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Plab Hla Myint Aung > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Nocturnal Enuresis PE 0170
P enuresis
P enuresis with daytime symptomes
S enuresis (search cause) - Refer to Pediatrician

A

1) Primary enuresis = NIGHT bedwetting only! -
<5 years: reassure -
> 5 years and bedwetting less than twice/week= reassure

  • *NB if mother wants a short term ttt (child going to sleepover at his friend’s house for ex) = desmopressin
    • If long term ttt= Alarm then reward

1) Primary enuresis with daytime symptoms
a child thats bedwet at day time REGARDLESS of age
Referred to an ENURESIS clinic or SECONDARY care.

DAY TIME: 1. bladder retraining 2. oxybutynin 3. oral/SL desmopressin
NIGHT TIME: 1. enuresis alarm 2. reward system

2)Secondary Enuresis: - A child that has been dry for at least 6 months and now consistently bedwet at night -

1) EMOTIONAL UPSET ( child abuse)
2) 2ry to infection and diabetes.

**Urine/ Glucose test
Culture for infection —>
if -ve= refer to pediatrician!

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2
Q

Bronchiolitis or Pneumonia in UK 4 week old with bilateral basal crepitation and T 38.4 and Tachypnoea ?

A

T>39, FOCAL crackles- PNEUMONIA

otherwise the most common in this age group is BRONCHIOLITIS
babies and children under 2 years of age and
most commonly in the first year of life, peaking between 3 and 6 months.

  1. Bronchiolitis is more commonly seen in healthy children born at term whereas pneumonia is more common in children with some underlying disease, preterm birth or a history of preceding viral infection.
  2. Pneumonia will usually present with more than 39 while bronchiolitis has fever less than 39.
  3. Pneumonia commonly has focal findings on auscultation while bronchiolitis will have more widespread findings.
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3
Q

Diarrhoea Differentials

A

travel + wt loss(in chronic case)+ watery D. + long duration + abd distention = giardia travel
Tx - rehydration plus metronidazole

watery D. + short duration + abd. crump = E. coli

bloody diarrhea = campylobacter jujeni / Salmonella and Shigella

bloody diarrhea after long term Antibiotics = clostridium difficile ( pseudomembarenous colitis)

bloody diarrhea: Campylobacter Jejuni
Traveler’s Diarrhea: E.Coli

Diarrhea in paeds: Viral (Rota Virus)
Diarrhea(GIT Infection) + weakness+ Areflexia : Guillian-Barre Syndrom
Diarrhea followed by RUQ pain: Amoeba Watery
Diarrhea after camping or long travels in Europe: Giardia Diarrhea
D after long-term antibiotics: Clostridium Difficle
Diarrhea after eating raw eggs or chicken: Salmonella
Diarrhea just hour after a meal: Staph Toxin
Diarrhea in bed ridden pt (e.g handicapped) + stony hard stools : Fecal impaction

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4
Q

Cough ddx

A

Epiglotitis….
Stridor + drooling of saliva n fever … (thumb sign L.Xray)
CALL anasthetist / Intubation of ET tube and Antibiotics

Bronchiolitis…. (Most common in children UK >pneumonia )
Cough fever +sob+ expiratory wheeze + bilat basal crep
humidified oxygen

Croup…
Barking cough+stridor…. (steeple sign)
oral dexamethasone

Pertussis.
Episodic severe cough+ fever n cyanosis….
Clarithromycin or Azithromycin

Scarlet fever
Sore throat/cough,fever n RASH …
.Antibiotics

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5
Q

Child fall while playing / with Subconjunctival Hemorrhage / You are FY2 DR/ X ray head or CT

A

X ray for confirmation and CT for diagnosis (as you are FY2 dr you can request Xray)

subconjuntival hemorrhage is the bleeding within the eye,
whereas racoon eyes/panda eyes/ periorbital ecchymosis is the accumulation of blood (that seeps down from the skull fracture) within the periorbital soft tissue.

so CT needed in case of racoon eyes and not for subconjuntival hemorrhage.

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6
Q

Scarlett Fever (2-8 yr / Fever / rash / sore throat / )

A

Caused by ( GAStrep or Streptococcal Pyrogens ) not Stap.A

(S)carlet fever: 7S; - 
Streptococcus pyogen - 
Sore throat with pale exudate - 
Strawberry tongue - 
Sandpaper RASH on the (TRUNK) - 
Spare sole and palm rash - 
around Six yr age (2-8 yr) -

Rx: Penici[S]lline V

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7
Q

Best consideration for Vesico-Ureteric reflux PE 4050

A

Ab Prophylaxis should be considered prior to Considering surgery (low reflux )

UV reflex does not cause renal scaring
UTI causes renal scarring and damages the most at early weeks of age

only surgical correction in two cases»»

