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Phase 3a > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Is bronchiolitis an upper or lower RTI?

A

Lower

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2
Q

Most common viral cause of bronchiolitis

A

RSV

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3
Q

Age group affected by bronchiolitis

A

Age 1-9 months

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4
Q

RF for bronchiolitis

A
  • Brest fed <2 months
  • Smoke exposure
  • Siblings
  • Chronic lung disease due to prematurity
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5
Q

Bronchiolitis pathophysiology

A
  • Proliferation of goblet cells –> excess mucus production
  • Inflammation, bronchiolar constriction
  • Lymphicytes –> submucosal oedema
  • Mucus, oedema and increased cells in bronchioles –> hyperinflation, increased airway resistance, atelectasis and VP mismatch
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6
Q

S+S of bronchiolitis

A
  • Coryzal Sx precede cough and breathlessness
  • Dry wheezy cough
  • Cyanosis
  • Tachypnoe and tachycardia
  • Recession
  • Hyperinflation
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7
Q

Ix bronchiolitis

A
  • Swabs
  • Urine and blood if pyrexic
  • Examination
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8
Q

When to admit with bronchiolitis

A
  • Apnoea
  • <92%
  • <70% normal drinking volume
  • Severe resp distress
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9
Q

Bronchiolitis Mx

A
  • Supportive
  • Oxygen
  • Fluids if dehydrated
  • CPAP if struggling to breathe
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10
Q

Croup

A

Common viral childhood illness

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11
Q

Age of croup

A

6 months to 6 years

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12
Q

Most common croup organism

A

Parainfluenza virus

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13
Q

S+S croup

A
  • Few days onset
  • Coryza preceding
  • Severe barking cough
  • Harsh rasping stridor
  • Worse at night
  • Temperature
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14
Q

Ix croup

A

CLinical diagnosis

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15
Q

Mx croup

A
  • All children with mild, moderate or severe - single dose or oral dexamethasome
  • Can be managed at home if mild
  • Severe upper airway obstruction = nebulised epinephrine with oxygen facemask
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16
Q

mild croup

A

occasional barking cough
no audible stridor at rest
no recession

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17
Q

moderate croup

A

Frequent barking cough
Audible stridor at rest
- Retraction at rest

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18
Q

Severe croup

A

Frequent cough
Priminent inspiratory stridor at rest
Sternal wall retractions
agitated child

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19
Q

Neonates pneumonia organisms

A

GBS
E coli
Klebsiella
S aureus

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20
Q

Infants pneumonia organisms

A

S pneumoniae
Chlamydia

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21
Q

School age oneumonia causes

A

S pneumoniae
S aureus
GAS
M pneumoniae

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22
Q

Intussusception definition

A

Invagination of proximal bowel into distal segment

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23
Q

S+S intussusception

A
  • Paroxysmal severe colicky pain with pallor
  • Pale around mouth, draw up legs
  • Recovery but increased lethargy between episodes
  • Vomit may be bile stained
  • Sausage shaped palpable mass
  • Redcurrant jelly = blood stained mucus
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24
Q

Mx intussucpetion

A

Fluid resus
Air insufflation
Surgery

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25
Q

Pyloric stenosis S+S

A

Non bilious vomiting after feed, increasing in frequency and forcefullness until projectile
- Keep feeding
- Gastric peristalsis
-Pyloric mass = palpable during feed in RUQ

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26
Q

Pyloric stenosis Ix

A
  • Test feed with NG tbe to aspirate stomach and exam
  • USS
  • hypochloremic hypokalaemic metabolic alkalosis
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27
Q

Mx pyloric stenosis

A
  • Fix acid base electrolyte imbalances before surgery
  • Pyloromyotomy
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28
Q

GORD definition

A

Involuntary passage of gastric contents into the oesophagus

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29
Q

Aetiology GORD

A

functional immaturity of lower oesophageal sphincter = inappropriately relaxed

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30
Q

RF for GORD

A

Prematurity
CP
Obesity
HH

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31
Q

S+S GORD

A
  • Faltering growth from severe vomiting
  • Oesophagitis
  • Aspiration, wheezing, hoarseness
  • Dystonic neck posturing
  • Apnoea
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32
Q

Ix GORD

A
  • Ph monitoring
  • Endoscopy
  • Barium swallow
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33
Q

Mx GORD

A
  • Feed thickening
  • PPI
  • Antacid, H2 blocker
  • Fundoplication
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34
Q

Kawasaki definition

A

Systemic vasculitis with a predisposition to involving coronary arteries

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35
Q

Kawasaki ep

A
  • Japan
  • 6months - 4YO
  • Peak at end of 1st year
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36
Q

Diagnostic criteria Kawasaki

A

Fever >5 days and 4/5 of
- Bilateral, bulbar, non purulent conjunctivitis
- Changes in lips/oral mucosa = cracked, strawberry tongue, erythema
- Changes in extremities = Oedema, erythema, desquamination
- Polymorphous rash
- Cervical lymphadenopathy

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37
Q

Kawasaki associated features

A
  • Urethritis
  • Arthralgia and arthritis
  • Aseptic meningitis
  • D+V
  • Congestive HF
  • Leucocytosis
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38
Q

Ix Kawasaki

A
  • CLinical findings
  • High inflam maekers
  • Platelet count rises in 2nd week
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39
Q

Mx kawasaki

A
  • IVIG 2g/kg 12hr apart
  • IV methylprednisolone and infliximab
  • Aspirin
  • Antiplatelet agents of risk of thrombus
  • Cardiology follow up
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40
Q

Measles features

A
  • Temperature
  • Rash = behind ears to body
  • Kolpik spots
  • Conjunctivitis and coryza
  • Cough and malaise
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41
Q

Measles treatment

A
  • Supportive
  • Immunocompromised = ribavirin
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42
Q

Nephrotic syndrome definition

A
  • Proteinuria, hypoalbuminaemia, oedema
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43
Q

Nephrotic pathophysiology

A
  • Podocytes flattened so allow leaking
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44
Q

S+S nephrotic syndrome

A

Oedema = initially on waking, periorbital
- Ascites, labial and scrotal swelling
- Pleural effusions and breathlessness

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45
Q

Nephrotic Ix

A
  • Urinalysis
  • Microscopy
  • Serum albumin
  • U+E/creatinine
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46
Q

Nephrotic Mx

A
  • Oral corticosteroids (60mg/m2 per day pred) –> 4 weeks change to 40 on alternate days
  • Resistant = diuretics, salt restriction, NSAIDs
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47
Q

Nephrotic indications for biopsy

A
  • <12 months or >12 years
  • Increased BP
  • Macroscopic haematuria
  • Impaired renal function
  • Decreased C3/C4
  • Failure to respond after 1 month daily steroid therapy
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48
Q

what direction does blood flow in VSD

A

Left to right
- pressure in LV greater than RV so L to R

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49
Q

S+S VSD

A
  • Small = asymptomatic
  • Pan systolic murmur lower left sternal edge
  • HF after 1 week if large (diuretics and captopril)
  • Tachycardia, pnoea and hepatomegaly
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50
Q

VSD radiograph findings

A
  • Cardiomegaly
  • Large pulmonary arteries
  • Increased pulmonary vascular markings
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51
Q

What direction is the shunt in transposition of the great arteries

A
  • Right to left
  • Aorta connected to RV and PA to LV
  • Blue blood therefore returned to body and pink blood to lungs
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52
Q

What direction is shunt in TOF

A
  • Right to left
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53
Q

4 cardinal features of TOF

A
  • Large VSD
  • Overriding aorta
  • Right ventricular hypertrophy
  • Sub pulmonary stenosis causing RV outflow tract obstruction
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54
Q

S+S TOF

A
  • Cyanosis
  • Paroxysmal hyper cyanotic spells
  • Ejection systolic murmur
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55
Q

Radiograph findings TOF

A
  • SMall heart
  • Uptilted apex
  • Pulmonary artery bay
  • Oligaemic lung fields
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56
Q

