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3A med mine > Selected Notes paeds 4 > Flashcards

Selected Notes paeds 4 Flashcards

1
Q

What kind of conjunctivitis doo you see in patients with Kawasaki?

A

Bilateral and non exudative

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2
Q

Why is aspiring usually contraindicated in children and when is it used as treatment?

A

Risk of Reye’s syndrome-Used as treatment of Kawaski’s

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3
Q

What kind of vurs is the measles morbillivirus?

A

Single stranded, enveloped RNA virus

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4
Q

When might the chicken pox rash leave scars?

A

If blisters have been scratched or infected

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5
Q

When is school exclusion recommended in patients with chicken pox?

A

In most infectious periods:1-2 days before rash and until all lesions have dried and crusted over (5 days post rash onset)

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6
Q

Who is most at risk from rubella?

A

Unvaccinated pregnant women due to risk of congenital rubella syndrome

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7
Q

When are rubella outbreaks most common?

A

In winter and spring

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8
Q

When are patient with rubella most infecitous?

A

From 7 days before symptoms start to 4 days after rash onset

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9
Q

Who does staphylococcal scalded skin syndrome mainly affect?

A

Mainly infants: those <5yrs Adults with renal insifficiency or immune compromi

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10
Q

When are children immunised against whooping cough?

A

2, 3, 4 months and 3-5 yearsPregnant women

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11
Q

Who should be admitted if presenting with suspected whooping cough?

A

Infants under 6 months

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12
Q

When should patients with whooping cough be kept off school?

A

Until 48 hours after commencing antibiotics OR 21 days from symptom onset if no antibiotics

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13
Q

When are pregnant women offered the whooping cough vaccine?

A

Women who are 16-32 weeks pregnant

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14
Q

When should children with slapped cheek suyndrome be excluded from school?

A

No exclusion necessary-no infectious once rash emerges

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15
Q

What might fifth disease cause in adults?

A

Acute arthritis

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16
Q

When are children with Fifth’s disease infectious?

A

3-5 days before rash onset

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17
Q

Why might parvovirus B19 result in an aplastic crisis?

A

Reduces erythropoiesis

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18
Q

What organisms commonly cause pneumonia in neonates?

A

Group B strep
Klebsiella
Staph aureus

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19
Q

What organisms commonly cause pneumonia in infants and young children?

A

Most common: RSV
S.pneumonia
Staph aureus
Also bordatella pertussis, chlamydia trachomatis

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20
Q

What organisms commonly cause pneumonia in children aged >5years?

A

Mycoplasma pneumonia
Strep pneumoniae
Chlamydia pneumoniae

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21
Q

What symptoms might point more towards a viral cause of pneumonia?

A

Wheeze
Hyperinflation

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22
Q

When should children with pneumonia be admitted to hospital

A

<ul><li>O2&lt;93%</li><li>Severe tachypnoea</li><li>Grunting</li><li>Not feeding</li></ul>

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23
Q

When should children with oneumonia be followed up?

A

<ul><li>At 4-6 weeks</li></ul>

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24
Q

What would you expected to find on spirometry in a patient with asthma?

A

<ul><li>FEV1 reduced</li><li>FVC normal</li><li>FEV1/FVC:&lt;70%</li></ul>

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25
Q

What should patients who have been hospitalised for an asthma attack be given on discharge?

A

<ul><li>Oral prednisolone for at least 3 days</li><li>Follow up and review of medication and inhaler technique</li><li>Trigger for attakc investigations</li></ul>

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26
Q

What might you see on a CXR of a patient with croup and why?

A

<ul><li>Steeple sign</li><li>Subglottic narrowing in severe or atypical cases</li></ul>

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27
Q

Whta is bacterial tracheitis?

A

<ul><li>Pseudomembranous croup</li><li>Similar to viral croup but caused by Staph aureus</li><li>Rare and a lot more dangerous</li></ul>

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28
Q

What is the treatment for bacterial tracheitis?

A

<ul><li>IV antibiotics</li><li>Intubation and ventilation if required</li></ul>

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29
Q

What might be seen on a CXR in a patient with bronchiolitis?