1) breakthrough UTI infection despite prophylactic antibiotics
2) persistent high grade VUR (4 or 5 ) with renal scaring

Surgery correction is generally reserved for Hight grade reflux

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8
Q

Umbilical Granuloma

A

Umbilical granuloma -
a red bump on baby’s navel after the cord falls off & dried -
it’s usually harmless unless infected

1st line : Table Salt (Simple & effective)
salt draws water out of the wet granuloma resulting in necrosis and shrink

2nd Line : Silver Nitrate (no improvement with Na 1 wk )

If pus seen + fever etc - Apply Fusidic Acid

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9
Q

Lymphangioma (cystic hygroma) / Brachial cyst / Thyroglossal cyst

A 
Lymphangioma : 
antero-Lateral to sternocleidomastoid muscle, 
Light translucence positive , 
Lymph present (soft and compressible), 
Age < 2 years(90%) Rule of L's. 
Branchial cyst: 
Antero-medial to sternocleidomastoid muscle, 
Hemorrhagic fluid present , 
Non-compressible, Non-translucent , 
Age=Early adulthood.
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10
Q

Non accidental injury Ddx

admit > analgesia > treat urgent medical condition > registered protection officer> social services

A 
Non blenching Bursing Ddx 
HS purpura 
Haemophilia 
ITP 
Leukemia

Fracture Ddx
Osteogenesis imperfecta - BLUE SCLERA , dental abn , brittle bones (Auto Dominant )

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11
Q

UTI in child Spiceman collection (clean catch / catheter / suprapubic aspiration)

A

1) Dip stick analysis of urine (+Nitrate and ±Leukocytes )
2) Urine Microscopy
3) Urine Culture

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12
Q
A

Malrotation and Volvulus- (neonate ) volve= rotate (twist in the intesting surrounding the mesentry )
(child - midgut / surgery need / adult - caecum and sigmoid / rerotate with colonoscope)
Sudden billious vomiting +
blood per rectum +
double bubble in X ray

Hirschsprung-----or congenital/toxic megacolon... (No peristalsis / nerve plexus or ganglion in colon (esp descending ) doesn't develop / resulting continuous contraction and  constipation )
may lead to sigmoid volvulus 
abdominal distension + 
failure to pass meconium + 
repeated vomiting 
Cystic Fibrosis-----
meconium ileus+  ( most children with thick meconium in ileus have cystic fibrosis)
failure to thrive +
Bilious vomiting 
Echogenic USG on perinatal USG 
Duodenal Atresia-
vomiting large amt bilious or non bilious, (right after birth / pass stool 2 times/ then no bowel movement ) 
abdominal distension , 
no passage stool, 
jaundice + double bubble sign 
Necrotising Enterocolitis--- (most common GI infection in premature babies)
premature or low weight bith+ 
bloody stools+ 
abdominal distension+
bilious vomiting.
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13
Q

Vitamin D take or not take

A

Babies having 500ml or > Formula Milk / DO NOT NEED VITAMIN D

All adults including babies need to take Vit D 400IU / 10mcg per day (also Caucasians )

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14
Q

Fever with Rash (Measles / Scarlet Fever / Rubella / Erythema Infectiosum) PE 0330

A

Measles(Rubeola) -
macules and patches / on face / neck and shoulders /
Koplik spots /
no cervical lymphadenopathy

Scarlet Fever -
sorethroat / strawberry tongue / sandpaper rash /
tender cervical lymphadenopathy

Rubella(German Measles) -
Pink macules and papules /
on forehead then to face/ trunk / extremities on 1st day/
Fades on face on first day and the rest of the body by third day
Cervical lymphadenopathy

Erythema infectiosum (Parvovirus B19)- 
Slapped Cheek appearence
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15
Q

Measles / Scarlet fever / Rubella

A

Measles - Koplic spots on Buccal mucosa / No cerval Lnodes
Rubella - Forshheimer spots on Soft palate / Cervial Lnodes
Scarlet fever - Sorethroat /

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16
Q

Neonatal Jaundice(24 hr or 2 to 14 days) / Prolong Jaundice (>14 days )

A

Pathological within the first 24 hours

Start form 2-14 common (40%) and PATHOLOGICAL
Seen in Breast Fed Babies

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17
Q

A child with 2cm lymph node and growing in size over 6 wk/ Immobile and non tender
No fever , wt loss , tiredness , signs of infection / Most app investigation

CP / USG / Infection screen

A

Full blood count and Blood Film for leukemia and lymphoma

Hodgkin lymphomas in 75 % of cases have no B symptoms (loss of wt, night sweat and fever)….they will present with enlarged cervical LN and be asymptomatic otherwise

ALL is the most common leukemia in peads.
AML is more of acute sympt. Like Gum bleeding.

