Paeds Flashcards
(116 cards)
1
Q
Bronchiolitis poem?
A
In kids under 1, there’s a common disease
With cough, snotty nose, crackles and wheeze
Always record the respiratory rate
If it’s severe, they’ll desaturate
2
Q
Acyanotic vs Cyanotic heart disease examples for each?
A
Acyanotic:
- VSD
- ASD
- PDA
- pulmonary stenosis
- aortic stenosis
- co-arctation
Cyanotic:
- ToF
- Transposition of the great arteries
3
Q
MURMURS!! ASD? VSD? - differentials? AS / pulmonary stenosis? PDA? Innocent murmur?
A
ASD - wide-fixed splitting s2 (delayed closure of P2)
VSD - pan-systolic (burrrrrr) - DDx - MR / TR
AS / PS - ejection systolic
PDA - machinery murmur (continous murmur)
Innocent - soft ejection systolic - LEFT STERNAL EDGE
4
Q
What keep PDA open? How to close?
A
Open - prostaglandins
Closed
- indomethacin / ibuprofen
- Transcatheter occlusion / surgical ligation
5
Q
VSD Ix + treatment? Small vs Large?
A
ECG (RVH), CXR, ECHO
Small: - None
Large:
- Repair (if risk of Pul HTN)
- Diuretics + ACE-I - for HF
6
Q
ASD treatment?
A
Trans-catheter closure - via femoral vein + IVC to R atrium
7
Q
ToF features?
What posture might the kid take - why?
A
PROVE (Infundibular) Pulmonary stenosis...causing: RVH over-riding aorta VSD - R-->L shunt Ejection systolic murmur
CYANOSIS + CLUBBING Squatting posture (partially occludes femoral = ^systemic resistance = more blood flow into PA through PDA = better oxygenation)
8
Q
Surgery for ToF before definitive?
A
Blalock-Taussig shunt = R subclavian to Pulmonary artery
Helps PA flow + helps develop them
9
Q
Transposition of great arteries:
- association
- Mx before definitive operation?
A
MATERNAL DIABETES!!
Prostaglandin infusion - keep PDA - DUCT DEPENDANT LESION
Atrial septostomy - encourage mixing
10
Q
Down’s syndrome face / head features?
Others?
A
ROSEOLA (n.b. roseola not more common in down’s)
Round face
Occipital flattening (&nasal flattening)
Speckled iris (Brushfield spots) + Squint
Epicanthic folds
Open mouth + protruding tongue
Low set ears
Almond (oval) up-slanted eyes
Others:
Hand - single transverse palmar crease, short fingers, curved little finger
Feet - sandal gap
11
Q
Down’s associations?
Heart specific? -bit on embryo pls
A
Duodenal atresia (double bubble) Hypothyroid, coeliac, Hirschprung's, squint, leukaemia
HEART: - endocardial cushion defect –> failure of septation
- ASD, VSD
- AV canal defect - low ASD + high VSD
- MR + TR
12
Q
Roseola? What is it?
A
6th disease! 3+3
Mild viral infection - herpes virus 6
Age 6months - 2 years
3 days fever –> 3 days viral macules on chest (i.e. 3+3)
13
Q
Kawasaki’s age + symptoms?
Major complication?
A
6months-5years
CRASH and BURN (MyHEART as well ;) )
Conjunctivitis (bilateral + non-purulent)
Rash - non-vesicular
Adenopathy (cervical + unilateral)
Strawberry tongue + inflammation of mouth + lips (cracked lips)
Hands/feet - palmer erythema/swelling/desquamation (2-5days after onset)
Fever > 5days (BURN)
Comp - coronary artery aneurysm!! (do ECHO) –> deaths+signif. morbidity
14
Q
Heart Failure - symps, signs, causes (neonate + infant)
A
symps:
poor feeding, sweating, SOB, poor weight gain, recurrent chest infections
Signs:
- tachypnoea, tachycardia
- extra HS - ‘gallop’ rhythm
- cardiomegaly, hepatomegaly
NEONATES - hypoplastic left heart, co-arctation
- VSD + PDA - L–>R shunts
15
Q
Rheumatic Fever Tx + Organism
Diagnostic Criteria?
A
Group A B-haemolytic Strep - PYOGENES JONES criteria - 2major / 1major+2minor - (JONES PEACE) Joints - large joint arthritis O - carditis N - nodules - painless + subcutaneous E - erythema marginatum S - syndenham's chorea
P - PR interval prolongation E - ESR v raised A - arthralgia C - CRP raised E - elevated temp
Aspirin
Benpen - help strep throat
Prednisolone - for Syndenhams chorea (consider haloperidol)
16
Q
Infective endocarditis:
Most common symps?
Signs
A
*Most common - fever, chills, weight loss, poor appetite
FROM JANE:
Fever>38 + tachycardia
Roth spots - eyes, retinal haemorrhage with pale centre
Osler’s nodes - painful red blisters @ terminal phalanges + toes
Murmur - tricuspid w/ s.aureus
Janeway lesions - painless red maculae on thenar eminence
Anaemia/arthritis: subacute - >3 joints (asymmetrical). acute: 1 joint septic
Nail splinter haemorrhages
Embolic phenomena - e.g. stroke
17
Q
Co-arctation.
