Paeds Flashcards
(144 cards)
1
Q
what is croup
A
viral laryngotracheobronchitis
stridor caused by laryngeal oedema and secretions
2
Q
which organisms cause croup
A
parainfluenza viruses
3
Q
when is croup more common
A
autumn
4
Q
what are the symptoms/signs of croup
A
stridor
barking cough
fever
coryzal symptoms
5
Q
how is croup diagnosed
A
clinically
6
Q
what might you see on cxr of croup
A
PA view shows subglottic narrowing (steeple sign)
7
Q
what treatment for croup
A
oral dex 0.15mg/kg
admit if stridor at rest
8
Q
what emergency treatment for croup
A
high flow o2
nebulised adrenaline
9
Q
what causes epiglottitis
A
haemophilus influenzae type b
10
Q
what are symptoms of epiglottitis
A
fever
stridor
drooling
tripod position
11
Q
how is epiglottitis diagnosed
A
- clinical by trained airway staff
12
Q
what sign on epiglottitis xray
A
lateral view - thumb sign - swelling of epiglottis
13
Q
what management of epiglottitis
A
immediate senior involvement
endotracheal intubation may be necessary to secure airway
oxygen
cefotaxime IV
14
Q
what type of vasculitis is kawasaki
A
medium vessel
15
Q
what are symptoms of kawasaki
A
- fever resistant to antipyretics
- cervical lymphadenopathy
- conjunctival injection
- bright red cracked lips
- strawberry tongue
- palmar, sole erythema, desquamation
16
Q
how is kawasaki managed
A
high-dose aspirin
IVIg
echocardiogram to screen for coronary artery aneurysm
17
Q
How is duchenne’s transmitted, what gene?
A
x linked recessive inherited disorder of dystrophin genes on xp21
18
Q
what are the symptoms of duchennes
A
- proximal muscle weakness
- calf pseudohypertrophy
- Gower’s sign
- some patients have intellectual impairment
19
Q
what investigations for muscular dystrophies
A
genetic testing (replaced muscle biopsy) creatinine kinase
20
Q
what management for muscular dystrophies
A
supportive
oral steroids can delay progression weakness
creatinine supplements can give some improvement in muscle strength
21
Q
what condition associated with duchenne’s
A
associated with dilated cardiomyopathy
22
Q
how is beckers muscular dystrophy inherited
A
x linked recessive, although dystrophin gene not as severely affected as in duchennes
23
Q
how is beckers different to duchennes and how are they managed
A
symptoms appear later (8+ y) in becker than duchenne
mgmt similar to duchennes
24
Q
what is immune thrombocytopaenic purpura
A
immune mediated reduction in platelet count
25
what are antibodies directed against in ITP and what type of hypersensitivity reaction is this
GP IIb/IIIa or Ib-V-IX complex
type 2 hypersensitivity
26
how does ITP present
usually following viral illness or vaccination
bruising
purpuric rash
bleeding less common (gingival/epistaxis)
27
how is ITP investigated
FBC - isolated thrombocytopaenia
blood film
bone marrow studies only if atypical features such as lymphadenopathy, splenomegaly or if failure to resolve
28
when would bone marrow studies be indicated in ITP and what would they show
lymph node enlargement
splenomegaly
failure to respond to treatment/resolve
megakaryocytes
29
what mgmt of ITP
usually resolves by 6mths
oral/IV steroids
IVIg
platelet transfusion if active haemorrhage
30
explain pathophys of hirschsprung's
aganglionic segment of bowel due to developmental failure of parasympathetic auerbach's and meissner plexuses
uncoordinated peristalsis -> obstruction
31
what is hirschsprung's associated with
down's
| more common in males
32
how would hirschsprungs present
failure to pass meconium by 3 days
constipation, abdo distension
33
how is hirschsprungs diagnosed
AXR
| gold standard: rectal biopsy
34
how is hirschsprung's managed in the immediate setting and definitively
immediate: rectal irrigation to prevent enterocolitis
| definitive - surgical resection of affected segment of bowel
35
what is congenital diaphragmatic hernia
incomplete formation of diaphragm
| herniation of abdominal viscera into thoracic cavity causing pulmonary hypoplasia and hypertension
36
how would congenital diaphragmatic hernia present
respiratory distress
tinkling bowel sounds in thorax
absent heart sounds on left hand side
37
what is best initial mgmt of congenital diaphragmatic hernia
intubate and ventilate
| NG tube to prevent air going into the stomach
38
what is gastroschisis?