  • If lymph nodes after infection (reactive lymphadenopathy) -> reassure
  • If >2cm or progressively enlarging Firm/ nontender/ hard

With fever/ weight loss/ night sweats Refer urgently.
1st test is FBC: if normal then ALL unlikely,
perform Excision biopsy to rule out lymphoma If FBC abnormal then do peripheral smear to look for blast cells.

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18
Q

Woff- Parkinson-White Syndrome

Wolf = DOg delta waves

A

breathless and palpitation following exercise followed by rapid recovery
inv - ecg,24 hours ecg holter
ecg- delta P wave, Pre-exitation pattern,
short PR, prolong QRS
rx- catheter ablation medication- flecainide, propafenon

AV-node pathway blockers:–
1) b-blockers, 2)ca-blockers(verapamil,diltiazem), 3)adenosine.

Accessory pathway(AP) (Kenth pathway in WPW$) blockers:-

1) Procainamide, propafenone,flecainide
2) amiodarone &sotalol

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19
Q

Respiratory Distress Syndrome in Infants
More common in < 32 weeks gestation
CXR - Ground Glass appearance

A

Premature infants / CS deli / Maternal DM / MAS

Tx - Endotracheal Surfactant Replacement
Intermittent PPventilation

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20
Q

MAS (Meconium Aspiration Syndrome )

More common in Gestation > 42 weeks / Maternal HT / Oligohydramnios

A

Meconium - stained Amniotic Fluid
Cxr - aspiration pneumonitis

Tx - Airway SUCTION
O2 / Fluid and electrolyte Balance

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21
Q

UTI not responding to antibiotics after C and sensitivity
DMSA (done only in small babies and 4-6 weeks after UTI resolve and clear)
MCUG(can be done during UTI for recurrent and atypical UTI)

A

If child responds to treatment to UTI within 48 hours,
Ultrasound is arranged in 6 weeks .

If child doesn’t respond well within 48h,
then MCUG to detect VUR.

IF VUR presents then DMSA in 4-6 months to assess renal scarring.

6-month baby DMSA to search for renal scarring
6-3 years consider DMSA in atypical and recurrent UTI
>3 year not DMSA

Mituration Cystourethrogram - 6-3yr old child UTI no improvement 48 hr after Antibiotics
in atypical and recurrent UTI

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22
Q

Neonatal Jaundice ddx

A

Prolonge jaundice: >14 days Unconjugated>Child is well> Breast Milk Jaundice

Unconjugated>started at day 1> child well> Gilbert

> failure to thrive>HepatoSpleenoMegaly > Galactosemia

Conjugated>No fever>Biliary atresia/Torch

Conjuagated> protruded tongue> Hypothyroidism

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23
Q

Pyloric Stenosis Vs GERD

A

PS- non bilious vomiting AFTER BIRTH
Constant Hunger and Weight LOSS

GERD - recurrent vomiting and cries shortly after FEEDS
REFUSAL of feed / growing well and normal weight
- Rx Gaviscon (antacid with coating and last 24hr)

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24
Q 
Necrotizing Enterocolitis (CL0080)  (Intestinal Barrier Dysfunction ↓ IgA)
Premature Birth(weak Blood supply) and Formula Feeding(weak immunity)
A

The smaller and earlier the baby, the higher the risk for NEC.
not enough blood and oxygen reach your baby’s immature intestinal tissues

Dx
Bell staging (Radiological Signs )
Stage 1 - ileus / dilatation
Stage 2 - pneumatosis intestinalis (air in intestine) / Portal Venous Gas (Met Acidosis)
Stage 3 - pneumoperitoneum (Met Acidosis )

Tx
Stopping enteral feedings,
performing nasogastric decompression, and
broad-spectrum antibiotics - Pen /. Genta / Metro
Pneumoperitoneum - Surgery

