Paediatrics Flashcards
1
Q
Name the 3 fetal shunts
A
ductus arteriosus
foramen ovale
ductus venosus
2
Q
Describe the changes at birth that close the 3 fetal shunts
A
first breath expands alveoli, lowers pulmonary vascular resistant, lower pressure in right atrium closes foramen ovale -> fossa ovalis
Blood oxygenation causes decrease in prostaglandins, closes ductus arteriosus -> ligamentum arteriosum
Clamping of umbilical cord, ductus venosus-> ligamentum venosum
3
Q
What is the purpose of the ductus venosus?
A
shunt connects the umbilical vein to the inferior vena cava and allows blood to bypass the liver
4
Q
what is the purpose of the foramen ovale ?
A
shunt connects the right atrium with the left atrium and allows blood to bypass the right ventricle and pulmonary circulation
5
Q
What is the purpose of the ductus arteriosus?
A
shunt connects the pulmonary artery with the aorta and allows blood to bypass the pulmonary circulation
6
Q
What are the typical features of an innocent murmur?
A
Soft
Short
Systolic
Symptomless
Situation dependent, particularly if the murmur gets quieter with standing or only appears when the child is unwell or feverish
7
Q
What features of a murmur would prompt further investigation ?
A
Murmur louder than 2/6
Diastolic murmurs
Louder on standing
Other symptoms such as failure to thrive, feeding difficulty, cyanosis or shortness of breath
8
Q
What are the key investigations to establish the cause of a murmur and rule out abnormalities in a child?
A
ECG
Chest Xray
Echocardiography
9
Q
What are 3 differentials for a pan-systolic murmur ?
A
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect
10
Q
Where can the murmur be heard with a ventricular septal defect?
A
left lower sternal border
11
Q
Name 3 differentials for an ejection-systolic murmur
A
Aortic stenosis
Pulmonary stenosis
Hypertrophic obstructive cardiomyopathy
12
Q
What murmur does an atrial septal defect cause?
A
mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border
fixed split second heart sound
13
Q
What murmur does patent ductus arteriosus cause?
A
continuous crescendo-decrescendo “machinery” murmur
14
Q
What murmur does tetralogy of Fallot cause?
A
ejection systolic murmur loudest at the pulmonary area
15
Q
Name 4 cyanotic heart diseases
A
Ventricular septal defect (VSD)
Atrial septal defect (ASD)
Patent ductus arteriosus (PDA)
Transposition of the great arteries
16
Q
When does the ductus arteriosus usually stop functioning and close?
A
normally stops functioning within 1-3 days of birth, and closes completely within the first 2-3 weeks of life
17
Q
Give 2 risk factors for patent ductus arteriosus
A
Rubella
Prematurity
18
Q
Describe the pathophysiology of heart failure in patent ductus arteriosus
A
Left to Right shunt leading to pulmonary hypertension which causes right sided heart strain and hypertrophy
19
Q
What are the symptoms of patent ductus arteriosus?
A
SOB
Difficulty feeding
Poor weight gain
LRTI
20
Q
How is patent ductus arteriosus diagnosed?
A
Echo
21
Q
How is patent ductus arteriosus managed?
A
monitoring with echo
Surgical or trans-catheter closure
22
Q
Describe the pathophysiology of atrial septal defects
A
left to right shunt -> right sided strain -> right heart failure -> pulmonary hypertension
23
Q
what are the 2 walls that form the atrial septum?
A
septum primum and septum secondum
24
Q
What are the 3 types of atrial septal defect?
A
Ostium secondum
Patent foramen ovale
Ostium prinum
25
State 4 complications of atrial septal defects
Stroke in the context of venous thromboembolism (see below)
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right sided heart failure
Eisenmenger syndrome
26
What symptoms may be present in a child with an atrial septal defect?
Shortness of breath
Difficulty feeding
Poor weight gain
Lower respiratory tract infections
27
What are the management options for an atrial septal defect?
watch and wait (small)
transvenous catheter closure or open heart surgery
anticoagulants (in adults)
28
Name 2 genetic conditions associated with ventricular septal defects
Down's syndrome
Turner's syndrome
29
What are the typical symptoms of ventricular septal defects?
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive
30
What are the examination findings of a ventricular septal defect?
pan-systolic murmur more prominently heard at the left lower sternal border in the third and fourth intercostal spaces. There may be a systolic thrill on palpation.
31
what are patients with a ventricular septal defect at increased risk of?
infective endocarditis
32
what is the management of a ventricular septal defect?
watch and wait
transvenous catheter closure or open heart surgery
33
What are the 3 underlying lesions that can result in Eisenmenger syndrome
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
34
Describe the pathophysiology of Eisenmenger syndrome
defect in heart causes left to right, over time pulmonary hypertension develops when it exceeds systemic pressure the shunt reverses and is right to left, deoxygenated blood bypasses lungs and causes cyanosis
35
What examination findings are associated with pulmonary hypertension ?
Right ventricular heave: the right ventricle contracts forcefully against increased pressure in the lungs
Loud P2: loud second heart sound due to forceful shutting of the pulmonary valve
Raised JVP
Peripheral oedema
36
What findings in Eisenmenger syndrome are related to the right to left shunt and chronic hypoxia ?
Cyanosis
Clubbing
Dyspnoea
Plethoric complexion
37
What is the only definitive treatment once Eisenmenger syndrome has developed?
heart-lung transplant
38
What is the medical management of Eisenmenger syndrome?
Oxygen
Treatment of pulmonary hypertension e.g. sildenafil
Treatment of arrhythmias
Treatment of polycythaemia with venesection
Prevention and treatment of thrombosis with anticoagulation
Prevention of infective endocarditis using prophylactic antibiotics
39
What is coarctation of the aorta?
narrowing of the aortic arch
40
What genetic condition is associated with coarctation of the aorta?
Turners syndrome
41
How may coarctation of the aorta present?
weak femoral pulses
systolic murmur
differences in blood pressure in limbs
tachypnoea
poor feeding
grey and floppy baby
legs and left arm may be underdeveloped
42
What is the management of critical coarctation of the aorta?
Prostaglandin E (to keep ductus arteriosus open) whilst waiting for surgery
43
What are the presenting symptoms of aortic valve stenosis?
fatigue, shortness of breath, dizziness and fainting.
Symptoms usually worse on exertion
44
What are the key examination findings in aortic valve stenosis?
ejection systolic murmur
crescendo-decrescendo that radiates to the carotids
ejection click
palpable thrill
slow rising pulse and narrow pulse pressure
45
What is the gold standard investigation for aortic valve stenosis?
echocardiogram
46
What are the treatment options for aortic valve stenosis?
Percutaneous balloon aortic valvoplasty
Surgical aortic valvotomy
Valve replacement
47
what are some complications of aortic valve stenosis?
Left ventricular outflow tract obstruction
Heart failure
Ventricular arrhythmia
Bacterial endocarditis
Sudden death, often on exertion
48
what conditions are associated with congenital pulmonary valve stenosis?
Tetralogy of Fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome
49
What are some symptoms of severe pulmonary valve stenosis?
fatigue on exertion, shortness of breath, dizziness and fainting
50
What are some signs of pulmonary valve stenosis?
Ejection systolic murmur heard loudest at the pulmonary area (second intercostal space, left sternal border)
Palpable thrill in the pulmonary area
Right ventricular heave due to right ventricular hypertrophy
Raised JVP with giant a waves
51
what is the gold standard diagnostic investigation in pulmonary valve stenosis?
echocardiogram
52
What are the 4 defects present in tetralogy of fallot?
Ventricular septal defect (VSD)
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy
53
What are the risk factors for tetralogy of fallot?
Rubella infection
Increased age of the mother (over 40 years)
Alcohol consumption in pregnancy
Diabetic mother
54
What is the investigation of choice for diagnosing tetralogy of fallot?
echocardiogram
55
What is the characteristic CXR finding in tetralogy of fallot?
“boot shaped” heart due to right ventricular thickening
56
what are some signs and symptoms of tetralogy of fallot?
Cyanosis
Clubbing
Poor feeding
Poor weight gain
Ejection systolic murmur heard loudest in the pulmonary area
“Tet spells”
57
What are some precipitating factors for a tet spell?
waking, physical exertion or crying
58
what are the symptoms of a tet spell?
irritable, cyanotic and short of breath
59
What are the conservative measures for managing a tet spell?
Older children may squat when a tet spell occurs. Younger children can be positioned with their knees to their chest. Squatting increases the systemic vascular resistance. This encourages blood to enter the pulmonary vessels.
60
what are the medical options for managing a tet spell?
O2
bblockers
IV fluids
morphine
sodium bicarbonate
phenylephrine infusion
61
what are the management options for tetralogy of fallot?
neonates - prostaglandin infusion to maintain ductus arteriosus
definitive - open heart surgery
62
what is Ebstein's anomaly?
congenital heart condition where the tricuspid valve is set lower in the right side of the heart (towards the apex), causing a bigger right atrium and a smaller right ventricle
63
what conditions are associated with ebstein's anomaly
right to left shunt via atrial septal defect
Wolff-Parkinson-White syndrome
64
What are the presenting features of Ebstein's Anomoly ?
Evidence of heart failure (e.g. oedema)
Gallop rhythm heard on auscultation characterised by the addition of the third and fourth heart sounds
Cyanosis
Shortness of breath and tachypnoea
Poor feeding
Collapse or cardiac arrest
65
How is ebstein's anomoly diagnosed?
Echocardiogram
66
what is the management of ebstein's anomoly?
treating arrhythmias and heart failure.
Prophylactic antibiotics
Surgical correction of defect
67
what is transposition of the great arteries?
condition where the attachments of the aorta and the pulmonary trunk to the heart are swapped
68
what defects are associated with transposition of the great arteries?
Ventricular septal defect
Coarctation of the aorta
Pulmonary stenosis
69
How does transposition of the great arteries present ?
usually picked up on antenatal scans
cyanosis
within a few weeks of life they will develop respiratory distress, tachycardia, poor feeding, poor weight gain and sweating
70
what is the management of transposition of the great arteries?
prostaglandin infusion to maintain ductus arteriosus
balloon septostomy
open heart surgery
71
what is bronchiolitis?
inflammation and infection in the bronchioles
72
what is the most common cause of bronchiolitis?
Respiratory syncytial virus
73
What are the presenting features of bronchiolitis?
Coryzal symptoms
signs of respiratory distress
dyspnoea
tachypnoea
poor feeding
mild fever
apnoeas
wheeze and crackles on auscultation
74
what are the signs of respiratory distress?
raised respiratory rate
use of accessory muscles (sternocleidomastoid, abdominal and intercostal)
Intercostal and subcostal recessions
nasal flaring
Head bobbing
tracheal tug
cyanosis
abnormal airway noises
75
children how have had bronchiolitis as infants are more likely to have what during childhood?
viral induced wheeze
76
When should you admit a child with bronchiolitis?
Aged under 3 months or any pre-existing condition such as prematurity, Downs syndrome or cystic fibrosis
50 – 75% or less of their normal intake of milk
Clinical dehydration
Respiratory rate above 70
Oxygen saturations below 92%
Moderate to severe respiratory distress, such as deep recessions or head bobbing
Apnoeas
Parents not confident in their ability to manage at home or difficulty accessing medical help from home
77
what is the management of bronchiolitis?
Ensuring adequate intake
Saline nasal drops and nasal suctioning
Supplementary oxygen if the oxygen saturations remain below 92%
Ventilatory support if required
78
what are the most helpful signs of poor ventilation on capillary blood gas?
Rising pCO2
falling pH
respiratory acidosis
79
what can be given as prevention against bronchiolitis?
Palivizumab
80
typical features of viral-induced wheeze (as opposed to asthma) are:
Presenting before 3 years of age
No atopic history
Only occurs during viral infections
81
how does viral-induced wheeze present ?
Presenting before 3 years of age
No atopic history
Only occurs during viral infections
82
how does an acute asthma exacerbation present?
Progressively worsening shortness of breath
Signs of respiratory distress
Fast respiratory rate
Expiratory wheeze on auscultation heard throughout the chest
The chest can sound “tight” on auscultation, with reduced air entry
83
what are the features of a moderate asthma attack?
peak flow >50% predicted
Normal speech
84
What are the features of a severe asthma attack?
peak flow <50% predicted
saturations <92%
Unable to complete sentences in one breath
signs of respiratory distress
resp rate >40 (1-5yrs), >30 (>5yrs)
heart rate >140 (1-5yrs), >125 (>5yrs)
85
What are the features of a life threatening asthma attack?
peak flow <33% predicted
Saturations <92%
Exhaustion and poor respiratory effort
hypotension
silent chest
cyanosis
altered consciousness/confusion
86
What is the stepwise treatment using bronchodilators in acute asthma and viral induced wheeze?