A

<ul><li>Hyperinflation of lungs</li><li>Flattening of diaphragm</li><li>Horizontal ribs</li><li>Increased hilar bronchial markings</li></ul>

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30
Q

When might bronchiolitis prophylaxis be given?

A

<ul><li>Children &lt;9 months with chronic lung disease/prematurity</li><li>Children &lt;2 years with severe immunodeficiency</li></ul>

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31
Q

What is the treatment for bronchiolitis obliterans?

A

<ul><li>Supportive</li><li>Immunosuppressive agents-&gt; cyclosporin, prednisone etc</li></ul>

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32
Q

What organism can cause chest infections in patients with cystic fibrosis?

A

<ul><li>Psuedomonas aeruginosa</li></ul>

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33
Q

What might be seen on an x ray in a patient with acute epiglottitis and why?

A

Lateral:<br></br><ul><li>Thumb sign</li><li>Epiglottis swelling</li><li><img></img><br></br></li></ul><div>Posterior-anterior:</div><div><ul><li>Steeple sign</li><li>Subglottic narrowing</li><li><img></img><br></br></li></ul></div>

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34
Q

What organism most commonly causes viral induced wheeze?

A

<ul><li>RSV/rhinovirus</li></ul>

<div><br></br></div>

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35
Q

What should you consider if you find a focal wheeze in a child and what should you do?

A

<ul><li>Focal wheeze-&gt; foca airway obstruction-&gt; inhaled foreign body/tumour-&gt; urgent senior review</li></ul>

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36
Q

Why are children most prone to otitis media?

A

<ul><li>Have narrower eustachian tube , more horizontal, less developed immune systems-&gt;easier for bacteria to colonise</li></ul>

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37
Q

What would be seen on otoscopy of a patient with otitis media?

A

<ul><li>Bulging tympanic membrane-&gt; loss of light reflex</li></ul>

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38
Q

What should be used if impetigo is likely caused by MRSA?

A

<ul><li>Topical mupirocin</li></ul>

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39
Q

When should patients with mpetigo be referred to secondary care?

A

<ul><li>Suspected complications</li><li>Immunocompromised and widespread infection</li></ul>

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40
Q

What is toxic shock syndrome?

A

<span>severe, life-threatening condition characterized by the sudden onset of shock, multi-organ failure, and rash.</span>

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41
Q

What organisms most commonly cause toxic shock syndrome?

A

<ul><li>Group A strep</li><li>S.aureus</li><li>MRSA</li></ul>

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42
Q

Why is clindamycin used in toxic shock syndrome?

A

<ul><li>Inhibits the produciton of superantigen</li></ul>

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43
Q

Whta condition is this rash likely to be seen in?<br></br><img></img>

A

Scarlet fever

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44
Q

Why is fetal circulation different?

A

Lungs don’t work so are bypassed and bloods need to get to placenta and back 

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45
Q

When might murmurs be further investigated in children?

A

<ul><li>Murmur louder than 2/6</li><li>Diastolic</li><li>Louder on standing</li><li>Symptomatic-&gt; failure to thrive, feeding difficulty, cyanosis or SOB</li></ul>

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46
Q

Where would a murmur caused by mitral regurgitation be heard the loudest?

A

5th intercostal space<br></br>Mid clavicular line

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47
Q

Where would a murmur caused by tricuspid regurgitaiton be heard the loudest?

A

5th IC<br></br>Left sternal border

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48
Q

Where would a murmur form a ventricular septal defect be heard loudest?

A

<ul><li>Left lower sternal border</li></ul>

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49
Q

Where would a murmur caused by aortic stenosis be heard the loudest?

A

2nd IC<br></br>Right sternal border

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50
Q

Where would a murmur caused by pulmonary stenosis be heard loudest?

A

2nd IC<br></br>Left sternal border

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51
Q

Where would a murmur caused by hypertophic obstructive cardiomyopathy be heard the loudest?

A

4th IC<br></br>Left sternal border

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52
Q

Within how many days does the ductus arteriosus close?

