Selected Notes paeds 4 Flashcards
What kind of conjunctivitis doo you see in patients with Kawasaki?
Bilateral and non exudative
Why is aspiring usually contraindicated in children and when is it used as treatment?
Risk of Reye’s syndrome-Used as treatment of Kawaski’s
What kind of vurs is the measles morbillivirus?
Single stranded, enveloped RNA virus
When might the chicken pox rash leave scars?
If blisters have been scratched or infected
When is school exclusion recommended in patients with chicken pox?
In most infectious periods:1-2 days before rash and until all lesions have dried and crusted over (5 days post rash onset)
Who is most at risk from rubella?
Unvaccinated pregnant women due to risk of congenital rubella syndrome
When are rubella outbreaks most common?
In winter and spring
When are patient with rubella most infecitous?
From 7 days before symptoms start to 4 days after rash onset
Who does staphylococcal scalded skin syndrome mainly affect?
Mainly infants: those <5yrs Adults with renal insifficiency or immune compromi
When are children immunised against whooping cough?
2, 3, 4 months and 3-5 yearsPregnant women
Who should be admitted if presenting with suspected whooping cough?
Infants under 6 months
When should patients with whooping cough be kept off school?
Until 48 hours after commencing antibiotics OR 21 days from symptom onset if no antibiotics
When are pregnant women offered the whooping cough vaccine?
Women who are 16-32 weeks pregnant
When should children with slapped cheek suyndrome be excluded from school?
No exclusion necessary-no infectious once rash emerges
What might fifth disease cause in adults?
Acute arthritis
When are children with Fifth’s disease infectious?
3-5 days before rash onset
Why might parvovirus B19 result in an aplastic crisis?
Reduces erythropoiesis
What organisms commonly cause pneumonia in neonates?
Group B strep
Klebsiella
Staph aureus
What organisms commonly cause pneumonia in infants and young children?
Most common: RSV
S.pneumonia
Staph aureus
Also bordatella pertussis, chlamydia trachomatis
What organisms commonly cause pneumonia in children aged >5years?
Mycoplasma pneumonia
Strep pneumoniae
Chlamydia pneumoniae
What symptoms might point more towards a viral cause of pneumonia?
Wheeze
Hyperinflation
When should children with pneumonia be admitted to hospital
<ul><li>O2<93%</li><li>Severe tachypnoea</li><li>Grunting</li><li>Not feeding</li></ul>
When should children with oneumonia be followed up?
<ul><li>At 4-6 weeks</li></ul>
What would you expected to find on spirometry in a patient with asthma?
<ul><li>FEV1 reduced</li><li>FVC normal</li><li>FEV1/FVC:<70%</li></ul>
What should patients who have been hospitalised for an asthma attack be given on discharge?
<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>
What might you see on a CXR of a patient with croup and why?
<ul><li>Steeple sign</li><li>Subglottic narrowing in severe or atypical cases</li></ul>
Whta is bacterial tracheitis?
<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>
What is the treatment for bacterial tracheitis?
<ul><li>IV antibiotics</li><li>Intubation and ventilation if required</li></ul>
What might be seen on a CXR in a patient with bronchiolitis?
<ul><li>Hyperinflation of lungs</li><li>Flattening of diaphragm</li><li>Horizontal ribs</li><li>Increased hilar bronchial markings</li></ul>
When might bronchiolitis prophylaxis be given?
<ul><li>Children <9 months with chronic lung disease/prematurity</li><li>Children <2 years with severe immunodeficiency</li></ul>
What is the treatment for bronchiolitis obliterans?
<ul><li>Supportive</li><li>Immunosuppressive agents-> cyclosporin, prednisone etc</li></ul>
What organism can cause chest infections in patients with cystic fibrosis?
<ul><li>Psuedomonas aeruginosa</li></ul>
What might be seen on an x ray in a patient with acute epiglottitis and why?
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>
What organism most commonly causes viral induced wheeze?
