Paeds short

Question 1

Rubella - urgently notifiable (within 24 hours)

Answer 1

Prodrome: fever, coryza, rash and lymphadenopathy

Rash: face to trunk, limb-sparing

Dx: serology rubella-specific IgM antibodies

Mx: supportive, off school until 5 days after rash develops

If unvaccinated pregnant woman: congenital rubella syndrome: cataracts, PDA, deafness

Question 2

Measles - urgently notifiable

Answer 2

Measles morbillivirus

Prodrome: fever >40, coryza, conjunctivitis, Koplik spots (grey spots in Mouth)

2-5 days after: rash behind ears spread to trunk and limbs

Dx: oral fluid sample for measles RNA and measles-specific IgM and IgG

Mx: supportive, off school until 4 days after rash development

Complications: AOM, pneumonia, blindness, subacute sclerosing panencephalitis

Question 3

Bacterial tonsillitis

Answer 3

Strep pyogenes (group A strep)

Centor: fever (>38), exudate, cervical lymphadenopathy, no cough

score 3/4 = abx, 1st line is Phenoxymethylpenicillin (pen V), macrolide if allergy

Question 4

Pyloric stenosis

Answer 4

Hypertrophy of the pyloric sphincter, leading to narrowing of pyloric canal

Key symptom: projectile vomiting post-feed

Key sign: hypokalaemic hypochloraemic metabolic alkalosis

Dx: abdominal ultrasound

Tx: IV fluids, pyloromyotomy

Question 5

Status Epilepticus

Answer 5

Seizure > 5 mins or multiple seizures w/o regaining awareness

Mx: IV lorazepam/buccal midazolam/rectal diazepam, repeat after 10 mins if needed

Then IV Levetiracetam

Then anaesthetist or PICU

Question 6

Nocturnal enuresis (bedwetting)

Answer 6

Primary: never been dry at night

Secondary: previously dry, now lost it (UTI, DMT1)

Dx: hx, examination, urine dip

Secondary - further Ix

Mx: avoid fluid intake before bed, regular toileting

2nd line: enuresis alarm

3rd: desmopressin (ADH analogue)

Question 7

Cystic fibrosis

Answer 7

Autosomal recessive condition due to mutation in CFTR gene on chromosome 7

Impaired ion transport:

• Thick biliary/pancreatic/ lung secretions
• Lack of pancreatic lipase in GI, mucus excess + bacterial colonisation in lungs

Ix: newborn heel-prick, sweat test

Mx: chest physio, high-calorie diet, dornase alfa, Creon, salbutamol, prophylactic flucloxacillin

Newborns = meconium ileus

Question 8

Osteosarcoma

Answer 8

• Malignant bone tumour, mainly affects children and adolescents.
• Clinical features: prolonged bone pain, bone swelling, decreased ROM.
• Dx: urgent X-ray within 48hrs (new bony growth - sunburnt look), CT, biopsy
• Mx: surgical resection, chemo +/= radio

Question 9

Down Syndrome (Trisomy 21)

Answer 9

Clinical features: upward slant to eyes, single palmar crease, hypotonia, leaning difficulties, VSD/ASD

Ix: combined or quadruple test antenatally, chorionic villus sampling, amniocentesis

Mx: MDT: physio, OT, speech + language, educational support, mx of complications, regular check ups

Question 10

Necrotising enterocolitis

Answer 10

Severe GI disease that mainly affects premature infants, intestinal ischaemia and infection

Clinical features: vomiting, bloody stools, abdo distension, acidosis

Dx: abdo x-ray shows dilated bowel loops, pneumatosis intestinalis, pneumoperitoneum

Mx: nil-by-mouth, broad-spectrum abx, Total Parenteral Nutrition , surgical resection

Question 11

Acute lymphoblastic leukaemia

Answer 11

Uncontrolled proliferation of mutated lymphoid progenitor cells, replacing normal haematopoietic cells in the bone marrow

Clinical features: lymphadenopathy (most common), pallor, unexplained petechiae, fever, fatigue

Dx: immediate specialist referral if unexplained petechiae or hepatosplenomegaly, otherwise 48-hr FBC