Association?
Key sign? Murmur?
A
TURNER’S!
Radio-femoral delay
Systolic murmur over BACK
18
Q
Only Tx option for Eisenmengers?
A
heart-lung transplant
19
Q
Paediatric Basic Life support algorithm?
A
DR ABC
DANGER:
SAFE approach (shout for help, approach with care, Free from danger, evaluate response)
RESPONSE - ‘are you okay?’
AIRWAY - head tilt, chin lift, jaw thrust
BREATHING:
- look, feel, listen
- 5 RESCUE BREATHS (different to adult as doing this first)
CIRCULATION: - pulse (>60) - CPR if <60
15 CHEST COMPRESSION : 2 BREATHS
999 after 5rounds / 1 minute!!
20
Q
Common life support q’s:
How long to continue CPR?
When perform CPR in presence of pulse?
What are signs of life?
A
1.
until further help arrives
until signs of life noted
until exhausted
- <60
thready pulse in collapsed child
no signs of life - spontaneous breathing
spontaneous movement
response to stimulation
21
Q
Anaphylaxis.
Features
Management algorithm
A
Mucosal membrane swelling, increased bronchial smooth muscle tone, loss of vascular, ^capillary permeability
Urticarial rash, wheeze, stridor, lips/face/tongue swelling
1.
ABCDE
2.
Call for help & remove allergen
3. Adrenaline IM (repeat after 5mins) 1in1000!!! - 0.15ml <6yrs - 0.3ml 6-12yrs IV fluid bolus - hypotension Neb salbutamol
- (following intial resus)
- IV hydrocortisone
- Antihistamine - chlorphenamine
- Blood IgE panel / skin prick test
- education of apotting anaphylaxis + auto-injectors (i.e. epipen)
22
Q
Meningococcal sepsis bug? gram pls
Meningitis features
Sepsis features
A
N. Meningitidis - g-ve diplococcus
Meningitis:
- Neck stiffness
- Kernig’s
- Photophobia
- BULGING FONTANELLE - ^ICP
Systemic sepsis:
- Non-blanching rash
- reduced consciousness
- shock
- multi-organ failure
- DIC
23
Q
TRAFFIC LIGHT SYSTEM.
General upset for intermediate risk? Amber
A
AMBER Appears pale (to parent/carer) Mucous membranes dry / reduced intake Behaviour / responsiveness reduced Elevated resp / HR Rigors
24
Q
V general meningitis Mx?
Additional points if:
If shocked?
If raised ICP
A
LP
IV ceftriaxone (+dexamethasone)
[BenPen if community]
Shocked:
- No LP
- add bolus 0.9% saline
- consider inotropes
raised ICP:
- NO LP!!!!!!!!
25
DKA Mx?
What rule for fluid calculation in exam specifically in DKA?!?!?
ABCDE
0.9% saline (NaCl)
Insulin
K+ - to correct it as it falls
If shocked = give bolus - REDUCED FLUID RULE (10ml/kg 0.9% saline)
FLUID RULES:
Dehydration:
-10% if severe = pH <7.1
-5% if mild = pH >=7.1
Reduced fluid rule - DUE TO RISK OF CEREBRAL OEDEMA
- <10kg = 2ml/kg/hr
- 10-40kg = 1ml/kg/hr
0 >40kg = fixed 40ml/hr
26
Status epilepticus management!
Oh My Lord Phone the Anaesthetist
Oxygen (after ABC)
Midazolam (buccal / rectal diazepam / IV lorazepam)
Lorazepam IV
Phenytoin IV
Rapid induction of anaethesia - risk of aspiration!!
27
ALL - 3comps + bit on path + Tx for each
Bone marrow failure
- malignant infiltration of bone marrow
- Pancytopaenia
- Transfusion / BM transplant
Neutropenic Sepsis
- low WBC
- Broad spec ABx
Tumour Lysis Syndrome
- Renal failure - SECONDARY to:
- ^urate, ^phosphate, ^ potassium
- AFTER STARTING CHEMO
- hyperhydration, allopurinol, dialysis, rasburicase
- sort ^K+
28
4 types of child abuse?
Physical (NAI)
Emotional
Sexual
Neglect
29
```
Osteogenesis imperfecta
what is it / path?
genetics?
symps/features?
2 associations
X-ray features - 2 pls
```
Group of conditions affecting collagen
Results in brittle bones=prone to #
AD - affects type 1 collagen
```
Blue sclera
Triangular face
Lax ligaments
Fractures from low force
Hearing loss - later on
```
Aortic regurg
Otosclerosis - conductive deafness
Osteopaenia + multiple healed fractures
30
```
Monogolian blue spot
What / where are they?
Ethnicity?
Do they go away?
May be confused with?
```
Blue/grey discolouration present from birth
Buttocks + base of spine (also wrists)
Asian / afro-carribean
Yes after about 5 years
Can be confused with bruising - i.e. ?NAI
31
Scalded skin syndrome
What is it? Bug?
