Paediatrics Flashcards
(94 cards)
1
Q
What is pityriasis versicolor and how is it treated?
A
common fungal skin infection that becomes more noticeable when spending time in the sun/after suntan: commonly affects trunk, patches may be hypopigmented, pink or brown, scaling is common, mild pruritis
Treatment is with ketoconazole shampoo
2
Q
What causes scarlet fever?
A
Group A haemolytic streptococci - usually Strep pyogenes
3
Q
What are the features of scarlet fever?
A
incubation period of 2-4 days:
fever
malaise, headache, nausea/vomiting
sore throat
strawberry tongue
rash -> fine punctuate erythema which generally appears on top of torso and spares the palm and soles, has rough sandpaper texture
4
Q
How is scarlet fever managed?
A
oral penicillin V for 10 days
Children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease
5
Q
What are the features of Edward’s syndrome (trisomy 18)?
A
Micrognathia - where lower jaw is undersized
Low-set ears
Rocker bottom feet
Overlapping of fingers
6
Q
What are features of Fragile X?
A
Learning difficulties
Macrocephaly
Long face
Long ears
Macro-orchidism - testes twice the normal size for age
7
Q
What are the features of William’s syndrome?
A
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
8
Q
What are the features of Prader-Willi syndrome?
A
Hypotonia
Hypogonadism
Obesity
9
Q
What is hydrops fetalis?
A
when abnormal amounts of fluid build up in two or more body areas of a foetus or newborn
10
Q
What electrolyte abnormality is seen in pyloric stenosis?
A
hypochloraemic, hypokalaemic alkalosis
11
Q
What is the standard test for Down’s syndrome?
A
combined test
done at 11-13+6 weeks
nuchal translucency measurement + serum BHCG + pregnancy associated plasma protein (PAPP-A_
12
Q
What results from the combined test suggest an increased chance of Down’s syndrome?
A
increased HCG
decreased PAPP-A
thickened nuchal translucency
13
Q
What is laryngomalacia? And how does it present?
A
Congenital abnormality of the larynx, typically presents at 4 weeks with stridor
14
Q
what are the features of minimal change disease?
A
nephrotic syndrome - haematuria, slight proteinuria
normotension - hypertension is rare
highly selective proteinuria
renal biopsy shows normal glomeruli on light microscopy
15
Q
What is a cephalohaematoma?
A
swelling due to bleeding between the periosteum and the skull, most commonly noted in the parietal region and is associated with instrumental deliveries
16
Q
what is caput succadeneum?
A
commonly seen in newborns immediately after birth, occurs due to generalised scalp oedema, which crosses suture lines
17
Q
How does Noonan syndrome present?
A
webbed neck
pectus excavatum
short stature
Pulmonary stenosis
18
Q
what is the classical murmur heard in PDA?
A
continuous machine whirring murmur throughout cardiac cycle
19
Q
what is the treatment of PDA?
A
only required if the baby is symptomatic
1/3 may require treatment with an NSAID - these inhibit prostaglandin synthesis which normally help maintain ductal patency
20
Q
What are the classic symptoms of measles?
A
development of a fever above 40 degrees
coryzal symptoms
conjunctivitis followed by a rash about 2-5 days after onset of symptoms
koplik spots -> small grey discolouration of the mucosal membranes in the mouth and appear 1-3 days after symptoms begin during the prodrome phase of infection –> PATHOGNOMONIC for measles infection
measles symptoms tend to develop 10-14 days post-exposure to an infected individual and last for 7-10 days
21
Q
how can measles be diagnosed?
A
1st: measles specific IgM and IgG serology (ELISA) is most sensitive 3-14 days after onset of rash
2nd: measles RNA detection by PCR best for swabs taken 1-3 days after rash onset
21
Q
how can measles be diagnosed?
A
1st: measles specific IgM and IgG serology (ELISA) is most sensitive 3-14 days after onset of rash
2nd: measles RNA detection by PCR best for swabs taken 1-3 days after rash onset
22
Q
how is measles managed?