What to do if a hypercyanotic spell >15 minutes

A
  • Sedation
  • IV propranolol
  • Bicarbonate
  • Knees to chest position
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57
Q

Management of cyanosed neonate

A
  • Prostaglandin E infusion 5ng/kg per minute for ductal patency
  • ABCDE
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58
Q

Definition of rheumatic fever

A

Multisystem autoimmune response to a group A strep infection

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59
Q

Major criteria for RF

A
  • Subcutaneous nodules
  • Erythema marginatum
  • Chorea (sydenham)
  • Migratory arthrotos = ankles, knees, wrists
  • Carditis
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60
Q

Minor criteria for RF

A
  • Fever
  • Polyarthralgia
  • Raised CRP/ESR
  • Prolonged PR
    need 2 makor or 1 major and 2 minor
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61
Q

Rheumatic Fever Mx

A
  • NSAIDs
  • Glucocorticoids if severe carditis
  • Penixillin
  • Assess for emergency valve replacement
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62
Q

Direction of shunt in PDA

A
  • Left to right
  • Flow of blood from aorta to PA following fall in PV resistance after birth
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63
Q

S+S PDA

A
  • Continuous murmur below left clavicle
  • Collapsing/bounding pulse
  • If large = poor growth, feeding difficulty, resp difficulty, tachypnoea
  • Thrill/gallop
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64
Q

Pathological triad required in infective endocarditis

A
  • Endothelial damage
  • Platelet adhesion
  • Microbial adherence
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65
Q

S+S IE

A
  • Sustained fever, malaise, raised ESR, unexplained anaemia or haematuria = suspect
  • Murmur/changing cardiac signs
  • Anaemia and pallor
  • Nail signs
  • Necrotic skin lesions
  • Splenomegaly
  • Neuro signs from cerebral infarction
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66
Q

Major Dukes criteria

A
  • +ve blood culture = 2 seperate
  • Evidence of endocardial involvement = +ve echo fidnings
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67
Q

Minor dukes criteria

A
  • Predisposition
  • FEver
  • Vascular phenomena
  • Immunologic phenomena
  • Microbiological evidence
  • ECHO
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68
Q

IE treatment

A
  • High dose enicillin and aminoglycoside
  • 6 weeks OV
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69
Q

Causes of HF in neonates

A
  • Hypoplastic left heart syndrome
  • Critical aortic valve stenosis
  • Severe aorta coartctation
    -Interruption aortic arch
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70
Q

Causes HF in infants and older

A
  • VSD
  • ASD
  • Persistent PDA
  • Eisenmenger
    RHD
  • Cardiomyopathy
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71
Q

S+S HF

A
  • Breathless on feeding or exertion
  • Sweating
  • CHest infections
  • Poor gain
  • Tachys
  • Murmur and gallop
  • Hepatomegaly
  • Cool peripheries
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72
Q

HF Mx

A
  • Underlying cause
  • Oxygen
  • Diet
  • Diuretics
  • ACEi
  • Resp support
  • Inotropic support
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73
Q

Patho of complete AVSD

A
  • L to R shunting
  • Excessive pulmonary blood flow= HF
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74
Q

Patho partial AVSD

A
  • L to R at ASD level
  • Volume overload of RA and RV
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75
Q

Aortic stenosis

A
  • AV leaflets partly fused together = restrictive exit from LV
  • ES murmur UR sternal edge
  • Carotid thrill
  • Slow rising pulses
  • Severe = reduced exercise tolerance, chest pain, syncope
    >64 = balloon valvotomy
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76
Q

Pulmonary stenosis

A

-Restrictive exit from RV
- ES at UL sternal edge
- Severe = RV heave
- >64 = transcatheter balloon dilatation

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77
Q

Direction of ASD

A
  • L to R
  • Septum between left and right atrium nor formed completely
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78
Q

S+S ASD

A

= Recurrent chest infections
- Srrhythmia
- Palpitation, fatigue, syncope in older
- ES murmur
- Fixed split 2nd HS

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79
Q

HSP definition

A

Small vessel non-granulomatous IgA leukocytoclastic vasculitis

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80
Q

RF HSP

A
  • URTI
  • Winter
  • 2-11
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81
Q

HSP patho

A

Circulating IgA levels increase and IgG synthesis disrupted. IgG and A produce complexes that activate complement and are deposited in affected organs

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82
Q

HSP S+S

A
  • Maculopapular purpuric palpable rash = legs, buttock, arms- Trunk spared
  • Oedema
  • Abdo colic pain (haem and melaena)
  • Arthralgia
  • Macrscopic haematuria
  • Severe = intussuception
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83
Q

HSP Tx

A
  • Steroids
  • Benign and self limiting = most recover in 8 weeks
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84
Q

HTN Tx

A

1 = A drugs ACEi or ARB
2 = A drug plus BB or CCB or diuretics
3 = triple therapy = ACD or BCD

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85
Q

Glomerulonephritis definition

A

Acute renal failure due to damage/injury of glomeruli

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86
Q

Causes GN

A
  • Postinfectious
  • Vasculitis
  • IgA nephropathy
  • Goodpastures
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87
Q

S+S GN

A
  • HTN –> seizures
  • Oedema
  • Reduced UO and volume overload
  • Haematuria and proteinuria
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88
Q

Ix GN

A
  • Urine dip
  • Microscopy = RBC and protein casts
  • USS
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89
Q

Mx Gn

A
  • Treat hyperK, HTN, acidosis, an hypoca
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90
Q

Poststrep GN

A
  • Throat or skin infection
  • Low complement C3 levels return normal after 4w
  • Culture to prove
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91
Q

IgA GN

A
  • Macroscopic haematuria
  • URTI
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92
Q

Alport syndrome

A
  • Abnormalities of collagen in BM
  • X linked recessive
  • Nerve deafness and ocular defects
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93
Q

Triad for nephrotic

A
  • Heavy proteinuria
  • Low plasma albumin
  • Oedema
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94
Q

S+S nephrotic

A
  • Initial periorbital oedema
  • Pitting
  • Ascites, labial and scrotal swelling
  • Pleural effusions and breathlessness
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95
Q

Ix nephrotic

A
  • Urinalysis
  • Microscopy (haem)
  • Serum albumin
  • U+E, creatinine
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96
Q

Mx nephrotic

A
  • Pred 60mg/m2
  • After 4 weeks reduce to 40 on alternate dats
  • No response = biopsy
  • Steroid resistant = diuretics, salt restriction, ACEi, NSAID
  • Diuretics
  • Frequent relapse = levamisole, mycophenolate, tacrolimus, rituximab
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97
Q

Indications for biopsy in nephrotic

A
  • <12 months or >12 years
  • Increased BP
  • Macro haem
  • Impaired renal function
  • Decreased C3 and 4
  • Failure to respond after 1 months daily steroids
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98
Q

Predisposing causes renal calculi

A
  • UTI
  • Structural abnormalities
  • Metabolic abnormalities
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99
Q

Vesicoureteric reflux

A

Ureters displaced laterally and enter directly into bladder rather than at an angle

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100
Q

Long term impact vesicoureteric reflux

A
  • Urine returning to bladder from ureters after voiding = incomplete empyting = infection
  • Pyelonephritis
  • Bladder voiding rpessure = transmitted to renal papillae = renal damage
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101
Q

Pre renal AKI

A
  • Most common children
  • Hypovolaemia
  • HF
  • Circulatory failure
  • Urinary Na <10mmol, FeNa <1% and osmolality >500
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102
Q

Renal AKI

A
  • Salt and water retention
  • Vascular
  • GN
  • pyelonephritis
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103
Q

AKI Ix

A
  • USS
  • Urine biochemisty
  • Coag screen
  • Cultures
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104
Q

Mx AKI

A
  • Pre = fluid replacement and circulatory support
  • Renal = restrict fluids, diuretic
  • Post = nephrostomy, surgery, catheter
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105
Q

