Paediatrics II Flashcards

Question

Eye condition associated with JIA

Answer 1

Chronic anterior uveitis Can be seen prior to, or after JIA Children with JIA screened on a 3 monthly basis

Answer 2

Skin disorder Immune-complex mediated hypersensitivity reaction Typically a reaction to drugs Less severe version of toxic epidermal necrolysis (>10% body coverage)

Answer 3

Medications: - Anti-epileptics - Antibiotics - Allopurinol - NSAIDs Infections: - HSV - Mycoplasma pneumonia - Cytomegalovirus - HIV

Answer 4

Start with non-specific symptoms: fever, cough, sore throat, mouth + eyes, and itchy skin Develop a purple/red rash --> spreads + blisters Skin then starts to break away + shed Pain, erythema, blistering + shedding can also happen to lips + mucous membranes Eyes can become inflamed and ulcerated Can affect urinary tract, lungs +- internal organs

Answer 5

Emergency --> admit to dermatology or burns unit Supportive care - nutrition, antiseptics, analgesia, ophthalmology input Treatment options: steroids, immunoglobulins, immunosuppressant medication

Answer 6

Secondary infection Permanent skin damage Visual complications --> scarring + blindness

Answer 7

Myoclonic seizures = sudden brief muscle contractions, patient usually awake during episode Common triggers include sleep deprivation + alcohol withdrawal (often have jerks in the hours after waking up) 10-20 years at onset Can have periods of absence which disrupt schooling

Answer 8

1st line = sodium valproate 1st line in girls = levetiracetam

Answer 9

1st line = ethosuximide (or sodium valproate) Most stop having them as they get older

Answer 10

Request an EEG - helps categorise type + severity Head MRI/CT - if unclear history, or atypical features

Answer 11

Varicella zoster virus

Answer 12

Widespread, erythematous raised, vesicular, blistering lesions Starts on trunk or face --> spreads outwards --> affects whole body over 2-5 days Eventually lesions scab over --> no longer contagious Fever = often first symptom Itch General fatigue + malaise

Answer 13

Bacterial superinfection - avoid NSAIDs Dehydration Conjunctival lesions Pneumonia Encephalitis (presents as ataxia) DIC Progressive disseminated disease

Answer 14

Keep cool, trim nails Calamine lotion School exclusion

Answer 15

Spread through direct contact with lesions, or through infected droplets from cough/sneeze Become symptomatic 10 days-3 weeks after exposure Stop being contagious once lesions have crusted over

Answer 16

NSAIDs may increase risk Most commonly caused by invasive group A streptococcal species --> soft tissue infections --> necrotising fasciitis

Answer 17

Consider in child <5 presenting with mass in abdomen (occurs 2-5 years old) Unilateral, painless, abdominal/flank mass Abdominal pain/distension Haematuria Lethargy Fever Hypertension Weight loss

Answer 18

USS abdomen with doppler - visualise kidney CT/MRI - staging of tumour Biopsy to identify histology required for definitive diagnosis

Answer 19

Surgical excision of tumour + nephrectomy Adjuvant treatment depends on staging + histology: chemotherapy, or radiotherapy

Answer 20

Majority are autosomal dominant

Answer 21

Short stature Broad forehead Downward sloping eyes with ptosis Hypertelorism (wide space between eyes) Prominent nasolabial folds Low set ears Webbed neck Widely spaced nipples

Answer 22

Congenital heart disease - especially pulmonary valve stenosis, hypertrophic cardiomyopathy + ASD Cryptoorchidism (normal fertility in women) LD Bleeding disorders Lymphoedema increased risk of leukaemia + neuroblastoma

Answer 23

Delayed onset of puberty is main presenting features e.g. small penis, reduced testicle size, no facial or body hair in males Anosmia Poor balance Learning difficulties

Answer 24

Male with additional X chromosome --> 47XXY Can have even more X chromosomes --> more severe features

