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General Medicine > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are the hormones significant in growth?

A
  1. Growth hormone
  2. Thyroid hormone
  3. Testosterone and Adrenal Androgens
  4. Oestrogens
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2
Q

Causes of transient hypothyroidism in neonates

A
  1. maternal antibody mediated
  2. Iodine deficiency
  3. prenatal exposure to antithyroid medications
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3
Q

Thyroxine is responsible for what growth in the foetus?

A

Brain and Bone

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4
Q

Earliest Sign of puberty in boys

A

Testicular Enlargement

around 11 years

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5
Q

Most common cause of short stature?

A

Familial

Constitutional Growth Delay

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6
Q

What causes Slapped Cheek?

A

Parvovirus B19

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7
Q

What is important to inform patients about Slapped cheek infections

A

Return if pain and swelling of joints in hand and feet

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8
Q

When do babies get their first tooth?

A

5-9 months

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9
Q

Definition of infantile Colic

A

unexplained paroxysms of irritability and crying for >3 hours/day, >3 d/week for >3wks in an otherwise healthy well fed baby

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10
Q

What is hypospadius?

And what are the different types?

A

An abnormality of the penis.

the opening of the urethra is not at the end of the penis
the foreskin may be all at the back of the penis (dorsal hood) and may have none on the undersurface
the penis may not be straight (chordee)
there is not a straight stream of urine

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11
Q

What is the most common cause of ambiguous genitalia

A

Congenital Adrenal Hyperplasia

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12
Q

What are the 3 hormones the adrenal cortex produces?

A

cortisol
aldosterone
androgens

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13
Q

What is Congenital Adrenal Hyperplasia?

A

CAH is autosomal recessive disorder characterised by the partial or total defect of various synthetic enzymes of the adrenal cortex required for cortisol and aldosterone production

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14
Q

When a child with CAH becomes unwell it important to administer what?

A

Hydrocortisone

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15
Q

What is the main hormone controlling puberty

A

GnRH

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16
Q

Delayed Puberty Definition

A

is defined as lack of any pubertal development by 13 years of age for girls and 14 years for boys. Delayed puberty is most often due to a constitutional (familial) delay or is associated with chronic disease.

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17
Q

thelarche

A

Onset of secondary breast development

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18
Q

pubarche

A

appearance of sexual hair

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19
Q

What is Harrison’s Sulcus

A

A horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm
Occurs in chronic asthma

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20
Q

Findings on Xray of child with asthma?

A

bronchial thickening
Hyperinflation
Flattening of diaphragm
Focal atelectasis

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21
Q

Treatment for croup

A

Dexamethasone 0.15mg/kg oral

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22
Q

Croup

A

subglottic layrngitis

narrowing caused by inflammation

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23
Q

Cystic Fibrosis Gene

A

CFTR gene found on chromosome 7

delta F508 mutation

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24
Q

Newborn Screening for CF

A
  • first step: screening for immunoreactive trypsinogen (IRT) as indirect measure of pancreatic injury that is present at birth
  • if IRT elevated: test for common mutations F508
  • 3rd step: sweat test for those with heterozygous (1 CFTR gene mutation) DNA results (if homozygous baby referred to CF clinic)
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25
Q

Neonatal Cystic Fibrosis Presentation

A

meconium ileus
jaundice
antenatal bowel perforation

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26
Q

Infancy Cystic Fibrosis Presentation

A

pancreatic insufficiency with steatorrhoea and failure to thrive
anaemia, hypoproteinemia, hyponatremia

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27
Q

Investigation for CF

A

Sweat chloride test

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28
Q

Most common cause of stridor

A

croup

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29
Q

Most common cause of persistent stridor

A

laryngomalacia

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30
Q

Marfan Syndrome

A

connective tissue disorder caused by mutations in the fibrillin gene at chromosome 15q21.1

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31
Q

CVS features of Marfan Syndrome

A

Mitral valve prolapse

Dilatation of the ascending aorta in 50%

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32
Q

Eye features of Marfan Syndrome

A

Ectopia lentis
myopia
retinal detachment

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33
Q

Musculoskeletal features of Marfan Syndrome

A

tall stature, long limbs, increased arm span
long fingers
joint laxity and flat feet
chest deformity
long narrow face with deep set eyes, high narrow palate and dental crowding

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34
Q

Inheritance of Marfan Sydrome

A

Autosomal dominant, 25% are new mutations

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35
Q

Turner Syndrome

A

Lack of or abnormality of the second X chromosome (only in girls)

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36
Q

Main features of Turner Syndrome

A

Short, lack ovaries that function correctly , lack of sexual development, infertility

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37
Q

Physical features of Turner Syndrome

A

Webbing of the neck, puffy hands and feet, short stature, coarctation of the aorta or other heart abnormalities

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38
Q

Klinefelter Syndrome

A

genetic disorder in which there is at least one extra X chromosome to a standard human male karyotype (47, XXY)

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39
Q

Neurofibromatosis inheritance

A

Autosomal dominant

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40
Q

what chromosome is affected in neurofibromatosis

A

17

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41
Q

What are the common characteristics of neurofibromatosis?

A

cafe au lait spots
neurofibromas
lisch nodules

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42
Q

what is the most important regular check up in neurofibromatosis?

A

eyes : optic gliomas

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43
Q

Classical neurological manifestations of tuberous sclerosis?

A

subependymal nodules and cortical tubers

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44
Q

What is tuberous Sclerosis?

A

rare multi system genetic disease that causes benign tumours to grow in the brain and on other vital organs such as kidneys, heart, eyes, lungs and skin

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45
Q

Signs and symptoms of tuberous sclerosis?

A

seizures, intellectual disability, developmental delay, behavioural problems, skin abnormalities, lung and kidney disease

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46
Q

Genetics of tuberous sclerosis

A

caused by a mutation of either of 2 genes TSC1 and TSC2 which code for the proteins hamartin and tuberin - these proteins act as tumour growth suppressors

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47
Q

What causes congenital melanocytic naevi?

A

Congenital melanocytic naevi are caused by localised genetic abnormalities resulting in the proliferation of melanocytes

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48
Q

Neurocutaneous melanosis

A

rare syndrome defined by the proliferation of melanocytes in the central nervous system (brain and spinal cord) and the presence of a congenital melanocytic naevus

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49
Q

Frey’s Syndrome

A

red superficial rash or discolouration on the face upon eating or drinking
presumed to be related to auricotemporal nerve damage due to forceps delivery
usually improves with age

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50
Q

Mongolian Blue Spot

A

bluish discolouration of the skin over the lower back and sacrum in darskinned babies
usually disappears over 1 year
can be mistaken for bruising

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51
Q

Transient neonatal pustular dermatosis

A

blistering eruption with pustules presenting at birth or in the first few hours of life
occurs mainly on trunk and buttocks
no treatment required

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52
Q

Milia

A

blocked sebaceous glands, especially on the face, present in 50% of neonates
the firm white papules are about 1-2,, in diameter and differ from the yellowish papules of sebaceous hyperplasia
disappear after several weeks

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53
Q

Miliaria

A

related to overheating, appears as 2 types
‘crystallina’: beads of swear trapped under the epidermis, mainly on the forehead
‘rubia’ or ‘heat rash’: mainly on forehead, scalp, face and trunk
benign condition that disappears after a few weeks

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54
Q

Common pathogens in croup

A

Parainfluenza virus

RSV, influenza A and B, adenovirus

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55
Q

X-ray sign for croup

A

Steeple sign - narrowing of subglottic trachea

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56
Q

X-ray sign for epiglottitis

A

Thumb sign on lateral c spine X-ray describes a swollen, enlarged epiglottis, usually with dilated hypo pharynx and normal subglottic structures

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57
Q

Antibiotics for epiglottitis

A

Ceftriaxone

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58
Q

Epiglottitis pathogens

A

Hib
Strep pyogenes
Pneumoniae
Staph aureus

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59
Q

Common pathogen in bronchiolitis

A

RSV

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60
Q

Asthma spirometer

A

FEV1 12%

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61
Q

Next step after determining foreign body

A

Rigid bronchoscopy

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62
Q

Where are aspirated objects most commonly found?

A

In children equally in right and left lungs

Older children more common on the right

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63
Q

Long term complications of foreign body aspiration

A

Pneumonia, abscesses, perforation, bronchiectasis and erosion

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64
Q

Chlaymidia trachomatis pneumonia

A

Conjunctivitis, tachypnoea, staccato cough, afebrile
Usually 5-14 days of age: conjunctivitis
2-12 weeks: respiratory symptoms

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65
Q

conservative treatment for reflux

A

upright positioning, feed thickening, reasurrance

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66
Q

surgical procedure for GORD

A

Nissen fundoplication

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67
Q

Sandifer Syndrome

A

disorder characterised by gastrointestinal symptoms and associated neurological features
Spasmodic torticollis and dsytonia

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68
Q

Hirschsprung Disease

A

disorder of the abdomen that occurs when part or all of the large intestine have no ganglion cells therefore cannot function

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69
Q

Chronic constipation in child definition

A

the occurrence of 2 or more of the following within the previous 8 weeks:

< 3 bowel motions per week
>1 episode of faecal incontinence per week
Large stools in rectum or palpable on abdominal examination
Retentive posturing and withholding behaviour
Painful defaecation

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70
Q

Organic causes of constipation in children

A

Dairy protein intolerance can manifest as constipation in first 3 years of life.
Hirschsprung’s disease usually causes failure to pass meconium in first 48 hrs of life, and virtually never causes faecal soiling.
Other rare organic causes include poor colonic transit and motility, coeliac disease, hypothyroidism, hypercalcemia and spinal cord problems.