Inhaled or nebulised salbutamol (a beta-2 agonist)
Inhaled or nebulised ipratropium bromide (an anti-muscarinic)
IV magnesium sulphate
IV aminophylline
87
What is the stepwise management of acute asthma or viral induced wheeze?
Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours
Nebulisers with salbutamol / ipratropium bromide
Oral prednisone (e.g. 1mg per kg of body weight once a day for 3 days)
IV hydrocortisone
IV magnesium sulphate
IV salbutamol
IV aminophylline
88
when can discharge be considered following an acute asthma exacerbation?
he child is well on 6 puffs 4 hourly of salbutamol
89
what presenting symptoms suggest a diagnosis of asthma?
Episodic symptoms with intermittent exacerbations
Diurnal variability, typically worse at night and early morning
Dry cough with wheeze and shortness of breath
Typical triggers
A history of other atopic conditions such as eczema, hayfever and food allergies
Family history of asthma or atopy
Bilateral widespread “polyphonic” wheeze heard by a healthcare professional
Symptoms improve with bronchodilators
90
what are some typical triggers of asthma?
Dust (house dust mites)
Animals
Cold air
Exercise
Smoke
Food allergens (e.g. peanuts, shellfish or eggs)
91
What investigations can be carried out to aid with the diagnosis of asthma?
Spirometry with reversibility testing (in children aged over 5 years)
Direct bronchial challenge test with histamine or methacholine
Fractional exhaled nitric oxide (FeNO)
Peak flow variability measured by keeping a diary of peak flow measurements several times a day for 2 to 4 weeks
92
What are the stages of medical therapy of chronic asthma in children under 5?
Start a short-acting beta-2 agonist inhaler (e.g. salbutamol) as required
Add a low dose corticosteroid inhaler or a leukotriene antagonist (i.e. oral montelukast)
Add the other option from step 2.
Refer to a specialist.
93
What is the medical therapy of chronic asthma in children 5-12yrs?
Start a short-acting beta-2 agonist inhaler (e.g. salbutamol) as required
Add a regular low dose corticosteroid inhaler
Add a long-acting beta-2 agonist inhaler (e.g. salmeterol). Continue salmeterol only if the patient has a good response.
Titrate up the corticosteroid inhaler to a medium dose. Consider adding:
Oral leukotriene receptor antagonist (e.g. montelukast)
Oral theophylline
Increase the dose of the inhaled corticosteroid to a high dose.
Referral to a specialist. They may require daily oral steroids.
94
Describe inhaler technique with a spacer
Assemble the spacer
Shake the inhaler (depending on the type)
Attach the inhaler to the correct end
Sit or stand up straight
Lift the chin slightly
Make a seal around the spacer mouthpiece or place the mask over the face
Spray the dose into the spacer
Take steady breaths in and out 5 times until the mist is fully inhaled
95
what investigations may be done in a child with recurrent lower respiratory tract infections?
FBC
CXR
serum immunoglobulins
Immunoglobulin G to previous vaccines
Sweat test
HIV test
96
what age group is typically affected by croup?
6 months to 2 years
97
What is the classic cause of croup that typically improves in less than 48hrs and responds well to dexamethasone?
Parainfluenza virus
98
name 4 causes of croup
Parainfluenza
Influenza
Adenovirus
Respiratory Syncytial Virus (RSV)
99
what is croup?
upper respiratory tract infection causing oedema in the larynx
100
what are the presenting features of croup?
Increased work of breathing
“Barking” cough, occurring in clusters of coughing episodes
Hoarse voice
Stridor
Low grade fever
101
What is the management of croup?
oral dexamethasone
Oxygen
Nebulised budesonide
Nebulised adrenalin
Intubation and ventilation
102
what is the typical cause of epiglottitis?
haemophilus influenza type B
103
what are the presenting features of epiglottitis?
Patient presenting with a sore throat and stridor
Drooling
Tripod position, sat forward with a hand on each knee
High fever
Difficulty or painful swallowing
Muffled voice
Scared and quiet child
Septic and unwell appearance
104
what would a lateral x-ray of the neck show in epiglottitis?
thumb sign
105
what is the management of epiglottitis?
do not distress patient
alert senior paediatrician and anaesthetist
ensure airway is secure
IV antibiotics e.g. ceftriaxone
Steroids e.g. dexamethasone
106
what is laryngomalacia?
part of the larynx above the vocal cords (the supraglottic larynx) is structured in a way that allows it to cause partial airway obstruction
107
what is the key presenting feature of laryngomalacia?
inspiratory stridor
108
what is the cause of whooping cough ?
Bordetella pertussis (a gram negative bacteria)
109
what are the presenting features of whooping cough?
mild coryzal symptoms
severe coughing fits - paroxysmal
inspiratory whoop
110
How is whooping cough diagnosed?
nasopharyngeal or nasal swab with PCR testing or bacterial culture can confirm the diagnosis within 2 to 3 weeks of the onset of symptoms.
Where the cough has been present for more than 2 weeks patients can be tested for the anti-pertussis toxin immunoglobulin G
111
what is the management of whooping cough?
notify public health
supportive care
Macrolide antibiotics e.g. azithromycin
prophylactic antibiotics to close contacts in vulnerable groups
112
how long do the symptoms of whooping cough typically last for?
8 weeks
113
what is a key complication of whooping cough?
bronchiectasis
114
what are the features of chronic lung disease of prematurity?
Low oxygen saturations
Increased work of breathing
Poor feeding and weight gain
Crackles and wheezes on chest auscultation
Increased susceptibility to infection
115
what can be done to prevent chronic lung disease of prematurity?
Corticosteroids e.g. betamethasone to mothers showing signs of premature labour
CPAP rather than intubation
Caffine
Not over-oxygenating
116
what is the management of chronic lung disease of prematurity ?
sleep study to assess oxygen
oxygen saturations
O2 therapy
monthly palivizumab
117
how is a diagnosis of chronic lung disease of prematurity made?
chest xray changes and when the infant requires oxygen therapy after they reach 36 weeks gestational age.
118
what is the inheritance pattern of cystic fibrosis?
autosomal recessive
119
a genetic mutation on which mutation causes cystic fibrosis
7
120
what proportion of the population are carriers and what proportion have cystic fibrosis?
carriers = 1/25
have CF= 1/2500
121
what are the key consequences of the cystic fibrosis mutation?
thick pancreatic and biliary secretions
low volume thick airway secretions
Congenital bilateral absence of the vas deferens
122
how is CF screened for at birth?
newborn bloodspot test
123
what is often the first sign of cystic fibrosis?
Meconium ileus
124
What are the symptoms of cystic fibrosis?
Chronic cough
Thick sputum production
Recurrent respiratory tract infections
Loose, greasy stools (steatorrhoea) due to a lack of fat digesting lipase enzymes
Abdominal pain and bloating
Parents may report the child tastes particularly salty when they kiss them, due to the concentrated salt in the sweat
Poor weight and height gain (failure to thrive)
125
what are some signs of cystic fibrosis?
Low weight or height on growth charts
Nasal polyps
Finger clubbing
Crackles and wheezes on auscultation
Abdominal distention
126
what are some causes of clubbing in children?
Hereditary clubbing
Cyanotic heart disease
Infective endocarditis
Cystic fibrosis
Tuberculosis
Inflammatory bowel disease
Liver cirrhosis
127
What are the 3 key methods for diagnosing cystic fibrosis?
Newborn blood spot testing
sweat test = gold standard
Genetic testing for CFTR gene
128
Name 4 common colonisers in people with cystic fibrosis
Staphylococcus aureus
Haemophilus influenza
Klebsiella pneumoniae
Escherichia coli
Burkhodheria cepacia
Pseudomonas aeruginosa
129
How is pseudomonas colonisation treated in patients with cystic fibrosis?
long term nebulised antibiotics such as tobramycin. Oral ciprofloxacin is also used.
130
What are the aspects of management in cystic fibrosis?
Chest physiotherapy
Exercise
High calorie diet
CREON tablets
prophylactic flucloxacillin
treat chest infections
bronchodilators
Nebulised DNase
Nebulised hypertonic saline
vaccinations enc. pneumococcal and varicella
131
What conditions do people with cystic fibrosis need monitoring and screening for?
diabetes, osteoporosis, vitamin D deficiency and liver failure
132
What is the inheritance pattern of primary ciliary dyskinesia?
autosomal recessive condition
133
what is Kartagner's triad in primary ciliary dyskinesia?
Paranasal sinusitis
Bronchiectasis
Situs Inversus
134
what is primary ciliary dyskinesia ?
ysfunction of the motile cilia around the body, most notably in the respiratory tract. This leads to a buildup of mucus in the lungs, providing a great site for infection that is not easily cleared
also affects the cilia in the fallopian tubes of women and the tails (flagella) of the sperm in men
135
what is situs inversus?
all the internal (visceral) organs are mirrored inside the body
136
What is a key risk factor for primary ciliary dyskinesia?
consanguinity in the parents
137
what are some medical causes of abdominal pain in children?
Constipation
Urinary tract infection
Coeliac disease
Inflammatory bowel disease
Irritable bowel syndrome
Mesenteric adenitis
Abdominal migraine
Pyelonephritis
Henoch-Schonlein purpura
Tonsilitis
Diabetic ketoacidosis
Infantile colic
138
What are some surgical causes of abdominal pain in children?
Appendicitis
Intussusception
Bowel obstruction
Testicular torsion
139
What are some red flags for serious abdominal pain in children?
Persistent or bilious vomiting
Severe chronic diarrhoea
Fever
Rectal bleeding
Weight loss or faltering growth
Dysphagia (difficulty swallowing)
Nighttime pain
Abdominal tenderness
140
What are the features of an abdominal migraine?
central abdominal pain lasting more than 1 hour
There may be associated:
Nausea and vomiting
Anorexia
Pallor
Headache
Photophobia
Aura
141
what is the main preventative medication for abdominal migraines?
Pizotifen
142
What are some typical features in a history and examination that suggest constipation?
Less than 3 stools a week
Hard stools that are difficult to pass
Rabbit dropping stools
Straining and painful passages of stools
Abdominal pain
Holding an abnormal posture, referred to as retentive posturing
Rectal bleeding associated with hard stools
Faecal impaction causing overflow soiling, with incontinence of particularly loose smelly stools
Hard stools may be palpable in abdomen
Loss of the sensation of the need to open the bowels
143
what is Encopresis?
faecal incontinence
144
at what age is faecal incontinence considered pathological?
4 years
145
what are some causes of faecal incontinence?
Chronic constipation
Spina bifida
Hirschprung's disease
Cerebral palsy
Learning disability
Psychosocial stress
Abuse
146
What lifestyle factors can contribute to constipation?
Habitually not opening the bowels
Low fibre diet
Poor fluid intake and dehydration
Sedentary lifestyle
Psychosocial problems
147
What are some red flags for constipation in children?
Not passing meconium within 48 hours of birth
Neurological signs or symptoms
Vomiting
Ribbon stool
Abnormal anus
Abnormal lower back or buttocks
Failure to thrive
Acute severe abdominal pain and bloating
148
What are some complications of constipation?
Pain
Reduced sensation
Anal fissures
Haemorrhoids
Overflow and soiling
Psychosocial morbidity
149
what are the management options for constipation ?
Correct any contributing factors
Movicol
disimpaction regime if required
encourage and praise visiting the toilet
150
what causes GORD in babies?
immaturity of the lower oesophageal sphincter
151
by what age do 90% of infants stop having reflux by?
1 year
152
What are some signs of problematic reflux?
Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Reluctance to feed
Pneumonia
Poor weight gain
153
What advise can be given to help reflux?
Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keep the baby upright after feeding (i.e. not lying flat)
154
what are the management options for problematic reflux?
Gaviscon mixed with feeds
Thickened milk or formula (specific anti-reflux formulas are available)
Proton pump inhibitors (e.g., omeprazole) where other methods are inadequate
155
what is Sandifer's syndrome?
rare condition causing brief episodes of abnormal movements associated with gastro-oesophageal reflux in infants
156
what is the key symptom of pyloric stenosis?
projectile vomiting
157
what may be felt on examination in pyloric stenosis?
olive mass in upper abdomen
158
What will blood gas analysis show in pyloric stenosis?
hypochloric (low chloride) metabolic alkalosis
159
How is a diagnosis of pyloric stenosis made?
abdominal ultrasound to visualise the thickened pylorus
160
what is the treatment of laparoscopic pyloromyotomy
laparoscopic pyloromyotomy
161
What is the main concern in gastroenteritis?
Dehydration
162
what are 2 common causes of viral gastroenteritis?
Rotavirus
Norovirus
163
What are the symptoms of e.coli gastroenteritis?
abdominal cramps, bloody diarrhoea and vomiting
164
What is a common cause of travellers diarrhoea?