A
supportive care -> antipyrexial
vitamin A in all children under 2
Ribavarin may reduce duration of symptoms but use is not routinely recommended
23
Q
what are the complications of measles?
A
acute otitis media
bronchopneumonia
encephalitis
24
How does oesophageal atresia present?
antenatal: polyhydramnios - as the oesophagus is blind-ending, fluid cannot pass through the baby to be absorbed, resulting in accumulation of fluid outside the baby
postnatal: respiratory distress, distended abdomen, choking/problems with swallowing, baby will have difficulty feeding and has overflow saliva, neonatal doctors will find difficulty passing the NG tube down
25
what is meconium aspiration syndrome?
presence of meconium in the amniotic fluid may lead to development of meconium aspiration syndrome
MAS is caused by passage of meconium from the amniotic fluid into the foetal lungs
It can cause blockage and inflammation of the airways and is associated with significant morbidity and mortality
26
what is meconium ileus?
condition where the meconium is thickened and causes obstruction of the bowel in the neonate - most commonly an early sign of cystic fibrosis
Meconium ileus usually presents as bilious vomiting, a distended abdomen and failure to pass meconium within the first 12-24 hours of life
It is important to recognise the obstruction may lead to bowel perforation, peritonitis, malrotation of the bowel and intestinal atresia
27
what are the diagnostic criteria for whooping cough/pertussis?
should be suspected if there is an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
- paroxysmal cough
- inspiratory whoop
- post-tussive vomiting
- undiagnosed apnoeic attacks in young infants
28
how is whooping cough diagnosed?
per nasal swab culture for bordatella pertussis
29
What are features of congenital hypothyroidism?
peripheral features: dry, thick skin, brittle hair, scanty 2ndary sexual hair
head and neck features: macroglossia, puffy face, loss of lateral 3rd of eyebrow, goitre
cardiac features: bradycardia, hepatomegaly
neurological features: carpal tunnel syndrome, slow relaxing reflexes, cerebellar ataxia, peripheral neuropathy
30
What causes roseola infantum?
a.k.a sixth disease
caused by human herpes virus 6
31
what are the features of roseola infantum?
- high fever: lasting a few days followed by
- maculopapular rash
- nagayama spots: spots on the uvula and soft palate
- febrile convulsions occur in around 10-15%
- diarrhoea and cough are also commonly seen
32
What is Kallmann's syndrome?
recognised cause of delayed puberty secondary to hypogonadotropic hypogonadism
usually inherited as an X-linked recessive trait
33
What are the features of Kallmann's syndrome?
- delayed puberty
- hypogonadism, cryptorchidism
- anosmia - lack of smell
- sex hormone levels are low
- LH, FSH levels are inappropriately low/normal
34
What are the features of Kallmann's syndrome?
- delayed puberty
- hypogonadism, cryptorchidism
- anosmia - lack of smell
- sex hormone levels are low
- LH, FSH levels are inappropriately low/normal
- patients are typically of normal or above-average height
presenting complaint is usually boy with delayed puberty who has lack of smell
35
What murmur is a VSD associated with?
pan systolic murmur which is louder in smaller defects
36
What is hand foot and mouth disease and how does it present?
self-limiting condition affecting children
commonly caused by coxsackie A16 and enterovirus 71
very contagious and typically occurs in outbreaks at nursery
Clinical features:
- mild systemic upset: sore throat, fever
- oral ulcers
- followed later by vesicles on palms and feet
37
what type of heart disease is Tetralogy of Fallot and when does it present?
most common cause of cyanotic congenital heart disease
typically presents at around 1-2 months although may not be picked up until the baby is 6 months old
38
what are the features of tetralogy of fallot?
ventricular septal defect
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
39
what are the other symptoms/signs of tetralogy of fallot?