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71
Q

First line treatment for constipation in children?

A

A stool softener like parrafin oil

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72
Q

Dyschezia

A

a healthy infant, straining and crying before passing soft stool

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73
Q

Complications of coeliac disease

A

osteoporosis

malignancy - Non-Hodgkin’s lymphoma, Upper digestive tract malignancies

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74
Q

Serum antibodies Coeliac Disease

A
  • Tissue transglutaminase (TTG)
  • Antigliadin antibodies
  • Anti-endomysial antibodies
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75
Q

Small bowel mucosal biospy coeliac disease

A

villous atrophy and crypt hyperplasia
increased number of llama cells and lymphocytes in lamina propria
increased intraepithelial lymphocytes

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76
Q

Coeliac Disease diagnosis

A

The presence of characteristic changers on small intestine biopsy in a symptomatic individual
complete symptom resolution on a gluten free diet

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77
Q

Genetics of coeliac disease

A

caused by a reaction to gliadin - a gluten protein found in wheat, barley, rye
antigen alpha gliadin, HLA-DQ2 (chromosome 6)
associated with thyroid disease

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78
Q

What age is intussusception most likely?

A

3-18 months

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79
Q

classical triad in intussusception

A

colicky abdominal pain + sausage shaped mass + red currant jelly stools

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80
Q

Signs of intussusception on a plain abdominal Xray

A

Target sign - 2 concentric circular radiolucent lines usually in the right upper quadrant
Crescent sign - a crescent shaped lucency usually in the left upper quadrant with a soft tissue mass

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81
Q

How do you confirm the diagnosis of malrotation with volvulus

A

barium meal

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82
Q

What is intestinal malrotation?

A

condition that is congenital and results from a problem in the normal formation of the fetal intestines. There is a disruption in the usual steps that the intestines follow to arrive at the correct position within the abdomen. Malrotation causes the parts of the intestine to settle in the wrong part of the abdomen, which can cause them to become blocked or to twist.

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83
Q

What is an intestinal volvulus?

A

part of the bowel becomes twisted

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84
Q

What does APGAR stand for?

A

Appearance, pulse rate, grimace reflex, activity, respiratory rate

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85
Q

APGAR scoring for appearance

A 
0 = pale or blue
1 = body pink, extremities blue
2 = pink
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86
Q

APGAR scoring for pulse rate

A 
0 = absent
1 = 100
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87
Q

APGAR scoring for Grimace reflex

A 
0= none
1= some
2= vigorous
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88
Q

APGAR scoring for activity

A

0=floppy
1= some tone
2=good flexion

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89
Q

APGAR Scoring for Respiratory rate

A

0=apnoeic
1= irregular, weak
2=active crying

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90
Q

cephalohaematoma

A

haemorrhage under the periosteum of a skull bone, most commonly the parietal: feel firm at the edges with a soft fluctuant centre before resolving

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91
Q

subgaleal haemorrhage

A

bleeding into the scalp in the subaponeurotic space, is much rarer and more serious because significant hypovolemia and anaemia can result. All the scalp feels boggy and loose.

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92
Q

capillary naevi

A

faint pink lesions over the eyelids temples, upper lip, nape of neck: benign and nearly always fade completely

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93
Q

Weight fluctuation after birth

A

normal infants lose up to 8% of their birth weight in the first 3-5 days and regain birth weight by 7-10 days

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94
Q

Bowel actions after birth

A

96% pass meconium by 24 hours and 99.9% by 48 hours

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95
Q

What causes failure to pass meconium?

A

almost always abnormal and may indicate Hirschsprung disease (disorder of the abdomen that occurs when part or all of the large intestine have no ganglion cells therefore cannot function), meconium plug syndrome or other bowel obstruction

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96
Q

Conditions tested for in newborn screening

A 
Cystic fibrosis
phenylketonuria
galactoseamia
primary congenital hypothyroidism
rare metabolic conditions
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97
Q

Newborn screening

A

Heel prick blood test collected 48-72 hours after birth

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98
Q

Phenylketonuria

A

caused by the absence of a fully active form of the liver enzyme phenylalanine hydroxyls, which is responsible for the conversion of the amino acid phenylalanine to tyrosine

accumulation of phenylalanine and its metabolite in the blood and tissues damages the brain

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99
Q

Inheritance of phenylketonuria

A

autosomal recessive

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100
Q

Galactossaemia

A

caused by a deficiency in the enzyme galactose-1-phospahate uridyltransferase that results in the accumulation of galactose and galactose - 1-phosphate

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101
Q

Symptoms of galactossaemia

A

Asymptomatic at birth
develop symptoms in first weeks of life
failure to thrive, lethargy, vomiting, liver disease, jaundice, cataracts, intellectual disability, septicaemia

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102
Q

What is primary congenital hypothyroidism?

A

due to an absent, ectopic or malfunctioning thyroid gland

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103
Q

Causes of vomiting in the neonatal period?

A 
Systemic Infection
Bowel obstruction
malrotation with volvulus
Cerebral Hypoxia
Subdural Haematoma
Hypoglycaemia
Renal Disease
Adrenal Insufficiency
Inborn metabolic Errors
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104
Q

ADHD Definition

A

ADHD is described as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with development, has symptoms presenting in two or more settings (e.g. at home, school, or work), and negatively impacts directly on social, academic or occupational functioning”. The symptoms must be present before age 12.

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105
Q

Most common cause of acute gastro <5 years

A

Rotavirus

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106
Q

When do physical signs of dehydration become apparent?

A

When 4% of body weight is lost

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107
Q

Treatment for no/mild dehydration

A

Oral rehydration solution

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108
Q

Treatment for moderate dehydration

A

Nasogastric rehydration therapy

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109
Q

Treatment for severe dehydration

A

Intravenous dehydration

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110
Q

rehydration initial saline bolus dose

A

20ml/kg, repeat until shock is corrected

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111
Q

complications of acute gastroenteritis

A
  1. Febrile convulsions

2. Sugar malabsorption

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112
Q

extraintestinal manifestation of Crohn Disease

A

growth retardation, anorexia, fatigue, delayed puberty, erythema nodosum, arthritis, clubbing, hepatitis and uveitis

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113
Q

hyphema

A

collection of blood in the anterior chamber of the eye

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114
Q

enophthalmos

A

posterior displacement of the eyeball within the orbit due to due to changes in the volume of the orbit (bone) relative to its contents (the eyeball and orbital fat), or loss of function of the orbitalis muscle

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115
Q

opthalmia neonatorium

A

conjuctivitis in first month of life

Gonococcal, bacterial, herpetic, chlamydial (most common)

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116
Q

Atonic Neck Reflex

A

lying supine, the head is turned by the examiner to one side

infant adopts a fencing posture with the arm outstretched on the side to which the head is turned

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117
Q

positive supporting reflex

A

infant held vertically, feet on a surface

legs take body weight, may push up against gravity

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118
Q

Placing Reflex

A

Infant held vertically and the dorsum of the feet brought into contact with a surface
Lifts first one foot, placing it on the surface, followed by the other

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119
Q

Rooting reflex

A

stimulus near mouth - turns head towards stimulus

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120
Q

Moro reflex

A

Sudden head Extension (drop the head)

Symmetrical extension, then flexion of all limbs

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121
Q

Grasp reflex

A

an object is placed in the palm at the base of the fingers

Flexion of the fingers of the hand

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122
Q

sit without support

A

6-8 months

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123
Q

crawling

A

8-9 months

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124
Q

walking unsteadily

A

12 months

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125
Q

walks alone steadily

A

15 months

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126
Q

Head control

A

6-8 weeks

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127
Q

Talking red flags

A

Does not babble by 7 months
does not join words by 2 years
does not speak in sentences by 3 years

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128
Q

Criteria for foetal alcohol spectrum

A

Growth Deficiency: low birth weight and/ or decelerating weight over time not due to nutrition

b) characteristic pattern of facial anomalies: short palpebral fissures, flattened philtrum, thin upper lip, flat midface
c) central nervous system dysfunction: microcephaly and/ or neurobehavioral dysfunction (hyperactivity, fine motor problems, attention deficits, learning disabilities, cognitive disabilities, difficulties in adaptive functioning

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129
Q

Anencephaly

A

at birth presents as an opened, malformed skull and brain
most babies are stillborn
no effective treatment is possible
death usually occurs within hours or days

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130
Q

encephalospele

A

a midline sac protrudes that may contain brain

hydrocephalus is common

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131
Q

spina bifida occulta

A

one or more vertebral arches are incomplete posteriorly but the overlying skin is intact

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132
Q

spina bifida

A

developmental congenital disorder caused by the incomplete closing of the embryonic neural tube
some vertebrae overlying the spinal cord are not fully formed and remain unfused and open
if the opening is large enough this allows a portion of the spinal cord to protrude through the opening in the bones

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133
Q

benefits of circumcision

A

prevention of phimosis and slightly reduced incidence of UTI, balanitis, cancer of the penis

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134
Q

milk carries

A

decay of superior front teeth and back molars in first 4 years of life

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135
Q

prevention of milk carries

A

no bottle at bed time, clean teeth after last feed
minimise juice and sweetened pacifier
clean teeth with soft damp cloth or toothbrush and water
water fluoridation

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136
Q

obesity

A

BMI > 95th percentile for age and height

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137
Q

organic cause of obesity

A

Prader Willi, Carpenter, Tuner, Cushing Syndromes, Hypothyroidism

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138
Q

Koplik spots

A

white spots on buccal mucosa

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139
Q

Clinical Features of measles

A

prodromal fever, a severe cough, conjunctivitis, coryza and Koplik’s spots on the buccal mucosa. These are present for three to four days prior to rash onset.