A

<ul><li>Stops functioning within 1-3 days of birth</li><li>Closes completely within first 2-3 weeks</li></ul>

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53
Q

What murmur is associated with a patent ductus arteriosus?

A

<ul><li>Continuous crescendo-descrescendo 'machinery' murmur that may continue during second ehart sound</li></ul>

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54
Q

Why are patients with atrial spetal defects more susceptible to strokes from DVTs?

A

<ul><li>Clot can travel from right atrium to left atrium across ASD-&gt; left ventricle-&gt; aorta0&gt; brain-&gt; large stroke</li></ul>

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55
Q

What murmur would you find in a patient with an ASD?

A

<ul><li>Mid-systolic crescendo-decrescendo murmur loudest at the upper left sternal border with a fixed split second heart sound</li></ul>

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56
Q

What might be the only indication of coarctation of the aorta in a neonate?

A

Weak femoral pulses

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57
Q

What kind of murmur is associated with coarctatin of the aorta?

A

<ul><li>Mid-systolic heard below the left clavicle and below the left scapula, maximal over the back</li></ul>

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58
Q

Why is prostaglandin E used for treatment of the coarctaiton of the aorta?

A

<ul><li>Keeps the ductus arteriosus open so blood is able to flow through into the systemic circulation distal to the coarctation</li></ul>

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59
Q

Where does the narrowing typically occur in coarctation of the aorta?

A

Just before the ductus arteriosus

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60
Q

What murmur is associated with a VSD?

A

Loud, harsh, pan-systolic murmur heard most in left lower sternal border in 3rd and 4th IC space<br></br>May be a systolic thrill on palpation

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61
Q

What part of the tetralogy of fallot determines the degree of severity of the cyanosis

A

<ul><li>Pulmonary stenossi</li></ul>

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62
Q

When is tetralogy of fallot most commonly diagnosed?

A

<ul><li>Antenatal scans</li><li>Newborn baby check</li><li>Heart failure symptoms</li></ul>

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63
Q

Why might a pehnylephrine infusion be used to treat a tet spell?

A

Increases systemic vascular resistance

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64
Q

Why might morphine be used to treat a tet spell?

A

Decreases respiratory drive resulting in more effective breathing

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65
Q

Why might beta blockers be used to treat a tet spell?

A

Relax right ventricle and improve flow to pulmonary vessels

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66
Q

Why might IV fluids be used to treat a tet spell?

A

Increases the pre-load, increasing the volume of blood flowing to the pulmonary vessels

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67
Q

What might be seen on a CXR in a patient with transposition of the great arteries

A

Egg-on-side appearance

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68
Q

When do patients with Ebstein’s anomaly typically present?

A

<ul><li>A few days post birth when the ductus arteriosus closes</li></ul>

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69
Q

What murmur is associated with congenital aortic valve stenosis

A

<ul><li>Crescendo decrescendo ejection systolic murmur</li><li>Heard loudest at 2nd IC, R sternal border</li><li>Radiates to carotids</li></ul>

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70
Q

What murmur is associated with congenital pulmonary valve stenosis

A

<ul><li>Ejection systolic murmur</li><li>Loudest at 2nd IC left sternal border</li></ul>

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71
Q

When might desmopressin be used as a treatment for nocturnal enuresis?

A

<ul><li>&gt;7 years and still struggling</li><li>Need rapid control e.g. child going to a sleep over may be offered a short term course</li></ul>

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72
Q

What is the typical triad of haemolytic uraemic syndrome?

A

<ul><li>AKI</li><li>Thrombocytopenia</li><li>Microangiopathic haemolytic anaemia</li></ul>

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73
Q

Which is more commmon: primary or secondary haemolytic uraemic syndrome

A

Secondary(AKA typical)

74
Q

What might be seen on an FBC in a patient with haemolytic uraemic syndrome?

A

Hg<8<br></br>Negative Coombs test<br></br>Thrombocytopenia<br></br>High platelets

75
Q

What might be seen on a blood film in a patient with haemolytic uraemic syndrome?