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25
painless rectal bleed in Meckel's Divertaculum painful bleed in Intussusception and Volvulus intramural air in Necrotizing enterocolitis non bilious projectile vomiting in Pyloric stenosis
26
Galactosaemia
Galactosaemia term infant gets an E. coli sepsis and when a neonate develops cataracts. It should also be considered with neonatal jaundice and haemorrhage. Inability to metabolize galactose( a sugar in milk) Accumulation In brain Eye --Cataract Kidney ---Kidney damage Liver... Liver damage.. No conjugation.. Unconjugated bilirubinememia.. Stool yellow and no change in urine Hypothyroidism impairs bilirubin conjugation, slows gut motility and impairs feeding leading to hyperbilirubinemia.
27
``` Dehydration Mild -decrease urine output 5% -plus dry mucus membrane 10% -plus sunken fontanelle >10% -plus shock (CRT>3sec, rapid thready pulse, ↓ Skin turgor, tachycardia & tachypnea (60,50,40rule), cold peripheries ) ```
Rx - if only just dehydrated & can tolerate oral feeds > ORS if in shock -> Give IV bolus dose of 0.9% NS @ rate of 100ml/kg for first 10kg 50ml/kg for next 10kg 20ml/kg for anything after 20kg total For maintenance --> 0.9%NS + 5% Dextrose
28
PM 5000 7 day baby initial birth weight 3.5kg now 3.3kg / What to do next
Reassure / Continue Child Care 5-10% wieght loss in first days after delivery... Is normal 14 days to gain weight more than birth weight.
29
Rash in Children and When to return to School PE 0230
Cannot Return to School (S.I.C.K Miss Ruby ) Scarlet Fever away form school until 24 hr after staring Abiotics Impetigo away form school until 48 hr after starting Ab or Lesions are Crusted or Healed Chicken pox Until VESICLES have Crusted or Healed 5 days after onset of rash keep away form pregnant women also Measles / Rubella 4 days after onset of rash Can return to School (Her simple Molly Rosey is Partying ) Rosella Parvo virus B19 or Slapped Cheek or the fifth disease or Erythema infentiosum (once rash has developed / self limiting / symptomatic tx) Molluscum contagiosum Herpes Simplex (cold sores ) Chicken pox--fluid filled blisters (centripetal distribution) Rubella :white spots on soft palate plus Swollen lymph nodes Measles: koblic spots on buccal mucosa Roseola: sudden onset fever plus chest rash Parvo: slap shaped distribution sparing nasolabial folds
30
Nephrotic Syndrome | 7 year old kid with 2 day leg odema / no other problems
2-3 months of Corticosteroids reduced Sodium intake and if SEVERE - -- Fluid restriction and use of Furosemide. Steroid dependent Nephrotic -- IV Cyclophosphamide PROteinuria >3g per 24 hr , HYPOalbuminemia < 30g per liter: NephROtic syndrome proteinuria <3 , hematuria : NephRItic syndrome
31
Cow Milk Allergy If CMA is suspected and reaction is Acute - IgE mediated If CMA is suspected and reaction is Delayed - (Reflux , Loose Stool , Growth ↓) - Non IgE mediated
IgE Mediated cow's milk protein allergy-- Acute -----skin prick/blood test [for acute, condition --- INVASIVE INVESTIGATION is ACCEPTED NON IgE Mediated --- Not acute presentation -----so stopping cow's milk and substituting with hypoallergenic {HYDROLYSED FORMULA } FOR 2 WEEKS CAN BE TRIED , IF NO IMPROVEMENT----Amino acid formuls can be tried
32
Signs of SHOCK and Severe Reflag Dehydration in P Normal Capillary Refill time < 2 sec 2 yr old child can have HR within 80-120 / RR 20-30 Weigh loss no rule in Dehydration
Signs of clinical shock in pediatrics: - **********Decreased level of consciousness. - Pale or mottled skin. - Cold extremities. - Tachycardia. - Tachypnea. - Hypotension. - *****Delayed capillary refill*****. (4 sec)- *********Weak peripheral pulse. Signs of reflag severe dehydration in Pediatrics ↓Urine output Sunken eyes Dry mucus membrane (except for mouth breather) Tachy / Tachypnea Reduced Skin Turgor
33
PE 5011 2yr old Child with night stridor / temperature 38 / RR 31 / PR 140 / O2 99% but no chest wall recession / percussion resonance for 3 nights what will happen if left untreated / most likely complication
STRIDOR (upper air way obstruction )- Coup WHEEZING (lower air way obstruction )- Bronchiolitis <2 year with fever 38 Most children Complete recovery (with or without tx ) oral dexa ARDS will not happen Its a case of UNCOMPLICATED Coup (laryngotracheobronchitis ) with peak incident 6mth - 3 years
34
Coagulation Pathway (2 pathway which Activates COMMON PATHWAY)
Damaged Vessel have TISSUE EXPOSURE and PLATLET DEPOSITION ***Extrinsic pathway*** start with TISSUE FACTOR / 7a ***Intrinsic pathway*** start with PLATLET / 12a / 11a / 9a Extrinsic (7a + Tissue factor ) or Intrinsic (9a + 8a ) (In HAEMPHILIA factor 8 defiency in type A and factor 9 defiency in B) CAN ACTIVATES ***Common Pathway*** 10a /5a / 2a(Thrombin ) / 1a(Fibrin) and 13a 1a + 13a CREATES MESHES AROUND THE PLATLET to make them FIRM and HARD