Campylobacter Jejuni
165
What is biliary atresia?
congenital condition where a section of the bile duct is either narrowed or absent
166
How does biliary atresia present?
persistent jaundice, lasting more than 14 days in term babies and 21 days in premature babies
167
what is the initial investigation for biliary atresia and what will it show?
conjugated and unconjugated bilirubin.
A high proportion of conjugated bilirubin
168
what is the management of biliary atresia?
Kasai portoenterostomy
169
what are some causes of intestinal obstruction
Meconium ileus
Hirschsprung’s disease
Oesophageal atresia
Duodenal atresia
Intussusception
Imperforate anus
Malrotation of the intestines with a volvulus
Strangulated hernia
170
How does bowel obstruction present?
Persistent vomiting. This may be bilious
Abdominal pain and distention
Failure to pass stools or wind
Abnormal bowel sounds.
171
What is the initial investigation for bowel obstruction?
abdominal xray
may show dilated loops of bowel proximal to the obstruction and absence of air in the rectum
172
what is the management of bowel obstruction?
nil by mouth
NG tube
IV fluids
Treat underlying cause
173
what is Hirschsprung's disease?
congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum.
174
what syndromes are associated with Hirschsprung's disease?
Downs syndrome
Neurofibromatosis
Waardenburg syndrome
Multiple endocrine neoplasia type II
175
what are the presenting features of Hirschsprungs disease?
Delay in passing meconium (more than 24 hours)
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive
176
What is Hirschsprung-Associated Enterocolitis
inflammation and obstruction of the intestine typically presents within 2-4 weeks of birth with fever, abdominal distention, diarrhoea
can lead to toxic megacolon and perforation of the bowel. It requires urgent antibiotics, fluid resuscitation and decompression
177
what investigations can be done to diagnose Hirshsprungs disease ?
Abdominal xray
Rectal biopsy
178
what will rectal biopsy show in Hirschsprungs disease?
absence of ganglionic cells
179
what is the definitive management of Hirschsprungs disease?
surgical removal of the aganglionic section of bowel
180
What conditions are associated with intussusception?
Concurrent viral illness
Henoch-Schonlein purpura
Cystic fibrosis
Intestinal polyps
Meckel diverticulum
181
What are the presenting symptoms of intussusception?
Severe, colicky abdominal pain
Pale, lethargic and unwell child
“Redcurrant jelly stool”
Right upper quadrant mass on palpation. This is described as “sausage-shaped”
Vomiting
Intestinal obstruction
182
how is intussusception diagnosed ?
ultrasound or contrast enema
183
what is the management of intussusception?
therapeutic enemas
surgical reduction
184
what are some complications of intussusception?
Obstruction
Gangrenous bowel
Perforation
Death
185
when is the peak age of appendicitis?
10 to 20 years
186
where is McBurney's point?
one third the distance from the anterior superior iliac spine (ASIS) to the umbilicus
187
what are the classic features of appendicitis?
pain (central -> RIF)
anorexia
N + V
Rovsing's sign
guarding
rebound and percussion tenderness
188
what is Rovsing's sign?
palpation of the left iliac fossa causes pain in the RIF
189
what does rebound and percussion tenderness suggest in appendicitis?
peritonitis caused by a ruptured appendix
190
what are some key differentials of appendicitis?
ectopic pregnancy
ovarian cysts
Meckel's diverticulum
Mesenteric adenitis
appendix mass
191
how is appendicitis managed?
appendicectomy
192
what are some complications of an appendicectomy?
Bleeding, infection, pain and scars
Damage to bowel, bladder or other organs
Removal of a normal appendix
Anaesthetic risks
Venous thromboembolism
193
What are the principles of DKA management in children?
Correct dehydration evenly over 48 hours. This will correct the dehydration and dilute the hyperglycaemia and the ketones. Correcting it faster increases the risk of cerebral oedema.
Give a fixed rate insulin infusion. This allows cells to start using glucose again. This in turn switches off the production of ketones.
194
what are some features of adrenal insufficiency in babies?
Lethargy
Vomiting
Poor feeding
Hypoglycaemia
Jaundice
Failure to thrive
195
what are some features of adrenal insufficiency in older children?
Nausea and vomiting
Poor weight gain or weight loss
Reduced appetite (anorexia)
Abdominal pain
Muscle weakness or cramps
Developmental delay or poor academic performance
Bronze hyperpigmentation to skin in Addison’s
196
How do females with congenital adrenal hyperplasia present?
virilised genitalia
an enlarged clitoris due to the high testosterone levels
197
Patients with more severe congenital adrenal hyperplasia can present shortly after birth with what symptoms?
hyponatraemia, hyperkalaemia and hypoglycaemia.
This leads to signs and symptoms:
Poor feeding
Vomiting
Dehydration
Arrhythmias
198
what are some features of mild congenital adrenal hyperplasia in males?
Tall for their age
Deep voice
Large penis
Small testicles
Early puberty
199
what is the management of congenital adrenal hyperplasia ?
Cortisol replacement, usually with hydrocortisone, similar to treatment for adrenal insufficiency
Aldosterone replacement, usually with fludrocortisone
Female patients with “virilised” genitals may require corrective surgery
200
how may growth hormone deficiency present at birth or in neonates?
Micropenis (in males)
Hypoglycaemia
Severe jaundice
201
how may growth hormone deficiency present in older infants or children?
Poor growth, usually stopping or severely slowing from age 2-3
Short stature
Slow development of movement and strength
Delayed puberty
202
what is the main investigation in growth hormone deficiency?
growth hormone stimulation test
203
What is the management growth hormone deficiency?
Daily subcutaneous injections of growth hormone (somatropin)
Treatment of other associated hormone deficiencies
Close monitoring of height and development
204
what are the presenting features of congenital hypothyroidism ?
Prolonged neonatal jaundice
Poor feeding
Constipation
Increased sleeping
Reduced activity
Slow growth and development
205
what are some symptoms of a UTI in babies?
Fever
Lethargy
Irritability
Vomiting
Poor feeding
Urinary frequency
206
what is the management of a UTI in children?
<3m with fever = immediate IV antibiotics
>3m and systemically well = oral antibiotics
207
when should children with UTIs have ultrasound scans?
All children under 6 months with their first UTI should have an abdominal ultrasound within 6 weeks, or during the illness if there are recurrent UTIs or atypical bacteria
Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks
Children with atypical UTIs should have an abdominal ultrasound during the illness
208
when should a DMSA scan be done?
4 – 6 months after the illness to assess for damage from recurrent or atypical UTIs
209
How is Vesico-ureteric reflux diagnosed?
micturating cystourethrogram (MCUG)
210
what is the management of vesico-ureteric reflux?
Avoid constipation
Avoid an excessively full bladder
Prophylactic antibiotics
Surgical input from paediatric urology
211
What can exacerbate vulvovaginitis?
Wet nappies
Use of chemicals or soaps in cleaning the area
Tight clothing that traps moisture or sweat in the area
Poor toilet hygiene
Constipation
Threadworms
Pressure on the area, for example horse riding
Heavily chlorinated pools
212
between what ages in vulvovaginitis common?
3 and 10 years
213
what are the presenting symptoms of vulvovaginitis?
Soreness
Itching
Erythema around the labia
Vaginal discharge
Dysuria (burning or stinging on urination)
Constipation
214
what is the management of vulvovaginitis?
Avoid washing with soap and chemicals
Avoid perfumed or antiseptic products
Good toilet hygiene, wipe from front to back
Keeping the area dry
Emollients, such as sudacrem can sooth the area
Loose cotton clothing
Treating constipation and worms where applicable
Avoiding activities that exacerbate the problem
215
What is the classic triad of Nephrotic syndrome?
Low serum albumin
High urine protein content (>3+ protein on urine dipstick)
Oedema
216
Apart from the classic triad what are 3 other feature that occur in patients with nephrotic syndrome?
Deranged lipid profile, with high levels of cholesterol, triglycerides and low density lipoproteins
High blood pressure
Hyper-coagulability, with an increased tendency to form blood clots
217
What is the most common cause of nephrotic syndrome in children?
minimal change disease
218
nephrotic disease can be secondary to what?
intrinsic kidney disease (focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis)
Systemic illness (HSP, diabetes, infection)
219
what is the management of minimal change disease?
corticosteroids
220
what is the general management of nephrotic syndrome?
High dose steroids (i.e. prednisolone)
Low salt diet
Diuretics may be used to treat oedema
Albumin infusions may be required in severe hypoalbuminaemia
Antibiotic prophylaxis may be given in severe cases
221
what may be used to manage nephrotic syndrome in steroid resistant children?
ACE inhibitors and immunosuppressants
222
What are some complications of nephrotic syndrome?
Hypovolaemia
Thrombosis
Infection
Acute or chronic renal failure
Relapse
223
what are the features of nephritis?
Reduction in kidney function
Haematuria: invisible or visible amounts of blood in the urine
Proteinuria: although less than in nephrotic syndrome
224
What are the 2 most common causes of Nephritis in children?
post-streptococcal glomerulonephritis and IgA nephropathy (Berger’s disease).
225
How long after streptococcus infection does post-streptococcal glomerulonephritis occur?
1 – 3 weeks
226
what condition is related to IgA Nephropathy?
Henoch-Schonlein Purpura
227
what is the management of nephritis ?
supportive
may require immunosupression
228
when do most children get control of daytime and night time urination?
Most children get control of daytime urination by 2 years and night time urination by 3 – 4 years.
229
what is primary nocturnal enuresis?
where the child has never managed to be consistently dry at night
230
What are causes of primary nocturnal enuresis?
variation on normal development
overactive bladder
fluid intake
failure to wake
psychological distress
secondary causes e.g. chronic constipation
231
what is the management of primary nocturnal enuresis?
Reassurance
Lifestyle changes e.g. pass urine before bed
Positive reinforcement
Treat underlying causes
Enuresis alarms
Pharmacological treatment
232
What is secondary nocturnal enuresis?
where a child begins wetting the bed when they have previously been dry for at least 6 months
233
What are some causes of secondary nocturnal enuresis?
Urinary tract infection
Constipation
Type 1 diabetes
New psychosocial problems (e.g. stress in family or school life)
Maltreatment
234
What medications are there for enuresis?
Desmopressin
Oxybutynin
Imipramine
235
what is multicystic dysplastic kidney?
one of the baby’s kidneys is made up of many cysts while the other kidney is normal
236
what is a Wilms tumour ?
specific type of tumour affecting the kidney in children, typically under the age of 5 years
237
what are the presenting features of a Wilms tumour?
mass in abdomen
Abdominal pain
Haematuria
Lethargy
Fever
Hypertension
Weight loss
238
what is the initial investigation of a wilms tumour
ultrasound
239
what is the management of a Wilms tumour?
nephrectomy
adjuvant chemo/radiotherapy
240
what is a posterior urethral valve?
where there is tissue at the proximal end of the urethra (closest to the bladder) that causes obstruction of urine output. It occurs in newborn boys.
241
what are the presenting features of a posterior urethral valve?
Difficulty urinating
Weak urinary stream
Chronic urinary retention
Palpable bladder
Recurrent urinary tract infections
Impaired kidney function
242
what investigations may be done for a posterior urethral valve?
Abdo ultrasound
MCUG
Cystoscopy
243
what is the management of a posterior urethral valve?
monitoring
temporary catheter
ablation
244
what percentage of boys have undescended testes at birth ?
5%
245
what are the risks of undescended testes in an older child?
testicular torsion
infertility
testicular cancer
246
what are the risk factors for undescended testes?
Family history of undescended testes
Low birth weight
Small for gestational age
Prematurity
Maternal smoking during pregnancy
247
what is the management of undescended testes?
watch and wait until 6m
seen by paeds urologist
Orchidopexy between 6 and 12 months
248
what is Hypospadias?
urethral meatus (the opening of the urethra) is abnormally displaced to the ventral side (underside) of the penis, towards the scrotum
249
what are some complications of hypospadias?
Difficulty directing urination
Cosmetic and psychological concerns
Sexual dysfunction
250
what is a hydrocele?
collection of fluid within the tunica vaginalis that surrounds the testes
251
what is a communicating hydrocele?
tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size
252
what are the examination findings of a hydrocele?
soft, smooth, non-tender swelling around one of the testes. The swelling will be in front of and below
transilluminate with light
253
what is the management of a hydrocele?
Ultrasound
if simple usually resolve within 2yrs
communicating require surgery
254
what cells produce surfactant?
type II alveolar cells
255
at what gestation do type II alveolar cells become mature enough to start producing surfactant?
24 and 34 weeks
256
what are the principles of neonatal resuscitation?
Warm the baby
calculate APGAR score (1,5 & 10 mins)
Stimulate breathing, head in neutral position, check for airway obstruction
Inflation breaths (2 cycles of 5 breaths, if no response then 30seconds of ventilation breaths) still no response start compressions
Chest compressions 3:1 ratio
257
prolonged hypoxia increases the risk of what in neonates?
hypoxic-ischaemic encephalopathy (HIE)
258
what are the features of the APGAR score ?