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140
Q

Measles rash

A

maculopapular
The characteristic red, blotchy rash appears on the third to seventh day. It begins on the face before becoming generalised and generally lasts four to seven days.

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141
Q

complications of measles

A

otitis media, pneumonia and encephalitis. Sub-acute sclerosing panencephalitis (SSPE) develops very rarely as a late sequela.

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142
Q

Period of communicability in measles?

A

infectious from slightly before the beginning of the prodromal period, usually five days prior to rash onset. They continue to be infectious until four days after the onset of the rash.

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143
Q

When is MMR vaccine given?

A

12 months of age and a second dose at four years of age (prior to school entry). The second dose is not a booster but is designed to vaccinate the approximately five per cent of children who do not seroconvert to measles after the first dose of vaccine.

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144
Q

Roseola infantum pathogen?

A

caused by infection with herpesvirus 6 and occasionally HHV-7

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145
Q

Differentiating feature between measles and roseola infantum?

A

In roseola infantum morbilliform (measles like) rash appears as high fever subsides
child well and afebrile when rash appears

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146
Q

Incubation period for chicken pox?

A

10-21 days

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147
Q

Ramsay Hunt Syndrome presentation

A

vesicels on the pinna of one ear and facial nerve palsy due to zoster of the geniculare ganglion

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148
Q

Epidemic Parotitis

A

Mumps - swelling pain and tenderness of the parotid glands

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149
Q

Kawasaki Disease

A

systemic vasculitis that predominantly affects children < 5 years of age

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150
Q

Scarlet Fever

A

Infectious toxin mediated disease caused by exotoxins elaborated by group A streptococcus and coded by plamids

widespread T cell activation

sore throat, fever and a characteristic red rash - bright red tongue with “strawberry appearance”, Forchheminer spots (fleeting small red spots on the soft palate)
Rash: fine, red and rough textured, blanches, appears 12-72 hours after the fever starts, generally begins on the chest and armpits and behind the ears, may also appear in the groin, worse in the skin folds

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151
Q

Scarlatina

A

mild form of Scarlet Fever, often affecting pre school age children, whereas Scarlet fever is commonest at age 5-10 years
in both the primary site of infection is the throat, causing exudative tonsillitis and/or pharyngitis

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152
Q

Diagnostic criterial for Kawasaki disease?

A

Fever for 5 days or more, plus 4 out of 5 of:
polymorphous rash
bilateral (non purulent) conjuctival injection
mucous membrane changes: e.g redened or dry cracked lips, strawberry tongue, diffuse redness of oral or pharyngeal mucosa
peripheral changes, e.g erythema of the palms or soles, oedema of the hands or feet and in convalescence desquamation
cervical lymphadenopathy

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153
Q

HSV -1

A

Primarily oropharyngeal

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154
Q

HSV-2

A

Primarily genital

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155
Q

commonest childhood HSV infection?

A

gingivostomatitis (HSV1)

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156
Q

At the time of vaginal delivery, what is the risk of herpes simplex virus transmission from a mother with true primary herpes simplex virus infection to her infant?

A

50%

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157
Q

Herpes Neonatorium classification

A

Skin, eye, and mucous membrane (SEM) disease
Disseminated infection
CNS infection

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158
Q

Hand Foot and Mouth Disease

A

caused by enteroviruses
coxsackie A virus typically implicated followed by enterovirus 71
mild febrile illness associated with maculopapular or vesicular lesions on the hands and feet and buccal mucosa
3-6 days incubation
illness lasts 2-3 days

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159
Q

pathogen of bone and joint infections?

A

staph aureus

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160
Q

complications of paediatric osteomyelitis?

A 
DVT
meningitis
chronic osteomyelitis
Growth disturbances and limb length discrepancies
pathological fractures
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161
Q

Radiographs of osteomyelitis

A

early films may be normal or show loss of soft tissue planes and soft tissue edema
new periosteal bone formation (5-7 days)
osteolysis (10-14 days)
late films (1-2 weeks) show metaphyseal rarefaction (reduction in metaphyseal bone density) or possible abscess

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162
Q

Breastfed fed infants should feed how often?

A

Every 2-5 hours

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163
Q

Duration of breast feeds

A

Duration of Feed depends upon the rate of transfer from breast to baby, which in turn depends on the babies suck and the mothers let down 5-6 mins to 20-30 mins

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164
Q

Most common cause of blood stained milk

A

Trauma to the nipple

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165
Q

Introducing solids

A

4-6 months

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166
Q

Gowers sign

A

Patient uses arms to walk up own body from a squatting/ lying down position. Indicates proximal muscle weakness.

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167
Q

opisthotonos

A

Rigid spasm of the body with the back fully arched and the heels and head bent back

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168
Q

Signs of meningism

A

Brudzinski’s sign
Opisthotonos
Nuchal rigidity
Kernig’s Sign

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169
Q

Glucose in bacterial vs viral meningitis

A

Bacterial: low
Viral: normal

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170
Q

Protein in bacterial vs viral meningitis

A

Bacterial: high
Viral: low or normal

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171
Q

Lymphocytes in bacterial vs viral meningitis

A

Bacterial: bit high
Viral: very very high

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172
Q

If encephalitis is suspected give what mediciation?

A

acyclovir

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173
Q

Bacterial meningitis ABX < 2 months

A

Cefotaxime AND

Benzylpenicillin*

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174
Q

Bacterial meningitis ABX > 2 months

A

Ceftriaxone

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175
Q

What to monitor in bacterial meningitis?

A

Neurological observations
weight and head circumference
electrolytes and glucose
ensure adequate pain relief

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176
Q

Follow up after bacterial meningitis

A

a formal audiology assessment 6-8 weeks after discharge (earlier if there are concerns regarding hearing).
Neurodevelopmental progress should be monitored in outpatients.

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177
Q

pathogen in Whooping cough

A

Bordetella pertussis

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178
Q

Clinical pattern of cough in Whooping cough

A

cough and coryza for one week (catarrhal phase), followed by a more pronounced cough in spells or paroxysms (paroxysmal phase)

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179
Q

Investigation for Whooping cough?

A

nasopharyngeal aspirate/swab for PCR

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180
Q

Erythema multiforme?

A

hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus (HSV). It presents with a skin eruption characterised by a typical target (iris) lesion. There may be mucous membrane involvement. It is acute and self-limiting, usually resolving without complications.

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181
Q

Stevens Johnson Syndrome

A

very rare, acute, serious, and potentially fatal skin reaction in which there is sheet-like skin and mucosal loss. nearly always caused by medications.

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182
Q

What is the llness severity score that has been developed to predict mortality in SJS and TEN cases?

A

SCORTEN
The SCORTEN criteria are:

Age >40 years
Presence of a malignancy (cancer)
Heart rate >120
Initial percentage of epidermal detachment >10%
Serum urea level >10 mmol/L
Serum glucose level >14 mmol/L
Serum bicarbonate level <20 mmol/L
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183
Q

Treatment for scabies

A

permethrin 5% cream

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184
Q

Most common congenital heart defect

A

Ventricular septal defect

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185
Q

Most common type of atrial septal defect

A

Ostium secondum

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186
Q

Patent ductus arteriosus

A

Patent vessel between descending aorta and left pulmonary artery

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187
Q

VSD murmur

A

Early systolic to holo systolic murmur best heard at LLSB

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188
Q

Management for PDA

A

Indomethacin: PGE2 antagonist - only effective in premature infants
Catheter or surgical closure if PDA causes respiratory compromise, FTT, or persists beyond 3rd month of life

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189
Q

Causes of cyanotic heart disease

A 
1,2,3,4,5
Truncus arteriosus
Transposition of the great vessels
Tricuspid atresia
Tetralogy of fallot
Total anomalous pulmonary venous return
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190
Q

Fallot tetralogy

A

VSD
Pulmonary stenosis
Overriding aorta
RV hypertrophy

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191
Q

When do you see a “snowman” heart

A

Total anomalous pulmonary venous return

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192
Q

When do you see an egg shaped heart

A

Transposition of great arteries

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193
Q

When do you see a boot shaped heart

A

Tetralology of fallot, tricuspid atresia

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194
Q

Ebsteins anomaly

A

Septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle

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195
Q

What is a wheal?

A

superficial skin coloured or pale skin swelling, usually surrounded by erythema, that lasts anything from a few minutes to 24 hours, usually very itchy, may have a burning sensation

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196
Q

complication of untreated Kawasaki disease?

A

Up to 30% of untreated children develop coronary artery involvement with dilation or aneurysm formation. These can occur up to 6-8 weeks after the onset of the illness. Echocardiography should therefore be performed at least twice: at the initial presentation and, if negative, again at 6-8 weeks.

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197
Q

most common worm infection

A

Enterobius vermicularis (threadworm, pinworm)

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198
Q

threadworm treatment?

A

mebendazole

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199
Q

Define febrile convulsions

A

febrile convulsions are usually brief, generalised seizures associated with a febrile illness, in the absence of any central nervous system infection or past history of afebrile seizures

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200
Q

risk of recurrence of febrile convulsions?

A

30%

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201
Q

Nutritional requirements for 0-6month year olds?