A

<ul><li>Fragmented blood film</li><li>Schistocytes</li><li>Helmet cells</li></ul>

76
Q

What might you see in the U&Es of a patient with haemolytic uraemic syndrome?

A

AKI<br></br><ul><li>High urea and creatinine</li></ul>

77
Q

What might you see on a stool culture in a patient with haemolytic uraemic syndrome?

A

Evidence of STEC infection: OCR for Shiga toxins

78
Q

What might be seen in a patient’s coagulation studies if they have suspected haemolytic uraemic syndrome?

A

Normal

79
Q

What might you do if a child is having atypical/recurrent UTI’s?

A

<ul><li>Consider further investigations or prophylaxis</li><li>Secindary care referral</li></ul>

80
Q

What is vesicoureteral reflux?

A

<ul><li>Urine flows backwards from bladder into ureters and potentially into the kidneys, sometimes resulting in recurrent UTI's</li></ul>

81
Q

What is Wilms’ tumour?

A

<ul><li>AKA nephroblastoma</li><li>Malignant embryonic tumour originating from the developing kidney</li></ul>

82
Q

What should be avoided in patient with phimosis/paraphimosis?

A

<ul><li>Forcible retraction</li><li>Can cause scarring</li></ul>

83
Q

What might suggest an atypical presentation of nephrotic syndrome

A

<ul><li>&lt;1 yrs</li><li>Poor response to steroids</li></ul>

84
Q

What would be seen on light microscopy in a patient with minimal change disease?

A

<ul><li>Nothing</li></ul>

85
Q

What would be seen on electron microscopy in a patient with minimal change disease?

A

<ul><li>Fusion of podocytes and effacement of foot processes</li></ul>

86
Q

What is used to treat patient with minimal change disease if they don’t respond well to steroids?

A

<ul><li>Cyclophosphamide/ciclosporin</li></ul>

87
Q

What would be seen on light microscopy in a patient with post strep glomerulonephritis?

A

Hypercellular glomeruli

88
Q

What would be seen on lectron microscopy in a patient with post strep glomerulonephritis

A

<ul><li>Subendothelial 'humps' (immune complex deposition)</li></ul>

89
Q

What would be seen on immunofluorescence in post strep glomerulonephritis

A

<ul><li>Starry sky appearance-IgG, IgM and C3 deposits along GBM and mesangium</li></ul>

90
Q

What might be tested in a patient with likely rapidly progressive GN?

A

ANCA

91
Q

What should be monitored in patients on testosterone therapy?

A

<ul><li>Polycythaemia(effect on erythropoeisis)</li><li>Changes in bone mineral density(DEXA scans)</li><li>Prostate status</li><li>LFTs: synthetic hormones can affect liver status</li></ul>

92
Q

What is Turner’s syndrome?

A

<ul><li>Condition only affects females and is caused by either only having one chromosome or a deletion of the short arm of one of the X chromosomes</li><li>45XO/45,X</li></ul>

<br></br>

93
Q

Will gonadotrophin levels be high or low in patients with Turner’s syndrome?

A

<ul><li>High-elevated</li></ul>

94
Q

What is the triple test(Down’s syndrome)?

A

<ul><li>14-20 weeks</li><li>B-HCG(higher)</li><li>AFP(lower)</li><li>Serum oestriol(lower)</li></ul>

95
Q

What si the quadruple test (Down’s syndrome)?

A

<ul><li>Same as triple test but also includes inhbin A(higher)</li></ul>

96
Q

What routine follow up investigations should be done for patients with Down’s syndrome?

A

<ul><li>Regular thryoid checks(2 yearly)</li><li>Echo to diagnose cardiac defects</li><li>Regular audiometry</li><li>Regular eye checks</li></ul>

97
Q

What is William’s syndrome?

A

<ul><li>Neurodevelopmental disorder caused by a microdeletion on chromosome 7</li><li>Usually random deletion rather than inherited</li></ul>

98
Q

What is transient synovitis?

A

<ul><li>Self-limiting condition characterised by the temporary inflammation of the synovial lining of the hip joint, often resulting in a limp in affected children.&nbsp;</li></ul>

99
Q

Whhat red flags in a child with a limp migh prompt an urgen specialist assessment

A

<ul><li>Fever</li><li>Appears unwell, abnormal observations</li><li>&lt;3 years old</li></ul>

100
Q

What organisms are usually implicated in septic arthritis?