Answer 25

Appear as normal males until puberty At puberty --> Taller height Wider hips Gynaecomastia Weaker muscles Small testicles Reduced libido Shyness Infertility Subtle LD (speech + language in particular)

Answer 26

Testosterone injections Advanced IVF may allow fertility Breast reduction surgery MDT e.g. SALT, OT, Physio for muscle weakness, educational support

Answer 27

Premature rupture of membranes Preterm delivery Maternal fever during labour Chorioamnionitis Siblings had previous GBS infection Maternal age <20 years hHeavy maternal colonisation (bacteriuria)

Answer 28

Benzylpenicillin/ampicillin + gentamicin If >1 month old --> cefotaxime or ceftriaxone instead 14-21 days of treatment if meningitis, 10 days otherwise Vancomycin + gentamicin if penicillin allergy

Answer 29

Retinal haemorrhages Subdural haematoma Encephalopathy

Answer 30

Pale, mottled, ashen or blue

Answer 31

No response to social cues Appears ill to professional Does not wake, or, if roused, des not stay awae Weak, high-pitched or continuous cry

Answer 32

Grunting Tachypnoea: RR >60 in any age Moderate or severe chest indrawing

Answer 33

Reduced skin turgor

Answer 34

Age <3 months, with temperature >/= 38 Non-blanching rash Bulging fonatanelle Neck stiffness Status epilepticus Focal neurological signs/seizures

Answer 35

6-12 months >50 breaths per minute >12 months >40 breaths per minute

Answer 36

<12 months >160bpm 12-24 months >150bpm 2-5 years >140 bpm

Answer 37

Type II hypersensitivity reaction Antibodies target + destroy platelets Key differential of a non-blanching rash

Answer 38

Usually presents in children <10 History of recent viral ilness common 24-48 hour onset of symptoms Bleeding e.g. gums, epistaxis, menorrhagia Bruising Petechial or purpuric rash

Answer 39

FBC --> low plately count, other values should be normmal Blood film Bone marrow examination if there are atypical features

Answer 40

Usually no treatment required - tends to resolve within 6 months Avoid activites that may result in trauma If platelets <10, or active bleeding --> - Prednisolone (commenced by a specialist) - IVIG - Blood transfusion if required - Platelet transfusion (only works temporarily) Avoid NSAIDs, aspirin and contact sports Splenectomy required if life-threatening bleeding, or ITP with severe symptoms for 12-24 months

Answer 41

Congenital condition of narrowing/absence of section of bile duct --> cholestasis

Answer 42

Typically presents in first few weeks of life Significant jaundice (high conjugated bilirubin) Growth + feeding disturbance Hepatomegaly with raised liver transaminases (GGT>others) Dark urine + pale stools

Answer 43

Surgery May require full liver transplantation Antibiotic coverage + bile acid enhancers following surgery

Answer 44

Ureters displaced laterally --> enter bladder more perpendicular Shortened intramural course of the ureter Vesicoureteric junction cannot therefore function adequately

Answer 45

Antenatally: hydronephrosis on USS Recurrent childhood UTIs Reflux nephropathy - Chronic pyelonephritis secondary to VUR (commonest cause) - May have hypertension (increased renin due to renal scarring)

Answer 46

Micturating cystourethrogram DMSA scan may be used to look for renal scarring

Answer 47

Hypoalbuminaemia High urinary protein Oedema

Answer 48

Commonly aged 2-5 years old Frothy urine Generalised oedema Pallor High blood pressure Deranged lipid profile: high cholesterol, triglycerides + LDLs Hypercoagulability

Answer 49

Most common in children = minimal change disease Intrinsic kidney disease - Focal segmental glomerulosclerosis - Membranoproliferative glomerulonephritis Systemic illness - Henoch schonlein purpura - Diabetes - Infection e.g. HIV, hepatitis, and malaria