Bone marrow biopsy: > 20% blast cells = diagnostic

Mx: chemo, bone marrow transplant

Question 12

Neonatal jaundice

Answer 12

Causes: HDN, sepsis, physiological, breast milk, infection

Clinical features: yellowing of skin and eyes, poor feeding, lethargy, well if physiological or breast milk jaundice

Starts around 2 days, better by 14 days at term, 21 days if pre-term

Ix: serum bilirubin levels

Mx:

• Admit if <24 hrs or >7 days old, if unwell, <35 weeks gestational age
• Phototherapy or exchange transfusion according to treatment threshold graph

Complication: kernicterus - brain damage due to excessive bilirulin

Question 13

Nephrotic syndrome: minimal change disease

Answer 13

Peripheral/facial oedema, proteinuria, hypoalbuminemia

Dx: urine dipstick show 3+/4+ protein, urine protein: creatinine > 200mg/mmol , serum albumin < 25g/L, kidney biopsy

Mx: oral prednisolone

Question 14

Immune thrombocytopenic purpura

Answer 14

Autoimmune disease characterised by reduced circulating platelets. Usually following a viral infection

Clinical features: easy bruising, petechiae, nosebleeds

Dx: FBC (thrombocytopenia), blood film, CRP

Mx: watch and wait as usually self-limiting

Question 15

Impetigo

Answer 15

Staphylococcus aureus

Bullous: fluid-filled lesions > 1cm

Non-bullous: erythematous macule becoming pustules/vesicles

Dries into homey-coloured lesions

Mx:

• Hydrogen peroxide 1%
• Face: fusidic acid
• Abx e.g. flucloxacillin (or clarithromycin) if widespread or bullous
• Stay off school until 48 hours after tx started

Question 16

Pertussis (whooping cough)

Answer 16

Bordetella pertussis - gram -ve coccobacillus

Clinical features: flu-like, coryza, fever for 1-2 weeks, then intense “whooping” cough fits, maybe vomit, faint or cyanosis after. Young infants: apnoea, no whoop

Dx: PCR + culture of nasopharyngeal swabs or secretions

Mx: < 21 days onset e.g. clarithromycin, admission if <6m or resp complications

Question 17

Preorbital cellulitis

Answer 17

Infection and inflammation of the superficial tissue around the eyes

Clinical features: erythema, swelling, pain, fever, malaise

Mx: immediate empirical oral/IV abx based on severity e.g. flucloxacillin

Question 18

Infectious mononucleosis (glandular fever)

Answer 18

Epstein Barr virus, transmitted via saliva

Clinical features: fever, sore throat, fatigue, hepato/splenomegaly

Dx: clinical, +ve heterophile antibody (Paul Bunnell) test

Mx: maculopapular rash if treated with amoxicillin otherwise supportive

Back to school once feeling better

Question 19

Parvovirus B19 infection (slapped cheek syndrome/5th disease)

Answer 19

Prodrome: fever, coryza, and diarrhoea

Then reticular (lace-like) rash across body and bright red cheeks . Perioral and forehead-sparing

Dx: clinical

Mx: supportive, children can go back to school when rash appears as no longer infectious

Can cause hydrops fetalis (oedema) in foetus and aplastic crisis in sickle cell anaemia

Question 20

Non-accidental injury

Answer 20

Clinical features: delayed presentation, inconsistent caregiver history, injuries/bruises at various healing stages, unwitnessed injury, subconjunctival/retinal haemorrhage

Dx: detailed hx, body map and skeletal survey

Mx: inform senior or safeguarding lead, admit for safeguarding while investigations, treat wounds, social service involvement

Question 21

Juvenile idiopathic arthritis

Answer 21

Common paediatric chronic inflammatory joint condition

Persistent joint swelling > 6 weeks before 16yo without infection/other causes

Clinical features: salmon pink rash, fever > 5 days, malaise, joint pain

Dx: negative antinuclear ab and rheumatoid factor, raised CRP, ESR, platelets, serum ferritin

Mx: MDT: paeds, physio, OT, ophthalmologists, NSAIDS, intra-articular (if only affecting a few joints) or oral steroids (systemic disease) for flares e.g. methylprednisolone

Question 22

Neonatal respiratory distress syndrome

Answer 22

Deficiency of surfactant in lungs = alveolar collapse

Preterm infants < 35weeks

Clinical features: respiratory distress: tachypnoea, nasal flaring, grunting and intercostal recession

Ix: X-ray: ground-glass appearance = oedema in alveoli

Mx: if preterm birth suspected, maternal corticosteroids to help foetal surfactant production

Neonate: Intratracheal artificial surfactant

Question 23

Duchenne muscular dystrophy

Answer 23

Most common type of muscular dystrophy, X-linked recessive (boys)

Gene mutation in dystrophin gene on X chromosome, dystropin protein absent, important for muscle structure.