Appearance?
Where does it affect?
Superficial staph infection
Thin walled bullae - rapidly burst
erythematous base - looks like a burn
skin folds + axilla affected
32
```
Vaccines?
8 week
12 week
16 week
1 year
Pre-school booster
14 years
```
extra? i.e. girls / flu jab age?
DTPP - diptheria, tetanus, polio, pertusiss
HiB - H. influenza B
8 weeks - 2/12
- 6 in 1 - DTPP, HiB, Hep B
- Pneumococcal
- Men. B
- Rotavirus (oral)
12 weeks - 3/12
- 6 in 1 - DTPP, HiB, Hep B
- Rotavirus (oral)
16 weeks - 4/12
- 6 in 1 - DTPP, HiB, Hep B
- Pneumococcal
- Men. B
1 year
- HiB with Men C
- Pneumococcal
- Men B
- MMR
Pre-school
- 4 in 1 - DTPP
- MMR
14 years
- 3 in 1 - DTP (no pertussis)
- Men ACWY
EXTRAs:
- Annual Flu jab - age 2-7
- HPV x2 - Girls 12-13
33
```
Turner syndrome
Path/Genetics
Features
Associations
Diagnosis
Management: drugs + monitor what?
```
1in2500 born girls!
Complete / partial absence of one of X chromosomes
SHORT STATURE + INFERTILITY
Neck webbing
Broad chest - wide nipples
Cubitus valgus - elbow angle out body wider
COARCTATION OF AORTA (?other cardiac defects aswell)
renal anomalies, AI thyroiditis, diabetes, learning difficulties, HTN, MIDDLE EAR DISEASE
Karyotype analysis
MDT - incl endocrine
- GH - optimise final height
- sex hormone replacement
- oestrogen - induce secondary sexual charact
- progesterone - induce menstruation
- IVF - for fertility
- Monitor - BP, diabetes, thyroid disease, hearing loss
34
GORD
Why does it occur? - think structural
When is it diagnosed over colic?
Complications of gord?
Management:
- simple measures
- stepwise approach
IMMATURE LOWER OESOPHAGEAL SPHINCTER
```
Colic = many babies pull legs up, arch backs and scream after feeds
GORD
- constantly miserable
- coughing / wheezing after feeds
- failing to put weight on
```
Comps:
- faltering growth / failure to thrive (vomming milk)
- oesophageal stricture (acidity in oesoph)
- Resp comps
- apnoeic episode
- reccurent micro-aspiration w/ wheeze/pneumonitis
```
Mx
Simple:
- wind baby
- smaller, more frequent feeds
- keep baby upright during feeds
- add thickeners to feeds
```
Stepwise:
- Trial thickened formula = 2 weeks
- alginate = 2weeks (GAVISCON)
- ONLY if others failed + comps = PPI / H2 receptor antagonist:
- omeprazole / ranitidine
35
```
GI RED FLAGS = to query other Dx?
Projectile vomit?
Green, bile stained vomit?
Chronic diarrhoea?
Haematemesis / melena?
Persists beyond 1 year?
Acutely unwell with vomiting?
```
?Pyloric stenosis
?Obstruction / NEC / Gastroenteritis
?Cows milk protein allergy
? cause of bleeding
?UTI / other
?Sepsis
36
Gastroenteritis
Bugs. More commonly viral or bacterial?
Treatment?
VIRAL - more common!
- rotavirus, adenovirus
Bacteria:
- Salmonella, Campylobacter, E.coli
SELF-LIMITING
some need admission for rehydration
37
Signs of dehydration
```
Dry mucus membranes
reduced urine output - less wet nappies?
reduced skin turgor
sunken eyes / fontanelle
tachycardia
lethargic/irritable
```
38
```
Haemolytic Uraemic Syndrome (HUS)
Aetiology, bugs?
Path
Commonest cause of what in kids?
TRIAD??
Best Ix? What is seen?
Mx?
```
1-2 after onset of diarrhoea - E.coli (also shigella, campylobacter)
E.coli 'shiga toxin' --> endothelial damage in kidneys --> activation of coag cascade + microvasc thrombosis --> platelet aggregation (CONSUMPTION THROMBOCYTOPAENIA) --> fibrin/mesh partly occludes renal vessels (AKI) --> mesh shreds RBCs + fragments them (HAEMOLYTIC ANAEMIA w/ SHISTOCYTES)
commenest cause of AKI! (in kids)
TRIAD - AKI, LOW PLATELETS, HAEMOLYTIC ANAEMIA
FBC + Blood film
- SCHISTOCYTES
- low platelets, low Hb
Mx:
- supportive +/- transfusion
- dialysis for AKI
39
Pyloric stenosis
path/what is it?
Age?
CLASSIC FEATURE?
IX - classic findings?
Mx?
commenest surgical emergency in infancy!