When dialysis

A
  • Failure of conservative Mx
  • HyperK
  • HypoNa or hyper Na
  • Pulmonary oedema or sever HTN
  • Severe metabolic acidosis
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106
Q

Triad of HUS

A
  • Microangiopathic haemolytic anaemia
  • Thrombocytopenia
  • AKI
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107
Q

HUS S+S

A
  • D+V = bloody
  • Rectal prolapse
  • CNS distrubance
  • DM
  • CM
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108
Q

Mx HUS

A
  • Eculizumab
  • Early supportive therapy and dialysis
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109
Q

Colic

A
  • Inconsolable crying
  • Drawing up knees
  • Excessive wind
  • Evening
  • Benign
  • > 2 weeks = cows milk allergy
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110
Q

Toddlers diarrhoea

A
  • ‘Peas and carrots’
  • Well and thriving children
  • Adequate fat and fibre
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111
Q

Whooping cough

A
  • Bordetella pertussis
  • 1 week of coryza develop paroxysmal or sporadic cough
  • Inspiratory whoop
  • Night worse
  • Vomiting
  • Red or blue in face and mucus
  • 3-6 weeks
  • PCR = marked lymphocytosis on blood film
  • Immunisation
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112
Q

polio

A
  • most asymptomatic
  • aseptic memingitis
  • <1% paralytic polio
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113
Q

Diphtheria

A
  • Local disease with membrane formation affecting nose, pharynx or systemic disease with myocarditis
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114
Q

Slapped cheek

A
  • Erythema infectiosum
  • viraemic phase of fever, malaise, headache and myalgia
  • rash on face turns to lace like maculopapular rash on trunk and limbs
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115
Q

Candida

A
  • May cause and often complicates napkin rashes
  • Erythematous
  • Skin flexures and may be satellite lesions
  • Topical antifungal
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116
Q

Breath holding episodes

A
  • Toddler
  • Precipitated by anger
  • Goes blue then limp
  • Rapid recovery
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117
Q

Reflex anoxic seizures

A
  • Toddler
  • Precipitated by pain
  • Stops breathing
  • Goes pale
  • Brief seizure
  • Rapid recovery
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118
Q

Juvenile myoclonic epilepsy

A
  • Myoclonic seizures shortly after waking
  • Throwing drinks or cornflakes
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119
Q

West syndrome

A
  • Infantile spasms
  • 6 months age
  • Clusters of full body spasms
  • Prednisolone and vigabatrin
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120
Q

Primary adrenal insufficiency

A
  • Addison’s disease
  • Adrenal glands damaged = reduced secretion of cortisol and aldosterone
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121
Q

Secondary adrenal insufficiency

A
  • Inadequate ACTH stimulating adrenal glands = low levels of cortisol released
  • Loss or damage to pituitary gland
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122
Q

Tertiary adrenal insufficiency

A
  • Inadequate CRH release by hypothalamus
  • Long term oral steroids cause hypothalamus suppression
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123
Q

Adrenal insufficiency S+S babies

A
  • Lethargy
  • Vomiting
  • Poor feeding
  • Hypoglycaemia
  • Jaundice
  • Failure to thrive
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124
Q

S+S adrenal insufficiency older children

A
  • N+V
  • Poor weight gain or weight loss
  • Reduced appetite
  • Abdo pain
  • Muscle weakness/cramps
  • Developmental delay
  • Bronzed skin (addisons)
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125
Q

Addisons blood results

A
  • Low cortisol
  • High ACTH
  • Low aldosterone
  • High renin
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126
Q

Secondary adrenal blood results

A
  • Low cortisol
    -Low ACTH
  • Normal aldosterone
  • Normal renin
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127
Q

Adrenal insufficiency Ix

A
  • Short synacthen test
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128
Q

Mx adrenal insufficiency

A
  • Hydrocortisone
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129
Q

Adrenal crisis

A
  • Reduced consciousness, hypotension, hypoglyc, hypona, hyperka
  • IV steroids and fluids
  • Correct hypo
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130
Q

presentation of growth hormone deficiency

A
  • Micropenis
  • Hypoglycaemia
  • Severe jaundice
  • Poor growth
  • Slow development of movement and strength
  • Delayed puberty
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131
Q

undescended testes

A
  • 4% at birth
  • Preterm more common
  • Retractacile = can be manpulated but then retracts
  • Palpable = can feel but not manipulate
  • Impalpable = no testis felt
    Ix = USS, measure testosterone after HCG injections, laparosciopy
    Mx = surgery
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132
Q

testicular torsion

A
  • Atypical presentation if young with lower or inguinal abdo pain of sudden onset
  • Surgical exploration mandatory
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133
Q

Definition haemolytic disease of new-born

A
  • Caused by incompatibility between rhesus antigens on surface of RBCs of mum and foetus
  • Mum Rh- and baby Rh+. 1st pregnancy mum will become sensitised to RhD antigens so subsequent pregnancies = anti D abs cross placenta = haemolysis = anaemia and high bilirubin levels
  • DCT
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134
Q

Microcytic anaemia causes

A

Thalassaemia
Anaemia chronic disease
Iron def
Lead poisoning
Sideroblastic
TAILS

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135
Q

Thalassaemia definition

A
  • A thal = defect in A globin chains
    B thal = defect in B globin chains
  • Autosomal recessive
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136
Q

Why is there a susceptibility to fractures in thalassaemia?

A
  • bone marrow expands to produce extra RBCs to compensate for chronic anaemia
  • Causes susceptibility
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137
Q

S+S thalassaemia

A
  • Microcytic anaemia
  • Fatigue and pallor
  • Jaundice
  • Gallstones
  • Splenomegaly
  • Pronounced forehead
  • Poor growth
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138
Q

Thalassaemia diagnosis

A
  • FBC = microcytic anaemia
  • Hb electrophoresis
  • DNA test
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139
Q

Thalassaemia iron overload Sx

A
  • fatigue
  • liver cirrhosis
  • infertility
  • impotence
  • HF
  • DM
  • arthritis, OP and joint pain
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140
Q

Mx alpha thalassaemia

A
  • Monitor FBC
  • Monitor complications
  • Blood transfusions
  • Splenectomy
  • BM transplant
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141
Q

Beta thalassaemia

A
  • Minor = carriers of abnormally functioning BG gene = mild microcytic anaemia
  • Intermedia = 2 abnormal copies = significant MA = transfusions and chelation
  • Major = homozygous = severe MA, splenomegaly, bone deformities
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142
Q

G6PD deficiency

A
  • X linked
  • Neonatal jaundice
  • Acute haemolysis = fever, malaise, dark urine
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143
Q

diagnosis and Mx G6PD

A
  • Measuring G6PD activity in RBC
  • Avoid precipitants
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144
Q

Sickle cell inheritance

A
  • Autosomal recessive
  • 1 abnormal = trait
  • 2 abnormal = disease
  • Sickle cell anaemia = homozygous
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145
Q

Paeds diagnosis SCD

A
  • Heelprick test newborn at 5 days old
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146
Q

manifestations of SCD

A
  • Anaemia and jaundice
  • Increased susceptibility to infection
  • Vaso-occlusive crises
  • Acute anaemia
  • Splenomegaly
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147
Q

Long term problems SCD

A
  • Short stature and delayed puberty
  • Stroke and cognitive problems
  • Adenotonsillar hypertrophy
  • Cardiomegaly
  • HF
  • Renal dysfuncton
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148
Q

SCD Mx

A
  • Antibiotic prophylaxis
  • Folic acid
    -Hydration
  • Crises = analgesia, hydration, abx, exchange of transfusion
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149
Q

Haemophilia definition

A
  • X linked recessive
  • A = FVIII deficiency
  • B = FIX
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150
Q

S+S haemophilia

A
  • Recurrent spontaneous bleeding into joints and muscles
  • Neonates = IC haemorrhage, prolonged bleeding from heel stick
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151
Q

Haemophilia management

A
  • Recombinant FVIII or FVIX concentrate IV infusion if bleeding
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152
Q