Appearance (blue centrally, blue extremities, pink)
Pulse (absent, <100, >100)
Grimmace (no, little, good response)
Activity (floppy, flexed, active)
Respiration (absent, slow/irregular, strong/crying)
259
what is the APGAR score measured out of?
10
260
what are the main aspects of normal care of the neonate after birth?
Skin to skin
Clamp the umbilical cord
Dry the baby
Keep the baby warm with a hat and blankets
Vitamin K
Label the baby
Measure the weight and length
261
when is the blood spot screening carried out?
day 5
262
what 9 conditions are tested for in blood spot screening?
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
Homocystin
263
when is the newborn examination carried out?
72 hours after birth
repeated at 6-8 weeks by GP
264
how do you measure pre-ductal saturations?
baby’s right hand
265
how do you measure post-ductal saturations?
in either foot
266
what are some features of general appearance in a NIPE?
Colour (pink is good)
Tone
Cry
skin changes
267
What should you inspect from a babies head in a NIPE?
General appearance: size, shape, dysmorphology, caput succedaneum, cephalohaematoma and any facial injury
Head circumference
Anterior and posterior fontanelles
Sutures
Ears
Eyes: slight squints are normal, epicanthic folds can indicate Down’s, purulent discharge could indicate infection
Red reflex
Mouth: cleft lip or tongue tie
Put your little finger in their mouth to check the suckling reflect and feel the palate all the way back, checking for a cleft palate.
268
What should you inspect on the shoulder and arms in a NIPE?
Shoulder symmetry: check for a clavicle fracture
Arm movements: check for an Erbs palsy
Brachial pulses
Radial pulses
Palmar creases: a single palmar crease is associated with Down’s, but can be normal
Digits: check the number of digits and if the fingers are straight or curved (clinodactyly)
Use a sats probe on the right wrist for a pre-ductal reading
269
What should you inspect from the chest in a NIPE?
Oxygen saturations in the right wrist and a feet: 95% and above is normal
Observe breathing: look for respiration distress, symmetry and listen for stridor
Heart sounds: listen for murmurs, heart sounds, heart rate and identify which side the heart is on heart
Breath sounds: listen for symmetry, good air entry and added sounds
269
What should you inspect from the abdomen in a NIPE?
Observe the shape: a concave abdomen may indicate diaphragmatic hernia with abdominal contents in the chest
Umbilical stump: look for discharge, infection and a periumbilical hernia
Palpate for organomegaly, hernias or masses
269
What should you examine from the genitals in a NIPE?
Observe for the sex, ambiguity and any obvious abnormalities
Palpate testes and scrotum: check both are present and descended, check for hernias or hydroceles
Inspect the penis for hypospadias, epispadias and urination
Inspect the anus to check if it is patent
Ask about meconium and whether the baby has opened the bowel
270
What should you inspect from the legs in a NIPE?
Observe the legs and hips for equal movements, skin creases, tone and talipes
Barlows and Ortolani manoeuvres: check for clunking, clicking and dislocation of the hips
Count the toes
271
what should you inspect from the back in a NIPE?
Inspect and palpate the spine: look for curvature, spina bifida and a pilonidal sinus
272
What reflexes should be tested in a NIPE?
Moro reflex: when rapidly tipped backwards the arms and legs will extend
Suckling reflex: placing a finger in the mouth will prompt them to suck
Rooting reflex: tickling the cheek will cause them to turn towards the stimulus
Grasp reflex: placing a finger in the palm will cause them to grasp
Stepping reflex: when held upright and the feet touch a surface they will make a stepping motion
273
What is Caput Succedaneum ?
fluid (oedema) collecting on the scalp, outside the periosteum (able to cross suture lines)
274
What is a cephalohaematoma?
collection of blood between the skull and the periosteum (does not cross suture lines)
275
What nerve is injured in Erbs palsy
C5/C6 nerves in the brachial plexus
276
what is the appearance of Erbs palsy?
“waiters tip” appearance:
Internally rotated shoulder
Extended elbow
Flexed wrist facing backwards (pronated)
Lack of movement in the affected arm
277
what will babies get weakness with if the have an Erbs palsy ?
shoulder abduction and external rotation, arm flexion and finger extension
278
how may a fractured clavicle present in a newborn?
Noticeable lack of movement or asymmetry of movement in the affected arm
Asymmetry of the shoulders, with the affected shoulder lower than the normal shoulder
Pain and distress on movement of the arm
279
what are some common organisms in neonatal sepsis?
Group B streptococcus (GBS)
Escherichia coli (e. coli)
Listeria
Klebsiella
Staphylococcus aureus
280
What are some risk factors for neonatal sepsis?
Vaginal GBS colonisation
GBS sepsis in a previous baby
Maternal sepsis, chorioamnionitis or fever > 38ºC
Prematurity (less than 37 weeks)
Early (premature) rupture of membrane
Prolonged rupture of membranes (PROM)
281
What are some clinical features of neonatal sepsis?
Fever
Reduced tone and activity
Poor feeding
Respiratory distress or apnoea
Vomiting
Tachycardia or bradycardia
Hypoxia
Jaundice within 24 hours
Seizures
Hypoglycaemia
282
what are some red flags for neonatal sepsis ?
Confirmed or suspected sepsis in the mother
Signs of shock
Seizures
Term baby needing mechanical ventilation
Respiratory distress starting more than 4 hours after birth
Presumed sepsis in another baby in a multiple pregnancy
283
how should you treat presumed neonatal sepsis?
If there are two or more risk factors or clinical feature of neonatal sepsis start antibiotics
Antibiotics should be started if there is a single red flag
Antibiotics should be given within 1 hour of making the decision to start them
Blood cultures should be taken before antibiotics are given
Check a baseline FBC and CRP
Perform a lumbar puncture if infection is strongly suspected or there are features of meningitis (e.g. seizures)
284
what do NICE recommend as first line antibiotics in neonatal sepsis?
benzylpenicillin and gentamycin
285
what is the ongoing management of neonatal sepsis?
Check the CRP again at 24 hours and check the blood culture results at 36 hours:
Consider stopping the antibiotics if the baby is clinically well, the blood cultures are negative 36 hours after taking them and both CRP results are less than 10.
Check the CRP again at 5 days if they are still on treatment:
Consider stopping antibiotics if the baby is clinically well, the lumbar puncture and blood cultures are negative and the CRP has returned to normal at 5 days.
286
what are some causes of hypoxic-ischaemic encephalopathy?
Maternal shock
Intrapartum haemorrhage
Prolapsed cord, causing compression of the cord during birth
Nuchal cord, where the cord is wrapped around the neck of the baby
287
what are the features of mild HIE with Sarnat staging?
Poor feeding, generally irritability and hyper-alert
Resolves within 24 hours
Normal prognosis
288
What are the features of moderate HIE with Sarnat staging?
Poor feeding, lethargic, hypotonic and seizures
Can take weeks to resolve
Up to 40% develop cerebral palsy
289
what are the features of severe HIE on Sarnat staging
Reduced consciousness, apnoeas, flaccid and reduced or absent reflexes
Up to 50% mortality
Up to 90% develop cerebral palsy
290
what is the management of HIE?
Supportive care
Therapeutic hypothermia
291
what are the causes of neonatal jaundice relating to increased production of bilirubin?
Haemolytic disease of the newborn
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and disseminated intravascular coagulation
G6PD deficiency
292
what are the causes of neonatal jaundice relating to decreased clearance of bilirubin?
Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders (hypothyroid and hypopituitary)
Gilbert syndrome
293
What is Kernicterus?
brain damage due to high bilirubin levels
294
What causes Haemolytic disease of the newborn?
incompatibility between the rhesus antigens on the surface of the red blood cells of the mother and fetus
295
how is prolonged jaundice defined?
More than 14 days in full term babies
More than 21 days in premature babies
296
Name 3 possible causes of prolonged jaundice in a neonate?
biliary atresia
hypothyroidism
G6PD deficiency
297
what investigations should you do to investigate neonatal jaundice ?
Full blood count and blood film for polycythaemia or anaemia
Conjugated bilirubin: elevated levels indicate a hepatobiliary cause
Blood type testing of mother and baby for ABO or rhesus incompatibility
Direct Coombs Test (direct antiglobulin test) for haemolysis
Thyroid function, particularly for hypothyroid
Blood and urine cultures if infection is suspected. Suspected sepsis needs treatment with antibiotics.
Glucose-6-phosphate-dehydrogenase (G6PD) levels for G6PD deficiency
298
what are the main 2 treatment options for neonatal jaundice?
Phototherapy
Exchamge transfusions
299
what can Kernicterus
cerebral palsy, learning disability and deafness
300
What is the WHO classification of prematurity?
Under 28 weeks: extreme preterm
28 – 32 weeks: very preterm
32 – 37 weeks: moderate to late preterm
301
What are some risk factors of prematurity
Social deprivation
Smoking
Alcohol
Drugs
Overweight or underweight mother
Maternal co-morbidities
Twins
Personal or family history of prematurity
302
What are the 2 options to try and delay birth in women with a history of preterm birth or an ultrasound demonstrating a cervical length of 25mm or less before 24 weeks gestation?
Prophylactic vaginal progesterone: putting a progesterone suppository in the vagina to discourage labour
Prophylactic cervical cerclage: putting a suture in the cervix to hold it closed
303
Where preterm labour is suspected or confirmed what are the options for improving outcomes?
Tocolysis with nifedipine
Maternal corticosteroids
IV Magnesium sulphate
Delayed cord clamping or cord milking
304
What are some issues of prematurity in early life?
Respiratory distress syndrome
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea and bradycardia
Neonatal jaundice
Intraventricular haemorrhage
Retinopathy of prematurity
Necrotising enterocolitis
Immature immune system and infection
305
what are some long term effects of prematurity?
Chronic lung disease of prematurity (CLDP)
Learning and behavioural difficulties
Susceptibility to infections, particularly respiratory tract infections
Hearing and visual impairment
Cerebral palsy
306
How are apnoea's defined?
periods where breathing stops spontaneously for more than 20 seconds, or shorter periods with oxygen desaturation or bradycardia
307
Apnoea are often a sign of developing illness, such as:
Infection
Anaemia
Airway obstruction (may be positional)
CNS pathology, such as seizures or haemorrhage
Gastro-oesophageal reflux
Neonatal abstinence syndrome
308
what is the management of apnoea?
Apnoea monitors
Tactile stimulation
IV caffeine
309
what babies does retinopathy of prematurity occur in?
babies born before 32 weeks gestation
310
When are babies screened for retinopathy of Prematurity?
30 – 31 weeks gestational age in babies born before 27 weeks
4 – 5 weeks of age in babies born after 27 weeks
311
what is the first line treatment of retinopathy of prematurity?
transpupillary laser photocoagulation
312
Respiratory distress syndrome commonly occurs below what gestational age?
32 weeks
313
What does chest x-ray show in respiratory distress syndrome?
“ground-glass” appearance
314
Describe the pathophysiology of respiratory distress syndrome?
Inadequate surfactant leads to high surface tension within alveoli. This leads to atelectasis (lung collapse), as it is more difficult for the alveoli and the lungs to expand. This leads to inadequate gaseous exchange, resulting in hypoxia, hypercapnia (high CO2) and respiratory distress.
315
What is the management of respiratory distress syndrome?
Antenatal steroids (i.e. dexamethasone) given to mothers with suspected or confirmed preterm labour
Premature neonates may need:
Intubation and ventilation
Endotracheal surfactant
Continuous positive airway pressure (CPAP)
Supplementary oxygen
316
What are some short term complications of respiratory distress syndrome?
Pneumothorax
Infection
Apnoea
Intraventricular haemorrhage
Pulmonary haemorrhage
Necrotising enterocolitis
317
What are some long term complications of respiratory distress syndrome?
Chronic lung disease of prematurity
Retinopathy of prematurity
Neurological, hearing and visual impairment
318
What is necrotising enterocolitis?
disorder affecting premature neonates, where part of the bowel becomes necrotic. It is a life threatening emergency. Death of the bowel tissue can lead to bowel perforation. Bowel perforation leads to peritonitis and shock.
319
What are some risk factors for necrotising enterocolitis?
Very low birth weight or very premature
Formula feeds (it is less common in babies fed by breast milk feeds)
Respiratory distress and assisted ventilation
Sepsis
Patient ductus arteriosus and other congenital heart disease
320
How may necrotising enterocolitis present?
Intolerance to feeds
Vomiting, particularly with green bile
Generally unwell
Distended, tender abdomen
Absent bowel sounds
Blood in stools
321
what will capillary blood gas show in necrotising enterocolitis?
metabolic acidosis
322
What will an xray show in necrotising enterocolitis?