Hypertrophy of gastric pylorus muscle (sphincter)
3-12weeks
NON-BILLOUS PROJECTILE VOMIT (yellow)
Watch for hyperperistalsis
HYPOKALAEMIC, HYPOCHLORAEMIC METABOLIC ALKALOSIS
U+Es - low potassium, low chloride
USS - thickened+lengthened pyloric muscle
Cap blood gas - metabolic alkalosis (i.e. high bicarb + BE)
Mx:
- ABC + nil by mouth
- NG tube
- IV access - fluid resus + maintenance
- Ramstedts pyloromyotomy
40
Pyloric stenosis buzzwords - i.e. Ix findings?
HYPOCHLORAEMIC, HYPOKALAEMIC, METABOLIC ALKALOSIS
41
Why lose K+ in Pyloric stenosis - 2 reasons
Why no alkalaosis in gastroent, but is in PS?
- lose stomach acid - K lost as KCl
- dehydration kicks off RAAS - K+ lost (aldosterone)
in gastroent = BOTH stomach acid + alkali small bowel contents --> evens out
42
```
Intussusception
Emergency?
Age?
What may trigger it?
Features?
Diagnostic Ix - CHARACTERISTIC FINDING?
Management?
```
DDx if reccurent - 2 pls
EMERGENCY!!
6mnths - 2yrs
Preceding viral illness - lymph node 'lead point'
Episodic pain, indrawing of legs, pallor
RECURRANT JELLY STOOL - late sign (blood+pus in stool)
TARGET SIGN - on USS (diagnostic)
ABC
Air enema reduction / surgery
Polyp / meckel's diverticulum
43
```
Coeliac disease
What is it?
2 antibodies present?
Genetics?
Features
Ix + diagnostic test? - What do you see - TRIAD
Associations?
Tx?
```
Comps if left undiagnosed?
Autoimmune allergy to gluten in wheat/barley/rye
Anti tissue transglutaminase Abs (Anti-tTg)
Anti endomysial Abs (Anti-EMA)
HLA-DQ2 + DQ8
Steatorrhoea
Faltering growth + short stature - kid smallest in class
5-6 loose stools per day
Distended abdo
Wasted buttocks
Pallor (anaemia) - iron deficient
```
Serology - Abs
HLA testing
Jejunal biopsy - DIAGNOSTIC
- villous cell atrophy
- crypt hyperplasia
- lymphocytic infiltrate
```
DERMATITIS HERPETIFORMIS!!!!
other AI - pernicious anaemia, Hashimoto's, T1DM
Lifelong gluten free diet
Gluten re-challenge if diagnosed <2years / diagonstic uncertainty (e.g. cows milk protein allergy)
Anaemia, faltering growth, osteopaenia = if left undiagnosed
44
UC or Crohns more common in kids?
CROHNS - childhood + adolescence
45
Cow's milk protein allergy
Immunology?
Features?
Mx?
Do they grow out of it - if so what age?
IgE or IgG associated
Widespread urticaria, facial swelling
Loose stools, failure to thrive, colic/GORD
Severe - anaphylaxis type thing - wheeze, stridor, blood/mucus in stool, shock/collapse
Confirmed in blood with cows milk challenge
Skin prick test
IgE in blood - RAST test
Mx:
AVOID COW'S MILK
- in breastfed babies - mother avoid cows milk
- in formula fed - hypoallergenic extensively hydrolysed / amino-acid formula
Antihistamines - if allergic reaction
Adrenaline = if bad
Usually grow out of it by 5
46
Signs of resp distress?
```
Head bobbing
Nasal flaring
Tracheal tug
Tachypnoea
Recessions
Use of accessory muscles
```
47
```
Bronchiolitis
Age?
Bug?
Features? - rule of 3's (how long does disease last)?
Ix? In what cases are these done?
Mx? - what not to give?
```
kids under 1
RSV!!! others: adenovirus, influenza, parainfluenza
9 DAY ILLNESS
- 3 days - coryza + harsh cough
- 3 days ill w/ fever (<39), wheeze, fine inspiratory crackles, breathlessness
- 3 days recovering
NOT DONE UNLESS SERIOUS - i.e. CYANOSIS
- cap blood gas - resp acidosis?
- nasal swab - resp viruses
- ?cxr - not routine
Mx:
- Fluids, oxygen, resp support (if needing admission)
- if Severe! = HDU/PICU - CPAP, IV fluids
DO NOT GIVE
- STEROIDS
- ABX, BRONCHODILATERS
48
What prompts admission for bronchiolitis?
DRAMAS
```
Dehydration
Resp rate >70 / marked increased WOB - recession/grunting
Apnoeic episodes
Milk/fljuid intake <50% of normal
Appearance - ill / exhausted
Sats <92%
```
49
Children that are high risk for bronchiolitis? 4 things
What are they given during autumn winter - monthly IM for 6 months
Premature
Chronic lung disease
CF
Congenital heart disease
Palivizumab - monoclonal AB to RSV
50
Asthma Ix + signs of severe asthma?
5 PROPS
```
Peak flow - <50% best/predicted
RR >30
O2 sats <92%
Pulse >125/min
Sentances - too breathless to talk
```
51
Life threatening asthma?
33, 92 CHEST
```
PEF < 33% best/predicted
Sats < 92% .... and any one of:
- Cyanosis
- Hypotension
- Exhausation w/ poor resp effort
- Silent chest
- Tired / confused (i.e. reduced conscious level)
```
52
CHRONIC ASTHMA MANAGEMENT
>5?