VWD

A
  • deficiency of VW factor = defective platelet plug formation
  • Autosomal dominant
153
Q

S+S VWD

A
  • bruising
  • prolonged bleeding
  • Mucosal bleeding
154
Q

VWD Mx

A
  • DDAVP
155
Q

ITP

A
  • Caused by type 2 sensitivity reaction
  • Antibodies target and destroy platelets
156
Q

ITP presentation

A
  • Under 10
  • Recent viral illness
  • Bleeding and bruising
  • purpuric non blanching rash
  • DO an urgent FBC for platelet count
157
Q

ITP Mx

A
  • Prednisolone
  • IVIG
  • Transfusions
  • Platelets
158
Q

Avoid in ITP

A
  • Contact sports
  • Avoid IM injections
  • Avoid NSAIDs, aspirin and blood thinners
159
Q

What leukaemia is most common in children

A

ALL

160
Q

Presentation ALL

A
  • 2-5 years
  • Malaise
  • Anorexia
  • Anaemia
  • Neutropenia
  • Pallor
  • Bruising, nosebleeds
  • Headaches, vomting, palsies
161
Q

Ix ALL

A
  • FBC (low Hb, TP)
  • Blood film
  • BM biopsy
  • CXR
162
Q

Mx ALL

A
  • Chemotherapy
163
Q
  • Brain tumours S+S and Ix
A
  • Always primary in children
  • Increased ICP
  • Focal neuro signs
  • Back pain, peripheral weakness
  • MRI
164
Q

Brain tumour Mx

A
  • Surgery
165
Q

Neuroblastoma

A
  • Arise from neural crest tissue in adrenal medulla and SNS
  • Common before age 5
166
Q

Neuroblastoma Ix

A
  • Raised urinary catecholamine levels
  • USS and MRI = abdo mass
167
Q

Neuroblastoma Mx

A
  • Surgery if localised
  • Metastatic = chemo
168
Q

Wilms tumour

A
  • Neuroblastoma
  • From embryonal renal tissue
169
Q

S+S Wilms

A
  • Large abdo mass
  • Anaemia, haematuria, HTN
170
Q

Wilms Ix and Mx

A
  • USS or CT/MRI = intrinsic renal mass
  • Initial chemo followed by delayed nephrectomy
171
Q

Bone tumour

A
  • Osteogenic sarcoma more common than Ewing
  • Ewing in younger children
  • Male predominance
  • Bone pain
  • XR
  • Chemo and surgery
172
Q

Retinoblastoma

A
  • Malignant tumour retinal cells
  • Csome 13 = susceptibility gene = dominant
173
Q

S+S retinoblastoma

A
  • white pupillary reflex to replace red reflex
  • Squint
174
Q

Ix and Mx retinoblastoma

A
  • Enucleation if advanced
  • Chemo t shrink
  • Local laser treatment
175
Q

Downs syndrome features

A

trisomy 21
- Hypotonia
- Brachycephaly
- Short neck
- Short stature
- Flattened face and nose
- Prominent epicanthic folds
- Upward sloping palpebral fissures
- Single palmar crease

176
Q

Downs syndrome complications

A
  • Learning disability
  • Recurrent otitis media
  • Deafness
  • Visual problems
  • Hypothyroid
  • Cardiac defects
  • Leukaemia
177
Q

Combined test results for downs

A
  • Increased HCG
  • Decreased PAPP-A
  • Thickened nuchal translucency
178
Q

Klinefelter syndrome

A
  • Male has additional X csome = 47XXY
179
Q

features Klinefelter

A
  • Taller
  • Wide hips
  • Gynacomastia
  • Weaker muscles
  • Small testicles
  • Reduced libido
  • Shyness
  • Infertility
180
Q

Mx klinefelter

A
  • Testosterone injecitions
  • MDT input
181
Q

Klinefelter complications

A
  • Breast cancer
  • OP
  • DM
  • anxiety and depression
182
Q

Turner syndrome

A
  • Female has single X csome = 45X0
183
Q

Turner features

A
  • short stature
  • Webbed neck
  • High arching palate
  • Ptosis
  • Broad chest
  • Cubitus valgus
  • Underdeveloped ovaries
  • Late or incomplete puberty
184
Q

Turners Mx

A
  • GH therapy
  • Oestrogen and progesterone
185
Q

Fragile X

A
  • Mutation in FMR1 gene on X csome
  • linked
186
Q

Features fragile X

A
  • Intellectual disability
  • Long narrow face
  • Large ears
  • Large testiles
  • Hypermobile joints
  • ADHD
  • Autism
  • Seizures
  • Mitral valve prolapse
187
Q

Prader Willi features

A
  • Csome 15 = deletion
  • Insatiable hunger
  • Hypotonia
  • Hypogonadism
  • Soft fair skin
  • MH problems
  • Narrow forehead
  • Strabismus
  • Thin upper lip
188
Q

William Features

A
  • Deletion on Csome 7
  • Starburst eyes, broad forehead
  • Flattened nasal bridge
  • Small chin
  • Socialble and trusting
  • Supravalvular aortic stenosis
  • Elfin features
189
Q

Associated conditions with williams

A
  • Supravalvular aortic stenosis
  • ADHD
  • HTN
  • Hypercalcaemia
190
Q

Patau syndrome

A
  • Trisomy 13
  • Rocker bottom feet
191
Q

Noonan features

A
  • autosomal dominant
  • Short stature, broad forehead
  • Ptosis
  • Hypertelorism
  • Low set ears
192
Q

Noonan associated features

A
  • CHD
  • Cryptorchism
  • Bleeding disorders
  • Lymphoedema
  • Increased risk leukaemia and neuroblastoma
193
Q

S+S HIE

A
  • Mild = irritable, excessive stimulation, staring, hyperventilation
  • Moderate = marked abnormalities of tone and movement, can’t feed, seizures
  • Severe = no normal spontaneous movements, hypo and hypertonia, prolonged seizures
194
Q

Mx HIE

A
  • Resp support
  • aEEG
  • Anticonvulsants
  • Fluid restriction
195
Q

RDS definition

A
  • Surfactant deficiency = lowers surface tension = alveolar collapse and inadequate GE
196
Q

How to reduce risk of RDS

A
  • Glucocorticoids gien antenatally to mother to stimulate foetal surfactant production
197
Q

S+S RDS

A
  • Within 4hrs of birth will get
  • Tachypnoea >60
  • Laboured breathing with chest wall recession and flaring
  • Expiratory grunting
  • Cyanosis
198
Q

RDS CXR

A
  • Ground glass appearance and air bronchogram
199
Q

RDS Mx

A
  • Raised ambient oxygen
  • May need continuous positive airway pressure or artificial ventilation
200
Q

Necrotising enterocolitis

A
  • Bacterial invasion of ischaemic bowel wall
201
Q

S+S NE

A
  • Stop tolerating feeds
  • Milk aspirated from stomach
  • Vomiting (bile)
  • Abdo distension
  • Blood in stool
  • Shock
202
Q

NE XR

A
  • distended bowel loops and thickening of bowel wall with intramural gas
203
Q

Mx NE

A
  • Artificial ventilation
  • Stop oral feeding
  • Broad spectrum abx
  • Parenteral nutrition
  • Surgery if perforation
204
Q

Bronchopulmonary dysplasia

A
  • Infants with oxygen requirement at post-menstrual age of 36 weeks
  • Lung damage from pressure and volume trauma
205
Q

Bronchopulmonary dysplasia XR

A
  • widespread areas of opacification, sometimes with cystic changes
206
Q

Bronchopulmonary Dysplasia Mx

A
  • Some need prolonged artificial ventilation
  • Most weaned onto CPAP
  • Corticosteroid therapy may facilitiate earlier weaning from ventilator
207
Q

Why do over 50% of newborn infants become jaundiced

A
  • Marked physiological release of Hb from breakdown of RBCs
  • RBC lifespan shorter than adults
  • Hepatic bilirubin metabolism less efficient in first few days of life
208
Q