Dilated loops of bowel
Bowel wall oedema (thickened bowel walls)
Pneumatosis intestinalis is gas in the bowel wall and is a sign of NEC
Pneumoperitoneum is free gas in the peritoneal cavity and indicates perforation
Gas in the portal veins
323
What is the management of necrotising enterocolitis?
nil by mouth
IV fluids
total parenteral nutrition
antibiotics
Surgery
324
What are some complications of necrotising enterocolitis?
Perforation and peritonitis
Sepsis
Death
Strictures
Abscess formation
Recurrence
Long term stoma
Short bowel syndrome after surgery
325
What substances can cause neonatal abstinence syndrome?
Opiates
Methadone
Benzodiazepines
Cocaine
Amphetamines
Nicotine or cannabis
Alcohol
SSRI antidepressants
326
What are some CNS signs and symptoms of neonatal abstinence syndrome?
Irritability
Increased tone
High pitched cry
Not settling
Tremors
Seizures
327
What are some vasomotor and respiratory signs and symptoms of neonatal abstinence syndrome?
Yawning
Sweating
Unstable temperature and pyrexia
Tachypnoea (fast breathing)
328
What are some metabolic and gastrointestinal symptoms of neonatal abstinence syndrome?
Poor feeding
Regurgitation or vomiting
Hypoglycaemia
Loose stools with a sore nappy area
329
What are the treatment options for moderate to severe neonatal abstinence syndrome ?
Oral morphine sulphate for opiate withdrawal
Oral phenobarbitone for non-opiate withdrawal
330
What can alcohol in early pregnancy lead to?
Miscarriage
Small for dates
Preterm delivery
331
what are some signs of fetal alcohol syndrome?
Microcephaly (small head)
Thin upper lip
Smooth flat philtrum
Short palpebral fissure
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy
332
When is the risk highest of congenital rubella syndrome?
first 3 months of pregnancy
333
What are some features of congenital rubella syndrome?
Congenital cataracts
Congenital heart disease (PDA and pulmonary stenosis)
Learning disability
Hearing loss
334
What should be given to a pregnant women exposed to chickenpox who is not immune?
IV varicella immunoglobulins (given within 10 days of exposure)
335
When should aciclovir be given to pregnant women?
If the chickenpox rash starts in pregnancy, they may be treated with oral aciclovir if they present within 24 hours and are more than 20 weeks gestation
336
What are some features of congenital varicella syndrome?
Fetal growth restriction
Microcephaly, hydrocephalus and learning disability
Scars and significant skin changes following the dermatomes
Limb hypoplasia (underdeveloped limbs)
Cataracts and inflammation in the eye (chorioretinitis)
337
What are some features of congenital CMV?
Fetal growth restriction
Microcephaly
Hearing loss
Vision loss
Learning disability
Seizures
338
What are the classic triad of features in congenital toxoplasmosis?
Intracranial calcification
Hydrocephalus
Chorioretinitis
339
What are the features of congenital Zika syndrome?
Microcephaly
Fetal growth restriction
Other intracranial abnormalities, such as ventriculomegaly and cerebellar atrophy
340
What are some risk factors for sudden infant death syndrome?
Prematurity
Low birth weight
Smoking during pregnancy
Male baby (only slightly increased risk)
341
How can you minimise the risk of SIDS?
Put the baby on their back when not directly supervised
Keep their head uncovered
Place their feet at the foot of the bed to prevent them sliding down and under the blanket
Keep the cot clear of lots of toys and blankets
Maintain a comfortable room temperature (16 – 20 ºC)
Avoid smoking. Avoid handling the baby after smoking
Avoid co-sleeping, particularly on a sofa or chair
If co-sleeping avoid alcohol, drugs, smoking, sleeping tablets or deep sleepers
342
How long do WHO recommend exclusive breastfeeding for?
6 months
343
what volume of formula should a baby receive?
150ml/kg (split between feeds every 2-3 hours initially, then to 4 hours, then feed on demand
344
how much weight loss is acceptable in breast and formula fed babies?
breast fed babies to loose up to 10% and formula fed babies to loose up to 5% of their body weight by day 5 of life
345
when should babies be back at their birth weight?
day 10
346
when does weaning usually start?
around 6 months
347
faltering growth is defined as a fall in weight across:
One or more centile spaces if their birthweight was below the 9th centile
Two or more centile spaces if their birthweight was between the 9th and 91st centile
Three or more centile spaces if their birthweight was above the 91st centile
348
what are the main categories of causes of failure to thrive?
Inadequate nutritional intake
Difficulty feeding
Malabsorption
Increased energy requirements
Inability to process nutrition
349
what are some causes of inadequate nutritional intake ?
Maternal malabsorption if breastfeeding
Iron deficiency anaemia
Family or parental problems
Neglect
Availability of food (i.e. poverty)
350
what are some causes of difficulty feeding?
Poor suck, for example due to cerebral palsy
Cleft lip or palate
Genetic conditions with an abnormal facial structure
Pyloric stenosis
351
what are some causes of malabsorption?
Cystic fibrosis
Coeliac disease
Cows milk intolerance
Chronic diarrhoea
Inflammatory bowel disease
352
what are some causes of increased energy requirements?
Hyperthyroidism
Chronic disease, for example congenital heart disease and cystic fibrosis
Malignancy
Chronic infections, for example HIV or immunodeficiency
353
how is mid parental height calculated?
(height of mum + height of dad) / 2
354
what are the initial investigations for faltering growth?
Urine dipstick, for urinary tract infection
Coeliac screen (anti-TTG or anti-EMA antibodies)
355
what are some options for inadequate nutrition?
Encouraging regular structured mealtimes and snacks
Reduce milk consumption to improve appetite for other foods
Review by a dietician
Additional energy dense foods to boost calories
Nutritional supplements drinks
356
how is short stature defined?
height more than 2 standard deviations below the average for their age and sex. This is the same as being below the 2nd centile
357
how do you calculate predicted height?
Boys: (mother height + fathers height + 14cm) / 2
Girls: (mothers height + father height – 14cm) / 2
358
what are some causes of short stature?
Familial short stature
Constitutional delay in growth and development
Malnutrition
Chronic diseases, such as coeliac disease, inflammatory bowel disease or congenital heart disease
Endocrine disorders, such as hypothyroidism
Genetic conditions, such as Down syndrome
Skeletal dysplasias, such as achondroplasia
359
what is a key feature of constitutional delay in growth and puberty?
delayed bone age - x-ray of wrist and hand
360
what are the 4 major domains of developmental milestones?
Gross motor
Fine motor
Language
Personal and social
361
when should a child be able to support their head ?
4 months
362
when should a child be able to sit unsupported and crawl?
9 months
363
when should a child stand and begin cruising?
12 months
364
when should a child walk unaided?
15 months
365
when should a child be able to run?
2 years
366
when should a child be able to hop?
4 years
367
when should a child fix their eyes on objects?
8 weeks
368
when should a child have a palmar grasp?
6 months
369
when should a child have a pincer grasp ?
12 months
370
what are the drawing skill milestones?
12 months: Holds crayon and scribbles randomly
2 years: Copies vertical line
2.5 years: Copies horizontal line
3 years: Copies circle
4 years: Copies cross and square
5 years: Copies triangle
371
when should a baby babble?
9 months
372
when should a child say single words e.g. Dad-da ?
12 months
373
when should a child use basic sentences?
3 years
374
when should a baby smile?
6 weeks
375
when should a baby wave bye, clap hands and point?
12 months
376
what are the red flags in developmental milestones?
Lost developmental milestones
Not able to hold an object at 5 months
Not sitting unsupported at 12 months
Not standing independently at 18 months
Not walking independently at 2 years
Not running at 2.5 years
No words at 18 months
No interest in others at 18 months
377
what are some causes of global developmental delay?
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
378
what are some causes of gross motor delay?
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
379
what are some causes of fine motor delay?
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia
380
what are some causes of language delay?
Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy
381
what are causes of personal and social delay?
Emotional and social neglect
Parenting issues
Autism
382
when does puberty start in females?
8-14
383
when does puberty start in boys?
9-15
384
what are the stages of puberty in females?
starts with the development of breast buds, then pubic hair and finally starting menstrual periods about 2 years from the start of puberty.
385
what are the stages of puberty in males?
enlargement of the testicles, then of the penis, gradual darkening of the scrotum, development of pubic hair and deepening of the voice
386
what staging system can determine pubertal stage?
Tanner staging
387
what is Kallman syndrome ?
genetic condition causing hypogonadotrophic hypogonadism, resulting in failure to start puberty. It is associated with a reduced or absent sense of smell (anosmia)
388
what are the different types of abuse?
Physical
Emotional
Sexual
Neglect
Financial
Identity
389
what are some risk factors for abuse?
Domestic violence
Previously abused parent
Mental health problems
Emotional volatility in the household
Social, psychological or economic stress
Disability in the child
Learning disability in the parents
Alcohol misuse
Substance misuse
Non-engagement with services
390
what are some possible signs of abuse ?
Change in behaviour or extreme emotional states
Dissociative disorders (feeling separated from their thoughts or identity)
Bullying, self harm or suicidal behaviours
Unusually sexualised behaviours
Unusual behaviour during examination
Poor hygiene
Poor physical or emotional development
Missing appointments or not complying with treatments
391
When can children under 16 make decisions about their health?
if they are deemed to have Gillick competence
392
what are the Frazer guidelines used for?
specific guidelines for providing contraception to patients under 16 years without having parental input and consent
393
What are the Frazer Guidelines?
They are mature and intelligent enough to understand the treatment
They can’t be persuaded to discuss it with their parents or let the health professional discuss it
They are likely to have intercourse regardless of treatment
Their physical or mental health is likely to suffer without treatment
Treatment is in their best interest
394
What is Mosaicism?
the chromosomal abnormality actually happens after conception. The abnormality occurs in a portion of cells in the body and not in others.
395
how is mitochondrial DNA inherited?
maternal inheritance
396
What is the genetics of Downs syndrome?
trisomy 21
397
What dysmorphic features are associated with downs syndrome?
Hypotonia (reduced muscle tone)
Brachycephaly (small head with a flat back)
Short neck
Short stature
Flattened face and nose
Prominent epicanthic folds
Upward sloping palpebral fissures
Single palmar crease
398
What are some complications of Downs syndrome?
Learning disability
Recurrent otitis media
Deafness. Eustachian tube abnormalities lead to glue ear and conductive hearing loss.
Visual problems such myopia, strabismus and cataracts
Hypothyroidism
Cardiac defects affect 1 in 3, particularly ASD, VSD, patent ductus arteriosus and tetralogy of Fallot
Atlantoaxial instability
Leukaemia is more common
Dementia is more common
399
What is the combined test and when is it carried out ?
11-14 weeks
USS for nuchal translucency
Maternal bloods: beta-hCG, PAPPA
400
When is the Triple test carried out and what are the components?
14-20 weeks
Beta-hCG
AFP
Serum oestriol
401
when is the quadruple test carried out and what are its components?
14-20 weeks
Beta-hCG
AFP
Serum oestriol
Inhibin A
402
when would a women be offered amniocentesis or chorionic villus sampling?
When the risk of Down’s is greater than 1 in 150
403
What is the genetics of Klinefelter syndrome?
47XXY
404
What are the features of Klinefelter syndrome?
Taller height
Wider hips
Gynaecomastia
Weaker muscles
Small testicles
Reduced libido
Shyness
Infertility
Subtle learning difficulties
405
what management options can help with the features of Klinefelter syndrome?
Testosterone injections improve many of the symptoms
Advanced IVF techniques have the potential to allow fertility
Breast reduction surgery for cosmetic purposes
406
People with Klinefelter syndrome have a slight increased risk of what conditions?
Breast cancer compared with other males (but still less than females)
Osteoporosis
Diabetes
Anxiety and depression
407
what is the genetics of Turner syndrome?
45XO
408
What are some features of Tuner syndrome?
Short stature
Webbed neck
High arching palate
Downward sloping eyes with ptosis
Broad chest with widely spaced nipples
Cubitus valgus
Underdeveloped ovaries with reduced function
Late or incomplete puberty
Most women are infertile
409
What conditions are associated with Turner syndrome?
Recurrent otitis media
Recurrent urinary tract infections
Coarctation of the aorta
Hypothyroidism
Hypertension
Obesity
Diabetes
Osteoporosis
Various specific learning disabilities
410
What are some management options for the symptoms of Turner syndrome?
Growth hormone therapy can be used to prevent short stature
Oestrogen and progesterone replacement can help establish female secondary sex characteristics, regulate the menstrual cycle and prevent osteoporosis
Fertility treatment can increase the chances of becoming pregnant
411
What is the main inheritance pattern of Noonan syndrome?
Autosomal dominant
412
What are some features of Noonan syndrome?