congenital defect in anterior abdominal wall just lateral to the umbilicus
39
what is the management of gastroschisis
vaginal delivery
| immediate surgical correction (within 4 hours)
40
what is exomphalos
abdo contents protrude through abdo wall but are covered in amniotic sac covered in amniotic membrane and peritoneum
41
how is exomphalos managed
c-section to decrease chance of rupture
| staged surgical correction
42
what is exomphalos associated with
down's
beckwith wiedemann syndrome
cardiac and renal problems
43
what is gastroschisis associated with
socioeconomic deprivation - smoking, drinking during preg
44
how is candidal nappy rash treated
topical imidazole
45
how do infantile spasms present
flexion of head arms trunk followed by extension of arms
| progressive mental handicap
46
what investigations for infantile spasms
EEG - hypsarrhythmia
| CT - diffuse/localised brain disease eg. tuberous sclerosis
47
how is infantile spasms treated
vigabatrin
| ACTH/pred
48
what is necrotising enterocolitis
disorder affecting prem neonates where a segment of bowel becomes necrotic
49
what RFs for nec
```
very low birth weight
formula feed
respiratory distress/assisted ventilation
sepsis
PDA and congenital heart disease
```
50
how would NEC present
```
bilious vomiting
intolerance to feeds
distended tender abdomen
blood in stools
absent bowel sounds
```
51
how would perforated NEC present
peritonitis and shock, severely unwell neonate
52
what investigations for NEC
AXR
| bloods - FBC, CBG, blood cultures, CRP
53
what would AXR show in NEC
- dilated loops of bowel
- gas in the bowel wall (pneumatosis intestinalis)
- bowel wall oedema
- gas in the peritoneal cavity if perforated (pneumoperitoneum)
- gas in portal veins
54
how is NEC managed
- NBM, IV fluids, total parenteral nutrition
- antibiotics
- immediate referral to neonatal surgical team for:
- surgical removal of necrotic bowel
55
what would CBG of NEC show
metabolic acidosis
56
what is pityriasis versicolour (aka tinea versicolour)
superficial cutaneous fungal infection caused by malassezia furfur
57
how does pityriasis versicolour present
affects trunks
hypopigmented/pink/brown lesions
scaly
mild pruritus
58
what are RFs for pityriasis versicolour
- immunosuppression
- cushing's disease
- malnutrition
59
what treatment for pityriasis versicolour
topical ketoconazole
| if persistent - oral itraconazole
60
what is pityriasis rosea
acute self-limiting rash affecting young adults
| thought to be linked to HHV-7 (herpes hominis)
61
how does pityriasis rosea present
- some prodromal viral illness
- herald patch on trunk
- followed by erythematous oval scaly patch in fir tree distribution
62
how is pityriasis rosea treated
self-limiting within 6-12 weeks
63
what are RFs for developing epilepsy following febrile convulsions
- family history of epilepsy
- complex febrile seizures
- background of neurodevelopmental disorder
64
what is biliary atresia
atresia/occlusion of biliary ducts
65
how does biliary atresia present
- obstructive jaundice after 2 weeks
- dark urine and pale stool
- appetite and growth disturbance
66
what signs would you find on examination of biliary atresia
- hepatosplenomegaly
- jaundice
- abnormal growth
- cardiac murmurs (associated with cardiac abnormalities)
67
what investigations for biliary atresia
- serum bilirubin - total bilirubin may be normal, but conjugated is VERY HIGH
- LFTs cannot differentiate between causes of jaundice
68
what management of biliary atresia
surgical - kasai portoenterostomy
| or liver transplant
69
what complications of biliary atresia
cirrhosis
portal hypertension
liver failure
70
why does biliary atresia not cause kernicterus
liver is still able to conjugate bilirubin. conjugated bilirubin is unable to cross BBB
71
what vitamin deficiencies are associated with biliary atresia and how would this present
ADEK, fat soluble vitamins
failure to thrive
bleeding
72
what is osteomalacia
softening of bones secondary to vit D deficiency
73
which organism causes measles
RNA paramyxovirus
74
what are the symptoms of measles
prodromal:
- fever
- irritability
- conjunctivitis
- koplik spots
- rash - macpap starts behind ears and spreads, becomes confluent
- some desquamation sparing palms and soles
10% get diarrhoea
75
what are the complications of measles
```
otitis media
pneumonia
encephalitis
subacute sclerosing panencephalitis
corneal ulceration/keratoconjunctivitis
diarrhoea
increased incidence of appendicitis
myocarditis
```
76
what investigation for measles
IgM antibodies
77
what mgmt for measles
supportive
| if preg/immunosuppressed admit
78
what mgmt for measles contacts
MMR vax within 72 hours (vax immunity develops faster than natural immunity)
