligohydramnios, classically due to bilateral renal agenesis.
Measles management
The illness is self-limiting, but because of the possible complications, routine immunisation is encouraged. It is caused by the measles virus.
What are features o an innocent murmur
Localised with no radiation May vary with posture Soft systolic murmur with no diastolic component No heaves or thrills Asymptomatic No added sounds
How is definitive diagnosis of Hirschprung’s disease done
Take a biopsy at least 1.5 cm above the pectinate line
Management of intussusception
Rectal air insufflation or contrast enema (only to be performed if child is stable) Operative reduction indicated if – Failure of non-operative management Peritonitis or perforation is present Haemodynamically unstable
What is Ebsteins anomaly
Small RV and large RA
