MedEd 1 Flashcards
(201 cards)
1
Q
6 week old baby with persistent vomitting, small volume after feeds. child is upset during feeds, but settles. thriving, well otherwise. Dx?
A
gastroesophageal reflux
2
Q
6 month old baby with diarrhoea, coliky abdo pain. sx started recently after starting formula.
O/E soft abdo, patches of eczema on flexural surfaces. Dx?
A
cows milk protein intolerance
3
Q
2y/o with faltering growth
O/E child is small, pale, thin
fallen centiles, now on 2nd for weight.
loose stools.
Dx?
A
coeliac
4
Q
features of reflux vomit
A
small volume
feed related
upset but settles after
back arching
irritability
5
Q
red flags of vomitting in baby
A
projectile
bilious
not passing stools
abdo distention
irritable / meningitic
bulging fontanelle
features of NAI
FTT
increased head circ / seizures
6
Q
what causes GOR
A
physiological
low tone in immature lower oesophageal sphincter
7
Q
what is GORD vs GOR
A
disease causing Sx that are troublesome
8
Q
Ix of GOR
A
clinical
+/- endoscopy
+/- pH monitoring
9
Q
advice for parents for GOR
A
avoid overfeeding
thickeners if formula
gaviscon if breastfed
10
Q
Ix to distinguish GOR and CMPA
A
CMPA - avoid diary and see if Sx settles
11
Q
triad of pyloric stenosis signs
A
projectile vomiting
visible peristalsis
palpable olive
12
Q
RFs for pyloric stenosis
A
male (4:1)
FH
13
Q
Ix for pyloric stenosis
A
abdo USS
blood gas
14
Q
abdo USS results of pyloric stenosis
A
antral nipple / target sign
15
Q
blood gas results of pyloric stenosis
A
low K
low Cl
metabolic alkalosis
16
Q
Mx of pyloric stenosis
A
pyloromyotomy
17
Q
normal age range of pyloric stenosis
A
6 weeks to 3 months ish
18
Q
red flags for diarrhoea
A
poor weight gain / weight loss / faltering growth
continuous sx
night stools
blood / mucous
systemic disease - rash / fever / joint pain
19
Q
DDx for diarrhoea
A
infection
coeliac
IBD
hyperthyroidism
CMPA
CF
drug induced - laxatives
congenital
overflow constipation
20
Q
who gets toddlers diarrhoea
A
2-4 (max 1-5)
21
Q
sx of toddlers diarrhoea
A
explosive diarrhoea
food present in it
well looking child, no growth issues
NO RED FLAGS
22
Q
Mx of toddlers diarrhoea
A
reassurance
avoidance of triggers
23
Q
when do kids get coeliac
A
after 6 months of life
24
Q
Ix of coeliac
A
IgA TTG
IgA level to rule out false negatives
small bowel biopsy only if unclear
25
sx of coealic in kids
diarrhoea
weight loss
FTT
pale
dermatitis herpetiformis
apthous ulcers
peripheral neuropathy / delayed puberty
26
other conditions that increase your risk of coeliac
downs
turners
thyroid disease
T1DM
27
prevelance of CMPA
2-7%
28
2 types of CMPA
IgE or non IgE mediated
29
Dx of CMPA
Hx
skin prick test
elimination diet trial
30
Mx of CMPA
- formula fed babies
- breastfed babies
- IgE mediated
- formula = hyrolysed formula
- breast = maternal allergen avoidance
- IgE mediated = anaphylaxis advice
31
Sx of CMPA
itchy, red skin
N&V, diarrhoea w blood / mucous
food refusal / aversion
sneezing / rhinorrhoea
anaphylaxis !!
32
Dx of IBD
barium radiology
MRI colon
endoscopy / colonoscopy
33
types of IBD in kids
UC
IBD
indeterminate
34
acute vs maintenance Mx of IBD
acute = elemental diet, steroids
maintenance = 5-ASA, AZ, methotrexate, biologics
35
what is an elemental diet
protein shakes for 6 weeks so that the gut can rest
- aim to avoid using steroids but most kids will need the steroids
36
is FTT a Dx
NO - its a Sx
37
2 day old baby with jaundice. term, SVD, no antenatal concerns.