Clinical features: muscle wasting, weakness, difficulties with movement, hypertrophic calves

Gower’s sign: use hands to climb up the legs when rising from floor

Dx: creatinine kinase, then genetic testing

Mx: MDT, exercise, physio, wheelchairs, mobility aids, glucocorticoids, genetic counselling, surgery to correct scoliosis and contractures

Complications: contractures, scoliosis, global developmental delay, dilated cardiomyopathy, learning difficulties

Question 24

Meningococcal infection - notifiable

Answer 24

Neisseria meningitidis

Clinical features: fever, lethargy, headache, rigors, vomiting, non-blanching purpuric rash, hypovolaemic shock

Dx: blood culture, CSF

Mx: DO NOT DELAY empirical IV abx, then treat based on sensitivities and local guidelines

<3 months = cefotaxime

> 3 months = ceftriaxone

Ciprofloxacin for close contacts

Question 25

Type 1 diabetes mellitus

Answer 25

Destruction of insulin-producing beta-cells in the pancreas Clinical features: polydipsia, polyuria, lethargy, weight loss Dx: - Oral glucose tolerance test > 11.1mmol/L - Random BM > 11.0mmol/L - Fasting BM > 7.0mmol/L - HbA1c: >6.5% or 48 mmol/mol) Mx: Basal-bolus insulin regime - long-acting at night and short-acting before meals Hypo: sugary snack if conscious, IV dextrose/IM glucagon if unconscious

Question 26

Neonatal sepsis

Answer 26

Severe infection in infants < 90 days Early onset within 72 hrs of life - Group B Strep (S. agalactiae) Late-onset after 72 hrs - Staph. aureus Clinical features: feeding difficulties, fever, respiratory distress, reduced GCS Dx: FBC, CRP, blood cultures, LP for meningitis, CXR for meconium aspiration. Add urine sample if late onset Mx: early onset = empirical IV benzylpenicillin and gentamicin, then based on culture results Late onset = broad spectrum (IV flucloxacillin + gentamicin)

Question 27

Febrile convulsions

Answer 27

Seizures that occur during febrile illness Simple: tonic-clonic, <15 mins, does not occur again in same illness Complex: focal, > 15 minutes, multiple seizures without recovery in between Dx: bloods to identify infection, LP if meningitis suspected, EEG if recurrent Mx: ensure safety, recovery position after, call ambulance if > 5 mins

Question 28

Testicular torsion

Answer 28

Twisting of the testicle around the spermatic cord Clinical features: sudden onset severe unilateral testicular pain, loss of cremaster reflex, persistent pain despite elevation (negative Prehn's sign) Dx: urgent surgical exploration and bilateral orchidopexy (fixation), whirlpool sign on testicular doppler

Question 29

UTI

Answer 29

Infection of the urethra, bladder, ureters or/and kidneys E.coli most common, Klebsiella, Proteus, Pseudomonas Clinical features: - Infant: fever, lethargy, vomiting, poor feeding, urinary frequency - Older: fever, abdo pain, vomiting, dysuria, urinary frequency Dx: urine dipstick (clean-catch sample), nitrites = UTI, nitrites + leukocytes = UTI, only leukocytes = not UTI unless clinical evidence Tx: trimethoprim, nitrofurantoin, amoxicillin for 3 days, admit if if < 3m with fever and start IV abx (e.g. ceftriaxone)

Question 30

Hernia

Answer 30

A protrusion of an internal organ through its surrounding wall, inguinal hernia protrude through the inguinal canal If strangulated (stuck) and compromised blood supply: severe pain, vomiting, signs of bowel obstruction, non-reducibility, swelling and tenderness in affected area Mx Inguinal: surgical intervention - emergency herniotomy Abdominal: surgical release of affected bowel

Question 31

Wilm's tumour (nephroblastoma)