A

exclusive breast milk during first 6 months recommended over formula unless contraindicated

breastfed infants require supplements: vitamin K (all babies get at birth breastfed or not), Vitamin D (400-800 IU//d), fluoride (after 6 months if not sufficeicnt in water), iron (6-12 months, only if not receiving fortified cereals/ meat/ meat alternatives

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202
Q

Nutritional requirements > 6 months

A

solid food introduction - do not delay beyond 9 months
2-3 new foods per week with a few days in between ach food to allow them time for adverse reaction identification
suggested order of introduction:
meat, meat alternatives and iron enriched cereal (rice cereal is least allergenic)
pureed vegetables
fruit

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203
Q

Nutritional requirements 9-12 months

A

finger foods and swtich to homogenised milk
foods to avoid
honey, until past 12 months - risk of botulism
added sugar, salt
excessive milk
juice
anything that is a choking hazard

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204
Q

Advantages of breastfeeding?

A

easily digested, low renal solute load
immunologic
contains IgA, macrophages, active lymphocytes, lysozymes, lactoferrin which inhibits E coli growth in intestine
lower pH promotes growth of lactobacillus in GI tract
parent - child bonding
economical, convenient

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205
Q

Content of breast milk?

A

colustrum (first few days): clear, rich in nutrient (i.e high protein, low low fat), immunoglobin
mature milk: 7-:30 whey: casein ratio, fat from dietary butterfat, carbohydrate from lactose

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206
Q

When is breastfeeding contraindicated?

A

is receiving chemotherapy or radioactive compounds
has HIV/ AIDS, active untreated TB, herpes in breast region
is using >0.5g/kg/d alcohol or illicit drugs
is taking medications known to cross breast milk
OCP is NOT a contraindication

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207
Q

Medications that cross into breast milk?

A 
antimetabolites
• bromocriptine
• chloramphenicol
• high dose diazepam • ergots
• gold
• metronidazole
• tetracycline
• lithium
• cyclophosphamide
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208
Q

Normal birth weight?

A

3.25kg

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209
Q

Average weight gain per day after birth

A

20-30g

twice birth weight by 4-5 months
(3x birth weight by 1 year)

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210
Q

Average height when born?

A

50cm

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211
Q

Average head circumference when born?

A

35cm

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212
Q

Fluid Requirements for 0-12 months

A

150ml/kg/day (for example, a child weighing 7kg should have approximately 1050ml/day)

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213
Q

Fluid Requirements for 1-3 years

A

120ml/kg/day(for example, a child weighing 10kg should have approximately 1200ml/day)

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214
Q

Fluid Requirements for over 3 years

A

1000-1500ml minimum/day (may require more).

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215
Q

how many wet nappies should infants have

A

6-8 per day

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216
Q

how many wet nappies should older children have?

A

4-5 day

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217
Q

Signs that a child requires more fluid

A 
Strong smelling nappies
Yellow urine
Less wet nappies than normal due to decreased amount of urine (infants should have 6-8 wet nappies/day and an older children should have 4-5/day)
Constipation
Headaches, tiredness
Dry lips and skin
More thirsty than usual
Dark circles around eyes
Weight loss.
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218
Q

Percentiles on growth charts?

A

3,10,25,50,75,90,97

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219
Q

What is bone age and how is it measured?

A

Bone age is an idex of physiological maturity indicating the state of bony epiphyseal maturation
bone age is obtained by perfuming an X-ray of the left wrist and hand and is interpreted according to an atlas of age and sex specific standards

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220
Q

4 questions to ask when evaluating short stature?

A

was there IUGR?
Is the growth proportionate?
Is the growth velocity normal?
is bone age delayed?

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221
Q

Familial short stature

A

these children will be growing on the 3rd centile or below but growth is parallel to the 3rd centile
growth velocity is usually normal
plot adult height percentiles
pubertal development occurs at appropriate time
makers of physical maturation such as bone age are consistent with chronological age

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222
Q

Constitutional Growth Delay

A

affects boys more commonly than girls
often there is a family history of a parent being short as a child with delayed puberty and eventual catch up with peers
typical growth pattern shows a growth rate that is mostly normal except for a period of 6-12 months in the first 2 years of life, when the growth rate falls transiently
tend to grow into their late teenage years or early twenties

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223
Q

Function of LH in puberty?

A

stimulates release of female and male sex hormones from the ovaries and testes

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224
Q

Function of FSH in puberty?

A

stimulates the ovaries and testes to produce egg and sperm

225
Q

Function of sex hormones in puberty?

A

Oestrogen: secreted by ovaries - responsible for breast development in girls and maturation of the uterus
Testosterone (androgen): secreted by the testes, stimulate pubic hair growth and underarm growth

226
Q

Most common cause of delayed puberty?

A

constitutional delay

227
Q

define precocious puberty

A

development of secondary sex characteristics 2-2.5SD before population mean
<9 years for males

228
Q

Eitiology of precocious puberty?

A

usually idiopathic in females (90%), more suggestive of pathology in males (50%)

229
Q

Vision and fine motor red flags

A

Does not fix and follow visually by 3 months
Does not reach for objects at 6 months
Does not transfer by 8 months
Does not pincer grip by 12 months

230
Q

Language red flags

A

Does not babble by 7 months
does not join words by 2 years
does not speak in sentences by 3 years

231
Q

WHO definition of adolescence

A

10-19 years old

232
Q

3 domains of adolescent development

A

Physical
Cognitive
Psychosocial

233
Q

leading cause of morbidity and mortality in adolescence

A

accidents and injuries, mental health problems and behavioural problems such as substance abuse

234
Q

How are children’s airways different?

A

narrower airways - more easily obstructed
larger tongue
longer floppy epiglottis
Higher anterior larynx
narrower airway at the cricoid just below the larynx
shorter trachea. chest xray is required to confirm ETT position
larger occiput. this results in the neck being flexed when a child is lying supine

235
Q

mechanisms of airway obstruction

A

supine posture in an unconscious child
displaced teeth
foreign body, such as food/ vomit/ blood/ saliva
haemorrhage into mouth, tongue, neck
burn associated oedema of mouth, pharynx, larynx

236
Q

Signs of airway obstruction

A

restlessness
cyanosis
low SpO2
Respiratory distress
rising respiratory rate
paradoxical movement of the chest and abdomen
use of accessory muscles, sternal, intercostal, subcostal recession
wheeze or prolonged expiration - intrathoracic obstruction (trachea or bronchi)
Stridor - extrathoracic obstruction (pharynx, larynx, upper trachea)
visible swelling of tongue, pharynx or neck
external signs of injury to face, mouth, mandible or neck
dysphonia

237
Q

How to insert an OPA in a child less than 8 years

A

Insert under direct vision, concave side down, using a tongue depressor.

238
Q

Indications for intubation

A

Airway obstruction persists despite oropharyngeal (Guedel) airway.
Adequate ventilation not possible via bag and mask ventilation;
Needs definitive airway protection;
Unresponsive to painful stimuli
Flaccid limbs, decerebrate/decorticate posturing; GCS <8.
Needs prolonged ventilation;
Respiratory burn injury.

239
Q

calculating endotracheal tube size

A

Age/4 + 4 mm internal diameter (ID)

240
Q

Rickets

A

defective mineralization or calcification of bones before epiphyseal closure in immature mammals due to deficiency or impaired metabolism of vitamin D, phosphorus or calcium

241
Q

Henoch Schonlein purpura triad

A

purpuric rash on the extensor surfaces of limbs (mainly lower) and buttocks,
joint pain/swelling and
abdominal pain.

242
Q

comments age group for Henoch Schonlein purpura

A

2-8 years

243
Q

Renal manifestations in Henoch Schonelin purpura

A

Haematuria is present in 90% of cases, but only 5% are persistent or recurrent. Less common renal manifestations include proteinuria, nephrotic syndrome, isolated hypertension, renal insufficiency and renal failure (<1%). Renal involvement may only present during the convalescent period.

244
Q

Investigations in meningococcal

A 
BLOOD CULTURE
Meningococcal PCR (2-5ml in EDTA tube) if blood cultures have been obtained post-antibiotics (including prior oral antibiotics)
Full blood count and differential
Glucose, urea and electrolytes
Coagulation screen if appropriate
245
Q

antibiotics in meningococcal

A

ceftriaxone 50mg/kg

246
Q

Chemoprophylaxis for meningococcal

A

Rifampicin

247
Q

Side effects of rifampicin

A

causes orange-red discolouration of tears, urine and contact lenses, and may also cause skin rashes and itching, and gastrointestinal disturbance. It negates the effect of the oral contraceptive pill and should not be used in pregnancy, breastfeeding women, or severe liver or renal disease.

248
Q

Petechiae or purpura are non blanching. True or false?

A

True

249
Q

Scissor walking

A

where the knees come in and cross

250
Q

cerebral palsy

A

persistent but not unchanging disorder or movement and posture due to a defect or lesion of the developing brain

251
Q

brain part damaged in spastic cerebral palsy

A

motor cortex or corticospinal tracts

252
Q

brain part damaged in dyskinetic CP

A

basal ganglia

253
Q

brain part damaged in ataxic CP

A

cerebellum

254
Q

Narcolepsy

A

recurrent periods of an irrepressible need to sleep, lapsing into sleep or napping that occurs within the same day. This must occur 3 times per week over 3 months

255
Q

Sleep walking

A

partial arousal from sleep during slow-wave stages 3 and 4. It is most common during the initial third stage of the sleep period.

256
Q

bruxism

A

(persistent grinding of the teeth) is considered a stereotyped movement disorder or rhythmic disorder.