BR > phototherapy threshold. Had tx.
no haemolysis on film, normal obs and exam. Dx?
physiological jaundice
38
12 hour old baby with jaundice on PNW. Poor tone, lethargic, resp distress. Dx?
early onset neonatal sepsis
39
3 week old baby at ED has jaundice persistent. first baby of non consanginous parents. pale stools, dark urine. Dx?
biliary atresia
40
what % of babies get jaundice
60% term
80% pre term
41
complication of jaundice in babies
kernicterus
- BR crossing BBB and causing profound disability / death
42
Ix of jaundice in neonate
clinical Dx
blood gas
Iab BR
split BR
group and DAT
FBC
43
Mx of jaundice
treat underlying cause
phototherapy / exchange transfusion - depends on level of BR
44
Sx of neonatal jaundice
lethargy
poor feeding
45
what % of physiological jaundice need Tx
1%
46
3 causes of physiological jaundice
increased haemolysis due to shorter lifespan of RBCs
immature hepatic enzyme systems
initial poor feeding / output
47
which babies get jaundice more
breastfed babies
48
red flags of jaundice in neonates
jaundice under 24hrs of life / after 14 days of life (21 in prem)
ABO / RhD incompatability
prev sibling neding photoTx
cephalohaematoma / birth trauma
FH of RBC defect
sepsis
prem
49
how long can breastmilk jaundice last
up to a few weeks
50
Mx of breastmilk jaundice and why
continue breastfeeding - benefits outweight risks
Tx algorithm - phototherapy etc
51
describe breastmilk jaundice picture
begins 3-5 days of life
very well child
breastfed !! - dont assume
52
what is haemolytic disease of newborn vs ABO incompatability
HDoN = RhD incompatability (or ant C/E/Kell/Duffy)
ABOI = AB incompatability
53
what is needed prior to HDoN and examples of this
sensitising events
- prev preg
- APH
- trauma
- antenatal procedure - inc TOP/miscarriage
54
prevention of HDoN
IM anti D to mum after possible sensitizing event
regular screening
55
Mx of HDoN
high risk of severe jaundice --> phototherapy
fetal blood transfusion
exchange transfusion
56
is HDoN or ABOI more common
ABOI
57
which preg is affected in ABOI vs HDoN
ABOI = 1st
HDoN = 2nd
58
blood film of ABOI vs HDoN
ABOI = spherocytosis
HDoN = erythroblastosis
59
which will have a + DAT , ABOI or HDoN
HDoN - strongly +
ABOI can be weakly positive or negative
60
which is more severe ABOI or HDoN
HDoN
61
haemolytic causes of neonatal jaundice
G6PD def
hereditary spherocytosis
PKD (rare)
sepsis
thalassaemia
ABO incompatability
HDoN
62
define prolonged jaundice
>14 days in term or >21 days in prem
63
causes of prolonged jaundice
immune mediated
red cell defects - G6PD / spherocytosis
enzyme deficiencies
structural causes - biliary atresia
liver disease
infection - CMV etc
64
Mx of prolonged neonatal jaundice
urgent paeds review !!
split BR
blood group / DAT
cultures
65
why is biliary atresia time critical
surgery should be done under 90 days of life
66
prevelance of biliary atresia
1/70,000
67
associations of biliary atresia
pancreatic abnormalities
cardiac anomalies
malrotation
downs
splenic malformation
68
prevelance of splenic malformation in biliary atresia
100%
69
PC of biliary atresia
prolonged jaundice
raised LFTs
70
what time of BR is raised in biliary atresia
conjugate
71
Ix for biliary atresia
abdo exam
LFTs
abdo USS
phenobarbital excretion radionucleotide scan
liver biopsy
72
Mx of biliary atresia, inc specific surgery name
Kasai's procedure
73
what % of biliary atresia pts have a liver transplant
80%
74
what can be felt on abdo exam in biliary atresia
hepatomegaly
75
what is kasai procedure
joining biliary tree to liver to duodenum
76
2 day boy, not passed urine since birth. AN scans show bilateral hydronephrosis. Dx?
