Paeds Flashcards

Question

Coeliac * what is it * symptoms * investigations * treatment

Answer 1

* T-cell mediated autoimmune disease due to chronic immune reaction to gluten * Risk factor - DQ2 or DQ8 HLA alleles, family Hx * Symptoms - diarrhoea, malabsorption, weight loss, failure to thrive, steattorhoea, abdominal pain, iron deficiency anaemia, bloating * Inv - Tiddue Transglutimase, Gluten challenge, Endoscopic findings in small bowel - villous blunting, elongated crypts, lymphocytes and inflammation * Note: people on a gluten free diet prior to evaluation cannot be differentiated. must be placed back on a diet involving gluten with serological/histological tests assessed after 2-8 weeks * Treatment - gluten free diet

Answer 2

SBO * Duodenal stenosis * Malrotation * Meconium ileus - usually in CF * Meconium plug * annular pancreas LBO * Hirschprung disease * rectal atresia Both * Intussusception * Post-op adhesions * abdominal hernia

Answer 3

* billious vomit (unless obstruction aboce ampulla of vater) * delayed/ absent passage of meconium, constipation or diarrhoea * abdominal distention * abdominal pain - lethargy, anorexia examination findings * abdominal tenderness * dehydration * bowel sounds * mechanical - high pitched * ileus - absent

Answer 4

* occurs when a section of bowel invaginates into the lumen of the immediately distal bowel resulting in infarction and gangrene of the inner bowel segment * Infants 3-12 months * Symptoms - colicky abdominal pain, flexing of the legs, vomiting, fever, lethargy, blood in stool, red currant jelly stool (late sign) * Signs - RUQ mass, abdo distention, peritonism if ruptures, dehydration * Investigations - abdo U/S best initial test (target sign or doughnut sign), contrast enema (best confirmatory test), can do abdo X-ray to assess for obstruction, perforation. FBC - assess for leukocytosis (peritonism) * Tx - fluid resuscitation, analgesia, NBM, nasogastric decompression * Non-surgical - air enema reduction (unless signs of peritonism or unstable) * Surgical - reduction (shock, failed conservative, peritonism or unstable)

Answer 5

* Inflammation of the veriform appendix usually due to appendiceal luminal obstruction * Symptoms * epigastric pain, intermittent dull pain --\> RLQ, sharp increasing severity and constant * N + V, anorexia * Exam - peritonism, guarding, rigidity, rebound tenderness, diminished bowel sounds on right * causes - obstruction of appendiceal lumen by faeces, infection, lymphoid hyperplasia, neoplasm * investigations - U/S, CT, FBC, CRP, Urinalysis, Pregnancy test * Treatment - NPO, analgesia, fluid resusc, IV ABs (cefazolin + metronidazole), laparoscopic appendectomy

Answer 6

* inflammation of the peritoneum * Symptoms * abdominal pain worse by moving and coughing * rigidity - involuntary contraction of abdo muscles * guarding * rebound tenderness * percussion tenderness * Causes * PID * gastric perforation - ulcer, appendicitis, diverticulitis, cholecystitic * abdominal trauma

Answer 7

Indirect hernia * most common groin hernia * passes throughdeep inguinal ring, follows spermatic cord and may protrude into superficial ring * lateral to inferior epigastric artery Direct hernia * Enters through the fascia transversalis on the posterior wall of inguinal canal in the area known as the Hasselbachs triangle * Medial - rectus abdominus, Lateral - epigastric artery, Inferior - Inguinal ligament * due to weak abdominal wall muscle * more common in elderly * medial to inferior epigastric artery

Answer 8

reducible - hernia can be pushed back with manual pressure irreducible - cannot be pushed back * obstructed - lumen of hernia is obstructed * strangulated - blood uspply to hernia is cut off - ischaemia3

Answer 9

concerning features of neonatal jaundice - appearing before 24 hours of life, or beyond 2 weeks, conjugated jaundice Unconjugated * Haemolytic * Intrinsic - * membrane conditions - spherocytosis, eliptocytosis * enzyme conditions - G6PD * Globin defect - thalassemia, sickle cell * Extrinsic * sepsis, AV malformation, infections- hepatitis, CMV, rubella * Autoimmunity - rhesus disease, other maternal-fetal blood group incompatibility * Non-haemolytic * breastmilk jaundice * gilberts syndrome Conjugated * Hepatic * Post hepatic * biliary atresia * bile duct obstruction

Answer 10

complications * acute bilirubin encephalopathy - hypotonia, poor feeding, high pitched cry * chronic bilirubin encephalopathy (kernicterus) - developmental delay, seizures, sensori-neural deafness, oculomotor dysfunction, cognitive impairment Investigations * if rhesus -ve mother * Serum bilirubin level - repeat after 4-6 houra * FBC * DAT (direct antibody test - coombs) Treatment * Phototherapy - for unconjugated bilirubin to prevent acute bilirubin encephalopathy and kernicterus * If rhesus isoimmunisation --\> IVIG and exchange transfusion

Answer 11

* Diarrhoea, V+V, fever, generally unwell, crampy abdominal pain, dehydration * causes * viral - norovirus, rotovirus * parasitic - emramoeba histolytica, giardia lamblia * bacterial - e.coli, salmonella, shigella, campylobacter jejuni * diagnosis - clinical, can do stool culture * treatment - Fluid and electrolyte replacement, if bacterial can give antibiotics, but usually viral so dont

Answer 12

Oesophageal atresia - congenital condition in which the oesophagus is not fully developed ending in a blinding pouch rather than stomach Tracheo-oesophageal fistula - congenital condition between the oesophagus and trachea Types 1. Type A - pure oeophageal atresia 2. Type B - proximal fistula with atresia 3. Type c - proximal atresia with distal fistula 4. Type D - proximal and distal fistula 5. Type H - fistula without atresia Symptoms * Prenatal - oligohydramnios * Post natal - feeding difficulties, respiratory distress, choking, recurrent RTIs Diagnosis * inability to pass NG tube * barium swallow for H type Treatment * surgical repair *