Answer 50

Renal biopsy + microscopy --> usually shows no change Urinalysis: small molecular weight proteins, hyaline casts

Answer 51

High dose steroids (80% steroid sensitive) If steroid resistant: ACEi and immunosuppressants Low salt diet Diuretics may be used for oedema Albumin infusions may be required Antibiotic prophylaxis in severe cases

Answer 52

Hypovolaemia Thrombosis Infection Acute/chronic renal failure Relapse Hypercholesterolaemia

Answer 53

Infertility Testicular torsion Testicular cancer

Answer 54

FHx of undescended testes Low birth weight Small for gestational age Prematurity Maternal smoking during pregnancy

Answer 55

Referral considered around 3 months of age Baby should see urological surgeon by 6 months Orchidopexy carried out 6-12 months of age

Answer 56

Congenital defect in the anterior abdominal wall, just lateral to the umbilical cord No peritoneal covering of the abdominal contents exists

Answer 57

Operate on as soon as possible In the meantime, cover the bowel with cling-film TPN may be required whilst intestinal function recovers

Answer 58

Abdominal contents protrude through the anterior abdominal wall, however, they are covered in an amniotic sac formed by amniotic membrane and peritoneum

Answer 59

Beckwith-Wiedemann syndrome Down's syndrome Cardiac + Kidney malformations

Answer 60

C-section indicated to reduce risk of sac rupture Maybe repaired quickly, but a staged repair is generally preferred - gradual closure allows pulmonary system to adapt to increased abdominal contents over 6-12 months

Answer 61

X-linked (unclear dominant or recessive) Caused by mutation in the fragile X mental retardation 1 gene (FMR1) on the X chromosome Trinucleotide repeat disorder Males always affected Females can vary in how much they are affected

Answer 62

Usually presents with delay in speech + language development Intellectual disability Long, narrow face Large ears Large testicles after puberty Hypermobile joint (esp. hands) ADHD Autism Seizures

Answer 63

Mitral valve prolapse

Answer 64

Upper GI contrast study USS

Answer 65

1st line = SABA e.g. salbutamol, or anticholinergic via a spacer Next step = intermittemt LTRA (montelukast), intermittent inhaled corticosteroids, or both

Answer 66

Most common cause of nappy rash Due to irritant effect of urinary ammonia + faeces Creases spared Erythematous rash

Answer 67

Erythematous rash Involves flexures Characteristic satellite lesions

Answer 68

Erythematous rash With flakes May have coexistent scalp rash

Answer 69

Disposable nappies > towel nappies Expose napkin area to air when possible Barrier cream e.g. zinc + castor oil Mild steroid cream in severe cases Topical imidazole if candidal nappy rash (apply barrier cream until candida has settled)

Answer 70

<3 stools per week (but can vary with what is normal for the child) Hard, difficult to pass stools Rabbit dropping stools Straining + painful passage Abdominal pain Retentive posutring Rectal bleeding (hard stools) Faecal impaction --> overflow soiling Hard stools may be palpable Loss of sensation of need to open bowels

Answer 71

Habitually not opening bowels Low fibre diet Poor fluid intake + dehydration Sedentary lifestyle Psychsocial probelms at home or school etc

Answer 72

Hirschsprung's disease Cystic fibrosis Hypothryoidism Spinal cord lesions Sexual abuse Intestinal obstruction Anal stenosis Cow's milk intolerance

Answer 73

Not passing meconium within 48 hours of birth --> cystic fibrosis, or Hirschsprung's disease Neurological signs or symptoms, esp in lower limbs --> cerebral palsy, spinal cord lesion Vomiting --> obstruction, or Hirschsprung's Ribbon stool --> anal stenosis Abnormal anus --> anal stenosis, IBD, sexual abuse Failure to thrive --> coeliac disease, hypothyroidism or safeguarding Acute severe abdo pain + bloating --> obstruction, intussusception