Short stature
Broad forehead
Downward sloping eyes with ptosis
Hypertelorism (wide space between the eyes)
Prominent nasolabial folds
Low set ears
Webbed neck
Widely spaced nipples
413
What conditions are associated with Noonan syndrome?
Congenital heart disease, particularly pulmonary valve stenosis, hypertrophic cardiomyopathy and ASD
Cryptorchidism (undescended testes) can lead to infertility. Fertility is normal in women.
Learning disability
Bleeding disorders
Lymphoedema
Increased risk of leukaemia and neuroblastoma
414
What is the genetics of Marfan syndrome?
Autosomal dominant
Fibrillin gene
415
What are the features of Marfan syndrome?
Tall stature
Long neck
Long limbs
Long fingers (arachnodactyly)
High arch palate
Hypermobility
Pectus carinatum or pectus excavatum
Downward sloping palpable fissures
416
What conditions are associated with Marfan syndrome?
Lens dislocation in the eye
Joint dislocations and pain due to hypermobility
Scoliosis of the spine
Pneumothorax
Gastro-oesophageal reflux
Mitral valve prolapse (with regurgitation)
Aortic valve prolapse (with regurgitation)
Aortic aneurysms
417
What is the genetics of Fragile X syndrome?
caused by a mutation in the FMR1 (fragile X mental retardation 1) gene on the X chromosome
418
What are some features of Fragile X syndrome?
Delay in speech and language development
Intellectual disability
Long, narrow face
Large ears
Large testicles after puberty
Hypermobile joints (particularly in the hands)
Attention deficit hyperactivity disorder (ADHD)
Autism
Seizures
419
what is the genetics of Prader-Willi Syndrome?
loss of functional genes on the proximal arm of the chromosome 15 inherited from the father
can be due to a deletion of this portion of the chromosome, or when both copies of chromosome 15 are inherited from the mother
420
What are the features of Prader-Willi
Constant insatiable hunger that leads to obesity
Poor muscle tone as an infant (hypotonia)
Mild-moderate learning disability
Hypogonadism
Fairer, soft skin that is prone to bruising
Mental health problems, particularly anxiety
Dysmorphic features
Narrow forehead
Almond shaped eyes
Strabismus
Thin upper lip
Downturned mouth
421
What is the genetics of Angelman syndrome?
genetic condition caused by loss of function of the UBE3A gene
can be caused by a deletion on chromosome 15, a specific mutation in this gene or where two copies of chromosome 15 are contributed by the father
422
What are the features of Angelman syndrome?
Delayed development and learning disability
Severe delay or absence of speech development
Coordination and balance problems (ataxia)
Fascination with water
Happy demeanour
Inappropriate laughter
Hand flapping
Abnormal sleep patterns
Epilepsy
Attention-deficit hyperactivity disorder
Dysmorphic features
Microcephaly
Fair skin, light hair and blue eyes
Wide mouth with widely spaced teeth
423
What is the genetics of William syndrome?
deletion of genetic material on one copy of chromosome 7
424
What are the features of William syndrome?
Broad forehead
Starburst eyes (a star-like pattern on the iris)
Flattened nasal bridge
Long philtrum
Wide mouth with widely spaced teeth
Small chin
Very sociable trusting personality
Mild learning disability
425
What conditions are associated with William syndrome?
Supravalvular aortic stenosis
Attention-deficit hyperactivity disorder
Hypertension
Hypercalcaemia
426
What are simple febrile convulsions?
generalised, tonic clonic seizures. They last less than 15 minutes and only occur once during a single febrile illness.
427
What are complex febrile convulsions?
partial or focal seizures, last more than 15 minutes or occur multiple times during the same febrile illness
428
At what age do breath holding spells typically occur?
between 6 and 18 months of age
429
What are the features of Dyskinetic cerebral palsy?
problems controlling muscle tone, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. This is the result of damage to the basal ganglia.
430
what are the types of cerebral palsy?
Spastic
Dyskinetic
Ataxic
Mixed
431
what are some signs and symptoms of cerebral palsy?
Failure to meet milestones
Increased or decreased tone, generally or in specific limbs
Hand preference below 18 months is a key sign to remember for exams
Problems with coordination, speech or walking
Feeding or swallowing problems
Learning difficulties
432
What is hydrocephalus?
cerebrospinal fluid (CSF) building up abnormally within the brain and spinal cord.
433
What is the most common cause of hydrocephalus?
aqueductal stenosis
434
How may hydrocephalus present?
enlarged and rapidly increasing head circumference
Bulging anterior fontanelle
Poor feeding and vomiting
Poor tone
Sleepiness
435
What are some complications of a Ventriculoperitoneal shunt?
Infection
Blockage
Excessive drainage
Intraventricular haemorrhage during shunt related surgery
Outgrowing them (they typically need replacing around every 2 years as the child grows)
436
What is Craniosynostosis?
skull sutures close prematurely
437
What does Gower's sign indicate?
proximal muscle weakness e.g. muscular dystrophy
438
What is the genetics of Duchennes Muscular Dystrophy?
X-linked recessive
defective gene for dystrophin
439
when does Duchennes muscular dystrophy typically present?
3-5 years
440
When does Beckers Muscular dystrophy typically present?
8-12 years
441
what is the inheritance of spinal muscular atrophy?
Autosomal recessive
442
what is spinal muscular atrophy?
progressive loss of motor neurones, leading to progressive muscular weakness, affects lower motor neurones
443
What are the categories of spinal muscular atrophy?
SMA type 1 has an onset in the first few months of life, usually progressing to death within 2 years.
SMA type 2 has an onset within the first 18 months. Most never walk, but survive into adulthood.
SMA type 3 has an onset after the first year of life. Most walk without support, but subsequently loose that ability. Respiratory muscles are less affected and life expectancy is close to normal.
SMA type 4 has an onset in the 20s. Most will retain the ability to walk short distances but require a wheelchair for mobility. Everyday tasks can lead to significant fatigue. Respiratory muscles and life expectancy are not affected.
444
What is the first line anti-depressant in children?
Fluoxetine 10mg
445
What are some causes of anaemia in infancy ?
Physiological anaemia of infancy
Anaemia of prematurity
Blood loss
Haemolysis
Twin-twin transfusion
446
What are some causes of haemolysis in a neonate?
Haemolytic disease of the newborn (ABO or rhesus incompatibility)
Hereditary spherocytosis
G6PD deficiency
447
What is the peak age of ALL?
2-3 years
448
what is the peak age of AML?
under 2 years
449
what conditions predispose children to developing leukaemia?
Down’s syndrome
Kleinfelter syndrome
Noonan syndrome
Fanconi’s anaemia
450
What are the 3 main ways to test for an allergy?
Skin prick testing
RAST testing, which involves blood tests for total and specific immunoglobulin E (IgE)
Food challenge testing
451
Describe the Coombs and Gell classification of hypersensitivity reactions
Type 1: IgE antibodies to a specific allergen trigger mast cells and basophils to release histamines and other cytokines. This causes an immediate reaction. e.g. food allergy
Type 2: IgG and IgM antibodies react to an allergen and activate the complement system, leading to direct damage to the local cells. E.g. haemolytic disease of the newborn and transfusion reactions.
Type 3: Immune complexes accumulate and cause damage to local tissues. E.g. systemic lupus erythematosus (SLE), rheumatoid arthritis and Henoch-Schönlein purpura (HSP)
Type 4: Cell mediated hypersensitivity reactions caused by T lymphocytes. T-cells are inappropriately activated, causing inflammation and damage to local tissues. E.g. organ transplant rejection and contact dermatitis.
452
What are the GI symptoms of cows milk protein allergy?
Bloating and wind
Abdominal pain
Diarrhoea
Vomiting
453
What is the management of cows milk protein allergy?
Breast feeding mothers should avoid dairy products
Replace formula with special hydrolysed formulas designed for cow’s milk allergy
454
By what age do most children outgrow a cows milk allergy?
3
455
How many respiratory infections a year is normal for a healthy child?
4-8
456
How may Severe combined immunodeficiency present?
Persistent severe diarrhoea
Failure to thrive
Opportunistic infections that are more frequent or severe than in healthy children, for example severe and later fatal chickenpox, Pneumocystis jiroveci pneumonia and cytomegalovirus
Unwell after live vaccinations such as the BCG, MMR and nasal flu vaccine
Omenn syndrome
457
What are the classic features of Omenn syndrome?
A red, scaly, dry rash (erythroderma)
Hair loss (alopecia)
Diarrhoea
Failure to thrive
Lymphadenopathy
Hepatosplenomegaly
458
what are the management options for severe combined immunodeficiency?
immunoglobulin therapy
sterile environment
haematopoietic stem cell transplant
459
What is the most common immunoglobulin deficiency?
Selective immunoglobulin A deficiency
460
What are the features of DiGeorge syndrome?
C – Congenital heart disease
A – Abnormal facies (characteristic facial appearance)
T – Thymus gland incompletely developed
C – Cleft palate
H – Hypoparathyroidism and resulting Hypocalcaemia
22nd chromosome affected
461
what are some Live attenuated vaccines?
MMR
BCG
Chicken pox
Nasal influenza
ROTAVIRUS
462
What vaccines are given at 8 weeks?
6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
Meningococcal type B
Rotavirus (oral vaccine)
463
what vaccines are given at 12 weeks
6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
Pneumoccocal
Rotavirus
464
What vaccinations are given at 16 weeks?
6 in 1 vaccine (diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
Meningococcal type B
465
What vaccinations are given at 1 year?
2 in 1 (haemophilus influenza type B and meningococcal type C)
Pneumococcal
MMR vaccine
Meningococcal type B
466
when is the influenza nasal vaccine given?
Yearly from age 2-8
467
What vaccinations are given at 3 years 4 months?
4 in 1 (diphtheria, tetanus, pertussis and polio)
MMR vaccine
468
when is the HPV vaccine given?
12-13
2 doses given 6 to 24 months apart
469
What vaccinations are given at 14 years ?
3 in 1 (tetanus, diphtheria and polio)
Meningococcal groups A, C, W and Y
470
What are some signs that can indicate sepsis in a child?
Deranged physical observations
Prolonged capillary refill time (CRT)
Fever or hypothermia
Deranged behaviour
Poor feeding
Inconsolable or high pitched crying
High pitched or weak cry
Reduced consciousness
Reduced body tone (floppy)
Skin colour changes (cyanosis, mottled pale or ashen)
471
All infants under 3 months with a temperature of 38 or above need to be treated urgently for what unless proven otherwise?
sepsis
472
what type of bacteria in Neisseria meningitidis?
gram-negative diplococcus
473
what is the most common cause of bacteria meningitis in neonates?
group B strep
474
What are the typical symptoms of meningitis?
fever, neck stiffness, vomiting, headache, photophobia, altered consciousness and seizures
475
what 2 special tests can you perform for meningeal irritation?
Kernig’s test
Brudzinski’s test
476
what should you send bloods for if you suspect meningococcal disease?
meningococcal PCR
477
what is the management of bacterial meningitis in infants <3 months?
cefotaxime plus amoxicillin (the amoxicillin is to cover listeria contracted during pregnancy)
478
what is the treatment of bacterial meningitis in children above 3 months?
ceftriaxone + dexamethasone
479
what is given to contacts of bacterial meningitis in the last 7 days?
single dose of ciprofloxacin
480
what are some common causes of viral meningitis?
herpes simplex virus (HSV), enterovirus and varicella zoster virus (VZV)
481
what are some complications of meningitis?
Hearing loss is a key complication
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Cerebral palsy, with focal neurological deficits such as limb weakness or spasticity
482
what does CSF show in bacterial meningitis?
cloudy, high protein, low glucose, high neutrophils
483
what does CSF show in viral meningitis?
clear, mildly raised or normal protein, normal glucose, high lymphocytes
484
what is the most common cause of encephalitis in children?
herpes simple type 1 (HSV-1)
485
what is the most common cause of encephalitis in neonates?
herpes simplex type 2 (HSV-2)
486
what is the presentation of encephalitis?
Altered consciousness
Altered cognition
Unusual behaviour
Acute onset of focal neurological symptoms
Acute onset of focal seizures
Fever
487
what key investigations are needed to establish a diagnosis of encephalitis?
Lumbar puncture, sending cerebrospinal fluid for viral PCR testing
CT scan if a lumbar puncture is contraindicated
MRI scan after the lumbar puncture to visualise the brain in detail
488
what is the management of encephalitis?
Aciclovir treats herpes simplex virus (HSV) and varicella zoster virus (VZV)
Ganciclovir treat cytomegalovirus (CMV)
489
What are some complications of encephalitis?
Lasting fatigue and prolonged recovery
Change in personality or mood
Changes to memory and cognition
Learning disability
Headaches
Chronic pain
Movement disorders
Sensory disturbance
Seizures
Hormonal imbalance
490
Infectious mononucleosis (IM) is a condition caused by infection with what?