cyanosis: unrepaired TOF infants may develop hypercyanotic "tet" spells due to near occlusion of the right ventricular outflow tract
features of tet spells include tachypnoea and severe cyanosis that may occasionally results in LOC
typically ocur when an infant is upset, is in pain or has a fever
causes a right-to-left shunt
ejection systolic murmur due to pulmonary stenosis
right-sided aortic arch is seen in 25% of patients
CXR shows boots shaped heart
40
What is the treatment of hand foot and mouth disease?
symptomatic treatment - advise abt analgesia and hydration
- children do not need to be excluded from school
40
What is the treatment of hand foot and mouth disease?
symptomatic treatment - advise abt analgesia and hydration
- children do not need to be excluded from school
41
what is the process of new-born resus?
1. dry baby and maintain temp
2. assess tone, resp rate, heart rate
3. if gasping or not breathing give 5 inflation breaths
4. reassess
5. if the heart rate is not improving and <60bpm start compr4essions and ventilation breaths at a rate of 3:1
42
What is intussusception?
where the bowel invaginates into itself - bowel is folded inwards
more common in boys
typically occurs in infants 6 months - 2years
43
what conditions are associated with intussesception?
concurrent viral illness
henoch-schonlein purpura
cystic fibrosis
intestinal polyps
meckel diverticulum
44
how does intussusception present?
severe colicky abdominal pain
pale, lethargic and unwell
redcurrant jelly stool
right upper quadrant mass on palpation - "sausage shaped"
vomiting
intestinal obstruction
45
how is intussusception diagnosed?
ultrasound scan or contrast enema
46
how is intussusception treated?
- therapeutic enemas can be used to try reduce intussusception - contrast, water or air are pumped into colon to force folded bowel out of bowel and into normal position
- surgical reduction may be necessary if enemas do not work
- if bowel becomes gangrenous (due to disruption of blood supply) or the bowel is perforated, then surgical resection is required
47
what are reasons for admission of bronchiolitis?
age under 3 or any pre-existing condition such as prematurity, downs syndrome or cystic fibrosis
consuming 50-75% or less of their normal intake of milk
clinical dehydration
resp rate above 70
o2 sats below 92%
moderate to severe RDS
apnoeas
parents not confident in ability to manage at home or difficulty accessing medical help from home
48
when can a child with acute asthma be discharged?
when a child is well on 6 puffs 4 hrly of salbutamol
49
what is the most common cause of croup?
parainfluenza virus
50
how is cystic fibrosis inherited?
autosomal recessive
51
what are the key consequences of the cystic fibrosis mutation?
- thick pancreatic and biliary secretions that cause blockage of the ducts, resulting in a lack of digestive enzymes such as pancreatic lipase in the digestive tract
- low volume thick airway secretions that reduce airway clearance, resulting in bacterial colonisation and susceptibility to airway infections
- congenital bilateral absence of the vas deferens in males - patients generally have healthy sperm but the sperm have no way of getting from the testes to the ejaculate, resulting in male infertility
52
what are the symptoms of cystic fibrosis?
- chronic cough
- thick sputum production
- recurrent resp tract infections
- loose, greasy stools due to a lack of fat digesting lipase enzymes
- abdo pain and bloating
- child tastes salty
- poor weight and height gain
53
What are the signs of cystic fibrosis?
low weight or height on growth charts
nasal polyps
finger clubbing
crackles and wheeze on auscultation
abdo distention
54
what is the gold standard test for confirming cystic fibrosis?
sweat test - measure chloride concentration of sweat - conc. for CF is more than 60mmol/L
55
what are the key bacterial colonisers in patients with CF and how are these prevented?
key colonisers are:
- staph aureus - long term prophylactic flucloxacillin can be given to prevent staph aureus infection
- pseudomonas - colonisation can be treated with long term nebulised antibiotics such as tobramycin, oral ciprofloxacin is also used
56
what are the aspects of cystic fibrosis management?