35
Hemophilia A and B Platelet is normal Pro time is normal Partial Pro time is prolong (Factor 8 or 9 defiency )
``` Prothrombin time test Extrinsic (Factor 7) Common Pathway (Factor 10 5 2 1 13) ``` ``` Partial Prothrombin time test Intrinsic (Factor 12 11 9 8 ) Common Pathway(10 5 2 1 13) ```
36
2 year old child Lost in Shopping Centre / Become Upset / Fall down / unconcious
Breath Holding Spells | Reassure
37
Kawasaki Disease
Strawberry tongue
38
Cystic Fibosis
``` Sweat test (>98% Sensitive Chloride >60) Genetic test (Carrier test for partents ) ```
39
NICE Red Traffic Features
Red Traffic (High Risk) features: - Pale/Mottled/Ashen/ Blue skin. - NO Response to Social Cues. (No Response At All!). - Appears ''ill'' to a healthcare professional. - Does not wake, Or, if Awaken (Roused) Does not stay awake. - The cry is either weak Or high pitched Or continuous. - Grunting (Not Flaring, Flaring is Yellow Traffic-Intermediate- Risk). - Respiratory Rate > 60 - Moderate or Severe Chest Indrawing. - Reduced Skin Turgor. - (Mild dehydration sunken eye also) Age < 3 months with Fever=> 38. - Non-Blancing Rash. - (Bact meningitis )(other Ddx HUS/ HSP / ALL / ITP ) Bulging Fontanelle. - Neck Stiffness. - Status Epilepticus. - Focal Seizure. - Focal Neurological Signs.
40
Malrotation and Volvulus or Intussusception CL 0061
1) bilious vomit rules out pyloric stenosis 2)duodenal/jejunal atresia are ruled out since he is passing blood with stool which is not seen in them. Usual picture is obstruction (no stool) and abdominal distention with bilious vomit 3)appendicitis vastly different clinical picture 4)confusion is bw intusussception and volvolus while bloody stools and bilious vomit is common in both but ---- ``` ***intussusception will say things like '"currant jelly red stools"' and '"raising legs while crying"' and ''donut/target sign'" and "sausage mass"" and "claw sign" ``` ***while malposition and double bubble point towards volvolus ***lastly Volvolus mostly occurs in First month of life and intusussception occurs mostly after 6 months kindly correct if anything wrong
41
ITP (isolated thrombocytopenia)< 20000 | CL007
Sudden onset of Petechiae and Bruising on the arms and legs 25% Nosebleeds commonly after Viral infection of URTI or Vaccination Primary ITP immunoglobin against platelet which carries the platlet to the spleen to destroy Mgx Low risk tx (petechial / large bruises without active bleeding ) Conservative Moderate risk tx (Epistasis for > 5 minutes ) (<20 X 109 without life threatening symp) Admitted to Hospital and Oral Prednisolone (1st line ) If fail to increase platelet after a few days IVIG(2nd line ) IVIG also before surgery to increase platelet High risk tx (Internal haemorrhage ICH / Muscles and Joints ) Admission and Prednisolone + IVIG other Tranexamid acid
42
Roseola Infantiosum / Child fever 39-40 rash / but eat and sleep normally VR1001
Roseola infantum, also known as sixth disease, is caused by infection with human herpes viruses 6 and 7 (HHV6 and 7). severe pyrexia 39-40 for 3-5 days alongside rhinorrhoea and fatigue, then on cessation of the fever an exanthem will appear on the face and body. It most commonly affects children between 6 months and 3 years of age Herpes 1/2 - oral / genital ulcers = herpes simplex virus Herpes virus 3 - varicella zoster = chicken pox Herpes 4 - epstein barr = mononucleosis Herpes 5 - Cytomegalovirus Herpes 6 - Roseola Herpes 8 - kaposi s sarcoma
43
indications for immediate IV access in pediatric and neonatal cases
cardiopulmonary arrest, major burns prolonged status epilepticus hypovolemic shock septic shock if IV line attempt unsuccessful within 60-90seconds, attempt Intraosseous line.
44
Infantile Spasms VS Breath Holding Spells
Infantile Spasm/ West Syndrome/Saalam attacks baby doing apparently well suddenly has jerky movements : SYMMETRICAL FLEXION of NECK & EXTENSION OF ARMS + maybe associated with Down's syndrome (more prevalent) + No fever + Learning problems/Developmental delay Cause - due to brain injury- idiopathic/acquired (down's) Ix - EEG (shows hyper arrhythmia) Rx- ACTH dept / Prednisolone/ Vigabatrin Breath Holding Spells child lost with parent / or fells down while playing tricycle / stairs hold breath
45
1. Cystic fibrosis increased viscosity of mucus dt Cl channels 2. Kartanagers syndrome ciliary dysfunction
Kartagener's Syndrome autosomal recessive defects ciliary function. common association with Dextrocardia. present with recurrent pneumonia, chronic rhinitis and otitis media and later bronchiectasis and infertility. airway biopsy for microscopic examination of the cilia is diagnostic. long term prophylactic antibiotic with chest physiotherapy carries good prognosis