<ul><li>RSV/rhinovirus</li></ul>
<div><br></br></div>
What should you consider if you find a focal wheeze in a child and what should you do?
<ul><li>Focal wheeze-> foca airway obstruction-> inhaled foreign body/tumour-> urgent senior review</li></ul>
Why are children most prone to otitis media?
<ul><li>Have narrower eustachian tube , more horizontal, less developed immune systems->easier for bacteria to colonise</li></ul>
What would be seen on otoscopy of a patient with otitis media?
<ul><li>Bulging tympanic membrane-> loss of light reflex</li></ul>
What should be used if impetigo is likely caused by MRSA?
<ul><li>Topical mupirocin</li></ul>
When should patients with mpetigo be referred to secondary care?
<ul><li>Suspected complications</li><li>Immunocompromised and widespread infection</li></ul>
What is toxic shock syndrome?
<span>severe, life-threatening condition characterized by the sudden onset of shock, multi-organ failure, and rash.</span>
What organisms most commonly cause toxic shock syndrome?
<ul><li>Group A strep</li><li>S.aureus</li><li>MRSA</li></ul>
Why is clindamycin used in toxic shock syndrome?
<ul><li>Inhibits the produciton of superantigen</li></ul>
Whta condition is this rash likely to be seen in?<br></br><img></img>
Scarlet fever
Why is fetal circulation different?
Lungs don’t work so are bypassed and bloods need to get to placenta and back
When might murmurs be further investigated in children?
<ul><li>Murmur louder than 2/6</li><li>Diastolic</li><li>Louder on standing</li><li>Symptomatic-> failure to thrive, feeding difficulty, cyanosis or SOB</li></ul>
Where would a murmur caused by mitral regurgitation be heard the loudest?
5th intercostal space<br></br>Mid clavicular line
Where would a murmur caused by tricuspid regurgitaiton be heard the loudest?
5th IC<br></br>Left sternal border
Where would a murmur form a ventricular septal defect be heard loudest?
<ul><li>Left lower sternal border</li></ul>
Where would a murmur caused by aortic stenosis be heard the loudest?
2nd IC<br></br>Right sternal border
Where would a murmur caused by pulmonary stenosis be heard loudest?
2nd IC<br></br>Left sternal border
Where would a murmur caused by hypertophic obstructive cardiomyopathy be heard the loudest?
4th IC<br></br>Left sternal border
Within how many days does the ductus arteriosus close?
<ul><li>Stops functioning within 1-3 days of birth</li><li>Closes completely within first 2-3 weeks</li></ul>
What murmur is associated with a patent ductus arteriosus?
<ul><li>Continuous crescendo-descrescendo 'machinery' murmur that may continue during second ehart sound</li></ul>
Why are patients with atrial spetal defects more susceptible to strokes from DVTs?
<ul><li>Clot can travel from right atrium to left atrium across ASD-> left ventricle-> aorta0> brain-> large stroke</li></ul>
What murmur would you find in a patient with an ASD?
<ul><li>Mid-systolic crescendo-decrescendo murmur loudest at the upper left sternal border with a fixed split second heart sound</li></ul>
What might be the only indication of coarctation of the aorta in a neonate?
Weak femoral pulses
What kind of murmur is associated with coarctatin of the aorta?
<ul><li>Mid-systolic heard below the left clavicle and below the left scapula, maximal over the back</li></ul>
Why is prostaglandin E used for treatment of the coarctaiton of the aorta?
<ul><li>Keeps the ductus arteriosus open so blood is able to flow through into the systemic circulation distal to the coarctation</li></ul>
Where does the narrowing typically occur in coarctation of the aorta?
Just before the ductus arteriosus
What murmur is associated with a VSD?
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
What part of the tetralogy of fallot determines the degree of severity of the cyanosis
<ul><li>Pulmonary stenossi</li></ul>
When is tetralogy of fallot most commonly diagnosed?