<5?
>5 = SAME AS ADULTS - but remove LTRA after step 3 --> whereas in adults it becomes (+/- LTRA)
<5 - essentially STOP AT STEP 3
- SABA
- SABA + 8week trial moderate ICS
- SABA + ICS + LTRA
53
ACUTE ASHTMA MANAGEMENT - kids
mild/moderate?
severe?
mild/moderate:
- inhaled salbutamol - SPACER NOT NEBULISER
- oral prednisolone
Severe = OSHITMS
54
Asthma
Description
Age
Associations
Reversible airway obstruction
usually >5
History of atopy? - hayfever, allergy, eczema
55
```
Viral induced wheeze
What is it?
Typical age?
Important point/question to ask that can exclude asthma?
Mx?
```
Wheeze episode - associated w/ viral URTI
typically children <5years
absence of strong atopy hx - eczema, hayfever
Treat as acute asthma - but only give steroids if pre-existing/suspected asthma
56
```
Croup
Description?
Bug?
Age?
Features? If severe - what added + what sats?
Mx? if mild / mod / severe
```
Acute viral laryngotracheobronchitis
PARAINFLUENZA (others: RSV, influenza)
6months to 6years
Mild fever, hoarse voice
BARKING COUGH
STRIDOR
+/- resp distress (severe = marked + <94% sats)
Mx
Every child = DEXAMETHASONE +/- adrenaline nebs
Moderate (some resp distress + features) - add neb budesonide
Severe (marked resp distress + constant features) - add neb adrenaline
57
Epiglottitis
Bug? - common cause of this?
Difference in severity to croup - differentiating feature (other than barking cough)?
Mx?
SERIOUS!!
H.influenza - due to HiB vaccine
Very unwell + toxic (croup = mild-severe)
DROOLING - not seen in croup
LEAVE ALONE - get ENT/anaesthetist
Abx after securing airway
58
```
Bronchiolitis vs Croup vs Viral Wheeze
Age
In Common - maybe a bit too obvious hehe
Typical differences / characteristic features
Basic mx for each
```
Common features:
- ^WOB
- ^RR
Bronchiolitis
<1years
expiratory Wheeze, inspiratory crackles
Supportive Mx
Croup
6months - 6years
Barking cough, inspiratory stridor, NO crackles
Dexamethasone
Viral induced Wheeze
<5years
Wheeze, NO STRIDOR, NO CRACKLES
Bronchodilators (i.e. same as acute asthma)
59
Cystic fibrosis
AD or AR?
Mutation?
Brief path --> lead on to what this causes --> symps
Main bug in CF infections?
Ix - what is seen on each?
MDT - who's involved?
AR!! F508 mutation
Mutation = abnormal CFTR (CF transmembrane conductase regulator protein) --> responsible for Cl transport!
= Thick secretions
= Pancreatic insufficiency (DM + Malabsorption)
+ Recurrent chest infections / Bronchiectasis
= Faltering growth / poor health / failure to pass meconium / chronic wet cough / clubbing (bronchiec)
Pseudomonas aeruginosa (H.influ, S.aureus, Klebsiella)
Newborn screening - ^ immunoreactive trypsin
Genetics - F508
Sweat test - GOLD = ^chloride - 2 abnormal for Dx
CXR - hyperinflation, bronchial thickeneing
Sputum - C+S
MDT:
- Dietician
- Physio
- Medical
- GP, Resp, GI, Endocrine, Paediatrician
- Nurses
60
Nephrotic syndrome (Non-proliferative)
Type in Kids? Other 2 types pls
TRIAD?
What is low, what is high? - i.e. in blood
What else is lost - 2 things? - what does this increase risk of - 2 things pls
Ix? what you looking for?
Minimal change in KIDS!
Membranous
FSG
Proteinuria, Oedema, Hypoalbuminaemia
Albumin low
Hyperlipidaemia --> compensatory liver protein synthesis
Loss of immunoglobulins - infection
Loss of anti-thrombin III - risk of clots!
FBC - haematocrit (intravascular volume depletion) + infection
U+E & creatinine - renal function
LFT - albumin
Urine - frothy, +++protein
Mx:
Steroids - pred
IV albumin = if fluid depleted
Penicillin prophylaxis
61
Nephritic
Most common type (hint:what bug) + other 2 pls
TRIAD?
Post-infective GN (strep)
IgA nephropathy
Rapidly progressive i.e. cresenteric (i.e. Vasculitis / Anti-GBM)
Haematuria - RBC casts
Oliguria/AKI
HTN
62
HSP - Henoch Schonelein purpura
What is it? What does it usually follow
Age?
TRIAD?
Ix? - what you checking for?
Mx?
IgA vasculitis
often recent URTI - Group A strep - Pyogenes
3-10years old
Abdo pain, arthropathy, Purpuric rash
Also renal involvement - i.e. Nephritic (sometimes nephrotic)
ankles, knees, elbows
Urinalysis - is it nephritic?
BP - HTN?