A

<ul><li>S.aureus-most common</li><li>Others: gonococcus, streptococcus spp, gram negative bacillli</li></ul>

101
Q

What joints are most commonly affect by septic arthritis?

A

<ul><li>Hips</li><li>Knees</li><li>Ankle</li></ul>

102
Q

What might be seen on examinatin of a patient with osgood schlatter

A

<ul><li>Swelling and tenderness over tibial tubercle</li><li>If severe: visible/palpable lump at tibial tuberosity</li></ul>

103
Q

What tests are done in a clinical exam to screen for developmental dysplasia of the hip

A

<ul><li>Barlow test: attempts to dislocate articulate femoral head(downward pressure on knees through femur to see if it dislocates posteriorly)</li><li>Ortolani test(attempt to relocate dislocated femoral head(palms on knees and thumbs n inner thigh and 4 fingers on outer thigh, abduct hips under pressure to see if it will dislocate anteriorly)</li><li><img></img><br></br></li></ul>

104
Q

What test results would be found in a patient with polyarticular JIA

A

<ul><li>RF: mostly negative</li><li>If positive: tends to happen more in adolescents and disease pattern more like RA in adults</li></ul>

105
Q

What test results would be found in a patient with oligoarticular JIA?

A

<ul><li>Usually normal/mildly elevated inflammatory markers</li><li>ANA often positive</li><li>RF usuaally negative</li></ul>

106
Q

What is torticollis?

A

<ul><li>Painful neck-&gt; local MSK irritation causing pain and spasms in neck muscle</li></ul>

107
Q

Which leukamia is most common in children?

A

<ul><li>ALL</li></ul>

108
Q

Where is a bone marrow biopsy taken from?

A

<ul><li>Iliac crest</li></ul>

109
Q

What symptoms indicate Richter’s transformation?

A

Patients become very unwell suddenly with one of:<br></br><ul><li>Fever with no infeciton</li><li>Weight loss</li><li>Night sweats</li><li>Nausea</li><li>Abdominal pain</li><li>Lymph node swelling</li></ul>

110
Q

Where do metastatic brain tumours that spread to the brain most commonly come from?

A

<ul><li>Lung-most common</li><li>Breast</li><li>Bowel</li><li>Skin-melanoma</li><li>Kidney</li></ul>

111
Q

What would be seen on histology in a patient with a pilocytic astrocytoma?

A

<ul><li>Rosenthal fibres(corkscrew eosinophilic bundle)</li></ul>

112
Q

Where does a medulloblastoma arise from and where does it spread to?

A

<ul><li>Within the infratentorial compartment-&gt; spreads through the CSF</li></ul>

113
Q

What would you expect to see on histology in a patient with a medulloblastoma?

A

<ul><li>Small blue cells</li><li>Rosette pattern of cells with many mitotic figures</li></ul>

114
Q

Where does a neuroblastoma arise from?

A

<ul><li>Neural crest of adrenal medulla(most commonly) and sympathetic nervous system</li></ul>

115
Q

When is surgery indicated for a patient with i<span>ntussusception?</span>

A

<ul><li>Non-operative management has failed</li><li>Child presents with peritonitis or perforation</li><li>Child is haemodynamically unstable</li></ul>

116
Q

When should a PPI be considered for a child with GORD?

A

<ul><li>Unexplained feeding difficulties( refusing feeds, gagging, choking)</li><li>Distressed behaviour</li><li>Faltering growth</li></ul>

117
Q

What part of the CNS is affected by spastic cerebral palsy?

A

<ul><li>Damage to pyramidal pathways-UMN's-&gt; increased tone</li></ul>

118
Q

When should the APGAR score be assessed?

A

<ul><li>1 minute, and 5 minutes</li><li>If low: repeat at 10 minutes</li></ul>

119
Q

What might a low APGAR score at 5 minutes be associated with?