257
Q

night terrors

A

very dramatic awakenings that happen during the night in the first few hours of sleep

258
Q

School Refusal

A

Severe difficulty attending school resulting in prolonged absence. Associated with severe emotional upset and absence of antisocial characteristics. Children are often at home with the parents knowledge, despite reasonable efforts by parents to enforce attendance.

259
Q

How does school refusal differ to truancy?

A

The child who truants avoids school because they want to engage in activities (often antisocial in nature) that are typically outside school/home. The school refuser often wants to be at school but cannot summon the courage to go due to anxiety.

260
Q

common reasons for school refusal

A 
Bullying (32%)
Transition to high school (29%)
Legitimate absence due to illness (29%)
Family stress (15%)
Academic problems (12%)
Illness in others (10%)
Traumatic life event (7%) 
Parent returning to work (7%)
Fear/difficulties with teacher (7%)
Change of school (7%)
Divorce/separation (5%)
261
Q

Intervention for school refusal

A 
Relaxation
CBT
Social skills training 
Answering questions re: absence
Brainstorming possible responses
Practicing role play
Assertiveness 
Dealing with bullying 
Joining in with groups 
Exposure 
Imaginal: Confronting the situation through imagination 
In vivo: Facing the situation by physically confronting the feared situation
262
Q

features of Haemolytic Uremic syndrome

A

microangiopathic haemolytic anaemia
thrombocytopenia
acute renal insufficiency

263
Q

causes of acute nephritis

A 
postinfectious glomerulonephritis
Henoch Schonlein purpura
IgA nephropathy
Lupus erythematosus
Membranoproliferative glomerulonephritis
vasculitis
264
Q

Benign focal epilepsy: where do seizures arise from

A

Rolandic or sylvan cortex

265
Q

Most children grow out of benign focal epilepsy. Tru or false

A

True

266
Q

Fanconi Syndrome

A

disease of the proximal renal tubules[1] of the kidney in which glucose, amino acids, uric acid, phosphate and bicarbonate are passed into the urine, instead of being reabsorbed.

267
Q

Type 1 Distal RTA

A

impairment in hydrogen ion secretion in the distal tubule

268
Q

most likely electrolyte abnormality in pyloric stenosis?

A

Hypocholaeremic Hypokalemic Metabolic Alkalosis

269
Q

Risk factors for pyloric stenosis

A

male
firstborn
caucasian
parental history of HPS

270
Q

Type 2 renal tubular acidosis

A

impaired HCO3 resorption

271
Q

Type 4 renal tubular acidosis

A

Decrease in aldosterone secretion or activity

272
Q

Battle’s sign

A

bruising behind the ear following basilar skull fracture

273
Q

Wilms tumour

A

nephroblastoma

274
Q

Wilms tumour associations

A

WAGR (rare genetic syndrome in which affected children are predisposed to develop Wilms tumour, Aniridia, Genitourinary abnormalities and Retardation) 11p13 deletion

275
Q

Phaeochromocytoma

A

catecholamine secreting tumour from chromaffin cells

276
Q

Genetics of phaeochromocytoma

A

autosomal dominant; associated with neurofibromatosis, MEN 2A and MEN 2B, tuberous sclerosis

277
Q

Clinical Presentation of phaeochromocytoma

A

episodic severe hypertension, palpitations and diaphoresis, headache, abdominal pain, dizziness, pallor, vomiting, sweating, encephalopathy
Retinal examination: papilloedema, haemorrhages, exudate

278
Q

most common type of brain tumours?

A

Infratentorial

279
Q

most common infratentorial brain tumour

A

juvenile pilocytic astrocytoma

280
Q

classic site of a juvenile pilocytic astrocytoma?

A

cerebellum

281
Q

tests recommended for someone with anal agenesis

A

Cardiac echocardiogram will be needed to rule out heart anomalies.
Renal ultrasound will be necessary to identify any urinary anomalies.
Spine MRI will be required to rule out a tethered cord or abnormal attachment of the spine cord to the vertebrae. A untreated tethered cord may lead to bowel and bladder dysfunction.

282
Q

Waht is important to consider in a child with bow legs?

A

rickets

283
Q

What do you measure in a child with bow legs?

A

ICS - intercondylar separation: distance between medial femoral condyles

284
Q

When do you refer a child with bow legs

A

when at 4 years of age the ICS > 6cm

285
Q

when are children usually knock kneed

A

from 2-8 years

286
Q

what to monitor with knock knees

A

monitor IMS - intermalleolar separation: distance between medial malleoli

287
Q

Diagnosis of oligohydramnios

A

MVP

288
Q

Corrigans syndrome

A

Congenital aortic regurgitation

289
Q

When to refer with knock knees

A

IMS > 8cm

290
Q

thalassemia

A

defects in production of the α or β chains of hemoglobin resulting imbalance in globin chains leads to ineffective erythropoiesis and hemolysis in the spleen or BM

291
Q

Aphalia

A

born without a penis, in a patient with otherwise typical male anatomy

292
Q

What HLA types are commonly associated with type 1 diabetes?

A

HLA/ DR3, HLA/ DR4 (located on chromosome 6))

293
Q

Kussmual respirations

A

rapid, shallow breaths that often occur in DKA, respiratory response to compensate for metabolic acidosis

294
Q

most common type of congenital diaphragmatic hernia?

A

Bochdalek Hernia

295
Q

Morgagni Hernia

A

characterised by herniation through the foramina of Morgagni which are located immediately adjacent and posterior to the xiphoid process of the sternum

296
Q

Diaphragm Eventration

A

the diagnosis of congenital diaphragmatic eventration is used when there is abnormal displacement (i.e elevation) of part or all of an otherwise intact diaphragm into the chest cavity
occurs because in the region of eventration the diaphragm is thinner

297
Q

childhood apraxia of speech

A

developmental verbal dyspraxia also known as childhood apraxia of speech is an inability to utilise motor planning to perform movements necessary for speech during a child’s language learning process.

298
Q

common causes of liver disease in the neonate?

A

bacterial sepsis

congenital infection

299
Q

congenital biliary atresia

A

the common bile duct between he liver and the small intestine is either blocked or absent

300
Q

Allagile Syndrome

A

rare autosomal dominant condition also presenting with prolonged jaundice

301
Q

Allagile Syndrome features

A

triangular facies, butterfly vertebrae on spinal Xray , posterior embryotoxon on eye examination and pulmonary valve stenosis.

302
Q

What Gi atresia has a strong association with Down Syndrome?

A

Duodenal atresia

303
Q

Which inflammatory bowel disease involves only the lining of the intestine?

A

UC

304
Q

Hydrocele

A

collection of fluid within the processes vaginalis (PV) that produces swelling in the inguinal region or scrotum

305
Q

Silk glove sign

A

Gently passing the fingers over the pubic tubercle may reveal a PPV. The thickened cord of a hernia or hydrocele sac within the spermatic cord provides the feel of 2 fingers of a silk glove rubbing together.

306
Q

causes of a reactive hydrocele

A

Trauma
Torsion
Infection (eg, epididymo-orchitis)
Abdominal or retroperitoneal operations that impair lymphatic drainage

307
Q

most common inguinal hernia in children?

A

Indirect hernia

308
Q

What is Noonan syndrome?

A

relatively common autosomal dominant congenital disorder that affects both males and females

309
Q

Features of Noonan syndrome?

A

congenital heart defect (typically pulmonary valve stenosis; also ASD and hypertrophic cardiomyopahty)
short stature
learning problems
pectus excavatum
impaired blood clotting
characteristic configuration of facial features including a webbed neck and a flat nose bridge

310
Q

pathophysiology of Noonan syndrome

A

is a RASopathy and caused by a disruption in the RAS-MAPK pathway signalling

311
Q

main heart abnormality in Turner Syndrome?

A

coarctation of aorta or aortic stenosis

312
Q

what is the commonest congenital cyanotic heart disease

A

tetralology of fallot

313
Q

Noonans syndrome is associated with what valvular disease?

A

Pulmonary stenosis

314
Q

Eisenmeger’s syndrome

A

the process in which a left to right shunt caused by a congenital heart defect in the fetal heart causes increased flow through the pulmonary vasculature, causing pulmonary hypertension, which in turn causes increased pressures in the right side of the heart and reversal of the shunt into a right-to-left shunt.

315
Q

fixed splitting of te second heart sound is a feature of what

A

arial septal defect

316
Q

What is Hess’s test?

A

test of platelet adhesion and aggregation

317
Q

name 5 causes for neck stiffness in a child

A
  1. Meningitis
  2. Meningeal luekaemia
  3. Tonsillits
  4. Subarachnoid haemorrhage
  5. Metoclompramide adverse effect
318
Q

Why do you not give a baby aspirin?

A

Risk of Reye’s syndrome

319
Q

What is the surgery called for undescended testicles?

A

orchioplexy

320
Q

Where is a cystic hygroma commonly found?

A

left posterior triangle of the neck and armpits.

321
Q

what percent of Marfan syndrome is a result of spontaneous mutations?

A

25%

322
Q

Features of infants of diabetic mothers

A 
Hypoglycaemia (as the fetus has been exposed to high circulating glucose levels resulting in the insulin hypersecretion and hence macrosomia)
Congenital abnormalities
Talipes
Congenital heart defects
Polycythaemia
Hypocalcaemia
Birth injuries/shoulder dystocia
323
Q

what confirms the diagnosis of beta thalassemia?

A

An elevation of Hb A2 (2 alpha-globin chains complexed with 2 delta-globin chains) demonstrated by electrophoresis confirms the diagnosis of beta thalassaemia. The Hb A2 level in these patients usually is approximately 4-6%.

324
Q

tetralology of fallot causes hypertophy of the?

