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1 - Paeds AE > Paeds revision lectures > Flashcards

Paeds revision lectures Flashcards

1
Q

What is a seizure?

A

An abnormal surge of electrical brain activity.

Clinical phenomena resulting from abnormal and excessive excitability of the neurones of the cerebral hemispheres

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2
Q

What is epilepsy?

A

2 or more unprovoked epileptic seizures

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3
Q

What are the symptomatic causes of seizures?

A

Infection (meningitis/encephalitis)
Metabolic disturbance (hypoglycaemia and calcaemia, hyperammonaemia)
Trauma
Vascular (haemorrhage/stroke)
Toxins (iatrogenic- recreational or prescribed)

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4
Q

What investigations would you do in epilepsy?

A

EEG (normal does not exclude epilepsy and abnormal does not mean epilepsy)
MRI (particularly in focal seizures or if they have other neurological deficits)
Potentially metabolic bloods, LP, Urine
Genetics

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5
Q

What is the main useful thing about an EEG?

A

Classifying the epilepsy after it has been diagnosed

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6
Q

What are the differential diagnoses of seizures in infants ?

A 
Bengign sleep myoclonus
Benign myoclonus of infancy
reflux
Shuddering attacks
Self gratifications
Benign paroxysmal upgaze
Spasmus nutans
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7
Q

What are the differential diagnoses of seizures in early childhood?

A 
Breath holding attcks
Reflex anoxic seizures
Daydreaming
Tics
Stereotypies
Syncope
Parasomnias
Shuddering attacks
Tantrums
Movement disorders
Vertigo type syndromes
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8
Q 
6 months old.
Episodes of shaking head when excited, not with it.
Normal development
Normal examination
Diagnosis?
A

Shuddering attack

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9
Q

18 months old
Lies on floor, stiffens up, crosses legs, starts in high chair.
Flushed, looks happy.
Normal development and normal examination
Diagnosis?

A

Self gratification

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10
Q 
14 year old girl
Feels hot, dizzy
Vision closes in, goes black
Collapses
Can't hear what's going on, can't move
Ok after a couple of minutes.
Diagnosis?
A

Syncope

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11
Q

13 year old girl.
Night time episodes of shaking - all four limbs, rhythmic, unresponsive, sometimes gets up, confused.
Video - brief repetitive jerks of arms/hands
Diagnosis?

A

Clonic seiures

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12
Q

What are the classifications of epilepsy?

A 
Tonic
Clonic (normally repetitive)
Tonic-clonic
Myoclonic (often occurs in isolation)
Atonic
Absence
Epileptic spasm
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13
Q

Summary of childhood absence epilepsy?

A

Starts age 4-7 years
Frequent absence seizures - 5-15 seconds, abrupt offset/onset, precipitated by hyperventilation, multiple times a day
Usually otherwise normal

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14
Q

What is the characteristic ECG in absence epilepsy?

A

Characteristic ECG - 3Hz spike/wave

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15
Q

What is the prognosis of absence epilepsy?

A

Good response to medication

Most outgrow in puberty 10% have generalised tonic clonic seizures in adulthood

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16
Q

Summary juvenile myoclonic epilspsy?

A

Starts usually 12-16 years
More common in girls
Myoclonic seizures
Can occur with absence and general tonic-clonic seizures

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17
Q

Summary genetic generalised epilepsy?

A 
Idiopathic
GTC alone
Age of onset variable over 5 years old
Occur in the morning
Investigate - photosensitivity
Treat - sodium valproate
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18
Q

How do you treat epilepsy?

A

None
Rescue medication - buccal midazolam
Regular medication - depends on seizure type and syndrome
Ketogenic diet
Epilepsy surgery - resective; corpus callosotomy

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19
Q

When should you not prescribe sodium valproate?

A

For girls of childbearing age (after periods start).
Unless it is a last resort.
Need to go on a pregnancy prevention programme

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20
Q

Summary febrile seizures?

A 
Not epilepsy
6 months - 6 years
5% of children have one
Seizure assocaited with fever (rate of rise)
Usually GTC and less than 5 minutes 
Risk of epilepsy in later life - 2-5%
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21
Q

What is a complex febrile seizure?