A

<ul><li>Cerebral palsy</li></ul>

120
Q

When does surfactant production start and when does it reach adequate levels?

A

<ul><li>Starts at 26 weeks</li><li>Adequate levels at about 35 weeks</li></ul>

121
Q

What is transient tachypnoea of the newborn?

A

<ul><li>Parenchymal lung disorder characterised by pulmonary oedema caused by delayed resorption and clearance of total alveolar fluid</li><li>Mc cause of respiratory distress in term babies</li></ul>

122
Q

Why do normal term babies often get transient hypoglycaemia?

A

<ul><li>Common in first few hours after birth</li><li>Can utilise alternate fuels like ketones and lactate so no ssequelae</li></ul>

123
Q

Which side is gastroschisis most common on?

A

<ul><li>Right side</li></ul>

124
Q

Which organs are usually implicated in gastroschisis?

A

<ul><li>Usually small intesine</li><li>Rare: stomach and liver too</li></ul>

125
Q

Which is associated with a higher mortality rate: exompahlos or gastroschisis?

A

<ul><li>Exomphalos</li></ul>

126
Q

What is VACTER syndrome?

A

<ul><li>Verterbal defects</li><li>Anorectal malformations</li><li>CVR defects</li><li>Tracheo-oesophageal defects</li><li>Oeophageal atresia</li><li>Renal abnormalities</li></ul>

127
Q

Why does necrotising enterocilitis affect premature infants?

A

<ul><li>Lack of defence mechanisms in bowels(gastric acid and digestive enzymes)</li></ul>

128
Q

What would be seen on an abdominal x-ray in a patient with necrotising enterocilitis

A

<ul><li>Dilated bowel loops</li><li>Bowel wall oedema</li><li>Pneumatosis intestinalis(intramural gas)</li><li>Pneumoperitoneum(indicator of severe disease-Rigler sign or Football Sign)</li></ul>

129
Q

What staging system is used to classify necrotising enterocilitis

A

<ul><li>Bell's classification</li></ul>

130
Q

When is jaundice considered normal/pathological in newborns?

A

<ul><li>First 24 hours-ALWAYS pathological</li><li>2-14 days: common and usually physiological</li><li>&gt;14 days: prolonged jaundice-should be investigated</li></ul>

131
Q

What might a raised conjugated bilirubin level in a neonate suggest

A

<ul><li>Biliary atresia-&gt; important differential</li><li>Rule out with USS/</li></ul>

132
Q

What is toxoplasma gondii and how is it transmitted?

A

<ul><li>Protozoan parasite</li><li>Consumption of undercooked meats or exposure to cat faeces</li></ul>

133
Q

What is the treatment for congenital CMV infection?

A

<ul><li>gangiciclovir</li></ul>

134
Q

What problems might someone with a cleft lip/palate experience?

A

<ul><li>Feeding: orthodontic devices</li><li>Speech</li><li>Increased risk of otitis media</li></ul>

135
Q

What might be done for pregnant women with a known GBS infection?

A

<ul><li>Offer intrapartum IV antibiotic propylaxis -penicllin</li></ul>

136
Q

What would be seen on EEG of a patient with Lennox Gastaut syndrome

A

<ul><li>Slow spike</li></ul>

137
Q

What would be seen on EEG in panayiotopoulos syndrome?

A

<ul><li>Multiple shifting foci predominantly in the occipital region</li></ul>

138
Q

What would be seen on EEG of a patient with benign rolandic epilepsy

A

<ul><li>During sleep: centro-temporal spikes</li></ul>

139
Q

When is it a red flag for a child tp not fix and follow light/face?

A

<ul><li>3 months</li></ul>

140
Q

Where does neuroblastoma most commonly metastasise to?

A

<ul><li>Bone</li></ul>

141
Q

WHat kind of tumour is a Ewing’s sarcoma?

A

<ul><li>Primitive neuroectodermal tumour</li></ul>

142
Q

Which bones are affected by Ewing’s sarcoma

A

<ul><li>Limbs-mc</li><li>Pelvis</li><li>Ribs</li><li>Vertebrae</li></ul>

143
Q

What staging system is used to classify Hodgkin’s lymphoma?