Answer 13

* birth defect in which nerve are absent in part og the intestine resultingi n functional obstruction (absence of ganglion cells) * Types - typically recto-sigmoid (75%), long segment (25%) * Risk factors - down's syndrome, genetic, male * symptoms - vomiting, abdo distention, delayed passage of meconium, enterocolitis, failure to thrive * investigations - contrast enema, AXR, rectal biopsy (diagnostic) * Tx - NGT, IV fluids, ABs prior to surgery, surgery

Answer 14

Lower UTI = infection of the bladder and the lower urinary tract Cystitis = infection of the bladder Pyelonephritis = infection of the parenchema and collecting system of the kidney

Answer 15

Positive nitrate and leukocyte esterase indicates high likelihood of uti * Cloudy - pyuria * Haematuria + * Leucocytes +++ * Proteinuria + * Nitrites (Nitrates convertet to nitrites with come bacteria (E.coli) * Alkaline (urea splitting organisms)

Answer 16

* \< 3 months --\> IV amoxicillin and gentamycin * \> 3 months * well --\> Augmentin Duo * unwell --\> IV amoxicillin and gentamycin If recurrent UTIs - book a renal U/S

Answer 17

retrograde passage of urine from the bladder to the upper urinary tract Primary = incompetent closure of the uretovesical junction Secondary = results from abnormal high voiding pressure in the bladder that leads to failure of the uterovesical junction

Answer 18

1. Grade 1 = reflux only fills the ureter without dilation 2. Grade 2 =reflux fills the ureter and collecting system without dilation 3. Grade 3 =reflux fills and midly dilates the ureter and collecting system 4. Grade 4 = reflux fills and grossly dilates the ureter and collecting system with blunting of the calices (some totuosity of the ureter is also present) 5. Grade 5 = massive reflux grossly dilates the collecting system. all the calices are blunted with a loss of papillary impression and intrarenal reflux may be present

Answer 19

symptoms = recurrent UTIs Investigations = abdominal U/S (ureteral dilation or hydronephrosis), cystography treatment * Grade I-II = surveillance, antibiotic prophylaxis to prevent UTIs, surgical correction if it doesnt correct by itself * grade III-V antibiotic prophylaxis and surgical correction

Answer 20

Definition: Twisting of the spermatic cord resulting in cutting off the testicular blood supply resulting in ischaemia and gangrene if not resolves. most common in adolescents and neonatal period Symptom: Rapid onset of severe testicular pain, N+V, swelling Examination: Swollen, tender, high riding, abnormal trasverse lie, absent cremaster reflex, Prehn's sign negative \*listing of the testis will not releive pain\* Diagnosis: Clinical - refer straight ot surgeons Treatment: Surgical emergency Complications: 6 hours - 90% saved, 12 hours 50% save, 24 hours 10% saved, \> 24 hours 0%

Answer 21

Symptom: * Orchitis = gradual onset testicular pain, testicular swelling and inflammation, haematuria, haematospermia * Epididymitis = gradual onset scrotal pain, swelling, dysuria, urethral discharge causes = chlamydia or gonorrhoea, UTI Treatment = antibiotics

Answer 22

When one or both testes are not present within the dependent portion of the scrotal sac. (Ascended testes: testes that were previously noted to be in the normal position but later ascended into the high portion of the scrotum or inguinal canal) risk factors: family history, prematurity, low birth weight treatment - surgery at 12-18 months to place testes into the dependant scrotum then requires annual follow up to determine location, viability and ize complications - lack of intervention associated with increased with of testicular cancer and infertility

Answer 23

A hydatid of Morgagni is an embryological remnant found in the upper pole of the testis. torsion of this appendage can occur characteristically in boys just prior to puberty Symptoms: testicular pain, swelling Examination: blue dot may be seen or felt in the testis, reactive hyrocele in 20%, cremaster reflex intact Diagnosis: surgical exploration Treatment: surgical interention to exclude testicular torsion, conservative management otherwise - pain usually resolvesi n a week

Answer 24

Abnormal dilation of the pampiniform plexus and the internal spermatic vein (90% left sided) Examination: bag of worms appearance, not transilluminable, do valsalver manouvre to check grade, check to see that it drains Treatment: usually no treatment, can do surgical repair, also semen analysis if concerned about fertility

Answer 25

Definition: * Usually occurs in children **6/52 post impetigo or 1-2/52 post throat infection** * **Post infection by group A beta-haemolytic strept (GAS)** * **immune complex deposition in glomerulus** Symptoms - haematuria, proteinuria, oliguria Investigations * Anti-streptolysin O test to prove strep infection Treatment: usually supportive, 90% of kids okay, 1/4 adults develop rapidly progressive glomerulonephritis

Answer 26

collection of fluid between the layers of the tunica vaginalis surrounding the testis or along the spermatic cord Symptoms and examination: Scrotal mass, non tender, transillumination, enlarged with increased intraabdominal pressure treatment * \< 2 = observation * \> 2 = surgical repair - ligation of the sac at the inguinal ring

Answer 27

painless fluid filled cyst that occurs in the epididymis, fluid contain spermatozoa Examination - smooth firm lump at top of testis, non tender, transilluminable can request U/S rule out testicular cancer Treatment - nil if small, spermatocelectomy if large

Answer 28

Characterised by: 1. Microangiopahtic haemolytic anaemia 2. Thrombocytopenia 3. Acute Kidney Injury Causes * Infection producing the Shiga-like toxin * enterohaemorrhagic E.coli * Shigella dysenteriae * also strept pneumoniae Symptoms * diarrhoea, preceding pneumonia, bloody diarrhoea, oliguira, haematuria * haemolytic anaemia, thrombocytopenia, AKI Investigations * FBC - decreased RBC, thrombocytopenia * Blood smeear - shistocytes (fragmented RBC indicating thrombotic microangiopathy) * Renal function - raised creatinine * Urinalysis - proteinuria, haematuria * stool culture * coagulation profile Treatment * fluid resus * red cell transfusion if severe

Answer 29

tonic clonic seizure lasting \> 30 minutes or repeated tonic clonic consultation over a 30 minute period with no period of recovery of consciousness between Treatment for seizure Midazolam buccal, IM, IV... Status epilepticus IV, if not IV then try IM then IO Midazolam or diazepam, repeat dose after minutes

Answer 30

benign convulsion in a child between the age of 6 months and 6 years in the setting of acute febrile illness without previous afebrile seizure. Investigations not usually required Treatment: reassurance, anti-convulsant if prolonged. Paracetamol has not been shown to reduce risk of further convulsions.