A

Right ventricle

325
Q

Left ventricular hypertrophy occurs with which congenital heart diseases?

A

a moderate sized ventricular septal defect
patent ductus arteriosus, and
coarctation.

326
Q

What is the most common cardiology complication of Down Syndrome?

A

endocardial cushion defect.

327
Q

Rate of spontaneous closure in VSD

A

> 50%

328
Q

congenital rubella cardiology manifestations

A

Patent ductus arteriosus, pulmonary stenotic lesions and atrial septal defect.

329
Q

CATCH 22 Syndromes

A

chromosome 22 micro deletion syndromes are the velocardial-facial syndrome
Cardiac, Abnormal Facies, Thymic Hypoplasia, Cleft Palate, Hypocalcemia

330
Q

Test for phagocytic cell defects

A

neutrophil respiratory burst; best way is rhodamine dye

331
Q

Test for agammaglobulinaemia

A

enumerate blood B cells - flow cytometry using dye conjugated monoclonal antibodies to B cell specific CD antigens (CD19, CD20

332
Q

DiGeorge Syndrome

A

dysmorphogenisis of the 3rd and 4th pharyngeal pouches; micro deletion 22q11.2

333
Q

worldwide what is the most common cause of adrenal insufficiency?

A

Tuberculosis

334
Q

Treatment of adrenal crisis

A

Intravenous Fluids
Steroid Replacement
Treat Hypoglyaemia
Treat Hyperkalemia

335
Q

What is Sandifer’s posturing? and what is it associated with?

A

Arching of the back

Reflux in infants

336
Q

What is used to treat apnoea of prematurity

A

caffeine citrate

337
Q

Tertiary Syphilis infection

A

cardiac or ophthalmic manifestations, auditory abnormalities, or gummatous lesions

338
Q

Investigations for syphilis

A

Darkfield examinations and direct fluorescent antibody (DFA) tests of lesion exudate

339
Q

cause of congenital syphilis

A

Fetal infection is a result of haematogenous spread from an infected mother, although transmission at the time of delivery can occur from direct contact with infectious genital lesions

340
Q

Clinical features of congenital syphilis

A

an abnormally bulky placenta – histological examination should be done
hydrops fetalis due to severe anaemia and/or severe liver disease
lymphadenopathy, hepatosplenomegaly, jaundice
osteochondritis with typical radiological changes; arthropathy or pseudoparalysis
rhinitis (‘snuffles’)
vesiculobullous rash on back, legs, palms and soles, followed by desquamation
condylomata lata – fleshy lesions in moist areas of skin.

341
Q

most common primary hepatic malignancy in childhood?

A

Hepatoblastoma

342
Q

Where do HCC metastases usually occur?

A

lung and lymph nodes

343
Q

Name the 2 malignant liver tumours in children?

A

Hepatoblastoma

Hepatocellular carcinoma

344
Q

most common benign liver tumour in children?

A

haemangioma

345
Q

what tumour is the OCP associated with

A

hepatic adenoma

346
Q

Absence epilepsy EEG

A

3 per second spike wave activity

347
Q

infantile spasms EEG

A

hypsarrhythmia

348
Q

Treatment for infantile spasms

A

ACTH, vigabatrin, benzodiazepines, prednisolone

349
Q

Physical signs of starvation

A 
Emanciated facies and body
Fine body hair growth
Dry hair
Cold hands
Slow pulse
Low BP
350
Q

Physical signs of bulimia

A

Dramatic weight fluctuations
Swollen salivary glands
Abraded knuckles
Dental carries

351
Q

Schwachman diamond syndrome

A

Pancreatic insufficiency
Neutropenia
Malabsorption

352
Q

Intestinal lymphangiectasia

A

Lymph fluid leaks into bowel lumen
Steatorrhoea
Protein losing enteropathy

353
Q

Disccaridase deficiency

A

Osmotic diarrhoea

Acidic stools

354
Q

Abetalipoproteinaemia

A

Severe fat malabsorption
Acanthodians
Very low to absent plasma cholesterol, triglycerides

355
Q

Pendred syndrome

A

Genetic disorder leading to congenital bilateral sensorineural hearing loss and goitre with occasional hypothyroidism

356
Q

Diagnostic sign for necrotising enterocolitis on X-ray

A

Pneumatosis intestinalis

357
Q

Complications of phototherapy

A

Loose stools
Erythematous macular rash
Overheating, leading to dehydration
Bronze baby syndrome - occurs with direct hyperbilirubinaemia

358
Q

Clinical features of conjugated hyperbilirubinaemia

A

Pale stools
Dark urine

Conjugated is not lipid soluble

359
Q

Causes of conjugated hyperbilirubinaemia

A

Biliary atresia
Choledochal cyst
Neonatal hepatitis
Galactossaemia

360
Q

Features of bilirubin encephalopathy

A 
Hypertonia
Arching
Retrocollis
Opisthotonus
Fever
High pitched cry
Seizures
361
Q

Kernicterus

A 
Sensorineural deafness
Athetoid cerebral palsy
Paralysis of upward gaze
Intellectual function less affected
Damage on MRI mainly in globus pallidus
362
Q

Most likely cause of early jaundice

A

Haemolysis

363
Q

What does the newborn screening heel prick test for?

A 
Cystic fibrosis
pKU
Galactossemia
Primary congenital hypothyroidism
Rare metabolic conditions
364
Q

Signs of primary congenital hypothyroidism

A 
Prolonged jaundice
Umbilical hernia
Constipation
Macroglossia
Feeding problems
Hypotonia
365
Q

Choice of imaging in SCFE

A

X-ray - frog leg lateral view

366
Q

Risk factors for developmental dysphasia of the hip

A

Female
Family history
Breech presentation
Oligohydramnios

367
Q

Treatment for DDH

A

Pavlik harness : under 6 months
Closed reduction
Open reduction: much older patient if closed reduction not possible

368
Q

Investigation of choice for DDH

A

Ultrasound

369
Q

Perthes disease

A

Self limited AVN of femoral head

370
Q

Characteristics of Perthes disease

A

More common in males
Presents at 4-10 years
Sometimes bilateral
Associated with family history, low birth weight, abnormal pregnancy, delivery, history of trauma to affected hip

371
Q

Treatment for Perthes disease

A

Bracing may be used in mild cases

Femoral neck and ace tabular osteotomies may be required to correct more sever abnormal femoroacetabular alignment

372
Q

How does the leg appear in SCFE

A

Externally rotated and shortened

373
Q

Conditions that may predispose a child to SCFE

A

Hypothyroidism
Hypopituitarism
hyperparathyroidism

374
Q

Treatment for SCFE

A

Surgical pinning

375
Q

Potential complications of SCFE

A 
A vascular necrosis of femoral head
Chondrolysis
Deformity
Long term degenerative osteoarthritis 
Limb length discrepancy
376
Q

Salter Harris fracture

A

A fracture that involves the epiphyseal plate or growth plate of a bone

377
Q

Type 1 salter Harris fracture

A

Transverse Fracture through the growth plate (physis)

378
Q

Type 2 salter Harris fracture

A

A fracture through the growth plate and the metaphysis sparing the epiphysis

379
Q

Type 3 salter Harris fracture

A

A fracture through the growth plate and epiphysis sparing the metaphysis
More common in older Children where the growth plate had started to close

380
Q

Type 4 salter Harris fracture

A

Vertical fracture through the growth plate, metaphysis and epiphysis

381
Q

Type 5 salter Harris fracture

A

Compression fracture of the growth plate

382
Q

Complications of physeal injuries

A 
Avascular necrosis
Direct crushing
The formation of a bony bar
Non Union
Hyperaemia
383
Q

Fragile x syndrome

A

Inherited cause of intellectual disability

384
Q

Physical features of fragile x syndrome

A

Long face
Protruding ears
Large testes
Tall stature

385
Q

Syndrome associated with tall stature and large head

A

Sotos syndrome

386
Q

Syndrome associated with short stature with webbed neck, widely spaced nipples, micrognathia and heart disease

A

Turner or Noonan syndrome

387
Q

Where are osteosarcoma found?

A

Metaphyses of long bones

most commonly seen around the knee and in the proximal humerus

388
Q

Who gets osteosarcoma?

A

often occur in young adults

also seen in the elderly in association with Paget’s disease

389
Q

Xray appearance of osteosarcoma

A

Periosteal elevation (Codman’s triangle) and a ‘sunburst’ appearance due to soft tissue involvement

390
Q

5 year survival rate of osteosarcoma?

A

50%

391
Q

Features of an insignificant heart murmur in a child?