Epstein Barr virus
491
what are the features of infectious mononucleosis?
Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement
Splenomegaly and in rare cases splenic rupture
492
how can you test for infectious mononucleosis ?
Monospot test
Paul-Bunnell test
EBV antibodies (IgM - acute, IgG)
493
what is the prognosis of infectious mononucleosis?
acute illness lasts around 2 – 3 weeks, however it can leave the patient with fatigue for several months once the infection is cleared
494
what should patients with EBV avoid
alcohol
contact sport - risk of splenic rupture
495
what are some complications of infectious mononucleosis ?
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
496
what cancer is associated with EBV
Burkitt’s lymphoma
497
what is the incubation period of Mumps?
14-25 days
498
what are the features of mumps?
Fever
Muscle aches
Lethargy
Reduced appetite
Headache
Dry mouth
Parotid gland swelling
499
how can you confirm a diagnosis of Mumps?
PCR testing on a saliva swab
500
what is the management of Mumps?
supportive, with rest, fluids and analgesia
501
what are the complications of mumps?
Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss
502
what testing is done to babies with HIV positive parents?
HIV viral load test at 3 months. If this is negative, the child has not contracted HIV during birth and will not develop HIV unless they have further exposure.
HIV antibody test at 24 months. This is to assess whether they have contracted HIV since their 3 month viral load, for example through breast feeding. If the 3 month test is negative and they are not breastfed, this should be negative.
503
To reduce the risk of the baby contracting hepatitis B, at birth (within 24 hours) neonates with hepatitis B positive mothers should be given both:
Hepatitis B vaccine
Hepatitis B immunoglobulin infusion
504
Babies to hepatitis C positive mothers are tested at what age?
18 months
505
what is the most common cause of tonsillitis ?
viral
506
what is the most common cause of bacterial tonsillitis?
group A streptococcus (Streptococcus pyogenes)
507
How should a Centor score guide management of tonsilitis?
A score of 3 or more gives a 40 – 60 % probability of bacterial tonsillitis, and it is appropriate to offer antibiotics.
508
what are the aspects of the centor criteria?
Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes
509
How should a FeverPain score guide management of tonsilitis?
A score of 2 – 3 gives a 34 – 40% probability and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis
510
what are the aspects of the fever pain score?
Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza
511
what is the antibiotic of choice for bacterial tonsilitis?
Penicillin V (10 days)
Clarithromycin in penicillin allergy
512
what are some complications of tonsillitis?
Chronic tonsillitis
Peritonsillar abscess (quinsy)
Otitis media
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
513
apart from the symptoms of tonsillitis what are some additional symptoms you may get with Quinsy?
Trismus, which refers to when the patient is unable to open their mouth
Change in voice due to the pharyngeal swelling “hot potato voice”
Swelling and erythema in the area beside the tonsils on examination
514
what is the most common cause of quinsy?
streptococcus pyogenes (group A strep)
515
what is the management of quinsy?
incision and drainage
antibiotics after surgery
516
what are the NICE guidelines for number of episodes of tonsillitis required for a tonsillectomy?
7 or more in 1 year
5 per year for 2 years
3 per year for 3 years
others:
Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing or snoring
517
what are some possible complications of a tonsillectomy?
Pain
Damage to teeth
infection
post-tonsillectomy bleeding
risks of general anaesthetic
518
where is the middle ear anatomically?
between the tympanic membrane (ear drum) and the inner ear
519
what is the most common cause of otitis media?
streptococcus pneumoniae
others:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
520
what are the presenting features of otitis media?
ear pain
reduced hearing
coryzal/URTI symptoms
521
what would be a sign that the tympanic membrane has ruptured?
discharge from the ear
522
what is the appearance of otitis media on otoscopy?
bulging, red, inflamed looking membrane
523
when should you consider prescribing antibiotics for otitis media?
patients who have significant co-morbidities, are systemically unwell or are immunocompromised. Children less than 2 years with bilateral otitis media and children with otorrhoea (discharge)
524
what is the 1st line abx for otitis media?
amoxicillin
525
what are some complications of otitis media?
Otitis medial with effusion
Hearing loss (usually temporary)
Perforated eardrum
Recurrent infection
Mastoiditis
Abscess
526
what may otoscopy show in glue ear?
dull tympanic membrane with air bubbles or a visible fluid level
527
how long does it usually take for glue ear to resolve without treatment?
3 months
528
what surgical intervention can be done for glue ear?
grommets
529
where do nose bleeds originate from?
Kiesselbach’s plexus, which is also known as Little’s area
530
what can be prescribed after a nosebleed to reduce crusting, inflammation and infection?
naseptin
531
when is a nose bleed classed as severe?
does not stop after 10 – 15 minutes,
532
what are the management options for severe nosebleeds?
Nasal packing using nasal tampons or inflatable packs
Nasal cautery using a silver nitrate stick
533
what is the medical term for tongue tie?
ankyloglossia
534
what is the management of tongue tie?
frenotomy
535
what is a cystic hygroma?
malformation of the lymphatic system that results in a cyst filled with lymphatic fluid. It is most commonly a congenital abnormality and is typically located in the posterior triangle of the neck on the left side
536
what are the key features of a cystic hygroma?
Can be very large
Are soft
Are non-tender
Transilluminate
537
what are the features of a thyroglossal cyst?
Mobile
Non-tender
Soft
Fluctuant
move up and down with tongue movement
538
where are branchial cysts found?
round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck
539
where does a branchial cyst arise form?
second branchial cleft
540
what are growth plates made from?
hyaline cartilage
541
where is the growth plate found?
end of long bones between the epiphysis and metaphysis
542
when the growth plates fuse during the teenage years, what do they become?
epiphyseal lines
543
what is a greenstick fracture?
only one side of the bone breaks whilst the other side of the bone stays intact
544
what is used to grade growth plate fractures?
Salter-Harris classification
545
What are the types of fracture in the Salter-Harris classification?
Type 1: Straight across
Type 2: Above
Type 3: BeLow
Type 4: Through
Type 5: CRush
546
what is the first principle of fracture management?
mechanical alignment of the fracture by:
Closed reduction via manipulation of the joint
Open reduction via surgery
547
what is the pain ladder for children?
Step 1: Paracetamol or ibuprofen
Step 2: Morphine
548
what are common causes of hip pain in a child 0-4 years?
Septic arthritis
Developmental dysplasia of the hip (DDH)
Transient sinovitis
549
what are common causes of hip pain in a child 5-10 years?
Septic arthritis
Transient sinovitis
Perthes disease
550
what are common causes of hip pain in a child 10-16 years?
Septic arthritis
Slipped upper femoral epiphysis (SUFE)
Juvenile idiopathic arthritis
551
what are some red flags for hip pain?
Child under 3 years
Fever
Waking at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Stiffness in the morning
Swollen or red joint
552
what is the criteria for urgent assessment of a child with a limp?
Child under 3 years
Child older than 9 with a restricted or painful hip
Not able to weight bear
Evidence of neurovascular compromise
Severe pain or agitation
Red flags for serious pathology
Suspicion of abuse
553
what are the symptoms of transient synovitis?
Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature
554
how long does it usually take for symptoms of transient synovitis to resolve?
within 1 – 2 weeks
555
what is Perthes disease?
disruption of blood flow to the femoral head, causing avascular necrosis of the bone
556
what is the epidemiology of Perthes disease?
4-12 years, boys
557
what are the symptoms of Perthes disease?
Pain in the hip or groin
Limp
Restricted hip movements
There may be referred pain to the knee
558
What are the main investigations in suspected Perthes disease?
xray
blood tests (normal)
Technetium bone scan
MRI scan
559
what are the management options for Perthes disease?
Bed rest
Traction
Crutches
Analgesia
Physio
regular x-rays
560
what is the main complication of Perthes disease?
soft and deformed femoral head, leading to early hip osteoarthritis
561
what is slipped upper femoral epiphysis?
head of the femur is displaced (“slips”) along the growth plate
562
what is the epidemiology of SUFE?
8-15. boys. obese
563
what may precipitate SUFE?
growth spurt, obesity, minor trauma
564
what are the presenting symptoms of SUFE?
Hip, groin, thigh or knee pain
Restricted range of movement in the hip
Painful limp
prefer to keep the hip in external rotation
565
what are the investigations for SUFE?
xray
bloods (normal)
technetium bone scan
CT scan
MRI scan
566
what is the management of SUFE?
Surgery to correct and fix position of femoral head
567
what is the most common cause of osteomyelitis?
staphylococcus aureus
568
what are some risk factors for osteomyelitis?
Open bone fracture
Orthopaedic surgery
Immunocompromised
Sickle cell anaemia
HIV
Tuberculosis
569
what are the presenting features of osteomyelitis?
Refusing to use the limb or weight bear
Pain
Swelling
Tenderness
may have fever
570
what is the peak age of osteosarcoma?
10 – 20 years
571
what bone is most commonly affected by osteosarcoma?
femur
572
what is the main presenting feature of osteosarcoma?
persistent bone pain, particularly worse at night time
others: bone swelling, a palpable mass and restricted joint movements
573
what will an xray show in osteosarcoma?
poorly defined lesion in the bone, with destruction of the normal bone and a “fluffy” appearance. There will be a periosteal reaction (irritation of the lining of the bone) that is classically described as a “sun-burst” appearance
574
What is Talipes?
fixed abnormal ankle position that presents at birth (clubfoot)
575
what is Talipes equinovarus?
ankle in plantar flexion and supination
576
What is Talipes calcaneovalgus
ankle in dorsiflexion and pronation
577
How is talipes treated?
Ponseti method
578
what are risk factors for developmental dysplasia of the hip?
First degree family history
Breech presentation from 36 weeks onwards
Breech presentation at birth if 28 weeks onwards
Multiple pregnancy
579
what findings may suggest developmental dysplasia of the hip?
Different leg lengths
Restricted hip abduction on one side
Significant bilateral restriction in abduction
Difference in the knee level when the hips are flexed
Clunking of the hips on special tests
580
How do you perform the Ortolani test?
baby on their back with the hips and knees flexed. Palms are placed on the baby’s knees with thumbs on the inner thigh and four fingers on the outer thigh. Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly
581
How do you perform the Barlow test?
baby on their back with the hips adducted and flexed at 90 degrees and knees bent at 90 degrees. Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly.
582
how is developmental dysplasia of the hip diagnosed?
ultrasound
583
what is the management of developmental dysplasia of the hip?
Pavlick harness (if <6m)
surgery, hip spica cast
584
What causes rickets?
deficiency in vitamin D or calcium
585
what bone deformities may be present in rickets?
Bowing of the legs, where the legs curve outwards
Knock knees, where the legs curve inwards
Rachitic rosary, where the ends of the ribs expand at the costochondral junctions, causing lumps along the chest
Craniotabes, which is a soft skull, with delayed closure of the sutures and frontal bossing
Delayed teeth with under-development of the enamel
586
what are some symptoms of rickets?
Lethargy
Bone pain
Swollen wrists
Bone deformity
Poor growth
Dental problems
Muscle weakness
Pathological or abnormal fractures
587
what is the lab investigation for vitD
Serum 25-hydroxyvitamin D
588
what is the inheritance of achondroplasia?
autosomal dominant (Mutations in the FGFR3 gene)
589
what conditions are associated with achondroplasia?
Recurrent otitis media, due to cranial abnormalities
Kyphoscoliosis
Spinal stenosis
Obstructive sleep apnoea
Obesity
Foramen magnum stenosis can lead to cervical cord compression and hydrocephalus
590
what causes Osgood-Schlatter disease?
inflammation at the tibial tuberosity where the patella ligament inserts
591
how does Osgood-schlatters present?
Visible or palpable hard and tender lump at the tibial tuberosity
Pain in the anterior aspect of the knee
The pain is exacerbated by physical activity, kneeling and on extension of the knee
592
what is the management of Osgood-Schlatters?
Reduction in physical activity
Ice
NSAIDS (ibuprofen) for symptomatic relief
593
what is a complication of Osgood-Schlatters?
avulsion fracture
594
what are some associated features of osteogenesis imperfecta?
Hypermobility
Blue / grey sclera
Triangular face
Short stature
Deafness from early adulthood
Dental problems, particularly with formation of teeth
Bone deformities, such as bowed legs and scoliosis
Joint and bone pain
595
What are some management options for osteogenesis imperfecta?
Bisphosphonates
Vitamin D supplementation
Physio
Orthopaedic surgeons
596
what are the features of systemic JIA (Still's disease) ?
Subtle salmon-pink rash
High swinging fevers
Enlarged lymph nodes
Weight loss
Joint inflammation and pain
Splenomegaly
Muscle pain
Pleuritis and pericarditis
597
what will be raised in systemic JIA?