Answer 31

Causes bacterial * \< 3 months - GBS, strep pneumoniae, neisseria meningitidis * Paediatric = Neisseria meningitidis, streptococcus pneumoniae, HiB * Adult = S. pneumoniae, N meningitidis, HiB viral * enteroviruses,HSV * Parasitic - cryptococcal neoformans, schistosoma symptoms * triad - fever, nick stiffness, headache * Children - irritable, feeding difficulty, rash, N+V, photophobia Examination * rash - petechial or purpura non-blanching (meningococcal meningitis) * nuchal rigidity - passively flex neck * brudzinski sign - spontaneous flexion of hipduring attempt to passively flex neck * kernig sign - inability to allow full extension of knee when hip is flexed at 90 Diagnosis - Lumbar puncture (before ABs) ---\> CSF microscopy, culture, protein, glucose, lactate, NAAT * bacterial - raised neutrophils, lowered/ normal glucose * viral - low neutrophils, lymphocytes high or normal, normal glucose Treatment 1. IV dexamethasone 2. Antibiotics Empirical * \< 1 month - cefotaxime + benzylpenicillin + acyclovir * \> 1 month - ceftriaxone + vancomycin Focused * benzylpenicillin - Neisseria meningitidis * Vanc and cefotaxime for penicillin resistant S. pneumoniae

Answer 32

Umbrella term that refers to a group of disorders that affect movement, tone and posture due to damage to the developing brain during the antenatal or early post-natal period when neuronal connections are still forming Causes * antenatal (75%)- prem, maternal thyroid disease, TORCH infection, teratogen * Perinatal - birth asphyxia (10%), placental abruption, prolonged labour * Postnatal - sepsis, hyperbilirubinaemia, respiratory distress, meningitis, head injury Classificaiton 1. spastic (motor cortex, loss of inhib GABA) - stiff muscles, hyperreflexia, hypertonia 2. dyskinesia (basal ganglia) - involuntary stereotyped movements with varying muscle tone 3. ataxia (cerebellar) - loss of motor coordination 4. mixed Symptoms - muscle symptoms, pain from tight muscles, abnormal posture, learning difficulties, speech difficulties, vision problems Treatment - rehab, physio, OT, speech therapist, adaptive equiptment

Answer 33

Failure of the neural tube to close posteriorly resulting in incomplete closure of the spine and membranes around the spinal cord. Exposure to the amniotic fluid causes irreversible damage to the spinal cord. Can affect th brain or SC at any level but most commonly affects the lumbosacral region. Note: neural tube defect during the first 4 weeks of embryogenesis. Risk factors: Folate (Vit. B9) deficiency, medications that interfere with folate metabolism (anti-convulsants) Symptoms - hair, dimple, birth mark above site lesion, loss of sensation, paralysis, bladder and bowel dysfuntion, leg/foot deformities Diagnosis: Antenatal screening - U/S, triple screen (alpha-fetal protein, hCG and uE3) Treatment = neurosurgery to repair defect Prevention - folic acid supplementation (elevit), (folate added to flower)

Answer 34

Excessive amount of CSF accumulating within the cerebral ventricles and/ or subarachnoid space resulting in ventricular dilation and increased ICP (imbalance between CSF produced by choroid plexus and reabsorbtion) Note: Choroid plexus produces CSF --\> ventricles --\> ubarachnoid space --\> arachnoid villi --\> systemic circulation Types 1. Non-communicating - blockage in the ventricular system --\> inadequate drainage 2. Communicating - impared absorption in the subarachnoid space or rarely due to increased production 3. Normal pressure hydrocephalus - cerebral ventricles are pathalogically enlarged but ICP not elevated (seen in elderly) 4. Ventriculomegaly - enlargement of the ventricles seen on neuroimaging 5. Hydrocephalus Ex-vacuo - enlargment of the CSF spaces caused by reduced brain volume due to atrophy 6. Benign external hydrocephaus - benign enlargment of the subarachnoid space Causes * Congenital CNS malformation * Teratogens * Neural tube defect * intra uterine infection - rubella, CMV, syphilis, siza * choroid plexus papilloma or carcinoma * Intraventriculr haemorrhage * CNS infection - meningitis, mumps, encephalitis

Answer 35

Autoimmune disease characterised by the destruction of B cells and an absolute deficiency of insulin. Pathophys: Decreased Insulin leads to: * Hyperglycaemia as glucose cant get into the tissues * Glyconeogenesis in the liver as glucagon is uninhibited * ketogenesis from AA breakdon * Increased lipolysis and FFA in blood * Glycosuria and polyuria Symptoms * polyuria, polydipsia * unexplained weight loss * abdominal pain * blurred vision * Nausea Diagnosis High BSL * Fasting BSL \> 7mmol/L * Glucose Tolerance test: 1hr \>7, 2hrs \> 11.1 * HbA1c \> 6.5% Autoantibodies (to distinguish between T2DM) * Anti-GAD antibodies * Anti-tyrosine-phosphate related islet antigen * Islet cell surface antibody C peptide * Increased C peptide --\> may indicate insulin resistance --\> T2DM * Decreased C peptide --\> absolute deficiency --\> T1DM Urinalysis * glycosuria, microalbuminuria (early signs of diabetic nephropathy), ketones (Up in DKA) Treatment * Gylcaemic control - BSL monitoring * Insulin (basal-bolus or pump) * Diet and exercise Complications * Hypoglycaemia * hyperglycaemia, DKA * Microvascular (retinopathy, nephropathy, neuropathy) * Macrovascular (Stroke, AMI) * Infections