46
6 month old boy / persistent irritability and lethargy
1) LESS than 3 months- do microscopy and culture and refer / NO DIP STICK 2) 3moths to 3yrs- both or either Nitrites and Leukocyte esterase positive- start antibiotics and send for culture. both negative- nothing 3) 3yrs and older- both positive- treat it/ both negative- do nothing/ nitrites positive- treat and sent culture/ leukocyte positive- send culture and WAIT.
47
Osteogenesis Imperfecta:
- Brittle bones - Blue sclera - Hearing loss ``` Tx: IV Bisphosphonates (PAMIDRONATE) ```
48
Overactive Bladder Syndrome (Only day time symptoms ) P bedwetting syndrome (always Night symptoms ± day symptoms)
OABS : 1st line - Bladder Training for 6wks ( Stepwise Scheduled Toileting+ Behavioral Therapy) 2nd line - Oral Oxybutynin (anti-cholinergic) Oral or Sublingual Desmoplasin
49
Systolic Murmur in Down Syndrome / Possible causes ?
The top 3 common cardiac defects in down syndrome are: 1. Endocardial cushion defect lead to AVSD ( the most common ). 2. VSD ( the 2nd common) 3. ASD ( the 3rd common)
50
Non accidental INJURY in children | Spiral Fracture of the HUMERUS
Due to twisting and sudden pull with force by an adult
51
PE 0571 4 yr old VESICLES on the Parm and sole / Ulcer on the mouth T 38
Hand foot and mouth disease Coxsackievirus IF THE CHILD FEEL WELL ENOUGH TO GO TO SCHOOL / NO NEED TO ISOLATE Ibuprofen used for sympetatic relief If you see Palms and soles(which are hard to have vesicles by other infections) always think of Hand Foot and Mouth(HFMD) disease; Caused by CoxSackie virus Leisons of measles are MACULOPAPULAR not vesicular. Koplik spots are whitish leisons in buccal mucosa with pale centres palm and sole RASH: Kawasaki disease hand foot mouth disease secondary syphilis
52
Chest Cough + Jaundice ? PE 1799
Chest + liver= alpha 1 antitrypsin defiency (inhibit elastase) (Elastase digest elastin in alveoli = Emphysema / Copd ) Chest +brain =Wilson Chest + GIT = Cystic Fibrosis Chest + kidney = Goodpasture syndrome.
53
Non Blotchy Purpura (do not turn white when pressed) | H.IT / Me / ALways
** Bact Meningitis ** - Neck stiffness / Photophobia / altered mental state **ITP** - Burses after a fever / isolated thrombocytopenia HSP (small vs vasculitis)- Asso with abd pain / rush on buttock and extensor of hand /IgA↑ HUS - (Anuria / Oliguria ). (E.coli / Diarrhoea illness ) (Anemia / Low platlet) Acute Leukaemia - Lymphadenopathy / Slow onset / Anaemia
54
PE 2505 <2year old child with Fever 38 and substernal resection and Wheeze Wheeze = lower RT obstruction Coup = upper RT obstruction
2-6 month Wheeze and fever = Bronchiolitis / 2-6month Tx - Supportive care with Nebulized Oxygen NICE RECOMMENDATION - LARGELY SUPPORTIVE Antibiotics Hypertonic saline other Ddx >39 Pneumonia focal crep No wheeze / Barking Cough - Coup
55
Congenital Hypothyroid
56
Weight Calculation in Babies for NON ACCIDENTAL INJURIES | 4 month old = 6.8kg / not 4.2kg
weight of infants 3-12 months age = age in months + 9 divided by 2 for children 1-6 years)= age x 2 + 8 >8 years) = age x 3
57
CS 3330 | Asthma distractor
Anaphylaxis
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Mother 8days after giving birth positive Varicella Zoster (7 days before or after giving birth) Infant is well / what to do next
Mother need 7 days to develop IgG antibodies and give it to infant via Placenta or newborn via Breast Milk Need VZIG immunoglobin within this time frame -7__________________birth_________________+7 if a mother develops pox more than 7 days before or 7 days after birth no need for VZIG within 7 before birth or 7 days after birth isolate and give IG if the neonate develops pox give acyclovir with 24h if preg with no previous exposure contact with pox person give IG within 10 days if preg and develops pox give acyclovir within 24h complication of pox congenital varecela when preg pneumonia and hepatitis when delivered
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Difficulty learning and writing at 7 years of age Which Social Service to Refer PE 1570
Educational psychologists - for children with learning difficulty to achieve their full potential NOT speech and language therapist (SALT) - for Post Stroke patient for swallowing and speaking
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Pertussis Whooping Cough / Bordetella Pertussis | Notifiable disease
Blouts of Cough / Cough Vomiting / Asphyxia and Cyanosis after cough in infants Paranasal Swab test and Nasopharyngeal aspiration (Difficult in child) test within 2 weeks of cough Culture (Gold standard)and PCR (done together with culture) Tx: Antibiotics Macrolides- Azithromycin or Clarithromycin