A

Systolic
soft and short duration
usually located along the left sternal border

392
Q

Complications of mumps

A

viral meningitis, encephalitis, orchitis, oophoritis, pancreatitis, thyroiditis, deafness

393
Q

4Ds of epiglottitis

A

Drooling
Dysphagia
Dysphonia
Distress

394
Q

What not to do in epiglottitis

A

Never lie the child down
Never examine the throat with a spatula
never take a lateral neck xray

395
Q

Treatment for epiglottitis

A

Humidified oxygen by face mask
intubation
antibiotics - ceftriaxone
prevented with Hib Vaccine

396
Q

Wilm’s Tumour Associations

A 
Hemihypertrophy
aniridia
WAGR
Beckwith-Wiedemann Syndrome
Denys-Drash Syndrome
397
Q

Denys Drash Syndrome

A

Gonadal dysgenesis and nephropathy leading to renal failure

Associated with Wilm’s tumour

398
Q

Beckwith-Wiedemann Syndrome

A

Enlargement of body organs, hemihypertrophy, macroglossia

399
Q

Differentials for an abdominal mass in children

A

Faeces
Neuroblastoma
Nephroblastoms

400
Q

Most common congenital cause of non communicating hydrocephalus

A

Slyvian aqueduct stenosis

401
Q

congenital causes of non communicating hydrocephalus

A

Slyvian aqueduct stenosis
Dandy-Walker Malformation (obstruction at 4th ventricle)
Arnold Chiari Malformation
Supresellar arachnoid cysts

402
Q

Most common location of brain tumours in children

A

posterior fossa

403
Q

Kernicterus

A

unconjugated bilirubin in the basal ganglia and brainstem causing neurological symptoms - seizures, hypotonia, opisthotonus, sensorineural hearing loss, paralysis of upward gaze

404
Q

Treatment for hyperbilirubinaemia

A

Phototherapy

- ionises the unconjugated bilirubin so it can be excreted

405
Q

Complications of phototherapy

A

Loose stools
eryhtmeatous maccular rash
over heating leading to dehydration
bronze baby syndrome

406
Q

Which side do most Bochdalek hernias occur on?

A

Left

407
Q

name the 3 layers of the omphalocele sac?

A

Peritoneum
Amnion
Wharton’s jelly

408
Q

What syndrome is omphalocele associated with

A

Beckwidth-Wiedemann Syndrome (overgrowth disorder)
- hemihypertrophy, hyperinsulinism, risk of Wilms’ tumour
Also associated with Edwards and Patau syndrome

409
Q

WHat congenital condition is umbilical hernia associated with?

A

Congenital Hypothyroidism

410
Q

What condition causes bile stained vomit (green vomit)

A

malrotation with volvulus

411
Q

procedure to repair malrotation with volvulus

A

Ladds procedure with laparotomy

412
Q

Gold standard Imaging for malrotation with volvulus

A

Upper GI contrast study

413
Q

2 reasons for not passing meconium

A

meconium ileus

Hirschprung’s disease

414
Q

meconium ileus

A

obstruction of the terminal ileum by abnormally tenacious meconium

415
Q

Xray findings in necrotising enterocolitis

A

pneumatosis intestinalis

416
Q

How do you prevent NEC

A

antenatal corticosteroids

417
Q

Symptoms of pellagra

A

dermatitis, dementia, diarrhoea

418
Q

What is pellagra

A

means “rough skin”

deficiency of niacin

419
Q

Xray findings in viral pneumonia

A

could be clear, could show peribronchial exudates

420
Q

cause of bronchopneumonia in kids

A

viral

421
Q

Definitive Test in congenital adrenal hyperplasia

A

17 hydroxyprogesterone (after 48 hours)

422
Q

Treatment for CAH

A

Life long hydrocortisone and fludrocortisone (aldosterone)

423
Q

Early onset neonatal sepsis

A

Sepsis within the first 48 hours, over 80% are due to Group B streptococcus

424
Q

Late onset neonatal sepsis

A

after the first 48 hours
organisms acquired either around the time of birth or in hospital
>70% dt coagulase negative staphylococcus and staph auresu

425
Q

Risk Factors for early onset neonatal sepsis

A

Prolonged rupture of membranes (>18 hours)
foetal distress
maternal pyrexia (>38) or overt infection eg UTI, gasro
multiple obstetric procuedures
preterm delivery
history of previous GBS infection in previous infnant
GBS bacteriuria

426
Q

Treatment for early onset sepsis

A

benzylpenicillin + gentamicin

427
Q

Maculopapular rash on palms and soles, snuffles, periostitis

A

Syphilis

428
Q

Hydrocephalus, intracranial calcifications and chorioretinitis

A

Toxoplasmosis

429
Q

Cataracts, deafness, and heart defects, extramedullary haematopoesis

A

Rubella

430
Q

Microcephaly, periventricular calcifications deafness, thrombocytopenia, petechiae

A

CMV

431
Q

Limb hypoplasia, cutaneous scars, cataracts, chrioretinitis, cortical atrophy

A

Congenital varicella

432
Q

Bilateral purulent conjuctivitis in the first few days of life

A

Gonococcal conjuctivitis

TReat with IV ceftriaxone and frequent eye irrigation

433
Q

Endocrine disorder more likely in Down Syndrome

A

Hypothyroidism

434
Q

MSK Disorder more likely in Down Syndrome

A

Atlanto-axial instability

435
Q

most common neural tube defect

A

meningomyelocele: a sac like structure protruding through a defect in the vertebral arches

436
Q

mandibular hypoplasia, glossoptosis, cleft soft palate

A

Pierre Robin Sequence

* can be associated with Foetal Alcohol syndrome or Edwards

437
Q

Broad, square face, short stature, self injurious behaviour. Deletion on chromosome 17

A

Smith Magenis

438
Q

Hypotonia, Hypogonadism, hyperphagia, skin pciking, aggression, deletion on paternal chromosome 15

A

Prader Willi

439
Q

Seizures, strabismus, sociable with episodic laughter. Deletion on maternal chromosome 15

A

Angleman Syndrome

440
Q

Elfin appearance, friendly, increased empathy and verbal reasoning ability, deletion on chromosome 7

A

Williams Syndrome

441
Q

IUGR, hypertonia, distinctive facies, limb malformation, self injurious behaviour, hyperactive

A

Cornelia De Lange

442
Q

Microcephaly, smooth philtrum, thin upper lip, ADHD like behaviour, most common cause of mental retardation

A

Foetal Alcohol Syndrome

443
Q

Most common type of mental retardation in boys. CGG repeats. Macrocephaly, large ears, macro-orchidisim

A

Fragile X Syndrome

444
Q

Autosomal dominant or associated with advanced paternal age. Short palpebral fissures, white forelock and deafness

A

Waardenburg syndrome

445
Q

Main features of Von Hippel Lindau Syndrome

A

Spinal or cerebellar Haemangioblastoma
Renal Cell carcinoma
Phaeochromocytoma

446
Q

Main features of Sturge Weber Syndrome

A

Port Wine Stain + Glaucoma + seizures + mental retardation

447
Q

sickle cell disease eitiology

A

glutamine is replaced by valine on the beta globin chain

448
Q

what is dactilytis a common presenting symptom of?

A

Sickle cell disease

449
Q

what do you see in blood smear in haemolytic uremic sydnrome?

A

Schistocytes

450
Q

what conditions can cause a 5 year old boy to have elevated levels of foetal haemoglobin

A

Pople with haemoglobinopathies such as aplastic anaemia or thalassemias have a slower decline of fetal haemoglobin

451
Q

Genetic translocation associated with Burkitt Lymphoma

A

translocation of the c-myc oncogene

452
Q

what is the fastest growing malignant tumour?

A

Burkitt Lymphoma

453
Q

Poor prognostic factors in ALL

A

WCC >50,000
Age 10
chromosomal translocation
CNS involvement

454
Q

What is the Philadelphia Chromosome

A

Translocation between chromosome 9 and 22
creates the BCR-ABL fusion gene
results in the production of a specific tyrosine kinase (wiht increased activity)
highly associated with CML, also occurs in about 5% of children with ALL

455
Q

cisplatin toxicity

A

acoustic nerve damage + renal failure

456
Q

Bleomycin toxicity

A

Pulmonary fibroiss

457
Q

Doxorubicin toxicity

A

Cardiotoxic

458
Q

Vincristine toxicity

A

peripheral neuropathies

459
Q

Pathogens in chronic suppurative otitis media

A

Pseudomonas aeruginosa and Staphylococcal Aureus

460
Q

What are the live vaccinations?

A 
Varicella
MMR
Rotavirus
Oral typhoid
Yellow Fever
461
Q

Measles complications

A 
Otitis Media
corneal ulceration
pneumonia
febrile convulsions
encephalitis
Sub acute sclerosing panencephalitis
462
Q

Chicken pox complications

A

secondary bacterial infection
pneumoniae
encephalitis

463
Q

Virus causing measles

A

RNA paramyxovirus

464
Q

Systemic JIA Symptoms

A

HIgh fever, arthritis, salmon pink rash

465
Q

ECG finding in Wolff Parkinson White

A

Delta wave (slurred upstroke)

466
Q

what drugs are contraindicated in WPW with AF

A

Av nodal blockers (adenosine, Bblockers, calcium channel blockers, digoxin, lignocaine)

467
Q

Definitive treatment for WPW

A

Radiofrequency ablation

468
Q

venous hum

A

continuous murmur ins supraclavicualr region, reduces on lying down or with pressure on neck

469
Q

Still’s murmur

A

low pitched vibratory systolic murmur, increases with lying down

470
Q

Where is a PDA murmur best heard?

A

just below the left clavicle

471
Q

what is endocardial cushion defect associated with

A

Atrioventicular septal defect

472
Q

Holt Oram Syndrome

A 
Autosomal dominant
Bone defects (hands and arm) and heart defect
ASD and first degree heart block
473
Q

heart defect in William’s syndrome

A

Aortic stenosis

474
Q

Purpura Fulminans

A
  • life threatening and rare form of non-thrombocytopenic purpura that may follow such infections such as scarlet fever, varicella, measles and some other viral infections
  • typically there are rapidly spreading skin haemorrhages involving the buttocks and lower extremeties
  • congenital deficiencies of either protein C or S are the cause of neonatal purpura
475
Q

treatment for minor bleeds in Haemophilia A

A

Desmopressin

476
Q

Treatment for major bleeds in haemophilia A

A

Factor VIII concentrate

477
Q

chance of replapse in kids with nephrotic syndrome (minimal change disease)

A

80%

478
Q

Triad of Haemolytic uremic syndrome

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute renal insufficiency

479
Q

Ehler-Danlos Syndrome

A

Inherited connective tissue disorder

joint hypermobility, fragile skin and easy bruising

480
Q

Gold standard test for pyelonephritis

A

DMSA (static renogram showing state of parenchyma)

481
Q

SPA insertion point

A

Midline lower abdominal crease

482
Q

what is the most common cause of severe obstructive uropathy in children?