Answer 36

Hyperglycaemia + Ketosis + acidosis Symptoms - fatigue, N+V, polyuria, polydipsia, polyphagia, dehydration, abdominal pain, acetone breath, decreased consciousness, coma examinaiton - dry MM, decreased skin turgor, tachycardia, raised RR, hypotension, abdominal tenderness, metabolic acidosis Causes * not taking insulin, inadequate dosage * infection, drinking alcohol Invesitgations * BSL - hyperglycaemia * Ketones - blood and urine * ABG - metabolic acidosis - Decreased pH,pCO2, Bicarb, Increased pO2, Anion gap, K+ can be up or down * Urine Dipstick testing * Serum electrolytes Treatment * Fluids #1 priority * Insulin * K+ if K+ deficiency * monitor electolytes * correct acid=base imbalance

Answer 37

Reduction in plasma glucose concentration to a level that can induce signs and symptoms (\<4mmol/L). Levels where the patient is symptomatic depend on the patient. Symptoms: Autonomic activation ---\> Dizziness, sweating, tremor, tahcycardia, palpitations, confusion, coma, seizures Cause: fasting, insulin OD, infection, drugs (salicylates), ETOH, endocrine causes Treament * glucose oral gel, sugar, follow up with carbohydrates * IV dextrose * IM glucagon * Insulin inhibitors (diazoxide, octreotide)

Answer 38

Definition and Pathophys: * Autosomal recessive, multisystem disease caused by mutation in the CFTR protein resulting alterations to chloride channels across epithelial surfaces. * Cl- cant be effectively transported across membrane * Cl- is used to draw water across diluting the secretion hence secretions become thick * deltaF508 mutation most common out of thousands Symptoms * Neonate --\> meconium ileus * Pancreatic insufficiency (thick secretions block pancreatic duct, pancreatic enzymes cant be released) * steatorrhoea, failure to thrive, malabsorption * Pancreatic damage (enzymes degrade cells of pancreatic duct over time, leading to pancreatitis) * Endocrine dysfunction * Insulin deficient diabetes * Respiratory in later childhood * thick mucus secretions in airway * impaired mucociliary action * bacterial colonisation, recurrent infections * bronchiectasis Examination * clubbing, malnutrition, nasal polyps, increased antero-posterior chest diametes, crackles upon auscultation, infertility in men - lack a vas deferens Screening * Heel prick test - serum immunoreactive trypsinogen Diagnostic * Sweat test - Cl cant be reabsorbed into sweat, extra salty (\>60mmol/L). Patient hould be \> 2 weeks * Prenatally - DNA analysis (If both parents are carriers) collected from choronic villus sampling or amniocentesis. \*Can also do a DNA assay postnatally if the sweat test is inconclusive . Monitoring * Pulmonary function tests * Annual Bronchoscopy \< 6 years (unable to cough), CT, sputum culture Treatment * Respiratory * Chest physiotherapy * Short acting bronchodilator * Mucolytics (N-acetylcysteine) * Antibiotics in exacerbation * Last resort - transplant * Hypertonic saline nebulisation * Pancreatic insufficiency * Enzyme replacement (Creon) * Fat soluble vitamin replacement (ADEK) * Diet * Additional sodium chloride intake * high energy diet to compensate for high demand * CFTR modulators - These drugs modulate the expression of the defective CFTR protein by improving the production, intracellular processing, and function of the defective protein (Ivacaftor)

Answer 39

Trisomy 21, most common form of genetic intellectual disibility with associated physical features and medical conditions Risk factors: increased maternal age, other children with Down syndrome, parental karyotype with translocation Clinical features * Global developmental delay * Hypotonia, Poor Moro reflex * Hyper-flexibility * extra skin on back of neck * fat facial profile * upward sloping eyes, skin fold that covers inner corner of eye * brushfield spot on eyes (white spot) * low nasal bridge with small nares * small low set ears * single palmar transvere creases * deep groove between first and second toe * protruding tongue Screening 1. combined first trimest screening (high false positive rate) - combination of US and maternal biochemistry (B-hCG, PAPP-A) 2. Non-invasive prenatal testing (detects free fetal DNA in maternal blood) Not available through medicare $400 Post natal - Karyotyping and genetic evaluation Associated medical conditions * congenital heart disease (50%) * hearing loss and visual issues * duodenal or anal atresia or stenosis * thyroid issues

Answer 40

Sideways curvature of the spine, usually S or C shaped Types 1. Adolescent idiopathic sclerosis (10-18yo) 2. Juvenile idiopathic scoliosis (3-10yo) 90% require surgical intervention 3. Infantile Idiopathic scoliosis (\<3yo) 90% resolve spontaneously Causes * Neuromuscular scoliosis * muscular dystrophy, spinal musculr atrophy, poliomyelitis, myonitis * Syndromic sclosiosis * Arnold-Chari malformation * Charcot-Marie-Tooth disease, cerebral palsy, CT disroders (Ehlers-Danlos, Marfancs), * Congenital scoliois Screening: Adams bend forward test Diagnostics: * X-ray Tx - refer to specialist, bracing, exercises

Answer 41

Inherited group of progressive myopathic disorders resulting from mutations in the dystrophin gene resulting in on going degeneration and regeneration of muscle fibres and weakness as the primary symptom Types * Duchene MD * most severe * X-linked recessive trait * delayed motor milstones - wlaking \> 18 months, toe walking (heel contractures), difficulty jumping, uses arms to stand) * Gait - hyperlordosis, wide based, unstabl * symptomsusually present by age 4 * lethal * Diagnostics - serum CK elevated, genetic test * becker MD * similar presentation but later and milder clinical course * less severe, rarely fatal