obstructive uropathy
77
4F in A&E due to facial swelling, abdo distention. afebrile, low BP. ++++ proteinuria. Dx?
nephrotic syndrome
78
6y/o in A&E with coke coloured urine, bad throat infection 3 weeks ago, otherwise well with no rashes. Dx?
post strep glomerulonephritis
79
what % of babies pass urine in 24hrs
90%
80
what Dx do you not want to miss in a bbay that has not passed urine in first 24hrs
pelviureteric junction obstruction
81
what is a posterior urethral valve
mucosal fold in posterior urethra (males) leading to obstruction
82
Ix in posterior urethral valve
MCUG
83
Mx of posterior urethral valve
suprapubic catheter
resection
84
Signs of PJO
unilateral
hydronephrosis noted on antenatal scans
85
Mx of PJO
ureteroplasty
86
what is the main cause of UTI in kids
e.coli 80%
87
atypical UTI features
seriously ill
poor urine flow
abdo mass
renal dysfunction
not responding to tx in 48hrs
non e coli organism
88
when are UTIs more common in boys than girls
<6 months
89
what % of first presentation UTI have renal scarring
15%
90
name an atypical UTI organism
klebsiella
91
what is a wilms tumour
nephroblastoma
92
prevelance of wilms tumour
1 in 10000 (5% of childhood cancers)
93
age of wilms tumours
95% in under 10s
94
PC of wilms tumour
asymptomatic massive abdo mass found during bathing
+/- abdo pain +/- HTN
95
Dx of wilms tumour
abdo USS
CT / MRI
96
Mx of wilms tumour
nephrectomy
97
what is the most common glomerular disorder of childhood
nephrotic syndrome
98
triad of nephrotic syndrome
proteinuria
hypoalbuminaemia
oedema
99
causes of nephrotic syndrome
minimal change disease
congenital
cancer
infections
immune disorders
100
Mx of nephrotic syndrome
prednisolone 60mg/m2/day for 4-6 weeks, then wean
diuretics and low salt diet
daily urine dips +/- ABx prophylaxis
101
why do you give ABx prophylaxis in nephrotic syndrome
glomerular issue so they lose lots of Ig in the urine and can become unwell with strep
102
define remission from nephrotic syndrome
negative urinalyis on first morning urine for 3 mornings
103
define relapse of nephrotic syndrome
3+ proteinuria on three or more consecutive days urine dip
104
define frequently relapsing nephrotic syndrome
2 relapses in 6 months
105
define steroid resistant nephrotic syndrome
no remission after 4 weeks of tx
106
complications of nephrotic syndrome
infection - s.pneumo
thrombosis
hypovolaemia
drug toxicity
107
indications for renal biopsy in nephrotic syndrome
congenital nephrotic syndrome
<1 year or >12 years
gross / persistent haematuria
low c3
HTN
impaired renal func
steroid resistant
108
coca cola urine
post strep glomerulonephritis
109
PC of PSGN
reddish brown (coke) coloured urine 10-14days after strep throat / skin infection
110
cause of PSGN
deposition of immune complexes in glomeruli
111
Ix of PSGN with results
throat swab
ASOT
low C3
normal c4
112
tx of PSGN
supportive
113
general features of glomerulonephritis
haematuria
proteinuria
nephrotic syndrome
acute nephritic syndrome - oliguria, HTN
114
difference between IgAN and PSGN
IgAN - days after strep URTI / gastro / UTI
PSGN - weeks post strep URTI / skin
115
how do c3 levels differ between IgAN and PSGN