MDT:
- chest physio several times a day to clear mucus and reduce risk of infection and colonisation
- exercise improves resp function and reserve
- high cal. diet
- CREONM tablets to digest fats in patients with pancreatic insufficiency
- prophylactic flucloxacillin to reduce risk of bacterial infection
- treat chest infections when they occur
- bronchodilators e.g. salbutamol
- nebulised hypertonic saline
- vaccinations: pneumococcal, influenza, varicella
57
what do patients with cystic fibrosis need screening for?
diabetes
osteoporosis
vit D deficiency
liver failure
58
how is pyloric stenosis diagnosed?
abdominal ultrasound to visualise the thickened pylorus
59
how is pyloric stenosis treated?
ramstedt's operation - laprosocopic pyloromyotomy - widening of smooth muscle - excellent prognosis
60
what antibodies are raised in coeliac disease?
ANTI-ttg
anti-endomysial
these are both igA antibodies
some people are IgA deficient so should also test for total IgA
61
what investigations can be done if you suspect coeliac disease and what would you see?
endoscopy and intestinal/jejunal biopsy
this will show crypt hypertrophy and villious atrophy
62
what is the key pathophysiology of Hirschsprung's disease?
absence of parasympathetic ganglion cells
the aganglionic section of colon doers not relax, causing it to become constricted - leads to loss of movement and faeces and obstruction in the bowel - proximal to the obstruction of the bowel becomes distended and full
63
how does Hirschsprung's disease present?
severity of presentation and age at diagnosis varies significantly depending on the individual and extent of bowel that is affected
it can present with acute intestinal obstruction shortly after birth or more gradually developing symptoms:
- delay in passing meconium (>24hrs)
- chronic constipation since birtg
- abdominal pain and distention
- vomiting
- poor weight gain and failure to thrive
64
what is Hirschprung's associated enterocolitis?
inflammation and obstruction of the intestine occurring in approx. 20% of patients within 2-4 weeks of birth with fever, abo distention, diarrhoea and features of sepsis
it is life threatening and can lead to toxic megacolon and perforation of the bowel
it requires urgent abx, fluid resuscitation and decompression of the obstructed bowel
65
how can Hirschsprung's disease be diagnosed?
rectal biopsy is used to confirm the diagnosis - absence of ganglionic cells
abdo xray can be helpful in diagnosing intestinal obstruction
66
what is definitive management of Hirschsprung's?
surgical removal of the aganglionic section of bowel - most pts will live a normal life after corrective surgery, although they can have long term disturbances in bowel function and may be left with some degree of incontinence
67
what is the cause of croup?
parainfluenza virus
68
what is the cause of bronchiolitis?
RSV
69
what is laryngomalacia?
condition affecting infants where part of larynx above vocal cords is structured in a way thar allows it to cause partial airway obstruction - leads to chronic stridor on inhalation
70
how is a diagnosis of recurrent abdominal pain made?
when a child presents with repeated episodes of abdo pain without an identifiable underlying cause
pain is described as non organic or functional
often corresponds to stressful life events such as loss of a relative or bullying - thought to be due to increased sensitivity and inappropriate pain signals from the visceral nerves in response to normal stimuli
71
what is the management of recurrent abdominal pain?
careful explanation and reassurance
- distracting the child from the pain with other activities/interests
- encourage parents not to ask or focus on pain
- advice abt sleep, regular meals, healthy balanced diet
- probiotic supplements
- avoid NSAIDS
- address psychological triggers
- support from school counsellor or child psychologist
72
what are abdominal migraines?
children are more likely to suffer with a condition called abdominal migraine - may occur in young children before they develop traditional migraine as they get older
abdominal migraine presents with episodes of central abdominal pain lasting more than 1 hour
there may be associated n&v, anorexia, pallor, headache, photophobia, aura
73
how do you treat acute attacks of abdominal migraine and what can be used as a preventative measure?
treating attack: low stimulus environment, paracetamol, ibuprofen, sumatriptan
preventative: pizotifen - serotonin agonist, propranolol
74
what is the typical presentation of rheumatic fever?