Answer 74

Lifestyle + reversal of contributing factors - high fibre diet + good hydration Laxatives - Movicol on increasing dose first - Add stimulant laxative e.g. senna, if no response - Substitute stimulant if Movicol is not tolerated. Add another laxative e.g. lactulose or docusate if stools are hard - Continue medication at maintenance dose for several weeks after regular bowel habit established, then reduce dose gradually

Answer 75

Depigmented 'ash-leaf' spots - fluoresce under UV light Roughened patches of skin over lumbar spine (Shagreen patches) Adenoma sebaceum (angiofibromas): butterfly distribution over nose Fibromata beneath nails Cafe-au-lait spots may be seen

Answer 76

Developmental delay Epilepsy Intellectual impairment

Answer 77

Retinal hamartomas Rhabdomyomas of the heart Gliomatous changes can occur in brain lesions Polycystic kidneys, renal angiomyolipomata Lymphangioleiomyomatosis

Answer 78

1st line for children >6 months = mebendazole Single dose given, alongside hygiene advice Recommended to treat whole houshold

Answer 79

Commonest cause of respiratory distress in term infants Caused by delay in resorption of lung liquid More common after birth by Caesarean section

Answer 80

Fluid in horizontal fissure Hyperinflated lung fields

Answer 81

Usually settles within the first day of life Supportive care - additional oxygen may be needed

Answer 82

Anything leading to asphyxia to the brain: - Maternal shock - Intrapartum haemorrhage - Prolapsed cord --> cord compression - Nuchal cord (wrappe around neck of the baby)

Answer 83

When there are events that could lead to hypoxia during perinatal or intrapartum period Acidosis (pH <7) on umbilical artery blood gas Poor Apgar scores Features of HIE or evidence of multi organ failure

Answer 84

Poor feeding, general irritability + hyper-alert Resolves within 24 hours Normal prognosis

Answer 85

Poor feeding, lethargic, hypotonic + seizures Can take weeks to resole Up to 40% develop cerebral palsy

Answer 86

Reduced consciousness, apnoeas, flaccid + reduced or absent reflexes Up to 50% mortality Up to 90% develop cerebral palsy

Answer 87

Supportive care Therapeutic hypothermia - in certain circumstances, may protect brain from hypoxic injury

Answer 88

Trisomy 13

Answer 89

Dysmorphic features Rocker bottom feet (convex soles of feet) Learning disability Microcephaly Small eyes Cleft lip/palate Polydactyly

Answer 90

Aqueductal stenosis --> insufficient drainage of CSF Arachnoid cysts (block outflow) Arnold-Chiari malformation: cerebellum herniates downards through foramen magnum --> prevents outflow Chromosomal abnormalities + congenital malformations

Answer 91

Enlarged + rapidly increased head circumference (as skull expands) Bulging anterior fontanelle Poor feeding + vomiting Poor tone Sleepiness

Answer 92

Ventriculoperitoneal shunt Complications include: - Infection - Blockage - Excessive drainage - Intraventricular haemorrhage - Outgrowing them (typically need replacing every 2 years as the child grows)

Answer 93

Routinely at 1 and 5 minutes of age If score <5 at 5 minutes --> repeat at 10, 15 and 30 minutes and consider umbilical cord blood gas sampling

Answer 94

0-3 = very low 4-6 = moderately low 7-10 = suggests baby is in a good state

Answer 95

A-ppearance --> colour P-ulse --> heart rate G-rimace --> reflex irritability A-ctivity --> muscle tone R-espiration --> respiratory function

Answer 96

Appear during first few weeks of life Blue or pink macules or patches Then enter proliferative phase --> may become elevated above surrounding skin surfaces

Answer 97

Nose Mouth Eyes Airway Places they may easily get knocked and bleed

Answer 98

Beta-blockers --> regression/prevents further growth Tend to involute by around 18 months of age (may leave tissue paper scar)