Inflammatory markers, CRP, ESR, platelets and serum ferritin
598
what is a key complication of systemic JIA?
macrophage activation syndrome (MAS), where there is severe activation of the immune system with a massive inflammatory response. It presents with an acutely unwell child with disseminated intravascular coagulation (DIC), anaemia, thrombocytopenia, bleeding and a non-blanching rash
will have low ESR
599
what is polyarticular JIA?
idiopathic inflammatory arthritis in 5 joints or more
600
what is the management of JIA?
NSAIDs, such as ibuprofen
Steroids, either oral, intramuscular or intra-artricular in oligoarthritis
Disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, sulfasalazine and leflunomide
Biologic therapy, such as the tumour necrosis factor inhibitors etanercept, infliximab and adalimumab
601
what are the 5 key subtypes of JIA?
Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis
602
what is the most common and least severe type of Ehlers-Danlos syndrome?
Hypermobile Ehlers-Danlos syndrome
603
what kind of vasculitis is Henoch-Schonlein Purpura?
IgA vasculitis
604
what is HSP often triggered by?
upper airway infection or gastroenteritis
605
what are the 4 classic features if henoch-Schonlein Purpura?
Purpura
Joint pain
Abdominal pain
Renal involvement
606
what is the management of HSP
Supportive-> analgesia, hydration
monitor with urine dipstick, blood pressure
607
what type of vasculitis is Kawasaki?
medium-sized vessel vasculitis
608
what is a key complication of Kawasaki disease?
coronary artery aneurysm
609
what are the key features of kawasaki disease?
persistent high fever (>5d)
widespread erythematous maculopapular rash and desquamation
Strawberry tongue
Cracked lips
Cervical lymphadenopathy
Bilateral conjunctivitis
610
what investigations may be useful in Kawasaki disease?
Full blood count can show anaemia, leukocytosis and thrombocytosis
Liver function tests can show hypoalbuminemia and elevated liver enzymes
Inflammatory markers (particularly ESR) are raised
Urinalysis can show raised white blood cells without infection
Echocardiogram can demonstrate coronary artery pathology
611
Describe the disease course of Kawasaki disease
Acute phase: The child is most unwell with the fever, rash and lymphadenopathy. This lasts 1 – 2 weeks.
Subacute phase: The acute symptoms settle, the desquamation and arthralgia occur and there is a risk of coronary artery aneurysms forming. This lasts 2 – 4 weeks.
Convalescent stage: The remaining symptoms settle, the blood tests slowly return to normal and the coronary aneurysms may regress. This last 2 – 4 weeks.
612
what is the management of Kawasaki disease?
High dose aspirin to reduce the risk of thrombosis
IV immunoglobulins to reduce the risk of coronary artery aneurysms
613
why is aspirin avoided in children
risk of Reye's syndrome
614
what causes rheumatic fever?
antibodies created against the streptococcus bacteria that also target tissues in the body - type 2 hypersensitivity reaction
615
How long after streptococcal infection do symptom of rheumatic fever occur?
2-4 weeks
616
what are some features of rheumatic fever?
Fever
Joint pain
Rash
Shortness of breath
Chorea
Nodules
Carditis
617
What investigations should be done to support a diagnosis of rheumatic fever?
Throat swab for bacterial culture
ASO antibody titres
Echocardiogram, ECG and chest xray can assess the heart involvement
618
what criteria is used to make a diagnosis of rheumatic fever?
jones criteria
619
what are the aspects of the Jones criteria?
Major Criteria:
J – Joint arthritis
O – Organ inflammation, such as carditis
N – Nodules
E – Erythema marginatum rash
S – Sydenham chorea
Minor Criteria:
Fever
ECG Changes (prolonged PR interval) without carditis
Arthralgia without arthritis
Raised inflammatory markers (CRP and ESR)
620
what is the management of rheumatic fever?
PenV (to prevent)/prophylactic
NSAIDs for joint pain
Aspirin + steroids for carditis
621
what are some complications of rheumatic fever?
Recurrence of rheumatic fever
Valvular heart disease, most notably mitral stenosis
Chronic heart failure
622
describe the stages of the steroid ladder in eczema
Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)
623
what is the most common cause of Eczema Herpeticum?
Herpes simplex virus 1
624
what is the presentation of eczema herpeticum?
patient who suffers with eczema that has developed a widespread, painful, vesicular rash with systemic symptoms such as fever, lethargy, irritability and reduced oral intake. There will usually be lymphadenopathy
625
what is the treatment of eczema herpecticum?
aciclovir
626
Name 4 types of psoriasis
Plaque (most common)
Guttate
Pustular
Erythrodermic
627
what is guttate psoriasis often triggered by?
streptococcal throat infection, stress or medications
628
what are the treatment options for psoriasis?
Topical steroids
Topical vitamin D analogues (calcipotriol)
Topical dithranol
Topical calcineurin inhibitors (tacrolimus) are usually only used in adults
Phototherapy
629
what are some signs of nail psoriasis?
nail pitting, thickening, discolouration, ridging and onycholysis (separation of the nail from the nail bed)
630
what is the pathophysiology of acne ?
increased production of sebum, trapping of keratin (dead skin cells) and blockage of the pilosebaceous unit. This leads to swelling and inflammation in the pilosebaceous unit.
631
what are the management options for acne vulgaris
Topical benzoyl peroxide
Topical retinoids (teratogenic)
Topical antibiotics e.g. clindamycin (prescribed with benzoyl peroxide to reduce resistance)
Oral antibiotics e.g. lymecycline
Oral contraceptive pill
Oral retinoid (Oral isotretinoin) last line
632
What are some side effects of isotretinoin?
Dry skin and lips
Photosensitivity of the skin to sunlight
Depression, anxiety, aggression and suicidal ideation. Patients should be screened for mental health issues prior to starting treatment.
Rarely Stevens-Johnson syndrome and toxic epidermal necrolysis
633
How long after exposure to measles virus do symptoms start?
10 – 12 days
634
what are the symptoms of measles?
fever
coryzal
conjunctivitis
Koplik spots
rash starts on the face, classically behind the ears, 3 – 5 days after the fever. It then spreads to the rest of the body - erythematous, macular rash with flat lesions.
635
what is the prognosis of measles?
self resolving after 7 – 10 days of symptoms
30% of patients with measles develop a complication
636
how long should a child with measles be isolated for?
4 days until after their symptoms resolve
637
what are some complications of measles?
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
638
what is associated with scarlet fever?
group A streptococcus infection, usually tonsillitis.
639
what are the features of Scarlet fever?
sandpaper rash
fever
Lethargy
Flushed face
Sore throat
Strawberry tongue
Cervical lymphadenopathy
640
what is the management of Scarlet fever?
phenoxymethylpenicillin (penicillin V) for 10 days
641
How long after exposure do symptoms of Rubella start?
2 weeks
642
what are the features of Rubella?
erythematous macular rash (starts on the face and spreads to the rest of the body)
mild fever
joint pain
sore throat
lymphadenopathy
643
how long should children stay off school with rubella?
at least 5 days after the rash appears
644
what causes erythema infactiosum (slapped cheek syndrome)?
parvovirus B19
645
what are the features of erythema infectiosum?
mild fever, coryzal
bright red rash on cheeks
reticular mildly erythematous rash on trunk and limbs
646
what are some complications of erythema infectiosum?
Aplastic anaemia
Encephalitis or meningitis
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis or nephritis
647
what causes Roseola Infantum?
human herpesvirus 6 (HHV-6) and less frequently by human herpesvirus 7 (HHV-7)
648
what are the features of Roseola Infantum?
high fever (1-2w after infection)
coryzal, sore throat, lymphadenopathy
rash after fever (mild erythematous macular rash)
649
what is the main complication of roseola infantum?
febrile convulsions
650
what are the features of erythema multiforme?
widespread, itchy, erythematous rash. It produces characteristic “target lesions”
651
what causes Erythema multiforme?
hypersensitivity reaction e.g. viral infections, medications
652
state 5 causes of acute urticaria
Allergies to food, medications or animals
Contact with chemicals, latex or stinging nettles
Medications
Viral infections
Insect bites
Dermatographism (rubbing of the skin)
653
what is the main management of urticaria ?
antihistamines e.g. fexofenadine
654
what causes chicken pox ?
varicella zoster virus (VZV)
655
what are the features of chicken pox?
widespread, erythematous, raised, vesicular (fluid filled), blistering lesions
Fever is often the first symptom
Itch
General fatigue and malaise
656
when do children with chicken pox stop being contagious?
after all the lesions have crusted over
657
what are some complications of chicken pox?
Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis
658
after VZV infection where can it lay dormant?
sensory dorsal root ganglion cells
659
when may aciclovir be offered in chicken pox?
immunocompromised patients, adults and adolescents over 14 years presenting within 24 hours, neonates or those at risk of complications
660
what causes hand foot and mouth disease?
coxsackie A virus
661
what is the incubation period of hand foot and mouth disease?
3 – 5 days
662
what are the features of hand, foot and mouth disease?
URTI symptoms
mouth/tongue ulcers, blistering red spots across body, most notable on hands, feet and around mouth
663
what type of virus is molluscum contagiosum virus?
poxvirus
664
what are the features of molluscum contagiosum?
small, flesh coloured papules (raised individual bumps on the skin) that characteristically have a central dimple
665
how long can the molluscum contagiosum rash take to go?
18 months
666
what are the key features of Pityriasis Rosea?
Herald patch (pink, scaly, oval, >2cm) then rash becomes widespread (may follow Christmas tree pattern)
667
how long does it take for the Pityriasis Rosea rash to resolve?
3 months
668
what is the management of infantile Seborrhoeic dermatitis (cradle cap) ?
apply oil and gently brush scalp
white petroleum jelly overnight
antifungal cream e.g. clotrimazole
669
what is the treatment of Mild seborrhoeic dermatitis of the scalp (dandruff) ?
ketoconazole shampoo, left on for 5 minutes before washing off
670
what is the management of the face and body?
anti fungal cream, such as clotrimazole or miconazole, used for up to 4 weeks.
671
what is Onychomycosis
fungal nail infection
672
what is the appearance of the rash in ringworm?
itchy rash that is erythematous, scaly and well demarcated
673
how do you treat ring worm?
Anti-fungal creams such as clotrimazole and miconazole
Anti-fungal shampoo such as ketoconazole for tinea capitis
Oral anti-fungal medications such as fluconazole, griseofulvin and itraconazole
Fungal nail infections can be treated with amorolfine nail lacquer for 6 – 12 months
674
what advice should be given to avoid spread of ring worm?
Wear loose breathable clothing
Keep the affected area clean and dry
Avoid sharing towels, clothes and bedding
Use a separate towel for the feet with tinea pedis
Avoid scratching and spreading to other areas
Wear clean dry socks every day
675
what increases the risk of nappy rash?
Delayed changing of nappies
Irritant soap products and vigorous cleaning
Certain types of nappies (poorly absorbent ones)
Diarrhoea
Oral antibiotics predispose to candida infection
Pre-term infants
676
what are some signs that point towards candidal infection rather than nappy rash?
Rash extending into the skin folds
Larger red macules
Well demarcated scaly border
Circular pattern to the rash spreading outwards, similar to ringworm
Satellite lesions
677
what are the management options for nappy rash?
switch to highly absorbent nappies
change nappy and clean skin as soon as possible
water or alcohol free products for cleaning
ensure nappy area is dry
maximise time not wearing nappy
678
what is the management of scabies?
permethrin cream to whole body (left for 8-12hrs), repeat 1 week later
679
what is the management of headlice?
Dimeticone 4% lotion
combing
680
what causes erythema nodosum?
inflammation of the subcutaneous fat on the shins due to a hypersensitivity reaction
681
what causes impetigo?
staphylococcus aureus
682
what are the management options for non-bullous impetigo?
Topical fusidic acid (or hydrogen peroxide)
Oral flucloxacillin (if more severe)
683
what causes staphylococcal scalded skin syndrome?
staphylococcus aureus bacteria that produces epidermolytic toxins. These toxins are protease enzymes that break down the proteins that hold skin cells together
684
what is Nikolsky sign?
very gentle rubbing of the skin causes it to peel away. This is positive in staphylococcal scalded skin syndrome
685
what is the management of staphylococcal scalded skin syndrome?
admission
IV antibiotics
electrolyte balance
686
what is the difference between Stevens-Johnson syndrome and toxic epidermal necrolysis?
SJS affects less that 10% of body surface area whereas TEN affects more than 10% of body surface area
687
Name 4 causes of SJS/TEN
Medications:
Anti-epileptics
Antibiotics
Allopurinol
NSAIDs
Infections:
Herpes simplex
Mycoplasma pneumonia
Cytomegalovirus
HIV
688
what is the management of SJS/TEN?
admission (burns/derm unit)
supportive -> analgesia, antiseptics, nutritional care, ophthalmology input
689
state 3 complications of SJS/TEN
Secondary infection
permanent skin damage
visual complications