Answer 31

Embryonic renal malignancy in children. Often found incidentally as abdominal mass Clinical features: asymptomatic, abdominal pain, haematuria, lethargy, fever, hypertension, weight loss Dx: abdo ultrasound, CT staging, biopsy for confirmation Mx: surgical excision and removal of affected kidney (nephrectomy)

Question 32

Paediatric basic life support

Answer 32

If infant or child unresponsive 1. Open airway 2. If not breathing normally, 5 rescue breaths with bag-mask ventilation 3. If no signs of life, 15 chest compressions (100 - 200 compressions/ min, lower half of sternum) then 2 rescue breaths 4. Repeat compressions and breaths in 15:2 ratio

Question 33

Moderate asthma exacerbation

Answer 33

- Peak flow > 50% predicted - Tachypnoea but <40 if 1 - 5 yo and <30 if >5 yo - Tachycardia but < 140 if 1 - 5 yo and < 125 if >5 yo - SpO2 > 92% - Speaks in full sentences

Question 34

Severe asthma exacerbation

Answer 34

- Peak flow 33 - 50% of predicted - Respiratory distress: accessory muscles - Can't speak in full sentences - Tachypnoea >40 if 1-5 yo and >30 if >5yo - Tachycardia >140 if 1-5 yo, >125 if >5yo - SpO2 < 92%

Question 35

Life-threatening asthma

Answer 35

33, 92, CHEST - Peak flow <33% predicted - SpO2 <92% - Cyanosis + confusion/altered consciousness - Hypotension - Exhaustion - Silent chest/poor respiratory effort - Tachycardia

Question 36

Mx of asthma exacerbation in children

Answer 36

Stepwise - O2 between 94 to 98% - Inhaled salbutamol - Nebulised salbutamol - Nebulised ipratropium - Senior for consideration of IV magnesium sulphate, IV salbutamol or aminophylline All patients given oral steroids (e.g. prednisolone) or IV hydrocortisone if not tolerated

Question 37

Asthma

Answer 37

Chronic inflammatory airway condition leading to reversible airway obstruction. The smooth muscles of airways are hypersensitive and respond and constrict in response to stimuli, causing airflow obstruction.

Question 38

Clinical features of asthma

Answer 38

Dry cough, wheeze, SOB, tight chest O/E: widespread expiratory wheeze, hyperinflated chest, respiratory distress during exacerbation Things that point towards asthma in a hx - Diurnal pattern - worse in morning and night - Interval symptoms - symptoms between exacerbations - Personal or family hx of atopy - Non-viral triggers e.g. dust, cold air, exercise

Question 39

Dx asthma

Answer 39

- Under 5: hx and examination and treat based on findings Over 5: - First line (quesmed): spirometry and bronchodilator reversibility, FEV1 improvement of 12% or more = dx asthma - If inconclusive = fractional exhaled nitric oxide (FeNO). > 35 ppb = positive - Offer PERF variability monitoring at the same time as FeNO. PERF variability > 20% + FeNO = dx asthma - If only PERF variability OR FeNO positive, trial bronchodilator to help confirm or refute dx

Question 40

Mx asthma in under 5 year olds

Answer 40

1. low-dose ICS as maintenance therapy for 8 to 12 weeks with SABA 2. Check inhaler techique and adherence 3. Check environmental source e.g. mould, smoking 4. Refer to asthma specalist NICE guidelines

Question 41

Mx asthma 5 - 11 years olds

Answer 41

1. Salbutamol inhaler + low-dose ICS as maintenance therapy MART route 2. MART with low-dose ICS and LABA (formoterol) 3. Moderate-dose MART Conventional pathway 2. LTRA added to the low-dose ICS and SABA, if unable to manage the MART - assess after 8 - 12 weeks 3. MART with low-dose ICS with LABA +/- LTRA 4. Secondary care referral for e.g. high-dose ICS

Question 42

Mx asthma for 12 years old and over

Answer 42

Same as adults 1. low-dose corticosteroids/formoterol combination inhaler (used as needed AIR therapy) 2. low-dose MART (low-dose ICS and LABA) 3. moderate-dose MART 4. check FeNo, if raised, refer to specialist 5. if FeNO not raised, LTRA or LAMA trial for 8 to 12 weeks 6. If not effective, try the other one 7. Refer to specialist