<ul><li>Antenatal scans</li><li>Newborn baby check</li><li>Heart failure symptoms</li></ul>
Why might a pehnylephrine infusion be used to treat a tet spell?
Increases systemic vascular resistance
Why might morphine be used to treat a tet spell?
Decreases respiratory drive resulting in more effective breathing
Why might beta blockers be used to treat a tet spell?
Relax right ventricle and improve flow to pulmonary vessels
Why might IV fluids be used to treat a tet spell?
Increases the pre-load, increasing the volume of blood flowing to the pulmonary vessels
What might be seen on a CXR in a patient with transposition of the great arteries
Egg-on-side appearance
When do patients with Ebstein’s anomaly typically present?
<ul><li>A few days post birth when the ductus arteriosus closes</li></ul>
What murmur is associated with congenital aortic valve stenosis
<ul><li>Crescendo decrescendo ejection systolic murmur</li><li>Heard loudest at 2nd IC, R sternal border</li><li>Radiates to carotids</li></ul>
What murmur is associated with congenital pulmonary valve stenosis
<ul><li>Ejection systolic murmur</li><li>Loudest at 2nd IC left sternal border</li></ul>
When might desmopressin be used as a treatment for nocturnal enuresis?
<ul><li>>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>
What is the typical triad of haemolytic uraemic syndrome?
<ul><li>AKI</li><li>Thrombocytopenia</li><li>Microangiopathic haemolytic anaemia</li></ul>
Which is more commmon: primary or secondary haemolytic uraemic syndrome
Secondary(AKA typical)
What might be seen on an FBC in a patient with haemolytic uraemic syndrome?
Hg<8<br></br>Negative Coombs test<br></br>Thrombocytopenia<br></br>High platelets
What might be seen on a blood film in a patient with haemolytic uraemic syndrome?
<ul><li>Fragmented blood film</li><li>Schistocytes</li><li>Helmet cells</li></ul>
What might you see in the U&Es of a patient with haemolytic uraemic syndrome?
AKI<br></br><ul><li>High urea and creatinine</li></ul>
What might you see on a stool culture in a patient with haemolytic uraemic syndrome?
Evidence of STEC infection: OCR for Shiga toxins
What might be seen in a patient’s coagulation studies if they have suspected haemolytic uraemic syndrome?
Normal
What might you do if a child is having atypical/recurrent UTI’s?
<ul><li>Consider further investigations or prophylaxis</li><li>Secindary care referral</li></ul>
What is vesicoureteral reflux?
<ul><li>Urine flows backwards from bladder into ureters and potentially into the kidneys, sometimes resulting in recurrent UTI's</li></ul>
What is Wilms’ tumour?
<ul><li>AKA nephroblastoma</li><li>Malignant embryonic tumour originating from the developing kidney</li></ul>
What should be avoided in patient with phimosis/paraphimosis?
<ul><li>Forcible retraction</li><li>Can cause scarring</li></ul>
What might suggest an atypical presentation of nephrotic syndrome
<ul><li><1 yrs</li><li>Poor response to steroids</li></ul>
What would be seen on light microscopy in a patient with minimal change disease?
<ul><li>Nothing</li></ul>
What would be seen on electron microscopy in a patient with minimal change disease?
<ul><li>Fusion of podocytes and effacement of foot processes</li></ul>
What is used to treat patient with minimal change disease if they don’t respond well to steroids?
<ul><li>Cyclophosphamide/ciclosporin</li></ul>
What would be seen on light microscopy in a patient with post strep glomerulonephritis?
Hypercellular glomeruli
What would be seen on lectron microscopy in a patient with post strep glomerulonephritis
<ul><li>Subendothelial 'humps' (immune complex deposition)</li></ul>
What would be seen on immunofluorescence in post strep glomerulonephritis
<ul><li>Starry sky appearance-IgG, IgM and C3 deposits along GBM and mesangium</li></ul>
What might be tested in a patient with likely rapidly progressive GN?