Intussuception ix
Paracetamol - pain
Steroids - kidneys
63
ITP
What is it? what does it usually follow
Features? where do you see it?
Ix - what do you see?
Mx? What to avoid - why?
Immunologically mediated destruction of platelets
Often 1-2 weeks after viral URTI
Petechiae + purpura - buttocks extensors
Ix:
Normal Hb, normal WCC
Low Platelets
```
IV immunogolobulin (IVIg) + steroids
Transfusion
```
Avoid NSAIDs + contact sport (risk of incranial haemorrhage)
64
```
Transient synovitis - commenest cause of limp in child
What is it? Usually preceded by?
Age? Gender?
Features?
Ix?
Mx?
```
Transiently inflamed synovium of hip joint
usually following viral infection
2-12years. M>F
Unilateral painful limp - may refer to thigh/knee
No pain at rest
Mildly decreased ROM
Child well, NO fever
FBC, CRP, X-Ray, Cultures - all NORMAL
USS - joint effusion
analgesia - NSAIDs
Self-limiting - few days
65
```
Septic arthritis
Most common bug?
Features?
Ix? Dx confirmed by?
Mx?
Comp if left untreated?
```
S. Aureus
Acute painful hip pain at rest
Child unwell + fever
Reluctance to move hip - decreased ROM
CRP + WCC^
Joint aspiration = confirm Dx
Abx + surgical drain
Joint destruction if left alone
66
```
Perthe's Disease
What is it? What can it lead to
Age? Gender?
Features?
Ix?
Mx? Prognosis?
```
Ischaemia of femoral epiphysis - can lead to ANV of femoral head
5-10 years. M>F
INSIDIOUS onset - initially painful
Decreased ROM - esp abduction + internal rotation
X-ray - initially ^ fem head density + later irregular fem head edge
Conservative management
Surgery if severe
Good prog if
67
SUFE - Slipped upper femoral epiphysis
What is it? Direction?
Age? Gender? Other RF?
Features - what may bring it on?
Displacement of femoral head - posteriorly + medially
10-15 years. M>F. Obesity
Acute painful - often after minor trauma (may refer to knee)
Reduced ROM - esp abduction + internal rotation
68
JIA
Definition
RheumF? exception to this
Types - quick def for each
Mx options?
Arthritis for >6weeks under the age of 16
RF -ve --> except in some girls with polyarticular
Oligoarticular - <=4 joints (60%)
Polyarticular >=5joints (20%)
Systemic: Still's disease (10%)
Others: enthesitis related, psoriatic (10%)
Mx:
- MDT - physio, OT, educational input
- Analgesia - paracetamol, NSAIDs
- Intra-articular steroid injection - oligo esp
- DMARDS - Methotrexate, anti-TNFs
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Systemic JIA - aka Still's disease
Age? Gender?
Features?
Ix?
DDx fever+ myalgia?
<5. M=F
Acute illness w/
- HIGH SWINGING FEVER
- SALMON COLOURED MACULAR RASH
Lymphadenopathy + hepatosplenomegaly
Pleurisy + pericarditis
SLE, Kawasakis, Rheumatic fever, Leukaemia, reactive arthritis
70
Oligo-articular
Age? Gender?
What joints affected? Distribution
Extra feature 1/3rd get? what +ve test pops up?
2-6years. F>M
Medium joints - NOT HIPS
- wrists, knees, ankles, elbows
ASYMMETRICAL
Anterior uveitis - ANA +ve
71
Poly-articular
What joints affected? Distribution?
What joint is spared - so unlike...
Any joints - SYMMETRICAL
- hands, wrist, knees
- neck / temporo-mandibular joint
Spares MCPJs - unlike RA
72
Measles
Bug?
Incubation period. Infectivity?
Features?
is it notifiable?
Comps?
RNA Mobillivirus
10 day incubation
infectious until day 5 of rash
4 C's - cough, conjuctivitis, coryza, cranky
Koplik spots
Maculopapular rash - from behind ears to face+trunk
YESSSSS
Pneumonia, encephalitis
73
Mumps
Incubation? Infectivity?
Features?
Comps?
2-3week incubation
7 days from onset of parotid swelling
Fever typically 4 days w/ uni then bilateral parotitis
Comps - orchitis, viral meningitis
74
Rubella
Features?
If in pregnancy?
Notifiable?
Well child
Low grade fever
Lymphadenopathy - posterior auricular + occipital
Congenital rubella syndrome = if pregnant mother gets it - risk to fetus
YEP IT IS!
75
Chicken pox
Bug?
Incubation. Infectivity?
Features? timeline of tings pls
Comps?
Mx?
VZV
2-3weeks (long like mumps)
Infectious 7 days from start of rash
Fever w/ widespread rash
Papules --> vesicles --> pustules --> crust
Comps:
- 2ndary bacterial skin infection
- chickenpox pneumonia
Mx:
Aciclovir
Calamine lotion - antihistamime/emollient
5 DAYS OFF SCHOOL
76
Slapped cheek disease - 5th disease!
Bug?
Features?
What can virus affect --> why is this a key worry in sickle cell pts?!?!?
