Core conditions Flashcards
Name 5 clinical features of acute viral bronchiolitis (WOB only counts as one)
- Fever
- Increased WOB or apnoea
- Cough (dry or moist)
- Widespread crackles/wheeze
Name 6 clinical features that would make acute viral bronchiolitis more than just “mild”
- Behaviour: irritability
- Respiratory rate: increased
- Work of breathing: suprasternal retraction, nasal flaring, retractions
- Oxygen status: <92% RA
- Apnoeic episodes: may be present
- Feeding: reduced/difficulty
Name 5 clinical features of Henoch-Schonlein purpura
- Rash (palpable petechiae-purpura-ecchymosis; symmetrical, dependent)
- Arthritis/arthralgia (large joints lower limb)
- Abdominal pain
- Renal impairment
- Painful subcutaneous oedema (periorbital, dependent)
Intussusception
- Age group typically affected?
- 6 clinical features?
- 3 complications?
- Gold-standard first-line investigation?
- Management?
- Chance of recurring?
- 3m-3y
- Pain (sudden onset, colicky), vomiting, systemic features, lethargy, fever, red currant jelly stool (in first 12 hours)
- Dehydration, bowel obstruction, bowel ischaemia
- Ultrasound (target sign on R side)
- Air enema reduction (for simple cases)
- 10% (usually within 24 hours)
Malrotation/volvulus
- Age group typically affected?
- 6 clinical features?
- Main complication?
- Gold-standard first-line investigation?
- Management
- Chance of recurring?
- First month of life
- Vomiting (bile-stained), feeding difficulties, PR bleeding (delayed), abdominal distension (delayed), abdominal tenderness (delayed)
- Intestinal ischaemia
- Upper GI contrast study
- Surgery (Ladd’s procedure)
- 3% (increased risk of intussusception as well)
Pyloric stenosis
- Age/gender group typically affected?
- 6 clinical features?
- 3 consequences?
- Gold-standard first-line investigation?
- What is the immediate management?
- Name 4 risks that this patient would have if going into surgery immediately
- Surgical procedure for definitive management?
- Male (85%), 3-6 weeks
- Vomiting (non-bilious, projectile, postprandial), dehydrated, decreased stools, weight loss, visible peristaltic waves, olive-sized mass in RUQ
- Dehydration, hypochloraemic hyperkalaemic metabolic alkalosis, paradoxical urine acidosis
- Abdominal ultrasound (will see long, thick pyloric canal with target-like appearance on cross-section)
- Rehydration and correction of metabolic disturbances (is a medical, not surgical emergency)
- Cardiovascular collapse (hypovolaemia), exacerbation of decreased resp drive (metabolic alkalosis), arrhythmias (hypokalaemia), aspiration (full stomach)
- Pyloromyotomy
- What are the diagnostic criteria for Kawasaki disease
- Name 6 investigations that are part of work-up
- Name 2 components of medical therapy
- Fever for 5+ days, plus 4 of:
i) Polymorphous rash
ii) Bilateral conjunctival injection
iii) Mucous membrane changes (red lips, strawberry tongue, diffuse oral redness)
iv) Peripheral changes (erythema of palms or soles, oedema of hands or feet, desquamation)
v) Cervical lymphadenopathy (>15mm) - ASOT/Anti-DNase B (exclude strep), echocardiography (at least 2x), FBE and film (thrombocytosis after 1 week, neutrophilia, normochromic normocytic anaemia), raised ESR/CRP, LFTs (elevated enzymes, low albumin)
- IVIg (within first 10 days), low-dose aspirin for 6-8 weeks
List the 4 most common symptoms of pneumonia in children
- High fever
- Tachypnoea
- Cough (initially usually absent, particularly with S. pneumoniae, becomes more prominent as inflammation spreads)
- Abdominal pain
List 5 complications of pneumonia
- Empyema (suspect if ongoing fever after 48 hours; usually has good prognosis)
- Necrotising pneumonia
- Lung abscess
- Sepsis
- Spread (osteomyelitis, septic arthritis)
Clinical stages of measles
- Prodrome: the 3 C’s, fever (sudden onset, high), irritability, nonspecific symptoms
- Rash
- Convalescent: rash fades, temporary brown staining
List 3 complications of measles
- Otitis media (10%)
- Pneumonia (5%) - responsible for majority of deaths
- Neurological
- Encephalitis
- Subacute sclerosing panencephalitis
5 differential diagnosis for the measles-like rash
- Roseola infantum (difference is child looks well, and rash only appears as fever subsides)
- Other viral infections
- Enterovirus
- Adenovirus
- EBV
- Influenza/parainfluenza - Antibiotic rash
- Kawasaki disease
- Scarlet fever
Name 6 different organ systems that may be affected by CF, and one resultant clinical feature for each
- Lungs: suppurative lung disease
- Pancreas: exocrine deficiency → malabsorption of fat-soluble vitamins, steatorrhoea, failure to thrive
- Liver: multifocal biliary cirrhosis
- GIT: meconium ileus, distal intestinal obstruction syndrome
- Reproductive: absent vas deferens
- Blood: hyponatremic, hypochloraemic metabolic alkalosis due to elevated sweat electrolytes
Name the three components of the screening regime for cystic fibrosis, and how they fit into the overall picture
- Serum trypsinogen - done on all newborns
- Gene mutation testing - done if trypsinogen result >99th percentile; need 2 mutations
- Sweat test - done if only one mutation
Name two differential diagnoses for cystic fibrosis
- Primary ciliary dyskinesia
2. Immunodeficiency (primary or secondary)