ANCA
What should be monitored in patients on testosterone therapy?
<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>
What is Turner’s syndrome?
<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>
Will gonadotrophin levels be high or low in patients with Turner’s syndrome?
<ul><li>High-elevated</li></ul>
What is the triple test(Down’s syndrome)?
<ul><li>14-20 weeks</li><li>B-HCG(higher)</li><li>AFP(lower)</li><li>Serum oestriol(lower)</li></ul>
What si the quadruple test (Down’s syndrome)?
<ul><li>Same as triple test but also includes inhbin A(higher)</li></ul>
What routine follow up investigations should be done for patients with Down’s syndrome?
<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>
What is William’s syndrome?
<ul><li>Neurodevelopmental disorder caused by a microdeletion on chromosome 7</li><li>Usually random deletion rather than inherited</li></ul>
What is transient synovitis?
<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. </li></ul>
Whhat red flags in a child with a limp migh prompt an urgen specialist assessment
<ul><li>Fever</li><li>Appears unwell, abnormal observations</li><li><3 years old</li></ul>
What organisms are usually implicated in septic arthritis?
<ul><li>S.aureus-most common</li><li>Others: gonococcus, streptococcus spp, gram negative bacillli</li></ul>
What joints are most commonly affect by septic arthritis?
<ul><li>Hips</li><li>Knees</li><li>Ankle</li></ul>
What might be seen on examinatin of a patient with osgood schlatter
<ul><li>Swelling and tenderness over tibial tubercle</li><li>If severe: visible/palpable lump at tibial tuberosity</li></ul>
What tests are done in a clinical exam to screen for developmental dysplasia of the hip
<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>
What test results would be found in a patient with polyarticular JIA
<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>
What test results would be found in a patient with oligoarticular JIA?
<ul><li>Usually normal/mildly elevated inflammatory markers</li><li>ANA often positive</li><li>RF usuaally negative</li></ul>
What is torticollis?
<ul><li>Painful neck-> local MSK irritation causing pain and spasms in neck muscle</li></ul>
Which leukamia is most common in children?
<ul><li>ALL</li></ul>
Where is a bone marrow biopsy taken from?
<ul><li>Iliac crest</li></ul>
What symptoms indicate Richter’s transformation?
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>
Where do metastatic brain tumours that spread to the brain most commonly come from?
<ul><li>Lung-most common</li><li>Breast</li><li>Bowel</li><li>Skin-melanoma</li><li>Kidney</li></ul>
What would be seen on histology in a patient with a pilocytic astrocytoma?
<ul><li>Rosenthal fibres(corkscrew eosinophilic bundle)</li></ul>
Where does a medulloblastoma arise from and where does it spread to?
<ul><li>Within the infratentorial compartment-> spreads through the CSF</li></ul>
What would you expect to see on histology in a patient with a medulloblastoma?
<ul><li>Small blue cells</li><li>Rosette pattern of cells with many mitotic figures</li></ul>
Where does a neuroblastoma arise from?
<ul><li>Neural crest of adrenal medulla(most commonly) and sympathetic nervous system</li></ul>
When is surgery indicated for a patient with i<span>ntussusception?</span>
<ul><li>Non-operative management has failed</li><li>Child presents with peritonitis or perforation</li><li>Child is haemodynamically unstable</li></ul>
When should a PPI be considered for a child with GORD?
<ul><li>Unexplained feeding difficulties( refusing feeds, gagging, choking)</li><li>Distressed behaviour</li><li>Faltering growth</li></ul>
What part of the CNS is affected by spastic cerebral palsy?
<ul><li>Damage to pyramidal pathways-UMN's-> increased tone</li></ul>
When should the APGAR score be assessed?
<ul><li>1 minute, and 5 minutes</li><li>If low: repeat at 10 minutes</li></ul>
What might a low APGAR score at 5 minutes be associated with?
<ul><li>Cerebral palsy</li></ul>
When does surfactant production start and when does it reach adequate levels?