Risk if infection in pregnancy?
Parvovirus B19
low grade fever for few days --> developing bright red cheeks
virus can affect erythroblasts in bone marrow --> can cause aplastic crisis in sickle cell!!
Infection in preg:
- fetal anaemia, HF, death
77
Scarlet fever
Bug?
Age?
Features - course of disease?
Mx?
How long it last?
Notifiable?
Group A strep - pyogenes
2-10years
high fever + sore throat
2 days later - rough rash on face, upper chest, armpits
flushed red cheeks + strawberry tongue w/ tonsilitis
Penicillin V - BenPen
Fever lasts 4 days --> Rash peels in a week
YESSIRRRRR
78
Term baby weeks?
37-42 weeks
79
```
Port wine stain
what is it. When does it appear?
Distribution
does it increase in size, appearance?
Association + path?
Features of this?
```
Present at birth - red 'stain' on face
Maxillary/opthalmic distribution
Flat + does not increase in size
Sturge-Weber syndrome - neuro disorder
Formed due to abundance of capillaries near surface of skin
(NB - will also have meninges problems on same side)
Seizures, glaucoma, hemiparesis
80
2 things you can get single transverse palmar crease in?
Down's
| Fetal alcohol syndrome
81
2 potential causes of absent unilateral red light reflex?
retinoblastoma
| congenital cataract
82
```
Carvenous hemangioma
What is common name?
When does it appear?
Does it increase in size?
What is it not associated - thus making it different from port wine stain
Does it go away? when?
```
Strawberry naevus
NOT AT BIRTH
get bigger boi - lil red bump on head
with intracranial abnormalities - i.e. so no sturge weber
Goes away by 5th birthday
83
2 tests for congenital dysplasia of the hip? which is which 0_o ?
Ortolani - dislocate
| Barlow - reduce
84
What is seen in talipes equinavarus? Tx?
Club foot!
| Physio/surgery
85
What is physiological jaundice of newborn? When would be worried it might be pathological?
What causes physiological?
>24hours after birth (typically day2-5)
resolves by 2 weeks
High RBC volume + decreased RBC survival
immature hepatic enzymes
pathological if <24hours
86
Haemolytic jaundice
Causes (other than physiological)
Test to do that could narrow down cause?
Problem with unconjugated bilirubin - comps?
Sepsis
Immune destruction - ABO incompatibility, rhesus
Congential - G6PD, hereditary spherocytosis
Positive Coomb's test
```
REMEMBER HAEMOLYSIS = UNCONJUGATED BILIRUBIN
- can cross BBB!!!! lead to:
kernicterus - damage to basal ganglia
encephalopathy
dyskinetic cerebral palsy
```
87
```
Billiary atresia
What is it?
Features?
Ix
Mx - when should it take place?
```
Congenital abnormalty - blockage/absence of bile ducts --> untreated = liver failure
Jaundice, pale stools, dark urine
imaging of hepatobiliary system
Surgery - Kasai hepataportoenterostomy / liver transplant
BEFORE 2 MONTHS!
88
Management of significant jaundice?
Hydration - throguh good feeding
Continue to breastfeed - whatever the cause
Phototherapy - breaks down bilirubin
Exchange blood transfusion
89
What complication of prematurity = leads to cerebral palsy?
HEADS (from tune)
| - Hypoxic ischaemic damage!!
90
RDS
Path?
Diagnosis (i.e. 1 Ix + features)
Mx
Deficiency of surfactant - from type 2 pneumocytes
- production begins 24-28weeks = adequate by 35weeks
resp distress symps - ^WOB, ^RR - in first 24hrs
CXR - ground glass shadowing, air bronchograms
Resp support - oxygen, CPAP, ventilation
Surfactant via ET tube
Can give antenatal steroids - to promote lung dev
91
```
NEC
Seen in what babies?
Path/features
symps
Ix
Mx
```
PREMATURE!!
Bowel ischaemia, inflam, necrosis, perforation
poor feed tolerance, abdo distention, bloody stools, vomiting
X-ray - pneumatosis intestinalis - air in intestinal wall
Bowel rest - NBM, TPN, ABx
Surgery to remove section of bowel
92
Commenest childhood seizure?
FEBRILE CONVULSIONS
93
Febrile convulsions
Age?
Association?
Typical seizure type/length? describe complex seizure
Mx?
Factors that ^risk of future epilepsy
6months - 5years
FEVER! - sudden increase in temp
generalised + short in duration (<5mins)
[Complex = >15mins, focal features, recurring in same illness]
ABC (+DEFG)
Symptomatic relief for fever, find cause +/- ABx
^Risk:
- Complex seizure
- FH of epilepsy
- neuro abnormalities on examination / dev delay
94
Epilepsy define
Can EEG exclude epilepsy?
chronic brain disorder w/ recurrent (2+) non-febrile seizures - in absence of acute cerebral insult
NO! EEG = normal in 50% w/ epilepsy
95
Absence epilepsy
Age?
What is it? What can precipitate it?
How long it last?
EEG features? IMPORTANT!!
Tx
does it last?
