Paediatrics Flashcards
(302 cards)
1
Q
Triggers for viral induced wheeze?
A
Viral infections - RSV, rhinovirus
2
Q
What age do children grow out of virally induced wheeze?
A
3-4 years
3
Q
Presentation of VIW:
A
SOB, signs of resp distress, expiratory wheeze
4
Q
Signs of respiratory distress:
A
Raised respect rate
Use of accessory muscles
Intercostal recessions
Subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises
5
Q
Management of VIW?
A
Bronchodilators in acute episodes
(usually salbutamol)
6
Q
Cystic fibrosis inheritance, gene defect, chromosome?
A
Autosomal recessive, due to defect in CFTR gene on chromosome 7
7
Q
What does CF affect?
A
Chloride channels
Pancreases, lungs, liver, gonads
8
Q
Presentation of CF
A
Newborn - bloodspot positive, meconium ileus
Recurrent LRTIs, failure to thrive, pancreatitis
Chronic cough with thick sputum
Steatorrhoea, abdominal pain, bloating
Low height and weight
Finger clubbing
Crackles and wheeze on auscultation
Male infertility
9
Q
Investigations for CF:
A
Newborn blood spot test
Sweat test - Cl 60-120mmol/L compared to 10-14
Raised immunoreactive trypsin
Genetic testing
10
Q
Management of CF:
A
Chest physio BD
Prophylactic ABx for staph aureus - fluclox
Daily nebuliser anti-pseudomonas abx
High calorie diet
CREON tablet for pancreatic insufficiency
Nebulised hypertonic saline or DNAase
Vaccination - pneumococcal, influenza, varicella
Bilateral lung transplant
11
Q
What does nebuliser hypertonic saline or DNAase do in CF treatment?
A
Decreases viscosity to increase clearance
12
Q
What is the causative agent of croup?
A
Parainfluenza, RSV
Metapneumovirus, influenza
13
Q
What age group get croup and when?
A
6 months - 3 years (up to 6)
Autumn time
14
Q
Croup presentation:
A
Barking cough (foehn worse at night)
Preceded by low-grade fever and coryza
Stridor, hoarseness, recession
15
Q
Treatment for croup?
A
Can be self-limiting
Oral dexamethasone 150mcg/kg, repeat after 12 hours if needed
Oxygen –> nebulised budesonide –> nebuliser adrenaline –> intubation
16
Q
What is the causative agent of epiglottitis?
A
Haemophilus influenza type B (HiB)
17
Q
Who gets epiglottitis?
A
1-6 years
18
Q
Presentation of epiglottitis:
A
Pyrexial (>39)
Stridor - soft inspiratory
Drooling
Muffled voice
No/minimal cough
Tripod position
19
Q
Investigations for epiglottitis:
A
Blood cultures
DO NOT EXAMINE
Lateral XR neck = thumb sign
20
Q
Treatment for epiglottitis:
A
Intubation
IV ceftriaxone for 2-5 days
Prophylaxis with rifampicin for close contacts
21
Q
Causative agent of bronchiolitis?
A
RSV
22
Q
What age group gets bronchiolitis?
A
1-9 months (rare after 1 year)
23
Q
Presentation of bronchiolitis?
A
Coryzal symptoms, respiratory distress, feeding difficulties, tachypnoea, apnoea episodes, wheeze and fine end inspiratory crackles on auscultation
24
Q
Investigations for bronchiolitis?
A
Nasopharyngeal aspirate rapid testing (PCR)
CXR not necessary but = hyper inflating, air trapping, focal atelectasis
25
Treatment for bronchiolitis:
Self-limiting
Admission if < 3 months, pre-existing condition =
Supportive management - NG/IV fluids, saline nasal drops, O2, ventilation support if severe (high flow, CPAP or intubation)
CF patients = broad spec abx for 2-3 weeks
Palivizumab month injections - high risk
26
What is palivizumab? Who is it used for?
Monoclonal antibody used to prevent bronchiolitis
High risk for bronchiolitis - ex-prem, chronic lung disease, pulmonary hypoplasia, congenital heart disease, immune deficiency, CF
Monthly IM injections in winter months
27
Most common bacterial cause of pneumonia in children?
Strep pneumoniae - most common
Group A strep - pyogenes
Group B strep - newborns
Staph aureus - infrewuent
HiB - unvaccinated
Mycoplasma pneumoniae - extrapulmonary manifestation
28
Most common viral cause of pneumonia in children?
RSV
29
Pneumonia presentation in children:
Productive cough
High fever >38.5
Tachypnoea, tachycardia
Lethargy
Hypoxia, hypotension
Bronchial breathing
Focal coarse crackles, dullness to percussion
30
Investigations for pneumonia in children?