Answer 99

Female Premature Low birth weight Multiple birth e.g. twins, triplets, quadruplets White ethnicity Advanced maternal age

Answer 100

Present from birth Persistent purple or dark red birth mark Generally appears on face and neck Grows with the infant Due to vascular malformation of capillaries in the dermis

Answer 101

No treatment required (unless on the eye) Can have laser therapy

Answer 102

Occur mainly in Asian/African chilldren Blue-grey macules Usually lumbrosacral Asymptomatic

Answer 103

FEVER in past 24 hours = 1 Purulent tonsils = 1 Attend rapidly (<3 days) = 1 Inflamed tonsils = 1 No cough or coryza = 1

Answer 104

Likelihood of streptococcal pharyngitis Score 4-5 --> consider immediate antibiotics (phenoxymethylpenicillin) if severe, or 48 hour short back-up prescription 2-3 --> delayed antibiotic prescription (3-5 days or worsening symptoms) 0-1 --> no antibitics

Answer 105

Streptococcus pneumoniae (commonest for rhino-sinusitis and tonsillitis as well) Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus

Answer 106

Ear pain Reduced hearing in affect ear Symptoms of upper airway infection e.g. fever, cough, coryzal symptoms, sore throat, malaise Can cause balance issues/vertigo Discharge from ear if membrane is perforated

Answer 107

Bulging, red, inflamed looking tympanic membrane Discharge may be visible if there is a perforation

Answer 108

Referral to specialist + consder admission if temperature >38 (0-3 months) or 39 (3-6 months) Most cases resolve without antibiotics - Consider if significant co-morbidities, systemically unwell or immunocompromised - Give if <2 years with bilateral otitis media, or if have discharge - Delayed prescriptions - Amoxicillin for 5 days Analgesia

Answer 109

Recurrent acute otitis media Age Learning difficulties Immunocompromised Anatomical abnormalities e.g. incomplete pneumatisation of the mastoid process, cholesteatoma

Answer 110

Parental smoking Atopy Formula-fed Nursery/day-care Socio-economic deprivation Family history

Answer 111

Recent episode of acute/recurrent otitis media Proptosed auricle Post-auricular swelling Post-auricular erythema Post-auricular tenderness In young children, may have ear-pulling and non-specific symptoms of systemic upset

Answer 112

Ear swab if discharging ear or oozing abscess --> MC+S Blood tests: raised inflammatory markers incl WCC + CRP CT head and mastoid with contrast MRI head - helpful in suspected complicated mastoiditis

Answer 113

Admit Intravenous antibiotics - most likely co-amoxiclav + ceftriaxone (oral switch if recovering + pyrexia settled) Surgical intervention - Failing to improve clinically after 48 hours - Continuing pyrexia, malaise - Persistent erythema or soft tissue swelling - Complications of mastoiditis

Answer 114

Extracranial - Facial nerve palsy - Hearing loss - Labyrinthitis - Subperiosteal abscess - Cranial osteomyelitis Intracranial - Intracranial infections - Dural sinus thrombosis

Answer 115

Trisomy 18

Answer 116

Unusually large uterus Unusually small placenta Polyhydramnios (likely secondary to renal dysfunction in the child)

Answer 117

Congenital heart disease - VSD, PDA, ASV Horseshoe kidneys

Answer 118

Small jaw (micrognathia) Low ears Rocker-bottom feet Overlapping fingers Prominent occiput Severe mental retardation

Answer 119

Radial Humeral Femoral

Answer 120

Distal radial Elbow Clavicular Tibial

Answer 121

Prematurity Male sex Family history

Answer 122

Groin swelling Inguinal/inguino-scrotal mass that you cannot 'get above' Reducible mass when lying flat Does not transilluminate Positive cough reflex 70% are right-sided, 10% bilateral Nausea, vomiting, constipation, abdo pain/discomfort --> indicate obstruction or strangulation Irreducible + tender if strangulated