A

Duration over 15 mins
Focal
Occurs within same illness

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22
Q

What’s in a septic screen?

A 
Blood cultures
MC&S
CXR
LP
Throat swabs/skin swabs
(FBC/CRP)
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23
Q

Why would you do blood cultures?

A

Bacteraemia/sepsis

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24
Q

What is sepsis

A

Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death

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25
What can cause sepsis?
Anything: bacterial, viral, fungal, parasitic
26
What are the red flags for sepsis
Inappropriate tachycardia Temperature <36 or >38.5 Altered mental states (sleeping, irritability, lethargic, floppiness) Reduced peripheral perfusion/ prolonged cap refil/ reduced urine output
27
What is bacteraemia?
Presence of bacteria in the blood stream - not sepsis
28
What are the important causes of bacteraemia in neonates?
Group B strep E. coli Listeria Coagulase negative staph (if they have complex neonatal history)
29
What are the important causes of bacteraemia in infants/young children
``` Strep pneumonia H influenza Staph aureus Group A strep Neisseria meningitidis Gram negative organisms (E.coli) ```
30
What are the important causes of bacteraemia in adolescents?
Neisseria meningitidis Staph aureus Group A strep Strep pneumonia
31
What are the important causes of bacteraemia in adolescents?
Neisseria meningitidis Staph aureus Group A strep Strep pneumonia
32
What are the clinical features of UTI in infants and young children?
``` Fever Lethargy Vomiting/diarrhoea Poor feeding Failure to thrice Prolonged jaundice Sepsis Ferile convulsions ```
33
What are the clinical features of UTI in older children?
``` Dysuria Frequency Fever ± rigors Lethargy, reduced appetite Vomiting/diarrhoea Abdominal (loin) pain Febrile convulsions (<6 years) Incontinence/enuresis ```
34
What would you find on dipstick of UTI?
Protein, white cells, nitrates
35
What would you investigate for and how after a UTI?
Underlying structural abnormalities - US Renal scarring - DMSA (radioisotope scan) Vesico-ureteric reflux - MSUG (micturating cystourethrogram)
36
How long do you wait to do a DMSA scan after an infection and why?
3 months otherwise the infection would cause a false positive
37
What is the main organism that causes epiglottis?
HiB
38
What is the main organism that causes bacterial thracheitis?
Staph aureus
39
What is the main organism that causes pneumonia in neonates?
Group B strep | E.Coli
40
What is the main organism that causes pneumonia in young children?
``` RSV Strep penumonia H. influenza Staph aureus Chlamydia trachomatis ```
41
What is the main organism that causes pneumonia in older children?
Strep pneumonias Mycoplasma pneumoniae Staph aureus TB
42
How would you treat empyema
Chest drain Urokinase Prolonged antibiotics Consider underlying immune deficiency
43
What is the main organism that causes meningitis in neonates?
Group B strep Gram negative organisms Listeria monocytogenes
44
What is the main organism that causes pneumonia in young children?
Neisseria meningitidis Strep pneumniae H influenza
45
Name a gram negative diplococci
Neisseria meningitidis
46
Name a gram positive diplococci
Strep pneumonia
47
Name a gram negative coccobacilli
H influenza
48
How do you treat septic arthritis?
Surgical drainage and antibiotics
49
How do you treat osteomyelitis?
Antibiotics
50
US is best imaging for in the joint, why?
Great for excluding infection Both sides Is there an effusion? Is there a subperiosteal abscess?
51
MRI is best imaging for in the bone, why?
Gold standard Especially for complex cases BUT may involve GA/sedation
52
What are the main things to look for in septic arthritis?
``` Non weight-bearing Pyrexia >38.5 WCC >12 ESR >40 CRP >20 ```
53
What are the clinical tests for DDH?
Barlow: subluxes/dislocates a hip posteriorly Ortolani: relocates a dislocated hip
54
What is the time difference between acute and chronic diarrhoea?
14
55
Causes of acute diarrhoea?