IgAN - normal
PSGN - low
116
pathogenesis of IgAN
IgA depositions causing inflammation
117
complication of IgAN
10-15% get HTN +/- renal failure
118
Tx of IgAN
ACEi
119
what is the most common cause of vasculitis
HSP
120
is there renal involvemet inHSP
YES - 70%
121
PC of HSP
abdo pain
arthritis
haematuria / proteinuria
purpura
recent URTI
122
Mx of HSP
self limiting and supportive
NSAIDs
monitor renal func
steroids have limited role
123
which HSP kids have worse outcome
renal involvement
124
age range of HSP
2-6 years old
125
how can HUS be distinguished from HSP in exams
HUS has recent history of bloody diarrhoea and they are SICK
126
triad of HUS
microangiopathic haemolytic anaemia
thrombocytopaenia
acute renal failure
127
what can HUS cause commonly in kids
renal failure
128
what infection do 90% of HUS pts have prior to HUS
E.Coli 0157
129
Mx of HUS
fluid management
blood products transfusion
dialysis if needed
130
dialysis criteria
persistent acidosis
diuretic resistant overload
refractory hyperkalaemia
uraemia sx
131
what is erythema toxicum
red rash anywhere on body
BENIGN
can be pustules / macules / papules
132
time frame of erythema toxicum
occurs within first 24hrs and persists 1-2 weeks
133
how can erythema toxicum change
changes position on body and distribution (migratory)
134
Tx of erythema toxicum
nothing - will go away by itself
135
PC of neonatal pustulosis melanosis
superficial fragile pustules, which can rupture and leave pigmented macule under which fades after 3 months
136
Tx of neonatal pustulosis melanosis
none (same as erythema toxicum)
137
what is a strawberry naevus
birth mark
infantile haemangioma - benign collection of BVs
138
RFs of strawberry naevus
low birth weight
advanced maternal age
multiple preg
PET / placenta praevia
139
feautres of strawberry naevus
solitary
head / neck
blanches
starts flat then progresses to be raised
140
what does multiple strawberry naevis indicate
internal organ involvement
141
growth of strawberry naevus
grows over first year then involutes
142
Ix of strawberry naevus
abdo USS
143
Mx of strawberry naevus
topical beta blockers
surgery / embolisation
144
complications of strawberry naevus
bleeding
infection
local sx
ulcerate
145
what is salmon patch / stalk bite / naevus simplex
benign capillary vascular malformation
146
what does stalk bite look like
pink / red flat patch usually on nape of neck
irregular borders
blanches on compression
147
progression of stalk bite
usually fades in first 2 years of life but never fully disapears
148
who gets stalk bites
40% people
male and female equally
149
prevelance of port wine stain
0.3%
150
what is a port wine stain
capillary vascular malformation
151
features of port wine stain
large flat red / purple patch on skin with well defined border
usually on face
152
what sydrome is port wine stain ass/w
sturge weber syndrome (cavernous haemangioma of trigeminal nerve)
153
progression of port wine stain
nothing - they will not go away on their own
154
other features of sturge weber syndrome
port wine stain
epilepsy
LD
155
3 y/o with fever, hepatosplenomegaly, enlarged tonsils and widespread rash. dx?