Kernicterus

A
  • Encephalopathy resulting from deposition of unconjucated bilirubin in basal ganglia and brainstem nuclei
209
Q

Acute and severe manifestations kernicterus

A
  • Lethargy
  • Poor feeding
    severe
  • Irritability
  • Increased muscle tone (arch back)
  • Seizures
  • Coma
210
Q

What level to babies become clinically jaundiced

A
  • 80 umol/l
211
Q

Jaundice <24 hrs age

A
  • Usually results from haemolysis
  • Bili = unconjugated and can rise rapidly
212
Q

Haemolytic disorders

A
  • Rhesus haemolytic disease
  • ABO incompatibility
  • G6PD
  • Spherocytosis
213
Q

Causes of jaundice 2 days - 2 weeks

A
  • Physiological
  • Breast milk jaundice
  • Dehydration
  • Infection
214
Q

Management of jaundice

A
  • Phototherapy
  • Exchange transfusion
215
Q

Jaundice >2 weeks old

A
  • Persistent neoneatal jaundice
  • May be caused by biliary atresia
216
Q

Meconium aspiration

A
  • Asphyxiated infants may start gasping and aspirate meconium before delivery
  • Meconium = lung irritant = mechanical obstruction and chemical pneumonitis
  • Overinflated lungs with patches of collapse and consolidation
  • Pneumothorax
  • May develop persistant pulmonary HTN
217
Q

S+S neonatal sepsis

A
  • Fever
  • Poor feeding
  • Vomiting
  • APnoea and bradycardia
  • RDS
  • Abdo distension
  • Jaundice
  • Neutropenia
  • Glycaemia
  • Shock
  • Seizures
218
Q

Group B strep infection RF

A
  • PPRM
  • Maternal fever in labour
  • Maternal chorioamnionitis
  • Previous infected infant
  • Prophylactic abx given
219
Q

Listeria infection

A
  • Through food = causes bacteraemia
  • Mild flu like illness in mother
  • Can cause spontaneous abortion, preterm delivery, sepsis
  • Meconium liquor, widespread rash, septicaemia, pneumonia and meningitis
220
Q

HSV infection S+S

A
  • Localised herpetic lesions on skin or eye
  • Encephalitis
  • Disseminated disease
221
Q

Hypoglycaemia symptoms

A
  • Jitteriness
  • Irritability
  • Apnoea
  • Lethargy
  • Drowsiness
  • Seizures
222
Q

Ix neonatal seizre

A
  • Cerebral USS
  • Hypoglycamia and meningitis need to be ruled out
223
Q

Oesophageal atresia

A
  • Associated with tracheo-oesophageal fistula
224
Q

Oesophageal Atresia Ix

A
  • Wide calibre feeding tube fitted and checked by XR
225
Q

Oesophageal Atresia S+S

A
  • Persitent saliva and drooling
  • Cough and choke when fed
  • Cyanotic episodes
226
Q

Other congenital malformations associated with Oesophageal Atresia

A
  • Vertebral
  • Anorectal
  • Cardiac
  • Tracheo-oesophageal
  • Reanal
  • Radial limb
227
Q

Mx Oesophageal Atresia

A
  • Continous suction
228
Q

Gastroschisis

A
  • Bowel protrudes through defect in anterior abdominal wall adjacent to umbilicus
  • Risk of dehydration and protein loss
  • Clingfilm to minimise fluid and heat loss
  • NG tube
  • IV dextrose
  • Colloid support
  • Surgerhy
229
Q

Foetal problems associated with maternal diabetes

A
  • Congenital malformations
  • IUGR
  • Macrosomia
230
Q

Pathophysiology T1DM

A
  • Destruction of pancreatic B cells by autoimmune process
231
Q

S+S DM1

A
  • Polydipsia
  • Polyura
  • Weight loss
  • Candida
  • Sking infection
  • DKA
  • 2 peak ages = age 5-7 and before puberty
232
Q

Ix DM1

A
  • Random glucose >11.1
  • U+E, ketones, urine, blood pH, autoantibodies
  • Fasting blood glucose >7
233
Q

Mx DM1

A

Requirement for insulin changes on age
- Childhood = 0.5-1 u/kg/day
- Puberty = 1.2 - 2 kg/day
- post puberty = 0.7-1.2 u/kg/day
Target = 4-10mmol/l

234
Q

S+S DKA

A
  • Acetone breath
  • Vomiting
  • Dehydration
  • Abdo pain
  • Kussmaul
  • Hypo shock
  • Drowsy
235
Q

Definition DKA

A
  • Hyperglycaemia >11mmol/l
  • pH <7.3
  • Bicarb <15
  • Urinary ketones
236
Q

DKA Ix

A
  • Glucose
  • Ketones >3
  • ABG
  • U+E, creatinine
  • Cardiac monitor
  • Weight
  • Lactate
237
Q

ABG results for mild, moderate and sever DKA

A
  • Mild = pH >7.2 or HCO3 10-15mmol/l
  • Moderate DKA = pH 7.1-7.2 or HCO3 5-10
  • Severe DKA = pH<7.1 or HCO3 <5
238
Q

Mx DKA

A
  • Emergency measures = if shocked give bolus 10ml/kg 0.9% NaCl and cosider abx
  • Fluids = no shock give initial 10ml/kg bolus +rehydration fluids + maintenance fluids
  • Insulin 0.05 units/kg/hr
239
Q

Complications DKA

A
  • Cerebral oedema
  • Rapid correction can cause rapid water shift from extra to intra = oedematous brain
240
Q

Mx hypoglycaemia

A
  • IV glucose 2ml/kg of 10% dextrose
  • Sweating, pallor, CNS
241
Q

Congenital hypothyroidism S+S

A
  • Guthrie positive
  • Prolonged neonatal jaundice
  • Poor feeding
  • Constiptation
  • Increased sleeping
  • Reduced activity
  • Slow growth and development
242
Q

Acquired hypothyroidism S+S

A
  • Fatigue and low energy
  • Poor growth
  • Weight gain
  • Poor school performance
  • Constipation
  • Dry skin and hair loss
243
Q

CAH definition

A
  • Underproduction of cortisol and aldosterone and overproduction of androgens from birth
  • AR = congenital deficiency of 21 hydroxylase
244
Q

CAH pathophysiology

A
  • 21H converts progesterone to aldosterone and cortisol. lack therefore means extra progesterone converted to testosterone = low ald and high test
245
Q

S+S CAH

A
  • Ambiguous genitalia, enlarged clitoris
  • Severe = after birth hypona, hyperka, hypogly
  • Poor feeding
  • Vomiting and dehydration
  • Arrhythmia
    older
  • Tall
  • Facial hair
  • Absent periods
  • Small testicles, large penis
  • Hyperpigmentation
246
Q

Adrenal crisis S+S

A
  • 1-3 weeks old
  • Vomiting
  • WL
  • Floppy
  • Circulatory collpase
    Mx
  • Hydrocortisone
  • Saline
  • Glucose
247
Q

CAH Ix

A
  • Low plasma Na
  • High plasma K
  • Met acodosis
  • hypo
248
Q

Mx CAH

A
  • Hydrocortisone to replace cortisol
  • Fludrocortisone to replace aldosterone
  • Surgery
249
Q

RF for OMedia

A
  • 6-16 months
  • Male
  • Passive smoking
  • Bottle feed
  • Craniofacial abnormalities
    suppurative = mucopurulent discharge
    Effusion = grey TM, loss of light and fluid behind TM
250
Q

S+S OMedia

A
  • Severe pain
  • Systemic features
  • Coryzal
  • Bright red and bulging tympanic membrane, loss of reflection
  • Test facial nerve function
251
Q

OMedia causative

A
  • S pneumonia
  • RSV, rhinovirus
252
Q

Mx OMedia

A
  • Usually spontaneous recovery
  • ABX shorten pain but dont reduce hearing loss
  • <2yo = antibiotics (amox, erythro)
253
Q