CXR, sputum cultures, viral PCR, blood cultures if septic
31
Antibiotics for pneumonia treatment in children?
First line - amoxicillin
Atypical - Amoxicillin +/- macrolide (eryth/clarith,azithromycin)
Complicated or influenza associated - co-amoxiclav
^5 days
32
Causative agent of whooping cough?
Bordetella pertussis = gram -ve
33
Presentation of whooping cough:
Low grade fever
Paroxysmal cough
Loud inspiratory whoop
Apnoeas
34
Investigations for whooping coughing?
Nasopharyngeal or nasal swab for PCR and cultures
35
What are the school attendance recommendations for whooping cough?
No school for 48 hours once abx started
36
Treatment for whooping cough
Supportive macrolide - azithromycin, erythromycin, clarithromycin within first 21 days (no longer contagious after this)
Vaccination as baby
37
Causes of heart failure in neonates?
Obstructed (duct-dependent) systemic circulation
- Hypoplastic left heart syndrome
- Critical aortic valve stenosis
- Severe coarctation of aorta
- Interruption of aortic arch
38
Causes of heart failure in infants?
High pulmonary blood flow:
- VSD
- AVSD
- Large PDA
39
Causes of heart failure in older children and adolescents?
Right or left heart failure:
- Eisenmenger syndrome (RHF only)
- Rheumatic heart disease
- Cardiomyopathy
40
Causes of heart failure in children - circulation failure?
Reduced oxygen carrying capacity - anaemia
Increased tissue demands - sepsis
Iatrogenic - fluid overload
41
Signs of innocent heart murmurs (s)
aSymptomatic
Soft blowing murmur
Systolic murmur only
left Sternal edge
+
Normal HS with no added sounds, no parasternal thrill, no radiation
42
Acyanotic heart defects:
VSD
ASD
AVSD
PDA
Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis
43
Cyanotic hearts defects:
ToF
TGA
Truncus arteriosus
Tricuspid atresia
Total anomalous pulmonary venous return
Eisenmenger's
Ebstein's
44
Which way is the shunt in acynanotic defects?
L --> R
45
Which way is the shunt in cyanotic defects?
R --> L
46
What conditions are associated with ASD?
Fetal alcohol syndrome, Downs, TORCH, Trisomy 13, Trisomy 18
47
What conditions are associated with VSD?
Downs, TORCH, fetal alcohol syndrome, trisomy 13, trisomy 18
48
What is associative with AVSD?
Trisomy 21
49
What is associated with PDA?
Maternal rubella
Prematurity
Females
50
What is associated with coarctation of the aorta?
Turner's, berry aneurysms, males, bicuspid aortic valve
51
What condition is associated with aortic stenosis?
Turner's
52
What conditions are associated with pulmonary stenosis?
Noonan's, William's, rubella
53
Which heart defects make up ToF?
VSD
Pulmonary stenosis
Overriding aorta
RVH
54
What conditions are associated with ToF?
DiGeorge syndrome (22q deletion)
Downs
Rubella
55
What causes Eisenmenger's syndrome?
LT complication of unrepared L --> R shunt (ASD, VSD, PDA) --> pulmonary hypertension --> reversal of shunt
56
What is Ebstein's anomaly associated with?
ASD, WPW, lithium use in pregnancy
57
Describe the murmur in ASD
Ejection systolic, upper left sternal border
Wide fixed split S2
58
Describe the murmur in VSD
Pansystolic lower left sternal border
Quiet pulmonary second sound
Systolic thrill
59
Describe the murmur in AVSD
Thrill, gallop rhythm
60
Describe the murmur in PDA
Continuous crescendo-decrescendo machinery, 2nd left intercostal space
61
Describe the murmur in coarctation of the aorta
Systolic murmur in left axilla or left infraclavicular area
62
Describe the murmur in aortic stenosis
Ejection systolic murmur in aortic area (RUSE)
Carotid thrill
Delayed and soft aortic 2nd sound
63
Describe the murmur in pulmonary stenosis
Ejection systolic murmur in LUSE (can radiate to back)
Ejection click
Right ventricular heave
64
Describe the murmur in ToF
Harsh ejection systolic murmur at left upper sternal border
(+/- at left mid-sternal border)
65
Describe the murmur in ToGA
No murmur
Can get loud, single 2nd heart sound
66
Describe the murmur in Eisenmenger's
No murmur or can be due to underlying septal defect
Loud P2
67
Presentation of ASD:
Asymptomatic
Resp infections, difficulty breathing, feeding difficulties, SOB, palpitations, HF, stroke
68
Presentation of VSD:
Asymptomatic
SOB, tachypnoea, sweating, feeding difficulties, poor weight gain, failure to thrive
69
Presentation of AVSD:
Poor feeding, failure to thrive, tachypnoea, hepatomegaly, oedema
70
Presentation of PDA:
Failure to thrive, SOB, poor feeding, tachycardia, tachypnoea
71
Presentation of coarctation of the aorta:
Weak femoral, pale, irritable, sweating, difficult breathing, higher BP in arms than legs, bounding pulses in arms and weak in legs
72
Presentation of aortic stenosis:
Asymptomatic
Weak pulses, reduced exercise tolerance, chest pain on exertion, syncope, dizziness
73
Investigations and findings for aortic stenosis:
CXR - post stenotic dilation of ascending aorta
ECG - LVH
74
Presentation of pulmonary stenosis:
Asymptomatic
Fatigue on exertion, SOBm dizziness, fainting
75
ECG findings for pulmonary stenosis:
RVH (upright T wave in V1)
76
Presentation of ToF?