<ul><li>Starts at 26 weeks</li><li>Adequate levels at about 35 weeks</li></ul>
What is transient tachypnoea of the newborn?
<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>
Why do normal term babies often get transient hypoglycaemia?
<ul><li>Common in first few hours after birth</li><li>Can utilise alternate fuels like ketones and lactate so no ssequelae</li></ul>
Which side is gastroschisis most common on?
<ul><li>Right side</li></ul>
Which organs are usually implicated in gastroschisis?
<ul><li>Usually small intesine</li><li>Rare: stomach and liver too</li></ul>
Which is associated with a higher mortality rate: exompahlos or gastroschisis?
<ul><li>Exomphalos</li></ul>
What is VACTER syndrome?
<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>
Why does necrotising enterocilitis affect premature infants?
<ul><li>Lack of defence mechanisms in bowels(gastric acid and digestive enzymes)</li></ul>
What would be seen on an abdominal x-ray in a patient with necrotising enterocilitis
<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>
What staging system is used to classify necrotising enterocilitis
<ul><li>Bell's classification</li></ul>
When is jaundice considered normal/pathological in newborns?
<ul><li>First 24 hours-ALWAYS pathological</li><li>2-14 days: common and usually physiological</li><li>>14 days: prolonged jaundice-should be investigated</li></ul>
What might a raised conjugated bilirubin level in a neonate suggest
<ul><li>Biliary atresia-> important differential</li><li>Rule out with USS/</li></ul>
What is toxoplasma gondii and how is it transmitted?
<ul><li>Protozoan parasite</li><li>Consumption of undercooked meats or exposure to cat faeces</li></ul>
What is the treatment for congenital CMV infection?
<ul><li>gangiciclovir</li></ul>
What problems might someone with a cleft lip/palate experience?
<ul><li>Feeding: orthodontic devices</li><li>Speech</li><li>Increased risk of otitis media</li></ul>
What might be done for pregnant women with a known GBS infection?
<ul><li>Offer intrapartum IV antibiotic propylaxis -penicllin</li></ul>
What would be seen on EEG of a patient with Lennox Gastaut syndrome
<ul><li>Slow spike</li></ul>
What would be seen on EEG in panayiotopoulos syndrome?
<ul><li>Multiple shifting foci predominantly in the occipital region</li></ul>
What would be seen on EEG of a patient with benign rolandic epilepsy
<ul><li>During sleep: centro-temporal spikes</li></ul>
When is it a red flag for a child tp not fix and follow light/face?
<ul><li>3 months</li></ul>
Where does neuroblastoma most commonly metastasise to?
<ul><li>Bone</li></ul>
WHat kind of tumour is a Ewing’s sarcoma?
<ul><li>Primitive neuroectodermal tumour</li></ul>
Which bones are affected by Ewing’s sarcoma
<ul><li>Limbs-mc</li><li>Pelvis</li><li>Ribs</li><li>Vertebrae</li></ul>
What staging system is used to classify Hodgkin’s lymphoma?
<ul><li>Used to be Ann Arbor staging</li><li>No lugano classification</li></ul>
What is von Willebrand disease?
<ul><li>Inherited bleeding disorder characterised by a reduced quantity or function of Von Willebrand factor</li></ul>
When is the neonatal blood spot screening performed?
<ul><li>5-9 days of life</li></ul>
When do beta thalassaemia major patients become symptomatic?
<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>
What monitoring is required for patients with beta thalassaemia
<ul><li>Ferritin 3 monthly</li><li>Annaul assessment of cardiac, liver, endocrine, audiology and ophthalmology</li></ul>
What screening is done for thalassaemia in the UK?
<ul><li>Maternal MCH<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>
What screening is available in the UK for sickle cell?
<ul><li>Most cases are picked up on in newbon screening programme</li><li>Screening offfered during pregnancy</li></ul>
What kind of hypersensitivity reaction is ITP?
