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Paediatrics > Core conditions > Flashcards

Core conditions Flashcards

1
Q

Name 5 clinical features of acute viral bronchiolitis (WOB only counts as one)

A
  1. Fever
  2. Increased WOB or apnoea
  3. Cough (dry or moist)
  4. Widespread crackles/wheeze
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2
Q

Name 6 clinical features that would make acute viral bronchiolitis more than just “mild”

A
  • 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
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3
Q

Name 5 clinical features of Henoch-Schonlein purpura

A
  1. Rash (palpable petechiae-purpura-ecchymosis; symmetrical, dependent)
  2. Arthritis/arthralgia (large joints lower limb)
  3. Abdominal pain
  4. Renal impairment
  5. Painful subcutaneous oedema (periorbital, dependent)
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4
Q

Intussusception

  1. Age group typically affected?
  2. 6 clinical features?
  3. 3 complications?
  4. Gold-standard first-line investigation?
  5. Management?
  6. Chance of recurring?
A
  1. 3m-3y
  2. Pain (sudden onset, colicky), vomiting, systemic features, lethargy, fever, red currant jelly stool (in first 12 hours)
  3. Dehydration, bowel obstruction, bowel ischaemia
  4. Ultrasound (target sign on R side)
  5. Air enema reduction (for simple cases)
  6. 10% (usually within 24 hours)
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5
Q

Malrotation/volvulus

  1. Age group typically affected?
  2. 6 clinical features?
  3. Main complication?
  4. Gold-standard first-line investigation?
  5. Management
  6. Chance of recurring?
A
  1. First month of life
  2. Vomiting (bile-stained), feeding difficulties, PR bleeding (delayed), abdominal distension (delayed), abdominal tenderness (delayed)
  3. Intestinal ischaemia
  4. Upper GI contrast study
  5. Surgery (Ladd’s procedure)
  6. 3% (increased risk of intussusception as well)
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6
Q

Pyloric stenosis

  1. Age/gender group typically affected?
  2. 6 clinical features?
  3. 3 consequences?
  4. Gold-standard first-line investigation?
  5. What is the immediate management?
  6. Name 4 risks that this patient would have if going into surgery immediately
  7. Surgical procedure for definitive management?
A
  1. Male (85%), 3-6 weeks
  2. Vomiting (non-bilious, projectile, postprandial), dehydrated, decreased stools, weight loss, visible peristaltic waves, olive-sized mass in RUQ
  3. Dehydration, hypochloraemic hyperkalaemic metabolic alkalosis, paradoxical urine acidosis
  4. Abdominal ultrasound (will see long, thick pyloric canal with target-like appearance on cross-section)
  5. Rehydration and correction of metabolic disturbances (is a medical, not surgical emergency)
  6. Cardiovascular collapse (hypovolaemia), exacerbation of decreased resp drive (metabolic alkalosis), arrhythmias (hypokalaemia), aspiration (full stomach)
  7. Pyloromyotomy
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7
Q
  1. What are the diagnostic criteria for Kawasaki disease
  2. Name 6 investigations that are part of work-up
  3. Name 2 components of medical therapy
A
  1. 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)
  2. 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)
  3. IVIg (within first 10 days), low-dose aspirin for 6-8 weeks
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8
Q

List the 4 most common symptoms of pneumonia in children

A
  • High fever
  • Tachypnoea
  • Cough (initially usually absent, particularly with S. pneumoniae, becomes more prominent as inflammation spreads)
  • Abdominal pain
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9
Q

List 5 complications of pneumonia

A
  1. Empyema (suspect if ongoing fever after 48 hours; usually has good prognosis)
  2. Necrotising pneumonia
  3. Lung abscess
  4. Sepsis
  5. Spread (osteomyelitis, septic arthritis)
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10
Q

Clinical stages of measles

A
  1. Prodrome: the 3 C’s, fever (sudden onset, high), irritability, nonspecific symptoms
  2. Rash
  3. Convalescent: rash fades, temporary brown staining
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11
Q

List 3 complications of measles

A
  1. Otitis media (10%)
  2. Pneumonia (5%) - responsible for majority of deaths
  3. Neurological
    - Encephalitis
    - Subacute sclerosing panencephalitis
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12
Q