Answer 42

A spectrum of disorders that includes multiple disorders and syndrome associated with maternal alcohol consumption Types 1. Fetal Alcohol Syndrome (most severe) 2. Partial Fetal Alcohol syndrome (dont meet full criteria of FAS) 3. Alcohol related neurodevelopmental disorder (PFAS subtype) 4. Alcoholrelated birth defect (PFAS subtype) Clinical * Height and weight \< 10th percentile * Microencephaly * Facial dysmorphology * smooth philtrum * thin upper lip flat midface * small palpebral fissure * large ears Medical conditions * congenital cardiac abnormalities * MSK - flexion contractures, scoliosis * renal - aplasia, dysplasia, hypoplasia, hydronephrosis * ocular- strabsmus, retinal vascular problems, refractive problems Criteria 1. confirmed or unconfirmed maternal alcohol exposure 2. facial features 3. growth retardation 4. CNS neudodevelopmental abnormalities

Answer 43

Kleinfelder Syndrome (47, XXY or 48 XXXY) * hypogonadism, delayed puberty, tall stature, sterile Turner Syndrome (45, X0) * short stature, webbed neck, low set ears, delayed or absent puberty, sterile

Answer 44

Systemic infection that develips 2-4/12 post group A streptococcal (GAS) Beta-haemolytic streptococcal, strept pyogenes Exam: MR or MS, AR or AS, prolonged PR interval Diagnosis - JONES CRITERIA 2 major or 1 major and 2 minor plus evidence of preceding GAS infection * Major - Joint arthritis, Pancarditis, Nodules subcutaneous, Erythema marginatum, Sydenham Chorea * Major - fever, raised ESR or CRP, monoarthralia, prolonged PR interval Investigations * ECG, CXR, Echo, CPR/ ESR, Cultures, Anti-streptolysin O test (prev GAS inf.) Treatment * Penicillin (even though GAS gone) - monthly for minimum 10 years or until 21yo * Steroids life severe * NSAIDs for arthritis * Valve repaire * Notifibale disease

Answer 45

Parasitic infection caused by Plasmodium. Types - P. Falciparum, P. vivax, P. Ovale Symptoms - travel, fever, headache, anorexia, N+V, diarrhoea, abdo pain Exam - hepatosplenomegaly, pallor, jaundice Diagnosis - FBC (anaemia), Blood smear thick and thin Treatment - Chloroquine Prevention * Chloroquine * Doxycycline in cloroquine resistant areas

Answer 46

Primary infection with varicella zoster virus. Can establish latency in the dorsal nerve root gangioa and reactivate as shingles. Transmission * Droplet or direct contact transmission * Incubation period 13-17 days (28 in vaccinated ppl) * Infective 2 days before rash and until vesibles have been crusted * infection rate up to 90% with household contacts Prevention * Vaccination at 18 months Symptoms * vesicular and pruritic rash * fever, anorexia nad lethargy Investigaitons - Clinical Diagnosis (PCR or skin lesion cab be used for Dx in unwell or when Dx is unclear. serology not recommended unless pregnany) Treatment * Isolate * in high risk patients - can give zoster immunoglobulin

Answer 47

Caused by measles virus. Vaccine available. Stages * Incubation perio 6-20 days * Prodrome (2-4 days) - fever, malaise, anorexia, conjuncitivitis, coryzal symptoms, cough, Koplik spots (white spots surrounded by erythema) * Exanthem - (2-4 days post fever) - maculopapular rash, lymphadenopathy, clinical improvment 2 days after rash Investigations * Measles autoantibodies (IgM and IgG) - pesist for month after rash, come up 1-2 post rash * PCR Treatment - isolation and supportive, notifibale disease

Answer 48

Rubella virus --\> mild, self limiting illness that is often asymptomatic but can cause multiple foetal issues if acquired in pregnancy Clinically - maculopapular rash, lymphadenopathy Diagnosis - anti-rubella IgM detected at onset of clinical illnes, IgG, viral culture or NAAT Treatment - supportive, if pregnant - refer to specialist, possible immunoglobulin Congenital rubella syndrome * sensorineural deafness * eye abnormalities - retinopathy, cataracts * congenital heart disease Can result in spontaneous abortion

Answer 49

Viral illness causing inflammation and swelling of one or both parotids Prevention - MMR vaccine Symptoms - swelling of parotid, painful swelling, prodrome - low grade fever, malaise, headahce, myalgia, anorexia Investigations - PCR saliva, serolofy 7-17 days after symptoms onset Treamtnet - symptomatic usually self limiting in 1-2 weeks

Answer 50

Sixth disease - common viral infection causing temperature and rash in children Epidemiology - common between 6-24 months (95% of children seropositive by 2 years) Infection - HHV 6 or 7, respiratory tranmission Symptoms - high fever (3-5 days before rash), rash is maculopapular on trunk, neck and proximal extremities Clinical diagnosis Treatment - antipyretics, oral rehydration

Answer 51

Common viral infection characterised by low grade fever, oral ulcers and vesicles/ rash on the hands and feet. Caused by the coxsackie virus. Symptom * low grade fever * painful oral ulcers * small oval white blisters or vesicles on palms of hands and soles of feet * sore mouth and throat --\> leads to dehydration * red skin rash with brown scales * not itchy treatment * analgesia so they eat * rehydration * self limiting - 10-14 days

Answer 52

Causes by sarcoptes scaniei, a mite that burrows through the stratum corneum. transmitted by skin to skin contact. Causes an itch and rash - erythematout papules, linear burrows. treatment - topical permethrin or oral ivermectin