Question 43

Complete asthma control in a patient

Answer 43

- No daytime symptoms - No night-time waking - No limitations on activities including exercise - Normal lung function - Minimal side effects from medication

Question 44

Intussusception

Answer 44

Invagination/telescoping of proximal segment of bowel into distal segment - commonly ileum into caecum Clinical features: severe colicky pain, vomiting, redcurrant jelly stool (blood-stained mucus, late), sausage-shaped abdominal mass Ix: abdominal ultrasound: target/donut sign Mx: air/contrast enema, surgical reduction if ineffective

Question 45

Bronchiolitis

Answer 45

1 - 12 months, inflammation of bronchioles. Respiratory syncytial virus Clinical features: preceding coryza 1 - 3 days, cough, fever (<39), tachypnoea, chest recessions, wheeze/crackles Mx: usually supportive (adequate fluids, nutrition, calpol if fever), hospital admission if RR >60, <50% oral intake, SpO2 < 92%, cyanosis, apnoea, respiratory distress (grunting, recession, tracheal tugging) - O2 therapy if <90% and NG tube if not tolerating oral Prevention: palivizumab injection (mAb)

Question 46

Kawasaki's disease

Answer 46

> 5 days fever, sore throatand CREAMPie - C - conjunctivitis - R - rash (erythematous, maculopapular) - oE - oEdema/erythema, - A - adenopathy - M - mucosal inflammation (strawberry tongue, cracked lips), - Peeling of skin of palms and feet (desquamation) Ix: ECG, echo Mx: IV immunoglobin + high-dose aspirin, regular echocardiogram for risk of coronary artery aneurysms

Question 47

Croup

Answer 47

6m - 2yrs, URTI causing laryngeal oedema Parainfluenza virus Clinical features: prodromal coryza, seal-bark cough, inspiratory stridor, respiratory distress (intercostal, subcostal, sternal recessions, grunting, nasal flaring) Ix: clinical, SpO2 Mx: 0.15mg/kg oral dexamethasone + supportive, consider hospital if: - Respiratory distress, high fever, RR>60, cyanosis, lethargy/agitation, reduced fluid intake and wet nappies, < 3 months, chronic disease e.g. heart, CF

Question 48

Acute epiglottitis

Answer 48

Inflammation of the epiglottis, 1 - 6 years old Haemophilus influenzae type B (HiB) - if not up to date with immunisation Clinical feature - acute onset, high fever "toxic-looking" child - drooling, struggling to breathe, can't speak, minimal cough, inspiratory stridor, tripoding! Mx: - DON'T EXAMINE THE THROAT + AIRWAY AS IT CAN MAKE OSTRUCTION WORSE! - Call senior paediatrician, ENT and anaesthetist to secure airway, e.g. endotracheal intubation, IV abx, e.g. cefuroxime.

Question 49

Developmental dysplasia of hip

Answer 49

The femoral head and acetabulum do not articulate correctly. RFx: Female, firstborn, breech, FHx Clinical features: limited hip abduction, asymmetrical thigh skinfolds Ix: Barlow's (posterior dislocation) and Ortolani's (relocation on hip abduction), if positive refer for hip USS Mx: mild = observation. More severe = Pavlik harness for 6 - 12 weeks or surgical correction

Question 50

ADHD

Answer 50

Triad of hyperactivity, impulsivity and inattention Dx: CAMHS psychiatrist via history + examination, behavioural observations, teacher/parent reports/rating scales, neuropsychological testing Mx: Behaviour: CBT, psychoeducation, extra support at school Medical: methylphenidate if > 5yo, monitor weight, height, BP, HR as can impact growth

Question 51

Ventricular septal defect

Answer 51

Congenital cardiac defect where there is a hole in the ventricular sputum Clinical features: - Asymptomatic if small - Larger VSD: Exertional SOB, fatigue, failure to thrive, difficulties with feeding - Undetected: heart failure or Eisenmenger's syndrome - pan systolic murmur at lower left sternal border Ix: ECG (LVH), CXR (cardiomegaly), echo to confirm Dx and grading Mx: most will self-resolve, larger VSD = diuretics + ACEi for HF, high-energy feeds for growth, surgical closure

Question 52

ASD (atrial septal defect)

