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pg 28 Flashcards

1
Q

¸What is the clinical examination of meningitis?

A

• Inspect: Fever, rash, unwell
• Meningisim:
o Neck stiffness: Hands on occiput sides (near ears), Rotate head,
Chin to chest, hold it there for 10 secs. (Assessing for resistance
to movement).
o Brudzinski sign: Flexion of the neck with child supine causes
flexion of the hips and knees.
o Kernig sign: Bend their knee with your hands on hamstrings and
the other supporting the thigh. Straighten: Positive if there is hamstring spasm or back pain, or flexion of the opposite leg on
extension.
o Papilledema and fontanelles.
o Focal neurological signs

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2
Q

Kawasaki disease

CP:

A

o High fever (> 5 days and difficult to manage)
o Strikingly miserable
o Non-purulent Conjunctivitis, strawberry tongue, lip cracking
o Hand and foot swelling, erythema, rash or peeling
o Inflammation of BCG scar.

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3
Q

Kawasaki disease

INVX

A

o Inflammatory markers

o Cardiac ECHO

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4
Q

Kawasaki disease

TX:

A

o IVIG
o High dose aspirin
o +/- Warfarin
o +/- Immunosuppression

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5
Q

Outline the UK immunisation schedule?

A 
Birth: BCG, HB (if high risk)
• 1 month: HB (If at risk)
2-3-4 months: HB (If at risk), 5 in one (DTAP, POLIO, HIF), PCV, Rota, and
MEN-B.
• 1 yr: MMR, HIB/MENC, MEN b, PCV, Hib
• 3 yrs: MMR, 4 IN one (remove Hib)
• 2-7: Flu shot each year.
• 12-13 girls: HPV
• 14 yrs: MENC ACWY, 3 in one
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6
Q

immunodeficiency syndromes

CP:

A

o Recurrent infections (Ear, sinus, lung, skin)
o Severe infections (Bone, brain, sepsis)
o Prolonged complicated infections
o Failure of antibiotics to clear infection
o Prolonged or recurrent diahorrea with Failure to thrive
o Deep sited and skin abscesses.
o Reactions to live vaccines
o Prolonged warts
o Opportunistic infections (candidiasis)

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7
Q

immunodeficiency syndromes

INVX:

A

o FBC with WBC differential
o IG levels and IgG subsets
o Compliment levels
o Special tests and genetics

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8
Q

immunodeficiency syndromes

Mgt:

A

o Anti-microbial prophylaxis
o Anti-biotic treatment
o Screen for end organ damage

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9
Q

examination findings in atopic child?

A
  • Mouth breathing
  • Allergic salute
  • Swollen and pale inferior turbinate
  • Allergic conjunctivitis with Dennie-Morgan folds and discoloration
  • Atopic eczema
  • Chest hyperinflation and Harrison sulcus
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10
Q

clinical features,
of food
hypersensitivity?

A
  • 6% of children are affected.
  • Allergic (Cow milk protein allergy)
    o IgE-mediated:
    Onset within 2 hours
    Mild: Urticaria and itchy skin & facial swelling.
    Severe: Wheeze, stridor, abdominal pain, vomiting and
    diarrohea, Shock and collapse.
    o Non-IgE: beyond 2 hrs. GI symptoms.
  • Non-allergic (Transient lactose intolerance).
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11
Q

Diagnosis of food

hypersensitivity?

A

Skin prick test (Most useful); wheel > 8 mm. Blood IgE

levels. Gold standard: Supervised food challenge.

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12
Q

Management of food

hypersensitivity?

A

Food avoidance with dietician advice (Traces,
Alternatives and nutritional deficiency avoidance). Written management
plan, carry epipen all the time. (Technique and expiry date).

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13
Q

Prognosis of food

hypersensitivity?

A

Egg and milk resolve but nut and fish do not.

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14
Q

What should the child with severe eczema be screened for?

A

Egg allergy (40%) with skin prick or blood test.

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15
Q

clinical presentation of hay fever?

A
  • Conjunctivitis
  • Rhinitis
  • Chronic nasal congestion sleep disturbance and impaired day time
    behaviour and concentration
  • Aden hypertrophy: Snoring, sleep apnoea, irritability and somnolence
    during the day.
  • Chronic cough
  • Sinusitis
  • Eczema, asthma
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16
Q

How is hay fever managed?

A 
2nd G antihistamine, 
topical steroid, 
cromogylcate, 
Monteleukast,
decongestants (< 7 days)
Allergen immunotherapy
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17
Q

How is urticaria classified and treated?