Answer 123

Hydrocele - can get above, transilluminates, non-tender Varicocele - scrotal heaviness, non-tender, 'bag-of-worms' on palpation

Answer 124

Surgical repair - performed on all full-term male infants Emergency surgery if irreducible --> prevent bowel + testicular ischaemia <6 weeks old = correct within 2 days <6 months = within 2 weeks <6 years = within 2 months

Answer 125

Accounts for 80% of childhood leukaemias Peak incidence 1-5 years Boys>girls (slightly) Most common malignancy affecting children No strong family correlation, but some genetic disorders (Down's syndrome) increase the likelihood

Answer 126

Bone marrow failure --> - Anaemi: lethargy + pallor - Neutropenia: frequent/severe infections - Thrombocytopenia: easy bruising, petechiae Bone pain (bone marrow infiltration) Splenomegaly Hepatomegaly Lymphadenopathy Fever present in upt o 50% of new cases Testicular swelling

Answer 127

B-cell lineage (85% cases) T-cell lineage (10-15%) Rare cases of NK cell lineage

Answer 128

Rhesus haemolytic disease ABO haemolytic disease Hereditary spherocytosis Glucose-6-phosphodehydrogenase

Answer 129

Biliary atresia Hypothyroidism Galactosaemia Urinary tract infection Breast milk jaundice Prematurity Congenital infections e.g. CMV, toxoplasmosis

Answer 130

Prematurity Male sex Diabetic mother Caesarean section Second born of premature twins

Answer 131

Non-progressive, permanent neurological disorder of abnormal movement and posture

Answer 132

80% antenatal causes Gene deletions Antenatal infecton Vascular occlusion - may need to screen for haematological disorders to exclude an antenatal/post-natal stroke Failure of cortical migration Trauma during pregnancy Multiple gestation Chorioamnionitis Maternal TORCH infections (toxoplasmosis, rubella, CMV, heres simplex)

Answer 133

Pre-term birth (periventricular leukomalacia) Low birth weight Birth asphyxia (hypoxic-ischaemic birth injury) Neonatal sepsis

Answer 134

Meningitis Severe hyperbilirubinaemi (neonatal jaundice) Head injury Encephalitis/encephalopathy Hypoglycaemia

Answer 135

Hypertonia Reduced function Resulting from damage to upper motor neurones Can be hemiplegic, diplegic or quadriplegic Also known as pyramidal CP

Answer 136

Athetoid movements Oro-motor problems Caused by damage to basal ganglia and substantia nigra Hypertonia + hypotonia Also known as athetoid or extrapyramidal CP

Answer 137

Caused by damage to the cerebellum with typical cerebellar signs --> problems with coordinated movement

Answer 138

Mix of spastic, dysinetic and/or ataxic features

Answer 139

Failure to meet milestones - especially motor Increased or decreased tone - can be general, or in specific limbs Hand preference <18 months Problems with coordination, speech or walking Feeding or swallowing problems Abnormal gait

Answer 140

Learning difficulties Epilepsy Squints Hearing impairment Visual impairment Gastro-oesophageal reflux Kyphoscoliosis Muscle contractures

Answer 141

MDT approach Treatment for spasticity e.g. oral diazepam, oral + intrathecal baclofen, botulinum toxin type A, orthopaedic surgery, selective dorsal rhizotomy Anticonvulsants + analgesia as required Glycopyrronium bromide for excessive drooling

Answer 142

In true precocious puberty, the course of puberty sill occurs in a normal synchronous manner --> suggests hypothalamic-pituitary axis intact In pseudo precocious puberty, puberty occurs in abnormal manner e.g. axillary + pubic hair in girls, with growth spurt but no breast budding, or prepubertal sized testicles with other signs of puberty in boys

Answer 143

Idiopathic = 80-90% Intracranial pathology e.g. tumours, haemorrhage, hydrocephalus, neurofibromatosis, cerebral palsy, primary hypothyroidism Less common in boys --> more likely to be central cause