Answer 52

Acyanotic heart disease as left to right shunt Symptoms - None (commonly) - Poor feeding, failure to thrive - Recurrent chest infections/wheeze - Arrhythmias (40+) Signs - Hepatomegaly - Oedema - Ejection systolic murmur particularly at the upper left sternal edge

Question 53

Diabetic ketoacidosis

Answer 53

Complication of T1DM: hyperglycaemia, ketonaemia and metabolic acidosis Clinical features: N+V, dehydration, abdominal pain, hyperventilation, altered mental status Ix: blood glucose (>11.1mmol/L), arterial blood gas (pH < 7.3), blood ketone levels (> 3mmol/L) Mx: - Senior paediatricians - ABCDE - initial bolus fluid of 10ml/kg of 0.9 NaCl over 15 mins - Rehydrate over 24 hours and avoid fluid bolus to reduce risk of cerebral oedema - Give fixed-rate insulin infusion + IV dextrose once glucose below 14mmol/L - Treat underlying cause e.g. sepsis

Question 54

Coeliac disease

Answer 54

Autoimmune disease where the immune system reacts to gluten and attacks the small bowel Clinical features: abdominal pain, steatorrhoea, fatigue, failure to thrive, dermatitis herpetiformis Dx: anti-tissue transglutaminase (TTG) IgA antibodies + total IgA levels, anti-TTG IgG if IgA deficiency, IgA anti-endomysial antibodies (EMA) Gold standard is OGD (oesphagogastroduodenoscopy) and duodenal/jejunal biopsy - villous atrophy and crypt hyperplasia Mx: life-long gluten free diet

Question 55

Hirschsprung's disease

Answer 55

Congenital condition, absence of parasympathetic ganglion cells from the colon (ranges from small area to entire colon) and rectum Clinical features: delay in passing meconium, chronic constipation since birth, abdominal pain and distention, vomiting, failure to thrive Dx: abdominal x-ray, rectal biopsy to confirm dx Mx: surgical removal of affected section of the bowel.

Question 56

Acute otitis media

Answer 56

Acute inflammation of the middle ear - viral or bacterial Clinical features: fever, malaise, pain in affected ear, preceding viral URTI Dx: clinical with otoscopy Mx: Most cases: supportive and analgesia Abx = amoxicillin or clarithromycin Consider admission if: - < 3 months + fever > 38 - 3 - 6 months + fever > 39 - Severe Consider immediate abx if: - systemically unwell - High risk of complications - Bilateral and under 2yo Delayed abx - For use after 3 days if no improvement

Question 57

Patent ductus arteriosus

Answer 57

Ductus arteriosus remains open > 1 month after birth Clinical features: asymptomatic, feeding difficulties, failure to thrive, or signs of heart failure, characteristic "machine-whirring" continuous murmur at upper left sternal border Mx: only if symptomatic - NSAIDs inhibits prostaglandin synthesis = closes PDA or paracetamol - Surgical ligation rarely

Question 58

Sickle cell disease

Answer 58

A genetic disorder causing dysmorphic shape of RBCs - autosomal recessive and affects the beta-chain of haemoglobin - HbS Afro-Caribbean, Hispanic or Mediterranean Symptoms from complications - Vaso-occlusive crises - severe pain from tissue ischaemia - Anaemia due to increased RBC haemolysis Mx: acute: IV opiates, oxygen therapy, IV fluids, top-up transfusions, abx if infection Long-term: hydroxyurea increase HbF, regular transfusions, folic acid, iron chelation, prophylactic penicillin, regular influenza and pneumococcal vaccines

Question 59

Cerebral palsy

Answer 59

Group of non-progressive permanent movement disorders due to damage to CNS area involved in motor control Clinical features: depends on site and extent of lesion, delays in reaching milestones, spasticity, increased deep tendon reflexes, increased muscle tone Dx: brain MRI to assess damage Mx: - Physio, occupational therapy, speech and language therapy - Baclofen for muscle spasms and Botox for contractures - Surgical for MSK deformities or releasing tendons

Question 60

Chickenpox (varicella zoster virus)

Answer 60

Intubation period up to 21 days Fever, fatigue, loss of appetite - Distinctive rash: starts as raised red, itchy spots on face or chest, spread to rest of body - Then small, fluid-filled vesicles over next few days - Within 5 days, lesions crust over and heal Mx: measures to prevent spread and infection e.g. keep fingernails short, long-sleeve shirts, oatmeal baths and calamine lotion, paracetamol School exclusion 1 - 2 days before rash development - most infectious