79
what causes mumps
RNA paramyxovirus
80
what symptoms of mumps
- fever
- malaise/muscle aches
- parotitis - ear pain, pain on eating. unilateral -> bilateral
81
what complications of mumps
- orchitis
- hearing loss (unilateral, transient)
- meningoencephalitis
- panencephalitis
- pancreatitis
82
what treatment for mumps
supportive, PHE notification
83
when is mumps infectious
7 days before parotitis and 9 days after
84
how is mumps spread
droplets
respiratory tract epithelial cells -> parotid cells -> other tissues
85
what topical Abx if resistance suspected for impetigo
mupirocin
oral fluclox/erythromycin if systemic infection
86
what is bullous impetigo
- caused by staph aureus bacteria releasing epidermolytic toxins causing vesicles to form
vesicles burst and release exudate forming golden crust without scarring
87
what is staphylococcus scalded skin syndrome
extensive bullous impetigo
88
what treatment for bullous impetigo/staph scalded skin syndrome
oral/IV fluclox
89
what complications of impetigo if caused by strep pyogenes
post-streptococcal glomerulonephritis
| scarlet fever
90
what causes rubella
togavirus
91
what are the symptoms of rubella
fever
macpap rash starts on face and spreads
lymphadenopathy - suboccipital and post-auricular
92
what are the complications of rubella
arthritis
thrombocytopaenia
encephalitis
myocarditis
93
what are the features of congenital rubella syndrome
- sensorineural deafness
- congenital heart disease eg PDA
- congenital cataracts
- salt and pepper chorioretinopathy
- micropthalmia
- purpuric skin lesions
- cerebral palsy
- growth retardation
- hepatosplenomegaly
94
how should cases of rubella in preg be managed
discuss with local health protection unit
avoid contact with other pregnant women
offer MMR vaccine post-natally
95
what causes chickenpox
varicella zoster virus
96
how is chickenpox spread
respiratory
97
how does chickenpox present
fever
itchy rash - mac then pap then vesicular
mild systemic upset (fatigue, malaise)
98
how is chickenpox managed
trim nails, keep cool
| calamine lotion/chlorphenamine for itching
99
how is chickenpox isolated?
until all lesions have dried and crusted over, usually about 5 days from onset of rash
100
what are the complications of chickenpox
- secondary bacterial infection
- group A strep -> necrotising fasciitis
- pneumonia
- encephalitis - ataxia
- disseminated haemorrhagic chickenpox
- pancreatitis
- arthritis
- nephritis
- conjunctival lesions
101
how does chickenpox encephalitis present
ataxia
102
where does chickenpox virus lie dormant
sensory dorsal root ganglion and cranial nerves
103
how do you manage chickenpox exposure in preg
check blood urgently for varicella antibodies
if none
<20 weeks - VZIG immediately
>20 weeks - aciclovir 10-14 days post exposure
104
how do you manage confirmed chickenpox in preg
seek specialist advice
| if rash - acyclovir. use with caution in <20 weeks
105
how does fetal varicella syndrome present
```
skin scarring
microcephaly
micropthalmia
limb hypoplasia
learning difficulties
```
106
what are the complications of maternal chickenpox exposure
fetal varicella syndrome
severe neonatal varicella
neonatal shingles
107
who is vaccinated against whooping cough and when
children and pregnant women 16-32 weeks
108
how does whooping cough present
```
fever
cough lasting 14+ days
cough, worse at night, paroxysmal cough
inspiratory whoop
post-tussive vomiting
apnoeic attacks in young infants
```
109
how is pertussis diagnosed
nasal swab with PCR/bacterial culture
110
how is pertussis managed
- if under 6m, admit
- notifiable disease
- macrolide if <21 days (clarithromycin, erythromycin in preg)
111
which antibiotics for pertussis in normal/preg
clarithromycin
erythromycin if preg
co-trimoxazole
112
what are the complications of whooping cough
- bronchiectasis
- subconjunctival haemorrhages
- pneumonia
- seizures
- pneumothorax
113
how should household contacts of pertussis be managed
```
prophylactic antibiotics (clari/erythromycin)
offer pertussis vaccine
```
114
how long exclusion for whooping cough
21 days from onset of cough
| 48 hours after starting Abx
115
what are the causes of cerebral palsy
antenatal:
- maternal infections
- trauma in pregnancy
perinatal
- birth asphyxiation
- pre-term birth
postnatal:
- meningitis
- head injury
- severe neonatal jaundice
116
what are the different types of cerebral palsy
spastic (UMN damage)
dyskinetic (basal ganglia damage)
ataxic (cerebellar damage)
mixed
117
what symptoms of spastic cerebral palsy
spasticity, UMN signs - hyperreflexia, hypertonia, power same or reduced
118
what symptoms of dyskinetic cerebral palsy?