OMedia complication

A

Mastoiditis
- Necrosis, subperiosteal abscess
- Boggy, erythematous swelling behind ear
- IV Abx

254
Q

OMedia with effusion

A
  • Glue ear = result of recurrent ear infection
  • Viscous inflammatory fluid build up
  • Eardrum dull, retraces, visible fluid level
  • Asymtpomatic apart from hearing loss
  • Spontaneous recovery
  • Grommets if not recovering
255
Q

S+S asthma

A
  • Suspect in any child with wheeze
  • Wheeze, cough and breathlessness worse at night and morning
  • Interval symptoms
256
Q

Mx asthma

A
  1. SABA for all
    >5
  2. ICS
  3. LRTA
  4. LABA
  5. MART
    <5
  6. ICS 8 week trial
  7. LRTA
257
Q

Moderate asthma attack

A
  • Talk
  • Sats >92
  • PF >50%
    • RR
  • <40 for 1-5
  • <30 for 5-12
  • <25 for 12-18
    • HR
  • <140 for 1-5
  • <125 for 5-12
  • <110 for 12-18
    • SABA, prednisolone, monitor
258
Q

Severe asthma attack

A

• Too breathless to talk
• O2 sats <92 for <12
• Peak flow 33 – 50%
• RR
- >40 1-5
- >30 5-12
- >25 12-18
• HR
- >140 1-5
- >125 5-12
- >110 12-18
• Oxygen, SABA, prednisolone
• Consider ipratropium

259
Q

Life threatening asthma attack

A
  • Silent chest, cyanosis
  • Poor resp effort
  • Exhaustion
  • Arrhhythmia, hypotension
  • PF <33
  • )2 <92
  • Oxygen, SABA, Pred, neb ipratropium
260
Q

Epiglottitis

A
  • Similar clinical to croup
  • H influenza
  • Ill child, high fever
  • Drooling unable to swallow
  • Soft stridor
    EMERGENCY
  • O2 and neb adrenaline
  • Anaesthetist, paeds and ENT
  • Keep calm as crying bad
261
Q

CF definition

A
  • AR = mutation in CF transmembrane condictance regulator fene
262
Q

CF Pathophysiology

A
  • Multisystem disorder = results from abnormal ion transport across epithelial cells
  • CFTR gene encoded CFTR protein = Cl channel. Cl is driven against its concentration gradient using ATP
  • Airways = reduction in airway surface liquid layer  impaired ciliary function and retention of mucopurulent secretions which are prone to infection
  • Defective CFTR = dysregulation of inflammation an defence against infection
    = Intestine = thick viscid meconium  meconium ileus in 10-20%
  • Pancreatic ducts = blocked with thick secretions  pancreatic enzyme deficiency and malabsorption
  • Sweat gland abnormal function  excessive concentration of Na and Cl in sweat
263
Q

CF S+S

A
  • Meconium ileus
  • Prolonged neonatal jaundice
  • Recurrent infections
  • Malabsorption, steatorrhea
  • Bronchiectasis
  • Persistent cough
  • DM
  • Cirrhosis and portal HTN
  • hyperinflation, coarse creps inspiration and expiratory wheeze , clubbing
264
Q

CF Ix

A
  • Sweat test
  • Genetic testing
  • CXR = hyperinflation, bronchial dilation, cysts, linear shadows
265
Q

CF Mx

A
  • Nebulized mucolytics = DNase and hypertonic saline
  • ABx
  • Lactulose
  • Pancreatic enzyme replacement
  • CFTR modulators
  • Physio
266
Q

JIA definition

A
  • Persistent joint swelling of >6 weeks presenting before 16 YO in absence of infection or other cause
  • Oligo = up to and including 4
  • Poly = more than 4
267
Q

S+S JIA

A
  • Morning joint stiff
  • Pain
  • Young = intermittent limp or mood deterioration
  • Swelling
  • Gradual onset
  • Non use
  • Rash, fever, WL
268
Q

Ix JIA

A
  • Exclusion in children <16
  • FBC, CRP/ESR, infection screen, Rh, ANA
  • Imaging
  • Early XR = soft tissue swelling, juxta-articular osteopenia
  • Late XR = joint space narrowing and erosions
  • Gadolinium enhanced MRO GS for synovitis
269
Q

Mx JIA

A
  • NSAIDs
  • Joint injections = 1st line in oligo
  • Methotrexate
  • Corticosteroids if severe
  • Biologics = cytokine modulators
270
Q

JIA complications

A
  • Chronic anterior uveitis
  • Joint contractures and erosions
271
Q

DDH RF

A
  • FHx
  • Female
  • Breech
272
Q

DDH S+S

A

Infant
- Asymmetrical gluteal folds
- Limited abduction
- LL discrepancy
- Galeazzi sign
Older
- Limp
- +ve trendelenburg
- Bilateral dislocations = exaggerated lumbar lordosis and limited hip abduxtion

273
Q

Ix DDH

A
  • Ortolani and Barlow = NIPE
  • <6 months USS
    >6 months AP pelvis radiograph = shallow acetabulum, increased ondex, hypoplastic femoral head
274
Q

DDH Mx

A

<6 months
- Pavlik harness
6-18 months
- Manipulation and closed reduction and plaster cast
18-24 months
- Trial of closed reduction +/- pelvic osteotomy and cast
2-6 years
- Open reduction +/- femoral shortening +/- pelvic osteotomy and cast

275
Q

Perthes definition

A
  • Idiopathic avascular necrosis of capital femoral head due to interruption of blood supply
276
Q

RF Perthes

A
  • Boys
  • 5-10
  • Obesity
  • Trauma
  • Endocrine/metabolic
277
Q

S+S Perthes

A
  • Insidious presentation
  • Limp, hip or knee pain
  • Mild intermittent anterior thigh/groin/knee pain
  • Bilateral
  • Painless limp
278
Q

Ix perthes

A
  • Early XR = normal
  • Later XR = increased density in femoral head = fragmented and residual deformity
    A = no loss of height of lateral 1/3
    B = up to 50% loss of height
    C = >50% loss of height
  • Technetium 99 scan
279
Q

Perthes on examination

A

Look
- Proximal thigh atrophy
- Mild short stature
- Limp/Trendelenberg/antalgic gait
Feel
- Effusion
- Groin/thigh tenderness
Move
- Decreased hip ROM with spasm

280
Q

Perhtes Mx

A
  • Physio
  • Rest and walking aids
  • NSAIDs
  • Surgery
  • Local self healing disorder
281
Q

Osteomyelitis definition

A
  • Infection of metaphysis of long bone
282
Q

Causative organisms Osteomyelitis

A
  • Staph aureus
  • Neonates = GBS
  • <2 HI
  • > 2 gram +ve
283
Q

S+S osteomyelitis

A
  • Low grade pyrexia and malaise
  • Markedly painful immobile limb
  • Tender, warm swelling
  • POM
  • Infants = swollen and ROM
284
Q

Ix osteomyelitis

A
  • Cultures
  • WCC, CRP and ESR raised
    _ XR = early normal, late = metaphyseal rarefaction, destructive changes after 10 days
285
Q

Mx osteomyelitis

A
  • IV Abx 2 weeks then oral for 4
  • Drainage and debridement
286
Q

Septic arthritis S+S

A

Knee>hip>ankle
- Erythematous warn tender joint
- Reduced ROM
- Hold limb still
- Joint effusion in peripheral joints
- 50% dont have fever

287
Q

SA Ix

A
  • Bloods = increased WCC
  • Cultures
  • XR = joint space narrowing and erosive changes
  • Aspiration
  • USS
  • MRI
288
Q

SA Mx

A
  • IV Abx after aspirate taken for up to 3 weeks then oral 4-6 weeks
  • Surgery = irrigation and debridement
  • Splnitage
  • Physio
289
Q

Type 1 osteogensis imperfecta

A
  • AD
  • Fractures in childhood
  • Blue sclera
290
Q

Type 2 OI

A
  • Lethal
  • Multiple fractures before birth
291
Q

S+S rickets

A
  • Rachitis rosary
  • Horizontal depression lower chest
  • Bowed legs
  • Softening of skull vault
  • Delayed closure fontanelle
  • Hypotonia
292
Q