Hypercyanotic 'tet' spells - irritability, inconsolable crying, cyanotic
Tissue acidosis - breathlessness, pallor
Clubbing
77
CXR findings for ToF:
Small heart
Uptilted apex (RVH) --> boot shaped
78
Presentation of ToGA:
Neonatal cyanosis and acidosis if closing/closed
Usually 2nd day of life
79
CXR findings for ToGA:
Egg on side
80
Presentation of Eisenmenger's:
Peripheral oedema, raised JVP, dyspnoea, cyanosis, clubbing, plethoric complexion (due to polycythaemia)
81
Describe the murmur in Ebstein's anomaly
Gallop rhythm
82
Presentation of Ebstein's anomaly:
HF
Gallop rhythm
Cyanosis, SOB, tachypnoea, poor feeding, collapse
Present when ductus arteriosus shuts (day 2)
83
Management of ASD:
Monitor
Surgery if symptomatic
84
Management of VSD:
Monitor
Surgery if symptoms persistent - transvenous catheter closure or open heart surgery
Diuretics, captopril, calories if large and HF
85
Management of AVSD:
Surgery at 3-5 years
86
Management of PDA:
Premature - NSAIDs or indomethacin
Prostaglandin E1 - keep open
Watchful waiting
Surgical ligation if > 1 y/o
87
Management of coarctation of the aorta:
Prostaglandin E1 - keep ductus open
Surgical repair between 2-4 y/o
88
Management of aortic stenosis:
Regular clinic appointments and ECHOs
Balloon valvotomy - if high pressure gradient across aortic valve (>64mmHg)
89
Management of pulmonary stenosis:
Monitoring
Transcatheter balloon dilation if pressure gradient across pulmonary valve > 64mmHG
90
Management of ToF:
Tet spells > 15 mins - sedation, pain relief, IV propranolol, bicard
Very cyanosed infants - Blalock Taussig shunt surgery at 6-9 months
91
ToGA management:
Prostaglandin infusion - maintains latency of foramen ovale
Balloon atrial septostomy
Arterial switch operation in neonatal period - 1 week
92
Management of Eisenmenger's syndrome:
Heart-lung transplant
Symptomatic treatment
93
Management of Ebstein's anomaly:
Prophylactic abx for IE
Surgical correction
94
Complications of ASD:
Right-sided HF
Pulmonary HTN --> Eisenmenger
AF
Stroke in context of VTE
95
Complications of VSD:
HF
Pulmonary HTN
Arrhythmias
Stroke
96
Complications of AVSD:
Pulmonary vascular disease
97
Complications of PDA:
Congestive HF
Recurrent pneumonia
98
Complications of coarctation of the aorta:
Heart failure
Duct closure - babies collapsed and acidotic its HF (2nd day of life)
99
Complications of aortic stenosis:
Left ventricular outflow obstruction --> LVH --> HF
100
Complications of pulmonary stenosis:
RVH
101
Complications of ToF:
RVH
102
Complications of Eisenmenger's:
HF
Infection
Thromboembolism
Haemorrhage
103
What is the definition of GORD in children?
Passage of gastric contents into oesophagus with or without regurgitation or vomiting due to immaturity of the LOS, mostly liquid diet and horizontal position
104
Risk factors for GORD:
Prematurity
Parental history of heartburn or acid regurgitation
Hx of congenital diaphragmatic hernia or congenital oesophageal atresia
Neurodisability --> cerebral palsy
105
GORD presentation red flags in paeds:
Projectile vomiting --> pyloric stenosis (up to 2 months)
Bile-stained vomit --> intestinal obstruction
Abdominal distension, tenderness, palpable mass
Blood in vomit or stool
Bulging fontanelle, altered responsiveness, increased head circumference
106
Presentation of GORD:
Distressed behaviour --> crying while feeding, unusual neck posture, change in crying, reluctance to feed
Hoarseness and/or chronic cough
Episode of pneumonia
Faltering growth
Severe signs = oesophagitis, apnoea, aspiration, IDA
107
Management of GORD:
Positioning and changing feeds - smaller, more frequent, sit upright after feeds
Thicken feeds - carobel
Drugs:
- 1-2 weeks of gaviscon --> if improves, continue for 2 weeks
- 4 weeks PPI (omeprazole) or histamine-2 receptor antagonist (ranitidine)
- surgery - fundoplication (>1y/o)
108
What is used to thicken milk for paediatric GORD?