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PE 3901 5week old Sticky LEFT eyes without red eyes / no lid swelling What to do next /
Blocked nasolacrimal duct (most common cause of eye discharge < 12 months ) Sticky eye without purulent = Blocked Nasolacrimal Duct Reassurance / Simple Massaging of the ducts Red eye + Sticky discharge = Secondary Care Purulent discharge after birth = Primary care will have already taken for Chlamydial
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16 yr old child with DM , goes hiking , penetrating wound to his left foot dev ulcer / REFUSE TO BEAR WEIGHT / fever / Causal organism
Osteomyelitis(Streptococcal Aureus) including MRSA In Children Long bones are most commonly affected Tibia / Fibula / Humerus Streptococcal Aureus
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Child Cystic Fibrosis(Auto Recessive ) with chronic cough for 2 year on Antibiotics ****************CHEST Physiotherapy******************** comes first PM 1117 PM 1116
CF in children Staph aureus then H influenzas. CF in teenage and adults Pseudomonas. Repeated chest infection.. Bronchiectasis... Ttt physiotherapy # antibiotics... Exacerbation and prophylaxis till 3_6 years SWEAT CHLORIDE test / DNA / Nasal Potential Difference P New Born Test Guthrie test Complication (all are obstruction with Thick mucus / ) Failure to thrive dt mal absorption Lungs - Bronchiectasis Bowel - Meconium ileus (X ray / bilus vomiting) Liver - Steatorrhea / Toxin cannot secret (Cirrhosis ) Pancreas- DM / Digestive enzymes self digest (Pancreatitis) Reproduction - Both Fertile but blocked Tubes ↓fertility TX *************CHEST Physiotherapy******************* Bronchodilator Azithromycin /Flucloxacillin is the antibiotic of choice. 3-6 years of age. for recurrent Mucolytic CFTR modulators (CL channels to work again )
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Congenital Pyloric Stenosis -
``` Male infant (9x more common in males) + projectile vomiting after each feed + Child always hungry+ >6wks baby*+ Faltering growth+ Visible peristalsis+ Olive sized palpable mass ``` Ix- ABDOMINAL USG (1st line) - increased thickness of pylorus Rx - Ramsted's pyloromyotomy GERD - crying after each feed / vomiting / no abd mass / Normal Growth
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Child with regurgdation
child with regurgitation treat as GORD first unless- 1. perianal redness 2. loose stools 3. erythema or atopic eczema Treatment of GORD 1. increase frequency , reduce amount per feed 2. trial of thickeners 3. gaviscon ( alginates) 4. ppi for 4 weeks 2 is tried first followed by 3 and then 4 Treatment of non IgE cow milk protein allergy first replace with Hypoallergenic formula if does not help switch to Amino acid formula
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DDx of Non tender Cervical Lymph node in child over few MONTHS
Take Excisional Biopsy USS guided (Needle Biopsy will disrupt the architecture of the Lnode) ALL - FBC - low RBC PT and high lymphocytes / lymphoblast Hodgkin Lymphoma - Reed Stenberg Giant Cells TB - constitutional symptoms
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HUS(Hemolytic Urinemic Syndrome ) or SHIGA TOXIN DONT NOT GIVE Antibiotics and Antispasmodic(Loperamide) Release More toxin when die Supportive Only (80% good prognosis ) Child go to visit farm and come back with BLOODY diarrhoea/ blood in urine /
Causal Organism/ E coli and Shigella Classical TRIAD ANAEMIA / THROMBOCYTOPENIA / ARF + (BLOODY DIARRHOEA ) First Abdominal pain and BLOODY diarrhoea for 5 days and they produce SHIGA TOXIN cause blood clots to form ( use up RBC and PT / Deposit in Kidney / hypertension ) Anaemia / Haematuria / AKI / THROMBOCYTOPENIA brusing
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HSP (CHLD RHEUMATOLOGY) < 10 year age with purpura and join pain IgA Deposition in Vessels after Upper RT infection and GE
CLASSICAL 4 symptoms Palpable Purpura 100% (Must Have ) with one of these Joint Pain 75% (Knee and Ankles ) Abd Pain 50% Kidney Impairment 50% (Micro or Macro Haemat / Proteinuria )
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At HOME CHILD Jaundice within 24 hours SHOULD ring EMERGENCY AMBULANCE to Hospital within 2 hours