<ul><li>Type 2</li></ul>
When would a bone marrow biopsy be done for ITP?
<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>
Why are platelet transfusions only a temporary measure in ITP?
<ul><li>Circulating antibodies will destroy the platelets-> giving more will increase rate of platelet destruction</li></ul>
What is thrombotic thromocytopenic purpura?
<ul><li>Disorder caused by abnormally cleaved vWF due to abnormal ADAMST13 activity-> platelet aggreagation, thrombus formation and systemic microangiopathy</li></ul>
What is thelarce?
<ul><li>First stage of breast development</li></ul>
Which is more common and which is more concerning: precocious puberty in females or males?
<ul><li>Mc in females</li><li>More concerning: males-usually has an organic cause</li></ul>
What might be needed in a salt-losing crisis in patients with congenital adrenal hyperplasia?
<ul><li>Fluids</li><li>Sodium chloride replacement</li></ul>
When should invesigations be considered in children with obesity?
<ul><li>BMI>98th centile</li><li>Waist: height ratio >0.5</li></ul>
What should be investigated in children with obesity?
<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>
What might be seen on physical exam of a patient with pica
<ul><li>Signs of nutritional deficiencies-> pallor, spoon-shaped nails etc)</li><li>GI sx-> perforations, obstructions</li><li>Dental erosions/abrasions</li><li>Psychiatric sx: ASD, OCD sx</li></ul>
When should a referral be made to dermatology for eczema?
<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>
When would you consider an ENT referral for allergic rhinitis
<ul><li>Red flag features suggesting an alternative/serious diagnosis</li><li>Refractory cases</li><li>Allergen testing is needed</li></ul>
What is urticaria?
<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>
When might a referral to derm/immunology be considered for urticaria
<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>
What provides evidence of a recent strep infection in rheumatic fever
<ul><li>Raised/rising strep antibodies</li><li>Positive throat swab</li><li>Positive rapid group A streptococcal antigen test</li></ul>
What secondary prophylaxis might be used for patients with rheumatic fever
<ul><li>Those who have carditis and persistent valve disease</li><li>Prophylactic abx to prevent recurrence of rheumatic fever: phenoxymethylpenicllin</li></ul>
When is congenital heart block most likely to develop?
<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>
What things would you look at to assess dehydration in a child?
<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>
What would be seen on colonoscopy with biopsy in a patient with Crohn’s disease
<ul><li>Skip lesions</li><li>Cobblestone mucosa</li><li>Rose thorn ulcers</li><li>Non caseating granulomas</li></ul>
What should be done before starting a patient on biologics therapy like infliximab
<ul><li>CXR: check for TB as can reactivate latent TB</li></ul>
When might surgery be used in treatment of Crohn’s disease
<ul><li>Control fistulae</li><li>Resection of strictures</li><li>Rest/defuncitoning of bowel</li></ul>
What is ulcerative colitis?
<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>
What would be seen on colonoscopy and biopsy and barium enema in a patient with Ulcerative colitis
<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>
What symptoms might a B12 deficiency cause in children?
<ul><li>Anaemia</li><li>Peripheral neuropathy</li></ul>
What symptoms might zinc deficiency cause?
<ul><li>Dermatitis</li><li>Increased infections</li></ul>
What might a vitamin C deficiency cause?
<ul><li>Scurvy</li></ul>
What is toddler’s diarrhoea?
<ul><li>Chronic non-specific diarrhoea usually in 1-5 yr olds</li></ul>
What should be prescribe for breastfeeding mother’s eliminating cow’s milk protein from their diet?
<ul><li>Calcium supplements</li></ul>
Why do children with neonatal hepatitis get FTT?
<ul><li>Decreased intestinal bile flow-> imapired fat digestion+vitamin absorption</li></ul>
How should pulses be checked in children and infants?
Infants: brachial/femoral artery
Children >1yr: carotid
In what conditions might you see a strawberry tongue?
Kawasaki disease
Scarlet fever