XR rickets

A
  • Cupping and fraying of metaphyses
  • Widened growth plate
  • Joint widening
  • Bowing of diaphysis
  • Thickening and widening of epiphysis
293
Q

Transient synovitis

A
  • Follows or accompanied by viral infection
  • Sudden onset in pain or a limp
  • No pain at rest
  • Decreased ROM
  • May refer to knee
  • Afebrile
294
Q

Slipped upper femoral epiphysis

A
  • RF = AA, endo, obese
  • Groin thigh or knee pain
  • Antalgic gait
  • Limited hip flexion and abduction
  • Thigh atrophy
295
Q

Idiopathic scoliosis

A
  • Painless, convex to right, no neuro
  • Ix = standing PA and lateral XR full spine
  • MRI if pain or neuro
  • TX = obs, manipulation, casting, surgery
296
Q

Malrotation

A
  • 1-3 days of life present with obstruction from Ladd bands obstructing duodenum or with volvulus
  • Bilious vomiting, abdo pain, tender from peritonitis
  • GI contrast study needed if bilious vomiting
  • Surgical correction
297
Q

Biliary atresia

A
  • Section of bile duct narrowed or absent
  • Cholestasis and prevented excretion conjugated bili
  • Present after birth = jaundice (persistent) and high conj bili
  • Surgery = kasai portoenterostomy
  • Transplant liver
298
Q

Pathophysiology cows milk allergy

A

IgE mediated
- Type 1 hypersensitivity
- CD4 + TH2 cells stimulate B to produce IgE abs = histomine and cytokines
Non IgE
- T cell activation againt CMP

299
Q

IgE CMP S+S

A
  • Acute onset
  • Pruritus, erythema, urticaria, angio-oedema
  • N+V
  • Colick, diarrhoea
300
Q

Non IgE CMP S+S

A
  • Delayed
  • Pruritus, erythema, atopic eczema
  • GORD
  • Loose stools
  • Blood/mucus
  • Abdo pain, food refusal, pallor, tiredness
301
Q

Mx CMP allergy

A
  • Avoidance
  • MAP guideline
  • Hydrolysed formula or AA formula
302
Q

UC histology and radiology

A
  • Crypt abscesses, mucosal inflammation, architectural distortion, crypt loss
  • Mucosal ulceration, haustration loss, colonic narrowing
303
Q

S+S UC

A
  • Rectal bleed
  • Diarrhoea
  • Colicky
  • Weight loss and grwoth failure
304
Q

MX UC

A
  • Amino salicylates for induction and maintenance
  • Aggressive = steroids
  • Surgery
305
Q

Crohns patho

A
  • Mouth to anus
  • Skip lesions
  • Transmural infalmmation = deep ulcers and fissures
  • Non caseating granulomatous inflamation
306
Q

Crohns S+S

A
  • Growth failure, puberty delayed
  • General ill health
  • Abdo pain, diarrhoea, blood, weight loss
  • Oral lesions
  • Uveitis
307
Q

Crohns Ix

A
  • Bloods
    PANCA
  • MC+S
  • Calcoprotein
  • Endoscopy and radiology (crypt abscesses, transmural inflammation, cobblestnes)
308
Q

Crohns Mx

A
  • Mild = oral 5 ASA dimers
  • Moderate = pred to induce remission
  • Maintenance = Immunomodifiers
309
Q

Crohn’s vs UC

A

Crohn’s
- Mouth to anus
- Transmural
- Discontinuous
- Granuloma and recr=tal sparing
- Fissures, fistula, strictures
- perianal disease
UC
- Colon only
- Mucosal
- Continuous
- no granuloma and no rectal sparing
- Abscesses and strictures rare
- primary sclerosing cholangitis

310
Q

Gastroenteritis - general Ix

A
  • Stool sample if blood, septicaemia, immunocompromised
    U+E = IVF if hyperna
311
Q

When to consider DD for gastroenterieis

A
  • Temp >38 if <3m
  • Tachy
  • GCS altered
  • Meningism
  • Blood/mucus
  • Green vomit
  • Distension or guarding
312
Q

Mx gastroenteritis general

A
  • no dehydrated = feeds, fluids
    dehydrated
  • fluid deficit replacement and maintenance
  • IV if shock
  • ORS 50ml/kg over 4 hrs
313
Q

Viral gastroenteritis

A
  • Rota, noro, adeno
  • S+S = watery, cramps, fever, dehydration, electrolyte
  • Rota = URT signs
  • Microscopy
  • Rehydrate to treat
314
Q

Bacterial gastroenteritis

A
  • Salmonella (egg, poultry), CB (poultry, UPmilk), shigella (water, pools, food), E coli (faeces, unwashed salad), bacillus cereus (cold rice)
  • malaise, dysentery, tenesmus
  • culture
  • rehydrate
    abx severe = azith or cipro
315
Q

Protozoa GE

A
  • Giardia = pets and animals = diarrhoea and abdo pain, metronidazole
  • Cryptosporidium = erythromycin, met or sripamycin
316
Q

Classical form coeliac

A
  • 9-24 months
  • Malabsorption
  • FTT and weight loss
  • Loose stools and steat
  • Anorexia
  • Abdo pain and distension
  • Behaviour change
  • Crypt hyperplasia and villous atrophy
317
Q

Atypical form coeliac

A
  • No intestinal sx
  • Extra sx = OP, neuropathy, anaemia, infertility
  • +ve serology
  • limited abnormalities
318
Q

Hirschprung’s disease

A
  • Absence ganglion cells in hindgut = ansence of coordinated peristalsis
  • Neonates, fail mec in 24hrs, abdo distension and bile vomit
  • older = chronic constipation, abdo distension, growth faltering
319
Q

Hirschprung Ix and Mx

A
  • DRE = gush stoll and flatus
  • AXR = distal intestinal obstruction
  • Biopsy
  • Colostomy and anastomosis = Swenson procedure
320
Q

When to biopsy for hirschprung

A
  • delayed mecomium 48hrs
  • constipation since first few weeks of life
  • chronic distension and vomiting
  • FHx
  • Faltering growth
321
Q

Diagnostic criteria for constipation

A
  • <3 complete stolls a week
  • hard large stool
  • rabbit droppings
  • overflow soiling
322
Q

Constipation management

A
  1. laxative (macrogol) and diet
  2. stimulant laxative (senna)
  3. lactulose/softener
323
Q

Measles

A
  • Temperature
  • rash = behind ears, whole body
  • Koplik spots = white on inside cheeks
  • Conjunctivitis, cough, malaise
  • Supportive treatment
  • immunocompromised = ribavarin
324
Q

Mumps

A
  • Fever, malaise,parotid gland swelling
  • 1 side face swollen
  • earache
  • plasma amylase elevated
325
Q

Rubella

A
  • Maculopapular rash, lymphadenopathy
    Complications
  • arthritis
  • encephalitis
  • thrombocytopenia
  • myocarditis
326
Q

Chicken pox

A
  • VZV
  • vessicles on trunk/face and spread outwards
  • lesions scab over = no longer infectious
  • fever, itch, malaise
  • 5 day exclusion
  • aziclovir if serious
  • VZIG prophylaxis
327
Q

Impetigo

A
  • staph or strep skin infection
  • lesions on facem neck and hands begin as erythematous papules
  • rupture of vesicles = honey coloured crusted lesions
  • topical abx
  • fluclox if severe
328
Q

toxic shock

A
  • s aureus or group a strep
  • fever over 39
  • hypotension
  • diffuse erythematou macular rash
  • organ dysfunction
  • thrombocytopenia, coagulopathy, abnomral LFTs
  • manage shock, debridement
  • cef with clindamycin
  • IVIG to neutralise circulating toxin
329
Q