Carobel
109
What is the definition of faltering growth?
Failure to gain adequate weight for achieve adequate growth during infancy or early childhood?
110
What is the classification for faltering growth?
- fall across 1 or more weight centile spaces, if birth weight was below 9th centile
- fall across 2 or more weight centile spaces, if birth weight was between 9th and 91st gentile
- fall across 3 or more weight gentile spaces, if birth weight was above the 91st centile
- when current weight is below the 2nd gentile for age, whatever the birth weight
111
Non-organic causes of faltering growth?
1. Inadequate availability of food
2. Psychosocial
3. Neglect or child abuse
112
Organic causes of faltering growth?
1. Impaired suck/swallow
- oro-motor dysfunction
- neurological disorder - cerebral palsy
2. Chronic illness leading to anorexia
- Crohn's
- Chronic renal failure
- CF
- Liver disease
- Congenital abnormalities
- GORD, CMPA
113
Risk factors for CMPA:
Boys
Know food allergy or family history
Atopic conditions or family history
114
What re the 2 different types of CMPA?
1. IgE
2. Non-IgE
115
Presentation of IgE CMPA:
Rapid onset - within 2 hours
Urticaria, rash
Colicky abdo pain, vomiting, bloody stools
Rhinorrhoea, itching nose
116
Presentation of non-IgE CMPA:
2-72 hours
Loose frequent stool with blood and mucus
Colicky abdo pain
117
Diagnosis of CMPA:
Elimination diet
IgE - skin/allergy test
118
Management of CMPA:
If breastfed - mum to have lactose free diet
Extensively hydrolysed formula
Amino acid formula
119
Definition of constipation:
Infrequent passage of dry, hard stool associated with strain, pain and bleeding
120
Presentation of constipation (paeds):
< 3 stools per week
Abdo pain - waxes and wanes
Encopresis
PR superficial bleeding
Avoidance of eating due to fear of pain
121
What is encopresis?
Involuntary faecal soiling or incontinence secondary to chronic constipation
122
What is encopresis?
Involuntary faecal soiling or incontinence secondary to chronic constipation
123
Constipation red flags:
Delayed meconium passage
Fever/vomiting/blood in stool
Failure to thrive
Empty rectum with presence of palpable abdominal mass
Abnormal neuro exam
124
Investigations for constipation (paeds):
Bloods - FBC, TFTs, anti-TTG
Abdominal XR
125
What does anti-TTG test for?
Coeliac disease
126
Management on constipation:
Reassurance, good hydration, good toilet habits, high fibre diet
Osmotic laxative - movicol
Softener - lactulose
Bulking agent - fybogel
Stimulant laxative - Senna
Treatment for 6 months
Can use disimpaction regime
127
What is a disimpaction regime?
Build up laxatives over a course of time to clear out bowels
128
Acute causes of diarrhoea:
Infection
Allergy/food hypersenisitivity reactions
Drugs
Haemolytic uraemia syndrome
Surgical
Toddler's diarrhoea
129
Causative agents of diarrhoea - viral:
Rotavirus
Norovirus
Adenovirus
Calicivirus
Astrovirus
130
Causative agents of diarrhoea - bacterial
C. jejuni traveller's diarrhoea
Salmonella
E. coli
Shigella
Bacillus cereus (eaten rice, recover in 24 hours)
131
Causative agents of diarrhoea - parasites:
Giardia lamblia
Cryptosporidium
132
What is toddler's diarrhoea?
> 3 weeks
Well child
Usually cleared by school age
133
Presentation of diarrhoea:
Diarrhoea +/- bloody stools
Fever +/- vomiting
Dehydration
134
Investigations for serious/ongoing/bloody diarrhoea??
Stool microbiology
Blood tests
135
Treatment for diarrhoea:
Antibiotics if bacterial gastroenteritis complicated by sepsis or immunocompromised
No anti-emetics or anti-motility drugs
136
Definition of coeliac disease:
Autoimmune chronic gluten enteropathy causing inflammation of the bowel
137
Presentation of coeliac disease:
Steatorrhea, diarrhoea
Weight loss
Neonatal failure to thrive, abdominal distension buttock wasting, irritability at 8-24 months
Non-classical:
IDA, osteoporosis, fatigue, dermatitis herpetiformis, short stature
138
Investigations for coeliac disease:
Anti-TTG, anti-EMA, gliadin antibodies
Endoscopy and duodenal bipsy
139
What does a duodenal biopsy show in coeliac disease?