Answer 53

Definition * acute otitis media - infection with abrupt onset that usually presents with pain * Otitis media with effusion (glue ear) - non-infective fluid accumulation in the middle ear and mastoid air cells due to negative pressure produced by the eustachian tube * chronic suppurative otitis media - middle ear infection \> 6 weeks with discharge through a perforated tympanic membrane * chronic serous otitis media - middle ear infection \> 6 weeks with no perforation Causes * strept pneumoniae (40%) * Haemophilus influenzae (30%) * Moraxella Catarrhalis (10%) Treatment * AOM - many resolve within 72 hours * analgesia - paracetamol or NSAIDs * ABs shorten duration by \< 1 day and dont decrease rate of complicaitons or reccurence * use antibiotics if symptoms persist beyon 48 hours, in high risk or more severe cases * Amoxycillin 5 days oral * Glue ear - watch and wait for 3/12, then trial 4 weeks of ABs. Grommets in the case of hearing loss or persistence * Chronic suppurative OM - topical ciprofloxacin, ear toilet (betadine or tissue spear), refer to ENT complications * perforated eardrum * mastoiditis * recurrent infection * hearing problems * febrile convulsion * VII cranial nerve palsy

Answer 54

causes * infection * trauma * excessive water pressure (overpressure) * improper attempt to clean ears treatment * topical ABs - ciprofloxacin 2/52 * dry ear toilet with tissue spears * ear toilet using betadine solution via syringe

Answer 55

Inflammation of the external ear canal Causes: Pseudomonas aeruginosa, staph aureus, aspergillosis Risk factors - humid environment, external auditory obstruction, warm temp, swimming, local trauma, skin disease, diabetes Symptoms - ear pain - otalgia, ear tenderness, ear itching, hearing loss Investigations * auroscope to exclude otitis media treatment * analgesia * cleaning of ear * topical ciprofloxacin * topical hydrocortisone to control itching and inflammaiton

Answer 56

Accumulation of keratinising squamous epithelium whithin the middle ear. is a benign growth but may enlarge and involve adjacent bone. Symptoms - hearing loss, tinnitus, malodorous discharge often refractive to ABs, otalgia, vertigo Exam - discharge, crust or ketarin seen Investigations - otoscopy and CT Treatment - refer to ENT, surgical removal and adjunct antibiotics

Answer 57

Cerumen impaction diagnosed when accumulation results in symptoms. Symptoms - hearing loss, fullness, otorrhoea, tinnitus Treatment - manual removal, irrigation, cerumenolytic agents

Answer 58

Avascular necrosis of the femoral head resulting from compromise of the blood supply to the area Epidemiology - usually 4-8 years, can range from 2-12 years. most common cause of limp in 4-10yo Symptoms * Limp (abductor lurch) often worse post exertion and initially painless * milkd or intermittent pain in anterior thigh may refer to knee * pain with passive movement - internal rotation and abduction * trendelenburg sing - muscle wasting * limited ROM Investigations * X-ray Treatment * Children less than 6 be conservative, consider brace * surgical - femoral osteotomy

Answer 59

Aberrant development of the acetabulum resulting in the abrnormal development of the hip joint. Risk factors * female * breech position * Family history * less space (oligohydramnios, twins) * disease of ligamentous laxity (Ehlers Danlos) Screening * Barlows - flex femur to 90 degs then push down * Ortolani - abduct and leaver hip forward * if risk factors - U/S at 6 weeks Symptoms * instability subluxation * stiffness and limited abduction if hip out of place for extended period * dislocaiton prolonged --\> hortening of affected leg * walking - short leg gait, trendelenburg gait (limp created by weakness of abduction) * trendelenburg sign * painless limp * hyperlordotic Treatment * \< 6 months * hip dysplasia - pelvic harness to ensure optimum development * Hip discloation - pavlick harness, ridged splinting, closed reduction * 18m-6 years - open reduction and spica cast * \> 6 years - little pottential for remodelling

Answer 60

Occurs when weakness in the proximal femoral growth plate allows displacement capital femoral head. Epidemiology - most common hip disorder in adolescents Symptoms * hip pain - may refer to medial knee, thigh, groin * limp * trendelenburg positive * reduced internal rotation X-ray - widened growth plate, displaced posteriorly and inferiorly Treatment - screw fixation

Answer 61

self limiting inflammatory disorder of the hip that commonly affects children. most common cause of acute hip pain and limp in 2-12yo. Clinical - hip resting in abduction and external rotation, decreased ROM Investigations * x-ray usually normal * US - effusion common * MRI - evaluaiton of disorder Treatment - rest and NSAIDs usually resolves within 7-10 days

Answer 62

Congenital defect in which the foot is fixed in adduction, Supination and varus Risk factors: Family History, male, restricted growth (oligohydramnios, malpresentation, multiple gestation) Treatment * Ponseti method - serial bracing and casting (foot progressively moved into an improved position) * Achilles tenotomy - achilles tendon may be legnthened and then braces worn untul age 4

Answer 63

Invasion of the joint by an infectious agent resulting in joint inflammation and rapidly progressive joint destruction Symptoms - fever, acute pain, impaired ROM, erythema, warm, swollen Cause * neisseria gonorrhoea * staph aureus * S viridans, S pneumoniae Risk factors: prosthetic joint, recent joint surgery, immunosuppression, diabetes, trauma, IVDU, RA Investigation * aspiration and culture * Synovial fluid - turbid, raised WCC \< 50,000, +++ leuks, bacteria present * U/S * Raised CRP, WCC * blood culture treatment * drainage of infected fluid * emperical and targeted antibiotics - vancomycin and ceftriaxone * analgesia

Answer 64

Osteopenia - defective mineralisation of bone matrix occuring in children Rickets - defective mineralisation at the growth plates resulting in deformity of the bone structure occuring in children whos growth plates have not yet fused Causes * Vitamin D deficiency - sunlight def, dietary, exlcusively breastfed * calcium deficiency or phorphorus Symptoms * poor growth * skeletal deformities (Bowed legs, knocked knees) * Sx of nutrient deficiency * delayed closure of fontanelles * Harrisons sulcus of thorax Investigations * Serum Ca, Phosphate * Calcitriol (active form of vitamin D) * Urine calcium * Alkaline phosphate * PTH * X-ray Treatment - supplements