Answer 144

Gonadotrophin-independent, and usually extra-cranial Adrenal virilising tumours Congenital adrenal hyperplasia Cushing syndrome Testicular or ovarian malignancy Gonadotrophin-secreting tumours e.g. hepatoblastoma

Answer 145

Conners' rating scale Strengths + Difficulties Questionnaire

Answer 146

At least 6 months Persistent pattern of inattention and/or hyperactivity-impulsivity Has a direct negative imapct on academic, occupational or social functioning

Answer 147

6+ symptoms for children up to 16, 5+ for adolescents/adults aged 17+ Present for at least 6 months, and inappropriatre for developmental level Fails to give close attention to details/makes careless mistakes Trouble holding attention on activities Does not seem to listen when spoken to directly Does not follow through on instructions + fails to finish tasks e.g. loses focus/side-tracked Trouble organising tasks and activities Avoids/dislikes/reluctant to do tasks requiring mental effort over a long period of time Loses things necessary for tasks + activities Easily distracted Forgetful in daily activities

Answer 148

6+ symptoms for children up to 16, 5+ for adolescents/adults aged 17+ Present for at least 6 months, and inappropriatre for developmental level Fidgets with/taps hands or feet, squirms in seat Leaves seat in situations when remaining seated is expected Runs about or climbs where it is not appropriate (or feels restless) Unable to take part in activities quietly Often 'on the go' acting as if 'driven by a motor' Talks excessively Blurts out an answer before a question has been completed Trouble waiting their turn Interrupts or intrudes on others

Answer 149

Several inattentive or hyperactive-impulsive symptoms present <12 years of age Present in two or more settings Clear evidence of interfering with functioning Symptoms not explained by another mental disorder/do not happen only during course of another disorder

Answer 150

Healthy diet + exercise (find links between certain foods and behaviour using food diary) Environmental modifications Training programmes for person/their parents/carers Consider medication in certain groups (not in children <5 without a second specialist opinion)

Answer 151

1st line = Methylphenidate 2nd line = lisdexamfetamine (used if 6-week trial of methylphenidate at adequate dose has not led to enough benefi) 3rd line = dexamfetamine (used if symptoms responding to lisdexamfetamine but unable to tolerate the longer effect profile) Atomeoxetine or guanfacine given if cannot tolerate 1st/2nd line, or symptoms not responding to separate 6 week trials

Answer 152

BP: normal --> hypotension HR: tachycardia --> bradycardia Respiration: tachypnoea --> acidotic (Kussmaul) Extremities: pale/mottled --> blue Urine output: reduced --> absent

Answer 153

Pale + cold extremities Prolonged capillary refill time

Answer 154

First 28 days of life Early neonate = first week of life (relevant for death classification)

Answer 155

Fatigue Joint pain Weakness of proximal muscles Malar rash Heliotrope rash over eyelids

Answer 156

Raised ESR Raised CK MRI scans --> muscle oedema Muscle biopsies Nailfold capillaroscopy --> microangiopathy

Answer 157

Steroids during acute flares Steroid-sparing immunosuppression for maintenance

Answer 158

X-linked recessive inherited disorder in the dystrophin genes

Answer 159

Progressive proximal muscle weakness Calf pseudohypertrophy Gower's sign = child uses arms to stand up from squatted position May have intellectual impairment

Answer 160

Raised creatinine kinas Genetic testing used for diagnosis (previously muscle biopsy)

Answer 161

Most children cannot walk by 12 years old Typical survival is to 25-30 years old Associated with dilated cardiomyopathy

Answer 162

Non-weight bearing = 1 Fever >38.5 = 1 WCC >12 = 1 ESR >40mm/hr = 1 0 = very low risk 1 = 3% chance 2 = 40% chance 3 = 93% chance 4 = 99% chance

Paediatrics II Flashcards

(186 cards)