5 differential diagnosis for the measles-like rash

A
  1. Roseola infantum (difference is child looks well, and rash only appears as fever subsides)
  2. Other viral infections
    - Enterovirus
    - Adenovirus
    - EBV
    - Influenza/parainfluenza
  3. Antibiotic rash
  4. Kawasaki disease
  5. Scarlet fever
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13
Q

Name 6 different organ systems that may be affected by CF, and one resultant clinical feature for each

A
  1. Lungs: suppurative lung disease
  2. Pancreas: exocrine deficiency → malabsorption of fat-soluble vitamins, steatorrhoea, failure to thrive
  3. Liver: multifocal biliary cirrhosis
  4. GIT: meconium ileus, distal intestinal obstruction syndrome
  5. Reproductive: absent vas deferens
  6. Blood: hyponatremic, hypochloraemic metabolic alkalosis due to elevated sweat electrolytes
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14
Q

Name the three components of the screening regime for cystic fibrosis, and how they fit into the overall picture

A
  1. Serum trypsinogen - done on all newborns
  2. Gene mutation testing - done if trypsinogen result >99th percentile; need 2 mutations
  3. Sweat test - done if only one mutation
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15
Q

Name two differential diagnoses for cystic fibrosis

A
  1. Primary ciliary dyskinesia

2. Immunodeficiency (primary or secondary)

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16
Q

What are the 4 most common pathogens responsible for acute otitis media in children?

A
  1. S. pneumonia (35%)
  2. Viral (25%)
  3. Non-typeable H. influenzae (25%)
  4. M. catarrhalis (15%)
17
Q

Name 3 clinical features of acute otitis media in children

A
  1. Fever
  2. Ear pain/tugging
  3. Nonspecific: anorexia, vomiting, lethargy
18
Q

Name 4 complications of acute otitis media

A
  1. Tympanic membrane perforation (will usually relieve pain)
  2. Spread of infection (suppurative): mastoiditis, labyrinthitis, intracranial infection
  3. Serous otitis media (“glue ear”) - can persist for weeks-months
  4. Chronic otitis media
19
Q

List 3 situations in which antibiotics ARE indicated as first-line management for otitis media

A
  1. <1yo
  2. Immunocompromised
  3. Severely unwell
20
Q

List 3 common clinical presentations of adenovirus infection, and how it is diagnosed

A
  1. Exudative tonsillitis: particularly in infancy (GAS rare)
  2. Conjunctivitis + red throat and fever
  3. Gastroenteritis

Diagnosis: throat swab → viral culture/immunofluorescence

21
Q

List 3 warning signs that may suggest appendicitis

  • Abdo pain….
  • Diarrhoea…
  • One extra sign

Is high fever characteristic?
List the preferred investigation that may help in difficult cases

A

Abdo pain lasting >4 hours (may be colicky initially)
Diarrhoea lasting >24 hours
Vomiting

Temperature is often normal
Abdominal ultrasound

22
Q

List three signs on examination one may find on advanced bronchiectasis (not related to vital signs)

What vaccine booster is indicated at 12 months of age in children with bronchiectasis

A
  1. Clubbing
  2. Hyperinflation
  3. Inspiratory crepitations

13-valent pneumococcal vaccine

23
Q

Croup

  1. Epidemiology? (2 points)
  2. Typical clinical progression in terms of symptoms (3 marks)
  3. 3 features on examination (not vital signs)
A
  1. Disease of toddlers, rare <6 months
  2. URTI → barking cough and stridor
  3. ↑WOB, diffuse wheeze may be heard, may have fever, no signs of toxicity
24
Q

When to treat croup?

A

When stridor at rest

25
Q
  1. Treatment of mild-moderate croup?
  2. Treatment of severe croup?
  3. Discharge requirements (2 points)
A
  1. Oral steroids (pred or dex)
  2. Nebulised adrenaline + IM/IV dexamethasone
    3.
    - 4 hours post-nebulised adrenaline or 30 mins post-oral steroid
    - Stridor-free at rest
26
Q

Usual presentation of ITP?

A 
Bruising and petechiae
In some cases, may also have bleeding from:
- Mucosa (ENT)
- GI tract
- Urinary tract
27
Q

List 2 options for medical therapy of ITP, and 3 pieces of advice that should be given to patient

A

Medical therapy (usually not needed)

  1. Oral steroids
  2. IVIg

Advice (for the next 3-6 months)

  1. Avoid contact sports/rough physical activity
  2. Avoid aspirin/NSAIDs
  3. Avoid IM injections

Paediatrics (1 decks)

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