Answer 65

Ortho * Legg-Calves-Perthes Disease * Transient Synovitis * Slipped Capital Femoral Epiphysis * Osgood-Schlatter disease * spondylosis * Leg legnth discrepency Infection * Septic arthritis * osteomyelitis Rheumatology * Juvenile Idiopathic arthritis Neurological * Cerebral palsy * cerebellar ataxia * spina bifida * charcot-marie tooth Muscular * trauma * muscular dystrophy * myositis Neoplasia * osteosarcoma * leukaemia Metabolic * Rickets, osteomalacia Other - poor footwear

Answer 66

Malignant renal tumour common in paediatrics * 2-5 years, most common paediatric renal tumour Symptoms * unilateral upper abdominal flank pain * unilateral upper upper abdominal/ flank mass - ballotable, smooth, firm to tough, non-tender * pallow, fatigue * haematuria * anorexia Investigation * Renal function tests * LFTs * FBC * Urinalysis * serum protein/ albumin * coagulation studies * abdominal U/S * CT abdo + pelvis Treatment - nephrectomy, chemo, radiotherapy

Answer 67

Malignant cancer that develops from the immature retinal cells. most common intraocular malignancy in children - most commonly \< 3yrs Symptoms * visual changes * pseudo-orbital cellulitis with periorbital oedema * strabismus (crossed or deviated eye) * ocular pain rare Clinical * Leukocoria (White papillary light reflex) * retinal detachment Investigations * Fundoscopy * Opthalmic U/S * CT+MRI staging * genetic testing - RB1 mutation \*Dont perform biopsy - risk of seeding Tx - chemo, focal laser cryotherapy Prognosis - 10yr survival 99%

Answer 68

Primary malignant tumour of bone that are characterized by the production of osteoid or immature bone by the malignant cells. Epid: Most common non-haem primary malignany in bone in paeds. 13-16yo. Distal femur most commonly affected. Symptoms * Bone pain - deep, dull and unremitting, can be worse at night and may wax and wane over time * limp * swelling * bone mass - tender to palpate * limited ROM in joint investigations * Alkaline phosphate up * LDH up * X-ray - disruption of normal trabecular bone pattern, medullary and cortical destruction, moth eaten appearance, periosteal reaction, codemans triangle * CT * PET scan * Bone scan Treatment - wide surgical resection and reconstruction Prognosis - 15% of people have malignant disease at presentation. 75% 5 year survival rate.

Answer 69

A malignant clonal disease that develops when a lymphoid progenitor cell becomes genetically altered through somatic changes and undergoes uncontrolled proliferation. Leukaemia - group of cancers that begin in the bone marrow and result in high numbers of abnormal white cells. these white blood cells are not fullydeveloped and are called blast cells. Epid - most common type of leukaemia in children Symptoms * fever, fatigue, dyspnoea, dizziness, pallor * bleeding, bruising * recurrent infections * hepatosplenomegaly (blasts in spleen) * lymphadenopahy * mediastinal mass * bone pain - worse at night Positive symptoms - no WCC leads to infection, no RBCs - anaemia, No platelets - bleeding Investigations * FBC - anaemia, thrombocytopenia, WCC can be anything * peripheral blood smear - presence of blasts * coagulation profile - rule out DIC * LDH raised - high cell turnover * UEC * Serum uric acid * Diagnosis - Bone marrow biopsy - presnce of blast cells * ALL --\> \> 20% lymphoblast cells * AML --\>\> 20% myeloblast cells * CXR - exclude mediastinal mass Tx - chemo, bone marrow transplant, manage associated issues * Infection - prophylactic antbiotics and antifungals * FLuid therapy prevents uric acid formation * manage thrombocytopenia * prophylactic haematopoietic growth factos * tx febrile neutropenia * preserve fertility Prognosis - 95% remission - 80-90% cure in cildren, adults \< 30% Negative symptoms - weight loss, fever, night sweats

Answer 70

Most common chronic rheumatological disease in children resulting in chronic joint inflammation Symptoms * Arthritis \> 6 weeks * Oligoarticular of monoarticular * large weight bearing joints * morning stiffness * Non-purpuric rash, macular, trunk Clinical features * Decreased ROM, synovitis, rash, muscle atrophy of extensors Investigations Clinical diagnosis * Raised ESR + CPR * RF negative * ANA may be elevated * Anti-CCP indicate poor prognosi * FBC- anaemia, thrombocytosis can be seen in systemic JIA * Arthrocentesis and synovial fluid analysis Treatment * NSAIDs * Corticosteroids intra-articular - triamcinalone * DMARDs e.g. methotrexare * Biologics - etanercept * Physiotherapy, OT Rarely use systemic steroids because of adverse effects - osteoporosis, growth restriction

Answer 71

Autoimmune IgA vasculitis involving the small vessels in the skin, GIT, kidneys and joints Symptoms * Palpable purpura (buttocks, legs, back) * Arthritis * Abdominal pain Erythematouc macular lesions, subcutaneous oedema, bloody stools Investigations clinical diagnosis * FBC - increased platelet count * coagulation profile normal * IgA raised * Raised creatinine * Urinalysis - Haematuria with red cell casts * raised inflammatory markers Treatment - symptomatic, NSAIDs

Answer 72

Medium vessel, common less than 5 year olds Symptoms CRASH and burn * Conjunctivitis * Rash * Adenopathy * Strawberry tongue * Hand and feet swelling and peeling * Fever Complications - cardiac ischaemia and aneurysm Investigations clinical diagnosis * Raised ESR and CRP * elevated WCC with neutrophilia * normocytic normochromic anaemia * sterile pyuria Investigations * coronary angiogram * Echocardiogram Treatment * Aspirin * IV immunoglobulin - relieves acute inflammation * second line - corticosteroids, biologics Prog - spontaneously resolvesin 6-8 weeks