Villous atrophy and crypt hyperplasia
140
Management of coeliac disease:
Lifelong gluten free diet
Complication prevention --> annual Ca and Vit D, DEXA scan when needed
141
Pathophysiology of Chrohn's:
Mouth to anus - terminal ileum mainly
Transmural inflammation
Skip lesions
Granuloma
142
Pathophysiology of UC:
Only colon affected
Mucosal inflammation
Continuous
No granulomas
143
Presentation of Chrohn's:
Abdominal pain, malaise, dehydration
No blood or mucus
Weight loss
Fissures, fistula, abscesses, stricture
Perianal disease (rectal sparing)
Extra-intestinal - clubbing, erythema, gangrenous, episcleritis, arthritis
144
Presentation of UC:
Abdominal pain, malaise, dehydration
Blood and mucus in stool
Extra-intestinal - clubbing, erythema, gangrenous, episcleritis, arthritis
145
What is UC associated with?
Primary sclerosis cholangitis
146
What is protective for ulcerative colitis?
Smoking
147
Investigations for IBD:
Faecal calprotectin - 90% sensitive and specific
Endoscopy (OGD and colonoscopy) + biopsy = gold standard
148
Treatment for Crohn's:
Induction: steroids (Fred) +/- azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab
Remission - azathioprine or mercaptopurine
Surgery if needed (distal ileum)
149
Treatment for UC:
Induction (mild/mod): aminosalicylates (mesalazine) --> corticosteroids
Induction (severe): IV steroids --> IV ciclosporin
Remission - aminosalicylates --> azathioprine/mercaptopurine
Surgery if needed --> ileostomy
150
Appendicitis presentation:
Central abdominal pain --> RIF pain (McBurney's)
Loss of appetite, N&V
Rovsing's sign
Guarding on abdominal palpation
Rebound and percussion tenderness --> ruptured
151
What is Rovsing's sign?
Palpation of LIF causes RIF pain
152
Investigations for appendicitis:
Clinical presentation and raised inflammatory marker
CT scan
USS - often in women to rile out ovarian/gynae pathology
153
Management for appendicitis:
Appendicectomy
154
What is mesenteric adenitis?
Infamed abdominal lymph nodes
155
Presentation of mesenteric adenitis:
Abdominal pain
Associated with tonsillitis or URTI
156
Management of mesenteric adenitis:
Supportive
157
What is pyloric stenosis?
Hypertrophy of the pylorus muscles --> causes gastric outlet obstruction
158
What age group does pyloric stenosis usually affect?
2-8 weeks
More common in boys
159
Presentation of pyloric stenosis:
Progressive projectile vomiting
Non bilious
Hungry after vomiting
Dehydration
Weight loss
160
What is the electrolyte imbalance in pyloric stenosis?
Hypokalaemic, hypochloraemic metabolic alkalosis
161
Examination findings in pyloric stenosis (test feed):
Olive size mass in RUQ
Visible peristalsis
162
USS findings in pyloric stenosis:
Thickened pylorus
163
Management of pyloric stenosis:
Fluid and electrolyte replacement
Non-urgent outpatient pyloromyotomy (Ramstedt's)
164
What is Meckel's diverticulum?
Malformation of distal ileum
165
When does Meckel's diverticulum present?
Under 2 years if symptomatic
Present at birth but often asymptomatic for life
166
Presentation of Meckel's if symptomatic:
GI bleeding, obstipation, abdo pain, N+V
167
Investigations for Meckel's diverticulum:
Technetium-99m pertechnetate scan (Meckel's scan)
USS
CT scan
168
Management for Meckel's diverticulum:
Surgical resection
169
What is intussusception?
1 section of bowel telescopes into the other (ileum into caecum)
170
At what age does intussusception usually present?
3 months to 2 years
171
Name 4 conditions that intussusception is associated with:
1. Meckel's
2. CF
3. Lymphoma
4. HSP
172
Presentation of intussusception:
Preceded by viral infection
Colicky abdo pain - legs draw up
Lethargic between episodes
SBO signs
Sausage shaped mass
Red currant jelly stool
173
USS and abdominal XR findings for intussusception:
USS - target/donut sign
AXR - dilated proximal bowel loop
174
Management of intussusception:
Rectal insufflation (75% success)
Surgical correction - if air insufflation fails or signs of peritonism
175
What is biliary atresia?
Narrow bile duct --> cholestasis
176
Presentation of biliary atresia:
Jaundice > 14 days in newborns or > 21 days if premature
177
Investigation findings for biliary atresia:
High conjugated bilirubin
178
Management of biliary atresia:
Kasai portoenterostomy
179
What is Hirschsprung's?