Infection - viral (rotavirus, noravirus, enterovirus), bacterial (salmonella, shigella) or protozoal
56
What is haemolytic uraemic syndrome (HUS) triad?
Anaemia, uraemia, multisystem disease
57
What organism causes HUS?
E.Coli O157
58
What organs can cause of chronic diarrhoea?
Normally intestinal but can be liver or pancreas as well
59
6 features of colitis?
``` Diarrhoea Cramping lower abdominal pain Urgency Tenesmus (feeling like there's more stool to come) Nocturnal stooling Mucus and blood ```
60
What are the causes of colitis?
Infective Inflammatory Other
61
What are the infective causes ?
Viral - enterovirus Inflammatory - crohns, UC Other - allographs (transplant from others)
62
12 year old Lethargy and diarrhoea for 3 months Since holiday in Greece where she had D&V Vomiting settled, diarrhoea hasn't, she started to feel unwell. Developed perianal disease, what investigations?
Stool MC&S If bloods are abnormal, might be helpful, if normal, not that helpful Faecal calprotectin (raised with any cause of rectal bleeding, so not specific)
63
Calprotectin
Produced by immune cells, involved in inducing apoptosis in unhealthy cells.
64
What is Crohn's disease of the mouth called?
Orofacialgranulomatosis
65
What are the things specific to Crohn's?
Mouth to anus Skip lesions Transmural Strictures and perforations
66
What are the things specific to UC?
Colon only Confluent disease Uniform disease (all ulcers look the same) Superficial inflammation Toxic megacolon with perforation (only cause of perforation in UC)
67
What is toxic megacolon?
UC for over 7cm In school aged children >6cm Any younger than that >5cm
68
What are the causes of toxic megacolon?
UC C.Diff Immunocompromised
69
What are the stages of treatment of colitis in IBD?
Induction of remission (steroids) and maintenance of remission (5-aminosalicylates)
70
How do you induce remission in small bowel disease?
Liquid nutritional therapy
71
How do you treat IBD remission?
Steroids then steroid sparing agents (azathioprine)
72
How do you treat poor disease control?
Biological agents (anti-TNF) (infliximab and adalimumab)
73
How do ou tret terminal ileitis?
TI resection and right hemiclectomy
74
How do you treat unresponsive Crohn's colitis?
Sub-total colectomy
75
What are the causes of chronic diarrhoea due to small bowel disease?
Coeliac disease | Post enteritis syndrome (lactose intolerance temporarily)
76
What are the features of small bowel diarrhoea?
No colitic features Abdominal pain is central, poor appetite, nutritional deficiencies (mainly iron and calcium) Steatorrhoea, lactose malabsorption (depending on cause)
77
What 4 things happen when coeliacs ingest gluten?
1. Gluten taken up by dendritic cells and presented on HLA DQ2 2. Forms a complex with matrix TTG 3. Recognised by TH1 cells, produce IFN-gamma and TNF alpha and IL-15 4. Recruits B cell binds to TTG-gluten-APC construct, makes anti-TTG (stimulated to class switch by IgA by TH1 cell)
78
What are the histological features of coeliac disease?
1. Villous atrophy 2. Crypt hypertrophy 3. Intraepithelial lymphocytosis 4. Infiltration of lamina propria
79
What are the pancreatic causes of diarrhoea?
All the causes of chronic pancreatitis CF Rare paediatric diseases (congenital pancreatic atresia)
80
What is trypsin?
Protease enzyme
81
What are the symptoms of diarrhoea due to pancreatic exocrine insufficiency?
Fat malabsorption - failure to thrive and catastrophic weight loss Fat soluble vitamin deficiency : ADEK (eyes, bones, nerves and bleeding) Measure exocrine function by faecal elastase
82
Signs of acute pancreatitis?
Grey Turner or Cullen's sign (rare in children)
83
Clinic features of acute pancreatitis
Severe dyspepsia, epigastric pain, sepsis, shock
84
SE of prednisolone
Eyes: glaucome, cataracts CVS: cardiomyopathy, HTN, post surgery or infarct dehisence MSK: proximal myopathy, stunting, osteoporosis Brain: depression, mania, poor sleep Skin: bruising, striae, fat redistribution Pancreatitis, avascular across of femoral head Infection: latent TB

1 - Paeds AE (24 decks)

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