A

<ul><li>Used to be Ann Arbor staging</li><li>No lugano classification</li></ul>

144
Q

What is von Willebrand disease?

A

<ul><li>Inherited bleeding disorder characterised by a reduced quantity or function of Von Willebrand factor</li></ul>

145
Q

When is the neonatal blood spot screening performed?

A

<ul><li>5-9 days of life</li></ul>

146
Q

When do beta thalassaemia major patients become symptomatic?

A

<ul><li>Levels of HbF(doesn't contain beta globin) fall</li><li>Should be replaced by HbA(2 alpha and 2 beta globin chains) but no beta globin in beta thalassaemia major</li></ul>

147
Q

What monitoring is required for patients with beta thalassaemia

A

<ul><li>Ferritin 3 monthly</li><li>Annaul assessment of cardiac, liver, endocrine, audiology and ophthalmology</li></ul>

148
Q

What screening is done for thalassaemia in the UK?

A

<ul><li>Maternal MCH&lt;27pg, iron studies and HPLC</li><li>If negative, DNA studies/analysis to look for alpha thalassaemia if pregnant woman and baby's father are from 'at risk' parts of the world</li><li>During pregnancy allows option for therapeutic abortion of affected fetus</li></ul>

149
Q

What screening is available in the UK for sickle cell?

A

<ul><li>Most cases are picked up on in newbon screening programme</li><li>Screening offfered during pregnancy</li></ul>

150
Q

What kind of hypersensitivity reaction is ITP?

A

<ul><li>Type 2</li></ul>

151
Q

When would a bone marrow biopsy be done for ITP?

A

<div>Atypical features:</div>

<div><ul><li>Lymphadenopathy/splenomegaly/changes in WCC</li><li>Failure to resolve/respond to treatment</li><li>Used to rule out malignancy</li></ul></div>

152
Q

Why are platelet transfusions only a temporary measure in ITP?

A

<ul><li>Circulating antibodies will destroy the platelets-&gt; giving more will increase rate of platelet destruction</li></ul>

153
Q

What is thrombotic thromocytopenic purpura?

A

<ul><li>Disorder caused by abnormally cleaved vWF due to abnormal ADAMST13 activity-&gt; platelet aggreagation, thrombus formation and systemic microangiopathy</li></ul>

154
Q

What is thelarce?

A

<ul><li>First stage of breast development</li></ul>

155
Q

Which is more common and which is more concerning: precocious puberty in females or males?

A

<ul><li>Mc in females</li><li>More concerning: males-usually has an organic cause</li></ul>

156
Q

What might be needed in a salt-losing crisis in patients with congenital adrenal hyperplasia?

A

<ul><li>Fluids</li><li>Sodium chloride replacement</li></ul>

157
Q

When should invesigations be considered in children with obesity?

A

<ul><li>BMI&gt;98th centile</li><li>Waist: height ratio &gt;0.5</li></ul>

158
Q

What should be investigated in children with obesity?

A

<ul><li>Associated comorbidities</li><li>BP</li><li>Fasting lipid profile, insulin and glucose levels</li><li>Liver and endocrine function</li><li>Pubertal status assessment</li><li>Psychological assessment</li></ul>

159
Q

What might be seen on physical exam of a patient with pica

A

<ul><li>Signs of nutritional deficiencies-&gt; pallor, spoon-shaped nails etc)</li><li>GI sx-&gt; perforations, obstructions</li><li>Dental erosions/abrasions</li><li>Psychiatric sx: ASD, OCD sx</li></ul>

160
Q

When should a referral be made to dermatology for eczema?

A

<ul><li>Severe and not responded to optimum topical tx after 1 wweek(urgent referral)</li><li>Dx uncertain</li><li>Current management not working</li><li>Tx resistant facial eczema</li><li>Contact allergic dermatitis suspected</li></ul>

161
Q

When would you consider an ENT referral for allergic rhinitis

A

<ul><li>Red flag features suggesting an alternative/serious diagnosis</li><li>Refractory cases</li><li>Allergen testing is needed</li></ul>

162
Q

What is urticaria?