Absence of ganglia in colon
Congenital
180
Name 4 conditions that Hirschsprung's is associated with:
1. Down's
2. Neurofibromatosis
3. Waardenburg syndrome
4. Multiple endocrine neoplasia type II
181
Presentation of Hirschsprung's:
Failure to pass meconium within 24-48 hours
Abdominal distension
Late bilious vomiting
Poor weight gain and failure to thrive
182
Name a complication of Hirschsprung's:
Enterocolitis (HAEC) - inflammation and obstruction can lead to toxic megacolon or perforation
183
Investigations and findings for Hirschsprung's:
PR - contracted distal segment followed by rush of liquid stool and temporary relief of symptoms
AXR - contracted distal segment + dilated proximal segment
Barium enema
Rectal suction biopsy - GOLD STANDARD
184
Management of Hirschsprung's:
Surgical removal of ganglionic section
185
Management of HAEC:
Fluid resuscitation, IV Abx, treatment of obstruction
186
When does duodenal atresia present?
0-2 days old
187
What is duodenal atresia associated with?
Downs syndrome
188
Presentation of duodenal atresia:
SCO symptoms
Bilious vomiting
189
What does AXR show for duodenal atresia?
Double bubble sign
190
Management of duodenal atresia:
Surgical correction
191
What is malrotation?
Abnormality in the bowel, does not form and turn as it should
192
What is intestinal volvulus?
Complication of malrotation
Bowel twist on itself and blood supply is cut off
193
When does malrotation/volvulus present?
2-30 days old
194
Presentation of volvulus:
Can pass meconium normally
SBO symptoms
Bilious vomiting
195
AXR findings in volvulus:
Coffee bean sign
196
Investigations for volvulus:
AXR
Upper GI contrast series
197
What are the upper GI contrast series findings in volvulus:
Spiral appearance of distal duodenum and proximal jejunum
198
Management of volvulus?
Ladd's procedure
199
What is meconium ileus?
Failure to pass meconium --> small bowel obstruction
200
What is meconium ileus associated with?
CF
201
Presentation of meconium ileus:
Failure to pass meconium
SBO symptoms
Bilious vomiting
202
Investigations for meconium ileus:
Heel prick test to confirm CF
203
Management for meconium ileus:
Therapeutic contrast enema
204
3 bacterial causes of paediatric meningitis:
1. Strep pneumoniae
2. Neisseria meningitidis
3. GBS
205
What is the most common cause of bacterial meningitis in newborns?
Group B strep
206
Name 4 viral causes of viral meningitis?
1. HSV
2. VSV
3. Enterovirus
4. Adenovirus
207
Describe the rash in meningococcal septicaemia:
Non-blanching rash
Red/pruple
Petechial rash/purpura
208
Presentation of meningitis:
Fever
Neck stiffness
Headache
Vomiting
Photophobia
Altered consciousness
Seizures
Kernig's sign
Brudzinski's sign
209
What is Kernig's sign?
Physical test used when meningitis is suspected
Patient supine with hip flexed to 90 degrees, knee can't be fully extended
210
What is Brudzinski's sign?
Physical tested used when meningitis is suspected
Passive flexion of the neck causes flexion of both legs
211
Investigations for meningitis:
LP
Blood cultures
212
LP findings for:
1 - bacterial meningitis
2 - viral meningitis
1 - cloudy, high protein, low glucose, high neutrophils
2 - clear, normal protein, normal glucose, high lymphocytes
213
Community treatment for meningitis:
IM benzylpenicillin
214
Meningitis treatment:
1. < 3 months
2. > 3 months
1. Cefotaxime + amoxicillin
2. Ceftriaxone + dexamethasone
215
What is given for prophylaxis of bacterial meningitis?
Single dose of ciprofloxacin or rifampicin
216
Treatment for viral meningitis:
Self-resolving
Aciclovir if HSV/VZV
217
Complication of meningitis:
Hearing loss
Epilepsy
Learning difficulties
Vision loss
Limb loss
Death
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Causative agent of chicken pox:
Varicella zoster virus
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Describe the 3 stages of rash in chicken pox:
Macular --> papular --> vesicles
Non-infectious after scabbing over
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Symptoms of chicken pox:
Rash
Fever
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Treatment for chicken pox:
Symptomatic - calamine lotion, antihistamine
Severe/ immunocompromised - IV acyclovir
If infection (staph aureus) - fluclox
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Causative agent of measles:
Morbillivirus of RNA paramyxovirus
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Describe the rash in measles:
Maculopapular and erythematous rash on face and ears --> descends down the body
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Presentation of measles:
Prodromal period
Fever > 39
Cough
Coryza
Conjunctivitis
Koplik spots
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What are Koplik spots?