Scalded skin syndrome

A
  • Exfolaitive staph toxin
  • fever, malaise
  • Purulent crusting around eyes,nose, mouth
  • widesread erythema and tenderness
  • areas seperate ong ente oressure
  • Fluclox, analgesia, hydration
330
Q

HIV S+S

A
  • lymphadenopathy
  • parotid enlargement
  • recurrent bacterial
  • candidiasis
  • chronic diarrhoea
  • pneumonitis
331
Q

HIV Ix

A
  • > 18m = detect antibodies
  • <18m = transplacental maternal IgG HIV antibodies so positive test shows exposure not infection
332
Q

HIV Mx

A
  • prophylactic co-trimoxazole if low CD4
  • Immunisations
333
Q

TB S+S

A

Asymptomatic
- Minimal or no S+S
- Positive Mantoux or interferongamma release assay = give chemoprophylaxis
Symptomatic
- Lung lesion plus LN = Ghon/primary complex
- Fever
- Weight loss
- Cough
- CXR changes
4-8 weeks
- Febrile illness
- Erythema nodosum
- Phlyctenular conjunctivitis
6-9 months
- Progressive healing of primary complex
- Effusion
- Cavitation
- Coin lesion on CXR
- Regional LN may obstruct bronchi
- Regional LN may erode into bronchus or pericardial sac
- Miliary spread
REACTIVATION = tuberculous meningitis

334
Q

TB Ix

A
  • Sputum on 3 consecutive = ZN stain for AFB
  • Urine, LN, CSF
  • CXR
  • Mantoux skin test
335
Q

Mx TB

A

pulmonary
- 2 months RIPE
- 4 months RI
miliary
- 3 months RIPE
- 12-18 months RI

336
Q

EBV

A
  • Causes mono
  • fever, malaise, tonsilitis, petechia palate, maculopapuar rash
  • +ve monospot test
  • Symptomatic treatment
337
Q

Febrile seizures

A
  • 2-5minutes, high fever, underlying illness
  • manage underlying source of infection
338
Q

Hypospadias

A
  • Urethral opening proximal to normal meatus
  • Hooded dorsal foreskin
  • Chordee
  • No circumsision
  • surgery before 2yo
339
Q

S+S and Tx chronic urticaria

A
  • Rapidly developing erythematous eruption with central white wheals, angio oedema, 4-24hrs
  • 1st line = high dose 2nd gen AH = cetirizine 40mg
  • severe = short coourse PO pred -.5mg/kg
340
Q

HSP

A
  • Non granulomatous IgA vasculitis
  • URTI
  • Purpura legs, bum, arms, symmetrical and trunk spared
  • macroscopic haem or mild protien
  • angioeoedema
  • Mx = rest, analgesia, hydrate, steroids
341
Q

Spina bifida occulta

A
  • No herniation neural tissue
  • dermal sinus, dimple, lipoma, hairy naevus
342
Q

Spina bifida meningocele

A
  • Herniation fluid and meninges only
    skin covering
  • surgical closure
343
Q

Spina bifida myelomeningocele

A
  • Herniation spinal neural tissue
  • adjacent spinal cord abnormal
  • flaccid paralysis below lesion, incontinence, urinary tract dilatation
  • surgical closure and hydrocephalus drainage
344
Q

Mx eneurisis

A
  • fluid restriction before bed and empty bladder
    -star chart
  • eneurisis alarm
    desmopressin
345
Q

Mx eczema

A
  • Mild = 1% hydrocortisone
  • Mild - moderate = clobetasome 0.05%
  • moderate to severe = monentason furouate
346
Q

Rickets biochemical picture

A
  • Reduced serum Ca and Phosphate
  • Raised serum ALP
347
Q

RF rickets

A
  • underexposure to sunlight esp if darker skin
  • Vit D deficiency from poor diet or malabsorption
  • Chornic liver disease or kidney disease
  • Anticonvulsants
348
Q

Esotropia

A

Inward positioned squint (affected eye towards nose)

349
Q

Exotropia

A
  • Outward positioned squint (affected eye towards ear)
350
Q

Hypertropia

A

Upward moving affected eye

351
Q

Hypotropia

A

Downward moving affected eye

352
Q

causes of squint

A
  • isiopathic
  • hydrocephalus
  • cerebral palsy
    = space occupying lesions
  • trauma
353
Q

Hirschberg’s test

A
  • pen torch from 1m
  • observe reflection of light source on cornea
  • Deviation from centre = squint
354
Q

Cover test

A
  • Cover 1 eye and ask patient to focus on an object in front
  • Move cover to opposite eye and watch movement of other eye
  • If move inwards it has drifted outwards when covered = exotropia
  • If moves outwards it has drifted inwards when covered = eso
355
Q

Audiometry

A
  • <3y tested for basic response to sound
  • Older = specific tones and volumes
  • Audiometry recorded on audiogram = identify conductive and sensorineural hearing loss
356
Q

Audiogram

A
  • Establish the minimum volume required for the patient to hear each frequency
  • Air and bone conduction tested seperately
  • Normal hearing = between 0 and 20 DB
357
Q

Sensorineural hearing loss

A
  • Air and bone more than 20 DB
358
Q

Conductive hearing loss

A
  • Bone - normal
  • Air = greater than 20db
359
Q

Mixed

A
  • Air abd bone more than 20
  • Difference of 15db between the 2
360
Q

Mx ADHD

A
  • Methylphenidate (ritalin)
  • Dexamfetamine
  • Atomoxetine
361
Q

IM adrenaline doses >12y

A
  • 500mcg IM (0.5ml)
362
Q

Adrenaline age 6-12y

A

300mcg IM

363
Q

adrenaline 6m-6y

A
  • 150mcg
364
Q

adrenaline <6m

A

100-150mcg

365
Q

roseola infantum

A
  • Herpes simplex 6
  • after fever subsides
  • SE = febrile seizures
366
Q

Nephrotic complications

A
  • Hypercholesterolaemia = cholesterol correlates inversely with serum albumin
  • Thrombosis
  • Infection
  • Hypovolaemia
367
Q

amblyopia

A
  • Defective visual acuity
  • Persists after correction of refractive error and removal of any pathology
368
Q

<3m S+S UTI

A
  • FTT
  • Irritable, lethargy
  • Fever, vomiting
  • Poor feed
  • <3m suspect UTI = refer = abx, sepsis screen, mc+s
369
Q

> 3m S+S UTI

A
  • Continence change
  • Vomiting
  • Frequency,dysuria
  • Pain and loin tenderness
  • Poor feed
370
Q

when do you need a urine sample

A
  • Fever >38
  • S+S
  • <3m
  • Alternative site infection but stays unwell
371
Q

Mx UTI

A
  • > 3m pyelo = cef or coamox
  • > 3m cystisis = triemth or nitro
  • <3m = IV cef
372
Q

Atypical UTI

A
  • Non e coli
  • increased creatinine
  • Fail respond 48hrs
  • mass felt
    ix
  • MCUG
  • DMSA scan
  • USS
373
Q

Impetigo

A
  • Staph aureus
  • Off school until dry and scabbed or 48hrs abx
  • Topical 1% hydrogen peroxide 5 days if non-bullous or uncomplicated
  • 2% fusidic acid or mupirocin for 5 days if hydro not tolerated or around eyes or ineffective
374
Q

Turners heart issues is…

A

bicuspid aortic valve or coarctation aorta

375
Q

Meningococcal sepsis mx <3m

A
  • Iv amox and IV cefotaxime
376
Q

meningococcal sepsis mx >3m

A

IV cefotaxime
Consider dex

377
Q

cerebral palsy definition

A

disorder of movement and posture due to non progressive lesion of motor pathways in developing brain

378
Q

possible manifestations cerebral palsy

A
  • Abnormal tone
  • delayed motor milestones
  • abnormal gait
  • feeding difficulty
379
Q

types of cerebral palsy

A
  • Spastic = increased tone due UMN damage
  • Dyskinetic = damage to BG and SN
  • Ataxic
  • Mixed

Phase 3a (23 decks)

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