A
  • Acute: Hours (drug), days (viral)
  • Chronic > 6 weeks
  • Physical
  • NSAIDS-induced
  • C1 esterase inhibitor deficiency (just angioedema)
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18
Q

What is the prognosis and management of insect bite allergy?

A
  • Mild: Local swelling
  • Moderate: generalised urticaria
  • Severe: Anaphylaxis.
  • Mild-moderate => Reassurance
  • Severe: Carry epipen.
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19
Q

Stridor is

A

Upper airway obstruction inspiratory

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20
Q

Wheeze is

A

Lower airway

Expiratory

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21
Q

causes of tonsillitis?

What is the treatment?

A

Viral, EBV, Strep-A

Penicillin for 10 days in strep A

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22
Q

What is Scarlet fever?

A

• GAS bacteria
• Fever => Tonsillitis, sand-paper rash, flushed cheeks with peri-oral
sparing, strawberry tongue.
• TX: penicillin V
• Complications: Glomerulonephritis and rarely RF

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23
Q

causes of acute

otitis media?

A

o Mostly viral (RSV, Rhino)

o Bacterial: Pneumococcus, non-typable H.Flu, Moraxella

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24
Q

complications of acute

otitis media?

A

Meningitis

Mastoiditis

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25
treatment of acute | otitis media?
Regular analgesia, Amoxicillin if still unwell after 2 days | Antibiotics marginally shorten the duration of pain but does not prevent hearing loss
26
What is Glue ear? | What is the treatment?
A cause of hearing loss and subsequent speech and language delay. OM with effusion => Conductive hearing loss on audiometry (after 4 years), dull retracted TM on tympanometry. TX: Grommets, adenoidectomy
27
indications for Tonsillectomy?
Severe recurrent OM | Peri-tonsillar abscess (quinsy)
28
indications for Adenotonsillectomy?
OME => hearing loss | OSA (Absolute indication)
29
child with stridor DDX
``` o Croup o Acute epiglottitis o Bacterial Tracheitis o Inhaled foreign body o Anaphylaxis o Recurrent/ chronic (Laryngomalycia) ```
30
child with | stridor Management
o O2 o Nebulised steroids +/- Adrenaline +/- Call Anaesthesia. o Observe SATS o Do not examine the throat
31
Acute epiglottitis
Hib, < 6 yrs, over hours, Toxic child with high fever, muffled voice, soft whispering stridor and drooling. ``` Call for help (anaesthesia, senior paediatrician, ENT surgeon) Intubate and transfer to ICU Blood cultures IV cefuroxime for 5 days Rifampicin prophylaxis for contacts ```
32
Croup
Parainfleunza virus, 2nd year, over days. Croyza => severe parking cough, hoarse voice, harsh rasping stridor. Nebulised steroids, warm moist air, observe
33
What is bacterial Tracheitis (Pseudomembranous croup)?
Just like epiglottitis | Caused by staph
34
bronchiolitis cause
RSV in 80% of cases
35
bronchiolitis features
Dry wheezy cough + Resp distress
36
bronchiolitis investigations
Oximetry, ABG, CXR
37
bronchiolitis Mgt steps
humidified O2 from head box + monitor for apnoea+/- fluids (NG or IV). Admission criteria: Apnoea, Sats <90, PO intake < 75%, severe resp distress.
38
What is bronchiolitis obliterans?
Recurrent cough and wheeze, if caused by | adenovirus
39
prevention of bronchiolitis?
Palivizumab to high risk PREMS (NNT= 17)
40
DDX of acute respiratory distress in infants?
* Bronchiolitis * Viral wheeze * Pneumonia * HF * Foreign body * Anaphylaxis
41
DDX of wheeze?
* Viral episodic * Multiple trigger * Asthma * CF * Chronic aspiration * Recurrent anaphylaxis
42
Chronic Asthma Sx
``` Cough, wheeze, breathlessness, chest tightness o Episodic o Non-viral riggers o Diurnal (worse at morning and night) o Response to bronchodilators ```
43
Chronic Asthma signs
o Polyphonic expiratory wheeze o Harrison sulcus (chronic airway obstruction) o Atopy
44
Chronic Asthma investigations
o Spirometry o Serial Peak flow o Skin prick
45
Chronic Asthma tx steps 1-5
1: SABA PRN 2: + inhaled steroids (200-400) (from now on can use LTRA) 3: + LABA, up steroids (800) (From now on can use SR theophylline) 4: Up steroids (1600)+ carry steroid card, refer if < 5 yrs. 5: + PO steroids