Sign of measles
Small white spots on buccal mucosa
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Investigations for measles:
Clinical diagnosis
Saliva swab for measles IgM to confirm
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Treatment for measles:
Self-limiting
Rest, isolation for 5 days after rash onset
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Complications of measles:
Otitis media, pneumonia, convulsions
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Causative agent of mumps:
RNA paramyxovirus
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What time of year is mumps most common?
Winter and spring months
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Presentation of mumps:
Parotid swelling - unilateral then bilateral
Fever
Malaise
Parotitis
Trismus (lockjaw)
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Blood test findings in mumps:
Raised plasma amylase
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Mumps treatment:
Self-limiting
No school for 7 days
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Complications of mumps:
Hearing loss
Orchitis
Meningitis
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Causative agent of rubella:
RNA paramyxovirus - rubivirus
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Describe the rash in rubella:
Non photogenic pink maculopapular rash --> starts on face
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Presentation of rubella (non-congenital):
Coryzal prodrome
Suboccipital and post auricular lymphadenopathy
Arthralgia
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Presentation of congenital rubella:
Sensorineural deafness
Cardiac and eye abnormalities
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Management of rubella:
Isolation for 5 days after rash appears
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What are the risks for pregnant women with rubella?
< 13 weeks - TOP, 80% risk of transmission, baby usually severely affected
> 13 weeks - 25% risk of transmission
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Causative agent of hand, foot and mouth disease:
Cocksackie (A16)
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Presentation of hand, foot and mouth disease:
Tender lumps of hand, feet and mouth
Sore throat
Dry cough
Fever
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Management of hand, foot and mouth disease:
Spontaenously resolves within 10 days
NO school exclusion
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Causative agent of slapped cheek syndrome?
Parvovirus B19
Also known as fifth disease
245
Presentation of slapped cheek syndrome:
Bright red malaria rash (not contagious once rash appears)
Asymptomatic
Coryzal prodrome
Fever
Hydrops in babies
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Management of slapped cheek syndrome:
Spontaneously resolves within 10 days
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Complications of slapped cheek syndrome:
Hydrops in babies
Pure red cell aplasia
Transient aplastic crisis
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Cause of scalded skin syndrome?
Reaction to staph toxin from stat aureus infection
Usually in children < 5
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Presentation of scalded skin syndrome:
Extensive tender erythema with flaccid superficial blisters/bullae
Erosion
+ve Nikolsky sign (rubbing causes skin to peel away)
Fever, lethargy, dehydration
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Management of scalded skin syndrome:
IV anti-staph abx
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Cause of Scarlet fever:
Strep A
(Reaction to strep A toxins)
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What age group is mostly affected by Scarlet fever?
2-8 years old
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Presentation of Scarlet Fever:
Rash - fingered sandpaper rash on neck and chest --> spreading to flexor creases
Prodrome - fever, vomiting, abdo pain
Strawberry tongue
Flushed red face, pale around mouth
Anterior cervical lymphadenopathy
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Investigations for Scarlet fever:
Throat swab
Serum antistreptolysin O and and antiDNAase B titres
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Management of Scarlet Fever:
Pen V for 10 days
No school until after 24 hours on Abx
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Complications of Scarlet Fever:
Peritonsillar or retropharyngeal abscess, acute glomerulonephritis, rheumatic fever
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What is Kawasaki's disease?
Medium sized vasculitis
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What age group does Kawasaki's mainly effect?
6 months - 5 years
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Presentation of Kawasaki's:
Widespread erythematous maculopapular rash and desquamation on palms and soles
Fever > 5 days
Bilateral conjunctivitis
Cracked lips
Cervical lymphadenopathy
Strawberry tongue
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Investigations for Scarlet Fever:
FBC - anaemia, leucocytosis, thrombocytosis
LFT - hypoalbuminaemia, elevated liver enzymes
ESR + CRP raised
Urinalysis - WBC without infection
ECHO
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Management of Kawasaki's disease:
High dose aspirin --> reduce risk of thrombosis then reduce until echo
IVIG --> reduced risk of coronary artery aneurysms for 10/7
Echo 6-8 weeks after for coronary artery aneurysms
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Cause of Toxic Shock Syndrome:
Toxins produced by staph aureus and group A strep
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Presentation of toxic shock syndrome:
Diffuse erythematous, macular rash
Fever > 39
Hypotension
Mucositis
Renal and liver impairment
Clotting abnormalities + thrombocytopenia
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Toxic shock syndrome management:
Debridement
Abx - ceftriaxone + clindamycin
IVIG
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Causative agent of Impetigo:
Staph aureus or group B strep
266
Which age group is impetigo most common in?