Answer 73

Inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course Epid: can affect all ages, most common \< 5yrs Rsk: family history of atopic disease Classification * infantile - often cheeks, forehead, scalp, extensor surfacers * childhoos - involvement of flexural skin with popliteal fossa, wrists, hands feet * adult - flexural skin, upper back, arms, dorsal hands Inv - clinical Tx * emollients and moisturisers - best utilised after a shower * topical steroids * calcineurin inhibitors - tacrolimis * topical coal tar * systemic immunosuppressives e.g. cyclosporine, methotrexate

Answer 74

tachypnoea resulting from delayed resorption and clearanance of fetal alveolar fluid from the lung parenchyma results in transient pulmonary oedema Risk factors: c/s, prem, diabetic mothers Clinical features - RR \> 60bpm. increased WOB, time of birth - 2hrs life, barrel chest, lungs equal to ausc Investigaitons * ABGs and VBG * CXR - increased lung volume with flattened diaphragm, mild cardiomegaly, prominenct vascular markings from himul * FBC, UEC, glucose, septic screen if needed Diagnosis of exclusion Treatment * most resolve within 12-24 hours * supportive management only - oxygen, commence feeding as soon as tolerated

Answer 75

Condition of respiratory insufficiency as a result of surfactant deficiency (urfactant reduces alveolar surface tension facilitating alveolae expansion and reduced likelihood of atelactesis) Causes: Prematurity Symptoms: Tachypnoea, increased WOB, cyanosis Investigations * ABGs * CXR - diffuse ground glass apearance * UEC, glucose, cultures, CRP, FBC Treatment - surfactant therapy and CPAP Prevention * 2 doses of 11.4mg celestone 24 hours apart

Answer 76

Unconjugated (Path or phys) * Haemolytic * intrinsic * membrane conditions e.g. spherocytosis * Enzyme conditions e.g. G6PD * Thalassemia, sickle cell * Extrinsic * Sepsis * Infection - hep, CMV, rubella * Alloimunity e.g. maternal fetal blood group incompatibility * Non-haem * Breastmilk * Gilberts syndrome Conjugated (Path) * Hepatic * Post hepatic e.g. biliary atresia, bile duct obstruction

Answer 77

Maternal IgG antibodies (Usually RhD antigen) produced by the maternal immune system pass freely through the placental circulation to the foetus and destroy fetal red blood cells (Haemolysis) resulting in anaemia and possibly hydrops fetalis. RhD neg mum to an RhD positive baby Presentation * antenatal * foetal anaemia * foetal hydrops fetalis * Postnatal * anaemia * jaundice * hepatosplenomegaly Screening - maternal blood type and antibody screen at first antenatal visit Diagnosis - after birth - Direct Coombs test Treatment * Antenatal - immunoprophylaxis - IV immunoglobulin (Anti-d administered at 28 weeks, at 34-36 weeks and within 72 hours of delivery) * Postnatal: supportive, phototherapy, exchange transfuction

Answer 78

Causes * Early \< 72 hours --\> GBS, E.coli, Listeria * Late \> 72 hours --\> Gram +ve cocci, gram negs Symptoms: poor feeding, irritabile, lethargic, hypotonia, apnoea, resp distress Investigations: * FBC, CRP, UEC, Blood cultures * Urinalysis * ear swab * CXR if resp sx * consider LP Treatment * early onset --\> amoxycillin + gentamycin * Late onset --\> vancomycin + gentamycin

Answer 79

Ideally want \> 3.5... hypoglycaemic is \< 2.6mmol/L Risk factors * inadequate supply - prem. SGA, poor feeding * Increased utilisation - infection, perinatal hypoxia, hypothermia * Hormonal - diabetic mother, congenital adrenal hypoplasia Symptoms * hypotonia * lethargy * poor feeding * tachycardia, hypotension, sweating Prevention * early feed- within 1 hour, frequent feeds * monitor BGL * warm baby investigations if recurrent low BSL * repeat BSL * hormones - insulin, cortisol, growth factor * blood gas, lactate, ketones * urine - AA _ organic acids Treatment * encourage hourly breast feeds * input - enteral feeds, IV supps, dextrose

Answer 80

Resp. ditress resulting from presence of meconium in resp. tract Risk factors * \> 42 week gestational age * maternal HTN, pre-eclampsia * smoking, substance abuse * fetal distress * oligohydramnios * chorioamnionitis Symptoms * meconium stained amnoitic fluid * resp distress Diagnosis - visual meconium, CXR - patching infiltration Tx - supportive, ABs until sepsis excluded

Answer 81

Abnormal rotation of them idgut during development Symptoms: bilious vomiting, dehydration, sepsis, inconsolable, failure to thrive. food intolerance, diarrhoea Complications * volvulos - loop of intestine twists around itself and supporting mesentary leads to ischaemic and necrosis of bowel * duodenal obstruction * perforation and peritonitis Investigations * CT contrast * AXR to rule out other abnormalities * US to eclude ofther ddx like intussusception * FBC * ABG - lactic acidosis, pH down Treatment - surgical

Answer 82

Disorder resulting from ischaemic necrosis of the intestinal mucosa in neonated. Most common GI condition in premature neonates. Characterised by inflammation, ischaemia and permeability of the neonatal bowel wall to bacteria. it is potentially life threatening. Risk factors - prem, antibiotics, non-human milk Sympptoms - feeding intolerance, bilious vomit, unsettled, pale, diarrhoea, abdo distention and tenderness investigaitons * FBC - anaemia, thrombocytopenis * septic screen * blood cultures * Diagnosis --\> AXR - abnormal gas pattern, bilated bowel loops. bowel wall oedema, pneumoperitoneum Treatment Medical - supportive. ABs, discontinue feeds (Bowel rest), fluid resusc Surgical - if there is a pneumoperitoneum or perforation --\> laparotomy

Answer 83

* Hirschprungs disease * hypothyroidism * cystic fibrois * anal atresia * meconium plug

Paeds Flashcards

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