``` Transcutaneous Bilirubin Measurement Liver Function Test Direct Coomb's test G6PD test Full blood count Blood film Blood group ``` to be seen within 6 hours (using clinical judgement regarding more urgent referral or admission) if: - Jaundice first appears at more than 7 days of age. - The neonate is unwell (for example, lethargy, fever, vomiting, irritability). - Gestational age of less than 35 weeks. - Prolonged jaundice is suspected — that is a gestational age of less than 37 weeks with more than 21 days of jaundice; or a gestational age of 37 weeks or more with more than 14 days of jaundice. - Poor feeding and/or concerns about weight, particularly in breastfed infants. - Pale stools and dark urine.
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Prader Willi Syndrome | Chromosomal Not expressing at certain part due to Blocker
Infant - failure to thrive | Child hood - Over eating / Obesity / Delay mental development
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Coeliac disease vs Cystic Fibrosis (with cough ) Coeliac disease = Gluten allergy (autoimmune to protein Gluten) (no respiratory symptoms) Inv - IgA transglutaminase Antibody or IgA endomysia antibody INV -Alpha Gliadin antibodies positive If TTG IgA / EMA is negative +IgA deficiency-----> perform IgG.************* And if TTG is positive-------> perform EMA (IgA endomysial antibody).
Coeliac disease All GI symptoms and Mal absorption Chronic or intermittent Diarrhoea Steatorrhea (stinking stools) Persistent Bloating and N and Vomiting iron B12 folate deficiency
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PE 0060 Streptococcus agalactiae ( a - decrease production of Galactic - MIlk in cows ) Preg women go S .agalactiae screen test
Streptococcus agalactiae, group B streptococcus, is a gram-positive It tends to cause invasive disease in high-risk populations including pregnant women, neonates and the elderly. Invasive group B streptococcus infections in adults tend to present as bacteraemia without an obvious focus.
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Streptococcus = Gram+ Chain cocci Three big groups 1. Alpha Hemolytic (haemolysis blood only 50%) 2.Beta Hemolytic (haemolysis blood 100%) 3.Gama Hemolytic (no haemolysis of blood) ... Streptococcus Faecalis and faecium (normal flora of gut)
``` Alpha Hemolytic contiains two types Strep pneumoniae (Macrolide sensitive) Strep Viridians (Macrolide nonsensitive) ``` Beta Haemolytic Two subtypes Group A streptococcus - Streptococcus Pyrogens Group B streptococcus - Streptococcus Agalactia (Pregnant mom and neonate infection)
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CPR in children
INFANT = seal Mouth + Nose with mouth Blow steadily over 1 second for 5 times then 100-120 per minute rate compression with two finger over the lower sternum (two finger method) Or two thumbs over the chest (Encircling method) 30:2 LARGE INFANT = Seal one and try one with mouth > 1 year old can use heel of hand over the lower half of the sternum to compress the chest older children like adult cpr
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TCA overdose in Children
TCA in addition to Setrionin reuptake blockage Blockes other 7 also H Respiratory and Metabolic acidosis Ach Dry mouth Dilated pupil Dry Mouth Dry skin Dry urine (urinary retention) Drowsiness and altered mental status 5HT GABA Alpha receptors Hypotension / Tachycardia Na+ Prolong QRS complex K + Hyperkalaemia / Tall T waves Ds Investigations.. ECG, ABC, electrolyte panek ECG... Wide QRS and hyperacute T ABG.. Metabolic acidosis Electrolyte.. Hyperkalemia Ttt.. Within one hour_____ Activated charcoal Hyperkalemia and metabolic acidosis... NaHco3
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Constitutional delay in growth and puberty VS Hypogonadotropic hypogonadism CDGP is diagnosis of Exclusion PE0021
Constitutional delay in growth and puberty ----- Short stature /No testicular development until 14 years or above hence no pubic hair. hypogonadotropc hypogonadism ,they will provide us with some hormonal values some pituitary gland abnormalities... Without any such detail lab values or info It cannot b declared as hypogonadotrophic hypoggonadism
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CATCH 22 DIGEORGE SYNDROME Chromosome 22 problem and ABSENT OF THYMUS
``` CATCH 22 ---------------------------- Cardiac abnormality Abnormal facies Thymic absence, T cell abnormality Cleft palate Hypocalcemia ``` Chromosome 22 Failure to develop the 3rd and 4th pharyngeal pouches. Therefore failure to develop the thyroid and parathyroid which are derived from the 3rd and 4th pharyngeal pouches. Absent thymic shadow on X-Ray. Thymic defect ¬>> reduce T-cell immunity Thyroid defect¬>>hypothyrodism hypocalcemia fits Truncus arteiosus & teratology of fallots Tubular nose & cleft palate Tolerism & hooded eyelid
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CZ 3540 Sudden Infant Death Syndrome

Plab Hla Myint Aung (29 decks)

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