2-5 years old
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Presentation of impetigo:
Rapidly spreading clear blisters --> straw-coloured lesions with yellow crusting
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Management of impetigo:
Hydrogen [eroxide 1% or fusidic acid
Severe - oral fluclox
No school for 48 hours after abx or crusted over
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What is molluscum contagiosum:
Common pox viral infection
Warm, overcrowded environments
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Presentation of molluscum contagiosum:
Pink umbilicate papule with central dimple
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Management of molluscum contagiosum:
Resolves spontaneously
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Causative agent of pityriasis:
Human herpes virus 6 or 7
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Presentation of pityriasis rosea:
Herald patch - faint red scaly oval 2cm lesion --> widespread faint scaly oval rash
Low grade fever, headache, lethargy
274
Management of pityriasis rosea:
Self-limiting
Non-contagious
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Causative agent of seborrhoeic dermatitis:
Malassezia yeast
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Presentation of seborrhoeic dermatitis:
Cradle cap flaky scalp, flaky itchy skin
277
Management of seborrhoeic dermatitis:
Cradle cap - vaseline
Face/body - clotrimazole or miconazole ring
Scalp - shampoo ketoconazole
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What is JIA?
Autoimmune onset of persistent joint inflammation lasting > 6 weeks before age 16 with no identified underlying cause
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What is Still's disease?
Systemic JIA
280
Presentation of systemic JIA:
Subtle salmon-pink rash
Spiking daily fever
Joint pain
Lymphadenopathy
Splenomegaly
Arthritis
Polyserositis --> pericarditis, pleurites, sterile peritonitis
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Blood findings in systemic JIA:
Raised CRP, ESR, platelets and serum ferritin
ANA antibodies -ve, RF -ve
282
What is the first line treatment for systemic JIA?
Methotrexate (DMARD)
283
Treatment for systemic JIA:
NSAIDs
Steroids
DMARDs
Biological therapies
284
Name a serious complication of JIA?
Macrophage activation syndrome
Life-threatening, low ESR
285
Name the 5 subtypes of JIA:
1. Systemic JIA
2. Polyarticular JIA
3. Oligoarticular JIA
4. Enthesitis-related arthritis
5. Juvenile psoriatic arthritis
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What is the inheritance pattern and genetic mutation in Osteogenesis Imperfecta?
AD (80% but can be AR)
Defect in type 1 collage genes (COL1A1, COL1A2)
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Presentation of OI:
Bone fragility, fracture, deformity
Bone ache/pain
Impaired mobility --> ligamentous laxity, sarcopenia
Poor growth
Deafness, hernias, valvular prolapse
Blue sclera
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What is the classification of OI?
Sillence Classification
I - Mild (AD)
II - Perinatally lethal (AR, AD)
III - Progressively deforming, severe (AR)
IV - moderate (AD, AR)
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Management of OI:
Education, PT/OT, analgesia
Vitamin D supplementation --> prevent deficiency
Bisphosphonate therapy - inhibits osteoclasts (stay on this until at least stopped growing)
Surgery --> long bones, spine, skull base, hearing, teeth
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What is Rickets?
Undermineralised bone (osteomalacia) usually due to vitamin D deficiency
291
What causes Rickets?
Lack of sunlight
Poor nutrition
Intestinal malabsorption --> pancreatic insufficiency (CF), coeliac, IBD
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Presentation of Rickets:
Metaphyseal swellings
Bowing deformities
Slowing of linear growth
Motor delay, hypotonia
Fractures
Splayed/frayed metaphyses
Ping pong ball sensation of the skull (craniotabes)
Harrison sulcus - horizontal depression of lower chest
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Blood and XR findings in Rickets:
Low phosphate, normal or low Ca, raised serum AlkP
If vit D deficiency - raised PTH and low vit D
XR - cupping and fraying of metaphases, widened epiphyseal plate
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Management of Rickets:
Treat underlying cause
Vit D3 +/- calcium
Cod liver oil, sunlight
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What is Developmental Dysplasia of the Hip?
Abnormal development resulting in instability, dysplasia, subluxation and possible dislocation of the hip
296
What are some risk factors for DDH?
Females
Breech
1st child
Prematurity
Oligohydramnios
FHx
Club feet
Spina bifida
297
Presentation of DDH:
Painless limp
Delayed walking
Prone to falls
Asymmetrical thigh/buttock skin creases
Unequal leg length
Galeazzi sign (flex knees with feet together) - +ve is unequal length (-ve if bilateral DDH)
298
What are the screening tests for DDH?
Barlow's and Ortolani's
299
Management of DDH:
< 6 months - Pavlik harness (keeps hips flexed and abducted)
Cosed reduction or open reduction +/- femoral shortening
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What is the triad of presentations for haemolytic uraemic syndrome?
1. AKI
2. Microangipathic haemolytic anaemia
3. Thrombocytopaenia
301
What is the most common cause of haemolytic uraemic syndrome?
Shigatoxin producing E.coli O157:H7
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