A

posterior urethral valves

483
Q

Absence seizures on EEG

A

3 second spike and wave pattern

484
Q

management of absence epilepsy

A

valproic acid or ethosuximide

485
Q

treatment for infantile spasms

A

ACTH

486
Q

coup injury

A

acceleration injury where the damage to the brain is at the point of impact

487
Q

Contra coup injury

A

Deceleration injuries and are located at the opposite site of the impact

488
Q

How do you diagnose Guillain Barre

A

Lumbar puncture: increase in CSF protein

489
Q

what cancers occur in von Hippel Lindau Disease

A

Retinal and CNS haemangioblastoma and Renal cell carcinoma

490
Q

what stage sleep do night terrors occur in

A

Non Rem sleep stage 4

491
Q

absence of the roof of the 4th ventricle with cystic dilation and enlargement of the posterior fossa. What is this defect called?

A

dandy Walker malformation, which is associated with agenesis or hypoplasia of the cerebellar vermis
often causes obstructive hydrocephalus

492
Q

what is the most common Arnold-Chiari malformation

A

Type 1: caudal displacement of the cerebellar tonsils, causing subsequent downward displacement of the 4th ventricle
2 and 3 are more severe and associated with meningomyeloceles and encephaloceles

493
Q

What is TOurette’s also associated with

A

OCD and ADHD

494
Q

what mutation is associated with Duchenne muscular dystrophy

A

Xp21 mutations

495
Q

What investigations would you do in Duchenne muscular dystrophy

A

CK levels
EMG
Genetic testing: Xp21 mutation
Muscle Biopsy: abscence of dystrophin

496
Q

name the 3 types of CP

A

Spastic
Dyskinetic
Ataxic

497
Q

what are the 4 domains of development

A

Gross motor
Fine motor and vision
Hearing, speech and language
Social emotional and behavioural

498
Q

what drug is used for meningococcal prophylaxis

A

Rifampicin

499
Q

what are the minor Jones criteria for rheumatic fever

A 
arthraligia
prolonged PR
raised ESR/ CRP
Previous Hx of RF or RHD
Fever
500
Q

Gold standard test for diagnosis of biliary atresia

A

INtraoperative cholangiogram

501
Q

Genu Varum

A

Bow legs

502
Q

Poor prognostic factors in ALL

A 
Age 10
WCC >50
CNS involvement
Malignant cells with hypoploidy
Chromosomal translocation abnormalities
503
Q

commonest glomerular causes of microscopic haematuria

A

IgA nephropathy
Alport Syndrome
Thin basement membrane disease

504
Q

Blount’s disease

A

Severe bow legedness
caused by obesity
they squash their gorwth plate

505
Q

Craniotabes

A

Softening of the skull that usually occus around the suture lines and disappears ithin days to a few weeks after birth
may be secondary to calcium deficiency and osteogenesis

506
Q

What are the Xray features of rickets

A

widening of the epiphyseal plate, cupping, splaying and fraying of metaphysis

507
Q

Treatment for mycoplasma pneumonia

A

erythromycin

508
Q

what does organic phosphate poisoning inhibit

A

acetylcholinesterase

Leads to accumulation of ACh in the body

509
Q

Organophosphate poisoning symptoms

A

SLUDGEM

salivation, lacrimation, urination, defecation, GI motility, Emesis, miosis

510
Q

Treatment for organophosphate poisoning

A

Atropine to treat muscarininc effects

Oxime therapy: reactives acetylcholineterase

511
Q

Treatment for salicylate overdose

A

Treat with activated charcoal

512
Q

Thiamine deficiency

A

BeriBeri

Neuritis, oedema,, cardiac failure

513
Q

what do Howell Jolly Bodies indicate

A

Hyposplenism

514
Q

How to you treat nephrogenic diabetes inspidus

A

Thiazide diuretics

515
Q

Spironolactone

A

Aldosterone antogneist

potassum sparing diuretic

516
Q

atropine

A

muscarinic antagonist

517
Q

congenital heart causes of neonatal collapse

A
  • severe aortic coarctation
  • aortic arch interruption
  • Hypoplastic Left Heart Syndrome
  • Critical Aortic Stenosis
518
Q

what is aortic coarctation and what level does it mostly occur

A

Narrowing of the aorta, level of ductus arteriosus

519
Q

what is coarctation of the aorta commonly associated with

A

bicuspid aortic valve and Turners syndrome

520
Q

Causes of a systolic murmur in a child

A
  • physiological murmur: Stills murmur, venous hum
  • Aortic stenosis
  • pulmonary stenosis
  • ASD
  • Coarctation
  • VSD
521
Q

ventolin deposition in lung

A

40%

522
Q

What variable are lung function values based on

A

height

523
Q

What happens in tumour lysis syndrome

A

cells lyse releasing K+, uric acid, phosphate

524
Q

What does T cell leukaemia often presnet with

A

mediastinal lump

525
Q

Prevalence of conduct disorder

A

3%

526
Q

HSV in neonate

A 
Skin Eye and Mouth Disease
Chorioretinitis
Conjunctivitis
Vesicular lesions on mouth and skin
treat with acyclovir
527
Q

Causes for racoon eyes

A

Basilar Skull fracture, Neuroblastoma

528
Q

Hutchinson Triad

A

8th cranial nerve deafness, interstitial keratitis, Hutchinson Incisors

529
Q

Topical antibiotics for impetigo

A

Bactroban

530
Q

kartagener syndrome

A

primary ciliary dyskinesia + Situs Invertus

531
Q

Fat soluble vitamins

A

ADEK

532
Q

Procedure for malrotation with volvulus

A

Ladd procedure

533
Q

usher Syndrome

A

Hearing loss + Retinitis pigmentosa

534
Q

Hearing test in newborns

A

Oto acoustic emissions

535
Q

hearing loss + kidney problems

A

Alport Syndrome

536
Q

Neonatal meningitis pathogens

A
  • S. agalactiae (group B strep)
  • E Coli
  • Listeria Monocytogenes
537
Q

Causes of Lobar Pneumonia

A

Strep pneumonia
Haemophilus influenza
Staph Aureus

538
Q

Forchheimer spots

A

fleeting enanthem seen as small, red spots (petechiae) on the soft palate in 20% of patients with rubella. They precede or accompany the skin rash of rubella. They are not diagnostic of rubella, as similar spots can be seen in measles and scarlet fever

539
Q

Orbital cellulitis

A
  • Surgical emergency
  • proptosis
  • limited eye movements
  • horizontal eye movements affected
  • decreased visual acuity
  • pain on occular movement
540
Q

cause of excessive eye watering in infant

A

Nasolacrimal duct obstruction

541
Q

treatment for infantile haemangioma

A

beta blocker

542
Q

Do congenital melanocytic naevi usually grow with the child?

A

Yes they proportionally grow with the child

543
Q

Neurocutaneous melanocytosis

A

rare syndrome defined by the proliferation of melanocytes in the CNS and the presence of a congenital melanocytic naevus
Can present with raised ICP

544
Q

What features about congenital melanocytic naevi increase the risk of melanoma

A 
large size
crosses the spine
multiple congenital satellite naevi
neurocutaneous melanosis
early childhood
545
Q

oxygen saturations in severe asthma

A
546
Q

Oxygen saturations in mild asthma

A

> 95%

547
Q

FEV1 in severe perisistent asthma

A
548
Q

FEV1 in moderate perisstent asthma

A
549
Q

Canavan disease

A
  • rare inherited disorder that damages the ability of nerve cells in the brain to send and receive messages
  • leukodystrophy
550
Q

Vascular Ring

A

Congenital defect in which there is an abnormal formation of the aorta and/or its surrounding blood vessels
- the trachea and oesophagus are completely encircled and sometimes compressed by a “ring” formed by these blood vessels
Can lead to breathing and digestive difficulties

551
Q

Tay Sachs Syndrome

A
  • caused by a total deficiency to hexosaminidase
  • a resulting accumulation of gangliosides in the brain
  • the infantile form is fatal by age 3 or 4 with early progressive loss of motor skills, dementia, blindness, macrocephaly and cherry red retinal spots
  • the juvenile onset form presents with dementia and ataxia, with death at age 10-15
  • the adult form has progression of neurological symptoms following clumsiness in childhood and motor weakness in adolescence
552
Q

Risk Factors for Cleft palate

A

Asian ancestry
Poor nutrition
family history
parental age (esp dad)

553
Q

Treatment for cleft lip/ palate

A

Surgery to correct cleft lip at 3-6 months

Surgery to corrent cleft palate at 6-12 months

554
Q

complications of cleft lip/palate

A

problems with feeding
ear infections
speech trouble
pyshcological issues

555
Q

Todd’s Paralysis

A

focal part of weakness in a part of the body after a seizure

usually subsides within 48 hours

556
Q

TB meningitis

A

lymphocytosis, normal to increased protein, LOW GLUCOSE

557
Q

Difference between TB and viral meningitis on CSF

A

TB has low glucose

558
Q

Findings of TB meningitis on contrast CT

A

Enhancement of the basal cisterns

General Medicine (15 decks)

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