A

<ul><li>(Hives) rapid development of itchy erythematous raised wheals that may vary in shape and size</li><li>Typically resolve in hours to days</li><li>Can occur anywhere in the boday</li></ul>

163
Q

When might a referral to derm/immunology be considered for urticaria

A

<ul><li>Painful /persistent-vasculitis</li><li>Not wwell controlled</li><li>Angioedema and no wheals that don't respond</li><li>Acute severe due to food/latex allergy</li><li>Chronic inducible urticaria-solar/cold urticaria</li></ul>

164
Q

What provides evidence of a recent strep infection in rheumatic fever

A

<ul><li>Raised/rising strep antibodies</li><li>Positive throat swab</li><li>Positive rapid group A streptococcal antigen test</li></ul>

165
Q

What secondary prophylaxis might be used for patients with rheumatic fever

A

<ul><li>Those who have carditis and persistent valve disease</li><li>Prophylactic abx to prevent recurrence of rheumatic fever: phenoxymethylpenicllin</li></ul>

166
Q

When is congenital heart block most likely to develop?

A

<ul><li>Between 18th and 25th week gestatioin</li><li>Prenatal scans: fetal bradycardia-reduce risk of progression from first/second degree heart block to complete heart block</li></ul>

167
Q

What things would you look at to assess dehydration in a child?

A

<ul><li>General appearance-confidence</li><li>Eye: sunken</li><li>Mucous membranes: dry</li><li>Tears: absent</li><li>Skin turgor</li><li>HR, Resp rate, cap refill, B</li><li>Urine output</li><li>Weight loss</li></ul>

168
Q

What would be seen on colonoscopy with biopsy in a patient with Crohn’s disease

A

<ul><li>Skip lesions</li><li>Cobblestone mucosa</li><li>Rose thorn ulcers</li><li>Non caseating granulomas</li></ul>

169
Q

What should be done before starting a patient on biologics therapy like infliximab

A

<ul><li>CXR: check for TB as can reactivate latent TB</li></ul>

170
Q

When might surgery be used in treatment of Crohn’s disease

A

<ul><li>Control fistulae</li><li>Resection of strictures</li><li>Rest/defuncitoning of bowel</li></ul>

171
Q

What is ulcerative colitis?

A

<ul><li>Chronic relapsingg remitting inflammatory disease that primarily affects the large bowel</li><li>Affects rectum first then extends to part of colon then whole colon</li><li>Does not spread beyond ileocaecal valve or to small bowel</li></ul>

172
Q

What would be seen on colonoscopy and biopsy and barium enema in a patient with Ulcerative colitis

A

<ul><li>Colonoscopu: continuous inflammation starting at rectum that doesn't go bbeyong dubmucosa</li><li>Biopsy: loss of goblet cells, crypt abscesses, lymphocytes</li><li>Barium enema: lead-piping inflammation and pseudopolypps</li></ul>

173
Q

What symptoms might a B12 deficiency cause in children?

A

<ul><li>Anaemia</li><li>Peripheral neuropathy</li></ul>

174
Q

What symptoms might zinc deficiency cause?

A

<ul><li>Dermatitis</li><li>Increased infections</li></ul>

175
Q

What might a vitamin C deficiency cause?

A

<ul><li>Scurvy</li></ul>

176
Q

What is toddler’s diarrhoea?

A

<ul><li>Chronic non-specific diarrhoea usually in 1-5 yr olds</li></ul>

177
Q

What should be prescribe for breastfeeding mother’s eliminating cow’s milk protein from their diet?

A

<ul><li>Calcium supplements</li></ul>

178
Q

Why do children with neonatal hepatitis get FTT?

A

<ul><li>Decreased intestinal bile flow-&gt; imapired fat digestion+vitamin absorption</li></ul>

179
Q

How should pulses be checked in children and infants?

A

Infants: brachial/femoral artery
Children >1yr: carotid

180
Q

In what conditions might you see a strawberry tongue?

A

Kawasaki disease
Scarlet fever

3A med mine (12 decks)

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