Question 61

Scarlet fever - notifiable urgently

Answer 61

- Cause: group A streptococcal infection (Streptococcus pyogenes) - Most common in children 5–12 years. - Fever, sore throat, headache 1 - 2 days before rash - Classic ‘sandpaper-like’ maculopapular rash that starts on chest or abdomen and spreads, with flushed cheeks and perioral sparing. - White-coated, sore or swollen tongue or strawberry tongue - Associated with lymphadenopathy - Only bacterial cause of childhood exanthema - Mx 10 days antibiotics (phenoxymethylpenicillin or erythromycin), infectious until after 1st abx dose Complications: glomerulonephritis, rheumatic fever, invasive group A strep

Question 62

Roseola infantum/sixth disease

Answer 62

Human herpes virus 6 Initial high fever > 40, up to 5 days Then blanching, rose-pink macular rash over trunk but can spread to face and limbs Rhinorrhoea, sore throat and lymphadenopathy Mx: paracetamol or ibuprofen, hydration and nutrition Once fever resolves, child can go back to school

Question 63

Gastro-oesophageal reflux (GOR)

Answer 63

Immaturity of the lower oesophageal sphincter, allowing stomach content to flow back into the oesophagus Vomiting post-feeds (usually milky), poor feeding, poor weight gain Mx: small frequent feeds, burping regularly, not overfeeding, gaviscon, thickened milk/special anti-reflux formula, PPI if ineffective

Question 64

Depression

Answer 64

- Mood changes: anhedonia, sadness - Cognitive changes: excess guilt - Physical: excessive sleep, lack of sleep, fatigue Dx: psychiatric, medical history and examination e.g. Patient Health Questionnaire for Adolescents (PHQ-A) Mx: refer to CAMHS if active suicide ideation, moderate to severe - CBT - Family and school support - fluoxetine

Question 65

Anaphylaxis

Answer 65

Acute, life-threatening allergic reaction characterised by wheezing (difficulties breathing), inspiratory stridor, hypotension, angioedema Mx: - ABCDE Adrenaline (1:1000) IM - < 6months: 100 - 150 micrograms - 6m - 6y: 150 micrograms - 6 - 12y: 300 micrograms - > 12y: 500 micrograms Post-crisis, observe for 6 - 12 hours in case of bi-phasic reaction

Question 66

Tetralogy of Fallot

Answer 66

Pulmonary stenosis, right ventricular hypertrophy, VSD and overriding aorta - detected at 20-week anomaly scan - Cyanosis - Poor feeding and growth - Tet spells (reversal of shunt to R to L) Dx: SpO2, echo to confirm, CXR might show boot-shaped heart Mx: corrective surgery at 3 - 6 months Tet spells: place infant on back and flex knees, O2 in hospital, propranolol

Question 67

Meconium aspiration

Answer 67

Meconium = first faeces passed by newborns, thick and dark green in colour. "Meconium-stained liquor" is when meconium is passed just before delivery into the amniotic fluid Can cause meconium aspiration if foetus inhales this = respiratory distress CXR = aspiration pneumonitis (patchy infiltrates) Mx: O2 therapy, antibiotics

Question 68

Lymphoma

Answer 68

Type of cancer affecting lymphocytes in the lymphatic system = lymphadenopathy - Hodgkin's (specific disease) - 20 - 25yo and 80yo. HIV, EBV, autoimmune conditions - Non-Hodgkin's (common in childhood- all other types) Most common features = unexplained lymphadenopathy in neck, axilla or inguinal region B symptoms: weight loss, fever, night sweats less common Classic exam trope = lymph node pain in HL after alcohol Ix: lymph node biopsy = Reed-Sternberg cells (owl face cells) CT, MRI, PET scan for staging Stages: Lugano classification: - Stage 1: confined to one node or group - Stage 2: multiple nodes on one side of diaphragm - Stage 3: nodes on both sides of diaphragm - Stage 4: widespread involvement Mx: HL = chemo and radiotherapy NHL: watch and wait, chemo, mAb (e.g. rituximab), radiotherapy, stem cell transplant