erythema multiforme
156
what is erythema multiforme
red papules and target lesions
acute, self limiting
symmetrical
can involve lips / tongue etc
157
causes of erythema multiforme
infections - HSV, EBV, chlamydia, mycoplasma
drugs - penicillin, sulfonamides
AI - SLE
malignancy
158
what causes scarlet fever
group a strep pyogenes
159
features of rash in scarlet fever inc timing
rough sandpaper rash, worse in skin fold
occurs 48hrs after fever
salmon pink
160
tx of scarlet fever
penicillin V
161
complications of scarlet fever
suppurative - otitis media, mastoiditis, tonsillar abscess, meningitis, endocarditis, invasive group a strep (bad pleual effusions)
non suppurative - rheumatic fever, PSGN
162
cause of erythema marginatum
immune reaction - delayed response to group a strep
occurs in 10% cases with rheumatic fever
163
tx of erythema marginatum
penecillin
164
features of erythema marginatum
target looking - red on the outside, paler on the inside
165
mneumonics for rheumatic fever signs
CASES (major)
carditis
arthritis
subcut nodules
erythema marginatum
sydenhams chorea
FRAPP (minor)
fever
esr / crp raised
arthralgia
prolonged pr interval
previous rf
166
describe erythema migrans
solitary bullseye lesion
- red papule with annular red ring
167
cause of erythema migrans
lyme disease
168
tx of erythema migrans
doxycycline
169
sx of measles
high fever
cough
coryzal sx 2-3 days before rash
170
describe measles rash
starts at head, 2 days post fever, and spread to body
morbilliform rash
palms and feet spared
koplik spots in mouth
171
mx of measles
low risk of comps due to vaccination
self limiting
172
complications of measles
encephalitis / meningitis
173
parvovirus rash features
slapped cheek
3-4d after fever starts
174
cafe au lait spots with axillary freckling
neurofibromatosis type 1
175
bone lesions, cafeau lait spots and prococious puberty
mccune albright syndrome
176
what % of NF is type 1 vs 2
90% type 1
177
inheritance of NFT1
AD
178
chromosome of NFT1
17
179
diagnostic criteria of NFT1
>2 of:
>6 cafe au lait spots
> 2 neurofibromas / 1 plexiform neurofibroma
axillary / inguinal freckling
optic glioma
lisch nodules
osseous lesions
1st degree relative
180
tuberous sclerosis features
epilepsy / seizures
developmental impairment / LD
retinal hamartomas
renal angiomas
cardiac rhabdomyomas
shagreen patches
hypopigmented macules
181
chromosome of tuberous sclerosis
9
182
inheritance of tuberous sclerosis
AD
183
cafe au lait differentials
NFT 1
tuberous sclerosis
ataxic telangiectasia
fanconi's anaemia
mccune -albright
russel silver syndrome
gaucher's disease
normal
184
most common organism causing early onset neonatal sepsis
GBS
185
2y/o with fever, reduced conciousnes, spreading purpuric rash. Dx?
meningococcal meningitis
186
4y/o 6/7 fever, red eyes, swollen hands and feet, widespread maculopapular rash. Dx?
kawasaki
187
which babies get e.coli early neonatal sepsis
recurrent UTI in mum
188
Rfs for neonatal sepsis
prem
prolonged ROM
maternal fever
maternal GBS
resus at birth
189
neonatal jaundice and thrombocytopaenia
CMV
190
neonatal congenital heart disease, cataracts, deafness
rubella
191
severe foetal anaemia / hydrops fetalis
parvovirus
192
hydrocephalus in neonate
toxoplasmosis
193
Dx criteria of encephalitis
major - altered mental status, lethargy, personality change >24hrs
minor - fever, seizures, focal neurology, CSF WBC >5, abnormal imaging / EEG
AND exclude trauma / metabolic / tumour / alcohol / abuse
194
mortality of encephalitis
10%
195
infectious causes of encephalitis
TORCH
cmv / toxo / MMR / enterovirus / syphillis
196
what is toxic shock syndrome
infection with toxin producing bacterium causing exaggerated immune response --> multi organ failure
197
causes of toxic shock
group a strep - scarlet fever, tonsilitis, cellulitis
burns /scalds
surgical wounds / deep abscesses (staph aureus infection)
retained POC / tampons
198
Mx of TSS
resus
IV ABx
IV Ig
199
features of kawasaki
fever over 5 days
bilateral non purulent conjucitivitis
cervical lymphadenopathy
rash
red / cracked lips
swelling / peeling of hands and feet
200
Tx of kawasaki
IVIG
aspirin
201
complications of Kawasaki
coronary artery aneurysms