4-10years
Transient LoC - often with open, blinking eyes / twitching mouth movements
Hyperventilation can precipitate
<30seconds
EEG - 3Hz spike and wave abnormaltiy - 3 per second spike and wave!
Valproate / ethosuximide
Usually grow out of by adolescence
96
```
West syndrome
Is it bad?
What is it?
Any associations?
TRIAD?
Tx? prog, go on to develop other things?
```
BAD bro
infantile spasms in 1st year of life
1/3rd = major organic disorders
- tuberous sclerosis
- hypoxic ischaemic encephalopathy
TRIAD:
- INFANTILE SPASMS
- DEVELOPMENTAL DELAY
- HYPSARRHYTHMIA ON EEG
Tx:
Pred / vigabatrin
Poor prog - w/ long term dev + behavioural difficulties
most go on to have other seizure types
97
4 domains for developement?
Gross motor
Fine motor / vision
Hearing/language
Social/behaviour
98
3 months dev?
Raises head and chest when prone
follows moving object
vocalises
Smiles (6-8weeks), Laughs
99
Dev milestones:
| 6months
Sits without support
Palmar grasp (5months), Transfers hand to hand
Turn head to loud sounds, Babbles
Reaches for bottle
100
Dev milestones:
| 9months
pulls to stand, crawls
Point with finger
responds to name
Takes everything to mouth
101
12months dev milestones!!!
Walks alone/one hand held (9-18months)
Neat pincer grip
1-3words - mama, dada
Waves byebye
102
18months dev milestones
SHOULD WALK - refer if not. runs/jumps
Tower of 2-4bricks, Hand preference
6-12 words
drinks from cup / uses spoon
103
What age can kids copy a circle? Ride a tricycle?
3years
104
What age can kids draw cross? Hop on 1 leg?
4years
105
Triangle draw kids? Knows name, age, address?
5 years
106
Cerebral palsy - an 'umbrella term'
Definition - when can it occur?
Clinical diagnosis, but what Ix is it supported by?
NON-PROGRESSIVE brain lesion = manifests as motor or postural abnormaltiies
lesion can occur at any point between conception + 3years old
MRI - PERIVENTRICULAR LEUCOMALACIA - caused by hypoxic ischaemic damage to ya head (i.e. in PREMS)
107
4 common presentations of cerebral palsy
- split into 2 categories
Types of movements - 2 pls in one of the types
SPASTIC: - most common
- Hemiplegia - vertical half
- Diplegia - horizontal half
- Quadriplegia
DYSKINETIC - involuntary movement disorder
- chorea - jerky
- athetosis - writhing
108
Spastic diplegia features
[ excluding UMN features!! ]
Adduction at hips + scissoring gait
Flexion at knee + genuvalgus
Plantar flexion at ankles + equinovarus - tiptoe gait
Rotation + swaying of trunk
109
Complications of cerebral palsy?
Epilepsy + learning disability
Speech + swallowing problems - PEG tube?
Spasicity + contractures
110
Cerebral palsy causes?
Commonly unknown
In utero:
- TORCH
Perinatal:
- Birth asphyxia
- PREMATURE
- Kernicterus --> i.e. why haemolytic anaemia of neborn may cause it!! (due to unconjugated bilirubin)
After delivery:
- Brain injury
- Meningitis / encephalitis
111
Congenital infections? 5 pls
```
TORCH
Toxoplasmosis
Other - HIV, measles, parvovirus, hepatitis
Rubella
CMV
Herpes simplex
```
112
Duchenne muscular dystrophy
Genetics?
Age?
Features - a bit of timeline
Key Ix?
X-linked! Frameshift mutation in dystrophin gene
**loss of dystrophin --> muscle cell damage
Boys 3-5years = onset
Waddling gait
Gower's sign!! - to stand uses hands to climb up legs
Proximal muscle weakness - wheelchair by age 9-12
Diaphragmatic weakness
Scoliosis / contractures
Cardiomyopathy
Clumsiness / motor delay
Cognitive impairment
Genetic testing
Creatinine Kinase
113
Breath holding attacks
Age?
Features - i.e. the process?
6months - 2 years
```
Pain/anger --> then brief cry
kid takes deep breath and stops breathing
turns blue + limbs extend
LOC
few convulsive jerks
NO POST-ICTAL phase
```
114
Reflex anoxia seizures
Age?
What is it + features?
Triggers?
infants + toddlers
similar to faint in older kid/adult
vagal activation = bradycardia
kid goes pale + collapses
potenital tonic-clonic
noxious stimulus - e.g. knock to the head
115
Autism TRIAD of impairment
| age they present with?
typically <3years
Reciprical social interaction - poor eye contact, difficulty establishing/maintaining friends
Social communication - delayed/disordered speech, lack of gestures, absent imaginative play
Restricted, repetitive stereotyped behaviours + interests
116
ADHD
Triad?
Diagnostic criteria?
Mx?
Inattentiveness, Hyperactivity, Impulsivity
Symptoms must be present before 7years old + observed in more than 1 setting (home + school)
Mx: - combination of behavioural + meds
- RITALIN - methylphenidate