46
Acute asthma assessment | A
A: Appearance and awareness: o Normal consciousness => Not life-threatening o Can speak => Not severe
47
Acute asthma management Moderate
o Inhaled salbutamol (up to 10 puffs) | o PO prednisolone (1-2 mg/g, up to 40)
48
Acute asthma assessment | B
B: Breathing/ Beak flow o RR: Poor guide o Recessions: Intercostal => Accessory muscles => poor effort (life-threatening) o Auscultation => Wheeze => silent (life threatening) o BF: > 50, < 50, < 33
49
Acute asthma assessment C
C: Circulation/ colour o Tachycardia: better than tachypnea, affected by B agonists. o Hypotension-Arrhythmia: Life-threatening. o Cyanosis: life-threatening. o Sats (< 92% = severe or life-threatening).
50
Acute asthma management Severe and life threatening:
o High flow O2 o Nebulised Salbutamol/ Ipratropium o Steroids: IV hydrocortisone
51
Acute asthma management | If no response:
Consider (IV SABA, MgSo4, theophylline) | ICU, intubation and mechanical ventilation, CXR, ABG
52
Acute asthma management | If response:
TX for 4 hrs Discharge on steroids (1 week) Review meds, technique, F/U
53
Acute asthma management | If response:
TX for 4 hrs Discharge on steroids (1 week) Review meds, technique, F/U
54
different types of inhalers and how do you choose them?
MDI (with spacer for all children)+ face mask if < 2 Powder inhaler Breath actuated MDI (simpler) Nebuliser (if O2 needed, at home in brittle asthma)
55
Bordetella pertussis PC Dx
Paroxysmal cough + inspiratory whoop or apnoea => Vomiting Culture from pre-nasal swap, blood film (lymphocytosis)
56
What is persistent cough? What is the DDX?
Cough lasting > 8 weeks or not improving > 4 weeks Recurrent URTI Certain infections RSV, pertussis, mycoplasma, TB), asthma, CF, inhaled foreign body, bacterial bronchitis, Aspiration (reflux), habit cough
57
pneumonia causes
Strep-B => RSV => Pneumococcus.
58
pneumonia Sx
URTI => Cough, fever, anorexia, lethargy, unwell, localised chest or abdominal pain, or neck stiffness (peritoneal irritation, bacterial)
59
pneumonia Signs
Tachypnea (the most sensitive sign), Nasal flaring, chest indrawing, crackles Classical (rare): Bronchial breathing, dullness, decreased breath sounds and sats.
60
pneumonia INVXL
CXR, bloods, Nasopharyngeal aspirate, Oximetry
61
pneumonia Mgt:
o Admit if (grunting, recurrent apnoea, sats < 92%, inability to maintain PO intake) o O2, IV fluids, analgesia, Amoxicillin. o If fever persists despite 2 days of antibiotics => suspect pleural collection (CXR: blunting of the costovertebral angle) => US guided drainage and fibrinolysis. o No follow-up unless there is lobar collapse or atelectasis (CXR in 1 month).
62
Cystic fibrosis Pathophysiology = Thick secretions Genetics:
Class 2 mutation; Change in F508; defective CFTR folding; never makes it to surface. Lumicaftor (increases number that makes it to surface). Class 3 and 4: defective function, G551D, use potentiator (Ivacaftor)
63
possible clinical examination findings in CF patients?
``` o Chest hyperinflation o Harrison’s sulcus o Coarse inspiratory crepitation o Expiratory wheeze o Chest infection o Clubbing ```
64
What is PCD, Kartagners syndrome?
o Recurrent chest infections => Bronchiectasis o Chronic Ear infections o CE: Situs inversus. o DX: cilia examination from nasal brush o TX: Chest physio, ENT follow-up and antibiotics
65
What are the indications of tracheostomy in children?
``` o Narrow upper or lower airways o Neuromuscular weakness o Need for long-term o Weaning of o Airway protection ```
66
sleep disordered breathing causes:
``` o Adenotonsillar hypertrophy o Severe obesity o Down syndrome o Cerebral palsy o DMD ```
67
sleep disordered breathing Mgt:
o Night oximetry o Sleep study o Night CPAP o Adenotonsillectomy
68
sleep disordered breathing | Symptoms:
``` o Loud snoring o Witnessed apnoea o Sleep disturbance and restlessness o Day-time sleepiness or hyperactivity o Learning and behavioural problems o Faltering growth ```
69
What are the methods and indications of long-term ventilation?
BiPAP CPAP via facemask or nasal mask tracheostomy Indications: BPD, NMD

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