occurs 2-4 weeks following a strep infection such as tonsillitis - symptoms affect multiple joints causing fever, joint pain, rash, SOB, chorea, nodules
75
what is the pattern of joint involvement in rheumatic fever?
migratory arthritis affecting large joints with hot, swollen, painful joints - migratory because different joints become inflamed and improved at different times - giving appearance that arthritis is moving from one joint to the next
76
what investigations can support a diagnosis of rheumatic fever?
throat swab for bacterial culture
ASO antibody titre - anti-streptococcus antibodies - indicate a recent strep infection and can be helpful in supporting diagnosis of rheumatic fever - levels usually:
- rise over 2-4 weeks
- peak around 3-6 weeks
- gradually fall over 3-12 months
levels are usually repeated after 2 weeks to confirm a negative test and to assess whether levels are falling or rising
echo, ecg, cxr can assess heart involvement
77
how can a diagnosis of rheumatic fever be made?
when there is evidence of recent strep infection + two major criteria or one major plus two minor criteria
major criteria - JONES
J - joint arthritis
O - organ inflammation - e.g. carditis
N - nodules
E - erythema marginatum rash
S - sydenham chorea
minor criteria - FEAR
F -fever
E - ecg changes
A - arthralgia without arthritis
R - raised inflammatory markers - crp and esr
78
How is rheumatic fever managed?
treatment of strep infections can help precent development - e.g. tonsillitis should be treated with penicillin V for 10 days
patients with clinical features of RA should be referred for specialist management - medications and follow up
- NSAIDs are helpful for joint pain
- Aspirin and steroids are used to treat carditis
- prophylactic antibiotics are used to prevent further strep infection
- monitoring and management of complications
79
what are the complications of rheumatic fever?
recurrence
valvular heart disease - most notably mitral stenosis
chronic heart failure
80
what are the clinical features of kawasaki disease?
persistent fever more than 5 days
widespread erythematous maculopapular rash
desquamation of skin on palms and soles
strawberry tongue
cracked lips
cervical lymphadenopathy
bilateral conjunctivitis
81
what is the treatment of Kawasaki?
high dose aspirin to reduce risk of thrombosis
IV immunoglobulins to reduce risk of coronary artery aneurysms
82
what are the features of mumps?
fever, malaise, muscular pain
parotitis - earache, pain on eating; unilateral initially then becomes bilateral in 70%
83
what are the features of mumps?
fever, malaise, muscular pain
parotitis - earache, pain on eating; unilateral initially then becomes bilateral in 70%
84
what are the features of rubella?
rash: pink maculopapular, initially on face before spreading to the whole body, usually fades by 3-5 days
lymphadenopathy: suboccipital and post-auricular
85
what are the features of scarlet fever?
fever, malaise, tonsillitis
strawberry tongue
rash - fine punctuate erythema sparing the area around the mouth
86
what is the rule of 2s in meckel's diverticulum?
occurs in 2% of the population
is 2 feet from the ileocecal valve
is 2 inches long
87
how does meckel's diverticulum present?
abdominal pain mimicking appendicitis
rectal bleeding - most common cause of painless massive GI bleeding requiring transfusion in children between age of 1 and 2
intestinal obstruction
88
What are the features of congenital rubella syndrome?
sensorineural deafness
congenital cataracts
congenital heart disease
glaucoma
89
what are the features of toxoplasmosis?
cerebral calcification
chorioretinitis
hydrocephalus
90
what are the features of cytomegalovirus?
low birth weight
purpuric skin lesions
sensorineural deafness
microcephaly
91
what is a venous hum?
benign murmur heard in children which sounds like a continuous blowing noise heard below the clavicles
92
what is Erb's palsy?
occurs due to damage to the upper brachial plexus most commonly from shoulder dystocia - damage to these nerve roots results in a characteristic pattern - adduction and internal rotation of the arm, with pronation of the forearm - classic physical position is commonly called the 'waiters tip'
