Paediatrics

Question 1

Rheumatic Fever + presentation

Answer 1

Acute autoimmune condition triggered by stretoccocus infection leading to antibodies attacking cells throughout the body. Rare in UK.

Presentation 2-4 weeks post strep infection ie tonsillitis:
- joint pain
- fever
- SOB
- rash
- chorea (involuntary movs)
- skin nodules

Heart may also be involved:
carditis leading to = murmurs, pericardial rub, HF

Question 2

Rheumatic fever assessment, management, complications

Answer 2

Assessment:
- throat swab - step A
- ASO antibodies - antistrep antibodies
- ECG + CXR for heart involvement
- JONES criteria

Management:
- specialist referral

Question 3

Anaphylaxis definition, pathophysiology

Answer 3

It is a life-threatening emergency. Caused by type-1 hypersensitivity reaction where IgE stimulate mast cell degranulation leading to release of histamine and other pro-inflammatory chemicals.

This results in widespread vasodilation and increased vascular permeability leading to symptoms causing airway, breathing + circulation compromise.

Question 4

Anaphylaxis symptoms A-E

Answer 4

Rapid release of inflammatory mediators and cytokines triggers widespread vasodilation and increased vascular permeability and activation of inflammatory cascade.

This results in:

A - laryngeal oedema
B - SOB, wheeze
C - cyanosis, tachycardia, hypotension (distributive shock)
D - reduced consciousness
E - angioedema, utricaria

Question 5

Anaphylaxis management A-E

Answer 5

A – Secure the airway
B – Provide oxygen if required. Salbutamol can help with wheezing.
C – Provide an IV bolus of fluids
D – Lie the patient flat to improve cerebral perfusion
E – Look for flushing, urticaria and angio-oedema

• Intramuscular adrenalin, repeated after 5 minutes if required (vasoconstrictor + active sympathetic NS)
• Antihistamines, such as oral chlorphenamine or cetirizine
• Steroids, usually intravenous hydrocortisone

admission due to occurrence of biphasic reactions
can be measured by serum mast cell tryptase within 6 hours
2 epipens + education

Question 6

Anaphylaxis management A-E, acute + long term

Answer 6

A – Secure the airway
B – Provide oxygen if required. Salbutamol can help with wheezing.
C – Provide an IV bolus of fluids
D – Lie the patient flat to improve cerebral perfusion
E – Look for flushing, urticaria and angio-oedema

• Intramuscular adrenalin, repeated after 5 minutes if required (vasoconstrictor + active sympathetic NS)
• Antihistamines, such as oral chlorphenamine or cetirizine
• Steroids, usually intravenous hydrocortisone

admission due to occurrence of biphasic reactions
can be measured by serum mast cell tryptase within 6 hours
2 epipens + education