athetoid movements
problems controlling muscle tone (hyper and hypotonia)
oro-motor problems
119
what symptoms of ataxic cerebral palsy?
problems with coordinated movement and cerebellar signs
120
what is extrapyramidal cerebral palsy?
another word for dyskinetic cerebral palsy
| so is athetoid cerebral palsy
121
how is cerebral palsy managed
multi-disciplinary team approach
- baclofen PO/ intrathecal for spasticity
- botox for spasticity
- selective dorsal rhizotomy for spasticity
- tenotomy for contractures
- glycopyrrhonium for secretions
- antiepileptics for seizures
122
what treatment for hypoxic-ischaemic encephalopathy (HIE)
therapeutic cooling to target of 33-34, rectal temp probe
| follow up by paediatrician and MDT
123
what can cause HIE?
- maternal shock
- intrapartum haemorrhage
- cord prolapse
- nuchal cord
124
what are the symptoms/signs of HIE?
mild:
- irritabilty
- hyper-alert
- poor feeding
moderate:
- poor feeding
- hypotonic
- seizures
- lethargic
severe:
- flaccid, reduced/absent reflexes
- reduced consciousness
- apnoeas
125
what management of GORD in infancy
advise re: positioning, burping after feeds, sleep on back
trial of feed thickeners
alginates, but not alongside thickeners
PPI
126
what causes of neonatal jaundice in first 24 hours
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- G6PD deficiency
- sepsis
- TORCH
Toxoplasmosis
CMV
Rubella
Syphillis
Hepatitis
Herpes
127
what causes of neonatal jaundice 24h-14 days
physiological, haemolysis of fetal RBC
breast milk jaundice
breastfeeding jaundice
infection
128
what causes of neonatal jaundice after 14 days
unconjugated - hypothyroidism, infection - UTI
| conjugated - biliary atresia/neonatal hepatitis
129
what causes kernicterus
high levels of unconjugated bilirubin cross BBB, depositing in the deep grey matter of brain and in basal ganglia causing encephalopathy
130
what are some possible features of chronic kernicterus
```
cerebral palsy
sensorineural hearing loss
gaze palsy
learning difficulties
death
```
131
how would acute kernicterus present
```
lethargy
irritability
abnormal muscle tone/posture
convulsions
apnoeic episodes
```
132
what is physiological jaundice
fetal RBC have shorter lifespan than adult FBC (70 days vs 120)
increased RBC breakdown increases circulating bilirubin
hepatic bilirubin metabolism is less efficient in first few days of life
jaundice
133
what is breast milk jaundice
not fully understood, thought to be due to levels of beta-glucoronidase in breast milk, blocking UGT, decreased metabolism of bilirubin causing jaundice
134
what is breastfeeding jaundice
poor feeding, presents alongside dehydration
| poor feeding causes reduced bilirubin excretion, increases enterohepatic circulation, more bilirubin enters system
135
what is crigler-najjar
Congenital unconjugated hyperbilirubinaemia
no UGT enzyme activity
no conjugation of bilirubin
causes kernicterus and d
136
what is gilbert syndrome
autosomal recessive condition causing defective conjugation of bilirubin
unconjugated hyperbilirubinaemia (not in urine)
presents with jaundice in fasting/illness/exercise
no treatment necessary
137
what is g6pd deficiency
x-linked recessive g6pd deficiency
| causing increased oxidative stress and intravascular haemolysis
138
what triggers in g6pd
fava beans
sulfa drugs, ciprofloxacin
anti-malarials
infections
139
what is associated with g6pd
splenomegaly
| gallstones
140
what investigations for g6pd
blood film - heinz bodies, bite and blister cells
| g6pd enzyme assay
141
what investigations for neonatal jaundice
FBC and blood film
conjugated bilirubin
blood type testing of mother and baby for ABO/Rh incompatibility
direct coomb's test (direct antiglobulin for haemolysis)
TFT
blood cultures and urine dip
G6PD enzyme assay
142
which brain haemorrhage is most common in prem infants and not associated with NAI
intraventricular haemorrhage
143
what mgmt for neonatal jaundice
dxfjkhs
144
what is tof
```
PROV
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect
```
